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Anitua E, Montalvillo A, Eguia A, Alkhraisat MH. Clinical Performance of Extra-Short (≤5.5 mm) Compared to Longer Implants Splinted under the Same Prosthesis: A Randomized Clinical Trial. Dent J (Basel) 2024; 12:292. [PMID: 39329858 PMCID: PMC11431532 DOI: 10.3390/dj12090292] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2024] [Revised: 08/26/2024] [Accepted: 09/11/2024] [Indexed: 09/28/2024] Open
Abstract
Objective: This randomized controlled split-mouth trial compared the performance of 5.5 mm length implants (test group; TG) splinted within the same fixed prosthesis as longer implants (≥6.5 mm; control group; CG) in posterior regions. Methods: The primary hypothesis was that implant length does not affect marginal bone loss (MBL) one year post-implantation, while the secondary hypotheses included implant survival, peri-implant clinical variables, and prosthetic complications. Fifteen patients (eight males, seven females) with a mean age of 67 ± 9 years were included. Results: No significant difference in the implant position between groups (p = 0.808) was observed. Implant diameters ranged from 3.00 to 4.25 mm, and the most common bone type was type I (67%). Bone density (p = 0.574) and implant insertion torque (p = 0.888) were similar between groups. Mesial MBL (mean: -0.1; range: -1.19 to 0.24 for TG, and -0.03; -1.75 to 0.45 for CG; p = 0.955) and distal MBL (mean: -0.05; range: -1.41 to 0.27 for TG, and 0.08; -1.45 to 0.72 for CG; p = 0.118) did not show statistical differences. There were no implant failures or technical complications. Conclusions: These findings suggest that 5.5 mm length implants could be a viable option for use in posterior regions, providing similar clinical outcomes to longer implants one year post-implantation.
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Affiliation(s)
- Eduardo Anitua
- University Institute for Regenerative Medicine and Oral Implantology-UIRMI (UPV/EHU-Fundación Eduardo Anitua), 01007 Vitoria, Spain
- BTI Biotechnology Institute, 01005 Vitoria, Spain
| | - Adriana Montalvillo
- Department of Cellular Biology and Histology, Faculty of Medicine and Nursing, Universidad del País Vasco/Euskal Herriko Unibertsitaea (UPV/EHU), 48940 Leioa, Spain
- Eduardo Anitua Dental Clinic, 01007 Vitoria, Spain
| | - Asier Eguia
- University Institute for Regenerative Medicine and Oral Implantology-UIRMI (UPV/EHU-Fundación Eduardo Anitua), 01007 Vitoria, Spain
- Department of Cellular Biology and Histology, Faculty of Medicine and Nursing, Universidad del País Vasco/Euskal Herriko Unibertsitaea (UPV/EHU), 48940 Leioa, Spain
| | - Mohammad Hamdan Alkhraisat
- University Institute for Regenerative Medicine and Oral Implantology-UIRMI (UPV/EHU-Fundación Eduardo Anitua), 01007 Vitoria, Spain
- BTI Biotechnology Institute, 01005 Vitoria, Spain
- Oral and Maxillofacial Surgery, Oral Medicine and Periodontics Department, Faculty of Dentistry, University of Jordan, Amman 11942, Jordan
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Baek SK, Aye WT, Htet AS, Stigum H, Gopinathan U, Bjertness E. Educational inequalities and self-reported health among men and women aged 18-49 years in Yangon Region, Myanmar: analysis of a population-based, cross-sectional study. BMJ Open 2024; 14:e074468. [PMID: 38890138 PMCID: PMC11191797 DOI: 10.1136/bmjopen-2023-074468] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/07/2023] [Accepted: 04/18/2024] [Indexed: 06/20/2024] Open
Abstract
OBJECTIVES To estimate the prevalence of good self-reported health (SRH) in subpopulations based on the social determinants of health and to investigate the association between education (measured in years of schooling) and good SRH among men and women aged 18-49 years in Yangon Region, Myanmar. DESIGN Analysis of data from a population-based, cross-sectional study conducted in Yangon, Myanmar, from October to November 2016. A multistage sampling procedure was employed, and structured face-to-face interviews were conducted with standardised questions adapted from the Myanmar Demographic and Health Survey. Prevalence ratios (PRs) with 95% CIs were estimated using Poisson regression analyses by sex. SETTING Urban and rural areas of Yangon Region, Myanmar. PARTICIPANTS The sample included 2,506 participants (91.8% response rate) aged 18-49 years and excluded nuns, monks, soldiers, institutionalised people and individuals deemed too ill physically and/or mentally to participate. RESULTS The prevalence of good SRH was 61.2% (95% CI 59.3 to 63.1), with higher rates among men (72.0%, 95% CI 69.3 to 74.5), younger individuals (69.2%, 95% CI 66.2 to 72.1), urban residents (63.6%, 95% CI 60.8 to 66.3), extended family dwellers (66.6%, 95% CI 63.7 to 69.4) and those with a higher level of education (66.0%, 95% CI 61.3 to 70.5). After adjusting for confounders (age and area of residence), the association between years of schooling and SRH (PR) was 1.01 (95% CI 1.01 to 1.02, p=0.002) in men and 1.01 (95% CI 0.99 to 1.02, p=0.415) in women. CONCLUSIONS Good SRH was more prevalent among men than among women. Additionally, a 1-year increase in education was associated with a 1% increase in the prevalence of good SRH among men, whereas the association was not statistically significant among women. In order to enhance the educational benefits of health in Myanmar, we recommend a higher focus on the length of education and addressing gender inequalities in wage return from education.
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Affiliation(s)
- Sel Ki Baek
- Department of Community Medicine and Global Health, Institute of Health and Society, Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Win Thuzar Aye
- Department of Community Medicine and Global Health, Institute of Health and Society, Faculty of Medicine, University of Oslo, Oslo, Norway
- Department of Epidemiology, Faculty of Medicine, Prince of Songkla University, Hat Yai, Songkhla, Thailand
| | - Aung Soe Htet
- Department of Community Medicine, UiT-The Arctic University of Norway, Tromsø, Norway
| | - Hein Stigum
- Department of Community Medicine and Global Health, Institute of Health and Society, Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Unni Gopinathan
- Division for Health Services, Norwegian Institute of Public Health, Oslo, Norway
| | - Espen Bjertness
- Department of Community Medicine and Global Health, Institute of Health and Society, Faculty of Medicine, University of Oslo, Oslo, Norway
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Guebeli A, Thieringer F, Honigmann P, Keller M. In-house 3D-printed custom splints for non-operative treatment of distal radial fractures: a randomized controlled trial. J Hand Surg Eur Vol 2024; 49:350-358. [PMID: 37458129 DOI: 10.1177/17531934231187554] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/18/2023]
Abstract
We compared patient satisfaction and clinical effectiveness of 3D-printed splints made of photopolymer resin to conventional fibre glass casts in treating distal radial fractures. A total of 39 patients with minimally displaced distal radius fractures were included and randomized. Of them, 20 were immobilized in a fibre glass cast and 19 in a 3D-printed forearm splint. The 3D-printed splints were custom-designed based on forearm surface scanning with a handheld device and printed in-house using digital light processing printing technology. Patient satisfaction and clinical effectiveness were assessed with questionnaires 1 and 6 weeks after the initiation of immobilization. Fracture healing, pain, range of motion, grip strength and the DASH and PRWE scores were assessed up to 1-year follow-up. 3D-printed splints proved to be equally well tolerated by the patients and equally clinically effective as conventional fibre glass casts although there was a higher rate of minor complications. 3D-printed splints present a safe alternative, especially in young, active patients, for non-operative treatment of distal radial fractures.Level of evidence: I.
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Affiliation(s)
- Alissa Guebeli
- Department of Plastic Surgery and Hand Surgery, Cantonal Hospital Aarau, Aarau, Switzerland
- Department of Orthopaedic Surgery and Traumatology, Hand and Peripheral Nerve Surgery, Kantonsspital Baselland (Bruderholz, Liestal, Laufen), Bruderholz, Switzerland
- Department of Biomedical Engineering, Medical Additive Manufacturing Research Group (MAM), University of Basel, Allschwil, Switzerland
| | - Florian Thieringer
- Department of Biomedical Engineering, Medical Additive Manufacturing Research Group (MAM), University of Basel, Allschwil, Switzerland
- Department of Oral and Cranio-Maxillofacial Surgery, University Hospital Basel, Basel, Switzerland
| | - Philipp Honigmann
- Department of Orthopaedic Surgery and Traumatology, Hand and Peripheral Nerve Surgery, Kantonsspital Baselland (Bruderholz, Liestal, Laufen), Bruderholz, Switzerland
- Department of Biomedical Engineering, Medical Additive Manufacturing Research Group (MAM), University of Basel, Allschwil, Switzerland
- Department of Biomedical Engineering and Physics, Amsterdam UMC, University of Amsterdam, Amsterdam Movement Sciences, Amsterdam, the Netherlands
| | - Marco Keller
- Department of Orthopaedic Surgery and Traumatology, Hand and Peripheral Nerve Surgery, Kantonsspital Baselland (Bruderholz, Liestal, Laufen), Bruderholz, Switzerland
- Department of Biomedical Engineering, Medical Additive Manufacturing Research Group (MAM), University of Basel, Allschwil, Switzerland
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Knež V, Hudetz D. Eccentric Exercises on the Board with 17-Degree Decline Are Equally Effective as Eccentric Exercises on the Standard 25-Degree Decline Board in the Treatment of Patellar Tendinopathy. MEDICINA (KAUNAS, LITHUANIA) 2023; 59:1916. [PMID: 38003964 PMCID: PMC10673171 DOI: 10.3390/medicina59111916] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/26/2023] [Revised: 10/23/2023] [Accepted: 10/26/2023] [Indexed: 11/26/2023]
Abstract
Background and Objectives: Patellar tendinopathy is one of the most significant problems in jumping and running athletes. Eccentric quadriceps exercise has been introduced into the therapy of patients with patellar tendinopathy in order to avoid weakening the tendon during rehabilitation. The use of decline boards with a decline angle of 25° has been the cornerstone of therapy over the last two decades. Biomechanical studies have suggested that an equal or potentially better outcome could be achieved with lower angles of decline (up to 16°). Materials and Methods: In this present research, we compared the effects of two various decline board angles on the clinical outcome of patients treated for patellar tendinopathy by performing eccentric quadriceps exercises. Patients were randomly allocated into two groups: patients practicing on the standard board with a 25° decline, and patients practicing on the 17° decline (n = 35 per group). Results: After 6 weeks of exercise, we found a significant improvement in all the clinical scores (VISA-P score, KOOS score, Lysholm Knee Questionnaire/Tegner Activity Scale, and VAS scale) of treated patients. However, there was no significant difference between the patients who performed eccentric quadriceps exercises on the standard 25° decline board and those exercising on the 17° decline board. A smaller additional degree of improvement was visible at the end of the follow-up period (at 12 weeks), but, again, no statistical difference could be detected between the investigated groups. We conclude that both treatment options provide similar short-term and midterm benefits regarding improvements in pain and clinical scores. The improvement in clinical scores does not depend on age, sex, BMI, or the professional sport of the patient. Conclusions: Our findings encourage changes in the decline angle of the board in the case of a patient's discomfort in order to achieve better compliance without affecting the recovery.
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Affiliation(s)
- Vladimir Knež
- Special Hospital for Medical Rehabilitation Varaždinske Toplice, 42223 Varaždinske Toplice, Croatia
| | - Damir Hudetz
- Department for Orthopaedic Surgery, University Hospital, “Sveti Duh”, Sveti Duh 64, 10000 Zagreb, Croatia;
- Department for Traumatology and Orthopaedics, University Hospital Dubrava, 10000 Zagreb, Croatia
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Senarath ID, Thalwathte RD, Pathirage M, Kularatne SAM. The effectiveness of radial extracorporeal shock wave therapy vs transcutaneous electrical nerve stimulation in the management of upper limb spasticity in chronic-post stroke hemiplegia-A randomized controlled trial. PLoS One 2023; 18:e0283321. [PMID: 37235581 DOI: 10.1371/journal.pone.0283321] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2022] [Accepted: 03/04/2023] [Indexed: 05/28/2023] Open
Abstract
BACKGROUND Traditionally both rESWT and TENS are used in treating post-stroke upper limb spasticity over years and their effectiveness had been assessed disjointedly. However, these methods were not yet compared for superiority. OBJECTIVES To compare rESWT vs TENS to assess their effectiveness in different parameters of stroke such as stroke type, gender, and the affected side. METHODS The experimental group was treated with rESWT application to the middle of the muscle belly of Teres major, Brachialis, Flexor carpi ulnaris, and Flexor digitorum profundus muscles using 1500 shots per muscle, frequency of 5Hz, energy of 0.030 mJ/mm. The TENS was applied to the same muscles in the control group using 100 Hz for 15 minutes. Assessments were taken at the baseline (T0), immediately after first application (T1), and at the end of four-week protocol (T2). RESULTS Patients 106 with a mean age of 63.87±7.052 years were equally divided into rESWT (53) and TENS (53) groups including 62 males, 44 females, 74 ischemic, 32 hemorrhagic, affecting 68 right, and 38 left. Statistical analysis has revealed significant differences at T1 and T2 in both groups. But at T2 compared to T0; the rESWT group has reduced spasticity 4.8 times (95% CI 1.956 to 2.195) while TENS reduced by 2.6 times (95% CI 1.351 to 1.668), improved voluntary control by 3.9 times (95% CI 2.314 to 2.667) and it was 3.2 times (95% CI 1.829 to 2.171) in TENS group. Improvement of the hand functions of the rESWT group was 3.8 times in FMA-UL (95% CI 19.549 to 22.602) and 5.5 times in ARAT (95% CI 22.453 to 24.792) while thrice (95% CI 14.587 to 17.488) and 4.1 times (95% CI 16.019 to 18.283) in TENS group respectively. CONCLUSION The rESWT modality is superior compared to the TENS modality for treating chronic post-stroke spastic upper limb.
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Affiliation(s)
- Iresha Dilhari Senarath
- Faculty of Allied Health Sciences, Department of Physiotherapy, University of Peradeniya, Sri Lanka
| | | | - Manoji Pathirage
- Faculty of Medicine, Department of Medicine, University of Peradeniya, Peradeniya, Sri Lanka
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Bloom JE, Partovi A, Bernard S, Okyere D, Heritier S, Mahony E, Eliakundu AL, Dawson LP, Voskoboinik A, Anderson D, Ball J, Chan W, Kaye DM, Nehme Z, Stub D. Use of a novel smartphone-based application tool for enrolment and randomisation in pre-hospital clinical trials. Resuscitation 2023; 187:109787. [PMID: 37028747 DOI: 10.1016/j.resuscitation.2023.109787] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2022] [Revised: 03/11/2023] [Accepted: 03/25/2023] [Indexed: 04/08/2023]
Abstract
The effective recruitment and randomisation of patients in pre-hospital clinical trials presents unique challenges. Owing to the time critical nature of many pre-hospital emergencies and limited resourcing, the use of traditional methods of randomisation that may include centralised telephone or web-based systems are often not practicable or feasible. Previous technological limitations have necessitated that pre-hospital trialists strike a compromise between implementing pragmatic, deliverable study designs, and robust enrolment and randomisation methodologies. In this commentary piece, we present a novel smartphone-based solution that has the potential to align pre-hospital clinical trial recruitment processes to that of best-in-practice in-hospital and ambulatory care setting studies. Running title: Smartphone application based randomisation in pre-hospital clinical trials.
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Affiliation(s)
- Jason E Bloom
- Department of Cardiology, Alfred Health, 55 Commercial Road, Melbourne, VIC 3004, Australia; Baker Heart and Diabetes Institute, 75 Commercial Road, Melbourne, VIC 3004, Australia; School of Public Health and Preventive Medicine, Monash University, 553 St Kilda Road, Melbourne, VIC 3004, Australia; Ambulance Victoria, 31 Joseph Street, Blackburn, VIC 3130, Australia
| | | | - Stephen Bernard
- School of Public Health and Preventive Medicine, Monash University, 553 St Kilda Road, Melbourne, VIC 3004, Australia
| | - Daniel Okyere
- Ambulance Victoria, 31 Joseph Street, Blackburn, VIC 3130, Australia
| | - Stephane Heritier
- School of Public Health and Preventive Medicine, Monash University, 553 St Kilda Road, Melbourne, VIC 3004, Australia
| | - Emily Mahony
- Ambulance Victoria, 31 Joseph Street, Blackburn, VIC 3130, Australia
| | - Amminadab L Eliakundu
- School of Public Health and Preventive Medicine, Monash University, 553 St Kilda Road, Melbourne, VIC 3004, Australia
| | - Luke P Dawson
- Department of Cardiology, Alfred Health, 55 Commercial Road, Melbourne, VIC 3004, Australia; School of Public Health and Preventive Medicine, Monash University, 553 St Kilda Road, Melbourne, VIC 3004, Australia
| | - Aleksandr Voskoboinik
- Department of Cardiology, Alfred Health, 55 Commercial Road, Melbourne, VIC 3004, Australia; Baker Heart and Diabetes Institute, 75 Commercial Road, Melbourne, VIC 3004, Australia
| | - David Anderson
- Ambulance Victoria, 31 Joseph Street, Blackburn, VIC 3130, Australia; Department of Paramedicine, Monash University, McMahons Road, Frankston, VIC 3199, Australia
| | - Jocasta Ball
- School of Public Health and Preventive Medicine, Monash University, 553 St Kilda Road, Melbourne, VIC 3004, Australia
| | - William Chan
- Department of Cardiology, Alfred Health, 55 Commercial Road, Melbourne, VIC 3004, Australia; Baker Heart and Diabetes Institute, 75 Commercial Road, Melbourne, VIC 3004, Australia
| | - David M Kaye
- Department of Cardiology, Alfred Health, 55 Commercial Road, Melbourne, VIC 3004, Australia; Baker Heart and Diabetes Institute, 75 Commercial Road, Melbourne, VIC 3004, Australia
| | - Ziad Nehme
- Ambulance Victoria, 31 Joseph Street, Blackburn, VIC 3130, Australia; Department of Paramedicine, Monash University, McMahons Road, Frankston, VIC 3199, Australia
| | - Dion Stub
- Department of Cardiology, Alfred Health, 55 Commercial Road, Melbourne, VIC 3004, Australia; Baker Heart and Diabetes Institute, 75 Commercial Road, Melbourne, VIC 3004, Australia; Ambulance Victoria, 31 Joseph Street, Blackburn, VIC 3130, Australia.
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Stowers MDJ, Rahardja R, Nicholson L, Svirskis D, Hannam J, Young SW. Safety and efficacy of intraosseous ropivacaine in lower extremity (SORE) study. ANZ J Surg 2023; 93:328-333. [PMID: 36627759 DOI: 10.1111/ans.18257] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2022] [Revised: 12/08/2022] [Accepted: 12/21/2022] [Indexed: 01/12/2023]
Abstract
BACKGROUND Day stay surgery for anterior cruciate ligament (ACL) reconstructions is an increasingly common practice and has driven clinicians to develop postoperative pain regimes that allow same day mobilization and a safe and timely discharge. There is a paucity of literature surrounding the use of intraosseous (IO) ropivacaine used as a Bier's block to provide both intraoperative and postoperative analgesia in lower limb surgery. METHODS This patient blinded, pilot study randomized 15 patients undergoing ACL reconstruction to receive either IO ropivacaine 1.5 or 2.0 mg/kg; or 300 mg of ropivacaine as local infiltration. The primary outcome for this study was arterial plasma concentration of ropivacaine. Samples were taken via an arterial line at prespecified times after tourniquet deflation. Secondary outcomes included immediate postoperative pain scores using the visual analogue scale and perioperative opioid equivalent consumption. RESULTS All patients in the intervention group receiving IO ropivacaine had plasma concentrations well below the threshold for central nervous system (CNS) toxicity (0.60 μg/mL). The highest plasma concentration was achieved in the intervention group receiving 1.5 mg/kg dose of ropivacaine reaching 2.93 mg/mL. This would equate to 0.18 μg/mL of free plasma ropivacaine. There were no differences across the three groups regarding pain scores or perioperative opioid consumption. CONCLUSIONS This study demonstrates that IO ropivacaine is both safe and effective in reducing perioperative pain in patients undergoing ACL reconstruction. There may be scope to increase the IO dose further or utilize other analgesics via the IO regional route to improve perioperative pain relief.
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Affiliation(s)
- Marinus D J Stowers
- North Shore Hospital, Waitemata District Health Board, Waitakere, New Zealand
| | - Richard Rahardja
- Auckland Medical School, University of Auckland, Auckland, New Zealand
| | - Lance Nicholson
- North Shore Hospital, Waitemata District Health Board, Waitakere, New Zealand
| | - Darren Svirskis
- School of Pharmacy, University of Auckland, Auckland, New Zealand
| | - Jacqueline Hannam
- School of Medical and Health Sciences, Department of Pharmacology and Clinical Pharmacology, University of Auckland, Auckland, New Zealand
| | - Simon W Young
- North Shore Hospital, Waitemata District Health Board, Waitakere, New Zealand
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Gurewich D, Kressin N, Bokhour BG, Linsky AM, Dichter ME, Hunt KJ, Fix GM, Niles BL. Randomised controlled trial evaluating the effects of screening and referral for social determinants of health on Veterans' outcomes: protocol. BMJ Open 2022; 12:e058972. [PMID: 36153033 PMCID: PMC9511545 DOI: 10.1136/bmjopen-2021-058972] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/04/2021] [Accepted: 08/12/2022] [Indexed: 11/21/2022] Open
Abstract
INTRODUCTION Health policy leaders recommend screening and referral (S&R) for unmet social needs (eg, food) in clinical settings, and the American Heart Association recently concluded that the most significant opportunities for reducing cardiovascular disease (CVD) death and disability lie with addressing the social determinants of CVD outcomes. A limited but promising evidence base supports these recommendations, but more rigorous research is needed to guide health care-based S&R efforts. Funded by the Veteran Health Administration (VA), the study described in this paper will assess the efficacy of S&R on Veterans' connections to new resources to address social needs, reduction of unmet needs and health-related outcomes (adherence, utilisation and clinical outcomes). METHODS AND ANALYSIS We will conduct a 1-year mixed-methods randomised controlled trial at three VA sites, enrolling Veterans with CVD and CVD-risk. 880 Veterans experiencing one or more social needs will be randomised within each site (n=293 per site) to one of three study arms representing referral mechanisms of varying intensity (screening only, screening and provision of resource sheet(s), screening and provision of resource sheet(s) plus social work assistance). For each Veteran, we will examine associations of unmet social needs with health-related outcomes at baseline, and longitudinally compare the impact of each approach on connection to new resources (primary outcome) and follow-up outcomes over a 12-month period. We will additionally conduct qualitative interviews with key stakeholders, including Veterans to identify potential explanatory factors related to the relative success of the interventions. ETHICS AND DISSEMINATION Ethics approval was obtained from the VA Central Internal Review Board on 13 July 2021 (reference #: 20-07-Amendment No. 02). Findings will be disseminated through reports, lay summaries, policy briefs, academic publications, and conference presentations. TRIAL REGISTRATION NUMBER NCT04977583.
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Affiliation(s)
- Deborah Gurewich
- Center for Healthcare Organization and Implementation Research, VA Boston Health Care System, Boston, Massachusetts, USA
- Section of General Internal Medicine, Boston University School of Medicine, Boston, Massachusetts, USA
| | - Nancy Kressin
- Section of General Internal Medicine, Boston University School of Medicine, Boston, Massachusetts, USA
| | - Barbara G Bokhour
- Center for Healthcare Organization and Implementation Research, VA Bedford Healthcare System, Bedford, MA, USA
- Department of Population and Quantitative Health Sciences, University of Massachusetts Chan School of Medicine, Worcester, MA, USA
| | - Amy M Linsky
- Center for Healthcare Organization and Implementation Research, VA Boston Health Care System, Boston, Massachusetts, USA
- Section of General Internal Medicine, Boston University School of Medicine, Boston, Massachusetts, USA
- General Internal Medicine, VA Boston Healthcare System, Boston, Massachusetts, USA
| | - Melissa E Dichter
- Center for Health Equity Research and Promotion (CHERP), Crescenz VA Medical Center, Philadelphia, Pennsylvania, USA
- School of Social Work, Temple University, Philadelphia, Pennsylvania, USA
| | - Kelly J Hunt
- Charleston Health Equity and Rural Outreach Innovation Center (HEROIC), Ralph H Johnson VAMC, Charleston, South Carolina, USA
| | - Gemmae M Fix
- Section of General Internal Medicine, Boston University School of Medicine, Boston, Massachusetts, USA
- Center for Healthcare Organization and Implementation Research, VA Bedford Healthcare System, Bedford, MA, USA
| | - Barbara L Niles
- National Center for PTSD, VA Boston Healthcare System, Boston, Massachusetts, USA
- Department of Psychiatry, Boston University School of Medicine, Boston, Massachusetts, USA
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9
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Local Triamcinolone Treatment Affects Inflammatory Response in Seroma Exudate of Abdominoplasty Patients: A Randomized Controlled Trial. Plast Reconstr Surg 2022; 149:825e-826e. [PMID: 35231017 DOI: 10.1097/prs.0000000000008935] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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10
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Nishino M, Egami Y, Nakamura H, Ukita K, Kawamura A, Matsuhiro Y, Yasumoto K, Tsuda M, Tanaka A, Okamoto N, Matsunaga‐Lee Y, Yano M, Shutta R, Tanouchi J. Prospective randomized comparison of effect on coronary endothelial and renal function between febuxostat and benzbromarone in hyperuricemic patients with coronary artery disease: EFEF study. Health Sci Rep 2022; 5:e563. [PMID: 35356803 PMCID: PMC8939499 DOI: 10.1002/hsr2.563] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2021] [Revised: 02/01/2022] [Accepted: 02/06/2022] [Indexed: 11/08/2022] Open
Abstract
Background and Aims There are two types of serum uric acid-lowering agents, the xanthine oxidoreductase (XO) inhibitor and non-XO inhibitor. We investigated whether febuxostat, XO inhibitor, could produce more favorable effects on coronary endothelial function (CEF) and renal function than benzbromarone, non-XO inhibitor, in hyperuricemic coronary artery disease (CAD) patients. Methods We divided 21 hyperuricemic patients with stenting for left anterior descending (LAD) or left circumflex (LCX) artery into patients started on febuxostat (F group) and those on benzbromarone (B group). After 8 months, all patients underwent CEF evaluations (acetylcholine provocation test) and optical coherence tomography (OCT) for non-culprit vessels (e.g. if patients received LAD stenting, we evaluated LCX). We compared the diameter ratio induced by acetylcholine and baseline (CEF ratio), thin-cap fibroatheroma and calcified plaque by OCT, uric acid, oxidative stress biomarkers, and renal function including estimated glomerular filtration rate (eGFR) between F and B groups. Creatinine 2 days after stenting was measured to evaluate contrast-induced nephropathy (CIN). Results Change of eGFR was significantly lower in F group (n= 11) than B group over 8 months while the other parameters including CEF ratio were similar. F group showed favorable effects for CIN. Conclusion In conclusion, 8-months of febuxostat, XO inhibitor, does not significantly protect CEF but can protect the renal function including CIN in hyperuricemic patients with CAD compared to benzbromarone, non-XO inhibitor.
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Affiliation(s)
| | | | | | - Kohei Ukita
- Division of CardiologyOsaka Rosai HospitalOsakaJapan
| | | | | | - Koji Yasumoto
- Division of CardiologyOsaka Rosai HospitalOsakaJapan
| | - Masaki Tsuda
- Division of CardiologyOsaka Rosai HospitalOsakaJapan
| | | | | | | | | | - Ryu Shutta
- Division of CardiologyOsaka Rosai HospitalOsakaJapan
| | - Jun Tanouchi
- Division of CardiologyOsaka Rosai HospitalOsakaJapan
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Amdie FZ, Luctkar-Flude M, Snelgrove-Clarke E, Sawhney M, Alemu S, Woo K. Feasibility of Virtual Simulation-Based Diabetes Foot Care Education in Patients with Diabetes in Ethiopia: Protocol for a Randomized Controlled Trial. Diabetes Metab Syndr Obes 2022; 15:995-1009. [PMID: 35386589 PMCID: PMC8979753 DOI: 10.2147/dmso.s345722] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/22/2021] [Accepted: 03/15/2022] [Indexed: 11/23/2022] Open
Abstract
INTRODUCTION Diabetes mellitus is a rapidly growing global public health problem; the number of adults with diabetes is expected to increase from 424.9 million in 2017 to 628.6 million in 2045. Approximately 80% of diabetic patients live in low- and middle-income countries where access to care may be limited. For example, in Ethiopia, diabetes care is often rudimentary, and formal, structured diabetes education is almost non-existent. One potential solution to the lack of diabetes management education for patients could be virtual simulation-based diabetes education incorporating the contextual realities of patients in Ethiopia. Despite its great potential to improve glycemic control, delay diabetes-related complications and reduce mortality associated with diabetes, the feasibility of virtual simulation-based diabetes self-management education has not been studied in low- and middle-income settings. OBJECTIVE The purpose of the current study is to evaluate the feasibility of a virtual simulation-based Diabetes Foot Care Education (DFCE) program among adult patients with diabetes in Ethiopia. METHODS A randomized controlled feasibility study including participants from University of Gondar Referral Hospital (UoGRH) will be conducted. A sample of 40 participants will be recruited, of which 20 participants will receive the virtual simulation-based education program, and the other 20 participants will continue with their usual diabetes care. After the education program, a questionnaire and structured interview will be used to explore the feasibility (acceptability, practicality) and the potential impact of virtual simulation-based DFCE intervention in patients with diabetes. Data will be analyzed using SPSS version 25 using descriptive statistics, independent t-tests, paired sample t-test, and factorial ANOVA at significance levels of less than 0.05. DISCUSSION Our study seeks to understand the perceived usefullness and usability of virtual simulation-based diabetes foot care education on behavioural (diabetes foot-care knowledge, foot self-care practices, and foot self-care efficacy). Furthermore, the study will provide insight to assist in the development of technologically assisted and contextually designed DFCE programs. TRIAL REGISTRATION NUMBER NCT04841291 (ClinicalTrials.gov Identifier).
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Affiliation(s)
- Fisseha Zewdu Amdie
- School of Nursing, University of Gondar, Gondar, Ethiopia
- School of Nursing, Queen’s University, Kingston, Ontario, Canada
- Correspondence: Fisseha Zewdu Amdie, Email
| | | | | | - Monakshi Sawhney
- School of Nursing, Queen’s University, Kingston, Ontario, Canada
| | - Shitaye Alemu
- Department of Internal Medicine, University of Gondar, Gondar, Ethiopia
| | - Kevin Woo
- School of Nursing, Queen’s University, Kingston, Ontario, Canada
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Effectiveness of Radial Extracorporeal Shockwave Therapy in Patients with Acute Low Back Pain-Randomized Controlled Trial. J Clin Med 2021; 10:jcm10235569. [PMID: 34884271 PMCID: PMC8658438 DOI: 10.3390/jcm10235569] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2021] [Revised: 11/24/2021] [Accepted: 11/26/2021] [Indexed: 11/17/2022] Open
Abstract
The aim of this study was to investigate the effect of radial extracorporeal shockwave therapy (rESWT) primarily on acute lumbar back pain (aLBP), and secondarily on physical function and quality of life. This randomized, placebo-controlled, single-blinded trial with 12-week follow-up (FU) randomized 63 patients with aLBP 1:1 into two groups receiving either rESWT (intervention) or sham rESWT (placebo) with a manipulated shockwave head not delivering any shockwaves. Both, rESWT and sham procedure were carried out eight times for four weeks. Both groups received additional analgesics and physiotherapy twice a week. Primary patient-reported outcome measure (PROM) was the visual analogue scale for aLBP (VAS-LBP). Secondary PROMs included the Oswestry disability index (ODI), Roland and Morris Disability Questionnaire (RDQ), EuroQol EQ-5D-3L, and the Beck Depression Index (BDI-II). Primary endpoint was a between-arm comparison of mean changes in VAS-LBP from baseline to final FU. At randomization, there were no differences between the two groups in relation to age and PROMs. Both groups showed significant improvement in all PROMs at final FU. VAS-LBP declined by 60.7% (p < 0.001) in the intervention and by 86.4% (p < 0.001) in the sham group. The intervention group showed significantly less pain relief after 4 and 12 weeks. The EQ-5D submodality pain showed significantly inferior results for the intervention (1.5 (0.58)) compared to the sham group (1.1 (0.33)) (p < 0.014) after eight weeks. No significant intergroup differences were observed for RDQ, ODI or BDI-II. Additional rESWT alongside conventional guideline therapy in aLBP does not have any significant effects on pain intensity, physical function, or quality of life. To the best of our knowledge, this is the first study with a high level of evidence reporting the efficacy of rESWT in aLBP treatment and will be a future basis for decision-making.
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Aye WT, Lien L, Stigum H, Bjertness E. Childhood abuse and its association with adults' mental health problems: a cross-sectional study among men and women in the Yangon Region of Myanmar. BMJ Open 2021; 11:e045870. [PMID: 34824104 PMCID: PMC8627399 DOI: 10.1136/bmjopen-2020-045870] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
OBJECTIVES To estimate the prevalence of emotional, physical and sexual childhood abuse, and symptoms of post-traumatic stress disorder (PTSD) and to examine the association between childhood abuse and adult mental health problems, including mental distress and PTSD symptoms. DESIGN A community-based cross-sectional study was conducted. Childhood abuse was assessed with the NorVold Abuse Questionnaire, and mental distress and symptoms of PTSD were measured using the Hopkins Symptom Checklist 10 and the Impact of Event Scale-Revised, respectively. The Wald test and multiple linear regression analysis were applied for testing differences between proportions and the association between childhood abuse and adult mental health outcomes, respectively. SETTING Urban and rural areas of the Yangon Region, Myanmar. PARTICIPANTS A total of 2377 men and women aged 18-49 years were included. Institutionalised people, monks, nuns and individuals deemed too ill physically and/or mentally to participate were excluded. RESULTS Overall, 21.1% (95% CI 18.8 to 23.6) reported any form of childhood abuse, 10.4% (95% CI 8.9 to 12.4) physical abuse, 10.4% (95% CI 8.8 to 12.2) emotional abuse and 7.3% (95% CI 5.7 to 9.3) sexual abuse. Childhood abuse was more common in women (29.8%) than in men (12.4%). The prevalence of PTSD symptoms in the total sample was 6.6%. After adjusting for confounding variables, positive associations were found between childhood abuse with adult mental distress and PTSD symptoms among women and older men. CONCLUSIONS Childhood abuse is prevalent among both men and women in the Yangon Region of Myanmar and associated with adult mental health problems. Approximately 7% of people report PTSD symptoms. It should prompt local health professionals and policy makers to establish prevention programmes to eliminate violence against children and to organise services for victims of childhood abuse. Care should be taken in generalising findings for less populated areas.
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Affiliation(s)
- Win Thuzar Aye
- Community Medicine and Global Health, University of Oslo Faculty of Medicine, Oslo, Norway
- Preventive and Social Medicine Department, University of Medicine 2, Yangon, Myanmar
| | - Lars Lien
- National Norwegian Advisory Board for Concurrent Addiction and Mental Health Problems, Inland Norway University of Applied Sciences, Elverum, Norway
| | - Hein Stigum
- Department of Community Medicine and Global Health, Institute of Health and Society, University of Oslo Faculty of Medicine, Oslo, Norway
| | - Espen Bjertness
- Department of Community Medicine and Global Health, Institute of Health and Society, University of Oslo Faculty of Medicine, Oslo, Norway
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Vorland CJ, Brown AW, Dawson JA, Dickinson SL, Golzarri-Arroyo L, Hannon BA, Heo M, Heymsfield SB, Jayawardene WP, Kahathuduwa CN, Keith SW, Oakes JM, Tekwe CD, Thabane L, Allison DB. Errors in the implementation, analysis, and reporting of randomization within obesity and nutrition research: a guide to their avoidance. Int J Obes (Lond) 2021; 45:2335-2346. [PMID: 34326476 PMCID: PMC8528702 DOI: 10.1038/s41366-021-00909-z] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/10/2020] [Revised: 06/26/2021] [Accepted: 07/06/2021] [Indexed: 02/06/2023]
Abstract
Randomization is an important tool used to establish causal inferences in studies designed to further our understanding of questions related to obesity and nutrition. To take advantage of the inferences afforded by randomization, scientific standards must be upheld during the planning, execution, analysis, and reporting of such studies. We discuss ten errors in randomized experiments from real-world examples from the literature and outline best practices for their avoidance. These ten errors include: representing nonrandom allocation as random, failing to adequately conceal allocation, not accounting for changing allocation ratios, replacing subjects in nonrandom ways, failing to account for non-independence, drawing inferences by comparing statistical significance from within-group comparisons instead of between-groups, pooling data and breaking the randomized design, failing to account for missing data, failing to report sufficient information to understand study methods, and failing to frame the causal question as testing the randomized assignment per se. We hope that these examples will aid researchers, reviewers, journal editors, and other readers to endeavor to a high standard of scientific rigor in randomized experiments within obesity and nutrition research.
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Affiliation(s)
- Colby J Vorland
- Department of Applied Health Science, Indiana University School of Public Health-Bloomington, Bloomington, IN, USA.
| | - Andrew W Brown
- Department of Applied Health Science, Indiana University School of Public Health-Bloomington, Bloomington, IN, USA
| | - John A Dawson
- Department of Nutritional Sciences, Texas Tech University, Lubbock, TX, USA
| | - Stephanie L Dickinson
- Department of Epidemiology and Biostatistics, Indiana University School of Public Health-Bloomington, Bloomington, IN, USA
| | - Lilian Golzarri-Arroyo
- Department of Epidemiology and Biostatistics, Indiana University School of Public Health-Bloomington, Bloomington, IN, USA
| | - Bridget A Hannon
- Division of Nutritional Sciences, University of Illinois at Urbana-Champaign, Urbana, IL, USA
| | - Moonseong Heo
- Department of Public Health Sciences, Clemson University, Clemson, SC, USA
| | - Steven B Heymsfield
- Pennington Biomedical Research Center, Louisiana State University, Baton Rouge, LA, USA
| | - Wasantha P Jayawardene
- Department of Applied Health Science, Indiana University School of Public Health-Bloomington, Bloomington, IN, USA
| | - Chanaka N Kahathuduwa
- Department of Psychiatry, School of Medicine, Texas Tech University Health Sciences Center, Lubbock, TX, USA
| | - Scott W Keith
- Department of Pharmacology and Experimental Therapeutics, Division of Biostatistics, Thomas Jefferson University, Philadelphia, PA, USA
| | - J Michael Oakes
- Department of Epidemiology, School of Public Health, University of Minnesota, Minneapolis, MN, USA
| | - Carmen D Tekwe
- Department of Epidemiology and Biostatistics, Indiana University School of Public Health-Bloomington, Bloomington, IN, USA
| | - Lehana Thabane
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, ON, Canada
| | - David B Allison
- Department of Epidemiology and Biostatistics, Indiana University School of Public Health-Bloomington, Bloomington, IN, USA.
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Effects of a personal trainer-led exercise intervention on physical activity, physical function, and quality of life of breast cancer survivors. Breast Cancer 2021; 28:737-745. [PMID: 33689150 DOI: 10.1007/s12282-020-01211-y] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2020] [Accepted: 12/24/2020] [Indexed: 12/22/2022]
Abstract
PURPOSE Exercise is important to address physical and emotional effects of breast cancer treatment. This study examines effects of a personal trainer led exercise intervention on physical activity levels, physical function and quality of life (QoL) in breast cancer survivors. METHODS Women post active breast cancer treatment were recruited from 2015 to 2017, randomized to immediate exercise or wait-list control, and received three personal training sessions for up to 30 weeks. Physical activity and function were assessed by pedometer, and tests of endurance, strength, and flexibility. Self-reported physical activity, physical activity self-efficacy, and QoL were also assessed. RESULTS 60 women were randomized to immediate intervention (n = 31) or wait-list control (n = 29). Subjects were aged (mean ± SD) 56 ± 10 years. On the endurance test, the exercise group significantly improved (increase of 18 ± 20 steps vs control 9 ± 12 steps) (p = 0.036). On the strength test, the exercise group significantly improved (increase of 4 ± 3 curls vs control 1 ± 3 curls) (p = 0.002). After intervention, change (mean ∆ ± SD) in the FACT-ES physical well-being subscale score was 1 ± 2 in the exercise group and - 1 ± 2 in the control group (p = 0.023). Improvement in Self-efficacy and Physical Activity (SEPA) score was significant with a change (mean ∆ ± SD) of 2 ± 5 for exercise vs 0 ± 5 for control (p = 0.047). The number of steps/day, back scratch test, weight, and self-reported physical activity did not significantly improve with intervention. CONCLUSIONS The intervention yielded significant improvements in endurance and strength but not physical activity or quality of life. IMPLICATIONS FOR CANCER SURVIVORS Future efforts to explore feasible ways to support patient's physical activity efforts need to be undertaken.
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Optimisation of Heart Failure Management in Nursing Homes Using Point-of-Care Ultrasonography: Harmonious Trial Rationale and Design. Zdr Varst 2020; 59:128-136. [PMID: 32952713 PMCID: PMC7478089 DOI: 10.2478/sjph-2020-0017] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2019] [Accepted: 05/07/2020] [Indexed: 12/28/2022] Open
Abstract
Introduction Heart failure is common in the nursing home population and presents many diagnostic and therapeutic challenges. Point-of-care ultrasonography is a bedside method that can be used to assess volume status more reliably than clinical examination. This trial was conceived to test whether point-of-care ultrasonography-guided management improves heart failure outcomes among nursing home residents. Methods Nursing home residents with heart failure will be enrolled in a multi-centre, prospective, randomised controlled trial. Residents will first be screened for heart failure. Patients with heart failure will be randomised in 1:1 fashion into two groups. Nursing home physicians will adjust diuretic therapy according to volume status for six months. Point-of-care ultrasonography will be used in the test group and clinical examination in the control group. The primary endpoint will be heart failure deterioration, defined as a composite of any of the following four events: the need for an intravenous diuretic application, the need for an emergency service intervention, the need for unplanned hospitalisation for non-injury causes, or death from whatever cause. Expected results The expected prevalence of heart failure among nursing home residents is above 10%. Point-of-care ultrasonography-guided heart failure management will reduce the number of deteriorations of heart failure in the nursing home population. Conclusion This study will explore the usefulness of point-of-care ultrasonography for heart failure management in the nursing home population.
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Aye WT, Lien L, Stigum H, Schei B, Sundby J, Bjertness E. Domestic violence victimisation and its association with mental distress: a cross-sectional study of the Yangon Region, Myanmar. BMJ Open 2020; 10:e037936. [PMID: 32938598 PMCID: PMC7497540 DOI: 10.1136/bmjopen-2020-037936] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
OBJECTIVES To estimate the prevalence of domestic violence, with subgroups of physical, sexual and emotional violence, among men and women and to assess the association between any lifetime domestic violence (DV) and mental distress among ever-married men and women. DESIGN We conducted a cross-sectional study from October to November 2016 using a multistage sampling design. DV questionnaire was adopted from the Demographic and Health Survey programme. Mental distress was estimated using the Hopkins Symptom Checklist-10 (HSCL-10). HSCL-score and DV were the outcome and exposure variables, respectively, in multiple linear regression. Prevalence estimates and associations were presented with a 95% CI and the Wald test. SETTING Urban and rural areas of the Yangon region, Myanmar. PARTICIPANTS Men and women ages 18 to 49 years were included. Institutionalised people, monks, nuns and individuals deemed too ill physically and/or mentally to participate were excluded. RESULTS A random sample of 2383 people was included in the analyses. Among ever-married participants, lifetime (LT) and past-12-month (12M) prevalence of any domestic violence victimisation was higher in women compared with men: LT women: 61.8% (95% CI: 54.3 to 68.9) versus LT men: 42.4% (95% CI: 37.5 to 47.5) and 12M women: 51.2% (95% CI: 44.9 to 57.5) versus 12M men: 37.7% (95% CI: 32.9 to 42.7). Among never-married participants, lifetime physical and sexual violence victimisation rates was higher in men (34.3% and 7.9%) compared with women (19.1% and 6.4%). Mental distress was significantly associated with lifetime DV in women who were afraid of their husbands and men who had wives who exhibited controlling behaviours. CONCLUSIONS Domestic violence is prevalent among both men and women and is associated with mental distress. The findings highlight an urgent need to prevent domestic violence in both sexes, including through legal and policy reform and improved mental health services for DV victims.
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Affiliation(s)
- Win Thuzar Aye
- Department of Community Medicine and Global Health, Institute of Health and Society, University of Oslo Faculty of Medicine, Oslo, Norway
- Department of Preventive and Social Medicine, University of Medicine (2), Yangon, Myanmar
| | - Lars Lien
- National Norwegian advisory board for concurrent addiction and mental health problems, Innlandet Hospital Trust, Brumunddal and Faculty of Social and Health Sciences, Inland Norway University of Applied Science, Elverum, Oslo, Norway
| | - Hein Stigum
- Department of Community Medicine and Global Health, Institute of Health and Society, University of Oslo Faculty of Medicine, Oslo, Norway
| | - Berit Schei
- Department of Public Health and Nursing, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology, Trondheim, Norway
| | - Johanne Sundby
- Department of Community Medicine and Global Health, Institute of Health and Society, University of Oslo Faculty of Medicine, Oslo, Norway
| | - Espen Bjertness
- Department of Community Medicine and Global Health, Institute of Health and Society, University of Oslo Faculty of Medicine, Oslo, Norway
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Mitchell A, Moe-Byrne T, Cunningham-Burley R, Dean A, Rangan A, Roche J, Torgerson DJ. Poor allocation concealment methods are associated with heterogeneity in age and statistical significance of the primary outcome: Review of recent trials published in four general medical journals. J Eval Clin Pract 2020; 26:1316-1319. [PMID: 31828920 DOI: 10.1111/jep.13313] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/17/2019] [Revised: 10/21/2019] [Accepted: 10/23/2019] [Indexed: 12/29/2022]
Abstract
OBJECTIVE To assess the association of the quality of allocation concealment with heterogeneity in age, the P value of the primary outcome and statistical significance of the primary outcome. STUDY DESIGN AND SETTING We extracted data from articles published in four major medical journals in 2017 and 2018 that reported the results of randomized controlled trials. The outcome measures were the quality of allocation concealment used in the trial, the P value of the primary outcome, whether the P value of the primary outcome was statistically significant and the level of heterogeneity in age between the treatment groups (measured using the I2 statistic). The association between the quality of allocation concealment and the P value of the primary outcome was assessed using a kernel density plot, while the association between the quality of allocation concealment and whether the P value was statistically significant was assessed using logistic regression. RESULTS Trials that used inadequate concealment methods were more likely to report statistically significant findings than trials that used good or adequate methods (OR 1.90; 95% CI: 0.91 to 3.95; P = .09). The values of I2 for trials that used good, adequate, inadequate and unclear concealment methods were 0%, 1.0%, 32.6%, and 93.8%, respectively. CONCLUSION There is evidence of an association between poor allocation concealment methods and statistical significance of the primary outcome. Trials that use inadequate allocation concealment methods are more likely to have statistically significant P values compared with trials using good or adequate allocation concealment methods.
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Affiliation(s)
- Alex Mitchell
- York Trials Unit, Department of Health Sciences, University of York, York, UK
| | | | | | - Alexandra Dean
- York Trials Unit, Department of Health Sciences, University of York, York, UK
| | - Aditi Rangan
- Newcastle Medical School, University of Newcastle, York, UK
| | - Jenny Roche
- York Trials Unit, Department of Health Sciences, University of York, York, UK
| | - David J Torgerson
- York Trials Unit, Department of Health Sciences, University of York, York, UK
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Aye WT, Lien L, Stigum H, Win HH, Oo T, Bjertness E. The prevalence of mental distress and the association with education: a cross-sectional study of 18-49-year-old citizens of Yangon Region, Myanmar. BMC Public Health 2020; 20:94. [PMID: 31969142 PMCID: PMC6977249 DOI: 10.1186/s12889-020-8209-8] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2019] [Accepted: 01/13/2020] [Indexed: 02/08/2023] Open
Abstract
Background Poor mental health is an important contributor to the global burden of disease. Mental health problems are often neglected in communities, and are scarcely studied in developing countries, including Myanmar. This study estimates the prevalence of mental distress by socio-demographic and health related factors, and the association between education and mental distress. As far as the authors are aware, this is the first population-based study in Myanmar estimating the prevalence of mental distress. Methods Between October and November 2016, a cross sectional study was conducted using a multi-stage sampling design with face-to-face interviews using the Hopkins Symptom Checklist (HSCL-10) for mental distress (symptoms of depression and anxiety). The multivariable analysis strategy was based on Directed Acyclic Graphs (DAGs), to identify confounders, mediators and colliders. Pearson’s chi-square was used for testing differences between proportions and multiple linear regression analysis was applied to explore the association between education (years at school) and mental distress (HSCL score). Results A random sample of 2391 (99.6% response) men and women aged 18–49 years participated in the study. The prevalence of mental distress was 18.0% (95% confidence interval (CI): 14.7–21.9), being higher among women (21.2%; 95% (CI): 16.6–26.6) than men (14.9%; 95% (CI): 11.4–19.2). Older-age, being separated or divorced and having a higher number of children were associated with increased mental distress. In linear regression analyses, adjusted for confounders (age, marital status and income), there was a significant negative association between years at school and mental distress among women and older men (> 30 years), but not among the youngest men. Conclusions The prevalence of mental distress is high, and there is an association between HSCL-10 score and education. Due to the scarcity of mental health services in Myanmar, the findings indicate a need for a mental health policy to handle the burden of mental health problems in Yangon, a burden which is probably high within the country.
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Affiliation(s)
- Win Thuzar Aye
- Department of Preventive and Social Medicine, University of Medicine, Yangon, Myanmar. .,Department of Community Medicine and Global Health, Institute of Health and Society, University of Oslo, Oslo, Norway.
| | - Lars Lien
- National Norwegian advisory board for concurrent addiction and mental health problems. Innlandet Hospital Trust, Brumunddal and Faculty of Social and Health Sciences, Inland Norway University of Applied science, Elverum, Norway
| | - Hein Stigum
- Department of Community Medicine and Global Health, Institute of Health and Society, University of Oslo, Oslo, Norway
| | - Hla Hla Win
- University of Public Health, Yangon, Myanmar
| | - Tin Oo
- Department of Mental Health, University of Medicine 1, Yangon, Myanmar
| | - Espen Bjertness
- Department of Community Medicine and Global Health, Institute of Health and Society, University of Oslo, Oslo, Norway
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Sum SK, Peng YC, Yin SY, Huang PF, Wang YC, Chen TP, Tung HH, Yeh CH. Using an incentive spirometer reduces pulmonary complications in patients with traumatic rib fractures: a randomized controlled trial. Trials 2019; 20:797. [PMID: 31888765 PMCID: PMC6937666 DOI: 10.1186/s13063-019-3943-x] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2019] [Accepted: 11/28/2019] [Indexed: 11/13/2022] Open
Abstract
Background An incentive spirometer (IS) is a mechanical device that promotes lung expansion. It is commonly used to prevent postoperative lung atelectasis and decrease pulmonary complications after cardiac, lung, or abdominal surgery. This study explored its effect on lung function and pulmonary complication rates in patients with rib fractures. Methods Between June 2014 and May 2017, 50 adult patients with traumatic rib fractures were prospectively investigated. Patients who were unconscious, had a history of chronic obstructive pulmonary disease or asthma, or an Injury Severity Score (ISS) ≥ 16 were excluded. Patients were randomly divided into a study group (n = 24), who underwent IS therapy, and a control group (n = 26). All patients received the same analgesic protocol. Chest X-rays and pulmonary function tests (PFTs) were performed on the 5th and 7th days after trauma. Results The groups were considered demographically homogeneous. The mean age was 55.2 years and 68% were male. Mean pretreatment ISSs and mean number of ribs fractured were not significantly different (8.23 vs. 8.08 and 4 vs. 4, respectively). Of 50 patients, 28 (56%) developed pulmonary complications, which were more prevalent in the control group (80.7% vs. 29.2%; p = 0.001). Altogether, 25 patients had delayed hemothorax, which was more prevalent in the control group (69.2% vs. 29.2%; p = 0.005). Two patients in the control group developed atelectasis, one patient developed pneumothorax, and five patients required thoracostomy. PFT results showed decreased forced vital capacity (FVC) and forced expiratory volume in 1 s (FEV1) in the control group. Comparing pre- and posttreatment FVC and FEV1, the study group had significantly greater improvements (p < 0.001). Conclusions In conclusion, the use of an IS reduced pulmonary complications and improved PFT results in patients with rib fractures. The IS is a cost-effective device for patients with rib fractures and its use has clinical benefits without harmful effects. Trial registration ClinicalTrials.gov, NCT04006587. Registered on 3 July 2019.
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Affiliation(s)
- Shao-Kai Sum
- Department of Thoracic and Cardiovascular Surgery, Chang Gung Memorial Hospital, 222 Mai-Chin Road, Keelung, 204, Taiwan, Republic of China
| | - Ya-Chuan Peng
- Department of Nursing, Chang Gung Memorial Hospital, Keelung, Taiwan
| | - Shun-Ying Yin
- Department of Thoracic and Cardiovascular Surgery, Chang Gung Memorial Hospital, 222 Mai-Chin Road, Keelung, 204, Taiwan, Republic of China
| | - Pin-Fu Huang
- Department of Thoracic and Cardiovascular Surgery, Chang Gung Memorial Hospital, 222 Mai-Chin Road, Keelung, 204, Taiwan, Republic of China
| | - Yao-Chang Wang
- Department of Thoracic and Cardiovascular Surgery, Chang Gung Memorial Hospital, 222 Mai-Chin Road, Keelung, 204, Taiwan, Republic of China
| | - Tzu-Ping Chen
- Department of Thoracic and Cardiovascular Surgery, Chang Gung Memorial Hospital, 222 Mai-Chin Road, Keelung, 204, Taiwan, Republic of China
| | - Heng-Hsin Tung
- School of Nursing, National Taipei University of Nursing and Health Science, Taipei, Taiwan
| | - Chi-Hsiao Yeh
- Department of Thoracic and Cardiovascular Surgery, Chang Gung Memorial Hospital, 222 Mai-Chin Road, Keelung, 204, Taiwan, Republic of China. .,School of Medicine, Chang Gung University, Tao-Yuan, Taiwan.
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Okyere CY, Pangaribowo EH, Gerber N. Household Water Quality Testing and Information: Identifying Impacts on Health Outcomes and Sanitation- and Hygiene-Related Risk-Mitigating Behaviors. EVALUATION REVIEW 2019; 43:370-395. [PMID: 31711300 DOI: 10.1177/0193841x19885204] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
BACKGROUND In 2014, a group of 512 households in multipurpose water systems and also relying on unimproved water, sanitation, and hygiene practices in the Greater Accra region of Ghana were randomly selected to participate in water quality self-testing and also receipt of information in the form of handouts on how to improve water quality. OBJECTIVES AND RESEARCH DESIGN Using a cluster-randomized controlled design, we study the health, sanitation, and hygiene behavior impacts of the household water quality testing and information experiment. SUBJECTS The study has three arms: (1) adult household members, (2) schoolgoing children, and (3) control group. MEASURES The study measures the effects on handwashing with soap, cleanliness of households, and prevalence of diarrhea and self-reported fever. We also address impacts on child health and nutrition outcomes, particularly diarrhea and anthropometric outcomes. RESULTS We show that there is high household willingness to participate in this intervention on water quality self-testing. About 7 months after households took part in the intervention, the study finds little impacts on health outcomes and on sanitation- and hygiene-related risk-mitigating behaviors, regardless of the intervention group, either schoolchildren or adult household members. Impacts (direction and extent) are rather homogeneous for most of the outcomes across treatment groups. CONCLUSIONS The study discusses the implications of the findings and also offers several explanations for the lack of transmission of impacts from the household water quality testing and information intervention on health outcomes and on sanitation and hygiene behaviors.
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Affiliation(s)
- Charles Yaw Okyere
- Department of Agricultural Economics and Agribusiness, College of Basic and Applied Sciences, University of Ghana, Legon, Accra, Ghana
- Center for Development Research (ZEF), University of Bonn, Germany
| | - Evita Hanie Pangaribowo
- Faculty of Geography, Department of Environmental Geography, Gadjah Mada University, Yogyakarta, Indonesia
| | - Nicolas Gerber
- Center for Development Research (ZEF), University of Bonn, Germany
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Azad TD, Veeravagu A, Mittal V, Esparza R, Johnson E, Ioannidis JPA, Grant GA. Neurosurgical Randomized Controlled Trials-Distance Travelled. Neurosurgery 2019. [PMID: 28645203 DOI: 10.1093/neuros/nyx319] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND The evidence base for many neurosurgical procedures has been limited. We performed a comprehensive and systematic analysis of study design, quality of reporting, and trial results of neurosurgical randomized controlled trials (RCTs). OBJECTIVE To systematically assess the design and quality characteristics of neurosurgical RCTs. METHODS From January 1961 to June 2016, RCTs with >5 patients assessing any 1 neurosurgical procedure against another procedure, nonsurgical treatment, or no treatment were retrieved from MEDLINE, Scopus, and Cochrane Library. RESULTS The median sample size in the 401 eligible RCTs was 73 patients with a mean patient age of 49.6. Only 111 trials (27.1%) described allocation concealment, 140 (34.6%) provided power calculations, and 117 (28.9%) were adequately powered. Significant efficacy or trend for efficacy was claimed in 226 reports (56.4%), no difference between the procedures was found in 166 trials (41.4%), and significant harm was reported in 9 trials (2.2%). Trials with a larger sample size were more likely to report randomization mode, specify allocation concealment, and power calculations (all P < .001). Government funding was associated with better specification of power calculations (P = .008) and of allocation concealment (P = .026), while industry funding was associated with reporting significant efficacy (P = .02). Reporting of funding, specification of randomization mode and primary outcomes, and mention of power calculations improved significantly (all, P < .05) over time. CONCLUSION Several aspects of the design and reporting of RCTs on neurosurgical procedures have improved over time. Better powered and accurately reported trials are needed in neurosurgery to deliver evidence-based care and achieve optimal outcomes.
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Affiliation(s)
- Tej D Azad
- Department of Neurosurgery, Stanford University School of Medicine, Stanford, CA
| | - Anand Veeravagu
- Department of Neurosurgery, Stanford University School of Medicine, Stanford, CA
| | - Vaishali Mittal
- Department of Neurosurgery, Stanford University School of Medicine, Stanford, CA
| | - Rogelio Esparza
- Department of Neurosurgery, Stanford University School of Medicine, Stanford, CA
| | - Eli Johnson
- Department of Neurosurgery, Stanford University School of Medicine, Stanford, CA
| | - John P A Ioannidis
- Stanford Prevention Research Center, Department of Medicine, and Department of Health Research and Policy, Stanford University School of Medicine, and MetaResearch Innovation Center at Stanford (METRICS), Stanford, California
| | - Gerald A Grant
- Department of Neurosurgery, Stanford University School of Medicine, Stanford, CA
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23
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Siddiq H, Pentapati KC, Acharya S. Adherence of Randomized Controlled Trials to Consolidated Standards of Reporting Trials 2010 Guidelines: A Survey of Randomized Controlled Trials Published in 2011-2016 in 3 Periodontology Journals. J Evid Based Dent Pract 2019; 19:260-272. [DOI: 10.1016/j.jebdp.2019.04.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2018] [Revised: 03/08/2019] [Accepted: 04/02/2019] [Indexed: 10/27/2022]
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24
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Adenekan AT, Aderounmu AA, Wuraola FO, Owojuyigbe AM, Adetoye AO, Nepogodiev D, Magill L, Bhangu A, Adisa AO. Feasibility study for a randomized clinical trial of bupivacaine, lidocaine with adrenaline, or placebo wound infiltration to reduce postoperative pain after laparoscopic cholecystectomy. BJS Open 2019; 3:453-460. [PMID: 31388637 PMCID: PMC6677102 DOI: 10.1002/bjs5.50159] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2018] [Accepted: 02/15/2019] [Indexed: 11/06/2022] Open
Abstract
Background Short‐term pain relief can be achieved by local anaesthetic infiltration of port sites at the end of laparoscopic surgery. This study aimed to assess feasibility of performing an RCT to evaluate short‐term postoperative analgesia after laparoscopic surgery in Nigeria using two local anaesthetics for port‐site infiltration versus saline placebo. Methods This was a placebo‐controlled, patient‐ and outcome assessor‐blinded, external feasibility RCT. Patients undergoing elective laparoscopic cholecystectomy for symptomatic ultrasound‐proven gallstones were randomized into three groups: lidocaine with adrenaline (epinephrine), bupivacaine or saline control. The feasibility of recruitment, compliance with randomized treatment allocation, and completion of pain and nausea outcome measures were evaluated. Pain was assessed at 2, 6, 12 and 24 h after surgery using a 0–10‐point numerical rating scale (NRS) and a four‐point verbal rating scale. Nausea was assessed using NRS at the same time points. Clinical outcomes were assessed only in patients who received the correct randomized treatment allocation. Results Of 79 patients screened for eligibility, 69 were consented and randomized (23 per group). Overall, compliance with randomized treatment allocation was achieved in 64 patients (93 per cent). All pain and nausea assessments were completed in these 64 patients. On the NRS, most patients had moderate to severe pain at 2 h (39 of 64, 61 per cent), which gradually reduced. Only six patients (9 per cent) had moderate to severe pain at 24 h. Conclusion Recruitment, compliance with the randomized allocation, and completion of pain outcome measures were satisfactory. This study demonstrates the feasibility of conducting a surgical RCT in a resource‐limited setting. Registration number: ISRCTN 17667918 (https://www.isrctn.com).
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Affiliation(s)
- A T Adenekan
- Department of Anaesthesia and Intensive Care Obafemi Awolowo University Ile-Ife Nigeria.,Department of Anaesthesia and Intensive Care Obafemi Awolowo University Teaching Hospitals Complex Ile-Ife Nigeria
| | - A A Aderounmu
- Department of Surgery Obafemi Awolowo University Teaching Hospitals Complex Ile-Ife Nigeria
| | - F O Wuraola
- Department of Surgery Obafemi Awolowo University Teaching Hospitals Complex Ile-Ife Nigeria
| | - A M Owojuyigbe
- Department of Anaesthesia and Intensive Care Obafemi Awolowo University Ile-Ife Nigeria.,Department of Anaesthesia and Intensive Care Obafemi Awolowo University Teaching Hospitals Complex Ile-Ife Nigeria
| | - A O Adetoye
- Department of Anaesthesia and Intensive Care Obafemi Awolowo University Ile-Ife Nigeria.,Department of Anaesthesia and Intensive Care Obafemi Awolowo University Teaching Hospitals Complex Ile-Ife Nigeria
| | - D Nepogodiev
- National Institute for Health Research Global Health Research Unit on Global Surgery University of Birmingham Birmingham UK
| | - L Magill
- National Institute for Health Research Global Health Research Unit on Global Surgery University of Birmingham Birmingham UK
| | - A Bhangu
- National Institute for Health Research Global Health Research Unit on Global Surgery University of Birmingham Birmingham UK
| | - A O Adisa
- Department of Surgery Obafemi Awolowo University Ile-Ife Nigeria.,Department of Surgery Obafemi Awolowo University Teaching Hospitals Complex Ile-Ife Nigeria
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25
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Caparrotta TM, Dear JW, Colhoun HM, Webb DJ. Pharmacoepidemiology: Using randomised control trials and observational studies in clinical decision-making. Br J Clin Pharmacol 2019; 85:1907-1924. [PMID: 31206748 DOI: 10.1111/bcp.14024] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2019] [Revised: 04/23/2019] [Accepted: 05/24/2019] [Indexed: 12/14/2022] Open
Abstract
Weighing up sources of evidence is a key skill for clinical decision-makers. Randomised controlled trials (RCTs) and observational studies each have advantages and disadvantages, and in both cases perceived weaknesses can be improved through modifications of design and analysis. In the field of pharmacoepidemiology, RCTs are the best way to determine whether an intervention modifies an outcome being studied, largely because randomisation reduces bias and confounding. Observational studies are useful to investigate whether benefits/harms of a treatment are seen in day-to-day clinical practice in a wider group of patients. Although observational studies, even in a small cohort, can provide very useful clinical evidence, they may also be misleading (as shown by subsequent RCTs), in part because of allocation bias. There is an unmet need for clinicians to become well versed in appraising the study design and statistical analysis of observational pharmacoepidemiology (OP) studies, rather like the medical training already offered for RCT evaluation. This is because OP studies are likely to become more common with the computerisation of healthcare records and increasingly contribute to the evidence base available for clinical decision-making. However, when the results of an RCT conflict with the results of an OP study, the findings of the RCT should be preferred, especially if its findings have been repeated elsewhere. Conversely, OP studies that align with the findings of RCTs can provide rich and useful information to complement that generated by RCTs.
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Affiliation(s)
| | - James W Dear
- Queen's Medical Research Institute, University of Edinburgh, UK
| | - Helen M Colhoun
- Institute of Genetics and Molecular Medicine, University of Edinburgh, UK
| | - David J Webb
- Queen's Medical Research Institute, University of Edinburgh, UK
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26
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Singh B, Ghosh N, Saha D, Sarkar S, Bhattacharyya P, Chaudhury K. Effect of doxycyline in chronic obstructive pulmonary disease - An exploratory study. Pulm Pharmacol Ther 2019; 58:101831. [PMID: 31349003 DOI: 10.1016/j.pupt.2019.101831] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/08/2019] [Revised: 07/15/2019] [Accepted: 07/23/2019] [Indexed: 01/09/2023]
Abstract
PURPOSE Various mechanisms, including oxidative stress, inflammation, and protease-antiprotease imbalance are proposed for the progressive decline in lung function in chronic obstructive pulmonary disease (COPD). Doxycycline, a broad spectrum tetracycline antibiotic, is reported to have non-antimicrobial matrix metalloproteinases (MMP) inhibitory action in various inflammatory conditions. The effect of doxycycline in COPD is hereby assessed in the present randomized prospective study. PATIENTS AND METHODS The first group of COPD patients (n = 30; mild (n = 3), moderate (n = 6), severe (n = 7), very severe (n = 14) as per GOLD II & III criteria was prescribed the standard therapy, a combination of (i) short acting anti-muscarinic agent (SAMA) + short acting β2 agonist (SABA) inhaled and (ii) corticosteroid inhaled (ICS) + long acting β2 agonist (LABA) (iii) ICS + LABA + LAMA. Whereas doxycycline (100 mg), was used daily once or twice as per Body Mass Index (BMI), as an add-on to existing standard therapy for the second group of patients (n = 30; mild (n = 2), moderate (n = 7), severe (n = 8), very severe (n = 13). All recruited patients were followed-up after 3 months of treatment. Lung function index FEV1(%) predicted, FEV1/FVC (%), quality of life status including COPD Assessment Test (CAT), St. George's Respiratory Questionnaire (SGRQ) were assessed. Routine blood cell count also was performed. RESULTS Biochemical analysis included estimation of oxidative stress markers, inflammatory cytokines and proteases in plasma of both the groups. Reduction in oxidative stress is evidenced by a significant decrease in Lipid hydro peroxides (LPO), total oxidative stress (TOS) and increase in glutathione peroxidase (GSH-PX), reduced glutathione (GSH) and total anti-oxidant capacity (TAO) nitrite and nitrate (NOx) along with peroxynitrate following 3 months of add-on doxycycline treatment. Reduced levels of cytokines such as interleukin IL-6, TNF-α, IL-8 were also observed. Multivariate analysis identified TNF-α major effective discriminant among pre and post doxycycline treated COPD patients. The expression of TNF-α was inversely correlated with FEV1/FVC (%) changes. The levels of MMP-2 and MMP-9/tissue inhibitors of metalloproteinases (TIMP)-1 ratio (MMP-9/ TIMP-1), also decreased significantly and the decline could be associated with TOS. A significant increase in bilirubin and reduced glutathione (GSH) level was noticed in standard therapy group. CONCLUSION These data suggest that the improvement in lung function and quality of life in COPD patients may probably be attributed to the antioxidant, anti-inflammatory and anti-MMP activity of doxycycline. The potential therapeutic role of long-term doxycycline, in addition to its traditional antibiotic effect, definitely warrants further attention.
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Affiliation(s)
- Brajesh Singh
- School of Medical Science and Technology, Indian Institute of Technology Kharagpur, West Bengal, India
| | - Nilanjana Ghosh
- School of Medical Science and Technology, Indian Institute of Technology Kharagpur, West Bengal, India
| | | | - Surita Sarkar
- Department of Applied Physics, University of Calcutta, Kolkata, India
| | | | - Koel Chaudhury
- School of Medical Science and Technology, Indian Institute of Technology Kharagpur, West Bengal, India.
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27
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Kim D, Park H, Cho S, Yoon H. The quality of reporting randomized controlled trials in the dermatology literature in an era where the
CONSORT
statement is a standard. Br J Dermatol 2019; 180:1361-1367. [DOI: 10.1111/bjd.17432] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/13/2018] [Indexed: 01/10/2023]
Affiliation(s)
- D.Y. Kim
- Department of Dermatology Seoul National University Hospital Seoul Korea
- Department of Dermatology SMG‐SNU Boramae Medical Center 20 Boramae‐ro 5‐gil, Dongjak‐gu Seoul 07061 Korea
| | - H.S. Park
- Department of Dermatology SMG‐SNU Boramae Medical Center 20 Boramae‐ro 5‐gil, Dongjak‐gu Seoul 07061 Korea
| | - S. Cho
- Department of Dermatology SMG‐SNU Boramae Medical Center 20 Boramae‐ro 5‐gil, Dongjak‐gu Seoul 07061 Korea
| | - H.S. Yoon
- Department of Dermatology SMG‐SNU Boramae Medical Center 20 Boramae‐ro 5‐gil, Dongjak‐gu Seoul 07061 Korea
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28
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Leme ACB, Philippi ST, Thompson D, Nicklas T, Baranowski T. "Healthy Habits, Healthy Girls-Brazil": an obesity prevention program with added focus on eating disorders. Eat Weight Disord 2019; 24:107-119. [PMID: 29730727 DOI: 10.1007/s40519-018-0510-5] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/06/2018] [Accepted: 04/24/2018] [Indexed: 12/21/2022] Open
Abstract
PURPOSE To evaluate the immediate post-intervention and 6-month post-intervention effects of a Brazilian school-based randomized controlled trial for girls targeting shared risk factors for obesity and disordered eating. METHODS Total of 253 girls, mean of 15.6 (0.05) years from 1st to 3rd grades of high school participated in this 6-month school-based cluster randomized controlled trial. "Healthy Habits, Healthy Girls-Brazil (H3G-Brazil)", originally developed in Australia, emphasized 10 key nutrition and physical activity (PA) messages delivered over 6 months. Disordered eating prevention procedures, i.e., prevention of weight-teasing, body satisfaction, and unhealthy weight control behavior, were added to the intervention. Body dissatisfaction, unhealthy weight control behaviors and social cognitive-related diet, and physical activity variables were assessed at baseline, immediate post-intervention, and 6-month post-intervention. Intervention effects were determined by one-way analysis of covariance or logistic regression, after checking for the clustering effects of school. The control group did not receive intervention prior to follow-up assessment. A conservative significance level was set at p < 0.01. RESULTS Beneficial effects were detected for PA social support (F = 6.005, p = 0.01), and healthy eating strategies (F = 6.08, p = 0.01) immediate post-intervention; and healthy eating social support (F = 14.731, p = 0.00) and healthy eating strategies (F = 5.812, p = 0.01) at 6-month post-intervention. Intervention group was more likely to report unhealthy weight control behaviors (OR = 1.92, 95% CI 1.15-3.21, p = 0.01) at 6-month post-intervention. No other significant immediate or 6-month post effects were detected. CONCLUSION H3G-Brazil demonstrated positive 6-month effects on some social cognitive variables but an adverse effect on unhealthy weight control behaviors. Thus, this study was not able to achieve synergy by combining obesity and disordered eating prevention procedures in an intervention among low-income girls in Brazil. TRIAL REGISTRATION Level I: cluster randomized controlled trial.
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Affiliation(s)
- Ana Carolina Barco Leme
- Children's Nutrition Research Center, Baylor College of Medicine, Houston, USA. .,Department of Nutrition, School of Public Health, University of São Paulo, São Paulo, Brazil.
| | | | - Debbe Thompson
- Children's Nutrition Research Center, Baylor College of Medicine, Houston, USA
| | - Theresa Nicklas
- Department of Nutrition, School of Public Health, University of São Paulo, São Paulo, Brazil
| | - Tom Baranowski
- Department of Nutrition, School of Public Health, University of São Paulo, São Paulo, Brazil
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29
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Gradidge PJL, Golele PN. Walking as a feasible means of effecting positive changes in BMI, waist, and blood pressure in black South African women. Afr Health Sci 2018; 18:917-921. [PMID: 30766555 PMCID: PMC6354885 DOI: 10.4314/ahs.v18i4.10] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023] Open
Abstract
Background In the context of a growing obesity pandemic in sub-Saharan African countries little is known on how to address the problem /disease in the region. Methods A randomised controlled trial of walking to decrease obesity was conducted using 115 women employed at the University of Venda, Limpopo province. 49 of these participants were randomly selected into an intervention group, which walked for 30 minutes, 3 days per week for a period of 12 weeks on treadmills located in the university gym. The control group were instructed to continue with usual activities. Baseline and follow-up body mass index (BMI), waist circumference, blood pressure (BP), body size discrepancy (measured by a feel-minus-ideal (FID) index), and physical activity were collected on all participants. Results The absolute changes in BMI, waist, systolic and diastolic BP in the intervention group was −0.80, −1.50, −4.02 and −2.37, respectively. In contrast, the absolute changes for these were +1.05, +1.73, +4.64 and +4.94, respectively in the control group. The results of the FID analysis showed that most had a desire for thinness. Conclusion Our data demonstrates that positive changes in BMI, waist, and BP were observed in the intervention group, indicating the potential scalability of the intervention.
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Affiliation(s)
- Philippe Jean-Luc Gradidge
- Centre for Exercise Science and Sports Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Precious Nkhensani Golele
- Centre for Exercise Science and Sports Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
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30
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Robinson AL, Schmeiser G, Robinson Y, Olerud C. Surgical vs. non-surgical management of displaced type-2 odontoid fractures in patients aged 75 years and older: study protocol for a randomised controlled trial. Trials 2018; 19:452. [PMID: 30134944 PMCID: PMC6106890 DOI: 10.1186/s13063-018-2690-8] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2017] [Accepted: 05/16/2018] [Indexed: 11/25/2022] Open
Abstract
Background Displaced odontoid fractures in the elderly are treated non-surgically with a cervical collar or surgically with C1–C2 fusion. Due to the paucity of evidence, the treatment decision is often left to the discretion of the expert surgeon. Methods The Uppsala Study on Odontoid Fracture Treatment (USOFT) is a multicentre, open-label, randomised controlled superiority trial evaluating the clinical superiority of the surgical treatment of type-2 odontoid fractures, with a 1-year Neck Disability Index (NDI) as the primary endpoint. Fifty consecutive patients aged ≥ 75 years, with displaced type-2 odontoid fracture, are randomised to non-surgical or surgical treatment. Excluded are patients with an American Society of Anaesthesiologists (ASA) score ≥ 4, dementia nursing care or anatomical cervical anomalies. The minimal clinically important difference of the NDI is 3.5 points. A minimum of 16 patients are needed in each group to test the superiority with 80% power. By considering a 1-year mortality forecast of 29%, up to 25 participants are recruited in each group. The non-surgical group is fitted with a rigid cervical collar for 12 weeks. The surgical group is treated with a posterior C1–C2 fusion. All participants are monitored with regard to the NDI, EuroQol score (EQ-5D), socio-demographics and computed tomography (CT) at the time of injury, at 6 weeks, 3 months and 12 months. At 12 months, a dynamic radiographical investigation of upper cervical stability is performed. The secondary endpoints are: EQ-5D score, activities of daily living (ADL), bony union, upper cervical stability and mortality. Discussion USOFT is the first randomised controlled trial comparing non-surgical and surgical management of type-2 odontoid fractures in the elderly. Using the NDI and EQ-5D as endpoints, future value-based decisions may consider quality-adjusted life years gained. Major limitations are (1) the allocation bias of the open-label study design, (2) that only higher training levels of all core specialties of spine surgery are included in the surgical treatment arm and (3) that only one type of surgical stabilisation is investigated (posterior C1–C2 fusion), while other methods are not included in this study. Trial registration ClinicalTrials.gov, NCT02789774. Registered retrospectively on 25 August 2015. Electronic supplementary material The online version of this article (10.1186/s13063-018-2690-8) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Anna-Lena Robinson
- Department of Surgical Sciences, Uppsala University Hospital, Uppsala, Sweden. .,Stockholm Spine Center, Stockholm, Sweden. .,Stockholm Spine Center, Löwenströmska Hospital, 194 89, Stockholm, Upplands Väsby, Sweden.
| | - Gregor Schmeiser
- Department of Surgical Sciences, Uppsala University Hospital, Uppsala, Sweden.,Schön Clinic Hamburg Eilbek, Hamburg, Germany
| | - Yohan Robinson
- Department of Surgical Sciences, Uppsala University Hospital, Uppsala, Sweden.,Dept. of Research and Development, Armed Forces Centre for Defence Medicine, Västra Frölunda, Gothenburg, Sweden
| | - Claes Olerud
- Department of Surgical Sciences, Uppsala University Hospital, Uppsala, Sweden
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Al Talhi A, Al Saran K, Osman ET, Al Shatri A, Osman M, Mirza K. A randomized study on a 3-month versus a 7-month prednisolone regimen for the initial episode of childhood idiopathic nephrotic syndrome at a large Saudi center. Int J Pediatr Adolesc Med 2018; 5:18-23. [PMID: 30805527 PMCID: PMC6363257 DOI: 10.1016/j.ijpam.2017.12.004] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2017] [Revised: 12/24/2017] [Accepted: 12/31/2017] [Indexed: 11/29/2022]
Abstract
BACKGROUND AND OBJECTIVES The standard International Study of Kidney Disease in Children (ISKDC) regimen of prednisolone of 2 months duration for the treatment of the initial episode of Idiopathic Nephrotic Syndrome (INS) was associated with a high relapse rate. The long prednisolone protocols were introduced in order to reduce the relapse rate and steroid toxicities. The main objective of this study was to assess the efficacy and safety of a 3 months protocol of prednisolone versus a 7 months protocol for the first episode of idiopathic nephrotic syndrome. DESIGN AND SETTING The study took place in the Pediatric Nephrology Department of King Saud Medical City, Riyadh which is a large referral center all over Saudi Arabia. The study was a randomized control trial using 2 groups. Group A received the 3 months protocol and Group B received the 7 months protocol. PATIENTS AND METHODS All children with a confirmed diagnosis of Idiopathic Nephrotic Syndrome were included. The patients were randomized by simple randomization using sealed envelopes into two groups; group A comprised of 60 children using the daily regimen prednisolone 60 mg/m2 OD X 1 ½ months then 40mg/m2 on alternate day for 1 ½ months (total = 3 months) and group B also comprised of 60 children using the 7 months protocol, Prednisolone 60mg/m2 OD x 1 month then 40mg/m2 EOD x 2 months then 30mg/m2 EOD for 2 months then 20mg/m2 EOD for 2 months. The efficacy and safety of these two prednisolone regimens were recorded. The follow-up period was two years. Statistical analysis was done using the SPSS progress version 16 (Chicago, USA) P < .05 was taken as a significant result. Consort guidelines for randomized controlled trials (RCTs) were followed. The hospital ethical committee approved the study. The parents gave an informed consent. RESULTS Group B protocol was found to be significantly better than the group A protocol in both years of follow-up. The mean time of first relapse was significantly better in group B than in group A (P < .0001). The relapse rate reduced significantly in group B vs group A in both the first year (P = .0031) as well as in the second year (P = .00002). The cumulative dose of steroids was significantly less in group B vs group A both in the first year of follow-up (P = .0039) as well as in the second year (P = .0026). The incidence of frequently relapsers was significantly less (P = .049) in group B as compared to group A. The risk of relapse was better in group B as compared to group A (RR 0.8039; 95% CI 0.6566 to 0.9843 significance (P = .0346). The side effects of corticosteroids were significantly less in group B protocol as compared to group A. CONCLUSION We concluded that the long 7 months protocol was significantly better than the 3 months prednisolone regimen in both efficacy and safety for the initial episode of childhood INS.
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Affiliation(s)
- AbdulHadi Al Talhi
- Department of Pediatric Nephrology King Saud Medical City Riyadh, Saudi Arabia
| | - Khalid Al Saran
- Dept. King Saud Medical City, Al Faisal University Riyadh, Saudi Arabia
| | - ElTayeb Taha Osman
- Department of Pediatric Nephrology King Saud Medical City Riyadh, Saudi Arabia
| | - AbdulAziz Al Shatri
- Department of Pediatric Nephrology King Saud Medical City Riyadh, Saudi Arabia
| | - Mutawakil Osman
- Department of Pediatric Nephrology King Saud Medical City Riyadh, Saudi Arabia
| | - Khalid Mirza
- Department of Pediatric Nephrology King Saud Medical City Riyadh, Saudi Arabia
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Hicks A, Fairhurst C, Torgerson DJ. A simple technique investigating baseline heterogeneity helped to eliminate potential bias in meta-analyses. J Clin Epidemiol 2018; 95:55-62. [DOI: 10.1016/j.jclinepi.2017.10.001] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2017] [Revised: 09/28/2017] [Accepted: 10/06/2017] [Indexed: 01/25/2023]
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Intraoperative Infiltration of Liposomal Bupivacaine vs Bupivacaine Hydrochloride for Pain Management in Primary Total Hip Arthroplasty: A Prospective Randomized Trial. J Arthroplasty 2018; 33:441-446. [PMID: 29033152 DOI: 10.1016/j.arth.2017.09.013] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/07/2017] [Revised: 09/06/2017] [Accepted: 09/11/2017] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND Pain management after total hip arthroplasty is well studied. Nevertheless, there is no consensus regarding the "cocktail" to use in periarticular infiltration (PAI). Liposomal bupivacaine (LB) is a slow release local anesthetic that can be infiltrated during surgery. In this study, we compared LB to bupivacaine hydrochloride (HCL). METHODS Between September 2014 and March 2016, 181 patients were screened for this prospective randomized trial. A total of 107 patients were enrolled and studied. Patients were separated into LB and control groups. LB group (50) received PAI with LB and bupivacaine HCL with epinephrine and the control group (57) received PAI with bupivacaine HCL and epinephrine. Patient morphine equivalent consumption, pain score estimated on visual analog scale, time to first ambulation greater than 20 feet, time to discharge, drug-related side effects, and patient falls were documented. Data were collected up to 72 hours postoperation. RESULTS There was no significant difference in morphine equivalent consumption in any of the 12-hour time blocks, up to 72 hours. No patient falls were documented in either group. Time to first ambulation greater than 20 feet, ambulation same day as surgery, time to discharge, and drug-related side effects were not significantly different between groups. CONLCUSION Intraoperative PAI with LB did not result in significant differences in postoperative opioid consumption, pain scores, opioid-related side effects, time to first ambulation, and length of stay up to 72 hours following total hip arthroplasty compared to a control group.
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Kaushal-Deep SM, Anees A, Khan S, Khan MA, Lodhi M. Randomized controlled study of intraincisional infiltration versus intraperitoneal instillation of standardized dose of ropivacaine 0.2% in post-laparoscopic cholecystectomy pain: Do we really need high doses of local anesthetics-time to rethink! Surg Endosc 2018; 32:3321-3341. [PMID: 29340809 DOI: 10.1007/s00464-018-6053-z] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2017] [Accepted: 01/11/2018] [Indexed: 12/31/2022]
Abstract
BACKGROUND Earlier studies done to compare the efficacy of use of local anesthetics at intraperitoneal location versus intraincisional use had utilized equal amount of drugs at the two locations, usually 10-20 ml. Using this large amount of drug in the small space of intraincisional location as compared to similar amount of drug in large intraperitoneal space created an inadvertent bias in favor of patients receiving the drug intraincisionally so these patients naturally experienced less pain. AIMS AND OBJECTIVES To conduct a randomized, triple-blind, placebo-controlled study by standardizing dose of local anesthetic, to compare the effectiveness of intraperitoneal against intraincisional use of ropivacaine 0.2% for post-laparoscopic cholecystectomy pain relief. MATERIALS AND METHODS 294 patients underwent elective 4-port laparoscopic cholecystectomy. Patients were triple blindly randomized. All patients received ~ 23 ml of solution, of which 20 ml was given intraperitoneally (1 ml/cm; 16 ml along right hemi-dome and 4 ml in gall bladder fossa) and ~ 3 ml intraincisionally (1 ml/cm of length of incision). Solution was either normal saline or drug (0.2% ropivacaine) depending on the group [controls (n = 86), intraperitoneal group (n = 100), and intraincisional group (n = 108)]. 5 different pain scales were used for assessment of overall pain. Pain scores were assessed at 5 points of time. RESULTS Patients in intraincisional group showed significantly less overall pain and rescue analgesia requirement (p < 0.05). Intraincisional group showed significantly less overall pain (p < 0.05) as compared to intraperitoneal group; however, use of rescue analgesia was comparable in the two groups (p > 0.05); and shoulder pain was significantly less in intraperitoneal group (p < 0.05). CONCLUSION The intraincisional use of injection ropivacaine at its minimum concentration of 0.2% in minimal doses of 1 ml/cm at the end of procedure provides significantly more post-operative analgesia as compared to intraperitoneal group and controls. However, for controlling shoulder pain, the use of intraperitoneal ropivacaine is desirable.
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Affiliation(s)
- Singh Mathuria Kaushal-Deep
- Department of Surgery, Jawaharlal Nehru Medical College and Hospital, Aligarh Muslim University, Aligarh, Uttar Pradesh, 202002, India.
| | - Afzal Anees
- Department of Surgery, Jawaharlal Nehru Medical College and Hospital, Aligarh Muslim University, Aligarh, Uttar Pradesh, 202002, India
| | - Shehtaj Khan
- Department of Surgery, Jawaharlal Nehru Medical College and Hospital, Aligarh Muslim University, Aligarh, Uttar Pradesh, 202002, India
| | - Mohammad Amanullah Khan
- Department of Surgery, Jawaharlal Nehru Medical College and Hospital, Aligarh Muslim University, Aligarh, Uttar Pradesh, 202002, India
| | - Mehershree Lodhi
- Department of Anesthesia, Institute of Medical Science, Banaras Hindu University, Varanasi, 22100, India
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Comparison of an interviewer-administered with an automated self-administered 24 h (ASA24) dietary recall in adolescents. Public Health Nutr 2017; 20:3060-3067. [PMID: 28889834 DOI: 10.1017/s1368980017002269] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
OBJECTIVE The current pilot study aimed to assess whether reporting quality would decline materially in adolescents completing weekly web-based Automated Self-Administered 24-Hour dietary recalls (ASA24-Kids-2014) and interviewer-administered 24 h dietary recalls for six weeks. We also aimed to assess method preference. DESIGN We conducted two studies. Study 1 (n 20) randomized participants to complete either one ASA24-Kids-2014 or one interviewer-administered recall weekly, for six weeks. Energy intake and number of foods reported were described for each method over time. Differences between recall methods for each measure were tested using mixed-effects regression. Study 2 (n 10) employed a randomized crossover design to describe method preference. SETTING Dietary intake was collected either by telephone (interviewer-administered dietary recalls) or via the Internet (ASA24-Kids-2014 dietary recalls). SUBJECTS Adolescents aged 12-17 years with no prior diet recording experience were enrolled. RESULTS In Study 1, mean (sd) total energy and number of foods reported decreased by 50 (222) kJ (12 (53) kcal) and 0·05 (0·31) items v. 38 (138) kJ (9 (33) kcal) and 0·17 (0·14) items per recall for participants randomized to the ASA24-Kids-2014 v. interviewer-administered recalls, respectively. There was no difference between groups for either measure (P > 0·57). In Study 2, eight of ten participants preferred the interviewer-administered recall over the ASA24-Kids-2014. Overall, seven of twenty participants experienced technical difficulties with the ASA24-Kids-2014. CONCLUSIONS No appreciable decay in reporting quality was seen for either method. However, participants reported a preference for the interviewer-administered recall. Our findings can help inform and support larger studies to further characterize the performance of the ASA24 in adolescents.
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Drew BT, Conaghan PG, Smith TO, Selfe J, Redmond AC. The effect of targeted treatment on people with patellofemoral pain: a pragmatic, randomised controlled feasibility study. BMC Musculoskelet Disord 2017; 18:338. [PMID: 28778218 PMCID: PMC5545020 DOI: 10.1186/s12891-017-1698-7] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/08/2017] [Accepted: 07/24/2017] [Indexed: 12/30/2022] Open
Abstract
BACKGROUND Targeted treatment, matched according to specific clinical criteria e.g. hip muscle weakness, may result in better outcomes for people with patellofemoral pain (PFP). However, to ensure the success of future trials, a number of questions on the feasibility of a targeted treatment need clarification. The aim of the study was to explore the feasibility of matched treatment (MT) compared to usual care (UC) management for a subgroup of people with PFP determined to have hip weakness and to explore the mechanism of effect for hip strengthening. METHODS In a pragmatic, randomised controlled feasibility study, 24 participants with PFP (58% female; mean age 29 years) were randomly allocated to receive either MT aimed specifically at hip strengthening, or UC over an eight-week period. The primary outcomes were feasibility outcomes, which included rates of adherence, attrition, eligibility, missing data and treatment efficacy. Secondary outcomes focused on the mechanistic outcomes of the intervention, which included hip kinematics. RESULTS Conversion to consent (100%), missing data (0%), attrition rate (8%) and adherence to both treatment and appointments (>90%) were deemed successful endpoints. The analysis of treatment efficacy showed that the MT group reported a greater improvement for the Global Rating of Change Scale (62% vs. 9%) and the Anterior Knee Pain Scale (-5.23 vs. 1.18) but no between-group differences for either average or worst pain. Mechanistic outcomes showed a greatest reduction in peak hip internal rotation angle for the MT group (13.1% vs. -2.7%). CONCLUSION This feasibility study indicates that a definitive randomised controlled trial investigating a targeted treatment approach is achievable. Findings suggest the mechanism of effect of hip strengthening may be to influence kinematic changes in hip function in the transverse plane. TRIAL REGISTRATION This study was registered retrospectively. ISRCTN74560952 . Registration date: 2017-02-06.
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Affiliation(s)
- Benjamin T Drew
- Leeds Institute of Rheumatic and Musculoskeletal Medicine, Chapel Allerton Hospital, Chapeltown Rd, Leeds, LS7 4SA, UK
- NIHR Leeds Biomedical Research Centre, Leeds, UK
| | | | - Toby O Smith
- School of Health Sciences, University of East Anglia, Norwich, UK
| | - James Selfe
- Department of Health Professions, Manchester Metropolitan University, Manchester, UK
| | - Anthony C Redmond
- Leeds Institute of Rheumatic and Musculoskeletal Medicine, Chapel Allerton Hospital, Chapeltown Rd, Leeds, LS7 4SA, UK.
- NIHR Leeds Biomedical Research Centre, Leeds, UK.
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Cramer H, Dobos G, Langhorst J. Editorial: yoga for QoL in ulcerative colitis-any better than other supportive activities? Authors' reply. Aliment Pharmacol Ther 2017. [PMID: 28621065 DOI: 10.1111/apt.14141] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/08/2022]
Affiliation(s)
- H Cramer
- Department of Internal and Integrative Medicine, Kliniken Essen-Mitte, Faculty of Medicine, University of Duisburg-Essen, Essen, Germany
| | - G Dobos
- Department of Internal and Integrative Medicine, Kliniken Essen-Mitte, Faculty of Medicine, University of Duisburg-Essen, Essen, Germany
| | - J Langhorst
- Department of Internal and Integrative Medicine, Kliniken Essen-Mitte, Faculty of Medicine, University of Duisburg-Essen, Essen, Germany
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Barban F, Mancini M, Cercignani M, Adriano F, Perri R, Annicchiarico R, Carlesimo GA, Ricci C, Lombardi MG, Teodonno V, Serra L, Giulietti G, Fadda L, Federici A, Caltagirone C, Bozzali M. A Pilot Study on Brain Plasticity of Functional Connectivity Modulated by Cognitive Training in Mild Alzheimer's Disease and Mild Cognitive Impairment. Brain Sci 2017; 7:brainsci7050050. [PMID: 28468232 PMCID: PMC5447932 DOI: 10.3390/brainsci7050050] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2016] [Revised: 03/08/2017] [Accepted: 04/26/2017] [Indexed: 11/16/2022] Open
Abstract
Alzheimer's disease (AD) alters the functional connectivity of the default mode network (DMN) but also the topological properties of the functional connectome. Cognitive training (CT) is a tool to slow down AD progression and is likely to impact on functional connectivity. In this pilot study, we aimed at investigating brain functional changes after a period of CT and active control (AC) in a group of 26 subjects with mild AD (mAD), 26 with amnestic mild cognitive impairment (aMCI), and a control group of 29 healthy elderly (HE) people. They all underwent a CT and AC in a counterbalanced order following a crossover design. Resting-state functional MRI and neuropsychological testing were acquired before and after each period. We tested post-CT and post-AC changes of cognitive abilities, of the functional connectivity of the DMN, and of topological network properties derived from graph theory and network-based statistics. Only CT produced functional changes, increasing the functional connectivity of the posterior DMN in all three groups. mAD also showed functional changes in the medial temporal lobe and topological changes in the anterior cingulum, whereas aMCI showed more widespread topological changes involving the frontal lobes, the cerebellum and the thalamus. Our results suggest specific functional connectivity changes after CT for aMCI and mAD.
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Affiliation(s)
- Francesco Barban
- Clinical and Behavioral Neurology Laboratory, IRCCS Santa Lucia Foundation, Rome 00179, Italy.
- Neuroimaging Laboratory, IRCCS Santa Lucia Foundation, Rome 00179, Italy.
- Humboldt-Universität zu Berlin, Berlin School of Mind and Brain, Berlin 10117, Germany.
| | - Matteo Mancini
- Department of Engineering, University of Rome "Roma Tre", Rome 00146, Italy.
| | - Mara Cercignani
- Clinical Imaging Sciences Centre, Brighton and Sussex and Medical School, Brighton BN1 9RR, UK.
| | - Fulvia Adriano
- Clinical and Behavioral Neurology Laboratory, IRCCS Santa Lucia Foundation, Rome 00179, Italy.
- Neuroimaging Laboratory, IRCCS Santa Lucia Foundation, Rome 00179, Italy.
| | - Roberta Perri
- Clinical and Behavioral Neurology Laboratory, IRCCS Santa Lucia Foundation, Rome 00179, Italy.
| | - Roberta Annicchiarico
- Clinical and Behavioral Neurology Laboratory, IRCCS Santa Lucia Foundation, Rome 00179, Italy.
| | - Giovanni Augusto Carlesimo
- Clinical and Behavioral Neurology Laboratory, IRCCS Santa Lucia Foundation, Rome 00179, Italy.
- Department of Systemic Medicine, University of Tor Vergata, Rome 00173, Italy.
| | - Claudia Ricci
- Clinical and Behavioral Neurology Laboratory, IRCCS Santa Lucia Foundation, Rome 00179, Italy.
| | - Maria Giovanna Lombardi
- Clinical and Behavioral Neurology Laboratory, IRCCS Santa Lucia Foundation, Rome 00179, Italy.
| | - Valeria Teodonno
- Clinical and Behavioral Neurology Laboratory, IRCCS Santa Lucia Foundation, Rome 00179, Italy.
| | - Laura Serra
- Neuroimaging Laboratory, IRCCS Santa Lucia Foundation, Rome 00179, Italy.
| | - Giovanni Giulietti
- Neuroimaging Laboratory, IRCCS Santa Lucia Foundation, Rome 00179, Italy.
| | - Lucia Fadda
- Clinical and Behavioral Neurology Laboratory, IRCCS Santa Lucia Foundation, Rome 00179, Italy.
- Department of Systemic Medicine, University of Tor Vergata, Rome 00173, Italy.
| | - Alessia Federici
- Clinical and Behavioral Neurology Laboratory, IRCCS Santa Lucia Foundation, Rome 00179, Italy.
| | - Carlo Caltagirone
- Clinical and Behavioral Neurology Laboratory, IRCCS Santa Lucia Foundation, Rome 00179, Italy.
- Department of Systemic Medicine, University of Tor Vergata, Rome 00173, Italy.
| | - Marco Bozzali
- Neuroimaging Laboratory, IRCCS Santa Lucia Foundation, Rome 00179, Italy.
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Reducing Fall Risk with Combined Motor and Cognitive Training in Elderly Fallers. Brain Sci 2017; 7:brainsci7020019. [PMID: 28208604 PMCID: PMC5332962 DOI: 10.3390/brainsci7020019] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2016] [Revised: 01/27/2017] [Accepted: 02/07/2017] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Falling is a major clinical problem in elderly people, demanding effective solutions. At present, the only effective intervention is motor training of balance and strength. Executive function-based training (EFt) might be effective at preventing falls according to evidence showing a relationship between executive functions and gait abnormalities. The aim was to assess the effectiveness of a motor and a cognitive treatment developed within the EU co-funded project I-DONT-FALL. METHODS In a sample of 481 elderly people at risk of falls recruited in this multicenter randomised controlled trial, the effectiveness of a motor treatment (pure motor or mixed with EFt) of 24 one-hour sessions delivered through an i-Walker with a non-motor treatment (pure EFt or control condition) was evaluated. Similarly, a 24 one-hour session cognitive treatment (pure EFt or mixed with motor training), delivered through a touch-screen computer was compared with a non-cognitive treatment (pure motor or control condition). RESULTS Motor treatment, particularly when mixed with EFt, reduced significantly fear of falling (F(1,478) = 6.786, p = 0.009) although to a limited extent (ES -0.25) restricted to the period after intervention. CONCLUSIONS This study suggests the effectiveness of motor treatment empowered by EFt in reducing fear of falling.
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Hubie C, Shaw M, Bydder S, Lane J, Waters G, McNabb M, Kearvell R, Concannon A, Bharat C, Appleyard R. A randomised comparison of three different immobilisation devices for thoracic and abdominal cancers. J Med Radiat Sci 2016; 64:90-96. [PMID: 27998039 PMCID: PMC5454323 DOI: 10.1002/jmrs.202] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2016] [Revised: 09/04/2016] [Accepted: 09/09/2016] [Indexed: 11/21/2022] Open
Abstract
Introduction Patient immobilisation is critically important for both highly conformal conventionally fractionated radiotherapy and for stereotactic body radiotherapy. Different immobilisation devices are available to maintain patient position for radiotherapy but the most suitable one remains unknown. Methods Forty‐five patients were randomly allocated to one of three immobilisation devices; the Q fix arm shuttle, BodyFIX without wrap or BodyFIX with wrap. Patients were imaged before and after treatment to ascertain intra‐fraction and inter‐fraction motion. Bony anatomy was used for matching to determine the positional accuracy of each device. Treatments were timed using a standard method. Patient comfort and staff satisfaction questionnaires were also issued to determine comfort, ease of use and preferences for each device. Results The BodyFIX without wrap was the more accurate device; however, the differences between the devices were not statistically significant. The BodyFIX with wrap was found to take significantly longer to set up and set down compared to the arm shuttle and the BodyFIX without wrap (all P < 0.001). Patients (37%) marginally preferred the BodyFIX with wrap. Most (81%) staff preferred the BodyFIX without wrap. Conclusion Immobilisation using the BodyFIX without wrap was deemed to be suitable for clinical use. It was a clinically accurate device, the more efficient in terms of set up and set down time, the most preferred by staff and was accepted by patients.
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Affiliation(s)
- Catherine Hubie
- Sir Charles Gairdner Hospital, Nedlands, Western Australia, Australia
| | - Maddison Shaw
- Sir Charles Gairdner Hospital, Nedlands, Western Australia, Australia
| | - Sean Bydder
- Sir Charles Gairdner Hospital, Nedlands, Western Australia, Australia
| | - Jonny Lane
- Sir Charles Gairdner Hospital, Nedlands, Western Australia, Australia
| | - Gemma Waters
- Sir Charles Gairdner Hospital, Nedlands, Western Australia, Australia
| | - Megan McNabb
- Sir Charles Gairdner Hospital, Nedlands, Western Australia, Australia
| | - Rachel Kearvell
- Sir Charles Gairdner Hospital, Nedlands, Western Australia, Australia
| | - Alicia Concannon
- Sir Charles Gairdner Hospital, Nedlands, Western Australia, Australia
| | - Chrianna Bharat
- Sir Charles Gairdner Hospital, Nedlands, Western Australia, Australia.,Centre for Applied Statistics, University Western Australia, Nedlands, Perth, Western Australia, Australia
| | - Rob Appleyard
- Faculty of Health Science, Sheffield Hallam University, Sheffield, UK
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Paludan-Müller A, Teindl Laursen DR, Hróbjartsson A. Mechanisms and direction of allocation bias in randomised clinical trials. BMC Med Res Methodol 2016; 16:133. [PMID: 27717321 PMCID: PMC5055724 DOI: 10.1186/s12874-016-0235-y] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2016] [Accepted: 09/27/2016] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Selective allocation of patients into the compared groups of a randomised trial may cause allocation bias, but the mechanisms behind the bias and its directionality are incompletely understood. We therefore analysed the mechanisms and directionality of allocation bias in randomised clinical trials. METHODS Two systematic reviews and a theoretical analysis. We conducted one systematic review of empirical studies of motives/methods for deciphering patient allocation sequences; and another review of methods publications commenting on allocation bias. We theoretically analysed the mechanisms of allocation bias and hypothesised which main factors predicts its direction. RESULTS Three empirical studies addressed motives/methods for deciphering allocation sequences. Main motives included ensuring best care for patients and ensuring best outcome for the trial. Main methods included various manipulations with randomisation envelopes. Out of 57 methods publications 11 (19 %) mentioned explicitly that allocation bias can go in either direction. We hypothesised that the direction of allocation bias is mainly decided by the interaction between the patient allocators' motives and treatment preference. CONCLUSION Inadequate allocation concealment may exaggerate treatment effects in some trials while underestimate effects in others. Our hypothesis provides a theoretical overview of the main factors responsible for the direction of allocation bias.
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Affiliation(s)
| | | | - Asbjørn Hróbjartsson
- The Nordic Cochrane Centre, Rigshospitalet 7811, Copenhagen, Denmark
- Centre for Evidence-Based Medicine, University of Southern Denmark and Odense University Hospital, Odense, Denmark
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Maynard LG, Barreto AS, Santana-Filho VJ, Cerqueira Neto MLD, Dias DPM, Silva-Júnior WMD. Effects of transcutaneous electrical diaphragmatic stimulation on the cardiac autonomic balance in healthy individuals: a randomized clinical trial. FISIOTERAPIA E PESQUISA 2016. [DOI: 10.1590/1809-2950/14720423032016] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
ABSTRACT The transcutaneous electrical diaphragmatic stimulation (TEDS) is a technique of respiratory muscle activation that affects breathing pattern and rhythm. In an attempt to evaluate changes in cardiac autonomic balance in response to TEDS in healthy individuals, we used a well-established TEDS model. Twenty-two volunteers aged between 22 and 35 years old, with no cardiac pathology history, were randomized into two groups (control, n = 8; TEDS, n = 14). The individuals were allowed to rest in supine position and were then subjected to the electrical stimulation protocol. The control group was subjected to electrical stimulation at perceptive level, whereas for the TEDS group the electric stimulus generated diaphragm contraction. Cardiac intervals (CI) were sampled by a Polar RS800CX monitor. Cardiac interval variability was studied in the time and frequency domains. In the control group, electrical stimulation did not change cardiac interval length and variability (CI: 761±44 vs. 807±39 ms; RMSSD: 37±9 vs. 42±13 ms ; LF: 69±6 vs. 67±5 nu; HF: 31±6 vs. 33±5 nu; all comparisons versus baseline). Nevertheless, as compared to baseline, TEDS group showed decreased sympathetic cardiac modulation (LF: 43±3 vs. 63±4 nu) and increased parasympathetic cardiac modulation (RMSSD: 109±10 vs. 41±6 ms; HF: 57±3 vs. 37±4 nu) during diaphragmatic stimulation. However, cardiac interval length was not changed by electrical stimulation (CI: 686±59 vs. 780±31 ms). It can be suggested that the use of TEDS stimulus leads to pronounced changes in the cardiac sympathovagal balance, with higher parasympathetic cardiac modulation, possibly induced by increased diaphragmatic excursion.
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Harting J, van Assema P, van Limpt P, Gorgels T, van Ree J, Ruland E, Vermeer F, de Vries NK. Effects of health counseling on behavioural risk factors in a high-risk cardiology outpatient population: a randomized clinical trial. ACTA ACUST UNITED AC 2016; 13:214-21. [PMID: 16575275 DOI: 10.1097/01.hjr.0000194416.39508.e9] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND An evaluation study of an individual lifestyle advice intervention to reduce cardiovascular risk behaviours (high fat consumption, smoking, physical inactivity). METHODS A randomized, controlled trial at the cardiology outpatient clinic of the University Hospital Maastricht. Participants were at high risk of incurring a cardiovascular event. Changes in risk behaviours and behavioural determinants were assessed with self-administered validated questionnaires. RESULTS Questionnaires were completed by 1270 patients at baseline, 1169 after 4 months (92%), and 1032 after 18 months (81.3%). After 4 months, intention-to-treat analyses revealed a decrease in fat consumption (-5.6%, P = 0.000), a reduction in the percentage of smokers [odds ratio (OR) 0.57, 95% confidence intervals (CI) 0.33-0.97] and a trend towards a maintained physical activity level (OR 1.28, 95% CI 0.97-1.70). No long-term effects were found. CONCLUSION The lifestyle advice intervention was potentially effective in changing cardiovascular risk behaviours, but should be further improved to be effective in secondary cardiovascular prevention. The main limitations of the study were related to the randomization procedure and the self-selection of patients and cardiologists.
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Affiliation(s)
- Janneke Harting
- Department of Health Education and Promotion, Maastricht University, Maastricht, The Netherlands.
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Suhaj A, Manu MK, Unnikrishnan MK, Vijayanarayana K, Mallikarjuna Rao C. Effectiveness of clinical pharmacist intervention on health-related quality of life in chronic obstructive pulmonary disorder patients - a randomized controlled study. J Clin Pharm Ther 2016; 41:78-83. [DOI: 10.1111/jcpt.12353] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2015] [Accepted: 12/13/2015] [Indexed: 12/11/2022]
Affiliation(s)
- A. Suhaj
- Department of Pharmacy Practice; Manipal College of Pharmaceutical Sciences; Manipal University; Manipal India
| | - M. K. Manu
- Department of Pulmonary Medicine; Kasturba Medical College Hospital; Manipal University; Manipal India
| | - M. K. Unnikrishnan
- Department of Pharmacy Practice; Manipal College of Pharmaceutical Sciences; Manipal University; Manipal India
| | - K. Vijayanarayana
- Department of Pharmacy Practice; Manipal College of Pharmaceutical Sciences; Manipal University; Manipal India
| | - C. Mallikarjuna Rao
- Department of Pharmacology; Manipal College of Pharmaceutical Sciences; Manipal University; Manipal India
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Identificación de ensayos clínicos en revistas dermatológicas publicadas en español. ACTAS DERMO-SIFILIOGRAFICAS 2015; 106:415-22. [DOI: 10.1016/j.ad.2015.01.005] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2014] [Revised: 01/13/2015] [Accepted: 01/25/2015] [Indexed: 11/19/2022] Open
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Yelland LN, Sullivan TR, Voysey M, Lee KJ, Cook JA, Forbes AB. Applying the intention-to-treat principle in practice: Guidance on handling randomisation errors. Clin Trials 2015; 12:418-23. [PMID: 26033877 PMCID: PMC4509880 DOI: 10.1177/1740774515588097] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Background: The intention-to-treat principle states that all randomised participants should be analysed in their randomised group. The implications of this principle are widely discussed in relation to the analysis, but have received limited attention in the context of handling errors that occur during the randomisation process. The aims of this article are to (1) demonstrate the potential pitfalls of attempting to correct randomisation errors and (2) provide guidance on handling common randomisation errors when they are discovered that maintains the goals of the intention-to-treat principle. Methods: The potential pitfalls of attempting to correct randomisation errors are demonstrated and guidance on handling common errors is provided, using examples from our own experiences. Results: We illustrate the problems that can occur when attempts are made to correct randomisation errors and argue that documenting, rather than correcting these errors, is most consistent with the intention-to-treat principle. When a participant is randomised using incorrect baseline information, we recommend accepting the randomisation but recording the correct baseline data. If ineligible participants are inadvertently randomised, we advocate keeping them in the trial and collecting all relevant data but seeking clinical input to determine their appropriate course of management, unless they can be excluded in an objective and unbiased manner. When multiple randomisations are performed in error for the same participant, we suggest retaining the initial randomisation and either disregarding the second randomisation if only one set of data will be obtained for the participant, or retaining the second randomisation otherwise. When participants are issued the incorrect treatment at the time of randomisation, we propose documenting the treatment received and seeking clinical input regarding the ongoing treatment of the participant. Conclusion: Randomisation errors are almost inevitable and should be reported in trial publications. The intention-to-treat principle is useful for guiding responses to randomisation errors when they are discovered.
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Affiliation(s)
- Lisa N Yelland
- Women's & Children's Health Research Institute, The University of Adelaide, Adelaide, SA, Australia School of Population Health, The University of Adelaide, Adelaide, SA, Australia
| | - Thomas R Sullivan
- School of Population Health, The University of Adelaide, Adelaide, SA, Australia
| | - Merryn Voysey
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Katherine J Lee
- Murdoch Children's Research Institute, Parkville, VIC, Australia Department of Paediatrics, University of Melbourne, Melbourne, VIC, Australia
| | - Jonathan A Cook
- Centre for Statistics in Medicine, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK Surgical Intervention Trials Unit, University of Oxford, Oxford, UK
| | - Andrew B Forbes
- Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, VIC, Australia
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Sanclemente G, Pardo H, Sánchez S, Bonfill X. Identifying Randomized Clinical Trials in Spanish-Language Dermatology Journals. ACTAS DERMO-SIFILIOGRAFICAS 2015. [DOI: 10.1016/j.adengl.2015.04.010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
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48
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Egbewale BE. Statistical issues in randomised controlled trials: a narrative synthesis. Asian Pac J Trop Biomed 2015. [DOI: 10.1016/s2221-1691(15)30367-1] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
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49
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A practical approach to evidence-based dentistry: III: how to appraise and use an article about therapy. J Am Dent Assoc 2014; 146:42-49.e1. [PMID: 25569497 DOI: 10.1016/j.adaj.2014.11.010] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
BACKGROUND AND OVERVIEW Dental practitioners spend most of their time administering treatments. To ensure that their clinical decisions are informed by the best available evidence, dental practitioners need to be skilled in critically appraising studies addressing therapy issues. Randomized controlled trials offer the optimal study design to inform decisions regarding therapy. The critical appraisal of randomized controlled trials involves assessing the risk of bias, results, and applicability. In this article, the authors present these concepts and provide guidance for this type of appraisal. PRACTICAL IMPLICATIONS Dentists who wish to inform their clinical decisions regarding therapy and prevention questions can use these guidelines to decide what type of studies to search, define the specific question of interest to search efficiently for these studies, and critically appraise an article about therapy or prevention.
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Simpson A, Flood C, Rowe J, Quigley J, Henry S, Hall C, Evans R, Sherman P, Bowers L. Results of a pilot randomised controlled trial to measure the clinical and cost effectiveness of peer support in increasing hope and quality of life in mental health patients discharged from hospital in the UK. BMC Psychiatry 2014; 14:30. [PMID: 24495599 PMCID: PMC3922504 DOI: 10.1186/1471-244x-14-30] [Citation(s) in RCA: 48] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/03/2013] [Accepted: 02/03/2014] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Mental health patients can feel anxious about losing the support of staff and patients when discharged from hospital and often discontinue treatment, experience relapse and readmission to hospital, and sometimes attempt suicide. The benefits of peer support in mental health services have been identified in a number of studies with some suggesting clinical and economic gains in patients being discharged. METHODS This pilot randomised controlled trial with economic evaluation aimed to explore whether peer support in addition to usual aftercare for patients during the transition from hospital to home would increase hope, reduce loneliness, improve quality of life and show cost effectiveness compared with patients receiving usual aftercare only, with follow-up at one and three-months post-discharge. RESULTS A total of 46 service users were recruited to the study; 23 receiving peer support and 23 in the care-as-usual arm. While this pilot trial found no statistically significant benefits for peer support on the primary or secondary outcome measures, there is an indication that hope may be further increased in those in receipt of peer support. The total cost per case for the peer support arm of the study was £2154 compared to £1922 for the control arm. The mean difference between costs was minimal and not statistically significant. However, further analyses demonstrated that peer support has a reasonably high probability of being more cost effective for a modest positive change in the measure of hopelessness. Challenges faced in recruitment and follow-up are explored alongside limitations in the delivery of peer support. CONCLUSIONS The findings suggest there is merit in conducting further research on peer support in the transition from hospital to home consideration should be applied to the nature of the patient population to whom support is offered; the length and frequency of support provided; and the contact between peer supporters and mental health staff. There is no conclusive evidence to support the cost effectiveness of providing peer support, but neither was it proven a costly intervention to deliver. The findings support an argument for a larger scale trial of peer support as an adjunct to existing services. TRIAL REGISTRATION Current Controlled Trials ISRCTN74852771.
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Affiliation(s)
- Alan Simpson
- School of Health Sciences, City University London, Northampton Square, London EC1V 0HB, UK.
| | - Chris Flood
- School of Health Sciences, City University London, Northampton Square, London EC1V 0HB, UK
| | - Julie Rowe
- KentHealth, Centre for Health Services Studies, University of Kent, Canterbury, Kent CT2 7NF, UK
| | - Jody Quigley
- School of Psychological Sciences and Health, University of Strathclyde, Graham Hills Building, 40 George Street, Glasgow G1 1QE, UK
| | - Susan Henry
- East London NHS Foundation Trust, 22 Commercial Street, London E1 6LPUK, UK
| | - Cerdic Hall
- East London NHS Foundation Trust, 22 Commercial Street, London E1 6LPUK, UK
| | - Richard Evans
- East London NHS Foundation Trust, 22 Commercial Street, London E1 6LPUK, UK
| | - Paul Sherman
- East London NHS Foundation Trust, 22 Commercial Street, London E1 6LPUK, UK
| | - Len Bowers
- Institute of Psychiatry, King’s College, London SE5 8AF, UK
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