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ELKasar AO, Hussien FZ, Abdel-Hamied HE, Saleh IG, Mahgoup EM, El-Arabey AA, Abd-Allah AR. Effect of lithium on chemotherapy-induced neutropenia in Egyptian breast cancer patients; a prospective clinical study. Cancer Chemother Pharmacol 2024; 93:541-554. [PMID: 38324036 DOI: 10.1007/s00280-023-04620-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2023] [Accepted: 11/06/2023] [Indexed: 02/08/2024]
Abstract
PURPOSE Myelosuppressive chemotherapy-induced neutropenia (CIN) remains a major limitation of cancer treatment efficacy, necessitating very expensive supportive care. Lithium carbonate, an inexpensive drug, can increase the number of neutrophils, possibly providing an efficacious and cost-effective alternative for treating CIN. The aim of this study was to determine whether lithium therapy can attenuate chemotherapy-induced neutropenia and leukopenia in breast cancer patients. METHODS A total of 50 breast cancer patients were enrolled in this prospective, interventional, randomized, controlled, and single-blind study. The patients were divided into two groups: a control group (group 1, N = 25 patients) and a lithium-treated (treatment) group (group 2, N = 25 patients). Group 1 patients were further subclassified into a non-neutropenic control group (N = 16) and a neutropenic control (N = 9) based on the subsequent development of severe neutropenia, or not. The control group received 4 cycles of doxorubicin or epirubicin plus cyclophosphamide followed by 2 cycles of paclitaxel. The treatment group received the same regimen as the control group as well as oral lithium carbonate throughout the chemotherapy cycles. RESULTS The results showed that the absolute neutrophil count (ANC) was increased in the lithium-treated group, while it was markedly reduced in both the non-neutropenic and neutropenic control groups (by 55.56% and 65.42% post-4 chemotherapy cycles, and by 19.57% and 39.90% post-6 cycles, respectively). The same pattern of alterations was observed for the total white blood cell count in both the control and treatment groups. In addition, the incidence and period prevalence were greatly reduced in the lithium-treated group compared to non-neutropenic and neutropenic control groups. CONCLUSION Lithium therapy ameliorated chemotherapy-induced leukopenia and neutropenia in breast cancer patients. This may provide a new strategy for cost-effective treatment of CIN, particularly in Egyptian cancer patients.
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Affiliation(s)
- Ahmed O ELKasar
- Department of Pharmacology and Toxicology, Faculty of Pharmacy (Boys), Al-Azhar University, Cairo, 11751, Egypt
| | - Fatma Z Hussien
- Department of Clinical Oncology and Nuclear Medicine, Oncology Center, Faculty of Medicine, Tanta University Hospital, Tanta, Egypt
| | - Hala E Abdel-Hamied
- Department of Pathology, Faculty of Medicine, Al-Azhar University, Cairo, Egypt
| | - Ibrahim G Saleh
- Department of Pharmacology and Toxicology, Faculty of Pharmacy (Boys), Al-Azhar University, Cairo, 11751, Egypt
| | - Elsayed M Mahgoup
- Department of Pharmacology and Toxicology, Faculty of Pharmacy (Boys), Al-Azhar University, Cairo, 11751, Egypt.
| | - Amr A El-Arabey
- Department of Pharmacology and Toxicology, Faculty of Pharmacy (Boys), Al-Azhar University, Cairo, 11751, Egypt
| | - Adel R Abd-Allah
- Department of Pharmacology and Toxicology, Faculty of Pharmacy (Boys), Al-Azhar University, Cairo, 11751, Egypt.
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Li SQ, Luo CL, Qiu H, Liu YX, Chen JM. Effect of Orem's self-care model on discharge readiness of patients undergoing enterostomy: A randomized controlled trial. Eur J Oncol Nurs 2024; 70:102549. [PMID: 38692158 DOI: 10.1016/j.ejon.2024.102549] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2023] [Revised: 02/18/2024] [Accepted: 03/03/2024] [Indexed: 05/03/2024]
Abstract
OBJECTIVE To evaluate the effectiveness of Orem's self-care model in preparing hospitals for the discharge of patients with colorectal cancer who undergo enterostomy. METHODS 92 patients with enterostomy were recruited between February 2022 and February 2023 from a general tertiary hospital. The participants were assigned to either the intervention group or the control group randomly. The intervention group received Orem's self-care program and a three-month follow-up, whereas the control group received only routine care and a three-month follow-up. Discharge readiness, self-care ability, and stoma-quality-of-life data were collected at hospital discharge (T1), 30 days (T2), and 90 days (T3) after discharge. RESULTS The intervention group had substantially higher discharge readiness (knowledge, p < 0.001; coping ability, p = 0.006; personal status, p = 0.001; expected support, p = 0.021; total score, p < 0.001), better self-care ability at T1 (self-care knowledge, p < 0.001; self-care skills, p = 0.010), better total quality of life (QoL) at T1, T2, and T3 (p < 0.001; p = 0.006; p = 0.014); better stoma management and daily routine at T1 (p = 0.004; p < 0.001); and better daily routine at T2 (p = 0.009) than the control group. CONCLUSIONS The designed discharge readiness program based on Orem's self-care could promote effective patient discharge readiness, self-care knowledge, self-care skills, and QoL. TRIAL REGISTRATION The trial number ChiCTR2200056302 registered on ClinicalTrials.gov.
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Affiliation(s)
- Si-Qing Li
- Department of Gastroenterology, The Fifth Affiliated Hospital of Sun Yat-sen University, Zhuhai, Guangdong, 51900, PR China.
| | - Cui-Lian Luo
- Department of Gastroenterology, The Fifth Affiliated Hospital of Sun Yat-sen University, Zhuhai, Guangdong, 51900, PR China.
| | - Hong Qiu
- Department of Gastroenterology, The Fifth Affiliated Hospital of Sun Yat-sen University, Zhuhai, Guangdong, 51900, PR China.
| | - Yu-Xia Liu
- Department of Gastroenterology, The Fifth Affiliated Hospital of Sun Yat-sen University, Zhuhai, Guangdong, 51900, PR China.
| | - Jian-Min Chen
- Department of Gastroenterology, The Fifth Affiliated Hospital of Sun Yat-sen University, Zhuhai, Guangdong, 51900, PR China.
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Prabha Shankar A, Br KK, Shankar B, Babu RH, Dholariya R, Priya, Muralidhar S, Subramanya GM. Oncological Surgical Wound Care: A Comparison of Theruptor NXT Non-adherent Dressing and the Current Standard of Care. Cureus 2024; 16:e56593. [PMID: 38650774 PMCID: PMC11034897 DOI: 10.7759/cureus.56593] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/19/2024] [Indexed: 04/25/2024] Open
Abstract
Background Oncological surgeries pose an elevated risk of surgical site infections (SSIs) due to their complexity and various associated treatments, impacting patient outcomes and healthcare costs. This has prompted a focus on advanced wound dressings that provide microbial protection, exudate absorption, and improved product performance, enhancing patient satisfaction. Our study aimed to compare the efficacy and safety of Theruptor NXT with the current standard of care (SOC) practice involving cotton/povidone/micropore dressings in the postoperative wound management of oncological surgeries. Methodology A total of 102 patients who underwent oncological surgeries in the Department of Surgical Oncology, Vydehi Institute of Medical Sciences and Research Centre, Bengaluru, India between May and September 2023 were randomized to Theruptor NXT and SOC dressing groups (51 patients each). The incidence of SSIs, wound pain score, cosmetic appearance of the wound, and adverse events were assessed in the two groups at various intervals, i.e., post-surgery day 2 ± 1, day of discharge, and post-surgery day 30 ± 7. Further, the subject satisfaction and product usage were evaluated on post-surgery day 2 ± 1. Results The baseline characteristics were found to be comparable in both groups, i.e., Theruptor NXT and SOC groups. Further, the SSI rates, scar outcomes, and physiological parameters were also similar between the Theruptor NXT and SOC groups, indicating a similar safety profile of both dressings (p > 0.05). However, the product usage assessment revealed statistically significant differences, favoring Theruptor NXT in terms of superior ease of application, stretchability, exudate management, breathability, and non-adherence properties (p < 0.05). Conclusions Our findings suggest that Theruptor NXT wound dressing is a promising, effective, and user-friendly alternative to SOC wound dressing in diverse clinical settings.
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Affiliation(s)
- Amritha Prabha Shankar
- Surgical Oncology, Vydehi Institute of Medical Sciences and Research Centre, Bengaluru, IND
| | - Kiran Kumar Br
- Radiation Oncology, Vydehi Institute of Medical Sciences and Research Centre, Bengaluru, IND
| | - Bharat Shankar
- Surgical Oncology, Vydehi Institute of Medical Sciences and Research Centre, Bengaluru, IND
| | - Ravoori H Babu
- Surgical Oncology, Vydehi Institute of Medical Sciences and Research Centre, Bengaluru, IND
| | - Rahul Dholariya
- Surgical Oncology, Vydehi Institute of Medical Sciences and Research Centre, Bengaluru, IND
| | - Priya
- Surgical Oncology, Vydehi Institute of Medical Sciences and Research Centre, Bengaluru, IND
| | - Shubhashree Muralidhar
- Surgical Oncology, Vydehi Institute of Medical Sciences and Research Centre, Bengaluru, IND
| | - Ganesh M Subramanya
- Surgical Oncology, Vydehi Institute of Medical Sciences and Research Centre, Bengaluru, IND
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D Cunha P, Gowda P. A Randomized Controlled Trial Comparing Two Wound Dressings Used in Obstetric and Gynecological Surgeries: Trushield NXT vs. Tegaderm. Cureus 2023; 15:e49207. [PMID: 38143644 PMCID: PMC10739573 DOI: 10.7759/cureus.49207] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/21/2023] [Indexed: 12/26/2023] Open
Abstract
Background Surgical site infection (SSI) is considered as a healthcare-associated infection. Wound dressings play an imperative role in altering the risk of SSI. In this study, we compared the efficacy and safety of Trushield NXT Non-adherent dressing (Healthium Medtech Limited, Bangalore, India) to the traditional Tegaderm HP+ Pad Film Dressing with Non-Adherent Pad (3M, Bangalore, India) in post-operative wound management of obstetrics and gynecological surgeries. Methodology This was a single-centre, prospective, two-arm, parallel-group, randomized, single-blind study conducted between January 2022 and May 2022. One hundred two subjects were enrolled and randomized to receive Trushield or Tegaderm dressing (n=51 each). The incidence of SSI, adverse events (AEs), comfort and performance of the dressings, subject satisfaction, and pain score were assessed in both groups. Results The baseline demographics and clinical and physical data were comparable among the groups. During the follow-up study, no SSI or AEs were reported. On the product usage assessment scale, surgeons rated both dressings "good" to "excellent" and favored Trushield for comfortable usage and removal, while Tegaderm was favored for ease of application and flexibility. On the wound pain assessment scale, the proportion of patients reporting "no pain" after surgery was 5.9% in the Trushield group and 4.2% in the Tegaderm group, which increased to 87.8% and 88.6%, respectively, at the end of the follow-up. The subject satisfaction for the comfort and wound healing properties was similar for both products. Conclusion Both dressings were equally safe, efficient, and beneficial in the post-operative wound management of obstetric and gynecological surgeries.
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Affiliation(s)
- Prema D Cunha
- Obstetrics and Gynaecology, Father Muller Medical College, Mangaluru, IND
| | - Prathima Gowda
- Obstetrics and Gynaecology, Father Muller Medical College, Mangaluru, IND
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Strouza AI, Lawrence AJ, Vissia EM, Kakouris A, Akan A, Nijenhuis ERS, Draijer N, Chalavi S, Reinders AATS. Identity state-dependent self-relevance and emotional intensity ratings of words in dissociative identity disorder: A controlled longitudinal study. Brain Behav 2023; 13:e3208. [PMID: 37721528 PMCID: PMC10570477 DOI: 10.1002/brb3.3208] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/13/2023] [Revised: 07/20/2023] [Accepted: 07/22/2023] [Indexed: 09/19/2023] Open
Abstract
INTRODUCTION Dissociative identity disorder (DID) is characterized by, among others, amnesic episodes and the recurrence of different dissociative identity states. While consistently observed in clinical settings, to our knowledge, no controlled research study has shown the degree to which different identity states report autobiographical knowledge over time. Hence, the current study investigates self-relevance and emotional intensity ratings of words longitudinally. METHODS Data of 46 participants were included: 13 individuals with DID, 11 DID-simulating actors, and a control group of 22 paired individuals. Individuals with DID and DID simulators participated once in the neutral identity state (NIS) and once in the trauma-related dissociative identity state (TIS). The control group paired 11 healthy controls with 11 participants with posttraumatic stress disorder (PTSD) as a NIS-TIS pair. Self-relevance ratings of different word types were collected in a baseline and a follow-up session, on average 6 weeks apart. A mixed ANOVA design was used to assess the effects of group, session, word type, and dissociative identity state. RESULTS All participants in TIS and individuals with DID in NIS rated self-relevant trauma-related words more negatively. In the NIS, the control group rated self-relevant trauma-related words as less negative, whereas the ratings of simulating actors were intermediate. There was no group-dependent longitudinal effect for intensity ratings. CONCLUSIONS This study was the first to confirm clinical observations that self-relevant and emotional processing are different between individuals with DID and controls, but consistent over time. Actors were unable to perfectly simulate DID. The finding that ratings of self-relevant trauma-related words differ between subgroups as included in the study is in line with clinical observations.
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Affiliation(s)
- Aikaterini I. Strouza
- Department of Psychological Medicine, Institute of Psychiatry, Psychology & NeuroscienceKing's College LondonLondonUK
- Department of Psychiatry, Amsterdam UMC, Location VUmcVU University AmsterdamAmsterdamThe Netherlands
| | - Andrew J. Lawrence
- Department of Psychological Medicine, Institute of Psychiatry, Psychology & NeuroscienceKing's College LondonLondonUK
| | | | - Andreana Kakouris
- Department of Psychosis Studies, Institute of PsychiatryKing's College LondonLondonUK
| | - Ayse Akan
- Department of Psychosis Studies, Institute of PsychiatryKing's College LondonLondonUK
- North East London NHS Foundation TrustLondonUK
| | - Ellert R. S. Nijenhuis
- Clienia Littenheid AGPrivate Clinic for Psychiatry and PsychotherapyLittenheidSwitzerland
| | - Nel Draijer
- Department of PsychiatryVU University Medical CenterAmsterdamThe Netherlands
| | - Sima Chalavi
- Movement Control and Neuroplasticity Research Group, Department of Movement SciencesKU LeuvenLeuvenBelgium
| | - Antje A. T. S. Reinders
- Department of Psychological Medicine, Institute of Psychiatry, Psychology & NeuroscienceKing's College LondonLondonUK
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Tinoco HA, Perdomo-Hurtado L, Henao-Cruz JA, Escobar-Serna JF, Jaramillo-Robledo O, Aguirre-Ospina OD, Hurtado-Hernández M, Lopez-Guzman J. Evaluation and Performance of a Positive Airway Pressure Device (CPAP-AirFlife™): A Randomized Crossover Non-Inferiority Clinical Study in Normal Subjects. MEDICINA (KAUNAS, LITHUANIA) 2023; 59:1372. [PMID: 37629662 PMCID: PMC10456951 DOI: 10.3390/medicina59081372] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/12/2023] [Revised: 07/21/2023] [Accepted: 07/21/2023] [Indexed: 08/27/2023]
Abstract
Background and Objectives: During the COVID-19, the demand for non-invasive ventilatory support equipment significantly increased. In response, a novel non-invasive ventilatory support model called CPAP-AirFlife™ was developed utilizing existing technologies. This model offers technological advantages, including an aerosol-controlled helmet suitable for high-risk environments such as ambulances. Additionally, it is cost-effective and does not require medical air, making it accessible for implementation in low-level hospitals, particularly in rural areas. This study aimed to assess the efficacy of CPAP-AirFlife™ by conducting a non-inferiority comparison with conventional ventilation equipment used in the Intensive Care Unit. Materials and Methods: A clinical study was conducted on normal subjects in a randomized and sequential manner. Parameters such as hemoglobin oxygen saturation by pulse oximetry, exhaled PCO2 levels, vital signs, and individual tolerance were compared between the CPAP-AirFlife™ and conventional equipment. The study population was described in terms of demographic characteristics and included in the analysis. Results: It was shown that the CPAP-AirFlife™ was not inferior to conventional equipment in terms of efficacy or tolerability. Hemoglobin oxygen saturation levels, exhaled PCO2 levels, vital signs, and individual tolerance did not significantly differ between the two models. Conclusions: The findings suggest that CPAP-AirFlife™ is a practical and cost-effective alternative for non-invasive ventilatory support. Its technological advantages, including the aerosol-controlled helmet, make it suitable for high-risk environments. The device's accessibility and affordability make it a promising solution for implementation in low-level hospitals, particularly in rural areas. This study supports using CPAP-AirFlife™ as a practical option for non-invasive ventilatory support, providing a valuable contribution to respiratory care during the COVID-19 pandemic and beyond.
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Affiliation(s)
- Héctor A. Tinoco
- Experimental and Computational Mechanics Laboratory, Universidad Autónoma de Manizales, Antigua Estación del Ferrocarril, Edificio Fundadores, Manizales-Caldas 170001, Colombia
| | - Luis Perdomo-Hurtado
- Experimental and Computational Mechanics Laboratory, Universidad Autónoma de Manizales, Antigua Estación del Ferrocarril, Edificio Fundadores, Manizales-Caldas 170001, Colombia
| | | | | | | | | | - Mateo Hurtado-Hernández
- Experimental and Computational Mechanics Laboratory, Universidad Autónoma de Manizales, Antigua Estación del Ferrocarril, Edificio Fundadores, Manizales-Caldas 170001, Colombia
| | - Juliana Lopez-Guzman
- Experimental and Computational Mechanics Laboratory, Universidad Autónoma de Manizales, Antigua Estación del Ferrocarril, Edificio Fundadores, Manizales-Caldas 170001, Colombia
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Flight L, Julious SA. Practical guide to sample size calculations: Installation of the app SampSize. Pharm Stat 2022; 21:1109-1110. [PMID: 35535737 DOI: 10.1002/pst.2215] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2022] [Revised: 03/31/2022] [Accepted: 04/10/2022] [Indexed: 11/12/2022]
Abstract
In 2016 we published three articles in Pharmaceutical Statistics that gave a practical guide to sample size calculations. In each of the articles there were instructions on how to obtain the App SampSize. This short communication updates these instructions and highlights the updates and added functionality to the App.
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Affiliation(s)
- Laura Flight
- School of Health and Related Research (ScHARR), The University of Sheffield, Sheffield, UK
| | - Steven A Julious
- School of Health and Related Research (ScHARR), The University of Sheffield, Sheffield, UK
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Flight L, Julious S, Brennan A, Todd S. Expected Value of Sample Information to Guide the Design of Group Sequential Clinical Trials. Med Decis Making 2021; 42:461-473. [PMID: 34859693 PMCID: PMC9005835 DOI: 10.1177/0272989x211045036] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Introduction Adaptive designs allow changes to an ongoing trial based on prespecified early examinations of accrued data. Opportunities are potentially being missed to incorporate health economic considerations into the design of these studies. Methods We describe how to estimate the expected value of sample information for group sequential design adaptive trials. We operationalize this approach in a hypothetical case study using data from a pilot trial. We report the expected value of sample information and expected net benefit of sampling results for 5 design options for the future full-scale trial including the fixed-sample-size design and the group sequential design using either the Pocock stopping rule or the O’Brien-Fleming stopping rule with 2 or 5 analyses. We considered 2 scenarios relating to 1) using the cost-effectiveness model with a traditional approach to the health economic analysis and 2) adjusting the cost-effectiveness analysis to incorporate the bias-adjusted maximum likelihood estimates of trial outcomes to account for the bias that can be generated in adaptive trials. Results The case study demonstrated that the methods developed could be successfully applied in practice. The results showed that the O’Brien-Fleming stopping rule with 2 analyses was the most efficient design with the highest expected net benefit of sampling in the case study. Conclusions Cost-effectiveness considerations are unavoidable in budget-constrained, publicly funded health care systems, and adaptive designs can provide an alternative to costly fixed-sample-size designs. We recommend that when planning a clinical trial, expected value of sample information methods be used to compare possible adaptive and nonadaptive trial designs, with appropriate adjustment, to help justify the choice of design characteristics and ensure the cost-effective use of research funding. Highlights
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Affiliation(s)
- Laura Flight
- Laura Flight, School of Health and Related Research (ScHARR), University of Sheffield, Regent Court, 30 Regent Street, Sheffield, S1 4DA, UK; ()
| | - Steven Julious
- School of Health and Related Research, University of Sheffield, Sheffield, UK
| | - Alan Brennan
- School of Health and Related Research, University of Sheffield, Sheffield, UK
| | - Susan Todd
- Department of Mathematics and Statistics, University of Reading, Reading, UK
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Louvardi M, Chrousos GP, Darviri C. The Effect of Stress Management Techniques on Persons with Addictive Behaviors: a Systematic Review. Mater Sociomed 2021; 33:213-218. [PMID: 34759780 PMCID: PMC8563055 DOI: 10.5455/msm.2021.33.213-218] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2021] [Accepted: 09/26/2021] [Indexed: 11/03/2022] Open
Abstract
Background According to the current state of knowledge, addictions are often developed as a maladaptive coping response to elevated stress levels. Stress management has a beneficial effect on various mental health problems. Yet, there is no strong evidence concerning the effect of stress management on stress levels of individuals with addictive behaviors, although such an effect might benefit their addictive symptoms. Objective To investigate the effect of stress management on stress levels of persons with addictive behaviors. Methods A systematic review of the literature was carried out on Biomed Central, PubMed, Scopus and Web of Science searching for relevant trials investigating the effect of stress management techniques, specifically of Progressive Muscle Relaxation (PMR), Autogenic Training (AT) and Guided Imagery (GI), on stress levels of individuals with addictive behaviors. In order to be included, the studies had to be randomized trials using an intervention and a non-intervention or a placebo control group, to apply PMR, GI or AT, to include a sample with addictive behaviors, to be published in English, to involve a baseline and at least one subsequent measurement, to be published in peer-review journals and to measure stress through instruments or biochemical assessments. The trials' quality was assessed by the use of the Jadad Scale. Results A total of four studies met the inclusion criteria and were further analyzed. The findings indicated that PMR might lead to a reduction of stress levels, while no such evidence is found concerning GI and AT. The quality of all trials was low. Conclusion Progressive Muscle Relaxation and GI might have a divergent effect on persons with addictive behaviors. Yet, the low number of the studies and their poor quality debars drawing reliable conclusions for potential beneficial effects.
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Affiliation(s)
- Maya Louvardi
- Postgraduate Course "Science of Stress and Health Promotion", Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - George P Chrousos
- Postgraduate Course "Science of Stress and Health Promotion", Medical School, National and Kapodistrian University of Athens, Athens, Greece.,Center for Adolescent Medicine and UNESCO Chair on Adolescent Health Care, First Department of Pediatrics, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Christina Darviri
- Postgraduate Course "Science of Stress and Health Promotion", Medical School, National and Kapodistrian University of Athens, Athens, Greece
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Klasen M, Sopka S. Demonstrating equivalence and non-inferiority of medical education concepts. MEDICAL EDUCATION 2021; 55:455-461. [PMID: 33206411 DOI: 10.1111/medu.14420] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/10/2020] [Revised: 10/23/2020] [Accepted: 11/09/2020] [Indexed: 06/11/2023]
Abstract
CONTEXT In medical education, there are often several didactic methods for teaching and learning a specific medical skill. For educators, there are often pragmatic reasons to decide for one or another of them, such as costs, infrastructural requirements, time expenditure or qualification of the teacher. However, a central aspect to consider is the learning outcome: Does a new method achieve a similar learning success as an established standard method? To answer this question, we need an appropriate method to assess comparability of learning outcomes. METHODS In this paper, we present two essential statistical concepts that can address the issue of comparability of learning outcomes: Equivalence and non-inferiority testing. We explain the ideas behind these concepts and illustrate them with an example data set. To clarify several concepts, we use theoretical examples from one selected field: the teaching and assessment of Basic Life Support (BLS). CONCLUSIONS Equivalence and non-inferiority tests can be powerful tools for comparing teaching and assessment methods. However, their correct application requires adequate knowledge about their strengths, pitfalls and application fields. The aim of this paper is to deliver this knowledge and to provide clinician researchers with a practical guidance to a successful application of these methods.
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Affiliation(s)
- Martin Klasen
- Interdisciplinary Training Centre for Medical Education and Patient Safety-AIXTRA, Medical Faculty, RWTH Aachen University, Aachen, Germany
| | - Saša Sopka
- Interdisciplinary Training Centre for Medical Education and Patient Safety-AIXTRA, Medical Faculty, RWTH Aachen University, Aachen, Germany
- Department of Anaesthesiology, University Hospital Aachen, Medical Faculty, RWTH Aachen University, Aachen, Germany
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Hermida RC, Smolensky MH, Balan H, Castriotta RJ, Crespo JJ, Dagan Y, El-Toukhy S, Fernández JR, FitzGerald GA, Fujimura A, Geng YJ, Hermida-Ayala RG, Machado AP, Menna-Barreto L, Mojón A, Otero A, Rudic RD, Schernhammer E, Skarke C, Steen TY, Young ME, Zhao X. Guidelines for the design and conduct of human clinical trials on ingestion-time differences - chronopharmacology and chronotherapy - of hypertension medications. Chronobiol Int 2020; 38:1-26. [PMID: 33342316 DOI: 10.1080/07420528.2020.1850468] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
Current hypertension guidelines fail to provide a recommendation on when-to-treat, thus disregarding relevant circadian rhythms that regulate blood pressure (BP) level and 24 h patterning and medication pharmacokinetics and pharmacodynamics. The ideal purpose of ingestion-time (chronopharmacology, i.e. biological rhythm-dependent effects on the kinetics and dynamics of medications, and chronotherapy, i.e. the timing of pharmaceutical and other treatments to optimize efficacy and safety) trials should be to explore the potential impact of endogenous circadian rhythms on the effects of medications. Such investigations and outcome trials mandate adherence to the basic standards of human chronobiology research. In-depth review of the more than 150 human hypertension pharmacology and therapeutic trials published since 1974 that address the differential impact of upon-waking/morning versus at-bedtime/evening schedule of treatment reveals diverse protocols of sometimes suboptimal or defective design and conduct. Many have been "time-of-day," i.e. morning versus evening, rather than circadian-time-based, and some relied on wake-time office BP rather than around-the-clock ambulatory BP measurements (ABPM). Additionally, most past studies have been of too small sample size and thus statistically underpowered. As of yet, there has been no consensual agreement on the proper design, methods and conduct of such trials. This Position Statement recommends ingestion-time hypertension trials to follow minimum guidelines: (i) Recruitment of participants should be restricted to hypertensive individuals diagnosed according to ABPM diagnostic thresholds and of a comparable activity/sleep routine. (ii) Tested treatment-times should be selected according to internal biological time, expressed by the awakening and bed times of the sleep/wake cycle. (iii) ABPM should be the primary or sole method of BP assessment. (iv) The minimum-required features for analysis of the ABPM-determined 24 h BP pattern ought to be the asleep (not "nighttime") BP mean and sleep-time relative BP decline, calculated in reference to the activity/rest cycle per individual. (v) ABPM-obtained BP means should be derived by the so-called adjusted calculation procedure, not by inaccurate arithmetic averages. (vi) ABPM should be performed with validated and calibrated devices at least hourly throughout two or more consecutive 24 h periods (48 h in total) to achieve the highest reproducibility of mean wake-time, sleep-time and 48 h BP values plus the reliable classification of dipping status. (vii) Calculation of minimum required sample size in adherence with proper statistical methods must be provided. (viii) Hypertension chronopharmacology and chronotherapy trials should preferably be randomized double-blind, randomized open-label with blinded-endpoint, or crossover in design, the latter with sufficient washout period between tested treatment-time regimens.
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Affiliation(s)
- Ramón C Hermida
- Bioengineering & Chronobiology Laboratories; Atlantic Research Center for Information and Communication Technologies (atlanTTic), University of Vigo , Vigo, Spain.,Department of Biomedical Engineering, Cockrell School of Engineering, the University of Texas at Austin , Austin, Texas, USA
| | - Michael H Smolensky
- Department of Biomedical Engineering, Cockrell School of Engineering, the University of Texas at Austin , Austin, Texas, USA.,Division of Cardiology, McGovern School of Medicine, the University of Texas at Houston , Houston, Texas, USA
| | - Horia Balan
- Department of Internal Medicine, "Carol Davila" University of Medicine and Pharmacy , Bucharest, Romania
| | - Richard J Castriotta
- Department of Medicine; Division of Pulmonary, Critical Care and Sleep Medicine; Keck School of Medicine, University of Southern California , Los Angeles, California, USA
| | - Juan J Crespo
- Bioengineering & Chronobiology Laboratories; Atlantic Research Center for Information and Communication Technologies (atlanTTic), University of Vigo , Vigo, Spain.,Centro de Salud de Bembrive, Estructura de Xestión Integrada de Vigo, Servicio Galego de Saúde (SERGAS) , Vigo, Spain
| | - Yaron Dagan
- Applied Chronobiology Research Center, Tel-Hai Academic College, Israel; Human Biology Department, Haifa University , Israel.,Sleep and Fatigue Institute, Assuta Medical Center , Israel
| | - Sherine El-Toukhy
- Intramural Research Program, National Institute on Minority Health and Health Disparities, National Institutes of Health , Bethesda, Maryland, USA
| | - José R Fernández
- Bioengineering & Chronobiology Laboratories; Atlantic Research Center for Information and Communication Technologies (atlanTTic), University of Vigo , Vigo, Spain
| | - Garret A FitzGerald
- Institute for Translational Medicine and Therapeutics, Smilow Center for Translational Research, Perelman School of Medicine, University of Pennsylvania , Philadelphia, Pennsylvania, USA
| | - Akio Fujimura
- Department of Clinical Pharmacology, Jichi Medical University , Tochigi, Japan.,Department of Internal Medicine, Shin-Kaminokawa Hospital , Tochigi, Japan
| | - Yong-Jian Geng
- Department of Internal Medicine, McGovern School of Medicine, University of Texas Health Science Center at Houston , Houston, Texas, USA
| | - Ramón G Hermida-Ayala
- Chief Pharmacology Officer, Circadian Ambulatory Technology & Diagnostics (CAT&D) , Santiago de Compostela, Spain
| | | | - Luiz Menna-Barreto
- Escola de Artes, Ciências e Humanidades, Grupo Multidisciplinar de Desenvolvimento e Ritmos Biológicos (GMDRB), Universidade de São Paulo , São Paulo, Brazil
| | - Artemio Mojón
- Bioengineering & Chronobiology Laboratories; Atlantic Research Center for Information and Communication Technologies (atlanTTic), University of Vigo , Vigo, Spain
| | - Alfonso Otero
- Servicio de Nefrología, Complejo Hospitalario Universitario de Ourense, Estructura de Xestión Integrada de Ourense, Verín e O Barco de Valdeorras, Servicio Galego de Saúde (SERGAS) , Ourense, Spain
| | - R Daniel Rudic
- Department of Pharmacology & Toxicology, Augusta University , Augusta, Georgia, USA
| | - Eva Schernhammer
- Department of Epidemiology, Harvard T.H Chan School of Public Health , Boston, Massachusetts, USA.,Department of Epidemiology, Center for Public Health, Medical University of Vienna , Vienna, Austria.,Channing Division of Network Medicine, Harvard Medical School , Boston, Massachusetts, USA
| | - Carsten Skarke
- Institute for Translational Medicine and Therapeutics, Smilow Center for Translational Research, Perelman School of Medicine, University of Pennsylvania , Philadelphia, Pennsylvania, USA
| | - Tomoko Y Steen
- Department of Microbiology and Immunology, School of Medicine, Georgetown University , Washington, DC, USA
| | - Martin E Young
- Division of Cardiovascular Diseases, Department of Medicine, University of Alabama at Birmingham , Birmingham, Alabama, USA
| | - Xiaoyun Zhao
- Respiratory and Critical Care Medicine Department, Sleep Medicine Center, Tianjin Chest Hospital , Tianjin, China
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Hermida RC, Mojón A, Fernández JR, Otero A, Crespo JJ, Domínguez-Sardiña M, Ríos MT, Smolensky MH. Ambulatory blood pressure monitoring-based definition of true arterial hypertension. Minerva Med 2020; 111:573-588. [DOI: 10.23736/s0026-4806.20.06834-2] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
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13
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Gebri E, Kovács Z, Mészáros B, Tóth F, Simon Á, Jankovics H, Vonderviszt F, Kiss A, Guttman A, Hortobágyi T. N-Glycosylation Alteration of Serum and Salivary Immunoglobulin a Is a Possible Biomarker in Oral Mucositis. J Clin Med 2020; 9:jcm9061747. [PMID: 32516910 PMCID: PMC7355945 DOI: 10.3390/jcm9061747] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2020] [Revised: 05/30/2020] [Accepted: 06/03/2020] [Indexed: 02/07/2023] Open
Abstract
Background: Oral and enteral mucositis due to high-dose cytostatic treatment administered during autologous and allogeneic stem-cell transplantation increases mortality. Salivary secretory immunoglobulin A (sIgA) is a basic pillar of local immunity in the first line of defense. Altered salivary sialoglycoprotein carbohydrates are important in the pathologies in the oral cavity including inflammation, infection and neoplasia. Therefore, we assessed whether changes in the salivary and serum IgA glycosylation correlated with development and severity of oral mucositis. Methods: Using capillary electrophoresis, comparative analysis of serum and salivary IgA total N-glycans was conducted in 8 patients with autologous peripheral stem-cell transplantation (APSCT) at four different stages of transplantation (day −3/−7, 0, +7, +14) and in 10 healthy controls. Results: Fourteen out of the 31 structures identified in serum and 6 out of 38 in saliva showed significant changes upon transplantation compared with the control group. Only serum core fucosylated, sialylated bisecting biantennary glycan (FA2BG2S2) showed significant differences between any two stages of transplantation (day −3/−7 and day +14; p = 0.0279). Conclusion: Our results suggest that changes in the serum IgA total N-glycan profile could serve as a disease-specific biomarker in patients undergoing APSCT, while analysis of salivary IgA N-glycan reflects the effect of APSCT on local immunity.
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Affiliation(s)
- Enikő Gebri
- Department of Dentoalveolar Surgery and Dental Outpatient Care, Faculty of Dentistry, University of Debrecen, Nagyerdei krt. 98., H-4032 Debrecen, Hungary;
| | - Zsuzsanna Kovács
- Horváth Csaba Laboratory of Bioseparation Sciences, Research Center for Molecular Medicine, Doctoral School of Molecular Medicine, Faculty of Medicine, University of Debrecen, Nagyerdei krt. 98., H-4032 Debrecen, Hungary; (Z.K.); (B.M.); (Á.S.); (A.G.)
- Research Institute of Biomolecular and Chemical Engineering, University of Pannonia, Egyetem u 10., H-8200 Veszprém, Hungary; (H.J.); (F.V.)
| | - Brigitta Mészáros
- Horváth Csaba Laboratory of Bioseparation Sciences, Research Center for Molecular Medicine, Doctoral School of Molecular Medicine, Faculty of Medicine, University of Debrecen, Nagyerdei krt. 98., H-4032 Debrecen, Hungary; (Z.K.); (B.M.); (Á.S.); (A.G.)
- Research Institute of Biomolecular and Chemical Engineering, University of Pannonia, Egyetem u 10., H-8200 Veszprém, Hungary; (H.J.); (F.V.)
| | - Ferenc Tóth
- Department of Biomaterials and Prosthetic Dentistry, Faculty of Dentistry, University of Debrecen, Nagyerdei krt. 98., H-4032 Debrecen, Hungary;
| | - Ádám Simon
- Horváth Csaba Laboratory of Bioseparation Sciences, Research Center for Molecular Medicine, Doctoral School of Molecular Medicine, Faculty of Medicine, University of Debrecen, Nagyerdei krt. 98., H-4032 Debrecen, Hungary; (Z.K.); (B.M.); (Á.S.); (A.G.)
| | - Hajnalka Jankovics
- Research Institute of Biomolecular and Chemical Engineering, University of Pannonia, Egyetem u 10., H-8200 Veszprém, Hungary; (H.J.); (F.V.)
| | - Ferenc Vonderviszt
- Research Institute of Biomolecular and Chemical Engineering, University of Pannonia, Egyetem u 10., H-8200 Veszprém, Hungary; (H.J.); (F.V.)
| | - Attila Kiss
- Department of Hematopoietic Transplantation Centre, Faculty of Medicine, University of Debrecen, Nagyerdei krt. 98., H-4032 Debrecen, Hungary;
| | - András Guttman
- Horváth Csaba Laboratory of Bioseparation Sciences, Research Center for Molecular Medicine, Doctoral School of Molecular Medicine, Faculty of Medicine, University of Debrecen, Nagyerdei krt. 98., H-4032 Debrecen, Hungary; (Z.K.); (B.M.); (Á.S.); (A.G.)
- Research Institute of Biomolecular and Chemical Engineering, University of Pannonia, Egyetem u 10., H-8200 Veszprém, Hungary; (H.J.); (F.V.)
| | - Tibor Hortobágyi
- Institute of Pathology, Faculty of Medicine, University of Szeged, Állomás utca 1., H-6725 Szeged, Hungary
- MTA-DE Cerebrovascular and Neurodegenerative Research Group, Department of Neurology, Faculty of Medicine, University of Debrecen, Nagyerdei krt. 98., H-4032 Debrecen, Hungary
- Institute of Psychiatry Psychology and Neuroscience, King’s College London, De Crespigny Park, London SE5 8AF, UK
- Correspondence: ; Tel.: +36-30-687-5983
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The authors reply. Crit Care Med 2020; 48:e263-e265. [DOI: 10.1097/ccm.0000000000004194] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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15
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Null hypothesis significance testing and effect sizes: can we 'effect' everything … or … anything? Curr Opin Pharmacol 2020; 51:68-77. [PMID: 31948894 DOI: 10.1016/j.coph.2019.12.001] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2019] [Accepted: 12/06/2019] [Indexed: 11/23/2022]
Abstract
The Null Hypothesis Significance Testing (NHST) paradigm is increasingly criticized. Estimation approaches such as point estimates and confidence intervals, while having limitations, provide better descriptions of results than P-values and statements about significance levels. Their use is supported by many statisticians. The effect size approach is an important part of power and sample size calculations at the experimental design stage and in meta-analysis and in the interpretation of the biological importance of study results. Care is needed, however, to ensure that such effect sizes are relevant for the endpoint. Effect sizes should not be used to interpret results without accompanying limits, such as confidence intervals. New methods, especially Bayesian approaches, are being developed; however, no single method provides a simple answer. Rather there is a need to improve researchers understanding of the complex issues underlying experimental design, statistical analysis and interpretation of results.
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16
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Beukes EW, Andersson G, Allen PM, Manchaiah V, Baguley DM. Effectiveness of Guided Internet-Based Cognitive Behavioral Therapy vs Face-to-Face Clinical Care for Treatment of Tinnitus: A Randomized Clinical Trial. JAMA Otolaryngol Head Neck Surg 2019; 144:1126-1133. [PMID: 30286238 DOI: 10.1001/jamaoto.2018.2238] [Citation(s) in RCA: 41] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
Importance Accessible clinical care is not always available to individuals with distressing tinnitus. Internet-based cognitive behavioral therapy has the potential to increase access to evidence-based services that manage tinnitus. Research comparing the effectiveness of this internet-based intervention with face-to-face care is required. Objective To evaluate whether an internet-based cognitive behavioral therapy intervention is at least as effective as established individualized face-to-face clinical care in reducing tinnitus distress and tinnitus-related difficulties. Design, Setting, and Participants A randomized, multicenter, 2-arm parallel group, noninferiority trial with 2-month follow-up was performed between October 4, 2016, and July 14, 2017. Invited to participate were 374 adults based in the United Kingdom who had been referred to their local tinnitus clinics because of bothersome tinnitus. The experimental group received the internet-based intervention online, and the active control group underwent the usual face-to-face tinnitus care at 1 of 3 UK-based National Health Service hospitals. Participants were randomly assigned (1:1) to either intervention using variable permuted block sizes of 4 and 6. Of 92 participants who were randomized (46 each in the experimental and control groups), 88 participants completed the assessment immediately after intervention and 74 participants completed the follow-up assessment. Interventions Participants were randomized to receive either 8 weeks of guided internet-based cognitive behavioral therapy or a mean of 2 to 3 individualized face-to-face appointments in a tinnitus clinic. Main Outcomes and Measures The primary outcome was a change in tinnitus distress (assessed by the Tinnitus Functional Index). Secondary assessment measures were included for insomnia, anxiety, depression, hearing disability, hyperacusis, cognitive failures, and satisfaction with life. Results Of 92 patients overall, 55 (60%) were men with a mean (SD) age of 52.96 (12.07) years and mean (SD) tinnitus duration of 6.54 (9.25) years. The between-group difference in the Tinnitus Functional Index scores after intervention were 5.18 (95% CI, -4.17 to 14.53) at the initial assessment and 5.52 (95% CI, -4.60 to 15.61) at follow-up; both differences were within the noninferiority margin of 13 points for the lower 95% CI. For the secondary outcomes, only outcomes for insomnia fell outside the noninferiority margin, both after intervention and at follow-up, favoring internet-based cognitive behavioral therapy. Conclusions and Relevance This is the first trial, to our knowledge, to compare an internet-based intervention with standard individualized face-to-face care for tinnitus. It revealed that both interventions are equally effective for reducing tinnitus distress and most tinnitus-related difficulties. Trial Registration ClinicalTrials.gov identifier: NCT02665975.
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Affiliation(s)
- Eldré W Beukes
- Department of Vision and Hearing Sciences, Anglia Ruskin University, Cambridge, United Kingdom.,Department of Speech and Hearing Sciences, Lamar University, Beaumont, Texas
| | - Gerhard Andersson
- Department of Behavioural Sciences and Learning, Linköping University, Linköping, Sweden.,Department of Clinical Neuroscience, Division of Psychiatry, Karolinska Institute, Stockholm, Sweden
| | - Peter M Allen
- Department of Vision and Hearing Sciences, Anglia Ruskin University, Cambridge, United Kingdom.,Vision and Eye Research Unit, Anglia Ruskin University, Cambridge, United Kingdom
| | - Vinaya Manchaiah
- Department of Speech and Hearing Sciences, Lamar University, Beaumont, Texas.,Audiology India, Mysore, Karnataka, India.,Department of Speech and Hearing, School of Allied Health Sciences, Manipal University, Karnataka, India
| | - David M Baguley
- National Institute for Health Research, Nottingham Biomedical Research Centre, Ropewalk House, Nottingham, United Kingdom.,Hearing Sciences, Division of Clinical Neuroscience, School of Medicine, University of Nottingham, Nottingham, United Kingdom.,Department of Audiology, Nottingham University Hospitals, Nottingham, United Kingdom
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17
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Cook JA, Julious SA, Sones W, Hampson LV, Hewitt C, Berlin JA, Ashby D, Emsley R, Fergusson DA, Walters SJ, Wilson EC, MacLennan G, Stallard N, Rothwell JC, Bland M, Brown L, Ramsay CR, Cook A, Armstrong D, Altman D, Vale LD. Practical help for specifying the target difference in sample size calculations for RCTs: the DELTA 2 five-stage study, including a workshop. Health Technol Assess 2019; 23:1-88. [PMID: 31661431 PMCID: PMC6843113 DOI: 10.3310/hta23600] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND The randomised controlled trial is widely considered to be the gold standard study for comparing the effectiveness of health interventions. Central to its design is a calculation of the number of participants needed (the sample size) for the trial. The sample size is typically calculated by specifying the magnitude of the difference in the primary outcome between the intervention effects for the population of interest. This difference is called the 'target difference' and should be appropriate for the principal estimand of interest and determined by the primary aim of the study. The target difference between treatments should be considered realistic and/or important by one or more key stakeholder groups. OBJECTIVE The objective of the report is to provide practical help on the choice of target difference used in the sample size calculation for a randomised controlled trial for researchers and funder representatives. METHODS The Difference ELicitation in TriAls2 (DELTA2) recommendations and advice were developed through a five-stage process, which included two literature reviews of existing funder guidance and recent methodological literature; a Delphi process to engage with a wider group of stakeholders; a 2-day workshop; and finalising the core document. RESULTS Advice is provided for definitive trials (Phase III/IV studies). Methods for choosing the target difference are reviewed. To aid those new to the topic, and to encourage better practice, 10 recommendations are made regarding choosing the target difference and undertaking a sample size calculation. Recommended reporting items for trial proposal, protocols and results papers under the conventional approach are also provided. Case studies reflecting different trial designs and covering different conditions are provided. Alternative trial designs and methods for choosing the sample size are also briefly considered. CONCLUSIONS Choosing an appropriate sample size is crucial if a study is to inform clinical practice. The number of patients recruited into the trial needs to be sufficient to answer the objectives; however, the number should not be higher than necessary to avoid unnecessary burden on patients and wasting precious resources. The choice of the target difference is a key part of this process under the conventional approach to sample size calculations. This document provides advice and recommendations to improve practice and reporting regarding this aspect of trial design. Future work could extend the work to address other less common approaches to the sample size calculations, particularly in terms of appropriate reporting items. FUNDING Funded by the Medical Research Council (MRC) UK and the National Institute for Health Research as part of the MRC-National Institute for Health Research Methodology Research programme.
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Affiliation(s)
- Jonathan A Cook
- Centre for Statistics in Medicine, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK
| | - Steven A Julious
- Medical Statistics Group, School of Health and Related Research, University of Sheffield, Sheffield, UK
| | - William Sones
- Centre for Statistics in Medicine, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK
| | - Lisa V Hampson
- Statistical Methodology and Consulting, Novartis Pharma AG, Basel, Switzerland
| | - Catherine Hewitt
- York Trials Unit, Department of Health Sciences, University of York, York, UK
| | | | - Deborah Ashby
- Imperial Clinical Trials Unit, Imperial College London, London, UK
| | - Richard Emsley
- Department of Biostatistics and Health Informatics, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Dean A Fergusson
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, ON, Canada
| | - Stephen J Walters
- Medical Statistics Group, School of Health and Related Research, University of Sheffield, Sheffield, UK
| | - Edward Cf Wilson
- Cambridge Centre for Health Services Research, Cambridge Clinical Trials Unit University of Cambridge, Cambridge, UK
- Health Economics Group, Norwich Medical School, University of East Anglia, Norwich, UK
| | - Graeme MacLennan
- Centre for Healthcare Randomised Trials, University of Aberdeen, Aberdeen, UK
| | - Nigel Stallard
- Warwick Medical School, Statistics and Epidemiology, University of Warwick, Coventry, UK
| | - Joanne C Rothwell
- Medical Statistics Group, School of Health and Related Research, University of Sheffield, Sheffield, UK
| | - Martin Bland
- Department of Health Sciences, University of York, York, UK
| | - Louise Brown
- MRC Clinical Trials Unit, Institute of Clinical Trials and Methodology, University College London, London, UK
| | - Craig R Ramsay
- Health Services Research Unit, University of Aberdeen, Aberdeen, UK
| | - Andrew Cook
- Wessex Institute, University of Southampton, Southampton, UK
| | - David Armstrong
- School of Population Health and Environmental Sciences, King's College London, London, UK
| | - Douglas Altman
- Centre for Statistics in Medicine, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK
| | - Luke D Vale
- Health Economics Group, Institute of Health & Society, Newcastle University, Newcastle upon Tyne, UK
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18
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Is trazodone more effective than clomipramine in major depressed outpatients? A single-blind study with intravenous and oral administration. CNS Spectr 2019; 24:258-264. [PMID: 29081313 DOI: 10.1017/s1092852917000773] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Some antidepressants, such as trazodone or clomipramine, can be administered intravenously in patients with major depressive disorder (MDD), with potential benefits compared to the standard oral treatment, but available data about their efficacy are limited. The present study was aimed to compare the effectiveness of trazodone and clomipramine (intravenous [i.v.] followed by oral administration). METHODS Some 42 patients with a diagnosis of MDD according to the DSM-5 were selected and treated with i.v. trazodone or clomipramine according to clinical judgment. The Hamilton Depression Rating Scale, the Hamilton Anxiety Rating Scale, and the Montgomery-Åsberg Depression Rating Scale were administered at baseline, after 2 weeks, and after 6 weeks, as well as after 1 week of intravenous antidepressant administration. Raters were blinded to type of treatment. RESULTS No significant differences were found between treatment groups in terms of effectiveness at endpoint. Borderline statistical significance was found in terms of number of responders in favor of trazodone. In addition, patients treated with trazodone reported fewer total side effects than those treated with clomipramine. CONCLUSION Both i.v. trazodone and clomipramine are rapid and effective options for improving depressive symptoms, although trazodone appears to be tolerated better. Further studies with larger samples and double-blind conditions are warranted to confirm our results.
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Farrokhpour M, Kiani A, Mortaz E, Taghavi K, Farahbod AM, Fakharian A, Kazempour-Dizaji M, Abedini A. Procalcitonin and Proinflammatory Cytokines in Early Diagnosis of Bacterial Infections after Bronchoscopy. Open Access Maced J Med Sci 2019; 7:913-919. [PMID: 30976333 PMCID: PMC6454165 DOI: 10.3889/oamjms.2019.208] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2019] [Revised: 03/10/2019] [Accepted: 03/11/2019] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND: Fiberoptic bronchoscopy (FOB) guided bronchoalveolar lavage (BAL) remains as the chief diagnostic tool in respiratory disorders. 1.2-16% of patients frequently experience fever after bronchoscopy. To exclude the need for multiple antibiotic prescribing in patients with post-bronchoscopy fever, the presence of the self-limiting inflammatory responses should be excluded. AIM: The current study was conducted to test the serum of patients undergoing bronchoscopy for some proinflammatory cytokines including Tumor Necrosis Factor-alpha (TNF-ɑ), Interleukin-1beta (IL-1β), Interleukin-8 (IL-8) and Interleukin-6 (IL-6) and the value of Procalcitonin (PCT). MATERIAL AND METHODS: Current case-control study was conducted at the National Research Institute of Tuberculosis and Lung Disease in Iran. Nineteen patients (48.72%) that attended with a reasonable sign for a diagnostic bronchoscopy from January 2016 to December 2017 were included in the case group. The control group consisted of 20 patients who underwent a simple bronchoscopy and without FOB-BAL. The laboratory findings for PCT concentrations and cytokine levels in the three serum samples (before FOB-BAL (t0), after 6 hr. (t1), and at 24 hr. past (t2) FOB-BAL) were compared between two groups. RESULTS: The frequency of post-bronchoscopy fever was 5.12, and the prevalence of post-bronchoscopy infectious fever was 2.56%. PCT level was considerably higher in the patient with a confirmed bacterial infection when compared to other participants (p-value < 0. 05). Interestingly, IL-8 level in the bacterial infection proven fever patient was higher than in other patients (p < 0.001). IL-8 levels displayed a specificity of 72.7% and a sensitivity of 100%, at the threshold point of 5.820 pg/ml. PCT levels had a specificity of 84% and a sensitivity of 81%, at the threshold point of 0.5 ng/ml. CONCLUSION: The present findings show that in patients with fever after bronchoscopy, PCT levels and IL-8 levels are valuable indicators for antibiotic therapy, proving adequate proof for bacterial infection. The current findings also illustrate that to monitor the serum levels of PCT and proinflammatory cytokines in the patients undergoing FOB-BAL, the best time is the 24-hour postoperative bronchoscopy.
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Affiliation(s)
- Mohsen Farrokhpour
- Chronic Respiratory Diseases Research Center, National Research Institute of Tuberculosis and Lung Diseases (NRITLD), Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Arda Kiani
- Tracheal Diseases Research Center (TDRC), National Research Institute of Tuberculosis and Lung Diseases (NRITLD), Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Esmaeil Mortaz
- Department of Immunology, Faculty of Medicine, Clinical Tuberculosis and Epidemiology Research Center, National Research Institute of Tuberculosis and Lung Diseases (NRITLD), Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Kimia Taghavi
- Chronic Respiratory Diseases Research Center, National Research Institute of Tuberculosis and Lung Diseases (NRITLD), Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Amir Masoud Farahbod
- Mycobacteriology Research Center (MRC), National Research Institute of Tuberculosis and Lung Diseases (NRITLD), Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Atefeh Fakharian
- Chronic Respiratory Diseases Research Center, National Research Institute of Tuberculosis and Lung Diseases (NRITLD), Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Mehdi Kazempour-Dizaji
- Mycobacteriology Research Center (MRC), National Research Institute of Tuberculosis and Lung Diseases (NRITLD), Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Atefeh Abedini
- Chronic Respiratory Diseases Research Center, National Research Institute of Tuberculosis and Lung Diseases (NRITLD), Shahid Beheshti University of Medical Sciences, Tehran, Iran
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20
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Julious SA. Calculation of confidence intervals for a finite population size. Pharm Stat 2018; 18:115-122. [PMID: 30411472 DOI: 10.1002/pst.1901] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2018] [Revised: 04/11/2018] [Accepted: 07/31/2018] [Indexed: 11/09/2022]
Abstract
For any estimate of response, confidence intervals are important as they help quantify a plausible range of values for the population response. However, there may be instances in clinical research when the population size is finite, but we wish to take a sample from the population and make inference from this sample. Instances where you can have a fixed population size include when undertaking a clinical audit of patient records or in a clinical trial a researcher could be checking for transcription errors against patient notes. In this paper, we describe how confidence interval calculations can be calculated for a finite population. These confidence intervals are narrower than confidence intervals from population samples. For the extreme case of when a 100% sample from the population is taken, there is no error and the calculation is the population response. The methods in the paper are described using a case study from clinical data management.
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Affiliation(s)
- Steven A Julious
- Medical Statistics Group, School of Health and Related Research (ScHARR), University of Sheffield, Sheffield, S1 4DA, UK
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21
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Guenzani D, Buoli M, Carnevali GS, Serati M, Messa P, Vettoretti S. Is there an association between severity of illness and psychiatric symptoms in patients with chronic renal failure? PSYCHOL HEALTH MED 2018; 23:970-979. [DOI: 10.1080/13548506.2018.1426868] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Affiliation(s)
- D. Guenzani
- Department of Psychiatry, University of Milan, Fondazione IRCCS Ca’Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - M. Buoli
- Department of Psychiatry, University of Milan, Fondazione IRCCS Ca’Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - G. S. Carnevali
- Department of Psychiatry, University of Milan, Fondazione IRCCS Ca’Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - M. Serati
- Department of Psychiatry, University of Milan, Fondazione IRCCS Ca’Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - P. Messa
- Unit of Nephrology Dialysis and Renal Transplantation, Fondazione Ca’ Granda Ospedale Maggiore Policlinico di Milano, Milano, Italy
| | - S. Vettoretti
- Unit of Nephrology Dialysis and Renal Transplantation, Fondazione Ca’ Granda Ospedale Maggiore Policlinico di Milano, Milano, Italy
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Buoli M, Esposito CM, Godio M, Caldiroli A, Serati M, Altamura AC. Have antipsychotics a different speed of action in the acute treatment of mania? A single-blind comparative study. J Psychopharmacol 2017; 31:1537-1543. [PMID: 28462607 DOI: 10.1177/0269881117705098] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
Available antipsychotics show different efficacy on manic symptoms of bipolar patients, but few studies have investigated the speed of action of the various compounds. For this reason, purpose of the present paper was to compare antipsychotic mono-therapies in terms of speed of action in a sample of manic bipolar patients. In total, 155 bipolar patients, treated with antipsychotic mono-therapy and followed-up in Inpatient Psychiatry Clinic of University of Milan, were included in this single-blind comparative study. Clinical response was defined as a reduction of Young Mania Rating Scale (YMRS) scores ⩾50%, while remission as a YMRS score <10. After 4 days patients who had been treated with asenapine, were more likely to have achieved a clinical response than those in treatment with haloperidol ( p = 0.001). After 7 days, a more frequent clinical response was achieved by patients treated with asenapine than those who had been treated with haloperidol ( p < 0.001) or olanzapine ( p = 0.047). Asenapine appears to be faster in determining treatment response in manic patients compared with haloperidol and less markedly with olanzapine.
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Affiliation(s)
- Massimiliano Buoli
- 1 Department of Psychiatry, University of Milan, Fondazione IRCCS Ca'Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Cecilia Maria Esposito
- 1 Department of Psychiatry, University of Milan, Fondazione IRCCS Ca'Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Marco Godio
- 2 Cantonal Psychiatric Clinic, Mendrisio, Switzerland
| | - Alice Caldiroli
- 1 Department of Psychiatry, University of Milan, Fondazione IRCCS Ca'Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Marta Serati
- 1 Department of Psychiatry, University of Milan, Fondazione IRCCS Ca'Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - A Carlo Altamura
- 1 Department of Psychiatry, University of Milan, Fondazione IRCCS Ca'Granda Ospedale Maggiore Policlinico, Milan, Italy
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In J. Introduction of a pilot study. Korean J Anesthesiol 2017; 70:601-605. [PMID: 29225742 PMCID: PMC5716817 DOI: 10.4097/kjae.2017.70.6.601] [Citation(s) in RCA: 77] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2017] [Revised: 08/03/2017] [Accepted: 08/03/2017] [Indexed: 11/28/2022] Open
Abstract
A pilot study asks whether something can be done, should the researchers proceed with it, and if so, how. However, a pilot study also has a specific design feature; it is conducted on a smaller scale than the main or full-scale study. In other words, the pilot study is important for improvement of the quality and efficiency of the main study. In addition, it is conducted in order to assess the safety of treatment or interventions and recruitment potentials, examine the randomization and blinding process, increase the researchers' experience with the study methods or medicine and interventions, and provide estimates for sample size calculation. This review discusses with a focus on the misconceptions and the ethical aspect of a pilot study. Additionally how to interpret the results of a pilot study is also introduced in this review.
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Affiliation(s)
- Junyong In
- Department of Anesthesiology and Pain Medicine, Dongguk University Ilsan Hospital, Goyang, Korea
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24
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Beukes EW, Baguley DM, Allen PM, Manchaiah V, Andersson G. Guided Internet-based versus face-to-face clinical care in the management of tinnitus: study protocol for a multi-centre randomised controlled trial. Trials 2017; 18:186. [PMID: 28431551 PMCID: PMC5399814 DOI: 10.1186/s13063-017-1931-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2016] [Accepted: 04/05/2017] [Indexed: 01/07/2023] Open
Abstract
Background Innovative strategies are required to improve access to evidence-based tinnitus interventions. A guided Internet-based cognitive behavioural therapy (iCBT) intervention for tinnitus was therefore developed for a U.K. population. Initial clinical trials indicated efficacy of iCBT at reducing tinnitus severity and associated comorbidities such as insomnia and depression. The aim of this phase III randomised controlled trial is to compare this new iCBT intervention with an established intervention, namely face-to-face clinical care for tinnitus. Methods/design This will be a multi-centre study undertaken across three hospitals in the East of England. The design is a randomised, two-arm, parallel-group, non-inferiority trial with a 2-month follow-up. The experimental group will receive the guided iCBT intervention, whereas the active control group will receive the usual face-to-face clinical care. An independent researcher will randomly assign participants, using a computer-generated randomisation schedule, after stratification for tinnitus severity. There will be 46 participants in each group. The primary assessment measure will be the Tinnitus Functional Index. Data analysis will establish whether non-inferiority is achieved using a pre-defined non-inferiority margin. Discussion This protocol outlines phase III of a clinical trial comparing a new iCBT with established face-to-face care for tinnitus. If guided iCBT for tinnitus proves to be as effective as the usual tinnitus care, it may be a viable additional management route for individuals with tinnitus. This could increase access to evidence-based effective tinnitus care and reduce the pressures on existing health care systems. Trial registration ClinicalTrials.gov identifier: NCT02665975. Registered on 22 January 2016. Electronic supplementary material The online version of this article (doi:10.1186/s13063-017-1931-6) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Eldré W Beukes
- Department of Vision and Hearing Sciences, Anglia Ruskin University, Cambridge, UK.
| | - David M Baguley
- Department of Vision and Hearing Sciences, Anglia Ruskin University, Cambridge, UK.,National Institute for Health Research [NIHR], Nottingham Biomedical Research Centre, Ropewalk House, 113 The Ropewalk, Nottingham, UK.,Otology and Hearing Group, Division of Clinical Neuroscience, School of Medicine, University of Nottingham, Nottingham, UK
| | - Peter M Allen
- Department of Vision and Hearing Sciences, Anglia Ruskin University, Cambridge, UK.,Vision and Eye Research Unit, Anglia Ruskin University, Cambridge, UK
| | - Vinaya Manchaiah
- Department of Speech and Hearing Sciences, Lamar University, Beaumont, Texas, USA.,Linnaeus Centre HEAD, Swedish Institute for Disability Research, Department of Behavioural Science and Learning, Linköping University, Linköping, Sweden.,Audiology India, Mysore, Karnataka, India.,Department of Speech and Hearing, School of Allied Health Sciences, Manipal University, Manipal, Karnataka, India
| | - Gerhard Andersson
- Department of Behavioural Sciences and Learning, Linköping University, Linköping, Sweden.,Division of Psychiatry, Department of Clinical Neuroscience, Karolinska Institute, Stockholm, Sweden
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Best practices for design and implementation of human clinical trials studying dietary oils. Prog Lipid Res 2017; 65:1-11. [DOI: 10.1016/j.plipres.2016.10.003] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2016] [Accepted: 10/24/2016] [Indexed: 12/19/2022]
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Flight L, Julious SA, Goodacre S. Can emergency medicine research benefit from adaptive design clinical trials? Emerg Med J 2016; 34:243-248. [DOI: 10.1136/emermed-2016-206046] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2016] [Accepted: 10/03/2016] [Indexed: 11/04/2022]
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Kieves NR, Bergh MS, Zellner E, Wang C. Pilot study measuring the effects of bandaging and cold compression therapy following tibial plateau levelling osteotomy. J Small Anim Pract 2016; 57:543-547. [PMID: 27467420 DOI: 10.1111/jsap.12533] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2015] [Revised: 03/22/2016] [Accepted: 03/28/2016] [Indexed: 11/27/2022]
Abstract
OBJECTIVES To compare cold compression therapy, modified Robert-Jones bandage or the combination of cold compression therapy plus modified Robert-Jones bandage on operated limbs following tibial plateau levelling osteotomy in dogs. METHODS Twenty-one client-owned dogs with cranial cruciate ligament disease were prospectively enrolled. Dogs were randomly assigned to one of three postoperative treatment groups: cold compression therapy, modified Robert-Jones bandage or a combination of both. Patients were evaluated preoperatively and at 12, 24 and 36 hours following tibial plateau levelling osteotomy. Measurements included weight-bearing on the operated limb, stifle flexion and extension angles and circumference of the operated limb at four levels. RESULTS There was no significant difference in weight-bearing, range of motion or limb swelling between groups. There was a trend for dogs in the cold compression therapy and cold compression therapy with a bandage groups to have a greater increase in weight-bearing after surgery compared with the bandage-only group. CLINICAL RELEVANCE Cold compression therapy is a safe modality following tibial plateau levelling osteotomy surgery. The trend towards improved use of the operated limb in the groups receiving cold compression therapy compared with those treated with only a bandage may be an indication that these patients are more comfortable in the postoperative period. The small sample size limits interpretation of the data but this pilot study provides data to guide future investigation.
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Affiliation(s)
- N R Kieves
- Department of Veterinary Clinical Sciences, Iowa State University, Ames, IA 50011, USA.
| | - M S Bergh
- Department of Veterinary Clinical Sciences, Iowa State University, Ames, IA 50011, USA
| | - E Zellner
- Department of Veterinary Clinical Sciences, Iowa State University, Ames, IA 50011, USA
| | - C Wang
- Department of Veterinary Diagnostic and Production Animal Medicine, Iowa State University, Ames, IA 50011, USA
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