Effect of Vitamin B12 Injection on the Vocal Performance of Professional Singers: A Randomized, Double-blind, Placebo-Controlled, Crossover Trial

Blinding Is Seeing: A Single-Centre Study Into the Viability of Auto-Injectors for Blinded-Drug Administration in Randomised Controlled Trials

Objective The aim of the study was to assess the viability of auto-injector systems (A-INJ) for preserving investigator blinding in randomized controlled trials (RCT). Background Blinding refers to the concealment of group allocation from one or more individuals involved in a clinical research study. In the dosing of subcutaneous (SC) and intramuscular (IM) investigational medicinal products (IMP), specific challenges arise in maintaining investigator blinding. These challenges primarily involve the active injectate's viscosity and visual appearance (colour/translucency) in comparison to the placebo. Existing methods to control these issues are not perfect. Common approaches include using unblinded investigators or applying films or additives to make the active and placebo injectates appear similar. Method A single-centre experimental and descriptive study was carried out to compare the use of an A-INJ (Owen Mumford, Autoject 2) with the use of a conventional syringe (CS) in delivering a 1 ml dose of both placebo and reference IMP. The percentage delivery of the injectate was compared between the A-INJ IMP and placebo groups. Additionally, eight trained research physicians serving as investigators recorded their assessments of safety and effectiveness after performing serial injections with the A-INJ into a human-tissue analogue. Results Overall, a mean of 95.38% of 1ml placebo injectate was released from the A-INJ, compared to 96.00% from the CS. A total of 94.715% of 1 ml IMP injectate was released from the A-INJ, as opposed to 94.74% from the CS. Independent t-test analyses showed no statistical significance between the experimental arms. The mean administration time was 8.5 seconds. Investigators were unable to differentiate between the two solutions when using the A-INJ. There were no recorded concerns about investigators becoming unblinded, which stands in contrast to concerns associated with using the CS. Conclusion In assessing the viability of A-INJ use in RCTs, we noted a marked improvement when blinding was used. A-INJ systems effectively administer both placebo and active injectates, thereby maintaining the benefit of blinding without the need to alter the placebo through the addition of colourants or viscosity additives. While audio cues from the A-INJ and the time required to administer the injectate pose challenges, solutions are suggested. Although our findings are preliminary, they add to the existing literature on the advantages of A-INJs for administering injectable compounds and offer new perspectives on their utility in RCTs.

Determining Knowledge Level, Attitude, Behaviors Regarding Vocal Hygiene and Use of Medical Drugs and Herbal Medicinal Products for Vocal Health in Second Level Professional Voice Users

OBJECTIVES

This study aims to determine the knowledge level, attitude, and behaviors regarding vocal hygiene and use of medical drugs and herbal medicinal products for vocal health in second level professional voice users.

METHODS

The study examined second level professional voice users comprised of amateur singers, religious officials,voice instructors and vocal coaches consisting of academicians working in conservatories and education faculties, music teachers, conservatory students majoring in opera or choir, students majoring in music education, and amateur actors who were reached via online platforms and were administered a 32-item questionnaire RESULTS: A total of 406 participants consisting of conservatory students (26.8%), religious officials (23.2%), academicians (9.1%), amateur or self-taught musicians (14.8%), conservatory graduates (8.6%), and music teachers affiliated with the Ministry of National Education were recruited for the study. It was determined that 78.8% of the participants knew the definition of vocal hygiene, and 60.6% made an effort to maintain vocal hygiene. 57.9% of the participants declared that they had at least one disease affecting their vocal health. According to our research data, 8.9% of the participants were using one or more prescription drugs or over-the-counter products daily to protect their vocal health. Lozenges, vitamins, and allergy medications constituted a large portion of these medicinal products. In total, 62.3% of participants used herbal products for vocal health in their daily life. Participants mostly consumed products containing linden, sage, ginger, chamomile, and turmeric. It was determined that more than 20 different herbal products containing plants in different mixtures and contents were used. Furthermore, 40% of the participants using herbal medicinal products consulted a health care professional.It was found that these products were mostly obtained from herbalists (79.5%), and the source of information regarding these products was quite diverse. The rate of experiencing side effects due to the use of herbal products was 2%.

CONCLUSIONS

There is a lack of knowledge regarding vocal hygiene and its application on real-life behavior among second-level sound professionals. In particular, the awareness of vocal hygiene should be increased among religious officials. It was observed that the rate of use of herbal products to protect vocal health or to treat hoarseness was quite high. Further studies are needed to prove the benefits of these herbal and medicinal products on vocal health.