Utilization and responsiveness of the asthma control test (ACT) at the initiation of therapy for patients with asthma: a randomized controlled trial

<p>Abstract</p> <p>Background</p> <p>The aim of this study was to assess the responsiveness of the asthma control test (ACT) to detect changes at the initiation of therapy and its utilization in the initiation of asthma treatment.</p> <p>Methods</p> <p>This study was designed as a randomized clinical trial conducted in a primary care setting. The subjects were asthma patients who had not received controller therapy for at least two months. The patients were randomized into two groups: The Saudi Initiative for Asthma (SINA) group and the Global Initiative for Asthma (GINA) group. Treatment in the SINA group was initiated at step1 when the ACT scores ≥ 20, step 2 when the score between16-19, and step 3 when the score < 16 began at step 3. The GINA group patients were started on step 2 when they had persistent asthma symptoms or step 3 when they had severely uncontrolled disease.</p> <p>Results</p> <p>Forty-five patients were analyzed in each group. The improvement in ACT score after treatment initiation was significantly higher when the SINA approach was used (2.9 in the SINA group compared to 1.7 in the GINA group (<it>p </it>= 0.04)). The improvement in FEV₁was 5.8% in the SINA group compared to 3.4% in the GINA group (<it>p </it>= 0.46). The number of patients who achieved asthma control at the follow-up visit and required no treatment adjustment was 33 (73.3%) in the SINA group and 27 (60%) in the GINA group (<it>p </it>= 0.0125).</p> <p>Conclusion</p> <p>The ACT was responsive to change at the initiation of asthma treatment and was useful for the initiation of asthma treatment.</p> <p>Trial Registration number</p> <p><a href="http://www.controlled-trials.com/ISRCTN31998214">ISRCTN31998214</a></p

The pressure to communicate efficiently continues to shape language use later in life

Language use is shaped by a pressure to communicate efficiently, yet the tendency towards redundancy is said to increase in older age. The longstanding assumption is that saying more than is necessary is inefficient and may be driven by age-related decline in inhibition (i.e. the ability to filter out irrelevant information). However, recent work proposes an alternative account of efficiency: In certain contexts, redundancy facilitates communication (e.g., when the colour or size of an object is perceptually salient and its mention aids the listener’s search). A critical question follows: Are older adults indiscriminately redundant, or do they modulate their use of redundant information to facilitate communication? We tested efficiency and cognitive capacities in 200 adults aged 19–82. Irrespective of age, adults with better attention switching skills were redundant in efficient ways, demonstrating that the pressure to communicate efficiently continues to shape language use later in life

Modifying effect of dual antiplatelet therapy on incidence of stent thrombosis according to implanted drug-eluting stent type

Aim To investigate the putative modifying effect of dual antiplatelet therapy (DAPT) use on the incidence of stent thrombosis at 3 years in patients randomized to Endeavor zotarolimus-eluting stent (E-ZES) or Cypher sirolimus-eluting stent (C-SES). Methods and results Of 8709 patients in PROTECT, 4357 were randomized to E-ZES and 4352 to C-SES. Aspirin was to be given indefinitely, and clopidogrel/ticlopidine for ≥3 months or up to 12 months after implantation. Main outcome measures were definite or probable stent thrombosis at 3 years. Multivariable Cox regression analysis was applied, with stent type, DAPT, and their interaction as the main outcome determinants. Dual antiplatelet therapy adherence remained the same in the E-ZES and C-SES groups (79.6% at 1 year, 32.8% at 2 years, and 21.6% at 3 years). We observed a statistically significant (P = 0.0052) heterogeneity in treatment effect of stent type in relation to DAPT. In the absence of DAPT, stent thrombosis was lower with E-ZES vs. C-SES (adjusted hazard ratio 0.38, 95% confidence interval 0.19, 0.75; P = 0.0056). In the presence of DAPT, no difference was found (1.18; 0.79, 1.77; P = 0.43). Conclusion A strong interaction was observed between drug-eluting stent type and DAPT use, most likely prompted by the vascular healing response induced by the implanted DES system. These results suggest that the incidence of stent thrombosis in DES trials should not be evaluated independently of DAPT use, and the optimal duration of DAPT will likely depend upon stent type (Clinicaltrials.gov number NCT00476957