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4. Discussion and conclusions | obese | OBESE | In the present study, we investigated whether near-infrared venous imaging or ultrasound guidance facilitates novices in obtaining difficult peripheral venous access using a simulated vein. The results show that obtaining difficult vascular access with near-infrared venous imaging was faster than when using ultrasound ... | PMC10036034 |
Acknowledgments | The authors thank Ms. Okada (Laboratory assistant, Division of Biological Function Research) for her assistance. | PMC10036034 | ||
References | PMC10036034 | |||
Background | infections | INFECTIONS | The authors have declared that no competing interests exist.Fishing exposes fishermen to schistosomiasis-infested fresh water and concurrently through precarious livelihoods to risky sexual behaviour, rendering these two infections occupational hazards for fishermen. This study aimed to characterize the knowledge of th... | PMC10187898 |
Methods | HIV and schistosomiasis | REGRESSION | Enumeration of all resident fishermen in 45 clusters (fishing communities) was carried out between November 2019 and February 2020. In a baseline survey, fishermen reported their knowledge, attitudes and practices in the uptake of HIV and schistosomiasis services. Knowledge of HIV status and previous receipt of praziqu... | PMC10187898 |
Results | HIV and schistosomiasis | A total of 6,297 fishermen were surveyed from the 45 clusters with harmonic mean number of fishermen per cluster of 112 (95% CI: 97; 134). The mean age was 31.7y (SD: 11.9) and nearly 40% (2,474/6,297) could not read or write. Overall, 1,334/6,293 (21.2%) had never tested for HIV, with 64.4% (3,191/4,956) having tested... | PMC10187898 | |
Conclusion | HIV and schistosomiasis | SCHISTOSOMIASIS | In a setting with an underlying high prevalence of both HIV and schistosomiasis, we found low knowledge of HIV status and low utilization of free schistosomiasis treatment. Among fishermen who accessed HIV services, there was a very high likelihood of taking praziquantel suggesting that integrated service delivery may ... | PMC10187898 |
Trial registration | This trial is registered in the ISRCTN registry: | PMC10187898 | ||
Author summary | schistosomiasis | SCHISTOSOMIASIS | Both HIV and schistosomiasis (bilharzia) remain public health threats especially in fishing communities along the Great Rift Valley in Africa. HIV remains generalized in fishing communities with up to 20% of fishing communities living with HIV. Similarly, although schistosomiasis is | PMC10187898 |
Data Availability | Data is available via the | PMC10187898 | ||
Introduction | HIV and schistosomiasis, HIV and human schistosomiasis, alcoholism | DISEASES, SCHISTOSOMIASIS | HIV and human schistosomiasis prevalence remain unacceptably high along the Great Rift Valley in Africa especially on lakeshores, due in part to complex behavioural patterns including fish-for-sex exchanges, alcoholism, condomless sex and poor access to health services[As well as strong geographical correlation between... | PMC10187898 |
Methods | PMC10187898 | |||
Ethics statement | The FISH CRT is registered in the ISRCTN registry, number ISRCTN14354324 accessible at | PMC10187898 | ||
Study design | This was a cross-sectional baseline survey conducted between November 2019 and February 2020 prior to the implementation of a community cluster-randomized trial (CRT) [ | PMC10187898 | ||
Setting | Preceding the baseline survey we undertook a formative social and physical mapping exercise on the shores of Mangochi, a district in the southeastern region of Malawi which borders Lake Malawi and Mozambique. On the southern lakeshore of Malawi, fishing is predominantly undertaken by men through small boats of up to 10... | PMC10187898 | ||
Participants and procedures | The baseline survey set out to investigate knowledge, attitudes and previous testing and treatment behaviour of fishermen in southern Malawi fishing communities. Within each cluster peer leaders provided a list of fishing boats operating in the cluster as well as a list of fishermen operating in the listed boats. To be... | PMC10187898 | ||
Outcomes | HIV and schistosomiasis, HIV and schistosomiaisis | Three main fisherman-level outcomes were examined in this analysis: proportion reported to have ever tested for HIV; proportion reported having tested for HIV in the last 12 months; and proportion who reported having taken praziquantel in the preceding 12 months. Explanatory variables included: age, literacy; education... | PMC10187898 | |
Statistical methods | The sample size for the survey was determined by the total number of fishermen in the clusters of the CRT. Assuming conservatively that 44% of fishermen had never tested for HIV[Analysis used R version 4.1.3 (R Core Data Team[ | PMC10187898 | ||
Results | A total of 6,297 participants in 45 clusters completed the baseline survey. The harmonic mean cluster size was 112 fishermen (range: 34; 245). Mean age of fishermen was 31.7 (SD: 11.9) years, with married individuals accounting for 3,924 (62.4%) ( | PMC10187898 | ||
Demographic characteristics. | therapyMissing, HIV or schistosomiasis separately or combined. | SCHISTOSOMIASIS | SD: standard deviation; MSCE: Malawi school certificate of education; ART: antiretroviral therapyMissing values, denominator = 6,297: age 3(0.05%); marital status 6 (0.10%); literacy 5 (0.08%); education level 4 (0.06%); tested for HIV before 4 (0.06%); tested for HIV in the last 12 months 4 (0.06%); currently on ART 7... | PMC10187898 |
Unadjusted and adjusted associations with HIV testing in the last 12 months. | aRR: adjusted risk ratio; CI: confidence interval; MSCE: Malawi school certificate of education; ART: antiretroviral therapyrho (The overall harmonic mean prevalence of reported praziquantel use in the last 12 months was 33.9% (95% CI: 30.4%; 38.4%) with notable variation ( | PMC10187898 | ||
Spatial distribution of antiretroviral therapy use, circumcision, and previous praziquantel use among fishermen across study clusters. | PMC10187898 | |||
Unadjusted and adjusted associations with taking schistosomiasis treatment in the last 12 months. | aRR: adjusted risk ratio; CI: confidence interval; MSCE: Malawi school certificate of educationrho (Willingness to attend a beach clinic offering both HIV and schistosomiasis testing was extremely high with 99.0% of indicating they would visit such a clinic (6,224/6297) (The variation in lifetime and recent (within las... | PMC10187898 | ||
Discussion | PMC10187898 | |||
Key results | HIV and schistosomiasis | SCHISTOSOMIASIS | The main findings from this study included low utilization of free HIV services and schistosomiasis treatment (Praziquantel) among a high risk population of fishermen on the shores of Lake Malawi, (indicating that service integration is likely to increase uptake of both services), and extremely high willingness to atte... | PMC10187898 |
Conclusions | HIV and Schistosomiasis, HIV and schistosomiasis | SCHISTOSOMIASIS | In summary, we found that fishermen who accessed HIV services had a high likelihood of having previously taken the schistosomiasis drug praziquantel providing evidence that integrated service delivery may lead to increase coverage. We observed that populations in settings with a high prevalence of both HIV and schistos... | PMC10187898 |
References | PMC10187898 | |||
PURPOSE | cancer | CANCER | Few cancer centers systematically engage patients with evidence-based tobacco treatment despite its positive effect on quality of life and survival. Implementation strategies directed at patients, clinicians, or both may increase tobacco use treatment (TUT) within oncology. | PMC10552951 |
METHODS | cancer | CANCER | We conducted a four-arm cluster-randomized pragmatic trial across 11 clinical sites comparing the effect of strategies informed by behavioral economics on TUT engagement during oncology encounters with cancer patients. We delivered electronic health record (EHR)–based nudges promoting TUT across four nudge conditions: ... | PMC10552951 |
RESULTS | From June 2021 to July 2022, we randomly assigned 246 clinicians in 95 clusters, and collected TUT penetration data from their encounters with 2,146 eligible patients who smoke receiving oncologic care. Intent-to-treat (ITT) analysis showed that the clinician nudge led to a significant increase in TUT penetration versu... | PMC10552951 | ||
CONCLUSION | EHR nudges, informed by behavioral economics and aimed at oncology clinicians, appear to substantially increase TUT penetration. Adding patient nudges to the implementation strategy did not affect TUT penetration rates. | PMC10552951 | ||
INTRODUCTION | cancer | CANCER | Continued tobacco smoking by patients with cancer worsens quality of life (QoL) and reduces survival. | PMC10552951 |
CONTEXT | cancer, non-White | CANCER |
Are nudges informed by behavioral economics during oncology encounters with patients with cancer effective for increasing engagement in tobacco use treatment (TUT)?
Clinician nudges aimed at counteracting omission bias and delivered via the electronic health record resulted in a significant (>3-fold) increase in TUT ... | PMC10552951 |
METHODS | PMC10552951 | |||
Design and Setting | Cancer | CANCER | We conducted a cluster-randomized pragmatic trial across five hospitals and six clinics within Penn Medicine's Abramson Cancer Center. | PMC10552951 |
Participant Eligibility | Diseases-10 cancer | RECRUITMENT | The clinician sample included physicians and advanced practice providers (APPs) within medical, radiation, and gynecologic oncology clinics. Eligibility criteria for clinicians included (1) currently practicing at an included site; (2) prescribing authority in Pennsylvania or New Jersey; (3) cared for ≥1 patient who us... | PMC10552951 |
Study Procedures | Clinician enrollment proceeded in two steps: (1) announcement of study initiation at staff meetings, with opportunity to ask questions about design and impact on workflow, and (2) a personalized email delivered to all eligible clinicians reiterating study methods and providing instructions for opting out. All eligible ... | PMC10552951 | ||
Intervention Content | PMC10552951 | |||
Clinician Nudge
| The findings from our preliminary work examining physician preferences toward TUT revealed a strong preference for interventions perceived as effective. | PMC10552951 | ||
Patient Nudge
| Status quo bias, or sticking with a current choice even if better alternatives exist, can reduce patient willingness to engage in TUT. | PMC10552951 | ||
Usual Care
| Clinicians can refer to TUTS or offer TUT on their own without prompting. Our previous evidence suggests this rarely, if ever, happens. | PMC10552951 | ||
Measures | During preparation for this trial, we identified alternate workflows that clinicians used to provide tobacco use medications without referring patients to the TUT program. | PMC10552951 | ||
Random Assignment | We randomized by clinician clusters identified on the basis of paired connections between physicians and APPs within networks of practice colleagues. Clusters were formed between clinicians with overlapping patient pools to reduce cross-cluster contamination. The clusters were not site-specific as many clinicians worke... | PMC10552951 | ||
Statistical Analysis | REGRESSION, SECONDARY | A sample of 900 patients provided ≥80% power to detect an 11% improvement in our primary outcome (eg, from 34% referral rate for current estimates to a clinically relevant 45%), using a two-sided type 1 error rate of 5% and an interclass correlation of 0.07, for planned comparisons between usual care and each nudge arm... | PMC10552951 | |
RESULTS | PMC10552951 | |||
Sample Characteristics and Covariates | Figure CONSORT diagram. For the assigned to usual care arm, treatment visit = 0 because of the nature of the intervention design. There are no nudges to be delivered. In other words, treatment is completed with the engaged visit, and there are no additional treatment visits. ITT, intent-to-treat.Baseline Demographics o... | PMC10552951 | ||
Models of TUT | All models controlled for variables in Tables Generalized Estimating Equations Predicting TUT EngagementRates of tobacco treatment engagement across treatment arms (ITT model). ITT, intent-to-treat.Tobacco Treatment Engagement Rates by Study Arm, Model, and CovariatesIn both models, clinician type was associated with T... | PMC10552951 | ||
DISCUSSION | cancer | CANCER | Nudges delivered through the EHR are a well-established way to affect clinical behaviors and can have a substantial effect on patient and implementation outcomes.The impact of patient-directed nudges is less well established, and depends on the style of the nudge and the nature of the target problem.When nudges are int... | PMC10552951 |
PRIOR PRESENTATION | Presented in part at the AcademyHealth and NIH's 15th Annual Conference on the Science of Dissemination and Implementation in Health, Washington, DC, December 11-14, 2022. | PMC10552951 | ||
SUPPORT | Cancer | CANCER | Supported by a grant from the National Cancer Institute (P50 CA244690). | PMC10552951 |
CLINICAL TRIAL INFORMATION | PMC10552951 | |||
DATA SHARING STATEMENT | Participant data reported in the article, after deidentification, will be available at the time of publication, along with a data dictionary. A methodologically rigorous proposal to use the data should be provided to the corresponding author, Brian Jenssen ( | PMC10552951 | ||
AUTHORS' DISCLOSURES OF POTENTIAL CONFLICTS OF INTEREST | PMC10552951 | |||
REFERENCES | PMC10552951 | |||
Background: | cirrhosis, HCC | CIRRHOSIS | Surveillance rates for HCC remain limited in patients with cirrhosis. We evaluated whether opt-out mailed outreach increased uptake with or without a $20 unconditional incentive. | PMC10727671 |
Methods: | cirrhosis, fibrosis | CIRRHOSIS, FIBROSIS | This was a pragmatic randomized controlled trial in an urban academic health system including adult patients with cirrhosis or advanced fibrosis, at least 1 visit to a specialty practice in the past 2 years and no surveillance in the last 7 months. Patients were randomized in a 1:2:2 ratio to (1) usual care, (2) a mail... | PMC10727671 |
Results: | Among the 562 patients included, the mean age was 62.1 (SD 11.1); 56.8% were male, 51.1% had Medicare, and 40.6% were Black. At 6 months, 27.6% (95% CI: 19.5–35.7) completed ultrasound in the Usual care arm, 54.5% (95% CI: 47.9–61.0) in the Letter + Order arm, and 54.1% (95% CI: 47.5–60.6) in the Letter + Order + Incen... | PMC10727671 | ||
Conclusions: | HCC | There was an increase in HCC surveillance from mailed outreach with opt-out framing and a signed order slip, but no increase in response to the financial incentive.
| PMC10727671 | |
INTRODUCTION | death, HCC | HEPATOCELLULAR CARCINOMA, LIVER CIRRHOSIS | Hepatocellular carcinoma (HCC) is a leading cause of cancer-related death in the United States, and the vast majority of cases occur in the setting of liver cirrhosis.Behavioral economics is a relatively new discipline that explores how humans have systematic biases that limit participation in prevention, such as inert... | PMC10727671 |
METHODS | PMC10727671 | |||
Study design | fibrosis, liver cirrhosis | FIBROSIS, LIVER CIRRHOSIS | This was a 3-arm randomized controlled trial applying behavioral economic approaches to encourage patients with liver cirrhosis or advanced fibrosis to complete routine surveillance ultrasounds. Eligible patients were randomized in a 1:2:2 ratio into 3 arms: (1) Usual care, (2) Letter + Order, or (3) Letter + Order + I... | PMC10727671 |
Study population | liver cancer, cirrhosis, fibrosis, HCC | LIVER CANCER, CIRRHOSIS, FIBROSIS, METASTATIC CANCER, DISEASE | From our electronic health record (EHR), we identified all patients who were 18 years or older with a current diagnosis of cirrhosis or advanced fibrosis (as defined by the clinician in the EHR), were followed by gastroenterology or hepatology (with one or more visit to any gastroenterology or hepatology practice in th... | PMC10727671 |
Interventions | cirrhosis, HCC, fibrosis | CIRRHOSIS, FIBROSIS | Eligible patients were identified and randomized through a series of 3 batches each approximately 3 months apart in September 2020, January 2021, and April 2021. Patients who were eligible and were not opted out of the intervention by their provider were randomized in a 1:2:2 allocation ratio using a computer-generated... | PMC10727671 |
Study outcomes | cirrhosis, HCC, gastrointestinal clinic | SECONDARY, CIRRHOSIS | The primary outcome was the proportion of patients who completed an abdominal ultrasound within 6 months of initial outreach. The secondary outcome was the proportion of patients who had any HCC imaging within 6 months of initial outreach, including MRI or CT with contrast. Additional outcomes included evaluating diffe... | PMC10727671 |
Statistical analysis | cirrhosis | REGRESSION, CIRRHOSIS | We estimated a 10% base response rate for the usual care arm based on prior studies and outreach programs. Based on a preliminary data review, we estimated that we would be able to identify approximately 600 eligible patients across the 3 batches. This sample size would provide 80% power to detect a 13 percentage point... | PMC10727671 |
Qualitative analysis | HCC | A random subsample of 135 patients from the 2 intervention arms were called to complete a postintervention phone interview at least 6 months after initial outreach was mailed. A group of patients were randomly selected from each of the three batches proportionate to the batch size. The patients were asked about their e... | PMC10727671 | |
RESULTS | PMC10727671 | |||
Participants | comorbidity, cirrhosis, fibrosis | HEMOCHROMATOSIS, CIRRHOSIS, FIBROSIS, PRIMARY BILIARY CIRRHOSIS, PRIMARY SCLEROSING CHOLANGITIS, BUDD-CHIARI SYNDROME | A total of 615 patients were randomized; 53 patients were excluded from analysis postrandomization due to ineligibility (32 were up-to-date on screening, 12 had a future ultrasound scheduled, 5 were on hospice or had a severe comorbidity, 1 did not have a definitive diagnosis of cirrhosis or advanced fibrosis, and 3 ha... | PMC10727671 |
Ultrasound completion | Six months after the initial outreach, 27.6% (95% CI: 19.5–35.7) completed an abdominal ultrasound in the Usual care arm, 54.5% (95% CI: 47.9–61.0) completed an abdominal ultrasound in the Letter + Order arm, and 54.1% (95% CI: 47.5–60.6) completed an abdominal ultrasound in the Letter + Order + Incentive arm. There wa... | PMC10727671 | ||
Any imaging completion | At 6 months after the initial outreach, 59.4% (95% CI: 52.9–65.8) completed any imaging (US, MRI, or CT) in the Letter + Order arm, 57.2% (95% CI: 50.7–63.7) completed any imaging in the Letter + Order + Incentive arm, and 32.8% (95% CI: 24.2–41.3) completed any imaging in the Usual Care arm. There was a significant in... | PMC10727671 | ||
Screening outcomes | HCC, BCLC | A total of 298 patients across arms completed any imaging (US, MRI, or CT) in the 6-month period following the initial outreach. Of those, 14 (4.7%) had abnormal results or required additional follow-up evaluation. Based on medical record review to date, 11 (78.6%) were ordered follow-up imaging, 9 (81.8%) completed fo... | PMC10727671 | |
Subgroup analyses | The subgroup analysis demonstrated a similar response to the interventions across demographic and clinical factors, with no significant interaction terms when accounting for multiple comparisons (Supplemental Figure S1, | PMC10727671 | ||
Qualitative interviews | A total of 135 patients in the intervention arms (opt-out and incentive arms only) were randomly selected to be contacted for a postintervention interview (stratified by batch). Of these, 18 interviews (13.3%) were completed, 37 declined (27.4%), 69 were unreachable (51.1%), and 11 had other issues (8.1%). Of the 5 tha... | PMC10727671 | ||
DISCUSSION | cancers, colorectal cancer, HCC | CANCERS, HEPATITIS C, COLORECTAL CANCER, LIVER DISEASE | In this study, we found that mailed outreach with opt-out framing and a signed preorder doubles the participation in HCC surveillance. However, there was no additional effect due to the $20 unconditional financial incentive when added to the mailed outreach intervention. Importantly, we did not find differential effect... | PMC10727671 |
Supplementary Material | PMC10727671 | |||
SUPPLEMENTARY MATERIAL | PMC10727671 | |||
FUNDING INFORMATION | Cancer | CANCER | This trial was funded as a UPenn P30 Roybal Center Pilot Project from the National Institute of Aging (5P30AG03456-10). Dr Shivan J. Mehta’s time was supported by grant number K08CA234326 from the National Cancer Institute. The funders had no role in the design, conduct, or analysis of the study. | PMC10727671 |
CONFLICTS OF INTEREST | Dr Shivan J. Mehta has received compensation from Guardant Health and the American Gastroenterological Association. Dr Tessa S. Cook is on the speakers’ bureau for Spectra. The remaining authors have no conflicts to report.
Supplemental Digital Content is available for this article. Direct URL citations are provided in... | PMC10727671 | ||
REFERENCES | PMC10727671 | |||
Abstract | Psoriasis, psoriasis | GENERALIZED PUSTULAR PSORIASIS, ERYTHRODERMIC PSORIASIS, PSORIASIS, PSORIASIS | Risankizumab, a humanized immunoglobin G1 monoclonal antibody that specifically inhibits interleukin 23 by binding to its p19 subunit, is approved in Japan to treat numerous indications, including generalized pustular psoriasis (GPP) and erythrodermic psoriasis (EP). Both GPP and EP are severe forms of psoriasis that h... | PMC10107196 |
INTRODUCTION | multisystem disorder, psoriasis | ERYTHRODERMIC PSORIASIS, GENERALIZED PUSTULAR PSORIASIS, PSORIASIS, STERILE, PSORIATIC ARTHRITIS, PLAQUE PSORIASIS | Generalized pustular psoriasis (GPP) and erythrodermic psoriasis (EP) are severe and rare forms of psoriasis. In patients with GPP, numerous tiny, sterile pustules cover the entire body and may cause a fatal multisystem disorder.Risankizumab, a humanized immunoglobin G1 monoclonal antibody that specifically inhibits in... | PMC10107196 |
METHODS | PMC10107196 | |||
Patients | erythema | ACTIVE TUBERCULOSIS, ACUTE INFECTIONS, ERYTHEMA, VIRAL HEPATITIS, INFLAMMATORY DISEASE | Eligible patients were aged 20 years or older and diagnosed with GPP or EP. Patients with GPP were diagnosed at least 60 days before informed consent was obtained, based on the Japanese Dermatological Association (JDA) criteria, and had an erythema area with pustules accounting for ≥10% of their body surface area and a... | PMC10107196 |
Study design and treatment | Psoriasis | PSORIASIS | IMMspire (A Study to Assess Efficacy and Safety of Two Different Dose Regimens of Risankizumab Administered Subcutaneously in Japanese Subjects With Generalized Pustular Psoriasis or Erythrodermic Psoriasis) (NCT03022045) was a phase 3, randomized, open‐label, parallel‐design study that compared two different doses of ... | PMC10107196 |
Assessments | PMC10107196 | |||
Efficacy | Psoriasis | PSORIASIS | The primary end point was the proportion of patients achieving clinical response at week 16. Clinical response was defined as “slightly improved” in the overall improvement rating from baseline according to the JDA total score for patients with GPP and as at least “minimally improved” in the Clinical Global Impression‐... | PMC10107196 |
Safety | Laboratory abnormalities, Cancer | ADVERSE EVENTS, ADVERSE EVENT, CANCER | Evaluation of safety included monitoring of adverse events (AEs), serious AEs (SAEs), changes in vital signs and clinical laboratory tests, and local tolerability. Laboratory abnormalities were classified by the National Cancer Institute Common Terminology Criteria for Adverse Events. | PMC10107196 |
Statistical analysis | The sample size was not powered for any hypothesis testing because of the limited number of enrolled patients; thus, the sample size was determined based on feasibility. All efficacy and safety analyses were conducted for the intent‐to‐treat population (all randomized patients who received one or more dose of the study... | PMC10107196 | ||
RESULTS | PMC10107196 | |||
Patients | Pustular Psoriasis, PGA‐GPP, Psoriasis, tumor necrosis | ERYTHRODERMIC PSORIASIS, TUMOR NECROSIS, PSORIASIS, DISEASE, GENERALIZED PUSTULAR PSORIASIS | A total of 17 patients, including eight patients with GPP and nine patients with EP, were enrolled and 10 (58.8%) patients completed the study Patient disposition. Baseline demographics and disease characteristicsAbbreviations: BMI, body mass index; BSA, body surface area; DLQI 0/1, Dermatology Life Quality Index of 0 ... | PMC10107196 |
Efficacy | PMC10107196 | |||
Patients with | Psoriasis | GENERALIZED PUSTULAR PSORIASIS, ERYTHRODERMIC PSORIASIS, PSORIASIS | All patients with GPP achieved the primary end point of clinical response at week 16 with risankizumab treatment, regardless of dose (Table Efficacy of risankizumab in Japanese patients with GPP or EPAbbreviations: CI, confidence interval; DLQI 0/1, Dermatology Life Quality Index of 0 or 1 (no effect); PASI 90; ≥90% re... | PMC10107196 |
Patients with | Similarly, all patients with EP achieved the primary end point of clinical response with risankizumab treatment, regardless of dose (Table | PMC10107196 | ||
Safety | hypoadrenalism, death, deterioration of hepatic function, ischemic heart failure, kidney calculus, pain, rash, Alcoholic liver disorder, scirrhous gastric cancer | DISORDER, HYPOADRENALISM, ERYTHRODERMIC PSORIASIS, ADVERSE EVENTS, INFLAMMATION, URINARY CALCULUS, ADVERSE EVENT, GENERALIZED PUSTULAR PSORIASIS, ALCOHOLIC LIVER DISORDER, URINARY TRACT INFECTION | Treatment‐emergent AEs were reported for most (88.2%) patients (Table Safety overview of risankizumab in Japanese patients with GPP or EPAbbreviations: AE, adverse event; EP, erythrodermic psoriasis; GPP, generalized pustular psoriasis; TEAE, treatment‐emergent adverse event.As assessed by the study investigator.Patien... | PMC10107196 |
DISCUSSION | psoriasis | PSORIASIS | Results from IMMspire demonstrated clinically meaningful efficacy with risankizumab, regardless of dose (75 or 150 mg); all patients achieved the primary end points of clinical response at week 16. Most patients achieved skin clearance assessed by PASI 90 at week 16. In addition, most of the patients who received risan... | PMC10107196 |
CONFLICT OF INTEREST | SKIN | AbbVie participated in the study design; study research; collection, analysis, and interpretation of data; and writing, reviewing, and approving this manuscript for publication. All authors had access to the data, participated in the development and review of the document, and agreed in the decision to submit this manu... | PMC10107196 | |
ACKNOWLEDGMENTS | AbbVie and the authors thank all of the study investigators for their contributions and the patients who participated in this study. All authors had access to the data and participated in the development, review, critique, and approval of the manuscript throughout the editorial process, and approved the final manuscrip... | PMC10107196 | ||
REFERENCES | PMC10107196 | |||
Background | Creatine is an organic compound that facilitates the recycling of energy-providing adenosine triphosphate (ATP) in muscle and brain tissue. It is a safe, well-studied supplement for strength training. Previous studies have shown that supplementation increases brain creatine levels, which might increase cognitive perfor... | PMC10647179 | ||
Methods | Our trial was preregistered, cross-over, double-blind, placebo-controlled, and randomised, with daily supplementation of 5 g for 6 weeks each. We tested participants on Raven’s Advanced Progressive Matrices (RAPM) and on the Backward Digit Span (BDS). In addition, we included eight exploratory cognitive tests. About ha... | PMC10647179 |
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