Department of Clinical Research

Abstract

Background:

Palliative care aims to alleviate suffering, improve quality of life, and address distressing symptoms in people with advanced disease. Despite its clinical importance, many interventions—particularly pharmacological approaches—are supported by limited high-quality evidence, with recommendations often relying on expert consensus or long-standing routine. Clinical trials are essential to strengthen the evidence base, yet research in palliative care faces well-described barriers such as recruitment challenges, underpowered studies, and premature termination. To our knowledge, no meta-research study has systematically mapped the clinical-trial landscape in palliative care. This review intends to establish a benchmark for research activity, identify under-represented areas, and outline priorities for future investigation, including recruitment expectations and attrition estimates.

Objectives:

This systematic review provides a comprehensive overview of clinical trials conducted in palliative care over the past two decades. We aim to (1) quantify the number, scope, and characteristics of registered and published trials; (2) identify which symptoms and interventions are studied more intensively, and compare this with the known prevalence of symptoms in advanced disease; and (3) document rates and reasons for non-completion or non-publication of registered studies.

Methods:

We will search major trial registries (ClinicalTrials.gov, WHO ICTRP, EudraCT) and bibliographic databases for interventional studies in adult palliative-care populations registered between 2000 and 2020. Eligible studies include prospective interventional designs; pediatric studies and disease-modifying cancer therapies will be excluded. Two reviewers will independently screen records and extract data using piloted forms. Discrepancies between registered and published outcomes will be assessed, and reasons for non-publication will be sought by contacting investigators. Descriptive statistics will summarize study characteristics, with subgroup analyses by symptom category, intervention type, sponsor, and region. Meta-analysis of publication rates will be conducted if appropriate.

Background: Assessment of the pupils regarding symmetry and reactivity to light are important parts of the neurological evaluation of critically ill patients treated in intensive care units. Thereby, anisocoria can be found in up to 60% of patients with acute neurologic injuries(2). Furthermore, anisocoria or pupillary areflexia can be signs of increasing intracranial hypertension with brain herniation, ischemia in traumatic brain injury, cerebrovascular accidents, intoxication with psychotropic and neurotropic drugs including anticholinergic, opioids, and cannabinoids. While anisocoria or impaired pupillary reactivity may result from such devastating cerebral injuries, they can also be caused by more benign and potentially reversible scenarios, such as pharmacological effects (e.g. agents such as ipatroprium bromide) or as part of the Horner’s syndrome following jugular central venous cannulation. Despite these well-known underlying pathomechanisms of pupillary anomalias, data on the prevalence and associated clinical consequences of anisocoria in non-selected general ICU populations is scarce. Due to the lack of data on the prognostic implications of anisocoria or changes in pupillary reactivity for non-neurological ICU patients, the new onset of any pupillary abnormality necessitates a rapid and thorough evaluation usually including clinical neurological examination and the performance of neuroimaging, such as a cerebral computed tomography (CT) or magnetic resonance imaging (MRI). Considering the the variety of more benign and reversible causes of pupillary abnormalities, alongside the potential for missed underlying pathomechanisms with severe clinical implications, it is highly probable that a significant number of unremarkable CT or MRI scans are conducted to investigate acute pupillary abnormalities. This practice may expose patients to unnecessary risks and contribute to increased healthcare costs. While quantitative pupillometry with dynamic pupil assessments after light has shown some promise to distinguish between clinically relevant anisocoria and benign variations, further validation is still lacking. Unfortunately, studies elucidating to what extent a cerebral CT or MRI detects clinically relevant findings in specific patient groups with particular clinical contexts, and in which clinical scenarios CTs are likely to provide no clinical relevance beyond exposing the patient to radiation are still pending.

Objectives: This retrospective single-center cohort study has four primary objectives. 

-   First, it aims to determine the prevalence of acute "new onset" pupillary abnormalities (anisocoria and/or impaired light-reactive pupillary response) in adult ICU patients. 

-   Second, it seeks to assess the clinical impact of these abnormalities, particularly in terms of the frequency of diagnostic tests ordered, such as neuroimaging (i.e., head CT or MRI scans, and ophthalmologic and neurologic consultations. 

-   Third, the study aims to identify specific clinical contexts in which significant pathological findings lead to treatment modifications, as well as those scenarios where no clinically relevant findings are detected.

-   Finally, it evaluates the prognostic implications of these pupillary abnormalities on patient outcomes.

There is widespread concern about how screen use might affect children’s development, but studies on this topic yelded mixed results. This is probably due to the fact that it is not just the time that children spend in front of a screen that matters, but also what children are watching and under what circumstances. Therefore, the goal of this study is to examine whether child screen time is a risk factor for child development, considering additional factors that might play a role, such as screen content, parental motivations, time of day, non-screen based activities, sleep, and physical activity. The present study thus adresses three research questions: 1) How do young children in Switzerland use screens and how does this change during childhood? 2) Is child screen time a longitudinal risk factor for socio-emotional, language, and motor development? and 3) Which factors play a role in the longitudinal associations between child screen time and socio-emotional, language, and motor development?

To answer these questions, we are conducting a study with three timepoints each one year apart. At each timepoint, parents will answer online surveys on child screen use and socio-emotional, language, and motor developmental outcomes. Some parents will be invited to also complete a web add-on with additional online surveys and in-depth screen use assessment and a lab add-on with behavioral tests that measure child socio-emotional, language, and motor development, as well as a parent-child interaction during joint screen use.

This study will be the largest longitudinal study on children’s screen use starting in early childhood in Switzerland.

Imported from Grants Tool 4717721