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Bobb JF, Idu AE, Qiu H, Yu O, Boudreau DM, Wartko PD, Matthews AG, McCormack J, Lee AK, Campbell CI, Saxon AJ, Liu DS, Altschuler A, Samet JH, Northrup TF, Braciszewski JM, Murphy MT, Arnsten JH, Cunningham CO, Horigian VE, Szapocznik J, Glass JE, Caldeiro RM, Tsui JI, Burganowski RP, Weinstein ZM, Murphy SM, Hyun N, Bradley KA. Offering nurse care management for opioid use disorder in primary care: Impact on emergency and hospital utilization in a cluster-randomized implementation trial. Drug Alcohol Depend 2024; 261:111350. [PMID: 38875880 PMCID: PMC11281026 DOI: 10.1016/j.drugalcdep.2024.111350] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/13/2023] [Revised: 05/20/2024] [Accepted: 05/23/2024] [Indexed: 06/16/2024]
Abstract
BACKGROUND Patients with opioid use disorder (OUD) have increased emergency and hospital utilization. The PROUD trial showed that implementation of office-based addiction treatment (OBAT) increased OUD medication treatment compared to usual care, but did not decrease acute care utilization in patients with OUD documented pre-randomization (clinicaltrials.gov/study/NCT03407638). This paper reports secondary emergency and hospital utilization outcomes in patients with documented OUD in the PROUD trial. METHODS This cluster-randomized implementation trial was conducted in 12 clinics from 6 diverse health systems (March 2015-February 2020). Patients who visited trial clinics and had an OUD diagnosis within 3 years pre-randomization were included in primary analyses; secondary analyses added patients with OUD who were new to the clinic or with newly-documented OUD post-randomization. Outcomes included days of emergency care and hospital utilization over 2 years post-randomization. Explanatory outcomes included measures of OUD treatment. Patient-level analyses used mixed-effect regression with clinic-specific random intercepts. RESULTS Among 1988 patients with documented OUD seen pre-randomization (mean age 49, 53 % female), days of emergency care or hospitalization did not differ between intervention and usual care; OUD treatment also did not differ. In secondary analyses among 1347 patients with OUD post-randomization, there remained no difference in emergency or hospital utilization despite intervention patients receiving 32.2 (95 % CI 4.7, 59.7) more days of OUD treatment relative to usual care. CONCLUSIONS Implementation of OBAT did not reduce emergency or hospital utilization among patients with OUD, even in the sample with OUD first documented post-randomization in whom the intervention increased treatment.
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Affiliation(s)
- Jennifer F Bobb
- Kaiser Permanente Washington Health Research Institute, 1730 Minor Ave., Suite 1600, Seattle, WA 98101, USA.
| | - Abisola E Idu
- Kaiser Permanente Washington Health Research Institute, 1730 Minor Ave., Suite 1600, Seattle, WA 98101, USA
| | - Hongxiang Qiu
- Kaiser Permanente Washington Health Research Institute, 1730 Minor Ave., Suite 1600, Seattle, WA 98101, USA
| | - Onchee Yu
- Kaiser Permanente Washington Health Research Institute, 1730 Minor Ave., Suite 1600, Seattle, WA 98101, USA
| | - Denise M Boudreau
- Kaiser Permanente Washington Health Research Institute, 1730 Minor Ave., Suite 1600, Seattle, WA 98101, USA
| | - Paige D Wartko
- Kaiser Permanente Washington Health Research Institute, 1730 Minor Ave., Suite 1600, Seattle, WA 98101, USA
| | - Abigail G Matthews
- The Emmes Company, 401 N Washington St, Suite 700, Rockville, MD 20850, USA
| | - Jennifer McCormack
- The Emmes Company, 401 N Washington St, Suite 700, Rockville, MD 20850, USA
| | - Amy K Lee
- Kaiser Permanente Washington Health Research Institute, 1730 Minor Ave., Suite 1600, Seattle, WA 98101, USA
| | - Cynthia I Campbell
- Kaiser Permanente Northern California Division of Research, 2000 Broadway, Oakland, CA 94612, USA
| | - Andrew J Saxon
- Center of Excellence in Substance Addiction Treatment and Education (CESATE), VA Puget Sound Health Care System, 1660 S. Columbian Way, Seattle, WA 98108, USA
| | - David S Liu
- National Institute on Drug Abuse Center for Clinical Trials Network, Three White Flint North, 11601 Landsdown Street, North Bethesda, MD 20852, USA
| | - Andrea Altschuler
- Kaiser Permanente Northern California Division of Research, 2000 Broadway, Oakland, CA 94612, USA
| | - Jeffrey H Samet
- Boston University Schools of Medicine and Public Health, Boston Medical Center, Crosstown Center, 801 Massachusetts Ave, Boston, MA 02119, USA
| | - Thomas F Northrup
- UTHealth Houston McGovern Medical School, Department of Family and Community Medicine, 6431 Fannin St, Houston, TX 77030, USA
| | - Jordan M Braciszewski
- Henry Ford Health, Center for Health Policy and Health Services Research, One Ford Place, Suite 5E, Detroit, MI 48202, USA
| | - Mark T Murphy
- MultiCare Health System, 315 Martin Luther King Jr. Way, Tacoma, WA 98415, USA
| | - Julia H Arnsten
- Montefiore Medical Center, 111 East 210 Street, Bronx, NY 10467, USA; Albert Einstein College of Medicine, 1300 Morris Park Ave, The Bronx, NY 10461, USA
| | - Chinazo O Cunningham
- Albert Einstein College of Medicine, 1300 Morris Park Ave, The Bronx, NY 10461, USA
| | - Viviana E Horigian
- Department of Public Health Sciences, University of Miami Miller School of Medicine, 1120 NW 14th Street, 10th Floor, Miami, FL 33136, USA
| | - José Szapocznik
- Department of Public Health Sciences, University of Miami Miller School of Medicine, 1120 NW 14th Street, 10th Floor, Miami, FL 33136, USA
| | - Joseph E Glass
- Kaiser Permanente Washington Health Research Institute, 1730 Minor Ave., Suite 1600, Seattle, WA 98101, USA
| | - Ryan M Caldeiro
- Mental Health and Wellness Department, Kaiser Permanente Washington, 1200 SW 27th St, Renton, WA 98057, USA
| | - Judith I Tsui
- Division of General Internal Medicine, Department of Medicine, University of Washington School of Medicine, 1959 NE Pacific St, Seattle, WA 98195, USA
| | - Rachael P Burganowski
- Kaiser Permanente Washington Health Research Institute, 1730 Minor Ave., Suite 1600, Seattle, WA 98101, USA
| | - Zoe M Weinstein
- Boston University Schools of Medicine and Public Health, Boston Medical Center, Crosstown Center, 801 Massachusetts Ave, Boston, MA 02119, USA
| | - Sean M Murphy
- Department of Population Health Sciences, Weill Cornell Medical College, 1300 York Avenue, New York, NY 10065, USA
| | - Noorie Hyun
- Kaiser Permanente Washington Health Research Institute, 1730 Minor Ave., Suite 1600, Seattle, WA 98101, USA
| | - Katharine A Bradley
- Kaiser Permanente Washington Health Research Institute, 1730 Minor Ave., Suite 1600, Seattle, WA 98101, USA
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Szigeti F J, Kazinczi C, Szabó G, Sipos M, Ujma PP, Purebl G. The clinical effectiveness of the Mind/Body Program for Infertility on wellbeing and assisted reproduction outcomes: a randomized controlled trial in search for active ingredients. Hum Reprod 2024; 39:1735-1751. [PMID: 38852061 PMCID: PMC11291950 DOI: 10.1093/humrep/deae119] [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: 12/19/2023] [Revised: 04/20/2024] [Indexed: 06/10/2024] Open
Abstract
STUDY QUESTION Does the Mind/Body Program for Infertility (MBPI) perform better, due to certain distinctive elements, than a partly matched support group in improving the wellbeing and medically assisted reproduction (MAR) outcomes of women with elevated distress levels in a clinical setting? SUMMARY ANSWER While robust enhancements occurred in the wellbeing overall, the cognitive behavioural and formalized stress management elements of the MBPI allowed a significantly stronger improvement in trait anxiety, but not in other mental health and MAR outcomes, compared with a support group. WHAT IS KNOWN ALREADY Mind-body psychological programmes adjacent to MAR have been found to improve women's mental states and possibly increase chances of pregnancy. However, not enough is known about the programme's effectiveness among patients with elevated distress levels in routine clinical settings, nor is it clear which of its particular ingredients are specifically effective. STUDY DESIGN, SIZE, DURATION A pre-post design, single-centre, randomized controlled trial was performed between December 2019 and October 2022 (start and end of recruitment, respectively). The sample size (n = 168) was calculated to detect superiority of the MBPI in improving fertility-related quality of life. Randomization was computer-based, with random numbers concealing identities of patients until after allocation. PARTICIPANTS/MATERIALS, SETTING, METHODS The trial was conducted at a large university teaching hospital. A total of 168 patients were randomly assigned to the mind-body (MBPI) group (n = 84) and the fertility support (FS) control group (n = 84). Patients received a 10-week, 135-min/week group intervention, with the FS group following the same format as the MBPI group, but with a less restricted and systematic content, and without the presumed effective factors. The number of patients analysed was n = 74 (MBPI) and n = 68 (FS) for post-intervention psychological outcomes, and n = 54 (MBPI) and n = 56 (FS) for pregnancy outcomes at a 30-month follow-up. MAIN RESULTS AND THE ROLE OF CHANCE Significant improvements occurred in both groups in all psychological domains (adjusted P < 0.001), except for treatment-related quality of life. Linear mixed-model regression analysis did not reveal significantly greater pre-post improvements in the MBPI group than in the FS group in fertility-related quality of life (difference in differences (DD) = 4.11 [0.42, 7.80], d = 0.32, adjusted P = 0.124), treatment-related quality of life (DD = -3.08 [-7.72, 1.55], d = -0.20, adjusted P = 0.582), infertility-specific stress (DD = -2.54 [-4.68, 0.41], d = -0.36, adjusted P = 0.105), depression (DD = -1.16 [3.61, 1.29], d = -0.13, adjusted P = 0.708), and general stress (DD = -0.62 [-1.91, 0.68], d = -0.13, adjusted P = 0.708), but it did show a significantly larger improvement in trait anxiety (DD = -3.60 [-6.16, -1.04], d = -0.32, adjusted P = 0.042). Logistic regression showed no group effect on MAR pregnancies, spontaneous pregnancies, or live births. LIMITATIONS, REASONS FOR CAUTION The follow-up only covered MAR-related medical outcomes and no psychological variables, and their rates were not equal in the two groups. Biological factors other than age, aetiology, and duration of infertility may have confounded the study results. Loss to follow-up was between 5% and 10%, which may have led to some bias. WIDER IMPLICATIONS OF THE FINDINGS The psychologically and medically heterogeneous sample, the normal clinical setting and the low attrition rate all raise the external validity and generalizability of our study. The MBPI works not only in controlled conditions, but also in routine MAR practice, where it can be introduced as a cost-effective, low-intensity psychological intervention, within the framework of stepped care. More studies are needed to further identify its active ingredients. STUDY FUNDING/COMPETING INTEREST(S) The authors received no financial support for the research, authorship, and/or publication of this article. The authors have no conflict of interest to disclose. TRIAL REGISTRATION NUMBER ClinicalTrials.gov NCT04151485. TRIAL REGISTRATION DATE 5 November 2019. DATE OF FIRST PATIENT’S ENROLMENT 15 December 2019.
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Affiliation(s)
- Judit Szigeti F
- Institute of Behavioural Sciences, Semmelweis University, Budapest, Hungary
- Department of Otorhinolaryngology, Head and Neck Surgery, Semmelweis University, Budapest, Hungary
| | - Csaba Kazinczi
- Department of Clinical Psychology, Semmelweis University, Budapest, Hungary
- Doctoral School of Clinical Medicine, University of Szeged, Szeged, Hungary
| | - Georgina Szabó
- Doctoral School of Mental Health Sciences, Semmelweis University, Budapest, Hungary
- Department of Psychiatry, North Buda Saint John’s Hospital Centre and Outpatient Clinic, Budapest, Hungary
| | - Miklós Sipos
- Department of Obstetrics and Gynecology, Assisted Reproduction Centre, Semmelweis University, Budapest, Hungary
| | | | - György Purebl
- Institute of Behavioural Sciences, Semmelweis University, Budapest, Hungary
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van Bruggen FH, Zuidema SU, Luijendijk HJ. Quantitative assessment of baseline imbalances in evolocumab and alirocumab trials: a meta-epidemiological study. BMC Med Res Methodol 2024; 24:137. [PMID: 38909176 PMCID: PMC11193208 DOI: 10.1186/s12874-024-02260-z] [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: 07/17/2023] [Accepted: 06/07/2024] [Indexed: 06/24/2024] Open
Abstract
BACKGROUND Baseline imbalances have been identified in randomized trials of evolocumab and alirocumab. Our aim was to quantitatively assess (1) the presence of systematic baseline differences, and (2) the relationship of baseline differences with effects on low-density lipoprotein-cholesterol (LDL-c) and clinical outcomes in the trials. METHODS We performed a meta-epidemiological study. PubMed, Embase, regulatory reports, ClinicalTrials.gov and company websites were searched for trials. Seven baseline characteristics (mean age, LDL-c, BMI, percentage males, diabetics, smokers, and hypertensives) and five outcomes (LDL-c, major adverse cardiac events, serious adverse events, any adverse events, all-cause mortality) were extracted. We calculated (1) range and distribution of baseline imbalances (sign-test), (2) pooled baseline differences and heterogeneity (meta-analysis), (3) differences in SDs around continuous variables (sign-test and pooling), and (4) the relationship of baseline differences with outcomes (meta-regression). The comparisons of PCSK9-inhibitor groups with either placebo or ezetimibe were analysed separately and combined. RESULTS We identified 43 trials with 63,193 participants. Baseline characteristics were frequently missing. Many trials showed small baseline imbalances, but some large imbalances. Only baseline BMI showed a statistically significant lower pooled mean for the drug versus placebo groups (MD -0.16; 95% CI -0.24 to -0.09). Heterogeneity in baseline imbalances was present in six placebo- and five ezetimibe-comparisons. Heterogeneity was statistically significant for BMI, males, diabetics and hypertensives in the combined comparisons. There was a statistically significant preponderance for larger SDs in the PCSK9-inhibitor versus control groups (sign-test age 0.014; LDL-c 0.014; BMI 0.049). Meta-regression showed clinically relevant relationships of baseline imbalances in age, BMI and diabetics with the risk of any adverse events and the risk of mortality. Two relationships were statistically significant: A higher mean BMI in the drug versus control group with a decreased risk of mortality (beta - 0.56; 95% CI -1.10 to -0.02), and a higher proportion of diabetics with an increased risk of any adverse events (beta 0.02; 95% 0.01 to 0.04). CONCLUSIONS Heterogeneous baseline imbalances and systematically different SDs were present in evolocumab and alirocumab trials, so study groups cannot be assumed to be comparable. These findings raise concerns about the design and conduct of the randomization procedures.
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Affiliation(s)
- F H van Bruggen
- Department of General Practice and Elderly Care Medicine, University of Groningen, University Medical Centre Groningen (UMCG), PO Box 196, Groningen, AD, 9700, The Netherlands
| | - S U Zuidema
- Department of General Practice and Elderly Care Medicine, University of Groningen, University Medical Centre Groningen (UMCG), PO Box 196, Groningen, AD, 9700, The Netherlands
| | - H J Luijendijk
- Department of General Practice and Elderly Care Medicine, University of Groningen, University Medical Centre Groningen (UMCG), PO Box 196, Groningen, AD, 9700, The Netherlands.
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Araújo R, Ramalhete L, Viegas A, Von Rekowski CP, Fonseca TAH, Calado CRC, Bento L. Simplifying Data Analysis in Biomedical Research: An Automated, User-Friendly Tool. Methods Protoc 2024; 7:36. [PMID: 38804330 PMCID: PMC11130801 DOI: 10.3390/mps7030036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2024] [Revised: 04/20/2024] [Accepted: 04/22/2024] [Indexed: 05/29/2024] Open
Abstract
Robust data normalization and analysis are pivotal in biomedical research to ensure that observed differences in populations are directly attributable to the target variable, rather than disparities between control and study groups. ArsHive addresses this challenge using advanced algorithms to normalize populations (e.g., control and study groups) and perform statistical evaluations between demographic, clinical, and other variables within biomedical datasets, resulting in more balanced and unbiased analyses. The tool's functionality extends to comprehensive data reporting, which elucidates the effects of data processing, while maintaining dataset integrity. Additionally, ArsHive is complemented by A.D.A. (Autonomous Digital Assistant), which employs OpenAI's GPT-4 model to assist researchers with inquiries, enhancing the decision-making process. In this proof-of-concept study, we tested ArsHive on three different datasets derived from proprietary data, demonstrating its effectiveness in managing complex clinical and therapeutic information and highlighting its versatility for diverse research fields.
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Affiliation(s)
- Rúben Araújo
- NMS—NOVA Medical School, FCM—Faculdade de Ciências Médicas, Universidade NOVA de Lisboa, Campo Mártires da Pátria 130, 1169-056 Lisbon, Portugal
- CHRC—Comprehensive Health Research Centre, Universidade NOVA de Lisboa, 1150-082 Lisbon, Portugal
- ISEL—Instituto Superior de Engenharia de Lisboa, Instituto Politécnico de Lisboa, Rua Conselheiro Emídio Navarro 1, 1959-007 Lisbon, Portugal
| | - Luís Ramalhete
- NMS—NOVA Medical School, FCM—Faculdade de Ciências Médicas, Universidade NOVA de Lisboa, Campo Mártires da Pátria 130, 1169-056 Lisbon, Portugal
- Blood and Transplantation Center of Lisbon, IPST—Instituto Português do Sangue e da Transplantação, Alameda das Linhas de Torres 117, 1769-001 Lisbon, Portugal
- iNOVA4Health—Advancing Precision Medicine, RG11: Reno-Vascular Diseases Group, NMS—NOVA Medical School, FCM—Faculdade de Ciências Médicas, Universidade NOVA de Lisboa, 1169-056 Lisbon, Portugal
| | - Ana Viegas
- CHRC—Comprehensive Health Research Centre, Universidade NOVA de Lisboa, 1150-082 Lisbon, Portugal
- ESTeSL—Escola Superior de Tecnologia da Saúde de Lisboa, Instituto Politécnico de Lisboa, Avenida D. João II, Lote 4.69.01, 1990-096 Lisbon, Portugal
- Neurosciences Area, Clinical Neurophysiology Unit, ULSSJ—Unidade Local de Saúde São José, Rua José António Serrano, 1150-199 Lisbon, Portugal
| | - Cristiana P. Von Rekowski
- NMS—NOVA Medical School, FCM—Faculdade de Ciências Médicas, Universidade NOVA de Lisboa, Campo Mártires da Pátria 130, 1169-056 Lisbon, Portugal
- CHRC—Comprehensive Health Research Centre, Universidade NOVA de Lisboa, 1150-082 Lisbon, Portugal
- ISEL—Instituto Superior de Engenharia de Lisboa, Instituto Politécnico de Lisboa, Rua Conselheiro Emídio Navarro 1, 1959-007 Lisbon, Portugal
| | - Tiago A. H. Fonseca
- NMS—NOVA Medical School, FCM—Faculdade de Ciências Médicas, Universidade NOVA de Lisboa, Campo Mártires da Pátria 130, 1169-056 Lisbon, Portugal
- CHRC—Comprehensive Health Research Centre, Universidade NOVA de Lisboa, 1150-082 Lisbon, Portugal
- ISEL—Instituto Superior de Engenharia de Lisboa, Instituto Politécnico de Lisboa, Rua Conselheiro Emídio Navarro 1, 1959-007 Lisbon, Portugal
| | - Cecília R. C. Calado
- ISEL—Instituto Superior de Engenharia de Lisboa, Instituto Politécnico de Lisboa, Rua Conselheiro Emídio Navarro 1, 1959-007 Lisbon, Portugal
- Institute for Bioengineering and Biosciences (iBB), The Associate Laboratory Institute for Health and Bioeconomy–i4HB, Instituto Superior Técnico (IST), Universidade de Lisboa (UL), Av. Rovisco Pais, 1049-001 Lisboa, Portugal
| | - Luís Bento
- Intensive Care Department, ULSSJ—Unidade Local de Saúde São José, Rua José António Serrano, 1150-199 Lisbon, Portugal;
- Integrated Pathophysiological Mechanisms, CHRC—Comprehensive Health Research Centre, NMS—NOVA Medical School, FCM—Faculdade de Ciências Médicas, Universidade NOVA de Lisboa, Campo Mártires da Pátria 130, 1169-056 Lisbon, Portugal
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Qiu H, Cook AJ, Bobb JF. Evaluating tests for cluster-randomized trials with few clusters under generalized linear mixed models with covariate adjustment: A simulation study. Stat Med 2024; 43:201-215. [PMID: 37933766 PMCID: PMC10872819 DOI: 10.1002/sim.9950] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2020] [Revised: 10/04/2023] [Accepted: 10/16/2023] [Indexed: 11/08/2023]
Abstract
Generalized linear mixed models (GLMM) are commonly used to analyze clustered data, but when the number of clusters is small to moderate, standard statistical tests may produce elevated type I error rates. Small-sample corrections have been proposed for continuous or binary outcomes without covariate adjustment. However, appropriate tests to use for count outcomes or under covariate-adjusted models remains unknown. An important setting in which this issue arises is in cluster-randomized trials (CRTs). Because many CRTs have just a few clusters (eg, clinics or health systems), covariate adjustment is particularly critical to address potential chance imbalance and/or low power (eg, adjustment following stratified randomization or for the baseline value of the outcome). We conducted simulations to evaluate GLMM-based tests of the treatment effect that account for the small (10) or moderate (20) number of clusters under a parallel-group CRT setting across scenarios of covariate adjustment (including adjustment for one or more person-level or cluster-level covariates) for both binary and count outcomes. We find that when the intraclass correlation is non-negligible (≥ $$ \ge $$ 0.01) and the number of covariates is small (≤ $$ \le $$ 2), likelihood ratio tests with a between-within denominator degree of freedom have type I error rates close to the nominal level. When the number of covariates is moderate (≥ $$ \ge $$ 5), across our simulation scenarios, the relative performance of the tests varied considerably and no method performed uniformly well. Therefore, we recommend adjusting for no more than a few covariates and using likelihood ratio tests with a between-within denominator degree of freedom.
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Affiliation(s)
- Hongxiang Qiu
- Department of Epiidemiology and Biostatistics, Michigan State University, Michigan, United States
| | - Andrea J. Cook
- Biostatistics unit, Kaiser Permanente Washington Health Research Institute, Washington, United States
- Department of Biostatistics, University of Washington, Washington, United States
| | - Jennifer F. Bobb
- Biostatistics unit, Kaiser Permanente Washington Health Research Institute, Washington, United States
- Department of Biostatistics, University of Washington, Washington, United States
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Kumar D, Dayal VM, Jha SK, Jha AK, Kumar RK. A Randomized Comparative Study of the Use of Individual Modality and Combination of Endoscopic Retrograde Cholangiopancreatography (ERCP) and Digital Single-Operator Cholangioscopy (DSOC) for Diagnosis of Indeterminate Biliary Strictures. Adv Biomed Res 2024; 13:4. [PMID: 38525391 PMCID: PMC10958731 DOI: 10.4103/abr.abr_220_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2023] [Revised: 08/22/2023] [Accepted: 08/23/2023] [Indexed: 03/26/2024] Open
Abstract
Background To determine the superiority of the combination of endoscopic retrograde cholangiopancreatography (ERCP) and digital single-operator cholangioscopy (DSOC) in the same sitting over the individual modality alone in patients with indeterminate biliary strictures. Materials and Methods A randomized study enrolled 60 adult patients with biliary strictures who were randomized into two groups: ERCP + DSOC and ERCP/DSOC. Histopathologic or cytologic assessment was performed in terms of benign, indeterminate, or malignant nature of the strictures. Procedural adverse events were documented. Accuracy in terms of sensitivity (Sn), specificity (Sp), and predictive value [positive (PPV) and negative (NPV)] were noted. Results As per final diagnosis, in ERCP/DSOC group, there were 12 (40%) benign cases and 18 (60%) malignant cases, and in group ERCP + DSOC, there were 8 (26.67%) benign cases and 22 (73.33%) malignant cases. ERCP/DSOC labeled 16 (53.33%) patients as benign, 8 (26.67%) as malignant, and 6 (20%) as indeterminate, while ERCP + DSOC labeled 8 (26.67%) as benign, 17 (56.67%) as malignant, and 5 (16.67%) as indeterminate. The Sn, Sp, PPV, and NPV of ERCP/DSOC were 44.4%, 75%, 100%, and 56.25%, and for ERCP + DSOC was 77.27%, 62.50%, 100%, and 62.5%, respectively (P = 0.033). Side effects were statistically similar in both the groups (P > 0.05). Conclusion To conclude, the combination of ERCP with DSOC is safe and effective with higher diagnostic sensitivity (77.27%) in comparison to standard ERCP or DSOC alone (44.4%) for the diagnosis of biliary strictures.
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Affiliation(s)
- Dheeraj Kumar
- Department of Gastroenterology IGIMS, Patna, Bihar, India
| | | | - Sanjeev K. Jha
- Department of Gastroenterology IGIMS, Patna, Bihar, India
| | - Ashish K. Jha
- Department of Gastroenterology IGIMS, Patna, Bihar, India
| | - Ravi K. Kumar
- Department of Gastroenterology IGIMS, Patna, Bihar, India
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Yang TL, Lin C, Ho CL, Huang TC, Wu YY, Jhou HJ, Chen PH, Lee CH. Progression-Free Survival Efficacy in Refractory/Relapsed Multiple Myeloma among Elderly Patients: A Systematic Review. Life (Basel) 2023; 13:2259. [PMID: 38137860 PMCID: PMC10744445 DOI: 10.3390/life13122259] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2023] [Revised: 11/19/2023] [Accepted: 11/25/2023] [Indexed: 12/24/2023] Open
Abstract
BACKGROUND Over the last decade, many studies have assessed the efficacy of treatments for refractory/relapsed multiple myeloma (R/R MM). While combination therapies show greater efficacy than traditional methods, limited research has targeted elderly patients who might be less resilient to treatments. Our study aimed to evaluate treatment efficacy for these elderly patients. METHODS We carried out a comprehensive review of the literature using a systematic approach. Initially, 4966 citations were retrieved and subsequently narrowed down to 13 eligible randomized controlled trials (RCTs) through our systematic review process from databases like Embase, PubMed, and Cochrane Library from 1 January 2000 to 31 December 2022. Evidence was collated through a frequentist network meta-analysis, using the hazard ratio (HR) for evaluation. RESULTS Combined therapy of daratumumab, lenalidomide, and dexamethasone (DaraLenDex) was the preferred treatment for R/R MM elderly patients. Its strengths included an HR for progression-free survival (0.15; 95% CI: 0.09-0.25) and a 96% P-score. CONCLUSIONS Our analysis suggests that, pending more comprehensive RCTs, DaraLenDex is the treatment with the highest efficacy for R/R MM in elderly patients.
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Affiliation(s)
- Tung-Lung Yang
- Division of Hematology and Oncology Medicine, Department of Internal Medicine, Tri-Service General Hospital, National Defense Medical Center, Taipei 114, Taiwan; (T.-L.Y.)
| | - Chin Lin
- School of Public Health, National Defense Medical Center, Taipei 114, Taiwan
- Department of Research and Development, National Defense Medical Center, Taipei 114, Taiwan
| | - Ching-Liang Ho
- Division of Hematology and Oncology Medicine, Department of Internal Medicine, Tri-Service General Hospital, National Defense Medical Center, Taipei 114, Taiwan; (T.-L.Y.)
| | - Tzu-Chuan Huang
- Division of Hematology and Oncology Medicine, Department of Internal Medicine, Tri-Service General Hospital, National Defense Medical Center, Taipei 114, Taiwan; (T.-L.Y.)
| | - Yi-Ying Wu
- Division of Hematology and Oncology Medicine, Department of Internal Medicine, Tri-Service General Hospital, National Defense Medical Center, Taipei 114, Taiwan; (T.-L.Y.)
| | - Hong-Jie Jhou
- Department of Neurology, Changhua Christian Hospital, Changhua 500, Taiwan;
| | - Po-Huang Chen
- Division of Hematology and Oncology Medicine, Department of Internal Medicine, Tri-Service General Hospital, National Defense Medical Center, Taipei 114, Taiwan; (T.-L.Y.)
| | - Cho-Hao Lee
- Division of Hematology and Oncology Medicine, Department of Internal Medicine, Tri-Service General Hospital, National Defense Medical Center, Taipei 114, Taiwan; (T.-L.Y.)
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El Azab A, Abdelbary A, El Faqeh M Okasha A, Aboulkassem H, Saad Zaghloul A, Mohamed Karkeet R, Abdelrahman I. The effect of immediate neoadjuvant electromotive instillation of mitomycin C with Bacillus Calmette-Guérin versus BCG alone in non-muscle-invasive bladder cancer: A randomized controlled trial. Investig Clin Urol 2023; 64:554-560. [PMID: 37932566 PMCID: PMC10630691 DOI: 10.4111/icu.20230161] [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: 05/12/2023] [Revised: 07/14/2023] [Accepted: 08/06/2023] [Indexed: 11/08/2023] Open
Abstract
PURPOSE The clinical effect of neoadjuvant intravesical instillation of chemotherapy immediately before transurethral resection of bladder tumors (TURBT) has been a subject of recent research. The aim of this study was to assess the effect of immediate neoadjuvant electromotive instillation of mitomycin C before transurethral resection for patients with non-muscle-invasive urothelial bladder cancer. MATERIALS AND METHODS Our study was a randomized clinical trial carried out on 50 patients diagnosed with non-muscle-invasive urothelial bladder cancer. Patients were classified into two groups: Group I consisted of 25 patients who received neoadjuvant electromotive drug administration of mitomycin C before TURBT and intravesical bacille Calmette-Guerin (BCG) per week for 6 weeks; Group II consisted of 25 patients who were treated with TURBT followed by intravesical BCG per week for 6 weeks alone (standard of care). Patients were followed up at 3, 6, 12, and 18 months by cystoscopy. RESULTS Patients who received neoadjuvant electromotive drug administration of mitomycin C before TURBT in combination with BCG had a low recurrence rate compared with those who received BCG alone (12.0% vs. 48.0%, respectively; p=0.012) and a longer disease-free interval (88.0% vs. 52.0%, respectively; p=0.012). Four patients developed progression to muscle-invasive disease (16.0%) in the BCG alone group. However, this difference was not statistically significant (p=0.516). Regarding adverse effects, there were no statistically significant differences between the groups. CONCLUSIONS Neoadjuvant intravesical electromotive drug administration of mitomycin C before TURBT is safe; reduces recurrence rates and enhances the disease-free interval compared with TURBT followed by BCG alone.
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Affiliation(s)
- Abdalla El Azab
- Department of Surgical Oncology, National Cancer Institute, Cairo University, Cairo, Egypt
| | - Ahmed Abdelbary
- Department of Surgical Oncology, National Cancer Institute, Cairo University, Cairo, Egypt.
| | - Aly El Faqeh M Okasha
- Department of Surgical Oncology, National Cancer Institute, Cairo University, Cairo, Egypt
| | - Hatem Aboulkassem
- Department of Surgical Oncology, National Cancer Institute, Cairo University, Cairo, Egypt
| | - Ashraf Saad Zaghloul
- Department of Surgical Oncology, National Cancer Institute, Cairo University, Cairo, Egypt
| | - Riham Mohamed Karkeet
- Department of Cancer Biology, Pharmacology and Experimental Oncology Unit, National Cancer Institute, Cairo University, Cairo, Egypt
| | - Ibrahim Abdelrahman
- Department of Surgical Oncology, National Cancer Institute, Cairo University, Cairo, Egypt
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Sherry AD, Msaouel P, McCaw ZR, Abi Jaoude J, Hsu EJ, Kouzy R, Patel R, Yang Y, Lin TA, Taniguchi CM, Rödel C, Fokas E, Tang C, Fuller CD, Minsky B, Meirson T, Sun R, Ludmir EB. Prevalence and implications of significance testing for baseline covariate imbalance in randomised cancer clinical trials: The Table 1 Fallacy. Eur J Cancer 2023; 194:113357. [PMID: 37827064 DOI: 10.1016/j.ejca.2023.113357] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2023] [Revised: 09/18/2023] [Accepted: 09/20/2023] [Indexed: 10/14/2023]
Abstract
BACKGROUND The 'Table 1 Fallacy' refers to the unsound use of significance testing for comparing the distributions of baseline variables between randomised groups to draw erroneous conclusions about balance or imbalance. We performed a cross-sectional study of the Table 1 Fallacy in phase III oncology trials. METHODS From ClinicalTrials.gov, 1877 randomised trials were screened. Multivariable logistic regressions evaluated predictors of the Table 1 Fallacy. RESULTS A total of 765 randomised controlled trials involving 553,405 patients were analysed. The Table 1 Fallacy was observed in 25% of trials (188 of 765), with 3% of comparisons deemed significant (59 of 2353), approximating the typical 5% type I error assertion probability. Application of trial-level multiplicity corrections reduced the rate of significant findings to 0.3% (six of 2345 tests). Factors associated with lower odds of the Table 1 Fallacy included industry sponsorship (adjusted odds ratio [aOR] 0.29, 95% confidence interval [CI] 0.18-0.47; multiplicity-corrected P < 0.0001), larger trial size (≥795 versus <280 patients; aOR 0.32, 95% CI 0.19-0.53; multiplicity-corrected P = 0.0008), and publication in a European versus American journal (aOR 0.06, 95% CI 0.03-0.13; multiplicity-corrected P < 0.0001). CONCLUSIONS This study highlights the persistence of the Table 1 Fallacy in contemporary oncology randomised controlled trials, with one of every four trials testing for baseline differences after randomisation. Significance testing is a suboptimal method for identifying unsound randomisation procedures and may encourage misleading inferences. Journal-level enforcement is a possible strategy to help mitigate this fallacy.
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Affiliation(s)
- Alexander D Sherry
- Department of Radiation Oncology, Division of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Pavlos Msaouel
- Department of Genitourinary Medical Oncology, Division of Cancer Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX, USA; Department of Translational Molecular Pathology, Division of Pathology/Lab Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Zachary R McCaw
- Insitro, South San Francisco, CA, USA; Department of Biostatistics, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Joseph Abi Jaoude
- Department of Radiation Oncology, Division of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA; Department of Radiation Oncology, Stanford University, Stanford, CA, USA
| | - Eric J Hsu
- Department of Radiation Oncology, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Ramez Kouzy
- Department of Radiation Oncology, Division of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Roshal Patel
- Department of Radiation Oncology, Division of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA; Department of Radiation Oncology, Memorial Sloan-Kettering Cancer Center, New York, NY, USA
| | - Yumeng Yang
- Department of Biomedical Informatics, The University of Texas Health Science Center at Houston, Houston, TX, USA
| | - Timothy A Lin
- Department of Radiation Oncology and Molecular Radiation Sciences, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Cullen M Taniguchi
- Department of Gastrointestinal Radiation Oncology, Division of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA; Department of Experimental Radiation Oncology, Division of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Claus Rödel
- Department of Radiotherapy and Oncology, University of Frankfurt, Frankfurt, Germany; Frankfurt Cancer Institute, Frankfurt, Germany; German Cancer Research Center (DKFZ), Heidelberg, German Cancer Consortium (DKTK), Partner Site Frankfurt am Main, Frankfurt, Germany
| | - Emmanouil Fokas
- Department of Radiotherapy and Oncology, University of Frankfurt, Frankfurt, Germany; Frankfurt Cancer Institute, Frankfurt, Germany; German Cancer Research Center (DKFZ), Heidelberg, German Cancer Consortium (DKTK), Partner Site Frankfurt am Main, Frankfurt, Germany
| | - Chad Tang
- Department of Translational Molecular Pathology, Division of Pathology/Lab Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX, USA; Department of Genitourinary Radiation Oncology, Division of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Clifton David Fuller
- Department of Radiation Oncology, Division of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Bruce Minsky
- Department of Gastrointestinal Radiation Oncology, Division of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Tomer Meirson
- Davidoff Cancer Center, Rabin Medical Center, Petach Tikva, Israel
| | - Ryan Sun
- Department of Biostatistics, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Ethan B Ludmir
- Department of Gastrointestinal Radiation Oncology, Division of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA; Department of Biostatistics, The University of Texas MD Anderson Cancer Center, Houston, TX, USA.
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Nikoletou D, Chis Ster I, Lech CY, MacNaughton IS, Chua F, Aul R, Jones PW. Comparison of high-intensity interval training versus moderate-intensity continuous training in pulmonary rehabilitation for interstitial lung disease: a randomised controlled pilot feasibility trial. BMJ Open 2023; 13:e066609. [PMID: 37607782 PMCID: PMC10445364 DOI: 10.1136/bmjopen-2022-066609] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/15/2022] [Accepted: 07/27/2023] [Indexed: 08/24/2023] Open
Abstract
OBJECTIVES This study aimed to investigate the feasibility and efficacy of high-intensity interval training (HIIT) compared with moderate-intensity continuous training (MICT) in pulmonary rehabilitation (PR) for people with interstitial lung disease (ILD). DESIGN Single-centre, randomised controlled feasibility, pilot trial. SETTING Patients were recruited from the chest clinic of a tertiary ILD centre and attended circuit-based PR in the hospital's gym, followed by a personalised 6-month community programme. PARTICIPANTS 58 patients, stratified per ILD type, were randomised into two groups: 33 to HIIT (18 males:15 females) (mean age (SD): 70.2 (11.4) years) and 25 to the MICT exercise mode (14 males:11 females) (mean age (SD): 69.8 (10.8) years). INTERVENTIONS 8-week, twice weekly, circuit-based PR programme of exercise and education, followed by a personalised 6-month community exercise programme. OUTCOME MEASURES Feasibility outcomes included staff-to-patient ratio and dropout rates per group. Primary outcome was the 6 min walk distance (6MWD). Secondary outcomes included the sniff nasal pressure, mouth inspiratory and expiratory pressures, handgrip and quadriceps strength and health status. Random-effects models were used to evaluate average variation in outcomes through time across the two groups. RESULTS The 6MWD peaked earlier with HIIT compared with MICT (at 4 months vs 5 months) but values were lower at peak (mean (95% CI): 26.3 m (3.5 to 49.1) vs 51.6 m (29.2 to 73.9)) and declined faster at 6 months post-PR. Secondary outcomes showed similar faster but smaller improvements with HIIT over MICT and more consistent maintenance 6 months post-PR with MICT than HIIT. CONCLUSIONS HIIT is feasible in circuit-based ILD PR programmes and provides quick improvements but requires closer supervision of training and resources than MICT and benefits may be less well sustained. This would make it a less attractive option for clinical PR programmes. A definitive, multicentre randomised controlled trial is required to address the role of HIIT in ILD. TRIAL REGISTRATION NUMBER ISRCTN55846300.
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Affiliation(s)
- Dimitra Nikoletou
- Centre for Allied Health, Institute of Medical and Biomedical Education, St George's University of London, London, UK
- Faculty of Health, Science, Social Care and Education, Kingston University, Kingston-Upon-Thames, London, UK
| | - Irina Chis Ster
- Infection and Immunity Research Institute, St George's University of London, London, UK
| | - Carmen Y Lech
- Infection and Immunity Research Institute, St George's University of London, London, UK
| | - Iain S MacNaughton
- Infection and Immunity Research Institute, St George's University of London, London, UK
| | - Felix Chua
- Interstitial Lung Disease Unit, Royal Brompton and Harefield NHS Foundation Trust, London, UK
- National Heart and Lung Institute, Imperial College London, London, UK
| | - Raminder Aul
- Respiratory Medicine, St George's University Hospitals NHS Foundation Trust, London, UK
| | - Paul W Jones
- Infection and Immunity Research Institute, St George's University of London, London, UK
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11
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Zhou T, Zhang J. Types and progress of clinical trial design for breast cancer: a narrative review. TRANSLATIONAL BREAST CANCER RESEARCH : A JOURNAL FOCUSING ON TRANSLATIONAL RESEARCH IN BREAST CANCER 2023; 4:20. [PMID: 38751463 PMCID: PMC11093090 DOI: 10.21037/tbcr-23-22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/05/2023] [Accepted: 07/26/2023] [Indexed: 05/18/2024]
Abstract
Background and Objective In recent years, the field of breast cancer diagnosis and therapy has witnessed rapid technological advances. Concurrently, the emergence of molecular biology and novel detection methodologies has facilitated the transition of breast cancer management into the precision medicine era. The primary objective of this review is to discuss the transformation in the research and development paradigm for breast cancer therapies and strategies. Methods We systematically searched PubMed, EMBASE and Cochrane databases for relevant studies published over the past 20 years using keywords including "breast cancer", "clinical trial", "seamless", "master protocol", "umbrella", "basket", "platform", and "precision medicine". Articles were screened for eligibility and key data extracted. The search was limited to English-language publications. Key Content and Findings The review identifies three core innovations in breast cancer trial methodology: (I) in terms of research speed, the traditional three-stage drug development models are being substituted by "seamless designs" as exemplified by the immunotherapy combination study NCT0328056. (II) Addressing research breadth, "master protocols" such as basket trials (IMMU-132-01), umbrella trials (FUTURE), and platform trials (I-SPY 2) have been introduced, allowing the simultaneous assessment of multiple treatments or disease subtypes within a singular framework. (III) Pertaining to research precision, newer designs utilize biomarkers such as "enrichment" (seen in EMBRACA and OlympiA trials) and "marker stratification" (as in the SOLAR-1 trial), enabling the identification of appropriate patient subgroups and the provision of tailored therapy strategies, a stark contrast to traditional histopathology-based evaluations. Conclusions Clinical trial design in breast cancer research has been revolutionized, moving towards more efficient and targeted strategies. Despite the presence of ethical, logistical, and data complexities, it is anticipated that ongoing technological and regulatory enhancements will pave the way for even more refined research approaches, subsequently influencing future research, clinical practices, and policymaking in breast cancer care.
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Affiliation(s)
- Teng Zhou
- Phase I Clinical Trial Center, Fudan University Shanghai Cancer Center, Shanghai, China
- Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China
| | - Jian Zhang
- Phase I Clinical Trial Center, Fudan University Shanghai Cancer Center, Shanghai, China
- Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China
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12
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Zhao W, Yeatts S, Broderick JP, Selim M, Adeoye OM, Durkalski-Mauldin VL, Meinzer CN, Martin RH, Dillon CR, Cassarly CN, Pauls K, Elm JJ. Optimal Randomization Designs for Large Multicenter Clinical Trials: From the National Institutes of Health Stroke Trials Network Funded by National Institutes of Health/National Institute of Neurological Disorders and Stroke Experience. Stroke 2023; 54:1909-1919. [PMID: 37078281 PMCID: PMC10343960 DOI: 10.1161/strokeaha.122.040743] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/21/2023]
Abstract
From 2016 to 2021, the National Institutes of Health Stroke Trials Network funded by National Institutes of Health/National Institute of Neurological Disorders and Stroke initiated ten multicenter randomized controlled clinical trials. Optimal subject randomization designs are demanded with 4 critical properties: (1) protection of treatment assignment randomness, (2) achievement of the desired treatment allocation ratio, (3) balancing of baseline covariates, and (4) ease of implementation. For acute stroke trials, it is necessary to minimize the time between eligibility assessment and treatment initiation. This article reviews the randomization designs for 3 trials currently enrolling in Stroke Trials Network funded by National Institutes of Health/National Institute of Neurological Disorders and Stroke, the SATURN (Statins in Intracerebral Hemorrhage Trial), the MOST (Multiarm Optimization of Stroke Thrombolysis Trial), and the FASTEST (Recombinant Factor VIIa for Hemorrhagic Stroke Trial). Randomization methods utilized in these trials include minimal sufficient balance, block urn design, big stick design, and step-forward randomization. Their advantages and limitations are reviewed and compared with traditional stratified permuted block design and minimization.
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Affiliation(s)
- Wenle Zhao
- Department of Public Health Sciences, Medical University of South Carolina, Charleston, SC
| | - Sharon Yeatts
- Department of Public Health Sciences, Medical University of South Carolina, Charleston, SC
| | - Joseph P. Broderick
- Departments of Neurology and Rehabilitation Medicine, University of Cincinnati Neuroscience Institute, University of Cincinnati Academic Health Center, OH
| | - Magdy Selim
- Department of Neurology, Beth Israel Deaconess Medical Center, Boston, MA
| | - Opeolu M. Adeoye
- Department of Emergency Medicine, Washington University School of Medicine, St. Louis, MO
| | | | - Caitlyn N. Meinzer
- Department of Public Health Sciences, Medical University of South Carolina, Charleston, SC
| | - Reneé H. Martin
- Department of Public Health Sciences, Medical University of South Carolina, Charleston, SC
| | - Catherine R. Dillon
- Department of Public Health Sciences, Medical University of South Carolina, Charleston, SC
| | - Christy N. Cassarly
- Department of Public Health Sciences, Medical University of South Carolina, Charleston, SC
| | - Keith Pauls
- Department of Public Health Sciences, Medical University of South Carolina, Charleston, SC
| | - Jordan J. Elm
- Department of Public Health Sciences, Medical University of South Carolina, Charleston, SC
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Hanna L, Burns C, O’Neill C, Coughlan E. A Systematic Review of the Implementation and Effectiveness of 'The Daily Mile' on Markers of Children's Health. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:6203. [PMID: 37444051 PMCID: PMC10340552 DOI: 10.3390/ijerph20136203] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/07/2023] [Revised: 06/02/2023] [Accepted: 06/20/2023] [Indexed: 07/15/2023]
Abstract
Currently, a high percentage of children globally fail to meet the World Health Organisation's (WHO) recommended daily physical activity (PA) guidelines. The Daily Mile (TDM) is a school-based PA initiative, designed to improve primary school children's PA behaviour. The purpose of this review was to evaluate the extant TDM implementation process and identify its impact on health-related metrics. Three databases were used to search for articles from the time TDM originated in 2012 until February 2022. The identification and screening process of articles for their ability to meet this review's eligibility criteria were facilitated by use of PRISMA and Rayyan. Sixteen articles from the initial search (n = 202) were deemed eligible for inclusion. An analysis of these articles identified five common outcome categories that permeated throughout the research articles: (1) cardiorespiratory fitness (CRF); (2) anthropometry and body composition; (3) PA; (4) cognition; and (5) process evaluation. Results presented from the included articles suggests TDM positively impacts markers of a variety of health-related metrics, namely CRF and PA. However, implementation barriers including TDM's repetitive nature, time constraints associated with competing curriculum demands and inadequate facilities regularly necessitate the adaptation and development of the original TDM format by schools and teachers.
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Affiliation(s)
- Luke Hanna
- Department of Sport, Leisure and Childhood Studies, Munster Technological University, Bishopstown, T12 P928 Cork, Ireland; (C.B.); (C.O.); (E.C.)
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Iliopoulos K, Koufaki P, Tsilikas S, Avramidis K, Tsagkalis A, Mavragani C, Zintzaras E. A randomized controlled trial evaluating the short-term efficacy of a single-administration intramuscular injection with the fixed combination of thiocolchicoside-diclofenac versus diclofenac monotherapy in patients with acute moderate-to-severe low back pain. BMC Musculoskelet Disord 2023; 24:476. [PMID: 37301824 DOI: 10.1186/s12891-023-06599-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/08/2022] [Accepted: 06/01/2023] [Indexed: 06/12/2023] Open
Abstract
BACKGROUND Non-specific acute low back pain (LBP) is a common health problem that may be accompanied by muscle spasm and decreased mobility. The combination of non-steroidal anti-inflammatory drugs and muscle relaxants represents an advantageous therapeutic option, however, available data on their combined use are conflicting. This prospective, randomized, single-blind, two-parallel-group trial assessed the efficacy of a single intramuscular (IM) injection of the fixed-dose combination (FDC) diclofenac (75 mg)-thiocolchicoside (4 mg/4 ml) product (test treatment) compared to diclofenac (75 mg/3 ml) alone (reference treatment) for the symptomatic relief of acute LBP. Tolerability and safety were also assessed as secondary variables. METHODS One hundred thirty-four patients were enrolled (safety population) and randomly allocated to the combination or single-agent regimen. Pain intensity and muscle spasm, assessed respectively by the patient-reported visual analogue scale and investigator-performed finger-to-floor distance test, were determined prior to the injection as well as 1 and 3 h post-injection in 123 patients (per-protocol population). The patients were blinded to treatment. Safety was assessed up to 24 h post-injection. RESULTS The test treatment was superior in both alleviating the pain intensity and reducing the finger-to-floor distance at both 1 (p < 0.01 and p = 0.023 respectively) and 3 h post-injection (p < 0.01). A higher percentage of patients experienced > 30% reduction in pain intensity at 1 and 3 h with the test treatment (p = 0.037 and p < 0.01 respectively). The corresponding VAS (SD) scores for the test treatment group were at baseline, 1 and 3 h post-injection 72.03 (± 11.72), 45.37 (± 16.28) and 31.56 (± 15.08) respectively and for the reference treatment group 65.20 (± 12.16), 48.98 (± 18.76) and 44.52 (± 17.33) respectively. No adverse effects were reported with the combination treatment, whereas two patients treated with diclofenac reported dizziness. CONCLUSIONS The FDC treatment is an effective and well-tolerated option for the symptomatic treatment of LBP. Clinical and patient-reported assessments confirmed that a single IM injection of FDC diclofenac-thiocolchicoside was more effective than diclofenac alone in conferring rapid and sustained improvement in mobility and pain intensity. TRIAL REGISTRATION EudraCT No: 2017-004530-29 Available at https://eudract.ema.europa.eu/ Registered 04 Dec 2017.
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Affiliation(s)
| | - Panagiota Koufaki
- WinMedica S.A, 1-3 Oidipodos Str., & Attiki Odos Turnoff 33-35, 15238, Chalandri, Athens, Greece.
| | - Stavros Tsilikas
- Orthopaedic Department, Central Clinic of Athens, Athens, Greece
| | | | | | - Clio Mavragani
- Department of Physiology, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - Elias Zintzaras
- BECRO, Athens, Greece
- Department of Biomathematics, University of Thessaly School of Medicine, Larissa, Greece
- Pharmacology & Drug Development Program, Sackler School of Graduate Biomedical, Tufts University School of Medicine, SciencesBoston, MA, USA
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Perneger T, Combescure C, Poncet A. Adjustment for baseline characteristics in randomized trials using logistic regression: sample-based model versus true model. Trials 2023; 24:107. [PMID: 36782238 PMCID: PMC9924183 DOI: 10.1186/s13063-022-07053-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2022] [Accepted: 12/26/2022] [Indexed: 02/15/2023] Open
Abstract
BACKGROUND Adjustment for baseline prognostic factors in randomized clinical trials is usually performed by means of sample-based regression models. Sample-based models may be incorrect due to overfitting. To assess whether overfitting is a problem in practice, we used simulated data to examine the performance of the sample-based model in comparison to a "true" adjustment model, in terms of estimation of the treatment effect. METHODS We conducted a simulation study using samples drawn from a "population" in which both the treatment effect and the effect of the potential confounder were specified. The outcome variable was binary. Using logistic regression, we compared three estimates of the treatment effect in each situation: unadjusted, adjusted for the confounder using the sample, adjusted for the confounder using the true effect. Experimental factors were sample size (from 2 × 50 to 2 × 1000), treatment effect (logit of 0, 0.5, or 1.0), confounder type (continuous or binary), and confounder effect (logit of 0, - 0.5, or - 1.0). The assessment criteria for the estimated treatment effect were bias, variance, precision (proportion of estimates within 0.1 logit units), type 1 error, and power. RESULTS Sample-based adjustment models yielded more biased estimates of the treatment effect than adjustment models that used the true confounder effect but had similar variance, accuracy, power, and type 1 error rates. The simulation also confirmed the conservative bias of unadjusted analyses due to the non-collapsibility of the odds ratio, the smaller variance of unadjusted estimates, and the bias of the odds ratio away from the null hypothesis in small datasets. CONCLUSIONS Sample-based adjustment yields similar results to exact adjustment in estimating the treatment effect. Sample-based adjustment is preferable to no adjustment.
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Affiliation(s)
- Thomas Perneger
- Division of Clinical Epidemiology, University of Geneva and Geneva University Hospitals, 6 Rue Gabrielle-Perret-Gentil, 1211, Geneva, Switzerland.
| | - Christophe Combescure
- grid.8591.50000 0001 2322 4988Division of Clinical Epidemiology, University of Geneva and Geneva University Hospitals, 6 Rue Gabrielle-Perret-Gentil, 1211 Geneva, Switzerland
| | - Antoine Poncet
- grid.8591.50000 0001 2322 4988Division of Clinical Epidemiology, University of Geneva and Geneva University Hospitals, 6 Rue Gabrielle-Perret-Gentil, 1211 Geneva, Switzerland
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Jules-Elysee K, Freeman C, Maalouf D, YaDeau J, Mayman D, Sculco P. Minimizing Opioid Use After Total Hip Arthroplasty: Comparing Periarticular Injection Versus Patient-Controlled Epidural Analgesia Versus a Combination Protocol. J Arthroplasty 2023; 38:101-107. [PMID: 35926795 DOI: 10.1016/j.arth.2022.06.025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/23/2021] [Revised: 06/27/2022] [Accepted: 06/29/2022] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND Effective management of postoperative pain after total hip arthroplasty (THA) may be challenging. We sought to develop an opioid-sparing pain management pathway by comparing the relative effectiveness of 3 different protocols: (1) Local anesthetic administered patient-controlled epidural analgesia (PCEA) without intrathecal opioids; (2) Periarticular injection (PAI); and (3) PCEA + PAI. METHODS In this double-blinded randomized controlled trial, 180 patients undergoing THA were randomized to receive either (1) PCEA with 0.06% bupivacaine, (2) PAI, or (3) a PAI + PCEA with 0.06% bupivacaine. All patients received the same postoperative multimodal analgesic regimen. The primary outcome was opioid consumption, measured in oral morphine equivalents, at 24, 48, and 72 hours after anesthesia stop time. Secondary measures included pain at rest and with movement, opioid side effects, patient satisfaction, and quality of recovery, as assessed via standardized self-reporting scales and surveys. RESULTS Opioid consumption was significantly higher in the PAI group in the first 24 hours postoperatively compared to the PAI + PCEA group (30 versus 15, P = .012). No differences were detected among groups for length of stay, pain scores, patient satisfaction, or duration of surgery. More patients in the PAI + PCEA group were opiate-free in the first 24 hours compared to PAI (23.7 versus 8.5%, P = .043). CONCLUSION Use of PAI + PCEA regimen was opioid-sparing in the first 24 hours after surgery, favoring this group when opioid reduction is desired. Increased drowsiness was noted in the subsequent 24 to 48 hours once the epidural catheter was removed and opioid consumption also increased.
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Affiliation(s)
- Kethy Jules-Elysee
- Department of Anesthesiology, Critical Care and Pain Management Hospital for Special Surgery, New York, New York; Department of Anesthesiology, Weill Cornell Medicine, New York, New York
| | - Carrie Freeman
- Department of Anesthesiology, Critical Care and Pain Management Hospital for Special Surgery, New York, New York
| | - Daniel Maalouf
- Department of Anesthesiology, Critical Care and Pain Management Hospital for Special Surgery, New York, New York; Department of Anesthesiology, Weill Cornell Medicine, New York, New York
| | - Jacques YaDeau
- Department of Anesthesiology, Critical Care and Pain Management Hospital for Special Surgery, New York, New York; Department of Anesthesiology, Weill Cornell Medicine, New York, New York
| | - David Mayman
- Department of Orthopaedic Surgery (Hip and Knee Replacement), Hospital for Special Surgery, New York, New York
| | - Peter Sculco
- Department of Orthopaedic Surgery (Hip and Knee Replacement), Hospital for Special Surgery, New York, New York
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Fatoye F, Gebrye T, Mbada CE, Fatoye CT, Makinde MO, Ayomide S, Ige B. Cost effectiveness of virtual reality game compared to clinic based McKenzie extension therapy for chronic non-specific low back pain. Br J Pain 2022; 16:601-609. [PMID: 36452130 PMCID: PMC9703246 DOI: 10.1177/20494637221109108] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2024] Open
Abstract
BACKGROUND Low-back pain (LBP) is a major public health problem globally and its direct and indirect healthcare costs are growing rapidly. Virtual reality involving the use of video games or non-game applications are alternatives to conventional face-to-face physical therapy for LBP. The purpose of this study was to assess the cost-effectiveness of Back Extension-Virtual Reality Game (BE-VRG) compared to Clinic-based McKenzie therapy (CBMT) for chronic non-specific LBP in Nigeria. METHODS Patients with chronic non-specific LBP were randomised into either BE-VRG or CBMT group. Patients' level of disability was assessed using Oswestry Disability Index (ODI) at week 4 and week 8. ODI was mapped to SF-6D to generate quality adjusted life years (QALYs) used for cost-effectiveness analysis. Resource use and costs were assessed based on rehabilitation services from a healthcare perspective. Cost-effectiveness analysis which included direct healthcare costs was conducted. Incremental cost per QALY was also calculated. RESULTS Forty-six patients (BE-VRG, n = 22; CBMT, n = 24) with the mean (±SD) age of 32.6 ± (11.5) years for BE-VRG and 48.8 ± (10.2) years for CBMT intervention completed in this study. The mean direct health costs per patient were USD100.67 and USD106.3 for BE-VRG and CBMT, respectively. The mean quality adjusted life years at week 4 and week 8 were (BE-VRG, 0.0574 ± (0.002); CBMT, 0.0548 ± (0.002)); and (BE-VRG; 0.116 ± (0.002); CBMT; 0.114 ± (0.004)), respectively. Incremental cost-effectiveness ratio showed that BE-VRG arm was less costly and more effective than CBMT. CONCLUSION The findings of this study suggest that BE-VRG was cost saving for chronic non-specific LBP compared to CBMT. This evidence could guide policy makers, payers and clinicians in evaluating BE-VRG as a treatment option for people with chronic non-specific LBP.
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Affiliation(s)
- Francis Fatoye
- Department of Health Professions, Manchester Metropolitan University, Manchester, UK
| | - Tadesse Gebrye
- Department of Health Professions, Manchester Metropolitan University, Manchester, UK
| | - Chidozie Emmanuel Mbada
- Department of Medical Rehabilitation, College of Health Sciences, Obafemi Awolowo University, Ile-Ife, Nigeria
| | - Clara T Fatoye
- Department of Health Professions, Manchester Metropolitan University, Manchester, UK
| | - Moses O Makinde
- Department of Medical Rehabilitation, College of Health Sciences, Obafemi Awolowo University, Ile-Ife, Nigeria
| | - Salami Ayomide
- Department of Medical Rehabilitation, College of Health Sciences, Obafemi Awolowo University, Ile-Ife, Nigeria
| | - Blessing Ige
- Department of Medical Rehabilitation, College of Health Sciences, Obafemi Awolowo University, Ile-Ife, Nigeria
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Arslan J, Benke KK. Application of Machine Learning to Ranking Predictors of Anti-VEGF Response. LIFE (BASEL, SWITZERLAND) 2022; 12:life12111926. [PMID: 36431061 PMCID: PMC9699567 DOI: 10.3390/life12111926] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/16/2022] [Revised: 11/03/2022] [Accepted: 11/08/2022] [Indexed: 11/22/2022]
Abstract
Age-related macular degeneration (AMD) is a heterogeneous disease affecting the macula of individuals and is a cause of irreversible vision loss. Patients with neovascular AMD (nAMD) are candidates for the anti-vascular endothelial growth factor (anti-VEGF) treatment, designed to regress the growth of abnormal blood vessels in the eye. Some patients fail to maintain vision despite treatment. This study aimed to develop a prediction model based on features weighted in order of importance with respect to their impact on visual acuity (VA). Evaluations included an assessment of clinical, lifestyle, and demographic factors from patients that were treated over a period of two years. The methods included mixed-effects and relative importance modelling, and models were tested against model selection criteria, diagnostic and assumption checks, and forecasting errors. The most important predictors of an anti-VEGF response were the baseline VA of the treated eye, the time (in weeks), treatment quantity, and the treated eye. The model also ranked the impact of other variables, such as intra-retinal fluid, haemorrhage, pigment epithelium detachment, treatment drug, baseline VA of the untreated eye, and various lifestyle and demographic factors. The results identified variables that could be targeted for further investigation in support of personalised treatments based on patient data.
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Affiliation(s)
- Janan Arslan
- Sorbonne Université, Institut du Cerveau—Paris Brain Institute—ICM, CNRS, Inria, Inserm, AP-HP, Hôpital de la Pitié Salpêtrière, F-75013 Paris, France
- Centre for Eye Research Australia, Royal Victorian Eye & Ear Hospital, University of Melbourne, East Melbourne, VIC 3002, Australia
- Correspondence: ; Tel.: +33-6-75-22-39-53
| | - Kurt K. Benke
- School of Engineering, University of Melbourne, Parkville, VIC 3010, Australia
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Papageorgiou SN. On correlation coefficients and their interpretation. J Orthod 2022; 49:359-361. [PMID: 36017900 PMCID: PMC9420886 DOI: 10.1177/14653125221076142] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Affiliation(s)
- Spyridon N Papageorgiou
- Clinic of Orthodontics and Pediatric Dentistry, Center of Dental Medicine, University of Zurich, Zurich, Switzerland
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Luo J. Key Principles for Conducting a Good Randomized Controlled Trial. Respir Care 2022; 67:1211-1213. [PMID: 36002160 PMCID: PMC9994347 DOI: 10.4187/respcare.10426] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/10/2023]
Affiliation(s)
- Jian Luo
- Respiratory Medicine Unit andOxford National Institute forHealth and Care ResearchBiomedical Research CentreNuffield Department of Medicine,Experimental MedicineUniversity of OxfordOxford, United Kingdom
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Virtual Immersion into a Poorly-Managed Medical Crisis Worsens Subsequent Performance: A Randomized, Controlled Trial. Clin Simul Nurs 2022. [DOI: 10.1016/j.ecns.2022.06.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Fountzilas E, Tsimberidou AM, Vo HH, Kurzrock R. Clinical trial design in the era of precision medicine. Genome Med 2022; 14:101. [PMID: 36045401 PMCID: PMC9428375 DOI: 10.1186/s13073-022-01102-1] [Citation(s) in RCA: 84] [Impact Index Per Article: 42.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2021] [Accepted: 08/09/2022] [Indexed: 12/24/2022] Open
Abstract
Recent rapid biotechnological breakthroughs have led to the identification of complex and unique molecular features that drive malignancies. Precision medicine has exploited next-generation sequencing and matched targeted therapy/immunotherapy deployment to successfully transform the outlook for several fatal cancers. Tumor and liquid biopsy genomic profiling and transcriptomic, immunomic, and proteomic interrogation can now all be leveraged to optimize therapy. Multiple new trial designs, including basket and umbrella trials, master platform trials, and N-of-1 patient-centric studies, are beginning to supplant standard phase I, II, and III protocols, allowing for accelerated drug evaluation and approval and molecular-based individualized treatment. Furthermore, real-world data, as well as exploitation of digital apps and structured observational registries, and the utilization of machine learning and/or artificial intelligence, may further accelerate knowledge acquisition. Overall, clinical trials have evolved, shifting from tumor type-centered to gene-directed and histology-agnostic trials, with innovative adaptive designs and personalized combination treatment strategies tailored to individual biomarker profiles. Some, but not all, novel trials now demonstrate that matched therapy correlates with superior outcomes compared to non-matched therapy across tumor types and in specific cancers. To further improve the precision medicine paradigm, the strategy of matching drugs to patients based on molecular features should be implemented earlier in the disease course, and cancers should have comprehensive multi-omic (genomics, transcriptomics, proteomics, immunomic) tumor profiling. To overcome cancer complexity, moving from drug-centric to patient-centric individualized combination therapy is critical. This review focuses on the design, advantages, limitations, and challenges of a spectrum of clinical trial designs in the era of precision oncology.
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Affiliation(s)
- Elena Fountzilas
- Department of Medical Oncology, St. Lukes's Hospital, Thessaloniki, Greece.,European University Cyprus, Limassol, Cyprus
| | - Apostolia M Tsimberidou
- Department of Investigational Cancer Therapeutics, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Henry Hiep Vo
- Department of Investigational Cancer Therapeutics, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
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Pijls BG. The Table I Fallacy: P Values in Baseline Tables of Randomized Controlled Trials. J Bone Joint Surg Am 2022; 104:e71. [PMID: 35230980 DOI: 10.2106/jbjs.21.01166] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Affiliation(s)
- Bart G Pijls
- Department of Orthopaedics, Leiden University Medical Center, Leiden, the Netherlands
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Erdmann TR, Gerber MT, Gaspareto PB, de Oliveira Filho GR. The effects of a short-term perioperative duloxetine treatment on post-colectomy pain: A randomized, controlled clinical trial. J Clin Anesth 2022; 82:110948. [PMID: 35963028 DOI: 10.1016/j.jclinane.2022.110948] [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: 06/09/2022] [Revised: 07/31/2022] [Accepted: 08/03/2022] [Indexed: 11/15/2022]
Abstract
STUDY OBJECTIVE To test the hypothesis that duloxetine reduces postoperative morphine consumption and pain intensity in patients undergoing major colonic surgeries. DESIGN Single-center, prospective, double-blinded, randomized, controlled trial. SETTING Tertiary university hospital, from December 2019 to September 2021. PATIENTS Sixty 18-85 years old, ASA I - III patients undergoing elective open major colonic surgeries were randomly allocated into duloxetine (duloxetine) or placebo (placebo) groups (n = 30 per group). INTERVENTIONS Duloxetine 60 mg or placebo was administered orally 2 h before and 24 h after surgery. MEASUREMENTS PCA morphine consumption, surgical pain at rest, and movement measured on 10-cm visual analog scales (VAS), Ramsay sedation scores, and the incidence of adverse effects potentially associated with duloxetine were assessed at patients' admission to the post-anesthesia care unit (PACU), 6, 24, and 48 h postoperatively (PO). MAIN RESULTS After adjusting for age, BMI, ASA physical status, education level, and incision type, no differences were found between groups in PCA morphine consumption 24 PO h (duloxetine = 5.44 ± 2.06 mg; placebo = 10.33 ± 2.06 mg, p = 0.62) or 48 h PO (duloxetine = 9.18 ± 2.06 mg, placebo = 12.93 ± 2.06, p = 1). Pain at rest also did not differ between groups at 24 h PO (duloxetine = 1.76 ± 0.67 cm; placebo = 1 ± 0.67 cm, p = 1) or at 48 h PO (duloxetine = 0.84 ± 0.67 cm; placebo = 0.49 ± 0.67 cm, p = 1). Similarly, groups did not differ regarding pain on movement at 24 h PO (duloxetine = 2.09 ± 0.68 cm; placebo = 1.80 ± 0.68, p = 1) or at 48 h PO (duloxetine = 1.16 ± 0.68 cm; placebo = 0.88 ± 0.68 cm, p = 1). Sedation scores and adverse effects also did not differ between groups. CONCLUSION Under this study's conditions, short-term duloxetine did not reduce total opioid consumption or pain intensity during the initial 48 h following major colon surgery.
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Affiliation(s)
- Thomas Rolf Erdmann
- Polydoro Ernani de São Thiago University Hospital, Federal University of Santa Catarina.
| | - Marlus Tavares Gerber
- Polydoro Ernani de São Thiago University Hospital, Federal University of Santa Catarina
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Lamidi S, Williams KM, Hind D, Peckham-Cooper A, Miller AS, Smith AM, Saha A, Macutkiewicz C, Griffiths EA, Catena F, Coccolini F, Toogood G, Tierney GM, Boyd-Carson H, Sartelli M, Blencowe NS, Lockwood S, Coe PO, Lee MJ, Barreto SG, Drake T, Gachabayov M, Hill J, Ioannidis O, Lostoridis E, Mehraj A, Negoi I, Pata F, Steenkamp C, Ahmed S, Alin V, Al-Rashedy M, Atici SD, Bains L, Bandyopadhyay SK, Baraket O, Bates T, Beral D, Brown L, Buonomo L, Burke D, Caravaglios G, Ceresoli M, Chapman SJ, Cillara N, Clarke R, Colak E, Daniels S, Demetrashvili Z, Di Carlo I, Duff S, Dziakova J, Elliott JA, El Zalabany T, Engledow A, Ewnte B, Fraga GP, George R, Giuffrida M, Glasbey J, Isik A, Kechagias A, Kenington C, Kessel B, Khokha V, Kong V, Laloë P, Litvin A, Lostoridis E, Marinis A, Martínez-Pérez A, Menzies D, Mills R, Monzon BI, Morgan R, Neri V, Nita GE, Perra T, Perrone G, Porcu A, Poskus T, Premnath S, Sall I, Sarma DR, Slavchev M, Spence G, Tarasconi A, Tolonen M, Toro A, Venn ML, Vimalachandran D, Wheldon L, Zakaria AD. Defining core patient descriptors for perforated peptic ulcer research: international Delphi. Br J Surg 2022; 109:603-609. [PMID: 35467718 DOI: 10.1093/bjs/znac096] [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: 12/01/2021] [Revised: 02/09/2022] [Accepted: 03/08/2022] [Indexed: 10/13/2023]
Abstract
BACKGROUND Perforated peptic ulcer (PPU) remains a common condition globally with significant morbidity and mortality. Previous work has demonstrated variation in reporting of patient characteristics in PPU studies, making comparison of studies and outcomes difficult. The aim of this study was to standardize the reporting of patient characteristics, by creating a core descriptor set (CDS) of important descriptors that should be consistently reported in PPU research. METHODS Candidate descriptors were identified through systematic review and stakeholder proposals. An international Delphi exercise involving three survey rounds was undertaken to obtain consensus on key patient characteristics for future research. Participants rated items on a scale of 1-9 with respect to their importance. Items meeting a predetermined threshold (rated 7-9 by over 70 per cent of stakeholders) were included in the final set and ratified at a consensus meeting. Feedback was provided between rounds to allow refinement of ratings. RESULTS Some 116 clinicians were recruited from 29 countries. A total of 63 descriptors were longlisted from the literature, and 27 were proposed by stakeholders. After three survey rounds and a consensus meeting, 27 descriptors were included in the CDS. These covered demographic variables and co-morbidities, risk factors for PPU, presentation and pathway factors, need for organ support, biochemical parameters, prognostic tools, perforation details, and surgical history. CONCLUSION This study defines the core descriptive items for PPU research, which will allow more robust synthesis of studies.
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Baber U. Polymer-Based Versus Polymer-Free Stents in High Bleeding Risk Patients: Less Is Not Always More. JACC Cardiovasc Interv 2022; 15:1164-1166. [PMID: 35680196 DOI: 10.1016/j.jcin.2022.04.043] [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: 04/26/2022] [Accepted: 04/27/2022] [Indexed: 10/18/2022]
Affiliation(s)
- Usman Baber
- University of Oklahoma Health Sciences Center, Department of Medicine, Cardiovascular Section, Oklahoma City, Oklahoma, USA.
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Alashram AR. Letter to the Editor: Effectiveness of a Web-Based Direct-to-User Transfer Training Program: Comments on A Randomized Controlled Trial. Arch Phys Med Rehabil 2022; 103:2063. [DOI: 10.1016/j.apmr.2022.04.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2022] [Accepted: 04/14/2022] [Indexed: 11/27/2022]
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Adler UC, Adler MS, Padula AEM, Hotta LM, de Toledo Cesar A, Diniz JNM, de Freitas Santos H, Martinez EZ. Homeopathy for COVID-19 in primary care: A randomized, double-blind, placebo-controlled trial (COVID-Simile study). JOURNAL OF INTEGRATIVE MEDICINE 2022; 20:221-229. [PMID: 35339397 PMCID: PMC8917006 DOI: 10.1016/j.joim.2022.03.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/16/2021] [Accepted: 02/21/2022] [Indexed: 12/03/2022]
Abstract
Background Different homeopathic approaches have been used as supportive care for coronavirus disease 2019 (COVID-19) cases, but none has been tested in a clinical trial. Objectives To investigate the effectiveness and safety of the homeopathic medicine, Natrum muriaticum LM2, for mild cases of COVID-19. Design, setting, participants, and interventions A randomized, double-blind, two‐armed, parallel, single-center, placebo-controlled clinical trial was conducted from June 2020 to April 2021 in São-Carlos, Brazil. Participants aged > 18 years, with influenza-like symptoms and positive result from a real-time polymerase chain reaction test for severe acute respiratory syndrome coronavirus 2 were recruited and randomized (1:1) into two groups that received different treatments during a period of at-home-isolation. One group received the homeopathic medicine Natrum muriaticum, prepared with the second degree of the fifty-millesimal dynamization (LM2; Natrum muriaticum LM2), while the other group received a placebo. Outcome measures The primary endpoint was time until recovery from COVID-19 influenza-like symptoms. Secondary measures included a survival analysis of the number and severity of COVID-19 symptoms (influenza-like symptoms plus anosmia and ageusia) from a symptom grading scale that was informed by the participant, hospital admissions, and adverse events. Kaplan-Meier curves were used to estimate time-to-event (survival) measures. Results Data from 86 participants were analyzed (homeopathy, n = 42; placebo, n = 44). There was no difference in time to recovery between two groups among participants who were reporting influenza-like symptoms at the beginning of monitoring (homeopathy, n = 41; placebo, n = 41; P = 0.56), nor in a sub-group that had at least 5 moderate to severe influenza-like symptoms at the beginning of monitoring (homeopathy, n = 15; placebo, n = 17; P = 0.06). Secondary outcomes indicated that a 50% reduction in symptom score was achieved significantly earlier in the homeopathy group (homeopathy, n = 24; placebo, n = 25; P = 0.04), among the participants with a basal symptom score ≥ 5. Moreover, values of restricted mean survival time indicated that patients receiving homeopathy might have improved 0.9 days faster during the first five days of follow-up (P = 0.022). Hospitalization rates were 2.4% in the homeopathy group and 6.8% in the placebo group (P = 0.62). Participants reported 3 adverse events in the homeopathy group and 6 in the placebo group. Conclusion Results showed that Natrum muriaticum LM2 was safe to use for COVID-19, but there was no statistically significant difference in the primary endpoints of Natrum muriaticum LM2 and placebo for mild COVID-19 cases. Although some secondary measures do not support the null hypothesis, the wide confidence intervals suggest that further studies with larger sample sizes and more symptomatic participants are needed to test the effectiveness of homeopathic Natrum muriaticum LM2 for COVID-19. Trial registration UMIN Clinical Trials Registry ID: JPRN-UMIN000040602.
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Fishel Bartal M, Chauhan SP, Sibai BM. Insulin Detemir vs Neutral Protamine Hagedorn in Pregnancy: a reply. Am J Obstet Gynecol 2022; 226:755. [PMID: 34929139 DOI: 10.1016/j.ajog.2021.12.028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2021] [Accepted: 12/14/2021] [Indexed: 11/24/2022]
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Gomutbutra P, Srikamjak T, Sapinun L, Kunaphanh S, Yingchankul N, Apaijai N, Shinlapawittayatorn K, Phuackchantuck R, Chattipakorn N, Chattipakorn S. Effect of intensive weekend mindfulness-based intervention on BDNF, mitochondria function, and anxiety. A randomized, crossover clinical trial. COMPREHENSIVE PSYCHONEUROENDOCRINOLOGY 2022; 11:100137. [PMID: 35757176 PMCID: PMC9216335 DOI: 10.1016/j.cpnec.2022.100137] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2022] [Revised: 04/19/2022] [Accepted: 04/20/2022] [Indexed: 11/23/2022] Open
Abstract
Background The previous metanalysis found that Mind-body intervention (MBI) improves neuropsychologic well-being and may increase brain-derived growth factor (BDNF). BDNF is a neurotrophic factor related to neuroplasticity. Objective To evaluate the effect of the short intensive MBI compared to control-relaxation on Site on BDNF and examine if this change is related to mitochondria function or stress-related neurohormonal activity. Methods Randomized, controlled, two-period cross-over trial conducted in a medical center in Thailand. Healthy-meditation naive Nurse and Occupational Therapy Students, 23 assigned randomly to MBI, and 24 relaxations at the site for 8 h during the weekend. The wash-out period was three months between the two periods. All volunteers took the blood test for BDNF, mitochondrial oxidative phosphorylation (OXPHOS), Cortisol, and Heart rate variability (HRV) measurement before and Visual Analogue Scale for Anxiety (VAS-A), forward and backward digit span after each period. Results A total of 40 participants finished the trials. The cross over trial analysis showed a significant treatment effect between MBI and Relaxation on-site for the mean VAS-A as 9.89 (95% CI 4.81 to 19.47; P = 0.001), serum BDNF as 1.24 (95% CI 0.16 to 2.32; P = 0.04), and OXPHOS complex-1 was decreased 0.41 (95% CI 0.03–0.29 p = 0.03). There were no significant differences for digit span, cortisol, and HRV. Conclusion In healthy meditation naïve females, even a short period of MBI may increase serum BDNF and reduce anxiety more than relaxation on-site. The more reduction of OXPHOS complex-1 in the mindfulness group suggests oxidative stress may be a more sensitive indicator than stress-related neurohormonal activity. The effects of a short, intensive mindfulness session are scarce. Brain-derived growth factor (BDNF) is impacted by mindfulness-based intervention. The results indicate that mindfulness practice increased BDNF. This can be applied to the promotion of women's health.
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Pescott OL, Stewart GB. Simulation‐based study design accuracy weights are not generalisable and can still lead to biased meta‐analytic inference: Comments on Christie et al. (2019). J Appl Ecol 2022. [DOI: 10.1111/1365-2664.14153] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Affiliation(s)
| | - Gavin B. Stewart
- Evidence Synthesis Lab, School of Natural and Environmental Science University of Newcastle Newcastle‐upon‐Tyne UK
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Urate-lowering therapy for CKD patients with asymptomatic hyperuricemia without proteinuria elucidated by attribute-based research in the FEATHER Study. Sci Rep 2022; 12:3784. [PMID: 35260678 PMCID: PMC8904814 DOI: 10.1038/s41598-022-07737-9] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2021] [Accepted: 02/21/2022] [Indexed: 11/08/2022] Open
Abstract
Attribute-based medicine is essential for patient-centered medicine. To date, the groups of patients with chronic kidney disease (CKD) requiring urate-lowering therapy are clinically unknown. Herein, we evaluated the efficacy of febuxostat using a cross-classification, attribute-based research approach. We performed post hoc analysis of multicenter, randomized, double-blind, placebo-controlled trial data for 395 patients with stage 3 CKD and asymptomatic hyperuricemia. Participants were divided into febuxostat or placebo groups and subcohorts stratified and cross-classified by proteinuria and serum creatinine concentrations. In patients stratified based on proteinuria, the mean eGFR slopes were significantly higher in the febuxostat group than in the placebo group (P = 0.007) in the subcohort without proteinuria. The interaction between febuxostat treatment and presence of proteinuria in terms of eGFR slope was significant (P for interaction = 0.019). When cross-classified by the presence of proteinuria and serum creatinine level, the mean eGFR slopes significantly differed between the febuxostat and placebo groups (P = 0.040) in cross-classified subcohorts without proteinuria and with serum creatinine level ≥ median, but not in the cross-classified subcohorts with proteinuria and serum creatinine level < median. Febuxostat mitigated the decline in kidney function among stage 3 CKD patients with asymptomatic hyperuricemia without proteinuria.
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Johns H, Italiano D, Campbell B, Churilov L. Common scale minimal sufficient balance: An improved method for covariate-adaptive randomization based on the Wilcoxon-Mann-Whitney odds ratio statistic. Stat Med 2022; 41:1846-1861. [PMID: 35176811 PMCID: PMC9303921 DOI: 10.1002/sim.9332] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2021] [Revised: 11/28/2021] [Accepted: 01/10/2022] [Indexed: 12/04/2022]
Abstract
Minimal sufficient balance (MSB) is a recently suggested method for adaptively controlling covariate imbalance in randomized controlled trials in a manner which reduces the impact on randomness of allocation over other approaches by only intervening when the imbalance is sufficiently significant. Despite its improvements, the approach is unable to consider the relative clinical importance or magnitude of imbalance in each covariate weight, and ignores any imbalance which is not statistically significant, even when these imbalances may collectively justify intervention. We propose the common scale MSB (CS‐MSB) method which addresses these limitations, and present simulation studies comparing our proposed method to MSB. We demonstrate that CS‐MSB requires less intervention than MSB to achieve the same level of covariate balance, and does not adversely impact either statistical power or Type‐I error.
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Affiliation(s)
- Hannah Johns
- Melbourne Medical School, University of Melbourne, Melbourne, Victoria, Australia
| | - Dominic Italiano
- Melbourne Medical School, University of Melbourne, Melbourne, Victoria, Australia
| | - Bruce Campbell
- Department of Medicine and Neurology, Melbourne Brain Centre and Royal Melbourne Hospital, University of Melbourne, Melbourne, Victoria, Australia.,Florey Institute of Neuroscience and Mental Health, University of Melbourne, Melbourne, Victoria, Australia
| | - Leonid Churilov
- Melbourne Medical School, University of Melbourne, Melbourne, Victoria, Australia
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Chan VCH, Welsh TN, Tremblay L, Frost DM, Beach TAC. A comparison of augmented feedback and didactic training approaches to reduce spine motion during occupational lifting tasks. APPLIED ERGONOMICS 2022; 99:103612. [PMID: 34743974 DOI: 10.1016/j.apergo.2021.103612] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/16/2021] [Revised: 09/04/2021] [Accepted: 10/14/2021] [Indexed: 06/13/2023]
Abstract
Manual handling training may be improved if it relied on the provision of individualized, augmented feedback about key movement features. The purpose of this study was to compare the reduction in sagittal spine motion during manual lifting tasks following two training approaches: didactic (DID) and augmented feedback (AUG). Untrained participants (n = 26) completed lifting tests (box, medication bag, and paramedic backboard) and a randomly-assigned intervention involving 50 practice box lifts. Lifting tests were performed immediately before and after training, and one-week after interventions. Both groups exhibited reductions in spine motions immediately and one-week after the interventions. However, the AUG intervention group elicited significantly greater reductions in 5 of 12 between-group comparisons (3 tasks × 4 spine motion variables). The results of the current study support the use of augmented feedback-based approaches to manual handling training over education-based approaches.
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Affiliation(s)
- Victor C H Chan
- Faculty of Kinesiology and Physical Education, University of Toronto, Toronto, ON, Canada; School of Human Kinetics, University of Ottawa, Ottawa, ON, Canada
| | - Timothy N Welsh
- Faculty of Kinesiology and Physical Education, University of Toronto, Toronto, ON, Canada; Centre for Motor Control, University of Toronto, Toronto, ON, Canada
| | - Luc Tremblay
- Faculty of Kinesiology and Physical Education, University of Toronto, Toronto, ON, Canada; Centre for Motor Control, University of Toronto, Toronto, ON, Canada
| | - David M Frost
- Faculty of Kinesiology and Physical Education, University of Toronto, Toronto, ON, Canada
| | - Tyson A C Beach
- Centre for Motor Control, University of Toronto, Toronto, ON, Canada; Department of Kinesiology & Health Sciences, University of Waterloo, Waterloo, ON, Canada.
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Khanna A, Banoth B, Verma A, Bhalla K, Holla S, Yadav S. Comparative effectiveness of oral dexamethasone vs. oral prednisolone for acute exacerbation of asthma: A randomized control trial. J Family Med Prim Care 2022; 11:1395-1400. [PMID: 35516722 PMCID: PMC9067196 DOI: 10.4103/jfmpc.jfmpc_1210_21] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2021] [Revised: 10/12/2021] [Accepted: 12/03/2021] [Indexed: 11/13/2022] Open
Abstract
Background: Acute exacerbation of asthma is a common condition leading to emergency visits. Prednisolone is a commonly prescribed drug in the standard management of acute exacerbation of asthma along with other drugs. This study was planned to see the efficacy of oral dexamethasone when compared with oral prednisolone in the management of acute exacerbation of asthma. Methods: A single-center pilot study in the form of randomized control trial was done by recruiting children aged 2–14 years diagnosed with acute asthma exacerbation with mild to moderate severity. A total of 88 patients received oral dexamethasone (0.3 mg/kg) in two doses 24 h apart, which was compared with 87 patients who received oral prednisolone (1 mg/kg) in two divided doses 12 h apart for 5 days. The patients were assessed at the time of admission (zero hour), at 4th hour, and on the 5th day by various parameters such as respiratory rate, use of accessory muscles, Pediatric Respiratory Assessment Measure (PRAM) score, peak expiratory flow rate (PEFR), 6-h admission stay, and rate of hospital admission. Results: Baseline demographic profile, clinical characteristics, comorbidities, indoor pollution, and use of Metered Dose Inhaler (MDI) among the two study groups were comparable. Six-hour emergency stay and rate of admission were significantly lower in the dexamethasone group (P < 0.05). Improvement in PRAM score, PEFR, use of accessory muscles, and respiratory rate was also better in dexamethasone group at the 4th hour and 5th day (P < 0.05). In addition, oral dexamethasone was shown to have less incidence of vomiting/gastritis than prednisolone (P < 0.05). Conclusion: Oral dexamethasone can be considered a reliable and better option as compared with prednisolone due to its faster action and minimal side effects.
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Messner W. The association of cultural and contextual factors with social contact avoidance during the COVID-19 pandemic. PLoS One 2021; 16:e0261858. [PMID: 34962946 PMCID: PMC8714113 DOI: 10.1371/journal.pone.0261858] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2021] [Accepted: 12/11/2021] [Indexed: 01/15/2023] Open
Abstract
As a first line of defense to the COVID-19 pandemic in 2020, people reduced social contacts to avoid pathogen exposure. Using a panel of countries, this research suggests that this was amplified in societies characterized by high social support and future orientation. People reacted more strongly in dense environments; government orders had more effect in high power distance societies. Conversely, a focus on accomplishments was associated with lower changes. Understanding people’s actual behaviors in response to health threats across societies is of great importance for epidemiology, public health, international business, and for the functioning of humanity as a whole.
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Affiliation(s)
- Wolfgang Messner
- Darla Moore School of Business, University of South Carolina, Columbia, SC, United States of America
- * E-mail:
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Li F, Tian Z, Bobb J, Papadogeorgou G, Li F. Clarifying selection bias in cluster randomized trials. Clin Trials 2021; 19:33-41. [PMID: 34894795 DOI: 10.1177/17407745211056875] [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: 11/16/2022]
Abstract
BACKGROUND In cluster randomized trials, patients are typically recruited after clusters are randomized, and the recruiters and patients may not be blinded to the assignment. This often leads to differential recruitment and consequently systematic differences in baseline characteristics of the recruited patients between intervention and control arms, inducing post-randomization selection bias. We aim to rigorously define causal estimands in the presence of selection bias. We elucidate the conditions under which standard covariate adjustment methods can validly estimate these estimands. We further discuss the additional data and assumptions necessary for estimating causal effects when such conditions are not met. METHODS Adopting the principal stratification framework in causal inference, we clarify there are two average treatment effect (ATE) estimands in cluster randomized trials: one for the overall population and one for the recruited population. We derive analytical formula of the two estimands in terms of principal-stratum-specific causal effects. Furthermore, using simulation studies, we assess the empirical performance of the multivariable regression adjustment method under different data generating processes leading to selection bias. RESULTS When treatment effects are heterogeneous across principal strata, the average treatment effect on the overall population generally differs from the average treatment effect on the recruited population. A naïve intention-to-treat analysis of the recruited sample leads to biased estimates of both average treatment effects. In the presence of post-randomization selection and without additional data on the non-recruited subjects, the average treatment effect on the recruited population is estimable only when the treatment effects are homogeneous between principal strata, and the average treatment effect on the overall population is generally not estimable. The extent to which covariate adjustment can remove selection bias depends on the degree of effect heterogeneity across principal strata. CONCLUSION There is a need and opportunity to improve the analysis of cluster randomized trials that are subject to post-randomization selection bias. For studies prone to selection bias, it is important to explicitly specify the target population that the causal estimands are defined on and adopt design and estimation strategies accordingly. To draw valid inferences about treatment effects, investigators should (1) assess the possibility of heterogeneous treatment effects, and (2) consider collecting data on covariates that are predictive of the recruitment process, and on the non-recruited population from external sources such as electronic health records.
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Affiliation(s)
- Fan Li
- Department of Statistical Science, Duke University, Durham, NC, USA
| | - Zizhong Tian
- Department of Public Health Sciences, Pennsylvania State University, Hershey, PA, USA
| | - Jennifer Bobb
- Kaiser Permanente Washington Health Research Institute, and Department of Biostatistics, University of Washington, Seattle, WA, USA
| | | | - Fan Li
- Department of Biostatistics, Yale University School of Public Health, New Haven, CT, USA
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Effect of Anodal Transcranial Direct Current Stimulation at the Right Dorsolateral Prefrontal Cortex on the Cognitive Function in Patients with Mild Cognitive Impairment: Comments on a Randomized Double-Blind Controlled Trial. Arch Phys Med Rehabil 2021; 103:372. [PMID: 34670135 DOI: 10.1016/j.apmr.2021.08.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2021] [Accepted: 08/17/2021] [Indexed: 11/21/2022]
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Development and validation of Yoga Module for Anger Management in adolescents. Complement Ther Med 2021; 61:102772. [PMID: 34506918 DOI: 10.1016/j.ctim.2021.102772] [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: 09/03/2020] [Revised: 08/20/2021] [Accepted: 08/25/2021] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Development of anger management programs and in particular, yoga module for anger management has not been well researched. Being a complex emotion, anger poses serious challenges in developing a comprehensive anger management program. While various theories of anger are dealt in modern psychology, several anger management techniques are set forth in Indian traditional texts. Yoga, which is considered as a holistic and integrated approach is explored in this study to develop and validate a school-based yoga program for anger management in adolescence. MATERIALS AND METHODS Integrated Approach to Yoga Therapy (IAYT) principles and literary review formed the basis for deriving the concepts of anger management. The methodology includes construction of the yoga module, validation of the module by 22 experts followed by a pilot non-randomised control study (n-50) to assess feasibility and initial effectiveness. Content Validity Ratio (CVR) and paired t-test were employed to analyse the experts' rating and pilot-study data respectively. RESULTS Emergence of IAYT based yoga program for anger management. Based on CVR ratio, 16 out of 18 yogic techniques qualified for the final module. The pilot study revealed viability of the module and its recognition as an anger management program. Significant reduction of anger scores in yoga group substantiates initial effectiveness of the module. CONCLUSION The developed and validated yoga module for anger management is recognised as a well-accepted and effective yoga program for anger management in adolescents.
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Hasan Ibrahim AS, Barry HE, Hughes CM. A systematic review of general practice-based pharmacists' services to optimize medicines management in older people with multimorbidity and polypharmacy. Fam Pract 2021; 38:509-523. [PMID: 33506870 DOI: 10.1093/fampra/cmaa146] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND Few studies have evaluated roles of general practice-based pharmacists (PBPs), particularly in optimizing medicines management for older people with both multimorbidity and polypharmacy. OBJECTIVE To explore the types and effectiveness of services provided by PBPs, either alone or in collaboration with other primary health care professionals, that sought to optimize medicines management for older people with multimorbidity and polypharmacy. METHODS Eight electronic databases and three trial registries were searched for studies published in English until April 2020. Inclusion criteria were randomized controlled trials, non-randomized controlled trials and controlled before-and-after studies of services delivered by PBPs in primary care/general practice, for patients aged ≥65 years with both multimorbidity and polypharmacy that focused on a number of outcomes. The Cochrane risk of bias tool for randomized trials (RoB 1) and the Risk of Bias in Non-randomized Studies-of Interventions (ROBINS-I) assessment tool were used for quality assessment. A narrative synthesis was conducted due to study heterogeneity. RESULTS Seven studies met inclusion criteria. All included studies employed PBP-led medication review accompanied by recommendations agreed and implemented by general practitioners. Other patient-level and practice-level interventions were described in one study. The limited available evidence suggested that PBPs, in collaboration with other practice team members, had mixed effects on outcomes focused on optimizing medicines management for older people. Most included studies were of poor quality and data to estimate the risk of bias were often missing. CONCLUSION Future high-quality studies are needed to test the effects of PBP interventions on a well-defined range of medicines management-related outcomes.
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Affiliation(s)
| | - Heather E Barry
- Primary Care Research Group, School of Pharmacy, Queen's University Belfast, Belfast, UK
| | - Carmel M Hughes
- Primary Care Research Group, School of Pharmacy, Queen's University Belfast, Belfast, UK
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Su JJ, Yu DSF. Effects of a nurse-led eHealth cardiac rehabilitation programme on health outcomes of patients with coronary heart disease: A randomised controlled trial. Int J Nurs Stud 2021; 122:104040. [PMID: 34333211 DOI: 10.1016/j.ijnurstu.2021.104040] [Citation(s) in RCA: 45] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2021] [Revised: 07/06/2021] [Accepted: 07/09/2021] [Indexed: 12/12/2022]
Abstract
BACKGROUND The uptake of and adherence to cardiac rehabilitation remain suboptimal despite its apparent health benefits in modifying risk factors and slowing disease progression. eHealth refers to the use of information and communication technologies for health-related purposes. It is a promising approach for improving participation in cardiac rehabilitation by enabling instant contact, hypermedia information delivery, technology-monitored functionalities and individualised progress monitoring. AIMS To evaluate the effects of a nurse-led eHealth cardiac rehabilitation (NeCR) system on health behaviours, cardiac self-efficacy, anxiety and depression, health-related quality of life, risk parameters and unplanned use of care services for people with coronary heart disease. DESIGN A single-blinded randomised controlled trial design was used. METHODS The study randomly assigned 146 patients hospitalised for coronary heart disease to receive either the NeCR intervention or the usual care. Underpinned by social cognitive theory, the intervention commenced before hospital discharge with an in-person session by the nurse to identify individualised self-care needs, set goals and develop an action plan to enhance behavioural risk factor modification and orientate the patient to the use of the information and communication technology platform for cardiac rehabilitation. After discharge, the e-platform helped patients gain knowledge of disease management and monitor goal attainment for health behavioural changes. The nurse provided feedback on the patients' goal attainment and lifestyle modifications on a weekly basis in a small group format through the WeChat platform, thus also mobilising peer influence. Data for lifestyle behaviours, physiological risk parameters and clinical outcomes were collected at baseline and at 6 and 12 weeks post-intervention. RESULTS At 6 weeks post-intervention, participants in the intervention group showed significant improvement in the number of steps/day (β = 2628.48, p = .022), the number of minutes/week sitting (β = -640.30, p = .006) and their health-promoting lifestyle profile (β = 25.17, p < .001) compared with the control group. Improvements in the number of steps/day (β = 2520.00, p = .006), the number of minutes/week sitting (β = -719.73, p = .004) and health-promoting lifestyle (β = 16.09, p < .001) were sustained until the 12-week post-intervention endpoint. Moreover, participants showed significantly greater improvement in self-efficacy (β = 0.61, p = .005) and health-related quality of life (mean difference = 0.56, p < .001) than the control group at the study endpoint. CONCLUSIONS The findings of this study demonstrate the effectiveness of the NeCR intervention in modifying behavioural risk factors and improving health-related quality of life. These findings also provide insights into the application of eHealth nursing interventions to enhance the rehabilitation of patients with coronary heart disease. TRIAL REGISTRATION ChiCTR1800020411.
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Affiliation(s)
- Jing Jing Su
- WHO Collaborating Centre for Community Health Services (WHOCC), School of Nursing, The Hong Kong Polytechnic University, Hong Kong Special Administrative Region, China
| | - Doris Sau-Fung Yu
- School of Nursing, Li Ka Shing Faculty of Medicine, The University of Hong Kong, 4/F, William MW Mong Block, 21 Sassoon Road, Hong Kong Special Administrative Region, Pokfulam, Hong Kong, China.
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Abstract
Randomised assignment of individuals to treatment and controls groups is often considered the gold standard to draw valid conclusions about the efficacy of an intervention. In practice, randomisation can lead to accidental differences due to chance. Researchers have offered alternatives to reduce such differences, but these methods are not used frequently due to the requirement of advanced statistical methods. Here, we recommend a simple assignment procedure based on variance minimisation (VM), which assigns incoming participants automatically to the condition that minimises differences between groups in relevant measures. As an example of its application in the research context, we simulated an intervention study whereby a researcher used the VM procedure on a covariate to assign participants to a control and intervention group rather than controlling for the covariate at the analysis stage. Among other features of the simulated study, such as effect size and sample size, we manipulated the correlation between the matching covariate and the outcome variable and the presence of imbalance between groups in the covariate. Our results highlighted the advantages of VM over prevalent random assignment procedure in terms of reducing the Type I error rate and providing accurate estimates of the effect of the group on the outcome variable. The VM procedure is valuable in situations whereby the intervention to an individual begins before the recruitment of the entire sample size is completed. We provide an Excel spreadsheet, as well as scripts in R, MATLAB, and Python to ease and foster the implementation of the VM procedure.
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Shoham Y, Shapira E, Haik J, Harats M, Egozi D, Robinson D, Kogan L, Elkhatib R, Telek G, Shalom A. Bromelain-based enzymatic debridement of chronic wounds: Results of a multicentre randomized controlled trial. Wound Repair Regen 2021; 29:899-907. [PMID: 34231281 DOI: 10.1111/wrr.12958] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2020] [Revised: 06/01/2021] [Accepted: 06/15/2021] [Indexed: 01/01/2023]
Abstract
Chronic wounds are estimated to affect over 6 million people annually in the United States with an estimated annual cost of $25 billion. Debridement represents a key step in their management and is considered a basic necessity to induce the functional process of tissue repair. However, there is an unmet need for an efficient rapid acting non-surgical debridement agent. Bromelain-based enzymatic debridement has been proven to provide an effective, selective and safe non-surgical debridement in deep burns. EscharEx (MediWound Ltd, Yavne, Israel), is a bromelain-based enzymatic debridement agent currently in development for chronic wounds. The aim of this study was to assess its safety and efficacy in chronic wounds. Seventy-three patients suffering from a lower extremity ulcer of diabetic/venous insufficiency/post-surgical/traumatic aetiology were enrolled in a multicentre, assessor blinded, randomized controlled trial. Patients were randomized to topical treatment by either EscharEx or its gel vehicle for up to 10 daily 4 hour applications, and then continued follow-up for up to 6 months. The EscharEx arm achieved a significantly higher incidence of complete debridement compared to the gel vehicle arm; 55 versus 29% (p = .047), thus meeting the primary endpoint of this study. The EscharEx and gel vehicle arms achieved similar reductions in wound area, non-viable tissue area and wound healing scores during the debridement period. There were no significant differences between the arms in the incidence of complete wound closure (41% in the EsxcharEx arm vs. 53% in the gel vehicle arm) and in the mean time to complete wound closure (70.0 ± 32.8 days in the EsxcharEx arm vs. 65.7 ± 38.4 days in gel vehicle arm). There were no significant safety issues and EscharEx demonstrated a favourable benefit to risk profile.
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Affiliation(s)
- Yaron Shoham
- Plastic and Reconstructive Surgery Department and Burn Unit, Soroka University Medical Center, Beer Sheba, Israel.,Faculty of Health Sciences, Ben Gurion University of the Negev, Beer Sheba, Israel
| | - Eyal Shapira
- Plastic and Reconstructive Surgery Department, Shamir Medical Center, Zerifin, Israel
| | - Josef Haik
- Plastic and Reconstructive Surgery Department and Burn Center, Sheba Medical Center, Tel Hashomer, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Moti Harats
- Plastic and Reconstructive Surgery Department and Burn Center, Sheba Medical Center, Tel Hashomer, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.,Talpiot Leadership Program, Shamir Medical Center, Tel Hashomer, Israel.,Institute for Health Research, University of Notre Dame, Fremantle, Western Australia, Australia
| | - Dana Egozi
- Plastic and Reconstructive Surgery Department, Kaplan Medical Center, Rehovot, Israel.,Hebrew University Medical School, Jerusalem, Israel
| | - Dror Robinson
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.,Orthopedic Surgery Department, Hasharon Hospital, Rabin Medical Center, Petah Tikva, Israel
| | - Leonid Kogan
- Plastic Surgery and Burns Department, Galilee Medical Center, Naharia, Israel
| | - Rania Elkhatib
- Plastic and Reconstructive Surgery Department, Rambam Health Care Campus, Haifa, Israel
| | - Geza Telek
- Surgery Department, South Pest Central Hospital, National Institute of Hematology and Infectious Diseases, and 1st. Department of Surgery and Interventional Gastroenterology (DPC Surgical Department Group), Faculty of Medicine, Faculty of Dentistry, Semmelweis University, Budapest, Hungary
| | - Avshalom Shalom
- Plastic and Reconstructive Surgery Department, Meir Medical Center, Kfar Saba, Israel
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Prostate Cancer Biomarkers: From diagnosis to prognosis and precision-guided therapeutics. Pharmacol Ther 2021; 228:107932. [PMID: 34174272 DOI: 10.1016/j.pharmthera.2021.107932] [Citation(s) in RCA: 45] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2021] [Revised: 05/10/2021] [Accepted: 05/12/2021] [Indexed: 12/23/2022]
Abstract
Prostate cancer (PCa) is one of the most commonly diagnosed malignancies and among the leading causes of cancer-related death worldwide. It is a highly heterogeneous disease, ranging from remarkably slow progression or inertia to highly aggressive and fatal disease. As therapeutic decision-making, clinical trial design and outcome highly depend on the appropriate stratification of patients to risk groups, it is imperative to differentiate between benign versus more aggressive states. The incorporation of clinically valuable prognostic and predictive biomarkers is also potentially amenable in this process, in the timely prevention of metastatic disease and in the decision for therapy selection. This review summarizes the progress that has so far been made in the identification of the genomic events that can be used for the classification, prediction and prognostication of PCa, and as major targets for clinical intervention. We include an extensive list of emerging biomarkers for which there is enough preclinical evidence to suggest that they may constitute crucial targets for achieving significant advances in the management of the disease. Finally, we highlight the main challenges that are associated with the identification of clinically significant PCa biomarkers and recommend possible ways to overcome such limitations.
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Powers JH. Scientific Evidence, Regulatory Decision Making, and Incentives for Therapeutics in Infectious Diseases: The Example of Cefiderocol. Clin Infect Dis 2021; 72:e1112-e1114. [PMID: 33257939 DOI: 10.1093/cid/ciaa1795] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2020] [Accepted: 11/26/2020] [Indexed: 11/12/2022] Open
Affiliation(s)
- John H Powers
- Department of Medicine, George Washington University School of Medicine, Rockville, MD, USA
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Shih HS, Jhou HJ, Ou YH, Liu YT, Kor CT, Chen AWG, Chen MK. The Efficacy and Adverse Events in Patients with Head and Neck Cancer Following Radiotherapy Combined with S-1 Therapy: A Meta-Analysis. Cancers (Basel) 2021; 13:cancers13122971. [PMID: 34199326 PMCID: PMC8231857 DOI: 10.3390/cancers13122971] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2021] [Revised: 06/06/2021] [Accepted: 06/09/2021] [Indexed: 11/16/2022] Open
Abstract
This meta-analysis was conducted to assess the efficacy and adverse events associated with S-1 chemotherapy combined with radiotherapy for patients with head and neck cancer. The PubMed, Embase, and Cochrane Library databases were searched up to 10 February 2021. Eligible studies included clinical trials using S-1 chemotherapy combined with radiotherapy for head and neck cancer patients that measured tumor response, local control rate, overall survival, and grade 3/4 adverse events. A meta-analysis was performed using a random effects model. Twelve trials involving 378 patients met the selection criteria. The objective response and clinical benefit rate (complete/partial response and stable disease) of S-1 chemotherapy with radiotherapy were 86.3% (95% confidence interval (CI), 60.3-96.3) and 88.3% (95% CI, 70.1-96.1), respectively. The median 3-year local control rate, 3-year overall survival rate, and grade 3/4 adverse event rate were 84.0% (95% CI, 71.4-91.7), 69.6% (95% CI, 54.9-81.1), and 42.0% (95% CI, 36.2-48.0), respectively. S-1 combined with radiotherapy for patients with head and neck squamous cell carcinoma results in a good tumor response, favorable survival rate, and low toxicity. A prospective randomized, double-blind trial is required to assess the efficacy and safety of S-1 combined with radiotherapy to treat HNSCC.
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Affiliation(s)
- Hung-Sheng Shih
- Division of General Practice, Department of Medical Education, Changhua Christian Hospital, Changhua 500, Taiwan; or
| | - Hong-Jie Jhou
- Department of Neurology, Changhua Christian Hospital, Changhua 500, Taiwan or (H.-J.J.); or (Y.-H.O.)
| | - Yang-Hao Ou
- Department of Neurology, Changhua Christian Hospital, Changhua 500, Taiwan or (H.-J.J.); or (Y.-H.O.)
| | - Yen-Tze Liu
- Institute of Medicine, Chung Shan Medical University, Taichung 402, Taiwan;
- Department of Family Medicine, Changhua Christian Hospital, Changhua 500, Taiwan
- Department of Holistic Wellness, Mingdao University, Changhua 500, Taiwan
- Oral Cancer Research Center, Changhua Christian Hospital, Changhua 500, Taiwan
- Big Data Center, Changhua Christian Hospital, Changhua 500, Taiwan;
| | - Chew-Teng Kor
- Big Data Center, Changhua Christian Hospital, Changhua 500, Taiwan;
- Graduate Institute of Statistics and Information Science, National Changhua University of Education, Changhua 500, Taiwan
| | - Andy Wei-Ge Chen
- Department of Otolaryngology-Head & Neck Surgery, Changhua Christian Hospital, Changhua 500, Taiwan
- Correspondence: (A.W.-G.C.); (M.-K.C.)
| | - Mu-Kuan Chen
- Department of Otolaryngology-Head & Neck Surgery, Changhua Christian Hospital, Changhua 500, Taiwan
- Correspondence: (A.W.-G.C.); (M.-K.C.)
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Te Lintel Hekkert M, Newton G, Chapman K, Aqil R, Downham R, Yan R, Merkus D, Whitlock G, Lane CAL, Cawkill D, Perrior T, Duncker DJ, Schneider MD. Preclinical trial of a MAP4K4 inhibitor to reduce infarct size in the pig: does cardioprotection in human stem cell-derived myocytes predict success in large mammals? Basic Res Cardiol 2021; 116:34. [PMID: 34018053 PMCID: PMC8137473 DOI: 10.1007/s00395-021-00875-7] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/04/2021] [Accepted: 04/19/2021] [Indexed: 01/09/2023]
Abstract
Reducing infarct size (IS) by interfering with mechanisms for cardiomyocyte death remains an elusive goal. DMX-5804, a selective inhibitor of the stress-activated kinase MAP4K4, suppresses cell death in mouse myocardial infarction (MI), human pluripotent stem cell-derived cardiomyocytes (hPSC-CMs), and 3D human engineered heart tissue, whose fidelity to human biology is hoped to strengthen the route to clinical success. Here, DMX-10001, a soluble, rapidly cleaved pro-drug of DMX-5804, was developed for i.v. testing in large-mammal MI. Following pharmacodynamic studies, a randomized, blinded efficacy study was performed in swine subjected to LAD balloon occlusion (60 min) and reperfusion (24 h). Thirty-six animals were enrolled; 12 were excluded by pre-defined criteria, death before infusion, or technical issues. DMX-10001 was begun 20 min before reperfusion (30 min, 60 mg/kg/h; 23.5 h, 17 mg/kg/h). At all times tested, beginning 30 min after the start of infusion, DMX-5804 concentrations exceeded > fivefold the levels that rescued hPSC-CMs and reduced IS in mice after oral dosing with DMX-5804 itself. No significant reduction occurred in IS or no-reflow corrected for the area at ischemic risk, even though DMX-10001 reduced IS, expressed in grams or % of LV mass, by 27%. In summary, a rapidly cleaved pro-drug of DMX-5804 failed to reduce IS in large-mammal MI, despite exceeding the concentrations for proven success in both mice and hPSC-CMs.
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Affiliation(s)
- Maaike Te Lintel Hekkert
- Department of Cardiology (Thoraxcenter), Erasmus University Medical Center, University Medical Center Rotterdam, PO Box 2040, 3000 CA, Rotterdam, The Netherlands
| | | | | | | | | | | | - Daphne Merkus
- Department of Cardiology (Thoraxcenter), Erasmus University Medical Center, University Medical Center Rotterdam, PO Box 2040, 3000 CA, Rotterdam, The Netherlands
| | | | | | | | | | - Dirk J Duncker
- Department of Cardiology (Thoraxcenter), Erasmus University Medical Center, University Medical Center Rotterdam, PO Box 2040, 3000 CA, Rotterdam, The Netherlands.
| | - Michael D Schneider
- National Heart and Lung Institute, Imperial College London, Du Cane Road, London, W12 0NN, UK.
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Abulmeaty MMA, Aljuraiban GS, Shaikh SM, ALEid NE, Mazrou LRA, Turjoman AA, Aldosari MS, Razak S, El-Sayed MM, Areabi TM, Alsalafi RM, Al-Helio YS, Almutairy AB, Molla HN. The Efficacy of Antioxidant Oral Supplements on the Progression of COVID-19 in Non-Critically Ill Patients: A Randomized Controlled Trial. Antioxidants (Basel) 2021; 10:804. [PMID: 34069549 PMCID: PMC8160844 DOI: 10.3390/antiox10050804] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2021] [Revised: 05/07/2021] [Accepted: 05/17/2021] [Indexed: 12/15/2022] Open
Abstract
Modulation of cytokine production using immunonutrition is a relatively novel concept to improve outcomes among patients with SARS-CoV-2 infection and is now hypothesized to help manage COVID-19, however, clinical evidence is lacking. This prospective, double-blinded, randomized parallel-controlled interventional clinical trial investigated the effect of antioxidant supplements on inflammatory cytokines and disease progression in non-critically ill patients. A total of 87 hospitalized COVID-19 patients were randomized using computer-generated-randomization into the supplement group (n = 18) and the placebo group (n = 16) for 10 days. Baseline and final nutritional screening via nutrition risk screening (NRS-2002) and subjective global assessment (SGA), as well as the recording of anthropometric, clinical, biochemical, and functional parameters, were done. Serum ferritin level, cytokine storm parameters such as interleukin-6 (IL-6), tumor necrosis factor-α (TNF-α), monocyte chemoattractant protein 1(MCP-1), C-reactive protein, total leukocyte count, lymphocytic count, and neutrophil-to-lymphocyte ratio were measured. Anthropometric and clinical parameters showed nonsignificant differences between groups. The hematology profile showed improvement in lymphocyte count in the supplement group. However, levels of alkaline phosphatase, IL-6, TNF-α, and MCP-1 were significantly lower in the supplement group. In conclusion, antioxidant oral supplementation significantly reduced the cytokine storm and led to partial improvements in clinical parameters among patients with non-critical COVID-19.
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Affiliation(s)
- Mahmoud M. A. Abulmeaty
- Department of Community Health Sciences, College of Applied Medical Sciences, King Saud University, Riyadh 11362, Saudi Arabia; (G.S.A.); (S.R.)
| | - Ghadeer S. Aljuraiban
- Department of Community Health Sciences, College of Applied Medical Sciences, King Saud University, Riyadh 11362, Saudi Arabia; (G.S.A.); (S.R.)
| | - Sumaya M. Shaikh
- Prince Mohamed Bin Abdulaziz Hospital, Riyadh 14214, Saudi Arabia; (S.M.S.); (N.E.A.); (L.R.A.M.); (A.A.T.); (T.M.A.); (R.M.A.); (Y.S.A.-H.); (A.B.A.)
| | - Naif E. ALEid
- Prince Mohamed Bin Abdulaziz Hospital, Riyadh 14214, Saudi Arabia; (S.M.S.); (N.E.A.); (L.R.A.M.); (A.A.T.); (T.M.A.); (R.M.A.); (Y.S.A.-H.); (A.B.A.)
| | - Lulwa R. Al Mazrou
- Prince Mohamed Bin Abdulaziz Hospital, Riyadh 14214, Saudi Arabia; (S.M.S.); (N.E.A.); (L.R.A.M.); (A.A.T.); (T.M.A.); (R.M.A.); (Y.S.A.-H.); (A.B.A.)
| | - Abdullah A. Turjoman
- Prince Mohamed Bin Abdulaziz Hospital, Riyadh 14214, Saudi Arabia; (S.M.S.); (N.E.A.); (L.R.A.M.); (A.A.T.); (T.M.A.); (R.M.A.); (Y.S.A.-H.); (A.B.A.)
| | - Mona S. Aldosari
- Clinical Nutrition Department, King Saud University Medical City, Riyadh 11472, Saudi Arabia; (M.S.A.); (H.N.M.)
| | - Suhail Razak
- Department of Community Health Sciences, College of Applied Medical Sciences, King Saud University, Riyadh 11362, Saudi Arabia; (G.S.A.); (S.R.)
| | - Mervat M. El-Sayed
- College of Food Sciences and Agriculture, King Saud University, Riyadh 11362, Saudi Arabia;
| | - Tahani M. Areabi
- Prince Mohamed Bin Abdulaziz Hospital, Riyadh 14214, Saudi Arabia; (S.M.S.); (N.E.A.); (L.R.A.M.); (A.A.T.); (T.M.A.); (R.M.A.); (Y.S.A.-H.); (A.B.A.)
| | - Rokia M. Alsalafi
- Prince Mohamed Bin Abdulaziz Hospital, Riyadh 14214, Saudi Arabia; (S.M.S.); (N.E.A.); (L.R.A.M.); (A.A.T.); (T.M.A.); (R.M.A.); (Y.S.A.-H.); (A.B.A.)
| | - Yasser S. Al-Helio
- Prince Mohamed Bin Abdulaziz Hospital, Riyadh 14214, Saudi Arabia; (S.M.S.); (N.E.A.); (L.R.A.M.); (A.A.T.); (T.M.A.); (R.M.A.); (Y.S.A.-H.); (A.B.A.)
| | - Abdulrhman B. Almutairy
- Prince Mohamed Bin Abdulaziz Hospital, Riyadh 14214, Saudi Arabia; (S.M.S.); (N.E.A.); (L.R.A.M.); (A.A.T.); (T.M.A.); (R.M.A.); (Y.S.A.-H.); (A.B.A.)
| | - Haneen N. Molla
- Clinical Nutrition Department, King Saud University Medical City, Riyadh 11472, Saudi Arabia; (M.S.A.); (H.N.M.)
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Yan B, Jiang Z, Yuan J, Li M, Zeng J, Tang J, Lu ZK, Ding H, Xia J, Wang Q, Wang J, Xie H, Li W, Zhang N, Li H, Sang X, Wu L, Xiong X, Tang S, Li Y, Tao M, Xie C, Yu S. Effects and safety of herbal medicines among community-dwelling residents during COVID-19 pandemic: A large prospective, randomized controlled trial (RCT). PHYTOMEDICINE : INTERNATIONAL JOURNAL OF PHYTOTHERAPY AND PHYTOPHARMACOLOGY 2021; 85:153403. [PMID: 33419674 PMCID: PMC7642754 DOI: 10.1016/j.phymed.2020.153403] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/16/2020] [Revised: 10/08/2020] [Accepted: 10/31/2020] [Indexed: 05/02/2023]
Abstract
BACKGROUND Since the declaration of COVID-19 as a global pandemic by the World Health Organization, countries are struggling with a shortage of medical capacities. It would be essential if the risk for preventable comorbidities, such as the common cold, can be reduced or prevented, so that the scarce medical resources and facilities can be focused on COVID-19. PURPOSE To evaluate the effects of two herbal medicines (Jinhaoartemisia antipyretic granules and Huoxiangzhengqi oral liquids) in reducing the risk of the common cold in community-dwelling residents in China during the COVID-19 outbreak. STUDY DESIGN A prospective open-label, parallel-group, cluster-randomized controlled trial (RCT), was conducted in Chengdu, China. METHODS A total of 22,065 participants from 11 communities were recruited during a period of one month. The trial started on 30 January and participants were followed up till 29 February 2020. Participants were randomly assigned to receive either a five-day herbal medicine therapy plus a reference manual or a reference manual only if they were allocated to the control group. The primary endpoint was the occurrence of patient-reported common cold symptoms. The secondary endpoint was the time in days from the receipt of herbal drugs/reference manual and the occurrence of the common cold symptoms. RESULTS Use of herbal medicine reduced the risk of the common cold by 89.6% (95% CI, 52.9% to 97.7%) in all community-dwelling residents, and by 94.0% (95% CI, 52.1% to 99.2%) in residents aged between 16 and 59 years old. Sensitivity analyses showed similar results. CONCLUSION This community-based RCT found that the use of a herbal medicine therapy (Jinhaoartemisia antipyretic granules and Huoxiangzhengqi oral liquids) could significantly reduce the risks of the common cold among community-dwelling residents, suggesting that herbal medicine may be a useful approach for public health intervention to minimize preventable morbidity during COVID-19 outbreak.
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Affiliation(s)
- Bohua Yan
- Hospital of Chengdu University of Traditional Chinese Medicine, Chengdu, China
| | - Zhiwei Jiang
- BeijingKeyTech Statistical Consulting Co. Ltd, Beijing, China
| | | | - Minghui Li
- University of Tennessee Health Science Center, Memphis, Tennessee, United States
| | - Jieping Zeng
- Hospital of Chengdu University of Traditional Chinese Medicine, Chengdu, China
| | - Jianyuan Tang
- Hospital of Chengdu University of Traditional Chinese Medicine, Chengdu, China.
| | - Z Kevin Lu
- University of South Carolina College of Pharmacy, Columbia, South Carolina, United States.
| | - Hong Ding
- Hospital of Chengdu University of Traditional Chinese Medicine, Chengdu, China
| | - Jielai Xia
- People's Liberation Army Air Force Military Medical University, Xi'an, China.
| | - Qiaoling Wang
- Hospital of Chengdu University of Traditional Chinese Medicine, Chengdu, China
| | - Jundong Wang
- Hospital of Chengdu University of Traditional Chinese Medicine, Chengdu, China
| | - Hongyan Xie
- Hospital of Chengdu University of Traditional Chinese Medicine, Chengdu, China
| | - Wenyuan Li
- Hospital of Chengdu University of Traditional Chinese Medicine, Chengdu, China
| | - Na Zhang
- Hospital of Chengdu University of Traditional Chinese Medicine, Chengdu, China
| | - Haiyan Li
- Hospital of Chengdu University of Traditional Chinese Medicine, Chengdu, China
| | - Xiaoya Sang
- Hospital of Chengdu University of Traditional Chinese Medicine, Chengdu, China
| | - Lina Wu
- Hospital of Chengdu University of Traditional Chinese Medicine, Chengdu, China
| | - Xiaomo Xiong
- University of South Carolina College of Pharmacy, Columbia, South Carolina, United States
| | - Shiyun Tang
- Hospital of Chengdu University of Traditional Chinese Medicine, Chengdu, China
| | - Yan Li
- Hospital of Chengdu University of Traditional Chinese Medicine, Chengdu, China
| | - Mengyao Tao
- Hospital of Chengdu University of Traditional Chinese Medicine, Chengdu, China
| | - Chunguang Xie
- Hospital of Chengdu University of Traditional Chinese Medicine, Chengdu, China.
| | - Shuguang Yu
- Chengdu University of Traditional Chinese Medicine, Chengdu, China.
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50
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Potter H, Woodcock JH, Boyd TD, Coughlan CM, O'Shaughnessy JR, Borges MT, Thaker AA, Raj BA, Adamszuk K, Scott D, Adame V, Anton P, Chial HJ, Gray H, Daniels J, Stocker ME, Sillau SH. Safety and efficacy of sargramostim (GM-CSF) in the treatment of Alzheimer's disease. ALZHEIMER'S & DEMENTIA (NEW YORK, N. Y.) 2021; 7:e12158. [PMID: 33778150 PMCID: PMC7988877 DOI: 10.1002/trc2.12158] [Citation(s) in RCA: 35] [Impact Index Per Article: 11.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/20/2021] [Accepted: 02/05/2021] [Indexed: 02/06/2023]
Abstract
INTRODUCTION Inflammatory markers have long been observed in the brain, cerebrospinal fluid (CSF), and plasma of Alzheimer's disease (AD) patients, suggesting that inflammation contributes to AD and might be a therapeutic target. However, non-steroidal anti-inflammatory drug trials in AD and mild cognitive impairment (MCI) failed to show benefit. Our previous work seeking to understand why people with the inflammatory disease rheumatoid arthritis are protected from AD found that short-term treatment of transgenic AD mice with the pro-inflammatory cytokine granulocyte-macrophage colony-stimulating factor (GM-CSF) led to an increase in activated microglia, a 50% reduction in amyloid load, an increase in synaptic area, and improvement in spatial memory to normal. These results called into question the consensus view that inflammation is solely detrimental in AD. Here, we tested our hypothesis that modulation of the innate immune system might similarly be used to treat AD in humans by investigating the ability of GM-CSF/sargramostim to safely ameliorate AD symptoms/pathology. METHODS A randomized, double-blind, placebo-controlled trial was conducted in mild-to-moderate AD participants (NCT01409915). Treatments (20 participants/group) occurred 5 days/week for 3 weeks plus two follow-up (FU) visits (FU1 at 45 days and FU2 at 90 days) with neurological, neuropsychological, blood biomarker, and imaging assessments. RESULTS Sargramostim treatment expectedly changed innate immune system markers, with no drug-related serious adverse events or amyloid-related imaging abnormalities. At end of treatment (EOT), the Mini-Mental State Examination score of the sargramostim group increased compared to baseline (P = .0074) and compared to placebo (P = .0370); the treatment effect persisted at FU1 (P = .0272). Plasma markers of amyloid beta (Aβ40 [decreased in AD]) increased 10% (P = .0105); plasma markers of neurodegeneration (total tau and UCH-L1) decreased 24% (P = .0174) and 42% (P = .0019), respectively, after sargramostim treatment compared to placebo. DISCUSSION The innate immune system is a viable target for therapeutic intervention in AD. An extended treatment trial testing the long-term safety and efficacy of GM-CSF/sargramostim in AD is warranted.
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Affiliation(s)
- Huntington Potter
- Department of NeurologyUniversity of Colorado School of MedicineAuroraColoradoUSA
- University of Colorado Alzheimer's and Cognition CenterAuroraColoradoUSA
- Linda Crnic Institute for Down SyndromeUniversity of Colorado School of MedicineAuroraColoradoUSA
| | - Jonathan H. Woodcock
- Department of NeurologyUniversity of Colorado School of MedicineAuroraColoradoUSA
- University of Colorado Alzheimer's and Cognition CenterAuroraColoradoUSA
| | - Timothy D. Boyd
- University of Colorado Alzheimer's and Cognition CenterAuroraColoradoUSA
- Linda Crnic Institute for Down SyndromeUniversity of Colorado School of MedicineAuroraColoradoUSA
| | - Christina M. Coughlan
- Department of NeurologyUniversity of Colorado School of MedicineAuroraColoradoUSA
- University of Colorado Alzheimer's and Cognition CenterAuroraColoradoUSA
- Linda Crnic Institute for Down SyndromeUniversity of Colorado School of MedicineAuroraColoradoUSA
| | - John R. O'Shaughnessy
- Department of NeurologyUniversity of Colorado School of MedicineAuroraColoradoUSA
- University of Colorado Alzheimer's and Cognition CenterAuroraColoradoUSA
| | - Manuel T. Borges
- Department of NeurologyUniversity of Colorado School of MedicineAuroraColoradoUSA
- Department of RadiologyUniversity of Colorado School of MedicineAuroraColoradoUSA
| | - Ashesh A. Thaker
- Department of NeurologyUniversity of Colorado School of MedicineAuroraColoradoUSA
- Department of RadiologyUniversity of Colorado School of MedicineAuroraColoradoUSA
| | | | | | | | - Vanesa Adame
- University of Colorado Alzheimer's and Cognition CenterAuroraColoradoUSA
- Linda Crnic Institute for Down SyndromeUniversity of Colorado School of MedicineAuroraColoradoUSA
| | - Paige Anton
- University of Colorado Alzheimer's and Cognition CenterAuroraColoradoUSA
- Linda Crnic Institute for Down SyndromeUniversity of Colorado School of MedicineAuroraColoradoUSA
| | - Heidi J. Chial
- Department of NeurologyUniversity of Colorado School of MedicineAuroraColoradoUSA
- University of Colorado Alzheimer's and Cognition CenterAuroraColoradoUSA
- Linda Crnic Institute for Down SyndromeUniversity of Colorado School of MedicineAuroraColoradoUSA
| | - Helen Gray
- Department of NeurologyUniversity of Colorado School of MedicineAuroraColoradoUSA
- University of Colorado Alzheimer's and Cognition CenterAuroraColoradoUSA
| | - Joseph Daniels
- Department of NeurologyUniversity of Colorado School of MedicineAuroraColoradoUSA
- University of Colorado Alzheimer's and Cognition CenterAuroraColoradoUSA
| | - Michelle E. Stocker
- Department of NeurologyUniversity of Colorado School of MedicineAuroraColoradoUSA
- University of Colorado Alzheimer's and Cognition CenterAuroraColoradoUSA
| | - Stefan H. Sillau
- Department of NeurologyUniversity of Colorado School of MedicineAuroraColoradoUSA
- University of Colorado Alzheimer's and Cognition CenterAuroraColoradoUSA
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