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Shiose S, Notomi S, Hashimoto S, Nagata J, Fukuda Y, Kano K, Ishikawa K, Sonoda KH. The factors associated with retinal pigment epithelium tear development in the early phase after treatment initiation for age-related macular degeneration. Graefes Arch Clin Exp Ophthalmol 2024:10.1007/s00417-024-06503-z. [PMID: 38713397 DOI: 10.1007/s00417-024-06503-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2023] [Revised: 04/17/2024] [Accepted: 04/28/2024] [Indexed: 05/08/2024] Open
Abstract
PURPOSE This study aimed to evaluate the factors associated with retinal pigment epithelium (RPE) tear development in the early phase after anti-vascular endothelial growth factor (VEGF) drug initiation in eyes with neovascular age-related macular degeneration (nAMD) and retinal pigment epithelial detachment (PED). METHODS Treatment-naive eyes with nAMD and PED for which anti-VEGF drug injections had been initiated and followed up for at least 3 months after the 1st anti-VEGF drug injection, were retrospectively investigated. Baseline characteristics of the PEDs, including type, height, and area, were evaluated using fundus photographs, fluorescein angiography, and optical coherence tomography images. The association between patient age, sex, medical history, PED characteristics, and the development of RPE tears within 3 months of starting anti-VEGF therapy was examined. RESULTS This study included 244 eyes (230 patients; mean age 75.0 years, 159 males and 71 females). RPE tears occurred in 13 eyes (5.3%) within 3 months of the start of anti-VEGF therapy. Multivariate analysis showed an association of the development of RPE tears with PED height (every 100 µm, odds ratio [OR]: 1.50, 95% confidence interval [CI]: 1.07-2.12, p = 0.019), PED area (every 10 mm2, OR: 3.02, CI: 1.22-7.46, p = 0.016), and the presence of fibrovascular PED (OR: 59.22, CI: 4.12-850.59, p = 0.002). Eyes with cleft (the hypo-reflective space beneath the fibrovascular PED) were more likely to develop an RPE tear (p = 0.01, χ-square test). CONCLUSIONS Fibrovascular PED, large PED area, high PED height, and the cleft finding are independent risk factors for the development of RPE tears early after the administration of anti-VEGF drugs.
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Affiliation(s)
- Satomi Shiose
- Department of Ophthalmology, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-Ku, Fukuoka, 812-8582, Japan.
| | - Shoji Notomi
- Department of Ophthalmology, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-Ku, Fukuoka, 812-8582, Japan
| | - Sawako Hashimoto
- Department of Ophthalmology, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-Ku, Fukuoka, 812-8582, Japan
| | - Junya Nagata
- Department of Ophthalmology, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-Ku, Fukuoka, 812-8582, Japan
| | - Yosuke Fukuda
- Department of Ophthalmology, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-Ku, Fukuoka, 812-8582, Japan
| | - Kumiko Kano
- Department of Ophthalmology, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-Ku, Fukuoka, 812-8582, Japan
| | - Keijiro Ishikawa
- Department of Ophthalmology, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-Ku, Fukuoka, 812-8582, Japan
| | - Koh-Hei Sonoda
- Department of Ophthalmology, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-Ku, Fukuoka, 812-8582, Japan
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Potter GE, Callier V, Shrestha B, Joshi S, Dwivedi A, Silva JC, Laurens MB, Follmann DA, Deye GA. Can incorporating genotyping data into efficacy estimators improve efficiency of early phase malaria vaccine trials? Malar J 2023; 22:383. [PMID: 38115002 PMCID: PMC10729369 DOI: 10.1186/s12936-023-04802-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2023] [Accepted: 11/22/2023] [Indexed: 12/21/2023] Open
Abstract
BACKGROUND Early phase malaria vaccine field trials typically measure malaria infection by PCR or thick blood smear microscopy performed on serially sampled blood. Vaccine efficacy (VE) is the proportion reduction in an endpoint due to vaccination and is often calculated as VEHR = 1-hazard ratio or VERR = 1-risk ratio. Genotyping information can distinguish different clones and distinguish multiple infections over time, potentially increasing statistical power. This paper investigates two alternative VE endpoints incorporating genotyping information: VEmolFOI, the vaccine-induced proportion reduction in incidence of new clones acquired over time, and VEC, the vaccine-induced proportion reduction in mean number of infecting clones per exposure. METHODS Power of VEmolFOI and VEC was compared to that of VEHR and VERR by simulations and analytic derivations, and the four VE methods were applied to three data sets: a Phase 3 trial of RTS,S malaria vaccine in 6912 African infants, a Phase 2 trial of PfSPZ Vaccine in 80 Burkina Faso adults, and a trial comparing Plasmodium vivax incidence in 466 Papua New Guinean children after receiving chloroquine + artemether lumefantrine with or without primaquine (as these VE methods can also quantify effects of other prevention measures). By destroying hibernating liver-stage P. vivax, primaquine reduces subsequent reactivations after treatment completion. RESULTS In the trial of RTS,S vaccine, a significantly reduced number of clones at first infection was observed, but this was not the case in trials of PfSPZ Vaccine or primaquine, although the PfSPZ trial lacked power to show a reduction. Resampling smaller data sets from the large RTS,S trial to simulate phase 2 trials showed modest power gains from VEC compared to VEHR for data like those from RTS,S, but VEC is less powerful than VEHR for trials in which the number of clones at first infection is not reduced. VEmolFOI was most powerful in model-based simulations, but only the primaquine trial collected enough serial samples to precisely estimate VEmolFOI. The primaquine VEmolFOI estimate decreased after most control arm liver-stage infections reactivated (which mathematically resembles a waning vaccine), preventing VEmolFOI from improving power. CONCLUSIONS The power gain from the genotyping methods depends on the context. Because input parameters for early phase power calculations are often uncertain, these estimators are not recommended as primary endpoints for small trials unless supported by targeted data analysis. TRIAL REGISTRATIONS NCT00866619, NCT02663700, NCT02143934.
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Affiliation(s)
- Gail E Potter
- Biostatistics Research Branch, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Rockville, MD, USA.
| | - Viviane Callier
- Clinical Monitoring Research Program Directorate, Frederick National Laboratory for Cancer Research, Frederick, MD, USA
| | - Biraj Shrestha
- Center for Vaccine Development and Global Health, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Sudhaunshu Joshi
- Center for Vaccine Development and Global Health, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Ankit Dwivedi
- Institute for Genomic Sciences, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Joana C Silva
- Institute for Genomic Sciences, University of Maryland School of Medicine, Baltimore, MD, USA
- Department of Microbiology & Immunology, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Matthew B Laurens
- Center for Vaccine Development and Global Health, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Dean A Follmann
- Biostatistics Research Branch, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Rockville, MD, USA
| | - Gregory A Deye
- Division of Microbiology and Infectious Diseases, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Rockville, MD, USA
- AstraZeneca PLC, Gaithersburg, MD, USA
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Lin Q, Shen Z, Zhou X. Intensive topical steroid regimen for enhanced very early recovery after small incision lenticule extraction. Int Ophthalmol 2023; 43:4097-4103. [PMID: 37561251 PMCID: PMC10520117 DOI: 10.1007/s10792-023-02827-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2021] [Accepted: 07/09/2023] [Indexed: 08/11/2023]
Abstract
OBJECTIVE This study aims to investigate the topical steroid regimen after small incision lenticule extraction (SMILE) for its effect on very early restoration of visual quality. METHODS A total of 180 patients (360 eyes) who underwent SMILE were enrolled. These patients were randomly assigned to three groups, with 60 patients in each group. The only difference among these three groups was the administration of 0.1% fluorometholone (FML) eye drops within two hours after SMILE: no FML in group A, 0.1% FML once every hour in group B and 0.1% FML once every half hour in group C. The corrected distance visual acuity (CDVA), objective scattering index (OSI), modulation transfer function (MTF) cut-off, Strehl ratio (SR) and incidence of subjective symptoms were evaluated preoperatively, at 2, 4 and 24 h and one week after SMILE. RESULTS The CDVA, MTF cut-off and SR values were significantly higher in group C, when compared to the other two groups, at 2 and 4 h after SMILE (p < 0.05). Furthermore, the OSI and incidence of subjective symptoms were significantly lower in group C, when compared to the other two groups, at 2 and 4 h after SMILE (p < 0.05). However, no significant differences in CDVA, MTF cut-off, SR, OSI and the incidence of subjective symptoms were detected among the three groups at 24 h and one week after SMILE (p > 0.05). CONCLUSION The administration of 0.1% FML eye drops every half hour within two hours after SMILE accelerates the restoration of visual and optical quality, and reduces the incidence of subjective symptoms during the very early phase after surgery.
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Affiliation(s)
- Qinghong Lin
- Eye Institute and Department of Ophthalmology, Eye and ENT Hospital, Fudan University, No.83 Fenyang Road, Shanghai, 200000, China
- Department of Refractive Surgery, Bright Eye Hospital, Fuzhou, 350000, China
| | - Zhengwei Shen
- Department of Refractive Surgery, Bright Eye Hospital, Fuzhou, 350000, China.
- Department of Refractive Surgery, Wuhan Bright Eye Hospital, No.179 Zhongshan Road, Wuhan, 430000, China.
| | - Xingtao Zhou
- Eye Institute and Department of Ophthalmology, Eye and ENT Hospital, Fudan University, No.83 Fenyang Road, Shanghai, 200000, China.
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Takamizawa S, Katsuya Y, Chen YN, Mizuno T, Koyama T, Sudo K, Yoshida T, Kondo S, Iwasa S, Yonemori K, Shimizu T, Yamamoto N, Suzuki S. Ocular toxicity of investigational anti-cancer drugs in early phase clinical trials. Invest New Drugs 2023; 41:173-181. [PMID: 36471215 PMCID: PMC10030433 DOI: 10.1007/s10637-022-01321-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2022] [Accepted: 11/22/2022] [Indexed: 12/12/2022]
Abstract
Ocular toxicities arising from anti-cancer drugs occur sporadically and are sometimes underestimated because they are not life-threatening. Reports focusing on ocular toxicities from cancer therapy are limited. We investigated the detailed progress of ocular toxicities of anti-cancer drugs including first-in-class ones. A retrospective review of medical records was conducted for patients who were involved in early phase clinical trials with scheduled ophthalmologic examinations according to their protocols between January 2014 and August 2021. Patients with ocular toxicity suspected to be related to the investigational drugs in the ophthalmic examination were investigated in detail. In total, 37 ocular toxicities related to investigational drugs occurred in 7.6% of patients (33/434). The median age of the 33 patients was 61 years (range, 33-76 years), and 20 were male. Causal drugs with a high incidence of ocular toxicities were HSP90 inhibitors and FGFR inhibitors. Retinopathy was most frequent, while conjunctivitis, dry eye, keratitis, keratopathy, and uveitis were also observed. Dim vision as a subjective finding was a unique adverse event. Most patients developed ocular toxicities even though their dose was below the drug's maximum tolerated dose. Except for one case, all ocular toxicities occurred bilaterally. About 60% (22/37) of ocular toxicity cases needed a temporary hold of the drug. All except for three cases fully recovered. This study reported the risks and timing of the onset of a variety of ocular toxicities of anti-cancer drugs, which were fundamentally controllable. (Trial registration number. Retrospectively registered).
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Affiliation(s)
- Shigemasa Takamizawa
- Department of Experimental Therapeutics, National Cancer Center Hospital, 5-1-1 Tsukiji, Chuo-Ku, Tokyo, 104-0045, Japan
| | - Yuki Katsuya
- Department of Experimental Therapeutics, National Cancer Center Hospital, 5-1-1 Tsukiji, Chuo-Ku, Tokyo, 104-0045, Japan.
| | - Yi-Ning Chen
- Department of Ophthalmic Oncology, National Cancer Center Hospital, Tokyo, Japan
| | - Takaaki Mizuno
- Department of Experimental Therapeutics, National Cancer Center Hospital, 5-1-1 Tsukiji, Chuo-Ku, Tokyo, 104-0045, Japan
| | - Takafumi Koyama
- Department of Experimental Therapeutics, National Cancer Center Hospital, 5-1-1 Tsukiji, Chuo-Ku, Tokyo, 104-0045, Japan
| | - Kazuki Sudo
- Department of Experimental Therapeutics, National Cancer Center Hospital, 5-1-1 Tsukiji, Chuo-Ku, Tokyo, 104-0045, Japan
| | - Tatsuya Yoshida
- Department of Experimental Therapeutics, National Cancer Center Hospital, 5-1-1 Tsukiji, Chuo-Ku, Tokyo, 104-0045, Japan
| | - Shunsuke Kondo
- Department of Experimental Therapeutics, National Cancer Center Hospital, 5-1-1 Tsukiji, Chuo-Ku, Tokyo, 104-0045, Japan
| | - Satoru Iwasa
- Department of Experimental Therapeutics, National Cancer Center Hospital, 5-1-1 Tsukiji, Chuo-Ku, Tokyo, 104-0045, Japan
| | - Kan Yonemori
- Department of Experimental Therapeutics, National Cancer Center Hospital, 5-1-1 Tsukiji, Chuo-Ku, Tokyo, 104-0045, Japan
| | - Toshio Shimizu
- Department of Experimental Therapeutics, National Cancer Center Hospital, 5-1-1 Tsukiji, Chuo-Ku, Tokyo, 104-0045, Japan
| | - Noboru Yamamoto
- Department of Experimental Therapeutics, National Cancer Center Hospital, 5-1-1 Tsukiji, Chuo-Ku, Tokyo, 104-0045, Japan
| | - Shigenobu Suzuki
- Department of Ophthalmic Oncology, National Cancer Center Hospital, Tokyo, Japan
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English BA, Ereshefsky L. Experimental Medicine Approaches in Early-Phase CNS Drug Development. Adv Neurobiol 2023; 30:417-455. [PMID: 36928860 DOI: 10.1007/978-3-031-21054-9_17] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 03/17/2023]
Abstract
Traditionally, Phase 1 clinical trials were largely conducted in healthy normal volunteers and focused on collection of safety, tolerability, and pharmacokinetic data. However, in the CNS therapeutic area, with more drugs failing in later phase development, Phase 1 trials have undergone an evolution that includes incorporation of novel approaches involving novel study designs, inclusion of biomarkers, and early inclusion of patients to improve the pharmacologic understanding of novel CNS-active compounds early in clinical development with the hope of improving success in later phase pivotal trials. In this chapter, the authors will discuss the changing landscape of Phase 1 clinical trials in CNS, including novel trial methodology, inclusion of pharmacodynamic biomarkers, and experimental medicine approaches to inform early decision-making in clinical development.
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Gajewski BJ, Kimler BF, Koestler DC, Mudaranthakam DP, Young K, Fabian CJ. A novel Bayesian adaptive design incorporating both primary and secondary endpoints for randomized IIB chemoprevention study of women at increased risk for breast cancer. Trials 2022; 23:981. [PMID: 36471449 DOI: 10.1186/s13063-022-06930-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2022] [Accepted: 11/15/2022] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND Our randomized controlled clinical trial will explore the potential of bazedoxifene plus conjugated estrogen to modulate breast tissue-based risk biomarkers as a surrogate for breast cancer risk reduction. This paper investigates the statistical design features of the trial and the rationale for the final choice of its design. Group sequential designs are a popular design approach to allow a trial to stop early for success or futility, potentially saving time and money over a fixed trial design. While Bayesian adaptive designs enjoy the same properties as group sequential designs, they have the added benefit of using prior information as well as inferential interpretation conditional on the data. Whether a frequentist or Bayesian trial, most adaptive designs have interim analyses that allow for early stopping, typically utilizing only the primary endpoint. A drawback to this approach is that the study may not have enough data for adequate comparisons of a single, key secondary endpoint. This can happen, for example, if the secondary endpoint has a smaller effect than the primary endpoint. METHODS In this paper, we investigate a trial design called two-endpoint adaptive, which stops early only if a criterion is met for primary and secondary endpoints. The approach focuses the final analysis on the primary endpoint but ensures adequate data for the secondary analysis. Our study has two arms with a primary (change in mammographic fibroglandular volume) and secondary endpoint (change in mammary tissue Ki-67). RESULTS We present operating characteristics including power, trial duration, and type I error rate and discuss the value and risks of modeling Bayesian group sequential designs with primary and secondary endpoints, comparing against alternative designs. The results indicate that the two-endpoint adaptive design has better operating characteristics than competing designs if one is concerned about having adequate information for a key secondary endpoint. DISCUSSION Our approach balances trial speed and the need for information on the single, key secondary endpoint.
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Wang K, Wang Y, Cao Y, Wang H, Zhou Y, Gao L, Zeng Z, Cheng M, Jin X, Chen J, Wen F, Wang T. Lumican is elevated in the lung in human and experimental acute respiratory distress syndrome and promotes early fibrotic responses to lung injury. J Transl Med 2022; 20:392. [PMID: 36059026 PMCID: PMC9440861 DOI: 10.1186/s12967-022-03597-z] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2022] [Accepted: 08/17/2022] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Fibroproliferative repair starts early in the inflammatory phase of acute respiratory distress syndrome (ARDS) and indicates a poor prognosis. Lumican, a small leucine-rich proteoglycan, is implicated in homeostasis and fibrogenesis, but its role in ARDS is unclear. METHODS Bronchoalveolar lavage fluid (BALF) samples were obtained from ARDS patients (n = 55) enrolled within 24 h of diagnosis and mechanically ventilated (n = 20) and spontaneously breathing (n = 29) control subjects. Lipopolysaccharide (LPS)-induced acute lung injury (ALI) mouse models were intratracheally administered an adeno-associated virus (AAV) vector expressing lumican shRNA. Primary human lung fibroblasts (HLF) and small airway epithelial cells (SAECs) were cultured with tumour necrosis factor (TNF)-α or lumican. Luminex/ELISA, histochemistry/immunohistochemistry, immunofluorescence microscopy, quantitative real-time PCR, and western blotting were performed. RESULTS Lumican levels were significantly higher in the BALF of ARDS patients than in that of ventilated or spontaneously breathing controls (both p < 0.0001); they were correlated with the PaO2/FiO2 ratio and levels of proinflammatory cytokines (interleukin-6, interleukin-8, and TNF-α) and profibrotic factors (fibronectin, alpha-1 type I collagen [COL1A1], and alpha-1 type III collagen [COL3A1]). Lumican expression was enhanced in the alveolar walls and airway epithelium in the ALI mouse model. Murine lumican levels were also linked to proinflammatory and profibrotic cytokine levels in the BALF. In vitro, TNF-α induced the synthesis and secretion of lumican in HLF. In turn, lumican increased the expression of alpha-smooth muscle actin (α-SMA), COL1A1, and COL3A1 in HLF, upregulated α-SMA and COL3A1, downregulated E-cadherin, and caused spindle-shaped morphological changes in SAECs. Moreover, increased ERK phosphorylation and Slug were noted in both HLF and SAECs treated with lumican. In vivo, AAV-mediated knockdown of lumican inhibited the pulmonary production of fibronectin and COL3A1 and alleviated lung fibrotic lesions in LPS-challenged mice. CONCLUSIONS Pulmonary lumican levels were increased early in human and experimental ARDS and linked to disease severity and inflammatory fibrotic processes. Lumican triggers the transdifferentiation of lung fibroblasts into myofibroblasts and epithelial-mesenchymal transition in SAECs, possibly via the ERK/Slug pathway. Knockdown of pulmonary lumican attenuated extracellular matrix deposition in ALI mice. Overall, lumican promotes fibrotic responses in the early phase of ARDS, suggesting its potential as a therapeutic target.
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Affiliation(s)
- Ke Wang
- Division of Pulmonary Diseases, State Key Laboratory of Biotherapy, and Department of Respiratory and Critical Care Medicine, West China Hospital of Sichuan University, No. 37, Guoxue Alley, Chengdu, 610041, Sichuan, China
| | - Youyu Wang
- Department of Thoracic Surgery, Sichuan Academy of Medical Sciences & Sichuan Provincial People's Hospital, Chengdu, China
| | - Yufang Cao
- Department of Critical Care Medicine, Affiliated Haikou Hospital of Xiangya Medical College, Central South University, Haikou, China
| | - Hao Wang
- Division of Pulmonary Diseases, State Key Laboratory of Biotherapy, and Department of Respiratory and Critical Care Medicine, West China Hospital of Sichuan University, No. 37, Guoxue Alley, Chengdu, 610041, Sichuan, China
| | - Yongfang Zhou
- Department of Critical Care Medicine, West China Hospital of Sichuan University, Chengdu, China
| | - Lijuan Gao
- Division of Pulmonary Diseases, State Key Laboratory of Biotherapy, and Department of Respiratory and Critical Care Medicine, West China Hospital of Sichuan University, No. 37, Guoxue Alley, Chengdu, 610041, Sichuan, China
| | - Zijian Zeng
- Division of Pulmonary Diseases, State Key Laboratory of Biotherapy, and Department of Respiratory and Critical Care Medicine, West China Hospital of Sichuan University, No. 37, Guoxue Alley, Chengdu, 610041, Sichuan, China
| | - Mengxin Cheng
- Division of Pulmonary Diseases, State Key Laboratory of Biotherapy, and Department of Respiratory and Critical Care Medicine, West China Hospital of Sichuan University, No. 37, Guoxue Alley, Chengdu, 610041, Sichuan, China
| | - Xiaodong Jin
- Department of Critical Care Medicine, West China Hospital of Sichuan University, Chengdu, China
| | - Jun Chen
- Division of Pulmonary Diseases, State Key Laboratory of Biotherapy, and Department of Respiratory and Critical Care Medicine, West China Hospital of Sichuan University, No. 37, Guoxue Alley, Chengdu, 610041, Sichuan, China
| | - Fuqiang Wen
- Division of Pulmonary Diseases, State Key Laboratory of Biotherapy, and Department of Respiratory and Critical Care Medicine, West China Hospital of Sichuan University, No. 37, Guoxue Alley, Chengdu, 610041, Sichuan, China.
| | - Tao Wang
- Division of Pulmonary Diseases, State Key Laboratory of Biotherapy, and Department of Respiratory and Critical Care Medicine, West China Hospital of Sichuan University, No. 37, Guoxue Alley, Chengdu, 610041, Sichuan, China.
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Moe C, Brinchmann B, Rasmussen L, Brandseth OL, McDaid D, Killackey E, Rinaldi M, Borg M, Mykletun A. Implementing individual placement and support (IPS): the experiences of employment specialists in the early implementation phase of IPS in Northern Norway. The IPSNOR study. BMC Psychiatry 2021; 21:632. [PMID: 34930203 PMCID: PMC8690340 DOI: 10.1186/s12888-021-03644-x] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/16/2021] [Accepted: 12/08/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND For decades there has been a continuous increase in the number of people receiving welfare benefits for being outside the work force due to mental illness. There is sufficient evidence for the efficacy of Individual Placement and Support (IPS) for gaining and maintaining competitive employment. Yet, IPS is still not implemented as routine practice in public community mental health services. Knowledge about implementation challenges as experienced by the practitioners is limited. This study seeks to explore the experiences of the front-line workers, known as employment specialists, in the early implementation phase. METHODS Qualitative data were collected through field notes and five focus group interviews. The study participants were 45 IPS employment specialists located at 14 different sites in Northern Norway. Transcripts and field notes were analysed by thematic analyses. RESULTS While employment specialists are key to the implementation process, implementing IPS requires more than creating and filling the role of the employment specialist. It requires adjustments in multiple organisations. The new employment specialist then is a pioneer of service development. Some employment specialists found this a difficult challenge, and one that did not correspond to their expectations going into this role. Others appreciated the pioneering role. IPS implementation also challenged the delegation of roles and responsibilities between sectors, and related legal frameworks related to confidentiality and access. The facilitating role of human relationships emphasised the importance of social support which is an important factor in a healthy work environment. Rural areas with long distances and close- knit societies may cause challenges for implementation. CONCLUSION The study provides increased understanding on what happens in the early implementation phase of IPS from the employment specialists' perspective. Results from this study can contribute to increased focus on job satisfaction, turnover and recruitment of employment specialists, factors which have previously been shown to influence the success of IPS. The greatest challenge for making "IPS efficacy in trials" become "IPS effectiveness in the real world" is implementation, and this study has highlighted some of the implementation issues.
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Affiliation(s)
- Cathrine Moe
- Nordland Hospital Trust, Centre for Work and Mental Health, Bodø, Norway. .,Faculty of Nursing and Health Sciences, Nord University, Bodø, Norway.
| | - Beate Brinchmann
- grid.420099.6Nordland Hospital Trust, Centre for Work and Mental Health, Bodø, Norway ,grid.10919.300000000122595234Department of Community Medicine, UiT – The Arctic University of Norway, Tromsø, Norway
| | - Line Rasmussen
- grid.420099.6Nordland Hospital Trust, Centre for Work and Mental Health, Bodø, Norway
| | - Oda Lekve Brandseth
- grid.420099.6Nordland Hospital Trust, Centre for Work and Mental Health, Bodø, Norway
| | - David McDaid
- grid.13063.370000 0001 0789 5319Care Policy and Evaluation Centre, Department of Health Policy, London School of Economics and Political Science, London, UK
| | - Eóin Killackey
- grid.488501.0Orygen, Melbourne, Australia ,grid.1008.90000 0001 2179 088XCentre for Youth Mental Health, The University of Melbourne, Melbourne, Australia
| | - Miles Rinaldi
- grid.439450.f0000 0001 0507 6811South West London and St George’s Mental Health NHS Trust, London, UK
| | - Marit Borg
- grid.420099.6Nordland Hospital Trust, Centre for Work and Mental Health, Bodø, Norway ,grid.463530.70000 0004 7417 509XUniversity of South-Eastern Norway, Drammen, Norway
| | - Arnstein Mykletun
- grid.420099.6Nordland Hospital Trust, Centre for Work and Mental Health, Bodø, Norway ,grid.10919.300000000122595234Department of Community Medicine, UiT – The Arctic University of Norway, Tromsø, Norway ,grid.412008.f0000 0000 9753 1393Centre for Research and Education in Forensic Psychiatry, Haukeland University Hospital, Bergen, Norway ,grid.418193.60000 0001 1541 4204Division for Health Sciences, Norwegian Institute of Public Health, Oslo, Norway
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Dehbi HM, O'Quigley J, Iasonos A. Controlled backfill in oncology dose-finding trials. Contemp Clin Trials 2021; 111:106605. [PMID: 34743987 DOI: 10.1016/j.cct.2021.106605] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2021] [Revised: 09/22/2021] [Accepted: 10/21/2021] [Indexed: 10/19/2022]
Abstract
The use of backfill in early phase dose-finding trials is a relatively recent practice. It consists of assigning patients to dose levels below the level where the study is at. The main reason for backfilling is to collect additional pharmacokinetic, pharmacodynamic and response data, in order to assess whether a plateau may exist on the dose-efficacy curve. This is a possibility in oncology with molecularly targeted agents or immunotherapy. Recommending for further study a dose level lower than the maximum tolerated dose could be supported in such situations. How to best allocate backfill patients to dose levels is not yet established. In this paper we propose to randomise backfill patients below the dose level where the study is at. A refinement of this would be to stop backfilling to lower dose levels when these show insufficient efficacy compared to higher levels, starting at dose level 1 and repeating this process sequentially. At study completion, data from all patients (both backfill patients and dose-finding patients) is used to estimate the dose-response curve. The fit from a change point model is compared to the fit of a monotonic model to identify a potential plateau. Using simulations, we show that this approach can identify the plateau on the dose-response curve when such a plateau exists, allowing the recommendation of a dose level lower than the maximum tolerated dose for future studies. This contribution provides a methodological framework for backfilling, from the perspective of both design and analysis in early phase oncology trials.
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Affiliation(s)
| | - John O'Quigley
- Department of Statistical Science, University College London, London, UK
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10
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Kunzler AM, Röthke N, Günthner L, Stoffers-Winterling J, Tüscher O, Coenen M, Rehfuess E, Schwarzer G, Binder H, Schmucker C, Meerpohl JJ, Lieb K. Mental burden and its risk and protective factors during the early phase of the SARS-CoV-2 pandemic: systematic review and meta-analyses. Global Health 2021; 17:34. [PMID: 33781283 PMCID: PMC8006628 DOI: 10.1186/s12992-021-00670-y] [Citation(s) in RCA: 120] [Impact Index Per Article: 40.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2020] [Accepted: 02/04/2021] [Indexed: 02/08/2023] Open
Abstract
BACKGROUND Mental burden due to the SARS-CoV-2 pandemic has been widely reported for the general public and specific risk groups like healthcare workers and different patient populations. We aimed to assess its impact on mental health during the early phase by comparing pandemic with prepandemic data and to identify potential risk and protective factors. METHODS For this systematic review and meta-analyses, we systematically searched PubMed, PsycINFO, and Web of Science from January 1, 2019 to May 29, 2020, and screened reference lists of included studies. In addition, we searched PubMed and PsycINFO for prepandemic comparative data. Survey studies assessing mental burden by the SARS-CoV-2 pandemic in the general population, healthcare workers, or any patients (eg, COVID-19 patients), with a broad range of eligible mental health outcomes, and matching studies evaluating prepandemic comparative data in the same population (if available) were included. We used multilevel meta-analyses for main, subgroup, and sensitivity analyses, focusing on (perceived) stress, symptoms of anxiety and depression, and sleep-related symptoms as primary outcomes. RESULTS Of 2429 records retrieved, 104 were included in the review (n = 208,261 participants), 43 in the meta-analysis (n = 71,613 participants). While symptoms of anxiety (standardized mean difference [SMD] 0.40; 95% CI 0.15-0.65) and depression (SMD 0.67; 95% CI 0.07-1.27) were increased in the general population during the early phase of the pandemic compared with prepandemic conditions, mental burden was not increased in patients as well as healthcare workers, irrespective of COVID-19 patient contact. Specific outcome measures (eg, Patient Health Questionnaire) and older comparative data (published ≥5 years ago) were associated with increased mental burden. Across the three population groups, existing mental disorders, female sex, and concerns about getting infected were repeatedly reported as risk factors, while older age, a good economic situation, and education were protective. CONCLUSIONS This meta-analysis paints a more differentiated picture of the mental health consequences in pandemic situations than previous reviews. High-quality, representative surveys, high granular longitudinal studies, and more research on protective factors are required to better understand the psychological impacts of the SARS-CoV-2 pandemic and to help design effective preventive measures and interventions that are tailored to the needs of specific population groups.
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Affiliation(s)
- Angela M Kunzler
- Department of Psychiatry and Psychotherapy, University Medical Center of the Johannes Gutenberg University Mainz, Mainz, Germany.
- Leibniz Institute for Resilience Research (LIR), Mainz, Germany.
| | - Nikolaus Röthke
- Department of Psychiatry and Psychotherapy, University Medical Center of the Johannes Gutenberg University Mainz, Mainz, Germany
| | - Lukas Günthner
- Leibniz Institute for Resilience Research (LIR), Mainz, Germany
| | - Jutta Stoffers-Winterling
- Department of Psychiatry and Psychotherapy, University Medical Center of the Johannes Gutenberg University Mainz, Mainz, Germany
- Leibniz Institute for Resilience Research (LIR), Mainz, Germany
| | - Oliver Tüscher
- Department of Psychiatry and Psychotherapy, University Medical Center of the Johannes Gutenberg University Mainz, Mainz, Germany
- Leibniz Institute for Resilience Research (LIR), Mainz, Germany
| | - Michaela Coenen
- Institute for Medical Information Processing, Biometry and Epidemiology, Chair of Public Health and Health Services Research, LMU Munich, Munich, Germany
- Pettenkofer School of Public Health Munich, Munich, Germany
| | - Eva Rehfuess
- Institute for Medical Information Processing, Biometry and Epidemiology, Chair of Public Health and Health Services Research, LMU Munich, Munich, Germany
- Pettenkofer School of Public Health Munich, Munich, Germany
| | - Guido Schwarzer
- Institute of Medical Biometry and Statistics, Faculty of Medicine and Medical Center, University of Freiburg, Freiburg, Germany
| | - Harald Binder
- Institute of Medical Biometry and Statistics, Faculty of Medicine and Medical Center, University of Freiburg, Freiburg, Germany
| | - Christine Schmucker
- Institute for Evidence in Medicine, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Joerg J Meerpohl
- Institute for Evidence in Medicine, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
- Cochrane Germany, Cochrane Germany Foundation, Freiburg, Germany
| | - Klaus Lieb
- Department of Psychiatry and Psychotherapy, University Medical Center of the Johannes Gutenberg University Mainz, Mainz, Germany.
- Leibniz Institute for Resilience Research (LIR), Mainz, Germany.
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11
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Williams J, Weekes L, Harvey S, Kumar A, Leigh M, Thiele F, Sabanathan D. Clinical trials best practice checklist: Guidance for Australian clinical research sites from CT:IQ. Contemp Clin Trials Commun 2020; 20:100651. [PMID: 33024881 PMCID: PMC7527699 DOI: 10.1016/j.conctc.2020.100651] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2020] [Accepted: 09/16/2020] [Indexed: 12/03/2022] Open
Abstract
The Australian clinical trials sector has grown steadily over the past decade, particularly with respect to early phase trials where Australia's research capacity, capability and quality of research is revered. With an increase in the number of internationally sponsored clinical research projects being conducted in Australia, particularly in the early phase setting, there has been a corresponding growth in the number of clinical research sites conducting early phase clinical trials. Australian researchers are guided by a multitude of research codes, guidance and statements which govern the conduct of clinical trials. Although international guidance regarding the conduct of early phase clinical trials exists, there is currently no single source outlining best practice recommendations for the conduct of early phase clinical trials in Australia. In recognition of this Clinical Trials: Impact & Quality (CT:IQ), a collaborative of sector stakeholders, convened a project team with comprehensive knowledge of the Australian clinical trials sector and particularly early phase research, to evaluate and collate broadly applicable and implementable guidance for the conduct of early phase clinical trials. Although the initial intent was to create guidance specific to early phase, we recognize the project outcomes are more broadly implementable irrespective of the research phase and are intended to support all clinical research sites to conduct high-quality clinical trials in Australia. No single source of best practice recommendations for clinical trial conduct in Australia exists. CT:IQ identified the importance of conducting continuous risk and quality assurance programs. CT:IQ identified the need to adopt clear communication practices. CT:IQ developed a best practice checklist & resource toolkit to support clinical research sites. The checklist helps to validate and further support and develop site practices.
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Affiliation(s)
- Jerneen Williams
- Bellberry Limited, 123 Glen Osmond Rd, Eastwood, SA, 5063, Australia
| | - Leanne Weekes
- CT:IQ, 123 Glen Osmond Rd, Eastwood, SA, 5063, Australia
| | - Sonia Harvey
- CT:IQ, 123 Glen Osmond Rd, Eastwood, SA, 5063, Australia
| | - Ashika Kumar
- ClinicaltrialsNSW, The Office for Health and Medical Research, NSW Ministry of Health, LMB 2030, St Leonards, NSW, 1590, Australia
| | - Meghan Leigh
- Department of Research, Icon Group, 22 Cordelia St, South Brisbane, QLD, 4101, Australia
| | - Falko Thiele
- BIOTRONIK Australia Pty Ltd., Level 4, Building 2, 20 Bridge Street, Pymble, NSW, 2073, Australia
| | - Dhanusha Sabanathan
- Faculty of Medicine, Health and Human Sciences, Macquarie University, Suite 407, Level 4 F10A Building, 2 Technology Place Macquarie University, NSW, 2109, Australia.,Department of Medical Oncology, Nepean Hospital, Derby Street, Kingswood, NSW, 2747, Australia
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12
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Köhrmann M, Kleinschnitz C. [Update on antithrombotic secondary prevention of ischemic stroke]. Nervenarzt 2019; 90:995-1004. [PMID: 31560112 DOI: 10.1007/s00115-019-00788-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
Over the past decade innovations regarding antithrombotic treatment for secondary stroke prevention have been particularly dominated by the non-vitamin K dependent anticoagulants in patients with cardioembolic stroke; however, several studies investigating other important aspects have also recently been published. This update focuses on new trials on intensified antiplatelet therapy in the early phase of (mild) stroke and transient ischemic attacks (TIA) as well as studies on secondary prevention in patients with embolic stroke of undetermined source (ESUS). Data from these studies are critically reviewed to demonstrate strategies for clinical implementation.
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Affiliation(s)
- Martin Köhrmann
- Klinik für Neurologie, Universitätsklinikum Essen, Hufelandstr. 55, 45147, Essen, Deutschland.
| | - Christoph Kleinschnitz
- Klinik für Neurologie, Universitätsklinikum Essen, Hufelandstr. 55, 45147, Essen, Deutschland
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13
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Ohashi A, Kataoka M, Kanao S, Iima M, Murata K, Weiland E, Onishi N, Kawai M, Toi M, Togashi K. Diagnostic performance of maximum slope: A kinetic parameter obtained from ultrafast dynamic contrast-enhanced magnetic resonance imaging of the breast using k-space weighted image contrast (KWIC). Eur J Radiol 2019; 118:285-292. [PMID: 31324411 DOI: 10.1016/j.ejrad.2019.06.012] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2018] [Revised: 05/14/2019] [Accepted: 06/11/2019] [Indexed: 11/18/2022]
Abstract
PURPOSE To compare the diagnostic performance of the kinetic parameter maximum slope (MS) in breast lesions obtained by ultrafast dynamic contrast-enhanced magnetic resonance imaging (DCE MRI) of the contrast wash-in period with that of the washout index (WI) derived from standard DCE MRI and that of the Breast Imaging Reporting and Data System (BI-RADS) category. MATERIALS AND METHODS In total, 138 contrast enhanced lesions (90 malignant, 48 benign) were evaluated. Ultrafast DCE MRI images were acquired using a k-space-weighted image contrast (KWIC), obtained 0-1 min after gadolinium injection (3.75 s/frame; 16 frames) and followed by standard DCE MRI (60 s/frame, 3 frames). MS was calculated for the KWIC time series as percentage relative enhancement per second (%/s). As a semi-quantitative parameter for the standard DCE MRI time series, WI was evaluated using the change in signal intensity between early and delayed phases. The diagnostic performance (malignant/benign differentiation) of MS, WI, and BI-RADS category was compared by ROC analysis using the area under the curve (AUC). RESULTS The AUC of MS was as good as that of WI (0.81 vs. 0.79, respectively; P = 0.81), yet inferior to the BI-RADS category (0.81 vs. 0.96, respectively; <0.001). MS tended to have higher sensitivity (91.1% [82/90]) compared with WI (87.8% [79/90]) with same specificity (62.5% [30/48]). CONCLUSIONS MS obtained by ultrafast DCE MRI of the breast is a promising kinetic parameter in the differential diagnosis of malignant and benign breast lesions with decreased scanning time.
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Affiliation(s)
- Akane Ohashi
- Department of Diagnostic Imaging and Nuclear Medicine, Kyoto University Graduate School of Medicine, Kyoto, Japan.
| | - Masako Kataoka
- Department of Diagnostic Imaging and Nuclear Medicine, Kyoto University Graduate School of Medicine, Kyoto, Japan.
| | - Shotaro Kanao
- Kobe City Medical Center General Hospital, Kobe, Hyogo, Japan.
| | - Mami Iima
- Department of Diagnostic Imaging and Nuclear Medicine, Kyoto University Graduate School of Medicine, Kyoto, Japan.
| | | | | | - Natsuko Onishi
- Department of Diagnostic Imaging and Nuclear Medicine, Kyoto University Graduate School of Medicine, Kyoto, Japan.
| | - Makiko Kawai
- Department of Diagnostic Imaging and Nuclear Medicine, Kyoto University Graduate School of Medicine, Kyoto, Japan.
| | - Masakazu Toi
- Department of Breast Surgery, Kyoto University Graduate School of Medicine, Kyoto, Japan.
| | - Kaori Togashi
- Department of Diagnostic Imaging and Nuclear Medicine, Kyoto University Graduate School of Medicine, Kyoto, Japan.
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14
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Fisher DJ, Rudolph ED, Ells EML, Knott VJ, Labelle A, Tibbo PG. Mismatch negativity-indexed auditory change detection of speech sounds in early and chronic schizophrenia. Psychiatry Res Neuroimaging 2019; 287:1-9. [PMID: 30933744 DOI: 10.1016/j.pscychresns.2019.03.010] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/27/2018] [Revised: 03/11/2019] [Accepted: 03/19/2019] [Indexed: 11/27/2022]
Abstract
Auditory change detection, as indexed by the EEG-derived mismatch negativity, has been demonstrated to be dysfunctional in chronic schizophrenia using both pure-tone and speech (phoneme) sounds. It is unclear, however, whether reduced MMN amplitudes to speech sound deviants are observed within the first 5 years of the illness. The present study investigated MMNs elicited by across-vowel (phoneme) change in early schizophrenia (ESZ; Experiment 1) as well as chronic schizophrenia (CSZ; Experiment 2). In both experiments, clinical and control participants were presented the Finnish phoneme /e/ (standard; P = .90) and the Finnish phoneme /ö/ (deviant; P = .10) within an oddball paradigm. In experiment 2 we report significantly reduced MMN amplitudes in CSZ relative to HCs, but no differences were found when comparing ESZ and HC in experiment 1. Additionally, in our clinical samples, MMN amplitudes were correlated with symptom scores. These findings suggest that early detection of phonetic change may be impaired in chronic schizophrenia, but not early in the progression of the illness. As MMN reductions only emerged in patients with a longer course of illness, and appeared to change with symptom severity, this suggests a dynamic change in the early auditory processing of language over time in schizophrenia.
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Affiliation(s)
- Derek J Fisher
- Department of Psychology, Mount Saint Vincent University, Halifax, Nova Scotia, Canada; The Royal's Institute of Mental Health Research, Ottawa, Ontario, Canada; Department of Psychiatry, Dalhousie University, Halifax, Nova Scotia, Canada; Department of Psychology, Saint Mary's University, Halifax, Nova Scotia, Canada.
| | - Erica D Rudolph
- Department of Psychology, Mount Saint Vincent University, Halifax, Nova Scotia, Canada; Department of Psychology, Saint Mary's University, Halifax, Nova Scotia, Canada
| | - Emma M L Ells
- Department of Psychology, Mount Saint Vincent University, Halifax, Nova Scotia, Canada
| | - Verner J Knott
- The Royal's Institute of Mental Health Research, Ottawa, Ontario, Canada
| | - Alain Labelle
- The Royal's Institute of Mental Health Research, Ottawa, Ontario, Canada
| | - Philip G Tibbo
- Department of Psychiatry, Dalhousie University, Halifax, Nova Scotia, Canada; Nova Scotia Early Psychosis Program, Nova Scotia Health Authority, Halifax, Nova Scotia, Canada
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15
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Kanjanapan Y, Day D, Butler MO, Wang L, Joshua AM, Hogg D, Leighl NB, Razak ARA, Hansen AR, Boujos S, Chappell M, Chow K, Sherwin B, Stayner LA, Soultani L, Zambrana A, Siu LL, Bedard PL, Spreafico A. Delayed immune-related adverse events in assessment for dose-limiting toxicity in early phase immunotherapy trials. Eur J Cancer 2018; 107:1-7. [PMID: 30529898 DOI: 10.1016/j.ejca.2018.10.017] [Citation(s) in RCA: 44] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2018] [Revised: 10/29/2018] [Accepted: 10/31/2018] [Indexed: 01/14/2023]
Abstract
BACKGROUND Immunotherapy (IO) agents can cause late-onset immune-related adverse events (irAEs). In phase I trials, observation for dose-limiting toxicities (DLTs) is typically limited to the first cycle. The incidence of delayed-onset DLTs and their potential impact on dose determination have not been fully elucidated. PATIENTS AND METHODS Consecutive patients enrolled in early phase IO trials at Princess Margaret Cancer Centre between August 2012 and September 2016 were retrospectively reviewed, applying trial-specific definitions for DLTs. A clinically significant AE (csAE) was defined as a treatment-related adverse event requiring corticosteroids, hormone replacement, IO delay or discontinuation. RESULTS A total of 352 consecutive trial enrolments in 21 early phase clinical trials were included. Two-hundred seventy-eight patients (79%) received monotherapy and 74 (21%) received combination IO. Two hundred sixty (74%) patients experienced irAEs. There were two protocol-defined DLTs. Twenty (5.7%) patients had 24 csAEs qualifying as DLTs except for occurrence after the protocol-specified DLT period. One-hundred and six (10%) of irAEs were csAEs, including endocrine (26%), respiratory (14%), gastrointestinal (11%), general (10%), dermatological (8%), hepatic (8%), musculoskeletal (6%), pancreatic (6%), haematological, metabolic, neurological, cardiac (each 2%), infective and ocular (each 1%) events. The highest risk of first-onset csAE was during the first 4 weeks compared with the period from 4 weeks to end of treatment (odds ratio 3.13, 95% confidence interval 1.95-5.02). The median time to first onset csAE was significantly shorter with combination than monotherapy IO (32 vs. 146 days, P < 0.001). CONCLUSIONS In our series of early phase IO trials, the risk of csAE was highest during the initial 4 weeks on IO treatment, supporting the use of the conventional DLT period for dose escalation decision. However, there were 24 clinically significant late-onset DLTs in 5.7% of patients. Combination IO was associated with greater risk of and also earlier onset for csAE, which may need to be considered for early phase trial design.
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Affiliation(s)
- Y Kanjanapan
- Division of Medical Oncology and Hematology, Princess Margaret Cancer Centre, University Health Network, Toronto, Canada; Department of Medicine, University of Toronto, Toronto, Canada; Drug Development Program, Princess Margaret Cancer Centre, University Health Network, Toronto, Canada
| | - D Day
- Division of Medical Oncology and Hematology, Princess Margaret Cancer Centre, University Health Network, Toronto, Canada; Department of Medicine, University of Toronto, Toronto, Canada; Drug Development Program, Princess Margaret Cancer Centre, University Health Network, Toronto, Canada
| | - M O Butler
- Division of Medical Oncology and Hematology, Princess Margaret Cancer Centre, University Health Network, Toronto, Canada; Department of Medicine, University of Toronto, Toronto, Canada; Drug Development Program, Princess Margaret Cancer Centre, University Health Network, Toronto, Canada
| | - L Wang
- Biostatistics Department, Princess Margaret Cancer Centre, University Health Network, Toronto, Canada
| | - A M Joshua
- Division of Medical Oncology and Hematology, Princess Margaret Cancer Centre, University Health Network, Toronto, Canada; Department of Medicine, University of Toronto, Toronto, Canada; Drug Development Program, Princess Margaret Cancer Centre, University Health Network, Toronto, Canada
| | - D Hogg
- Division of Medical Oncology and Hematology, Princess Margaret Cancer Centre, University Health Network, Toronto, Canada; Department of Medicine, University of Toronto, Toronto, Canada; Drug Development Program, Princess Margaret Cancer Centre, University Health Network, Toronto, Canada
| | - N B Leighl
- Division of Medical Oncology and Hematology, Princess Margaret Cancer Centre, University Health Network, Toronto, Canada; Department of Medicine, University of Toronto, Toronto, Canada; Drug Development Program, Princess Margaret Cancer Centre, University Health Network, Toronto, Canada
| | - A R Abdul Razak
- Division of Medical Oncology and Hematology, Princess Margaret Cancer Centre, University Health Network, Toronto, Canada; Department of Medicine, University of Toronto, Toronto, Canada; Drug Development Program, Princess Margaret Cancer Centre, University Health Network, Toronto, Canada
| | - A R Hansen
- Division of Medical Oncology and Hematology, Princess Margaret Cancer Centre, University Health Network, Toronto, Canada; Department of Medicine, University of Toronto, Toronto, Canada; Drug Development Program, Princess Margaret Cancer Centre, University Health Network, Toronto, Canada
| | - S Boujos
- Drug Development Program, Princess Margaret Cancer Centre, University Health Network, Toronto, Canada
| | - M Chappell
- Division of Medical Oncology and Hematology, Princess Margaret Cancer Centre, University Health Network, Toronto, Canada
| | - K Chow
- Drug Development Program, Princess Margaret Cancer Centre, University Health Network, Toronto, Canada
| | - B Sherwin
- Division of Medical Oncology and Hematology, Princess Margaret Cancer Centre, University Health Network, Toronto, Canada
| | - L-A Stayner
- Drug Development Program, Princess Margaret Cancer Centre, University Health Network, Toronto, Canada
| | - L Soultani
- Drug Development Program, Princess Margaret Cancer Centre, University Health Network, Toronto, Canada
| | - A Zambrana
- Division of Medical Oncology and Hematology, Princess Margaret Cancer Centre, University Health Network, Toronto, Canada
| | - L L Siu
- Division of Medical Oncology and Hematology, Princess Margaret Cancer Centre, University Health Network, Toronto, Canada; Department of Medicine, University of Toronto, Toronto, Canada; Drug Development Program, Princess Margaret Cancer Centre, University Health Network, Toronto, Canada
| | - P L Bedard
- Division of Medical Oncology and Hematology, Princess Margaret Cancer Centre, University Health Network, Toronto, Canada; Drug Development Program, Princess Margaret Cancer Centre, University Health Network, Toronto, Canada
| | - A Spreafico
- Division of Medical Oncology and Hematology, Princess Margaret Cancer Centre, University Health Network, Toronto, Canada; Department of Medicine, University of Toronto, Toronto, Canada; Drug Development Program, Princess Margaret Cancer Centre, University Health Network, Toronto, Canada.
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Brown SR, Sherratt D, Booth G, Brown J, Collinson F, Gregory W, Flanagan L. Experiences of establishing an academic early phase clinical trials unit. Clin Trials 2017; 14:349-356. [PMID: 28532202 DOI: 10.1177/1740774517710250] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Early phase trials are essential in drug development, determining appropriate dose levels and assessing preliminary activity. These trials are undertaken by industry and academia, with increasing collaborations between the two. There is pressure to perform these trials quickly, safely, and robustly. However, there are inherent differences between developing and managing early phase, compared to late phase, drug trials. This article describes an approach to establishing an academically led early phase trial portfolio, highlighting lessons learned and sharing experiences. METHODS In 2009, the University of Leeds Clinical Trials Research Unit became the Clinical Trials Coordinating Office for Myeloma UK's phase I and II trials. We embarked on a transition from working extensively in phase III to early phase trials development and conduct. This involved evaluating and revising our well-established standard operating procedures, visiting other academic early phase units, and developing essential new documentation and processes. RESULTS A core team of trial and data managers and statisticians was established to facilitate expertise and knowledge retention. A detailed training plan was implemented focussing on essential standard practices for early phase. These included pharmacovigilance, recruitment, trial design and set-up, data and site monitoring, and oversight committees. Training in statistical methods for early phase trials was incorporated. CONCLUSION Initial scoping of early phase trial management and conduct was essential in establishing this early phase portfolio. Many of the processes developed were successful. However, regular review and evaluation were implemented to enable changes and ensure efficiencies. It is recommended that others embarking on this venture build on the experiences described in this article.
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Affiliation(s)
- Sarah R Brown
- Leeds Institute of Clinical Trials Research (LICTR), University of Leeds, Leeds, UK
| | - Debbie Sherratt
- Leeds Institute of Clinical Trials Research (LICTR), University of Leeds, Leeds, UK
| | - Gill Booth
- Leeds Institute of Clinical Trials Research (LICTR), University of Leeds, Leeds, UK
| | - Julia Brown
- Leeds Institute of Clinical Trials Research (LICTR), University of Leeds, Leeds, UK
| | - Fiona Collinson
- Leeds Institute of Clinical Trials Research (LICTR), University of Leeds, Leeds, UK
| | - Walter Gregory
- Leeds Institute of Clinical Trials Research (LICTR), University of Leeds, Leeds, UK
| | - Louise Flanagan
- Leeds Institute of Clinical Trials Research (LICTR), University of Leeds, Leeds, UK
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Sasaki N, Abo M, Hara T, Yamada N, Niimi M, Kakuda W. High-frequency rTMS on leg motor area in the early phase of stroke. Acta Neurol Belg 2017; 117:189-194. [PMID: 27502413 DOI: 10.1007/s13760-016-0687-1] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2016] [Accepted: 08/01/2016] [Indexed: 10/21/2022]
Abstract
Although repetitive transcranial magnetic stimulation (rTMS) for upper limb motor area in stroke patients is beneficial, it has been poorly investigated in rTMS for leg motor area. Furthermore, no study has examined the usefulness of rTMS for leg motor area in patients in the early phase of stroke. Twenty-one patients with a hemispheric stroke lesion in the early phase were randomly assigned into two groups: the high-frequency (HF)-rTMS group [N = 11] and the sham stimulation group [N = 10]. Patients received rTMS for 5 consecutive days, beginning 10.9 ± 6.6 days on average after the onset. Brunnstrom Recovery Stages (BRS) for the lower limbs and the Ability for Basic Movement Scale Revised (ABMS II) were assessed before and after the intervention. The improvement in BRS for the lower limbs was significant after the intervention in the HF-rTMS group. Although both the HF-rTMS and sham stimulation groups had significant improvements in ABMS II scores, the extent of improvement in the AMBS II was significantly greater in the HF-rTMS group than in the sham stimulation group. Application of HF-rTMS over the bilateral leg motor areas has potential to be a new rehabilitation therapy for patients in the acute phase of stroke.
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Chalela P, Suarez L, Muñoz E, Gallion KJ, Pollock BH, Weitman SD, Karnad A, Ramirez AG. Promoting Factors and Barriers to Participation in Early Phase Clinical Trials: Patients Perspectives. J Community Med Health Educ 2014; 4:1000281. [PMID: 25077043 PMCID: PMC4112537 DOI: 10.4172/2161-0711.1000281] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
BACKGROUND Inclusion of minorities in clinical research is an essential step to develop novel cancer treatments, improve health care overall, understand potential differences in pharmacogenomics and address minorities' disproportionate cancer burden. However, Latinos and other minority groups continue to be critically underrepresented, particularly in early-phase clinical trials (EPCTs). The objective of the present study was to explore barriers and promoting factors influencing patients' decisions to enroll or not in early phase clinical trials (EPCTs) and identify areas for intervention to increase minority enrollment into clinical research. METHODS An interviewer-administered survey was conducted with 100 cancer patients in the predominantly Latino region of South Texas. Exploratory factor analysis was conducted to identify underlying dimensions, and multiple logistic regression assessed significant factors that promote or deter patients enrollment to EPCTs. In addition, a separate subgroup mean analysis assessed differences by enrollment status and race/ethnicity. RESULTS For one standard deviation increase in the importance given to the possibility of symptoms improvement, the predicted odds of refusing enrollment were 3.20 times greater (OR=3.20, 95% CI=1.06-9.71, p 0.040). Regarding barriers, among patients who considered fear/uncertainty of the new treatment a deterrent to enrollment, one standard deviation increase in agreement with these barriers was associated with a 3.60 increase (OR=3.60, 95% CI=1.30-9.97h, p 0.014) in the odds of not being enrolled in an EPCT. In contrast, non-enrolled patients were less likely (OR=0.14, 95% CI=0.05-0.44, p 0.001) to consider fatalistic beliefs as an important barrier. CONCLUSION This study, one of the first to identify South Texas patients' barriers to enroll in EPCTs, highlights potential focal areas to increase participation of both minority and non-minority patients in clinical research. Culturally tailored interventions promoting patient-centered care and bilingual, culturally competent study teams could solve common barriers and enhance Latinos' likelihood of joining clinical trials. These interventions may simultaneously increase opportunities to involve patients and physicians in clinical trials, while ensuring the benefits of participation are equitably distributed to all patients.
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Affiliation(s)
- Patricia Chalela
- Institute for Health Promotion Research The University of Texas Health Science Center at San Antonio 7411 John Smith Dr., Suite 1000 San Antonio, TX 78229
| | | | - Edgar Muñoz
- Institute for Health Promotion Research The University of Texas Health Science Center at San Antonio 7411 John Smith Dr., Suite 1000 San Antonio, TX 78229
| | - Kipling J Gallion
- Institute for Health Promotion Research The University of Texas Health Science Center at San Antonio 7411 John Smith Dr., Suite 1000 San Antonio, TX 78229
| | - Brad H Pollock
- Department of Epidemiology and Biostatistics The University of Texas Health Science Center at San Antonio 7703 Floyd Curl Ave., Mail Code 7933 San Antonio, TX 78229-3901
| | - Steven D Weitman
- The University of Texas Health Science Center at San Antonio Cancer Therapy & Research Center Institute for Drug Development 7979 Wurzbach Road, Room Z459 San Antonio, Texas 78229
| | - Anand Karnad
- The University of Texas Health Science Center at San Antonio Cancer Therapy & Research Center Institute for Drug Development 7979 Wurzbach Road, Room Z459 San Antonio, Texas 78229
| | - Amelie G Ramirez
- Institute for Health Promotion Research The University of Texas Health Science Center at San Antonio 7411 John Smith Dr., Suite 1000 San Antonio, TX 78229
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Yamaguchi K, Wakatsuki T, Niki T, Taketani Y, Oezuka H, Kusunose K, Iwase T, Yamada H, Soeki T, Sata M. Observation of short-term atorvastatin-induced changes in coronary arterial plaque properties using integrated backscatter intravascular ultrasound in a patient. J Cardiol Cases 2011; 3:e111-4. [PMID: 30532851 DOI: 10.1016/j.jccase.2011.03.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2011] [Revised: 03/15/2011] [Accepted: 03/22/2011] [Indexed: 11/23/2022] Open
Abstract
Integrated backscatter intravascular ultrasound (IB-IVUS) capable of assessing plaque properties has recently become clinically applicable. We observed short-term atorvastatin-induced changes in coronary arterial plaque properties using IB-IVUS. The patient was a 57-year-old man who underwent coronary angiography when admitted to our hospital for cerebrovascular surgery, and lesions were observed in 2 branches: 99% and 90% stenoses in the proximal anterior descending branch (LAD) and middle region of the circumflex, respectively. Stenting was performed for the LAD on November 4, 2009 and for the circumflex on December 9. Oral atorvastatin administration at 10 mg/day was initiated on November 5 because the LDL-cholesterol level was high (160 mg/dl). A region about 5 mm in length proximal to the stent placed in the LAD was analyzed using IB-IVUS. Atorvastatin lowered the LDL cholesterol level from 160 to 79 mg/dl. On IB image analysis, although the period was as short as about 1 month, a marked decrease in the fatty component (44% → 26%) and an increase in the fibrous component (53% → 66%) were observed in the plaque. It was suggested that atorvastatin changes the tissue properties of coronary arterial plaques from a very early phase. It might be associated with the stabilization of coronary plaque.
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