1
|
Capion T, Lilja-Cyron A, Olsen MH, Juhler M, Møller K, Sorteberg A, Rønning PA, Poulsen FR, Wismann J, Ravlo C, Isaksen J, Lindschou J, Gluud C, Mathiesen T. Prompt closure versus gradual weaning of external ventricular drainage for hydrocephalus following aneurysmal subarachnoid haemorrhage: Protocol for the DRAIN randomised clinical trial. Acta Anaesthesiol Scand 2023; 67:1121-1127. [PMID: 37165711 DOI: 10.1111/aas.14263] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2023] [Accepted: 04/29/2023] [Indexed: 05/12/2023]
Abstract
BACKGROUND Aneurysmal subarachnoid haemorrhage (aSAH) is a life-threatening disease caused by rupture of an intracranial aneurysm. A common complication following aSAH is hydrocephalus, for which placement of an external ventricular drain (EVD) is an important first-line treatment. Once the patient is clinically stable, the EVD is either removed or replaced by a ventriculoperitoneal shunt. The optimal strategy for cessation of EVD treatment is, however, unknown. Gradual weaning may increase the risk of EVD-related infection, whereas prompt closure carries a risk of acute hydrocephalus and redundant shunt implantations. We designed a randomised clinical trial comparing the two commonly used strategies for cessation of EVD treatment in patients with aSAH. METHODS DRAIN is an international multi-centre randomised clinical trial with a parallel group design comparing gradual weaning versus prompt closure of EVD treatment in patients with aSAH. Participants are randomised to either gradual weaning which comprises a multi-step increase of resistance over days, or prompt closure of the EVD. The primary outcome is a composite outcome of VP-shunt implantation, all-cause mortality, or ventriculostomy-related infection. Secondary outcomes are serious adverse events excluding mortality, functional outcome (modified Rankin scale), health-related quality of life (EQ-5D) and Fatigue Severity Scale (FSS). Outcome assessment will be performed 6 months after ictus. Based on the sample size calculation (event proportion 80% in the gradual weaning group, relative risk reduction 20%, type I error 5%, power 80%), 122 patients are needed in each intervention group. Outcome assessment for the primary outcome, statistical analyses and conclusion drawing will be blinded. TRIAL REGISTRATION ClinicalTrials.gov identifier: NCT03948256.
Collapse
Affiliation(s)
- Tenna Capion
- Department of Neurosurgery, The Neuroscience Centre, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - Alexander Lilja-Cyron
- Department of Neurosurgery, The Neuroscience Centre, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - Markus Harboe Olsen
- Copenhagen Trial Unit, Centre for Clinical Intervention Research, The Capital Region, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
- Department of Neuroanaesthesiology, The Neuroscience Centre, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - Marianne Juhler
- Department of Neurosurgery, The Neuroscience Centre, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Kirsten Møller
- Department of Neuroanaesthesiology, The Neuroscience Centre, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | | | | | - Frantz Rom Poulsen
- Department of Neurosurgery, Odense University Hospital, Odense, Denmark
- BRIDGE (Brain Research-Inter Disciplinary Guided Excellence), University of Southern Denmark, Odense, Denmark
| | - Joakim Wismann
- Department of Neurosurgery, Odense University Hospital, Odense, Denmark
- BRIDGE (Brain Research-Inter Disciplinary Guided Excellence), University of Southern Denmark, Odense, Denmark
| | - Celina Ravlo
- Department of Neurosurgery, Ophthalmology and Otorhinolaryngology, Division of Clinical Neurosciences, University Hospital of North Norway, Tromsø, Norway
- Department of Clinical Medicine, Faculty of Health Sciences, UiT The Arctic University of Norway, Tromsø, Norway
| | - Jørgen Isaksen
- Department of Neurosurgery, Ophthalmology and Otorhinolaryngology, Division of Clinical Neurosciences, University Hospital of North Norway, Tromsø, Norway
- Department of Clinical Medicine, Faculty of Health Sciences, UiT The Arctic University of Norway, Tromsø, Norway
| | - Jane Lindschou
- Copenhagen Trial Unit, Centre for Clinical Intervention Research, The Capital Region, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - Christian Gluud
- Copenhagen Trial Unit, Centre for Clinical Intervention Research, The Capital Region, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
- Department of Regional Health Research, The Faculty of Health Sciences, University of Southern Denmark, Odense, Denmark
| | - Tiit Mathiesen
- Department of Neurosurgery, The Neuroscience Centre, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| |
Collapse
|
2
|
Hansen ML, Jørgensen CK, Thabane L, Rulli E, Biagioli E, Chiaruttini M, Mbuagbaw L, Mathiesen O, Gluud C, Jakobsen JC. Observed intervention effects for mortality in randomised clinical trials: a methodological study protocol. BMJ Open 2023; 13:e072550. [PMID: 37316319 DOI: 10.1136/bmjopen-2023-072550] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/16/2023] Open
Abstract
INTRODUCTION It is essential to choose a realistic anticipated intervention effect when calculating a sample size for a randomised clinical trial. Unfortunately, anticipated intervention effects are often inflated, when compared with the 'true' intervention effects. This is documented for mortality in critical care trials. A similar pattern might exist across different medical specialties. This study aims to estimate the range of observed intervention effects for all-cause mortality in trials included in Cochrane Reviews, within each Cochrane Review Group. METHODS AND ANALYSIS We will include randomised clinical trials assessing all-cause mortality as an outcome. Trials will be identified from Cochrane Reviews published in the Cochrane Database of Systematic Reviews. Cochrane Reviews will be clustered according to the registered Cochrane Review Group (eg, Anaesthesia, Emergency and Critical Care) and the statistical analyses will be conducted for each Cochrane Review Group and overall. The median relative risk and IQR for all-cause mortality and the proportion of trials with a relative all-cause mortality risk within seven different ranges will be reported (relative risk below 0.70, 0.70-0.79, 0.80-0.89, 0.90-1.09, 1.10-1.19, 1.20-1.30 and above 1.30). Subgroup analyses will explore the effects of original design, sample size, risk of bias, disease, intervention type, follow-up length, participating centres, funding type, information size and outcome hierarchy. ETHICS AND DISSEMINATION Since we will use summary data from trials already approved by relevant ethical committees, this study does not require ethical approval. Regardless of our findings, the results will be published in an international peer-reviewed journal.
Collapse
Affiliation(s)
- Mathias Lühr Hansen
- Department of Neonatology, Copenhagen University Hospital - Rigshospitalet, Copenhagen, Denmark
- Copenhagen Trial Unit, Centre for Clinical Intervention Research, The Capital Region, Copenhagen University Hospital - Rigshospitalet, Copenhagen, Denmark
| | - Caroline Kamp Jørgensen
- Copenhagen Trial Unit, Centre for Clinical Intervention Research, The Capital Region, Copenhagen University Hospital - Rigshospitalet, Copenhagen, Denmark
- Department of Regional Health Research, The Faculty of Health Sciences, University of Southern Denmark, Odense, Denmark
| | - Lehana Thabane
- Department of Health Research Methods, Evidence, and Impact, McMaster University, and St Joseph's Healthcare, Hamilton, Ontario, Canada
- Faculty of Health Sciences, University of Johannesburg, Johannesburg, South Africa
| | - Eliana Rulli
- Methodology for Clinical Research Laboratory, Oncology Department, Istituto di Ricerche Farmacologiche Mario Negri IRCCS, Milan, Italy
| | - Elena Biagioli
- Methodology for Clinical Research Laboratory, Oncology Department, Istituto di Ricerche Farmacologiche Mario Negri IRCCS, Milan, Italy
| | - Maria Chiaruttini
- Methodology for Clinical Research Laboratory, Oncology Department, Istituto di Ricerche Farmacologiche Mario Negri IRCCS, Milan, Italy
| | - Lawrence Mbuagbaw
- Department of Health Research Methods, Evidence, and Impact, McMaster University, and St Joseph's Healthcare, Hamilton, Ontario, Canada
- Centre for Development of Best Practices in Health (CDBPH), Yaoundé Central Hospital, Yaoundé, Cameroon
| | - Ole Mathiesen
- Department of Clinical Medicine, Copenhagen University, Copenhagen, Denmark
- Centre for Anaesthesiological Research, Department of Anaesthesiology, Zealand University Hospital, Køge, Denmark
| | - Christian Gluud
- Copenhagen Trial Unit, Centre for Clinical Intervention Research, The Capital Region, Copenhagen University Hospital - Rigshospitalet, Copenhagen, Denmark
- Department of Regional Health Research, The Faculty of Health Sciences, University of Southern Denmark, Odense, Denmark
| | - Janus Christian Jakobsen
- Copenhagen Trial Unit, Centre for Clinical Intervention Research, The Capital Region, Copenhagen University Hospital - Rigshospitalet, Copenhagen, Denmark
- Department of Regional Health Research, The Faculty of Health Sciences, University of Southern Denmark, Odense, Denmark
| |
Collapse
|
3
|
Olsen MH, Almdal TP, Madsbad S, Ovesen C, Gluud C, Sneppen SB, Breum L, Hedetoft C, Krarup T, Lundby-Christensen L, Mathiesen ER, Røder ME, Vestergaard H, Wiinberg N, Jakobsen JC. Quality of life, patient satisfaction, and cardiovascular outcomes of the randomised 2 x 3 factorial Copenhagen insulin and Metformin therapy (CIMT) trial - A detailed statistical analysis plan. Contemp Clin Trials Commun 2023; 33:101095. [PMID: 36923108 PMCID: PMC10009439 DOI: 10.1016/j.conctc.2023.101095] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2022] [Revised: 02/07/2023] [Accepted: 02/17/2023] [Indexed: 03/06/2023] Open
Abstract
Background The evidence on the effects of metformin and insulin in type 2 diabetes patients on quality of life, patient satisfaction, and cardiovascular outcomes is unclear. Methods The Copenhagen Insulin and Metformin Therapy (CIMT) trial is an investigator-initiated multicentre, randomised, placebo-controlled trial with a 2 × 3 factorial design conducted at eight hospitals in Denmark. Participants with type 2 diabetes were randomised to metformin (n = 206) versus placebo (n = 206); in combination with open-label biphasic insulin aspart one to three times daily (n = 137) versus insulin aspart three times daily in combination with insulin detemir once daily (n = 138) versus insulin detemir once daily (n = 137).We present a detailed description of the methodology and statistical analysis of the clinical CIMT outcomes including a detailed description of tests of the assumptions behind the statistical analyses. The outcomes are quality of life (Short Form Health Survey (SF-36)), Diabetes Medication Satisfaction Questionnaire, and Insulin Treatment Satisfaction Questionnaire (assessed at entry and 18 months after randomisation) and cardiovascular outcomes including time to a composite of either myocardial infarction, stroke, peripheral amputation, coronary revascularisation, peripheral revascularisation, or death. Discussions This statistical analysis plan ensure the highest possible quality of the subsequent post-hoc analyses. Trial registration The protocol was approved by the Regional Committee on Biomedical Research Ethics (H-D-2007-112), the Danish Medicines Agency (EudraCT: 2007-006665-33 CIMT), and registered within ClinicalTrials.gov (NCT00657943, 8th of April 2008).
Collapse
Affiliation(s)
- Markus Harboe Olsen
- Copenhagen Trial Unit, Centre for Clinical Intervention Research, Copenhagen University Hospital - Rigshospitalet, The Capital Region, Copenhagen, Denmark.,Department of Neuroanaesthesiology, The Neuroscience Centre, Copenhagen University Hospital - Rigshospitalet, Copenhagen, Denmark
| | - Thomas P Almdal
- Department of Endocrinology, Centre for Cancer and Organ Diseases, Copenhagen University Hospital - Rigshospitalet, Copenhagen, Denmark
| | - Sten Madsbad
- Department of Endocrinology, Copenhagen University Hospital - Amager and Hvidovre, Copenhagen, Denmark
| | - Christian Ovesen
- Copenhagen Trial Unit, Centre for Clinical Intervention Research, Copenhagen University Hospital - Rigshospitalet, The Capital Region, Copenhagen, Denmark.,Department of Neurology, Copenhagen University Hospital - Bispebjerg and Frederiksberg, Copenhagen, Denmark
| | - Christian Gluud
- Copenhagen Trial Unit, Centre for Clinical Intervention Research, Copenhagen University Hospital - Rigshospitalet, The Capital Region, Copenhagen, Denmark.,Department of Regional Health Research, The Faculty of Health Sciences, University of Southern Denmark, Odense, Denmark
| | - Simone B Sneppen
- Section of Endocrinology, Department of Internal Medicine, Copenhagen University Hospital - Herlev and Gentofte, Copenhagen, Denmark
| | - Leif Breum
- Department of Medicine and Endocrinology, Zealand University Hospital, Køge, Denmark
| | - Christoffer Hedetoft
- Department of Medicine and Endocrinology, Zealand University Hospital, Køge, Denmark
| | | | | | - Elisabeth R Mathiesen
- Department of Endocrinology, Centre for Cancer and Organ Diseases, Copenhagen University Hospital - Rigshospitalet, Copenhagen, Denmark.,Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Michael E Røder
- Steno Diabetes Center Odense, Odense University Hospital, Odense, Denmark
| | - Henrik Vestergaard
- Department of Medicine, Bornholms Hospital, Rønne, Denmark.,Novo Nordisk Foundation Center for Basic Metabolic Research, University of Copenhagen, Copenhagen, Denmark
| | - Niels Wiinberg
- Department of Clinical Physiology and Nuclear Medicine, Copenhagen University Hospital - Bispebjerg and Frederiksberg, Copenhagen, Denmark
| | - Janus C Jakobsen
- Copenhagen Trial Unit, Centre for Clinical Intervention Research, Copenhagen University Hospital - Rigshospitalet, The Capital Region, Copenhagen, Denmark.,Department of Regional Health Research, The Faculty of Health Sciences, University of Southern Denmark, Odense, Denmark
| |
Collapse
|
4
|
Marchi M, Magarini FM, Galli G, Mordenti F, Travascio A, Uberti D, De Micheli E, Pingani L, Ferrari S, Galeazzi GM. The effect of ketamine on cognition, anxiety, and social functioning in adults with psychiatric disorders: A systematic review and meta-analysis. Front Neurosci 2022; 16:1011103. [PMID: 36507365 PMCID: PMC9730521 DOI: 10.3389/fnins.2022.1011103] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2022] [Accepted: 11/07/2022] [Indexed: 11/25/2022] Open
Abstract
Background It has been shown that ketamine can improve suicidality and depression. Evidence for other dimensions of psychopathology is lacking. We undertook a systematic review to investigate the effect of ketamine on cognition, anxiety, quality of life, and social functioning in adults with psychiatric disorders. Methods PubMed (Medline), Scopus, PsycINFO, and EMBASE were searched up to April 2022. Randomized controlled trials (RCTs) on ketamine [or its S (+) enantiomer] reporting data on cognition, anxiety, quality of life, social functioning in adults with psychiatric disorders were included. Standardized mean difference (SMD) was used for summarizing continuous outcomes. Results Twenty-two reports were included in the final selection, of which 20, corresponding to 1,298 participants, were included in the quantitative synthesis. Affective disorders were the predominant diagnostic category. Median follow-up time was 21 days. The evidence was rated moderate to very low. In most trials, ketamine was administered intravenously or as adjuvant to electro-convulsant therapy (ECT). Only 2 trials of intranasal esketamine were identified. The effect of ketamine on depression was confirmed (SMD: -0.61 [95% CI: -1.06; -0.16]). Furthermore, by pooling results of 6 RCTs, ketamine may be effective in reducing anxiety symptoms (SMD: -0.42 [95% CI: -0.84; 0.003]), particularly when administered not within ECT (5 trials; SMD: -0.58 [95% CI: -1.07; -0.09]). However, there was moderate heterogeneity of results. Patients treated with ketamine also had an improvement in social functioning (SMD: -0.31 [95% CI: -0.52; -0.10]), although the estimate was based only on 2 studies. No difference to comparators was found with respect to cognition and quality of life. Conclusion Alongside the antidepressant effect, ketamine may also improve anxiety and social functioning in adults with affective disorders.
Collapse
Affiliation(s)
- Mattia Marchi
- Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Modena, Italy,Dipartimento ad Attività Integrata di Salute Mentale e Dipendenze Patologiche, Azienda USL-IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Federica Maria Magarini
- Department of Mental Health and Drug Abuse, Azienda Unità Sanitaria Locale (AUSL) Modena, Modena, Italy
| | | | - Federico Mordenti
- Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Modena, Italy
| | - Antonio Travascio
- Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Modena, Italy
| | - Daniele Uberti
- Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Modena, Italy
| | - Edoardo De Micheli
- Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Modena, Italy
| | - Luca Pingani
- Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Modena, Italy,Dipartimento ad Attività Integrata di Salute Mentale e Dipendenze Patologiche, Azienda USL-IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Silvia Ferrari
- Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Modena, Italy,Dipartimento ad Attività Integrata di Salute Mentale e Dipendenze Patologiche, Azienda USL-IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Gian Maria Galeazzi
- Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Modena, Italy,Dipartimento ad Attività Integrata di Salute Mentale e Dipendenze Patologiche, Azienda USL-IRCCS di Reggio Emilia, Reggio Emilia, Italy,*Correspondence: Gian Maria Galeazzi
| |
Collapse
|
5
|
Henn M, Martin-Gorgojo V, Martin-Moreno JM. Vitamin D in Cancer Prevention: Gaps in Current Knowledge and Room for Hope. Nutrients 2022; 14:4512. [PMID: 36364774 PMCID: PMC9657468 DOI: 10.3390/nu14214512] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2022] [Revised: 10/20/2022] [Accepted: 10/21/2022] [Indexed: 08/03/2023] Open
Abstract
Intensive epigenome and transcriptome analyses have unveiled numerous biological mechanisms, including the regulation of cell differentiation, proliferation, and induced apoptosis in neoplastic cells, as well as the modulation of the antineoplastic action of the immune system, which plausibly explains the observed population-based relationship between low vitamin D status and increased cancer risk. However, large randomized clinical trials involving cholecalciferol supplementation have so far failed to show the potential of such interventions in cancer prevention. In this article, we attempt to reconcile the supposed contradiction of these findings by undertaking a thorough review of the literature, including an assessment of the limitations in the design, conduct, and analysis of the studies conducted thus far. We examine the long-standing dilemma of whether the beneficial effects of vitamin D levels increase significantly above a critical threshold or if the conjecture is valid that an increase in available cholecalciferol translates directly into an increase in calcitriol activity. In addition, we try to shed light on the high interindividual epigenetic and transcriptomic variability in response to cholecalciferol supplementation. Moreover, we critically review the standards of interpretation of the available study results and propose criteria that could allow us to reach sound conclusions in this field. Finally, we advocate for options tailored to individual vitamin D needs, combined with a comprehensive intervention that favors prevention through a healthy environment and responsible health behaviors.
Collapse
Affiliation(s)
- Matthias Henn
- Department of Preventive Medicine and Public Health, University of Navarra-IdiSNA (Instituto de Investigación Sanitaria de Navarra), 31008 Pamplona, Spain
- Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, MA 02115, USA
| | - Victor Martin-Gorgojo
- Biomedical Research Institute INCLIVA, Hospital Clínico Universitario de Valencia, 46010 Valencia, Spain
- Orthopedic Surgery and Traumatology Department, Hospital Clínico Universitario de Valencia, 46010 Valencia, Spain
| | - Jose M. Martin-Moreno
- Biomedical Research Institute INCLIVA, Hospital Clínico Universitario de Valencia, 46010 Valencia, Spain
- Department of Preventive Medicine and Public Health, Universitat de Valencia, 46010 Valencia, Spain
| |
Collapse
|
6
|
Olsen MH, Hagstrøm J, Lønfeldt NN, Uhre C, Uhre V, Pretzmann L, Christensen SH, Thoustrup C, Korsbjerg NLJ, Mora-Jensen ARC, Ritter M, Engstrøm J, Lindschou J, Siebner HR, Verhulst F, Jeppesen P, Jepsen JRM, Vangkilde S, Thomsen PH, Hybel K, Clemmesen LKH, Gluud C, Plessen KJ, Pagsberg AK, Jakobsen JC. Family-based cognitive behavioural therapy versus family-based relaxation therapy for obsessive-compulsive disorder in children and adolescents (the TECTO trial): a statistical analysis plan for the randomised clinical trial. Trials 2022; 23:854. [PMID: 36203215 PMCID: PMC9535232 DOI: 10.1186/s13063-022-06799-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2022] [Accepted: 09/28/2022] [Indexed: 11/20/2022] Open
Abstract
Background Obsessive-compulsive disorder (OCD) is a debilitating psychiatric disorder which affects up to 3% of children and adolescents. OCD in children and adolescents is generally treated with cognitive behavioural therapy (CBT), which, in more severely affected patients, can be combined with antidepressant medication. The TECTO trial aims to compare the benefits and harms of family-based CBT (FCBT) versus family-based psychoeducation/relaxation training (FPRT) in children and adolescents aged 8 to 17 years. This statistical analysis plan outlines the planned statistical analyses for the TECTO trial. Methods The TECTO trial is an investigator-initiated, independently funded, single-centre, parallel-group, superiority randomised clinical trial. Both groups undergo 14 sessions of 75 min each during a period of 16 weeks with either FCBT or FPRT depending on the allocation. Participants are randomised stratified by age and baseline Children’s Yale–Brown Obsessive-Compulsive Scale (CY-BOCS) score. The primary outcome is the CY-BOCS score. Secondary outcomes are health-related quality of life assessed using KIDSCREEN-10 and adverse events assessed by the Negative Effects Questionnaire (NEQ). Primary and secondary outcomes are assessed at the end of the intervention. Continuous outcomes will be analysed using linear regression adjusted for the stratification variables and baseline value of the continuous outcome. Dichotomous outcomes will be analysed using logistic regression adjusted for the stratification variables. The statistical analyses will be carried out by two independent blinded statisticians. Discussion This statistical analysis plan includes a detailed predefined description of how data will be analysed and presented in the main publication before unblinding of study data. Statistical analysis plans limit selective reporting bias. This statistical analysis plan will increase the validity of the final trial results. Trial registration ClinicalTrials.gov NCT03595098. July 23, 2018 Supplementary Information The online version contains supplementary material available at 10.1186/s13063-022-06799-4.
Collapse
Affiliation(s)
- Markus Harboe Olsen
- Copenhagen Trial Unit, Centre for Clinical Intervention Research, Copenhagen University Hospital - Rigshospitalet, Copenhagen, Denmark. .,Department of Neuroanaesthesiology, The Neuroscience Centre, Copenhagen University Hospital - Rigshospitalet, Copenhagen, Denmark.
| | - Julie Hagstrøm
- Child and Adolescent Mental Health Center, Copenhagen University Hospital, Mental Health Services CPH, Copenhagen, Denmark
| | - Nicole Nadine Lønfeldt
- Child and Adolescent Mental Health Center, Copenhagen University Hospital, Mental Health Services CPH, Copenhagen, Denmark
| | - Camilla Uhre
- Child and Adolescent Mental Health Center, Copenhagen University Hospital, Mental Health Services CPH, Copenhagen, Denmark.,Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Valdemar Uhre
- Child and Adolescent Mental Health Center, Copenhagen University Hospital, Mental Health Services CPH, Copenhagen, Denmark.,Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark.,Danish Research Centre for Magnetic Resonance, Centre for Functional and Diagnostic Imaging and Research, Copenhagen University Hospital - Amager and Hvidovre, Copenhagen, Denmark
| | - Linea Pretzmann
- Child and Adolescent Mental Health Center, Copenhagen University Hospital, Mental Health Services CPH, Copenhagen, Denmark.,Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Sofie Heidenheim Christensen
- Child and Adolescent Mental Health Center, Copenhagen University Hospital, Mental Health Services CPH, Copenhagen, Denmark
| | - Christine Thoustrup
- Child and Adolescent Mental Health Center, Copenhagen University Hospital, Mental Health Services CPH, Copenhagen, Denmark.,Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | | | - Anna-Rosa Cecilie Mora-Jensen
- Child and Adolescent Mental Health Center, Copenhagen University Hospital, Mental Health Services CPH, Copenhagen, Denmark.,Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Melanie Ritter
- Child and Adolescent Mental Health Center, Copenhagen University Hospital, Mental Health Services CPH, Copenhagen, Denmark
| | - Janus Engstrøm
- Copenhagen Trial Unit, Centre for Clinical Intervention Research, Copenhagen University Hospital - Rigshospitalet, Copenhagen, Denmark
| | - Jane Lindschou
- Copenhagen Trial Unit, Centre for Clinical Intervention Research, Copenhagen University Hospital - Rigshospitalet, Copenhagen, Denmark
| | - Hartwig Roman Siebner
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark.,Danish Research Centre for Magnetic Resonance, Centre for Functional and Diagnostic Imaging and Research, Copenhagen University Hospital - Amager and Hvidovre, Copenhagen, Denmark.,Department of Neurology, Copenhagen University Hospital - Bispebjerg and Frederiksberg, Copenhagen, Denmark
| | - Frank Verhulst
- Child and Adolescent Mental Health Center, Copenhagen University Hospital, Mental Health Services CPH, Copenhagen, Denmark.,Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Pia Jeppesen
- Child and Adolescent Mental Health Center, Copenhagen University Hospital, Mental Health Services CPH, Copenhagen, Denmark.,Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark.,Child and Adolescent Psychiatric Department, Region Zealand, Psychiatry, Research Unit, Roskilde, Denmark
| | - Jens Richardt Møllegaard Jepsen
- Child and Adolescent Mental Health Center, Copenhagen University Hospital, Mental Health Services CPH, Copenhagen, Denmark.,Center for Clinical Intervention and Neuropsychiatric Schizophrenia Research (CINS), Mental Health Center Glostrup, Copenhagen University Hospital - Rigshospitalet, Copenhagen, Denmark
| | - Signe Vangkilde
- Child and Adolescent Mental Health Center, Copenhagen University Hospital, Mental Health Services CPH, Copenhagen, Denmark.,Department of Psychology, Faculty Social Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Per Hove Thomsen
- Department of Child and Adolescent Psychiatry, Aarhus University Hospital, Aarhus, Denmark
| | - Katja Hybel
- Department of Child and Adolescent Psychiatry, Aarhus University Hospital, Aarhus, Denmark
| | | | - Christian Gluud
- Copenhagen Trial Unit, Centre for Clinical Intervention Research, Copenhagen University Hospital - Rigshospitalet, Copenhagen, Denmark.,Institute of Regional Health Research, The Faculty of Health Sciences, University of Southern Denmark, Odense, Denmark
| | - Kerstin Jessica Plessen
- Child and Adolescent Mental Health Center, Copenhagen University Hospital, Mental Health Services CPH, Copenhagen, Denmark.,Division of Child and Adolescent Psychiatry, Department of Psychiatry, Lausanne University Hospital (CHUV) and University of Lausanne, Lausanne, Switzerland
| | - Anne Katrine Pagsberg
- Child and Adolescent Mental Health Center, Copenhagen University Hospital, Mental Health Services CPH, Copenhagen, Denmark.,Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Janus Christian Jakobsen
- Copenhagen Trial Unit, Centre for Clinical Intervention Research, Copenhagen University Hospital - Rigshospitalet, Copenhagen, Denmark.,Institute of Regional Health Research, The Faculty of Health Sciences, University of Southern Denmark, Odense, Denmark
| |
Collapse
|
7
|
Kim S, Xu Y, Dore K, Gewurtz R, Larivière N, Letts L. Fatigue self-management led by occupational therapists and/or physiotherapists for chronic conditions: A systematic review and meta-analysis. Chronic Illn 2022; 18:441-457. [PMID: 34515530 PMCID: PMC9397391 DOI: 10.1177/17423953211039783] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
OBJECTIVE The aim of this study was to investigate the effectiveness of occupational therapist-/physiotherapist-guided fatigue self-management for individuals with chronic conditions. METHODS Eight databases, including MEDLINE and EMBASE, were searched until September 2019 to identify relevant studies. Randomised controlled trials and quasi-experimental studies of self-management interventions specifically developed or delivered by occupational therapists/physiotherapists to improve fatigue symptoms of individuals with chronic conditions were included. A narrative synthesis and meta-analysis were conducted to determine the effectiveness of fatigue self-management. RESULTS Thirty-eight studies were included, and fatigue self-management approaches led by occupational therapists/physiotherapists were divided into six categories based on the intervention focus: exercise, energy conservation, multimodal programmes, activity pacing, cognitive-behavioural therapy, and comprehensive fatigue management. While all exercise programmes reported significant improvement in fatigue, other categories showed both significant improvement and no improvement in fatigue. Meta-analysis yielded a standardised mean difference of the overall 13 studies: 0.42 (95% confidence interval:-0.62 to - 0.21); standardised mean difference of the seven exercise studies was -0.55 (95% confidence interval: -0.78 to -0.31). DISCUSSION Physical exercises inspired by the self-management principles may have positive impacts on fatigue symptoms, quality of life, and other functional abilities.
Collapse
Affiliation(s)
- Sungha Kim
- 63662School of Rehabilitation Science, 3710McMaster University, Hamilton, ON, Canada
| | - Ying Xu
- 63662School of Rehabilitation Science, 3710McMaster University, Hamilton, ON, Canada
| | - Kelly Dore
- Department of Medicine, 12362McMaster Education Research, Innovation & Theory (MERIT), 12370David Braley Health Science Centre, Hamilton, ON, Canada
| | - Rebecca Gewurtz
- 63662School of Rehabilitation Science, 3710McMaster University, Hamilton, ON, Canada
| | - Nadine Larivière
- Department of Medicine, 12362McMaster Education Research, Innovation & Theory (MERIT), 12370David Braley Health Science Centre, Hamilton, ON, Canada
| | - Lori Letts
- 63662School of Rehabilitation Science, 3710McMaster University, Hamilton, ON, Canada
| |
Collapse
|
8
|
Cannabidiol treatment for seizures in tuberous sclerosis complex. Epilepsy Behav 2022; 132:108761. [PMID: 35636350 DOI: 10.1016/j.yebeh.2022.108761] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/16/2022] [Accepted: 05/17/2022] [Indexed: 11/23/2022]
|
9
|
Critical Appraisal of Large Vitamin D Randomized Controlled Trials. Nutrients 2022; 14:nu14020303. [PMID: 35057483 PMCID: PMC8778517 DOI: 10.3390/nu14020303] [Citation(s) in RCA: 53] [Impact Index Per Article: 26.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2021] [Revised: 01/05/2022] [Accepted: 01/10/2022] [Indexed: 12/11/2022] Open
Abstract
As a consequence of epidemiological studies showing significant associations of vitamin D deficiency with a variety of adverse extra-skeletal clinical outcomes including cardiovascular diseases, cancer, and mortality, large vitamin D randomized controlled trials (RCTs) have been designed and conducted over the last few years. The vast majority of these trials did not restrict their study populations to individuals with vitamin D deficiency, and some even allowed moderate vitamin D supplementation in the placebo groups. In these RCTs, there were no significant effects on the primary outcomes, including cancer, cardiovascular events, and mortality, but explorative outcome analyses and meta-analyses revealed indications for potential benefits such as reductions in cancer mortality or acute respiratory infections. Importantly, data from RCTs with relatively high doses of vitamin D supplementation did, by the vast majority, not show significant safety issues, except for trials in critically or severely ill patients or in those using very high intermittent vitamin D doses. The recent large vitamin D RCTs did not challenge the beneficial effects of vitamin D regarding rickets and osteomalacia, that therefore continue to provide the scientific basis for nutritional vitamin D guidelines and recommendations. There remains a great need to evaluate the effects of vitamin D treatment in populations with vitamin D deficiency or certain characteristics suggesting a high sensitivity to treatment. Outcomes and limitations of recently published large vitamin D RCTs must inform the design of future vitamin D or nutrition trials that should use more personalized approaches.
Collapse
|
10
|
Effectiveness of Specific Techniques in Behavioral Teacher Training for Childhood ADHD Behaviors: Secondary Analyses of a Randomized Controlled Microtrial. Res Child Adolesc Psychopathol 2022; 50:867-880. [PMID: 35015187 PMCID: PMC9246781 DOI: 10.1007/s10802-021-00892-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/17/2021] [Indexed: 12/04/2022]
Abstract
Behavioral teacher training is an effective intervention for children with attention-deficit/hyperactivity disorder (ADHD). Intervention effectiveness may be enhanced by including intervention components that carry the strongest evidence for their effectiveness. A previous article of this group showed that both antecedent- (i.e., stimulus-control) and consequent-based (i.e., contingency management) techniques were highly effective in reducing daily teacher-rated, individually selected problem behaviors in a specific situation of the child. Effects were observed up to three months post intervention. Here, we tested whether effects were also present in teacher-rated and masked DSM-based assessments that comprise the full range of ADHD and oppositional defiant disorder (ODD) symptoms, as well as on teacher-rated impairment. Teachers of 90 children with (subthreshold) ADHD (6–12 years) were randomly assigned to one of three conditions: a short (two sessions), individualized intervention consisting of either a) antecedent-based techniques or b) consequent-based techniques; or c) waitlist. Multilevel analyses showed that both sets of techniques were effective in reducing teacher-rated ADHD symptoms and impairment immediately after the intervention and up to three months later, as compared to waitlist. Masked observations of ADHD behavior were in line with teacher ratings, with effects being most pronounced for inattention. No effects on teacher-rated or masked ODD behavior were found. This study showed that antecedent- and consequent-based techniques were effective in improving classroom ADHD symptoms and impairment. Long-term changes in teacher-rated ADHD are promising. These results extend previous findings and show the potential of short individually tailored interventions in classroom settings as treatment of ADHD symptoms.
Collapse
|
11
|
Cohen SP, Doshi TL, Kurihara C, Reece D, Dolomisiewicz E, Phillips CR, Dawson T, Jamison D, Young R, Pasquina PF. Multicenter study evaluating factors associated with treatment outcome for low back pain injections. Reg Anesth Pain Med 2021; 47:89-99. [PMID: 34880117 DOI: 10.1136/rapm-2021-103247] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2021] [Accepted: 11/10/2021] [Indexed: 01/03/2023]
Abstract
BACKGROUND There has been a worldwide surge in interventional procedures for low back pain (LBP), with studies yielding mixed results. These data support the need for identifying outcome predictors based on unique characteristics in a pragmatic setting. METHODS We prospectively evaluated the association between over two dozen demographic, clinical and technical factors on treatment outcomes for three procedures: epidural steroid injections (ESIs) for sciatica, and sacroiliac joint (SIJ) injections and facet interventions for axial LBP. The primary outcome was change in patient-reported average pain intensity on a numerical rating scale (average NRS-PI) using linear regression. For SIJ injections and facet radiofrequency ablation, this was average LBP score at 1 and 3 months postprocedure, respectively. For ESI, it was average leg pain 1- month postinjection. Secondary outcomes included a binary indicator of treatment response (success). RESULTS 346 patients were enrolled at seven hospitals. All groups experienced a decrease in average NRS-PI (p<0.0001; mean 1.8±2.6). There were no differences in change in average NRS-PI among procedural groups (p=0.50). Lower baseline pain score (adjusted coefficient -0.32, 95% CI -0.48 to -0.16, p<0.0001), depressive symptomatology (adjusted coefficient 0.076, 95% CI 0.039 to 0.113, p<0.0001) and obesity (adjusted coefficient 0.62, 95% CI 0.038 to 1.21, p=0.037) were associated with smaller pain reductions. For procedural outcome, depression (adjusted OR 0.94, 95% CI 0.91, 0.97, p<0.0001) and poorer baseline function (adjusted OR 0.59, 95% CI 0.36, 0.96, p=0.034) were associated with failure. Smoking, sleep dysfunction and non-organic signs were associated with negative outcomes in univariate but not multivariate analyses. CONCLUSIONS Identifying treatment responders is a critical endeavor for the viability of procedures in LBP. Patients with greater disease burden, depression and obesity are more likely to fail interventions. Steps to address these should be considered before or concurrent with procedures as considerations dictate. TRIAL REGISTRATION NUMBER NCT02329951.
Collapse
Affiliation(s)
- Steven P Cohen
- Department of Anesthesiology, Johns Hopkins School of Medicine, Baltimore, Maryland, USA .,Departments of Physical Medicine & Rehabilitation and Anesthesiology, Walter Reed National Military Medical Center, Bethesda, Maryland, USA
| | - Tina L Doshi
- Department of Anesthesiology, Johns Hopkins School of Medicine, Baltimore, Maryland, USA
| | - Connie Kurihara
- Department of Physical Medicine & Rehabilitation, Walter Reed National Military Medical Center, Bethesda, Maryland, USA
| | - David Reece
- Department of Physical Medicine & Rehabilitation, Walter Reed National Military Medical Center, Bethesda, Maryland, USA
| | - Edward Dolomisiewicz
- Department of Physical Medicine & Rehabilitation, Walter Reed National Military Medical Center, Bethesda, Maryland, USA
| | | | - Timothy Dawson
- Department of Anesthesiology, VA Puget Sound Health Care System Seattle Division, Seattle, Washington, USA
| | - David Jamison
- Department of Anesthesiology, Walter Reed National Military Medical Center, Bethesda, Maryland, USA
| | - Ryan Young
- Department of Surgery, Landstuhl Regional Medical Center, Landstuhl Kirchberg, Rheinland-Pfalz, Germany
| | - Paul F Pasquina
- Department of Physical Medicine & Rehabilitation, Walter Reed National Military Medical Center, Bethesda, Maryland, USA
| |
Collapse
|
12
|
Juul S, Simonsen S, Poulsen S, Lunn S, Sørensen P, Bateman A, Jakobsen JC. Detailed statistical analysis plan for the short-term versus long-term mentalisation-based therapy for outpatients with subthreshold or diagnosed borderline personality disorder randomised clinical trial (MBT-RCT). Trials 2021; 22:497. [PMID: 34321051 PMCID: PMC8316699 DOI: 10.1186/s13063-021-05450-y] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2021] [Accepted: 07/12/2021] [Indexed: 11/10/2022] Open
Abstract
Background Psychotherapy for borderline personality disorder is often extensive and resource-intensive. Mentalisation-based therapy is a psychodynamically oriented treatment option for borderline personality disorder, which includes a case formulation, psychoeducation, and group and individual therapy. The evidence on short-term compared with long-term mentalisation-based therapy is currently unknown. Methods/design The Short-Term MBT Project (MBT-RCT) is a single-centre, parallel-group, investigator-initiated, randomised clinical superiority trial in which short-term (20 weeks) will be compared with long-term (14 months) mentalisation-based therapy for outpatients with subthreshold or diagnosed borderline personality disorder. Outcome assessors, data managers, the data safety and monitoring committee, statisticians, and decision-makers will be blinded to treatment allocation. Participants will be assessed before randomisation and at 8, 16, and 24 months after randomisation. The primary outcome will be the severity of borderline symptomatology assessed with the Zanarini Rating Scale for Borderline Personality Disorder. Secondary outcomes will be functional impairment (Work and Social Adjustment Scale), quality of life (Short-Form Health Survey 36—mental component), global functioning (Global Assessment of Functioning), and proportion of participants with severe self-harm. In this paper, we present a detailed statistical analysis plan including a comprehensive explanation of the planned statistical analyses, methods to handle missing data, and assessments of the underlying statistical assumptions. Final statistical analyses will be conducted independently by two statisticians following the present plan. Discussion We have developed this statistical analysis plan before unblinding of the trial results in line with the Declaration of Helsinki and the International Conference on Harmonization of Good Clinical Practice Guidelines, which should increase the validity of the MBT-RCT trial by mitigation of analysis bias. Trial registration ClinicalTrials.gov NCT03677037. Registered on 19 September 2018 Supplementary Information The online version contains supplementary material available at 10.1186/s13063-021-05450-y.
Collapse
Affiliation(s)
- Sophie Juul
- Stolpegaard Psychotherapy Centre, Mental Health Services in the Capital Region of Denmark, Stolpegårdsvej 20, 2820, Gentofte, Denmark. .,Department of Psychology, University of Copenhagen, Copenhagen, Denmark. .,Copenhagen Trial Unit, Centre for Clinical Intervention Research, Department 7812, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark.
| | - Sebastian Simonsen
- Stolpegaard Psychotherapy Centre, Mental Health Services in the Capital Region of Denmark, Stolpegårdsvej 20, 2820, Gentofte, Denmark
| | - Stig Poulsen
- Department of Psychology, University of Copenhagen, Copenhagen, Denmark
| | - Susanne Lunn
- Department of Psychology, University of Copenhagen, Copenhagen, Denmark
| | - Per Sørensen
- Stolpegaard Psychotherapy Centre, Mental Health Services in the Capital Region of Denmark, Stolpegårdsvej 20, 2820, Gentofte, Denmark
| | | | - Janus Christian Jakobsen
- Copenhagen Trial Unit, Centre for Clinical Intervention Research, Department 7812, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark.,Department of Regional Health Research, The Faculty of Health Sciences, University of Southern Denmark, Odense, Denmark
| |
Collapse
|
13
|
Improving prediction for medical institution with limited patient data: Leveraging hospital-specific data based on multicenter collaborative research network. Artif Intell Med 2021; 113:102024. [PMID: 33685587 DOI: 10.1016/j.artmed.2021.102024] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2020] [Revised: 11/25/2020] [Accepted: 01/18/2021] [Indexed: 12/18/2022]
Abstract
BACKGROUND AND OBJECTIVE Clinical decision support assisted by prediction models usually faces the challenges of limited clinical data and a lack of labels when the model is developed with data from a single medical institution. Accordingly, research on multicenter clinical collaborative networks, which can provide external medical data, has received increasing attention. With the increasing availability of machine learning techniques such as transfer learning, leveraging large-scale patient data from multiple hospitals to build data-driven predictive models with clinical application potential provides an alternative solution to address the problem of limited patient data. METHODS A multicenter hybrid semi-supervised transfer learning model (MHSTL) is proposed in this study on the basis of unified common data model to ensure multicenter data standardized representation. Then the hospital-specific features, along with the co-occurrence features across domains, are aligned through a representation learning architecture that is built based on deep neural networks and the newly proposed neural decision forest model. In this process, limited patient data from the target hospital, both labeled and unlabeled, are incorporated during the feature adaptation process, thereby contributing to better model performance. Without patient-level data sharing, the proposed model learning strategy which overcomes feature misalignment and distribution divergence, enables the multi-source transfer learning process in the case of insufficient and unlabeled patient data at target hospital. RESULTS The effectiveness of the proposed transfer learning model was evaluated on a collaborative research network of colorectal cancer patients in the US and China. The results demonstrate that the proposed model can achieve much better performance for predicting target risk with limited resources on patient data than baseline models . Better discrimination and calibration ability are also observed when sufficient labeled data are not available in the target hospital for prognosis prediction tasks . Further exploratory experiments show that the proposed approach exhibits good model generalizability regardless of the data heterogeneity. With the help of the SHapley Additive exPlanations for model interpretation, the effectiveness of incorporating hospital-specific features in the transfer learning model is shown. CONCLUSIONS In this study, the proposed method can develop prediction models from multiple source hospitals and exhibit good performance by leveraging cross-domain hospital-specific feature information, therefore enhancing the model prediction when applied to single medical institution with limited patient data.
Collapse
|
14
|
Jakobsen JC, Dankiewicz J, Lange T, Cronberg T, Lilja G, Levin H, Bělohlávek J, Callaway C, Cariou A, Erlinge D, Hovdenes J, Joannidis M, Nordberg P, Oddo M, Pelosi P, Kirkegaard H, Eastwood G, Rylander C, Saxena M, Storm C, Taccone FS, Wise MP, Morgan MPG, Young P, Nichol A, Friberg H, Ullén S, Nielsen N. Targeted hypothermia versus targeted normothermia after out-of-hospital cardiac arrest: a statistical analysis plan. Trials 2020; 21:831. [PMID: 33028425 PMCID: PMC7542893 DOI: 10.1186/s13063-020-04654-y] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2020] [Accepted: 08/05/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND To date, targeted temperature management (TTM) is the only neuroprotective intervention after resuscitation from cardiac arrest that is recommended by guidelines. The evidence on the effects of TTM is unclear. METHODS/DESIGN The Targeted Hypothermia Versus Targeted Normothermia After Out-of-hospital Cardiac Arrest (TTM2) trial is an international, multicentre, parallel group, investigator-initiated, randomised, superiority trial in which TTM with a target temperature of 33 °C after cardiac arrest will be compared with a strategy to maintain normothermia and active treatment of fever (≥ 37.8 °C). Prognosticators, outcome assessors, the steering group, the trial coordinating team, and trial statisticians will be blinded to treatment allocation. The primary outcome will be all-cause mortality at 180 days after randomisation. We estimate a 55% mortality in the targeted normothermia group. To detect an absolute risk reduction of 7.5% with an alpha of 0.05 and 90% power, 1900 participants will be enrolled. The secondary neurological outcome will be poor functional outcome (modified Rankin scale 4-6) at 180 days after cardiac arrest. In this paper, a detailed statistical analysis plan is presented, including a comprehensive description of the statistical analyses, handling of missing data, and assessments of underlying statistical assumptions. Final analyses will be conducted independently by two qualified statisticians following the present plan. DISCUSSION This SAP, which was prepared before completion of enrolment, should increase the validity of the TTM trial by mitigation of analysis-bias.
Collapse
Affiliation(s)
- Janus Christian Jakobsen
- Copenhagen Trial Unit, Centre for Clinical Intervention Research, Department 7812, Rigshospitalet, Copenhagen University Hospital, Tagensvej 22, Copenhagen, Denmark. .,Department of Cardiology, Holbæk Hospital, Holbæk, Denmark. .,Department of Regional Health Research, The Faculty of Health Sciences, University of Southern Denmark, Odense, Denmark.
| | - Josef Dankiewicz
- Department of Clinical Sciences, Cardiology, Lund University, Skåne University Hospital, Lund, Sweden
| | - Theis Lange
- Section of Biostatistics, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Tobias Cronberg
- Department of Clinical Sciences, Neurology, Lund University, Skåne University Hospital, Lund, Sweden
| | - Gisela Lilja
- Department of Clinical Sciences, Neurology, Lund University, Skåne University Hospital, Lund, Sweden
| | - Helena Levin
- Department of Clinical Sciences, Research and Education, Lund University, Skåne University Hospital, Lund, Sweden
| | - Jan Bělohlávek
- 2nd Department of Medicine, First Faculty of Medicine, Charles University in Prague and General University Hospital, Prague, Czech Republic
| | - Clifton Callaway
- Department of Emergency Medicine, University of Pittsburgh, Pittsburgh, PA, USA
| | - Alain Cariou
- Medical Intensive Care Unit, Cochin University Hospital (APHP) and Paris Descartes University, Paris, France
| | - David Erlinge
- Department of Clinical Sciences, Cardiology, Lund University, Skåne University Hospital, Lund, Sweden
| | - Jan Hovdenes
- Department of Anesthesia and Intensive Care, Oslo University Hospital, Rikshospitalet, Oslo, Norway
| | - Michael Joannidis
- Division of Intensive Care and Emergency Medicine, Department of Internal Medicine, Medical University Innsbruck, Innsbruck, Austria
| | - Per Nordberg
- Department of Medicine, Center for Resuscitation Science, Karolinska Institute, Solna, Sweden
| | - Mauro Oddo
- Department of Intensive Care Medicine, Faculty of Biology and Medicine, Centre Hospitalier Universitaire Vaudois (CHUV) - University Hospital, University of Lausanne, Lausanne, Switzerland
| | - Paolo Pelosi
- Department of Surgical Sciences and Integrated Diagnostics (DISC), University of Genoa, Genoa, Italy.,San Martino Policlinico Hospital, IRCCS for Oncology and Neurosciences, University of Genoa, Genoa, Italy
| | - Hans Kirkegaard
- Research Center for Emergency Medicine, Department of Clinical Medicine, Aarhus University Hospital and Aarhus University, Aarhus N, Denmark
| | - Glenn Eastwood
- Department of Intensive Care, Austin Hospital, Heidelberg, Australia
| | - Christian Rylander
- Department of Anesthesiology and Intensive Care Medicine, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Manoj Saxena
- Bankstown Hospital Clinical School and The George Institute for Global Health, University of New South Wales, Kensington, Australia
| | - Christian Storm
- Department of Nephrology and Medical Intensive Care, Charité - Universitätsmedizin Berlin, Berlin, Germany.,Division of Neuroscience Critical Care, Department of Anesthesiology and Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Fabio Silvio Taccone
- Department of Intensive Care, Erasme University Hospital, Université Libre de Bruxelles (ULB), Brussels, Belgium
| | - Matthew P Wise
- Adult Critical Care, University Hospital of Wales, Cardiff, UK
| | - Matt P G Morgan
- Adult Critical Care, University Hospital of Wales, Cardiff, UK
| | - Paul Young
- Medical Research Institute of New Zealand, Wellington, New Zealand
| | - Alistair Nichol
- University Collage Dublin-Clinical Research Centre, St Vincent's University Hospital, Dublin, Ireland.,Australian and New Zealand Intensive Care-Research Centre, Monash University, Melbourne, Australia.,Department of Critical Care, Alfred Hospital, Melbourne, Australia
| | - Hans Friberg
- Department of Clinical Sciences, Anesthesia & Intensive Care, Lund University, Skåne University Hospital, Lund, Sweden
| | - Susann Ullén
- Clinical Studies Sweden, Skåne University Hospital, Lund, Sweden
| | - Niklas Nielsen
- Department of Clinical Sciences Lund, Anesthesia & Intensive Care, Lund University, Helsingborg Hospital, Lund, Sweden
| |
Collapse
|
15
|
Condon TM, Sexton RW, Wells AJ, To MS. The weakness of fragility index exposed in an analysis of the traumatic brain injury management guidelines: A meta-epidemiological and simulation study. PLoS One 2020; 15:e0237879. [PMID: 32810192 PMCID: PMC7433866 DOI: 10.1371/journal.pone.0237879] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2020] [Accepted: 08/04/2020] [Indexed: 11/18/2022] Open
Abstract
OBJECTIVES To perform fragility index (FI) analysis on the evidence that forms the basis of the guidelines for the management of severe traumatic brain injury (TBI), and develop a deeper understanding of the pitfalls associated with FI. DESIGN Meta-epidemiological analysis and numerical simulations. METHODS The Brain Trauma Foundation guidelines (4th edition) for management of severe TBI were used to identify relevant randomised controlled trials (RCTs). FI based on Fisher's exact test and relative risk was performed on eligible RCTs. The relationship between FI, event counts and P values was explored by exhaustively considering different combinations of outcomes for studies of total size ranging from 80 to 10000. Sample size calculations were also performed for a range of power, baseline risk and relative risk, to determine the influence of study design on FI. RESULTS FI analysis of the severe TBI management guidelines revealed that most studies were associated with a low FI. In the majority of studies, FI was of a similar magnitude to the number lost to follow-up. The simulations revealed that while FI was inversely related to P value, a wide range of FI may be associated with a given P value. FI is also affected by sample size, baseline risk and effect size. Sample size calculations suggest that aside from very high-powered studies, most are likely to yield low FI values in the range typically encountered in the literature. CONCLUSIONS Many studies are underpowered and are expected to be associated with a small FI. Furthermore, FI over-simplifies the complex, non-linear relationships between sample size, effect size and P value, which hinder comparisons of FI between studies. FI places undue importance on the "significance" of P values and accordingly should only be used sparingly.
Collapse
Affiliation(s)
- Thomas M. Condon
- Department of Intensive Care Medicine, Royal Adelaide Hospital, Adelaide, South Australia, Australia
| | - Richard W. Sexton
- Department of Emergency Medicine, Lyell McEwin Hospital, Elizabeth Vale, South Australia, Australia
| | - Adam J. Wells
- Faculty of Health and Medical Sciences, The University of Adelaide, Adelaide, South Australia, Australia
- Department of Neurosurgery, Royal Adelaide Hospital, Adelaide, South Australia, Australia
| | - Minh-Son To
- Division of Surgery and Perioperative Medicine, Flinders Medical Centre, Bedford Park, South Australia, Australia
- College of Medicine and Public Health, Flinders University, Bedford Park, South Australia, Australia
- * E-mail:
| |
Collapse
|
16
|
Gasbjerg KS, Hägi‐Pedersen D, Lunn TH, Overgaard S, Pedersen NA, Bagger J, Lindholm P, Brorson S, Schrøder HM, Thybo KH, Mathiesen O, Jakobsen JC. DEX-2-TKA - DEXamethasone twice for pain treatment after Total Knee Arthroplasty: Detailed statistical analysis plan for a randomized, blinded, three-group multicentre clinical trial. Acta Anaesthesiol Scand 2020; 64:839-846. [PMID: 32048274 DOI: 10.1111/aas.13560] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2020] [Accepted: 02/03/2020] [Indexed: 12/26/2022]
Abstract
BACKGROUND Optimization of post-operative pain treatment is of upmost importance. Multimodal analgesia is the main post-operative pain treatment principle, but the evidence on optimal analgesic combinations is unclear. With the "DEXamethasone twice for pain treatment after TKA" trial, we aim to investigate the role of one or two doses of glucocorticoid for post-operative pain treatment after total knee arthroplasty. To ensure transparency and minimization of bias, we present this article with a detailed statistical analysis plan, to be published before the last participant is enrolled. METHODS "DEXamethasone twice for pain treatment after TKA" (DEX-2-TKA) is a randomized, blinded, three-group multicentre clinical trial. Participants will be randomized to one of three intervention groups: single dose of iv dexamethasone 24 mg, two consecutive doses of iv dexamethasone 24 mg or matching iv placebo. All three intervention groups will receive paracetamol, NSAID (ibuprofen) and local infiltration analgesia. Participants, treatment providers, outcome assessors, data managers, statisticians and conclusion drawers will be blinded to the allocated intervention. The primary outcome is total opioid consumption (iv morphine milligram equivalents) 0-48 hours post-operatively. Secondary outcomes are (1) visual analogue scale pain levels: (a) during active 45 degrees flexion of the knee at 24 and 48 hours post-operatively, (b) at rest at 24 and 48 hours post-operatively, and (c) during 0-24 hours (highest score) and 24-48 hours post-operatively (highest score); and (2) the proportion of participants with one or more adverse events within 48 hours post-operatively. DISCUSSION The DEX-2-TKA trial will provide high quality data regarding benefits and harms of adding one or two high-doses of dexamethasone to a multimodal analgesic regimen. TRIAL REGISTRATION EudraCT: 2018-001099-39 (08/06-18); ClinicalTrials.gov: NCT03506789 (24/04-2019).
Collapse
Affiliation(s)
- Kasper S. Gasbjerg
- Department of Anaesthesiology Næstved‐Slagelse‐Ringsted Hospitals Næstved Denmark
| | - Daniel Hägi‐Pedersen
- Department of Anaesthesiology Næstved‐Slagelse‐Ringsted Hospitals Næstved Denmark
- Department of Regional Health Research The Faculty of Health Sciences University of Southern Denmark Odense Denmark
| | - Troels H. Lunn
- Department of Anaesthesiology Bispebjerg and Frederiksberg University Hospital Copenhagen Denmark
- Department of Clinical Medicine Faculty of Health and Medical Sciences Copenhagen University Copenhagen Denmark
| | - Søren Overgaard
- Orthopedic Research Unit Department of Orthopaedic Surgery and Traumatology Odense University Hospital Odense Denmark
- Department of Clinical Research University of Southern Denmark Odense Denmark
| | | | - Jens Bagger
- Department of Orthopaedics Bispebjerg and Frederiksberg University Hospital Copenhagen Denmark
| | - Peter Lindholm
- Department of Anaesthesiology and Intensive Care Odense University Hospital Odense Denmark
| | - Stig Brorson
- Department of Clinical Medicine Faculty of Health and Medical Sciences Copenhagen University Copenhagen Denmark
- Department of Orthopaedic Surgery Zealand University Hospital Køge Denmark
| | - Henrik M. Schrøder
- Department of Clinical Research University of Southern Denmark Odense Denmark
- Department of Orthopaedic Surgery Næstved‐Slagelse‐Ringsted Hospitals Næstved Denmark
| | - Kasper H. Thybo
- Department of Anaesthesiology Bispebjerg and Frederiksberg University Hospital Copenhagen Denmark
| | - Ole Mathiesen
- Department of Clinical Medicine Faculty of Health and Medical Sciences Copenhagen University Copenhagen Denmark
- Centre for Anaesthesiological Research Department of Anaesthesiology Zealand University Hospital Køge Denmark
| | - Janus C. Jakobsen
- Department of Regional Health Research The Faculty of Health Sciences University of Southern Denmark Odense Denmark
- Department of Cardiology Holbæk Hospital Holbæk Denmark
| |
Collapse
|
17
|
Debeuf T, Verbeken S, Boelens E, Volkaert B, Van Malderen E, Michels N, Braet C. Emotion regulation training in the treatment of obesity in young adolescents: protocol for a randomized controlled trial. Trials 2020; 21:153. [PMID: 32039739 PMCID: PMC7011608 DOI: 10.1186/s13063-019-4020-1] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2019] [Accepted: 12/20/2019] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND The prevalence rates of childhood obesity are increasing. The current multidisciplinary treatments for (childhood) obesity are effective but only moderately and in the short term. A possible explanation for the onset and maintenance of childhood obesity is that it reflects a maladaptive mechanism for regulating high levels of stress and emotions. Therefore, the current RCT study aims to test the effectiveness of adding an emotion regulation training to care as usual (multidisciplinary obesity treatment) in young inpatients (10-14) involved in an obesity treatment program compared to care as usual alone. The research model for this RCT study states that when high levels of stress are regulated in a maladaptive way, this can contribute to the development of obesity. METHODS The current study will recruit 140 youngsters (10-14 years) who are involved in an inpatient multidisciplinary obesity treatment (MOT) program. After giving consent to participate in the study, youngsters will be randomly assigned, during consecutive waves, to one of two conditions: care as usual (receiving MOT) or intervention (receiving MOT in addition to emotion regulation training). The training itself consists of 12 weekly sessions, followed by a booster session after 3 and 5 months. The participants will be tested pretraining, post-training, and at 6 months' follow-up. We hypothesize that, compared to the control condition, youngsters in the intervention condition will (1) use more adaptive emotion regulation strategies and (2) report less emotional eating, both primary outcome measures. Moreover, on the level of secondary outcome measures, we hypothesize that youngsters in the intervention condition, compared with the control condition, will (3) report better sleep quality, (4) undergo improved weight loss and weight loss maintenance, and (5) experience better long-term (6-months) psychological well-being. DISCUSSION This study will add to both the scientific and clinical literature on the role of emotion regulation in the development and maintenance of different psychopathologies, as emotion regulation is a transdiagnostic factor. TRIAL REGISTRATION The RCT study protocol is registered at ISRCTN Registry, with study ID "ISRCTN 83822934." Registered on 13 December 2017.
Collapse
Affiliation(s)
- Taaike Debeuf
- Department of Developmental, Personality and Social Psychology, Ghent University, Ghent, Belgium
| | - Sandra Verbeken
- Department of Developmental, Personality and Social Psychology, Ghent University, Ghent, Belgium
| | - Elisa Boelens
- Department of Developmental, Personality and Social Psychology, Ghent University, Ghent, Belgium
| | - Brenda Volkaert
- Department of Developmental, Personality and Social Psychology, Ghent University, Ghent, Belgium
| | - Eva Van Malderen
- Department of Developmental, Personality and Social Psychology, Ghent University, Ghent, Belgium
| | - Nathalie Michels
- Department of Developmental, Personality and Social Psychology, Ghent University, Ghent, Belgium
| | - Caroline Braet
- Department of Developmental, Personality and Social Psychology, Ghent University, Ghent, Belgium
| |
Collapse
|