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Researchers are evaluating two different early treatment methods for adults hospitalized with sepsis, a serious condition caused by the body's extreme response to infection. This study focuses on comparing starting a vasopressor medication called norepinephrine immediately versus the standard approach of first giving fluid through a drip and then adding vasopressors if needed. The goal is to see which method better improves recovery, reduces complications, shortens hospital stay, and enhances long-term health. This is a Phase 3 clinical trial addressing a critical and complex condition with significant risks to patients' organs and survival. The study compares early peripheral vasopressor infusion (PVI) started within 12 hours of hospital admission targeting a mean arterial pressure (MAP) of 65 mmHg or higher, against the usual care involving intravenous fluids followed by vasopressors as needed. Norepinephrine is prepared at a concentration of 16 micrograms/ml and administered either as an early continuous infusion or after fluid resuscitation. Balanced crystalloid fluids are given according to standard care practices. Current guidelines and clinical practices inform the treatment approach, but this study aims to clarify the benefits of early vasopressor use in septic shock. Participants will be monitored for clinical effectiveness during the first 48 hours, with follow-up extending to 90 days after randomization. The study includes assessments such as blood pressure, serum lactate levels, and clinical status evaluations. Researchers will track recovery times, complications, hospital length of stay, and long-term health outcomes. Safety monitoring and evaluation of adverse effects will be ongoing throughout the study period to ensure participant well-being.

Researchers are investigating whether Dyadic Developmental Psychotherapy (DDP), a parent-child therapy, can improve the mental health of fostered or adopted children aged 5 to 12 years who have experienced abuse or neglect and have complex mental health problems known as Maltreatment-Associated Psychiatric Problems (MAPP). The study also aims to evaluate how well social care and health services work together to support these families and whether the time and costs involved in DDP are worthwhile. The research is carried out in three phases to explore the therapy's feasibility, effectiveness, and cost-effectiveness compared to usual services. The study involves three phases. Phase 1 lasts 9 months and focuses on optimizing DDP delivery in three different UK settings: the NHS, Social Services, and Private Practice, using interviews and focus groups with practitioners and families. Phase 2 is a 17-month single-blind randomized controlled trial with about 60 families, comparing DDP (around twenty 1-hour sessions over 6-9 months) to Services as Usual (SAU). Phase 3 will extend the trial over 27 months with an additional 180 families to confirm the clinical and cost-effectiveness of DDP. Throughout, qualitative evaluations will explore service delivery and participant experiences. Participants will be assessed at baseline and 12 months after starting the study. Researchers will collect data through interviews, questionnaires, and focus groups involving children, parents, therapists, and service managers. Key outcome measures include assessments of Reactive Attachment Disorder, Disinhibited Social Engagement Disorder, and behavioral difficulties. The study also monitors treatment adherence, mental health service pathways, and the social context affecting child mental health. The total study duration for each family varies by phase but includes up to 12 months of follow-up.

Waldenstrf6m's macroglobulinaemia (WM) is a rare, slow-growing lymphoma where abnormal white blood cells develop, mostly affecting older adults with a median age over 70. Current treatments often lead to incomplete responses and disease recurrence, so this study seeks better first-line therapies to improve outcomes and quality of life. The RAINBOW trial is a combined phase 2 and 3 study comparing a chemotherapy-free regimen to standard chemotherapy in patients newly diagnosed with WM. The study compares two treatment plans: one group receives rituximab and ibrutinib (RI) without chemotherapy, while the other group receives the standard combination of dexamethasone, rituximab, and cyclophosphamide (DRC). Eligible adults with untreated WM will be randomly assigned to either group and receive up to 6 treatment cycles. Those on the RI arm may continue ibrutinib alone for up to 5 years after initial therapy. Treatment response is assessed after 3 cycles and at 24 weeks. Participants will be closely monitored throughout treatment and then every 3 months for 5 years after stopping therapy. Annual follow-up for survival continues until the trial ends, which is expected to last about 9 and a half years. Researchers measure treatment effectiveness by overall response rates at 24 weeks and progression-free survival up to 2 years after the last patient is randomized, with ongoing safety and quality of life assessments.