Treatment Location (treatment + location)

Distribution by Scientific Domains

Selected Abstracts

Computer-delivered interventions for alcohol and tobacco use: a meta-analysis

ADDICTION, Issue 8 2010
Sally Rooke
ABSTRACT Aims To quantify the overall effectiveness of computer-delivered interventions for alcohol and tobacco use. Methods Meta-analysis of 42 effect sizes from randomized controlled trials, based on the responses of 10 632 individuals. Results The weighted average effect size (d) was 0.20, P < 0.001. While lower effect sizes were associated with studies addressing tobacco use (d = 0.14) this may well reflect differences in the types of outcome measure used. Effect sizes did not vary significantly as a function of treatment location, inclusion of entertaining elements, provision of normative feedback, availability of a discussion feature, number of treatment sessions, emphasis on relapse prevention, level of therapist involvement or follow-up period. Conclusion Findings of the meta-analysis suggest that minimal contact computer-delivered treatments that can be accessed via the internet may represent a cost-effective means of treating uncomplicated substance use and related problems. [source]

Racial/Ethnic Disparities in Knowledge about Risks and Benefits of Breast Cancer Treatment: Does It Matter Where You Go?

Sarah T. Hawley
Objective. To evaluate the association between provider characteristics and treatment location and racial/ethnic minority patients' knowledge of breast cancer treatment risks and benefits. Data Sources/Data Collection. Survey responses and clinical data from breast cancer patients of Detroit and Los Angeles SEER registries were merged with surgeon survey responses (N=1,132 patients, 277 surgeons). Study Design. Cross-sectional survey. Multivariable regression was used to identify associations between patient, surgeon, and treatment setting factors and accurate knowledge of the survival benefit and recurrence risk related to mastectomy and breast conserving surgery with radiation. Principal Findings. Half (51 percent) of respondents had survival knowledge, while close to half (47.6 percent) were uncertain regarding recurrence knowledge. Minority patients and those with lower education were less likely to have adequate survival knowledge and more likely to be uncertain regarding recurrence risk than their counterparts (p<.001). Neither surgeon characteristics nor treatment location attenuated racial/ethnic knowledge disparities. Patient,physician communication was significantly (p<.001) associated with both types of knowledge, but did not influence racial/ethnic differences in knowledge. Conclusions. Interventions to improve patient understanding of the benefits and risks of breast cancer treatments are needed across surgeons and treatment setting, particularly for racial/ethnic minority women with breast cancer. [source]

Bridging the gap between evidence and practice in acute decompensated heart failure management

FACP, Franklin A. Michota Jr MD
Abstract Registry data indicate a gap between evidence-based guidelines and current management of patients with acute decompensated heart failure (ADHF). Bridging this gap is crucial given the frequency and cost of hospitalization for this disorder. Patients with ADHF require rapid assessment to determine appropriate treatment location and initial therapy. Patients with impending respiratory failure or cardiogenic shock should be managed in an intensive care setting, patients with congestion that is expected to require prolonged intravenous therapy should be admitted to the hospital, and patients with congestion that is likely to respond within 12,24 hours can be managed in an observation unit. Clinical status should guide selection of initial therapy. Initially, therapeutic response should be assessed every couple of hours. Once effective acute therapy has been established, it is important to implement strategies to improve long-term outcomes. These strategies include ensuring that care complies with established core performance measures, providing patient education in a manner suited to ensure comprehension and retention, and arranging for appropriate outpatient follow-up, ideally in a comprehensive heart failure disease management program. The purpose of this review is (1) to examine evidence-based guidelines for the treatment of ADHF, (2) to present a practical algorithm for patient assessment and treatment derived from these guidelines and personal experience, and (3) to discuss systems to enhance the ultimate transition of patient care from the inpatient to outpatient setting. Journal of Hospital Medicine 2008;3(Suppl 6):S7,S15. 2008 Society of Hospital Medicine. [source]

Self-monitoring of blood glucose; frequency, determinants and self-adjustment of treatment in an adult Swedish diabetic population

Utilisation, determinants of SMBG
Abstract Objective To analyse the utilisation of self-monitoring of blood glucose (SMBG) among adult diabetic subjects. Methods A cross-sectional study with a standardized interview, a physical examination, and an evaluation of medical records comprising all known diabetic subjects living in six defined primary health care districts in southern Sweden. Of 1861 identified subjects aged >25 years, 90.1% participated. Mean age was 660.4,yrs; 94% were diagnosed ,30,yrs, and 70.4% were not gainfully employed. Results SMBG was used by 36.3% of all subjects (20.5% regularly, 15.8% sporadically). In 51.8% of cases regularly performing SMBG the results were used for self-adjustment of treatment (SAT). In multiple logistic regression analysis SMBG was related to awareness of illness (OR [95% CI]; 2.64[1.59,4.40]), treatment with insulin (2.52 [1.92,3.29]), and inversely related to age (50,69,yrs; 0.70[0.50,0.99], >70,yrs; 0.40[0.28,0.59]). The strongest independent influence on SAT based on SMBG results was awareness of illness (3.42[1.74,6.74]), followed by duration >10,yrs (1.74[1.28,2.38]), and there was an inverse relation to a multiple disease pattern in terms of cardiocerebrovascular disease and age. Living conditions, social position, or treatment location were not evidently related to SMBG or SAT. Conclusions A large proportion of adult individuals does not use SMBG regularly. Regular SMBG performers do not use it for SAT, and thus the use is not optimized for achieving good glycaemic control and especially with regard to awareness of illness. Copyright 2001 John Wiley & Sons, Ltd. [source]