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Acknowledgements
We thank Mark Solms, Charles Fischer, Harriet Wolfe, Cheryl Goodrich, Linda Goodman, Bart Blinder, Jean Nicolas Despland, Nicolas de Coulon, Erwin Sturm, Lisa Kallenbach-Kaminski, Andju Labuhn, Elisabeth Imhorst, Christine Huth, Serge Croes, Silvia Janko-Milch, Manfred Beutel as well as 72 psychoanalysts in our differe...
PMC10652457
Study registration
DRKS-ID: DRKS00016872.Date of Registration in DRKS: 2019/03/12 Last update 2023/01/30.Universal Trial Number (UTN): U1111-1229-2321.
PMC10652457
Authors’ contributions
MLB and BSP both international principal investigators and sponsors for the study conceived the study. MLB, BSP, GA, RB, NA, EH and TF developed the design of the study. GA, MLB, and BSP were major contributors in writing the manuscript. All authors read and approved the final manuscript.
PMC10652457
Funding
Open access funding provided by University of Lausanne This study is funded by grants of the International Psychoanalytic Association, the American Psychoanalytic Association, the Alfred Berman Foundation for Medical Research, and the Wallerstein foundation (The Robert S. Wallerstein Fellowship in Psychoanalytic Resear...
PMC10652457
Availability of data and materials
The datasets generated and/or analysed during the current study will be available on reasonable request to the PIs, via the corresponding author (gilles.ambresin@chuv.ch).
PMC10652457
Declarations
PMC10652457
Consent for publication
Not applicable.
PMC10652457
Competing interests
The authors declare no competing interests.
PMC10652457
References
PMC10652457
Background
RECRUITMENT
Online studies offer an efficient method of recruiting participants and collecting data. Whilst delivering an online randomised trial, we detected unusual recruitment activity. We describe our approach to detecting and managing suspected fraud and share lessons for researchers.
PMC10401790
Methods
Our trial investigated the single and combined effects of different ways of presenting clinical audit and feedback. Clinicians and managers who received feedback from one of five United Kingdom national clinical audit programmes were emailed invitations that contained a link to the trial website. After providing consen...
PMC10401790
Results
MINOR
Following a rapid increase in trial participation, we identified 268 new voucher claims from three email addresses that we had reason to believe were linked. Further scrutiny revealed duplicate trial completions and voucher requests from 24 email addresses. We immediately suspended the trial, improved security measures...
PMC10401790
Conclusion
Online studies offering incentives for participation are at risk of attempted fraud. Systematic monitoring and analysis can help detect such activity. Measures to protect study integrity include linking participant identifiers to study data, balancing study security and ease of participation, and safeguarding the alloc...
PMC10401790
Trial registration
International Standard Randomised Controlled Trial Number: ISRCTN41584028. Registration date is August 17, 2017.
PMC10401790
Keywords
PMC10401790
Background
RECRUITMENT
Online studies offer an efficient method of recruiting participants and collecting data. They are increasingly being used in health research, including for randomised trials. A PubMed search for randomised controlled trials featuring ‘online’ or ‘internet’ in the title found a total of 2742 records, with steady growth ...
PMC10401790
Methods
PMC10401790
Overview of design
We conducted an online fractional factorial trial, described in full elsewhere [
PMC10401790
Setting and participant recruitment
Myocardial Ischaemia, Trauma, Diabetes
BLOOD, RECRUITMENT, DIABETES
We developed our online trial in partnership with five United Kingdom (UK) national clinical audit programmes: the Myocardial Ischaemia National Audit Project (MINAP), the National Comparative Audit of Blood Transfusion (NCABT), the National Diabetes Core Audit (NDA), the Paediatric Intensive Care Network (PICANet), an...
PMC10401790
Results
PMC10401790
Detection of unusual study activity
RECRUITMENT
The study launched 10 April 2019 when the five national clinical audits emailed their initial distribution lists, totalling around 2000 recipients. We reached half of our target of 500 randomised participants within a fortnight. The NDA’s distribution list was far larger than that of the other four audits, and so we ha...
PMC10401790
Primary and secondary analysis populations
SECONDARY
Given that study and personal data were not linked, we were unable to directly identify the study data from the 268 duplicate entries from the total 603 randomisations which took place during the same period. We therefore produced two datasets for analysis, aiming to protect trial validity by using objective criteria t...
PMC10401790
Action taken
RECRUITMENT
Upon discovery of the suspicious activity, we promptly reported the incident to our independent study steering Committee, the research funder (National Institute for Health and Care Research), the University of Leeds School of Medicine Research Ethics Committee that had approved the study, and the study sponsor. We sub...
PMC10401790
Study completion
RECRUITMENT
We successfully completed our trial after the second recruitment period. We identified the effects of varying the content and format of feedback from national clinical audits on health professionals’ responses [
PMC10401790
Discussion
RECRUITMENT
Online studies offer the potential for efficient and practical recruitment of large numbers of participants within a relatively brief period. However, our experience illustrates that this is not always necessarily a good thing. Without appropriate monitoring and safeguards, online studies are potentially vulnerable to ...
PMC10401790
Conclusion
Online studies, and particularly those offering incentives for participation, are at risk of encountering fraudulent activity. Whilst live monitoring and systematic analysis of data can help detect such activity, researchers can build in measures during the design stage to help protect study integrity. These may includ...
PMC10401790
Acknowledgements
WRIGHT
We thank Sabahi Juma for her contribution to the trial and wider programme of research. In particular, she was the first to identify the problem detailed in this paper and enabled a rapid response. We also wish to thank the members of our study steering committee for their advice in relation to this incident. We thank ...
PMC10401790
Authors’ contributions
This paper recounts our experience of discovering and managing an attempted fraud incident during the conduct of an online trial. TW was programme manager and drafted the manuscript; AWH was the trial statistician and led the identification of suspect data; CS was the Head of Research Integrity and Governance in the Fa...
PMC10401790
Funding
This study was funded by the National Institute for Health and Care Research (NIHR) Health Services & Delivery Research Programme (Grant Reference Number 16/04/13). The funder had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript. The views expressed are those ...
PMC10401790
Availability of data and materials
The datasets generated and analysed during the current study are available from the corresponding author on reasonable request.
PMC10401790
Declarations
PMC10401790
Ethics approval and consent to participate
The original study and subsequent revisions were approved by the University of Leeds School of Medicine Research Ethics Committee (ref: 14–180). The trial website included a consent form which participants were required to complete before they could proceed to be randomised.
PMC10401790
Consent for publication
Not applicable.
PMC10401790
Competing interests
TW, RW, AJF, and RF are members of the Audit and Feedback MetaLab. The MetaLab is an international collaboration to advance learning and expertise on audit and feedback. AWH is a member of the Trials editorial board.
PMC10401790
References
PMC10401790
Background
Diabetes
TYPE 2 DIABETES MELLITUS, DIABETES
It is critical to assess implementation fidelity of evidence-based interventions and factors moderating fidelity, to understand the reasons for their success or failure. However, fidelity and fidelity moderators are seldom systematically reported. The study objective was to conduct a concurrent implementation fidelity ...
PMC10045092
Methods
prediabetes
REGRESSION, PREDIABETES, SDH
We applied the Conceptual Framework for Implementation Fidelity to assess implementation fidelity and factors moderating it across the four core intervention components: patient goal setting, education topic coaching, primary care (PC) visits, and referrals to address social determinants of health (SDH), using descript...
PMC10045092
Results
SDH
Content adherence was high for three components with nearly 80.0% of patients setting ≥ 1 goal, having ≥ 1 PC visit and receiving ≥ 1 education session. Only 45.0% patients received ≥ 1 SDH referral. After adjusting for patient gender, language, race, ethnicity, and age, the implementation site moderated adherence to g...
PMC10045092
Conclusions
The fidelity to the four CHORD intervention components differed between the two implementation sites, demonstrating the challenges in implementing complex evidence-based interventions in different settings. Our findings underscore the importance of measuring implementation fidelity in contextualizing the outcomes of ra...
PMC10045092
Trial registration
The trial was registered with ClinicalTrials.gov on 30/12/2016 and the registration number is
PMC10045092
Supplementary Information
The online version contains supplementary material available at 10.1186/s12889-023-15477-2.
PMC10045092
Keywords
PMC10045092
Background
pre-diabetic, DM, Diabetes
PRE-DIABETIC, TYPE II DIABETES MELLITUS, SDH, DIABETES
The NationalInstitutes for Health recommends fidelity measurement in health behavior studies because without the knowledge of implementation fidelity, it may be impossible to draw correct inferences about the effectiveness of or to replicate an intervention [CHORD (Community Health Outreach to Reduce Diabetes), launche...
PMC10045092
Methods
PMC10045092
Trial participants and description
prediabetes
PREDIABETES
The CHORD trial’s priority population was patients with prediabetes receiving care at two PC clinics, the Manhattan campus of the VA NY Harbor Healthcare System (VA), and Bellevue Hospital Center (BH) of New York City’s municipal hospital system [Briefly, all PC clinicians within each site were randomized to interventi...
PMC10045092
Implementation of CHORD behavioral components
In the first component, CHWs established individualized goals with each patient and completed a 6-item, Patient Activation Measure (PAM) [
PMC10045092
CHW training and fidelity monitoring
diabetes
DIABETES
To facilitate and standardize the implementation of the intervention, CHWs received comprehensive training and then ongoing feedback during weekly team meetings and case review sessions. To address behavioral components, CHWs completed training on coaching competencies, motivational interviewing, mental health and nutr...
PMC10045092
Data collection
Figure The Modified Version of the Conceptual Framework for Implementation Fidelity that guided Fidelity Assessment of the CHORD intervention (adapted from Carroll et al. and Hasson et al.)Data on the CFIR implementation fidelity elements identified above were collected from the start of the CHORD trial (December 2017)...
PMC10045092
Analysis
Fidelity measures of coverage, content and dose were reported using applicable descriptive statistics including percentage for categorical variables or median with inter-quartile ranges (IQRs) for continuous or count variables. To evaluate fidelity moderation, we computed unadjusted Among patients who completed intake ...
PMC10045092
Results
PMC10045092
Fidelity measures
PMC10045092
Content adherence
Eighty percent of patients had ≥ 1 successful encounter with the CHW (Table
PMC10045092
Impact of moderators on fidelity measures
PMC10045092
Patient activation
The median PAM score was 18 of a maximal score of 24. None of the fidelity measures were moderated by PAM score when dichotomized at the median (Supplemental Table
PMC10045092
Context
The implementation of the CHORD intervention was moderated by clinical site, with 60% of patients from BH and 40% from VA. VA patients had higher coverage and overall content adherence than BH. But a greater percentage of BH patients received coaching on all education modules and received all four core components. Thre...
PMC10045092
Discussion
prediabetes, diabetes
RECRUITMENT, PREDIABETES, DIABETES
In the CHORD study, we hypothesized that trained CHWs, through individualized goal setting, educational coaching, and facilitated referrals, would support positive lifestyle changes and prevent the onset of diabetes among patients with prediabetes. However, an intervention may not affect lifestyle change if it deviates...
PMC10045092
Study limitations
First, as a pragmatic trial, the CHORD implementation did not start or end on fixed days, because CHWs maintained continued contacts with their patients. As a result, some interventions, such as referrals, were delivered outside of the intervention period. We included them in this analysis if they were recorded by CHWs...
PMC10045092
Study strengths and contributions
Our study adds to the limited literature with systematically reported concurrent evaluation of implementation processes of multicomponent complex behavioral interventions [
PMC10045092
Conclusion
diabetes
DIABETES
Our concurrent quantitative, implementation evaluation of a complex pragmatic trial to prevent diabetes in safety-net settings, found moderate-to-high adherence to the core components of the intervention, as well as moderation of several fidelity measures by implementation site, with no impact of the baseline patient-a...
PMC10045092
Acknowledgements
Presented in part at Society of General Internal Medicine (SGIM) 2021 conference and Academy Health ARM 2021 conference. We thank Dr. Erin Rogers, Assistant Professor at the Department of Population Health, NYU Grossman School of Medicine, for her valuable review of the manuscript.
PMC10045092
Authors’ contributions
AG conceptualized the paper, wrote the first draft and finalized the subsequent revisions along with data interpretation and data presentation. JH led data management, data analyses and data presentation along with reviewing multiple versions of the manuscript to offer critical edits and comments. SH performed data man...
PMC10045092
Authors’ information
Not applicable.
PMC10045092
Funding
Digestive, Diabetes
KIDNEY DISEASES, DIABETES
This study has undergone peer-review by and is supported by the National Institutes of Health—National Institute of Diabetes and Digestive and Kidney Diseases under award number R18DK110740. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Ins...
PMC10045092
Availability of data and materials
The datasets used and/or analyzed during the current study are not publicly available due to patient identifiers but is available from the corresponding author on reasonable request.
PMC10045092
Declarations
PMC10045092
Ethics approval and consent to participate
This study was approved by the New York University Langone Health (Protocol #:16–00690) and the Veterans Affairs (Protocol #:1609) Institutional Review Boards. Informed consent was obtained from all the participants in the study. All the procedures were followed in accordance with the relevant guidelines (eg. Declarati...
PMC10045092
Consent for publication
Not applicable.
PMC10045092
Competing interests
The authors declare no competing interests.
PMC10045092
References
PMC10045092
Keywords
toenail onychomycosis, onychomycosis
ONYCHOMYCOSIS
Keratolytic properties of urea 40% have long time used for the treatment of onychomycosis. Fractional ablative lasers enhance the delivery of topically applied photosensitizers improving photodynamic therapy (PDT) efficacy. The aim of this study was to compare the short- and medium-term efficacy of a pretreatment with ...
PMC10085931
Introduction
toenail onychomycosis, onychomycosis
FUNGAL NAIL INFECTION, DISEASE, ONYCHOMYCOSIS, SEPARATION, ONYCHOMYCOSIS
Fractional photothermolysis is considered a significant technological advance in dermatology. In fractional lasers, the laser beam is split into a pattern of microbeams. This results in thermal microscopic wounds into deep skin structures [Onychomycosis is a fungal nail infection often with thickening, discoloration an...
PMC10085931
Materials and methods
PMC10085931
Pretreatment
PMC10085931
Group I (urea 40% pretreatment)
HYPERKERATOSIS
40% urea ointment was employed to soften the plates of the affected nails and vaseline was applied in periungual skin to prevent irritating effects of urea at high concentrations. Once the urea and vaseline were applied, the nail was covered by an occlusive dressing for 12 h at night. Urea softening treatment was limit...
PMC10085931
Treatment
After any of the pretreatment used, a PDT mediated by MB (MB/PDT) was carried out, for which a solution of MB in water (2%) was applied to the affected nail, and 3 min later, the nail was photoactivated by a red light-emitting diode (LED) lamp (Aktilite
PMC10085931
Statistical analysis
ONYCHOMYCOSIS
Sample size calculation was based on detecting differences of more than 10 points between groups in the primary outcome (Onychomycosis Severity Index, OSI), assuming standard deviation of 6, error of 0.05 and power of 90% [To check assumptions of normality for the tested variables (OSI, degree of improvement, % of invo...
PMC10085931
Results
No side reactions were found during the study period. MB application resulted in a widespread temporary discoloration of the toenails (Fig. Both groups demonstrated a continuous and significant decline in the OSI scores throughout the first 12 weeks of the evaluated period, but a slight rebound through the following 12...
PMC10085931
Acknowledgements
This research was supported by a grant from the Eugenio Rodríguez Pascual Foundation (Madrid, Spain) and by the Spanish Research Project MICINN (Ref.:PiD2020-114755GB-C31). The authors wish to thank Professor Mª José Ortiz for her assistance with the ethical evaluation of the study and Dr. Santiago Cano for his assista...
PMC10085931
Author contributions
Both authors contributed equally to producing the work.
PMC10085931
Funding
Open Access funding provided thanks to the CRUE-CSIC agreement with Springer Nature.
PMC10085931
Declarations
PMC10085931
Competing interests
The authors declare no competing interests.
PMC10085931
References
PMC10085931
Abstract
PMC10114123
Background
Maternal age is increasingly recognized as a predictor of birth outcomes. Given the importance of birth and growth outcomes for children’s development, wellbeing and survival, this study examined the effect of maternal age on infant birth and growth outcomes at 6 months and mortality. Additionally, we conducted quantit...
PMC10114123
Methods
REGRESSION
We used data from randomized–controlled trials (RCTs) of 21 555 neonates in Burkina Faso conducted in 2019–2020. Newborns of mothers aged 13–19 years (adolescents) and 20–40 years (adults) were enrolled in the study 8–27 days after birth and followed for 6 months. Measurements of child’s anthropometric measures were co...
PMC10114123
Results
Babies born to adolescent mothers on average had lower weight at birth, lower anthropometric measures at baseline, similar growth outcomes from enrolment to 6 months and higher odds of all-cause mortality by 6 months (adjusted OR = 2.17, 95% CI 1.35 to 3.47) compared with those born to adult mothers. In QBA, we found t...
PMC10114123
Conclusions
Our findings suggest that delaying the first birth from adolescence to adulthood may improve birth outcomes and reduce mortality of neonates. Babies born to younger mothers, who are smaller at birth, may experience catch-up growth, reducing some of the anthropometric disparities by 6 months of age.Babies born to adoles...
PMC10114123
Introduction
YOUNG MATERNAL AGE
Maternal age is increasingly recognized as a predictor of birth outcomes. Studies show that pregnancies in the extremes, at ages <17 and >40 years, are at a higher risk of negative birth outcomes than other age groups.Previous studies show that babies born to young mothers have a greater risk of very-pre-term and pre-t...
PMC10114123
Methods
PMC10114123
Study design, setting and population
This analysis used data from a randomized–controlled trial of azithromycin vs placebo conducted to establish the efficacy and safety of administration of a dose of azithromycin during the neonatal period.
PMC10114123
Data collection and measures
wasting
WASTING
At baseline, trained field workers collected information of the infant and mother via a questionnaire. Child information included birthweight, type and timing of breastfeeding initiation and whether the child was born at a health centre. Maternal information collected included age, education level, number of previous p...
PMC10114123
Statistical analysis methods
REGRESSION
To assess the effect of maternal age on birth and growth outcomes, we used simple and multivariable linear regression. The changes in outcomes between maternal age groups were expressed as beta coefficients.Potential confounders of the association between maternal age and birth and growth outcomes and mortality were se...
PMC10114123
Results
death
Characteristics of mothers and infants enrolled in the NAITRE trial in Burkina Faso 2019–2020Excludes missing NAITRE, Neonates and Azithromycin, an Innovation in the Treatment of Children in Burkina Faso; MUAC, mid-upper arm circumference; LAZ, Length-for-Age Z Score; WAZ: Weight-for-Age Z Score; WLZ, Weight-for-Lengt...
PMC10114123
Discussion
In this study, babies born to adolescent mothers had poorer birth and neonatal outcomes as seen in baseline anthropometric measures and a higher risk of all-cause mortality by 6 months but similar growth outcomes at 6 months compared with those born to adult mothers.Similarly to findings of previous studies, babies bor...
PMC10114123
Conclusion
Our findings show that delaying the first birth from adolescence to adulthood can improve birth outcomes and reduce mortality of neonates. Delaying pregnancy may allow young girls to mature mentally and physically and improve their social status, autonomy and decision-making, which can lead to better outcomes for their...
PMC10114123
Ethics approval
The randomized–controlled trial from which the data were obtained was reviewed and approved by the Comité d’Ethique pour la Recherche en Santé (National Research Ethics Committee) in Ouagadougou, Burkina Faso (protocol 2018–10-123) and the University of California, San Francisco Institutional Review Board (protocol 18–...
PMC10114123
Supplementary Material
Click here for additional data file.
PMC10114123
Data availability
The data for this study are available upon request.
PMC10114123
Supplementary data
PMC10114123