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Suresh H, Mithani K, Warsi N, Ochi A, Otsubo H, Drake JM, Rutka JT, Kerr E, Smith ML, Breitbart S, Yau I, McRae L, Chau V, Weiss S, Jain P, Donner E, Fasano A, Gorodetsky C, Ibrahim GM. Add-On Deep Brain Stimulation versus Continued Vagus Nerve Stimulation for Childhood Epilepsy (ADVANCE): A Partially Randomized Patient Preference Trial. Ann Neurol 2024; 96:405-411. [PMID: 38822686 DOI: 10.1002/ana.26956] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2024] [Revised: 02/28/2024] [Accepted: 04/27/2024] [Indexed: 06/03/2024]
Abstract
Outcomes following vagus nerve stimulation (VNS) improve over years after implantation in children with drug-resistant epilepsy. The added value of deep brain stimulation (DBS) instead of continued VNS optimization is unknown. In a prospective, non-blinded, randomized patient preference trial of 18 children (aged 8-17 years) who did not respond to VNS after at least 1 year, add-on DBS resulted in greater seizure reduction compared with an additional year of VNS optimization (51.9% vs. 12.3%, p = 0.047). Add-on DBS also resulted in less bothersome seizures (p = 0.03), but no change in quality of life. DBS may be considered earlier for childhood epilepsy after non-response to VNS. ANN NEUROL 2024;96:405-411.
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Affiliation(s)
- Hrishikesh Suresh
- Institute of Biomedical Engineering, University of Toronto, Toronto, ON, Canada
- Program in Neuroscience and Mental Health, The Hospital for Sick Children Research Institute, Toronto, ON, Canada
- Division of Neurosurgery, Department of Surgery, University of Toronto, Toronto, ON, Canada
| | - Karim Mithani
- Institute of Biomedical Engineering, University of Toronto, Toronto, ON, Canada
- Program in Neuroscience and Mental Health, The Hospital for Sick Children Research Institute, Toronto, ON, Canada
- Division of Neurosurgery, Department of Surgery, University of Toronto, Toronto, ON, Canada
| | - Nebras Warsi
- Institute of Biomedical Engineering, University of Toronto, Toronto, ON, Canada
- Program in Neuroscience and Mental Health, The Hospital for Sick Children Research Institute, Toronto, ON, Canada
- Division of Neurosurgery, Department of Surgery, University of Toronto, Toronto, ON, Canada
| | - Ayako Ochi
- Division of Neurology, The Hospital for Sick Children, Toronto, ON, Canada
| | - Hiroshi Otsubo
- Division of Neurology, The Hospital for Sick Children, Toronto, ON, Canada
| | - James M Drake
- Division of Neurosurgery, Department of Surgery, University of Toronto, Toronto, ON, Canada
- Division of Neurosurgery, The Hospital for Sick Children, Toronto, ON, Canada
| | - James T Rutka
- Division of Neurosurgery, Department of Surgery, University of Toronto, Toronto, ON, Canada
- Division of Neurosurgery, The Hospital for Sick Children, Toronto, ON, Canada
| | - Elizabeth Kerr
- Division of Neurology, The Hospital for Sick Children, Toronto, ON, Canada
| | - Mary Lou Smith
- Program in Neuroscience and Mental Health, The Hospital for Sick Children Research Institute, Toronto, ON, Canada
- Division of Neurology, The Hospital for Sick Children, Toronto, ON, Canada
| | - Sara Breitbart
- Division of Neurosurgery, The Hospital for Sick Children, Toronto, ON, Canada
| | - Ivanna Yau
- Division of Neurology, The Hospital for Sick Children, Toronto, ON, Canada
| | - Lyndsey McRae
- Division of Neurology, The Hospital for Sick Children, Toronto, ON, Canada
| | - Vann Chau
- Division of Neurology, The Hospital for Sick Children, Toronto, ON, Canada
| | - Shelly Weiss
- Division of Neurology, The Hospital for Sick Children, Toronto, ON, Canada
| | - Puneet Jain
- Division of Neurology, The Hospital for Sick Children, Toronto, ON, Canada
| | - Elizabeth Donner
- Division of Neurology, The Hospital for Sick Children, Toronto, ON, Canada
| | - Alfonso Fasano
- Division of Neurology, The Hospital for Sick Children, Toronto, ON, Canada
- Institute of Medical Science, University of Toronto, Toronto, ON, Canada
- Edmond J. Safra Program in Parkinson's Disease, Morton and Gloria Shulman Movement Disorders Clinic, Toronto Western Hospital, UHN, Toronto, ON, Canada
- Division of Neurology, University of Toronto, Toronto, ON, Canada
- Krembil Brain Institute, Toronto, ON, Canada
| | | | - George M Ibrahim
- Institute of Biomedical Engineering, University of Toronto, Toronto, ON, Canada
- Program in Neuroscience and Mental Health, The Hospital for Sick Children Research Institute, Toronto, ON, Canada
- Division of Neurosurgery, Department of Surgery, University of Toronto, Toronto, ON, Canada
- Division of Neurosurgery, The Hospital for Sick Children, Toronto, ON, Canada
- Institute of Medical Science, University of Toronto, Toronto, ON, Canada
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Hansson E, Löfstrand J, Larsson C, Uusimaki A, Svensson K, Ekman A, Svensson M, Paganini A. Gothenburg Breast reconstruction (GoBreast) II protocol: a Swedish partially randomised patient preference, superiority trial comparing autologous and implant-based breast reconstruction. BMJ Open 2024; 14:e084025. [PMID: 39019639 PMCID: PMC11256070 DOI: 10.1136/bmjopen-2024-084025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/06/2024] [Accepted: 06/27/2024] [Indexed: 07/19/2024] Open
Abstract
INTRODUCTION Although breast reconstruction is an integral part of breast cancer treatment, there is little high-quality evidence to indicate which method is the most effective. Randomised controlled trials (RCTs) are generally thought to provide the most solid scientific evidence, but there are significant barriers to conducting RCTs in breast reconstruction, making both recruitment and achieving unbiased and generalisable results a challenge. The objective of this study is to compare implant-based and autologous breast reconstruction in non-irradiated patients. Moreover, the study aims to improve the evidence for trial decision-making in breast reconstruction. METHODS AND ANALYSIS The study design partially randomised patient preference trial might be a way to overcome the aforementioned challenges. In the present study, patients who consent to randomisation will be randomised to implant-based and autologous breast reconstruction, whereas patients with strong preferences will be able to choose the method. The study is designed as a superiority trial based on the patient-reported questionnaire BREAST-Q and 124 participants will be randomised. In the preference cohort, patients will be included until 62 participants have selected the least popular alternative. Follow-up will be 60 months. Embedded qualitative studies and within-trial economic evaluation will be performed. The primary outcome is patient-reported breast-specific quality of life/satisfaction, and the secondary outcomes are complications, factors affecting satisfaction and cost-effectiveness. ETHICS AND DISSEMINATION The study has been approved by the Swedish Ethical Review Authority (2023-04754-01). Results will be published in peer-reviewed scientific journals and presented at peer-reviewed scientific meetings. TRIAL REGISTRATION NUMBER NCT06195865.
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Affiliation(s)
- Emma Hansson
- Department of Plastic Surgery, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Region Västra Götaland, Sahlgrenska University Hospital, Department of Plastic and Reconstructive Surgery, Gothenburg, Sweden
| | - Jonas Löfstrand
- Department of Plastic Surgery, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Region Västra Götaland, Sahlgrenska University Hospital, Department of Plastic and Reconstructive Surgery, Gothenburg, Sweden
| | - Camilla Larsson
- Johanna, Regional branch of the Swedish Breast Cancer Association, Gothenburg, Sweden
| | - Alexandra Uusimaki
- Johanna, Regional branch of the Swedish Breast Cancer Association, Gothenburg, Sweden
| | - Karolina Svensson
- Johanna, Regional branch of the Swedish Breast Cancer Association, Gothenburg, Sweden
| | - Anna Ekman
- Department of Public Health and Community Medicine, Institute of Medicine, Sahlgrenska Academy, Gothenburg University, Gothenburg, Sweden
| | - Mikael Svensson
- Department of Public Health and Community Medicine, Institute of Medicine, Sahlgrenska Academy, Gothenburg University, Gothenburg, Sweden
| | - Anna Paganini
- Department of Plastic Surgery, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Region Västra Götaland, Sahlgrenska University Hospital, Department of Plastic and Reconstructive Surgery, Gothenburg, Sweden
- Department of Diagnostics, Acute and Critical Care, Institute of Health and Care Sciences, Sahlgrenska Academy, Gothenburg University, Gothenburg, Sweden
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Deng YP, Zhou YL, Wei TT, He GS, Zhu ZX, Zhang SN, Liu MJ, Xue JJ, Zhang WX, Yang XG. Combined traditional Chinese medicine therapy for the treatment of infertility with polycystic ovary syndrome: A network meta-analysis of randomized controlled trials. Medicine (Baltimore) 2024; 103:e38912. [PMID: 38996123 PMCID: PMC11245265 DOI: 10.1097/md.0000000000038912] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/26/2023] [Accepted: 06/21/2024] [Indexed: 07/14/2024] Open
Abstract
BACKGROUND Polycystic ovary syndrome (PCOS) infertility has attracted great attention from researchers due to its high incidence. Numerous studies have shown that Chinese medicine is effective in treating this disease, but there is a wide variety of Chinese medicine therapies available, and there is a lack of comparative evaluation of the efficacy of various Chinese medicine combination therapies in the clinic, which requires further in-depth exploration. This study aims to evaluate the efficacy of a combined traditional Chinese medicine (TCM) therapy for the treatment of infertility with PCOS using network meta-analysis (NMA). METHODS In PubMed, web of Science, Cochrane Library, Embase, China Knowledge Network, Wanfang Data, VIP Database, China Biomedical Literature Database (SinoMed) databases, searchs were conducted for information about the randomized controlled trials (RCTs) of combined TCM therapy for the treatment of infertility with PCOS. Quality evaluation was performed using the Cochrane 5.3 risk of bias assessment tool, and NMA using Stata 16.0. RESULTS This study comprised 28 RCTs using 8 combined TCM therapies in total. The results of the NMA showed that moxibustion + herbal, fire acupuncture + herbal, acupuncture + herbal, electroacupuncture + herbal, and acupoint application + herbal improved the clinical pregnancy rate better than acupuncture, herbal, and western medicines monotherapy (P < .05). Additionally, ear point pressure + herbal enema + herbal, acupuncture and moxibustion + herbal, fire acupuncture + herbal, and acupuncture + herbal improved the ovulation rate better than acupuncture, herbal, and western medicines monotherapy (P < .05). Moxibustion + herbal, fire acupuncture + herbal, and acupuncture + herbal are the 3 most effective therapies for improving the clinical pregnancy rate. Fire acupuncture + herbal, acupuncture + herbal, and ear point pressure + herbal enema + herbal are the 3 most effective therapies for improving the ovulation rate. CONCLUSION The combined TCM therapy demonstrated better efficacy for the treatment of infertility with PCOS compared to acupuncture, herbal, and western medicines monotherapy. However, the optimal treatment therapy varied depending on the outcome indicators. Further large sample, high-quality, and standardized RCTs are needed to verify these findings.
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Affiliation(s)
- Yun-Peng Deng
- Henan University of Chinese Medicine, Zhengzhou, China
- Third Affiliated Hospital of Henan University of Chinese Medicine, Zhengzhou, China
| | - Yan-Li Zhou
- Henan University of Chinese Medicine, Zhengzhou, China
- Third Affiliated Hospital of Henan University of Chinese Medicine, Zhengzhou, China
| | - Teng-Teng Wei
- Henan University of Chinese Medicine, Zhengzhou, China
- Third Affiliated Hospital of Henan University of Chinese Medicine, Zhengzhou, China
| | - Guang-Shuai He
- Henan University of Chinese Medicine, Zhengzhou, China
- Third Affiliated Hospital of Henan University of Chinese Medicine, Zhengzhou, China
| | - Zhi-Xin Zhu
- Henan University of Chinese Medicine, Zhengzhou, China
- Third Affiliated Hospital of Henan University of Chinese Medicine, Zhengzhou, China
| | - Shu-Ning Zhang
- Henan University of Chinese Medicine, Zhengzhou, China
- Third Affiliated Hospital of Henan University of Chinese Medicine, Zhengzhou, China
| | - Mei-Jun Liu
- Henan University of Chinese Medicine, Zhengzhou, China
- Third Affiliated Hospital of Henan University of Chinese Medicine, Zhengzhou, China
| | - Jing-Jing Xue
- Henan University of Chinese Medicine, Zhengzhou, China
- Third Affiliated Hospital of Henan University of Chinese Medicine, Zhengzhou, China
| | - Wei-Xing Zhang
- Henan University of Chinese Medicine, Zhengzhou, China
- Third Affiliated Hospital of Henan University of Chinese Medicine, Zhengzhou, China
| | - Xu-Guang Yang
- Henan University of Chinese Medicine, Zhengzhou, China
- Third Affiliated Hospital of Henan University of Chinese Medicine, Zhengzhou, China
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Brock H, Dwinger S, Bergelt C, Sender A, Geue K, Mehnert-Theuerkauf A, Richter D. Peer2Me - evaluation of a peer supported program for adolescent and young adult (AYA) cancer patients: study protocol of a randomised trial using a comprehensive cohort design. BMC Cancer 2024; 24:788. [PMID: 38956510 PMCID: PMC11221107 DOI: 10.1186/s12885-024-12547-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2024] [Accepted: 06/20/2024] [Indexed: 07/04/2024] Open
Abstract
BACKGROUND Developing cancer in young adulthood is a non-normative life event and associated with adverse physical, social and psychological consequences. High psychological distress is common in AYA cancer patients including anxiety, depression or fear of recurrence. At the same time, it is well known that AYA often report unmet needs for support, particularly in terms of informational exchange and emotional support from peers in order to benefit from shared experiences and enhance self-efficacy. Especially in the AYA group, interactions with other same-aged cancer patients may represent an essential resource in terms of coping with the disease, as family members and friends are often overwhelmed and struggling with helplessness. Currently, there is a lack of professional support services using peer support (e.g. psycho-oncological support, aftercare consultations, social legal counselling) or evaluated peer support interventions in Germany. Our aim is to assess the effectiveness of the Peer2Me intervention for AYAs, in which acute patients (mentees) are accompanied by an AYA survivor (mentor) over a period of three months. METHODS A prospective Comprehensive Cohort Design with repeated measures will be used to evaluate the effectiveness of Peer2Me for AYA. A sample of 180 patients in active cancer treatment aged 18 to 39 years will be enrolled and randomized to the intervention or control condition (a single AYA-specific consultation). Following mentor training, mentees and mentors are matched by diagnosis, age, and gender. The primary outcome is self-efficacy; secondary outcomes include measures of anxiety, depression, health literacy, life satisfaction and social support life. Outcomes will be measured at baseline before the intervention (t1), immediately after completion of the three-month intervention (t2) and three months after completion the intervention (t3). For the final analyses, we will use an intention-to-treat approach (ITT) and compare patients in the assigned treatment groups. DISCUSSION Peer2Me might be an important addition to existing professional psychosocial support services for young cancer patients. At the end of the study, a psycho-oncological intervention for young cancer patients undergoing acute treatment should be available, from which both mentors and mentees could benefit. The long-term continuity of Peer2Me should be ensured through collaboration with different partners. TRIAL REGISTRATION The study was retrospectively registered on February 4, 2022 at clinicaltrials.gov (NCT05336318).
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Affiliation(s)
- Hannah Brock
- Department of Medical Psychology and Medical Sociology, University Medical Center Leipzig, Comprehensive Cancer Center Central Germany (CCCG), Philipp-Rosenthal-Straße 55, 04103, Leipzig, Germany
| | - Sarah Dwinger
- Department of Medical Psychology, University Medical Center Hamburg-Eppendorf, Martinistraße 52, 20246, Hamburg, Germany
| | - Corinna Bergelt
- Department of Medical Psychology, University Medicine Greifswald, Walther-Rathenau-Straße 48, 17475, Greifswald, Germany
| | - Annekathrin Sender
- Department of Medical Psychology and Medical Sociology, University Medical Center Leipzig, Comprehensive Cancer Center Central Germany (CCCG), Philipp-Rosenthal-Straße 55, 04103, Leipzig, Germany
| | - Kristina Geue
- Department of Medical Psychology and Medical Sociology, University Medical Center Leipzig, Comprehensive Cancer Center Central Germany (CCCG), Philipp-Rosenthal-Straße 55, 04103, Leipzig, Germany
- Department of Psychosomatic Medicine and Psychotherapy, Medical Faculty, Otto-von-Guericke-University Magdeburg, Leipziger Str. 44, 39120, Magdeburg, Germany
| | - Anja Mehnert-Theuerkauf
- Department of Medical Psychology and Medical Sociology, University Medical Center Leipzig, Comprehensive Cancer Center Central Germany (CCCG), Philipp-Rosenthal-Straße 55, 04103, Leipzig, Germany
| | - Diana Richter
- Department of Medical Psychology and Medical Sociology, University Medical Center Leipzig, Comprehensive Cancer Center Central Germany (CCCG), Philipp-Rosenthal-Straße 55, 04103, Leipzig, Germany.
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Prompiengchai S, Dunlop K. Breakthroughs and challenges for generating brain network-based biomarkers of treatment response in depression. Neuropsychopharmacology 2024:10.1038/s41386-024-01907-1. [PMID: 38951585 DOI: 10.1038/s41386-024-01907-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/29/2024] [Revised: 05/17/2024] [Accepted: 06/13/2024] [Indexed: 07/03/2024]
Abstract
Treatment outcomes widely vary for individuals diagnosed with major depressive disorder, implicating a need for deeper understanding of the biological mechanisms conferring a greater likelihood of response to a particular treatment. Our improved understanding of intrinsic brain networks underlying depression psychopathology via magnetic resonance imaging and other neuroimaging modalities has helped reveal novel and potentially clinically meaningful biological markers of response. And while we have made considerable progress in identifying such biomarkers over the last decade, particularly with larger, multisite trials, there are significant methodological and practical obstacles that need to be overcome to translate these markers into the clinic. The aim of this review is to review current literature on brain network structural and functional biomarkers of treatment response or selection in depression, with a specific focus on recent large, multisite trials reporting predictive accuracy of candidate biomarkers. Regarding pharmaco- and psychotherapy, we discuss candidate biomarkers, reporting that while we have identified candidate biomarkers of response to a single intervention, we need more trials that distinguish biomarkers between first-line treatments. Further, we discuss the ways prognostic neuroimaging may help to improve treatment outcomes to neuromodulation-based therapies, such as transcranial magnetic stimulation and deep brain stimulation. Lastly, we highlight obstacles and technical developments that may help to address the knowledge gaps in this area of research. Ultimately, integrating neuroimaging-derived biomarkers into clinical practice holds promise for enhancing treatment outcomes and advancing precision psychiatry strategies for depression management. By elucidating the neural predictors of treatment response and selection, we can move towards more individualized and effective depression interventions, ultimately improving patient outcomes and quality of life.
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Affiliation(s)
| | - Katharine Dunlop
- Centre for Depression and Suicide Studies, Unity Health Toronto, Toronto, ON, Canada.
- Keenan Research Centre for Biomedical Science, Unity Health Toronto, Toronto, ON, Canada.
- Department of Psychiatry and Institute of Medical Science, University of Toronto, Toronto, ON, Canada.
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Gonzalez T, Tucker K, Wakefield CE, Geelan-Small P, Macmillan S, Taylor N, Williams R. Comparing cancer genetic counselling using telegenetics with in-person and telephone appointments: Results of a partially randomised patient-preference pilot study. J Telemed Telecare 2024; 30:949-960. [PMID: 35833346 DOI: 10.1177/1357633x221112556] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
INTRODUCTION Direct-to-patient telegenetics, which uses video conferencing to connect health professionals directly to patients' devices, has been widely adopted during the pandemic. However, limited evidence currently supports its use in cancer genetic counselling. METHODS Before the pandemic, we conducted a two-arm partially randomised patient-preference pilot trial to evaluate direct-to-patient telegenetics for patients and genetic counsellors. Patients were randomised to a standard care (telephone/in-person) or direct-to-patient telegenetics appointment. Patients completed questionnaires before, during and after appointments measuring: psychological distress, perceived genetic counsellor empathy, telegenetics satisfaction and technical challenges. Genetic counsellor-reported outcomes -measured using purpose-designed questionnaires- included telegenetics satisfaction, therapeutic alliance and time for assessment. Open-ended patient and genetic counsellor questionnaire responses were synthesised using content analysis. RESULTS Fifty-six patients and seven genetic counsellors participated. Thirteen patients switched appointment type. No significant differences in distress (P = 0.84) were identified between direct-to-patient telegenetics and standard care. Perceived genetic counsellor empathy was high for all appointment types. There was no evidence of differences in reported maximum empathy scores between direct-to-patient telegenetics and standard care [telephone (P = 0.57); in-person (P = 0.44)]. Patients reported high direct-to-patient telegenetics satisfaction despite technical challenges in most appointments (65%). Genetic counsellors were satisfied with direct-to-patient telegenetics and perceived high therapeutic alliance irrespective of appointment type. No significant differences in genetic counsellor time were identified between direct-to-patient telegenetics and standard care [telephone (P > 0.90); in-person (P = 0.35)]. DISCUSSION Our results suggest that direct-to-patient telegenetics is a satisfactory service delivery model that does not appear to compromise patient-genetic counsellor relationships or increase patient distress. These findings support direct-to-patient telegenetics use in cancer genetic counselling, although larger trials are needed.
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Affiliation(s)
- Tina Gonzalez
- Prince of Wales Hereditary Cancer Centre, Prince of Wales Hospital, Randwick, NSW, Australia
- Department of Clinical Genetics, Royal North Shore Hospital, St Leonards, NSW, Australia
| | - Kathy Tucker
- Prince of Wales Hereditary Cancer Centre, Prince of Wales Hospital, Randwick, NSW, Australia
- Prince of Wales Clinical School, UNSW Medicine and Health, UNSW Sydney, Kensington, NSW, Australia
| | - Claire E Wakefield
- School of Women's and Children's Health, UNSW Medicine and Health, UNSW Sydney, Kensington, NSW, Australia
- Kids Cancer Centre, Sydney Children's Hospital, Randwick, NSW, Australia
| | - Peter Geelan-Small
- Stats Central, Mark Wainwright Analytical Centre, UNSW Sydney, Kensington, NSW, Australia
| | - Stephanie Macmillan
- Prince of Wales Clinical School, UNSW Medicine and Health, UNSW Sydney, Kensington, NSW, Australia
| | - Natalie Taylor
- School of Population Health, UNSW Medicine and Health, UNSW Sydney, Kensington, NSW, Australia
| | - Rachel Williams
- Prince of Wales Hereditary Cancer Centre, Prince of Wales Hospital, Randwick, NSW, Australia
- Prince of Wales Clinical School, UNSW Medicine and Health, UNSW Sydney, Kensington, NSW, Australia
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Hansson E, Larsson C, Uusimäki A, Svensson K, Widmark Jensen E, Paganini A. A systematic review of randomised controlled trials in breast reconstruction. J Plast Surg Hand Surg 2024; 59:53-64. [PMID: 38751090 DOI: 10.2340/jphs.v59.40087] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/11/2024] [Accepted: 04/29/2024] [Indexed: 05/26/2024]
Abstract
BACKGROUND For preference sensitive treatments, such as breast reconstructions, there are barriers to conducting randomised controlled trials (RCTs). The primary aims of this systematic review were to investigate what type of research questions are explored by RCTs in breast reconstruction, where have they been performed and where have they been published, and to thematise the research questions and thus create an overview of the state of the research field. METHODS Randomised controlled trials investigating any aspect of breast reconstructions were included. The PubMed database was searched with a pre-defined search string. Inclusion and data abstraction was performed in a pre-defined standardised fashion. For the purpose of this study, we defined key issues as comparison of categories of breast reconstruction and comparison of immediate and delayed breast reconstruction, when the thematisation was done. RESULTS A total of 419 abstracts were retrieved from the search. Of the 419, 310 were excluded as they were not RCTs concerning some aspect of breast reconstruction, which left us with 110 abstracts to be included in the study. The research questions of the included studies could more or less be divided into seven different themes inclusive of 2 key issues: Other issues - comparison of different categories of breast reconstruction, comparison of immediate and delayed breast reconstruction, surgical details within a category of breast reconstruction, surgical details valid for several categories of breast reconstruction, donor site management, anaesthetics, and non-surgical details. Only five studies compared key issues, and they all illustrate the challenges with RCTs in breast reconstruction. CONCLUSIONS A total of 110 publications based on RCTs in breast reconstruction have been published. Seven themes of research questions could be identified. Only five studies have explored the key issues. Better scientific evidence is needed for the key issues in breast reconstruction, for example by implementing a new study design in the field.
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Affiliation(s)
- Emma Hansson
- Department of Plastic surgery, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden; Region Västra Götaland, Sahlgrenska University Hospital, Department of Plastic and Reconstructive Surgery, Gothenburg, Sweden.
| | - Camilla Larsson
- The Breast Cancer Association Johanna, Gothenburg. Regional branch of the patient organisation the Swedish Breast Cancer Association
| | - Alexandra Uusimäki
- The Breast Cancer Association Johanna, Gothenburg. Regional branch of the patient organisation the Swedish Breast Cancer Association
| | - Karolina Svensson
- The Breast Cancer Association Johanna, Gothenburg. Regional branch of the patient organisation the Swedish Breast Cancer Association
| | - Emmelie Widmark Jensen
- Department of Plastic surgery, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden; Region Västra Götaland, Sahlgrenska University Hospital, Department of Plastic and Reconstructive Surgery, Gothenburg, Sweden
| | - Anna Paganini
- Department of Plastic surgery, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden; Region Västra Götaland, Sahlgrenska University Hospital, Department of Plastic and Reconstructive Surgery, Gothenburg, Sweden; Department of Diagnostics, Acute and Critical Care, Institute of Health and Care Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
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Vieujean S, Lindsay JO, D'Amico F, Ahuja V, Silverberg MS, Sood A, Yamamoto-Furusho JK, Nagahori M, Watanabe M, Koutroubakis IE, Foteinogiannopoulou K, Avni Biron I, Walsh A, Outtier A, Nordestgaard RLM, Abreu MT, Dubinsky M, Siegel C, Louis E, Dotan I, Reinisch W, Danese S, Rubin DT, Peyrin-Biroulet L. Analysis of Clinical Trial Screen Failures in Inflammatory Bowel Diseases [IBD]: Real World Results from the International Organization for the study of IBD. J Crohns Colitis 2024; 18:548-559. [PMID: 37864829 DOI: 10.1093/ecco-jcc/jjad180] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/04/2023] [Indexed: 10/23/2023]
Abstract
BACKGROUND Recruitment for randomized controlled trials [RCTs] in inflammatory bowel diseases [IBD] has substantially dropped over time. This study aimed to assess reasons why IBD patients are not included in sponsored multicentre phase IIb-III RCTs. METHODS All IOIBD members [n = 58] were invited to participate. We divided barriers to participation as follows: [1] reasons patients with active IBD were not deemed appropriate for an RCT; [2] reasons qualified patients did not wish to participate; and [3] reasons for screen failure [SF] in patients agreeing to participate. We assess these in a 4-week prospective study including, consecutively, all patients with symptomatic disease for whom a treatment change was required. In addition, we performed a 6-month retrospective study to further evaluate reasons for SF. RESULTS A total of 106 patients (60 male [56.6%], 63 Crohn's disease [CD] [59.4%]), from ten centres across the world, were included in the prospective study. An RCT has not been proposed to 65 of them [mainly due to eligibility criteria]. Of the 41 patients to whom an RCT was offered, eight refused [mainly due to reluctance to receive placebo] and 28 agreed to participate. Among these 28 patients, five failed their screening and 23 were finally included in an RCT. A total of 107 patients (61 male [57%], 67 CD [62.6%]), from 13 centres worldwide, were included in our retrospective study of SFs. The main reason was insufficient disease activity. CONCLUSION This first multicentre study analysing reasons for non-enrolment in IBD RCTs shows that we lose patients at each step. Eligibility criteria, the risk of placebo assignment, and insufficient disease activity were part of the main barriers.
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Affiliation(s)
- Sophie Vieujean
- Hepato-Gastroenterology and Digestive Oncology, University Hospital CHU of Liège, Liège, Belgium
| | - James O Lindsay
- Blizard Institute, Barts and the London School of Medicine and Dentistry, London, UK; Department of Gastroenterology, The Royal London Hospital, Barts Health NHS Trust, London, UK
| | - Ferdinando D'Amico
- Department of Gastroenterology and Endoscopy, IRCCS San Raffaele Hospital and Vita-Salute San Raffaele University, Milan, Italy
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy
| | - Vineet Ahuja
- Department of Gastroenterology, All India Institute of Medical Sciences, New Delhi, India
| | | | - Ajit Sood
- Department of Gastroenterology, Dayanand Medical College and Hospital, Ludhiāna, Punjab, India
| | - Jesus K Yamamoto-Furusho
- Inflammatory Bowel Disease Clinic, Department of Gastroenterology, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Tlalpa, Mexico
| | - Masakazu Nagahori
- Department of Gastroenterology and Hepatology, Tokyo Medical and Dental University, Tokyo, Japan
| | - Mamoru Watanabe
- Advanced Research Institute, Tokyo Medical and Dental University, Tokyo, Japan
| | - Ioannis E Koutroubakis
- Department of Gastroenterology, University Hospital of Heraklion, Heraklion, Crete, Greece
| | | | - Irit Avni Biron
- Division of Gastroenterology, Rabin Medical Center, Petah Tikva, Israel, and Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Alissa Walsh
- Translational Gastroenterology Unit, John Radcliffe Hospital, Oxford University Hospitals NHS Foundation Trust and NIHR Biomedical Research Centre, Oxford, UK
| | - An Outtier
- Department of Gastroenterology and Hepatology, University Hospitals Leuven, KU Leuven, Leuven, Belgium
| | | | - Maria T Abreu
- Division of Gastroenterology, Department of Medicine, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Marla Dubinsky
- Division of Pediatric Gastroenterology and Nutrition, Icahn School of Medicine, Mount Sinai, New York, NY, USA
| | - Corey Siegel
- Inflammatory Bowel Disease Center, Section of Gastroenterology and Hepatology, Dartmouth-Hitchcock Medical Center, Lebanon, NH, USA
| | - Edouard Louis
- Hepato-Gastroenterology and Digestive Oncology, University Hospital CHU of Liège, Liège, Belgium
| | - Iris Dotan
- Division of Gastroenterology, Rabin Medical Center, Petah Tikva, Israel, and Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Walter Reinisch
- Department of Internal Medicine III, Medical University of Vienna, Vienna, Austria
| | - Silvio Danese
- Department of Gastroenterology and Endoscopy, IRCCS San Raffaele Hospital and Vita-Salute San Raffaele University, Milan, Italy
| | - David T Rubin
- University of Chicago Medicine Inflammatory Bowel Disease Center, Chicago, IL, USA
| | - Laurent Peyrin-Biroulet
- Department of Gastroenterology, Nancy University Hospital, F-54500 Vandœuvre-lès-Nancy, France
- INSERM, NGERE, University of Lorraine, F-54000 Nancy, France
- INFINY Institute, Nancy University Hospital, F-54500 Vandœuvre-lès-Nancy, France
- FHU-CURE, Nancy University Hospital, F-54500 Vandœuvre-lès-Nancy, France
- Groupe Hospitalier privé Ambroise Paré - Hartmann, Paris IBD center, 92200 Neuilly sur Seine, France
- Division of Gastroenterology and Hepatology, McGill University Health Centre, Montreal, Quebec, Canada
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9
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Voderholzer U, Meule A, Koch S, Pfeuffer S, Netter AL, Lehr D, Zisler EM. Effectiveness of One Videoconference-Based Exposure and Response Prevention Session at Home in Adjunction to Inpatient Treatment in Persons With Obsessive-Compulsive Disorder: Nonrandomized Study. JMIR Ment Health 2024; 11:e52790. [PMID: 38477970 DOI: 10.2196/52790] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/15/2023] [Revised: 11/24/2023] [Accepted: 12/19/2023] [Indexed: 03/14/2024] Open
Abstract
BACKGROUND Therapist-guided exposure and response prevention (ERP) for the treatment of obsessive-compulsive disorder (OCD) is frequently conducted within clinical settings but rarely at places where patients are usually confronted with OCD symptom-provoking situations in daily life (eg, at home). OBJECTIVE This study aimed to investigate patients' views on 1 ERP session at home via videoconference and its impact on treatment outcome. METHODS A total of 64 inpatients with OCD received 1 session of therapist-guided videoconference-based ERP at home in adjunction to a multimodal inpatient treatment between 2015 and 2020. RESULTS Compared with 64 age- and sex-matched controls who received a multimodal inpatient treatment without 1 session of videoconference-based ERP at home, patients who received 1 session of videoconference-based ERP in adjunction to a multimodal inpatient treatment showed stronger reductions in OCD symptom severity from admission to discharge. Before the videoconference-based ERP session, patients reported high rationale credibility and treatment expectancy. After the videoconference-based ERP session, patients reported medium-to-high positive mood as well as depth and smoothness of the session, and they perceived the working alliance as high. CONCLUSIONS Results highlight the importance of administering therapist-guided ERP sessions in patients' natural environment to enhance treatment response in OCD. Videoconference-based ERP as add-on to treatment as usual is, therefore, a promising approach to facilitate the application of ERP in patients' natural environment and foster the generalization of ERP conducted in clinical settings.
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Affiliation(s)
- Ulrich Voderholzer
- Schoen Clinic Roseneck, Prien am Chiemsee, Germany
- Department of Psychiatry and Psychotherapy, University Hospital, LMU Munich, Munich, Germany
- Medical Center, Department of Psychiatry and Psychotherapy, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Adrian Meule
- Schoen Clinic Roseneck, Prien am Chiemsee, Germany
- Department of Psychiatry and Psychotherapy, University Hospital, LMU Munich, Munich, Germany
- Institute of Medical Psychology, Faculty of Medicine, LMU Munich, Munich, Germany
| | - Stefan Koch
- Schoen Clinic Roseneck, Prien am Chiemsee, Germany
| | | | | | - Dirk Lehr
- Leuphana Universität Lüneburg, Lüneburg, Germany
| | - Eva Maria Zisler
- Schoen Clinic Roseneck, Prien am Chiemsee, Germany
- Department of Psychiatry and Psychotherapy, University Hospital, LMU Munich, Munich, Germany
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10
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Haviari S, Mentré F. Distributive randomization: a pragmatic fractional factorial design to screen or evaluate multiple simultaneous interventions in a clinical trial. BMC Med Res Methodol 2024; 24:64. [PMID: 38468221 PMCID: PMC11340141 DOI: 10.1186/s12874-024-02191-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2023] [Accepted: 02/23/2024] [Indexed: 03/13/2024] Open
Abstract
BACKGROUND In some medical indications, numerous interventions have a weak presumption of efficacy, but a good track record or presumption of safety. This makes it feasible to evaluate them simultaneously. This study evaluates a pragmatic fractional factorial trial design that randomly allocates a pre-specified number of interventions to each participant, and statistically tests main intervention effects. We compare it to factorial trials, parallel-arm trials and multiple head-to-head trials, and derive some good practices for its design and analysis. METHODS We simulated various scenarios involving 4 to 20 candidate interventions among which 2 to 8 could be simultaneously allocated. A binary outcome was assumed. One or two interventions were assumed effective, with various interactions (positive, negative, none). Efficient combinatorics algorithms were created. Sample sizes and power were obtained by simulations in which the statistical test was either difference of proportions or multivariate logistic regression Wald test with or without interaction terms for adjustment, with Bonferroni multiplicity-adjusted alpha risk for both. Native R code is provided without need for compiling or packages. RESULTS Distributive trials reduce sample sizes 2- to sevenfold compared to parallel arm trials, and increase them 1- to twofold compared to factorial trials, mostly when fewer allocations than for the factorial design are possible. An unexpectedly effective intervention causes small decreases in power (< 10%) if its effect is additive, but large decreases (possibly down to 0) if not, as for factorial designs. These large decreases are prevented by using interaction terms to adjust the analysis, but these additional estimands have a sample size cost and are better pre-specified. The issue can also be managed by adding a true control arm without any intervention. CONCLUSION Distributive randomization is a viable design for mass parallel evaluation of interventions in constrained trial populations. It should be introduced first in clinical settings where many undercharacterized interventions are potentially available, such as disease prevention strategies, digital behavioral interventions, dietary supplements for chronic conditions, or emerging diseases. Pre-trial simulations are recommended, for which tools are provided.
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Affiliation(s)
- Skerdi Haviari
- Université Paris Cité, Inserm, IAME, Paris, 75018, France.
- Département Epidémiologie Biostatistiques Et Recherche Clinique, AP-HP, Hôpital Bichat, Paris, 75018, France.
| | - France Mentré
- Université Paris Cité, Inserm, IAME, Paris, 75018, France
- Département Epidémiologie Biostatistiques Et Recherche Clinique, AP-HP, Hôpital Bichat, Paris, 75018, France
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11
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Haighton C, Watson RM, Wilson JA, Powell S. Caregiver acceptability of a UK trial for paediatric sleep disordered breathing: A qualitative interview study. Clin Otolaryngol 2024; 49:254-257. [PMID: 37968090 DOI: 10.1111/coa.14125] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2023] [Revised: 06/06/2023] [Accepted: 10/27/2023] [Indexed: 11/17/2023]
Affiliation(s)
- Catherine Haighton
- Faculty of Health and Life Sciences, Northumbria University, Newcastle upon Tyne, UK
| | - Rose Mary Watson
- Faculty of Health and Life Sciences, Northumbria University, Newcastle upon Tyne, UK
| | - Janet A Wilson
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Steven Powell
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
- The Department of Otolaryngology (Ear, Nose and Throat) Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
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12
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Lodewijks Y, van Ede L, Scheerhoorn J, Bouwman A, Nienhuijs S. Patient's Preference for Same-Day Discharge or Hospitalization After Bariatric Surgery. Obes Surg 2024; 34:716-722. [PMID: 38278982 DOI: 10.1007/s11695-024-07068-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2023] [Revised: 01/11/2024] [Accepted: 01/18/2024] [Indexed: 01/28/2024]
Abstract
PURPOSE Enhanced Recovery After Bariatric Surgery protocols have proven to be effective in reducing complication rates and length of stay. Guidelines do not include a recommendation on the length of hospital stay whereas same-day discharge is currently widely investigated on safety and feasibility. However, none of these studies takes patient preferences into account. The study aimed to reveal the patient's preference for outpatient surgery (OS) in patients who underwent primary bariatric surgery. MATERIALS AND METHODS A single-center preference-based randomized trial was performed between March and December of 2021. Adult patients planned for primary bariatric surgery were able to choose their care pathway, either OS with remote heart and respiratory rate monitoring by a wearable data logger or standard care with at least one-night hospitalization. RESULTS Out of the 202 patients, nearly everyone (98.5%) had a preference. Of 199 patients, 99 (49.7%) chose inpatient surgery. Of the 100 with a preference for OS, 23 stayed in the hospital due to medical reasons and 12 patients changed their preference. Based on both initial preference and changed preference, there were no differences between sex, age, body mass index, and co-morbidities such as diabetes mellitus, hypertension, and atrial fibrillation, nor in the use of anticoagulants or type of surgery. CONCLUSION Patients seemed to have a strong preference for their stay after a bariatric procedure. The preference is equally divided between outpatient and inpatient surgery and is not influenced by any patient characteristics.
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Affiliation(s)
- Yentl Lodewijks
- Department of Obesity Surgery, Catharina Hospital Eindhoven, Michelangelolaan 2, 5623 EJ, Eindhoven, The Netherlands.
| | - Lisa van Ede
- Department of Anesthesiology, Catharina Hospital, Michelangelolaan 2, 5623 EJ, Eindhoven, The Netherlands
| | - Jai Scheerhoorn
- Department of Obesity Surgery, Catharina Hospital Eindhoven, Michelangelolaan 2, 5623 EJ, Eindhoven, The Netherlands
| | - Arthur Bouwman
- Department of Anesthesiology, Catharina Hospital, Michelangelolaan 2, 5623 EJ, Eindhoven, The Netherlands
- Department of Electrical Engineering, Signal Processing Systems, Eindhoven Technical University, De Zaale, Eindhoven, The Netherlands
| | - Simon Nienhuijs
- Department of Obesity Surgery, Catharina Hospital Eindhoven, Michelangelolaan 2, 5623 EJ, Eindhoven, The Netherlands
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13
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Verhoeven JE, Han LKM, Penninx BWJH. Response to Słupski & Słupska. J Affect Disord 2024; 346:28-29. [PMID: 37940051 DOI: 10.1016/j.jad.2023.10.152] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/16/2023] [Accepted: 10/29/2023] [Indexed: 11/10/2023]
Affiliation(s)
- Josine E Verhoeven
- Department of Psychiatry, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam Public Health Research Institute & Amsterdam Neuroscience, Oldenaller 1, Amsterdam, the Netherlands.
| | - Laura K M Han
- Department of Psychiatry, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam Public Health Research Institute & Amsterdam Neuroscience, Oldenaller 1, Amsterdam, the Netherlands
| | - Brenda W J H Penninx
- Department of Psychiatry, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam Public Health Research Institute & Amsterdam Neuroscience, Oldenaller 1, Amsterdam, the Netherlands
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14
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Wijlens KAE, Beenhakker L, Witteveen A, Siemerink EJM, Jansen L, Gernaat C, Schellekens MPJ, Siesling S, Vollenbroek-Hutten MMR, Bode C. A holistic profile for cancer-related fatigue for women with breast cancer - a qualitative study. Psychol Health 2023:1-25. [PMID: 38108624 DOI: 10.1080/08870446.2023.2289457] [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: 03/28/2023] [Accepted: 11/21/2023] [Indexed: 12/19/2023]
Abstract
Objective: Cancer- related fatigue (CRF) is one of the most reported long-term effects after breast cancer and severely impacts quality of life. To come towards optimal treatment of multidimensional CRF, the first step is to use a holistic approach to develop a holistic patient profile including the patient's experience and impact of CRF on their life. Methods and measures: Four semi- structured focus groups with twenty- seven breast cancer patients and fourteen interviews with healthcare professionals (HCPs) were held. Reflexive thematic analysis was used to define (sub)themes for the holistic patient profile. The themes of the interviews and focus groups were compared for validity. Results: Breast cancer patients and HCPs described the same five major themes, consisting of experience of CRF, impact and consequences, coping, personality, and CRF treatment. Experience of CRF consists of cognitive, emotional, and physical aspects. Impact and consequences include work, family, partner relation, social contact and hobbies, body, and misunderstanding. Coping consists of twelve (mal)adaptive strategies. Personality and CRF treatment were summarised as themes. Conclusions: A first holistic patient profile was introduced for CRF for breast cancer. This profile can be conceptualized into a questionnaire to collect information for personalized treatment recommendations and monitoring of CRF over time.
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Affiliation(s)
- Kim A E Wijlens
- Department of Biomedical Signals and Systems, Technical Medical Centre, University of Twente, Enschede, The Netherlands
| | - Lian Beenhakker
- Department of Biomedical Signals and Systems, Technical Medical Centre, University of Twente, Enschede, The Netherlands
| | - Annemieke Witteveen
- Department of Biomedical Signals and Systems, Technical Medical Centre, University of Twente, Enschede, The Netherlands
| | - Ester J M Siemerink
- Department of Internal Medicine, Ziekenhuisgroep Twente, Hengelo, The Netherlands
| | - Liesbeth Jansen
- Department of Surgical Oncology, University Medical Center Groningen, Groningen, The Netherlands
| | - Christine Gernaat
- Department Oncology Rehabilitation, Roessingh Rehabilitation Center, Enschede, The Netherlands
| | - Melanie P J Schellekens
- Scientific Research Department, Helen Dowling Institute, Bilthoven, The Netherlands
- Department of Medical and Clinical Psychology, Tilburg University, Tilburg, The Netherlands
| | - Sabine Siesling
- Department of Health Technology and Services Research, Technical Medical Centre, University of Twente, Enschede, The Netherlands
- Department of Research and Development, Netherlands Comprehensive Cancer Organisation (IKNL), Utrecht, The Netherlands
| | - Miriam M R Vollenbroek-Hutten
- Department of Biomedical Signals and Systems, Technical Medical Centre, University of Twente, Enschede, The Netherlands
- Board of Directors, Medisch Spectrum Twente, Enschede, The Netherlands
| | - Christina Bode
- Department of Psychology, Health and Technology, University of Twente, Enschede, The Netherlands
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15
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Chong HY, McNamee P, Bachmair EM, Martin K, Aucott L, Dhaun N, Dures E, Emsley R, Gray SR, Kidd E, Kumar V, Lovell K, MacLennan G, Norrie J, Paul L, Packham J, Ralston SH, Siebert S, Wearden A, Macfarlane G, Basu N. Cost-effectiveness of cognitive behavioural and personalized exercise interventions for reducing fatigue in inflammatory rheumatic diseases. Rheumatology (Oxford) 2023; 62:3819-3827. [PMID: 37018151 PMCID: PMC10691924 DOI: 10.1093/rheumatology/kead157] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2022] [Revised: 02/09/2023] [Accepted: 02/27/2023] [Indexed: 04/06/2023] Open
Abstract
OBJECTIVES To estimate the cost-effectiveness of a cognitive behavioural approach (CBA) or a personalized exercise programme (PEP), alongside usual care (UC), in patients with inflammatory rheumatic diseases who report chronic, moderate to severe fatigue. METHODS A within-trial cost-utility analysis was conducted using individual patient data collected within a multicentre, three-arm randomized controlled trial over a 56-week period. The primary economic analysis was conducted from the UK National Health Service (NHS) perspective. Uncertainty was explored using cost-effectiveness acceptability curves and sensitivity analysis. RESULTS Complete-case analysis showed that, compared with UC, both PEP and CBA were more expensive [adjusted mean cost difference: PEP £569 (95% CI: £464, £665); CBA £845 (95% CI: £717, £993)] and, in the case of PEP, significantly more effective [adjusted mean quality-adjusted life year (QALY) difference: PEP 0.043 (95% CI: 0.019, 0.068); CBA 0.001 (95% CI: -0.022, 0.022)]. These led to an incremental cost-effectiveness ratio (ICER) of £13 159 for PEP vs UC, and £793 777 for CBA vs UC. Non-parametric bootstrapping showed that, at a threshold value of £20 000 per QALY gained, PEP had a probability of 88% of being cost-effective. In multiple imputation analysis, PEP was associated with significant incremental costs of £428 (95% CI: £324, £511) and a non-significant QALY gain of 0.016 (95% CI: -0.003, 0.035), leading to an ICER of £26 822 vs UC. The estimates from sensitivity analyses were consistent with these results. CONCLUSION The addition of a PEP alongside UC is likely to provide a cost-effective use of health care resources.
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Affiliation(s)
- Huey Yi Chong
- Health Economics Research Unit, Institute of Applied Health Sciences, University of Aberdeen, Aberdeen, UK
| | - Paul McNamee
- Health Economics Research Unit, Institute of Applied Health Sciences, University of Aberdeen, Aberdeen, UK
| | - Eva-Maria Bachmair
- Institute of Infection, Immunity and Inflammation, University of Glasgow, Glasgow, UK
- Aberdeen Centre for Arthritis and Musculoskeletal Health (Epidemiology Group), University of Aberdeen, Aberdeen, UK
| | - Kathryn Martin
- Aberdeen Centre for Arthritis and Musculoskeletal Health (Academic Primary Care Group), University of Aberdeen, Aberdeen, UK
| | - Lorna Aucott
- Centre of Healthcare and Randomised Trials (CHaRT), Health Service Research Unit, University of Aberdeen, Aberdeen, UK
| | - Neeraj Dhaun
- Centre for Cardiovascular Science, The Queen's Medical Research Institute, University of Edinburgh/British Heart Foundation Centre of Research Excellence, Edinburgh, UK
| | - Emma Dures
- Faculty of Health and Applied Sciences, University of the West of England, Bristol, UK
| | - Richard Emsley
- Department of Biostatistics and Health Informatics, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, UK
| | - Stuart R Gray
- Institute of Cardiovascular and Medical Sciences, BHF Glasgow Cardiovascular Research Centre, University of Glasgow, Glasgow, UK
| | - Elizabeth Kidd
- Department of Rheumatology, Freeman’s Hospital, The Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
| | - Vinod Kumar
- Department of Rheumatology, Ninewells Hospital, NHS Tayside, Dundee, UK
| | - Karina Lovell
- School of Health Sciences, University of Manchester, Manchester, UK
| | - Graeme MacLennan
- Centre of Healthcare and Randomised Trials (CHaRT), Health Service Research Unit, University of Aberdeen, Aberdeen, UK
| | - John Norrie
- Edinburgh Clinical Trials Unit, University of Edinburgh, Western General Hospital, Edinburgh, UK
| | - Lorna Paul
- School of Health and Life Science, Glasgow Caledonian University, Glasgow, UK
| | - Jonathan Packham
- Physiotherapy and Paramedicine, Haywood Rheumatology Centre, Stoke-on-Trent, UK
| | - Stuart H Ralston
- Rheumatology and Bone Disease, University of Edinburgh, Western General Hospital, Edinburgh, UK
| | - Stefan Siebert
- Institute of Infection, Immunity and Inflammation, University of Glasgow, Glasgow, UK
| | - Alison Wearden
- School of Health Sciences, University of Manchester, Manchester, UK
| | - Gary Macfarlane
- Aberdeen Centre for Arthritis and Musculoskeletal Health (Epidemiology Group), University of Aberdeen, Aberdeen, UK
- Aberdeen Centre for Arthritis and Musculoskeletal Health (Academic Primary Care Group), University of Aberdeen, Aberdeen, UK
| | - Neil Basu
- Institute of Infection, Immunity and Inflammation, University of Glasgow, Glasgow, UK
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16
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Słupski J, Słupska A. Comment on "Antidepressants or running therapy: Comparing effects on mental and physical health in patients with depression and anxiety disorders". J Affect Disord 2023; 339:547. [PMID: 37467790 DOI: 10.1016/j.jad.2023.07.092] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/08/2023] [Revised: 06/27/2023] [Accepted: 07/16/2023] [Indexed: 07/21/2023]
Affiliation(s)
- Jakub Słupski
- Department of Psychiatry, Faculty of Medicine, Medical University of Gdańsk, Smoluchowskiego 17 St., 80-214 Gdańsk, Poland.
| | - Anita Słupska
- Department of Psychiatry, Faculty of Medicine, Medical University of Gdańsk, Smoluchowskiego 17 St., 80-214 Gdańsk, Poland.
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17
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Kellett S, Bee C, Smithies J, Aadahl V, Simmonds-Buckley M, Power N, Dugen-Williams C, Fallon N, Delgadillo J. Cognitive-behavioural versus cognitive-analytic guided self-help for mild-to-moderate anxiety: a pragmatic, randomised patient preference trial. Br J Psychiatry 2023; 223:438-445. [PMID: 37395600 PMCID: PMC10895510 DOI: 10.1192/bjp.2023.78] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/21/2022] [Revised: 04/04/2023] [Accepted: 05/16/2023] [Indexed: 07/04/2023]
Abstract
BACKGROUND Guided self-help (GSH) for anxiety is widely implemented in primary care services because of service efficiency gains, but there is also evidence of poor acceptability, low effectiveness and relapse. AIMS The aim was to compare preferences for, acceptability and efficacy of cognitive-behavioural guided self-help (CBT-GSH) versus cognitive-analytic guided self-help (CAT-GSH). METHOD This was a pragmatic, randomised, patient preference trial (Clinical trials identifier: NCT03730532). The Beck Anxiety Inventory (BAI) was the primary outcome at 8- and 24-week follow-up. Interventions were delivered competently on the telephone via structured workbooks over 6-8 (30-35 min) sessions by trained practitioners. RESULTS A total of 271 eligible participants were included, of whom 19 (7%) accepted being randomised and 252 (93%) chose their treatment. In the preference cohort, 181 (72%) chose CAT-GSH and 71 (28%) preferred CBT-GSH. BAI outcomes in the preference and randomised cohorts did not differ at 8 weeks (-0.80, 95% confidence interval (CI) -4.52 to 2.92) or 24 weeks (0.85, 95% CI -2.87 to 4.57). After controlling for allocation method and baseline covariates, there were no differences between CAT-GSH and CBT-GSH at 8 weeks (F(1, 263) = 0.22, P = 0.639) or at 24 weeks (F(1, 263) = 0.22, P = 0.639). Mean BAI change from baseline was a reduction of 9.28 for CAT-GSH and 9.78 for CBT-GSH at 8 weeks and 12.90 for CAT-GSH and 12.43 for CBT-GSH at 24 weeks. CONCLUSIONS Patients accessing routine primary care talking treatments prefer to choose the intervention they receive. CAT-GSH expands the treatment offer in primary care for patients with anxiety seeking a brief but analytically informed GSH solution.
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Affiliation(s)
- Stephen Kellett
- Rotherham Doncaster and South Humber NHS Foundation Trust, UK; and University of Sheffield, UK
| | | | | | | | | | - Niall Power
- Derbyshire Community Health Services NHS Foundation Trust, UK
| | | | | | - Jaime Delgadillo
- Rotherham Doncaster and South Humber NHS Foundation Trust, UK; and University of Sheffield, UK
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18
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Ceelen W, Soreide K. Randomized controlled trials and alternative study designs in surgical oncology. EUROPEAN JOURNAL OF SURGICAL ONCOLOGY 2023; 49:1331-1340. [PMID: 36964056 DOI: 10.1016/j.ejso.2023.03.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2023] [Revised: 02/17/2023] [Accepted: 03/01/2023] [Indexed: 03/08/2023]
Abstract
Surgery is central to the cure of most solid cancers and an integral part of modern multimodal cancer management for early and advanced stage cancers. Decisions made by surgeons and multidisciplinary team members are based on best available knowledge for the defined clinical situation at hand. While surgery is both an art and a science, good decision-making requires data that are robust, valid, representative and, applicable to most if not all patients with a specific cancer. Such data largely comes from clinical observations and registries, and more preferably from trials conducted with the specific purpose of arriving at new answers. As part of the ESSO core curriculum development an increased focus has been put on the need to enhance research literacy among surgical candidates. As an expansion of the curriculum catalogue list and to enhance the educational value, we here present a set of principles and emerging concepts which applies to surgical oncologist for reading, understanding, planning and contributing to future surgeon-led cancer trials.
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Affiliation(s)
- Wim Ceelen
- Department of GI Surgery, Ghent University Hospital, Ghent, Belgium; Department of Human Structure and Repair, Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium; Cancer Research Institute Ghent (CRIG), Ghent, Belgium.
| | - Kjetil Soreide
- Department of Gastrointestinal Surgery, Stavanger University Hospital, Stavanger, Norway; Department of Clinical Medicine, University of Bergen, Bergen, Norway; SAFER Surgery, Surgical Research Unit, Stavanger University Hospital, Stavanger, Norway.
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Gaunt DM, Papastavrou Brooks C, Pedder H, Crawley E, Horwood J, Metcalfe C. Participant retention in paediatric randomised controlled trials published in six major journals 2015-2019: systematic review and meta-analysis. Trials 2023; 24:403. [PMID: 37316945 DOI: 10.1186/s13063-023-07333-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2023] [Accepted: 04/28/2023] [Indexed: 06/16/2023] Open
Abstract
BACKGROUND The factors which influence participant retention in paediatric randomised controlled trials are under-researched. Retention may be more challenging due to child developmental stages, involving additional participants, and proxy-reporting of outcomes. This systematic review and meta-analysis explores the factors which may influence retention in paediatric trials. METHODS Using the MEDLINE database, paediatric randomised controlled trials published between 2015 and 2019 were identified from six general and specialist high-impact factor medical journals. The review outcome was participant retention for each reviewed trial's primary outcome. Context (e.g. population, disease) and design (e.g. length of trial) factors were extracted. Retention was examined for each context and design factor in turn, with evidence for an association being determined by a univariate random-effects meta-regression analysis. RESULTS Ninety-four trials were included, and the median total retention was 0.92 (inter-quartile range 0.83 to 0.98). Higher estimates of retention were seen for trials with five or more follow-up assessments before the primary outcome, those less than 6 months between randomisation and primary outcome, and those that used an inactive data collection method. Trials involving children aged 11 and over had the higher estimated retention compared with those involving younger children. Those trials which did not involve other participants also had higher retention, than those where they were involved. There was also evidence that a trial which used an active or placebo control treatment had higher estimated retention, than treatment-as-usual. Retention increased if at least one engagement method was used. Unlike reviews of trials including all ages of participants, we did not find any association between retention and the number of treatment groups, size of trial, or type of treatment. CONCLUSIONS Published paediatric RCTs rarely report the use of specific modifiable factors that improve retention. Including multiple, regular follow-ups with participants before the primary outcome may reduce attrition. Retention may be highest when the primary outcome is collected up to 6 months after a participant is recruited. Our findings suggest that qualitative research into improving retention when trials involve multiple participants such as young people, and their caregivers or teachers would be worthwhile. Those designing paediatric trials also need to consider the use of appropriate engagement methods. RESEARCH ON RESEARCH (ROR) REGISTRY: https://ror-hub.org/study/2561.
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Affiliation(s)
- Daisy M Gaunt
- Population Health Sciences, Bristol Medical School, University of Bristol, Canynge Hall, 39 Whatley Road, Bristol, BS8 2PS, UK.
| | - Cat Papastavrou Brooks
- Population Health Sciences, Bristol Medical School, University of Bristol, Canynge Hall, 39 Whatley Road, Bristol, BS8 2PS, UK
| | - Hugo Pedder
- Population Health Sciences, Bristol Medical School, University of Bristol, Canynge Hall, 39 Whatley Road, Bristol, BS8 2PS, UK
| | - Esther Crawley
- Population Health Sciences, Bristol Medical School, University of Bristol, Canynge Hall, 39 Whatley Road, Bristol, BS8 2PS, UK
| | - Jeremy Horwood
- Population Health Sciences, Bristol Medical School, University of Bristol, Canynge Hall, 39 Whatley Road, Bristol, BS8 2PS, UK
- NIHR Applied Research Collaboration West, 9th Floor, Whitefriars, Lewins Mead, Bristol, BS1 2NT, UK
| | - Chris Metcalfe
- Population Health Sciences, Bristol Medical School, University of Bristol, Canynge Hall, 39 Whatley Road, Bristol, BS8 2PS, UK
- Bristol Trials Centre, Population Health Sciences, Bristol Medical School, University of Bristol, 1-5 Whiteladies Road, Bristol, BS8 1NU, UK
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20
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Verhoeven JE, Han LKM, Lever-van Milligen BA, Hu MX, Révész D, Hoogendoorn AW, Batelaan NM, van Schaik DJF, van Balkom AJLM, van Oppen P, Penninx BWJH. Antidepressants or running therapy: Comparing effects on mental and physical health in patients with depression and anxiety disorders. J Affect Disord 2023; 329:19-29. [PMID: 36828150 DOI: 10.1016/j.jad.2023.02.064] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/25/2022] [Revised: 02/11/2023] [Accepted: 02/14/2023] [Indexed: 02/24/2023]
Abstract
BACKGROUND Antidepressant medication and running therapy are both effective treatments for patients with depressive and anxiety disorders. However, they may work through different pathophysiological mechanisms and could differ in their impact on physical health. This study examined effects of antidepressants versus running therapy on both mental and physical health. METHODS According to a partially randomized patient preference design, 141 patients with depression and/or anxiety disorder were randomized or offered preferred 16-week treatment: antidepressant medication (escitalopram or sertraline) or group-based running therapy ≥2 per week. Baseline (T0) and post-treatment assessment at week 16 (T16) included mental (diagnosis status and symptom severity) and physical health indicators (metabolic and immune indicators, heart rate (variability), weight, lung function, hand grip strength, fitness). RESULTS Of the 141 participants (mean age 38.2 years; 58.2 % female), 45 participants received antidepressant medication and 96 underwent running therapy. Intention-to-treat analyses showed that remission rates at T16 were comparable (antidepressants: 44.8 %; running: 43.3 %; p = .881). However, the groups differed significantly on various changes in physical health: weight (d = 0.57; p = .001), waist circumference (d = 0.44; p = .011), systolic (d = 0.45; p = .011) and diastolic (d = 0.53; p = .002) blood pressure, heart rate (d = 0.36; p = .033) and heart rate variability (d = 0.48; p = .006). LIMITATIONS A minority of the participants was willing to be randomized; the running therapy was larger due to greater preference for this intervention. CONCLUSIONS While the interventions had comparable effects on mental health, running therapy outperformed antidepressants on physical health, due to both larger improvements in the running therapy group as well as larger deterioration in the antidepressant group. TRIAL REGISTRATION Trialregister.nl Number of identification: NTR3460.
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Affiliation(s)
- Josine E Verhoeven
- Department of Psychiatry, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam Public Health Research Institute & Amsterdam Neuroscience, Oldenaller 1, Amsterdam, the Netherlands.
| | - Laura K M Han
- Department of Psychiatry, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam Public Health Research Institute & Amsterdam Neuroscience, Oldenaller 1, Amsterdam, the Netherlands
| | - Bianca A Lever-van Milligen
- Department of Psychiatry, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam Public Health Research Institute & Amsterdam Neuroscience, Oldenaller 1, Amsterdam, the Netherlands
| | - Mandy X Hu
- Department of Psychiatry, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam Public Health Research Institute & Amsterdam Neuroscience, Oldenaller 1, Amsterdam, the Netherlands
| | - Dóra Révész
- Center of Research on Psychological and Somatic Disorders (CoRPS), Department of Medical and Clinical Psychology, Tilburg University, Tilburg, the Netherlands
| | - Adriaan W Hoogendoorn
- Department of Psychiatry, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam Public Health Research Institute & Amsterdam Neuroscience, Oldenaller 1, Amsterdam, the Netherlands
| | - Neeltje M Batelaan
- Department of Psychiatry, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam Public Health Research Institute & Amsterdam Neuroscience, Oldenaller 1, Amsterdam, the Netherlands
| | - Digna J F van Schaik
- Department of Psychiatry, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam Public Health Research Institute & Amsterdam Neuroscience, Oldenaller 1, Amsterdam, the Netherlands
| | - Anton J L M van Balkom
- Department of Psychiatry, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam Public Health Research Institute & Amsterdam Neuroscience, Oldenaller 1, Amsterdam, the Netherlands
| | - Patricia van Oppen
- Department of Psychiatry, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam Public Health Research Institute & Amsterdam Neuroscience, Oldenaller 1, Amsterdam, the Netherlands
| | - Brenda W J H Penninx
- Department of Psychiatry, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam Public Health Research Institute & Amsterdam Neuroscience, Oldenaller 1, Amsterdam, the Netherlands
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21
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Piccoli GB, Cederholm T, Avesani CM, Bakker SJL, Bellizzi V, Cuerda C, Cupisti A, Sabatino A, Schneider S, Torreggiani M, Fouque D, Carrero JJ, Barazzoni R. Nutritional status and the risk of malnutrition in older adults with chronic kidney disease - implications for low protein intake and nutritional care: A critical review endorsed by ERN-ERA and ESPEN. Clin Nutr 2023; 42:443-457. [PMID: 36857954 DOI: 10.1016/j.clnu.2023.01.018] [Citation(s) in RCA: 32] [Impact Index Per Article: 32.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2023] [Accepted: 01/27/2023] [Indexed: 02/04/2023]
Abstract
Increased life expectancy is posing unprecedented challenges to healthcare systems worldwide. These include a sharp increase in the prevalence of chronic kidney disease (CKD) and of impaired nutritional status with malnutrition-protein-energy wasting (PEW) that portends worse clinical outcomes, including reduced survival. In older adults with CKD, a nutritional dilemma occurs when indications from geriatric nutritional guidelines to maintain the protein intake above 1.0 g/kg/day to prevent malnutrition need to be adapted to the indications from nephrology guidelines, to reduce protein intake in order to prevent or slow CKD progression and improve metabolic abnormalities. To address these issues, the European Society for Clinical Nutrition and Metabolism (ESPEN) and the European Renal Nutrition group of the European Renal Association (ERN-ERA) have prepared this conjoint critical review paper, whose objective is to summarize key concepts related to prevention and treatment of both CKD progression and impaired nutritional status using dietary approaches, and to provide guidance on how to define optimal protein and energy intake in older adults with differing severity of CKD. Overall, the authors support careful assessment to identify the most urgent clinical challenge and the consequent treatment priority. The presence of malnutrition-protein-energy wasting (PEW) suggests the need to avoid or postpone protein restriction, particularly in the presence of stable kidney function and considering the patient's preferences and quality of life. CKD progression and advanced CKD stage support prioritization of protein restriction in the presence of a good nutritional status. Individual risk-benefit assessment and appropriate nutritional monitoring should guide the decision-making process. Higher awareness of the challenges of nutritional care in older adult patients with CKD is needed to improve care and outcomes. Research is advocated to support evidence-based recommendations, which we still lack for this increasingly large patient subgroup.
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Affiliation(s)
| | - Tommy Cederholm
- Department of Public Health and Caring Sciences, Uppsala University. Theme Inflammation & Aging, Karolinska University Hospital, Stockholm, Sweden
| | - Carla Maria Avesani
- Department of Clinical Science, Technology and Intervention, Division of Renal Medicine and Baxter Novum, Karolinska Institute, Stockholm, Sweden
| | - Stephan J L Bakker
- Division of Nephrology, Department of Internal Medicine, University Medical Center Groningen, Groningen, the Netherlands
| | - Vincenzo Bellizzi
- Nephrology and Dialysis Division - Department of Medical Sciences, Hospital "Sant'Anna e San Sebastiano", Caserta, Italy
| | - Cristina Cuerda
- Departamento de Medicina, Universidad Complutense de Madrid, Nutrition Unit, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - Adamasco Cupisti
- Department of Clinical and Experimental Medicine, University of Pisa, Via Roma 67, 56126, Pisa, Italy
| | - Alice Sabatino
- UO Nefrologia, Azienda Ospedaliera- Universitaria Parma, Parma, Italy
| | - Stephane Schneider
- Gastroenterology and Nutrition, Nice University Hospital, Université Côte d'Azur, Nice, France
| | - Massimo Torreggiani
- Néphrologie et dialyse, Centre Hospitalier Le Mans, Avenue Rubillard, 72037, Le Mans, France
| | - Denis Fouque
- Renal Department, Lyon SUD Hospital, Hospices Civils de Lyon, Université de Lyon, Pierre Benite, France
| | - Juan Jesus Carrero
- Department of Medical Epidemiology and Biostatistics, Karolinska Institute, Stockholm, Sweden; Division of Nephrology, Department of Clinical Sciences, Karolinska Institute, Danderyd Hospital, Stockholm, Sweden
| | - Rocco Barazzoni
- Department of Medical, Surgical and Health Sciences, University of Trieste, Trieste, Italy.
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22
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Chen S, Wang W. A scoping review on two-stage randomized preference trial in the field of mental health and addiction. BMC Psychiatry 2023; 23:192. [PMID: 36959551 PMCID: PMC10037890 DOI: 10.1186/s12888-023-04676-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/13/2022] [Accepted: 03/13/2023] [Indexed: 03/25/2023] Open
Abstract
BACKGROUND Randomized Controlled Trial is the most rigorous study design to test the efficacy and effectiveness of an intervention. Patient preference may negatively affect patient performance and decrease the generalizability of a trial to clinical population. Patient preference trial have particular implications in the field of mental health and addiction since mental health interventions are generally complex, blinding of intervention is often difficult or impossible, patients may have strong preference, and outcome measures are often subjective patient self-report which may be greatly influenced if patient's preference did not match with the intervention received. METHODS In this review, we have surveyed the application of two-stage randomized preference trial with focus on studies in the field of mental health and addiction. The study selection followed the guideline provided by Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for Scoping Reviews. RESULTS Six two-stage randomized preference trials (ten publications) have been identified in the field of mental health field and addiction. In these trials, the pooled dropout rates were 18.3% for the preference arm, and 28.7% for the random arm, with a pooled RR of 0.70 (95% CI, 0.56-0.88; P = 0.010) indicating lower risk of dropout in the preference arm. The standardized preference effects varied widely from 0.07 to 0.57, and could be as large as the treatment effect in some of the trials. CONCLUSION This scoping review has shown that two-stage randomized preference trials are not as popular as expected in mental health research. The results indicated that two-stage randomized preference trials in mental health would be beneficial in retaining patients to expand the generalizability of the trial.
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Affiliation(s)
- Sheng Chen
- Biostatistics Core, Centre for Addiction and Mental Health, 1001 Queen Street West, Toronto, ON, Canada
- Center for Complex Interventions, Centre for Addiction and Mental Health, Toronto, ON, Canada
| | - Wei Wang
- Biostatistics Core, Centre for Addiction and Mental Health, 1001 Queen Street West, Toronto, ON, Canada.
- Center for Complex Interventions, Centre for Addiction and Mental Health, Toronto, ON, Canada.
- College of Public Health, University of South Florida, 13201 Bruce B Downs Blvd, Tampa, FL, USA.
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23
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Torreggiani M, Wang AYM, Fois A, Piccoli GB. Personalized Low-Protein Diet Prescription in CKD Population: Merging Evidence From Randomized Trials With Observational Data. Semin Nephrol 2023; 43:151402. [PMID: 37536057 DOI: 10.1016/j.semnephrol.2023.151402] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/05/2023]
Abstract
Nutritional therapy is a cornerstone of the clinical management of chronic kidney disease (CKD). Nevertheless, randomized controlled trials often have failed to show a relevant benefit of low-protein diets in nonselected CKD populations in terms of slowing the progression of kidney disease and need for dialysis. The more the target population is selected, the less the results can be generalizable to implement in clinical practice. On the contrary, observational studies, especially if performed with patient-centered, flexible approaches, point toward an extensive implementation of dietary protein restriction in different and unselected CKD populations. The observational evidence cannot be disregarded anymore. The most recent guidelines advise implementing low-protein diets or even very-low-protein diets in all CKD patients as early as stage 3. However, the lack of data from large randomized controlled trials on unselected CKD populations as well as on specific subpopulations, such as diabetic or obese patients, which nowadays comprise the majority of CKD subjects, reduces the generalizability of the recommendations. For some patient populations, such as those encompassing very old, nephrotic, or pregnant patients, the literature is even more limited because of the lower prevalence of these conditions and diffused prejudices against reducing protein intake. This pragmatic review discusses the need for integrating information derived from randomized trials with evidence derived from observational studies to guide feasible strategies for more successful implementation of low-protein diets in the treatment of all segments of the CKD population.
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Affiliation(s)
| | - Angela Yee-Moon Wang
- Department of Medicine, Queen Mary Hospital, The University of Hong Kong, Hong Kong SAR, China
| | - Antioco Fois
- Néphrologie et Dialyse, Centre Hospitalier Le Mans, Le Mans, France
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24
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Mavragani A, Kreca S, van Dieren S, van der Wal-Huisman H, Romijn JA, Chaboyer W, Nieveen van Dijkum EJM, Eskes AM. Activating Relatives to Get Involved in Care After Surgery: Protocol for a Prospective Cohort Study. JMIR Res Protoc 2023; 12:e38028. [PMID: 36440980 PMCID: PMC9862329 DOI: 10.2196/38028] [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: 03/16/2022] [Revised: 10/31/2022] [Accepted: 11/02/2022] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND Postoperative complications and readmissions to hospital are factors known to negatively influence the short- and long-term quality of life of patients with gastrointestinal cancer. Active family involvement in activities, such as fundamental care activities, has the potential to improve the quality of health care. However, there is a lack of evidence regarding the relationship between active family involvement and outcomes in patients with gastrointestinal cancer after surgery. OBJECTIVE This protocol aims to evaluate the effect of a family involvement program (FIP) on unplanned readmissions of adult patients undergoing surgery for malignant gastrointestinal tumors. Furthermore, the study aims to evaluate the effect of the FIP on family caregiver (FC) burden and their well-being and the fidelity of the FIP. METHODS This cohort study will be conducted in 2 academic hospitals in the Netherlands. The FIP will be offered to adult patients and their FCs. Patients are scheduled for oncological gastrointestinal surgery and have an expected hospital stay of at least 5 days after surgery. FCs must be willing to participate in fundamental care activities during hospitalization and after discharge. Consenting patients and their families will choose to either participate in the FIP or be included in the usual care group. According to the power calculation, we will recruit 150 patients and families in the FIP group and 150 in the usual care group. The intervention group will receive the FIP that consists of information, shared goal setting, task-oriented training, participation in fundamental care, presence of FCs during ward rounds, and rooming-in for at least 8 hours a day. Patients in the comparison group will receive usual postoperative care. The primary outcome measure is the number of unplanned readmissions up to 30 days after surgery. Several secondary outcomes will be collected, that is, total number of complications (sensitive to fundamental care activities) at 30 and 90 days after surgery, emergency department visits, intensive care unit admissions up to 30 and 90 days after surgery, hospital length of stay, patients' quality of life, and the amount of home care needed after discharge. FC outcomes are caregiver burden and well-being up to 90 days after participating in the FIP. To evaluate fidelity, we will check whether the FIP is executed as intended. Univariable regression and multivariable regression analyses will be conducted. RESULTS The first participant was enrolled in April 2019. The follow-up period of the last participant ended in May 2022. The study was funded by an unrestricted grant of the University hospital in 2018. We aim to publish the results in 2023. CONCLUSIONS This study will provide evidence on outcomes from a FIP and will provide health care professionals practical tools for family involvement in the oncological surgical care setting. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) DERR1-10.2196/38028.
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Affiliation(s)
| | - Sani Kreca
- Department of Surgery, Amsterdam UMC, Cancer Center Amsterdam, University of Amsterdam, Amsterdam, Netherlands
| | - Susan van Dieren
- Department of Surgery, Amsterdam UMC, Cancer Center Amsterdam, University of Amsterdam, Amsterdam, Netherlands
| | | | | | - Wendy Chaboyer
- Menzies Health Institute Queensland and School of Nursing and Midwifery, Griffith University, Gold Coast, Australia
| | - Els J M Nieveen van Dijkum
- Department of Surgery, Amsterdam UMC, Amsterdam Gastroenterology Endocrinology Metabolism and Cancer Center Amsterdam, University of Amsterdam,, Amsterdam, Netherlands
| | - Anne M Eskes
- Department of Surgery, Amsterdam UMC, Cancer Center Amsterdam, University of Amsterdam, Amsterdam, Netherlands.,Menzies Health Institute Queensland and School of Nursing and Midwifery, Griffith University, Gold Coast, Australia
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25
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van Ede ES, Scheerhoorn J, Buise MP, Bouwman RA, Nienhuijs SW. Telemonitoring for perioperative care of outpatient bariatric surgery: Preference-based randomized clinical trial. PLoS One 2023; 18:e0281992. [PMID: 36812167 PMCID: PMC9946229 DOI: 10.1371/journal.pone.0281992] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2022] [Accepted: 01/24/2023] [Indexed: 02/24/2023] Open
Abstract
IMPORTANCE Implementation of bariatric surgery on an outpatient basis is hampered by concerns about timely detection of postoperative complications. Telemonitoring could enhance detection and support transition to an outpatient recovery pathway. OBJECTIVE This study aimed to evaluate non-inferiority and feasibility of an outpatient recovery pathway after bariatric surgery, supported by remote monitoring compared to standard care. DESIGN Preference-based non-inferiority randomized trial. SETTING Center for obesity and metabolic surgery, Catharina hospital Eindhoven, the Netherlands. PARTICIPANTS Adult patients scheduled for primary gastric bypass or sleeve gastrectomy. INTERVENTIONS Same-day discharge with one week ongoing Remote Monitoring (RM) of vital parameters or Standard Care (SC) with discharge on postoperative day one. MAIN OUTCOMES Primary outcome was a thirty-day composite Textbook Outcome score encompassing mortality, mild and severe complications, readmission and prolonged length-of-stay. Non-inferiority of same-day discharge and remote monitoring was accepted below the selected margin of 7% upper limit of confidence interval. Secondary outcomes included admission duration, post-discharge opioid use and patients' satisfaction. RESULTS Textbook Outcome was achieved in 94% (n = 102) in RM versus 98% (n = 100) in SC (RR 2.9; 95% CI, 0.60-14.23, p = 0.22). The non-inferiority margin was exceeded which is a statistically inconclusive result. Both Textbook Outcome measures were above Dutch average (5% RM and 9% SC). Same-day discharge reduced hospitalization days by 61% (p<0.001) and by 58% with re-admission days included (p<0.001). Post-discharge opioid use and satisfaction scores were equal (p = 0.82 and p = 0.86). CONCLUSION In conclusion, outpatient bariatric surgery supported with telemonitoring is clinically comparable to standard overnight bariatrics in terms of textbook-outcome. Both approaches reached primary endpoint results above Dutch average. However, statistically the outpatient surgery protocol was neither inferior, nor non-inferior to the standard pathway. Additionally, offering same-day discharge reduces the total hospitalization days while maintaining patient satisfaction and safety.
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Affiliation(s)
- E. S. van Ede
- Department of Anesthesiology, Catharina Hospital Eindhoven, Eindhoven, The Netherlands
- Department of Electrical Engineering, Signal Processing Systems, Eindhoven University of Technology, Eindhoven, The Netherlands
- * E-mail:
| | - J. Scheerhoorn
- Department of Surgery, Catharina hospital Eindhoven, Eindhoven, The Netherlands
| | - M. P. Buise
- Department of Anesthesiology, Catharina Hospital Eindhoven, Eindhoven, The Netherlands
| | - R. A. Bouwman
- Department of Anesthesiology, Catharina Hospital Eindhoven, Eindhoven, The Netherlands
- Department of Electrical Engineering, Signal Processing Systems, Eindhoven University of Technology, Eindhoven, The Netherlands
| | - S. W. Nienhuijs
- Department of Surgery, Catharina hospital Eindhoven, Eindhoven, The Netherlands
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26
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Wilson MG, Palmer E, Asselbergs FW, Harris SK. Integrated rapid-cycle comparative effectiveness trials using flexible point of care randomisation in electronic health record systems. J Biomed Inform 2023; 137:104273. [PMID: 36535604 DOI: 10.1016/j.jbi.2022.104273] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2022] [Revised: 10/13/2022] [Accepted: 12/12/2022] [Indexed: 12/23/2022]
Abstract
Whilst the Randomised Controlled Trial remains the gold standard for deriving robust causal estimates of treatment efficacy, too often a traditional design proves prohibitively expensive or cumbersome when it comes to assessing questions regarding the comparative effectiveness of routinely used treatments. As a result, patients experience variation in practice as clinicians lack the evidence needed to personalise treatments effectively. This variation may be classified as unwarranted, where existing evidence is ignored, or legitimate where in the absence of evidence, clinicians rely on experience, expert opinion, and inferred principles from basic science to make decisions. We argue that within the right ethical and technological framework, legitimate variation can be transformed into a mechanism for evidence generation and learning. Learning Health Systems which harness existing variation in practice, represent a novel approach for generating evidence from everyday clinical practice. The development of these systems has gained traction due to the increased availability of modern Electronic Health Record Systems. However, despite their promise, overcoming hurdles to successfully integrating clinical trials within Learning Health Systems has proven challenging. This article describes the origins of integrated clinical trials and explores two main barriers to their further implementation - how best to obtain informed consent from patients to participate in routine comparative effectiveness research, and how to automate and integrate randomisation into a clinical workflow. Having described these barriers, we present a potential solution in the form of a research pipeline using a novel form of flexible point-of-care randomisation to allow clinicians and patients to participate in studies where there is clinical equipoise.
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Affiliation(s)
- Matthew G Wilson
- Institute of Health Informatics, Faculty of Population Health Sciences, University College London, UK.
| | - Edward Palmer
- Bloomsbury Institute of Intensive Care Medicine, University College London, UK; Whittington Hospital NHS Trust, UK
| | - Folkert W Asselbergs
- Institute of Cardiovascular Science and Institute of Health Informatics, Faculty of Population Health Sciences, University College London, UK; Department of Cardiology, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, the Netherlands
| | - Steve K Harris
- Institute of Health Informatics, Faculty of Population Health Sciences, University College London, UK; Critical Care Department, University College London Hospital, UK
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27
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Ferguson MC, McNicol E, Kleykamp BA, Sandoval K, Haroutounian S, Holzer KJ, Kerns RD, Veasley C, Turk DC, Dworkin RH. Perspectives on Participation in Clinical Trials Among Individuals With Pain, Depression, and/or Anxiety: An ACTTION Scoping Review. THE JOURNAL OF PAIN 2023; 24:24-37. [PMID: 36152760 DOI: 10.1016/j.jpain.2022.09.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/24/2022] [Revised: 08/10/2022] [Accepted: 09/04/2022] [Indexed: 02/08/2023]
Abstract
For individuals experiencing pain, the decision to engage in clinical trials may be influenced by a number of factors including current and past care, illness severity, physical functioning, financial stress, and caregiver support. Co-occurring depression and anxiety may add to these challenges. The aim of this scoping review was to describe perspectives about clinical trial participation, including recruitment and retention among individuals with pain and pain comorbidities, including depression and/or anxiety. We searched PubMed, CINAHL, PsycINFO, and Cochrane CENTRAL databases. Study features, sample demographics, perspectives, barriers and/or motivations were collected and described. A total of 35 assessments were included in this scoping review with 24 focused on individuals with pain (24/35, 68.6%), 9 on individuals with depression and/or anxiety (9/35, 25.7%), and 2 on individuals with pain and co-occurring depression/anxiety (2/35, 5.7%). Barriers among participants with pain and those with depression included: research team's communication of information, fear of interventional risks, distrust (only among respondents with pain), too many procedures, fear of inadequate treatment, disease-life stressors, and embarrassment with study procedures (more commonly reported in participants with depression). Facilitators in both groups included: altruism and supportive staff, better access to care, and the ability to have outcome feedback (more commonly among individuals with depression). Individuals with pain and depression experience challenges that affect trial recruitment and retention. Engaging individuals with pain within research planning may assist in addressing these barriers and the needs of individuals affected by pain and/or depression. PERSPECTIVE: This review highlights the need to address barriers and facilitators to participation in clinical trials, including the need for an assessment of perspectives from underserved or marginalized populations.
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Affiliation(s)
- McKenzie C Ferguson
- School of Pharmacy, Southern Illinois University Edwardsville, Edwardsville, Illinois.
| | - Ewan McNicol
- School of Pharmacy, MCPHS University, Boston, Massachusetts
| | - Bethea A Kleykamp
- Department of Anesthesiology and Perioperative Medicine, University of Rochester Medical Center, Rochester, New York
| | - Karin Sandoval
- School of Pharmacy, Southern Illinois University Edwardsville, Edwardsville, Illinois
| | - Simon Haroutounian
- Department of Anesthesiology, Washington University School of Medicine, St. Louis, Missouri
| | - Katherine J Holzer
- Department of Anesthesiology, Washington University School of Medicine, St. Louis, Missouri
| | - Robert D Kerns
- Departments of Psychiatry, Neurology and Psychology, Yale University, New Haven, Connecticut
| | - Christin Veasley
- Co-founder and Director, Chronic Pain Research Alliance, North Kingstown, Rhode Island
| | - Dennis C Turk
- University of Washington School of Medicine, Seattle, Washington
| | - Robert H Dworkin
- Department of Anesthesiology and Perioperative Medicine, University of Rochester Medical Center, Rochester, New York
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Parsons J, Forde R, Brackenridge A, Hunt KF, Ismail K, Murrells T, Reid A, Rogers H, Rogers R, Forbes A. The gestational diabetes future diabetes prevention study (GODDESS): A partially randomised feasibility controlled trial. PLoS One 2022; 17:e0273992. [PMID: 36584120 PMCID: PMC9803154 DOI: 10.1371/journal.pone.0273992] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2021] [Accepted: 08/19/2022] [Indexed: 12/31/2022] Open
Abstract
OBJECTIVES To assess the feasibility of an ante- and post-natal lifestyle intervention for women with gestational diabetes mellitus (GDM) to reduce type 2 diabetes risk. DESIGN A partially randomised patient preference feasibility trial. SETTING Diabetes antenatal clinics in two inner-London hospitals, UK. PARTICIPANTS Pregnant women ≥18 years with a GDM diagnosis and pre-pregnancy body mass index of ≥25kg/m2. INTERVENTION Participants in the intervention group were offered four motivational interview-based sessions (two antenatally and two postnatally, at 3 and 6 months postpartum), a WhatsApp support group, a FitBit and electronic self-help resources. OUTCOME MEASURES Recruitment; retention; intervention dose received; data completion; adaptions; proportion achieving ≥5% weight loss; weight change, blood glucose; blood pressure; diet, physical activity, breastfeeding and depression. Clinical outcomes were measured at baseline and 6 months postpartum. RESULTS 50 participants were recruited from 155 eligible women (32% recruitment rate). Thirty-four were recruited to the intervention group (23 following randomisation (RI-group) and 11 based on preference (PI-group)); and 16 to the control group (13 randomised (RC-group) and 3 preference (PC-group)). Attrition was 44% (n = 22/50). Forty-six percent (n = 6) of the intervention group (25% (n = 2) of the RI-group and 80% (n = 4) of the PI-group) achieved ≥5% weight loss compared to 8% (n = 1) in the control group (95% confidence interval (CI) -0.69 to 0.07). Mean weight change was -2.1kg±9.0 in the intervention group (0kg±5.4 in the RI-group and -5.4kg±13.0 in the PI-group) compared to +4.4kg±4.9 in the control group (RC +4.4kg ±5.3 and PC +4.7kg ±3.1, 95% CI -12.4 to 0.2). CONCLUSIONS Recruitment was feasible, but strategies to improve retention are needed. The findings suggest the intervention can support women with GDM to lose weight. The observed weight loss was primarily in women who preferred the intervention. Therefore, future trials may need to adopt a preference design and consider factors associated with preference. TRIAL REGISTRATION Trial registration: ISRCTN52675820 https://www.isrctn.com/ISRCTN52675820?q=ISRCTN52675820&filters=&sort=&offset=1&totalResults=1&page=1&pageSize=10&searchType=basic-search.
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Affiliation(s)
- Judith Parsons
- Care in Long Term Conditions Research Division, Florence Nightingale Faculty of Nursing, Midwifery and Palliative Care, King’s College London, London, United Kingdom
- * E-mail:
| | - Rita Forde
- Care in Long Term Conditions Research Division, Florence Nightingale Faculty of Nursing, Midwifery and Palliative Care, King’s College London, London, United Kingdom
| | | | - Katharine F. Hunt
- Diabetes & Nutritional Sciences Division, Diabetes Research Group, King’s College London, London, United Kingdom
| | - Khalida Ismail
- Department of Psychological Medicine, Institute of Psychiatry, King’s College London, London, United Kingdom
| | - Trevor Murrells
- Methodologies Research Division, Florence Nightingale Faculty of Nursing, Midwifery and Palliative Care, King’s College London, London, United Kingdom
| | - Anna Reid
- Guy’s and St Thomas’ NHS Foundation Trust, London, United Kingdom
| | - Helen Rogers
- Diabetes & Nutritional Sciences Division, Diabetes Research Group, King’s College London, London, United Kingdom
| | - Rebecca Rogers
- Care in Long Term Conditions Research Division, Florence Nightingale Faculty of Nursing, Midwifery and Palliative Care, King’s College London, London, United Kingdom
| | - Angus Forbes
- Care in Long Term Conditions Research Division, Florence Nightingale Faculty of Nursing, Midwifery and Palliative Care, King’s College London, London, United Kingdom
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Alibhai SMH, Papadopoulos E, Durbano S, Tomlinson G, Mina DS, Ritvo P, Sabiston CM, Matthew AG, Chiarotto J, Sidani S, Culos-Reed SN. Preference-based versus randomized controlled trial in prostate cancer survivors: Comparison of recruitment, adherence, attrition, and clinical outcomes. Front Oncol 2022; 12:1033229. [PMID: 36578945 PMCID: PMC9791189 DOI: 10.3389/fonc.2022.1033229] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2022] [Accepted: 11/24/2022] [Indexed: 12/14/2022] Open
Abstract
Introduction Patients' unwillingness to be randomized to a mode of exercise may partly explain their poor recruitment, adherence, and attrition in randomized controlled trials (RCTs) of exercise in oncology. It is unknown whether a preference-based trial can improve recruitment, adherence, retention, and clinical outcomes compared to a RCT of the same exercise interventions. Objective We assessed the effects of a 2-arm exercise preference trial on adherence and clinical outcomes compared to a similar 2-arm RCT in men with prostate cancer (PC). Methods This was a two-arm preference-based trial of group-based training (GROUP) or home-based training (HOME). PC survivors on androgen deprivation therapy (ADT) who declined randomization to the RCT but chose to participate in a preference trial were recruited in four Canadian centers. All study participants engaged in aerobic and resistance training, 4-5 days weekly for 6 months, aiming for 150 minutes/week of moderate-to-vigorous physical activity. The primary outcomes were changes from baseline to 6 months in fatigue and functional endurance. Secondary outcomes were quality of life, physical fitness, body composition, blood markers, and adherence. Linear mixed models were used to assess the effects of HOME versus GROUP on primary outcomes. In pooled preference and RCT data, the selection effect (i.e., difference between those who were and were not willing to be randomized) and treatment effect (i.e., difference between GROUP and HOME) were estimated using linear regression. Results and conclusion Fifty-four participants (mean [SD] age, 70.2 [8.6] years) were enrolled (GROUP n=17; HOME n=37). Comparable effects on primary and secondary outcomes were observed following GROUP or HOME in the preference-based trial. Adherence was similar between preference and RCT participants. However, attrition was higher in the RCT (50.0% vs. 27.8%, p= 0.04). Compared to GROUP, HOME was more effective in ameliorating fatigue (mean difference: +5.2, 95%CI=1.3 to 9.3 p=0.01) in pooled preference and RCT data. A preference-based trial results in comparable observed effects on clinical outcomes and adherence and lower attrition compared with a RCT of the same exercise interventions in PC survivors on ADT. Given the appeals of preference-based trials to study participants, additional studies are warranted. Clinical trial registration clinicaltrials.gov, identifier (NCT03335631).
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Affiliation(s)
- Shabbir M. H. Alibhai
- Department of Medicine, University Health Network, Toronto, ON, Canada,Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada,*Correspondence: Shabbir M. H. Alibhai,
| | | | - Sara Durbano
- Department of Medicine, University Health Network, Toronto, ON, Canada
| | - George Tomlinson
- Department of Medicine, University Health Network, Toronto, ON, Canada,Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada
| | - Daniel Santa Mina
- Faculty of Kinesiology and Physical Education, University of Toronto, Toronto, ON, Canada
| | - Paul Ritvo
- Department of Psychology, School of Kinesiology and Health Science, York University, Toronto, ON, Canada
| | - Catherine M. Sabiston
- Faculty of Kinesiology and Physical Education, University of Toronto, Toronto, ON, Canada
| | - Andrew G. Matthew
- Department of Surgical Oncology, Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada
| | - James Chiarotto
- Department of Medicine, Division of Hematology/Oncology, Scarborough Health Network, Scarborough, ON, Canada
| | - Souraya Sidani
- Daphne Cockwell School of Nursing, Toronto Metropolitan University, Toronto, ON, Canada
| | - S. Nicole Culos-Reed
- Faculty of Kinesiology, University of Calgary, Calgary, AB, Canada,Department of Oncology, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
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Zaccari B, Sherman ADF, Febres-Cordero S, Higgins M, Kelly U. Findings from a pilot study of Trauma Center Trauma-Sensitive Yoga versus cognitive processing therapy for PTSD related to military sexual trauma among women Veterans. Complement Ther Med 2022; 70:102850. [PMID: 35820575 PMCID: PMC9704511 DOI: 10.1016/j.ctim.2022.102850] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2022] [Revised: 07/03/2022] [Accepted: 07/07/2022] [Indexed: 11/19/2022] Open
Abstract
OBJECTIVE The study objective was to explore the preliminary efficacy of trauma-sensitive yoga compared to cognitive processing therapy (CPT) for women Veterans with posttraumatic stress disorder (PTSD) related to military sexual trauma (MST) in a pilot randomized control trial (RCT). We then compared these results to published interim results for the subsequent full-scale RCT. METHOD The analytic sample included women Veterans (N = 41) with PTSD related to MST accessing healthcare in a southeastern Veterans Affairs Health Care System. The majority were African American, non-Hispanic (80.5 %). The protocol-driven group interventions, Trauma Center Trauma-Sensitive Yoga (TCTSY; n = 17) and the evidence-based control condition, CPT (n = 24), were delivered weekly for 10 and 12 sessions, respectively. Multilevel linear models (MLM) were used to compare changes over time between the two groups. RESULTS The primary outcomes presented here are PTSD symptom severity and diagnosis, assessed using the Clinician Administered PTSD Scale (CAPS) and the PTSD Symptom Checklist (PCL) total scores. PTSD symptom severity on both clinician-administered (CAPS) and self-reported (PCL) measures, improved significantly (p < .005) over time, with large within group effect sizes (0.90-0.99) consistent with the subsequent RCT. Participants in the TCTSY group showed clinically meaningful improvements earlier than the CPT group participants from baseline on the CAPS and PCL Total scores. CONCLUSIONS Results support published findings of the effectiveness of TCTSY in the treatment for PTSD related to MST among women Veterans, particularly African American women. TCTSY warrants consideration as an adjunctive, precursor, or concurrent treatment to evidence-based psychotherapies. Future research should include patient preference, men with sexual trauma, and civilian populations.
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Affiliation(s)
- Belle Zaccari
- Veterans Affairs Portland Health Care System, 3710 SW US Veterans Hospital Rd, Portland, OR 97239, USA; Department of Psychiatry, Oregon Health & Science University, 3181 SW Sam Jackson Park Road, Portland, OR 97239, USA.
| | - Athena D F Sherman
- Nell Hodgson Woodruff School of Nursing, Emory University, 1520 Clifton Rd, Atlanta, GA, USA.
| | - Sarah Febres-Cordero
- Nell Hodgson Woodruff School of Nursing, Emory University, 1520 Clifton Rd, Atlanta, GA, USA.
| | - Melinda Higgins
- Nell Hodgson Woodruff School of Nursing, Emory University, 1520 Clifton Rd, Atlanta, GA, USA.
| | - Ursula Kelly
- Nell Hodgson Woodruff School of Nursing, Emory University, 1520 Clifton Rd, Atlanta, GA, USA; Atlanta VA Health Care System, Decatur, GA, USA.
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Noor NM, Siegel C. Partially randomised, patient preference trials for inflammatory bowel disease. Lancet Gastroenterol Hepatol 2022; 7:981-983. [PMID: 36208633 DOI: 10.1016/s2468-1253(22)00240-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/03/2022] [Revised: 07/15/2022] [Accepted: 07/15/2022] [Indexed: 06/16/2023]
Affiliation(s)
- Nurulamin M Noor
- Department of Gastroenterology, Addenbrooke's Hospital, Cambridge University Hospitals NHS Foundation Trust, Cambridge CB2 0QQ, UK; Medical Research Council Clinical Trials Unit, University College London, London, UK.
| | - Corey Siegel
- Inflammatory Bowel Disease Center, Section of Gastroenterology and Hepatology, Dartmouth-Hitchcock Medical Center, Lebanon, NH, USA; The Dartmouth Institute for Health Policy and Clinical Practice, Geisel School of Medicine at Dartmouth, Hanover, NH, USA
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Beenhakker L, Witteveen A, Wijlens KAE, Siemerink EJM, van der Lee ML, Bode C, Siesling S, Vollenbroek‐Hutten MMR. Patient preference attributes in eHealth interventions for cancer-related fatigue: A scoping review. Eur J Cancer Care (Engl) 2022; 31:e13754. [PMID: 36385440 PMCID: PMC9786794 DOI: 10.1111/ecc.13754] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2022] [Revised: 10/05/2022] [Accepted: 10/09/2022] [Indexed: 11/18/2022]
Abstract
INTRODUCTION Cancer-related fatigue (CRF) is one of the most reported long-term effects breast cancer patients experience after diagnosis. Many interventions for CRF are effective, however, not for every individual. Therefore, intervention advice should be adjusted to patients' preferences and characteristics. Our aim was to develop an overview of eHealth interventions and their (preference sensitive) attributes. METHODS eHealth interventions were identified using a scoping review approach. Eligible studies included breast cancer patients and assessed CRF as outcome. Interventions were categorised as physical activity, mind-body, psychological, 'other' or 'combination'. Information was extracted on various (preference sensitive) attributes, like duration, intensity, peer support and costs. RESULTS Thirty-five interventions were included and divided over the intervention categories. (Preference sensitive) attributes varied both within and between these categories. Duration varied from 4 weeks to 6 months, intensity from daily to own pace. Peer support was present in seven interventions and costs were known for six. CONCLUSION eHealth interventions exist in various categories, additionally, there is much variation in (preference sensitive) attributes. This provides opportunities to implement our overview for personalised treatment recommendations for breast cancer patients struggling with CRF. Taking into account patients' preferences and characteristics suits the complexity of CRF and heterogeneity of patients.
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Affiliation(s)
- Lian Beenhakker
- Department of Biomedical Signals and SystemsUniversity of TwenteEnschedeThe Netherlands
| | - Annemieke Witteveen
- Department of Biomedical Signals and SystemsUniversity of TwenteEnschedeThe Netherlands
| | - Kim A. E. Wijlens
- Department of Biomedical Signals and SystemsUniversity of TwenteEnschedeThe Netherlands
| | | | - Marije L. van der Lee
- Scientific Research DepartmentHelen Dowling InstituteBilthovenThe Netherlands,Department of Medical and Clinical Psychology, Center of Research on Psychology in Somatic diseasesTilburg UniversityTilburgThe Netherlands
| | - Christina Bode
- Department of Psychology, Health and TechnologyUniversity of TwenteEnschedeThe Netherlands
| | - Sabine Siesling
- Department of Health Technology and Services Research, Technical Medical CentreUniversity of TwenteEnschedeThe Netherlands,Department of Research and DevelopmentNetherlands Comprehensive Cancer Organisation (IKNL)UtrechtThe Netherlands
| | - Miriam M. R. Vollenbroek‐Hutten
- Department of Biomedical Signals and SystemsUniversity of TwenteEnschedeThe Netherlands,Board of DirectorsMedisch Spectrum TwenteEnschedeThe Netherlands
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Wilson MG, Asselbergs FW, Miguel R, Brealey D, Harris SK. Embedded point of care randomisation for evaluating comparative effectiveness questions: PROSPECTOR-critical care feasibility study protocol. BMJ Open 2022; 12:e059995. [PMID: 36123103 PMCID: PMC9486229 DOI: 10.1136/bmjopen-2021-059995] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
INTRODUCTION Many routinely administered treatments lack evidence as to their effectiveness. When treatments lack evidence, patients receive varying care based on the preferences of clinicians. Standard randomised controlled trials are unsuited to comparisons of different routine treatment strategies, and there remains little economic incentive for change.Integrating clinical trial infrastructure into electronic health record systems offers the potential for routine treatment comparisons at scale, through reduced trial costs. To date, embedded trials have automated data collection, participant identification and eligibility screening, but randomisation and consent remain manual and therefore costly tasks.This study will investigate the feasibility of using computer prompts to allow flexible randomisation at the point of clinical decision making. It will compare the effectiveness of two prompt designs through the lens of a candidate research question-comparing liberal or restrictive magnesium supplementation practices for critical care patients. It will also explore the acceptability of two consent models for conducting comparative effectiveness research. METHODS AND ANALYSIS We will conduct a single centre, mixed-methods feasibility study, aiming to recruit 50 patients undergoing elective surgery requiring postoperative critical care admission. Participants will be randomised to either 'Nudge' or 'Preference' designs of electronic point-of-care randomisation prompt, and liberal or restrictive magnesium supplementation.We will judge feasibility through a combination of study outcomes. The primary outcome will be the proportion of prompts displayed resulting in successful randomisation events (compliance with the allocated magnesium strategy). Secondary outcomes will evaluate the acceptability of both prompt designs to clinicians and ascertain the acceptability of pre-emptive and opt-out consent models to patients. ETHICS AND DISSEMINATION This study was approved by Riverside Research Ethics Committee (Ref: 21/LO/0785) and will be published on completion. TRIAL REGISTRATION NUMBER NCT05149820.
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Affiliation(s)
- Matthew G Wilson
- Institute of Health Informatics, University College London, London, UK
| | - Folkert W Asselbergs
- Institute of Health Informatics, University College London, London, UK
- Department of Cardiology, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, The Netherlands
| | - Ruben Miguel
- Clinical Research Informatics Unit, Institute of Health Informatics, University College London, London, UK
| | - David Brealey
- Bloomsbury Institute for Intensive Care Medicine, University College London, London, UK
- Critical Care Department, University College London Hospitals NHS Foundation Trust, London, UK
| | - Steve K Harris
- Institute of Health Informatics, University College London, London, UK
- Critical Care Department, University College London Hospitals NHS Foundation Trust, London, UK
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Wang Y, Li F, Blaha O, Meng C, Esserman D. Design and analysis of partially randomized preference trials with propensity score stratification. Stat Methods Med Res 2022; 31:1515-1537. [PMID: 35469503 PMCID: PMC10530658 DOI: 10.1177/09622802221095673] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
While the two-stage randomized design allows us to unbiasedly evaluate the impact of patients' treatment preference on the outcome of interest, it may not always be practical to implement in clinical practice; patients with a strong preference may not be willing to be randomized. The more pragmatic, partially randomized preference design (PRPD) allows patients who are unwilling to be randomized, but willing to state their preference, to receive their preferred treatment in lieu of the first-stage randomization in the two-stage design, at the cost of potentially introducing bias in estimating the effects of interest. In this article, we consider the application of propensity score stratification (PSS) in a PRPD to recreate a conditional first-stage randomization based on observed covariates, enabling the estimation and inference of the overall treatment, selection and preference effects with minimum bias. We additionally derive a set of closed-form sample size formulas for detecting all three effects of interest in a PSS-PRPD. Simulation studies demonstrate the bias reduction properties of the PSS-PRPD, and validate the accuracy of the proposed sample size formulas. Our results show that 5 to 10 propensity score strata may be needed to correct for biases in effect estimates, and the exact number of strata needed to achieve the best match between the empirical power and formula prediction may depend on the degree of effect heterogeneity. Finally, we demonstrate our proposed formulas by estimating the required sample sizes to detect treatment, selection and preference effects in the context of the Harapan Study.
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Affiliation(s)
- Yumin Wang
- Department of Biostatistics, 50296Yale School of Public Health, New Haven, Connecticut, USA
| | - Fan Li
- Department of Biostatistics, 50296Yale School of Public Health, New Haven, Connecticut, USA
| | - Ondrej Blaha
- Department of Biostatistics, 50296Yale School of Public Health, New Haven, Connecticut, USA
| | - Can Meng
- Department of Biostatistics, 50296Yale School of Public Health, New Haven, Connecticut, USA
| | - Denise Esserman
- Department of Biostatistics, 50296Yale School of Public Health, New Haven, Connecticut, USA
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Health Literacy-Based Self-Management Intervention for Patient-Family Caregiver Dyads Undergoing Hemodialysis. Rehabil Nurs 2022; 47:187-197. [PMID: 35787612 DOI: 10.1097/rnj.0000000000000381] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE The aim of this study was to determine the effect of a health literacy-based self-management intervention for patient-family caregiver dyads undergoing hemodialysis. DESIGN A quasi-experimental design was used. METHODS The intervention group (n = 20) received a health literacy-based self-management intervention for patient-family caregiver dyads, whereas the control group (n = 23) received standard informational messages through a short messaging service for 8 weeks. All participants were assessed for hemodialysis knowledge, self-efficacy, family support, self-management, the ratio of interdialytic weight gain to dry weight, and serum phosphorus and potassium levels at pretest and posttest. RESULTS Participants in the intervention group exhibited higher scores on hemodialysis knowledge, self-efficacy, family support, and self-management than those in the control group. In addition, the ratio of interdialytic weight gain to dry weight decreased significantly in the intervention group. CONCLUSIONS The health literacy-based self-management intervention for patient-family caregiver dyads undergoing hemodialysis was effective in improving hemodialysis knowledge, self-efficacy, family support, self-management, and the ratio of interdialytic weight gain to dry weight. CLINICAL RELEVANCE Because health literacy is an important factor influencing self-management, interventions for patients undergoing hemodialysis should consider the health literacy level of patients and their family caregivers.
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Chevance A, Ravaud P, Cornelius V, Mayo-Wilson E, Furukawa TA. Designing clinically useful psychopharmacological trials: challenges and ways forward. Lancet Psychiatry 2022; 9:584-594. [PMID: 35525252 DOI: 10.1016/s2215-0366(22)00041-4] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/23/2021] [Revised: 01/15/2022] [Accepted: 02/01/2022] [Indexed: 12/23/2022]
Abstract
The clinical guidelines that underpin the use of drugs for mental disorders are informed by evidence from randomised controlled trials (RCTs). RCTs are performed to obtain marketing authorisation from regulators. The methods used in these RCTs could be appropriate for early phases of drug development because they identify drugs with important harms and drugs that are efficacious for specific health problems and populations. RCTs done before marketing authorisation do not tend to address clinical questions that concern the effectiveness of a drug in heterogeneous and comorbid populations, the optimisation of drug sequencing and discontinuation, or the comparative benefits and harms of different drugs that could be used for the same health problem. This Review proposes an overview of some shortcomings of RCTs, at an individual level and at the whole portfolio level, and identifies some methods in planning, conducting, and carrying out analyses in RCTs that could enhance their ability to support therapeutic decisions. These suggestions include: identifying patient-important questions to be investigated by psychopharmacological RCTs; embedding pragmatic RCTs within clinical practice to improve generalisability to target populations; collecting evidence about drugs in overlooked populations; developing methods to facilitate the recruitment of patients with mental disorders and to reduce the number of patients who drop out, using specific methods; using core outcome sets to standardise the assessment of benefits and harms; and recording systematically serious objective outcomes, such as suicide or hospitalisation, to be evaluated in meta-analyses. This work is a call to address questions relevant to patients using diverse design of RCTs, thus contributing to the development of a patient-centred, evidence-based psychiatry.
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Affiliation(s)
- Astrid Chevance
- Université Paris Cité, CRESS, INSERM, INRAE, Paris, France; Centre d'Epidémiologie Clinique, Hôpital Hôtel-Dieu, AP-HP, Paris, France.
| | - Philippe Ravaud
- Université Paris Cité, CRESS, INSERM, INRAE, Paris, France; Centre d'Epidémiologie Clinique, Hôpital Hôtel-Dieu, AP-HP, Paris, France
| | - Victoria Cornelius
- Imperial Clinical Trials Unit, School of Public Health, Imperial College London, London, UK
| | - Evan Mayo-Wilson
- Department of Epidemiology and Biostatistics, Indiana University School of Public Health-Bloomington, Bloomington, IN, USA
| | - Toshi A Furukawa
- Department of Health Promotion and Human Behavior and Department of Clinical Epidemiology, School of Public Health, Kyoto University Graduate School of Medicine, Kyoto, Japan
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Meima-van Praag EM, van Rijn KL, Wasmann KATGM, Snijder HJ, Stoker J, D'Haens GR, Gecse KB, Gerhards MF, Jansen JM, Dijkgraaf MGW, van der Bilt JDW, Mundt MW, Spinelli A, Danese S, Bemelman WA, Buskens CJ. Short-term anti-TNF therapy with surgical closure versus anti-TNF therapy in the treatment of perianal fistulas in Crohn's disease (PISA-II): a patient preference randomised trial. Lancet Gastroenterol Hepatol 2022; 7:617-626. [PMID: 35427495 DOI: 10.1016/s2468-1253(22)00088-7] [Citation(s) in RCA: 20] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/21/2022] [Revised: 03/07/2022] [Accepted: 03/08/2022] [Indexed: 06/14/2023]
Abstract
BACKGROUND Guidelines on Crohn's perianal fistulas recommend anti-tumour necrosis factor (TNF) treatment and suggest considering surgical closure for patients with surgically amenable disease. However, long-term outcomes following these two strategies have not been directly compared. The aim of this study was to assess radiological healing in patients who received short-term anti-TNF treatment and surgical closure compared with those who received anti-TNF treatment alone. METHODS The PISA-II trial was a multicentre, patient preference study done in nine hospitals in the Netherlands and one hospital in Italy. Adult patients with Crohn's disease and an active high perianal fistula with a single internal opening were eligible for inclusion. After counselling, patients with no treatment preference were randomly assigned (1:1) using random block randomisation (block sizes of six without statification), to 4-month anti-TNF therapy and surgical closure or anti-TNF therapy for 1 year, after seton insertion. Patients with a treatment preference received their preferred therapy. The primary outcome was radiological healing assessed by MRI at 18 months, defined as a complete fibrotic tract or a MAGNIFI-CD (Magnetic Resonance Index for Fistula Imaging in Crohn's Disease) score of 0, assessed according to the intention-to-treat principle. Secondary outcomes included clinical closure, number of patients undergoing surgical reintervention and number of reinterventions, recurrences, and impact on quality of life measured by the Perianal Disease Activity Index (PDAI). Analyses were performed on an intention-to-treat basis and additionally an as-treated analysis for radiological healing and clinical closure. This study was registered at the Dutch Trial Registry, NL7625, and with EudraCT, 2018-002064-15, and is closed to accrual due to completion. FINDINGS Between Sept 14, 2013, and Dec 7, 2019, 94 patients were enrolled onto the trial, of whom 32 (34%) were randomly assigned and 62 (66%) chose a specific treatment. 38 (40%) patients were assigned to the surgical closure group and 56 (60%) patients to the anti-TNF group. At 18 months, radiological healing was significantly more common in the surgical closure group (12 [32%] patients) than in the anti-TNF group (five [9%] patients; p=0·005). By contrast, clinical closure was not significantly different between the two treatment groups (26 [68%] patients in the surgical closure group vs 29 [52%] patients in the anti-TNF group; p=0·076). Significantly fewer patients required a reintervention in the surgical closure group than in the anti-TNF therapy group (five [13%] patients in the surgical closure group, median one reintervention [IQR one to three] vs 24 [43%] patients in the anti-TNF group, median two reinterventions [one to two]; p=0·005). Among patients who reached clinical closure during follow-up, four (14%) of 29 in the surgical closure group and five (16%) of 31 in the anti-TNF therapy group had a recurrence, which occurred only in patients without radiological healing. PDAI was significantly lower in the surgical closure group than in the anti-TNF group after 18 months (p=0·031). Adverse events and serious adverse events were similar in both treatment groups and mostly entailed reinterventions. Ten (11%) patients had side-effects associated with anti-TNF treatment. Two serious adverse events unrelated to study treatment occurred (appendicitis and myocardial infarction). One patient died from a tongue base carcinoma, unrelated to study treatment. INTERPRETATION Short-term anti-TNF treatment combined with surgical closure induces long-term MRI healing more frequently than anti-TNF therapy in patients with Crohn's perianal fistulas. These data suggest that patients with Crohn's perianal fistula amenable for surgical closure should be counselled for this therapeutic approach. FUNDING Netherlands Organisation for Health Research and Development and Broad Medical Research Program.
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Affiliation(s)
- Elise M Meima-van Praag
- Department of Surgery, Amsterdam University Medical Centre, University of Amsterdam, Amsterdam, Netherlands
| | - Kyra L van Rijn
- Department of Radiology and Nuclear Medicine, Amsterdam University Medical Centre, University of Amsterdam, Amsterdam, Netherlands
| | - Karin A T G M Wasmann
- Department of Surgery, Amsterdam University Medical Centre, University of Amsterdam, Amsterdam, Netherlands
| | - Harmanna J Snijder
- Department of Gastroenterology and Hepatology, Amsterdam University Medical Centre, University of Amsterdam, Amsterdam, Netherlands
| | - Jaap Stoker
- Department of Radiology and Nuclear Medicine, Amsterdam University Medical Centre, University of Amsterdam, Amsterdam, Netherlands
| | - Geert R D'Haens
- Department of Gastroenterology and Hepatology, Amsterdam University Medical Centre, University of Amsterdam, Amsterdam, Netherlands
| | - Krisztina B Gecse
- Department of Gastroenterology and Hepatology, Amsterdam University Medical Centre, University of Amsterdam, Amsterdam, Netherlands
| | - Michael F Gerhards
- Department of Surgery, Onze Lieve Vrouwe Gasthuis, Amsterdam, Netherlands
| | - Jeroen M Jansen
- Department of Gastroenterology and Hepatology, Onze Lieve Vrouwe Gasthuis, Amsterdam, Netherlands
| | - Marcel G W Dijkgraaf
- Department of Epidemiology and Data Science, Amsterdam University Medical Centre, University of Amsterdam, Amsterdam, Netherlands
| | | | - Marco W Mundt
- Department of Gastroenterology and Hepatology, Flevoziekenhuis, Almere, Netherlands
| | - Antonino Spinelli
- Department of Biomedical Sciences, Humanitas University, IRCCS Humanitas Research Hospital, Milan, Italy
| | - Silvio Danese
- Department of Gastroenterology and Endoscopy, Istituto di Ricovero e Cura a Carattere Scientifico Ospedale San Raffaele and University Vita-Salute San Raffaele, Milan, Italy
| | - Willem A Bemelman
- Department of Surgery, Amsterdam University Medical Centre, University of Amsterdam, Amsterdam, Netherlands; Department of Gastroenterology and Endoscopy, Istituto di Ricovero e Cura a Carattere Scientifico Ospedale San Raffaele and University Vita-Salute San Raffaele, Milan, Italy
| | - Christianne J Buskens
- Department of Surgery, Amsterdam University Medical Centre, University of Amsterdam, Amsterdam, Netherlands.
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Steenstrup B, Cartier M, Nouhaud F, Kerdelhue G, Gilliaux M. A systematic review of supervised comprehensive functional physiotherapy after radical prostatectomy. Prog Urol 2022; 32:525-539. [DOI: 10.1016/j.purol.2022.04.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2022] [Revised: 04/19/2022] [Accepted: 04/24/2022] [Indexed: 10/18/2022]
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Davidson GH, Monsell SE, Evans H, Voldal EC, Fannon E, Lawrence SO, Krishnadasan A, Talan DA, Bizzell B, Heagerty PJ, Comstock BA, Lavallee DC, Villegas C, Winchell R, Thompson CM, Self WH, Kao LS, Dodwad SJ, Sabbatini AK, Droullard D, Machado-Aranda D, Gibbons MM, Kaji AH, DeUgarte DA, Ferrigno L, Salzberg M, Mandell KA, Siparsky N, Price TP, Raman A, Corsa J, Wisler J, Ayoung-Chee P, Victory J, Jones A, Kutcher M, McGrane K, Holihan J, Liang MK, Cuschieri J, Johnson J, Fischkoff K, Drake FT, Sanchez SE, Odom SR, Kessler LG, Flum DR. Self-selection vs Randomized Assignment of Treatment for Appendicitis. JAMA Surg 2022; 157:598-608. [PMID: 35612859 DOI: 10.1001/jamasurg.2022.1554] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Importance For adults with appendicitis, several randomized clinical trials have demonstrated that antibiotics are an effective alternative to appendectomy. However, it remains unknown how the characteristics of patients in such trials compare with those of patients who select their treatment and whether outcomes differ. Objective To compare participants in the Comparison of Outcomes of Antibiotic Drugs and Appendectomy (CODA) randomized clinical trial (RCT) with a parallel cohort study of participants who declined randomization and self-selected treatment. Design, Setting, and Participants The CODA trial was conducted in 25 US medical centers. Participants were enrolled between May 3, 2016, and February 5, 2020; all participants were eligible for at least 1 year of follow-up, with all follow-up ending in 2021. The randomized cohort included 1094 adults with appendicitis; the self-selection cohort included patients who declined participation in the randomized group, of whom 253 selected appendectomy and 257 selected antibiotics. In this secondary analysis, characteristics and outcomes in both self-selection and randomized cohorts are described with an exploratory analysis of cohort status and receipt of appendectomy. Interventions Appendectomy vs antibiotics. Main Outcomes and Measures Characteristics among participants randomized to either appendectomy or antibiotics were compared with those of participants who selected their own treatment. Results Clinical characteristics were similar across the self-selection cohort (510 patients; mean age, 35.8 years [95% CI, 34.5-37.1]; 218 female [43%; 95% CI, 39%-47%]) and the randomized group (1094 patients; mean age, 38.2 years [95% CI, 37.4-39.0]; 386 female [35%; 95% CI, 33%-38%]). Compared with the randomized group, those in the self-selection cohort were less often Spanish speaking (n = 99 [19%; 95% CI, 16%-23%] vs n = 336 [31%; 95% CI, 28%-34%]), reported more formal education (some college or more, n = 355 [72%; 95% CI, 68%-76%] vs n = 674 [63%; 95% CI, 60%-65%]), and more often had commercial insurance (n = 259 [53%; 95% CI, 48%-57%] vs n = 486 [45%; 95% CI, 42%-48%]). Most outcomes were similar between the self-selection and randomized cohorts. The number of patients undergoing appendectomy by 30 days was 38 (15.3%; 95% CI, 10.7%-19.7%) among those selecting antibiotics and 155 (19.2%; 95% CI, 15.9%-22.5%) in those who were randomized to antibiotics (difference, 3.9%; 95% CI, -1.7% to 9.5%). Differences in the rate of appendectomy were primarily observed in the non-appendicolith subgroup. Conclusions and Relevance This secondary analysis of the CODA RCT found substantially similar outcomes across the randomized and self-selection cohorts, suggesting that the randomized trial results are generalizable to the community at large. Trial Registration ClinicalTrials.gov Identifier: NCT02800785.
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Affiliation(s)
| | | | | | - Heather Evans
- Harborview Medical Center, Seattle, Washington.,Medical University of South Carolina, Charleston, South Carolina
| | | | - Erin Fannon
- University of Washington, Seattle, Washington
| | | | | | - David A Talan
- Olive View UCLA Medical Center, Los Angeles, California.,Ronald Reagan UCLA Medical Center, Los Angeles, California
| | | | | | | | - Danielle C Lavallee
- University of Washington, Seattle, Washington.,BC Academic Health Science Network, Vancouver, British Columbia, Canada
| | | | | | - Callie M Thompson
- Vanderbilt University Medical Center, Nashville, Tennessee.,University of Utah, Salt Lake City, Utah
| | - Wesley H Self
- Vanderbilt University Medical Center, Nashville, Tennessee
| | - Lillian S Kao
- McGovern Medical School at The University of Texas Health Science Center at Houston (UTHealth), Houston, Texas
| | - Shah-Jahan Dodwad
- McGovern Medical School at The University of Texas Health Science Center at Houston (UTHealth), Houston, Texas
| | | | | | | | | | - Amy H Kaji
- Harbor UCLA Medical Center, Los Angeles, California.,Statistical Editor, JAMA Surgery
| | | | - Lisa Ferrigno
- UCHealth University of Colorado Hospital, Denver, Colorado
| | | | | | | | - Thea P Price
- Rush University Medical Center, Chicago, Illinois
| | | | - Joshua Corsa
- Providence Regional Medical Center, Everett, Washington
| | - Jon Wisler
- The Ohio State University Wexner Medical Center, Columbus, Ohio
| | - Patricia Ayoung-Chee
- Tisch Hospital NYU Langone Medical Center, New York, New York.,Grady Health, Morehouse School of Medicine, Atlanta, Georgia
| | - Jesse Victory
- Bellevue Hospital Center NYU School of Medicine, New York, New York
| | - Alan Jones
- University of Mississippi Medical Center, Jackson, Mississippi
| | - Matthew Kutcher
- University of Mississippi Medical Center, Jackson, Mississippi
| | - Karen McGrane
- Madigan Army Medical Center, Tacoma, Washington.,Mason General Hospital, Shelton, Washington
| | - Julie Holihan
- University of Texas Lyndon B. Johnson General Hospital, Houston, Texas
| | - Mike K Liang
- University of Texas Lyndon B. Johnson General Hospital, Houston, Texas.,University of Houston, HCA Healthcare, Kingwood, Texas
| | - Joseph Cuschieri
- Harborview Medical Center, Seattle, Washington.,University of California, San Francisco, San Francisco, California
| | | | | | | | | | - Stephen R Odom
- Beth Israel Deaconess Medical Center, Boston, Massachusetts
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Parent Fruit and Vegetable Consumption Outcomes from the Translational 'Time for Healthy Habits' Trial: Secondary Outcomes from a Partially Randomized Preference Trial. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19106165. [PMID: 35627702 PMCID: PMC9141017 DOI: 10.3390/ijerph19106165] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/14/2022] [Revised: 05/12/2022] [Accepted: 05/13/2022] [Indexed: 11/17/2022]
Abstract
Healthy eating and active living interventions targeting parents of young children could have benefits for both children and parents. The aim of this study was to assess the effectiveness of two remotely delivered healthy eating and active living interventions delivered at scale to parents, in increasing parent vegetable and fruit consumption (pre-specified secondary outcomes). Parents of children aged 2–6 years residing in New South Wales, Australia (n = 458), were recruited to a partially randomized preference trial consisting of three groups (telephone intervention (n = 95); online intervention (n = 218); written material (Control) (n = 145)). This design allowed parents with a strong preference to select their preferred intervention, and once preference trends had been established, all parents that were subsequently recruited were randomized to obtain robust relative effects. Parent vegetable and fruit consumption was assessed via telephone interview at baseline and 9 months later. At follow-up, randomized parents who received the telephone intervention (n = 73) had significantly higher vegetable consumption compared to those who received the written control (n = 81) (+0.41 serves/day, p = 0.04), but there were no differences in parents allocated to intervention groups based on preference. No differences in fruit consumption were found for randomized or preference participants for either the telephone or online intervention. There may be some benefit to parents participating in the Healthy Habits Plus (telephone-based) intervention aimed at improving the eating behaviors of their children.
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Gong Y, Wang X, Li N, Fu Y, Zheng H, Zheng Y, Zhan S, Ling Y. A Partially Randomized Patient Preference Trial to Assess the Quality of Life and Patency Rate After Minimally Invasive Cardiac Surgery-Coronary Artery Bypass Grafting: Design and Rationale of the MICS-CABG PRPP Trial. Front Cardiovasc Med 2022; 9:804217. [PMID: 35548423 PMCID: PMC9081498 DOI: 10.3389/fcvm.2022.804217] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2021] [Accepted: 03/28/2022] [Indexed: 12/04/2022] Open
Abstract
Background Minimally invasive cardiac surgery-coronary artery bypass grafting (MICS-CABG) has emerged as a safe alternative to standard cardiac surgery. However, treatment preferences can decrease the generalizability of RCT results to the clinical population (i.e., reduce external validity) and influence adherence to the treatment protocol and study outcomes (i.e., reduce internal validity). However, this has not yet been properly investigated in randomized trials with consideration of treatment preferences. Study Design In this study, patients with a preference will be allocated to treatment strategies accordingly, whereas only those patients without a distinct preference will be randomized. The randomized trial is a 248-patient controlled, randomized, investigator-blinded trial. It is designed to compare whether treatment with MICS-CABG is beneficial in comparison to CABG. This study is aimed to establish the superiority hypothesis for the physical component summary (PCS) accompanied by the non-inferiority hypothesis for overall graft patency. Patients with no treatment preference will be randomized in a 1:1 fashion to one of the two treatment arms. The primary efficacy endpoints are the PCS score at 30 days after surgery and the overall patency rate of the grafts within 14 days after surgery. Secondary outcome measures include the PCS score and patency rate at different time points. Safety endpoints include major adverse cardiac and cerebrovascular events, complications, bleeding, wound infection, death, etc. Conclusions This trial will address essential questions of the efficacy and safety of MICS-CABG. The study will also address the impact of patients' preferences on external validity and internal validity.
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Affiliation(s)
- Yichen Gong
- Department of Cardiac Surgery, Peking University Third Hospital, Beijing, China
| | - Xiaoxiao Wang
- Research Center of Clinical Epidemiology, Peking University Third Hospital, Beijing, China
| | - Nan Li
- Research Center of Clinical Epidemiology, Peking University Third Hospital, Beijing, China
| | - Yuanhao Fu
- Department of Cardiac Surgery, Peking University Third Hospital, Beijing, China
| | - Hui Zheng
- Department of Cardiac Surgery, Peking University Third Hospital, Beijing, China
| | - Ye Zheng
- Department of Cardiac Surgery, Peking University Third Hospital, Beijing, China
| | - Siyan Zhan
- Research Center of Clinical Epidemiology, Peking University Third Hospital, Beijing, China
- Department of Epidemiology and Biostatistics, School of Public Health, Peking University, Beijing, China
- Siyan Zhan
| | - Yunpeng Ling
- Department of Cardiac Surgery, Peking University Third Hospital, Beijing, China
- *Correspondence: Yunpeng Ling
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Lansdorp CA, Buskens CJ, Gecse KB, Löwenberg M, Stoker J, Bemelman WA, D'Haens GRAM, van Hulst RA. Hyperbaric oxygen therapy for the treatment of perianal fistulas in 20 patients with Crohn's disease: Results of the HOT-TOPIC trial after 1-year follow-up. United European Gastroenterol J 2022; 10:160-168. [PMID: 35146959 PMCID: PMC8911540 DOI: 10.1002/ueg2.12189] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/06/2021] [Accepted: 12/01/2021] [Indexed: 12/18/2022] Open
Abstract
Background Previously published short‐term results (week 16) of this trial showed a significant improvement in clinical, radiologic and biochemical outcomes in Crohn's disease patients with therapy‐refractory perianal fistulas after treatment with hyperbaric oxygen therapy. Objective To assess the long‐term (week 60) efficacy, safety and feasibility of hyperbaric oxygen therapy in perianal fistula in Crohn's disease. Methods Crohn's disease patients with high perianal fistula(s) failing conventional treatment >6 months were included. Exclusion criteria were presence of a stoma, rectovaginal fistula(s) and recent changes in treatment regimens. Patients received 40 hyperbaric oxygen sessions and outcomes were assessed at week 16 and week 60. Results Twenty patients were included (median age 34 years). At week 16, median scores of the perianal disease activity index and modified Van Assche index (co‐primary outcomes) decreased from 7.5 (95% CI 6–9) to 4 (95% CI 3–6, p < 0.001) and 9.2 (95% CI 7.3–11.2) to 7.3 (95% CI 6.9–9.7, p = 0.004), respectively. At week 60, the respective scores remained significantly lower than baseline: 4 (95% CI 3–7, p < 0.001) and 7.7 (95% CI 5.2–10.2, p = 0.003). Perianal disease activity index score of 4 or less (representing inactive perianal disease) was observed in 13 patients at week 16 and 12 patients at week 60. Using fistula drainage assessment, 12 and 13 patients showed a clinical response at week 16 and 60, respectively, and clinical remission was achieved in four patients for both time points. At week 16, a statistically significant biochemical improvement (C‐reactive protein and faecal calprotectin levels) was found, but this effect was no longer significant at week 60. Conclusions The clinical and radiologic improvement of perianal fistula in Crohn's disease, that was found at week 16 after treatment with hyperbaric oxygen therapy, is maintained at 1‐year follow‐up.
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Affiliation(s)
- Corine A Lansdorp
- Department of Anaesthesiology/Hyperbaric Medicine, Amsterdam UMC, Location AMC, Amsterdam, The Netherlands
| | - Christianne J Buskens
- Department of Surgery, Amsterdam UMC, Location AMC, Amsterdam Gastroenterology Endocrinology Metabolism, Amsterdam, The Netherlands
| | - Krisztina B Gecse
- Department of Gastroenterology and Hepatology, Amsterdam UMC, Location AMC, Amsterdam, The Netherlands
| | - Mark Löwenberg
- Department of Gastroenterology and Hepatology, Amsterdam UMC, Location AMC, Amsterdam, The Netherlands
| | - Jaap Stoker
- Department of Radiology and Nuclear Medicine, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Willem A Bemelman
- Department of Surgery, Amsterdam UMC, Location AMC, Amsterdam Gastroenterology Endocrinology Metabolism, Amsterdam, The Netherlands
| | - Geert R A M D'Haens
- Department of Gastroenterology and Hepatology, Amsterdam UMC, Location AMC, Amsterdam, The Netherlands
| | - Rob A van Hulst
- Department of Anaesthesiology/Hyperbaric Medicine, Amsterdam UMC, Location AMC, Amsterdam, The Netherlands
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Scheerhoorn J, van Ede L, Luyer MDP, Buise MP, Bouwman RA, Nienhuijs SW. Postbariatric EArly discharge Controlled by Healthdot (PEACH) trial: study protocol for a preference-based randomized trial. Trials 2022; 23:67. [PMID: 35063007 PMCID: PMC8781161 DOI: 10.1186/s13063-022-06001-9] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2021] [Accepted: 01/04/2022] [Indexed: 11/10/2022] Open
Abstract
Abstract
Introduction
Performing bariatric surgery in a daycare setting has a potential reduction in hospital costs and increase in patients’ satisfaction. Although the feasibility and safety of such care pathway has already been proven, its implementation is hampered by concerns about timely detection of short-term complications. This study is designed to evaluate a combined outcome measurement in outpatient bariatric surgery supplemented by a novel wireless remote monitoring system versus current standard of care.
Methods and analysis
A total of 200 patients with multidisciplinary team approval for primary bariatric surgery will be assigned based on their preference to one of two postoperative trajectories: (1) standard of in-hospital care with discharge on the first postoperative day or (2) same day discharge with ongoing telemonitoring up to 7 days after surgery. The device (Healthdot R Philips) transfers heart rate, respiration rate, activity, and body posture of the patient continuously by LoRaWan network to our hospital’s dashboard (Philips Guardian). The primary outcome is a composite outcome measure within 30 days postoperative based on mortality, mild and severe complications, readmission, and prolonged length-of-stay. Secondary outcomes include patients’ satisfaction and data handling dimensions.
Trial registration
ClinicalTrials.govNCT04754893, Registered on 12 February 2021.
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Hesketh K, Jones H, Kinnafick F, Shepherd SO, Wagenmakers AJM, Strauss JA, Cocks M. Home-Based HIIT and Traditional MICT Prescriptions Improve Cardiorespiratory Fitness to a Similar Extent Within an Exercise Referral Scheme for At-Risk Individuals. Front Physiol 2021; 12:750283. [PMID: 34858205 PMCID: PMC8631444 DOI: 10.3389/fphys.2021.750283] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2021] [Accepted: 10/21/2021] [Indexed: 11/13/2022] Open
Abstract
Exercise referral schemes (ERS) are used to promote physical activity within primary care. Traditionally, ERS are conducted in a gym or leisure-center setting, with exercise prescriptions based on moderate-intensity continuous training (MICT). Home-based high-intensity interval training (Home-HIIT) has the potential to reduce perceived barriers to exercise, including lack of time and access to facilities, compared to traditional MICT prescription used with ERS and improve health related outcomes. We hypothesized that Home-HIIT would mediate greater improvement in cardiorespiratory fitness (CRF) by virtue of greater adherence and compliance to the exercise prescription, compared to MICT. Methods: Patients enrolled on an ERS (Liverpool, United Kingdom) were recruited for a pragmatic trial. Participants self-selected either 12 weeks of MICT (45-135 min/week at 50-70% HRmax) or Home-HIIT (4-9 min × 1 min intervals at ≥80% of HRmax, interspersed with 1 min rest). The primary outcome was the change in CRF (VO2 peak) at post-intervention (12 weeks) and follow-up (3-month post intervention), using intention-to-treat analysis. Results: 154 participants (age 48 ± 10y; BMI 30.5 ± 6.1 kg/m2) were recruited between October 2017 and March 2019, 87 (56%) participants chose Home-HIIT and 67 (44%) MICT. VO2 peak increased post-intervention in both groups (MICT 3.9 ± 6.0 ml.kg-1.min-1, Home-HIIT 2.8 ± 4.5 ml.kg-1.min-1, P < 0.001), and was maintained at follow-up (P < 0.001). Fat mass was only reduced post MICT (MICT -1.5 ± 6.3 kg, P < 0.05, Home-HIIT -0.2 ± 2.0 kg, P = 1.00), but the reduction was not maintained at follow-up (MICT -0.6 ± 5.1 kg, Home-HIIT 0.0 ± 2.2 kg, P > 0.05). Adherence to the prescribed programs was similar (MICT 48 ± 35%, Home-HIIT 39 ± 36%, P = 0.77). Conclusion: This is the first study to evaluate the use of Home-HIIT for individuals in a primary care setting. Contrary to our hypothesis, adherence to both exercise prescriptions was poor, and CRF improved to a similar extent in both groups with improvements maintained at 3-month follow-up. We provide evidence that, although not superior, Home-HIIT could be an effective and popular additional exercise choice for patients within primary care based ERS. Clinical Trial Registration: [ClinicalTrials.gov], identifier [NCT04553614].
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Affiliation(s)
- Katie Hesketh
- Research Institute for Sport and Exercise Science, Liverpool John Moores University, Liverpool, United Kingdom
| | - Helen Jones
- Research Institute for Sport and Exercise Science, Liverpool John Moores University, Liverpool, United Kingdom
| | - Florence Kinnafick
- School of Sport, Exercise and Health Sciences, National Centre for Sport and Exercise Medicine, Loughborough University, Loughborough, United Kingdom
| | - Sam O Shepherd
- Research Institute for Sport and Exercise Science, Liverpool John Moores University, Liverpool, United Kingdom
| | - Anton J M Wagenmakers
- Research Institute for Sport and Exercise Science, Liverpool John Moores University, Liverpool, United Kingdom
| | - Juliette A Strauss
- Research Institute for Sport and Exercise Science, Liverpool John Moores University, Liverpool, United Kingdom
| | - Matthew Cocks
- Research Institute for Sport and Exercise Science, Liverpool John Moores University, Liverpool, United Kingdom
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A Mixed-apprOach program To help women wIth breast cancer stay actiVE (MOTIVE program): A pilot-controlled study. Heliyon 2021; 7:e08252. [PMID: 34765775 PMCID: PMC8572138 DOI: 10.1016/j.heliyon.2021.e08252] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2021] [Revised: 09/17/2021] [Accepted: 10/21/2021] [Indexed: 11/23/2022] Open
Abstract
Given the benefits of physical activity for breast cancer survivals, this pilot study aims to assess the feasibility of the MOTIVE program at achieving and maintaining the recommended physical activity level in women diagnosed and treated breast cancer, over 16 weeks. We conduct a pilot-controlled study of 20 women diagnosed with breast cancer stage I, II or IIIa. In this study, women of Intervention Arm (n = 10) received the MOTIVE program. This group was compared to women of Control Arm (n = 10) who received only counselling. Health-related fitness measures, and quality of life were assessed at baseline (t0) and after 4 (t1), 8 (t2) and 16 (t3) weeks. Intervention Arm women reached the recommended physical activity guidelines at t1 and t2 (eff.size = 1.9 [1.0-3.1]), and 90% continued to be active, autonomously, at t3 (eff.size = 1.12 [0.21-2.12]). Intervention Arm participants' arm strength, fitness levels and quality of life also improved over time. No significant improvements in outcome measures were observed in Control Arm participants. These results are encouraging and suggest that the MOTIVE program may be a viable, well tolerated and effective option to help breast cancer women reaching a stable physical activity level over time, which meets prevention-related goals.
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Bialosky JE, Cleland JA, Mintken P, Beneciuk JM, Bishop MD. The healthcare buffet: preferences in the clinical decision-making process for patients with musculoskeletal pain. J Man Manip Ther 2021; 30:68-77. [PMID: 34657575 DOI: 10.1080/10669817.2021.1989754] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
Abstract
The preferences a person has for care are associated with outcomes for patients presenting with musculoskeletal pain conditions. These include preferences for differing levels of involvement in the decision-making process, preferences for the provider attributes, and preferences for particular interventions. In this paper, we discuss these various forms of preference, as well as how they influence clinical care within shared decision-making frameworks. We also present a conceptual framing for how patient preferences can be incorporated in clinical decision-making by orthopedic manual physical therapists. Finally, research implications for interpreting findings from clinical studies are discussed.
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Affiliation(s)
- Joel E Bialosky
- Department of Physical Therapy, University of Florida, Gainesville, Florida, USA.,Center for Pain Research and Behavioral Health, Gainesville, Florida, USA.,Brooks-PHHP Research Collaboration, Gainesville, Florida, USA
| | - Josh A Cleland
- Department of Physical Therapy, Tufts University, Boston, Massachusetts, USA
| | - Paul Mintken
- Department of Physical Therapy, University of Colorado Physical Medicine and Rehabilitation- Physical Therapy, Aurora, Colorado, USA
| | - Jason M Beneciuk
- Department of Physical Therapy, University of Florida, Gainesville, Florida, USA.,Center for Pain Research and Behavioral Health, Gainesville, Florida, USA
| | - Mark D Bishop
- Department of Physical Therapy, University of Florida, Gainesville, Florida, USA.,Center for Pain Research and Behavioral Health, Gainesville, Florida, USA
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Esserman L, Eklund M, Veer LV, Shieh Y, Tice J, Ziv E, Blanco A, Kaplan C, Hiatt R, Fiscalini AS, Yau C, Scheuner M, Naeim A, Wenger N, Lee V, Heditsian D, Brain S, Parker BA, LaCroix AZ, Madlensky L, Hogarth M, Borowsky A, Anton-Culver H, Kaster A, Olopade OI, Sheth D, Garcia A, Lancaster R, Plaza M. The WISDOM study: a new approach to screening can and should be tested. Breast Cancer Res Treat 2021; 189:593-598. [PMID: 34529196 DOI: 10.1007/s10549-021-06346-w] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2021] [Accepted: 07/28/2021] [Indexed: 11/25/2022]
Affiliation(s)
- Laura Esserman
- University of California, San Francisco, CA, 94158, USA.
| | | | | | - Yiwey Shieh
- University of California, San Francisco, CA, 94158, USA
| | - Jeffrey Tice
- University of California, San Francisco, CA, 94158, USA
| | - Elad Ziv
- University of California, San Francisco, CA, 94158, USA
| | - Amie Blanco
- University of California, San Francisco, CA, 94158, USA
| | - Celia Kaplan
- University of California, San Francisco, CA, 94158, USA
| | - Robert Hiatt
- University of California, San Francisco, CA, 94158, USA
| | | | - Christina Yau
- University of California, San Francisco, CA, 94158, USA
| | | | - Arash Naeim
- University of California, Los Angeles, CA, 90095, USA
| | - Neil Wenger
- University of California, Los Angeles, CA, 90095, USA
| | - Vivian Lee
- University of California, San Francisco, CA, 94158, USA
| | | | - Susie Brain
- University of California, San Francisco, CA, 94158, USA
| | | | | | | | | | | | | | | | | | - Deepa Sheth
- University of Chicago, Chicago, IL, 60637, USA
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Uhls YT, Felt L, Wartella E, Sanders A. Investigating Viewership of Season 3 of "13 Reasons Why" and the Mental Wellness of Adolescents: Partially Randomized Preference Trial. JMIR Ment Health 2021; 8:e25782. [PMID: 34524097 PMCID: PMC8482170 DOI: 10.2196/25782] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/28/2020] [Revised: 03/21/2021] [Accepted: 04/19/2021] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND A conflicting body of research suggests that additional investigation is needed to understand how globally watched television shows featuring social and mental health issues, such as 13 Reasons Why, might affect adolescents' mental wellness. OBJECTIVE This study aims to investigate adolescents' viewership of the third season of the Netflix drama 13 Reasons Why (13RW-3) and their engagement with show-related content, paying special attention to mental health outcomes and conversational partners. METHODS A panel-based research platform operated by the National Opinion Research Center at the University of Chicago recruited 157 adolescents aged 13 to 17 years from its nationally representative pool of participants. Participants answered questions about how they discussed and learned about social and mental health issues portrayed in 13RW-3 (eg, masculine role pressure and sexual assault) and questions about mental wellness (eg, mental health self-efficacy and depression). After the participants completed the survey (T1), they were directed to either watch 13RW-3 as it aired for the first time (intervention group) or not watch 13RW-3 (control group). Approximately one month later (T2), all the participants were asked to complete the postsurvey. Additional survey questions about conversational partners, information seeking because of watching the show, and use of show-related content were included in the intervention postsurvey. RESULTS Our sample (N=157) was 52.2% (n=82) female and 54.8% (n=86) White, with a mean age of 14.99 (SD 1.4) years. At T2, viewers of 13RW-3 spoke about suicide significantly more frequently than nonviewers (P=.007). From T1 to T2, viewers increasingly discussed issues explored by 13RW-3 (P=.002), especially suicide, mental health, and bullying. Adolescent viewers were most likely to speak with friends, and parents were the second most commonly named. Two variables emerged as consistent moderators of conversational choices-having depressive symptoms and being impacted by sexual assault. There was no association between conversational frequency and information seeking around social and mental health issues, and neither mental health self-efficacy scores nor masculine role pressure scores significantly differed between viewers and nonviewers at T2. CONCLUSIONS Viewing 13RW-3, a globally watched television show featuring social and mental health issues, led to adolescent conversations and information searches about topics explored by the show. Depressive symptoms and the impact of sexual assault moderated several relationships, guiding participants toward engaging with certain issues and seeking out specific conversational partners. As 13RW-3's stories drove conversations-and story-driven conversations can raise awareness, reduce stigma, shift attitudes, normalize certain behaviors, and strengthen supportive relationships-potential wellness implications for television shows featuring social and mental health issues are considerable.
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Affiliation(s)
- Yalda T Uhls
- University of California, Los Angeles, Los Angeles, CA, United States
| | - Laurel Felt
- University of Southern California, Los Angeles, CA, United States
| | - Ellen Wartella
- School of Communication, Northwestern University, Evanston, IL, United States
| | - Andrew Sanders
- University of California, Los Angeles, Los Angeles, CA, United States
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Hartmann AM, Dell'Oro M, Kessler CS, Schumann D, Steckhan N, Jeitler M, Fischer JM, Spoo M, Kriegel MA, Schneider JG, Häupl T, Kandil FI, Michalsen A, Koppold-Liebscher DA. Efficacy of therapeutic fasting and plant-based diet in patients with rheumatoid arthritis (NutriFast): study protocol for a randomised controlled clinical trial. BMJ Open 2021; 11:e047758. [PMID: 34380725 PMCID: PMC8359474 DOI: 10.1136/bmjopen-2020-047758] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND Previous studies have shown beneficial effects of therapeutic fasting and plant-based dietary interventions on disease activity in patients with rheumatoid arthritis (RA) for a duration of up to 1 year. To date, the effects of such interventions on the gut microbiome and on modern diagnostic markers in patients with RA have not been studied. This trial aims to investigate the clinical effects of therapeutic fasting and a plant-based diet in patients with RA, additionally considering current immunological diagnostic tools and microbiome analyses. METHODS/DESIGN This trial is an open-label, single-centre, randomised, controlled, parallel-group clinical trial. We will randomly assign 84 patients with RA under a stable standard therapy to either (1) therapeutic fasting followed by a plant-based dietary intervention or (2) to a conventional nutritional counselling focusing on an anti-inflammatory dietary pattern according to the recommendations of the Deutsche Gesellschaft für Ernährung (German society for nutrition). Primary outcome parameter is the group difference from baseline to 12 weeks on the Health Assessment Questionnaire (HAQ). Other secondary outcomes include established clinical criteria for disease activity and treatment response in RA (Disease Activity Score 28, Simple Disease Activity Index, ACR-Response Criteria), changes in self-reported health and physical functional ability, mood, stress, quality of life, dietary behaviour via 3-day food records and a modified Food Frequency Questionnaire, body composition, changes in the gut microbiome, metabolomics and cytometric parameters. Outcomes will be assessed at baseline and day 7, after 6 weeks, 12 weeks and after 6 months. ETHICS AND DISSEMINATION Ethical approval to process and analyse data, and to publish the results was obtained through the institutional review board of Charité-Universitätsmedizin Berlin. Results of this trial will be disseminated through peer-reviewed publications and scientific presentations. TRIAL REGISTRATION NUMBER NCT03856190.
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Affiliation(s)
- Anika M Hartmann
- Institute of Social Medicine, Epidemiology and Health Economics, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
| | - Melanie Dell'Oro
- Department of Internal and Integrative Medicine, Immanuel Hospital Berlin-Wannsee Branch, Berlin, Germany
| | - Christian S Kessler
- Institute of Social Medicine, Epidemiology and Health Economics, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
- Department of Internal and Integrative Medicine, Immanuel Hospital Berlin-Wannsee Branch, Berlin, Germany
| | - Dania Schumann
- Institute of Social Medicine, Epidemiology and Health Economics, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
| | - Nico Steckhan
- Institute of Social Medicine, Epidemiology and Health Economics, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
| | - Michael Jeitler
- Institute of Social Medicine, Epidemiology and Health Economics, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
- Department of Internal and Integrative Medicine, Immanuel Hospital Berlin-Wannsee Branch, Berlin, Germany
| | - Jan Moritz Fischer
- Institute of Social Medicine, Epidemiology and Health Economics, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
| | - Michaela Spoo
- Institute of Social Medicine, Epidemiology and Health Economics, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
- Department of Internal and Integrative Medicine, Immanuel Hospital Berlin-Wannsee Branch, Berlin, Germany
| | - Martin A Kriegel
- Institute for Musculoskeletal Medicine, Department of Translational Rheumatology and Immunology, University of Münster, Münster, Germany
- Department of Immunobiology, Yale University School of Medicine, New Haven, Connecticut, USA
| | - Jochen G Schneider
- Department of Internal Medicine II, Universitätsklinikum des Saarlandes und Medizinische Fakultät der Universität des Saarlandes, Homburg, Germany
- Luxembourg Centre for Systems Biomedicine (LCSB), University of Luxembourg, Luxembourg, Luxembourg
| | - Thomas Häupl
- Department of Rheumatology and Clinical Immunology, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
| | - Farid I Kandil
- Institute of Social Medicine, Epidemiology and Health Economics, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
- Department of Neurology, Campus Benjamin Franklin, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
| | - Andreas Michalsen
- Institute of Social Medicine, Epidemiology and Health Economics, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
- Department of Internal and Integrative Medicine, Immanuel Hospital Berlin-Wannsee Branch, Berlin, Germany
| | - Daniela A Koppold-Liebscher
- Institute of Social Medicine, Epidemiology and Health Economics, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
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Byng D, Retèl VP, Engelhardt EG, Groothuis-Oudshoorn CGM, van Til JA, Schmitz RSJM, van Duijnhoven F, Wesseling J, Bleiker E, van Harten WH. Preferences of Treatment Strategies among Women with Low-Risk DCIS and Oncologists. Cancers (Basel) 2021; 13:3962. [PMID: 34439126 PMCID: PMC8394332 DOI: 10.3390/cancers13163962] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2021] [Revised: 07/29/2021] [Accepted: 08/02/2021] [Indexed: 12/27/2022] Open
Abstract
As ongoing trials study the safety of an active surveillance strategy for low-risk ductal carcinoma in situ (DCIS), there is a need to explain why particular choices regarding treatment strategies are made by eligible women as well as their oncologists, what factors enter the decision process, and how much each factor affects their choice. To measure preferences for treatment and surveillance strategies, women with newly-diagnosed, primary low-risk DCIS enrolled in the Dutch CONTROL DCIS Registration and LORD trial, and oncologists participating in the Dutch Health Professionals Study were invited to complete a discrete choice experiment (DCE). The relative importance of treatment strategy-related attributes (locoregional intervention, 10-year risk of ipsilateral invasive breast cancer (iIBC), and follow-up interval) were discerned using conditional logit models. A total of n = 172 patients and n = 30 oncologists completed the DCE. Patient respondents had very strong preferences for an active surveillance strategy with no surgery, irrespective of the 10-year risk of iIBC. Extensiveness of the locoregional treatment was consistently shown to be an important factor for patients and oncologists in deciding upon treatment strategies. Risk of iIBC was least important to patients and most important to oncologists. There was a stronger inclination toward a twice-yearly follow-up for both groups compared to annual follow-up.
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Affiliation(s)
- Danalyn Byng
- Division of Psychosocial Research and Epidemiology, The Netherlands Cancer Institute-Antoni van Leeuwenhoek Hospital, 1066 CX Amsterdam, The Netherlands; (V.P.R.); (E.G.E.); (E.B.); (W.H.v.H.)
- Department of Health Technology and Services Research, Technical Medical Centre, University of Twente, 7522 NB Enschede, The Netherlands; (C.G.M.G.-O.); (J.A.v.T.)
| | - Valesca P. Retèl
- Division of Psychosocial Research and Epidemiology, The Netherlands Cancer Institute-Antoni van Leeuwenhoek Hospital, 1066 CX Amsterdam, The Netherlands; (V.P.R.); (E.G.E.); (E.B.); (W.H.v.H.)
- Department of Health Technology and Services Research, Technical Medical Centre, University of Twente, 7522 NB Enschede, The Netherlands; (C.G.M.G.-O.); (J.A.v.T.)
| | - Ellen G. Engelhardt
- Division of Psychosocial Research and Epidemiology, The Netherlands Cancer Institute-Antoni van Leeuwenhoek Hospital, 1066 CX Amsterdam, The Netherlands; (V.P.R.); (E.G.E.); (E.B.); (W.H.v.H.)
- Division of Molecular Pathology, The Netherlands Cancer Institute-Antoni van Leeuwenhoek Hospital, 1066 CX Amsterdam, The Netherlands; (R.S.J.M.S.); (J.W.)
| | - Catharina G. M. Groothuis-Oudshoorn
- Department of Health Technology and Services Research, Technical Medical Centre, University of Twente, 7522 NB Enschede, The Netherlands; (C.G.M.G.-O.); (J.A.v.T.)
| | - Janine A. van Til
- Department of Health Technology and Services Research, Technical Medical Centre, University of Twente, 7522 NB Enschede, The Netherlands; (C.G.M.G.-O.); (J.A.v.T.)
| | - Renée S. J. M. Schmitz
- Division of Molecular Pathology, The Netherlands Cancer Institute-Antoni van Leeuwenhoek Hospital, 1066 CX Amsterdam, The Netherlands; (R.S.J.M.S.); (J.W.)
| | - Frederieke van Duijnhoven
- Division of Surgical Oncology, The Netherlands Cancer Institute-Antoni van Leeuwenhoek Hospital, 1066 CX Amsterdam, The Netherlands;
| | - Jelle Wesseling
- Division of Molecular Pathology, The Netherlands Cancer Institute-Antoni van Leeuwenhoek Hospital, 1066 CX Amsterdam, The Netherlands; (R.S.J.M.S.); (J.W.)
- Department of Pathology, Leiden University Medical Center, 2333 ZA Leiden, The Netherlands
| | - Eveline Bleiker
- Division of Psychosocial Research and Epidemiology, The Netherlands Cancer Institute-Antoni van Leeuwenhoek Hospital, 1066 CX Amsterdam, The Netherlands; (V.P.R.); (E.G.E.); (E.B.); (W.H.v.H.)
- Department of Clinical Genetics, Leiden University Medical Center, 2333 ZA Leiden, The Netherlands
| | - Wim H. van Harten
- Division of Psychosocial Research and Epidemiology, The Netherlands Cancer Institute-Antoni van Leeuwenhoek Hospital, 1066 CX Amsterdam, The Netherlands; (V.P.R.); (E.G.E.); (E.B.); (W.H.v.H.)
- Department of Health Technology and Services Research, Technical Medical Centre, University of Twente, 7522 NB Enschede, The Netherlands; (C.G.M.G.-O.); (J.A.v.T.)
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