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  1. Article ; Online: Choosing and evaluating randomisation methods in clinical trials: a qualitative study.

    Bruce, Cydney L / Iflaifel, Mais / Montgomery, Alan / Ogollah, Reuben / Sprange, Kirsty / Partlett, Christopher

    Trials

    2024  Volume 25, Issue 1, Page(s) 199

    Abstract: Background: There exist many different methods of allocating participants to treatment groups during a randomised controlled trial. Although there is research that explores trial characteristics that are associated with the choice of method, there is ... ...

    Abstract Background: There exist many different methods of allocating participants to treatment groups during a randomised controlled trial. Although there is research that explores trial characteristics that are associated with the choice of method, there is still a lot of variety in practice not explained. This study used qualitative methods to explore more deeply the motivations behind researchers' choice of randomisation, and which features of the method they use to evaluate the performance of these methods.
    Methods: Data was collected from online focus groups with various stakeholders involved in the randomisation process. Focus groups were recorded and then transcribed verbatim. A thematic analysis was used to analyse the transcripts.
    Results: Twenty-five participants from twenty clinical trials units across the UK were recruited to take part in one of four focus groups. Four main themes were identified: how randomisation methods are selected; researchers' opinions of the different methods; which features of the method are desirable and ways to measure method features. Most researchers agree that the randomisation method should be selected based on key trial characteristics; however, for many, a unit standard is in place. Opinions of methods were varied with some participants favouring stratified blocks and others favouring minimisation. This was generally due to researchers' perception of the effect these methods had on balance and predictability. Generally, predictability was considered more important than balance as adjustments cannot be made for it; however, most researchers felt that the importance of these two methods was dependent on the design of the study. Balance is usually evaluated by tabulating variables by treatment arm and looking for perceived imbalances, predictability was generally considered much harder to measure, partly due to differing definitions.
    Conclusion: There is a wide variety in practice on how randomisation methods are selected and researcher's opinions on methods. The difference in practice observed when looking at randomisation method selection can be explained by a difference in unit practice, and also by a difference in researchers prioritisation of balance and predictability. The findings of this study show a need for more guidance on randomisation method selection.
    MeSH term(s) Humans ; Qualitative Research ; Focus Groups
    Language English
    Publishing date 2024-03-20
    Publishing country England
    Document type Randomized Controlled Trial ; Journal Article
    ZDB-ID 2040523-6
    ISSN 1745-6215 ; 1468-6694 ; 1745-6215
    ISSN (online) 1745-6215
    ISSN 1468-6694 ; 1745-6215
    DOI 10.1186/s13063-024-08005-z
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  2. Article ; Online: Should we adjudicate outcomes in stroke trials? A systematic review.

    Godolphin, Peter J / Bath, Philip M / Montgomery, Alan A

    International journal of stroke : official journal of the International Stroke Society

    2022  Volume 18, Issue 2, Page(s) 154–162

    Abstract: Background: Central adjudication of outcomes is common in randomized clinical trials in stroke. The rationale for adjudication is clear; centrally adjudicated outcomes should have less random and systematic errors than outcomes assessed locally by site ... ...

    Abstract Background: Central adjudication of outcomes is common in randomized clinical trials in stroke. The rationale for adjudication is clear; centrally adjudicated outcomes should have less random and systematic errors than outcomes assessed locally by site investigators. However, adjudication brings added complexities to a clinical trial and can be costly.
    Aim: To assess the evidence for outcome adjudication in stroke trials.
    Summary of review: We identified 12 studies evaluating central adjudication in stroke trials. The majority of these were secondary analyses of trials, and the results of all of these would have remained unchanged had central adjudication not taken place, even for trials without sufficient blinding. The largest differences between site-assessed and adjudicator-assessed outcomes were between the most subjective outcomes, such as causality of serious adverse events. We found that the cost of adjudication could be upward of £100,000 for medium to large prevention trials. These findings suggest that the cost of central adjudication may outweigh the advantages it brings in many cases. However, through simulation, we found that only a small amount of bias is required in site investigators' outcome assessments before adjudication becomes important.
    Conclusion: Central adjudication may not be necessary in stroke trials with blinded outcome assessment. However, for open-label studies, central adjudication may be more important.
    MeSH term(s) Humans ; Stroke/drug therapy ; Outcome Assessment, Health Care ; Research Design
    Language English
    Publishing date 2022-05-10
    Publishing country United States
    Document type Systematic Review ; Journal Article ; Review ; Research Support, Non-U.S. Gov't
    ZDB-ID 2303728-3
    ISSN 1747-4949 ; 1747-4930
    ISSN (online) 1747-4949
    ISSN 1747-4930
    DOI 10.1177/17474930221094682
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  3. Article ; Online: Optimising the analysis of vascular prevention trials: Re-Assessment of the TARDIS trial, the first prevention trial to adopt an ordinal primary outcome measure.

    Woodhouse, Lisa J / Montgomery, Alan A / Pocock, Stuart / James, Marilyn / Ranta, Anna / Bath, Philip M

    Contemporary clinical trials communications

    2023  Volume 35, Page(s) 101186

    Abstract: Background: Ordinalised vascular outcomes incorporating event severity are more informative than binary outcomes that just include event numbers. The TARDIS trial was the first vascular prevention study to use an ordinalised vascular outcome as its ... ...

    Abstract Background: Ordinalised vascular outcomes incorporating event severity are more informative than binary outcomes that just include event numbers. The TARDIS trial was the first vascular prevention study to use an ordinalised vascular outcome as its primary efficacy and safety measures and collected severity information for other vascular events.
    Methods: TARDIS was an international prospective randomised open-label blinded-endpoint trial assessing one month of intensive versus guideline antiplatelet therapy in patients with acute non-cardioembolic stroke or TIA. Vascular events and their severity were recorded up to final follow-up at 90 days post randomisation. For each outcome, statistical techniques compared ordinal/continuous (10 models) and dichotomous (5 models) analyses; results were then ranked with the smallest p-value being given the smallest rank. Outcomes were also assessed within the pre-defined subgroup of participants with mild stroke (NIHSS≤3), or TIA recruited within 24 h.
    Results: Ordinal versions of vascular event outcomes were created in 3096 participants for stroke, myocardial infarction, major cardiac events, bleeding events, serious adverse events and venous thromboembolism (VTE), with 32 outcomes being created overall (29 in the subgroup population due to the absence of VTE events). Overall, the tests run on ordinal outcomes tended to rank higher than tests performed on binary outcomes. 764 (24.7%) participants were recruited within 24 h of a mild stroke/TIA; again, tests run on ordinal outcomes ranked higher.
    Conclusions: In TARDIS, tests performed on ordinal vascular outcomes tended to attain a higher rank than those performed on binary outcomes.
    Trial registration: ISRCTN47823388.
    Language English
    Publishing date 2023-07-05
    Publishing country Netherlands
    Document type Journal Article
    ISSN 2451-8654
    ISSN (online) 2451-8654
    DOI 10.1016/j.conctc.2023.101186
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  4. Article ; Online: Full Milk Feeds from Day 1.

    Ojha, Shalini / Mitchell, Eleanor / Montgomery, Alan / Dorling, Jon

    Neonatology

    2019  Volume 116, Issue 1, Page(s) 67

    MeSH term(s) Animals ; Enteral Nutrition ; Humans ; Infant ; Infant, Newborn ; Infant, Very Low Birth Weight ; Milk ; Milk, Human
    Language English
    Publishing date 2019-05-02
    Publishing country Switzerland
    Document type Letter ; Research Support, Non-U.S. Gov't ; Comment
    ZDB-ID 2266911-5
    ISSN 1661-7819 ; 1661-7800
    ISSN (online) 1661-7819
    ISSN 1661-7800
    DOI 10.1159/000499676
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  5. Article ; Online: A systematic review of randomisation method use in RCTs and association of trial design characteristics with method selection.

    Bruce, Cydney L / Juszczak, Edmund / Ogollah, Reuben / Partlett, Christopher / Montgomery, Alan

    BMC medical research methodology

    2022  Volume 22, Issue 1, Page(s) 314

    Abstract: Background: When conducting a randomised controlled trial, there exist many different methods to allocate participants, and a vast array of evidence-based opinions on which methods are the most effective at doing this, leading to differing use of these ... ...

    Abstract Background: When conducting a randomised controlled trial, there exist many different methods to allocate participants, and a vast array of evidence-based opinions on which methods are the most effective at doing this, leading to differing use of these methods. There is also evidence that study characteristics affect the performance of these methods, but it is unknown whether the study design affects researchers' decision when choosing a method.
    Methods: We conducted a review of papers published in five journals in 2019 to assess which randomisation methods are most commonly being used, as well as identifying which aspects of study design, if any, are associated with the choice of randomisation method. Randomisation methodology use was compared with a similar review conducted in 2014.
    Results: The most used randomisation method in this review is block stratification used in 162/330 trials. A combination of simple, randomisation, block randomisation, stratification and minimisation make up 318/330 trials, with only a small number of more novel methods being used, although this number has increased marginally since 2014. More complex methods such as stratification and minimisation seem to be used in larger multicentre studies.
    Conclusions: Within this review, most methods used can be classified using a combination of simple, block stratification and minimisation, suggesting that there is not much if any increase in the uptake of newer more novel methods. There seems to be a noticeable polarisation of method use, with an increase in the use of simple methods, but an increase in the complexity of more complex methods, with greater numbers of variables included in the analysis, and a greater number of strata.
    MeSH term(s) Humans ; Research Design ; Randomized Controlled Trials as Topic
    Language English
    Publishing date 2022-12-07
    Publishing country England
    Document type Systematic Review ; Journal Article
    ZDB-ID 2041362-2
    ISSN 1471-2288 ; 1471-2288
    ISSN (online) 1471-2288
    ISSN 1471-2288
    DOI 10.1186/s12874-022-01786-4
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  6. Article ; Online: Occipital Nerve Stimulation: An Alternative Treatment of Chronic Migraine.

    Maxey, Benjamin S / Pruitt, John W / Deville, Ashley / Montgomery, Carver / Kaye, Alan D / Urits, Ivan

    Current pain and headache reports

    2022  Volume 26, Issue 4, Page(s) 337–346

    Abstract: Purpose of review: This paper will examine the efficacy and safety of occipital nerve stimulation as a non-pharmacological alternative treatment for migraine.: Recent findings: Migraine is characterized as a primary headache disorder with possible ... ...

    Abstract Purpose of review: This paper will examine the efficacy and safety of occipital nerve stimulation as a non-pharmacological alternative treatment for migraine.
    Recent findings: Migraine is characterized as a primary headache disorder with possible premonitory and aura phases, both of which vary greatly in symptomatology. The most common treatments for chronic migraine are pharmacological and are aimed at both acute relief (e.g., nonsteroidal anti-inflammatory drugs, triptans, and ergots) and prophylaxis (e.g., propranolol, valproic acid, and topiramate). For patients with medically refractory migraine, acute relief medication overuse can increase the risk of developing more severe and more frequent migraine attacks. Occipital nerve stimulation is a non-pharmacological alternative treatment for chronic migraine, which could eliminate the risk of adverse effects from acute relief medication overuse. Neurostimulation is thought to prevent pain by blocking signal transduction from small nociceptive fibers with non-painful signaling in larger adjacent fibers. Existing data from clinical trials support the overall safety and efficacy of occipital nerve stimulation for the treatment of chronic migraine. However, few large controlled, double-blinded studies have been conducted, due to both practical and ethical concerns. Currently, occipital nerve stimulation is available as an off-label use of neurostimulation for pain prevention but is not approved by the FDA specifically for the treatment of chronic migraine.
    MeSH term(s) Electric Stimulation Therapy ; Humans ; Migraine Disorders/therapy ; Pain ; Peripheral Nerves ; Treatment Outcome
    Language English
    Publishing date 2022-03-14
    Publishing country United States
    Document type Journal Article ; Review
    ZDB-ID 2055062-5
    ISSN 1534-3081 ; 1531-3433
    ISSN (online) 1534-3081
    ISSN 1531-3433
    DOI 10.1007/s11916-022-01026-w
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  7. Article ; Online: SuperAger Initiative: unlocking the genetic potential of exceptional longevity.

    Milman, Sofiya / Barzilai, Nir / Wilson, Kara A / Van der Willik, Odette / Lederman, Stephanie / Perls, Thomas / Gao, Tina / Leahy, Aoife McGovern / Jain, Praduman / Montgomery, Aisha / Shuldiner, Alan R

    Nature aging

    2023  Volume 3, Issue 6, Page(s) 627–628

    MeSH term(s) Genotype ; Longevity/genetics ; Humans
    Language English
    Publishing date 2023-05-16
    Publishing country United States
    Document type Letter
    ISSN 2662-8465
    ISSN (online) 2662-8465
    DOI 10.1038/s43587-023-00429-7
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  8. Article ; Online: Optimising the analysis of vascular prevention trials

    Lisa J. Woodhouse / Alan A. Montgomery / Stuart Pocock / Marilyn James / Anna Ranta / Philip M. Bath

    Contemporary Clinical Trials Communications, Vol 35, Iss , Pp 101186- (2023)

    Re-Assessment of the TARDIS trial, the first prevention trial to adopt an ordinal primary outcome measure

    2023  

    Abstract: Background: Ordinalised vascular outcomes incorporating event severity are more informative than binary outcomes that just include event numbers. The TARDIS trial was the first vascular prevention study to use an ordinalised vascular outcome as its ... ...

    Abstract Background: Ordinalised vascular outcomes incorporating event severity are more informative than binary outcomes that just include event numbers. The TARDIS trial was the first vascular prevention study to use an ordinalised vascular outcome as its primary efficacy and safety measures and collected severity information for other vascular events. Methods: TARDIS was an international prospective randomised open-label blinded-endpoint trial assessing one month of intensive versus guideline antiplatelet therapy in patients with acute non-cardioembolic stroke or TIA. Vascular events and their severity were recorded up to final follow-up at 90 days post randomisation. For each outcome, statistical techniques compared ordinal/continuous (10 models) and dichotomous (5 models) analyses; results were then ranked with the smallest p-value being given the smallest rank. Outcomes were also assessed within the pre-defined subgroup of participants with mild stroke (NIHSS≤3), or TIA recruited within 24 h. Results: Ordinal versions of vascular event outcomes were created in 3096 participants for stroke, myocardial infarction, major cardiac events, bleeding events, serious adverse events and venous thromboembolism (VTE), with 32 outcomes being created overall (29 in the subgroup population due to the absence of VTE events). Overall, the tests run on ordinal outcomes tended to rank higher than tests performed on binary outcomes. 764 (24.7%) participants were recruited within 24 h of a mild stroke/TIA; again, tests run on ordinal outcomes ranked higher. Conclusions: In TARDIS, tests performed on ordinal vascular outcomes tended to attain a higher rank than those performed on binary outcomes. Trial registration: ISRCTN47823388
    Keywords TARDIS ; Stroke ; Severity ; Outcome ; Time ; Medicine (General) ; R5-920
    Subject code 150
    Language English
    Publishing date 2023-10-01T00:00:00Z
    Publisher Elsevier
    Document type Article ; Online
    Database BASE - Bielefeld Academic Search Engine (life sciences selection)

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  9. Article ; Online: Short email with attachment versus long email without attachment when contacting authors to request unpublished data for a systematic review: a nested randomised trial.

    Godolphin, Peter J / Bath, Philip M / Montgomery, Alan A

    BMJ open

    2019  Volume 9, Issue 1, Page(s) e025273

    Abstract: Objective: Systematic reviews often rely on the acquisition of unpublished analyses or data. We carried out a nested randomised trial comparing two different approaches for contacting authors to request additional data for a systematic review.: ... ...

    Abstract Objective: Systematic reviews often rely on the acquisition of unpublished analyses or data. We carried out a nested randomised trial comparing two different approaches for contacting authors to request additional data for a systematic review.
    Participants: Participants were authors of published reports of prevention or treatment trials in stroke in which there was central adjudication of events. A primary and secondary research active author were selected as contacts for each trial.
    Interventions: Authors were randomised to be sent either a short email with a protocol of the systematic review attached ('Short') or a longer email that contained detailed information and without the protocol attached ('Long'). A maximum of two emails were sent to each author to obtain a response. The unit of analysis was trial, accounting for clustering by author.
    Primary and secondary outcome measures: The primary outcome was whether a response was received from authors. Secondary outcomes included time to response, number of reminders needed before a response was received and whether authors agreed to collaborate.
    Results: 88 trials with 76 primary authors were identified in the systematic review, and of these, 36 authors were randomised to Short (trials=45) and 40 to Long (trials=43). Responses were received for 69 trials. There was no evidence of a difference in response rate between trial arms (Short vs Long, OR 1.10, 95% CI 0.36 to 3.33). There was no evidence of a difference in time to response between trial arms (Short vs Long, HR 0.91, 95% CI 0.55 to 1.51). In total, 27% of authors responded within a day and 22% of authors never responded.
    Conclusions: There was no evidence to suggest that email format had an impact on the number of responses received when acquiring data for a systematic review involving stroke trials or the time taken to receive these responses.
    MeSH term(s) Humans ; Authorship ; Clinical Trials as Topic ; Electronic Mail/statistics & numerical data ; Health Personnel/statistics & numerical data ; Information Storage and Retrieval/methods ; Logistic Models ; Random Allocation ; Stroke/therapy ; Systematic Reviews as Topic
    Language English
    Publishing date 2019-01-30
    Publishing country England
    Document type Journal Article ; Research Support, Non-U.S. Gov't
    ZDB-ID 2599832-8
    ISSN 2044-6055 ; 2044-6055
    ISSN (online) 2044-6055
    ISSN 2044-6055
    DOI 10.1136/bmjopen-2018-025273
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  10. Article ; Online: Glossopharyngeal Neuralgia: Epidemiology, Risk factors, Pathophysiology, Differential diagnosis, and Treatment Options.

    Han, Andrew / Montgomery, Carver / Zamora, Alexandra / Winder, Emilie / Kaye, Adam / Carroll, Caroline / Aquino, Alfonso / Kakazu, Juyeon / Kaye, Alan

    Health psychology research

    2022  Volume 10, Issue 3, Page(s) 36042

    Abstract: Purpose of review: This is a comprehensive review of the most recent literature on glossopharyngeal neuralgia (GPN), a relatively rare form of neuropathic facial pain. It covers the epidemiology, risk factors, pathophysiology, and differential diagnosis ...

    Abstract Purpose of review: This is a comprehensive review of the most recent literature on glossopharyngeal neuralgia (GPN), a relatively rare form of neuropathic facial pain. It covers the epidemiology, risk factors, pathophysiology, and differential diagnosis given that glossopharyngeal neuralgia can often be confused with other facial pain syndromes. Finally, we extensively review recent findings regarding medical or conservative measures, minimally invasive, and surgical options for potentially treating and managing glossopharyngeal neuralgia.
    Recent findings: An in-depth analysis of the recent literature indicates that glossopharyngeal neuralgia is not only rare but its etiology and pathophysiology are complex and are often secondary to other disease processes. Regardless, current management options are shown to be effective in controlling pain. Conservatively, first-line management of GPN is carbamazepine, but gabapentin and eslicarbazepine acetate are suitable alternatives. In terms of current minimally invasive pain management techniques, pulsed radiofrequency ablation, nerve blocks, or percutaneous radiofrequency thermocoagulation are effective. Finally, surgical management involves microvascular decompression and rhizotomy.
    Summary: While there are currently many viable options for addressing glossopharyngeal neuralgia pain ranging from conservative to surgical management, the complex nature of GPN etiology, pathophysiology, and involved anatomical structures prompts further research for more effective ways to treat the disease.
    Language English
    Publishing date 2022-06-28
    Publishing country United States
    Document type Journal Article
    ZDB-ID 2709692-0
    ISSN 2420-8124 ; 2420-8124
    ISSN (online) 2420-8124
    ISSN 2420-8124
    DOI 10.52965/001c.36042
    Database MEDical Literature Analysis and Retrieval System OnLINE

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