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Comparative Effectiveness (comparative + effectiveness)
Terms modified by Comparative Effectiveness Selected AbstractsComparative Effectiveness of Methylprednisolone and Zero-balance Ultrafiltration on Inflammatory Response After Pediatric Cardiopulmonary BypassARTIFICIAL ORGANS, Issue 7 2007Jinping Liu Abstract:, Studies have demonstrated that systemic inflammatory response syndrome (SIRS) remains one of the major causes of cardiopulmonary bypass (CPB)-associated organ injury during pediatric cardiac surgery. The purpose of this investigation was to compare the effectiveness of methylprednisolone (MP) and zero-balance ultrafiltration (ZBUF) on SIRS during pediatric CPB. Thirty infants undergoing open-heart surgeries were randomized to receive either MP in the priming solution (group M, n = 15) or ZBUF during CPB (group Z, n = 15). All the patients survived. Plasma levels of tumor necrosis factor-, (TNF-,), interleukin-6 (IL-6), interleukin-8 (IL-8), and interleukin-10 (IL-10) were measured before CPB (T1), 5 min after the start of CPB (T2), at the termination of CPB (T3), the fourth hour (T4), and the eighth hour (T5) postoperatively. The results showed that the plasma concentrations of TNF-, in the Z group were significantly less than those in the M group at T4 and T5 (P < 0.05), and the plasma concentrations of IL-6 were significantly less than those in the M group at T4 (P < 0.05); the plasma concentrations of IL-8 in the Z group were significantly less than those in the M group at T5 (P < 0.05). There was no difference between two groups on the plasma concentrations of IL-10. The duration of postoperative mechanical ventilation was (9.6 ± 0.8 h) in the M group and (7.8 ± 0.4 h) in the Z group (P < 0.05). This study showed that application of ZBUF is more effective to decrease the level of inflammatory mediators including TNF-,, IL-6, and IL-8 than administration of MP after pediatric CPB. [source] Comparative effectiveness of hand and ultrasonic instrumentations in root surface planing in vitroJOURNAL OF CLINICAL PERIODONTOLOGY, Issue 3 2004Mahmood Khosravi Abstract Background/aims: A variety of techniques are employed for planing and scaling of the superficial root surfaces, of which hand and ultrasonic instrumentations have been preferentially used in routine periodontics clinics. This study was undertaken to compare the effectiveness of ultrasonic scalers and hand curettes in facilitating fibroblast attachment to the scaled root surfaces. Materials and Methods: Sixteen patients with periodontally involved teeth and nine subjects without periodontal diseases (control subjects) were selected. Two single-rooted teeth were extracted from each subject. Mesial and distal surfaces of teeth were selected in treated and untreated groups, respectively. The mesial surface of each tooth was randomly chosen to be treated either by hand curettes or ultrasonic instrumentation. The degree of cell attachment on the root surfaces of treated and untreated groups from control subjects and patients was then determined by the use of a gingival fibroblast line established and employed at early passages. The attachment and proliferation of gingival fibroblasts on the root surfaces were evaluated using neutral red assay and scanning electron microscopy (SEM). Results: Fibroblast survival and proliferation on the surfaces of untreated periodontally involved roots were found to be significantly lower compared with control untreated surfaces (p<0.0001) or treated surfaces from patients (p<0.0001). No significant difference, however, was observed between root surfaces treated either by hand curettes or ultrasonic scalers. Conclusion: These results indicate the beneficial effectiveness of both techniques in root treatment and planing. [source] Comparative effectiveness of azathioprine in Crohn's disease and ulcerative colitis: prospective, long-term, follow-up study of 394 patientsALIMENTARY PHARMACOLOGY & THERAPEUTICS, Issue 2 2008J. P. GISBERT Summary Background The long-term efficiacy for thiopurinic drugs in Crohn's disease (CD), and particularly in ulcerative colitis (UC), has been insufficiently studied. Aim To evaluate prospectively and compare the long-term effectiveness of azathioprine (AZA) in CD and UC. Methods Three hundred and ninety-four AZA treated patients were included consecutively included. Truelove-modified index and CDAI were used to assess effectiveness. Hospitalizations and surgical procedures were recorded. Results Two hundred and thirty-eight patients with CD and 156 with UC received AZA for a median of 38 months. Effectiveness: Partial response/remission was achieved in 34%/49% of CD patients and in 47%/42% of UC (nonstatistically significant differences). Steroid treatment: Prior to AZA, 49% of CD patients were receiving steroids, whereas only 8% needed steroids after therapy (P < 0.001). Corresponding figures in UC patients were 39% vs. 9% (P < 0.001). Hospitalizations: Prior to AZA, the rate of hospitalizations in CD was 0.190 per-patient-year, while after treatment, it decreased to 0.099 (P < 0.001). Corresponding hospitalization rates in UC were 0.108 vs. 0.038 (P < 0.001). Surgery: The rate of surgery in CD prior/after AZA was 0.038/0.011 per-patient-year (P < 0.001). The number of surgical interventions in UC prior/after AZA treatment was 26/0 (the rate per-patient-year was 0.018/0) (P < 0.001). Conclusions Our results confirm the effectiveness of AZA in inflammatory bowel disease, not only in the short term but also in the long term, resulting in a steroid sparing effect and in both a reduction in the number of hospitalizations and surgical procedures. AZA is similarly effective for both CD and UC patients. [source] Efficacy, effectiveness, and comparative effectiveness in liver disease,HEPATOLOGY, Issue 2 2010Hashem B. El-Serag M.D., M.P.H. First page of article [source] Cooperative Dementia Care Clinics: A New Model for Managing Cognitively Impaired PatientsJOURNAL OF AMERICAN GERIATRICS SOCIETY, Issue 12 2006Mary Lessig BS Cooperative health care clinics (CHCCs), or shared medical appointments, are a healthcare innovation that can improve access and expand physicians' capacity to manage common geriatric conditions. This report describes a pilot program and working model for extending CHCCs to patients with dementia. Three cooperative dementia care clinics (CDCCs) met monthly for up to 1 year, drawing participants from a dementia clinic roster of patients and caregivers who had required continued specialty care for at least 3 months. Twenty-six of 33 eligible patient,caregiver dyads expressed interest, and 21 enrolled; five whose clinical status changed during the year withdrew and were replaced with new members. Brief introductory socialization, individualized clinical management, and an educational focus selected from problems of patients and caregivers were common to all sessions. Most participants required several types of clinical intervention and educational support. One group ended after reaching a natural termination point, and two others are ongoing at the request of participants. CDCCs can be a viable approach to increasing dementia care capacity in health systems. Formal service intervention trials to evaluate the generalizability and comparative effectiveness and economic viability of this model versus usual care are an appropriate next step. [source] Confounder summary scores when comparing the effects of multiple drug exposures,PHARMACOEPIDEMIOLOGY AND DRUG SAFETY, Issue 1 2010Suzanne M. Cadarette PhD Abstract Purpose Little information is available comparing methods to adjust for confounding when considering multiple drug exposures. We compared three analytic strategies to control for confounding based on measured variables: conventional multivariable, exposure propensity score (EPS), and disease risk score (DRS). Methods Each method was applied to a dataset (2000,2006) recently used to examine the comparative effectiveness of four drugs. The relative effectiveness of risedronate, nasal calcitonin, and raloxifene in preventing non-vertebral fracture, were each compared to alendronate. EPSs were derived both by using multinomial logistic regression (single model EPS) and by three separate logistic regression models (separate model EPS). DRSs were derived and event rates compared using Cox proportional hazard models. DRSs derived among the entire cohort (full cohort DRS) was compared to DRSs derived only among the referent alendronate (unexposed cohort DRS). Results Less than 8% deviation from the base estimate (conventional multivariable) was observed applying single model EPS, separate model EPS or full cohort DRS. Applying the unexposed cohort DRS when background risk for fracture differed between comparison drug exposure cohorts resulted in ,7 to,+,13% deviation from our base estimate. Conclusions With sufficient numbers of exposed and outcomes, either conventional multivariable, EPS or full cohort DRS may be used to adjust for confounding to compare the effects of multiple drug exposures. However, our data also suggest that unexposed cohort DRS may be problematic when background risks differ between referent and exposed groups. Further empirical and simulation studies will help to clarify the generalizability of our findings. Copyright © 2009 John Wiley & Sons, Ltd. [source] A randomized, controlled study of Internet peer-to-peer interactions among women newly diagnosed with breast cancerPSYCHO-ONCOLOGY, Issue 4 2010Mark S. Salzer Abstract Objective: Peer-to-peer interactions are associated with enhanced psychosocial adjustment among women with breast cancer. Millions of women with cancer and others with various health conditions use the Internet to establish peer relationships, usually without professional moderation. This paper reports findings from the first randomized, controlled study of the benefits of these types of Internet-based peer interactions. Methods: This pilot study involved seventy-eight women who were recently diagnosed with breast cancer. Participants were randomly assigned to either an Internet peer support condition or Internet-based educational control condition. Data were gathered at baseline and 4- and 12-months. Primary outcomes of interest were psychological distress and quality of life. Results: Contrary to hypotheses, participants in the Internet peer support condition tended to do worse over time on primary outcome measures. There were no differences between groups on secondary outcomes of perceived social support, self-efficacy, or hope. Paradoxically, many women in the Internet peer support condition actively participated and reported high levels of satisfaction, suggesting some self-perceived benefits. Conclusions: These results suggest that Internet based peer-to-peer interactions may not necessarily be universally beneficial despite the positive experiences reported by many participants. Further research is needed to understand the magnitude of this effect with a larger sample. Moreover, these results raise questions about the need to understand the comparative effectiveness of Internet-based communications by group structure (i.e., unstructured/structured; unmoderated/moderated) and the effect of content (i.e., expression of fear/anxiety, insightful disclosures, etc.) on outcomes. Copyright © 2009 John Wiley & Sons, Ltd. [source] Evidence-based Reviews and Databases: Are They Worth the Effort?ACADEMIC EMERGENCY MEDICINE, Issue 11 2007Developing Evidence Summaries for Emergency Medicine A broad range of relevant evidence-based resources within and outside of emergency medicine (EM) collates and summarizes research evidence pertaining to many questions relevant to clinical emergency care. Such resources may or may not constitute the equivalent of health care recommendations, and their relationship to clinical decision-making may be complex. Many efforts in evidence-based medicine resource development, and their products, are marginally relevant to EM practice but may serve as useful models for parallel EM relevant efforts. A trade-off exists between synthesis quality and ease of practitioner access and use. Keeping all such resources up to date is a major challenge. Although observational evidence suggests that dynamic interactivity and information retrieval technology may enhance practitioner utilization, little evidence exists supporting the absolute or comparative effectiveness of different kinds of resources and databases in enhancing evidence uptake or changing clinician behavior. [source] | ||||||||||