"Flogging dead horses": evaluating when have clinical trials achieved sufficiency and stability? A case study in cardiac rehabilitation

<p>Abstract</p> <p>Background</p> <p>Most systematic reviews conclude that another clinical trial is needed. Measures of sufficiency and stability may indicate whether this is true.</p> <p>Objectives: To show how evidence accumulated on centre-based versus home-based cardiac rehabilitation, including estimates of sufficiency and stability</p> <p>Methods</p> <p>Systematic reviews of clinical trials of home versus centre-based cardiac rehabilitation were used to develop a cumulative meta-analysis over time. We calculated the standardised mean difference (SMD) in effect, confidence intervals and indicators of sufficiency and stability. Sufficiency refers to whether the meta-analytic database adequately demonstrates that an intervention works - is statistically superior to another. It does this by assessing the number of studies with null results that would be required to make the meta-analytic effect non-statistically significant. Stability refers to whether the direction and size of the effect is stable as new studies are added to the meta-analysis.</p> <p>Results</p> <p>The standardised mean effect difference reduced over fourteen comparisons from a non-significant difference favouring home-based cardiac rehabilitation to a very small difference favouring hospital (SMD -0.10, 95% CI -0.32 to 0.13). This difference did not reach the sufficiency threshold (failsafe ratio 0.039 < 1) but did achieve the criteria for stability (cumulative slope 0.003 < 0.005).</p> <p>Conclusions</p> <p>The evidence points to a relatively small effect difference which was stable but not sufficient in terms of the suggested thresholds. Sufficiency should arguably be based on substantive significance and decided by patients. Research on patient preferences should be the priority. Sufficiency and stability measures are useful tools that need to be tested in further case studies.</p

Internet of things: where to be is to trust

[EN] Networks' creation is getting more and more required, anytime, anywhere. Devices that can participate on these networks can be quite different among them. Sensors, mobiles, home appliances, or other type of devices will have to collaborate to increase and improve the services provided to clients. In the same way, network configuration, security mechanisms establishment, and optimal performance control must be done by them. Some of these devices could have limited resources to work, sometimes even resources restriction not existing, they must work to optimize network traffic. In this article, we center our researching on spontaneous networks. We propose a secure spontaneous ad-hoc network, based on direct peer-to-peer interaction and communities' creation to grant a quick, easy, and secure access to users to surf the Web. Each device will have an identity in the network. Each community will also have an identity and will act as a unity on a world based on Internet connection. Security will be established in the moment they access to the network through the use of the trust chain generated by nodes. Trust is modified by each node on the basis of nodes behaviorLacuesta, R.; Palacios-Navarro, G.; Cetina Englada, C.; Peñalver Herrero, ML.; Lloret, J. (2012). Internet of things: where to be is to trust. EURASIP Journal on Wireless Communications and Networking. (203):1-16. doi:10.1186/1687-1499-2012-203S116203Lipnack J, Stamps J: Virtual Teams: Researching Across Space, Time, and Organizations with Technology. New York: John Wiley and Sons; 1997.Ahuja MK, Carley KN: Network structure in virtual organizations, organization science, Vol. 10, No. 6, Special Issue: Communication Processes for Virtual Organizations, November–December. 1999, 741-757.Mowshowitz A: Virtual organization. Commun ACM 1997, 40(9):30-37. 10.1145/260750.260759Preuß S: CH Cap, Overview of spontaneous networking-evolving concepts and technologies, in Rostocker Informatik-Berichte. 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A higher effort-based paradigm in physical activity and exercise for public health: making the case for a greater emphasis on resistance training

It is well known that physical activity and exercise is associated with a lower risk of a range of morbidities and all-cause mortality. Further, it appears that risk reductions are greater when physical activity and/or exercise is performed at a higher intensity of effort. Why this may be the case is perhaps explained by the accumulating evidence linking physical fitness and performance outcomes (e.g. cardiorespiratory fitness, strength, and muscle mass) also to morbidity and mortality risk. Current guidelines about the performance of moderate/vigorous physical activity using aerobic exercise modes focuses upon the accumulation of a minimum volume of physical activity and/or exercise, and have thus far produced disappointing outcomes. As such there has been increased interest in the use of higher effort physical activity and exercise as being potentially more efficacious. Though there is currently debate as to the effectiveness of public health prescription based around higher effort physical activity and exercise, most discussion around this has focused upon modes considered to be traditionally ‘aerobic’ (e.g. running, cycling, rowing, swimming etc.). A mode customarily performed to a relatively high intensity of effort that we believe has been overlooked is resistance training. Current guidelines do include recommendations to engage in ‘muscle strengthening activities’ though there has been very little emphasis upon these modes in either research or public health effort. As such the purpose of this debate article is to discuss the emerging higher effort paradigm in physical activity and exercise for public health and to make a case for why there should be a greater emphasis placed upon resistance training as a mode in this paradigm shift

PHYSICAL INACIVITY IN ADULTS WITH RHEUMATIC DISEASES

15th Annual European Congress of Rheumatology (EULAR) -- JUN 11-14, 2014 -- Paris, FRANCEWOS: 000346919806511

PHYSICAL ACTIVITY LEVEL AND PHYSICAL FITNESS IN PATIENTS WITH RHEUMATOID ARTHRITIS

WOS: 000331587905577

THE EFFECTS OF AEROBIC EXERCISE TRAINING ON PAIN AND DISABILITY FROM OSTEOARTHRITIS OF THE KNEE IN POSTMENOPAUSAL WOMEN

Congress of the European-League-Against-Rheumatism (EULAR) -- JUN 13-16, 2018 -- Amsterdam, NETHERLANDSWOS: 000444351005530…European League Against Rheumatis

Comparison Of Supervised Exercise Training And Home-Based Exercise Training In Chronic Heart Failure

Objective: This study was planned to compare the outcomes between supervised and home-based exercise training in patients with chronic heart failure. Methods: The study was conducted at the Department of Physical Therapy in Ankara University, Faculty of Medicine, Turkey between 2000 and 2001. Twenty-two patients with stable chronic heart failure were randomly assigned to the supervised exercise training group (n=11) or the home-based exercise training group (n=11). Symptom-limited maximal exercise tests with gas exchange analysis were carried out before randomization. Work load equivalent to 60% of achieved peak heart rate at the tests was determined as exercise training work load for each subject. Both groups participated in a program of 3 exercise training sessions per week for 3 months. The exercise tests were repeated after 3 months. Results: After training, peak exercise duration increased significantly in the supervised exercise training group and the home-based exercise training group (p0.05). Conclusion: Supervised and home-based exercise training enhanced exercise capacity in patients with chronic heart failure. The training program must be tailored to each patient's specific limitations, individual needs and possibilities. Home-based exercise training may be a training alternative to stable chronic heart failure patients who prefer not to participate in an outpatient supervised training program.Wo