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Receiving Treatment (receiving + treatment)
Selected AbstractsEstimation and Inference for the Causal Effect of Receiving Treatment on a Multinomial OutcomeBIOMETRICS, Issue 1 2009Jing Cheng Summary This article considers the analysis of two-arm randomized trials with noncompliance, which have a multinomial outcome. We first define the causal effect in these trials as some function of outcome distributions of compliers with and without treatment (e.g., the complier average causal effect, the measure of stochastic superiority of treatment over control for compliers), then estimate the causal effect with the likelihood method. Next, based on the likelihood-ratio (LR) statistic, we test those functions of or the equality of the outcome distributions of compliers with and without treatment. Although the corresponding LR statistic follows a chi-squared (,2) distribution asymptotically when the true values of parameters are in the interior of the parameter space under the null, its asymptotic distribution is not ,2 when the true values of parameters are on the boundary of the parameter space under the null. Therefore, we propose a bootstrap/double bootstrap version of a LR test for the causal effect in these trials. The methods are illustrated by an analysis of data from a randomized trial of an encouragement intervention to improve adherence to prescribed depression treatments among depressed elderly patients in primary care practices. [source] Coercive treatment for drug misuse: a dialogical junctureJOURNAL OF COMMUNITY & APPLIED SOCIAL PSYCHOLOGY, Issue 5 2004Christine Horrocks Abstract This article adopts a ,dialogical' relational perspective to explore the recently introduced initiative of coercive treatment for drug misuse in the UK. Conversational interviews were undertaken with 11 people who had been sentenced to the Drug Treatment and Testing Order. Receiving treatment for drug misuse is often storied within a motivational account that is expectant of a ,readiness to change'; such assumptions seem theoretically problematic when change is legally imposed. Therefore, moral and ethical concerns surround the introduction of this initiative, however the interview data illustrates the potential that participation might offer for the creation of ,counterstories' where a more moral self can be enacted. Our analysis suggests that this counterstory is co-constructed thus being an outcome of both self and other. Furthermore such stories appear fragile; constantly under assault from detrimental authoritative discourses that are not only part of wider social understandings around drug misuse but also permeate the policy and practice of coercive treatment. Copyright © 2004 John Wiley & Sons, Ltd. [source] A comparison of budesonide/formoterol maintenance and reliever therapy vs. conventional best practice in asthma managementINTERNATIONAL JOURNAL OF CLINICAL PRACTICE, Issue 10 2009R. Louis Summary Objective:, To study the effectiveness and safety of budesonide/formoterol (Symbicort®) Maintenance And Reliever Therapy (Symbicort SMART®, AstraZeneca, Södertalje, Sweden), a simplified management approach with one inhaler compared with conventional best practice (CBP) with multiple inhalers in patients with persistent asthma. Design:, Open-label randomised controlled parallel group trial, 6-month treatment. Participants:, A total of 908 patients , 12 years of age, with persistent asthma receiving treatment with inhaled corticosteroids (ICS), either alone or in conjunction with long-acting ,2 -agonist. Main outcome measures:, Time to first severe asthma exacerbation and number of severe asthma exacerbations. Results:, No difference between groups was seen in time to first severe exacerbation (p = 0.75). Exacerbation rates were low in both groups. A total of 12 patients in the Symbicort SMART® group experienced a total of 14 severe asthma exacerbations, and 19 patients in the CBP group experienced a total of 25 severe asthma exacerbations (annual rate 0.07 vs. 0.13 p = 0.09). The mean daily dose of ICS expressed in BDP equivalent was significantly lower in the Symbicort SMART® group (including as-needed use) vs. in the CBP group (749 ,g vs. 1059 ,g; p < 0.0001). Mean scores in Asthma Control Questionnaire, 5 question version improved significantly in the SMART group compared with the CBP group (p = 0.0026). Symbicort SMART and CBP were equally well tolerated. The mean drug cost/patient/month was significantly lower for the patients in the Symbicort SMART group compared with patients receiving CBP (51.3 , vs. 66.5 ,; p < 0.0001). Conclusions:, In Belgian patients, a simplified regimen using budesonide/formoterol maintenance and reliever therapy was at least as effective at improving clinical control compared with CBP with a significantly lower ICS dose and significantly lower drug costs. [source] Development of a registry for monitoring psychotropic drug prescriptions: aims, methods and implications for ordinary practice and researchINTERNATIONAL JOURNAL OF METHODS IN PSYCHIATRIC RESEARCH, Issue 3 2005Dr Corrado Barbui Abstract In psychiatry, individual-based registries have provided key information on risks and benefits associated with the use of psychotropic drugs but they have rarely been employed for monitoring and evaluating the everyday prescribing of psychopharmacological treatments. This article describes the cultural background that gave impetus to the idea of registering all prescriptions of psychotropic drugs dispensed by physicians working in the South Verona community mental health service, and presents the methodology employed to develop such a registry in a community psychiatric service where a psychiatric case register (PCR) has been operating since 1978. We developed a registry including every patient receiving psychotropic medications in ordinary practice. This registry is linked to the PCR in order to obtain data on social and demographic characteristics, clinical symptoms, diagnosis, use of services, and outcomes. No exclusion criteria are allowed , anyone receiving treatment is automatically included. This system, which can link drug and service-use data with hard outcome indicators, can generate information on the proportion of subjects discontinuing treatment, switching medication because of side-effects, recovery or inefficacy, as well as on the proportion of subjects failing to return to the physician, and the proportion of patients who improve. The innovative aspect of this approach is that this registry is developed, organized and used by physicians interested in monitoring their clinical practice and in providing patients, relatives and the public with accurate information on drug use in their specific context of care. Copyright © 2005 John Wiley & Sons, Ltd. [source] Enhanced healing of diabetic foot ulcers using local heat and electrical stimulation for 30 min three times per weekJOURNAL OF DIABETES, Issue 1 2010Jerrold Scott PETROFSKY Abstract Background:, Electrical stimulation (ES) with heating is effective in healing chronic wounds. However, it this effect due to ES alone or both heating and ES? The aim of the present study was to deduce the individual roles of heat and ES in the healing of chronic wounds. Methods:, The study was performed on 20 patients (mean age 48.4 ± 14.6 years) with non-healing diabetic foot ulcers (mean duration 38.9 ± 23.7 months) who received local dry heat (37°C; n = 10) or local dry heat + ES (n = 10) three times a week for 4 weeks. Patients were given ES using biphasic sine wave stimulation (30 Hz, pulse width 250 ,s, current approximately 20 mA). Results:, Skin blood flow in and around the wound was measured with a laser Doppler flow imager. In the ES + heat group, the average wound area and volume decreased significantly by 68.4 ± 28.6% and 69.3 ± 27.1%, respectively (both P < 0.05), over the 1-month period. During the average session, blood flow increased to 102.3 ± 25.3% with local heat and to 152.3 ± 23.4% with ES + heat. In the group receiving treatment with local heat only, wounds that had not healed for at least 2 months showed 30.1 ± 22.6% healing (i.e. a decrease in wound area) after 1 month. Although this level of healing was significant, it was less than that observed in the ES + heat group (P < 0.05). Conclusions:, Local dry heat and ES work well together to heal chronic diabetic foot wounds; however, local heat would appear to be a relevant part of this therapy because ES alone has produced little healing in previous studies. [source] Effects of Written Information Material on Help-Seeking Behavior in Patients with Erectile Dysfunction: A Longitudinal StudyTHE JOURNAL OF SEXUAL MEDICINE, Issue 2 2008Michael M. Berner MD ABSTRACT Introduction., Neither men with erectile dysfunction (ED) nor their physicians are willing to discuss sexual problem sufficiently. Written information material could facilitate a dialogue and encourage men to seek treatment. Aim., The central task of this article was to determine the effectiveness and acceptance of patient information material for sexual dysfunction. Methods., Through an information campaign, men received informational material. Eight thousand men also received a first survey, which asked about the intention to seek treatment and to discuss the sexual problem with a physician or partner. A second follow-up questionnaire, 3,6 months after the first one, asked for the implementation of these intentions. Descriptive and regression-based analyses were applied. Main Outcome Measures., Help-seeking behavior, subjective assessment of change in disease severity and partnership quality, satisfaction. Results., Four hundred forty-three men participated in both surveys. Nearly 90% of them became active after reading the information material. More than half talked with their partner (57.8%) and a physician (65%), and one-third sought treatment (31.8%). Especially discussing the problem with the partner and receiving treatment improved erectile functioning and led to an increase in the quality of partnership (P , 0.05). The initial intention to become active was a good predictor for completing an action. The main reasons for not becoming active were inhibitions to talk about ED (46.8%) and fear of a medical examination (27.7%). Conclusions., Overall, the results demonstrate that written information material is a useful resource for men with ED, because it evokes a high help-seeking behavior. It was perceived both to improve the sexual problem as well as to increase the quality of partnership. Providing such material in the medical practice may be an appropriate way to overcome inhibitions and to initiate dialogue with affected men. However, the results must be interpreted with caution because of possible motivationally driven self-selection bias. Berner MM, Leiber C, Kriston L, Stodden V, and Günzler C. Effects of written information material on help-seeking behavior in patients with erectile dysfunction: A longitudinal study. J Sex Med 2008;5:436,447. [source] | ||||||||||