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Clinic Setting (clinic + setting)
Kinds of Clinic Setting Selected AbstractsThe effect of time spent in treatment and dropout status on rates of convictions, cautions and imprisonment over 5 years in a primary care-led methadone maintenance serviceADDICTION, Issue 4 2010Phillip Oliver ABSTRACT Background Methadone maintenance treatment (MMT) in primary care settings is used increasingly as a standard method of delivering treatment for heroin users. It has been shown to reduce criminal activity and incarceration over periods of periods of 12 months or less; however, little is known about the effect of this treatment over longer durations. Aims To examine the association between treatment status and rates of convictions and cautions (judicial disposals) over a 5-year period in a cohort of heroin users treated in a general practitioner (GP)-led MMT service. Design Cohort study. Setting The primary care clinic for drug dependence, Sheffield, 1999,2005. Participants The cohort comprised 108 consecutive patients who were eligible and entered treatment. Ninety were followed-up for the full 5 years. Intervention The intervention consisted of MMT provided by GPs in a primary care clinic setting. Measurements Criminal conviction and caution rates and time spent in prison, derived from Police National Computer (PNC) criminal records. Findings The overall reduction in the number of convictions and cautions expected for patients entering MMT in similar primary care settings is 10% for each 6 months retained in treatment. Patients in continuous treatment had the greatest reduction in judicial disposal rates, similar to those who were discharged for positive reasons (e.g. drug free). Patients who had more than one treatment episode over the observation period did no better than those who dropped out of treatment. Conclusions MMT delivered in a primary care clinic setting is effective in reducing convictions and cautions and incarceration over an extended period. Continuous treatment is associated with the greatest reductions. [source] Treatment outcomes amongst previously antiretroviral-naïve HIV-infected patients starting lopinavir/ritonavir-containing antiretroviral regimens at the Royal Free Hospital,HIV MEDICINE, Issue 1 2007CJ Smith Objective To describe outcomes in patients starting first-line antiretroviral regimens including lopinavir/ritonavir (LPV/r) in a routine clinic setting. Methods Previously naïve patients starting LPV/r-containing antiretroviral therapy were included in the study. Virological failure was defined as the first of two viral loads >500 HIV-1 RNA copies/mL more than 6 months after starting LPV/r. Cumulative percentages experiencing virological failure were calculated using Kaplan,Meier methods. Results A total of 195 individuals had a median follow-up time of 1.7 years. At 48 weeks, 87.9, 77.4 and 71.6% of patients with pretreatment CD4 counts of <50, 50,200 and >200 cells/,L, respectively, remained on LPV/r. By 48, 72 and 96 weeks, 2.2, 3.0 and 5.0% of patients, respectively, had experienced virological failure, ignoring treatment changes but censoring follow-up at discontinuation of all antiretrovirals; these percentages became 24.0, 33.7 and 42.3% when LPV/r discontinuation was considered as virological failure. Censoring those who stopped LPV/r with a viral load <50 copies/mL and considering as virological failures those who stopped LPV/r with a viral load >50 copies/mL gave 12.1, 14.6 and 17.0% virological failure at 48, 72 and 96 weeks, respectively. Median CD4 count increases at 24, 48 and 72 weeks were 167, 230 and 253 cells/,L, respectively. Conclusions Few patients experienced virological failure whilst on a LPV/r-based regimen, although it was not uncommon for patients in our clinic with higher baseline CD4 counts to discontinue LPV/r. [source] Long-term utility of measuring adherence by self-report compared with pharmacy record in a routine clinic settingHIV MEDICINE, Issue 5 2005CK Fairley Objectives To compare long-term adherence to antiretroviral therapy in an HIV service, as measured by self-report and by pharmacy records. To determine the level of adherence by each measure required to suppress viral load in a majority of patients. Methods The percentage of prescribed doses taken was calculated from (a) the number of missed doses in the previous 28 days reported by patients in a questionnaire at each clinic visit, and (b) pharmacy dispensing records. These were compared with each other and with HIV viral load data. Results Mean adherence was 96.2% by pharmacy record over 44 months and 98.6% by self-report over 25 months. The two methods correlated with each other (P<0.001) and the proportion of patients with viral load <400 HIV-1 RNA copies/mL increased with adherence as measured by self-report (P=0.001) and pharmacy record (P=0.004). Fewer than 60% of patients always had viral loads <400 copies/mL if adherence fell below 95% (pharmacy record) or 97% (self-report). Adherence was higher for once-daily than for twice-daily therapy (by pharmacy record: 97.2% vs. 96.0%; P<0.001). Adherence by both measures increased over time. Conclusions Self-reported antiretroviral adherence correlates with pharmacy dispensing records and predicts suppression of viral load at levels ,97%. It is practical to adopt this into routine HIV clinical care. [source] Retrospective database analysis on the effectiveness of typical and atypical antipsychotic drugs in an outpatient clinic settingHUMAN PSYCHOPHARMACOLOGY: CLINICAL AND EXPERIMENTAL, Issue 8 2007Cengiz Akkaya Abstract Objective To report the outcomes of a retrospective database analysis to compare the effectiveness of atypical and typical antipsychotic drugs. Methods Medical records of patients admitted to the psychiatry outpatient clinic between January 1998 and October 2005 were retrospectively reviewed. Data obtained from patient records were noted on a special form assessing four aspects of the treatment history: socio-demographic features, disease characteristics, initial treatment at the time of admission, and course of treatment. Patient groups (typical/atypical and Risperidone/Haloperidol/Olanzapine) were compared for time to all-cause medication discontinuation and rate of discontinuation. Results There was no statistically significant difference in the duration of treatment between patients using atypical (n,=,150) and typical (n,=,124) antipsychotics. The duration of treatment was significantly longer in patients on Haloperidol (n,=,91) compared with those on Risperidone (n,=,63). Rates of discontinuation over 18 months were 59.3% for patients on atypical antipsychotics and 57.3% for those on typical antipsychotics, and 68.3% for patients on Risperidone, 51.6% for patients on Haloperidol and 54.3% for patients on Olanzapine. Conclusion Despite our hypothesis patients with chronic schizophrenia discontinued their atypical and typical antipsychotics, at a high rate with no significant difference indicating substantial limitations in the effectiveness of these drugs. Copyright © 2007 John Wiley & Sons, Ltd. [source] Impact of cerebrovascular pathology on behavioural and neuropsychiatric symptoms in patients with Alzheimer's dementia: findings from a retrospective, naturalistic studyINTERNATIONAL JOURNAL OF CLINICAL PRACTICE, Issue 7 2009A. Klugman Summary Aim:, Cerebrovascular disease (CVD) has been associated with depression and a host of neuropsychiatric conditions including dementia. This study assessed the relationship between cerebrovascular findings reported on MRI brain scans and neuropsychiatric symptoms (NPS) and behavioural problems in patients with Alzheimer's disease (AD). Methods:, Medical notes were retrospectively reviewed in patients undergoing brain MRI following referral for cognitive impairment to a memory clinic between January 2004 and June 2008. Patients with AD were graded into four categories of CVD severity based on neuroradiology reports and assessed for behavioural and NPS and activities of daily living using Neuropsychiatric Inventory (NPI), Geriatric Depression Scale (GDS) and Bristol Activities of Daily Living (BADL). Frontal lobe symptoms and parkinsonian features were also evaluated. Results:, Of the initial 232 patients who underwent MRI 72% were diagnosed with AD. 89% of AD patients had CVD findings reported on MRI. Moderate-to-severe CVD was present in 47% of patients. None of the AD patients satisfied a diagnosis of vascular dementia. There was no significant relationship observed between level of MRI CVD findings and scores on NPI (p = 0.57), GDS (p = 0.26) and BADL (p = 0.46). The level of CVD severity did not appear to influence frontal lobe and parkinsonian assessments (p = 0.60). Conclusion:, The contribution of CVD to the pathogenesis of various NPS is still debated. Our study, based on patients diagnosed with AD in a memory clinic setting, suggests that there is no relationship between the extent of CVD pathology and neuropsychiatric and behavioural measures in AD patients. Further prospective quantitative studies are needed to assess the role of CVD, if any, in neuropsychiatric and behavioural symptoms in AD. It is possible that the relatively small pathological contribution of CVD to the development of these symptoms is obscured by the effect of the wider neurodegeneration encountered in AD. [source] Billing effectively with the new health and behavior current procedural terminology codes in primary care and specialty clinicsJOURNAL OF CLINICAL PSYCHOLOGY, Issue 10 2006Robin E. S. Miyamoto The health and behavior current procedural terminology (CPT) codes introduced in 2003 have gained nationwide acceptance through Medicare and limited acceptance through third party payers. The codes facilitate accurate description and quantification of behavioral medicine services within a primary care or specialty clinic setting. The author reviews their appropriate utilization to enhance reimbursement and facilitate development of self-sustaining behavioral medicine programs. Information is provided on increased use and reimbursement of codes within psychology. Future directions for continued advocacy, increased acceptance, training, and research are discussed. © 2006 Wiley Periodicals, Inc. J Clin Psychol 62: 1221,1229, 2006. [source] Indicators of anxiety and depression in women with the fragile X premutation: assessment of a clinical sampleJOURNAL OF INTELLECTUAL DISABILITY RESEARCH, Issue 7 2010A. Lachiewicz Abstract Background Current research suggests that depression and anxiety may be common problems in women with the fragile X (FMR1) premutation. Methods To learn more about this in a clinical setting, we asked 33 women with the FMR1 premutation and 20 women without the FMR1 premutation to complete the Brief Carroll Depression Scale (Brief CDS) and the Multidimensional Anxiety Questionnaire (MAQ) and to provide information about mental health medication use. Questionnaire findings were compared between groups and with normative samples. Trinucleotide (CGG) repeat counts were also correlated to checklist findings. Results Both women with the FMR1 premutation and the comparison group had high current mental health medication use (33% vs. 35%). Approximately 1/3 of the women from both groups had high Brief CDS Total T-scores (33% vs. 30%). More women with the FMR1 premutation had at least one elevated MAQ Total or sub-scale T-score than the comparison group (39% vs. 10%, P = 0.03). Twenty-one per cent of women with the FMR1 premutation had all three of the indicators of distress targeted in this study vs. none of the women in the comparison samples (P < 0.05). There was no statistically significant correlation between CGG repeat size and abnormal checklist findings using the Spearman rank correlation, although a higher percentage of women with >100 CGG repeats (57%) had an elevated Brief CDS Total T-score than women with ,100 CGG repeats (16%) (P = 0.02). More women with >100 CGG repeats also had all three indicators of anxiety and depression (P = 0.03). Conclusions Women with the FMR1 premutation appear to have a high incidence of depression and increased symptoms of anxiety. Screening tools like the Brief CDS and the MAQ may be useful to identify these women in the clinic setting. Positive identification could lead to increased mental health care and treatment. [source] A Qualitative Study of Intimate Partner Violence Universal Screening by Family Therapy Interns: Implications for Practice, Research, Training, and SupervisionJOURNAL OF MARITAL AND FAMILY THERAPY, Issue 1 2008Jeffrey L. Todahl Although a few family therapy researchers and clinicians have urged universal screening for intimate partner violence (IPV), how screening is implemented,and, in particular, client and therapist response to screening,is vaguely defined and largely untested. This qualitative study examined the dilemmas experienced by couples and family therapy interns when implementing universal screening for IPV in an outpatient clinic setting. Twenty-two graduate students in a COAMFTE-accredited program were interviewed using qualitative research methods grounded in phenomenology. Three domains, 7 main themes, and 26 subthemes were identified. The three domains that emerged in this study include (a) therapist practice of universal screening, (b) client response to universal screening, and (c) therapist response to universal screening. Implications for practice, research, training, and supervision are discussed. [source] Lung function testing in preschool-aged children with cystic fibrosis in the clinical settingPEDIATRIC PULMONOLOGY, Issue 5 2010Catherine L. Gangell BSc(hons) Abstract In cystic fibrosis (CF) lung function testing is a means of monitoring progression of lung disease. The preschool years have often been referred to as the "silent years" due to the previous lack suitable measures of lung function testing in this age group. This review outlines the various techniques of lung function testing in preschool children with CF in the clinical setting. This includes measures requiring tidal breathing including the forced oscillation technique, the interrupter technique, plethysmography, and multiple breath washout, as well as spirometry that requires respiratory maneuvers. We describe the feasibility and variability of different lung function methods used in preschoolers and report measurements made during tidal breathing have greater feasibility, although greater variability compared to spirometry. We also report associations with lung function and markers of CF lung disease. In the preschool age group measurements made during tidal breathing may be more appropriate in the clinic setting than those that require a higher degree of cooperation and specific respiratory maneuvers.maneuvers. Pediatr Pulmonol. 2010; 45:419,433. © 2010 Wiley-Liss, Inc. [source] Asthma Control Test correlates well with the treatment decisions made by asthma specialistsRESPIROLOGY, Issue 4 2009Fanny W.S. KO ABSTRACT Background and objective: Poor assessment of asthma control results in suboptimal treatment. Identifying parameters that accurately assess control will benefit treatment decisions. The Asthma Control Test (ACT) is a five-item questionnaire for the assessment of asthma control. This study evaluated its correlation with the treatment decisions made by asthma specialists in an outpatient clinic setting, and compared its performance with other conventional parameters including spirometry, PEF rate (PEFR), fractional exhaled nitric oxide (FeNO) and BHR. Methods: The 383 (122 men) study subjects completed a 1-month diary on symptoms and PEFR before the assessment. All subjects then completed the ACT together with same-day spirometry and FeNO measurement. BHR to methacholine was performed in 73 subjects in the week before assessment. Asthma specialists, blinded to the results of the ACT, FeNO and BHR (but not spirometry and PEFR), assessed the patients' level of control according to the 2006 version of the Global Initiative for Asthma guidelines and made appropriate treatment decision. Results: The group mean (SD) age was 46.1 (13.4) years with pre-bronchodilator FEV1 84.72 (20.81) % predicted. Receiver operating characteristic (ROC) curve analysis found that an ACT score of ,20 best correlated with uncontrolled asthma (area under curve (AUC) = 0.76) with a sensitivity of 70.5%, specificity 76.0%, positive predictive value 76.2% and negative predictive value 70.2% for predicting step-up of asthma therapy. On ROC analysis, the ACT score had the highest AUC (0.81 (P < 0.001)) for changing asthma therapy when compared with FeNO, spirometry, PEFR and BHR parameters Conclusions: The ACT correlated better with treatment decisions made by asthma specialists than spirometry, PEFR and FeNO. [source] In Vivo Diagnosis of Nasopharyngeal Carcinoma Using Contact RhinoscopyTHE LARYNGOSCOPE, Issue 8 2001Martin Wai Pak FRCSEd(ORL) Abstract Objectives To evaluate the potential use of contact endoscopy for the diagnosis of nasopharyngeal carcinoma (NPC). Study Design Prospective study to examine the nasopharynx of 30 patients with nasopharyngeal carcinoma and 18 subjects with normal nasopharynx in a clinic setting using contact rhinoscopes (Karl Storz, Tuttlingen, Germany, 7215 AA, 00 and 7215 BA, 300; 23 cm long; 4 mm in diameter). Methods The superficial cells of the normal nasopharynx and the nasopharyngeal tumors were stained with 1% methylene blue and examined with contact rhinoscopes at high magnifications (×60 and ×150). The areas under examination were then biopsied. The contact endoscopic images were compared with the corresponding hematoxylin and eosin-stained histologic sections of the biopsied tissues. Results Sixty-six procedures were performed in 48 patients. The images of normal pseudostratified ciliated epithelium and squamous epithelium were readily recognized by contact endoscopy in all subjects with normal nasopharynx (10 men and 8 women; mean age, 51.9 y). Twenty-six of 30 patients with NPC (86.6%; 18 men and 8 women; mean age, 50.6 y) were successfully examined by contact endoscopy under local anesthesia. In these 26 patients, two patterns of malignant cells were identified with contact endoscopy. The patterns of contact endoscopic images corresponded well with the histologic findings. Conclusion Contact endoscopy is an accurate and reliable office-based procedure, which allows for in-vivo diagnosis of nasopharyngeal carcinoma. [source] Functional assessment and treatment of pica: a single-case experimentBEHAVIORAL INTERVENTIONS, Issue 2 2001John T. Rapp The pica of a 6-year-old girl diagnosed with autism was initially shown to persist in the absence of socially mediated consequences. In an attempt to provide a competing source of oral stimulation, we used a stimulus preference assessment to identify food items that were subsequently presented noncontingently. However, the noncontingent schedule could not be thinned to a practical variation while still maintaining reductions in pica. A subsequent multielement evaluation of response blocking and verbal reprimands demonstrated that neither intervention both produced and maintained low levels of pica. Verbal reprimands were then used in conjunction with noncontingent food presentation, but this intervention did not produce significant reductions in pica. Suppression of pica was ultimately obtained in both a clinic setting and in the child's natural environment using contingent, varied auditory stimulation. The results are discussed in the context of the ,least restrictive alternative' model of treatment selection. Copyright © 2001 John Wiley & Sons, Ltd. [source] A randomised comparison of SurePath liquid-based cytology and conventional smear cytology in a colposcopy clinic settingBJOG : AN INTERNATIONAL JOURNAL OF OBSTETRICS & GYNAECOLOGY, Issue 11 2008PH Sykes Objective, The objective of this study was to compare the sensitivity of cervical cytology using conventional smears and SurePath liquid-based cytology (LBC). Design, Prospective randomised evaluation of diagnostic test. Setting, A single institution colposcopy clinic. Population, Women attending first visit colposcopy appointments were offered entry into the study. Methods, Cervical cytology samples from 913 women of age 16,75 years were randomly processed as SurePath LBC or conventional smears. Conventional smears were taken for 453 women and a SurePath LBC taken for 451 women. Cytology results were correlated with colposcopic findings and histology from colposcopic biopsies, treatment and follow up. Main outcome measures, To compare the sensitivity of SurePath LBC and conventional smears for histologically proven abnormality. Other outcome measures include a comparison of their sensitivity for high-grade abnormalities and their satisfactory rate. Results, Accounting for all randomised samples, there was a trend towards improved sensitivity for SurePath LBC (79.1 versus 73.7%, P = 0.1). However, excluding unsatisfactory cytology (and samples not taken) eliminated this trend; the sensitivity for both LBC and conventional smears for any epithelial abnormality was 81%. With a threshold of atypical squamous cells of uncertain significance (ASC-US), both SurePath LBC and conventional smears had a sensitivity of 92% for high-grade lesions. SurePath LBC was less likely to be reported as unsatisfactory (2.7 versus 9.1%, P < 0.0001). Conclusions, In this context, with a threshold of ASC-US, both SurePath LBC and conventional smears offer high sensitivity for the detection of CIN2/3, but SurePath LBC is less likely to be reported as unsatisfactory. [source] The cost of microwave endometrial ablation under different anaesthetic and clinical settingsBJOG : AN INTERNATIONAL JOURNAL OF OBSTETRICS & GYNAECOLOGY, Issue 10 2003Janelle Seymour Objective To compare the costs of microwave endometrial ablation under local anaesthetic and general anaesthetic in an operating theatre and to estimate the cost of performing treatment under local anaesthetic in a dedicated clinic setting. Design The costing study was undertaken alongside a randomised controlled trial comparing the acceptability of microwave endometrial ablation using local versus general anaesthetic in a theatre setting. Setting Department of Gynaecology, Aberdeen Royal Infirmary, Scotland. Sample One hundred and twenty-seven women undergoing microwave endometrial ablation who had been randomly allocated to general or local anaesthetic. Methods Health and non-health service resource use was recorded prospectively. Data on resource use were combined with unit costs estimated using standardised methods to determine the cost per patient for microwave endometrial ablation under local or general anaesthetic in theatre. A model was developed to estimate the health service cost of microwave endometrial ablation under local anaesthetic in a clinic setting. Main outcome measures Health and non-health service costs. Results There was little difference in cost when treatments were performed under local or general anaesthetic in theatre. The median health and non-health cost of microwave endometrial ablation was £440 and £120, respectively, under general anaesthetic and £428 and £125 per women under local anaesthetic. The health service cost of microwave endometrial ablation using local anaesthetic in a clinic setting was estimated to be £432 per treatment; however, this varied from £389 to £491 in the sensitivity analysis. Conclusion There are minimal cost savings to the patient or health service from using local rather than general anaesthetic for microwave endometrial ablation in a theatre setting. Cost modelling suggests that in a clinic setting microwave endometrial ablation has a similar cost to theatre based treatment once re-admissions for treatment under general anaesthetic are considered. Sensitivity analysis indicated that these findings were sensitive to assumptions in the model. [source] The risk of renal impairment in hormone-refractory prostate cancer patients with bone metastases treated with zoledronic acid,CANCER, Issue 6 2007William K. Oh MD Abstract BACKGROUND Bisphosphonates have been used to treat bone metastases in hormone-refractory prostate cancer (HRPC), but certain agents have been associated with renal toxicity. For this observational study, the authors assessed the risk of renal impairment in patients with HRPC who received zoledronic acid from December 1999 to April 2005. METHODS A comprehensive medical records review was performed in a major tertiary oncology center (n = 122 patients). The primary outcome of renal impairment was defined as an increase ,0.5 mg/dL or ,1.0 mg/dL over baseline creatinine value if the baseline value was <1.4 mg/dL or ,1.4 mg/dL, respectively. A risk factor analysis was conducted using the Andersen-Gill extension to the Cox proportional hazards model. RESULTS Renal impairment was observed in 23.8% of patients. The risk of renal impairment increased with an extended duration of zoledronic acid therapy (<6 months, 11.1%; ,24 months, 26.3%) and previous pamidronate treatment (45.5% vs 19.0% for patients with no prior pamidronate). A significantly greater risk of renal impairment was associated with increasing age at zoledronic acid initiation, prior pamidronate use, and a history of renal disease, hypertension, or smoking (P , 0.05). CONCLUSIONS In an outpatient clinic setting, the risk of renal impairment among patients with HRPC who received zoledronic acid was greater than the risk reported previously in clinical trials. Cancer 2007 © 2007 American Cancer Society. [source] Maternal hypothyroidism in early and late gestation: effects on neonatal and obstetric outcomeCLINICAL ENDOCRINOLOGY, Issue 5 2005Iskandar Idris Summary Background, Maternal hypothyroidism may be associated with a variety of adverse neonatal and obstetric outcomes. Whether these outcomes are affected by maternal thyroid status at initial presentation or in late gestation specifically within a dedicated antenatal endocrine clinic remains unclear. The effects of thyroxine dose requirement during pregnancy and serum concentrations of TSH within such clinic settings are still not known. Objectives, We investigated these outcomes in patients with hypothyroidism during early and late gestation. TSH levels and thyroxine dose requirement during early and late gestation were also evaluated. Methods, We performed a retrospective study of data from 167 pregnancies managed in the antenatal endocrine clinic. Analysis of outcomes was linked to TSH at first presentation and in the third trimester. Outcome variables included: rate of caesarean section, pre-eclampsia, neonatal unit admission, neonatal weight and gestational age. Controlled TSH was defined as mothers with TSH between 0·1 and 2 with normal free thyroid hormone levels. Results, The caesarean section (CS) rates were higher in the study cohort (H) compared with the local (C) rate (H = 28·7%, C = 18%). The higher rate in our patient cohort was not due to a higher rate of emergency section nor to a lower threshold for performing elective caesarean section. The infant birthweight (IBW) from mothers with TSH > 5·5 (H1) and mothers with TSH between 0·1 and 5·5 at presentation (H2) was [median (range)] 3·38 (1·73,4·70) vs. 3·45 (1·36,4·76); P = ns. The prevalence of low-birthweight (LBW) infants (< 2·5 g) in groups H1 and H2 was 15% and 4·8%, respectively [odds ratio (OR) = 3·55, 95% confidence interval (95% CI) = 0·96,10·31]. IBW from mothers with TSH > 2 (H3) and mothers with controlled TSH in the third trimester (H4) were similar [3·38 (1·78,4·4) vs. 3·46 (1·36,4·76); P = ns]. The prevalence of LBW in groups H3 and H4 was 9% and 4·9%, respectively (OR = 1·95, 95% CI = 0·52,7·26). The median thyroxine dose (µg) increased significantly during pregnancy (first trimester: 100; second trimester: 125, P < 0·001; and third trimester: 150, P < 0·001) associated with appropriate suppression of TSH levels in the second and third trimesters. Rates of pre-eclampsia or admissions to neonatal units were negligible. Conclusion, Thyroxine dose requirement increases during pregnancy and thus close monitoring of thyroid function with appropriate adjustment of thyroxine dose to maintain a normal serum TSH level is necessary throughout gestation. Within a joint endocrine,obstetric clinic, maternal hypothyroidism at presentation and in the third trimester may increase the risk of low birthweight and the likelihood for caesarean section. The latter observation was not due to a higher rate of emergency caesarean section nor to a lower threshold for performing elective caesarean section. A larger study with adjustments made for the various confounders is required to confirm this observation. [source] Progression of Therapy Research and Clinical Application of Treatment Require Better Understanding of the Change ProcessCLINICAL PSYCHOLOGY: SCIENCE AND PRACTICE, Issue 2 2001Alan E. KazdinArticle first published online: 11 MAY 200 The stage model of therapy research focuses on the development of treatment from pilot work, through randomized controlled clinical trials, to tests in clinic settings. A goal of the model is to develop effective treatments that can be used clinically. The present comments begin with a similar goal but emphasize the importance of a broader agenda designed to understand therapy. A central thesis is that developing effective treatments depends heavily on investigations that address critical scientific questions; particularly, what are the mechanisms through which therapy operates and under what conditions is therapy likely to be effective and why? The comments argue for a portfolio of research that addresses a broader range of questions and encompasses more diverse methods of evaluating treatment. Breadth and diversity are not ends in themselves but will be essential to obtain the requisite knowledge to effect optimal changes in clinical applications of treatment. [source] | |||||||||||||