CONSORT 2010 Statement: updated guidelines for reporting parallel group randomised trials

Orifice barrier preferences for coronal restoration of root filled teeth by endodontists and other dental practitioners in Australia: A questionnaire survey

OBJECTIVES

To compare the use of orifice barriers (OB) in root-filled teeth (RFT) between specialist endodontic practitioners (SEP) and general and other specialist practitioners (GDP+), and identify common materials, reasons for selection, and techniques.

METHODS

An online survey was distributed to SEP and GDP+ practising in Australia. Demographic and multiple-choice questions relating to material selection and technique choices were asked to evaluate and relate usage patterns to practising and training backgrounds. Fisher's exact tests were undertaken to compare categorical variables across practitioner groups. Significance level was set at p<.05.

RESULTS

There were 457 eligible responses: 393(86%) GDP+ and 64(14%) SEP. Of 429 reporting endodontically treating or restoring teeth, 317(73.9%) placed OB; preferred depth of root filling removal by most (91.8%) was ≤ 2 mm, with more SEP preferring 2 mm than GDP+(p=.02). Preferred materials for OB were conventional and resin-modified GIC (GIC), resin composite materials (RC), Cavit™ and zinc polycarboxylate cement (ZPC). 'Ease of use' was a common reason among all practitioners for GIC and RC. Significantly more SEP(p<.001) chose ZPC in all teeth and more commonly because of 'Ease of use' for both posterior (p<.001) and anterior (p=.002) teeth. All ZPC-using SEP preferred using a paste-filler/lentulo spiral, significantly more than GDP+ for posterior (p<.001) and anterior (p=.002) teeth. Cavit™ was often chosen for 'Sealing ability'.

CONCLUSIONS

OB were widely placed by dental practitioners in Australia, with a small group of materials selected, most commonly for ease of use or sealing ability. The findings of this study suggest that further research should be undertaken to investigate the relative performance of these materials as OB and to inform the clinician's choices when restoring RFT.

Outcomes of emergency colorectal surgery within a non-colorectal split site service-a retrospective cohort study

BACKGROUND

Emergency colorectal surgery carries a high risk of morbidity and mortality. Subspecialisation and split-site geographically distinct services may lead to critically unwell patients presenting to a non-colorectal specialist centre requiring urgent on-site intervention.

AIMS

This study aims to determine outcomes of this high-risk patient cohort.

METHODS

An observational retrospective study of emergency colorectal laparotomies at the Royal Infirmary of Edinburgh (RIE) between January 2016 and August 2020 was performed. The primary outcome was 30-day mortality. Secondary outcomes included rate of primary anastomosis, complications and overall mortality. Subgroup analysis of the vascular ischaemia cohort and colorectal surgeon involvement was performed.

RESULTS

One hundred and eighteen patients were included. The median NELA (National Emergency Laparotomy Audit) score was 6.4% (IQR 2.5%-16.7%) and the 30-day mortality rate was 22% (26/118). The rate of primary anastomosis was 24.6%. Twenty-five patients had a vascular ischaemic pathology demonstrating a higher median NELA score (14.3%, IQR 5-22.4% vs. non-ischaemic group 5.7%, IQR 1.7-14.2%, p = 0.013) and thirty-day mortality (44%, 11/25 vs. 16.1%, 15/93, p = 0.006) than those without ischaemic pathology. Colorectal surgeon involvement in cases without ischaemia (23/93) was associated with a similar 30-day mortality (13.1% colorectal surgeon vs. 17.1% non-colorectal specialist surgeon, p = 0.755) and rate of primary anastomosis (30.4% colorectal surgeon vs. 31.8% non-colorectal specialist surgeon, p = 1).

CONCLUSIONS

The high mortality rate described highlights a specific group of unwell patients unfit for transfer. Research registration number: researchregistry7101.

Understanding Noninferiority Trials: What Stroke Specialists Should Know

Noninferiority trials aim to prove that the efficacy, defined in terms of a key clinical outcome, of a new treatment is not meaningfully worse than that of an established active control. Noninferiority trials are important when other aspects of care can be improved, such as convenience, toxicity, costs, and safety (nonefficacy benefits). While the motivation for a noninferiority trial is straightforward, the design, execution, and interpretation of these trials is not a trivial task. Several safeguards that protect superiority trials from incorrect conclusions do not apply or even work in reverse for noninferiority trials. This review aims to provide stroke clinicians and researchers with a general overview of noninferiority trials and a deeper understanding of 10 pitfalls they should consider when designing and interpreting such trials.

Comparison of mephentermine and norepinephrine infusions for prevention of post-spinal hypotension during elective caesarean delivery: a randomised, double-blind trial

BACKGROUND

Vasopressors having α-agonist and some β-agonist activity are thought to maintain heart rate better than pure α-agonist agents when used for prevention and treatment of post-spinal hypotension during caesarean delivery. Norepinephrine and mephentermine are two such agents. They have been compared by some network meta-analyses; however, no direct comparative studies of prophylactic infusions of these two vasopressors are available in literature.

METHODS

Sixty mothers with term, uncomplicated, singleton pregnancy undergoing elective caesarean delivery under spinal anaesthesia received either mephentermine (600 μg/min) or norepinephrine (4 μg/min) infusion initially for prophylaxis of post-spinal hypotension. The infusion rate was titrated to maintain systolic blood pressure near baseline. The primary outcome measure was umbilical artery pH; the secondary outcome measures included Apgar scores, incidence of fetal acidosis (umbilical artery pH <7.2), and maternal hypotension, hypertension, bradycardia, tachycardia, maternal complications. Data presented as mean ± standard deviation.

RESULTS

Mean umbilical artery pH was significantly higher in mephentermine group than in norepinephrine group (7.275 ± 0.061 vs. 7.244 ± 0.049; P=0.039). Umbilical artery and venous base excess and venous pH were also significantly higher in mephentermine group. Secondary outcomes did not differ between the groups. Mephentermine group required a significantly higher total infusion volume than norepinephrine group (16.3 ± 5.8 mL vs. 12.9 ± 6.7 mL; P=0.045).

CONCLUSION

Prophylactic titrated infusions of both mephentermine and norepinephrine maintained good fetal blood gases during elective caesarean delivery, but mephentermine demonstrated superiority over norepinephrine in this respect. However, higher volumes of mephentermine infusion were required to maintain maternal systolic blood pressure near baseline values. Therefore, further studies are required to determine the equipotent doses of these two vasopressors.

Is inverse probability of censoring weighting a safer choice than per-protocol analysis in clinical trials?

Deviation from the treatment strategy under investigation occurs in many clinical trials. We term this intervention deviation. Per-protocol analyses are widely adopted to estimate a hypothetical estimand without the occurrence of intervention deviation. Per-protocol by censoring is prone to selection bias when intervention deviation is associated with time-varying confounders that also influence counterfactual outcomes. This can be corrected by inverse probability of censoring weighting, which gives extra weight to uncensored individuals who had similar prognostic characteristics to censored individuals. Such weights are computed by modelling selected covariates. Inverse probability of censoring weighting relies on the no unmeasured confounding assumption whose plausibility is not statistically testable. Suboptimal implementation of inverse probability of censoring weighting which violates the assumption will lead to bias. In a simulation study, we evaluated the performance of per-protocol and inverse probability of censoring weighting with different implementations to explore whether inverse probability of censoring weighting is a safe alternative to per-protocol. Scenarios were designed to vary intervention deviation in one or both arms with different prevalences, correlation between two confounders, effect of each confounder, and sample size. Results show that inverse probability of censoring weighting with different combinations of covariates outperforms per-protocol in most scenarios, except for an unusual case where selection bias caused by two confounders is in two directions, and 'cancels' out.

Evaluation of the extent of plaque removal and users' experience of alternative toothbrushes: A randomized single-blind crossover study

INTRODUCTION

In residential care, tooth brushing with a manual toothbrush can be challenging because of technical difficulties, time consumption and poor patient cooperation, resulting in a sub-optimal cleaning. The study aimed at comparing the efficiency in plaque removal, brushing time and users' experience between three toothbrushes: a single-headed conventional manual toothbrush, a triple-headed manual toothbrush and a U-shaped electric toothbrush.

METHODS

This was a single-blind crossover study with three pre-post-test conditions. Participants were 26 dental students divided into fixed pairs to play the role of caregivers and care receivers. Pre/post plaque scores were determined by two independent investigators according to the Quigley-Hein Plaque Index (QHI). Questionnaires evaluated participants' experiences. Statistical tests of significances of differences and ANOVA were performed.

RESULTS

Results showed that plaque removal was more effective for the manual toothbrush and the triple-headed toothbrush compared to the U-shaped electric toothbrush (p < 0.001). Brushing time was the longest for the single manual toothbrush (149 s). The U-shaped electric toothbrush showed significantly better results for aspects related to comfort and salivation. The manual and triple-headed toothbrush showed better results for aspects related to cleanliness and motivation to use.

CONCLUSION

Notwithstanding its favourable comfort, tooth plaque removal is not enhanced by a U-shaped electric toothbrush. The triple-headed and single-headed toothbrushes reduced plaque more substantially than the U-shaped toothbrush. In addition, the triple-headed manual toothbrush was not only effective in plaque removal, but also had a shorter brushing time and was easy to use, being an adequate alternative for care-dependent patient groups.

Augmented Reality-Guided Mastoidectomy Simulation: A Randomized Controlled Trial Assessing Surgical Proficiency

OBJECTIVE

Mastoidectomy surgical training is challenging due to the complex nature of the anatomical structures involved. Traditional training methods based on direct patient care and cadaveric temporal bone training have practical shortcomings. 3D-printed temporal bone models and augmented reality (AR) have emerged as promising solutions, particularly for mastoidectomy surgery, which demands an understanding of intricate anatomical structures. Evidence is needed to explore the potential of AR technology in addressing these training challenges.

METHODS

21 medical students in their clinical clerkship were recruited for this prospective, randomized controlled trial assessing mastoidectomy skills. The participants were randomly assigned to the AR group, which received real-time guidance during drilling on 3D-printed temporal bone models, or to the control group, which received traditional training methods. Skills were assessed on a modified Welling scale and evaluated independently by two senior otologists.

RESULTS

The AR group outperformed the control group, with a mean overall drilling score of 19.5 out of 25, compared with the control group's score of 12 (p < 0.01). The AR group was significantly better at defining mastoidectomy margins (p < 0.01), exposing the antrum, preserving the lateral semicircular canal (p < 0.05), sharpening the sinodural angle (p < 0.01), exposing the tegmen and attic, preserving the ossicles (p < 0.01), and thinning and preserving the external auditory canal (p < 0.05).

CONCLUSION

AR simulation in mastoidectomy, even in a single session, improved the proficiency of novice surgeons compared with traditional methods.

LEVEL OF EVIDENCE

NA Laryngoscope, 135:894-900, 2025.

Evaluation of Effects of Verbal and Video-Based Instructions on the Improvement of Oral Hygiene Status in Children: A Randomised Clinical Trial

OBJECTIVES

To evaluate the effects of verbal and video-based oral hygiene instructions (OHIs) on the improvement of the oral hygiene status (OHS) in children of different age groups in the mixed dentition period.

METHODS

In total, 202 children aged 6-9 and 10-12 years (n = 101 each) were included. Before providing the OHIs, the baseline OHS was determined using the Simplified Oral Hygiene Index (OHI-S). From each age group, approximately half of the participants were randomly assigned to the verbal (n = 50 and n = 51 from the 6-9-year and 10-12-year age groups, respectively) or video-based (n = 51 and n = 50 from the 6-9-year and 10-12-year age groups, respectively) OHI groups. Children were recalled after 30 days and post-instruction OHI-S were recorded. Data were analysed using Shapiro-Wilk, Mann-Whitney U, and Wilcoxon signed-rank tests. The statistical significance level was set at 5%.

RESULTS

For both OHI methods, no significant difference was found between the age groups in terms of the OHI-S at both the pre- and post-instruction timepoints (verbal OHIs: p = 0.354, p = 0.860 and video-based OHIs: p = 0.174, p = 0.632, respectively). In both age groups, a significant difference was found between the baseline (pre-) and post-instruction OHI-S for both OHI methods (p < 0.001); the post-instruction OHS was found to be better than the pre-instruction OHS. In both age groups, video-based OHIs resulted in a significantly higher improvement in the OHS, compared with verbal OHIs (p = 0.004 and p < 0.001, respectively).

CONCLUSION

OHIs are effective in improving the OHS of children. In addition, video-based education is preferable to verbal instruction for improving the OHS of children.

TRIAL REGISTRATION

ClinicalTrials.gov identifier: NCT06449950.

Mamá Empoderada: study protocol for a pilot trial of a novel parenting and mental health prevention intervention for migrant mothers with young children at the Mexico-US border

INTRODUCTION

Migrant women in transit face high risk of developing mental health problems such as depression and anxiety, driven by gendered social-structural factors including violence, social isolation, migration uncertainty, limited access to services and gender inequities. Although migrant women who endure such conditions have high need for mental health prevention, few evidence-based interventions are tailored to this population. Moreover, while women and children's mental health are interconnected, few mental health interventions address parenting needs. The aim of this study is to pilot-test a novel parenting and mental health prevention intervention for migrant mothers with young children (MMC) in Tijuana, Mexico, including (a) assessing acceptability; (b) estimating effect sizes on symptoms of depression, anxiety, and parenting stress; (c) identifying which theory-based mechanisms of action predict changes in outcomes; and (d) identifying factors associated with differential intervention response.

METHODS AND ANALYSIS

'Mamá Empoderada' (Mom Power) is a theory-based, trauma-informed group intervention to promote mental health and responsive parenting among mothers with young children (0-5 years). This is an evidence-based intervention that has been previously evaluated in the USA and has been recently adapted for Spanish-speaking mothers. We have recently adapted this intervention for MMC in Mexico and will conduct a pilot randomised controlled trial (RCT) of the intervention with MMC (n=100; Ntreatment=50; Ncontrol=50). The intervention group (IG) will receive 10 group and three individual sessions addressing attachment-based parenting skills, linkage to resources (eg, food, shelter), social support, and self-care and resilience over a 5-week period. The control group will receive standard of care programming and will be offered participation in the intervention following completion. Both groups will complete baseline and exit surveys, as well as follow-up surveys at 2, 4 and 6 months postintervention. Statistical analyses will compare primary (ie, symptoms of depression and anxiety; parenting stress) and intermediate outcomes (eg, resilience, service utilisation) by exposure to intervention condition.

ETHICS AND DISSEMINATION

This study is approved by the San Diego State University and El Colegio de la Frontera Norte Institutional Research Boards. Findings will inform a larger trial to evaluate intervention efficacy. In collaboration with our community partners, results will be disseminated via peer-reviewed publications; presentations; and plain-language reports, infographics, and presentations to community, clinical, and policy audiences. If efficacious, this intervention is highly promising as a novel, low-cost, and feasible model that could be implemented in border settings in Mexico, the USA and elsewhere. Amid rising population displacement and prolonged and traumatic migration journeys, this study addresses an urgent need for scalable and tailored mental health prevention for MMC in border contexts.

TRIAL REGISTRATION NUMBER

NCT06468046.

A BiO-Optimizing Site Targeted (BOOST) Approach to Periodontal Regeneration Through Local Doxycycline Prior to Surgery: A Randomized Clinical Trial

AIM

To test a BiO-Optimizing Site Targeted (BOOST) approach to periodontal regeneration by the adjunctive use of locally delivered doxycycline (DOX) 2 weeks prior to minimally invasive surgery in terms of clinical and radiographic outcomes at 1 year.

METHODS

For this randomized clinical trial, stage III/IV periodontitis patients presenting sites with intrabony defects and bleeding on probing (BoP+) after steps 1-2 of periodontal treatment were included. Sites were treated via subgingival instrumentation with or without a BOOST approach by local DOX. After 2 weeks, defects were accessed by minimally invasive surgical technique with xenograft and amelogenins. Primary (clinical attachment level [CAL] gain) and secondary (probing pocket depth [PPD] reduction, composite outcomes, radiographic bone defect fill) outcomes were assessed at 12 months.

RESULTS

Sixty patients completed the study (30 on each group). BOOST led to lower preoperative BoP (p < 0.001) and better wound healing after surgery (p = 0.027). Both groups showed clinical and radiographic improvements at 1 year, with significant differences in mean CAL gain (4.1 ± 1.9 vs. 3.2 ± 2.0 mm; p = 0.019) and PPD reduction (4.4 ± 1.8 vs. 3.6 ± 1.9 mm; p = 0.040) favoring the test group. BOOST group also achieved higher composite outcome measure (PPD ≤ 4 mm and CAL gain ≥ 3; 83.3% vs. 46.7%; p = 0.006), pocket closure (PPD ≤ 3 mm or 4 mm BoP-; 83.3% vs. 60.0%; p = 0.045), and defect fill (3.5 ± 1.2 vs. 2.7 ± 1.3 mm; p < 0.001) compared to the control group.

CONCLUSION

A BOOST approach by local doxycycline 2 weeks before surgery enhanced the local inflammatory control prior to periodontal regeneration and post-operative early wound healing, yielding to improved clinical and radiographic outcomes at 1 year.

TRIAL REGISTRATION

ClinicalTrials.gov identifier: NCT05878353.

Levels of evidence in hand surgery: a review and guide

This article explores the background to the concept of levels of evidence and their role in promoting the principles of evidence-based medicine within hand surgery. The Journal of Hand Surgery (European Volume) requires allocation of a level of evidence to each full-length clinical research article. The system employed by the Journal is described, together with discussion of limitations and difficulties in application. Most articles published on hand surgery still have a low level of evidence. Insights and editorial perspectives on various types of research study and the classification of evidence levels are included. Clinical importance of articles and the need to encourage innovation as opposed to high levels of evidence are also discussed.

Integrating Videoconferencing Therapist Guidance Into Stepped Care Internet-Delivered Cognitive Behavioral Therapy for Child and Adolescent Anxiety: Noninferiority Randomized Controlled Trial

BACKGROUND

Self-guided internet-delivered cognitive behavioral therapy (ICBT) achieves greater reach than ICBT delivered with therapist guidance, but demonstrates poorer engagement and fewer clinical benefits. Alternative models of care are required that promote engagement and are effective, accessible, and scalable.

OBJECTIVE

This randomized trial evaluated whether a stepped care approach to ICBT using therapist guidance via videoconferencing for the step-up component (ICBT-SC[VC]) is noninferior to ICBT with full therapist delivery by videoconferencing (ICBT-TG[VC]) for child and adolescent anxiety.

METHODS

Participants included 137 Australian children and adolescents aged 7 to 17 years (male: n=61, 44.5%) with a primary anxiety disorder who were recruited from participants presenting to the BRAVE Online website. This noninferiority randomized trial compared ICBT-SC[VC] to an ICBT-TG[VC] program, with assessments conducted at baseline, 12 weeks, and 9 months after treatment commencement. All ICBT-TG[VC] participants received therapist guidance (videoconferencing) after each session for all 10 sessions. All ICBT-SC[VC] participants completed the first 5 sessions online without therapist guidance. If they demonstrated response to treatment after 5 sessions (defined as reductions in anxiety symptoms to the nonclinical range), they continued sessions without therapist guidance. If they did not respond, participants were stepped up to receive supplemental therapist guidance (videoconferencing) for the remaining sessions. The measures included a clinical diagnostic interview (Anxiety Disorders Interview Schedule) with clinician-rated severity rating as the primary outcome and parent- and child-reported web-based surveys assessing anxiety and anxiety-related interference (secondary outcomes).

RESULTS

Although there were no substantial differences between the treatment conditions on primary and most secondary outcome measures, the noninferiority of ICBT-SC[VC] compared to ICBT-TG[VC] could not be determined. Significant clinical benefits were evident for participants in both treatments, although this was significantly higher for the ICBT-TG[VC] participants. Of the 89 participants (38 in ICBT-SC[VC] and 51 in ICBT-TG[VC]) who remained in the study, 26 (68%) in ICBT-SC[VC] and 45 (88%) in ICBT-TG[VC] were free of their primary anxiety diagnosis by the 9-month follow-up. For the intention-to-treat sample (N=137), 41% (27/66) ICBT-SC[VC], and 69% (49/71) ICBT-TG[VC] participants were free of their primary anxiety diagnosis. Therapy compliance was lower for the ICBT-SC[VC] participants (mean 7.39, SD 3.44 sessions) than for the ICBT-TG[VC] participants (mean 8.73, SD 3.08 sessions), although treatment satisfaction was moderate to high in both conditions.

CONCLUSIONS

This study provided further support for the benefits of low-intensity ICBT for children and adolescents with a primary anxiety disorder and highlighted the excellent treatment outcomes that can be achieved through therapist-guided ICBT delivered via videoconferencing. Although noninferiority of the stepped care adaptive approach could not be determined, it was acceptable to families, produced good outcomes, and could assist in increasing access to evidence-based care.

TRIAL REGISTRATION

Australian New Zealand Clinical Trials Registry (ANZCTR) ACTRN12618001418268; https://anzctr.org.au/Trial/Registration/TrialReview.aspx?ACTRN=12618001418268.

Enhancing patient engagement: the influence of an in-consult patient decision aid on shared decision-making for lung tumour radiation - protocol for the randomised trial 'SDM Lung SBRT'

INTRODUCTION

Patient engagement is continuously being promoted by patients as well as politicians and healthcare professionals. One way of increasing patient engagement is by using shared decision-making (SDM), which is a joint effort of clinicians and patients making decisions together.When planning stereotactic body radiation therapy (SBRT) for a lung tumour located close to the thoracic wall, there are conflicting interests between (1) delivering the highest possible dose to obtain local tumour control and (2) reducing the dose to the thoracic wall to decrease the risk of chest wall pain and rib fractures following treatment. The radiation oncologist often makes the choice of dose without any engagement of the patient. We believe that the patients should be engaged in such a decision.To explore this matter, we have designed a randomised trial, 'SDM Lung SBRT', for which we present our study protocol with a special focus on a patient decision aid (PtDA), which is being tested in this trial.

METHODS AND ANALYSIS

This study includes patients with a lung tumour located ≤1 cm from the thoracic wall. Patients are randomised to have the primary consultation with or without use of the PtDA. Treatment options are a radiation dose of either 66 Gray (Gy) in three fractions, 45 Gy in three fractions or no treatment. The primary outcome is patient engagement in decision-making measured by the validated observer-rated OPTION-12 score. Secondary outcomes are patient-reported outcomes, quality of life and side effects following treatment.

ETHICS AND DISSEMINATION

All patients give informed consent to participate. According to Danish legislation, ethical approval is not required for this study as studies using questionnaires, observations or other non-biological studies are not considered interventions according to the Committee Act. Results from this study will be presented at scientific meetings and published in English peer-reviewed journals.

TRIAL REGISTRATION NUMBER

ClinicalTrials.gov (NCT04940936).

Acceptability and effectiveness of a study information video in improving the research consent process for youth: a non-inferiority trial

INTRODUCTION

Obtaining informed consent for research includes the use of information sheets, which are often long and may be difficult for participants to understand. We conducted a trial to investigate whether consent procedures using a study information video coupled with electronic consent were non-inferior to standard consent procedures using participant information sheets (PIS) among youth aged 18-24 years in Zimbabwe.

METHODS

The trial was nested within an endline population-based survey for a cluster-randomised trial from October 2021 to June 2022. Randomisation of participants to video or paper-based consent was at household level. We assessed non-inferiority in comprehension of the study using a questionnaire. The video method was accepted as non-inferior to standard consent procedures if the 95% CIs of the mean difference did not fall below the prespecified margin of 1.98. Thematic analysis was conducted on brief qualitative discussions with randomly selected youth to explore the acceptability of video and PIS within consent methods.

RESULTS

Overall, 921 participants were enrolled (54% female). The median age was 20 (IQR 18-24) years. The mean comprehension score was 25.4/30 in both arms. The mean difference in comprehension between arms was -0.02 (95% CI -0.51 to 0.47) showing non-inferiority of the intervention in comprehension of study information. Youth (N=90) described both consent methods as interactive and inclusive. Those in the video consent arm felt it was exciting and youth focused. The use of imagery to explain procedures strengthened the perceived trustworthiness of the research. However, the high volume of information in both arms reduced acceptability.

CONCLUSION

Comprehension of study information using an information video is non-inferior to a paper-based consent method. Using information videos for consent processes shows promise as a person-centred and context-sensitive approach to enhance the informed consent process and should be encouraged by ethics committees.

Intermittent enteral nutrition shortens the time to achieve nutritional goals in critically ill patients

Nutritional support is associated with improved clinical outcomes in critically ill patients; however, loss of muscle mass during critical illness leads to weakness, delayed return to work, and increased healthcare consumption. Animal data have suggested that intermittent feeding decreases protein catabolism. This study was aimed at determining whether the mode of enteral nutrition administration might lead to differences in meeting nutritional goals, tolerance, and complications. A prospective, randomized, single-center clinical trial was conducted in four intensive care units in the Czech Republic. Critically ill adult patients with high nutritional risk were randomized to continuous or intermittent enteral nutrition administration through a tolerance-driven protocol. The primary outcome was the time to reach the energetic target. Secondary outcomes included assessment of tolerance (high gastric residual volume, vomitus, and diarrhea), complications (aspiration or ventilator-associated pneumonia), and 28-day mortality. A total of 300 patients were randomized, and 294 were analyzed: 148 in the continuous arm and 146 in the intermittent arm. Regarding the primary outcome, log-rank test indicated that the intermittent group, compared with continuous group, had a statistically significantly shorter time (p = 0.009) and greater diarrhea occurrence (7 (4.7%) vs. 16 (11%), p = 0.049). No statistically significant differences in ventilator-associated pneumonia incidence (18 (12.2%) vs. 18 (12.3%), p = 0.965), 28-day mortality (46 (31.1%) vs. 40 (27.4%), p = 0.488), and other secondary outcomes were observed between groups. Thus, intermittent enteral nutrition was superior to continuous enteral nutrition in terms of time to reach the energetic target with the tolerance-driven administration protocol but was associated with higher diarrhea incidence. No statistically significant differences in the other secondary outcomes were observed.

Cost-utility and cost-benefit analysis of a multi-component intervention (NEXpro) for neck-related symptoms in Swiss office workers

BACKGROUND

Neck pain is a significant public health issue, especially among office workers, with a prevalence ranging from 42 to 68%. This study aimed to evaluate the cost-utility and cost-benefit of a multi-component intervention targeting neck pain in the general population of office workers in Switzerland. The 12-week multi-component intervention consisted of neck exercises, health promotion information workshops, and workplace ergonomics sessions.

METHODS

The study was designed as a stepped-wedge cluster randomized controlled trial and assessed using an employer's perspective. The main analysis focused on the immediate post-intervention period. Long-term effects were examined in a subsample at the 4, 8, and 12-month follow-ups. The intervention effects on costs and quality-adjusted life years (QALYs) were estimated using generalized linear mixed-effects models, controlling for confounding factors. Incremental cost-effectiveness ratios (ICERs) and cost-effectiveness acceptability curves were presented, along with calculations of the break-even point and the return on investment. Various sensitivity analyses were performed.

RESULTS

A total of 120 office workers participated in the trial, with 100 completing the intervention period and 94 completing the entire study. The main analysis included 392 observations. The intervention had a significant positive effect on QALYs and a nonsignificant effect on costs. The ICER was estimated at -25,325 per QALY gain, and the probability of the intervention being cost saving was estimated at 88%. The break-even point was reached one week after the end of the intervention.

CONCLUSION

The multi-component intervention is likely to reduce company costs and simultaneously improve the quality of life of employees. However, the implementation of such interventions critically depends on evidence of their cost-effectiveness. As there is still a large research gap in this area, future studies are needed.

TRIAL REGISTRATION

ClinicalTrials.gov, NCT04169646 . Registered 15 November 2019-Retrospectively registered.

TRIAL PROTOCOL

Aegerter AM, Deforth M, Johnston V, Ernst MJ, Volken T, Luomajoki H, et al. On-site multi-component intervention to improve productivity and reduce the economic and personal burden of neck pain in Swiss office-workers (NEXpro): protocol for a cluster-randomized controlled trial. BMC Musculoskelet Disord. 2020;21(1):391.  https://doi.org/10.1186/s12891-020-03388-x .

Reporting Standards for Bayesian Network Modelling

Reproducibility is a key measure of the veracity of a modelling result or finding. In other research areas, notably in medicine, reproducibility is supported by mandating the inclusion of an agreed set of details into every research publication, facilitating systematic reviews, transparency and reproducibility. Governments and international organisations are increasingly turning to modelling approaches in the development and decision-making for policy and have begun asking questions about accountability in model-based decision making. The ethical issues of relying on modelling that is biased, poorly constructed, constrained by heroic assumptions and not reproducible are multiplied when such models are used to underpin decisions impacting human and planetary well-being. Bayesian Network modelling is used in policy development and decision support across a wide range of domains. In light of the recent trend for governments and other organisations to demand accountability and transparency, we have compiled and tested a reporting checklist for Bayesian Network modelling which will bring the desirable level of transparency and reproducibility to enable models to support decision making and allow the robust comparison and combination of models. The use of this checklist would support the ethical use of Bayesian network modelling for impactful decision making and research.

Evidence Communication Rules for Policy (ECR-P) critical appraisal tool

BACKGROUND

Scientific papers increasingly put forward scientific-based policy recommendations (SPRs) as a means of closing the circle of science, policy and practice. Assessing the quality of such SPRs is crucial, especially within the context of a systematic review. Here, we present ECR-P (Evidence Communication Rules for Policy)-a critical appraisal tool that we have developed, which can be used in assessing not only the quality of SPRs but also the quality of their evidence base and how effectively these have both been communicated.

METHODS

The rationale behind ECR-P centres on three dimensions of quality; two are the well-established concepts of internal and external validity. Here, we introduce a third-evidence communication-encompassing both evidence veracity and quality of communication. Elements of the three dimensions of quality are considered within the context of the five rules of evidence communication. These are as follows: inform, not persuade; offer balance, not false balance; disclose uncertainties; state evidence quality and pre-empt misunderstandings.

RESULTS

Development of ECR-P has been carried out by an interdisciplinary team and was piloted with a systematic review reported more fully elsewhere. ECR-P comprises a set of preliminary considerations which capture key aspects for the assessment, leading on to the main tool whose structure is domain-based, each domain mapping to one of the five rules of evidence communication. The domains include 25 signalling questions designed to obtain essential information for the critical appraisal. The questions focus on either the study's evidence or the policy recommendations. Domain-based judgement is derived from responses to the signalling questions and an accompanying algorithm, followed by an overall quality judgement.

CONCLUSIONS

ECR-P has been designed to provide a standardised and transparent approach to assess the quality and communication of SPRs and their evidence base. The tool, which could be applied across all scientific fields, has been developed to fit primarily with the systematic reviewing process but could also serve as a stand-alone tool. Besides review assessors, it can also be used by policymakers, researchers, peer reviewers, editors and any other stakeholders interested in evidence-based policymaking and high-quality evidence communication. We encourage further independent testing of the tool in real-world evidence-based research.

Efficacy of the ECHOMANTRA online intervention to support recovery from anorexia nervosa in adult patients: study protocol of a randomized controlled multi-center trial

BACKGROUND

Poor quality of life in adults with anorexia nervosa (AN) and persistent high rates of readmission highlight the necessity of developing interventions to optimize treatment outcomes. ECHOMANTRA is a novel online intervention based on interventions for carers (Experienced Carers Helping Others, ECHO) and patients (Maudsley Model of Anorexia Nervosa Treatment for Adults, MANTRA) with anorexia nervosa. The objective of this paper is to describe the study protocol of a randomized control trial (RCT) aimed at evaluating the efficacy of an adaptation of the ECHOMANTRA for adults AN inpatients and outpatients, and their carers, to be implemented as an add-on to treatment-as-usual (TAU).

METHODS

In a multi - center pilot randomized controlled trial (RCT), 148 adult AN patients, and their carers, will be randomized to receive treatment as usual (TAU) or TAU plus ECHOMANTRA. Assessments will take place at baseline (T0), post-intervention (2-month) (T1), 6-month follow-up (T2), and 12-month follow-up (T3). Primary outcomes will be eating disorder psychopathology and psychological well-being. For carers, outcome variables will include psychological well-being, accommodation and enabling behaviors, expressed emotion, illness burden, quality of life and care skills.

DISCUSSION

This study will provide evidence of the efficacy of this novel, online and protocolized intervention in facilitating the recovery of these patients.

TRIAL REGISTRATION

ISRCTN registry (Identifier: 80253157 https://doi.org/10.1186/ISRCTN80253157 ).

Impact of an SMS intervention to support type 2 diabetes self-management: DiabeText clinical trial

BACKGROUND

Complications arising from uncontrolled type 2 diabetes mellitus (T2DM) pose a significant burden on individuals' wellbeing and healthcare resources. Digital interventions may play a key role in mitigating such complications by supporting patients to adequately self-manage their condition.

AIM

To assess the impact of DiabeText, a new theory-based, patient-centred, mobile health intervention integrated with electronic health records to send tailored short text messages to support T2DM self-management.

DESIGN AND SETTING

A pragmatic, phase-three, 12-month, two-arm randomised clinical trial involving primary care patients with T2DM in the Balearic Islands, Spain, including in urban and rural areas.

METHOD

In total, 742 participants with suboptimal glycaemic control (glycated haemoglobin [HbA1c] level >7.5) were randomly allocated to a control (usual care) or intervention (DiabeText) group. In addition to usual care, the DiabeText group received 167 messages focused on healthy lifestyle and medication adherence. The primary outcome was HbA1c level. Secondary outcomes were: medication possession ratio; health-related quality of life (measured using the EQ-5D-5L questionnaire); diabetes self-efficacy (measured using the Diabetes Self-Efficacy Scale [DSES]); and self-reported adherence to medication, Mediterranean diet (measured using the 14-Item Mediterranean Diet Adherence Screener [MEDAS-14]), and physical activity (measured using the International Physical Activity Questionnaire [IPAQ]).

RESULTS

Over the 12-month period, no statistically significant differences in HbA1c were observed between the intervention and the control groups (ß = -0.025 [95% confidence interval {CI} = -0.198 to 0.147; P = 0.772]). In comparison with the control group, the DiabeText group showed significant (P<0.05) improvements in self-reported medication adherence (odds ratio = 1.4; 95% CI = 1.0 to 1.9), DSES (Cohen's d = 0.35), and EQ-5D-5L (Cohen's d = 0.18) scores, but not for the rest of the secondary outcomes.

CONCLUSION

DiabeText successfully improved quality of life, diabetes self-management, and self-reported medication adherence in primary care patients with T2DM. Further research is needed to enhance its effects on physiological outcomes.

The effect of an additional pre-extubational loading dose of caffeine citrate on mechanically ventilated preterm infants (NEOKOFF trial): Study protocol for a multicenter randomized clinical trial

BACKGROUND

Minimizing the duration of mechanical ventilation is one of the most important therapeutic goals during the care of preterm infants at neonatal intensive care units (NICUs). The rate of extubation failure among preterm infants is between 16% and 40% worldwide. Numerous studies have been conducted on the assessment of extubation suitability, the optimal choice of respiratory support around extubation, and the effectiveness of medical interventions. Since the Caffeine Therapy for Apnea of Prematurity (CAP) trial, caffeine has become one of the essential drugs at NICUs. However, the optimal dosage and timing for adequate effectiveness still need to be more conclusive. Previous studies suggest that higher doses of caffeine treatment increase the success rate of extubation. Therefore, we aim to determine whether using a single additional loading dose of caffeine citrate one hour prior to extubation impacts the success rate of extubation.

METHODS

The study is an open-label, multicenter randomized clinical trial testing the effectiveness and safety of pre-extubational loading dose of caffeine citrate. Inclusion criteria will be infants born before the 32nd gestational week, before the first extubation attempt after at least 48 hours of mechanical ventilation, and a signed parental informed consent. A total of 226 patients will be randomly allocated to either the experimental or control group. The randomization will be stratified by gestational age and antenatal steroid prophylaxis. Preterm infants in the experimental group will receive an additional intravenous (IV) loading dose (20 mg/kg) of caffeine citrate one hour before the first planned extubation, in addition to the standard dosing regimen (20 mg/kg caffeine citrate IV on the first day of life and 5 to 10 mg/kg IV or orally caffeine citrate each consecutive day). Preterm infants in the control group will receive the standard dosing regimen. The primary outcome will be reintubation within 48 hours.

DISCUSSION

A pre-extubational loading dose of caffeine citrate can reduce extubation failure. Obtaining evidence on this feature has the potential to contribute to finding the optimal dosing regimen.

TRIAL REGISTRATION NUMBER

The study protocol was approved by the Hungarian Ethics Committee for Clinical Pharmacology of the Medical Research Council and National Institute of Pharmacy and Nutrition (OGYÉI/6838-11/2023). ClinicalTrials.gov identifier NCT06401083 Registered 06. May 2024.; EudraCT number: 2022-003202-77.

Effects of Therapeutic Taping on Clinical Symptoms of Students with Primary Dysmenorrhea

STUDY OBJECTIVES

Primary dysmenorrhea (PD) is a prevalent gynecologic condition affecting young females, characterized by cyclic, cramping pelvic pain with no organic pathology. It can significantly impact their quality of life and academic performance. This study aimed to determine the effect of therapeutic taping on the clinical symptoms, quality of life, and academic performance of students with PD.

DESIGN

This was a single-blind, parallel design, randomized controlled trial.

SETTING

The study was conducted from May to September 2023 at a girls' hostel in Islamabad, Pakistan.

PARTICIPANTS

Women aged 18-25 years with PD and pain severity rated 4 or higher on a visual analogue scale (VAS) were recruited. Those with other health conditions and having an allergy to Kinesio tape (KT) were excluded from the study.

INTERVENTION

A total of 66 women completed the study. They were randomly assigned to 3 groups: experimental (KT), sham tape (ST), and control group (CG). KT was applied to the suprapubic and sacral regions using the ligament technique in the KT group and without stretch in the ST group. Assessments were taken at baseline and on the 8th and 12th weeks.

MAIN OUTCOME MEASURES

The study tools were the VAS, Menstrual Symptom Questionnaire, health-related quality of life questionnaire (SF-36), and Academic Performance Questionnaire. Data analysis was done using SPSS-25.

RESULTS

The participants' mean age (years) was 22.04 ± 2.13 (KT), 22.35 ± 3.11 (ST), and 23 ± 2.52 (CG). Between-group analysis showed a statistically significant difference in the VAS (P < .05) and Menstrual Symptom Questionnaire (P < .01) scores after the 12th week of intervention, the difference in the Academic Performance Questionnaire score was statistically significant (P < .01) on the 8th and 12th weeks. Similarly, the SF-36 score was significantly different for both the physical (P < .001) and mental (P < .05) component summary between the intervention groups.

CONCLUSION

KT is an effective intervention option for pain reduction, menstrual symptom relief, and improved academic performance for individuals with PD.

Amino Acid Supplementation May Help Prevent Muscle Wasting After Orthopedic Surgery, but Additional Studies Are Warranted: A Systematic Review of Randomized Clinical Trials

Background: Essential amino acid (EAA) supplementation, including conditionally essential amino acid (CEAA) and branched-chain amino acids (BCAA) supplementation, has been suggested as a mechanism to optimize patient outcomes by counteracting the atrophy associated with orthopedic procedures. Purpose: We sought to investigate the effect of EAA supplementation in the perioperative period on patients undergoing orthopedic and spine surgery, specifically whether it is associated with (1) reductions in postoperative muscle atrophy and (2) improved postoperative function including range of motion, strength, and mobility. Methods: We conducted a systematic review of the literature. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines were used, and the protocol was registered in the Prospective Register of Systematic Reviews (PROSPERO) database (CRD42023447774). Studies of interest were prospective, placebo-controlled, randomized clinical trials (RCTs) published between 2002 and 2023 evaluating the impact of EAA supplementation on patients undergoing orthopedic and spine surgery. Results: Ten RCTs evaluating EAA supplementation in trauma, adult reconstruction, and spine surgery were identified; half of these focused on adult reconstruction. The EAA supplementation dose (3.4-20 g), frequency (daily to 3 times per day), and duration (14-49 days) varied widely across studies. Seven studies reported parameters relating to muscle size and/or composition, with 3 studies reporting superior muscle size/composition in patients receiving perioperative EAA supplementation, when compared with controls. Three studies reported favorable mobility outcomes for patients receiving EAA. Meta-analysis was prohibited by variation in measurement and outcome variables across the studies. Conclusions: Pooled data from level I studies supports the use of EAA, BCAA, and CEAA supplementations across several orthopedic subspecialties. However, significant heterogeneity exists in the quantity, duration, and content of EAA administered. Further prospective studies are needed to determine optimal/standardized parameters for supplementation.

Socket Sealing Using Free Gingival Grafts: A Randomized Controlled Trial

Background: Post-extraction ridge resorption is an inevitable phenomenon that cannot be eliminated but is significantly reduced using additional surgical techniques known as socket preservation. They aim to create favorable conditions for implant placement and prosthetic restoration. This study aims to assess the effect of socket sealing (SS) with free gingival grafts on the vertical resorption of socket walls at the premolar and molar regions over 3 months. Methods: This randomized two-arm controlled trial with parallel groups (1:1 allocation) was conducted at the Department of Oral Surgery, Medical University-Varna, Bulgaria, from 27 June 2022 to 20 April 2023. Forty patients aged 30-65 were equally and randomly allocated to the SS or the control groups. Atraumatic tooth extraction was performed. In the control group, the socket was left on secondary wound healing. In the SS group, the socket orifice was "sealed" with an FGG harvested from the hard palate or maxillary tuberosity. Results: Data analysis demonstrated that SS with an FGG is a successful method for reducing the post-extraction resorption of the socket walls. In addition, this study confirms that the thickness of the buccal wall is a significant factor in its vertical resorption. Conclusions: Socket sealing with an FGG is a valuable method that eliminates the need for flap reflection and compensates for the soft tissue deficit when immediate implant placement or bone augmentation is required. Further research is necessary to determine the role of different factors influencing bone resorption and compare the effect of different socket preservation methods.

Efficacy of delivery of care with Tele-continuous EEG in critically ill patients: a multicenter randomized controlled trial (Tele-cRCT study) study

BACKGROUND

Continuous electroencephalography (cEEG) has been recommended in critically ill patients although its efficacy for improving patients' functional status remains unclear. This study aimed to compare the efficacy of Tele-cEEG with Tele-routine EEG (Tele-rEEG), in terms of seizure detection rate, mortality and functional outcomes.

METHODS

This study is a 3-year randomized, controlled, parallel, multicenter trial, conducted in eight regional hospitals across Thailand. Eligible participants were critically ill patients aged ≥ 15 years and at-risk for developing nonconvulsive seizure (NCS)/nonconvulsive status epilepticus (NCSE). Study interventions were 24-72 h Tele-cEEG versus 30-min Tele-rEEG. Study outcomes were seizure detection rate, mortality and functional outcomes (mRS), assessed at hospital discharge, ≤ 7 days, 3-, 6-, 9-months and 1 year.

RESULTS

Two hundred and fifty-four patients were randomized, 128 and 126 patients received Tele-cEEG and Tele-rEEG, respectively. NCS/NCSE were detected more commonly in the Tele-cEEG (21.88%) than Tele-rEEG arm (14.29%) but this was not statistically significant (p = 0.116). Intention-to-treat, per-protocol and as-treated analysis showed non-significant differences in mortality at all assessment periods, with corresponding mortality rates of 10.03% (Tele-cEEG) versus 10.10% (Tele-rEEG) (p = 0.894), 9.67% versus 9.06% (p = 0.833) and 10.34% versus 9.06% (p = 0.600), respectively. Functional outcome was also not significantly different in all analyses.

CONCLUSIONS

Both Tele-cEEG and Tele-rEEG are feasible, although Tele-EEG requires additional EEG specialists, budget, and computational resources. While Tele-cEEG may help detect NCS/NCSE, this study had limited power to detect its efficacy in reducing mortality or improving functional outcomes. In limited-resource settings, Tele-rEEG approximating 30 min or longer offers a feasible and potentially valuable initial screening tool for critically ill patients at-risk of seizures. However, where Tele-cEEG is readily available, it remains the recommended approach. Trial registration Thai Clinical Trials Registry (TTCTR20181022002); Registered 22 October 2018.

Pain-Related Behavior and Pain Perception Associated with Intraosseous Local Anesthesia (QuickSleeper 5®) in Pediatric Patients: A Randomized Controlled Clinical Trial

BACKGROUND

Managing pain during dental procedures is crucial, particularly for children, as pain can induce anxiety. Local anesthesia is the most anxiety-inducing procedure in pediatric patients. Consequently, this study aimed to assess and compare the pain-related behaviors and perceptions associated with two anesthesia techniques for children: traditional local anesthesia and intraosseous local anesthesia administered via the QuickSleeper 5® system.

METHODS

A split-mouth randomized clinical trial was conducted involving 33 children aged 4-9 years. Each participant received both traditional local anesthesia and intraosseous local anesthesia with QuickSleeper 5 across two visits. Pain-related behaviors were evaluated by calibrated pediatric dentists through video recordings, and pain perceptions were assessed using the Wong-Baker Faces Pain Rating Scale. Heart rate measurements offered objective insights into patients' anxiety; finally, the time needed to administer anesthesia was recorded.

RESULTS

This study found no statistically significant differences between traditional local anesthesia and intraosseous local anesthesia with QuickSleeper 5 regarding pain perception, heart rate, or pain-related behaviors, indicating that both techniques are effective at minimizing discomfort. However, QuickSleeper 5 demonstrated a significantly shorter administration time, enhancing the procedural efficiency of pediatric dentistry.

CONCLUSIONS

The QuickSleeper 5 system is a valuable tool for pediatric dental care, delivering comparable comfort levels to traditional anesthesia while significantly reducing the time that is required for administration. The QuickSleeper 5 system's efficiency advantage could make it the preferred choice for treating children, especially given the stress that is often associated with local anesthesia and the need for quick, smooth procedures in pediatric care.

Efficacy of priming and commitment posters on urgent care patients' antibiotic expectations and knowledge: a cluster randomized trial

Objective

Successfully educating urgent care patients on appropriate use and risks of antibiotics can be challenging. We assessed the conscious and subconscious impact various educational materials (informational handout, priming poster, and commitment poster) had on urgent care patients' knowledge and expectations regarding antibiotics.

Design

Stratified Block Randomized Control Trial.

Setting

Urgent care centers (UCCs) in Colorado, Florida, Georgia, and New Jersey.

Participants

Urgent care patients.

Methods

We randomized 29 UCCs across six study arms to display specific educational materials (informational handout, priming poster, and commitment poster). The primary intention-to-treat (ITT) analysis evaluated whether the materials impacted patient knowledge or expectations of antibiotic prescribing by assigned study arm. The secondary as-treated analysis evaluated the same outcome comparing patients who recalled seeing the assigned educational material and patients who either did not recall seeing an assigned material or were in the control arm.

Results

Twenty-seven centers returned 2,919 questionnaires across six study arms. Only 27.2% of participants in the intervention arms recalled seeing any educational materials. In our primary ITT analysis, no difference in knowledge or expectations of antibiotic prescribing was noted between groups. However, in the as-treated analysis, the handout and commitment poster were associated with higher antibiotic knowledge scores.

Conclusions

Educational materials in UCCs are associated with increased antibiotic-related knowledge among patients when they are seen and recalled; however, most patients do not recall passively displayed materials. More emphasis should be placed on creating and drawing attention to memorable patient educational materials.

Does dietary supplementation of pregnant mares with a commercial stud feed balancer improve the transfer of passive immunity in their foals? A controlled field trial

This prospective, controlled field trial aimed to determine the effect of dietary supplementation of mares in late pregnancy with a commercial stud feed balancer on the transfer of passive immunity to their foals. Eighty-two pregnant mares on a single stud farm that were eligible for inclusion were assigned into two groups (Intervention and Control) based primarily on existing social groupings. Between 64-224 days prepartum, all mares received the same forage-based diet but mares in the Intervention group received an in-feed commercial stud feed balancer and mares in the Control group received the stud's home-mix concentrate. Data from 68 mare and foal pairs were analysed according to Intention To Treat (ITT) principles and sensitivity analysis was performed on 57 mare and foal pairs who fulfilled the study protocol. The primary outcome of interest was failure of passive transfer of immunity (FPT), defined as foal IgG <8g/l at 12-36 h after first suckle. Foals of mares in the Intervention group were significantly less likely to develop FPT compared to those in the Control group. Colostral quality (Brix ≥23.0) was also significantly greater in mares in the Intervention compared to the Control group. Group (Intervention vs. Control) and sex of foal were the only variables that were significantly associated with FPT in a multivariable model that explored the effect of other potential risk factors for FPT.

Mindfulness Interfused with Humor: Insights From a Randomized Controlled Trial of a Humor-Enriched Mindfulness-Based Program

Objectives

Both mindfulness and humor are inherently connected to well-being. Recent research found evidence for their combined effect in a joint training, the Humor-Enriched Mindfulness-Based Program (HEMBP). This study extends these findings by exploring (1) effects of Mindfulness-Based Stress Reduction (MBSR) on different forms of humor, (2) differential effects of the HEMBP on outcomes compared to MBSR, and (3) whether the HEMBP and MBSR may alter worldviews.

Method

Ninety participants were randomly allocated to three conditions: the HEMBP, MBSR, and a wait-list control group. Participants' mindfulness, psychological well-being, life satisfaction, perceived stress, comic styles, and primal world beliefs (primals) were assessed before and after the trainings, and at 1-, 3-, and 6-month follow-ups. Changes in outcome variables over time were modeled by applying linear mixed-effects models.

Results

The HEMBP enhanced participants' mindfulness, benevolent humor, psychological well-being, and life satisfaction compared to the wait-list control. Similarly, MBSR increased participants' mindfulness and life satisfaction while reducing perceived stress and primal good, but no effects on humor were observed. Comparison between the two trainings revealed trends toward a greater increase in benevolent humor in the HEMBP group and a greater decrease in good in the MBSR group.

Conclusion

The results largely replicate previous research on the efficacy of the HEMBP. Both programs demonstrated similar effects on outcomes, with only the HEMBP increasing benevolent humor and psychological well-being, while MBSR reduced stress. Further research is needed to investigate qualitative aspects of the integration of humor in MBPs and the long-term impact of MBPs on individuals' worldviews.

Preregistration

This study is not preregistered.

The effect of Chinese 5-element music with midnight-noon ebb-flow theory on depression, anxiety, quality of life satisfaction among older adults: A randomized controlled trial

BACKGROUND

The prevalence rates of depression and anxiety are constantly increasing, and the aging population is growing in China. Music-based intervention is a nonpharmacological treatment that is used to treat depression and anxiety and that has very few side effects. The aim of this study was to explore the effect of Chinese 5-element music-based intervention (CFEMBI) based on the midnight-noon ebb-flow theory on depression and anxiety among older adults.

METHODS

A total of 86 patients were divided into the control and experimental groups. The control group underwent a traditional CFEMBI, and the experimental group underwent a CFEMBI based on the midnight-noon ebb-flow theory. Outcomes were assessed at the 4th week, 8th week, and 12th week during the intervention.

RESULTS

After the 12th week, there was a significant difference in scores on the Hamilton Depression Rating Scale (HAM-D) between the control and experimental groups (Z = -6.375, P value < 0.001). Additionally, there was a significant difference in the cure rate of depression between the 2 groups at week 12 (P < .001). After the 8th week, there was a significant difference in Hamilton Anxiety Rating Scale (HAM-A) scores between the 2 groups (t = 7.422, P value < 0.001). Furthermore, there was a significant difference in scores on the Quality of Life, Enjoyment, and Satisfaction Questionnaire-Short Form (Q-LES-Q-SF) between the 2 groups (Z = 4.991, P value < 0.001; Z = 3.023, P value < 0.01; Z = 3.023, P value < 0.01).

CONCLUSIONS

CFEMBI based on the midnight-noon ebb-flow theory is effective at alleviating depression and anxiety in older adults and improving life satisfaction.

Impact of iron chelation with deferasirox on telomere length and oxidative stress in hemodialysis patients: A randomized study

BACKGROUND

Recent studies have demonstrated the effectiveness, safety, and tolerability of deferasirox in patients in peritoneal dialysis, however, its effect has not been studied in patients undergoing hemodialysis.

OBJECTIVE

To investigate the impact of iron chelation on telomere length, oxidative stress, and ferritin levels in patients undergoing hemodialysis.

METHODS

This is an open-label study, with a control group of patients undergoing hemodialysis, who will receive treatment with deferasirox 15mg/kg/day for 6 months for iron chelation. Telomere length was measured using real-time PCR. Serum ferritin levels and oxidation markers were evaluated. To evaluate the pharmacokinetics and safety of deferasirox, plasma concentrations were analyzed by HPLC.

RESULTS

Fifty-four patients were included to receive deferasirox, and a control group of 50 patients. Significant differences were observed in serum ferritin levels (p<0.0001), TBARS (thiobarbituric acid reactive substances) (p<0.01). Telomere length had a significant increase after chelation (p<0.001). The serum deferasirox concentration at zero time at 48h was maintained within a range of 2.67-23.78mmol/L.

CONCLUSIONS

Our results demonstrate that iron chelation in hemodialysis patients significantly reduces ferritin and TBARS, resulting in an increase in telomere length. Deferasirox proves to be beneficial for patients with iron overload undergoing hemodialysis.

SPIRIT-DEFINE explanation and elaboration: recommendations for enhancing quality and impact of early phase dose-finding clinical trials protocols

Transparent and accurate reporting in early phase dose-finding (EPDF) clinical trials is crucial for informing subsequent larger trials. The SPIRIT statement, designed for trial protocol content, does not adequately cover the distinctive features of EPDF trials. Recent findings indicate that the protocol contents in past EPDF trials frequently lacked completeness and clarity. To address this gap, the international consensus-driven SPIRIT-DEFINE checklist was developed through a robust methodological framework for guideline development, with the aim to improve completeness and clarity in EPDF trial protocols. The checklist builds on the SPIRIT statement, adding 17 new items and modifying 15 existing ones.The SPIRIT-DEFINE explanation and elaboration (E&E) document provides comprehensive information to enhance understanding and usability of the SPIRIT-DEFINE checklist when writing an EPDF trial protocol. Each new or modified checklist item is accompanied by a detailed description, its rationale with supportive evidence, and examples of good reporting curated from EPDF trial protocols covering a range of therapeutic areas and interventions. We recommend utilising this paper alongside the SPIRIT statement, and any relevant extensions, to enhance the development and review of EPDF trial protocols.By facilitating adoption of the SPIRIT-DEFINE statement for EPDF trials, this E&E document can promote enhancement of methodological rigour, patient safety, transparency, and facilitate the generation of high-quality, reproducible evidence that will strengthen the foundation of early phase research and ultimately improve patient outcomes.

Funding

This work is a further extension of the SPIRIT-DEFINE study, which obtained no external funding. The principal investigator (CY) used internal staff resources, together with additional resources from external partners, to conduct this study. The SPIRIT-DEFINE study is a component of the DEFINE project, which also developed the MRC/NIHR funded CONSORT-DEFINE guidance. ICR-CTSU receives programmatic infrastructure funding from Cancer Research UK (C1491/A25351; CTUQQR-Dec22/100004), which has contributed to accelerating the advancement and successful completion of this work.

Practical considerations of promising zone design for interim sample size Re-estimation: An application to GRAPHITE for graft vs host disease

BACKGROUND

Sample size calculation and power estimate are an integral part of clinical trials. With accelerated development to address the unmet medical needs, the fast-paced development may lead to uncertainties in initial planning and assumptions of clinical trials. Promising zone design presents sponsors an opportunity to re-estimate the sample size based on the interim data to mitigate risks, reduce uncertainties, and increase probability of trial success.

METHODS

This paper aims to use the GRAPHITE trial (NCT03657160) as a real data application to showcase the practical considerations in implementation of promising zone design for interim sample size re-estimation (SSR), in light of sample size adaptation rules, maximum sample size allowed, multiplicity adjustment, and sponsor access to interim results. GRAPHITE is a phase 3 trial with vedolizumab for prophylaxis of acute graft vs host disease (aGvHD) after allogeneic hematopoietic stem cell transplant (allo-HSCT). The primary efficacy endpoint is lower intestinal aGVHD-free survival by Day +180 after allo-HSCT. A simulation study was conducted to demonstrate the evaluation of operating characteristics by various true underlying treatment effects at the design stage.

CONCLUSION

The application of promising zone design for interim SSR is novel and has successfully helped the sponsor achieve the balance between minimizing the risks and maintaining scientific integrity. This work aims to highlight the necessity of empirical guidance to gain better insights for clinical researchers in practice and is expected to facilitate the understanding and implementation of promising zone design for interim SSR in phase 3 trials.

A peer support intervention in patients with hematologic malignancies undergoing hematopoietic stem cell transplantation (HSCT): The STEPP randomized pilot trial design and methods

BACKGROUND

Despite the association between peer support interventions and improved patient-reported outcomes (PROs) across cancer populations, there is a lack of structured peer support interventions for patients with hematologic malignancies undergoing hematopoietic stem cell transplantation (HSCT).

OBJECTIVE

To test the feasibility, acceptability, and preliminary efficacy of a novel five-session, phone-delivered peer support intervention (STEPP: Supporting Transplant Experiences with Peer Program) for improving quality of life (QOL) and reducing psychological distress in patients undergoing HSCT.

METHODS

This single-center pilot randomized clinical trial (RCT) will compare the STEPP intervention to usual transplant care among 90 patients hospitalized for HSCT. Eligible participants include adults (age ≥ 18 years) with hematologic malignancies hospitalized for autologous or allogeneic HSCT. The STEPP intervention provides informational, emotional, and practical support. To test the primary aim of intervention feasibility, we have established a priori benchmarks of 60 % enrollment of eligible patients and 60 % completion of at least 3 out of 5 intervention sessions among those randomized to STEPP. Acceptability will be assessed using the Client Satisfaction Questionnaire, with scores ≥3.0/4.0 indicating greater intervention acceptability. To test the secondary aim of preliminary efficacy, we will examine changes in PROs (e.g., anxiety symptoms and QOL) from pre- to post-intervention.

DISCUSSION

This pilot RCT of a structured, phone-delivered peer support intervention tailored to the needs of patients preparing to undergo HSCT will elucidate the feasibility, acceptability, and preliminary efficacy of the STEPP intervention. We will then be poised to conduct a future, full-scale RCT to establish the efficacy of STEPP on patient outcomes.

CLINICALTRIALS

gov: NCT06010017.

Efficacy of a physical rehabilitation program using virtual reality in patients with chronic tendinopathy: A randomized controlled trial protocol (VirTendon-Rehab)

Objectives

To analyze the efficacy of a virtual reality (VR)-based rehabilitation program in people with chronic tendinopathy (CT) on pain, muscle activation pattern, range of motion, muscle strength, kinesiophobia, physical function, quality of life, and user satisfaction compared to a control group. In addition, the relationship between these variables and the clinical profile of this population will be analyzed.

Design

A 12-week, single-blind, low-risk, randomized controlled trial.

Methods

Sixty patients diagnosed with CT will be enrolled and randomly assigned to two groups. The control group will receive a physical exercise program without VR support (45 min), whereas the experimental group will receive an additional 15-min intervention through a physical exercise program delivered by VR. Both groups will receive three sessions per week, and the outcomes will be collected at baseline, after 12 weeks, and at the 24-week follow-up. Stratified groups will be established according to tendinopathy location (shoulder rotator cuff, elbow, patella, and Achilles tendon). Statistical analyses using SPSS v.24 will include descriptive analysis, stratified analysis by tendinopathy location, normality checks, intragroup and intergroup differences, effect sizes, and variable relationships.

Discussion

The results of this project may have a significant impact on the knowledge of using VR in tendinopathy management, understanding how the outcomes are related, and characterizing the clinical profiles of the population diagnosed with CT. If these results are confirmed, VR would be clinically useful for the treatment of these conditions.

Trial registration number

NCT06056440.

Comparison of dexmedetomidine versus propofol sedation on microcirculation and organ injuries in critically ill surgical patients: A randomized controlled pilot study

BACKGROUND

Recent studies have shown that dexmedetomidine may improve microcirculation and prevent organ failure. However, most evidence was obtained from experimental animals and patients receiving cardiac surgery with cardiopulmonary bypass. This study aimed to investigate the effect of dexmedetomidine on microcirculation and organ injuries in critically ill general surgical patients.

METHODS

In this prospective randomized trial, patients admitted to the surgical intensive care unit after general surgery were enrolled and randomly allocated to the dexmedetomidine or propofol groups. Patients received continuous dexmedetomidine or propofol infusions to meet their requirement of sedation according to their grouping. At each time point, sublingual microcirculation images were obtained using the incident dark field video microscope.

RESULTS

Overall, 60 patients finished the trial and were analyzed. Microcirculation parameters did not differ significantly between two groups. Heart rate at 4 h after ICU admission and mean arterial pressures at 12 h and 24 h after ICU admission were lower in the dexmedetomidine group than in the propofol group. At 24 h, serum aspartate aminotransferase (41 (25-118) vs 86 (34-129) U/L, p = 0.035) and alanine aminotransferase (50 (26-160) vs 68 (35-172) U/L, p = 0.019) levels were significantly lower in the dexmedetomidine group than in the propofol group.

CONCLUSION

Microcirculation parameters did not differ significantly between the dexmedetomidine and propofol groups. At 24 h after ICU admission, serum liver enzyme levels were lower in patients receiving dexmedetomidine as compared to propofol.

The Effect of Montelukast on Urinary Symptoms in Children With Bladder Pain Syndrome: A Randomized Clinical Trial

Montelukast by inhibiting leukotriene receptors in the bladder can prevent the activation of mast cells. We investigated the effectiveness of Montelukast in reducing the symptoms of children with bladder pain syndrome (BPS). In this randomized clinical trial, children were allocated into groups of intervention (Montelukast and oxybutynin) and the control (oxybutynin). At the beginning and after 14 days, questions from mothers of children about their urinary condition were asked about the frequency of nocturnal enuresis, frequent urination, urinary incontinence, urinary urgency, and their pain severity. There was no significant difference between two groups in terms of frequency of nocturnal enuresis, frequent urination, urinary incontinence, and urinary urgency. Regarding the frequency of pain distribution, the frequency of pain-free people in the Montelukast group was higher than control group (84.4% vs 56.3%, P = .023). The results showed that adding Montelukast to oxybutynin has a significant decrease in pain in children with BPS.

CONSORT-DEFINE explanation and elaboration: recommendations for enhancing reporting quality and impact of early phase dose-finding clinical trials

Early phase dose-finding (EPDF) trials are key in the development of novel therapies, with their findings directly informing subsequent clinical development phases and providing valuable insights for reverse translation. Comprehensive and transparent reporting of these studies is critical for their accurate and critical interpretation, which may improve and expedite therapeutic development. However, quality of reporting of design characteristics and results from EPDF trials is often variable and incomplete. The international consensus-based CONSORT-DEFINE (Consolidated Standards for Reporting Trials Dose-finding Extension) statement, an extension of the CONSORT statement for randomised trials, was developed to improve the reporting of EPDF trials. The CONSORT-DEFINE statement introduced 21 new items and modified 19 existing CONSORT items.This CONSORT-DEFINE Explanation and Elaboration (E&E) document provides important information to enhance understanding and facilitate the implementation of the CONSORT-DEFINE checklist. For each new or modified checklist item, we provide a detailed description and its rationale with supporting evidence, and present examples from EPDF trial reports published in peer-reviewed scientific journals. When reporting the results of EPDF trials, authors are encouraged to consult the CONSORT-DEFINE E&E document, together with the CONSORT and CONSORT-DEFINE statement papers, and adhere to their recommendations. Widespread adoption of the CONSORT-DEFINE statement is likely to enhance the reporting quality of EPDF trials, thus facilitating the peer review of such studies and their appraisal by researchers, regulators, ethics committee members, and funders.

Funding

This work is a further extension of the CONSORT-DEFINE study, which was funded by the UK Medical Research Council (MRC)-National Institute for Health and Care Research (NIHR) Methodology Research Programme (MR/T044934/1). The Clinical Trials and Statistics Unit at The Institute of Cancer Research (ICR-CTSU) receives programmatic infrastructure funding from Cancer Research UK (C1491/A25351; CTUQQR-Dec 22/100 004), which has contributed to accelerating the advancement and successful completion of this work.

Personalized (N-of-1) Clinical Trials for Inflammatory Bowel Disease: Opportunities and Challenges

BACKGROUND & AIMS

Heterogeneity of treatment effects in inflammatory bowel disease (IBD) means that many individuals or patient subgroups depart from the average for whom the outcomes from traditional randomized trials may not be applicable. The N-of-1 trial is a design in which a single patient is followed over time with the treatments being randomized from period to period with the intention of finding the most effective treatment for that patient. The aim was to investigate the utility of N-of-1 trials in IBD.

METHODS

To identify relevant articles for this scoping review, a MEDLINE literature search was conducted through the PubMed platform for articles published in the English language using the search terms "inflammatory bowel disease," "Crohn's disease," "ulcerative colitis," "N-of-1 trials," "single case designs," and "personalized trials."

RESULTS

N-of-1 trials have seen a resurgence across several medical disciplines, driven by a need for more personalized medicine and patient-centered health care; their use in IBD is scarce with only 3 trials identified. Studies involving multiple N-of-1 trials can generate robust evidence for each participant and average effect estimates. The N-of-1 trial may hold potential for studying patients with IBD that are excluded from or underrepresented by randomized trials, such as those with extraintestinal manifestations, pouchitis, and proctitis. Although methodologically sound and akin to the rigor of a randomized controlled trial, the crossover periods inherent to the study design can be perceived as burdensome by patients and researchers.

CONCLUSIONS

The N-of-1 trial design provides a patient-centered means of objectively determining individual response to therapy.

Efficacy of a smartphone application assisting home-based rehabilitation and symptom management for patients with lung cancer undergoing video-assisted thoracoscopic lobectomy: a prospective, single-blinded, randomised control trial (POPPER study)

BACKGROUND

Video-assisted thoracoscopic (VATS) lobectomy can affect patients' pulmonary function and quality of life significantly. No optimal protocol combining patient-reported outcome-based symptom management and postdischarge rehabilitation programme has yet been established. This study aimed to assess the efficacy of a novel smartphone app designed for home-based symptom management and rehabilitation.

METHODS

The app was developed based on three modules: a symptom reporting system with alerts, aerobic and respiratory training exercises, and educational material. Four core symptoms were selected based on a questionnaire survey of 201 patients and three rounds of Delphi voting by 30 experts. The authors screened 265 patients and randomly assigned 136 equally to the app group and usual care group. The primary outcome was pulmonary function recovery at 30 days postoperatively. Secondary outcomes included symptom burden and interference with daily living (both rated using the MD Anderson Symptom Inventory for Lung Cancer), aerobic exercise intensity, emergency department visits, app-related safety, and satisfaction with the app.

FINDINGS

Of the 136 participants, 56.6% were women and their mean age was 61 years. The pulmonary function recovery ratio 1 month after surgery in the app group was significantly higher than that in the usual care group (79.32 vs. 75.73%; P =0.040). The app group also recorded significantly lower symptom burden and interference with daily living scores and higher aerobic exercise intensity after surgery than the usual care group. Thirty-two alerts were triggered in the app group. The highest pulmonary function recovery ratio and aerobic exercise intensity were recorded in those patients who triggered alerts in both groups.

INTERPRETATION

Using a smartphone app is an effective approach to accelerate home-based rehabilitation after VATS lobectomy. The symptom alert mechanism of this app could optimise recovery outcomes, possibly driven by patients' increased self-awareness.

Mapping the reporting practices in recent randomised controlled trials published in Knee Surgery, Sports Traumatology, Arthroscopy: A scoping review of methodological quality

The official medical journals of scientific societies advocate for high-quality standards. It's important to assess whether randomized controlled trials (RCTs) in influential journals, such as the hybrid journal of the European Society of Sports Traumatology, Knee Surgery, and Arthroscopy (ESSKA), adhere to reporting guidelines and best practices. Therefore, the present scoping review aimed to explore and map the reporting practices and methodological quality in recent RCTs published in the Knee Surgery, Sports Traumatology, Arthroscopy (KSSTA) journal, focusing on identifying gaps in adherence to reporting guidelines and transparency. The study was preregistered and followed the PRISMA-ScR checklist. RCTs published in KSSTA between 2022 and 2023 were included. The search was conducted via PubMed. A two-stage selection process was employed, with two independent reviewers conducting study selection and data extraction. Data collected included study characteristics, intervention details, sample size calculation reporting, data transparency, and adherence to Consolidated Standards of Reporting Trials (CONSORT) guidelines. Critical appraisal was conducted using the JBI tool for RCTs. All included RCTs (n = 25) reported a predetermined minimum sample size. Study protocol preregistration was reported in 52% of the RCTs, while only 24% provided data availability statements. Most RCTs offering data availability indicated data would be shared upon request. Adherence to CONSORT guidelines was reported in 96% of studies, with only one RCT not adhering to recognized reporting standards. All the included studies adequately addressed statistical conclusion validity. However, internal validity was less consistently addressed across the studies.

Conclusions

While most recently published RCTs in KSSTA adhered to CONSORT guidelines, there is potential for improvement in the reporting of protocol preregistration and data availability statements. Although all studies reported sample size calculations, transparency in data sharing remains limited.

Level of Evidence

Level I.

Add on effect of Whole System Ayurveda protocol in suboptimal controlled Primary Hypothyroidism - A randomized controlled trial

BACKGROUND

Primary hypothyroidism (PH) is a common chronic life style disorder. Whole system Ayurveda protocol on PH (WSAPH) is explored for it's possible complimentary role in the management of suboptimal controlled PH on stable levothyroxine therapy.

OBJECTIVE

To evaluate the efficacy of whole system Ayurveda protocol on Primary hypothyroidism with suboptimal response to stable levothyroxine therapy.

MATERIAL AND METHODS

Study was a randomized controlled trial. Total 46 known patients of suboptimal response to stable levothyroxine therapy, age group 20-60 years of either sex participated in the study. They were randomly placed in two groups, Group KG received Kanchanara guggulu two tablets of 500 mg each, thrice a day with water and group WSAPH was on whole system Ayurveda protocol for primary hypothyroidism (WSAPH). Interventions were for 60 days. Assessments were done through various parameters like Thyroid profiles (TSH, T3, T4, Free T4), Weight, BMI, Skin fold thickness (SFT), Body fat index (BFI), Waist hip ratio (WHR), Lipid profile, Zulewskis clinical score for hypothyroidism (ZUL), WHO Quality of Life- BREF (WHOQOL-BREF), Clinical Global Improvement scales (CGI). Clinical assessments were done on every 15th day and biochemical were done before and after interventions.

RESULTS

Study showed that WSAPH group produced significant outcome improvement compared to KG group in TSH (p = 0.02), weight (p = 0.02), SFT (p = 0.04), BFI (p = 0.01), WHOQOL-BREF (p = 0.004) and ZUL (p = 0.02). Both the group showed improvements in BMI, WHR, BFI, SFT, WHOQOL-BREF, ZUL, CGI scales. Effect size was medium in TSH, weight, BFI, SFT and ZUL.

CONCLUSION

WSAPH was effective in management of PH and normalized TSH and ZUL scores in patients with suboptimal response to stable levothyroxine therapy. Further studies are needed.

Program for the Education and Enrichment of Relational Skills (PEERS®) for Italy: A Randomized Controlled Trial of a Social Skills Intervention for Autistic Adolescents

The Program for the Education and Enrichment of Relational Skills (PEERS®) is an intervention targeting social skills for autistic adolescents and those with other social challenges. The efficacy of the PEERS® on adolescents has been extensively explored but the program has not been validated in Italy. In the present study, we adapted PEERS® to Italian culture and evaluated its efficacy in an Italian sample. A Randomized Controlled Trial was conducted, analyzing the results of 37 autistic adolescents who were randomly assigned to two groups: experimental group (TG) and waitlist group (WL). The primary outcomes (social abilities) and secondary outcomes (co-occurring conditions, executive functions) were assessed at four time points. No differences were found at pre-treatment between groups on baseline measures and primary outcomes. At post-treatment, significant group differences emerged in primary outcomes (social knowledge and social performance) and secondary outcomes (emotion regulation). The groups' results pooled together (TG + WL) confirmed the findings at post-treatment and showed further changes in primary outcomes (global social competence and social cognition) and secondary outcomes (externalizing problems, emotive and behavioral total problems, functional problems related to depressive symptoms). The improvements were maintained at a 3-month follow-up, except for global social competence and social cognition. Additionally, new results emerged regarding internalizing problems and global executive functioning. The efficacy of the Italian version of PEERS® was ascertained on primary and secondary outcomes. Innovative findings on emotion regulation, behavioral problems, and depression symptoms also emerged.Clinical trial registration information Program for the Education and Enrichment of Relational Skills (PEERS®) for Italy. An RCT's Study on Social Skills Intervention for Adolescents with Autism Spectrum Disorder (ASD). URL: http://clinicaltrials.gov . TRN: NCT05473104. Release Date: July 21, 2022.

Prospective, randomized clinical trial evaluating the clinical performance of a new universal adhesive in Class I and Class II restorations at 1 year

OBJECTIVE

This randomized controlled trial compared the 1-year clinical efficacy of Scotchbond Universal Adhesive Plus (SBU+) with that of its predecessor Scotchbond Universal Adhesive (SBU) to restore Class I and Class II preparations using the self-etch strategy in adult patients.

MATERIALS AND METHODS

Fifty-one subjects participated in this study. Two posterior teeth in each subject were randomized to a restoration with SBU+ or to a restoration with SBU (control) using the self-etch strategy. Teeth were restored with Filtek Universal Restorative. Restorations were evaluated at baseline, 6 months and 1 year using the FDI criteria. The Wilcoxon signed-rank test was used to compare outcomes.

RESULTS

No restorations were graded as "Insufficient/Unsatisfactory" or "Poor" for any of the FDI criteria at the baseline, 6-month, or 1-year visits. At 1 year the retention rate was 100% for both SBU+ and SBU. For fracture of the restorative material 42/44 SBU+ restorations (95%) and 44/44 SBU restorations (100%) were graded "Excellent/Very Good" (p > 0.05). All restorations were clinically acceptable for marginal adaptation at 1 year with no statistical differences between the two adhesive materials. There were no recurrent caries lesions at the 1-year visit.

CONCLUSIONS

The clinical efficacy of the SBU+ at 1-year was not different to that of its predecessor SBU in Class I and Class II restorations of adult patients using the self-etch strategy.

CLINICAL RELEVANCE

The two dental adhesives used in this clinical trial showed excellent results in posterior restorations at 1 year without using a separate phosphoric etching step.

Effectiveness, pharmacokinetics, and safety of triptorelin acetate microspheres in patients with locally advanced and metastatic prostate cancer

Background

A newly generic microspheres, sustained-release formulation of triptorelin acetate 3.75 mg has been developed.

Objectives

To evaluate the efficacy, pharmacokinetics, and safety of triptorelin 1-month formulation in Chinese patients with prostate cancer.

Design

An open-label, multicenter clinical trial with one arm testing a 1-month sustained-release triptorelin formulation in prostate cancer patients.

Methods

Patients with prostate cancer received three consecutive 28-day injections of triptorelin acetate. The primary endpoint was the proportion of successful patients over the total number of evaluable patients. Treatment success was defined as testosterone suppression below the clinical castration level (i.e., <0.5 ng/mL) at day 28 and maintenance of clinical castration until study completion (day 84). The frequency of patients with testosterone concentrations <0.2 ng/mL was also studied.

Results

The study included 125 patients. All 125 patients received at least one dose of the study drug and 122 completed the study. The successful patient proportion among the evaluable patients was 97.6% (122/125; 95% CI, 92.7-99.2). 95.1% (116/122) achieved testosterone concentrations <0.2 ng/mL. The pharmacokinetic profile of triptorelin during the first 3 months of treatment, evaluated in a subset of the study population (n = 11), showed sustained release of triptorelin from the formulation. Values for AUC0-τ calculated from day 0 to 28, and day 56 to 84 were 134.42 (28.76), and 154.72 (21.86) h*ng/mL, respectively. The most common treatment-related adverse events were increased alanine aminotransferase (18.4%), increased aspartate aminotransferase (16.0%), and hot flashes (9.6%). Prolonged QT interval on electrocardiogram, erectile dysfunction, and decreased libido each occurred in ⩽4% of the patients. The frequently reported local adverse reaction was pain at the injection site, experienced by 2.4% (3/125) of the patients.

Conclusion

3.75-mg Triptorelin acetate microspheres for injection were effective in achieving and maintaining testosterone suppression and were well tolerated in patients with prostate cancer.

Trial registration

chictr.org.cn (ChiCTR2000033188).

Evaluation of leukocyte-platelet rich fibrin as an antibiotic slow-release biological device in the treatment of moderate periodontitis: a randomized controlled clinical trial

BACKGROUND

Periodontitis is a chronic inflammatory disease caused by the accumulation of biofilm. Antimicrobials have been used as adjuncts to non-surgical periodontal therapy. However, systemic antibiotics often require large dosages to achieve suitable concentrations at the disease site. Leukocyte platelet-rich fibrin (L-PRF) is a promising bio-material, with antimicrobial, anti-inflammatory, and wound-healing enhancement effects. This study aimed to evaluate the efficacy of L-PRF as a locally sustained released device for metronidazole antimicrobial.

METHODS

Twenty-four patients with eighty periodontal pockets had moderate periodontitis with attachment loss of 3-4 mm, and probing depth ≤ 5, which was equally divided into two groups: Group (I) underwent scaling and root planing with intra-pocket application of L-PRF loaded with Metronidazole, while Group (II) was treated by scaling and root planing with intra-pocket application of L-PRF alone. Microbiological measurements were taken at baseline and after one month to analyze the relative count of Porphyromonas gingivalis (P. gingivalis) using real time PCR. Clinical parameters were measured at baseline and after 1, 3, and 6 months. These parameters included probing depth (PD), clinical attachment loss (CAL), plaque index (PI), modified gingival index (MGI), and bleeding index (BI).

RESULTS

Microbiological and clinical findings revealed that both treatment methods resulted in a reduction in P. gingivalis counts, in addition to improvements in the clinical parameters: PD reduction, CAL gain, PI reduction, BI decrease and MGI reduction compared to baseline. However, L-PRF-metronidazole group showed superior results in the studied parameters over the study period. Nonetheless, there was no statistically significant improvement. (p < .001).

CONCLUSION

The intra-pocket application of both L-PRF loaded with Metronidazole and L-PRF alone contributed to the successful treatment of moderate periodontitis.

TRIAL REGISTRATION

NCT06153706 ( http://www.clinical-trials.gov/ ); 1/12/2023, retrospective registration.

PTSD Coach as an early mobile intervention to improve cancer-related anxiety and psychosocial oncology uptake in patients newly diagnosed with head and neck cancer: pilot randomized controlled trial

BACKGROUND

This pilot study aimed to provide supportive evidence for the feasibility of conducting a full-scale intervention trial with patients newly diagnosed with head and neck cancer (HNC). This included assessing the acceptability and potential usefulness of the PTSD Coach mobile app as an early self-management intervention that gives information about anxiety symptoms, offers self-assessment of symptoms with feedback, tools to self-manage anxiety, and connects to support.

METHODS

A three-arm randomized controlled trial was conducted. The primary pilot study questions related to feasibility were: (1) can we recruit enough (i.e., n = 60 over 8 months or 8/month) and retain a sufficient proportion (i.e., ≥ 85% at three months post-randomization, having completed the primary outcome) of patients with HNC in all trial arms? (2) Will there be at least a 90% completion rate of PTSD Coach within 3 weeks from randomization? (3) Will at least 85% of the content for each module of PTSD Coach be completed? (4) Will there be at least a 90% completion rate of the attention-control tasks (i.e., 45 min/week over 3 weeks)? (5) What would be the anticipated sample size for a full study? (6) We also explored a signal for intervention effects on 1-, 3-, and 6-month levels of cancer-related anxiety, quality of life, anxiety and depression, self-stigma of seeking help, and professional psycho-oncology service uptake.

RESULTS

Participants comprised 39 patients (11 experimental group (EG), 13 attention-control (AC), 15 usual care (UC)), primarily male (82%). Enrolment was lower than expected, with strategies implemented to increase the study's participation rate (i.e., shortening the questionnaire, more relevant AC games, pacing study components, and enlarging eligibility to 4 weeks post-diagnosis instead of 2). Retention rates, intervention completion rates, and completion time were adequate. The intervention was acceptable with all patients (100%) who received PTSD Coach reporting it a positive experience and that they would recommend it to others. When compared to UC, there was a signal for the PTSD Coach group to report lower 3-month cancer-related anxiety (PCL-S; eta squared = 0.013), lower anxiety and depression (HADS; eta squared = 0.015), anxiety (HADS-A; eta squared = 0.028), and higher functional wellbeing (FACT-FW; eta squared = 0.09), based on effect sizes calculated across all three groups. The sample size for a full study was estimated to be 118 to 154 per group.

CONCLUSION

A repeat pilot study with an expanded oncology population is warranted to further investigate feasibility prior to a full Phase III study. PTSD Coach could be a valuable self-management tool as an initial stepped-care approach intervention in patients newly diagnosed with HNC.

TRIAL REGISTRATION

ClinicalTrials.gov, NCT03651570 . Registered June 26, 2018.

A Meal with Ultra-Processed Foods Leads to a Faster Rate of Intake and to a Lesser Decrease in the Capacity to Eat When Compared to a Similar, Matched Meal Without Ultra-Processed Foods

Background/Objectives: It is unknown whether the negative health effects associated with ultra-processed foods (UPFs) are due to their nutritional composition or to the extent of food processing itself. We evaluated the impact of a test meal composed only of UPF, according to the NOVA classification, compared to a similar meal without UPF in adults with obesity. Methods: This is a parallel, randomized trial. Adult individuals with obesity, according to BMI, % body fat, and/or waist circumference were included. Individuals ate one out of two test meals, matched for energy density, macronutrients, sodium, and fiber, differing in NOVA classification, as a breakfast after a 12-h fast. The rate of intake, appetite, satiety hormones, energy expenditure, and autonomic function were measured. Data were analyzed using mixed analysis of variance. Results: Forty-two individuals were included. We found a significantly faster intake rate (07:52 ± 3:00 vs. 11:07 ± 03:16 min), with less chewing and bites, and greater capacity to eat (39.68 ± 22.69 vs. 23.95 ± 18.92 mm) after the UPF meal, without observed differences in the metabolic outcomes. In an exploratory analysis, after adjusting by sex, leptin levels showed a greater decrease after the test meal in the control group. Conclusions: Although we found a faster intake rate in the UPF meal, only marginal effects were found on the participants' capacity to eat after the UPF meal. The high similarity between meals, despite differences according to the NOVA classification, may explain these results. As our study was small, these findings require further investigation.

Predictors for pain and functioning in patients with plantar fasciopathy one year after inclusion in a treatment trial in specialist care

BACKGROUND

Plantar fasciopathy is common, is characterized by heel pain and is associated with decreased functioning and health-related quality of life. While many recover from this condition, a considerable number of people experience persistent heel pain. This study seeks to evaluate predictors for pain and function twelve months after inclusion in a treatment trial in specialist care.

METHODS

Secondary analysis was conducted on 200 patients with plantar fasciopathy included in a randomized controlled trial and followed for twelve months. Baseline demographics and clinical characteristics were included as possible predictors. Univariate and multivariable linear regression models were applied to identify predictors for foot pain (Numeric rating scale) and function (Foot Function Index revised short form) at 12-month follow-up.

RESULTS

Unilateral heel pain, lower physical activity level and higher number of repetitions in the clinical heel-rise test were identified as statistically significant predictors for reduced pain. Unilateral heel pain, shorter duration of heel pain and being married/cohabitating were predictors for better functioning.

CONCLUSIONS

Unilateral heel pain as opposed to bilateral heel pain, was the most consistent positive predictor for the outcomes pain and function in plantar fasciopathy at 12-month follow-up. Hence, patients with bilateral PF may need extended assessment and treatment. Other predictors varied among outcomes. These findings may be used to improve clinical management of patients with persistent PF.

TRIAL REGISTRATION

ClinicalTrials.gov NCT03472989. Date of registration 2018-03-20.

Energetic activity for depression in young people aged 13-17 years: the READY feasibility RCT

Background

Prevalence of depression is increasing in young people. Behaviour change interventions providing benefits equal to or greater than talking therapies or pharmacological alternatives are needed. Exercise could be beneficial for young people with depression, but we lack robust trials of its effectiveness.

Objective

To test whether an exercise intervention targeting young people with depression is feasible, including recruitment and retention of young people, recruitment and training of exercise professionals and intervention delivery.

Design

Three-arm cluster feasibility randomised controlled trial with embedded process evaluation and health economic data collection.

Setting

Local community venues in Hertfordshire, Bedfordshire and Norfolk.

Participants

Young people aged 13-17 years experiencing mild to moderate low mood or depression (indicated by scoring 17-36 on the Child Depression Inventory version 2) identified by mental health services, schools or self-referral.

Interventions

Participants were randomised to one of three groups: high-intensity exercise, low-intensity exercise or a social activity control. Group sessions ran twice-weekly for 12 weeks delivered by registered exercise professionals, supported by mental health support workers.

Main outcome measures

Referral, recruitment and retention rates; attendance at group sessions; adherence to and ability to reach intensity during exercise sessions; proportions of missing data, and adverse events measured at baseline and at 3 and 6 months; resource use; and reach and representativeness.

Results

Of 321 referrals to the study, 173 were assessed for eligibility, and of the target sample size of 81, 15 were recruited and 14 were randomised (one withdrew). The retention rate was 71.4% and attendance at intervention sessions was > 67%; data completeness was > 80% for baseline assessments. Follow-up completion rate at 14 weeks was > 80% for most outcomes, with 50% for accelerometer data in the low-intensity group. Trial processes and the intervention were acceptable to young people. Barriers to and facilitators of intervention delivery were identified.

Limitations

Findings highlighted challenges around recruitment, delivery of exercise interventions and informed ways of addressing barriers to recruitment for future studies. The study was conducted between October 2020 and August 2022 and consequently the COVID-19 pandemic had a disruptive impact on implementation.

Conclusions

A large randomised trial of the effectiveness of the intervention is not feasible using the current study design, but issues relating to recruitment could be addressed with further work.

Future work

Developing appropriate recruitment strategies via triage services, general practitioner practices, schools and social media and early engagement with the local Clinical Research Network to support recruitment to the study would address the significant shortfalls identified. Young people who are deemed unsuitable for mental health services should be followed up to be offered participation in such interventions. Collaborations between the NHS services and sports delivery partners should consider in-person contact with young people rather than remote consultations. Recruiting through general practitioner practices is effective and relatively inexpensive. The role of community engagement (socialmedia, public health agencies, community groups) needs to be further explored. Strong public and patient involvement and engagement via young people advisory groups is important to ensure that research is relevant to young people.

Funding

This article presents independent research funded by the National Institute for Health and Care Research (NIHR) Health Technology Assessment programme as award number 17/78/10.