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Jung SJ, Song JE, Bae SH, Lee Y, Gwon SH, Park JH. Simulation-based training program on patient safety management: A quasi-experimental study among new intensive care unit nurses. Nurse Educ Today 2023; 126:105823. [PMID: 37080013 DOI: 10.1016/j.nedt.2023.105823] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/16/2023] [Accepted: 04/10/2023] [Indexed: 05/03/2023]
Abstract
BACKGROUND Patient safety is an essential responsibility of nurses. However, newly graduated nurses experience patient safety incidents due to a lack of patient safety competency. In particular, intensive care unit nurses provide care to critical patients, making it difficult for new nurses to maintain patient safety. Therefore, it is necessary to improve the patient safety competency of newly graduated nurses working in the intensive care unit. OBJECTIVES To analyze the effects of a simulation-based training program on patient safety management on the patient safety competency, patient safety management activity, communication self-efficacy, and teamwork of newly graduated nurses working in an intensive care unit. DESIGN A quasi-experimental study. SETTINGS The study was conducted at a university in Korea. PARTICIPANTS A total of 44 newly graduated nurses working in the intensive care unit of a university hospital. METHODS A simulation-based training program on patient safety management was applied to the experimental group (n = 22), while only the usual hospital training program was used for the control group (n = 22). A structured questionnaire survey comprising Patient Safety Competency Self-Evaluation, Patient Safety Management Activities, the Korean version of the self-efficacy questionnaire, and K-self assessment of teamwork was conducted at baseline test (T1), post test (T2), and follow-up test (T3). Data were analyzed using a repeated measures ANOVA. RESULTS The experimental group showed significantly higher patient safety competency, patient safety knowledge, and patient safety skills, along with higher communication self-efficacy scores than the control group (p < .05) after the intervention and at four weeks after the intervention. CONCLUSIONS The simulation-based training program on patient safety management effectively improved the patient safety competency, patient safety knowledge, and patient safety skills as well as communication self-efficacy of newly graduated nurses working in an intensive care unit.
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Affiliation(s)
- Su Jin Jung
- College of Nursing Research Institute of Nursing Science, Ajou University, Suwon, Republic of Korea
| | - Ju-Eun Song
- College of Nursing Research Institute of Nursing Science, Ajou University, Suwon, Republic of Korea
| | - Sun Hyoung Bae
- College of Nursing Research Institute of Nursing Science, Ajou University, Suwon, Republic of Korea
| | - Youngjin Lee
- College of Nursing Research Institute of Nursing Science, Ajou University, Suwon, Republic of Korea
| | - Seok Hyun Gwon
- College of Nursing, University of Wisconsin-Milwaukee, Milwaukee, WI, USA
| | - Jin-Hee Park
- College of Nursing Research Institute of Nursing Science, Ajou University, Suwon, Republic of Korea.
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Turbyfill C, Adams K, Tenforde MW, Murray NL, Gaglani M, Ginde AA, McNeal T, Ghamande S, Douin DJ, Keipp Talbot H, Casey JD, Mohr NM, Zepeski A, Shapiro NI, Gibbs KW, Clark Files D, Hager DN, Shehu A, Prekker ME, Frosch AE, Exline MC, Gong MN, Mohamed A, Johnson NJ, Srinivasan V, Steingrub JS, Peltan ID, Brown SM, Martin ET, Lauring AS, Khan A, Busse LW, Ten Lohuis CC, Duggal A, Wilson JG, June Gordon A, Qadir N, Chang SY, Mallow C, Rivas C, Kwon JH, Halasa N, Chappell JD, Grijalva CG, Rice TW, Stubblefield WB, Baughman A, Rhoads JP, Lindsell CJ, Hart KW, McMorrow M, Surie D, Self WH, Patel MM. Comparison of test-negative and syndrome-negative controls in SARS-CoV-2 vaccine effectiveness evaluations for preventing COVID-19 hospitalizations in the United States. Vaccine 2022; 40:6979-86. [PMID: 36374708 DOI: 10.1016/j.vaccine.2022.10.034] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2022] [Revised: 10/11/2022] [Accepted: 10/13/2022] [Indexed: 01/27/2023]
Abstract
BACKGROUND Test-negative design (TND) studies have produced validated estimates of vaccine effectiveness (VE) for influenza vaccine studies. However, syndrome-negative controls have been proposed for differentiating bias and true estimates in VE evaluations for COVID-19. To understand the use of alternative control groups, we compared characteristics and VE estimates of syndrome-negative and test-negative VE controls. METHODS Adults hospitalized at 21 medical centers in 18 states March 11-August 31, 2021 were eligible for analysis. Case patients had symptomatic acute respiratory infection (ARI) and tested positive for SARS-CoV-2. Control groups were test-negative patients with ARI but negative SARS-CoV-2 testing, and syndrome-negative controls were without ARI and negative SARS-CoV-2 testing. Chi square and Wilcoxon rank sum tests were used to detect differences in baseline characteristics. VE against COVID-19 hospitalization was calculated using logistic regression comparing adjusted odds of prior mRNA vaccination between cases hospitalized with COVID-19 and each control group. RESULTS 5811 adults (2726 cases, 1696 test-negative controls, and 1389 syndrome-negative controls) were included. Control groups differed across characteristics including age, race/ethnicity, employment, previous hospitalizations, medical conditions, and immunosuppression. However, control-group-specific VE estimates were very similar. Among immunocompetent patients aged 18-64 years, VE was 93 % (95 % CI: 90-94) using syndrome-negative controls and 91 % (95 % CI: 88-93) using test-negative controls. CONCLUSIONS Despite demographic and clinical differences between control groups, the use of either control group produced similar VE estimates across age groups and immunosuppression status. These findings support the use of test-negative controls and increase confidence in COVID-19 VE estimates produced by test-negative design studies.
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Masse MH, Adhikari NKJ, Théroux X, Battista MC, D'Aragon F, Pinto R, Cohen A, Mayette M, St-Arnaud C, Kho M, Chassé M, Lebrasseur M, Watpool I, Porteous R, Wilcox ME, Lamontagne F. The evolution of mean arterial pressure in critically ill patients on vasopressors before and during a trial comparing a specific mean arterial pressure target to usual care. BMC Anesthesiol 2022; 22:6. [PMID: 34979938 PMCID: PMC8722048 DOI: 10.1186/s12871-021-01529-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2021] [Accepted: 11/19/2021] [Indexed: 11/24/2022] Open
Abstract
Background In randomized clinical controlled trials, the choice of usual care as the comparator may be associated with better clinician uptake of the study protocol and lead to more generalizable results. However, if care processes evolve to resemble the intervention during the course of a trial, differences between the intervention group and usual care control group may narrow. We evaluated the effect on mean arterial pressure of an unblinded trial comparing a lower mean arterial pressure target to reduce vasopressor exposure, vs. a clinician-selected mean arterial pressure target, in critically ill patients at least 65 years old. Methods For this multicenter observational study using data collected both prospectively and retrospectively, patients were recruited from five of the seven trial sites. We compared the mean arterial pressure of patients receiving vasopressors, who met or would have met trial eligibility criteria, from two periods: [1] at least 1 month before the trial started, and [2] during the trial period and randomized to usual care, or not enrolled in the trial. Results We included 200 patients treated before and 229 after trial initiation. There were no differences in age (mean 74.5 vs. 75.2 years; p = 0.28), baseline Acute Physiology and Chronic Health Evaluation II score (median 26 vs. 26; p = 0.47) or history of chronic hypertension (n = 126 [63.0%] vs. n = 153 [66.8%]; p = 0.41). Mean of the mean arterial pressure was similar between the two periods (72.5 vs. 72.4 mmHg; p = 0.76). Conclusions The initiation of a trial of a prescribed lower mean arterial pressure target, compared to a usual clinician-selected target, was not associated with a change in mean arterial pressure, reflecting stability in the net effect of usual clinician practices over time. Comparing prior and concurrent control groups may alleviate concerns regarding drift in usual practices over the course of a trial or permit quantification of any change. Supplementary Information The online version contains supplementary material available at 10.1186/s12871-021-01529-w.
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Affiliation(s)
- Marie-Hélène Masse
- Faculty of Medicine and Health Sciences, Université de Sherbrooke, 12e Avenue Nord, Sherbrooke, Québec, J1H 5N4, Canada
| | - Neill K J Adhikari
- Interdepartmental Division of Critical Care Medicine, University of Toronto, 209 Victoria Street, Toronto, Ontario, M5B 1T8, Canada.,Department of Critical Care Medicine, Sunnybrook Health Sciences Centre, 2075 Bayview Avenue, Toronto, Ontario, M4N 3M5, Canada
| | - Xavier Théroux
- Faculty of Medicine and Health Sciences, Université de Sherbrooke, 12e Avenue Nord, Sherbrooke, Québec, J1H 5N4, Canada
| | - Marie-Claude Battista
- Faculty of Medicine and Health Sciences, Université de Sherbrooke, 12e Avenue Nord, Sherbrooke, Québec, J1H 5N4, Canada
| | - Frédérick D'Aragon
- Faculty of Medicine and Health Sciences, Université de Sherbrooke, 12e Avenue Nord, Sherbrooke, Québec, J1H 5N4, Canada
| | - Ruxandra Pinto
- Department of Critical Care Medicine, Sunnybrook Health Sciences Centre, 2075 Bayview Avenue, Toronto, Ontario, M4N 3M5, Canada
| | - Alan Cohen
- Faculty of Medicine and Health Sciences, Université de Sherbrooke, 12e Avenue Nord, Sherbrooke, Québec, J1H 5N4, Canada
| | - Michaël Mayette
- Faculty of Medicine and Health Sciences, Université de Sherbrooke, 12e Avenue Nord, Sherbrooke, Québec, J1H 5N4, Canada
| | - Charles St-Arnaud
- Faculty of Medicine and Health Sciences, Université de Sherbrooke, 12e Avenue Nord, Sherbrooke, Québec, J1H 5N4, Canada
| | - Michelle Kho
- Faculty of Health Sciences, School of Rehabilitation Science, Institute of Applied Health Sciences, McMaster University, 1280 Main Street West, Hamilton, Ontario, L8S 4L8, Canada
| | - Michaël Chassé
- Department of Medicine, Université de Montréal, 2900 Boulevard Édouard-Montpetit, Montréal, Québec, H3T 1J4, Canada
| | - Martine Lebrasseur
- Centre de recherche, Centre hospitalier de l'Université de Montréal, 900 rue Saint-Denis, Montréal, Québec, H2X 0A9, Canada
| | - Irene Watpool
- Ottawa Hospital Research Institute, 1053 Carling Ave, Ottawa, Ontario, K1Y 4E9, Canada
| | - Rebecca Porteous
- Ottawa Hospital Research Institute, 1053 Carling Ave, Ottawa, Ontario, K1Y 4E9, Canada
| | - M Elizabeth Wilcox
- Interdepartmental Division of Critical Care Medicine, University of Toronto, 209 Victoria Street, Toronto, Ontario, M5B 1T8, Canada
| | - François Lamontagne
- Faculty of Medicine and Health Sciences, Université de Sherbrooke, 12e Avenue Nord, Sherbrooke, Québec, J1H 5N4, Canada.
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Mangset M, Kitzmüller G, Evju AS, Angel S, Aadal L, Martinsen R, Bronken BA, Kvigne KJ, Bragstad LK, Hjelle EG, Sveen U, Kirkevold M. Perceived study-induced influence on the control group in a randomized controlled trial evaluating a complex intervention to promote psychosocial well-being after stroke: a process evaluation. Trials 2021; 22:850. [PMID: 34838094 PMCID: PMC8627040 DOI: 10.1186/s13063-021-05765-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2021] [Accepted: 10/27/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND A commonly applied control condition in trials evaluating complex interventions in rehabilitation research is "usual care." The main challenge is to ensure that the control group receives genuine usual care as delivered in everyday clinical practice. The assessment interviews and dialogues with the data collectors may influence the control group participants' reflections on their condition and adjustments. This represents a threat to the internal validity of the trial. Thus, the aim of this study was to explore the perceived study-induced influence of assessment interviews on the adjustment of the members of a control group in a randomized clinical trial. The aim of the trial was to test a dialogue-based psychosocial intervention aiming at promoting the psychosocial well-being and adjustment of stroke survivors. METHODS Fifteen participants in the control group of a multicenter stroke rehabilitation trial participated in narrative semi-structured interviews. Ricoeur's interpretation theory guided the analysis. RESULTS The perceived study-induced influence of the assessment interviews on the adjustment process of members of the control group varied considerably. The results demonstrated that the assessment interviews facilitated some participants' feelings of control and their ability to cope. Other participants' statements indicate that they relied on their existing personal capacity to cope and adjust and that the assessment interviews did not make any difference either on their coping ability or on their process of adjustment. Five themes were identified that described the perceived study-induced influence of the assessment interviews in the control group. The themes illustrated that the assessments served as a safety net, enhanced awareness and understanding, encouraged seeking support, allowed the opportunity to vent disappointment, or did not make any difference either way. CONCLUSIONS RCT assessment interviews may influence the adjustment process and represent a serious problem in measuring interventions over time in trials of complex interventions in rehabilitation research. To uphold rigor and stringency, the usual care control conditions should be thoroughly assessed and described. Informing participants only about the treatment they were allocated to receive might counteract the potential to dilute the difference between the two arms of the trial. TRIAL REGISTRATION ClinicalTrials.gov NCT02338869. Registered on October 4, 2014.
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Affiliation(s)
- Margrete Mangset
- Department of Geriatric Medicine, Oslo University Hospital, Ullevaal, P.O. Box 4956, 0424 Oslo, Nydalen Norway
| | - Gabriele Kitzmüller
- Faculty of Health Sciences, Department of Health and Care Sciences, UiT The Arctic University of Norway, P.O. Box 385, 8505 Narvik, Norway
| | - Anne S. Evju
- Faculty of Health Sciences, Department of Health and Care Sciences, UiT The Arctic University of Norway, P.O. Box 385, 8505 Narvik, Norway
| | - Sanne Angel
- Department of Public Health – Research Unit for Nursing and Healthcare, Department of Science in Nursing, Aarhus University, 8000 Aarhus, Denmark
- Faculty of Health Sciences and Social Care, Molde University College, P.O. Box 2110, NO-6402 Molde, Norway
| | - Lena Aadal
- Faculty of Health Sciences and Social Care, Molde University College, P.O. Box 2110, NO-6402 Molde, Norway
- Hammel Neurorehabilitation Centre and University Research Clinic, 8450 Hammel, Denmark
- Department of Clinical Medicine, Aarhus University, C, 8000 Aarhus, Denmark
| | - Randi Martinsen
- Inland Norway University of Applied Sciences, P.B. 400, 2418 Elverum, Norway
| | | | - Kari J. Kvigne
- Inland Norway University of Applied Sciences, P.B. 400, 2418 Elverum, Norway
- The Faculty of Nursing and Health Sciences, Nord University, P.B. 1490, 8049 Bodø, Norway
| | - Line K. Bragstad
- Department of Geriatric Medicine, Oslo University Hospital, Ullevaal, P.O. Box 4956, 0424 Oslo, Nydalen Norway
- University of Oslo, P.O. Box 1130, 0318 Oslo, Blindern Norway
- Institute of Health and Society and Research Center for Habilitation and Rehabilitation Services and Models (CHARM), University of Oslo, P.O. Box 1130, 0318 Oslo, Blindern Norway
| | - Ellen Gabrielsen Hjelle
- University of Oslo, P.O. Box 1130, 0318 Oslo, Blindern Norway
- Institute of Health and Society and Research Center for Habilitation and Rehabilitation Services and Models (CHARM), University of Oslo, P.O. Box 1130, 0318 Oslo, Blindern Norway
| | - Unni Sveen
- Department of Geriatric Medicine, Oslo University Hospital, Ullevaal, P.O. Box 4956, 0424 Oslo, Nydalen Norway
- Oslo Metropolitan University, P.O. Box 4, St. Olavs plass, 0130 Oslo, Norway
| | - Marit Kirkevold
- University of Oslo, P.O. Box 1130, 0318 Oslo, Blindern Norway
- Oslo Metropolitan University, P.O. Box 4, St. Olavs plass, 0130 Oslo, Norway
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Wang LC, Phyland D, Giddings CE. A randomised trial of single or extended dosing ciprofloxacin versus no intervention for Prevention of Ventilation Tube Otorrhoea and Obstruction (PreVenTO2). Clin Otolaryngol 2021; 47:287-294. [PMID: 34758186 DOI: 10.1111/coa.13887] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2021] [Revised: 10/07/2021] [Accepted: 10/25/2021] [Indexed: 11/29/2022]
Abstract
OBJECTIVES To determine the effectiveness of ciprofloxacin 0.3% antibiotic eardrops in preventing clinically significant postoperative otorrhoea and tube obstruction following grommet insertion in children. DESIGN 3-arm parallel assessor-blinded randomised controlled trial. Randomisation in 1:1:1 ratio to single intraoperative application of ciprofloxacin drops, extended 5-day postoperative application and no drops. Patients were assessed by blinded assessors at 6 weeks postoperatively. SETTING The study was conducted in a large tertiary health network in Melbourne, Australia. PARTICIPANTS All children, 17 years and under, undergoing bilateral MEVT surgery with or without concurrent upper airway surgery for recurrent acute otitis media and chronic otitis media with effusion were approached. MAIN OUTCOME MEASURES Presence of postoperative otorrhoea and ventilation tube obstruction at 6 weeks postoperatively. RESULTS 256 paediatric patients completed the study with a median age of 4.02 years. 153 participants were male. By ear-analysis (n=512) showed intraoperative antibiotics were more effective than no drops in preventing otorrhoea (RR=0.341, 95%CI 0.158-0.738, NNT= 11.25, p=.006). Postoperative antibiotics were more effective than no drops in preventing ventilation tube obstruction (RR=0.424, 95%CI 0.193 to 0.930, NNT=14.7 p=.032). CONCLUSION Intraoperative topical ciprofloxacin was effective at preventing early postoperative otorrhoea and a prolonged course was effective at preventing ventilation tube obstruction. Future studies on this topic should seek to clarify whether particular subgroups of patients benefit more from prophylactic topical antibiotics and model for cost-effectiveness.
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Affiliation(s)
- Luke Chenkan Wang
- Department of Surgery, School of Clinical Sciences, Monash University, Melbourne, Australia.,Department of ENT Surgery, Monash Health, Melbourne, Australia
| | - Debra Phyland
- Department of Surgery, School of Clinical Sciences, Monash University, Melbourne, Australia.,Department of ENT Surgery, Monash Health, Melbourne, Australia
| | - Charles Edward Giddings
- Department of Surgery, School of Clinical Sciences, Monash University, Melbourne, Australia.,Department of ENT Surgery, Monash Health, Melbourne, Australia
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Freedland KE, King AC, Ambrosius WT, Mayo-Wilson E, Mohr DC, Czajkowski SM, Thabane L, Collins LM, Rebok GW, Treweek SP, Cook TD, Edinger JD, Stoney CM, Campo RA, Young-Hyman D, Riley WT. The selection of comparators for randomized controlled trials of health-related behavioral interventions: recommendations of an NIH expert panel. J Clin Epidemiol 2019; 110:74-81. [PMID: 30826377 PMCID: PMC6543841 DOI: 10.1016/j.jclinepi.2019.02.011] [Citation(s) in RCA: 95] [Impact Index Per Article: 19.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2018] [Revised: 12/20/2018] [Accepted: 02/16/2019] [Indexed: 11/16/2022]
Abstract
OBJECTIVES To provide recommendations for the selection of comparators for randomized controlled trials of health-related behavioral interventions. STUDY DESIGN AND SETTING The National Institutes of Health Office of Behavioral and Social Science Research convened an expert panel to critically review the literature on control or comparison groups for behavioral trials and to develop strategies for improving comparator choices and for resolving controversies and disagreements about comparators. RESULTS The panel developed a Pragmatic Model for Comparator Selection in Health-Related Behavioral Trials. The model indicates that the optimal comparator is the one that best serves the primary purpose of the trial but that the optimal comparator's limitations and barriers to its use must also be taken into account. CONCLUSION We developed best practice recommendations for the selection of comparators for health-related behavioral trials. Use of the Pragmatic Model for Comparator Selection in Health-Related Behavioral Trials can improve the comparator selection process and help resolve disagreements about comparator choices.
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Affiliation(s)
| | - Abby C King
- Stanford University School of Medicine, Stanford, CA, USA
| | | | - Evan Mayo-Wilson
- Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD, USA
| | - David C Mohr
- Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | | | - Lehana Thabane
- McMaster University Department of Health Research Methods, Evidence, and Impact, Hamilton, Ontario, Canada
| | - Linda M Collins
- Pennsylvania State University College of Health and Human Development, University Park, PA, USA
| | - George W Rebok
- Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD, USA
| | - Shaun P Treweek
- University of Aberdeen Health Services Research Unit, Aberdeen, Scotland
| | - Thomas D Cook
- Northwestern University Institute for Policy Research, Evanston, IL, USA
| | | | | | - Rebecca A Campo
- National Institutes of Health Office of Behavioral and Social Sciences Research, Bethesda, MD, USA
| | - Deborah Young-Hyman
- National Institutes of Health Office of Behavioral and Social Sciences Research, Bethesda, MD, USA
| | - William T Riley
- National Institutes of Health Office of Behavioral and Social Sciences Research, Bethesda, MD, USA
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Toija AS, Kettunen TH, Leidenius MHK, Vainiola THK, Roine RPA. Effectiveness of peer support on health-related quality of life in recently diagnosed breast cancer patients: a randomized controlled trial. Support Care Cancer 2018; 27:123-130. [PMID: 30338354 PMCID: PMC6280804 DOI: 10.1007/s00520-018-4499-0] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2018] [Accepted: 10/03/2018] [Indexed: 11/30/2022]
Abstract
Purpose Breast cancer is the most common cancer of Finnish women. Peer support could be a way to help breast cancer patients to deal with the disease but studies on its effectiveness have produced conflicting results. The aim of this randomized controlled trial was to study the effectiveness of peer support on health-related quality of life (HRQoL) of breast cancer patients. Methods Patients with recently diagnosed breast cancer at the Helsinki University Hospital were randomly allocated to intervention (n = 130) or control (n = 130) groups. The intervention group patients received peer support via telephone one to five times according to their preference. The control group received usual care only. HRQoL was assessed with generic (15D) and disease-specific (EORTC QLQ-30 and its breast cancer specific module BR23) instruments at baseline and at 3-, 6-, and 12-month follow-up points. Results The mean (SD) age of the patients was 60.0 (10.5) years and their baseline mean 15D score 0.922 (0.066). At baseline, the intervention and control groups did not differ from each other. During follow-up, the 15D score deteriorated statistically significantly (p < 0.001) and clinically importantly in both groups but slightly less in the intervention group although the difference was not significant. Regarding individual 15D dimensions, the EORTC-QLQ30, or its breast-specific module, peer support did not show any consistent advantage compared to usual care. Conclusion Peer support had no clear effect on the HRQoL of breast cancer patients.
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Affiliation(s)
- Anu Susanna Toija
- University of Jyväskylä, PL 35 (L), 40014, Jyväskylä, Finland. .,EJY, Kauppamiehentie 6, 02100, Espoo, Finland.
| | - Tarja Helena Kettunen
- University of Jyväskylä, PL 35 (L), 40014, Jyväskylä, Finland.,Central Finland Health Care District, Unit of Primary Health Care, Keskussairaalantie 19, 40620, Jyväskylä, Finland
| | | | | | - Risto Paavo Antero Roine
- University of Helsinki and Helsinki University Hospital, PL 100, 00029 HUS, Helsinki, Finland.,University of Eastern Finland, PL 1627, 70211, Kuopio, Finland
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8
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Frazer KM, Richards Q, Keith DR. The long-term effects of cocaine use on cognitive functioning: A systematic critical review. Behav Brain Res 2018; 348:241-262. [PMID: 29673580 DOI: 10.1016/j.bbr.2018.04.005] [Citation(s) in RCA: 41] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2017] [Revised: 04/03/2018] [Accepted: 04/04/2018] [Indexed: 12/16/2022]
Abstract
BACKGROUND The predominant view of chronic cocaine use maintains that it causes a broad range of cognitive deficits. However, concerns about the possibly deleterious impact of cocaine on cognitive functioning have yet to be thoroughly vetted. This review addresses the impact of cocaine use on such cognitive domains as executive function, memory, language, and psychomotor speed. Additionally, relevant neuroimaging data is considered to understand the neural basis underlying cocaine-related effects on cognitive functioning. METHODS We searched PubMed, Google Scholar, and Embase using the search terms "cocaine and cognition," "cocaine and cognitive functioning," and "cocaine and cognitive deficits or impairment." To meet inclusion criteria we evaluated only cognitive and neuroimaging studies describing the long-term effects of cocaine on cognitive functioning published from 1999 to 2016. RESULTS The majority of studies reported statistically significant differences between cocaine users and non-drug-using controls in brain structures, blood-oxygen-level dependent signals, and brain metabolism. However, differences in cognitive performance were observed on a minority of measures. Additionally, the majority of studies were not compared against normative data. CONCLUSIONS The current evidence does not support the view that chronic cocaine use is associated with broad cognitive deficits. The view that cocaine users have broad cognitive deficits is inaccurate based upon current evidence, and the perpetuation of this view may have negative implications for treatment programs and development of public policies.
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Affiliation(s)
- Kirsten M Frazer
- Department of Psychology, Columbia University, 1190 Amsterdam Ave., New York, NY 10027, USA.
| | - Qwynten Richards
- Department of Psychology, Columbia University, 1190 Amsterdam Ave., New York, NY 10027, USA
| | - Diana R Keith
- Department of Psychiatry, University of Vermont Medical Center, 1 South Prospect Street, Burlington, VT 05401, USA
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Liu XX, Li DD, Li HL, Hou LA, Liu ZJ, Yang HY, Qiu L. [Research on blood distribution of Tibetan population in Ali area]. Zhonghua Yi Xue Za Zhi 2017; 97:3628-3631. [PMID: 29275605 DOI: 10.3760/cma.j.issn.0376-2491.2017.46.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Objective: To explore the distribution of ABO blood group in the healthy population in the Ali area of Tibet, and to analyze the difference of blood group distribution between the Tibetan population in Ali and the Tibet Tibetan population. Methods: The blood distribution of 509 apparent healthy volunteers of Tueti County and Gal County, Tibet, which were randomly selected from September to November in 2016; 137 Tibetan blood donors, from 2016 September to2017 July and 84 Tibetan blood donors from 2015 August to 2017 July was analyzed retrospectively. The blood type was tested by the slide method. By reviewing the Chinese and foreign language database, seven articles on Tibetan blood group distribution were obtained. And the data of the blood distribution of the Ali area population and the Tibet Tibetan population were compared. Results: The ABO phenotype frequencies of 507 apparent healthy people, 137 blood donors and 84 recipients were B>O>A>AB. The composition ratio were 36.1%, 34.5%, 21.5 %, 7.9%; 40.1%, 35.0%, 17.5%, 7.3%; 39.3%, 34.5%, 20.2%, 6.0%.There was no statistically significant difference in blood group distribution between the donors and the recipients (P>0.05). And there was no significant difference in the blood group distribution between Ali and Shigatse, Nagqu, Lhasa, Shannan. However, the differences between Ali and Qamdo, Nyingchi areas were statistically significant. Conclusion: The geographical position of the blood from the west to east, B type shows a downward trend, O type blood composition ratio shows an upward trend.
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Affiliation(s)
- X X Liu
- Department of Clinical Laboratory, Ali District People's Hospital, Tibet Ali 859000, China
| | - D D Li
- Department of Clinical Laboratory, Peking Union Medical College Hospital, Peking Union Medical College & Chinese Academy of Medical Science, Beijing 100730, China
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Barać J, Biuk D, Matić S, Barać I, Pelčić G, Bradvica M. Prevalence of Open Angle Glaucoma in Risk Groups in Slavonia and Baranya Region. Acta Clin Croat 2017; 56:789-794. [PMID: 29590737 DOI: 10.20471/acc.2017.56.04.29] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
The aim of this prospective study was to detect primary open angle glaucoma (POAG) in its early stage in patients at a higher risk of its development, and to identify the risk group with the highest prevalence of POAG. The study was conducted at Department of Ophthalmology, Osijek University Hospital Centre, and included 250 patients divided into five groups, as follows: group 1, patients with diabetes type 1 and type 2; group 2, patients with arterial hypertension (blood pressure >140/90 mm Hg); group 3, patients with positive family history of POAG; group 4, patients with myopia between -3.0 and -8.0 diopters; and group 5, control group including patients aged 40 with no risk factors for POAG development. Study results showed that distribution of glaucoma patients was not equal across the groups. The prevalence of POAG in all patients was 5.6%, whereas in patients with positive family history of POAG it was 14%, which was statistically significantly higher than in patients with diabetes and myopia (4% both), as well as in control group. The difference was greatest in comparison to control group. There was no statistically significant difference in glaucoma incidence between the group of patients with positive family history (14%) and patients with systemic hypertension (6%). The results obtained suggest that of all risk factors analyzed, positive family history of POAG is the most important risk factor for glaucoma development in all risk groups.
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Affiliation(s)
| | - Dubravka Biuk
- Department of Ophthalmology, Osijek University Hospital Centre, Osijek, Croatia
| | - Suzana Matić
- Department of Ophthalmology, Osijek University Hospital Centre, Osijek, Croatia
| | - Ivona Barać
- School of Medicine, Josip Juraj Strossmayer University of Osijek, Osijek, Croatia
| | - Goran Pelčić
- Department of Ophthalmology, School of Medicine, University of Rijeka, Rijeka, Croatia
| | - Mario Bradvica
- Department of Ophthalmology, Osijek University Hospital Centre, Osijek, Croatia
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Puhl AA, Reinhart CJ, Doan JB, Vernon H. The quality of placebos used in randomized, controlled trials of lumbar and pelvic joint thrust manipulation-a systematic review. Spine J 2017; 17:445-456. [PMID: 27888138 DOI: 10.1016/j.spinee.2016.11.003] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/30/2016] [Revised: 10/25/2016] [Accepted: 11/09/2016] [Indexed: 02/03/2023]
Abstract
BACKGROUND CONTEXT Spinal manipulative therapy (SMT) has been attributed with substantial non-specific effects. Accurate assessment of the non-specific effects of SMT relies on high-quality studies with low risk of bias that compare with appropriate placebos. PURPOSE This review aims to characterize the types and qualities of placebo control procedures used in controlled trials of manually applied, lumbar and pelvic (LP)-SMT, and to evaluate the assessment of subject blinding and expectations. STUDY DESIGN This is a systematic review of randomized, placebo-controlled trials. METHODS We searched MEDLINE, EMBASE, Cochrane Central Register of Controlled Trials, Index to Chiropractic Literature, and relevant bibliographies. We included randomized, placebo or sham-controlled trials where the index treatment was manually applied LP-SMT. There were no restrictions on the type of condition being investigated. Two independent reviewers selected the studies, assessed study quality, and extracted the data. Relevant data were the type and quality of placebo control(s) used, the assessment of blinding and expectations, and the results of those assessments. RESULTS Twenty-five randomized, placebo-controlled trials were included in this review. There were 18 trials that used a sham manual SMT procedure for their placebo control intervention; the most common approach was with an SMT setup but without the application of any thrust. One small pilot study used an unequivocally indistinguishable placebo, two trials used placebos that had been validated as inert a priori, and eight trials reported on the success of subject blinding. Risk of bias was high or unclear, for all included studies. CONCLUSIONS Imperfect placebos are ubiquitous in clinical trials of LP-SMT, and few trials have assessed for successful subject blinding or balanced expectations of treatment success between active and control group subjects. There is thus a strong potential for unmasking of control subjects, unequal non-specific effects between active and control groups, and non-inert placebos in existing trials. Future trials should consider assessing the success of subject blinding and ensuring inertness of their placebo a priori, as a minimum standard for quality.
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Affiliation(s)
- Aaron A Puhl
- Private Practice, Able Body Health Clinic, 1212 - 3rd Ave South, Lethbridge, Alberta T1J 0J9, Canada.
| | - Christine J Reinhart
- Private Practice, Able Body Health Clinic, 1212 - 3rd Ave South, Lethbridge, Alberta T1J 0J9, Canada
| | - Jon B Doan
- Engineering and Human Performance Laboratory, Department of Kinesiology and Physical Education, University of Lethbridge, 4401 University Drive West, Lethbridge, Alberta, T1K 6T5, Canada
| | - Howard Vernon
- Division of Research, Canadian Memorial Chiropractic College, 6100 Leslie Street North York, Toronto, Ontario M2H 3J1, Canada
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Abstract
AIMS Suppose you are the developer of a new therapy for a mental health problem or you have several years of experience working with such a therapy, and you would like to prove that it is effective. Randomised trials have become the gold standard to prove that interventions are effective, and they are used by treatment guidelines and policy makers to decide whether or not to adopt, implement or fund a therapy. METHODS You would want to do such a randomised trial to get your therapy disseminated, but in reality your clinical experience already showed you that the therapy works. How could you do a trial in order to optimise the chance of finding a positive effect? RESULTS Methods that can help include a strong allegiance towards the therapy, anything that increases expectations and hope in participants, making use of the weak spots of randomised trials (risk of bias), small sample sizes and waiting list control groups (but not comparisons with existing interventions). And if all that fails one can always not publish the outcomes and wait for positive trials. CONCLUSIONS Several methods are available to help you show that your therapy is effective, even when it is not.
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Estellat C, Tubach F, Seror R, Alfaiate T, Hajage D, De Rycke Y, Ravaud P. Control treatments in biologics trials of rheumatoid arthritis were often not deemed acceptable in the context of care. J Clin Epidemiol 2016; 69:235-44. [PMID: 26344809 DOI: 10.1016/j.jclinepi.2015.08.016] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2014] [Revised: 07/30/2015] [Accepted: 08/28/2015] [Indexed: 12/19/2022]
Abstract
OBJECTIVES Control treatments in randomized controlled trials (RCTs) should not deliberately disadvantage patients. The objectives of the study were to compare (1) willingness to include vs. (2) willingness to prescribe control treatment among physicians randomized to assess, respectively, either (1) enrollment in a trial or (2) appropriateness of control treatment in a care context for the same fictional patient. STUDY DESIGN AND SETTING Physicians were authors of articles about rheumatoid arthritis (RA), involved in RA patient care, and used to enrolling patients in trials. The outcomes were willingness to give control treatment: trial enrollment or control-treatment appropriateness in care context. We derived three case vignettes of fictional standard eligible patients for each of 30 RCTs assessing biologics in RA. Physicians were randomly allocated to the "trial" or "care" arm. For each of the 90 fictional patients, physicians assigned to the trial arm were asked if they would enroll the patient in the RCT the patient was derived from. For the same 90 fictional patients, physicians assigned to the care arm were asked if the control treatment of the RCT was appropriate in a context of usual care. RESULTS Of the 1,779 physicians invited to participate, 151 were randomized. Half of the fictional patients {41/90; 45% [95% confidence interval (CI): 37%, 53%]} would be enrolled in the RCT although the control-arm treatment of the RCT was not considered appropriate for them in the context of care. This rate differed by type of comparator [55% for non-head-to-head RCTs vs. 6% for head-to-head RCTs; adjusted odds ratio (aOR), 23.9 (95% CI: 5.5, 92.7)] and duration of trial control treatment [56% for ≤24 weeks and 15% for >24 weeks; aOR, 10.7 (95% CI: 2.8, 63.9)] but not patient RA activity [aOR, 2.5 (95% CI: 1.0, 6.6)]. The limitation of this study was that physicians gave their opinion on fictional patients with only RA. CONCLUSIONS Control treatments in RCTs of biologics in RA are often deemed not acceptable in the context of usual care, especially those for non-head-to-head RCTs. These findings raise ethical concerns and challenge the choice of the comparator in RCTs.
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Moseng T, Tveter AT, Holm I, Dagfinrud H. Patients with musculoskeletal conditions do less vigorous physical activity and have poorer physical fitness than population controls: a cross-sectional study. Physiotherapy 2014; 100:319-24. [PMID: 24529543 DOI: 10.1016/j.physio.2013.11.005] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2013] [Accepted: 11/08/2013] [Indexed: 11/19/2022]
Abstract
OBJECTIVES To compare physical activity and physical fitness in patients with various musculoskeletal conditions receiving physiotherapy in primary care with population controls. DESIGN Cross-sectional. PARTICIPANTS One hundred and sixty-seven patients with musculoskeletal conditions receiving physiotherapy in primary care and 313 population controls from various settings and geographical areas. MAIN OUTCOME MEASURES Physical activity was measured with the International Physical Activity Questionnaire short-form (IPAQ-sf) and reported in metabolic equivalents (METs). The 6-minute walk test and 30-second sit-to-stand test reflected cardiorespiratory endurance and muscular strength, respectively. RESULTS Differences in physical activity between the groups were explored using the Mann-Whitney U-test. The patient group reported significantly less vigorous activity compared with the control group {median 0 [interquartile range (IQR) 0 to 960] vs median 240 [IQR 0 to 1440] MET minutes/week, respectively)} (P=0.001). A similar proportion of patients (68%) and controls (75%) reached the recommended level of health-enhancing physical activity (P=0.11). Linear regression analyses adjusted for age, body mass index and gender showed significantly poorer fitness in the patient group compared with the control group, reflected by the 6-minute walk test and the 30-second sit-to-stand test {mean difference 69m [95% confidence interval (CI) 52 to 85; P≤0.001] and six repetitions [95% CI 5 to 7; P≤0.001], respectively}. CONCLUSIONS Patients with various long-term musculoskeletal conditions receiving physiotherapy in primary care had significantly poorer physical fitness and reported less vigorous physical activity compared with population controls.
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Affiliation(s)
- T Moseng
- Institute of Health and Society, Medical Faculty, University of Oslo, Oslo, Norway.
| | - A T Tveter
- Institute of Health and Society, Medical Faculty, University of Oslo, Oslo, Norway
| | - I Holm
- Institute of Health and Society, Medical Faculty, University of Oslo, Oslo, Norway; Division of Surgery and Clinical Neuroscience, Orthopaedic Department, Section of Research, Oslo University Hospital, Oslo, Norway
| | - H Dagfinrud
- Institute of Health and Society, Medical Faculty, University of Oslo, Oslo, Norway; National Resource Centre for Rehabilitation in Rheumatology, Diakonhjemmets Hospital, Oslo, Norway
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Borji R, Fereshtehnejad SM, Taba Taba Vakili S, Daryani NE, Ajdarkosh H. Association between irritable bowel syndrome and restless legs syndrome: a comparative study with control group. J Neurogastroenterol Motil 2012; 18:426-33. [PMID: 23106004 PMCID: PMC3479257 DOI: 10.5056/jnm.2012.18.4.426] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/26/2012] [Revised: 05/10/2012] [Accepted: 07/04/2012] [Indexed: 01/04/2023] Open
Abstract
BACKGROUND/AIMS As a common gastrointestinal (GI) disorder, irritable bowel syndrome (IBS) has been reported to be associated with some psychological and neurological factors. This study aimed to evaluate the prevalence rate of restless legs syndrome (RLS) in a sample of IBS patients and to compare this prevalence with that of matched healthy controls. METHODS This prospective comparative study was conducted in Tehran, Iran during 2010-2011. Based on the Rome III criteria, a total number of 225 definite IBS patients and 262 age- and sex-matched healthy controls were recruited in the final assessment to compare the prevalence rate of RLS between the 2 groups. RESULTS RLS was significantly more frequent in IBS group (25.3% vs 6.5%, P < 0.001) which led to an odds ratio (OR) of 4.89 (95% CI, 2.75-8.70). IBS patients with co-morbid RLS significantly suffered more from stomach pain (96.5% vs 86.3%, OR = 4.36 [95% CI, 1.00-19.12]), nausea (40.4% vs 21.4%, OR = 2.48 [95% CI, 1.30-4.73]) and vomiting (10.5% vs 2.4%, OR = 4.82 [95% CI, 1.31-17.76]). CONCLUSIONS By enrolling a considerable number of IBS patients and healthy controls, our study showed a significantly higher prevalence of RLS in IBS patients. Surprisingly, a higher prevalence rate of RLS was also accompanied with a more severe discomfort and stomach pain in IBS patients. It seems that screening patients with IBS for RLS may lead to greater identification of RLS and improved treatment for both conditions.
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Affiliation(s)
- Roghayyeh Borji
- Internal Medicine, Imam Khomeini Hospital Complex, Tehran University of Medical Sciences, Tehran, Iran
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