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Hohenschurz-Schmidt D, Cherkin D, Rice ASC, Dworkin RH, Turk DC, McDermott MP, Bair MJ, DeBar LL, Edwards RR, Evans SR, Farrar JT, Kerns RD, Rowbotham MC, Wasan AD, Cowan P, Ferguson M, Freeman R, Gewandter JS, Gilron I, Grol-Prokopczyk H, Iyengar S, Kamp C, Karp BI, Kleykamp BA, Loeser JD, Mackey S, Malamut R, McNicol E, Patel KV, Schmader K, Simon L, Steiner DJ, Veasley C, Vollert J. Methods for pragmatic randomized clinical trials of pain therapies: IMMPACT statement. Pain 2024; 165:2165-2183. [PMID: 38723171 PMCID: PMC11404339 DOI: 10.1097/j.pain.0000000000003249] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2023] [Accepted: 03/08/2024] [Indexed: 09/18/2024]
Abstract
ABSTRACT Pragmatic, randomized, controlled trials hold the potential to directly inform clinical decision making and health policy regarding the treatment of people experiencing pain. Pragmatic trials are designed to replicate or are embedded within routine clinical care and are increasingly valued to bridge the gap between trial research and clinical practice, especially in multidimensional conditions, such as pain and in nonpharmacological intervention research. To maximize the potential of pragmatic trials in pain research, the careful consideration of each methodological decision is required. Trials aligned with routine practice pose several challenges, such as determining and enrolling appropriate study participants, deciding on the appropriate level of flexibility in treatment delivery, integrating information on concomitant treatments and adherence, and choosing comparator conditions and outcome measures. Ensuring data quality in real-world clinical settings is another challenging goal. Furthermore, current trials in the field would benefit from analysis methods that allow for a differentiated understanding of effects across patient subgroups and improved reporting of methods and context, which is required to assess the generalizability of findings. At the same time, a range of novel methodological approaches provide opportunities for enhanced efficiency and relevance of pragmatic trials to stakeholders and clinical decision making. In this study, best-practice considerations for these and other concerns in pragmatic trials of pain treatments are offered and a number of promising solutions discussed. The basis of these recommendations was an Initiative on Methods, Measurement, and Pain Assessment in Clinical Trials (IMMPACT) meeting organized by the Analgesic, Anesthetic, and Addiction Clinical Trial Translations, Innovations, Opportunities, and Networks.
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Affiliation(s)
- David Hohenschurz-Schmidt
- Pain Research, Department of Surgery & Cancer, Faculty of Medicine, Imperial College London, United Kingdom
- Research Department, University College of Osteopathy, London, United Kingdom
| | - Dan Cherkin
- Osher Center for Integrative Health, Department of Family Medicine, University of Washington, Seattle, WA, United States
| | - Andrew S C Rice
- Pain Research, Department of Surgery & Cancer, Faculty of Medicine, Imperial College London, United Kingdom
| | - Robert H Dworkin
- Department of Anesthesiology and Perioperative Medicine, University of Rochester Medical Center, Rochester, NY, United States
| | - Dennis C Turk
- Anesthesiology and Pain Medicine, University of Washington, Seattle, WA, United States
| | - Michael P McDermott
- Department of Biostatistics and Computational Biology, University of Rochester, Rochester, NY, United States
| | - Matthew J Bair
- VA Center for Health Information and Communication, Regenstrief Institute, and Indiana University School of Medicine, Indianapolis, IN, United States
| | - Lynn L DeBar
- Kaiser Permanente Washington Health Research Institute, Seattle, WA, United States
| | | | - Scott R Evans
- Biostatistics Center and the Department of Biostatistics and Bioinformatics, Milken Institute School of Public Health, George Washington University, Rockville, MD, United States
| | - John T Farrar
- Department of Biostatistics, Epidemiology, and Informatics, University of Pennsylvania, Philadelphia, PA, United States
| | - Robert D Kerns
- Department of Psychiatry, Yale School of Medicine, New Haven, CT, United States
| | - Michael C Rowbotham
- Department of Anesthesia, University of California San Francisco School of Medicine, San Francisco, CA, United States
| | - Ajay D Wasan
- Departments of Anesthesiology & Perioperative Medicine, and Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, PA, United States
| | - Penney Cowan
- American Chronic Pain Association, Rocklin, CA, United States
| | - McKenzie Ferguson
- Department of Pharmacy Practice, Southern Illinois University Edwardsville, Edwardsville, IL, United States
| | - Roy Freeman
- Department of Neurology, Harvard Medical School, Boston, MA, United States
| | - Jennifer S Gewandter
- Department of Anesthesiology and Perioperative, University of Rochester, Rochester, NY, United States
| | - Ian Gilron
- Departments of Anesthesiology & Perioperative Medicine, Biomedical & Molecular Sciences, Centre for Neuroscience Studies, and School of Policy Studies, Queen's University, Kingston Health Sciences Centre, Kingston, ON, Canada
| | - Hanna Grol-Prokopczyk
- Department of Sociology, University at Buffalo, State University of New York, Buffalo, NY, United States
| | | | - Cornelia Kamp
- Center for Health and Technology (CHeT), Clinical Materials Services Unit (CMSU), University of Rochester Medical Center, Rochester, NY, United States
| | - Barbara I Karp
- National Institutes of Health, Bethesda, MD, United States
| | - Bethea A Kleykamp
- University of Maryland, School of Medicine, Baltimore, MD, United States
| | - John D Loeser
- Departments of Neurological Surgery and Anesthesia and Pain Medicine, University of Washington, Seattle, WA, United States
| | - Sean Mackey
- Stanford University School of Medicine, Department of Anesthesiology, Perioperative, and Pain Medicine, Neurosciences and Neurology, Palo Alto, CA, United States
| | | | - Ewan McNicol
- Department of Pharmacy Practice, Massachusetts College of Pharmacy and Health Sciences University, Boston, MA, United States
| | - Kushang V Patel
- Department of Anesthesiology and Pain Medicine, University of Washington, Seattle, WA, United States
| | - Kenneth Schmader
- Department of Medicine-Geriatrics, Center for the Study of Aging, Duke University Medical Center, and Geriatrics Research Education and Clinical Center, Durham VA Medical Center, Durham, NC, United States
| | - Lee Simon
- SDG, LLC, Cambridge, MA, United States
| | | | | | - Jan Vollert
- Department of Clinical and Biomedical Sciences, Faculty of Health and Life Sciences, University of Exeter, Exeter, United Kingdom
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Maaß L, Hrynyschyn R, Lange M, Löwe A, Burdenski K, Butten K, Vorberg S, Hachem M, Gorga A, Grieco V, Restivo V, Vella G, Varnfield M, Holl F. Challenges and Alternatives to Evaluation Methods and Regulation Approaches for Medical Apps as Mobile Medical Devices: International and Multidisciplinary Focus Group Discussion. J Med Internet Res 2024; 26:e54814. [PMID: 39348678 DOI: 10.2196/54814] [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] [Received: 11/28/2023] [Revised: 05/15/2024] [Accepted: 07/24/2024] [Indexed: 10/02/2024] Open
Abstract
BACKGROUND The rapid proliferation of medical apps has transformed the health care landscape by giving patients and health care providers unprecedented access to personalized health information and services. However, concerns regarding the effectiveness and safety of medical apps have raised questions regarding the efficacy of randomized controlled trials (RCTs) in the evaluation of such apps and as a requirement for their regulation as mobile medical devices. OBJECTIVE This study aims to address this issue by investigating alternative methods, apart from RCTs, for evaluating and regulating medical apps. METHODS Using a qualitative approach, a focus group study with 46 international and multidisciplinary public health experts was conducted at the 17th World Congress on Public Health in May 2023 in Rome, Italy. The group was split into 3 subgroups to gather in-depth insights into alternative approaches for evaluating and regulating medical apps. We conducted a policy analysis on the current regulation of medical apps as mobile medical devices for the 4 most represented countries in the workshop: Italy, Germany, Canada, and Australia. We developed a logic model that combines the evaluation and regulation domains on the basis of these findings. RESULTS The focus group discussions explored the strengths and limitations of the current evaluation and regulation methods and identified potential alternatives that could enhance the quality and safety of medical apps. Although RCTs were only explicitly mentioned in the German regulatory system as one of many options, an analysis of chosen evaluation methods for German apps on prescription pointed toward a "scientific reflex" where RCTs are always the chosen evaluation method. However, this method has substantial limitations when used to evaluate digital interventions such as medical apps. Comparable results were observed during the focus group discussions, where participants expressed similar experiences with their own evaluation approaches. In addition, the participants highlighted numerous alternatives to RCTs. These alternatives can be used at different points during the life cycle of a digital intervention to assess its efficacy and potential harm to users. CONCLUSIONS It is crucial to recognize that unlike analog tools, digital interventions constantly evolve, posing challenges to inflexible evaluation methods such as RCTs. Potential risks include high dropout rates, decreased adherence, and nonsignificant results. However, existing regulations do not explicitly advocate for other evaluation methodologies. Our research highlighted the necessity of overcoming the gap between regulatory demands to demonstrate safety and efficacy of medical apps and evolving scientific practices, ensuring that digital health innovation is evaluated and regulated in a way that considers the unique characteristics of mobile medical devices.
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Affiliation(s)
- Laura Maaß
- University of Bremen, SOCIUM - Research Center on Inequality and Social Policy, Department of Health, Long Term Care and Pensions, Bremen, Germany
- Leibniz ScienceCampus Digital Public Health, Bremen, Germany
- Digital Health Section, European Public Health Association (EUPHA), Utrecht, Netherlands
| | - Robert Hrynyschyn
- Leibniz ScienceCampus Digital Public Health, Bremen, Germany
- Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Institute of Health and Nursing Science, Institute of Health and Nursing Science, Berlin, Germany
| | - Martin Lange
- Department of Fitness & Health, IST University of Applied Sciences, Düsseldorf, Germany
| | - Alexandra Löwe
- Department of Fitness & Health, IST University of Applied Sciences, Düsseldorf, Germany
| | - Kathrin Burdenski
- School of Sport, Exercise and Health Sciences, Loughborough University, Loughborough, United Kingdom
| | - Kaley Butten
- Australian eHealth Research Centre (CSIRO), Brisbane, Australia
| | - Sebastian Vorberg
- QuR.digital - Vorberg.law, Hamburg, Germany
- Bundesverband Internetmedizin eV, Hamburg, Germany
| | - Mariam Hachem
- Department of Medicine, Austin Health, Faculty of Dentistry, Medicine and Health Sciences, University of Melbourne, Melbourne, Australia
- Australian Centre for Accelerating Diabetes Innovations, Faculty of Dentistry, Medicine and Health Sciences, University of Melbourne, Melbourne, Australia
| | - Aldo Gorga
- Department of Sciences of Public Health and Pediatrics, University of Turin, Turin, Italy
| | - Vittorio Grieco
- Department of Medical, Surgical Sciences and Advanced Technologies "GF Ingrassia", University of Catania, Catania, Italy
| | | | - Giuseppe Vella
- Department of Health Promotion, Maternal and Infant Care, Internal Medicine and Medical Specialties (PROMISE) "G. D'Alessandro", University of Palermo, Palermo, Italy
| | | | - Felix Holl
- Leibniz ScienceCampus Digital Public Health, Bremen, Germany
- DigiHealth Institute, Neu-Ulm University of Applied Sciences, Neu-Ulm, Germany
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Sten-Gahmberg S, Pedersen K, Harsheim IG, Løyland HI, Snilsberg Ø, Iversen T, Godager G, Sæther EM, Abelsen B. Pragmatic randomized controlled trial comparing a complex telemedicine-based intervention with usual care in patients with chronic conditions. THE EUROPEAN JOURNAL OF HEALTH ECONOMICS : HEPAC : HEALTH ECONOMICS IN PREVENTION AND CARE 2024; 25:1275-1289. [PMID: 38291176 PMCID: PMC11377648 DOI: 10.1007/s10198-023-01664-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/22/2023] [Accepted: 12/21/2023] [Indexed: 02/01/2024]
Abstract
This study evaluates a complex telemedicine-based intervention targeting patients with chronic health problems. Computer tablets and home telemonitoring devices are used by patients to report point-of-care measurements, e.g., blood pressure, blood glucose or oxygen saturation, and to answer health-related questions at a follow-up center. We designed a pragmatic randomized controlled trial to compare the telemedicine-based intervention with usual care in six local centers in Norway. The study outcomes included health-related quality of life (HRQoL) based on the EuroQol questionnaire (EQ-5D-5L), patient experiences, and utilization of healthcare. We also conducted a cost-benefit analysis to inform policy implementation, as well as a process evaluation (reported elsewhere). We used mixed methods to analyze data collected during the trial (health data, survey data and interviews with patients and health personnel) as well as data from national health registers. 735 patients were included during the period from February 2019 to June 2020. One year after inclusion, the effects on the use of healthcare services were mixed. The proportion of patients receiving home-based care services declined, but the number of GP contacts increased in the intervention group compared to the control group. Participants in the intervention group experienced improved HRQoL compared to the control group and were more satisfied with the follow-up of their health. The cost-benefit of the intervention depends largely on the design of the service and the value society places on improved safety and self-efficacy.
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Affiliation(s)
- Susanna Sten-Gahmberg
- Oslo Economics, Klingenberggata 7, 0161, Oslo, Norway.
- The Finnish Centre for Pensions, 00065, ELÄKETURVAKESKUS, Finland.
| | - Kine Pedersen
- Oslo Economics, Klingenberggata 7, 0161, Oslo, Norway
- Department of Health Management and Health Economics, University of Oslo, Postboks 1089 Blindern, 0317, Oslo, Norway
| | | | | | - Øyvind Snilsberg
- Department of Health Management and Health Economics, University of Oslo, Postboks 1089 Blindern, 0317, Oslo, Norway
| | - Tor Iversen
- Department of Health Management and Health Economics, University of Oslo, Postboks 1089 Blindern, 0317, Oslo, Norway
| | - Geir Godager
- Department of Health Management and Health Economics, University of Oslo, Postboks 1089 Blindern, 0317, Oslo, Norway
| | | | - Birgit Abelsen
- Norwegian Centre for Rural Medicine, Department of Community Medicine, UiT - The Arctic University of Norway, 9037, Tromsø, Norway
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Burchert S, Alkneme MS, Alsaod A, Cuijpers P, Heim E, Hessling J, Hosny N, Sijbrandij M, van’t Hof E, Ventevogel P, Knaevelsrud C. Effects of a self-guided digital mental health self-help intervention for Syrian refugees in Egypt: A pragmatic randomized controlled trial. PLoS Med 2024; 21:e1004460. [PMID: 39250521 PMCID: PMC11419380 DOI: 10.1371/journal.pmed.1004460] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/09/2024] [Revised: 09/23/2024] [Accepted: 08/14/2024] [Indexed: 09/11/2024] Open
Abstract
BACKGROUND Digital mental health interventions for smartphones, such as the World Health Organization (WHO) Step-by-Step (SbS) program, are potentially scalable solutions to improve access to mental health and psychosocial support in refugee populations. Our study objective was to evaluate the effectiveness of SbS as self-guided intervention with optional message-based contact-on-demand (COD) support on reducing psychological distress, functional impairment, symptoms of posttraumatic stress disorder (PTSD), and self-identified problems in a sample of Syrian refugees residing in Egypt. METHODS AND FINDINGS We conducted a 2-arm pragmatic randomized controlled trial. A total of 538 Syrians residing in Egypt with elevated levels of psychological distress (Kessler Psychological Distress Scale; K10 > 15) and reduced psychosocial functioning (WHODAS 2.0 > 16) were randomized into SbS + CAU (N = 266) or CAU only (N = 272). Primary outcomes were psychological distress (Hopkins Symptom Checklist 25) and impaired functioning (WHO Disability Assessment Schedule 2.0) at 3-month follow-up. Secondary outcomes were symptoms of PTSD (PTSD Checklist for DSM-5 short form, PCL-5 short) and self-identified problems (Psychological Outcomes Profiles Scale, PSYCHLOPS). Intention-to-treat (ITT) analyses showed significant but small effects of condition on psychological distress (mean difference: -0.15; 95% CI: -0.28, -0.02; p = .02) and functioning (mean difference: -2.04; 95% CI: -3.87, -0.22; p = .02) at 3-month follow-up. There were no significant differences between groups on symptoms of PTSD and self-identified problems. Remission rates did not differ between conditions on any of the outcomes. COD was used by 9.4% of participants for a median of 1 contact per person. The main limitations are high intervention dropout and low utilization of COD support. CONCLUSIONS The trial provides a real-world implementation case, showing small positive effects of a digital, potentially scalable and self-guided mental health intervention for Syrian refugees in Egypt in reducing psychological distress and improving overall functioning. Further user-centered adaptations are required to improve adherence and effectiveness while maintaining scalability. TRIAL REGISTRATION German Register for Clinical Studies DRKS00023505.
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Affiliation(s)
- Sebastian Burchert
- Department of Education and Psychology, Division of Clinical Psychological Intervention, Freie Universität Berlin, Berlin, Germany
| | - Mhd Salem Alkneme
- Department of Education and Psychology, Division of Clinical Psychological Intervention, Freie Universität Berlin, Berlin, Germany
| | - Ammar Alsaod
- Department of Education and Psychology, Division of Clinical Psychological Intervention, Freie Universität Berlin, Berlin, Germany
| | - Pim Cuijpers
- Department of Clinical, Neuro and Developmental Psychology, WHO Collaborating Center for Research and Dissemination of Psychological Interventions, Amsterdam Public Health Research Institute, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
- Babeș-Bolyai University, International Institute for Psychotherapy, Cluj-Napoca, Romania
| | - Eva Heim
- Department of Psychology, University of Lausanne, Lausanne, Switzerland
| | - Jonas Hessling
- Department of Education and Psychology, Division of Clinical Psychological Intervention, Freie Universität Berlin, Berlin, Germany
| | - Nadine Hosny
- Department of Psychology, University of Lausanne, Lausanne, Switzerland
- Department of Psychology, The American University in Cairo, New Cairo, Egypt
| | - Marit Sijbrandij
- Department of Clinical, Neuro and Developmental Psychology, WHO Collaborating Center for Research and Dissemination of Psychological Interventions, Amsterdam Public Health Research Institute, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
| | | | - Pieter Ventevogel
- Public Health Section, Division of Resilience and Solutions, United Nations High Commissioner for Refugees, Geneva, Switzerland
| | - Christine Knaevelsrud
- Department of Education and Psychology, Division of Clinical Psychological Intervention, Freie Universität Berlin, Berlin, Germany
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Mitteregger E, Dirks T, Theiler M, Kretschmar O, Latal B. The implementation of EMI-Heart, a family-tailored early motor intervention in infants with complex congenital heart disease, in practice: a feasibility RCT. Pilot Feasibility Stud 2024; 10:105. [PMID: 39095881 PMCID: PMC11295334 DOI: 10.1186/s40814-024-01532-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2023] [Accepted: 07/15/2024] [Indexed: 08/04/2024] Open
Abstract
BACKGROUND Children with congenital heart disease (CHD) who undergo open-heart surgery are at risk of developmental impairment, including motor delay, which contributes to parental concerns. Additionally, parents experience prolonged stress associated with their child's disease. There is a lack of early motor interventions in infants with CHD accounting for parental burdens. We developed a family-tailored early motor intervention (EMI-Heart), aiming to promote motor development in infants with CHD and family well-being. The primary aim was to evaluate the feasibility of the study design and the intervention. The secondary aim was to evaluate differences between the intervention and the control group in motor outcomes and family well-being at baseline (3-5 months), post-treatment (6-8 months), and at follow-up (12 months). METHOD In this single-centre feasibility randomized control trial (RCT), infants with CHD after open-heart surgery without genetic or major neurological comorbidities were randomly allocated to EMI-Heart or the control group (standard of care). EMI-Heart's key elements promote postural functional activities and encourage parental sensitivity to infants' motor and behaviour cues. Infants assigned to EMI-Heart received nine sessions of early motor intervention at home, in the hospital, and online for a duration of 3 months by a paediatric physiotherapist. We performed descriptive statistics for feasibility and secondary outcomes. RESULTS The recruitment rate was 59% (10/17), all participating families completed the study (10/10), and the intervention duration was 3.9 months (± 0.54), including nine intervention sessions per family. Median acceptability to parents was 3.9 (1 = not agree-4 = totally agree, Likert scale). The paediatric physiotherapist considered the intervention as feasible. The comparison of motor outcomes did not show differences between groups. However, we detected improved reliable change scores in family well-being outcomes for families of the intervention group compared to the controls. CONCLUSIONS Our research indicates that EMI-Heart is a feasible intervention for infants with CHD after open-heart surgery. The intervention was highly acceptable both to parents and to the paediatric physiotherapist. Online treatment sessions offer a valuable alternative to home and hospital visits. This feasibility RCT provides a foundation for a future full trial. TRIAL REGISTRATION ClinicalTrials.gov, NCTT04666857. Registered 23.11.2020.
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Affiliation(s)
- Elena Mitteregger
- Child Development Center, University Children's Hospital Zurich, Steinwiesstrasse 75, Zurich, CH-8032, Switzerland.
- Children's Research Center, University Children's Hospital Zurich, Zurich, Switzerland.
- University of Zurich, Zurich, Switzerland.
| | - Tineke Dirks
- Lecturer Emerita, Paediatric, Physiotherapy, Groningen, Netherlands
| | - Manuela Theiler
- Swiss Parents' Association for Children with Heart Disease (Elternvereinigung für das Herzkranke Kind), Aarau, Switzerland
| | - Oliver Kretschmar
- University of Zurich, Zurich, Switzerland
- Department of Pediatric Cardiology, University Children's Hospital Zurich, Zurich, Switzerland
| | - Beatrice Latal
- Child Development Center, University Children's Hospital Zurich, Steinwiesstrasse 75, Zurich, CH-8032, Switzerland
- Children's Research Center, University Children's Hospital Zurich, Zurich, Switzerland
- University of Zurich, Zurich, Switzerland
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Strechen I, Wilson P, Eltalhi T, Piche K, Tschida-Reuter D, Howard D, Sutor B, Tiong I, Herasevich S, Pickering B, Barwise A. Harnessing health information technology to promote equitable care for patients with limited English proficiency and complex care needs. Trials 2024; 25:450. [PMID: 38961501 PMCID: PMC11223355 DOI: 10.1186/s13063-024-08254-y] [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: 03/01/2024] [Accepted: 06/18/2024] [Indexed: 07/05/2024] Open
Abstract
BACKGROUND Patients with language barriers encounter healthcare disparities, which may be alleviated by leveraging interpreter skills to reduce cultural, language, and literacy barriers through improved bidirectional communication. Evidence supports the use of in-person interpreters, especially for interactions involving patients with complex care needs. Unfortunately, due to interpreter shortages and clinician underuse of interpreters, patients with language barriers frequently do not get the language services they need or are entitled to. Health information technologies (HIT), including artificial intelligence (AI), have the potential to streamline processes, prompt clinicians to utilize in-person interpreters, and support prioritization. METHODS From May 1, 2023, to June 21, 2024, a single-center stepped wedge cluster randomized trial will be conducted within 35 units of Saint Marys Hospital & Methodist Hospital at Mayo Clinic in Rochester, Minnesota. The units include medical, surgical, trauma, and mixed ICUs and hospital floors that admit acute medical and surgical care patients as well as the emergency department (ED). The transitions between study phases will be initiated at 60-day intervals resulting in a 12-month study period. Units in the control group will receive standard care and rely on clinician initiative to request interpreter services. In the intervention group, the study team will generate a daily list of adult inpatients with language barriers, order the list based on their complexity scores (from highest to lowest), and share it with interpreter services, who will send a secure chat message to the bedside nurse. This engagement will be triggered by a predictive machine-learning algorithm based on a palliative care score, supplemented by other predictors of complexity including length of stay and level of care as well as procedures, events, and clinical notes. DISCUSSION This pragmatic clinical trial approach will integrate a predictive machine-learning algorithm into a workflow process and evaluate the effectiveness of the intervention. We will compare the use of in-person interpreters and time to first interpreter use between the control and intervention groups. TRIAL REGISTRATION NCT05860777. May 16, 2023.
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Affiliation(s)
- Inna Strechen
- Department of Anesthesiology and Perioperative Medicine, Division of Critical Care, Mayo Clinic, Rochester, MN, USA.
| | - Patrick Wilson
- Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, MN, USA
| | - Targ Eltalhi
- Language Services, Mayo Clinic, Rochester, MN, USA
| | | | | | - Diane Howard
- Language Services Operations Administrator, Mayo Clinic, Rochester, MN, USA
| | - Bruce Sutor
- Department of Psychiatry and Psychology and Medical Director of Language Services, Mayo Clinic, Rochester, MN, USA
| | - Ing Tiong
- Information Technology, Mayo Clinic, Rochester, MN, USA
| | - Svetlana Herasevich
- Department of Anesthesiology and Perioperative Medicine, Division of Critical Care, Mayo Clinic, Rochester, MN, USA
| | - Brian Pickering
- Department of Anesthesiology and Perioperative Medicine, Division of Critical Care, Mayo Clinic, Rochester, MN, USA
| | - Amelia Barwise
- Biomedical Ethics Research Program and Division of Pulmonary and Critical Care Medicine, Mayo Clinic, Rochester, MN, USA
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7
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Oh SL, Mishler O, Syme S, Jones D, Saito H. Impact of the modified curricula on periodontal instrumentation skills development during the COVID-19 pandemic from 2020 to 2023. J Dent Educ 2024. [PMID: 38953146 DOI: 10.1002/jdd.13632] [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: 02/05/2024] [Revised: 04/23/2024] [Accepted: 06/02/2024] [Indexed: 07/03/2024]
Abstract
OBJECTIVES This study aimed to evaluate the impact of curriculum modifications on periodontal instrumentation skills development among classes of 2021, 2022, and 2023 during the COVID-19 pandemic. METHODS The pandemic began and affected the three classes at different stages of their studies. Onsite simulation-based learning (SBL) was employed for the classes of 2021 and 2022; remote SBL was adopted for the class of 2023. Modified clinical education, due to social distancing guidelines, impacted the class of 2021 significantly and the class of 2022 to a lesser extent. A multiple linear regression model was built to examine the association between the fourth-year patient-based scaling competency examination scores and selected predictors. RESULTS The classes of 2021 and 2023 showed consistent performances over time, while the class of 2022 exhibited significant variation exhibiting the lowest performance at the second-year practical examination. While the clinical experience of the class of 2021 was significantly less than that of the classes of 2022 and 2023, the fourth-year competency examination scores did not differ across the three classes. The clinic points (p = 0.014) significantly affected the fourth-year competency examination score while student gender (p = 0.18), the first-year (p = 0.736), and second-year (p = 0.198) practical examination scores showed no correlations. CONCLUSION Based on student performance in the fourth-year scaling competency examination, the curriculum modifications due to the COVID pandemic did not affect student learning outcomes. Clinical experience was the most influential determinant of skill development in periodontal instrumentation.
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Affiliation(s)
- Se-Lim Oh
- Department of Advanced Oral Sciences and Therapeutics, University of Maryland School of Dentistry, Baltimore, Maryland, USA
| | - Oksana Mishler
- Department of Advanced Oral Sciences and Therapeutics, University of Maryland School of Dentistry, Baltimore, Maryland, USA
| | - Sheryl Syme
- Department of Advanced Oral Sciences and Therapeutics, University of Maryland School of Dentistry, Baltimore, Maryland, USA
| | - Deborah Jones
- Department of Advanced Oral Sciences and Therapeutics, University of Maryland School of Dentistry, Baltimore, Maryland, USA
| | - Hanae Saito
- Department of Advanced Oral Sciences and Therapeutics, University of Maryland School of Dentistry, Baltimore, Maryland, USA
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Katheria AC, El Ghormli L, Clark E, Yoder B, Schmölzer GM, Law BHY, El-Naggar W, Rittenberg D, Sheth S, Martin C, Vora F, Lakshminrusimha S, Underwood M, Mazela J, Kaempf J, Tomlinson M, Gollin Y, Rich W, Morales A, Varner M, Poeltler D, Vaucher Y, Mercer J, Finer N, Rice MM. Two-Year Outcomes of Umbilical Cord Milking in Nonvigorous Infants: A Secondary Analysis of the MINVI Randomized Clinical Trial. JAMA Netw Open 2024; 7:e2416870. [PMID: 38949814 PMCID: PMC11217871 DOI: 10.1001/jamanetworkopen.2024.16870] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/19/2024] [Accepted: 04/15/2024] [Indexed: 07/02/2024] Open
Abstract
Importance Compared with early cord clamping (ECC), umbilical cord milking (UCM) reduces delivery room cardiorespiratory support, hypoxic-ischemic encephalopathy, and therapeutic hypothermia in nonvigorous near-term and full-term infants. However, UCM postdischarge outcomes are not known. Objective To determine the 2-year outcomes of children randomized to UCM or ECC at birth in the Milking in Nonvigorous Infants (MINVI) trial. Design, Setting, and Participants A secondary analysis to evaluate longer-term outcomes of a cluster-randomized crossover trial was conducted from January 9, 2021, to September 25, 2023. The primary trial took place in 10 medical centers in the US, Canada, and Poland from January 5, 2019, to June 1, 2021, and hypothesized that UCM would reduce admission to the neonatal intensive care unit compared with ECC; follow-up concluded September 26, 2023. The population included near-term and full-term infants aged 35 to 42 weeks' gestation at birth who were nonvigorous; families provided consent to complete developmental screening questionnaires through age 2 years. Intervention UCM and ECC. Main Outcomes and Measures Ages and Stages Questionnaire, 3rd Edition (ASQ-3) and Modified Checklist for Autism in Toddlers, Revised/Follow-Up (M-CHAT-R/F) questionnaires at ages 22 to 26 months. Intention-to-treat analysis and per-protocol analyses were used. Results Among 1730 newborns from the primary trial, long-term outcomes were evaluated in 971 children (81%) who had ASQ-3 scores available at 2 years or died before age 2 years and 927 children (77%) who had M-CHAT-R/F scores or died before age 2 years. Maternal and neonatal characteristics by treatment group were similar, with median birth gestational age of 39 (IQR, 38-40) weeks in both groups; 224 infants (45%) in the UCM group and 201 (43%) in the ECC group were female. The median ASQ-3 total scores were similar (UCM: 255 [IQR, 225-280] vs ECC: 255 [IQR, 230-280]; P = .87), with no significant differences in the ASQ-3 subdomains. Medium- to high-risk M-CHAT-R/F scores were also similar (UCM, 9% [45 of 486] vs ECC, 8% [37 of 441]; P = .86). Conclusions and Relevance In this secondary analysis of a randomized clinical trial among late near-term and full-term infants who were nonvigorous at birth, ASQ-3 scores at age 2 years were not significantly different between the UCM and ECC groups. Combined with previously reported important short-term benefits, this follow-up study suggests UCM is a feasible, no-cost intervention without longer-term neurodevelopmental risks of cord milking in nonvigorous near-term and term newborns. Trial Registration ClinicalTrials.gov Identifier: NCT03631940.
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Affiliation(s)
- Anup C. Katheria
- Neonatal Research Institute, Sharp Mary Birch Hospital for Women & Newborns, San Diego, California
| | - Laure El Ghormli
- George Washington University Biostatistics Center, Milken Institute School of Public Health, Rockville, Maryland
| | - Erin Clark
- School of Medicine, University of Utah Salt Lake City
| | - Bradley Yoder
- School of Medicine, University of Utah Salt Lake City
| | - Georg M. Schmölzer
- Faculty of Medicine and Dentistry, University of Alberta Alberta, Canada
| | - Brenda H. Y. Law
- Faculty of Medicine and Dentistry, University of Alberta Alberta, Canada
| | | | | | - Sheetal Sheth
- School of Medicine, George Washington University, Washington, DC
| | | | - Farha Vora
- Loma Linda University, Loma Linda, California
| | | | - Mark Underwood
- School of Medicine, University of California, Davis, Sacramento
| | - Jan Mazela
- Poznan University of Medical Sciences, Poznan, Poland
| | - Joseph Kaempf
- Providence St Vincent Medical Center, Portland, Oregon
| | | | - Yvonne Gollin
- Neonatal Research Institute, Sharp Mary Birch Hospital for Women & Newborns, San Diego, California
| | - Wade Rich
- Neonatal Research Institute, Sharp Mary Birch Hospital for Women & Newborns, San Diego, California
| | - Ana Morales
- Neonatal Research Institute, Sharp Mary Birch Hospital for Women & Newborns, San Diego, California
| | | | - Debra Poeltler
- Neonatal Research Institute, Sharp Mary Birch Hospital for Women & Newborns, San Diego, California
| | | | - Judith Mercer
- Neonatal Research Institute, Sharp Mary Birch Hospital for Women & Newborns, San Diego, California
- University of Rhode Island, Kingston
| | - Neil Finer
- Neonatal Research Institute, Sharp Mary Birch Hospital for Women & Newborns, San Diego, California
| | - Madeline Murguia Rice
- George Washington University Biostatistics Center, Milken Institute School of Public Health, Rockville, Maryland
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9
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Sankar K, Redman MW, Dragnev KH, Henick BS, Iams WT, Blanke CD, Herbst RS, Gray JE, Reckamp KL. Pragmaticism in Cancer Clinical Trials. Am Soc Clin Oncol Educ Book 2024; 44:e100040. [PMID: 38771997 DOI: 10.1200/edbk_100040] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/23/2024]
Abstract
Clinical trials are essential for advancing oncology treatment strategies and have contributed significantly to the decline in cancer mortality rates over the past decades. Traditional explanatory trials, focused on establishing intervention efficacy in ideal settings, often lack generalizability and may not reflect real-world patient care scenarios. Furthermore, increasing complexity in cancer clinical trial design has led to challenges such as protocol deviations, slow enrollment leading to lengthened durations of trial, and escalating costs. By contrast, pragmatic trials aim to assess intervention effectiveness in more representative patient populations under routine clinical conditions. Here, we review the principles, methodologies, challenges, and advantages of incorporating pragmatic features (PFs) into cancer clinical trials. We illustrate the application of pragmatic trial designs in oncology and discuss the QUASAR collaborative, TAPUR study, and the ongoing PRAGMATICA-LUNG trial. Although not all oncology trials may be amenable to adopting fully pragmatic designs, integration of PFs when feasible will enhance trial generalizability and real-world applicability. Project Pragmatica and similar initiatives advocate for the integration of real-world practice with clinical trials, fostering a nuanced approach to oncology research that balances efficacy and effectiveness assessments, ultimately with a goal of improving patient outcomes.
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Affiliation(s)
| | - Mary W Redman
- SWOG Statistics and Data Management Center, Seattle, WA
- Fred Hutchinson Cancer Center, Seattle, WA
| | | | - Brian S Henick
- Columbia University/Herbert Irving Comprehensive Cancer Center, New York, NY
| | - Wade T Iams
- Vanderbilt University Medical Center, Nashville, TN
| | - Charles D Blanke
- SWOG Network Operations Center/Oregon Health & Science University, Portland, OR
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10
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Marbán-Castro E, Muhwava L, Kamau Y, Safary E, Rheeder P, Karsas M, Kemp T, Freitas J, Carrihill M, Dave J, Katambo D, Kimetto J, Allie R, Ndungu J, Sigwebela N, Akach D, Girdwood S, Erkosar B, Nichols BE, Haldane C, Vetter B, Shilton S. Implementation research: a protocol for two three-arm pragmatic randomised controlled trials on continuous glucose monitoring devices in people with type 1 diabetes in South Africa and Kenya. Trials 2024; 25:331. [PMID: 38773658 PMCID: PMC11107040 DOI: 10.1186/s13063-024-08132-7] [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: 01/18/2024] [Accepted: 04/22/2024] [Indexed: 05/24/2024] Open
Abstract
BACKGROUND Self-monitoring of glucose is an essential component of type 1 diabetes (T1D) management. In recent years, continuous glucose monitoring (CGM) has provided an alternative to daily fingerstick testing for the optimisation of insulin dosing and general glucose management in people with T1D. While studies have been conducted to evaluate the impact of CGM on clinical outcomes in the US, Europe and Australia, there are limited data available for low- and middle-income countries (LMICs) and further empirical evidence is needed to inform policy decision around their use in these countries. METHODS This trial was designed as a pragmatic, parallel-group, open-label, multicentre, three-arm, randomised (1:1:1) controlled trial of continuous or periodic CGM device use versus standard of care in people with T1D in South Africa and Kenya. The primary objective of this trial will be to assess the impact of continuous or periodic CGM device use on glycaemic control as measured by change from baseline glycosylated haemoglobin (HbA1c). Additional assessments will include clinical outcomes (glucose variation, time in/below/above range), safety (adverse events, hospitalisations), quality of life (EQ-5D, T1D distress score, Glucose Monitoring Satisfaction Survey for T1D), and health economic measures (incremental cost-effectiveness ratios, quality adjusted life years). DISCUSSION This trial aims to address the substantial evidence gap on the impact of CGM device use on clinical outcomes in LMICs, specifically South Africa and Kenya. The trial results will provide evidence to inform policy and treatment decisions in these countries. TRIAL REGISTRATION NCT05944731 (Kenya), July 6, 2023; NCT05944718 (South Africa), July 13, 2023.
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Affiliation(s)
| | - Lorrein Muhwava
- FIND, Campus Biotech, Chemin Des Mines 9, 1202, Geneva, Switzerland
| | - Yvonne Kamau
- FIND, Campus Biotech, Chemin Des Mines 9, 1202, Geneva, Switzerland
| | - Elvis Safary
- FIND, Campus Biotech, Chemin Des Mines 9, 1202, Geneva, Switzerland
| | - Paul Rheeder
- University of Pretoria Diabetes Research Centre, Gezina, Pretoria, South Africa
| | - Maria Karsas
- University of Pretoria Diabetes Research Centre, Gezina, Pretoria, South Africa
| | - Tanja Kemp
- University of Pretoria Diabetes Research Centre, Gezina, Pretoria, South Africa
| | - Johanè Freitas
- University of Pretoria Diabetes Research Centre, Gezina, Pretoria, South Africa
| | - Michelle Carrihill
- Red Cross Childrens Hospital, Paediatric Clinic, Cape Town, South Africa
| | - Joel Dave
- Division of Endocrinology, Groote Schuur Hospital and the University of Cape Town, Cape Town, South Africa
| | - Daniel Katambo
- Kenya Diabetes Management and Information Centre, Nairobi, Kenya
| | - Joan Kimetto
- Kenya Diabetes Management and Information Centre, Nairobi, Kenya
| | - Razana Allie
- University of Pretoria Diabetes Research Centre, Gezina, Pretoria, South Africa
| | - Joseph Ndungu
- FIND, Campus Biotech, Chemin Des Mines 9, 1202, Geneva, Switzerland
| | - Ntombi Sigwebela
- FIND, Campus Biotech, Chemin Des Mines 9, 1202, Geneva, Switzerland
| | - Dorcas Akach
- FIND, Campus Biotech, Chemin Des Mines 9, 1202, Geneva, Switzerland
| | - Sarah Girdwood
- FIND, Campus Biotech, Chemin Des Mines 9, 1202, Geneva, Switzerland
| | - Berra Erkosar
- FIND, Campus Biotech, Chemin Des Mines 9, 1202, Geneva, Switzerland
| | - Brooke E Nichols
- FIND, Campus Biotech, Chemin Des Mines 9, 1202, Geneva, Switzerland
| | - Cathy Haldane
- FIND, Campus Biotech, Chemin Des Mines 9, 1202, Geneva, Switzerland
| | - Beatrice Vetter
- FIND, Campus Biotech, Chemin Des Mines 9, 1202, Geneva, Switzerland
| | - Sonjelle Shilton
- FIND, Campus Biotech, Chemin Des Mines 9, 1202, Geneva, Switzerland
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11
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Grisay G, Turco F, Litiere S, Fournier B, Patrikidou A, Gallardo E, McDermott R, Alanya A, Gillessen S, Tombal B. EORTC 2238 "De-Escalate": a pragmatic trial to revisit intermittent androgen deprivation therapy in the era of new androgen receptor pathway inhibitors. Front Oncol 2024; 14:1391825. [PMID: 38779087 PMCID: PMC11109389 DOI: 10.3389/fonc.2024.1391825] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2024] [Accepted: 03/20/2024] [Indexed: 05/25/2024] Open
Abstract
The landscape of treating metastatic prostate cancer has evolved with the addition of Androgen Receptor pathway inhibitor (ARPI) to Androgen Deprivation Therapy (ADT), significantly improving survival rates. However, prolonged use of these therapies introduces notable side effects, prompting a need to revisit intermittent treatment duration. The EORTC 2238 De-Escalate trial is a pragmatic trial seeking to reassess the role of intermittent therapy in patients undergoing maximal androgen blockade (MAB) for metastatic hormone naïve prostate cancer (mHNPC), i.e., the combination of ADT with an ARPI, with the aims of reducing side effects, enhancing Quality of Life (QoL) and optimizing resource usage, while maintaining oncological benefits.
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Affiliation(s)
- Guillaume Grisay
- Department of Medical Oncology, Centres Hospitaliers Universitaires HELORA, La Louvière, Belgium
| | - Fabio Turco
- Oncology Institute of Southern Switzerland, Ente Ospedaliero Cantonale, Bellinzona, Switzerland
| | - Saskia Litiere
- Statistics Department, European Organization for Research and Treatment of Cancer (EORTC), Brussels, Belgium
| | - Béatrice Fournier
- Medical Department, European Organization for Research and Treatment of Cancer (EORTC), Brussels, Belgium
| | - Anna Patrikidou
- Genito-Urinary Oncology Group and Early Drug Development (DITEP), Gustave Roussy, Villejuif, France
| | - Enrique Gallardo
- Department of Oncology, Parc Taulí Hospital Universitari, Institut d’Investigació i Innovació Parc Taulí (I3PT-CERCA), Universitat Autònoma de Barcelona, Sabadell, Spain
| | - Ray McDermott
- Department of Medical Oncology, St Vincents University Hospital and Cancer Trials, Dublin, Ireland
| | - Ahu Alanya
- Quality of Life Department, European Organization for Research and Treatment of Cancer (EORTC), Brussels, Belgium
| | - Silke Gillessen
- Oncology Institute of Southern Switzerland, Ente Ospedaliero Cantonale, Bellinzona, Switzerland
- Faculty of Biomedical Sciences, Università della Svizzera Italiana, Lugano, Switzerland
| | - Bertrand Tombal
- Division of Urology, Cliniques Universitaires Saint Luc, Brussels, Belgium
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12
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Mori Y, Patel HK, Repici A, Rex DK, Sharma P, Hassan C. Computer-aided detection for colorectal neoplasia in randomized and non-randomized studies. Endosc Int Open 2024; 12:E598-E599. [PMID: 38654966 PMCID: PMC11039027 DOI: 10.1055/a-2295-2177] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/26/2024] [Accepted: 03/20/2024] [Indexed: 04/26/2024] Open
Affiliation(s)
- Yuichi Mori
- Clinical Effectiveness Research Group, University of Oslo, Oslo, Norway
- Digestive Disease Center, Showa University Northern Yokohama Hospital, Yokohama, Japan
| | - Harsh K Patel
- Gastroenterology and Hepatology, University of Kansas Medical Center, Kansas City, United States
| | - Alessandro Repici
- Department of Biomedical Sciences, Humanitas University, Milan, Italy
- Endoscopy Unit, Humanitas Clinicial and Research Center - IRCCS, Milan, Italy
| | - Douglas K Rex
- Division of Gastroenterology, Indiana University School of Medicine, Indianapolis, United States
| | - Prateek Sharma
- Gastroenterology and Hepatology, University of Kansas Medical Center, Kansas City, United States
- Gastroenterology and Hepatology, Kansas City VA Medical Center and University of Kansas School of Medicine, Kansas City, United States
| | - Cesare Hassan
- Department of Biomedical Sciences, Humanitas University, Milan, Italy
- Endoscopy Unit, Humanitas Clinicial and Research Center - IRCCS, Milan, Italy
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13
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Dandurand C, Öner CF, Hazenbiller O, Bransford RJ, Schnake K, Vaccaro AR, Benneker LM, Vialle E, Schroeder GD, Rajasekaran S, El-Skarkawi M, Kanna RM, Aly M, Holas M, Canseco JA, Muijs S, Popescu EC, Tee JW, Camino-Willhuber G, Joaquim AF, Keynan O, Chhabra HS, Bigdon S, Spiegel U, Dvorak MF. Understanding Decision Making as It Influences Treatment in Thoracolumbar Burst Fractures Without Neurological Deficit: Conceptual Framework and Methodology. Global Spine J 2024; 14:8S-16S. [PMID: 38324598 PMCID: PMC10867530 DOI: 10.1177/21925682231210183] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/09/2024] Open
Abstract
STUDY DESIGN This paper presents a description of a conceptual framework and methodology that is applicable to the manuscripts that comprise this focus issue. OBJECTIVES Our goal is to present a conceptual framework which is relied upon to better understand the processes through which surgeons make therapeutic decisions around how to treat thoracolumbar burst fractures (TL) fractures. METHODS We will describe the methodology used in the AO Spine TL A3/4 Study prospective observational study and how the radiographs collected for this study were utilized to study the relationships between various variables that factor into surgeon decision making. RESULTS With 22 expert spine trauma surgeons analyzing the acute CT scans of 183 patients with TL fractures we were able to perform pairwise analyses, look at reliability and correlations between responses and develop frequency tables, and regression models to assess the relationships and interactions between variables. We also used machine learning to develop decision trees. CONCLUSIONS This paper outlines the overall methodological elements that are common to the subsequent papers in this focus issue.
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Affiliation(s)
- Charlotte Dandurand
- Combined Neurosurgical and Orthopedic Spine Program, Vancouver General Hospital, University of British Columbia, Vancouver, BC, Canada
| | | | - Olesja Hazenbiller
- AO Spine, AO Network Clinical Research, AO Foundation, Davos, Switzerland
| | - Richard J Bransford
- Harborview Medical Center, Department of Orthopaedics and Sports Medicine, University of Washington, Seattle, WA, USA
| | - Klaus Schnake
- Center for Spinal and Scoliosis Surgery, Malteser Waldkrankenhaus St. Marien, Erlangen, Germany
- Private Medical University Nuremberg, Nuremberg, Germany
| | - Alexander R Vaccaro
- Department of Orthopaedic Surgery, Rothman Institute, Thomas Jefferson University Hospital, Philadelphia, PA, USA
| | - Lorin M Benneker
- Spine Unit, Sonnenhof Spital, University of Bern, Bern, Switzerland
| | - Emiliano Vialle
- Cajuru Hospital, Catholic University of Paraná, Curitiba, Brazil
| | - Gregory D Schroeder
- Department of Orthopaedic Surgery, Rothman Institute, Thomas Jefferson University Hospital, Philadelphia, PA, USA
| | | | - Mohammad El-Skarkawi
- Department of Orthopaedic and Trauma Surgery, Faculty of Medicine, Assiut University, Assiut, Egypt
| | - Rishi M Kanna
- Department of Orthopaedics and Spine Surgery, Ganga Hospital, Coimbatore, India
| | - Mohamed Aly
- Department of Neurosurgery, Prince Mohammed Bin Abdulaziz Hospital, Riyadh, Saudi Arabia
- Department of Neurosurgery, Mansoura University, Mansoura, Egypt
| | - Martin Holas
- Klinika Úrazovej Chirurgie SZU a FNsP F.D.Roosevelta, Banská Bystrica, Slovakia
| | - Jose A Canseco
- Department of Orthopaedic Surgery, Rothman Institute, Thomas Jefferson University Hospital, Philadelphia, PA, USA
| | - Sander Muijs
- University Medical Centers, Utrecht, Netherlands
| | | | - Jin Wee Tee
- Department of Neurosurgery, National Trauma Research Institute (NTRI), The Alfred Hospital, Melbourne, VIC, Australia
| | - Gaston Camino-Willhuber
- Orthopaedic and Traumatology Department, Institute of Orthopedics "Carlos E. Ottolenghi" Hospital Italiano de Buenos Aires, Buenes Aires, Argentina
| | | | - Ory Keynan
- Rambam Health Care Campus, Haifa, Israel
| | | | - Sebastian Bigdon
- Department of Orthopaedic Surgery and Traumatology, Inselspital, University Hospital, University of Bern, Bern, Switzerland
| | - Ulrich Spiegel
- Department of Orthopaedics, Trauma Surgery and Plastic Surgery, University of Leipzig, Leipzig, Germany
| | - Marcel F Dvorak
- Combined Neurosurgical and Orthopedic Spine Program, Vancouver General Hospital, University of British Columbia, Vancouver, BC, Canada
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14
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Canseco JA, Paziuk T, Schroeder GD, Dvorak MF, Öner CF, Benneker LM, Vialle E, Rajasekaran S, El-Sharkawi M, Bransford RJ, Kanna RM, Holas M, Muijs S, Popescu EC, Dandurand C, Tee JW, Camino-Willhuber G, Aly MM, Joaquim AF, Keynan O, Chhabra HS, Bigdon S, Spiegl UJ, Schnake K, Vaccaro AR. Interobserver Reliability in the Classification of Thoracolumbar Fractures Using the AO Spine TL Injury Classification System Among 22 Clinical Experts in Spine Trauma Care. Global Spine J 2024; 14:17S-24S. [PMID: 38324600 PMCID: PMC10867533 DOI: 10.1177/21925682231202371] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/09/2024] Open
Abstract
STUDY DESIGN Reliability study utilizing 183 injury CT scans by 22 spine trauma experts with assessment of radiographic features, classification of injuries and treatment recommendations. OBJECTIVES To assess the reliability of the AOSpine TL Injury Classification System (TLICS) including the categories within the classification and the M1 modifier. METHODS Kappa and Intraclass correlation coefficients were produced. Associations of various imaging characteristics (comminution, PLC status) and treatment recommendations were analyzed through regression analysis. Multivariable logistic regression modeling was used for making predictive algorithms. RESULTS Reliability of the AO Spine TLICS at differentiating A3 and A4 injuries (N = 71) (K = .466; 95% CI .458 - .474; P < .001) demonstrated moderate agreement. Similarly, the average intraclass correlation coefficient (ICC) amongst A3 and A4 injuries was excellent (ICC = .934; 95% CI .919 - .947; P < .001) and the ICC between individual measures was moderate (ICC = .403; 95% CI .351 - .461; P < .001). The overall agreement on the utilization of the M1 modifier amongst A3 and A4 injuries was fair (K = .161; 95% CI .151 - .171; P < .001). The ICC for PLC status in A3 and A4 injuries averaged across all measures was excellent (ICC = .936; 95% CI .922 - .949; P < .001). The M1 modifier suggests respondents are nearly 40% more confident that the PLC is injured amongst all injuries. The M1 modifier was employed at a higher frequency as injuries were classified higher in the classification system. CONCLUSIONS The reliability of surgeons differentiating between A3 and A4 injuries in the AOSpine TLICS is substantial and the utilization of the M1 modifier occurs more frequently with higher grades in the system.
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Affiliation(s)
- Jose A Canseco
- Department of Orthopaedic Surgery, Rothman Orthopaedic Institute at Thomas Jefferson University, Philadelphia, PA, USA
| | - Taylor Paziuk
- Department of Orthopaedic Surgery, Rothman Orthopaedic Institute at Thomas Jefferson University, Philadelphia, PA, USA
| | - Gregory D Schroeder
- Department of Orthopaedic Surgery, Rothman Orthopaedic Institute at Thomas Jefferson University, Philadelphia, PA, USA
| | - Marcel F Dvorak
- Combined Neurosurgical and Orthopedic Spine Program, Vancouver General Hospital, University of British Columbia, Vancouver, Canada
| | - Cumhur F Öner
- University Medical Centers, Utrecht, the Netherlands
| | - Lorin M Benneker
- Spine Unit, Sonnenhof Spital, University of Bern, Bern, Switzerland
| | - Emiliano Vialle
- Cajuru Hospital, Catholic University of Paraná, Curitiba, Brazil
| | | | - Mohammad El-Sharkawi
- Department of Orthopaedic and Trauma Surgery, Faculty of Medicine, Assiut University Medical School, Assiut, Egypt
| | - Richard J Bransford
- Department of Orthopaedics and Sports Medicine, Harborview Medical Center, University of Washington, Seattle, WA, USA
| | - Rishi M Kanna
- Department of Orthopaedics and Spine Surgery, Ganga Hospital, Coimbatore, India
| | - Martin Holas
- Klinika Úrazovej Chirurgie SZU a FNsP F.D.Roosevelta, Banská Bystrica, Slovakia
| | - Sander Muijs
- University Medical Centers, Utrecht, the Netherlands
| | | | - Charlotte Dandurand
- Combined Neurosurgical and Orthopedic Spine Program, Vancouver General Hospital, University of British Columbia, Vancouver, Canada
| | - Jin W Tee
- Department of Neurosurgery, National Trauma Research Institute (NTRI), The Alfred Hospital, Melbourne, VIC, Australia
| | - Gaston Camino-Willhuber
- Orthopaedic and Traumatology Department, Institute of Orthopedics "Carlos E. Ottolenghi" Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
| | - Mohamed M Aly
- Department of Neurosurgery, Prince Mohammed Bin Abdulaziz Hospital, Riyadh, Saudi Arabi
- Department of Neurosurgery, Mansoura University, Mansoura, Egypt
| | - Andrei Fernandes Joaquim
- Neurosurgery Division, Department of Neurology, State University of Campinas, Campinas-Sao Paulo, Brazil
| | - Ory Keynan
- Rambam Health Care Campus, Haifa, Israel
| | | | - Sebastian Bigdon
- Department of Orthopaedic Surgery and Traumatology, Inselspital, University Hospital, University of Bern, Bern, Switzerland
| | - Ulrich J Spiegl
- Department of Orthopaedics, Trauma Surgery and Plastic Surgery, University of Leipzig, Leipzig, Germany
| | - Klaus Schnake
- Center for Spinal and Scoliosis Surgery, Malteser Waldkrankenhaus St. Marien Erlangen, Erlangen, Germany
- Department of Orthopedics and Traumatology, Paracelsus Private Medical University Nuremberg, Nuremberg, Germany
| | - Alexander R Vaccaro
- Department of Orthopaedic Surgery, Rothman Orthopaedic Institute at Thomas Jefferson University, Philadelphia, PA, USA
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15
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Wen J, Hou J, Bonzel CL, Zhao Y, Castro VM, Gainer VS, Weisenfeld D, Cai T, Ho YL, Panickan VA, Costa L, Hong C, Gaziano JM, Liao KP, Lu J, Cho K, Cai T. LATTE: Label-efficient incident phenotyping from longitudinal electronic health records. PATTERNS (NEW YORK, N.Y.) 2024; 5:100906. [PMID: 38264714 PMCID: PMC10801250 DOI: 10.1016/j.patter.2023.100906] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/27/2023] [Revised: 09/06/2023] [Accepted: 12/01/2023] [Indexed: 01/25/2024]
Abstract
Electronic health record (EHR) data are increasingly used to support real-world evidence studies but are limited by the lack of precise timings of clinical events. Here, we propose a label-efficient incident phenotyping (LATTE) algorithm to accurately annotate the timing of clinical events from longitudinal EHR data. By leveraging the pre-trained semantic embeddings, LATTE selects predictive features and compresses their information into longitudinal visit embeddings through visit attention learning. LATTE models the sequential dependency between the target event and visit embeddings to derive the timings. To improve label efficiency, LATTE constructs longitudinal silver-standard labels from unlabeled patients to perform semi-supervised training. LATTE is evaluated on the onset of type 2 diabetes, heart failure, and relapses of multiple sclerosis. LATTE consistently achieves substantial improvements over benchmark methods while providing high prediction interpretability. The event timings are shown to help discover risk factors of heart failure among patients with rheumatoid arthritis.
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Affiliation(s)
- Jun Wen
- Harvard Medical School, Boston, MA, USA
- VA Boston Healthcare System, Boston, MA, USA
| | - Jue Hou
- University of Minnesota, Minneapolis, MN, USA
| | - Clara-Lea Bonzel
- Harvard Medical School, Boston, MA, USA
- VA Boston Healthcare System, Boston, MA, USA
| | | | | | | | | | - Tianrun Cai
- VA Boston Healthcare System, Boston, MA, USA
- Mass General Brigham, Boston, MA, USA
| | - Yuk-Lam Ho
- VA Boston Healthcare System, Boston, MA, USA
| | - Vidul A. Panickan
- Harvard Medical School, Boston, MA, USA
- VA Boston Healthcare System, Boston, MA, USA
| | | | | | - J. Michael Gaziano
- Harvard Medical School, Boston, MA, USA
- VA Boston Healthcare System, Boston, MA, USA
- Brigham and Women’s Hospital, Boston, MA, USA
| | - Katherine P. Liao
- Harvard Medical School, Boston, MA, USA
- VA Boston Healthcare System, Boston, MA, USA
- Brigham and Women’s Hospital, Boston, MA, USA
| | - Junwei Lu
- VA Boston Healthcare System, Boston, MA, USA
- Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Kelly Cho
- Harvard Medical School, Boston, MA, USA
- VA Boston Healthcare System, Boston, MA, USA
- Brigham and Women’s Hospital, Boston, MA, USA
| | - Tianxi Cai
- Harvard Medical School, Boston, MA, USA
- VA Boston Healthcare System, Boston, MA, USA
- Harvard T.H. Chan School of Public Health, Boston, MA, USA
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16
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Kajander-Unkuri S, Vaismoradi M, Katajisto J, Kangasniemi M, Turjamaa R. Effect of robot for medication management on home care professionals' use of working time in older people's home care: a non-randomized controlled clinical trial. BMC Health Serv Res 2023; 23:1344. [PMID: 38042773 PMCID: PMC10693699 DOI: 10.1186/s12913-023-10367-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2023] [Accepted: 11/22/2023] [Indexed: 12/04/2023] Open
Abstract
BACKGROUND Medication management has a key role in the daily tasks of home care professionals delivered to older clients in home care. The aim of this study was to examine the effect of using a robot for medication management on home care professionals´ use of working time. METHODS A pragmatic non-randomized controlled clinical trial was conducted. The participants were home care professionals who carried out home care clients' medication management. Home care clients were allocated into intervention groups (IG) and control groups (CG) (n = 64 and 46, respectively) based on whether or not they received the robot. Data were collected using the Working Time Tracking Form prior to and 1 and 2 months after introducing the intervention. The t-test was used to compare the groups at each three timepoints. Analysis of Covariance was used to examine the groups' differences for the total time for medications as the number of visits per day as the covariate. RESULTS With robot use, the total amount of home visits decreased by 89.4% and 92.4% after 1 and 2 months of intervention use, respectively, compared to pre-intervention (p < 0.001). The total working time used for medication management considering the number of visits per day decreased from 54.2 min (95% CI 37.4-44.3) to 34.9 min (31.4-38.3), i.e., by slightly over 19 min (p < 0.001) in the IG group. During the follow-up, the total working time used for medication management considering the number of visits per day remained the same in the CG group. CONCLUSION Using a robot for medication management had a notable effect on decreasing the use of working time of home care professionals. For health services, decreased use of working time for medication management means that the time saved can be assigned to services that cannot be replaced otherwise. More digital solutions should be developed based on home care clients' and professionals' needs to meet the challenge of the growing number of older people in need of home care and ensure their safety. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT05908604 retrospectively registered (18/06/2023).
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Affiliation(s)
- Satu Kajander-Unkuri
- Department of Nursing Science, Faculty of Medicine, University of Turku, Turku, Finland
- Diaconia University of Applied Sciences, Helsinki, Finland
| | - Mojtaba Vaismoradi
- Faculty of Nursing and Health Sciences, Nord University, Bodø, Norway.
- Faculty of Science and Health, Charles Sturt University, Orange, NSW, Australia.
| | - Jouko Katajisto
- Department of Mathematics and Statistics, University of Turku, Turku, Finland
| | - Mari Kangasniemi
- Department of Nursing Science, Faculty of Medicine, University of Turku, Turku, Finland
- Satasairaala, Pori, Finland
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17
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Temte JL, Checovich MM, Barlow S, Shult PA, Reisdorf E, Haupt TE, Hamrick I, Mundt MP. Rapid Detection of Influenza Outbreaks in Long-Term Care Facilities Reduces Emergency Room Visits and Hospitalization: A Randomized Trial. J Am Med Dir Assoc 2023; 24:1904-1909. [PMID: 37421970 DOI: 10.1016/j.jamda.2023.05.035] [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] [Received: 01/20/2023] [Revised: 05/30/2023] [Accepted: 05/31/2023] [Indexed: 07/10/2023]
Abstract
OBJECTIVES To assess whether the use of rapid influenza diagnostic tests (RIDTs) for long-term care facility (LTCF) residents with acute respiratory infection is associated with increased antiviral use and decreased health care utilization. DESIGN Nonblinded, pragmatic, randomized controlled trial evaluating a 2-part intervention with modified case identification criteria and nursing staff-initiated collection of nasal swab specimen for on-site RIDT. SETTING AND PARTICIPANTS Residents of 20 LTCFs in Wisconsin matched by bed capacity and geographic location and then randomized. METHODS Primary outcome measures, expressed as events per 1000 resident-weeks, included antiviral treatment courses, antiviral prophylaxis courses, total emergency department (ED) visits, ED visits for respiratory illness, total hospitalizations, hospitalizations for respiratory illness, hospital length of stay, total deaths, and deaths due to respiratory illness over 3 influenza seasons. RESULTS Oseltamivir use for prophylaxis was higher at intervention LTCFs [2.6 vs 1.9 courses per 1000 person-weeks; rate ratio (RR) 1.38, 95% CI 1.24-1.54; P < .001]; rates of oseltamivir use for influenza treatment were not different. Rates of total ED visits (7.6 vs 9.8/1000 person-weeks; RR 0.78, 95% CI 0.64-0.92; P = .004), total hospitalizations (8.6 vs 11.0/1000 person-weeks; RR 0.79, 95% CI 0.67-0.93; P = .004), and hospital length of stay (35.6 days vs 55.5 days/1000 person-weeks; RR 0.64, 95% CI 0.0.59-0.69; P < .001) were lower at intervention as compared to control LTCFs. No significant differences were noted for respiratory-related ED visits or hospitalizations or in rates for all-cause or respiratory-associated mortality. CONCLUSIONS AND IMPLICATIONS The use of low threshold criteria to trigger nursing staff-initiated testing for influenza with RIDT resulted in increased prophylactic use of oseltamivir. There were significant reductions in the rates of all-cause ED visits (22% decline), hospitalizations (21% decline), and hospital length of stay (36% decline) across 3 combined influenza seasons. No significant differences were noted in respiratory-associated and all-cause deaths between intervention and control sites.
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Affiliation(s)
- Jonathan L Temte
- Department of Family Medicine and Community Health, University of Wisconsin, Madison, WI, USA.
| | - Mary M Checovich
- Department of Family Medicine and Community Health, University of Wisconsin, Madison, WI, USA
| | - Shari Barlow
- Department of Family Medicine and Community Health, University of Wisconsin, Madison, WI, USA
| | - Peter A Shult
- Wisconsin State Laboratory of Hygiene, Madison, WI, USA
| | - Erik Reisdorf
- Wisconsin State Laboratory of Hygiene, Madison, WI, USA
| | - Thomas E Haupt
- Division of Public Health, Wisconsin Department of Health Services, Madison, WI, USA
| | - Irene Hamrick
- Department of Family Medicine and Community Health, University of Wisconsin, Madison, WI, USA
| | - Marlon P Mundt
- Department of Family Medicine and Community Health, University of Wisconsin, Madison, WI, USA
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18
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Khanal S, Miani C, Finne E, Zielke J, Boeckmann M. Effectiveness of behavior change interventions for smoking cessation among expectant and new fathers: findings from a systematic review. BMC Public Health 2023; 23:1812. [PMID: 37723506 PMCID: PMC10506219 DOI: 10.1186/s12889-023-16713-5] [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: 02/24/2023] [Accepted: 09/06/2023] [Indexed: 09/20/2023] Open
Abstract
BACKGROUND Smoking cessation during pregnancy and the postpartum period by both women and their partners offers multiple health benefits. However, compared to pregnant/postpartum women, their partners are less likely to actively seek smoking cessation services. There is an increased recognition about the importance of tailored approaches to smoking cessation for expectant and new fathers. While Behavior Change Interventions (BCIs) are a promising approach for smoking cessation interventions, evidence on effectiveness exclusively among expectant and new fathers are fragmented and does not allow for many firm conclusions to be drawn. METHODS We conducted a systematic review on effectiveness of BCIs on smoking cessation outcomes of expectant and new fathers both through individual and/or couple-based interventions. Peer reviewed articles were identified from eight databases without any date or language restriction.Two independent reviewers screened studies for relevance, assessed methodological quality of relevant studies, and extracted data from studies using a predeveloped data extraction sheet. RESULTS We retrieved 1222 studies, of which 39 were considered for full text screening after reviewing the titles and abstracts. An additional eight studies were identified from reviewing the reference list of review articles picked up by the databases search. A total of nine Randomised Control Trials were included in the study. Six studies targeted expectant/new fathers, two targeted couples and one primarily targeted women with an intervention component to men. While the follow-up measurements for men varied across studies, the majority reported biochemically verified quit rates at 6 months. Most of the interventions showed positive effects on cessation outcomes. BCI were heterogenous across studies. Findings are suggestive of gender targeted interventions being more likely to have positive cessation outcomes. CONCLUSIONS This systematic review found limited evidence supporting the effectiveness of BCI among expectant and new fathers, although the majority of studies show positive effects of these interventions on smoking cessation outcomes. There remains a need for more research targeted at expectant and new fathers. Further, there is a need to identify how smoking cessation service delivery can better address the needs of (all) gender(s) during pregnancy.
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Affiliation(s)
- Sudeepa Khanal
- Department of Epidemiology & International Public Health, School of Public Health, Bielefeld University, Universitätsstraße 25, 33615, Bielefeld, Germany.
| | - Céline Miani
- Department of Epidemiology & International Public Health, School of Public Health, Bielefeld University, Universitätsstraße 25, 33615, Bielefeld, Germany
| | - Emily Finne
- Department of Epidemiology & International Public Health, School of Public Health, Bielefeld University, Universitätsstraße 25, 33615, Bielefeld, Germany
| | - Julia Zielke
- Department of Epidemiology & International Public Health, School of Public Health, Bielefeld University, Universitätsstraße 25, 33615, Bielefeld, Germany
| | - Melanie Boeckmann
- Department of Global Health, Institute of Public Health and Nursing Research, University of Bremen, Bremen, Germany
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19
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Dolovich C, Unruh C, Moffatt DC, Loewen C, Kaita B, Barkun AN, Martel M, Singh H. Mandatory vs. optional split-dose bowel preparation for morning colonoscopies: a pragmatic noninferiority randomized controlled trial. Endoscopy 2023; 55:822-835. [PMID: 37023789 DOI: 10.1055/a-2070-5561] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/08/2023]
Abstract
BACKGROUND : We compared the effectiveness of optional split-dose bowel preparation (SDBP) with mandatory SDBP for morning colonoscopies in usual clinical practice. METHODS : Adult patients undergoing outpatient early morning (8:00 AM-10:30 PM) and late morning (10:30 AM-12:00 PM) colonoscopies were included. Written bowel preparation instructions were provided based on randomization: one group were instructed to take their bowel preparation (4 L polyethylene glycol solution) as a split dose (mandatory), while the comparator group was allowed the choice of SDBP or single-dose bowel preparation administered entirely on the day before (optional). The primary end point, using noninferiority hypothesis testing with a 5 % margin, was adequate bowel cleanliness measured by the Boston Bowel Preparation Scale (BBPS) and defined by a BBPS score ≥ 6. RESULTS : Among 770 randomized patients with complete data, there were 267 mandatory SDBP and 265 optional SDBP patients for early morning colonoscopies, and 120 mandatory SDBP and 118 optional SDBP patients for late morning colonoscopies. Optional SDBP was inferior to mandatory SDBP, with a lower proportion of adequate BBPS cleanliness for early morning colonoscopies (78.9 % vs. 89.9 %; absolute risk difference [aRD] 11.0 %, 95 %CI 5.9 % to 16.1 %), but was not statistically different for late morning colonoscopies (76.3 % vs. 83.3 %; aRD 7.1 %, 95 %CI -1.5 % to 15.5 %). CONCLUSIONS : Optional SDBP is inferior to mandatory SDBP in providing adequate bowel preparation quality for early morning colonoscopies (8:00 AM-10:30 AM), and probably inferior for late morning colonoscopies (10:30 AM-12:00 PM).
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Affiliation(s)
- Casandra Dolovich
- Internal Medicine, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Claire Unruh
- Internal Medicine, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Dana C Moffatt
- Internal Medicine, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Carrie Loewen
- Internal Medicine, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Brennan Kaita
- Internal Medicine, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Alan N Barkun
- Division of Gastroenterology, McGill University Health Center, Montreal, Quebec, Canada
- Department of Clinical Epidemiology, Biostatistics, and Occupational Health, McGill University, Montreal, Quebec, Canada
| | - Myriam Martel
- Division of Gastroenterology, McGill University Health Center, Montreal, Quebec, Canada
| | - Harminder Singh
- Internal Medicine, University of Manitoba, Winnipeg, Manitoba, Canada
- Community Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
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20
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Matheson EL, Schneider J, Tinoco A, Gentili C, Silva-Breen H, LaVoi NM, White P, Diedrichs PC. The co-creation, initial piloting, and protocol for a cluster randomised controlled trial of a coach-led positive body image intervention for girls in sport. BMC Public Health 2023; 23:1467. [PMID: 37525161 PMCID: PMC10391850 DOI: 10.1186/s12889-023-16360-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2023] [Accepted: 07/20/2023] [Indexed: 08/02/2023] Open
Abstract
BACKGROUND Globally, girls disengage from sports at an earlier age and higher rate than boys. This is, in part, due to the unique body image challenges that girls face, relative to their male peers. Existing intervention efforts that aim to reduce girls' negative body image and movement experiences have proven marginally effective, if not ineffective. This paper outlines the co-creation, initial piloting and protocol for a cluster randomised controlled trial of Body Confident Athletes (BCA); an in-person, coach-led intervention that aims to foster positive body image and sports enjoyment among girls. METHODS Following co-creation and an initial pilot, a two-armed cluster randomised controlled trial will assess the immediate (post-intervention) and short-term (1-month and 3-month follow-up) impact of BCA on girls' (N = 1,036; 11-17 years old) body image, sports enjoyment, and affect. Sport organisations will be randomly allocated (1:1) into either an intervention or waitlist control condition. Girls and coaches in the intervention condition will complete three 60-minute sessions over three consecutive weeks. The primary outcome will be the immediate change in girls' body esteem, with secondary outcomes assessing the immediate and short-term changes in girls' body appreciation, self-objectification, attuned self-care, sports enjoyment, and affect. DISCUSSION This research is the first to utilise an international multi-stakeholder partnership to co-create and evaluate an intervention that addresses the intersection of girls' body image and sport experiences. The theoretical and methodological considerations of this research have led to a feasible intervention and trial protocol, and if proven effective, BCA may assist in reducing the global gender disparity in sports participation. TRIAL REGISTRATION NUMBER NCT05594524 , registered 25th October 2022.
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Affiliation(s)
- E L Matheson
- Centre for Appearance Research, School of Social Sciences, College of Health, Science and Society, University of the West of England, Coldharbour Lane, Bristol, BS16 1QY, UK.
| | - J Schneider
- Centre for Appearance Research, School of Social Sciences, College of Health, Science and Society, University of the West of England, Coldharbour Lane, Bristol, BS16 1QY, UK
| | - A Tinoco
- Centre for Appearance Research, School of Social Sciences, College of Health, Science and Society, University of the West of England, Coldharbour Lane, Bristol, BS16 1QY, UK
| | - C Gentili
- Centre for Appearance Research, School of Social Sciences, College of Health, Science and Society, University of the West of England, Coldharbour Lane, Bristol, BS16 1QY, UK
| | - H Silva-Breen
- Department of Sport, Exercise, and Performance Psychology, West Virginia University, Morgantown, WV, 26506, USA
| | - N M LaVoi
- Tucker Center for Research on Girls & Women in Sport, University of Minnesota, 1900 University Avenue SE, Minneapolis, MN, 55455, USA
| | - P White
- Centre for Appearance Research, School of Social Sciences, College of Health, Science and Society, University of the West of England, Coldharbour Lane, Bristol, BS16 1QY, UK
| | - P C Diedrichs
- Centre for Appearance Research, School of Social Sciences, College of Health, Science and Society, University of the West of England, Coldharbour Lane, Bristol, BS16 1QY, UK
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21
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Graever L, Issa AFC, da Fonseca VBP, Melo MM, da Silva GPDC, da Nóbrega ICP, Savassi LCM, Dias MB, Gomes MK, Lapa e Silva JR, Guimarães RM, Seródio RC, Frølich A, Gudbergsen H, Jakobsen JC, Dominguez H. Telemedicine Support for Primary Care Providers versus Usual Care in Patients with Heart Failure: Protocol of a Pragmatic Cluster Randomised Trial within the Brazilian Heart Insufficiency with Telemedicine (BRAHIT) Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:5933. [PMID: 37297537 PMCID: PMC10253100 DOI: 10.3390/ijerph20115933] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/16/2023] [Revised: 04/27/2023] [Accepted: 05/15/2023] [Indexed: 06/12/2023]
Abstract
Heart failure is a prevalent condition and a frequent cause of hospital readmissions and poor quality of life. Teleconsultation support from cardiologists to primary care physicians managing patients with heart failure may improve care, but the effect on patient-relevant outcomes is unclear. We aim to evaluate whether collaboration through a novel teleconsultation platform in the Brazilian Heart Insufficiency with Telemedicine (BRAHIT) project, tested on a previous feasibility study, can improve patient-relevant outcomes. We will conduct a parallel-group, two-arm, cluster-randomised superiority trial with a 1:1 allocation ratio, with primary care practices from Rio de Janeiro as clusters. Physicians from the intervention group practices will receive teleconsultation support from a cardiologist to assist patients discharged from hospitals after admission for heart failure. In contrast, physicians from the control group practices will perform usual care. We will include 10 patients per each of the 80 enrolled practices (n = 800). The primary outcome will be a composite of mortality and hospital admissions after six months. Secondary outcomes will be adverse events, symptoms frequency, quality of life, and primary care physicians' compliance with treatment guidelines. We hypothesise that teleconsulting support will improve patient outcomes.
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Affiliation(s)
- Leonardo Graever
- Departamento de Clínica Médica, Faculdade de Medicina, Universidade Federal do Rio de Janeiro, Rio de Janeiro 21044-020, Brazil
- Department of Biomedical Sciences, Faculty of Health and Medical Sciences, University of Copenhagen, 2200 Copenhagen, Denmark;
| | - Aurora Felice Castro Issa
- Instituto Nacional de Cardiologia, Rio de Janeiro 22240-006, Brazil; (A.F.C.I.); (V.B.P.d.F.); (M.M.M.); (I.C.P.d.N.)
| | | | - Marcelo Machado Melo
- Instituto Nacional de Cardiologia, Rio de Janeiro 22240-006, Brazil; (A.F.C.I.); (V.B.P.d.F.); (M.M.M.); (I.C.P.d.N.)
| | | | | | | | | | - Maria Kátia Gomes
- Departamento de Clínica Médica, Faculdade de Medicina, Universidade Federal do Rio de Janeiro, Rio de Janeiro 21044-020, Brazil
| | - Jose Roberto Lapa e Silva
- Departamento de Clínica Médica, Faculdade de Medicina, Universidade Federal do Rio de Janeiro, Rio de Janeiro 21044-020, Brazil
| | | | | | - Anne Frølich
- Department of Public Health, Faculty of Health and Medical Sciences, University of Copenhagen, 1353 Copenhagen, Denmark; (A.F.); (H.G.)
| | - Henrik Gudbergsen
- Department of Public Health, Faculty of Health and Medical Sciences, University of Copenhagen, 1353 Copenhagen, Denmark; (A.F.); (H.G.)
| | - Janus Christian Jakobsen
- Copenhagen Trial Unit, Centre for Clinical Intervention Research, Capital Region of Denmark & Department of Regional Health Research, The Faculty of Health Sciences, University of Southern Denmark, 2200 Copenhagen, Denmark;
| | - Helena Dominguez
- Department of Biomedical Sciences, Faculty of Health and Medical Sciences, University of Copenhagen, 2200 Copenhagen, Denmark;
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22
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de Oliveira LM, da Silva Dal Pizzol T. Comment on "Tacrolimus Drug-Drug Interaction with Nirmatrelvir/Ritonavir (Paxlovid™) Managed with Phenytoin". J Med Toxicol 2023:10.1007/s13181-023-00936-4. [PMID: 36988814 PMCID: PMC10054184 DOI: 10.1007/s13181-023-00936-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2023] [Revised: 02/17/2023] [Accepted: 02/20/2023] [Indexed: 03/30/2023] Open
Affiliation(s)
- Luciana Mello de Oliveira
- Núcleo de Avaliação de Tecnologias em Saúde, Gerência de Ensino e Pesquisa, Grupo Hospitalar Conceição (GEP-GHC), Porto Alegre, Rio Grande do Sul, Brazil.
| | - Tatiane da Silva Dal Pizzol
- Programa de Pós-Graduação em Epidemiologia (PPGEPI), Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, Rio Grande do Sul, Brazil
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23
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Evaluating a body image school-based intervention in India: A randomized controlled trial. Body Image 2023; 44:148-156. [PMID: 36608434 DOI: 10.1016/j.bodyim.2022.12.006] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/09/2022] [Revised: 12/14/2022] [Accepted: 12/14/2022] [Indexed: 01/06/2023]
Abstract
Body dissatisfaction is highly prevalent among adolescents in low- and middle- income countries, including in India. However, evidence-based interventions are lacking. This study evaluated the efficacy of a school-based mixed-gender body image intervention among adolescents in India. A randomized controlled trial was conducted among 568 (43 % girls) Year 7 students (aged 11-14; 94 % aged 12-13) in six schools in Delhi. Each school was randomly allocated to receive five 45-minute intervention sessions delivered by trained psychologists or a wait-list control condition. The primary outcome of body image and related secondary outcomes were assessed at pre-intervention, post-intervention, and 3-month follow-up. Intention-to-treat linear mixed models analyses showed improvements in body image relative to the control group at post-intervention and 3-month follow-up. Significant improvements were identified at post-intervention for internalization, life disengagement, disordered eating, self-esteem, and negative affect, with effects maintained in nearly all outcomes (girls only - internalization, boys only - life disengagement) at 3-month follow-up. This study presents the first mixed-gender school-based body image intervention in India, which was efficacious in improving urban adolescents' body image, disordered eating, and related outcomes.
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Hossain MB, Karim ME. Key considerations for choosing a statistical method to deal with incomplete treatment adherence in pragmatic trials. Pharm Stat 2023; 22:205-231. [PMID: 36637242 DOI: 10.1002/pst.2258] [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: 08/13/2021] [Revised: 05/27/2022] [Accepted: 07/15/2022] [Indexed: 02/01/2023]
Abstract
Pragmatic trials offer practical means of obtaining real-world evidence to help improve decision-making in comparative effectiveness settings. Unfortunately, incomplete adherence is a common problem in pragmatic trials. The commonly used methods in randomized control trials often cannot handle the added complexity imposed by incomplete adherence, resulting in biased estimates. Several naive methods and advanced causal inference methods (e.g., inverse probability weighting and instrumental variable-based approaches) have been used in the literature to deal with incomplete adherence. Practitioners and applied researchers are often confused about which method to consider under a given setting. This current work is aimed to review commonly used statistical methods to deal with non-adherence along with their key assumptions, advantages, and limitations, with a particular focus on pragmatic trials. We have listed the applicable settings for these methods and provided a summary of available software. All methods were applied to two hypothetical datasets to demonstrate how these methods perform in a given scenario, along with the R codes. The key considerations include the type of intervention strategy (point treatment settings, where treatment is administered only once versus sustained treatment settings, where treatment has to be continued over time) and availability of data (e.g., the extent of measured or unmeasured covariates that are associated with adherence, dependent confounding impacted by past treatment, and potential violation of assumptions). This study will guide practitioners and applied researchers to use the appropriate statistical method to address incomplete adherence in pragmatic trial settings for both the point and sustained treatment strategies.
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Affiliation(s)
- Md Belal Hossain
- School of Population and Public Health, University of British Columbia, Vancouver, Canada
| | - Mohammad Ehsanul Karim
- School of Population and Public Health, University of British Columbia, Vancouver, Canada.,Centre for Health Evaluation and Outcome Sciences, University of British Columbia, Vancouver, Canada
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25
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Over Half of Clinical Trials of Mobilization and Manipulation for Patients With Low Back Pain May Have Limited Real-World Applicability: A Systematic Review of 132 Clinical Trials. J Orthop Sports Phys Ther 2022; 52:532-545. [PMID: 35722756 DOI: 10.2519/jospt.2022.10962] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
OBJECTIVE To evaluate the existing body of trials assessing manual therapy for low back pain (LBP) to determine where it falls on the efficacyeffectiveness continuum. DESIGN Methodology systematic review. LITERATURE SEARCH PubMed, CINAHL (Cumulative Index to Nursing and Allied Health Literature), CENTRAL (Cochrane Central Register of Controlled Trials), and PEDro (Physiotherapy Evidence Database) were searched for trials published between January 1, 2000, and April 30, 2021. STUDY SELECTION CRITERIA We included randomized clinical trials investigating joint mobilization and manipulation for adults with nonspecific LBP that were available in English. DATA SYNTHESIS We used the Rating of Included Trials on the Efficacy-Effectiveness Spectrum (RITES) tool to score included trials across 4 domains: participant characteristics, trial setting, flexibility of intervention(s), and clinical relevance of experimental and comparison intervention(s). Proportions of trials with greater emphasis on efficacy or effectiveness were calculated for each domain. RESULTS Of the 132 included trials, a greater proportion emphasized efficacy than effectiveness for domains participant characteristics (50% vs 38%), trial setting (71% vs 20%), and flexibility of intervention(s) (61% vs 25%). The domain clinical relevance of experimental and comparison intervention(s) had lower emphasis on efficacy (41% vs 50%). CONCLUSION Most trials investigating manual therapy for LBP lack pragmatism across the RITES domains (ie, they emphasize efficacy). To improve real-world implementation, more research emphasizing effectiveness is needed. This could be accomplished by recruiting from more diverse participant pools, involving multiple centers that reflect common clinical practice settings, involving clinicians with a variety of backgrounds/experience, and allowing flexibility in how interventions are delivered. J Orthop Sports Phys Ther 2022;52(8):532-545. Epub: 19 June 2022. doi:10.2519/jospt.2022.10962.
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Moens K, Peeters M, Van den Bulcke M, Leys M, Horlait M. Development, Testing, and Implementation of the Belgian Patient Reported Experience Measure for Pancreatic Cancer Care (PREPARE) Project: Protocol for a Multi-Method Research Project. JMIR Res Protoc 2022; 11:e29004. [PMID: 35666559 PMCID: PMC9210207 DOI: 10.2196/29004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2021] [Revised: 03/30/2022] [Accepted: 04/28/2022] [Indexed: 11/25/2022] Open
Abstract
Background Patients with pancreatic cancer do not feel involved in the development of their treatment and care plans. In Belgium, these plans are decided on during multidisciplinary team meetings. However, limited time is spent on the discussion of the preferences of the patient during these meetings. This research project aims to develop a patient-reported experience measure (PREM) for pancreatic cancer and assess if its use can support collaborative treatment decision-making. Objective This paper aims to outline the protocol for a multi-method research project to improve person-centered pancreatic cancer care in Belgium. Three subobjectives are pursued: (1) to develop a PREM to assess the experiences of care-related aspects in pancreatic cancer care, (2) to validate the PREM, and (3) to develop and evaluate an educational intervention to support the use of the PREM’s results. Methods For the development of the PREM, an exploratory mixed methods study design will be used. The study will start with a survey followed by a telephone interview involving patients with pancreatic cancer and digestive oncology health care professionals. Study two is the testing of the content and construct validity of the PREM. Study three involves the implementation study according to the Medical Research Council framework of a complex intervention introducing the PREM in practice. The effectiveness of the intervention will be investigated using a pragmatic randomized controlled trial study design. Results The protocol presents the entire structure of the research project. Ethics approval to conduct the exploratory mixed methods study (objective 1) has been obtained, and recruitment has started since January 2022. Conclusions The poor prognosis of patients with pancreatic cancer should not be considered a hurdle to not study this patient population group. Involving patients in the research and decision-making processes early on is key. This project aims to realize a scientifically sound research process providing research outputs that can easily and timely be implemented in the care trajectory of patients with pancreatic cancer. This research project will also lead to recommendations on how to involve patients with pancreatic cancer and how the methodology of this research project can be translated to other patient groups. International Registered Report Identifier (IRRID) PRR1-10.2196/29004
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Affiliation(s)
| | - Marc Peeters
- University Hospital Antwerp (UZA), Antwerp, Belgium
| | | | - Mark Leys
- Organisation, Policy & Social Inequalities in Healthcare Research Group (OPIH), Vrije Universiteit Brussels, Brussels, Belgium
| | - Melissa Horlait
- Organisation, Policy & Social Inequalities in Healthcare Research Group (OPIH), Vrije Universiteit Brussels, Brussels, Belgium
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Carli V, Petros NG, Hadlaczky G, Vitcheva T, Berchialla P, Bianchi S, Carletto S, Christinaki E, Citi L, Dinis S, Gentili C, Geraldes V, Giovinazzo L, Gonzalez-Martinez S, Meyer B, Ostacoli L, Ottaviano M, Ouakinin S, Papastylianou T, Paradiso R, Poli R, Rocha I, Settanta C, Scilingo EP, Valenza G. The NEVERMIND e-health system in the treatment of depressive symptoms among patients with severe somatic conditions: A multicentre, pragmatic randomised controlled trial. EClinicalMedicine 2022; 48:101423. [PMID: 35706482 PMCID: PMC9092507 DOI: 10.1016/j.eclinm.2022.101423] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/19/2021] [Revised: 04/08/2022] [Accepted: 04/11/2022] [Indexed: 11/17/2022] Open
Abstract
Background This study assessed the effectiveness of the NEVERMIND e-health system, consisting of a smart shirt and a mobile application with lifestyle behavioural advice, mindfulness-based therapy, and cognitive behavioural therapy, in reducing depressive symptoms among patients diagnosed with severe somatic conditions. Our hypothesis was that the system would significantly decrease the level of depressive symptoms in the intervention group compared to the control group. Methods This pragmatic, randomised controlled trial included 425 patients diagnosed with myocardial infarction, breast cancer, prostate cancer, kidney failure, or lower limb amputation. Participants were recruited from hospitals in Turin and Pisa (Italy), and Lisbon (Portugal), and were randomly assigned to either the NEVERMIND intervention or to the control group. Clinical interviews and structured questionnaires were administered at baseline, 12 weeks, and 24 weeks. The primary outcome was depressive symptoms at 12 weeks measured by the Beck Depression Inventory II (BDI-II). Intention-to-treat analyses included 425 participants, while the per-protocol analyses included 333 participants. This trial is registered in the German Clinical Trials Register, DRKS00013391. Findings Patients were recruited between Dec 4, 2017, and Dec 31, 2019, with 213 assigned to the intervention and 212 to the control group. The sample had a mean age of 59·41 years (SD=10·70), with 44·24% women. Those who used the NEVERMIND system had statistically significant lower depressive symptoms at the 12-week follow-up (mean difference=-3·03, p<0·001; 95% CI -4·45 to -1·62) compared with controls, with a clinically relevant effect size (Cohen's d=0·39). Interpretation The results of this study show that the NEVERMIND system is superior to standard care in reducing and preventing depressive symptoms among patients with the studied somatic conditions. Funding The NEVERMIND project received funding from the European Union's Horizon 2020 Research and Innovation Programme under grant agreement No. 689691.
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Affiliation(s)
- Vladimir Carli
- National Centre for Suicide Research and Prevention of Mental Ill-Health, Karolinska Institutet, Stockholm, Sweden
| | - Nuhamin Gebrewold Petros
- National Centre for Suicide Research and Prevention of Mental Ill-Health, Karolinska Institutet, Stockholm, Sweden
| | - Gergö Hadlaczky
- National Centre for Suicide Research and Prevention of Mental Ill-Health, Karolinska Institutet, Stockholm, Sweden
| | - Tereza Vitcheva
- National Centre for Suicide Research and Prevention of Mental Ill-Health, Karolinska Institutet, Stockholm, Sweden
| | - Paola Berchialla
- Department of Clinical and Biological Sciences, Università degli Studi di Torino, Turin, Italy
| | - Silvia Bianchi
- Research Center "E.Piaggio" and Department of Information Engineering, School of Engineering, Università di Pisa, Pisa, Italy
| | - Sara Carletto
- Department of Neuroscience "Rita Levi Montalcini", Università degli Studi di Torino, Turin, Italy
| | - Eirini Christinaki
- School of Computer Science and Electronic Engineering, University of Essex, Colchester, UK
| | - Luca Citi
- School of Computer Science and Electronic Engineering, University of Essex, Colchester, UK
| | - Sérgio Dinis
- Faculdade de Medicina and CCUL, Universidade de Lisboa, Lisbon, Portugal
| | - Claudio Gentili
- General Psychology Department, Università degli Studi di Padova, Padua, Italy
| | - Vera Geraldes
- Faculdade de Medicina and CCUL, Universidade de Lisboa, Lisbon, Portugal
| | - Lorena Giovinazzo
- Department of Clinical and Biological Sciences, Università degli Studi di Torino, Turin, Italy
| | | | | | - Luca Ostacoli
- Department of Clinical and Biological Sciences, Università degli Studi di Torino, Turin, Italy
| | - Manuel Ottaviano
- Life Supporting Technologies, Universidad Politécnica de Madrid, Madrid, Spain
| | - Silvia Ouakinin
- Faculdade de Medicina, Universidade de Lisboa, Lisbon, Portugal
| | - Tasos Papastylianou
- School of Computer Science and Electronic Engineering, University of Essex, Colchester, UK
| | | | - Riccardo Poli
- School of Computer Science and Electronic Engineering, University of Essex, Colchester, UK
| | - Isabel Rocha
- Faculdade de Medicina and CCUL, Universidade de Lisboa, Lisbon, Portugal
| | - Carmen Settanta
- Department of Clinical and Biological Sciences, Università degli Studi di Torino, Turin, Italy
| | - Enzo Pasquale Scilingo
- Research Center "E.Piaggio" and Department of Information Engineering, School of Engineering, Università di Pisa, Pisa, Italy
| | - Gaetano Valenza
- Research Center "E.Piaggio" and Department of Information Engineering, School of Engineering, Università di Pisa, Pisa, Italy
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The feasibility of pragmatic influenza vaccine randomized controlled real-world trials in Denmark and England. NPJ Vaccines 2022; 7:25. [PMID: 35197469 PMCID: PMC8866398 DOI: 10.1038/s41541-022-00444-6] [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: 07/09/2021] [Accepted: 01/20/2022] [Indexed: 11/08/2022] Open
Abstract
We estimated the frequency of non-specific influenza-associated clinical endpoints to inform the feasibility of pragmatic randomized controlled trials (RCT) assessing relative vaccine effectiveness (rVE). Hospitalization rates of respiratory, cardiovascular and diabetic events were estimated from Denmark and England's electronic databases and stratified by age, comorbidity and influenza vaccination status. We included a seasonal average of 4.5 million Danish and 7.2 million English individuals, 17 and 32% with comorbidities. Annually, approximately 1% of Danish and 0.5% of English individuals were hospitalized for selected events, ~50% of them respiratory. Hospitalization rates were 40-50-fold and 2-10-fold higher in those >50 years and with comorbidities, respectively. Our findings suggest that a pragmatic RCT using non-specific endpoints is feasible. However, for outcomes with rates <2.5%, it would require randomization of ~100,000 participants to have the power to detect a rVE difference of ~13%. Targeting selected groups (older adults, those with comorbidities) where frequency of events is high would improve trial efficiency.
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Mulder M, Nijland RHM, Vloothuis JDM, van den Berg M, Crotty M, Kwakkel G, van Wegen EEH. Comparing two identically protocolized, multicentre, randomized controlled trials on caregiver-mediated exercises poststroke: Any differences across countries? PLoS One 2022; 17:e0263013. [PMID: 35077507 PMCID: PMC8789096 DOI: 10.1371/journal.pone.0263013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2021] [Accepted: 01/10/2022] [Indexed: 11/19/2022] Open
Abstract
Background The evidence for rehabilitation interventions poststroke lack sufficient robustness. However, variation in treatment effects across countries have been given little attention. Objective To compare two identically protocolized trials conducted in different western countries in order to identify factors that may have caused variation in secondary trial outcomes. Methods Comparative study based on individual patient data (N = 129) from two randomized controlled trials, conducted in hospitals and rehabilitation facilities in the Netherlands (N = 66) and Australia (N = 63). Patients with stroke and their caregivers were randomly allocated to an 8-week caregiver-mediated exercises intervention (N = 63; 31 Australian and 32 Dutch) or to a control group (N = 66; 32 Australian and 34 Dutch). Patient characteristics, compliance, usual care and process measures were compared across countries. We examined if study setting significantly moderated the trial outcomes: Hospital Anxiety and Depression Scale, Fatigue Severity Scale and General Self-Efficacy Scale, measured at 8- and 12 weeks follow-up. In addition, we explored if factors that were significantly different across countries caused variation in these trial outcomes. Results Most patients suffered an ischemic stroke, were in the subacute phase and participated with their partner. Dutch patients were younger (P = 0.005) and had a lower functional status (P = 0.001). Australian patients were recruited earlier poststroke (P<0.001), spent less time in exercise therapy (P<0.001) and had a shorter length of stay (P<0.001). The level of contamination was higher (P = 0.040) among Dutch controls. No effect modification was observed and trial outcomes did not change after controlling for cross-country differences. Conclusions The present study highlighted important clinical differences across countries whilst using an identical study protocol. The observed differences could result in a different potential for recovery and variation in treatment effects across trials. We argue that we can proceed faster to evaluating interventions within international pragmatic trials.
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Affiliation(s)
- Marijn Mulder
- Department of Rehabilitation Medicine, Amsterdam Movement Sciences, Amsterdam UMC, VU University Medical Centre, Amsterdam, The Netherlands
- Rehabilitation Research Centre, Reade, Amsterdam, The Netherlands
| | | | | | - Maayken van den Berg
- Department of Rehabilitation, Aged and Extended Care, Flinders University, Adelaide, Australia
| | - Maria Crotty
- Department of Rehabilitation, Aged and Extended Care, Flinders University, Adelaide, Australia
| | - Gert Kwakkel
- Department of Rehabilitation Medicine, Amsterdam Movement Sciences, Amsterdam UMC, VU University Medical Centre, Amsterdam, The Netherlands
- Rehabilitation Research Centre, Reade, Amsterdam, The Netherlands
- Amsterdam Neuroscience, Amsterdam, The Netherlands
- Department of Physical Therapy and Human Movement Sciences, Northwestern University, Chicago, Illinois, United States of America
| | - Erwin E. H. van Wegen
- Department of Rehabilitation Medicine, Amsterdam Movement Sciences, Amsterdam UMC, VU University Medical Centre, Amsterdam, The Netherlands
- Amsterdam Neuroscience, Amsterdam, The Netherlands
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30
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Oche O, Wu C, Murry LT, Kennelty KA. Research and Scholarly Methods: Pragmatic Clinical Trials. JOURNAL OF THE AMERICAN COLLEGE OF CLINICAL PHARMACY 2022; 5:99-106. [PMID: 35274088 PMCID: PMC8903093 DOI: 10.1002/jac5.1557] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Affiliation(s)
- Onyeche Oche
- University of Iowa, College of Pharmacy, Department of Pharmacy Practice and Science, Iowa City, Iowa, USA
| | - Chaorong Wu
- University of Iowa, Institute for Clinical and Translational Science, Iowa City, Iowa, USA
| | - Logan T. Murry
- University of Iowa, College of Pharmacy, Department of Pharmacy Practice and Science, Iowa City, Iowa, USA
| | - Korey A. Kennelty
- University of Iowa, College of Pharmacy, Department of Pharmacy Practice and Science, Iowa City, Iowa, USA
- University of Iowa, Carver College of Medicine, Department of Family Medicine, Iowa City, Iowa, USA
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31
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Dagenais S, Russo L, Madsen A, Webster J, Becnel L. Use of Real-World Evidence to Drive Drug Development Strategy and Inform Clinical Trial Design. Clin Pharmacol Ther 2022; 111:77-89. [PMID: 34839524 PMCID: PMC9299990 DOI: 10.1002/cpt.2480] [Citation(s) in RCA: 42] [Impact Index Per Article: 21.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2021] [Accepted: 10/30/2021] [Indexed: 12/28/2022]
Abstract
Interest in real-world data (RWD) and real-world evidence (RWE) to expedite and enrich the development of new biopharmaceutical products has proliferated in recent years, spurred by the 21st Century Cures Act in the United States and similar policy efforts in other countries, willingness by regulators to consider RWE in their decisions, demands from third-party payers, and growing concerns about the limitations of traditional clinical trials. Although much of the recent literature on RWE has focused on potential regulatory uses (e.g., product approvals in oncology or rare diseases based on single-arm trials with external control arms), this article reviews how biopharmaceutical companies can leverage RWE to inform internal decisions made throughout the product development process. Specifically, this article will review use of RWD to guide pipeline and portfolio strategy; use of novel sources of RWD to inform product development, use of RWD to inform clinical development, use of advanced analytics to harness "big" RWD, and considerations when using RWD to inform internal decisions. Topics discussed will include the use of molecular, clinicogenomic, medical imaging, radiomic, and patient-derived xenograft data to augment traditional sources of RWE, the use of RWD to inform clinical trial eligibility criteria, enrich trial population based on predicted response, select endpoints, estimate sample size, understand disease progression, and enhance diversity of participants, the growing use of data tokenization and advanced analytical techniques based on artificial intelligence in RWE, as well as the importance of data quality and methodological transparency in RWE.
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Affiliation(s)
| | - Leo Russo
- Global Medical Epidemiology, Worldwide Medical and SafetyPfizer IncCollegevillePennsylvaniaUSA
| | - Ann Madsen
- Global Medical Epidemiology, Worldwide Medical and SafetyPfizer IncNew YorkNew YorkUSA
| | - Jen Webster
- Real World EvidencePfizer IncNew YorkNew YorkUSA
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32
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Sandy LC, Glorioso TJ, Weinfurt K, Sugarman J, Peterson PN, Glasgow RE, Ho PM. Leave me out: Patients' characteristics and reasons for opting out of a pragmatic clinical trial involving medication adherence. Medicine (Baltimore) 2021; 100:e28136. [PMID: 34941059 PMCID: PMC8702195 DOI: 10.1097/md.0000000000028136] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/07/2021] [Accepted: 11/16/2021] [Indexed: 01/05/2023] Open
Abstract
Opt-out procedures are sometimes used instead of standard consent practices to enable patients to exercise their autonomous preferences regarding research participation while reducing patient and researcher burden. However, little is known about the characteristics of patients who opt-out of research and their reasons for doing so. We gathered such information in a large pragmatic clinical trial (PCT) evaluating the effect of theory informed text messages on medication adherence.Eligible patients, identified through electronic health records, were sent information about the study and provided with an opportunity to opt-out. Those opting out were asked to complete a voluntary survey regarding their reasons for doing so. Demographic data were compared among patients opting-out vs those included in the study using chi-squared tests and a log binomial regression model.Of 9046 patients receiving study packets, 906 (10.0%) patients returned opt-out forms. Of those, 451 (49.8%) returned the opt-out survey. Patients who opted out were more likely to be older, white, and nonHispanic than those who were included in the PCT. Survey respondents expressed high levels of trust in their health care providers, research, and system. Nearly half (46.6%) reported concerns about time as a reason to opt-out.In this PCT, 10% of patients receiving packets opted out, with significant differences in age, race, gender, and ethnicity compared to those included. Future trials should further investigate representativeness and reasons patients choose to opt-out of participating in research.
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Affiliation(s)
- Lisa Caputo Sandy
- General Internal Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO
- University of Colorado University of Colorado Anschutz Medical Campus, 13199 E Montview Blvd, Suite 300 Aurora, CO
| | | | - Kevin Weinfurt
- Department of Population and Health Sciences, Duke University, Durham, NC
| | - Jeremy Sugarman
- Berman Institute of Bioethics, Johns Hopkins University, Baltimore, MD
| | - Pamela N. Peterson
- Department of Internal Medicine, Denver Health and Hospital Authority, Denver, CO
- School of Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO
| | - Russell E. Glasgow
- Department of Family Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO
- Adult and Child Consortium for Health Outcomes Research and Delivery Science, University of Colorado Anschutz Medical Campus, Aurora, CO
| | - P. Michael Ho
- VA Eastern Colorado Health Care System, Aurora, CO
- School of Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO
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Zuidgeest MGP, Goetz I, Meinecke AK, Boateng D, Irving EA, van Thiel GJM, Welsing PMJ, Oude-Rengerink K, Grobbee DE, Initiative G. The GetReal Trial Tool: Design, Assess and Discuss Clinical Drug Trials in Light of RWE Generation. J Clin Epidemiol 2021; 149:244-253. [PMID: 34929319 DOI: 10.1016/j.jclinepi.2021.12.019] [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: 08/27/2021] [Revised: 10/25/2021] [Accepted: 12/13/2021] [Indexed: 10/19/2022]
Abstract
Methodologies incorporating Real World Elements into clinical trial design (also called pragmatic trials) offer an attractive opportunity to assess the effect of a treatment strategy in routine care and as such guide decision making in practice. Uptake of these methods is slow for several reasons, including uncertainty about acceptability of trial results, lack of experience with the methodology and operational challenges. We developed the 'Get Real Trial Tool', an easy-to-use interface, which allows users to assess the impact of design choices on generalisability to routine clinical practice, while taking into account risk of bias, precision, acceptability and operational feasibility. The tool is grounded in the scientific literature on pragmatic trials combined with knowledge of experts from academia, pharmaceutical companies, HTA bodies, patient organisations, and regulators. The aim is to help researchers optimise trial design and facilitate translation of evidence from pragmatic trials to clinical practice. In this paper we describe the development, structure and application of the GetReal Trial Tool.
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Affiliation(s)
- Mira G P Zuidgeest
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, the Netherlands.
| | | | - Anna-Katharina Meinecke
- Partnerships and IEG Office, Integrated Evidence Generation & Business Innovation, Medical Affairs & Pharmacovigilance, Bayer AG
| | - Daniel Boateng
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Elaine A Irving
- Clinical Development, GSK Research & Development Ltd., Stevenage, Hertfordshire, SG1 2NY, UK
| | - Ghislaine J M van Thiel
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Paco M J Welsing
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, the Netherlands; Department of Rheumatology & Clinical immunology, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Katrien Oude-Rengerink
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Diederick E Grobbee
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, the Netherlands; Julius Clinical, Zeist, the Netherlands
| | - GetReal Initiative
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, the Netherlands; Eli Lilly & Co Ltd, Bracknell, UK; Partnerships and IEG Office, Integrated Evidence Generation & Business Innovation, Medical Affairs & Pharmacovigilance, Bayer AG; Clinical Development, GSK Research & Development Ltd., Stevenage, Hertfordshire, SG1 2NY, UK; Department of Rheumatology & Clinical immunology, University Medical Center Utrecht, Utrecht, the Netherlands; Julius Clinical, Zeist, the Netherlands
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Matheson EL, Smith HG, Amaral ACS, Meireles JFF, Almeida MC, Mora G, Leon C, Gertner G, Ferrario N, Suarez Battan L, Linardon J, Fuller-Tyszkiewicz M, Diedrichs PC. Improving body image at scale among Brazilian adolescents: study protocol for the co-creation and randomised trial evaluation of a chatbot intervention. BMC Public Health 2021; 21:2135. [PMID: 34801002 PMCID: PMC8605542 DOI: 10.1186/s12889-021-12129-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2021] [Accepted: 10/29/2021] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Body image concerns are prevalent among Brazilian adolescents and can lead to poor psychological and physical health. Yet, there is a scarcity of culturally-appropriate, evidence-based interventions that have been evaluated and made widely available. Chatbot technology (i.e., software that mimics written or spoken human speech) offers an innovative method to increase the scalability of mental health interventions for adolescents. The present protocol outlines the co-creation and evaluation of a body image chatbot for Brazilian adolescents via a partnership between academics, industry organisations and the United Nations Children's Fund (UNICEF). METHODS A two-armed fully remote randomised controlled trial will evaluate the chatbot's effectiveness at improving body image and well-being. Adolescent girls and boys (N = 2800) aged 13-18 years recruited online will be randomly allocated (1:1) into either: 1) a body image chatbot or 2) an assessment-only control condition. Adolescents will engage with the chatbot over a 72-hour period on Facebook Messenger. Primary outcomes will assess the immediate and short-term impact of the chatbot on state- and trait-based body image, respectively. Secondary outcomes will include state- and trait-based affect, trait self-efficacy and treatment adherence. DISCUSSION This research is the first to develop an evidence-informed body image chatbot for Brazilian adolescents, with the proposed efficacy trial aiming to provide support for accessible, scalable and cost-effective interventions that address disparities in body image prevalence and readily available resources. TRIAL REGISTRATION NUMBER NCT04825184 , registered 30th March 2021.
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Affiliation(s)
- E L Matheson
- Centre for Appearance Research, Department of Health and Social Sciences, University of the West of England, Coldharbour Lane, Bristol, BS16 1QY, UK.
| | - H G Smith
- Centre for Appearance Research, Department of Health and Social Sciences, University of the West of England, Coldharbour Lane, Bristol, BS16 1QY, UK
| | - A C S Amaral
- Federal Institute of Education, Science and Technology of Southeast of Minas Gerais, 204 Monsenhor José Augusto, Barbacena, 36205018, Brazil
| | - J F F Meireles
- Department of Exercise Science and Sport Management, Kennesaw State University, Kennesaw, GA, USA
| | - M C Almeida
- Department of Psychiatry, Universidade Federal de São Paulo, São Paulo, Brazil
| | - G Mora
- UNICEF Brasília, Office of the Representative of UNICEF in Brazil, SEPN 510, Block A - 2nd floor, Brasília, DF, 70750-521, Brazil
| | - C Leon
- UNICEF Brasília, Office of the Representative of UNICEF in Brazil, SEPN 510, Block A - 2nd floor, Brasília, DF, 70750-521, Brazil
| | - G Gertner
- Talk2U LLC, 777 Brickell Ave Ste 1210, Miami, Florida, 33131, USA
| | - N Ferrario
- Talk2U LLC, 777 Brickell Ave Ste 1210, Miami, Florida, 33131, USA
| | - L Suarez Battan
- Talk2U LLC, 777 Brickell Ave Ste 1210, Miami, Florida, 33131, USA
| | - J Linardon
- School of Psychology, Deakin University, Geelong, Australia
| | | | - P C Diedrichs
- Centre for Appearance Research, Department of Health and Social Sciences, University of the West of England, Coldharbour Lane, Bristol, BS16 1QY, UK
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Price G, Mackay R, Aznar M, McWilliam A, Johnson-Hart C, van Herk M, Faivre-Finn C. Learning healthcare systems and rapid learning in radiation oncology: Where are we and where are we going? Radiother Oncol 2021; 164:183-195. [PMID: 34619237 DOI: 10.1016/j.radonc.2021.09.030] [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] [Received: 04/26/2021] [Revised: 09/02/2021] [Accepted: 09/26/2021] [Indexed: 01/31/2023]
Abstract
Learning health systems and rapid-learning are well developed at the conceptual level. The promise of rapidly generating and applying evidence where conventional clinical trials would not usually be practical is attractive in principle. The connectivity of modern digital healthcare information systems and the increasing volumes of data accrued through patients' care pathways offer an ideal platform for the concepts. This is particularly true in radiotherapy where modern treatment planning and image guidance offers a precise digital record of the treatment planned and delivered. The vision is of real-world data, accrued by patients during their routine care, being used to drive programmes of continuous clinical improvement as part of standard practice. This vision, however, is not yet a reality in radiotherapy departments. In this article we review the literature to explore why this is not the case, identify barriers to its implementation, and suggest how wider clinical application might be achieved.
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Affiliation(s)
- Gareth Price
- The University of Manchester, Manchester Academic Health Science Centre, The Christie NHS Foundation Trust, United Kingdom.
| | - Ranald Mackay
- The University of Manchester, Manchester Academic Health Science Centre, The Christie NHS Foundation Trust, United Kingdom
| | - Marianne Aznar
- The University of Manchester, Manchester Academic Health Science Centre, The Christie NHS Foundation Trust, United Kingdom
| | - Alan McWilliam
- The University of Manchester, Manchester Academic Health Science Centre, The Christie NHS Foundation Trust, United Kingdom
| | - Corinne Johnson-Hart
- The University of Manchester, Manchester Academic Health Science Centre, The Christie NHS Foundation Trust, United Kingdom
| | - Marcel van Herk
- The University of Manchester, Manchester Academic Health Science Centre, The Christie NHS Foundation Trust, United Kingdom
| | - Corinne Faivre-Finn
- The University of Manchester, Manchester Academic Health Science Centre, The Christie NHS Foundation Trust, United Kingdom
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Agarwal A, Selvam MKP, Baskaran S, Finelli R, Leisegang K, Barbăroșie C, Pushparaj PN, Robert KA, Ambar RF, Iovine C, Durairajanayagam D, Henkel R. Highly Cited Articles in the Field of Male Infertility and Antioxidants: A Scientometric Analysis. World J Mens Health 2021; 39:760-775. [PMID: 33663027 PMCID: PMC8443986 DOI: 10.5534/wjmh.200181] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2020] [Revised: 12/14/2020] [Accepted: 01/02/2021] [Indexed: 11/23/2022] Open
Abstract
PURPOSE The objective of this scientometric analysis was to recognize the top 100 cited articles on 'Male infertility and Antioxidants' and analyze its publication characteristics. MATERIALS AND METHODS The Scopus database was used to retrieve related articles and the top 100 identified based on citation rate. RESULTS The articles were published in 56 journals between 1995 and 2019 with a median (interquartile range) citation score of 17 (5-62). Among the top 100 articles, 69 were clinical studies, which included controlled and blinded (33.33%), prospective (27.54%), randomized-controlled trials (26.09%), uncontrolled (11.59%), and retrospective (1.45%) studies. In addition to conventional semen parameters, advanced sperm function tests such as oxidative stress (51%) and sperm DNA damage (23%) were reported. Pregnancy rate (33%) was found to be the most reported reproductive outcome. Antioxidant therapy was mostly investigated in male cohorts with sperm abnormalities such as asthenozoospermia (28%) and clinical conditions such as idiopathic male infertility (20%), varicocele/varicocelectomy (17%) and general male infertility (16%). CONCLUSIONS The most influential publications on antioxidants and male infertility were identified for the first time in the literature. This will serve as a reliable source of information for researchers and clinicians alike.
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Affiliation(s)
- Ashok Agarwal
- American Center for Reproductive Medicine, Cleveland Clinic, Cleveland, OH, USA.
| | | | - Saradha Baskaran
- American Center for Reproductive Medicine, Cleveland Clinic, Cleveland, OH, USA
| | - Renata Finelli
- American Center for Reproductive Medicine, Cleveland Clinic, Cleveland, OH, USA
| | - Kristian Leisegang
- School of Natural Medicine, Faculty of Community and Health Sciences, University of the Western Cape, Bellville, South Africa
| | - Cătălina Barbăroșie
- Department of Genetics, Faculty of Biology, University of Bucharest, Bucharest, Romania
| | - Peter Natesan Pushparaj
- King Abdulaziz University, Center of Excellence in Genomic Medicine, Jeddah, Saudi Arabia
- Department of Medical Laboratory Technology, Faculty of Applied Medical Sciences, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Kathy Amy Robert
- American Center for Reproductive Medicine, Cleveland Clinic, Cleveland, OH, USA
| | - Rafael F Ambar
- Urology Department of Centro Universitario em Saude do ABC/Andrology Group at Ideia Fertil Institute of Human Reproduction, Santo André, Brazil
| | - Concetta Iovine
- Department of Environmental, Biological and Pharmaceutical Sciences and Technologies, University of Campania Luigi Vanvitelli, Caserta, Italy
| | - Damayanthi Durairajanayagam
- Department of Physiology, Faculty of Medicine, Universiti Teknologi MARA, Sungai Buloh Campus, Selangor, Malaysia
| | - Ralf Henkel
- American Center for Reproductive Medicine, Cleveland Clinic, Cleveland, OH, USA
- Department of Medical Bioscience, University of the Western Cape, Bellville, South Africa
- Department of Metabolism, Digestion and Reproduction, Imperial College London, London, UK
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Davies-Teye BB, Medeiros M, Chauhan C, Baquet CR, Mullins CD. Pragmatic patient engagement in designing pragmatic oncology clinical trials. Future Oncol 2021; 17:3691-3704. [PMID: 34337970 DOI: 10.2217/fon-2021-0556] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
Oncology trials are the cornerstone of effective and safe therapeutic discoveries. However, there is increasing demand for pragmatism and patient engagement in the design, implementation and dissemination of oncology trials. Many researchers are uncertain about making trials more practical and even less knowledgeable about how to meaningfully engage patients without compromising scientific rigor to meet regulatory requirements. The present work provides practical guidance for addressing both pragmaticism and meaningful patient engagement. Applying evidence-based approaches like PRECIS-2-tool and the 10-Step Engagement Framework offer practical guidance to make future trials in oncology truly pragmatic and patient-centered. Consequently, such patient-centered trials have improved participation, faster recruitment and greater retention, and uptake of innovative technologies in community-based care.
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Affiliation(s)
- Bernard Bright Davies-Teye
- Department of Pharmaceutical Health Services Research, University of Maryland School of Pharmacy, Baltimore, MD 21201, USA.,The PATIENTS Program, University of Maryland, Baltimore, MD 21201, USA
| | - Michelle Medeiros
- Department of Pharmaceutical Health Services Research, University of Maryland School of Pharmacy, Baltimore, MD 21201, USA.,The PATIENTS Program, University of Maryland, Baltimore, MD 21201, USA
| | - Cynthia Chauhan
- The PATIENTS Program, University of Maryland, Baltimore, MD 21201, USA
| | - Claudia Rose Baquet
- Department of Pharmaceutical Health Services Research, University of Maryland School of Pharmacy, Baltimore, MD 21201, USA.,The PATIENTS Program, University of Maryland, Baltimore, MD 21201, USA
| | - C Daniel Mullins
- Department of Pharmaceutical Health Services Research, University of Maryland School of Pharmacy, Baltimore, MD 21201, USA.,The PATIENTS Program, University of Maryland, Baltimore, MD 21201, USA
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38
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Price D, Jones R, Pfister P, Cao H, Carter V, Kemppinen A, Holzhauer B, Kaplan A, Clark A, Halpin DMG, Pinnock H, Chalmers JD, van Boven JFM, Beeh KM, Kostikas K, Roche N, Usmani O, Mastoridis P. Maximizing Adherence and Gaining New Information For Your Chronic Obstructive Pulmonary Disease (MAGNIFY COPD): Study Protocol for the Pragmatic, Cluster Randomized Trial Evaluating the Impact of Dual Bronchodilator with Add-On Sensor and Electronic Monitoring on Clinical Outcomes. Pragmat Obs Res 2021; 12:25-35. [PMID: 34079422 PMCID: PMC8163732 DOI: 10.2147/por.s302809] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/21/2021] [Accepted: 04/19/2021] [Indexed: 12/20/2022] Open
Abstract
Background Poor treatment adherence in COPD patients is associated with poor clinical outcomes and increased healthcare burden. Personalized approaches for adherence management, supported with technology-based interventions, may offer benefits to patients and providers but are currently unproven in terms of clinical outcomes as opposed to adherence outcomes. Methods Maximizing Adherence and Gaining New Information For Your COPD (MAGNIFY COPD study), a pragmatic cluster randomized trial, aims to evaluate the impact of an adherence technology package (interventional package), comprising an adherence review, ongoing provision of a dual bronchodilator but with an add-on inhaler sensor device and a connected mobile application. This will compare time to treatment failure and other clinical outcomes in patients identified at high risk of exacerbations with historic poor treatment adherence as measured by prescription collection to mono/dual therapy over one year (1312 patients) versus usual care. Treatment failure is defined as the first occurrence of one of the following: (1) moderate/severe COPD exacerbation, (2) prescription of triple therapy (inhaled corticosteroid/long-acting β2-agonist/long-acting muscarinic antagonist [ICS/LABA/LAMA]), (3) prescription of additional chronic therapy for COPD, or (4) respiratory-related death. Adherence, moderate/severe exacerbations, respiratory-related healthcare resource utilization and costs, and intervention package acceptance rate will also be assessed. Eligible primary care practices (N=176) participating in the Optimum Patient Care Quality Improvement Program will be randomized (1:1) to either adherence support cluster arm (suitable patients already receiving or initiated Ultibro® Breezhaler® [indacaterol/glycopyrronium] will be offered interventional package) or the control cluster arm (suitable patients continue to receive usual clinical care). Patients will be identified and outcomes collected from anonymized electronic medical records within the Optimum Patient Care Research Database. On study completion, electronic medical record data will be re-extracted to analyze outcomes in both study groups. Registration Number ISRCTN10567920. Conclusion MAGNIFY will explore patient benefits of technology-based interventions for electronic adherence monitoring.
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Affiliation(s)
- David Price
- Observational and Pragmatic Research Institute, Singapore, Singapore.,Centre of Academic Primary Care, Division of Applied Health Sciences, University of Aberdeen, Aberdeen, UK
| | - Rupert Jones
- Faculty of Health, University of Plymouth, Plymouth, Devon, UK
| | | | - Hui Cao
- Novartis Pharmaceuticals Corporation, East Hanover, NJ, USA
| | - Victoria Carter
- Observational and Pragmatic Research International Ltd, Stubbs House Stubbs Green, London, Norwich, UK
| | - Anu Kemppinen
- Observational and Pragmatic Research International Ltd, Stubbs House Stubbs Green, London, Norwich, UK
| | | | - Alan Kaplan
- Department of Family and Community Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Allan Clark
- Norwich Medical School, University of East Anglia, Norwich, UK
| | - David M G Halpin
- University of Exeter Medical School, College of Medicine and Health, University of Exeter, Exeter, UK
| | - Hilary Pinnock
- Allergy and Respiratory Research Group, Usher Institute, University of Edinburgh, Edinburgh, UK
| | | | - Job F M van Boven
- Department of Clinical Pharmacy & Pharmacology, Groningen Research Institute for Asthma and COPD (GRIAC), University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
| | - Kai M Beeh
- Clinical Research, Insaf Respiratory Research Institute, Wiesbaden, Germany
| | - Konstantinos Kostikas
- Respiratory Medicine Department, University of Ioannina School of Medicine, Ioannina, Greece
| | - Nicolas Roche
- Cochin Hospital and Institute, APHP Centre, University of Paris, Paris, France
| | - Omar Usmani
- National Heart & Lung Institute (NHLI), Imperial College London and Royal Brompton Hospital, London, UK
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39
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Darsaut TE, Raymond J. Ethical care requires pragmatic care research to guide medical practice under uncertainty. Trials 2021; 22:143. [PMID: 33588946 PMCID: PMC7885344 DOI: 10.1186/s13063-021-05084-0] [Citation(s) in RCA: 37] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2019] [Accepted: 01/29/2021] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND The current research-care separation was introduced to protect patients from explanatory studies designed to gain knowledge for future patients. Care trials are all-inclusive pragmatic trials integrated into medical practice, with no extra tests, risks, or cost, and have been designed to guide practice under uncertainty in the best medical interest of the patient. PROPOSED REVISION Patients need a distinction between validated care, previously verified to provide better outcomes, and promising but unvalidated care, which may include unnecessary or even harmful interventions. While validated care can be practiced normally, unvalidated care should only be offered within declared pragmatic care research, designed to protect patients from harm. The validated/unvalidated care distinction is normative, necessary to the ethics of medical practice. Care trials, which mark the distinction and allow the tentative use of promising interventions necessarily involve patients, and thus the design and conduct of pragmatic care research must respect the overarching rule of care ethics "to always act in the best medical interest of the patient." Yet, unvalidated interventions offered in contexts of medical uncertainty cannot be prescribed or practiced as if they were validated care. The medical interests of current patients are best protected when unvalidated practices are restricted to a care trial protocol, with 1:1 random allocation (or "hemi-prescription") versus previously validated care, to optimize potential benefits and minimize risks for each patient. CONCLUSION Pragmatic trials can regulate medical practice by providing (i) a transparent demarcation between unvalidated and validated care; (ii) norms of medical conduct when using tests and interventions of yet unknown benefits in practice; and eventually (iii) a verdict regarding optimal care.
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Affiliation(s)
- Tim E. Darsaut
- Mackenzie Health Sciences Centre, Department of Surgery, Division of Neurosurgery, University of Alberta Hospital, 8440 - 112 Street, Edmonton, Alberta T6G 2B7 Canada
| | - Jean Raymond
- Department of Radiology, Service of Interventional Neuroradiology, Centre Hospitalier de l’Université de Montréal – CHUM, 1000 St-Denis, room D03-5462B, Montreal, QC H2X 0C1 Canada
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40
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Jacobs ME, Pouw JN, Welsing P, Radstake TRDJ, Leijten EFA. First-line csDMARD monotherapy drug retention in psoriatic arthritis: methotrexate outperforms sulfasalazine. Rheumatology (Oxford) 2021; 60:780-784. [PMID: 32797218 PMCID: PMC7850548 DOI: 10.1093/rheumatology/keaa399] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2020] [Revised: 05/18/2020] [Indexed: 01/06/2023] Open
Abstract
Objectives Conventional synthetic DMARDs (csDMARDs) are the first-line treatment for PsA, but there is conflicting data regarding their efficacy and scarce reports describing the duration of use (drug retention) of csDMARD in this population. Their position in treatment recommendations is a matter of growing debate due to the availability of alternative treatment options with higher levels of evidence. We aimed to study drug retention and predictors for drug retention among PsA patients receiving first-line csDMARD monotherapy. Methods Retrospective cohort study in DMARD-naïve adult PsA patients in whom a first csDMARD was prescribed as monotherapy primarily to treat PsA-related symptoms. The main outcome was time to failure of the csDMARD (i.e. stopping the csDMARD or adding another DMARD). Results A total of 187 patients were included, who were mainly prescribed MTX (n = 163) or SSZ (n = 21). The pooled median drug retention time was 31.8 months (interquartile range 9.04–110). Drug retention was significantly higher in MTX (median 34.5 months; interquartile range 9.60–123) as compared with SSZ-treated patients (median 12.0 months; interquartile range 4.80– 55.7) (P =0.016, log-rank test). In multivariable Cox regression, the use of MTX and older age were associated with increased retention. The main reasons for treatment failure were inefficacy (52%) and side effects (28%). Upon failure, MTX treated patients were more commonly, subsequently treated with a biologic DMARD compared with SSZ (P < 0.05). Conclusion MTX outperforms SSZ as a first-line csDMARD in DMARD-naïve PsA patients with respect to monotherapy drug retention in daily clinical practice.
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Affiliation(s)
- Marleen E Jacobs
- Department of Rheumatology and Clinical Immunology, Utrecht, the Netherlands.,Center for Translational Immunology, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Juliëtte N Pouw
- Department of Rheumatology and Clinical Immunology, Utrecht, the Netherlands.,Center for Translational Immunology, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Paco Welsing
- Department of Rheumatology and Clinical Immunology, Utrecht, the Netherlands
| | - Timothy R D J Radstake
- Department of Rheumatology and Clinical Immunology, Utrecht, the Netherlands.,Center for Translational Immunology, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Emmerik F A Leijten
- Department of Rheumatology and Clinical Immunology, Utrecht, the Netherlands.,Center for Translational Immunology, University Medical Center Utrecht, Utrecht, the Netherlands
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41
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Diedrichs PC, Atkinson MJ, Garbett KM, Leckie G. Evaluating the "Dove Confident Me" Five-Session Body Image Intervention Delivered by Teachers in Schools: A Cluster Randomized Controlled Effectiveness Trial. J Adolesc Health 2021; 68:331-341. [PMID: 33243723 DOI: 10.1016/j.jadohealth.2020.10.001] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/30/2020] [Revised: 09/05/2020] [Accepted: 10/04/2020] [Indexed: 10/22/2022]
Abstract
PURPOSE Body dissatisfaction is common during adolescence and predicts poor psychological and physical health. Interventions have traditionally overrelied on delivery by external providers (e.g., researchers and psychologists), preventing scalability. This study evaluated the acceptability and effectiveness of a school-based body image intervention delivered by schoolteachers. METHODS Six British schools participated in a pragmatic cluster randomized controlled trial. Girls and boys aged 11-13 years received the five-session intervention delivered by their teachers (n = 848) or lessons-as-usual control (n = 647) and were assessed at baseline, postintervention, and 2-, 6-, 12-, 24- and 36-month follow-up. The primary outcome was body image (body esteem), secondary outcomes included risk factors for body image (internalization of appearance ideals, sociocultural pressures, social comparisons, appearance-related teasing, and conversations), and tertiary outcomes included psychosocial well-being (negative affect, self-esteem, dietary restraint, and life engagement). RESULTS Compared with the control group, intervention students demonstrated improvements in the primary outcome of body esteem at postintervention (Cohen's d = .15), 2-month (d = .26), and 6-month follow-up (d = .15). For girls, there was also a significant reduction in experienced appearance-related teasing at 6-month (d = .24) and 12-month (d = .30) follow-up. No other significant intervention effects were observed. The intervention was acceptable to students. CONCLUSIONS These findings present the longest sustained improvements in a cognitive-affective body image outcome observed among girls and boys during a teacher-led universal body image program to date. Intervention refinement and improved teacher training may further improve outcomes. Task-shifting intervention delivery to community providers to scale up interventions is a promising strategy.
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Affiliation(s)
- Phillippa C Diedrichs
- Centre for Appearance Research, University of the West of England, Bristol, United Kingdom.
| | - Melissa J Atkinson
- Centre for Appearance Research, University of the West of England, Bristol, United Kingdom; Department of Psychology, University of Bath, Bath, United Kingdom
| | - Kirsty M Garbett
- Centre for Appearance Research, University of the West of England, Bristol, United Kingdom
| | - George Leckie
- Centre for Multilevel Modelling, University of Bristol, Bristol, United Kingdom
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42
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Clougherty JE, Kinnee EJ, Cardet JC, Mauger D, Bacharier L, Beigelman A, Blake KV, Cabana MD, Castro M, Chmiel JF, Covar R, Fitzpatrick A, Gaffin JM, Gentile D, Israel E, Jackson DJ, Kraft M, Krishnan JA, Kumar HV, Lang JE, Lazarus SC, Lemanske RF, Lima J, Martinez FD, Morgan W, Moy J, Myers R, Naureckas ET, Ortega VE, Peters SP, Phipatanakul W, Pongracic JA, Ross K, Sheehan WJ, Smith LJ, Solway J, Sorkness CA, Wechsler ME, Wenzel S, White SR, Holguin F. Geography, generalisability, and susceptibility in clinical trials. THE LANCET RESPIRATORY MEDICINE 2021; 9:330-332. [PMID: 33539731 PMCID: PMC8009610 DOI: 10.1016/s2213-2600(21)00046-1] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [MESH Headings] [Grants] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/15/2020] [Revised: 01/11/2021] [Accepted: 01/14/2021] [Indexed: 11/16/2022]
Affiliation(s)
- Jane E Clougherty
- Department of Environmental and Occupational Health, Drexel University Dornsife School of Public Health, Philadelphia, PA 19104, USA.
| | - Ellen J Kinnee
- University Center for Social and Urban Research, University of Pittsburgh, Pittsburgh, PA, USA
| | - Juan Carlos Cardet
- Department of Internal Medicine, University of South Florida, Tampa, FL, USA
| | - David Mauger
- Department of Public Health Sciences, Penn State University, Hershey, PA, USA
| | - Leonard Bacharier
- Department of Pediatrics, Washington University in St Louis School of Medicine, St Louis, MO, USA
| | - Avraham Beigelman
- The Kipper Institute of Allergy and Immunology, Schneider Children's Medical Center of Israel, Tel Aviv University, Tel Aviv, Israel
| | - Kathryn V Blake
- Biomedical Research Department, Nemours Children's Health System, Jacksonville, FL, USA
| | - Michael D Cabana
- Department of Pediatrics, Children's Hospital at Montefiore and the Albert Einstein College of Medicine, Bronx, NY, USA
| | - Mario Castro
- Division of Pulmonary, Critical Care and Sleep Medicine, University of Kansas School of Medicine, Kansas City, KS, USA
| | - James F Chmiel
- Department of Pediatrics, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Ronina Covar
- Department of Pediatrics, National Jewish Health, Denver, CO, USA
| | | | - Jonathan M Gaffin
- Division of Pulmonary Medicine, Boston Children's Hospital, Boston, MA, USA
| | | | - Elliot Israel
- Division of Pulmonary and Critical Care Medicine, Brigham and Women's Hospital, Harvard University, Boston MA, USA
| | - Daniel J Jackson
- Department of Pediatrics, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
| | - Monica Kraft
- Department of Medicine, University of Arizona, Tucson, AZ, USA
| | - Jerry A Krishnan
- Breathe Chicago Center, University of Illinois at Chicago, Chicago, IL, USA
| | - Harsha Vardhan Kumar
- Division of Allergy/Immunology/Pulmonology, University of Illinois at Chicago, Chicago, IL, USA
| | - Jason E Lang
- Department of Pediatrics, Duke University School of Medicine, Durham, NC, USA
| | - Stephen C Lazarus
- Department of Medicine, University of California, San Francisco, San Francisco, CA, USA
| | - Robert F Lemanske
- Department of Pediatrics, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
| | - John Lima
- Pharmacogenomics & Translational Research, Nemours Children's Health System, Jacksonville, FL, USA
| | - Fernando D Martinez
- Asthma and Airway Disease Research Center, University of Arizona, Tucson, AZ, USA
| | - Wayne Morgan
- Asthma and Airway Disease Research Center, University of Arizona, Tucson, AZ, USA
| | - James Moy
- Department of Medicine, Rush University Medical Center, Chicago, IL, USA
| | - Ross Myers
- Department of Pediatrics, Case Western Reserve University School of Medicine, Cleveland, OH, USA
| | | | - Victor E Ortega
- Department of Internal Medicine, Winston-Salam, NC, USA; Center for Precision Medicine at the Wake Forest School of Medicine, Winston-Salam, NC, USA
| | | | - Wanda Phipatanakul
- Division of Allergy/Immunology, Boston Children's Hospital, Harvard Medical School, Boston, MA, USA
| | - Jacqueline A Pongracic
- Department of Pediatrics, Ann & Robert H Lurie Children's Hospital of Chicago, Chicago, IL, USA
| | - Kristie Ross
- Department of Pediatrics, Case Western Reserve University School of Medicine, Rainbow Babies and Children's Hospital, Cleveland, OH, USA
| | - William J Sheehan
- Division of Allergy/Immunology, Children's National Hospital, George Washington University School of Medicine and Health Sciences, Washington, DC, USA
| | - Lewis J Smith
- Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago IL, USA
| | - Julian Solway
- Department of Medicine, University of Chicago, Chicago, IL, USA
| | - Christine A Sorkness
- Division of Allergy, Pulmonary, and Critical Care Medicine, University of Wisconsin-Madison, Madison, WI, USA
| | | | - Sally Wenzel
- Department of Environmental and Occupational Health, University of Pittsburgh, Pittsburgh, PA, USA
| | - Steven R White
- Department of Medicine, University of Chicago, Chicago, IL, USA
| | - Fernando Holguin
- Division of Pulmonary Sciences & Critical Care, University of Colorado, Denver, CO, USA
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43
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Ioannou M, Szabó Z, Widmark-Jensen M, Vyrinis G, Karlsson C, Steingrimsson S. Total Sleep Deprivation Followed by Bright Light Therapy as Rapid Relief for Depression: A Pragmatic Randomized Controlled Trial. Front Psychiatry 2021; 12:705090. [PMID: 34526921 PMCID: PMC8435586 DOI: 10.3389/fpsyt.2021.705090] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/04/2021] [Accepted: 08/11/2021] [Indexed: 11/17/2022] Open
Abstract
Background: Total sleep deprivation (TSD) combined with bright light therapy (BLT) has been suggested as a valuable add-on to standard treatment for rapid relief of depression. However, there is a lack of randomized controlled trials in real-life clinical settings. The aim of this pragmatic randomized clinical trial was to investigate the effectiveness, acceptance, and feasibility of TSD combined with BLT as add-on to standard treatment for depression in a real-life clinical setting. Methods: Thirty-three inpatients were randomly assigned to either: a) an intervention group receiving a single-night TSD followed by 6 days BLT (10.000 lux, 30 min/day) as add-on to standard treatment; or b) a control group receiving a short sleep-hygiene consultation in addition to standard treatment. The follow-up period was 1 week. Results: No statistical differences were found in response rates, reduction of depressive and insomnia symptoms, length of stay, readmission rate, and clinical improvement. Both groups reported positive experiences toward the received treatment with low drop-out rates. Conclusions: One-night TSD followed by BLT was not effective as a rapid relief for depression at 1-week follow-up; however, the treatment was feasible and well-tolerated.
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Affiliation(s)
- Michael Ioannou
- University of Gothenburg, Sahlgrenska Academy, Institute of Neuroscience and Physiology, Gothenburg, Sweden.,Region Västra Götaland, Psykiatri Affektiva, Department of Psychiatry, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Zoltán Szabó
- Region Västra Götaland, Psykiatri Affektiva, Department of Psychiatry, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Mats Widmark-Jensen
- Region Halland, Varberg's Hospital, Anaesthesia and Intensive Care, Varberg, Sweden
| | - Georgios Vyrinis
- Region Västra Götaland, Psykiatri Affektiva, Department of Psychiatry, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Christopher Karlsson
- Region Västra Götaland, Psykiatri Affektiva, Department of Psychiatry, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Steinn Steingrimsson
- University of Gothenburg, Sahlgrenska Academy, Institute of Neuroscience and Physiology, Gothenburg, Sweden.,Region Västra Götaland, Psykiatri Affektiva, Department of Psychiatry, Sahlgrenska University Hospital, Gothenburg, Sweden
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44
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Goodie JL, Kanzler KE, McGeary CA, Blankenship AE, Young-McCaughan S, Peterson AL, Cobos BA, Dobmeyer AC, Hunter CL, Blue Star J, Bhagwat A, McGeary DD. Targeting Chronic Pain in Primary Care Settings by Using Behavioral Health Consultants: Methods of a Randomized Pragmatic Trial. PAIN MEDICINE (MALDEN, MASS.) 2020; 21:S83-S90. [PMID: 33313725 PMCID: PMC7825087 DOI: 10.1093/pm/pnaa346] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
BACKGROUND Manualized cognitive and behavioral therapies are increasingly used in primary care environments to improve nonpharmacological pain management. The Brief Cognitive Behavioral Therapy for Chronic Pain (BCBT-CP) intervention, recently implemented by the Defense Health Agency for use across the military health system, is a modular, primary care-based treatment program delivered by behavioral health consultants integrated into primary care for patients experiencing chronic pain. Although early data suggest that this intervention improves functioning, it is unclear whether the benefits of BCBT-CP are sustained. The purpose of this paper is to describe the methods of a pragmatic clinical trial designed to test the effect of monthly telehealth booster contacts on treatment retention and long-term clinical outcomes for BCBT-CP treatment, as compared with BCBT-CP without a booster, in 716 Defense Health Agency beneficiaries with chronic pain. DESIGN A randomized pragmatic clinical trial will be used to examine whether telehealth booster contacts improve outcomes associated with BCBT-CP treatments. Monthly booster contacts will reinforce BCBT-CP concepts and the home practice plan. Outcomes will be assessed 3, 6, 12, and 18 months after the first appointment for BCBT-CP. Focus groups will be conducted to assess the usability, perceived effectiveness, and helpfulness of the booster contacts. SUMMARY Most individuals with chronic pain are managed in primary care, but few are offered biopsychosocial approaches to care. This pragmatic brief trial will test whether a pragmatic enhancement to routine clinical care, monthly booster contacts, results in sustained functional changes among patients with chronic pain receiving BCBT-CP in primary care.
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Affiliation(s)
- Jeffrey L Goodie
- Department of Medical and Clinical Psychology, Uniformed Services University of the Health Sciences, Bethesda, Maryland
| | - Kathryn E Kanzler
- Department of Psychiatry and Behavioral Sciences, University of Texas Health Science Center at San Antonio, San Antonio, Texas
- Department of Family and Community Medicine, University of Texas Health Science Center at San Antonio, San Antonio, Texas
| | - Cindy A McGeary
- Department of Psychiatry and Behavioral Sciences, University of Texas Health Science Center at San Antonio, San Antonio, Texas
- South Texas Veterans Health Care System, San Antonio, Texas
| | - Abby E Blankenship
- Department of Psychiatry and Behavioral Sciences, University of Texas Health Science Center at San Antonio, San Antonio, Texas
| | - Stacey Young-McCaughan
- Department of Psychiatry and Behavioral Sciences, University of Texas Health Science Center at San Antonio, San Antonio, Texas
| | - Alan L Peterson
- Department of Psychiatry and Behavioral Sciences, University of Texas Health Science Center at San Antonio, San Antonio, Texas
- South Texas Veterans Health Care System, San Antonio, Texas
- Department of Psychology, University of Texas at San Antonio, San Antonio, Texas
| | - Briana A Cobos
- Department of Psychiatry and Behavioral Sciences, University of Texas Health Science Center at San Antonio, San Antonio, Texas
| | - Anne C Dobmeyer
- Psychological Health Center of Excellence, Defense Health Agency, Falls Church, Virginia
| | - Christopher L Hunter
- Patient Centered Medical Home Branch, Defense Health Agency, Falls Church, Virginia
| | - John Blue Star
- Wilford Hall Ambulatory Surgical Center, Joint Base San Antonio-Lackland, Texas
| | - Aditya Bhagwat
- Patient Centered Medical Home Branch, Defense Health Agency, Falls Church, Virginia
| | - Donald D McGeary
- Department of Psychiatry and Behavioral Sciences, University of Texas Health Science Center at San Antonio, San Antonio, Texas
- Department of Family and Community Medicine, University of Texas Health Science Center at San Antonio, San Antonio, Texas
- South Texas Veterans Health Care System, San Antonio, Texas
- Department of Rehabilitation Medicine, University of Texas Health Science Center at San Antonio, San Antonio, Texas, USA
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45
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Anzueto A, Kaplan A. Dual bronchodilators in chronic obstructive pulmonary disease: Evidence from randomized controlled trials and real-world studies. RESPIRATORY MEDICINE: X 2020. [DOI: 10.1016/j.yrmex.2020.100016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
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Abstract
OBJECTIVE Behavioral health homes, which provide onsite primary medical care in mental health clinics, face challenges in integrating information across multiple health records. This study tested whether a mobile personal health record application improved quality of medical care for individuals treated in these settings. METHODS This randomized study enrolled 311 participants with a serious mental illness and one or more cardiometabolic risk factors across two behavioral health homes to receive a mobile personal health record application (N=156) or usual care (N=155). A secure mobile personal health record (mPHR) app provided participants in the intervention group with key information about diagnoses, medications, and laboratory test values and allowed them to track health goals. The primary study outcome was a chart-derived composite measure of quality of cardiometabolic and preventive services. RESULTS At 12-month follow-up, participants in the mPHR group maintained high quality of care (70% of indicated services at baseline and at 12-month follow-up), in contrast to a decline in quality for the usual-care group (71% at baseline and 67% at follow-up), resulting in a statistically significant but clinically modest differential impact between the groups. No differences between the study groups were found in secondary self-reported outcomes, including delivery of chronic illness care, patient activation, and quality of life related to mental or general medical health. CONCLUSIONS Use of a mPHR app was associated with a statistically significant but clinically modest differential benefit for quality of medical care among individuals with serious mental illness and comorbid cardiometabolic conditions.
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Affiliation(s)
- Benjamin G Druss
- Department of Health Policy and Management, Rollins School of Public Health, Emory University, Atlanta
| | - Jianheng Li
- Department of Health Policy and Management, Rollins School of Public Health, Emory University, Atlanta
| | - Stephanie Tapscott
- Department of Health Policy and Management, Rollins School of Public Health, Emory University, Atlanta
| | - Cathy A Lally
- Department of Health Policy and Management, Rollins School of Public Health, Emory University, Atlanta
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The Platelet Concentrates Therapy: From the Biased Past to the Anticipated Future. Bioengineering (Basel) 2020; 7:bioengineering7030082. [PMID: 32751638 PMCID: PMC7552713 DOI: 10.3390/bioengineering7030082] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2020] [Revised: 07/25/2020] [Accepted: 07/28/2020] [Indexed: 12/23/2022] Open
Abstract
The ultimate goal of research on platelet concentrates (PCs) is to develop a more predictable PC therapy. Because platelet-rich plasma (PRP), a representative PC, was identified as a possible therapeutic agent for bone augmentation in the field of oral surgery, PRP and its derivative, platelet-rich fibrin (PRF), have been increasingly applied in a regenerative medicine. However, a rise in the rate of recurrence (e.g., in tendon and ligament injuries) and adverse (or nonsignificant) clinical outcomes associated with PC therapy have raised fundamental questions regarding the validity of the therapy. Thus, rigorous evidence obtained from large, high-quality randomized controlled trials must be presented to the concerned regulatory authorities of individual countries or regions. For the approval of the regulatory authorities, clinicians and research investigators should understand the real nature of PCs and PC therapy (i.e., adjuvant therapy), standardize protocols of preparation (e.g., choice of centrifuges and tubes) and clinical application (e.g., evaluation of recipient conditions), design bias-minimized randomized clinical trials, and recognize superfluous brand competitions that delay sound progress. In this review, we retrospect the recent past of PC research, reconfirm our ultimate goals, and discuss what will need to be done in future.
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48
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Wright PJ, Pinto BM, Corbett CF. Balancing Internal and External Validity Using Precis-2 and Re-Aim: Case Exemplars. West J Nurs Res 2020; 43:163-171. [PMID: 32648834 DOI: 10.1177/0193945920940308] [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: 11/15/2022]
Abstract
The National Institutes of Health estimated that $3-$4 billion is spent supporting clinical trials annually, yet an average of 17 years is required for research evidence to be implemented into practice. Study designs that balance external and internal validity, based on the goals of the study and relative to the state of the science, may accelerate knowledge translation. The purpose of this case study was to evaluate two randomized control trials on the effectiveness-efficacy continuum using the PRagmatic Explanatory Continuum Indicator Summary and the Research Effectiveness Adoption Implementation Maintenance model. Findings provided insight into strategies that may lead to more balanced approaches to research design. Incorporating tools such as PRECIS-2 and RE-AIM when designing and implementing research interventions may accelerate knowledge translation to close the gap between scientific knowledge and clinical practice.
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Affiliation(s)
- Pamela J Wright
- College of Nursing, Advancing Chronic Care through Research and Innovation Center (ACORN Center), University of South Carolina, Columbia, SC, USA
| | | | - Cynthia F Corbett
- College of Nursing, Advancing Chronic Care through Research and Innovation Center (ACORN Center), University of South Carolina, Columbia, SC, USA
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Tyl B, Lopez Sendon J, Borer JS, Lopez De Sa E, Lerebours G, Varin C, De Montigny A, Pannaux M, Komajda M. Comparison of Outcome Adjudication by Investigators and by a Central End Point Committee in Heart Failure Trials. Circ Heart Fail 2020; 13:e006720. [DOI: 10.1161/circheartfailure.119.006720] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background:
The usefulness of adjudication by central end point committees (CECs) is poorly assessed in heart failure (HF) trials. We aimed to assess its impact on the outcome of the SHIFT trial (Systolic HF Treatment With the If Inhibitor Ivabradine Trial).
Methods:
SHIFT was a randomized placebo-controlled trial investigating the effect of ivabradine in 6505 HF patients with reduced ejection fraction. Prespecified end points, reported by investigators (all cardiologists) using specific case report form pages, included all-cause and specific causes of deaths and hospitalizations. The primary end point was a composite of cardiovascular deaths or hospitalizations for worsening HF. We compared the adjudication of prespecified end points made by investigators and by the CEC.
Results:
Investigators identified 7529 prespecified end points, 6793 of which were confirmed by the CEC: 98.1% of cardiovascular deaths, 88.6% of all hospitalizations, and 84.4% of hospitalizations for worsening HF. These differences had no meaningful impact on the study results; hazard ratio for the primary composite end point: investigators, 0.83 (95% CI, 0.76–0.91) versus CEC, 0.82 (95% CI, 0.75–0.90), with similar results for each component of the primary end point (hazard ratio of 0.92 versus 0.91 for cardiovascular death and 0.78 versus 0.74 for hospitalization for worsening HF).
Conclusions:
Central adjudication by a CEC in the SHIFT study confirmed most of cardiovascular deaths and worsening HF hospitalizations assessed by cardiologists and did not result in a significant change of the final result as compared to investigator judgment. In this context, the benefits of CEC in blinded HF trials should be reconsidered.
Registration:
URL:
https://www.clinicaltrials.gov
; Unique identifier: NCT02441218. URL:
http://www.isrctn.com/ISRCTN70429960
; Unique identifier: ISRCTN70429960.
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Affiliation(s)
- Benoît Tyl
- CardioVascular & Metabolic Disease Center for Therapeutic Innovation (B.T., C.V.), Institut de Recherches Internationales Servier, Suresnes, France
| | - José Lopez Sendon
- Cardiology Department (J.L.S.), University Hospital La Paz, UAM, IdiPaz, CiberCV, Madrid, Spain
| | - Jeffrey S. Borer
- College of Medicine, School of Public Health, SUNY Downstate Medical Center, Brooklyn, New York (J.S.B.)
- Weill Cornell Medicine, New York, NY (J.S.B.)
| | - Esteban Lopez De Sa
- Acute Cardiac Care Unit (E.L.D.S.), University Hospital La Paz, UAM, IdiPaz, CiberCV, Madrid, Spain
| | | | - Claire Varin
- CardioVascular & Metabolic Disease Center for Therapeutic Innovation (B.T., C.V.), Institut de Recherches Internationales Servier, Suresnes, France
| | - Aurélie De Montigny
- Center of Excellence Methodology and Valorisation of Data (A.D.M., M.P.), Institut de Recherches Internationales Servier, Suresnes, France
| | - Matthieu Pannaux
- Center of Excellence Methodology and Valorisation of Data (A.D.M., M.P.), Institut de Recherches Internationales Servier, Suresnes, France
| | - Michel Komajda
- Department of Cardiology, Hospital Saint Joseph, Paris, France (M.K.)
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50
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Tashkin DP, Amin AN, Kerwin EM. Comparing Randomized Controlled Trials and Real-World Studies in Chronic Obstructive Pulmonary Disease Pharmacotherapy. Int J Chron Obstruct Pulmon Dis 2020; 15:1225-1243. [PMID: 32581529 PMCID: PMC7276323 DOI: 10.2147/copd.s244942] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2020] [Accepted: 05/03/2020] [Indexed: 12/11/2022] Open
Abstract
Analytic epidemiological studies cover a large spectrum of study methodologies, ranging from noninterventional observational studies (population-based, case-control, or cohort studies) to interventional studies (clinical trials). Herein, we review the different research methodologies or study designs and discuss their advantages and disadvantages in the context of chronic obstructive pulmonary disease (COPD) pharmacotherapy. Although randomized controlled trials (RCTs) are considered the "gold standard" for evaluating the efficacy and safety of an intervention, observational studies conducted in a real-world scenario are useful in providing evidence on the effectiveness of the intervention in clinical practice; understanding both efficacy and effectiveness is important from the clinician's perspective. Pragmatic clinical trials that use real-world data while retaining randomization bridge the gap between explanatory RCTs and noninterventional observational studies. Overall, different study designs have their associated advantages and disadvantages; together, findings from all types of studies bring about progress in clinical research as elucidated through examples from COPD research in this paper.
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Affiliation(s)
- Donald P Tashkin
- The Division of Pulmonary and Critical Care Medicine, David Geffen School of Medicine, University of California, Los Angeles, CA, USA
| | - Alpesh N Amin
- Department of Medicine, School of Medicine University of California, Irvine, CA, USA
| | - Edward M Kerwin
- Crisor, LLC Clinical Research Institute of Southern Oregon, Medford, OR, USA
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