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Abstract
Hypertension and depression, as 2 major public health issues, are closely related. For patients having hypertension, in particular, depression is a risk factor for mortality and jeopardizes their wellbeing. The aim of the study is to apply support vector machine (SVM) learning to blood tests and vital signs to classify patients having hypertension complicated by depression and patients having hypertension alone for the identification of novel markers.Data on patients having both hypertension and depression (n = 147) and patients having hypertension alone (n = 147) were obtained from electronic medical records of admissions containing the records on blood tests and vital signs. Using SVM, we distinguished patients having both hypertension and depression from gender- and age-matched patients having hypertension alone.SVM-based classification achieved 73.5% accuracy by 10-fold cross-validation between patients having both hypertension and depression and those having hypertension alone. Twelve features were selected to compose the optimal feature sets, including body temperature (T), glucose (GLU), creatine kinase (CK), albumin (ALB), hydroxybutyrate dehydrogenase (HBDH), blood urea nitrogen (BUN), uric Acid (UA), creatinine (Crea), cholesterol (TC), total protein (TP), pulse (P), and respiration (R).SVM can be used to distinguish patients having both hypertension and depression from those having hypertension alone. A significant association was identified between depression and blood tests and vital signs. This approach can be helpful for clinical diagnosis of depression, but further studies are needed to verify the role of these candidate markers for depression diagnosis.
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Affiliation(s)
- Xiuli Song
- Psychiatric Laboratory and Mental Health Center, West China Hospital of Sichuan University Web Sciences Center Big Data Research Center, University of Electronic Science and Technology of China Information Center, West China Hospital, Sichuan University College of Foreign Languages and Cultures, Sichuan University, Chengdu, PR China
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Hughes-Morley A, Hann M, Fraser C, Meade O, Lovell K, Young B, Roberts C, Cree L, More D, O’Leary N, Callaghan P, Waheed W, Bower P. The impact of advertising patient and public involvement on trial recruitment: embedded cluster randomised recruitment trial. Trials 2016; 17:586. [PMID: 27931252 PMCID: PMC5146878 DOI: 10.1186/s13063-016-1718-1] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2016] [Accepted: 11/19/2016] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Patient and public involvement in research (PPIR) may improve trial recruitment rates, but it is unclear how. Where trials use PPIR to improve design and conduct, many do not communicate this clearly to potential participants. Better communication of PPIR might encourage patient enrolment, as trials may be perceived as more socially valid, relevant and trustworthy. We aimed to evaluate the impact on recruitment of directly advertising PPIR to potential trial participants. METHODS This is a cluster trial, embedded within a host trial ('EQUIP') recruiting service users diagnosed with severe mental illness. The intervention was informed by a systematic review, a qualitative study, social comparison theory and a stakeholder workshop including service users and carers. Adopting Participatory Design approaches, we co-designed the recruitment intervention with PPIR partners using a leaflet to advertise the PPIR in EQUIP and sent potential participants invitations with the leaflet (intervention group) or not (control group). Primary outcome was the proportion of patients enrolled in EQUIP. Secondary outcomes included the proportions of patients who positively responded to the trial invitation. RESULTS Thirty-four community mental health teams were randomised and 8182 service users invited. For the primary outcome, 4% of patients in the PPIR group were enrolled versus 5.3% of the control group. The intervention was not effective for improving recruitment rates (adjusted OR = 0.75, 95% CI = 0.53 to 1.07, p = 0.113). For the secondary outcome of positive response, the intervention was not effective, with 7.3% of potential participants in the intervention group responding positively versus 7.9% of the control group (adjusted OR = 0.74, 95% CI = 0.53 to 1.04, p = 0.082). We did not find a positive impact of directly advertising PPIR on any other outcomes. CONCLUSION To our knowledge, this is the largest ever embedded trial to evaluate a recruitment or PPIR intervention. Advertising PPIR did not improve enrolment rates or any other outcome. It is possible that rather than advertising PPIR being the means to improve recruitment, PPIR may have an alternative impact on trials by making them more attractive, acceptable and patient-centred. We discuss potential reasons for our findings and implications for recruitment practice and research. TRIAL REGISTRATION NUMBERS ISRCTN, ISRCTN16488358 . Registered on 14 May 2014. Study Within A Trial, SWAT-26 . Registered on 21 January 2016.
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Affiliation(s)
- Adwoa Hughes-Morley
- York Trials Unit, Department of Health Sciences, University of York, York, YO10 5DD UK
- Division of Population Health, Health Services Research and Primary Care, University of Manchester, Williamson Building, Manchester, M13 9PL UK
| | - Mark Hann
- Division of Population Health, Health Services Research and Primary Care, University of Manchester, Williamson Building, Manchester, M13 9PL UK
| | - Claire Fraser
- Division of Nursing, Midwifery and Social Work, University of Manchester, Jean McFarlane Building, Manchester, M13 9PL UK
| | - Oonagh Meade
- School of Health Sciences, Queen’s Medical Centre, The University of Nottingham, Nottingham, NG7 2HA UK
| | - Karina Lovell
- Division of Nursing, Midwifery and Social Work, University of Manchester, Jean McFarlane Building, Manchester, M13 9PL UK
| | - Bridget Young
- MRC North West Hub for Trials Methodology Research, Institute of Psychology, Health and Society, University of Liverpool, Liverpool, UK
| | - Chris Roberts
- Division of Population Health, Health Services Research and Primary Care, University of Manchester, Williamson Building, Manchester, M13 9PL UK
| | - Lindsey Cree
- Division of Nursing, Midwifery and Social Work, University of Manchester, Jean McFarlane Building, Manchester, M13 9PL UK
| | - Donna More
- Division of Nursing, Midwifery and Social Work, University of Manchester, Jean McFarlane Building, Manchester, M13 9PL UK
| | - Neil O’Leary
- HRB Clinical Research Facility, National University of Ireland Galway, Galway, Republic of Ireland
| | - Patrick Callaghan
- School of Health Sciences and Institute of Mental Health, The University of Nottingham, Jubilee Campus, Nottingham, NG7 2TU UK
| | - Waquas Waheed
- Division of Population Health, Health Services Research and Primary Care, University of Manchester, Williamson Building, Manchester, M13 9PL UK
| | - Peter Bower
- MRC North West Hub for Trials Methodology Research, Manchester Academic Health Science Centre, University of Manchester, Williamson Building, Manchester, M13 9PT UK
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Eldridge SM, Chan CL, Campbell MJ, Bond CM, Hopewell S, Thabane L, Lancaster GA. CONSORT 2010 statement: extension to randomised pilot and feasibility trials. BMJ 2016; 355:i5239. [PMID: 27777223 PMCID: PMC5076380 DOI: 10.1136/bmj.i5239] [Citation(s) in RCA: 1453] [Impact Index Per Article: 181.6] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/18/2016] [Indexed: 12/27/2022]
Affiliation(s)
- Sandra M Eldridge
- Centre for Primary Care and Public Health, Queen Mary University of London, London, UK
| | - Claire L Chan
- Centre for Primary Care and Public Health, Queen Mary University of London, London, UK
| | - Michael J Campbell
- School of Health and Related Research, University of Sheffield, Sheffield, UK
| | - Christine M Bond
- Centre of Academic Primary Care, University of Aberdeen, Aberdeen, Scotland, UK
| | - Sally Hopewell
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK
| | - Lehana Thabane
- Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, Ontario, Canada
| | - Gillian A Lancaster
- Department of Mathematics and Statistics, Lancaster University, Lancaster, UK
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Eldridge SM, Chan CL, Campbell MJ, Bond CM, Hopewell S, Thabane L, Lancaster GA. CONSORT 2010 statement: extension to randomised pilot and feasibility trials. Pilot Feasibility Stud 2016; 2:64. [PMID: 27965879 PMCID: PMC5154046 DOI: 10.1186/s40814-016-0105-8] [Citation(s) in RCA: 668] [Impact Index Per Article: 83.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2016] [Accepted: 10/10/2016] [Indexed: 01/10/2023] Open
Abstract
The Consolidated Standards of Reporting Trials (CONSORT) statement is a guideline designed to improve the transparency and quality of the reporting of randomised controlled trials (RCTs). In this article we present an extension to that statement for randomised pilot and feasibility trials conducted in advance of a future definitive RCT. The checklist applies to any randomised study in which a future definitive RCT, or part of it, is conducted on a smaller scale, regardless of its design (eg, cluster, factorial, crossover) or the terms used by authors to describe the study (eg, pilot, feasibility, trial, study). The extension does not directly apply to internal pilot studies built into the design of a main trial, non-randomised pilot and feasibility studies, or phase II studies, but these studies all have some similarities to randomised pilot and feasibility studies and so many of the principles might also apply. The development of the extension was motivated by the growing number of studies described as feasibility or pilot studies and by research that has identified weaknesses in their reporting and conduct. We followed recommended good practice to develop the extension, including carrying out a Delphi survey, holding a consensus meeting and research team meetings, and piloting the checklist. The aims and objectives of pilot and feasibility randomised studies differ from those of other randomised trials. Consequently, although much of the information to be reported in these trials is similar to those in randomised controlled trials (RCTs) assessing effectiveness and efficacy, there are some key differences in the type of information and in the appropriate interpretation of standard CONSORT reporting items. We have retained some of the original CONSORT statement items, but most have been adapted, some removed, and new items added. The new items cover how participants were identified and consent obtained; if applicable, the prespecified criteria used to judge whether or how to proceed with a future definitive RCT; if relevant, other important unintended consequences; implications for progression from pilot to future definitive RCT, including any proposed amendments; and ethical approval or approval by a research review committee confirmed with a reference number. This article includes the 26 item checklist, a separate checklist for the abstract, a template for a CONSORT flowchart for these studies, and an explanation of the changes made and supporting examples. We believe that routine use of this proposed extension to the CONSORT statement will result in improvements in the reporting of pilot trials. Editor's note: In order to encourage its wide dissemination this article is freely accessible on the BMJ and Pilot and Feasibility Studies journal websites.
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Affiliation(s)
- Sandra M. Eldridge
- Centre for Primary Care and Public Health, Queen Mary University of London, London, UK
| | - Claire L. Chan
- Centre for Primary Care and Public Health, Queen Mary University of London, London, UK
| | - Michael J. Campbell
- School of Health and Related Research, University of Sheffield, Sheffield, UK
| | - Christine M. Bond
- Centre of Academic Primary Care, University of Aberdeen, Aberdeen, Scotland, UK
| | - Sally Hopewell
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK
| | - Lehana Thabane
- Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, Ontario Canada
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Hughes-Morley A, Young B, Hempel RJ, Russell IT, Waheed W, Bower P. What can we learn from trial decliners about improving recruitment? Qualitative study. Trials 2016; 17:494. [PMID: 27733181 PMCID: PMC5062905 DOI: 10.1186/s13063-016-1626-4] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2016] [Accepted: 09/28/2016] [Indexed: 11/10/2022] Open
Abstract
Background Trials increasingly experience problems in recruiting participants. Understanding the causes of poor recruitment is critical to developing solutions. We interviewed people who had declined a trial of an innovative psychological therapy for depression (REFRAMED) about their response to the trial invitation, in order to understand their decision and identify ways to improve recruitment. Methods Of 214 people who declined the trial, 35 (16 %) gave permission to be contacted about a qualitative study to explore their decision. Analysis of transcripts of semi-structured interviews was informed by grounded theory. Results We interviewed 20 informants: 14 women and six men, aged 18 to 77 years. Many interviewees had prior experience of research participation and positive views of the trial. Interviewees’ decision making resembled a four-stage sequential process; in each stage they either decided not to participate in the trial or progressed to the next stage. In stage 1, interviewees assessed the invitation in the context of their experiences and attitudes; we term those who opted out at this stage ‘prior decliners’ as they had an established position of declining trials. In stage 2, interviewees assessed their own eligibility; those who judged themselves ineligible and opted out at this stage are termed ‘self-excluders’. In stage 3, interviewees assessed their need for the trial therapy and potential to benefit; we term those who decided they did not need the trial therapy and opted out at this stage ‘treatment decliners’. In stage 4, interviewees deliberated the benefits and costs of trial participation; those who opted out after judging that disadvantages outweighed advantages are termed ‘trial decliners’. Across all stages, most individuals declined because they judged themselves ineligible or not in need of the trial therapy. While ‘prior decliners’ are unlikely to respond to any trial recruitment initiative, the factors leading others to decline are amenable to amelioration as they do not arise from a rejection of trials or a personal stance. Conclusions To improve recruitment in similar trials, the most successful interventions are likely to address patients’ assessments of their eligibility and their potential to benefit from the trial treatment, rather than reducing trial burden. Trial registration International Standard Randomised Controlled Trial Number: ISRCTN85784627. Registration date 10 August 2011. Electronic supplementary material The online version of this article (doi:10.1186/s13063-016-1626-4) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Adwoa Hughes-Morley
- MRC North West Hub for Trials Methodology Research, Manchester Academic Health Science Centre, University of Manchester, Oxford Road, Manchester, M13 9PT, UK. .,York Trials Unit, Department of Health Sciences, University of York, York, YO10 5DD, UK.
| | - Bridget Young
- MRC North West Hub for Trials Methodology Research, Department of Psychology, Institute of Psychology, Health and Society, University of Liverpool, Liverpool, UK
| | - Roelie J Hempel
- School of Psychology, University of Southampton, Southampton, SO17 1BJ, UK
| | - Ian T Russell
- Swansea University Medical School, Swansea University, Swansea, SA2 8PP, UK
| | - Waquas Waheed
- NIHR School for Primary Care Research, Manchester Academic Health Science Centre, The University of Manchester, Williamson Building, Manchester, M13 9PT, UK
| | - Peter Bower
- MRC North West Hub for Trials Methodology Research, Manchester Academic Health Science Centre, University of Manchester, Oxford Road, Manchester, M13 9PT, UK.,NIHR School for Primary Care Research, Manchester Academic Health Science Centre, The University of Manchester, Williamson Building, Manchester, M13 9PT, UK
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