PREPRINT - Predictors, Moderators and Mediators of Treatment Outcome in Randomized Controlled Trials for Adolescents with Depression: A scoping review.

2021 ◽  
Author(s):  
Darren Courtney ◽  
Priya Watson ◽  
Karolin Rose Krause ◽  
Benjamin Chan ◽  
Kathryn Bennett ◽  
...  
Keyword(s):  
Randomized Controlled Trials ◽  
Scoping Review ◽  
A Priori ◽  
Multiple Comparisons ◽  
Controlled Trials ◽  
Depression Symptom ◽  
Randomized Controlled ◽  
Treatment Of Depression ◽  
Variable Domains ◽  
Symptom Outcome

Background: Advancing the field of precision medicine in the treatment of depression in adolescents requires an examination of predictors, moderators and mediators (PMMs) of depression symptom outcome in randomized controlled trials (RCTs). Aims: This scoping review describes findings of PMM analyses in RCTs for the treatment of depression in adolescents. Methods: Databases searched included: MEDLINE, Embase, APA PsycInfo and CINAHL. Included publications tested PMMs of depression symptom outcome (e.g. symptom reduction, remission, etc.) in RCTs pertaining to the treatment of adolescents, ages 13-17. Results were extracted and coded for statistical significance, analytic approach, a priori model development, and adjustment for multiple comparisons. Aggregated results were summarized by PMM variable domain and RCT sample.Results: Eighty-one papers reporting on PMM results across 33 RCTs were identified. Fifty-three variable domains were tested as baseline predictors of depression severity outcome, 41 as moderators, 19 as post-baseline predictors, and 5 as mediators. Most reported results were nonsignificant. For variable domains tested as a PMM in three or more RCTs, only improvements in sleep throughout treatment and early response predicted outcome with complete agreement across relevant studies. The two publications that reported a priori hypotheses and adjustment for multiple comparisons both found that baseline depression symptom severity and family conflict predicted poorer outcomes. Conclusions: Clinicians need to recognize the current limited evidence from RCTs to practice precision medicine principles when treating adolescents with depression. Our findings inform future study design for researchers who wish to incorporate questions about specific PMM variables into their study methods.

scholarly journals Multidisciplinary Chronic Kidney Disease Clinic Practices: A Scoping Review

2019 ◽  
Vol 6 ◽  
pp. 205435811988266 ◽  
Author(s):  
David Collister ◽  
Lonnie Pyne ◽  
Jessie Cunningham ◽  
Maoliosa Donald ◽  
Amber Molnar ◽  
...  
Keyword(s):  
Chronic Kidney Disease ◽  
Kidney Disease ◽  
Randomized Controlled Trials ◽  
Glomerular Filtration ◽  
Scoping Review ◽  
Observational Studies ◽  
Controlled Trials ◽  
Team Composition ◽  
Randomized Controlled

Background: Multidisciplinary chronic kidney disease (CKD) clinics improve patient outcomes but their optimal design is unclear. Objective: To perform a scoping review to identify and describe current practices (structure, function) associated with multidisciplinary CKD clinics. Design: Scoping review. Setting: Databases included Medline, EMBASE, Cochrane, and CINAHL. Patients: Patients followed in multidisciplinary CKD clinics globally. Measurements: Multidisciplinary CKD clinic composition, entry criteria, follow-up, and outcomes. Methods: We systematically searched the literature to identify randomized controlled trials, non-randomized interventional studies, or observational studies of multidisciplinary CKD clinics defined by an outpatient setting where two or more allied health members (with or without a nephrologist) provided longitudinal care to 50 or more adult or pediatric patients with CKD. Included studies were from 2002 to present. Searches were completed on August 10, 2018. Title, abstracts, and full texts were screened independently by two reviewers with disagreements resolved by a third. We abstracted data from included studies to summarize multidisciplinary CKD clinic team composition, entry criteria, follow-up, and processes. Results: 40 studies (8 randomized controlled trials and 32 non-randomized interventional studies or observational studies) involving 23 230 individuals receiving multidisciplinary CKD care in 12 countries were included. Thirty-eight focused on adults (27 with CKD, 10 incident dialysis patients, one conservative therapy) while two studies focused on adolescents or children with CKD. The multidisciplinary team included a mean of 4.6 (SD 1.5) members consisting of a nephrologist, nurse, dietician, social worker, and pharmacist in 97.4%, 86.8%, 84.2%, 57.9%, and 42.1% of studies respectively. Entry criteria to multidisciplinary CKD clinics ranged from glomerular filtration rates of 20 to 70 mL/min/1.73m2 or CKD stages 1 to 5 without any proteinuria or risk equation-based criteria. Frequency of follow-up was variable by severity of kidney disease. Team member roles and standardized operating procedures were infrequently reported. Limitations: Unstandardized definition of multidisciplinary CKD care, studies limited to CKD defined by glomerular filtration rate, and lack of representation from countries other than Canada, Taiwan, the United States, and the United Kingdom. Conclusions: There is heterogeneity in multidisciplinary CKD team composition, entry criteria, follow-up, and processes with inadequate reporting of this complex intervention. Additional research is needed to determine the best model for multidisciplinary CKD clinics. Trial registration: Not applicable.

A Scoping Review on the Use of Antibiotic-Impregnated Beads and Applications to Vascular Surgery

2019 ◽  
Vol 54 (2) ◽  
pp. 147-161 ◽  
Author(s):  
Brandon McGuinness ◽  
Khatija Pinky Ali ◽  
Steven Phillips ◽  
Michael Stacey
Keyword(s):  
High Risk ◽  
Vascular Surgery ◽  
Randomized Controlled Trials ◽  
Scoping Review ◽  
Graft Infection ◽  
Risk Of Bias ◽  
Controlled Trials ◽  
High Risk Patients ◽  
Randomized Controlled ◽  
Risk Patients

Introduction: Surgical site infection (SSI) presents a ubiquitous concern to surgical specialties, especially in the presence of prosthetic material. Antibiotic-impregnated beads present a novel and evolving means to combat this condition. This review aims to analyze the quality of evidence and methods of antibiotic bead use, particularly for application within vascular surgery. Methods: A systematic scoping review was conducted within Embase, MEDLINE, and the Cochrane Registry of Randomized Controlled Trials. Articles were evaluated by 2 independent reviewers. Level of evidence was evaluated using the Oxford Center for Evidence-Based Medicine Criteria and the Cochrane Risk of Bias Tool for Randomized Controlled Trials. Results: The search yielded 6951 papers, with 275 included for final analysis. Publications increased in frequency from 1978 to the present. The most common formulation was polymethyl methacrylate; however publications on biodegradable formulations, including calcium sulfate beads, have been published with increasing frequency. Most publications had positive conclusions (94.2%); however, the data was mainly subjective and may be prone to publication bias. Only 11 randomized controlled trials were identified and all but one was evaluated to be at a high risk of bias. The most common indication was for osteomyelitis (52%), orthopedic prosthetic infections (20%), and trauma (9%). Within vascular surgery, beads have been used primarily for the treatment of graft infection, with freedom from recurrence rates being reported from 41% to 87.5%. Conclusions: Antibiotic-impregnated beads provide a means to deliver high doses of antibiotic directly to a surgical site, without the risks of parenteral therapy. There has yet to be significant high-level quality data published on their use. There is a large body of evidence that suggests antibiotic beads may be used in SSIs in high-risk patients, prosthetic infections, and other complex surgical infections. Important potential areas of application in vascular surgery include graft infection, prevention of wound infection in high-risk patients, and diabetic foot infection.

scholarly journals Effectiveness of Hyaluronic Acid Administration in Treating Adhesive Capsulitis of the Shoulder: A Systematic Review of Randomized Controlled Trials

2015 ◽  
Vol 2015 ◽  
pp. 1-8 ◽  
Author(s):  
Lin-Chien Lee ◽  
Fu-Kong Lieu ◽  
Hung-Lin Lee ◽  
Tao-Hsin Tung
Keyword(s):  
Hyaluronic Acid ◽  
Randomized Controlled Trials ◽  
Adhesive Capsulitis ◽  
A Priori ◽  
Shoulder Function ◽  
Medical Expenditure ◽  
Cochrane Library ◽  
Controlled Trials ◽  
Randomized Controlled ◽  
Insidious Onset

Introduction. Adhesive capsulitis (AC) of the shoulder presents with an insidious onset of pain and progressive limitation of shoulder movement.Objectives. To investigate whether intra-articular hyaluronic acid (HA) administration alone is superior to conventional therapies and whether the addition of intra-articular HA administration to conventional therapies improves clinical outcomes in patients with AC.Methods. The PubMed, EMBASE, CINAHL, and Cochrane Library electronic databases were searched without language restrictions in July 2014 witha prioridefined inclusion and exclusion criteria.Results. Four randomized controlled trials (273 participants, 278 shoulders) were included in this review. Two trials compared intra-articular HA administration with conventional therapies and 2 trials evaluated intra-articular HA administration as an addition to conventional therapies. Pain and shoulder function/disability outcomes in the HA injection group were not superior to those achieved in the conventional therapy groups. No significant differences in pain or shoulder function/disability outcomes were noted between the groups with and without adjunctive HA administration.Conclusions. Intra-articular HA administration alone is not superior to conventional AC treatments, and the addition of intra-articular HA administration to conventional therapies does not provide significant added benefits. HA administration in AC patients who are receiving conventional therapies should be evaluated to avoid unnecessary medical expenditure.

scholarly journals Pork consumption and its relationship to human nutrition and health: a scoping review

2021 ◽  
Author(s):  
Laura Paige Penkert ◽  
Ruogu Li ◽  
Jing Huang ◽  
Anil Gurcan ◽  
Mei Chun Chung ◽  
...  
Keyword(s):  
Randomized Controlled Trials ◽  
Scoping Review ◽  
Case Control ◽  
Human Nutrition ◽  
Controlled Trials ◽  
Case Control Studies ◽  
Nutrition And Health ◽  
Randomized Controlled ◽  
Scoping Reviews ◽  
Pork Consumption

Pork is a frequently consumed red meat that provides substantial amounts of energy, macronutrients, and micronutrients to the diet. Its role in human nutrition and health is controversial and a plethora of data exist in the peer-reviewed scientific literature. Therefore, we conducted a scoping review of clinical and population-based studies to assess the effects of pork consumption on human nutrition and health. Results are reported according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) extension for scoping reviews. Data were extracted from 86 studies, including 16 randomized controlled trials, 1 uncontrolled trial, 7 cohort studies, 4 nonrandomized controlled trials, 4 case-cohort and nested case-control studies, 33 case-control studies, and 21 cross-sectional studies. Intervention studies were conducted in healthy individuals and were short to moderate in duration. The effect of pork intake on patients’ nutrient status was the most commonly assessed outcome. The majority of observational studies assessed the effect of pork on cancer incidence, but no studies assessed the effects of pork on inflammation or oxidative stress. No interventional studies explored diabetes mellitus risk, and only one study assessed cancer risk associated with pork consumption. Several micronutrients in pork, including zinc, iron, selenium, choline, thiamin, and vitamins B6 and vitamin B12, are thought to influence cognitive function and may prove to be a unique area of research. To date, there is a dearth of high-quality randomized controlled trials assessing the effects of pork intake on disease risk factors and outcomes. This review helps highlight the many research gaps that future studies should be designed to address.

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