1
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Cheng Y, Xue FS, Yuan YJ. Letter to the Editor regarding "Efficacy of adjuvant dexmedetomidine on penile block for pediatric hypospadias repair.". J Pediatr Urol 2024; 20:560-561. [PMID: 38360427 DOI: 10.1016/j.jpurol.2024.01.036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/14/2024] [Accepted: 01/15/2024] [Indexed: 02/17/2024]
Affiliation(s)
- Yi Cheng
- Department of Anesthesiology, Beijing Friendship Hospital, Capital Medical University, Beijing, People's Republic of China
| | - Fu-Shan Xue
- Department of Anesthesiology, Beijing Friendship Hospital, Capital Medical University, Beijing, People's Republic of China.
| | - Yu-Jing Yuan
- Department of Anesthesiology, Beijing Friendship Hospital, Capital Medical University, Beijing, People's Republic of China
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2
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Cheng Y, Xue FS, Yuan YJ. Letter to the Editor in Response to: Comparing Efficacy of Different Regional Analgesia Methods for Pediatric Laparoscopic Cholecystectomy. J Pediatr Surg 2024; 59:1228. [PMID: 38365471 DOI: 10.1016/j.jpedsurg.2024.01.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/16/2024] [Accepted: 01/23/2024] [Indexed: 02/18/2024]
Affiliation(s)
- Yi Cheng
- Department of Anesthesiology, Beijing Friendship Hospital, Capital Medical University, Beijing, People's Republic of China
| | - Fu-Shan Xue
- Department of Anesthesiology, Beijing Friendship Hospital, Capital Medical University, Beijing, People's Republic of China; Department of Anesthesiology, Shengli Clinical Medical College of Fujian Medical University, Fujian Provincial Hospital, Fuzhou City, Fujian Province, People's Republic of China.
| | - Yu-Jing Yuan
- Department of Anesthesiology, Beijing Friendship Hospital, Capital Medical University, Beijing, People's Republic of China
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3
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Li XY, Xue FS, Li XT. Comparing Analgesic Effects of Different Interventions After Thoracoscopic Pneumonectomy. J Perianesth Nurs 2024; 39:343-344. [PMID: 38823961 DOI: 10.1016/j.jopan.2023.10.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2023] [Accepted: 10/28/2023] [Indexed: 06/03/2024]
Affiliation(s)
- Xin-Yue Li
- Department of Anesthesiology, Beijing Friendship Hospital, Capital Medical University, Beijing, China
| | - Fu-Shan Xue
- Department of Anesthesiology, Beijing Friendship Hospital, Capital Medical University, Beijing, China.
| | - Xin-Tao Li
- Department of Anesthesiology, Beijing Friendship Hospital, Capital Medical University, Beijing, China
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4
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Li XT, Xue FS, Li CW. Letter to the Editor regarding Vijittrakarnrung et al: "Periarticular injection in addition to interscalene nerve block can decrease opioid consumption and pain following total shoulder arthroplasty: a comparison cohort study". J Shoulder Elbow Surg 2024; 33:e278-e279. [PMID: 37844832 DOI: 10.1016/j.jse.2023.09.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/19/2023] [Accepted: 09/03/2023] [Indexed: 10/18/2023]
Affiliation(s)
- Xin-Tao Li
- Department of Anesthesiology, Beijing Friendship Hospital, Capital Medical University, Beijing, China
| | - Fu-Shan Xue
- Department of Anesthesiology, Beijing Friendship Hospital, Capital Medical University, Beijing, China.
| | - Cheng-Wen Li
- Department of Anesthesiology, Beijing Friendship Hospital, Capital Medical University, Beijing, China
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5
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Chen M, Zhang B. Letter to the Editor Regarding "Effect of Ropivacaine Intercostal Nerve Block Combined with Patient Controlled Intravenous Analgesia on Postoperative Analgesia After Breast Augmentation". Aesthetic Plast Surg 2024:10.1007/s00266-024-04081-3. [PMID: 38691175 DOI: 10.1007/s00266-024-04081-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2024] [Accepted: 04/09/2024] [Indexed: 05/03/2024]
Abstract
We read the recently published article "Effect of Ropivacaine Intercostal Nerve Block Combined with Patient Controlled Intravenous Analgesia on Postoperative Analgesia after Breast Augmentation" by You et al. We have noticed several issues in the methods and results of this study and would appreciate the responses from the authors. We question several aspects, opioid-sparing effect, sufentanil consumption, sample size evaluation, exclusion reasons, and side effects.
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Affiliation(s)
- Minghao Chen
- Department of Anesthesia, Weihai Municipal Hospital, Cheeloo College of Medicine, Shandong University, Weihai, China.
- Department of Anesthesia, Weihai Municipal Hospital, No.70 Heping Road, Huancui District, Weihai, 264200, Shandong, China.
| | - Beibei Zhang
- Department of Anesthesia, Weihai Municipal Hospital, Cheeloo College of Medicine, Shandong University, Weihai, China
- Department of Anesthesia, Weihai Municipal Hospital, No.70 Heping Road, Huancui District, Weihai, 264200, Shandong, China
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6
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Olivier CB, Struß L, Sünnen N, Kaier K, Heger LA, Westermann D, Meerpohl JJ, Mahaffey KW. Accuracy of Event Rate and Effect Size Estimation in Major Cardiovascular Trials: A Systematic Review. JAMA Netw Open 2024; 7:e248818. [PMID: 38687478 PMCID: PMC11061773 DOI: 10.1001/jamanetworkopen.2024.8818] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/12/2023] [Accepted: 02/29/2024] [Indexed: 05/02/2024] Open
Abstract
Importance For the design of a randomized clinical trial (RCT), estimation of the expected event rate and effect size of an intervention is needed to calculate the sample size. Overestimation may lead to an underpowered trial. Objective To evaluate the accuracy of published estimates of event rate and effect size in contemporary cardiovascular RCTs. Evidence Review A systematic search was conducted in MEDLINE for multicenter cardiovascular RCTs associated with MeSH (Medical Subject Headings) terms for cardiovascular diseases published in the New England Journal of Medicine, JAMA, or the Lancet between January 1, 2010, and December 31, 2019. Identified trials underwent abstract review; eligible trials then underwent full review, and those with insufficiently reported data were excluded. Data were extracted from the original publication or the study protocol, and a random-effects model was used for data pooling. This review was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses reporting guideline. The primary outcome was the accuracy of event rate and effect size estimation. Accuracy was determined by comparing the observed event rate in the control group and the effect size with their hypothesized values. Linear regression was used to determine the association between estimation accuracy and trial characteristics. Findings Of the 873 RCTs identified, 374 underwent full review and 30 were subsequently excluded, resulting in 344 trials for analysis. The median observed event rate was 9.0% (IQR, 4.3% to 21.4%), which was significantly lower than the estimated event rate of 11.0% (IQR, 6.0% to 25.0%) with a median deviation of -12.3% (95% CI, -16.4% to -5.6%; P < .001). More than half of the trials (196 [61.1%]) overestimated the expected event rate. Accuracy of event rate estimation was associated with a higher likelihood of refuting the null hypothesis (0.13 [95% CI, 0.01 to 0.25]; P = .03). The median observed effect size in superiority trials was 0.91 (IQR, 0.74 to 0.99), which was significantly lower than the estimated effect size of 0.72 (IQR, 0.60 to 0.80), indicating a median overestimation of 23.1% (95% CI, 17.9% to 28.3%). A total of 216 trials (82.1%) overestimated the effect size. Conclusions and Relevance In this systematic review of contemporary cardiovascular RCTs, event rates of the primary end point and effect sizes of an intervention were frequently overestimated. This overestimation may have contributed to the inability to adequately test the trial hypothesis.
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Affiliation(s)
- Christoph B. Olivier
- Department of Cardiology and Angiology, Cardiovascular Clinical Research Center, University Heart Center Freiburg–Bad Krozingen, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Lasse Struß
- Department of Cardiology and Angiology, Cardiovascular Clinical Research Center, University Heart Center Freiburg–Bad Krozingen, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Nathalie Sünnen
- Department of Cardiology and Angiology, Cardiovascular Clinical Research Center, University Heart Center Freiburg–Bad Krozingen, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Klaus Kaier
- Institute of Medical Biometry and Medical Informatics, University Medical Center Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Lukas A. Heger
- Department of Cardiology and Angiology, Cardiovascular Clinical Research Center, University Heart Center Freiburg–Bad Krozingen, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Dirk Westermann
- Department of Cardiology and Angiology, Cardiovascular Clinical Research Center, University Heart Center Freiburg–Bad Krozingen, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Joerg J. Meerpohl
- Institute for Evidence in Medicine, University Medical Center Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
- Cochrane Germany, Cochrane Germany Foundation, University of Freiburg, Freiburg, Germany
| | - Kenneth W. Mahaffey
- Department of Medicine, Stanford Center for Clinical Research, Stanford University School of Medicine, Stanford, California
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7
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Pasli M, Tumin D, Guffey R. Simulation-Based Analysis of Trial Design in Regional Anesthesia. Anesthesiol Res Pract 2024; 2024:6651894. [PMID: 38525205 PMCID: PMC10959581 DOI: 10.1155/2024/6651894] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2023] [Revised: 08/01/2023] [Accepted: 02/12/2024] [Indexed: 03/26/2024] Open
Abstract
Background In regional anesthesia, the efficacy of novel blocks is typically evaluated using randomized controlled trials (RCTs), the findings of which are aggregated in systematic reviews and meta-analyses. Systematic review authors frequently point out the small sample size of RCTs as limiting conclusions from this literature. We sought to determine via statistical simulation if small sample size could be an expected property of RCTs focusing on novel blocks with typical effect sizes. Methods We simulated the conduct of a series of RCTs comparing a novel block versus placebo on a single continuous outcome measure. Simulation analysis inputs were obtained from a systematic bibliographic search of meta-analyses. Primary outcomes were the predicted number of large trials (empirically defined as N ≥ 256) and total patient enrollment. Results Simulation analysis predicted that a novel block would be tested in 16 RCTs enrolling a median of 970 patients (interquartile range (IQR) across 1000 simulations: 806, 1269), with no large trials. Among possible modifications to trial design, decreasing the statistical significance threshold from p < 0.05 to p < 0.005 was most effective at increasing the total number of patients represented in the final meta-analysis, but was associated with early termination of the trial sequence due to futility in block vs. block comparisons. Conclusion Small sample size of regional anesthesia RCTs comparing novel block to placebo is a rational outcome of trial design. Feasibly large trials are unlikely to change conclusions regarding block vs. placebo comparisons.
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Affiliation(s)
- Melisa Pasli
- Brody School of Medicine, East Carolina University, Greenville, NC, USA
| | - Dmitry Tumin
- Department of Pediatrics, Brody School of Medicine, East Carolina University, Greenville, NC, USA
- Department of Academic Affairs, Brody School of Medicine, East Carolina University, Greenville, NC, USA
| | - Ryan Guffey
- Department of Anesthesiology, Washington University School of Medicine, Saint Louis, MO, USA
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8
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Chen PS, Li XT, Xue FS. Letter to the Editor Regarding "The Impact of Laparoscopic Intraperitoneal Instillation of Ropivacaine in Enhancing Respiratory Recovery and Reducing Acute Postoperative Pain in Laparoscopic Sleeve Gastrectomy: a Double-Blinded Randomised Control; RELiEVE Trial". Obes Surg 2024; 34:1022-1023. [PMID: 38280158 DOI: 10.1007/s11695-023-06976-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2023] [Revised: 09/29/2023] [Accepted: 11/13/2023] [Indexed: 01/29/2024]
Affiliation(s)
- Pei-Shan Chen
- Department of Anesthesiology, Beijing Friendship Hospital, Capital Medical University, NO. 95 Yong-An Road, Xi-Cheng District, Beijing, 100050, People's Republic of China
| | - Xin-Tao Li
- Department of Anesthesiology, Beijing Friendship Hospital, Capital Medical University, NO. 95 Yong-An Road, Xi-Cheng District, Beijing, 100050, People's Republic of China
| | - Fu-Shan Xue
- Department of Anesthesiology, Beijing Friendship Hospital, Capital Medical University, NO. 95 Yong-An Road, Xi-Cheng District, Beijing, 100050, People's Republic of China.
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9
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Yang WH, Xue FS, Li XT, Tian T. Determining Effects of Preoperative Nursing Visit on Anxiety and Pain Level of Patients After Surgery: The Right Methodology Is Needed. J Perianesth Nurs 2023; 38:836-837. [PMID: 38042578 DOI: 10.1016/j.jopan.2023.05.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2023] [Accepted: 05/16/2023] [Indexed: 12/04/2023]
Affiliation(s)
- Wen-He Yang
- Department of Anesthesiology, Beijing Friendship Hospital, Capital Medical University, Beijing, China
| | - Fu-Shan Xue
- Department of Anesthesiology, Beijing Friendship Hospital, Capital Medical University, Beijing, China.
| | - Xin-Tao Li
- Department of Anesthesiology, Beijing Friendship Hospital, Capital Medical University, Beijing, China
| | - Tian Tian
- Department of Anesthesiology, Beijing Friendship Hospital, Capital Medical University, Beijing, China
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10
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Yang WH, Tian T, Xue FS. Re: "Effect of Multimodal Preemptive Analgesia of Flurbiprofen Axetil, Nalbuphine, and Retrobulbar Block on Postoperative Pain and Enhanced Recovery in Patients Undergoing Oculoplastic Day Surgery: A Prospective, Randomized, Double-Blinded Study". Ophthalmic Plast Reconstr Surg 2023; 39:647. [PMID: 37922045 DOI: 10.1097/iop.0000000000002503] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2023]
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11
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Xue B, Li XT, Xue FS. Letter to the Editor Regarding "Bilateral Ultrasound-Guided Erector Spinae Plane Block for Perioperative Analgesia in Breast Reduction Surgery: A Prospective Randomized and Controlled Trial". Aesthetic Plast Surg 2023:10.1007/s00266-023-03653-z. [PMID: 37749416 DOI: 10.1007/s00266-023-03653-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2023] [Accepted: 09/06/2023] [Indexed: 09/27/2023]
Affiliation(s)
- Bai Xue
- Department of Anesthesiology, Sengkang General Hospital, Singapore, Singapore
| | - Xin-Tao Li
- Department of Anesthesiology, Beijing Friendship Hospital, Capital Medical University, NO. 95 Yong-An Road, Xi-Cheng District, Beijing, 100050, People's Republic of China
| | - Fu-Shan Xue
- Department of Anesthesiology, Beijing Friendship Hospital, Capital Medical University, NO. 95 Yong-An Road, Xi-Cheng District, Beijing, 100050, People's Republic of China.
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12
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Xue B. Comment on "Effect of Ultrasound-Guided Transversus Abdominis Plane Block Combined with Patient-Controlled Intravenous Analgesia on Postoperative Analgesia After Laparoscopic Cholecystectomy: a Double-Blind, Randomized Controlled Trial". J Gastrointest Surg 2023; 27:2035-2036. [PMID: 37528317 DOI: 10.1007/s11605-023-05791-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/06/2023] [Accepted: 07/22/2023] [Indexed: 08/03/2023]
Affiliation(s)
- Bai Xue
- Department of Anaesthesiology, Sengkang General Hospital, 110 Sengkang East Way, Singapore, Singapore.
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13
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Chen PS, Xue FS, Li CW. Evaluation of the Effect of New Multimodal Analgesia Regimen for Cardiac Surgery: A Prospective, Randomized Controlled, Single-Center Clinical Study [Letter]. Drug Des Devel Ther 2023; 17:2353-2354. [PMID: 37583845 PMCID: PMC10424689 DOI: 10.2147/dddt.s429365] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2023] [Accepted: 08/03/2023] [Indexed: 08/17/2023] Open
Affiliation(s)
- Pei-Shan Chen
- Department of Anesthesiology, Beijing Friendship Hospital, Capital Medical University, Beijing, People’s Republic of China
| | - Fu-Shan Xue
- Department of Anesthesiology, Beijing Friendship Hospital, Capital Medical University, Beijing, People’s Republic of China
| | - Cheng-Wen Li
- Department of Anesthesiology, Beijing Friendship Hospital, Capital Medical University, Beijing, People’s Republic of China
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14
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Kounatidou NE, Tzavara C, Palioura S. Systematic review of sample size calculations and reporting in randomized controlled trials in ophthalmology over a 20-year period. Int Ophthalmol 2023; 43:2999-3010. [PMID: 36917324 DOI: 10.1007/s10792-023-02687-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2022] [Accepted: 03/04/2023] [Indexed: 03/16/2023]
Abstract
PURPOSE Randomized Controlled Trials (RCTs) are considered the gold standard for the practice of evidence-based medicine. The purpose of this study is to systematically assess the reporting of sample size calculations in ophthalmology RCTs in 5 leading journals over a 20-year period. Reviewing sample size calculations in ophthalmology RCTs will shed light on the methodological quality of RCTs and, by extension, on the validity of published results. METHODS The MEDLINE database was searched to identify full reports of RCTs in the journals Ophthalmology, JAMA Ophthalmology, American Journal of Ophthalmology, Investigative Ophthalmology and Visual Science, and British Journal of Ophthalmology between January and December of the years 2000, 2010 and 2020. Screening identified 559 articles out of which 289 met the inclusion criteria for this systematic review. Data regarding sample size calculation reporting and trial characteristics was extracted for each trial by independent investigators. RESULTS In 2020, 77.9% of the RCTs reported sample size calculations as compared with 37% in 2000 (p < 0.001) and 60.7% in 2010 (p = 0.012). Studies reporting all necessary parameters for sample size recalculation increased significantly from 17.2% in 2000 to 39.3% in 2010 and 43.0% in 2020 (p < 0.001). Reporting of funding was greater in 2020 (98.8%) compared with 2010 (89.3%) and 2000 (53.1%). Registration in a clinical trials database occurred more frequently in 2020 (94.2%) compared to 2000 (1.2%; p < 0.001) and 2010 (68%; p < 0.001). In 2020, 38.4% of studies reported different sample sizes in the online registry from the published article. Overall, the most studied area in 2000 was glaucoma (29.6% of RCTs), whereas in 2010 and 2020, it was retina (40.2 and 37.2% of the RCTs, respectively). The number of patients enrolled in a study and the number of eyes studied was significantly greater in 2020 compared to 2000 and 2010 (p < 0.001). CONCLUSION Sample size calculation reporting in ophthalmology RCTs has improved significantly between the years 2000 and 2020 and is comparable to other fields in medicine. However, reporting of certain parameters remains inconsistent with current publication guidelines.
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Affiliation(s)
| | - Chara Tzavara
- Department of Biostatistics, National and Kapodistrian University of Athens Medical School, Athens, Greece
| | - Sotiria Palioura
- Department of Ophthalmology, University of Cyprus Medical School, Aglantzia, Cyprus.
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15
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Hou HJ, Xue FS, Li CW. Comparing Analgesic Efficacy and Clinical Benefits of Fascial Plane Blocks Following Open Hepatectomy [Letter]. J Pain Res 2023; 16:2665-2666. [PMID: 37538248 PMCID: PMC10395508 DOI: 10.2147/jpr.s431210] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2023] [Accepted: 07/24/2023] [Indexed: 08/05/2023] Open
Affiliation(s)
- Hai-Jun Hou
- Department of Anesthesiology, Beijing Friendship Hospital, Capital Medical University, Beijing, People’s Republic of China
| | - Fu-Shan Xue
- Department of Anesthesiology, Beijing Friendship Hospital, Capital Medical University, Beijing, People’s Republic of China
| | - Cheng-Wen Li
- Department of Anesthesiology, Beijing Friendship Hospital, Capital Medical University, Beijing, People’s Republic of China
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16
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Elshazly M, Shaban A, Gouda N, Rashad M, Soaida SM. Ultrasound-guided lumbar erector spinae plane block versus caudal block for postoperative analgesia in pediatric hip and proximal femur surgery: a randomized controlled study. Korean J Anesthesiol 2023; 76:194-202. [PMID: 36274252 DOI: 10.4097/kja.22421] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2022] [Accepted: 10/21/2022] [Indexed: 06/02/2023] Open
Abstract
BACKGROUND According to previous research, 20% of infants experience prolonged postsurgical pain 6-12 months after major surgery, which is linked to functional impairment and a lower quality of life. The aim of our study is to evaluate whether the analgesic effect of the erector spinae plane block (ESPB) is superior to that of caudal epidural anesthesia (CEA) in pediatric patients undergoing hip or proximal femoral surgeries. METHODS Seventy-six children ranging in age from 1 to 7 years scheduled for hip or proximal femur surgery were randomly assigned to receive either a unilateral ultrasound-guided ESPB or CEA with bupivacaine 0.25% at a dose of 0.5 ml/kg. The primary outcome was the Face, Legs, Activity, Cry, and Consolability (FLACC) scale 2 h postoperatively. The secondary outcomes were pain scores every 15 min for the first hour and then at 6, 12, and 24 h postoperatively; the block failure rate; time to perform a successful block; and time to first rescue analgesia. RESULTS The FLACC score 2 h post¬operatively was not superior in the ESPB group compared to the CEA group; indeed, it was significantly higher in the ESPB group at 15 and 30 min post-operation (P = 0.005, 0.004, respectively). Additionally, the time to first rescue analgesia was prolonged in the CEA group (P < 0.001). The time to perform a successful block was comparable between the groups. CONCLUSIONS The analgesic effect of the ESPB was not superior to that of CEA in pediatric patients undergoing hip and proximal femur surgery.
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Affiliation(s)
- Mohamed Elshazly
- Department of Anesthesia, Surgical Intensive Care Unit, and Pain Management, Faculty of Medicine, Cairo University, Cairo, Egypt
| | - AbdelKhalek Shaban
- Department of Anesthesia, Surgical Intensive Care Unit, and Pain Management, Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Nevine Gouda
- Department of Anesthesia, Surgical Intensive Care Unit, and Pain Management, Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Mahitab Rashad
- Department of Anesthesia, Surgical Intensive Care Unit, and Pain Management, Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Sherif M Soaida
- Department of Anesthesia, Surgical Intensive Care Unit, and Pain Management, Faculty of Medicine, Cairo University, Cairo, Egypt
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17
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Perra A, Galetti A, Zaccheddu R, Locci A, Piludu F, Preti A, Primavera D, Di Natale L, Nardi AE, Kurotshka PK, Cossu G, Sancassiani F, Stella G, De Lorenzo V, Zreik T, Carta MG. A Recovery-Oriented Program for People with Bipolar Disorder through Virtual Reality-Based Cognitive Remediation: Results of a Feasibility Randomized Clinical Trial. J Clin Med 2023; 12:jcm12062142. [PMID: 36983145 PMCID: PMC10056011 DOI: 10.3390/jcm12062142] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2023] [Revised: 03/02/2023] [Accepted: 03/07/2023] [Indexed: 03/11/2023] Open
Abstract
Background: Cognitive impairment is a frequent consequence of bipolar disorder (BD) that is difficult to prevent and treat. In addition, the quality of the preliminary evidence on the treatment of BD through Cognitive Remediation (CR) with traditional methods is poor. This study aims to evaluate the feasibility of a CR intervention with fully immersive Virtual Reality (VR) as an additional treatment for BD and offers preliminary data on its efficacy. Methods: Feasibility randomized controlled cross-over clinical study, with experimental condition lasting three months, crossed between two groups. Experimental condition: CR fully immersive VR recovery-oriented program plus conventional care; Control condition: conventional care. The control group began the experimental condition after a three months period of conventional care (waiting list). After the randomization of 50 people with BD diagnosis, the final sample consists of 39 participants in the experimental condition and 25 in the control condition because of dropouts. Results: Acceptability and tolerability of the intervention were good. Compared to the waitlist group, the experimental group reported a significant improvement regarding cognitive functions (memory: p = 0.003; attention: p = 0.002, verbal fluency: p = 0.010, executive function: p = 0.003), depressive symptoms (p = 0.030), emotional awareness (p = 0.007) and biological rhythms (p = 0.029). Conclusions: The results are preliminary and cannot be considered exhaustive due to the small sample size. However, the evidence of efficacy, together with the good acceptability of the intervention, is of interest. These results suggest the need to conduct studies with larger samples that can confirm this data. Trial registration: ClinicalTrialsgov NCT05070065, registered in September 2021
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Affiliation(s)
- Alessandra Perra
- International PhD in Innovation Sciences and Technologies, University of Cagliari, 09124 Cagliari, Italy
- Department of Medical Sciences and Public Health, University of Cagliari, 09124 Cagliari, Italy
- Correspondence:
| | - Alessia Galetti
- Department of Medical Sciences and Public Health, University of Cagliari, 09124 Cagliari, Italy
| | - Rosanna Zaccheddu
- Department of Medical Sciences and Public Health, University of Cagliari, 09124 Cagliari, Italy
| | - Aurora Locci
- Department of Medical Sciences and Public Health, University of Cagliari, 09124 Cagliari, Italy
| | - Federica Piludu
- Department of Medical Sciences and Public Health, University of Cagliari, 09124 Cagliari, Italy
| | - Antonio Preti
- Department of Neuroscience, University of Turin, 10125 Turin, Italy
| | - Diego Primavera
- Department of Medical Sciences and Public Health, University of Cagliari, 09124 Cagliari, Italy
| | | | - Antonio Egidio Nardi
- Institute of Psychiatry, Federal University of Rio de Janeiro, Rio de Janeiro 21941-901, Brazil
| | | | - Giulia Cossu
- Department of Medical Sciences and Public Health, University of Cagliari, 09124 Cagliari, Italy
| | - Federica Sancassiani
- Department of Medical Sciences and Public Health, University of Cagliari, 09124 Cagliari, Italy
| | - Giusy Stella
- Department of Mental Health and Pathological Addiction, ASL 5, 00034 Rome, Italy
| | | | - Thurayya Zreik
- Mental Health Service User Association, 11072070 Beirut, Lebanon
| | - Mauro Giovanni Carta
- Department of Medical Sciences and Public Health, University of Cagliari, 09124 Cagliari, Italy
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Letter to Editor on "Effect of Ultrasound-Guided Transversus Abdominis Plane Block Combined with Patient-Controlled Intravenous Analgesia on Postoperative Analgesia After Laparoscopic Cholecystectomy: a Double-Blind, Randomized Controlled Trial". J Gastrointest Surg 2022; 26:2626-2627. [PMID: 36333641 DOI: 10.1007/s11605-022-05510-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/08/2022] [Accepted: 10/15/2022] [Indexed: 11/06/2022]
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19
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Letter to the Editor Regarding "Preemptive Intravenous Nalbuphine for the Treatment of Post-Operative Visceral Pain: A Multicenter, Double-Blind, Placebo-Controlled, Randomized Clinical Trial". Pain Ther 2022; 11:1493-1496. [PMID: 35947338 PMCID: PMC9633898 DOI: 10.1007/s40122-022-00414-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2022] [Accepted: 06/23/2022] [Indexed: 10/15/2022] Open
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20
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Chen WX, Xue FS, Li CW. Letter to the Editor regarding Hillesheim et al: "Periarticular liposomal bupivacaine mixture injection vs. single-shot interscalene block for postoperative pain in arthroscopic rotator cuff repair: a prospective randomized controlled trial". J Shoulder Elbow Surg 2022; 31:e359-e360. [PMID: 35304283 DOI: 10.1016/j.jse.2022.02.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/23/2021] [Accepted: 02/20/2022] [Indexed: 02/01/2023]
Affiliation(s)
- Wen-Xuan Chen
- Sixth Clinical Medical College and Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Fu-Shan Xue
- Department of Anesthesiology, Beijing Friendship Hospital, Capital Medical University, Beijing, China.
| | - Cheng-Wen Li
- Department of Anesthesiology, Beijing Friendship Hospital, Capital Medical University, Beijing, China
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21
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Cui LL, Luo X, Xue FS. Letter to the Editor Regarding "Effect of Ultrasound-Guided Erector Spinae Plane Block on Postoperative Pain and Intraoperative Opioid Consumption in Bariatric Surgery". Obes Surg 2022; 32:2786-2787. [PMID: 35680775 DOI: 10.1007/s11695-022-06106-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2022] [Revised: 04/06/2022] [Accepted: 04/12/2022] [Indexed: 10/18/2022]
Affiliation(s)
- Ling-Li Cui
- Department of Anesthesiology, Beijing Friendship Hospital, Capital Medical University, No. 95 Yong-An Road, Xi-Cheng District, Beijing, 100050, People's Republic of China
| | - Xin Luo
- Department of Anesthesiology, Beijing Friendship Hospital, Capital Medical University, No. 95 Yong-An Road, Xi-Cheng District, Beijing, 100050, People's Republic of China
| | - Fu-Shan Xue
- Department of Anesthesiology, Beijing Friendship Hospital, Capital Medical University, No. 95 Yong-An Road, Xi-Cheng District, Beijing, 100050, People's Republic of China.
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22
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He N, Li CW, Hu B, Xue FS. Assessing perioperative benefits of bilateral transversus thoracis muscle plane block in patients undergoing open cardiac surgery. J Card Surg 2021; 37:462-463. [PMID: 34826152 DOI: 10.1111/jocs.16165] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2021] [Accepted: 11/16/2021] [Indexed: 11/28/2022]
Affiliation(s)
- Nong He
- Department of Anesthesiology, Beijing Friendship Hospital, Capital Medical University, Beijing, China
| | - Cheng-Wen Li
- Department of Anesthesiology, Beijing Friendship Hospital, Capital Medical University, Beijing, China
| | - Bin Hu
- Department of Anesthesiology, Beijing Friendship Hospital, Capital Medical University, Beijing, China
| | - Fu-Shan Xue
- Department of Anesthesiology, Beijing Friendship Hospital, Capital Medical University, Beijing, China
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Tulka S, Knippschild S, Funck S, Goetjes I, Uluk Y, Baulig C. Reporting of statistical sample size calculations in publications of trials on age-related macular degeneration, glaucoma and cataract. PLoS One 2021; 16:e0252640. [PMID: 34086796 PMCID: PMC8177464 DOI: 10.1371/journal.pone.0252640] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2020] [Accepted: 05/20/2021] [Indexed: 11/18/2022] Open
Abstract
Background Transparent and complete publications of randomised controlled trials (RCT) ought to comply with the guidelines of the CONSORT Statement, which stipulates sample size calculation as an important aspect of trial planning. The objective of this study was to analyse and compare the reporting of statistical sample size calculations in RCT papers on the treatment of age-related macular degeneration (AMD), glaucoma and cataract published in 2018. Material and methods This study comprises a total of 113 RCT papers (RCT-P) published in 2018 (AMD: 14, glaucoma: 28, cataract: 71), in English or German, and identified through an internet-based literature search in PubMed and EMBASE. The primary outcome measure of the study was the number of trials providing a complete description of the underlying sample case calculation on the basis of the variables required (significance level, expected outcomes, power, and resulting sample size). Results Of the RCTs reviewed, 64% (AMD), 61% (glaucoma) and 31% (cataract) provided a justification of the number of patients included. A complete description of the described studies’ sample size calculation including all the necessary values (primary outcome measure of this study) was described by 21% of the AMD, 29% of the cataract and 18% of the glaucoma RCT publications (in total: 24 of 113 (21%) at a confidence interval of 95%: [13%; 29%]). Conclusion All three treatment areas analysed lacked reporting quality regarding the justification of the number of patients included in a clinical trial based on a sample size calculation required for ethical reasons. More than half of all RCT publications reviewed did not provide all of the required information on statistical sample size calculation, and thus lacked transparency and completeness. It is therefore urgently required to involve methodologists in a study’s planning and publishing processes to ensure that methodology descriptions are transparent and of high quality.
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Affiliation(s)
- Sabrina Tulka
- Chair for Medical Biometry and Epidemiology (IMBE), Faculty of Health, Witten/Herdecke University, Witten, Germany
- * E-mail:
| | - Stephanie Knippschild
- Chair for Medical Biometry and Epidemiology (IMBE), Faculty of Health, Witten/Herdecke University, Witten, Germany
| | - Sina Funck
- Chair for Medical Biometry and Epidemiology (IMBE), Faculty of Health, Witten/Herdecke University, Witten, Germany
| | - Isabelle Goetjes
- Chair for Medical Biometry and Epidemiology (IMBE), Faculty of Health, Witten/Herdecke University, Witten, Germany
| | - Yasmin Uluk
- Chair for Medical Biometry and Epidemiology (IMBE), Faculty of Health, Witten/Herdecke University, Witten, Germany
| | - Christine Baulig
- Chair for Medical Biometry and Epidemiology (IMBE), Faculty of Health, Witten/Herdecke University, Witten, Germany
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24
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Tzanetakis GN, Koletsi D. A priori power considerations in Endodontic Research. Do we miss the timeline? Int Endod J 2021; 54:1516-1526. [PMID: 33872405 DOI: 10.1111/iej.13531] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2021] [Revised: 04/10/2021] [Accepted: 04/13/2021] [Indexed: 12/21/2022]
Abstract
AIM To record the prevalence of a priori power calculations in manuscripts published in three endodontic journals between 2018 and 2020 and detect further associations with a number of study characteristics including journal, publication year, study design, geographic region, number of centres and authors, whether the primary outcome pertained to a statistically significant effect and whether confidence intervals (CIs) were reported. METHODOLOGY The contents of the three leading endodontic journals with the highest impact factor (International Endodontic Journal, IEJ; Journal of Endodontics, JOE; and Australian Endodontic Journal, AEJ) were assessed from January 2018 to December 2020. The proportion of articles reporting a priori power calculations were recorded, and relevant associations as described above were assessed. Univariable and multivariable logistic regression were used to identify significant predictors, whilst interaction and linear trend effects were also considered. RESULTS A total of 716 original research articles were included. The vast majority were published in the JOE (417/716; 58.2%), followed by the IEJ (225/716; 31.4%) and the AEJ (74/716; 10.4%). Overall, a priori power considerations were reported in 243 out of 716 articles (33.9%). The IEJ presented 1.61 times higher odds for including a priori power considerations compared to JOE (adjusted odds ratio, OR = 1.61; 95%CI: 1.11, 2.34), whilst for the AEJ, the corresponding odds were 41% lower in comparison to JOE (adjusted OR = 0.59; 95%CI: 0.31, 1.14). For each additional year indicating more recent publication, the odds for adopting appropriate reporting practices for power considerations were increased by 64% (adjusted OR = 1.64; 95%CIs: 1.32, 2.04). There was strong evidence that interventional research was associated with 10.54 times higher odds for a priori considerations compared to observational study design (adjusted OR = 10.54; 95%CIs: 5.50, 20.19). CONCLUSIONS The high prevalence of failure to include a priori power considerations was indicative of suboptimal reporting in endodontic research, in the three endodontic journals analysed. Although the condition improved over time, efforts to incorporate a correct determination of the required sample size at the design stage for any future study should be endorsed by journal editors, authors and the scientific community.
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Affiliation(s)
- G N Tzanetakis
- Department of Endodontics, School of Dentistry, National and Kapodistrian University of Athens, Athens, Greece
| | - D Koletsi
- Clinic of Orthodontics and Pediatric Dentistry, Center of Dental Medicine, University of Zurich, Zurich, Switzerland
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Nassar H, Hasanin A, Sewilam M, Ahmed H, Abo-Elsoud M, Taalab O, Rady A, Zoheir HA. Transmuscular Quadratus Lumborum Block versus Suprainguinal Fascia Iliaca Block for Hip Arthroplasty: A Randomized, Controlled Pilot Study. Local Reg Anesth 2021; 14:67-74. [PMID: 33907462 PMCID: PMC8068517 DOI: 10.2147/lra.s308964] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2021] [Accepted: 03/24/2021] [Indexed: 01/05/2023] Open
Abstract
Background This study aimed to investigate the analgesic efficacy and motor block profile of single-shot transmuscular quadratus lumborum block (QLB) in comparison with those of suprainguinal fascia iliaca block (FIB) in patients undergoing hip arthroplasty. Methods This randomized, double-blinded, controlled trial included adult patients undergoing hip arthroplasty under spinal anesthesia. Patients were allocated to one of two groups according to the regional block received: FIB group (n=19) or QLB group (n=17). Both study groups were compared with regard to the duration of analgesia (primary outcome), block performance time, pain during positioning for spinal anesthesia, total morphine consumption in the first postoperative 24-h period, quadriceps muscle power, and static and dynamic visual analog scale. Results Thirty-six patients were included in the final analysis. Both study groups had comparable durations of analgesia. Postoperative visual analog scale (static and dynamic) values were comparable between the two groups in most readings. The block performance time was shorter in the FIB group. The number of patients with pain during positioning for the subarachnoid block was lower in the QLB group. The total morphine requirement during the first 24 h was marginally lower in the FIB group, whereas the quadriceps motor grade was higher in the FIB group than in the QLB group at 4 h and 6 h after surgery. Conclusion Both single-shot blocks, namely the suprainguinal FIB and transmuscular QLB, provide effective postoperative analgesia after hip arthroplasty. FIB showed slightly lower 24-h morphine consumption, while QLB showed better quadriceps motor power. Clinical Trial Registration The study was registered at clinical trials registry system before enrollment of the first participant (NCT04005326; initial release date, 2 July 2019; https://clinicaltrials.gov/ct2/show/NCT04005326).
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Affiliation(s)
- Heba Nassar
- Department of Anesthesia and Critical Care Medicine, Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Ahmed Hasanin
- Department of Anesthesia and Critical Care Medicine, Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Mahmoud Sewilam
- Department of Anesthesia and Critical Care Medicine, Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Heba Ahmed
- Department of Anesthesia and Critical Care Medicine, Faculty of Medicine, Cairo University, Cairo, Egypt
| | | | - Omar Taalab
- Department of Orthopedic Surgery, Cairo University, Cairo, Egypt
| | - Ashraf Rady
- Department of Anesthesia and Critical Care Medicine, Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Heba Allah Zoheir
- Department of Anesthesia and Critical Care Medicine, Faculty of Medicine, Cairo University, Cairo, Egypt
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Laigaard J, Pedersen C, Rønsbo TN, Mathiesen O, Karlsen APH. Minimal clinically important differences in randomised clinical trials on pain management after total hip and knee arthroplasty: a systematic review. Br J Anaesth 2021; 126:1029-1037. [PMID: 33678402 DOI: 10.1016/j.bja.2021.01.021] [Citation(s) in RCA: 147] [Impact Index Per Article: 49.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2020] [Revised: 12/19/2020] [Accepted: 01/10/2021] [Indexed: 01/02/2023] Open
Abstract
BACKGROUND Sample size determination is essential for reliable hypothesis testing in clinical trials and should rely on adequate sample size calculations with alpha, beta, variance, and an effect size being the minimal clinically important difference (MCID). This facilitates interpretation of the clinical relevance of statistically significant results. No gold standard for MCIDs exists in postoperative pain research. METHODS We searched Cochrane Central Register of Controlled Trials, MEDLINE, and Embase for English language articles on randomised trials investigating analgesic interventions after total hip or knee arthroplasty. Primary outcomes were the reported MCIDs for pain score and cumulated rescue opioid consumption. Secondary outcomes included reported sample size calculations and propensity to report statistical significance without reaching MCID. Trend analyses were conducted using statistical process control. RESULTS We included 570 trials. Median MCID for 0-24 h opioid consumption was 10 mg i.v. morphine equivalents for absolute reductions (interquartile range [IQR]: 6.8-14.5) and relative 40% (IQR: 30-50%). Median MCIDs for pain scores were absolute 15 mm at rest (IQR: 10-20) and 18 mm during movement (IQR: 10-20) on a 0-100 mm VAS and relative 30% (IQR: 20-30%). No trends were demonstrated for MCIDs. Adequate sample size calculations were reported in 34% of trials. In 46% of trials with statistically significant primary outcomes, the differences did not reach the predetermined MCID. CONCLUSIONS We provide clinician-perceived MCID estimates for rescue opioid consumption and pain scores that can be used for sample size calculations until reliable evidence-based patient-rated MCIDs emerge. Nearly half of the trials with significant findings did not reach the predetermined MCID.
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Affiliation(s)
- Jens Laigaard
- Centre for Anaesthesiological Research, Department of Anaesthesia, Zealand University Hospital, Køge, Denmark.
| | - Casper Pedersen
- Centre for Anaesthesiological Research, Department of Anaesthesia, Zealand University Hospital, Køge, Denmark
| | - Thea Nørgaard Rønsbo
- Centre for Anaesthesiological Research, Department of Anaesthesia, Zealand University Hospital, Køge, Denmark
| | - Ole Mathiesen
- Centre for Anaesthesiological Research, Department of Anaesthesia, Zealand University Hospital, Køge, Denmark; Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Anders Peder Højer Karlsen
- Centre for Anaesthesiological Research, Department of Anaesthesia, Zealand University Hospital, Køge, Denmark
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Iheozor-Ejiofor Z, Lakunina S, Gordon M, Akintelure D, Sinopoulou V, Akobeng A. Sample-size estimation is not reported in 24% of randomised controlled trials of inflammatory bowel disease: A systematic review. United European Gastroenterol J 2021; 9:47-53. [PMID: 33104495 PMCID: PMC8259284 DOI: 10.1177/2050640620967899] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/18/2020] [Accepted: 09/23/2020] [Indexed: 01/15/2023] Open
Abstract
BACKGROUND Sample-size estimation is an important factor in designing a clinical trial. A recent study found that 65% of Cochrane systematic reviews had imprecise results. OBJECTIVE This study set out to review the whole body of inflammatory bowel disease (IBD) randomised controlled trials systematically in order to identify the reporting of sample-size estimation. METHODS We conducted a comprehensive hand search of the Cochrane Library and Cochrane IBD Specialized Trials Register. We extracted information on relevant features and the results of the included studies. We produced descriptive statistics for our results. RESULTS A total of 242 randomised controlled trials were included from 44 Cochrane systematic reviews. About 25% of the studies failed to report on sample-size estimation. Of those that did report on sample-size estimation, 33% failed to recruit their target sample size. CONCLUSIONS Around half of the randomised controlled trials in IBD either do not report sample-size estimation or reach their recruitment target with the level of detail in reporting being limited.
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Affiliation(s)
| | - Svetlana Lakunina
- Biomedical Evidence Synthesis and Translation to Practice (BEST) Research Unit, School of Medicine, University of Central Lancashire, National Institute of Health Research, Preston, UK
| | - Morris Gordon
- Biomedical Evidence Synthesis and Translation to Practice (BEST) Research Unit, School of Medicine, University of Central Lancashire, National Institute of Health Research, Preston, UK
| | - Daniel Akintelure
- Biomedical Evidence Synthesis and Translation to Practice (BEST) Research Unit, School of Medicine, University of Central Lancashire, National Institute of Health Research, Preston, UK
| | - Vasiliki Sinopoulou
- Biomedical Evidence Synthesis and Translation to Practice (BEST) Research Unit, School of Medicine, University of Central Lancashire, National Institute of Health Research, Preston, UK
| | - Anthony Akobeng
- Department of Gastroenterology, Sidra Medical Centre, Ar-Rayyan, Qatar
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Amiri M, Kumbhare D. Randomized controlled trials in non-pharmacological rehabilitation research: a scoping review of the reporting of sample size calculation, randomization procedure, and statistical analyses. Eur J Phys Rehabil Med 2020; 56:790-798. [PMID: 32935956 DOI: 10.23736/s1973-9087.20.06451-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
INTRODUCTION The randomized controlled trials (RCTs) are often considered as the gold standard for clinical trials and researchers argue that the quality of RCT reports should be of the highest standards due to their clinical significance. To review the quality of reporting of the sample size calculation methods, and randomization procedures, and assess whether the statistical analyses correlate as reported in the trials' Evidence acquisition and Evidence synthesis sections in non-pharmacological, physiological rehabilitation RCT interventions. EVIDENCE ACQUISITION A systematic electronic search was conducted in Cochrane Central from 1 January 2019 to 16 December 2019. Titles and abstracts were analyzed for inclusion independently by two authors, and disagreements were resolved by a third reader. Studies were included if they met the following criteria: 1) assessed and reported a type of non-pharmacological rehabilitation RCT (e.g. physiotherapy); 2) randomized intervention to patients with a disease comparing to healthy or patients without intervention as the comparison group; 3) published in an indexed journal; and 4) original research, available full text, human study, published in 2019, and written in English. The following information was extracted from the included articles: journal impact factor (JIF), sample size calculation methods (SS), randomization procedure (RND), and statistical analyses (STAT) reported. Analyzing the full text, whether SS and RND were reported or not and whether the STAT correlated with the Methods and Results sections. The prevalence of each statistical method was derived from the Methods section of the report and compared if it was reported in the Results section. The continuous variable of JIF was tested for normality and used for independent t-test for equality of means between categories. In addition, using Downs and Black checklist the methodological quality of the articles was assessed and categorized to be poor, fair, good, and excellent based on the checklist's score. Finally, the association between the assessed quality (categorical variable) of the articles and the reporting variables (categorical variables) was analyzed utilizing the Pearson χ2. EVIDENCE SYNTHESIS One hundred and nighty-four articles were retrieved from the systematic search out of which 99 (51%) were included for data extraction and further analyses. About one in five (20.2%) and two in five (37.4%) did not properly and adequately report the SS and RND while one in five (19.2%) there was at least one mismatch in STAT. The JIF was not significantly associated to the quality of reporting of SS (t=1.974, P=0.051), RND (t=0.309, P=0.758), and STAT (t=-0.275, P=0.784). This finding could indicate that the quality of the journal did not assure the quality of the reporting these methods. However, there was a significant association between the assessed quality of the article measured with the Down's and Black checklist and the reporting of SS (χ2=29.149, DF=2, P<0.0001), RND (χ2=55.079, df=2, P<0.0001) and STAT (χ2=25.778, df=2, P<0.0001). CONCLUSIONS Recent reporting quality of non-pharmacological rehabilitation RCTs was investigated. We found that the quality of the article but not the quality of the journal in which it is published in may be associated to the quality of reporting in sample size methods, randomization processes, and statistical analyses reporting. The quality of study reporting may be enhanced utilizing a guideline that addresses the required information in sample size calculation, randomization of individuals, and proper statistical analyses used and reported.
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Affiliation(s)
- Mohammadreza Amiri
- Toronto Rehabilitation Institute, University Health Network, Toronto, ON, Canada
| | - Dinesh Kumbhare
- Department of Medicine and Institute of Biomaterials and Biomedical Engineering, University of Toronto, Toronto, ON, Canada -
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[Influence of impact factor on reporting sample size calculations in publications on studies exemplified by AMD treatment : Cross-sectional investigation on the presence of sample size calculations in publications of RCTs on AMD treatment in journals with low and high impact factors]. Ophthalmologe 2020; 117:125-131. [PMID: 31201561 DOI: 10.1007/s00347-019-0924-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
BACKGROUND For scientific and ethical reasons randomized controlled clinical trials (RCTs) should be based on a sample size calculation. The CONSORT statement, an established publication guideline for transparent study reporting, requires a sample size calculation in every study publication. OBJECTIVE The availability of sample size calculations in RCT publications on treatment of age-related macular degeneration (AMD) was investigated. The primary hypothesis of this investigation compared the prevalence of reported sample size calculations between journals with higher (≥5) versus lower (<5) impact factors (IF). MATERIAL AND METHODS It was examined whether information on sample size calculation was available in a series of 97 publications of RTCs on AMD treatment published between 2004 and 2014. RESULTS Only 46 out of 97 (47%) study publications provided information on the reason for the number of patients enrolled. The comparison of publications from journals with an IF ≥ 5 (63%, 30) and from journals with an IF < 5 (40%, 67) showed a statistically significant difference of 23% in the frequencies of available sample size calculations (95% confidence interval, CI 2%; 44%). Of the publications published before 2010, 43% reported a sample size calculation versus 51% of the publications afterwards. CONCLUSION Publications in journals with higher IF more frequently reported a sample size calculation. More than 50% of the publications did not report any sample size calculation. Authors and reviewers of publications should pay more attention to the explicit reporting of sample size calculations.
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Tam W, Lo K, Woo B. Reporting sample size calculations for randomized controlled trials published in nursing journals: A cross-sectional study. Int J Nurs Stud 2019; 102:103450. [PMID: 31731176 DOI: 10.1016/j.ijnurstu.2019.103450] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2019] [Revised: 10/10/2019] [Accepted: 10/12/2019] [Indexed: 12/13/2022]
Abstract
BACKGROUND Prior sample size calculation is essential to ensure that a randomized controlled trial (RCT) has enough power to detect any statistical differences between two groups while not over-recruiting participants. However, the compliance among RCTs published in nursing field is unknown. OBJECTIVE To describe the reporting of sample size methodology and parameters used in RCTs published in nursing journals. DESIGN A cross-sectional database search of all RCTs published in nursing journals was conducted. SETTING 116 journals in the category of nursing. PARTICIPANTS Not applicable. METHODS A database search was conducted to identify all RCTs published in nursing journals from January 2016 to December 2016. Two-arm RCTs were reviewed to see if sample size estimation was mentioned in the text and if the parameters were sufficient for the estimation. For RCTs with effect size, sample sizes were recomputed and compared with the reported size. RESULTS Two hundred and twenty-three RCTs were included in this study, and 143 (64.1%) studies mentioned how they obtained their sample sizes. Among these 143 studies, 132 (92.3%), 133 (93.0%), 33 (23.1%), and 84 (58.7%) specified their levels of significance (α), powers, tails of the test, and effect size related information, respectively. Only 22 (15.4%) provided all the necessary parameters to compute their sample sizes. Out of the 84 RCTs with effect size information, 49 (58.3%) had a relative difference of less than 25%. DISCUSSION Around 36% of the RCTs published in nursing journals did not report how they reached their sample sizes. For those that had reported, only 15% provided all the necessary parameters to re-compute their sizes. It is concluded that the methodology and parameters used for sample size determination are inadequately reported in RCTs published in nursing journals.
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Affiliation(s)
- Wilson Tam
- Alice Lee Centre for Nursing Studies, Yong Loo Lin School of Medicine, National University of Singapore, Singapore.
| | - Kenneth Lo
- Department of Cardiology, Guangdong Cardiovascular Institute, Hypertension Research Laboratory, Guangdong Provincial People's Hospital, Guangdong Provincial Key Laboratory of Coronary Heart Disease Prevention, Guangdong Academy of Medical Sciences, Guangzhou 510080, China; Centre for Global Cardiometabolic Health, Department of Epidemiology, Brown University, USA.
| | - Brigitte Woo
- Alice Lee Centre for Nursing Studies, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
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Tulka S, Geis B, Baulig C, Knippschild S, Krummenauer F. Validity of sample sizes in publications of randomised controlled trials on the treatment of age-related macular degeneration: cross-sectional evaluation. BMJ Open 2019; 9:e030312. [PMID: 31601589 PMCID: PMC6797239 DOI: 10.1136/bmjopen-2019-030312] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
OBJECTIVE The aim of this cross-sectional study was to examine the completeness and accuracy of the reporting of sample size calculations in randomised controlled trial (RCT) publications on the treatment of age-related macular degeneration (AMD). METHODS A sample of 97 RCTs published between 2004 and 2014 was reviewed for the calculation of their sample size. It was examined whether a (complete) description of the sample size calculation was presented. Furthermore, the sample size was recalculated, whenever possible based on the published details, in order to verify the reported number of patients. PRIMARY OUTCOME MEASURE The primary endpoint of this cross-sectional investigation was a described sample size calculation that was reproducible, complete and correct (maximum tolerated deviation between reported and replicated sample size ±2 participants per trial arm). RESULTS A total of 50 publications (52%) did not provide any information on the justification of the number of patients included. Only 17 publications (18%) provided all the necessary parameters for recalculation; 8 of 97 (8%, 95%-CI: 4% to 16%) publications achieved the primary endpoint. The median relative deviation between reported and recalculated sample sizes was 1%, with a range from -43% to +66%. CONCLUSION Although a transparent sample size legitimation is a crucial determinant of an RCT's methodological validity, more than half of the RCT publications considered failed to report them. Furthermore, reported sample size legitimations were often incomplete or incorrect. In summary, clinical authors should pay more attention to the transparent reporting of sample size calculation, and clinical journal reviewers may opt to reproduce reported sample size calculations. SYNOPSIS More than half of the analysed RCT publications on the treatment of AMD did not report a transparent sample size calculation. Only 8% reported a complete and correct sample size calculation.
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Affiliation(s)
- Sabrina Tulka
- Institute for Medical Biometry and Epidemiology, University Witten Herdecke Faculty of Health, Witten, Germany
| | - Berit Geis
- Institute for Medical Biometry and Epidemiology, University Witten Herdecke Faculty of Health, Witten, Germany
| | - Christine Baulig
- Institute for Medical Biometry and Epidemiology, University Witten Herdecke Faculty of Health, Witten, Germany
| | - Stephanie Knippschild
- Institute for Medical Biometry and Epidemiology, University Witten Herdecke Faculty of Health, Witten, Germany
| | - Frank Krummenauer
- Institute for Medical Biometry and Epidemiology, University Witten Herdecke Faculty of Health, Witten, Germany
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Sim J. Should treatment effects be estimated in pilot and feasibility studies? Pilot Feasibility Stud 2019; 5:107. [PMID: 31485336 PMCID: PMC6712606 DOI: 10.1186/s40814-019-0493-7] [Citation(s) in RCA: 62] [Impact Index Per Article: 12.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2019] [Accepted: 08/21/2019] [Indexed: 12/02/2022] Open
Abstract
Background Feasibility studies and external pilot studies are used increasingly to inform planning decisions related to a definitive randomized controlled trial. These studies can provide information on process measures, such as consent rates, treatment fidelity and compliance, and methods of outcome measurement. Additionally, they can provide initial parameter estimates for a sample size calculation, such as a standard deviation or the ‘success’ rate for a binary outcome in the control group. However, the issue of estimating treatment effects in pilot or feasibility studies is controversial. Methodological discussion Between-group estimates of treatment effect from pilot studies are sometimes used to calculate the sample size for a main trial, alongside estimated standard deviations. However, whilst estimating a standard deviation is an empirical matter, a targeted treatment effect should be established in terms of clinical judgement, as a minimum important difference (MID), not through analysis of pilot data. Secondly, between-group effects measured in pilot studies are sometimes used to indicate the magnitude of an effect that might be obtained in a main trial, and a decision on progression made with reference to the associated confidence interval. Such estimates will be imprecise in typically small pilot studies and therefore do not allow a robust decision on a main trial; both a decision to proceed and a decision not to proceed may be made too readily. Thirdly, a within-group change might be estimated from a pilot or a feasibility study in a desire to assess the potential efficacy of a novel intervention prior to testing it in a main trial, but again such estimates are liable to be imprecise and do not allow sound causal inferences. Conclusion Treatment effects calculated from pilot or feasibility studies should not be the basis of a sample size calculation for a main trial, as the MID to be detected should be based primarily on clinical judgement rather than statistics. Deciding on progression to a main trial based on these treatment effects is also misguided, as they will normally be imprecise, and may be biased if the pilot or feasibility study is unrepresentative of the main trial.
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Affiliation(s)
- Julius Sim
- School of Primary, Community and Social Care and Keele Clinical Trials Unit, Keele University, Staffordshire, ST5 5BG UK
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Copsey B, Thompson JY, Vadher K, Ali U, Dutton SJ, Fitzpatrick R, Lamb SE, Cook JA. Sample size calculations are poorly conducted and reported in many randomized trials of hip and knee osteoarthritis: results of a systematic review. J Clin Epidemiol 2018; 104:52-61. [DOI: 10.1016/j.jclinepi.2018.08.013] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2018] [Revised: 07/20/2018] [Accepted: 08/17/2018] [Indexed: 12/22/2022]
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Eichner FA, Groenwold RHH, Grobbee DE, Oude Rengerink K. Systematic review showed that stepped-wedge cluster randomized trials often did not reach their planned sample size. J Clin Epidemiol 2018; 107:89-100. [PMID: 30458261 DOI: 10.1016/j.jclinepi.2018.11.013] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2018] [Revised: 10/15/2018] [Accepted: 11/14/2018] [Indexed: 12/14/2022]
Abstract
OBJECTIVE To determine how often stepped-wedge cluster randomized controlled trials reach their planned sample size, and what reasons are reported for choosing a stepped-wedge trial design. STUDY DESIGN AND SETTING We conducted a PubMed literature search (period 2012 to 2017) and included articles describing the results of a stepped-wedge cluster randomized trial. We calculated the percentage of studies reaching their prespecified number of participants and clusters, and we summarized the reasons for choosing the stepped-wedge trial design as well as difficulties during enrollment. RESULTS Forty-six individual stepped-wedge studies from a total of 53 articles were included in our review. Of the 35 studies, for which recruitment rate could be calculated, 69% recruited their planned number of participants, with 80% having recruited the planned number of clusters. Ethical reasons were the most common motivation for choosing the stepped-wedge trial design. Most important difficulties during study conduct were dropout of clusters and delayed implementation of the intervention. CONCLUSION About half of recently published stepped-wedge trials reached their planned sample size indicating that recruitment is also a major problem in these trials. Still, the stepped-wedge trial design can yield practical, ethical, and methodological advantages.
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Affiliation(s)
- Felizitas A Eichner
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, the Netherlands.
| | - Rolf H H Groenwold
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, the Netherlands; Department of Clinical Epidemiology, Leiden University Medical Center, Leiden, the Netherlands
| | - Diederick E Grobbee
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Katrien Oude Rengerink
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, the Netherlands
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Abdulatif M, Lotfy M, Mousa M, Afifi MH, Yassen K. Sugammadex antagonism of rocuronium-induced neuromuscular blockade in patients with liver cirrhosis undergoing liver resection: a randomized controlled study. Minerva Anestesiol 2018; 84:929-937. [DOI: 10.23736/s0375-9393.18.12217-6] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
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Huang YQ, Traore K, Ibrahim B, Sewitch MJ, Nguyen LHP. Reporting quality of randomized controlled trials in otolaryngology: review of adherence to the CONSORT statement. J Otolaryngol Head Neck Surg 2018; 47:34. [PMID: 29764496 PMCID: PMC5952888 DOI: 10.1186/s40463-018-0277-8] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2017] [Accepted: 04/29/2018] [Indexed: 11/30/2022] Open
Abstract
Background Randomized controlled trials are the gold standard in medical and surgical research to assess the efficacy of therapeutic interventions. The reporting of these trials should be of high quality to allow readers’ appropriate interpretation and application. Methods The objectives of our study were to assess the extent to which the recent Otolaryngology – Head and Neck Surgery (ORL-HNS) randomized control trials in the top nine journals and in the top Canadian journal comply with the Consolidated Standards of Reporting Trials (CONSORT) statement, and to identify the CONSORT items most in need of improvement. Based on the impact factor and circulation number of 2014, the top nine Otolaryngology journals and the top Canadian Otolaryngology journal were selected and were searched to identify RCTs published in English and between 2010 and 2014. Two authors independently reviewed and extracted data using a standardized data extraction form constructed with the help of a medical librarian. Our outcome was to assess the adherence of articles reporting to the CONSORT items. Descriptive statistics were used. Results One hundred and eighty-two Otolaryngologic RCTs were identified in the top nine international journals and in the top Canadian journal. The inter-rater reliability between two raters was 0.32. The extent of adherence to CONSORT Statement ranged from 25 to 93.5% with a mean of 59.0% and a median of 59.4%. Only 6.5% of RCTs described the individual responsible for enrolling and assigning subjects and method of randomization; 32.4% reported the estimated effect size and precision; 40.6% reported a sample size calculation and 32.4% mentioned external validity or implications of the findings. Conclusion Findings revealed that the reporting of RCTs in the top nine ORL-HNS journals and in the top Canadian ORL-HNS journal is suboptimal. The quality of reporting can be improved by addressing the three CONSORT items found most deficient in this study namely, sample size calculations, estimated effect size and precision, and external validity.
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Affiliation(s)
- Yu Qing Huang
- Faculty of Medicine, McGill University, Montreal, Quebec, Canada
| | | | - Badr Ibrahim
- Department of Otolaryngology - Head and Neck Surgery, University of Montreal, Montreal, Quebec, Canada
| | - Maida J Sewitch
- Faculty of Medicine, McGill University, Montreal, Quebec, Canada.,Department of Otolaryngology - Head and Neck Surgery, McGill University, Montreal, Quebec, Canada.,Division of Clinical Epidemiology, Research Institute of the McGill University Health Centre, Montreal, Quebec, Canada
| | - Lily H P Nguyen
- Department of Otolaryngology - Head and Neck Surgery, McGill University, Montreal, Quebec, Canada. .,Center for Medical Education, McGill University, Montreal, Quebec, Canada. .,Department of ORL-HNS, Montreal Children's Hospital, 1001 Boulevard Décarie, Montréal, Quebec, H4A 3J1, Canada.
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Chow JTY, Turkstra TP, Yim E, Jones PM. Sample size calculations for randomized clinical trials published in anesthesiology journals: a comparison of 2010 versus 2016. Can J Anaesth 2018; 65:611-618. [DOI: 10.1007/s12630-018-1109-z] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2017] [Revised: 02/14/2018] [Accepted: 02/26/2018] [Indexed: 12/01/2022] Open
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El-Boghdadly K, Wiles MD, Atton S, Bailey CR. Adherence to guidance on registration of randomised controlled trials published in Anaesthesia. Anaesthesia 2018; 73:556-563. [DOI: 10.1111/anae.14103] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/17/2017] [Indexed: 11/30/2022]
Affiliation(s)
- K. El-Boghdadly
- Department of Anaesthesia, Guys and St; Thomas’ NHS Foundation Trust; London UK
| | - M. D. Wiles
- Department of Anaesthesia; Sheffield Teaching Hospital NHS Foundation Trust; Sheffield UK
| | | | - C. R. Bailey
- Department of Anaesthetics, Guys and St; Thomas’ NHS Foundation Trust; London UK
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Yang GZ, Xue FS, Li HX, Liu YY. Perioperative use of 5% dextrose to decrease postoperative nausea and vomiting. J Clin Anesth 2017; 41:63-64. [DOI: 10.1016/j.jclinane.2017.06.015] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2017] [Accepted: 06/24/2017] [Indexed: 10/19/2022]
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41
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Li HX, Xue FS, Liu YY, Yang GZ. Application of a flexible lightwand during percutaneous dilatational tracheotomy. J Crit Care 2017; 41:320-321. [PMID: 28755851 DOI: 10.1016/j.jcrc.2017.07.037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2017] [Accepted: 07/20/2017] [Indexed: 11/25/2022]
Affiliation(s)
- Hui-Xian Li
- Department of Anesthesiology, Plastic Surgery Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Fu-Shan Xue
- Department of Anesthesiology, Plastic Surgery Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.
| | - Ya-Yang Liu
- Department of Anesthesiology, Plastic Surgery Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Gui-Zhen Yang
- Department of Anesthesiology, Plastic Surgery Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
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42
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Wang YH, Xue FS, Li HX, Liu YY. Comparing Shikani Optical Stylet and Macintosh Laryngoscope for Orotracheal Intubation. Chin Med J (Engl) 2017. [PMID: 28639586 PMCID: PMC5494934 DOI: 10.4103/0366-6999.208240] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Affiliation(s)
- Yu-Hui Wang
- Department of Anesthesiology, Plastic Surgery Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100144, China
| | - Fu-Shan Xue
- Department of Anesthesiology, Plastic Surgery Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100144, China
| | - Hui-Xian Li
- Department of Anesthesiology, Plastic Surgery Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100144, China
| | - Ya-Yang Liu
- Department of Anesthesiology, Plastic Surgery Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100144, China
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Patient Eligibility for Randomized Controlled Trials in Critical Care Medicine: An International Two-Center Observational Study. Crit Care Med 2017; 45:216-224. [PMID: 27779514 DOI: 10.1097/ccm.0000000000002061] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
OBJECTIVE We conducted this study to determine the generalizability of information gained from randomized controlled trials in critically ill patients by assessing the incidence of eligibility for each trial. DESIGN Prospective, observational cohort study. We identified the 15 most highly cited randomized controlled trials in critical care medicine published between 1998 and 2008. We examined the inclusion and exclusion criteria for each randomized controlled trial and then assessed the eligibility of each patient admitted to a study ICU for each randomized controlled trial and calculated rates of potential trial eligibility in the cohort. SETTING Three ICUs in two academic medical centers in Canada and the United States. PATIENTS Adults admitted to participating medical or surgical ICU in November 2010 or July 2011. MEASUREMENTS AND MAIN RESULTS Among the 15 trials, the most common trial inclusion criteria were clinical criteria for sepsis (six trials) or acute respiratory distress syndrome (four trials), use of invasive mechanical ventilation (five trials) or related to ICU type or duration of ICU stay (five trials). Of the 93 patients admitted to a study ICU, 52% of patients (n = 48) did not meet enrollment criteria for any studied randomized controlled trial and 30% (n = 28) were eligible for only one of the 15. Trial ineligibility was mostly due to failure to meet inclusion criteria (87% of screening assessments) rather than meeting specific exclusion criteria (52% of screening assessments). Of the positive screening assessments, 85% occurred on the first day of ICU admission. CONCLUSIONS Slightly more than half of the patients assessed were not eligible for enrollment in any of 15 major randomized controlled trials in critical care, most often due to the absence of the specific clinical condition of study. The majority of patients who met criteria for a randomized controlled trial did so on the first day of ICU admission.
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Li HX, Xue FS, Liu YY, Yang GZ. Comparing direct and indirect laryngoscopy: Study design is crucial. J Clin Anesth 2017; 38:22-23. [PMID: 28372667 DOI: 10.1016/j.jclinane.2017.01.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2016] [Revised: 01/08/2017] [Accepted: 01/09/2017] [Indexed: 11/20/2022]
Affiliation(s)
- Hui-Xian Li
- Department of Anesthesiology, Plastic Surgery Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Fu-Shan Xue
- Department of Anesthesiology, Plastic Surgery Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.
| | - Ya-Yang Liu
- Department of Anesthesiology, Plastic Surgery Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Gui-Zhen Yang
- Department of Anesthesiology, Plastic Surgery Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
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Treister R, Eaton TA, Trudeau JJ, Elder H, Katz NP. Development and preliminary validation of the focused analgesia selection test to identify accurate pain reporters. J Pain Res 2017; 10:319-326. [PMID: 28243138 PMCID: PMC5315353 DOI: 10.2147/jpr.s121455] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Clinical trials of analgesics have been plagued with poor assay sensitivity due, in part, to variability in subjects' pain reporting. Herein, we develop and evaluate the focused analgesia selection test (FAST), a method to measure patients' pain reporting skills. Subjects with osteoarthritis of the hip, knee, and/or ankle with pain intensity of ≥3/10 on a 0-10 numerical rating scale were enrolled. Subjects underwent the FAST procedure, which consists of recording subjects' pain reports in response to repeated administration of thermal noxious stimuli of various intensities applied on the arm with the Medoc® Thermal Sensory Analyzer II. Subjects also rated non-noxious stimuli consisting of visual contrast rating. After performing an exercise task, subjects also rated clinical pain and were asked to report whether their pain had increased, decreased, or stayed the same. Overall, 88 subjects were enrolled, and 83 were included in the analyses. FAST's outcomes including the R2, intraclass correlation coefficient (ICC), and coefficient of variation (CoV) indicated that subjects' pain reporting skills were widely distributed. Higher FAST ICC significantly predicted greater changes in clinical pain following exercise (p=0.017), whereas the visual contrast test did not predict postexercise pain. FAST is the first method that measures subjects' pain reporting skills. Using FAST to enrich clinical trials with "good" pain reporters (with high FAST ICC) could increase assay sensitivity. Further evaluation of FAST is ongoing.
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Affiliation(s)
- Roi Treister
- Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston; Analgesic Solutions, Natick, MA
| | - Thomas A Eaton
- Department of Psychology, University of Connecticut, Storrs
| | | | | | - Nathaniel P Katz
- Analgesic Solutions, Natick, MA; Anesthesiology and Perioperative Medicine, Tufts University School of Medicine, Boston, MA, USA
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Larson MJ, Carbine KA. Sample size calculations in human electrophysiology (EEG and ERP) studies: A systematic review and recommendations for increased rigor. Int J Psychophysiol 2017; 111:33-41. [DOI: 10.1016/j.ijpsycho.2016.06.015] [Citation(s) in RCA: 64] [Impact Index Per Article: 9.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2016] [Revised: 06/03/2016] [Accepted: 06/28/2016] [Indexed: 10/21/2022]
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High-flow nasal cannula in the postoperative period: is positive pressure the phantom of the OPERA trial? Intensive Care Med 2016; 43:119-121. [PMID: 27853821 DOI: 10.1007/s00134-016-4627-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2016] [Accepted: 11/08/2016] [Indexed: 10/20/2022]
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48
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Abdulatif M, Fawzy M, Nassar H, Hasanin A, Ollaek M, Mohamed H. The effects of perineural dexmedetomidine on the pharmacodynamic profile of femoral nerve block: a dose-finding randomised, controlled, double-blind study. Anaesthesia 2016; 71:1177-85. [DOI: 10.1111/anae.13603] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/17/2016] [Indexed: 12/18/2022]
Affiliation(s)
- M. Abdulatif
- Anaesthetic Department; Faculty of Medicine; Cairo University; Cairo Egypt
| | - M. Fawzy
- Anaesthetic Department; Faculty of Medicine; Cairo University; Cairo Egypt
| | - H. Nassar
- Anaesthetic Department; Faculty of Medicine; Cairo University; Cairo Egypt
| | - A. Hasanin
- Anaesthetic Department; Faculty of Medicine; Cairo University; Cairo Egypt
| | - M. Ollaek
- Anaesthetic Department; Faculty of Medicine; Cairo University; Cairo Egypt
| | - H. Mohamed
- Anaesthetic Department; Faculty of Medicine; Cairo University; Cairo Egypt
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An Overview of Challenges and Approaches to Minimize Bias in Randomized Controlled Trials in Perioperative Medicine. CURRENT ANESTHESIOLOGY REPORTS 2016. [DOI: 10.1007/s40140-016-0172-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Abstract
Addressing a sample size is a practical issue that has to be solved during planning and designing stage of the study. The aim of any clinical research is to detect the actual difference between two groups (power) and to provide an estimate of the difference with a reasonable accuracy (precision). Hence, researchers should do a priori estimate of sample size well ahead, before conducting the study. Post hoc sample size computation is not encouraged conventionally. Adequate sample size minimizes the random error or in other words, lessens something happening by chance. Too small a sample may fail to answer the research question and can be of questionable validity or provide an imprecise answer while too large a sample may answer the question but is resource-intensive and also may be unethical. More transparency in the calculation of sample size is required so that it can be justified and replicated while reporting.
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Affiliation(s)
- Sabyasachi Das
- Department of Anaesthesiology and Critical Care, Medical College, Kolkata, West Bengal, India
| | - Koel Mitra
- Department of Anaesthesiology and Critical Care, Medical College, Kolkata, West Bengal, India
| | - Mohanchandra Mandal
- Department of Anaesthesiology and Critical Care, North Bengal Medical College, Sushrutanagar, Darjeeling, West Bengal, India
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