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Wakil A, Niazi M, Meybodi MA, Pyrsopoulos NT. Emerging Pharmacotherapies in Alcohol-Associated Hepatitis. J Clin Exp Hepatol 2023; 13:116-126. [PMID: 36647403 PMCID: PMC9840076 DOI: 10.1016/j.jceh.2022.06.012] [Citation(s) in RCA: 2] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/14/2022] [Accepted: 06/25/2022] [Indexed: 02/07/2023] Open
Abstract
The incidence of alcoholic-associated hepatitis (AH) is increasing. The treatment options for severe AH (sAH) are scarce and limited to corticosteroid therapy which showed limited mortality benefit in short-term use only. Therefore, there is a dire need for developing safe and effective therapies for patients with sAH and to improve their high mortality rates.This review article focuses on the current novel therapeutics targeting various mechanisms in the pathogenesis of alcohol-related hepatitis. Anti-inflammatory agents such as IL-1 inhibitor, Pan-caspase inhibitor, Apoptosis signal-regulating kinase-1, and CCL2 inhibitors are under investigation. Other group of agents include gut-liver axis modulators, hepatic regeneration, antioxidants, and Epigenic modulators. We describe the ongoing clinical trials of some of the new agents for alcohol-related hepatitis. Conclusion A combination of therapies was investigated, possibly providing a synergistic effect of drugs with different mechanisms. Multiple clinical trials of novel therapies in AH remain ongoing. Their result could potentially make a difference in the clinical course of the disease. DUR-928 and granulocyte colony-stimulating factor had promising results and further trials are ongoing to evaluate their efficacy in the large patient sample.
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Key Words
- AH, alcohol-Associated hepatitis
- ALD, Alcohol-associated liver disease
- ASK-1, Apoptosis signal-regulating kinase-1
- AUD, alcohol use disorder
- CCL2, C–C chemokine ligand type 2
- CVC, Cenicriviroc
- ELAD, Extracorporeal liver assist device
- FMT, Fecal Microbiota Transplant
- G-CSF, Granulocyte colony-stimulating factor
- HA35, Hyaluronic Acid 35KD
- IL-1, interleukin 1
- IL-6, interleukin 6
- LCFA, saturated long-chain fatty acids
- LDL, low-density lipoprotein cholesterol
- LPS, Lipopolysaccharides
- MCP-1, monocyte chemoattractant protein −1
- MDF, Maddrey's discriminant function
- MELD, Model for end-stage disease
- NAC, N-acetylcysteine
- NLRs, nucleotide-binding oligomerization domain-like receptors
- PAMPs, Pathogen-associated molecular patterns
- RCT, Randomized controlled trial
- SAM, S-Adenosyl methionine
- SCFA, short-chain fatty acids. 5
- TLRs, Toll-like receptors
- TNF, tumor necrotic factor
- alcohol-associated hepatitis
- anti-inflammatory
- antioxidants
- liver-gut axis
- microbiome
- sAH, severe alcohol-associated hepatitis
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Affiliation(s)
- Ali Wakil
- Department of Gastroenterology and Hepatology, Rutgers New Jersey Medical School, New York, New Jersey, USA
| | - Mumtaz Niazi
- Department of Gastroenterology and Hepatology, Rutgers New Jersey Medical School, New York, New Jersey, USA
| | - Mohamad A. Meybodi
- Department of Internal Medicine, Rutgers New Jersey Medical School, New York, New Jersey, USA
| | - Nikolaos T. Pyrsopoulos
- Department of Gastroenterology and Hepatology, Rutgers New Jersey Medical School, New York, New Jersey, USA
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Pahwa R, Aldred J, Merola A, Gupta N, Terasawa E, Garcia-Horton V, Steffen DR, Kandukuri PL, Bao Y, Ladhani O, Yan CH, Chaudhari V, Isaacson SH. Long-term results of carbidopa/levodopa enteral suspension across the day in advanced Parkinson's disease: Post-hoc analyses from a large 54-week trial. Clin Park Relat Disord 2023; 8:100181. [PMID: 36594071 DOI: 10.1016/j.prdoa.2022.100181] [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: 07/18/2022] [Revised: 10/26/2022] [Accepted: 11/15/2022] [Indexed: 12/24/2022] Open
Abstract
Introduction Carbidopa/levodopa enteral suspension (CLES) previously demonstrated reduction in total daily OFF from baseline by over 4 hours in advanced Parkinson's disease patients across 54 weeks. Evidence on CLES's long-term effectiveness on patterns of motor-symptom control throughout the day remains limited. Methods We present post-hoc analyses of a large, open-label study of CLES monotherapy (N = 289). Diary data recorded patients' motor states at 30-minute intervals over 3 days at baseline and weeks 4, 12, 24, 36, and 54. Adjusted generalized linear mixed models assessed changes from baseline at each timepoint for four outcome measures: time to ON without troublesome dyskinesia (ON-woTD) after waking, motor-symptom control as measured by motor states' durations throughout the day, number of motor-state transitions, and presence of extreme fluctuations (OFF to ON with TD). Results Patients demonstrated short-term (wk4) and sustained (wk54) improvement in all outcomes compared to baseline. At weeks 4 and 54, patients were more likely to reach ON-woTD over the course of their day (HR: 1.86 and 2.51, both P < 0.0001). Across 4-hour intervals throughout the day, patients also experienced increases in ON-woTD (wk4: 58-65 min; wk54: 60-78 min; all P < 0.0001) and reductions in OFF (wk4: 50-61 min; wk54: 56-68 min; all P < 0.0001). At weeks 4 and 54, patients' motor-state transitions were reduced by about half (IRR: 0.53 and 0.49, both P < 0.0001), and fewer patients experienced extreme fluctuations (OR: 0.22 and 0.15, both P < 0.0001). Conclusion CLES monotherapy was associated with significant long-term reductions in motor-state fluctuations, faster time to ON-woTD upon awakening, and increased symptom control throughout the day.
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Key Words
- ADL, Activities of daily living
- APD, Advanced Parkinson's disease
- CGI-S, Clinical Global Impression of disease severity
- CLES, Carbidopa/levodopa enteral suspension
- Carbidopa/levodopa enteral suspension
- Carbidopa/levodopa intestinal gel
- Duodopa
- Duopa
- Dyskinesia
- HR, Hazard ratio
- IRR, Incidence rate ratio
- Long-term effectiveness
- OFF, “Off” time
- ON, “On” time
- ON-wTD, “On” time with troublesome dyskinesia
- ON-woTD, “On” time without troublesome dyskinesia
- OR, Odds ratio
- PD, Parkinson’s disease
- PEG-J, Percutaneous endoscopic gastrojejunostomy
- Parkinson’s disease
- QoL, Quality of life
- RCT, Randomized controlled trial
- SD, Standard deviation
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Waid JL, Wendt AS, Sinharoy SS, Kader A, Gabrysch S. Impact of a homestead food production program on women's empowerment: Pro-WEAI results from the FAARM trial in Bangladesh. World Dev 2022; 158:106001. [PMID: 36193041 PMCID: PMC9351289 DOI: 10.1016/j.worlddev.2022.106001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Accepted: 06/09/2022] [Indexed: 06/16/2023]
Abstract
Nutrition-sensitive agricultural programs have the potential to improve women's and children's nutrition, along with women's empowerment. The project-level Women's Empowerment in Agriculture Index (pro-WEAI) aims to standardize the measurement of women's agency and enable the assessment of impact over typical project timelines. Within the Food and Agricultural Approaches to Reducing Malnutrition (FAARM) cluster-randomized controlled trial in rural Habiganj, Sylhet, Bangladesh, we examined quantitative pro-WEAI data collected from a subsample of trial participants and their husbands (n = 885) approximately four months after the end of the intervention. We evaluated the impact of a three-year homestead food production program on men's and women's agency separately by pro-WEAI domain and indicator, using multilevel logistic and linear regression. We show that women in the FAARM intervention group had levels of agency similar to men and much higher than women in the control group (Odds Ratio [OR] 7.7, p < 0.001), corresponding to better gender equity in intervention areas (OR 3.5, p < 0.001). The higher levels of agency among intervention women were driven by greater intrinsic and collective agency but not by instrumental agency. Compared to controls, more women in the intervention group found intimate partner violence unacceptable (OR 3.5, p < 0.001), had greater ownership of assets (OR 2.6, p = 0.001), better control of income (OR 1.8, p = 0.042), higher levels of group membership (OR 14.0, p < 0.001), and membership in groups they considered influential (OR 166.8, p < 0.001). Self-efficacy was greater in intervention areas for both women (OR 3.2, p < 0.001) and men (OR 2.3, p = 0.002). Our results contribute to the development of benchmarks for interpreting pro-WEAI scores across programs. Our assessment of the impact of a homestead food production program on women's agency provides additional rationale for women-led agricultural projects. We plan to build on these findings by examining the role of improved women's agency on the pathway from the intervention to nutritional impacts.
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Key Words
- 3DE, Three domains of empowerment
- Agency
- Agriculture
- DHS, Demographic and Health Survey
- FAARM, Food and Agricultural Approaches to Reducing Malnutrition
- GAAP2, Gender, Agriculture, and Assets Project–Phase 2
- GPI, Gender Parity Index
- Gender equity
- Homestead food production
- IFPRI, International Food Policy Research Institute
- ODK, Open Data Kit
- OR, Odds Ratio
- RCT, Randomized controlled trial
- SDG, Sustainable Development Goal
- Self-efficacy
- WEAI, Women's Empowerment in Agriculture Index
- Women’s groups
- pro-WEAI, project-level Women's Empowerment in Agriculture Index
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Affiliation(s)
- Jillian L. Waid
- Research Department 2, Potsdam Institute for Climate Impact Research (PIK), Member of the Leibniz Association, Potsdam, Germany
- Heidelberg Institute of Global Health, Heidelberg University, Heidelberg, Germany
- Bangladesh Country Office, Helen Keller International, Dhaka, Bangladesh
| | - Amanda S. Wendt
- Research Department 2, Potsdam Institute for Climate Impact Research (PIK), Member of the Leibniz Association, Potsdam, Germany
- Heidelberg Institute of Global Health, Heidelberg University, Heidelberg, Germany
| | - Sheela S. Sinharoy
- Hubert Department of Global Health and Gangarosa Department of Environmental Health, Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - Abdul Kader
- Bangladesh Country Office, Helen Keller International, Dhaka, Bangladesh
| | - Sabine Gabrysch
- Research Department 2, Potsdam Institute for Climate Impact Research (PIK), Member of the Leibniz Association, Potsdam, Germany
- Heidelberg Institute of Global Health, Heidelberg University, Heidelberg, Germany
- Institute of Public Health, Charité – Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
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Lam CS, Koon HK, Ma CT, Au KY, Zuo Z, Chung VCH, Cheung YT. Real-world data on herb-drug interactions in oncology: A scoping review of pharmacoepidemiological studies. Phytomedicine 2022; 103:154247. [PMID: 35716539 DOI: 10.1016/j.phymed.2022.154247] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/28/2021] [Revised: 05/14/2022] [Accepted: 06/05/2022] [Indexed: 06/15/2023]
Abstract
BACKGROUND The concurrent use of conventional drugs and herbal medicines is becoming popular among patients with cancer. However, the potential risk of herb-drug interactions (HDI) remains under-addressed in the literature. Previous reviews have mainly focused on the prevalence of interactions, with less attention paid to the methods used by pharmacoepidemiological studies on evaluating HDI. This scoping review aims to summarize the existing pharmacoepidemiological studies that evaluate HDI using real-world data and to identify gaps to be addressed in future research. METHODS A comprehensive search was performed in nine English- and Chinese-language databases from their inception to May 2021. Gray literature and manual searches were conducted to identify additional studies. The recommended components of the pharmacoepidemiological studies and key findings related to HDI were summarized. The proportion (%) of patients with cancer at risk of HDI was estimated by combining data from eligible studies. RESULTS Twenty-eight studies were included in the review. More than half of these studies were cross-sectional studies (n = 18, 64.3%), followed by retrospective cohort studies (n = 5, 17.9%) and prospective cohort studies (n = 2, 7.1%). The three cancer drugs most commonly studied for their interaction potential with herbs were tamoxifen (n = 11, 39.3%), cyclophosphamide (n = 6, 21.4%), and paclitaxel (n = 6, 21.4%). Most cross-sectional studies identified potential HDI using tertiary databases and primary literature searches. Conversely, prospective and retrospective studies mainly investigated actual clinical outcomes, such as adverse events and secondary cancer occurrences. Most interaction outcomes identified using real-world data did not lead to negative clinical consequences. Collectively, 45.4% of herbal medicine users of the included studies were found to be at risk of HDI. We infer from this review that the common limitations of these studies were limited sample size, lack of data on herbal medicine use and details of HDI, and lack of evidence of HDI. Based on the study limitations, several recommendations to enrich the data sources and optimize the study designs were proposed. CONCLUSIONS There is a high demand for pharmacoepidemiological research on HDI, considering the increasing popularity of herbal medicine among patients with cancer. It is anticipated that emerging real-world data in this field can guide the development of safe and effective approaches to integrative oncology.
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Affiliation(s)
- Chun Sing Lam
- School of Pharmacy, Faculty of Medicine, The Chinese University of Hong Kong, 8th Floor, Lo Kwee-Seong Integrated Biomedical Sciences Building, Area 39, Shatin, NT, Hong Kong
| | - Ho Kee Koon
- School of Chinese Medicine, Faculty of Medicine, Chung Chi College, The Chinese University of Hong Kong, Room 101, Li Wai Chun Building, Shatin, NT, Hong Kong
| | - Chung Tin Ma
- School of Pharmacy, Faculty of Medicine, The Chinese University of Hong Kong, 8th Floor, Lo Kwee-Seong Integrated Biomedical Sciences Building, Area 39, Shatin, NT, Hong Kong
| | - Kwok Yin Au
- Hong Kong Institute of Integrative Medicine, The Chinese University of Hong Kong, Prince of Wales Hospital, 4L, 4/F, Day Treatment Block, Shatin, NT, Hong Kong
| | - Zhong Zuo
- School of Pharmacy, Faculty of Medicine, The Chinese University of Hong Kong, 8th Floor, Lo Kwee-Seong Integrated Biomedical Sciences Building, Area 39, Shatin, NT, Hong Kong
| | - Vincent Chi-Ho Chung
- School of Chinese Medicine, Faculty of Medicine, Chung Chi College, The Chinese University of Hong Kong, Room 101, Li Wai Chun Building, Shatin, NT, Hong Kong; Jockey Club School of Public Health and Primary Care, The Chinese University of Hong Kong, Prince of Wales Hospital, Room 202, School of Public Health Building, Shatin, NT, Hong Kong
| | - Yin Ting Cheung
- School of Pharmacy, Faculty of Medicine, The Chinese University of Hong Kong, 8th Floor, Lo Kwee-Seong Integrated Biomedical Sciences Building, Area 39, Shatin, NT, Hong Kong.
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Cohen KA, Schleider JL. Adolescent dropout from brief digital mental health interventions within and beyond randomized trials. Internet Interv 2022; 27:100496. [PMID: 35257001 DOI: 10.1016/j.invent.2022.100496] [Citation(s) in RCA: 16] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/17/2021] [Revised: 01/09/2022] [Accepted: 01/14/2022] [Indexed: 11/30/2022] Open
Abstract
OBJECTIVE Many adolescents struggle to access appropriate mental health care due to structural or psychological barriers. Although traditional barriers to participation (e.g., location, cost) are hypothetically reduced or removed in internet interventions, low retention reduces the likelihood that adolescents will receive the intervention dosage intended to produce beneficial effects. It is therefore key to determine what factors are associated with dropout in digital mental health interventions with adolescents both within and beyond the context of research studies. METHODS We compare completion rates from two projects evaluating self-guided, online single-session mental health interventions (SSIs) for adolescents. One was a randomized controlled trial (RCT) in which participants were paid for participation. The other was a program evaluation project in which participants were not paid for participation. We additionally compare SSI completion rates across various demographic groups and across baseline hopelessness levels. RESULTS There was a statistically significant difference in SSI completion status between the RCT (84.75% full-completers) and the program evaluation (36.86% full-completers), X 2 (2, N = 2436) = 583.5, p < 0.05. There were no significant differences in the baseline hopelessness scores across completion statuses in either study. There were no significant differences in full-completion rates across demographic groups in either project. CONCLUSION Adolescents may be more likely to complete a brief digital mental health intervention in a paid, research-based context than in an unpaid, naturalistic context. Additionally, it is possible that the brevity of SSIs reduces demographic disparities related to retention by minimizing the time required to complete an intervention.
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Robinson JK, Wahood S, Ly S, Kirk J, Yoon J, Sterritt J, Gray E, Kwasny M. Melanoma detection by skin self-examination targeting at-risk women: A randomized controlled trial with telemedicine support for concerning moles. Prev Med Rep 2021; 24:101532. [PMID: 34976609 PMCID: PMC8683880 DOI: 10.1016/j.pmedr.2021.101532] [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] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2021] [Revised: 08/16/2021] [Accepted: 08/22/2021] [Indexed: 12/04/2022] Open
Abstract
Secondary melanoma prevention remains crucial to reduce morbidity and mortality for the 200,000 people in the United States estimated to develop melanoma in 2021. This 3-month randomized controlled trial of online skin self-examination (SSE) education among 1000 at-risk women who received care at Northwestern Medicine in Illinois sought to determine SSE initiation and monthly performance, SSE anxiety and confidence, and health care practitioner (HCP) visits for concerning moles. Positive responses to a personal history of sunburn, a personal or family history of skin cancer, and/or having 10 or more lifetime indoor tanning sessions identified and informed women of their increased risk of melanoma. At one month, 96.2% of women receiving SSE education (SSE women) initiated SSE compared to 48.1% in the active control arm (control) (p < 0.001). More control women sought HCP visits (n = 107) than SSE women (n = 39). Control women seen by HCPs identified benign lesions, especially seborrheic keratosis, more often than SSE women. More atypical nevi (SSE 38.5%, control 8.4%) and melanomas (SSE 25.6%, control 4.7%) were visually identified by SSE women seeing HPCs (p < 0.001). There was no significant difference in SSE anxiety between the control and SSE arms. Confidence increased significantly in the SSE arm whereas there was no change in the control group (p < 0.001). Women checked someone else for concerning moles [315/ 494 (63.8%) of SSE women]. Targeting at-risk women for SSE education may help reduce melanoma mortality, especially in rural communities where incidence and mortality are greater than in urban areas.
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Affiliation(s)
- June K. Robinson
- Department of Dermatology, Northwestern University, Feinberg School of Medicine, Chicago, IL, USA
| | - Samer Wahood
- Department of Dermatology, Northwestern University, Feinberg School of Medicine, Chicago, IL, USA
| | - Sophia Ly
- Department of Dermatology, Northwestern University, Feinberg School of Medicine, Chicago, IL, USA
| | - Jessie Kirk
- Department of Dermatology, Northwestern University, Feinberg School of Medicine, Chicago, IL, USA
| | - Jamie Yoon
- Department of Dermatology, Northwestern University, Feinberg School of Medicine, Chicago, IL, USA
| | - James Sterritt
- Department of Dermatology, Northwestern University, Feinberg School of Medicine, Chicago, IL, USA
| | - Elizabeth Gray
- Department of Preventive Medicine, Northwestern University, Feinberg School of Medicine, Chicago, IL, USA
| | - Mary Kwasny
- Department of Preventive Medicine, Northwestern University, Feinberg School of Medicine, Chicago, IL, USA
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7
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Feemster KA, Head KJ, Panozzo CA, O'Dell SM, Zimet GD, Kornides ML. Efficacy of tailored messages to improve behavioral intent to accept HPV vaccination among mothers may be moderated by sociodemographics. Prev Med Rep 2021; 23:101413. [PMID: 34150474 PMCID: PMC8192722 DOI: 10.1016/j.pmedr.2021.101413] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2021] [Revised: 05/10/2021] [Accepted: 05/25/2021] [Indexed: 12/04/2022] Open
Abstract
The efficacy of a tailored video intervention differed by sociodemographics. Further research should evaluate interventions tailored by sociodemographics. Tailoring interventions by child age and other factors may improve efficacy.
We assessed differences in response to a tailored recommendation intervention for HPV vaccine by participants’ sociodemographic characteristics in this exploratory sub-analysis of a larger web-based, randomized-controlled trial on tailored messaging among mothers with low intent to vaccinate their 11–14-year-old child against HPV. The intervention consisted of pre-recorded video messages tailored to 1–5 common concerns about HPV vaccine. In these exploratory analyses, we used generalized linear models to assess differences in post-intervention intent across intervention arms, stratified by sociodemographic characteristics among 496 trial participants. We found significantly higher post-intervention intent in the intervention participants versus the control group among mothers: 1) with younger children; 2) with white vs. black children; 3) with Non-Hispanic children; 4) who were younger; 5) with some college or vocational training; with household incomes of ≥$100,000; and 7) with 1–2 children. Our findings of effect modification by certain sociodemographic factors such as age, race/ethnicity, and household income should be considered when designing similar tailored messaging interventions.
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Affiliation(s)
- Kristen A Feemster
- Vaccine Education Center, Children's Hospital of Philadelphia, Philadelphia, PA.,Division of Infectious Diseases, Children's Hospital of Philadelphia, 3401 Civic Center Boulevard, Philadelphia, PA 19104, USA.,Department of Pediatrics, Perelman School of Medicine, University of Pennsylvania, 3400 Civic Center Boulevard, Philadelphia, PA 19104, USA
| | - Katharine J Head
- Indiana University School of Liberal Arts, Department of Communication Studies, Cavanaugh Hall 307C, 425 University Boulevard, Indianapolis, IN 46202, USA
| | | | - Sean M O'Dell
- Department of Psychiatry and Behavioral Health, Geisinger, 100 North Academy Avenue, Danville, PA 17822, USA.,Department of Population Health Sciences, Geisinger, 100 North Academy Avenue, Danville, PA 17822, USA
| | - Gregory D Zimet
- Department of Pediatrics, Indiana University School of Medicine, 410 West 10 Street Suite 1001, Indianapolis, IN 46202, USA
| | - Melanie L Kornides
- Department of Family & Community Health, University of Pennsylvania School of Nursing, Division of Adolescent Medicine, Perelman School of Medicine, 418 Curie Boulevard, Office 401, Philadelphia, PA 19104, USA
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Polak M, Tanzer NK, Bauernhofer K, Andersson G. Disorder-specific internet-based cognitive-behavioral therapy in treating panic disorder, comorbid symptoms and improving quality of life: A meta-analytic evaluation of randomized controlled trials. Internet Interv 2021; 24:100364. [PMID: 33643852 PMCID: PMC7889983 DOI: 10.1016/j.invent.2021.100364] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/23/2019] [Revised: 12/15/2020] [Accepted: 12/21/2020] [Indexed: 02/08/2023] Open
Abstract
Compared to conventional face-to-face psychological treatments, internet-based cognitive-behavioral therapy (iCBT) presents an innovative alternative that has been found to be effective in the treatment of anxiety disorders. The current study provides a meta-analysis investigating the efficacy of disorder-specific guided self-help (Gsh) iCBT compared to various active and inactive control conditions, with focus on adult panic disorder sufferers with or without agoraphobia (PD/A). Systematic literature search yielded 13 randomized controlled trials (RCTs) (N = 1214) that met the eligibility criteria for this study. We found no statistically significant differences between Gsh iCBT and various active CBT interventions in reducing PD/A symptoms at both post-test (g = 0.015, k = 10) and follow-up (g = 0.113, k = 6) levels. Also, comorbid anxiety and depression were reduced equivalently at post-test (g = 0.004, k = 6) and follow-up (g = 0.004, k = 6). Quality of life was equally improved at post-test (g = -0.100, k = 5) and follow-up (g = 0.074, k = 2). When compared to inactive controls, we found large effect sizes in PD/A (g = -0.892, k = 9) and comorbid anxiety and depression (g = -0.723, k = 9) symptoms, and moderate change in quality of life (g = -0.484, k = 3) at post-test. There was no difference between Guided self-help iCBT and Self-help iCBT in PD/A (g = -0.025, k = 3) and comorbid anxiety and depression (g = -0.025, k = 3) at post-test. Baseline severity, country of original research and adherence to the treatment in form of initial uptake were identified as statistically significant moderators of the iCBT treatment.
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Affiliation(s)
- Martin Polak
- Department of Psychology, University of Graz, Austria
| | | | | | - Gerhard Andersson
- Department of Behavioural Sciences and Learning, Linköping University, Sweden
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Tosta Maciel RRB, Chiavegato LD, Camelier FW, Portella DD, De Souza MC, Padula RS. Does tutors' support contribute to a telehealth program that aims to promote the quality of life of office workers? A cluster randomized controlled trial. Contemp Clin Trials Commun 2021; 21:100722. [PMID: 33604486 PMCID: PMC7875823 DOI: 10.1016/j.conctc.2021.100722] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2020] [Revised: 10/23/2020] [Accepted: 01/11/2021] [Indexed: 11/25/2022] Open
Abstract
The quality of life in the workplace can be achieved by creating a place more humanized and strategies that provide wellness to workers. The aim of this study was to investigate the effectiveness of telehealth education program to promote quality of life of office workers. This is a cluster randomized controlled trial (RCT). The participants were office workers computer users (n = 326). All received 9 audiovisual content (grouped into topics: musculoskeletal health, healthy diet, and mental health) that addresses the real needs identified by them in the focus groups. The intervention group (n = 178) was instructed to seek the tutor support about topics addressed by the audiovisual content. The primary outcome measure was quality of life by WHOQOL-BREF. The secondary outcome measure was level of physical activity of the participants. Data analysis was performed by General Linear Mixed Model. After six months of telehealth education program a general improvement in health and environmental domain, was observed in the intervention group. During that period, a within-group analysis showed that there was a significant improvement in the intervention group, with respect to quality of life in general health (p < 0.05) and in the environmental domain (p < 0.01). In the baseline to the eighth month, there were statistically significant changes within-group for the general health (p < 0.05) and for the physical domain (p < 0.01) in both groups (p < 0.01). Telehealth education program promoted an improvement in the participants' quality of life. There was no benefit in favor of the telehealth education program, with tutor support in relation to the conventional program. Trial registration The trial was prospectively registered at ClinicalTrial.gov (NCT02980237). The date of registration was August 23, 2016.
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Affiliation(s)
- Roberto Rodrigues Bandeira Tosta Maciel
- Masters and Doctoral Program in Physical Therapy, Universidade Cidade de São Paulo, São Paulo, SP, Brazil.,Department of Life Sciences, Universidade do Estado da Bahia, Salvador, Bahia, Brazil
| | - Luciana Dias Chiavegato
- Masters and Doctoral Program in Physical Therapy, Universidade Cidade de São Paulo, São Paulo, SP, Brazil.,Pulmonology Division, Universidade Federal de São Paulo, São Paulo, Brazil
| | | | | | - Marcio Costa De Souza
- Department of Life Sciences, Universidade do Estado da Bahia, Salvador, Bahia, Brazil
| | - Rosimeire Simprini Padula
- Masters and Doctoral Program in Physical Therapy, Universidade Cidade de São Paulo, São Paulo, SP, Brazil
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Keller A, Babl A, Berger T, Schindler L. Efficacy of the web-based PaarBalance program on relationship satisfaction, depression and anxiety - A randomized controlled trial. Internet Interv 2020; 23:100360. [PMID: 33520669 PMCID: PMC7820550 DOI: 10.1016/j.invent.2020.100360] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/23/2020] [Revised: 12/13/2020] [Accepted: 12/21/2020] [Indexed: 11/27/2022] Open
Abstract
OBJECTIVE Although relationship distress is strongly associated with mental health problems, poorer social functioning and lower quality of life, only a minority of distressed couples engage in effective couples therapy. Common barriers are the financial burden, fear of being stigmatized, long waitlists and logistical concerns, such as the difficulty in scheduling appointments. Therefore, more accessible help for relationship distress is needed, such as internet-based interventions. METHOD This study evaluates the efficacy of the German web-based PaarBalance program, an 18-sessions online program for couples and individuals in an intimate relationship. Participants with relationship distress recruited via the internet had access to the unguided self-help program for twelve weeks. A total of 117 individuals (N = 60 participated as couples, N = 57 participated without a partner) were randomly assigned to begin the intervention immediately or to a 12-week waitlist control group. The primary outcome was relationship satisfaction. Secondary outcomes included symptoms of depression and anxiety. RESULTS The intervention group showed significant improvement in relationship satisfaction (Cohen's d =0.77) compared with the waitlist control group. Small to medium effect sizes in favor of the intervention group, but no statistically significant differences were found regarding depression (d = 0.43) and anxiety (d = 0.45). CONCLUSION PaarBalance seems to be an effective self-guided intervention to improve relationship satisfaction in people with relationship problems.
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Key Words
- Couples therapy
- DRKS, Deutsches Register Klinischer Studien
- GAD-7, Generalized Anxiety Disorder 7-item Scale
- HLM, Hierarchical linear modeling
- Marriage
- OR, OurRelationship program
- Online
- PFB, Partnerschaftsfragebogen
- PFB-K, Partnerschaftsfragebogen – Kurzform
- PHQ-9, Patient Health Questionnaire 9-item depression scale
- RCT, Randomized controlled trial
- Relationship satisfaction
- SD, Standard deviation
- WHOQOL, World Health Organization quality of life scale
- Web-based interventions
- ePREP, Prevention and Relationship Enhancement Program
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Affiliation(s)
- Alina Keller
- Department of Clinical Psychology and Psychotherapy, University of Bamberg, Germany
| | - Anna Babl
- Department of Clinical Psychology and Psychotherapy, University of Bern, Switzerland,Corresponding author at: University of Bern, Fabrikstrasse 8, 3012 Bern, Switzerland.
| | - Thomas Berger
- Department of Clinical Psychology and Psychotherapy, University of Bern, Switzerland
| | - Ludwig Schindler
- Department of Clinical Psychology and Psychotherapy, University of Bamberg, Germany
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11
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De Jong HJI, Voorham J, Scadding GK, Bachert C, Canonica GW, Smith P, Wahn U, Ryan D, Castillo JA, Carter VA, Murray RB, Price DB. Evaluating the real-life effect of MP-AzeFlu on asthma outcomes in patients with allergic rhinitis and asthma in UK primary care. World Allergy Organ J 2020; 13:100490. [PMID: 33376573 PMCID: PMC7753940 DOI: 10.1016/j.waojou.2020.100490] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2020] [Revised: 10/30/2020] [Accepted: 11/03/2020] [Indexed: 12/18/2022] Open
Abstract
Background MP-AzeFlu (Dymista®; spray of azelastine/fluticasone propionate) is the most effective allergic rhinitis (AR) treatment available. Its effect on asthma outcomes in patients with AR and asthma is unknown. Methods This pre-post historical cohort study, using the Optimum Patient Care Research Database, included patients aged ≥12 years, from UK general practice with active asthma (defined as a recorded diagnosis, with ≥1 prescription for reliever or controller inhaler) in the year before or at the initiation date. The primary study outcome was change in number of acute respiratory events (i.e. exacerbation or antibiotic course for a respiratory event) between baseline and outcome years. The effect size of MP-AzeFlu was quantified as the difference in % of patients that improved and worsened. Results Of the 1,188 patients with AR and asthma included, many had a record of irreversible obstruction (67%), and uncontrolled asthma (70.4%), despite high mean daily doses of reliever/controller therapy and acute oral corticosteroid use, in the year pre-MP-AzeFlu initiation. MP-AzeFlu initiation was associated with fewer acute respiratory events (effect size (e) = 5.8%, p = 0.0129) and a reduction in daily use of short-acting β2-agonists, with fewer patients requiring >2 SABA puffs/week (e = 7.7% p < 0.0001). More patients had well-controlled asthma 1-year post-MP-AzeFlu initiation (e = 4.1%; p = 0.0037), despite a reduction in inhaled corticosteroids (e = 4.8%; p = 0.0078). Conclusions This study provides the first direct evidence of the beneficial effect of MP-AzeFlu on asthma outcomes in co-morbid patients in primary care in the United Kingdom. Trial registration EUPAS30940. Registered August 13, 2019.
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Key Words
- ADEPT, Anonymized data ethics & protocol transparency
- AR, Allergic rhinitis
- ATS, American Thoracic society
- BEC, Blood eosinophil count
- CRS, Chronic rhinosinusitis
- Control
- ERS, European respiratory society
- Exacerbations
- FEV1, forced expiratory volume in 1 s
- FVC, Forced vital capacity
- GERD, Gastroesophageal reflux disease
- GINA, Global initiative for asthma
- ICS, Inhaled corticosteroid
- INS, Intranasal corticosteroid
- NP, Nasal polyps
- OAC, Overall asthma control
- OAH, Oral anti-histamine
- OCS, Oral corticosteroid
- OPCRD, Optimum patient care research database
- OTC, Over the counter
- PEF, Peak expiratory flow rate
- RCT, Randomized controlled trial
- RDAC, Risk domain asthma control
- Rescue medication
- SABA, Short-acting β2-agonist
- SMD, Standardised mean difference
- UK, United Kingdom
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Affiliation(s)
| | - Jaco Voorham
- Observational and Pragmatic Research Institute, Singapore
| | - Glenis K Scadding
- Royal National Throat, Nose and Ear Hospital, University College London School of Medicine, London, UK
| | | | - Giorgio Walter Canonica
- Personalized Medicine Asthma & Allergy Clinic, Humanitas University & Research Hospital, SANI-Severe Asthma Network, Milan, Italy
| | - Peter Smith
- Griffith University, Southport, QLD, Australia
| | | | - Dermot Ryan
- Usher Institute, University of Edinburgh, Edinburgh, UK.,Optimum Patient Care, Cambridge, UK
| | | | | | | | - David B Price
- Observational and Pragmatic Research Institute, Singapore.,Optimum Patient Care, Cambridge, UK.,Academic Primary Care, University of Aberdeen, Aberdeen, UK
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12
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Fornari M, Robertson SC, Pereira P, Zileli M, Anania CD, Ferreira A, Ferrari S, Gatti R, Costa F. Conservative Treatment and Percutaneous Pain Relief Techniques in Patients with Lumbar Spinal Stenosis: WFNS Spine Committee Recommendations. World Neurosurg X 2020; 7:100079. [PMID: 32613192 PMCID: PMC7322792 DOI: 10.1016/j.wnsx.2020.100079] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [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: 02/25/2020] [Accepted: 03/25/2020] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Degenerative lumbar spinal stenosis (LSS) is a progressive disease with potentially dangerous consequences that affect quality of life. Despite the detailed literature, natural history is unpredictable. This uncertainty presents a challenge making the correct management decisions, especially in patients with mild to moderate symptoms, regarding conservative or surgical treatment. This article focused on conservative treatment for degenerative LSS. METHODS To standardize clinical practice worldwide as much as possible, the World Federation of Neurosurgical Societies Spine Committee held a consensus conference on conservative treatment for degenerative LSS. A team of experts in spinal disorders reviewed the literature on conservative treatment for degenerative LSS from 2008 to 2018 and drafted and voted on a number of statements. RESULTS During 2 consensus meetings, 14 statements were voted on. The Committee agreed on the use of physical therapy for up to 3 months in cases with no neurologic symptoms. Initial conservative treatment could be applied without major complications in these cases. In patients with moderate to severe symptoms or with acute radicular deficits, surgical treatment is indicated. The efficacy of epidural injections is still debated, as it shows only limited benefit in patients with degenerative LSS. CONCLUSIONS A conservative approach based on therapeutic exercise may be the first choice in patients with LSS except in the presence of significant neurologic deficits. Treatment with instrumental modalities or epidural injections is still debated. Further studies with standardization of outcome measures are needed to reach high-level evidence conclusions.
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Affiliation(s)
- Maurizio Fornari
- Neurosurgery Department, Humanitas Research Hospital, Rozzano, Milan, Italy
| | - Scott C. Robertson
- Neurosurgery Department, Laredo Medical Center, University of the Incarnate Word School of Osteopathic Medicine, Laredo, Texas, USA
| | - Paulo Pereira
- Department of Neurosurgery, University Hospital Center of São João and Faculty of Medicine of the University of Porto, Porto, Portugal
| | - Mehmet Zileli
- Department of Neurosurgery, Ege University Faculty of Medicine, Bornova, Izmir, Turkey
| | - Carla D. Anania
- Neurosurgery Department, Humanitas Research Hospital, Rozzano, Milan, Italy
| | - Ana Ferreira
- Department of Neurosurgery, University Hospital Center of São João and Faculty of Medicine of the University of Porto, Porto, Portugal
| | | | | | - Francesco Costa
- Neurosurgery Department, Humanitas Research Hospital, Rozzano, Milan, Italy
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13
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Sharif S, Shaikh Y, Bajamal AH, Costa F, Zileli M. Fusion Surgery for Lumbar Spinal Stenosis: WFNS Spine Committee Recommendations. World Neurosurg X 2020; 7:100077. [PMID: 32613190 PMCID: PMC7322802 DOI: 10.1016/j.wnsx.2020.100077] [Citation(s) in RCA: 8] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2020] [Accepted: 03/11/2020] [Indexed: 02/06/2023] Open
Abstract
Lumbar spine stenosis represents a complex degenerative pathology that has been a subject of significant dispute when it comes to fusion. A review of the literature from 2008 to 2019 was performed on the role of fusion in the treatment of lumbar spinal stenosis using PubMed, Ovid Medline, Cochrane Central Register of Controlled Trials, and the Cochrane Database of Systematic Reviews. Using the key words "lumbar spinal stenosis," "lumbar fusion," "lumbar decompression," and "lumbar pedicle screw fixation," the search revealed 490 papers. Of these, only Level 1 or Level 2 evidence papers were selected, leading to only 3 randomized controlled trials (RCTs) that were analyzed. None of the good-quality studies (RCTs) performed so far have proven any clinical benefit of adding fusion to degenerative lumbar spine decompression. The effect of spinal instability on the outcome following decompression remains controversial. At present, no unanimous criteria exist among the RCTs to identify what constitutes true instability. Fusion for instability or stenosis alone remains controversial, and the results are unconvincing. At this point, the issue expands to not only lumbar degenerative diseases but spinal fractures and lumbar isthmic spondylolisthesis. We thereby present the consensus of the World Federation of Neurosurgical Societies Spine Committee, which formulated the indications for lumbar spine fusion in degenerative lumbar stenosis.
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Affiliation(s)
- Salman Sharif
- Department of Neurosurgery, Liaquat National Hospital & Medical College, Karachi, Pakistan
| | - Yousuf Shaikh
- Department of Neurosurgery, Liaquat National Hospital & Medical College, Karachi, Pakistan
| | - Abdul Hafid Bajamal
- Department of Neurosurgery, Airlangga University, Dr. Soetomo General Hospital, Surabaya, Indonesia
| | - Francesco Costa
- Department of Neurosurgery, Humanitas Research Hospital, Milan, Italy
| | - Mehmet Zileli
- Department of Neurosurgery, Ege University Bornova, Izmir, Turkey
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14
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Costa F, Alves OL, Anania CD, Zileli M, Fornari M. Decompressive Surgery for Lumbar Spinal Stenosis: WFNS Spine Committee Recommendations. World Neurosurg X 2020; 7:100076. [PMID: 32613189 PMCID: PMC7322794 DOI: 10.1016/j.wnsx.2020.100076] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [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: 01/14/2020] [Accepted: 03/02/2020] [Indexed: 11/30/2022] Open
Abstract
Objective Lumbar spine stenosis is a common disease with a prevalence progressively increasing due to the aging of the population. Despite many papers having been published over the last decades, there still remain many doubts regarding its natural history and appropriate treatment. To overcome these problems and reach some globally accepted recommendations, the World Federation of Neurosurgical Society Spine Committee organized a consensus conference on this topic. This paper describes recommendations about the efficacy of surgical decompression, the difference between surgical techniques, and complications of surgery. Methods World Federation of Neurosurgical Society Spine Committee aimed to standardize clinical practice worldwide as much as possible and held a 2-round consensus conference on lumbar spinal stenosis. A team of expert spine surgeons reviewed literature regarding surgical treatment from over the last 10 years, and then drafted and voted on some statements based on the presented literature. Results Ten statements were voted. The committee agreed on the effectiveness of surgical decompression in patients with moderate-to-severe symptoms or with neurologic deficits. There was no consensus on the best surgical technique and, in particular, about the equivalence of microscopic techniques and an open approach. Regarding complications, we agreed that the most frequent complications are incidental durotomy and general complications in the elderly. Conclusions Surgical decompression represents the treatment of choice for symptomatic lumbar spinal stenosis with a low complication rate. However, which surgical technique is the best is still under debate. Further studies with standardized outcome measures are needed to understand the real complication rate and frequency of different unwanted events.
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Affiliation(s)
- Francesco Costa
- Neurosurgery Department, Humanitas Clinical and Research Hospital, Rozzano, Milan, Italy
| | - Oscar L Alves
- Neurosurgery Department, Hospital Lusiadas Porto, Porto, Portugal
| | - Carla D Anania
- Neurosurgery Department, Humanitas Clinical and Research Hospital, Rozzano, Milan, Italy
| | - Mehmet Zileli
- Department of Neurosurgery, Ege University Faculty of Medicine, Bornova, Izmir, Turkey
| | - Maurizio Fornari
- Neurosurgery Department, Humanitas Clinical and Research Hospital, Rozzano, Milan, Italy
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15
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Gupta N, Verma R, Dhiman RK, Rajsekhar K, Prinja S. Cost-Effectiveness Analysis and Decision Modelling: A Tutorial for Clinicians. J Clin Exp Hepatol 2020; 10:177-184. [PMID: 32189934 PMCID: PMC7068010 DOI: 10.1016/j.jceh.2019.11.001] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/31/2019] [Accepted: 11/14/2019] [Indexed: 12/12/2022] Open
Abstract
Cost-effectiveness analysis (CEA) provides information on how much extra do we need to spend per unit gain in health outcomes with introduction of any new healthcare intervention or treatment as compared to the alternative. This information is crucial to make decision regarding funding any new drug, diagnostic test or determining standard treatment protocol. It becomes even more important to consider this evidence in resource constrained low-income and middle-income country settings. Generating evidence on costs and consequences of a treatment or intervention could be performed in the setting of a randomized controlled trial, which is the perfect platform to evaluate efficacy or effectiveness. However, we argue that randomized controlled trial (RCT) offers an incomplete setting to generate comprehensive data on all costs and consequences for the purpose of a CEA. Hence, it is needed to use a decision model, either in combination with the evidence from RCT or alone. In this article, we demonstrate the application of decision model-based economic evaluation using 2 separate techniques - a decision tree and a Markov model. We argue that application of a decision model allows computation of health benefits in terms of utility-based measure such as a quality-adjusted life year or disability-adjusted life year which is preferred for a CEA, measure distal costs and consequences which are much more downstream to the application of intervention, allows comparison with multiple intervention and comparators, and provides opportunity of making use of evidence from multiple sources rather than a single RCT which may have limited generalizability. This makes the use of such evidence much more acceptable for clinical use and policy relevant.
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Key Words
- BCLC, Barcelona Clinic Liver Cancer
- BSC, Best Supportive Care
- CAD, Coronary Artery Disease
- CEA, Cost-Effectiveness Analysis
- DALY, Disability Adjusted Life Year
- EE, Economic Evaluation
- HCC, Hepatocellular Carcinoma
- HCV, Hepatitis C Virus
- HPV, Human Papillomavirus
- Hib, Hemophilus Influenza
- ICER, Incremental Cost-Effectiveness Ratio
- PD, Progressive Disease
- PFS, Progression-Free State
- QALY, Quality Adjusted Life Year
- RCT, Randomized controlled trial
- SNCU, Special Newborn Care Unit
- cost-effectiveness
- decision model
- decision tree
- economic evaluation
- markov model
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Affiliation(s)
- Nidhi Gupta
- Department of Radiation Oncology, Government Medical College and Hospital, Chandigarh, India
| | - Rohan Verma
- School of Public Health, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Radha K. Dhiman
- Department of Hepatology, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Kavitha Rajsekhar
- Department of Health Research, Ministry of Health and Family Welfare, Government of India
| | - Shankar Prinja
- School of Public Health, Post Graduate Institute of Medical Education and Research, Chandigarh, India,Address for correspondence: Shankar Prinja, Additional Professor of Health Economics School of Public Health, Post Graduate Institute of Medical Education and Research Sector-12, Chandigarh, 60012, India.
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16
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Krutsinger DC, Yadav KN, Cooney E, Brooks S, Halpern SD, Courtright KR. A pilot randomized trial of five financial incentive strategies to increase study enrollment and retention rates. Contemp Clin Trials Commun 2019; 15:100390. [PMID: 31431933 PMCID: PMC6580090 DOI: 10.1016/j.conctc.2019.100390] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [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: 02/25/2019] [Revised: 05/21/2019] [Accepted: 06/01/2019] [Indexed: 11/21/2022] Open
Abstract
Background Enrollment and retention difficulties remain major barriers to conducting clinical trials. Financial incentives may promote clinical trial enrollment, however delivery methods to maximize enrollment, maximize retention, and minimize cost remains uncertain. Methods We conducted a single-blind, web-based randomized controlled trial of five financial incentive strategies on enrollment and retention rates in a longitudinal study of advance directives among community-dwelling older adults. Participants were eligible to receive a fixed total financial incentive, but the disbursement amounts at each study timepoint (baseline, 2-weeks, 4-weeks, and 6-weeks) differed between study arms. At each timepoint, participants completed a different advance directive. We conducted an intention-to-treat analysis for the primary and secondary outcomes of enrollment and retention. Results 1803 adults were randomized to one of five incentive strategies: constant n = 361; increasing n = 357; U-shaped n = 361; surprise n = 360; self-select n = 364. Overall, 989 (54.9%) participants elected to enroll in the advance directive study. There were no differences in enrollment rates between the control (constant 53.5%) and any of the four intervention study arms (increasing 54.3%, p = 0.81; U-shaped 57.3%, p = 0.30; surprise 56.9%, p = 0.35; and self-select 52.2%, p = 0.73). There were no differences in retention rates between the control (constant 2.1%) and any of the four intervention study arms (increasing 5.2%, p = 0.09; U-shaped 3.9%, p = 0.23; surprise 2.4%, p = 0.54; self-select 2.1%, p = 0.63). Conclusions Financial incentive programs for trial enrollment informed by behavioral economic insights were no more effective than a constant-payment approach in this web-based pilot study.
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Affiliation(s)
- Dustin C Krutsinger
- Palliative and Advanced Illness Research Center, USA.,Fostering Improvement in End-of-Life Decision Science Program, USA.,Center of Health Incentives and Behavioral Economics, USA.,Leonard Davis Institute of Health Economics, USA.,Division of Pulmonary, Allergy and Critical Care Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Kuldeep N Yadav
- Palliative and Advanced Illness Research Center, USA.,Fostering Improvement in End-of-Life Decision Science Program, USA.,Center of Health Incentives and Behavioral Economics, USA
| | - Elizabeth Cooney
- Palliative and Advanced Illness Research Center, USA.,Fostering Improvement in End-of-Life Decision Science Program, USA.,Center of Health Incentives and Behavioral Economics, USA.,Leonard Davis Institute of Health Economics, USA
| | - Steven Brooks
- Palliative and Advanced Illness Research Center, USA
| | - Scott D Halpern
- Palliative and Advanced Illness Research Center, USA.,Fostering Improvement in End-of-Life Decision Science Program, USA.,Center of Health Incentives and Behavioral Economics, USA.,Leonard Davis Institute of Health Economics, USA.,Division of Pulmonary, Allergy and Critical Care Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA.,Department of Biostatistics, Epidemiology and Informatics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Katherine R Courtright
- Palliative and Advanced Illness Research Center, USA.,Fostering Improvement in End-of-Life Decision Science Program, USA.,Center of Health Incentives and Behavioral Economics, USA.,Leonard Davis Institute of Health Economics, USA.,Division of Pulmonary, Allergy and Critical Care Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
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