Home About us Contact
|
Home About us Contact | ||
|
|
||
Score Reduction (score + reduction)
Selected AbstractsEfficacy and safety of duloxetine in the treatment of generalized anxiety disorder: a flexible-dose, progressive-titration, placebo-controlled trialDEPRESSION AND ANXIETY, Issue 3 2008Moira 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] Outcome of suicidal patients with schizophrenia: results from a naturalistic studyACTA PSYCHIATRICA SCANDINAVICA, Issue 5 2010R. Schennach-Wolff Schennach-Wolff R, Jäger M, Seemüller F, Obermeier M, Schmauss M, Laux G, Pfeiffer H, Naber D, Schmidt LG, Gaebel W, Klosterkötter J, Heuser I, Maier W, Lemke MR, Rüther E, Klingberg S, Gastpar M, Möller H-J, Riedel M. Outcome of suicidal patients with schizophrenia: results from a naturalistic study. Objective:, Purpose was to assess suicidality before and at the time of admission in patients with schizophrenia and compare outcome differences. Method:, Biweekly PANSS (Positive and Negative Syndrome Scale), HAMD (Hamilton Depression Rating Scale) and UKU (Udvalg for Klinske Undersogelser Side Effect Rating Scale) ratings were evaluated in 339 in-patients with schizophrenic spectrum disorders. Response was defined as an initial 20% PANSS total score reduction at discharge, remission was defined according to the proposed consensus criteria by the Remission in Schizophrenia Working Group. Results:, Suicidal patients (22%) scored significantly higher on the PANSS negative subscore, PANSS insight item and HAMD total score at admission and at discharge. They developed significantly more side effects. No differences were found concerning response and remission between the two patient subgroups. Conclusion:, Despite receiving significantly more antidepressants the suicidal patients suffered from significantly more depressive symptoms up to discharge, yet without differing regarding response and remission. [source] Combined Ultrapulse CO2 Laser and Q-Switched Alexandrite Laser Compared with Q-Switched Alexandrite Laser Alone for Refractory Melasma: Split-Face DesignDERMATOLOGIC SURGERY, Issue 1 2003Suhattaya Angsuwarangsee MD Background. Melasma is common and can cause major psychological impact. To date, the mainstay of treatment, including various hypopigmenting agents and chemical peels, is ineffective and can cause adverse effects. Laser is a new approach and is yet to be explored for its efficacy and safety. Objective. To compare combined Ultrapulse CO2 laser and Q-switched alexandrite laser (QSAL) with QSAL alone in the treatment of refractory melasma. Methods. Six Thai females were treated with combined Ultrapulse CO2 laser and QSAL on one side of the face and QSAL alone on the other side. The outcome was evaluated periodically for up to 6 months using the modified Melasma Area and Severity Index score and the modified Melasma Area and Melanin Index score. Results. The side with combination treatment had a statistically significant reduction of both scores. On the QSAL side, the score reduction was not significant. Two cases developed severe postinflammatory hyperpigmentation and were effectively treated with bleaching agents. Transient hypopigmentation and contact dermatitis were observed with the combination treatment side. Conclusions. Combined Ultrapulse CO2 laser and QSAL showed a better result than QSAL alone but was associated with more frequent adverse effects. Long-term follow-up and a larger number of cases are required to determine its efficacy and safety for refractory melasma. [source] Persistent cognitive decline in older hospitalized patients in TaiwanJOURNAL OF ADVANCED NURSING, Issue 9 2010Cheryl Chia-Hui Chen chen c.c.-h., chang y.-c., huang g.-h., peng j.-h. & tseng c.-n. (2010) Persistent cognitive decline in older hospitalized patients in Taiwan. Journal of Advanced Nursing,66(9), 1991,2001. Abstract Aim., This paper is a report of a study conducted to determine the prevalence and predictors of persistent and transient cognitive decline in older hospitalized patients over 6 months after hospital discharge. Background., Cognitive decline occurs in 16,35·5% of older hospitalized patients, but this decline may be persistent rather than transient. Distinguishing persistent from transient cognitive decline is clinically useful. Methods., For this prospective cohort study, 291 older patients were recruited from five medical and surgical units at a tertiary medical centre in Taiwan between 2004 and 2006. Participants were assessed for cognitive status by scores on the Mini-Mental State Examination at admission, discharge, 3 and 6 months postdischarge. Persistent cognitive decline was defined as continuing score reduction and ,3-point reduction 6 months postdischarge. Transient decline was defined as ,3-point reduction at some stage, with a total decline <3 points 6 months postdischarge. Findings., The cognitive status of the majority of participants (57·4%, n = 167) decreased ,3 points during follow-up. Of these decliners, 59 (35·3%) had persistent cognitive decline, with an average 5·32-point reduction 6 months postdischarge. Forty-six (27·5%) participants experienced transient cognitive decline. After multiple adjustments in logistic regression analysis, persistent decline was predicted by no in-hospital functional decline (OR = 0·16, P = 0·002), more re-admissions after discharge (OR = 2·42, P = 0·020), and older age (OR = 1·09, P = 0·048). Conclusion., A new perspective is needed on discharge planning on patients at risk for persistent cognitive decline. Nurses can oversee the delivery of care, identify cognitive decline, refer patients, and educate families on strategies to enhance cognitive functioning for their aging relatives. [source] Management of post-operative bladder spasmJOURNAL OF PAEDIATRICS AND CHILD HEALTH, Issue 1-2 2005D Chiang Objective: Pain management following bladder surgery in children is often complicated by bladder spasm. The overall severity of spasm can be reduced with opioids, anticholinergic medication and sedatives, although breakthrough spasms often occur. At the Royal Children's Hospital, Melbourne, intravesical bupivacaine has been used to manage postoperative bladder spasm to good effect. The administration of intravesical bupivacaine is analysed in this prospective audit of locally applied intravesical anaesthetic and compared with other methods. Method: From February to August 2003, histories of 58 patients who had intravesical bupivacaine were studied and compared with six other methods of management of postoperative bladder spasm. Conclusion: Data showed that epidural anaesthesia was the most effective treatment of pain, with a pain score reduction of 6.6, compared with a reduction of 6.1 with intravesical bupivacaine, and 4.5 using intravenous morphine. However, intravesical bupivacaine was the most effective method for the relief of bladder spasm. [source] Adjuvant treatment of atopic eczema: assessment of an emollient containing N-palmitoylethanolamine (ATOPA study)JOURNAL OF THE EUROPEAN ACADEMY OF DERMATOLOGY & VENEREOLOGY, Issue 1 2008B Eberlein Abstract Background For long-term management of atopic eczema, the use of skin care creams is recommended, but effectiveness of this treatment is not well established. Objective The objective of this study was to yield data on the skin care properties of a cream with a unique lamellar matrix containing N -palmitoylethanolamine (PEA) and to assess quality-of-life variables in patients with mild to moderate atopic eczema. Setting In this multinational, multicentre, observational, non-controlled, prospective cohort study, patients between 2 and 70 years of age were enrolled. All patients were supplied with the study product sufficient for treatment over the entire study period. Outcome was followed in periods between 3 and 7 days and 4 and 6 weeks after study start. Data were gathered from doctor reports and patient self-assessments via patient questionnaires. Results Data from 2456 patients entered the database. The mean examination intervals were 6 days for the 3- to 7-day period and 38 days for the 4- to 6-week period. At study end, intensities of erythema, pruritus, excoriation, scaling, lichenification and dryness were significantly reduced with a combined score reduction of 58.6% in the entire population (57.7% in adults > 12 years and 60.5% in children , 12 years) according to doctors' reports. Patients reported a reduction of pruritus on visual analogue scales from 4.9 ± 2.6 to 2.7 ± 2.4 6 days after treatment start and a further reduction to 2.0 ± 2.3 at study end (P < 0.001 each). Likewise, sleep quality improved significantly during the study period. Earlier-used topical corticosteroids were omitted by 56% of all patients (53.4% in adults and 62.5% in children) at study end, and the average weekly application rate decreased by 62% from 7.9 ± 6.0 to 3.0 ± 5.1 (P < 0.001). The tolerance was assessed as very good or good in 92% of cases by both patients and doctors. Conclusion This study showed substantial relief of objective and subjective symptoms of atopic eczema after regular skin care with the study cream. The patient-related effectiveness (decline of pruritus and loss of sleep) indicated a gain in quality of life in these patients. The reduced use of topical corticosteroids is important in view of safety and pharmacoeconomic implications in the treatment of atopic eczema. [source] Randomized study of sertraline and low-dose amitriptyline in patients with Parkinson's disease and depression: Effect on quality of lifeMOVEMENT DISORDERS, Issue 8 2006Angelo Antonini MD Abstract We assessed the effect of 3-month treatment of sertraline (50 mg) or low-dose amitriptyline (25 mg) on depression and quality of life in 31 patients with Parkinson's disease in a prospective single-blind randomized study. Both drugs significantly reduced the Hamilton Depression Rating Scale (HDRS-17) score. Completion rate was 75% for sertraline (12 of 16) and 73% for amitriptyline (11 of 15). Responder rate (HDRS-17 score reduction , 50%) was 83.3% for sertraline and 72.7% for amitriptyline. Sertraline but not amitriptyline treatment determined a significant benefit on quality of life (PDQ-39 scale). We found no change in Unified Parkinson's Disease Rating Scale scores. However, the improvement in specific PDQ-39 subscores (mobility, activities of daily living, and stigma) suggests that depression affects patient self-perception of motor function and further emphasizes the need for its treatment. © 2006 Movement Disorder Society [source] Three-year follow-up of clinical and inflammation parameters in children monosensitized to mites undergoing sub-lingual immunotherapyPEDIATRIC ALLERGY AND IMMUNOLOGY, Issue 6 2005F. Marcucci Parallel follow-up of clinical and inflammatory markers during sub-lingual immunotherapy (SLIT) is highly beneficial. Twenty-four children (age 4,16) monosensitized to house dust mite were randomized to receive either active or placebo SLIT for 1 yr in a double-blind placebo controlled design (Marcucci et al., Allergy 2003: 58: 657,62). Thereafter, for 2 yr they all received active treatment. Symptom scores for rhinitis, asthma, and drug usage were daily recorded. Eosinophil cationic proten (ECP) and tryptase in sputum and nasal secretions, serum and nasal mite-specific immunoglobulin E (IgE) were recorded before treatment and at 10,12 months intervals. Nasal ECP and nasal tryptase after specific nasal provocation tests were significantly reduced as compared to baseline values (p = 0.0043 and 0.0195, respectively) in the third year of active treatment. None of the other inflammatory parameters was increased. In placebo treated patients all these parameters tended to decrease only after switching to active treatment. Clinical scores did not improve in treated vs. placebo patients in the double-blind placebo-controlled phase of the study. In both cohorts a clinical benefit was observed as intra-group score reduction as compared to baseline. A significant difference was reached in patients treated for 2 yr for rhinitis and asthma (p = 0.0009 and 0.0019, respectively) but not for drug usage and in patients treated for 3 yr for rhinitis, asthma, and drug usage (p = 0.0105, 0.0048, and 0.02, respectively). SLIT in children monosensitized to mites reverted the spontaneous increase in nasal IgE and in local parameters of allergic inflammation. These outcomes were followed by a consolidated clinical improvement in the second and third year of treatment. [source] Outcomes After Intravenous Opioids in Emergency Patients: A Prospective Cohort AnalysisACADEMIC EMERGENCY MEDICINE, Issue 6 2009Alec B. O'Connor MD Abstract Objectives:, Pain management continues to be suboptimal in emergency departments (EDs). Several studies have documented failures in the processes of care, such as whether opioid analgesics were given. The objectives of this study were to measure the outcomes following administration of intravenous (IV) opioids and to identify clinical factors that may predict poor analgesic outcomes in these patients. Methods:, In this prospective cohort study, emergency patients were enrolled if they were prescribed IV morphine or hydromorphone (the most commonly used IV opioids in the study hospital) as their initial analgesic. Patients were surveyed at the time of opioid administration and 1 to 2 hours after the initial opioid dosage. They scored their pain using a verbal 0,10 pain scale. The following binary analgesic variables were primarily used to identify patients with poor analgesic outcomes: 1) a pain score reduction of less than 50%, 2) a postanalgesic pain score of 7 or greater (using the 0,10 numeric rating scale), and 3) the development of opioid-related side effects. Logistic regression analyses were used to study the effects of demographic, clinical, and treatment covariates on the outcome variables. Results:, A total of 2,414 were approached for enrollment, of whom 1,312 were ineligible (658 were identified more than 2 hours after IV opioid was administered and 341 received another analgesic before or with the IV opioid) and 369 declined to consent. A total of 691 patients with a median baseline pain score of 9 were included in the final analyses. Following treatment, 57% of the cohort failed to achieve a 50% pain score reduction, 36% had a pain score of 7 or greater, 48% wanted additional analgesics, and 23% developed opioid-related side effects. In the logistic regression analyses, the factors associated with poor analgesia (both <50% pain score reduction and postanalgesic pain score of ,7) were the use of long-acting opioids at home, administration of additional analgesics, provider concern for drug-seeking behavior, and older age. An initial pain score of 10 was also strongly associated with a postanalgesic pain score of ,7. African American patients who were not taking opioids at home were less likely to achieve a 50% pain score reduction than other patients, despite receiving similar initial and total equianalgesic dosages. None of the variables we assessed were significantly associated with the development of opioid-related side effects. Conclusions:, Poor analgesic outcomes were common in this cohort of ED patients prescribed IV opioids. Patients taking long-acting opioids, those thought to be drug-seeking, older patients, those with an initial pain score of 10, and possibly African American patients are at especially high risk of poor analgesia following IV opioid administration. [source] The impact of lower urinary tract symptoms and comorbidities on quality of life: the BACH and UREPIK studiesBJU INTERNATIONAL, Issue 2 2007Chris Robertson In a large epidemiological study, authors investigated the effect of LUTS on quality of life among various cultures. They showed a close association between the two, and that the effect of having moderate symptoms has a similar effect on quality of life as diabetes, hypertension or cancer, and that having severe symptoms had a similar effect as a heart attack or stroke. OBJECTIVES To investigate the effect of lower urinary tract symptoms (LUTS) on quality of life (QoL) and to determine its extent across a variety of cultures, and the confounding effects of self-reported comorbidities and demographics. SUBJECTS AND METHODS Data were obtained from two population-based studies in five cities: UREPIK (Boxmeer, the Netherlands; Auxerre, France; Birmingham, UK; and Seoul, Korea) and the Boston Area Community Health (BACH) study (Boston, USA). UREPIK used stratified random samples of men aged 40,79 years. BACH used a multistage stratified cluster sample to randomly select adults aged 40,79 years. QoL was assessed using a standard Medical Outcomes Study,Short Form 12 (SF-12, mental and physical health component scores); LUTS was assessed using the International Prostate Symptom Score (IPSS). The association between QoL and IPSS, associated illnesses, and lifestyle factors was investigated using weighted regression. RESULTS The UREPIK studied 4800 men aged 40,79 years; BACH recruited 1686 men aged 40,79 years. The prevalence of LUTS, defined as an IPSS of ,8, varied by city (P < 0.001), with Auxerre reporting a prevalence (se) of 18.1 (1.2)%, Birmingham 25.6 (1.5)%, Boston 25.1 (1.6)%, Boxmeer 21.2 (1.3)%, and Seoul 19.0 (1.2)%. Overall, this was similar to the reported rate of high blood pressure. Severe LUTS, defined as an IPSS of ,20, affected , 3.3% of the age group; this was roughly similar to stroke (2.2%), cancer (4.5%), or heart attack (4.5%) and less than half as much as diabetes (8.6%). A 10-point increase in IPSS was associated with a 3.3 (0.3)-point reduction in SF-12 physical health component score, with the same effect in all cities (P = 0.682 for the interaction test). This was more than the physical health component score reduction caused by cancer, diabetes, or high blood pressure (2 points each), but less than stroke or heart attack (6 points). The comorbidities had no significant impact on SF-12 mental health component score (other than a heart attack, that had a 1.8-point reduction). A 10-point increase in IPSS was associated with a 3.4 (0.6)-point reduction of the mental health component score in the four western cities and a 1.4 (0.3)-point reduction in Seoul. CONCLUSIONS Increasingly severe LUTS is associated with a lower QoL. The effect of moderate LUTS on QoL physical health component score is similar to that of having diabetes, high blood pressure or cancer, while the effect of severe LUTS is similar to a heart attack or stroke. These changes were consistent across cultures. This analysis shows the magnitude and consistency of the effects of LUTS on QoL. While these patients might be seen by several types of practitioners, it is likely that urologists will be in the best position to recognize the true impact of LUTS on a patient's QoL, to be aware of the effects of therapies for LUTS on QoL, and to ensure that colleagues in other disciplines recognize the importance of these symptoms and their treatment. [source] Comparison of a Long-Pulse Nd:YAG Laser and a Combined 585/1,064-nm Laser for the Treatment of Acne Scars: A Randomized Split-Face Clinical StudyDERMATOLOGIC SURGERY, Issue 11 2009SEONG UK MIN MD BACKGROUND Nonablative laser is gaining popularity because of the low risk of complications, especially in patients with darker skin. OBJECTIVE To compare the efficacy and safety of a long-pulse neodymium-doped yttrium aluminium garnet (Nd:YAG) laser and a combined 585/1,064-nm laser for the treatment of acne scars. MATERIALS AND METHODS Nineteen patients with mild to moderate atrophic acne scars received four long-pulse Nd:YAG laser or combined 585/1,064-nm laser treatment sessions at fortnightly intervals. Treatments were administered randomly in a split-face manner. RESULTS Acne scars showed mild to moderate improvement, with significant Echelle d'évaluation clinique des cicatrices d'acné (ECCA) score reductions, after both treatments. Although intermodality differences were not significant, combined 585/1,064-nm laser was more effective for deep boxcar scars. In patients with combined 585/1,064-nm laser-treated sides that improved more than long-pulse Nd:YAG laser-treated sides, ECCA scores were significantly lower for combined 585/1,064-nm laser treatment. Histologic evaluations revealed significantly greater collagen deposition, although there was no significant difference between the two modalities. Patient satisfaction scores concurred with physicians' evaluations. CONCLUSION Both lasers ameliorated acne scarring with minimal downtime. In light of this finding, optimal outcomes might be achieved when laser treatment types are chosen after considering individual scar type and response. [source] Impact of seasonal scarcity on energy balance and body composition in peasant adolescents from Calakmul, Campeche MexicoAMERICAN JOURNAL OF HUMAN BIOLOGY, Issue 6 2007José A. Alayón Gamboa A time allocation and anthropometric study were performed on 46 male and 38 female adolescents from 16 peasant households from two different adaptive strategies in the municipio of Calakmul, Campeche Mexico to see if they could maintain energy balance during the annual scarcity season. These strategies were called: "household subsistence agricultural strategy" (HSA) and "household commercial agricultural strategy" (HCA). Each month, from June 2001 to May 2002, adolescents were measured and followed for 24 h. Their activities were recorded at 15 min intervals. Weight for age (W/A), height for age (H/A), body mass index (BMI), arm muscle area, arm fat area, total energy expenditure (TEE), activity energy expenditure (AEE), and basal metabolic rate (BMR) were estimated and the data compared between seasons using a repeated measurements analysis of variance. The results suggest that HCA offers their adolescents better buffering against seasonal scarcity, and that HSA males are better protected than females. HCA adolescents didn't show significant losses of weight, and HCA females lost body fat during the scarcity season. HSA vulnerability was observed in W/A and BMI z score reductions during the scarcity season. It also reflected itself in stunted adolescent males and adolescent females with fewer fat reserves. HSA adolescents reduced their BMR to down regulate their energy expenditure during the scarcity season without reducing TEE and physical activity levels. HSA females lost muscle mass during the scarcity season while HSA males didn't. This difference was associated with a more demanding work schedule throughout the year for females. Am. J. Hum. Biol., 2007. © 2007 Wiley-Liss, Inc. [source] | ||||||||||||||||||||||