Treatment Effectiveness (treatment + effectiveness)

Distribution by Scientific Domains
Distribution within Medical Sciences

Selected Abstracts

A Cost Utility Analysis of Interdisciplinary Early Intervention Versus Treatment as Usual For High-Risk Acute Low Back Pain Patients

PAIN PRACTICE, Issue 5 2010
Mark D. Rogerson PhD
Abstract Chronic pain is a costly and debilitating condition that has proven difficult to treat, solely with medical interventions, due to the complex interplay of biological, psychological, and social factors in its onset and persistence. Many studies have demonstrated the effectiveness of interdisciplinary treatment that includes psychosocial interventions for low back pain. Nevertheless, these interventions continue to be under-utilized due to concerns of cost and applicability. The present study utilized a cost utility analysis to evaluate effectiveness and associated costs of interdisciplinary early intervention for individuals with acute low back pain that was identified as high-risk for becoming chronic. Treatment effectiveness was evaluated using a standard pain measure and quality-adjusted life years, and associated medical and employment costs were gathered for 1 year. Results indicated that subjects improved significantly from pretreatment to 1-year follow-up, and that the early intervention group reported fewer health-care visits and missed workdays than the treatment as usual group. The majority of 1,000 bootstrapped samples demonstrated the dominance of the early intervention program as being both more effective and less costly from a societal perspective. The early intervention treatment was the preferred option in over 85% of samples within an established range of acceptable costs. These results are encouraging evidence for the cost-effectiveness of interdisciplinary intervention and the benefits of targeted early treatment. [source]

Atypical depression: retrospective self-reporting of treatment effectiveness

G. Parker
Objective:, Earlier studies demonstrated that those with atypical depression show a differentially superior response to monoamine oxidase inhibitor (MAOI) antidepressants. This study compares ratings of effectiveness for a range of treatments, amongst depressed subjects with and without atypical features. Method:, In an on-line survey, individuals experiencing likely clinical depression rated symptoms experienced when depressed, including ,atypical features' and the effectiveness of previous treatments. Mean treatment effectiveness ratings were compared amongst those with ,atypical depression' (n = 338) and ,non-atypical depression' (n = 377). Results:, There were few significant differences between the ,atypical depression' and ,non-atypical depression' groups in effectiveness ratings for drug treatments, and none for psychological treatments. The ,atypical depression' group had significantly lower mean effectiveness ratings for some selective serotonin reuptake inhibitor antidepressants. Few respondents had trialed MAOIs. Conclusion:, While MAOIs are rarely prescribed, a range of non-MAOI drug and psychological treatments are of some perceived benefit for depressed patients with atypical features. [source]

The influence of health threat communication and personality traits on personal models of diabetes in newly diagnosed diabetic patients

V. L. Lawson
Abstract Background, Personal models of diabetes, i.e. patients' beliefs about symptoms, treatment effectiveness, consequences (impact on life, seriousness) and emotional response to possible short- and long-term complications, have been associated with diabetes self-care behaviours. Little work has examined potential determinants of personal models. Aims, To examine the influence of health threat communication and personality traits on personal models in newly diagnosed patients. Methods, Newly diagnosed patients (n = 158; 32 Type 1 and 126 Type 2) completed the Big Five Personality Inventory, Diabetes Health Threat Communication Questionnaire (DHTCQ), Personal Models of Diabetes Interview-Adapted (PMDI) and Illness Perception Questionnaire-Revised (IPQ-R). Results, Emotional responses to diabetes (PMDI) were associated with perceptions of a more threatening health message (22% explained variance), less emotional stability (5%) and the presence of dependent children (3%). Emotional representations (IPQ-R) were associated with a threatening health message (6%) and less emotional stability (15%). An adverse view of consequences (PMDI) was predicted by a more threatening/less reassuring health message (15%), less emotional stability (6%) and Type 1 diabetes (4%). Consequences (IPQ-R) were predicted by perceptions of a more threatening health message (20%), being less agreeable/cooperative (7%) and having dependent children (4%). Treatment effectiveness beliefs (PMDI) were associated with perceptions of a more reassuring health message (31%), younger age (3%) and more openness/intellect (2%). Conclusions, Personal models of diabetes are influenced by health threat communication, demographic and personality factors. These findings support the concept of tailoring health messages to the needs of individual patients and provide information on factors to be taken into account in the education process. [source]

Improved methods for carbon adsorption studies for water and wastewater treatment

Wei-chi Ying
Abstract An improved method was developed to rank activated carbon in removing organic water pollutants. The simple and standardized evaluation method uses a set of four adsorptive capacity indicators: phenol, iodine, methylene blue, and tannic acid numbers; those four indicator compounds were selected because they cover the molecular size range of most organic water pollutants. An improved microcolumn rapid breakthrough (MCRB) test method was developed from the existing HPMC (high-pressure minicolumn) and RSSCT (rapid small-scale column test) methods by simplifying the experimental procedure and using readily available low-cost pump, sampler, piping, and fittings. This method can be practiced in an ordinary environmental laboratory to select the best carbon, to verify the treatment effectiveness, and to estimate the adsorption treatment cost based on the observed capacity utilization rate for carbon in the adsorber without the problems often encountered with using small and mini traditional columns. The benefits of the four-parameter carbon selection method and the MCRB method were demonstrated by adsorption isotherm and breakthrough data for several indicator compounds and organic water pollutants. These improved methods will enable efficient carbon adsorption studies necessary for more applications of carbon adsorption technology in water and wastewater treatment. © 2006 American Institute of Chemical Engineers Environ Prog, 2006 [source]

Effects of dose and particle size on activated carbon treatment to sequester polychlorinated biphenyls and polycyclic aromatic hydrocarbons in marine sediments

John R. Zimmerman
Abstract Recent laboratory studies show that mixing activated carbon with contaminated sediment reduces the chemical and biological availability of hydrophobic organic contaminants. In this study, we test the effects of varying the activated carbon dose and particle size in reducing the aqueous availability of polychlorinated biphenyls (PCBs) and polycyclic aromatic hydrocarbons (PAHs) and the uptake of PCBs by two benthic organisms. We mixed PCB- and PAH-contaminated sediment from Hunters Point Naval Shipyard, San Francisco Bay (CA, USA), for one month with activated carbon, at doses of 0.34, 1.7, and 3.4% dry mass basis. We found that increasing the carbon dose increased the effectiveness in reducing PCB bioaccumulation. In 56-d uptake tests with the benthic organisms Neanthes arenaceodentata and Leptocheirus plumulosus, PCB bioaccumulation was reduced by 93 and 90%, respectively, with 3.4% carbon. Increasing the dose also increased the effectiveness in reducing PCB and PAH aqueous concentrations and uptake by semipermeable membrane devices and quiescent flux of PCBs to overlying water. Decreasing activated carbon particle size increased treatment effectiveness in reducing PCB aqueous concentration, and larger-sized activated carbon (400,1,700 ,m) was ineffective with a contact period of one month. We invoke a numerical model based on intraparticle diffusion in sediment and activated carbon particles to help interpret our experimental results. This model was useful in explaining the trends for the effect of activated carbon dose and particle size on PCB aqueous concentrations in well-mixed systems. [source]

Recent life problems and non-fatal overdose among heroin users entering treatment

ADDICTION, Issue 2 2005
Joanne Neale
ABSTRACT Aims To investigate the role of recent life problems in non-fatal overdose among heroin users entering various drug treatment settings. Design Cross-sectional data from a longitudinal study investigating drug treatment effectiveness. Setting Five prison drug treatment services, three residential rehabilitation units, three residential detoxification units and 21 community drug treatment services located in rural, urban and inner-city areas of Scotland. Participants Of a total of 793 primary heroin users commencing drug treatment during 2001,02, 337 (42.5%) were prison drug service clients; 91 (11.5%) were residential rehabilitation clients; 97 (12.2%) were residential detoxification clients; and 268 (33.8%) were community drug treatment clients. Measurements Univariate and stepwise multivariate logistic regression analyses examined associations between overdosing in the 90 days prior to treatment entry and basic demographic characteristics, recent drug use and recent life problems. Findings Ninety-one study participants (11.5%) reported at least one overdose and 19 (2.4%) reported more than one overdose in the 90 days prior to treatment entry. A ,2 test revealed no significant difference in rates of recent overdosing between the four treatment settings (P = 0.650). Recent drug use and recent life problems,but not demographic characteristics,were associated independently with recent overdosing. However, recent life problems were not associated independently with recent overdosing among clients entering prison, clients entering residential rehabilitation or with multiple recent overdosing. Conclusions Associations between recent life problems and recent overdose were evident, but varied by treatment setting. Treatment providers should identify and address heroin users' life problems as part of a broad strategy of overdose prevention. [source]

Assessing the Therapeutic Use of Lafoensia pacari St. Hil.

HELICOBACTER, Issue 3 2006
Extract (Mangava-Brava) in the Eradication of Helicobacter pylori: Double-Blind Randomized Clinical Trial
Abstract Background:, The eradication of Helicobacter pylori is easily achieved by combining antisecretory agents and antibiotics; however, the cost of these associations is very high for the population of Third World countries, where the prevalence of the infection is even higher and leads to markedly reduced treatment effectiveness. We tested a plant (Lafoensia pacari) that is used in the central region of Brazil. According to previous studies, this plant has high concentrations of ellagic acid, which presents gastric antisecretory and antibacterial actions. Material and Methods:, One hundred dyspeptic, urease-positive patients were randomized to receive 500 mg of methanolic extract of L. pacari (n = 55) or placebo (n = 45), for 14 days, in a double-blind clinical trial. The main variables assessed were the eradication of H. pylori 8 weeks after the intervention and complete symptom relief at the end of the treatment. Results:, The examinations (urease and histology) showed persistence of H. pylori in 100% of participants. Complete symptom relief was experienced by 42.5% of patients (95% CI: 29.4,55.8) in the intervention group and by 21% (95% CI: 8.8,33.1) in the control group, p = .020. The side-effects were minimal and similar in both groups. Conclusions:, The extract of L. pacari as a single agent was not effective to eradicate H. pylori. However, it was well tolerated and many participants reported relief of symptoms. Future studies may test the agent using larger doses and longer periods, in monotherapy or in combination with antibiotics. [source]

Viral dynamics and response differences in HCV-infected African American and white patients treated with IFN and ribavirin

HEPATOLOGY, Issue 6 2003
Jennifer E. Layden-Almer
Studies have suggested that African American patients infected with hepatitis C virus (HCV) do not respond as well to treatment with interferon (IFN) as white patients. Here we analyzed the difference in the viral kinetic response between genotype 1 HCV-infected African American patients (n = 19) and white patients (n = 16). Patients were treated with 10 mIU IFN-,2b daily with or without ribavirin for 1 month followed by 3 mIU IFN-,2b 3 times a week with ribavirin. The kinetic parameters (,, treatment effectiveness at inhibiting virion production; ,, loss rate of virus-producing cells; c, clearance rate of free virions; ,, delay until viral decline starts) were estimated from the viral load decay profiles using a previously described mathematical model. Differences in early kinetic parameters and viral negativity frequencies at weeks 4, 12, and 48 were compared. Ribavirin did not appear to enhance any of the viral kinetic parameters, although this may have been due to the high dose of IFN used. African American patients exhibited significantly (P = .005) lower drug effectiveness (88.6% vs. 98.2%) compared with white patients, accounting for a 0.8 log lower HCV RNA decrease in the first 24 hours of treatment. Significant differences (P = .006) were also noted for ,. There was no correlation between any of the viral kinetic parameters and either age, body mass index (BMI), or genotype 1 subtype. No patient achieved viral negativity at weeks 4, 12, or 48 without an , greater than 90%. The mean viral decline and viral negativity rates were statistically different between the two races; however, when controlling for treatment effectiveness, these differences were no longer apparent. In conclusion, the failure of IFN response in African American patients infected with genotype 1 HCV is in part due to an impaired ability to inhibit viral production. [source]

Modelling lifetime QALYs and health care costs from different drinking patterns over time: a Markov model

Carolina Barbosa
Abstract The negative health consequences of alcohol use and its treatment account for significant health care expenditure worldwide. Long-term modelling techniques are developed in this paper to establish a link between drinking patterns, health consequences and alcohol treatment effectiveness and cost-effectiveness. The overall change in health related quality and quantity of life which results from changes in health-related behaviour is estimated. Specifically, a probabilistic lifetime Markov model is presented where alcohol consumption in grams of alcohol per day and drinking history are used for the categorization of patients into four Markov states. Utility weights are assigned to each drinking state using EQ-5D scores. Mortality and morbidity estimates are state, gender and age specific, and are alcohol-related and non-alcohol-related. The methodology is tested in a case study. This represents a major development in the techniques traditionally used in alcohol economic models, in which short-term costs and outcomes are assessed, omitting potential longer term cost savings and improvements in health related quality of life. Assumptions and implications of the approach are discussed. Copyright © 2010 John Wiley & Sons, Ltd. [source]

Has ,lifetime prevalence' reached the end of its life?

An examination of the concept
Abstract Many cross-sectional surveys in psychiatric epidemiology report estimates of lifetime prevalence, and the results consistently show a declining trend with age for such disorders as depression and anxiety. In a closed cohort with no mortality, lifetime prevalence should increase or remain constant with age. For mortality to account for declining lifetime prevalence, mortality rates in those with a disorder must exceed those without a disorder by a sufficient extent that more cases would be removed from the prevalence pool than are added by new cases, and this is unlikely to occur across most of the age range. We argue that the decline in lifetime prevalence with age cannot be explained by period or cohort effects or be due to a survivor effect, and are likely due to a variety of other factors, such as study design, forgetting, or reframing. Further, because lifetime prevalence is insensitive to changes in treatment effectiveness or demand for services, it is a parameter that should be dropped from the lexicon of psychiatric epidemiology. Copyright © 2009 John Wiley & Sons, Ltd. [source]

Offenders with intellectual disability: the size of the problem and therapeutic outcomes

P. Barron
Abstract Background People with intellectual disability (ID) who offend may be subject to a variety of disposals within the criminal justice system, or via diversion to health and social services in inpatient units or in community ID teams. Offenders with ID are a group with complex needs who may pose a recurrent risk to the public. Despite the significant number of offenders with ID, there is limited evidence on treatment effectiveness and outcomes. Methods A literature search of all electronic databases was undertaken, and journals were hand-searched for clinical trials or case studies of interventions for offenders with ID. The main outcome was recidivism rates. Results There were no published clinical trials of offenders with ID. A series of small-scale group cognitive-behavioural treatments for sex offenders offers the most persuasive evidence of success in reducing recidivism. Conclusion Offenders with ID often receive inadequate services as a result of poor identification through the criminal justice system and research into effective treatments is rudimentary. Further studies are necessary in order to improve treatment efficacy and service provision for a complex group of individuals. [source]


Howard Protinsky
Eye Movement Desenitization and Reprocessing (EMDR) as a clinical technique may enhance treatment effectiveness when applied within a couple therapy approach that is emotionally and experientially oriented. Clinical experience indicates that EMDR-based interventions are useful for accessing, activating, tolerating, and reprocessing the intense emotions that often fuel dysfunctional couple, interactions. Using EMDR within conjoint to reprocess negative emotions can amplify intimacy, increase connection, and subsequently lead to a change in problematic relationship patterns. [source]

Amitriptyline treatment of chronic pain in patients with temporomandibular disorders

O. Plesh
Randomized clinical trials of amitriptyline will require data from pilot studies to be used for sample size estimates, but such data are lacking. This study investigated the 6-week and 1-year effectiveness of low dose amitriptyline (10,30 mg) for the treatment of patients with chronic temporomandibular disorder (TMD) pain. Based on clinical examination, patients were divided into two groups: myofascial and mixed (myofascial and temporomandibular joint disorders). Baseline pain was assessed by a Visual Analogue Scale (VAS) for pain intensity and by the McGill Pain Questionnaire (MPQ). Depression was assessed by the Beck Depression Inventory (BDI) short form. Patient assessment of global treatment effectiveness was obtained after 6 weeks and 1 year of treatment by using a five-point ordinal scale: (1) worse, (2) unchanged, (3) minimally improved, (4) moderately improved, (5) markedly improved. The results showed a significant reduction for all pain scores after 6 weeks and 1 year post-treatment. The depression scores changed in depressed but not in non-depressed patients. Global treatment effectiveness showed significant improvement 6 weeks and 1 year post-treatment. However, pain and global treatment effectiveness were less improved at 1 year than at 6 weeks. [source]

Adrenocortical and Pituitary Glucocorticoid Feedback in Abstinent Alcohol-Dependent Women

ALCOHOLISM, Issue 5 2010
Bryon Adinoff
Background:, The long-term ingestion of alcohol diminishes hypothalamic,pituitary,adrenal (HPA) axis reactivity in alcohol-dependent men, potentially altering future relapse risk. Although sex differences in HPA axis functioning are apparent in healthy controls, disruptions in this system have received little attention in alcohol-dependent women. In this study, we assessed the basal secretory profile of adrenocorticotropic hormone (ACTH) and cortisol, adrenocortical sensitivity in both the presence and absence of endogenous corticotropic pituitary activation, and feedback pituitary glucocorticoid sensitivity to dexamethasone. Methods:, Seven women 4- to 8-week abstinent alcohol-only dependent subjects and 10 age-matched female healthy controls were studied. All subjects were between 30 and 50 years old, not taking oral contraceptives, and were studied during the early follicular phase of their menstrual cycle. Circulating concentrations of ACTH and cortisol were measured in blood samples collected at frequent intervals from 2000 to 0800 hour. A submaximal dose of cosyntropin (0.01 ,g/kg), a synthetic ACTH (1,24), was administered at 0800 hour to assess adrenocortical sensitivity. In a separate session, low-dose cosyntropin was also administered following high-dose dexamethasone (8 mg intravenous) to assess adrenocortical sensitivity in the relative absence of endogenous ACTH. In addition, the ACTH response to dexamethasone was measured to determine the pituitary glucocorticoid negative feedback. Sessions were 5 days apart, and blood draws were obtained every 5 to 10 minutes. Results:, Mean concentrations and pulsatile characteristics of ACTH and cortisol over 12 hours were not statistically different between the 2 groups. Healthy controls had a somewhat higher (p < 0.08) net peak, but not net integrated, cortisol response to cosyntropin relative to the alcohol-dependent women. There were no significant group differences in either the ACTH or cortisol response to dexamethasone nor in the net cortisol response to cosyntropin following dexamethasone. Conclusion:, Significant differences in pituitary,adrenal function were not apparent between alcohol-dependent women and matched controls. Despite the small n, it appears that alcohol-dependent women do not show the same disruptions in HPA activity as alcohol-dependent men. These findings may have relevance for gender-specific treatment effectiveness. [source]

Imperative ideals and the strenuous reality: focusing on acute psychiatry

J. K. Hummelvoll RPN RNT BA DrPH
The aim of this study was to describe the complexity of the working situation on an acute psychiatric ward as well as how nurses balance tensions between ideals and the reality of daily work. By means of field research, the study aimed to arrive at a deeper understanding of the reality that nursing staff and patients experience. The analysis shows that the acute and unpredictable character of the working situation in combination with short hospital stays results in a tentative and summary nursing care characterized by ,therapeutic superficiality'. This constitutes a hindrance to encountering the patient as a person. The demand on ,treatment effectiveness' creates work-related stress. Hence, a partly articulated conflict develops between the professional and humanistic ideals of psychiatric nursing and the strenuous reality that the staff have to adjust to. This conflict is solved in various ways, depending on whether they belong to the pragmatic, idealist, traditionalist or enforcer attitude in relation to the ward's mandate. The demand on treatment effectiveness seems to promote a medical model in the daily work, even though a humanistic and existential approach can be traced in the nurses' caring philosophy. [source]

Mechanisms of anger and treatment outcome in combat veterans with posttraumatic stress disorder

David Forbes
Research has identified anger as prominent in, and an influence on, treatment outcome for military veterans with posttraumatic stress disorder (PTSD). This study examined factors influencing the relationship between anger and outcome to improve treatment effectiveness. Participants comprised 103 veterans attending PTSD treatment. Measures of PTSD and comorbidity were obtained at intake and 9-month follow-up. Measures also included potential mediators of therapeutic alliance, social support, problematic/undermining relationships and fear of emotion. Path analyses supported anger as a predictor of treatment outcome, with only fear of anger and alcohol comorbidity accounting for the variance between anger and outcome. To improve treatment effectiveness, clinicians need to assess veterans' anger, aggression, and alcohol use, as well as their current fear of anger and elucidate the relationship between these factors. [source]

Primary Hepatitis in Dogs: A Retrospective Review (2002,2006)

J.H. Poldervaart
Background: Little is known about etiology, disease progression, treatment outcome, survival time, and factors affecting prognosis in dogs with primary hepatitis (PH). Objectives: To review retrospectively different forms of hepatitis in a referral population, by the World Small Animal Veterinary Association Standardization criteria. Animals: One-hundred and one dogs examined for histologically confirmed PH between 2002 and 2006. Dogs with nonspecific reactive hepatitis were excluded. Methods: Retrospective study. Medical records were reviewed for prevalence, signalment, clinical and clinicopathologic manifestation, outcome, survival time, and prognostic factors for shortened survival. Results: PH occurred in 0.5% of dogs in this referral population. Acute (AH) and chronic hepatitis (CH) were diagnosed in 21 and 67 dogs, respectively. Progression from AH to CH occurred in 5/12 of the repeatedly sampled dogs. CH was idiopathic in 43 (64%) dogs, and was associated with copper accumulation in 24 (36%) dogs. Median survival time was longer in dogs with AH than in dogs with CH (either idiopathic or copper associated), and dogs with lobular dissecting hepatitis had the shortest survival time. Prognostic factors predicting shortened survival were associated with decompensated liver function and cirrhosis at initial examination. Conclusions and Clinical Importance: The majority of PH in dogs is CH. Previous studies appear to have underestimated the etiologic role of copper in both AH and CH. Prognosis is reduced in dogs with hepatic cirrhosis or cirrhosis-related clinical findings. Further research into etiology and treatment effectiveness in all PH forms is needed. [source]

Physician and patient survey of allergic rhinitis: methodology

ALLERGY, Issue 2007
V. Higgins
Methodology for Disease Specific Programme (DSP©) surveys designed by Adelphi Group Products is used each year to survey patients and physicians on their perceptions of treatment effectiveness, symptoms and impact of diseases. These point-in-time surveys, conducted in the USA and Europe (France, Germany, Italy, Spain and UK), provide useful information on the real-world management and treatment of diseases. This paper describes the methodology for the DSP survey in allergic rhinitis, detailing the preparation of materials, recruitment of physicians, data collection and data management. [source]

The relationship between subjective and objective assessments of sacral neuromodulation effectiveness in patients with urgency-frequency,

Kenneth M. Peters
Abstract Aims Global response assessment (GRA) has been used to evaluate patients' perceptions of treatment effectiveness. However, few studies have scrutinized the relationship between GRAs and objective voiding diary outcomes data. This study explores the relationship between self-reported symptom-specific GRA responses and objective changes in frequency, urgency and pelvic pain in patients with urgency-frequency with or without pelvic pain after implantation of a prosthetic sacral nerve stimulation device. Methods Patients scheduled for a staged procedure were enrolled in a prospective, observational, longitudinal study. Post implantation, patietns were grouped into "responders" or "non-responders" based on their answers to symptom-specific GRAs at three and six months. Treatment responders were defined as those reporting "moderately" or "markedly improved" on a 7-point scale, and all others were considered non-responders. Pre- and post-implant changes in mean 24-hour voiding frequency, voided volume, urgency and pelvic pain scores as recorded on voiding diaries were compared between groups using paired t-test. Results At three months, responders demonstrated corresponding statistically significant improvement in voiding frequency (P,<,0.001), average voided volume (P,=,0.003), urgency (P,=,0.022) and pelvic pain (P,=,0.039). At six months, responders demonstrated statistically significant improvements in frequency (P,=,0.025) and urgency (P,=,0.006). None of the symptom changes were statistically significant in treatment non-responders. Conclusions The GRA non-responders groups' perceptions of treatment response agreed with their objective changes in bothersome symptoms and responders' changes agreed with their perception of improvement in the majority of symptoms. Further study is needed to standardize the GRA, and explore its potential for use in clinical practice. Neurourol. Urodynam. 27:775,778, 2008, © 2008 Wiley-Liss, Inc. [source]


PAIN MEDICINE, Issue 2 2002
Article first published online: 4 JUL 200
Forest Tennant, MD, Dr PH; Laura Herman RN BSN FNP Veract Intractable Pain Centers, 338 S. Glendora Ave., West Covina, CA 91790 It is recognized that biologic markers of severe, intractable pain (SIP) can help distinguish degrees of pain and assist in monitoring treatment effectiveness. Fifty (50.0%) adult ambulatory SIP patients, at the time of referral described their pain as constant, excruciating, produced a bed or house-bound state, and was uncontrolled by non-opioid medications and low dosages of the weak opioids, hydrocodone or codeine. Patients were treated with a long-acting opioid preparation consisting of methadone, oxycodone, morphine, or transdermal fentanyl in addition to a short-acting opioid for breakthrough pain. These patients were screened before treatment and after three months of opioid treatment by: (1) blood pressure; (2) pulse rate; (3) morning cortisol and pregnenolone serum concentrations; and (4) erythrocyte sedimentation rate (ESR). The percentage of patients with physiologic abnormalities before and after three months of treatment were as follows: (1) hypertension above 140/90 mm/Hg; 28 (56.0%) vrs 14 (28.0%); (2) tachycardia above 84/minute; 21 (42.0%) vrs 9 (18.0%); (3) elevated serum cortisol concentration; 12 (24.0%) vrs 2 (4.0%); (4) low serum cortisol serum concentration; 7 (14.0% vrs 1 (2.0%); (5) low pregnenolone serum concentration; 18 (36.0%) vrs 3 (6.0%); and (6) elevated ESR; 10 (20.0%) vrs 3 (6.0%) (p<.05). Mean blood pressure, pulse rate, ESR, and serum concentrations of cortisol and pregnenolone in patients who demonstrated a physiologic abnormality all positively and significantly (p<.05) altered these markers toward normal. This study indicates that some physiologic abnormalities, particularly those related to pituitary-adrenal over-stimulation with excess output of catecholamines and glucocorticoids, may serve as biologic markers which can help to identify SIP and monitor treatment effectiveness. [source]

Cryotherapy after total knee replacement: a survey of current practice

Simon Barry
Abstract Background and Purpose Cryotherapy is commonly used during physio-therapeutic rehabilitation after total knee replacement (TKR). Evidence for treatment effectiveness is contradictory and there are no clinical guidelines to inform treatment protocols within this patient group. The present survey investigated current cryotherapy practice after TKR throughout the United Kingdom (UK). Method A postal survey, containing open and closed questions, was distributed to senior inpatient orthopaedic physiotherapists (n = 453). Results The response rate was 67% (304/453) and 58% (263/453) of the responses were completed by physiotherapists who treated TKR patients in the acute phase. Of these, 33% (85/263) routinely applied some form of cryotherapy after TKR. Physiotherapists working in the private sector were more likely to use cryotherapy and had greater access to Cryocuff equipment. The two main methods of cryotherapy application were the Cryocuff device, 59% (155/263) and crushed ice, 30% (79/263). Treatments were applied most frequently between 24 and 48 hours post-surgery, for 20 minutes, twice a day. Lack of proven efficacy was the most frequently stated reason for not applying cryotherapy treatment, and swelling was the most common indicator for treatment. There was particular uncertainty about the physical management of the Cryocuff device. Conclusions There was little consensus with regard to treatment indicators, method of application and the management of cryotherapy after TKR. The results highlight a lack of consistency in the application of cryotherapy after TKR, indicating a need for further research. Copyright © 2003 Whurr Publishers Ltd. [source]

Conceptual frame for selecting individual psychotherapy in the schools

Tammy L. Hughes
Psychotherapy is a service-delivery that is provided for both general and special education students. This manuscript examines a conceptual framework for determing when to employ psychotherapy within the school-based setting. Decisions are informed by the relationship between problem behavior, therapeutic techniques, short-term outcomes, and overall child development. Both the individual needs of students and the cumulative body of evidence regarding treatment effectiveness are required for intervention selection. The school psychologists' unique training in psychology and education affords the opportunity to effectively use psychotherapy to enhance the academic and social development of children. © 2009 Wiley Periodicals, Inc. [source]

The Addiction Severity Index at 25: Origins, Contributions and Transitions

A. Thomas McLellan PhD
The Addiction Severity Index (ASI) is a multidimensional interview used to measure the substance use, health, and social problems of those with alcohol and other drug problems, both at admission to treatment and subsequently at follow-up contacts. This article first discusses the conceptual and practical importance of the ASI's multi-dimensional approach to measuring addiction severity, as illustrated by two case presentations. The second section of the paper reviews how this measurement approach has led to some important findings regarding the prediction and measurement of addiction treatment effectiveness. The third section describes the historical and practical considerations that have changed the instrument over time, details the problems with the instrument, and describes our efforts to correct those problems with the ASI-6. Finally, some recent ASI data collected from over 8,400 patients admitted to a nationally representative sample of U.S. addiction treatment programs are presented. [source]

Health-related Quality of Life for Adults Participating in Outpatient Substance Abuse Treatment

Thomas J. Morgan Psy.D.
Interest exists in assessing health-related quality of life as one aspect of treatment effectiveness with substance abuse clients. The SF-36 Health Survey is a self-report measure assessing subjective health status along physical and mental health dimensions. Subjects were 252 adults in an outpatient, randomized clinical trial for substance abuse treatment. Subjects reported significantly more impairments in functioning when compared to U.S. population norms, but differences disappeared after three months of treatment. There was little support that quality of life functioning was significantly related to substance use during treatment. Results highlight the importance of using the SF-36 to facilitate treatment planning. [source]

Three-dimensional ultrasound image-guided robotic system for accurate microwave coagulation of malignant liver tumours

Jing Xu
Abstract Background The further application of conventional ultrasound (US) image-guided microwave (MW) ablation of liver cancer is often limited by two-dimensional (2D) imaging, inaccurate needle placement and the resulting skill requirement. The three-dimensional (3D) image-guided robotic-assisted system provides an appealing alternative option, enabling the physician to perform consistent, accurate therapy with improved treatment effectiveness. Methods Our robotic system is constructed by integrating an imaging module, a needle-driven robot, a MW thermal field simulation module, and surgical navigation software in a practical and user-friendly manner. The robot executes precise needle placement based on the 3D model reconstructed from freehand-tracked 2D B-scans. A qualitative slice guidance method for fine registration is introduced to reduce the placement error caused by target motion. By incorporating the 3D MW specific absorption rate (SAR) model into the heat transfer equation, the MW thermal field simulation module determines the MW power level and the coagulation time for improved ablation therapy. Two types of wrists are developed for the robot: a ,remote centre of motion' (RCM) wrist and a non-RCM wrist, which is preferred in real applications. Results The needle placement accuracies were < 3 mm for both wrists in the mechanical phantom experiment. The target accuracy for the robot with the RCM wrist was improved to 1.6 ± 1.0 mm when real-time 2D US feedback was used in the artificial-tissue phantom experiment. By using the slice guidance method, the robot with the non-RCM wrist achieved accuracy of 1.8 ± 0.9 mm in the ex vivo experiment; even target motion was introduced. In the thermal field experiment, a 5.6% relative mean error was observed between the experimental coagulated neurosis volume and the simulation result. Conclusion The proposed robotic system holds promise to enhance the clinical performance of percutaneous MW ablation of malignant liver tumours. Copyright © 2010 John Wiley & Sons, Ltd. [source]

Gynaecologists blaze the trail in primary studies and systematic reviews of diagnostic test accuracy

Neil Philip JOHNSON
As the Cochrane Collaboration is poised to begin publishing systematic reviews of diagnostic test accuracy studies in addition to its traditional systematic reviews of treatment effectiveness, we are likely to see a major expansion in the number of primary studies and systematic reviews of diagnostic test accuracy in the medical literature. Obstetricians and gynaecologists have played an important role in initiating this newer area of research. However, the methodology for such studies is challenging and the published literature is riddled with pitfalls. This editorial seeks to simplify the concepts involved in diagnostic test accuracy studies and systematic reviews, to reflect on the early development of this research in our specialty and to envision the future pathway for screening and diagnostic research. [source]

Validity and clinical feasibility of the ADHD rating scale (ADHD-RS) A Danish Nationwide Multicenter Study

N Szomlaiski
Abstract Aim: To establish the validity of a Danish version of the Attention Deficit Hyperactivity Disorder Rating Scale (ADHD-RS), secondly to present national norm scores compared to that of United States and other European data and thirdly to evaluate ADHD-RS when used for monitoring treatment effectiveness. Methods: A Danish translation of the ADHD-RS was used on a normative sample of 837 children. Two clinical samples, 138 hyperkinetic disorder (HKD) cases and 110 clinical controls were recruited from eleven Danish Child and Adolescent Mental Health (CAMH) centres and assessed according to usual clinical standards. The HKD children were rated by parents and teachers at baseline and at follow-up 3 months later. Results: Internal validity of ADHD-RS was high and the factor structure supported the diagnostic classification system ICD-10. The questionnaire discriminated HKD patients in a mixed clinical sample, and was sensitive to change in symptom load as measured before and after commencing of the treatment. Conclusion: The Danish version of ADHD-RS is valid and clinically feasible when measuring HKD symptom load in a CAMH-setting. The questionnaire provides useful data in patient management, quality improvement and service planning as well as in effectiveness studies of different interventions for patients with HKD and related disorders in routine clinical settings. [source]

Imperative ideals and the strenuous reality: focusing on acute psychiatry

J. K. Hummelvoll RPN RNT BA DrPH
The aim of this study was to describe the complexity of the working situation on an acute psychiatric ward as well as how nurses balance tensions between ideals and the reality of daily work. By means of field research, the study aimed to arrive at a deeper understanding of the reality that nursing staff and patients experience. The analysis shows that the acute and unpredictable character of the working situation in combination with short hospital stays results in a tentative and summary nursing care characterized by ,therapeutic superficiality'. This constitutes a hindrance to encountering the patient as a person. The demand on ,treatment effectiveness' creates work-related stress. Hence, a partly articulated conflict develops between the professional and humanistic ideals of psychiatric nursing and the strenuous reality that the staff have to adjust to. This conflict is solved in various ways, depending on whether they belong to the pragmatic, idealist, traditionalist or enforcer attitude in relation to the ward's mandate. The demand on treatment effectiveness seems to promote a medical model in the daily work, even though a humanistic and existential approach can be traced in the nurses' caring philosophy. [source]