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Ulfsdotter Gunnarsson K, Henriksson M, McCambridge J, Bendtsen M. Effects of a waiting list control design on alcohol consumption among online help-seekers: A randomised controlled trial. Drug Alcohol Depend 2024; 263:112409. [PMID: 39153442 DOI: 10.1016/j.drugalcdep.2024.112409] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/30/2024] [Revised: 08/05/2024] [Accepted: 08/06/2024] [Indexed: 08/19/2024]
Abstract
BACKGROUND Indirect evidence suggests that using waiting list control designs in behavioural research may have unintended consequences. The aim of this study was to estimate the effects of a waiting list design on alcohol consumption among individuals who had looked online for help. METHODS A two-arm randomised controlled trial was employed. The intervention group was informed that they belonged to the intervention group and would receive immediate access to a digital alcohol intervention. The waiting list control group was informed that they belonged to the group that had to wait four weeks to be given access to the intervention and in the meantime, they would be given a summary of their drinking. However, both groups received immediate access to the same digital alcohol intervention; the experimental contrast was thus between being told to wait or not. RESULTS We randomised 3388 participants (intervention: 1692, waiting list: 1696). Data were available for 954 participants at 1-month follow-up. We found no strong evidence that alcohol consumption differed between groups, but the evidence pointed towards the intervention group reporting lowering weekly alcohol consumption compared to the waiting list control group (IRR = 0.95, 95 % CI = 0.83; 1.08, probability of effect = 78.8 %). CONCLUSION We found no strong evidence that being informed that access to an intervention would be delayed produced differential self-reported alcohol consumption compared to being informed that access would be immediate. We did find a difference in engagement with the intervention materials, indicating that the experimental manipulation was successful.
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Affiliation(s)
| | - Martin Henriksson
- Department of Health, Medicine and Caring Sciences, Linköping University, Sweden.
| | - Jim McCambridge
- Department of Health Sciences, University of York, United Kingdom.
| | - Marcus Bendtsen
- Department of Health, Medicine and Caring Sciences, Linköping University, Sweden.
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2
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Friehs T, Milde C, Glombiewski JA, Kube T. Change in pain expectations but no open-label placebo analgesia: An experimental study using the heat pain paradigm. Eur J Pain 2024; 28:769-785. [PMID: 38108636 DOI: 10.1002/ejp.2216] [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: 05/10/2023] [Revised: 09/24/2023] [Accepted: 11/22/2023] [Indexed: 12/19/2023]
Abstract
BACKGROUND Open-label placebos (OLP) prescribed without deception and with a convincing rationale have been shown to evoke powerful treatment effects. Patients' treatment expectations seem to influence the magnitude of the effect. OBJECTIVE We examined if two different OLP rationales increased pain tolerance and reduced pain intensity and unpleasantness in a standardized heat pain experiment. METHODS Participants (N = 71) who self-reported reoccurring pain for at least the last 3 months were randomly assigned to one of three groups. We compared a personal-emotional and a scientific-matter-of-fact rationale with a control group (CG) that received the same placebo without any rationale. The rationale suggested a desensitizing effect on pain perception and improved pain coping of the placebo, whereas in the CG it was introduced as an ointment for measurement. The primary outcomes were pre-post changes in pain tolerance, expected and experienced pain intensity and unpleasantness. RESULTS Participants showed a decrease in expected pain intensity, but not expected pain unpleasantness for both rationales. There were no differences in pain tolerance and experienced pain intensity and unpleasantness. CONCLUSIONS Our study suggests that evoking positive treatment expectations is not sufficient to elicit an OLP response. Possibly, the magnitude of expectations change in this study was not powerful enough to evoke an OLP effect. Additionally, it is possible that OLP effects in pain are unrelated to positive treatment expectations. The failure of OLP in our study is in contrast to a number of previous studies examining the effects of OLP in experimental and clinical pain. SIGNIFICANCE This study provides evidence that positive treatment expectations are not sufficient to evoke an open-label placebo effect in a standardized heat pain experiment. We showed that two different rationales improved participants treatment expectations, but failed to evoke a placebo effect in comparison to a control group that received the same placebo, labelled as an ointment to improve measurement quality.
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Affiliation(s)
- Thilo Friehs
- Pain and Psychotherapy Research Lab, Department for Adult Clinical Psychology and Psychotherapy, University of Kaiserslautern-Landau (RPTU), Landau, Germany
| | - Christopher Milde
- Pain and Psychotherapy Research Lab, Department for Adult Clinical Psychology and Psychotherapy, University of Kaiserslautern-Landau (RPTU), Landau, Germany
| | - Julia Anna Glombiewski
- Pain and Psychotherapy Research Lab, Department for Adult Clinical Psychology and Psychotherapy, University of Kaiserslautern-Landau (RPTU), Landau, Germany
| | - Tobias Kube
- Pain and Psychotherapy Research Lab, Department for Adult Clinical Psychology and Psychotherapy, University of Kaiserslautern-Landau (RPTU), Landau, Germany
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3
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Higgins KM, Levin G, Busch R. Considerations for open-label randomized clinical trials: Design, conduct, and analysis. Clin Trials 2024:17407745241244788. [PMID: 38618711 DOI: 10.1177/17407745241244788] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/16/2024]
Abstract
Randomization and blinding are regarded as the most important tools to help reduce bias in clinical trial designs. Randomization is used to help guarantee that treatment arms differ systematically only by treatment assignment at baseline, and blinding is used to ensure that differences in endpoint evaluation and clinical decision-making during the trial arise only from the treatment received and not, for example, the expectation or desires of the people involved. However, given that there are times when it is not feasible or ethical to conduct fully blinded trials, we discuss what can be done to improve a trial, including conducting the trial as if it were a fully blinded trial and maintaining confidentiality of ongoing study results. In this article, we review how best to design, conduct, and analyze open-label trials to ensure the highest level of study integrity and the reliability of the study conclusions.
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Affiliation(s)
- Karen M Higgins
- Center for Drug Evaluation and Research, Food and Drug Administration, Silver Spring, MD, USA
| | - Gregory Levin
- Center for Drug Evaluation and Research, Food and Drug Administration, Silver Spring, MD, USA
| | - Robert Busch
- Center for Drug Evaluation and Research, Food and Drug Administration, Silver Spring, MD, USA
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Tseng PT, Zeng BS, Hsu CW, Thompson T, Stubbs B, Hsueh PR, Su KP, Chen YW, Chen TY, Wu YC, Lin PY, Carvalho AF, Li DJ, Yeh TC, Sun CK, Cheng YS, Shiue YL, Liang CS, Tu YK. The difference in all-cause mortality between COVID-19 patients treated with standard of care plus placebo and those treated with standard of care alone: a network meta-analysis of randomised controlled trials of immunomodulatory kinase inhibitors. J R Soc Med 2024; 117:57-68. [PMID: 37971412 PMCID: PMC10949870 DOI: 10.1177/01410768231202657] [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: 03/27/2023] [Accepted: 09/02/2023] [Indexed: 11/19/2023] Open
Abstract
OBJECTIVES The aim of this network meta-analysis (NMA) was to assess whether participants assigned to a placebo and standard of care (SoC) group had different major coronavirus disease 2019 (COVID-19)-related outcomes than those assigned to SoC alone. DESIGN Frequentist model-based NMA. SETTING We searched for randomised controlled trials (RCTs) of Janus kinase/Bruton tyrosine kinase inhibitors for the management of COVID-19. PARTICIPANTS Patients with COVID-19 infection. MAIN OUTCOME MEASURES The primary outcome was the 28-day all-cause mortality, and secondary outcomes were: (1) use of mechanical ventilation; (2) secondary bacterial infection; (3) acceptability (i.e. drop-out rate); and (4) safety (i.e. serious adverse events). We conducted an NMA using the frequentist model. Effect sizes were estimated using odds ratios (ORs) with 95% confidence intervals (95% CIs). RESULTS We identified 14 eligible RCTs enrolling a total of 13,568 participants with COVID-19. Participants assigned to placebo plus SoC had a significantly higher risk of 28-day all-cause mortality than those receiving SoC alone (OR = 1.39, 95% CI = 1.07-1.79). This finding did not change substantially by subgroup analysis stratified by epidemiology factor, pandemic history progression and statistical methodologic consideration. In addition, none of the treatments investigated were associated with a significantly different risk of secondary bacterial infection, acceptability or safety compared with the SoC group. CONCLUSIONS This NMA suggested a higher all-cause mortality in patients treated with placebo plus SoC compared with those treated with SoC alone. However, caution is advised in interpreting these results due to the absence of a direct head-to-head comparison. Future research should critically evaluate the necessity of placebo administration in COVID-19 RCTs and consider alternative study designs to minimise potential biases.Trial registration: The current study was approved by the Institutional Review Board of the Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan (TSGHIRB No. B-109-29) and registered in PROSPERO (CRD42022376217).
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Affiliation(s)
- Ping-Tao Tseng
- Institute of Biomedical Sciences, National Sun Yat-sen University, Kaohsiung, 80424, Taiwan
- Department of Psychology, College of Medical and Health Science, Asia University, Taichung, 41354, Taiwan
- Prospect Clinic for Otorhinolaryngology & Neurology, Kaohsiung, 811, Taiwan
- Institute of Precision Medicine, National Sun Yat-sen University, Kaohsiung City, 80424, Taiwan
| | - Bing-Syuan Zeng
- Institute of Biomedical Sciences, National Sun Yat-sen University, Kaohsiung, 80424, Taiwan
- Department of Internal Medicine, E-Da Cancer Hospital, I-Shou University, Kaohsiung, 824, Taiwan
| | - Chih-Wei Hsu
- Department of Psychiatry, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, 833, Taiwan
| | - Trevor Thompson
- Centre for Chronic Illness and Ageing, University of Greenwich, London, SE10 9LS, UK
| | - Brendon Stubbs
- Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, WC2R 2LS, UK
- Physiotherapy Department, South London and Maudsley NHS Foundation Trust, London, BR3 3BX, UK
- Faculty of Health, Social Care Medicine and Education, Anglia Ruskin University, Chelmsford, CB1 1PT, UK
| | - Po-Ren Hsueh
- Departments of Laboratory Medicine and Internal Medicine, China Medical University Hospital, Taichung, 404327, Taiwan
- School of Medicine, China Medical University, Taichung, 404327, Taiwan
| | - Kuan-Pin Su
- College of Medicine, China Medical University, Taichung, 404327, Taiwan
- Mind-Body Interface Research Center (MBI-Lab), China Medical University and Hospital, Taichung 404, Taiwan
- An-Nan Hospital, China Medical University, Tainan 709, Taiwan
| | - Yen-Wen Chen
- Prospect Clinic for Otorhinolaryngology & Neurology, Kaohsiung, 811, Taiwan
| | - Tien-Yu Chen
- Department of Psychiatry, Tri-Service General Hospital; School of Medicine, National Defense Medical Center, Taipei, 11490, Taiwan
- Institute of Brain Science, National Yang Ming Chiao Tung University, Taipei 112, Taiwan
| | - Yi-Cheng Wu
- Department of Sports Medicine, Landseed International Hospital, Taoyuan, 32449, Taiwan
| | - Pao-Yen Lin
- Department of Psychiatry, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, 833, Taiwan
- Institute for Translational Research in Biomedical Sciences, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung, 833, Taiwan
| | - Andre F Carvalho
- Innovation in Mental and Physical Health and Clinical Treatment (IMPACT) Strategic Research Centre, School of Medicine, Barwon Health, Deakin University, Geelong, VIC, 3125, Australia
| | - Dian-Jeng Li
- Department of Addiction Science, Kaohsiung Municipal Kai-Syuan Psychiatric Hospital, Kaohsiung City, 802211, Taiwan
| | - Ta-Chuan Yeh
- Department of Psychiatry, Tri-Service General Hospital; School of Medicine, National Defense Medical Center, Taipei, 11490, Taiwan
| | - Cheuk-Kwan Sun
- Department of Emergency Medicine, E-Da Hospital, I-Shou University, Kaohsiung, 824, Taiwan
- School of Medicine for International Students, College of Medicine, I-Shou University Kaohsiung, 824, Taiwan
| | - Yu-Shian Cheng
- Department of Psychology, College of Medical and Health Science, Asia University, Taichung, 41354, Taiwan
- Department of Psychiatry, Tsyr-Huey Mental Hospital, Kaohsiung Jen-Ai’s Home, Kaohsiung, 831, Taiwan
| | - Yow-Ling Shiue
- Institute of Biomedical Sciences, National Sun Yat-sen University, Kaohsiung, 80424, Taiwan
- Institute of Precision Medicine, National Sun Yat-sen University, Kaohsiung City, 80424, Taiwan
| | - Chih-Sung Liang
- Department of Psychiatry, National Defense Medical Center, Taipei, 11490, Taiwan
| | - Yu-Kang Tu
- Institute of Health Data Analytics & Statistics, College of Public Health, National Taiwan University, Taipei, 100, Taiwan
- Department of Dentistry, National Taiwan University Hospital, Taipei, 100, Taiwan
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Gunnarsson KU, McCambridge J, Bendtsen M. Reactions to being allocated to a waiting list control group in a digital alcohol intervention trial. PATIENT EDUCATION AND COUNSELING 2023; 107:107572. [PMID: 36442435 DOI: 10.1016/j.pec.2022.11.014] [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: 06/23/2022] [Revised: 10/14/2022] [Accepted: 11/16/2022] [Indexed: 06/16/2023]
Abstract
OBJECTIVE To study reactions of control group participants allocated to two different presentations of basic health information in a digital alcohol intervention trial. METHOD Control participants were randomised to wait with one of two different presentations of basic health information. Multiple choice questions and free-text comments assessed reactions, four months post randomisation. Effects of differential health information on responses were estimated, as were associations between responses, baseline characteristics and change in alcohol consumption. RESULT Of 1066 control group participants, 572 (54%) responded to the questionnaire. Contrasting two different presentations of basic health information revealed no statistically significant differences. Responses revealed that 38% were interested sufficiently to look at the information while 42% felt frustration, irritation, or disappointment about having to wait. Approximately 55% responded that they decided to reduce their drinking whilst 17% stated that they continued to drink as usual, and 11% gave up on the idea of reducing their drinking. The two latter groups reported markedly higher alcohol consumption at follow-up in comparison to the former (probability of association >99.9%). CONCLUSION Being made to wait may invite negative research participation effects. PRACTICE IMPLICATION Comparator guidance should be updated to reflect the potentially negative consequences which are under researched.
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Affiliation(s)
| | | | - Marcus Bendtsen
- Department of Health, Medicine and Caring Sciences, Linköping University, Sweden
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6
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Oxman AD, Chalmers I, Dahlgren A. Key concepts for informed health choices. 2.1: comparisons of treatments should be fair. J R Soc Med 2023; 116:21-26. [PMID: 36453850 PMCID: PMC9909114 DOI: 10.1177/01410768221140733] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Affiliation(s)
- A D Oxman
- Centre for Epidemic Interventions Research, Norwegian Institute of Public Health, 0213 Oslo, Norway
| | - I Chalmers
- Centre for Evidence-Based Medicine, University of Oxford, OX2 6GG, UK
| | - A Dahlgren
- Faculty of Health Sciences, Oslo Metropolitan University, 0130 Oslo, Norway
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Manoj P, Derwin R, George S. What is the impact of daily oral supplementation of vitamin D3 (cholecalciferol) plus calcium on the incidence of hip fracture in older people? A systematic review and meta-analysis. Int J Older People Nurs 2023; 18:e12492. [PMID: 35842938 PMCID: PMC10078370 DOI: 10.1111/opn.12492] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2020] [Revised: 06/11/2022] [Accepted: 06/13/2022] [Indexed: 01/13/2023]
Abstract
INTRODUCTION Hip fractures have a huge impact in reducing the quality of life and increasing mortality. This review aims to assess the impact of daily oral supplementation of vitamin D3 plus calcium on the incidence of hip fracture in people over 65 years. METHODS PRISMA guidelines were followed and RCTs that evaluated the effectiveness of daily oral supplementation of vitamin D3 plus calcium in preventing hip fracture in adults over 65 years were included in the study. The databases such as Cochrane Library, Embase, Medline, PubMed, CINAHL, Web of Science and Scopus were searched from October 2019- January 2020.The Cochrane risk of bias tool was used to check the quality of the included studies. A meta-analysis with fixed effect model using Review Manager (Revman 5.3) was used to analyse the data. RESULTS The meta-analysis of seven RCTs on vitamin D3 plus calcium supplementation and hip fracture (n = 12,620) identified odds ratio (OR) of 0.75; 95% Confidence interval (CI): 0.64, 0.87; p = .0003. Daily oral supplementation of 800 IU of Vitamin D3 plus 1200 mg of calcium was found more effective (n = 5676 participants; OR = 0.69; 95% CI: 0.58, 0.82; p < .0001) than daily oral supplementation of 800 IU of Vitamin D3 plus 1000 mg of calcium (n = 6555,OR = 1.08; 95% CI: 0.74, 1.56; p = .70) in reducing hip fracture. A meta-analysis of the seven RCTs to identify the incidence of non-vertebral fracture gave the OR of 0.80; 95% CI: 0.72, 0.89; p < .0001. A meta-analysis of three RCTs on femoral neck bone mineral density (BMD) (n = 483) gave a mean difference of 1.21; 95% CI: -0.79, 3.20; p = .24. CONCLUSION Daily oral supplementation 800 IU of vitamin D3 plus 1200 mg of calcium reduces hip fracture and non-vertebral fracture in older people. Administering vitamin D3 and calcium supplements had no effect in increasing the femoral neck BMD. IMPLICATIONS FOR PRACTICE Even though it is evident from the review that optimal daily intake of vitamin D3 plus calcium supplementation help in the prevention of fracture, it is only one essential element in fracture prevention. Also, people who are on dietary supplements should be compliant with same for better result. Efforts to prevent bone loss and osteoporosis should begin from an early age. It includes maintaining a healthy lifestyle, optimal intake of calcium and vitamin D3, proper nutrition, adequate exposure to sunlight, exercise etc. Proper education on healthy lifestyle, avoiding risk factors like smoking, caffeine, alcohol and awareness of bone health should continue throughout life with emphasis during menopause when increased bone loss is expected.
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Affiliation(s)
- Preethy Manoj
- School of Nursing and Midwifery, The Royal College of Surgeons in Ireland (RCSI), University of Medicine and Health Sciences, Dublin 2, Ireland.,Connolly Hospital, Blanchardstown, Dublin 15, Ireland
| | - Rosemarie Derwin
- School of Nursing and Midwifery, The Royal College of Surgeons in Ireland (RCSI), University of Medicine and Health Sciences, Dublin 2, Ireland
| | - Sherly George
- School of Nursing and Midwifery, The Royal College of Surgeons in Ireland (RCSI), University of Medicine and Health Sciences, Dublin 2, Ireland
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Rotational thromboelastometry for the transfusion management of postpartum hemorrhage after cesarean or vaginal delivery: A single-center randomized controlled trial. J Gynecol Obstet Hum Reprod 2022; 51:102470. [DOI: 10.1016/j.jogoh.2022.102470] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2022] [Accepted: 09/02/2022] [Indexed: 11/21/2022]
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9
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Innovative Bariatric Procedures and Ethics in Bariatric Surgery: the IFSO Position Statement. Obes Surg 2022; 32:3217-3230. [PMID: 35922610 DOI: 10.1007/s11695-022-06220-8] [Citation(s) in RCA: 21] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2022] [Revised: 07/17/2022] [Accepted: 07/24/2022] [Indexed: 02/06/2023]
Abstract
With the rise in obesity and bariatric procedures worldwide, there has been a surge in new and innovative procedures that has been increasingly offered to patients. In this position statement, IFSO highlights the importance of surgical ethics in innovation and when offering new procedures. Furthermore, the task force reviewed the current literature to describe which procedures can be offered as mainstream outside research protocols versus those that are still investigational and need further data.
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10
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Bendtsen M, Åsberg K, McCambridge J. Effectiveness of a digital intervention versus alcohol information for online help-seekers in Sweden: a randomised controlled trial. BMC Med 2022; 20:176. [PMID: 35578276 PMCID: PMC9112593 DOI: 10.1186/s12916-022-02374-5] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/05/2022] [Accepted: 04/12/2022] [Indexed: 11/21/2022] Open
Abstract
BACKGROUND The ubiquity of Internet connectivity, and widespread unmet needs, requires investigations of digital interventions for people seeking help with their drinking. The objective of this study was to test the effectiveness of a digital alcohol intervention compared to existing online resources for help seekers. METHODS This parallel randomised controlled trial included 2129 risky drinkers with access to a mobile phone and aged 18 years or older. Randomised sub-studies investigated consent procedures and control group design. Simple computerised randomisation was used. Participants were aware of allocation after randomisation; research personnel were not. The digital intervention was designed around weekly monitoring of alcohol consumption followed by feedback and tools for behaviour change. Primary outcomes were total weekly consumption (TWC) and frequency of heavy episodic drinking (HED), measured 2 and 4 months post-randomisation. RESULTS Between 25/04/2019 and 26/11/2020, 2129 participants were randomised (intervention: 1063, control: 1066). Negative binomial regression was used to contrast groups, with both Bayesian and maximum likelihood inference. The posterior median incidence rate ratio (IRR) of TWC was 0.89 (95% CI = 0.81;0.99, 98.2% probability of effect, P-value = 0.033) at 2 months among 1557 participants and 0.77 (95% CI = 0.69;0.86, > 99.9% probability of effect, P-value < 0.001) at 4 months among 1429 participants. For HED, the IRR was 0.83 (95% CI = 0.75;0.93, > 99.9% probability of effect, P-value = 0.0009) at 2 months among 1548 participants and 0.71 (95% CI = 0.63;0.79, probability of effect > 99.9%, P-value < 0.0001) at 4 months among 1424 participants. Analyses with imputed data were not markedly different. CONCLUSIONS A digital alcohol intervention produced self-reported behaviour change among online help seekers in the general population. The internal and external validity of this trial is strong, subject to carefully considered study limitations arguably inherent to trials of this nature. Limitations include higher than anticipated attrition to follow-up and lack of blinding. TRIAL REGISTRATION The trial was prospectively registered ( ISRCTN48317451 ).
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Affiliation(s)
- Marcus Bendtsen
- Department of Health, Medicine and Caring Sciences, Division of Society and Health, Linköping University, 581 83, Linköping, Sweden.
| | - Katarina Åsberg
- Department of Health, Medicine and Caring Sciences, Division of Society and Health, Linköping University, 581 83, Linköping, Sweden
| | - Jim McCambridge
- Department of Health Sciences, University of York, York, England
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11
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French DP, Miles LM, Elbourne D, Farmer A, Gulliford M, Locock L, Sutton S, McCambridge J. Reducing bias in trials from reactions to measurement: the MERIT study including developmental work and expert workshop. Health Technol Assess 2021; 25:1-72. [PMID: 34553685 DOI: 10.3310/hta25550] [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: 11/22/2022] Open
Abstract
BACKGROUND Measurement can affect the people being measured; for example, asking people to complete a questionnaire can result in changes in behaviour (the 'question-behaviour effect'). The usual methods of conduct and analysis of randomised controlled trials implicitly assume that the taking of measurements has no effect on research participants. Changes in measured behaviour and other outcomes due to measurement reactivity may therefore introduce bias in otherwise well-conducted randomised controlled trials, yielding incorrect estimates of intervention effects, including underestimates. OBJECTIVES The main objectives were (1) to promote awareness of how and where taking measurements can lead to bias and (2) to provide recommendations on how best to avoid or minimise bias due to measurement reactivity in randomised controlled trials of interventions to improve health. METHODS We conducted (1) a series of systematic and rapid reviews, (2) a Delphi study and (3) an expert workshop. A protocol paper was published [Miles LM, Elbourne D, Farmer A, Gulliford M, Locock L, McCambridge J, et al. Bias due to MEasurement Reactions In Trials to improve health (MERIT): protocol for research to develop MRC guidance. Trials 2018;19:653]. An updated systematic review examined whether or not measuring participants had an effect on participants' health-related behaviours relative to no-measurement controls. Three new rapid systematic reviews were conducted to identify (1) existing guidance on measurement reactivity, (2) existing systematic reviews of studies that have quantified the effects of measurement on outcomes relating to behaviour and affective outcomes and (3) experimental studies that have investigated the effects of exposure to objective measurements of behaviour on health-related behaviour. The views of 40 experts defined the scope of the recommendations in two waves of data collection during the Delphi procedure. A workshop aimed to produce a set of recommendations that were formed in discussion in groups. RESULTS Systematic reviews - we identified a total of 43 studies that compared interview or questionnaire measurement with no measurement and these had an overall small effect (standardised mean difference 0.06, 95% confidence interval 0.02 to 0.09; n = 104,096, I2 = 54%). The three rapid systematic reviews identified no existing guidance on measurement reactivity, but we did identify five systematic reviews that quantified the effects of measurement on outcomes (all focused on the question-behaviour effect, with all standardised mean differences in the range of 0.09-0.28) and 16 studies that examined reactive effects of objective measurement of behaviour, with most evidence of reactivity of small effect and short duration. Delphi procedure - substantial agreement was reached on the scope of the present recommendations. Workshop - 14 recommendations and three main aims were produced. The aims were to identify whether or not bias is likely to be a problem for a trial, to decide whether or not to collect further quantitative or qualitative data to inform decisions about if bias is likely to be a problem, and to identify how to design trials to minimise the likelihood of this bias. LIMITATION The main limitation was the shortage of high-quality evidence regarding the extent of measurement reactivity, with some notable exceptions, and the circumstances that are likely to bring it about. CONCLUSION We hope that these recommendations will be used to develop new trials that are less likely to be at risk of bias. FUTURE WORK The greatest need is to increase the number of high-quality primary studies regarding the extent of measurement reactivity. STUDY REGISTRATION The first systematic review in this study is registered as PROSPERO CRD42018102511. FUNDING Funded by the Medical Research Council UK and the National Institute for Health Research as part of the Medical Research Council-National Institute for Health Research Methodology Research Programme.
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Affiliation(s)
- David P French
- Manchester Centre for Health Psychology, University of Manchester, Manchester, UK
| | - Lisa M Miles
- Manchester Centre for Health Psychology, University of Manchester, Manchester, UK
| | - Diana Elbourne
- Department of Medical Statistics, London School of Hygiene and Tropical Medicine, London, UK
| | - Andrew Farmer
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Martin Gulliford
- School of Population Health and Environmental Sciences, King's College London, London, UK
| | - Louise Locock
- Health Services Research Unit, University of Aberdeen, Aberdeen, UK
| | - Stephen Sutton
- Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK
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Bendtsen M, Ulfsdotter Gunnarsson K, McCambridge J. Effects of a waiting list control design on alcohol consumption among online help-seekers: protocol for a randomised controlled trial. BMJ Open 2021; 11:e049810. [PMID: 34446493 PMCID: PMC8395291 DOI: 10.1136/bmjopen-2021-049810] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
INTRODUCTION Sparse attention has been given to the design of control conditions in trials, despite their important role as contrasts for novel treatments, and thus as a key determinant of effect sizes. This undermines valid inferences on effect estimates in trials, which are fundamentally comparative in nature. Such challenges to understanding also makes generalisation of effect estimates complex, for example, it may not be clear to what degree real-world alternatives to the novel treatments in pragmatic trials are similar to the control conditions studied. The present study aims to estimate the effects of being allocated to a waiting list control condition. METHODS AND ANALYSIS Individuals searching online for help to reduce their drinking will be invited to take part in a study. Individuals aged 18 years or older, who in the past month consumed six or more drinks on one occasion, or consumed 10 or more drinks the past week, will be eligible to participate. Both groups will receive identical feedback and advice on behaviour change; however, one group will be informed that they have to wait 1 month for the intervention materials. One month postrandomisation, participants will receive an email with the follow-up questionnaire measuring the primary outcomes: (1) frequency of heavy episodic drinking (defined as at study entry) in the past month; and (2) overall past week alcohol consumption. Differences between groups will be analysed using negative binomial regression models estimated using Bayesian inference. Recruitment will begin in October 2021. A Bayesian group sequential design will be employed to determine when to end enrolment (expected to be between 500 and 1500 individuals). ETHICS AND DISSEMINATION The study was approved by the Swedish Ethical Review Authority on 2021-01-25 (Dnr 2020-06267). Findings will be disseminated in open access peer-reviewed journals no later than 2023. TRIAL REGISTRATION TRIAL ISRCTN14959594; Pre-results.
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Affiliation(s)
- Marcus Bendtsen
- Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden
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Shimizu R, Rodwin AH, Munson MR. A Systematic Review of Psychosocial Nutrition Interventions for Young Adults. JOURNAL OF NUTRITION EDUCATION AND BEHAVIOR 2021; 53:316-335. [PMID: 33640278 DOI: 10.1016/j.jneb.2021.01.002] [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: 08/03/2020] [Revised: 12/23/2020] [Accepted: 01/03/2021] [Indexed: 06/12/2023]
Abstract
INTRODUCTION Few have examined the effects of psychosocial nutrition interventions targeting young adults, a population with low fruit and vegetable (FV) consumption. This study investigated the impact of nutrition interventions with psychosocial content on improving young adult FV intake. METHOD This registered systematic review was guided by the Preferred Reported Items for Systematic Reviews and Meta-Analyses. RESULTS Searches on CINAHL, Embase, Medline PubMed, Ovid-Medline, PsychInfo, and Web of Science identified 4,113 records. Twenty-four randomized controlled trials were extracted. Eighteen studies found significant between-group differences in fruit and/or vegetable intake. Young adults with low income and racial-ethnic subgroups were underrepresented. A typology emerged as an organizing framework from the psychosocial intervention content. Interventions were anticipatory, socially engaged, a hybrid (anticipatory and socially engaged), or exposure-based. Studies also reported unintended consequences. DISCUSSION Significant between-group differences were mostly reported by anticipatory, socially engaged, or hybrid interventions, aligning with young adult developmental needs through detailed planning, goal-setting tasks, and/or addressing social norms. Interventions with insignificant differences lacked engagement and adequate exposure. IMPLICATIONS FOR RESEARCH AND PRACTICE Demographically inclusive studies are imperative in addressing dietary disparities by socioeconomic status. A typology of interventions emphasizing content rather than theories or treatment strategies widens opportunities for interdisciplinary collaboration. More research is needed to mitigate unintended consequences (boomerang effects) in which FV intake decreased postintervention or participants disengaged in activities intended to increase FV intake.
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Affiliation(s)
- Rei Shimizu
- Silver School of Social Work, New York University, New York, NY.
| | - Aaron H Rodwin
- Silver School of Social Work, New York University, New York, NY
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Jennings Mayo-Wilson L, Coleman J, Timbo F, Ssewamala FM, Linnemayr S, Yi GT, Kang BA, Johnson MW, Yenokyan G, Dodge B, Glass NE. Microenterprise Intervention to Reduce Sexual Risk Behaviors and Increase Employment and HIV Preventive Practices Among Economically-Vulnerable African-American Young Adults (EMERGE): A Feasibility Randomized Clinical Trial. AIDS Behav 2020; 24:3545-3561. [PMID: 32494942 PMCID: PMC7667139 DOI: 10.1007/s10461-020-02931-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Economic vulnerability, such as homelessness and unemployment, contributes to HIV risk among U.S. racial minorities. Yet, few economic-strengthening interventions have been adapted for HIV prevention in this population. This study assessed the feasibility of conducting a randomized clinical trial of a 20-week microenterprise intervention for economically-vulnerable African-American young adults. Engaging MicroenterprisE for Resource Generation and Health Empowerment (EMERGE) aimed to reduce sexual risk behaviors and increase employment and uptake of HIV preventive behaviors. The experimental group received text messages on job openings plus educational sessions, mentoring, a start-up grant, and business and HIV prevention text messages. The comparison group received text messages on job openings only. Primary feasibility objectives assessed recruitment, randomization, participation, and retention. Secondary objectives examined employment, sexual risk behaviors, and HIV preventive behaviors. Outcome assessments used an in-person pre- and post-intervention interview and a weekly text message survey. Several progression criteria for a definitive trial were met. Thirty-eight participants were randomized to experimental (n = 19) or comparison group (n = 19) of which 95% were retained. The comparison intervention enhanced willingness to be randomized and reduced non-participation. Mean age of participants was 21.0 years; 35% were male; 81% were unemployed. Fifty-eight percent (58%) of experimental participants completed ≥ 70% of intervention activities, and 74% completed ≥ 50% of intervention activities. Participation in intervention activities and outcome assessments was highest in the first half (~ 10 weeks) of the study. Seventy-one percent (71%) of weekly text message surveys received a response through week 14, but responsiveness declined to 37% of participants responding to ≥ 70% of weekly text message surveys at the end of the study. The experimental group reported higher employment (from 32% at baseline to 83% at week 26) and lower unprotected sex (79% to 58%) over time compared to reported changes in employment (37% to 47%) and unprotected sex (63% to 53%) over time in the comparison group. Conducting this feasibility trial was a critical step in the process of designing and testing a behavioral intervention. Development of a fully-powered effectiveness trial should take into account lessons learned regarding intervention duration, screening, and measurement.Trial Registration ClinicalTrials.gov. NCT03766165. Registered 04 December 2018. https://clinicaltrials.gov/ct2/show/NCT03766165.
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Affiliation(s)
- Larissa Jennings Mayo-Wilson
- Indiana University School of Public Health, Department of Applied Health Science, 1025 E. 7th Street, Bloomington, IN USA
- Johns Hopkins University School of Public Health, Department of International Health, 615 N. Wolfe Street, Baltimore, MD USA
| | - Jessica Coleman
- Johns Hopkins University School of Public Health, Department of International Health, 615 N. Wolfe Street, Baltimore, MD USA
| | - Fatmata Timbo
- Johns Hopkins University School of Public Health, Department of International Health, 615 N. Wolfe Street, Baltimore, MD USA
| | - Fred M. Ssewamala
- The Brown School, Washington University in St. Louis, Goldfarb, One Brookings, Drive, St. Louis, MO USA
| | | | - Grace T. Yi
- Johns Hopkins University School of Public Health, Department of International Health, 615 N. Wolfe Street, Baltimore, MD USA
| | - Bee-Ah Kang
- Johns Hopkins University School of Public Health, Department of International Health, 615 N. Wolfe Street, Baltimore, MD USA
| | - Matthew W. Johnson
- Johns Hopkins University School of Medicine, Department of Psychiatry and Behavioral Sciences, 5510 Nathan Shock Drive, Baltimore, MD USA
| | - Gayane Yenokyan
- Johns Hopkins Bloomberg School of Public Health, Department of Biostatistics, 615 N. Wolfe Street, Baltimore, MD USA
| | - Brian Dodge
- Johns Hopkins University School of Public Health, Department of International Health, 615 N. Wolfe Street, Baltimore, MD USA
| | - Nancy E. Glass
- Johns Hopkins University School of Nursing, 525 N. Wolfe Street, Baltimore, MD USA
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Brown SM, Peltan I, Kumar N, Leither L, Webb BJ, Starr N, Grissom CK, Buckel WR, Srivastava R, Butler AM, Groat D, Haaland B, Ying J, Harris E, Johnson S, Paine R, Greene T. Hydroxychloroquine vs. Azithromycin for Hospitalized Patients with COVID-19 (HAHPS): Results of a Randomized, Active Comparator Trial. Ann Am Thorac Soc 2020; 18:590-597. [PMID: 33166179 PMCID: PMC8009003 DOI: 10.1513/annalsats.202008-940oc] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2020] [Accepted: 11/09/2020] [Indexed: 12/22/2022] Open
Abstract
RATIONALE The COVID-19 pandemic struck an immunologically naïve, globally interconnected population. In the face of a new infectious agent causing acute respiratory failure for which there were no known effective therapies, rapid, often pragmatic trials were necessary to evaluate potential treatments, frequently starting with medications that are already marketed for other indications. Early in the pandemic, hydroxychloroquine and azithromycin were two such candidates. OBJECTIVE Assess the relative efficacy of hydroxychloroquine and azithromycin among hospitalized patients with COVID-19. METHODS We performed a randomized clinical trial of hydroxychloroquine vs. azithromycin among hospitalized patients with COVID-19. Treatment was 5 days of study medication. The primary endpoint was the COVID Ordinal Outcomes scale at day 14. Secondary endpoints included hospital-, ICU-, and ventilator-free days at day 28. The trial was stopped early after enrollment of 85 patients when a separate clinical trial concluded that a clinically important effect of hydroxychloroquine over placebo was definitively excluded. Comparisons were made a priori using a proportional odds model from a Bayesian perspective. RESULTS We enrolled 85 patients at 13 hospitals over 11 weeks. Adherence to study medication was high. The estimated odds ratio for less favorable status on the ordinal scale for hydroxychloroquine vs. azithromycin from the primary analysis was 1.07, with a 95% credible interval from 0.63 to 1.83 with a posterior probability of 60% that hydroxychloroquine was worse than azithryomycin. Secondary outcomes displayed a similar, slight preference for azithromycin over hydroxychloroquine. QTc prolongation was rare and did not differ between groups. The twenty safety outcomes were similar between arms with the possible exception of post-randomization onset acute kidney injury, which was more common with hydroxychloroquine (15% vs. 0%). Patients in the hydroxychloroquine arm received remdesivir more often than in the azithromycin arm (19% vs. 2%). There was no apparent association between remdesivir use and acute kidney injury. CONCLUSIONS While early termination limits the precision of our results, we found no suggestion of substantial efficacy for hydroxychloroquine over azithromycin. Acute kidney injury may be more common with hydroxychloroquine than azithromycin, although this may be due to the play of chance. Differential use of remdesivir may have biased our results in favor of hydroxychloroquine. Our results are consistent with conclusions from other trials that hydroxychloroquine cannot be recommended for inpatients with COVID-19; azithromycin may merit additional investigation. CLINICAL TRIAL REGISTRATION This trial was prospectively registered (NCT04329832) before enrollment of the first patient.
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Affiliation(s)
- Samuel M Brown
- Intermountain Medical Center, Center for Humanizing Critical Care, Murray, Utah, United States;
| | - Ithan Peltan
- Intermountain Medical Center, 98078, Division of Pulmonary & Critical Care Medicine, Murray, Utah, United States
- University of Utah School of Medicine, 12348, Division of Pulmonary & Critical Care Medicine, Salt Lake City, Utah, United States
| | - Naresh Kumar
- Intermountain Medical Center, Office of Research, Murray, Utah, United States
| | - Lindsay Leither
- Intermountain Medical Center, 98078, Murray, Utah, United States
| | - Brandon J Webb
- Intermountain Medical Center, Division of Clinical Epidemiology and Infectious Diseases, Murray, Utah, United States
| | - Nathan Starr
- Intermountain Medical Center, Internal Medicine, Murray, Utah, United States
| | - Colin K Grissom
- Intermountain Medical Center, Critical Care Medicine, Murray, Utah, United States
| | - Whitney R Buckel
- Intermountain Medical Center, Pharmacy, Murray, Utah, United States
| | - Rajendu Srivastava
- Intermountain Medical Center, 98078, Office of Research, Murray, Utah, United States
| | - Allison M Butler
- Intermountain Healthcare, Statistical Data Center, Salt Lake City, Utah, United States
| | - Danielle Groat
- Intermountain Medical Center, Center for Humanizing Critical Care, Murray, Utah, United States
| | - Benjamin Haaland
- University of Utah, Biostatistics, Salt Lake City, Utah, United States
| | - Jian Ying
- University of Utah, Biostatistics, Salt Lake City, Utah, United States
| | - Estelle Harris
- University of Utah School of Medicine, 12348, Division of Pulmonary & Critical Care Medicine, Salt Lake City, Utah, United States
| | - Stacy Johnson
- University of Utah School of Medicine, 12348, Internal Medicine, Salt Lake City, Utah, United States
| | - Robert Paine
- University of Utah, Salt Lake City, Utah, United States
| | - Tom Greene
- University of Utah School of Medicine, 12348, Study Design and Biostatistics Center and Division of Epidemiology, Salt Lake City, Utah, United States
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Yeo HJ, Kim D, Ha M, Je HG, Kim JS, Cho WH. Chlorhexidine bathing of the exposed circuits in extracorporeal membrane oxygenation: an uncontrolled before-and-after study. Crit Care 2020; 24:595. [PMID: 33023624 PMCID: PMC7538059 DOI: 10.1186/s13054-020-03310-w] [Citation(s) in RCA: 5] [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: 08/04/2020] [Accepted: 09/24/2020] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND Although the prevention of extracorporeal membrane oxygenation (ECMO) catheter-related infection is crucial, scientific evidence regarding best practices are still lacking. METHODS We conducted an uncontrolled before-and-after study to test whether the introduction of disinfection with 2% chlorhexidine gluconate (CHG) and 70% isopropyl alcohol (IPA) of the exposed circuits and hub in patients treated with ECMO would affect the rate of blood stream infection (BSI) and microbial colonization of the ECMO catheter. We compared the microbiological and clinical data before and after the intervention. RESULTS A total of 1740 ECMO catheter days in 192 patients were studied. These were divided into 855 ECMO catheter days in 96 patients before and 885 ECMO catheter days in 96 patients during the intervention. The rates of BSI were significantly decreased during the intervention period at 11.7/1000 ECMO catheter days before vs. 2.3/1000 ECMO catheter days during (difference 9.4, 95% confidence interval (CI) 1.5-17.3, p = 0.019). Furthermore, the colonization of the ECMO catheter was similarly significantly reduced during the intervention period at 10.5/1000 ECMO catheter days before vs. 2.3/1000 ECMO catheter days during intervention (difference 8.3, 95% CI 0.7-15.8, p = 0.032). Hospital mortality (41.7% vs. 24%, p = 0.009) and sepsis-related death (17.7% vs. 6.3%, p = 0.014) were also significantly decreased during intervention. CONCLUSION Extensive disinfection of exposed ECMO circuits and hub with 2% CHG/IPA was associated with a reduction in both BSI and microbial colonization of ECMO catheters. A further randomized controlled study is required to verify these results. TRIAL REGISTRATION KCT 0004431.
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Affiliation(s)
- Hye Ju Yeo
- Department of Pulmonology and Critical Care Medicine, Research Institute for Convergence of Biomedical Science and Technology, Pusan National University Yangsan Hospital, Geumo-ro 20, Beomeo-ri, Mulgeum-eup, Yangsan-si, Gyeongsangnam-do, 626-770, Republic of Korea
| | - Dohyung Kim
- Department of Thoracic and Cardiovascular Surgery, Pusan National University Yangsan Hospital, Yangsan-si, South Korea
| | - Mihyang Ha
- Interdisciplinary program of Genomic Science, Pusan National University, Yangsan-si, South Korea
| | - Hyung Gon Je
- Department of Thoracic and Cardiovascular Surgery, Pusan National University Yangsan Hospital, Yangsan-si, South Korea
| | - Jeong Soo Kim
- Division of cardiology, Department of Internal Medicine, Pusan National University Yangsan Hospital, Yangsan-si, South Korea
| | - Woo Hyun Cho
- Department of Pulmonology and Critical Care Medicine, Research Institute for Convergence of Biomedical Science and Technology, Pusan National University Yangsan Hospital, Geumo-ro 20, Beomeo-ri, Mulgeum-eup, Yangsan-si, Gyeongsangnam-do, 626-770, Republic of Korea.
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McCambridge J, Wilson A, Attia J, Weaver N, Kypri K. The reply to Sharpe et al.: Hawthorne effect in the YourCall trial suggested by participants qualitative responses. J Clin Epidemiol 2019; 115:180-181. [DOI: 10.1016/j.jclinepi.2019.05.034] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2019] [Accepted: 05/29/2019] [Indexed: 10/26/2022]
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Norris M, Poltawski L, Calitri R, Shepherd AI, Dean SG. Hope and despair: a qualitative exploration of the experiences and impact of trial processes in a rehabilitation trial. Trials 2019; 20:525. [PMID: 31443735 PMCID: PMC6708169 DOI: 10.1186/s13063-019-3633-8] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2019] [Accepted: 08/08/2019] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Unanticipated responses by research participants can influence randomised controlled trials (RCTs) in multiple ways, many of which are poorly understood. This study used qualitative interviews as part of an embedded process evaluation to explore the impact participants may have on the study, but also unintended impacts the study may have on them. AIM The aim of the study was to explore participants' experiences and the impact of trial involvement in a pilot RCT in order to inform the designing and delivery of a definitive RCT. METHODS In-depth interviews with 20 participants (10 in the intervention and 10 in the control group) enrolled in a stroke rehabilitation pilot trial. A modified framework approach was used to analyse transcripts. RESULTS Participation in the study was motivated partly by a desperation to receive further rehabilitation after discharge. Responses to allocation to the control group included an increased commitment to self-treatment, and negative psychological consequences were also described. Accounts of participants in both control and intervention groups challenge the presumption that they were neutral, or in equipoise, regarding group allocation prior to consenting to randomisation. CONCLUSIONS Considering and exploring participant and participation effects, particularly in the control group, highlights numerous issues in the interpretation of trial studies, as well as the in ethics of RCTs more generally. While suggestions for a definitive trial design are given, further research is required to investigate the significant implications these findings may have for trial design, monitoring and funding. TRIAL REGISTRATION ClinicalTrials.gov, NCT02429180 . Registered on 29 April/2015.
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Affiliation(s)
- Meriel Norris
- College of Health and Life Sciences, Brunel University London, Uxbridge, UB8 3PH UK
| | | | - Raff Calitri
- University of Exeter Medical School, Exeter, EX1 2LU UK
| | - Anthony I. Shepherd
- Department of Sport and Exercise Science, University of Portsmouth, Portsmouth, PO1 2ER UK
| | - Sarah G. Dean
- University of Exeter Medical School, Exeter, EX1 2LU UK
| | - on behalf of the ReTrain Team
- College of Health and Life Sciences, Brunel University London, Uxbridge, UB8 3PH UK
- University of Exeter Medical School, Exeter, EX1 2LU UK
- Department of Sport and Exercise Science, University of Portsmouth, Portsmouth, PO1 2ER UK
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Bendtsen M, McCambridge J. Reducing Alcohol Consumption Among Risky Drinkers in the General Population of Sweden Using an Interactive Mobile Health Intervention: Protocol for a Randomized Controlled Trial. JMIR Res Protoc 2019; 8:e13119. [PMID: 30998221 PMCID: PMC6495288 DOI: 10.2196/13119] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2018] [Revised: 02/28/2019] [Accepted: 03/03/2019] [Indexed: 12/25/2022] Open
Abstract
Background Harmful use of alcohol continues to be a leading contributor to premature deaths globally. Not only does harmful drinking have consequences for the individuals consuming at increased levels, but it may also result in a range of negative consequences for their family members and friends. Interventions delivered via mobile phones (mobile health [mHealth] interventions) could potentially support risky drinkers seeking help to reduce their alcohol consumption. Objective This protocol describes a randomized controlled trial that aims to validly estimate the effect of a novel mHealth intervention targeting risky drinkers in the general population of Sweden. Nested within the trial are 3 substudies that focus on methodological and user satisfaction research questions. Methods A 2-arm parallel group randomized controlled trial will be employed to estimate the effect of the novel intervention. Participants will be recruited through Web advertisements and social media. The inclusion criteria are as follows: 18 years or older, ownership of a mobile phone, and being classified as a risky drinker according to Swedish guidelines. Participants allocated to the intervention group will receive a novel mHealth intervention. The intervention consists of weekly screening, personalized feedback on current consumption, functions allowing for planning of future consumption, as well as a series of messages delivered throughout the week. Participants allocated to the control group will receive a short message regarding negative consequences of alcohol consumption and a hyperlink that offers more information. Following 2 and 4 months after randomization, both groups will be asked to complete follow-up questionnaires (2-month interval being primary). Primary outcomes are weekly alcohol consumption and heavy episodic drinking. Participants in the control group will be given access to the novel intervention after completing the 4-month follow-up. The trial includes 3 substudies: We will explore whether the mode of presenting information before participants giving informed consent affects participation rates and recall of trial parameters, investigate if the content of the short message received by the control group affects study outcomes and requests for more information, and explore user satisfaction with the intervention and reactions of the control group. Results Participant recruitment is planned to begin in April 2019 and to last for a maximum of 24 months. The first dataset will be available approximately 2 months after the final participant has been recruited, and the final dataset will be available approximately 2 months later. No participants had been recruited at the time of submitting this protocol. Conclusions If found effective, the intervention has the potential to reduce negative consequences of alcohol consumption for individuals. The technology has been designed to have potential for extensive reach among those who may benefit. Trial Registration ISRCTN Registry ISRCTN48317451; http://www.isrctn.com/ISRCTN48317451 (Archived by WebCite at http://www.webcitation.org/779tKLsu3) International Registered Report Identifier (IRRID) PRR1-10.2196/13119
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Affiliation(s)
- Marcus Bendtsen
- Department of Medical and Health Sciences, Linköping University, Linköping, Sweden
| | - Jim McCambridge
- Department of Health Sciences, University of York, York, United Kingdom
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20
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Müssener U, Linderoth C, Bendtsen M. Exploring the Experiences of Individuals Allocated to a Control Setting: Findings From a Mobile Health Smoking Cessation Trial. JMIR Hum Factors 2019; 6:e12139. [PMID: 30938682 PMCID: PMC6465977 DOI: 10.2196/12139] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2018] [Revised: 12/05/2018] [Accepted: 12/29/2018] [Indexed: 11/13/2022] Open
Abstract
Background Tobacco smoking is the primary cause of preventable premature disease and death worldwide. Evidence of the efficacy of text messaging interventions to reduce smoking behavior is well established, but there is still a need for studies targeting young people, especially because young adult smokers are less likely to seek treatment than older adults. A mobile health intervention, Nicotine Exit (NEXit), targeting smoking among university students was developed to support university students to quit smoking. Short-term effectiveness was measured through a randomized controlled trial, which found that immediately after the 12-week intervention, 26% of smokers in the intervention group had prolonged abstinence compared with 15% in the control group. Objective The objective of this study was to explore the experience of being allocated to the control group in the NEXit smoking cessation intervention. Methods We asked students who were allocated to the control group in the main NEXit randomized controlled trial to report their experiences. An email was sent to the participants with an electronic link to a short questionnaire. We assessed the distribution of the responses to the questionnaire by descriptive analysis. We analyzed free-text comments to 4 questions. Results The response rate for the questionnaire was 33.8% (258/763), and we collected 143 free-text comments. Of the responders, 60.9% (157/258) experienced frustration, disappointment, and irritation about being allocated to the control group; they felt they were being denied support by having to wait for the intervention. Monthly text messages during the waiting period thanking them for taking part in the trial were perceived as negative by 72.3% (189/258), but for some the messages served as a reminder about the decision to quit smoking. Of the responders, 61.2% (158/258) chose to wait to quit smoking until they had access to the intervention, and 29.8% (77/258) decided to try to quit smoking without support. Of the respondents, 77.5% (200/258) claimed they were still smoking and had signed up or were thinking about signing up for the smoking cessation program at the time of the questionnaire. Conclusions Most of the respondents reported negative feelings about having to wait for the support of the intervention and that they had decided to continue smoking. A similar number decided to wait to quit smoking until they had access to the intervention, and these respondents reported a high interest in the intervention. Free-text comments indicated that some control group participants believed that they had been excluded from the trial, while others were confused when asked to sign up for the intervention again. Trial Registration ISRCTN Registry ISRCTN75766527; http://www.isrctn.com/ISRCTN75766527 (Archived by WebCite at http://www.webcitation.org/7678sUKbR)
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Affiliation(s)
- Ulrika Müssener
- Department of Medical and Health Sciences, Linköping University, Linköping, Sweden
| | - Catharina Linderoth
- Department of Medical and Health Sciences, Linköping University, Linköping, Sweden
| | - Marcus Bendtsen
- Department of Medical and Health Sciences, Linköping University, Linköping, Sweden
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Randomized trial seeking to induce the Hawthorne effect found no evidence for any effect on self-reported alcohol consumption online. J Clin Epidemiol 2019; 108:102-109. [DOI: 10.1016/j.jclinepi.2018.11.016] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2018] [Revised: 10/17/2018] [Accepted: 11/14/2018] [Indexed: 11/22/2022]
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Is the rationale more important than deception? A randomized controlled trial of open-label placebo analgesia. Pain 2018; 158:2320-2328. [PMID: 28708766 DOI: 10.1097/j.pain.0000000000001012] [Citation(s) in RCA: 116] [Impact Index Per Article: 19.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Research on open-label placebos questions whether deception is a necessary characteristic of placebo effects. Yet, comparisons between open-label and deceptive placebos (DPs) are lacking. We therefore assessed effects of open-label placebos and DPs in comparison with no treatment (NT) with a standardized experimental heat pain paradigm in a randomized controlled trial in healthy participants. Participants (N = 160) were randomly assigned to NT, open-label placebo without rationale (OPR-), open-label placebo with rationale (OPR), and DP. We conducted baseline and posttreatment measurements of heat pain threshold and tolerance. Apart from the NT, all groups received an application of a placebo cream. Primary outcomes were planned comparisons of heat pain tolerance and the corresponding intensity and unpleasantness ratings. Objective posttreatment pain tolerance did not differ among groups. However, for subjective heat pain ratings at the posttreatment tolerance level, groups with a rationale (OPR and DP) reported diminished heat pain intensity (t(146) = -2.15, P = 0.033, d = 0.43) and unpleasantness ratings (t(146) = -2.43, P = 0.016, d = 0.49) compared with the OPR-group. Interestingly, the OPR and the DP groups did not significantly differ in heat pain intensity (t(146) = -1.10, P = 0.272) or unpleasantness ratings (t(146) = -0.05, P = 0.961) at the posttreatment tolerance level. Our findings reveal that placebos with a plausible rationale are more effective than without a rationale. Even more, open-label placebos did not significantly differ in their effects from DPs. Therefore, we question the ubiquitously assumed necessity of concealment in placebo administration.
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Velez-Viveros CA, González-González JG, Rodríguez-Flores M, Mancillas-Adame LG. Comparing Apples to Apples. Is it Fair to Compare Suboptimal Doses of Medications to Surgery? Obes Surg 2018; 28:850-851. [PMID: 29307106 DOI: 10.1007/s11695-017-3082-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Affiliation(s)
- Claudia A Velez-Viveros
- Endocrinology Division, Internal Medicine Department, University Hospital "Dr. José Eleuterio González" and Medical School, Universidad Autónoma de Nuevo León, Ave. Madero y Gonzalitos S/N Servicio de Endocrinología, Colonia Mitras Centro, C.P. 64460, Monterrey, N.L., Mexico
| | - José G González-González
- Endocrinology Division, Internal Medicine Department, University Hospital "Dr. José Eleuterio González" and Medical School, Universidad Autónoma de Nuevo León, Ave. Madero y Gonzalitos S/N Servicio de Endocrinología, Colonia Mitras Centro, C.P. 64460, Monterrey, N.L., Mexico
| | - Marcela Rodríguez-Flores
- Obesity Clinic, Endocrinology and Metabolism Department, Instituto Nacional de Ciencias Médicas y Nutrición "Salvador Zubirán", Vasco de Quiroga 15, Colonia Sección XVI, Delegación Tlalpan, C.P. 14050, Mexico City, Mexico
| | - Leonardo G Mancillas-Adame
- Endocrinology Division, Internal Medicine Department, University Hospital "Dr. José Eleuterio González" and Medical School, Universidad Autónoma de Nuevo León, Ave. Madero y Gonzalitos S/N Servicio de Endocrinología, Colonia Mitras Centro, C.P. 64460, Monterrey, N.L., Mexico.
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Shepherd-Banigan M, Goldstein KM, Coeytaux RR, McDuffie JR, Goode AP, Kosinski AS, Van Noord MG, Befus D, Adam S, Masilamani V, Nagi A, Williams JW. Improving vasomotor symptoms; psychological symptoms; and health-related quality of life in peri- or post-menopausal women through yoga: An umbrella systematic review and meta-analysis. Complement Ther Med 2017; 34:156-164. [PMID: 28917368 DOI: 10.1016/j.ctim.2017.08.011] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2017] [Revised: 06/05/2017] [Accepted: 08/17/2017] [Indexed: 12/11/2022] Open
Abstract
OBJECTIVES Vasomotor symptoms (VMS), commonly reported during menopausal transition, negatively affect psychological health and health-related quality of life (HRQoL). While hormone therapy is an effective treatment, its use is limited by concerns about possible harms. Thus, many women with VMS seek nonhormonal, nonpharmacologic treatment options. However, evidence to guide clinical recommendations is inconclusive. This study reviewed the effectiveness of yoga, tai chi and qigong on vasomotor, psychological symptoms, and HRQoL in peri- or post-menopausal women. DESIGN MEDLINE, Cochrane Database of Systematic Reviews, EMBASE, CINAHL and the Allied and Complementary Medicine Database were searched. Researchers identified systematic reviews (SR) or RCTs that evaluated yoga, tai chi, or qigong for vasomotor, psychological symptoms, and health-related quality of life (HRQoL) in peri- or post-menopausal women. Data were abstracted on study design, participants, interventions and outcomes. Risk of bias (ROB) was assessed and updated meta-analyses were performed. RESULTS We identified one high-quality SR (5 RCTs, 582 participants) and 3 new RCTs (345 participants) published after the SR evaluating yoga for vasomotor, psychological symptoms, and HRQoL; no studies evaluated tai chi or qigong. Updated meta-analyses indicate that, compared to controls, yoga reduced VMS (5 trials, standardized mean difference (SMD) -0.27, 95% CI -0.49 to -0.05) and psychological symptoms (6 trials, SDM -0.32; 95% CI -0.47 to -0.17). Effects on quality of life were reported infrequently. Key limitations are that adverse effects were rarely reported and outcome measures lacked standardization. CONCLUSIONS Results from this meta-analysis suggest that yoga may be a useful therapy to manage bothersome vasomotor and psychological symptoms.
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Affiliation(s)
- M Shepherd-Banigan
- Center for Health Services Research in Primary Care, Durham Veterans Affairs Medical Center, 508 Fulton Street, Durham, NC, 27705, USA.
| | - K M Goldstein
- Center for Health Services Research in Primary Care, Durham Veterans Affairs Medical Center, 508 Fulton Street, Durham, NC, 27705, USA; Department of Medicine, Division of General Internal Medicine, Duke University Medical Center 6301 Herndon Road, Durham, NC, USA
| | - R R Coeytaux
- Duke Clinical Research Institute, 2400 Pratt Street, Durham, NC 27705, USA
| | - J R McDuffie
- Center for Health Services Research in Primary Care, Durham Veterans Affairs Medical Center, 508 Fulton Street, Durham, NC, 27705, USA; Department of Medicine, Division of General Internal Medicine, Duke University Medical Center 6301 Herndon Road, Durham, NC, USA
| | - A P Goode
- Department of Physical Therapy, Duke University Medical Center 2200 W. Main Street Durham, NC 27705, USA
| | - A S Kosinski
- Department of Biostatistics and Bioinformatics, Duke University School of Medicine, 8 Duke University Medical Center, Durham, MC 27703, USA
| | - M G Van Noord
- Duke University Medical Center Library, Durham, NC 27708, USA
| | - D Befus
- Duke University School of Nursing, 307 Trent Drive, Durham, NC 27710, USA
| | - S Adam
- Department of Medicine, Division of Hematology Oncology, Duke University Medical Center, 8 Duke University Medical Center, Durham, NC 27703, USA
| | - V Masilamani
- Center for Health Services Research in Primary Care, Durham Veterans Affairs Medical Center, 508 Fulton Street, Durham, NC, 27705, USA
| | - A Nagi
- Center for Health Services Research in Primary Care, Durham Veterans Affairs Medical Center, 508 Fulton Street, Durham, NC, 27705, USA
| | - J W Williams
- Center for Health Services Research in Primary Care, Durham Veterans Affairs Medical Center, 508 Fulton Street, Durham, NC, 27705, USA; Department of Medicine, Division of General Internal Medicine, Duke University Medical Center 6301 Herndon Road, Durham, NC, USA
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Tan BY, Shafie AA, Hassali MAA, Saleem F. Assessment of medication adherence and the costs associated with a calendar blister pack intervention among hypertensive patients in Malaysia: A randomized controlled trial. SAGE Open Med 2017; 5:2050312117709189. [PMID: 28839933 PMCID: PMC5546697 DOI: 10.1177/2050312117709189] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2016] [Accepted: 04/18/2017] [Indexed: 12/04/2022] Open
Abstract
Objectives: To assess the efficacy and costs of a calendar blister packaging intervention used to improve medication adherence. Method: A parallel randomized controlled trial was conducted with 73 hypertensive patients (intervention group = 35, control group = 38) at Hospital Kulim, Malaysia, for 7 months. Results: The intervention group demonstrated a significant improvement in medication possession ratio (p < 0.05) and percentage of on-time refills (p < 0.01) compared to control group. In addition, there was significantly lower blood pressure (p < 0.05) in intervention group. From the provider perspective, the average annual treatment cost per patient in the intervention group was MYR 2178.66 (~USD 526.95) (95% confidence interval = 1786.39–2570.94) compared to MYR 2693.09 (~USD 651.37) (95% confidence interval = 1903.23–3482.95) in the control group. Conclusion: This study provides evidence that calendar blister packaging has a positive impact on medication adherence, blood pressure and also has the potential for considerable cost savings.
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Affiliation(s)
- Bee Ying Tan
- Discipline of Social & Administrative Pharmacy, School of Pharmaceutical Sciences, Universiti Sains Malaysia, Pulau Pinang, Malaysia
| | - Asrul Akmal Shafie
- Discipline of Social & Administrative Pharmacy, School of Pharmaceutical Sciences, Universiti Sains Malaysia, Pulau Pinang, Malaysia
| | - Mohamed Azmi Ahmad Hassali
- Discipline of Social & Administrative Pharmacy, School of Pharmaceutical Sciences, Universiti Sains Malaysia, Pulau Pinang, Malaysia
| | - Fahad Saleem
- Faculty of Pharmacy and Health Sciences, University of Balochistan, Quetta, Pakistan
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Turner KM, Percival J, Kessler D, Donovan J. Exploring patients' treatment journeys following randomisation in mental health trials to improve future trial conduct: a synthesis of multiple qualitative data sets. Trials 2017; 18:279. [PMID: 28619121 PMCID: PMC5472926 DOI: 10.1186/s13063-017-2030-4] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2016] [Accepted: 05/31/2017] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND The way in which pragmatic trials are designed suggests that there are differences between the experiences of participants randomised to usual care and intervention arms. These potential differences relate not only to which treatment participants receive but also how they access and engage with their allocated treatment. Such differences could affect trial results. The aim of this study was to assess whether such differences exist and, if they do, to consider their implications for the design of future trials. METHODS Interview transcripts were sampled from data sets gathered during three qualitative studies, all of which had been nested within large, primary care depression trials. Each study had explored trial participants' views and experiences of treatments received following randomisation. Transcripts from 37 participants were purposefully sampled, 20 of which were from interviews held with individuals allocated to receive usual GP care. Data were analysed thematically. RESULTS There was evidence of differences between trial arms across all three data sets. Intervention participants were willing and able to engage with the treatment to which they had been allocated. Randomisation had led to them embarking upon a clear treatment pathway and receiving care in a context where they felt comfortable discussing their mental health and had sufficient time to do so. Intervention participants also had continuity with and confidence in the practitioners they saw. A few usual-care participants talked about having continuity with and confidence in their GPs. However, most of the usual-care participants reported a reluctance to consult GPs about mental health, difficulties in securing treatment appointments, and little or no changes in care following randomisation. Additionally, most reported a lack of continuity of care and a lack confidence in the treatment available to them. CONCLUSIONS There are important differences between usual-care and intervention arms that go beyond treatment received, and they relate to how participants experience accessing and engaging with their allocated care. As these differences could affect trial results, researchers may want to measure or reduce them in order to fully appreciate or control for the range of factors that might affect treatment outcomes.
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Affiliation(s)
- Katrina M. Turner
- School of Social and Community Medicine, University of Bristol, Bristol, UK
- The National Institute for Health Research Collaboration for Leadership in Applied Health Research and Care West (NIHR CLAHRC West) at University Hospitals Bristol NHS Foundation Trust, Bristol, UK
| | - John Percival
- School of Social and Community Medicine, University of Bristol, Bristol, UK
| | - David Kessler
- School of Social and Community Medicine, University of Bristol, Bristol, UK
| | - Jenny Donovan
- School of Social and Community Medicine, University of Bristol, Bristol, UK
- The National Institute for Health Research Collaboration for Leadership in Applied Health Research and Care West (NIHR CLAHRC West) at University Hospitals Bristol NHS Foundation Trust, Bristol, UK
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Whybrow P, Pickard R, Hrisos S, Rapley T. Equipoise across the patient population: optimising recruitment to a randomised controlled trial. Trials 2017; 18:140. [PMID: 28347354 PMCID: PMC5369002 DOI: 10.1186/s13063-016-1711-8] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2016] [Accepted: 11/16/2016] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND This paper proposes a novel perspective on the value of qualitative research for improving trial design and optimising recruitment. We report findings from a qualitative study set within the OPEN trial, a surgical randomised controlled trial (RCT) comparing two interventions for recurrent bulbar urethral stricture, a common cause of urinary problems in men. METHODS Interviews were conducted with men meeting trial eligibility criteria (n = 19) to explore reasons for accepting or declining participation and with operating urologists (n = 15) to explore trial acceptability. RESULTS Patients expressed various preferences and understood these in the context of relative severity and tolerability of their symptoms. Accounts suggest a common trajectory of worsening symptoms with a particular window within which either treatment arm would be considered acceptable. Interviews with clinician recruiters found that uncertainty varied between general and specialist sites, which reflect clinicians' relative exposure to different proportions of the patient population. CONCLUSION Recruitment post referral, at specialist sites, was challenging due to patient (and clinician) expectations. Trial design, particularly where there are fixed points for recruitment along the care pathway, can enable or constrain the possibilities for effective accrual depending on how it aligns with the optimum point of patient equipoise. Qualitative recruitment investigations, often focussed on information provision and patient engagement, may also look to better understand the target patient population in order to optimise the point at which patients are approached. TRIAL REGISTRATION ISRCTN Registry, ISRCTN98009168 . Registered on 29 November 2012.
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Affiliation(s)
- Paul Whybrow
- Newcastle University, Baddiley-Clark Building, Newcastle Upon Tyne, NE2 4AX UK
- Present address: School for Social and Community Medicine, Canynge Hall, 39 Whatley Road, Bristol, BS8 2PS UK
| | - Robert Pickard
- Institute of Cellular Medicine, The Medical School, Newcastle University, 3rd Floor William Leech Building, Newcastle upon Tyne, NE2 4HH UK
| | - Susan Hrisos
- Newcastle University, Baddiley-Clark Building, Newcastle Upon Tyne, NE2 4AX UK
| | - Tim Rapley
- Newcastle University, Baddiley-Clark Building, Newcastle Upon Tyne, NE2 4AX UK
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Olker SJ, Parrott JS, Swarbrick MA, Spagnolo AB. Weight management interventions in adults with a serious mental illness: A meta-analytic review. AMERICAN JOURNAL OF PSYCHIATRIC REHABILITATION 2016. [DOI: 10.1080/15487768.2016.1231643] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Affiliation(s)
- Stephen J. Olker
- Department of Psychiatric Rehabilitation and Counseling Professions, Rutgers University, Newark, New Jersey, USA
| | - James Scott Parrott
- Department of Interdisciplinary Studies, Rutgers University, Newark, New Jersey, USA
| | - Margaret A. Swarbrick
- Department of Psychiatric Rehabilitation and Counseling Professions, Rutgers University, Newark, New Jersey, USA
| | - Amy B. Spagnolo
- Department of Psychiatric Rehabilitation and Counseling Professions, Rutgers University, Newark, New Jersey, USA
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Qualitative process study of community pharmacist brief alcohol intervention effectiveness trial: Can research participation effects explain a null finding? Drug Alcohol Depend 2016; 161:36-41. [PMID: 26875673 DOI: 10.1016/j.drugalcdep.2016.01.023] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/06/2015] [Revised: 12/16/2015] [Accepted: 01/10/2016] [Indexed: 11/23/2022]
Abstract
AIMS This qualitative process study, nested within a randomised controlled trial evaluating community pharmacist brief alcohol intervention delivery, aims to explore participants' engagement with the trial, so as to identify whether research participation effects may explain why the brief intervention was not found to be effective. METHOD Qualitative interviews were conducted with 24 randomly selected participants approximately one month after the end of the trial. Semi structured Interviews were conducted by telephone in which participants were asked to give a chronological account of their trial participation, leading to a discussion of possible impacts. These were digitally recorded, transcribed verbatim, and analysed using the Framework method. RESULTS A range of motivations for taking part in the trial were identified, including pharmacy visitors wanting to obtain an assessment of their drinking. Participants in both arms of the trial spoke of the potent effect that screening had on them. All participants were exposed to discussions about alcohol with empathic pharmacists and, as this is an integral intervention component, this constitutes contamination. Participants' pre-existing ideas about the nature of alcohol problems had an important bearing on how relevant they thought the intervention was to them. CONCLUSION A detailed appreciation of participant engagement with the trial can provide a strong basis for interpretation of trial outcome data, and in this instance does help explain the null finding. Other findings also indicate the need for dedicated studies of public understanding of the nature of alcohol problems, and their implications for receptivity to brief interventions.
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MacNeill V, Foley M, Quirk A, McCambridge J. Shedding light on research participation effects in behaviour change trials: a qualitative study examining research participant experiences. BMC Public Health 2016; 16:91. [PMID: 26825583 PMCID: PMC4733277 DOI: 10.1186/s12889-016-2741-6] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2015] [Accepted: 01/15/2016] [Indexed: 11/15/2022] Open
Abstract
Background The sequence of events in a behaviour change trial involves interactions between research participants and the trial process. Taking part in such a study has the potential to influence the behaviour of the participant, and if it does, this can engender bias in trial outcomes. Since participants’ experience has received scant attention, the aim of this study is thus to generate hypotheses about which aspects of the conduct of behaviour change trials might matter most to participants, and thus have potential to alter subsequent behaviours and bias trial outcomes Methods Twenty participants were opportunistically screened for a health compromising behaviour (unhealthy diet, lack of exercise, smoking or alcohol consumption) and recruited if eligible. Semi structured face to face interviews were conducted, after going through the usual processes involved in trial recruitment, baseline assessment and randomisation. Participants were given information on the contents of an intervention or control condition in a behaviour change trial, which was not actually implemented. Three months later they returned to reflect on these experiences and whether they had any effect on their behaviour during the intervening period. Data from the latter interview were analysed thematically using a modified grounded theory approach. Results The early processes of trial participation raised awareness of unhealthy behaviours, although most reported having had only fleeting intentions to change their behaviour as a result of taking part in this study, in the absence of interventions. However, careful examination of the accounts revealed evidence of subtle research participation effects, which varied according to the health behaviour, and its perceived social acceptability. Participants’ relationships with the research study were viewed as somewhat important in stimulating thinking about whether and how to make lifestyle changes. Conclusion These participants described no dramatic impacts attributable to taking part in this study. This study demonstrates the likely value of well conducted qualitative studies of subtle research participation effects, which may be particularly important to explore for alcohol. Separating unintended influences in trial participation from the effects of behaviour change interventions being evaluated therein is necessary for valid estimates of intervention effects.
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Affiliation(s)
- Virginia MacNeill
- Faculty of Public Health & Policy, London School of Hygiene & Tropical Medicine, 15-17 Tavistock Place, London, WC1H 9SH, UK
| | - Marian Foley
- Faculty Health, Psychology and Social Care Manchester Metropolitan University, 799 Wilmslow Road, Manchester, M20 2RR, UK
| | - Alan Quirk
- Royal College of Psychiatrists' Centre for Quality Improvement, 21 Prescot Street, London, E1 8BB, UK
| | - Jim McCambridge
- Faculty of Public Health & Policy, London School of Hygiene & Tropical Medicine, 15-17 Tavistock Place, London, WC1H 9SH, UK. .,Department of Health Sciences, University of York, Heslington, York, YO10 5DD, UK.
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Steventon A, Grieve R, Bardsley M. An Approach to Assess Generalizability in Comparative Effectiveness Research: A Case Study of the Whole Systems Demonstrator Cluster Randomized Trial Comparing Telehealth with Usual Care for Patients with Chronic Health Conditions. Med Decis Making 2015; 35:1023-36. [PMID: 25986472 PMCID: PMC4592957 DOI: 10.1177/0272989x15585131] [Citation(s) in RCA: 12] [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: 03/31/2014] [Accepted: 02/25/2015] [Indexed: 01/25/2023]
Abstract
BACKGROUND Policy makers require estimates of comparative effectiveness that apply to the population of interest, but there has been little research on quantitative approaches to assess and extend the generalizability of randomized controlled trial (RCT)-based evaluations. We illustrate an approach using observational data. METHODS Our example is the Whole Systems Demonstrator (WSD) trial, in which 3230 adults with chronic conditions were assigned to receive telehealth or usual care. First, we used novel placebo tests to assess whether outcomes were similar between the RCT control group and a matched subset of nonparticipants who received usual care. We matched on 65 baseline variables obtained from the electronic medical record. Second, we conducted sensitivity analysis to consider whether the estimates of treatment effectiveness were robust to alternative assumptions about whether "usual care" is defined by the RCT control group or nonparticipants. Thus, we provided alternative estimates of comparative effectiveness by contrasting the outcomes of the RCT telehealth group and matched nonparticipants. RESULTS For some endpoints, such as the number of outpatient attendances, the placebo tests passed, and the effectiveness estimates were robust to the choice of comparison group. However, for other endpoints, such as emergency admissions, the placebo tests failed and the estimates of treatment effect differed markedly according to whether telehealth patients were compared with RCT controls or matched nonparticipants. CONCLUSIONS The proposed placebo tests indicate those cases when estimates from RCTs do not generalize to routine clinical practice and motivate complementary estimates of comparative effectiveness that use observational data. Future RCTs are recommended to incorporate these placebo tests and the accompanying sensitivity analyses to enhance their relevance to policy making.
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Affiliation(s)
- Adam Steventon
- Adam Steventon, Health Foundation, 90 Long Acre, London WC2E 9RA; e-mail:
| | - Richard Grieve
- Health Foundation, London, UK (AS)
- London School of Hygiene and Tropical Medicine, Keppel Street, London (AS, RG)
- Nuffield Trust, London (MB)
| | - Martin Bardsley
- Health Foundation, London, UK (AS)
- London School of Hygiene and Tropical Medicine, Keppel Street, London (AS, RG)
- Nuffield Trust, London (MB)
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Dhital R, Norman I, Whittlesea C, Murrells T, McCambridge J. The effectiveness of brief alcohol interventions delivered by community pharmacists: randomized controlled trial. Addiction 2015; 110:1586-94. [PMID: 25988589 PMCID: PMC4765086 DOI: 10.1111/add.12994] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/25/2014] [Revised: 12/02/2014] [Accepted: 05/12/2015] [Indexed: 11/30/2022]
Abstract
BACKGROUND AND AIMS To undertake the first randomized controlled trial to evaluate the effectiveness of a brief intervention delivered by community pharmacists to reduce hazardous or harmful drinking. DESIGN This parallel group randomized trial allocated participants individually to brief alcohol intervention (n = 205) or a leaflet-only control condition (n = 202), with follow-up study after 3 months. SETTING Sixteen community pharmacies in one London Borough, UK. PARTICIPANTS A total of 407 pharmacy customers (aged 18 years or over) with Alcohol Use Disorder Identification Test (AUDIT) scores 8-19, inclusive. INTERVENTION A brief motivational discussion of approximately 10 minutes' duration, for which 17 pharmacists received a half-day of training. MEASUREMENTS Hazardous or harmful drinking was assessed using the AUDIT administered by telephone by a researcher blind to allocation status. The two primary outcomes were: (1) change in AUDIT total scores and (2) the proportions no longer hazardous or harmful drinkers (scoring < 8) at 3 months. The four secondary outcomes were: the three subscale scores of the AUDIT (for consumption, problems and dependence) and health status according to the EQ-5D (a standardized instrument for use as a measure of health outcome). FINDINGS At 3 months 326 (80% overall; 82% intervention, 78% control) participants were followed-up. The difference in reduction in total AUDIT score (intervention minus control) was -0.57, 95% confidence interval (CI) = -1.59 to 0.45, P = 0.28. The odds ratio for AUDIT ˂ 8 (control as reference) was 0.87, 95% CI = 0.50 to 1.51, P = 0.61). For two of the four secondary outcomes (dependence score: -0.46, 95% CI = -0.82 to -0.09, P = 0.014; health status score: -0.09, 95% CI = -0.16 to -0.02, P = 0.013) the control group did better, and in the other two there were no differences (consumption score: -0.05, 95% CI = -0.54 to 0.44, P = 0.85; non-dependence problems score: -0.13, 95% CI = -0.66 to 0.41). Sensitivity analyses did not change these findings. CONCLUSIONS A brief intervention delivered by community pharmacists appears to have had no effect in reducing hazardous or harmful alcohol consumption.
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Affiliation(s)
- Ranjita Dhital
- King's College London, Florence Nightingale Faculty of Nursing and Midwifery, London, UK
| | - Ian Norman
- King's College London, Florence Nightingale Faculty of Nursing and Midwifery, London, UK
| | - Cate Whittlesea
- School of Medicine, Pharmacy and Health, Durham University, Stockton-on-Tees, UK
| | - Trevor Murrells
- King's College London, Florence Nightingale Faculty of Nursing and Midwifery, London, UK
| | - Jim McCambridge
- Mental Health and Addictions Research Group, Department of Health Sciences, Faculty of Science, University of York, York, UK
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Kypri K, Wilson A, Attia J, Sheeran PJ, McCambridge J. Effects of study design and allocation on self-reported alcohol consumption: randomized trial. Trials 2015; 16:127. [PMID: 25872651 PMCID: PMC4393640 DOI: 10.1186/s13063-015-0642-0] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2014] [Accepted: 03/09/2015] [Indexed: 11/29/2022] Open
Abstract
Background What participants think about the nature of a study might affect their behaviour and bias findings. We tested two hypotheses: (1) participants told they were in an intervention trial would report lower alcohol consumption at follow-up than those told they were in a cohort study; (2) participants told they were in the intervention group in a trial would have lower alcohol consumption at follow-up than those told they were in the control group. Methods Students from four universities (N = 72,903) were invited to participate in a ‘research project on student drinking’. Of 10,415 respondents, 6,788 were moderate to heavy drinkers and were randomized. Group A (‘cohort’) were informed their drinking would be assessed at baseline and again in one month. Group B (‘control’) were told the study was an intervention trial and they were in the control group. Group C (‘intervention’) were told the study was an intervention trial and they were to receive the intervention. All were assessed and directed to read identical online alcohol education material. Whether and how long they accessed the material were recorded. One month later, alcohol intake was reassessed. Results In relation to hypothesis 1, there were no differences between the groups on the prespecified outcome measures. In relation to hypothesis 2, there were no differences though all point estimates were in the hypothesized direction (that is, ‘intervention’ < ‘control’). The ‘cohort’ and ‘control’ groups accessed the material to a similar extent (59% versus 57%) while the ‘intervention’ group were more likely to access it (78%) and to read it for longer (median 35 s (25th and 75th percentiles: 6, 97) versus medians of 7 s (0, 28) and 8 s (4, 42) for the ‘cohort’ and ‘control’ groups, respectively). Conclusions Although the context given to the research participants significantly influenced access to the online information and reading time, this did not translate into any effect on drinking behaviour, for either hypothesis. This might be because of failure in the experimental paradigm or the possibility of weaker effects using the online approach. Trial registration Australian New Zealand Clinical Trials Registry ACTRN12610000846022
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Affiliation(s)
- Kypros Kypri
- Centre for Clinical Epidemiology and Biostatistics, School of Medicine and Public Health, University of Newcastle, Callaghan, NSW, 2308, Australia.
| | - Amanda Wilson
- Centre for Clinical Epidemiology and Biostatistics, School of Medicine and Public Health, University of Newcastle, Callaghan, NSW, 2308, Australia.
| | - John Attia
- Centre for Clinical Epidemiology and Biostatistics, School of Medicine and Public Health, University of Newcastle, Callaghan, NSW, 2308, Australia.
| | - Paschal J Sheeran
- Department of Psychology, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.
| | - Jim McCambridge
- Centre for Clinical Epidemiology and Biostatistics, School of Medicine and Public Health, University of Newcastle, Callaghan, NSW, 2308, Australia. .,Faculty of Public Health & Policy, London School of Hygiene & Tropical Medicine, London, UK.
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McCambridge J, Kypri K, Elbourne D. Research participation effects: a skeleton in the methodological cupboard. J Clin Epidemiol 2014; 67:845-9. [PMID: 24766858 PMCID: PMC4236591 DOI: 10.1016/j.jclinepi.2014.03.002] [Citation(s) in RCA: 109] [Impact Index Per Article: 10.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2013] [Revised: 03/10/2014] [Accepted: 03/14/2014] [Indexed: 11/26/2022]
Abstract
Objective There have been concerns about impacts of various aspects of taking part in research studies for a century. The concerns have not, however, been sufficiently well conceptualized to form traditions of study capable of defining and elaborating the nature of these problems. In this article we present a new way of thinking about a set of issues attracting long-standing attention. Study Design and Setting We briefly review existing concepts and empirical work on well-known biases in surveys and cohort studies and propose that they are connected. Results We offer the construct of “research participation effects” (RPE) as a vehicle for advancing multi-disciplinary understanding of biases. Empirical studies are needed to identify conditions in which RPE may be sufficiently large to warrant modifications of study design, analytic methods, or interpretation. We consider the value of adopting a more participant-centred view of the research process as a way of thinking about these issues, which may also have benefits in relation to research methodology more broadly. Conclusion Researchers may too readily overlook the extent to which research studies are unusual contexts, and that people may react in unexpected ways to what we invite them to do, introducing a range of biases.
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Affiliation(s)
- Jim McCambridge
- Faculty of Public Health & Policy, London School of Hygiene & Tropical Medicine, 15-17 Tavistock Place, London WC1H 9SH, UK.
| | - Kypros Kypri
- Centre for Clinical Epidemiology and Biostatistics, School of Medicine and Public Health, University of Newcastle, HMRI Building, Callaghan NSW 2308, Australia
| | - Diana Elbourne
- Department of Medical Statistics, Faculty of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, Keppel Street, London WC1E 7HT, UK
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