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Future Recommendations (future + recommendation)

Distribution by Scientific Domains

Medical Sciences	75%

Selected Abstracts

Psychological Intervention Following Implantation of an Implantable Defibrillator: A Review and Future Recommendations

PACING AND CLINICAL ELECTROPHYSIOLOGY, Issue 12 2007
SUSANNE S. PEDERSEN Ph.D.
Background:The medical benefits of the implantable cardioverter defibrillator (ICD) are unequivocal, but a subgroup of patients experiences emotional difficulties following implantation. For this subgroup, some form of psychological intervention may be warranted. This review provides an overview of current evidence on the efficacy of psychological intervention in ICD patients and recommendations for future research. Methods:We searched the PubMed and PsycInfo databases in the period between January 1980 and April 2007, using a set of a priori determined keywords. Based on the search and a hand search of the reference lists of the included articles, we identified nine studies that fulfilled the inclusion criteria. Results:The majority of studies used a randomized controlled trial design, but studies varied considerably in sample size, response, attrition rate, and type of intervention. However, most interventions were multifactorial, using cognitive behavioral therapy as one of the mainstays of treatment. Overall, psychological interventions seem to have little impact on shocks and heart rate variability. Some studies found a decrease in depressive symptoms and gains in quality of life, but the most notable effects are seen in improved exercise capacity and reductions in anxiety. Effect sizes for changes in anxiety in the intervention group ranged from small to large compared to small in the usual care group, using Cohen's effect size index. Conclusions:Preliminary evidence from small-scale intervention trials suggests that psychological intervention is worthwhile in ICD patients. Nevertheless, large-scale, well-designed trials are warranted to substantiate these findings. A multifactorial approach using a cognitive behavioral component paired with exercise training is likely to be the most successful. [source]

Treatment effects, disease recurrence, and survival in obese women with early endometrial carcinoma,

CANCER, Issue 12 2006
A Gynecologic Oncology Group study
Abstract BACKGROUND. The objective was to examine whether rates of disease recurrence, treatment-related adverse effects, and survival differed between obese or morbidly obese and nonobese patients. METHODS. Data from patients who participated in a randomized trial of surgery with or without adjuvant radiation therapy were retrospectively reviewed. RESULTS. Body mass index (BMI) data were available for 380 patients, of whom 24% were overweight (BMI, 25,29.9), 41% were obese (BMI, 30,39.9), and 12% were morbidly obese (BMI, ,40). BMI did not significantly differ based on age, performance status, histology, tumor grade, myometrial invasion, or lymphovascular-space involvement. BMI > 30 was more common in African Americans (73%) than non-African Americans (50%). Patients with a BMI , 40 compared with BMI < 30 (hazards ratio [HR], 0.42; 95% confidence interval [CI], 0.09,1.84; P = .246) did not have lower recurrence rates. Compared with BMI < 30, there was no significant difference in survival in patients with BMI 30,39.9 (HR, 1.48; 95% CI, 0.82,2.70; P = .196); however, there was evidence for decreased survival in patients with BMI , 40 (HR, 2.77; 95% CI, 1.21,6.36; P = .016). Unadjusted and adjusted BMI hazards ratios for African Americans versus non-African Americans in the current study differed, thus suggesting a confounding effect of BMI on race. Eight (67%) of 12 deaths among 45 morbidly obese patients were from noncancerous causes. For patients who received adjuvant radiation therapy, increased BMI was significantly associated with less gastrointestinal (R, ,0.22; P = .003) and more cutaneous (R, 0.17; P = .019) toxicities. RESULTS. In the current study, obesity was associated with higher mortality from causes other than endometrial cancer but not disease recurrence. Increased BMI was also associated with more cutaneous and less gastrointestinal toxicity in patients who received adjuvant radiation therapy. Future recommendations include lifestyle intervention trials to improve survival in obese endometrial cancer patients. Cancer 2006. © 2006 American Cancer Society. [source]

3445: Evaluation, diagnosis and grading of severity of MGD

ACTA OPHTHALMOLOGICA, Issue 2010
AJ BRON
Purpose To evaluate current diagnostic tests and make future recommendations. Methods An evidence-based review of procedures. Results MGD is a common symptomatic disorder leading to associated ocular surface disease including evaporative dry eye. A two stage diagnostic approach is recommended including an assessment of meibomian function based on lid morphology, gland mass, expressibility, lipid layer appearance and tear evaporation. A diagnosis of dry eye is based on measures of tear production and clearance, tear osmolarity, tear film stability and the presence of ocular surface changes revealed by tissue staining and inflammatory biomarkers. Quantification of MGD depends on grading meibum quality and expressibility. Newer, quantitative methods will make grading more accurate in the future and include quantitative meibomian expression, non-invasive meibography, confocal microscopy, video-interferometry and the use of inflammatory biomarkers. Meibomian gland dropout can be to monitor and stratify MGD in clinical trials. Conclusion A provisional severity rating of MGD and MGD-related disease has been proposed as a guide to the selection of treatment and the monitoring of disease progression. [source]

Coping strategies used by hypersexual patients to defend against the painful effects of shame

CLINICAL PSYCHOLOGY AND PSYCHOTHERAPY (AN INTERNATIONAL JOURNAL OF THEORY & PRACTICE), Issue 2 2009
Rory C. Reid
This article reports the findings of a study investigating coping strategies used by hypersexual patients (n = 71), compared with a control group (n = 73), in their attempts to defend against shame. Coping strategies were measured using the Compass of Shame Scale (CoSS) and hypersexual behaviour was measured by the Hypersexual Behavior Inventory (HBI). A multivariate analysis of variance of between-group differences was significant, and examination of post hoc univariate tests revealed that the sample of hypersexual patients defended against shame with higher levels of withdrawal and higher tendencies to attack self and others when compared with the control group. The effect sizes of these differences were moderate to large. A categorical analysis of the patient group indicated that the greatest percentages of elevated shame scores were clustered on the Withdrawal and Attack Self subscales of the CoSS. Between-group differences on the Avoidance subscale of the CoSS were not significant. The results of this study are discussed as they pertain to clinical practice, and future recommendations for research are offered.,Copyright © 2009 John Wiley & Sons, Ltd. [source]