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Response Rate (response + rate)
Kinds of Response Rate Selected AbstractsPrevalence and projections of diabetes and pre-diabetes in adults in Sri Lanka,Sri Lanka Diabetes, Cardiovascular Study (SLDCS)DIABETIC MEDICINE, Issue 9 2008P. Katulanda Abstract Aims To determine the prevalence of diabetes mellitus and pre-diabetes (impaired fasting glucose and impaired glucose tolerance) in adults in Sri Lanka. Projections for the year 2030 and factors associated with diabetes and pre-diabetes are also presented. Methods This cross-sectional study was conducted between 2005 and 2006. A nationally representative sample of 5000 adults aged , 18 years was selected by a multi-stage random cluster sampling technique. Fasting plasma glucose was tested in all participants and a 75-g oral glucose tolerance test was performed in non-diabetic subjects. Prevalence was estimated for those > 20 years of age. Results Response rate was 91% (n = 4532), males 40%, age 46.1 ± 15.1 years (mean ± standard deviation). The age,sex standardized prevalence (95% confidence interval) of diabetes for Sri Lankans aged , 20 years was 10.3% (9.4,11.2%) [males 9.8% (8.4,11.2%), females 10.9% (9.7,12.1%), P = 0.129). Thirty-six per cent (31.9,40.1%) of all diabetic subjects were previously undiagnosed. Diabetes prevalence was higher in the urban population compared with rural [16.4% (13.8,19.0%) vs. 8.7% (7.8,9.6%); P < 0.001]. The prevalence of overall, urban and rural pre-diabetes was 11.5% (10.5,12.5%), 13.6% (11.2,16.0%) and 11.0% (10.0,12.0%), respectively. Overall, 21.8% (20.5,23.1%) had some form of dysglycaemia. The projected diabetes prevalence for the year 2030 is 13.9%. Those with diabetes and pre-diabetes compared with normal glucose tolerance were older, physically inactive, frequently lived in urban areas and had a family history of diabetes. They had higher body mass index, waist circumference, waist,hip ratio, systolic/diastolic blood pressure, low-density lipoprotein cholesterol and triglycerides. Insulin was prescribed to 4.4% (2.7,6.1%) of all diabetic subjects. Conclusions One in five adults in Sri Lanka has either diabetes or pre-diabetes and one-third of those with diabetes are undiagnosed. [source] Efficacy of single-agent bortezomib vs. single-agent thalidomide in patients with relapsed or refractory multiple myeloma: a systematic comparisonEUROPEAN JOURNAL OF HAEMATOLOGY, Issue 2 2007H. Miles Prince Abstract Objective:, To conduct a systematic review of the efficacy of single-agent bortezomib vs. single-agent thalidomide in patients with relapsed/refractory multiple. Methods:, Publications in English from 1966 to June 2005 (MEDLINE, EMBASE, Cochrane library), publication reference lists, Janssen-Cilag data-on-file and abstracts from recent multiple myeloma conferences were reviewed. Prospective studies containing at least a single arm of either treatment group with n,30 were included. Studies adding dexamethasone for non-responders were excluded. Statistical pooling was performed for response rate and overallsurvival. Results:, One bortezomib study (n = 333, NEJM 2005, 352; 2487,98) and 15 thalidomide (n = 1007) studies met these criteria and were included. Patient baseline characteristics including age, gender, IgG : IgA, disease duration and beta-2 microglobulin were well matched except that 48% of bortezomib patients had received prior thalidomide. Response rate, defined as serum M-protein reduction ,50%, was 53% for patients receiving bortezomib vs. 32% for thalidomide (P < 0.001, n = 10 studies). Response rate determined by European Group for Blood and Marrow Transplantation (EBMT) criteria was 41% for patients receiving bortezomib vs. 22% for thalidomide (P < 0.001, n = 4 studies). Conclusion:, Bortezomib was associated with a significantly higher response rate and complete remission rate using both M-protein and EBMT criteria. [source] Large particle hyaluronic acid for the treatment of facial lipoatrophy in HIV-positive patients: 3-year follow-up studyHIV MEDICINE, Issue 3 2010L Skeie Objectives Facial lipoatrophy can be a stigmatizing side effect of antiretroviral (AVR) treatment for HIV-infected patients. We sought to evaluate the long-term efficacy and safety of a new formulation of hyaluronic acid that can be injected in larger amounts and into deeper skin layers during 3 years of follow-up. Methods Twenty patients received injections of Restylane SubQÔ. Refill treatment was offered at 12 and 24 months. Treatment effects were evaluated using ultrasound, the Global Aesthetic Improvement Scale, visual analogue scale (VAS) and the Rosenberg self-esteem scale. Results Seventeen patients remained at 36 months. Mean (± standard deviation) total cutaneous thickness increased from 6 ± 1 mm at baseline to 12 ± 1 mm (P<0.001) at 36 months. Response rate (total cutaneous thickness >10 mm) was 70%. Fifteen patients classified their facial appearance as very much or moderately improved. VAS increased from 39 ± 25 to 70 ± 20 (P<0.05) and higher self-esteem scores were reported. Local swelling and tenderness after treatment was common. Persistent papules found in several patients after treatment were removed effectively with hyaluronidase injections. Three patients, treated only at baseline, still had higher total cutaneous thickness scores at 36 months. Conclusions Our results indicate that a large particle hyaluronic acid formulation is a durable and well-tolerated dermal filler for treating HIV-positive patients with facial lipoatrophy. [source] The status of training and education in information and computer technology of Australian nurses: a national surveyJOURNAL OF CLINICAL NURSING, Issue 20 2008Robert Eley Aims and objectives., A study was undertaken of the current knowledge and future training requirements of nurses in information and computer technology to inform policy to meet national goals for health. Background., The role of the modern clinical nurse is intertwined with information and computer technology and adoption of such technology forms an important component of national strategies in health. The majority of nurses are expected to use information and computer technology during their work; however, the full extent of their knowledge and experience is unclear. Design., Self-administered postal survey. Methods., A 78-item questionnaire was distributed to 10,000 Australian Nursing Federation members to identify the nurses' use of information and computer technology. Eighteen items related to nurses' training and education in information and computer technology. Results., Response rate was 44%. Computers were used by 86·3% of respondents as part of their work-related activities. Between 4,17% of nurses had received training in each of 11 generic computer skills and software applications during their preregistration/pre-enrolment and between 12,30% as continuing professional education. Nurses who had received training believed that it was adequate to meet the needs of their job and was given at an appropriate time. Almost half of the respondents indicated that they required more training to better meet the information and computer technology requirements of their jobs and a quarter believed that their level of computer literacy was restricting their career development. Nurses considered that the vast majority of employers did not encourage information and computer technology training and, for those for whom training was available, workload was the major barrier to uptake. Nurses favoured introduction of a national competency standard in information and computer technology. Conclusions., For the considerable benefits of information and computer technology to be incorporated fully into the health system, employers must pay more attention to the training and education of nurses who are the largest users of that technology. Relevance to clinical practice., Knowledge of the training and education needs of clinical nurses with respect to information and computer technology will provide a platform for the development of appropriate policies by government and by employers. [source] Implementation of an intravenous medication infusion pump system: implications for nursingJOURNAL OF NURSING MANAGEMENT, Issue 2 2008Marilyn Bowcutt MSN Aim, To assess perceptions of nurses regarding the implementation of intravenous medication infusion system technology and its impact on nursing care, reporting of medication errors and job satisfaction. Background, Medication errors are placing patients at high risk and creating an economic burden for hospitals and health care providers. Infusion pumps are available to decrease errors and promote safety. Methods, Survey of 1056 nurses in a tertiary care Magnet hospital, using the Infusion System Perception Scale. Response rate was 65.43%. Results, Nurses perceived the system would enhance their ability to provide quality nursing care, reduce medication errors. Job satisfaction was related to higher ratings of the management team and nursing staff. Perceptions verified the pump was designed to promote safe nursing practices. Conclusions, It is important to consider relationships with job satisfaction, safe nursing practice and the importance of ratings of nursing staff and management teams when implementing infusion technology. Implications for nursing management, Infusion pumps are perceived by nurses to enhance safe nursing practice. Results stress the importance of management teams in sociotechnological transformations and their impact on job satisfaction among nurses. [source] Infection control nurse: a national surveyJOURNAL OF NURSING MANAGEMENT, Issue 5 2004R. Quattrin MD Aim, To study presence and activity of Infection Control Nurses (ICN) in Italian National Health System (NHS) hospitals. Background, Infection Control Nurses play an essential and evidence-based role for optimal infrastructure and essential activities of infection control and epidemiology programmes in hospitals. Methods, A survey of all Italian NHS hospitals (N = 529). Hospital health directors were asked to complete a questionnaire with a specific section on ICN presence, activities and roles played. Response rate was 87.5% (463 of 529). Results, More than 50% of hospitals (250 of 463) have an ICN: 25% (116 of 463) have at least one part-time employed ICN and 23.3% (108 of 250) have at least one ICN employed full-time. Infection Control Nurses are more common in hospitals with >250 beds (P < 0.01). Infection Control Nurses working in hospitals with >250 beds are highly active in surveillance activities, personnel education and management of study groups (P < 0.01). Conclusions, In Italian NHS hospitals ICNs have yet to become pillar figures in hospital infection control. [source] Response rate and predictors of response in a short-term empirical trial of high-dose rabeprazole in patients with globusALIMENTARY PHARMACOLOGY & THERAPEUTICS, Issue 12 2008D. H. SINN Summary Background, Although the aetiology of globus (the sensation of a lump in the throat) remains unclear, gastro-oesophageal reflux disease is associated with globus. A short-term trial with a high-dose proton pump inhibitor has been shown to be a sensitive tool for diagnosing gastro-oesophageal reflux disease. Aim, To see whether patients with globus symptom responded to short-term high-dose rabeprazole trial and assess predictors of symptom response. Methods, Sixty-four patients with globus symptom were analysed. Patients received rabeprazole 20 mg b.d. for 14 days. Patients completed a daily diary assessing the severity and frequency of globus. Results, Forty-one patients (64%) were diagnosed clinically with gastro-oesophageal reflux disease. Based on the pH testing and endoscopy, the prevalence of gastro-oesophageal reflux disease was 22% (14 of 64). The globus symptom score was significantly higher in patients with gastro-oesophageal reflux disease compared with patients without gastro-oesophageal reflux disease (P = 0.004). Two patients (3%) had complete resolution and 22 (34%) had more than a 50% improvement in the globus symptom score. Endoscopic findings (P = 0.714), pathological acid exposure on pH testing (P = 0.741) or baseline gastro-oesophageal reflux disease symptoms (P = 0.606) were not associated with improvement of globus symptom. Conclusion, While gastro-oesophageal reflux disease may be an aggravating factor in patients with globus, it does not appear to be the sole cause of globus symptom. [source] Raised serum ferritin predicts non-response to interferon and ribavirin treatment in patients with chronic hepatitis C infectionLIVER INTERNATIONAL, Issue 3 2002S Distante Abstract: Background/Aim: Previous studies have indicated that response to interferon therapy is inversely proportional to the amount of body iron stores. We have studied the relationship between serum ferritin, transferrin saturation, liver iron, presence of HFE-C282Y gene mutation and response to treatment in patients with chronic hepatitis C infection. Methods: Two hundred and fifty-six naive, HCV-RNA positive patients (60% males, median age 38 years, range 21,70) were treated with interferon and ribavirin for 6 months. Iron indices and the presence of the C282Y mutation were measured. In 242 (94%) patients iron deposition were determined by Perls staining method. Patients with negative HCV-RNA at 6 months after the end of treatment were defined as sustained viral responders. Results: Non-responders (n = 127) had significantly higher median s-ferritin values compared with sustained viral responders (130 µg/L vs. 75 µg/L P < 0.001). There was no difference in transferrin saturation among the two response groups. Only 23% (4/7) of patients with Perls grade 1 in liver biopsies responded to treatment vs. 54% (122/225) patients without iron deposition (P = 0.02), however, 10/13-non-responders had HCV genotype one. Two patients (0.8%) were homozygous for the C282Y mutation, 36 patients were heterozygous (14%). Among mutation carriers 26/38 achieved sustained response compared with 102/216 non-carriers (68% vs. 48%, P = 0.02). In a multivariate analysis s-ferritin (P = 0.030) and C282Y carrier status (P = 0.012) remained independent predict of sustained response. Conclusions: Raised s-ferritin values predicate non-response to interferon-ribavirin therapy in hepatitis C patients. Response rate in C282Y mutation carriers seems greater than in non-carriers. [source] Young adolescents' use of medicine for headache: sources of supply, availability and accessibility at home,PHARMACOEPIDEMIOLOGY AND DRUG SAFETY, Issue 4 2008Bjørn E. Holstein Mag. Abstract Objective Use of medicines for headache is common among young adolescents but little is known about their sources of supply and access to medicines. The purpose was to describe sources of supply, availability and accessibility at home and to examine if supply, availability and accessibility were associated with medicine use. Methods Cross-sectional study in eight schools where all fifth and seventh grade students (11- and 13-year-olds) answered a questionnaire about socio-demographic factors, health and medicine use. Response rate: 84.0%, n,=,595. Results The reported prevalence of headache at least monthly was 45.0%, and 42.5% had used medicines for headache during the past month. 68.2% reported that medicines for headache were always available at home, and 22.2% were allowed to use these without asking for permission. Most pupils received medicine from their parents (73.1%) and physicians (25.4%). Smaller proportions had received medicine from school nurses, teachers, friends and others; 11.6% mentioned at least three sources of supply. Pupils with frequent episodes of headache reported more sources of supply and higher availability and accessibility at home. OR for medicine use among children who mentioned three or more sources of supply was 4.53 (95% CI 2.63,7.83) in a multivariate model controlled for sex, age and prevalence of headache. Use of medicine was also associated with availability at home (OR,=,1.51, 1.01,2.27) and accessibility (OR,=,2.49, 1.57,3.93). Conclusion Medicine use for headache among children and young adolescents is common and control of access may be the key issue for safe medicine use. Copyright © 2008 John Wiley & Sons, Ltd. [source] Long-term cancer survivors experience work changes after diagnosis: results of a population-based studyPSYCHO-ONCOLOGY, Issue 12 2009Floortje Mols Abstract Background: Although cancer survivorship is increasing with improved diagnosis and treatments, few studies have explored employment changes and the factors related to this change among cancer survivors. Therefore, we aim to explore the prevalence of employment problems in long-term cancer survivors. In addition, we explored what patient or tumour characteristics predicted employment changes. Methods: All 1893 long-term survivors of prostate cancer, endometrial cancer, non-Hodgkin's lymphoma, and Hodgkin's lymphoma diagnosed between 1989 and 1998 in the area of the Comprehensive Cancer Centre South, The Netherlands were included in a population-based cross-sectional survey. Results: Response rate was 80% (n=1511). After excluding survivors without a job before diagnosis, 403 survivors remained; 197 (49%) experienced no changes in their work situation following cancer diagnosis, 69 (17%) were working fewer hours, and 137 (34%) stopped working or retired. A medium educational level was significant in reducing the risk of work changes. Being older, having more than one comorbid condition, being treated with chemotherapy, and disease progression were significant independent predictors of work changes after cancer. Experiencing work changes was associated with lower physical functioning but positively associated with social well-being. Discussion: Long-term cancer survivors experience work changes after diagnosis and treatment, and clinical factors significantly predicted work change after cancer. As such, our study underscores the importance of rehabilitation programs in improving the return to work after cancer. Copyright © 2009 John Wiley & Sons, Ltd. [source] Physical activity of older Australians measured by pedometryAUSTRALASIAN JOURNAL ON AGEING, Issue 3 2009Ben Ewald Aim:, To established population norms for pedometer determined step counts in older Australians. Methods:, A representative sample of 684 participants over the age of 55 years wore a pedometer for a week in Newcastle, Australia. Results:, Response rate was 32%. Median daily step count was 8605 in those aged 55,59 years declining to 3778 in those over 80 years old. The proportion who reached 8000 steps per day was 62% in those 55,59 years and 12% in those over 80 years. Daily step counts were highest on Thursdays and Fridays and least on Sundays. Weekend days had on average 620 less steps than weekdays. After adjusting for age, there was a negative association of step count with body mass index >30, and with a history of arthritis but no significant association with other demographic variables. Conclusion:, Pedometry is feasible in an elderly sample, and research involving pedometers must take days of the week into account. [source] Safety and efficacy of bortezomib in high-risk and elderly patients with relapsed multiple myelomaBRITISH JOURNAL OF HAEMATOLOGY, Issue 5 2007Paul G. Richardson Summary Adverse prognostic factors in multiple myeloma include advanced age, number of prior therapies, and higher International Staging System (ISS) disease stage. In the international, randomised, phase-3 Assessment of Proteasome Inhibition for Extending Remissions (APEX) study, bortezomib demonstrated significantly longer time to progression (TTP), higher response rates and improved survival compared with high-dose dexamethasone in patients with relapsed multiple myeloma following one to three prior therapies. In this APEX subgroup analysis, efficacy of bortezomib and dexamethasone was compared in elderly (age ,65 years) and high-risk (>1 prior line of therapy; ISS stage II/III; refractory to prior therapy) patients. Bortezomib demonstrated substantial clinical activity in these patients. Response rate (34,40% vs. 13,19%), including complete response rate (5,8% vs. 0,1%), was significantly higher with bortezomib versus dexamethasone in all four subgroups. Similarly, median TTP was significantly longer with bortezomib versus dexamethasone, and 1-year survival probability was significantly higher in all subgroups. As in the total APEX population, rates of grade 3/4 adverse events were higher in bortezomib- versus dexamethasone-treated patients aged ,65 years and with >1 prior line, while rates of serious adverse events were similar; toxicities generally proved manageable. Bortezomib should be considered an appropriate treatment for elderly and high-risk patients with relapsed multiple myeloma. [source] Administration of medicines to children using sports and leisure facilities: a survey of the South West of EnglandCHILD: CARE, HEALTH AND DEVELOPMENT, Issue 2 2008S. Bedwani Abstract Background It is widely recognized that a healthy diet and regular exercise are important for general health. Sports and leisure centres are providing many opportunities for children to participate in various activities. Methods A pre-piloted questionnaire was sent to the manager of sports and leisure centres throughout the South West of England to look at provision for the administration and storage of medication. Results Response rate is 66%. While 91% of centres have sessions for children without a parent present, only 57% had a policy for administration of medication. Conclusion Despite clear guidance on administration of medicine being available, relatively few sports and leisure facilities we surveyed are currently operating within this framework. At present, the current practice regarding administration of medicine in many leisure facilities seems to be suboptimal. [source] Child Health Assessment at School Entry (CHASE) project: evaluation in 10 London primary schoolsCHILD: CARE, HEALTH AND DEVELOPMENT, Issue 2 2005S. Edmunds Abstract Aims To assess the feasibility of implementing the Child Health Assessment at School Entry (CHASE) questionnaire, developed to capture the multiple dimensions of the health of children in their first year at school, and to evaluate data quality, reliability and validity. Methods Parents of 278 year-1 children, from 10 primary schools in two London boroughs, received a parent questionnaire and school nurses completed a separate questionnaire from health and education records for children whose parents consented. Additional data on free school meal eligibility and ethnicity were obtained from the two Local Education Authorities. The parent questionnaire included the Strengths and Difficulties Questionnaire (SDQ) and four dimensions of the Child Health Questionnaire Parent Form-28 (CHQ-PF28). Results Response rate was 61%. The association between school free school meals eligibility and response rate in each school approached significance (r = ,0.62, P = 0.05). Data completeness of the parent questionnaire was high (mean 98%). Data completeness of the school nurse questionnaire was more variable (mean 82%). Cronbach's Alpha was greater than 0.6 for four of the five SDQ scales and greater than 0.7 for the two CHQ-PF28 multi-item scales. Relative to parents with qualifications, parents with no qualifications rated their children as having significantly more conduct problems, peer problems, and overall mental health problems (P < 0.01) as assessed by the SDQ, and significantly lower global health (P < 0.01) as assessed by the CHQ-PF28. Children with special educational needs and children with long-standing illness or disability were rated as having significantly lower global health (P < 0.05) than children without these. Sample tables of inter-school and inter-borough comparison of key findings demonstrate considerable differences in physical and mental health status. Discussion The questionnaire was acceptable to parents and school nurses, and feasible to implement within existing school resources. Initial tests of internal reliability and validity are satisfactory. These data have the potential to inform interventions and service provision at school and borough level, and public health trends over time. [source] Response rate and nonresponse bias in a questionnaire survey of dentistsCOMMUNITY DENTISTRY AND ORAL EPIDEMIOLOGY, Issue 1 2005Peter Parashos Abstract , Objectives:, (a) To report on response rate and nonresponse bias of a questionnaire survey of dentists. (b) To make recommendations for future questionnaire survey research in dentistry. Methods:, A questionnaire was mailed to a stratified systematic sample of 908 Australian dentists. The strategy included three mailings, a final telephonic contact, university stationery, paid reply envelopes and personalized correspondence. Nonresponse bias was assessed by comparing responses to a simple ,yes/no' question from each contact (late responders), and by comparing demographic information (nonresponders). Results:, The response rate achieved was 87% and there was no evidence of nonresponse bias based on practice location or year of graduation. The cumulative proportions of ,yes/no' responses essentially remained constant after each contact, but significantly more late responders answered in the negative to the test question than did early responders. The telephonic contact aided in the identification of nonparticipants and ineligible units. Conclusions:, The current survey indicates that differences in data between early and nonresponders can occur despite there being no demographic differences. Therefore, assessment of nonresponse bias based on demographic data alone would seem to be insufficient. Questionnaire survey research must first be based on sound sampling techniques, and then on achieving as high a response rate as possible using the many incentives available. [source] Multicenter, randomized, double-blind, active comparator and placebo-controlled trial of a corticotropin-releasing factor receptor-1 antagonist in generalized anxiety disorder,DEPRESSION AND ANXIETY, Issue 5 2010Vladimir Coric M.D. Abstract Background: Antagonism of corticotropin-releasing factor (CRF) receptors has been hypothesized as a potential target for the development of novel anxiolytics. This study was designed to determine the safety and efficacy of pexacerfont, a selective CRF-1 receptor antagonist, in the treatment of generalized anxiety disorder (GAD). Method: This was a multicenter, randomized, double-blind, placebo-controlled and active comparator trial. Two hundred and sixty patients were randomly assigned to pexacerfont 100,mg/day (after a 1 week loading dose of 300,mg/day), placebo or escitalopram 20,mg/day in a 2:2:1 ratio. The primary outcome was the mean change from baseline to end point (week 8) in the Hamilton Anxiety Scale total score. Results: Pexacerfont 100,mg/day did not separate from placebo on the primary outcome measure. The half-powered active comparator arm, escitalopram 20,mg/day, demonstrated efficacy with significant separation from placebo at weeks 1, 2, 3, 6, and 8 (P<.02). Response rates for pexacerfont, placebo, and escitalopram were 42, 42, and 53%, respectively. Genetic and psychometric rating scale data was obtained in 175 randomized subjects. There was a significant association between a single nucleotide polymorphism (SNP) of the gene encoding plexin A2 (PLXNA2-2016) with the HAM-A psychic subscale score for the entire cohort at baseline (FDR-adjusted P=.015). Conclusions: Pexacerfont did not demonstrate efficacy compared to placebo for the treatment of GAD. Whether these findings are generalizable to this class of agents remains to be determined. Our preliminary genetic finding of an association between a SNP for the gene encoding plexin A2 and an anxiety phenotype in this study merits further exploration. The trial was registered at clinicaltrials.gov (NCT00481325) before enrollment. Depression and Anxiety, 2010. © 2010 Wiley-Liss, Inc. [source] Citalopram treatment of social anxiety disorder with comorbid major depressionDEPRESSION AND ANXIETY, Issue 4 2003Franklin 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] The utility of online panel surveys versus computer-assisted interviews in obtaining substance-use prevalence estimates in the NetherlandsADDICTION, Issue 10 2009Renske Spijkerman ABSTRACT Aims Rather than using the traditional, costly method of personal interviews in a general population sample, substance-use prevalence rates can be derived more conveniently from data collected among members of an online access panel. To examine the utility of this method, we compared the outcomes of an online survey with those obtained with the computer-assisted personal interviews (CAPI) method. Design Data were gathered from a large sample of online panellists and in a two-stage stratified sample of the Dutch population using the CAPI method. Setting The Netherlands. Participants The online sample comprised 57 125 Dutch online panellists (15,64 years) of Survey Sampling International LLC (SSI), and the CAPI cohort 7204 respondents (15,64 years). Measurements All participants answered identical questions about their use of alcohol, cannabis, ecstasy, cocaine and performance-enhancing drugs. The CAPI respondents were asked additionally about internet access and online panel membership. Both data sets were weighted statistically according to the distribution of demographic characteristics of the general Dutch population. Findings Response rates were 35.5% (n = 20 282) for the online panel cohort and 62.7% (n = 4516) for the CAPI cohort. The data showed almost consistently lower substance-use prevalence rates for the CAPI respondents. Although the observed differences could be due to bias in both data sets, coverage and non-response bias were higher in the online panel survey. Conclusions Despite its economic advantage, the online panel survey showed stronger non-response and coverage bias than the CAPI survey, leading to less reliable estimates of substance use in the general population. [source] Doing harm reduction better: syringe exchange in the United StatesADDICTION, Issue 9 2009Don C. Des Jarlais ABSTRACT Objective To trace the growth of syringe exchange programs (SEPs) in the United States since 1994,95 and assess the current state of SEPs. Methods Annual surveys of US SEPs known to North American Syringe Exchange Network (NASEN). Surveys mailed to executive directors with follow-up interviews by telephone and/or e-mail. Response rates have varied between 70% and 88% since surveys were initiated in 1996. Results The numbers of programs known to NASEN have increased from 68 in 1994,95 to 186 in 2007. Among programs participating in the survey, numbers of syringes exchanged have increased from 8.0 million per year to 29.5 million per year, total annual budgets have increased from $6.3 to $19.6 million and public funding (from state and local governments) has increased from $3.9 to $14.4 million. In 2007, 89% of programs permitted secondary exchange and 76% encouraged it. Condoms, referrals to substance abuse treatment, human immunodeficiency virus (HIV), hepatitis C virus (HCV), hepatitis B virus (HBV) counseling and testing and naloxone for overdose were among the most commonly provided services in addition to basic syringe exchange. Each of these services was provided by 40% or more of SEPs in 2007. Conclusions While syringe exchange has remained controversial in the United States, there has been very substantial growth in numbers of programs, syringes exchange and program budgets. Utilizing secondary exchange to reach large numbers of injecting drug users and utilizing SEPs as a new platform for providing health and social services beyond basic syringe exchange have been the two major organizational strategies in the growth of SEPs in the United States. [source] Corticosteroid side-effects and risk for bleeding in immune thrombocytopenic purpura: patient and hematologist perspectivesEUROPEAN JOURNAL OF HAEMATOLOGY, Issue 3 2009Jacqueline A. Guidry Abstract Objectives:, The purpose of this study was to examine hematologist and patient perspectives about the side-effects of the corticosteroid treatment of immune thrombocytopenic purpura (ITP) and their perspectives about the patient's risk for bleeding. The specific aim was to compare patient and hematologist perspectives and, if a difference was documented, the implications of that difference. We hypothesized that patients with ITP may have more concern about corticosteroid side-effects and less concern about serious bleeding than hematologists. Methods:, We surveyed 80 patients in the Oklahoma ITP Registry and all 83 hematologists in Oklahoma about the occurrence and severity of 18 corticosteroid side-effects and risks for serious bleeding. Results:, Response rates were 80% (patients) and 71% (hematologists). Responses of patients and hematologists were significantly different from each other regarding both the frequency of severe corticosteroid side-effects and the risk of serious bleeding. For 13 of the 18 corticosteroid side-effects, patients reported more frequent occurrence of severe symptoms than hematologists (P < 0.05); physicians reported more frequent occurrence for one side-effect (P < 0.05). Conversely, 69% and 93% of hematologists reported being very worried about serious bleeding when responding to two case scenarios describing patients with platelet counts of 10 000/,L and 5000/,L (P < 0.05), compared with only 16 (31%) of 51 patients whose lowest platelet count had been <10 000/,L. Conclusion:, Awareness of the different opinions about corticosteroid side-effects and risk for bleeding between ITP patients and hematologists may improve management decisions. [source] Predictors of response to therapy with terlipressin and albumin in patients with cirrhosis and type 1 hepatorenal syndrome,HEPATOLOGY, Issue 1 2010André Nazar Terlipressin plus albumin is an effective treatment for type 1 hepatorenal syndrome (HRS), but approximately only half of the patients respond to this therapy. The aim of this study was to assess predictive factors of response to treatment with terlipressin and albumin in patients with type 1 HRS. Thirty-nine patients with cirrhosis and type 1 HRS were treated prospectively with terlipressin and albumin. Demographic, clinical, and laboratory variables obtained before the initiation of treatment as well as changes in arterial pressure during treatment were analyzed for their predictive value. Response to therapy (reduction in serum creatinine <1.5 mg/dL at the end of treatment) was observed in 18 patients (46%) and was associated with an improvement in circulatory function. Independent predictive factors of response to therapy were baseline serum bilirubin and an increase in mean arterial pressure of ,5 mm Hg at day 3 of treatment. The cutoff level of serum bilirubin that best predicted response to treatment was 10 mg/dL (area under the receiver operating characteristic curve, 0.77; P < 0.0001; sensitivity, 89%; specificity, 61%). Response rates in patients with serum bilirubin <10 mg/dL or ,10 mg/dL were 67% and 13%, respectively (P = 0.001). Corresponding values in patients with an increase in mean arterial pressure ,5 mm Hg or <5 mm Hg at day 3 were 73% and 36%, respectively (P = 0.037). Conclusion: Serum bilirubin and an early increase in arterial pressure predict response to treatment with terlipressin and albumin in type 1 HRS. Alternative treatment strategies to terlipressin and albumin should be investigated for patients with type 1 HRS and low likelihood of response to vasoconstrictor therapy. (HEPATOLOGY 2009.) [source] Treatment response to transcatheter arterial embolization and chemoembolization in primary and metastatic tumors of the liverHPB, Issue 6 2008Avo Artinyan Abstract Introduction. Transcatheter arterial embolization (TAE) and chemoembolization (TACE) are increasingly used to treat unresectable primary and metastatic liver tumors. The purpose of this study was to determine the objective response to TAE and TACE in unresectable hepatic malignancies and to identify clinicopathologic predictors of response. Materials and methods. Seventy-nine consecutive patients who underwent 119 TAE/TACE procedures between 1998 and 2006 were reviewed. The change in maximal diameter of 121 evaluable lesions in 56 patients was calculated from pre and post-procedure imaging. Response rates were determined using Response Evaluation Criteria in Solid Tumors (RECIST) guidelines. The Kaplan-Meier method was used to compare survival in responders vs. non-responders and in primary vs. metastatic histologies. Results. TAE and TACE resulted in a mean decrease in lesion size of 10.3%±1.9% (p<0.001). TACE (vs. TAE) and carcinoid tumors were associated with a greater response (p<0.05). Lesion response was not predicted by pre-treatment size, vascularity, or histology. The RECIST partial response (PR) rate was 12.3% and all partial responders were in the TACE group. Neuroendocrine tumors, and specifically carcinoid lesions, had a significantly greater PR rate (p<0.05). Overall survival, however, was not associated with histology or radiologic response. Discussion. TAE and TACE produce a significant objective treatment response by RECIST criteria. Response is greatest in neuroendocrine tumors and is independent of vascularity and lesion size. TACE appears to be superior to TAE. Although an association of response with improved survival was not demonstrated, large cohort studies are necessary to further define this relationship. [source] Infliximab treatment for Crohn's disease: One-year experience in a Dutch Academic HospitalINFLAMMATORY BOWEL DISEASES, Issue 2 2002Dr. Daan W. Hommes Abstract The aim of this study was to report the 1-year clinical experience with infliximab treatment for Crohn's disease (CD) in the Netherlands. All 73 CD patients receiving infliximab infusions were prospectively followed during 1 year after the drugs' registration in the Netherlands. Clinical response and adverse events were assessed for both active luminal disease as well as fistulous disease. A total of 212 infusions were administered to 57 patients with active luminal CD and 16 patients with fistulous CD. The mean duration between infusions was 60 days. In 17% of patients, adverse events were recorded, of which one was serious. The response rate was 81% in active luminal CD and 87% in fistulous disease. Response rates were highest in patients receiving concomitant methotrexate as maintenance therapy. Steroids could successfully be tapered off in 73% of responding luminal CD patients and 100% of responding CD patients with fistulae. Eleven patients showed a loss of response to continuous infliximab readministration. Our clinical experience with infliximab for active luminal and fistulous CD showed that the administration is safe, effective, and has high steroid-sparing efficacy. Higher response rates were seen with methotrexate as concomitant medication. [source] What happens when people disclose sexual or physical abuse to staff at a community mental health centre?INTERNATIONAL JOURNAL OF MENTAL HEALTH NURSING, Issue 2 2002Kirsty Agar ABSTRACT: The files of 200 users of a community mental health centre revealed that 46% of the files contained documentation of sexual or physical abuse as children or adults. Only 36% of summary formulations and 33% of treatment plans for the abused clients mentioned the abuse. Only 22% of the abused clients received abuse-focused therapy. Response rates were lower for clients who were male or had a schizophrenia spectrum diagnosis, and if the clinician was male or a psychiatrist. None of the alleged crimes, past, recent or ongoing, was reported to legal authorities. Development of unit policies and training programmes to ensure appropriate response to abuse histories is recommended. [source] Evaluation of a clinical examination skills training course in an undergraduate pharmacy programmeINTERNATIONAL JOURNAL OF PHARMACY PRACTICE, Issue 4 2008Dr. Andy Wearn senior lecturer, director Objective To introduce and evaluate a short clinical examination skills course in a BPharm programme. The study objectives were to assess needs, explore attitudes, record perceived competence requirements and assess the value of physical examination skills learning. Setting BPharm programme in Auckland, New Zealand. Participants were students enrolled in years 3 and 4 of the programme (2003). Method The design was a longitudinal, dual cohort, educational intervention evaluation using a self-completed questionnaire. An examination skills component was added to the fourth year of the pharmacy programme. Year 3 and 4 students were recruited, and completed the questionnaire at two points. Year 3 students were sampled one year before and soon after the skills sessions. Year 4 students were sampled after the sessions and 18 months later (once registered). The questionnaire sought their attitudes towards clinical skills training and practical relevance for future practice, and evaluated their learning experience. Key findings Response rates at the four points were 42,67%. Year 3 students identified a similar set of appropriate skills to those actually taught in year 4. Overall, attitudes to introducing examination skills learning were positive at all points. At follow-up, both cohorts agreed more strongly that examination skills training should be core (significantly for registered pharmacists versus year 3, P < 0.006). Measuring manual blood pressure was deemed the most difficult skill. All taught skills were used in practice except for respiratory rate; most used were body mass index (BMI), temperature and peak flow measurement. Conclusions There was a close correlation between what was offered in the course, what students felt they needed to learn and what was relevant in practice. Once registered, pharmacists were aware of their limitations and level of competence in relation to clinical skills. The small changes in attitudinal scores appear to reflect maturity and experience. The study design allowed us to adapt the educational component to student need. Health professional educators need to be aware of and respond to changes in professional scopes of practice. [source] Community pharmacy provision of allergic rhinitis treatments: a longitudinal study of patient reported outcomeINTERNATIONAL JOURNAL OF PHARMACY PRACTICE, Issue 4 2005Dr. Hazel Sinclair Phd research fellow Objective To monitor and compare the symptoms, and reported quality of life, of two groups of people who obtained treatment for allergic rhinitis from community pharmacies (prescribed or purchased). Method Subjects were recruited by 64 community pharmacies in 2001 and followed up by postal questionnaire at four time points: five days, four weeks, eight weeks and 26 weeks. Setting Primary care: community pharmacies in Grampian, Scotland. Results Response rates: five days , 84%; four weeks , 63%; eight weeks , 59%; 26 weeks , 56%. Three hundred and twenty-four subjects completed the five-day questionnaire (138 prescribed, 186 purchased). There were no important differences between groups in socio-economic variables monitored. The commonest treatments provided were antihistamines (non-sedating: 63% prescribed, 59% purchased; sedating: 3% prescribed, 16% purchased). Despite treatment, symptoms and quality-of-life impairments remained high; the prescribed group reported higher levels of many symptoms (including asthma), and lower quality of life at early time points. Most were satisfied with their treatment and few reported unmet need for pharmacy advice (11% prescribed, 3% purchased group). Conclusion Despite high levels of patient satisfaction with allergic rhinitis treatment, symptoms and quality-of-life impairments remained high in both groups. Widespread implementation of ,allergic rhinitis and its impact on asthma' (ARIA) guidelines for physicians and for pharmacists might improve management of symptoms and quality of life of patients. [source] Survey of consent practices for inpatient colonoscopy and endoscopic retrograde cholangiopancreatography at a tertiary referral centerJOURNAL OF GASTROENTEROLOGY AND HEPATOLOGY, Issue 8 2006Cynthia H Seow Abstract Background:, The purpose of the present paper was to determine informed consent practices for inpatient, open-access colonoscopy and endoscopic retrograde cholangiopancreatography (ERCP) at a tertiary referral center. Methods:, A two-part prospective study incorporating (i) an audit of consent practices for colonoscopy and ERCP; and (ii) a questionnaire directed at gastroenterologists and interns regarding information imparted to patients in the process of acquiring informed consent, was undertaken at Sir Charles Gairdner Hospital, Western Australia. Study subjects consisted of inpatients undergoing open-access colonoscopy and/or ERCP at the study center commencing May 2003; and gastroenterologists and interns at the study center. Results:, Written consent was obtained by junior medical staff in 89% of cases. Response rates for the questionnaire was 100% from interns, and 91% from gastroenterologists. Of interns surveyed, 93% had witnessed a colonoscopy, and 59% had witnessed an ERCP. For 12% of interns, colonoscopic bleeding or perforation were not always mentioned. Colonoscopy failure rate and perforation were overestimated by 51% and 63% of interns, respectively. Only 56% of interns always mentioned pancreatitis as a complication of ERCP. The rate of post-ERCP pancreatitis was overestimated by 25% of interns. Only 40% of gastroenterologists always provided additional information to patients whose consent was obtained by someone else. Written material was not routinely provided for patients. Consent was usually obtained on the day of the procedure. Conclusions:, Written consent for inpatients undergoing open-access colonoscopy and ERCP is rarely obtained by the proceduralist. There is substantial variability in the information provided to patients. Guidelines are required to ensure best practice in this area. [source] Clinical Practice Characteristics and Preconception Counseling Strategies of Health Care Providers Who Recommend Alcohol Abstinence During PregnancyALCOHOLISM, Issue 11 2004Suzanne C. Tough Objective: National initiatives on fetal alcohol syndrome in Canada and the United States aimed at prevention, identification, and treatment of individuals who are affected by alcohol exposure in utero recommend that women abstain from consuming alcohol during pregnancy. Health care providers are key educators regarding appropriate alcohol use. The objective of this study was to describe characteristics of physicians who recommend alcohol abstinence during pregnancy with regard to knowledge of fetal alcohol syndrome and preconception counseling strategies. Methods: A survey was mailed to Canadian physicians and midwives between 2001 and 2002. Participants consisted of a national random sample of 1090 Canadian obstetricians and gynecologists, midwives, and family physicians who were current members of provincial and national professional organizations. The main outcome measure was questionnaire responses to knowledge, prevention, and diagnosis of issues related to alcohol use during pregnancy. Results: Response rates ranged from 31.1% among family physicians to 63.5% among midwives. Overall, 91.2% of providers recommended abstinence from alcohol during pregnancy. These providers were significantly more likely to believe that there is sufficient information about alcohol use and that clients were interested in discussing alcohol (p < 0.05). They were also significantly more likely to discuss depression, personal alcohol use, partner's use of alcohol, and family history of alcohol misuse with women of childbearing age (p < 0.05). Once a patient became pregnant, fewer practice differences were noted, although those who recommended alcohol abstinence were significantly more likely to take clinical action when pregnant patients were consuming moderate amounts of alcohol (p < 0.05). Conclusions: It is encouraging that almost 90% of Canadian health care providers recommend abstinence from alcohol during pregnancy. However, differences in clinical practice exist between providers who recommend alcohol abstinence during pregnancy as compared with those who recommend a "glass in moderation." [source] Intraindividual, right,left comparison of topical 5-aminolevulinic acid photodynamic therapy vs.JOURNAL OF THE EUROPEAN ACADEMY OF DERMATOLOGY & VENEREOLOGY, Issue 9 20095% imiquimod cream for actinic keratoses on the upper extremities Abstract Backround, Actinic keratoses (AKs) are considered as in situ squamous cell carcinoma. Early and effective treatment is important. Objective, To compare the efficacy, cosmetic outcome and patient preference of 5-aminolevulinic acid photodynamic therapy (ALA-PDT) with that of 5% imiquimod (IMIQ) cream in patients with AKs on the dorsa of hands and forearms. Methods, Subjects received two ALA-PDT treatment sessions and one or two courses of imiquimod (three times per week for 4 weeks each). Treatments were randomly allocated to alternate upper extremities. Assessments included lesion response one and six months after treatment, cosmetic outcome evaluated by the investigators and patients' preference 6 months after treatment. Efficacy end point included the individual AK lesion clearance rate. Results, Thirty patients with 256 lesions were included in the study. At the first follow-up, treatment with ALA-PDT resulted in significantly larger rate of cured lesions relative to 5% IMIQ cream (70.16% vs. 18.26%). At the second follow-up both treatments showed a high rate of cured lesions (65.32% for PDT vs. 55.65% for IMIQ cream). Response rates obtained in grade I lesions were higher for both treatments (71.64% for PDT vs. 72.13% for IMIQ), while treatment with PDT resulted in a significant larger rate of cured grade II lesions (57.89% for PDT vs. 37.03 for IMIQ). Difference in cosmetic outcome was not statistically significant. Results for subject preference favoured ALA-PDT. Conclusions, Our study shows that ALA-PDT and 5% IMIQ cream are both attractive treatment options for upper extremities AKs with comparable efficacy and cosmetic outcomes. Conflicts of interest None declared. [source] A controlled study of the short- and long-term effects of a Train the Trainers courseMEDICAL EDUCATION, Issue 7 2008Sune Rubak Objectives, This study aimed to establish the longterm effects of a 3-day ,Training for Trainers' course (TTC) on doctors' knowledge, teaching behaviour and clinical learning climate. Methods, The study was designed as an intervention study with pre-, post- and long-term measurements. The intervention group (I-group) included 118 doctors from the departments of internal medicine and orthopaedic surgery at one university hospital. The control group (C-group) consisted of 125 doctors from the corresponding departments at another university hospital. Gains in knowledge about teaching skills were assessed by a written test. Teaching behaviour and learning climate were evaluated by questionnaires. Results, In the I-group, 98.4% of doctors, both specialists and trainees, participated in a TTC. Response rates on the written test varied from 90% at baseline to 70% at 6 months after the intervention. Knowledge about teaching skills increased in the I-group by 25% after the TTC and was sustained at 6 months. Questionnaire response rates varied from 98.4% at baseline to 84.8% at 6 months. Post-course, the teaching behaviour of the I-group significantly changed and its learning climate improved compared with the C-group. Scores for use of feedback and supervision in the I-group increased from 4,5 to 6,7 (maximum score = 9). This was significantly higher than in the C-group. Conclusions, A 3-day residential TTC has a significant impact in terms of gains of knowledge concerning teaching skills, teaching behaviour and learning climate after 6 months. The positive effects demonstrated in this study were rooted in both the specialists and trainees who attended the course. [source] | ||||||||||||||||||||||||||||||||||||||||