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Peters EM, Yilmaz O, Li C, Balbuena L. Interpersonal sensitivity and response to selective serotonin reuptake inhibitors in patients with acute major depressive disorder. J Affect Disord 2024; 355:422-425. [PMID: 38537756 DOI: 10.1016/j.jad.2024.03.112] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/05/2023] [Revised: 02/29/2024] [Accepted: 03/23/2024] [Indexed: 04/09/2024]
Abstract
BACKGROUND Patients with major depression often suffer from excessive interpersonal sensitivity, although it is not typically measured in antidepressant clinical trials. Preliminary evidence suggests selective serotonin reuptake inhibitors have the capacity to reduce interpersonal sensitivity. METHODS This was a pooled analysis of data from 1709 patients in three randomized, double-blind, placebo-controlled trials of fluoxetine and paroxetine for acute major depressive disorder. Depressive symptoms were assessed with the Hamilton Depression Rating Scale. A factor from the Symptom Checklist was used to assess interpersonal sensitivity. Our outcome of interest was change from baseline scores at the last assessment (up to 8 or 12 weeks, depending on the trial). RESULTS Both medications produced significantly greater reductions in interpersonal sensitivity relative to placebo. The effect of medication remained significant after controlling for depression improvement, which explained 18.5% of the variation in interpersonal sensitivity improvement among those treated with active medication. The effect of medication on depressive symptoms, relative to placebo, was not influenced by baseline interpersonal sensitivity. LIMITATIONS The outcome measured interpersonal sensitivity over the last week, and the results do not necessarily reflect changes in long-standing, trait-like patterns of interpersonal sensitivity. Only two medications were studied. CONCLUSIONS Selective serotonin reuptake inhibitors are effective at treating interpersonal sensitivity in acutely depressed patients. This appears to be a unique drug effect that is not only the result of depression improvement. Future clinical trials might benefit from assessing interpersonal sensitivity more routinely.
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Affiliation(s)
- Evyn M Peters
- Department of Psychiatry, College of Medicine, University of Saskatchewan, Canada.
| | - Orhan Yilmaz
- Department of Psychiatry, College of Medicine, University of Saskatchewan, Canada
| | - Cindy Li
- Department of Psychiatry, College of Medicine, University of Saskatchewan, Canada
| | - Lloyd Balbuena
- Department of Psychiatry, College of Medicine, University of Saskatchewan, Canada
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Calear AL, Macleod E, Hoye AM, McCallum S, Morse A, Farrer LM, Batterham PJ. Pragmatic controlled trial of a school-based emotion literacy program for 8- to 10-year-old children: study protocol. BMC Psychiatry 2024; 24:275. [PMID: 38609882 PMCID: PMC11010293 DOI: 10.1186/s12888-024-05628-z] [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: 12/18/2023] [Accepted: 02/20/2024] [Indexed: 04/14/2024] Open
Abstract
BACKGROUND Mental disorders are common in childhood, but many young people do not receive adequate professional support. Help-seeking interventions may bridge this treatment gap, however, there is limited research on interventions for primary-school children. This study aims to evaluate the effectiveness of an emotion literacy program at increasing literacy, reducing stigma, and promoting help-seeking in children aged 8-10 years. METHODS AND ANALYSIS A two-arm pragmatic cluster-controlled trial will compare Thriving Minds, an emotion literacy program for middle primary school children, to a wait-list control condition. Children aged 8-10 years will be recruited from approximately 12 schools (6 intervention schools/6 wait-list control) to participate in Thriving Minds via direct invitation by the program delivery service. Allocation to the intervention condition will be pragmatically, by school. Children will receive the intervention over two 50-minute sessions, across two weeks. Using story books and interactive discussion, the program aims to develop children's knowledge of their own and other's emotional experiences and emotion regulation strategies (self-care and help-seeking). The primary outcome is help-seeking intentions. Secondary outcomes include help-seeking knowledge, attitudes, and behaviours, emotion knowledge and attitudes, and stigma. Children will complete surveys at pre-intervention, post-intervention (one week after the program) and 12-week follow-up. Additional satisfaction data will be collected from teachers in intervention schools via surveys (post-intervention and 3-month follow-up) and semi-structured interviews (after follow-up), and selected children via focus groups (12-week follow-up). Analyses will compare changes in help-seeking intentions relative to the waitlist control condition using mixed-model repeated-measures analyses to account for clustering within schools. DISCUSSION With demonstrated effectiveness, this universal emotion literacy program for promoting help-seeking for mental health could be more widely delivered in Australian primary schools, providing a valuable new resource, contributing to the mental health of young people by improving help-seeking for early mental health difficulties. TRIAL REGISTRATION Australian New Zealand Clinical Trials Registry, ACTRN12623000910606 Registered on 24 August 2023.
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Affiliation(s)
- Alison L Calear
- Centre for Mental Health Research, College of Health and Medicine, The Australian National University, Canberra, Australia.
| | - Emily Macleod
- Centre for Mental Health Research, College of Health and Medicine, The Australian National University, Canberra, Australia
| | - Ashley M Hoye
- Centre for Mental Health Research, College of Health and Medicine, The Australian National University, Canberra, Australia
| | - Sonia McCallum
- Centre for Mental Health Research, College of Health and Medicine, The Australian National University, Canberra, Australia
| | - Alyssa Morse
- Centre for Mental Health Research, College of Health and Medicine, The Australian National University, Canberra, Australia
| | - Louise M Farrer
- Centre for Mental Health Research, College of Health and Medicine, The Australian National University, Canberra, Australia
| | - Philip J Batterham
- Centre for Mental Health Research, College of Health and Medicine, The Australian National University, Canberra, Australia
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Hankenson FC, Prager EM, Berridge BR. Advocating for Generalizability: Accepting Inherent Variability in Translation of Animal Research Outcomes. Annu Rev Anim Biosci 2024; 12:391-410. [PMID: 38358839 DOI: 10.1146/annurev-animal-021022-043531] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/17/2024]
Abstract
Advancing scientific discovery requires investigators to embrace research practices that increase transparency and disclosure about materials, methods, and outcomes. Several research advocacy and funding organizations have produced guidelines and recommended practices to enhance reproducibility through detailed and rigorous research approaches; however, confusion around vocabulary terms and a lack of adoption of suggested practices have stymied successful implementation. Although reproducibility of research findings cannot be guaranteed due to extensive inherent variables in attempts at experimental repetition, the scientific community can advocate for generalizability in the application of data outcomes to ensure a broad and effective impact on the comparison of animals to translation within human research. This report reviews suggestions, based upon work with National Institutes of Health advisory groups, for improving rigor and transparency in animal research through aspects of experimental design, statistical assessment, and reporting factors to advocate for generalizability in the application of comparative outcomes between animals and humans.
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Affiliation(s)
- F C Hankenson
- Division of Laboratory Animal Medicine, Department of Pathobiology, School of Veterinary Medicine and University Laboratory Animal Resources, University of Pennsylvania, Philadelphia, Pennsylvania, USA;
| | - E M Prager
- Research Program Management, Regeneron Pharmaceuticals, Inc., Tarrytown, New York, USA;
| | - B R Berridge
- B2 Pathology Solutions LLC, Cary, North Carolina, USA;
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Green ZA, Rizwan S. Art-of-Living Intervention Imparted Through a Blended Learning Approach to Nurture Positivity Among Pakistan's University Students During COVID-19: A Growth Curve Analysis. JOURNAL OF HAPPINESS STUDIES 2023; 24:1-32. [PMID: 37358970 PMCID: PMC10248975 DOI: 10.1007/s10902-023-00664-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Accepted: 04/21/2023] [Indexed: 06/28/2023]
Abstract
Art-of-living allows individuals to live a contemplative, mindful, and active life to attain well-being. This study demonstrates the development and implementation of an art-of-living training intervention to nurture positivity among Pakistan's university students during COVID-19. To ensure the efficacy of teaching and learning during the second wave of the pandemic, the intervention was imparted through a blended learning approach comprising two modes: (1) online learning and (2) offline personal and collaborative learning. This approach was based on the emotionalized learning experiences (ELE) format to make learning more engaging, permanent, and gratifying. The study comprised 243 students randomly assigned to an experimental group (n = 122) and a wait-list control group (n = 121). Growth curve analysis indicated that positivity together with the components of art-of-living-self-efficacy, savoring, social contacts, physical care, and meaning-and overall art-of-living increased at a greater rate in the experimental group than in the control group from pretest to posttest and from posttest to follow-up measurement. The analysis provided an all-encompassing view of how positivity developed in the two groups over time. There were significant variations in participants' initial status (intercepts) and growth trajectories (slopes). The influence of participants' initial positivity scores suggested that students with high initial positivity scores had a slower increase in linear growth, whereas those with low initial positivity scores had a faster increase in linear growth over time. The success of the intervention may be attributed to the dimensions of ELE-embodied in the two modes-and fidelity to intervention for effectively implementing the blended learning approach. Supplementary Information The online version contains supplementary material available at 10.1007/s10902-023-00664-0.
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Affiliation(s)
- Zane Asher Green
- Faculty of Business Administration, Preston University, No. 85, Street 3, H-8/1, Islamabad, Pakistan
- Contemporary Research Initiative, Preston University, Islamabad, Pakistan
| | - Sophie Rizwan
- Department of Leadership & Management Studies, National Defence University, E-9, Islamabad, Pakistan
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Han CY, Sharma Y, Yaxley A, Baldwin C, Woodman R, Miller M. Individualized Hospital to Home, Exercise-Nutrition Self-Managed Intervention for Pre-Frail and Frail Hospitalized Older Adults: The INDEPENDENCE Randomized Controlled Pilot Trial. Clin Interv Aging 2023; 18:809-825. [PMID: 37220521 PMCID: PMC10200110 DOI: 10.2147/cia.s405144] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2023] [Accepted: 04/22/2023] [Indexed: 05/25/2023] Open
Abstract
Purpose Pre-frailty and frailty in older adults are associated with poor health outcomes and increase health-care costs, and further worsening during hospitalization. This study aimed to examine the effect of an individualized hospital to home, exercise-nutrition self-managed intervention for pre-frail and frail hospitalized older adults. Patients and Methods Older adults admitted to an acute medical unit of a tertiary hospital in South Australia who were pre-frail or frail were recruited from September 2020 to June 2021, randomized to either control or intervention group and followed up at 3 and 6 months. The outcome variables were program adherence, frailty status by the Edmonton Frail Scale (EFS) score, lower extremity physical function, handgrip strength, nutritional status, cognition, mood, health-related quality of life, risk of functional decline, unplanned readmissions. Results Participants were 79.2 ±6.6 years old, 63% female, mostly frail (67%), with EFS of 8.6±1.9. Adherence to the inpatient and home visits/telehealth intervention were high (91±13% and 92±21%, respectively). Intention-to-treat analysis using linear regression models showed that participants in the intervention group had significantly greater reduction in EFS at 3 (-3.0; 95% CI: -4.8 to -3.0) and 6 months (-2.5; 95% CI: -3.8 to -1.0, P<0.001 for both) compared to the control group; particularly the functional performance component. There were also improvements in overall Short Physical Performance Battery score at 3 (4.0; 95% CI: 1.3 to 6.6) and 6 months (3.9; 95% CI: 1.0 to 6.9, P<0.05 for both), mini-mental state examination (2.6; 95% 0.3-4.8, P=0.029) at 3 months and handgrip strength (3.7; 95% CI: 0.2-7.1, P=0.039) and Geriatric Depression Scale, at 6 months (-2.2; 95% CI: -4.1 to -0.30, P=0.026) in the intervention group as compared to control. Conclusion This study provided evidence of acceptability to a patient self-managed exercise-nutrition program that may benefit and alleviate pre-frailty and frailty in hospitalised older adults.
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Affiliation(s)
- Chad Yixian Han
- Caring Futures Institute, College of Nursing and Health Sciences, Flinders University, Adelaide, SA, Australia
| | - Yogesh Sharma
- College of Medicine and Public Health, Flinders University, Adelaide, SA, Australia
- Department of General Medicine, Flinders Medical Centre, Adelaide, SA, Australia
| | - Alison Yaxley
- Caring Futures Institute, College of Nursing and Health Sciences, Flinders University, Adelaide, SA, Australia
| | - Claire Baldwin
- Caring Futures Institute, College of Nursing and Health Sciences, Flinders University, Adelaide, SA, Australia
| | - Richard Woodman
- College of Medicine and Public Health, Flinders University, Adelaide, SA, Australia
| | - Michelle Miller
- Caring Futures Institute, College of Nursing and Health Sciences, Flinders University, Adelaide, SA, Australia
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Tenan MS. Missing Data in Sport Science: A Didactic Example Using Wearables in American Football. Sports Med 2023; 53:1109-1116. [PMID: 37027076 DOI: 10.1007/s40279-023-01829-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/20/2023] [Indexed: 04/08/2023]
Abstract
Data are often recorded from athletes to make decisions regarding the mitigation of injuries or the enhancement of performance. However, data collection in the real-world is difficult, and it is common for data to be missing from a particular training session due to equipment malfunction, athlete non-compliance, etc. The statistical community has long recognized that proper handling of missing data is vital to unbiased analyses and decision making, yet most dashboards in sport science and medicine do not recognize the issues introduced by missing data and practitioners are largely unaware that their displays are conveying biased information. The goal of this leading article is to show how real-world data can violate the 'missing completely at random' assumption in an American Football example and then demonstrate some potential imputation solutions which appear to maintain the underlying properties of the data in the presence of missingness. Whether data are aggregated on a dashboard as simple histograms and averages or with higher-level analytics, violating the 'missing completely at random' assumption results in a biased dashboard. Practitioners need to insist that dashboard developers perform missing data analyses and impute data as needed so valid data-driven decisions can be made.
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Affiliation(s)
- Matthew S Tenan
- Rockefeller Neuroscience Institute, West Virginia University, Morgantown, WV, USA.
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Bragesjö M, Arnberg FK, Olofsdotter Lauri K, Aspvall K, Särnholm J, Andersson E. Condensed Internet-delivered prolonged exposure provided soon after trauma: a randomised trial. Psychol Med 2023; 53:1989-1998. [PMID: 37310324 PMCID: PMC10106292 DOI: 10.1017/s0033291721003706] [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: 04/23/2021] [Revised: 07/06/2021] [Accepted: 08/23/2021] [Indexed: 11/06/2022]
Abstract
BACKGROUND Exposure to trauma is common and can have a profoundly negative impact on mental health. Interventions based on trauma-focused cognitive behavioural therapy have shown promising results to facilitate recovery. The current trial evaluated whether a novel, scalable and digital early version of the intervention, Condensed Internet-Delivered Prolonged Exposure (CIPE), is effective in reducing post-traumatic stress symptoms. METHOD A single-site randomised controlled trial with self-referred adults (N = 102) exposed to trauma within the last 2 months. The participants were randomised to 3 weeks of CIPE or a waiting list (WL) for 7 weeks. Assessments were conducted at baseline, week 1-3 (primary endpoint), week 4-7 (secondary endpoint) and at 6-month follow-up. The primary outcome measure was PTSD Checklist for DSM-5 (PCL-5). RESULTS The main analysis according to the intention-to-treat principle indicated statistically significant reductions in symptoms of post-traumatic stress in the CIPE group as compared to the WL group. The between-group effect size was moderate at week 3 (bootstrapped d = 0.70; 95% CI 0.33-1.06) and large at week 7 (bootstrapped d = 0.83; 95% CI 0.46-1.19). Results in the intervention group were maintained at the 6-month follow-up. No severe adverse events were found. CONCLUSIONS CIPE is a scalable intervention that may confer early benefits on post-traumatic stress symptoms in survivors of trauma. The next step is to compare this intervention to an active control group and also investigate its effects when implemented in regular care.
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Affiliation(s)
- Maria Bragesjö
- Department of Clinical Neuroscience, Division of Psychology, Nobels väg 9, Karolinska Institutet, 171 77 Stockholm, Sweden
| | - Filip K. Arnberg
- Department of Neuroscience, Psychiatry, National Centre for Disaster Psychiatry, 751 24 Uppsala, Sweden
- Stress Research Institute, Stockholm University, 106 91 Stockholm, Sweden
| | - Klara Olofsdotter Lauri
- Department of Clinical Neuroscience, Division of Psychology, Nobels väg 9, Karolinska Institutet, 171 77 Stockholm, Sweden
| | - Kristina Aspvall
- Department of Clinical Neuroscience, Centre for Psychiatry Research, Karolinska Institutet, 171 77 Stockholm, Sweden
- Stockholm Health Care Services, Region Stockholm, Stockholm, Sweden
| | - Josefin Särnholm
- Department of Clinical Neuroscience, Division of Psychology, Nobels väg 9, Karolinska Institutet, 171 77 Stockholm, Sweden
| | - Erik Andersson
- Department of Clinical Neuroscience, Division of Psychology, Nobels väg 9, Karolinska Institutet, 171 77 Stockholm, Sweden
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Robertson AM, Cruwys T, Stevens M, Platow MJ. Aspirational leaders help us change: Ingroup prototypicality enables effective group psychotherapy leadership. BRITISH JOURNAL OF CLINICAL PSYCHOLOGY 2023; 62:243-259. [PMID: 36458503 PMCID: PMC10947317 DOI: 10.1111/bjc.12406] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2022] [Accepted: 11/10/2022] [Indexed: 12/03/2022]
Abstract
OBJECTIVES Research suggests that leaders are effective when they are ingroup prototypical (represent the identity of the group they seek to lead). However, it is unclear whether leaders should represent the group's current identity ("who we are") or aspired identity ("who we want to be"). This study investigated which of these forms of prototypicality best predicted leadership effectiveness in group psychotherapy. DESIGN Longitudinal study. METHODS 519 questionnaire responses were obtained from 112 women attending a four-session body acceptance program. Focal measures included participant ratings of how often they thought their psychotherapy leaders and fellow group members would (a) engage in dieting thoughts and behaviours and (b) approve of dieting. Given the program's body acceptance focus, leader prototypicality was conceptualized as the difference between participants' perceptions of how often their leaders, versus group members, would diet at the start of therapy. Leadership effectiveness was conceptualized as reductions in perceived group approval of dieting across therapy. Two therapeutic outcomes were considered: body satisfaction and dieting intentions. RESULTS A mixed-effects repeated measures analysis indicated that group approval of dieting decreased more rapidly when participants perceived their leaders to be aspirational (thought that group leaders dieted less frequently than group members) than when they perceived them to be exemplary (thought that group leaders dieted as frequently as group members). Changes in group approval of dieting mediated the relationship between leader prototypicality and improved therapeutic outcomes. CONCLUSIONS Findings suggest that group psychotherapy leaders may increase their effectiveness by striving to embody their group's aspired identity.
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Affiliation(s)
- Alysia M. Robertson
- Research School of Psychology, The Australian National UniversityCanberraACTAustralia
| | - Tegan Cruwys
- Research School of Psychology, The Australian National UniversityCanberraACTAustralia
| | - Mark Stevens
- Research School of Psychology, The Australian National UniversityCanberraACTAustralia
| | - Michael J. Platow
- Research School of Psychology, The Australian National UniversityCanberraACTAustralia
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Grudin R, Ahlen J, Mataix-Cols D, Lenhard F, Henje E, Månsson C, Sahlin H, Beckman M, Serlachius E, Vigerland S. Therapist-guided and self-guided internet-delivered behavioural activation for adolescents with depression: a randomised feasibility trial. BMJ Open 2022; 12:e066357. [PMID: 36572500 PMCID: PMC9806095 DOI: 10.1136/bmjopen-2022-066357] [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] [Indexed: 12/27/2022] Open
Abstract
OBJECTIVE Access to effective treatments for adolescents with depression needs to improve. Few studies have evaluated behavioural activation (BA) for adolescent depression, and none remotely delivered BA. This study explored the feasibility and acceptability of therapist-guided and self-guided internet-delivered BA (I-BA) in preparation for a future randomised controlled trial (RCT). DESIGN A single-blinded randomised controlled feasibility trial. SETTING A specialist outpatient clinic in Sweden. PARTICIPANTS Thirty-two adolescents with mild-to-moderate major depression, aged 13-17 years. INTERVENTIONS Ten weeks of therapist-guided I-BA or self-guided I-BA, or treatment as usual (TAU). Both versions of I-BA included parental support. TAU included referral to usual care within child and youth psychiatry or primary care. OUTCOMES Feasibility measures included study take-up, participant retention, acceptability, safety and satisfaction. The primary outcome measure was the blinded assessor-rated Children's Depression Rating Scale, Revised. The primary endpoint was the 3-month follow-up. RESULTS 154 adolescents were screened and 32 were randomised to therapist-guided I-BA (n=11), self-guided I-BA (n=10) or TAU (n=11). Participant retention was acceptable, with two drop-outs in TAU. Most participants in TAU had been offered interventions by the primary endpoint. The mean number of completed chapters (total of 8) for adolescents was 7.5 in therapist-guided I-BA and 5.4 in self-guided I-BA. No serious adverse events were recorded. Satisfaction was acceptable in both I-BA groups. Following an intent-to-treat approach, the linear mixed-effects model revealed that both therapist-guided and self-guided I-BA (Cohen's d=2.43 and 2.23, respectively), but not TAU (Cohen's d=0.95), showed statistically significant changes on the primary outcome measure with large within-group effect sizes. CONCLUSIONS Both therapist-guided and self-guided I-BA are acceptable and potentially efficacious treatments for adolescents with depression. It is feasible to conduct a large-scale RCT to establish the efficacy and cost-effectiveness of I-BA versus TAU. TRIAL REGISTRATION NUMBER ClinicalTrials.gov Registry (NCT04117789).
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Affiliation(s)
- Rebecca Grudin
- Centre for Psychiatry Research,Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
- Stockholm Health Care Services, Region Stockholm, Stockholm, Sweden
| | - Johan Ahlen
- Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden
- The Centre for Epidemiology and Community Medicine, Region Stockholm, Stockholm, Sweden
| | - David Mataix-Cols
- Centre for Psychiatry Research,Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
- Stockholm Health Care Services, Region Stockholm, Stockholm, Sweden
| | - Fabian Lenhard
- Centre for Psychiatry Research,Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
| | - Eva Henje
- Department of Clinical Science, Child and Adolescent Psychiatry, Umeå Universitet, Umea, Sweden
| | - Cecilia Månsson
- Stockholm Health Care Services, Region Stockholm, Stockholm, Sweden
| | - Hanna Sahlin
- Centre for Psychiatry Research,Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
- Stockholm Health Care Services, Region Stockholm, Stockholm, Sweden
| | - Maria Beckman
- Centre for Psychiatry Research,Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
- Stockholm Health Care Services, Region Stockholm, Stockholm, Sweden
| | - Eva Serlachius
- Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
- Department of Clinical Sciences, Faculty of Medicine, Lund University, Lund, Sweden
| | - Sarah Vigerland
- Centre for Psychiatry Research,Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
- Stockholm Health Care Services, Region Stockholm, Stockholm, Sweden
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García-Hernandez A, Pérez T, Pardo MDC, Rizopoulos D. A flexible analytical framework for reference-based imputation, delta adjustment and tipping-point stress-testing. Stat Biopharm Res 2022. [DOI: 10.1080/19466315.2022.2151506] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Affiliation(s)
| | - Teresa Pérez
- Facultad de Estudios Estadísticos, Univ. Complutense, Madrid, Spain
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Gastelum-Leyva F, Pena-Jasso A, Alvarado-Vera M, Plascencia-López I, Patrón-Romero L, Loera-Castañeda V, Gándara-Mireles JA, Lares-Asseff I, Leal-Ávila MÁ, Alvelais-Palacios JA, Almeida-Pérez J, Bogdanchikova N, Pestryakov A, Almanza-Reyes H. Evaluation of the Efficacy and Safety of Silver Nanoparticles in the Treatment of Non-Neurological and Neurological Distemper in Dogs: A Randomized Clinical Trial. Viruses 2022; 14:2329. [PMID: 36366427 PMCID: PMC9694365 DOI: 10.3390/v14112329] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2022] [Revised: 10/14/2022] [Accepted: 10/19/2022] [Indexed: 02/01/2023] Open
Abstract
Canine distemper is caused by canine distemper virus (CDV), a multisystemic infectious disease with a high morbidity and mortality rate in dogs. Nanotechnology represents a development opportunity for new molecules with antiviral effects that may become effective treatments in veterinary medicine. This study evaluated the efficacy and safety of silver nanoparticles (AgNPs) in 207 CDV, naturally infected, mixed-breed dogs exhibiting clinical signs of the non-neurological and neurological phases of the disease. Group 1a included 52 dogs (experimental group) diagnosed with non-neurologic distemper treated with 3% oral and nasal AgNPs in addition to supportive therapy. Group 1b included 46 dogs (control group) diagnosed with non-neurological distemper treated with supportive therapy only. Group 2a included 58 dogs with clinical signs of neurological distemper treated with 3% oral and nasal AgNPs in addition to supportive therapy. Group 2b included 51 dogs (control group) diagnosed with clinical signs of neurological distemper treated with supportive therapy only. Efficacy was measured by the difference in survival rates: in Group 1a, the survival rate was 44/52 (84.6%), versus 7/46 in Group 1b (15.2%), while both showed clinical signs of non-neurological distemper. The survival rate of dogs with clinical signs of neurological distemper in Group 2a (38/58; 65.6%) was significantly higher than those in Control Group 2b (0/51; 0%). No adverse reactions were detected in experimental groups treated with AgNPs. AgNPs significantly improved survival in dogs with clinical signs of neurological and non-neurological distemper. The use of AgNPs in the treatment of neurological distemper led to a drastic increase in the proportion of dogs recovered without sequels compared to dogs treated without AgNPs. The evidence demonstrates that AgNP therapy can be considered as a targeted treatment in dogs severely affected by canine distemper virus.
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Affiliation(s)
| | | | | | - Ismael Plascencia-López
- Faculty of Accounting and Administration, Autonomous University of Baja California, Tijuana 22390, Mexico
| | - Leslie Patrón-Romero
- Faculty of Medicine and Psychology, Autonomous University of Baja California, Tijuana 22390, Mexico
| | | | | | | | - María Ángeles Leal-Ávila
- School of Heath Sciences, Valle de Las Palmas, Autonomous University of Baja California, Tijuana 22260, Mexico
| | - J. A. Alvelais-Palacios
- School of Heath Sciences, Valle de Las Palmas, Autonomous University of Baja California, Tijuana 22260, Mexico
| | | | - Nina Bogdanchikova
- Center of Nanoscience and Nanotechnology, UNAM (CNyN-UNAM), Ensenada 22860, Mexico
| | - Alexey Pestryakov
- Research School of Chemistry and Applied Biomedical Sciences, Tomsk Polytechnic University, 634050 Tomsk, Russia
| | - Horacio Almanza-Reyes
- Cluster de Bioeconomía de Baja California, A.C., Tijuana 22040, Mexico
- Faculty of Medicine and Psychology, Autonomous University of Baja California, Tijuana 22390, Mexico
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Lu J, Chen YF. Consideration of the adaptive randomization allocation ratio in the presence of treatment group heteroscedasticity in clinical trials. J Biopharm Stat 2022; 32:511-526. [PMID: 35695576 DOI: 10.1080/10543406.2022.2080697] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
For randomized clinical trials, subjects' variance structures may vary over time among treatment groups, resulting in the heteroscedasticity of residuals in a regression analysis. Commonly used methods that assume equal variance among all treatment groups may not be able to control for a type I error. When the variances are indeed the same across treatment groups, an equal randomization allocation ratio will yield the greatest study power. However, out of ethical concern or urgent need for rare disease clinical trials, more patients may have to be allocated to the study drug arm. In these situations, an unequal randomization ratio should be considered. We propose a group variance-covariance and structures-based method to adapt the randomization ratio after interim analysis. We use simulations to compare commonly used statistical methods for continuous endpoints in assessing the impact of heteroscedasticity in equal and unequal randomization ratios and examine the extent to which the findings are affected by missing data.
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Affiliation(s)
- Jiashen Lu
- Department of Statistics, University of Pittsburgh, Pennsylvania, United States
| | - Yeh-Fong Chen
- Division of Biometrics IX, Office of Biostatistics, US Food and Drug Administration Center for Drug Evaluation and Research, Maryland, United States
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13
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Mitroiu M, Teerenstra S, Oude Rengerink K, Pétavy F, Roes KCB. Estimation of treatment effects in short-term depression studies. An evaluation based on the ICH E9(R1) estimands framework. Pharm Stat 2022; 21:1037-1057. [PMID: 35678545 PMCID: PMC9543408 DOI: 10.1002/pst.2214] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2021] [Revised: 02/18/2022] [Accepted: 04/11/2022] [Indexed: 11/25/2022]
Abstract
Estimands aim to incorporate intercurrent events in design, data collection and estimation of treatment effects in clinical trials. Our aim was to understand what estimands may correspond to efficacy analyses commonly employed in clinical trials conducted before publication of ICH E9(R1). We re‐analysed six clinical trials evaluating a new anti‐depression treatment. We selected the following analysis methods—ANCOVA on complete cases, following last observation carried forward (LOCF) imputation and following multiple imputation; mixed‐models for repeated measurements without imputation (MMRM), MMRM following LOCF imputation and following jump‐to‐reference imputation; and pattern‐mixture mixed models. We included a principal stratum analysis based on the predicted subset of the study population who would not discontinue due to adverse events or lack of efficacy. We translated each analysis into the implicitly targeted estimand, and formulated corresponding clinical questions. We could map six estimands to analysis methods. The same analysis method could be mapped to more than one estimand. The major difference between estimands was the strategy for intercurrent events, with other attributes mostly the same across mapped estimands. The quantitative differences in MADRS10 population‐level summaries between the estimands were 4–8 points. Not all six estimands had a clinically meaningful interpretation. Only a few analyses would target the same estimand, hence only few could be used as sensitivity analyses. The fact that an analysis could estimate different estimands emphasises the importance of prospectively defining the estimands targeting the primary objective of a trial. The fact that an estimand can be targeted by different analyses emphasises the importance of prespecifying precisely the estimator for the targeted estimand.
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Affiliation(s)
- Marian Mitroiu
- Methodology Working Group, College ter Beoordeling van Geneesmiddelen - Medicines Evaluation Board, Utrecht, The Netherlands.,Clinical Trial Methodology Department, Biostatistics and Research Support, Julius Center for Health Sciences and Primary Care, Biostatistics and Research Support, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Steven Teerenstra
- Methodology Working Group, College ter Beoordeling van Geneesmiddelen - Medicines Evaluation Board, Utrecht, The Netherlands.,Department for Health Evidence, Section Biostatistics, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Katrien Oude Rengerink
- Methodology Working Group, College ter Beoordeling van Geneesmiddelen - Medicines Evaluation Board, Utrecht, The Netherlands.,Clinical Trial Methodology Department, Biostatistics and Research Support, Julius Center for Health Sciences and Primary Care, Biostatistics and Research Support, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Frank Pétavy
- Data Analytics and Methods Taskforce, European Medicines Agency, Amsterdam, The Netherlands
| | - Kit C B Roes
- Methodology Working Group, College ter Beoordeling van Geneesmiddelen - Medicines Evaluation Board, Utrecht, The Netherlands.,Department for Health Evidence, Section Biostatistics, Radboud University Medical Center, Nijmegen, The Netherlands
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14
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Calear AL, McCallum SM, Christensen H, Mackinnon AJ, Nicolopoulos A, Brewer JL, Werner-Seidler A, Morse AR, Kazan D, Farrer LM, Kampel L, Batterham PJ. The Sources of Strength Australia project: A cluster randomised controlled trial of a peer-connectedness school-based program to promote help-seeking in adolescents. J Affect Disord 2022; 299:435-443. [PMID: 34952104 DOI: 10.1016/j.jad.2021.12.043] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/07/2021] [Revised: 11/08/2021] [Accepted: 12/18/2021] [Indexed: 01/01/2023]
Abstract
BACKGROUND Suicide is a significant public health problem and there is a clear need for interventions to improve help seeking for suicide and psychological distress in young people. This trial aimed to assess the effectiveness of the school-based Sources of Strength program in increasing help-seeking intentions and behaviours in adolescents. METHODS A cluster, randomised controlled trial was conducted in 13 Australian secondary schools (N = 1633), with each school randomly allocated to the intervention (n = 7) or wait-list control condition (n = 6). Participants in the intervention condition received the Sources of Strength program over two years and all participants completed self-report measures of help-seeking intentions and behaviour at four time-points. Staff and students in the intervention condition also provided qualitative feedback on the perceived impact of the program. RESULTS Mixed model repeated measures analyses demonstrated no significant effect of the Sources of Strength program on help-seeking intentions or behaviour at post-intervention or 6- or 18-month follow-up. Staff and students reported, through qualitative feedback, that the program increased awareness of and openness to help seeking and promoted a common language and school community. LIMITATIONS The current study only included self-report measures that may have been influenced by situational factors or biases. CONCLUSIONS Although the Sources of Strength program may have increased awareness of help seeking, there was no evidence that it is effective in increasing help-seeking intentions or behaviours in this cohort. The program may be more suitable for schools in disadvantaged areas where there may be limited existing connections to trusted adults.
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Affiliation(s)
- Alison L Calear
- Centre for Mental Health Research, Research School of Population Health, The Australian National University, Canberra, ACT, Australia.
| | - Sonia M McCallum
- Centre for Mental Health Research, Research School of Population Health, The Australian National University, Canberra, ACT, Australia
| | - Helen Christensen
- Black Dog Institute, University of New South Wales, Sydney, NSW, Australia
| | - Andrew J Mackinnon
- Black Dog Institute, University of New South Wales, Sydney, NSW, Australia
| | | | - Jacqueline L Brewer
- Centre for Mental Health Research, Research School of Population Health, The Australian National University, Canberra, ACT, Australia
| | | | - Alyssa R Morse
- Centre for Mental Health Research, Research School of Population Health, The Australian National University, Canberra, ACT, Australia
| | - Dominique Kazan
- Centre for Mental Health Research, Research School of Population Health, The Australian National University, Canberra, ACT, Australia
| | - Louise M Farrer
- Centre for Mental Health Research, Research School of Population Health, The Australian National University, Canberra, ACT, Australia
| | - Laura Kampel
- Black Dog Institute, University of New South Wales, Sydney, NSW, Australia
| | - Philip J Batterham
- Centre for Mental Health Research, Research School of Population Health, The Australian National University, Canberra, ACT, Australia
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Miyano T, Irvine AD, Tanaka RJ. Model-based meta-analysis to optimise S. aureus-targeted therapies for atopic dermatitis. JID INNOVATIONS 2022; 2:100110. [PMID: 35757782 PMCID: PMC9214323 DOI: 10.1016/j.xjidi.2022.100110] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2021] [Revised: 01/18/2022] [Accepted: 01/25/2022] [Indexed: 11/29/2022] Open
Abstract
Several clinical trials of Staphylococcus aureus (S. aureus)‒targeted therapies for atopic dermatitis (AD) have shown conflicting results about whether they improve AD severity scores. This study performs a model-based meta-analysis to investigate the possible causes of these conflicting results and suggests how to improve the efficacies of S. aureus‒targeted therapies. We developed a mathematical model that describes systems-level AD pathogenesis involving dynamic interactions between S. aureus and coagulase-negative Staphylococcus (CoNS). Our model simulation reproduced the clinically observed detrimental effects of the application of S. hominis A9 and flucloxacillin on AD severity and showed that these effects disappeared if the bactericidal activity against CoNS was removed. A hypothetical (modeled) eradication of S. aureus by 3.0 log10 colony-forming unit per cm2 without killing CoNS achieved Eczema Area and Severity Index 75 comparable with that of dupilumab. This efficacy was potentiated if dupilumab was administered in conjunction with S. aureus eradication (Eczema Area and Severity Index 75 at week 16) (S. aureus eradication: 66.7%, dupilumab 61.6% and combination 87.8%). The improved efficacy was also seen for virtual dupilumab poor responders. Our model simulation suggests that killing CoNS worsens AD severity and that S. aureus‒specific eradication without killing CoNS could be effective for patients with AD, including dupilumab poor responders. This study will contribute to designing promising S. aureus‒targeted therapy.
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Affiliation(s)
- Takuya Miyano
- Department of Bioengineering, Imperial College London, London, United Kingdom
| | - Alan D. Irvine
- Pediatric Dermatology, Children’s Health Ireland at Crumlin, Dublin, Ireland
- Clinical Medicine, College of Medicine, Trinity College Dublin, The University of Dublin, Dublin, Ireland
| | - Reiko J. Tanaka
- Department of Bioengineering, Imperial College London, London, United Kingdom
- Correspondence: Reiko J. Tanaka, Department of Bioengineering, Imperial College London, South Kensington Campus, London SW7 2AZ, United Kingdom.
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Munsch S, Forrer F, Naas A, Mueller V, Rubo M, Hannoun F, Mugellini E. Correlates of interpersonal emotion regulation problems in Loss of Control eating (LOC) in youth: study protocol of the combined online and App based questionnaire, laboratory and randomized controlled online intervention i-BEAT trial. BMC Psychol 2021; 9:193. [PMID: 34895337 PMCID: PMC8666071 DOI: 10.1186/s40359-021-00690-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2021] [Accepted: 11/22/2021] [Indexed: 12/03/2022] Open
Abstract
BACKGROUND Binge Eating Disorder (BED) represents a common eating disorder associated with marked health impairments. A subclinical variant, loss of control eating (LOC) is prevalent in youth. LOC is associated with similar mental distress as full-blown BED, increases the risk to develop a BED and promotes continuous weight gain. The etiology of LOC is not yet fully understood and specialized treatment for youth is scarce. METHODS The i-BEAT study includes a cross-sectional and longitudinal online questionnaire study (N = 600), an App based daily-life approach and a laboratory virtual reality study in N = 60 youths (14-24 years) with and without LOC as well as a controlled randomized online treatment trial to investigate the feasibility, acceptance and efficacy of a CBT and an interpersonal emotion regulation module for youth (N = 120). The primary outcomes include self-reported as well as measured (heart rate variability, gaze behavior, reaction times in stop signal task) associations between emotion regulation problems (such as dealing with RS), psychological impairment and binge eating in a healthy control group and youth with LOC. Secondary outcomes encompass general eating disorder pathology, social anxiety, body mass index, hyperscanning behavior and therapists' rating of patients' condition pre and post treatment. Epigenetic correlates of RS are assessed in healthy controls and youth with LOC and explored before and after treatment. DISCUSSION The expected findings will specify the role of interpersonal emotion regulation problems such as coping with the experience of social exclusion and rejection sensitivity (RS) in LOC and clarify, whether including a training to cope with RS adds to the efficacy of a cognitive behavioral treatment (CBT). TRIAL REGISTRATION German Clinical Trial Register: DRKS00023706. Registered 27 November 2020, https://www.drks.de/drks_web/navigate.do?navigationId=trial.HTML&TRIAL_ID=DRKS00023706.
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Affiliation(s)
- Simone Munsch
- Clinical Psychology and Psychotherapy, Department of Psychology, University of Fribourg, Rue P.-A.-de-Faucigny 2, 1700 Fribourg, Switzerland
| | - Felicitas Forrer
- Clinical Psychology and Psychotherapy, Department of Psychology, University of Fribourg, Rue P.-A.-de-Faucigny 2, 1700 Fribourg, Switzerland
| | - Adrian Naas
- Clinical Psychology and Psychotherapy, Department of Psychology, University of Fribourg, Rue P.-A.-de-Faucigny 2, 1700 Fribourg, Switzerland
| | - Verena Mueller
- Clinical Psychology and Psychotherapy, Department of Psychology, University of Fribourg, Rue P.-A.-de-Faucigny 2, 1700 Fribourg, Switzerland
| | - Marius Rubo
- Clinical Psychology and Psychotherapy, Department of Psychology, University of Fribourg, Rue P.-A.-de-Faucigny 2, 1700 Fribourg, Switzerland
| | - Fouad Hannoun
- Technology for Human Well-Being Institute (HumanTech), University of Applied Sciences of Western Switzerland, Boulevard de Pérolles 80, Fribourg, Switzerland
| | - Elena Mugellini
- Technology for Human Well-Being Institute (HumanTech), University of Applied Sciences of Western Switzerland, Boulevard de Pérolles 80, Fribourg, Switzerland
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Wang B, Susukida R, Mojtabai R, Amin-Esmaeili M, Rosenblum M. Model-Robust Inference for Clinical Trials that Improve Precision by Stratified Randomization and Covariate Adjustment. J Am Stat Assoc 2021. [DOI: 10.1080/01621459.2021.1981338] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Affiliation(s)
- Bingkai Wang
- Department of Biostatistics, Johns Hopkins Bloomberg School of Public Health, MD
| | - Ryoko Susukida
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, MD
| | - Ramin Mojtabai
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, MD
| | - Masoumeh Amin-Esmaeili
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, MD
- Iranian National Center for Addiction Studies (INCAS), Tehran University of Medical Sciences, Tehran, Iran
| | - Michael Rosenblum
- Department of Biostatistics, Johns Hopkins Bloomberg School of Public Health, MD
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18
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Ponsford JL, Hicks AJ, Gould KR, Downing MG, Hopwood M, Feeney TJ. Positive Behaviour Support for adults with acquired brain injury and challenging behaviour: a randomised controlled trial. Ann Phys Rehabil Med 2021; 65:101604. [PMID: 34774810 DOI: 10.1016/j.rehab.2021.101604] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2021] [Revised: 10/05/2021] [Accepted: 10/07/2021] [Indexed: 10/19/2022]
Abstract
BACKGROUND Challenging behaviours are common and disabling consequences of acquired brain injury (ABI), causing stress for close-others and disrupting community integration. Positive Behaviour Support (PBS) interventions have support from case studies as a means of reducing these behaviours, but controlled trials are lacking. OBJECTIVES This study aimed to evaluate, with a randomised waitlist-controlled trial, the efficacy of a 12-month PBS intervention, termed PBS+PLUS, in reducing challenging behaviours after ABI. METHODS Participants included 49 individuals with ABI (PBS+PLUS Intervention and Waitlist Treatment-as-usual groups) and their close-others. The design was a randomised waitlist-controlled trial with 12-month follow-up. PBS+PLUS involved setting collaborative goals toward a more meaningful life with the individual with ABI and addressing barriers to achieving these, including challenging behaviours, through skill-building, restructuring environments and executive strategies. The primary outcome measure was the Overt Behaviour Scale (OBS). The Challenging Behaviour Self-Efficacy Scale (CBSES) was a secondary outcome, assessing close-others' self-efficacy in addressing challenging behaviour. Measures were completed at baseline and every 4 months. Data analyses involved mixed-effects and negative binomial regressions examining change over time by group. RESULTS The PBS+PLUS Intervention group included 24 participants and the Waitlist group 25 participants. On the OBS, the Intervention group showed a significant reduction in challenging behaviour over the 12-month intervention. However, the Waitlist group showed similar improvement on the OBS over the 12-month waitlist period. The Waitlist group was not denied an intervention from other providers during this period. Gains continued for 8 months post-intervention. The PBS+PLUS intervention resulted in significantly greater gains in close-others' confidence in addressing challenging behaviours on the CBSES, relative to those in the Waitlist group, who showed no such gains. CONCLUSIONS Although we cannot say this intervention is more effective than any other, the study did show that PBS+PLUS can result in significant and sustained reductions in challenging behaviour in individuals with severe ABI and increased confidence of close-others in addressing these difficult behaviours. AUSTRALIAN NEW ZEALAND CLINICAL TRIALS REGISTRY: #ACTRN12616001704482.
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Affiliation(s)
- Jennie L Ponsford
- Turner Institute for Brain and Mental Health, School of Psychological Sciences, Monash University, Clayton, 3800, Victoria, Australia; Monash Epworth Rehabilitation Research Centre, Epworth Healthcare, Richmond, 3121, Victoria, Australia.
| | - Amelia J Hicks
- Turner Institute for Brain and Mental Health, School of Psychological Sciences, Monash University, Clayton, 3800, Victoria, Australia; Monash Epworth Rehabilitation Research Centre, Epworth Healthcare, Richmond, 3121, Victoria, Australia
| | - Kate R Gould
- Turner Institute for Brain and Mental Health, School of Psychological Sciences, Monash University, Clayton, 3800, Victoria, Australia; Monash Epworth Rehabilitation Research Centre, Epworth Healthcare, Richmond, 3121, Victoria, Australia
| | - Marina G Downing
- Turner Institute for Brain and Mental Health, School of Psychological Sciences, Monash University, Clayton, 3800, Victoria, Australia; Monash Epworth Rehabilitation Research Centre, Epworth Healthcare, Richmond, 3121, Victoria, Australia
| | - Malcolm Hopwood
- Department of Psychiatry, University of Melbourne, Parkville, 3052, Victoria, Australia
| | - Tim J Feeney
- Belvedere Health Services and the Mill School, Essex Junction, VT, USA
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Köck P, Lang E, Trulley VN, Dechent F, Mercer-Chalmers-Bender K, Frei P, Huber C, Borgwardt S. Cannabidiol Cigarettes as Adjunctive Treatment for Psychotic Disorders - A Randomized, Open-Label Pilot-Study. Front Psychiatry 2021; 12:736822. [PMID: 34803760 PMCID: PMC8599279 DOI: 10.3389/fpsyt.2021.736822] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/05/2021] [Accepted: 10/13/2021] [Indexed: 11/13/2022] Open
Abstract
Background: Psychotic disorders are associated with high rates of comorbid substance use disorders. Use of cannabis rich in tetrahydrocannabinol (THC) is linked to an increased risk of psychosis, worsening of psychotic symptoms, and an adverse course of psychotic disorders. Previous studies suggest oral cannabidiol (CBD) as possible novel antipsychotic agent; however, no studies evaluated the effects of smoked CBD. Objective: The main aim of the study was to clarify the antipsychotic potential of CBD used as adjunctive therapy simulating a naturalistic setting. Our trial is the first study evaluating the effects of smoked CBD-cigarettes as adjunctive therapy for psychotic symptoms. Methods: A randomized, placebo-controlled open-label trial of cigarettes containing CBD-rich cannabis (THC < 1%) as adjunctive therapy to standard psychiatric treatment was conducted (ClinicalTrials.gov identifier NCT04700930). Primary outcomes were mean scores of Positive and Negative Syndrome Scale (PANSS), Brøset Violence Checklist, the Beck's Depression Inventory (BDI), the Subjective Well-Being Under Neuroleptics Scale short form (SWN-K), and antipsychotic medication equivalent doses. Outcomes were assessed after 4 weeks of acute treatment and long-term follow-up after discontinuation of CBD-cigarettes after 25 weeks. Participants were 31 acutely psychotic patients with tobacco use disorder and a mean age of 35.1 ± 10.58 years (71% male). Comorbid cannabis use was diagnosed in 51.6%. Results: A discontinuous multilevel model revealed no significant group differences for primary outcomes. After 4 weeks of acute treatment, mean PANSS and BDI decreased in both groups, while an increase of antipsychotic medication equivalent was observed in the placebo group. Conclusions: The presented findings might suggest an antipsychotic medication sparing effect of CBD-cigarettes as adjunctive treatment of acute psychosis. However, the low number of participants did not allow for further statistical analysis. Hence, a larger study sample and a more rigorous study design (blinding of the interventional product, fixed dosing regimen) may reveal different results. Clinical Trial Registration: ClinicalTrials.gov, identifier: NCT04700930.
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Affiliation(s)
- Patrick Köck
- University Psychiatric Clinics Basel, University of Basel, Basel, Switzerland
| | - Elisabeth Lang
- University Psychiatric Clinics Basel, University of Basel, Basel, Switzerland
| | - Valerie-Noelle Trulley
- University Psychiatric Clinics Basel, University of Basel, Basel, Switzerland
- Department of Psychiatry and Psychotherapy, University of Lübeck, Lübeck, Germany
| | - Frieder Dechent
- University Psychiatric Clinics Basel, University of Basel, Basel, Switzerland
| | | | - Priska Frei
- Department of Biomedical Engineering, Institute of Forensic Medicine, University of Basel, Basel, Switzerland
| | - Christian Huber
- University Psychiatric Clinics Basel, University of Basel, Basel, Switzerland
| | - Stefan Borgwardt
- University Psychiatric Clinics Basel, University of Basel, Basel, Switzerland
- Department of Psychiatry and Psychotherapy, University of Lübeck, Lübeck, Germany
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Behrens F, Sewerin P, de Miguel E, Patel Y, Batalov A, Dokoupilova E, Kleinmond C, Pournara E, Shekhawat A, Jentzsch C, Wiedon A, Baraliakos X. Efficacy and safety of secukinumab in patients with spondyloarthritis and enthesitis at the Achilles tendon: Results from a Phase 3b trial. Rheumatology (Oxford) 2021; 61:2856-2866. [PMID: 34730795 PMCID: PMC9258542 DOI: 10.1093/rheumatology/keab784] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2021] [Accepted: 10/17/2021] [Indexed: 12/29/2022] Open
Abstract
Objective ACHILLES aimed to demonstrate efficacy of secukinumab on Achilles’ tendon enthesitis in spondyloarthritis (SpA) patients. Methods Patients ≥18 years (n = 204) with active PsA or axial SpA and heel enthesitis were randomized 1:1 to secukinumab 150/300 mg or placebo up to week 24, and thereafter placebo patients were switched to secukinumab. Results At week 24, a higher, yet statistically non-significant (P = 0.136), proportion of patients in secukinumab vs placebo reported resolution of Achilles tendon enthesitis in affected foot (42.2% vs 31.4%; odds ratio [OR] = 1.63; 95% CI: 0.87, 3.08). Proportion of patients reporting resolution of enthesitis based on Leeds Enthesitis Index was higher with secukinumab vs placebo (33.3% vs 23.5%; OR = 1.65; 95% CI: 0.85, 3.25) at week 24. Mean change from baseline in heel pain at week 24 was higher in secukinumab patients vs placebo (−2.8 [3.0] vs −1.9 [2.7]). Greater improvements with secukinumab were observed in heel enthesopathy activity and global assessment of disease activity. Imaging evaluation by local reading confirmed heel enthesitis on MRI at screening for all patients. Based on central reading, 56% presented with bone marrow oedema and/or tendinitis; according to Heel Enthesitis MRI Scoring System (HEMRIS) post hoc analysis, 76% had signs of entheseal inflammation while 86% had entheseal inflammation and/or structural changes. Conclusion A substantial proportion of patients showed no signs of inflammation on the centrally read MRIs despite a clinical diagnosis of heel enthesitis, thus highlighting that the discrepancy between the clinical and imaging assessments of enthesitis requires further investigation. Although ACHILLES did not meet the primary end point, the study reported clinically meaningful improvements in patient-related outcomes. Trial registration clinicaltrials.gov, NCT02771210
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Affiliation(s)
- Frank Behrens
- CIRI/Rheumatology and Fraunhofer Institute for Translationale Medicine & Pharmacology (ITMP) and Cluster of Excellence Immune-Mediated Diseases (CIMD), Goethe-University, Frankfurt, Germany
| | - Philipp Sewerin
- Department of Rheumatology & Hiller Research Unit, University Hospital Duesseldorf, Duesseldorf, Germany
| | - Eugenio de Miguel
- Rheumatology Department, Hospital Universitario La Paz, Madrid, Spain
| | - Yusuf Patel
- Hull University Teaching Hospitals, Hull, United Kingdom
| | - Anastas Batalov
- Medical University of Plovdiv, University Hospital Kaspela, Plovdiv, Bulgaria
| | - Eva Dokoupilova
- Medical Plus, s.r.o., Uherske Hradiste; Masaryk University, Faculty of Pharmacy, Department of Pharmaceutical Technology, Brno, Czech Republic
| | | | | | | | | | | | - Xenofon Baraliakos
- Rheumazentrum Ruhrgebiet-Ruhr-University Bochum, Herne, Germany, Herne, Germany
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Han CY, Crotty M, Thomas S, Cameron ID, Whitehead C, Kurrle S, Mackintosh S, Miller M. Effect of Individual Nutrition Therapy and Exercise Regime on Gait Speed, Physical Function, Strength and Balance, Body Composition, Energy and Protein, in Injured, Vulnerable Elderly: A Multisite Randomized Controlled Trial (INTERACTIVE). Nutrients 2021; 13:nu13093182. [PMID: 34579060 PMCID: PMC8468965 DOI: 10.3390/nu13093182] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2021] [Revised: 09/07/2021] [Accepted: 09/10/2021] [Indexed: 11/17/2022] Open
Abstract
It is imperative that the surgical treatment of hip fractures is followed up with rehabilitation to enhance recovery and quality of life. This randomized controlled trial aimed to determine if an individualised, combined exercise–nutrition intervention significantly improved health outcomes in older adults, after proximal femoral fracture. We commenced the community extended therapy while in hospital, within two weeks post-surgery. The primary outcome was gait speed and secondary outcomes included physical function, strength and balance, body composition, energy and protein intake. Eighty-six and 89 participants were randomized into six months individualised exercise and nutrition intervention and attention-control groups, respectively. There were no statistically significant differences in gait speed between the groups at six and 12 months. There were no major differences between groups with respect to the secondary outcomes, except estimated energy and protein intake. This may be explained by the sample size achieved. Participants in the intervention group had greater increment in energy (235 kcal; 95% CI, 95 to 375; p = 0.01) and protein intake (9.1 g; 95% CI, 1.5 to 16.8; p = 0.02), compared with those in the control group at six months but not significant at 12 months. This study has demonstrated that providing early, combined exercise and nutrition therapy can improve dietary energy and protein intake in older adults with hip fractures.
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Affiliation(s)
- Chad Yixian Han
- Caring Futures Institute, College of Nursing and Health Sciences, Flinders University, Adelaide, SA 5042, Australia;
| | - Maria Crotty
- Rehabilitation and Ageing Studies Unit, Flinders University, Adelaide, SA 5042, Australia; (M.C.); (S.T.); (C.W.)
| | - Susie Thomas
- Rehabilitation and Ageing Studies Unit, Flinders University, Adelaide, SA 5042, Australia; (M.C.); (S.T.); (C.W.)
| | - Ian D. Cameron
- John Walsh Centre for Rehabilitation Research, Faculty of Medicine and Health, University of Sydney, Sydney, NSW 2065, Australia;
| | - Craig Whitehead
- Rehabilitation and Ageing Studies Unit, Flinders University, Adelaide, SA 5042, Australia; (M.C.); (S.T.); (C.W.)
| | - Susan Kurrle
- Division of Rehabilitation and Aged Care, Hornsby Ku-ring-gai Hospital, Hornsby, NSW 2077, Australia;
| | - Shylie Mackintosh
- Allied Health and Human Performance, University of South Australia, Adelaide, SA 5042, Australia;
| | - Michelle Miller
- Caring Futures Institute, College of Nursing and Health Sciences, Flinders University, Adelaide, SA 5042, Australia;
- Correspondence: ; Tel.: +61-8-82012421
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Dalgıç ÖO, Wu H, Safa Erenay F, Sir MY, Özaltın OY, Crum BA, Pasupathy KS. Mapping of critical events in disease progression through binary classification: Application to amyotrophic lateral sclerosis. J Biomed Inform 2021; 123:103895. [PMID: 34450286 DOI: 10.1016/j.jbi.2021.103895] [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: 03/26/2021] [Revised: 07/05/2021] [Accepted: 08/22/2021] [Indexed: 11/29/2022]
Abstract
BACKGROUND The progression of many degenerative diseases is tracked periodically using scales evaluating functionality in daily activities. Although estimating the timing of critical events (i.e., disease tollgates) during degenerative disease progression is desirable, the necessary data may not be readily available in scale records. Further, analysis of disease progression poses data challenges, such as censoring and misclassification errors, which need to be addressed to provide meaningful research findings and inform patients. METHODS We developed a novel binary classification approach to map scale scores into disease tollgates to describe disease progression leveraging standard/modified Kaplan-Meier analyses. The approach is demonstrated by estimating progression pathways in amyotrophic lateral sclerosis (ALS). Tollgate-based ALS Staging System (TASS) specifies the critical events (i.e., tollgates) in ALS progression. We first developed a binary classification predicting whether each TASS tollgate was passed given the itemized ALSFRS-R scores using 514 ALS patients' data from Mayo Clinic-Rochester. Then, we utilized the binary classification to translate/map the ALSFRS-R data of 3,264 patients from the PRO-ACT database into TASS. We derived the time trajectories of ALS progression through tollgates from the augmented PRO-ACT data using Kaplan-Meier analyses. The effects of misclassification errors, condition-dependent dropouts, and censored data in trajectory estimations were evaluated with Interval Censored Kaplan Meier Analysis and Multistate Model for Panel Data. RESULTS The approach using Mayo Clinic data accurately estimated tollgate-passed states of patients given their itemized ALSFRS-R scores (AUCs > 0.90). The tollgate time trajectories derived from the augmented PRO-ACT dataset provide valuable insights; we predicted that the majority of the ALS patients would have modified arm function (67%) and require assistive devices for walking (53%) by the second year after ALS onset. By the third year, most (74%) ALS patients would occasionally use a wheelchair, while 48% of the ALS patients would be wheelchair-dependent by the fourth year. Assistive speech devices and feeding tubes were needed in 49% and 30% of the patients by the third year after ALS onset, respectively. The onset body region alters some tollgate passage time estimations by 1-2 years. CONCLUSIONS The estimated tollgate-based time trajectories inform patients and clinicians about prospective assistive device needs and life changes. More research is needed to personalize these estimations according to prognostic factors. Further, the approach can be leveraged in the progression of other diseases.
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Affiliation(s)
- Özden O Dalgıç
- Harvard Medical School, Boston, MA, USA; Institute for Technology Assessment, Massachusetts General Hospital, Boston, MA, USA
| | - Haoran Wu
- Department of Management Sciences, University of Waterloo, Waterloo, ON, Canada; School of Business, Sun Yat-sen University, Guangzhou, Guangdong, China
| | - F Safa Erenay
- Department of Management Sciences, University of Waterloo, Waterloo, ON, Canada
| | - Mustafa Y Sir
- Department of Health Sciences Research, Mayo Clinic, Rochester, MN, USA; Mayo Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, MN, USA
| | - Osman Y Özaltın
- E. P. Fitts Department of Industrial and Systems Engineering, NC State University, Raleigh, NC, USA
| | - Brian A Crum
- Department of Neurology, Mayo Clinic, Rochester, MN, USA
| | - Kalyan S Pasupathy
- Department of Health Sciences Research, Mayo Clinic, Rochester, MN, USA; Mayo Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, MN, USA.
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23
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Wyssen A, Meyer AH, Messerli-Bürgy N, Forrer F, Vanhulst P, Lalanne D, Munsch S. BED-online: Acceptance and efficacy of an internet-based treatment for binge-eating disorder: A randomized clinical trial including waitlist conditions. EUROPEAN EATING DISORDERS REVIEW 2021; 29:937-954. [PMID: 34418221 PMCID: PMC9292199 DOI: 10.1002/erv.2856] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2021] [Revised: 07/04/2021] [Accepted: 07/31/2021] [Indexed: 01/21/2023]
Abstract
Objective Internet‐based guided self‐help (GSH) programs increase accessibility and utilization of evidence‐based treatments in binge‐eating disorder (BED). We evaluated acceptance and short as well as long‐term efficacy of our 8‐session internet‐based GSH program in a randomized clinical trial with an immediate treatment group, and two waitlist control groups, which differed with respect to whether patients received positive expectation induction during waiting or not. Method Sixty‐three patients (87% female, mean age 37.2 years) followed the eight‐session guided cognitive‐behavioural internet‐based program and three booster sessions in a randomized clinical trial design including an immediate treatment and two waitlist control conditions. Outcomes were treatment acceptance, number of weekly binge‐eating episodes, eating disorder pathology, depressiveness, and level of psychosocial functioning. Results Treatment satisfaction was high, even though 27% of all patients dropped out during the active treatment and 9.5% during the follow‐up period of 6 months. The treatment, in contrast to the waiting conditions, led to a significant reduction of weekly binge‐eating episodes from 3.4 to 1.7 with no apparent rebound effect during follow‐up. All other outcomes improved as well during active treatment. Email‐based positive expectation induction during waiting period prior to the treatment did not have an additional beneficial effect on the temporal course and thus treatment success, of binge episodes in this study. Conclusion This short internet‐based program was clearly accepted and highly effective regarding core features of BED. Dropout rates were higher in the active and lower in the follow‐up period. Positive expectations did not have an impact on treatment effects. The present internet‐based guided self‐help program adds to the existing research regarding online treatment of binge‐eating disorder and is currently one of the two existing validated programs available in German language. It is based on an established cognitive‐behavioural treatment approach, shows high acceptance by patients and high efficacy after eight guided online sessions, thereby representing the shortest duration of currently evaluated treatments During the internet‐based therapy, the number of weekly binge‐eating episodes, depressive symptoms, eating disorder pathology as well as impairments in psychosocial functioning all significantly decreased. These positive effects were maintained during follow‐up (6 months). Abstainer rate (no binge‐eating during last month) continued to increase during follow‐up with booster sessions An email‐based pre‐treatment positive expectation induction did not alter the temporal course and thus treatment success, of binge episodes
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Affiliation(s)
- Andrea Wyssen
- Department of Psychology, Clinical Psychology and Psychotherapy, University of Fribourg, Fribourg, Switzerland.,University Hospital of Child and Adolescent Psychiatry and Psychotherapy, University of Bern, Bern, Switzerland
| | - Andrea H Meyer
- Department of Psychology, Clinical Psychology and Psychotherapy, University of Fribourg, Fribourg, Switzerland.,Institute of Psychology, Clinical Psychology and Epidemiology, University of Basel, Basel, Switzerland
| | - Nadine Messerli-Bürgy
- Department of Psychology, Clinical Child Psychology & Biological Psychology, University of Fribourg, Fribourg, Switzerland
| | - Felicitas Forrer
- Department of Psychology, Clinical Psychology and Psychotherapy, University of Fribourg, Fribourg, Switzerland
| | - Pierre Vanhulst
- Department of Informatics, Human-IST Institute, University of Fribourg, Fribourg, Switzerland
| | - Denis Lalanne
- Department of Informatics, Human-IST Institute, University of Fribourg, Fribourg, Switzerland
| | - Simone Munsch
- Department of Psychology, Clinical Psychology and Psychotherapy, University of Fribourg, Fribourg, Switzerland
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24
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Gornet MF, Sorensen KM, Schranck FW. Cervical Disc Arthroplasty for Axial Neck Pain: Comparison of Outcomes to 2 Other Common Cervical Conditions. Int J Spine Surg 2021; 15:692-700. [PMID: 34281954 DOI: 10.14444/8091] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND Cervical disc arthroplasty (CDA) is an established treatment for degenerative disc disease with radiculopathy and/or myelopathy. There is, however, little published evidence of its effectiveness to relieve pain and improve function in patients with a primary diagnosis of axial neck pain. Such patients were excluded from all previous Food and Drug Administration clinical trials for CDA. We compare the outcomes of patients who underwent CDA for 3 common cervical conditions from 2003 to 2018. METHODS Seven hundred and eighty-two CDA patients at a single site were grouped by primary diagnosis: predominant axial neck pain (ANP) (n = 257), predominant radiculopathy (RAD) (n = 331), or a combination of both (ANP + RAD) (n = 195). Mixed models for repeated measures predicted and analyzed scores at all time points, adjusting for diagnosis group, time point, and, if statistically significant, number of operative levels and demographic characteristics. Outcome measures included the Neck Disability Index, numerical pain scales (intensity plus frequency), the Veterans RAND 12 Item Health Survey (VR-12) Physical Component Score, the Mental Component Score, and reoperations. Patients were assessed preoperatively and postoperatively at 6 weeks, 3 months, 6 months, 1 year, and annually thereafter. RESULTS At baseline, arm pain scores in the ANP group were statistically lower (P = .0002) than in the RAD and ANP + RAD groups, consistent with preoperative diagnoses. Surgeries included 40.8% 1-level, 41.6% 2-level, 14.7% 3-level, and 2.9% 4-level. For all outcome measures, improvements were statistically significant from baseline to each postoperative time point without statistical difference between the 3 diagnosis groups. In total, 45/782 patients (5.8%) underwent a secondary surgery: 3.5% ANP, 5.8% RAD, and 8.7% ANP + RAD. Days to reoperation did not statistically differ between groups (P = .489). CONCLUSIONS Appropriately selected patients with predominant axial neck pain treated with CDA may achieve clinical and functional outcomes comparable to patients with a primary diagnosis of radiculopathy or of axial neck pain with concomitant radiculopathy. CLINICAL RELEVANCE This study provides information that should help clinicians decide whether to offer CDA for patients with a primary diagnosis of axial neck pain and to appropriately counsel such patients about expected outcomes. LEVEL OF EVIDENCE 4.
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Affiliation(s)
- Matthew F Gornet
- Orthopedic Center of St. Louis, St. Louis, Missouri.,Orthopedic Center of St. Louis, St. Louis, Missouri
| | - Katrine M Sorensen
- SPIRITT Research, St. Louis, Missouri.,Orthopedic Center of St. Louis, St. Louis, Missouri
| | - Francine W Schranck
- SPIRITT Research, St. Louis, Missouri.,Orthopedic Center of St. Louis, St. Louis, Missouri
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25
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Wallén H, Lindfors P, Andersson E, Hedman-Lagerlöf E, Hesser H, Lindefors N, Svanborg C, Ljótsson B. Return on investment of internet delivered exposure therapy for irritable bowel syndrome: a randomized controlled trial. BMC Gastroenterol 2021; 21:289. [PMID: 34256715 PMCID: PMC8276403 DOI: 10.1186/s12876-021-01867-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/16/2021] [Accepted: 06/21/2021] [Indexed: 12/31/2022] Open
Abstract
Background Irritable bowel syndrome (IBS) is a debilitating and costly disorder. Cognitive behavior therapy (CBT) is effective in the treatment of IBS, both when delivered over the internet and in face-to-face settings. CBT consists of different components and little is known about their relative importance. We have in an earlier study showed that inclusion of exposure in the CBT for IBS makes it even more effective. In the present study we wanted to evaluate the economic effects for society of inclusion vs exclusion of exposure in an internet delivered CBT for IBS. Methods We used data from a previous study with 309 participants with IBS. Participants were randomized to internet delivered CBT with (ICBT) or without exposure (ICBT-WE). We compared direct and indirect costs at baseline, after treatment, and 6 months after treatment (primary endpoint; 6MFU). Data was also collected on symptom severity and time spent by therapists and participants. The relative Incremental Cost Effectiveness Ratio (ICER) was calculated for the two treatment conditions and the return on investment (ROI). Results Results showed that ICBT cost $213.5 (20%) more than ICBT-WE per participant. However, ICBT was associated with larger reductions regarding both costs and symptoms than ICBT-WE at 6MFU. The ICER was − 301.69, meaning that for every point improvement on the Gastrointestinal Symptom Rating Scale—IBS version in ICBT, societal costs would be reduced with approximately $300. At a willingness to pay for a case of clinically significant improvement in IBS symptoms of $0, there was an 84% probability of cost-effectiveness. ROI analysis showed that for every $1 invested in ICBT rather than ICBT-WE, the return would be $5.64 six months after treatment. Analyses of post-treatment data showed a similar pattern although cost-savings were smaller. Conclusions Including exposure in Cognitive Behavior Treatment for IBS is more cost-effective from a societal perspective than not including it, even though it may demand more therapist and patient time in the short term. Trial registration This study is reported in accordance with the CONSORT statement for non-pharmacological trials [1]. Clinicaltrials.gov registration ID: NCT01529567 (14/02/2013).
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Affiliation(s)
- Hugo Wallén
- Department of Clinical Neuroscience, Division of Psychology, Karolinska Institutet, Nobels väg 9, 171 65, Stockholm, Sweden.
| | - Perjohan Lindfors
- Department of Clinical Neuroscience, Division of Psychology, Karolinska Institutet, Nobels väg 9, 171 65, Stockholm, Sweden
| | - Erik Andersson
- Department of Clinical Neuroscience, Division of Psychology, Karolinska Institutet, Nobels väg 9, 171 65, Stockholm, Sweden
| | - Erik Hedman-Lagerlöf
- Department of Clinical Neuroscience, Division of Psychology, Karolinska Institutet, Nobels väg 9, 171 65, Stockholm, Sweden
| | - Hugo Hesser
- School of Law, Psychology and Social Work, Center for Health and Medical Psychology, Örebro University, Örebro, Sweden.,Department of Behavioural Sciences and Learning, Linköping University, Linköping, Sweden
| | - Nils Lindefors
- Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden.,Stockholm Health Care Services, Region Stockholm, Karolinska University Hospital, 141 86, Stockholm, Sweden
| | - Cecilia Svanborg
- Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden.,Stockholm Health Care Services, Region Stockholm, Karolinska University Hospital, 141 86, Stockholm, Sweden
| | - Brjánn Ljótsson
- Department of Clinical Neuroscience, Division of Psychology, Karolinska Institutet, Nobels väg 9, 171 65, Stockholm, Sweden
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26
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Lim SL, Ong KW, Johal J, Han CY, Yap QV, Chan YH, Chooi YC, Zhang ZP, Chandra CC, Thiagarajah AG, Khoo CM. Effect of a Smartphone App on Weight Change and Metabolic Outcomes in Asian Adults With Type 2 Diabetes: A Randomized Clinical Trial. JAMA Netw Open 2021; 4:e2112417. [PMID: 34081137 PMCID: PMC8176331 DOI: 10.1001/jamanetworkopen.2021.12417] [Citation(s) in RCA: 28] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
IMPORTANCE Lifestyle interventions are effective in diabetes management, with smartphone apps that manage health data and dietary and exercise schedules gaining popularity. However, limited evidence from randomized clinical trials exists regarding the effectiveness of smartphone-based interventions among Asian adults with type 2 diabetes. OBJECTIVE To compare the effects of a culturally contextualized smartphone-based intervention with usual care on weight and metabolic outcomes. DESIGN, SETTING, AND PARTICIPANTS This randomized clinical trial conducted at multiple primary care centers in Singapore included 305 adults with type 2 diabetes and body mass index (BMI) of 23 or greater who had literacy in English and smartphone access. Participants were recruited between October 3, 2017, and September 9, 2019, and were randomly assigned (1:1; stratified by gender, age, and BMI) to intervention (99 participants) or control (105 participants) groups. Participants' data were analyzed using intention-to-treat analysis. INTERVENTIONS Both control and intervention participants received diet and physical activity advice from a dietitian at a baseline face-to-face visit. Intervention participants additionally used a smartphone app to track weight, diet, physical activity, and blood glucose and then communicated with dietitians for 6 months. MAIN OUTCOMES AND MEASURES Primary outcome was change in body weight, while secondary outcomes were changes in hemoglobin A1c (HbA1c), fasting blood glucose, blood pressure, lipids, and diet. Post hoc analyses included glycemic changes in the subgroup with HbA1c levels of 8% or greater and diabetes medication changes. RESULTS Among the 204 randomized participants (mean [SD] age, 51.2 [9.7] years; 132 [64.7%] men), baseline mean (SD) BMI was 30.6 (4.3). Compared with the control group, intervention participants achieved significantly greater reductions in weight (mean [SD] change, -3.6 [4.7] kg vs -1.2 [3.6] kg) and HbA1c levels (mean [SD] change, -0.7% [1.2] vs -0.3% [1.0]), with a greater proportion having a reduction in diabetes medications (17 participants [23.3%] vs 4 participants [5.4%]) at 6 months. The intervention led to a greater HbA1c reduction among participants with HbA1c levels of 8% or higher (mean [SD] change, -1.8% [1.4] vs -1.0% [1.4]; P = .001). Intergroup differences favoring the intervention were also noted for fasting blood glucose, diastolic blood pressure, and dietary changes. CONCLUSIONS AND RELEVANCE In this study, a smartphone-based lifestyle intervention was more effective in achieving weight and glycemic reductions among Asian adults with type 2 diabetes compared with usual care, supporting the use of apps in lifestyle intervention delivery. TRIAL REGISTRATION anzctr.org.au Identifier: ACTRN12617001112358.
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Affiliation(s)
- Su Lin Lim
- Department of Dietetics, National University Hospital, Singapore
| | - Kai Wen Ong
- Department of Dietetics, National University Hospital, Singapore
| | - Jolyn Johal
- Faculty of Health Sciences, University of Adelaide, Australia
| | - Chad Yixian Han
- Caring Future Institute, College of Nursing and Health Sciences, Flinders University, Australia
| | - Qai Ven Yap
- Biostatistics Unit, Yong Loo Lin School of Medicine, National University Health System, Singapore
| | - Yiong Huak Chan
- Biostatistics Unit, Yong Loo Lin School of Medicine, National University Health System, Singapore
| | - Yu Chung Chooi
- Singapore Institute for Clinical Services, Agency for Science, Technology and Research, Singapore
| | | | | | | | - Chin Meng Khoo
- Division of Endocrinology, National University Hospital, Singapore
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
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27
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Dobson KS, Markova V, Wen A, Smith LM. Effects of the Anti-stigma Workplace Intervention "Working Mind" in a Canadian Health-Care Setting: A Cluster-Randomized Trial of Immediate Versus Delayed Implementation. CANADIAN JOURNAL OF PSYCHIATRY. REVUE CANADIENNE DE PSYCHIATRIE 2021; 66:495-502. [PMID: 32960651 PMCID: PMC8107952 DOI: 10.1177/0706743720961738] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
OBJECTIVES The Working Mind is a program designed to reduce stigmatizing attitudes toward mental illness, improve resilience, and promote mental health in the general workplace. Previous research has revealed positive program effects in a variety of workplace settings. This study advances previous work in implementing randomization and a control group to assess the intervention's efficacy. METHODS The program was evaluated using a cluster-randomized design, with pretest, posttest, and a 3-month follow-up in 2 implementation groups across 4 sites. RESULTS The Working Mind program was effective at decreasing mental health stigma and increasing self-reported resilience and coping skills at the pre-post assessment in both delivery groups. The program's effects were maintained to the time of 3-month follow-up. Qualitative data provided further evidence that participants benefited from the program. CONCLUSIONS This study represents an advancement over past research and provides further support for efficacy of the Working Mind program. Directions for future research, including replication using rigorous methodological procedures and examination of program effects over longer follow-up intervals, are discussed.
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28
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Eshraghi Y, Chakravarthy K, Strand NH, Shirvalkar P, Schuster NM, Abdallah RT, Vallejo R, Sayed D, Kim D, Kim C, Meacham K, Deer T. The American Society of Pain and Neuroscience (ASPN) Practical Guidelines to Study Design and Scientific Manuscript Preparation in Neuromodulation. J Pain Res 2021; 14:1027-1041. [PMID: 33889019 PMCID: PMC8057952 DOI: 10.2147/jpr.s295502] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2020] [Accepted: 03/09/2021] [Indexed: 11/28/2022] Open
Abstract
Background Healthcare clinical and even policy decisions are progressively made based on research-based evidence. The process by which the appropriate trials are developed and well-written manuscripts by means of evidence-based medicine recommendations has resulted in unprecedented necessity in evidence-based medicine in neuromodulation. Methods The essential considerations in the planning of neuromodulation research are discussed in the light of available scientific literature as well as the authors’ scientific expertise regarding research study design and scientific manuscript preparation. Conclusion This article should enable the reader to understand how to appropriately design a clinical research study and prepare scientific manuscripts. The high-quality and well-designed studies, when performed and reported effectively, support evidence-based medicine and foster improved patient outcomes.
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Affiliation(s)
- Yashar Eshraghi
- Department of Anesthesia, Interventional Pain Management, Ochsner Health System, New Orleans, LA, USA.,University of Queensland Ochsner Clinical School. Academics Department, Ochsner Health System, New Orleans, LA, USA.,Louisiana State University School of Medicine, New Orleans, LA, USA
| | - Krishnan Chakravarthy
- Division of Pain Medicine, Department of Anesthesiology, University of California San Diego, San Diego, CA, USA.,VA San Diego Health Care, San Diego, CA, USA
| | - Natalie H Strand
- Division of Pain Medicine, Department of Anesthesiology, Mayo Clinic, Phoenix, Arizona, USA
| | - Prasad Shirvalkar
- Department of Anesthesiology (Pain Management), Department of Neurology, UCSF School of Medicine, San Francisco, CA, USA
| | - Nathaniel M Schuster
- Division of Pain Medicine, Department of Anesthesiology, University of California San Diego, San Diego, CA, USA
| | - Rany T Abdallah
- Center for Interventional Pain and Spine, Wilmington, DE, USA
| | - Ricardo Vallejo
- National Spine and Pain Center, Bloomington, IL, USA.,Psychology Department, Illinois Wesleyan University, Bloomington, IL, USA
| | - Dawood Sayed
- University of Kansas Medical Center, Kansas City, KS, USA
| | - David Kim
- University of Kansas Medical Center, Kansas City, KS, USA
| | - Chong Kim
- Departments of Physical Medicine and Rehabilitation and Anesthesiology, Case Western Reserve University/MetroHealth, Cleveland, OH, USA
| | - Kathleen Meacham
- Division of Pain Management, Department of Anesthesiology, Washington University School of Medicine, St Louis, MO
| | - Timothy Deer
- The Spine and Nerve Center of the Virginias, Charleston, WV, USA.,West Virginia University, School of Medicine, Charleston, WV, USA
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29
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Busmann M, Meyer AH, Wrege J, Lang UE, Gaab J, Walter M, Euler S. Vulnerable narcissism as beneficial factor for the therapeutic alliance in borderline personality disorder. Clin Psychol Psychother 2021; 28:1222-1229. [PMID: 33619789 DOI: 10.1002/cpp.2570] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2020] [Revised: 01/23/2021] [Accepted: 01/24/2021] [Indexed: 01/13/2023]
Abstract
Evidence suggests that narcissism and borderline personality disorder are associated with each other. This naturalistic study investigated the predictive value of grandiose and vulnerable narcissism on the development of the therapeutic alliance in short-term psychodynamic treatment across 12 weeks. The sample consisted of 99 patients with borderline personality disorder. Narcissism was assessed with the Pathological Narcissism Inventory at treatment onset. The therapeutic alliance was rated with the Scale to Assess Therapeutic Relationships by both patient and therapist at four time points during treatment. Results showed a significant predictive value of vulnerable narcissism on the therapeutic alliance, revealing a more beneficial progression for patients with higher vulnerable narcissism. Grandiose narcissism had no predictive value on the therapeutic alliance. The study strengthens the clinical utility of the concept of vulnerable narcissism towards the evaluation of treatment processes in borderline personality disorder.
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Affiliation(s)
- Mareike Busmann
- Psychiatric University Hospital Basel, Centre of Psychosomatics and Psychotherapy, Basel, Switzerland
| | - Andrea H Meyer
- Faculty of Psychology, University of Basel, Basel, Switzerland
| | - Johannes Wrege
- Psychiatric University Hospital Basel, Centre of Psychosomatics and Psychotherapy, Basel, Switzerland
| | - Undine E Lang
- Psychiatric University Hospital Basel, Centre of Psychosomatics and Psychotherapy, Basel, Switzerland
| | - Jens Gaab
- Faculty of Psychology, University of Basel, Basel, Switzerland
| | - Marc Walter
- Psychiatric University Hospital Basel, Centre of Psychosomatics and Psychotherapy, Basel, Switzerland
| | - Sebastian Euler
- Department of Consultation Psychiatry and Psychosomatics, University Hospital Zürich, Zürich, Switzerland
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30
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Lutz M, Streb J, Titze L, Büsselmann M, Riemat N, Prüter-Schwarte C, Dudeck M. Migrants With Schizophrenia in Forensic Psychiatric Hospitals Benefit From High-Intensity Second Language Programs. Front Psychiatry 2021; 12:711836. [PMID: 34456766 PMCID: PMC8385231 DOI: 10.3389/fpsyt.2021.711836] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/19/2021] [Accepted: 07/16/2021] [Indexed: 11/13/2022] Open
Abstract
Background: As a result of migration, an increasing number of patients in forensic psychiatric hospitals show poor skills in the national language, which can affect their treatment. Improving the second language (L2) of inpatients with schizophrenia may help to enable effective psychotherapy and thus reduce the risk of criminal recidivism and facilitate reintegration into society, for example because of a language-related higher degree of social functioning. For this purpose, a Hessian forensic psychiatric hospital established a ward specialized in L2 acquisition. The ward accommodates up to 21 patients with schizophrenia, who attend an L2 program consisting of 800-900 lessons within 1 year. Aims: The study aimed to evaluate whether patients on the specialized ward (experimental group) achieve at least Common European Framework of Reference (CEFR) level A2 in the L2 program. Additionally, it examined whether language acquisition is better among participants in the experimental group than among those on regular wards (control group). Methods: Achievements in the L2 were assessed by an L2 test 3 times: at the beginning of the program, after 6 months, and after 1 year. The impact of intelligence on achievements in L2 was evaluated using Raven's Standard Progressive Matrices. Results: The experimental group showed significantly better improvement than the control group. Literacy was a significant predictor of improvement in the L2. The majority of the experimental group reached at least CEFR level A2 after 1 year. Conclusions: High-intensity L2 programs are an effective way to improve the L2 of inpatients with schizophrenia in forensic psychiatric hospitals.
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Affiliation(s)
- Maximilian Lutz
- Department of Forensic Psychiatry and Psychotherapy, Ulm University, Ulm, Germany
| | - Judith Streb
- Department of Forensic Psychiatry and Psychotherapy, Ulm University, Ulm, Germany
| | - Larissa Titze
- Department of Forensic Psychiatry and Psychotherapy, Ulm University, Ulm, Germany
| | - Michael Büsselmann
- Department of Forensic Psychiatry and Psychotherapy, Ulm University, Ulm, Germany
| | - Nadja Riemat
- Vitos Clinic for Forensic Psychiatry Hadamar, Hadamar, Germany
| | - Christian Prüter-Schwarte
- Department of Forensic Psychiatry and Psychotherapy II, Hospital of the Landschaftsverband Rheinland, Academic Teaching Hospital of the University of Cologne, Cologne, Germany.,Medical Faculty, Institute for the History of Medicine and Medical Ethics, University Hospital, University of Cologne, Cologne, Germany.,Chair of Social Philosophy and Ethics in Health Sciences, Department of Medicine, Faculty of Health Sciences, University Witten/Herdecke, Witten, Germany
| | - Manuela Dudeck
- Department of Forensic Psychiatry and Psychotherapy, Ulm University, Ulm, Germany
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31
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Zhuang W, Camacho L, Silva CS, Hong H. Reproducibility challenges for biomarker detection with uncertain but informative experimental data. Biomark Med 2020; 14:1255-1263. [PMID: 33021389 DOI: 10.2217/bmm-2019-0599] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023] Open
Abstract
Recent studies have revealed that circulating microRNAs are promising biomarkers for detecting toxicity or disease. Quantitative real-time polymerase chain reaction (qPCR) is often used to measure the levels of microRNAs. Besides complete and certain data, investigators inevitably have observed technically incomplete or uncertain qPCR data. Investigators usually set incomplete observations equal to the maximum quality number of qPCR cycles, apply the complete-observation method, or choose not to analyze targets with incomplete observations. Using biostatistical knowledge and published studies, we show that three commonly applied methods tend to cause biased inference and decrease reproducibility in biomarker detection. More efforts are needed to address the challenges to identify and detect reliable, novel circulating biomarkers in liquid biopsies.
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Affiliation(s)
- Wei Zhuang
- Division of Bioinformatics & Biostatistics, NCTR, US FDA, Jefferson, AR 72079, USA
| | - Luísa Camacho
- Division of Biochemical Toxicology, NCTR, US FDA, Jefferson, AR 72079, USA
| | - Camila S Silva
- Division of Biochemical Toxicology, NCTR, US FDA, Jefferson, AR 72079, USA
| | - Huixiao Hong
- Division of Bioinformatics & Biostatistics, NCTR, US FDA, Jefferson, AR 72079, USA
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García-Hernandez A, Pérez T, Pardo MDC, Rizopoulos D. MMRM vs joint modeling of longitudinal responses and time to study drug discontinuation in clinical trials using a "de jure" estimand. Pharm Stat 2020; 19:909-927. [PMID: 32725810 DOI: 10.1002/pst.2045] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2019] [Revised: 06/07/2020] [Accepted: 06/16/2020] [Indexed: 01/13/2023]
Abstract
In pre-marketing stages of drug development, trialists focus on drug efficacy rather than effectiveness, and observations collected after study drug discontinuation are excluded from the analysis, following the so-called "de jure" estimand. In this setting, mixed models for repeated measures (MMRM) are becoming the benchmark to analyze normally distributed longitudinal responses. We have compared the performance of MMRM against shared parameter models (SPM) that jointly fit the longitudinal response and time to study drug discontinuation. Our simulations have first confirmed that MMRM lead to biased treatment effect estimates when longitudinal and event processes are associated via latent shared parameters, especially if the relationship is heterogeneous across treatment groups. SPM produced unbiased estimates with SPM data but faced two important obstacles: (a) SPM led to considerable bias when treatment discontinuation and response were associated with models of the time-varying covariates (TVC) family, and (b) SPM were rather sensitive to the choice of the parameterization to model the relationship between longitudinal and time-to-event processes. When we simulated SPM data but used an incorrect equation to relate the random effects and time-to-event response, SPM led to a bigger bias than that seen with MMRM. We have finally evaluated a methodology to choose between MMRM and SPM consisting of expanding the MMRM density into the likelihood of both longitudinal and time-to-event data by plugging in the likelihood of a parametric TVC model. This approach allowed us to accurately select the optimal tool (MMRM or SPM) with sample sizes typical of phases 2b and 3.
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Affiliation(s)
| | - Teresa Pérez
- Facultad de Estudios Estadísticos, Univ. Complutense, Madrid, Spain
| | | | - Dimitris Rizopoulos
- Department of Biostatistics, Erasmus Medical Center, Rotterdam, The Netherlands
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Kitzerow J, Hackbusch M, Jensen K, Kieser M, Noterdaeme M, Fröhlich U, Taurines R, Geißler J, Wolff N, Roessner V, Bast N, Teufel K, Kim Z, Freitag CM. Study protocol of the multi-centre, randomised controlled trial of the Frankfurt Early Intervention Programme A-FFIP versus early intervention as usual for toddlers and preschool children with Autism Spectrum Disorder (A-FFIP study). Trials 2020; 21:217. [PMID: 32093772 PMCID: PMC7038602 DOI: 10.1186/s13063-019-3881-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2019] [Accepted: 11/04/2019] [Indexed: 12/27/2022] Open
Abstract
BACKGROUND Naturalistic developmental behavioural interventions (NDBI) have been shown to improve autism-specific symptoms in young children with Autism Spectrum Disorder (ASD). NDBI approaches, such as the ASD-specific Frankfurt Early Intervention Programme for ASD (A-FFIP), are based on ASD-specific developmental and learning aspects. A-FFIP is a low-intensity intervention which can easily be implemented in the local health care/social welfare system. The aim of the present study is to establish 1-year efficacy of the manualised early intervention programme A-FFIP in toddlers and preschool children with ASD. It is hypothesised that A-FFIP will result in improved ASD-specific symptoms compared to early intervention as usual (EIAU). Child- and family-specific secondary outcomes, as well as moderators and mediators of outcome, will be explored. METHODS/DESIGN A prospective, multi-centre, parallel-group, randomised controlled, phase-III trial comparing A-FFIP versus EIAU. A total of 134 children (A-FFIP: 67, EIAU: 67) aged 24-66 months at baseline assessment meeting the criteria for ASD (DSM-5) will be included. The primary outcome is the absolute change of the total score of the Brief Observation of Social Communication Change (BOSCC-AT) between baseline (T2) and 1-year follow-up (T6). The treatment effect will be tested, adjusted for relevant covariates applying a mixed model for repeated measures. Secondary outcomes are BOSCC social communication and repetitive-behaviour scores, single ASD symptoms, language, cognition, psychopathology, parental well-being and family quality of life. Predictors, moderators and mediating mechanisms will be explored. DISCUSSION If efficacy of the manualised A-FFIP early intervention is established, the current study has the potential to change clinical practice strongly towards the implementation of a low-intensity, evidence-based, natural early intervention in ASD. Early intervention in ASD requires specialist training, which subsequently needs to be developed or included into current training curricula. TRIAL REGISTRATION German Registry for Clinical Trials (Deutscher Register Klinischer Studien, DRKS); ID: 00016330. Retrospectively registered on 4 January 2019. URL: https://www.drks.de/drks_web/navigate.do?navigationId=trial.HTML&TRIAL_ID=DRKS00016330.
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Affiliation(s)
- Janina Kitzerow
- Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, Autism Therapy and Research Centre of Excellence, University Hospital Frankfurt Goethe University, Deutschordenstr. 50, 60528, Frankfurt am Main, Germany
| | - Matthes Hackbusch
- Institute of Medical Biometry and Informatics (IMBI), University Hospital Heidelberg, Im Neuenheimer Feld 130.3, 69120, Heidelberg, Germany
| | - Katrin Jensen
- Institute of Medical Biometry and Informatics (IMBI), University Hospital Heidelberg, Im Neuenheimer Feld 130.3, 69120, Heidelberg, Germany
| | - Meinhard Kieser
- Institute of Medical Biometry and Informatics (IMBI), University Hospital Heidelberg, Im Neuenheimer Feld 130.3, 69120, Heidelberg, Germany
| | - Michele Noterdaeme
- Department of Child and Adolescent Psychiatry and Psychotherapy, Josefinum Augsburg, Kapellenstrasse 30, 86154, Augsburg, Germany
| | - Ulrike Fröhlich
- Department of Child and Adolescent Psychiatry and Psychotherapy, Josefinum Augsburg, Kapellenstrasse 30, 86154, Augsburg, Germany
| | - Regina Taurines
- Center of Mental Health, Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, University Hospital Würzburg, Margarete-Höppel-Platz 1, 97080, Würzburg, Germany
| | - Julia Geißler
- Center of Mental Health, Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, University Hospital Würzburg, Margarete-Höppel-Platz 1, 97080, Würzburg, Germany
| | - Nicole Wolff
- Department of Child and Adolescent Psychiatry, Medical Faculty Carl Gustav Carus, Technische Universitaet Dresden, Fetscherstr. 74, 01307, Dresden, Germany
| | - Veit Roessner
- Department of Child and Adolescent Psychiatry, Medical Faculty Carl Gustav Carus, Technische Universitaet Dresden, Fetscherstr. 74, 01307, Dresden, Germany
| | - Nico Bast
- Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, Autism Therapy and Research Centre of Excellence, University Hospital Frankfurt Goethe University, Deutschordenstr. 50, 60528, Frankfurt am Main, Germany
| | - Karoline Teufel
- Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, Autism Therapy and Research Centre of Excellence, University Hospital Frankfurt Goethe University, Deutschordenstr. 50, 60528, Frankfurt am Main, Germany
| | - Ziyon Kim
- Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, Autism Therapy and Research Centre of Excellence, University Hospital Frankfurt Goethe University, Deutschordenstr. 50, 60528, Frankfurt am Main, Germany
| | - Christine M Freitag
- Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, Autism Therapy and Research Centre of Excellence, University Hospital Frankfurt Goethe University, Deutschordenstr. 50, 60528, Frankfurt am Main, Germany.
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Kikuchi S, Oe Y, Sasaki Y, Ishii H, Ito Y, Horikoshi M, Sozu T, Seno H, Furukawa TA. Group cognitive behavioural therapy (GCBT) versus treatment as usual (TAU) in the treatment of irritable bowel syndrome (IBS): a study protocol for a randomized controlled trial. BMC Gastroenterol 2020; 20:29. [PMID: 32019509 PMCID: PMC7001234 DOI: 10.1186/s12876-020-1157-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2018] [Accepted: 12/31/2019] [Indexed: 12/30/2022] Open
Abstract
BACKGROUND Irritable bowel syndrome (IBS) is a common disease that affects the quality of life (QOL) and social functioning of sufferers. Visceral anxiety is currently considered a key factor in the onset and exacerbation of IBS, and cognitive-behavioural therapy (CBT) targeting visceral anxiety is thought to be effective. However, access to CBT is limited due to the lack of trained therapists, the substantial time required for therapy and the associated costs. Group CBT (GCBT) may solve some of these problems. We have therefore planned this trial to examine the efficacy of GCBT for IBS. METHODS The trial is a two-armed, parallel group, open label, stratified block randomized superiority trial. The study group will consist of 112 participants (aged 18-75 years) with IBS (Rome-III or IV criteria). Participants will be randomly allocated 1:1 to (i) the intervention group: ten-week GCBT plus treatment as usual (TAU) or (ii) the control group: waiting list (WL) plus TAU. The co-primary outcomes are the change in IBS severity or disease-specific quality of life from baseline to week 13 which is 1 month after the end of treatment. The efficacy of GCBT for IBS will be examined through mixed-effects repeated-measures analysis. DISCUSSION GCBT, if found effective, can address the issues of the shortage of therapists as well as the time required and the costs associated with individual CBT. Clinically, the findings will help make effective CBT programmes accessible to a large number of distressed IBS patients at lower costs. Theoretically, the results will clarify the relationship between IBS and psychological stress and will help elucidate the underlying mechanisms of IBS. TRIAL REGISTRATION UMIN, CTR-UMIN000031710. Registered on March 13, 2018.
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Affiliation(s)
- Shino Kikuchi
- Department of Gastroenterology and Hepatology, Kyoto University Graduate School of Medicine, 54 Kawahara-cho, Shogoin, Sakyo-ku, Kyoto, Japan
- Department of Health Promotion and Human Behavior, Kyoto University Graduate School of Medicine / School of Public Health, Yoshida Konoe-cho, Sakyo-ku, Kyoto, Japan
| | - Yuki Oe
- National Center for Cognitive Behavior Therapy and Research, National Center of Neurology and Psychiatry, 4-1-1 Ogawa Higashi, Kodaira, Tokyo Japan
| | - Yohei Sasaki
- National Center for Cognitive Behavior Therapy and Research, National Center of Neurology and Psychiatry, 4-1-1 Ogawa Higashi, Kodaira, Tokyo Japan
| | - Hirono Ishii
- National Center for Cognitive Behavior Therapy and Research, National Center of Neurology and Psychiatry, 4-1-1 Ogawa Higashi, Kodaira, Tokyo Japan
| | - Yuri Ito
- Department of Computer Science, Tokyo University of Science, 6-3-1 Shinjyuku, Katuragi-ku, Tokyo, Japan
| | - Masaru Horikoshi
- National Center for Cognitive Behavior Therapy and Research, National Center of Neurology and Psychiatry, 4-1-1 Ogawa Higashi, Kodaira, Tokyo Japan
| | - Takashi Sozu
- Kyoto University Hospital 54 Kawaharacho, Shogoin, Sakyo-ku, Kyoto, Japan
| | - Hiroshi Seno
- Department of Gastroenterology and Hepatology, Kyoto University Graduate School of Medicine, 54 Kawahara-cho, Shogoin, Sakyo-ku, Kyoto, Japan
| | - Toshi A. Furukawa
- Department of Health Promotion and Human Behavior, Kyoto University Graduate School of Medicine / School of Public Health, Yoshida Konoe-cho, Sakyo-ku, Kyoto, Japan
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Rigaux C, Sébastien B. Evaluation of non-linear-mixed-effect modeling to reduce the sample sizes of pediatric trials in type 2 diabetes mellitus. J Pharmacokinet Pharmacodyn 2020; 47:59-67. [PMID: 31907713 DOI: 10.1007/s10928-019-09668-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2019] [Accepted: 12/21/2019] [Indexed: 01/19/2023]
Abstract
Recruitment for pediatric trials in Type II Diabetes Mellitus (T2DM) is very challenging, necessitating the exploration of new approaches for reducing the sample sizes of pediatric trials. This work aimed at assessing if a longitudinal Non-Linear-Mixed-Effect (NLME) analysis of T2DM trial could be more powerful and thus require fewer patients than two standard statistical analyses commonly used as primary or sensitivity efficacy analysis: Last-Observation-Carried-Forward (LOCF) followed by (co)variance (AN(C)OVA) analysis at the evaluation time-point, and Mixed-effects Model Repeated Measures (MMRM) analysis. Standard T2DM efficacy studies were simulated, with glycated hemoglobin (HbA1c) as the main endpoint, 24 weeks' study duration, 2 arms, assuming a placebo and a treatment effect, exploring three different scenarios for the evolution of HbA1c, and accounting for a dropout phenomenon. 1000 trials were simulated, then analyzed using the 3 analyses, whose powers were compared. As expected, the longitudinal modeling MMRM analysis was found to be more powerful than the LOCF + ANOVA analysis at week 24. The NLME analysis gave slightly more accurate drug-effect estimations than the two other methods, however it tended to slightly overestimate the magnitude of the drug effect, and it was more powerful than the MMRM analysis only in some scenarios of slow HbA1c decrease. The gain in power afforded by NLME was more apparent when two additional assessments enriched the design; however, the gain was not systematic for all scenarios. Finally, this work showed that NLME analyses may help to reduce significantly the required sample sizes in T2DM pediatric studies, but only for enriched designs and slow HbA1c decrease.
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Affiliation(s)
- Clémence Rigaux
- Digital Data Sciences, Sanofi R&D, 1 Avenue Pierre Brossolette, 91385, Chilly-Mazarin, France.
| | - Bernard Sébastien
- Digital Data Sciences, Sanofi R&D, 1 Avenue Pierre Brossolette, 91385, Chilly-Mazarin, France
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The Role of Self-Determination in Changing Physical Activity Behavior in People Diagnosed With Bowel Polyps: A Pilot Randomized Controlled Trial. J Aging Phys Act 2020; 28:42-52. [PMID: 31188705 DOI: 10.1123/japa.2018-0279] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2018] [Revised: 04/17/2019] [Accepted: 05/09/2019] [Indexed: 11/18/2022]
Abstract
This nonblinded randomized controlled trial investigated the efficacy of a physical activity (PA) intervention underpinned by self-determination theory. Participants (N = 31, mean age 69 years [SD = 4.9]) diagnosed with bowel polyps were randomized to an active lifestyle program (ALP; n = 17) or standard care (n = 14). ALP received supervised exercise and counseling for 6 months. Both groups were followed up at 12 months. Outcomes were change in PA and behavioral regulation. Data were analyzed with intention to treat. At 6 months, differences were observed for behavioral regulation in favor of ALP (p < .05). PA differences were significant for leisure, walking, and vigorous in favor of ALP (p < .05). The self-determination theory can be an effective strategy for promoting PA behavior change in this population, but a larger trial is needed to further explore the utility of the self-determination theory in this context.
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Rioux C, Little TD. Missing data treatments in intervention studies: What was, what is, and what should be. INTERNATIONAL JOURNAL OF BEHAVIORAL DEVELOPMENT 2019. [DOI: 10.1177/0165025419880609] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
Missing data are ubiquitous in studies examining preventive interventions. This missing data need to be handled appropriately for data analyses to yield unbiased results. After a brief discussion of missing data mechanisms, inappropriate missing data treatments and appropriate missing data treatments, we review the current state of missing data treatments in intervention studies as well as how they have evolved over the years. Although missing data treatments have improved over the years, antiquated missing data treatments associated with biased results are still prevalent. Furthermore, many studies do not appropriately report their rates of missing data and missing data treatments. Using appropriate missing data treatments is elemental to accurately identify effective preventive interventions and properly inform practice and policy.
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Affiliation(s)
| | - Todd D. Little
- Texas Tech University, USA
- North-West University, South Africa
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Köhler-Forsberg O, Larsen ER, Buttenschøn HN, Rietschel M, Hauser J, Souery D, Maier W, Farmer A, McGuffin P, Aitchison KJ, Uher R, Mors O. Effect of antidepressant switching between nortriptyline and escitalopram after a failed first antidepressant treatment among patients with major depressive disorder. Br J Psychiatry 2019; 215:494-501. [PMID: 30698114 PMCID: PMC6624130 DOI: 10.1192/bjp.2018.302] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
BACKGROUND For patients with major depressive disorder (MDD) experiencing side-effects or non-response to their first antidepressant, little is known regarding the effect of switching between a tricyclic antidepressant (TCA) and a selective serotonin reuptake inhibitor (SSRI).AimsTo compare the switch between the TCA nortriptyline and the SSRI escitalopram. METHOD Among 811 adults with MDD treated with nortriptyline or escitalopram for up to 12 weeks, 108 individuals switched from nortriptyline to escitalopram or vice versa because of side-effects or non-response (trial registration: EudraCT No.2004-001723-38 (https://eudract.ema.europa.eu/) and ISRCTN No.03693000 (http://www.controlled-trials.com)). Patients were followed for up to 26 weeks after switching and response was measured with the Montgomery-Åsberg Depression Rating scale (MADRS). We performed adjusted mixed-effects linear regression models with full information maximum likelihood estimation reporting β-coefficients with 95% CIs. RESULTS Switching antidepressants resulted in a significant decrease in MADRS scores. This was present for switchers from escitalopram to nortriptyline (n = 36, β = -0.38, 95% CI -0.51 to -0.25, P<0.001) and from nortriptyline to escitalopram (n = 72, β = -0.34, 95% CI -0.41 to -0.26, P<0.001). Both switching options resulted in significant improvement among individuals who switched because of non-response or side-effects. The results were supported by analyses on other rating scales and symptom dimensions. CONCLUSIONS These results suggest that switching from a TCA to an SSRI or vice versa after non-response or side-effects to the first antidepressant may be a viable approach to achieve response among patients with MDD.Declarations of interestK.J.A. holds an Alberta Centennial Addiction and Mental Health Research Chair, funded by the Government of Alberta. K.J.A. has been a member of various advisory boards, received consultancy fees and honoraria, and has received research grants from various companies including Johnson and Johnson Pharmaceuticals Research and Development and Bristol-Myers Squibb Pharmaceuticals Limited. D.S. has served on advisory boards for, and received unrestricted grants from, Lundbeck and AstraZeneca. A.F. and P.M. have received honoraria for participating in expert panels for Lundbeck and GlaxoSmithKline.
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Affiliation(s)
- Ole Köhler-Forsberg
- Psychosis Research Unit, Aarhus University Hospital – Psychiatry, Denmark,Department of Clinical Medicine, Aarhus University, Denmark,iPSYCH, The Lundbeck Foundation Initiative for Integrative Psychiatric Research, Aarhus, Denmark,Corresponding author: Ole Köhler-Forsberg; Psychosis Research Unit; Aarhus University Hospital, Risskov; Skovagervej 2; DK-8240 Risskov; Phone: +45 2342 0661; ; Fax: +45 7847 1609
| | - Erik Roj Larsen
- Department of Psychiatry, Psychiatry in the Region of Southern Denmark; Institute of Clinical Research, Research Unit of Psychiatry, University of Southern Denmark
| | - Henriette N. Buttenschøn
- iPSYCH, The Lundbeck Foundation Initiative for Integrative Psychiatric Research, Aarhus, Denmark,Translational Neuropsychiatry Unit, Department of Clinical Medicine, Aarhus University, Denmark
| | - Marcella Rietschel
- Central Institute of Mental Health, Department of Genetic Epidemiology in Psychiatry, Medical Faculty Mannheim/Heidelberg University, Mannheim Germany
| | - Joanna Hauser
- Laboratory of Psychiatric Genetics, Department of Psychiatry, Poznan University of Medical Sciences, Poland
| | - Daniel Souery
- Laboratoire de Psychologie Médicale, Université Libre de Bruxelles; Psy Pluriel - Centre Européen de Psychologie Médicale, Belgium
| | | | - Anne Farmer
- Social, Genetic and Developmental Psychiatry Centre, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, UK
| | - Peter McGuffin
- Social, Genetic and Developmental Psychiatry Centre, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, UK
| | | | - Rudolf Uher
- Social, Genetic and Developmental Psychiatry Centre, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, UK,Department of Psychiatry, Dalhousie University, Halifax, NS, Canada
| | - Ole Mors
- Psychosis Research Unit, Aarhus University Hospital – Psychiatry, Denmark,Department of Clinical Medicine, Aarhus University, Denmark,iPSYCH, The Lundbeck Foundation Initiative for Integrative Psychiatric Research, Aarhus, Denmark
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Ownsworth T, Chambers S, Aitken JF, Foote M, Pinkham MB, Gordon LG, Lock G, Hanley B, Gardner T, Jones S, Robertson J, Shum D, Conlon E. Evaluation of a telehealth psychological support intervention for people with primary brain tumour and their family members: Study protocol for a randomised controlled trial. Eur J Cancer Care (Engl) 2019; 28:e13132. [DOI: 10.1111/ecc.13132] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2018] [Revised: 04/30/2019] [Accepted: 06/22/2019] [Indexed: 01/08/2023]
Affiliation(s)
- Tamara Ownsworth
- School of Applied Psychology, Menzies Health Institute Queensland Griffith University Brisbane Queensland Australia
| | - Suzanne Chambers
- University of Technology Sydney Sydney New South Wales Australia
- Menzies Health Institute Queensland Griffith University Southport Queensland Australia
- Australian and New Zealand Urogenital and Prostate Cancer (ANZUP) Trials Group Sydney New South Wales Australia
- Exercise Medicine Research Institute Edith Cowan University Perth Western Australia Australia
- Institute for Resilient Regions University of Southern Queensland Toowoomba Queensland Australia
| | - Joanne F. Aitken
- Menzies Health Institute Queensland Griffith University Southport Queensland Australia
- Institute for Resilient Regions University of Southern Queensland Toowoomba Queensland Australia
- Cancer Council Queensland Brisbane Queensland Australia
- School of Public Health University of Queensland Brisbane Queensland Australia
- School of Research–Public Health Queensland University of Technology Brisbane Queensland Australia
| | - Matthew Foote
- Department of Radiation Oncology Princess Alexandra Hospital Brisbane Queensland Australia
- School of Medicine University of Queensland Brisbane Queensland Australia
| | - Mark B. Pinkham
- Department of Radiation Oncology Princess Alexandra Hospital Brisbane Queensland Australia
- School of Medicine University of Queensland Brisbane Queensland Australia
| | - Louisa G. Gordon
- School of Public Health University of Queensland Brisbane Queensland Australia
- QIMR Berghofer Medical Research Institute Brisbane Queensland Australia
- School of Nursing Queensland University of Technology Brisbane Queensland Australia
| | - Gemma Lock
- Cancer Council Queensland Brisbane Queensland Australia
| | - Brigid Hanley
- Cancer Council Queensland Brisbane Queensland Australia
| | | | - Stephanie Jones
- School of Applied Psychology, Menzies Health Institute Queensland Griffith University Brisbane Queensland Australia
| | - Julia Robertson
- School of Applied Psychology, Menzies Health Institute Queensland Griffith University Brisbane Queensland Australia
| | - David Shum
- School of Applied Psychology, Menzies Health Institute Queensland Griffith University Brisbane Queensland Australia
- Department of Rehabilitation Sciences Hong Kong Polytechnic University Hong Kong China
| | - Elizabeth Conlon
- School of Applied Psychology, Menzies Health Institute Queensland Griffith University Brisbane Queensland Australia
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Lavallee K, Schuck K, Blatter-Meunier J, Schneider S. Transgenerational improvements following child anxiety treatment: An exploratory examination. PLoS One 2019; 14:e0212667. [PMID: 30817752 PMCID: PMC6394948 DOI: 10.1371/journal.pone.0212667] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2018] [Accepted: 02/02/2019] [Indexed: 11/18/2022] Open
Abstract
Background The present study conducted secondary analyses of a randomized controlled trial to examine the transgenerational relationship between cognitive-behavioral therapy for child Separation Anxiety Disorder (SepAD) and the mental health of parents. Symptoms of anxiety and depression were compared before and after child treatment between parents of children treated for SepAD and parents of healthy children, who did not receive any treatment. Methods One hundred and seven children aged 4–14 years with SepAD received one of two cognitive behavioral treatment programs for SepAD (TAFF; TrennungsAngstprogramm Für Familien; English: Separation Anxiety Family Therapy or CC; Coping Cat). Their parents (N = 189; 101 mothers and 88 fathers) were assessed at baseline and post-treatment for symptoms of separation anxiety, general anxiety, and depression. A comparison group of parents (N = 74; 42 mothers and 32 fathers) of 45 children without SepAD, who did not receive any treatment, were also assessed. Results Results indicated a significant interaction effect between group and time on mothers’ depression and separation anxiety, indicating that maternal symptoms of depression and separation anxiety improved in the child treatment condition in comparison to mothers of healthy children. There was no significant improvement in parental pathology levels among fathers of children treated for SepAD. Conclusions Treatment for child SepAD may have subsequent positive effects on mothers’ own levels of separation anxiety and depression, though the mechanisms are yet unknown. Future studies are needed that test the transgenerational effect of child SepAD treatment on parental mental health as the primary research question.
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Tollgate-based progression pathways of ALS patients. J Neurol 2019; 266:755-765. [PMID: 30684209 DOI: 10.1007/s00415-019-09199-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2018] [Revised: 01/11/2019] [Accepted: 01/11/2019] [Indexed: 12/11/2022]
Abstract
OBJECTIVE To capture ALS progression in arm, leg, speech, swallowing, and breathing segments using a disease-specific staging system, namely tollgate-based ALS staging system (TASS), where tollgates refer to a set of critical clinical events including having slight weakness in arms, needing a wheelchair, needing a feeding tube, etc. METHODS: We compiled a longitudinal dataset from medical records including free-text clinical notes of 514 ALS patients from Mayo Clinic, Rochester-MN. We derived tollgate-based progression pathways of patients up to a 1-year period starting from the first clinic visit. We conducted Kaplan-Meier analyses to estimate the probability of passing each tollgate over time for each functional segment. RESULTS At their first clinic visit, 93%, 77%, and 60% of patients displayed some level of limb, bulbar, and breathing weakness, respectively. The proportion of patients at milder tollgate levels (tollgate level < 2) was smaller for arm and leg segments (38% and 46%, respectively) compared to others (> 65%). Patients showed non-uniform TASS pathways, i.e., the likelihood of passing a tollgate differed based on the affected segments at the initial visit. For instance, stratified by impaired segments at the initial visit, patients with limb and breathing impairment were more likely (62%) to use bi-level positive airway pressure device in a year compared to those with bulbar and breathing impairment (26%). CONCLUSION Using TASS, clinicians can inform ALS patients about their individualized likelihood of having critical disabilities and assistive-device needs (e.g., being dependent on wheelchair/ventilation, needing walker/wheelchair or communication devices), and help them better prepare for future.
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Vannoy S, Brodt M, Cosgrove L, Shaughnessy AF. Variation in analytic transparency in recent efficacy studies of antidepressant medication. BMJ Evid Based Med 2018; 23:177-182. [PMID: 29950314 DOI: 10.1136/bmjebm-2018-110947] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/10/2018] [Indexed: 11/03/2022]
Abstract
The validity of clinical trial results is influenced by researchers' decisions regarding the management of missing data. Inadequate management of missing data has been identified as a significant source of bias that can result in an overestimation of drug efficacy. Transparency related to the management of missing data is essential to assess the strength of evidence reported in publications. In a subset of 17 randomised clinical trials for two new antidepressant medications, we present a case study in which we examined investigators' decisions regarding how to handle missing data and if their chosen method took into account, possible violations of analytic requirements that could affect results. The majority of trials (76%) concluded that there was a benefit of antidepressant treatment and in 94% the methodology for handling missing data was identifiable. Of these, 50% imputed data using the last observation carried forward and half used a mixed-effects model repeated measure approach. Most reports did not provide a rationale for the method used, and no trials described analyses regarding differences between completers and dropouts. Sensitivity analysis was inconsistently reported and correction for multiple comparisons was not uniformly applied. Lack of transparency for analytic choices related to handling of missing data testing was common in this subset of RCTs. Because management of missing data can directly influence the quality of study results, it is critical that journal editors develop and enforce standards for methodological transparency.
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Affiliation(s)
- Steven Vannoy
- Counseling and School Psychology, University of Massachusetts Boston, Boston, Massachusetts, USA
| | - Madeline Brodt
- Counseling and School Psychology, University of Massachusetts Boston, Boston, Massachusetts, USA
| | - Lisa Cosgrove
- Counseling and School Psychology, University of Massachusetts Boston, Boston, Massachusetts, USA
| | - Allen F Shaughnessy
- Department of Family Medicine, Tufts University School of Medicine, Boston, Massachusetts, USA
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Rondung E, Ternström E, Hildingsson I, Haines HM, Sundin Ö, Ekdahl J, Karlström A, Larsson B, Segeblad B, Baylis R, Rubertsson C. Comparing Internet-Based Cognitive Behavioral Therapy With Standard Care for Women With Fear of Birth: Randomized Controlled Trial. JMIR Ment Health 2018; 5:e10420. [PMID: 30097422 PMCID: PMC6109226 DOI: 10.2196/10420] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/19/2018] [Revised: 05/21/2018] [Accepted: 06/06/2018] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Although many pregnant women report fear related to the approaching birth, no consensus exists on how fear of birth should be handled in clinical care. OBJECTIVE This randomized controlled trial aimed to compare the efficacy of a guided internet-based self-help program based on cognitive behavioral therapy (guided ICBT) with standard care on the levels of fear of birth in a sample of pregnant women reporting fear of birth. METHODS This nonblinded, multicenter randomized controlled trial with a parallel design was conducted at three study centers (hospitals) in Sweden. Recruitment commenced at the ultrasound screening examination during gestational weeks 17-20. The therapist-guided ICBT intervention was inspired by the Unified protocol for transdiagnostic treatment of emotional disorders and consisted of 8 treatment modules and 1 module for postpartum follow-up. The aim was to help participants observe and understand their fear of birth and find new ways of coping with difficult thoughts and emotions. Standard care was offered in the three different study regions. The primary outcome was self-assessed levels of fear of birth, measured using the Fear of Birth Scale. RESULTS We included 258 pregnant women reporting clinically significant levels of fear of birth (guided ICBT group, 127; standard care group, 131). Of the 127 women randomized to the guided ICBT group, 103 (81%) commenced treatment, 60 (47%) moved on to the second module, and only 13 (10%) finished ≥4 modules. The levels of fear of birth did not differ between the intervention groups postintervention. At 1-year postpartum follow-up, participants in the guided ICBT group exhibited significantly lower levels of fear of birth (U=3674.00, z=-1.97, P=.049, Cohen d=0.28, 95% CI -0.01 to 0.57). Using the linear mixed models analysis, an overall decrease in the levels of fear of birth over time was found (P≤ .001), along with a significant interaction between time and intervention, showing a larger reduction in fear of birth in the guided ICBT group over time (F1,192.538=4.96, P=.03). CONCLUSIONS Fear of birth decreased over time in both intervention groups; while the decrease was slightly larger in the guided ICBT group, the main effect of time alone, regardless of treatment allocation, was most evident. Poor treatment adherence to guided ICBT implies low feasibility and acceptance of this treatment. TRIAL REGISTRATION ClinicalTrials.gov NCT02306434; https://clinicaltrials.gov/ct2/show/NCT02306434 (Archived by WebCite at http://www.webcitation.org/70sj83qat).
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Affiliation(s)
- Elisabet Rondung
- Department of Psycholgy, Mid Sweden University, Östersund, Sweden
| | - Elin Ternström
- Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden
| | - Ingegerd Hildingsson
- Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden.,Department of Nursing, Mid Sweden University, Sundsvall, Sweden
| | - Helen M Haines
- Department of Rural Health, The University of Melbourne, Victoria, Australia
| | - Örjan Sundin
- Department of Psycholgy, Mid Sweden University, Östersund, Sweden
| | - Johanna Ekdahl
- Department of Psycholgy, Mid Sweden University, Östersund, Sweden
| | | | | | - Birgitta Segeblad
- Department of Obstetrics and Gynecology, Uppsala University Hospital, Uppsala, Sweden
| | - Rebecca Baylis
- Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden
| | - Christine Rubertsson
- Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden.,Department of Health Science, Faculty of Medicine, Lund university, Lund, Sweden
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Effect of heteroscedasticity between treatment groups on mixed-effects models for repeated measures. Pharm Stat 2018; 17:578-592. [DOI: 10.1002/pst.1872] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2018] [Revised: 05/13/2018] [Accepted: 05/22/2018] [Indexed: 11/07/2022]
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Hewett K, Sanders DB, Grove RA, Broderick CL, Rudo TJ, Bassiri A, Zvartau-Hind M, Bril V. Randomized study of adjunctive belimumab in participants with generalized myasthenia gravis. Neurology 2018; 90:e1425-e1434. [PMID: 29661905 PMCID: PMC5902787 DOI: 10.1212/wnl.0000000000005323] [Citation(s) in RCA: 79] [Impact Index Per Article: 13.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2017] [Accepted: 01/17/2018] [Indexed: 01/28/2023] Open
Abstract
Objective To investigate the efficacy and safety of belimumab, a fully human immunoglobulin G1λ monoclonal antibody against B-lymphocyte stimulator, in participants with generalized myasthenia gravis (MG) who remained symptomatic despite standard of care (SoC) therapy. Methods Eligible participants with MG were randomized 1:1 to receive IV belimumab 10 mg/kg or placebo in this phase II, placebo-controlled, multicenter, double-blind study (NCT01480596; BEL115123). Participants received SoC therapies throughout the 24-week treatment phase and 12-week follow-up period. The primary efficacy endpoint was mean change from baseline in the Quantitative Myasthenia Gravis (QMG) scale at week 24; safety assessments included the frequency and severity of adverse events (AEs) and serious AEs. Results Forty participants were randomized (placebo n = 22; belimumab n = 18). The mean change in QMG score from baseline at week 24 was not significantly different for belimumab vs placebo (p = 0.256). There were no statistically significant differences between treatment groups for secondary endpoints, including the MG Composite and MG–Activity of Daily Living scores. Acetylcholine receptor antibody levels decreased over time in both treatment groups. No unexpected AEs were identified and occurrence was similar in the belimumab (78%) and placebo (91%) groups. One participant receiving placebo died (severe sepsis) during the treatment phase. Conclusions The primary endpoint was not met for belimumab in participants with generalized MG receiving SoC. There was no significant difference in mean change in the QMG score at week 24 for belimumab vs placebo. The safety profile of belimumab was consistent with previous systemic lupus erythematosus studies. Classification of evidence This study provides Class I evidence that for participants with generalized MG, belimumab did not significantly improve QMG score compared with placebo.
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Affiliation(s)
- Karen Hewett
- From GSK (K.H.), Stevenage, Herts, UK; Department of Neurology (D.B.S.), Duke University School of Medicine, Durham, NC; GSK (R.A.G.), Uxbridge, Middlesex, UK; GSK (C.L.B., T.J.R., A.B.), Philadelphia, PA; GSK (M.Z.-H.), Brentford, London, UK; and University Health Network (V.B.), University of Toronto, Canada
| | - Donald B Sanders
- From GSK (K.H.), Stevenage, Herts, UK; Department of Neurology (D.B.S.), Duke University School of Medicine, Durham, NC; GSK (R.A.G.), Uxbridge, Middlesex, UK; GSK (C.L.B., T.J.R., A.B.), Philadelphia, PA; GSK (M.Z.-H.), Brentford, London, UK; and University Health Network (V.B.), University of Toronto, Canada
| | - Richard A Grove
- From GSK (K.H.), Stevenage, Herts, UK; Department of Neurology (D.B.S.), Duke University School of Medicine, Durham, NC; GSK (R.A.G.), Uxbridge, Middlesex, UK; GSK (C.L.B., T.J.R., A.B.), Philadelphia, PA; GSK (M.Z.-H.), Brentford, London, UK; and University Health Network (V.B.), University of Toronto, Canada
| | - Christine L Broderick
- From GSK (K.H.), Stevenage, Herts, UK; Department of Neurology (D.B.S.), Duke University School of Medicine, Durham, NC; GSK (R.A.G.), Uxbridge, Middlesex, UK; GSK (C.L.B., T.J.R., A.B.), Philadelphia, PA; GSK (M.Z.-H.), Brentford, London, UK; and University Health Network (V.B.), University of Toronto, Canada
| | - Todd J Rudo
- From GSK (K.H.), Stevenage, Herts, UK; Department of Neurology (D.B.S.), Duke University School of Medicine, Durham, NC; GSK (R.A.G.), Uxbridge, Middlesex, UK; GSK (C.L.B., T.J.R., A.B.), Philadelphia, PA; GSK (M.Z.-H.), Brentford, London, UK; and University Health Network (V.B.), University of Toronto, Canada
| | - Ashlyn Bassiri
- From GSK (K.H.), Stevenage, Herts, UK; Department of Neurology (D.B.S.), Duke University School of Medicine, Durham, NC; GSK (R.A.G.), Uxbridge, Middlesex, UK; GSK (C.L.B., T.J.R., A.B.), Philadelphia, PA; GSK (M.Z.-H.), Brentford, London, UK; and University Health Network (V.B.), University of Toronto, Canada
| | - Marina Zvartau-Hind
- From GSK (K.H.), Stevenage, Herts, UK; Department of Neurology (D.B.S.), Duke University School of Medicine, Durham, NC; GSK (R.A.G.), Uxbridge, Middlesex, UK; GSK (C.L.B., T.J.R., A.B.), Philadelphia, PA; GSK (M.Z.-H.), Brentford, London, UK; and University Health Network (V.B.), University of Toronto, Canada
| | - Vera Bril
- From GSK (K.H.), Stevenage, Herts, UK; Department of Neurology (D.B.S.), Duke University School of Medicine, Durham, NC; GSK (R.A.G.), Uxbridge, Middlesex, UK; GSK (C.L.B., T.J.R., A.B.), Philadelphia, PA; GSK (M.Z.-H.), Brentford, London, UK; and University Health Network (V.B.), University of Toronto, Canada.
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Mayer JS, Hees K, Medda J, Grimm O, Asherson P, Bellina M, Colla M, Ibáñez P, Koch E, Martinez-Nicolas A, Muntaner-Mas A, Rommel A, Rommelse N, de Ruiter S, Ebner-Priemer UW, Kieser M, Ortega FB, Thome J, Buitelaar JK, Kuntsi J, Ramos-Quiroga JA, Reif A, Freitag CM. Bright light therapy versus physical exercise to prevent co-morbid depression and obesity in adolescents and young adults with attention-deficit / hyperactivity disorder: study protocol for a randomized controlled trial. Trials 2018; 19:140. [PMID: 29482662 PMCID: PMC5828138 DOI: 10.1186/s13063-017-2426-1] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2017] [Accepted: 12/18/2017] [Indexed: 01/19/2023] Open
Abstract
BACKGROUND The risk for major depression and obesity is increased in adolescents and adults with attention-deficit / hyperactivity disorder (ADHD) and adolescent ADHD predicts adult depression and obesity. Non-pharmacological interventions to treat and prevent these co-morbidities are urgently needed. Bright light therapy (BLT) improves day-night rhythm and is an emerging therapy for major depression. Exercise intervention (EI) reduces obesity and improves depressive symptoms. To date, no randomized controlled trial (RCT) has been performed to establish feasibility and efficacy of these interventions targeting the prevention of co-morbid depression and obesity in ADHD. We hypothesize that the two manualized interventions in combination with mobile health-based monitoring and reinforcement will result in less depressive symptoms and obesity compared to treatment as usual in adolescents and young adults with ADHD. METHODS This trial is a prospective, pilot phase-IIa, parallel-group RCT with three arms (two add-on treatment groups [BLT, EI] and one treatment as usual [TAU] control group). The primary outcome variable is change in the Inventory of Depressive Symptomatology total score (observer-blinded assessment) between baseline and ten weeks of intervention. This variable is analyzed with a mixed model for repeated measures approach investigating the treatment effect with respect to all three groups. A total of 330 participants with ADHD, aged 14 - < 30 years, will be screened at the four study centers. To establish effect sizes, the sample size was planned at the liberal significance level of α = 0.10 (two-sided) and the power of 1-β = 80% in order to find medium effects. Secondary outcomes measures including change in obesity, ADHD symptoms, general psychopathology, health-related quality of life, neurocognitive function, chronotype, and physical fitness are explored after the end of the intervention and at the 12-week follow-up. DISCUSSION This is the first pilot RCT on the use of BLT and EI in combination with mobile health-based monitoring and reinforcement targeting the prevention of co-morbid depression and obesity in adolescents and young adults with ADHD. If at least medium effects can be established with regard to the prevention of depressive symptoms and obesity, a larger scale confirmatory phase-III trial may be warranted. TRIAL REGISTRATION German Clinical Trials Register, DRKS00011666. Registered on 9 February 2017. ClinicalTrials.gov, NCT03371810. Registered on 13 December 2017.
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Affiliation(s)
- Jutta S Mayer
- Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, University Hospital Frankfurt, Goethe University, Deutschordenstr. 50, 60528, Frankfurt am Main, Germany.
| | - Katharina Hees
- Institute of Medical Biometry and Informatics, University Hospital Heidelberg, Heidelberg, Germany
| | - Juliane Medda
- Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, University Hospital Frankfurt, Goethe University, Deutschordenstr. 50, 60528, Frankfurt am Main, Germany
| | - Oliver Grimm
- Department of Psychiatry, Psychosomatic Medicine and Psychotherapy, University Hospital Frankfurt, Goethe University, Frankfurt am Main, Germany
| | - Philip Asherson
- King's College London, Social, Genetic and Developmental Psychiatry Centre, Institute of Psychiatry, Psychology and Neuroscience, London, UK
| | - Mariano Bellina
- Department of Psychiatry, Hospital Universitari Vall d'Hebron, Barcelona, Catalonia, Spain.,Psychiatric Genetics Unit, Group of Psychiatry, Mental Health and Addiction, Vall d'Hebron Research Institute (VHIR), Barcelona, Catalonia, Spain
| | - Michael Colla
- Department of Psychiatry, School of Medicine, University of Rostock, Rostock, Germany
| | - Pol Ibáñez
- Psychiatric Genetics Unit, Group of Psychiatry, Mental Health and Addiction, Vall d'Hebron Research Institute (VHIR), Barcelona, Catalonia, Spain
| | - Elena Koch
- Mental mHealth Lab, Department of Sport and Sport Science, Karlsruhe Institute of Technology (KIT), Karlsruhe, Germany
| | - Antonio Martinez-Nicolas
- PROFITH "PROmoting FITness and Health through physical activity" research group, Department of Physical Education and Sports, Faculty of Sport Sciences, University of Granada, Granada, Spain.,Chronobiology Research Group, Department of Physiology, Faculty of Biology, University of Murcia. Campus Mare Nostrum. IUIE. IMIB-Arrixaca. Ciber Fragilidad y Envejecimiento Saludable (CIBERFES), Madrid, Spain
| | - Adrià Muntaner-Mas
- PROFITH "PROmoting FITness and Health through physical activity" research group, Department of Physical Education and Sports, Faculty of Sport Sciences, University of Granada, Granada, Spain.,Physical Activity and Exercise Sciences Research Group, University of Balearic Islands, Palma, Spain
| | - Anna Rommel
- King's College London, Social, Genetic and Developmental Psychiatry Centre, Institute of Psychiatry, Psychology and Neuroscience, London, UK
| | - Nanda Rommelse
- Department of Psychiatry, Radboudumc, Nijmegen, The Netherlands.,Karakter Child and Adolescent Psychiatry University Centre, Nijmegen, The Netherlands
| | - Saskia de Ruiter
- Karakter Child and Adolescent Psychiatry University Centre, Nijmegen, The Netherlands.,Department of Cognitive Neuroscience, Donders Institute for Brain, Cognition and Behaviour, Radboudumc, Nijmegen, The Netherlands
| | - Ulrich W Ebner-Priemer
- Mental mHealth Lab, Department of Sport and Sport Science, Karlsruhe Institute of Technology (KIT), Karlsruhe, Germany
| | - Meinhard Kieser
- Institute of Medical Biometry and Informatics, University Hospital Heidelberg, Heidelberg, Germany
| | - Francisco B Ortega
- PROFITH "PROmoting FITness and Health through physical activity" research group, Department of Physical Education and Sports, Faculty of Sport Sciences, University of Granada, Granada, Spain
| | - Johannes Thome
- Department of Psychiatry, School of Medicine, University of Rostock, Rostock, Germany
| | - Jan K Buitelaar
- Karakter Child and Adolescent Psychiatry University Centre, Nijmegen, The Netherlands.,Department of Cognitive Neuroscience, Donders Institute for Brain, Cognition and Behaviour, Radboudumc, Nijmegen, The Netherlands
| | - Jonna Kuntsi
- King's College London, Social, Genetic and Developmental Psychiatry Centre, Institute of Psychiatry, Psychology and Neuroscience, London, UK
| | - J Antoni Ramos-Quiroga
- Department of Psychiatry, Hospital Universitari Vall d'Hebron, Barcelona, Catalonia, Spain.,Psychiatric Genetics Unit, Group of Psychiatry, Mental Health and Addiction, Vall d'Hebron Research Institute (VHIR), Barcelona, Catalonia, Spain.,Biomedical Network Research Centre on Mental Health (CIBERSAM), Instituto de Salud Carlos III, Madrid, Spain.,Department of Psychiatry and Forensic Medicine, Universitat Autònoma de Barcelona, Barcelona, Catalonia, Spain
| | - Andreas Reif
- Department of Psychiatry, Psychosomatic Medicine and Psychotherapy, University Hospital Frankfurt, Goethe University, Frankfurt am Main, Germany
| | - Christine M Freitag
- Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, University Hospital Frankfurt, Goethe University, Deutschordenstr. 50, 60528, Frankfurt am Main, Germany
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McRobbie H, Hajek P, Peerbux S, Kahan BC, Eldridge S, Trépel D, Parrott S, Griffiths C, Snuggs S, Myers Smith K. Tackling obesity in areas of high social deprivation: clinical effectiveness and cost-effectiveness of a task-based weight management group programme - a randomised controlled trial and economic evaluation. Health Technol Assess 2018; 20:1-150. [PMID: 27802843 DOI: 10.3310/hta20790] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND An increasing number of people require help to manage their weight. The NHS recommends weight loss advice by general practitioners and/or a referral to a practice nurse. Although this is helpful for some, more effective approaches that can be disseminated economically on a large scale are needed. OBJECTIVE To assess whether or not a task-based weight management programme [Weight Action Programme (WAP)] has better long-term effects than a 'best practice' intervention provided in primary care by practice nurses. DESIGN Randomised controlled trial with cost-effectiveness analysis. SETTING General practices in east London, UK. PARTICIPANTS Three hundred and thirty adults with a body mass index (BMI) of ≥ 30 kg/m2 or a BMI of ≥ 28 kg/m2 plus comorbidities were recruited from local general practices and via media publicity. Those who had a BMI of > 45 kg/m2, had lost > 5% of their body weight in the previous 6 months, were currently pregnant or taking psychiatric medications were excluded. Participants were randomised (2 : 1) to the WAP or nurse arms. INTERVENTIONS The WAP intervention was delivered in eight weekly group sessions that combined dietary and physical activity, advice and self-monitoring in a group-oriented intervention. The initial course was followed by 10 monthly group maintenance sessions open to all participants in this study arm. The practice nurse intervention (best usual care) consisted of four one-to-one sessions delivered over 8 weeks, and included standard advice on diet and physical activity based on NHS 'Change4Life' materials and motivational support. MAIN OUTCOME MEASURES The primary outcome measure was weight change at 12 months. Secondary outcome measures included change in BMI, waist circumference and blood pressure, and proportion of participants losing at least 5% and 10% of baseline body weight. Staff collecting measurements at the 6- and 12-month follow-ups were blinded to treatment allocation. The primary outcome measure was analysed according to the intention-to-treat principle, and included all participants with at least one recorded outcome at either 1, 2, 6 or 12 months. The analysis employed a mixed-effects linear regression model, adjusted for baseline weight, age, sex, ethnicity, smoking status and general practice. The European Quality of Life-5 Dimensions-5 Levels questionnaire was completed and used to estimate quality-adjusted life-years (QALYs) within the cost-effectiveness analysis. RESULTS There were 330 participants (WAP arm, n = 221; nurse arm, n = 109; 72% women). A total of 291 (88%) participants (WAP arm, n = 194; nurse arm, n = 97) were included in the main analysis for the primary outcome. Weight loss at 12 months was greater in the WAP arm than in the nurse intervention arm [-4.2 kg vs. -2.3 kg; difference -1.9 kg, 95% confidence interval (CI) -3.7 to -0.1 kg; p = 0.04]. Participants in the WAP arm were more likely than participants in the nurse arm to have lost at least 5% of their baseline body weight at 12 months (41% vs. 27%; odds ratio 14.61, 95% CI 2.32 to 91.96; p = 0.004). The incremental cost-effectiveness ratio for WAP over and above the nurse arm is £7742 per QALY. CONCLUSIONS A WAP delivered in general practice better promotes weight loss over 12 months than a best usual practice nurse-led weight loss programme. LIMITATIONS The trial recruited mostly women. Research is needed into factors that would make weight loss programmes more attractive to men. TRIAL REGISTRATION Current Controlled Trials ISRCTN45820471. FUNDING This project was funded by the National Institute for Health Research (NIHR) Health Technology Assessment programme and will be published in full in Health Technology Assessment; Vol. 20, No. 79. See the NIHR Journals Library website for further project information.
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Affiliation(s)
- Hayden McRobbie
- Health and Lifestyle Research Unit, Wolfson Institute of Preventive Medicine, Queen Mary University of London, London, UK
| | - Peter Hajek
- Health and Lifestyle Research Unit, Wolfson Institute of Preventive Medicine, Queen Mary University of London, London, UK
| | - Sarrah Peerbux
- Health and Lifestyle Research Unit, Wolfson Institute of Preventive Medicine, Queen Mary University of London, London, UK
| | - Brennan C Kahan
- Pragmatic Clinical Trials Unit, Queen Mary University of London, London, UK
| | - Sandra Eldridge
- Pragmatic Clinical Trials Unit, Queen Mary University of London, London, UK
| | - Dominic Trépel
- Department of Health Sciences, University of York, York, UK
| | - Steve Parrott
- Department of Health Sciences, University of York, York, UK
| | - Chris Griffiths
- Centre for Primary Care and Public Health, Blizard Institute, Queen Mary University of London, London, UK
| | - Sarah Snuggs
- Health and Lifestyle Research Unit, Wolfson Institute of Preventive Medicine, Queen Mary University of London, London, UK
| | - Katie Myers Smith
- Health and Lifestyle Research Unit, Wolfson Institute of Preventive Medicine, Queen Mary University of London, London, UK
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Fojecki GL, Tiessen S, Osther PJS. Effect of Linear Low-Intensity Extracorporeal Shockwave Therapy for Erectile Dysfunction-12-Month Follow-Up of a Randomized, Double-Blinded, Sham-Controlled Study. Sex Med 2017; 6:1-7. [PMID: 29275957 PMCID: PMC5815970 DOI: 10.1016/j.esxm.2017.09.002] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2017] [Revised: 09/22/2017] [Accepted: 09/30/2017] [Indexed: 11/18/2022] Open
Abstract
INTRODUCTION Short-term data on the effect of low-intensity extracorporeal shockwave therapy (Li-ESWT) on erectile dysfunction (ED) have been inconsistent. The suggested mechanisms of action of Li-ESWT on ED include stimulation of cell proliferation, tissue regeneration, and angiogenesis, which can be processes with a long generation time. Therefore, long-term data on the effect of Li-ESWT on ED are strongly warranted. AIM To assess the outcome at 6 and 12 months of linear Li-ESWT on ED from a previously published randomized, double-blinded, sham-controlled trial. METHODS Subjects with ED (N = 126) who scored lower than 25 points in the erectile function domain of the International Index of Erectile Function (IIEF-EF) were eligible for the study. They were allocated to 1 of 2 groups: 5 weekly sessions of sham treatment (group A) or linear Li-ESWT (group B). After a 4-week break, the 2 groups received active treatment once a week for 5 weeks. At baseline and 6 and 12 months, subjects were evaluated by the IIEF-EF, the Erectile Hardness Scale (EHS), and the Sexual Quality of Life in Men. MAIN OUTCOME MEASURES The primary outcome measure was an increase of at least 5 points in the IIEF-EF (ΔIIEF-EF score). The secondary outcome measure was an increase in the EHS score to at least 3 in men with a score no higher than 2 at baseline. Data were analyzed by linear and logistic regressions. RESULTS Linear regression of the ΔIIEF-EF score from baseline to 12 months included 95 patients (dropout rate = 25%). Adjusted for the IIEF-EF score at baseline, the difference between groups B and A was -1.30 (95% CI = -4.37 to 1.77, P = .4). The success rate based on the main outcome parameter (ΔIIEF-EF score ≥ 5) was 54% in group A vs 47% in group B (odds ratio = 0.67, P = .28). Improvement based on changes in the EHS score in groups A and B was 34% and 24%, respectively (odds ratio = 0.47, P = .82). CONCLUSION Exposure to 2 cycles of linear Li-ESWT for ED is not superior to 1 cycle at 6- and 12-month follow-ups. Fojecki GL, Tiessen S, Osther PJS. Effect of Linear Low-Intensity Extracorporeal Shockwave Therapy for Erectile Dysfunction-12-Month Follow-Up of a Randomized, Double-Blinded, Sham-Controlled Study. Sex Med 2018;6:1-7.
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Affiliation(s)
| | - Stefan Tiessen
- Department of Urology, Odense University Hospital, Odense, Denmark
| | - Palle Jørn Sloth Osther
- Urological Research Center, Department of Urology, Lillebaelt Hospital, University of Southern, Denmark
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Nordahl H, Havnen A, Hansen B, Öst LG, Kvale G. Sleep disturbances in treatment-seeking OCD-patients: Changes after concentrated exposure treatment. Scand J Psychol 2017; 59:186-191. [PMID: 29244201 DOI: 10.1111/sjop.12417] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2017] [Accepted: 11/01/2017] [Indexed: 11/29/2022]
Abstract
Research indicates that patients with Obsessive Compulsive Disorder (OCD) frequently suffer from comorbid sleep difficulties, and that these difficulties often are not clinically recognized and diagnosed. There has been limited research investigating if comorbid sleep difficulties impair treatment outcome for OCD and if the sleep difficulties change following OCD-treatment. Thirty-six patients with obsessive compulsive disorder underwent concentrated exposure treatment delivered in a group over four consecutive days and were assessed with measures of OCD, depressive symptoms and sleep disturbance at three different time points (pre, post and 6 months follow-up). The sample was characterized by a high degree of comorbidity with other psychiatric disorders. At pre-treatment nearly 70% of the patients reported sleep difficulties indicative of primary insomnia. The results showed that patients had large reductions of OCD-symptoms as well as significant improvements in sleep disturbance assessed after treatment, and that these improvements were maintained at follow-up. Sleep disturbance did not impair treatment outcome, on the contrary patients with higher degree of sleep disturbance at pre-treatment had better outcome on OCD-symptoms after treatment. The results indicated that the majority of the OCD sample suffered from sleep disturbances and that these sleep disturbances were significantly reduced following adequate treatment of OCD without specific sleep interventions. However, a proportion of the patients suffered from residual symptoms of insomnia after treatment.
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Affiliation(s)
- Håkon Nordahl
- Haukeland University Hospital, OCD-team, Bergen, Norway
| | - Audun Havnen
- Haukeland University Hospital, OCD-team, Bergen, Norway.,Department of Clinical Psychology, University of Bergen, Norway
| | - Bjarne Hansen
- Haukeland University Hospital, OCD-team, Bergen, Norway.,Department of Clinical Psychology, University of Bergen, Norway
| | - Lars-Göran Öst
- Haukeland University Hospital, OCD-team, Bergen, Norway.,Department of Psychology, Stockholm University, Sweden
| | - Gerd Kvale
- Haukeland University Hospital, OCD-team, Bergen, Norway.,Department of Clinical Psychology, University of Bergen, Norway
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50
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Boswood A, Gordon SG, Häggström J, Wess G, Stepien RL, Oyama MA, Keene BW, Bonagura J, MacDonald KA, Patteson M, Smith S, Fox PR, Sanderson K, Woolley R, Szatmári V, Menaut P, Church WM, O'Sullivan ML, Jaudon JP, Kresken JG, Rush J, Barrett KA, Rosenthal SL, Saunders AB, Ljungvall I, Deinert M, Bomassi E, Estrada AH, Fernandez Del Palacio MJ, Moise NS, Abbott JA, Fujii Y, Spier A, Luethy MW, Santilli RA, Uechi M, Tidholm A, Schummer C, Watson P. Longitudinal Analysis of Quality of Life, Clinical, Radiographic, Echocardiographic, and Laboratory Variables in Dogs with Preclinical Myxomatous Mitral Valve Disease Receiving Pimobendan or Placebo: The EPIC Study. J Vet Intern Med 2017; 32:72-85. [PMID: 29214723 PMCID: PMC5787203 DOI: 10.1111/jvim.14885] [Citation(s) in RCA: 48] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2017] [Revised: 08/21/2017] [Accepted: 10/23/2017] [Indexed: 11/30/2022] Open
Abstract
Background Changes in clinical variables associated with the administration of pimobendan to dogs with preclinical myxomatous mitral valve disease (MMVD) and cardiomegaly have not been described. Objectives To investigate the effect of pimobendan on clinical variables and the relationship between a change in heart size and the time to congestive heart failure (CHF) or cardiac‐related death (CRD) in dogs with MMVD and cardiomegaly. To determine whether pimobendan‐treated dogs differ from dogs receiving placebo at onset of CHF. Animals Three hundred and fifty‐four dogs with MMVD and cardiomegaly. Materials and Methods Prospective, blinded study with dogs randomized (ratio 1:1) to pimobendan (0.4–0.6 mg/kg/d) or placebo. Clinical, laboratory, and heart‐size variables in both groups were measured and compared at different time points (day 35 and onset of CHF) and over the study duration. Relationships between short‐term changes in echocardiographic variables and time to CHF or CRD were explored. Results At day 35, heart size had reduced in the pimobendan group: median change in (Δ) LVIDDN −0.06 (IQR: −0.15 to +0.02), P < 0.0001, and LA:Ao −0.08 (IQR: −0.23 to +0.03), P < 0.0001. Reduction in heart size was associated with increased time to CHF or CRD. Hazard ratio for a 0.1 increase in ΔLVIDDN was 1.26, P = 0.0003. Hazard ratio for a 0.1 increase in ΔLA:Ao was 1.14, P = 0.0002. At onset of CHF, groups were similar. Conclusions and Clinical Importance Pimobendan treatment reduces heart size. Reduced heart size is associated with improved outcome. At the onset of CHF, dogs treated with pimobendan were indistinguishable from those receiving placebo.
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Affiliation(s)
- A Boswood
- department of Veterinary Clinical Sciences, The Royal Veterinary College, Hatfield, Hertfordshire, UK
| | - S G Gordon
- Small Animal Clinical Science, Texas A&M University, College Station, TX
| | - J Häggström
- Department of Clinical Sciences, Swedish University of Agricultural Sciences, Uppsala, Sweden
| | - G Wess
- Clinic of Small Animal Medicine, University of Munich, Munich, Germany
| | - R L Stepien
- Medical Sciences, University of Wisconsin Madison School of Veterinary Medicine, Madison, WI
| | - M A Oyama
- Clinical Studies-Philadelphia, MJR-VHUP-Cardiology, University of Pennsylvania, Philadelphia, PA
| | - B W Keene
- Department of Clinical Sciences, College of Veterinary Medicine, North Carolina State University, Raleigh, NC
| | - J Bonagura
- Department of Veterinary Clinical Sciences, The Ohio State University, Columbus, OH
| | | | - M Patteson
- HeartVets @ Vale Referrals, The Animal Hospital, Dursley, Gloucestershire, UK
| | - S Smith
- Sarah Smith Cardiology, Derby, UK
| | - P R Fox
- Animal Medical Center, New York, NY
| | - K Sanderson
- Rocky Mountain Veterinary Cardiology, Boulder, CO
| | - R Woolley
- Cardio Respiratory Pet Referrals Victoria, Mordialloc, Vic., Australia
| | - V Szatmári
- Clinical Sciences of Companion Animals, Faculty of Veterinary Medicine, Utrecht University, Utrecht, The Netherlands
| | - P Menaut
- Internal Medicine and Cardiology, Clinique Vétérinaire Aquivet, Eysines, France
| | - W M Church
- Desert Veterinary Medical Specialists, Phoenix, AZ
| | - M L O'Sullivan
- Department of Clinical Studies, Ontario Veterinary College, University of Guelph, Guelph, ON, Canada
| | - J-P Jaudon
- Clinique Veterinaire Des Etangs, Villars Les Dombes, France
| | - J-G Kresken
- Clinic for Small Animals Kaiserberg, Duisburg, Germany
| | - J Rush
- Clinical Sciences, Tufts University Cummings School of Veterinary Medicine, North Grafton, MA
| | - K A Barrett
- Cardiology, VCA West Los Angeles, Los Angeles, CA
| | | | - A B Saunders
- Small Animal Clinical Science, Texas A&M University, College Station, TX
| | - I Ljungvall
- Department of Clinical Sciences, Swedish University of Agricultural Sciences, Uppsala, Sweden
| | - M Deinert
- Tierklinik am Sandpfad, Wiesloch, Germany
| | - E Bomassi
- Cardiology, Centre Hospitalier Vétérinaire des Cordeliers, Meaux, France
| | - A H Estrada
- Small Animal Clinical Sciences, University of Florida College of Veterinary Medicine, Gainesville, FL
| | | | - N S Moise
- Clinical Sciences, College of Veterinary Medicine, Cornell University, Ithaca, NY
| | - J A Abbott
- Department of Small Animal Clinical Sciences, Virginia-Maryland College of Veterinary Medicine, Virginia Tech, Blacksburg, VA
| | - Y Fujii
- Surgery 1, Azabu University, Sagamihara, Kanagawa, Japan
| | - A Spier
- Blue Pearl Veterinary Partners, Tampa, FL
| | - M W Luethy
- Chicago Veterinary Emergency and Specialty Center, Chicago, IL
| | - R A Santilli
- Cardiology, Clinica Veterinaria Malpensa, Gallarate, Varese, Italy
| | - M Uechi
- Japan Animal Specialty Medical Institute Inc., JASMINE Veterinary Cardiovascular Medical Center, Yokohama, Japan
| | - A Tidholm
- Djursjukhuset Albano, Danderyd, Sweden
| | - C Schummer
- Animal Health, Boehringer Ingelheim, Ingelheim am Rhein, Germany
| | - P Watson
- Animal Health, Boehringer Ingelheim, Ingelheim am Rhein, Germany
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