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11.
Mia L. van der Kop Sarah Karanja Lehana Thabane Carlo Marra Michael H. Chung Lawrence Gelmon Joshua Kimani Richard T. Lester 《PloS one》2012,7(9)
Background
The WelTel Kenya1 trial demonstrated that text message support improved adherence to antiretroviral therapy (ART) and suppression of HIV-1 RNA load. The intervention involved sending weekly messages to patients inquiring how they were doing; participants were required to respond either that they were well or that there was a problem.Objectives
1) Describe problems participants identified through mobile phone support and reasons why participants did not respond to the messages; 2) investigate factors associated with indicating a problem and not responding; and 3) examine participant perceptions of the intervention.Design
Secondary analysis of WelTel Kenya1 trial data.Methods
Reasons participants indicated a problem or did not respond were extracted from the study log. Negative binomial regression was used to determine participant characteristics associated with indicating a problem and non-response. Data from follow-up questionnaires were used to describe participant perceptions of the intervention.Results
Between 2007 and 2009, 271 participants generated 11,873 responses; 377 of which indicated a problem. Health issues were the primary reason for problem responses (72%). Rural residence (adjusted incidence rate ratio [IRR] 1.96; 95%CI 1.19–3.25; p = 0.009 and age were associated with indicating a problem (adjusted IRR 0.63 per increase in age group category; 95%CI 0.50–0.80; p<0.001). Higher educational level was associated with a decreased rate of non-response (adjusted IRR 0.81; 95%CI 0.69–0.94; p = 0.005). Of participants interviewed, 62% (n = 129) stated there were no barriers to the intervention; cell phone issues were the most common barrier. Benefits included reminding patients to take medication and promoting a feeling that “someone cares”.Conclusions
The WelTel intervention enabled frequent communication between clinicians and patients during the WelTel Kenya1 trial. Many patients valued the service for the support it provided, with health-related concerns comprising the majority of problems identified by participants. Few sociodemographic characteristics were associated with participant engagement in the intervention. 相似文献12.
Anna M. Sawka Nofisat Ismaila Ann Cranney Lehana Thabane Monika Kastner Amiram Gafni Linda J. Woodhouse Richard Crilly Angela M. Cheung Jonathan D. Adachi Robert G. Josse Alexandra Papaioannou 《PloS one》2010,5(3)
Background
Elderly nursing home residents are at increased risk of hip fracture; however, the efficacy of fracture prevention strategies in this population is unclear.Objective
We performed a scoping review of randomized controlled trials of interventions tested in the long-term care (LTC) setting, examining hip fracture outcomes.Methods
We searched for citations in 6 respective electronic searches, supplemented by hand searches. Two reviewers independently reviewed all citations and full-text papers; consensus was achieved on final inclusion. Data was abstracted in duplicate.Findings
We reviewed 22,349 abstracts or citations and 949 full-text papers. Data from 20 trials were included: 7 - vitamin D (n = 12,875 participants), 2 - sunlight exposure (n = 522), 1 - alendronate (n = 327), 1 - fluoride (n = 460), 4 – exercise or multimodal interventions (n = 8,165), and 5 - hip protectors (n = 2,594). Vitamin D, particularly vitamin D3 ≥800 IU orally daily, reduced hip fracture risk. Hip protectors reduced hip fractures in included studies, although a recent large study not meeting inclusion criteria was negative. Fluoride and sunlight exposure did not significantly reduce hip fractures. Falls were reduced in three studies of exercise or multimodal interventions, with one study suggesting reduced hip fractures in a secondary analysis. A staff education and risk assessment strategy did not significantly reduce falls or hip fractures. In a study underpowered for fracture outcomes, alendronate did not significantly reduce hip fractures in LTC.Conclusions
The intervention with the strongest evidence for reduction of hip fractures in LTC is Vitamin D supplementation; more research on other interventions is needed. 相似文献13.
Lehana M 《Biotechnology and bioengineering》1990,36(2):198-206
The energy of the total transmitted light was subtracted from that of the incident light in a culture vessel and the difference was divided by the weight of cells. The value thus obtained was defined as the amount, E(x), of light energy absorbed per unit cell weight per unit time.Batch and continuous cultures of Chlorella vulgaris were carried out at 30 degrees C in the pH range of 6.4-6.7 while restricting illumination. Next the specific growth rate, mu, in the batch culture and the fixed dilution rate, D, in the continuous culture were plotted against E(x). The results showed that the relation between D and E(x) can be expressed in a Michaelis-Menten equation, where the maximal specific growth rate is 0.24 h (-1) and the saturation constant is 6.58 kcal/g . h.Cell concentration calculated by substituting the apparent concentration, X(e), of incubated cells and the apparent maintenance constant, M(e), for this equation agreed with that observed in almost all growth phases. Furthermore, from the change of chlorophyll productivity and the relationship between D and E(x) expressed in this equation, it is assumed that E(x) involves the light energy directly utilized in photosynthesis in the cells and that which is converted into, e.g., heat. This equation also indicated that a maximum in the growth yield existed. Then the growth yield of 0.029 g/kcal obtained at the incident light of 1.46 or 2.63 cal/cm(2) . h was maximum (maximal conversion efficiency of light energy, 15.6%).These results indicate that this method of deriving the equation for the growth rate from this study is a useful procedure for obtaining bioengineering findings. 相似文献
14.
Conventional methods for sample size calculation for population-based longitudinal studies tend to overestimate the statistical power by overlooking important determinants of the required sample size, such as the measurement errors and unmeasured etiological determinants, etc. In contrast, a simulation-based sample size calculation, if designed properly, allows these determinants to be taken into account and offers flexibility in accommodating complex study design features. The Canadian Longitudinal Study on Aging (CLSA) is a Canada-wide, 20-year follow-up study of 30,000 people between the ages of 45 and 85 years, with in-depth information collected every 3 years. A simulation study, based on an illness-death model, was conducted to: (1) investigate the statistical power profile of the CLSA to detect the effect of environmental and genetic risk factors, and their interaction on age-related chronic diseases; and (2) explore the design alternatives and implementation strategies for increasing the statistical power of population-based longitudinal studies in general. The results showed that the statistical power to identify the effect of environmental and genetic risk exposures, and their interaction on a disease was boosted when: (1) the prevalence of the risk exposures increased; (2) the disease of interest is relatively common in the population; and (3) risk exposures were measured accurately. In addition, the frequency of data collection every three years in the CLSA led to a slightly lower statistical power compared to the design assuming that participants underwent health monitoring continuously. The CLSA had sufficient power to detect a small (1<hazard ratio (HR)≤1.5) or moderate effect (1.5< HR≤2.0) of the environmental risk exposure, as long as the risk exposure and the disease of interest were not rare. It had enough power to detect a moderate or large (2.0<HR≤3.0) effect of the genetic risk exposure when the prevalence of the risk exposure was not very low (≥0.1) and the disease of interest was not rare (such as diabetes and dementia). The CLSA had enough power to detect a large effect of the gene-environment interaction only when both risk exposures had relatively high prevalence (0.2) and the disease of interest was very common (such as diabetes). The minimum detectable hazard ratios (MDHR) of the CLSA for the environmental and genetic risk exposures obtained from this simulation study were larger than those calculated according to the conventional sample size calculation method. For example, the MDHR for the environmental risk exposure was 1.15 according to the conventional method if the prevalence of the risk exposure was 0.1 and the disease of interest was dementia. In contrast, the MDHR was 1.61 if the same exposure was measured every 3 years with a misclassification rate of 0.1 according to this simulation study. With a given sample size, higher statistical power could be achieved by increasing the measuring frequency in participants with high risk of declining health status or changing risk exposures, and by increasing measurement accuracy of diseases and risk exposures. A properly designed simulation-based sample size calculation is superior to conventional methods when rigorous sample size calculation is necessary. 相似文献
15.
Ian W. Rodger Dorothy Dilar Janet Dwyer John Bienenstock Andu Coret Judith Coret-Simon Gary Foster Arlene Franchetto Slobodan Franic Charles H. Goldsmith David Koff Norman B. Konyer Mitchell Levine Ellen McDonald Michael D. Noseworthy John Paulseth Luciana Ribeiro Mary Jane Sayles Lehana Thabane 《PloS one》2013,8(8)
Objective
Multiple sclerosis (MS) is a chronic neurodegenerative disease of the CNS. Recently a controversial vascular hypothesis for MS, termed chronic cerebrospinal venous insufficiency (CCSVI), has been advanced. The objective of this study was to evaluate the relative prevalence of the venous abnormalities that define CCSVI.Methods
A case-control study was conducted in which 100 MS patients aged between 18–65 y meeting the revised McDonald criteria were randomly selected and stratified into one of four MS subtypes: relapsing/remitting, secondary progressive, primary progressive and benign. Control subjects (16–70 y) with no known history of MS or other neurological condition were matched with the MS cases. All cases and controls underwent ultrasound imaging of the veins of the neck plus the deep cerebral veins, and magnetic resonance imaging of the neck veins and brain. These procedures were performed on each participant on the same day.Results
On ultrasound we found no evidence of reflux, stenosis or blockage in the internal jugular veins (IJV) or vertebral veins (VV) in any study participant. Similarly, there was no evidence of either reflux or cessation of flow in the deep cerebral veins in any subject. Flow was detected in the IJV and VV in all study participants. Amongst 199 participants there was one MS subject who fulfilled the minimum two ultrasound criteria for CCSVI. Using MRI we found no significant differences in either the intra- or extra-cranial venous flow velocity or venous architecture between cases and controls.Conclusion
This case-control study provides compelling evidence against the involvement of CCSVI in multiple sclerosis. 相似文献16.
17.
K Thorlund G Imberger BC Johnston M Walsh T Awad L Thabane C Gluud PJ Devereaux J Wetterslev 《PloS one》2012,7(7):e39471
Background
Assessment of heterogeneity is essential in systematic reviews and meta-analyses of clinical trials. The most commonly used heterogeneity measure, I2, provides an estimate of the proportion of variability in a meta-analysis that is explained by differences between the included trials rather than by sampling error. Recent studies have raised concerns about the reliability of I2 estimates, due to their dependence on the precision of included trials and time-dependent biases. Authors have also advocated use of 95% confidence intervals (CIs) to express the uncertainty associated with I2 estimates. However, no previous studies have explored how many trials and events are required to ensure stable and reliable I2 estimates, or how 95% CIs perform as evidence accumulates.Methodology/Principal Findings
To assess the stability and reliability of I2 estimates and their 95% CIs, in relation to the cumulative number of trials and events in meta-analysis, we looked at 16 large Cochrane meta-analyses - each including a sufficient number of trials and events to reliably estimate I2 - and monitored the I2 estimates and their 95% CIs for each year of publication. In 10 of the 16 meta-analyses, the I2 estimates fluctuated more than 40% over time. The median number of events and trials required before the cumulative I2 estimates stayed within +/−20% of the final I2 estimate was 467 and 11. No major fluctuations were observed after 500 events and 14 trials. The 95% confidence intervals provided good coverage over time.Conclusions/Significance
I2 estimates need to be interpreted with caution when the meta-analysis only includes a limited number of events or trials. Confidence intervals for I2 estimates provide good coverage as evidence accumulates, and are thus valuable for reflecting the uncertainty associated with estimating I2. 相似文献18.
Vincent G DePaul Laurie R Wishart Julie Richardson Timothy D Lee Lehana Thabane 《BMC neurology》2011,11(1):129
Background
Although task-oriented training has been shown to improve walking outcomes after stroke, it is not yet clear whether one task-oriented approach is superior to another. The purpose of this study is to compare the effectiveness of the Motor Learning Walking Program (MLWP), a varied overground walking task program consistent with key motor learning principles, to body-weight-supported treadmill training (BWSTT) in community-dwelling, ambulatory, adults within 1 year of stroke. 相似文献19.
When the individual outcomes within a composite outcome appear to have different treatment effects, either in magnitude or direction, researchers may question the validity or appropriateness of using this composite outcome as a basis for measuring overall treatment effect in a randomized controlled trial. The question remains as to how to distinguish random variation in estimated treatment effects from important heterogeneity within a composite outcome. This paper suggests there may be some utility in directly testing the assumption of homogeneity of treatment effect across the individual outcomes within a composite outcome. We describe a treatment heterogeneity test for composite outcomes based on a class of models used for the analysis of correlated data arising from the measurement of multiple outcomes for the same individuals. Such a test may be useful in planning a trial with a primary composite outcome and at trial end with final analysis and presentation. We demonstrate how to determine the statistical power to detect composite outcome treatment heterogeneity using the POISE Trial data. Then we describe how this test may be incorporated into a presentation of trial results with composite outcomes. We conclude that it may be informative for trialists to assess the consistency of treatment effects across the individual outcomes within a composite outcome using a formalized methodology and the suggested test represents one option. 相似文献
20.
Amro Qaddoura Payam Yazdan-Ashoori Conrad Kabali Lehana Thabane R. Brian Haynes Stuart J. Connolly Harriette Gillian Christine Van Spall 《PloS one》2015,10(6)