Paediatrics

Including children in randomized controlled trials has obvious complications. Balancing competing requirements is especially challenging, when designing research questions in paediatric trials, and children are often excluded from larger trials, because of the difficulties in obtaining consent. In the long run, this is detrimental to children’s health, as too much clinical practice is extrapolated from adult medicine. This chapter identifies and examines these issues, with the aims of encouraging researchers to appropriately involve children in their research and to help researchers improve the quality of trials involving children. Issues covered include diversity, dynamic child development, practical issues, and ethical concerns. Although such issues can complicate research, they also highlight the individual care and attention that children receive and the need for a holistic perspective.

2016 ◽  
Author(s):  
Amy Price ◽  
Amanda Burls ◽  
Lenny Vasanthan ◽  
Mike Clarke ◽  
Su May Liew ◽  
...  

BACKGROUND: The use of public engagement and self-management in online clinical trials is growing with benefits, boundaries and minimal methodological guidance. This analysis explores whether running self-recruited online trials can provide trustworthy and useful answers to research questions. AIM: To systematically explore existing self-recruited online randomized controlled trials of self-management interventions and analyze the trials to assess their strengths and weaknesses, the quality of trials reporting and to report how participants were involved in the research process. METHODS: The Online Randomized Controlled Trials of Health Information Database (ORCHID) will be used as a sampling framework to identify a subset of self-management self-recruited interventions. The trials will be used to explore the qualities of self-recruited online randomized controlled trials and to evaluate how useful they are for obtaining trustworthy answers to questions about health self-management and citizen research involvement. This research employs participatory action research where researchers and participants work as collaborators. SUMMARY: This analysis can provide an overall view of effective methods for online trials and to provide insights into integration for online trials development as early as the protocol planning stage.


2016 ◽  
Author(s):  
Amy Price ◽  
Amanda Burls ◽  
Lenny Vasanthan ◽  
Mike Clarke ◽  
Su May Liew ◽  
...  

BACKGROUND: The use of public engagement and self-management in online clinical trials is growing with benefits, boundaries and minimal methodological guidance. This analysis explores whether running self-recruited online trials can provide trustworthy and useful answers to research questions. AIM: To systematically explore existing self-recruited online randomized controlled trials of self-management interventions and analyze the trials to assess their strengths and weaknesses, the quality of trials reporting and to report how participants were involved in the research process. METHODS: The Online Randomized Controlled Trials of Health Information Database (ORCHID) will be used as a sampling framework to identify a subset of self-management self-recruited interventions. The trials will be used to explore the qualities of self-recruited online randomized controlled trials and to evaluate how useful they are for obtaining trustworthy answers to questions about health self-management and citizen research involvement. This research employs participatory action research where researchers and participants work as collaborators. SUMMARY: This analysis can provide an overall view of effective methods for online trials and to provide insights into integration for online trials development as early as the protocol planning stage.


2020 ◽  
Author(s):  
Bennian Huo ◽  
Su-juan Ran ◽  
Yun-tao JIA ◽  
yao LIU ◽  
mao-lin AI ◽  
...  

Abstract Objective: Randomized controlled trials (RCTs) are usually the basis of evidence-based medicine and provide important information for pediatric clinical practice, but whether the results of RCTs can be correctly translated into clinical practice depends on the quality of the literature reported. In this study, we evaluated the general characteristics and quality of pediatric RCTs published in mainland China over the decades 1999-2018.Methods: We individually searched all 20 available pediatric journals published between January 1, 1999, and December 30, 2018 and selected RCTs with participants less than 18 years. Each review author extracted details data from each of the selected RCTs including general characteristics, ethical characteristics, trial characteristics. Using Cochrane Collaboration methods for risk assessment.Results: Totally, 4093 RCTs were included for analysis. The average annual growth rate of published pediatric RCTs was 35.22% (p = 0.000), a notable increase occurred in 2017, and most of the studies were carried out in east China (32%). Only 1.98% of RCTs conducted in multiple-center, and 13.73% of the RCTs reported funding resources, 15.34% of the RCTs stated that it was approved by the ethics committee and 34.99% of the authors stated that the patients signed the informed consent. Comparing RCTs published in 2014-2018 with RCTs published in 1999-2003, we found the quality of RCTs has improved in random sequence generation, blinding participants and personnel, and incomplete outcome data. RCTs stated the approval of the ethics committee and the signing of the informed consent form, conducted in teaching hospitals, with multiple-centers, funding were of better quality in all the analyzed items.Conclusions: The number of pediatric RCTs has increased significantly over time in mainland China, and the quality have improved over the decades 1999-2018, but quality of the RCTs initiated by investigators published in mainland China still need to be improved, special attention should be paid to allocation concealment, blinding outcome assessment and selective outcome reporting.


2018 ◽  
Author(s):  
David R Vago ◽  
Resh Gupta ◽  
Sara Lazar

One potential pathway by which mindfulness-based meditation improves health outcomes is through changes in cognitive functioning. A systematic review of randomized controlled trials of mindfulness-based interventions (MBIs) was conducted with a focus on assessing the state of the evidence for effects on cognitive processes and associated assays. Here, we comment on confounding issues surrounding the reporting of these and related findings, including 1) criteria that appropriately define an MBI; 2) limitations of assays used to measure cognition; and 3) methodological quality of MBI trials and reporting of findings. Because these issues contribute to potentially distorted interpretations of existing data, we offer constructive means for interpretation and recommendations for moving the field of mindfulness research forward regarding the effects on cognition.


2021 ◽  
Vol 12 (02) ◽  
pp. 199-207
Author(s):  
Liang Yan ◽  
Thomas Reese ◽  
Scott D. Nelson

Abstract Objective Increasingly, pharmacists provide team-based care that impacts patient care; however, the extent of recent clinical decision support (CDS), targeted to support the evolving roles of pharmacists, is unknown. Our objective was to evaluate the literature to understand the impact of clinical pharmacists using CDS. Methods We searched MEDLINE, EMBASE, and Cochrane Central for randomized controlled trials, nonrandomized trials, and quasi-experimental studies which evaluated CDS tools that were developed for inpatient pharmacists as a target user. The primary outcome of our analysis was the impact of CDS on patient safety, quality use of medication, and quality of care. Outcomes were scored as positive, negative, or neutral. The secondary outcome was the proportion of CDS developed for tasks other than medication order verification. Study quality was assessed using the Newcastle–Ottawa Scale. Results Of 4,365 potentially relevant articles, 15 were included. Five studies were randomized controlled trials. All included studies were rated as good quality. Of the studies evaluating inpatient pharmacists using a CDS tool, four showed significantly improved quality use of medications, four showed significantly improved patient safety, and three showed significantly improved quality of care. Six studies (40%) supported expanded roles of clinical pharmacists. Conclusion These results suggest that CDS can support clinical inpatient pharmacists in preventing medication errors and optimizing pharmacotherapy. Moreover, an increasing number of CDS tools have been developed for pharmacists' roles outside of order verification, whereby further supporting and establishing pharmacists as leaders in safe and effective pharmacotherapy.


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