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Demographic and clinical characters of active and sham MM groups.
LATERAL EPICONDYLITIS
MM–Mill’s manipulation, y–year, m–meter, kg–kilogram, LE–Lateral epicondylitis, m–months.
PMC9925075
Pre and post primary and secondary outcome measures of active and sham MM groups.
Depression, Anxiety
TENNIS ELBOW
*Significant, MM–Mill’s manipulationVAS–Visual analog scale, MRI–Magnetic resonance imaging, PRTEE—Patient-rated Tennis Elbow Evaluation, kg–Kilogram, GPI–Global perceived improvement, TSK–AV—The Tampa Scale for Kinesiophobia–adjusted version, HADS—Hospital Anxiety and Depression Scale, EuroQol EQ-5D –European quality ...
PMC9925075
3.2 Compliance with the study protocol
All registered outcome measures are reported in this manuscript. There was minimal loss to follow-up, as presented in
PMC9925075
3.3 Effects of the intervention
PMC9925075
3.3.1 Primary and secondary outcomes
Functional disability, pain
The time and group (4 × 2) linear mixed model (LMM) of primary variable (pain intensity—VAS) reports statistically significant difference (p<0.001) between active and sham groups at baseline, 4 weeks, 8 weeks and at 6 months follow up. The post intervention at 4 weeks 1.6 (CI 95% 0.97 to 2.22) shows improvement in the ...
PMC9925075
Pre and post primary outcome measures of active and sham MM groups.
depression
SECONDARY
The time and group (4 × 2) linear mixed model (LMM) of all the other variables (patient perception, kinesiophobia, depression and quality of life) reports statistically significant difference (p = 0.001) between active and sham groups at baseline, 4 weeks, 8 weeks and at 6 months follow up. The post intervention at 4 w...
PMC9925075
Pre and post-secondary outcome measures of active and sham ESWT groups.
PMC9925075
Pre and post mean difference and confidence interval (upper limit and lower limit) of primary and secondary outcome scores of active and sham MM groups.
PMC9925075
3.4 Adverse events with the study intervention
ADVERSE REACTIONS
There was no adverse reactions or side effects noted in both the experimental and control groups during and after the corticosteroid injection and joint manipulation treatment.
PMC9925075
4. Discussion
abnormal motion or compensation, pain
SECONDARY
Participants in the active group showed significant improvement compared to the sham group at various intervals in all the outcome measures. Sham group also showed a statistically significant improvement over time across the primary and secondary outcomes. A study by Olaussen M et al, observed that corticosteroid (CS) ...
PMC9925075
4.1 Strengths and weaknesses
Type-1 errors
We used 8 weeks and 6 months’ follow-up with several outcomes to register the development of improvement after different interventions. The clinical setting and the choice of ordinary, well known physiotherapeutic approach ensured the external validity. This study strictly adhered to the CONSORT guidelines for randomiz...
PMC9925075
5. Conclusion
depression, pain
Corticosteroid injection with deep transverse friction massage and Mill’s manipulation is effective in terms of reducing pain, improving tissue healing, functional disability, handgrip strength, patient perception, kinesiophobia and depression status and, health related quality of life in people with lateral epicondyla...
PMC9925075
Supporting information
PMC9925075
CONSORT 2010 checklist of information to include when reporting a randomised trial*.
(RTF)Click here for additional data file.(XLSX)Click here for additional data file.(DOCX)Click here for additional data file.
PMC9925075
References
PMC9925075
Background:
COPD
COPD
COPD causes high morbidity and mortality, emphasizing the need for palliative care.
PMC10227092
Aim:
COPD
COPD
To assess the effectiveness of palliative care in patients with COPD.
PMC10227092
Design:
depression, death, COPD, anxiety
COPD
Cluster randomized controlled trial (COMPASSION study; Netherlands Trial Register (NTR): NL7644, 07-04-2019). Healthcare providers within the intervention group were trained to implement palliative care components into routine COPD care. Patients completed questionnaires at baseline, after 3 and 6 months; medical recor...
PMC10227092
Setting:
Eight hospital regions in the Netherlands.
PMC10227092
Participants:
ACUTE EXACERBATION OF COPD
Patients hospitalized for an acute exacerbation of COPD and positive ProPal-COPD score.
PMC10227092
Results:
COPD
COPD
Of 222 patients included, 106 responded to the questionnaire at 6 months. Thirty-six of 98 intervention patients (36.7%) received the intervention. Intention-to-treat-analysis showed no effect on the primary outcome (adjusted difference: 1.09; 95% confidence interval: −5.44 to 7.60). In the intervention group, fewer in...
PMC10227092
Conclusions:
organ failure, COPD
COPD, SECONDARY
We found no evidence that palliative care improves quality of life in patients with COPD. However, it can potentially reduce acute healthcare use. The consequences of the COVID-19 pandemic led to suboptimal implementation and insufficient power, and may have affected some of our findings. Patients in advanced stages of...
PMC10227092
Introduction
cancer, death, COPD, deaths
COPD, SECONDARY, CANCER, CHRONIC OBSTRUCTIVE PULMONARY DISEASE
Chronic obstructive pulmonary disease (COPD) causes considerable morbidity and is the third leading cause of death worldwide.In patients with cancer, quality of life can be improved and healthcare use reduced by timely initiation of palliative care.In a recent systematic review, only 4 out of 20 palliative care interve...
PMC10227092
Methods
PMC10227092
Design
A cluster randomized controlled trial was performed. A detailed study protocol has been published previously.
PMC10227092
Setting
This study took place in pulmonary care departments of eight hospitals in the Netherlands, that collaborated with affiliated general practitioners, primary care nurses and palliative care consultation teams, further referred to as ‘hospital regions’ or ‘clusters’.
PMC10227092
Randomization
Hospital regions were randomized to the intervention or control condition (four clusters in each group) by an independent statistician, stratified by the number of COPD-related hospital admissions per year.
PMC10227092
Intervention
An integrated palliative care intervention was developed following national guidelines, literature and stakeholders’ input and comprised (1) palliative care conversations tailored to the patient’s needs, (2) care coordination and continuity and (3) aftercare if a patient had died (Description of the implementation stra...
PMC10227092
Participants
MAY
Between May 2019 and August 2020, patients admitted to the hospital for an acute exacerbation were invited by a pulmonologist or nurse to participate and subsequently screened with the ProPal-COPD tool (see ProPal-COPD tool.Inclusion and exclusion criteria of study participants.
PMC10227092
Blinding
Complete blinding of participants for group allocation was impossible, but patients were not explicitly told whether their hospital was assigned to the intervention or control group. Further, healthcare providers of control regions were blinded for the ProPal-COPD score (whether positive and thus needing palliative car...
PMC10227092
Data collection
death, COPD
COPD
Demographics and patient-reported outcome measures were collected using a questionnaire at three time points. At baseline, patients completed a paper questionnaire during hospitalization. After 3 and 6 months, a follow-up questionnaire was sent to the patient’s home or email, depending on the patient’s preference. Pati...
PMC10227092
Outcome measures
The primary outcome was quality of life measured with the validated 46-item Functional Assessment of Chronic Illness Therapy-Palliative care (FACIT-Pal) scale.
PMC10227092
Data analyses
Data cleaning and descriptive statistics were performed using SPSS, version 25, and outcome analyses were conducted using R software, version 3.6.2. We calculated that 347 participants were required to find an effect of minimum nine points at the primary outcome with an assumed standard deviation of 25, taking clusteri...
PMC10227092
Ethics approval and consent
All participants received oral and written study information and gave written informed consent. Ethical approval was granted by the Medical Ethics Committee of Arnhem-Nijmegen (file number 2018-4833) on 15 October 2018.
PMC10227092
Results
PMC10227092
Participant characteristics
COPD
MAY, COPD
Between May 2019 and August 2020, 735 patients admitted to the hospital for an acute exacerbation COPD were screened for eligibility (Flow diagram of inclusion of participants and response rates of questionnaires at baseline (T0), after 3 months (T3) and 6 months (T6).Demographic- and clinical characteristics of partic...
PMC10227092
Intervention delivery
In the intervention group, an outpatient palliative care conversation occurred in 36 of 98 patients within 6 months after inclusion (36.7%). In eight patients, a conversation took place later than after 6 months. Reasons for no outpatient palliative care conversation were: transferral to a different care setting (prima...
PMC10227092
Discussion
PMC10227092
Main findings
COPD
COPD, SENSITIVITY
In this cluster randomized controlled trial, we assessed the effectiveness of palliative care components integrated into regular COPD care. We found no effects on quality of life nor other patient-reported outcome measures. However, intervention patients were less frequently admitted to the ICU than control patients, a...
PMC10227092
Interpretation of findings
organ failure, COPD
COPD, RECRUITMENT, DISEASE COURSE
Similar to our study, a recent systematic review found no effect of palliative care interventions on the quality of life of patients with COPD; effects on acute healthcare use were inconclusive.Our findings could be explained in several ways. First, we did not reach sufficient statistical power to detect effects on the...
PMC10227092
Strengths and limitations
death, COPD
COPD
This study is the first large randomized controlled trial assessing the effectiveness of palliative care integrated into regular COPD care. As part of a hybrid type 2 effectiveness-implementation study,However, our study also has limitations. Next to insufficient study power, we had a high rate of missing data due to t...
PMC10227092
Conclusions
COPD
COPD, DISEASE
The effect of integrated palliative care on clinical outcomes in patients with COPD remains inconclusive. We found no evidence that palliative care improves quality of life in patients with COPD, but it can potentially reduce ICU admissions. Better implementation of palliative care components is needed to enhance relia...
PMC10227092
Supplemental Material
PMC10227092
References
PMC10227092
Supplementary Information
depression, anxiety
The aim of the present research was to develop and test the efficacy of a novel online contingent attention training (i.e., OCAT) to modify attention and interpretation biases, improve emotion regulation, and reduce emotional symptom levels in the face of major stressors. Two proof-of-principle studies were carried out...
PMC10166036
Keywords
PMC10166036
Significance statement
depression, anxiety
DISORDERS
Cognitive biases (e.g., attention and interpretation biases) are conceptualized as central mechanisms for the onset and maintenance of emotional disorders such as depression and anxiety. Cognitive models have posited that these biases emerge under stressful situations, impairing peoples’ ability to regulate negative em...
PMC10166036
General introduction
depression, Depression, ABM, anxiety
DISORDERS
Depression and anxiety disorders are highly prevalent worldwide (Steel et al., Importantly, novel approaches conveying the use of precise knowledge on neurocognitive mechanisms of stress and emotional dysfunctions have been developed in recent years (see, for instance, Goodwin et al., These attentional and interpretati...
PMC10166036
Study 1. Effectiveness of OCAT to target cognitive biases, emotion regulation and psychological symptoms during a stressful exam period in undergraduate students
The main aim of this first study was to validate the new OCAT variant and analyze its efficacy as a 10-session online protocol to modify both attention and interpretation biases and transfer to improvements in the use of emotion regulation strategies and/or emotional symptomatology. Following previous research (Sanchez...
PMC10166036
Method
PMC10166036
Participants
Sixty-four undergraduate students took part in the study in exchange for course credits. All participants were recruited three-weeks before they began their final examination period and they were then randomly allocated to start the active OCAT or the control sham-training group in the same time period (i.e., within th...
PMC10166036
General procedure
As depicted in Fig. 
PMC10166036
Data analysis plan
Prior to the analysis, normality and homoscedasticityFinally, exploratory analyses were conducted to test the influence of cognitive bias changes as a response of cognitive training to account for training effects in transfer psychological measures (see Sanchez et al.,
PMC10166036
Results
PMC10166036
Exploratory analyses of relations between in-training cognitive and symptom changes
’ depression
Analyses showed that larger decreases in the time attending to negative words were significantly related to larger decreases in participants’ depression levels from pre- to post-training (
PMC10166036
Interim discussion
depressive, anxiety
The aim of this first pilot study was to analyze the efficacy of OCAT on targeting attention and interpretation biases as well as its transfer effects to emotion regulation and emotional symptom levels in an unselected sample of undergraduate students who were about to confront a naturalistic stressor (i.e., beginning ...
PMC10166036
Study 2. Validation and effectiveness of OCAT to target cognitive biases, emotion regulation and psychological symptoms during COVID-19 lockdown in a community sample
depression, anxiety
The beginning of COVID-19 pandemic comprised a significant major stressor for the general population, resulting in increased rates of depression and anxiety (Shevlin et al.,
PMC10166036
Method
PMC10166036
Participants
Fifty-eight participants took part in the study voluntarily. They were recruited by advertising on social media and social networks. As in Study 1, participants were randomly allocated to the active OCAT and the control sham-training group through a simple randomization procedure. Six participants of the active OCAT gr...
PMC10166036
General procedure
post-training cognitive bias
MINOR, RECRUITMENT
The general procedure was identical to study 1, except for the following minor differences. Due to the COVID-19 lockdown restrictions, participants were contacted through advertising in social media and social networks, and the entire procedure was conducted online. Thus, after participants were randomized to the OCAT ...
PMC10166036
Experimental task and materials
Experimental task and materials were the same as in study 1.
PMC10166036
Attention and interpretation dependent variables
Attention and interpretation were assessed in the same manner as in study 1. Further, reliability analyses were conducted on the measures in the current study. As in study 1, the results showed excellent internal consistencies of both attention and interpretation bias measures at Time 1 and Time 2 (see Table Internal c...
PMC10166036
Psychological measures
depression, anxiety
Given the null finding for reappraisal transfer in study 1, reappraisal was assessed using a different reappraisal measure, the reappraisal subscale of the Emotion Regulation Questionnaire (ERQ—Gross & John, The rest of the self-reported variables (i.e., depression, anxiety, and brooding rumination) were assessed using...
PMC10166036
Data analysis plan
The data analysis plan followed in the present study was identical to the one used in the study 1.
PMC10166036
Results
PMC10166036
Effects of the OCAT on cognitive bias measures
PMC10166036
Interim discussion
anxiety
Previous research has shown that attention and interpretation biases play a major role in psychological adjustment during COVID-19 lockdown (Blanco et al., Following the results of Study 1, we also hypothesized that training-related improvements in attention and interpretation biases would transfer to improved ruminati...
PMC10166036
General discussion
depression, anxiety
MACLEOD
Cognitive processing (e.g., attention and interpretation) of emotional information have been postulated as crucial variables implicated in the onset and maintenance of diverse forms of psychopathology such as depression and anxiety (Mathews & MacLeod, Overall, the results of both studies show that the OCAT app is effec...
PMC10166036
Acknowledgements
We thank Ricardo Rey and Angela Socastro for their collaboration during the sample recollection of both studies.
PMC10166036
Author contributions
TB
IB: conceptualization, methodology, formal analysis, investigation, data curation, writing—original draft preparation; OM-G: methodology, investigation, data curation, writing—review & editing; TB: investigation, data curation, writing—review & editing. EHWK: supervision, writing—review & editing; RDR: supervision, wri...
PMC10166036
Funding
This work was supported by a grant of the Program for the Attraction of Scientific Talent of the Community of Madrid (Spain), reference 2017-T1/SOC-5359, and grants of the Spanish Ministry of Science, Program “Generation of Knowledge” ref. PGC2018-095723-A-I00; and ref. PID2021-127480NB-I00, awarded to the last author....
PMC10166036
Availability of data and materials
The datasets used and/or analyzed during the current study are available from the corresponding author on reasonable request.
PMC10166036
Declarations
PMC10166036
Ethics approval and consent to participate
These studies was approved by the Complutense University Ethical Committee. All participants signed a consent form prior to their participation on the studies.
PMC10166036
Consent for publication
Not applicable.
PMC10166036
Competing interests
Authors report no competing interests.
PMC10166036
References
PMC10166036
Background
PONV, postoperative nausea and vomiting, pain
Butorphanol slightly influences the respiratory and circulatory systems, has a better effect on relieving the discomfort caused by mechanical traction, and has a low incidence of postoperative nausea and vomiting (PONV). Combined butorphanol and propofol may suppress postoperative visceral pain, which is avoidable in g...
PMC10044711
Methods
visceral pain, pain
ADVERSE EVENTS, SECONDARY
This was a randomized, placebo-controlled, and double-blinded trial. Patients undergoing gastrointestinal endoscopy were randomized to intravenously receive either butorphanol (Group I) or normal saline (Group II). The primary outcome was visceral pain after the procedure 10 min after recovery. The secondary outcomes i...
PMC10044711
Results
A total of 206 patients were enrolled in the trial. Ultimately, 203 patients were randomly assigned to Group I (
PMC10044711
Conclusions
visceral pain
The trial indicated that adding butorphanol to propofol results in a lower incidence of visceral pain after surgery without noticeable fluctuations in circulatory and respiratory functions for gastrointestinal endoscopy patients.
PMC10044711
Trial registration
Clinicaltrials.gov NCT04477733 (PI: Ruquan Han; date of registration: 20/07/2020).
PMC10044711
Supplementary Information
The online version contains supplementary material available at 10.1186/s12871-023-02053-9.
PMC10044711
Keywords
PMC10044711
Background
pain, Cancer
GASTROINTESTINAL CANCER, CANCER
More than two million people die of gastrointestinal cancer, accounting for approximately 60% of new cases, based on Global Cancer Statistics 2018 [Propofol is widely used in endoscopy due to its fast onset of action, short action time, and quick and complete postoperative recovery [Butorphanol is a mixed opioid recept...
PMC10044711
Methods
PMC10044711
Study design and participants
This dual-center, randomized, placebo-controlled study was conducted at Beijing Tiantan Hospital, Capital Medical University, and Beijing Daxing People’s Hospital between August 14th, 2020, and September 30th, 2021. This study was approved by the China Ethics Committee of Registering Clinical Trials (Registration numbe...
PMC10044711
Blinding and randomization
Patients were randomly assigned to receive butorphanol (Group I) or normal saline (Group II) in a 1:1 ratio based on computer-generated stratified randomization numbers. The random numbers were sealed in separate opaque envelopes until the analysis was complete. Patients in Group I received 10 μg/kg butorphanol intrave...
PMC10044711
Perioperative management
intravascular hypovolemia
The regimens were standardized in both groups. Patients were deprived of water for 2 h and fasted for 8 h before surgery. Based on the requirements of anesthesia and surgery, venous access (central vein of the upper limb) was established. As perioperative fasting and bowel preparation are believed to cause intravascula...
PMC10044711
Data collection and outcomes
nausea or vomiting, bradycardia, visceral pain, fatigue, pain, dizziness, hypoxemia, hypotension, headache, abdominal bloating
ADVERSE EVENTS, SECONDARY
Baseline data were recorded, such as age, sex, height, weight, body mass index, ASA physical status, and type of operation. The MAP, HR, RR, and SpOThe primary outcome was the incidence of visceral pain after the procedure. Because there is no universal scale for quantifying visceral pain, we defined a visual analog sc...
PMC10044711
Sample size calculation
pain
We used PASS software to calculate the necessary sample size for this study. A cohort study reported that 45% of participants (124 of 277) undergoing colonoscopy and gastroscopy complained of pain during follow-up [
PMC10044711
Statistical analysis
visceral pain
SECONDARY
The data were analyzed using SPSS 26.0, and the figures were created by GraphPad Prism 9.0. All analyses were based on the intention-to-treat (ITT) principle. The Kolmogorov–Smirnov test was used to analyze continuous outcomes to judge the normality of their distributions. Normally distributed continuous variables were...
PMC10044711
Results
PMC10044711
Visceral pain
nausea or vomiting, bloating, visceral pain, fatigue, abdominal pain, pain, dizziness, hypoxemia, headache, abdominal bloating
ADVERSE EVENTS, ADVERSE EVENT
The incidence of visceral pain at 10 min after recovery was significantly lower with butorphanol (31.5% Comparison of efficacy and safety outcomes (median and interquartile range or frequency and percentage)Incidence of visceral pain recovery at 10 (The incidence of visceral pain at 20 and 30 min after recovery showed ...
PMC10044711
Discussion
hypoxemia, visceral pain, fatigue, pain
ADVERSE EVENTS, COMPLICATIONS
This study demonstrates that butorphanol results in a statistically lower incidence of visceral pain after surgery and reduced propofol consumption for gastrointestinal endoscopy without noticeable fluctuations in circulatory and respiratory functions. Intravenous butorphanol neither prolongs recovery time nor increase...
PMC10044711
Acknowledgements
Not Applicable.
PMC10044711
Authors’ contributions
HL
Each author's individual contributions to the manuscript are as follows: HL, RH: Conceptualization and design. JW, HL: Investigation. XW: Writing - Original draft of the manuscript and statistical analysis. HL, RH: Writing - Review & Editing. XW, HL and RH had full access to the data in the study and take responsibilit...
PMC10044711
Funding
No funding.
PMC10044711
Availability of data and materials
The datasets generated and analyzed during the current study are not publicly available due to institutional restrictions but are available from the corresponding author on reasonable request.
PMC10044711
Declarations
PMC10044711