Topic
Randomized controlled trial
About: Randomized controlled trial is a research topic. Over the lifetime, 119828 publications have been published within this topic receiving 4861808 citations. The topic is also known as: RCT & randomized control trial.
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TL;DR: The restricted perioperative intravenous fluid regimen aiming at unchanged body weight reduces complications after elective colorectal resection.
Abstract: Objective: To investigate the effect of a restricted intravenous fluid regimen versus a standard regimen on complications after colorectal resection. Summary Background Data: Current fluid administration in major surgery causes a weight increase of 3‐ 6 kg. Complications after colorectal surgery are reported in up to 68% of patients. Associations between postoperative weight gain and poor survival as well as fluid overload and complications have been shown. Methods: We did a randomized observer-blinded multicenter trial. After informed consent was obtained, 172 patients were allocated to either a restricted or a standard intraoperative and postoperative intravenous fluid regimen. The restricted regimen aimed at maintaining preoperative body weight; the standard regimen resembled everyday practice. The primary outcome measures were complications; the secondary measures were death and adverse effects. Results: The restricted intravenous fluid regimen significantly reduced postoperative complications both by intention-to-treat (33% versus 51%, P 0.013) and per-protocol (30% versus 56%, P 0.003) analyses. The numbers of both cardiopulmonary (7% versus 24%, P 0.007) and tissue-healing complications (16% versus 31%, P 0.04) were significantly reduced. No patients died in the restricted group compared with 4 deaths in the standard group (0% versus 4.7%, P 0.12). No harmful adverse effects were observed. Conclusion: The restricted perioperative intravenous fluid regimen aiming at unchanged body weight reduces complications after elective colorectal resection.
1,348 citations
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TL;DR: In patients with moderate to severe AD receiving stable doses of donepezil, memantine resulted in significantly better outcomes than placebo on measures of cognition, activities of daily living, global outcome, and behavior and was well tolerated.
Abstract: ContextMemantine is a low- to moderate-affinity, uncompetitive N-methyl-D-aspartate receptor antagonist. Controlled
trials have demonstrated the safety and efficacy of memantine monotherapy
for patients with moderate to severe Alzheimer disease (AD) but no controlled
trials of memantine in patients receiving a cholinesterase inhibitor have
been performed.ObjectiveTo compare the efficacy and safety of memantine vs placebo in patients
with moderate to severe AD already receiving stable treatment with donepezil.Design, Setting, and ParticipantsA randomized, double-blind, placebo-controlled clinical trial of 404
patients with moderate to severe AD and Mini-Mental State Examination scores
of 5 to 14, who received stable doses of donepezil, conducted at 37 US sites
between June 11, 2001, and June 3, 2002. A total of 322 patients (80%) completed
the trial.InterventionsParticipants were randomized to receive memantine (starting dose 5 mg/d,
increased to 20 mg/d, n = 203) or placebo (n = 201) for 24 weeks.Main Outcome MeasuresChange from baseline on the Severe Impairment Battery (SIB), a measure
of cognition, and on a modified 19-item AD Cooperative Study–Activities
of Daily Living Inventory (ADCS-ADL19). Secondary outcomes included
a Clinician's Interview-Based Impression of Change Plus Caregiver Input (CIBIC-Plus),
the Neuropsychiatric Inventory, and the Behavioral Rating Scale for Geriatric
Patients (BGP Care Dependency Subscale).ResultsThe change in total mean (SE) scores favored memantine vs placebo treatment
for SIB (possible score range, 0-100), 0.9 (0.67) vs –2.5 (0.69), respectively
(P<.001); ADCS-ADL19 (possible score
range, 0-54), –2.0 (0.50) vs –3.4 (0.51), respectively (P = .03); and the CIBIC-Plus (possible score range, 1-7),
4.41 (0.074) vs 4.66 (0.075), respectively (P = .03).
All other secondary measures showed significant benefits of memantine treatment.
Treatment discontinuations because of adverse events for memantine vs placebo
were 15 (7.4%) vs 25 (12.4%), respectively.ConclusionsIn patients with moderate to severe AD receiving stable doses of donepezil,
memantine resulted in significantly better outcomes than placebo on measures
of cognition, activities of daily living, global outcome, and behavior and
was well tolerated. These results, together with previous studies, suggest
that memantine represents a new approach for the treatment of patients with
moderate to severe AD.
1,339 citations
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1,334 citations
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Dartmouth College1, University of North Carolina at Chapel Hill2, University of Southern California3, University of Colorado Denver4, Veterans Health Administration5, Henry Ford Health System6, University of Toronto7, University of Iowa8, Cleveland Clinic9, University of Minnesota10, Emory University11
TL;DR: Low-dose aspirin has a moderate chemopreventive effect on adenomas in the large bowel, using generalized linear models to compute risk ratios and 95 percent confidence intervals.
Abstract: Background Laboratory and epidemiologic data suggest that aspirin has an antineoplastic effect in the large bowel. Methods We performed a randomized, double-blind trial of aspirin as a chemopreventive agent against colorectal adenomas. We randomly assigned 1121 patients with a recent history of histologically documented adenomas to receive placebo (372 patients), 81 mg of aspirin (377 patients), or 325 mg of aspirin (372 patients) daily. According to the protocol, follow-up colonoscopy was to be performed approximately three years after the qualifying endoscopy. We compared the groups with respect to the risk of one or more neoplasms (adenomas or colorectal cancer) at least one year after randomization using generalized linear models to compute risk ratios and 95 percent confidence intervals. Results Reported adherence to study medications and avoidance of nonsteroidal antiinflammatory drugs were excellent. Follow-up colonoscopy was performed at least one year after randomization in 1084 patients (97 perc...
1,330 citations
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TL;DR: Carotid endarterectomy reduced the overall incidence of ipsilateral neurologic events in a selected group of male patients with asymptomatic carotid stenosis, and overall mortality was primarily due to coronary atherosclerosis.
Abstract: Background The efficacy of carotid endarterectomy in patients with asymptomatic carotid stenosis has not been confirmed in randomized clinical trials, despite the widespread use of operative intervention in such patients. Methods We conducted a multicenter clinical trial at 11 Veterans Affairs medical centers to determine the effect of carotid endarterectomy on the combined incidence of transient ischemic attack, transient monocular blindness, and stroke. We studied 444 men with asymptomatic carotid stenosis shown arteriographically to reduce the diameter of the arterial lumen by 50 percent or more. The patients were randomly assigned to optimal medical treatment including antiplatelet medication (aspirin) plus carotid endarterectomy (the surgical group; 211 patients) or optimal medical treatment alone (the medical group; 233 patients). All the patients at each center were followed independently by a vascular surgeon and a neurologist for a mean of 47.9 months. Results The combined incidence of ipsilatera...
1,324 citations