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Baseline Score (baseline + score)

Distribution by Scientific Domains

Medical Sciences	95%

Distribution within Medical Sciences

Psychiatry	18%
Dermatology	13%
10 Other Subdomains	56%

Selected Abstracts

Treatment of Parthenium dermatitis with methotrexate

CONTACT DERMATITIS, Issue 2 2007
Vinod K. Sharma
Patients with parthenium dermatitis are often unresponsive to topical steroids, and immunosuppressive agents may be necessary to reduce their need for systemic corticosteroids. We evaluated the efficacy of methotrexate in parthenium dermatitis. Sixteen patients unresponsive to topical treatment were included after baseline investigations, and treated with oral methotrexate (15 mg/week). Clinical response was monitored using a dermatitis area and severity index (DASI). Seven patients completed ,6 months' follow-up, and their mean DASI fell to 5, 2.7 and 2.1 at the end of 1, 3 and 6 months respectively, from a baseline score of 10. Only 3/7 patients required oral prednisolone in the initial 2,4 weeks. Side effects were minor, being mainly folliculitis and furuncles. Methotrexate may hence be a useful alternative for patients with severe parthenium dermatitis. [source]

Definitions of response and remission in schizophrenia: recommendations for their use and their presentation

ACTA PSYCHIATRICA SCANDINAVICA, Issue 2009
S. Leucht
Objective:, To review and make recommendations for the definition and presentation of the terms ,response' and ,remission' in schizophrenia. Method:, Selective review of publications on definitions of response and remission in schizophrenia. Results:, When the Brief Psychiatric Rating Scale (BPRS) or the Positive and Negative Syndrome Scale (PANSS) are used for definitions of response, a cut-off of at least 50% reduction of the baseline score should be used for acutely ill, non-refractory patients and a cut-off of at least 25% reduction for refractory patients. When percentage BPRS/PANSS reduction is calculated, the 18/30 points minimum scores meaning ,no symptoms' on the should be subtracted. In addition, responder rates from 0,100% could be presented in a table in steps of 25%. For large and simple practical trials, the Clinical Global Impression scale with suggested improvements could be used 1-7 scale. Conclusion:, To show how many patients are still symptomatic at the end of study and to show the overall amount of change in both remission and responder criteria should be presented. [source]

How long should a trial of escitalopram treatment be in patients with major depressive disorder, generalised anxiety disorder or social anxiety disorder?

HUMAN PSYCHOPHARMACOLOGY: CLINICAL AND EXPERIMENTAL, Issue 4 2009
An exploration of the randomised controlled trial database
Abstract Objective To extend the knowledge of course of improvement in patients with major depressive disorder (MDD), social anxiety disorder (SAD) or generalised anxiety disorder (GAD) participating in randomised placebo-controlled trials (RCTs) and to infer the optimal duration of initial escitalopram treatment in clinical practice, after which intervention might be reasonable in case of non-response. Methods Post hoc analysis of pooled clinical trial database for escitalopram in MDD (14 studies), GAD (4 studies) and SAD (2 studies). ,Onset' of action was defined as a 20% or more decrease from baseline score in disorder-specific psychopathological rating scales: ,response' as a 50% or more decrease from baseline score. Results In MDD, the probability of responding at week 8 if no onset was apparent at week 2 was 43%; in patients with an onset of effect the probability was nearly 80%. Similar patterns were observed in GAD and SAD. The chance of responding beyond week 4 in MDD, GAD and SAD was 20% or less if no effect had occurred by week 2. Conclusions The pattern of response in these RCTs suggests that in patients with MDD, GAD or SAD in wider clinical practice, a period of at least 4,weeks is worthwhile before considering further intervention. Copyright © 2009 John Wiley & Sons, Ltd. [source]

Ginkgo biloba for mild to moderate dementia in a community setting: a pragmatic, randomised, parallel-group, double-blind, placebo-controlled trial

INTERNATIONAL JOURNAL OF GERIATRIC PSYCHIATRY, Issue 12 2008
Rob McCarney
Abstract Objectives Doubt over the cost-effectiveness of the cholinesterase inhibitors in dementia has renewed interest in alternative treatments such as Ginkgo biloba. We aimed to determine the effectiveness and the safety profile of Ginkgo biloba for treating early stage dementia in a community setting. Methods We conducted a community-based, pragmatic, randomised, double-blind, parallel-group trial where participants were given a standardised extract of Ginkgo biloba (120,mg daily) or a placebo control for 6 months. Our primary outcomes were cognitive functioning (ADAS-Cog) and participant and carer-rated quality of life (QOL-AD). Results We recruited 176 participants, mainly through general practices. In the ANCOVA model with baseline score as a co-variate (n,=,176), Ginkgo did not have a significant effect on outcome at six months on either the ADAS-Cog score (p,=,0.392), the participant-rated QOL-AD score (p,=,0.787) nor the carer-rated QOL-AD score (p,=,0.222). Conclusion We found no evidence that a standard dose of high purity Ginkgo biloba confers benefit in mild-moderate dementia over 6 months. Copyright © 2008 John Wiley & Sons, Ltd. [source]

Randomized, Placebo-Controlled Trial of the Cognitive Effect, Safety, and Tolerability of Oral Extended-Release Oxybutynin in Cognitively Impaired Nursing Home Residents with Urge Urinary Incontinence

JOURNAL OF AMERICAN GERIATRICS SOCIETY, Issue 5 2008
Thomas E. Lackner PharmD
OBJECTIVES: Determine the cognitive effect, safety, and tolerability of oral extended-release oxybutynin in cognitively impaired older nursing home residents with urge urinary incontinence. DESIGN: Randomized, double-blinded, placebo-controlled trial. SETTING: Twelve skilled nursing homes. PARTICIPANTS: Fifty women aged 65 and older with urge incontinence and cognitive impairment. INTERVENTION: Four-week treatment with once-daily oral extended-release oxybutynin 5 mg or placebo. MEASUREMENTS: Withdrawal rates and delirium or change in cognition from baseline at 1, 3, 7, 14, 21, and 28 days after starting treatment using the Confusion Assessment Method (CAM), Mini-Mental State Examination (MMSE), and Severe Impairment Battery (SIB). The Brief Agitation Rating Scale, adverse events, falls incidence, and serum anticholinergic activity change with treatment were also assessed. RESULTS: Participants' mean age ±standard deviation was 88.6±6.2, and MMSE baseline score was 14.5±4.3. Ninety-six percent of subjects receiving oxybutynin (n=26) and 92% receiving placebo (n=24) completed treatment (P=.50). The differences in mean change in CAM score from baseline to all time points were equivalent between the oxybutynin and placebo groups. Delirium did not occur in either group. One participant receiving oxybutynin was withdrawn because of urinary retention, which resolved without treatment. Mild adverse events occurred in 38.5% of participants receiving oxybutynin and 37.5% receiving placebo (P=.94). CONCLUSION: Short-term treatment using oral extended-release oxybutynin 5 mg once daily was safe and well tolerated, with no delirium, in older female nursing home participants with mild to severe dementia. Future research should investigate different dosages and long-term treatment. [source]

Prognostic models in cirrhotics admitted to intensive care units better predict outcome when assessed at 48 h after admission

JOURNAL OF GASTROENTEROLOGY AND HEPATOLOGY, Issue 8pt1 2008
Evangelos Cholongitas
Abstract Background and Aim:, The accuracy of prognostic models in critically ill cirrhotics at admission to intensive care units (ICU) may be unreliable. Predictive accuracy could be improved by evaluating changes over time, but this has not been published. The aim of the present study was to assess the performance of prognostic models in cirrhotics at admission (baseline) and at 48 h to predict mortality in the ICU or within 6 weeks after discharge from the ICU. Methods:, One hundred and twenty-eight cirrhotics (77 males, mean age 49 ± 11.3 years) were consecutively admitted and alive 48 h after admission with 89% on mechanical ventilation, 76% on inotrope support, and 42% with renal failure. Prognostic models used were Child-Turcotte-Pugh (CTP), Model for End-stage Liver Disease (MELD), Acute Physiology and Chronic Health Evaluation (APACHE) II, Sequential Organ Failure Assessment (SOFA), failing organ systems (FOS) at baseline and at 48 h, ,score (difference between baseline and at 48 h) and the mean score (MN , score admission + 48 h/2) which were compared by area under the receiver operating characteristic curves (AUC). Results:, Mortality was 54.7% (n = 70) due to multiple organ failure in 55%. CTP, MELD, APACHE II, SOFA and FOS performed better at 48 h (AUC: 0.78, 0.86, 0.78, 0.88 and 0.85, respectively) than at baseline (AUC: 0.75, 0.78, 0.75, 0.81 and 0.79, respectively). The mean score had better discrimination than the baseline score; the ,score had poor predictive ability (AUC < 0.70). SOFA score (48 h: 0.88, mean: 0.88) and FOS (mean: 0.88) had the best accuracy, with a SOFA and MN-SOFA , 10 predicting mortality in 93% and 91%, respectively, and MN-FOS , 1.5 in 98%. Conclusions:, In cirrhotics, prognostic scores in the ICU at 48 h had better discrimination than baseline scores for short-term mortality. SOFA and FOS models had the best performance. [source]

Competence in the musculoskeletal system: assessing the progression of knowledge through an undergraduate medical course

MEDICAL EDUCATION, Issue 12 2004
Subhashis Basu
Background, Professional bodies have expressed concerns that medical students lack appropriate knowledge in musculoskeletal medicine despite its high prevalence of use within the community. Changes in curriculum and teaching strategies may be contributing factors to this. There is little evidence to evaluate the degree to which these concerns are justified. Objectives, To design and evaluate an assessment procedure that tests the progress of medical students in achieving a core level of knowledge in musculoskeletal medicine during the course. Participants and Setting, A stratified sample of 136 volunteer students from all 5 years of the medical course at Sheffield University. Methods, The progress test concept was adapted to provide a cross-sectional view of student knowledge gain during each year of the course. A test was devised which aimed to provide an assessment of competence set at the standard required of the newly qualified doctor in understanding basic and clinical sciences relevant to musculoskeletal medicine. The test was blueprinted against internal and external guidelines. It comprised 40 multiple-choice and extended matching questions administered by computer. Six musculoskeletal practitioners set the standard using a modified Angoff procedure. Results, Test reliability was 0.6 (Cronbach's ,). Mean scores of students increased from 41% in Year 1 to 84% by the final year. Data suggest that, from a baseline score in Year 1, there is a disparate experience of learning in Year 2 that evens out in Year 3, with knowledge progression becoming more consistent thereafter. All final year participants scored above the standard predicted by the Angoff procedure. Conclusions, This short computer-based test was a feasible method of estimating student knowledge acquisition in musculoskeletal medicine across the undergraduate curriculum. Tested students appear to have acquired a satisfactory knowledge base by the end of the course. Knowledge gain seemed relatively independent of specialty-specific clinical training. Proposals from specialty bodies to include long periods of disciplinary teaching may be unnecessary. [source]

Placebo-associated improvements in motor function: Comparison of subjective and objective sections of the UPDRS in early Parkinson's disease,

MOVEMENT DISORDERS, Issue 2 2002
Christopher G. Goetz MD
Abstract The Unified Parkinson's Disease Rating Scale (UPDRS) is primarily composed of an investigator-derived objective rating of motor function and a patient-derived assessment of activities of daily living (ADL). Using a stringent definition of placebo effect, we examined the frequency, temporal development, and stability of improvements during placebo treatment over 6 months in a large placebo-controlled trial of deprenyl and tocopherol in early Parkinson's disease (DATATOP). One hundred ninety-nine subjects received placebo treatment in the randomized, multicenter, placebo-controlled DATATOP study. We compared the baseline UPDRS motor section scores with follow-up scores at 4, 13, and 26 weeks. Placebo-associated improvement was defined as an improvement over baseline score in motor UPDRS of at least 50% or a change in at least two motor items at any one visit by two or more points. Seventeen percent of the 185 subjects who qualified for analysis met the placebo response criteria. The group prevalence of response was steady (7% to 10%) at any one visit without a marked predominance of an early study effect. Older subjects with more motor impairment at baseline were most likely to show a placebo-associated improvement. ADL scores were low throughout the study, and ADL improvements did not identify the subjects with objectively defined placebo-associated improvement. Prominent improvements in investigator-derived objective measures of Parkinson's disease motor impairment occur during clinical trials, including one that was not aimed at showing improved short-term efficacy. Although the notion of placebo effect often implies patient-based perceptions, we found subjective changes to be infrequent in placebo-treated patients, suggesting that either: (1) the placebo effect was rater-driven; (2) the ADL questionnaire is insensitive to transient but objectively demonstrable motor changes; or (3) that the objective changes, albeit major, are within the realm of natural variation in the UPDRS motor scale from visit to visit. © 2002 Movement Disorder Society. [source]

Cross-sectional and longitudinal construct validity of the Saint George's Respiratory Questionnaire in patients with IPF

RESPIROLOGY, Issue 6 2008
Shouchun PENG
Background and objective: This study was performed to confirm the cross-sectional and longitudinal construct validity of the Saint George's Respiratory Questionnaire (SGRQ) for the measurement of health-related quality of life (HRQoL) in patients with IPF. Methods: Sixty-eight patients with IPF responded to the SGRQ and pulmonary function tests (PFT), dyspnoea testing, arterial blood gas analysis, 6-min walk tests (6MWT) and high-resolution computed tomography were performed in a baseline study. A follow-up study was performed on 45 of these patients. Results: In the baseline study HRQoL as measured by the SGRQ was substantially impaired in IPF patients, especially in symptoms and activity domains. A significant decline in HRQoL was observed in the activity domain during follow up. TLC and changes in TLC showed the most significant inverse correlations with each SGRQ domain (r < ,0.3, P < 0.05). In a stepwise multiple regression analysis, TLC contributed most significantly to each SGRQ component baseline score. Similar results were also observed during follow up. There was a significant correlation between total CT scores and each component of the SGRQ (r > 0.3, P , 0.001). Changes in ground-glass opacity on CT (CT-alv) were also correlated with changes in each SGRQ domain (r > 0.3, P , 0.001). Stepwise multiple regression analysis showed that interstitial opacity on CT (CT-fib) contributed to variation in the baseline activity score, and that changes in CT-alv independently contributed to overall changes in the SGRQ domains during follow up. The dyspnoea score, and changes in the dyspnoea score, correlated significantly with the SGRQ sores, with the exception of the symptoms score, in both the baseline and follow-up studies. Conclusions: HRQoL as assessed by the SGRQ showed good cross-sectional and longitudinal construct validity in patients with IPF. However, additional studies are required to analyse the reliability and responsiveness so that the SGRQ can be used in patients with IPF. [source]

Personality Disorder Features as Predictors of Symptoms Five Years Post-Treatment

THE AMERICAN JOURNAL ON ADDICTIONS, Issue 3 2008
Irene Jansson MSc
Personality disorders are associated with dysfunction in a variety of areas. Recent longitudinal research has shown that personality disorders are also predictive of problems later in life, as well as of poor response to treatment of depression and anxiety. This study assessed whether personality disorder features were associated with psychiatric symptoms in a cohort of women treated for substance abuse in Sweden. Patients were diagnosed with personality disorders using the Structured Clinical Interview for DSM-IV (SCID-II) personality questionnaire and SCID-II interview, and were then administered a self-report questionnaire designed to measure symptoms of psychiatric illness, the Symptoms Checklist-90 (SCL-90), during and five years after treatment. Concurrently, features of all personality disorders, except histrionic, were associated with SCL-90 score. At five-year follow-up, most personality disorders remained associated with SCL-90 score, with the exception of paranoid and schizoid personality disorder. After controlling for baseline score on the SCL-90, conduct disorder, borderline personality disorder, and narcissistic personality disorder remained significantly associated with symptoms at follow-up. After controlling for abstinence and baseline score, only borderline personality disorder features remained associated with SCL-90 score at follow-up. Patients with personality disorders should be monitored after treatment for psychiatric symptoms. [source]

Telomere length predicts poststroke mortality, dementia, and cognitive decline

ANNALS OF NEUROLOGY, Issue 2 2006
Carmen Martin-Ruiz PhD
Objective Long-term cognitive development is variable among stroke survivors, with a high proportion developing dementia. Early identification of those at risk is highly desirable to target interventions for secondary prevention. Telomere length in peripheral blood mononuclear cells was tested as prognostic risk marker. Methods A cohort of 195 nondemented stroke survivors was followed prospectively from 3 months after stroke for 2 years for cognitive assessment and diagnosis of dementia and for 5 years for survival. Telomere lengths in peripheral blood mononuclear cells were measured at 3 months after stroke by in-gel hybridization. Hazard ratios for survival in relation to telomere length and odds ratios for dementia were estimated using multivariate techniques, and changes in Mini-Mental State Examination scores between baseline and 2 years were related to telomere length using multivariate linear regression. Results Longer telomeres at baseline were associated with reduced risk for death (hazard ratio for linear trend per 1,000bp = 0.52; 95% confidence interval, 0.28,0.98; p = 0.04, adjusted for age) and dementia (odds ratio for linear trend per 1,000bp = 0.19; 95% confidence interval, 0.07,0.54; p = 0.002) and less reduction in Mini-Mental State Examination score (p = 0.04, adjusted for baseline score). Interpretation Telomere length is a prognostic marker for poststroke cognitive decline, dementia, and death. Ann Neurol 2006 [source]

A Multicenter, Placebo-Controlled, Double-Blind, Randomized Study of Efficacy and Safety of Ocinaplon (DOV 273,547) in Generalized Anxiety Disorder

CNS: NEUROSCIENCE AND THERAPEUTICS, Issue 2 2010
Pál Czobor
Preclinical studies demonstrated that ocinaplon, a positive allosteric modulator of GABAA receptors, possesses anxiolytic-like actions at doses devoid of the side effects typically associated with benzodiazepines. The aim of this study was to evaluate the effects of ocinaplon in a multicenter, double-blind proof-of-concept trial of male and female outpatients who met DSM-IV criteria for GAD with no coexisting depression, and had a baseline score of ,20 on the Hamilton Scale for Anxiety (HAM-A). Patients with <20% reduction in HAM-A to placebo in a single-blind 7-day run-in period were randomly assigned to treatment with ocinaplon 90 mg t.i.d. (n = 31) or placebo for 28 days (n = 29). Ocinaplon was more effective than placebo in reducing HAM-A scores (P= 0.009). Patients assigned to ocinaplon exhibited a mean improvement of 14.2 points (SE = 2.6) on the total score of the HAM-A scale at the conclusion of the trial, while patients assigned to placebo obtained a mean improvement of 6.3 points (SE = 2.0). A significant (P= 0.023) difference in improvement between ocinaplon and placebo was observed beginning at and continuing from 1-week after the initiation of dosing. The proportion of patients with treatment-emergent adverse events (TEAE) was not statistically significant between ocinaplon and placebo. One serious adverse event (SAE) occurred in the ocinaplon group that was considered possibly related to study medication (icterus following transaminase elevations). The patient had preexisting medical conditions that may have contributed to this SAE. A full recovery was observed with no residual effects. The overall safety profile revealed no patterns of TEAEs, including those effects typically associated with other anxiolytic and/or benzodiazepine compounds, such as sedation. Ocinaplon appears to be a well-tolerated and effective treatment for GAD. It produces a rapid onset of anxiolytic action absent the side effects (e.g., dizziness, sedation) typically reported following anxiolytic doses of benzodiazepines. [source]

Effect of isometric exercise and body scanning on cigarette cravings and withdrawal symptoms

ADDICTION, Issue 7 2009
Michael Ussher
ABSTRACT Aims To examine the acute effects of a guided relaxation routine (body scan) and isometric exercise on desire to smoke and tobacco withdrawal symptoms. Design Experimental comparison of three conditions. Participants Forty-eight individuals reporting smoking ,10 cigarettes daily. Intervention Random assignment to one of three interventions delivered via a 10-minute audio: isometric exercise (IE, n = 14), body scanning (BS, n = 18) or a reading about natural history (control group, n = 16). Interventions were delivered twice on the same day: in the laboratory, then in their ,normal' environment. Measurements Desire to smoke (primary outcome) and withdrawal symptoms were rated at pre-intervention and up to 30 minutes post-intervention. Findings Controlling for baseline scores, post-intervention desire to smoke and withdrawal symptoms were significantly lower for IE and BS groups, compared with the controls, in both environments. There were no significant differences for IE versus BS. For desire to smoke, controlling for baseline values, ratings in the laboratory were significantly lower for IE and BS versus the control up to 30 minutes post-intervention. In the normal environment, these ratings were significantly lower only up to 5 minutes post-intervention. Conclusions Brief IE and BS interventions are effective for reducing desire to smoke and withdrawal symptoms in temporarily abstaining smokers. These interventions were found to be more effective in the laboratory than in the smoker's normal environment, but this may be an artefact of there not being a sufficient ,wash-out' period between interventions. These techniques may be beneficial for managing desire to smoke and tobacco withdrawal. [source]

What changes in health-related quality of life matter to multiple myeloma patients?

EUROPEAN JOURNAL OF HAEMATOLOGY, Issue 4 2010
A prospective study
Abstract Objective: To determine the clinical significance of changes in quality-of-life scores in patients with multiple myeloma (MM), we have estimated the minimal important difference (MID) for the health-related quality-of-life instrument, the European Organization for Research and Treatment of Cancer (EORTC) QLQ-C30. The MID is the smallest change in a quality-of-life score considered important to patients. Methods: Between 2006 and 2008, 239 patients with MM completed the EORTC QLQ-C30 at inclusion (T1) and after 3 months (T2). At T2, a structured quality-of-life interview was also performed. MIDs were calculated by using mean score changes (T2,T1) for patients who in the interview stated they had improved, deteriorated or were unchanged. MIDs were also estimated by the receiver-operating characteristic (ROC) curve method as well as by calculation effect sizes using standard deviations of baseline scores. Results: MIDs varied slightly depending on the method used. Patients stating in the interview that they had ,improved' or ,deteriorated' had a corresponding change in EORTC QLQ-C30 score ranging from 6 to15 (improvement) and from 9 to17 (deterioration) (scale range 0,100). The ROC analysis indicated that changes in score from 7 to17 represent clinically important changes to patients. The effect size method suggested 5,6 to be a small and 11,15 to be a medium change. Conclusion: Calculation of MIDs as mean score changes or by ROC analysis suggested that a change in the EORTC QLQ-C30 score in the range of approximately 6,17 is considered important by patients with MM. These MIDs are closer to a medium effect size than to a small effect size. Our findings imply that mean score changes smaller than 6 are unlikely to be important to the patients, even if these changes are statistically significant. [source]

The MMSE orientation for time domain is a strong predictor of subsequent cognitive decline in the elderly

INTERNATIONAL JOURNAL OF GERIATRIC PSYCHIATRY, Issue 12 2009
Elizabeth Guerrero-Berroa
Abstract Background The mini-mental state exam (MMSE) has been used to address questions such as determination of appropriate cutoff scores for differentiation of individuals with intact cognitive function from patients with dementia and rate of cognitive decline. However, little is known about the relationship of performance in specific cognitive domains to subsequent overall decline. Objective To examine the specific and/or combined contribution of four MMSE domains (orientation for time, orientation for place, delayed recall, and attention) to prediction of overall cognitive decline on the MMSE. Methods Linear mixed models were applied to 505 elderly nursing home residents (mean age,=,85,,>,12 years education,=,27%; 79% F, mean follow-up,=,3.20 years) to examine the relationship between baseline scores of these domains and total MMSE scores over time. Results Orientation for time was the only domain significantly associated with MMSE decline over time. Combination of poor delayed recall with either attention or orientation for place was associated with significantly increased decline on the MMSE. Conclusions The MMSE orientation for time predicts overall decline on MMSE scores over time. A good functioning domain added to good functioning delayed recall was associated with slower rate of decline. Copyright © 2009 John Wiley & Sons, Ltd. [source]

Prognostic models in cirrhotics admitted to intensive care units better predict outcome when assessed at 48 h after admission

Quality of life in mild to moderate acne: relationship to clinical severity and factors influencing change with treatment

JOURNAL OF THE EUROPEAN ACADEMY OF DERMATOLOGY & VENEREOLOGY, Issue 2 2007
M Jones-Caballero
Abstract Background, Because of its effects on quality of life, acne vulgaris is more than a merely physiological or cosmetic entity. Objectives, To describe the influence of mild to moderate acne on patients' quality of life, measured using Skindex-29, and to correlate changes in Skindex-29 scores with changes in objective and subjective indices in clinical severity after treatment with topical 4% erythromycin 0.2% zinc. Also, to evaluate efficacy and side-effects of the treatment. Methods, Observational, prospective study of 1878 patients cared for by 252 clinicians in Spain. Data included epidemiological information and responses to Skindex-29, a subjective change and objective severity index. Results, Baseline Skindex scale scores were worse in women, older patients, and those with more severe clinical disease. Skindex was sensitive to changes in objective severity but changes in Skindex scale scores were also related to other factors. Patients who reported their skin condition to be ,the same' or ,worse' at the end of the study had significantly worse baseline scores on the ,symptoms' and ,emotions' scales but ,functioning' scores were not worse than for those who reported their condition had improved. Conclusion, The effects of acne vulgaris on quality of life and changes in quality of life after treatment are not only explainable by objective severity of acne. Patients' and clinicians' judgements about acne severity are different. [source]

Targeting T-cell subsets to achieve remission

JOURNAL OF THE EUROPEAN ACADEMY OF DERMATOLOGY & VENEREOLOGY, Issue 2003
E Christophers
ABSTRACT Patients with psoriasis have an increase in pathogenic CD45RO+ memory-effector T cells during active disease. The genetically engineered fully human fusion protein alefacept has been developed to selectively target this subset of T cells. Alefacept binds to memory-effector CD45RO+ T cells, inhibiting their activation and inducing T-cell apoptosis. The selectivity of alefacept for memory-effector CD45RO+ T cells was evaluated in 229 patients with chronic psoriasis in a randomized, placebo-controlled, double-blind study conducted at 22 centres in the USA. Patients received alefacept intravenously at doses of 0.025 mg/kg, 0.075 mg/kg, or 0.150 mg/kg, or placebo once weekly for 12 weeks. Two weeks after completing treatment, patients receiving alefacept showed significant improvement in the Psoriasis Area and Severity Index (PASI) compared with those receiving placebo. Mean reductions in the PASI score were up to 53% lower than baseline scores in the alefacept treatment group, compared with a 21% decline from baseline in the placebo group (P < 0.001). In addition to the significant improvement in psoriasis, treatment with alefacept produced long-term remission in some patients. Twelve weeks after completion of therapy, 28 patients became clear or almost clear. The therapy was well tolerated and nonimmunogenic. Importantly, during treatment, there was a correlation between improvement in psoriasis and a dose-dependent reduction in peripheral blood CD45RO+ memory-effector T cells, but not in CD45RA+ naive T cells. This correlation indicates a relationship between a specific T-cell subset reduction (CD45RO+) and clinical outcome in psoriasis. [source]

Does patient feedback improve the consultation skills of general practice trainees?

MEDICAL EDUCATION, Issue 2 2010
A controlled trial
Medical Education 2010:44: 156,164 Context, This study aimed to assess if an additional patient feedback training programme leads to better consultation skills in general practice trainees (GPTs) than regular communication skills training, and whether process measurements (intensity of participation in the programme) predict the effect of the intervention. Methods, We carried out a controlled trial in which two sub-cohorts of GPTs were allocated to an intervention group (n = 23) or a control group (n = 30), respectively. In 2006, allocated first-year GPTs in the VU University Medical Centre attended a patient feedback training programme in addition to the regular communication skills training. The control group attended only regular communication skills training. Trainees were assessed by simulated patients who visited the practices and videotaped the consultations at baseline and after 3 months. The videotapes were randomly assigned to eight trained staff members. The MAAS-Global Instrument (range 0,6) was used to assess (a change in) trainee consultation skills. Results were analysed using a multi-level, linear mixed-model analysis. Results, Data on 50 GPTs were available for the follow-up analysis. Both intervention group and control group GPTs improved their consultation skills: mean MAAS-Global scores for all participants were 3.29 (standard deviation [SD] 0.75) at baseline and 3.54 (SD 0.66) at follow-up (P = 0.047). The improvement in MAAS-Global scores in the intervention group did not differ significantly from the improvement in the control group. The analysis showed a trend for intensity of participation in the patient feedback programme to predict greater improvement in MAAS-Global scores. Discussion, Although the baseline scores were already in the high range, consultation skills in both groups improved significantly. This is reassuring for current teaching methods. The patient feedback programme did not improve consultation skills more than regular communication skills training. However, a subgroup of GPTs who participated intensively in the programme did improve their consultation skills further in comparison with the less motivated subgroup. [source]

Health-related quality of life over time since resective epilepsy surgery

ANNALS OF NEUROLOGY, Issue 4 2007
Susan S. Spencer MD
Objective Health-related quality of life (HRQOL) improves after resective epilepsy surgery, but data are limited to short follow-up in mostly retrospective reports, with minimal consideration of other potential factors that might influence HRQOL. Methods In a prospective multicenter study, 396 patients underwent resective epilepsy surgery. They completed the Quality of Life in Epilepsy Inventory-89 (QOLIE-89) before surgery, within 6 months, and at approximately yearly intervals after surgery. Seizure outcome was ascertained by phone calls every 3 months, and dates of postoperative seizures were chronicled. Overall HRQOL as measured by the QOLIE-89 was evaluated with respect to seizure outcome using logistic regression. Results QOLIE-89 scores increased significantly at the first postoperative measurement (within 6 months after surgery) in the cohort overall; subsequent changes over time were sensitive to seizure-free and aura-free status. After adjusting for baseline scores, the corresponding postsurgical QOLIE-89 overall, and four dimension scores, increased as a function of square root of time seizure-free, and independently as a function of square root of time aura free, leveling by 2 years of stable seizure (aura) status. HRQOL was not independently related to duration of epilepsy, duration of intractable epilepsy, or continuation of medications. Interpretation HRQOL improves early after surgery, regardless of seizure outcome. Subsequent changes parallel length of time seizure free or aura free, stabilize after 2 years, and are unrelated to duration of epilepsy, duration of intractable epilepsy, or continued medication use. Ann Neurol 2007 [source]

Measuring the psychosocial impact of population-based prostate-specific antigen testing for prostate cancer in the UK

BJU INTERNATIONAL, Issue 4 2006
Lucy A. Brindle
OBJECTIVE To evaluate the psychosocial impact of participation in a population-based prostate-specific antigen (PSA) testing programme, akin to screening, and to explore the relationship between urinary symptoms reported before PSA testing and the response to the subsequent PSA result. PATIENTS AND METHODS This prospective questionnaire study was nested within the case-finding component of the ProtecT (prostate testing for cancer and treatment) feasibility study (ISRCTN20141297). Men aged 50,69 years from 18 general practices in three cities in the UK completed the Hospital Anxiety and Depression Scale (HADS), the Short Form-12 (SF-12) Health Survey, and the International Continence Society ,male' (ICSmale) questionnaires before giving consent for a PSA test in a community clinic (baseline). Men with an ,abnormal' PSA result returned for further investigation (including biopsy) and repeated these questionnaires before biopsy. RESULTS At baseline, study participants had similar levels of anxiety and depression to the general male population. There was no increase in the HADS scores, or reduction in the SF-12 mental health component summary score, on attendance at the biopsy clinic after receiving an ,abnormal' PSA result. Urinary symptoms were associated with levels of anxiety and depression before receiving a PSA result (baseline), but were not associated with anxiety and depression at biopsy independently of baseline scores. Therefore changes in anxiety or depression at biopsy did not appear to differ between those with and without urinary symptoms. CONCLUSIONS This study confirms the findings of other studies that the deleterious effects of receiving an abnormal PSA result during population screening are not identified by generic health-status questionnaires. Comparisons with outcomes of studies measuring cancer-specific distress and using qualitative research methods raise the question of whether a prostate cancer screening-specific instrument is required. However, a standardized measure of anxiety identified differences at baseline between those who did and did not report urinary symptoms. These findings suggest that it might be advisable to better inform men undergoing PSA testing about the uncertain relationship between urinary symptoms and prostate cancer, to minimize baseline levels of psychological distress. [source]

Assessment of a Cross-Disciplinary Domestic Violence Training for Emergency Medicine Residents and Law Students

ACADEMIC EMERGENCY MEDICINE, Issue 2008
Cameron Crandall
Objectives:, Domestic violence (DV) patients often have complex medical, social and legal issues that challenge assessment, treatment and referral. We designed a brief cross-disciplinary training for emergency medicine residents and upper level law students to determine the baseline level of resident and law student competence in assessment and management of patients with a history of domestic violence. Methods:, The study included 23 emergency medicine residents and 28 upper level law students at an urban university. The design included pretest, intervention, and retest with 4 standardized patient assessments. The intervention included for each 2 hours of cross-disciplinary lectures on DV and one joint case-based 2 hour learning session with the medical and legal learners. Communication skills (CSs) were assessed using a validated criterion standard. History taking competence (HX) was assessed with a prespecified checklist of critical elements designed to elicit key medico-legal factors relevant to each case. Data were compared with t tests. Results:, 18 (78%) residents and 26 (93%) law students completed the study. Pre-intervention, residents scored 63% (8% standard deviation (SD)) on CS and gathered 71% (13%) of critical HX elements. Law students scored 62% (8%) on CS and gathered 66% (8%) of critical HX elements. Residents (64% (6%)) and law students (63% (6%) showed similar post-intervention CS scores. Both residents (77% (10%), improvement 6%, p = 0.13) and law students (71% (14%), improvement 8%, p = .15) showed modest but non-significant improvement in critical HX gathering. Conclusions:, A brief cross-disciplinary training between medical and legal learners demonstrated low baseline scores in DV assessment for both learning groups with modest, but non-significant improvements in gathering of critical HX elements following intervention. Longer didactic training or more focused skill building might improve skills. [source]