Crossville

This research aims to determine if the Quest AD-Detect blood test can help diagnose underlying Alzheimers disease earlier in patients hospitalized with cognitive issues such as delirium or encephalopathy. The study focuses on patients aged 60 to 90 who have no prior diagnosis of dementia but show cognitive impairment possibly related to toxic or metabolic conditions. Researchers want to see if the blood test can distinguish Alzheimers disease from other causes of cognitive problems in the hospital setting. All eligible patients will have their blood collected and tested using the Quest AD-Detect blood test during their hospital stay. The study involves only one group where every participant receives this diagnostic blood test. There are no placebo or comparison groups in this trial. Participants will be followed up for six months after hospitalization through a Neurology Clinic to discuss their risk assessment results. The main outcome measured is the percentage of patients with a positive biomarker for Alzheimers dementia among those presenting with cognitive diagnoses. The trials total duration extends from enrollment to the six-month post-hospital follow-up visit.

Researchers are evaluating whether a modified version of metaxalone 640 mg can reduce pain in adults aged 18 to 80 years who have newly occurring low back or leg pain due to acute lumbosacral musculoskeletal conditions with spinal stenosis and sciatica. This study is a phase 4, double-blind, randomized, placebo-controlled trial designed to compare the effects of the active drug with a placebo. The goal is to understand the impact on pain levels, physical activity, and sleep interference. Participants will be randomly assigned to receive either metaxalone 640 mg capsules or inactive placebo capsules. Both treatments are taken orally every six hours for seven days alongside standard care. The study includes an initial pilot phase followed by a larger randomized phase to ensure proper evaluation with adequate participant numbers. During the study, participants will complete surveys on day 1 before starting treatment and again seven days later to report on pain amount and quality, as well as how pain affects their physical activities and sleep. Researchers will monitor changes in pain using the Numeric Pain Scale from day 1 to day 7. The total participation involves these assessments and treatment over the one-week period with attention to any safety or health changes.

Researchers are evaluating treatments for patients with psoriatic arthritis PsA who have not responded well to tumor necrosis factor inhibitors TNFi. The trial aims to find out if switching to guselkumab, a selective interleukin 23 inhibitor IL23i, is more effective than switching to a second TNFi, golimumab. This is the first study to compare these treatment switches in PsA patients and will focus on those who have an inadequate response to TNFi in a real-world clinical setting. Participants will be randomly assigned to one of three treatment groups guselkumab 100mg every 4 weeks, guselkumab 100mg every 8 weeks, or golimumab 50mg every 4 weeks. Both medications are given as subcutaneous injections. The study is open-label, meaning both patients and researchers know which treatment is given. The trial will continue for 12 months to assess treatment effectiveness. Throughout the study, participants will be monitored for disease activity using measures like cDAPSA low disease activity and Investigator Global Assessment of Psoriasis. Additional assessments include minimal disease activity, quality of life questionnaires, fatigue, and resolution of symptoms such as dactylitis and enthesitis. Safety and treatment response will be evaluated regularly, with the main outcomes measured at 6 and 12 months.

Researchers are comparing treatments for people with active rheumatoid arthritis RA who have not responded well to tumor necrosis factor inhibitor TNFi biologics. This study evaluates switching to either a non-TNFi biologic drug including rituximab, abatacept, tocilizumab, or sarilumab or a targeted synthetic DMARD tsDMARD such as tofacitinib, baricitinib, or upadacitinib. The study aims to provide important real-world data on patient-reported outcomes PROs to help guide treatment decisions, as current guidelines are based on limited evidence and often influenced by insurance or physician preference. Participants will be randomized to one of two groups switching to a targeted synthetic DMARD or switching to a non-TNFi biologic drug. Both treatment options are widely used in clinical practice, but have not been directly compared in a pragmatic trial focusing on PROs. The study will allow patients to continue stable doses of conventional synthetic DMARDs like methotrexate if used for at least three months. The trial will assess changes over 12 months, focusing on functional limitation and quality of life. During the trial, participants will be monitored regularly to assess their function and symptoms using patient-reported tools such as the Health Assessment Questionnaire HAQ. Researchers will collect information on treatment effectiveness, side effects, and safety in a real-world population, including those with other health conditions. The study is designed to reflect routine clinical care and will last for at least 12 months, with follow-up to evaluate changes from baseline in physical function and other outcomes important to patients.