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Background Asthma education programs (AEPs) have been shown to increase quality of life and reduce emergency treatments and hospital admissions. Despite the proven benefits, only a minority of asthma patients attend such programs. To increase the number of educated patients, an online education program (electronic AEP, eAEP) for asthma patients has been developed. The present study aims to investigate the effectiveness of the eAEP in terms of asthma knowledge, asthma control and emergency treatments in general practice settings. Methods This is a cluster randomized controlled trial including 100 patients with bronchial asthma from 20 general practices in Bavaria, Germany. General practices will be randomly assigned to either the intervention or control group. Patients in the intervention group will receive access to the eAEP and instructions to complete this program within two weeks. Patients in the control group will receive usual care including a referral to face-to-face AEP (fAEP) by a certified primary care physician or a pulmonologist according to guideline recommendations. Furthermore, patients of both the intervention and control groups will be invited to a follow-up consultation in their general practice after completion of the eAEP and fAEP (three weeks and twelve weeks after study inclusion, respectively) to discuss any open issues. Outcomes for both groups will be assessed at baseline (t0), after two weeks (t1), three months (t2) and six months (t3). The primary outcome is the comparison of asthma knowledge gain between intervention and control groups after completion of the eAEP (two weeks after study inclusion) and fAEP (twelve weeks after study inclusion), respectively. Secondary outcomes include asthma control, frequency of emergency treatments, patient autonomy as well as attitudes towards asthma medication. Discussion The results of the present trial will provide knowledge about the effectiveness of an online education program for asthma patients compared to usual care in primary care. Trial registration German Clinical Trials Register (DRKS), DRKS00028805. Registered 22 April 2022.

Whether bleeding and myocardial infarction (MI) improve the performance of risk prediction models for mortality in patients with acute coronary syndromes (ACS) treated with percutaneous coronary intervention (PCI) remains unknown.This study included 3377 patients with ACS who underwent PCI in the setting of the ISAR-REACT 5 trial. Patients with bleeding, MI or those dying at 1 year after PCI were characterized in terms of baseline characteristics, risk estimates and C-statistic of the risk prediction models for these outcomes.Major bleeding (Bleeding Academic Research Consortium types 3-5), MI and mortality occurred in 195 patients (5.8%), 143 patients (4.3%) and 143 patients (4.3%), respectively. After adjustment, bleeding [hazard ratio = 5.08; 95% confidence interval (CI), 3.03-8.53; P 0.001] and MI [hazard ratio = 5.90; 95% CI, (3.00-11.65); P 0.001) remained independently associated with the risk for 1-year mortality. The C-statistic (with 95% CI) of the model for bleeding, MI and mortality was, 0.755 (0.722-0.786), 0.752 (0.717-0.789) and 0.868 (0.837-0.896), respectively. The inclusion of bleeding [C-statistic: 0.892 (0.867-0.913); delta C-statistic 0.024 (-0.014 to 0.065); P = 0.200] or MI [C-statistic: 0.878 (0.851-0.903); delta C-statistic 0.011 (-0.030 to 0.053); P = 0.635] in the risk prediction models for mortality alongside baseline demographical and clinical variables did not improve prediction for mortality.In patients with ACS treated with PCI, mortality is the most accurately predicted outcome. Bleeding and MI did not improve risk discrimination for mortality when added in the risk prediction models for mortality suggesting that these outcomes do not provide incremental prognostic information on top of baseline demographical and clinical data.

Supplemental material, sj-docx-1-msj-10.1177_13524585221080542 for Association of pregnancies with risk of multiple sclerosis by Christiane Gasperi, Alexander Hapfelmeier, Antonius Schneider, Klaus A Kuhn, Ewan Donnachie and Bernhard Hemmer in Multiple Sclerosis Journal

Supplemental material, sj-docx-1-mdm-10.1177_0272989X21989692 for Educational Intervention Reduced Family Medicine Residents’ Intention to Request Diagnostic Tests: Results of a Controlled Trial by Antonius Schneider, Markus Bühner, Therese Herzog, Siona Laverty, Stefanie Ziehfreund, Alexander Hapfelmeier, Dagmar Schneider, Pascal O. Berberat and Marco Roos in Medical Decision Making

Supplemental material, sj-pdf-2-ctj-10.1177_1740774520984866 for A systematic review of subgroup analyses in randomised clinical trialsin cardiovascular disease by Korbinian J Brand, Alexander Hapfelmeier and Bernhard Haller in Clinical Trials

Additional file 1. Questionnaire.

Supplemental material, sj-pdf-2-ctj-10.1177_1740774520984866 for A systematic review of subgroup analyses in randomised clinical trialsin cardiovascular disease by Korbinian J Brand, Alexander Hapfelmeier and Bernhard Haller in Clinical Trials

Supplemental material, sj-pdf-1-ctj-10.1177_1740774520984866 for A systematic review of subgroup analyses in randomised clinical trialsin cardiovascular disease by Korbinian J Brand, Alexander Hapfelmeier and Bernhard Haller in Clinical Trials

Supplemental material, sj-docx-1-mdm-10.1177_0272989X21989692 for Educational Intervention Reduced Family Medicine Residents’ Intention to Request Diagnostic Tests: Results of a Controlled Trial by Antonius Schneider, Markus Bühner, Therese Herzog, Siona Laverty, Stefanie Ziehfreund, Alexander Hapfelmeier, Dagmar Schneider, Pascal O. Berberat and Marco Roos in Medical Decision Making

Additional file 1 Supplementary information. This document includes the following supplementary information: supplementary methods, supplementary figures, supplementary tables, supplementary reference list.

Supplemental material, sj-pdf-1-ctj-10.1177_1740774520984866 for A systematic review of subgroup analyses in randomised clinical trialsin cardiovascular disease by Korbinian J Brand, Alexander Hapfelmeier and Bernhard Haller in Clinical Trials

Additional file 3 Review history.

Additional file 1: Table S1. Results of the Random Forest and AdaBoost procedures for different sets of variables included. The table shows the variables in the rank order of importance according to the criterion of the mean decrease in accuracy (Random Forest) and the importance measure defined in the AdaBoost procedure. The overall classification error refers to 10-fold cross-validation in the case of AdaBoost and CHAID. SGRQ4 “I have attacks of wheezing”, SGRQ5 “How many attacks of chest trouble did you have during the last year?”, SGRQ8, “How would you describe your chest condition?”, SGRQ11 sub-item 5 “I have become frail or an invalid because of my chest”, SGRQ12 sub-item 1 “I take a long time to get washed or dressed”, SGRQ12 sub-item 3 “I walk slower than other people, or I stop for rests”, SGRQ12 sub-item 4 “Jobs such as housework take a long time, or I have to stop for rests”, SGRQ13 sub-item 1 “I cannot play sports or games”, SGRQ14 “How does your chest trouble affect you? Table S2. Technical details of the CT assessment. The acquisition protocol is given in the upper part and details on the scanner models in the lower part of the table. *Vendor-specific generic names for Siemens/GE/Philips. Table S3. Items from the “St. George’s Respiratory Questionnaire” (SGRQ) that turned out to be informative in the single decision trees. Table S4. Items from the COPD Assessment test (CAT). Table S5. Modified Medical Research Council (mMRC) scale. This self-rating questionnaire is used to measure the degree of disability that breathlessness poses on day-to-day activities on a scale from 0 to 4.

Appendix 1. Topics, number of associated items and relevant literature. (DOCX 87Â kb)

Appendix 2. Questionnaire for the evaluation of the participantsâ self-confidence related to palliative care medicine. (DOCX 88Â kb)

Appendix 3. Knowledge test. (DOCX 20Â kb)

Context: Oral activated charcoal (AC) for toxin absorption should be applied as soon as possible. Extra-hospital AC-application on site by medical laypersons with pre-emptive obtained AC may save time, but may be inferior to AC-application by medical professionals. Objective: 1) Availability and incidence of pre-emptive stockpiling of AC on site in the German region Bavaria 2) time saved by AC-stockpiling and application on site, 3) quality of AC-application defined by completeness of the applied AC-dose, time needed, incidence of side-effects in lay-care and in professional-care, considering confounding variables: AC-formulation/powder/tablets, recommended AC-dose, patientâs age. Method: telephone-interviews in cases with AC-recommendation by a Poison Information Centre (PIC). Lay-care was suggested according to risk-assessment by PIC. Ingestion sites were classified as either apt for AC-stockpiling or not apt. Results: 1) availability: In Bavaria only 20%â22% of eligible cases had AC on-hand, 2) time-saving was at least 14Â min. 3) Lay-care/professional-care or patientâs age had no significant influence on the completeness of the applied AC-dose, which was higher with AC as powder but negatively correlated with the recommended AC-dose. No significant difference was seen with time needed for application and incidence of side-effects. Conclusion: pre-emptive AC-stocking should be encouraged. Keywords: Activated Charcoal, Poisons Information Centre, Layperson, Extra-hospital, Pre-hospital, pre-emptive stockpiling

Additional file 1: Table S1. Magnitude of background activity measured in unstimulated control wells.

Additional file 3: Table S3. Intra-assay variability of antigen-specific IFNγ, IL2, and IFNγ + IL2 responses ranging between 11-50 SFC/well.

Additional file 4: Table S4. Diagnostic specificity and sensitivity of the EBV-specific IFNÎł/IL2 FluoroSpot.

Additional file 2: Table S2. Intra-assay variability of antigen-specific IFNγ, IL2, and IFNγ + IL2 responses ranging between 1-10 SFC/well.