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Randomized controled trial critical care

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https://www.readbyqxmd.com/read/28089599/impact-of-oral-chlorhexidine-on-bloodstream-infection-in-critically-ill-patients-systematic-review-and-meta-analysis-of-randomized-controlled-trials
#1
REVIEW
Luciano Silvestri, William I Weir, Dario Gregori, Nia Taylor, Durk F Zandstra, Joris J M van Saene, Hendrick K F van Saene
OBJECTIVES: Oropharyngeal overgrowth of microorganisms in the critically ill is a risk factor for lower respiratory tract infection and subsequent invasion of the bloodstream. Oral chlorhexidine has been used to prevent pneumonia, but its effect on bloodstream infection never has been assessed in meta-analyses. The authors explored the effect of oral chlorhexidine on the incidence of bloodstream infection, the causative microorganism, and on all-cause mortality in critically ill patients...
November 2, 2016: Journal of Cardiothoracic and Vascular Anesthesia
https://www.readbyqxmd.com/read/28077529/poor-agreement-in-significant-findings-between-meta-analyses-and-subsequent-large-randomized-trials-in-perioperative-medicine
#2
REVIEW
H Sivakumar, P J Peyton
BACKGROUND: The reliability of meta-analysis (MA) in predicting the findings of subsequent large randomized controlled trials (RCTs) has not been assessed in perioperative medicine and anaesthesia. METHODS: Using Medline and PubMed, large RCTs (n≥1000) published since 2000 in the anaesthesia and perioperative medicine/critical care literature were identified. All previous MAs of RCTs investigating the same intervention and population were sourced. For all reported major morbid endpoints common to each, results (significant/non-significant P<0...
October 2016: British Journal of Anaesthesia
https://www.readbyqxmd.com/read/28075489/cough-augmentation-techniques-for-extubation-or-weaning-critically-ill-patients-from-mechanical-ventilation
#3
REVIEW
Louise Rose, Neill Kj Adhikari, David Leasa, Dean A Fergusson, Douglas McKim
BACKGROUND: There are various reasons why weaning and extubation failure occur, but ineffective cough and secretion retention can play a significant role. Cough augmentation techniques, such as lung volume recruitment or manually- and mechanically-assisted cough, are used to prevent and manage respiratory complications associated with chronic conditions, particularly neuromuscular disease, and may improve short- and long-term outcomes for people with acute respiratory failure. However, the role of cough augmentation to facilitate extubation and prevent post-extubation respiratory failure is unclear...
January 11, 2017: Cochrane Database of Systematic Reviews
https://www.readbyqxmd.com/read/28068789/pragmatic-trial-of-video-education-in-nursing-homes-the-design-and-rationale-for-a-pragmatic-cluster-randomized-trial-in-the-nursing-home-setting
#4
Vincent Mor, Angelo E Volandes, Roee Gutman, Constantine Gatsonis, Susan L Mitchell
Background/Aims Nursing homes are complex healthcare systems serving an increasingly sick population. Nursing homes must engage patients in advance care planning, but do so inconsistently. Video decision support tools improved advance care planning in small randomized controlled trials. Pragmatic trials are increasingly employed in health services research, although not commonly in the nursing home setting to which they are well-suited. This report presents the design and rationale for a pragmatic cluster randomized controlled trial that evaluated the "real world" application of an Advance Care Planning Video Program in two large US nursing home healthcare systems...
January 1, 2017: Clinical Trials: Journal of the Society for Clinical Trials
https://www.readbyqxmd.com/read/28068459/does-pharmacogenomic-testing-improve-clinical-outcomes-for-major-depressive-disorder-a-systematic-review-of-clinical-trials-and-cost-effectiveness-studies
#5
Joshua D Rosenblat, Yena Lee, Roger S McIntyre
OBJECTIVE: Pharmacogenomic testing has become scalable and available to the general public. Pharmacogenomics has shown promise for predicting antidepressant response and tolerability in the treatment of major depressive disorder (MDD). In theory, pharmacogenomics can improve clinical outcomes by guiding antidepressant selection and dosing. The current systematic review examines the extant literature to determine the impact of pharmacogenomic testing on clinical outcomes in MDD and assesses its cost-effectiveness...
January 3, 2017: Journal of Clinical Psychiatry
https://www.readbyqxmd.com/read/28068239/stereotactic-body-radiation-therapy-for-locally-advanced-pancreatic-cancer-a-systematic-review-and-pooled-analysis-of-19-trials
#6
REVIEW
Fausto Petrelli, Tiziana Comito, Antonio Ghidini, Valter Torri, Marta Scorsetti, Sandro Barni
PURPOSE: Although surgery is the standard of care for resectable pancreatic cancer (PC), standard-dose chemoradiation therapy and chemotherapy alone are suitable for patients with unresectable disease. Stereotactic body radiation therapy (SBRT) is an alternative, focused local therapy that delivers high radiation doses within a few fractions to the cancer, sparing the surrounding critical tissue. We performed a systematic review and pooled analysis of published trials to evaluate the efficacy and safety of this emerging treatment modality...
February 1, 2017: International Journal of Radiation Oncology, Biology, Physics
https://www.readbyqxmd.com/read/28056024/a-double-blind-randomized-controlled-trial-of-maternal-postpartum-deworming-to-improve-infant-weight-gain-in-the-peruvian-amazon
#7
Layla S Mofid, Martín Casapía, Eder Aguilar, Hermánn Silva, Antonio Montresor, Elham Rahme, William D Fraser, Grace S Marquis, Jozef Vercruysse, Lindsay H Allen, Brittany Blouin, Hugo Razuri, Lidsky Pezo, Theresa W Gyorkos
BACKGROUND: Nutritional interventions targeting the critical growth and development period before two years of age can have the greatest impact on health trajectories over the life course. Compelling evidence has demonstrated that interventions investing in maternal health in the first 1000 days of life are beneficial for both mothers and their children. One such potential intervention is deworming integrated into maternal postpartum care in areas where soil-transmitted helminth (STH) infections are endemic...
January 2017: PLoS Neglected Tropical Diseases
https://www.readbyqxmd.com/read/28055143/no-wrong-doors-findings-from-a-critical-review-of-behavioral-randomized-clinical-trials-for-individuals-with-co-occurring-alcohol-drug-problems-and-ptsd
#8
Tracy L Simpson, Keren Lehavot, Ismene L Petrakis
Prior reviews of behavioral treatments for individuals with comorbid alcohol and drug use disorders (SUD) and PTSD have not systematically considered whether comparison conditions are matched to target treatments on time and attention. A systematic literature search using PubMed MESH terms for alcohol and substance use disorders, PTSD, and treatment identified relevant behavioral randomized clinical trials (RCTs) that evaluated PTSD-oriented exposure-based treatments, addiction-focused treatments, and coping-based treatments that do not involve exposure to trauma memories...
January 5, 2017: Alcoholism, Clinical and Experimental Research
https://www.readbyqxmd.com/read/28051976/military-mental-health-first-aid-development-and-preliminary-efficacy-of-a-community-training-for-improving-knowledge-attitudes-and-helping-behaviors
#9
Nathaniel Vincent Mohatt, Robert Boeckmann, Nicola Winkel, Dennis F Mohatt, Jay Shore
INTRODUCTION: Persistent stigma, lack of knowledge about mental health, and negative attitudes toward treatment are among the most significant barriers to military service members and veterans seeking behavioral health care. With the high rates of untreated behavioral health needs among service members and veterans, identifying effective programs for reducing barriers to care is a national priority. This study adapted Mental Health First Aid (MHFA), an evidence-based program for increasing mental health knowledge, decreasing stigma, and increasing laypeople's confidence in helping and frequency of referring people in need, for military and veteran populations and pilot tested the adapted training program with 4 Army National Guard armories...
January 2017: Military Medicine
https://www.readbyqxmd.com/read/28049256/initial-energy-supplementation-in-critically-ill-patients-receiving-enteral-nutrition-a-systematic-review-and-meta-analysis-of-randomized-controlled-trials
#10
Feng Tian, Xuejin Gao, Chao Wu, Li Zhang, Xianfeng Xia, Xinying Wang
BACKGROUND AND OBJECTIVES: Here we systematically reviewed and quantitatively analyzed randomized controlled trials (RCTs) to compare the important initial outcomes of critically ill adults receiving low- and highenergy enteral nutrition. METHODS AND STUDY DESIGN: RCTs comparing low- and high-energy supplementation in critically ill adults receiving enteral nutrition admitted to the intensive care unit for an expected stay of >48 h were included. Abstracts submitted to major scientific meetings were included and the primary endpoint was mortality...
January 2017: Asia Pacific Journal of Clinical Nutrition
https://www.readbyqxmd.com/read/28049079/prediction-of-motivational-impairment-12-month-follow-up-of-the-randomized-controlled-trial-on-extended-early-intervention-for-first-episode-psychosis
#11
W C Chang, V W Y Kwong, G H K Chan, O T T Jim, E S K Lau, C L M Hui, S K W Chan, E H M Lee, E Y H Chen
BACKGROUND: Amotivation is prevalent in first-episode psychosis (FEP) patients and is a major determinant of functional outcome. Prediction of amotivation in the early stage of psychosis, however, is under-studied. We aimed to prospectively examine predictors of amotivation in FEP patients in a randomized-controlled trial comparing a 1-year extension of early intervention (Extended EI, 3-year EI) with step-down psychiatric care (SC, 2-year EI). METHODS: One hundred sixty Chinese patents were recruited from a specialized EI program for FEP in Hong Kong after they have completed this 2-year EI service, randomly allocated to Extended EI or SC, and followed up for 12 months...
December 29, 2016: European Psychiatry: the Journal of the Association of European Psychiatrists
https://www.readbyqxmd.com/read/28034967/a-randomized-controlled-trial-of-the-effects-of-online-pain-management-education-on-primary-care-providers
#12
Kimberlee J Trudeau, Cristina Hildebrand, Priyanka Garg, Emil Chiauzzi, Kevin L Zacharoff
OBJECTIVE:  To improve pain management practices, we developed an online interactive continuing education (CE) program for primary care providers (PCPs). This program follows the flow of clinical decision-making through simulated cases at critical pain treatment points along the pain treatment continuum. DESIGN:  A randomized controlled trial was conducted to test the efficacy of this program. Participants were randomized to either the experimental condition or the control condition (online, text-based CE program)...
December 29, 2016: Pain Medicine: the Official Journal of the American Academy of Pain Medicine
https://www.readbyqxmd.com/read/28034281/is-there-any-role-for-splenectomy-in-adulthood-onset-chronic-immune-thrombocytopenia-in-the-era-of-tpo-receptors-agonists-a-critical-overview
#13
Vibor Milunovic, Inga Mandac Rogulj, Slobodanka Kolonic Ostojic
Immune thrombocytopenia (ITP) in adulthood is characterized by chronic relapsing course. Despite the efficacious first line treatment (corticosteroid, intravenous immunoglobulin), majority of patients will enter the chronic phase warranting another treatment approach. Until recently, splenectomy performed in ITP chronic phase represented the standard of care with long-term remissions in more than 70% of patients, but however has never been tested in clinical trials. However, with the advances of our understanding of ITP pathophysiology and the shifting focus on megakaryocyte impairment, novel drugs were introduced in treatment paradigm, mainly trombopoietin receptor agonists (TPO-RAs); romiplostim and eltrombopag...
December 29, 2016: Cardiovascular & Hematological Disorders Drug Targets
https://www.readbyqxmd.com/read/28030547/practice-doesn-t-always-make-perfect-a-qualitative-study-explaining-why-a-trial-of-an-educational-toolkit-did-not-improve-quality-of-care
#14
Janet A Parsons, Catherine H Y Yu, Natalie A Baker, Muhammad M Mamdani, Onil Bhattacharyya, Merrick Zwarenstein, Baiju R Shah
BACKGROUND: Diabetes is a chronic disease commonly managed by family physicians, with the most prevalent complication being cardiovascular disease (CVD). Clinical practice guidelines have been developed to support clinicians in the care of diabetic patients. We conducted a pragmatic cluster randomized controlled trial (RCT) of a printed educational toolkit aimed at improving CVD management in diabetes in primary care, and found no effect, and indeed, the possibility of some harm. We conducted a qualitative evaluation to study the strategy for guideline implementation employed in this trial, and to understand its effects...
2016: PloS One
https://www.readbyqxmd.com/read/28008609/randomized-trial-of-the-family-intervention-telephone-tracking-caregiver-for-dementia-caregivers-use-of-community-and-healthcare-resources
#15
Geoffrey Tremont, Jennifer D Davis, Brian R Ott, Rachel Galioto, Cara Crook, George D Papandonatos, Richard H Fortinsky, Pedro Gozalo, Duane S Bishop
OBJECTIVES: To examine the effects of a telephone-delivered intervention, Family Intervention: Telephone Tracking-Caregiver (FITT-C), on community support and healthcare use by dementia caregivers. DESIGN: Randomized, controlled trial. SETTING: Academic medical center. PARTICIPANTS: Dyads (n = 250) of distressed informal dementia caregivers and care recipients. INTERVENTION: Caregivers were randomly assigned to receive the FITT-C (n = 133) or telephone support (TS; n = 117)...
December 23, 2016: Journal of the American Geriatrics Society
https://www.readbyqxmd.com/read/28002714/hypothermia-for-neuroprotection-in-convulsive-status-epilepticus
#16
RANDOMIZED CONTROLLED TRIAL
Stephane Legriel, Virginie Lemiale, Maleka Schenck, Jonathan Chelly, Virginie Laurent, Fabrice Daviaud, Mohamed Srairi, Aicha Hamdi, Guillaume Geri, Thomas Rossignol, Julia Hilly-Ginoux, Julie Boisramé-Helms, Benjamin Louart, Isabelle Malissin, Nicolas Mongardon, Benjamin Planquette, Marina Thirion, Sybille Merceron, Emmanuel Canet, Fernando Pico, Yves-Roger Tran-Dinh, Jean-Pierre Bedos, Elie Azoulay, Matthieu Resche-Rigon, Alain Cariou
Background Convulsive status epilepticus often results in permanent neurologic impairment. We evaluated the effect of induced hypothermia on neurologic outcomes in patients with convulsive status epilepticus. Methods In a multicenter trial, we randomly assigned 270 critically ill patients with convulsive status epilepticus who were receiving mechanical ventilation to hypothermia (32 to 34°C for 24 hours) in addition to standard care or to standard care alone; 268 patients were included in the analysis. The primary outcome was a good functional outcome at 90 days, defined as a Glasgow Outcome Scale (GOS) score of 5 (range, 1 to 5, with 1 representing death and 5 representing no or minimal neurologic deficit)...
22, 2016: New England Journal of Medicine
https://www.readbyqxmd.com/read/28000127/intensive-care-unit-admission-for-patients-in-the-interact2-ich-blood-pressure-treatment-trial-characteristics-predictors-and-outcomes
#17
Katja E Wartenberg, Xia Wang, Paula Muñoz-Venturelli, Alejandro A Rabinstein, Pablo M Lavados, Craig S Anderson, Thompson Robinson
BACKGROUND: Wide variation exists in criteria for accessing intensive care unit (ICU) facilities for managing patients with critical illnesses such as acute intracerebral hemorrhage (ICH). We aimed to determine the predictors of admission, length of stay, and outcome for ICU among participants of the main Intensive Blood Pressure Reduction in Acute Cerebral Hemorrhage Trial (INTERACT2). METHODS: INTERACT2 was an international, open, blinded endpoint, randomized controlled trial of 2839 ICH patients (<6 h) and elevated systolic blood pressure (SBP) allocated to receive intensive (target SBP <140 mmHg within 1 h) or guideline-recommended (target SBP <180 mmHg) BP-lowering treatment...
December 20, 2016: Neurocritical Care
https://www.readbyqxmd.com/read/27984323/use-of-large-healthcare-databases-for-rheumatology-clinical-research
#18
Rishi J Desai, Daniel H Solomon
PURPOSE OF REVIEW: Large healthcare databases, which contain data collected during routinely delivered healthcare to patients, can serve as a valuable resource for generating actionable evidence to assist medical and healthcare policy decision-making. In this review, we summarize use of large healthcare databases in rheumatology clinical research. RECENT FINDINGS: Large healthcare data are critical to evaluate medication safety and effectiveness in patients with rheumatologic conditions...
December 15, 2016: Current Opinion in Rheumatology
https://www.readbyqxmd.com/read/27967228/safety-and-efficacy-of-personalized-glycemic-control-in-critically-ill-patients-a-2-year-before-and-after-interventional-trial
#19
James S Krinsley, Jean-Charles Preiser, Irl B Hirsch
Objective To determine the safety and efficacy of a change in blood glucose (BG) control protocol from a single target to 2 targets based on diabetes status and glycated hemoglobin (A1C) in a cohort of critically ill patients. Methods This investigation includes 1,979 patients admitted to a single intensive care unit between September 16, 2013 and September 15, 2015. The BG target was 90-120 mg/dL in the PRE era and 80-140 mg/dL for patients without diabetes (NON) and diabetes patients (DM) with A1C < 7% and 110-160 mg/dL for DM with A1C > 7% (TIGHT and LOOSE protocols) in the POST era...
December 14, 2016: Endocrine Practice
https://www.readbyqxmd.com/read/27965838/immediate-tumor-resection-in-patients-with-locally-advanced-gastroesophageal-adenocarcinoma-with-nonresponse-to-chemotherapy-after-4%C3%A2-weeks-of-treatment-versus-resection-after-completion-of-chemotherapy-optitreat-trial-drks00004668-study-protocol-for-a-randomized
#20
Susanne Blank, Phillip Knebel, Georg-Martin Haag, Thomas Bruckner, Ulla Klaiber, Maria Burian, Anja Schaible, Leila Sisic, Thomas Schmidt, Markus K Diener, Katja Ott
BACKGROUND: Neoadjuvant chemotherapy is a standard of care for patients with adenocarcinoma of the esophagus and stomach in Europe, but still only 20-40 % respond to therapy and the critical issue; how to treat nonresponding patients is still unclear. So far, there is no randomized trial evaluating the impact of early termination of neoadjuvant chemotherapy and immediate tumor resection in nonresponding patients with locally advanced gastroesophageal cancer on postoperative outcome. With this exploratory pilot trial, we want to get first estimates about the effect of discontinuation of chemotherapy with the aim to plan and conduct a further definitive trial...
2016: Pilot and Feasibility Studies
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