Distribution by Scientific Domains
Distribution within Medical Sciences

Kinds of Improvement

  • additional improvement
  • adhesion improvement
  • age-related improvement
  • appreciable improvement
  • average improvement
  • best improvement
  • biochemical improvement
  • clear improvement
  • clinical improvement
  • cognitive improvement
  • comparable improvement
  • concomitant improvement
  • considerable improvement
  • consistent improvement
  • continuous improvement
  • continuous quality improvement
  • cosmetic improvement
  • crop improvement
  • definite improvement
  • demonstrated improvement
  • design improvement
  • dramatic improvement
  • durable improvement
  • early improvement
  • efficiency improvement
  • environmental improvement
  • excellent improvement
  • experience improvement
  • experience significant improvement
  • fatigue life improvement
  • fold improvement
  • function improvement
  • functional improvement
  • future improvement
  • general improvement
  • genetic improvement
  • global improvement
  • good improvement
  • gradual improvement
  • great improvement
  • greater improvement
  • greatest improvement
  • habitat improvement
  • health improvement
  • hematologic improvement
  • hemodynamic improvement
  • histological improvement
  • immediate improvement
  • important improvement
  • incremental improvement
  • initial improvement
  • institutional improvement
  • large improvement
  • larger improvement
  • life improvement
  • limited improvement
  • little improvement
  • long-term improvement
  • major improvement
  • many improvement
  • marginal improvement
  • marked improvement
  • maximal improvement
  • mean improvement
  • meaningful improvement
  • measurable improvement
  • methodological improvement
  • mild improvement
  • minimal improvement
  • minor improvement
  • model improvement
  • moderate improvement
  • modest improvement
  • neurological improvement
  • non-significant improvement
  • notable improvement
  • noticeable improvement
  • objective improvement
  • observed improvement
  • ongoing improvement
  • operational improvement
  • other improvement
  • parallel improvement
  • partial improvement
  • percent improvement
  • percentage improvement
  • performance improvement
  • phase improvement
  • possible improvement
  • postoperative improvement
  • potential improvement
  • practice improvement
  • process improvement
  • product improvement
  • productivity improvement
  • program improvement
  • progressive improvement
  • property improvement
  • quality improvement
  • radiographic improvement
  • radiological improvement
  • rapid clinical improvement
  • rapid improvement
  • real improvement
  • recent improvement
  • relative improvement
  • remarkable improvement
  • reported improvement
  • resulting improvement
  • safety improvement
  • school improvement
  • sensitivity improvement
  • service improvement
  • short-term improvement
  • show improvement
  • showed significant improvement
  • shows improvement
  • significant clinical improvement
  • significant improvement
  • significant performance improvement
  • similar improvement
  • simultaneous improvement
  • slight improvement
  • small improvement
  • spontaneous improvement
  • stability improvement
  • steady improvement
  • subjective improvement
  • subsequent improvement
  • substantial improvement
  • sustained improvement
  • symptom improvement
  • symptomatic improvement
  • systematic improvement
  • technical improvement
  • technological improvement
  • temporary improvement
  • therapeutic improvement
  • transient improvement
  • tremendous improvement
  • visual improvement
  • yield improvement

  • Terms modified by Improvement

  • improvement activity
  • improvement approach
  • improvement center
  • improvement criterioN
  • improvement effort
  • improvement in pain
  • improvement in pain score
  • improvement initiative
  • improvement intervention
  • improvement methods
  • improvement only
  • improvement option
  • improvement potential
  • improvement process
  • improvement professional
  • improvement program
  • improvement programme
  • improvement project
  • improvement rate
  • improvement scale
  • improvement score
  • improvement strategy
  • improvement tool

  • Selected Abstracts


    EDUCATIONAL THEORY, Issue 3 2005
    Margaret Eisenhart
    This article examines different conceptions of causation and their implications for understanding educational phenomena and conducting educational research. Specifically, I discuss four research designs for pursuing questions about causation in education. Two of these research designs take a variance approach to causation (that is, they attempt to show correlations between earlier events and subsequent ones), while the other two take a process approach (that is, they attempt to show a demonstrable sequence of events by which one variable flows into or leads to another). The point of the discussion is to illustrate, first, their respective strengths and, second, their necessary interdependence. Ultimately, I argue that just as both hammers and saws are needed to build a good house, both variance and process approaches are needed to build a good understanding of causation in education. [source]


    ADDICTION, Issue 8 2009
    No abstract is available for this article. [source]


    Haruo Hanyu MD
    No abstract is available for this article. [source]


    Francesco Giallauria MD
    No abstract is available for this article. [source]


    ER SHI
    ABSTRACT A composite polydimethylsiloxane (PDMS) membrane was used to separate aroma compounds from Chinese new-type liquor by pervaporation at 30, 35 and 40C and 10-mmHg downstream pressure. The gas chromatography analysis of aroma compounds in the retentate and permeate showed that PDMS membrane had excellent separation performance. Separation efficiencies for five kinds of esters (except ethyl lactate) and acetal in the original liquor are 100%, over 70% for alcohols (except methanol) and above 87% for aldehyde. The average flux for ethanol reached 3,539 g/m2 · h at 40C. Sensory analysis of the separated ingredients indicates that the sensory quality of the new liquor was significantly superior to that of the original liquor. Experiments suggest that pervaporation is a promising technique for the improvement of Chinese new-type liquor in terms of its flavor. [source]


    ABSTRACT Maintaining the quality of a fresh-cut fruit or vegetable product is a major concern and a priority in the development and in the production of fresh-cut produce products of the industry. The industry has been searching for alternative methods to protect fresh-cut produce from decay and to prolong shelf life. The objective of this research is to enhance the quality and the shelf life of fresh-cut pineapple by exposure to methyl jasmonate (MJ). The exposure of the diced pineapple to a MJ emulsion at a concentration of 10,4 M for 5 min in a sealed container decreased microbiological growth by 3 logs after 12 days of storage at 7C, compared with the control pineapple. Methyl jasmonate as vapor or as dip did not affect the firmness or the color of the fruit. Methyl jasmonate may be a practical treatment to ensure the safety and the quality of fresh-cut pineapple and other fruits and vegetables. [source]


    ABSTRACT The use of whey protein concentrate (WPC) for the improvement of physical properties of nonfat fermented milk drink was investigated. Drinks were prepared from nonfat milk powder and WPC at different proportions. Rheological properties, serum separation and particle size of the drinks were measured. The effect of WPC on the physical properties of the drinks was evaluated by comparison with those of commonly used stabilizers, including propylene glycol alginate and locust bean gum. WPC addition caused an increase in the consistency coefficient and thixotropy and a decrease in the particle size of the samples. There was no serum separation in the sample with 2% WPC. Large unstable aggregates were observed in the sample with 3% WPC, which also exhibited the highest serum separation. WPC up to a level of 2% positively influenced the physical properties of nonfat fermented milk drink similar to stabilizers. PRACTICAL APPLICATIONS Fermented milk drinks are consumed especially for their beneficial health effects. Physical properties of fermented milk drinks influence their quality and consumer acceptability. Hydrocolloid stabilizers are used for the improvement of physical properties of fermented milk products. Whey protein concentrates (WPC) with high protein content can be used to substitute hydrocolloid stabilizers. In this study, the effect of the addition of WPC with 75% protein in place of a part of the nonfat milk powder on the physical properties of nonfat fermented milk drink with 6% dry matter was investigated. Use of an appropriate level of WPC was found to be important for obtaining a desirable effect on the physical properties of nonfat fermented milk drink. The effect of WPC was found to be comparable to those of commonly used hydrocolloid stabilizers. Use of WPC also enhances the nutritional value of the product as whey proteins have a high biological value. [source]


    A. Bersano
    A delayed progressive impairment of peripheral nervous system including brachial and lumbosacral radiculoplexopathy is a well-known complication of local radiotherapy. No treatment for this infrequent complication is currently available. Recently, improvement after treatment with high dose immunoglobulin (IVIg) has been reported in some patients, suggesting either an immune-mediated inflammatory nerve damage induced by irradiation or a dysimmune neuropathy (CIDP-like) misdiagnosed as a postirradiation disease. We report on two patients who developed motor lumbosacral radiculoplexopathy several years after local radiotherapy. The first patient (ZA) is a 49 y.o. man developing a progressive proximal>distal weakness and hypotrophy of lower limbs, 20 years after radiotherapy of lumbosacral region for seminoma. Electrophysiological studies showed markedly reduced motor conduction velocities (CV) and prolonged F-wave latencies in lower limb nerves. The second patient (BF), is a 52 y.o. woman who developed progressive left brachial plexopathy and distal>proximal weakness and hypotrophy of lower limbs 12 years after a first course of toracoascellar and lumbar irradiation for Hodgkin lymphoma followed by a second course of cervicoclavicular irradiation for tumor recurrence 7 years later. Electrophysiological studies showed markedly reduced CMAP amplitudes and proportionally reduced CV in motor nerves. No sensory impairment was detected in both patients. CSF protein was elevated in both patients while cells were normal. On the assumption of a possible dysimmune origin of the disease, patient ZA underwent high dose intravenous steroid treatment, while patient BF, who had previously deteriorated after steroids, was treated with IVIg. After treatment, patient ZA became able to walk with less waddling, to rise from the floor and climb stairs without support, and to run. Improvement was less consistent in patient BF, whose right leg strength improved even if she still needed bilateral support to walk. The improvement observed in both patients supports the hypothesis that, at least in some patients, an immune-mediated mechanism may underlie postirradiation radiculoplexopathy. [source]


    Geoffrey Fishburn
    More recently it has been shown that improvements confined to the country's import competing industry can never be impoverishing if, in that country, no commodity is inferior in consumption. However, in all available proofs of these propositions, it has been assumed that for each country there exists an autarkic equilibrium. It will be shown that, without that assumption, the second proposition must be severely qualified. [source]


    Luis Currais
    I10; I20; O10 ABSTRACT The central component of most economic models that analyse the transition from the Malthusian regime to self-sustaining developed economies is education. Improved health is normally envisaged as simply a by-product of economic growth. Whereas growth does, indeed, tend to improve health status, the reverse is also true, namely that health improvements are a dynamic force capable of driving economic expansion. This paper underlines the importance of health improvements in escaping from Malthusian stagnation. Further, and in contrast to existing literature, which emphasizes the effects of changes in mortality rates, this paper focuses on the relationship between health status and the efficiency of human capital technology. Through this channel, health improvements stimulate investments in child quality in terms of both nourishing and schooling and drive the economy towards the Modern Growth regime. [source]

    Management Strategies and Improvement of Performance of Sewer Networks

    Denys Breysse
    Even when they are conscious about the needs of maintenance to keep the system in a good condition, they lack efficient methods and tools that may help them in taking appropriate decisions. One can say that no really satisfactory and efficient tool exists, enabling the optimization of Inspection, Maintenance, or Rehabilitation (IMR) strategies on such systems. Sewer managers and researchers have been involved for many years in the French National Research Project for Renewal of Non Man Entry Sewer System (RERAU,Réhabilitation des Réseaux d'Assainissement Urbains, in French) to improve their knowledge of these systems and the management policies. During the RERAU project, a specific action has been dedicated to the modeling of asset ageing and maintenance. A special attention has been dedicated to the description of defects and dysfunctions, to the evaluation of performances and its modeling, accounting for its various dimensions (from the point of view of the manager, of the user, of the environment,). After having defined an Index of Technical Performance (ITp), we will introduce the Index of Technical and Economic Performance (ITEp) that is a combined measure of performance (including social costs) and technical costs. This index provides an objective standard tool for managers to compare different alternatives. It is used in the article to compare some simple IMR strategies. It sets the basis of a new method for no-man entry sewer system management, enabling us to analyze the profitableness of investment in terms of both technical and economic performance. [source]

    Heart changes in 17-day-old fetuses of diabetic ICR (Institute of Cancer Research) mothers: Improvement with maternal immune stimulation

    Juan Claudio Gutierrez
    ABSTRACT Maternal diabetes mellitus is associated with increased fetal teratogenesis, including cardiovascular defects. Non-specific maternal immune stimulation with Freund's complete adjuvant (FCA) or interferon gamma (IFN,) has been associated with protection against birth malformations. Using a diabetic mouse model, late-gestation fetal heart and great vessel morphology were analyzed. Four groups of mice were used: non-diabetic females as a control group, hyperglycemic females induced by streptozotocin as a diabetic group, and diabetic females injected either with FCA or IFN,. At day 17 of gestation, females were euthanized and one fetus was arbitrarily selected per litter for fixation and sectioning. Treatment-induced changes in cardiac development were assessed from digital images of serial sections taken at standardized levels in the thorax. One-way parametric and non-parametric ANOVA and ordinal logistic regression were performed to compare the difference among groups (P < 0.05). Maternal hyperglycemia altered morphology of the late-gestation fetal mouse heart by causing ventricular chamber dilation, sectional myocardial reduction, and an increase in transversal aortic area. FCA protected the fetal heart from cavitary dilation in diabetic mothers. FCA and IFN, protected the fetal heart against reduction of myocardial area, and ascending thoracic aorta dilation. Consequences of late gestation heart chamber dilation and myocardial reduction are not yet known. Maternal immune stimulation partially protected against these developmental defects by mechanisms that remain unclear. [source]

    Mechanical Bridging to Improvement in Severe Acute ,Nonischemic, Nonmyocarditis' Heart Failure

    O.H. Frazier MD
    Improved myocardial function has been observed in patients with acute myocarditis who have had short-term support with a ventricular assist system. Additionally, a limited number of patients with nonischemic cardiomyopathy have undergone successful device explantation after their myocardial function improved during ventricular assist system support. The authors present their experience with four patients who had acute, severe heart failure without coronary artery disease or biopsy-proven myocarditis. After receiving prolonged ventricular assist system support, all four patients had significantly improved left ventricular function, returning to New York Heart Association functional class I without inotropic therapy. In each case, dobutamine stress echocardiography and invasive hemodynamic tests were performed to confirm improvement of cardiac function before device explantation was undertaken. In all four cases, device explantation was followed by early successful maintenance of left ventricular function. These cases reveal a unique clinical syndrome that may be successfully treated with early institution of ventricular assist system support followed by explantation after myocardial recovery. [source]

    Improvement In Blood Pressure Control With Impedance Cardiography-Guided Pharmacologic Decision Making

    Donald L. Sharman MD
    Previous reports have demonstrated improvement in blood pressure (BP) control utilizing noninvasive hemodynamic measurements with impedance cardiography (ICG). The purpose of this article is to report the effect of utilizing ICG-guided decision making to treat uncontrolled hypertension in a community generalist setting. Patient medical records were retrospectively reviewed for subjects on two antihypertensive agents with systolic blood pressure ,140 mm Hg or diastolic blood pressure ,90 mm Hg. All subjects were treated utilizing a previously published ICG-guided treatment algorithm. Twenty-one subjects met the BP and medication criteria. BP at entry was 157.2±13.9/78.7±9.9 mm Hg. Subjects were treated for 215±85 days (5.0±2.0 visits). After ICG-guided treatment, 12/21 (57.1%) achieved sustained BP control (p<0.001). BP was lowered to 141.6±22.0 (p<0.001)/77.1±10.7 (p>0.05) mm Hg. Antihypertensive agents increased from 2.0±0.0 to 2.5±0.7 (p<0.05). In this series of subjects with uncontrolled BP taking two antihypertensive agents, ICG-guided pharmacologic decision making resulted in significant reduction in BP and improvement in BP control. [source]

    Improvement in Exercise Tolerance and Symptoms of Congestive Heart Failure During Treatment With Candesartan Cilexetil

    David Tepper MD Editor
    No abstract is available for this article. [source]

    The prognosis of occupational contact dermatitis in 2004

    CONTACT DERMATITIS, Issue 5-6 2004
    Jennifer Cahill
    The prognosis of occupational contact dermatitis (OCD) takes into account the extent of healing, effect on quality of life and employment, and financial costs for both the individual and the wider community. We reviewed 15 studies published between 1958 and 2002, reporting the complete clearance of dermatitis (range of 18,72%). 9 of the 15 studies reported a clearance rate of between 18 and 40%. Improvement was reported as an outcome in 3 studies between 1991 and 2002 (range of 70,84%). A number of common variables were identified as of possible influence. These include age, sex, atopy, patient knowledge, disease aetiology, duration of symptoms and job change; clinical, financial and social issues are also described. All of these factors need to be considered when managing a patient with OCD. Improved patient knowledge and early diagnosis may be associated with improved prognosis, whereas job change does not make a significant difference. Some patients will develop persistent post-occupational dermatitis, which has important implications for prognosis and workers' compensation. Only a small proportion of eligible patients receive workers' compensation, even though financially supported healing time soon after diagnosis may result in an improved prognosis. [source]

    CI Implementation: An Empirical Test of the CI Maturity Model

    Frances Jørgensen
    There are a number of tools available for organizations wishing to measure and subsequently develop Continuous Improvement (CI). In this article, we review and evaluate a well-accepted CI development model, namely the CI Maturity Model (Bessant and Caffyn, 1997), against data collected from the 2nd Continuous Improvement Network Survey and a number of empirical cases described in the literature. While the CI Maturity Model suggests that CI maturation ought to be a linear process, the findings in this article suggest that there are feasible alternatives for companies to develop CI capability. [source]

    Learning How and Learning What: Effects of Tacit and Codified Knowledge on Performance Improvement Following Technology Adoption

    DECISION SCIENCES, Issue 2 2003
    Amy C. Edmondson
    ABSTRACT This paper examines effects of tacit and codified knowledge on performance improvement as organizations gain experience with a new technology. We draw from knowledge management and learning curve research to predict improvement rate heterogeneity across organizations. We first note that the same technology can present opportunities for improvement along more than one dimension, such as efficiency and breadth of use. We compare improvement for two dimensions: one in which the acquisition of codified knowledge leads to improvement and another in which improvement requires tacit knowledge. We hypothesize that improvement rates across organizations will be more heterogeneous for dimensions of performance that rely on tacit knowledge than for those that rely on codified knowledge (H1), and that group membership stability predicts improvement rates for dimensions relying on tacit knowledge (H2). We further hypothesize that when performance relies on codified knowledge, later adopters should improve more quickly than earlier adopters (H3). All three hypotheses are supported in a study of 15 hospitals learning to use a new surgical technology. Implications for theory and practice are discussed. [source]

    Atomoxetine treatment in adults with attention-deficit/hyperactivity disorder and comorbid social anxiety disorder

    Lenard A. Adler M.D.
    Abstract Background: To evaluate the effect of atomoxetine (ATX) on attention-deficit/hyperactivity disorder (ADHD) and comorbid social anxiety disorder in adults. Methods: Randomized, double-blind, placebo-controlled, conducted in adults with ADHD and social anxiety disorder. Patients received 40,100,mg ATX (n=224) or placebo (n=218) for 14 weeks following a 2-week placebo lead-in period. Efficacy measures included the Conners' Adult ADHD Rating Scale: Investigator-Rated: Screening Version (CAARS:Inv:SV), Liebowitz Social Anxiety Scale (LSAS), Clinical Global Impression-Overall-Severity (CGI-O-S), State-Trait Anxiety Inventory (STAI), Social Adjustment Scale-Self Report (SAS), and Adult ADHD Quality of Life Scale-29 (AAQoL). Safety and tolerability were also assessed. Results: ATX mean change (,8.7±10.0) from baseline (29.6±10.4) on CAARS:Inv:SV Total ADHD Symptoms score was significantly greater than placebo mean change (,5.6±10.2) from baseline (31.2±9.4; P<.001). ATX mean change (,22.9±25.3) from baseline (85.3±23.6) on LSAS Total score was significant compared to placebo mean change (,14.4±20.3) from baseline (82.1±21.3; P<.001). The visit-wise analysis revealed greater improvement on the CAARS:Inv:SV Total ADHD Symptoms score and LSAS Total score for ATX at every time point throughout the study (P values ,.012). Mean changes in CGI-O-S, STAI-Trait Anxiety scores, and AAQoL Total score were significantly greater for ATX compared to placebo. Mean change for both groups on STAI-State Anxiety scores was comparable. Improvement on SAS for ATX compared to placebo was not significant. Rates of insomnia, nausea, dry mouth, and dizziness were higher with ATX than with placebo. Discontinuation rates due to treatment-emergent adverse events were similar between groups. Conclusions: ATX monotherapy effectively improved symptoms of ADHD and comorbid social anxiety disorder in adults and was well tolerated. Depression and Anxiety, 2009. Published 2009 Wiley-Liss, Inc. [source]

    Efficacy and safety of duloxetine in the treatment of generalized anxiety disorder: a flexible-dose, progressive-titration, placebo-controlled trial

    Moira Rynn M.D.
    Abstract Generalized anxiety disorder (GAD), a prevalent and chronic illness, is associated with dysregulation in both serotonergic and noradrenergic neurotransmission. Our study examined the efficacy, safety, and tolerability of duloxetine hydrochloride, a dual reuptake inhibitor of serotonin and norepinephrine, for short-term treatment of adults with GAD. In a 10-week, double-blind, progressive-titration, flexible-dose trial, 327 adult outpatients with a DSM-IV,defined GAD diagnosis were randomized to duloxetine 60,120,mg (DLX, N=168) or placebo (PLA, N=159) treatment. The primary efficacy measure was mean change from baseline to endpoint in Hamilton Anxiety Scale (HAMA) total score. Secondary outcome measures included response rate (HAMA total score reduction ,50% from baseline), Clinician Global Impression,Improvement (CGI-I) scores, and Sheehan Disability Scale (SDS) scores. Patients who received duloxetine treatment demonstrated significantly greater improvement in HAMA total scores (P=.02); a higher response rate (P=.03), and greater improvement (P=.04) than patients who received placebo. Duloxetine-treated patients were also significantly more improved than placebo-treated patients on SDS global functional (P<.01) and work, social, and family/home impairment scores (P<.05). The rate of discontinuation due to adverse events (AEs) was higher for the duloxetine group compared with the placebo group (P=.002). The AEs most frequently associated with duloxetine were nausea, dizziness, and somnolence. Duloxetine was an efficacious, safe, and well-tolerated treatment that resulted in clinically significant improvements in symptom severity and functioning for patients with GAD. Depression and Anxiety 0:1,8, 2007. © 2007 Wiley-Liss, Inc. [source]

    A double-blind study of the efficacy of venlafaxine extended-release, paroxetine, and placebo in the treatment of panic disorder

    Mark H. Pollack M.D.
    Abstract To date, no large-scale, controlled trial comparing a serotonin,norepinephrine reuptake inhibitor and selective serotonin reuptake inhibitor with placebo for the treatment of panic disorder has been reported. This double-blind study compares the efficacy of venlafaxine extended-release (ER) and paroxetine with placebo. A total of 664 nondepressed adult outpatients who met DSM-IV criteria for panic disorder (with or without agoraphobia) were randomly assigned to 12 weeks of treatment with placebo or fixed-dose venlafaxine ER (75,mg/day or 150,mg/day), or paroxetine 40,mg/day. The primary measure was the percentage of patients free from full-symptom panic attacks, assessed with the Panic and Anticipatory Anxiety Scale (PAAS). Secondary measures included the Panic Disorder Severity Scale, Clinical Global Impressions,Severity (CGI-S) and ,Improvement (CGI-I) scales; response (CGI-I rating of very much improved or much improved), remission (CGI-S rating of not at all ill or borderline ill and no PAAS full-symptom panic attacks); and measures of depression, anxiety, phobic fear and avoidance, anticipatory anxiety, functioning, and quality of life. Intent-to-treat, last observation carried forward analysis showed that mean improvement on most measures was greater with venlafaxine ER or paroxetine than with placebo. No significant differences were observed between active treatment groups. Panic-free rates at end point with active treatment ranged from 54% to 61%, compared with 35% for placebo. Approximately 75% of patients given active treatment were responders, and nearly 45% achieved remission. The placebo response rate was slightly above 55%, with remission near 25%. Adverse events were mild or moderate and similar between active treatment groups. Venlafaxine ER and paroxetine were effective and well tolerated in the treatment of panic disorder. Depression and Anxiety 24:1,14, 2007. © 2006 Wiley-Liss, Inc. [source]

    Early response and 8-week treatment outcome in GAD ,

    Moira Rynn M.D.
    Abstract Our objective was to compare the predictive value of early response to treatment outcome in patients with generalized anxiety disorder (GAD) treated with benzodiazepines, serotonin receptor (5HT-1A) partial agonists, or placebo. Data from two double-blind GAD studies were combined. Subjects were evaluated with the Hamilton Anxiety Scale (HAM-A) and the Clinical Global Impression of Improvement (CGI-I) scale over 8 weeks. Categories of response at weeks 1 and 2 were defined by the HAM-A total score. Analyses of covariance and Kaplan,Meier survival analyses were the primary analyses used to assess 8-week end point treatment outcomes as a function of early improvement. HAM-A change from baseline to weeks 1 and 2 significantly predicted last observation carried forward (LOCF) response at week 8 for both medications and for placebo (P<.001). Early improvement was a strong predictor for treatment outcome irrespective of whether active medication or placebo was the treatment agent. Depression and Anxiety 23:461,465, 2006. Published 2006 Wiley-Liss, Inc. [source]

    Citalopram treatment of social anxiety disorder with comorbid major depression

    Franklin R. Schneier M.D.
    Abstract Treatment of patients with both social anxiety disorder and major depression has been little studied although social anxiety disorder and depression frequently co-occur. Each disorder has been shown to respond to serotonin reuptake inhibitor treatment. Objectives of this study were to characterize a sample of these comorbid patients and to assess response to treatment with citalopram. Patients with primary DSM-IV generalized subtype of social anxiety disorder and comorbid major depression (N = 21) were assessed for symptoms of each disorder, including atypical depressive features, and functional impairment. Patients were treated with a flexible dose of open label citalopram for 12 weeks. Response rates for the intention-to-treat sample at week 12 were 14/21 (66.7%) for social anxiety disorder and 16/21 (76.2%) for depression. All continuous measures of social anxiety, depression, and functional impairment improved significantly with treatment, but depression symptoms responded more rapidly and more completely than social anxiety symptoms. Mean dose of citalopram at study endpoint was 37.6 mg/day. Only three patients (14.3%) fulfilled DSM-IV criteria for atypical features of depression, although 18 (85.7%) fulfilled the criterion for interpersonal rejection sensitivity. Citalopram treatment may benefit patients with primary social anxiety disorder and comorbid major depression, and it should be further studied in controlled trials. Improvement in social anxiety disorder symptoms lagged behind improvement in depression, and greater than 12 weeks of treatment may be required to assess full social anxiety response in patients with comorbid depression. The overlap of social anxiety disorder with atypical features of depression may primarily be due to the shared feature of rejection sensitivity. Depression and Anxiety 17:191,196, 2003. © 2003 Wiley-Liss, Inc. [source]

    Achieving remission with venlafaxine and fluoxetine in major depression: its relationship to anxiety symptoms

    Jonathan R.T. Davidson M.D., M.B.A.
    Abstract Venlafaxine, a serotonin and norepinephrine reuptake inhibitor (SNRI), produces significantly higher remission rates in depressed patients than do the selective serotonin reuptake inhibitors (SSRIs). In this analysis of pooled data, we explored the relationship between differences in treatment efficacy, early improvement of symptoms, and severity of baseline anxiety in depressed patients treated with either venlafaxine or fluoxetine. A pooled analysis was performed on data from 1,454 outpatients with major depression from five double-blind, randomized studies comparing the 6-week efficacy of venlafaxine (542 patients) with fluoxetine (555 patients). The Hamilton rating scale for depression (HAM-D) total and item scores were analyzed at different treatment times up to 6 weeks. Venlafaxine and fluoxetine both produced statistically significant higher response and remission rates compared with placebo starting from week 2 for response and weeks 3 to 4 for remission. Venlafaxine was statistically significantly superior to fluoxetine from week 3 until week 6 in respect of response rate, and from week 2 until week 6 for remission rate. After 1 week of treatment, greater improvement in individual symptoms was observed in the depressed mood, suicide, and psychic anxiety items of the HAM-D scale for both venlafaxine- and fluoxetine-treated patients compared with placebo. Improvement in psychic anxiety was statistically significantly greater with venlafaxine than with fluoxetine. The presence of baseline psychic anxiety correlated significantly to treatment outcome when analyzing the remission rates. In depressed patients with moderate anxiety (HAM-D psychic anxiety score ,2), venlafaxine statistically significantly increased remission rates compared with placebo from week 4 until week 6, while a significant effect of fluoxetine on remission rates was observed starting at week 6. Remission rates in the severely anxious depressed patients (score >2) were statistically significantly higher with venlafaxine than placebo starting from week 3 until the end of the study period, but no difference could be observed between fluoxetine and placebo. Baseline severity of psychic anxiety had a significant impact on remission rates after treatment of patients diagnosed with depression. Venlafaxine's superior remission rates in the more severely anxious patients and its ability to improve psychic anxiety as early as week 1 compared with fluoxetine suggest that venlafaxine's early efficacy on anxiety symptoms may be the basis for its superior efficacy in depression. Depression and Anxiety 16:4,13, 2002. © 2002 Wiley-Liss, Inc. [source]

    Improvement of Postfractional Laser Erythema with Light-Emitting Diode Photomodulation

    BACKGROUND The most common side effects of fractional laser skin treatment are erythema and edema. Low-level light therapy and light-emitting diode (LED) devices have been used to stimulate fibroblast activity and hasten wound healing. OBJECTIVE To determine whether LED treatment immediately after fractional laser skin resurfacing affects the severity and duration of postoperative eythema. MATERIALS AND METHODS Twenty patients received treatment with a 590-nm wavelength LED array to randomly selected facial halves immediately after undergoing full-face fractional laser skin resurfacing with a 1,550-nm erbium-doped fiber laser. Differences in erythema between LED-treated and untreated facial halves were recorded at 24, 48, and 96 hours post-treatment. RESULTS The LED-treated facial halves were less erythematous in all 20 patients 24 hours postoperatively. The six patients who received the highest mean energy densities during fractional laser treatment continued to exhibit decreased erythema in the LED-treated areas at 48 hours. At 96 hours post-treatment, no discernible differences between facial halves were observed in any patient. CONCLUSIONS Photomodulation with a 590-nm-wavelength LED array can decrease the intensity and duration of postfractional laser treatment erythema. [source]

    Persistence and Improvement of Nasolabial Fold Correction with Nonanimal-Stabilized Hyaluronic Acid 100,000 Gel Particles/mL Filler on Two Retreatment Schedules: Results up to 18 Months on Two Retreatment Schedules

    BACKGROUND Nonanimal-stabilized hyaluronic acid (NASHA) fillers are frequently used for facial soft tissue augmentation. Their long-term efficacy and the effects of different retreatment schedules are not well established. OBJECTIVE This is an 18-month interim analysis of a 30-month study to evaluate the efficacy and persistence of NASHA 100,000 gel particles/mL filler with two different retreatment schedules. METHODS This multicenter, randomized, evaluator-blinded study enrolled 75 patients with moderate to severe nasolabial folds. Patients were randomized to retreatment of one nasolabial fold at 4.5 months and the contralateral fold at 9 months after correction of both folds at the initial visit. RESULTS Wrinkle Severity Rating Scale scores improved significantly (p<.001) from baseline, with mean improvements ranging from 1.1 to 1.7 grades. Almost all patients (97%) responded satisfactorily, and the efficacy of the retreatment schedules did not differ significantly. Adverse events, primarily swelling and bruising, occurred in 33% of patients; none were serious. CONCLUSION The improvements seen after initial treatment with NASHA 100,000 gel particles/mL filler persisted for up to 18 months with one retreatment. The response was equivalent for retreatment at 4.5 and 9 months. [source]

    Split-Face Treatment of Facial Dyschromia: Pulsed Dye Laser with a Compression Handpiece versus Intense Pulsed Light

    BACKGROUND Many visible light lasers and intense pulsed light (IPL) devices are available to treat photodamaged skin. OBJECTIVES The objective was to perform a multiple-treatment split-face comparison evaluating a pulsed dye laser (PDL) with a compression handpiece versus IPL for photorejuvenation. METHODS Ten subjects were treated three times at 3- to 4-week intervals. One side of the face was treated with the PDL with compression handpiece, and the other with IPL. One month after final treatment, blinded evaluation assessed for improvements in dyschromias and texture. Patients provided self-assessment of improvement in dyschromias and texture. Time to complete final treatments and pain during all treatments were recorded for each device. RESULTS Improvement of the PDL was (mean) 86.5, 65, 85, 38, and 40% for dark lentigines, light lentigines, vessels <0.6 mm, vessels >0.6 mm, and texture, respectively, versus 82, 62.5, 78.5, 32.5, and 32%, respectively, for the IPL side. Patient-evaluated difference in improvement for vascular lesions significantly favored the PDL (p=.011). Mean third treatment times were 7.7 minutes for PDL versus 4.6 minutes for the IPL (p=.005). Mean pain ratings were 5.8 for the PDL and 3.1 for the IPL (p=.007). Purpura-free procedures depended on proper technical use of the compression handpiece when treating lentigines with the PDL. CONCLUSIONS The PDL with compression handpiece and IPL are highly effective for photorejuvenation. [source]

    Making Scents: Improvement of Olfactory Profile after Botulinum Toxin-A Treatment in Healthy Individuals

    BACKGROUND The axilla is particularly associated with body odor and putative pheromone production in humans. Although botulinum toxin type A (BT-A) is injected increasingly into the axillary skin to stop excessive sweating, its potential to control body odor is largely unexplored. OBJECTIVE The objective was to measure the impact of BT-A on human axillary odor in an objective and reproducible fashion. METHODS This study was a randomized, double-blind, placebo-controlled trial with 51 healthy volunteers receiving 50 U of BOTOX (Allergan, Inc.) in one axilla and placebo in the other. Odor quality was assessed by treated subjects (questionnaire) as well as by independent raters who were exposed to blinded T-shirt samples. RESULTS No major side effects occurred, and no subject withdrew from the study for medical reasons. Samples from the BT-A,treated side smelled less intense (p<.001) and better (p<.001) according to self-assessments. Likewise, independent raters found the BT-A,treated samples to smell less intense and better (p<.001). They preferred "to work together with the respective person" and found the odor "more erotic" (p<.001). CONCLUSION Side-by-side comparison of odor samples (T-shirt sniff test) by independent raters showed that axillary odor in healthy individuals is significantly more appealing after BT-A injection. [source]

    Utilization of the 1320-nm Nd:YAG Laser for the Reduction of Photoaging of the Hands

    FAACS, Neil Sadick MD
    Background. Nonablative laser resurfacing has been shown to improve the appearance photoaged skin. Clinical improvement has been associated with dermal collagen remodeling. Objective. The objective was to determine the efficacy of a 1320-nm Nd:YAG laser for the treatment of photoaging hands. Methods. Seven patients with photoaged hands received six monthly treatments with a 1320-nm Nd:YAG laser. Improvement in skin smoothness was evaluated by objective and patient assessment using a 6-point improvement scale: 1=no improvement and 6=80% to 100% improvement. Results. Mild to moderate improvement was achieved as determined by both objective and patient assessment. Mean improvement by objective assessment was 2.4 points. Objective improvement was noted in four of seven patients, and these patients demonstrated a mean improvement score of 3.5 points. The mean improvement by patient assessment was 3.1 points. Conclusion. This case series demonstrates that the 1320-nm Nd:YAG laser with cryogen cooling can be effective for rejuvenation of photoaged hands. [source]

    Tumescent Liposuction Report Performance Measurement Initiative: National Survey Results

    William Hanke MD
    Background. This study was created by the Accreditation Association for Ambulatory Health Care Institute for Quality Improvement to measure clinical performance and improvement opportunities for physicians and ambulatory health-care organizations. Data were collected prospectively between February 2001 and August 2002. Thirty-nine study centers participated, and 688 patients who had tumescent liposuction were surveyed and followed for 6 months. Objective. The objective was to determine patient satisfaction with tumescent liposuction and examine current liposuction practice and the safety of tumescent liposuction in a representative cohort of patients. Methods. The Accreditation Association for Ambulatory Health Care Institute for Quality Improvement collected prospective data from February 2001 to August 2002 from 68 organizations registered for this study. Ultimately 39 organizations submitted 688 useable cases performed totally with local anesthesia, "tumescent technique." Results. The overall clinical complication rate found in the Accreditation Association for Ambulatory Health Care Institute for Quality Improvement study was 0.7% (5 of 702). There was a minor complication rate of 0.57%. The major complication rate was 0.14% with one patient requiring hospitalization. Seventy-five percent of the patients reported no discomfort during their procedures. Of the 59% of patients who responded to a 6-month postoperative survey, 91% were positive about their decision to have liposuction (rating of 4 or 5 on a scale of 1,5) and 84% had high levels (4 or 5 on a scale of 1,5) of overall satisfaction with the procedure. Conclusions. Our findings are consistent with others in that tumescent liposuction is a safe procedure with a low complication rate and high patient satisfaction. [source]