scholarly journals Reduced Cognitive and Psychomotor Impairment with Extended-Release Oxymorphone Versus Controlled-Release Oxycodone

2010 ◽  
Vol 6;13 (6;12) ◽  
pp. 561-573
Author(s):  
Kerri A. Schoedel
Keyword(s):  
Reaction Time ◽  
Controlled Release ◽  
Extended Release ◽  
Mixed Model ◽  
Linear Mixed Model ◽  
Analysis Of Covariance ◽  
Tracking Accuracy ◽  
Double Blind ◽  
Psychomotor Effects ◽  
Psychomotor Impairment

Background: Opioids provide effective pain control, yet have risks including adverse events (AEs) (e.g., constipation, nausea/vomiting, sedation) and cognitive/psychomotor effects. Objective: To compare cognitive and psychomotor effects of oxymorphone extended release (OM-ER) versus oxycodone controlled release (OC-CR). Study design: Randomized, double-blind, 5-way crossover Setting: Single inpatient research unit Methods: Nondependent recreational opioid users were administered single intact oral tablets of placebo, OM-ER (15 and 30 mg), and OC-CR (30 and 60 mg), separated by a 7- to 21-day washout. The divided attention (DA) test measured psychomotor impairment (e.g., manual tracking [e.g., percentage over road], target accuracy [e.g., target hits], reaction time [hit latency]). Visual analog scales measured alertness/drowsiness, agitation/relaxation, and dizziness. Sedative, stimulant, and dysphoric effects were measured using the Addiction Research Center Inventory PentobarbitalChlorpromazine-Alcohol (PCAG), Benzedrine Group (BG), and Lysergic Acid Diethylamide (LSD) scales, respectively. Comparisons were made between equianalgesic doses (OM-ER 15 mg vs OCCR 30 mg; OM-ER 30 mg vs OC-CR 60 mg), within active drug doses, and between active drugs and placebo using least squares (LS) mean difference of the peak maximum (Emax) or minimum (Emin) effect using linear mixed model analysis of covariance. Results: Thirty-five participants received all 5 treatments. Peak cognitive and psychomotor impairment (LS mean [SE]) was less with OM-ER than equianalgesic doses of OC-CR for reaction time (Emax hit latency, longer if impaired; 571.2 [13.4] vs 588.1 ms [13.4], P=0.03 for OM-ER 15 mg vs OC-CR 30 mg, respectively; 572.4 [13.4] vs 604.3 ms [13.4], P<0.001 for OM-ER 30 mg vs OC-CR 60 mg, respectively); tracking accuracy (Emin percentage over road, lower if impaired; 71.4 [2.4] vs 65.3 [2.4], P=0.007; 69.9 [2.4] vs 59.4 [2.4], P<0.001), and target accuracy (Emin target hits percentage, lower if impaired; 81.0 [3.1] vs 74.5 [3.1], P=0.02; 79.4 [3.1] vs 66.1 [3.1], P<0.001). Several other DA measures showed that OC-CR, especially 60 mg, produced more psychomotor impairment than equianalgesic OM-ER. Compared to OM-ER, OC-CR produced more dizziness (Emax, P<0.001 for OM-ER 15 mg vs OC-CR 30 mg and for OM-ER 30 mg vs OC-CR 60 mg), drowsiness (Emax, P<0.001 for both equianalgesic dose groups), relaxation (Emin, P=0.003 for OM-ER 15 mg vs OC-CR 30 mg; P=0.001 for OM-ER 30 mg vs OC-CR 60 mg), dysphoria (Emax LSD, P<0.001 for both equianalgesic dose groups), and sedation (Emax, PCAG; P<0.001 for both equianalgesic dose groups) and less stimulation (BG, Emin; P=0.01 for OM-ER 15 mg vs OC-CR mg; P<0.001 for OM-ER 30 mg vs OC-CR 60 mg). Several AEs occurred more commonly with OC-CR than OM-ER (e.g., euphoria, nausea, somnolence, vomiting, dizziness). Limitations: Participants were young, healthy volunteer nondependent recreational drug users, and only single doses were evaluated. The effects of tampering or higher doses were not assessed. Conclusions: Single oral intact low and high doses of OM-ER produced less cognitive and psychomotor impairment plus less sedation than equianalgesic OC-CR in this exploratory study. ClinicalTrials.gov registration NCT00955110 Key words: opioid, cognitive effects, psychomotor effects, sedation, dysphoria, oxymorphone, oxycodone, long-acting opioids

scholarly journals Fructose Consumption Contributes to Hyperinsulinemia in Adolescents With Obesity Through a GLP-1–Mediated Mechanism

2019 ◽  
Vol 104 (8) ◽  
pp. 3481-3490 ◽  
Author(s):  
Alfonso Galderisi ◽  
Cosimo Giannini ◽  
Michelle Van Name ◽  
Sonia Caprio
Keyword(s):  
Glucose Tolerance ◽  
Mixed Model ◽  
Linear Mixed Model ◽  
Cell Function ◽  
Insulin Response ◽  
Tolerance Test ◽  
Oral Glucose ◽  
Double Blind ◽  
Obesity And Diabetes ◽  
Glucose Ingestion

Abstract Context The consumption of high-fructose beverages is associated with a higher risk for obesity and diabetes. Fructose can stimulate glucagon-like peptide 1 (GLP-1) secretion in lean adults, in the absence of any anorexic effect. Objective We hypothesized that the ingestion of glucose and fructose may differentially stimulate GLP-1 and insulin response in lean adolescents and adolescents with obesity. Design We studied 14 lean adolescents [four females; 15.9 ± 1.6 years of age; body mass index (BMI), 21.8 ± 2.2 kg/m2] and 23 adolescents with obesity (five females; 15.1 ± 1.6 years of age; BMI, 34.5 ± 4.6 kg/m2). Participants underwent a baseline oral glucose tolerance test to determine their glucose tolerance and estimate insulin sensitivity and β-cell function [oral disposition index (oDIcpep)]. Eligible subjects received, in a double-blind, crossover design, 75 g of glucose or fructose. Plasma was obtained every 10 minutes for 60 minutes for the measures of glucose, insulin, and GLP-1 (radioimmunoassay) and glucose-dependent insulinotropic polypeptide (GIP; ELISA). Incremental glucose and hormone levels were compared between lean individuals and those with obesity by a linear mixed model. The relationship between GLP-1 increment and oDIcpep was evaluated by regression analysis. Results Following the fructose challenge, plasma glucose excursions were similar in both groups, yet the adolescents with obesity exhibited a greater insulin (P &lt; 0.001) and GLP-1 (P &lt; 0.001) increase than did their lean peers. Changes in GIP were similar in both groups. After glucose ingestion, the GLP-1 response (P &lt; 0.001) was higher in the lean group. The GLP-1 increment during 60 minutes from fructose drink was correlated with a lower oDIcpep (r2 = 0.22, P = 0.009). Conclusion Fructose, but not glucose, ingestion elicits a higher GLP-1 and insulin response in adolescents with obesity than in lean adolescents. Fructose consumption may contribute to the hyperinsulinemic phenotype of adolescent obesity through a GLP-1–mediated mechanism.

scholarly journals Acute memory and psychotomimetic effects of cannabis and tobacco both ‘joint’ and individually: a placebo-controlled trial

2017 ◽  
Vol 47 (15) ◽  
pp. 2708-2719 ◽  
Author(s):  
C. Hindocha ◽  
T. P. Freeman ◽  
J. X. Xia ◽  
N. D. C. Shaban ◽  
H. V. Curran
Keyword(s):  
Verbal Memory ◽  
Mixed Model ◽  
Linear Mixed Model ◽  
Controlled Trial ◽  
Subjective Effects ◽  
Preliminary Evidence ◽  
Interactive Effects ◽  
Double Blind ◽  
Mixed Model Analysis ◽  
Psychotomimetic Effects

BackgroundCannabis and tobacco have contrasting cognitive effects. Smoking cannabis with tobacco is prevalent in many countries and although this may well influence cognitive and mental health outcomes, the possibility has rarely been investigated in human experimental psychopharmacological research.MethodThe individual and interactive effects of cannabis and tobacco were evaluated in 24 non-dependent cannabis and tobacco smokers in a randomized, placebo-controlled, double-blind, 2 (cannabis, placebo) × 2 (tobacco, placebo) crossover design. Verbal memory (prose recall), working memory (WM) performance including maintenance, manipulation and attention (N-back), psychotomimetic, subjective and cardiovascular measures were recorded on each of four sessions.ResultsCannabis alone impaired verbal memory. A priori contrasts indicated that tobacco offset the effects of cannabis on delayed recall. However, this was not supported by linear mixed model analysis. Cannabis load-dependently impaired WM. By contrast, tobacco improved WM across all load levels. The acute psychotomimetic effects and ratings of ‘stoned’ and ‘dizzy’ induced by cannabis were not altered by tobacco. Cannabis and tobacco had independent effects on increasing heart rate and interacting effects on increasing diastolic blood pressure.ConclusionsRelative to placebo, acute cannabis impaired verbal memory and WM. Tobacco enhanced performance on WM, independently of cannabis. Moreover, we found some preliminary evidence that tobacco may offset the effects of cannabis on delayed, but not immediate, verbal recall. In contrast, the psychotomimetic and subjective effects of cannabis were unaffected by tobacco co-administration. By reducing the cognitive impairment from cannabis, tobacco co-administration may perpetuate use despite adverse health consequences.

Effect of dalfampridine on information processing speed impairment in multiple sclerosis

Neurology ◽  
2019 ◽  
Vol 93 (8) ◽  
pp. e733-e746 ◽  
Author(s):  
Laura De Giglio ◽  
Francesca De Luca ◽  
Flavia Gurreri ◽  
Ilaria Ferrante ◽  
Luca Prosperini ◽  
...  
Keyword(s):  
Multiple Sclerosis ◽  
Information Processing ◽  
Processing Speed ◽  
Mixed Model ◽  
Linear Mixed Model ◽  
Controlled Trial ◽  
Information Processing Speed ◽  
Effective Treatment Option ◽  
Double Blind ◽  
To Receive

ObjectiveTo test a possible benefit of dalfampridine on information processing speed (IPS), a key function for cognitive impairment (CogIm) in multiple sclerosis (MS).MethodsIn this randomized, double-blind, placebo-controlled trial, we included patients with a score on the Symbol Digit Modalities Test (SDMT) under the 10th percentile of the reference value. Patients were randomized in a 2:1 ratio to receive dalfampridine 10 mg or placebo twice daily for 12 weeks. They underwent a comprehensive neuropsychological evaluation at screening (T0), at the end of treatment (T1), and after a 4-week follow-up (T2). The primary endpoint was improvement in SDMT.ResultsOut of 208 patients screened, 120 were randomized to receive either dalfampridine (n = 80) or placebo (n = 40). At T1, the dalfampridine group presented an increase of SDMT scores vs placebo group (mean change 9.9 [95% confidence interval (CI) 8.5–11.4] vs 5.2 [95% CI 2.8–7.6], p = 0.0018; d = 0.60 for raw score; and 0.8 [95% CI 0.6–1] vs 0.3 [95% CI 0.0–0.5], p = 0.0013; d = 0.61 for z scores; by linear mixed model with robust standard error). The improvement was not sustained at T2. A beneficial effect of dalfampridine was observed in the Paced Auditory Serial Addition Test and in cognitive fatigue.ConclusionDalfampridine could be considered as an effective treatment option for IPS impairment in MS.Trial registration2013-002558-64 EU Clinical Trials Register.Classification of evidenceThis study provides Class I evidence that for patients with MS with low scores on the SDMT, dalfampridine improves IPS.

scholarly journals Effect of low-intensity pulsed ultrasound on orthodontically induced root resorption caused by torque: A prospective, double-blind, controlled clinical trial

2015 ◽  
Vol 86 (4) ◽  
pp. 550-557 ◽  
Author(s):  
Hasnain Raza ◽  
Paul Major ◽  
Douglas Dederich ◽  
Tarek El-Bialy
Keyword(s):  
Mixed Model ◽  
Linear Mixed Model ◽  
Tooth Movement ◽  
Root Resorption ◽  
Mean Difference ◽  
Controlled Clinical Trial ◽  
Pulsed Ultrasound ◽  
Double Blind ◽  
Low Intensity Pulsed Ultrasound ◽  
Low Intensity

ABSTRACT Objectives:  To evaluate the effects of low-intensity pulsed ultrasound (LIPUS) on orthodontically induced tooth root resorption caused by torque in human subjects. Materials and Methods:  Ten healthy patients (12–35 years of age) who required extraction of all first premolars as a part of their routine orthodontic treatment were recruited. A 15° twist was applied in the arch wire using 0.019 × 0.025-inch TMA in a 0.022-inch bracket system (Synergy R) that produced a buccal root torque of approximately 5 N/mm at the bracket level. Using a split mouth design, randomization, and blinding, one side of the arch received LIPUS for 20 minutes per day for 4 weeks at an incident intensity of 30 mW/cm2 of the transducers’ surface area. The other side served as a self-control, which received a sham transducer. After 4 weeks, all first premolars were extracted and micro–computed tomographic analysis was performed on these extracted teeth. A linear mixed-model statistical analysis was used. Results:  LIPUS-treated teeth showed significantly less total volume of resorption lacunae compared to control teeth by a mean difference of (0.54 ± 0.09 mm3) (P &lt; .001) and percentage of root resorption by a mean difference of (0.33 ± 0.05 mm3) (P &lt; .001). In addition, significantly fewer resorption lacunae were found on all root surfaces in the LIPUS group compared to the control except in the instance of the distal surface. Limitations:  This study was performed on limited number of cases during a 4-week period. Conclusions:  LIPUS minimizes root resorption when applied during torque tooth movement over a 4-week period.

scholarly journals Triamcinolone Acetonide in the Treatment of Perennial Allergic Rhinitis: A post hoc Efficacy Analysis of a Phase III Study Performed in Russia

2021 ◽  
pp. 1-8
Author(s):  
Alexander V. Karaulov ◽  
Natalia I. Ilina ◽  
Natalia Shartanova ◽  
Aleksandr Maslakov ◽  
Luiz Lucio
Keyword(s):  
Allergic Rhinitis ◽  
Triamcinolone Acetonide ◽  
Mixed Model ◽  
Linear Mixed Model ◽  
Nasal Symptom ◽  
Phase Iii ◽  
Double Blind ◽  
Post Hoc Analysis ◽  
Post Hoc ◽  
To Receive

<b><i>Introduction:</i></b> Allergic rhinitis (AR) is a disease which affects &#x3e;24% of the population in Russia. Triamcinolone acetonide (TAA) is a corticosteroid used for treating AR. This post hoc analysis assesses the efficacy of intranasal TAA in improving perennial AR (PAR) symptom scores over 4 weeks. <b><i>Methods:</i></b> NASANIF (NCT03317015) was a double-blind, parallel-group, multicenter, prospective, non-inferiority, phase III clinical trial in which patients with PAR were randomized (1:1) to receive TAA or fluticasone propionate (FP) over 4 weeks. Our post hoc analysis evaluates weekly change in PAR symptoms using the reflective Total Nasal Symptom Score (rTNSS), overall and for individual symptoms (sneezing, nasal itching, rhinorrhoea, and nasal obstruction). Proportion of patients and time to achieve a ≥50 or ≥75% reduction in rTNSS were assessed. For rTNSS endpoints, a linear mixed-model methodology was used; for time-to-event endpoints, cumulative incidence functions were estimated using the Kaplan-Meier method, in the per-protocol population. <b><i>Results:</i></b> Of 260 patients, 128 each completed the study and were randomized to receive TAA or FP. From baseline to week 4, the changes in total rTNSS were −7.78 (95% CI: −8.1701 to −7.3967; <i>p</i> &#x3c; 0.001) and −7.52 (−7.9053 to −7.1320; <i>p</i> &#x3c; 0.001) for TAA and FP, respectively. Individual symptoms improved significantly from baseline. The proportion of patients achieving ≥50 and ≥75% reductions in total rTNSS was 88.0 and 67.2%, respectively in the TAA group. No significant differences were observed between the TAA and FP in any analyses. <b><i>Conclusions:</i></b> TAA produced effective and prolonged improvement of PAR symptoms over a 4-week treatment period.

scholarly journals Intraoperative Flurbiprofen Treatment Alters Immune Checkpoint Expression in Patients Undergoing Elective Thoracoscopic Resection of Lung Cancer

2019 ◽  
Vol 29 (2) ◽  
pp. 150-159 ◽  
Author(s):  
Ji-cheng Hu ◽  
Xiao-qing Chai ◽  
Di Wang ◽  
Shu-hua Shu ◽  
Costan G. Magnussen ◽  
...  
Keyword(s):  
T Cells ◽  
Cd8 T Cells ◽  
Mixed Model ◽  
Linear Mixed Model ◽  
Thoracoscopic Surgery ◽  
Inflammatory Marker ◽  
T Cell Subsets ◽  
Control Group ◽  
Double Blind ◽  
T1 And T2

Objectives: This study aimed to determine the effect of intraoperative administration of flurbiprofen on postoperative levels of programmed death 1 (PD-1) in patients undergoing thoracoscopic surgery. Materials and Methods: In this prospective double-blind trial, patients were randomized to receive intralipid (control group, n = 34, 0.1 mL/kg, i.v.) or flurbiprofen axetil (flurbiprofen group, n = 34, 50 mg, i.v.) before induction of anesthesia. PD-1 levels on T cell subsets, inflammation, and immune markers in peripheral blood were examined before the induction of anesthesia (T0) and 24 h (T1), 72 h (T2), and 1 week (T3) after surgery. A linear mixed model was used to determine whether the changes from baseline values (T0) between groups were significantly different. Results: The increases in the percentage of PD-1(+)CD8(+) T cells observed at T1 and T2 in the control group were higher than those in the flurbiprofen group (T1: 12.91 ± 1.65 vs. 7.86 ± 5.71%, p = 0.031; T2: 11.54 ± 1.54 vs. 8.75 ± 1.73%, p = 0.004), whereas no differences were observed in the changes in the percentage of PD-1(+)CD4(+) T cells at T1 and T2 between the groups. Moreover, extensive changes in the percentage of lymphocyte subsets and inflammatory marker concentrations were observed at T1 and T2 after surgery and flurbiprofen attenuated most of these changes. Conclusions: Perioperative administration of flurbiprofen attenuated the postoperative increase in PD-1 levels on CD8(+) T cells up to 72 h after surgery, but not after this duration. The clinical relevance of changes in PD-1 levels to long-term surgical outcome remains unknown.

Prophylactic oral glutamine for docetaxel or paclitaxel associated taste alterations in cancer patients: A randomised, parallel, placebo-controlled, double-blind study

2007 ◽  
Vol 25 (18_suppl) ◽  
pp. 9104-9104
Author(s):  
F. Strasser ◽  
R. Demmer ◽  
C. Boehme ◽  
S. Schmitz ◽  
B. Thuerlimann ◽  
...  
Keyword(s):  
Mixed Model ◽  
Linear Mixed Model ◽  
Linear Time ◽  
Group Analysis ◽  
Estimating Equation ◽  
Taste Perception ◽  
Double Blind Study ◽  
Double Blind ◽  
Baseline Effect ◽  
First Time

9104 Background: Taste alterations (TA) can occur as side-effects of taxane-based chemotherapy (T-Ch) and studies suggest that glutamin can reduce neurotoxicity. We compared in patients (pts) with a first time T-Ch oral glutamin (G) with placebo (P) for occurrence and severity of TA. Methods: Pts were randomised for 30g per day G or P (maltodextrin) (Baxter, Switzerland) from the first day of T-Ch. Subjective TA (dysgeusia) was measured daily by VAS, at baseline 3 times. On each cycle of T-Ch, objective (sour, sweet, salty, bitter) and subjective (4-categorical scale of 4 tastes) TA, and toxicity (NCI CTC V.3) were assessed. Stomatitis and zinc deficiency were screened for and treated. Of 47 pts receiving at least one day G or P, three (2 G, 1 P) died to tumor progression and three (2 G, 1 P) withdraw consent in the first cycle of T-Ch. For primary outcomes, repeated dysgeusia scores were analyzed by linear mixed model and repeated binary values of each objective taste item by generalized estimating equation using logit link function. Results: G (n=21) and P (n=20) pts groups were comparable for demographics (f:m 5:16, median age 67 [49,83], 9 prostate, 3 lung, 3 breast, 6 other cancer; 8:12, 63 [40,73], 2, 6, 6, 6), and T-Ch drug (docetaxel 11/paclitaxel 10; 7/13), schedule (weekly 18/3-weekly 3; 14/6), or goal (adjuvant 1/palliative 20; 5/15). At baseline, average median dysgeusia was 11 in both groups (0,90; SD 23. 0,99; 22), 4 tastes were recognized by 12, 16, 13, and 15 pts in G (n=16) and 16, 19, 17, 19 in P (n=20). Study duration was 73 days for G (median; 4, 385) and 74 for P (7, 187). 19 of 39 pts (11 G, 8 P) developed peripheral neuropathy G1 or G2, none G3. Maximal (mean) dysgeusia was 31 (1, 100) in G and 33 (4, 74) in P; increase from baseline was 20 (1, 100) and 22 (1, 63). No effect of G or P on dysgeusia was detected (p=ns), linear time effect was p=0.46. Baseline dysgeusia effect was significant (p<0.0001), two group analysis (dysgeusia =11) did not alter results. Objective taste tests (no baseline effect) or subjective TA were not different, as were adverse events. Conclusions: Oral glutamin at the dose given did not decrease subjective taste disturbances or altered taste perception associated with T-Ch compared to placebo. No significant financial relationships to disclose.

scholarly journals Comparative effectiveness of levothyroxine, desiccated thyroid extract, and levothyroxine+Liothyronine in hypothyroidism

2021 ◽  
Author(s):  
Mohamed K M Shakir ◽  
Daniel I Brooks ◽  
Elizabeth A McAninch ◽  
Tatiana De Lourdes Fonseca ◽  
Vinh Q Mai ◽  
...  
Keyword(s):  
Gene Polymorphism ◽  
Visual Memory ◽  
Mixed Model ◽  
Linear Mixed Model ◽  
General Health Questionnaire ◽  
Treatment Preference ◽  
Thyroid Extract ◽  
Double Blind ◽  
Random Factor ◽  
Hypothyroid Patients

Abstract Introduction Studies comparing LT4 therapy with LT4+LT3 or desiccated thyroid extract (DTE) did not detect consistent superiority of either treatment. Here we investigated these therapies, focusing on the whole group of LT4-treated hypothyroid patients, while also exploring the most symptomatic patients. Methodology Prospective, randomized, double-blind, crossover study of 75 hypothyroid patients randomly allocated to one of three treatment arms, LT4, LT4+LT3 and DTE, for 22 weeks. The primary outcomes were post-treatment scores on the 36-point thyroid symptom questionnaire (TSQ-36), 12-point quality of life general health questionnaire (GHQ-12), the Wechsler memory scale-Version IV (VMS-IV), and the Beck Depression Inventory (BDI). Secondary endpoints included treatment preference, biochemical and metabolic parameters, etiology of hypothyroidism, and Thr92Ala-DIO2 gene polymorphism. Analyses were performed with a linear mixed model using subject as a random factor and group as a fixed effect. Results Serum TSH remained within reference range across all treatment arms. There were no differences for primary and secondary outcomes, except for a minor increase in heart rate caused by DTE. Treatment preference was not different and there were no interferences of the etiology of hypothyroidism or Thr92Ala-DIO2 gene polymorphism in the outcomes. Subgroup analyses of the 1/3 most symptomatic patients on LT4 revealed strong preference for treatment containing T3, which improved performance on TSQ-36, GHQ-12, BDI and visual memory index (VMS-IV component). Conclusions As a group, outcomes were similar among hypothyroid patients taking DTE vs. LT4+T3 vs. LT4. However, those patients that were most symptomatic on LT4 preferred and responded positively to therapy with LT4+LT3 or DTE.

scholarly journals Education Research: Resident education through adult learning in neurology

Neurology ◽  
2018 ◽  
Vol 91 (5) ◽  
pp. 234-238
Author(s):  
Hazem Shoirah ◽  
Achilles Ntranos ◽  
Rachel Brandstadter ◽  
Yangbo Liu ◽  
Elisha Medina ◽  
...  
Keyword(s):  
Adult Learning ◽  
Residency Program ◽  
Mixed Model ◽  
Linear Mixed Model ◽  
Resident Education ◽  
Analysis Of Covariance ◽  
Medical Licensing ◽  
Service Training ◽  
Score Reports ◽  
Change In Mean

ObjectiveTo enhance residency education by implementing the 6 principles of adult learning theory (ALT) in a large academic neurology residency program.MethodsWe implemented a set of curricular interventions aimed at Resident Education through Adult Learning in Neurology (REAL Neurology), in a large, academic neurology residency program. Interventions included didactic reform, increasing resident-as-teacher activities, and enhancing residents' interaction. The primary outcome was the change in mean Residency In-service Training Examination (RITE) percentile between the preintervention and postintervention cohorts, adjusting for US Medical Licensing Examination step 1 and 2 score. Other analysis included evaluating the effect of the duration of intervention exposure on outcome and evaluating the intervention effect on the proportion of advanced performers.ResultsA total of 134 RITE score reports were evaluated (87 preintervention and 47 postintervention). The mean RITE score percentile postintervention was 11.7 points higher than preintervention (adjusted, longitudinal analysis: fit linear mixed model, p < 0.0001). Postgraduate year 3 learners who had 1 and 2 years of exposure scored 13.4 and 18.9 points higher than those with no exposure at all, respectively (analysis of covariance, p = 0.04). The adjusted odds of better performance with REAL Neurology was 5.77 (ordinal logistic regression, 95% confidence interval 2.37–14.07, p < 0.05).ConclusionThis study evaluated the efficacy and feasibility of an ALT-based curricular program in neurology education. The results show robust and sustainable benefit for residents in training without imposing a financial or logistical burden on programs. REAL Neurology could serve as a model for curricular reform in other programs across subspecialties.

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