scholarly journals Endoscopic polypectomy performed in clinic for chronic rhinosinusitis with nasal polyps: study protocol for the EPIC multicentre randomised controlled trial

BMJ Open ◽  
2020 ◽  
Vol 10 (12) ◽  
pp. e042413
Author(s):  
Shaun Kilty ◽  
Kednapa Thavorn ◽  
Arif Janjua ◽  
John Lee ◽  
Kristian MacDonald ◽  
...  
Keyword(s):  
Surgical Treatment ◽  
Randomised Controlled Trial ◽  
Research Ethics ◽  
Chronic Rhinosinusitis ◽  
Nasal Polyps ◽  
Controlled Trial ◽  
Sinus Surgery ◽  
Endoscopic Polypectomy ◽  
Research Ethics Board ◽  
Randomised Controlled

IntroductionChronic rhinosinusitis (CRS) is common, with a Canadian prevalence of 5%, and associated with significant morbidity. Understandably, CRS impairs workplace productivity but that productivity substantially increases following surgical treatment. CRS with nasal polyps (CRSwNP), the most common type of CRS, is usually treated with a combination of medications and endoscopic sinus surgery (ESS). Historically, surgical treatment has only been performed in the operating room at a cost of about $C3500. However, recent studies have shown that a de-escalated procedure, endoscopic polypectomy performed in clinic (EPIC), can provide an improvement in patient symptoms to levels equal to those for ESS. Moreover, EPIC has additional proposed advantages including shorter recovery time, significantly lower cost to the healthcare system and shorter wait time for the patient. There is currently insufficient evidence to draw conclusions about the superiority of polypectomy or ESS for the management of CRSwNP.Methods and analysisWe designed a multicentre, open-label, randomised controlled trial to evaluate whether EPIC was non-inferior to the current clinical standard, ESS for the treatment of CRSwNP. The primary outcome is the Sinonasal Outcome Test-22 score measured at baseline and at 3 months after surgery. Other outcomes include peak nasal inspiratory flow, quality of life measured by the EuroQoL 5 Dimensions 5 Levels questionnaire and work impairment using the Work Productivity and Activity Impairment Questionnaire.We aim to recruit 140 patients from sites across Canada. Participants will be randomly assigned to EPIC or ESS and followed up for 3 months in clinic after the procedure. Additionally, participants will enter a 5-year long-term follow-up period.Ethics and disseminationThis study was approved by the Ottawa Health Sciences Network Research Ethics Board for all sites in Ontario, Canada (study number CTO0801). Sites located outside of Ontario obtained approval from their local/institutional research ethics board.Trial registration numberNCT02975310.

scholarly journals Protocol for a randomised controlled trial for Treatment in Thoracic Aortic Aneurysm: Surgery versus Surveillance (TITAN: SvS)

BMJ Open ◽  
2021 ◽  
Vol 11 (5) ◽  
pp. e052070
Author(s):  
Ming Hao Guo ◽  
Jehangir J Appoo ◽  
George A Wells ◽  
Michael Chu ◽  
Maral Ouzounian ◽  
...  
Keyword(s):  
Randomised Controlled Trial ◽  
Aortic Aneurysm ◽  
Research Ethics ◽  
Thoracic Aortic Aneurysm ◽  
Controlled Trial ◽  
Health Science ◽  
Aneurysm Surgery ◽  
Research Ethics Board ◽  
Randomised Controlled ◽  
Aortic Aneurysm Surgery

IntroductionAscending thoracic aortic aneurysm (ATAA) is an asymptomatic condition that can lead to catastrophic events of rupture or dissection. Current guidelines are based on limited retrospective data and recommend surgical intervention for ATAA with a diameter of greater or equal to 5.5 cm. Treatment in Thoracic Aortic Aneurysm: Surgery versus Surveillance is the first prospective, multicentre, randomised controlled trial that compares outcomes of patients undergoing early elective ascending aortic surgery to patients undergoing medical surveillance.Methods and analysisPatients between the ages of 18 and 80 with an asymptomatic ATAA between 5.0 cm and 5.4 cm in diameter are eligible for randomisation to early surgery or surveillance. Patients in the surgery group will be followed at 1 month after discharge, then annually for a minimum of 2 years and up to 5 years. Patients in the surveillance group will be followed annually from their index clinic visit for a minimum of 2 years and up to 5 years. The primary outcome is all-cause mortality at follow-up. A sample size of 618 subjects (309 in each group) will achieve an 80% power at a 0.047 significance level.Ethics and disseminationThis study has received Ottawa Health Science Network Research Ethics Board approval (Protocol 20180007-01H), which was most recently updated on 25 November 2020. The Research Ethics Board have granted approval to the study at 14 participating institutions, including the Ottawa Health Science Network Research Ethics Board. On completion of data analysis, the result of the trial will be presented at national and international conferences, and published in relevant journals, regardless of the finding of the trial.Trial registration numberNCT03536312.

scholarly journals Patterns and predictors of high-cost users of the health system: a data linkage protocol to combine a cohort study and randomised controlled trial of adults with a history of homelessness

BMJ Open ◽  
2020 ◽  
Vol 10 (12) ◽  
pp. e039966
Author(s):  
Kathryn Wiens ◽  
Laura C Rosella ◽  
Paul Kurdyak ◽  
Stephen W Hwang
Keyword(s):  
Cohort Study ◽  
Randomised Controlled Trial ◽  
Health System ◽  
Research Ethics ◽  
Survey Data ◽  
Controlled Trial ◽  
Healthcare Utilisation ◽  
History Of ◽  
Research Ethics Board ◽  
Randomised Controlled

IntroductionHomelessness is a global issue with a detrimental impact on health. Individuals who experience homelessness are often labelled as frequent healthcare users; yet it is a small group of individuals who disproportionately use the majority of services. This protocol outlines the approach to combine survey data from a prospective cohort study and randomised controlled trial with administrative healthcare data to characterise patterns and predictors of healthcare utilisation among a group of adults with a history of homelessness.Methods and analysisThis cohort study will apply survey data from the Health and Housing in Transition study and the At Home/Chez Soi study linked with administrative healthcare databases in Ontario, Canada. We will use count models to quantify the associations between baseline predisposing, enabling, and need factors and hospitalisations, emergency department visits and physician visits in the following year. Subsequently, we will identify individuals who are high-cost users of the health system (top 5%) and characterise their patterns of healthcare utilisation. Logistic regression will be applied to develop a set of models to predict who will be high-cost users over the next 5 years based on predisposing, enabling and need factors. Calibration and discrimination will be estimated with bootstrapped optimism (bootstrap performance—test performance) to ensure the model performance is not overestimated.Ethics and disseminationThis study is approved by the St Michael’s Hospital Research Ethics Board and the University of Toronto Research Ethics Board. Findings will be disseminated through publication in peer-reviewed journals, presentations at research conferences and brief reports made available to healthcare professionals and the general public.Trial Registration NumberThis is a secondary data analysis of a cohort study and randomized trial. The At Home/Chez Soi study has been registered with the International Standard Randomised Control Trial Number Register and assigned ISRCTN42520374.

scholarly journals Study protocol for Vitality: a proof-of-concept randomised controlled trial of exercise training or complex mental and social activities to promote cognition in adults with chronic stroke

BMJ Open ◽  
2018 ◽  
Vol 8 (3) ◽  
pp. e021490 ◽  
Author(s):  
John R Best ◽  
Janice J Eng ◽  
Jennifer C Davis ◽  
Robin Hsiung ◽  
Peter A Hall ◽  
...  
Keyword(s):  
Cognitive Function ◽  
Randomised Controlled Trial ◽  
Exercise Training ◽  
Research Ethics ◽  
Controlled Trial ◽  
Chronic Stroke ◽  
Intervention Strategies ◽  
Proof Of Concept ◽  
Research Ethics Board ◽  
Randomised Controlled

IntroductionCerebrovascular disease—such as stroke—is the second most common cause of dementia (ie, vascular dementia). Specifically, a stroke increases one’s risk for dementia by a factor of two. Thus, stroke survivors represent a target population in need of intervention strategies to promote cognitive function and prevent dementia. The current standard of care in stroke rehabilitation does not adequately address the significant cognitive consequences of stroke, especially for those who are in the chronic phase (ie, >12 months since an index stroke). Two potential intervention strategies are: (1) exercise training and (2) cognitive and social enrichment activities.Methods and analysisThe aim of this proof-of-concept randomised controlled trial is to determine whether a 6-month targeted exercise training programme or a 6-month cognitive and social enrichment programme can efficaciously and efficiently improve cognitive function in older adults with chronic stroke compared with a 6-month stretch and tone programme (ie, control). The primary measurement periods will be baseline, month 6 (postintervention) and month 12 (6-month follow-up). The primary outcome measure will be performance on the Alzheimer’s Disease Assessment Scale-Cognitive-Plus (ADAS-Cog-Plus), a global measure of cognitive performance using multidimensional item response theory to summarise scores from the 13-item ADAS-Cog and other standard cognitive assessments. The primary analysis will compare changes in ADAS-Cog-Plus performance from baseline to month 6. Proof-of-concept outcomes relating to intervention feasibility will be analysed descriptively. The economic evaluation will examine the incremental costs and health outcome benefits generated by both interventions versus the control.Ethics and disseminationEthical approval has been obtained from the University of British Columbia’s Clinical Research Ethics Board (H13-00715, 26 July 2013). Any modifications to the protocol will require a formal amendment to the protocol and approval by the Research Ethics Board. Outcomes of this randomised controlled trial and the statistical code to generate those outcomes will be disseminated through publication in peer-reviewed journals as well as conference presentations.Trial registration numberNCT01916486.

scholarly journals SURGICAL TREATMENT OF PATIENTS WITH CHRONIC RHINOSINUSITIS AND NASAL POLYPS UNDER ELECTIVE DENTAL IMPLANTAT PLACEMENT WITH SINUS LIFTING SURGERY

2021 ◽  
Vol 21 (3) ◽  
pp. 123-128
Author(s):  
Ya.V. Shkorbotun
Keyword(s):  
Surgical Treatment ◽  
Chronic Rhinosinusitis ◽  
Dental Implant ◽  
Nasal Polyps ◽  
Sinus Surgery ◽  
Endoscopic Polypectomy ◽  
Bone Augmentation ◽  
Implant Placement ◽  
Increased Risk ◽  
Sinus Lifting

Dental implant placement is widely used method of dentition restoration, and if necessary, is performed with subantral augmentation of bone tissue and can be associated with an increased risk of complications in cases of mucosa alterations. To the disease and patency of the ostiomeatal complex and to minimize the possible risks is the key task when preparing patients with chronic rhinosinusitis and nasal polyps for sinus lifting. The aim of the study is to investigate the effect of shaver polipectomy method in chronic rhinosinusitis and nasal polyps on the outcomes of sinus lifting and the frequency rate of complications. Materials and methods. The study was based on data obtained from 72 patients having chronic rhinosinusitis and nasal polyps, who underwent endoscopic functional sinus surgery according to the principles of sparing effect on the periosteum in the alveolar bay (periosteum-preserving technology). The patients were divided into two groups: I group included 35 patients subjected to shaver polypectomy; II group consisted of 37 individuals operated on by standard conventional method. Results. The average total Lund-Mackay (LM) score before endoscopic rhinosurgery in I group was 14.57±0.52 scores, and 13.32±0.6 scores in the II group. It went down to 4.26±0.38 in I group and to 4.61±0.39 in II group (p <0.05) 3 months after the intervention. In the 6th month of post-surgical follow up there was a significant increase in the total LM score in the patients of II group up to 6.84±0.6 that indicates a more stable result after shaver-assisted sinusotomy. The incidence of sinus lifting complications after endoscopic polypectomy was 24.32±7.05% of cases in the patients of I group compared to the individuals of II group having 2 37.14±8.17% of complicated cases (p <0.05). Sinus lifting and dental implant placement were found out to be effective in all patients of I group and in 94.29±3.92% of patients in the II group. Conclusions. Endoscopic intervention stuck to principles of preserving periosteum and providing appropriate therapeutic support to patients with chronic rhinosinusitis under control allows oral surgeons to perform safe dental implant placement with subantral bone augmentation. Applying shaver-assisted periosteum-preserving technique for surgical treatment of patients with chronic rhinosinusitis and nasal polyps provides a longer clinical effect and reduces the incidence of postoperative complications of subantral bone augmentation by 12.82%.

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