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Coathup V, Ashdown HF, Carson C, Santorelli G, Quigley MA. Associations between maternal body mass index and childhood infections in UK primary care: findings from the Born in Bradford birth cohort study. Arch Dis Child 2024:archdischild-2024-326951. [PMID: 39332843 DOI: 10.1136/archdischild-2024-326951] [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: 02/05/2024] [Accepted: 09/17/2024] [Indexed: 09/29/2024]
Abstract
OBJECTIVE To explore associations between maternal body mass index (BMI) in early pregnancy and childhood infections. DESIGN Birth cohort study linked to primary care records. SETTING Bradford, UK. PARTICIPANTS Live singleton births within the Born in Bradford cohort study between 2007 and 2011. EXPOSURES Maternal BMI in early pregnancy. MAIN OUTCOME MEASURES The total number of infections between birth and ~14 years of age with subgroup analysis by infection type and age. RESULTS A total of 9037 mothers and 9540 children were included in the main analysis. 45% of women were of Pakistani ethnicity and 6417 women (56%) were overweight or obese. There was an overall trend for an increasing infection rate with increasing maternal BMI. In adjusted models, only those with obesity grade 2-3 had offspring with significantly higher rates of infection during the first year of life (RR 1.12 (95% CI 1.05 to 1.20)) compared with women of healthy weight. However, by age 5 to <15 years, children born to overweight women (RR 1.09 (95% CI 1.02 to 1.16)), obese grade 1 women (RR 1.18 (95% CI 1.09 to 1.28)) or obese grade 2 women (RR 1.31 (95% CI 1.16 to 1.48)) all had significantly higher rates of infection compared with those born to healthy weight mothers. Respiratory tract and skin/soft tissue infections made up the majority of excess infections. CONCLUSIONS Maternal BMI was positively associated with rates of offspring infection in this study cohort, and suggests that we should be supporting women to achieve a healthy weight for pregnancy. Future research should investigate whether this is replicated in other populations, whether there is a causal association and the potential mechanisms and areas for intervention.
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Affiliation(s)
- Victoria Coathup
- National Perinatal Epidemiology Unit, Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Helen Frances Ashdown
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Claire Carson
- National Perinatal Epidemiology Unit, Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Gillian Santorelli
- Bradford Institute for Health Research, Bradford Teaching Hospitals NHS Trust, Bradford, UK
| | - Maria A Quigley
- National Perinatal Epidemiology Unit, Nuffield Department of Population Health, University of Oxford, Oxford, UK
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2
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Raglin JS, Lindheimer JB. The Placebo Effect in Exercise and Mental Health Research. Curr Top Behav Neurosci 2024. [PMID: 39042249 DOI: 10.1007/7854_2024_506] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/24/2024]
Abstract
This chapter describes the placebo effect in the context of physical activity and mental health. Following a brief historical overview, definitions for placebos, placebo effects, and related terminology are discussed. Next, three major methodological challenges posed from studying the placebo effect in the context of exercise are described. Additionally, the role of a primary psychological mechanism of placebo and nocebo effects - expectations - will be summarized through the lens of key terminology. Findings from relevant chronic and acute exercise studies that have measured or manipulated exercise-associated expectations will be presented. The chapter concludes with recommendations for controlling or quantifying the placebo effect in exercise and mental health research and its implications in clinical practice.
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Affiliation(s)
- John S Raglin
- Department of Kinesiology, School of Public Health, Indiana University, Bloomington, IN, USA.
| | - Jacob B Lindheimer
- William S. Middleton Memorial Veterans Hospital, Madison, WI, USA
- Department of Kinesiology, University of Wisconsin-Madison, Madison, WI, USA
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3
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Laberge M, Brundisini F, Daniel I, Espinoza Moya ME. Population-based integrated care funding values and guiding principles: An empirical qualitative study. Heliyon 2024; 10:e24904. [PMID: 38317986 PMCID: PMC10839591 DOI: 10.1016/j.heliyon.2024.e24904] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2023] [Revised: 01/03/2024] [Accepted: 01/17/2024] [Indexed: 02/07/2024] Open
Abstract
There is wide agreement on the benefits of integrated care; yet funding barriers persist. We suggest that funding models could currently hinder quality of care and that identifying values is necessary to designing adequate funding models. Yet it is currently unclear what are these values that ought to shape healthcare policy decisions. To fill in this gap, we conducted semi-structure interviews with fourteen health policy officials, managers, and researchers to elicit and explore how they conceptualize the values and guiding principles underlying these funding policies. Our findings suggest that values guide population-based integrated funding models, namely: accountability & integrity, transparency, equity, and innovation. Overall, funding mechanisms could incentivize integrated population-based care when the following conditions are met: a) there is transparent governance, with a whole-system approach, political will, and engagement and collaboration across health system partners, organizations and institutions, b) regulatory and evaluative frameworks support accountability including in decision-making, in outcomes and quality of care, as well as financial accountability; c) funding is equitable with a fair distribution of resources and supports accessibility to services; and d) funding mechanisms design and implementation include innovation enabling change, which are continuously evaluated. These values and guiding principles could be used in the development of funding models and future studies need to evaluate the effect of these values on decisions made by policy makers with respect to funding allocations and investments.
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Affiliation(s)
- Maude Laberge
- Department of Social and Preventive Medicine, Faculty of Medicine, Université Laval, 1050 av de la Médecine, Québec, QC, G1V 0A6, Canada
- Centre de Recherche du CHU de Québec-Université Laval, HÔpital du Saint-Sacrement, 1050, Chemin Ste-Foy, Québec, QC, G1S 4L8, Canada
- Vitam, Centre de Recherche en Santé Durable - Université Laval, Quebec City, Canada
| | - Francesca Brundisini
- Department of Social and Preventive Medicine, Faculty of Medicine, Université Laval, 1050 av de la Médecine, Québec, QC, G1V 0A6, Canada
- Vitam, Centre de Recherche en Santé Durable - Université Laval, Quebec City, Canada
| | - Imtiaz Daniel
- Institute of Health Policy, Management and Evaluation, University of Toronto Health Sciences Building, 155 College Street, Suite 425, Toronto, ON, M5T 3M6, Canada
- Ontario Hospital Association, Toronto, Canada
| | - Maria Eugenia Espinoza Moya
- Department of Social and Preventive Medicine, Faculty of Medicine, Université Laval, 1050 av de la Médecine, Québec, QC, G1V 0A6, Canada
- Centre de Recherche du CHU de Québec-Université Laval, HÔpital du Saint-Sacrement, 1050, Chemin Ste-Foy, Québec, QC, G1S 4L8, Canada
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4
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Davenport MH, Ray L, Nesdoly A, Thornton JS, Khurana R, McHugh TLF. Filling the evidence void: exploration of coach and healthcare provider experiences working with pregnant and postpartum elite athletes - a qualitative study. Br J Sports Med 2023; 57:1559-1565. [PMID: 37879857 DOI: 10.1136/bjsports-2023-107100] [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] [Accepted: 10/12/2023] [Indexed: 10/27/2023]
Abstract
OBJECTIVE Recent research grounded in the experiences of elite female athletes has shed light on the complex challenges of navigating sport environments that do not support or value pregnant or postpartum athletes. The purpose of this study was to explore the unique experiences of coaches and healthcare providers working with pregnant and postpartum elite athletes, and to identify actionable steps for research, policy and culture change to support them. METHODS Sixteen participants (five coaches, three physicians and eight physiotherapists), who have worked with pregnant and/or postpartum elite athletes within the last 5 years, participated in this qualitative study. Thirteen participants self-identified as women, and three as men. Data were generated via semistructured one-on-one interviews that were audiorecorded, transcribed verbatim and analysed through a process of content analysis. RESULTS The findings of this research are represented by five main themes: (a) lack of female athlete reproductive research, (b) need for evidence-informed education and training, (c) need to develop evidence-based progression for sport participation in pregnancy and postpartum, (d) open communication to support athlete-centred care and (e) essential supports and changes required for pregnant/postpartum athletes. CONCLUSION Findings from this study, which are grounded in the unique perspectives of coaches and healthcare providers, outline specific recommendations to inform policy and practices that support athletes through the perinatal period, such as developing evidence-based return-to-sport protocols.
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Affiliation(s)
- Margie H Davenport
- Program for Pregnancy and Postpartum Health, Faculty of Kinesiology, Sport, and Recreation, University of Alberta, Edmonton, Alberta, Canada
| | - Lauren Ray
- Faculty of Kinesiology, Sport, and Recreation, University of Alberta, Edmonton, Alberta, Canada
| | - Autumn Nesdoly
- Faculty of Kinesiology, Sport, and Recreation, University of Alberta, Edmonton, Alberta, Canada
| | - Jane S Thornton
- Public Health and Family Medicine, University of Western Ontario Schulich School of Medicine and Dentistry, London, Ontario, Canada
| | - Rshmi Khurana
- Departments of Medicine and Obstetrics & Gynecology, University of Alberta, Edmonton, Alberta, Canada
| | - Tara-Leigh F McHugh
- Faculty of Kinesiology, Sport, and Recreation, University of Alberta, Edmonton, Alberta, Canada
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5
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Henrich L, Wilhelm M, Lange P, Rief W. The role of the communicated treatment rationale on treatment outcome: study protocol for a randomized controlled trial. Trials 2023; 24:540. [PMID: 37592320 PMCID: PMC10433650 DOI: 10.1186/s13063-023-07557-w] [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: 06/08/2023] [Accepted: 07/30/2023] [Indexed: 08/19/2023] Open
Abstract
BACKGROUND Placebo effects are a well-established phenomenon in the treatment of depression. However, the mechanism underlying these effects are not fully understood. Treatment expectations are considered one explanation for why placebos work. Treatment expectations are likely to be affected by clinician-patient interactions. This study aims to investigate the role of the communicated treatment rationale in modulating treatment expectations and its effects on the treatment outcomes of a pharmacological and a psychological active placebo intervention for depression. In this study, treatment expectations are modulated by presenting illness models that are either congruent or incongruent with the treatment intervention that follows. METHODS This 2 × 2 randomized controlled trial will involve patients with major depression. Participants will either receive a biological or a psychological illness model from a clinician. Following this, they are randomly assigned to receive either a pharmacological or a psychological active placebo intervention. The illness model and the treatment are either congruent or incongruent with each other, resulting in four groups. In addition, a natural course control group will be included. DISCUSSION This study will provide insights into the mechanism of expectation modulation in active placebo treatments for major depression. The results may provide insights for clinicians to improve their communication with patients by focusing on treatment expectations. By identifying the factors that contribute to placebo effects, this study has the potential to improve the effectiveness of existing depression treatments and reduce the burden of this highly prevalent mental health condition. TRIAL REGISTRATION This trial has been registered prospectively at ClinicalTrials.gov under the identifier: NCT04719663. Registered on January 22, 2021.
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Affiliation(s)
- Liv Henrich
- Department of Psychology, Division of Clinical Psychology and Psychotherapy, Philipps University of Marburg, Gutenbergstraße 18, 35032, Marburg, Germany.
| | - Marcel Wilhelm
- Department of Psychology, Division of Clinical Psychology and Psychotherapy, Philipps University of Marburg, Gutenbergstraße 18, 35032, Marburg, Germany
| | - Philipp Lange
- Department of Psychology, Division of Clinical Psychology and Psychotherapy, Philipps University of Marburg, Gutenbergstraße 18, 35032, Marburg, Germany
| | - Winfried Rief
- Department of Psychology, Division of Clinical Psychology and Psychotherapy, Philipps University of Marburg, Gutenbergstraße 18, 35032, Marburg, Germany
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Ali FZ, Parsey RV, Lin S, Schwartz J, DeLorenzo C. Circadian rhythm biomarker from wearable device data is related to concurrent antidepressant treatment response. NPJ Digit Med 2023; 6:81. [PMID: 37120493 PMCID: PMC10148831 DOI: 10.1038/s41746-023-00827-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2022] [Accepted: 04/11/2023] [Indexed: 05/01/2023] Open
Abstract
Major depressive disorder (MDD) is associated with circadian rhythm disruption. Yet, no circadian rhythm biomarkers have been clinically validated for assessing antidepressant response. In this study, 40 participants with MDD provided actigraphy data using wearable devices for one week after initiating antidepressant treatment in a randomized, double-blind, placebo-controlled trial. Their depression severity was calculated pretreatment, after one week and eight weeks of treatment. This study assesses the relationship between parametric and nonparametric measures of circadian rhythm and change in depression. Results show significant association between a lower circadian quotient (reflecting less robust rhythmicity) and improvement in depression from baseline following first week of treatment (estimate = 0.11, F = 7.01, P = 0.01). There is insufficient evidence of an association between circadian rhythm measures acquired during the first week of treatment and outcomes after eight weeks of treatment. Despite this lack of association with future treatment outcome, this scalable, cost-effective biomarker may be useful for timely mental health care through remote monitoring of real-time changes in current depression.
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Affiliation(s)
- Farzana Z Ali
- Department of Biomedical Engineering, Stony Brook University, 100 Nicolls Road, Stony Brook, NY, 11794, USA.
| | - Ramin V Parsey
- Department of Biomedical Engineering, Stony Brook University, 100 Nicolls Road, Stony Brook, NY, 11794, USA
- Department of Psychiatry, Renaissance School of Medicine at Stony Brook University, 100 Nicolls Road, Stony Brook, NY, 11794, USA
- Department of Psychology, Stony Brook University, 100 Nicolls Road, Stony Brook, NY, 11794, USA
- Department of Radiology, Stony Brook University, 100 Nicolls Road, Stony Brook, NY, 11794, USA
| | - Shan Lin
- Department of Electrical and Computer Engineering, Stony Brook University, 100 Nicolls Road, Stony Brook, NY, 11794, USA
| | - Joseph Schwartz
- Department of Psychiatry, Renaissance School of Medicine at Stony Brook University, 100 Nicolls Road, Stony Brook, NY, 11794, USA
| | - Christine DeLorenzo
- Department of Biomedical Engineering, Stony Brook University, 100 Nicolls Road, Stony Brook, NY, 11794, USA
- Department of Psychiatry, Renaissance School of Medicine at Stony Brook University, 100 Nicolls Road, Stony Brook, NY, 11794, USA
- Department of Psychiatry, Columbia University, 1051 Riverside Drive, New York, NY, 10032, USA
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Takeuchi H, Shimomura Y, Kikuchi Y, Nomura N, Hird E, Wu H, Agid O, Leucht S. Placebo versus no treatment for people with schizophrenia. THE COCHRANE DATABASE OF SYSTEMATIC REVIEWS 2023; 2023:CD015403. [PMCID: PMC9831027 DOI: 10.1002/14651858.cd015403] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
This is a protocol for a Cochrane Review (intervention). The objectives are as follows: To compare the effects of placebo versus no treatment in people with schizophrenia.
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Affiliation(s)
| | - Hiroyoshi Takeuchi
- Department of NeuropsychiatryKeio University School of MedicineTokyoJapan
| | - Yutaro Shimomura
- Department of NeuropsychiatryKeio University School of MedicineTokyoJapan
| | - Yuhei Kikuchi
- Department of NeuropsychiatryKeio University School of MedicineTokyoJapan
| | - Nobuyuki Nomura
- Section for Evidence Based Medicine in Psychiatry and Psychotherapy, Department of Psychiatry and Psychotherapy, School of MedicineTechnical University of MunichMunichGermany
| | - Emily Hird
- Institute of Psychiatry, Psychology and NeuroscienceKing’s CollegeLondonUK
| | - Hui Wu
- Section for Evidence Based Medicine in Psychiatry and Psychotherapy, Department of Psychiatry and Psychotherapy, School of MedicineTechnical University of MunichMunichGermany
| | - Ofer Agid
- Schizophrenia ProgramCentre for Addiction and Mental HealthTorontoCanada,Department of PsychiatryUniversity of TorontoTorontoCanada,Institute of Medical ScienceUniversity of TorontoTorontoCanada
| | - Stefan Leucht
- Section for Evidence Based Medicine in Psychiatry and Psychotherapy, Department of Psychiatry and Psychotherapy, School of MedicineTechnical University of MunichMunichGermany
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Elliott S, Pankowiak A, Eime R, Drummond M. Sport parenting during the COVID-19 pandemic: Perceptions of parents and youth in Australia. PSYCHOLOGY OF SPORT AND EXERCISE 2023; 64:102299. [PMID: 36213492 PMCID: PMC9528014 DOI: 10.1016/j.psychsport.2022.102299] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/06/2022] [Revised: 09/22/2022] [Accepted: 09/24/2022] [Indexed: 06/16/2023]
Abstract
Understanding the impact of the COVID-19 pandemic on parental involvement in youth sport is largely unknown. The objective of the study presented in this paper was to understand parental involvement in relation to their child's participation in organised sport during the COVID-19 pandemic. Using an interpretive descriptive methodology, online qualitative interviews and online focus groups with parents and youth (15-18 years) (n = 29) were conducted during June 2020. Following a rigorous reflexive thematic analysis, four themes illustrated the nature of sport parenting during this stressful and uncertain period: (a) reshaping sport parenting identity, (b) the unexpected growth of sport parenting responsibilities, (c) responding to children's loss of sport, and (d) policies impact family commitment and attitudes to returning to sport. The findings are discussed considering Harwood and Knight's (2015) postulates of parenting expertise in sport and offer potential ideas to better support parents and children situated in unexpectedly stressful situations.
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Affiliation(s)
- Sam Elliott
- SHAPE Research Centre, Flinders University, Adelaide, South Australia, Australia
| | - Aurélie Pankowiak
- Institute for Health and Sport, Victoria University, Melbourne, Victoria, Australia
| | - Rochelle Eime
- Institute for Health and Sport, Victoria University, Melbourne, Victoria, Australia
- Institute of Health and Wellbeing, Federation University, Ballarat, Victoria, Australia
| | - Murray Drummond
- SHAPE Research Centre, Flinders University, Adelaide, South Australia, Australia
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D'Alessandro G, Ruffini N, Iacopini A, Annoni M, Kossowsky J, Cerritelli F. Five challenges for manual therapies trials with placebo controls: A proposal. INT J OSTEOPATH MED 2022. [DOI: 10.1016/j.ijosm.2022.08.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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10
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Burns A, Donnelly B, Feyi-Waboso J, Shephard E, Calitri R, Tarrant M, Dean SG. How do electronic risk assessment tools affect the communication and understanding of diagnostic uncertainty in the primary care consultation? A systematic review and thematic synthesis. BMJ Open 2022; 12:e060101. [PMID: 35768084 PMCID: PMC9244669 DOI: 10.1136/bmjopen-2021-060101] [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: 11/23/2022] Open
Abstract
OBJECTIVES To conduct a systematic review and synthesise qualitative research of electronic risk assessment tools (eRATs) in primary care, examining how they affect the communication and understanding of diagnostic risk and uncertainty. eRATs are computer-based algorithms designed to help clinicians avoid missing important diagnoses, pick up possible symptoms early and facilitate shared decision-making. DESIGN Systematic search, using predefined criteria of the published literature and synthesis of the qualitative data, using Thematic Synthesis. Database searches on 27 November 2019 were of MEDLINE, Embase, CINAHL and Web of Science, and a secondary search of the references of included articles. Included studies were those involving electronic risk assessment or decision support, pertaining to diagnosis in primary care, where qualitative data were presented. Non-empirical studies and non-English language studies were excluded. 5971 unique studies were identified of which 441 underwent full-text review. 26 studies were included for data extraction. A further two were found from citation searches. Quality appraisal was via the CASP (Critical Appraisal Skills Program) tool. Data extraction was via line by line coding. A thematic synthesis was performed. SETTING Primary care. RESULTS eRATs included differential diagnosis suggestion tools, tools which produce a future risk of disease development or recurrence or calculate a risk of current undiagnosed disease. Analytical themes were developed to describe separate aspects of the clinical consultation where risk and uncertainty are both central and altered via the use of an eRAT: 'Novel risk', 'Risk refinement', 'Autonomy', 'Communication', 'Fear' and 'Mistrust'. CONCLUSION eRATs may improve the understanding and communication of risk in the primary care consultation. The themes of 'Fear' and 'Mistrust' could represent potential challenges with eRATs. TRIAL REGISTRATION NUMBER CRD219446.
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Affiliation(s)
- Alex Burns
- College of Medicine and Health, University of Exeter, Exeter, Devon, UK
- PenARC, Exeter, Devon, UK
| | | | | | | | - Raff Calitri
- College of Medicine and Health, University of Exeter, Exeter, Devon, UK
| | - Mark Tarrant
- College of Medicine and Health, University of Exeter, Exeter, Devon, UK
- PenARC, Exeter, Devon, UK
| | - Sarah Gerard Dean
- College of Medicine and Health, University of Exeter, Exeter, Devon, UK
- PenARC, Exeter, Devon, UK
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Avian A, Clemente N, Mauro E, Isidoro E, Di Napoli M, Dudine S, Del Fabro A, Morini S, Perin T, Giudici F, Cammisuli T, Foschi N, Mocenigo M, Montrone M, Modena C, Polenghi M, Puzzi L, Tomaic V, Valenti G, Sola R, Zanolla S, Vogrig E, Riva E, Angeletti S, Ciccozzi M, Castriciano S, Pachetti M, Petti M, Centonze S, Gerin D, Banks L, Marini B, Canzonieri V, Sopracordevole F, Zanconati F, Ippodrino R. Clinical validation of full HR-HPV genotyping HPV Selfy assay according to the international guidelines for HPV test requirements for cervical cancer screening on clinician-collected and self-collected samples. J Transl Med 2022; 20:231. [PMID: 35581584 PMCID: PMC9115952 DOI: 10.1186/s12967-022-03383-x] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2022] [Accepted: 04/07/2022] [Indexed: 01/28/2023] Open
Abstract
BACKGROUND According to international guidelines, Human Papillomavirus (HPV) DNA tests represent a valid alternative to Pap Test for primary cervical cancer screening, provided that they guarantee balanced clinical sensitivity and specificity for cervical intraepithelial neoplasia grade 2 or more (CIN2+) lesions. The study aimed to assess whether HPV Selfy (Ulisse BioMed - Trieste, Italy), a full-genotyping HPV DNA test that detects and differentiates 14 high-risk HPV (HR-HPV) types, meets the criteria for primary cervical cancer screening described in the international guidelines, on clinician-collected as well as on self-collected samples. METHODS For each participant woman, consecutively referring to Azienda Sanitaria Universitaria Giuliano Isontina (Trieste, Italy) and CRO-National Cancer Institute (Aviano, Italy) for the cervical cancer screening program, the following samples were tested: (a) a clinician-collected cervical specimen, analyzed with the reference test (Hybrid Capture®2 test, HC2) and HPV Selfy; and (b) a self-collected vaginal sample, analyzed with HPV Selfy. Enrolled women were also asked to fulfill a questionnaire about self-sampling acceptability. As required by guidelines, a non-inferiority test was conducted to compare the clinical performance of the test under evaluation with its reference test. RESULTS HPV Selfy clinical sensitivity and specificity resulted non-inferior to those of HC2. By analysis of a total of 889 cervical liquid-based cytology samples from a screening population, of which 98 were from women with CIN2+, HPV Selfy showed relative sensitivity and specificity for CIN2+ of 0.98 and 1.00 respectively (non-inferiority score test: P = 0.01747 and P = 0.00414, respectively); the test reached adequate intra- and inter-laboratory reproducibility. Moreover, we demonstrated that the performance of HPV Selfy on self-collected vaginal samples was non-inferior to the performance obtained on clinician-collected cervical specimen (0.92 relative sensitivity and 0.97 relative specificity). Finally, through HPV Selfy genotyping, we were able to describe HPV types prevalence in the study population. CONCLUSIONS HPV Selfy fulfills all the requirements of the international Meijer's guidelines and has been clinically validated for primary cervical cancer screening purposes. Moreover, HPV Selfy has also been validated for self-sampling according to VALHUDES guidelines. Therefore, at date, HPV Selfy is the only full-genotyping test validated both for screening purposes and for self-sampling. Trial registration ASUGI Trieste n. 16008/2018; CRO Aviano n.17149/2018.
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Affiliation(s)
- Alice Avian
- Ulisse BioMed S.P.a, Area Science Park, SS 14, km 163.5, Trieste, Italy ,grid.438882.d0000 0001 0212 6916Molecular Genetics and Biotechnology PhD Study Programme, University of Nova Gorica, Nova Gorica, Slovenia
| | - Nicolò Clemente
- grid.418321.d0000 0004 1757 9741Ginecologia Oncologica, IRCCS - Centro Di Riferimento Oncologico (CRO) (Istituto Nazionale Tumori – National Cancer Institute), Aviano, Italy
| | - Elisabetta Mauro
- Ulisse BioMed S.P.a, Area Science Park, SS 14, km 163.5, Trieste, Italy
| | - Erica Isidoro
- grid.413694.dAzienda Sanitaria Universitaria Giuliano Isontina UCO/SC Anatomia e Istologia Patologica, Cattinara Hospital, Trieste, Italy
| | - Michela Di Napoli
- grid.413694.dAzienda Sanitaria Universitaria Giuliano Isontina UCO/SC Anatomia e Istologia Patologica, Cattinara Hospital, Trieste, Italy
| | - Sandra Dudine
- grid.413694.dAzienda Sanitaria Universitaria Giuliano Isontina UCO/SC Anatomia e Istologia Patologica, Cattinara Hospital, Trieste, Italy
| | - Anna Del Fabro
- grid.418321.d0000 0004 1757 9741Ginecologia Oncologica, IRCCS - Centro Di Riferimento Oncologico (CRO) (Istituto Nazionale Tumori – National Cancer Institute), Aviano, Italy
| | - Stefano Morini
- grid.418321.d0000 0004 1757 9741Ginecologia Oncologica, IRCCS - Centro Di Riferimento Oncologico (CRO) (Istituto Nazionale Tumori – National Cancer Institute), Aviano, Italy
| | - Tiziana Perin
- grid.418321.d0000 0004 1757 9741Ginecologia Oncologica, IRCCS - Centro Di Riferimento Oncologico (CRO) (Istituto Nazionale Tumori – National Cancer Institute), Aviano, Italy
| | - Fabiola Giudici
- grid.5133.40000 0001 1941 4308Department of Medicine, Surgery and Health Sciences, University of Trieste, Trieste, Italy
| | - Tamara Cammisuli
- grid.418321.d0000 0004 1757 9741Anatomia Patologica, IRCCS – CRO (Istituto Nazionale Tumori - National Cancer Institute), Aviano, Italy
| | - Nicola Foschi
- Ulisse BioMed S.P.a, Area Science Park, SS 14, km 163.5, Trieste, Italy
| | - Marco Mocenigo
- Ulisse BioMed S.P.a, Area Science Park, SS 14, km 163.5, Trieste, Italy ,grid.438882.d0000 0001 0212 6916Molecular Genetics and Biotechnology PhD Study Programme, University of Nova Gorica, Nova Gorica, Slovenia
| | - Michele Montrone
- Ulisse BioMed S.P.a, Area Science Park, SS 14, km 163.5, Trieste, Italy
| | - Chiara Modena
- Ulisse BioMed S.P.a, Area Science Park, SS 14, km 163.5, Trieste, Italy
| | - Martina Polenghi
- Ulisse BioMed S.P.a, Area Science Park, SS 14, km 163.5, Trieste, Italy
| | - Luca Puzzi
- Ulisse BioMed S.P.a, Area Science Park, SS 14, km 163.5, Trieste, Italy
| | - Vjekoslav Tomaic
- grid.4905.80000 0004 0635 7705Institut Ruđer Bošković, Zagreb, Croatia
| | - Giulio Valenti
- Ulisse BioMed S.P.a, Area Science Park, SS 14, km 163.5, Trieste, Italy
| | - Riccardo Sola
- Ulisse BioMed S.P.a, Area Science Park, SS 14, km 163.5, Trieste, Italy
| | - Shivani Zanolla
- Ulisse BioMed S.P.a, Area Science Park, SS 14, km 163.5, Trieste, Italy
| | - Enea Vogrig
- Ulisse BioMed S.P.a, Area Science Park, SS 14, km 163.5, Trieste, Italy
| | - Elisabetta Riva
- grid.488514.40000000417684285Policlinico Universitario Campus Biomedico, Rome, Italy
| | - Silvia Angeletti
- grid.488514.40000000417684285Policlinico Universitario Campus Biomedico, Rome, Italy
| | - Massimo Ciccozzi
- grid.488514.40000000417684285Policlinico Universitario Campus Biomedico, Rome, Italy
| | | | - Maria Pachetti
- Ulisse BioMed S.P.a, Area Science Park, SS 14, km 163.5, Trieste, Italy ,grid.418712.90000 0004 1760 7415Institute of Maternal and Child Health, IRCCS Burlo Garofolo, Trieste, Italy
| | - Matteo Petti
- Ulisse BioMed S.P.a, Area Science Park, SS 14, km 163.5, Trieste, Italy
| | - Sandro Centonze
- Clinical Research Unit, Azienda Sanitaria Universitaria Giuliano Isontina, Trieste, Italy
| | - Daniela Gerin
- Cervical Cancer Screening Coordination Unit, Azienda Sanitaria Universitaria Giuliano Isontina, Trieste, Italy
| | - Lawrence Banks
- grid.425196.d0000 0004 1759 4810International Centre for Genetic Engineering and Biotechnology, Trieste, Italy
| | - Bruna Marini
- Ulisse BioMed S.P.a, Area Science Park, SS 14, km 163.5, Trieste, Italy
| | - Vincenzo Canzonieri
- grid.5133.40000 0001 1941 4308Department of Medicine, Surgery and Health Sciences, University of Trieste, Trieste, Italy ,grid.418321.d0000 0004 1757 9741Anatomia Patologica, IRCCS – CRO (Istituto Nazionale Tumori - National Cancer Institute), Aviano, Italy
| | - Francesco Sopracordevole
- grid.418321.d0000 0004 1757 9741Ginecologia Oncologica, IRCCS - Centro Di Riferimento Oncologico (CRO) (Istituto Nazionale Tumori – National Cancer Institute), Aviano, Italy
| | - Fabrizio Zanconati
- grid.413694.dAzienda Sanitaria Universitaria Giuliano Isontina UCO/SC Anatomia e Istologia Patologica, Cattinara Hospital, Trieste, Italy ,grid.5133.40000 0001 1941 4308Department of Medicine, Surgery and Health Sciences, University of Trieste, Trieste, Italy
| | - Rudy Ippodrino
- Ulisse BioMed S.P.a, Area Science Park, SS 14, km 163.5, Trieste, Italy
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12
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Mellman TA, Birku K, Sandhu I, Lavela P, Kobayashi I. Evaluation of suvorexant for trauma-related insomnia. Sleep 2022; 45:zsac068. [PMID: 35554590 DOI: 10.1093/sleep/zsac068] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2021] [Revised: 03/06/2022] [Indexed: 11/14/2022] Open
Abstract
STUDY OBJECTIVES Effective pharmacological treatments for sleep disturbance related to trauma with and without co-occurring posttraumatic stress disorder (PTSD) are needed. There is debate regarding what effects on rapid eye movement sleep (REMS) would be beneficial. Suvorexant is the first dual orexin receptor antagonist (DORA) approved for the treatment of insomnia. In contrast to most psychotropic agents, DORAs can enhance REMS while reducing arousal. We evaluated 6 weeks of suvorexant treatment for trauma-related insomnia in a double-blind, placebo-controlled clinical trial with clinical and polysomnographic evaluation. METHODS Participants with insomnia that followed a traumatic event were recruited from the community. Representation of current, past-only, and never having met criteria for PTSD was similar and most participants had experienced trauma-related nightmares. Participants were randomly assigned to receive suvorexant or placebo, initially at 10 mg and increased to 20 mg after 1 week, if tolerated. Polysomnography was obtained for screening, at baseline, and at 2 weeks of treatment. RESULTS The thirty-seven evaluable participants had significant improvement of PTSD and insomnia symptoms, however, there were no significant interactions with treatment condition. Medication was well tolerated with only one dropout being related to side effects. Within the suvorexant group increased REM segment duration correlated with concurrent PTSD symptom reduction. Nightmares remitted in all of the participants who received suvorexant and all but one of those receiving placebo. CONCLUSIONS A robust placebo response undermined detecting a medication effect. Further evaluation of DORAs for trauma-related insomnia, as well as factors contributing to placebo-response, are warranted.
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Affiliation(s)
- Thomas A Mellman
- Department of Psychiatry and Behavioral Medicine, Howard University College of Medicine, Washington, DC, USA
| | - Kiya Birku
- Department of Psychiatry and Behavioral Medicine, Howard University College of Medicine, Washington, DC, USA
| | - Ishaan Sandhu
- Department of Psychiatry and Behavioral Medicine, Howard University College of Medicine, Washington, DC, USA
| | - Pewu Lavela
- Department of Psychiatry and Behavioral Medicine, Howard University College of Medicine, Washington, DC, USA
| | - Ihori Kobayashi
- Department of Psychiatry and Behavioral Medicine, Howard University College of Medicine, Washington, DC, USA
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Hoosain M, Plastow NA. Workplace-based occupational therapy for mental health in Africa: a scoping review protocol. BMJ Open 2022; 12:e054821. [PMID: 35450899 PMCID: PMC9024242 DOI: 10.1136/bmjopen-2021-054821] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/24/2021] [Accepted: 04/04/2022] [Indexed: 11/10/2022] Open
Abstract
INTRODUCTION Although mental health at work is a pressing and growing concern, mental healthcare accounts for less than 2% of global healthcare, with marked inequality across continents. Africa has the smallest proportion of mental health service providers, and the highest rate of out-of-pocket expenditure for mental health service users. Poor mental health at work results in costs to workers, employers and the economy. This review aims to collaborate with stakeholders to identify literature on workplace-based occupational therapy interventions supporting the mental health of workers in Africa. METHODS AND ANALYSIS We will search Medline (PubMed), EBSCOhost (Academic Search Premier, AfricaWide Information, CINAHL, Health Source: Nursing/Academic), Scopus, Web of Science, Sabinet, Cochrane and OTSeeker for qualitative and quantitative primary research studies. Grey literature will be searched via Sabinet and ProQuest. No language or date restrictions will be applied. Title and abstract screening as well as full-text screening will be done independently by two reviewers. Data extracted will include information about the articles, characteristics of studies and interventions, and findings. Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for Scoping Reviews guidelines will be used for reporting results. Three groups of stakeholders will be consulted during the review process: service users/workers, employers and service providers/occupational therapists. ETHICS AND DISSEMINATION This scoping review does not require ethics approval. Findings of the review will be disseminated through stakeholder engagements, peer-reviewed publications and conference presentations.
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Affiliation(s)
- Munira Hoosain
- Occupational Therapy, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, Western Cape, South Africa
| | - Nicola Ann Plastow
- Occupational Therapy, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, Western Cape, South Africa
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14
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Hennein R, Ggita JM, Turimumahoro P, Ochom E, Gupta AJ, Katamba A, Armstrong-Hough M, Davis JL. Core components of a Community of Practice to improve community health worker performance: a qualitative study. Implement Sci Commun 2022; 3:27. [PMID: 35272705 PMCID: PMC8908651 DOI: 10.1186/s43058-022-00279-1] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2021] [Accepted: 02/24/2022] [Indexed: 12/28/2022] Open
Abstract
Background Communities of Practice (CoPs) offer an accessible strategy for healthcare workers to improve the quality of care through knowledge sharing. However, not enough is known about which components of CoPs are core to facilitating behavior change. Therefore, we carried out a qualitative study to address these important gaps in the literature on CoPs and inform planning for an interventional study of CoPs. Methods We organized community health workers (CHWs) from two tuberculosis (TB) clinics in Kampala, Uganda, into a CoP from February to June 2018. We conducted interviews with CoP members to understand their perceptions of how the CoP influenced delivery of TB contact investigation. Using an abductive approach, we first applied inductive codes characterizing CHWs’ perceptions of how the CoP activities affected their delivery of contact investigation. We then systematically mapped these codes into their functional categories using the Behavior Change Technique (BCT) Taxonomy and the Behavior Change Wheel framework. We triangulated all interview findings with detailed field notes. Results All eight members of the CoP agreed to participate in the interviews. CHWs identified five CoP activities as core to improving the quality of their work: (1) individual review of feedback reports, (2) collaborative improvement meetings, (3) real-time communications among members, (4) didactic education sessions, and (5) clinic-wide staff meetings. These activities incorporated nine different BCTs and five distinct intervention functions. CHWs reported that these activities provided a venue for them to share challenges, exchange knowledge, engage in group problem solving, and benefit from social support. CHWs also explained that they felt a shared sense of ownership of the CoP, which motivated them to propose and carry out innovations. CHWs described that the CoP strengthened their social and professional identities within and outside the group, and improved their self-efficacy. Conclusions We identified the core components and several mechanisms through which CoPs may improve CHW performance. Future studies should evaluate the importance of these mechanisms in mediating the effects of CoPs on program effectiveness. Supplementary Information The online version contains supplementary material available at 10.1186/s43058-022-00279-1.
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Affiliation(s)
- Rachel Hennein
- Uganda Tuberculosis Implementation Research Consortium, Makerere University, Kampala, Uganda.,Department of Epidemiology of Microbial Diseases, Yale School of Public Health, New Haven, CT, USA.,Yale School of Medicine, New Haven, CT, USA
| | - Joseph M Ggita
- Uganda Tuberculosis Implementation Research Consortium, Makerere University, Kampala, Uganda
| | - Patricia Turimumahoro
- Uganda Tuberculosis Implementation Research Consortium, Makerere University, Kampala, Uganda
| | - Emmanuel Ochom
- Uganda Tuberculosis Implementation Research Consortium, Makerere University, Kampala, Uganda
| | - Amanda J Gupta
- Uganda Tuberculosis Implementation Research Consortium, Makerere University, Kampala, Uganda.,Department of Epidemiology of Microbial Diseases, Yale School of Public Health, New Haven, CT, USA
| | - Achilles Katamba
- Uganda Tuberculosis Implementation Research Consortium, Makerere University, Kampala, Uganda.,Clinical Epidemiology and Biostatistics Unit, Department of Medicine, Makerere University College of Health Sciences, Kampala, Uganda
| | - Mari Armstrong-Hough
- Uganda Tuberculosis Implementation Research Consortium, Makerere University, Kampala, Uganda. .,Department of Social and Behavioral Sciences, New York University, New York, NY, USA. .,Department of Epidemiology, New York University, New York, NY, USA.
| | - J Lucian Davis
- Uganda Tuberculosis Implementation Research Consortium, Makerere University, Kampala, Uganda.,Department of Epidemiology of Microbial Diseases, Yale School of Public Health, New Haven, CT, USA.,Pulmonary, Critical Care, and Sleep Medicine Section, Yale School of Medicine, New Haven, CT, USA.,Center for Methods in Implementation and Prevention Science, Yale School of Public Health, New Haven, CT, USA
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15
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Haber T, Hinman RS, Dobson F, Bunzli S, Hall M. How do middle-aged and older adults with chronic hip pain view their health problem and its care? A protocol for a systematic review and qualitative evidence synthesis. BMJ Open 2021; 11:e053084. [PMID: 34764175 PMCID: PMC8587503 DOI: 10.1136/bmjopen-2021-053084] [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] [Received: 05/04/2021] [Accepted: 10/11/2021] [Indexed: 12/02/2022] Open
Abstract
INTRODUCTION Chronic hip pain in middle-aged and older adults is common and disabling. Patient-centred care of chronic hip pain requires a comprehensive understanding of how people with chronic hip pain view their health problem and its care. This paper outlines a protocol to synthesise qualitative evidence of middle-aged and older adults' views, beliefs, expectations and preferences about their chronic hip pain and its care. METHODS AND ANALYSIS We will perform a qualitative evidence synthesis using a framework approach. We will conduct this study in accord with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) Statement and the Enhancing Transparency in Reporting the synthesis of Qualitative research checklist. We will search MEDLINE, CINAHL, The Cochrane Central Register of Controlled Trials, EMBASE and PsycINFO using a comprehensive search strategy. A priori selection criteria include qualitative studies involving samples with a mean age over 45 and where 80% or more have chronic hip pain. Two or more reviewers will independently screen studies for eligibility, assess methodological strengths and limitations using the Critical Appraisal Skills Programme qualitative studies checklist, perform data extraction and synthesis and determine ratings of confidence in each review finding using the Grading of Recommendations Assessment, Development and Evaluation-Confidence in the Evidence from Reviews of Qualitative research approach. Data extraction and synthesis will be guided by the Common-Sense Model of Self-Regulation. All authors will contribute to interpreting, refining and finalising review findings. This protocol is registered on PROSPERO and reported according to the PRISMA Statement for Protocols (PRISMA-P) checklist. ETHICS AND DISSEMINATION Ethics approval is not required for this systematic review as primary data will not be collected. The findings of the review will be disseminated through publication in an academic journal and scientific conferences. PROSPERO REGISTRATION NUMBER PROSPERO registration number: CRD42021246305.
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Affiliation(s)
- Travis Haber
- Centre for Health, Exercise and Sports Medicine, Department of Physiotherapy, School of Health Sciences, The University of Melbourne, Melbourne, Victoria, Australia
| | - Rana S Hinman
- Centre for Health, Exercise and Sports Medicine, Department of Physiotherapy, School of Health Sciences, The University of Melbourne, Melbourne, Victoria, Australia
| | - Fiona Dobson
- Physiotherapy, The University of Melbourne, Melbourne, Victoria, Australia
| | - Samantha Bunzli
- Department of Surgery, St Vincent's Hospital, The University of Melbourne, Melbourne, Victoria, Australia
| | - Michelle Hall
- Centre for Health, Exercise and Sports Medicine, Department of Physiotherapy, School of Health Sciences, The University of Melbourne, Melbourne, Victoria, Australia
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16
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Differential power of placebo across major psychiatric disorders: a preliminary meta-analysis and machine learning study. Sci Rep 2021; 11:21301. [PMID: 34716400 PMCID: PMC8556377 DOI: 10.1038/s41598-021-99534-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2021] [Accepted: 09/09/2021] [Indexed: 11/09/2022] Open
Abstract
The placebo effect across psychiatric disorders is still not well understood. In the present study, we conducted meta-analyses including meta-regression, and machine learning analyses to investigate whether the power of placebo effect depends on the types of psychiatric disorders. We included 108 clinical trials (32,035 participants) investigating pharmacological intervention effects on major depressive disorder (MDD), bipolar disorder (BD) and schizophrenia (SCZ). We developed measures based on clinical rating scales and Clinical Global Impression scores to compare placebo effects across these disorders. We performed meta-analysis including meta-regression using sample-size weighted bootstrapping techniques, and machine learning analysis to identify the disorder type included in a trial based on the placebo response. Consistently through multiple measures and analyses, we found differential placebo effects across the three disorders, and found lower placebo effect in SCZ compared to mood disorders. The differential placebo effects could also distinguish the condition involved in each trial between SCZ and mood disorders with machine learning. Our study indicates differential placebo effect across MDD, BD, and SCZ, which is important for future neurobiological studies of placebo effects across psychiatric disorders and may lead to potential therapeutic applications of placebo on disorders more responsive to placebo compared to other conditions.
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17
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Cutoff criteria for the placebo response: a cluster and machine learning analysis of placebo analgesia. Sci Rep 2021; 11:19205. [PMID: 34584181 PMCID: PMC8479132 DOI: 10.1038/s41598-021-98874-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2021] [Accepted: 09/16/2021] [Indexed: 11/08/2022] Open
Abstract
Computations of placebo effects are essential in randomized controlled trials (RCTs) for separating the specific effects of treatments from unspecific effects associated with the therapeutic intervention. Thus, the identification of placebo responders is important for testing the efficacy of treatments and drugs. The present study uses data from an experimental study on placebo analgesia to suggest a statistical procedure to separate placebo responders from nonresponders and suggests cutoff values for when responses to placebo treatment are large enough to be separated from reported symptom changes in a no-treatment condition. Unsupervised cluster analysis was used to classify responders and nonresponders, and logistic regression implemented in machine learning was used to obtain cutoff values for placebo analgesic responses. The results showed that placebo responders can be statistically separated from nonresponders by cluster analysis and machine learning classification, and this procedure is potentially useful in other fields for the identification of responders to a treatment.
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18
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Zeng L, Lytvyn L, Wang X, Kithulegoda N, Agterberg S, Shergill Y, Esfahani MA, Heen AF, Agoritsas T, Guyatt GH, Busse JW. Values and preferences towards medical cannabis among people living with chronic pain: a mixed-methods systematic review. BMJ Open 2021; 11:e050831. [PMID: 34493521 PMCID: PMC8451285 DOI: 10.1136/bmjopen-2021-050831] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/08/2021] [Accepted: 05/24/2021] [Indexed: 12/21/2022] Open
Abstract
OBJECTIVE To explore values and preferences towards medical cannabis among people living with chronic pain. DESIGN Mixed-methods systematic review. DATA SOURCES We searched MEDLINE, EMBASE and PsycINFO from inception to 17 March 2020. STUDY SELECTION Pairs of reviewers independently screened search results and included quantitative, qualitative and mixed-methods studies reporting values and preferences towards medical cannabis among people living with chronic pain. REVIEW METHODS We analysed data using meta-narrative synthesis (quantitative findings were qualitised) and tabulated review findings according to identified themes. We used the Grading of Recommendations Assessment, Development and Evaluation approach to assess certainty of evidence. RESULTS Of 1838 initial records, 15 studies proved eligible for review. High to moderate certainty evidence showed that patient's use of medical cannabis for chronic pain was influenced by both positive (eg, support from friends and family) and negative social factors (eg, stigma surrounding cannabis use). Most patients using medical cannabis favoured products with balanced ratios of tetrahydrocannabinol (THC) and cannabidiol (CBD), or high levels of CBD, but not high THC preparations. Many valued the effectiveness of medical cannabis for symptom management even when experiencing adverse events related to concentration, memory or fatigue. Reducing use of prescription medication was a motivating factor for use of medical cannabis, and concerns regarding addiction, losing control or acting strangely were disincentives. Out-of-pocket costs were a barrier, whereas legalisation of medical cannabis improved access and incentivised use.Low to very low certainty evidence suggested highly variable values towards medical cannabis among people living with chronic pain. Individuals with pain related to life-limiting disease were more willing to use medical cannabis, and preferred oral over inhaled administration. CONCLUSIONS Our findings highlight factors that clinicians should consider when discussing medical cannabis. The variability of patients' values and preferences emphasise the need for shared decision making when considering medical cannabis for chronic pain.
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Affiliation(s)
- Linan Zeng
- Pharmacy Department/Evidence-based Pharmacy Center, West China Second University Hospital, Chengdu, Sichuan, China
- Department of Health Research Methods, Evidence & Impact, McMaster University, Hamilton, Ontario, Canada
| | - Lyubov Lytvyn
- Department of Health Research Methods, Evidence & Impact, McMaster University, Hamilton, Ontario, Canada
| | - Xiaoqin Wang
- Michael G. DeGroote Institute for Pain Research and Care, McMaster University, Hamilton, Ontario, Canada
| | - Natasha Kithulegoda
- Institute for Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
- Women's College Institute for Health System Solutions and Virtual Care, Women's College Hospital, Toronto, Ontario, Canada
| | - Silvana Agterberg
- Ferkauf Graduate School of Psychology, Yeshiva University, New York, New York, USA
| | - Yaad Shergill
- Department of Health Research Methods, Evidence & Impact, McMaster University, Hamilton, Ontario, Canada
| | - Meisam Abdar Esfahani
- Department of Health Research Methods, Evidence & Impact, McMaster University, Hamilton, Ontario, Canada
| | - Anja Fog Heen
- Department of Medicine, Lovisenberg Diaconal Hospital, Oslo, Norway
| | - Thomas Agoritsas
- Department of Health Research Methods, Evidence & Impact, McMaster University, Hamilton, Ontario, Canada
- Division of General Internal Medicine & Division of Clinical Epidemiology, University Hospitals of Geneva, Geneva, Switzerland
| | - Gordon H Guyatt
- Department of Health Research Methods, Evidence & Impact, McMaster University, Hamilton, Ontario, Canada
| | - Jason W Busse
- Department of Health Research Methods, Evidence & Impact, McMaster University, Hamilton, Ontario, Canada
- The Michael G. DeGroote Centre for Medicinal Cannabis Research, McMaster University, Hamilton, Ontario, Canada
- Department of Anesthesia, McMaster University, Hamilton, Ontario, Canada
- The Michael G. DeGroote National Pain Centre, McMaster University, Hamilton, Ontario, Canada
- Chronic Pain Centre of Excellence for Canadian Veterans, Hamilton, Ontario, Canada
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19
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Howick J. Unethical informed consent caused by overlooking poorly measured nocebo effects. JOURNAL OF MEDICAL ETHICS 2021; 47:590-594. [PMID: 32063581 DOI: 10.1136/medethics-2019-105903] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/23/2019] [Revised: 01/04/2020] [Accepted: 01/13/2020] [Indexed: 06/10/2023]
Abstract
Unlike its friendly cousin the placebo effect, the nocebo effect (the effect of expecting a negative outcome) has been almost ignored. Epistemic and ethical confusions related to its existence have gone all but unnoticed. Contrary to what is often asserted, adverse events following from taking placebo interventions are not necessarily nocebo effects; they could have arisen due to natural history. Meanwhile, ethical informed consent (in clinical trials and clinical practice) has centred almost exclusively on the need to inform patients about intervention risks with patients to preserve their autonomy. Researchers have failed to consider the harm caused by the way in which the information is conveyed. In this paper, I argue that the magnitude of nocebo effects must be measured using control groups consisting of untreated patients. And, because the nocebo effect can produce harm, the principle of non-maleficence must be taken into account alongside autonomy when obtaining (ethical) informed consent and communicating intervention risks with patients.
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Affiliation(s)
- Jeremy Howick
- Faculty of Philosophy, University of Oxford, Oxford OX2 6GG, UK
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20
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Bérubé M, Martorella G, Côté C, Gélinas C, Feeley N, Choinière M, Parent S, Streiner DL. The Effect of Psychological Interventions on the Prevention of Chronic Pain in Adults: A Systematic Review and Meta-analysis. Clin J Pain 2021; 37:379-395. [PMID: 33577194 DOI: 10.1097/ajp.0000000000000922] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2020] [Accepted: 01/22/2021] [Indexed: 11/27/2022]
Abstract
OBJECTIVE Up to 50% of patients develop high-impact chronic pain after an acute care experience and many psychological variables have been identified in this process. We conducted a systematic review and meta-analysis of randomized controlled trials to assess the effect of psychological interventions within 3 months after pain onset. METHODS We searched databases for articles published from databases inceptions until July 2019. We used standardized mean differences with 95% confidence intervals to assess treatment effect. RESULTS In all, 18 trials were found eligible; 11 of which were included in the meta-analyses. Trials were mainly performed in back pain patients in the middle to late adulthood. Regarding pain intensity, the effect of psychological interventions compared with standard treatments was nonsignificant at 3, 6, and 12 months. We found a moderate significant effect size in favor of psychological interventions compared with standard treatments with regard to disability at 12 months and a small significant effect with regard to coping with pain at 3 months when compared with information alone. Most of meta-analysis findings were associated with a low level of evidence. DISCUSSION This systematic review and meta-analysis showed no significant effect of psychological interventions on pain intensity. A positive and significant trend related to these interventions was shown on disability and coping with pain, when compared with standard treatment and information, respectively. However, these findings must be interpreted with caution considering the limited sample of trials. More rigorous randomized controlled trials performed in patients with a high-risk psychological profile are required to elucidate the efficacy of psychological interventions in preventing chronic pain.
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Affiliation(s)
- Mélanie Bérubé
- Faculty of Nursing, Laval University
- Population Health and Optimal Health Practices Research Unit, Trauma-Emergency-Critical Care Medicine, Research Center of the Quebec University Health Center (Enfant-Jesus Hospital), Quebec City
| | - Géraldine Martorella
- College of Nursing, Florida State University
- Tallahassee Memorial Hospital Center for Research and Evidence-Based Practice, Tallahassee, FL
| | | | - Céline Gélinas
- Ingram School of Nursing, McGill University
- Center for Nursing Research and Lady Davis Institute, Jewish General Hospital
| | - Nancy Feeley
- Ingram School of Nursing, McGill University
- Center for Nursing Research and Lady Davis Institute, Jewish General Hospital
| | - Manon Choinière
- Research Center of the Montreal University Health Center
- Department of Anesthesiology and Pain Medicine, Faculty of Medicine, Montreal University
| | - Stefan Parent
- Orthopaedic Department, Montreal University Health Center (Ste-Justine Hospital)
- Surgery Department, University of Montreal, Montreal, QC
| | - David L Streiner
- Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton
- Department of Psychiatry, University of Toronto, Toronto, ON, Canada
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21
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Burton LJ, Forster A, Johnson J, Crocker TF, Tyson SF, Wray F, Clarke DJ. Experiences and views of receiving and delivering information about recovery in acquired neurological conditions: a systematic review of qualitative literature. BMJ Open 2021; 11:e045297. [PMID: 33906841 PMCID: PMC8088240 DOI: 10.1136/bmjopen-2020-045297] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/04/2022] Open
Abstract
OBJECTIVE To review and synthesise qualitative literature relating to the views, perceptions and experiences of patients with acquired neurological conditions and their caregivers about the process of receiving information about recovery; as well as the views and experiences of healthcare professionals involved in delivering this information. DESIGN Systematic review of qualitative studies. DATA SOURCES MEDLINE, Embase, AMED, CINAHL, PsycINFO, Web of Science and the Cochrane library were searched from their inception to July 2019. DATA EXTRACTION AND SYNTHESIS Two reviewers extracted data from the included studies and assessed quality using an established tool. Thematic synthesis was used to synthesise the findings of included studies. RESULTS Searches yielded 9105 titles, with 145 retained for full-text screening. Twenty-eight studies (30 papers) from eight countries were included. Inductive analysis resulted in 11 descriptive themes, from which 5 analytical themes were generated: the right information at the right time; managing expectations; it's not what you say, it's how you say it; learning how to talk about recovery and manage emotions; the context of uncertainty. CONCLUSIONS Our findings highlight the inherent challenges in talking about recovery in an emotional context, where breaking bad news is a key feature. Future interventions should focus on preparing staff to meet patients' and families' information needs, as well as ensuring they have the skills to discuss potential recovery and break bad news compassionately and share the uncertain trajectory characteristic of acquired neurological conditions. An agreed team-based approach to talking about recovery is recommended to ensure consistency and improve the experiences of patients and their families.
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Affiliation(s)
- Louisa-Jane Burton
- Academic Unit for Ageing and Stroke Research, University of Leeds, Leeds, UK
- Academic Unit for Ageing and Stroke Research, Bradford Institute for Health Research, Bradford Teaching Hospitals NHS Foundation Trust, Bradford, UK
| | - Anne Forster
- Academic Unit for Ageing and Stroke Research, University of Leeds, Leeds, UK
- Academic Unit for Ageing and Stroke Research, Bradford Institute for Health Research, Bradford Teaching Hospitals NHS Foundation Trust, Bradford, UK
| | - Judith Johnson
- School of Psychology, University of Leeds Faculty of Biological Sciences, Leeds, UK
- Bradford Institute for Health Research, Bradford Teaching Hospitals NHS Foundation Trust, Bradford, UK
- School of Public Health and Community Medicine, University of New South Wales, Sydney, New South Wales, Australia
| | - Thomas F Crocker
- Academic Unit for Ageing and Stroke Research, Bradford Institute for Health Research, Bradford Teaching Hospitals NHS Foundation Trust, Bradford, UK
| | - Sarah F Tyson
- Division of Nursing, Midwifery and Social Work, The University of Manchester, Manchester, UK
| | - Faye Wray
- Academic Unit for Ageing and Stroke Research, University of Leeds, Leeds, UK
| | - David J Clarke
- Academic Unit for Ageing and Stroke Research, University of Leeds, Leeds, UK
- Academic Unit for Ageing and Stroke Research, Bradford Institute for Health Research, Bradford Teaching Hospitals NHS Foundation Trust, Bradford, UK
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Probiotics as a treatment for prenatal maternal anxiety and depression: a double-blind randomized pilot trial. Sci Rep 2021; 11:3051. [PMID: 33542275 PMCID: PMC7862351 DOI: 10.1038/s41598-021-81204-9] [Citation(s) in RCA: 27] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2019] [Accepted: 12/23/2020] [Indexed: 02/07/2023] Open
Abstract
Probiotic use may be an efficacious treatment option to effectively manage symptoms of prenatal maternal anxiety and depression. Our primary aim was to test feasibility and acceptability for a probiotic randomized controlled trial (RCT) in pregnant women with pre-existing symptoms. This double-blind pilot RCT included 40 pregnant women with low-risk pregnancies and elevated depressive symptoms and/or anxiety. Once daily, participants orally consumed a probiotic (Ecologic Barrier) or a placebo, from 26 to 30 weeks gestation until delivery. A priori key progression criteria for primary outcomes were determined to decide whether or not a full RCT was feasible and acceptable. Secondary outcomes included depressive symptoms, anxiety, stress, and maternal bonding to offspring. In 19 months, 1573 women were screened; following screening, 155 women (10%) were invited for participation, of whom 135 (87%) received study information, and 40 women (30%) were included. Four out of six a priori determined criteria for success on feasibility and acceptability were met. After 8 weeks of intervention, there was no significant difference between the probiotic and placebo groups for secondary outcomes. The pilot trial was feasible and acceptable, but hampered by recruitment method and study design. Secondary endpoints did not reveal differences between the groups for improving maternal mood.
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Chen AM, Roberts TL, Cotter SA, Kulp MT, Sinnott LT, Borsting EJ, Tea YC, Jones-Jordan LA, Hertle R, Mitchell GL, Arnold LE, Chase C, Scheiman MM. Effectiveness of vergence/accommodative therapy for accommodative dysfunction in children with convergence insufficiency. Ophthalmic Physiol Opt 2021; 41:21-32. [PMID: 33119180 PMCID: PMC10545079 DOI: 10.1111/opo.12747] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2020] [Accepted: 09/04/2020] [Indexed: 12/01/2022]
Abstract
PURPOSE To determine the effectiveness of office-based vergence/accommodative therapy for improving accommodative amplitude and accommodative facility in children with symptomatic convergence insufficiency and accommodative dysfunction. METHODS We report changes in accommodative function following therapy among participants in the Convergence Insufficiency Treatment Trial - Attention and Reading Trial with decreased accommodative amplitude (115 participants in vergence/accommodative therapy; 65 in placebo therapy) or decreased accommodative facility (71 participants in vergence/accommodative therapy; 37 in placebo therapy) at baseline. The primary analysis compared mean change in amplitude and facility between the vergence/accommodative and placebo therapy groups using analyses of variance models after 4, 8, 12 and 16 weeks of treatment. The proportions of participants with normal amplitude and facility at each time point were calculated. The average rate of change in amplitude and facility from baseline to week 4, and from weeks 4 to 16, were determined in the vergence/accommodative therapy group. RESULTS From baseline to 16 weeks, the mean improvement in amplitude was 8.6 dioptres (D) and 5.2 D in the vergence/accommodative and placebo therapy groups, respectively (mean difference = 3.5 D, 95% confidence interval (CI): 1.5 to 5.5 D; p = 0.01). The mean improvement in facility was 13.5 cycles per minute (cpm) and 7.6 cpm in the vergence/accommodative and placebo therapy groups, respectively (mean difference = 5.8 cpm, 95% CI: 3.8 to 7.9 cpm; p < 0.0001). Significantly greater proportions of participants treated with vergence/accommodative therapy achieved a normal amplitude (69% vs. 32%, difference = 37%, 95% CI: 22 to 51%; p < 0.0001) and facility (85% vs. 49%, difference = 36%, 95% CI: 18 to 55%; p < 0.0001) than those who received placebo therapy. In the vergence/accommodative therapy group, amplitude increased at an average rate of 1.5 D per week during the first 4 weeks (p < 0.0001), then slowed to 0.2 D per week (p = 0.002) from weeks 4 to 16. Similarly, facility increased at an average rate of 1.5 cpm per week during the first 4 weeks (p < 0.0001), then slowed to 0.6 cpm per week from weeks 4 to 16 (p < 0.0001). CONCLUSION Office-based vergence/accommodative therapy is effective for improving accommodative function in children with symptomatic convergence insufficiency and coexisting accommodative dysfunction.
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Affiliation(s)
- Angela M. Chen
- Southern California College of Optometry at Marshall B. Ketchum University, CA
| | - Tawna L. Roberts
- Department of Ophthalmology, Stanford University School of Medicine, CA
| | - Susan A. Cotter
- Southern California College of Optometry at Marshall B. Ketchum University, CA
| | | | | | - Eric J. Borsting
- Southern California College of Optometry at Marshall B. Ketchum University, CA
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Sadeghian M, Asadi M, Rahmani S, Sadeghi N, Hosseini SA, Zare Javid A. Lycopene Does Not Affect Prostate-Specific Antigen in Men with Non-Metastatic Prostate Cancer: A Systematic Review and Meta-Analysis of Randomized Controlled Trials. Nutr Cancer 2020; 73:2796-2807. [PMID: 33355018 DOI: 10.1080/01635581.2020.1862254] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Several randomized controlled trials (RCTs) have investigated the effect of lycopene supplementation on serum levels of prostate-specific antigen (PSA) in patients with prostate cancer. However, results have been inconclusive. We systematically searched PubMed, Embase, and Scopus up to January 2020 to find RCTs investigating the effect of lycopene supplementation on serum levels of PSA in patients with non-metastatic prostate cancer. Using a random-effects model, the reported risk estimates were pooled. A total of six trials were included in the final analysis. we found no significant effect of lycopene on circulating PSA (WMD: -0.60, 95% CI: -2.01, 0.81 µg/L). However, we observed a significant reducing effect when the analysis was confined to studies that included patients with higher baseline levels of PSA (≥6.5 µg/L) (WMD: -3.74 µg/L, 95% CI: -5.15, -2.32, P < 0.001). Subgroup analysis based on the duration of intervention did not result in any significant effect. Non-linear dose-response analysis did not show any significant effects of lycopene dosage (Pnon-linearity = 0.50) and duration of the intervention (Pnon-linearity = 0.63) on serum levels of PSA. Although lycopene supplementation did not produce any reduction in PSA levels overall, a significant reducing effect was observed in patients with higher levels of baseline PSA. Due to the heterogeneity of our results, further high-quality clinical trials with long-term duration are required to determine the efficacy of lycopene in patients with non-metastatic prostate cancer.
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Affiliation(s)
- Mehdi Sadeghian
- Student Research Committee, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran.,Department of Nutrition, School of Allied Medical Sciences, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
| | - Maryam Asadi
- Student Research Committee, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran.,Department of Nutrition, School of Allied Medical Sciences, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
| | - Sepideh Rahmani
- Food Security Research Center, Department of Community Nutrition, School of Nutrition and Food Science, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Narges Sadeghi
- Student Research Committee, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran.,Department of Nutrition, School of Allied Medical Sciences, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
| | - Seyed Ahmad Hosseini
- Department of Nutrition, School of Allied Medical Sciences, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran.,Nutrition and Metabolic Diseases Research Center, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
| | - Ahmad Zare Javid
- Department of Nutrition, School of Allied Medical Sciences, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran.,Nutrition and Metabolic Diseases Research Center, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
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Design and conduct of confirmatory chronic pain clinical trials. Pain Rep 2020; 6:e845. [PMID: 33511323 PMCID: PMC7837951 DOI: 10.1097/pr9.0000000000000854] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2020] [Revised: 08/07/2020] [Accepted: 08/19/2020] [Indexed: 12/30/2022] Open
Abstract
The purpose of this article is to provide readers with a basis for understanding the emerging science of clinical trials and to provide a set of practical, evidence-based suggestions for designing and executing confirmatory clinical trials in a manner that minimizes measurement error. The most important step in creating a mindset of quality clinical research is to abandon the antiquated concept that clinical trials are a method for capturing data from clinical practice and shifting to a concept of the clinical trial as a measurement system, consisting of an interconnected set of processes, each of which must be in calibration for the trial to generate an accurate and reliable estimate of the efficacy (and safety) of a given treatment. The status quo of inaccurate, unreliable, and protracted clinical trials is unacceptable and unsustainable. This article gathers aspects of study design and conduct under a single broad umbrella of techniques available to improve the accuracy and reliability of confirmatory clinical trials across traditional domain boundaries.
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Özdemir V, Endrenyi L. Rethinking Clinical Trials and Personalized Medicine with Placebogenomics and Placebo Dose. OMICS-A JOURNAL OF INTEGRATIVE BIOLOGY 2020; 25:1-12. [PMID: 33305994 DOI: 10.1089/omi.2020.0208] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Pharmacogenomics, nutrigenomics, vaccinomics, and the nascent field of plant omics are examples of variability science. They are embedded within an overarching framework of personalized medicine. Across these public health specialties, the significance and biology of the placebo response have been historically neglected. A placebo is any substance such as a sugar pill administered in the guise of medication, but one that does not have pharmacological activity. Placebos do have clinical effects, however, that can be substantive in magnitude and vary markedly from person-to-person depending, for example, on the type of disease, symptoms, or clinical trial design. Research over the past several decades attests to a genuine neurobiological basis for placebo effects. All drugs have placebo components that contribute to their overall treatment effect. Placebos are used in clinical trials as control groups to ascertain the net pharmacological effect of a drug candidate. Not only less well known but also relevant to rational therapeutics and personalized medicine is the nocebo. A nocebo effect occurs when an inert substance is administered in a context that induces negative expectations, worsening patients' symptoms. With the COVID-19 pandemic, there are high public expectations for new vaccines and medicines to end the contagion, while at the same time antiscience, post-truth, and antivaccine movements are worrisomely on the rise. These social movements, changes in public health cultures, and conditioned behavioral responses can trigger both placebo and nocebo effects. Hence, in clinical trials, forecasting and explaining placebo and nocebo variability are more important than ever for robust science and personalized health care. Against this overarching context, this article provides (1) a brief history of placebo and (2) a discussion on biology, mechanisms, and variability of placebo effects, and (3) discusses three emerging new concepts: placebogenomics, nocebogenomics, and augmented placebo, that is, the notion of a "placebo dose." We conclude with a roadmap for placebogenomics, its synergies with the nascent field of social pharmacology, and the ways in which a new taxonomy of drug and placebo variability can be anticipated in the next decade.
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Affiliation(s)
- Vural Özdemir
- OMICS: A Journal of Integrative Biology, New Rochelle, New York, USA
| | - Laszlo Endrenyi
- Department of Pharmacology and Toxicology, Faculty of Medicine, University of Toronto, Toronto, Canada
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Diaz-Quijano FA. Estimating and testing an index of bias attributable to composite outcomes in comparative studies. J Clin Epidemiol 2020; 132:1-9. [PMID: 33309888 DOI: 10.1016/j.jclinepi.2020.12.003] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2020] [Revised: 09/28/2020] [Accepted: 12/01/2020] [Indexed: 01/07/2023]
Abstract
OBJECTIVES This study aimed to develop an index to evaluate the bias attributable to composite outcomes (BACOs) in comparative clinical studies. STUDY DESIGN AND SETTING The author defined the BACO index as the ratio of the logarithm of the association measure (e.g., relative risk) of the composite outcome to that of its most relevant component endpoint (e.g., mortality). Methods to calculate the confidence intervals and test the null hypotheses (BACO index = 1) were described and applied in systematically selected clinical trials. Two other preselected trials were included as "positive controls" for being examples of primary composite outcomes disregarded because of inconsistency with the treatment effect on mortality. RESULTS The BACO index values different from 1 were classified according to whether the use of composite outcomes overestimated (BACO index >1), underestimated (BACO index between 0 and <1), or inverted (BACO index <0) the association between exposure and prognosis. In 3 of 23 systematically selected trials and the two positive controls, the BACO indices were significantly lower than 1 (P < 0.005). CONCLUSION BACO index can warn that the composite outcome association is stronger, weaker, or even opposite than that of its most critical component.
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Affiliation(s)
- Fredi Alexander Diaz-Quijano
- Department of Epidemiology, Laboratório de Inferência Causal em Epidemiologia (LINCE-USP), School of Public Health, University of São Paulo, São Paulo, São Paulo, Brazil.
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Capion T, Lilja-Cyron A, Juhler M, Mathiesen TI, Wetterslev J. Prompt closure versus gradual weaning of external ventricular drainage for hydrocephalus in adult patients with aneurysmal subarachnoid haemorrhage: a systematic review. BMJ Open 2020; 10:e040722. [PMID: 33243807 PMCID: PMC7692827 DOI: 10.1136/bmjopen-2020-040722] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
OBJECTIVES To summarise the evidence on benefits and harms of prompt closure versus gradual weaning of external ventricular drainage (EVD) in patients with hydrocephalus following aneurysmal subarachnoid haemorrhage (aSAH) based on randomised clinical trials (RCTs) in humans. SETTING RCTs comparing prompt closure versus gradual weaning of EVD in adult patients with hydrocephalus following aSAH were included. PARTICIPANTS Patients aged equal to or greater than 18 years with an EVD due to hydrocephalus following aSAH were eligible for inclusion. PRIMARY AND SECONDARY OUTCOME MEASURES Primary outcomes were all-cause mortality, any serious adverse event, rate of ventriculoperitoneal (VP) shunt placement and quality of life. Secondary outcomes were patients with shunt failure, hospital and neuro intensive care unit (NICU) length of stay (LOS) and complications related to treatment with an EVD. Data permitted report of rate of VP shunt placement, and hospital and NICU LOS. RESULTS Six studies were assessed in full text. One RCT with 81 patients was included. Rate of VP shunt placement was 63.4% in the rapid weaning group (ie, prompt closure of the EVD; 41 patients) and 62.5% in the gradual weaning group (40 patients; p=0.932). LOS in hospital and NICU was significantly shorter in the rapidly weaned group compared with the gradually weaned group (mean 19.1 vs 21.5 days in hospital (p=0.03); and mean 14.1 vs 16.9 days in NICU (p=0.0002)). Data were insufficient to conduct meta-analysis, trial sequential analysis or subgroup analysis of heterogeneity and sensitivity. One RCT is currently ongoing. CONCLUSIONS We found insufficient evidence to favour any of the two strategies for EVD discontinuation in patients with hydrocephalus following aSAH. PROSPERO REGISTRATION NUMBER CRD42018108801.
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Affiliation(s)
- Tenna Capion
- Department of Neurosurgery, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark
| | - Alexander Lilja-Cyron
- Department of Neurosurgery, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark
| | - Marianne Juhler
- Department of Neurosurgery, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark
| | - Tiit Illimar Mathiesen
- Department of Neurosurgery, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark
| | - Jørn Wetterslev
- Copenhagen Trial Unit, Centre for Clinical Intervention Research, Rigshospitalet, Copenhagen, Denmark
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Kortekaas-Rijlaarsdam AF, Luman M, Sonuga-Barke E, Bet P, Oosterlaan J. Methylphenidate-Related Improvements in Math Performance Cannot Be Explained by Better Cognitive Functioning or Higher Academic Motivation: Evidence From a Randomized Controlled Trial. J Atten Disord 2020; 24:1824-1835. [PMID: 28608744 PMCID: PMC7543012 DOI: 10.1177/1087054717713640] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
Objective: This study investigated whether improvements in working memory, reaction time, lapses of attention, interference control, academic motivation, and perceived competence mediated effects of methylphenidate on math performance. Method: Sixty-three children (ADHD diagnosis; methylphenidate treatment; age 8-13; IQ > 70) were randomly allocated to a 7-day methylphenidate or placebo treatment in this double-blind placebo-controlled crossover study and compared with 67 controls. Data were collected at schools and analyzed using mixed-model analysis. Methylphenidate was hypothesized to improve all measures; all measures were evaluated as potential mediators of methylphenidate-related math improvements. Results: Controls mostly outperformed the ADHD group. Methylphenidate did not affect measures of cognitive functioning (p = .082-.641) or academic motivation (p = .199-.865). Methylphenidate improved parent ratings of their child's self-perceived competence (p < .01), which mediated methylphenidate efficacy on math productivity. Conclusion: These results question the necessity of improvements in specific cognitive and motivational deficits associated with ADHD for medication-related academic improvement. They also stimulate further study of perceived competence as a mediator.
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Affiliation(s)
- Anne Fleur Kortekaas-Rijlaarsdam
- Vrije Universiteit Amsterdam, The Netherlands,Anne Fleur Kortekaas-Rijlaarsdam, Vrije Universiteit Amsterdam, Van der Boechorststraat 1, Amsterdam 1081 BT, The Netherlands.
| | | | | | - Pierre Bet
- VU University Medical Centre, Amsterdam, The Netherlands
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Huneke NT, van der Wee N, Garner M, Baldwin DS. Why we need more research into the placebo response in psychiatry. Psychol Med 2020; 50:2317-2323. [PMID: 33028433 PMCID: PMC7610180 DOI: 10.1017/s0033291720003633] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/26/2020] [Revised: 09/08/2020] [Accepted: 09/11/2020] [Indexed: 12/18/2022]
Abstract
Placebos are not inert, but exert measurable biological effects. The placebo response in psychiatric illness is important and clinically relevant, but remains poorly understood. In this paper, we review current knowledge about the placebo response in psychiatric medicine and identify research directions for the future. We argue that more research is needed into the placebo response in psychiatric medicine for three broad reasons. First, awareness of factors that cause placebo response, for whom, and when, within clinical trials will allow us to better evidence efficacy of new treatments. Second, by understanding how placebo mechanisms operate in the clinic, we can take advantage of these to optimise the effects of current treatments. Finally, exploring the biological mechanisms of placebo effects might reveal tractable targets for novel treatment development.
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Affiliation(s)
- Nathan T.M. Huneke
- Clinical and Experimental Sciences, Faculty of Medicine, University of Southampton, Southampton, UK
- University Department of Psychiatry, Academic Centre, College Keep, 4-12 Terminus Terrace, Southampton, SO14 3DT, UK
| | - Nic van der Wee
- Department of Psychiatry, Leiden University Medical Center, Leiden, The Netherlands
| | - Matthew Garner
- Clinical and Experimental Sciences, Faculty of Medicine, University of Southampton, Southampton, UK
- Academic Unit of Psychology, Faculty of Environmental and Life Sciences, University of Southampton, Southampton, UK
| | - David S. Baldwin
- Clinical and Experimental Sciences, Faculty of Medicine, University of Southampton, Southampton, UK
- University Department of Psychiatry, Academic Centre, College Keep, 4-12 Terminus Terrace, Southampton, SO14 3DT, UK
- University Department of Psychiatry and Mental Health, University of Cape Town, Cape Town, South Africa
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Sullivan JK, Shrestha S, Collins JE, Safran-Norton CE, Losina E, Katz JN. Association between changes in muscle strength and pain in persons with meniscal tear and osteoarthritis. OSTEOARTHRITIS AND CARTILAGE OPEN 2020; 2:100072. [DOI: 10.1016/j.ocarto.2020.100072] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2020] [Accepted: 05/08/2020] [Indexed: 11/24/2022] Open
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Enck P, Klosterhalfen S. Placebo Responses and Placebo Effects in Functional Gastrointestinal Disorders. Front Psychiatry 2020; 11:797. [PMID: 33192627 PMCID: PMC7477083 DOI: 10.3389/fpsyt.2020.00797] [Citation(s) in RCA: 28] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/25/2019] [Accepted: 07/24/2020] [Indexed: 12/14/2022] Open
Abstract
Much has been written about the placebo effects in functional gastrointestinal disorders (FGD), especially in irritable bowel syndrome (IBS), driven by the early hypothesis that in randomized controlled trials (RCTs) of IBS, the placebo effect might be specifically high and thus, corrupts the efficacy of novel drugs developed for this condition. This narrative review is based on a specific search method, a database (www.jips.online) developed since 2004 containing more than 4,500 papers (data papers, meta-analyses, systematic reviews, reviews) pertinent to the topic placebo effects/placebo response. Three central questions-deducted from the body of current literature-are addressed to explore the evidence behind this hypothesis: What is the size placebo effect in FGD, especially in IBS, and is it different from the placebo effect seen in other gastrointestinal disorders? Is the placebo effect in FGD different from other functional, non-intestinal disorders, e.g. in other pain syndromes? Is the placebo effect in FGD related to placebo effects seen in psychiatry, e.g. in depression, anxiety disorders, and alike? Following this discussion, a fourth question is raised as the result of the three: What are the consequences of this for future drug trials in FGD? In summary it is concluded that, contrary to common belief and discussion, the placebo effect seen in RCT in FGD is not specifically high and extraordinary as compared to other comparable (i.e. functional) disorders. It shares less than expected commonalities with the placebo effect in psychiatry, and very few predictors have yet been identified that determine its effect size, especially some that are driven by design features of the studies. Current practice of RCT in IBS seems to limit and control the placebo effect quite well, and future trial practice, e.g. head-to-head trial, still offers options to maintain this control, even in the absence of placebos used.
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Affiliation(s)
- Paul Enck
- Department of Internal Medicine VI: Psychosomatic Medicine and Psychotherapy, University Hospital Tübingen, Tübingen, Germany
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Sevcikova M, Maslej MM, Stipl J, Andrews PW, Pastrnak M, Vechetova G, Bartoskova M, Preiss M. Testing the Analytical Rumination Hypothesis: Exploring the Longitudinal Effects of Problem Solving Analysis on Depression. Front Psychol 2020; 11:1344. [PMID: 32714239 PMCID: PMC7344354 DOI: 10.3389/fpsyg.2020.01344] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2020] [Accepted: 05/20/2020] [Indexed: 11/13/2022] Open
Abstract
Depression is a mental health condition for which individuals commonly seek treatment. However, depressive episodes often resolve on their own, even without treatment. One evolutionary perspective, the analytical rumination hypothesis (ARH), suggests that depression occurs in response to complex problems. According to this perspective, depressive symptoms promote analytical rumination, i.e., distraction-resistant thoughts about the causes of problems [causal analysis (CA)] and how they can be solved [problem-solving analysis (PSA)]. By helping individuals solve complex problems, analytical rumination may contribute to remission from depression. The aim of this study was to investigate (1) whether clinically-depressed individuals have more complex problems and engage in more CA and PSA than non-depressed and (2) the effects of CA and PSA on decreases in problem complexity, depressive symptoms, and remission from the depression. Samples of 85 patients were treated for depression with antidepressants and psychotherapy, and 49 healthy subjects were assessed three times over a 4-month period (at Weeks 1, 5, and 16). At each assessment, they completed measures of depression, analytical rumination, and problem complexity. Depressed individuals reported having more complex problems and engaging in more CA than non-depressed participants. The two groups engaged in a similar degree of PSA. Findings from a multiple regression suggested that more PSA at Week 1 was related to a decrease in depressive symptoms at Week 5, even after controlling for baseline depression, problem number, and complexity. PSA at Week 1 did not predict the remission after hospitalization or at follow-up; however, having less complex problems at the baseline made it more likely that a patient would later remit. Engaging in more CA or PSA at Week 1 did not affect perceived problem complexity at Week 5 or at follow-up. However, these findings were not statistically significant when influential observations (or outliers) were included in the analysis. Our findings suggest that PSA may contribute to a decrease in symptoms of depression over time. However, alleviations in problem complexity and remission might only be achieved if problems are initially less complex. Future directions involve exploring how PSA might contribute to decreases in depressive symptoms and other mechanisms underlying remission from depression.
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Affiliation(s)
- Marcela Sevcikova
- National Institute of Mental Health, Klecany, Czechia
- First Faculty of Medicine, Charles University, Prague, Czechia
| | - Marta M. Maslej
- Krembil Centre for Neuroinformatics, Centre for Addiction and Mental Health, Toronto, ON, Canada
| | - Jiri Stipl
- National Institute of Mental Health, Klecany, Czechia
| | - Paul W. Andrews
- Department of Psychology, Neuroscience and Behaviour, McMaster University, Hamilton, ON, Canada
| | - Martin Pastrnak
- National Institute of Mental Health, Klecany, Czechia
- Third Faculty of Medicine, Charles University, Prague, Czechia
| | - Gabriela Vechetova
- National Institute of Mental Health, Klecany, Czechia
- First Faculty of Medicine, Charles University, Prague, Czechia
| | - Magda Bartoskova
- National Institute of Mental Health, Klecany, Czechia
- Department of Psychology, Faculty of Education, Charles University, Prague, Czechia
| | - Marek Preiss
- National Institute of Mental Health, Klecany, Czechia
- University of New York in Prague, Prague, Czechia
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Kligerman MP, Devine EE, Bentzley JP, Megwalu UC. Cost-Effectiveness of Depression Screening for Otolaryngology-Head and Neck Surgery Residents. Laryngoscope 2020; 131:502-508. [PMID: 32510589 DOI: 10.1002/lary.28780] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2020] [Revised: 04/29/2020] [Accepted: 05/10/2020] [Indexed: 11/08/2022]
Abstract
OBJECTIVES This study aims to determine the cost-effectiveness of screening and treating otolaryngology-head and neck surgery residents for depression. METHODS A Markov model was built using TreeAgePro, version 2019 (TreeAge Software Inc.; Williamstown, MA) to assess the cost-effectiveness of five potential treatment algorithms: 1) treat all residents with psychotherapy, 2) screen and treat depressed residents with psychotherapy, 3) screen and treat depressed residents with pharmacotherapy, 4) screen and treat depressed residents with combination psychotherapy/pharmacotherapy, and 5) no intervention. A Monte Carlo probabilistic sensitivity analysis (PSA), consisting of 1 thousand simulations over a cumulative 5-year period, was performed to evaluate both base case values and a range of values for model variables. RESULTS Screening residents for depression and treating with combination psychotherapy/pharmacotherapy was cost-effective and the optimal strategy at a willingness-to-pay threshold of $50 thousand per quality-adjusted life year (QALY). This option demonstrated an incremental cost-effectiveness ratio of $27,578 per QALY for base case values. PSA confirmed these results and demonstrated that screening residents for depression and treating with either combination pharmacotherapy/psychotherapy, pharmacotherapy alone, or psychotherapy alone were cost-effective options in 94.9% of simulations. CONCLUSION Depression and burnout remain crucial issues among resident physicians. This study demonstrates that actively screening residents for depression is cost-effective. Based on these results, residency programs may consider trialing standardized depression screening protocols. LEVEL OF EVIDENCE I and II. Laryngoscope, 131:502-508, 2021.
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Affiliation(s)
- Maxwell P Kligerman
- Department of Otolaryngology, School of Medicine, Stanford University, Stanford, California, USA
| | - Erin E Devine
- Department of Otolaryngology, School of Medicine, Stanford University, Stanford, California, USA
| | - Jessica P Bentzley
- Department of Psychiatry, School of Medicine, Stanford University, Stanford, California, U.S.A
| | - Uchechukwu C Megwalu
- Department of Otolaryngology, School of Medicine, Stanford University, Stanford, California, USA
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Khullar V, Rahnama'i MS, Veit-Rubin N, Cardozo L, Wein AJ. Can we harness the placebo effect to improve care in lower urinary tract dysfunction? ICI-RS 2019. Neurourol Urodyn 2020; 39 Suppl 3:S80-S87. [PMID: 32311166 DOI: 10.1002/nau.24351] [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: 03/25/2020] [Accepted: 03/26/2020] [Indexed: 11/09/2022]
Abstract
The proposal "Can we harness the placebo effect to improve care in lower urinary tract dysfunction?" was discussed at the International Consultation on Incontinence-Research Society (ICI-RS) 2019 meeting. The placebo effect can change the treatment outcome whether the treatment is an active treatment or placebo. The total active treatment outcome is a combination of the placebo and the active treatment effect which is seen in placebo-controlled trials. The placebo effect plays an important role in the treatment of lower urinary tract dysfunction in overactive bladder, bladder pain syndrome, and stress urinary incontinence. In clinical practice, a number of factors can be employed to use the placebo effect to maximize its effect on patients receiving an active treatment, such as having the same environment for review such as the same appointment time, same room, and same clinician. Clinicians should also be aware of the nocebo effect which is increased with an overemphasis on side effects or negative outcomes.
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Affiliation(s)
- Vik Khullar
- Urogynaecology Department, St Mary's Hospital, Imperial College London, London, UK
| | - Mohammad S Rahnama'i
- Department of Urology, University Hospital Maastricht, Maastricht, The Netherlands
| | - Nikolaus Veit-Rubin
- Department of Obstetrics and Gynecology, Medical University of Vienna, Vienna, Austria
| | - Linda Cardozo
- Department of Urogynaecology, Kings College Hospital, London, UK
| | - Alan J Wein
- Department of Urology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania
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Marsman MS, Wetterslev J, Vriens PWHE, Bleys RLAW, Jahrome AK, Moll FL, Keus F, Koning GG. Eversion technique versus conventional endarterectomy with patch angioplasty in carotid surgery: protocol for a systematic review with meta-analyses and trial sequential analysis of randomised clinical trials. BMJ Open 2020; 10:e030503. [PMID: 32312723 PMCID: PMC7245381 DOI: 10.1136/bmjopen-2019-030503] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/17/2019] [Revised: 11/12/2019] [Accepted: 11/20/2019] [Indexed: 01/04/2023] Open
Abstract
INTRODUCTION Traditional carotid endarterectomy is considered to be the standard technique for prevention of a new stroke in patients with a symptomatic carotid stenosis. Use of patch angioplasty to restore the arterial wall after longitudinal endarterectomy is, to date, not unequivocally proven to be superior to eversion technique. A systematic review is needed for evaluation of benefits and harms of the eversion technique versus the traditional endarterectomy with patch angioplasty in patients with symptomatic carotid stenosis. METHODS AND OUTCOMES The review will be conducted according to this protocol following the recommendations of the 'Cochrane Handbook for Systematic Reviews' and reported according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses. Randomised clinical trials comparing eversion technique versus endarterectomy with patch angioplasty in patients with a symptomatic stenosis of the internal carotid artery will be included. Primary outcomes are all-cause mortality rate, health-related quality of life and serious adverse events. Secondary outcomes are 30-day stroke and mortality rate, symptomatic arterial restenosis or occlusion and non-serious adverse events. The databases Cochrane Central Register of Controlled Trials, PubMed/MEDLINE and EMBASE will be searched (November 2019). We will primarily base our conclusions on meta-analyses of trials with overall low-risk of bias. We will use trial sequential analysis to assist the evaluation of imprecision in Grading of Recommendations, Assessment, Development and Evaluation. However, if pooled point estimates of all trials are similar to pooled point estimates of trials with overall low risk of bias and there is lack of a statistical significant interaction between estimates from trials with overall high risk of bias and trials with overall low risk of bias we will consider the trial sequential analysis adjusted precision of the estimate achieved in all trials as the result of our meta-analyses. ETHICS AND DISSEMINATION The proposed systematic review will collect and analyse data from published studies, therefore, ethical approval is not required. The results of the review will be disseminated by publication in a peer-review journal and submitted for presentation at conferences. PROSPERO REGISTRATION NUMBER CRD42019119361.
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Affiliation(s)
- Martijn S Marsman
- Department of Vascular Surgery, Rijnstate Hospital, Arnhem, The Netherlands
| | - Jorn Wetterslev
- Rigshospitalet, Copenhagen Trial Unit, Centre for Clinical Intervention Research, Copenhagen, Denmark
| | - Patrick W H E Vriens
- Department of Vascular Surgery, Elisabeth-Tweesteden Hospital, Tilburg, The Netherlands
| | - Ronald L A W Bleys
- Department of Anatomy, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Abdelkarime Kh Jahrome
- Department of Vascular Surgery, HFG, Medical Center Leeuwarden, Leeuwarden, The Netherlands
| | - Frans L Moll
- Department of Vascular Surgery, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Frederik Keus
- Department of Critical Care, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Giel G Koning
- Department of Vascular Surgery, Ikazia Hospital, Rotterdam, The Netherlands
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Meister R, Abbas M, Antel J, Peters T, Pan Y, Bingel U, Nestoriuc Y, Hebebrand J. Placebo response rates and potential modifiers in double-blind randomized controlled trials of second and newer generation antidepressants for major depressive disorder in children and adolescents: a systematic review and meta-regression analysis. Eur Child Adolesc Psychiatry 2020; 29:253-273. [PMID: 30535589 PMCID: PMC7056684 DOI: 10.1007/s00787-018-1244-7] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/11/2018] [Accepted: 10/20/2018] [Indexed: 12/17/2022]
Abstract
Children and adolescents with major depressive disorder (MDD) appear to be more responsive to placebo than adults in randomized placebo-controlled trials (RCTs) of second and newer generation antidepressants (SNG-AD). Previous meta-analyses obtained conflicting results regarding modifiers. We aimed to conduct a meta-analytical evaluation of placebo response rates based on both clinician-rating and self-rating scales. Based on the most recent and comprehensive study on adult data, we tested whether the placebo response rates in children and adolescents with MDD also increase with study duration and number of study sites. We searched systematically for published RCTs of SNG-AD in children and/or adolescents (last update: September 2017) in public domain electronic databases and additionally for documented studies in clinical trial databases. The log-transformed odds of placebo response were meta-analytically analyzed. The primary and secondary outcomes were placebo response rates at the end of treatment based on clinician-rating and self-rating scales, respectively. To examine the impact of study duration and number of study sites on placebo response rates, we performed simple meta-regression analyses. We selected other potential modifiers of placebo response based on significance in at least one previous pediatric meta-analysis and on theoretical considerations to perform explorative analyses. We applied sensitivity analyses with placebo response rates closest to week 8 to compare our data with those reported for adults. We identified 24 placebo-controlled trials (2229 patients in the placebo arms). The clinician-rated placebo response rates ranged from 22 to 62% with a pooled response rate of 45% (95% CI 41-50%). The number of study sites was a significant modifier in the simple meta-regression analysis [odds ratio (OR) 1.01, 95% CI 1.01-1.02, p = 0.0003, k = 24) with more study sites linked to a higher placebo response. Study duration was not significantly associated with the placebo response rate. The explorative simple analyses revealed that publication year may be an additional modifier. However, in the explorative multivariable analysis including the number of study sites and the publication year only the number of study sites reached a p value ≤ 0.05. The self-rated placebo response rates ranged from 1 to 68% with a pooled response rate of 26% (95% CI 10-54%) (k = 6; n = 396). This meta-analysis confirms a high pooled placebo response rate in children and adolescents based on clinician ratings, which exceeds that observed in the most recent meta-analysis of placebo effects in adults (36%; 95% CI 35-37%) published in 2016. However, and similar to findings in adults, the pooled response rates based on self-ratings were substantially lower. In accordance with previous meta-analyses, we corroborated the number of study sites as significant modifier. In comparison to the recent adult meta-analysis, the substantially lower number of pediatric studies entails a reduced power to detect modifiers. Future studies should provide more precise and homogenous information to support discovery of potential modifiers and consider no-treatment-if ethically permissible-to allow differentiation between placebo and spontaneous remission rates. If these differ, practicing clinicians should facilitate placebo effects as an addition to the verum effect to maximize benefits. Further research is required to explain the discrepant response rates between clinician and self-ratings.
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Affiliation(s)
- Ramona Meister
- Department of Medical Psychology, University Medical Center Hamburg-Eppendorf, Martinistraße 52, 20246, Hamburg, Germany.
| | - Mariam Abbas
- grid.5718.b0000 0001 2187 5445Department of Child and Adolescent Psychiatry, University Hospital Essen, University of Duisburg-Essen, Essen, Germany
| | - Jochen Antel
- grid.5718.b0000 0001 2187 5445Department of Child and Adolescent Psychiatry, University Hospital Essen, University of Duisburg-Essen, Essen, Germany
| | - Triinu Peters
- grid.5718.b0000 0001 2187 5445Department of Child and Adolescent Psychiatry, University Hospital Essen, University of Duisburg-Essen, Essen, Germany
| | - Yiqi Pan
- grid.13648.380000 0001 2180 3484Department of Psychosomatic Medicine and Psychotherapy, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Ulrike Bingel
- grid.5718.b0000 0001 2187 5445Department of Neurology, University Hospital Essen, University of Duisburg-Essen, Essen, Germany
| | - Yvonne Nestoriuc
- grid.13648.380000 0001 2180 3484Department of Psychosomatic Medicine and Psychotherapy, University Medical Center Hamburg-Eppendorf, Hamburg, Germany ,grid.49096.320000 0001 2238 0831Clinical Psychology, Helmut-Schmidt-University, University of the Federal Armed Forces Hamburg, Hamburg, Germany
| | - Johannes Hebebrand
- grid.5718.b0000 0001 2187 5445Department of Child and Adolescent Psychiatry, University Hospital Essen, University of Duisburg-Essen, Essen, Germany
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Simon DA, Friesen CA, Schurman JV, Colombo JM. Biliary Dyskinesia in Children and Adolescents: A Mini Review. Front Pediatr 2020; 8:122. [PMID: 32266192 PMCID: PMC7105807 DOI: 10.3389/fped.2020.00122] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/21/2020] [Accepted: 03/06/2020] [Indexed: 12/12/2022] Open
Abstract
Introduction: While functional gallbladder disorder is a well-recognized and defined condition in adults, its pediatric analog, biliary dyskinesia, lacks uniformity in diagnosis. Yet, biliary dyskinesia is among the most common conditions resulting in cholecystectomy in youth and its frequency continues to rise. The primary aims of the current review were assess the efficacy of cholecystectomy in children diagnosed with biliary dyskinesia and the utility of cholescintigraphy in predicting outcomes. Results: All previous studies assessing outcomes in youth with biliary dyskinesia have been retrospective and therefore of low quality. There is a lack of uniformity in patient selection. Short term follow-up reveals partial response in 63.4-100% with complete resolution in 44.2-100%. Only 4 studies have reported long-term outcomes with complete symptom resolution in 44-60.7%. The published research generally indicates that the gallbladder ejection fraction (GBEF) as determined by cholescintigraphy lacks utility in predicting cholecystectomy outcome utilizing the commonly used cut-off values. There are data suggesting that more extreme cut-off values may improve the predictive value of GBEF. Conclusion: There is a lack of consensus on the symptom profile defining biliary dyskinesia in youth and current literature does not support the use of cholescintigraphy to select patients for cholecystectomy. There is a substantial portion of pediatric patients diagnosed with biliary dyskinesia who do not experience long-term benefit from cholecystectomy. Well-designed prospective studies of surgical outcomes are lacking. Increasing the uniformity in patient selection, including both symptom profiles and cholescintigraphy results, will be key in understanding the utility of cholecystectomy for this condition.
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Affiliation(s)
- David A Simon
- Department of Pediatrics, Children's Mercy Kansas City, Kansas City, MO, United States
| | - Craig A Friesen
- Division of Pediatric Gastroenterology, Children's Mercy Kansas City, Kansas City, MO, United States
| | - Jennifer V Schurman
- Division of Developmental and Behavioral Sciences, Children's Mercy Kansas City, Kansas City, MO, United States
| | - Jennifer M Colombo
- Division of Pediatric Gastroenterology, Children's Mercy Kansas City, Kansas City, MO, United States
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Capion T, Lilja-Cyron A, Juhler M, Mathiesen TI, Wetterslev J. Prompt closure versus gradual weaning of extraventricular drainage for hydrocephalus in adult patients with aneurysmal subarachnoid haemorrhage: a systematic review protocol with meta-analysis and trial sequential analysis. BMJ Open 2019; 9:e029719. [PMID: 31575534 PMCID: PMC6797380 DOI: 10.1136/bmjopen-2019-029719] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/13/2019] [Revised: 07/25/2019] [Accepted: 08/09/2019] [Indexed: 11/09/2022] Open
Abstract
INTRODUCTION In Neuro Intensive Care Units (NICU) and neurosurgical units, patients with an external ventricular drain (EVD) due to hydrocephalus following aneurysmal subarachnoid haemorrhage (SAH) are commonly seen. Cessation of the EVD involves the dilemma of either closing the EVD directly, or gradually weaning it before removal. Development of increased intracranial pressure (ICP) and acute hydrocephalus with subsequent need of a permanent shunt has been associated with prompt closure of theEVD, whereas increased risk of infection with possible spreading to the brain and subsequent patient fatality is suspected in connection to a longer treatment as seen in gradual weaning. Sparse data exist on the recommendation of cessation strategy and patients are currently being treated on the basis of personal experience and expert opinion. The objective of this systematic review is to assess the available evidence from clinical trials on the effects of prompt closure versus gradual weaning of EVD treatment for hydrocephalus in adult patients with SAH. METHODS AND ANALYSIS We will search for randomised clinical trials in major international databases. Two authors will independently screen and select references for inclusion, extract data and assess the methodological quality of the included randomised clinical trials using the Cochrane risk of bias tool. Any disagreement will be resolved by consensus. We will analyse the extracted data using Review Manager and trial sequential analysis. To assess the quality of the evidence, we will create a 'Summary of Findings' table containing our primary and secondary outcomes using the GRADE assessment. ETHICS AND DISSEMINATION Results will be published widely according to the interest of the society. No possible impact, harm or ethical concerns are expected doing this protocol. TRIAL REGISTRATION NUMBER PROSPERO CRD42018108801.
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Affiliation(s)
- Tenna Capion
- Department of Neurosurgery, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark
| | - Alexander Lilja-Cyron
- Department of Neurosurgery, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark
| | - Marianne Juhler
- Department of Neurosurgery, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark
| | - Tiit Illimar Mathiesen
- Department of Neurosurgery, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark
| | - Jørn Wetterslev
- Copenhagen Trial Unit, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark
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Bérubé M, Gélinas C, Feeley N, Martorella G, Côté J, Laflamme GY, Rouleau DM, Choinière M. Feasibility of a Hybrid Web-Based and In-Person Self-management Intervention Aimed at Preventing Acute to Chronic Pain Transition After Major Lower Extremity Trauma (iPACT-E-Trauma): A Pilot Randomized Controlled Trial. PAIN MEDICINE (MALDEN, MASS.) 2019; 20:2018-2032. [PMID: 30840085 PMCID: PMC6784743 DOI: 10.1093/pm/pnz008] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
Objective 1) To assess the feasibility of research methods to test a self-management intervention aimed at preventing acute to chronic pain transition in patients with major lower extremity trauma (iPACT-E-Trauma) and 2) to evaluate its potential effects at three and six months postinjury. Design A pilot randomized controlled trial (RCT) with two parallel groups. Setting A supraregional level 1 trauma center. Methods Fifty-six adult patients were randomized. Participants received the intervention or an educational pamphlet. Several parameters were evaluated to determine the feasibility of the research methods. The potential efficacy of iPACT-E-Trauma was evaluated with measures of pain intensity and pain interference with activities. Results More than 80% of eligible patients agreed to participate, and an attrition rate of ≤18% was found. Less than 40% of screened patients were eligible, and obtaining baseline data took 48 hours postadmission on average. Mean scores of mild pain intensity and pain interference with daily activities (<4/10) on average were obtained in both groups at three and six months postinjury. Between 20% and 30% of participants reported moderate to high mean scores (≥4/10) on these outcomes at the two follow-up time measures. The experimental group perceived greater considerable improvement in pain (60% in the experimental group vs 46% in the control group) at three months postinjury. Low mean scores of pain catastrophizing (Pain Catastrophizing Scale score < 30) and anxiety and depression (Hospital Anxiety and Depression Scale scores ≤ 10) were obtained through the end of the study. Conclusions Some challenges that need to be addressed in a future RCT include the small proportion of screened patients who were eligible and the selection of appropriate tools to measure the development of chronic pain. Studies will need to be conducted with patients presenting more serious injuries and psychological vulnerability or using a stepped screening approach.
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Affiliation(s)
- M Bérubé
- Faculty of Nursing, Laval University, Quebec City, Quebec, Canada
- Research Center of the CHU de Québec, Quebec City, Quebec, Canada
| | - C Gélinas
- Faculty of Nursing, Laval University, Quebec City, Quebec, Canada
- Ingram School of Nursing, McGill University, Montréal, Québec, Canada
| | - N Feeley
- Ingram School of Nursing, McGill University, Montréal, Québec, Canada
- Centre for Nursing Research and Lady Davis Institute, Jewish General Hospital, Montréal, Quebec, Canada
| | - G Martorella
- College of Nursing, Florida State University, Tallahassee, Florida, USA
| | - J Côté
- Centre de Recherche, Centre Hospitalier de l’Université Montréal (CRCHUM), Montréal, Québec, Canada
| | - G Y Laflamme
- Hôpital du Sacré-Cœur de Montréal, Centre Intégré Universitaire du Nord de l’Île-de-Montréal, Montréal, Québec, Canada
| | - D M Rouleau
- Hôpital du Sacré-Cœur de Montréal, Centre Intégré Universitaire du Nord de l’Île-de-Montréal, Montréal, Québec, Canada
| | - M Choinière
- Centre de Recherche, Centre Hospitalier de l’Université Montréal (CRCHUM), Montréal, Québec, Canada
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Callesen P, Capobianco L, Heal C, Juul C, Find Nielsen S, Wells A. A Preliminary Evaluation of Transdiagnostic Group Metacognitive Therapy in a Mixed Psychological Disorder Sample. Front Psychol 2019; 10:1341. [PMID: 31281277 PMCID: PMC6595247 DOI: 10.3389/fpsyg.2019.01341] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2018] [Accepted: 05/23/2019] [Indexed: 12/30/2022] Open
Abstract
Objective: Comorbidity is common among anxiety and depression. Transdiagnostic treatment approaches have been developed to optimize treatment and offer a more unified approach suitable for individuals with comorbidities. Metacognitive therapy (MCT) is a transdiagnostic therapy for psychological disorder and is based on the metacognitive model. The present study is a service evaluation of the outcomes associated with group MCT delivered to unselected patients at a Danish outpatient clinic. Methods: A total of 131 self-diagnosed patients received 6 sessions of group MCT. Symptoms of anxiety and depression were measured by the Hospital Anxiety and Depression scale (HADS) and metacognition was assessed using the Cognitive Attentional Syndrome-1 (CAS-1). Participants were assessed at pre-treatment, post-treatment, and at 6 months follow-up as per usual clinic protocol. Linear mixed-effects regressions were used to assess the transdiagnostic effects of group MCT. Treatment effect sizes are reported for subgroups based on participant’s reason for seeking treatment (anxiety, depression, or comorbid). Effect sizes were not conducted for the depression subgroup given the limited number of participants. Clinically significant change is reported for all subgroups. Results: Group MCT was associated with large effect sizes for symptoms of anxiety and depression for patients seeking treatment for anxiety (d = 1.68), or comorbid (1.82). In addition, 66.7% of patients were classified as recovered at post-treatment, and 12.9% were classified as improved. These results were largely maintained at 6-month follow-up. Conclusion: These preliminary findings support the continued use of group MCT in the current outpatient clinic and suggest that it may be an efficacious and cost-effective treatment when delivered in “transdiagnostic” groups.
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Affiliation(s)
- Pia Callesen
- School of Health Sciences, Division of Psychology and Mental Health, University of Manchester, Manchester, United Kingdom.,CEKTOS, Copenhagen, Denmark
| | - Lora Capobianco
- School of Health Sciences, Division of Psychology and Mental Health, University of Manchester, Manchester, United Kingdom.,Research and Innovation, Greater Manchester Mental Health NHS Foundation Trust, Manchester, United Kingdom
| | - Calvin Heal
- School of Health Sciences, Division of Population Health, Health Services Research and Primary Care, Manchester, United Kingdom
| | | | | | - Adrian Wells
- School of Health Sciences, Division of Psychology and Mental Health, University of Manchester, Manchester, United Kingdom.,Research and Innovation, Greater Manchester Mental Health NHS Foundation Trust, Manchester, United Kingdom
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Verhoeven MM, de Hair MJ, Tekstra J, Bijlsma JW, van Laar JM, Pethoe-Schramm A, Borm ME, Ter Borg EJ, Linn-Rasker SP, Teitsma XM, Lafeber FP, Jacobs JW, Welsing PM. Initiating tocilizumab, with or without methotrexate, compared with starting methotrexate with prednisone within step-up treatment strategies in early rheumatoid arthritis: an indirect comparison of effectiveness and safety of the U-Act-Early and CAMERA-II treat-to-target trials. Ann Rheum Dis 2019; 78:1333-1338. [PMID: 31196844 DOI: 10.1136/annrheumdis-2019-215304] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2019] [Revised: 05/24/2019] [Accepted: 05/25/2019] [Indexed: 11/04/2022]
Abstract
OBJECTIVES Methotrexate (MTX), often combined with low moderately dosed prednisone, is still the cornerstone of initial treatment for early rheumatoid arthritis (RA). It is not known how this strategy compares with initial treatment with a biological. We therefore compared the effectiveness of tocilizumab (TCZ), or TCZ plus MTX (TCZ+MTX) with MTX plus 10 mg prednisone (MTX+pred), all initiated within a treat-to-target treatment strategy in early RA. METHODS Using individual patient data of two trials, we indirectly compared tight-controlled treat-to-target strategies initiating TCZ (n=103), TCZ+MTX (n=106) or MTX+pred (n=117), using initiation of MTX (n=227) as reference. Primary outcome was Disease Activity Score assessing 28 joints (DAS28) over 24 months. To assess the influence of acute phase reactants (APRs), a disease activity composite outcome score without APR (ie, modification of the Clinical Disease Activity Index (m-CDAI)) was analysed. Secondary outcomes were remission (several definitions), physical function and radiographic progression. Multilevel models were used to account for clustering within trials and patients over time, correcting for relevant confounders. RESULTS DAS28 over 24 months was lower for TCZ+MTX than for MTX+Pred (mean difference: -0.62 (95% CI -1.14 to -0.10)). Remission was more often achieved in TCZ+MTX and in TCZ versus MTX+pred (p=0.02/0.05, respectively). Excluding APRs from the disease activity outcome score, TCZ-based strategies showed a slightly higher m-CDAI compared with MTX+pred, but this was not statistically significant. Other outcomes were also not statistically significantly different between the strategies. CONCLUSIONS In patients with early RA, although TCZ-based strategies resulted in better DAS28 and remission rates compared with MTX+pred, at least part of these effects may be due to a specific effect of TCZ on APRs.
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Affiliation(s)
| | | | - Janneke Tekstra
- Rheumatology and Clinical Immunology, UMC Utrecht, Utrecht, The Netherlands
| | | | - Jacob M van Laar
- Rheumatology and Clinical Immunology, UMC Utrecht, Utrecht, The Netherlands
| | | | | | - Evert-Jan Ter Borg
- Department of Rheumatology, Sint Antonius Ziekenhuis, Nieuwegein, The Netherlands
| | | | - Xavier M Teitsma
- Rheumatology and Clinical Immunology, UMC Utrecht, Utrecht, The Netherlands
| | - Floris Pjg Lafeber
- Rheumatology and Clinical Immunology, UMC Utrecht, Utrecht, The Netherlands
| | - Johannes Wg Jacobs
- Rheumatology and Clinical Immunology, UMC Utrecht, Utrecht, The Netherlands
| | - Paco Mj Welsing
- Rheumatology and Clinical Immunology, UMC Utrecht, Utrecht, The Netherlands
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Ballou S. Reply. Clin Gastroenterol Hepatol 2019; 17:1216. [PMID: 30639777 DOI: 10.1016/j.cgh.2019.01.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/04/2019] [Accepted: 01/05/2019] [Indexed: 02/07/2023]
Affiliation(s)
- Sarah Ballou
- Division of Gastroenterology, Beth Israel Deaconesses Medical Center/Harvard Medical School, Boston, Massachusetts
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Enck P. A Matter of Perspective: Sham Surgery as Effective as Surgery, or Surgery as Uneffective as Sham? PAIN MEDICINE 2019; 20:200-201. [PMID: 29924354 DOI: 10.1093/pm/pny127] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Affiliation(s)
- Paul Enck
- Department of Internal Medicine VI, University Hospital, Tübingen, Germany
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45
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Shaw MK, Babovič M, Monrouxe LV. Healthcare professionals', students', patients' and donors' perceptions of stem cell research and therapy: a systematic review protocol. BMJ Open 2019; 9:e025801. [PMID: 30798317 PMCID: PMC6398628 DOI: 10.1136/bmjopen-2018-025801] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
INTRODUCTION Stem cell research (SCR) and the biomedical potential of developing therapies are crucial topics in biomedicine. Like other biotechnologies, stem cells are context specific entities understood through local conceptualisations of culture, politics, nationhood, as well as their perceived therapeutic efficacy. There is a need to recognise how these developments are understood within the healthcare community and by those who may use them. This protocol describes a systematic literature review that aims to explore healthcare professionals', healthcare students', patients', and donors' perceptions of SCR and therapy (SCR/T) and the factors that influence their perceptions. METHODS AND ANALYSIS Following Preferred Reporting Items for Systematic Reviews and Meta Analyses guidelines a systematic review will be undertaken. Web of Science, Scopus, Medline+Journals @Ovid and Ariti Library will be systematically searched for studies on healthcare professionals', healthcare students', patients' and donors' perceptions of SCR and developing therapies. All articles will be screened by a researcher for inclusion and evaluation based on 12 criteria for evaluating qualitative research. At least 20% of articles will also be reviewed by a second researcher and any disagreement will be solved via consensus. Data extracted from the articles will be analysed using thematic synthesis enabling the identification of concepts across studies and the development of new theory. ETHICS AND DISSEMINATION As part of a larger research project, ethical approval has been provided by the Institutional Research Board (IRB) at Chang Gung Memorial Hospital. This review will be able to determine the impact that certain perceptions of SCR/T will have on the development of future medical knowledge and practice. The results of the study will be published in a peer-reviewed journal and disseminated at relevant conferences. PROSPERO REGISTRATION NUMBER CRD42018103627.
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Affiliation(s)
- Malissa Kay Shaw
- Chang Gung Medical Education Research Centre (CG-MERC), Chang Gung Memorial Hospital Taoyuan Branch, Taoyuan, Taiwan
| | - Mojca Babovič
- Chang Gung Medical Education Research Centre (CG-MERC), Chang Gung Memorial Hospital Taoyuan Branch, Taoyuan, Taiwan
| | - Lynn Valerie Monrouxe
- Chang Gung Medical Education Research Centre (CG-MERC), Chang Gung Memorial Hospital Taoyuan Branch, Taoyuan, Taiwan
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46
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Abstract
The issue of placebo response and the extent of its effect on psychotherapy is complex for two specific reasons: i) Current standards for drug trials, e.g., true placebo interventions, double-blinding, cannot be applied to most psychotherapy techniques, and ii) some of the "nonspecific effects" in drug therapy have very specific effects in psychotherapy, such as the frequency and intensity of patient-therapist interaction. In addition, different psychotherapy approaches share many such specific effects (the "dodo bird verdict") and lack specificity with respect to therapy outcome. Here, we discuss the placebo effect in psychotherapy under four aspects: a) nonspecific factors shared with drug therapy (context factors); b) nonspecific factors shared among all psychotherapy traditions (common factors); c) specific placebo-controlled options with different psychotherapy modalities; and d) nonspecific control options for the specific placebo effect in psychotherapy. The resulting framework proposes that the exploration and enumeration of context factors, common factors, and specific factors contributes to the placebo effects in psychotherapy.
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Affiliation(s)
- Paul Enck
- Psychosomatic Medicine and Psychotherapy, Department of Internal Medicine VI, University Hospital Tübingen, Tübingen, Germany
| | - Stephan Zipfel
- Psychosomatic Medicine and Psychotherapy, Department of Internal Medicine VI, University Hospital Tübingen, Tübingen, Germany
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47
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Abstract
In this review, we explored different ways of controlling the placebo effects in clinical trials and described various factors that may increase/decrease the placebo effect in randomized placebo-controlled trials. These factors can be subdivided into four groups, and while not all factors are effective in every study and under all clinical conditions, they show on the whole that - even under the ideal condition of drug therapy, where blinded placebo provision is much easier and warranted than in, e.g., psychotherapy - many factors need to be controlled to ascertain that the goal of the clinical trials, fair assessment of superiority of the drug over placebo in placebo-controlled trials and fair assessment of non-inferiority of the drug compared to another drug in comparator trials, is reached. Ignorance towards the placebo effect, which was common in the past, is no longer acceptable; instead, it should be the goal of all therapeutic trials to minimize the placebo effect in clinical trials, while utilizing and maximizing it in clinical routine.
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Affiliation(s)
- Paul Enck
- Department of Internal Medicine VI: Psychosomatic Medicine and Psychotherapy , University Hospital Tübingen, Tübingen, Germany.
| | - Sibylle Klosterhalfen
- Department of Internal Medicine VI: Psychosomatic Medicine and Psychotherapy , University Hospital Tübingen, Tübingen, Germany
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48
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Sullivan JK, Irrgang JJ, Losina E, Safran-Norton C, Collins J, Shrestha S, Selzer F, Bennell K, Bisson L, Chen AT, Dawson CK, Gil AB, Jones MH, Kluczynski MA, Lafferty K, Lange J, Lape EC, Leddy J, Mares AV, Spindler K, Turczyk J, Katz JN. The TeMPO trial (treatment of meniscal tears in osteoarthritis): rationale and design features for a four arm randomized controlled clinical trial. BMC Musculoskelet Disord 2018; 19:429. [PMID: 30501629 PMCID: PMC6271417 DOI: 10.1186/s12891-018-2327-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/03/2018] [Accepted: 10/29/2018] [Indexed: 01/01/2023] Open
Abstract
BACKGROUND Meniscal tears often accompany knee osteoarthritis, a disabling condition affecting 14 million individuals in the United States. While several randomized controlled trials have compared physical therapy to surgery for individuals with knee pain, meniscal tear, and osteoarthritic changes (determined via radiographs or magnetic resonance imaging), no trial has evaluated the efficacy of physical therapy alone in these subjects. METHODS The Treatment of Meniscal Tear in Osteoarthritis (TeMPO) Trial is a four-arm multi-center randomized controlled clinical trial designed to establish the comparative efficacy of two in-clinic physical therapy interventions (one focused on strengthening and one containing placebo) and two protocolized home exercise programs. DISCUSSION The goal of this paper is to present the rationale behind TeMPO and describe the study design and implementation strategies, focusing on methodologic and clinical challenges. TRIAL REGISTRATION The TeMPO Trial was first registered at clinicaltrials.gov with registration No. NCT03059004 . on February 14, 2017.
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Affiliation(s)
- James K. Sullivan
- Orthopaedic and Arthritis Center for Outcomes Research (OrACORe) and Policy and Innovation eValuation in Orthopedic Treatments (PIVOT), Department of Orthopaedic Surgery, Brigham and Women’s Hospital, 60 Fenwood Road, BTM 5016, Boston, MA 02115 USA
| | - James J. Irrgang
- Department of Physical Therapy, School of Health and Rehabilitation Sciences, University of Pittsburgh, Pittsburgh, PA USA
| | - Elena Losina
- Orthopaedic and Arthritis Center for Outcomes Research (OrACORe) and Policy and Innovation eValuation in Orthopedic Treatments (PIVOT), Department of Orthopaedic Surgery, Brigham and Women’s Hospital, 60 Fenwood Road, BTM 5016, Boston, MA 02115 USA
- Harvard Medical School, Boston, MA USA
- Section of Clinical Sciences, Division of Rheumatology, Immunology and Allergy, Brigham and Women’s Hospital, Boston, MA USA
- Department of Biostatistics, Boston University School of Public Health, Boston, MA USA
| | - Clare Safran-Norton
- Department of Rehabilitation Services – Physical and Occupational Therapy, Brigham and Women’s Hospital, Boston, MA USA
| | - Jamie Collins
- Orthopaedic and Arthritis Center for Outcomes Research (OrACORe) and Policy and Innovation eValuation in Orthopedic Treatments (PIVOT), Department of Orthopaedic Surgery, Brigham and Women’s Hospital, 60 Fenwood Road, BTM 5016, Boston, MA 02115 USA
- Harvard Medical School, Boston, MA USA
| | - Swastina Shrestha
- Orthopaedic and Arthritis Center for Outcomes Research (OrACORe) and Policy and Innovation eValuation in Orthopedic Treatments (PIVOT), Department of Orthopaedic Surgery, Brigham and Women’s Hospital, 60 Fenwood Road, BTM 5016, Boston, MA 02115 USA
| | - Faith Selzer
- Orthopaedic and Arthritis Center for Outcomes Research (OrACORe) and Policy and Innovation eValuation in Orthopedic Treatments (PIVOT), Department of Orthopaedic Surgery, Brigham and Women’s Hospital, 60 Fenwood Road, BTM 5016, Boston, MA 02115 USA
- Harvard Medical School, Boston, MA USA
| | - Kim Bennell
- Centre for Health, Exercise and Sports Medicine, School of Health Sciences, University of Melbourne, Parkville, Australia
| | - Leslie Bisson
- UBMD Department of Orthopaedics and Sports Medicine, Jacobs School of Medicine and Biomedical Sciences, State University of New York at Buffalo, Buffalo, NY USA
| | - Angela T. Chen
- Orthopaedic and Arthritis Center for Outcomes Research (OrACORe) and Policy and Innovation eValuation in Orthopedic Treatments (PIVOT), Department of Orthopaedic Surgery, Brigham and Women’s Hospital, 60 Fenwood Road, BTM 5016, Boston, MA 02115 USA
| | - Courtney K. Dawson
- Harvard Medical School, Boston, MA USA
- Department of Orthopaedics, Brigham and Women’s Hospital, Boston, MA USA
| | - Alexandra B. Gil
- Department of Physical Therapy, School of Health and Rehabilitation Sciences, University of Pittsburgh, Pittsburgh, PA USA
| | - Morgan H. Jones
- Department of Orthopaedic Surgery, Cleveland Clinic, Cleveland, OH USA
| | - Melissa A. Kluczynski
- UBMD Department of Orthopaedics and Sports Medicine, Jacobs School of Medicine and Biomedical Sciences, State University of New York at Buffalo, Buffalo, NY USA
| | - Kathleen Lafferty
- UBMD Department of Orthopaedics and Sports Medicine, Jacobs School of Medicine and Biomedical Sciences, State University of New York at Buffalo, Buffalo, NY USA
| | - Jeffrey Lange
- Harvard Medical School, Boston, MA USA
- Department of Orthopaedics, Brigham and Women’s Hospital, Boston, MA USA
| | - Emma C. Lape
- Orthopaedic and Arthritis Center for Outcomes Research (OrACORe) and Policy and Innovation eValuation in Orthopedic Treatments (PIVOT), Department of Orthopaedic Surgery, Brigham and Women’s Hospital, 60 Fenwood Road, BTM 5016, Boston, MA 02115 USA
| | - John Leddy
- UBMD Department of Orthopaedics and Sports Medicine, Jacobs School of Medicine and Biomedical Sciences, State University of New York at Buffalo, Buffalo, NY USA
| | - Aaron V. Mares
- Department of Orthopaedic Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA USA
| | - Kurt Spindler
- Department of Orthopaedic Surgery, Cleveland Clinic, Cleveland, OH USA
| | - Jennifer Turczyk
- Department of Orthopaedic Surgery, Cleveland Clinic, Cleveland, OH USA
| | - Jeffrey N. Katz
- Orthopaedic and Arthritis Center for Outcomes Research (OrACORe) and Policy and Innovation eValuation in Orthopedic Treatments (PIVOT), Department of Orthopaedic Surgery, Brigham and Women’s Hospital, 60 Fenwood Road, BTM 5016, Boston, MA 02115 USA
- Harvard Medical School, Boston, MA USA
- Section of Clinical Sciences, Division of Rheumatology, Immunology and Allergy, Brigham and Women’s Hospital, Boston, MA USA
- Departments of Epidemiology and Environmental Health, Harvard T. H. Chan School of Public Health, Boston, MA USA
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49
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Abstract
PURPOSE OF REVIEW Pain is the most common symptom of chronic pancreatitis, having a profound effect on patients and a broad socioeconomic impact. Endoscopy is guideline recommended as first-line management for chronic pancreatitis pain in certain clinical scenarios. Herein, we provide an evidence-based review of the endoscopic treatment of pain due to chronic pancreatitis while highlighting some important confounders in the measurement of this outcome in clinical practice and research. RECENT FINDINGS Multiple recent studies have reported on the efficacy of current endoscopic therapies for chronic pancreatitis pain. Despite the high technical success rates of these procedures, pain outcomes remain disappointing. Complex mechanisms beyond ductal hypertension, such as central sensitization, visceral hypersensitivity and inflammatory neuritis account for some of the discordance observed between the rates of technical and clinical success. In addition, the sham effect is increasingly recognized as a confounder when interpreting the procedural benefit. Nevertheless, there are multiple promising innovations in the field of pancreatic endoscopy that are aimed to improve technical and clinical outcomes, but rigorous investigation is necessary to establish their role in clinical practice. SUMMARY Endoscopic therapy for chronic pancreatitis pain appears to be safe and effective in certain contexts and recent innovations in the field will hopefully further improve outcomes. In addition to evaluating the technical success of endotherapy in chronic pancreatitis, methodologically rigorous research focusing on patient-centered outcomes and accounting for the sham effect is necessary to advance this field.
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50
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Santisteban JA, Brown TG, Ouimet MC, Gruber R. Cumulative mild partial sleep deprivation negatively impacts working memory capacity but not sustained attention, response inhibition, or decision making: a randomized controlled trial. Sleep Health 2018; 5:101-108. [PMID: 30670158 DOI: 10.1016/j.sleh.2018.09.007] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2018] [Revised: 08/16/2018] [Accepted: 09/18/2018] [Indexed: 10/28/2022]
Abstract
BACKGROUND Twenty-eight per cent (28%) of adults sleep at least 1 hour less than they consider optimal, yet the effects of such cumulative mild partial sleep deprivation on cognitive functions are unknown. The objective of this study was to examine how cumulative mild partial sleep deprivation over 6 nights can impact working memory, sustained attention, response inhibition, and decision making. METHODS A double-blind placebo-controlled randomized study was conducted to determine the impact of sleep restriction (elimination of 1 hour of sleep relative to the baseline habitual sleep duration) vs placebo (exposure to a lamp with no known therapeutic effect) on cognitive performance. The primary outcomes were performance on tasks that measure working memory, sustained attention, response inhibition, and decision making. The participants consisted of 93 adults (mean age 24.3 years, SD 4.7; 46 men, 47 women) with no reported sleep problem, behavioral issue, or medical issue. RESULTS Performance on the working memory capacity task improved between the baseline and experimental sessions for the placebo group but not the sleep-restriction group. Performance on tasks measuring sustained attention, response inhibition, and decision making did not change under either experimental condition. CONCLUSION Cumulative partial sleep deprivation negatively affects performance on a test of working memory capacity but does not affect performance on tests of sustained attention, response inhibition, or decision making.
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Affiliation(s)
- Jose Arturo Santisteban
- Department of Psychiatry, McGill University, Montreal, Quebec, Canada; Attention, Behavior and Sleep Lab, Douglas Mental Health University Institute, Montreal, Quebec, Canada
| | - Thomas G Brown
- Department of Psychiatry, McGill University, Montreal, Quebec, Canada; Addiction Research Program, Research Centre of the Douglas Mental Health, University Institute, Montreal, Quebec, Canada
| | - Marie Claude Ouimet
- Faculty of Medicine and Health Sciences, Université de Sherbrooke, Longueuil, Quebec, Canada; Charles-Le Moyne Hospital Research Centre, Longueuil, Quebec, Canada
| | - Reut Gruber
- Department of Psychiatry, McGill University, Montreal, Quebec, Canada; Attention, Behavior and Sleep Lab, Douglas Mental Health University Institute, Montreal, Quebec, Canada.
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