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Large-scale Trials (large-scale + trials)
Selected AbstractsShort-term anti-plaque effect of two chlorhexidine varnishesJOURNAL OF CLINICAL PERIODONTOLOGY, Issue 8 2005Jan Cosyn Abstract Background: Chlorhexidine (CHX) varnishes have been mainly used for the prevention of caries in high-risk populations. Reports regarding their anti-plaque effect on a clinical level are limited to non-existing as opposed to their microbiological impact on plaque formation. Aim: The aim of this preliminary investigation was to evaluate the anti-plaque effect of two CHX varnishes applied on sound enamel in relation to a positive control, a negative control and to one another. Methods: Sixteen healthy subjects volunteered for this randomized-controlled, single-blind, four-treatment,four-period crossover-designed clinical trial. A 3-day plaque re-growth model was used to determine de novo plaque accumulation following CHX rinsing, Cervitec® application, EC40® application and no therapy. The amount of plaque was measured using the Quigley and Hein plaque index and "automatic image analysis" (AIA). Results and Conclusions: Varnish treatment resulted in significantly higher plaque levels than CHX rinsing irrespective of the varnish that was used (p0.002), implying that the latter is likely to remain the gold standard as an anti-plaque agent. However, highly significant differences were also found in favour of both varnish systems when compared with no therapy (p<0.001), which indicates that varnish treatment is an effective means of inhibiting plaque formation in a short time span. Cervitec® exhibited slightly, yet significantly, higher plaque levels in comparison with EC40® as determined by AIA (p=0.006). Large-scale trials with a longer observation period are necessary to substantiate these results. [source] An experimental test of a visual-based push,pull strategy for control of wood boring phytosanitary pestsAGRICULTURAL AND FOREST ENTOMOLOGY, Issue 3 2009Stephen Mark Pawson Abstract 1,International phytosanitary standards require mandatory fumigation for key wood boring beetle pests prior to export. Pressure to reduce the use of toxic fumigants has created a need for alternative control techniques. 2,A visual based push,pull strategy that exploits a differential attraction to yellow and ultra violet (UV) lights was tested for its efficacy at controlling Cerambycidae. 3,The relative attraction of four ,push' lighting treatments [two yellow (high and low-pressure Sodium), one white (metal halide) and a control (no light)] to beetles was assessed. Highly attractive UV ,pull' traps were compared with a paired control trap, the difference used as a measure of the UV traps attractiveness to residual beetles attracted by ,push' lights. 4,Trap catch beneath the two yellow ,push' lights was more similar to the control (no light) treatment than the white light for both species. Control ,push' lights had the highest average catch of Arhopalus ferus, whereas white light was least attractive. This finding was counter intuitive to expectations, and potential mechanisms are discussed. The white ,push' light was most attractive to Prionoplus reticularis. 5,Ultraviolet ,pull' traps were highly attractive to residual beetles drawn to yellow ,push' light treatments. Relative attraction to the UV ,pull' traps beneath control and white ,push' lights differed between species. 6,The results obtained suggest that a push,pull strategy combining yellow site lighting with UV kill traps could provide site specific control of wood borers. Future research should attempt large-scale trials that are subject to competing alternative stimuli at a wood processing site. [source] Fostering a culture of engagement: an evaluation of a 2-day training in solution-focused brief therapy for mental health workersJOURNAL OF PSYCHIATRIC & MENTAL HEALTH NURSING, Issue 4 2009H. FERRAZ msc pg dip ed rmn The focus of mental health care has changed considerably in recent years, from an almost exclusive inpatient system of care to one where the majority of care is being delivered within the community. Arguably this has contributed to a reduction in the length of inpatient admissions. Therefore, there is a need to understand the ramifications that shorter admissions have on inpatient care and nursing practice. This paper reports on a study designed to test the knowledge and skill acquisition and self-reported application of solution-focused brief therapy by staff following a 2-day training. The study adopted a repeated measures design where participants' baseline knowledge was measured prior to the 2-day training and then at 3 and 6 months post-training. This study has demonstrated that the 2-day training was effective in increasing participants' reported knowledge and understanding of solution-focused brief therapy and their self-reported use of the techniques in routine clinical practice. In conclusion, this study has established that staff from a variety of professional and non-professional backgrounds can make good skill acquisition from a fairly modest training. Additionally, the current study has also highlighted the need for well-conducted large-scale trials of this potentially important technology. [source] Thrombin generation time is a novel parameter for monitoring enoxaparin therapy in patients with end-stage renal diseaseJOURNAL OF THROMBOSIS AND HAEMOSTASIS, Issue 2 2006D. F. BROPHY Summary.,Background:,Patients with end-stage renal disease (ESRD) who receive enoxaparin are at increased risk for adverse bleeding episodes. This phenomenon appears to occur despite judicious monitoring of antifactor Xa (aFXa) activity. Better monitoring parameters are needed to quantify the anticoagulant effects of enoxaparin in the ESRD population. Objectives:,The objective of this study was to determine the utility of using thrombin generation time (TGT), platelet contractile force (PCF) and clot elastic modulus (CEM) to monitor the degree of anticoagulation in ESRD subjects, and to compare these results to aFXa activity, the current gold-standard monitoring parameter. Methods:,Eight healthy volunteers without renal dysfunction and eight ESRD subjects were enrolled into this study. Subjects received a single dose of enoxaparin 1 mg kg,1 subcutaneously, and blood samples were obtained for the determination of aFXa activity, TGT, PCF and CEM at baseline, 4, 8, and 12 h postdose. Results:,Baseline, 4, 8, and 12-h aFXa activity concentrations were not different between groups. However, the corresponding TGT at 8 and 12 h was significantly prolonged in the ESRD group (P = 0.04, and P = 0.008, respectively). The 4-h peak TGT trended toward significance (P = 0.06). There were no differences in PCF or CEM across time. Conclusions:,These data suggest that the parameter aFXa activity is a poor predictor of the anticoagulant effect of enoxaparin in patients with ESRD. Thrombin generation time appears to be more sensitive to the antithrombotic effects of enoxaparin in this population. Further large-scale trials are needed to corroborate these data. [source] Contributions of Anopheles larval control to malaria suppression in tropical Africa: review of achievements and potentialMEDICAL AND VETERINARY ENTOMOLOGY, Issue 1 2007K. WALKER Abstract Malaria vector control targeting the larval stages of mosquitoes was applied successfully against many species of Anopheles (Diptera: Culicidae) in malarious countries until the mid-20th Century. Since the introduction of DDT in the 1940s and the associated development of indoor residual spraying (IRS), which usually has a more powerful impact than larval control on vectorial capacity, the focus of malaria prevention programmes has shifted to the control of adult vectors. In the Afrotropical Region, where malaria is transmitted mainly by Anopheles funestus Giles and members of the Anopheles gambiae Giles complex, gaps in information on larval ecology and the ability of An. gambiae sensu lato to exploit a wide variety of larval habitats have discouraged efforts to develop and implement larval control strategies. Opportunities to complement adulticiding with other components of integrated vector management, along with concerns about insecticide resistance, environmental impacts, rising costs of IRS and logistical constraints, have stimulated renewed interest in larval control of malaria vectors. Techniques include environmental management, involving the temporary or permanent removal of anopheline larval habitats, as well as larviciding with chemical or biological agents. This present review covers large-scale trials of anopheline larval control methods, focusing on field studies in Africa conducted within the past 15 years. Although such studies are limited in number and scope, their results suggest that targeting larvae, particularly in human-made habitats, can significantly reduce malaria transmission in appropriate settings. These approaches are especially suitable for urban areas, where larval habitats are limited, particularly when applied in conjunction with IRS and other adulticidal measures, such as the use of insecticide treated bednets. [source] Is laparoscopic surgery acceptable for advanced colon cancer?CANCER SCIENCE, Issue 4 2009Seigo Kitano Laparoscopic surgery is widespread in the treatment of colorectal cancer. In Japan, a nationwide survey has shown that the rate of advanced colorectal cancer has increased gradually to 65% of total laparoscopic surgeries in 2007. Many randomized controlled trials have demonstrated that in the short term, laparoscopic surgery is feasible, safe, and has many benefits, including reduction of peri-operative mortality. In terms of long-term outcomes, four randomized controlled trials suggest that there are no differences in laparosupic and open surgery for colon cancer. However, important issues, including long-term oncological outcome, cost effectiveness, and the impact on the quality of life of patients, should be addressed in well-designed large-scale trials. In Japan, a retrospective multicenter study has demonstrated that the short-term outcomes of laparoscopic surgery are beneficial, and the long-term outcomes are the same as for open surgery. In 2004, a prospective large-scale randomized controlled trial (JCOG0404) to compare laparoscopic surgery with open surgery was started to evaluate oncological outcomes for advanced colon cancer. This trial is supported in part by a Grant-in-Aid for Cancer Research from the Japanese Ministry of Health, Labour, and Welfare. In the present study, laparoscopic surgery is found to be acceptable for stage I disease of colon cancer, whereas it is controversial for stage II/III disease because of inadequate clinical evidence. Whether laparoscopic surgery is acceptable for advanced colon cancer or not should be confirmed by the Japanese large-scale prospective randomized controlled trial (JCOG0404) in the near future. (Cancer Sci 2009; 100: 567,571) [source] Understanding risk in hypercholesterolemiaCLINICAL CARDIOLOGY, Issue S1 2003John C. Larosa M.D. President Abstract Atherosclerosis was relatively uncommon 100 years ago, when researchers first established its link to elevated cholesterol. As the twentieth century progressed, however, factors such as high-fat diets, sedentary lifestyles, cigarette smoking, and urbanization combined to increase the prevalence of both hypercholesterolemia and coronary heart disease (CHD) throughout the developed world. Atherogenesis begins at an early age and progresses throughout life, and cholesterol levels during young adulthood strongly predict the risk of CHD and related mortality during the ensuing decades. The total cholesterol level in youth also determines the actual age at which a critical level of atherosclerosis will be reached. Early studies on the primary and secondary prevention of CHD failed to identify a linear relationship between lipid lowering and risk reduction, primarily because older lipid-lowering agents lacked the potency to reduce cholesterol levels significantly enough to achieve lower cardiovascular event and mortality rates. The introduction of the statins, with their powerful lipid-lowering activity, overcame this limitation. Several large-scale trials of statins firmly established the efficacy of these agents in both primary and secondary CHD prevention. With the availability of statin therapy, we are now able to reduce the risk of major adverse CHD events by an average of 30%, regardless of patient age or gender. [source] | ||||||||||