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We propose a methodology for conducting phase II clinical trials in settings where the disease is categorized into multiple subtypes.
Few randomized clinical trials have been conducted.
This study shows that a selected group of clinical trials, some of which were controversial and expensive, were indeed a good investment.
Open accessJournal ArticleDOI
Carmen Tur, Xavier Montalban 
20 Citations
Third, outcome measures used in future phase 2 and phase 3 trials should be highly sensitive and be accompanied by smart trial designs.
Both phase 0 and phase II NF2 trials are near-term options for NF2 clinical trials.
Findings from small pilot studies suggest that phase II and III clinical trials result in at most modest increases in cost over standard treatment costs.
This has implications for patients' planning on participating in phase I clinical trials.
Clinical trial simulation can improve decisions made in learning Phase I and Phase II studies, leading to better designs and reduced chance of failure in high-cost, confirmatory Phase III trials.
As the main cost drivers in these phase II clinical trials are laboratory and imaging tests, the cost of clinical trials could potentially be reduced by ensuring that only essential tests are required by protocol.
Open accessJournal ArticleDOI
11 Dec 1999-BMJ
60 Citations
#### Summary points Clinical trials should be registered so that essential details are made public from a trial's inception, rather than from publication many years later Openness about trials in progress reduces the …
These methods are useful for designing stratified phase II clinical trials.
The observations that many new therapeutics “fail” in definitive phase III studies, coupled with the numbers of new agents to be tested as well as the increasing costs and complexity of clinical trials, further emphasize the critical importance of robust and efficient phase II design.
However, the lack of reproducibility is more likely due to small sample sizes for phase I trials and differences between patients enrolled on phase I trials and those enrolled on phase II and II trials.
As a result, accurately informed patients may reasonably decide to enroll in phase 1 oncology trials in hopes of obtaining benefit, after considering the anticipated risks and available clinical alternatives.
We develop the method in the context of phase II oncology trials, but the method applies readily to other clinical areas in which multiple responses per patient are of interest.

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Current treatment approaches and limitations of Metabolic Disorders ?
6 answers
The treatment landscape for metabolic disorders encompasses a variety of strategies, each with its own set of limitations and challenges. Traditional pharmacotherapy and surgery have been the mainstay treatments, but they often fall short in terms of efficacy and patient compliance. This is particularly true for systemic drug therapy, which is limited and ineffective for many metabolic disorders, leading to reduced patient adherence to treatment protocols. The discomfort and inconvenience associated with daily insulin injections for diabetics exemplify the challenges in patient compliance and highlight the need for more effective delivery systems. Emerging therapeutic approaches, such as gene editing and RNA interference, target the genetic underpinnings of metabolic disorders. These novel strategies offer hope for more precise and personalized treatments but are still in the developmental stages, especially for less common disorders like Krabbe and Gaucher diseases, where research and development investment is lacking. Moreover, inherited metabolic diseases (IMDs), which are mostly monogenic, have seen advancements in gene therapy, cellular therapies, and organ transplantation. However, these interventions cannot fully cure the main genetic defects, indicating a gap between therapeutic potential and actual clinical outcomes. The complexity of metabolic disorders, such as obesity and type 2 diabetes mellitus (T2DM), requires multifaceted treatment approaches. Combination pharmacotherapy targeting multiple signaling pathways has emerged as a promising strategy, yet the sustainability and efficacy of current pharmacological options remain limited. Interventional metabolic therapy, including bariatric arterial embolization (BAE) and endovascular denervation (EDN), represents a novel and less invasive treatment avenue. These techniques, however, are still under investigation for their safety and effectiveness. In the context of dilated cardiomyopathy (DCM), metabolic dysfunction has been identified as a potential therapeutic target. Small-scale pilot trials have shown some success in enhancing cardiac function through metabolic interventions, yet large-scale clinical trials are lacking. This underscores a broader issue in the treatment of metabolic disorders: the need for comprehensive clinical validation of new therapeutic approaches to ensure they can meet the complex needs of patients.
How to achieve goals on time?
5 answers
To achieve goals on time, individuals must consider the temporal aspects of their work and personal development, acknowledging the difference between chronology and temporality. Preparation for timely completion of tasks begins early, with the development of academic self-esteem in high school and a personal vision for success. Self-motivation and determination play crucial roles in meeting deadlines, with internal and external motivation sources being significant factors. Creating a detailed plan from the outset, incorporating it into regular academic advising sessions, and updating it as progress is made are essential for on-time goal achievement. Additionally, active engagement in campus life through clubs, organizations, or athletics can enhance persistence and support timely completion of objectives. By understanding and leveraging these temporal and motivational factors, individuals can increase their likelihood of achieving goals on time.
How much sleep does an elite athlete need?
4 answers
Elite athletes generally require around 8.3 hours of sleep to feel rested, as indicated by self-assessment surveys and objective sleep monitoring studies. However, despite this perceived need, many elite athletes fall short of obtaining sufficient sleep, with only 3% achieving their required amount and 71% experiencing a sleep deficit of an hour or more. Studies have shown that poor sleep quality, irregular sleep-wake patterns, and environmental factors like blue-light exposure can impact athletes' sleep hygiene and overall restfulness. Additionally, both elite and sub-elite athletes report poor sleep quality, high levels of fatigue, stress, and pain, emphasizing the importance of individualized support for optimizing sleep and recovery practices in athletes. Inadequate sleep quantity and quality can negatively affect an athlete's physical and mental performance, highlighting the significance of prioritizing optimal sleep habits in elite sports training.
Can micronutrient supplementation improve the outcomes of wound healing in postoperative elderly patients?
5 answers
Micronutrient supplementation has the potential to enhance wound healing outcomes in postoperative elderly patients. Research suggests that micronutrients play a crucial role in metabolic function, wound healing, and infection prevention. While macronutrient supplementation is well-documented, the use of vitamins and minerals for optimizing wound healing lacks official recommendations. Studies have shown that specific micronutrients like vitamins A, B, D, E, and minerals such as zinc, calcium, and selenium can improve outcomes in various wound types. Additionally, oral nutritional supplements containing minerals, vitamins, and antioxidants have been found to be more beneficial in wound healing compared to non-enriched protein supplements, especially in diabetic foot and pressure ulcers. Therefore, incorporating micronutrient supplementation tailored to individual needs may be a promising strategy to enhance wound healing in elderly postoperative patients.
What are the meta analyses done on amphbians so far?
5 answers
Meta-analyses on amphibians have covered various aspects. Studies have focused on the impact of pollutants, showing a medium decrease in survival and mass, along with a large increase in abnormality frequency due to exposure to pollutants like nitrogenous compounds and heavy metals. Additionally, research has explored the effects of UVB radiation on amphibians, revealing a 1.9-fold reduction in survival compared to shielded controls, with larvae being more susceptible than embryos, and salamanders more than frogs and toads. Furthermore, synergistic interactions between UVB radiation and other stressors have been observed, leading to greater than additive effects on survival. Moreover, the influence of alien species on native amphibians has been investigated, indicating a significant decrease in amphibian performance and behavioral activity in the presence of alien species, particularly invertebrates.
What are the current statistics on the prevalence of smoking among high school students in the United States?
5 answers
In the United States, the prevalence of smoking among high school students remains a significant public health concern. According to recent data from the National Youth Tobacco Survey (NYTS) in 2021, approximately 13.4% of high school students, totaling 2.06 million individuals, reported current (past 30-day) use of a tobacco product, with electronic cigarettes (e-cigarettes) being the most commonly used product. Additionally, the survey revealed that 11.3% of middle school students, equivalent to 1.34 million students, reported ever using a tobacco product. These findings underscore the ongoing challenge of tobacco use among youth despite efforts to curb its prevalence, emphasizing the importance of continued surveillance and comprehensive tobacco control strategies to address this issue.
What is ileus?
4 answers
Ileus refers to a condition characterized by impaired gastrointestinal transit, commonly occurring after abdominal surgery. The pathophysiology of ileus involves multifactorial influences, with early dysfunction linked to opioid use and autonomic shifts, while prolonged postoperative ileus (PPOI) is more associated with inflammation. It is crucial to differentiate between mechanical and functional ileus, with management typically being supportive and involving identification and treatment of the underlying cause. Diagnosis of ileus relies on clinical symptoms such as nausea, vomiting, and distension, along with radiological confirmation. Treatment approaches have evolved, with conservative management becoming more common, particularly for small bowel ileus, reducing the necessity for immediate surgical intervention.
What is development research design?
5 answers
Development research design involves creating a structured plan to investigate the feasibility and acceptability of implementing interventions before full-scale evaluation. It aims to understand the needs of the target audience, design appropriate interventions, and assess their effectiveness. This type of research is crucial in various fields, including project management and drug development, where innovative approaches are being explored. Development research often utilizes models like ADDIE to guide the process, ensuring that the designed interventions align with the desired outcomes and are validated by experts. By combining the knowledge gained from research with the insights derived from design, development research can lead to improved interventions and theories, benefiting both specific interventions and broader theoretical frameworks.
How treat iga nefropathy?
5 answers
The treatment of IgA nephropathy involves a multifaceted approach. Supportive therapy, such as renin-angiotensin system blockade, is commonly utilized, especially for patients with less severe histological changes. In cases where patients exhibit endocapillary proliferative changes or crescentic morphology, immunosuppressive therapy, including corticosteroids, is often effective. Clinical guidelines recommend a combination of immunosuppressive agents like corticosteroids, cytostatics, cyclosporine A, and mycophenolate-mofetil for adults with severe IgA nephropathy. Additionally, non-immunosuppressive therapies like ACE inhibitors, angiotensin II receptor blockers, fish oil, statins, and antiplatelets are also considered beneficial in managing IgA nephropathy. Overall, treatment decisions should be individualized based on the patient's clinical presentation and histological findings, aiming to optimize outcomes and minimize adverse effects.
What are the negative of having a structured paedogological approach?
4 answers
Having a structured paedological approach in managing paediatric emergencies can lead to challenges in assessing and managing children with stroke due to the wide variation in clinical features and underlying causes. However, a structured approach by checklist during trauma resuscitation may improve adherence to guidelines and potentially reduce mortality among severely injured patients compared to a non-structured approach. Additionally, the quality of actual palliative care service for children and adolescents with end-stage renal disease was rated as moderate, indicating room for improvement in palliative care structures within paediatric nephrology. Despite these challenges, structured approaches remain essential for ensuring a logical and effective management of paediatric emergencies.
What are the potential challenges and limitations associated with implementing telecommunications-based remote decentralized clinical trials in neurology?
5 answers
Implementing telecommunications-based remote decentralized clinical trials in neurology presents several challenges and limitations. These include issues related to the feasibility of decentralized clinical trials (DCTs) in Alzheimer's disease (AD), the need for careful consideration of challenges concerning equity in digital health, and the potential disparities between internet and non-internet participants in terms of demographics and health status. Furthermore, the sensitivity and reliability of digital endpoints in assessing neurodegenerative diseases need to be thoroughly evaluated. Overall, the challenges encompass the feasibility of DCTs in AD, ensuring equity in digital health, addressing demographic disparities among participants, and validating the effectiveness of digital endpoints in neurodegenerative disease assessment.