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Design of a pragmatic trial integrating human papillomavirus (HPV) self-sampling into primary care to reduce cervical cancer screening disparities in Somali American individuals: The Isbaar project 设计一项将人类乳头瘤病毒(HPV)自我采样纳入初级保健的实用试验,以减少美国索马里人的宫颈癌筛查差异:Isbaar 项目。
IF 2 3区 医学 Q3 MEDICINE, RESEARCH & EXPERIMENTAL Pub Date : 2024-11-17 DOI: 10.1016/j.cct.2024.107754
John Lin , Rachel L. Winer , Christina Bliss Barsness , Jay Desai , Kristi Fordyce , Rahel Ghebre , Anisa M. Ibrahim , Sharif Mohamed , Timothy Ramer , Adam A. Szpiro , Bryan J. Weiner , Sophia Yohe , Rebekah Pratt

Background

Somali American individuals have lower cervical cancer screening rates than the U.S. general population. Offering HPV self-sampling in primary care clinics could increase screening rates in Somali American individuals by addressing screening barriers.

Methods

The Isbaar Project is a Hybrid Type 2 effectiveness-implementation study of a patient-centered, culturally tailored HPV self-sampling intervention for Somali American individuals. Guided by the Consolidated Framework for Implementation Research and Social Cognitive Theory, we conducted focus groups with Somali American individuals, and interviews with clinicians and clinic staff to inform refinement and development of implementation strategies. HPV self-sampling was then implemented as a usual care screening option at 3 community-based primary care clinics in Minneapolis, Minnesota in February 2023. The primary objective is to assess the effect of implementing in-clinic HPV self-sampling on screening completion in Somali American individuals. The secondary objective is to assess the effect of implementing HPV self-sampling on screening completion in all patients. Using difference-in-difference methods, we will evaluate changes in screening rates one-year pre and post implementation and compare changes with control clinics followed over the same time period. Using RE-AIM, we will conduct a post-implementation mixed methods analysis of processes and strategies needed to successfully implement HPV self-sampling in primary care.

Conclusions

The study was designed to evaluate a real-world in-clinic HPV self-sampling intervention for Somali American individuals, generating data on both effectiveness and implementation applicable to other community-based clinics in the U.S. The objective of this report is to describe the rationale and design of the study.
背景:索马里裔美国人的宫颈癌筛查率低于美国普通人群。在初级保健诊所提供 HPV 自我采样可通过解决筛查障碍来提高索马里裔美国人的筛查率:Isbaar 项目是一项混合型 2 效能实施研究,研究对象是以患者为中心、针对索马里裔美国人文化背景量身定制的 HPV 自我采样干预措施。在 "实施研究综合框架 "和 "社会认知理论 "的指导下,我们对索马里裔美国人进行了焦点小组讨论,并对临床医生和诊所工作人员进行了访谈,以便为实施策略的完善和发展提供信息。随后,我们于 2023 年 2 月在明尼苏达州明尼阿波利斯市的 3 家社区初级保健诊所实施了 HPV 自我采样,作为常规护理筛查选项。主要目标是评估在诊所内实施 HPV 自我采样对美国索马里人完成筛查的影响。次要目标是评估在所有患者中实施 HPV 自我采样对筛查完成率的影响。我们将采用差分法评估实施前后一年筛查率的变化,并与同期跟踪的对照诊所进行比较。利用 RE-AIM,我们将对在初级保健中成功实施 HPV 自我采样所需的流程和策略进行实施后混合方法分析:本研究旨在评估针对索马里裔美国人的诊所内 HPV 自我采样干预措施的实际效果,从而生成适用于美国其他社区诊所的有效性和实施情况的数据。
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引用次数: 0
CarersCanADAPT: Study protocol of a stepped care pathway and hybrid type 1 effectiveness-implementation trial of an online cognitive behavioural therapy (iCBT) program for cancer carers with anxiety and depression CarersCanADAPT:针对患有焦虑症和抑郁症的癌症照护者的在线认知行为疗法 (iCBT) 程序的阶梯式照护路径和混合型 1 类有效性实施试验的研究方案。
IF 2 3区 医学 Q3 MEDICINE, RESEARCH & EXPERIMENTAL Pub Date : 2024-11-17 DOI: 10.1016/j.cct.2024.107749
Rebekah Laidsaar-Powell , Sarah Giunta , Lisa Beatty , Phyllis Butow , Daniel Costa , Aaron Lam , Ilona Juraskova , Olivia Cook , Fiona Crawford-Williams , Nicole M. Rankin , Joanne Shaw

Background

Family or friend carers of people with cancer report high levels of depression, anxiety, caregiving strain, and unmet needs. Limited strategies for identification and management of distress have been established among cancer carers. This paper describes the protocol of two linked studies: Study 1a, a distress screening and stepped care pathway feasibility study and Study 1b, a hybrid implementation-effectiveness Randomised Controlled Trial (RCT) to assess the benefit of a comprehensive, carer-centred online Cognitive Behavioural Therapy (iCBT) program for carers with anxiety and depression.

Methods

For Study 1a, 300 cancer carers will be screened for distress. Carers with low distress will be referred to publicly available carer resources. Carers scoring 4 and higher on the distress thermometer will complete depression and anxiety measures. Carers with high anxiety/depression will be recommended psychological therapy. Carers with mild/moderate anxiety and/or depression will be allocated to the Carers iCBT Program, evaluated via a RCT with waitlist control group (Study 1b). For Study 1b, intervention group carers will receive access to a 6-lesson self-directed online iCBT program. Waitlist-controls will access the intervention at 14 weeks. Intervention and control groups will complete baseline, 6 week, and 14 week self-report measures; controls will complete additional measures at 20 and 28 weeks. A sample size of n = 166 carers in the iCBT RCT is needed.

Conclusions

If acceptable, feasible and effective, this pathway and iCBT intervention could offer a sustainable, scalable and low-cost approach to identifying and managing distress in carers, and potentially improving patient and carer outcomes.
Trial Registration: Australian and New Zealand Clinical Trial Registry number: ACTRN12623001341617p.
背景:癌症患者的家人或朋友照护者报告了高水平的抑郁、焦虑、照护压力和未满足的需求。在癌症照护者中,用于识别和管理痛苦的策略十分有限。本文介绍了两项关联研究的方案:研究 1a 是一项困扰筛查和阶梯式护理路径可行性研究,研究 1b 是一项混合实施效果随机对照试验 (RCT),旨在评估以护理者为中心的综合在线认知行为疗法 (iCBT) 项目对焦虑和抑郁护理者的益处:在研究 1a 中,将对 300 名癌症照护者进行压力筛查。痛苦程度较低的照护者将被转介到可公开获取的照护者资源。照护者在痛苦温度计上得分 4 分及以上者将完成抑郁和焦虑测量。焦虑/抑郁程度较高的照护者将被推荐接受心理治疗。轻度/中度焦虑和/或抑郁的照护者将被分配到照护者 iCBT 计划中,该计划将通过 RCT 与候补对照组(研究 1b)进行评估。在研究 1b 中,干预组的照护者将获得 6 课时的自主在线 iCBT 课程。候补对照组将在 14 周后接受干预。干预组和对照组将完成基线、6 周和 14 周的自我报告测量;对照组将在 20 周和 28 周完成额外的测量。iCBT RCT 的样本量需要达到 n = 88:如果该路径和 iCBT 干预是可接受的、可行的和有效的,则可提供一种可持续的、可扩展的和低成本的方法来识别和管理照护者的痛苦,并有可能改善患者和照护者的预后:试验注册:澳大利亚和新西兰临床试验注册号:ACTRN12623001341617p.
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引用次数: 0
Overcoming therapeutic inertia in newly diagnosed type 2 diabetes: Protocol of a randomized, quality improvement trial 克服新诊断 2 型糖尿病患者的治疗惰性:随机质量改进试验方案。
IF 2 3区 医学 Q3 MEDICINE, RESEARCH & EXPERIMENTAL Pub Date : 2024-11-17 DOI: 10.1016/j.cct.2024.107751
Thanh K. Thai , Christine A. Board , Joshua R. Nugent , Jessica L. Johnston , Esther Y. Huynh , Cindy Hanh Chen , Andy H. Chan , Richard W. Grant , Lisa K. Gilliam , Anjali Gopalan
Therapeutic inertia, the delay in the appropriate initiation and intensification of recommended therapies, is a major contributor to the lack of improvement in type 2 diabetes outcomes over the past decade. Therapeutic inertia during the period following diagnosis, when improvements in glycemic control can have lasting benefits, is often overlooked. Technology and team-based care approaches can effectively address therapeutic inertia. Here, we describe the protocol for a randomized, quality improvement trial targeting metformin-related therapeutic inertia among adults with recently diagnosed type 2 diabetes and a hemoglobin A1c <8 %. Service areas within an integrated healthcare delivery system were randomized to 1) usual care, 2) physician education on therapeutic inertia, and 3) physician education on therapeutic inertia paired with proactive outreach by a clinical pharmacist. The physician education sessions were offered to primary care providers working in the service areas randomized to Arm 2 and Arm 3, and proactive outreach by a clinical pharmacist was performed for patients of the providers in service areas randomized to Arm 3. Outcomes will be abstracted from the EHR at 6, 12, and 18 months following the physician education sessions. The primary outcome will be the proportion of patients with an HbA1c <7 % at each of the follow-up time points. Outcome abstraction and analyses will occur in late 2024. This trial seeks to rigorously evaluate care strategies that can shift stagnant type 2 diabetes outcomes. Our protocol, along with the pending results, may offer examples to other healthcare systems working to improve type 2 diabetes care.
治疗惰性,即延迟适当启动和加强推荐疗法,是过去十年中 2 型糖尿病治疗效果没有改善的主要原因。确诊后的治疗惰性往往被忽视,而血糖控制的改善却能带来持久的益处。技术和团队护理方法可以有效解决治疗惰性问题。在此,我们介绍一项随机质量改进试验的方案,该试验针对的是新近确诊的 2 型糖尿病患者中与二甲双胍相关的治疗惰性,其血红蛋白 A1c
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引用次数: 0
Qualitative understanding of experiences of people with cystic fibrosis in a treatment discontinuation trial: The QUEST study 定性了解囊性纤维化患者在停止治疗试验中的经历:QUEST 研究。
IF 2 3区 医学 Q3 MEDICINE, RESEARCH & EXPERIMENTAL Pub Date : 2024-11-17 DOI: 10.1016/j.cct.2024.107752
Jill Maggs , Gregory S. Sawicki , Callie Bacon , Emma McWilliams , Dana Yablon , Benjamin Ertman , Liam Sweeney , Jennifer L. Butcher , Robin S. Everhart , Michelle Prickett , Christopher Siracusa , Alex H. Gifford , Nicole Mayer-Hamblett , David P. Nichols , Andrea Goodman , Tia Woo , Kristin A. Riekert

Background

As people with cystic fibrosis (PWCF) live longer due to the breakthrough drug elexacaftor-tezacaftor-ivacaftor (ETI), they have questioned whether other CF therapies could be safely discontinued. SIMPLIFY was the first prospective, randomized trial to evaluate non-inferiority of discontinuing versus continuing two therapies. The QUEST (Qualitative Understanding of Experiences in the SIMPLIFY Trial) study was conducted to understand experiences of PWCF enrolled in SIMPLIFY, including why they joined, perceptions of randomization, decision-making around study withdrawal, and considerations for future discontinuation studies.

Methods

QUEST enrolled SIMPLIFY participants 14 years or older stable on ETI and caregivers of the 14–17 year-olds. Interviews were audio-recorded, transcribed, and coded. A phenomenological approach was used to inductively develop codes with no a priori hypotheses; identified themes were then organized around current research and recruitment literature.

Results

114 interviews were completed (68 adults, 23 teenagers, and 23 caregivers). Among PWCF, median age was 27.8 years, 49 % were female and 80 % had participated in research before SIMPLIFY. Five themes were identified: (1) Experience with SIMPLIFY randomization, [2] Trust, [3] Altruism, [4] Perceived personal benefits, and [5]) Perceived risks and protocol burden.

Conclusion

QUEST findings highlight how a long-standing culture of research and thoughtful protocol design contributed to SIMPLIFY's successful recruitment and retention. This included understanding the importance of remaining in the trial despite not being randomized to their preferred treatment assignment. Using patient-centered approaches to select research questions, design a protocol to minimize participant barriers, and frame recruitment materials messaging contribute to successful research participation.
背景:由于突破性药物 elexacaftor-tezacaftor-ivacaftor (ETI)的问世,囊性纤维化患者(pwCF)的寿命延长了,他们对是否可以安全停用其他 CF 疗法提出了质疑。SIMPLIFY 是首个前瞻性随机试验,旨在评估停用两种疗法与继续使用两种疗法的非劣效性。QUEST(Qualitative Understanding of Experiences in the SIMPLIFY Trial)研究旨在了解加入 SIMPLIFY 的儿童患者的经历,包括他们加入的原因、对随机化的看法、围绕研究退出的决策以及未来停药研究的考虑因素:QUEST招募了SIMPLIFY的14岁或14岁以上稳定接受ETI的参与者以及14-17岁儿童的照顾者。对访谈进行了录音、转录和编码。在没有先验假设的情况下,采用现象学方法归纳出编码;然后根据当前的研究和招募文献对确定的主题进行整理:共完成了 114 次访谈(68 名成人、23 名青少年和 23 名护理人员)。在儿童和青少年中,年龄中位数为 27.8 岁,49% 为女性,80% 在 SIMPLIFY 之前参与过研究。研究确定了五个主题:(Gul和Ali,2010 [1])SIMPLIFY随机化的经验,CFF患者注册年度数据报告[互联网](2017)[2]信任,CFF患者注册年度数据报告[互联网](2022)[3]利他主义,Goss等人(2008)[4]感知到的个人利益,以及(Goss等人,2002 [5])感知到的风险和协议负担:QUEST 的研究结果突显了长期的研究文化和周到的方案设计是如何帮助 SIMPLIFY 成功招募和留住人才的。这包括理解在未被随机分配到首选治疗方案的情况下仍留在试验中的重要性。使用以患者为中心的方法来选择研究问题、设计方案以最大限度地减少参与者的障碍,以及编写招募材料信息,都有助于成功参与研究。
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引用次数: 0
INteractive survivorship program to improve health care REsources [INSPIRE]: A study protocol testing a digital intervention with stepped care telehealth to improve outcomes for adolescent and young adult survivors 改善医疗保健资源的互动式幸存者计划 [INSPIRE]:一项研究方案,通过测试分级护理远程保健的数字干预措施,改善青少年和年轻成人幸存者的治疗效果。
IF 2 3区 医学 Q3 MEDICINE, RESEARCH & EXPERIMENTAL Pub Date : 2024-11-17 DOI: 10.1016/j.cct.2024.107745
Jean C. Yi , Sheri Ballard , Casey Walsh , Danielle N. Friedman , Patricia A. Ganz , Linda A. Jacobs , Ann H. Partridge , Sandra A. Mitchell , Wendy M. Leisenring , Karen L. Syrjala , K. Scott Baker

Background

Adolescents and young adults with cancer (AYAs, ages 15–39 at the time of diagnosis) experience significant adverse health and psychosocial outcomes. AYAs live with emotional distress and health care demands that exceed those of their healthy peers but can have difficulty accessing care. Digitally delivered interventions are an attractive option for AYA survivors, a population that routinely utilizes online resources when seeking health information and support.

Aim

By improving access to survivorship resources and support and strengthening health literacy and self-management skills, the INteractive Survivorship Program to Improve Health care REsources [INSPIRE] is designed to improve adherence to AYA health care guidelines and reduce cancer-related distress. We describe the protocol for a two-arm randomized controlled trial (RCT) testing the AYA-adapted INSPIRE program.

Methods/Design

The intervention includes an interactive mobile app, study website, and social media platforms, adding telehealth for those with continued distress, lower survivorship health care literacy, or poor engagement with the digital program at 6 weeks. Participants are randomized to INSPIRE or an active control. In the active control arm, survivors receive access to a study website with links to existing AYA survivor resources followed by delayed access to the INSPIRE program. Participants are not blinded; study staff not providing telehealth are blinded. The primary outcomes are cancer-related distress and health care adherence specific to second cancer and cardiometabolic screenings.

Discussion

If effective, the program is positioned for accelerated implementation to improve care for AYA survivors by using a scalable informatics-based administration and largely digital intervention program.
背景:患有癌症的青少年和年轻成人(AYAs,确诊时年龄为 15-39 岁)在健康和社会心理方面会经历严重的不良后果。青少年和青年癌症患者的情绪困扰和医疗保健需求超过了健康的同龄人,但却很难获得医疗保健服务。目的:"改善医疗保健资源的互动幸存者计划"[INSPIRE]旨在通过改善幸存者资源和支持的获取途径,加强健康素养和自我管理技能,从而提高亚裔幸存者对医疗保健指南的依从性,减少与癌症相关的困扰。我们介绍了一项双臂随机对照试验(RCT)的方案,该试验测试了适合亚裔青少年的 INSPIRE 计划:方法/设计:干预措施包括互动式移动应用程序、研究网站和社交媒体平台,并为那些持续感到痛苦、幸存者医疗保健知识水平较低或在 6 周内对数字程序参与度较低的人增加了远程医疗服务。参与者被随机分配到 INSPIRE 或积极对照组。在积极对照组中,幸存者会访问一个研究网站,该网站上有与现有 AYA 幸存者资源的链接,随后会延迟访问 INSPIRE 计划。参与者不会被蒙蔽;不提供远程保健服务的研究人员也不会被蒙蔽。主要结果是与癌症有关的痛苦以及坚持进行第二次癌症和心脏代谢筛查:讨论:如果该计划有效,则可加速实施,通过使用可扩展的基于信息学的管理和大体上数字化的干预计划,改善对青壮年幸存者的护理。
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引用次数: 0
Keep it Movin’: Design and methods of a church-based physical activity program to improve physical function among midlife and older black adults 保持运动:以教堂为基础的体育活动计划的设计和方法,以改善中老年黑人的身体机能。
IF 2 3区 医学 Q3 MEDICINE, RESEARCH & EXPERIMENTAL Pub Date : 2024-11-13 DOI: 10.1016/j.cct.2024.107742
Brittney S. Lange-Maia , Amber Deckard , Sheila A. Dugan , Yolanda Cartwright , Steve M. Epting , LaDawne Jenkins , Sumihiro Suzuki , Valerie G. Press , Steven K. Rothschild , Elizabeth B. Lynch

Background

Older Black adults have high rates of physical function (PF) limitations. Physical activity (PA) is effective for improving PF and reducing mobility disability risk; however, community-based PA interventions focused on improving PF for older Black adults are lacking. Given the importance of churches as trusted institutions in Black communities, church-based interventions developed through community collaborations may help increase access to PA interventions.

Methods

Keep it Movin’ is a church-based cluster randomized controlled trial testing the effectiveness of a 24-week group-based (intervention arm) versus a self-guided (comparator arm) program in improving PF among Black adults aged ≥ 40 years with PF limitations (short physical performance battery [SPPB] score ≤ 9). A church-wide virtual walking program is available to congregants in both arms. The intervention arm receives weekly group-based classes held at the church that include education, goal setting, and structured PA (walking, lower-extremity strength, balance, and stretching). The comparator arm receives educational materials about PA appropriate for people with PF limitations. Outcomes are assessed at 6 (program completion) and 12 months (maintenance). The primary outcome is PF change as measured by the SPPB at 6 months. Secondary outcomes include change in moderate-to-vigorous PA, social support and self-efficacy for PA, quality of life, and self-reported PF. Factors related to successful adoption, implementation, and maintenance are assessed using the Reach, Effectiveness, Adoption, Implementation, and Maintenance (RE-AIM) framework.

Conclusion

This is the first study to evaluate the effectiveness of a group-based PA program delivered in Black churches to improve PF.
背景:黑人老年人的身体功能(PF)受限率很高。体力活动(PA)可有效改善身体功能并降低行动不便的风险;然而,以社区为基础、专注于改善黑人老年人身体功能的体力活动干预措施却很缺乏。鉴于教会作为黑人社区中值得信赖的机构的重要性,通过社区合作开发基于教会的干预措施可能有助于增加获得 PA 干预措施的机会:Keep it Movin'是一项以教堂为基础的群组随机对照试验,该试验测试了为期 24 周的集体计划(干预组)与自我指导计划(比较组)在改善年龄≥40 岁、有运动能力限制(短期体能测试 [SPPB] 得分≤9)的黑人成年人的运动能力方面的效果。两组参与者均可参加全教会范围内的虚拟步行计划。干预组每周在教堂举办一次小组课程,内容包括教育、目标设定和有组织的体育锻炼(步行、下肢力量、平衡和伸展)。对比组则接受适合有运动功能障碍的人的体育锻炼教育材料。结果在 6 个月(计划完成)和 12 个月(维持)时进行评估。主要结果是 6 个月时通过 SPPB 测定的 PF 变化。次要结果包括中度到剧烈运动的变化、社会支持和运动自我效能、生活质量以及自我报告的 PF。与成功采用、实施和维持有关的因素将使用 "到达、效果、采用、实施和维持"(RE-AIM)框架进行评估:这是第一项评估在黑人教堂开展的以小组为基础的锻炼计划对改善 PF 的有效性的研究。
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引用次数: 0
Challenges and prospects of clinical trials in Nigeria - Lessons from the WHO COVID-19 solidarity plus trial 尼日利亚临床试验的挑战和前景--世界卫生组织 COVID-19 团结加试验的经验教训。
IF 2 3区 医学 Q3 MEDICINE, RESEARCH & EXPERIMENTAL Pub Date : 2024-11-13 DOI: 10.1016/j.cct.2024.107743
Adefolarin Opawoye , Vivian Kwaghe , Zaiyad G. Habib , Yusuf Jibrin , Ibrahim Maigari , Bashir Hussaini , Olukemi Adekanmbi , Uche Unigwe , Olusola Ayoola , Akin Osibogun , Kolawole Salami , Marie-Pierre Preziosi , Abdulrazaq G. Habib
Conducting randomized clinical trials (RCTs) during a pandemic is essential for obtaining timely evidence on safe and effective treatments, but it presents numerous obstacles. During the COVID-19 pandemic, the World Health Organization (WHO) sponsored multinational RCTs investigating repurposed drugs among hospitalized COVID-19 patients across countries with varying clinical research capacities. In Nigeria, several challenges hindered our progress, including inadequate infrastructure, initial insufficient investigator certification and expertise, and delays in securing regulatory approvals due to bureaucratic hurdles. Despite these challenges, the WHO-sponsored Solidarity Plus Trial (SPT) offered valuable opportunities to enhance research capacity, streamline participant enrolment through electronic randomization, and bolster infection prevention and control measures for healthcare workers. Moreover, the trial enabled us to upgrade infrastructure at multiple sites, facilitating improved case detection through more testing and data collection. A crucial lesson learned was the importance of expediting trial initiation to capitalize on the limited window for data collection during an outbreak. To optimize RCTs during pandemics, we advocate for enhanced community engagement, collaborative efforts across sectors, strengthened research capacity, flexible regulatory frameworks, and the establishment of adaptive clinical trial units. By addressing these challenges and leveraging opportunities, we can significantly enhance the efficiency and impact of RCTs during public health emergencies.
在大流行期间开展随机临床试验(RCT)对于及时获得安全有效的治疗证据至关重要,但也存在诸多障碍。在 COVID-19 大流行期间,世界卫生组织(WHO)赞助了多国 RCT,在临床研究能力各不相同的国家对 COVID-19 住院患者中的再利用药物进行调查。在尼日利亚,有几项挑战阻碍了我们的进展,包括基础设施不足、最初的研究人员认证和专业知识不足,以及由于官僚主义障碍而导致的监管审批延误。尽管存在这些挑战,但世界卫生组织赞助的 "团结加试验"(SPT)为我们提供了宝贵的机会,使我们能够提高研究能力,通过电子随机化简化参与者注册程序,并加强医护人员的感染预防和控制措施。此外,该试验还使我们能够升级多个地点的基础设施,通过更多的检测和数据收集来改进病例检测。我们学到的一个重要经验是,在疫情爆发期间,必须加快试验的启动,以充分利用有限的数据收集时间。为了优化大流行期间的临床试验,我们主张加强社区参与、跨部门合作、加强研究能力、灵活的监管框架以及建立适应性临床试验单位。通过应对这些挑战和利用各种机遇,我们可以大大提高公共卫生突发事件期间 RCT 的效率和影响。
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引用次数: 0
Protocol for a randomized controlled trial to evaluate the effectiveness of a telehealth group intervention to reduce perinatal depressive symptoms 随机对照试验方案,评估远程保健小组干预对减轻围产期抑郁症状的效果。
IF 2 3区 医学 Q3 MEDICINE, RESEARCH & EXPERIMENTAL Pub Date : 2024-11-13 DOI: 10.1016/j.cct.2024.107738
Eli Iacob , Ryoko Kausler , Marcia Williams , Sara Simonsen , Marcela Smid , Kristen Weissinger , Gwen Latendresse

Background

Perinatal depression and anxiety (PDA) affect approximately 20 % of individuals and are associated with adverse outcomes, including preterm birth, low birth weight, and impaired cognitive development of the child. Telehealth may reduce access barriers to needed mental health services. However, lack of disseminated, standardized study protocols aimed at investigating the role of telehealth in reducing PDA symptoms limits the ability to compare findings across studies. The purpose of this paper is to provide a conceptual framework and a randomized controlled trial protocol (RCT) for use in future studies.

Methods and analysis

An RCT was designed to evaluate the effectiveness of a group videoconference intervention (VCI) to reduce PDA symptoms across pregnancy and postpartum period. Participants are randomly assigned to study groups: VCI + standard of care, or attention control (AC) + standard of care. Both groups have weekly one-hour group videoconference sessions for 9 weeks. The VCI groups are facilitated by a mental health professional using a manualized program based on mindfulness-based practices and cognitive behavioral therapy (MBCT). The AC groups are facilitated by a registered nurse using a manualized program for childbirth and parenting education. The primary outcomes are depressive symptoms as measured by the Edinburgh Postnatal Depression Scale (EPDS) and anxiety symptoms as measured by the Generalized Anxiety Disorder (GAD-7).

Conclusion

This RCT study protocol can be used as a standard approach to improve the ability to compare findings across studies, applied in any setting (e.g., rural or urban), and adapted to diverse communities.
Trial Registration: ClinicalTrials.gov NCT03932760
背景:围产期抑郁和焦虑(PDA)影响着约 20% 的人,并与早产、出生体重不足和儿童认知发展受损等不良后果相关。远程保健可减少获得所需心理健康服务的障碍。然而,由于缺乏旨在研究远程保健在减少 PDA 症状方面作用的标准化研究方案,因此无法对不同研究的结果进行比较。本文旨在提供一个概念框架和随机对照试验方案(RCT),供未来研究使用:设计了一项随机对照试验,以评估小组视频会议干预(VCI)对减轻孕期和产后 PDA 症状的效果。参与者被随机分配到研究小组:VCI + 标准护理,或注意力控制 (AC) + 标准护理。两组均每周进行一小时的小组视频会议,为期 9 周。VCI 小组由一名心理健康专业人士主持,使用基于正念实践和认知行为疗法 (MBCT) 的手册化程序。AC 小组由一名注册护士主持,使用的是分娩和育儿教育手册程序。主要结果为爱丁堡产后抑郁量表(EPDS)测量的抑郁症状和广泛性焦虑症(GAD-7)测量的焦虑症状:该 RCT 研究方案可用作标准方法,以提高比较不同研究结果的能力,适用于任何环境(如农村或城市),并适用于不同社区:试验注册:ClinicalTrials.govNCT03932760。
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引用次数: 0
Design and methodology of a randomized clinical trial of quetiapine to reduce central nervous system polypharmacy in veterans with postconcussive syndrome symptoms 喹硫平随机临床试验的设计与方法,以减少有震颤后综合征症状的退伍军人中枢神经系统的多重药物治疗。
IF 2 3区 医学 Q3 MEDICINE, RESEARCH & EXPERIMENTAL Pub Date : 2024-11-10 DOI: 10.1016/j.cct.2024.107741
Muhammad R. Baig , Gerardo Villarreal , Lizette Aviles , Adeel Meraj , Betsy Davis , Eric C. Meyer , Casey Straud , Stacey Young-McCaughan , Alan L. Peterson , John D. Roache
Lack of evidence to guide medication treatments for mild traumatic brain injury (mTBI) in veterans too often results in polypharmacy practices attempting to provide symptomatic relief from multiple postconcussive syndrome symptoms. Therefore, the field needs to find an effective medication that reduces the burden of postconcussive symptoms without complicating the treatment burden of veterans. This clinical trial seeks to determine whether switching veterans to quetiapine monotherapy (intervention) is superior to continuing to receive treatment as usual (TAU, control) polypharmacy for veterans with symptoms of postconcussive syndrome and posttraumatic stress disorder who are receiving rehabilitation treatment for mTBI. This study will test the conceptual mediation model hypothesis that quetiapine monotherapy may enhance recovery from mTBI by (1) increasing engagement in rehabilitation services, and/or (2) reducing the adverse effects of TAU polypharmacy. This study will enroll 146 patients from two Veterans Administration Medical Centers into a 12- week phase III, randomized, pragmatic clinical trial comparing outcomes from treatment with quetiapine monotherapy and TAU. Quetiapine will be cross tapered up to a maximum dose of 200 mg (as tolerated) as other medications are discontinued. The primary outcome measures are postconcussive syndrome symptoms (Neurobehavioral Symptom Inventory), functional disability (World Health Organization Disability Assessment), and quality of life (World Health Organization Quality of Life Assessment). Overall, this study aims to determine whether quetiapine monotherapy is superior to TAU polypharmacy and improves the quality of life for veterans with comorbid postconcussive syndrome and posttraumatic stress disorder symptoms who are receiving rehabilitation treatment for mTBI.
由于缺乏指导退伍军人轻度脑外伤(mTBI)药物治疗的证据,退伍军人往往会尝试使用多种药物来缓解多种撞击后综合征症状。因此,该领域需要找到一种有效的药物,既能减轻撞击后症状的负担,又不会加重退伍军人的治疗负担。本临床试验旨在确定,对于有撞击后综合征和创伤后应激障碍症状并正在接受创伤后应激障碍康复治疗的退伍军人来说,让他们改用喹硫平单药治疗(干预)是否优于继续接受常规治疗(TAU,对照组)。本研究将验证概念中介模型假设,即奎硫平单药治疗可通过(1)提高康复服务的参与度,和/或(2)减少TAU多药治疗的不良反应,从而促进mTBI的康复。这项研究将从两家退伍军人管理局医疗中心招募 146 名患者,进行为期 12 周的 III 期随机实用临床试验,比较喹硫平单药治疗和 TAU 治疗的效果。在停用其他药物的同时,喹硫平将交叉减量,最大剂量为200毫克(视耐受情况而定)。主要结果测量指标包括:震后综合征症状(神经行为症状量表)、功能性残疾(世界卫生组织残疾评估)和生活质量(世界卫生组织生活质量评估)。总之,本研究旨在确定喹硫平单药治疗是否优于TAU多药治疗,以及是否能改善正在接受创伤后应激障碍康复治疗的合并有撞击后综合征和创伤后应激障碍症状的退伍军人的生活质量。
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引用次数: 0
The eACT study design and methods: A sequential, multiple assignment, randomized trial of A novel adherence intervention for youth with epilepsy eACT 研究的设计和方法:一项针对青少年癫痫患者的新型坚持治疗干预的连续、多重分配、随机试验。
IF 2 3区 医学 Q3 MEDICINE, RESEARCH & EXPERIMENTAL Pub Date : 2024-11-10 DOI: 10.1016/j.cct.2024.107739
Janelle L. Wagner , Anup D. Patel , Heather Huszti , Matthew Schmidt , Gigi Smith , Sonal Bhatia , Shanna M. Guilfoyle , Amy Lang , Stacy Buschhaus , Shannon Williams , Jessica Ardo , Marie Davidian , Avani C. Modi

Background

Epilepsy is a common, chronic pediatric neurological condition predominately treated with anti-seizure medications (ASMs) to control or reduce seizures. Approximately 60 % of youth with epilepsy demonstrate suboptimal adherence to their ASM. This paper describes the methodology, recruitment, design, and baseline participant characteristics of a sequential, multiple assignment, randomized trial (SMART) designed to test the effectiveness of a behavioral health intervention to improve adherence in families of young children with epilepsy.

Methods

Using a two-stage SMART, youth ages 2–12 years old with newly diagnosed epilepsy and their families were enrolled. Following an 8-week run-in phase, families with ≤95 % adherence were randomized to control (education + automated digital reminders) or intervention (education + automated digital reminders + individualized feedback) arms. After three months, families in the intervention group who remained non-adherent (i.e., ≤ 95 %) were re-randomized to 1) continue with same intervention or 2) receive two telehealth problem-solving sessions with an interventionist over the next two months. Study measures were completed at baseline, 8-, 14-, and 20-months post-baseline.

Results

Of the n = 466 ethnically and racially diverse study participants, n = 268 participants were non-adherent and were randomized. The primary outcome was electronically monitored ASM adherence at post-intervention, while secondary outcomes included seizure freedom, health care utilization, and epilepsy-specific health-related quality of life.

Conclusions

Novel aspects of the trial design (e.g., sequential, recruitment of racial and ethnic diverse youth), modifications to the protocol related to the COVID-19 pandemic and evolving socio-political and medical climate, as well as recruitment and retention challenges are discussed.
ClinicalTrials.gov Number: NCT03817229
背景:癫痫是一种常见的慢性儿科神经系统疾病,主要通过抗癫痫药物(ASM)来控制或减少癫痫发作。约 60% 的青少年癫痫患者对抗癫痫药物的依从性不佳。本文介绍了一项顺序、多重分配、随机试验(SMART)的方法、招募、设计和基线参与者特征,该试验旨在测试行为健康干预对改善癫痫幼儿家庭依从性的有效性:方法:采用两阶段 SMART,招募 2-12 岁新确诊癫痫的青少年及其家庭。在为期8周的磨合阶段后,依从性低于95%的家庭被随机分配到对照组(教育+自动数字提醒)或干预组(教育+自动数字提醒+个性化反馈)。三个月后,干预组中仍未坚持治疗的家庭(即坚持率低于 95%)被重新随机分配为:1)继续接受相同的干预;或 2)在接下来的两个月中接受两次由干预专家提供的远程医疗问题解决课程。在基线、基线后 8 个月、14 个月和 20 个月完成研究测量:在 n = 466 名不同民族和种族的研究参与者中,n = 268 名参与者未坚持治疗,他们被随机分组。主要结果是干预后电子监测的ASM依从性,次要结果包括癫痫发作自由度、医疗保健利用率以及与癫痫相关的健康生活质量:讨论了试验设计的新颖之处(如顺序、招募不同种族和民族的青少年)、与 COVID-19 大流行和不断变化的社会政治和医疗环境相关的方案修改,以及招募和留住人员方面的挑战:NCT03817229。
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引用次数: 0
期刊
Contemporary clinical trials
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