Radboud Universitair Medisch Centrum

To determine whether ivermectin improves outcomes for critically and noncritically ill hospitalized patients with COVID-19.

An ongoing international, multifactorial, adaptive platform, randomized, controlled trial.

Hospitals in Pakistan, India, and Ireland between June 11, 2021, and September 9, 2022.

Critically and noncritically ill patients.

Randomized to ivermectin or no ivermectin (control).

The primary outcome was respiratory and cardiovascular organ support-free days, assessed on an ordinal scale combining in-hospital death (assigned a value of –1) and days free of organ support through day 21 in survivors. Analyses used a Bayesian cumulative logistic model. Enrollment was closed for operational futility, following external evidence suggesting no benefit with ivermectin in nonhospitalized patients with COVID-19. Among 61 critically ill patients, the median number of organ support-free days was –1, indicating death was the most common vital outcome (interquartile range [IQR], –1 to 17), for the ivermectin group and –1 (IQR, –1 to 17.25) for the control group (adjusted proportional odds ratio [OR], 0.94; 95% credible interval [CrI], 0.40–2.07) and the posterior probability of superiority to control was 44.2%. Among 89 noncritically ill patients, the median number of organ support-free days was 22 (IQR, 18.5–22) for ivermectin and 22 (IQR, 16–22) for control (adjusted proportional OR, 1.04; 95% CrI, 0.48–2.34) and the posterior probability of superiority was 53.7%. Among critically ill patients, hospital survival was 35.1% (13/37) for ivermectin and 37.5% (9/24) for control (adjusted OR, 1.00; 95% CrI, 0.39–2.32), posterior probability of superiority was 50.0%. Among noncritically ill patients, hospital survival was 84.1% (37/44) for ivermectin and 77.8% (35/45) for control (adjusted OR, 1.16; 95% CrI, 0.5–3.07), posterior probability of superiority was 63.3%.

For critically and noncritically ill hospitalized patients with COVID-19, ivermectin was unlikely to improve the primary composite outcome of organ support-free days and hospital survival.

Treatment advancements in chronic myeloid leukaemia (CML) have made the disease manageable but carry significant risk of side effects. Bridging information gaps between patients and physicians through shared decision-making (SDM) is increasingly favoured, yet understanding treatment complexities remains a challenge. This study sought to identify decisional and informational needs of both patients and physicians in CML care.

A qualitative study using semi-structured interviews was conducted to investigate the opinions, attitudes and preferences of both patients with chronic myeloid leukaemia and physicians.

Patients and physicians were recruited through the Dutch CMyLife platform, an initiative of haematologists, patients and patient organisations. They were provided with the participant information and invited to participate if interested.

A total of 15 interviews (n=10 patients, n=5 physicians) were conducted between April and October 2023.

A pre-defined interview guide was developed based on the Decisional Needs Assessment questionnaire. Interview transcripts were thematically analysed.

Eight themes and 28 sub-themes were observed, highlighting patient needs, treatment choices and informational preferences. Patients emphasised the importance of understanding medication options and side effects, while physicians stressed the necessity of delivering up-to-date and comprehensible information. Almost all participants had experienced professionals making the treatment decision, without patient involvement, especially when initiating treatment. Some patients expressed too little information and missed partnership with professionals at treatment onset. Peer support, decision-making dynamics and the role of caregivers were also significant considerations.

Both shared and distinct perspectives on CML treatment decision-making between patients and physicians were revealed, underscoring the complexity of decisional needs in CML management. The findings emphasise the importance of patient-centred care, SDM and tailored communication strategies to optimise patient outcomes and satisfaction. Improved communication and evidence-based decision-making tools can significantly impact patient well-being. Further research and interventions are necessary to address the challenges in decision-making processes in CML care.

The current 'gold standard' of audiometry relies on subjective behavioural responses, which is impractical and unreliable for certain groups such as children, individuals with severe disabilities, or the disabled elderly. This study aims to validating blindly a novel electroencephalography (EEG) technique to estimate audiometric thresholds quickly.

Air-conduction audiometric thresholds at 250, 500, 1000, 2000, 4000, and 8000 Hz at 5 dB resolution were measured using three different systems: the novel EEG system, conventional pure-tone audiometry (PTA), and an automated behavioural test with the same stimulus properties as in the EEG test. EEG data were collected for 15 min from 32 semi-dry EEG electrodes. Later, the EEG system was trimmed to 8 electrodes and 7.5 min of data with satisfactory results. EEG and PTA thresholds were estimated blindly.

Audiometric thresholds were estimated from 10 elderly patients with asymmetric sensorineural hearing loss and five normal hearing young adults at both ears.

Correlation and regression analysis validated the hearing thresholds derived from both EEG configurations relative to the behavioural hearing thresholds - Spearman's correlation of 0.78 between PTA and 8-electrode 7.5-min EEG data.

The results of this study open the door to rapid and objective hearing threshold estimation with EEG.