CONSORT 2010 explanation and elaboration: updated guidelines for reporting parallel group randomised trials

Exploring computational thinking, executive functions, visuospatial skills and experiences with toys in early childhood: Protocol for a controlled trial

The research aims to evaluate the effect of a robotics-based computational thinking program on executive functions and visuospatial skills in preschool children. Additionally, the study will explore the relationship between these three variables and early experiences with toys. The study will be a cluster-randomized controlled trial with pre- and post-intervention measures. Participants will be preschool children aged 5 to 6 years from both public and private institutions. The intervention will involve a new educational robotics device called ROVERSA and will consist of eight sessions distributed over four weeks, with the experimental group placed on a waitlist. To assess executive functions and visuospatial skills, standardized and validated neuropsychological measures will be used, including the Flanker task, the NIH Toolbox Card Sorting Test, the Corsi Block Test, the NEPSY-II Mental Rotation Test, the Pyramid of Mexico from the ENI-2 battery, and the Computational Thinking Test (CTt). Data analysis will begin with a hypothesis tested through ANOVA-MR, and linear regressions will be implemented to assess the relationship between variables. It is expected that the results will contribute to the discussion on teaching computational thinking and educational robotics as early learning experiences and their impact on the cognitive development of children.

Randomized trials evaluating volar locking plates against casting of distal radius fractures are statistically fragile: A systematic review

Introduction

Despite randomized controlled trials (RCTs) largely supporting volar locking plates (VLPs) for the management of distal radius fractures (DRFs), surgeons often opt for non-invasive interventions such as casting. This study used the fragility index (FI), reverse fragility index (rFI), and fragility quotient (FQ) to assess the statistical robustness of RCTs assessing the efficacy of VLP in DRF management.

Methods

PubMed, Embase, and MEDLINE were queried for RCTs evaluating VLP versus casting for DRFs published from January 1st, 2000-June 30, 2024. FI and rFI were quantified for all dichotomous outcomes, and represent the number of event reversals required to alter statistical significance or non-significance, respectively. The FQ was then determined by dividing the FI or rFI by the sample size. A subanalysis was performed for outcomes pertaining to patient satisfaction, healing/function, and adverse events.

Results

A total of 699 RCTs were identified in the initial literature search. 13 RCTs were eventually included in the final analysis, yielding 36 dichotomous outcomes. The median FI across these outcomes was 3 (IQR 3-5) and the median FQ was 0.037 (IQR 0.014-0.067). Among the 15 significant outcomes, the median FI was 2 (IQR 2-4) and the median FQ was 0.029 (IQR 0.013-0.055). The remaining 21 non-significant outcomes yielded a median rFI of 4 (IQR 2-5) and a median FQ of 0.042 (IQR 0.021-0.091). The most statistically fragile outcome category was patient satisfaction, with a median FI of 2 (IQR 2-3.5) and median FQ of 0.016 (IQR 0.013-0.030). Among 21 of the included outcomes (58.3 %), the number of patients lost to follow up exceeded the respective FI or rFI.

Conclusion

A statistical fragility analysis of VLP versus casting for DRFs demonstrated fragile outcomes, reporting a median FQ of 0.037, or 3.7 %. Statistically significant outcomes and patient satisfaction results were particularly fragile, and large losses to follow up were found to be an important contributor to RCT fragility. Although VLP is largely recommended by level I evidence, its superiority may not be as ubiquitous as argued by contemporary literature.

Comparing the efficacy of two E-learning programs on physiotherapists' knowledge, attitudes, and confidence in musculoskeletal pain management: A randomized trial

BACKGROUND

Physiotherapists play a crucial role in managing patients with musculoskeletal pain. However, their training often lacks focus on pain management.

OBJECTIVES

This randomized controlled trial evaluated the effects of two e-learning programs on physiotherapists' knowledge, attitudes, and confidence in musculoskeletal pain management.

METHODS

Eligible participants had active professional registration, treated patients with musculoskeletal pain, and had internet access. Participants were randomized into two groups (video-based and booklet-based), with interventions lasting 5 weeks. Assessments were conducted at baseline, 6 weeks (T1), and 12 weeks (T2) using the Neurophysiology of Pain Questionnaire, a pain attitude survey, and self-reported confidence.

RESULTS

A total of 211 physiotherapists were randomized (video = 106; booklet = 105). Both groups improved pain neurophysiology knowledge, with the booklet group scoring higher at T1 (adjusted mean difference = 1.25, 95%CI = 0.93 to 1.58) and T2 (adjusted mean difference = 1.30, 95%CI = 0.97 to 1.63). Attitudes varied: the booklet group improved in emotion (adjusted mean difference = -0.19, 95%CI = -0.35 to -0.03) and control (adjusted mean difference = -0.20, 95%CI = -0.37 to -0.03) at T2, while the video group improved in solicitude (adjusted mean difference = -0.37, 95% CI: 0.55 to -0.19) and disability at T1 and T2. No significant effects were found in the medical cure domain, and no interaction effects were observed in the physical harm domain. Confidence increased in both groups, with no between-group differences.

CONCLUSION

Both e-learning programs effectively enhanced physiotherapists' knowledge, attitudes, and confidence in musculoskeletal pain management, demonstrating the value of e-learning for continuing education.

How many doses and what type of antibiotic should be used as systemic antibiotic prophylaxis in primary hip and knee arthroplasty? A register-based study on 301,204 primary total and hemi- hip and total knee arthroplasties in Norway 2005-2023

BACKGROUND AND PURPOSE

 Guidelines for systemic antibiotic prophylaxis (SAP) in arthroplasty surgery vary worldwide from repeated doses to only 1 preoperatively. We aimed to investigate, primarily whether 4 doses reduced the risk of PJI compared with 1 to 3 doses, and secondarily if there was a difference between types of antibiotics.

METHODS

 Patients reported to the Norwegian Arthroplasty Register and the Norwegian Hip Fracture Register with primary total knee (TKA), total (THA) or hemi- (HA) hip arthroplasty between 2005 and 2023 were included. Cases with 1 to 4 doses of cefalotin (half-life = 45 minutes), cefazolin (90 minutes), cefuroxime (70 minutes), cloxacillin (30 minutes), or clindamycin (180 minutes) were assessed. Primary outcome was 1-year risk of reoperation (adjusted hazard rate ratio; aHRR) for PJI and was estimated by Cox regression analyses. Secondary outcomes were reoperation for PJI and reoperation for any cause with follow-up of up to 19 years. Non-inferiority analyses and propensity score matching with subsequent Kaplan-Meier analyses were performed with a predetermined non-inferiority margin of 15% (aHRR = 1.15).

RESULTS

 301,204 cases were included. Of these, 3,388 (1.1%) were reoperated on for PJI within 1 year. The 1-year incidence of reoperation for PJI was 98/9,760 (1.0%) for 1 dose of SAP, 109/10,956 (0.9%) for 2 doses, 178/18,948 (0.9 %) for 3 doses, and 3,003/261,540 (1.0%) for 4 doses. The 1-year risk (aHRR, 95% confidence interval [CI]) of reoperation for PJI was 1.0 (CI 0.8-1.2), 0.9 (CI 0.8-1.2), and 0.9 (CI 0.9-1.1) for 1, 2, and 3 doses, respectively, compared with 4 doses. The 1-year incidence of reoperation for PJI was 2,162/183,964 (1.2%) for cefalotin, 993/91,159 (1.1%) for cefazolin, 35/4,435 (0.8%) for cefuroxime, 85/9,022 (0.9%) for cloxacillin, and 113/12,624 (0.9%) for clindamycin. Compared with cefazolin, cloxacillin (1.2, CI 1.0-1.6) and cefalotin (1.4, CI 1.2-1.5) had a higher risk of reoperation for PJI, whereas cefuroxime (1.0, CI 0.7-1.4) and clindamycin (1.1, CI 0.9-1.3) had a similar risk.

CONCLUSION

 4 doses of SAP did not reduce the risk of PJI compared with 1 to 3 doses in primary arthroplasty as measured against PJI. Cefazolin, the 1st-generation cephalosporin with the longest half-life, showed the lowest risk of PJI.

Randomized clinical trial (RCT): An overview

•Randomized Clinical Trials (RCTs) are the gold standard for human experimental studies.•RCTs demand equipoise and freedom from treatment preference among investigators.•Neurologic RCTs are costly, time-intensive, and have high participant exclusion rates.•RCTs use randomization to minimize bias/ confounding and test with probability statistical theory the treatment effects.•The CONSORT guidelines enhance the quality of RCT reporting.

Impact of sodium-glucose cotransporter 2 inhibitors on catheter ablation for atrial fibrillation in heart failure patients without type-2 diabetes

BACKGROUND

Sodium-glucose cotransporter 2 inhibitors (SGLT2is) reportedly decreased the new-onset atrial arrhythmias in patients with type-2 diabetes (T2DM) or heart failure (HF). This study examined the impact of SGLT2is on catheter ablation for atrial fibrillation (AF) in HF patients without T2DM.

METHODS

Persistent AF (PeAF) and HF (N-terminal prohormone of brain natriuretic peptide, NT-proBNP ≥400 pg/ml) patients without T2DM undergoing catheter ablation were prospectively enrolled (n = 102). SGLT2is were prescribed from ≥1 month prior to the procedure and were continued during the follow-up in 51 patients (SGLT2i[+]) but not prescribed in 51 patients (SGLT2i[-]). Left atrial pressure (LAP) was measured via the sheath placed in the LA before starting catheter ablation. The event-free rate of early and 1-year atrial-arrhythmia recurrence were compared between SGLT2i[+] and SGLT2i[-].

RESULTS

There was no significant difference in baseline characteristics between SGLT2i[+] and SGLT2i[-]. SGLT2i[+] significantly decreased average LAP compared to SGLT2i[-] (9.3 ± 4.8 mmHg vs. 12.1 ± 6.6 mmHg, p < 0.01); normalized LAP to systemic blood pressure also decreased in SGLT2i[+] (0.11 ± 0.05 vs. 0.15 ± 0.07, p < 0.01). The serum NT-proBNP levels at the enrollment were unchanged between the two groups but SGLT2i[+] had lower values on the day of catheter ablation (p = 0.06) and at 1 month after the procedure (p < 0.01) than SGLT2i[-]. SGLT2i[+] had significantly higher event-free rate of early (92 % vs. 60 %, p < 0.01) and 1-year (89 % vs. 75 %, p < 0.05) atrial-arrhythmia recurrence than SGLT2i[-].

CONCLUSION

Periprocedural SGLT2i treatment decreased LAP and improved the outcomes of catheter ablation for PeAF in HF patients without T2DM.

Fast-tracking ERCP learning with the Boškoski-Costamagna Trainer: results of a multicenter randomized clinical trial

BACKGROUND

Achieving competence in endoscopic retrograde cholangiopancreatography (ERCP) requires extensive training. Recognizing the potential of simulator-based education for safe and effective skill development, we aimed to assess whether initial training with the Boškoski-Costamagna ERCP Trainer (BCT) is beneficial compared with conventional training alone (i.e. predictive validity).

METHODS

A prospective multicenter randomized trial involving 16 novice ERCP trainees, randomly assigned to intervention or control groups, was performed. Both underwent hands-on training, with the intervention group receiving additional simulation training during the first 3 months. Each trainee was required to complete a minimum of 60 ERCPs in up to 1 year. The TEESAT score evaluated rates of global overall competence (primary outcome), biliary cannulation, and adverse events (AEs; secondary outcomes). Mixed-effect logistic regression models assessed differences in between-group ERCP procedure competence and success. Learning curves were generated cumulatively over the training period.

RESULTS

1106 ERCPs (562 simulator group; 544 control group) were included. Although no statistically significant difference in global overall competence was observed between the groups, possibly owing to data heterogeneity, simulation training demonstrated higher success for native biliary cannulation (52% vs. 42%; P<0.001) and faster median (interquartile range) biliary cannulation times (3 [6] vs. 5 [8] minutes; P<0.001). The simulator group also showed faster improvements in overall performance, native biliary cannulation, and sphincterotomy. No statistical difference was found in overall AEs between the groups.

CONCLUSION

Early simulation training with the BCT improved technical competence in native biliary cannulation and accelerated overall ERCP learning. This approach has the potential to enhance ERCP training programs.

Metformin for low back pain: Study protocol for a randomised, double-blind, placebo-controlled trial

Background

Chronic low back pain is a major cause of pain and disability with limited effective therapies. Metformin is a safe, inexpensive, well-tolerated drug that has pleotropic effects, including effects on pain pathways that may influence low back pain. The aim of this randomised, double-blind, placebo-controlled trial is to determine whether metformin reduces low back pain over 4 months in individuals with chronic low back pain.

Methods and analysis

One hundred and twenty-three participants with chronic low back pain will be recruited from the community in Melbourne, Australia, and randomly allocated in a 1:1 ratio to receive either metformin 2g or identical placebo daily for 4 months. The primary outcome will be change in pain intensity assessed using a 100 ​mm visual analogue scale at 4 months and the secondary outcomes will be change in low back disability, physical activity and narcotic use. Adverse events will be recorded. The primary analysis will be by intention to treat.

Discussion

Given the societal burden of LBP and the limited effective treatment options available, this study that evaluates the efficacy of metformin in LBP, if proves to be effective, will offer an important therapeutic approach for this disabling condition.

Ethics and dissemination

Ethics approval has been obtained from the Alfred Hospital Ethics Committee (392/21) and Monash University Human Research Ethics Committee (30607). Written informed consent will be obtained from all the participants. The findings will be disseminated through peer-review publications and conference presentations.

Trial registration

Australian New Zealand Clinical Trials Registry, ACTRN12621001453875 (registered 25th October 2021).

Effectiveness of an Exercise Therapy Program Based on Sports in Adults With Acquired Brain Injury: A Randomized Controlled Trial

OBJECTIVE

To examine the effects of a sport-based exercise therapy (ET) program combined with usual care (sET+UC) compared with usual care (UC) alone on health-related quality of life, upper limb motor control, functional capacity, mobility, balance, and physical activity participation in ambulant adults with acquired brain injury (ABI).

DESIGN

Single-blind, parallel-group, randomized controlled trial.

SETTING

Rehabilitation center.

PARTICIPANTS

Twenty-three adults with ABI (82.6% stroke; 17 men; mean age of 59.6±10.3y).

INTERVENTION

Participants received either sET+UC (n=11) or UC (n=12). The sET+UC group received sixteen 60-minute sessions of a sport-based ET program in addition to sixteen 60-minute sessions of UC, whereas the UC group attended UC only.

MAIN OUTCOME MEASURES

Primary outcome measures were health-related quality of life (Short Form-36 [SF-36]) and upper limb motor control (Fugl-Meyer Upper Extremity [FM-UE]), whereas the secondary included functional capacity (6-minute walk test and 10-meter walk test), mobility (timed Up and Go Test), balance (Berg Balance Scale), and physical activity participation (Global Physical Activity Questionnaire).

RESULTS

Significant differences were found in all outcome analyses at postintervention when comparing between groups. The sET+UC group showed significant improvements in both the physical (P=.027, r=.46) and mental component summary (P=.001, r=.71) of the SF-36 as well as FM-UE (P=.004, r=.60), with large effect sizes. In turn, all secondary outcomes were also significantly improved in this group (all P<.05 r>.05). In contrast, the UC group showed slight improvements in postintervention scores but did not reach significance in any of these measures.

CONCLUSIONS

This study shows that a sport-based ET program combined with UC can effectively improve all the aforementioned outcomes measures in ABI population. Further research with larger sample sizes and follow-up assessments is crucial to gain a more comprehensive understanding of the long-term effects of the intervention in this specific population.

SPIRIT-CONSORT-TM: a corpus for assessing transparency of clinical trial protocol and results publications

Randomized controlled trials (RCTs) can produce valid estimates of the benefits and harms of therapeutic interventions. However, incomplete reporting can undermine the validity of their conclusions. Reporting guidelines, such as SPIRIT for protocols and CONSORT for results, have been developed to improve transparency in RCT publications. In this study, we report a corpus of 200 RCT publications, named SPIRIT-CONSORT-TM, annotated for transparency. We used a comprehensive data model that includes 83 items from SPIRIT and CONSORT checklists for annotation. Inter-annotator agreement was calculated for 30 pairs. The dataset includes 26,613 sentences annotated with checklist items and 4,231 terms. We also trained natural language processing (NLP) models that automatically identify these items in publications. The sentence classification model achieved 0.742 micro-F1 score (0.865 at the article level). The term extraction model yielded 0.545 and 0.663 micro-F1 score in strict and lenient evaluation, respectively. The corpus serves as a benchmark to train models that assist stakeholders of clinical research in maintaining high reporting standards and synthesizing information on study rigor and conduct.

Outcomes from the Victorian Healthy Homes Program: a randomised control trial of home energy upgrades

OBJECTIVES

The Victorian Healthy Homes Program investigated the impact of thermal home upgrades on energy and health outcomes in vulnerable, older individuals over winter in Victoria, Australia.

DESIGN

A staggered parallel-group randomised control trial design of 984 (764 per protocol (PP)) vulnerable households and 1313 (1015 PP) individuals. The intervention group received their upgrade prior to their winter of recruitment, and the control group received their upgrade after the winter of their recruitment.

SETTING

Western Melbourne (metropolitan) and the Goulburn Valley (regional) in Victoria, Australia.

PARTICIPANTS

1000 households were recruited: 800 from western Melbourne (metropolitan) and 200 from the Goulburn Valley (regional).

INTERVENTION

A thermal comfort and home energy efficiency upgrade of up to $AUD3500 per household.

PRIMARY AND SECONDARY OUTCOME MEASURES

The primary outcome was the change in indoor temperature over winter and the secondary outcomes were changes in quality of life, healthcare use and costs, self-reported health measures, energy use and costs and humidity.

RESULTS

A relatively low-cost and simple home upgrade (average cost $A2809) resulted in reduced gas consumption (-25.5 MJ/day) and increased indoor winter temperatures (average daily increase of 0.33°C), and a reduction of exposure to cold conditions (<18°C) by an average of 0.71 hours (43 min) per day. The intervention group experienced improved mental health as measured by the short-form 36 mental component summary and social care related quality of life measured by the Adult Social Care Outcomes Toolkit, less breathlessness and lower overall healthcare costs (an average of $A887 per person) over the winter period.

CONCLUSIONS

The home upgrades significantly increased average winter indoor temperature, improved mental health and social care-related quality of life and made householders more comfortable while yielding reductions in overall healthcare use and costs.

TRIAL REGISTRATION NUMBER

Australian and New Zealand Clinical Trials Registry: ACTRN12618000160235.

Physical activity calorie equivalent (PACE) food labelling on discretionary foods in secondary school canteens in England: an efficacy cluster randomised controlled trial

BACKGROUND

Schools do not typically implement food labelling in their canteens, therefore young people may not be given nutrition information on which to make their food choices. One way of expressing the energy/calorie content of foods is to provide this information in the form of physical activity calorie equivalent (PACE) food labelling, which may help to contextualise the energy content of food/drinks to young people in a simple and understandable way. The study aimed to assess the usefulness of implementing PACE labelling in school canteens and to conduct a process evaluation of using this type of food labelling with young people.

METHODS

A parallel two-armed cluster RCT to evaluate a PACE labelling intervention in secondary schools (typically, adolescents aged 11 and above) in England was conducted. Schools were randomised on a 2:1 basis to display PACE labelling by cakes/sweet biscuits in canteens or to continue with usual practice (comparator) for up to six weeks. There was a baseline period of no PACE labelling for a minimum of four weeks in all schools. Anonymised purchase data were provided by schools and analysed both descriptively and using analysis of covariance.

RESULTS

Eighteen schools in England were randomised and 11 participated (6 intervention and 5 comparators). Analyses are based on ~ 99,000 purchase transactions of cakes and biscuits from participating schools. There was a reduction in cake/biscuit purchases in intervention schools versus comparators of ~ 11 items per week per 100 students at follow-up (adjusted mean difference = -0.112, 95% CI [-0.179 to -0.045], p = 0.005). Intervention schools did not report major difficulties with the implementation of PACE labelling.

CONCLUSIONS

PACE labelling appeared to reduce cakes/biscuit purchases by a small amount and may be a useful approach to reducing the purchase of discretionary foods in young people in the school environment. The implementation of PACE labelling appeared feasible for some schools, but other schools had reservations about the adverse effects this type of labelling may have on the well-being of students.

TRIAL REGISTRATION

Registered on ClinicalTrials.gov on 18th November 2022. NCT05623618, https://clinicaltrials.gov/study/NCT05623618 .

Effectiveness of reducing tendon compression in the rehabilitation of insertional Achilles tendinopathy: a randomised clinical trial

OBJECTIVE

To assess the effectiveness of low tendon compression rehabilitation (LTCR) versus high tendon compression rehabilitation (HTCR) for treating patients with insertional Achilles tendinopathy.

METHODS

In an investigator-blinded, stratified randomised trial, 42 sport-active patients (30 males and 12 females; age 45.8±8.2 years) with chronic (> 3 months) insertional Achilles tendinopathy were allocated in a 1:1 ratio to receive LTCR or HTCR. Both rehabilitation protocols consisted of a progressive 4-stage tendon-loading programme, including isometric, isotonic, energy-storage and release and sport-specific exercises. The LTCR programme was designed to control Achilles tendon compression by limiting ankle dorsiflexion during exercise, eliminating calf stretching and incorporating heel lifts. The primary outcome was the Victorian Institute of Sports Assessment-Achilles (VISA-A) score at 12 and 24 weeks, which measures tendon pain and function and was analysed on an intention-to-treat basis using a linear mixed model. Significance was accepted when p<0.05.

RESULTS

20 patients were randomised to the LTCR group and 22 to the HTCR group. Improvement in VISA-A score was significantly greater for LTCR compared with HTCR after 12 weeks (LTCR=24.4; HTCR=12.2; mean between-group difference=12.9 (95% CI: 6.2 to 19.6); p<0.001) and after 24 weeks (LTCR=29.0; HTCR=19.3; mean between-group difference=10.4 (95% CI: 3.7 to 17.1); p<0.001). These differences exceeded the minimal clinically important difference of 10.

CONCLUSIONS

In sport-active patients with insertional Achilles tendinopathy, LTCR was more effective than HTCR in improving tendon pain and function at 12 and 24 weeks. Consequently, LTCR should be considered in the treatment of insertional Achilles tendinopathy.

TRIAL REGISTRATION NUMBER

ClinicalTrials.gov (ID: NCT05456620).

The short-term effects of full-mouth or quadrant-wise applied subgingival instrumentation on immune response and oxidation process in saliva: a randomized clinical trial

AIM

To evaluate oxidation and antioxidant activity in the saliva of periodontitis patients following non-surgical periodontal therapy applied either as full mouth subgingival instrumentation (FM) or quadrantwise (Q).

METHODS

Patients affected by periodontitis were randomly allocated to receive FM or Q and followed up at 1st and 3rd months. Saliva samples and periodontal variables were collected at baseline, 1st, and 3rd month. The primary outcomes were the total antioxidant status (TAS), total oxidant status (TOS). Secondary outcomes were clinical measurements, Tumour Necrosis Factor alpha (TNF alpha), and Oxidative Stress Index (OSI) parameters.

RESULTS

Forty-five subjects were included in the study. Both FM and Q resulted reductions in all periodontal variables, TNF alpha and TOS values, with an improvement in TAS values compared to baseline. Significant differences were observed in the reductions of probing pocket depth (PPD) and clinical attachment level (CAL) between the FM group and the Q group as periodontal variables (p < 0.05). The change in TNF alpha (ng/L) and TAS (mmol Trolox Eq/L) from baseline to post treatment significantly improved in FM group compared to Q.

CONCLUSION

Both treatment protocols were efficient in the treatment of periodontitis but the FM therapy significantly reduced periodontal tissue inflammation, as evidenced by changes in both clinical and biochemical parameters in our study. However, it may be seen that FM therapy is more effective during short-term recovery, maybe the reason could be attributed to TAS and TNF alpha changes following FM therapy.

TRIAL REGISTRATION

This study was registered at Thai Clinical Trials Registry. ( https://www.thaiclinicaltrials.org/show/TCTR20240416007 , TCTR ID: TCTR20240416007; date of registration: 16 April 2024)-retrospectively registered).

A structured, home-based exercise programme in kidney transplant recipients (ECSERT): A randomised controlled feasibility study

BACKGROUND

Cardiometabolic diseases are a major cause of morbidity and mortality in kidney transplant recipients (KTR) due to clustering of traditional and non-traditional risk factors including poor physical fitness and physical inactivity. Exercise may mitigate the risk of these diseases in this population but evidence is limited, and physical activity levels are low. The ECSERT randomised controlled trial assessed the feasibility of delivering a structured, home-based exercise intervention in KTR at increased cardiometabolic risk.

METHODS

Fifty KTR (>1-year post-transplant) were randomised 1:1 to: intervention (INT: a 12-week home-based combined aerobic and resistance exercise programme) or control (CTR: guideline-directed care). The a-priori thresholds for feasibility were: recruitment of 20% of eligible participants (≥2 participants per month); adherence (an average of ≥ 3 exercise sessions per week); and attrition (≤30%).

RESULTS

One hundred and seventy-one patients were screened and 94 (55%) were eligible and invited to take part in the study. Fifty of those invited (53%) were recruited across 22 months of recruitment. Consented participant characteristics were: age 50 ± 14 years (INT 49 ± 13; CTR 51 ± 15), 23 male (INT 10; CTR 13), eGFR 59 ± 19 ml/min/1.73m2 (INT 60 ± 20; CTR 61 ± 21), 35 White British (WB), 13 South Asian (SA), 1 Caribbean, and 1 Mixed ethnicity (INT 17 WB, 7 SA, 1 Mixed; CTR 18 WB, 6 SA, 1 Caribbean). Intervention participants (n = 22 completed) recorded an average of 4.4 ± 1.4 exercise sessions per week (aerobic 2.8 ± 1.1; strength 1.6 ± 0.5). Three participants withdrew from the intervention group (1 COVID-19 infection, 1 recurrent urine infections unrelated to the trial, 1 time/family circumstances) and one from the control group (lost to follow-up; 8% attrition). There were no serious adverse events reported.

CONCLUSION

Despite previous evidence showing physical fitness and activity levels are low in KTR, the present results support that a structured, home-based exercise programme is feasible in this population. Specifically, a-priory recruitment, adherence, and retention thresholds were all exceeded. The groups were well matched and there was encouraging representation of female participants and participants from a non-white background. Thus, this study supports further development and testing of home-based programmes of exercise and activity for KTR.

TRIAL REGISTRATION

ClinicalTrials.gov NCT04123951.

Effect of adaptive variable-resistance training on chemotherapy-induced sarcopenia, fatigue, and functional restriction in pediatric survivors of acute lymphoblastic leukemia: a prospective randomized controlled trial

PURPOSE

With the rising survival rate among children and adolescents with acute lymphoblastic leukemia (ALL), prioritizing patient-centered care to address the long-term effects of chemotherapy through tailored rehabilitation interventions is essential for optimizing their quality of life. The purpose of this study was to investigate the impact of an 8-week intervention using adaptive variable-resistance training (Adaptive-VRT) on chemotherapy-induced sarcopenia, fatigue, and functional restrictions in pediatric survivors of ALL.

METHODS

A prospective randomized controlled trial included a total of 62 survivors of ALL, aged 12-18 years, and completed maintenance chemotherapy. Participants were randomized into two groups: the Adaptive-VRT group (n = 31), assigned the Adaptive-VRT intervention, and the control group (n = 31), which adhered to the standard exercise protocol. Baseline and post-intervention measurements were undertaken to analyze sarcopenia-related variables (i.e., muscle thickness and muscle strength), fatigue, and functional performance.

RESULTS

The Adaptive-VRT group exhibited more favorable changes in muscle thickness [thigh thickness (P < .001; η2P = 0.32); rectus femoris (P < .001; η2P = 0.21); vastus intermedius (P = .002; η2P = 0.15)], and peak concentric torque of quadriceps [at speed of 90°/s (P = .005; η2P = 0.13), 120°/s (P = .021; η2P = 0.10), or 180°/s (P = .008; η2P = 0.11)] in comparison with the control group. Additionally, the Adaptive-VRT group reported lower fatigue levels (P = .031; η2P = 0.08) and demonstrated better functional performance [6-min walk test (P < .001; η2P = 0.25), 4 × 10-m shuttle running test (P < .001; η2P = 0.24), as well as timed up and down stairs (P < .0006; η2P = 0.18)].

CONCLUSION

The findings suggest that Adaptive-VRT is a promising intervention for ameliorating chemotherapy-induced sarcopenia, fatigue, and functional limitations in pediatric ALL survivors.

TRIAL REGISTRATION

ClinicalTrials.gov Identifier: NCT06338020.

Effect of water-based aerobic training on anthropometric, biochemical, cardiovascular, and explosive strength parameters in young overweight and obese women: a randomized controlled trial

Background

Obesity is a major health concern that raises the risk of chronic illnesses such as heart disease, diabetes, and metabolic disorders. Traditional workouts such as running or walking can be difficult for overweight individuals due to the heavy impact on joints, which causes discomfort and the possibility of injury. Water-based exercises offer a low-impact alternative that overweight people may find more tolerable. There is minimal research on the specific effects of structured water aerobic exercise on health markers in young overweight and obese women, despite the acknowledged benefits of physical activity for weight control and overall health. This study aimed to assess the effects of 10-week water-based aerobic training (thrice a week) on anthropometric, biochemical, cardiovascular parameters, and explosive strength in young overweight and obese women.

Methods

In a randomized controlled trial with a pre-to-post testing design, twenty-seven young overweight and obese women (age: 27 ± 1 years; body mass index (BMI) = 30.0 ± 3.1) were randomly assigned into experimental (EG: performing a water-based aerobic training, n = 16) or control (CG: maintaining their usual activities during the intervention, n = 11) groups. The pre- and post-intervention participants were assessed for their anthropometrics (body height, body weight, body mass index (BMI), body fat and circumferences), biochemical (fasting glycemia, total cholesterol, high-density lipoprotein cholesterol (HDL-C), low-density lipoprotein cholesterol (LDL-C) and triglyceride (TG)), cardiovascular parameters (resting blood pressure and resting heart rate (RHR)), and explosive strength of upper and lower limbs.

Results

EG showed reductions in body weight, BMI, %BF, fasting glycemia, and TG, along with improvements in HDL-C, LDL-C, RHR, and explosive strength (all p < 0.05; effect size (ES) = 0.180-1.512, trivial to large). In contrast, CG exhibited increases in body weight, BMI, fasting glycemia, LDL-C, and RHR (all p < 0.05; ES = 0.127-0.993, trivial to large), with no significant changes observed in other measured variables. EG showed superior post-test results in fasting glycemia (p < 0.0001; ES = 2.559, large), LDL-C (p < 0.0001; ES = 0.971, large), and explosive strength measures (0.003 ≤ p < 0.0001; ES = 1.145-1.311, large) compared to the CG.

Conclusions

Our findings indicate that water-based aerobic training could be a useful program to enhance anthropometric, biochemical, cardiovascular, and explosive strength parameters in young overweight and obese women compared to inactive persons.

Distinct muscle growth and strength adaptations after preacher and incline biceps curls

We compared performing preacher and incline biceps curls on changes in elbow flexor muscle size and strength. This was a between-group repeated measure randomized trial. Sixty-three young women performed the preacher biceps curl (n=30) or the incline biceps curl (n=33) for 8 weeks, twice a week. We measured the muscle thickness of elbow flexors at the proximal, middle, and distal sites. We assessed the muscle strength using three repetition maximum tests in the preacher curl and the incline curl. We observed a greater increase in the proximal elbow flexor thickness in the incline biceps curl compared to the preacher biceps curl (mean difference=0.08 cm [95% confidence interval: 0.02, 0.13 cm]). We observed a greater increase in the distal elbow flexor thickness in the preacher biceps curl compared to the incline biceps curl (mean difference=0.10 cm [95%CI: 0.04, 0.15 cm]). The preacher biceps curl showed a greater increase in three repetition maximum tests in the preacher curl (mean difference=1.88 kg [95%CI: 1.14, 2.62 kg]). The incline biceps curl showed a greater increase in three repetition maximum tests in the incline biceps curl (mean difference=0.86 kg [95%CI: 0.10, 1.62 kg]). Our findings suggest regional differences in muscle growth induced by the preacher and incline biceps curls. Strength gains appear to follow the principle of specificity.

Thyroidectomy under local versus general anesthesia in health camp settings in Uganda: a randomized prospective equivalence single-blind controlled trial

BACKGROUND

Endemic goiter is highly prevalent in Uganda, placing a considerable surgical burden on the healthcare system. Across Africa, prevalence varies widely, reaching 60.2%, with visible goiter affecting 30% of Uganda's rural population despite salt iodization programs. Despite evidence supporting thyroidectomy under local anesthesia (LA) for selected cases, its importance is underestimated moreover with limited access to general anesthesia (GA) and critical care providers in resource-constrained settings. The trial compared outcomes of thyroidectomy under LA versus GA in grade 1-2 uncomplicated euthyroid goiter patients in Uganda, with an aim to assess feasibility of LA as an alternative technique.

METHODS

In this prospective equivalence randomized, single-blind controlled trial, participants with grade 1-2 uncomplicated euthyroid goiters were enrolled and randomly assigned to two arms (LA and GA) during surgical camps in Uganda. The study compared early postoperative outcomes, including nausea, vomiting, hematoma formation, transient voice changes, and pain at 6, 12, and 24 h. It also assessed overall incurred material and medication costs, patient satisfaction using a 5-point Likert scale, and willingness to undergo a similar procedure with the same anesthetic technique at 30 days.

RESULTS

Fifty-eight participants undergoing thyroidectomy received random assignment, twenty-nine for each arm. No significant differences were found between the 2 groups in demographics, symptom duration, and early post-operative complications or patients' level of satisfaction (P > 0.05). However, the overall material and medication costs were significantly lower in the LA Group (P < 0.001).

CONCLUSIONS

Thyroidectomy under LA can be performed in a well-selected patient population with low complication rates and comparable patient satisfaction to GA. These findings may support LA for thyroidectomy as a valuable cost-efficient alternative, especially in low-resource settings with fewer GA providers.

TRIAL REGISTRATION

First registered on 31/07/2022, PACTR202208635457430 by Pan African Clinical Trial Registry.

Assessing accuracy of BiliPredics algorithm in predicting individual bilirubin progression in neonates-results from a prospective multi-center study

Background

Neonatal jaundice affects more than half of neonates. As bilirubin values usually peak few days after hospital discharge, jaundice remains a leading cause of rehospitalization. The recently developed BiliPredics algorithm, integrated in the first CE-approved bilirubin prediction tool, predicts individual bilirubin progression for up to 60 h into the future. Goal of the prospective study was to assess accuracy of this algorithm in predicting individual bilirubin prior to hospital discharge in neonates.

Methods

A prospective multi-center study was conducted in 2021 at the University Children's Hospitals in Tübingen and Regensburg, Germany. Various scenarios differing in type and number of bilirubin measurements and in prediction horizon were tested. Primary objective was prediction accuracy of the BiliPredics algorithm based on total serum bilirubin (TSB) measurements or based on transcutaneous bilirubin (TcB) measurements alone. Secondary objective was prediction accuracy based on combinations of TSB and TcB measurements. For assessment of accuracy, two validation metrics, absolute prediction error ( a P E ) and relative prediction error ( r P E ) , and two clinical acceptance conditions, margin of error of the 95%-confidence interval (95%-CI) and percentage of clinically relevant mis-predictions defined as a P E > 85 μ mol / L , were investigated.

Results

Out of 455 enrolled neonates, 276 neonates met bilirubin inclusion criteria and were included in the analyses. Irrespective from tested prediction horizons, median r P E was small (8.5% to 9.5%) utilizing TSB measurements for up to 30 and 60 h and slightly higher (13.8%) utilizing TcB measurements for up to 48 h. The same applied for median a P E . Both clinical acceptance conditions were fulfilled across tested scenarios. Results for combined TSB-TcB scenarios up to a prediction horizon of 48 h without adjustment for type of measurement were comparable to TSB and TcB scenarios fulfilling both clinical acceptance conditions.

Conclusion

Results from this prospective study in neonates confirm that the BiliPredics algorithm accurately predicts bilirubin progression up to 60 h with TSB measurements and up to 48 h with TcB or combined TSB-TcB measurements. As such, prediction tools utilizing this algorithm are expected to facilitate and safely optimize jaundice risk assessment at hospital discharge with the potential to reduce jaundice-related rehospitalizations.

Low-Dose Dexmedetomidine Attenuates the Dose Requirement of Propofol for Suppression of Body Movement in Patients Undergoing Operative Hysteroscopy

Background

Dexmedetomidine is a central α-2 adrenergic agonist characterized by its sedative, analgesic, and sympatholytic properties. We investigated the effect of low dose dexmedetomidine on the dose-response relationship of propofol for sedation in patients undergoing operative hysteroscopy.

Methods

The patients were firstly randomly assigned to receive either propofol and fentanyl (P group, n = 100) or a combination of propofol, dexmedetomidine, and fentanyl (DP group, n = 100). Subsequently, participants were further randomized to receive propofol at doses of 1.0, 1.5, 2.0, and 2.5 mg/kg in P group, and 0.5, 1.0, 1.5, and 2.0 mg/kg in DP group. The primary outcome of this study was the incidence of patients achieving effective propofol dose, defined as the dosage at which a patient exhibited no body movement during cervical dilation and had a BIS value below60. The Probit method was used to calculate the ED50 and ED95 of propofol in the inhibition of body movement reaction to cervical dilation during hysteroscopic surgery.

Results

The ED50 and ED95 values for propofol in the inhibition of body movement reaction to cervical dilation during hysteroscopic surgery were 1.781 (95% CI 1.507~2.118) and 4.670 (95% CI 3.555~7.506) mg/kg, respectively, in P group; while in the DP group, these values were found to be 0.983 (95% CI 0.800~1.173) and 2.578 (95% CI 2.013~3.895) mg/kg.

Conclusion

Low-dose dexmedetomidine (0.5μg/kg) could reduce the requirement of propofol for suppression of body movement in patients undergoing operative hysteroscopy.

Health Benefits of Montmorency Tart Cherry Juice Supplementation in Adults with Mild to Moderate Ulcerative Colitis; A Placebo Randomized Controlled Trial

AIMS

Ulcerative colitis (UC) significantly impacts individuals' self-perception, body image, and overall quality of life, while also imposing considerable economic costs. These challenges highlight the necessity for complementary therapeutic strategies with reduced adverse effects to support conventional pharmacological treatments. Among natural interventions, Montmorency tart cherries, noted for their high anthocyanin content have emerged as a natural anti-inflammatory agent for UC. The current trial aimed to investigate the effects of Montmorency tart cherries compared to placebo in patients with mild to moderate UC.

MATERIALS AND METHODS

Thirty-five patients with UC were randomly assigned to receive either placebo or Montmorency tart cherry juice, of which they drank 60 mL per day for 6 weeks. The primary outcomes and health-related quality of life, measured via the Inflammatory Bowel Disease Quality of Life Questionnaire (IBDQ), and the secondary measures, including other health-related questionnaires, blood biomarkers, and faecal samples, were measured before and after the intervention. Linear mixed-effects models were adopted to contrast the changes from baseline to 6 weeks between trial arms. Effect sizes were calculated using Cohen's d.

RESULTS

There were significantly greater improvements in the IBDQ (22.61 (95% CI = 5.24 to 39.99) d = 0.90) and simple clinical colitis activity index (-3.98 (95% CI = -6.69 to -1.28) d = -1.01) in the tart cherry trial arm compared to placebo. In addition, reductions in faecal calprotectin levels were significantly greater in the tart cherry trial arm compared to placebo (-136.17 µg/g (95% CI = -258.06 to -4.28) d = -1.14). Loss to follow-up (N = 1) and adverse events (N = 1) were low and compliance was very high in the tart cherry (95.8%) trial arm.

CONCLUSIONS

Given the profoundly negative effects of UC on health-related quality of life and its fiscal implications for global healthcare systems, this trial indicates that twice-daily tart cherry supplementation can improve IBD-related quality of life as well as the severity of symptoms and therefore may be important in the management of UC.

Exploring the connection between erythrocyte membrane fatty acid composition and oxidative stress in patients undergoing the Crohn's disease Therapeutic Diet Intervention (CD-TDI)

Background

Dietary fatty acids (FA) are crucial to the pathophysiology of inflammatory bowel disease (IBD), influencing systemic and gut inflammatory responses. Dietary FA intake influences the fatty acid profiles of vital cell membranes, which might be a source of inflammatory mediators. Despite their significance, research on dietary FA subtypes and their effects on inflammation and oxidative stress in IBD is limited.

Objective

We investigated the association between dietary FA intake, the erythrocyte membrane FA composition (EMFA), and inflammation and oxidative stress markers in patients with mild-moderate luminal Crohn's Disease (CD) participating in the CD Therapeutic Dietary Intervention (CD-TDI).

Design

A cross-sectional analysis was performed on 24 participants (13 CD-TDI, 11 habitual diet controls) from a 13-week randomized controlled trial assessing the efficacy of CD-TDI in inducing clinical and biomarker remission in CD.

Methods

EMFA was analyzed using direct-injection gas chromatography, and dietary FA intake was assessed using the ASA 24-h Dietary Assessment Tool®.

Results

The CD-TDI group showed a significant increase in dietary n-3 polyunsaturated fatty acids (PUFA) at Week 13 (p = 0.04) compared to no changes in the control group. Participants on the CD-TDI also demonstrated a significant reduction in total fat, saturated fat, and arachidonic acid (AA) (p < 0.01). EMFA analysis revealed lower percentages of AA (p = 0.03) in the CD-TDI group. Positive correlations were observed between C-reactive protein, fecal calprotectin, and dietary stearic acid (p < 0.05). Inverse correlations were found between malondialdehyde (MDA) and the Mediterranean Diet Score (r = -0.67) as well as MDA and the intake of whole fruit, legumes, and nuts/seeds (r > -0.50).

Conclusion

The CD-TDI significantly increased dietary n-3 PUFA intake, reduced pro-inflammatory n-6 PUFA (AA), and improved markers of oxidative stress, supporting its potential in CD management. The cell membrane fatty acid profile might be a therapeutic target in CD.

Trial registration

NCT04596566.

Bone Remodeling Around Implants with Different Macro-Design Placed in Post-Extraction Sockets: A Cone-Beam Computed Tomography (CBCT) Randomized Controlled Clinical Trial (RCT)

Background: Immediate post-extraction dental implants are increasingly popular, but ensuring primary stability and managing peri-implant tissues remain challenging. Implant macro-design significantly impacts stability and osseointegration. This study used Cone-beam Computed Tomography (CBCT) to evaluate changes in alveolar bone following immediate placement of two implant designs, System 2P and Dura-Vit 3P, which feature semi-conical microgeometry and apical self-tapping portions for improved stability and bone regeneration. Methods: With a 1:1 allocation ratio, the current investigation was a two-arm parallel group randomized clinical trial. Patients qualified if they required immediate dental replacements with adequate buccal bone support. Two types of implants were placed: System 2P (cylindrical shape) and Dura-Vit 3P (more conical shape, with a particular architecture of threads). Following the intervention, CBCT was performed both immediately (T1) and six months later (T2). Measurements of CBCT horizontal bone level at apical, medial, and bevel height on the palatal/lingual and vestibular sides as well as the buccal vertical gap were the primary results. Complications, implant stability quotient (ISQ), and torque insertion were evaluated. The Mann-Whitney test was used to determine time-based differences within each group, while the Wilcoxon test was used to estimate differences between groups. The impact of baseline marginal gap dimension and gingival biotype was estimated using multiple regressions. Results: Thirty patients were recruited and randomized to treatments, with two lost to follow-up. One System 2P implant failed and two patients of the Dura-Vit 3P group dropped out. At T1, the Dura-Vit 3P group exhibited a lower mean insertion torque and a higher ISQ than the System 2P group. Furthermore, the Dura-Vit 3P group showed lower bone reduction compared to System 2P at horizontal and vertical measurements with significant differences for the vestibular and palatal base and medial level (p-values < 0.05). Regression models indicated a positive effect of thick biotypes on gap filling and dimensional bone reduction. No complications were observed in both groups. Conclusions: The Dura-Vit 3P implant exhibits high primary stability when inserted in post-extraction sites. Furthermore, this kind of implant stimulates higher bone stability on both the palatal and buccal side when compared to the System 2P implant. The present findings support the evidence that the macro-design of the Dura-Vit 3P implant promotes increased primary stability and reduces bone loss.

Efficacy of a Blended Low-Intensity Internet-Delivered Psychological Program in Patients With Multimorbidity in Primary Care: Randomized Controlled Trial

BACKGROUND

Multimorbidity is a highly prevalent phenomenon whose presence causes a profound physical, psychological, and economic impact. It hinders help seeking, diagnosis, quality of care, and adherence to treatment, and it poses a significant dilemma for present-day health care systems.

OBJECTIVE

This study aimed to assess the effectiveness of improved treatment as usual (iTAU) combined with a blended low-intensity psychological intervention delivered using information and communication technologies for the treatment of multimorbidity (depression and type 2 diabetes or low back pain) in primary care settings.

METHODS

A 2-armed, parallel-group, superiority randomized controlled trial was designed for this study. Participants diagnosed with depression and either type 2 diabetes or low back pain (n=183) were randomized to "intervention + iTAU" (combining a face-to-face intervention with a supporting web-based program) or "iTAU" alone. The main outcome consisted of a standardized composite score to consider (1) severity of depressive symptoms and (2a) diabetes control or (2b) pain intensity and physical disability 3 months after the end of treatment as the primary end point. Differences between the groups were estimated using mixed effects linear regression models, and mediation evaluations were conducted using path analyses to evaluate the potential mechanistic role of positive and negative affectivity and openness to the future.

RESULTS

At 3-month follow-up, the intervention + iTAU group (vs iTAU) exhibited greater reductions in composite multimorbidity score (B=-0.34, 95% CI -0.64 to -0.04; Hedges g=0.39) as well as in depression and negative affect and improvements in perceived health, positive affect, and openness to the future. Similar positive effects were observed after the intervention, including improvements in physical disability. No significant differences were found in glycosylated hemoglobin, pain intensity, or disability at 3-month follow-up (P=.60; P=.79; and P=.43, respectively). Path analyses revealed that the intervention had a significant impact on the primary outcome, mediated by both positive and negative affect (positive affect: indirect effect=-0.15, bootstrapped 95% CI -0.28 to -0.03; negative affect: indirect effect=-0.14, bootstrapped 95% CI -0.28 to -0.02).

CONCLUSIONS

This study supports the efficacy of a low-intensity psychological intervention applied in a blended format on multimorbidity in primary care. It justifies the exploration of the conceptualization of depression in type 2 diabetes as well as the analysis of the implementation of such interventions in routine clinical practice.

TRIAL REGISTRATION

ClinicalTrials.gov NCT03426709; https://clinicaltrials.gov/study/NCT03426709.

INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID)

RR2-10.1186/S12888-019-2037-3.

Clinical efficacy of Chinese herbal medicine formula for Graves' hyperthyroidism: A multicentre, randomized, double-blind, placebo-controlled clinical trial

ETHNOPHARMACOLOGICAL RELEVANCE

According to the theory of traditional Chinese medicine, Graves' disease (GD) is called 'Ying Bing', which is a kind of goiter. Haizao Yuhu decoction, originated from the medical book of the Ming Dynasty 'Waikezhengzong', is a classic Chinese herbal formula for the treatment of 'Ying Bing' for more than 400 years. Pingkang granules, modified from the Chinese herbal formula Haizao Yuhu decoction specialized in GD, has shown effectiveness in several single-centre studies. However, high-quality clinical evidence for the management of GD using Pingkang granules remains insufficient.

AIM OF THE STUDY

To obtain high-quality medical evidence for the treatment of GD with Pingkang granules through randomized controlled clinical trial.

MATERIALS AND METHODS

A multicentre, randomized, double-blinded, placebo-controlled clinical trial was designed. A total of 186 patients with Graves' hyperthyroidism from five medical centers were randomly assigned to receive methimazole [MMI] and Pingkang granules placebo (group A), MMI and Pingkang granules (group B), or MMI placebo and Pingkang granules (group C) in a 1:1:1 ratio for 12 weeks. The primary clinical outcomes were serum free triiodothyronine (FT3) and free thyroxine (FT4) levels from baseline until the end of the research. Secondary clinical outcomes included serum thyrotrophin receptor antibody (TRAb) levels at 4- and 12-weeks post-intervention, thyroid volume, peak systolic velocity of the superior thyroid artery (STA-PSV), 39-item version of Thyroid-Related Patient-Reported Outcome (ThyPRO39) scores, and safety assessment included blood routine, liver and kidney function tests from baseline to the endpoint.

RESULTS

150 patients were included in the full analysis set for efficacy analysis, including 48, 50, and 52 in groups A, B, and C, respectively. At the endpoint, three regimens significantly reduced serum FT3 levels (group A, p=0.0027; group B, p < 0.0001; group C, p=0.0028) and FT4 levels (group A, p < 0.0001; group B, p < 0.0001; group C, p < 0.0001), and the combination of MMI and Pingkang granules markedly reduced serum TRAb levels (p = 0.0014). The thyroid volume in group A was significantly larger than that at baseline at week 12 (p=0.0370), and there were no statistically significant differences in the thyroid volume among groups at week 4 (p=0.7485) and 12 (p=0.1333). STA-PSV values in group B were significantly higher than those in group A at week 4 (p=0.0409). The STA-PSV levels in groups A (p < 0.0001) and C (p=0.0025) were significantly lower than those at baseline at week 4, and STA-PSV levels in all groups were significantly lower than those at baseline at week 12 (group A, p=0.0095; group B, p=0.0138; group C, p=0.0423). Pingkang granule monotherapy significantly ameliorated symptoms related to hyperthyroidism (p < 0.0001), eye (p=0.0490), tiredness (p < 0.0001), cognition (p < 0.0001), depression (p=0.0478), and susceptibility (p=0.0052). No severe adverse events were reported in either group or three regimens showed similar safety.

CONCLUSIONS

Pingkang granules significantly reduced serum FT3, FT4 and STA-PSV levels, improved ThyPRO39 scores, and lowered serum TRAb levels when combined with MMI in patients with Grave's hyperthyroidism.

Effects of a school-based physical activity intervention on mental health indicators in a sample of Brazilian adolescents: a cluster randomized controlled trial

PURPOSE

To test the effects of a physical activity intervention program on symptoms of mental disorders among adolescents.

METHODS

This study is a 12-week cluster randomized controlled trial. The sample consisted of 306 adolescents (45,8% male, age: 13,6 [0,72] years; 54.2% female, age: 13.5 [0.69] years), randomized into an intervention group (N = 165) and a control group (N = 141). The physical activity program involved sessions including muscle strengthening and cardiorespiratory exercises and lifestyle guidance. The mental health indicators analyzed were: anxiety, depression, sleep, and psychological well-being. Intervention effects were analyzed by generalized estimating equations.

RESULTS

After 12 weeks, no significant improvements were observed in the intervention group for sleep; anxiety; depression, and psychological well-being. In the subgroup analysis, significant group×time interactions were observed for adolescents who were classified with moderate symptoms of depression (mean difference: -0.97, p = 0.002) and anxiety (mean difference: -3.03, p = 0.01) with favorable effects for intervention group.

CONCLUSION

After the 12-week intervention period, it can be concluded that 12 weeks of school-based physical activity intervention significantly reduced symptoms of anxiety and depression in adolescents with moderate/severe symptoms. Furthermore, the intervention contributed to the maintenance of psychological well-being, since the control group showed a significant reduction in this mental health indicator.

Modulatory Effects of Multi-species/Multi-strain Synbiotic and L-carnitine Concomitant Supplementation on Atherogenic-Indices, Body Composition, Visceral Obesity, and Appetite in Metabolically Healthy Women with Obesity: A Double-Blind Randomized Controlled Clinical Trial

Obesity, a chronic disease with pandemic proportions, is recognized as a major risk factor for cardiometabolic disorders due to its association with atherogenic dyslipidemia, a common characteristic attributed to visceral adiposity in patients with obesity. Atherogenic and visceral-obesity indices have been conceded as surrogate cardiovascular diseases (CVD) indicators surpassing the conventional markers due to stronger predictive power for obesity-induced cardiometabolic risk and CVD mortality rate. Nutraceuticals have been suggested as emerging approaches to counteract obesity-associated cardiometabolic disorders. Considering the evidence addressing the ameliorating effects of either L-carnitine or biotics on metabolic indices, also the reports addressing higher efficacy of concomitant supplementation versus single-therapies, this clinical trial was conducted to assess the effects of L-carnitine + multi-species/multi-strain synbiotic combined supplementation compared to L-carnitine mono-therapy on atherogenic-indices, body composition, visceral obesity, and appetite sensations in 46 metabolically healthy women with obesity, randomly assigned to co-supplementation (L-carnitine-tartrate (2 × 500 mg/dl) + synbiotic (one capsule/day)) or mono-therapy (L-carnitine-tartrate (2 × 500 mg/dl) + maltodextrin (one capsule/day)) groups for 8 weeks. L-carnitine + synbiotic co-supplementation led to a significantly greater reduction in atherogenic-indices including atherogenic-index-of-plasma (AIP), Castelli's-risk-index-I (CRI-I), Castelli's-risk-index-II (CRI-II), atherogenic-coefficient (AC), lipoprotein-combine index (LCI), systolic blood pressure (SBP), fat-mass (FM) weight/percent, visceral-adiposity index (VAI), waste-to-height ratio (WHtR), body-adiposity index (BAI), and appetite sensation scores compared to L-carnitine mono-therapy. L-carnitine + synbiotic combined supplementation was more efficient in improving atherogenic-indices as cardiovascular risk markers, body composition, visceral obesity, and appetite sensations in metabolically healthy women with obesity. Therefore, simultaneous supplementation of L-carnitine + synbiotic might be considered a promising approach to ameliorate cardiometabolic risk factors in healthy individuals with obesity. Further longer period studies are required to confirm these findings. (Iranian Registry of Clinical Trials (IRCT; https://irct.behdasht.gov.ir/trial/28048 ).

Effects of manual osteopathic interventions on psychometric and psychophysiological indicators of anxiety, depression and stress in adults: a systematic review and meta-analysis of randomised controlled trials

OBJECTIVES

To evaluate whether osteopathic and related manual interventions improve adult mental health (depression, anxiety, stress) and psychophysiological measures (eg, heart rate variability, skin conductance).

DESIGN

Systematic review and meta-analysis of randomised controlled trials (RCTs).

DATA SOURCES

PubMed, MEDLINE (Ovid), Scopus, Cochrane, and AMED, searched through September 2024.

ELIGIBILITY CRITERIA

English-language RCTs with ≥30 participants investigating osteopathic or related manual therapies (eg, myofascial release, high-velocity low-amplitude thrusts) delivered by qualified practitioners, compared with no treatment or sham, and reporting immediate postintervention mental health or psychophysiological outcomes.

DATA EXTRACTION AND SYNTHESIS

Full-text screening, risk-of-bias assessment and data extraction were conducted independently by multiple reviewers using a standardised Joanna Briggs Institute (JBI) Extraction Form. Risk of bias was assessed using the JBI Critical Appraisal Checklist. For meta-analyses, Hedges' g (with 95% CIs) was calculated from postintervention means and SD. Random-effects models accounted for heterogeneity, and prediction intervals were calculated to assess uncertainty in effect estimates.

RESULTS

20 RCTs were included. Osteopathic interventions reduced depression (Hedges' g=-0.47, 95% CI: -0.86 to -0.09, p=0.02) and increased skin conductance (Hedges' g=0.67, 95% CI: 0.00 to 1.34, p=0.05). Depression improvements were greater in pain populations (Hedges' g=-0.61, 95% CI: -1.06 to -0.17, p=0.01). However, wide prediction intervals and moderate heterogeneity indicate uncertainty in true effect sizes, and limited studies and sample sizes restrict assessment of publication bias.

CONCLUSIONS

Osteopathic and related manual therapies may reduce depression and influence certain psychophysiological markers, particularly in pain populations, but uncertainty and heterogeneity limit confidence. More rigorous, larger, and longitudinal RCTs are needed.

TRIAL REGISTRATION NUMBER

This meta-analysis was not formally registered, though the protocol and search strategy can be found at Open Science Framework, registration identification: https://osf.io/jrtpx/.

Smartphone-Based Intervention Targeting Norms and Risk Perception Among University Students with Unhealthy Alcohol Use: Secondary Mediation Analysis of a Randomized Controlled Trial

BACKGROUND

Many digital interventions for unhealthy alcohol use are based on personalized normative feedback (PNF) and personalized feedback on risks for health (PFR). The hypothesis is that PNF and PFR affect drinkers' perceptions of drinking norms and risks, resulting in changes in drinking behaviors. This study is a follow-up mediation analysis of the primary and secondary outcomes of a randomized controlled trial testing the effect of a smartphone-based intervention to reduce alcohol use.

OBJECTIVE

This study aimed to investigate whether perceptions of drinking norms and risks mediated the effects of a smartphone-based intervention to reduce alcohol use.

METHODS

A total of 1770 students from 4 higher education institutions in Switzerland (mean age 22.35, SD 3.07 years) who screened positive for unhealthy alcohol use were randomized to receive access to a smartphone app or to the no-intervention control condition. The smartphone app provided PNF and PFR. Outcomes were drinking volume (DV) in standard drinks per week and the number of heavy drinking days (HDDs) assessed at baseline and 6 months. Mediators were perceived drinking norms and perceived risks for health measured at baseline and 3 months. Parallel mediation analyses and moderated mediation analyses were conducted to test whether (1) the intervention effect was indirectly related to lower DV and HDDs at 6 months (adjusting for baseline values) through perceived drinking norms and perceived risks for health at 3 months (adjusting for baseline values) and (2) the indirect effects through perceived drinking norms differed between participants who overestimated or who did not overestimate other people's drinking at baseline.

RESULTS

The intervention's total effects were significant (DV: b=-0.85, 95% bootstrap CI -1.49 to -0.25; HDD: b=-0.44, 95% bootstrap CI -0.72 to -0.16), indicating less drinking at 6 months in the intervention group than in the control group. The direct effects (ie, controlling for mediators) were significant though smaller (DV: b=-0.73, 95% bootstrap CI -1.33 to -0.16; HDD: b=-0.39, 95% bootstrap CI -0.66 to -0.12). For DV, the indirect effect was significant through perceived drinking norms (b=-0.12, 95% bootstrap CI -0.25 to -0.03). The indirect effects through perceived risk (for DV and HDD) and perceived drinking norms (for HDD) were not significant. Results of moderated mediation analyses showed that the indirect effects through perceived drinking norms were significant among participants overestimating other people's drinking (DV: b=-0.17, 95% bootstrap CI -0.32 to -0.05; HDD: b=-0.08, 95% bootstrap CI -0.15 to -0.01) but not significant among those not overestimating.

CONCLUSIONS

Perceived drinking norms, but not perceived risks, partially mediated the intervention's effect on alcohol use, confirming one of its hypothesized mechanisms of action. These findings lend support to using normative feedback interventions to discourage unhealthy alcohol use.

TRIAL REGISTRATION

ISRCTN Registry 10007691; https://doi.org/10.1186/ISRCTN10007691.

Prefrontal Transcranial Direct Current Stimulation in Pediatric Attention-Deficit/Hyperactivity Disorder: A Randomized Clinical Trial

Importance

Transcranial direct current stimulation (tDCS) has the potential to be a sustainable treatment option in pediatric attention-deficit/hyperactivity disorder (ADHD), but rigorously controlled multicenter clinical trials using state-of-the-art stimulation techniques are lacking.

Objectives

To determine effect sizes of changes in cognitive and clinical measures and to assess safety and tolerability in the course of optimized multichannel tDCS over prefrontal target regions in pediatric ADHD.

Design, Setting, and Participants

In the sham-controlled, double-blind, parallel-group randomized clinical trial E-StimADHD (Improving Neuropsychological Functions and Clinical Course in Children and Adolescents With ADHD With Anodal Transcranial Direct Current Stimulation of the Prefrontal Cortex: A Randomized, Double-Blind, Sham-Controlled, Parallel Group Trial Using an Uncertified Class IIa Device) with 2 independent study arms, participants were enrolled from September 15, 2018, to August 10, 2021, and follow-up was completed October 4, 2021. Data were analyzed January 26, 2022, to November 8, 2023. The trial was conducted at the departments of child and adolescent psychiatry or pediatrics of 5 university hospitals in Portugal and Germany. Youths 10 to 18 years of age with ADHD according to the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (all presentations), an IQ of at least 80, and the ability to refrain from stimulant medication during participation in the trial were eligible.

Interventions

Optimized multichannel anodal tDCS or sham stimulation (1 mA, 20 minutes) targeting the left dorsolateral prefrontal cortex (lDLPFC; study A) or the right inferior frontal gyrus (rIFG; study B) was applied in 10 sessions, concurrent with performance on a cognitive target task (study A, working memory assessed in the n-back task; study B, interference control assessed in the flanker task).

Main Outcomes and Measures

Effect sizes for changes in accuracy measures (d-prime or flanker effect) in the target tasks assessed after the intervention. Primary analyses were based on the modified intention-to-treat set.

Results

This study included 69 youths (54 [78%] male) with a median age of 13.3 years (IQR, 11.9-14.9 years). Compared with sham tDCS, verum stimulation of the lDLPFC led to significantly lower working memory accuracy (effect size, -0.43 [95% CI, -0.68 to -0.17]; P = .001). Stimulation of the rIFG significantly improved interference control (effect size, 0.30 [95% CI, 0.04-0.56]; P = .02). Adverse events were mostly mild and transient and did not occur more often in the verum group. For example, the most frequent adverse events were headache (sham, n = 30; verum, n = 20), nasopharyngitis (sham, n = 11; verum, n = 5), and feeling of electric discharge (sham, n = 5; verum, n = 3).

Conclusions and Relevance

In this randomized clinical trial, prefrontal anodal tDCS induced small- to medium-sized effects in youths with ADHD, with only mild and transient adverse events. The optimized multichannel montage chosen to target the lDLPFC, however, decreased working memory performance. This unexpected finding stresses the importance of incorporating insights from basic research on the mechanisms and preconditions of successful tDCS in future study designs to advance application of tDCS in pediatric ADHD.

Trial Registration

German Clinical Trials Register ID: DRKS00012659.

One-month outcomes of a culturally tailored alcohol-exposed pregnancy prevention mobile app among urban Native young women: A randomized controlled trial of Native WYSE CHOICES

BACKGROUND

The majority of alcohol-exposed pregnancy (AEP) prevention programs for Native women have focused on at-risk adult women residing in rural tribal communities; however, over 70% of the Native population resides in urban areas. Moreover, Native young women universally-regardless of risk status-may benefit from culturally tailored resources. We hypothesized that urban Native young women who engaged with Native WYSE CHOICES (NWC), a culturally tailored AEP prevention intervention delivered by mobile phone app, would report reduced risk of AEP at the 1-month follow-up compared to those who engaged with a comparison condition.

METHODS

From August 2021 to January 2023, we recruited 439 urban Native young women (ages 16-20) nationally to a randomized controlled trial administered fully virtually including most recruitment, data collection and intervention engagement. Participants were randomly assigned to the NWC app or an alternative app. We used linear and logistic regression analyses to predict scores on 1-month outcome variables by study arm assignment.

RESULTS

Results of regression analyses predicting scores on 1-month outcomes by study arm showed trending intervention effects on measures of AEP knowledge (p = 0.06), alcohol use with sexual activity (p = 0.10), and an AEP risk index (p = 0.12). At 1-month follow-up, intervention group participants reported greater AEP knowledge, lower likelihood of alcohol-involved sexual activity in the past month, and lower scores on an AEP risk index compared to the comparison group.

CONCLUSIONS

The NWC app produced trending changes in key areas of knowledge and behavior that may result in reduced AEP risk among urban Native young women. These findings suggest that the NWC app holds promise for addressing AEP in Native populations. Small changes in these areas may result in lifelong changes in the current generation that impact the health and wellbeing of generations to come.

Does the outcome of acupuncture differ according to the location of sham needling points in acupuncture trials for migraine? A systematic review and network meta-analysis

Various acupuncture clinical trials have been conducted on migraine; however, the conclusions remain controversial especially when acupuncture was compared with sham acupuncture. Sham acupuncture is sometimes performed at the same acupuncture points used for verum acupuncture despite the evidence on acupuncture point specificity. Four databases were searched for sham acupuncture or waiting list-controlled acupuncture trials for migraine on December 25, 2023. Sham acupuncture was classified according to the needling points: sham acupuncture therapy at verum points (SATV) or at sham points (SATS). Network meta-analysis was performed based on the frequentist framework for headache pain intensity and response rate. A total of 18 studies involving 1936 participants were analyzed. Headache pain intensity and response rate were significantly improved in verum acupuncture compared with SATS. However, there was no significant difference between SATV and verum acupuncture. When comparing SATS and SATV, there was no significant difference in headache pain intensity and response rate; however, the results were in favor of SATV. The effect of the risk of bias on the certainty of evidence between verum and sham acupunctures was judged to be generally low. SATV should not be misused as a placebo control to evaluate the efficacy of acupuncture.

Effects of X-ray-based diagnosis and explanation of knee osteoarthritis on patient beliefs about osteoarthritis management: A randomised clinical trial

BACKGROUND

Although X-rays are not recommended for routine diagnosis of osteoarthritis (OA), clinicians and patients often use or expect X-rays. We evaluated whether: (i) a radiographic diagnosis and explanation of knee OA influences patient beliefs about management, compared to a clinical diagnosis and explanation that does not involve X-rays; and (ii) showing the patient their X-ray images when explaining radiographic report findings influences beliefs, compared to not showing X-ray images.

METHODS AND FINDINGS

This was a 3-arm randomised controlled trial conducted between May 23, 2024 and May 28, 2024 as a single exposure (no follow-up) online survey. A total of 617 people aged ≥45 years, with and without chronic knee pain, were recruited from the Australian-wide community. Participants were presented with a hypothetical scenario where their knee was painful for 6 months and they had made an appointment with a general practitioner (primary care physician). Participants were randomly allocated to one of 3 groups where they watched a 2-min video of the general practitioner providing them with either: (i) clinical explanation of knee OA (no X-rays); (ii) radiographic explanation (not showing X-ray images); or (iii) radiographic explanation (showing X-ray images). Primary comparisons were: (i) clinical explanation (no X-rays) versus radiographic explanation (showing X-ray images); and (ii) radiographic explanation (not showing X-ray images) versus radiographic explanation (showing X-ray images). Primary outcomes were perceived (i) necessity of joint replacement surgery; and (ii) helpfulness of exercise and physical activity, both measured on 11-point numeric rating scales (NRS) ranging 0 to 10. Compared to clinical explanation (no X-rays), those who received radiographic explanation (showing X-ray images) believed surgery was more necessary (mean 3.3 [standard deviation: 2.7] versus 4.5 [2.7], respectively; mean difference 1.1 [Bonferroni-adjusted 95% confidence interval: 0.5, 1.8]), but there were no differences in beliefs about the helpfulness of exercise and physical activity (mean 7.9 [standard deviation: 1.9] versus 7.5 [2.2], respectively; mean difference -0.4 [Bonferroni-adjusted 95% confidence interval: -0.9, 0.1]). There were no differences in beliefs between radiographic explanation with and without showing X-ray images (for beliefs about necessity of surgery: mean 4.5 [standard deviation: 2.7] versus 3.9 [2.6], respectively; mean difference 0.5 [Bonferroni-adjusted 95% confidence interval: -0.1, 1.2]; for beliefs about helpfulness of exercise and physical activity: mean 7.5 [standard deviation: 2.2] versus 7.7 [2.0], respectively; mean difference -0.2 [Bonferroni-adjusted 95% confidence interval: -0.7, 0.3]). Limitations of our study included the fact that participants were responding to a hypothetical scenario, and so findings may not necessarily translate to real-world clinical situations, and that it is unclear whether effects would impact subsequent OA management behaviours.

CONCLUSIONS

An X-ray-based diagnosis and explanation of knee OA may have potentially undesirable effects on people's beliefs about management.

TRIAL REGISTRATION

ACTRN12624000622505.

Efficacy and working mechanisms of a Go/No-Go task-based inhibition training in smoking: A randomized-controlled trial

OBJECTIVE

Deficits in inhibitory control contribute to smoking behavior. Inhibitory control training (ICT), which involves repeatedly inhibiting responses to general or substance-related stimuli, shows promise in reducing problematic substance use. This preregistered randomized-controlled trial is the first to investigate the efficacy of general and smoking-specific Go/No-Go task-based ICT on smoking behavior compared to control groups receiving no ICT. Three potential working mechanisms were examined: inhibitory enhancement, automatic stimulus-stop associations, and stimulus devaluation.

METHOD

Individuals who smoke (N = 122) were randomly assigned to complete 28 sessions of smoking-specific Go/No-Go, general Go/No-Go, Sham training, or to a Waitlist control condition. Clinical outcomes included daily cigarettes (primary outcome), carbon monoxide levels, tobacco dependence severity, and craving, assessed at post-intervention and 3-month follow-up.

RESULTS

Go/No-Go training resulted in a significantly greater reduction in tobacco dependence (β = -0.88, p = .004) and craving (β = -4.31, p = .012) post-intervention compared to both control groups. The greater reduction in craving remained significant when compared to the Sham training group only (β = -4.64, p = .026). No significant effects of group were observed on daily cigarette consumption (β = -1.97, p = .093) or carbon monoxide levels (β = 2.16, p = .818) post-intervention. At the 3-month follow-up, no significant effects of group emerged (all ps > .794). Smoking-specific Go/No-Go training did not outperform general Go/No-Go training (all ps > .075). No working mechanism for clinical outcome improvements was identified.

CONCLUSIONS

Preliminary evidence suggests that (smoking-specific) GNG training reduces tobacco dependence severity and craving post-intervention in individuals who smoke compared to non-ICT-based control conditions. Its efficacy as an add-on in smoking cessation needs to be investigated.

CLINICAL TRIAL REGISTRATION NUMBER

DRKS00014652.

Optimized computer-assisted technique for increasing adenoma detection during colonoscopy: a randomized controlled trial

BACKGROUND

Efforts to improve colonoscopy have recently focused on improving adenoma detection through individual interventions. We evaluated an optimized computer-assisted technique (CADopt) versus standard colonoscopy.

METHODS

A prospective randomized controlled trial was conducted enrolling adults (45-80 years) undergoing elective colonoscopy. Participants were randomized (1:1) to the intervention group (CADopt), and control group. In the CADopt group, endoscopists used a computer-aided polyp detection combined with linked color imaging, water exchange colonoscopy, and cecal retroflexion. In the control group, standard colonoscopy was performed. Primary outcome was Adenoma Detection Rate (ADR) in the intervention and control groups. Secondary outcomes included polyp detection rate (PDR), advanced ADR (AADR), sessile-serrated lesion detection rates (SDR), and Adenoma per colonoscopy (APC).

RESULTS

A total of 467 patients were recruited and randomized (CADopt group 229 patients, 50.2% female vs 238 patients, 48.3% female in the control group). ADR was 49.3% (95% CI 42.7-56.0) for the CADopt group vs 38.2% (95% CI 32.0-44.7) for the control group (p = 0.016). PDR, AADR, SDR, and APC were 78.2% (95% CI 72.2-83.3), 13.1% (95% CI 9.0-18.2), 6.6% (95% CI 3.7-10.6), and 0.86 (95% CI 0.70-1.02) for the CADopt group versus 59.2% (95% CI 52.7-65.5), 8.0% (95% CI 4.9-12.2), 7.1% (95% CI 4.2-11.1), and 0.75 (95% CI 0.58-0.92) for the control group, respectively.

CONCLUSION

Using an optimized computer-assisted technique led to significant improvements in ADR, PDR, and a trend towards AADR improvements.

Age differences in pedestrian navigational skills and performance: A systemic review and meta-analysis

OBJECTIVES

This study summarized current findings on age differences (young vs. older adults) in pedestrian navigational performance, spatial learning, and examined moderating effects of experimental environment (e.g., real-world vs. virtual environments).

METHODS

Two reviewers independently screened studies from PubMed, Web of Science, PsychInfo, and AgeLine until December 2022.

INCLUSION CRITERIA

(1) empirical navigational study; (2) healthy older adults (mean age above 60); (3) age as a categorical variable; (4) peer-reviewed paper in English.

EXCLUSION CRITERIA

(1) overly simplified environments; (2) tasks performed with transportation; (3) small sample size (n < 10).

RESULTS

5981 studies were screened, 18 were eligible with 406 total participants. Three-level meta-analysis estimated standardized mean age difference of 1.15 (95 % CI: [0.64, 1.65]) in navigational performance, and 0.97 (95 % CI: [0.81, 1.13]) in spatial learning. Study environments were found to marginally moderate age differences in navigational performance, but not in spatial learning.

DISCUSSION

Older adults have poorer navigational performance and spatial learning outcomes compared to their younger counterparts, with marginally greater performance differences in virtual environments than in the real world. Findings were limited by low number eligible studies, especially real-world experiments. Future studies should continue to test generalizability of high-fidelity VR and identify spatial design elements that can mitigate age differences.

Silicone Irregular Hexagon Pessary Versus Polyvinyl Chloride Ring Pessary for Pelvic Organ Prolapse: Randomised Controlled Trial

INTRODUCTION AND HYPOTHESIS

Vaginal pessaries are the mainstay of the non-surgical management of pelvic organ prolapse (POP). A flexible silicone irregular hexagonal (SIH) pessary was developed based on the results of a prior vaginal case study. We hypothesised that the SIH pessary would have a higher rate of retention and self-management than the polyvinyl chloride (PVC) pessary.

METHODS

This was a prospective non-blinded, randomised controlled trial with institutional review board approval. Eligible participants were randomised and fitted with the assigned pessary. They were reviewed 1 week, 6 months and 1 year after the initial pessary fitting. Participants who returned for follow-up completed the study questionnaires. The primary outcome was success, defined as continued use of the allocated pessary at 6 months. Secondary outcomes included the ability to perform pessary self-care, treatment satisfaction and pessary-related complications. Statistical tests were performed with alpha or statistical significance defined as a p value of ≤ 0.05, two-tailed.

RESULTS

A total of 104 participants were randomised, with 52 subjects in each arm. Primary outcome data were analysed using per protocol analysis. Continuing pessary usage at 6 months was 68.1% for the PVC pessary group and 65.1% for the SIH group, with no statistically significant differences between the two groups (p = 0.765). Subjects with SIH were more likely to perform pessary self-care. There were no significant differences in subjects' satisfaction, quality-of-life scores or treatment complications between groups.

CONCLUSIONS

The pessary continuation rate between the SIH and the PVC pessary groups was similar at 6 months. Participants with an SIH pessary were more likely to self-manage.

Effects of structured positive feedback intervention on standing reach ability among older adults admitted to a convalescent rehabilitation ward: a small-sample pilot randomized controlled trial

PURPOSE

Interventions to improve the standing reach ability of older adults are essential for full functional independence, and structured positive feedback (PF) may be an effective intervention strategy. The purposes of this pilot randomized controlled trial (RCT) are to investigate the preliminary efficacy of structured PF for improving the standing reach ability of older patients admitted to a convalescent rehabilitation ward and evaluate the feasibility of a future full-scale RCT.

METHODS

Thirty-two eligible older adults (83.3 ± 5.9 years, 23 women) out of 587 potential participants were randomly assigned 1:1 to structured PF (experimental) and conventional rehabilitation (control) groups. Only the experimental group received PF intervention for standing reach ability once every 3 days. Both groups engaged in conventional rehabilitation programs for 2-3 h every day. The primary outcome was change in Functional Reach Test (FRT) performance after 5 weeks of the indicated intervention compared to baseline. Secondary outcomes were change in Short Falls Efficacy Scale International (Short FES-I), a self-reported measure of fear of falling, and Functional Independence Measure (FIM) scores after the 5-week intervention.

RESULTS

The estimated difference in mean FRT change (∆) between experimental and control groups was - 4.1 cm (P = 0.07) according to a linear mixed model, supporting the potential efficacy of PF for improving standing reach ability. Further, Hedge's g value was 0.71, consistent with a moderate effect size. However, the estimated mean change in Short FES-I between groups also indicated greater fear of falling in the experimental group (∆ = - 4.5, P = 0.009, g = 1.0). In contrast, the intervention effect on FIM was negligible (∆ = 2.0, P = 0.66, g = - 0.1).

CONCLUSIONS

These results support the preliminary effectiveness of structured PF for improving the standing reach ability of older adults. A larger-sample RCT is warranted for validation and optimization of the structured PF protocol.

TRIAL REGISTRATION

The University Hospital Medical Information Network (UMIN) Registered 31 May 2022 (UMIN000047647).

Securing Jugular Central Venous Catheters With Dressings Fixed to a Liquid Adhesive to Prevent Dressing Failure in Intensive Care Patients (the STICKY Trial): A Randomized Controlled Trial

OBJECTIVES

Central venous catheters (CVCs) are vital for treating ICU patients. However, up to a quarter of CVCs fail from mechanical or infective complications. Poor securement of CVCs to the skin contributes to catheter failure, particularly CVCs placed in the jugular vein, which are highly vulnerable to pullout forces. This study evaluated the effectiveness of medical liquid adhesive (MLA) for improving jugular CVC dressing adhesion.

DESIGN

Multisite parallel group, superiority, randomized controlled trial.

SETTING

Four metropolitan Australian ICUs.

PATIENTS

Eligible patients were 18 years old or older, within 12 hours of jugular CVC insertion, expected to need the CVC for greater than or equal to 72 hours, and remain in ICU for greater than or equal to 24 hours.

INTERVENTIONS

Patients were randomly allocated (stratified by hospital and gender) to standard CVC dressings with the application of MLA to skin under the dressing border (intervention) or standard care CVC dressings (control).

MEASUREMENTS AND MAIN RESULTS

The primary endpoint was dressing failure within 7 days due to lifting edges. Secondary outcomes included the total number of dressing changes, skin injury, and CVC failure. In total, 160 participants (82 control; 78 intervention) were enrolled. There were 22 (28%) and 41 (50%) cases of premature dressing failure in the intervention and control groups respectively (odds ratio, 0.39; 95% CI, 0.20-0.76; p = 0.005). The intervention group had fewer dressing changes (incidence rate ratio [IRR], 0.74; 95% CI, 0.55-0.99). Time to dressing failure (log-rank test; p = 0.12) and all-cause CVC failure (IRR, 1.44; 95% CI, 0.36-5.79) did not differ between groups. Three skin injuries occurred: one in the intervention (blister) and two in the control (maceration and skin tear) groups.

CONCLUSIONS

MLA is associated with significantly decreased jugular CVC dressing failure and longer dressing dwell, with an acceptable safety profile. MLA should be considered to preserve jugular CVC dressings in ICU.

Immediate single-tooth implant placement in bony defect sites: A 10-year randomized controlled trial

BACKGROUND

It is unclear whether an intact buccal bony plate is a prerequisite for immediate implant placement in postextraction sockets. The aim of this 10-year randomized controlled trial was to compare peri-implant soft and hard tissue parameters, esthetic ratings of, and patient-reported satisfaction with immediate implant placement in postextraction sockets with buccal bony defects ≥5 mm in the esthetic zone versus delayed implant placement after alveolar ridge preservation.

METHODS

Patients presenting a failing tooth in the esthetic region and a buccal bony defect ≥5 mm after an extraction were randomly assigned to immediate (Immediate Group, n = 20) or delayed (Delayed Group, n = 20) implant placement. The second-stage surgery and provisional restoration placement occurred 3 months after implant placement in both groups, followed by definitive restorations 3 months thereafter. During a 10-year follow-up period, marginal bone levels (primary outcome), buccal bone thickness, soft tissue parameters, esthetics, and patient-reported satisfaction were recorded.

RESULTS

The mean marginal bone level change was -0.71 ± 0.59 mm and -0.36 ± 0.39 mm in the Immediate Group and the Delayed Group after 10 years (p = 0.063), respectively. The secondary outcomes were not significantly different between both groups.

CONCLUSIONS

Marginal bone level changes, buccal bone thickness, clinical outcomes, esthetics, and patients' satisfaction following immediate implant placement, in combination with bone augmentation in postextraction sockets with buccal bony defects ≥5 mm, were not statistically different to those following delayed implant placement after ridge preservation in the esthetic zone.

PLAIN LANGUAGE SUMMARY

Immediate implant placement in case of a failing tooth is a favorable treatment option for patients because it considerably shortens treatment time and the number of surgical treatments. The question is if an intact buccal bone wall is necessary for immediate implant placement. A 10-year study was performed in which 20 patients with a failing tooth in the frontal region of the upper jaw were treated with immediate implant placement and were compared with 20 patients in whom a more conventional treatment strategy was followed in which the failing tooth was first removed and the bone gap restored and the implant placed in a second step. After a 10-year follow-up period, it appeared that the bone around the implant was very stable, gums were healthy, and patients were very satisfied with the result. There was no difference between the two treatment procedures. Such results mean that professionals can discuss the procedure with the patient and apply the individual's preference.

Efficacy of a group-based 8-week multicomponent cognitive training on cognition, mood and activities of daily living among healthy older adults: A two-year follow-up of a randomized controlled trial

BACKGROUND

Cognitive training (CT) has been one of the important non-pharmaceutical interventions that could delay cognitive decline. Currently, no definite CT methods are available. Furthermore, little attention has been paid to the effect of CT on mood and instrumental activities of daily living (IADL).

OBJECTIVES

To assess the effectiveness of a multicomponent CT using a training program of executive functions, attention, memory and visuospatial functions (TEAM-V Program) on cognition, mood and instrumental ADL.

DESIGN

A randomized, single-blinded, treatment-as-usual controlled trial.

SETTING

Geriatric clinic in Bangkok, Thailand.

PARTICIPANTS

80 nondemented community-dwelling older adults (mean age 65.7 ± 4.3 years).

INTERVENTION

The CT (TEAM-V) Program or the treatment-as-usual controlled group. The TEAM-V intervention was conducted over 5 sessions, with a 2-week interval between each session. A total of 80 participants were randomized (n = 40 the TEAM-V Program; n = 40 the control group).

MEASUREMENTS

The Thai version of Montreal Cognitive Assessment (MoCA), The Alzheimer's Disease Assessment Scale-Cognitive Subscale (ADAS-cog), Thai version of Hospital Anxiety and Depression Scale (HADS) and The Chula ADL were used to assess at baseline, 6 months, 1 year and 2 years.

RESULTS

Compared with the control arm (n = 36), the TEAM-V Program (n = 39) was associated with significantly improved general cognition (MoCA, P = 0.02) at 2 years. Compared with baseline, participants receiving the TEAM-V Program were associated with significantly improved immediate recall (word recall task, P < 0.001), retrieval and retention of memory processes (word recognition task, P = 0.01) and attention (number cancellation part A, P = 0.01) at 2 years. No training effects on anxiety (P = 0.94), depression (P = 0.093) and IADL (P = 0.48) were detected.

CONCLUSIONS

The TEAM-V Program was effective in improving global cognitive function. Even though, the program did not significantly improve anxiety, depression and IADL compared with the control group, memory and attention improved in the intervention group compared with baseline. Further studies incorporating a larger sample size, longitudinal follow-up and higher-intensity CT should be conducted.

Effectiveness of an Intervention to Prevent Ultra-Processed Foods and Added Sugar in the First Year of Life: A Multicentre Randomised Controlled Trial in Brazil

BACKGROUND

The early consumption of ultra-processed foods (UPFs) and added sugars (AS) has been linked to adverse outcomes in infancy. The objective of this study was to determine the effectiveness of a dietary counselling strategy to prevent the consumption of UPFs and AS in the first year of life.

METHODOLOGY

A multicentre randomised controlled trial was conducted with 516 mother-child pairs in three state capitals of Brazil. Mothers were randomly assigned to the control group (CG) or intervention group (IG) after childbirth. The IG received orientation based on UNICEF dietary guidelines and five monthly telephone calls to reinforce the intervention. Dietary intake was measured using food introduction questionnaires and 24-h recalls during home visits at 6 and 12 months. Between-group differences were analysed by generalised estimating equations and presented as mean difference (95% CI).

RESULTS

Children in the IG had lower UPF intake at 6 and 12 months of age (-20.69 g/day; 95% CI: -37.87 to -3.50; p = 0.018 and -32.51 g/day; 95% CI: -61.03 to -3.99; p = 0.025) and lower AS intake at 12 months of age (-4.92 g/day; 95% CI: -9.43 to -0.41; p = 0.033). The intervention also had a positive impact on the period of exclusive breastfeeding, reducing the offer of infant formula, cow's milk, and toddler milk in the first year of life.

PRINCIPAL CONCLUSIONS

The dietary counselling strategy was effective at preventing the early consumption of UPFs and AS in the first year of life. Future research should focus on social and cultural barriers to improve adherence to infant feeding interventions.

PETRICCS Guideline Protocol: A Call to Improve Reporting Standards in Cell Culture Research

BACKGROUND

Cell culture studies play an important role in addressing fundamental scientific questions. However, inadequate reporting of these studies results in a lack of transparency and reproducibility. Recognizing the need for improvement, several ongoing efforts, such as CRIS guidelines and the ICLAC checklist, are focused on enhancing best practices for in vitro studies. Nonetheless, a comprehensive guideline specifically addressing the reporting of cell culture methods remains lacking. In this manner, a consensus-based approach is being undertaken to develop the Preferred and Transparent Reporting Items for Cell Culture Studies (PETRICCS) guideline. This project aims to present the protocol and the details for its development.

METHODS

The process comprises five phases: (i) Initial Steps: a Steering Committee identifies the need for a guideline and drafts the PETRICCS protocol; (ii) Pre-meeting: an International Group of Cell Culture Experts (IGCE) reviews the draft guideline through a Delphi consensus exercise; (iii) Consensus Meeting: the steering committee presents the guideline's development, addresses concerns, and reaches consensus on the final items; (iv) Post-meeting: explanatory documents are prepared to assist authors in reporting their findings; and (v) Post-publication: PETRICCS, along with supporting documents, is published and made freely accessible.

RESULTS AND CONCLUSIONS

PETRICCS will assist researchers in reporting and reviewing cell culture findings, enhancing transparency and reproducibility while filling a gap in this crucial scientific field. The guideline will incorporate the experiences of experts, creating a more equitable environment for authors, peer-reviewers, and editors during the publication process.

Three-dimensional assessment on digital cast of spontaneous upper first molar distorotation after Ni-ti leaf springs expander and rapid maxillary expander: A two-centre randomized controlled trial

OBJECTIVE

The aim of this randomized controlled trial (RCT) was to evaluate the spontaneous distorotation of upper first permanent molars and the transverse dentoalveolar changes on digital casts in growing patients following maxillary expansion treatment using either the Leaf Expander® or the rapid maxillary expander (RME), both anchored to the deciduous second molar.

TRIAL DESIGN AND SETTING

This study was a two-arm, parallel-assignment, RCT with a dual-centre design conducted at two teaching hospitals in Italy.

PARTICIPANTS

Inclusion criteria included maxillary transverse deficiency, prepubertal development stage (cervical vertebra maturation stage [CVMS] 1-2) and early mixed dentition with fully erupted upper first permanent molars. Exclusion criteria were systemic diseases or syndromes, CVMS 3-6, agenesis of upper second premolars, unavailability of the second deciduous molar for anchorage and Class III malocclusion.

RANDOMIZATION

Patients were randomly assigned to the Leaf Expander® or RME group using a computer-generated randomization list created by a central randomization centre. Randomization was conducted immediately before the start of treatment.

INTERVENTION

The intervention involved treatment with either the Leaf Expander® or the RME. Both devices were anchored to the second deciduous molars. Following randomization, patients were further categorized based on the presence of no crossbite, unilateral crossbite or bilateral crossbite.

MAIN OUTCOME MEASURE

The primary outcome measure was the distorotation of the upper first molar (U6). Secondary outcomes included measurements of interdental linear dimensions, specifically upper inter-canine width (53-63), upper inter-molar width (MV16-MV26) and upper inter-deciduous second molar width (55-65).

BLINDING

The examiner analysing the digital casts was blinded to the treatment groups to prevent detection bias and ensure objective assessment. However, due to the nature of the intervention, blinding was not feasible for the patients and clinicians involved in administering the treatment.

RESULTS

A total of 150 patients were enrolled and randomly assigned to two groups: 75 to the Leaf Expander® group and 75 to the RME group. Recruitment started in November 2021 and was completed in November 2022. At the time of analysis, the trial was complete with no ongoing follow-ups. ANOVA tests revealed no significant differences between the three subgroups (no-cross, unilateral-cross and bilateral-cross) within both the Leaf Expander® and RME groups at T0. The Leaf Expander® demonstrated significantly greater distorotation in the unilateral crossbite subgroup compared to the RME (p = .014). In terms of total molar distorotation, the Leaf Expander® appliance showed a significantly greater effect (12.66°) compared with conventional RME (7.83°). Linear regression analysis demonstrated a significant correlation between the extent of expansion and the degree of molar rotation.

CONCLUSIONS

Maxillary expansion resulted in significant spontaneous molar distorotation when the appliance was bonded to the second deciduous molars. The Leaf Expander® exhibited significantly greater molar distorotation compared with conventional RME. The degree of molar distorotation was correlated with the extent of expansion obtained on the second deciduous molar.

TRIAL REGISTRATION

The trial was registered at ClinicalTrials.gov (ID: NCT05135962).