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Own Treatment (own + treatment)
Selected AbstractsFive-year follow-up during antipsychotic treatment: efficacy, safety, functional and social outcomeACTA PSYCHIATRICA SCANDINAVICA, Issue 2007E. Lindström Objective:, Explore the long-term course of schizophrenia and related disorders. Method:, Naturalistic study of 225 patients initially treated with risperidone (monotherapy or in combination with other psychotropic drugs) over 5 years. Results:, Stable symptomatology and side effects were observed. Clinician GAF scores were 55,61, but patients' self-ratings were higher. Clinician and patient CGI scores were at the same level. Annual in-patient days decreased but days in sheltered accommodations increased still more. Only 12% of the patients studied or worked full-time. One in four had no social contacts except with staff. Eight patients died during the 5 years. Conclusion:, The findings underline the chronicity and seriousness of psychotic disorders in terms of social outcome and, indirectly, the low quality of life of this group of persons. Patients were generally well aware of their illness and able to sort out symptoms from drug side effects. This opens for more active involvement of patients in monitoring their own treatment. [source] Whistles, bells, and cogs in machines: Thomas Huxley and epiphenomenalismJOURNAL OF THE HISTORY OF THE BEHAVIORAL SCIENCES, Issue 3 2010John Greenwood In this paper I try to shed some historical light upon the doctrine of epiphenomenalism, by focusing on the version of epiphenomenalism championed by Thomas Huxley, which is often treated as a classic statement of the doctrine. I argue that it is doubtful if Huxley held any form of metaphysical epiphenomenalism, and that he held a more limited form of empirical epiphenomenalism with respect to consciousness but not with respect to mentality per se. Contrary to what is conventionally supposed, Huxley's empirical epiphenomenalism with respect to consciousness was not simply based upon the demonstration of the neurophysiological basis of conscious mentality, or derived from the extension of mechanistic and reflexive principles of explanation to encompass all forms of animal and human behavior, but was based upon the demonstration of purposive and coordinated animal and human behavior in the absence of consciousness. Given Huxley's own treatment of mentality, his characterization of animals and humans as "conscious automata" was not well chosen. © 2010 Wiley Periodicals, Inc. [source] Leg clubs: A new approach to patient-centred leg ulcer managementNURSING & HEALTH SCIENCES, Issue 3 2000DNCERT, DipHE, Ellie Lindsay BSC(HONS) Abstract Loneliness is a significant health-care issue for many elderly patients in the community. The correlation between social isolation, poor compliance to treatment, and low healing rates for patients suffering from leg ulcers is well documented. Pain, odour, bandages etc. contribute to low self-esteem, depression and social stigma. Home visits by community nurses cannot provide the social and psychological support required by these patients. Responding to the holistic needs of this client group, the author set up Debenham Leg Club in 1995 to provide leg ulcer management in an informal, non-medical setting, where the emphasis is on social interaction, participation, empathy and peer support. This social model was conceived as a unique partnership between the district nurses and the local community, in which patients are empowered, through a sense of ownership, to become stakeholders in their own treatment. The value of the ,club' concept is evident in the happy, welcoming, uninhibited atmosphere that characterizes the clinic. Non-compliance to treatment has been virtually eliminated and evidence of greater healing rates has been illustrated through many patients whose long-standing ulcers have healed or greatly improved as a direct result of this change in approach. Patients' willingness to attend for systematic ,well leg' checks and ongoing health education has dramatically reduced the incidence of recurrence. [source] Not Afraid to Blame: The Neglected Role of Blame Attribution in Medical Consumerism and Some Implications for Health PolicyTHE MILBANK QUARTERLY, Issue 1 2002Marsha Rosenthal Starting roughly a quarter century ago, american medicine began a dramatic transformation from a system dominated by clinicians' decision making and professional norms to one in which medical care is expected to reflect the preferences and choices of individual consumers. This growing aspiration toward "medical consumerism" began during the 1970s with a set of popular social movements devoted to giving patients more control over their own treatment and a more informed choice of their physicians (Rodwin 1994). Although the seeds of consumerism were only haphazardly sown and incompletely germinated (Hibbard and Weeks 1987), by the end of the decade they had grown into a noticeable presence in the health care system (Haug and Lavin 1981). During the 1980s, these shifts in popular attitudes were reinforced by public policies and private practices intended to give consumers greater incentives to learn more about their medical choices and to exercise these choices in a cost-conscious manner (Arnould, Rich, and White 1993). [source] The impact of prognosis without treatment on doctors' and patients' resource allocation decisions and its relevance to new drug recommendation processesBRITISH JOURNAL OF CLINICAL PHARMACOLOGY, Issue 2 2008D. Ross Camidge What is already known about this subject ,,The dominant health economic units upon which new treatment funding decisions are made are the incremental cost per life year gained (LYG) or the cost per quality-adjusted life year (QALY) gained. ,,Neither of these units modifies the amount of health gained, by the amount of health patients would have had if they had not been given the treatment under consideration, which may unfairly undervalue the treatments for poor prognosis conditions. ,,How certain patients make decisions about their own treatment has previously been explored, but not how they, or doctors, would allocate hypothetical resource within a healthcare system given information on disease-treatment scenarios' prognoses with and without treatment. What this study adds ,,Information on prognosis without treatment is used within the resource allocation strategies of many doctors and most patients. ,,Individuals use this information in a variety of different ways and a single dominant strategy for quantitative modification of health units is not apparent. ,,Information on prognosis without treatment, or prognosis with standard treatment, is available from the control arm of randomized controlled clinical trials and should be used qualitatively to facilitate decision-making around the second inflexion point on cost per QALY/LYG acceptability curves. Aims Health economic assessments increasingly contribute to funding decisions on new treatments. Treatments for many poor prognosis conditions perform badly in such assessments because of high costs and modest effects on survival. We aimed to determine whether underlying shortness of prognosis should also be considered as a modifier in such assessments. Methods Two hundred and eighty-three doctors and 201 oncology patients were asked to allocate treatment resource between hypothetical patients with unspecified life-shortening diseases. The prognoses with and without treatment were varied such that consistent use of one of four potential allocation strategies could be deduced: life years gained (LYGs) , which did not incorporate prognosis without treatment information; percentage increase in life years (PILY); life expectancy with treatment (LEWT) or immediate risk of death (IRD). Results Random choices were rare; 47% and 64% of doctors and patients, respectively, used prognosis without treatment in their strategies; while 50% and 32%, respectively, used pure LYG-based strategies. Ranking orders were LYG > PILY > IRD > LEWT (doctors) and LEWT > LYG > IRD > PILY (patients). When LYG information alone could not be used, 76% of doctors prioritized shorter prognoses, compared with 45% of patients. Conclusions Information on prognosis without treatment is used within the resource allocation strategies of many doctors and most patients, and should be considered as a qualitative modifier during the health economic assessments of new treatments for life-shortening diseases. A single dominant strategy incorporating this information for any quantitative modification of health units is not apparent. [source] The Perceived Efficacy and Risks of Complementary and Alternative Medicine and Conventional Medicine: A Vignette Study,JOURNAL OF APPLIED BIOBEHAVIORAL RESEARCH, Issue 1 2001Adrian Furnham Participants (N= 148), including CAM users and general practitioner (GP) patients who had never used CAM treatments, read a series of 6 vignettes describing 3 medical conditions being treated using orthodox and CAM methods. As expected, results indicated that both CAM users and GP patients were more likely to agree that their own treatments were effective and were associated with fewer generic risks. Contrary to expectation, both CAM and GP patients were more likely to agree that orthodox treatments were associated with more actual risks than were CAM treatments, and all orthodox treatments for each medical condition were perceived as having more side effects than CAM treatments. [source] Quantifying the Magnitude of Baseline Covariate Imbalances Resulting from Selection Bias in Randomized Clinical TrialsBIOMETRICAL JOURNAL, Issue 2 2005Vance W. Berger Abstract Selection bias is most common in observational studies, when patients select their own treatments or treatments are assigned based on patient characteristics, such as disease severity. This first-order selection bias, as we call it, is eliminated by randomization, but there is residual selection bias that may occur even in randomized trials which occurs when, subconsciously or otherwise, an investigator uses advance knowledge of upcoming treatment allocations as the basis for deciding whom to enroll. For example, patients more likely to respond may be preferentially enrolled when the active treatment is due to be allocated, and patients less likely to respond may be enrolled when the control group is due to be allocated. If the upcoming allocations can be observed in their entirety, then we will call the resulting selection bias second-order selection bias. Allocation concealment minimizes the ability to observe upcoming allocations, yet upcoming allocations may still be predicted (imperfectly), or even determined with certainty, if at least some of the previous allocations are known, and if restrictions (such as randomized blocks) were placed on the randomization. This mechanism, based on prediction but not observation of upcoming allocations, is the third-order selection bias that is controlled by perfectly successful masking, but without perfect masking is not controlled even by the combination of advance randomization and allocation concealment. Our purpose is to quantify the magnitude of baseline imbalance that can result from third-order selection bias when the randomized block procedure is used. The smaller the block sizes, the more accurately one can predict future treatment assignments in the same block as known previous assignments, so this magnitude will depend on the block size, as well as on the level of certainty about upcoming allocations required to bias the patient selection. We find that a binary covariate can, on average, be up to 50% unbalanced by third-order selection bias. (© 2005 WILEY-VCH Verlag GmbH & Co. KGaA, Weinheim) [source] | |||||||||||||