Background: Guidelines for randomised controlled trials (RCTs) recommend reporting relative and absolute measures of effect for binary outcomes while adjusting for covariates. There are a number of different ways covariate-adjusted relative risks and risk differences can be estimated.
Objectives: Our goal was to identify methods used to estimate covariate-adjusted relative risk and risk differences in RCTs published in high-impact journals with binary outcomes.
Objectives: To evaluate the cost-effectiveness of long-acting progestogens (LAP), including levonorgestrel-releasing intrauterine system (LNG-IUS) and depot-medroxyprogesterone acetate (DMPA), compared with the combined oral contraceptives pill (COCP) in preventing recurrence of endometriosis-related pain postsurgery.
Design: Within-trial economic evaluation alongside a multicentre, pragmatic, parallel-group, open-label, randomised controlled trial (Preventing Recurrence of Endometriosis by means of Long-Acting Progestogen Therapy trial).
Setting: Thirty-four UK hospitals recruiting participants from November 2015 to March 2019.
Purpose: Based on an initial hypothesis that the abdominal radiograph is rarely useful in the radiographic shunt series (SS), this study sought to determine which components of the SS are useful in identifying and diagnosing shunt dysfunction. This enquiry broadened to evaluate which modalities were most clinically useful in patients who ultimately underwent shunt revision for their suspected dysfunction.
Methods: Arm1: Abdominal radiographs (AXR) performed over a 2-year period were reviewed retrospectively to identify shunt abnormalities.
We characterized the longitudinal serum protein signatures of women 6 and 10 years after gestational diabetes mellitus (GDM) to identify factors associated with the development of type 2 diabetes mellitus (T2D) and prediabetes in this at-risk post-GDM population, aiming to discover potential biomarkers for early diagnosis and prevention of T2D. Our study identified 75 T2D-associated serum proteins and 23 prediabetes-associated proteins, some of which were validated in an independent T2D cohort. Machine learning (ML) performed on the longitudinal proteomics highlighted protein signatures associated with progression to post-GDM diabetes.
View Article and Find Full Text PDFIntroduction: The 1985 Hames Consortium convened family medicine researchers to identify outstanding questions in their practice.
Method: In this descriptive review, we collected, codified, and analyzed available literature to describe the availability of evidence to answer these questions.
Results: Of 136 total questions, researchers rated 33 questions as not at all answered (24.
Background: Exercise (EX) or cognitive and social enrichment (ENRICH) are 2 strategies for promoting cognition poststroke. Whether sleep moderates the effects of EX or ENRICH on cognition in adults with chronic stroke is unknown.
Methods: A 3-arm parallel randomized clinical trial among community-dwelling adults aged 55+ years with chronic stroke (ie, ≥12 months since stroke).
After a number of failed drug studies on Alzheimer's disease (AD) over the past decade, clinical trials of AD started to show encouraging results and were approved or pending approval for clinical use. However, controversies on the clinically meaningful benefits and risks of brain edema and microhemorrhages have reminded us to think further about monitoring treatment and developing new drug targets. The goal of this review is to find insights from clinical trials that aimed at two key pathological features of AD, i.
View Article and Find Full Text PDFBackground: Rehabilitation can help long-term care (LTC) residents with dementia maintain their independence. However, many residents do not receive rehabilitation. This study aimed to identify the barriers and facilitators to providing rehabilitation for LTC residents with dementia and propose practical interventions for overcoming them.
View Article and Find Full Text PDFBackground: The reported inverse association between cancer and subsequent Alzheimer's disease and related dementias (ADRD) remains uncertain.
Objectives: To investigate the association between these common conditions of old age and explore possible causal factors.
Design, Setting, Participants And Measurements: We conducted a large population-based cohort analysis using data from 3,021,508 individuals aged 60 and over in the UK Clinical Practice Research Datalink (CPRD), over a period up to 30 years (1988-2018).
J Prev Alzheimers Dis
October 2024
Recent positive results of three phase III anti-amyloid monoclonal antibody trials are transforming the landscape of disease-modifying therapeutics for Alzheimer's disease, following several decades of failures. Indeed, all three trials have met their primary endpoints. However, the absolute size of the benefit measured in these trials has generated a debate on whether the change scores observed on clinical outcome assessments represent a clinically meaningful benefit to patients.
View Article and Find Full Text PDFThe emergence of biobank-level datasets offers new opportunities to discover novel biomarkers and develop predictive algorithms for human disease. Here, we present an ensemble machine-learning framework (machine learning with phenotype associations, MILTON) utilizing a range of biomarkers to predict 3,213 diseases in the UK Biobank. Leveraging the UK Biobank's longitudinal health record data, MILTON predicts incident disease cases undiagnosed at time of recruitment, largely outperforming available polygenic risk scores.
View Article and Find Full Text PDFObjectives: This study sought to understand how university student's academic discipline relates to sleep factors including attitudes, hygiene, quality, and duration.
Methods: Using a cross-sectional approach, a 30-min survey was advertised to students at two Canadian universities in March of 2022. Sleep measures included the Dysfunctional Beliefs and Attitudes Scale, the Sleep Hygiene Index, the Pittsburgh Sleep Quality Index, and the Insomnia Severity Index.
Background: Developing medicine from scratch to governmental authorization and detecting adverse drug reactions (ADR) have barely been economical, expeditious, and risk-averse investments. The availability of large-scale observational healthcare databases and the popularity of large language models offer an unparalleled opportunity to enable automatic high-throughput drug screening for both repurposing and pharmacovigilance.
Objectives: To demonstrate a general workflow for automatic high-throughput drug screening with the following advantages: (i) the association of various exposure on diseases can be estimated; (ii) both repurposing and pharmacovigilance are integrated; (iii) accurate exposure length for each prescription is parsed from clinical texts; (iv) intrinsic relationship between drugs and diseases are removed jointly by bioinformatic mapping and large language model - ChatGPT; (v) causal-wise interpretations for incidence rate contrasts are provided.
Cognitive impairment among older adults is a growing public health challenge and environmental chemicals may be modifiable risk factors. A wide array of chemicals has not yet been tested for association with cognition in an environment-wide association framework. In the US National Health and Nutrition Examination Survey (NHANES) 1999-2000 and 2011-2014 cross-sectional cycles, cognition was assessed using the Digit Symbol Substitution Test (DSST, scores 0-117) among participants aged 60 years and older.
View Article and Find Full Text PDFBackground: A maturity matrix can be a useful tool for organisations implementing large-system transformation (LST) initiatives in complex systems. Insights from implementation of a local LST initiative using collaborative networks, known as Alliances, highlighted a tool was needed to help health system leaders prompt discussions on how and where to focus their change efforts. In the New Zealand (NZ) health system, Alliances were introduced to integrate the planning and delivery of health care between primary and hospital care.
View Article and Find Full Text PDFIntroduction Within primary health care policy, there is an increasing focus on enhancing involvement with secondary health care, social care services and communities. Yet, translating these expectations into tangible changes frequently encounters significant obstacles. As part of an investigation into the progress made in achieving primary health care reform in Aotearoa New Zealand, realist research was undertaken with those charged with responsibility for national and local policies.
View Article and Find Full Text PDFBackground: Improving survival for patients diagnosed with metastatic disease and overcoming chemoresistance remain significant clinical challenges in treating breast cancer. Triple-negative breast cancer (TNBC) is an aggressive subtype characterized by a lack of therapeutically targetable receptors (ER/PR/HER2). TNBC therapy includes a combination of cytotoxic chemotherapies, including microtubule-targeting agents (MTAs) like paclitaxel (taxane class) or eribulin (vinca class); however, there are currently no FDA-approved MTAs that bind to the colchicine-binding site.
View Article and Find Full Text PDFTimely detection and treatment of postpartum hemorrhage (PPH) are crucial to prevent complications or death. A calibrated blood-collection drape can help provide objective, accurate and early diagnosis of PPH, and a treatment bundle can address delays or inconsistencies in the use of effective interventions. Here we conducted an economic evaluation alongside the E-MOTIVE trial, an international, parallel cluster-randomized trial with a baseline control phase involving 210,132 women undergoing vaginal delivery across 78 secondary-level hospitals in Kenya, Nigeria, South Africa and Tanzania.
View Article and Find Full Text PDFObjectives: To evaluate the clinical effectiveness of long acting progestogens compared with the combined oral contraceptive pill in preventing recurrence of endometriosis related pain.
Design: The PRE-EMPT (preventing recurrence of endometriosis) pragmatic, parallel group, open label, randomised controlled trial.
Setting: 34 UK hospitals.