Treatment Delivery (treatment + delivery)

Distribution by Scientific Domains

Selected Abstracts

Treatment process, alliance and outcome in brief versus extended treatments for marijuana dependence

ADDICTION, Issue 10 2010
Carly J. Gibbons
ABSTRACT Aims The Marijuana Treatment Project, a large multi-site randomized clinical trial, compared a delayed treatment control condition with a brief (two-session) and extended (nine-session) multi-component treatment among 450 marijuana-dependent participants. In this report we present treatment process data, including the fidelity of treatment delivery in the three community-based treatment settings as well as the relationships between treatment process and outcome. Design Independent evaluations of clinician adherence and competence ratings were made based on 633 videotaped sessions from 163 participants. Relationships between clinician adherence and competence, ratings of the working alliance and marijuana treatment outcomes were evaluated. Findings Protocol treatments were implemented with strong fidelity to manual specifications and with few significant differences in adherence and competence ratings across sites. In the brief two-session treatment condition, only the working alliance was associated significantly with frequency of marijuana use, but in the extended treatment therapist ratings of working alliance predicted outcomes, as did the interaction of alliance and curvilinear adherence. Conclusions Behavioral treatments for marijuana use were delivered in community settings with good fidelity. Participant and therapist working alliance scores were associated significantly with improved marijuana use outcomes in a brief behavioral treatment for adults with marijuana dependence. In extended treatment the therapist ratings of working alliance were associated with more positive outcome. However, in that treatment there was also a significant interaction between alliance and curvilinear adherence. [source]

Considerations when choosing oral chemotherapy: identifying and responding to patient need

S. IRSHAD mrcp, specialist registrar in medical oncology
IRSHAD S. & MAISEY N. (2010) European Journal of Cancer Care19, 5,11 Considerations when choosing oral chemotherapy: identifying and responding to patient need Oral chemotherapeutics are becoming increasingly accepted for the treatment of cancers and their future has never been brighter. They offer a more convenient and less invasive therapeutic option, moving cancer treatment from a predominantly hospital-based day unit into the ambulatory setting. Oral chemotherapy has the potential to maintain patient's quality of life and avoid the complications and costs of intravenous chemotherapy. It offers sustained drug exposure by providing prolonged therapy compared with intermittent IV exposure and lends itself more easily to the delivery of combination therapy. In this article we highlight the expansion of oral chemotherapeutic drug development in cancer treatment and the challenges posed by this change in treatment delivery. [source]

Health Insurance, Moral Hazard, and Managed Care

Ching-To Albert Ma
If an illness is not contractible, then even partially insured consumers demand treatment for it when the benefit is less than the cost, a condition known as moral hazard. Traditional health insurance, which controls moral hazard with copayments (demand management), can result in either a deficient or an excessive provision of treatment relative to ideal insurance. In particular, treatment for a low-probability illness is deficient if illness per se has little effect on the consumer's marginal utility of income and if the consumer's price elasticity of expected demand for treatment is large relative to the risk-spreading distortion when these are evaluated at a copayment that brings forth the ideal provision of treatment. Managed care, which controls moral hazard with physician incentives, can either increase or decrease treatment delivery relative to traditional insurance, depending on whether demand management results in deficient or excessive treatment. [source]

Breast radiation therapy guideline implementation in low- and middle-income countries,

CANCER, Issue S8 2008
Nuran Senel Bese MD
Abstract Radiation therapy plays a critical role in the management of breast cancer and often is unavailable to patients in low- and middle-income countries (LMCs). There is a need to provide appropriate equipment and to improve the techniques of administration, quality assurance, and use of resources for radiation therapy in LMCs. Although the linear accelerator is the preferred equipment, telecobalt machines may be considered as an acceptable alternative in LMCs. Applying safe and effective treatment also requires well trained staff, support systems, geographic accessibility, and the initiation and completion of treatment without undue delay. In early-stage breast cancer, standard treatment includes the irradiation of the entire breast with an additional boost to the tumor site and should be delivered after treatment planning with at least 2-dimensional imaging. Although postmastectomy radiation therapy (PMRT) has demonstrated local control and overall survival advantages in all patients with axillary lymph node metastases, preference in limited resource settings could be reserved for patients who have ,4 positive lymph nodes. The long-term risks of cardiac morbidity and mortality require special attention to the volume of heart and lungs exposed. Alternative treatment schedules like hypofractionated radiation and partial breast irradiation currently are investigational. Radiation therapy is an integral component for patients with locally advanced breast cancer after initial systemic treatment and surgery. For patients with distant metastases, radiation is an effective tool for palliation, especially for bone, brain, and soft tissue metastases. The implementation of quality-assurance programs applied to equipment, the planning process, and radiation treatment delivery must be instituted in all radiation therapy centers. Cancer 2008;113(8 suppl):2305,14. 2008 American Cancer Society. [source]