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A randomized controlled trial of cryoprobe versus forceps for transbronchial biopsy (FROSTBITE-2): Study protocol for a multi-center pragmatic clinical trial 冷冻探针与钳经支气管活检的随机对照试验(FROSTBITE-2):一项多中心实用临床试验的研究方案。
IF 1.9 3区 医学 Q3 MEDICINE, RESEARCH & EXPERIMENTAL Pub Date : 2026-03-01 Epub Date: 2026-02-03 DOI: 10.1016/j.cct.2026.108251
Jeffrey Thiboutot , Ardian Latifi , Peter Illei , Christopher M. Kapp , Fabien Maldonado , Sonali Sethi , Scott Shofer , Christopher Gilbert , Momen Wahidi , Andrew DeMaio , Ashutosh Sachdeva , David DiBardino , Anil Vachani , Nicholas Pastis , Daniela Molena , Miranda R. Jones , Najib M. Rahman , Gerard Silvestri , Lonny Yarmus

Background

Transbronchial biopsy is a common bronchoscopic procedure that is traditionally performed with forceps. However, its diagnostic capability is limited by small specimen size and crush artifact. A 1.1 mm cryoprobe was developed to overcome these limitations utilizing rapid, controlled, freezing to retrieve larger specimens which are extractable through the bronchoscope's working channel. Whether this improves diagnostic yield remains uncertain. The 1.1 mm cryoprobe has not been directly compared to standard capacity forceps in a prospective, randomized fashion.

Methods

This multicenter randomized controlled trial evaluates whether transbronchial biopsy with a 1.1 mm cryoprobe yields superior diagnostic yield compared to standard capacity forceps in adults undergoing transbronchial biopsy for diffuse parenchymal lung disease, parenchymal pulmonary lesions, or lung allografts. Participants will be randomized 1:1 to either biopsy tool, stratified by indication. Primary outcomes include indication-specific and overall diagnostic yield, adjudicated by centralized pathology review. Secondary outcomes include histologic quality metrics and complication rates. This trial is individually powered for each indication-specific primary outcome, and can detect an 11.3% difference in overall diagnostic yield with 250 participants per arm.

Discussion

This trial will provide high-quality evidence to guide transbronchial biopsy tool selection to maximize diagnostic yield. Results of this trial may yield practice changing data for the evaluation of patients with diffuse parenchymal lung disease, parenchymal pulmonary lesions, and lung allografts. Unique design features include the use of a centralized histopathology core to minimize bias and interobserver variability and a pragmatic design to facilitate integration into clinical workflows and optimize recruitment.
背景:经支气管活检是一种常见的支气管镜手术,传统上是用镊子进行的。然而,其诊断能力受到样品尺寸小和挤压伪影的限制。为了克服这些限制,开发了1.1 毫米冷冻探头,利用快速、可控的冷冻来检索较大的标本,这些标本可通过支气管镜的工作通道提取。这是否能提高诊断率仍不确定。1.1 mm冷冻探针尚未以前瞻性随机方式直接与标准容量钳进行比较。方法:本多中心随机对照试验评估在弥漫性肺实质疾病、肺实质病变或同种异体肺移植的成人经支气管活检中,与标准容量钳相比,1.1 mm冷冻探针的经支气管活检是否具有更高的诊断率。参与者将按1:1随机分配到活检工具,根据适应症分层。主要结果包括指征特异性和总体诊断率,由集中病理检查决定。次要结局包括组织学质量指标和并发症发生率。该试验对每个特定适应症的主要结局进行单独支持,每组250名参与者可以检测到11.3%的总诊断率差异。讨论:本试验将提供高质量的证据,指导经支气管活检工具的选择,以最大限度地提高诊断率。该试验的结果可能为弥漫性肺实质疾病、肺实质病变和肺同种异体移植患者的评估提供实践改变的数据。独特的设计特点包括使用集中的组织病理学核心,以最大限度地减少偏见和观察者之间的差异,以及实用的设计,以促进整合到临床工作流程和优化招聘。
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引用次数: 0
TELE-SLEEP OSA: A protocol for a hybrid type I randomized clinical trial of telemedicine for obstructive sleep apnea among military dependents and retirees 远程睡眠呼吸暂停:一项混合I型随机远程医疗治疗军人家属和退休人员阻塞性睡眠呼吸暂停的临床试验方案。
IF 1.9 3区 医学 Q3 MEDICINE, RESEARCH & EXPERIMENTAL Pub Date : 2026-03-01 Epub Date: 2026-02-04 DOI: 10.1016/j.cct.2026.108252
Emerson M. Wickwire , Vincent F. Capaldi II , Jennifer Y. So , Eungjae Kim , Connie Thomas , Christine W. Johnston , Sarah Maggio , Joshua S. Elmore , Jennifer S. Albrecht , Avelino C. Verceles , Shuo Chen

Background

Obstructive sleep apnea (OSA) is common and costly in the U.S. military health system (MHS). OSA is associated with poor health outcomes as well as increased economic burden borne by the Defense Health Agency. The MHS lacks the capacity to meet the available demand for sleep specialty care. Thus, most military OSA care is provided by private sector TRICARE-contracted civilian providers. Given the burden of OSA and limited access to OSA care, optimizing OSA care within the MHS is vital. TELE-SLEEP OSA is a randomized, parallel group, single blind, controlled clinical trial comparing OSA telehealth care to standard private sector TRICARE.

Methods

Participants will include 160 active-duty family members and Defense Enrollment Eligibility Reporting System beneficiaries who are referred for OSA consultation. Following informed consent, participants will complete baseline assessments prior to randomization. Participants randomized to private sector TRICARE will receive treatment as usual, including positive airway pressure (PAP) therapy. Participants randomized to OSA telehealth care will undergo telehealth consultation with a board-certified sleep medicine specialist, undergo home sleep apnea testing, receive auto-titrating PAP therapy, and receive ongoing support from educator-level sleep navigators throughout the study. Quantitative follow-up assessments will be completed at 30 and 90 days after treatment initiation. Qualitative focus groups to assess participant satisfaction and other implementation outcomes will be conducted with participants from both treatment groups. Outcomes include PAP adherence (primary outcome), OSA symptoms, implementation, and cost-effectiveness.

Conclusion

Our telemedicine approach to OSA treatment aims to reduce costs and improve health outcomes within the MHS.

Clinical trial registration

NCT07121452.
背景:阻塞性睡眠呼吸暂停(OSA)在美国军事卫生系统(MHS)中是常见且昂贵的。阻塞性睡眠呼吸暂停与不良的健康结果以及国防卫生机构所承担的经济负担增加有关。MHS缺乏满足睡眠专业护理需求的能力。因此,大多数军事OSA护理是由私营部门tricare合同的民用供应商提供的。鉴于阻塞性睡眠呼吸暂停的负担和获得阻塞性睡眠呼吸暂停治疗的机会有限,在MHS内优化阻塞性睡眠呼吸暂停治疗至关重要。TELE-SLEEP OSA是一项随机、平行组、单盲、对照临床试验,比较OSA远程医疗与标准私营部门TRICARE。方法:参与者将包括160名现役家庭成员和国防登记资格报告系统受益人,他们被转介进行OSA咨询。根据知情同意,参与者将在随机化之前完成基线评估。随机分配到私营TRICARE的参与者将照常接受治疗,包括气道正压(PAP)治疗。随机分配到OSA远程医疗的参与者将接受委员会认证的睡眠医学专家的远程医疗咨询,接受家庭睡眠呼吸暂停测试,接受自动滴定PAP治疗,并在整个研究过程中接受教育级睡眠导航员的持续支持。定量随访评估将在治疗开始后30和90 天完成。定性焦点小组将对来自两个治疗组的参与者进行评估,以评估参与者满意度和其他实施结果。结局包括PAP依从性(主要结局)、OSA症状、实施和成本-效果。结论:我们的远程医疗方法治疗阻塞性睡眠呼吸暂停旨在降低成本,改善MHS内的健康结果。临床试验注册:NCT07121452。
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引用次数: 0
Design and implementation of data collection and linkage of electronic health records in a large UK cluster-randomised trial of asthma management (ARRISA-UK) 英国哮喘管理的一项大型集群随机试验(ARRISA-UK)中数据收集和电子健康记录链接的设计和实施
IF 1.9 3区 医学 Q3 MEDICINE, RESEARCH & EXPERIMENTAL Pub Date : 2026-03-01 Epub Date: 2026-01-21 DOI: 10.1016/j.cct.2026.108242
Polly-Anna Ashford , Stanley Musgrave , Allan B. Clark , Susan Stirling , Martin Pond , David Price , Francis Appiagyei , Estelle Payerne , Jane R. Smith , Michael Noble , Andrew M. Wilson
Electronic health record data holds great potential for conducting large, efficient randomised controlled trials. Despite progress towards greater availability of linked NHS datasets, the use of routine clinical data remains challenging for trialists. In this paper we describe the design, adaptations and implementation of methods for data collection and linkage in ARRISA-UK: a cluster-randomised controlled trial of a complex asthma management intervention involving 275 primary care practices across England, Wales and Scotland.
Our methods were designed to build a dataset of linked primary care and secondary care data for approximately 10,000 ‘at-risk’ asthma patients to measure the trial's primary outcome (asthma crisis events comprising respiratory-related hospital admissions, emergency department attendances and/or death for ‘at-risk’ asthma patients) and secondary clinical outcomes including the impact of the intervention on ∼180,000 asthma patients at participating practices.
A high level of practice attrition (33%) was observed due to data extraction delays and technical barriers, patient identification errors, and concerns about the processing of patient identifiable data for the purpose of record linkage. We highlight the technical achievements, barriers and lessons learned from ARRISA-UK and propose recommendations to facilitate future data-enabled trials, including greater resourcing in recognition of their complex nature, improved systems of support and training in primary care, and the need to maintain and improve clinician and public trust in research data use for long term sustainability.
电子健康记录数据在进行大规模、高效的随机对照试验方面具有巨大潜力。尽管在提高NHS数据集的可用性方面取得了进展,但常规临床数据的使用对试验人员来说仍然具有挑战性。在本文中,我们描述了ARRISA-UK中数据收集和联系方法的设计、调整和实施:ARRISA-UK是一项复杂哮喘管理干预的随机对照试验,涉及英格兰、威尔士和苏格兰的275个初级保健实践。我们的方法旨在为大约10,000名“高危”哮喘患者建立一个关联的初级保健和二级保健数据集,以测量试验的主要结果(哮喘危机事件,包括呼吸相关的住院率、急诊科就诊率和/或“高危”哮喘患者的死亡)和次要临床结果,包括干预对参与实践的约180,000名哮喘患者的影响。由于数据提取延迟和技术障碍、患者识别错误以及出于记录链接目的对患者可识别数据的处理的担忧,观察到高水平的执业人员流失(33%)。我们强调了从ARRISA-UK获得的技术成就、障碍和经验教训,并提出了促进未来数据支持试验的建议,包括承认其复杂性的更多资源,改进初级保健支持和培训系统,以及维护和提高临床医生和公众对长期可持续性研究数据使用的信任的需要。
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引用次数: 0
Efficacy of a transdiagnostic guided internet-delivered intervention for anxiety, depression, trauma and stress-related symptoms: A randomized controlled trial 一种跨诊断引导互联网干预焦虑、抑郁、创伤和压力相关症状的疗效:一项随机对照试验
IF 1.9 3区 医学 Q3 MEDICINE, RESEARCH & EXPERIMENTAL Pub Date : 2026-03-01 Epub Date: 2026-01-20 DOI: 10.1016/j.cct.2026.108229
Anabel de la Rosa Gómez , Pablo D. Valencia , Dulce M. Díaz Sosa , Lorena Alejandra Flores Plata , Raquel García Flores , Carolina Santillán Torres Torija , Alejandra Mares Portillo , Alfonso Mendoza Leal , Alicia Ivet Flores Elvira , Esteban Eugenio Esquivel-Santoveña , Enrique Berra Ruiz

Objective

There is strong evidence that online transdiagnostic interventions are effective in treating anxiety and depression, and contribute to improving patients' quality of life. This study aimed to evaluate the efficacy and acceptability of an internet-guided transdiagnostic intervention (guided UP) versus a self-guided internet-based transdiagnostic intervention (unguided UP) for the transdiagnostic treatment of emotional disorders targeting the Mexican community.

Methods

A randomized clinical trial was conducted to compare therapist-supported online transdiagnostic treatment with an unguided version and a waiting list control group. 247 individuals aged 18 to 70 years were assessed at four time points (before and after treatment, three and six months follow- up) to identify levels of anxiety, depression, trauma and stress-related symptoms. Participants who qualified and decided to participate were randomly assigned to one of three conditions.

Results

Higher levels of acceptability, satisfaction, and suitability were reported for the intervention with therapeutic support compared to the UP-unguided condition. After treatment, significant mean differences were found between the waitlist group and both the UP-guided and unguided groups in anxiety, depression, trauma and stress-related symptoms, and general distress, as well as in emotional dysregulation for the guided group only, all with large effect sizes. Direct comparisons between the UP-guided and unguided groups showed significant differences favoring the UP-guided treatment at post-test for depression and emotional dysregulation. However, at the 3- and 6-month follow-ups, the UP-unguided group continued to improve, whereas the UP-guided group tended to remain stable. As a result, by the end of the follow-up period, the UP-unguided group showed significantly lower levels of anxiety, PTSD symptoms, and emotional dysregulation.

Conclusions

The study supports the preliminary evidence of the clinical utility of UP online interventions in a specific sample recruited for the treatment of anxiety, depression, trauma and stress-related symptoms with the advantage of reaching a larger number of people. Even though the UP-unguided intervention showed clinical utility, the support of a therapist in an online intervention could offer an advantage that improves treatment adherence and, in particular, resulted in a greater reduction in symptoms of depression and emotional dysregulation, making it the superior option from a clinical perspective.
目的:有强有力的证据表明,在线跨诊断干预在治疗焦虑和抑郁方面是有效的,并有助于提高患者的生活质量。本研究旨在评估互联网引导的跨诊断干预(guided UP)与自我引导的基于互联网的跨诊断干预(unguided UP)在针对墨西哥社区的情绪障碍跨诊断治疗中的疗效和可接受性。方法:进行一项随机临床试验,比较治疗师支持的在线跨诊断治疗与无指导的版本和等待名单对照组。247名年龄在18至70岁 岁之间的个体在四个时间点(治疗前后,3个月和6个月的随访)进行评估,以确定焦虑、抑郁、创伤和压力相关症状的水平。符合条件并决定参加的参与者被随机分配到三种情况中的一种。结果:与UP-unguided条件相比,有治疗性支持的干预具有更高的可接受性、满意度和适宜性。治疗后,等候组与up指导组和未指导组在焦虑、抑郁、创伤和压力相关症状、一般痛苦以及仅指导组的情绪失调方面均存在显著的平均差异,均具有较大的效应量。向上引导组和非向上引导组之间的直接比较显示,在抑郁和情绪失调的后测试中,向上引导治疗有显著差异。然而,在3个月和6个月的随访中,无up指导组继续改善,而up指导组趋于稳定。结果,在随访期结束时,未接受up指导的组表现出明显较低的焦虑、PTSD症状和情绪失调水平。结论:该研究支持了UP在线干预在特定样本中的临床效用的初步证据,该样本用于治疗抑郁、焦虑、抑郁、创伤和压力相关症状,其优势是可以覆盖更多的人群。尽管UP-unguided intervention显示了临床效用,但治疗师在在线干预中的支持可以提供一个优势,即提高治疗依从性,特别是导致抑郁和情绪失调症状的更大减少,从临床角度来看,使其成为更好的选择。
{"title":"Efficacy of a transdiagnostic guided internet-delivered intervention for anxiety, depression, trauma and stress-related symptoms: A randomized controlled trial","authors":"Anabel de la Rosa Gómez ,&nbsp;Pablo D. Valencia ,&nbsp;Dulce M. Díaz Sosa ,&nbsp;Lorena Alejandra Flores Plata ,&nbsp;Raquel García Flores ,&nbsp;Carolina Santillán Torres Torija ,&nbsp;Alejandra Mares Portillo ,&nbsp;Alfonso Mendoza Leal ,&nbsp;Alicia Ivet Flores Elvira ,&nbsp;Esteban Eugenio Esquivel-Santoveña ,&nbsp;Enrique Berra Ruiz","doi":"10.1016/j.cct.2026.108229","DOIUrl":"10.1016/j.cct.2026.108229","url":null,"abstract":"<div><h3>Objective</h3><div>There is strong evidence that online transdiagnostic interventions are effective in treating anxiety and depression, and contribute to improving patients' quality of life. This study aimed to evaluate the efficacy and acceptability of an internet-guided transdiagnostic intervention (guided UP) versus a self-guided internet-based transdiagnostic intervention (unguided UP) for the transdiagnostic treatment of emotional disorders targeting the Mexican community.</div></div><div><h3>Methods</h3><div>A randomized clinical trial was conducted to compare therapist-supported online transdiagnostic treatment with an unguided version and a waiting list control group. 247 individuals aged 18 to 70 years were assessed at four time points (before and after treatment, three and six months follow- up) to identify levels of anxiety, depression, trauma and stress-related symptoms. Participants who qualified and decided to participate were randomly assigned to one of three conditions.</div></div><div><h3>Results</h3><div>Higher levels of acceptability, satisfaction, and suitability were reported for the intervention with therapeutic support compared to the UP-unguided condition. After treatment, significant mean differences were found between the waitlist group and both the UP-guided and unguided groups in anxiety, depression, trauma and stress-related symptoms, and general distress, as well as in emotional dysregulation for the guided group only, all with large effect sizes. Direct comparisons between the UP-guided and unguided groups showed significant differences favoring the UP-guided treatment at post-test for depression and emotional dysregulation. However, at the 3- and 6-month follow-ups, the UP-unguided group continued to improve, whereas the UP-guided group tended to remain stable. As a result, by the end of the follow-up period, the UP-unguided group showed significantly lower levels of anxiety, PTSD symptoms, and emotional dysregulation.</div></div><div><h3>Conclusions</h3><div>The study supports the preliminary evidence of the clinical utility of UP online interventions in a specific sample recruited for the treatment of anxiety, depression, trauma and stress-related symptoms with the advantage of reaching a larger number of people. Even though the UP-unguided intervention showed clinical utility, the support of a therapist in an online intervention could offer an advantage that improves treatment adherence and, in particular, resulted in a greater reduction in symptoms of depression and emotional dysregulation, making it the superior option from a clinical perspective.</div></div>","PeriodicalId":10636,"journal":{"name":"Contemporary clinical trials","volume":"162 ","pages":"Article 108229"},"PeriodicalIF":1.9,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146028602","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Increasing COVID-19 vaccine uptake through motivational interviewing-informed tailored digital intervention: Study protocol 通过基于动机性访谈的量身定制数字干预提高COVID-19疫苗的吸收率:研究方案。
IF 1.9 3区 医学 Q3 MEDICINE, RESEARCH & EXPERIMENTAL Pub Date : 2026-03-01 Epub Date: 2026-01-17 DOI: 10.1016/j.cct.2026.108221
C.P. Ku , Alex Christian , Emerson Delacroix , Kirsten Trzeciak , Ken Resnicow , Sarah Bailey , Barbara Israel , Felix Valbuena , Susie Williamson

Background

Marginalized communities have been disproportionately impacted by COVID-19. In Michigan as of 2024, while 59% of Hispanic people, 46% of African American people, and 56% of White people received at least one dose of vaccine, only 8% of African American and 8% of Hispanic residents report being up-to-date, per CDC definition, compared to 13% of White residents. The goals of the project were to increase vaccine uptake through the implementation and evaluation of a tailored behavioral intervention.

Methods

This group-tailored digital intervention investigates the effect of an SMS-based health education program on vaccine intent in African American and Latino/Hispanic individuals. Recruited in-person and digitally throughout Michigan, 1327 participants were randomized into two arms, and then stratified into four audience segment groups based on vaccine readiness. The primary aim of the study is to increase uptake of the COVID-19 vaccine following receipt of the tailored text messages. Participants were evaluated pre- and post-intervention for intent to vaccinate, perceptions of barriers to vaccination, attitudes towards the vaccine, and knowledge of common vaccine misinformation.

Discussion

This study will inform future literature in addressing vaccine hesitancy for racial and ethnic populations, the use of motivational interviewing-based interventions, and digital health interventions in general.
背景:边缘化社区受到COVID-19的不成比例的影响。在密歇根州,截至2024年,59%的西班牙裔美国人、46%的非洲裔美国人和56%的白人至少接种了一剂疫苗,但根据疾病预防控制中心的定义,只有8%的非洲裔美国人和8%的西班牙裔居民报告接种了最新疫苗,而白人居民的这一比例为13%。该项目的目标是通过实施和评估量身定制的行为干预措施来提高疫苗的吸收率。方法:这个群体定制的数字干预调查了基于短信的健康教育计划对非裔美国人和拉丁裔/西班牙裔个体疫苗意向的影响。1327名参与者在密歇根州进行了面对面和数字化招募,随机分为两组,然后根据疫苗准备情况分为四个受众群体。该研究的主要目的是在收到量身定制的短信后增加COVID-19疫苗的吸收量。在干预前和干预后对参与者进行评估,以了解疫苗接种的意图、对疫苗接种障碍的认识、对疫苗的态度以及对常见疫苗错误信息的了解。讨论:这项研究将为未来的文献提供信息,以解决种族和民族人群的疫苗犹豫问题,使用基于动机访谈的干预措施,以及一般的数字健康干预措施。
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引用次数: 0
Rationale and design of a three-arm randomized clinical trial to improve drug use and retention in care of people with opioid use disorder on buprenorphine: OVERCOME II study 一项三组随机临床试验的基本原理和设计,以改善丁丙诺啡阿片类药物使用障碍患者的药物使用和保留:克服II研究。
IF 1.9 3区 医学 Q3 MEDICINE, RESEARCH & EXPERIMENTAL Pub Date : 2026-03-01 Epub Date: 2026-01-17 DOI: 10.1016/j.cct.2026.108226
Irene Pericot-Valverde , Moonseong Heo , Kaileigh A. Byrne , Alison Karasz , Angelica Perez , Snehal Lopes , Megan Groome , Sarah Voss , Ashley King , Katy Barnick , Alain H. Litwin
Medications for opioid use disorder (MOUD) are effective in reducing opioid use, but retention to buprenorphine remains suboptimal among OUD patients. Integration of computer-based cognitive behavioral therapy (CBT4CBT) and utilization of recovery coaches (RCs), called RC + CBT4CBT-Buprenorphine, into OUD care could improve drug use and retention in care among patients taking buprenorphine. The OVERCOME II (OUD Intervention Recovery Coach CBT and OUD Medications II) study is a three-arm 1:1:1 randomized clinical trial designed to test the remotely delivered RC + CBT4CBT-Buprenorphineintervention as an adjunct to buprenorphine treatment for patients with OUD, and to compare it with both CBT4CBT-Buprenorphine alone and the treatment as usual (TAU). Patients (n = 90) who have newly initiated buprenorphine in the past 90 days are planned to be recruited. Comprehensive measures on demographics, various conditions/constructs, and outcomes will be collected from medical charts and survey instruments. Additionally, neurophysiological outcomes and neurocognitive inhibitory controls will be measured using the NEXUS-10-MKII physiological system with BioTrace+ software and computerized Drug Go/NoGo Task, respectively. Qualitative analysis of interviews with N = 2 RCs and N = 15 participants will also be conducted. The study will be the first to examine the effectiveness of the remotely delivered RC + CBT4CBT-Buprenorphine intervention on drug use (during the first 8 weeks and follow-up) and retention in care, as well as on various neurophysiological and cognitive performances in comparison to CBT4CBT-Buprenorphine alone and TAU.
Clinical Trial Registration: This study was registered at ClinicalTrials.gov (NCT06102200, www.clinicaltrials.gov/) on August 31, 2023, with a title, An Integrated Intervention Involving Recovery Coaching and Cognitive Behavioral Therapy for Opioid Use Disorder (OVERCOME 2).
阿片类药物使用障碍(mod)药物在减少阿片类药物使用方面是有效的,但在OUD患者中,丁丙诺啡的保留率仍然是次优的。将基于计算机的认知行为疗法(CBT4CBT)和康复教练(RC) (RC + CBT4CBT-丁丙诺啡)整合到OUD护理中,可以改善丁丙诺啡患者的药物使用和保留。克服II (OUD干预恢复教练CBT和OUD药物II)研究是一项三组1:1:1随机临床试验,旨在测试远程递送RC + cbt4cbt -丁丙诺啡干预作为丁丙诺啡治疗OUD患者的辅助治疗,并将其与cbt4cbt -丁丙诺啡单独治疗和常规治疗(TAU)进行比较。计划招募在过去90 天内新开始使用丁丙诺啡的患者(n = 90)。将从医疗图表和调查工具中收集有关人口统计、各种条件/结构和结果的综合措施。此外,神经生理结果和神经认知抑制控制将分别使用带有BioTrace+软件的NEXUS-10-MKII生理系统和计算机化的Drug Go/NoGo Task进行测量。对N = 2个rc和N = 15个参与者的访谈进行定性分析。该研究将首次检查远程递送RC + cbt4cbt -丁丙诺啡干预对药物使用(在前8 周和随访期间)和护理保留的有效性,以及与cbt4cbt -丁丙诺啡单独和TAU相比的各种神经生理和认知表现。临床试验注册:本研究于2023年8月31日在ClinicalTrials.gov (NCT06102200, www.clinicaltrials.gov/)注册,标题为:阿片类药物使用障碍的康复指导和认知行为治疗的综合干预(OVERCOME 2)。
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引用次数: 0
Early intervention versus treatment as usual for adolescents with first-episode psychosis: Protocol for the randomized OPUS YOUNG trial 早期干预与常规治疗对首发精神病青少年:随机OPUS YOUNG试验方案
IF 1.9 3区 医学 Q3 MEDICINE, RESEARCH & EXPERIMENTAL Pub Date : 2026-03-01 Epub Date: 2026-02-05 DOI: 10.1016/j.cct.2026.108253
Mathilde S. Madsen , Marianne Melau , Naja K. Andersen , Caroline Friis Nielsen , Natascha Larsen , Thomas Lind Andersen , Merete Nordentoft , Jens Richardt M. Jepsen , Anne A.E. Thorup , Pia Jeppesen , Birgitte Fagerlund , Martin Køster Rimvall , Patrick McGorry , Swaran Singh , Ditte Lammers Vernal , Lene Halling Hastrup , Lis Raabæk Olsen , Jacob Rydkjær , Christoph U. Correll , Robin Christensen , Anne Katrine Pagsberg

Background

The prognosis for early onset psychosis (EOP) is poor for a broad range of outcomes. Early intervention services (EIS) have proven beneficial for adult-onset first-episode psychosis, but no randomized trials have investigated EIS in samples of patients aged <18 years. We will examine benefits and harms of a new integrated intervention OPUS YOUNG for EOP. The primary objective is to compare the effect of the OPUS YOUNG intervention versus treatment as usual (TAU) on change in social functioning at end-of-treatment after two years.

Methods

This investigator-initiated, single-center, pragmatic randomized clinical trial with blinded outcome assessment takes place in child- and adolescent mental health services in Copenhagen, Denmark. We randomize 290 participants aged 12 to 17 years with first-onset psychosis in a 1:1 ratio to a two-year intervention with OPUS YOUNG versus TAU. The OPUS YOUNG manual builds on the Danish evidence-based intervention for young adults (OPUS) adjusted to meet the specific needs of youths. The primary outcome is social functioning (Personal and Social Performance Scale [PSP] total score). Key secondary outcomes include measures of psychotic, negative, and disorganized symptom dimensions, client satisfaction, and health-related quality of life. Analyses will follow the intention-to-treat principle and use mixed-effects repeated measures models.

Discussion

In a rigorous research design, we address the urgent need for evidence-based interventions integrating psychosocial and pharmacological treatments in an age-appropriate manualized program for EOP. The primary trial limitations are the risk of attrition during follow-up, and the inherent inability to mask for allocation in trials with psychosocial interventions.

Trial registration

ClinicalTrials.gov: NCT04916626, registered June 2021. Protocol and modifications is presented here:
https://classic.clinicaltrials.gov/ct2/show/NCT04916626
背景:早发性精神病(EOP)的预后在很多方面都很差。早期干预服务(EIS)已被证明对成人发病的首发精神病有益,但没有随机试验调查EIS在老年患者样本中的作用。方法:这项研究者发起的、单中心的、实用的随机临床试验,采用盲法结果评估,在丹麦哥本哈根的儿童和青少年精神卫生服务中心进行。我们随机选取290名年龄在12 - 17 岁的首发精神病患者,以1:1的比例进行为期两年的OPUS YOUNG与TAU干预。OPUS YOUNG手册建立在丹麦针对年轻人的循证干预(OPUS)的基础上,对其进行了调整,以满足年轻人的具体需求。主要结果是社会功能(个人和社会表现量表[PSP]总分)。主要的次要结局包括精神病性、阴性和紊乱症状维度、病人满意度和健康相关生活质量的测量。分析将遵循意向治疗原则,并使用混合效应重复测量模型。讨论:在严格的研究设计中,我们解决了基于证据的干预措施的迫切需要,将社会心理和药物治疗结合在一个适合年龄的EOP手动计划中。试验的主要局限性是随访期间的减员风险,以及内在的无法掩盖在社会心理干预试验中的分配。试验注册:ClinicalTrials.gov: NCT04916626,注册于2021年6月。协议和修改如下:https://classic.Clinicaltrials: gov/ct2/show/NCT04916626。
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引用次数: 0
Estimating the probability of experiencing an improvement in randomized controlled trials based on anchor-based MIC studies – An alternative to responder analyses 在基于锚定的MIC研究的随机对照试验中评估经历改善的概率-应答者分析的替代方案。
IF 1.9 3区 医学 Q3 MEDICINE, RESEARCH & EXPERIMENTAL Pub Date : 2026-03-01 Epub Date: 2026-01-28 DOI: 10.1016/j.cct.2026.108243
Werner Vach , Franziska Saxer

Background

When using a patient reported outcome as primary endpoint in a randomized contolled trial (RCT), responder analyses are widely used to describe the relevance of an observed effect attributable to the intervention of interest. The choice of thresholds in responder analyses is often based on minimal important change (MIC) values.

Methods

As an alternative to simply computing MIC values, we suggest determining a translation function allowing to translate change scores values into the probability of experiencing an improvement. The application of such a translation function to the change scores observed in an RCT allows estimating arm-specific probabilities of experiencing an improvement. These values are conceptually similar to responder frequencies. The approach is illustrated using a pair of synthetic studies, both constructed mimicking existing studies. A simulation study investigates the gain in efficiency from avoiding the dichotomization.

Results

The illustrative application of the methodology demonstrates that the approach is feasible and allows drawing conclusions in a similar way as in a responder analysis, but with greater precision. The simulation study confirms that this gain in efficiency holds more generally. Considering all response levels of the anchor variable may allow gaining more nuanced insights.

Conclusions

Estimating the probability of experiencing an improvement provides an alternative to responder analyses. This approach makes more efficient use of information comprised in the data from anchor-based MIC studies than the translation into MIC values to inform the choice of thresholds in a responder analysis.
背景:在随机对照试验(RCT)中,当使用患者报告的结果作为主要终点时,应答者分析被广泛用于描述可归因于感兴趣干预的观察效果的相关性。在应答者分析中,阈值的选择通常基于最小重要变化(MIC)值。方法:作为简单计算MIC值的替代方法,我们建议确定一个翻译函数,允许将更改分数值转换为经历改进的概率。将这种转换函数应用于RCT中观察到的变化分数,可以估计出经历改善的特定手臂概率。这些值在概念上与应答器频率相似。该方法是用一对合成研究来说明的,这两个研究都是模仿现有的研究。仿真研究了避免二分类对效率的提高。结果:该方法的说明性应用表明,该方法是可行的,并允许以类似于响应者分析的方式得出结论,但精度更高。仿真研究证实,这种效率的提高更为普遍。考虑锚变量的所有响应水平可以获得更细致入微的见解。结论:评估经历改善的可能性为应答者分析提供了另一种选择。这种方法可以更有效地利用基于锚点的MIC研究数据中包含的信息,而不是将其转换为MIC值,从而为响应者分析中的阈值选择提供信息。
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引用次数: 0
A protocol for a randomized comparative effectiveness trial for treating PTSD symptoms for LGBTQIA+ people 治疗LGBTQIA+人群PTSD症状的随机比较有效性试验方案
IF 1.9 3区 医学 Q3 MEDICINE, RESEARCH & EXPERIMENTAL Pub Date : 2026-03-01 Epub Date: 2026-01-29 DOI: 10.1016/j.cct.2026.108246
Madeline Price , Gowri Sunder , Marylene Cloitre , Debra Kaysen , Martha Shumway , James W. Dilley , Nadra E. Lisha , Belin Marko , William Hua , Tiffany Artime , Ell Hundertmark , Emily Huang , Antonia Clifford , Annesa Flentje

Background

LGBTQIA+ (Lesbian, Gay, Bisexual, Transgender, Queer, Intersex, and Asexual +) individuals face higher rates of posttraumatic stress disorder (PTSD) due to increased trauma exposure. Further, they may experience factors that complicate treatment, like exposure to minority stress and increased substance use. No prior large-scale clinical trial has compared the effectiveness of PTSD treatments among LGBTQIA+ populations.

Study objectives

We are conducting a comparative effectiveness study that will compare two evidence-based psychotherapeutic interventions to reduce PTSD and depression symptoms and improve quality of life in LGBTQIA+ populations. Treatment dropout and satisfaction will be compared between the interventions. Minority stress and substance use will be examined as moderators for treatment effectiveness. We will also examine heterogeneity of treatment effects by gender subgroups, participant residence (urban versus suburban or rural), and race and ethnicity.

Methods

Participants will be recruited from community mental health settings, from the community, and through organizations throughout California. Eligibility will be based on PTSD symptom severity as determined by PTSD Checklist for DSM-5 (PCL-5) scores ≥33 during an initial phone screening. Each participant will be randomized to receive either Cognitive Processing Therapy (CPT) or STAIR Narrative Therapy (SNT). Study participants will complete survey assessments at baseline, 3 months, 6 months, and 12 months.

Discussion

This study will fill critical research gaps to inform effective PTSD treatments for LGBTQIA+ communities.
背景:LGBTQIA+(女同性恋、男同性恋、双性恋、变性人、酷儿、双性人和无性恋者)个体由于创伤暴露的增加而面临更高的创伤后应激障碍(PTSD)发病率。此外,他们可能会遇到使治疗复杂化的因素,如暴露于少数民族压力和增加药物使用。之前没有大规模的临床试验比较过LGBTQIA+人群治疗PTSD的有效性。研究目的:我们正在进行一项比较有效性的研究,将比较两种基于证据的心理治疗干预措施,以减少LGBTQIA+人群的创伤后应激障碍和抑郁症状,并改善生活质量。将比较干预措施之间的治疗退出率和满意度。少数民族压力和物质使用将作为治疗效果的调节因素进行研究。我们还将根据性别亚组、参与者居住地(城市与郊区或农村)以及种族和民族来检查治疗效果的异质性。方法:参与者将从社区心理健康机构、社区和整个加州的组织中招募。入选资格将基于PTSD症状严重程度,在最初的电话筛查中,PTSD检查表DSM-5 (PCL-5)评分≥33分。每位参与者将随机接受认知加工疗法(CPT)或STAIR叙事疗法(SNT)。研究参与者将在基线、3 个月、6 个月和12 个月完成调查评估。讨论:这项研究将填补关键的研究空白,为LGBTQIA+社区提供有效的创伤后应激障碍治疗。
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引用次数: 0
A multilevel clinic- and community-based intervention to increase COVID-19 vaccination among Latinos in San Diego County: Protocol description of the vaccine promotion program 在圣地亚哥县开展多层次诊所和社区干预,以增加拉丁裔人的COVID-19疫苗接种:疫苗推广计划的方案描述。
IF 1.9 3区 医学 Q3 MEDICINE, RESEARCH & EXPERIMENTAL Pub Date : 2026-03-01 Epub Date: 2026-01-19 DOI: 10.1016/j.cct.2026.108227
Noe C. Crespo , John Elder , Eyal Oren , Elva Arredondo , Chii-Dean Joey Lin , Job Godino , Hala Madanat , Griselda Cervantes , Amanda Patron , Kiria Fraga , Bianca Vargas-Tequida , Christian B. Ramers

Background

COVID-19 has disproportionately affected minority groups, including Latinos. Since the development of COVID-19 vaccines, effective implementation faced challenges due to multiple factors, necessitating multi-level and multi-sector approaches. This study describes the Vaccine Promotion Program (VPP), a multi-level intervention to increase COVID-19 vaccine uptake among Latinos in clinical and community settings.

Methods

VPP is a double-blind, pragmatic, 12-month cluster-randomized trial in collaboration with a large Federally Qualified Health Center (FQHC) in San Diego, CA. Ten clinics will be randomized to a Multilevel Intervention involving activities at the interpersonal, clinic, and community levels (VPP) or Standard Clinical Practice (SCP) (n = 5 clinics, respectively). Patients in VPP clinics will receive tailored clinic-originated messages about COVID-19 vaccination and motivational interviews (MI) (15–30-min telephone/telehealth encounters) from Health Educators (HE) to encourage COVID-19 vaccination. HEs will send emails and/or text message-based information to encourage vaccination. The community-level intervention involves targeted and tailored activities to promote COVID-19 vaccine uptake in neighborhoods surrounding the five VPP clinics. A cohort of 200 patients will be enrolled to participate in comprehensive surveys and follow-up for 24 months to assess longer-term outcomes. The primary outcome (COVID-19 aggregated vaccination rates) will be compared at baseline, 6, and 12 months between VPP and SCP clinics and neighborhoods, respectively.

Discussion

VPP directly addresses the most prominent COVID-19 vaccination barriers, including health literacy, community trust, and vaccine access, through a multi-level approach in collaboration with an FQHC. This approach has the potential to be an effective and scalable public health approach to vaccination among underserved communities.
背景:2019冠状病毒病对包括拉丁美洲人在内的少数群体的影响尤为严重。自COVID-19疫苗开发以来,实施工作面临多种因素的挑战,需要采取多层次、多部门的方法。本研究描述了疫苗推广计划(VPP),这是一项旨在提高临床和社区环境中拉丁裔人COVID-19疫苗接种率的多层次干预措施。方法:VPP是一项双盲、实用的、为期12个月的集群随机试验,与加利福尼亚州圣地亚哥的一家大型联邦合格健康中心(FQHC)合作。10家诊所将被随机分配到涉及人际、诊所和社区层面活动的多层次干预(VPP)或标准临床实践(SCP) (n = ,各5家诊所)。VPP诊所的患者将收到量身定制的诊所发起的关于COVID-19疫苗接种的信息和健康教育者的动机性访谈(15-30分钟的电话/远程医疗接触),以鼓励接种COVID-19疫苗。卫生主任将发送电子邮件和/或短信信息,鼓励接种疫苗。社区层面的干预包括有针对性和量身定制的活动,以促进五个VPP诊所周围社区的COVID-19疫苗接种。将招募200名患者参加综合调查和随访24 个月,以评估长期结果。将分别在基线、6和12 个月比较VPP和SCP诊所和社区的主要结局(COVID-19总疫苗接种率)。讨论:VPP通过与FQHC合作的多层次方法,直接解决最突出的COVID-19疫苗接种障碍,包括卫生素养、社区信任和疫苗获取。这种方法有可能成为在服务不足的社区进行疫苗接种的有效和可扩展的公共卫生方法。
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引用次数: 0
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Contemporary clinical trials
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