Treatment Goals (treatment + goal)

Distribution by Scientific Domains
Distribution within Medical Sciences

Selected Abstracts

People With Diabetes Not Meeting Treatment Goals

Carolyn Davis Cockey MLS executive editor
No abstract is available for this article. [source]

Are differences in guidelines for the treatment of nicotine dependence and non-nicotine dependence justified?

ADDICTION, Issue 12 2009
John R. Hughes
ABSTRACT Despite the many similarities between nicotine dependence and other drug dependences, national guidelines for their treatment differ in several respects. The recent national guideline for the treatment of nicotine dependence has (i) less emphasis on detailed assessment; (ii) less emphasis on treatment of psychiatric comorbidity; (iii) less acceptance of reduction of use as an initial treatment goal; (iv) greater emphasis on pharmacological interventions; and (v) less emphasis on psychosocial treatment than national guidelines for non-nicotine dependences. These treatment differences may occur because (i) nicotine does not cause behavioral intoxication; (ii) psychiatric comorbidity is less problematic with nicotine dependence; (iii) psychosocial problems are less severe with nicotine dependence; and (iv) available pharmacotherapies for nicotine dependence are safer, more numerous and more easily available. However, it is unclear whether these treatment differences are, in fact, justifiable because of the scarcity of empirical tests. We suggest several possible empirical tests. [source]

Reduced smoking: an introduction and review of the evidence

ADDICTION, Issue 1s1 2000
John R. Hughes
The major questions about reductions in the number of cigarettesday as a treatment goal are (1) how many smokers can reduce and maintain such reduction, (2) how much compensation will occur, (3) will reduced smoking significantly decrease the risk of smoking and (4) will reduction promote or undermine cessation. Naturalistic studies of smokers who are not trying to stop smoking indicate that a substantial minority of smokers spontaneously reduce their number of cigarettesday and can maintain significant reductions (-7% to -43%) over long periods of time. Six experimental trials of smokers not interested in quitting were able to induce large reductions in cigarettesday (-15% to -63%) using behavioral therapy andor nicotine replacement. Reductions in toxin exposure (carbon monoxide) were not as large but still substantial (-21% to -35%). The three studies with long-term follow-ups found little loss of effects over 6-30 months. Although face-valid, there is no direct test of whether reduced smoking will decrease smoking risks and such a study would need to be very large and last for a long time. None of the above-cited studies indicate that reduction undermines the probability of future cessation attempts and several found reduction promotes future cessation. [source]

Achieving Goal Blood Pressure in Patients With Type 2 Diabetes: Conventional Versus Fixed-Dose Combination Approaches

George L. Bakris MD
Data from the Third National Health and Nutrition Examination Survey (NHANES III) demonstrate that only 11% of people with diabetes who are treated for high blood pressure achieve the blood pressure goal of <130/85 mm Hg recommended in the sixth report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure (JNC VI). The current study tests the hypothesis that initial therapy with a fixed-dose combination will achieve the recommended blood pressure goal in patients with type 2 diabetes faster than conventional monotherapy. This randomized, double-blind, placebo-controlled study had as a primary end point achievement of blood pressure <130/85 mm Hg. Participants (N=214) with hypertension and type 2 diabetes received either amlodipine/benazepril 5/10 mg (combination) or enalapril 10 mg (conventional) once daily for 4 weeks, titrated to 5/20 mg/day or 20 mg/day, respectively at this time, if target blood pressure was not achieved. Hydrochlorothiazide (HCTZ) 12.5 mg/day was added for the final 4 weeks, if target blood pressure was still not reached. Time from baseline to achieve blood pressure <130/85 mm Hg was shorter in the combination group (5.3±3.1 weeks combination vs. 6.4±3.8 weeks conventional; p=0.001). At 3 months, more participants in the combination group achieved treatment goal (63% combination vs. 37% conventional; p=0.002). Data analysis at 3 months comparing blood pressure control rates between the fixed-dose combination group (with out HCTZ) to the conventional group (receiving HCTZ) showed an even greater disparity in blood pressure goal achievement (87% combination without HCTZ vs. 37% conventional group with HCTZ; p=0.0001). We conclude that initial therapy with a fixed-dose combination may be more efficacious than conventional monotherapy approaches for achieving blood pressure goals in the diabetic patient. A fixed-dose combination approach appears as safe as the current conventional approaches. [source]

Reduction in Medication Costs for Patients with Chronic Nonmalignant Pain Completing a Pain Rehabilitation Program: A Prospective Analysis of Admission, Discharge, and 6-Month Follow-Up Medication Costs

PAIN MEDICINE, Issue 5 2009
Julie L. Cunningham PharmD
ABSTRACT Objective., Chronic nonmalignant pain (CNMP) is both a prevalent and a costly health problem in our society. Pain rehabilitation programs have been shown to provide cost-effective treatment. A treatment goal for some rehabilitation programs is reduction in the use of pain-related medication. Medication costs savings from pain rehabilitation programs have not been analyzed in previous studies. Design., This prospective cohort study of 186 patients with CNMP addresses the costs of medications at admission to a 3-week outpatient pain rehabilitation program, at discharge, and at 6-month follow-up. Medication use was determined through a detailed pharmacist interview with patients at admission and discharge. Patients were sent questionnaires 6 months after program completion, which obtained current medication information. Results., Statistically significant medication cost savings were seen for program completers at discharge and at 6-month follow-up (P < 0.05). The mean (standard deviation) daily prescription medication cost reduction from admission to discharge was $9.31 ($12.70) using the average wholesale price of medications. From the original study cohort, 121 patients completed the 6-month follow-up survey. The mean daily prescription medication cost savings from admission to 6-month follow-up was $6.68 ($14.40). Conclusion., Patients benefited from significant medication cost savings at the completion of the 3-week outpatient pain rehabilitation program and maintained significant savings after 6 months. This study adds to the current literature on the economic value of comprehensive pain rehabilitation programs. [source]

Malignant Tumors of the Maxilla: Virtual Planning and Real-Time Rehabilitation with Custom-Made R-zygoma Fixtures and Carbon,Graphite Fiber-Reinforced Polymer Prosthesis

Karl Ekstrand LDS
ABSTRACT Background: Oral cancer is a mutilating disease. Because of the expanding application of computer technology in medicine, new methods are constantly evolving. This project leads into a new technology in maxillofacial reconstructive therapy using a redesigned zygoma fixture. Purpose: Previous development experiences showed that the procedure was time-consuming and painful for the patients. Frequent episodes of sedation or general anesthetics were required and the rehabilitation is costly. The aim of our new treatment goal was to allow the patients to wake up after tumor surgery with a functional rehabilitation in place. Materials and Methods: Stereolithographic models were introduced to produce a model from the three-dimensional computed tomography (CT). A guide with the proposed resection was fabricated, and the real-time maxillectomy was performed. From the postoperative CT, a second stereolithographic model was manufactured and in addition, a stent for the optimal position of the implants. Customized zygoma implants were installed (R-zygoma, Integration AB, Göteborg, Sweden). A fixed construction was fabricated by using a new material based on poly(methylacrylate) reinforced with carbon/graphite fibers and attached to the implants. On the same master cast, a separate obturator was fabricated in permanent soft silicon. Results: The result of this project showed that it was possible to create a virtual plan preoperatively to apply during surgery in order for the patient to wake up functionally rehabilitated. Conclusion: From a quality-of-life perspective, it is an advantage to be rehabilitated fast. By using new computer technology, pain and discomfort are less and the total rehabilitation is faster, which in turn reduces days in hospital and thereby total costs. [source]

Scaling Up AIDS Treatment in Developing Countries: A Review of Current and Future Arguments

Jens Kovsted
Until recently, antiretroviral treatment against AIDS was perceived to be beyond the reach of the majority of patients in developing countries. This situation has changed drastically as international funding for AIDS treatment has swelled to several billion dollars a year. What has brought about this change? Analysis of the merit of six arguments often put forward against scaling up AIDS treatment in developing countries makes it clear that the most significant (and perhaps only) real change has been the large reduction in the price of the drugs. Although affordability is obviously a central issue, it is noticeable that most of the remaining arguments continue to be unresolved. This underlines the dangers of proceeding too fast towards treatment goals. [source]

Glycaemic status and cardiovascular disease in type 2 diabetes mellitus: re-visiting glycated haemoglobin targets for cardiovascular disease prevention

Sherita H. Golden
Cardiovascular disease (CVD) is the leading cause of death among people with type 2 diabetes. Recent attention has focused on chronic hyperglycaemia as an additional risk factor in people with diabetes since their excess CVD risk is not entirely explained by traditional cardiovascular risk factors. Clinical trials of intensive glucose control to reduce CVD events have been equivocal, but recent epidemiological studies have shown that HbAlc, a measure of chronic hyperglycaemia, predicts incident cardiovascular events. This review, which focuses on type 2 diabetes, summarizes (i) the epidemiological literature examining the relation between glycaemic status, as assessed by glycated haemoglobin (HbAlc) and CVD, (ii) the controversy regarding treatment goals for HbAlc in terms of preventing microvascular disease vs. macrovascular disease and (iii) on-going clinical trials of intensive glycaemic control for CVD prevention. [source]

Adding biphasic insulin aspart 30 once or twice daily is more efficacious than optimizing oral antidiabetic treatment in patients with type 2 diabetes

W. M. W. Bebakar
Aim:, To evaluate the efficacy and safety of adding biphasic insulin aspart 30 (BIAsp30; NovoMix® 30) to existing oral antidiabetic agents (OADs) vs. optimizing OADs in a subgroup of Western Pacific patients with type 2 diabetes inadequately controlled on oral monotherapy or oral combination therapy. Methods:, This 26-week, multi-centre, open-labelled, randomized, two-arm parallel trial consisted of a 2-week screening period, followed by 24 weeks of treatment. Subjects randomized to BIAsp30 treatment (n = 129) received BIAsp30 once daily (o.d.) at dinnertime between Week 2 and Week 14, and those not reaching treatment targets were switched to twice daily (b.i.d.) BIAsp30 at Week 14 (n = 50). Subjects randomized to the OAD-only arm (n = 63) continued with their previous OAD treatment and, in an attempt to reach treatment goals, the dose was optimized (but OAD unchanged) in accordance to local treatment practice and labelling. Results:, Significantly greater reductions in HbA1c over Weeks 0,13 with BIAsp30 (o.d.) vs. OAD-only treatment (1.16 vs. 0.58%; p < 0.001), and over Weeks 0,26, with BIAsp30 (o.d.) and BIAsp30 (b.i.d.) treatments vs. OAD-only treatment (1.24 vs. 1.34 vs. 0.67%; p < 0.01). Hypoglycaemic episodes were reported in 54% of the patients in BIAsp30 (o.d. and b.i.d. pooled) and 30% of the patients in OAD-only group. All episodes were minor or symptomatic, except for one in each treatment group, which was major. Conclusions:, Initiating BIAsp30 treatment is a safe and more effective way to improve glycaemic control in Western Pacific patients with type 2 diabetes inadequately controlled with oral monotherapy or oral combination therapy compared with optimizing oral combination therapy alone. In patients not reaching treatment target on BIAsp30 (o.d.), treatment with BIAsp30 (b.i.d.) should be considered. [source]

Insulin therapy in Europe

Werner A. Scherbaum
Abstract The prevalence of type 1 diabetes is rising in all European countries, particularly in Scandinavia and the UK. Insulin therapy in Europe is strongly influenced by the results of the Diabetes Control and Complications Trial (DCCT) and the United Kingdom Prospective Diabetes Study (UKPDS), both of which showed the importance of tight metabolic control in patients with diabetes. The importance of tight glycemic control is also emphasized in the Saint Vincent Declaration, which established 5-year goals for antidiabetic therapy in Europe. Insulin therapy in Europe has been significantly improved over the past 10,years, owing to a number of developments. These include increased use of intensive insulin therapy in patients with type 1 diabetes; the development of new insulin analogs, including insulin glargine for injection therapy and short-acting agents that are particularly suitable for use in pumpsand the establishment of comprehensive and standardized treatment goals and guidelines. Nevertheless, important obstacles must still be overcome to optimize therapy for patients with diabetes and reduce the long-term complications of this disease. These obstacles include low public awareness of diabetes and its symptoms, training of physicians as well as patients that is often insufficient to ensure adherence to professional guidelines for diabetes care, and limitations in communication among professional care providers. Copyright © 2002 John Wiley & Sons, Ltd. [source]

Group therapy for somatization disorders in primary care: maintenance of treatment goals of short cognitive-behavioural treatment one-and-a-half-year follow-up

J. Lidbeck
Objective:, The objective of this study was to evaluate the maintenance of treatment goals of a short cognitive-behavioural group treatment programme for the management of somatization disorders in primary care. Method:, In a previous controlled 6-month follow-up study, patients with somatization disorders (n=32) improved with respect to illness and somatic preoccupation, hypochondriasis, and medication usage. In the present report the same group of patients were also investigated one-and-a-half year after initial treatment. Results:, The long-term follow-up manifested maintained improvement with respect to hypochondriasis. There was additional reduction of anxiety and psychosocial preoccupation, whereas somatization and depression-anxiety scores improved progressively. Conclusion:, A short cognitive-behavioural group treatment of psychosomatic patients can be useful in primary care and may manifest maintained or progressive beneficial outcome. [source]

Evaluation of a holistic treatment and teaching programme for patients with Type 1 diabetes who failed to achieve their therapeutic goals under intensified insulin therapy

U. Bott
SUMMARY Aims To evaluate a treatment and teaching programme including psychosocial modules for patients with Type 1 diabetes mellitus on intensified insulin therapy who failed to achieve their treatment goals despite participation in standard programmes. Methods The 5-day inpatient programme comprises small groups of 4,6 patients, focusing on individual needs and problems. Beyond the teaching lessons (most topics are deliberately chosen by the patients), the programme provides intensive group discussions and offers individual counselling concerning motivational aspects, psychosocial problems and coping strategies. Of the first consecutive 83 participants, 76 were re-examined after 17.5 ± 5.5 months (range 9,31 months). Results At follow-up, HbA1c was not improved compared to baseline (8.0 ± 1.3% vs. 8.1 ± 1.5%). However, the incidence of severe hypoglycaemia per patient/year (glucose i.v., glucagon injection) was substantially decreased: 0.62 ± 1.5 episodes at baseline compared to 0.16 ± 0.9 at follow-up (P < 0.001). Twenty-six per cent of the patients at baseline, and 4% at re-examination had experienced at least one episode of severe hypoglycaemia during the preceding year (P < 0.001). Sick leave days per patient/year decreased from 17.0 ± 38.5,7.7 ± 13.6 days (P < 0.05). Patients improved their perceptions of self-efficacy, their relationship to doctors and felt less externally controlled (P < 0.001). The majority of patients perceived an improved competence regarding diet (80.6%) and adaptation of insulin dosage (82.4%), an improved knowledge (82.2%), and a renewed motivation for the treatment (84.5%). Treatment success was significantly associated with baseline HbA1c, stability of motivation, frequency of blood glucose self-monitoring, control beliefs and change in subsequent outpatient care. Conclusions The programme improved glycaemic control mainly as a result of a substantial reduction in the incidence of severe hypoglycaemia. Patients with persistent poor glycaemic control may benefit from structured follow-up care focusing on motivational aspects of self-management and psychosocial support. [source]

Concurrent validity of the Alcohol Use Disorders Identification Test (AUDIT) and AUDIT zones in defining levels of severity among out-patients with alcohol dependence in the COMBINE study

ADDICTION, Issue 12 2006
Dennis M. Donovan
ABSTRACT Aims To examine among alcohol-dependent out-patient clients the concurrent validity of the Alcohol Use Disorders Identification Test (AUDIT) total score and ,zones' suggested by the World Health Organization for defining levels of severity of alcohol use problems. Design Participants were classified into AUDIT zones (AUDIT total score = 8,15, 16,19, 20,40) and compared on measures of demographics, treatment goals, alcohol consumption, alcohol-related consequences, severity of dependence, physiological dependence, tolerance, withdrawal and biomarkers of alcohol use. Setting Eleven out-patient academic clinical research centers across the United States. Participants Alcohol dependent individuals (n = 1335) entering out-patient treatment in the Combined Pharmacotherapies and Behavioral Interventions (COMBINE) study. Measurements The AUDIT was administered as part of an initial screening. Baseline measures used for concurrent validation included the Structured Clinical Interview for Diagnostic and Statistical Manual, 4th edition (DSM-IV) Disorders, the Alcohol Dependence Scale, the Drinker Inventory of Consequences, the Obsessive-Compulsive Drinking Scale, the University of Rhode Island Change Assessment, the Thoughts about Abstinence Scale, the Form-90, %carbohydrate-deficient transferrin and gamma-glutamyl transferase. Findings Indicators of severity of dependence and alcohol-related problems increased linearly with total score and differed significantly across AUDIT zones. The highest zone, with scores of 20 and above, was markedly different with respect to severity from the other two zones and members of this group endorsed an abstinence goal more strongly. Conclusions The AUDIT total score is a brief measure that appears to provide an index of severity of dependence in a sample of alcohol-dependent individuals seeking out-patient treatment, extending its potential utility beyond its more traditional role as a screening instrument in general populations. [source]

Towards consensus in the long-term management of relapse prevention in schizophrenia

M. Taylor
Abstract Approach to developing guidance When developing guidance for the long-term management of schizophrenia, one approach is to adopt a proactive strategy that sets out clear treatment goals and strategies. This should involve a broad view being taken, embracing overall mental and physical well-being rather than simply the absence of illness. Although relapse prevention is an important goal of any long-term management strategy, there are other aspects that need to be considered, such as reintegration into society, regaining independence and quality of life. Current treatment To help achieve these goals, a range of interventions can be incorporated into long-term management strategies for schizophrenia, including pharmacological interventions, psychosocial therapies and alliance-building initiatives. The current UK National Institute for Clinical Excellence guidelines already recommend that continuous therapy should be practised using an atypical (second-generation) antipsychotic drug, whenever possible, in preference to older typical drugs. The launch of the first long-acting atypical antipsychotic is an interesting new advance that may benefit many patients with schizophrenia. Psychosocial interventions, particularly family-based therapies, as well as cognitive behavioural and compliance therapies, when used alongside antipsychotics, have been shown to reduce relapse rates dramatically and to assist in social reintegration. In addition, forging collaborative alliances with patients and their carers can help to demystify schizophrenia and empower patients to take responsibility for their illness. Consensus statement This article outlines a consensus reached by a panel of leading UK healthcare professionals working with schizophrenia brought together to discuss long-term management strategies. Copyright © 2005 John Wiley & Sons, Ltd. [source]

Primary care physician beliefs about insulin initiation in patients with type 2 diabetes

R. P. Hayes
Summary Background:, Insulin is the most effective drug available to achieve glycaemic goals in patients with type 2 diabetes. Yet, there is reluctance among physicians, specifically primary care physicians (PCPs) in the USA, to initiate insulin therapy in these patients. Aims:, To describe PCPs' attitudes about the initiation of insulin in patients with type 2 diabetes and identify areas in which there is a clear lack of consensus. Methods:, Primary care physicians practicing in the USA, seeing 10 or more patients with type 2 diabetes per week, and having > 3 years of clinical practice were surveyed via an internet site. The survey was developed through literature review, qualitative study and expert panel. Results:, Primary care physicians (n = 505, mean age = 46 years, 81% male, 62% with > 10 years practice; 52% internal medicine) showed greatest consensus on attitudes regarding risk/benefits of insulin therapy, positive experiences of patients on insulin and patient fears or concerns about initiating insulin. Clear lack of consensus was seen in attitudes about the metabolic effects of insulin, need for insulin therapy, adequacy of self-monitoring blood glucose, time needed for training and potential for hypoglycaemia in elderly patients. Conclusions:, The beliefs of some PCPs are inconsistent with their diabetes treatment goals (HbA1c , 7%). Continuing medical education programmes that focus on increasing primary care physician knowledge about the progression of diabetes, the physiological effects of insulin, and tools for successfully initiating insulin in patients with type 2 diabetes are needed. [source]

Impact of traumatic experiences and violent acts upon response to treatment of a sample of Colombian women with eating disorders

Maritza Rodríguez MD
Abstract Objective The current article compared the impact of exposure to sexual trauma and other types of physical threats against the patient or the patient's family on response to treatment, relapse, and dropout rates in 160 Colombian women between 12 and 49 years of age with eating disorders. Method A comparison was made to 70 cases with unsatisfactory response to treatment and 90 controls with a better response to treatment goals. Results Forty-five percent had a history of sexual abuse, other violent traumas, or both. Significant statistical differences were observed between both groups in exposure variables. The highest probability of poor outcome was observed in patients with sexual abuse and exposure to other violent acts (odds ratio [OR] = 6.37, 95% confidence interval [CI] = 2.1,19.07). The risk of dropout or relapse was, respectively, 10 and 3 times greater among those exposed. Discussion Violent social conditions should be noted as another form of trauma with potential impact on outcome in Colombian women with eating disorders. © 2005 by Wiley Periodicals, Inc. [source]

Systematic review of the effectiveness of integrated care pathways: what works, for whom, in which circumstances?

Davina Allen RGN BA(Hons) PhD
Abstract Aim, Integrated care pathways (ICP) are management technologies which formalise multidisciplinary team-working and enable professionals to examine their roles and responsibilities. ICPs are now being implemented across international healthcare arena, but evidence to support their use is equivocal. The aim of this study was to identify the circumstances in which ICPs are effective, for whom and in what contexts. Methods, A systematic review of high-quality randomised controlled trials published between 1980 and 2008 (March) evaluating ICP use in child and adult populations in the full range of healthcare settings. Results 1For relatively predictable trajectories of care ICPs can be effective in supporting proactive care management and ensuring that patients receive relevant clinical interventions and/or assessments in a timely manner. This can lead to improvements in service quality and service efficiency without adverse consequences for patients. 2ICPs are an effective mechanism for promoting adherence to guidelines or treatment protocols thereby reducing variation in practice. 3ICPs can be effective in improving documentation of treatment goals, documentation of communication with patients, carers and health professionals. 4ICPs can be effective in improving physician agreement about treatment options. 5ICPs can be effective in supporting decision-making when they incorporate a decision-aide. 6The evidence considered in this review indicates that ICPs may be particularly effective in changing professional behaviours in the desired direction, where there is scope for improvement or where roles are new. 7Even in contexts in which health professionals are already experienced with a particular pathway, ICP use brings additional beneficial effects in directing professional practice in the desired direction. 8ICPs may be less effective in bringing about service quality and efficiency gains in variable patient trajectories. 9ICPs may be less effective in bringing about quality improvements in circumstances in which services are already based on best evidence and multidisciplinary working is well established. 10Depending on their purpose, the benefits of ICPs may be greater for certain patient subgroups than others. 11We do not know whether the costs of ICP development and implementation are justified by any of their reported benefits. 12ICPs may need supporting mechanisms to underpin their implementation and ensure their adoption in practice, particularly in circumstances in which ICP use is a significant change in organisational culture. 13ICP documentation can introduce scope for new kinds of error. Conclusions, ICPs are most effective in contexts where patient care trajectories are predictable. Their value in settings in which recovery pathways are more variable is less clear. ICPs are most effective in bringing about behavioural changes where there are identified deficiencies in services; their value in contexts where inter-professional working is well established is less certain. None of the studies reviewed included an economic evaluation and thus it is not known whether their benefits justify the costs of their implementation. [source]

Secondary Hypertension: Obesity and the Metabolic Syndrome

Gregory M. Singer MD
The epidemic of obesity in the United States and around the world is intensifying in severity and scope and has been implicated as an underlying mechanism in systemic hypertension. Obese hypertensive individuals characteristically exhibit volume congestion, relative elevation in heart rate, and high cardiac output with concomitant activation of the renin-angiotensin-aldosterone system. When the metabolic syndrome is present, insulin resistance and hyperinsulinemia may contribute to hypertension through diverse mechanisms. Blood pressure can be lowered when weight control measures are successful, using, for example, caloric restriction, aerobic exercise, weight loss drugs, or bariatric surgery. A major clinical challenge resides in converting short-term weight reduction into a sustained benefit. Pharmacotherapy for the obese hypertensive patient may require multiple agents, with an optimal regimen consisting of inhibitors of the renin-angiotensin-aldosterone system, thiazide diuretics, ,-blockers, and calcium channel blockers if needed to attain contemporary blood pressure treatment goals. [source]

Beyond ethnic match: Effects of client,therapist cognitive match in problem perception, coping orientation, and therapy goals on treatment outcomes

Nolan Zane
This study examined the outcome effects of cognitive match between Asian and White outpatient clients and their therapists. Many clinicians believe that one hindrance to the treatment of ethnic minority clients is that therapists and clients may not share common assumptions and attitudes about therapy and about the problems that are presented in treatment. The study investigated client,therapist similarity in their perceptions of the presenting problem, coping orientation, and expectations about treatment goals. This study constituted a more rigorous test of the cognitive match hypotheses in that it was prospective in nature, used separate and independent sources for the cognitive predictors, employed multiple outcome measures, and focused on specific attitudes and perceptions that are quite salient and relevant to treatment. Cognitive match on treatment goals was predictive of session impact. Moreover, cognitive matches in avoidant coping orientation and in perceived distress associated with interpersonal problems were predictive of certain treatment outcomes. The findings may help explain why clients matched on ethnicity with their therapists tend to stay longer in treatment and do better in psychotherapy. © 2005 Wiley Periodicals, Inc. J Comm Psychol 33: 569,585, 2005. [source]

Emerging concepts in cardiovascular disease risk assessment: Where do women fit in?

Adjunct Instructor, CRNP Cardiovascular Nurse Practitioner, Deborah Gleeson MSN
Abstract Purpose: To highlight the current limitations in the assessment of cardiovascular disease (CVD) risk for women. This article will offer the reader information on the current process for assessing CVD risk in women, the pitfalls associated with this current strategy, and the role of novel risk factors. Data sources: Extensive review of the medical literature in the area of women's cardiovascular health. Conclusions: The assessment of CVD risk for women is currently an evolving science. Limitations in the ability of the Framingham score to accurately estimate risk in women from diverse populations are increasingly recognized. Vastly different treatment goals between the genders for similar levels of risk factors have led to a re-evaluation of this strategy in women. While the Framingham score is still useful for guiding cholesterol treatment goals, the current preventive guidelines for women emphasize assessing a woman's risk throughout her lifetime. The future development of tools for improved risk stratification that incorporate novel risk factors may in fact improve our ability to appropriately risk stratify women to evidence-based therapies. Implications for practice: Utilizing the Framingham Risk Assessment Tool and further CVD risk stratification using novel markers such as high sensitivity C-reactive protein, family history, and functional capacity may identify unique subsets of women at higher risk for CVD. Nurse practitioners can be instrumental in this assessment, education, and treatment of women at risk for CVD. [source]

Promoting Lifestyle Change in the Prevention and Management of Type 2 Diabetes

APRN, Robin Whittemore PhD
Purpose To present the theoretical background for lifestyle change interventions in the prevention and management of type 2 diabetes and to provide pragmatic strategies for advanced practice nurses (APNs) to incorporate such interventions into their practices. Data Sources Selected scientific literature and the Internet. Conclusions There is an epidemic of obesity and type 2 diabetes among adults in the United States. Preventing or managing these health conditions requires significant lifestyle changes by individuals. Implications for Practice APNs are in a key role to deliver lifestyle change interventions, particularly in the primary care setting. Strategies to assist APNs with lifestyle change counseling include (a) assessment, (b) mutual decision making, (c) referral to education programs, (d) individualized treatment goals, (e) strategies to assist with problem solving, (f) continuing support and encouragement, (g) relapse prevention, and (h) ongoing follow-up. [source]

Systematic review: steroid withdrawal in anti-TNF-treated patients with inflammatory bowel disease

E. Bultman
Aliment Pharmacol Ther 2010; 32: 313,323 Summary Background, The increasing awareness of increased risk for opportunistic infections when combining several immunosuppressant drugs led to new treatment goals for inflammatory bowel disease including limited use of steroids. Aim, To conduct a systematic review to establish figures for steroid withdrawal in anti-TNF treated inflammatory bowel disease-patients. Methods, Medline was searched using the search-terms Ulcerative Colitis (UC) [Mesh], Crohn Disease (CD) [Mesh], IBD [Mesh], crohn, colitis, IBD and steroid sparing, all combined with infliximab and adalimumab. We selected English-language publications that addressed the effect of anti-TNF on steroid withdrawal. Studies had to assess patients with luminal CD or UC. Numbers of patients who were able to withdraw steroids were calculated. Results, Six studies could be included; five reporting on infliximab and one on adalimumab. Studies were heterogeneously designed. Overall, in the adult population, up to 38% of the patients were able to withdraw corticosteroids during infliximab therapy. In the paediatric population, up to 75% of the patients were able to withdraw corticosteroids during infliximab therapy. Conclusions, Although a consensus on the definition of steroid-sparing is lacking, approximately two-thirds of the inflammatory bowel disease-patients are unable to withdraw corticosteroid treatment during anti-TNF therapy. [source]

Understanding Recreation and Sport as a Rehabilitative Tool Within Juvenile Justice Programs

ABSTRACT This article discusses relevant literature on the potential benefits of sport, recreation, and leisure, and how these benefits relate to rehabilitation of juveniles. Many professionals involved in juvenile rehabilitation believe sport and recreation are beneficial adjuncts to treatment programming; however, it can be difficult to structure sport and recreation in ways that directly correspond to treatment goals. The purpose of this article is to provide insights for professionals working with juveniles on how sport and recreation programming can be an effective means of helping to achieve rehabilitation goals. Attention is given to approaches, particularly the Teaching Games for Understanding model (Bunker & Thorpe, 1982), which can be used to effectively link recreation and sport to the rehabilitation process. [source]

Goal, intervention and outcome of occupational therapy in individuals with psychoses.

Content analysis through a chart review
Abstract The purpose of the study was to analyse the content of occupational therapy records documenting treatment for individuals with psychoses. A retrospective content analysis of occupational therapy records regarding treatment goals, interventions and outcome was undertaken using a coding scheme, the Template of Occupational Therapy (TOT). Twenty-five occupational therapists chosen at random contributed 64 occupational therapy records, generating 2992 statements. The patients' disorders and functional and activity limitations (n=1723) were comprehensively described. Ability to manage self-care and the home environment, and to engage in a daily occupation, emerged as the prominent treatment goals. The content of the occupational therapy interventions was characterized by descriptions of a wide range of activities, which were used as therapeutic resources. The occupational therapist had a client-centred approach, combining the use of the current activity with the use of herself/himself as a resource. A few statements in the records were interpreted as relating to outcomes of treatment for this patient group. Statements related to outcome were the patients' self-reports and how they were able to manage activities of daily living. This retrospective study was found to be a useful conceptual model for designing studies of evidence-based occupational therapy in mental health. Copyright © 2000 Whurr Publishers Ltd. [source]

Intensified Screening and Treatment of the Metabolic Syndrome for Cardiovascular Risk Reduction

Nathan D. Wong PhD
The metabolic syndrome (MetS), characterized by a clustering of risk factors associated with insulin resistance and abdominal obesity, is associated with an increased risk of coronary heart disease and cardiovascular disease mortality. Persons with MetS have a wide spectrum of coronary heart disease risk and appropriate evaluation of risk using global risk algorithms. Measurement of other risk markers and subclinical disease is potentially needed to best set treatment goals and accompanying treatment regimens. The presence of MetS risk factors should be considered in global risk assessment. Clinical management emphasizes addressing underlying risk factors predisposing to MetS-specifically overweight/obesity and physical inactivity. Further recommendations are given for clinical risk factors, including atherogenic dyslipidemia, elevated blood pressure, insulin resistance/hyperglycemia, prothrombotic state, and proinflammatory state. Clinicians are recommended to assess MetS in their routine practice and to intensify efforts to adequately treat accompanying lifestyle and clinical risk factors. [source]

The effect of enzyme replacement therapy on bone crisis and bone pain in patients with type 1 Gaucher disease

J Charrow
The effect of enzyme replacement therapy (ERT) on bone crisis and bone pain was investigated in patients with Gaucher disease (GD) type 1 followed over 4 years. Data from the International Collaborative Gaucher Group Gaucher Registry were used. Only patients with bone crisis and/or bone pain data for 1 year prior to ERT, and for each of 3 years after the start of ERT, were included. Bone crises were reported in 17% of patients during the year before starting ERT. The frequencies of bone crises decreased to 5%, <1% and 3% for 1, 2, and 3 years after initiation of treatment, respectively (p < 0.0001). Bone pain followed a similar pattern of response. Bone pain was reported in 49% of patients the year before treatment and decreased to 30% in the first year, 29% in the second year, and 30% in the third year of ERT (p < 0.0001). ERT is associated with a reduction in bone crisis and bone pain in patients with GD type 1 . This study shows that significant improvements in symptoms of skeletal disease are achievable clinical outcomes and treatment goals in GD type 1. [source]

Gas embolism: pathophysiology and treatment

Robert A. van Hulst
Summary Based on a literature search, an overview is presented of the pathophysiology of venous and arterial gas embolism in the experimental and clinical environment, as well as the relevance and aims of diagnostics and treatment of gas embolism. The review starts with a few historical observations and then addresses venous air embolism by discussing pulmonary vascular filtration, entrapment, and the clinical occurrence of venous air emboli. The section on arterial gas embolism deals with the main mechanisms involved, coronary and cerebral air embolism (CAE), and the effects of bubbles on the blood,brain barrier. The diagnosis of CAE uses various techniques including ultrasound, perioperative monitoring, computed tomography, brain magnetic resonance imaging and other modalities. The section on therapy starts by addressing the primary treatment goals and the roles of adequate oxygenation and ventilation. Then the rationale for hyperbaric oxygen as a therapy for CAE based on its physiological mode of action is discussed, as well as some aspects of adjuvant drug therapy. A few animal studies are presented, which emphasize the importance of the timing of therapy, and the outcome of patients with air embolism (including clinical patients, divers and submariners) is described. [source]

Therapy goals in inpatient psychotherapy: differences between diagnostic groups and psychotherapeutic orientations

Jörg Dirmaier
Many studies have suggested the importance of therapy goals for the treatment process, especially in a multi-professional treatment context such as inpatient psychotherapy. However, only very few studies have examined differences between various groups of patients with regard to their respective treatment goals. Using a previously developed system for the categorization of therapy goals based on computer-assisted, qualitative data analysis, we have extracted 7157 therapy goals from a sample of 1192 discharge reports of treatment periods from inpatient psychotherapy in Germany. To test the inter-rater reliability of the system, a sample of 400 randomly chosen goals was classified by two independent raters. Logistic regression analysis was used to test whether different goal areas prove to be of different predictive value with regard to the respective dependent variables (diagnostic groups, psychotherapeutic orientations). Inter-rater reliability ranged between 0.73 and 0.82. Results of using the logistic regression model indicate that the selection of certain goal categories predicts affiliation to specific diagnostic groups and psychotherapeutic orientations. The resulting odds ratios vary between 1.2 and 16. These findings can be used for a more individualized treatment planning and outcome measurement in inpatient psychotherapeutic treatment. However, there are also goal categories that do not differentiate and therefore need to be further investigated.,Copyright © 2006 John Wiley & Sons, Ltd. [source]