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Italiano D, Campbell B, Hill MD, Johns HT, Churilov L. Adaptive Randomization Method to Prevent Extreme Instances of Group Size and Covariate Imbalance in Stroke Trials. Stroke 2024; 55:1962-1972. [PMID: 38920051 DOI: 10.1161/strokeaha.123.046269] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2023] [Accepted: 04/17/2024] [Indexed: 06/27/2024]
Abstract
BACKGROUND A recent review of randomization methods used in large multicenter clinical trials within the National Institutes of Health Stroke Trials Network identified preservation of treatment allocation randomness, achievement of the desired group size balance between treatment groups, achievement of baseline covariate balance, and ease of implementation in practice as critical properties required for optimal randomization designs. Common-scale minimal sufficient balance (CS-MSB) adaptive randomization effectively controls for covariate imbalance between treatment groups while preserving allocation randomness but does not balance group sizes. This study extends the CS-MSB adaptive randomization method to achieve both group size and covariate balance while preserving allocation randomness in hyperacute stroke trials. METHODS A full factorial in silico simulation study evaluated the performance of the proposed new CSSize-MSB adaptive randomization method in achieving group size balance, covariate balance, and allocation randomness compared with the original CS-MSB method. Data from 4 existing hyperacute stroke trials were used to investigate the performance of CSSize-MSB for a range of sample sizes and covariate numbers and types. A discrete-event simulation model created with AnyLogic was used to dynamically visualize the decision logic of the CSSize-MSB randomization process for communication with clinicians. RESULTS The proposed new CSSize-MSB algorithm uniformly outperformed the CS-MSB algorithm in controlling for group size imbalance while maintaining comparable levels of covariate balance and allocation randomness in hyperacute stroke trials. This improvement was consistent across a distribution of simulated trials with varying levels of imbalance but was increasingly pronounced for trials with extreme cases of imbalance. The results were consistent across a range of trial data sets of different sizes and covariate numbers and types. CONCLUSIONS The proposed adaptive CSSize-MSB algorithm successfully controls for group size imbalance in hyperacute stroke trials under various settings, and its logic can be readily explained to clinicians using dynamic visualization.
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Affiliation(s)
- Dominic Italiano
- Melbourne Medical School (D.I., H.T.J., L.C.), University of Melbourne, Parkville, Victoria, Australia
- Department of Medicine and Neurology, Melbourne Brain Centre at the Royal Melbourne Hospital (B.C.), University of Melbourne, Parkville, Victoria, Australia
| | - Bruce Campbell
- Department of Medicine and Neurology, Melbourne Brain Centre at the Royal Melbourne Hospital (B.C.), University of Melbourne, Parkville, Victoria, Australia
- Australian Stroke Alliance, Melbourne Brain Centre, Royal Melbourne Hospital, Victoria, Australia (D.I., B.C., H.T.J., L.C.)
| | - Michael D Hill
- Department of Clinical Neurosciences, Cumming School of Medicine, University of Calgary, Alberta, Canada (M.D.H.)
| | - Hannah T Johns
- Melbourne Medical School (D.I., H.T.J., L.C.), University of Melbourne, Parkville, Victoria, Australia
- Australian Stroke Alliance, Melbourne Brain Centre, Royal Melbourne Hospital, Victoria, Australia (D.I., B.C., H.T.J., L.C.)
| | - Leonid Churilov
- Melbourne Medical School (D.I., H.T.J., L.C.), University of Melbourne, Parkville, Victoria, Australia
- Australian Stroke Alliance, Melbourne Brain Centre, Royal Melbourne Hospital, Victoria, Australia (D.I., B.C., H.T.J., L.C.)
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Martin E, Le Malicot K, Guérin-Charbonnel C, Bocquet F, Bouché O, Turpin A, Aparicio T, Legoux JL, Dahan L, Taieb J, Lepage C, Dourthe LM, Pétorin C, Bourgeois V, Raoul JL, Seegers V. How to Balance Prognostic Factors in Controlled Phase II Trials: Stratified Permuted Block Randomization or Minimization? An Analysis of Clinical Trials in Digestive Oncology. Curr Oncol 2024; 31:3513-3528. [PMID: 38920742 PMCID: PMC11202503 DOI: 10.3390/curroncol31060259] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2024] [Revised: 06/06/2024] [Accepted: 06/13/2024] [Indexed: 06/27/2024] Open
Abstract
In controlled phase II trials, major prognostic factors need to be well balanced between arms. The main procedures used are SPBR (Stratified Permuted Block Randomization) and minimization. First, we provide a systematic review of the treatment allocation procedure used in gastrointestinal oncology controlled phase II trials published in 2019. Second, we performed simulations using data from six phase II studies to measure the impacts of imbalances and bias on the efficacy estimations. From the 40 articles analyzed, all mentioned randomization in both the title and abstract, the median number of patients included was 109, and 77.5% were multicenter. Of the 27 studies that reported at least one stratification variable, 10 included the center as a stratification variable, 10 used minimization, 9 used SBR, and 8 were unspecified. In real data studies, the imbalance increased with the number of centers. The total and marginal imbalances were higher with SBR than with minimization, and the difference increased with the number of centers. The efficiency estimates per arm were close to the original trial estimate in both procedures. Minimization is often used in cases of numerous centers and guarantees better similarity between arms for stratification variables for total and marginal imbalances in phase II trials.
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Affiliation(s)
- Elodie Martin
- Institut de Cancérologie de l’Ouest, F 49055 Angers, France
| | - Karine Le Malicot
- Fédération Francophone de Cancérologie Digestive (FFCD), EPICAD INSERM LNC-UMR 1231, University of Burgundy, F 21078 Dijon, France
| | - Catherine Guérin-Charbonnel
- Institut de Cancérologie de l’Ouest, F 49055 Angers, France
- CRCI2NA, INSERM U1307, CNRS UMR6075, University of Nantes, F 44000 Nantes, France
| | - François Bocquet
- Institut de Cancérologie de l’Ouest, F 49055 Angers, France
- Law and Social Change Laboratory, Faculty of Law and Political Sciences, CNRS UMR 6297, Nantes University, F 44035 Nantes, France
| | - Olivier Bouché
- Department of Digestive Oncology, CHU Reims, F 51092 Reims, France
| | - Anthony Turpin
- Department of Medical Oncology, University Hospital, F 59000 Lille, France;
| | - Thomas Aparicio
- Department of Gastroenterology, Saint Louis Hospital, APHP, Université Paris Cité, F 75010 Paris, France
| | - Jean-Louis Legoux
- Department of Hepato-Gastroenterology and Digestive Oncology, Centre Hospitalier Régional, F 45100 Orléans, France
| | - Laetitia Dahan
- C.H.U. la Timone and Université de la Méditerranée Marseille, F 13005 Marseille, France
| | - Julien Taieb
- Institut du Cancer Paris CARPEM, Gastroenterology and Digestive Oncology Department, APHP Centre–Université Paris Cité, Hôpital Européen G. Pompidou, F 75015 Paris, France
- Centre de Recherche des Cordeliers, INSERM, CNRS, Sorbonne Université, USPC, Université de Paris, Université Paris Cité, F 75006 Paris, France
| | - Côme Lepage
- Department of HGE & Digestive Oncology, EPICAD INSERM UMR LNC 1231, University Hospital Dijon, University of Burgundy, F 21078 Dijon, France
| | | | - Caroline Pétorin
- Service d’Oncologie Digestive, CHU Clermont-Ferrand, F 63000 Clermont-Ferrand, France
| | - Vincent Bourgeois
- Service d’Oncologie Digestive, Centre Hospitalier de Boulogne sur Mer, F 62321 Boulogne-sur-Mer, France
| | - Jean-Luc Raoul
- Institut de Cancérologie de l’Ouest, F 49055 Angers, France
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Shan G, Li Y, Lu X, Zhang Y, Wu SS. Comparison of Pocock and Simon's covariate-adaptive randomization procedures in clinical trials. BMC Med Res Methodol 2024; 24:22. [PMID: 38273261 PMCID: PMC10809571 DOI: 10.1186/s12874-024-02151-3] [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: 09/12/2023] [Accepted: 01/16/2024] [Indexed: 01/27/2024] Open
Abstract
When multiple influential covariates need to be balanced during a clinical trial, stratified blocked randomization and covariate-adaptive randomization procedures are frequently used in trials to prevent bias and enhance the validity of data analysis results. The latter approach is increasingly used in practice for a study with multiple covariates and limited sample sizes. Among a group of these approaches, the covariate-adaptive procedures proposed by Pocock and Simon are straightforward to be utilized in practice. We aim to investigate the optimal design parameters for the patient treatment assignment probability of their developed three methods. In addition, we seek to answer the question related to the randomization performance when additional covariates are added to the existing randomization procedure. We conducted extensive simulation studies to address these practically important questions.
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Affiliation(s)
- Guogen Shan
- Department of Biostatistics, University of Florida, Gainesville, 32610, FL, USA.
| | - Yulin Li
- Department of Biostatistics, University of Florida, Gainesville, 32610, FL, USA
| | - Xinlin Lu
- Department of Biostatistics, University of Florida, Gainesville, 32610, FL, USA
| | - Yahui Zhang
- Department of Biostatistics, University of Florida, Gainesville, 32610, FL, USA
| | - Samuel S Wu
- Department of Biostatistics, University of Florida, Gainesville, 32610, FL, USA
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Hertling S, Hertling D, Matziolis G, Schleußner E, Loos F, Graul I. Digital teaching tools in sports medicine: A randomized control trial comparing the effectiveness of virtual seminar and virtual fishbowl teaching method in medical students. PLoS One 2022; 17:e0267144. [PMID: 35709198 PMCID: PMC9202876 DOI: 10.1371/journal.pone.0267144] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2021] [Accepted: 04/01/2022] [Indexed: 11/19/2022] Open
Abstract
Background
Since the COVID-19 pandemic, the demand for online courses has increased enormously. Therefore, finding new methods to improve medical education is imperative.
Objective
The aim of this study was to compare the self-reports of the individual student-centered virtual teaching techniques (seminar versus fishbowl) in a group of medical students.
Methods
During the second semester of 2020, students in the clinical phase of the study (n = 144) participated in the optional subject of Sports Medicine. The students were divided into 2 groups. One group (n = 72) received the knowledge transfer in the form of a virtual seminar, the other group (n = 72) in the form of a virtual fishbowl.
Results
Virtual seminar and virtual fishbowl students gave insights into these teaching techniques. Most of the students from the virtual fishbowl group believed that the virtual fishbowl format allowed them to be more actively involved in learning. The mean quiz scores were statistically higher for students in the virtual fishbowl group than students in the virtual seminar group (p < 0. 001).
Conclusion
This study concluded that virtual seminars and virtual fishbowl formats could be served as structured learning and teaching formats. At the same time, the virtual fishbowl format can promote an active exchange of knowledge from students’ perspectives.
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Affiliation(s)
- Stefan Hertling
- Department of Gynecology and Obstetrics, University Hospital Jena, Jena, Germany
- Orthopaedic Department, Campus Eisenberg, University Hospital Jena, Jena, Eisenberg, Germany
- Fakultät für Gesundheit (Department für Humanmedizin), Lehrstuhl für Medizintheorie, Integrative und Anthroposophische Medizin, Witten/Herdecke, Germany
- Department of Obstetrics, University Hospital Jena, Jena, Germany
| | - Doreen Hertling
- Department of Gynecology, Hospital Rummelsberg, Schwarzenbruck, Germany
| | - Georg Matziolis
- Orthopaedic Department, Campus Eisenberg, University Hospital Jena, Jena, Eisenberg, Germany
| | | | - Franziska Loos
- Practice for Orthopaedics and Shoulder Surgery, Leipzig, Germany
| | - Isabel Graul
- Orthopaedic Department, Campus Eisenberg, University Hospital Jena, Jena, Eisenberg, Germany
- Department of Trauma, Hand and Reconstructive Surgery, University Hospital Jena, Jena, Germany
- Department für Orthopädie, Unfall - Universitätsklinikum Halle, Halle, Germany
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