The multiple assignment statement

2005 ◽  
pp. 100-112 ◽  
Author(s):  
David Gries
Keyword(s):  
Assignment Statement ◽  
Multiple Assignment

scholarly journals A Sequential Multiple Assignment Randomized Trial (SMART) study of medication and CBT sequencing in the treatment of pediatric anxiety disorders

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Bradley S. Peterson ◽  
Amy E. West ◽  
John R. Weisz ◽  
Wendy J. Mack ◽  
Michele D. Kipke ◽  
...  
Keyword(s):  
Anxiety Disorder ◽  
Anxiety Disorders ◽  
Randomized Trial ◽  
The Other ◽  
Smart Study ◽  
Main Effect ◽  
Multiple Assignment ◽  
Stage 1 ◽  
Main Effects ◽  
Treatment Sequences

Abstract Background Treatment of a child who has an anxiety disorder usually begins with the question of which treatment to start first, medication or psychotherapy. Both have strong empirical support, but few studies have compared their effectiveness head-to-head, and none has investigated what to do if the treatment tried first isn’t working well—whether to optimize the treatment already begun or to add the other treatment. Methods This is a single-blind Sequential Multiple Assignment Randomized Trial (SMART) of 24 weeks duration with two levels of randomization, one in each of two 12-week stages. In Stage 1, children will be randomized to fluoxetine or Coping Cat Cognitive Behavioral Therapy (CBT). In Stage 2, remitters will continue maintenance-level therapy with the single-modality treatment received in Stage 1. Non-remitters during the first 12 weeks of treatment will be randomized to either [1] optimization of their Stage 1 treatment, or [2] optimization of Stage 1 treatment and addition of the other intervention. After the 24-week trial, we will follow participants during open, naturalistic treatment to assess the durability of study treatment effects. Patients, 8–17 years of age who are diagnosed with an anxiety disorder, will be recruited and treated within 9 large clinical sites throughout greater Los Angeles. They will be predominantly underserved, ethnic minorities. The primary outcome measure will be the self-report score on the 41-item youth SCARED (Screen for Child Anxiety Related Disorders). An intent-to-treat analysis will compare youth randomized to fluoxetine first versus those randomized to CBT first (“Main Effect 1”). Then, among Stage 1 non-remitters, we will compare non-remitters randomized to optimization of their Stage 1 monotherapy versus non-remitters randomized to combination treatment (“Main Effect 2”). The interaction of these main effects will assess whether one of the 4 treatment sequences (CBT➔CBT; CBT➔med; med➔med; med➔CBT) in non-remitters is significantly better or worse than predicted from main effects alone. Discussion Findings from this SMART study will identify treatment sequences that optimize outcomes in ethnically diverse pediatric patients from underserved low- and middle-income households who have anxiety disorders. Trial registration This protocol, version 1.0, was registered in ClinicalTrials.gov on February 17, 2021 with Identifier: NCT04760275.

scholarly journals LIBERTI: A SMART study in plastic surgery

2018 ◽  
Vol 15 (3) ◽  
pp. 286-293
Author(s):  
Jonathan C Hibbard ◽  
Jonathan S Friedstat ◽  
Sonia M Thomas ◽  
Renee E Edkins ◽  
C Scott Hultman ◽  
...  
Keyword(s):  
Randomized Trial ◽  
Precision Medicine ◽  
Laser Treatment ◽  
Population Level ◽  
Patient Characteristics ◽  
Patient Response ◽  
Multiple Assignment ◽  
Laser Treatments ◽  
Treatment Plans ◽  
Treatment Rules

Background/aims: Laser treatment of burns scars is considered by some providers to be standard of care. However, there is little evidence-based research as to the true benefit. A number of factors hinder evaluation of the benefit of laser treatment. These include significant heterogeneity in patient response and possible delayed effects from the laser treatment. Moreover, laser treatments are often provided sequentially using different types of equipment and settings, so there are effectively a large number of overall treatment options that need to be compared. We propose a trial capable of coping with these issues and that also attempts to take advantage of the heterogeneous response in order to estimate optimal treatment plans personalized to each individual patient. It will be the first large-scale randomized trial to compare the effectiveness of laser treatments for burns scars and, to our knowledge, the very first example of the utility of a Sequential Multiple Assignment Randomized Trial in plastic surgery. Methods: We propose using a Sequential Multiple Assignment Randomized Trial design to investigate the effect of various permutations of laser treatment on hypertrophic burn scars. We will compare and test hypotheses regarding laser treatment effects at a general population level. Simultaneously, we hope to use the data generated to discover possible beneficial personalized treatment plans, tailored to individual patient characteristics. Results: We show that the proposed trial has good power to detect laser treatment effect at the overall population level, despite comparing a large number of treatment combinations. The trial will simultaneously provide high-quality data appropriate for estimating precision-medicine treatment rules. We detail population-level comparisons of interest and corresponding sample size calculations. We provide simulations to suggest the power of the trial to detect laser effect and also the possible benefits of personalization of laser treatment to individual characteristics. Conclusion: We propose, to our knowledge, the first use of a Sequential Multiple Assignment Randomized Trial in surgery. The trial is rigorously designed so that it is reasonably straightforward to implement and powered to answer general overall questions of interest. The trial is also designed to provide data that are suitable for the estimation of beneficial precision-medicine treatment rules that depend both on individual patient characteristics and on-going real-time patient response to treatment.

Sequential Multiple-Assignment Randomized Trials: Developing and Evaluating Adaptive Interventions in Special Education

2018 ◽  
Vol 40 (5) ◽  
pp. 267-276 ◽  
Author(s):  
Jason C. Chow ◽  
Lauren H. Hampton
Keyword(s):  
Special Education ◽  
Individual Differences ◽  
Educational Outcomes ◽  
Randomized Trials ◽  
Sufficient Evidence ◽  
Adaptive Intervention ◽  
Meaningful Information ◽  
Adaptive Interventions ◽  
Multiple Assignment ◽  
Individual Variables

Interventions often require multiple decisions to improve outcomes for every student. Whether the decision to implement a practice, tailor an existing protocol, or change approaches, these decisions should be based on individual variables and outcomes via a sequence of treatment. To develop adaptive interventions that have sufficient evidence to support decisions, components, and sequences, they must be evaluated as they operate. The sequential multiple-assignment randomized trial is a design that experimentally assesses the efficacy of the decisions, components, and sequence of an adaptive intervention. The purpose of this article is to provide an overview of this novel methodology and describe how this design can provide meaningful information about components and sequence based on individual differences and response to maximize educational outcomes in special education.

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