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Chang Y, Yao Y, Cui Z, Yang G, Li D, Wang L, Tang L. Changing antibiotic prescribing practices in outpatient primary care settings in China: Study protocol for a health information system-based cluster-randomised crossover controlled trial. PLoS One 2022; 17:e0259065. [PMID: 34995279 PMCID: PMC8741015 DOI: 10.1371/journal.pone.0259065] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2021] [Accepted: 10/01/2021] [Indexed: 11/18/2022] Open
Abstract
Background
The overuse and abuse of antibiotics is a major risk factor for antibiotic resistance in primary care settings of China. In this study, the effectiveness of an automatically-presented, privacy-protecting, computer information technology (IT)-based antibiotic feedback intervention will be evaluated to determine whether it can reduce antibiotic prescribing rates and unreasonable prescribing behaviours.
Methods
We will pilot and develop a cluster-randomised, open controlled, crossover, superiority trial. A total of 320 outpatient physicians in 6 counties of Guizhou province who met the standard will be randomly divided into intervention group and control group with a primary care hospital being the unit of cluster allocation. In the intervention group, the three components of the feedback intervention included: 1. Artificial intelligence (AI)-based real-time warnings of improper antibiotic use; 2. Pop-up windows of antibiotic prescription rate ranking; 3. Distribution of educational manuals. In the control group, no form of intervention will be provided. The trial will last for 6 months and will be divided into two phases of three months each. The two groups will crossover after 3 months. The primary outcome is the 10-day antibiotic prescription rate of physicians. The secondary outcome is the rational use of antibiotic prescriptions. The acceptability and feasibility of this feedback intervention study will be evaluated using both qualitative and quantitative assessment methods.
Discussion
This study will overcome limitations of our previous study, which only focused on reducing antibiotic prescription rates. AI techniques and an educational intervention will be used in this study to effectively reduce antibiotic prescription rates and antibiotic irregularities. This study will also provide new ideas and approaches for further research in this area.
Trial registration
ISRCTN, ID: ISRCTN13817256. Registered on 11 January 2020.
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Affiliation(s)
- Yue Chang
- School of Public Health, Guizhou Medical University, Guiyang, Guizhou Province, China
- * E-mail: (YC); (GY); (DL)
| | - Yuanfan Yao
- School of Medicine and Health Management, Guizhou Medical University, Guiyang, Guizhou Province, China
| | - Zhezhe Cui
- Guangxi Zhuang Autonomous Region Center for Disease Control and Prevention, Nan’ning, Guangxi Province, China
| | - Guanghong Yang
- School of Medicine and Health Management, Guizhou Medical University, Guiyang, Guizhou Province, China
- * E-mail: (YC); (GY); (DL)
| | - Duan Li
- School of Medicine and Health Management, Guizhou Medical University, Guiyang, Guizhou Province, China
- * E-mail: (YC); (GY); (DL)
| | - Lei Wang
- Primary Health Department of Guizhou Provincial Health Commission, Guiyang, Guizhou Province, China
| | - Lei Tang
- School of Medicine and Health Management, Guizhou Medical University, Guiyang, Guizhou Province, China
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Immunization Against Plague: An Argument for Controlled Experiment. JAMA 2020; 323:2347. [PMID: 32515807 DOI: 10.1001/jama.2019.13488] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
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4
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Olotu C, Lebherz L, Härter M, Mende A, Plümer L, Goetz AE, Zöllner C, Kriston L, Kiefmann R. Improvement of perioperative care of the elderly patient (PeriAge): protocol of a controlled interventional feasibility study. BMJ Open 2019; 9:e031837. [PMID: 31767591 PMCID: PMC6886921 DOI: 10.1136/bmjopen-2019-031837] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
INTRODUCTION Geriatric patients have a pronounced risk to suffer from postoperative complications. While effective risk-specific perioperative measures have been studied in controlled experimental settings, they are rarely found in routine healthcare. This study aims (1) to implement a multicomponent preoperative and intraoperative intervention, and investigate its feasibility, and (2) exploratorily assess the effectiveness of the intervention in routine healthcare. METHODS AND ANALYSIS Feasibility and exploratory effectiveness of the intervention will be investigated in a monocentric, prospective, non-randomised, controlled trial. The intervention includes systematic information for patients and family about measures to prevent postoperative complications; preoperative screening for frailty, malnutrition, strength and mobility with nutrient supplementation and physical exercise (prehabilitation) as needed. Further components focus on potentially inadequate medication, patient blood-management and carbohydrate loading prior to surgery, retainment of orientation aids in the operating room and a geriatric anaesthesia concept. Data will successively be collected from control, implementation and intervention groups. Patients aged 65+ with impending surgery will be included. A sample size of 240, n=80 per group, is planned. Assessments will take place at inclusion and 2, 30 and 180 days after surgery. Mixed-methods analyses will be performed. Exploratory effectiveness will be assessed using mixed segmented regressions. The primary endpoint is functional status. Secondary endpoints include cognitive performance, health-related quality of life, length of inpatient stay and occurrence of postoperative complications. Feasibility will be assessed through semi-structured interviews with staff and patients and quantitative analyses of the data quality, focussing on practicability, acceptance, adoption and fidelity to protocol. ETHICS AND DISSEMINATION The study will be carried out in accordance with the Helsinki Declaration and to principles of good scientific practice. The Ethics Committee of the Medical Association Hamburg, Germany, approved the protocol (study ID: PV5596). Results will be disseminated in scientific journals and healthcare conferences. TRIAL REGISTRATION NUMBER ClinicalTrials.gov Identifier: NCT03325413.
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Affiliation(s)
- Cynthia Olotu
- Department of Anaesthesiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Lisa Lebherz
- Department of Medical Psychology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Martin Härter
- Department of Medical Psychology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Anna Mende
- Department of Anaesthesiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Lili Plümer
- Department of Anaesthesiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Alwin E Goetz
- Department of Anaesthesiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Christian Zöllner
- Department of Anaesthesiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Levente Kriston
- Department of Medical Psychology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Rainer Kiefmann
- Department of Anaesthesiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
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5
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Clough AJ, Hilmer SN, Kouladjian‐O'Donnell L, Naismith SL, Gnjidic D. Health professionals' and researchers' opinions on conducting clinical deprescribing trials. Pharmacol Res Perspect 2019; 7:e00476. [PMID: 31049205 PMCID: PMC6482940 DOI: 10.1002/prp2.476] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2019] [Accepted: 03/11/2019] [Indexed: 12/16/2022] Open
Abstract
While clinical deprescribing trials are increasingly being performed, there is no guidance on the optimum conduction of such studies. The aim of this survey was to explore the perspectives, attitudes, interests, barriers, and enablers of conducting clinical deprescribing trials among health professionals and researchers. An anonymous survey was developed, reviewed, and piloted by all investigators and informed by consultation with experts, as well as current deprescribing guidelines. The questions were formulated around current clinical trial frameworks and incorporated identified enablers and barriers of performing deprescribing studies. The survey was sent to members of Australian and international deprescribing, pharmacological, and pharmacy organizations, and other researchers published in deprescribing. A total of 96 respondents completed the survey (92.3% completion rate). Respondents indicated the main deprescribing trial rationale is to generate evidence to optimize patient-centered outcomes (79.2%). Common barriers identified included the time and effort required (18.2%), and apprehension of health professionals involved in trials (17.1%). Studies are enabled by positive attitudes toward deprescribing of treating prescribers (24.4%) and patients (20.9%). Classical randomized controlled trials (RCTs) were deemed the most appropriate methodology (93.2%). Sixty percent of participants indicated a good clinical practice framework is required to guide the conduct of deprescribing trials. There were no significant differences in responses based on previous experience in conducting clinical deprescribing trials. In conclusion, clinical deprescribing trials should be conducted to investigate whether deprescribing medications improves patient care. A future deprescribing trial framework should use classical RCTs as a model, ensure participant safety, and target patient-centered outcomes.
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Affiliation(s)
- Alexander J. Clough
- School of PharmacyUniversity of SydneyCamperdownNSWAustralia
- Kolling Institute of Medical ResearchUniversity of Sydney and Royal North Shore HospitalSt LeonardsNSWAustralia
| | - Sarah N. Hilmer
- Kolling Institute of Medical ResearchUniversity of Sydney and Royal North Shore HospitalSt LeonardsNSWAustralia
| | - Lisa Kouladjian‐O'Donnell
- Kolling Institute of Medical ResearchUniversity of Sydney and Royal North Shore HospitalSt LeonardsNSWAustralia
| | - Sharon L. Naismith
- Brain & Mind CentreUniversity of SydneyCamperdownNSWAustralia
- Charles Perkins CentreUniversity of SydneyCamperdownNSWAustralia
| | - Danijela Gnjidic
- School of PharmacyUniversity of SydneyCamperdownNSWAustralia
- Charles Perkins CentreUniversity of SydneyCamperdownNSWAustralia
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6
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Fudim M, Ali-Ahmed F, Patel MR, Sobotka PA. Sham trials: benefits and risks for cardiovascular research and patients. Lancet 2019; 393:2104-2106. [PMID: 31226034 DOI: 10.1016/s0140-6736(19)31120-1] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/12/2019] [Revised: 03/12/2019] [Accepted: 04/23/2019] [Indexed: 01/09/2023]
Affiliation(s)
- Marat Fudim
- Division of Cardiology, Duke University Medical Center, Durham, NC 27710, USA; Duke Clinical Research Institute, Durham, NC, USA.
| | - Fatima Ali-Ahmed
- Duke Clinical Research Institute, Durham, NC, USA; Division of Cardiology, Beaumont Health, Dearborn, MI, USA
| | - Manesh R Patel
- Division of Cardiology, Duke University Medical Center, Durham, NC 27710, USA; Duke Clinical Research Institute, Durham, NC, USA
| | - Paul A Sobotka
- Division of Cardiology, The Ohio State University, Columbus, OH, USA
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Anselma M, Altenburg T, Chinapaw M. Kids in Action: the protocol of a Youth Participatory Action Research project to promote physical activity and dietary behaviour. BMJ Open 2019; 9:e025584. [PMID: 30928943 PMCID: PMC6475341 DOI: 10.1136/bmjopen-2018-025584] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/26/2018] [Revised: 02/07/2019] [Accepted: 03/05/2019] [Indexed: 01/01/2023] Open
Abstract
INTRODUCTION In this study, researchers collaborate with children from a low socioeconomic neighbourhood in Amsterdam in developing, implementing and evaluating interventions targeting their health behaviours. This Youth Participatory Action Research project focuses on the promotion of physical activity and healthy dietary behaviour. METHODS AND ANALYSIS This study is a controlled trial using participatory methods to develop interventions together with children aged 9-12 years. At four primary schools in a low socioeconomic neighbourhood in Amsterdam, an 'Action Team' is installed: a group of six to eight children who actively participate as co-researchers in developing, implementing and evaluating interventions. An academic researcher facilitates the participatory process. Four control schools, also located in low socioeconomic areas in and around Amsterdam, continue with their regular curriculum and do not participate in the participatory process. For the effect evaluation, physical activity and sedentary behaviour are assessed using accelerometers and self-reporting; dietary behaviour using self-reporting and motor fitness (strength, flexibility, coordination, speed and endurance) using the motor performance fitness test. Effectiveness of the interventions is evaluated by multilevel regression analysis. The process of co-creating interventions and the implemented interventions is continually evaluated during meetings of the Action Teams and with children participating in the interventions. Empowerment of children is evaluated during focus groups. Summaries and transcripts of meetings are coded and analysed to enrich children's findings. ETHICS AND DISSEMINATION The Medical Ethics Committee of the VU Medical Center approved the study protocol (2016.366). TRIAL REGISTRATION NUMBER TC=6604.
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Affiliation(s)
- Manou Anselma
- Public and Occupational Health, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Teatske Altenburg
- Public and Occupational Health, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Mai Chinapaw
- Public and Occupational Health, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
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Thompson A, Carroll K, A. Inker L, Floege J, Perkovic V, Boyer-Suavet S, W. Major R, I. Schimpf J, Barratt J, Cattran DC, S. Gillespie B, Kausz A, W. Mercer A, Reich HN, H. Rovin B, West M, Nachman PH. Proteinuria Reduction as a Surrogate End Point in Trials of IgA Nephropathy. Clin J Am Soc Nephrol 2019; 14:469-481. [PMID: 30635299 PMCID: PMC6419287 DOI: 10.2215/cjn.08600718] [Citation(s) in RCA: 116] [Impact Index Per Article: 23.2] [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] [Indexed: 02/02/2023]
Abstract
IgA nephropathy (IgAN) is an important cause of ESKD for which there are no approved therapies. A challenge for evaluating treatments for IgAN is the usual long time course for progression to ESKD. The aim of this Kidney Health Initiative project was to identify surrogate end points that could serve as reliable predictors of a treatment's effect on long-term kidney outcomes in IgAN and be used as a basis for approval. Proteinuria was identified as the most widely recognized and well studied risk factor for progression to ESKD in IgAN. The workgroup performed a critical review of the data on proteinuria reduction as a surrogate end point for a treatment's effect on progression to ESKD in IgAN. Epidemiologic data indicate a strong and consistent relationship between the level and duration of proteinuria and loss of kidney function. Trial-level analyses of data from 13 controlled trials also show an association between treatment effects on percent reduction of proteinuria and treatment effects on a composite of time to doubling of serum creatinine, ESKD, or death. We conclude that data support the use of proteinuria reduction as a reasonably likely surrogate end point for a treatment's effect on progression to ESKD in IgAN. In the United States, reasonably likely surrogate end points can be used as a basis for accelerated approval of therapies intended to treat serious or life-threatening conditions, such as IgAN. The clinical benefit of products approved under this program would need to be verified in a postmarketing confirmatory trial.
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Affiliation(s)
- Aliza Thompson
- Division of Cardiovascular and Renal Products, Office of New Drugs, Center for Drug Evaluation and Research, Food and Drug Administration, Silver Spring, Maryland
| | | | | | - Jürgen Floege
- Division of Nephrology, RWTH University of Aachen, Aachen, Germany
| | - Vlado Perkovic
- The George Institute for Global Health, University of New South Wales, Sydney, Australia
| | - Sonia Boyer-Suavet
- Service de Néphrologie, Hôpital Pasteur, Centre Hospitalier Universitaire de Nice, Université Nice Sophia-Antipolis, Nice, France; Departments of
| | | | | | - Jonathan Barratt
- Infection, Inflammation and Immunity, University of Leicester, Leicester, UK
| | - Daniel C. Cattran
- University Health Network, University of Toronto, Toronto, Ontario, Canada
| | | | | | | | - Heather N. Reich
- University Health Network, University of Toronto, Toronto, Ontario, Canada
| | - Brad H. Rovin
- The Ohio State University Wexner Medical Center, Columbus, Ohio
| | - Melissa West
- American Society of Nephrology, Washington, DC; and
| | - Patrick H. Nachman
- Division of Renal Diseases and Hypertension, University of Minnesota, Minneapolis, Minnesota
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van Hamersvelt RW, Išgum I, de Jong PA, Cramer MJM, Leenders GEH, Willemink MJ, Voskuil M, Leiner T. Application of speCtraL computed tomogrAphy to impRove specIficity of cardiac compuTed tomographY (CLARITY study): rationale and design. BMJ Open 2019; 9:e025793. [PMID: 30826767 PMCID: PMC6429912 DOI: 10.1136/bmjopen-2018-025793] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/11/2023] Open
Abstract
INTRODUCTION Anatomic stenosis evaluation on coronary CT angiography (CCTA) lacks specificity in indicating the functional significance of a stenosis. Recent developments in CT techniques (including dual-layer spectral detector CT [SDCT] and static stress CT perfusion [CTP]) and image analyses (including fractional flow reserve [FFR] derived from CCTA images [FFRCT] and deep learning analysis [DL]) are potential strategies to increase the specificity of CCTA by combining both anatomical and functional information in one investigation. The aim of the current study is to assess the diagnostic performance of (combinations of) SDCT, CTP, FFRCT and DL for the identification of functionally significant coronary artery stenosis. METHODS AND ANALYSIS Seventy-five patients aged 18 years and older with stable angina and known coronary artery disease and scheduled to undergo clinically indicated invasive FFR will be enrolled. All subjects will undergo the following SDCT scans: coronary calcium scoring, static stress CTP, rest CCTA and if indicated (history of myocardial infarction) a delayed enhancement acquisition. Invasive FFR of ≤0.80, measured within 30 days after the SDCT scans, will be used as reference to indicate a functionally significant stenosis. The primary study endpoint is the diagnostic performance of SDCT (including CTP) for the identification of functionally significant coronary artery stenosis. Secondary study endpoint is the diagnostic performance of SDCT, CTP, FFRCT and DL separately and combined for the identification of functionally significant coronary artery stenosis. ETHICS AND DISSEMINATION Ethical approval was obtained. All subjects will provide written informed consent. Study findings will be disseminated through peer-reviewed conference presentations and journal publications. TRIAL REGISTRATION NUMBER NCT03139006; Pre-results.
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Affiliation(s)
| | - Ivana Išgum
- Image Sciences Institute, University Medical Centre Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Pim A de Jong
- Department of Radiology, University Medical Centre Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Maarten Jan Maria Cramer
- Department of Cardiology, University Medical Centre Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Geert E H Leenders
- Department of Cardiology, University Medical Centre Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Martin J Willemink
- Department of Radiology, University Medical Centre Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Michiel Voskuil
- Department of Cardiology, University Medical Centre Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Tim Leiner
- Department of Radiology, University Medical Centre Utrecht, Utrecht University, Utrecht, The Netherlands
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Abstract
Most controlled trials of acupuncture have used minimal, superficial, sham, or ‘placebo’ acupuncture. It has recently been demonstrated that light touch of the skin stimulates mechanoreceptors coupled to slow conducting unmyelinated (C) afferents resulting in activity in the insular region, but not in the somatosensory cortex. Activity in these C tactile afferents has been suggested to induce a ‘limbic touch’ response resulting in emotional and hormonal reactions. It is likely that, in many acupuncture studies, control procedures that are meant to be inert are in fact activating these C tactile afferents and consequently result in the alleviation of the affective component of pain. This could explain why control interventions are equally effective as acupuncture in alleviating pain conditions that are predominantly associated with affective components such as migraine or low back pain, but not those with a more pronounced sensory component, such as osteoarthritis of the knee or lateral epicondylalgia.
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Affiliation(s)
- Iréne Lund
- Karolinska Institutet, Stockholm, Sweden
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Namazi N, Larijani B, Ayati MH, Abdollahi M. The effects of Nigella sativa L. on obesity: A systematic review and meta-analysis. J Ethnopharmacol 2018; 219:173-181. [PMID: 29559374 DOI: 10.1016/j.jep.2018.03.001] [Citation(s) in RCA: 50] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/05/2017] [Revised: 03/02/2018] [Accepted: 03/03/2018] [Indexed: 06/08/2023]
Abstract
ETHNOPHARMACOLOGICAL RELEVANCE Nigella sativa L. (N.sativa) is a traditional herbal medicine that has been used for centuries to treat rheumatoid arthritis, diabetes, asthma, and other metabolic disorders. Recently, anti-obesity characteristics of N.sativa have been indicated. AIM OF THE STUDY The effects of N. sativa as a complementary therapy in obesity management remains controversial. We aimed to perform a meta-analysis on the effects of supplementation with N. sativa on some anthropometric indices in adult subjects. MATERIALS AND METHODS We searched PubMed/Medline, Cochrane Library, ISI Web of Science, and Scopus databases until June 2017 to identify relevant placebo-controlled clinical trials. Data was reported as weighted mean differences and standard deviations to show the magnitude of effects for N. sativa on body weight, body mass index (BMI) and waist circumference (WC). RESULTS Findings of 11 studies revealed that N. sativa supplement reduced body weight (-2.11 kg, 95% CI: -3.61, -0.61, I2:72.4%), BMI (-1.16 kg/m2; 95%CI: -1.81, -0.51; I2: 40.1%) and WC (-3.52 cm, 95%CI: -4.10, -2.92, I2 =0%) significantly compared to placebo groups. CONCLUSION Supplementation with N. sativa exerts a moderate effect on reduction in body weight, BMI and WC. However, due to the high heterogeneity for body weight and limited high quality studies, the findings should be declared by caution. No serious side effects were also reported following N. sativa supplementation. Further studies are needed to clarify the effects of N. sativa on other anthropometric indices.
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Affiliation(s)
- Nazli Namazi
- Obesity and Eating Habits Research Center, Endocrinology and Metabolism Molecular-Cellular Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran.
| | - Bagher Larijani
- Endocrinology and Metabolism Research Center, Endocrinology and Metabolism Clinical Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran.
| | | | - Mohammad Abdollahi
- Department of Toxicology and Pharmacology Faculty of Pharmacy, Pharmaceutical Sciences Research Centre, Tehran University of Medical Sciences, Tehran, Iran.
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Fuentes Camps I, Rodríguez A, Agustí A. Non-commercial vs. commercial clinical trials: a retrospective study of the applications submitted to a research ethics committee. Br J Clin Pharmacol 2018; 84:1384-1388. [PMID: 29446851 PMCID: PMC5980428 DOI: 10.1111/bcp.13555] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [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: 07/26/2017] [Revised: 12/18/2017] [Accepted: 02/07/2018] [Indexed: 11/29/2022] Open
Abstract
There are many difficulties in undertaking independent clinical research without support from the pharmaceutical industry. In this retrospective observational study, some design characteristics, the clinical trial public register and the publication rate of noncommercial clinical trials were compared to those of commercial clinical trials. A total of 809 applications of drug-evaluation clinical trials were submitted from May 2004 to May 2009 to the research ethics committee of a tertiary hospital, and 16.3% of trials were noncommercial. They were mainly phase IV, multicentre national, and unmasked controlled trials, compared to the commercial trials that were mainly phase II or III, multicentre international, and double-blind masked trials. The commercial trials were registered and published more often than noncommercial trials. More funding for noncommercial research is still needed. The results of the research, commercial or noncommercial, should be disseminated in order not to compromise either its scientific or its social value.
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Affiliation(s)
- Inmaculada Fuentes Camps
- Clinical Pharmacology ServiceHospital Universitari Vall d'HebronBarcelonaSpain
- Vall d'Hebron Research Institute (VHIR)BarcelonaSpain
| | - Alexis Rodríguez
- Clinical Pharmacology ServiceHospital Universitari Vall d'HebronBarcelonaSpain
- Vall d'Hebron Research Institute (VHIR)BarcelonaSpain
| | - Antonia Agustí
- Clinical Pharmacology ServiceHospital Universitari Vall d'HebronBarcelonaSpain
- Department of Pharmacology, Therapeutics and ToxicologyUniversitat Autònoma de BarcelonaCerdanyola del Vallès, BarcelonaSpain
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13
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Dickert NW, Miller FG. Sham-Controlled Trials for Coronary Interventions: Ethically Acceptable and Ethically Important. J Am Coll Cardiol 2018; 71:95-97. [PMID: 29301633 DOI: 10.1016/j.jacc.2017.11.032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Affiliation(s)
- Neal W Dickert
- Division of Cardiology, Emory University School of Medicine, Atlanta, Georgia.
| | - Franklin G Miller
- Division of Medical Ethics, Weill Cornell Medical College, New York, New York
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14
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Affiliation(s)
- Richard Doll
- Clinical Trial Service Unit & Epidemiological Studies Unit, Harkness Building, Radcliffe Infirmary, Oxford OX2 6HE, UK
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15
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Abstract
In phase II platform trials, ‘many-to-one’ comparisons are performed when K experimental treatments are compared with a common control to identify the most promising treatment(s) to be selected for Phase III trials. However, when sample sizes are limited, such as when the disease of interest is rare, only a single Phase II/III trial addressing both treatment selection and confirmatory efficacy testing may be feasible. In this paper, we suggest a two-step safety selection and testing procedure for such seamless trials. At the end of the study, treatments are first screened on the basis of safety, and those deemed to be sufficiently safe are then taken forwards for efficacy testing against a common control. All safety and efficacy evaluations are therefore performed at the end of the study, when for each patient all safety and efficacy data are available. If confirmatory conclusions are to be drawn from the trial, strict control of the family-wise error rate (FWER) is essential. However, to avoid unnecessary losses in power, no type I error rate should be “wasted” on comparisons which are no longer of interest because treatments have been dropped due to safety concerns. We investigate the impact on power and FWER control of multiplicity adjustments which correct efficacy tests only for the number of safe selected treatments instead of adjusting for all K null hypotheses the trial begins testing. We derive conditions under which strict control of the FWER can be achieved. Procedures using the estimated association between safety and efficacy outcomes are developed for the case when the correlation between endpoints is unknown. The operating characteristics of the proposed procedures are assessed via simulation.
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Affiliation(s)
- Gerald Hlavin
- Section for Medical Statistics, Center for Medical Statistics, Informatics, and Intelligent Systems, Medical University of Vienna, Vienna, Austria
| | - Lisa V. Hampson
- Statistical Innovation, Advanced Analytics Centre, AstraZeneca, Cambridge, United Kingdom
- Department of Mathematics & Statistics, Lancaster University, Lancaster, United Kingdom
| | - Franz Koenig
- Section for Medical Statistics, Center for Medical Statistics, Informatics, and Intelligent Systems, Medical University of Vienna, Vienna, Austria
- * E-mail:
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16
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Abstract
The estimation of causal effects in nonrandomized studies should comprise two distinct phases: design, with no outcome data available; and analysis of the outcome data according to a specified protocol. Here, we review and compare point and interval estimates of common statistical procedures for estimating causal effects (i.e. matching, subclassification, weighting, and model-based adjustment) with a scalar continuous covariate and a scalar continuous outcome. We show, using an extensive simulation, that some highly advocated methods have poor operating characteristics. In many conditions, matching for the point estimate combined with within-group matching for sampling variance estimation, with or without covariance adjustment, appears to be the most efficient valid method of those evaluated. These results provide new conclusions and advice regarding the merits of currently used procedures.
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Affiliation(s)
- R Gutman
- Department of Biostatistics, Brown University, Providence, RI, USA
| | - DB Rubin
- Department of Statistics, Harvard University, Cambridge, MA, USA
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17
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Abstract
Due to past success in testing and gaining regulatory approval for a variety of therapies in multiple sclerosis (MS), the conduct of future clinical trials has become increasingly problematic. An international workshop has met to discuss the issues facing the MS clinical trial community and to examine possible new strategies for the design of trials. Particular focus has been placed on trials that either avoid the use of a placebo because of ethical considerations or on designs that allow new therapies to be studied more rapidly or with fewer patients than needed in a conventional placebo-controlled trial. The discussions resulting from the workshop should provide a basis for the examination and implementation of innovative clinical trial designs in MS.
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Affiliation(s)
- H F McFarland
- Neuroimmunology Branch, National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, MD, USA.
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Hofmann SG, Doan SN, Sprung M, Wilson A, Ebesutani C, Andrews LA, Curtiss J, Harris PL. Training children's theory-of-mind: A meta-analysis of controlled studies. Cognition 2016; 150:200-12. [PMID: 26901235 PMCID: PMC4792776 DOI: 10.1016/j.cognition.2016.01.006] [Citation(s) in RCA: 55] [Impact Index Per Article: 6.9] [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: 06/11/2015] [Revised: 12/19/2015] [Accepted: 01/12/2016] [Indexed: 11/18/2022]
Abstract
BACKGROUND Theory-of-mind (ToM) refers to knowledge and awareness of mental states in oneself and others. Various training programs have been developed to improve ToM in children. OBJECTIVES In the present study, we conducted a quantitative review of ToM training programs that have been tested in controlled studies. DATA SOURCES A literature search was conducted using PubMed, PsycInfo, the Cochrane Library, and manual searches. REVIEW METHODS We identified 32 papers with 45 studies or experiments that included 1529 children with an average age of 63 months (SD=28.7). RESULTS ToM training procedures were more effective than control procedures and their aggregate effect size was moderately strong (Hedges' g=0.75, CI=0.60-0.89, p<.001). Moderator analyses revealed that although ToM training programs were generally effective, ToM skill-related outcomes increased with length of training sessions and were significantly higher in active control studies. CONCLUSION ToM training procedures can effectively enhance ToM in children.
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Affiliation(s)
- Stefan G Hofmann
- Department of Psychological and Brain Sciences, Boston University, 648 Beacon Street, 6th Floor, Boston, MA 02215, USA.
| | - Stacey N Doan
- Department of Psychology, Claremont McKenna College, 850 Columbia Ave., Claremont, CA 91711, USA.
| | - Manuel Sprung
- Psychosomatisches Zentrum Waldviertel, Grafenberg Straße 2, 3730 Eggenburg, Austria.
| | - Anne Wilson
- Department of Psychology, Ohio State University, 225 Psychology Building, 1835 Neil Avenue, Columbus, OH 43210, USA.
| | - Chad Ebesutani
- Department of Psychology, Duksung Women's University, 33, Samyangro 144-gil, (419 Ssangmun Dong), Dobong Gu, Seoul 132-714, South Korea.
| | - Leigh A Andrews
- Department of Psychological and Brain Sciences, Boston University, 648 Beacon Street, 6th Floor, Boston, MA 02215, USA
| | - Joshua Curtiss
- Department of Psychological and Brain Sciences, Boston University, 648 Beacon Street, 6th Floor, Boston, MA 02215, USA
| | - Paul L Harris
- Graduate School of Education, Harvard University, 503A Larsen Hall, Appian Way, Cambridge, MA 02138, USA.
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Punga AR, Eriksson A, Alimohammadi M. Regional diffusion of botulinum toxin in facial muscles: a randomised double-blind study and a consideration for clinical studies with split-face design. Acta Derm Venereol 2015; 95:948-51. [PMID: 25766591 DOI: 10.2340/00015555-2093] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Despite the extensive use of botulinum toxin A (BoNTA) in medical and cosmetic treatments, the potential spreading of BoNTA to surrounding tissues remains unknown. A patient with hemifacial paralysis upon blepharospasm treatment with low dose of BoNTA, prompted us to investigate the spreading effect. A randomised, double-blind study was conducted in which 5 healthy women (33-52 years) were treated with different doses of onabotulinum toxin unilaterally in the corrugator muscle. Parameters of efficacy and diffusion (CMAP; EMG and jitter analysis) in both glabellar and frontalis muscles were assessed at baseline, 2 and 4 weeks following BoNTA injection. CMAP of the treated glabellar muscles was reduced to approximately 40% in all dose groups. Additionally, contralateral CMAP reduction was observed in 3 of 5 subjects. These data confirm regional diffusion of BoNTA in facial muscle application, which raises question on the reliability of split-face models in BoNTA studies.
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Affiliation(s)
- Anna Rostedt Punga
- Department of Clinical Neurophysiology, Uppsala University, Uppsala, Sweden
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Abstract
INTRODUCTION Although strengths-based models are popular within recovery-oriented approaches, there is still a lack of conclusive research to guide how they should be implemented. A recent meta-analysis confirmed the lack of clarity in how this perspective is operationalised and that fidelity monitoring during the implementation process is lacking. Hence, there is a clear need to evaluate the feasibility of delivering and evaluating a clearly operationalised strengths-based intervention that incorporates fidelity checks to inform more definitive research. This protocol therefore describes a controlled trial of Strengths Model Case Management (SMCM), a complex intervention, for people with severe mental illnesses in Hong Kong. This trial follows the guidelines of the Medical Research Council as a phase 2 trial. Hence, it is a pilot study that tests the feasibility and effectiveness of the model. METHODS AND ANALYSIS This is a 9-month controlled trial that uses the Kansas Model. Participants and a matched control group are recruited on a voluntary basis, after screening for eligibility. Effectiveness of the SMCM will be measured through outcome measures taken at baseline, the mid-point and at the end of the trial. Outcomes for service users include personal recovery, hope, subjective well-being, psychiatric symptoms, perceived level of recovery features within the organisation, therapeutic alliance and achievement of recovery goals. Outcomes for care workers will include job burnout, organisational features of recovery and perceived supervisory support. With a 2×3 analysis of variance design and a moderate intervention effect (Cohen's d=0.50), a total of 86 participants will be needed for a statistical power of 0.80. ETHICS AND DISSEMINATION Ethical approval has been obtained from the Human Research Ethics Committee for Non-Clinical Faculties at The University of Hong Kong (HRECNCF: EA140913). TRIAL REGISTRATION NUMBER Australian New Zealand Clinical Trial Registry (ACTRN)12613001120763.
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Affiliation(s)
- Wing-See Emily Tsoi
- Department of Social Work and Social Administration, University of Hong Kong, Hong Kong, Hong Kong
| | - Samson Tse
- Department of Social Work and Social Administration, University of Hong Kong, Hong Kong, Hong Kong
| | - Sadaaki Fukui
- Center for Mental Health Research and Innovation, School of Social Welfare, University of Kansas, Lawrence, Kansas, USA
| | - Steven Jones
- Division of Health Research, Faculty of Health and Medicine,Spectrum Centre for Mental Health Research, Lancaster University, Lancaster, UK
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Simon JR, Broadbent A, Gifford F. Beyond bioethics: the 5th International Philosophy of Medicine Roundtable. Theor Med Bioeth 2015; 36:1-5. [PMID: 25644975 DOI: 10.1007/s11017-015-9316-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Affiliation(s)
- Jeremy R Simon
- Center for Bioethics and Department of Medicine, Columbia University, 630 West 168th Street, P&S 3-470, New York, NY, 10032, USA,
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Abstract
It has been almost 20 years since the field of bioethics was galvanized by a controversial series of multinational AZT trials employing placebo controls on pregnant HIV-positive women in the developing world even though a standard of care existed in the sponsor countries. The trove of ethical investigations that followed was thoughtful and challenging, yet an important and problematic methodological assumption was left unexplored. In this article, I revisit the famous "double standard of care" case study in order to offer novel consideration of the placebo orthodoxy that underlies much of the ethical debate. This majority view found in medical research is that placebo-controlled trials are methodologically superior to comparative trials that use active controls. I challenge this orthodoxy and argue that lives were unnecessarily lost in these trials as a result. Furthermore, current HIV research on vaccines and microbicides is now poised to repeat the error of subscribing to the placebo orthodoxy.
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Affiliation(s)
- Maya J Goldenberg
- Department of Philosophy, University of Guelph, Guelph, ON, N1G 2W1, Canada,
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Ma L, Zhao L, Xu Y, Yim S, Doddapaneni S, Sahajwalla CG, Wang Y, Ji P. Clinical endpoint sensitivity in rheumatoid arthritis: modeling and simulation. J Pharmacokinet Pharmacodyn 2014; 41:537-43. [PMID: 25283268 DOI: 10.1007/s10928-014-9385-x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2014] [Accepted: 09/16/2014] [Indexed: 11/25/2022]
Abstract
The commonly used efficacy endpoints in Rheumatoid Arthritis (RA) clinical trials are American College of Rheumatology 20 % improvement criteria (ACR20), ACR50, and ACR70 response rates, and the 28-joint disease activity score (DAS28). Longitudinal models to quantitate the exposure-response relationships for ACRs and DAS28 score were developed for four biologics used for the management of RA. The models were then used to simulate the clinical outcome at various time points following different treatment regimens. Discriminative sensitivity of these endpoints was assessed using a power analysis. The trial simulation and subsequent power analysis showed that both ACR20 and DAS28 exhibit much lower power in distinguishing between two doses investigated compared with distinguishing treatment effect over placebo/Methotrexate (MTX) control. ACR20 response rate is generally more powerful in detecting treatment effect over placebo/MTX control as compared to DAS28. The findings of current study provide useful information which will help future clinical trial design for the treatment of patients with RA.
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Affiliation(s)
- Lian Ma
- Division of Pharmacometrics, Office of Clinical Pharmacology, Center for Drug Evaluation and Research, Food and Drug Administration, Silver Spring, MD, USA
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Peinemann F, Labeit AM, Thielscher C, Pinkawa M. Failure to address potential bias in non-randomised controlled clinical trials may cause lack of evidence on patient-reported outcomes: a method study. BMJ Open 2014; 4:e004720. [PMID: 24898087 PMCID: PMC4054649 DOI: 10.1136/bmjopen-2013-004720] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/19/2013] [Revised: 04/28/2014] [Accepted: 05/13/2014] [Indexed: 12/30/2022] Open
Abstract
OBJECTIVES We conducted a workup of a previously published systematic review and aimed to analyse why most of the identified non-randomised controlled clinical trials with patient-reported outcomes did not match a set of basic quality criteria. SETTING There were no limits on the level of care and the geographical location. PARTICIPANTS The review evaluated permanent interstitial low-dose rate brachytherapy in patients with localised prostate cancer and compared that intervention with alternative procedures such as external beam radiotherapy, radical prostatectomy and no primary therapy. PRIMARY OUTCOME MEASURE Fulfilment of basic inclusion criteria according to a Participants, Interventions, Comparisons, Outcomes (PICO) framework and accomplishment of requirements to contain superimposed risk of bias. RESULTS We found that 21 of 50 excluded non-randomised controlled trials did not meet the PICO inclusion criteria. The remaining 29 studies showed a lack in the quality of reporting. The resulting flaws included attrition bias due to loss of follow-up, lack of reporting baseline data, potential confounding due to unadjusted data and lack of statistical comparison between groups. CONCLUSIONS With respect to the reporting of patient-reported outcomes, active efforts are required to improve the quality of reporting in non-randomised controlled trials concerning permanent interstitial low-dose rate brachytherapy in patients with localised prostate cancer.
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Affiliation(s)
- Frank Peinemann
- Children's Hospital, University of Cologne, Cologne, Germany
| | | | | | - Michael Pinkawa
- Department of Radiotherapy, University Hospital, Aachen, Germany
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Gribble PA, Delahunt E, Bleakley CM, Caulfield B, Docherty CL, Fong DTP, Fourchet F, Hertel J, Hiller CE, Kaminski TW, McKeon PO, Refshauge KM, van der Wees P, Vicenzino W, Wikstrom EA. Selection criteria for patients with chronic ankle instability in controlled research: a position statement of the International Ankle Consortium. J Athl Train 2014; 49:121-7. [PMID: 24377963 PMCID: PMC3917288 DOI: 10.4085/1062-6050-49.1.14] [Citation(s) in RCA: 263] [Impact Index Per Article: 26.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
While research on chronic ankle instability (CAI) and awareness of its impact on society and health care systems has grown substantially in the last 2 decades, the inconsistency in participant or patient selection criteria across studies presents a potential obstacle to addressing the problem properly. This major gap within the literature limits the ability to generalize this evidence to the target patient population. Therefore, there is a need to provide standards for patient or participant selection criteria in research focused on CAI with justifications using the best available evidence. The International Ankle Consortium provides this position paper to present and discuss an endorsed set of selection criteria for patients with CAI based on the best available evidence to be used in future research and study designs. These recommendations will enhance the validity of research conducted in this clinical population with the end goal of bringing the research evidence to the clinician and patient.
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Affiliation(s)
| | | | | | | | | | | | - François Fourchet
- Aspire Health Centre, National Sports Medicine Programme (NSMP), Doha, Qatar
| | - Jay Hertel
- The University of Virginia, Charlottesville
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[Summary of the discussion part 5]. Z Evid Fortbild Qual Gesundhwes 2013; 107:235. [PMID: 23790702 DOI: 10.1016/j.zefq.2013.04.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
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Mao WC, Liu BY, He LY, Liu ZS. [Thinking on controlled setting of plarebo acupuncture in clinical trial of acupuncture and moxibustion]. Zhongguo Zhen Jiu 2013; 33:367-371. [PMID: 23819251] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
Differences and relations between effects of acupuncture therapy and sham acupuncture are systematically analyzed in this article through the influential factors of acupuncture effect. And it is held that sham acupuncture effect is not exactly equal to placebo effect. The effects of both acupuncture and sham acupuncture are composed by specific effects and non-specific effects, and the differences of non-specific effects between acupunc ture and sham acupuncture can be minimized furthest with blinding and randomized method. Therefore, the difference of acupuncture and sham acupuncture treatment rests with the degree of differences of the specific effects. Only when both of the specific effect of acupuncture and the effect of acupuncture are minimized, can it be applied as the ideal placebo control. Consequently when placebo acupunture are setted up, factors such as the body condition, site of stimulation and stimulation parameters which can influence the specific effect of acupuncture should be taken into consideration to produce the relatively minimum specific effect.
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Affiliation(s)
- Wen-Chao Mao
- Institute of Basic Research of Clinical Medicine, China Academy of Chinese Medical Sciences, Beijing 100700, China; 2. China Academy of Chinese Medical
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Farkouh ME. Getting to the heart of the matter: a trialist's approach to the use of nonsteroidal anti‑inflammatory drugs for patients with chronic pain syndromes. Pol Arch Med Wewn 2013; 123:433-435. [PMID: 24084249] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
In this editorial, I refer to the relative risks associated with different interventions. To provide a perspective of what it means, please consider the risks of particular events in the placebo group of controlled trials of cyclooxygenase-2 inhibitors: major vascular events (0.82%) including nonfatal myocardial infarction (MI; 0.29%) or any MI (0.33%), any stroke (0.36%), heart failure (0.26%), upper gastrointestinal (GI) bleeding (0.14%) with any major GI complication (0.19%).
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Abstract
The recent rush of enthusiasm for public investment in comparative effectiveness research (CER) in the US has focussed attention on these public investments. However, little attention has been given to how changing public investment in CER may affect private manufacturers' incentives for CER, which has long been a major source of CER. In this work, based on a simple revenue maximizing economic framework, we generate predictions on thresholds to invest in CER for a private manufacturer that compares its own product to a competitor's product in head-to-head trials. Our analysis shows that private incentives to invest in CER are determined by how the results of CER may affect the price and quantity of the product sold and the duration over which resulting changes in revenue would accrue, given the time required to complete CER and the time from the completion of CER to the time of patent expiration. We highlight the result that private incentives may often be less than public incentives to invest in CER and may even be negative if the likelihood of adverse findings is sufficient. We find that these incentives imply a number of predictions about patterns of CER and how they will be affected by changes in public financing of CER and CER methods. For example, these incentives imply that incumbent patent holders may be less likely to invest in CER than entrants and that public investments in CER may crowd out similar private investments. In contrast, newer designs and methods for CER, such as Bayesian adaptive trials, which can reduce ex post risk of unfavourable results and shorten the time for the production of CER, may increase the expected benefits of CER and may tend to increase private investment in CER as long as the costs of such innovative designs are not excessive. Bayesian approaches to design also naturally highlight the dynamic aspects of CER, allowing less expensive initial studies to guide decisions about future investments and thereby encouraging greater initial investments in CER. However, whether the potential effects we highlight of public funding of CER and of Bayesian approaches to trial design actually produce changes in private investment in CER remains an empirical question.
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Affiliation(s)
- Anirban Basu
- Department of Health Services and Pharmaceutical Outcomes Research and Policy Program (PORPP), University of Washington, Seattle, WA 98195-7660, USA.
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Rutherford BR, Sneed JR, Roose SP. Does differential drop-out explain the influence of study design on antidepressant response? A meta-analysis. J Affect Disord 2012; 140:57-65. [PMID: 22387053 PMCID: PMC3586309 DOI: 10.1016/j.jad.2012.01.031] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/04/2011] [Revised: 01/10/2012] [Accepted: 01/30/2012] [Indexed: 12/28/2022]
Abstract
BACKGROUND Response to antidepressants is higher in active comparator relative to placebo-controlled clinical trials. Increased patient expectancy in comparator trials has been hypothesized to explain this finding, but previous analyses have not accounted for the increased drop-out observed in placebo-controlled trials. METHODS A systematic literature review was conducted to identify published antidepressant clinical trials reporting data on intent-to-treat (ITT) as well as completer patient populations. The influence of participant drop-out on observed antidepressant response was investigated by comparing the ITT and completer data sets in separate multilevel meta-analyses of antidepressant response in placebo-controlled and comparator trials. RESULTS 18 placebo-controlled and 18 active comparator studies were available for analysis. Using the intent-to-treat data, the odds of responding to medication in comparator trials were 1.9 times the odds in placebo-controlled trials (95% CI=1.3-2.7, p=0.001). The same pattern was obtained among study completers, in whom the odds of responding to antidepressant medication were 1.9 times higher in comparator as opposed to placebo-controlled study designs (95% CI=1.2-3.0, p=0.009). LIMITATIONS Publication bias, the use of trial-level summary data, and unreported clinical or demographic differences between the ITT and completer patient populations may have influenced the study results. CONCLUSIONS Increased drop-out in placebo-controlled vs. active comparator studies of antidepressant medications does not appear to explain the difference in response rates between these study types. Rather, increased patient expectancy resulting from the certainty of receiving active medication in comparator trials may lead to improved response rates.
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Affiliation(s)
- Bret R Rutherford
- Columbia University College of Physicians and Surgeons, New York State Psychiatric Institute, United States.
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Gagnier JJ, Moher D, Boon H, Beyene J, Bombardier C. Investigating clinical heterogeneity in systematic reviews: a methodologic review of guidance in the literature. BMC Med Res Methodol 2012; 12:111. [PMID: 22846171 PMCID: PMC3564789 DOI: 10.1186/1471-2288-12-111] [Citation(s) in RCA: 120] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2011] [Accepted: 06/15/2012] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND While there is some consensus on methods for investigating statistical and methodological heterogeneity, little attention has been paid to clinical aspects of heterogeneity. The objective of this study is to summarize and collate suggested methods for investigating clinical heterogeneity in systematic reviews. METHODS We searched databases (Medline, EMBASE, CINAHL, Cochrane Library, and CONSORT, to December 2010) and reference lists and contacted experts to identify resources providing suggestions for investigating clinical heterogeneity between controlled clinical trials included in systematic reviews. We extracted recommendations, assessed resources for risk of bias, and collated the recommendations. RESULTS One hundred and one resources were collected, including narrative reviews, methodological reviews, statistical methods papers, and textbooks. These resources generally had a low risk of bias, but there was minimal consensus among them. Resources suggested that planned investigations of clinical heterogeneity should be made explicit in the protocol of the review; clinical experts should be included on the review team; a set of clinical covariates should be chosen considering variables from the participant level, intervention level, outcome level, research setting, or others unique to the research question; covariates should have a clear scientific rationale; there should be a sufficient number of trials per covariate; and results of any such investigations should be interpreted with caution. CONCLUSIONS Though the consensus was minimal, there were many recommendations in the literature for investigating clinical heterogeneity in systematic reviews. Formal recommendations for investigating clinical heterogeneity in systematic reviews of controlled trials are required.
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Affiliation(s)
- Joel J Gagnier
- Departments of Orthopaedic Surgery and Epidemiology, University of Michigan, 24 Frank Lloyd Wright Drive, Ann Arbor, MI, USA
| | - David Moher
- Clinical Epidemiology Program, Ottawa Health Research Institute, Ottawa, ON, Canada
- Department of Epidemiology & Community Medicine, Faculty of Medicine, University of Ottawa, Ottawa, ON, Canada
| | - Heather Boon
- Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, ON, Canada
| | - Joseph Beyene
- Child Health and Evaluative Sciences, The Hospital for Sick Children, Toronto, ON, Canada
| | - Claire Bombardier
- Health Policy, Management & Evaluation, Faculty of Medicine, University of Toronto, Toronto, ON, Canada
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Abstract
BACKGROUND Primary healthcare (PHC) workers often work alone or in isolation. Healthcare managerial supervision is recommended to help assure quality; but this requires skilled supervisors and takes time and resources. It is therefore important to assess to what extent supervision is beneficial and the ways in which it can be implemented. OBJECTIVES To review the effects of managerial supervision of health workers to improve the quality of PHC (such as adherence to guidance or coverage of services) in low- and middle-income countries. SEARCH STRATEGY We searched The Cochrane Central Register of Controlled Trials (CENTRAL) 2011, Issue 1, part of The Cochrane Library. www.thecochranelibrary.com, including the Cochrane Effective Practice and Organisation of Care (EPOC) Group Specialised Register (searched 10 March 2011); MEDLINE, Ovid 1950 to March Week 1 2011 (searched 08 March 2011); EMBASE, Ovid 1980 to 2011 Week 12 (searched 08 March 2011); CINAHL, Ebsco 1981 - present (searched 10 March 2011); LILACS, VHL (searched 10 March 2011). SELECTION CRITERIA Randomised controlled trials, controlled before-and-after studies, and interrupted time series studies, conducted in PHC in low- and middle-income countries. Supervision includes site visits from a central level of the health system, plus at least one supervisory activity. We excluded studies aimed solely at improving the clinical skills of PHC workers. DATA COLLECTION AND ANALYSIS We extracted data using a predefined form and assessed for risk of bias using the EPOC risk of bias criteria. Data are presented in a narrative way without pooling the effects on the outcomes as studies and outcomes were diverse. MAIN RESULTS Nine studies met the inclusion criteria: three compared supervision with no supervision, five compared enhanced supervision with routine supervision, and one study compared less intensive supervision with routine supervision. Most outcomes were scores relating to providers' practice, knowledge and provider or user satisfaction. The majority of the outcomes were measured within nine months after the interventions were introduced. In two studies comparing supervision with no supervision, small benefits on provider practice and knowledge were found. For methods of enhancing supervision, we identified five studies, and two studies of frequent supportive supervision demonstrated small benefits on workers performance. The one study examining the impact of less intensive supervision found no evidence that reducing the frequency of visits had any effect on the utilisation of services. The GRADE evidence quality for all comparisons and outcomes was "low" or "very low". AUTHORS' CONCLUSIONS It is uncertain whether supervision has a substantive, positive effect on the quality of primary health care in low- and middle-income countries. The long term effectiveness of supervision is unknown.
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Affiliation(s)
- Xavier Bosch‐Capblanch
- Swiss Tropical and Public Health InstituteSwiss Centre for International HealthSocinstrasse 57BaselSwitzerland4002
| | - Sajil Liaqat
- Liverpool School of Tropical MedicineInternational Health GroupPembroke PlaceLiverpoolMerseysideUKL3 5QA
| | - Paul Garner
- Liverpool School of Tropical MedicineDepartment of Clinical SciencesPembroke PlaceLiverpoolMerseysideUKL3 5QA
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Abstract
A complete defense of deceptive placebo use must address this ethical objection: deceptive placebo use violates patient autonomy, because deceiving a patient about the placebo nature of a proposed treatment prevents her from giving informed consent to the treatment. Unfortunately, this objection isn't always recognized and clearly disambiguated from other ethical concerns. I consider how well several bioethicists who write about placebo use have responded to, or evaded, this objection. I conclude that defenders of deceptive placebo use should, following the lead of Onora O'Neill, argue that deceptive placebo use is compatible with informed consent.
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Extended-release hydromorphone (Exalgo) for pain. Med Lett Drugs Ther 2011; 53:62-3. [PMID: 21836545] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
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Abstract
BACKGROUND Suppose a standard therapy (Standard) has been established to provide a clinically important reduction in risk of irreversible morbidity or mortality. In that setting, the safety and efficacy of an experimental intervention likely would be assessed in a clinical trial providing a comparison with Standard rather than a placebo arm. Such a trial often is designed to assess whether the efficacy of the experimental intervention is not unacceptably worse than that of Standard, and is called a non-inferiority trial. Formally, the non-inferiority trial usually is designed to rule out a non-inferiority margin, defined as the minimum threshold for what would constitute an unacceptable loss of efficacy. PURPOSE Even though the literature has many important articles identifying various approaches to the design and conduct of non-inferiority trials, confusion remains especially regarding key considerations for selecting the non-inferiority margin. The purpose of this article is to provide improved clarity regarding these considerations. METHODS We present scientific insights into many factors that should be addressed in the design and conduct of non-inferiority trials to enhance their integrity and reliability, and provide motivation for key considerations that guide the selection of non-inferiority margins. We also provide illustrations and insights from recent experiences. RESULTS Two considerations are essential, and should be addressed in separate steps, in the formulation of the non-inferiority margin. First, the margin should be formulated using adjustments to account for bias or lack of reliability in the estimate of the effect of Standard in the non-inferiority trial setting. Second, the non-inferiority margin should be formulated to achieve preservation of an appropriate percentage of the effect of Standard. LIMITATIONS The considerations, in particular regarding the importance of preservation of effect, might not apply to settings where it would be ethical as well as clinically relevant to include both Standard and placebo arms in the trial for direct comparisons with the experimental intervention arm. CONCLUSIONS Non-inferiority trials with non-rigorous margins allow substantial risk for accepting inadequately effective experimental regimens, leading to the risk of erosion in quality of health care. The design and conduct of non-inferiority trials, including selection of non-inferiority margins, should account for many factors that can induce bias in the estimated effect of Standard in the non-inferiority trial and thus lead to bias in the estimated effect of the experimental treatment, for the need to ensure the experimental treatment preserves a clinically acceptable fraction of Standard's effect, and for the particular vulnerability of the integrity of a non-inferiority trial to the irregularities in trial conduct. Due to the inherent uncertainties in non-inferiority trials, alternative designs should be pursued whenever possible.
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Affiliation(s)
- Thomas R Fleming
- Department of Biostatistics, University of Washington, Seattle, WA 98195-7232, USA.
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How can I find out if I'm eligible for a clinical trial? Mayo Clin Womens Healthsource 2011; 15:8. [PMID: 21540792] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
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Odgaard‐Jensen J, Vist GE, Timmer A, Kunz R, Akl EA, Schünemann H, Briel M, Nordmann AJ, Pregno S, Oxman AD. Randomisation to protect against selection bias in healthcare trials. Cochrane Database Syst Rev 2011; 2011:MR000012. [PMID: 21491415 PMCID: PMC7150228 DOI: 10.1002/14651858.mr000012.pub3] [Citation(s) in RCA: 122] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
BACKGROUND Randomised trials use the play of chance to assign participants to comparison groups. The unpredictability of the process, if not subverted, should prevent systematic differences between comparison groups (selection bias). Differences due to chance will still occur and these are minimised by randomising a sufficiently large number of people. OBJECTIVES To assess the effects of randomisation and concealment of allocation on the results of healthcare studies. SEARCH STRATEGY We searched the Cochrane Methodology Register, MEDLINE, SciSearch and reference lists up to September 2009. In addition, we screened articles citing included studies (ISI Science Citation Index) and papers related to included studies (PubMed). SELECTION CRITERIA Eligible study designs were cohorts of studies, systematic reviews or meta-analyses of healthcare interventions that compared random allocation versus non-random allocation or adequate versus inadequate/unclear concealment of allocation in randomised trials. Outcomes of interest were the magnitude and direction of estimates of effect and imbalances in prognostic factors. DATA COLLECTION AND ANALYSIS We retrieved and assessed studies that appeared to meet the inclusion criteria independently. At least two review authors independently appraised methodological quality and extracted information. We prepared tabular summaries of the results for each comparison and assessed the results across studies qualitatively to identify common trends or discrepancies. MAIN RESULTS A total of 18 studies (systematic reviews or meta-analyses) met our inclusion criteria. Ten compared random allocation versus non-random allocation and nine compared adequate versus inadequate or unclear concealment of allocation within controlled trials. All studies were at high risk of bias.For the comparison of randomised versus non-randomised studies, four comparisons yielded inconclusive results (differed between outcomes or different modes of analysis); three comparisons showed similar results for random and non-random allocation; two comparisons had larger estimates of effect in non-randomised studies than in randomised trials; and two comparisons had larger estimates of effect in randomised than in non-randomised studies.Five studies found larger estimates of effect in trials with inadequate concealment of allocation than in trials with adequate concealment. The four other studies did not find statistically significant differences. AUTHORS' CONCLUSIONS The results of randomised and non-randomised studies sometimes differed. In some instances non-randomised studies yielded larger estimates of effect and in other instances randomised trials yielded larger estimates of effect. The results of controlled trials with adequate and inadequate/unclear concealment of allocation sometimes differed. When differences occurred, most often trials with inadequate or unclear allocation concealment yielded larger estimates of effects relative to controlled trials with adequate allocation concealment. However, it is not generally possible to predict the magnitude, or even the direction, of possible selection biases and consequent distortions of treatment effects from studies with non-random allocation or controlled trials with inadequate or unclear allocation concealment.
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Affiliation(s)
- Jan Odgaard‐Jensen
- Norwegian Knowledge Centre for the Health ServicesGlobal Health UnitPO Box 7004, St. Olavs PlassOsloNorwayN‐0130
| | - Gunn E Vist
- Norwegian Knowledge Centre for the Health ServicesPrevention, Health Promotion and Organisation UnitPO Box 7004St Olavs PlassOsloNorway0130
| | - Antje Timmer
- Carl von Ossietzky University of OldenburgDepartment of Health Services ResearchOldenburgGermany
| | - Regina Kunz
- University of Basel Hospitalasim, Swiss Academy of Insurance MedicineUniversity of BaselPetersgraben 4BaselSwitzerland4031
| | - Elie A Akl
- American University of BeirutDepartment of Internal MedicineRiad El Solh StBeirutLebanon
| | - Holger Schünemann
- McMaster UniversityDepartments of Clinical Epidemiology and Biostatistics and of Medicine1280 Main Street WestHamiltonONCanadaL8N 4K1
| | - Matthias Briel
- University Hospital Basel (USB)Basel Institute for Clinical Epidemiology and BiostatisticsBaselSwitzerland
| | - Alain J Nordmann
- University Hospital BaselInstitute for Clinical Epidemiology and BiostatisticsHebelstrasse 10BaselSwitzerland4031
| | - Silvia Pregno
- University of Modena and Reggio EmiliaCattedra di Statistica MedicaVia del Pozzo 7141100 ModenaItaly
| | - Andrew D Oxman
- Norwegian Knowledge Centre for the Health ServicesGlobal Health UnitPO Box 7004, St. Olavs PlassOsloNorwayN‐0130
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Reiter RJ, Tan DX, Korkmaz A, Fuentes-Broto L. Drug-mediated ototoxicity and tinnitus: alleviation with melatonin. J Physiol Pharmacol 2011; 62:151-157. [PMID: 21673362] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Received: 01/12/2011] [Accepted: 03/30/2011] [Indexed: 05/30/2023]
Abstract
This review evaluates the published basic science and clinical reports related to the role of melatonin in reducing the side effects of aminoglycosides and the cancer chemotherapeutic agent cisplatin, in the cochlea and vestibule of the inner ear. A thorough search of the literature was performed using available databases for the purpose of uncovering articles applicable to the current review. Cochlear function was most frequently evaluated by measuring otoacoustic emissions and their distortion products after animals were treated with cytotoxic drugs alone or in combination with melatonin. Vestibular damage due to aminoglycosides was evaluated by estimating hair cell loss in explanted utricles of newborn rats. Tinnitus was assessed in patients who received melatonin using a visual analogue scale or the Tinnitus Handicap Inventory. Compared to a mixture of antioxidants which included tocopherol, ascorbate, glutathione and N-acetyl-cysteine, melatonin, also a documented antioxidant, was estimated to be up to 150 times more effective in limiting the cochlear side effects, evaluated using otoacoustic emission distortion products, of gentamicin, tobramycin and cisplatin. In a dose-response manner, melatonin also reduced vestibular hair cell loss due to gentamicin treatment in explanted utricles of newborn rats. Finally, melatonin (3 mg daily) limited subjective tinnitus in patients. These findings suggest the potential use of melatonin to combat the ototoxicity of aminoglycosides and cancer chemotherapeutic agents. Additional studies at both the experimental and clinical levels should be performed to further document the actions of melatonin at the cochlear and vestibular levels to further clarify the protective mechanisms of action of this ubiquitously-acting molecule. Melatonin's low cost and minimal toxicity profile supports its use to protect the inner ear from drug-mediated damage.
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Affiliation(s)
- R J Reiter
- Department of Cellular and Structural Biology, The University of Texas Health Science Center, San Antonio, TX 78229, USA.
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In brief: Non-inferiority trials. Med Lett Drugs Ther 2011; 53:1. [PMID: 21212743] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
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Blundell R, Lillis S, Gibbons V. Cultural issues in research, a reflection. N Z Med J 2010; 123:97-105. [PMID: 20186246] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
In New Zealand, Maori have been the subject of research where the objectives, methodology and outcomes have failed to address many issues for Maori including power, equity, and the validity of alternative understandings of health and knowledge. A community-based diabetes intervention in the Waikato was designed as a partnership between Maori, health workers and researchers to demonstrate a significant reduction in diabetes incidence in Maori over 3 years. The priorities and challenges which face Maori and community-based researchers are explored in this paper particularly with reference to being both providers of and participants in research.
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Affiliation(s)
- Rawiri Blundell
- Te Puna Oranga (Maori Health Service), Waikato District Health Board, PO Box 934, Hamilton 3240, New Zealand.
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Asenapine (Saphris) sublingual tablets for schizophrenia and bipolar disorder. Med Lett Drugs Ther 2010; 52:9-10. [PMID: 20216523] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
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Abstract
SUMMARY In 32 controlled trials of calcium supplementation (700-2000 mg) in 3,169 postmenopausal women, mean bone loss in the controls was -1.07% p.a. and in the treated subjects -0.27% p.a. (P for difference <0.001). The effect was similar at all measured sites and at all doses of 700 mg or more but became weaker after 4 years. INTRODUCTION We have reviewed 32 trials of calcium supplementation in 3,169 postmenopausal women. METHODS We found 24 publications reporting 32 controlled trials lasting at least 1 year, which provided annual percentage changes in bone mass or density at one or more sites in the calcium-treated and control subjects. RESULTS The median calcium supplement was 1,000 mg, median duration of the trials 2 years and total number of sites measured 79. The average of the mean rates of change in bone mass or density was -1.07% p.a. (P < 0.001) in the controls and -0.27% p.a. (ns) in the treated subjects (P for difference < 0.001). The effect of calcium was much the same at all measured sites (forearm/hand, proximal femur, spine, and total body and others). Supplements of less than 700 mg were not effective, but there was no significant beneficial effect of higher doses. There was significantly faster bone loss at total calcium intakes below 1,150 mg than on intakes over 1,350 mg. The effect of calcium appeared to be lost after 4 years of treatment. CONCLUSION Calcium supplementation of about 1,000 mg daily has a significant preventive effect on bone loss in postmenopausal women for at least 4 years.
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Affiliation(s)
- B E C Nordin
- Endocrine and Metabolic Unit, Royal Adelaide Hospital, Adelaide, Australia,
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Abstract
BACKGROUND An increase in the number of immunocompromised patients has led to a rising burden of systemic fungal infections. Historically, conventional amphotericin B has been used to treat these infections due to its broad spectrum of activity. The development of lipid-based amphotericin B agents, such as Abelcet * (ABLC), has allowed clinicians to take advantage of the broad spectrum of activity of amphotericin B while reducing adverse events. As well as this, a number of new antifungal agents have been developed in recent years which have significantly added to the treating physician's antifungal armamentarium. * Abelcet is a registered trade name of Cephalon Ltd, Herts, UK. OBJECTIVES Review the clinical data that support the use of ABLC and discuss the evidence for its continuing role in the treatment of invasive fungal infections in light of the introduction of newer antifungal agents. METHODS Published studies were identified by searching the MEDLINE database and the Cochrane Centre for Reviews up to August 2009. The search was conducted using the following key words: Amphotericin, Lipid, Abelcet, AmBisome, Efficacy, Nephrotoxicity, Renal, Toxicity. FINDINGS ABLC is effective and well-tolerated in the treatment of systemic fungal infections and remains a valuable therapeutic option in a variety of immunocompromised patients due to its broad antifungal spectrum and rarity of resistance. LIMITATIONS Data from randomised controlled trials of lipid-based amphotericin B formulations, as well as head-to-head comparison studies between ABLC and other antifungal agents are limited. In addition, the review uses a narrative approach and relies to a great extent on the authors' personal views and experiences.
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Szucs A, Harsányi L. [Problem-based evidence: non-conventional methods of clinical investigations in surgery]. Magy Seb 2009; 62:336-339. [PMID: 19945934 DOI: 10.1556/maseb.62.2009.6.2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
In the era of evidence-based medicine the application of randomised controlled trials (RCT) are crucial for innovations. In contrast with pharmacological studies surgical innovations have several difficulties: setting up a control group is not always simple, placebo is not easy to define and ethico-legal regulation of sham-operations is not well established yet. Risks of the learning curve, which are variable in time and space are quite characteristic for surgical innovations. There is a need therefore to develop new methodologies to overcome these difficulties and resulting in a widely acceptable outcome. The method of problem-based evidence (PBE) obtains the evidences from particular problems of health care using knowledge and experience; and hereby providing advantage for surgical innovations compared to RCT's. PBE provides more opportunity for organizing surgical research and their international acceptance.
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Affiliation(s)
- Akos Szucs
- Semmelweis Egyetem, Altalános Orvostudományi Kar I. sz. Sebészeti Klinika, Budapest.
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Anderson JA. Who's in control of the choice of control? Am J Bioeth 2009; 9:60-62. [PMID: 19998199 DOI: 10.1080/15265160903095974] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Affiliation(s)
- James A Anderson
- Biomedical Ethics Unit, McGill University, Montreal, Quebec, Canada.
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Howick J. Reviewing the unsubstantiated claims for the methodological superiority of 'placebo' over 'active' controlled trials: reply to open peer commentaries. Am J Bioeth 2009; 9:W5-W7. [PMID: 19998178 DOI: 10.1080/15265160903149417] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Affiliation(s)
- Jeremy Howick
- University of Oxford, Centre for Evidence-Based Medicine, Old Road Campus, Oxford, United Kingdom.
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Affiliation(s)
- Stuart Rennie
- Dental Ecology, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA. stuart
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