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Pereira PE, Esteves G, Carvas N, Azevedo PH. Effects of high-intensity interval and moderate-intensity continuous training on the anaerobic threshold of highly trained athletes in endurance sports: a systematic review with meta-analysis. J Sports Med Phys Fitness 2024; 64:898-907. [PMID: 38842374 DOI: 10.23736/s0022-4707.24.15855-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/07/2024]
Abstract
INTRODUCTION The anaerobic threshold (AT) is an important physiological index used as a parameter for predicting performance and evaluating adaptations induced by training. The aim of this study was to carry out a systematic literature review to survey the randomized studies that compared the effects of high-intensity interval training (HIIT) with the effects of moderate intensity continuous training (MICT) on the anaerobic threshold of highly trained athletes in endurance sports. EVIDENCE ACQUISITION The following databases were searched: MEDLINE, Embase, Cochrane Wiley, PubMed, SPORTDiscus, Web of Science, and ProQuest for randomized trials. The search terms covered the areas of HIIT and MICT. This study was registered in the International Prospective Register of Systematic under the number CRD42020155474. EVIDENCE SYNTHESIS Three studies were included for the qualitative and quantitative synthesis, totaling 72 participants, of whom 28 belonged to the MICT group and 44 to the HIIT group. CONCLUSIONS The summary result showed that HIIT promotes greater adaptation in the AT of highly trained athletes compared to continuous training (ES=0.73; 95% CI: 0.25-1.21); however, the certainty of evidence evaluated by the GRADE method is low and heterogeneity is high (I2=82%; P<0.01).
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Affiliation(s)
- Paulo E Pereira
- Federal University of São Paulo, Santos, Brazil -
- Metropolitan University of Santos, Santos, Brazil -
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Almufleh B, Arellanob A, Tamimi F. Patient-reported outcomes and framework fit accuracy of removable partial dentures fabricated using digital techniques: A systematic review and meta-analysis. J Prosthodont 2024; 33:626-636. [PMID: 37930081 DOI: 10.1111/jopr.13786] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2023] [Revised: 09/26/2023] [Accepted: 10/20/2023] [Indexed: 11/07/2023] Open
Abstract
PURPOSE This review aimed to summarize the evidence on patient-reported outcomes and clinical performance of digitally fabricated removable partial dentures (RPDs) compared to traditionally fabricated dentures. METHODS Three databases were systematically searched (PubMed, CENTRAL, and Wiley online library) for clinical studies comparing digitally and conventionally fabricated RPDs regardless of data acquisition methods used for fabrication. The Cochrane Collaboration risk of bias assessment tool 2 and the Oxford Center for Evidence-based Medicine tool were used to assess risk of bias, and level of evidence, respectively. Descriptive narrative analysis was used to summarize data on patient-reported outcomes, as there were inadequate studies to pool data in a meta-analysis. A random-effects model was used to analyze the data of framework fit accuracy. RESULTS Ten randomized controlled trials were included in the systematic review, and 4 were included in the meta-analysis. Two studies showed that digitally fabricated RPDs are associated with higher patient satisfaction than conventionally fabricated RPDs (with a mean difference of 12.5 mm on a 100-satisfaction scale, p = .008). The pooled standardized mean difference for framework fit accuracy was 0.49 (p = 0.02) in favor of conventionally fabricated RPDs, which showed that conventionally fabricated RPDs have a quantitatively better fit compared to digitally fabricated RPDs. However, clinical evaluation studies showed that both frameworks have clinically acceptable fit. CONCLUSIONS Current evidence shows that digitally fabricated RPDs are associated with higher patient satisfaction compared to conventionally fabricated RPDs. However, the scarcity of literature here warrants the generalization of this conclusion. Both digitally and conventionally fabricated metal RPD frameworks showed acceptable fit clinically.
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Affiliation(s)
- Balqees Almufleh
- Department of Prosthetic Dental Sciences, College of Dentistry, King Saud University, Riyadh, Saudi Arabia
| | - Alexia Arellanob
- College of Dental Medicine, QU Health, Qatar University, Doha, Qatar
| | - Faleh Tamimi
- College of Dental Medicine, QU Health, Qatar University, Doha, Qatar
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Bates A, Baldwin DS, Pattison N, Moyses H, Huneke NT, Cortese S, Grocott MP, Cusack R. Eye movement desensitisation and reprocessing for survivors of life-threatening medical events. Cochrane Database Syst Rev 2024; 7:CD015640. [PMID: 39041417 PMCID: PMC11264321 DOI: 10.1002/14651858.cd015640] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/24/2024]
Abstract
OBJECTIVES This is a protocol for a Cochrane Review (intervention). The objectives are as follows: To assess the effects of eye movement desensitisation and reprocessing (EMDR), a psychological intervention programme, on symptoms related to traumatic stress in survivors of life-threatening medical events. SECONDARY OBJECTIVES to evaluate whether the effects of EMDR differ according to the nature of the medical event (associated diagnosis or setting), measured outcome (post-traumatic stress disorder (PTSD), anxiety, depression, or quality of life), or intervention (online, face-to-face, group or individual sessions).
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Affiliation(s)
- Andrew Bates
- Clinical and Experimental Sciences, Faculty of Medicine, University of Southampton, Southampton, UK
- Perioperative Medicine and Critical Care Research Theme, Southampton NIHR Biomedical Research Centre, University Hospital Southampton, Southampton, UK
| | - David S Baldwin
- Clinical and Experimental Sciences, Faculty of Medicine, University of Southampton, Southampton, UK
- University Department of Psychiatry and Mental Health, University of Cape Town, Cape Town, South Africa
- Southern Health NHS Foundation Trust, Southampton, UK
| | - Natalie Pattison
- School of Health and Social Work, University of Hertfordshire, Hatfield, UK
- East and North Herts NHS Trust, Stevenage, UK
| | - Helen Moyses
- Clinical and Experimental Sciences, Faculty of Medicine, University of Southampton, Southampton, UK
- Perioperative Medicine and Critical Care Research Theme, Southampton NIHR Biomedical Research Centre, University Hospital Southampton, Southampton, UK
| | - Nathan Tm Huneke
- Clinical and Experimental Sciences, Faculty of Medicine, University of Southampton, Southampton, UK
- Southern Health NHS Foundation Trust, Southampton, UK
- Dorset Healthcare University NHS Foundation Trust, Bournemouth, UK
| | - Samuele Cortese
- School of Psychology, Faculty of Medicine, University of Southampton, Southampton, UK
- Solent NHS Trust, Southampton, UK
| | - Michael Pw Grocott
- Clinical and Experimental Sciences, Faculty of Medicine, University of Southampton, Southampton, UK
- Perioperative and Critical Care Research Theme, NIHR Southampton Biomedical Research Centre, University Hospital Southampton, Southampton, UK
| | - Rebecca Cusack
- Clinical and Experimental Sciences, Faculty of Medicine, University of Southampton, Southampton, UK
- Perioperative Medicine and Critical Care Research Theme, Southampton NIHR Biomedical Research Centre, University Hospital Southampton, Southampton, UK
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Lem WG, Kawata KHDS, Oyama H. Exploring the impact of immersive virtual reality on depression knowledge and stigma reduction: a cross-over RCT fMRI study. Sci Rep 2024; 14:5193. [PMID: 38431655 PMCID: PMC10908822 DOI: 10.1038/s41598-024-55797-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2023] [Accepted: 02/27/2024] [Indexed: 03/05/2024] Open
Abstract
The stigma of mental illness is a form of negative judgmental knowledge and is a barrier to individual seeking treatment. Contact-based educational interventions with first-person perspective (1PP) combined with immersive virtual reality (IVR) is promising as an anti-stigma intervention. This study aims to investigate the effectiveness of 1PP anti-stigma IVR intervention compared to video in enhancing depression knowledge and reducing stigma, as well as to examine the corresponding depression knowledge brain activity change using functional magnetic resonance imaging (fMRI). Participants engaged in a 1PP anti-stigma intervention using both IVR and conventional video, focusing on the daily life and recovery of a patient with mild depression. The change in depression knowledge, stigma-related behavioral, and brain activity using fMRI were measured at pre- and post-interventions. Depression knowledge improved for both interventions; however, only the IVR intervention reduced stigma. In the IVR intervention, depression knowledge score was positively associated with neural response in the right superior frontal gyrus activation, indicative of empathic concern. Conversely, the video intervention correlated with increased activity in the right anterior insula, suggesting a distress-related response. The findings demonstrate that the immersive nature of IVR can reduce stigma more effectively than video intervention. This effectiveness is underpinned by the change in depression knowledge on neural activity, with IVR fostering empathy-related behavioral responses. The results highlight the potential of IVR in enhancing empathic understanding and reducing stigma towards mental illness, emphasizing the need for further exploration into immersive technologies for mental health education.
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Affiliation(s)
- Wey Guan Lem
- Department of Clinical Information Engineering, Graduate School of Medicine, The University of Tokyo, Hongo 7-3-1, Bunkyo-ku, Tokyo, 113-0033, Japan.
| | - Kelssy Hitomi Dos Santos Kawata
- Department of Clinical Information Engineering, Graduate School of Medicine, The University of Tokyo, Hongo 7-3-1, Bunkyo-ku, Tokyo, 113-0033, Japan.
| | - Hiroshi Oyama
- Department of Clinical Information Engineering, Graduate School of Medicine, The University of Tokyo, Hongo 7-3-1, Bunkyo-ku, Tokyo, 113-0033, Japan
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Cohen SP, Larkin TM, Weitzner AS, Dolomisiewicz E, Wang EJ, Hsu A, Anderson-White M, Smith MS, Zhao Z. Multicenter, Randomized, Placebo-controlled Crossover Trial Evaluating Topical Lidocaine for Mechanical Cervical Pain. Anesthesiology 2024; 140:513-523. [PMID: 38079112 DOI: 10.1097/aln.0000000000004857] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/15/2024]
Abstract
BACKGROUND There are few efficacious treatments for mechanical neck pain, with controlled trials suggesting efficacy for muscle relaxants and topical nonsteroidal anti-inflammatory drugs. Although studies evaluating topical lidocaine for back pain have been disappointing, the more superficial location of the cervical musculature suggests a possible role for topical local anesthetics. METHODS This study was a randomized, double-blind, placebo-controlled crossover trial performed at four U.S. military, Veterans Administration, academic, and private practice sites, in which 76 patients were randomized to receive either placebo followed by lidocaine patch for 4-week intervals (group 1) or a lidocaine-then-placebo patch sequence. The primary outcome measure was mean reduction in average neck pain, with a positive categorical outcome designated as a reduction of at least 2 points in average neck pain coupled with at least a 5-point score of 7 points on the Patient Global Impression of Change scale at the 4-week endpoint. RESULTS For the primary outcome, the median reduction in average neck pain score was -1.0 (interquartile range, -2.0, 0.0) for the lidocaine phase versus -0.5 (interquartile range, -2.0, 0.0) for placebo treatment (P = 0.17). During lidocaine treatment, 27.7% of patients experienced a positive outcome versus 14.9% during the placebo phase (P = 0.073). There were no significant differences between treatments for secondary outcomes, although a carryover effect on pain pressure threshold was observed for the lidocaine phase (P = 0.015). A total of 27.5% of patients in the lidocaine group and 20.5% in the placebo group experienced minor reactions, the most common of which was pruritis (P = 0.36). CONCLUSIONS The differences favoring lidocaine were small and nonsignificant, but the trend toward superiority of lidocaine suggests more aggressive phenotyping and applying formulations with greater penetrance may provide clinically meaningful benefit. EDITOR’S PERSPECTIVE
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Affiliation(s)
- Steven P Cohen
- Department of Anesthesiology, Pain Medicine Division and Departments of Physical Medicine and Rehabilitation, Neurology, Psychiatry and Neurosurgery, Northwestern Feinberg School of Medicine, Chicago, Illinois; Departments of Anesthesiology and Physical Medicine and Rehabilitation, Walter Reed National Military Medical Center, Uniformed Services University of the Health Sciences, Bethesda, Maryland
| | - Thomas M Larkin
- Pain Management Institute, Bethesda, Maryland, and Washington, D.C
| | | | - Edward Dolomisiewicz
- Department of Physical Medicine and Rehabilitation, Walter Reed National Military Medical Center, Uniformed Services University of the Health Sciences, Bethesda, Maryland
| | - Eric J Wang
- Department of Anesthesiology and Critical Care Medicine, Pain Medicine Division, Johns Hopkins School of Medicine, Baltimore, Maryland
| | - Annie Hsu
- Department of Anesthesiology and Critical Care Medicine, Pain Medicine Division, Johns Hopkins School of Medicine, Baltimore, Maryland
| | - Mirinda Anderson-White
- Department of Anesthesiology and Critical Care Medicine, Pain Medicine Division, Johns Hopkins School of Medicine, Baltimore, Maryland
| | - Marin S Smith
- Department of Physical Medicine and Rehabilitation, Walter Reed National Military Medical Center, Uniformed Services University of the Health Sciences, Bethesda, Maryland; Geneva Foundation, Bethesda, Maryland
| | - Zirong Zhao
- Departments of Neurology and Internal Medicine, District of Columbia Veterans Affairs Medical Center, Washington, D.C
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Manfredi C, Franco A, Ditonno F, Mathur R, Franco G, Lombardo R, Russo GI, DE Cillis S, Fiori C, Arcaniolo D, Antonelli A, Autorino R, DE Sio M, DE Nunzio C. Treatment preferences of patients with erectile dysfunction: a systematic review of randomized controlled trials. Minerva Urol Nephrol 2024; 76:42-51. [PMID: 38426421 DOI: 10.23736/s2724-6051.23.05552-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/02/2024]
Abstract
INTRODUCTION Patients' treatment preferences (PTP) depend on the complex interaction of numerous patient- and treatment-related factors; their assessment can guide therapy and promote compliance of patients with erectile dysfunction (ED). We aimed to systematically describe the literature evaluating the treatment preferences of patients with ED, published in the last 25 years. EVIDENCE ACQUISITION A comprehensive bibliographic search of multiple databases was conducted in June, 2023. The literature search was limited to the articles published since 1998. Articles were deemed eligible if they described male patients with ED (P) undergoing treatment for this condition (I) compared with other treatments, placebo or sham therapy (C), and reported PTP (O). Only randomized controlled trials (RCTs) and post-hoc analyses of RCTs were selected (S). The data were presented in a narrative fashion. The risk of bias (RoB) was evaluated using the RoB 2 tool and the Mulhall-Montorsi model. EVIDENCE SYNTHESIS A total 14 RCTs evaluating 6,841 patients and 4 post-hoc analyses of RCTs were included. All RCTs were considered to be at high RoB. No validated tool was used to investigate PTP. Sildenafil was the most frequently evaluated ED treatment (9 RCTs). Sildenafil was chosen over placebo by 78-100% of subjects and over ICI in 70% of patients due to its easier route of administration. No significant difference in patient preference was recorded between Sildenafil tablets and orodispersible (53% vs. 47%, P>0.05). Tadalafil was preferred over Sildenafil by 66-73% of patients (P<0.05), mainly because it allowed an erection long after taking the drug (55-67%). Tadalafil as-needed was chosen over Tadalafil 3 times/week by 57-59% of the patients (P<0.05). CONCLUSIONS The available RCTs support the preference of ED patients for Sildenafil over ICI, Tadalafil over Sildenafil, and Tadalafil as-needed over Tadalafil 3 times/week. However, these findings should be considered at high RoB.
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Affiliation(s)
- Celeste Manfredi
- Unit of Urology, Department of Woman, Child and General and Specialized Surgery, University of Campania "Luigi Vanvitelli", Naples, Italy
- Department of Urology, Rush University Medical Center, Chicago, IL, USA
| | - Antonio Franco
- Department of Urology, Rush University Medical Center, Chicago, IL, USA -
- Department of Urology, Sant'Andrea Hospital, Sapienza University, Rome, Italy
| | - Francesco Ditonno
- Department of Urology, Rush University Medical Center, Chicago, IL, USA
- Department of Urology, University of Verona, Azienda Ospedaliera Universitaria Integrata, Verona, Italy
| | - Raman Mathur
- Medical School, Midwestern University, Downers Grove, IL, USA
| | - Giorgio Franco
- Department of Urology, Policlinico Umberto I Hospital, Sapienza University, Rome, Italy
| | - Riccardo Lombardo
- Department of Urology, Sant'Andrea Hospital, Sapienza University, Rome, Italy
| | - Giorgio I Russo
- Section of Urology, Department of Surgery, University of Catania, Catania, Italy
| | - Sabrina DE Cillis
- Department of Urology, San Luigi Gonzaga Hospital, University of Turin, Orbassano, Turin, Italy
| | - Cristian Fiori
- Department of Urology, San Luigi Gonzaga Hospital, University of Turin, Orbassano, Turin, Italy
| | - Davide Arcaniolo
- Unit of Urology, Department of Woman, Child and General and Specialized Surgery, University of Campania "Luigi Vanvitelli", Naples, Italy
| | - Alessandro Antonelli
- Department of Urology, University of Verona, Azienda Ospedaliera Universitaria Integrata, Verona, Italy
| | - Riccardo Autorino
- Department of Urology, Rush University Medical Center, Chicago, IL, USA
| | - Marco DE Sio
- Unit of Urology, Department of Woman, Child and General and Specialized Surgery, University of Campania "Luigi Vanvitelli", Naples, Italy
| | - Cosimo DE Nunzio
- Department of Urology, Sant'Andrea Hospital, Sapienza University, Rome, Italy
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Vaccaro MG, Innocenti B, Cione E, Gallelli L, De Sarro G, Bonilla DA, Cannataro R. Acute effects of a chewable beetroot-based supplement on cognitive performance: a double-blind randomized placebo-controlled crossover clinical trial. Eur J Nutr 2024; 63:303-321. [PMID: 37875637 PMCID: PMC10799154 DOI: 10.1007/s00394-023-03265-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2022] [Accepted: 10/03/2023] [Indexed: 10/26/2023]
Abstract
BACKGROUND Dietary nitrate (NO3-) has been shown to be useful as an ergogenic aid with potential applications in health and disease (e.g., blood pressure control). However, there is no consensus about the effects of dietary NO3- or beetroot (BR) juice supplementation on cognitive function. OBJECTIVE The aim of this study was to evaluate the effects of a single dose of a chewable BR-based supplement on cognitive performance. METHODS A double-blind randomized placebo-controlled two-period crossover clinical trial was carried out based on the extension of the CONSORT guidelines for randomized crossover trials. A total of 44 participants (24 F; 20 M; 32.7 [12.5] years; 66.3 [9.0] kg; 170 [9.2] cm; 22.8 [1.4] kg/m2) were randomly allocated to receive first either four BR-based chewable tablets (BR-CT) containing 3 g of a Beta vulgaris extract (RedNite®) or four tablets of a placebo (maltodextrin). A 4-day washout period was used before crossover. Ninety minutes after ingestion of the treatments, a neuropsychological testing battery was administered in each period. The trial was registered at clinicaltrials.gov NCT05509075. RESULTS Significant improvements with moderate effect size were found on memory consolidation at the short and long term only after BR-CT supplementation via the Rey Auditory Verbal Learning Test immediate (+ 20.69%) and delayed (+ 12.34%) recalls. Likewise, enhancement on both frontal lobe functions (+ 2.57%) and cognitive flexibility (+ 11.16%) were detected after BR-CT. There was no significant change (p < 0.05) on verbal memory of short-term digits, working memory and information processing speed. Mixed results were found on mood and anxiety through the Beck Depression Inventory-II (BDI-II) and the State-Trait Anxiety Inventory (STAI-Y1 and STAI-Y2); however, sequence and period effects were seen on STAI-Y2. CONCLUSIONS The acute administration of a chewable BR-based supplement improves certain aspects of cognitive function in healthy females and males, particularly memory capacity and frontal skills.
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Affiliation(s)
- Maria Grazia Vaccaro
- Department of Medical and Surgical Sciences, University of Magna Graecia, Catanzaro, Italy
| | | | - Erika Cione
- Department of Pharmacy, Health and Nutritional Sciences, University of Calabria, Rende, Italy
- Galascreen Laboratories, University of Calabria, Rende, Italy
| | - Luca Gallelli
- Clinical Pharmacology and Pharmacovigilance Operative Unit, Department of Health Science, University of Magna Graecia, Mater Domini Hospital, Catanzaro, Italy
| | - Giovambattista De Sarro
- Clinical Pharmacology and Pharmacovigilance Operative Unit, Department of Health Science, University of Magna Graecia, Mater Domini Hospital, Catanzaro, Italy
| | - Diego A Bonilla
- Research Division, Dynamical Business and Science Society-DBSS International SAS, 110861, Bogotá, Colombia
- Research Group in Physical Activity, Sports and Health Sciences (GICAFS), Universidad de Córdoba, 230002, Montería, Colombia
- Research Group in Biochemistry and Molecular Biology, Universidad Distrital Francisco José de Caldas, 110311, Bogotá, Colombia
| | - Roberto Cannataro
- Department of Pharmacy, Health and Nutritional Sciences, University of Calabria, Rende, Italy.
- Galascreen Laboratories, University of Calabria, Rende, Italy.
- Research Division, Dynamical Business and Science Society-DBSS International SAS, 110861, Bogotá, Colombia.
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Zandi S, Sarlak H, Safari M, Momeni E. The prophylactic effect of photobiomodulation therapy on pain perception due to infiltration injection: a randomized clinical trial. Clin Oral Investig 2024; 28:69. [PMID: 38170234 DOI: 10.1007/s00784-023-05394-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2023] [Accepted: 12/05/2023] [Indexed: 01/05/2024]
Abstract
OBJECTIVES Fear of pain in dentistry especially the injection involved in most of the processes has always been an important issue preventing the patients from consulting a dentist at the right time. This study aims to evaluate the effect of photobiomodulation therapy on reduction of pain in infiltration injection. MATERIALS AND METHODS This trial is a crossover study including 30 patients. The patients are divided into two groups (laser therapy in the first period and placebo effect in the next period or vice versa with split-mouth design) using the covariate adaptive randomization method. All the patients received bilateral maxillary canine anesthesia in two periods performed with an ICT injection device (amount of anesthesia solution loaded: 1.8 mL) at a speed of 1 mL/min and a temperature of the solution of 37 °C. In each period, patients received either a prophylactic dose of 940-nm laser (500 mW, 10 J/cm2) or its placebo effect before the injection. The degree of pain perception after each sort of treatment is evaluated by both SEM (Sound, Eye, Motor, and Pain) and VAS (Visual Analogue Scale) scales. RESULTS According to analysis, all the patients scored a VAS scale under 3 in the period they received intervention. Also considering the SEM scale, most of the patients scored 0 in the intervention period. No adverse effect was reported during or after the process. CONCLUSIONS The study showed a significant effect of photobiomodulation on reducing pain perception during infiltration injection. CLINICAL RELEVANCE This method can be useful in order to lower the pain for the patients consulting a dentist and therefore facilitate consulting at early stages of the dental issues. TRIAL REGISTRATION The registration number (date) of the clinical trial in a Primary Registry in the WHO Registry Network is IR.ARAKMU.REC.1398.248(13/03/2020). The related URL is https://en.irct.ir/trial/45362 .
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Affiliation(s)
- Shakiba Zandi
- School of Dentistry, Arak University of Medical Sciences, Arak, Iran
| | - Hamid Sarlak
- Department of Pediatric Dentistry, School of Dentistry, Arak University of Medical Sciences, Arak, Iran
| | - Malihe Safari
- Department of Biostatistics, School of Medicine, Arak University of Medical Sciences, Arak, Iran
| | - Ehsan Momeni
- Department of Oral and Maxillofacial Medicine, School of Dentistry, Arak University of Medical Sciences, Arak, Iran.
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Feehan J, Mack A, Tuck C, Tchongue J, Holt DQ, Sievert W, Moore GT, de Courten B, Hodge A. Time-Restricted Fasting Improves Liver Steatosis in Non-Alcoholic Fatty Liver Disease-A Single Blinded Crossover Trial. Nutrients 2023; 15:4870. [PMID: 38068729 PMCID: PMC10708421 DOI: 10.3390/nu15234870] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2023] [Revised: 11/13/2023] [Accepted: 11/16/2023] [Indexed: 12/18/2023] Open
Abstract
BACKGROUND Non-alcoholic fatty liver disease (NAFLD) is associated with visceral adiposity. We assessed the effectiveness of time-restricted fasting (TRF) for 16 h daily without calorie restrictions compared to standard care (SC; diet and lifestyle advice) in improving visceral adiposity and steatosis via controlled attenuation parameter (CAP). METHODS In a prospective single-blind randomized controlled trial, 32 participants with NAFLD were randomly assigned to TRF or SC for 12 weeks. The secondary endpoints were changes in liver stiffness, anthropometry, blood pressure, and other metabolic factors. RESULTS Twenty-eight participants completed the first arm of the study (TRF = 14, SC = 14), with 23 completing the crossover arm (TRF = 10, SC = 13). The baseline demographics were similar between the groups. Intermittent fasting caused a significant decrease in hepatic steatosis (p = 0.038), weight (p = 0.005), waist circumference (p = 0.001), and BMI (p = 0.005) compared to standard care. Intermittent fasting also resulted in additional within-group changes that were not seen in the standard care intervention. CONCLUSION TRF offers superior improvements in patients with NAFLD, improving steatosis, weight, and waist circumference despite a lack of change in overall caloric intake. Time-restricted fasting should be considered as a primary weight loss intervention in the context of NAFLD. TRIAL REGISTRATION ACTRN12613000935730.
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Affiliation(s)
- Jack Feehan
- Institute for Health and Sport, Victoria University, Melbourne 3011, Australia;
| | - Alexandra Mack
- School of Clinical Sciences, Monash University, Melbourne 3168, Australia; (A.M.); (W.S.); (G.T.M.)
| | - Caroline Tuck
- Department of Nursing and Allied Health, Swinburne University of Technology, Hawthorn 3122, Australia
| | - Jorge Tchongue
- Gastroenterology and Hepatology Unit, Monash Health, Melbourne 3168, Australia (D.Q.H.)
| | - Darcy Q. Holt
- Gastroenterology and Hepatology Unit, Monash Health, Melbourne 3168, Australia (D.Q.H.)
| | - William Sievert
- School of Clinical Sciences, Monash University, Melbourne 3168, Australia; (A.M.); (W.S.); (G.T.M.)
- Gastroenterology and Hepatology Unit, Monash Health, Melbourne 3168, Australia (D.Q.H.)
| | - Gregory T. Moore
- School of Clinical Sciences, Monash University, Melbourne 3168, Australia; (A.M.); (W.S.); (G.T.M.)
- Gastroenterology and Hepatology Unit, Monash Health, Melbourne 3168, Australia (D.Q.H.)
| | - Barbora de Courten
- School of Health and Biomedical Sciences, RMIT, Bundoora 3083, Australia
| | - Alexander Hodge
- School of Clinical Sciences, Monash University, Melbourne 3168, Australia; (A.M.); (W.S.); (G.T.M.)
- Gastroenterology and Hepatology Unit, Monash Health, Melbourne 3168, Australia (D.Q.H.)
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10
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Oscar GE, Irene S, Raul M. Visual satisfaction with progressive addition lenses prescribed with novel foveal fixation axis measurements. Sci Rep 2023; 13:11262. [PMID: 37438410 DOI: 10.1038/s41598-023-38446-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2023] [Accepted: 07/08/2023] [Indexed: 07/14/2023] Open
Abstract
Progressive addition lens (PAL) prescription is usually conducted using the pupillary centre as a reference, which in general does not coincide with the visual axis (kappa distance), and this difference could induce undesired prismatic effects in far and near vision distances and adaptation problems. This study aimed to assess the impact on subjects' visual satisfaction with PALs prescribed based on foveal fixation axis (FFA) measurements. Two different PALs (LifeStyle 3i, Hoya Lens Iberia) were randomly prescribed [one with a customized inset (the difference between the FFA measurements (Ergofocus®, Lentitech, Spain) at far and near distances and the second with a standard inset (2.5 mm)] to be used by 71 healthy presbyopic volunteers in a prospective double-masked crossover clinical study involving one month of use of each PAL. Patients were self-classified into four groups according to their previous experience with PALs: neophyte, PAL users, PAL drop-out, and uncomfortable PAL users. Visual function and overall satisfaction with each PAL were collected and compared. Ninety-seven percent (95% CI 93-100%) of participants successfully adapted to PALs prescribed with FFA without significant differences (P = 0.26) among the study groups (100% neophyte and uncomfortable PAL users (95% CI 100% in both groups), 89% (95% CI 67-100%) PAL users and 94% (95% CI 82-100%) PAL drop-out group). There were no statistically significant differences in visual function (P > 0.05) between customized and standard inset PALs. Customized and standard inset lenses showed similar satisfaction (P > 0.42) that increased significantly (P < 0.01 without any carry-over effect) after 30 days of wear. PALs prescribed with FFA measurements showed high visual satisfaction, suggesting that these measurements are suitable for prescribing PAL adaptation processes. Additional research is necessary to assess differences in PAL users' performance with different prescription methods and lens designs.
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Affiliation(s)
- Garcia-Espinilla Oscar
- Optometry Research Group, IOBA Eye Institute, School of Optometry, University of Valladolid, 47011, Valladolid, Spain
- Departamento de Física Teórica, Atómica y Óptica, Universidad de Valladolid, Paseo de Belén, 7 - Campus Miguel Delibes, 47011, Valladolid, Spain
- Instituto Universitario de Oftalmobiología Aplicada (IOBA), Universidad de Valladolid, Paseo de Belén, 17 - Campus Miguel Delibes, 47011, Valladolid, Spain
| | - Sanchez Irene
- Optometry Research Group, IOBA Eye Institute, School of Optometry, University of Valladolid, 47011, Valladolid, Spain.
- Departamento de Física Teórica, Atómica y Óptica, Universidad de Valladolid, Paseo de Belén, 7 - Campus Miguel Delibes, 47011, Valladolid, Spain.
- Instituto Universitario de Oftalmobiología Aplicada (IOBA), Universidad de Valladolid, Paseo de Belén, 17 - Campus Miguel Delibes, 47011, Valladolid, Spain.
| | - Martin Raul
- Optometry Research Group, IOBA Eye Institute, School of Optometry, University of Valladolid, 47011, Valladolid, Spain
- Departamento de Física Teórica, Atómica y Óptica, Universidad de Valladolid, Paseo de Belén, 7 - Campus Miguel Delibes, 47011, Valladolid, Spain
- Instituto Universitario de Oftalmobiología Aplicada (IOBA), Universidad de Valladolid, Paseo de Belén, 17 - Campus Miguel Delibes, 47011, Valladolid, Spain
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Georgeto SM, Andraus RAC, de Oliveira Júnior E, da Silva RA, Ngomo S, Fernandes KBP. Bilateral Idiopathic Carpal Tunnel Syndrome: Clinical-Functional Characterization and Efficacy of Two Combined Postoperative Physiotherapeutic Treatments. Orthop Surg 2023. [PMID: 37154094 DOI: 10.1111/os.13705] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/28/2022] [Revised: 01/27/2023] [Accepted: 02/19/2023] [Indexed: 05/10/2023] Open
Abstract
OBJECTIVE To evaluate the efficacy of combined association instrument myofascial mobilization (IASTM) and stretching in patients with idiopathic bilateral carpal tunnel syndrome (CTS) operated on one hand and to analyze the response of the operated (OH) and non-operated (NH) hand according to the sequence of therapies. Research on these parameters has not yet been found in the literature. METHODS Randomized controlled crossover study with 43 participants using the objective and subjective outcome variables. Patients were randomly assigned to two groups: starting with stretching followed by IASTM and starting with IASTM followed by stretching. Then patients underwent surgery on the hand with more severe involvement and physical therapy rehabilitation was started 30 days after for a period of 4 weeks. After the 1-week interval the participants who started with stretching were referred to IASTM and vice versa, following the same previous patterns. The outpatient reassessments took place at 3 to 6 months. Crossover ANOVA and effect sizes were used as analysis methods. RESULTS Time was the most significant outcome for all variables both during therapies and at 6-month follow-up. Regarding response to the combined therapies between OH and NH, there were differences for both OH and NH, with the greatest impact on NH for the palmar grip and VAS variables. The treatment sequences were significant for pain on the NH and mental SF-12, suggesting that starting with IASTM followed by stretching had a superior outcome for these outcomes. CONCLUSION The combination of IASTM with stretching, used in the postoperative period of bilateral idiopathic CTS, proved to be supplementary, with significant results and large effect sizes for most of the outcomes assessed, both during the time of application of the therapies and in the 6-month follow-up for both hands, and may constitute a viable therapeutic alternative for this population.
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Affiliation(s)
- Sergio Murilo Georgeto
- Department of Neurosurgery, Irmandade da Santa Casa de Londrina (ISCAL); Doctoral Program in Rehabilitation Sciences UEL/UNOPAR, Universidade Pitágoras UNOPAR, Londrina, PR, Brazil
| | | | - Eros de Oliveira Júnior
- Instituto Avançado de Ensino, Pesquisa e Tecnologia de Londrina (IAEPETEL), Londrina, PR, Brazil
| | - Rubens A da Silva
- Département des Sciences de la Santé, Centre Intersectoriel en Santé Durable, Laboratoire de Recherche BioNR, Université du Québec à Chicoutimi (UQAC); Centre Intégré de Santé et Services Sociaux du Saguenay-Lac-Saint-Jean (CIUSSS SLSJ), Services Spécialisés de Gériatrie - Hôpital de La Baie, Saguenay, Québec, Canada
| | - Suzy Ngomo
- Département des Sciences de la Santé, Centre Intersectoriel en Santé Durable, Laboratoire de recherche BioNR, Université du Québec à Chicoutimi (UQAC), Saguenay, Québec, Canada
| | - Karen Barros Parron Fernandes
- School of Medicine, Pontifical Catholic University of Parana (PUCPR), Londrina, PR, Brazil; Département des Sciences de la Santé, Centre Intersectoriel en Santé Durable, Laboratoire de recherche BioNR, Université du Québec à Chicoutimi (UQAC), Saguenay, Québec, Canada; Instituto de Ensino, Pesquisa e Inovação da Irmandade da Santa Casa de Londrina (IEPI-ISCAL), Londrina, PR, Brazil
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12
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Efficacy of methylphenidate for the treatment of apathy in patients with Alzheimer's disease: a systematic review and meta-analysis of randomized controlled studies. Psychopharmacology (Berl) 2022; 239:3743-3753. [PMID: 36243827 DOI: 10.1007/s00213-022-06261-y] [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: 04/09/2022] [Accepted: 10/06/2022] [Indexed: 10/17/2022]
Abstract
RATIONALE Despite the reported efficacy of methylphenidate (MET) against Alzheimer's disease (AD)-associated apathy, a recent larger clinical trial was not included in pooled analysis. OBJECTIVES This study aimed at investigating the efficacy of MET for attenuating apathy in patients diagnosed with AD. METHODS The PubMed, Cochrane Library, and EMBASE databases were searched from inception until March, 2022 to identify randomized controlled trials (RCTs). The primary outcome was apathy improvement assessed with the Neuropsychiatric Inventory (NPI) apathy subscale, Apathy Evaluation Scale (AES), or Clinical Global Impressions of Change scale (CGI-C apathy). RESULTS Meta-analysis of four RCTs revealed an improvement in apathy among patients receiving MET compared to placebo (MD = - 5.12, p = 0.04, three trials, 144 participants) at follow-ups of 1-3 months assessed with AES score. Despite the absence of improvement on NPI-apathy subscale at follow-ups of 1-2 months (MD = - 0.74, p = 0.37, three trials, 265 participants), significant improvement was noted at follow-ups of 6 months (MD = - 1.4, p = 0.02, one trial, 180 participants). Assessment with CGI-C apathy revealed no significant association between improvement in apathy with MET use (RR = 1.38, p = 0.05, three trials, 265 participants). No significant differences in global cognitive function (using the Mini Mental State Exam) or adverse events were noted between the two groups. CONCLUSION While AES score suggested an early attenuation effect of MET on apathy in different domains, the NPI-apathy subscale did not show early improvement in apathy until the 6-month follow-up. Further studies with longer follow-ups are needed to elucidate the efficacy of MET for relieving caregiver burden and improving global functional performance.
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13
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Potential Benefits of Selenium Supplementation in Reducing Insulin Resistance in Patients with Cardiometabolic Diseases: A Systematic Review and Meta-Analysis. Nutrients 2022; 14:nu14224933. [PMID: 36432623 PMCID: PMC9693215 DOI: 10.3390/nu14224933] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2022] [Revised: 11/11/2022] [Accepted: 11/18/2022] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Selenium is a trace element that has been reported to be effective in regulating glucose and lipid metabolism. However, there is conflicting evidence from different clinical trials of selenium supplementation in treating cardiometabolic diseases (CMDs). OBJECTIVE This meta-analysis aimed to identify the effects of selenium supplementation on insulin resistance, glucose homeostasis, and lipid profiles in patients with CMDs. METHODS Randomized controlled trials (RCTs) of selenium supplementation for treating CMDs were screened in five electronic databases. Insulin levels, homeostatic model assessment of insulin resistance (HOMA-IR), fasting plasma glucose (FPG), and glycosylated hemoglobin A1C (HbA1c) were defined as the primary outcome markers, and lipid profiles were considered the secondary outcome markers. RESULTS Ten studies involving 526 participants were included in the meta-analysis. The results suggested that selenium supplementation significantly reduced serum insulin levels (standardized men difference [SMD]: -0.53; 95% confidence interval [CI] [-0.84, -0.21], p = 0.001, I2 = 68%) and HOMA-IR (SMD: -0.50, 95% CI [-0.86, -0.14], p = 0.006, I2 = 75%) and increased high-density lipoprotein cholesterol (HDL-C) levels (SMD: 0.97; 95% CI [0.26, 1.68], p = 0.007, I2 = 92%), but had no significant effect on FPG, total cholesterol (TC), triglycerides (TG), low-density lipoprotein cholesterol (LDL-C), and very low-density lipoprotein cholesterol (VLDL-C). CONCLUSION Current evidence supports the beneficial effects of selenium supplementation on reducing insulin levels, HOMA-IR, and increasing HDL-C levels. Selenium supplementation may be an effective strategy for reducing insulin resistance in patients with CMDs. However, more high-quality clinical studies are needed to improve the certainty of our estimates.
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14
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Zavorsky GS, Brooks RA. The influence of sexual activity on athletic performance: a systematic review and meta-analyses. Sci Rep 2022; 12:15609. [PMID: 36114261 PMCID: PMC9481637 DOI: 10.1038/s41598-022-19882-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2022] [Accepted: 09/06/2022] [Indexed: 11/28/2022] Open
Abstract
Several anecdotal reports suggest that sex before competition can affect performance. Our objective was to perform a systematic review and meta-analysis to determine whether athletic performance or some physical fitness measure is affected by prior sexual activity. Web of Science (all databases) and Google Scholar were used to identify studies from which adult healthy subjects were included. As all studies were crossover trials, an inverse variance statistical method with random effects was used to minimize the uncertainty of the pooled effect estimate. Bias was assessed via the revised Cochrane Risk of Bias tool (RoB 2) with a "per protocol" analysis. Nine crossover studies (133 subjects, 99% male) were used in this meta-analysis. All those studies did not examine athletic performance per se, but all studies assessed one or more physical fitness parameters. The RoB 2 suggested that overall, there were some concerns with bias. As there was moderate heterogeneity amongst the different outcomes (Tau2 = 0.02, Chi-square = 17.2, df = 8, p = 0.03, I2 = 54%), a random-effects model was used. The results neither favored abstinence nor sexual activity before a physical fitness test [standardized mean difference = 0.03 (- 0.10 to 0.16), Z = 0.47, p = 0.64, where a negative standardized mean difference favors abstinence, and a positive standardized mean difference favors sexual activity]. The results demonstrate that sexual activity within 30 min to 24 h before exercise does not appear to affect aerobic fitness, musculoskeletal endurance, or strength/power.
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Affiliation(s)
- Gerald S Zavorsky
- Department of Physiology and Membrane Biology, University of California-Davis, Davis, CA, USA.
| | - Rebecca A Brooks
- Division of Gynecologic Oncology, University of California-Davis, Medical Center, Sacramento, CA, USA
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15
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Jabaudon M, Neto AS. Open the lungs, keep them open and… take a break? Anaesth Crit Care Pain Med 2022; 41:101057. [PMID: 35523479 PMCID: PMC9062598 DOI: 10.1016/j.accpm.2022.101057] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- Matthieu Jabaudon
- Inserm, Department of Perioperative Medicine, GReD, CNRS, CHU de Clermont-Ferrand, Université Clermont Auvergne, Clermont-Ferrand, France.
| | - Ary Serpa Neto
- Australian and New Zealand Intensive Care Research Centre (ANZIC-RC), Department of Intensive Care and Data Analytics Research and Evaluation (DARE) Centre, Department of Critical Care, Melbourne Medical School, Monash University, University of Melbourne, Austin Hospital, Melbourne, VIC, Australia; Department of Intensive Care, Austin Hospital, Melbourne, Australia; Honorary Senior Clinical Fellow, Department of Critical Care, University of Melbourne, Melbourne, Australia; Department of Critical Care Medicine, Hospital Israelita Albert-Einstein, São Pãulo, Brazil
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16
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Effect of Brazil Nuts on Selenium Status, Blood Lipids, and Biomarkers of Oxidative Stress and Inflammation: A Systematic Review and Meta-Analysis of Randomized Clinical Trials. Antioxidants (Basel) 2022; 11:antiox11020403. [PMID: 35204285 PMCID: PMC8869304 DOI: 10.3390/antiox11020403] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2022] [Revised: 02/09/2022] [Accepted: 02/15/2022] [Indexed: 02/06/2023] Open
Abstract
Tree nuts, including Brazil nuts, have been hypothesized to impact cardiovascular health through the modulation of oxidative stress and inflammation. Nonetheless, a quantitative analysis of these effects has not been performed. Therefore, the aim of this study was to systematically revise and quantify the effect of Brazil nut intervention on selenium status, blood lipids, and biomarkers of oxidative stress and inflammation using a meta-analytical approach. To meet the goals of this study, a systematic search of PubMed, EMBASE, and Web of Science databases of published randomised clinical trials reporting on dietary interventions with Brazil nuts and their effects on selenium status, blood lipids, and markers of oxidative stress and inflammation was performed. Eight articles were included for systematic review and meta-analysis. Based on the conducted analysis, a significant positive effect of Brazil nuts on selenium blood concentration (SMD = 6.93, 95% CI: 3.99; 9.87) was found. Additionally, a positive effect of Brazil nut intervention on glutathione peroxidase activity (SMD = 0.53, 95% CI: 0.07; 0.99) was observed. However, no significant results were found when considering blood lipid levels, including results for total cholesterol (SMD = −0.22, 95% CI: −0.57; 0.14), HDL cholesterol (SMD = −0.04, 95% CI: −0.28; 0.19) and LDL cholesterol (SMD = −0.15; 95% CI: −0.43; 0.13). In conclusion, the findings from this study suggest that Brazil nut consumption improves selenium status and exerts antioxidant effects, which could be considered a potential pathway for the prevention of metabolic disorders related to altered blood lipid profiles. However, further studies are needed to elucidate the effect of Brazil nuts toward blood lipid profile, also preferably controlling for other biomarkers.
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17
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Zhou Q, Chen ZH, Zhang JX, Peng S. A systematic review of the quality of reporting and risk of bias for randomized crossover trials in digestive disease journals. Therap Adv Gastroenterol 2022; 15:17562848211067874. [PMID: 35069802 PMCID: PMC8777342 DOI: 10.1177/17562848211067874] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/27/2021] [Accepted: 11/29/2021] [Indexed: 02/04/2023] Open
Abstract
BACKGROUND The quality of randomized crossover studies on digestive diseases is unclear. We aimed to review crossover trials in digestive disease journals and evaluate their reporting quality and risk of bias. METHODS We searched the PubMed, Web of Science, and Scopus databases for all crossover trials in 39 digestive journals between January 2011 and September 2021. Reporting adherence was based on the CONSORT 2010 statement: extension to randomized crossover trials published in July 2019. A newly released Cochrane risk of bias tool 2.0 extension for crossover trials was applied to assess the risk of bias. RESULTS In total, 173 studies were included in the analysis, and 16.2% were published following the CONSORT statement extension. The crossover design was not only widely used in drug efficacy trials (48.6%) but also in endoscopic ultrasound trials (23.7%) and dietary studies (17.9%) in the field of digestive diseases. The overall reporting adherence was 37.6% for full texts and 43.4% for abstracts. The proportions of trials with low, some concerns, and high risk of bias were 13.9%, 15.6%, and 70.5%, respectively. The difference in reporting adherence and high risk of bias between pre- and post-CONSORT was not significant. Having a sample size plan, defining primary end points, and pre-registration showed higher reporting adherence and lower risk of bias than those who did not. CONCLUSION These findings demonstrated the inadequate quality of randomized crossover trials for digestive diseases. Compliance with the CONSORT extension for crossover trials must be strengthened and improved (PROSPERO CRD: 42021248723).
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Affiliation(s)
| | - Zhi-hang Chen
- Department of Liver Surgery, The First
Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Jin-xin Zhang
- Department of Medical Statistics, School of
Public Health, Sun Yat-sen University, Guangzhou, China
| | - Sui Peng
- Clinical Trials Unit, The First Affiliated
Hospital, Sun Yat-sen University, Guangzhou 510080, China,Department of Gastroenterology, The First
Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
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Long A, Cartwright M, Reilly CC. Impact of fan therapy during exercise on breathlessness and recovery time in patients with COPD: a pilot randomised controlled crossover trial. ERJ Open Res 2021; 7:00211-2021. [PMID: 34760995 PMCID: PMC8573226 DOI: 10.1183/23120541.00211-2021] [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: 03/24/2021] [Accepted: 08/10/2021] [Indexed: 11/23/2022] Open
Abstract
Background Patients with COPD reduce physical activity to avoid the onset of breathlessness. Fan therapy can reduce breathlessness at rest, but the efficacy of fan therapy during exercise remains unknown in this population. The aim of the present study was to investigate 1) the effect of fan therapy on exercise-induced breathlessness and post-exercise recovery time in patients with COPD and 2) the acceptability of fan therapy during exercise; and 3) to assess the reproducibility of any observed improvements in outcome measures. Methods A pilot single-centre, randomised, controlled, crossover open (nonmasked) trial (clinicaltrials.gov NCT03137524) of fan therapy versus no fan therapy during 6-min walk test (6MWT) in patients with COPD and a modified Medical Research Council (mMRC) dyspnoea score ≥2. Breathlessness intensity was quantified before and on termination of the 6MWT, using the numerical rating scale (NRS) (0–10). Post-exertional recovery time was measured, defined as the time taken to return to baseline NRS breathlessness score. Oxygen saturation and heart rate were measure pre- and post-6MWT. Results 14 patients with COPD completed the trial per protocol (four male, 10 female; median (interquartile range (IQR)) age 66.50 (60.75 to 73.50) years); mMRC dyspnoea 3 (2 to 3)). Fan therapy resulted in lower exercise-induced breathlessness (ΔNRS; Δ modified Borg scale) (within-individual differences in medians (WIDiM) −1.00, IQR −2.00 to −0.50; p<0.01; WIDiM −0.25, IQR −2.00 to 0.00; p=0.02), greater distance walked (metres) during the 6MWT (WIDiM 21.25, IQR 12.75 to 31.88; p<0.01), and improved post-exertional breathlessness (NRS) recovery time (WIDiM −10.00, IQR −78.75 to 50.00; p<0.01). Fan therapy was deemed to be acceptable by 92% of participants. Conclusion Fan therapy was acceptable and provided symptomatic relief to patients with COPD during exercise. These data will inform larger pilot studies and efficacy studies of fan therapy during exercise. Fan therapy was acceptable and provided symptomatic relief to patients with COPD during exercise; these positive preliminary findings suggest that fan therapy merits further investigation in larger and more methodologically rigorous studieshttps://bit.ly/3xR2GDW
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Affiliation(s)
- Alex Long
- Dept of Physiotherapy, King's College Hospital NHS Foundation Trust, London, UK.,School of Health Sciences, City, University of London, London, UK
| | | | - Charles C Reilly
- Dept of Physiotherapy, King's College Hospital NHS Foundation Trust, London, UK.,Cicely Saunders Institute of Palliative Care, Policy and Rehabilitation, King's College London, London, UK
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Chen Y, Wang X, Jia Y, Zou M, Zhen Z, Xue Y. Effect of a sodium restriction diet on albuminuria and blood pressure in diabetic kidney disease patients: a meta-analysis. Int Urol Nephrol 2021; 54:1249-1260. [PMID: 34671892 DOI: 10.1007/s11255-021-03035-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2021] [Accepted: 10/12/2021] [Indexed: 12/24/2022]
Abstract
BACKGROUND A sodium restriction diet is a key component of chronic kidney disease (CKD) management. However, the efficacy of its use in patients with diabetic kidney disease (DKD) is uncertain. The present meta-analysis explored the effects of restricting sodium intake on albuminuria and blood pressure in DKD patients with albuminuria. METHODS We searched the Cochrane Central Register of Controlled Trials, Web of Science, MEDLINE, and EMBASE for randomized controlled trials, and we reviewed the references of all searched articles to avoid omitting other relevant articles. Our primary endpoints were blood pressure, albumin excretion rate, and plasma renin activity. We assessed pooled data using a random-effects model. RESULTS Of the 661 articles identified, a total of 12 articles were included in the meta-analysis. The random-effects model indicated that salt-restriction diet interventions led to a poled - 4.72 mmHg (95% CI - 6.71, - 2.73) difference in systolic blood pressure and that the intervention resulted in a 2.33 mmHg lower diastolic blood pressure (95% CI - 3.61, - 1.05). In patients with microalbuminuria, restricted sodium intake decreased the albumin excretion rate (AER) by 12.62 mg/min (95% CI - 19.64, - 5.60). Furthermore, the AER was 127.69 mg/min lower in patients with macroalbuminuria (95% CI - 189.07, - 66.32). CONCLUSION Moderate sodium restriction diets reduce urinary albumin excretion and decrease the level of blood pressure, especially for patients with macro-albuminuria. Thus, it is necessary to strengthen the intervention and health education as well as to provide individualized dietary advice.
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Affiliation(s)
- Yanrong Chen
- Department of Endocrinology and Metabolism, Nanfang Hospital, Southern Medical University, 1838, Guangzhou Avenue North, Guangzhou, Guangdong, China
| | - Xiangyu Wang
- Department of Endocrinology and Metabolism, Nanfang Hospital, Southern Medical University, 1838, Guangzhou Avenue North, Guangzhou, Guangdong, China
| | - Yijie Jia
- Department of Endocrinology and Metabolism, Nanfang Hospital, Southern Medical University, 1838, Guangzhou Avenue North, Guangzhou, Guangdong, China
| | - Meina Zou
- Department of Endocrinology and Metabolism, Nanfang Hospital, Southern Medical University, 1838, Guangzhou Avenue North, Guangzhou, Guangdong, China
| | - Zongji Zhen
- Department of Endocrinology and Metabolism, Nanfang Hospital, Southern Medical University, 1838, Guangzhou Avenue North, Guangzhou, Guangdong, China
| | - Yaoming Xue
- Department of Endocrinology and Metabolism, Nanfang Hospital, Southern Medical University, 1838, Guangzhou Avenue North, Guangzhou, Guangdong, China.
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Eckert I, Koehler IC, Bauer J, Busnello FM, Silva FM. Effects of different sources of dietary protein on markers of kidney function in individuals with diabetes: a systematic review and meta-analysis of randomized controlled trials. Nutr Rev 2021; 80:812-825. [PMID: 34338778 DOI: 10.1093/nutrit/nuab042] [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: 11/13/2022] Open
Abstract
CONTEXT The type of dietary protein may modulate markers of diabetic kidney disease; however, no attempt to summarize the evidence from randomized controlled trials (RCTs) has been performed to date. OBJECTIVE To assess the effects of different types of dietary protein on urinary albumin excretion and glomerular filtration rate in individuals with diabetes. DATA SOURCES MEDLINE, EMBASE, and Scopus were searched for all published RCTs, with no language restriction, up to July 2020. DATA EXTRACTION Study selection and data extraction were performed independently by 3 authors. Risk of bias was assessed independently by 2 authors, and the GRADE approach was used to assess the quality of the evidence. RESULTS Twelve RCTs were included, of which 11 (involving 228 participants) were compiled in meta-analyses of random-effects models. Interventions consisted of diets emphasizing plant or white meat protein, with reduced intake of animal or red meat protein. Pooled data from crossover trials (n = 8) favored intervention diets for urinary albumin excretion (ratio of means, 0.86; 95% confidence interval 0.80 to 0.94; I2 = 4%) and glomerular filtration rate (ratio of means, 0.90; 95% confidence interval 0.87 to 0.94; I2 = 45%), compared with control diets. Results from parallel-design studies (n = 3), however, were not statistically significant for any outcome. The quality of the evidence ranged from very low to moderate, and most studies were judged with at least some concerns in terms of risk of bias. CONCLUSION This meta-analysis found weak evidence for small to moderate improvements in markers of kidney function in favor of interventions with lower animal protein (or red meat protein) compared with usual diets in short-term crossover trials. These findings require confirmation in well-designed randomized controlled trials.
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Affiliation(s)
- Igor Eckert
- I. Eckert is with the Undergraduate Nutrition Program, Federal University of Health Sciences of Porto Alegre (UFCSPA), Rio Grande do Sul, Brazil. I.C. Koehler is with the Undergraduate Medical Program, Federal University of Health Sciences of Porto Alegre (UFCSPA), Rio Grande do Sul, Brazil. J. Bauer is with the Postgraduate Program in Nutrition Sciences, Federal University of Health Sciences of Porto Alegre (UFCSPA), Rio Grande do Sul, Brazil. F.M. Busnello and F.M. Silva are with the Department of Nutrition and Postgraduate Program in Nutrition Sciences, Federal University of Health Sciences of Porto Alegre (UFCSPA), Rio Grande do Sul, Brazil
| | - Igor C Koehler
- I. Eckert is with the Undergraduate Nutrition Program, Federal University of Health Sciences of Porto Alegre (UFCSPA), Rio Grande do Sul, Brazil. I.C. Koehler is with the Undergraduate Medical Program, Federal University of Health Sciences of Porto Alegre (UFCSPA), Rio Grande do Sul, Brazil. J. Bauer is with the Postgraduate Program in Nutrition Sciences, Federal University of Health Sciences of Porto Alegre (UFCSPA), Rio Grande do Sul, Brazil. F.M. Busnello and F.M. Silva are with the Department of Nutrition and Postgraduate Program in Nutrition Sciences, Federal University of Health Sciences of Porto Alegre (UFCSPA), Rio Grande do Sul, Brazil
| | - Julia Bauer
- I. Eckert is with the Undergraduate Nutrition Program, Federal University of Health Sciences of Porto Alegre (UFCSPA), Rio Grande do Sul, Brazil. I.C. Koehler is with the Undergraduate Medical Program, Federal University of Health Sciences of Porto Alegre (UFCSPA), Rio Grande do Sul, Brazil. J. Bauer is with the Postgraduate Program in Nutrition Sciences, Federal University of Health Sciences of Porto Alegre (UFCSPA), Rio Grande do Sul, Brazil. F.M. Busnello and F.M. Silva are with the Department of Nutrition and Postgraduate Program in Nutrition Sciences, Federal University of Health Sciences of Porto Alegre (UFCSPA), Rio Grande do Sul, Brazil
| | - Fernanda M Busnello
- I. Eckert is with the Undergraduate Nutrition Program, Federal University of Health Sciences of Porto Alegre (UFCSPA), Rio Grande do Sul, Brazil. I.C. Koehler is with the Undergraduate Medical Program, Federal University of Health Sciences of Porto Alegre (UFCSPA), Rio Grande do Sul, Brazil. J. Bauer is with the Postgraduate Program in Nutrition Sciences, Federal University of Health Sciences of Porto Alegre (UFCSPA), Rio Grande do Sul, Brazil. F.M. Busnello and F.M. Silva are with the Department of Nutrition and Postgraduate Program in Nutrition Sciences, Federal University of Health Sciences of Porto Alegre (UFCSPA), Rio Grande do Sul, Brazil
| | - Flávia M Silva
- I. Eckert is with the Undergraduate Nutrition Program, Federal University of Health Sciences of Porto Alegre (UFCSPA), Rio Grande do Sul, Brazil. I.C. Koehler is with the Undergraduate Medical Program, Federal University of Health Sciences of Porto Alegre (UFCSPA), Rio Grande do Sul, Brazil. J. Bauer is with the Postgraduate Program in Nutrition Sciences, Federal University of Health Sciences of Porto Alegre (UFCSPA), Rio Grande do Sul, Brazil. F.M. Busnello and F.M. Silva are with the Department of Nutrition and Postgraduate Program in Nutrition Sciences, Federal University of Health Sciences of Porto Alegre (UFCSPA), Rio Grande do Sul, Brazil
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21
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Tricco AC, Ashoor HM, Antony J, Bouck Z, Rodrigues M, Pham B, Khan PA, Nincic V, Darvesh N, Yazdi F, Ghassemi M, Ivory JD, Veroniki AA, Yu CH, Moja L, Straus SE. Comparative Efficacy and Safety of Ultra-Long-Acting, Long-Acting, Intermediate-Acting, and Biosimilar Insulins for Type 1 Diabetes Mellitus: a Systematic Review and Network Meta-Analysis. J Gen Intern Med 2021; 36:2414-2426. [PMID: 33742305 PMCID: PMC8342652 DOI: 10.1007/s11606-021-06642-7] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/24/2020] [Accepted: 01/26/2021] [Indexed: 10/21/2022]
Abstract
BACKGROUND Increasing availability of competing biosimilar alternatives makes it challenging to make treatment decisions. The purpose of this review is to evaluate the comparative efficacy and safety of ultra-long-/long-/intermediate-acting insulin products and biosimilar insulin compared to human/animal insulin in adults with type 1 diabetes mellitus (T1DM). METHODS MEDLINE, EMBASE, CENTRAL, and grey literature were searched from inception to March 27, 2019. Randomized controlled trials (RCTs), quasi-experimental studies, and cohort studies of adults with T1DM receiving ultra-long-/long-/intermediate-acting insulin, compared to each other, as well as biosimilar insulin compared to human/animal insulin were eligible for inclusion. Two reviewers independently screened studies, abstracted data, and appraised risk-of-bias. Pairwise meta-analyses and network meta-analyses (NMA) were conducted. Summary effect measures were mean differences (MD) and odds ratios (OR). RESULTS We included 65 unique studies examining 14,200 patients with T1DM. Both ultra-long-acting and long-acting insulin were superior to intermediate-acting insulin in reducing A1c, FPG, weight gain, and the incidence of major, serious, or nocturnal hypoglycemia. For fasting blood glucose, long-acting once a day (od) was superior to long-acting twice a day (bid) (MD - 0.44, 95% CI: - 0.81 to - 0.06) and ultra-long-acting od was superior to long-acting bid (MD - 0.73, 95% CI - 1.36 to - 0.11). For weight change, long-acting od was inferior to long-acting bid (MD 0.58, 95% CI: 0.05 to 1.10) and long-acting bid was superior to long-action biosimilar od (MD - 0.90, 95% CI: - 1.67 to - 0.12). CONCLUSIONS Our results can be used to tailor insulin treatment according to the desired results of patients and clinicians and inform strategies to establish a competitive clinical market, address systemic barriers, expand the pool of potential suppliers, and favor insulin price reduction. PROSPERO REGISTRATION CRD42017077051.
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Affiliation(s)
- Andrea C. Tricco
- Knowledge Translation Program, Li Ka Shing Knowledge Institute, St. Michael’s Hospital, Unity Health Toronto, Toronto, Ontario Canada
- Epidemiology Division and Institute for Health Policy, Management, and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario Canada
| | - Huda M. Ashoor
- Knowledge Translation Program, Li Ka Shing Knowledge Institute, St. Michael’s Hospital, Unity Health Toronto, Toronto, Ontario Canada
| | - Jesmin Antony
- Knowledge Translation Program, Li Ka Shing Knowledge Institute, St. Michael’s Hospital, Unity Health Toronto, Toronto, Ontario Canada
| | - Zachary Bouck
- Centre for Drug Policy and Evaluation, Li Ka Shing Knowledge Institute, St. Michael’s Hospital, Toronto, Ontario Canada
| | - Myanca Rodrigues
- Knowledge Translation Program, Li Ka Shing Knowledge Institute, St. Michael’s Hospital, Unity Health Toronto, Toronto, Ontario Canada
| | - Ba’ Pham
- Knowledge Translation Program, Li Ka Shing Knowledge Institute, St. Michael’s Hospital, Unity Health Toronto, Toronto, Ontario Canada
| | - Paul A. Khan
- Knowledge Translation Program, Li Ka Shing Knowledge Institute, St. Michael’s Hospital, Unity Health Toronto, Toronto, Ontario Canada
| | - Vera Nincic
- Knowledge Translation Program, Li Ka Shing Knowledge Institute, St. Michael’s Hospital, Unity Health Toronto, Toronto, Ontario Canada
| | - Nazia Darvesh
- Knowledge Translation Program, Li Ka Shing Knowledge Institute, St. Michael’s Hospital, Unity Health Toronto, Toronto, Ontario Canada
| | - Fatemeh Yazdi
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ontario Canada
| | - Marco Ghassemi
- Knowledge Translation Program, Li Ka Shing Knowledge Institute, St. Michael’s Hospital, Unity Health Toronto, Toronto, Ontario Canada
| | - John D. Ivory
- Knowledge Translation Program, Li Ka Shing Knowledge Institute, St. Michael’s Hospital, Unity Health Toronto, Toronto, Ontario Canada
| | - Areti Angeliki Veroniki
- Knowledge Translation Program, Li Ka Shing Knowledge Institute, St. Michael’s Hospital, Unity Health Toronto, Toronto, Ontario Canada
- Department of Primary Education, School of Education, University of Ioannina, Ioannina, Greece
- Institute of Reproductive and Developmental Biology, Department of Surgery & Cancer, Faculty of Medicine, Imperial College, London, UK
| | - Catherine H. Yu
- Knowledge Translation Program, Li Ka Shing Knowledge Institute, St. Michael’s Hospital, Unity Health Toronto, Toronto, Ontario Canada
| | - Lorenzo Moja
- Department of Essential Medicines and Health Products, World Health Organization, Geneva, Switzerland
| | - Sharon E. Straus
- Knowledge Translation Program, Li Ka Shing Knowledge Institute, St. Michael’s Hospital, Unity Health Toronto, Toronto, Ontario Canada
- Department of Geriatric Medicine, University of Toronto, Toronto, Ontario Canada
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22
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VanderPluym JH, Halker Singh RB, Urtecho M, Morrow AS, Nayfeh T, Torres Roldan VD, Farah MH, Hasan B, Saadi S, Shah S, Abd-Rabu R, Daraz L, Prokop LJ, Murad MH, Wang Z. Acute Treatments for Episodic Migraine in Adults: A Systematic Review and Meta-analysis. JAMA 2021; 325:2357-2369. [PMID: 34128998 PMCID: PMC8207243 DOI: 10.1001/jama.2021.7939] [Citation(s) in RCA: 48] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
IMPORTANCE Migraine is common and can be associated with significant morbidity, and several treatment options exist for acute therapy. OBJECTIVE To evaluate the benefits and harms associated with acute treatments for episodic migraine in adults. DATA SOURCES Multiple databases from database inception to February 24, 2021. STUDY SELECTION Randomized clinical trials and systematic reviews that assessed effectiveness or harms of acute therapy for migraine attacks. DATA EXTRACTION AND SYNTHESIS Independent reviewers selected studies and extracted data. Meta-analysis was performed with the DerSimonian-Laird random-effects model with Hartung-Knapp-Sidik-Jonkman variance correction or by using a fixed-effect model based on the Mantel-Haenszel method if the number of studies was small. MAIN OUTCOMES AND MEASURES The main outcomes included pain freedom, pain relief, sustained pain freedom, sustained pain relief, and adverse events. The strength of evidence (SOE) was graded with the Agency for Healthcare Research and Quality Methods Guide for Effectiveness and Comparative Effectiveness Reviews. FINDINGS Evidence on triptans and nonsteroidal anti-inflammatory drugs was summarized from 15 systematic reviews. For other interventions, 115 randomized clinical trials with 28 803 patients were included. Compared with placebo, triptans and nonsteroidal anti-inflammatory drugs used individually were significantly associated with reduced pain at 2 hours and 1 day (moderate to high SOE) and increased risk of mild and transient adverse events. Compared with placebo, calcitonin gene-related peptide receptor antagonists (low to high SOE), lasmiditan (5-HT1F receptor agonist; high SOE), dihydroergotamine (moderate to high SOE), ergotamine plus caffeine (moderate SOE), acetaminophen (moderate SOE), antiemetics (low SOE), butorphanol (low SOE), and tramadol in combination with acetaminophen (low SOE) were significantly associated with pain reduction and increase in mild adverse events. The findings for opioids were based on low or insufficient SOE. Several nonpharmacologic treatments were significantly associated with improved pain, including remote electrical neuromodulation (moderate SOE), transcranial magnetic stimulation (low SOE), external trigeminal nerve stimulation (low SOE), and noninvasive vagus nerve stimulation (moderate SOE). No significant difference in adverse events was found between nonpharmacologic treatments and sham. CONCLUSIONS AND RELEVANCE There are several acute treatments for migraine, with varying strength of supporting evidence. Use of triptans, nonsteroidal anti-inflammatory drugs, acetaminophen, dihydroergotamine, calcitonin gene-related peptide antagonists, lasmiditan, and some nonpharmacologic treatments was associated with improved pain and function. The evidence for many other interventions, including opioids, was limited.
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Affiliation(s)
- Juliana H. VanderPluym
- Mayo Clinic Evidence-based Practice Center, Rochester, Minnesota
- Department of Neurology, Mayo Clinic, Scottsdale, Arizona
| | - Rashmi B. Halker Singh
- Mayo Clinic Evidence-based Practice Center, Rochester, Minnesota
- Department of Neurology, Mayo Clinic, Scottsdale, Arizona
| | - Meritxell Urtecho
- Mayo Clinic Evidence-based Practice Center, Rochester, Minnesota
- Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, Minnesota
| | - Allison S. Morrow
- Mayo Clinic Evidence-based Practice Center, Rochester, Minnesota
- Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, Minnesota
| | - Tarek Nayfeh
- Mayo Clinic Evidence-based Practice Center, Rochester, Minnesota
- Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, Minnesota
| | - Victor D. Torres Roldan
- Mayo Clinic Evidence-based Practice Center, Rochester, Minnesota
- Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, Minnesota
| | - Magdoleen H. Farah
- Mayo Clinic Evidence-based Practice Center, Rochester, Minnesota
- Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, Minnesota
| | - Bashar Hasan
- Mayo Clinic Evidence-based Practice Center, Rochester, Minnesota
- Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, Minnesota
| | - Samer Saadi
- Mayo Clinic Evidence-based Practice Center, Rochester, Minnesota
- Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, Minnesota
| | - Sahrish Shah
- Mayo Clinic Evidence-based Practice Center, Rochester, Minnesota
- Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, Minnesota
| | - Rami Abd-Rabu
- Mayo Clinic Evidence-based Practice Center, Rochester, Minnesota
- Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, Minnesota
| | - Lubna Daraz
- Mayo Clinic Evidence-based Practice Center, Rochester, Minnesota
- Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, Minnesota
| | - Larry J. Prokop
- Department of Library–Public Services, Mayo Clinic, Rochester, Minnesota
| | - Mohammad Hassan Murad
- Mayo Clinic Evidence-based Practice Center, Rochester, Minnesota
- Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, Minnesota
| | - Zhen Wang
- Mayo Clinic Evidence-based Practice Center, Rochester, Minnesota
- Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, Minnesota
- Division of Health Care Delivery Research, Mayo Clinic, Rochester, Minnesota
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Huang YS, Yeh CB, Chen CH, Shang CY, Gau SSF. A Randomized, Double-Blind, Placebo-Controlled, Two-Way Crossover Clinical Trial of ORADUR-Methylphenidate for Treating Children and Adolescents with Attention-Deficit/Hyperactivity Disorder. J Child Adolesc Psychopharmacol 2021; 31:164-178. [PMID: 33395356 PMCID: PMC8066345 DOI: 10.1089/cap.2020.0104] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Objective: Methylphenidate (MPH) is efficacious in reducing symptoms of attention-deficit/hyperactivity disorder (ADHD), but there are no data about the efficacy and safety of its new formulation (ORADUR®-MPH extended release, ORADUR-MPH) in patients with ADHD, which is the study objective. Method: This was a Phase III, multicenter, randomized, double-blind, placebo-controlled, two-way crossover clinical trial. One hundred children and adolescents with a clinical diagnosis of ADHD (72.7% male) received at least one dose of ORADUR-MPH or a placebo during the 2-week treatment period of each phase. The primary efficacy measure was the Swanson, Nolan, and Pelham-IV-teacher (SNAP-IV-T) form. Secondary efficacy measures included the SNAP-IV-parent form, the Clinical Global Impression: ADHD-Severity score, the Conner's Teacher's Rating Scale score, and the investigator's rating for 18 Diagnostic and Statistical Manual of Mental Disorders, 5th edition ADHD symptoms. In addition, data related to vital signs, body weight, physical examination, laboratory testing, and adverse events (AEs) were also collected. All data were analyzed on an intent-to-treat basis. Results: Without adjusting for differences in demographics and baseline measures, both treatment groups showed significant reductions in ADHD and oppositional defiant disorder symptoms after a 2-week treatment with greater effect sizes (Cohen's d) in the ORADUR-MPH group (Cohen's d ranging from -0.41 to -1.64; placebo, Cohen's d ranging from -0.26 to -1.18), except for oppositional symptoms, regardless of the informants. For the primary efficacy measure, ORADUR-MPH was significantly superior to the placebo, as evidenced by lower values for and greater reductions in the SNAP-IV-T scores at the endpoint (Cohen's d = -0.16, p = 0.005) and from baseline to the endpoint (Cohen's d = -0.19, p = 0.006), respectively. There were no serious AEs during the clinical study period. The most frequently observed AE was decreased appetite (49.1%). Most physical and laboratory test variables remained within the normal range. Conclusions: Once-daily ORADUR-MPH is an effective, well-tolerable, and safe treatment for children and adolescents with ADHD. ClinicalTrials.gov number, NCT02450890.
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Affiliation(s)
- Yu-Shu Huang
- Department of Child Psychiatry, Chang Gung Memorial Hospital and University, Taoyuan, Taiwan
| | - Chin-Bin Yeh
- Department of Psychiatry, Tri-Service General Hospital and University, Taipei, Taiwan
| | - Chin-Hung Chen
- Department of Psychiatry, Chang Gung Memorial Hospital and University, Chiayi, Taiwan
| | - Chi-Yung Shang
- Department of Psychiatry, National Taiwan University Hospital and College of Medicine, National Taiwan University, Taipei, Taiwan
| | - Susan Shur-Fen Gau
- Department of Psychiatry, National Taiwan University Hospital and College of Medicine, National Taiwan University, Taipei, Taiwan.,Address correspondence to: Susan Shur-Fen Gau, MD, PhD, Department of Psychiatry, National Taiwan University Hospital and College of Medicine, No. 7, Chung-Shan South Road, Taipei 10002, Taiwan
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24
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Noor Azhar M, Bustam A, Poh K, Ahmad Zahedi AZ, Mohd Nazri MZA, Azizah Ariffin MA, Md Yusuf MH, Zambri A, Chong JYO, Kamarudin A, Ang BT, Iskandar A, Chew KS. COVID-19 aerosol box as protection from droplet and aerosol contaminations in healthcare workers performing airway intubation: a randomised cross-over simulation study. Emerg Med J 2021; 38:111-117. [PMID: 33219133 PMCID: PMC7681799 DOI: 10.1136/emermed-2020-210514] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2020] [Revised: 10/16/2020] [Accepted: 10/19/2020] [Indexed: 01/25/2023]
Abstract
BACKGROUND Concerns over high transmission risk of SARS-CoV-2 have led to innovation and usage of an aerosol box to protect healthcare workers during airway intubation in patients with COVID-19. Its efficacy as a barrier protection in addition to the use of a standard personal protective equipment (PPE) is not fully known. We performed a simulated study to investigate the relationship between aerosol box usage during intubation and contaminations on healthcare workers pre-doffing and post-doffing of PPE. METHODS This was a randomised cross-over study conducted between 9 April to 5 May 2020 in the ED of University Malaya Medical Centre. Postgraduate Emergency Medicine trainees performed video laryngoscope-assisted intubation on an airway manikin with and without an aerosol box in a random order. Contamination was simulated by nebulised Glo Germ. Primary outcome was number of contaminated front and back body regions pre-doffing and post-doffing of PPE of the intubator and assistant. Secondary outcomes were intubation time, Cormack-Lehane score, number of intubation attempts and participants' feedback. RESULTS Thirty-six trainees completed the study interventions. The number of contaminated front and back body regions pre-doffing of PPE was significantly higher without the aerosol box (all p values<0.001). However, there was no significant difference in the number of contaminations post-doffing of PPE between using and not using the aerosol box, with a median contamination of zero. Intubation time was longer with the aerosol box (42.5 s vs 35.5 s, p<0.001). Cormack-Lehane scores were similar with and without the aerosol box. First-pass intubation success rate was 94.4% and 100% with and without the aerosol box, respectively. More participants reported reduced mobility and visibility when intubating with the aerosol box. CONCLUSIONS An aerosol box may significantly reduce exposure to contaminations but with increased intubation time and reduced operator's mobility and visibility. Furthermore, the difference in degree of contamination between using and not using an aerosol box could be offset by proper doffing of PPE.
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Affiliation(s)
- Muhaimin Noor Azhar
- Academic Unit of Emergency Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Aida Bustam
- Academic Unit of Emergency Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Khadijah Poh
- Academic Unit of Emergency Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | | | | | | | - Mohd Hafyzuddin Md Yusuf
- Academic Unit of Emergency Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Aliyah Zambri
- Academic Unit of Emergency Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Johnathan Y O Chong
- Department of Emergency Medicine, University of Malaya Medical Centre, Kuala Lumpur, Malaysia
| | - Anhar Kamarudin
- Academic Unit of Emergency Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Bin Ting Ang
- Department of Emergency Medicine, University of Malaya Medical Centre, Kuala Lumpur, Malaysia
| | - Affan Iskandar
- Department of Emergency Medicine, University of Malaya Medical Centre, Kuala Lumpur, Malaysia
| | - Keng Sheng Chew
- Faculty of Medicine and Health Sciences, University of Malaysia Sarawak, Kota Samarahan, Malaysia
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25
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Ferro Y, Mazza E, Angotti E, Pujia R, Mirarchi A, Salvati MA, Terracciano R, Savino R, Romeo S, Scuteri A, Mare R, Costanzo FS, Pujia A, Montalcini T. Effect of a novel functional tomato sauce (OsteoCol) from vine-ripened tomatoes on serum lipids in individuals with common hypercholesterolemia: tomato sauce and hypercholesterolemia. J Transl Med 2021; 19:19. [PMID: 33407609 PMCID: PMC7788951 DOI: 10.1186/s12967-020-02676-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2020] [Accepted: 12/11/2020] [Indexed: 12/01/2022] Open
Abstract
Background Most studies focused on the benefits of lycopene on serum lipids but no studies have been specifically designed to assess the role of a tomato sauce from vine-ripened tomatoes on patients affected by polygenic hypercholesterolemia. The aim of this study was to compare the lipid-lowering effect of a novel functional tomato sauce with a well-known functional food with a lipid-lowering effect, i.e. a sterol-enriched yogurt. Methods In this cross-over study, we evaluated a population of 108 ambulatory patients affected by polygenic hypercholesterolemia of both gender, who were allocated to a tomato sauce (namely OsteoCol) 150 ml/day or a sterol-enriched yogurt (containing sterols 1.6 g/die) treatment, for 6 weeks. Carotenoids content was 3.5 mg per gram of product. We measured serum lipids and creatinine and transaminases at basal and follow-up visit. Results A total of 91 subjects completed the protocol. A significant difference in LDL-cholesterol change was found between participants taking yogurt, tomato sauce (high adherence) and tomato sauce (low adherence) (− 16; − 12; + 8 mg/dl respectively; p < 0.001). We found a greater LDL-cholesterol reduction in the participants with a basal LDL-cholesterol more than 152 mg/dl (15% for sterol-enriched yogurt and 12% for tomato sauce at high adherence). Conclusion A novel functional tomato sauce from vine-ripened tomatoes compares favourably with a commercialised sterol-enriched yogurt in term of absolute LDL-cholesterol change. Intake of a tomato sauce with a high carotenoid content may support treatment of patients affected by common hypercholesterolemia. The present study has various limitations. The presence of other dietary components, which may have influenced the results, cannot be ruled out. Of course, these results cannot be extrapolated to other populations. Furthermore, there was a low adherence rate in the tomato sauce group. Moreover, we did not report serum carotenoids data. Trial registration: ID: 13244115 on the ISRCTN registry, retrospectively registered in 2019-5-14. URL: http://www.isrctn.com/ISRCTN13244115
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Affiliation(s)
- Yvelise Ferro
- Department of Health Science, University Magna Grecia, 88100, Catanzaro, Italy
| | - Elisa Mazza
- Department of Medical and Surgical Science, Nutrition Unit, University Magna Grecia, 88100, Catanzaro, Italy
| | - Elvira Angotti
- Department of Clinical and Experimental Medicine, Nutrition Unit, University Magna Grecia, 88100, Catanzaro, Italy
| | - Roberta Pujia
- Department of Health Science, University Magna Grecia, 88100, Catanzaro, Italy
| | - Angela Mirarchi
- Department of Health Science, University Magna Grecia, 88100, Catanzaro, Italy
| | - Maria Antonietta Salvati
- Department of Medical and Surgical Science, Nutrition Unit, University Magna Grecia, 88100, Catanzaro, Italy
| | - Rosa Terracciano
- Department of Health Science, University Magna Grecia, 88100, Catanzaro, Italy
| | - Rocco Savino
- Department of Health Science, University Magna Grecia, 88100, Catanzaro, Italy
| | - Stefano Romeo
- Department of Medical and Surgical Science, Nutrition Unit, University Magna Grecia, 88100, Catanzaro, Italy.,Department of Molecular and Clinical Medicine, University of Gothenburg, 41101, Gothenburg, Sweden
| | | | - Rosario Mare
- Department of Clinical and Experimental Medicine, Nutrition Unit, University Magna Grecia, 88100, Catanzaro, Italy
| | - Francesco Saverio Costanzo
- Department of Clinical and Experimental Medicine, Nutrition Unit, University Magna Grecia, 88100, Catanzaro, Italy
| | - Arturo Pujia
- Department of Medical and Surgical Science, Nutrition Unit, University Magna Grecia, 88100, Catanzaro, Italy
| | - Tiziana Montalcini
- Department of Clinical and Experimental Medicine, Nutrition Unit, University Magna Grecia, 88100, Catanzaro, Italy.
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26
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Siemens W, Boehlke C, Bennett MI, Offner K, Becker G, Gaertner J. Transcutaneous electrical nerve stimulation for advanced cancer pain inpatients in specialist palliative care-a blinded, randomized, sham-controlled pilot cross-over trial. Support Care Cancer 2020; 28:5323-5333. [PMID: 32128614 PMCID: PMC7547037 DOI: 10.1007/s00520-020-05370-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2019] [Accepted: 02/19/2020] [Indexed: 02/01/2023]
Abstract
PURPOSE Transcutaneous electrical nerve stimulation (TENS) is a treatment option for cancer pain, but the evidence is inconclusive. We aimed to evaluate the efficacy and safety of TENS. METHODS A blinded, randomized, sham-controlled pilot cross-over trial (NCT02655289) was conducted on an inpatient specialist palliative care ward. We included adult inpatients with cancer pain ≥ 3 on an 11-point numerical rating scale (NRS). Intensity-modulated high TENS (IMT) was compared with placebo TENS (PBT). Patients used both modes according to their preferred application scheme during 24 h with a 24-h washout phase. The primary outcome was change in average pain intensity on the NRS during the preceding 24 h. Responders were patients with at least a "slight improvement." RESULTS Of 632 patients screened, 25 were randomized (sequence IMT-PBT = 13 and PBT-IMT = 12). Finally, 11 patients in IMT-PBT and 9 in PBT-IMT completed the study (N = 20). The primary outcome did not differ between groups (IMT minus PBT: - 0.2, 95% confidence interval - 0.9 to 0.6). However, responder rates were higher in IMT (17/20 [85%] vs. 10/20 [50%], p = 0.0428). Two patients experienced an uncomfortable feeling caused by the current, one after IMT and one after PBT. Seven patients (35%) desired a TENS prescription. Women and patients with incident pain were most likely to benefit from TENS. CONCLUSION TENS was safe, but IMT was unlikely to offer more analgesic effects than PBT. Even though many patients desired a TENS prescription, 50% still reported at least "slight pain relief" from PBT. Differences for gender and incident pain aspects demand future trials.
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Affiliation(s)
- Waldemar Siemens
- Clinic for Palliative Care, Medical Center, Faculty of Medicine, University of Freiburg, Robert-Koch-Str 3, 79106, Freiburg, Germany.
| | - Christopher Boehlke
- Clinic for Palliative Care, Medical Center, Faculty of Medicine, University of Freiburg, Robert-Koch-Str 3, 79106, Freiburg, Germany
| | - Michael I Bennett
- Academic Unit of Palliative Care, Leeds Institute of Health Sciences (LIHS), School of Medicine, University of Leeds, Leeds, UK
| | - Klaus Offner
- Department of Anesthesiology and Critical Care, Medical Center, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Gerhild Becker
- Clinic for Palliative Care, Medical Center, Faculty of Medicine, University of Freiburg, Robert-Koch-Str 3, 79106, Freiburg, Germany
| | - Jan Gaertner
- Center for Palliative Care Hildegard, Basel, Switzerland
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Mat Nawi N, Tagiling N, Mohd Rohani MF, Wan Zainon WMN, Zanial MS, Wong MS, Lee YY. 99mTc-sodium phytate is a valid alternative to the gold-standard 99mTc-sulfur colloid in the measurement of gastric emptying among healthy multi-ethnic Asian population: results of a randomized cross-over trial. BMC Gastroenterol 2020; 20:293. [PMID: 32867699 PMCID: PMC7457507 DOI: 10.1186/s12876-020-01426-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/06/2020] [Accepted: 08/13/2020] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND It is unclear if the 99mTc-sodium phytate (99mTc-SP) is as reliable as the gold-standard 99mTc-sulfur colloid (99mTc-SC) for gastric emptying scintigraphy (GES). This study is aimed to compare the emptying rates of both radiotracers in a prospective, randomized cross-over trial and to determine the normative data of a healthy multi-ethnic Asian population. METHODS Out of the 44 healthy individuals screened, 31 (14 females; mean age: 28.4 ± 7.0 years) were enrolled and underwent GES using the standardized egg-white meal. All participants were randomly assigned to either 99mTc-SP or 99mTc-SC on the first GES session before crossed over to the other formulation after 2 weeks. RESULTS Both kits achieved the radiochemical purities of > 95%. The median rate (95th upper normative limit) of gastric emptying, reported as total gastric meal retention between 99mTc-SP and 99mTc-SC, was found to be comparable at all measured time points: 0.5 h [85.0% (96.6%) vs. 82.0% (94.0%)], 1 h [70.0% (86.4%) vs. 65.0% (86.6%)], 2 h [31.0% (55.8%) vs. 25.0% (64.4%)], 3 h [7.0% (26.3%) vs. 5.0% (29.9%)], and 4 h [3.0% (10.3%) vs. 2.0% (9.9%)]; P > 0.05. In addition, both radiotracers correlated well (Kendall's Tau (τ) coefficient = 0.498, P < 0.001) and presented with a good agreement at the 4th-hour time frame based on the Bland-Altman plot analysis. CONCLUSIONS 99mTc-SP is a valid radiotracer alternative to 99mTc-SC for routine GES examination. The normative values for both radiotracers have also been determined for the healthy multi-ethnic Asian population. TRIAL REGISTRATION This trial was registered retrospectively in the Thai Clinical Trials Registry on May 23rd, 2020 (Identifier: TCTR20200526004; http://www.clinicaltrials.in.th/index.php?tp=regtrials&menu=trialsearch&smenu=fulltext&task=search&task2=view1&id=6296 ).
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Affiliation(s)
- Norazlina Mat Nawi
- Department of Nuclear Medicine, Radiotherapy and Oncology, School of Medical Sciences, Universiti Sains Malaysia, Kubang Kerian, 16150, Kelantan, Malaysia
- Hospital USM, Universiti Sains Malaysia, Kubang Kerian, 16150, Kelantan, Malaysia
| | - Nashrulhaq Tagiling
- Department of Nuclear Medicine, Radiotherapy and Oncology, School of Medical Sciences, Universiti Sains Malaysia, Kubang Kerian, 16150, Kelantan, Malaysia
| | | | - Wan Mohd Nazlee Wan Zainon
- Hospital USM, Universiti Sains Malaysia, Kubang Kerian, 16150, Kelantan, Malaysia
- School of Dental Sciences, Universiti Sains Malaysia, Kubang Kerian, 16150, Kelantan, Malaysia
| | | | - Mung Seong Wong
- Hospital USM, Universiti Sains Malaysia, Kubang Kerian, 16150, Kelantan, Malaysia
- Department of Medicine, School of Medical Sciences, Universiti Sains Malaysia, Kubang Kerian, 16150, Kelantan, Malaysia
| | - Yeong Yeh Lee
- Hospital USM, Universiti Sains Malaysia, Kubang Kerian, 16150, Kelantan, Malaysia.
- Department of Medicine, School of Medical Sciences, Universiti Sains Malaysia, Kubang Kerian, 16150, Kelantan, Malaysia.
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The efficacy of ball blankets on insomnia in depression in outpatient clinics: study protocol for a randomized crossover multicentre trial. Trials 2020; 21:720. [PMID: 32807208 PMCID: PMC7430021 DOI: 10.1186/s13063-020-04638-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2020] [Accepted: 07/27/2020] [Indexed: 11/10/2022] Open
Abstract
Background Depression affects approx. 4% of the global population and is often accompanied by insomnia. Medications used to treat insomnia can have side effects such as development of tolerance and addiction. The Protac Ball Blanket™ (PBB) is a non-pharmacological supplement to sedatives and hypnotics, but evidence for the efficacy of PBB is needed before the treatment is implemented. The objective of this trial is to test the efficacy of PBB on insomnia caused by depression in a randomized controlled design. Methods This study is a multicentre, randomized crossover trial with planned inclusion of 45 patients. The randomization procedure is permuted-block randomization with varying block sizes. Patients are allocated into either a sequence “AB” or “BA” each lasting 4 weeks (28 nights). Patients randomized to the “AB” sequence receive treatment A (Protac Ball Blanket™) in the first 2 weeks and switch to treatment B (treatment as usual) in the second period, whereas patients who are randomized to the BA sequence receive treatment B in the first period and treatment A in the second period. The participants will serve as their own control in this design. The primary outcome is changes in total sleep time. Secondary outcome measures are changes in sleep onset latency, number of awakenings, wake after sleep onset, and use of sedatives and hypnotics. Furthermore, quality of sleep, insomnia severity status, and self-reported symptoms of depression, anxiety, interpersonal sensitivity, and neurasthenia will be measured. A paired, two-sided t test to compare the means of the differences in the outcomes will be performed. Discussion This clinical trial will assess the effect of PBB on depression-related insomnia. The outcomes are of high interest as the PBB is a potential non-pharmacological supplement to medical treatment of patients with insomnia due to depression. Trial registration ClinicalTrials.gov Identifier: NCT03730974. Registered on 5 November 2018.
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Bertolaccini L, Spaggiari L. The synthesis of scientific shreds of evidence: a critical appraisal on systematic review and meta-analysis methodology. J Thorac Dis 2020; 12:3399-3403. [PMID: 32642265 PMCID: PMC7330768 DOI: 10.21037/jtd.2020.03.07] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
Synthesising results across studies to recognise the causes of variation in outcomes and to reach an overall understanding of a problem is a crucial part of the scientific method. Until in recent times, the results of scientific findings have been summarised in narrative reviews where the summary of transparent and objective results have become increasingly difficult. Systematic reviews and meta-analyses, conducted by subsequent strict protocols to guarantee reproducibility and decrease bias, have become more common in the synthesis of evidence.
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Affiliation(s)
- Luca Bertolaccini
- Department of Thoracic Surgery, IEO, European Institute of Oncology IRCCS, Milan, Italy
| | - Lorenzo Spaggiari
- Department of Thoracic Surgery, IEO, European Institute of Oncology IRCCS, Milan, Italy.,Department of Oncology and Hemato-Oncology, University of Milan, Milan, Italy
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Helou N, Talhouedec D, Zumstein-Shaha M, Zanchi A. A Multidisciplinary Approach for Improving Quality of Life and Self-Management in Diabetic Kidney Disease: A Crossover Study. J Clin Med 2020; 9:E2160. [PMID: 32650548 PMCID: PMC7408890 DOI: 10.3390/jcm9072160] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2020] [Accepted: 07/06/2020] [Indexed: 01/07/2023] Open
Abstract
Individuals with diabetic kidney disease are at high risk of complications and challenged to self-manage. Previous research suggested that multidisciplinary approaches would improve health outcomes. This study investigated the effect of a multidisciplinary self-management approach of diabetic kidney disease on quality of life, and self-management, glycemic control, and renal function. A uniform balanced crossover design was used because it attains a high level of statistical power with a lower sample size. A total of 32 participants (aged 67.8 ± 10.8) were randomized into four study arms. In differing sequences, each participant was treated twice with three months of usual care alternated with three months of multidisciplinary management. The intervention improved the present dimension of quality of life demonstrating higher mean rank as compared to usual care (52.49 vs. 41.01; p = 0.026, 95% CI) and three self-care activities, general diet habits, diabetes diet habits, and blood sugar testing (respectively: 55.43 vs. 38.31; p = 0.002, 56.84 vs. 37.02; p = 0.000, 53.84 vs. 39.77; p = 0.008; 95% CI). Antihypertensive medication engagement was high across the study period (Mean = 95.38%, Min = 69%, Max = 100%). Glycemic control and renal function indicators were similar for the intervention and the usual care. Studies are needed to determine how the new recommended therapies for diabetic kidney disease such as SGLT2 inhibitors and GLP-1 receptor agonists impact on self-management and quality of life.
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Affiliation(s)
- Nancy Helou
- School of Health Sciences (HESAV), HES-SO University of Applied Sciences and Arts Western Switzerland, 1011 Lausanne, Switzerland
| | | | - Maya Zumstein-Shaha
- Department of Health, Bern University of Applied Sciences, 3010 Bern, Switzerland;
| | - Anne Zanchi
- Service of Nephrology and Hypertension, Service of Endocrinology, Diabetes and Metabolism, Department of Medicine, Lausanne University Hospital and University of Lausanne, 1011 Lausanne, Switzerland;
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Zeng L, Qureshi R, Viswanathan S, Drye L, Li T. Registration of phase 3 crossover trials on ClinicalTrials.gov. Trials 2020; 21:613. [PMID: 32631413 PMCID: PMC7336618 DOI: 10.1186/s13063-020-04545-2] [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] [Subscribe] [Scholar Register] [Received: 02/21/2020] [Accepted: 06/22/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND In a randomized crossover trial, each participant is randomized to a sequence of treatments and treatment effect is estimated based on within-individual difference because each participant serves as his/her own control. This feature makes the design and reporting of randomized crossover trials different from that of parallel trials. Our objective was to characterize phase 3 crossover trials with results reported on ClinicalTrials.gov and identify issues and best practices for reporting. METHODS We searched ClinicalTrials.gov for phase 3 randomized crossover trials that provided results, registered at least one primary outcome, and included at least one link to a results publication in the record by August 6, 2019. Two reviewers independently assessed the eligibility and extracted information from each record into an electronic form developed and maintained in the Systematic Review Data Repository. RESULTS Of the 124 crossover trials analyzed, two thirds were a simple "Intervention A then B" or "Intervention B then A" (AB|BA) design. Most trials (78%, 97/124) provided enough information to understand the participant flow throughout the trial. Baseline characteristics were most often reported for all participants as a single group (52%, 65/124). Primary outcomes and adverse events were most commonly reported "per intervention" (85%, 105/124, and 80%, 99/124, respectively). CONCLUSIONS The registration and reporting of randomized crossover trials must account for the paired nature of the design. Our observations and recommendations informed the development of guidelines for good reporting practices in the registration and reporting of randomized crossover trials.
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Affiliation(s)
- Lijuan Zeng
- Statistics Collaborative, Inc, Washington, D. C., USA
| | - Riaz Qureshi
- Center for Clinical Trials and Evidence Synthesis, Department of Epidemiology, Johns Hopkins Bloomberg School of Public Heath, Baltimore, MD, USA
| | | | - Lea Drye
- Blue Cross Blue Shield Association, Chicago, IL, USA
| | - Tianjing Li
- Department of Ophthalmology, School of Medicine, University of Colorado Denver, Aurora, CO, USA.
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Rafiee M, Patel K, Groppe DM, Andrade DM, Bercovici E, Bui E, Carlen PL, Reid A, Tai P, Weaver D, Wennberg R, Valiante TA. Daily listening to Mozart reduces seizures in individuals with epilepsy: A randomized control study. Epilepsia Open 2020; 5:285-294. [PMID: 32524054 PMCID: PMC7278546 DOI: 10.1002/epi4.12400] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2020] [Revised: 05/02/2020] [Accepted: 05/03/2020] [Indexed: 11/06/2022] Open
Abstract
OBJECTIVE Epilepsy is one of the most common neurological disorders . Many individuals continue to have seizures despite medical and surgical treatments, suggesting adjunctive management strategies are required. Promising effects of daily listening to Mozart on reducing seizure frequency in individuals with epilepsy have been demonstrated over the last 20 years, but not in a rigorously controlled manner. In this study, we compared the effect on seizure frequency of daily listening to either Mozart K.448 or a spectrally similar, yet non-rhythmic control piece. We hypothesized that there would be no difference in seizure counts when participants listened to Mozart K.448 vs when they listened to the control piece. METHODS We employed a randomized crossover design, in which each participant was exposed to both three months of daily listening to the first six minutes of Sonata for two pianos in D major by Mozart (Mozart K.448; treatment period) and three months of daily listening to phase-scrambled version (control period). There was a three-month baseline and a three-month follow-up period before and after the six-month listening period, respectively. Change in seizure counts obtained from the seizure diaries was considered as the main study outcome. RESULTS Using three methodologies to investigate the existence of the treatment effect (paired t test, estimation statistics and plots, and Cohen's d), our results revealed a reduction in seizure counts during the treatment period, which was not observed for the control period (P-value < .001). SIGNIFICANCE Using a spectrally similar control piece, our study advances previous reports that were limited by a "no music" control condition. Daily listening to Mozart K.448 was associated with reducing seizure frequency in adult individuals with epilepsy. These results suggest that daily Mozart listening may be considered as an adjunctive therapeutic option to reduce seizure burden in individuals with epilepsy.
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Affiliation(s)
| | - Kramay Patel
- Krembil Brain InstituteTorontoONCanada
- Institute of Biomaterials and Biomedical Engineering, and Electrical and Computer EngineeringUniversity of TorontoTorontoONCanada
| | | | - Danielle M. Andrade
- Krembil Brain InstituteTorontoONCanada
- Division of NeurologyDepartment of MedicineUniversity of TorontoTorontoONCanada
| | - Eduard Bercovici
- Krembil Brain InstituteTorontoONCanada
- Division of NeurologyDepartment of MedicineUniversity of TorontoTorontoONCanada
| | - Esther Bui
- Krembil Brain InstituteTorontoONCanada
- Division of NeurologyDepartment of MedicineUniversity of TorontoTorontoONCanada
| | - Peter L. Carlen
- Krembil Brain InstituteTorontoONCanada
- Institute of Biomaterials and Biomedical Engineering, and Electrical and Computer EngineeringUniversity of TorontoTorontoONCanada
- Division of NeurologyDepartment of MedicineUniversity of TorontoTorontoONCanada
- Department of PhysiologyUniversity of TorontoTorontoONCanada
- Division of NeurosurgeryDepartment of SurgeryUniversity of TorontoTorontoONCanada
| | - Aylin Reid
- Krembil Brain InstituteTorontoONCanada
- Division of NeurologyDepartment of MedicineUniversity of TorontoTorontoONCanada
| | - Peter Tai
- Krembil Brain InstituteTorontoONCanada
- Division of NeurologyDepartment of MedicineUniversity of TorontoTorontoONCanada
| | - Donald Weaver
- Krembil Brain InstituteTorontoONCanada
- Division of NeurologyDepartment of MedicineUniversity of TorontoTorontoONCanada
- Department of ChemistryUniversity of TorontoTorontoONCanada
| | - Richard Wennberg
- Krembil Brain InstituteTorontoONCanada
- Division of NeurologyDepartment of MedicineUniversity of TorontoTorontoONCanada
| | - Taufik A. Valiante
- Krembil Brain InstituteTorontoONCanada
- Institute of Biomaterials and Biomedical Engineering, and Electrical and Computer EngineeringUniversity of TorontoTorontoONCanada
- Division of NeurosurgeryDepartment of SurgeryUniversity of TorontoTorontoONCanada
- Institute of Medical ScienceFaculty of MedicineUniversity of TorontoTorontoONCanada
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Cuyul-Vásquez I, Leiva-Sepúlveda A, Catalán-Medalla O, Berríos-Contreras L. [Blood flow restriction training for people with cardiovascular disease: An exploratory review]. Rehabilitacion (Madr) 2020; 54:116-127. [PMID: 32370826 DOI: 10.1016/j.rh.2020.01.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2019] [Revised: 11/10/2019] [Accepted: 01/11/2020] [Indexed: 06/11/2023]
Abstract
OBJECTIVE To analyse the evidence on the effects of blood flow restriction training in people with cardiovascular disease. MATERIALS AND METHODS We searched MEDLINE, EMBASE, SPORTDiscus, CINAHL, LILACS, SCOPUS and Wiley databases. Experimental and non-experimental studies investigating the effects of blood flow restriction in participants with cardiovascular disease were included. RESULTS Six clinical trials and three non-experimental studies met the inclusion criteria. The experimental studies were conducted in participants with hypertension and ischaemic heart disease. Non-experimental studies described hemodynamic adaptations and potential adverse effects of therapy. The risk of bias of the included clinical trials was moderate to high. Exercise-induced hemodynamic stress increased significantly during training with blood flow restriction compared with traditional training. The small number of available studies have focused mostly on acute effects, but chronic effects are unknown. CONCLUSION There is currently no evidence to recommend the use of blood flow restriction in people with cardiovascular disease.
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Affiliation(s)
- I Cuyul-Vásquez
- Departamento de Procesos Terapéuticos, Facultad de Ciencias de la Salud, Universidad Católica de Temuco, Temuco, Chile.
| | - A Leiva-Sepúlveda
- Departamento de Procesos Terapéuticos, Facultad de Ciencias de la Salud, Universidad Católica de Temuco, Temuco, Chile
| | - O Catalán-Medalla
- Departamento de Procesos Terapéuticos, Facultad de Ciencias de la Salud, Universidad Católica de Temuco, Temuco, Chile
| | - L Berríos-Contreras
- Departamento de Kinesiología, Facultad de Ciencias de la Salud, Universidad Católica del Maule, Talca, Chile
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Effect of Neurally Adjusted Ventilatory Assist on Patient-Ventilator Interaction in Mechanically Ventilated Adults: A Systematic Review and Meta-Analysis. Crit Care Med 2020; 47:e602-e609. [PMID: 30882481 DOI: 10.1097/ccm.0000000000003719] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
OBJECTIVES Patient-ventilator asynchrony is common among critically ill patients undergoing mechanical ventilation and has been associated with adverse outcomes. Neurally adjusted ventilatory assist is a ventilatory mode that may lead to improved patient-ventilator synchrony. We conducted a systematic review to determine the impact of neurally adjusted ventilatory assist on patient-ventilator asynchrony, other physiologic variables, and clinical outcomes in adult patients undergoing invasive mechanical ventilation in comparison with conventional pneumatically triggered ventilatory modes. DATA SOURCES We searched Medline, EMBASE, Cochrane Database of Systematic Reviews, Cochrane Central, CINAHL, Scopus, Web of Science, conference abstracts, and ClinicalTrials.gov until July 2018. STUDY SELECTION Two authors independently screened titles and abstracts for randomized and nonrandomized controlled trials (including crossover design) comparing the occurrence of patient-ventilator asynchrony between neurally adjusted ventilatory assist and pressure support ventilation during mechanical ventilation in critically ill adults. The asynchrony index and severe asynchrony (i.e., asynchrony index > 10%) were the primary outcomes. DATA EXTRACTION Two authors independently extracted study characteristics and outcomes and assessed risk of bias of included studies. DATA SYNTHESIS Of 11,139 unique citations, 26 studies (522 patients) met the inclusion criteria. Sixteen trials were included in the meta-analysis using random effects models through the generic inverse variance method. In several different clinical scenarios, the use of neurally adjusted ventilatory assist was associated with significantly reduced asynchrony index (mean difference, -8.12; 95% CI, -11.61 to -4.63; very low quality of evidence) and severe asynchrony (odds ratio, 0.42; 95% CI, 0.23-0.76; moderate quality of evidence) as compared with pressure support ventilation. Furthermore, other measurements of asynchrony were consistently improved during neurally adjusted ventilatory assist. CONCLUSIONS Neurally adjusted ventilatory assist improves patient-ventilator synchrony; however, its effects on clinical outcomes remain uncertain. Randomized controlled trials are needed to determine whether the physiologic efficiency of neurally adjusted ventilatory assist affects patient-important outcomes in critically ill adults.
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Saito Y, Watanabe T, Sasaki T, Watanabe K, Hirayama M, Fujita N. Effects of single ingestion of rice cracker and cooked rice with high resistant starch on postprandial glucose and insulin responses in healthy adults: two randomized, single-blind, cross-over trials. Biosci Biotechnol Biochem 2020; 84:365-371. [DOI: 10.1080/09168451.2019.1687282] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
ABSTRACT
Rice with double mutation of starch synthase IIIa and branching enzyme IIb (ss3a/be2b) has much higher amounts of apparent amylose and resistant starch (RS) than usual varieties. In this study, we conducted two randomized, single-blind, crossover trials to investigate the effect of single ingestion of two processed foods composed of ss3a/be2b mutant rice on postprandial blood glucose and insulin response in healthy adults, compared to those of usual cultivar. In trial 1, of ingestion of rice crackers, the incremental area under the curves of glucose (IAUCglc) and insulin (IAUCins) in RS group was significantly lower than in the control group. In trial 2, of the ingestion of cooked rice, IAUCglc in the RS group was significantly lower than in the control group. These results showed that the ss3a/be2b-mutant rice cracker and cooked rice having high RS can attenuate postprandial blood glucose and insulin response.
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Affiliation(s)
- Yuhi Saito
- Kameda Seika Co., Ltd, Konan-ku, Niigata, Japan
| | | | | | - Kenichi Watanabe
- Department of Clinical Pharmacology, Niigata University of Pharmacy and Applied Life Sciences, Akiha-ku, Niigata, Japan
| | - Masao Hirayama
- Department of Food Science, Niigata University of Pharmacy and Applied Life Sciences, Akiha-ku, Niigata, Japan
| | - Naoko Fujita
- Laboratory of Plant Physiology, Department of Biological Production, Faculty of Bioresource Sciences, Akita Prefectural University, Shimoshinjo-nakano, Akita, Japan
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Koutsos A, Riccadonna S, Ulaszewska MM, Franceschi P, Trošt K, Galvin A, Braune T, Fava F, Perenzoni D, Mattivi F, Tuohy KM, Lovegrove JA. Two apples a day lower serum cholesterol and improve cardiometabolic biomarkers in mildly hypercholesterolemic adults: a randomized, controlled, crossover trial. Am J Clin Nutr 2020; 111:307-318. [PMID: 31840162 PMCID: PMC6997084 DOI: 10.1093/ajcn/nqz282] [Citation(s) in RCA: 47] [Impact Index Per Article: 11.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2019] [Accepted: 10/21/2019] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND Apples are rich in bioactive polyphenols and fiber. Evidence suggests that consumption of apples or their bioactive components is associated with beneficial effects on lipid metabolism and other markers of cardiovascular disease (CVD). However, adequately powered randomized controlled trials are necessary to confirm these data and explore the mechanisms. OBJECTIVE We aimed to determine the effects of apple consumption on circulating lipids, vascular function, and other CVD risk markers. METHODS The trial was a randomized, controlled, crossover, intervention study. Healthy mildly hypercholesterolemic volunteers (23 women, 17 men), with a mean ± SD BMI 25.3 ± 3.7 kg/m2 and age 51 ± 11 y, consumed 2 apples/d [Renetta Canada, rich in proanthocyanidins (PAs)] or a sugar- and energy-matched apple control beverage (CB) for 8 wk each, separated by a 4-wk washout period. Fasted blood was collected before and after each treatment. Serum lipids, glucose, insulin, bile acids, and endothelial and inflammation biomarkers were measured, in addition to microvascular reactivity, using laser Doppler imaging with iontophoresis, and arterial stiffness, using pulse wave analysis. RESULTS Whole apple (WA) consumption decreased serum total (WA: 5.89 mmol/L; CB: 6.11 mmol/L; P = 0.006) and LDL cholesterol (WA: 3.72 mmol/L; CB: 3.86 mmol/L; P = 0.031), triacylglycerol (WA: 1.17 mmol/L; CB: 1.30 mmol/L; P = 0.021), and intercellular cell adhesion molecule-1 (WA: 153.9 ng/mL; CB: 159.4 ng/mL; P = 0.028), and increased serum uric acid (WA: 341.4 μmol/L; CB: 330 μmol/L; P = 0.020) compared with the CB. The response to endothelium-dependent microvascular vasodilation was greater after the apples [WA: 853 perfusion units (PU), CB: 760 PU; P = 0.037] than after the CB. Apples had no effect on blood pressure or other CVD markers. CONCLUSIONS These data support beneficial hypocholesterolemic and vascular effects of the daily consumption of PA-rich apples by mildly hypercholesterolemic individuals.This trial was registered at clinicaltrials.gov as NCT01988389.
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Affiliation(s)
- Athanasios Koutsos
- Hugh Sinclair Unit of Human Nutrition and the Institute for Cardiovascular and Metabolic Research, Department of Food and Nutritional Sciences, University of Reading, Reading, United Kingdom
- Department of Food Quality and Nutrition, Research and Innovation Centre, Fondazione Edmund Mach, San Michele all'Adige, Italy
| | - Samantha Riccadonna
- Unit of Computational Biology, Research and Innovation Centre, Fondazione Edmund Mach, San Michele all'Adige, Italy
| | - Maria M Ulaszewska
- Department of Food Quality and Nutrition, Research and Innovation Centre, Fondazione Edmund Mach, San Michele all'Adige, Italy
| | - Pietro Franceschi
- Unit of Computational Biology, Research and Innovation Centre, Fondazione Edmund Mach, San Michele all'Adige, Italy
| | - Kajetan Trošt
- Department of Food Quality and Nutrition, Research and Innovation Centre, Fondazione Edmund Mach, San Michele all'Adige, Italy
- Steno Diabetes Centre Copenhagen, Gentofte, Denmark
| | - Amanda Galvin
- Hugh Sinclair Unit of Human Nutrition and the Institute for Cardiovascular and Metabolic Research, Department of Food and Nutritional Sciences, University of Reading, Reading, United Kingdom
| | - Tanya Braune
- Hugh Sinclair Unit of Human Nutrition and the Institute for Cardiovascular and Metabolic Research, Department of Food and Nutritional Sciences, University of Reading, Reading, United Kingdom
| | - Francesca Fava
- Department of Food Quality and Nutrition, Research and Innovation Centre, Fondazione Edmund Mach, San Michele all'Adige, Italy
| | - Daniele Perenzoni
- Department of Food Quality and Nutrition, Research and Innovation Centre, Fondazione Edmund Mach, San Michele all'Adige, Italy
| | - Fulvio Mattivi
- Department of Food Quality and Nutrition, Research and Innovation Centre, Fondazione Edmund Mach, San Michele all'Adige, Italy
- Department of Physics, University of Trento, Povo, Italy
| | - Kieran M Tuohy
- Department of Food Quality and Nutrition, Research and Innovation Centre, Fondazione Edmund Mach, San Michele all'Adige, Italy
| | - Julie A Lovegrove
- Hugh Sinclair Unit of Human Nutrition and the Institute for Cardiovascular and Metabolic Research, Department of Food and Nutritional Sciences, University of Reading, Reading, United Kingdom
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Jówko E, Płaszewski M, Cieśliński M, Sacewicz T, Cieśliński I, Jarocka M. The effect of low level laser irradiation on oxidative stress, muscle damage and function following neuromuscular electrical stimulation. A double blind, randomised, crossover trial. BMC Sports Sci Med Rehabil 2019; 11:38. [PMID: 31890228 PMCID: PMC6933902 DOI: 10.1186/s13102-019-0147-3] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2019] [Accepted: 11/01/2019] [Indexed: 12/16/2022]
Abstract
BACKGROUND Low level laser therapy (LLLT) is among novel methods for preventing and treating muscle damage and soreness induced by volitional exercise, but little is known about using LLLT before neuromuscular electrical stimulation. The aim of this first randomised, double blind, crossover trial addressing this issue was to evaluate effects of LLLT on muscle damage and oxidative stress, as well as recovery of muscle function after a single session of isometric neuromuscular electrical stimulation(NMES). METHODS Twenty four moderately active, healthy men aged 21-22 years received 45 electrically evoked tetanic, isometric contractions of the quadriceps femoris, preceded by LLLT or sham-LLLT. Maximal isometric voluntary muscle torques, perceived soreness, and blood samples were analysed from baseline to 96 h post intervention. We measured plasma markers of muscle damage (the activity of creatine kinase), and inflammation (C-reactive protein), and evaluated redox state parameters. RESULTS NMES-evoked contractions induced oxidative stress, demonstrated by an increase in lipid peroxidation and impairments in enzymatic antioxidant system. LLLT irradiations had a protective effect on NMES-induced decrease in enzymatic antioxidant defence and shortened the duration of inflammation. This effect of irradiations on redox state and inflammation did not affect lipid peroxidation, muscle damage, and muscle torque. CONCLUSIONS LLLT may protect from impairments in enzymatic antioxidant system and may shorten inflammation induced by a single NMES session in moderately active, healthy men. However, the effects of LLLT on redox state and inflammatory processes do not seem to affect muscle damage and recovery of muscle function after NMES. TRIAL REGISTRATION The study was retrospectively registered in the Australian New Zealand Clinical Trials Registry (ANZCTR); The trial registration number: ACTRN12619000678190; date of registration: 6 May 2019.
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Affiliation(s)
- Ewa Jówko
- Józef Piłsudski University of Physical Education in Warsaw; Faculty of Physical Education and Health in Biała Podlaska, Chair of Natural Sciences, Akademicka 2, 21-500 Biała Podlaska, Poland
| | - Maciej Płaszewski
- Józef Piłsudski University of Physical Education in Warsaw; Faculty of Physical Education and Health in Biała Podlaska, Chair of Rehabilitation, Biała Podlaska, Poland
| | - Maciej Cieśliński
- Józef Piłsudski University of Physical Education in Warsaw; Faculty of Physical Education and Health in Biała Podlaska, Chair of Rehabilitation, Biała Podlaska, Poland
| | - Tomasz Sacewicz
- Józef Piłsudski University of Physical Education in Warsaw; Faculty of Physical Education and Health in Biała Podlaska, Chair of Natural Sciences, Akademicka 2, 21-500 Biała Podlaska, Poland
| | - Igor Cieśliński
- Józef Piłsudski University of Physical Education in Warsaw; Faculty of Physical Education and Health in Biała Podlaska, Chair of Rehabilitation, Biała Podlaska, Poland
| | - Marta Jarocka
- Józef Piłsudski University of Physical Education in Warsaw; Faculty of Physical Education and Health in Biała Podlaska, Chair of Rehabilitation, Biała Podlaska, Poland
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Budhram DR, Shi D, McDonald SD, Walter SD. The crossover design for studies of infertility employing in-vitro fertilization: A methodological survey. Contemp Clin Trials Commun 2019; 16:100426. [PMID: 31517133 PMCID: PMC6734149 DOI: 10.1016/j.conctc.2019.100426] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2019] [Revised: 07/21/2019] [Accepted: 08/04/2019] [Indexed: 01/06/2023] Open
Abstract
Background Infertility has become increasingly common worldwide. There is a need for the infertility literature to evaluate new interventions with IVF. The crossover design presents many methodological advantages for IVF trials. In addition to providing a within-person comparison of outcomes, it offers participants the opportunity to potentially benefit from more than one available treatment. However, infertility studies present a unique challenge in terms of bias: successful participants do not cross over to the second treatment group. Objectives The main objective of our study was to survey the methodological features of crossover trials for infertility with in-vitro fertilization (IVF) based interventions. A secondary focus was reporting key results. Study design & setting We conducted a methodological survey by systematically searching Medline and Embase databases. The capture-recapture technique was used to estimate the number of relevant studies that were not retrieved by our search strategy. We employed the Cochrane risk of bias tool to assess methodological rigour. Crossover-specific methods features were summarized. Treatment effects for pregnancy outcomes across studies are also presented. Results 15 studies met inclusion criteria. Most studies were deemed to have high or unclear risks of bias, usually because of incomplete reporting of outcome data and assessment procedures. 13 studies did not employ crossover-specific methods to analyze outcome data by period, which may bias treatment effect estimates. Four studies reported pregnancy outcome data with sample sizes from both treatment periods. Of these four studies, three reported that the control intervention was favoured. Conclusions The main limitation of our survey was the small sample size of studies. Future reviews should be larger and seek to encompass a broader range of the infertility literature. Despite the issues identified in the included trials, consideration should still be given to using the crossover design in future infertility research. Employing crossover-specific analysis methods, such as accounting for participant non-completion, along with strict adherence to CONSORT reporting guidelines, may significantly reduce the risk of bias in individual studies.
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Affiliation(s)
- Dalton R Budhram
- Department of Health Research Methods, Evidence, and Impact, McMaster University Faculty of Health Sciences, Hamilton, ON, L8S 4K1, Canada
| | - Daniel Shi
- Department of Health Research Methods, Evidence, and Impact, McMaster University Faculty of Health Sciences, Hamilton, ON, L8S 4K1, Canada
| | - Sarah D McDonald
- Department of Health Research Methods, Evidence, and Impact, McMaster University Faculty of Health Sciences, Hamilton, ON, L8S 4K1, Canada.,Department of Obstetrics and Gynecology, McMaster University Faculty of Health Sciences, Hamilton, ON, L8S 4K1, Canada.,Department of Radiology, McMaster University Faculty of Health Sciences, Hamilton, ON, L8S 4K1, Canada
| | - Stephen D Walter
- Department of Health Research Methods, Evidence, and Impact, McMaster University Faculty of Health Sciences, Hamilton, ON, L8S 4K1, Canada
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Dwan K, Li T, Altman DG, Elbourne D. CONSORT 2010 statement: extension to randomised crossover trials. BMJ 2019; 366:l4378. [PMID: 31366597 PMCID: PMC6667942 DOI: 10.1136/bmj.l4378] [Citation(s) in RCA: 296] [Impact Index Per Article: 59.2] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/07/2019] [Indexed: 12/11/2022]
Affiliation(s)
- Kerry Dwan
- Review Production and Quality Unit, Editorial and Methods Department, Cochrane Central Executive, Cochrane, St Alban's House, London SW1Y 4QX, UK
| | - Tianjing Li
- Center for Clinical Trials and Evidence Synthesis, Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Douglas G Altman
- Centre for Statistics in Medicine, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK
| | - Diana Elbourne
- London School of Hygiene and Tropical Medicine, Department of Medical Statistics, London, UK
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Effect of MyMAFI-A Newly Developed Mobile App for Field Investigation of Food Poisoning Outbreak on the Timeliness in Reporting: A Randomized Crossover Trial. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2019; 16:ijerph16142453. [PMID: 31295907 PMCID: PMC6678406 DOI: 10.3390/ijerph16142453] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/22/2019] [Revised: 07/03/2019] [Accepted: 07/05/2019] [Indexed: 02/05/2023]
Abstract
Prompt investigation of food poisoning outbreak are essential, as it usually involves a short incubation period. Utilizing the advancement in mobile technology, a mobile application named MyMAFI (My Mobile Apps for Field Investigation) was developed with the aim to be an alternative and better tool for current practices of field investigation of food poisoning outbreak. A randomized cross-over trial with two arms and two treatment periods was conducted to assess the effectiveness of the newly developed mobile application as compared to the standard paper-based format approach. Thirty-six public health inspectors from all districts in Kelantan participated in this study and they were randomized into two equal sized groups. Group A started the trial as control group using the paper-format investigation form via simulated outbreaks and group B used the mobile application. After a one-month ‘washout period’, the group was crossed over. The primary outcome measured was the time taken to complete the outbreak investigation. The treatment effects, the period effects and the period-by-treatment interaction were analyzed using Pkcross command in Stata software. There was a significant treatment effect with mean square 21840.5 and its corresponding F statistic 4.47 (p-value = 0.038), which indicated that the mobile application had significantly improve the reporting timeliness. The results also showed that there was a significant period effect (p-value = 0.025); however, the treatment by period interaction was not significant (p-value = 0.830). The newly developed mobile application—MyMAFI—can improve the timeliness in reporting for investigation of food poisoning outbreak.
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Zavorsky GS, Newton WL. Effects of sexual activity on several measures of physical performance in young adult males. J Sports Med Phys Fitness 2019; 59:1102-1109. [DOI: 10.23736/s0022-4707.18.09070-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
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Koehler-McNicholas SR, Danzl L, Cataldo AY, Oddsson LIE. Neuromodulation to improve gait and balance function using a sensory neuroprosthesis in people who report insensate feet - A randomized control cross-over study. PLoS One 2019; 14:e0216212. [PMID: 31039180 PMCID: PMC6490932 DOI: 10.1371/journal.pone.0216212] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2018] [Accepted: 04/13/2019] [Indexed: 12/16/2022] Open
Abstract
Peripheral neuropathy may cause loss of sensory information from plantar cutaneous mechanoreceptors that is important for balance control and falls management. The current study investigated short-term effects of using Walkasins, an external lower-limb sensory neuroprosthesis, on clinical outcomes of balance and gait in persons who reported peripheral neuropathy and balance problems. The device replaces lost plantar sensation with tactile balance information that modulates cutaneous mechanoreceptors above the ankle where sensation is intact. Thirty-one male community-dwelling Veterans, 56–84 years old with insensate feet and balance problems participated. Initial Functional Gait Assessment, gait speed, and 4-Stage Balance Test outcomes were assessed. After initial assessment, subjects were randomly assigned to either wearing Walkasins turned ON, or OFF, and outcomes were re-assessed following a set of standardized balance exercises. Following a one-hour rest and washout period, treatments were crossed-over between groups and a third outcomes assessment was performed. Before cross-over, 10 of 15 subjects in the ON-then-OFF group improved their Functional Gait Assessment score by at least four points, the Minimal Clinically Important Difference, compared to 5 of 16 in the OFF-then-ON group. After cross-over, 7 of 16 subjects in the OFF-then-ON group improved by at least four points versus 2 of 15 in the ON-then-OFF group. ON treatment was associated with a Functional Gait Assessment improvement of 4.4 ± 3.7 points versus 1.5 ± 1.2 for the OFF treatment (p<0.01). Overall, Functional Gait Assessment scores changed from 15.2 ± 4.8 at initial assessment to 21.1 ± 5.2 after final assessment (p<0.001). At the end of the two treatment sessions, 16 of the 31 individuals had improved their Functional Gait Assessment score beyond 23, indicating normal fall-risk status. Future studies should investigate long-term benefits of the device to reduce fall risk and actual falls in patients with peripheral neuropathy and balance problems.
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Affiliation(s)
- Sara R. Koehler-McNicholas
- Minneapolis Department of Veterans Affairs Health Care System, Minneapolis, MN, United States of America
- * E-mail:
| | - Lori Danzl
- Minneapolis Department of Veterans Affairs Health Care System, Minneapolis, MN, United States of America
| | - Alana Y. Cataldo
- Minneapolis Department of Veterans Affairs Health Care System, Minneapolis, MN, United States of America
| | - Lars I. E. Oddsson
- Division of Rehabilitation Science, Department of Rehabilitation Medicine, Medical School, University of Minnesota, Minneapolis, MN, United States of America
- Recanati School of Community Health, Ben Gurion University of the Negev, Be’er Sheva, Israel
- RxFunction Inc., Eden Prairie, MN, United States of America
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Effects of Interactive Video Game-Based Exercise on Balance in Diabetic Patients with Peripheral Neuropathy: An Open-Level, Crossover Pilot Study. EVIDENCE-BASED COMPLEMENTARY AND ALTERNATIVE MEDICINE 2019; 2019:4540709. [PMID: 30956680 PMCID: PMC6431378 DOI: 10.1155/2019/4540709] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/01/2018] [Revised: 02/13/2019] [Accepted: 02/21/2019] [Indexed: 12/01/2022]
Abstract
Purpose. This study evaluated the effects of interactive video game-based (IVGB) exercise on balance in diabetic patients with peripheral neuropathy. Materials and Methods. Twenty-four patients were randomly assigned to two groups (12 participants per group). Group A received IVGB training for the first 6 weeks, with no exercise in the subsequent 6 weeks. Group B had no exercise for the first 6 weeks and then underwent IVGB training in the subsequent 6 weeks. For all participants, the Modified Falls Efficacy Scale (MFES), Time Up and Go (TUG) test, Berg Balance Scale (BBS), and Unipedal Stance Test (UST) were employed at weeks 0, 6, and 12 of the experiment. Results. BBS, right-leg UST, and TUG test scores significantly improved after IVGB intervention, whereas MFES and left-leg UST tended to improve after IVGB intervention. Conclusions. This study revealed that 6-week balance-based exercise training using the IVGB system exerted positive effects on functional balance in patients with diabetic peripheral neuropathy (DPN).
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Krogh HB, Storebø OJ, Faltinsen E, Todorovac A, Ydedahl-Jensen E, Magnusson FL, Holmskov M, Gerner T, Gluud C, Simonsen E. Methodological advantages and disadvantages of parallel and crossover randomised clinical trials on methylphenidate for attention deficit hyperactivity disorder: a systematic review and meta-analyses. BMJ Open 2019; 9:e026478. [PMID: 30928951 PMCID: PMC6475340 DOI: 10.1136/bmjopen-2018-026478] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/06/2018] [Revised: 12/18/2018] [Accepted: 01/14/2019] [Indexed: 12/31/2022] Open
Abstract
OBJECTIVE To assess the methodological advantages and disadvantages of parallel and crossover designs in randomised clinical trials on methylphenidate for children and adolescents with attention deficit hyperactivity disorder (ADHD). DESIGN Secondary analyses of a Cochrane systematic review. SETTING AND PARTICIPANTS We searched relevant databases up to March 2015 and included data from parallel and crossover randomised trials assessing children and adolescents up to 18 years with ADHD. INTERVENTIONS Methylphenidate compared with placebo or no-treatment interventions. PRIMARY AND SECONDARY OUTCOMES The primary outcomes were teacher-rated ADHD symptoms and serious adverse events. The secondary outcomes were non-serious adverse events. RESULTS We included 38 parallel trials (n=5111) and 147 crossover trials (n=7134). When comparing methylphenidate with placebo or no-treatment on ADHD symptoms, we found no differences between the end of parallel trials and the first-period from crossover trials (Χ²=1.06, df=1, p=0.30, I²=5.5%). We also found no differences when combining the end of first-period crossover trials with the end of parallel trials and comparing them to the end of last-period crossover trials (Χ²=3.25, df=1, p=0.07, I²=69.2%). We found no differences in serious and non-serious adverse events, and no risk of period and carryover effects. However, only two trials contributed data to the latter analyses. CONCLUSIONS Both parallel and crossover trials seem suitable for investigating methylphenidate in children and adolescents with ADHD, with comparable estimates on ADHD symptom severity and adverse events. However, parallel trials might still offer ethical and statistical advantages over crossover trials.
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Affiliation(s)
- Helle B Krogh
- Psychiatric Department, Psychiatric Research Unit, Slagelse, 4200, Denmark
| | - Ole Jakob Storebø
- Psychiatric Department, Psychiatric Research Unit, Slagelse, 4200, Denmark
| | - Erlend Faltinsen
- Psychiatric Department, Psychiatric Research Unit, Slagelse, 4200, Denmark
| | - Adnan Todorovac
- Psychiatric Department, Psychiatric Research Unit, Slagelse, 4200, Denmark
| | | | | | - Mathilde Holmskov
- Psychiatric Department, Psychiatric Research Unit, Slagelse, 4200, Denmark
| | - Trine Gerner
- Psychiatric Department, Psychiatric Research Unit, Slagelse, 4200, Denmark
| | - Christian Gluud
- Center for Clinical Intervention Research, Copenhagen Trial Unit (CTU), Copenhagen Ø, Denmark
| | - Erik Simonsen
- Psychiatric Department, Psychiatric Research Unit, Slagelse, 4200, Denmark
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Sexual Activity the Night Before Exercise Does Not Affect Various Measures of Physical Exercise Performance. Sex Med 2019; 7:235-240. [PMID: 30674446 PMCID: PMC6522944 DOI: 10.1016/j.esxm.2018.12.002] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2018] [Revised: 12/11/2018] [Accepted: 12/16/2018] [Indexed: 11/22/2022] Open
Abstract
INTRODUCTION The idea that sexual activity can affect athletic performance has been a matter of conjecture for the past several decades. AIM To provide preliminary data on whether sexual activity the evening before several physical exercise performance tests affects performance the next day. METHODS Eight participants (mean age, 28 ± 5 years) underwent several physical exercise performance tests on 3 different mornings, under 3 conditions: (i) no sexual intercourse the night before the tests (control), (ii) sexual intercourse the night before the tests, and (iii) yoga the night before the tests (randomized, single-blinded). MAIN OUTCOME MEASURES Physical work capacity, lower body muscular power (standing vertical jump), upper body strength (handgrip strength), reaction time, and upper body musculoskeletal endurance (number of push-ups completed). RESULTS All participants experienced orgasm through intercourse. The more pleasurable the orgasm, the lower the systolic blood pressure (SBP) on the day after intercourse (Spearman's rho = -0.86; P = .007). For every 2% increase in the total orgasm score, SBP decreased by 1 mmHg. Intercourse lasted 13 minutes; mean heart rate (HR) and caloric expenditure ranged from 88 to 145 beats/minute and from 53 to 190 kcal, respectively. There were no significant differences in the physical working capacity that elicited an HR of 170 beats/minute, number of push-ups completed, vertical jump height, grip strength, or reaction time across the 3 conditions. CONCLUSION Orgasm through sexual activity on the night before physical exercise may reduce SBP; however, we were unable to demonstrate a statistically significant difference in physical exercise performance in any of the 3 conditions. Zavorsky GS, Vouyoukas E, Pfaus JG. Sexual Activity the Night Before Exercise Does Not Affect Various Measures of Physical Exercise Performance. Sex Med 2019;7:235-240.
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Cavaleri R, Thapa T, Beckenkamp PR, Chipchase LS. The influence of kinesiology tape colour on performance and corticomotor activity in healthy adults: a randomised crossover controlled trial. BMC Sports Sci Med Rehabil 2018; 10:17. [PMID: 30410769 PMCID: PMC6211494 DOI: 10.1186/s13102-018-0106-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2018] [Accepted: 10/18/2018] [Indexed: 11/10/2022]
Abstract
Background There exists conflicting evidence regarding the impact of kinesiology tape on performance and muscle function. One variable that may account for disparities in the findings of previous studies is the colour of the tape applied. Colour is hypothesised to influence sporting performance through modulation of arousal and aggression. However, few studies have investigated the influence of colour on products designed specifically to enhance athletic performance. Further, no studies have investigated the potential influence of colour on other drivers of performance, such as corticomotor activity and neuromuscular function. Thus, the aim of this study was to investigate the influence of kinesiology tape colour on athletic performance, knee extensor torque, and quadriceps neuromuscular function. Methods Thirty two healthy participants were assessed under five conditions, applied in random order: (1) no kinesiology tape (control), (2) beige-coloured kinesiology tape applied with tension (sham A), (3) beige-coloured kinesiology tape applied with no tension (sham B), (4) red-coloured kinesiology tape applied with tension, and (5) blue-coloured kinesiology tape applied with tension. Athletic performance was assessed using a previously validated hop test, knee extensor torque was measured using an isokinetic dynamometer, and transcranial magnetic stimulation was utilised to provide insight into the neuromuscular functioning of the quadriceps musculature. Results Kinesiology tape had no beneficial impact on lower limb performance or muscle strength in healthy adults. The colour of the tape did not influence athletic performance (F (4, 120) = 0.593, p = 0.669), quadriceps strength (F (4, 120) = 0.787, p = 0.536), or neuromuscular function (rectus femoris: F (2.661, 79.827) = 1.237, p = 0.301). Conclusion This study found that kinesiology tape does not alter lower limb performance or muscle function in healthy adults, irrespective of the colour of the tape applied. Future research should seek to confirm these findings beyond the research setting, across a range of sports, and at a range of skill levels. Trial registration Australian New Zealand Clinical Trials Registry. ACTRN12616001506482. Prospectively registered on 01/11/2016.
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Affiliation(s)
- Rocco Cavaleri
- 1Brain Rehabilitation and Neuroplasticity Unit, School of Science and Health, Western Sydney University, Sydney, NSW 2560 Australia
| | - Tribikram Thapa
- 1Brain Rehabilitation and Neuroplasticity Unit, School of Science and Health, Western Sydney University, Sydney, NSW 2560 Australia
| | - Paula R Beckenkamp
- 1Brain Rehabilitation and Neuroplasticity Unit, School of Science and Health, Western Sydney University, Sydney, NSW 2560 Australia.,2Musculoskeletal Health, Faculty of Health Sciences, Discipline of Physiotherapy, The University of Sydney, Sydney, NSW Australia
| | - Lucy S Chipchase
- 2Musculoskeletal Health, Faculty of Health Sciences, Discipline of Physiotherapy, The University of Sydney, Sydney, NSW Australia.,3Faculty of Health, University of Canberra, Canberra, ACT Australia
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Aitken D, Laslett LL, Pan F, Haugen IK, Otahal P, Bellamy N, Bird P, Jones G. A randomised double-blind placebo-controlled crossover trial of HUMira (adalimumab) for erosive hand OsteoaRthritis - the HUMOR trial. Osteoarthritis Cartilage 2018; 26:880-887. [PMID: 29499287 DOI: 10.1016/j.joca.2018.02.899] [Citation(s) in RCA: 89] [Impact Index Per Article: 14.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/18/2017] [Revised: 02/16/2018] [Accepted: 02/20/2018] [Indexed: 02/02/2023]
Abstract
OBJECTIVE To assess the efficacy of adalimumab in patients with erosive hand osteoarthritis (OA). METHOD Patients >50 years old, meeting the American College of Rheumatology (ACR) criteria for hand OA, with pain >50 on 100 mm visual analogue scale (VAS), morning stiffness >30 min and ≥1 erosive joint on X-ray with synovitis present on magnetic resonance imaging (MRI) were included in a randomised double-blind placebo-controlled crossover trial. Patients were randomised to adalimumab (40 mg subcutaneous injections every other week) or identical placebo injections for 12 weeks followed by an 8-week washout and then crossed over treatment groups for another 12 weeks. The primary outcome was change in VAS hand pain over 12 weeks. Secondary outcomes included change in Australian/Canadian Hand OA Index (AUSCAN) pain, function and stiffness subscales from baseline to 4, 8 and 12 weeks, change in MRI-detected synovitis and bone marrow lesions (BMLs) from baseline to 12 weeks and change in VAS from baseline to 4 and 8 weeks. RESULTS We recruited 51 patients and 43 were randomised to either Group 1 (N = 18, active then placebo) or Group 2 (N = 25, placebo then active). At 12 weeks there was no difference between the groups on the primary outcome measure (mean decrease in VAS pain of 3.2 mm standard deviation (SD 16.7) for adalimumab vs 0.8 mm (SD 29.6) for placebo). The adjusted treatment effect was -0.7 mm (95% confidence interval (CI) -9.3 to 8.0), P = 0.87. No statistically significant differences were found for any secondary outcomes. CONCLUSION Adalimumab did not show any effect on pain, synovitis or BMLs in patients with erosive hand OA with MRI-detected synovitis as compared to placebo after 12 weeks. CLINICAL TRIAL REGISTRATION NUMBER ACTRN12612000791831.
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Affiliation(s)
- D Aitken
- Menzies Institute for Medical Research, University of Tasmania, Hobart, Australia
| | - L L Laslett
- Menzies Institute for Medical Research, University of Tasmania, Hobart, Australia
| | - F Pan
- Menzies Institute for Medical Research, University of Tasmania, Hobart, Australia
| | - I K Haugen
- Department of Rheumatology, Diakonhjemmet Hospital, Oslo, Norway
| | - P Otahal
- Menzies Institute for Medical Research, University of Tasmania, Hobart, Australia
| | - N Bellamy
- University of Queensland School of Medicine, Brisbane, Queensland, Australia; Royal Brisbane and Women's Hospital, Herston, Queensland, Australia
| | - P Bird
- University of NSW, Sydney, Australia
| | - G Jones
- Menzies Institute for Medical Research, University of Tasmania, Hobart, Australia.
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Burghardt KJ, Seyoum B, Mallisho A, Burghardt PR, Kowluru RA, Yi Z. Atypical antipsychotics, insulin resistance and weight; a meta-analysis of healthy volunteer studies. Prog Neuropsychopharmacol Biol Psychiatry 2018; 83:55-63. [PMID: 29325867 PMCID: PMC5817633 DOI: 10.1016/j.pnpbp.2018.01.004] [Citation(s) in RCA: 48] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/05/2017] [Revised: 01/05/2018] [Accepted: 01/07/2018] [Indexed: 11/26/2022]
Abstract
Atypical antipsychotics increase the risk of diabetes and cardiovascular disease through their side effects of insulin resistance and weight gain. The populations for which atypical antipsychotics are used carry a baseline risk of metabolic dysregulation prior to medication which has made it difficult to fully understand whether atypical antipsychotics cause insulin resistance and weight gain directly. The purpose of this work was to conduct a systematic review and meta-analysis of atypical antipsychotic trials in healthy volunteers to better understand their effects on insulin sensitivity and weight gain. Furthermore, we aimed to evaluate the occurrence of insulin resistance with or without weight gain and with treatment length by using subgroup and meta-regression techniques. Overall, the meta-analysis provides evidence that atypical antipsychotics decrease insulin sensitivity (standardized mean difference=-0.437, p<0.001) and increase weight (standardized mean difference=0.591, p<0.001) in healthy volunteers. It was found that decreases in insulin sensitivity were potentially dependent on treatment length but not weight gain. Decreases in insulin sensitivity occurred in multi-dose studies <13days while weight gain occurred in studies 14days and longer (max 28days). These findings provide preliminary evidence that atypical antipsychotics cause insulin resistance and weight gain directly, independent of psychiatric disease and may be associated with length of treatment. Further, well-designed studies to assess the co-occurrence of insulin resistance and weight gain and to understand the mechanisms and sequence by which they occur are required.
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Affiliation(s)
- Kyle J. Burghardt
- Wayne State University Eugene Applebaum College of Pharmacy and Health Sciences, Department of Pharmacy Practice; 259 Mack Avenue, Suite 2190, Detroit, MI 48201. USA
| | - Berhane Seyoum
- Wayne State University School of Medicine, Division of Endocrinology, 4201 St Antoine, Detroit, MI 48201, USA.
| | - Abdullah Mallisho
- Wayne State University School of Medicine, Division of Endocrinology, 4201 St Antoine, Detroit, MI 48201, USA.
| | - Paul R. Burghardt
- Wayne State University College of Liberal Arts & Sciences, Nutrition and Food Science; 5045 Cass Avenue, Detroit, MI 48202. USA
| | - Renu A. Kowluru
- Wayne State University School of Medicine, Department of Anatomy and Cell Biology; 540 E Canfield St, Detroit, MI 48201. USA
| | - Zhengping Yi
- Wayne State University Eugene Applebaum College of Pharmacy and Health Sciences, Department of Pharmaceutical Science, 259 Mack Avenue, Detroit, MI 48201, USA.
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Phenylephrine does not improve oxygenation during one-lung ventilation: A randomized, double-blind, cross-over study. PLoS One 2018; 13:e0195576. [PMID: 29630639 PMCID: PMC5891027 DOI: 10.1371/journal.pone.0195576] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2018] [Accepted: 03/23/2018] [Indexed: 11/19/2022] Open
Abstract
Background Phenylephrine is an α1 adrenergic receptor agonist that causes pulmonary vasoconstriction, and so may effectively enhance hypoxic pulmonary vasoconstriction (HPV). However, there is little evidence that phenylephrine augments HPV in clinical situations. This study aimed to evaluate the clinical effects of phenylephrine infusion on oxygenation during one-lung ventilation (OLV) in patients undergoing thoracic surgery. Methods This was a prospective, randomized, double-blind, cross-over study. Included patients were those undergoing elective thoracic surgery in the lateral decubitus position with OLV. Patients were randomly allocated to two groups. The N-P group initially had OLV with normal saline infusion for 30 minutes; after a 10 minute interval, OLV was then maintained with phenylephrine infusion for 30 minutes. The P-N group had the drug-infusion in the reverse order. The primary outcome was arterial partial pressure of oxygen. Secondary outcomes were mean arterial pressure, heart rate, pulse pressure variation, perfusion index, and difference between bladder and skin temperature. Statistical analysis was performed using the student t-test, Fisher's exact test, and ANOVA for Cross-over design. P < 0.05 was considered statistically significant. Results Twenty-nine patients were analyzed. Although phenylephrine infusion significantly increased mean arterial pressure (P < 0.001), arterial partial pressure of oxygen did not differ between the two timepoints (P = 0.19). There was no carryover effect in arterial partial pressure of oxygen (P = 0.14). Phenylephrine infusion significantly decreased heart rate (P = 0.02) and pulse pressure variation (P < 0.001). Conclusions Phenylephrine infusion did not improve oxygenation during OLV. The present results indicate that phenylephrine does not have clinically meaningful effects on HPV. Trial registration University Hospital Medical Information Network 000024317
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Radd-Vagenas S, Duffy SL, Naismith SL, Brew BJ, Flood VM, Fiatarone Singh MA. Effect of the Mediterranean diet on cognition and brain morphology and function: a systematic review of randomized controlled trials. Am J Clin Nutr 2018; 107:389-404. [PMID: 29566197 DOI: 10.1093/ajcn/nqx070] [Citation(s) in RCA: 95] [Impact Index Per Article: 15.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2017] [Accepted: 12/13/2017] [Indexed: 12/11/2022] Open
Abstract
Background Observational studies of the Mediterranean diet suggest cognitive benefits, potentially reducing dementia risk. Objective We performed the first published review to our knowledge of randomized controlled trials (RCTs) investigating Mediterranean diet effects on cognition or brain morphology and function, with an additional focus on intervention diet quality and its relation to "traditional" Mediterranean dietary patterns. Design We searched 9 databases from inception (final update December 2017) for RCTs testing a Mediterranean compared with alternate diet for cognitive or brain morphology and function outcomes. Results Analyses were based on 66 cognitive tests and 1 brain function outcome from 5 included studies (n = 1888 participants). The prescribed Mediterranean diets varied considerably between studies, particularly with regards to quantitative food advice. Only 8/66 (12.1%) of individual cognitive outcomes at trial level significantly favored a Mediterranean diet for cognitive performance, with effect sizes (ESs) ranging from small (0.32) to large (1.66), whereas 2 outcomes favored controls. Data limitations precluded a meta-analysis. Of 8 domain composite cognitive scores from 2 studies, the 3 (Memory, Frontal, and Global function) from PREDIMED (PREvención con DIeta MEDiterránea) were significant, with ESs ranging from 0.39 to 1.29. A posttest comparison at a second PREDIMED site found that the Mediterranean diet modulates the effect of several genotypes associated with dementia risk for some cognitive outcomes, with mixed results. Finally, the risk of low-plasma brain-derived neurotrophic factor was reduced by 78% (OR = 0.22; 95% CI: 0.05, 0.90) in those who consumed a Mediterranean diet compared to control diet at 3 y in this trial. There was no benefit of the Mediterranean diet for incident cognitive impairment or dementia. Conclusions Five RCTs of the Mediterranean diet and cognition have been published to date. The data are mostly nonsignificant, with small ESs. However, the significant improvements in cognitive domain composites in the most robustly designed study warrant additional research.
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Affiliation(s)
- Sue Radd-Vagenas
- Faculty of Health Sciences, Healthy Brain Ageing Program, Brain and Mind Centre, Charles Perkins Centre, Woolcock Institute of Medical Research, Central Clinical School, Faculty of Medicine, and Charles Perkins Centre, School of Psychology, Faculty of Science, The University of Sydney, Sydney, NSW, Australia
| | - Shantel L Duffy
- Healthy Brain Ageing Program, Brain and Mind Centre, 3Charles Perkins Centre, Woolcock Institute of Medical Research, Central Clinical School, Faculty of Medicine, and 4Charles Perkins Centre, School of Psychology, Faculty of Science, The University of Sydney, Sydney, NSW, Australia.,Charles Perkins Centre, Woolcock Institute of Medical Research, Central Clinical School, Faculty of Medicine, and Charles Perkins Centre, School of Psychology, Faculty of Science, The University of Sydney, Sydney, NSW, Australia
| | - Sharon L Naismith
- Healthy Brain Ageing Program, Brain and Mind Centre, 3Charles Perkins Centre, Woolcock Institute of Medical Research, Central Clinical School, Faculty of Medicine, and 4Charles Perkins Centre, School of Psychology, Faculty of Science, The University of Sydney, Sydney, NSW, Australia.,Charles Perkins Centre, School of Psychology, Faculty of Science, The University of Sydney, Sydney, NSW, Australia
| | - Bruce J Brew
- Faculty of Medicine, University of New South Wales, Sydney, NSW, Australia.,Peter Duncan Neurosciences Unit; St Vincent's Centre for Applied Medical Research, St Vincent's Hospital, Sydney, NSW, Australia
| | - Victoria M Flood
- Faculty of Health Sciences, Healthy Brain Ageing Program, Brain and Mind Centre, Charles Perkins Centre, Woolcock Institute of Medical Research, Central Clinical School, Faculty of Medicine, and Charles Perkins Centre, School of Psychology, Faculty of Science, The University of Sydney, Sydney, NSW, Australia.,Western Sydney Local Health District, Westmead Hospital, Westmead, NSW, Australia
| | - Maria A Fiatarone Singh
- Faculty of Health Sciences, Healthy Brain Ageing Program, Brain and Mind Centre, Charles Perkins Centre, Woolcock Institute of Medical Research, Central Clinical School, Faculty of Medicine, and Charles Perkins Centre, School of Psychology, Faculty of Science, The University of Sydney, Sydney, NSW, Australia.,Hebrew SeniorLife and Jean Mayer USDA Human Nutrition Research Center on Aging, Tufts University, Boston, MA
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