scholarly journals Behavioral nudges increase COVID-19 vaccinations: Two randomized controlled trials

2021 ◽  
Author(s):  
Hengchen Dai ◽  
Silvia Saccardo ◽  
Maria A Han ◽  
Lily Roh ◽  
Naveen Raja ◽  
...  
Keyword(s):  
Randomized Controlled Trials ◽  
Behavioral Science ◽  
Age Groups ◽  
Text Messages ◽  
Vaccine Uptake ◽  
Vaccine Hesitancy ◽  
Controlled Trials ◽  
Vaccination Rates ◽  
Effective Strategies ◽  
Randomized Controlled

AbstractFighting the COVID-19 pandemic requires quick and effective strategies to maximize vaccine uptake. We present two sequential randomized controlled trials (RCTs) that tackle this challenge with behavioral science insights. We deliver text-based nudges to UCLA Health patients one day (first RCT; N=113,229) and eight days (second RCT; N=90,662) after they receive notifications of vaccine eligibility. In the first RCT, text messages designed to make vaccination salient and easy to schedule boost appointment and vaccination rates by 86% and 26%, respectively. Nudges that make patients feel endowed with the vaccine heighten these effects, but addressing vaccine hesitancy via a video-based information intervention does not yield benefits beyond simple text. These results hold across ethnicity and age groups. By contrast, online experiments (N=2,003) soliciting hypothetical responses to the same messages reveal the opposite patterns, underscoring the importance of pilot-testing behavioral nudges in the real world before scaling them up. In the second RCT, we further find that receiving a second reminder boosts appointment and vaccination rates by 52% and 16%, respectively. Our findings suggest that text-based nudges can substantially increase and accelerate COVID-19 vaccinations at almost zero marginal cost, highlighting the promising role of behavioral science in addressing a critical component of the COVID-19 pandemic response.

Teledentistry and mHealth for Promotion and Prevention of Oral Health: A Systematic Review and Meta-analysis

2021 ◽  
pp. 002203452110038
Author(s):  
C.E. Fernández ◽  
C.A. Maturana ◽  
S.I. Coloma ◽  
A. Carrasco-Labra ◽  
R.A. Giacaman
Keyword(s):  
Systematic Review ◽  
Oral Health ◽  
Randomized Controlled Trials ◽  
Communication Systems ◽  
Text Messages ◽  
Mean Difference ◽  
Controlled Trials ◽  
Large Reduction ◽  
Randomized Controlled ◽  
Standardized Mean Difference

The dental profession has experienced a dramatic acceleration in the use of communication systems and information-based technologies over recent years, originating new paradigms for the prevention and promotion of oral health. The purpose of this systematic review was to determine the effect of teledentistry-based (telematic) strategies, reported in randomized controlled trials and quasi-randomized trials, with a focus on oral health prevention and promotion–related outcomes in patients of all ages. We searched Medline via PubMed, SCOPUS, and Web of Science from inception until August 2020, regardless of the language of publication. We selected studies for inclusion and conducted data extraction, assessed risk of bias (Cochrane tool), and evaluated the certainty of the evidence (GRADE approach) in duplicate and independently. Out of 898 potentially eligible references, we selected 43 for full-text screening, of which 19 studies proved eligible: 18 randomized controlled trials and 1 quasi-randomized study. Virtual interventions were mostly asynchronous via apps ( n = 9), text messages ( n = 9), or computer-aided learning ( n = 1). The use of teledentistry as compared with conventional strategies may result in a large reduction in the plaque index (standardized mean difference, −1.18; 95% CI, −1.54 to −0.82; I2 = 92%; low certainty) and will likely result in a large reduction in the gingival index (standardized mean difference, −2.17; 95% CI, −3.15 to −1.19; I2 = 97%; moderate certainty) and in the incidence of white spot lesions (risk ratio, 0.48; 95% CI, 0.35 to 0.66; I2 = 0%; moderate certainty), with an increased effect over time. Evidence suggests that teledentistry, particularly mHealth (messages and apps), is a promising clinical tool for preventing and promoting oral health, especially under the accelerated virtualization of dentistry. Future studies should include a broader spectrum of the population, including adults and elders, to better inform policy and implementation of teledentistry (PROSPERO: CRD42020192685).

scholarly journals Outcomes of older patients with follicular lymphoma using individual data from 5922 patients in 18 randomized controlled trials

2021 ◽  
Vol 5 (6) ◽  
pp. 1737-1745
Author(s):  
Carla Casulo ◽  
Jesse G. Dixon ◽  
Fang-Shu Ou ◽  
Eva Hoster ◽  
Bruce A. Peterson ◽  
...  
Keyword(s):  
Elderly Patients ◽  
Follicular Lymphoma ◽  
Randomized Controlled Trials ◽  
Age Groups ◽  
Progression Free Survival ◽  
Controlled Trials ◽  
Early Disease ◽  
End Points ◽  
Randomized Controlled ◽  
Disease Outcomes

Abstract Limited data exist to describe the clinical features and outcomes for elderly patients with follicular lymphoma (FL). The Follicular Lymphoma Analysis of Surrogacy Hypothesis (FLASH) group performed a prospectively planned pooled analysis of individual patient data from first-line randomized controlled trials (RCTs) and examined associations between age (≤70 vs >70 years), clinical characteristics, and FL outcomes. We identified 18 multicenter clinical RCTs in the FLASH database that enrolled elderly patients (>70 years). Primary end points were early disease outcomes, CR24 and CR30, and progression-free survival (PFS) at 24 months (PFS24). Secondary end points were PFS and overall survival (OS). We identified 5922 previously untreated FL patients from 18 RCTs. Patients age >70 years (vs ≤70 years) more commonly had elevated lactate dehydrogenase, hemoglobin <12 g/dL, ECOG PS ≥2, and elevated β2-microglobulin. Median follow-up was 5.6 years. Patients >70 years did not differ from patients ≤70 years in rates of CR24, CR30, or PFS24. With a median OS of 14.6 years for all patients, median OS was 7.4 and 15.7 years for patients >70 and ≤70 years of age, respectively (hazard ratio = 2.35; 95% confidence interval = 2.03-2.73; P < .001). Age >70 years was a significant predictor of OS and PFS due to higher rates of death without progression, but not PFS24, CR24, or CR30. FL patients >70 years treated on trials have similar early disease outcomes to younger patients. There is no disease-specific outcome difference between age groups. Age alone should not disqualify patients from standard treatments or RCTs.

scholarly journals A Systematic Review and Meta-Analysis Estimating the Expected Dropout Rates in Randomized Controlled Trials on Yoga Interventions

2016 ◽  
Vol 2016 ◽  
pp. 1-7 ◽  
Author(s):  
Holger Cramer ◽  
Heidemarie Haller ◽  
Gustav Dobos ◽  
Romy Lauche
Keyword(s):  
Randomized Controlled Trials ◽  
Psychological Control ◽  
Age Groups ◽  
Dropout Rate ◽  
Health Condition ◽  
Dropout Rates ◽  
Cochrane Library ◽  
Controlled Trials ◽  
Control Groups ◽  
Randomized Controlled

A reasonable estimation of expected dropout rates is vital for adequate sample size calculations in randomized controlled trials (RCTs). Underestimating expected dropouts rates increases the risk of false negative results while overestimating rates results in overly large sample sizes, raising both ethical and economic issues. To estimate expected dropout rates in RCTs on yoga interventions, MEDLINE/PubMed, Scopus, IndMED, and the Cochrane Library were searched through February 2014; a total of 168 RCTs were meta-analyzed. Overall dropout rate was 11.42% (95% confidence interval [CI] = 10.11%, 12.73%) in the yoga groups; rates were comparable in usual care and psychological control groups and were slightly higher in exercise control groups (rate = 14.53%; 95% CI = 11.56%, 17.50%; odds ratio = 0.82; 95% CI = 0.68, 0.98;p=0.03). For RCTs with durations above 12 weeks, dropout rates in yoga groups increased to 15.23% (95% CI = 11.79%, 18.68%). The upper border of 95% CIs for dropout rates commonly was below 20% regardless of study origin, health condition, gender, age groups, and intervention characteristics; however, it exceeded 40% for studies on HIV patients or heterogeneous age groups. In conclusion, dropout rates can be expected to be less than 15 to 20% for most RCTs on yoga interventions. Yet dropout rates beyond 40% are possible depending on the participants’ sociodemographic and health condition.

scholarly journals Face masks to prevent transmission of respiratory diseases: Systematic review and meta-analysis of randomized controlled trials*

2020 ◽  
Author(s):  
Hanna M. Ollila ◽  
Markku Partinen ◽  
Jukka Koskela ◽  
Riikka Savolainen ◽  
Anna Rotkirch ◽  
...  
Keyword(s):  
Systematic Review ◽  
Randomized Controlled Trials ◽  
Respiratory Infections ◽  
Meta Analysis ◽  
Age Groups ◽  
Face Mask ◽  
Controlled Trials ◽  
Randomized Controlled ◽  
The Face ◽  
Intent To Treat

AbstractObjectiveTo examine the effect of face mask intervention in respiratory infections across different exposure settings and age groups.DesignSystematic review and meta-analysis.Data sourcesPubMed, Cochrane Central Register of Controlled Trials (CENTRAL), and Web of Science were searched for randomized controlled trials investigating the effect of face masks on respiratory infections published by November 18th 2020. Our reporting follows the PRISMA guidelines.Eligibility criteria for selecting studiesRandomized controlled trials investigating the effect of face masks in respiratory infections and influenza-like illness across different exposure settings and age groups. Two reviewers independently performed the search, extracted the data, and assessed the risk of bias. A random effects meta-analysis with risk ratio, risk difference, and number needed to treat were performed. Findings in exposure settings, age groups, and role of non-compliance were examined using a subgroup analysis.ResultsTotal of 17 studies were included, with N = 11, 601 individuals in intervention and N = 10, 286 in the control group with follow-up duration from 4 days to 19 months). 14 trials included adults (and children) and 3 included children only. 12 studies suffered from non-compliance in the treatment arm and 11 in the control arm. All studies were intent-to-treat analyses, and, thus, non-compliance can bias individual intent-to-treat estimates towards zero. Four out of seventeen studies supported use of face masks. A meta-analysis of all 17 studies found no association between face mask intervention and respiratory infections (RR = 0.9046 [0.777 - 1.053], p = 0.196, p fixed effect = 0.0006). However, a meta-analysis using odds ratios adjusted for age, sex, and vaccination (when available) suggests protective effect of the face mask intervention (17 studies, OR = 0.850 [0.736 - 0.982], p=0.027). A subgroup meta-analysis among adults with (unadjusted) risk ratios found a decrease in respiratory infections (14 studies, RR = 0.859 [0.750 - 0.983], p = 0.026, and 4 studies with a combined face masks and hand hygiene intervention RR = 0.782 [0.696 - 0.879], p < 0.0001). Finally, the face mask use is also supported by a meta-regression adjusting the effect estimates for non-compliance in the controls (17 studies RR = 0.87 [0.780 - 0.980], p = 0.017).ConclusionOur findings support the use of face masks to prevent respiratory infections.

Intraoperative Cryoanalgesia for Reducing Post-Tonsillectomy Pain: A Systemic Review

2018 ◽  
Vol 127 (6) ◽  
pp. 395-401 ◽  
Author(s):  
Blake S. Raggio ◽  
Blair M. Barton ◽  
Maria C. Grant ◽  
Edward D. McCoul
Keyword(s):  
Postoperative Pain ◽  
Randomized Controlled Trials ◽  
English Language ◽  
Postoperative Bleeding ◽  
Age Groups ◽  
Normal Diet ◽  
Systemic Review ◽  
Controlled Trials ◽  
Randomized Controlled ◽  
Significant Difference

Objective: Summarize the effectiveness of intraoperative cryoanalgesia in the management of postoperative pain among patients undergoing palatine tonsillectomy. Methods: A systematic review of PubMED, MEDLINE, EMBASE, Google Scholar, and Cochrane trial registries was performed through January 2017 using the PRISMA standards. We included English-language randomized controlled trials evaluating patients of all age groups with benign pathology who underwent tonsillectomy with cryoanalgesia versus without. Results: Three limited quality randomized controlled trials involving 153 participants (age range, 1-60 years) were included. Cryoanalgesia was performed with a cryotherapy probe (−56°C) in 1 trial and ice-water cooling (4°C to 10°C) in 2. In the 3 trials reviewed, patients who received cryoanalgesia reported 21.38%, 28.33%, and 31.53% less average relative postoperative pain than controls on the visual analog scale. Review of secondary outcomes suggested no significant difference in time to resume normal diet (2 studies) or postoperative bleeding (2 studies) between the 2 groups. Cryoanalgesia allowed patients to return to work 4 days earlier than controls in 1 study. Two studies reported a trend toward less postoperative analgesia use among the treatment group; however, no statistical conclusions could be drawn. Conclusion: The available evidence suggests that patients undergoing tonsillectomy with cryoanalgesia experience less average postoperative pain without additional complications.

scholarly journals BNT162b2 vaccine uptake and effectiveness in UK healthcare workers – a single centre cohort study

2021 ◽  
Vol 12 (1) ◽  
Author(s):  
Tariq Azamgarhi ◽  
Michelle Hodgkinson ◽  
Ashik Shah ◽  
John A. Skinner ◽  
Iva Hauptmannova ◽  
...  
Keyword(s):  
Cohort Study ◽  
Healthcare Workers ◽  
Cox Regression ◽  
Age Groups ◽  
Vaccine Uptake ◽  
Vaccine Hesitancy ◽  
Single Centre ◽  
Cox Regression Analysis ◽  
Vaccination Rates ◽  
Job Roles

AbstractIn this single centre cohort study we assessed BNT162B2 vaccine uptake and effectiveness among UK healthcare workers (HCWs) during a time of high community COVID-19 prevalence. Early uptake among HCWs was 62.3% (1409/2260), however there were significant differences in uptake between age groups, ethnic origins, and job roles. Uptake increased to 72.9% after a vaccine hesitancy working group implemented specific measures. In the 42 days after vaccination, 49 new cases of COVID-19 were identified, of which 7 (14.3%) occurred in HCWs who were beyond 10 days of vaccination. Kaplan–Meier curves for partially vaccinated and unvaccinated groups were congruent until day 14 and continued to diverge up to 42 days. Cox regression analysis showed a 70.0% (95%CI 6.0–91.0; p=0.04) risk reduction for COVID-19 infection in partially vaccinated HCWs. Here we report early vaccination rates among HCWs are generally high although uptake is lower in certain groups. It is possible to improve vaccine uptake and efforts should focus on this, however, significant resource is required. The BNT162B2 vaccine is effective from 14 days post-vaccination in a frontline clinical setting and protection continues beyond 21 days post 1st dose without a 2nd dose, being given.

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