SciCombinator

Discover the most talked about and latest scientific content & concepts.

Concept: Efficacy

209

To determine the effectiveness of helmet therapy for positional skull deformation compared with the natural course of the condition in infants aged 5-6 months.

Concepts: Clinical trial, Randomized controlled trial, Efficacy

193

A systematic review to examine the efficacy of computer-based cognitive interventions for cognitively healthy older adults was conducted. Studies were included if they met the following criteria: average sample age of at least 55 years at time of training; participants did not have Alzheimer’s disease or mild cognitive impairment; and the study measured cognitive outcomes as a result of training. Theoretical articles, review articles, and book chapters that did not include original data were excluded. We identified 151 studies published between 1984 and 2011, of which 38 met inclusion criteria and were further classified into three groups by the type of computerized program used: classic cognitive training tasks, neuropsychological software, and video games. Reported pre-post training effect sizes for intervention groups ranged from 0.06 to 6.32 for classic cognitive training interventions, 0.19 to 7.14 for neuropsychological software interventions, and 0.09 to 1.70 for video game interventions. Most studies reported older adults did not need to be technologically savvy in order to successfully complete or benefit from training. Overall, findings are comparable or better than those from reviews of more traditional, paper-and-pencil cognitive training approaches suggesting that computerized training is an effective, less labor intensive alternative.

Concepts: Alzheimer's disease, Effectiveness, Cognitive psychology, Cognitive neuroscience, Efficacy, Meta-analysis, Video game, Mild cognitive impairment

176

OBJECTIVE: Walking groups are increasingly being set up but little is known about their efficacy in promoting physical activity. The present study aims to assess the efficacy of interventions to promote walking in groups to promoting physical activity within adults, and to explore potential moderators of this efficacy. METHOD: Systematic literature review searches were conducted using multiple databases. A random effect model was used for the meta-analysis, with sensitivity analysis. RESULTS: The effect of the interventions (19 studies, 4 572 participants) on physical activity was of medium size (d = 0.52), statistically significant (95%CI 0.32 to 0.71, p < 0.0001), and with large fail-safe of N = 753. Moderator analyses showed that lower quality studies had larger effect sizes than higher quality studies, studies reporting outcomes over six months had larger effect sizes than studies reporting outcomes up to six months, studies that targeted both genders had higher effect sizes than studies that targeted only women, studies that targeted older adults had larger effect sizes than studies that targeted younger adults. No significant differences were found between studies delivered by professionals and those delivered by lay people. CONCLUSION: Interventions to promote walking in groups are efficacious at increasing physical activity. Despite low homogeneity of results, and limitations (e.g. small number of studies using objective measures of physical activity, publication bias), which might have influence the findings, the large fail-safe N suggests these findings are robust. Possible explanations for heterogeneity between studies are discussed, and the need for more investigation of this is highlighted.

Concepts: Systematic review, Statistical significance, Effectiveness, Efficacy, Effect size, Meta-analysis, Statistical power, Gene V. Glass

173

We report information about an unpublished 1970s study (“8-way” Bendectin Study) that aimed to evaluate the relative therapeutic efficacy of doxylamine, pyridoxine, and dicyclomine in the management of nausea and vomiting during pregnancy. We are publishing the trial’s findings according to the restoring invisible and abandoned trials (RIAT) initiative because the trial was never published.

Concepts: Epidemiology, Randomized controlled trial, ClinicalTrials.gov, Efficacy, The Trial, Nausea, Trial, Morning sickness

172

BACKGROUND: Tinnitus is the perception of a sound in the absence of an objective physical source. Up to now, there is no generally accepted view how these phantom sounds come about, and also no efficient treatment. Patients are turning to complementary or alternative medical therapies, such as acupuncture. Based on the theory of traditional Chinese medicine, acupoints located on both the adjacent and distal area of the disease can be needled to treat disease. Furthermore, the way of combining acupoints is for strengthening the curative effect. We aim to evaluate the efficacy of acupuncture at local points in combination with distal points in subjective tinnitus patients. METHOD: This trial is a randomized, single-blind, controlled study. A total of 112 participants will be randomly assigned to one of four treatment groups receiving acupuncture treatment for 4 weeks. The primary outcome measure is subjective tinnitus loudness and annoyance perception, which is graded using the Visual Analogue Scale (VAS). The assessment is at baseline (before treatment initiation), 4 weeks after the first acupuncture session, and 8 weeks after the first acupuncture session. DISCUSSION: Completion of this trial will help to identify whether acupuncture at local acupoints in combination with distal acupoints may be more effective than needling points separately.Trial registrationInternational Standard Randomized Controlled Trial Number Register: ISRCTN29230777.

Concepts: Medicine, Randomized controlled trial, Effectiveness, Efficacy, Acupuncture, Alternative medicine, Traditional Chinese medicine, Acupuncture point

169

Over the past decade, there has been a considerable increase in research on, and media attention to, sports-related concussion. However, despite accurate diagnosis, effective treatment and management of sports-related concussion have remained a challenge. There are approximately 1.8 million traumatic brain injuries in the United States annually (Faul et al., 2010) and emergency department pediatric visits for suspected concussion have doubled in the past decade (Bakhos et al., 2010). However, health care providers and medical researchers have yet to offer an effective, reliable evidence-based treatment for concussive brain injury. The Zurich 2008 Consensus Statement on Concussion in Sport codified the prescription for cognitive and physical rest immediately following a concussion based on clinical acumen and common sense (McCrory et al., 2009). Currently, rest is the considered the best immediate treatment for concussion. Other supportive and anecdotal treatments are often applied throughout the post-concussive recovery process to address persistent symptoms. The need for empirical research to translate current guidelines for rest into evidence-based treatment protocols is essential. A recent study evaluated the efficacy of comprehensive rest and concluded that such rest may be helpful whether applied soon after a concussion or weeks to months later (Moser et al., 2012). Here, we present a case illustrating the effectiveness of rest in a youth athlete, commenced after experiencing 13 months of post-concussion symptoms. There appears to be value in applying a specific period of cognitive and physical rest following concussion, whether immediately or later in the recovery phase.

Concepts: Traumatic brain injury, Effectiveness, Research, Efficacy, Post-concussion syndrome, Focal and diffuse brain injury, Concussion, Dementia pugilistica

169

BACKGROUND: Haemorrhoids (piles) are a very common condition seen in surgical clinics. After exclusion of more sinister causes of haemorrhoidal symptoms (rectal bleeding, perianal irritation and prolapse), the best option for treatment, depends upon persistence and severity of the symptoms. Minor symptoms often respond to conservative treatment such as dietary fibre and reassurance. For more severe symptoms treatment such as rubber band ligation may be therapeutic and is a very commonly performed procedure in the surgical outpatient setting. Surgery is usually reserved for those who have more severe symptoms, as well as those who do not respond to non-operative therapy; surgical techniques include haemorrhoidectomy and haemorrhoidopexy. More recently, haemorrhoidal artery ligation has been introduced as a minimally invasive, non destructive surgical option. There are substantial data in the literature concerning efficacy and safety of ‘rubber band ligation including multiple comparisons with other interventions, though there are no studies comparing it to haemorrhoidal artery ligation. A recent overview has been carried out by the National Institute for Health and Clinical Excellence which concludes that current evidence shows haemorrhoidal artery ligation to be a safe alternative to haemorrhoidectomy and haemorrhoidopexy though it also highlights the lack of good quality data as evidence for the advantages of the technique. Methods/design The aim of this study is to establish the clinical effectiveness and cost effectiveness of haemorrhoidal artery ligation compared with conventional rubber band ligation in the treatment of people with symptomatic second or third degree (Grade II or Grade III) haemorrhoids. DESIGN: A multi-centre, parallel group randomised controlled trial. Outcomes: The primary outcome is patient-reported symptom recurrence twelve months following the intervention. Secondary outcome measures relate to symptoms, complications, health resource use, health related quality of life and cost effectiveness following the intervention. Participants: 350 patients with grade II or grade III haemorrhoids will be recruited in surgical departments in up to 14 NHS hospitals. Randomisation: A multi-centre, parallel group randomised controlled trial. Block randomisation by centre will be used, with 175 participants randomised to each group. DISCUSSION: The results of the research will help inform future practice for the treatment of grade II and III haemorrhoids. Trial Registration ISRCTN41394716.

Concepts: Clinical trial, Randomized controlled trial, Efficacy, Dietary fiber, Prolapse, Hemorrhoid, Rubber band ligation, Perianal hematoma

167

Mesoporous silica-encapsulated gold nanorods (GNRs@mSiO(2)) have great potential both in photothermal therapy and drug delivery. In this paper, we firstly developed GNRs@mSiO(2) as a synergistic therapy tool for delivery heat and drug to the tumorigenic region. We studied the ablation of tumor both in vitro and in vivo by the combination of photothermal therapy and chemotherapy using doxorubicin (DOX)-loaded GNRs@mSiO(2). Significantly greater cell killing was observed when A549 cells incubated with DOX-loaded GNRs@mSiO(2) were irradiated with near-infrared (NIR) illumination, attributable to both GNRs@mSiO(2)-mediated photothermal ablation and cytotoxicity of light-triggered DOX release. We then performed in vivo therapy studies and observed a promising tumor treatment. Compared with chemotherapy or photothermal treatment alone, the combined treatment showed a synergistic effect, resulting in higher therapeutic efficacy. Furthermore, the lower systematic toxicity of GNRs@mSiO(2) has been validated.

Concepts: DNA, Cancer, Oncology, Chemotherapy, Therapy, Efficacy, Doxorubicin, Photothermal Therapy

165

Many brain-injured patients referred for outpatient rehabilitation have executive deficits, notably difficulties with planning, problem-solving and goal directed behaviour. Goal Management Training (GMT) has proven to be an efficacious cognitive treatment for these problems. GMT entails learning and applying an algorithm, in which daily tasks are subdivided into multiple steps. Main aim of the present study is to examine whether using an errorless learning approach (preventing the occurrence of errors during the acquisition phase of learning) contributes to the efficacy of Goal Management Training in the performance of complex daily tasks.

Concepts: Time, Psychology, Randomized controlled trial, Effectiveness, Management, Efficacy, Learning, Problem solving

161

The primary aim of the current study was to examine self-criticism as a potential mechanism mediating the relation between mothers' own childhood maltreatment history and changes in subsequent maternal efficacy beliefs in a diverse sample of low-income mothers with and without major depressive disorder. Longitudinal data were drawn from a larger randomized clinical trial evaluating the effectiveness of interpersonal psychotherapy for depression among low-income mothers and their 12-month-old infant. Results indicated that higher levels of maltreatment in childhood led mothers to hold more self-critical judgments in adulthood. Additionally, mothers who had experienced more extensive childhood maltreatment histories perceived themselves as less efficacious in their role as mother. Structural equation modeling indicated that self-criticism mediated the relationship between childhood maltreatment and mothers' decreased perceived competency in her maternal role from when her child was an infant to the more demanding toddler years. Finally, this relationship held over and above the influence of mothers' depressive diagnostic status. Directions for future research and the clinical implications of these findings are discussed.

Concepts: Clinical trial, Randomized controlled trial, Effectiveness, Efficacy, Cognitive behavioral therapy, Major depressive disorder, Dysthymia, Interpersonal psychotherapy