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Peinemann F, Hoemberg M. Metronomic chemotherapy for paediatric extracranial solid tumours: a systematic review and meta-analysis of randomised clinical trials. BMJ Open 2024; 14:e084477. [PMID: 39395824 DOI: 10.1136/bmjopen-2024-084477] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/14/2024] Open
Abstract
BACKGROUND Metronomic chemotherapy ('less is more, regularly') could be an alternative to the maximum tolerated dose ('the more, the better') in the chemotherapeutic cancer treatment of high-risk malignant solid extracranial tumours in children or young adults. OBJECTIVE To evaluate the efficacy of metronomic chemotherapy compared with placebo or stop treatment in paediatric patients with extracranial malignant solid tumours. METHODS We searched the databases MEDLINE and CENTRAL on 8 September 2023 and included randomised clinical trials (RCTs). Primary outcome was overall survival, and the main outcome measure was the HR. RESULTS We identified three RCTs with parallel assignment and intention-to-treat analyses of data from 775 people. The studies primarily reported on participants with rhabdomyosarcoma, neuroblastoma and osteosarcoma. The HR favoured the metronomic chemotherapy group (0.75 (95% CI 0.56 to 0.98)). CONCLUSIONS The evidence base is compatible with a favourable effect of metronomic chemotherapy on children and young adults with high-risk extracranial malignant solid tumours, especially other than bone tumours, when compared with placebo or stop treatment. Statistical heterogeneity is low while clinical heterogeneity is substantial. Thus, the results must be interpreted with caution and applicability of the results is limited. Future RCTs could provide more data on individual tumour entities and subsequently add information on tumour-specific responses. PROSPERO REGISTRATION NUMBER CRD42023457195.
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Affiliation(s)
- Frank Peinemann
- Children's Hospital, University of Cologne, Cologne, Germany
- FOM Hochschule, Essen, Germany
| | - Marc Hoemberg
- Children's Hospital, University of Cologne, Cologne, Germany
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2
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Juul S, Siddiqui F, Faltermeier P, Petersen JJ, Kamp CB, Jakobsen RH, Thabane L, Moncrieff J, Horowitz M, Samaan Z, Hengartner MP, Mbuagbaw L, Olsen MH, Gluud C, Jakobsen JC. Less focus on symptom scales in psychiatric trials: it is time to ensure research equality between psychiatry and other medical specialities. THE LANCET REGIONAL HEALTH. EUROPE 2024; 43:100993. [PMID: 39055683 PMCID: PMC11269807 DOI: 10.1016/j.lanepe.2024.100993] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/20/2024] [Revised: 06/18/2024] [Accepted: 06/18/2024] [Indexed: 07/27/2024]
Affiliation(s)
- Sophie Juul
- Copenhagen Trial Unit, Centre for Clinical Intervention Research, The Capital Region, Copenhagen University Hospital – Rigshospitalet, Copenhagen, Denmark
- Stolpegaard Psychotherapy Centre, Mental Health Services, The Capital Region, Gentofte, Denmark
- Department of Psychology, University of Copenhagen, Copenhagen, Denmark
| | - Faiza Siddiqui
- Copenhagen Trial Unit, Centre for Clinical Intervention Research, The Capital Region, Copenhagen University Hospital – Rigshospitalet, Copenhagen, Denmark
| | - Pascal Faltermeier
- Copenhagen Trial Unit, Centre for Clinical Intervention Research, The Capital Region, Copenhagen University Hospital – Rigshospitalet, Copenhagen, Denmark
| | - Johanne Juul Petersen
- Copenhagen Trial Unit, Centre for Clinical Intervention Research, The Capital Region, Copenhagen University Hospital – Rigshospitalet, Copenhagen, Denmark
| | - Caroline Barkholt Kamp
- Copenhagen Trial Unit, Centre for Clinical Intervention Research, The Capital Region, Copenhagen University Hospital – Rigshospitalet, Copenhagen, Denmark
- Department of Regional Health Research, The Faculty of Health Sciences, University of Southern Denmark, Odense, Denmark
| | - Rikke Hermann Jakobsen
- Copenhagen Trial Unit, Centre for Clinical Intervention Research, The Capital Region, Copenhagen University Hospital – Rigshospitalet, Copenhagen, Denmark
| | - Lehana Thabane
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Ontario, Canada
- St Joseph's Healthcare Hamilton, Hamilton, Ontario, Canada
| | - Joanna Moncrieff
- Division of Psychiatry, University College London, London, United Kingdom
- Research and Development Department, North East London NHS Foundation Trust (NELFT), London, United Kingdom
| | - Mark Horowitz
- Research and Development Department, North East London NHS Foundation Trust (NELFT), London, United Kingdom
| | - Zainab Samaan
- Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, Ontario, Canada
| | | | - Lawrence Mbuagbaw
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Ontario, Canada
- St Joseph's Healthcare Hamilton, Hamilton, Ontario, Canada
| | - Markus Harboe Olsen
- Copenhagen Trial Unit, Centre for Clinical Intervention Research, The Capital Region, Copenhagen University Hospital – Rigshospitalet, Copenhagen, Denmark
- Department of Neuroanaesthesiology, The Neuroscience Centre, Copenhagen University Hospital – Rigshospitalet, Copenhagen, Denmark
| | - Christian Gluud
- Copenhagen Trial Unit, Centre for Clinical Intervention Research, The Capital Region, Copenhagen University Hospital – Rigshospitalet, Copenhagen, Denmark
- Department of Regional Health Research, The Faculty of Health Sciences, University of Southern Denmark, Odense, Denmark
| | - Janus Christian Jakobsen
- Copenhagen Trial Unit, Centre for Clinical Intervention Research, The Capital Region, Copenhagen University Hospital – Rigshospitalet, Copenhagen, Denmark
- Department of Regional Health Research, The Faculty of Health Sciences, University of Southern Denmark, Odense, Denmark
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3
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Sinha AP, Raja D, Mahajan KS, Sharma P, Gupta SS, Poluru R, Kawade AS, Dayma G, Sazawal S, Bavdekar A, Parida S, Nangia S, Raut AV, Bethou A, Devi P, Gorpade M, Fatima T, Nayak R, Kapil A, Azam M, Khan PA, Pandey RM, Arora NK. Role of central endpoint adjudication and challenges in trials on neonatal sepsis-a case of ProSPoNS trial. Trials 2024; 25:458. [PMID: 38970042 PMCID: PMC11227181 DOI: 10.1186/s13063-024-08298-0] [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: 02/02/2024] [Accepted: 06/27/2024] [Indexed: 07/07/2024] Open
Abstract
Despite progress in reducing the infant mortality in India, the neonatal mortality decline has been slower, necessitating concerted efforts to achieve Sustainable Development Goal-3. A promising strategy aiming to prevent neonatal sepsis in high-risk, vulnerable, low birth weight neonates through an innovative intervention includes probiotic supplementation. This article communicates the decision by the ProSPoNS trial investigators to establish a Central Endpoint Adjudication Committee (CEAC) as an addendum to the protocol published in Trials in 2021 for the purpose of clarifying the primary outcome. In the published protocol, the study hypothesis and primary objective are based on "sepsis," the primary outcome has been specified as sepsis/PSBI, whereas the sample size estimation was performed based on the "physician diagnosed sepsis." To align all the three above, the investigators meeting, held on 17th-18th August 2023, at MGIMS Sevagram, Wardha, deliberated and unanimously agreed that "physician diagnosed sepsis" is the primary study outcome which includes sepsis/PSBI. The CEAC, chaired by an external subject expert and members including trial statistician, a microbiologist, and all site principal investigators will employ four criteria to determine "physician diagnosed sepsis": (1) blood culture status, (2) sepsis screen status, (3) PSBI/non-PSBI signs and symptoms, and (4) the clinical course for each sickness event. Importantly, this clarification maintains consistency with the approved study protocol (Protocol No. 5/7/915/2012 version 3.1 dated 14 Feb 2020), emphasizing the commitment to methodological transparency and adherence to predefined standards. The decision to utilize the guidance of a CEAC is recommended as the gold standard in multicentric complex clinical trials to achieve consistency and accuracy in assessment of outcomes.Trial registrationClinical Trial Registry of India (CTRI) CTRI/2019/05/019197. Registered on 16 May 2019.
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Affiliation(s)
- Anju Pradhan Sinha
- Division of Reproductive, Child Health and Nutrition (RCN), Indian Council of Medical Research (ICMR) Headquarters, V Ramalingaswami Bhawan, Ansari Nagar, New Delhi, Delhi, 110029, India.
| | - Dilip Raja
- Division of Reproductive, Child Health and Nutrition (RCN), Indian Council of Medical Research (ICMR) Headquarters, V Ramalingaswami Bhawan, Ansari Nagar, New Delhi, Delhi, 110029, India
| | - Kamlesh S Mahajan
- Department of Community Medicine, Dr. Sushila Nayar School of Public Health, Mahatma Gandhi Institute of Medical Sciences (MGIMS), Sewagram, Wardha, Maharashtra, 442102, India
| | - Piyu Sharma
- Division of Reproductive, Child Health and Nutrition (RCN), Indian Council of Medical Research (ICMR) Headquarters, V Ramalingaswami Bhawan, Ansari Nagar, New Delhi, Delhi, 110029, India
| | - Subodh S Gupta
- Department of Community Medicine, Dr. Sushila Nayar School of Public Health, Mahatma Gandhi Institute of Medical Sciences (MGIMS), Sewagram, Wardha, Maharashtra, 442102, India
| | - Ramesh Poluru
- The International Clinical Epidemiology Network (INCLEN) Trust International, F-1/5, 2Nd Floor, Okhla Industrial Area Phase - 1, New Delhi, Delhi, 110019, India
| | - Anand S Kawade
- Department of Pediatrics, KEM Hospital Research Centre, 489 Rasta Peth, Sardar Moodliar Road, Pune, Maharashtra, 411011, India
| | - Girish Dayma
- Department of Pediatrics, KEM Hospital Research Centre, 489 Rasta Peth, Sardar Moodliar Road, Pune, Maharashtra, 411011, India
| | - Sunil Sazawal
- Centre for Public Health Kinetics (CPHK), 214 A, Vinoba Puri, Lajpat Nagar-II, New Delhi, Delhi, 110024, India
| | - Ashish Bavdekar
- Department of Pediatrics, KEM Hospital Research Centre, 489 Rasta Peth, Sardar Moodliar Road, Pune, Maharashtra, 411011, India
| | - Sailajanandan Parida
- Neonatal Health & Human Nutrition, Asian Institute of Public Health (AIPH), 8A, Unit-6, Ganga Nagar (Near Raj Bhawan), Bhubaneswar, Odisha, 751001, India
| | - Sushma Nangia
- Department of Neonatology, Lady Hardinge Medical College and Associated Kalawati Saran Children's Hospital (KSCH), Near Gole Market, Central Dist. New Delhi, Delhi, 110001, India
| | - Abhishek V Raut
- Department of Community Medicine, Dr. Sushila Nayar School of Public Health, Mahatma Gandhi Institute of Medical Sciences (MGIMS), Sewagram, Wardha, Maharashtra, 442102, India
| | - Adhisivam Bethou
- Department of Neonatology, Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER), Dhanvantri Nagar, Gorimedu, Puducherry, 605006, India
| | - Prabhabati Devi
- Centre for Public Health Kinetics (CPHK), 214 A, Vinoba Puri, Lajpat Nagar-II, New Delhi, Delhi, 110024, India
| | - Makrand Gorpade
- Department of Pediatrics, KEM Hospital Research Centre, 489 Rasta Peth, Sardar Moodliar Road, Pune, Maharashtra, 411011, India
| | - Tharika Fatima
- Department of Neonatology, Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER), Dhanvantri Nagar, Gorimedu, Puducherry, 605006, India
| | - Rashmita Nayak
- Neonatal Health & Human Nutrition, Asian Institute of Public Health (AIPH), 8A, Unit-6, Ganga Nagar (Near Raj Bhawan), Bhubaneswar, Odisha, 751001, India
| | - Arti Kapil
- Department of Microbiology, All India Institute of Medical Sciences (AIIMS), New Delhi, Delhi, 110029, India
| | - Mohd Azam
- Department of Neonatology, Lady Hardinge Medical College and Associated Kalawati Saran Children's Hospital (KSCH), Near Gole Market, Central Dist. New Delhi, Delhi, 110001, India
| | - Pearlin A Khan
- Division of Reproductive, Child Health and Nutrition (RCN), Indian Council of Medical Research (ICMR) Headquarters, V Ramalingaswami Bhawan, Ansari Nagar, New Delhi, Delhi, 110029, India
| | - Ravindra Mohan Pandey
- Department of Biostatistics, All India Institute of Medical Sciences (AIIMS), New Delhi, Delhi, 110029, India
| | - Narendra Kumar Arora
- The International Clinical Epidemiology Network (INCLEN) Trust International, F-1/5, 2Nd Floor, Okhla Industrial Area Phase - 1, New Delhi, Delhi, 110019, India
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Breel JS, de Klerk ES, Strypet M, de Heer F, Hermanns H, Hollmann MW, Eberl S. What Really Matters to Survivors of Acute Type A Aortic Dissection-A Survey of Patient-Reported Outcomes in the Dutch National Aortic Dissection Advocacy Group. J Clin Med 2023; 12:6584. [PMID: 37892723 PMCID: PMC10607692 DOI: 10.3390/jcm12206584] [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: 09/18/2023] [Revised: 10/09/2023] [Accepted: 10/13/2023] [Indexed: 10/29/2023] Open
Abstract
(1) Background: Type A acute aortic dissection (TAAAD) almost always requires emergency surgery, and postoperative complications are common. Quality assurance systems tend to measure only the hard outcomes, e.g., complications and mortality. Our aim was to assess the health-related quality of life of TAAAD survivors. (2) Methods: An anonymized, Dutch language, web-based survey was sent out to all of the participants of the 2022 Annual Meeting of the Dutch National Aortic Dissection (DNAD) advocacy group via their own representatives. The survey was divided into five sections: patient information, global satisfaction, surgery, including complications, and the recovery period. (3) Results: Ninety members of the DNAD group attended the meeting. Seventy-five (83%) participated in the survey, and the responses from 61 (81%) were available for analysis. Despite hindrances in their daily life (complications, changes in physical, cognitive, and social functioning), patients were satisfied with their treatment, and all would undergo the procedure again. In addition they requested better post-discharge guidance and communication (4) Conclusion: The emphasis lies in equipping patients with knowledge about potential outcomes and effective coping strategies. This underscores the importance of communication and expectation management, in line with established literature.
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Affiliation(s)
- Jennifer S. Breel
- Department of Anesthesiology, Amsterdam University Medical Centers, Location Meibergdreef, 1105 AZ Amsterdam, The Netherlands; (J.S.B.); (E.S.d.K.); (M.S.); (H.H.); (S.E.)
| | - Eline S. de Klerk
- Department of Anesthesiology, Amsterdam University Medical Centers, Location Meibergdreef, 1105 AZ Amsterdam, The Netherlands; (J.S.B.); (E.S.d.K.); (M.S.); (H.H.); (S.E.)
| | - Magnus Strypet
- Department of Anesthesiology, Amsterdam University Medical Centers, Location Meibergdreef, 1105 AZ Amsterdam, The Netherlands; (J.S.B.); (E.S.d.K.); (M.S.); (H.H.); (S.E.)
| | - Frederiek de Heer
- Department of Cardiac Surgery, Amsterdam University Medical Centers, Location Meibergdreef, 1105 AZ Amsterdam, The Netherlands;
| | - Henning Hermanns
- Department of Anesthesiology, Amsterdam University Medical Centers, Location Meibergdreef, 1105 AZ Amsterdam, The Netherlands; (J.S.B.); (E.S.d.K.); (M.S.); (H.H.); (S.E.)
| | - Markus W. Hollmann
- Department of Anesthesiology, Amsterdam University Medical Centers, Location Meibergdreef, 1105 AZ Amsterdam, The Netherlands; (J.S.B.); (E.S.d.K.); (M.S.); (H.H.); (S.E.)
| | - Susanne Eberl
- Department of Anesthesiology, Amsterdam University Medical Centers, Location Meibergdreef, 1105 AZ Amsterdam, The Netherlands; (J.S.B.); (E.S.d.K.); (M.S.); (H.H.); (S.E.)
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5
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Clemm H, Røksund OD, Andersen T, Heimdal JH, Karlsen T, Hilland M, Fretheim-Kelly Z, Hufthammer KO, Sandnes A, Hjelle S, Vollsæter M, Halvorsen T. Exercise-induced Laryngeal Obstruction: Protocol for a Randomized Controlled Treatment Trial. Front Pediatr 2022; 10:817003. [PMID: 35198517 PMCID: PMC8858975 DOI: 10.3389/fped.2022.817003] [Citation(s) in RCA: 2] [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] [Received: 11/17/2021] [Accepted: 01/10/2022] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND Exercise-induced laryngeal obstruction (EILO) is a common cause of exertional breathing problems in young individuals, caused by paradoxical inspiratory adduction of laryngeal structures, and diagnosed by continuous visualization of the larynx during high-intensity exercise. Empirical data suggest that EILO consists of different subtypes, possibly requiring different therapeutic approaches. Currently applied treatments do not rest on randomized controlled trials, and international guidelines based on good evidence can therefore not be established. This study aims to provide evidence-based information on treatment schemes commonly applied in patients with EILO. METHODS AND ANALYSIS Consenting patients consecutively diagnosed with EILO at Haukeland University Hospital will be randomized into four non-invasive treatment arms, based on promising reports from non-randomized studies: (A) standardized information and breathing advice only (IBA), (B) IBA plus inspiratory muscle training, (C) IBA plus speech therapy, and (D) IBA plus inspiratory muscle training and speech therapy. Differential effects in predefined EILO subtypes will be addressed. Patients failing the non-invasive approach and otherwise qualifying for surgical treatment by current department policy will be considered for randomization into (E) standard or (F) minimally invasive laser supraglottoplasty or (G) no surgery. Power calculations are based on the main outcomes, laryngeal adduction during peak exercise, rated by a validated scoring system before and after the interventions. ETHICS AND DISSEMINATION The study will assess approaches to EILO treatments that despite widespread use, are insufficiently tested in structured, verifiable, randomized, controlled studies, and is therefore considered ethically sound. The study will provide knowledge listed as a priority in a recent statement issued by the European Respiratory Society, requested by clinicians and researchers engaged in this area, and relevant to 5-7% of young people. Dissemination will occur in peer-reviewed journals, at relevant media platforms and conferences, and by engaging with patient organizations and the healthcare bureaucracy.
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Affiliation(s)
- Hege Clemm
- Department of Clinical Science, University of Bergen, Bergen, Norway.,Department of Pediatric and Adolescent Medicine, Haukeland University Hospital, Bergen, Norway
| | - Ola D Røksund
- Department of Pediatric and Adolescent Medicine, Haukeland University Hospital, Bergen, Norway.,Faculty of Health and Social Sciences, Western Norway University of Applied Sciences, Bergen, Norway.,Department of Otolaryngology and Head and Neck Surgery, Haukeland University Hospital, Bergen, Norway
| | - Tiina Andersen
- Faculty of Health and Social Sciences, Western Norway University of Applied Sciences, Bergen, Norway.,Department of Physiotherapy, Haukeland University Hospital, Bergen, Norway.,Norwegian Advisory Unit on Home Mechanical Ventilation, Thoracic Department, Haukeland University Hospital, Bergen, Norway
| | - John-Helge Heimdal
- Department of Otolaryngology and Head and Neck Surgery, Haukeland University Hospital, Bergen, Norway.,Department of Surgery, Haukeland University Hospital, Bergen, Norway.,Department of Clinical Medicine, University of Bergen, Bergen, Norway
| | - Tom Karlsen
- Department of Pediatric and Adolescent Medicine, Haukeland University Hospital, Bergen, Norway
| | - Magnus Hilland
- Department of Pediatric and Adolescent Medicine, Haukeland University Hospital, Bergen, Norway
| | - Zoe Fretheim-Kelly
- Department of Pediatric and Adolescent Medicine, Haukeland University Hospital, Bergen, Norway.,Faculty of Veterinary Medicine, Norwegian University of Life Sciences, Oslo, Norway
| | | | - Astrid Sandnes
- Department of Internal Medicine, Innlandet Hospital Trust, Gjøvik, Norway
| | - Sigrun Hjelle
- Department of Pediatric and Adolescent Medicine, Haukeland University Hospital, Bergen, Norway
| | - Maria Vollsæter
- Department of Clinical Science, University of Bergen, Bergen, Norway.,Department of Pediatric and Adolescent Medicine, Haukeland University Hospital, Bergen, Norway
| | - Thomas Halvorsen
- Department of Clinical Science, University of Bergen, Bergen, Norway.,Department of Pediatric and Adolescent Medicine, Haukeland University Hospital, Bergen, Norway.,Department of Sports Medicine, Norwegian School of Sport Sciences, Oslo, Norway
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