David-Ferdon, Corinne; Kaslow, Nadine J.
The evidence-base of psychosocial treatment outcome studies for depressed youth conducted since 1998 is examined. All studies for depressed children meet Nathan and Gorman's (2002) criteria for Type 2 studies whereas the adolescent protocols meet criteria for both Type 1 and Type 2 studies. Based on the Task Force on the Promotion and…
Huey, Stanley J., Jr.; Polo, Antonio J.
This article reviews research on evidence-based treatments (EBTs) for ethnic minority youth using criteria from Chambless et al. (1998), Chambless et al. (1996), and Chambless and Hollon (1998). Although no "well-established" treatments were identified, "probably efficacious" or "possibly efficacious" treatments were found for ethnic minority…
Huey, Stanley J.; Polo, Antonio J.
This article reviews research on evidence-based treatments (EBTs) for ethnic minority youth using criteria from Chambless et al. (1998), Chambless et al. (1996), and Chambless and Hollon (1998). Although no well-established treatments were identified, probably efficacious or possibly efficacious treatments were found for ethnic minority youth with anxiety-related problems, attention-deficit/hyperactivity disorder, depression, conduct problems, substance use problems, trauma-related syndromes, and other clinical problems. In addition, all studies met either Nathan and Gorman's (2002) Type 1 or Type 2 methodological criteria. A brief meta-analysis showed overall treatment effects of medium magnitude (d = .44). Effects were larger when EBTs were compared to no treatment (d = .58) or psychological placebos (d = .51) versus treatment as usual (d = .22). Youth ethnicity (African American, Latino, mixed/other minority), problem type, clinical severity, diagnostic status, and culture-responsive treatment status did not moderate treatment outcome. Most studies had low statistical power and poor representation of less acculturated youth. Few tests of cultural adaptation effects have been conducted in the literature and culturally validated outcome measures are mostly lacking. Recommendations for clinical practice and future research directions are provided. PMID:18444061
Freeman, Jennifer; Garcia, Abbe; Frank, Hannah; Benito, Kristen; Conelea, Christine; Walther, Michael; Edmunds, Julie
Objective Pediatric Obsessive Compulsive Disorder (OCD) is a chronic and impairing condition that often persists into adulthood. Barrett and colleagues (2008), in this journal, provided a detailed review of evidence based psychosocial treatments for youth with OCD. The current review provides an evidence base update of the pediatric OCD psychosocial treatment literature with particular attention to advances in the field as well as to the methodological challenges inherent in evaluating such findings. Method Psychosocial treatment studies conducted since the last review are described and evaluated according to methodological rigor and evidence-based classification using the JCCAP evidence based treatment (EBT) evaluation criteria (Southam-Gerow and Prinstein, this issue). Results Findings from this review clearly converge in support of CBT as an effective and appropriate first line treatment for youth with OCD (either alone or in combination with medication). Although no treatment for pediatric OCD has yet to be designated as “well established”, both individual and individual family based treatments have been shown to be “probably efficacious.” Conclusions Moderators and predictors of treatment outcome are discussed as are the areas where we have advanced the field and the areas where we have room to grow. The methodological and clinical challenges inherent in a review of the evidence base are reviewed. Finally, future research directions are outlined. PMID:23746138
Marsch, Lisa A; Dallery, Jesse
The clinical community has a growing array of psychosocial interventions with a strong evidence base available for the treatment of SUDs. Considerable opportunity exists for leveraging technology in the delivery of evidence-based interventions to promote widespread reach and impact of evidence-based care. Data from this line of research to date are promising, and underscore the potential public health impact of technology-based therapeutic tools. To fully realize the potential of technology-delivered interventions, several areas of inquiry remain important. First, scientifically sound strategies should be explored to ensure technology-based interventions are optimally designed to produce maximal behavior change. Second, efficient and effective methods should be identified to integrate technology-based interventions into systems of care in a manner that is most responsive to the needs of individual users. Third, payment, privacy, and regulatory systems should be refined and extended to go beyond electronic medical records and telehealth/distance care models, and support the deployment of technology-based systems to enhance the quality, efficiency and cost-effectiveness of care. Fourth, the mechanisms underlying behavior change derived from technology-based treatments should be explicated, including new mechanisms that may be tapped via novel, technology-based tools. Such work will be critical in isolating mechanisms that are useful in predicting treatment response, and in ensuring that key ingredients are present in technology-based interventions as they are made widely available.
Dorsey, Shannon; McLaughlin, Katie A; Kerns, Suzanne E U; Harrison, Julie P; Lambert, Hilary K; Briggs, Ernestine C; Cox, Julia Revillion; Amaya-Jackson, Lisa
Child and adolescent trauma exposure is prevalent, with trauma exposure-related symptoms, including posttraumatic stress, depressive, and anxiety symptoms often causing substantial impairment. This article updates the evidence base on psychosocial treatments for child and adolescent trauma exposure completed for this journal by Silverman et al. (2008). For this review, we focus on 37 studies conducted during the seven years since the last review. Treatments are grouped by overall treatment family (e.g., cognitive behavioral therapy), treatment modality (e.g., individual vs. group), and treatment participants (e.g., child only vs. child and parent). All studies were evaluated for methodological rigor according to Journal of Clinical Child & Adolescent Psychology evidence-based treatment evaluation criteria (Southam-Gerow & Prinstein, 2014), with cumulative designations for level of support for each treatment family. Individual CBT with parent involvement, individual CBT, and group CBT were deemed well-established; group CBT with parent involvement and eye movement desensitization and reprocessing (EMDR) were deemed probably efficacious; individual integrated therapy for complex trauma and group mind-body skills were deemed possibly efficacious; individual client-centered play therapy, individual mind-body skills, and individual psychoanalysis were deemed experimental; and group creative expressive + CBT was deemed questionable efficacy. Advances in the evidence base, with comparisons to the state of the science at the time of the Silverman et al. (2008) review, are discussed. Finally, we present dissemination and implementation challenges and areas for future research.
Glenn, Catherine R.; Franklin, Joseph C.; Nock, Matthew K.
Objective To review the current evidence base of psychosocial treatments for suicidal and nonsuicidal self-injurious thoughts and behaviors (SITBs) in youth. Method We reviewed major scientific databases (HealthSTAR, MEDLine, PsycInfo, PubMed) for relevant studies published prior to June 2013. Results The search identified 29 studies examining interventions for suicidal or nonsuicidal SITBs in children or adolescents. No interventions currently meet the JCCAP standards for Level 1: well-established treatments. Six treatment categories were classified as Level 2: probably efficacious or Level 3: possibly efficacious for reducing SITBs in youth. These treatments came from a variety of theoretical orientations, including cognitive-behavioral, family, interpersonal, and psychodynamic theories. Common elements across efficacious treatments included family skills training (e.g., family communication and problem-solving), parent education and training (e.g., monitoring and contingency management), and individual skills training (e.g., emotion regulation and problem-solving). Conclusions Several treatments have shown potential promise for reducing SITBs in children and adolescents. However, the probably/possibly efficacious treatments identified each have evidence from only a single randomized controlled trial. Future research should focus on: replicating studies of promising treatments; identifying active treatment ingredients; examining mediators and moderators of treatment effects; and developing brief interventions for high-risk periods (e.g., following hospital discharge). PMID:25256034
Evans, Steven W; Owens, Julie Sarno; Bunford, Nora
The purpose of this research was to update the Pelham and Fabiano ( 2008 ) review of evidence-based practices for children and adolescents with attention-deficit/hyperactivity disorder. We completed a systematic review of the literature published between 2007 and 2013 to establish levels of evidence for psychosocial treatments for these youth. Our review included the identification of relevant articles using criteria established by the Society of Clinical Child and Adolescent Psychology (see Southam-Gerow & Prinstein, in press ) using keyword searches and a review of tables of contents. We extend the conceptualization of treatment research by differentiating training interventions from behavior management and by reviewing the growing literature on training interventions. Consistent with the results of the previous review we conclude that behavioral parent training, behavioral classroom management, and behavioral peer interventions are well-established treatments. In addition, organization training met the criteria for a well-established treatment. Combined training programs met criteria for Level 2 (Probably Efficacious), neurofeedback training met criteria for Level 3 (Possibly Efficacious), and cognitive training met criteria for Level 4 (Experimental Treatments). The distinction between behavior management and training interventions provides a method for considering meaningful differences in the methods and possible mechanisms of action for treatments for these youth. Characteristics of treatments, participants, and measures, as well as the variability in methods for classifying levels of evidence for treatments, are reviewed in relation to their potential effect on outcomes and conclusions about treatments. Implications of these findings for future science and practice are discussed.
Barrett, Paula M.; Farrell, Lara; Pina, Armando A.; Peris, Tara S.; Piacentini, John
Child and adolescent obsessive-compulsive disorder (OCD) is a chronic and debilitating condition associated with a wide range of impairments. This article briefly discusses the phenomenology of OCD, the theory underlying current treatment approaches, and the extant psychosocial treatment literature for child and adolescent OCD relative to the…
Silverman, Wendy K.; Pina, Armando A.; Viswesvaran, Chockalingam
The article reviews psychosocial treatments for phobic and anxiety disorders in youth. Using criteria from Nathan and Gorman (2002), 32 studies are evaluated along a continuum of methodological rigor. In addition, the treatments evaluated in each of the 32 studies are classified according to Chambless et al.'s (1996) and Chambless and Hollon's…
Eating disorders are relatively common and serious disorders in adolescents. However, there are few controlled psychosocial intervention studies with this younger population. This review updates a previous Journal of Clinical Child and Adolescent Psychology review published in 2008. The recommendations in this review were developed after searching the literature including PubMed/Medline and employing the relevant medical subject headings. In addition, the bibliographies of book chapters and treatment guideline articles were reviewed; last, colleagues were asked for suggested additional source materials. Psychosocial treatments examined include family therapy, individual therapy, cognitive behavioral therapy, interpersonal psychotherapy, cognitive training, and dialectical behavior therapy. Using the most recent Journal of Clinical Child and Adolescent Psychology methodological review criteria, family treatment-behavior (FT-B) is the only well-established treatment for adolescents with anorexia nervosa. Family treatment-systemic and insight oriented individual psychotherapy are probably efficacious treatments for adolescents with anorexia nervosa. There are no well-established treatments for adolescents with bulimia nervosa, binge eating disorder, or avoidant restrictive food intake disorder. Possibly efficacious psychosocial treatments for adolescent bulimia nervosa include FT-B and supportive individual therapy. Internet-delivered cognitive behavioral therapy is a possibly efficacious treatment for binge eating disorder. Experimental treatments for adolescent eating disorders include enhanced cognitive behavioral therapy, dialectical behavioral therapy, cognitive training, and interpersonal psychotherapy. FT-B is the only well-established treatment for adolescent eating disorders. Additional research examining treatment for eating disorders in youth is warranted.
Keel, Pamela K.; Haedt, Alissa
Eating disorders represent a significant source of psychological impairment among adolescents. However, most controlled treatment studies have focused on adult populations. This review provides a synthesis of existing data concerning the efficacy of various psychosocial interventions for eating disorders in adolescent samples. Modes of therapy…
Fristad, Mary A.; MacPherson, Heather A.
Objective Pediatric bipolar spectrum disorders (BPSDs) are serious conditions associated with morbidity and mortality. Although most treatment research examined pharmacotherapy for pediatric BPSDs, growing literature suggests that psychosocial interventions are also important to: provide families with an understanding of symptoms, course, and treatment of BPSDs; teach youth and parents methods for coping with symptoms (e.g., problem-solving, communication, cognitive-behavioral skills); and prevent relapse. Method Thirteen psychosocial intervention trials for pediatric BPSDs were identified via a comprehensive literature search and evaluated according to the Task Force on the Promotion and Dissemination of Psychological Procedures guidelines. All interventions were examined adjunctive to pharmacotherapy and/or treatment as usual (TAU). Results No well-established or questionably efficacious treatments were identified. Family psychoeducation plus skill building was probably efficacious (i.e., Multi-Family Psychoeducational Psychotherapy, Family-Focused Treatment); cognitive-behavioral therapy (CBT) was possibly efficacious. Dialectical behavior therapy (DBT) and interpersonal and social rhythm therapy (IPSRT) were experimental. Limited research precluded subdivision of treatments by format and age. Only single- and multiple-family psychoeducation plus skill building and CBT were evaluated with children. Only single-family psychoeducation plus skill building and DBT, and individual (commonly with limited familial involvement) CBT and IPSRT were evaluated with adolescents. Conclusions Psychosocial interventions that involve families, psychoeducation, and skill building may offer added benefit to pharmacotherapy and/or other TAU. Limitations of current research include few outcome studies, small samples, and failure to use stringent control conditions or randomization. The review concludes with a discussion of mediators and moderators, recommendations for best practice
Garland, Ann F.; Hawley, Kristin M.; Brookman-Frazee, Lauren; Hurlburt, Michael S.
The article reviews a new method to identify common core elements of evidence-based practice (EBP) for children with disruptive behavior problems and their parents. This will not only help in characterizing practice, but also will enhance the skills and attitudes of therapists and be useful in implementing EBP in community-based service settings.
Pelham, William E., Jr.; Fabiano, Gregory A.
Pelham, Wheeler, and Chronis (1998) reviewed the treatment literature on attention-deficit/hyperactivity disorder (ADHD) and concluded behavioral parent training (BPT) and behavioral classroom management (BCM) were well-established treatments for children with ADHD. This review updates and extends the finding of the prior review. Studies conducted…
Pelham, William E; Fabiano, Gregory A
Pelham, Wheeler, and Chronis (1998) reviewed the treatment literature on attention-deficit/hyperactivity disorder (ADHD) and concluded behavioral parent training (BPT) and behavioral classroom management (BCM) were well-established treatments for children with ADHD. This review updates and extends the finding of the prior review. Studies conducted since the 1998 review were identified and coded based on standard criteria, and effect sizes were calculated where appropriate. The review reinforces the conclusions of Pelham, Wheeler, and Chronis regarding BPT and BCM. Further, the review shows that intensive peer-focused behavioral interventions implemented in recreational settings (e.g., summer programs) are also well-established. The results of this update are discussed in the context of the existing treatment literature on ADHD. Implications for practice guidelines are suggested, as are directions for future research.
Lecomte, Tania; Corbière, Marc; Simard, Stéphanie; Leclerc, Claude
Psychosocial interventions are an essential part of the treatment for people with severe mental illness such as schizophrenia. The criteria regarding what makes an intervention “evidence-based” along with a current list of evidence-based interventions are presented. Although many evidence-based interventions exist, implementation studies reveal that few, if any, are ever implemented in a given setting. Various theories and approaches have been developed to better understand and overcome implementation obstacles. Among these, merging two evidence-based interventions, or offering an evidence-based intervention within an evidence-based service, are increasingly being reported and studied in the literature. Five such merges are presented, along with their empirical support: cognitive behavior therapy (CBT) with skills training; CBT and family psychoeducation; supported employment (SE) and skills training; SE and cognitive remediation; and SE and CBT. PMID:25431447
Rosen, A; O'Halloran, P
While mental health recovery is a very personal process, the approach also offers possibilities as a meta-framework for improving quality of services to support people with severe and enduring mental illness. This paper explores how a recovery paradigm offers opportunities to better understand how efforts within the personal, clinical, and psychosocial disability domains of well-being relate and need bridging and integration with an evidence-based framework of practice to optimise outcomes. Recovery from a severe and persisting mental illness such as schizophrenia is optimised by a holistic approach integrating the domains of clinical treatment and psychosocial rehabilitation with the personal efforts of individuals. For service providers, a monolithic or single paradigm approach with an exclusive or predominant biological, psychological, social, or cultural focus is unable to offer effective guidance on the treatment and rehabilitation support needed to enable community participation and ameliorate the impact which problems associated with mental illness have on individuals, their families, and their wider communities. Moreover, recovery-oriented services need to be effective, embracing evidence-based policy, practice and service delivery by providing treatment and support which actually work to improve outcomes for consumers and families.
Higa, Janelle; Trentacosta, Christopher J.; Herschell, Amy D.; Kolko, David J.
We review 85 empirical articles published since 2000 that measured the acquisition and/or utilization of parent management skills and/or child cognitive-behavioral skills in the context of an evidence-based treatment (EBT) for childhood behavior problems. Results showed that: (1) there are no standardized measures of skill acquisition or skill utilization that are used across treatments, (2) little is known about predictors, correlates, or outcomes associated with skill acquisition and utilization, and (3) few studies systematically examined techniques to enhance the acquisition and utilization of specific skills. Meta-analytic results from a subset of 68 articles (59 studies) showed an overall treatment–control ES =.31, p < .01 for skill acquisition and ES =.20, p = ns for skill utilization. We recommend that future research focus on the following three areas: (1) development of standardized measures of skill acquisition and utilization from a “common elements” perspective that can used across EBTs; (2) assessment of the predictors, correlates, and outcomes associated with skill acquisition and utilization; and (3) development of innovative interventions to enhance the acquisition and utilization of cognitive-behavioral and parent management skills. PMID:23649324
American Journal on Mental Retardation, 2000
The third in seven sets of guidelines based on the consensus of experts in the treatment of psychiatric and behavioral problems in mental retardation (MR) focuses on psychosocial treatment. Guidelines cover general principles, choosing among psychosocial treatments, severity of MR and psychiatric/behavior symptoms, diagnosable disorders, target…
Thill, Azure Welborn; Bachanas, Pamela; Garber, Judy; Miller, Karen Bearman; Abad, Mona; Bruno, Elizabeth Franks; Carter, Jocelyn Smith; David-Ferdon, Corinne; Jandasek, Barbara; Mennuti-Washburn, Jean E.; O’Mahar, Kerry; Zukerman, Jill
Objective To provide an evidence-based review of measures of psychosocial adjustment and psychopathology, with a specific focus on their use in the field of pediatric psychology. Methods As part of a larger survey of pediatric psychologists from the Society of Pediatric Psychology e-mail listserv (American Psychological Association, APA, Division 54), 37 measures were selected for this psychometric review. Measures that qualified for the review fell into one of the following three categories: (a) internalizing or externalizing rating scales, (b) broad-band rating scales, and (c) self-related rating scales. Results Psychometric characteristics (i.e., three types of reliability, two types of validity) were strong for the majority of measures reviewed, with 34 of the 37 measures meeting “well-established” evidence-based assessment (EBA) criteria. Strengths and weaknesses of existing measures were noted. Conclusions Recommendations for future work in this area of assessment are presented, including suggestions that more fine-grained EBA criteria be developed and that evidence-based “profiles” be devised for each measure. PMID:17728305
Prins, David; Ingham, Roger J.
Purpose: To illustrate the way in which both fluency shaping (FS) and stuttering management (SM) treatments for developmental stuttering in adults are evidence based. Method: A brief review of the history and development of FS and SM is provided. It illustrates that both can be justified as evidence-based treatments, each treatment seeking…
Scott, Jan; Colom, Francesc
Psychosocial problems may be causes or consequences of BP relapses,and adding psychologic therapies to usual-treatment approaches may improve the prognosis of those at risk of persistent symptoms or frequent episodes. The three core individual manualized therapies (IPSRT, cognitive therapy, and FFT) have all developed specific models for use in BP. Colom et al's group psychoeducation model also has a clearly developed rationale and format, and it allows individuals to share their views of BP with others, to learn adaptive coping strategies from the other 8 to 12 members of the group, and to have regular contact with an expert therapist. Careful review of the four more extended and comprehensive approaches and the brief technique-driven interventions demonstrates that the effective therapies incorporate one or more of the modules show in Box 1. At present,the choice between the four extended models is more likely to be dictated by patient choice or the availability of a trained therapist. The technique-driven interventions are briefer than the specific therapies (about 6-9 sessions compared with about 20-22 sessions) and usually offer a generic, fixed treatment package targeted at a circumscribed issue such as medication adherence or managing early symptoms of relapse. These brief interventions can be delivered by a less-skilled or less-experienced professional than the specific model. They potentially seem to be useful in day-to-day clinical practice in general adult psychiatry settings; additional larger-scale, randomized trials should be encouraged. Given the reduction in relapse rates and hospitalizations associated with the use of psychologic therapy as an adjunct to medication, it is likely that these approaches will prove to be clinically and cost effective. They may provide a significant improvement in the quality of life of individuals with BP (and indirectly to that of their partners and family members). Brief,evidence-based therapies represent an
Recent reviews of evidence-based treatment for depression did not identify behavioral activation as an evidence-based practice. Therefore, this article conducted a systematic review of behavioral activation treatment of depression, which identified three meta-analyses, one recent randomized controlled trial and one recent follow-up of an earlier…
Powell, Byron J; Hausmann-Stabile, Carolina; McMillen, J Curtis
Implementation research has tremendous potential to bridge the research-practice gap; however, we know more about barriers to evidence-based care than the factors that contribute to the adoption and sustainability of evidence-based treatments. In this qualitative study the authors explore the experiences of clinicians (N = 11) who were implementing evidence-based treatments, highlighting the factors that they perceived to be most critical to successful implementation. The clinicians' narratives reveal many leverage points that can inform administrators, clinical supervisors, and clinicians who wish to implement evidence-based treatments, as well as other stakeholders who wish to develop and test strategies for moving evidence-based treatments into routine care.
Nusrat, Salman; Khan, Muhammad S; Fazili, Javid; Madhoun, Mohammad F
Cirrhosis results from progressive fibrosis and is the final outcome of all chronic liver disease. It is among the ten leading causes of death in United States. Cirrhosis can result in portal hypertension and/or hepatic dysfunction. Both of these either alone or in combination can lead to many complications, including ascites, varices, hepatic encephalopathy, hepatocellular carcinoma, hepatopulmonary syndrome, and coagulation disorders. Cirrhosis and its complications not only impair quality of life but also decrease survival. Managing patients with cirrhosis can be a challenge and requires an organized and systematic approach. Increasing physicians' knowledge about prevention and treatment of these potential complications is important to improve patient outcomes. A literature search of the published data was performed to provide a comprehensive review regarding the management of cirrhosis and its complications.
Nusrat, Salman; Khan, Muhammad S; Fazili, Javid; Madhoun, Mohammad F
Cirrhosis results from progressive fibrosis and is the final outcome of all chronic liver disease. It is among the ten leading causes of death in United States. Cirrhosis can result in portal hypertension and/or hepatic dysfunction. Both of these either alone or in combination can lead to many complications, including ascites, varices, hepatic encephalopathy, hepatocellular carcinoma, hepatopulmonary syndrome, and coagulation disorders. Cirrhosis and its complications not only impair quality of life but also decrease survival. Managing patients with cirrhosis can be a challenge and requires an organized and systematic approach. Increasing physicians’ knowledge about prevention and treatment of these potential complications is important to improve patient outcomes. A literature search of the published data was performed to provide a comprehensive review regarding the management of cirrhosis and its complications. PMID:24833875
Gooriah, Rubesh; Buture, Alina; Ahmed, Fayyaz
Cluster headache (CH), one of the most painful syndromes known to man, is managed with acute and preventive medications. The brief duration and severity of the attacks command the use of rapid-acting pain relievers. Inhalation of oxygen and subcutaneous sumatriptan are the two most effective acute therapeutic options for sufferers of CH. Several preventive medications are available, the most effective of which is verapamil. However, most of these agents are not backed by strong clinical evidence. In some patients, these options can be ineffective, especially in those who develop chronic CH. Surgical procedures for the chronic refractory form of the disorder should then be contemplated, the most promising of which is hypothalamic deep brain stimulation. We hereby review the pathogenesis of CH and the evidence behind the treatment options for this debilitating condition. PMID:26635477
Chorpita, Bruce F.; Bernstein, Adam; Daleiden, Eric L.
Objective: Despite substantial progress in the development and identification of psychosocial evidence-based treatments (EBTs) in mental health, there is minimal empirical guidance for selecting an optimal "set" of EBTs maximally applicable and generalizable to a chosen service sample. Relevance mapping is a proposed methodology that…
Schaffner, Angela D.; Buchanan, Linda Paulk
This study examined the current issues relevant to implementing evidence-based practices in the context of outpatient treatment for eating disorders. The study also examined the effectiveness of an outpatient treatment program for eating disorders among a group of 196 patients presenting with anorexia nervosa, bulimia nervosa, or eating disorder…
Keller, Robert G; Patel, Krishna G
Over the past decade, the treatment of infantile hemangiomas has undergone dramatic breakthroughs. This review critically evaluates the latest literature that supports the myriad treatment options for infantile hemangiomas. It chronicles the fading role of steroid therapy and evolution of propranolol use as the major treatment modality. Although propranolol is helping this disease become more of a medical disease and less of a surgical dilemma, the report also reveals a continued search to find nonsystemic treatment options. In summary, this is an evidence-based medicine review for the treatment of infantile hemangiomas.
Cooper, Zafra; Bailey-Straebler, Suzanne
The research-practice gap is of concern in the treatment of eating disorders. Despite the existence of empirically supported treatments, few receive them. The barriers to wider dissemination and implementation of evidence-based treatment include clinician attitudes towards such treatments and the lack of sufficient numbers of suitably trained therapists to provide treatment. In this review we discuss these barriers in the context of the wider issue of the dissemination and implementation of psychological treatments and review the research with regard to the treatment of eating disorders. Particular emphasis is placed on examining recent efforts to expand the availability and reach of treatments by making treatment delivery and training more scalable. We highlight promising developments and areas where further research is needed.
Guerrero, Erick G; He, Amy; Kim, Ahraemi; Aarons, Gregory A
We evaluated organizational factors associated with the implementation of contingency management treatment (CMT) and medication-assisted treatment (MAT) in substance abuse treatment (SAT) programs serving racial and ethnic minority communities. Analysis of cross-sectional data collected in 2010-2011 from a random sample of 148 publicly funded SAT programs showed that accepting private insurance was positively associated with CMT and MAT implementation, whereas larger programs were associated with greater implementation of MAT. Supervisorial openness to and expectations about implementing evidence-based practices (EBPs) and attributes for change were strongly associated with CMT, whereas the interactions between openness to EBPs and programs that accept private insurance and that are governed by parent organizations were positively associated with MAT. These external expectations and managerial attitudes supported the implementation of psychosocial and pharmacotherapy treatments in SAT. Implications for improving standards of care in minority communities are discussed.
van den Brink, Wim
This review summarizes our current knowledge of the pharmacological treatment of substance use disorders and pathological gambling using data mainly from randomized controlled trials and meta-analyses regarding these randomized controlled trials. The review is restricted to the selection of first and second line pharmacological treatments for smoking, alcohol dependence, opioid dependence, cocaine dependence, cannabis dependence and pathological gambling. It is concluded that great progress has been made in the last three decades and that currently evidence-based pharmacological treatments are available for smoking cessation, alcohol and opioid dependence and pathological gambling. At the same time a series of existing and new pharmacological compounds are being tested in cocaine and cannabis dependence. The review concludes with a summary of additional strategies to increase the effect size of already available pharmacological interventions, including polypharmacy, combining pharmacotherapy with psychotherapy and psychosocial support, and improved patient-treatment matching.
Tilsen, Julie; McNamee, Sheila
This article explores the challenges presented by the mandate for evidence-based practice for family therapists who identify with the philosophical stance of social construction. The history of psychotherapy outcome research is reviewed, as are current findings that provide empirical evidence for an engaged, dialogic practice. The authors suggest that the binary between empiricism and social construction may be unhinged by understanding empiricism as a particular discursive frame (i.e., a particular way of talking, acting, and being in the world), one of many available as a way of understanding and talking about our work. Through a case vignette, the authors introduce the evidence-based practice of Feedback Informed Treatment as an elaboration of social construction, and as an example of bridging the gap between the discursive frames of empiricism and social construction.
Werdin, Frank; Tennenhaus, Mayer; Schaller, Hans-Eberhardt; Rennekampff, Hans-Oliver
The care and management of patients with chronic wounds and their far-reaching effects challenge both the patient and the practitioner. Further complicating this situation is the paucity of evidence-based treatment strategies for chronic wound care. After searching both MEDLINE and Cochrane databases, we reviewed currently available articles concerning chronic wound care. Utilizing this information, we have outlined a review of current, evidence-based concepts as they pertain to the treatment of chronic wounds, focusing on fundamental treatment principles for the management of venous, arterial, diabetic, and pressure ulcers. Individualized treatment options as well as general wound management principles applicable to all varieties of chronic wounds are described. Classification and treatment guidelines as well as the adoption of the TIME acronym facilitate an organized conceptional approach to wound care. In so doing, individual aspects of generalized wound care such as debridement, infection, and moisture control as well as attention to the qualities of the wound edge are comprehensively evaluated, communicated, and addressed. Effective adjuvant agents for the therapy of chronic wounds including nutritional and social support measures are listed, as is a brief review of strategies helpful for preventing recurrence. An appreciation of evidence-based treatment pathways and an understanding of the pathophysiology of chronic wounds are important elements in the management of patients with chronic wounds. To achieve effective and long-lasting results, a multidisciplinary approach to patient care, focused on the education and coordination of patient, family as well as medical and support staff can prove invaluable. PMID:19578487
Schoenwald, Sonja K.
This article describes the journey toward evidence-based transport and implementation in usual care settings of Multisystemic Therapy (MST) for youth with drug abuse and behavioral problems (Henggeler, Schoenwald, Borduin, Rowland, & Cunningham, 1998). Research and experience informing the design of the MST transport strategy, progress in…
Bril, V.; England, J.; Franklin, G.M.; Backonja, M.; Cohen, J.; Del Toro, D.; Feldman, E.; Iverson, D.J.; Perkins, B.; Russell, J.W.; Zochodne, D.
Objective: To develop a scientifically sound and clinically relevant evidence-based guideline for the treatment of painful diabetic neuropathy (PDN). Methods: We performed a systematic review of the literature from 1960 to August 2008 and classified the studies according to the American Academy of Neurology classification of evidence scheme for a therapeutic article, and recommendations were linked to the strength of the evidence. The basic question asked was: “What is the efficacy of a given treatment (pharmacologic: anticonvulsants, antidepressants, opioids, others; and nonpharmacologic: electrical stimulation, magnetic field treatment, low-intensity laser treatment, Reiki massage, others) to reduce pain and improve physical function and quality of life (QOL) in patients with PDN?” Results and Recommendations: Pregabalin is established as effective and should be offered for relief of PDN (Level A). Venlafaxine, duloxetine, amitriptyline, gabapentin, valproate, opioids (morphine sulfate, tramadol, and oxycodone controlled-release), and capsaicin are probably effective and should be considered for treatment of PDN (Level B). Other treatments have less robust evidence or the evidence is negative. Effective treatments for PDN are available, but many have side effects that limit their usefulness, and few studies have sufficient information on treatment effects on function and QOL. PMID:21482920
Kurtz, Matthew M.
Impairment in functional status is a hallmark of schizophrenia that has been linked to deficits in aspects of neurocognition (e.g., attention, memory, and problem-solving). A growing number of evidence-based behavioral interventions have been developed to address impairment in functional status, yet the relationships between these interventions and neurocognitive impairment are not well-understood. We conducted a synthetic, critical literature review of studies of performance on neurocognitive tests as a predictor of response to evidence-based behavioral treatment in schizophrenia. Behavioral treatments were selected based on the Patient Outcomes Research Team (PORT; Dixon et al., 2010) recommendations for practice and areas of emerging interest. Comprehensive searches of PsychINFO and MEDLINE/PUBMED databases identified 20 relevant studies. Results revealed that: (1) attention and memory measured at study entry were most frequently linked to proximal measures of progress in social skill training programs, (2) composite measures of neurocognitive function, as well attention, memory and problem-solving, were linked to progress in work therapy and supported employment programs, and comprehensive, integrated programs of psychosocial rehabilitation, while (3) baseline impairment on neurocogntive tests was not shown to limit progress in treatment studies of cognitive-behavioral therapy. The relevance of these findings for clinical practice and future research is discussed. PMID:21482324
Wu, Monica S; Hamblin, Rebecca J; Storch, Eric A
With many youth presenting to primary care settings for mental health difficulties, knowledge of the respective evidence-based psychotherapies is imperative in ensuring that these youth receive the appropriate interventions in a timely manner. Most frequently, children present with internalizing and/or externalizing disorders, which cover a broad range of common pediatric mental disorders. Treatments of these disorders generally incorporate cognitive and/or behavioral components, which are derived from theoretical underpinnings and empirical support. Although the interventions share common components, they are distinctive in nature and are further tailored toward the idiosyncratic needs of children and their families. Careful consideration of the apposite intervention and individual needs of youth are pertinent to the effective amelioration of symptomology.
Breitbart, William; Alici, Yesne
Delirium is the most common neuropsychiatric complication seen in patients with cancer, and it is associated with significant morbidity and mortality. Increased health care costs, prolonged hospital stays, and long-term cognitive decline are other well-recognized adverse outcomes of delirium. Improved recognition of delirium and early treatment are important in diminishing such morbidity. There has been an increasing number of studies published in the literature over the last 10 years regarding delirium treatment as well as prevention. Antipsychotics, cholinesterase inhibitors, and alpha-2 agonists are the three groups of medications that have been studied in randomized controlled trials in different patient populations. In patients with cancer, the evidence is most clearly supportive of short-term, low-dose use of antipsychotics for controlling the symptoms of delirium, with close monitoring for possible adverse effects, especially in older patients with multiple medical comorbidities. Nonpharmacologic interventions also appear to have a beneficial role in the treatment of patients with cancer who have or are at risk for delirium. This article presents evidence-based recommendations based on the results of pharmacologic and nonpharmacologic studies of the treatment and prevention of delirium. PMID:22412123
Bride, Brian E.; Kintzle, Sara; Abraham, Amanda J.; Roman, Paul M.
The purpose of this study was to examine factors that may be associated with variation in social workers' perceptions of effectiveness, perceptions of acceptability, and use of psychosocial evidence-based practices (EBPs) for the treatment of substance use disorders (SUD) in comparison to other SUD counselors who are non-social workers. A national…
Plakun, Eric M
Psychotherapy and psychosocial treatment have been shown to be effective forms of treatment of a range of individual and complex comorbid disorders. The future role of psychotherapy and psychosocial treatment depends on several factors, including full implementation of mental health parity, correction of underlying false assumptions that shape treatment, payment priorities and research, identification and teaching of common factors or elements shared by effective psychosocial therapies, and adequate teaching of psychotherapy and psychosocial treatment.
Novins, Douglas K.; Croy, Calvin D.; Moore, Laurie A.; Rieckmann, Traci
Background Research and health surveillance activities continue to document the substantial disparities in the impacts of substance abuse on the health of American Indian and Alaska Native (AI/AN) people. While Evidence-Based Treatments (EBTs) hold substantial promise for improving treatment for AI/ANs with substance use problems (as they do for non-AI/ANs), anecdotal reports suggest that their use is limited. In this study, we examine the awareness of, attitudes towards, and use of EBTs in substance abuse treatment programs serving AI/AN communities. Methods Data are drawn from the first national survey of tribal substance abuse treatment programs. Clinicians or clinical administrators from 192 programs completed the survey. Participants were queried about their awareness of, attitudes towards, and use of 9 psychosocial and 3 medication EBTs. Results Cognitive Behavioral Therapy (82.2%), Motivational Interviewing (68.6%), and Relapse Prevention Therapy (66.8%) were the most commonly implemented psychosocial EBTs; medications for psychiatric comorbidity was the most commonly implemented medication treatment (43.2%). Greater EBT knowledge and use were associated with both program (e.g., funding) and staff (e.g., educational attainment) characteristics. Only two of the commonly implemented psychosocial EBTs (Motivational Interviewing and Relapse Prevention Therapy) were endorsed as culturally appropriate by a majority of programs that had implemented them (55.9% and 58.1%, respectively). Conclusions EBT knowledge and use is higher in substance abuse treatment programs serving AI/AN communities than has been previously estimated. However, many users of these EBTs continue to have concerns about their cultural appropriateness, which likely limits their further dissemination. PMID:26898185
Chronic pain in children and adolescents is associated with major disruption to developmental experiences crucial to personal adjustment, quality of life, academic, vocational and social success. Caring for these patients involves understanding cognitive, affective, social and family dynamic factors associated with persistent pain syndromes. Evaluation and treatment necessitate a comprehensive multimodal approach including psychological and behavioral interventions that maximize return to more developmentally appropriate physical, academic and social activities. This article will provide an overview of major psychosocial factors impacting on pediatric pain and disability, propose an explanatory model for conceptualizing the development and maintenance of pain and functional disability in medically difficult-to-explain pain syndromes, and review representative evidence-based cognitive behavioral and systemic treatment approaches for improving functioning in this pediatric population. PMID:22676345
Lucak, Susan; Chang, Lin; Halpert, Albena; Harris, Lucinda A.
Irritable bowel syndrome with diarrhea (IBS-D) is a common, chronic functional gastrointestinal disorder with symptoms that can be distressing for patients and often result in substantially impaired quality of life. This review focuses on providing clinicians with information on practical, evidence-based treatment for IBS-D. Current therapies commonly used for the treatment of IBS-D, including pharmacologic and nonpharmacologic interventions, are briefly reviewed, followed by discussion of the emergent pharmacologic treatments (rifaximin and eluxadoline) and medical foods (IBgard® and EnteraGam®). Given the lack of a standard treatment algorithm for IBS-D and the emergence of new pharmacologic therapies, treatment needs to be tailored to the individual patient and take into account the severity of disease. In this context, the latter part of this manuscript examines how treatments for IBS-D can be used in clinical practice by presenting three patient case scenarios with varying degrees of IBS-D severity. For each case, the patient’s medical history and clinical presentation are related to the Rome Foundation multidimensional clinical profile (MDCP) and potential treatment options with current and emergent therapies are reviewed. The interplay of gastrointestinal symptoms and their psychosocial impact, as well as the importance of a patient-centered approach to therapy, are discussed. Consideration is given to the potential need for combination therapies and how emergent treatments could fit into the treatment pathway for mild, moderate, and severe cases of IBS-D in clinical practice. PMID:28203283
Müller, Hendrik; Laier, Sonja; Bechdolf, Andreas
The aim of psychotherapy among individuals at clinical high risk (CHR) for psychosis is to prevent transition to full-blown psychosis. Psychotherapy in individuals with a first-episode psychosis (FEP) aims to reduce relapse rates. Remission of (pre-) psychotic symptoms, psychosocial functioning, quality of life, comorbid disorders and self-esteem are also important outcomes in individuals at CHR and with FEP. Antipsychotics, Qmega-3-Fatty acids and psychotherapy have been found to be effective in CHR for most of these aims. Thereby psychotherapy presents a better benefit/risk ratio than antipsychotic medication. The most evidence-based intervention is cognitive-behavioral therapy (CBT). Psychotherapy is mostly offered to FEP patients within specialized early intervention services (including assertiveness community treatment and antipsychotic medication). Thereby, CBT is effective for positive symptoms and family intervention is particularly effective for the prevention of relapses. We introduce the principles of CBT for psychosis and suggest adaptions for individuals at CHR and FEP. We conclude that the needs of young people at CHR and with FEP are best met by specially designed, low threshold outpatient clinical services, which include intensive psychotherapy treatment. A number of countries have implemented early detection and intervention services based on this model, while the implementation within in Germany is still marginal.
Lass, Norman J.; Pannbacker, Mary
Purpose: The purpose of this article is to help speech-language pathologists (SLPs) apply the principles of evidence-based practice (EBP) to nonspeech oral motor treatments (NSOMTs) in order to make valid, evidence-based decisions about NSOMTs and thus determine if they are viable treatment approaches for the management of communication disorders.…
Donohue, Brad; Allen, Daniel N.; Romero, Valerie; Hill, Heather H.; Vasaeli, Kathryn; Lapota, Holly; Tracy, Kendra; Gorney, Suzanne; Abdel-al, Ruweida; Caldas, Diana; Herdzik, Karen; Bradshaw, Kelsey; Valdez, Robby; Van Hasselt, Vincent B.
Developers of evidence-based therapies are enhancing methods of teaching therapists to implement “best practices” with integrity. However, there is a relative dearth of information available as to clinic operations and related contextual factors necessary to sustain successful implementation of these treatments. This article describes various evidence-based administrative strategies and methods utilized by clinic staff to effectively implement a comprehensive evidence-based treatment for substance abuse (i.e., Family Behavior Therapy). The basic structure of the clinic, standardized behavioral methods associated with its day-to-day operations, and maintenance of treatment integrity are delineated. Infrastructural systems are underscored, including clinical record keeping, quality assurance, and staff management. PMID:19535671
Southam-Gerow, Michael A; Prinstein, Mitchell J
This article introduces a new feature in the journal: Evidence Base Updates. Starting with this issue of the journal, there will be one such update in each issue. The updates will focus on reviewing the treatments studies focused on a specific child/adolescent problem area and identifying those treatments with the strongest evidence base. Updates will use a revised set of criteria for evaluating the evidence, based on past work, but modified to emphasize methodological rigor of studies and designed to identify those treatments with questionable efficacy. The article also places the evaluation of psychological treatments in historical context. As well, the changes made in the criteria are discussed.
DiMeo, Michelle A.; Moore, G. Kurt; Lichtenstein, Carolyn
Evidence-based treatments (EBTs) are "interventions" that have been proven effective through rigorous research methodologies. Evidence-based practice (EBP), however, refers to a "decision-making process" that integrates the best available research, clinician expertise, and client characteristics. This study examined community mental health service…
Ashcraft, Rindee G. P.; Foster, Sharon L.; Lowery, Amy E.; Henggeler, Scott W.; Chapman, Jason E.; Rowland, Melisa D.
A better understanding of clinicians' attitudes toward evidence-based treatments (EBT) will presumably enhance the transfer of EBTs for substance-abusing adolescents from research to clinical application. The reliability and validity of two measures of therapist attitudes toward EBT were examined: the Evidence-Based Practice Attitude Scale…
Barham, Rasha; El Rami, Hala; Sun, Jennifer K; Silva, Paolo S
Diabetes mellitus is a chronic disease that affects 415 million people worldwide. Despite treatment advances, diabetic eye disease remains a leading cause of vision loss worldwide. Diabetic macular edema (DME) is a common cause of vision loss in diabetic patients. The pathophysiology is complex and involves multiple pathways that ultimately lead to central retinal thickening and, if untreated, visual loss. First-line treatment of DME has evolved from focal/grid laser established by the Early Treatment of Diabetic Retinopathy Study (ETDRS) to intravitreous pharmacologic therapy. Landmark prospective clinical trials examining the effect of intravitreous injections of vascular endothelial growth factor (VEGF) inhibitors in the treatment of DME have demonstrated improved visual outcomes over focal grid laser. This review focuses on the scientific evidence treatment of DME, disease pathophysiology, clinical disease course, current treatment standards, and emerging novel therapeutic approaches.
Go, C.Y.; Mackay, M.T.; Weiss, S.K.; Stephens, D.; Adams-Webber, T.; Ashwal, S.; Snead, O.C.
Objective: To update the 2004 American Academy of Neurology/Child Neurology Society practice parameter on treatment of infantile spasms in children. Methods: MEDLINE and EMBASE were searched from 2002 to 2011 and searches of reference lists of retrieved articles were performed. Sixty-eight articles were selected for detailed review; 26 were included in the analysis. Recommendations were based on a 4-tiered classification scheme combining pre-2002 evidence and more recent evidence. Results: There is insufficient evidence to determine whether other forms of corticosteroids are as effective as adrenocorticotropic hormone (ACTH) for short-term treatment of infantile spasms. However, low-dose ACTH is probably as effective as high-dose ACTH. ACTH is more effective than vigabatrin (VGB) for short-term treatment of children with infantile spasms (excluding those with tuberous sclerosis complex). There is insufficient evidence to show that other agents and combination therapy are effective for short-term treatment of infantile spasms. Short lag time to treatment leads to better long-term developmental outcome. Successful short-term treatment of cryptogenic infantile spasms with ACTH or prednisolone leads to better long-term developmental outcome than treatment with VGB. Recommendations: Low-dose ACTH should be considered for treatment of infantile spasms. ACTH or VGB may be useful for short-term treatment of infantile spasms, with ACTH considered preferentially over VGB. Hormonal therapy (ACTH or prednisolone) may be considered for use in preference to VGB in infants with cryptogenic infantile spasms, to possibly improve developmental outcome. A shorter lag time to treatment of infantile spasms with either hormonal therapy or VGB possibly improves long-term developmental outcomes. PMID:22689735
Donohue, Brad; Allen, Daniel N.; Romero, Valerie; Hill, Heather H.; Vasaeli, Kathryn; Lapota, Holly; Tracy, Kendra; Gorney, Suzanne; Abdel-al, Ruweida; Caldas, Diana; Herdzik, Karen; Bradshaw, Kelsey; Valdez, Robby; Van Hasselt, Vincent B.
Developers of evidence-based therapies are enhancing methods of teaching therapists to implement "best practices" with integrity. However, there is a relative dearth of information available as to clinic operations and related contextual factors necessary to sustain successful implementation of these treatments. This article describes various…
Larsen, Maja; Nordentoft, Merete
A systematic review of the literature shows that it is possible to reduce homelessness among mentally ill homeless persons, partly by offering access to housing and partly by providing intensive care through Assertive Community Treatment. Assertive Community Treatment can, to some extent, decrease psychiatric symptoms and increase quality of life. It is evident that by offering housing, homelessness may be reduced, but the comparison of independent housing and group living did not reveal big differences.
Nock, Matthew K.; Goldman, Jennifer L.; Wang, Yanping; Albano, Anne Marie
Psychosocial treatment options are nearly as broad as the behavioral problems that they address. With literally hundreds of treatment approaches available, how should clinicians select the most appropriate and effective intervention? One way is to consider using only those treatments with evidence of therapeutic efficacy. Indeed, funding agencies…
Frank, Madeleine; Cavanna, Andrea Eugenio
Tourette syndrome (TS) is a disorder characterised by multiple motor and vocal tics and is frequently associated with behavioural problems. Tics are known to be affected by internal factors such as inner tension and external factors such as the surrounding environment. A number of behavioural treatments have been suggested to treat the symptoms of TS, in addition to pharmacotherapy and surgery for the most severe cases. This review compiled all the studies investigating behavioural therapies for TS, briefly describing each technique and assessing the evidence in order to determine which of these appear to be effective. Different behavioural therapies that were used included habit reversal training (HRT), massed negative practice, supportive psychotherapy, exposure with response prevention, self-monitoring, cognitive-behavioural therapy, relaxation therapy, assertiveness training, contingency management, a tension-reduction technique and biofeedback training. Overall, HRT is the best-studied and most widely-used technique and there is sufficient experimental evidence to suggest that it is an effective treatment. Most of the other treatments, however, require further investigation to evaluate their efficacy. Specifically, evidence suggests that exposure with response prevention and self-monitoring are effective, and more research is needed to determine the therapeutic value of the other treatments. As most of the studies investigating behavioural treatments for TS are small-sample or single-case studies, larger randomised controlled trials are advocated.
Frank, Madeleine; Cavanna, Andrea Eugenio
Tourette syndrome (TS) is a disorder characterised by multiple motor and vocal tics and is frequently associated with behavioural problems. Tics are known to be affected by internal factors such as inner tension and external factors such as the surrounding environment. A number of behavioural treatments have been suggested to treat the symptoms of TS, in addition to pharmacotherapy and surgery for the most severe cases. This review compiled all the studies investigating behavioural therapies for TS, briefly describing each technique and assessing the evidence in order to determine which of these appear to be effective. Different behavioural therapies that were used included habit reversal training (HRT), massed negative practice, supportive psychotherapy, exposure with response prevention, self-monitoring, cognitive-behavioural therapy, relaxation therapy, assertiveness training, contingency management, a tension-reduction technique and biofeedback training. Overall, HRT is the best-studied and most widely-used technique and there is sufficient experimental evidence to suggest that it is an effective treatment. Most of the other treatments, however, require further investigation to evaluate their efficacy. Specifically, evidence suggests that exposure with response prevention and self-monitoring are effective, and more research is needed to determine the therapeutic value of the other treatments. As most of the studies investigating behavioural treatments for TS are small-sample or single-case studies, larger randomised controlled trials are advocated. PMID:23187152
Gooriah, Rubesh; Nimeri, Randa; Ahmed, Fayyaz
Migraine, a significantly disabling condition, is treated with acute and preventive medications. However, some individuals are refractory to standard treatments. Although there is a host of alternative management options available, these are not always backed by strong evidence. In fact, most of the drugs used in migraine were initially designed for other purposes. Whilst effective, the benefits from these medications are modest, reflecting the need for newer and migraine-specific therapeutic agents. In recent years, we have witnessed the emergence of novel treatments, of which noninvasive neuromodulation appears to be the most attractive given its ease of use and excellent tolerability profile. This paper reviews the evidence behind the available treatments for migraine. PMID:26839703
Rogers, Sally J.; Vismara, Laurie A.
Early intervention for children with autism is currently a politically and scientifically complex topic. Randomized controlled trials have demonstrated positive effects in both short-term and longer term studies. The evidence suggests that early intervention programs are indeed beneficial for children with autism, often improving developmental functioning and decreasing maladaptive behaviors and symptom severity at the level of group analysis. Whether such changes lead to significant improvements in terms of greater independence and vocational and social functioning in adulthood is also unknown. Given the few randomized controlled treatment trials that have been carried out, the few models that have been tested, and the large differences in interventions that are being published, it is clear that the field is still very early in the process of determining (a) what kinds of interventions are most efficacious in early autism, (b) what variables moderate and mediate treatment gains and improved outcomes following intervention, and (c) the degree of both short-term and long-term improvements that can reasonably be expected. To examine these current research needs, the empirical studies of comprehensive treatments for young children with autism published since 1998 were reviewed. Lovaas's treatment meet Chambless and colleague's (Chambless et al., 1998; Chambless et al., 1996) criteria for “well-established” and no treatment meets the “probably efficacious” criteria, though three treatments meet criteria for “possibly efficacious” (Chambless & Hollon, 1998). Most studies were either Type 2 or 3 in terms of their methodological rigor based on Nathan and Gorman's (2002) criteria. Implications of these findings are also discussed in relation to practice guidelines as well as critical areas of research that have yet to be answered PMID:18444052
OBJECTIVE: To evaluate the strength of evidence for treatments for premenstrual syndrome (PMS) and to derive a set of practical guidelines for managing PMS in family practice. QUALITY OF EVIDENCE: An advanced MEDLINE search was conducted from January 1990 to December 2001. The Cochrane Library and personal contacts were also used. Quality of evidence in studies ranged from level I to level III, depending on the intervention. MAIN MESSAGE: Good scientific evidence shows that calcium carbonate (1200 mg/d) and selective serotonin reuptake inhibitors are effective treatments for PMS. The most commonly used therapies (including vitamin B6, evening primrose oil, and oral contraceptives) are based on inconclusive evidence. Other treatments for which there is inconclusive evidence include aerobic exercise, stress reduction, cognitive therapy, spironolactone, magnesium, nonsteroidal anti-inflammatory drugs, various hormonal regimens, and a complex carbohydrate-rich diet. Although evidence for them is inconclusive, it is reasonable to recommend healthy lifestyle changes given their overall health benefits. Progesterone and bromocriptine, which are still widely used, are ineffective. CONCLUSION: Calcium carbonate should be recommended as first-line therapy for women with mild-to-moderate PMS. Selective serotonin reuptake inhibitors can be considered as first-line therapy for women with severe affective symptoms and for women with milder symptoms who have failed to respond to other therapies. Other therapies may be tried if these measures fail to provide adequate relief. PMID:12489244
Although epilepsy has a prevalence of 5 to 7 per 1000 persons in the United States, it continues to be a poorly understood condition. Given the number of patients in the United States with epilepsy, it is very likely that primary care physicians will continue to provide care for these patients. This article refreshes some of the knowledge around the diagnosis of epilepsy, discusses special populations that may require additional management considerations, highlights the association of epilepsy with multiple comorbidities, and discusses antiepileptic drug (AED) treatment, including issues surrounding adherence and safety of AED therapy.
Hypertension is the most common cardiovascular condition in adults. It is also very common in athletes. When lifestyle changes fail, medications may be needed for the treatment of hypertension. When choosing a drug for antihypertensive therapy, providers should choose an agent that has favorable effects on blood pressure and minimal detrimental hemodynamic change during exercise. Evidence supports that the medications with the most favorable effects are angiotensin-converting enzyme inhibitors, calcium channel blockers, alpha-blockers, and cardiac-selective beta-blockers. The effects of diuretics are less desirable, and nonselective beta-blockers should be a last choice for hypertensive patients who are physically active.
Fabiano, Gregory A; Pelham, William E
In the past decade, increased emphasis has been placed on identifying treatments for childhood disorders that are supported by empirical evidence of their effectiveness. This process was spearheaded by an American Psychological Association division 12 task force that identified evidence-based treatments--mostly for disorders of adulthood. Because of the publication of the task force results, other studies have been published that contribute to the knowledge base of evidence-based treatment, and these studies are briefly reviewed. Across evidence-based treatments, common features of effective treatments, such as parent involvement, use of a treatment manual, and the emphasis on generalization of treatment effects to natural settings, are also identified and reviewed.Introduction
Deshazer, Garron; Dupuy, Damian E.; Walsh, Edward; Prakash, Punit; Fairchild, Dillon; Glidden, David; Collins, Scott A.; Cook, Madeleine L.; Ryan, Thomas P.; Merck, Derek
The clinical utility of current thermal ablation planning tools is severely limited by treatment variability. We discuss the development of an open platform for evidence-based thermal ablation treatment planning and validation. Improved predictive treatment modeling and consistent outcome analysis are crucial components for useful planning and guidance tools.
Faraone, Stephen V; Antshel, Kevin M
We have created an evidence-based guide for clinicians to the relative utility of nonpharmacologic treatments for attention-deficit/hyperactivity disorder (ADHD). This article uses the term evidence-based in the sense applied by the Oxford Center for Evidenced-Based Medicine to help readers understand the degree to which nonpharmacologic treatments are supported by the scientific literature. This article also reviews the magnitude of the treatment effect expressed as the standardized mean difference effect size (also known as Cohen D). It then describes a meta-algorithm to describe how to integrate pharmacologic and nonpharmacologic treatments for ADHD.
Longo, David J.; And Others
Assigned 21 individuals with recurrent genital herpes to psychosocial intervention, social support, or waiting-list control conditions. Those receiving psychosocial intervention (herpes simplex virus information, relaxation training, stress management instructions, and an imagery technique) reported significantly greater reductions in herpes…
Gilliland, Kevin Clark
Cervical cancer is a diagnosis that has a profound psychosocial impact, constituting a physical and emotional crisis for patients as well as family. In general, research indicates that the choice of treatment and the stage of the disease are instrumental in determining the psychosocial adjustment. Disruptions are likely to occur in self-esteem,…
Southam-Gerow, Michael A.; Hourigan, Shannon E.; Allin, Robert B.
This paper describes the application of a university-community partnership model to the problem of adapting evidence-based treatment approaches in a community mental health setting. Background on partnership research is presented, with consideration of methodological and practical issues related to this kind of research. Then, a rationale for using partnerships as a basis for conducting mental health treatment research is presented. Finally, an ongoing partnership research project concerned with the adaptation of evidence-based mental health treatments for childhood internalizing problems in community settings is presented, with preliminary results of the ongoing effort discussed. PMID:18697917
Tetracycline is known as an effective agent in the treatment of recurrent aphthous stomatitis. A less-known treatment option for this pathology is minocycline. Many articles have been published in the International Journal of Pharmaceutical Compounding about recurrent aphthous stomatitis, however, this is the first article published in the journal that concentrates on the evidence-based data of minocycline as a promising agent to treat this pathology in what some scientific reports indicate to be a more efficacious manner than tetracycline. Few options to compound topical preparations based on minocycline and other evidence-based agents are proposed in the treatment of recurrent aphthous stomatitis.
Meyer, Isuzu; Richter, Holly E.
Synopsis Fecal incontinence is a highly prevalent and distressing condition which negatively impacts quality of life. The etiology is often multifactorial, and the evaluation and treatment of this condition can be hindered by a lack of understanding of the mechanisms and currently available treatment options. This article will review the evidence-based update for the management of fecal incontinence. PMID:26880511
Kazdin, Alan E.; Whitley, Moira K.
Comorbidity and complexity of cases seen in clinical work form a basis for discounting the applicability and generality of evidence-based treatments (EBTs). The authors evaluated treatment outcomes in 2 samples of clinically referred children who met criteria for oppositional defiant disorder (n = 183; 42 girls, 141 boys; ages 3-14) or conduct…
Haug, Nancy A.; Shopshire, Michael; Tajima, Barbara; Gruber, Valerie; Guydish, Joseph
This research was conducted at a Substance Abuse Forum designed to address local community needs by focusing on Evidence-Based Practices (EBPs) in addiction treatment. The purpose of the study was to assess substance abuse treatment professionals' readiness to adopt EBPs, experience with EBPs, and attitudes toward EBPs, as well as agency support…
Penadés, Rafael; Catalán, Rosa; Pujol, Núria; Masana, Guillem; García-Rizo, Clemente; Bernardo, Miquel
Cognitive remediation therapies seem to ameliorate cognitive impairments in patients with schizophrenia. Interestingly, some improvement in daily functioning can also be expected as a result. However, to achieve these results it is necessary that cognitive remediation is carried out in the context of broader psychosocial rehabilitation involving the learning of other communication, social, and self-control skills. Unfortunately, little is known about how to integrate these different rehabilitation tools in broader rehabilitation programs. Based on both the neurocognitive behavioral approach and the action theory framework, a hierarchical flowchart is represented in this paper to integrate CRT with other evidence-based psychological therapies in outpatient settings. Finally, some evidence is provided in which cognitive abilities need to be targeted in remediation programs to improve functioning. In summary, to improve daily functioning, according to these studies, cognitive remediation needs to include the teaching of some cognitive strategies that target executive skills. PMID:22966461
Penadés, Rafael; Catalán, Rosa; Pujol, Núria; Masana, Guillem; García-Rizo, Clemente; Bernardo, Miquel
Cognitive remediation therapies seem to ameliorate cognitive impairments in patients with schizophrenia. Interestingly, some improvement in daily functioning can also be expected as a result. However, to achieve these results it is necessary that cognitive remediation is carried out in the context of broader psychosocial rehabilitation involving the learning of other communication, social, and self-control skills. Unfortunately, little is known about how to integrate these different rehabilitation tools in broader rehabilitation programs. Based on both the neurocognitive behavioral approach and the action theory framework, a hierarchical flowchart is represented in this paper to integrate CRT with other evidence-based psychological therapies in outpatient settings. Finally, some evidence is provided in which cognitive abilities need to be targeted in remediation programs to improve functioning. In summary, to improve daily functioning, according to these studies, cognitive remediation needs to include the teaching of some cognitive strategies that target executive skills.
Lancaster, Cynthia L.; Teeters, Jenni B.; Gros, Daniel F.; Back, Sudie E.
Posttraumatic stress disorder (PTSD) is a chronic psychological disorder that can develop after exposure to a traumatic event. This review summarizes the literature on the epidemiology, assessment, and treatment of PTSD. We provide a review of the characteristics of PTSD along with associated risk factors, and describe brief, evidence-based measures that can be used to screen for PTSD and monitor symptom changes over time. In regard to treatment, we highlight commonly used, evidence-based psychotherapies and pharmacotherapies for PTSD. Among psychotherapeutic approaches, evidence-based approaches include cognitive-behavioral therapies (e.g., Prolonged Exposure and Cognitive Processing Therapy) and Eye Movement Desensitization and Reprocessing. A wide variety of pharmacotherapies have received some level of research support for PTSD symptom alleviation, although selective serotonin reuptake inhibitors have the largest evidence base to date. However, relapse may occur after the discontinuation of pharmacotherapy, whereas PTSD symptoms typically remain stable or continue to improve after completion of evidence-based psychotherapy. After reviewing treatment recommendations, we conclude by describing critical areas for future research. PMID:27879650
Higa-McMillan, Charmaine K; Francis, Sarah E; Rith-Najarian, Leslie; Chorpita, Bruce F
Anxiety disorders are the most common mental health disorder among children and adolescents. We examined 111 treatment outcome studies testing 204 treatment conditions for child and adolescent anxiety published between 1967 and mid-2013. Studies were selected for inclusion in this review using the PracticeWise Evidence-Based Services database. Using guidelines identified by this journal (Southam-Gerow & Prinstein, 2014), studies were included if they were conducted with children and/or adolescents (ages 1-19) with anxiety and/or avoidance problems. In addition to reviewing the strength of the evidence, the review also examined indicators of effectiveness, common practices across treatment families, and mediators and moderators of treatment outcome. Six treatments reached well-established status for child and adolescent anxiety, 8 were identified as probably efficacious, 2 were identified as possibly efficacious, 6 treatments were deemed experimental, and 8 treatments of questionable efficacy emerged. Findings from this review suggest substantial support for cognitive-behavioral therapy (CBT) as an effective and appropriate first-line treatment for youth with anxiety disorders. Several other treatment approaches emerged as probably efficacious that are not primarily CBT based, suggesting that there are alternative evidence-based treatments that practitioners can turn to for children and adolescents who do not respond well to CBT. The review concludes with a discussion of treatments that improve functioning in addition to reducing symptoms, common practices derived from evidence-based treatments, mediators and moderators of treatment outcomes, recommendations for best practice, and suggestions for future research.
Haug, Nancy A; Duffy, Megan; McCaul, Mary E
Women who use tobacco, alcohol and drugs during pregnancy are at increased risk of maternal and fetal morbidity. Universal screening using empirically validated approaches can improve identification of substance-using pregnant women and facilitate comprehensive assessment of treatment needs. There is strong evidence for effectiveness of psychosocial and behavioral substance abuse treatments across a range of intensities and levels of care. In addition to addressing substance use, services for co-occurring psychiatric disorders, trauma exposure, and prenatal care are important components of coordinated systems of care. More research on and greater access to evidence-based interventions is needed for this underserved population.
Kivimäki, Mika; Singh-Manoux, Archana; Virtanen, Marianna; Ferrie, Jane E; Batty, G David; Rugulies, Reiner
Established in 2008 and comprising over 60 researchers, the IPD-Work (individual-participant data meta-analysis in working populations) consortium is a collaborative research project that uses pre-defined meta-analyses of individual-participant data from multiple cohort studies representing a range of countries. The aim of the consortium is to estimate reliably the associations of work-related psychosocial factors with chronic diseases, disability, and mortality. Our findings are highly cited by the occupational health, epidemiology, and clinical medicine research community. However, some of the IPD-Work's findings have also generated disagreement as they challenge the importance of job strain as a major target for coronary heart disease (CHD) prevention, this is reflected in the critical discussion paper by Choi et al (1). In this invited reply to Choi et al, we aim to (i) describe how IPD-Work seeks to advance research on associations between work-related psychosocial risk factors and health; (ii) demonstrate as unfounded Choi et al's assertion that IPD-Work has underestimated associations between job strain and health endpoints; these include the dichotomous measurement of job strain, potential underestimation of the population attributable risk (PAR) of job strain for CHD, and policy implications arising from the findings of the IPD-Work consortium; and (iii) outline general principles for designing evidence-based policy and prevention from good-quality evidence, including future directions for research on psychosocial factors at work and health. In addition, we highlight some problems with Choi et al's approach.
Yon, Adriana; Scogin, Forrest
The authors describe the methods used to identify evidence-based psychological treatments for older adults in this contribution to the special section. Coding teams were assembled to review the literature on several problems relevant to mental health and aging. These teams used the manual developed by the Committee on Science and Practice of the Society for Clinical Psychology (Division 12) of the American Psychological Association that provided definitions of key constructs used in coding. The authors provide an overview of the process followed by the review teams and of some of the issues that emerged to illustrate the steps involved in the coding procedure. Identifying evidence-based treatments is a fundamental aspect of promoting evidence-based practice with older adults; such practice is advocated by most health care disciplines, including psychology.
Southam-Gerow, Michael A.; Hourigan, Shannon E.; Allin, Robert B., Jr.
This article describes the application of a university-community partnership model to the problem of adapting evidence-based treatment approaches in a community mental health setting. Background on partnership research is presented, with consideration of methodological and practical issues related to this kind of research. Then, a rationale for…
Ogden, Terje; Hagen, Kristine Amlund; Askeland, Elisabeth; Christensen, Bernadette
This article sums up 8 years of experience with evidence-based programs in the treatment of conduct problems in children and youth. A conceptual model describing the implementation components relevant to the Norwegian project is presented and discussed. Next, we describe a case study of the implementation strategy accompanied by outcomes from the…
Metzger, Robert L
Low back pain remains one of the most common patient complaints. It can exist alone or with the presence of lower extremity symptoms. Review of evidence-based guidelines will assist primary care providers in the identification and treatment of various lumbar disorders in addition to ruling out specific lumbar spinal pathologies.
Brent, David A.; Maalouf, Fadi T.
Although there have been advances in our ability to treat child and adolescent depression, use of evidence-based treatments still results in many patients with residual symptoms. Advances in our understanding of cognitive, emotional, and ecological aspects of early-onset depression have the potential to lead to improvements in the assessment and…
Keen, Jenny; Oliver, Philip
Aims: To provide a brief review of relevant existing evidence regarding pharmacological treatment for drug users, in order to enable commissioners and service providers to make informed decisions that are evidence based wherever possible. Methods: The review process involved an examination of key reference texts and literature derived from…
Sheidow, Ashli J.; Jayawardhana, Jayani; Bradford, W. David; Henggeler, Scott W.; Shapiro, Steven B.
The 12-month cost-effectiveness of juvenile drug court and evidence-based treatments within court were compared with traditional Family Court for 128 substance-abusing/dependent juvenile offenders participating in a 4-condition randomized trial. Intervention conditions included Family Court with community services (FC), Drug Court with community…
Becker, Sara J.; Spirito, Anthony; Vanmali, Roshani
Objective: Several national organisations in the USA have recently developed educational materials that encourage substance use disorder treatment consumers to seek out approaches supported by scientific evidence in order to promote the use of "evidence-based practice" (EBP). This study aimed to explore how adolescents (young people aged…
Lacroix, Sheila I.
Introduces concepts, such as evidence-based medicine and best practices, explores these concepts in terms of addiction treatment, discusses practice guidelines, offers suggestions to find and select science-based resources, and explores the librarian's or information specialist's role in the dissemination of this information. (LRW)
Chronis-Tuscano, Andrea; Wang, Christine H; Woods, Kelsey E; Strickland, Jennifer; Stein, Mark A
One fourth to one half of parents of children with attention-deficit/hyperactivity disorder (ADHD) have ADHD themselves, complicating delivery of evidence-based child behavioral and pharmacological treatments. In this article, we review the literature examining the relation between parent ADHD and outcomes following behavioral and pharmacological treatments for children with ADHD. We also review research that has incorporated treatment of parent ADHD (either alone or in combination with child treatment) with the goal of improving parenting and child outcomes. Finally, we offer recommendations for future research on the relation between parent ADHD and evidence-based treatment outcomes for their children, with the purpose of advancing the science and informing clinical care of these families.
Robertson, Angela; Walker, Courtney S; Stovall, Mark; McCluskey, Lee
Over the past decade, substance abuse treatment professionals have begun to implement evidence-based practices (EBPs) into the treatment of substance use disorders. There is a growing body of research on the diffusion of EBP in addiction treatment; however, less is known about individual state initiatives to implement EBPs among community providers. The current study aimed to evaluate the progress of an initiative of the Mississippi Department of Mental Health (MDMH) to increase the implementation of evidence-based substance abuse treatment practices by certified providers. In addition, the study examines potential barriers to implementing these practices. To accomplish this goal, we reported the findings of two surveys of Mississippi addiction professionals conducted in 2010 and in 2013.
Kukafka, Rita; Millery, Mari; Chan, Connie; LaRock, William; Bakken, Suzanne
Psychosocial counselors have a vital and challenging role in supporting persons living with HIV/AIDS (PLWH/A) to better manage their disease. However, gaps in training, education, and skills limit the effectiveness of counselors' efforts. We propose that the use of a decision-support tool for counselors at the point of care can support them in their work as well as help alleviate many training and practice gaps. Decision-support tools aimed at reducing knowledge and practice gaps are used extensively to assist clinical providers at the point of care; however, there is a need for decision-support tools designed specifically for HIV/AIDS counselors. To identify requirements for such a tool, we conducted a needs assessment through interviews of 19 HIV/AIDS clinic counselors who provide 20 or more hours per week of psychosocial support to PLWH/A. The assessment explored their education and training backgrounds, the extent to which evidence-based practices are implemented, and how a decision-support tool can support counselor work practices. Qualitative analysis was organized around seven main categories: counselor characteristics, patient characteristics, barriers, definitions of key concepts, use of guidelines, client assessments, and resources. The resulting coding schemes revealed knowledge and practice gaps among the interviewees, as well as barriers and challenges of counseling. Education and training background of the counseling staff varied widely. When asked to define five key concepts related to HIV counseling, 26-47% of respondents were unable to articulate an adequate definition. Less than half of the interviewees recalled sources of guidelines used in their work and specific models of care introduced during trainings. Interviews identified environmental barriers, language and literacy, patient education, and patient communication as the most prominent challenges to counseling work. The results from this study inform the need for and development of a
Addressing Mental Health Disparities through Clinical Competence Not Just Cultural Competence: The Need for Assessment of Sociocultural Issues in the Delivery of Evidence-Based Psychosocial Rehabilitation Services
Yamada, Ann-Marie; Brekke, John S
Recognition of ethnic/racial disparities in mental health services has not directly resulted in the development of culturally responsive psychosocial interventions. There remains a fundamental need for assessment of sociocultural issues that have been linked with the expectations, needs, and goals of culturally diverse consumers with severe and persistent mental illness. The authors posit that embedding the assessment of sociocultural issues into psychosocial rehabilitation practice is one step in designing culturally relevant empirically supported practices. It becomes a foundation on which practitioners can examine the relevance of their interventions to the diversity encountered in everyday practice. This paper provides an overview of the need for culturally and clinically relevant assessment practices and asserts that by improving the assessment of sociocultural issues the clinical competence of service providers is enhanced. The authors offer a conceptual framework for linking clinical assessment of sociocultural issues to consumer outcomes and introduce an assessment tool adapted to facilitate the process in psychosocial rehabilitation settings. Emphasizing competent clinical assessment skills will ultimately offer a strategy to address disparities in treatment outcomes for understudied populations of culturally diverse consumers with severe and persistent mental illness. PMID:18778881
Sheidow, Ashli J; Jayawardhana, Jayani; Bradford, W David; Henggeler, Scott W; Shapiro, Steven B
The 12-month cost effectiveness of juvenile drug court and evidence-based treatments within Court were compared with traditional Family Court for 128 substance abusing/dependent juvenile offenders participating in a four-condition randomized trial. Intervention conditions included Family Court with community services (FC), Drug Court with community services (DC), Drug Court with Multisystemic Therapy (DC/MST), and Drug Court with MST enhanced with a contingency management program (DC/MST/CM). Average cost effectiveness ratios for substance use and criminal behavior outcomes revealed that economic efficiency in achieving outcomes generally improved from FC to DC, with the addition of evidence-based treatments improving efficiency in obtaining substance use outcomes.
Sheidow, Ashli J.; Jayawardhana, Jayani; Bradford, W. David; Henggeler, Scott W.; Shapiro, Steven B.
The 12-month cost effectiveness of juvenile drug court and evidence-based treatments within Court were compared with traditional Family Court for 128 substance abusing/dependent juvenile offenders participating in a four-condition randomized trial. Intervention conditions included Family Court with community services (FC), Drug Court with community services (DC), Drug Court with Multisystemic Therapy (DC/MST), and Drug Court with MST enhanced with a contingency management program (DC/MST/CM). Average cost effectiveness ratios for substance use and criminal behavior outcomes revealed that economic efficiency in achieving outcomes generally improved from FC to DC, with the addition of evidence-based treatments improving efficiency in obtaining substance use outcomes. PMID:22389577
Lopata, Christopher; Toomey, Jennifer A.; Thomeer, Marcus L.; McDonald, Christin A.; Fox, Jeffery D.; Smith, Rachael A.; Meichenbaum, David L.; Volker, Martin A.; Lee, Gloria K.; Lipinski, Alanna M.
This community effectiveness trial examined the feasibility and efficacy of a comprehensive psychosocial treatment for 28 children, aged 7 to 10 years with high-functioning autism spectrum disorders (HFASDs). Treatment included instruction and therapeutic activities targeting social skills, face-emotion recognition skills, interest expansion, and…
Harvey, Allison G.; Lee, Jason; Williams, Joseph; Hollon, Steven D.; Walker, Matthew P.; Thompson, Monique A.; Smith, Rita
Mental disorders are prevalent and lead to significant impairment. Progress toward establishing treatments has been good. However, effect sizes are small to moderate, gains may not persist, and many patients derive no benefit. Our goal is to highlight the potential for empirically-supported psychosocial treatments to be improved by incorporating insights from cognitive psychology and research on education. Our central question is: If it were possible to improve memory for content of sessions of psychosocial treatments, would outcome substantially improve? This question arises from five lines of evidence: (a) mental illness is often characterized by memory impairment, (b) memory impairment is modifiable, (c) psychosocial treatments often involve the activation of emotion, (d) emotion can bias memory and (e) memory for psychosocial treatment sessions is poor. Insights from scientific knowledge on learning and memory are leveraged to derive strategies for a transdiagnostic and transtreatment cognitive support intervention. These strategies can be applied within and between sessions and to interventions delivered via computer, the internet and text message. Additional novel pathways to improving memory include improving sleep, engaging in exercise and imagery. Given that memory processes change across the lifespan, services to children and older adults may benefit from cognitive support. PMID:25544856
Liddle, Howard A
This article summarizes the 30+-year evidence base of Multidimensional Family Therapy (MDFT), a comprehensive treatment for youth substance abuse and antisocial behaviors. Findings from four types of MDFT studies are discussed: hybrid efficacy/effectiveness randomized controlled trials, therapy process studies, cost analyses, and implementation trials. This research has evaluated various versions of MDFT. These studies have systematically tested adaptations of MDFT for diverse treatment settings in different care sectors (mental health, substance abuse, juvenile justice, and child welfare), as well as adaptations according to treatment delivery features and client impairment level, including adolescents presenting with multiple psychiatric diagnoses. Many published scientific reviews, including meta-analyses, national and international government publications, and evidence-based treatment registries, offer consistent conclusions about the clinical effectiveness of MDFT compared with standard services as well as active treatments. The diverse and continuing MDFT research, the favorable, multi-source independent evaluations, combined with the documented receptivity of youth, parents, community-based clinicians and administrators, and national and international MDFT training programs (U.S.-based organization is MDFT International, www.mdft.org; and Europe-based organization is www.mdft.nl) all support the potential for continued transfer of MDFT to real-world clinical settings.
Schneider, Myra G.; Forthofer, Melinda S.
This study investigated psychosocial factors thought to be associated with perceived stress over the course of infertility treatment. The research was based on secondary analysis of data from the Study of Marriage, Family, and Life Quality with a sample of 128 people who completed an infertility-related stress instrument at all three measurement…
Blotcky, Alan D.; And Others
Psychosocial variables were examiend by comparing 10 adolescents (and their mothers) who had refused cancer treatment with a group of 10 consenting adolescents who were matched on demographic and illness variables. Adolescent refusers scored lower on State Anxiety and Subjective Distress but scored higher on Trait Anxiety, Religiosity, and…
Yu, Yong-qiang; Yang, Huai-an; Xiao, Ming; Wang, Jing-wei; Huang, Dong-yan; Bhambhani, Yagesh; Sonnenberg, Lyn; Clark, Brenda; Jin, Yuan-zhe; Fu, Wei-neng; Zhang, Jie; Yu, Qian; Liang, Xue-ting; Zhang, Ming
In this article, the mechanism of inheritance behind inherited hearing loss and genetic susceptibility in noise-induced hearing loss are reviewed. Conventional treatments for sensorineural hearing loss (SNHL), i.e. hearing aid and cochlear implant, are effective for some cases, but not without limitations. For example, they provide little benefit for patients of profound SNHL or neural hearing loss, especially when the hearing loss is in poor dynamic range and with low frequency resolution. We emphasize the most recent evidence-based treatment in this field, which includes gene therapy and allotransplantation of stem cells. Their promising results have shown that they might be options of treatment for profound SNHL and neural hearing loss. Although some treatments are still at the experimental stage, it is helpful to be aware of the novel therapies and endeavour to explore the feasibility of their clinical application.
Kravitz, Richard L; Duan, Naihua; Braslow, Joel
Evidence-based medicine is the application of scientific evidence to clinical practice. This article discusses the difficulties of applying global evidence (“average effects” measured as population means) to local problems (individual patients or groups who might depart from the population average). It argues that the benefit or harm of most treatments in clinical trials can be misleading and fail to reveal the potentially complex mixture of substantial benefits for some, little benefit for many, and harm for a few. Heterogeneity of treatment effects reflects patient diversity in risk of disease, responsiveness to treatment, vulnerability to adverse effects, and utility for different outcomes. Recognizing these factors, researchers can design studies that better characterize who will benefit from medical treatments, and clinicians and policymakers can make better use of the results. PMID:15595946
Compton, Scott N; Burns, Barbara J; Helen, L Egger; Robertson, Elizabeth
This article reviews the empirical literature on psychosocial, psychopharmacological, and adjunctive treatments for children between the ages of 6 and 12 with internalizing disorders. The aim of this review was to identify interventions that have potential to prevent substance use disorders in adolescence by treating internalizing disorders in childhood. Results suggest that a variety of behavioral, cognitive-behavioral, and pharmacological interventions are effective in reducing symptoms of childhood depression, phobias, and anxiety disorders. None of the studies reviewed included substance abuse outcomes. Thus, little can be said about the relationship between early treatment and the prevention of later substance use. The importance of evaluating the generalizability of research-supported interventions to community settings is highlighted and recommendations for future research are offered.
Berninger, Virginia W.; May, Maggie O'Malley
Programmatic, multidisciplinary research provided converging brain, genetic, and developmental support for evidence-based diagnoses of three specific learning disabilities based on hallmark phenotypes (behavioral expression of underlying genotypes) with treatment relevance: dysgraphia (impaired legible automatic letter writing, orthographic…
Modi, Avani C.; Lemanek, Kathleen L.; Ievers-Landis, Carolyn E.; Rapoff, Michael A.
Objectives Adherence to medical regimens for children and adolescents with chronic conditions is generally below 50% and is considered the single, greatest cause of treatment failure. As the prevalence of chronic illnesses in pediatric populations increases and awareness of the negative consequences of poor adherence become clearer, the need for reliable and valid measures of adherence has grown. Methods This review evaluated empirical evidence for 18 measures utilizing three assessment methods: (a) self-report or structured interviews, (b) daily diary methods, and (c) electronic monitors. Results Ten measures met the “well-established” evidence-based (EBA) criteria. Conclusions Several recommendations for improving adherence assessment were made. In particular, consideration should be given to the use of innovative technologies that provide a window into the “real time” behaviors of patients and families. Providing written treatment plans, identifying barriers to good adherence, and examining racial and ethnic differences in attitudes, beliefs and behaviors affecting adherence were strongly recommended. PMID:17846042
Harvey, Allison G; Gumport, Nicole B
The prevalence of mental disorders is high and appears to be growing, yet the majority of individuals who meet diagnostic criteria for a mental disorder are not able to access an adequate treatment. While evidence-based psychological treatments (EBPTs) are effective single or adjunctive treatments for mental disorders, there is also evidence that access to these treatments is diminishing. We seek to highlight modifiable barriers to these problems at the patient, therapist, treatment, organization and government-levels of analysis. A range of solutions to each set of contributors is offered and domains for future research are highlighted. In particular, we focus on the need to continue to work toward innovation in treatment development while also solving the difficulties relating to the dissemination of EBPTs. Several relatively new concepts in the field will be discussed (implementation cliff, program drift, voltage drop and deployment treatment development) and we contrast America and England as examples of government-level processes that are in the process of major change with respect to EBPTs. We conclude that there is a need for people in our field to become more knowledgeable about, and get involved in, shaping public policy.
Harvey, Allison G.; Gumport, Nicole B.
The prevalence of mental disorders is high and appears to be growing, yet the majority of individuals who meet diagnostic criteria for a mental disorder are not able to access an adequate treatment. While evidence-based psychological treatments (EBPTs) are effective single or adjunctive treatments for mental disorders, there is also evidence that access to these treatments is diminishing. We seek to highlight modifiable barriers to these problems at the patient, therapist, treatment, organization and government-levels of analysis. A range of solutions to each set of contributors is offered and domains for future research are highlighted. In particular, we focus on the need to continue to work toward innovation in treatment development while also solving the difficulties relating to the dissemination of EBPTs. Several relatively new concepts in the field will be discussed (implementation cliff, program drift, voltage drop and deployment treatment development) and we contrast America and England as examples of government-level processes that are in the process of major change with respect to EBPTs. We conclude that there is a need for people in our field to become more knowledgeable about, and get involved in, shaping public policy. PMID:25768982
Friedmann, Peter D.; Taxman, Faye S.; Henderson, Craig E.
OBJECTIVE To estimate the extent and organizational correlates of evidence-based practices (EBPs) in correctional facilities and community-based substance abuse treatment programs that manage drug-involved adult offenders. METHODS Correctional administrators and treatment program directors affiliated with a national sample of 384 criminal justice and community-based programs providing substance abuse treatment to adult offenders in the United States were surveyed in 2004. Correctional administrators reported the availability of up to 13 specified EBPs and treatment directors up to 15. The sum total of EBPs indicates their extent. Linear models regress the extent of EBPs on variables measuring structure and leadership, culture and climate, administrator attitudes and network connectedness of the organization. RESULTS Most programs offer fewer than 60% of the specified EBPs to drug-involved offenders. In multiple regression models, offender treatment programs that provided more EBPs were community-based, accredited, and network-connected; with a performance-oriented, non-punitive culture, more training resources; and leadership with a background in human services, a high regard for the value of substance abuse treatment and an understanding of EBPs. CONCLUSIONS The use of EBPs among facility- and community-based programs that serve drug-involved adult offenders has room for improvement. Initiatives to disseminate EBPs might target these institutional and environmental domains, but further research is needed to determine whether such organization interventions can promote the uptake of EBPs. PMID:17383551
Anderson-Peacock, Elizabeth; Blouin, Jean-Sébastien; Bryans, Roland; Danis, Normand; Furlan, Andrea; Marcoux, Henri; Potter, Brock; Ruegg, Rick; Gross Stein, Janice; White, Eleanor
OBJECTIVE To provide an evidence-based clinical practice guideline for the chiropractic cervical treatment of adults with acute or chronic neck pain not due to whiplash. This is a considerable health concern considered to be a priority by stakeholders, and about which the scientific information was poorly organized. OPTIONS Cervical treatments: manipulation, mobilization, ischemic pressure, clinic- and home-based exercise, traction, education, low-power laser, massage, transcutaneous electrical nerve stimulation, pillows, pulsed electromagnetic therapy, and ultrasound. OUTCOMES The primary outcomes considered were improved (reduced and less intrusive) pain and improved (increased and easier) ranges of motion (ROM) of the adult cervical spine. EVIDENCE An “extraction” team recorded evidence from articles found by literature search teams using 4 separate literature searches, and rated it using a Table adapted from the Oxford Centre for Evidence-based Medicine. The searches were 1) Treatment; August, 2003, using MEDLINE, CINAHL, AMED, MANTIS, ICL, The Cochrane Library (includes CENTRAL), and EBSCO, identified 182 articles. 2) Risk management (adverse events); October, 2004, identified 230 articles and 2 texts. 3) Risk management (dissection); September, 2003, identified 79 articles. 4) Treatment update; a repeat of the treatment search for articles published between September, 2003 and November, 2004 inclusive identified 121 articles. VALUES To enable the search of the literature, the authors (Guidelines Development Committee [GDC]) regarded chiropractic treatment as including elements of “conservative” care in the search strategies, but not in the consideration of the range of chiropractic practice. Also, knowledge based only on clinical experience was considered less valid and reliable than good-caliber evidence, but where the caliber of the relevant evidence was low or it was non-existent, unpublished clinical experience was considered to be equivalent to
Behçet's disease (BD) is a chronic, relapsing, and debilitating systemic vasculitis of unknown aetiology with the clinical features of mucocutaneous lesions, ocular, vascular, articular, neurologic, gastrointestinal, urogenital, and pulmonary involvement. The disease is much more frequent along the ancient “Silk Route” extending from Eastern Asia to the Mediterranean basin, compared with Western countries. The disease usually starts around the third or fourth decade of life. Male sex and a younger age of onset are associated with more severe disease. Although the treatment has become much more effective in recent years, BD is still associated with severe morbidity and considerable mortality. The main aim of the treatment should be the prevention of irreversible organ damage. Therefore, close monitoring, early, and appropriate treatment is mandatory to reduce morbidity and mortality. The treatment is mainly based on the suppression of inflammatory attacks of the disease using immunomodulatory and immunosuppressive agents. In this paper, current state of knowledge regarding the therapeutic approaches is outlined. To provide a rational framework for selecting the appropriate therapy along the various treatment choices, a stepwise, symptom-based, evidence-based algorithmic approach was developed. PMID:22007346
Goldfried, Marvin R
In conceptualizing CBT as an approach to treatment that is closely linked to basic empirical principles of human behavior, it is possible to incorporate evidence-based contributions from different theoretical orientations. This is illustrated by how CBT can be open to a variety of interventions that are not typically associated with CBT, but which nonetheless have empirical support. This article describes the following clinical interventions, together with their theoretical rationale and empirical support: (a) Having a therapeutic focus on what is occurring within the session itself, (b) Becoming aware of one's negative reactions toward the patient and transforming them into a more compassionate stance, and (c) Using procedures for enhancing emotional arousal in changing a patient's cognitive-affective distortions.
Schmidt, Lone; Sejbæk, Camilla Sandal
Infertility and its treatment are severe, chronic, low-control stressors. Among women unsuccessful treatment is associated with increased risk of developing depressive symptoms. Among men infertility is associated with more negative emotional responses. Lifelong involuntary childlessness is associated with reduced mental well-being. It is recommended in the future to integrate mental health professionals at fertility clinics in Denmark in order to secure that also the psychosocial consequences of infertility and fertility treatment are taken care of with the highest professional standard based on scientific knowledge within this field.
Forrest, Jane L
The aims of this paper are to present the findings from the scientific literature that discuss strategies that can contribute to a "best practices" treatment plan model for effectively integrating Evidence-Based Decision Making (EBDM) into curricula. MEDLINE, CINAHL, and HealthSTAR databases were searched, as was the Cochrane Database of Systematic Reviews. Studies and articles, ranging from systematic reviews to articles proposing models and recommendations for how to implement EBDM into curricula and faculty development were reviewed. Several common themes emerged and form the basis for a treatment plan model. The first step in developing any treatment plan is a thorough assessment of the current situation or problem. Recognizing that there are multiple phases to the assessment of an educational system, the focus of this paper will be to understand which teaching and learning strategies are most effective. These, in turn, will inform faculty of needed curricular changes and skill development training, requisites in order for them to prepare students to be successful in providing patient care using the best available evidence. Elements of a suggested treatment plan will be presented with the caveat that each dental school will need to develop an implementation plan based on an assessment of its own environment and needs.
Jordan, Liz; Beaver, Kinta; Foy, Sharon
Clinical staff and researchers working together can do much to bridge the gap between research and practice. This paper reports on the practice of treating severe radiotherapy skin reactions with ozone therapy; a practice that has been in place for a number of years at a specialist oncology hospital in England and perceived to be beneficial in terms of wound healing and pain relief. A multidisciplinary team of clinical staff and researchers questioned the evidence base for this practice and a literature search revealed little support for the effectiveness of this treatment in this particular context. The views of patients receiving ozone therapy were sought and assessment forms were completed to gain objective information on the progress (or otherwise) of wound healing. While patients perceived the ozone treatment to be beneficial in terms of pain relief, it was impossible to isolate the impact of ozone alone as other preparations and treatments were also being given. Patient reports and nursing assessments did not support that ozone was effective at wound healing. A more formal evaluation of this treatment is being planned, supported by the shared governance initiative at the study site and a continued collaboration between clinical staff and researchers.
Kopp, I.; Augustin, M.; Banditt, K. B.; Boehncke, W. H.; Follmann, M.; Friedrich, M.; Huber, M.; Kahl, C.; Klaus, J.; Koza, J.; Kreiselmaier, I.; Mohr, J.; Mrowietz, U.; Ockenfels, H. M.; Orzechowski, H. D.; Prinz, J.; Reich, K.; Rosenbach, T.; Rosumeck, S.; Schlaeger, M.; Schmid-Ott, G.; Sebastian, M.; Streit, V.; Weberschock, T.; Rzany, B.
Psoriasis vulgaris is a common and chronic inflammatory skin disease which has the potential to significantly reduce the quality of life in severely affected patients. The incidence of psoriasis in Western industrialized countries ranges from 1.5 to 2%. Despite the large variety of treatment options available, patient surveys have revealed insufficient satisfaction with the efficacy of available treatments and a high rate of medication non-compliance. To optimize the treatment of psoriasis in Germany, the Deutsche Dermatologische Gesellschaft and the Berufsverband Deutscher Dermatologen (BVDD) have initiated a project to develop evidence-based guidelines for the management of psoriasis. The guidelines focus on induction therapy in cases of mild, moderate, and severe plaque-type psoriasis in adults. The short version of the guidelines reported here consist of a series of therapeutic recommendations that are based on a systematic literature search and subsequent discussion with experts in the field; they have been approved by a team of dermatology experts. In addition to the therapeutic recommendations provided in this short version, the full version of the guidelines includes information on contraindications, adverse events, drug interactions, practicality, and costs as well as detailed information on how best to apply the treatments described (for full version, please see Nast et al., JDDG, Suppl 2:S1–S126, 2006; or http://www.psoriasis-leitlinie.de). PMID:17497162
Holland, S.; Silberstein, S.D.; Freitag, F.; Dodick, D.W.; Argoff, C.; Ashman, E.
Objective: To provide updated evidence-based recommendations for the preventive treatment of migraine headache. The clinical question addressed was: Are nonsteroidal anti-inflammatory drugs (NSAIDs) or other complementary treatments effective for migraine prevention? Methods: The authors analyzed published studies from June 1999 to May 2009 using a structured review process to classify the evidence relative to the efficacy of various medications for migraine prevention. Results: The author panel reviewed 284 abstracts, which ultimately yielded 49 Class I or Class II articles on migraine prevention; of these 49, 15 were classified as involving nontraditional therapies, NSAIDs, and other complementary therapies that are reviewed herein. Recommendations: Petasites (butterbur) is effective for migraine prevention and should be offered to patients with migraine to reduce the frequency and severity of migraine attacks (Level A). Fenoprofen, ibuprofen, ketoprofen, naproxen, naproxen sodium, MIG-99 (feverfew), magnesium, riboflavin, and subcutaneous histamine are probably effective for migraine prevention (Level B). Treatments considered possibly effective are cyproheptadine, Co-Q10, estrogen, mefenamic acid, and flurbiprofen (Level C). Data are conflicting or inadequate to support or refute use of aspirin, indomethacin, omega-3, or hyperbaric oxygen for migraine prevention. Montelukast is established as probably ineffective for migraine prevention (Level B). PMID:22529203
Scudder, Ashley; Herschell, Amy D.
In order to make EBTs available to a large number of children and families, developers and expert therapists have used their experience and expertise to train community-based therapists in EBTs. Understanding current training practices of treatment experts may be one method for establishing best practices for training community-based therapists prior to comprehensive empirical examinations of training practices. A qualitative study was conducted using surveys and phone interviews to identify the specific procedures used by treatment experts to train and implement an evidence-based treatment in community settings. Twenty-three doctoral-level, clinical psychologists were identified to participate because of their expertise in conducting and training Parent-Child Interaction Therapy. Semi-structured qualitative interviews were completed by phone, later transcribed verbatim, and analyzed using thematic coding. The de-identified data were coded by two independent qualitative data researchers and then compared for consistency of interpretation. The themes that emerged following the final coding were used to construct a training protocol to be empirically tested. The goal of this paper is to not only understand the current state of training practices for training therapists in a particular EBT, Parent-Child Interaction Therapy, but to illustrate the use of expert opinion as the best available evidence in preparation for empirical evaluation. PMID:26504259
Aaronson, Neil K; Mattioli, Vittorio; Minton, Ollie; Weis, Joachim; Johansen, Christoffer; Dalton, Susanne O; Verdonck-de Leeuw, Irma M; Stein, Kevin D; Alfano, Catherine M; Mehnert, Anja; de Boer, Angela; van de Poll-Franse, Lonneke V
The population of cancer survivors has grown steadily over the past several decades. Surviving cancer, however, is not synonymous with a life free of problems related to the disease and its treatment. In this paper we provide a brief overview of selected physical and psychosocial health problems prevalent among cancer survivors, namely pain, fatigue, psychological distress and work participation. We also address issues surrounding self-management and e-Health interventions for cancer survivors, and programmes to encourage survivors to adopt healthier lifestyles. Finally, we discuss approaches to assessing health-related quality of life in cancer survivors, and the use of cancer registries in conducting psychosocial survivorship research. We highlight research and practice priorities in each of these areas. While the priorities vary per topic, common themes that emerged included: (1) Symptoms should not be viewed in isolation, but rather as part of a cluster of interrelated symptoms. This has implications for both understanding the aetiology of symptoms and for their treatment; (2) Psychosocial interventions need to be evidence-based, and where possible should be tailored to the needs of the individual cancer survivor. Relatively low cost interventions with self-management and e-Health elements may be appropriate for the majority of survivors, with resource intensive interventions being reserved for those most in need; (3) More effort should be devoted to disseminating and implementing interventions in practice, and to evaluating their cost-effectiveness; and (4) Greater attention should be paid to the needs of vulnerable and high-risk populations of survivors, including the socioeconomically disadvantaged and the elderly.
Mahajan, Kanika; Singh, Girish Kumar; Kumar, Santosh; Avasthi, Sachin
Introduction A recent concept review in Journal of Bone and Joint Surgery (JBJS) outlines evidence to control peri-operative infections in compound fractures. However, evidence for impact of adopting a protocol combining measures that have some evidence is lacking in literature. The present method of treatment at King George’s Medical University (KGMU) is representative of the conventional practice of managing compound fractures in India and is an appropriate control for trial against the Experimental Evidence Based Protocol (EBP). Aim To study the additional impact of adopting Evidence Based Protocol on parameters defining infection rate and bone union. Materials and Methods This randomized controlled study was conducted at the orthopaedics department of KGMU. Two hundred and twenty six patients of compound fractures of both bone leg, age > 12y were randomized to two groups. One group received standard treatment and the experimental group received treatment as per JBJS review. Statistical Analysis Random allocation was tested by comparing baseline characteristics of the two groups. The two groups were compared for all the outcome variables in terms of time to a negative wound culture, time to wound healing, time to union at fracture site and time to achieve complete range of motion at knee joint. Results Random allocation was successful. EBP group reported significantly lesser time to a negative culture report from wound (mean in conventional=4.619, experimental=1.9146, p=0.0006), lesser time to bony union (mean in conventional=23.8427 weeks, experimental=22.8125 weeks, p=0.0027), lesser time to wound healing (mean in conventional=14.4425 weeks experimental=10.4513 weeks, p=0.0032), and a lesser duration of hospital stay (mean in conventional=6.5982 days, experimental=4.5000 days, p=0.0343). Conclusion EBP based on the guidelines suggested by Fletcher et al., significantly shorten the time taken for achieving a negative culture and hasten wound and fracture
Logsdon, Rebecca G; McCurry, Susan M; Teri, Linda
In this article, the authors review the literature regarding evidence-based psychological treatments (EBTs) for behavioral disturbances in older adults with dementia, as proposed by the American Psychological Association's Committee on Science and Practice of the Society for Clinical Psychology. Fifty-seven randomized clinical trials were reviewed for inclusion on the basis of titles or abstract information. Forty-three were excluded either because they did not meet EBT methodological criteria or because they involved environmental or psychoeducational nursing interventions in which the psychological component could not be separately evaluated. Fourteen studies were considered for inclusion as EBTs; of these, 8 showed significant differences between treatment and control groups. Results of this review indicate that behavioral problem-solving therapies that identify and modify antecedents and consequences of problem behaviors and increase pleasant events and individualized interventions based on progressively lowered stress threshold models that include problem solving and environmental modification meet EBT criteria. Additional randomized clinical trials are needed to evaluate the generalizability and efficacy of these and other promising psychological interventions in a variety of settings with individuals who have a range of cognitive, functional, and physical strengths and limitations.
Mannucci, Pier Mannuccio; Franchini, Massimo; Castaman, Giancarlo; Federici, Augusto B.
Background von Willebrand disease (VWD) is the most common hereditary bleeding disorder affecting both males and females. It arises from quantitative or qualitative defects of von Willebrand factor (VWF) and causes bleeding of mucous membranes and soft tissues. The aim of treatment is to correct the dual defect of haemostasis caused by the abnormal/reduced VWF and the concomitant deficiency of factor VIII (FVIII). Material and methods This document contains evidence-based recommendations for the management of VWD compiled by AICE (the Italian Association of Haemophilia Centres). All the evidence supporting these recommendations are based on non-randomised comparative studies or case series, because randomised controlled clinical trials or meta-analyses are not available for this disease. Results and conclusions Desmopressin (DDAVP) is the treatment of choice for patients with type 1 VWD with FVIII and VWF levels of 10 U/dL or more, while VWF/FVIII concentrates are indicated for those who are unresponsive or insufficiently responsive to DDAVP (severe type 1, type 2 and 3 VWD). VWF concentrates devoid of FVIII, not yet licensed in Italy, may be considered for short-term prophylaxis in elective surgery or for long-term secondary prophylaxis. PMID:19503633
Donaldson, Sandra; Chundamala, Josie; Yandow, Suzanne; Wright, James G.
The purpose of this paper is to perform an evidence based review for treatment of unicameral bone cysts. A search of MEDLINE (1966 to 2009) was conducted and the studies were classified according to levels of evidence. This review includes only comparative Level I-III studies. The systematic review identified 16 studies. There is one level I study, one level II study and the remaining 14 studies are level III. Seven of the sixteen studies had statistically different results: three studies indicated that steroid injection was superior to bone marrow injection or curettage and bone grafting; one study indicated that cannulated screws were superior to steroid injections; one study indicated resection and myoplasty was superior to steroid injection; one study indicated a combination of steroid, demineralized bone matrix and bone marrow aspirate, and curettage and bone grafting were superior to steroid injection; and one study indicated that curettage and bone grafting was superior to non-operative immobilization. Based on one Level I study, including a limited number of individuals, steroid injection seems to be superior to bone marrow injection. As steroid injections have already demonstrated superiority over bone marrow injections in a randomized clinical trial, the next step would be a prospective trial comparing steroid injections with other treatments. PMID:21808696
Sanders, K A; Bruce, N W
This study investigated the association between psychosocial stress and outcome of in-vitro fertilization and gamete intra-Fallopian transfer treatment. Ninety women, enrolled for treatment at a private infertility clinic, completed two self-administered psychometric tests (Bi-polar Profile of Mood States, POMS; and State-Trait Anxiety Inventory, STAI) and a questionnaire to ascertain demographic and lifestyle characteristics before the start of treatment. Approximately 12 months later an outcome measure was determined for each participant in terms of whether she was pregnant or not pregnant and the number of treatment cycles undertaken to achieve clinical pregnancy. The women's scores on the psychological tests were similar to published normative scores. On univariate analysis, history of a previous pregnancy was positively related to the probability of pregnancy and full-time employment, a more 'hostile' mood state and higher trait anxiety were associated with a lower cumulative pregnancy rate. A Cox multiple regression model found previous pregnancy history, trait anxiety, and the POMS agreeable-hostile and elated-depressed scales to be the most important lifestyle and stress variables predictive of pregnancy. The results emphasize the importance of psychosocial stress in treatment outcome but indicate that the relationships are complex. Further studies are required to validate whether these findings can be generalized to other populations.
Jongedijk, Ruud A
Narrative exposure therapy (NET) is a recently developed, short-term treatment for patients with a posttraumatic stress disorder (PTSD) as a result of multiple trauma. NET can be applied very successfully in patients with complex trauma complaints (Jongedijk, 2014; Schauer, Neuner, & Elbert, 2011). An important feature of NET is that trauma processing is never an isolated event but is always embedded in the context of a traumatic event and in the life history as a whole. At the start, the lifeline is laid. The lifeline is made up of a rope, with flowers (happy events), stones (traumatic events), sometimes candles (grief), or recently also sticks for aggressive acts (NET for offenders; see Stenmark, Cuneyt Guzey, Elbert, & Holen, 2014). These symbols are laid down along the rope, in chronological order. Subsequently, in the subsequent therapy sessions the lifeline is processed in chronological order, giving attention to all the important events a person has experienced in his or her life, both the adverse as well as the pleasurable ones. The narration ends with a written testimony. To date, there is good evidence NET is effective in the treatment of PTSD patients, with support from 18 RCTs (N=950). For culturally diverse populations, NET is recommended as the most evidence-based trauma treatment, besides culturally adapted CBT. NET has been investigated in different populations in Africa, Europe, and Asia. In Asia, research has been carried out in Sri Lanka as well as in China. In China, NET was conducted and investigated with survivors of the Sichuan earthquake (Zang, Hunt, & Cox, 2013, 2014). NET is understandable, even appealing and also supportive for patients with multiple trauma. In this presentation, the treatment principles and the practice of NET will be explained.
Daly, Brian P; Creed, Torrey; Xanthopoulos, Melissa; Brown, Ronald T
This article reviews studies examining the efficacy of behavioral interventions for the treatment of attention-deficit/hyperactivity disorder (ADHD). A specific emphasis is placed on evidence-based interventions that include parent training, classroom, academic, and peer interventions. Results indicate that school-aged children respond to behavioral interventions when they are appropriately implemented both at home and in the classroom setting. Combined treatments (behavioral management and stimulant medication) represent the gold standard in ADHD treatment and are often recommended as the first-line treatment option due to the many problems faced by children with ADHD. Diversity issues, although an important consideration in the treatment of ADHD, continue to remain an understudied area. Recommendations for future research are made pertaining to treatment sequencing with regard to behavior management as well as for subgroups of ADHD children who may respond best to specific treatments.
Walsh, Kate; Hope, Debra A.
Guided by the American Psychological Association's principles of evidence-based practice, this article reviews a single-case treatment outcome study whereby a client characteristic, sexual identity, was integrated into the assessment and treatment of social anxiety symptoms. The case involved a young adult European-American male who presented to a…
Verduin, Timothy L.; Abikoff, Howard; Kurtz, Steven M. S.
This case study illustrates a behavioral treatment of "Peter," a 4-year-old male with attention deficit/hyperactivity disorder (ADHD) and oppositional defiant disorder. Multiple evidence-based treatment procedures were implemented, affording the opportunity to explore issues common to the clinical application of empirically supported…
Funderburk, Beverly; Chaffin, Mark; Bard, Elizabeth; Shanley, Jenelle; Bard, David; Berliner, Lucy
Posttraining expert case consultation is a key component of transporting and scaling up evidence-based treatments, and hopefully retaining their efficacy. Live practice observation and in vivo coaching is a strategy used in academic training environments, but is rarely feasible in field settings. Post hoc telephone consultation is a substitute strategy but does not approximate many aspects of live coaching. Live video technology offers a closer approximation but has not yet been sufficiently tested. Using a roll-out experimental design, this study compared client outcomes across doses of two posttraining expert consultation strategies-standard telephone consultation and live video coaching. The study was conducted during a two-state, 30-agency implementation involving 80 therapists and 330 cases receiving Parent-Child Interaction Therapy (PCIT). Child behavior problems fell from well above to below clinical cutoff values, with about a 1 standard deviation improvement in 14 sessions, which is within the range reported in laboratory efficacy trials. Symptom improvement was augmented by increased therapist dose of live video consultations. Phone consultation dose had no association with client level outcomes. PCIT benefits appear to be retained when the model is transported at scale into the field, and live video consultation appeared to offer small but significant advantages over telephone consultation as one element of an overall transport strategy.
Bonham, Caroline A.; Sommerfeld, David; Willging, Cathleen; Aarons, Gregory A.
Objective. In recent years, New Mexico has prioritized integrated treatment for cooccurring mental health and substance use disorders within its public behavioral health system. This report describes factors likely to be important when implementing evidence-based practices (EBPs) in community agencies. Methods. Our mixed-method research design consisted of observations, semistructured interviews, and surveys undertaken with employees at 14 agencies at baseline and after 18 months. We developed four-agency typologies based on iterative coding and analysis of observations and interviews. We then examined survey data from employees at the four exemplar agencies to validate qualitative findings. Results. Financial resources and strong leadership impacted agency capacity to train providers and implement EBPs. Quantitative analysis of service provider survey responses from these agencies (N = 38) supported qualitative findings and demonstrated significant mean score differences in leadership, organizational climate, and attitudes toward EBPs in anticipated directions. Conclusion. The availability of strong leadership and financial resources were key components to initial implementation success in this study of community agencies in New Mexico. Reliance only on external funding poses risks for sustainment when demoralizing work climates precipitate employee turnover. Strong agency leadership does not always compensate for deficient financial resources in vulnerable communities. PMID:24772411
Irritable bowel syndrome (IBS) is a chronic and debilitating functional gastrointestinal disorder that affects 9%-23% of the population across the world. The percentage of patients seeking health care related to IBS approaches 12% in primary care practices and is by far the largest subgroup seen in gastroenterology clinics. It has been well documented that these patients exhibit a poorer quality of life and utilize the health care system to a greater degree than patients without this diagnosis. The pathophysiology of IBS is not clear. Many theories have been put forward, but the exact cause of IBS is still uncertain. According to the updated ROME III criteria, IBS is a clinical diagnosis and presents as one of the three predominant subtypes: (1) IBS with constipation (IBS-C); (2) IBS with diarrhea (IBS-D); and (3) mixed IBS (IBS-M); former ROME definitions refer to IBS-M as alternating IBS (IBS-A). Across the IBS subtypes, the presentation of symptoms may vary among patients and change over time. Patients report the most distressing symptoms to be abdominal pain, straining, myalgias, urgency, bloating and feelings of serious illness. The complexity and diversity of IBS presentation makes treatment difficult. Although there are reviews and guidelines for treating IBS, they focus on the efficacy of medications for IBS symptoms using high-priority endpoints, leaving those of lower priority largely unreported. Therefore, the aim of this review is to provide a comprehensive evidence-based review of the diagnosis, pathogenesis and treatment to guide clinicians diagnosing and treating their patients. PMID:24944467
Irritable bowel syndrome (IBS) is a chronic and debilitating functional gastrointestinal disorder that affects 9%-23% of the population across the world. The percentage of patients seeking health care related to IBS approaches 12% in primary care practices and is by far the largest subgroup seen in gastroenterology clinics. It has been well documented that these patients exhibit a poorer quality of life and utilize the health care system to a greater degree than patients without this diagnosis. The pathophysiology of IBS is not clear. Many theories have been put forward, but the exact cause of IBS is still uncertain. According to the updated ROME III criteria, IBS is a clinical diagnosis and presents as one of the three predominant subtypes: (1) IBS with constipation (IBS-C); (2) IBS with diarrhea (IBS-D); and (3) mixed IBS (IBS-M); former ROME definitions refer to IBS-M as alternating IBS (IBS-A). Across the IBS subtypes, the presentation of symptoms may vary among patients and change over time. Patients report the most distressing symptoms to be abdominal pain, straining, myalgias, urgency, bloating and feelings of serious illness. The complexity and diversity of IBS presentation makes treatment difficult. Although there are reviews and guidelines for treating IBS, they focus on the efficacy of medications for IBS symptoms using high-priority endpoints, leaving those of lower priority largely unreported. Therefore, the aim of this review is to provide a comprehensive evidence-based review of the diagnosis, pathogenesis and treatment to guide clinicians diagnosing and treating their patients.
Terplan, Mishka; Ramanadhan, Shaalini; Locke, Abigail; Longinaker, Nyaradzo; Lui, Steve
taken in the presence of other comprehensive care options. However, few studies evaluated obstetrical or neonatal outcomes and rarely did so in a systematic way, making it difficult to assess the effect of psychosocial interventions on these clinically important outcomes. It is important to develop a better evidence base to evaluate psychosocial modalities of treatment in this important population. PMID:25835053
Kazak, Anne E.; Brier, Moriah; Alderfer, Melissa A.; Reilly, Anne; Parker, Stephanie Fooks; Rogerwick, Stephanie; Ditaranto, Susan; Barakat, Lamia P.
Major professional organizations have called for psychosocial risk screening to identify specific psychosocial needs of children with cancer and their families and facilitate the delivery of appropriate evidence-based care to address these concerns. However, systematic screening of risk factors at diagnosis is rare in pediatric oncology practice. Subsequent to a brief summary of psychosocial risks in pediatric cancer and the rationale for screening, this review identified three screening models and two screening approaches (Distress Thermometer [DT], Psychosocial Assessment Tool [PAT]), among many more papers calling for screening. Implications of broadly implemented screening for all patients across treatment settings are discussed. PMID:22492662
Kazak, Anne E; Brier, Moriah; Alderfer, Melissa A; Reilly, Anne; Fooks Parker, Stephanie; Rogerwick, Stephanie; Ditaranto, Susan; Barakat, Lamia P
Major professional organizations have called for psychosocial risk screening to identify specific psychosocial needs of children with cancer and their families and facilitate the delivery of appropriate evidence-based care to address these concerns. However, systematic screening of risk factors at diagnosis is rare in pediatric oncology practice. Subsequent to a brief summary of psychosocial risks in pediatric cancer and the rationale for screening, this review identified three screening models and two screening approaches [Distress Thermometer (DT), Psychosocial Assessment Tool (PAT)], among many more articles calling for screening. Implications of broadly implemented screening for all patients across treatment settings are discussed.
Kerns, Suzanne E. U.; Cevasco, Molly; Comtois, Katherine A.; Dorsey, Shannon; King, Kevin; McMahon, Robert; Sedlar, Georganna; Lee, Terry G.; Mazza, James J.; Lengua, Liliana; Davis, Carol; Evans-Campbell, Tessa; Trupin, Eric W.
States and jurisdictions are under increased pressure to demonstrate the use of evidence-based treatments (EBTs) for children's mental health, increasing the demand for a workforce trained in these practices. Universities are a critical pipeline for this workforce. This article describes the genesis and evolution of a university-based initiative…
Munoz, Ricardo F.; Mendelson, Tamar
Clinical trials have seldom included adequate samples of people of color. Therefore, practitioners serving ethnic minorities often do not have access to readily available evidence-based interventions. This article summarizes the development and empirical evaluation of prevention and treatment manuals designed for low-income ethnic minority…
Laska, Kevin M.; Smith, Tracey L.; Wislocki, Andrew P.; Minami, Takuya; Wampold, Bruce E.
Objective: Various factors contribute to the effective implementation of evidence-based treatments (EBTs). In this study, cognitive processing therapy (CPT) was administered in a Veterans Affairs (VA) posttraumatic stress disorder (PTSD) specialty clinic in which training and supervision were provided following VA implementation guidelines. The…
Gray, Mikel; Bliss, Donna; Klem, Mary Lou
In 2001, the Journal began publishing a special feature the Evidence-Based Report Card. These articles were designed to systematically identify and review evidence pertaining to wound, ostomy and continence specialty practice and summarize recommendations for clinical practice. Based on feedback from WOCN members and Society leadership, the Journal will relaunch this popular and valuable special feature. This article describes methods used to generate Evidence-Based Report Cards, a taxonomy of levels of evidence, and criteria for ranking the strength of recommendations for treatment.
Liddle, Howard A
For over four decades family therapy research and family centered evidence-based therapies for justice-involved youths have played influential roles in changing policies and services for these young people and their families. But research always reveals challenges as well as advances. To be sure, demonstration that an evidence-based therapy yields better outcomes than comparison treatments or services as usual is an accomplishment. But the extraordinary complexity embedded in that assertion feels tiny relative to what we are now learning about the so-called transfer of evidence-based treatments to real world practice settings. Today's family therapy studies continue to assess outcome with diverse samples and presenting problems, but research and funding priorities also include studying particular treatments in nonresearch settings. Does an evidence-based intervention work as well in a community clinic, with clinic personnel? How much of a treatment has to change to be accepted and implemented in a community clinic? Perhaps it is the setting and existing procedures that have to change? And, in those cases, do accommodations to the context compromise outcomes? Thankfully, technology transfer notions gave way to more systemic, dynamic, and frankly, more family therapy-like conceptions of the needed process. Implementation science became the more sensible, as well as the theoretically and empirically stronger overarching framework within which the evidence-based family based therapies now operate. Using the example of Multidimensional Family Therapy, this article discusses treatment development, refinement, and implementation of that adapted approach in a particular clinical context-a sector of the juvenile justice system-juvenile detention.
Dunkel-Jackson, Sarah M.; Dixon, Mark R.; Szekely, Susan
The emerging era of "evidence-based practice" emphasizes that human service agencies need to find effective and efficient means of training staff and implementing systems change based on scientific evidence. Additional advancements in technology use across populations and settings within the field have also served as a catalyst for the development…
Staudt, Marlys; Williams-Hayes, Mona
The objective of this descriptive study was to examine Child Advocacy Center therapists' attitudes toward treatment manuals and evidence-based practices and to gather information about the treatments they use most frequently. An online survey was sent to 30 therapists employed by 15 Child Advocacy Centers in a southeastern state. The response rate was 70%. The respondents generally had positive attitudes toward the use of treatment manuals and the implementation of evidence-based practices. The treatment utilized most frequently was trauma focused cognitive-behavioral therapy. More outcome research of Child Advocacy Center services is needed, and information about how children and parents perceive the acceptability and outcomes of Child Advocacy Center services can be used to enhance services.
Danielson, Carla Kmett; Feeny, Norah C.; Findling, Robert L.; Youngstrom, Eric A.
Despite the severity of bipolar disorder (BP) and the amount of attention the psychosocial treatment of BP among adults has been given (e.g., Basco & Rush, 1996; Miklowitz, Frank, & George, 1996), no published outcome study or psychosocial treatment manual to date exists for children with this disorder. Based upon what is known about the…
Garbacz, Lauren L; Brown, Dawn M; Spee, Grace A; Polo, Antonio J; Budd, Karen S
The current review evaluates the use of treatment fidelity strategies in evidence-based parent training programs for treating externalizing disorders. We used a broad framework for evaluating treatment fidelity developed by the National Institutes of Health Treatment Fidelity Workgroup that includes the aspects of treatment design, treatment delivery, training providers, and assessment of participant receipt of treatment and enactment of treatment skills. Sixty-five articles reporting outcome trials of evidence-based parent training programs met inclusion criteria and were coded for treatment fidelity strategies. The mean adherence to fidelity strategies was .73, which was higher than two previous review studies employing this framework in the health literature. Strategies related to treatment design showed the highest mean adherence (.83), whereas training of providers and enactment of treatment skills had the lowest (.58). In light of an increasing emphasis on effectiveness and dissemination trials, the broader treatment fidelity framework as applied in this review focuses needed attention on areas often overlooked in fidelity practices, such as training providers and generalization of treatment skills. We discuss the strengths and limitations of fidelity practices in parent training studies, implications of these findings, and areas for future research.
Mailis, Angela; Taenzer, Paul
BACKGROUND: The Special Interest Group of the Canadian Pain Society has produced consensus-based guidelines for the pharmacological management of neuropathic pain. The society aimed to generate an additional guideline for other forms of neuropathic pain treatments. OBJECTIVE: To develop evidence-based recommendations for neuropathic pain interventional treatments. METHODS: A task force was created and engaged the Institute of Health Economics in Edmonton, Alberta, to survey the literature pertaining to multiple treatments. Sufficient literature existed on four interventions only: spinal cord stimulation; epidural injections; intravenous infusions; and nerve blocks. A comprehensive search was conducted for systematic reviews, randomized controlled trials and evidence-based clinical practice guidelines; a critical review was generated on each topic. A modified United States Preventive Services Task Force tool was used for quality rating and grading of recommendations. RESULTS: Investigators reviewed four studies of spinal cord stimulation, 19 studies of intravenous infusions, 14 studies of epidural injections and 16 studies of nerve blocks that met the inclusion criteria. The task force chairs rated the quality of evidence and graded the recommendations. Feedback was solicited from the members of the task force. CONCLUSION: There is sufficient evidence to support recommendations for some of these interventions for selected neuropathic pain conditions. This evidence is, at best, moderate and is often limited or conflicting. Pain practitioners are encouraged to explore evidence-based treatment options before considering unproven treatments. Full disclosure of risks and benefits of the available options is necessary for shared decision making and informed consent. PMID:22606679
Fitzcharles, Mary-Ann; Buskila, Dan; Shir, Yoram; Sommer, Claudia
Objective. Current evidence indicates that there is no single ideal treatment for fibromyalgia syndrome (FMS). First choice treatment options remain debatable, especially concerning the importance of complementary and alternative medicine (CAM) treatments. Methods. Three evidence-based interdisciplinary guidelines on FMS in Canada, Germany, and Israel were compared for their first choice and CAM-recommendations. Results. All three guidelines emphasized a patient-tailored approach according to the key symptoms. Aerobic exercise, cognitive behavioral therapy, and multicomponent therapy were first choice treatments. The guidelines differed in the grade of recommendation for drug treatment. Anticonvulsants (gabapentin, pregabalin) and serotonin noradrenaline reuptake inhibitors (duloxetine, milnacipran) were strongly recommended by the Canadian and the Israeli guidelines. These drugs received only a weak recommendation by the German guideline. In consideration of CAM-treatments, acupuncture, hypnosis/guided imagery, and Tai Chi were recommended by the German and Israeli guidelines. The Canadian guidelines did not recommend any CAM therapy. Discussion. Recent evidence-based interdisciplinary guidelines concur on the importance of treatment tailored to the individual patient and further emphasize the need of self-management strategies (exercise, and psychological techniques). PMID:24348701
Sonne, Charlotte; Carlsson, Jessica; Bech, Per; Vindbjerg, Erik; Mortensen, Erik Lykke; Elklit, Ask
Background The effects of treatment in trials with trauma-affected refugees vary considerably not only between studies but also between patients within a single study. However, we know little about why some patients benefit more from treatment, as few studies have analysed predictors of treatment outcome. Objective The objective of the study was to examine possible psychosocial predictors of treatment outcome for trauma-affected refugees. Method The participants were 195 adult refugees with posttraumatic stress disorder (PTSD) who were enrolled in a 6- to 7-month treatment programme at the Competence Centre for Transcultural Psychiatry (CTP), Denmark. The CTP Predictor Index used in the study included 15 different possible outcome predictors concerning the patients’ past, chronicity of mental health problems, pain, treatment motivation, prerequisites for engaging in psychotherapy, and social situation. The primary outcome measure was PTSD symptoms measured on the Harvard Trauma Questionnaire (HTQ). Other outcome measures included the Hopkins Symptom Check List-25, the WHO-5 Well-being Index, Sheehan Disability Scale, Hamilton Depression and Anxiety Scales, the somatisation scale of the Symptoms Checklist-90, Global Assessment of Functioning scales, and pain rated on visual analogue scales. The relations between treatment outcomes and the total score as well as subscores of the CTP Predictor Index were analysed. Results Overall, the total score of the CTP Predictor Index was significantly correlated to pre- to post treatment score changes on the majority of the ratings mentioned above. While employment status was the only single item significantly correlated to HTQ-score changes, a number of single items from the CTP Predictor Index correlated significantly with changes in depression and anxiety symptoms, but the size of the correlation coefficients were modest. Conclusions The total score of the CTP Predictor Index correlated significantly with outcomes on most
Given the importance of the term 'evidence' in evidence-based medicine (EBM), the meaning of this term is evaluated, going back to the philosophical tradition and current meaning of the terms 'evidence' and 'truth'. Based on this, current problems in the definition of evidence and in the grading of evidence in EBM are described, taking examples from the field of psychiatry and especially pharmacopsychiatry. These problems underline that the use of the term evidence in EBM is inconsistent and inconclusive. This should be fairly stated in all EBM-related publications, especially in EBM-based guidelines, to avoid severe misunderstandings in and outside the field of psychiatry. Although EBM might have increased empirically driven rational decision-making in psychiatry/medicine, the current limitations should be carefully considered.
The 2003 Texas 78th Legislature passed a bill that implemented several strategies to help realize a $1 billion decrease to health and human services spending (Senate Research Committee, 2003). A component of House Bill (HB) 2292 aimed at cost savings was the requirement for implementation of a resiliency and disease management model of service delivery in public mental health. As operationalized by the newly formed Department of State Health Services, the result was the legislation of evidence-based practice in community mental health in Texas. The purpose of this paper is to examine and analyze the policy change requiring a resiliency and disease management model for children's public mental health in response to HB 2292.
Houston, Brian A; Kalathiya, Rohan J; Kim, Daniel A; Zakaria, Sammy
Acute decompensated heart failure is the leading cause of hospital admission in the United States, with a high risk of readmission within 30 days. Most acute decompensated heart failure admissions are driven by congestive signs and symptoms resulting from fluid and sodium overload. We reviewed the evidence base addressing the management and prevention of fluid overload in heart failure, focusing on recent clinical trials. All the references in this review were obtained through PubMed and had at least 1 of the following key words: heart failure and volume overload, congestion, loop diuretics, thiazide diuretics, aldosterone antagonists, dopamine, cardiorenal syndrome, nesiritide, vasopressin antagonists, ultrafiltration, sodium restriction, fluid restriction, telemonitoring, and invasive hemodynamic monitoring. We also reviewed relevant references cited in the obtained articles, especially articles addressing methods of treating or preventing volume overload in patients with heart failure.
Crisp, Heather L.; Gudmundsen, Gretchen R.; Shirk, Stephen R.
This paper describes the Adolescent Mood Project (Project AMP), a study transporting an evidence-based, cognitive-behavioral treatment (CBT) for adolescent depression from the university lab setting to a school-based setting. Extant research on the psychosocial treatment of adolescent depression is reviewed and rationale for transporting evidence…
Lundgren, Lena; Krull, Ivy; Zerden, Lisa de Saxe; McCarty, Dennis
This national study of community-based addiction-treatment organizations' (CBOs) implementation of evidence-based practices explored CBO Program Directors' (n = 296) and clinical staff (n = 518) attitudes about the usefulness of science-based addiction treatment. Through multivariable regression modeling, the study identified that identical…
Berninger, Virginia W; May, Maggie O'Malley
Programmatic, multidisciplinary research provided converging brain, genetic, and developmental support for evidence-based diagnoses of three specific learning disabilities based on hallmark phenotypes (behavioral expression of underlying genotypes) with treatment relevance: dysgraphia (impaired legible automatic letter writing, orthographic coding, and finger sequencing), dyslexia (impaired pseudoword reading, spelling, phonological and orthographic coding, rapid automatic naming, and executive functions; inhibition and rapid automatic switching), and oral and written language learning disability (same impairments as dyslexia plus morphological and syntactic coding and comprehension). Two case studies illustrate how these differential diagnoses can be made within a conceptual framework of a working memory architecture and generate treatment plans that transformed treatment nonresponders into treatment responders. Findings are discussed in reference to the importance of (a) considering individual differences (diagnosis of impaired hallmark phenotypes) in planning and evaluating response to instruction and modifying instruction when a student is not responding; (b) recognizing that teaching may change epigenetic gene expression at one stage of schooling, but not the underlying gene sequences that render individuals still vulnerable as curriculum requirements increase in nature, complexity, and volume in the upper grades; and (c) using evidence-based diagnoses of specific learning disabilities that are consistent across states for free and appropriate education K to 12 and for accommodations throughout higher education and professional credentialing.
Pineau, Joelle; Bellemare, Marc G; Rush, A John; Ghizaru, Adrian; Murphy, Susan A
This paper details a new methodology, instance-based reinforcement learning, for constructing adaptive treatment strategies from randomized trials. Adaptive treatment strategies are operationalized clinical guidelines which recommend the next best treatment for an individual based on his/her personal characteristics and response to earlier treatments. The instance-based reinforcement learning methodology comes from the computer science literature, where it was developed to optimize sequences of actions in an evolving, time varying system. When applied in the context of treatment design, this method provides the means to evaluate both the therapeutic and diagnostic effects of treatments in constructing an adaptive treatment strategy. The methodology is illustrated with data from the STAR*D trial, a multi-step randomized study of treatment alternatives for individuals with treatment-resistant major depressive disorder.
Eilers, June; Harris, Debra; Henry, Karen; Johnson, Lee Ann
Mucositis is an inflammatory process that can involve the mucosal epithelial cells from the mouth to the rectum. Historically, mucositis and stomatitis were used interchangeably, but momentum has increased toward more specific terminology since the 2000s. Stomatitis refers to inflammatory diseases of the mouth, including the mucosa, dentition, periapices, and periodontium, whereas mucositis refers more globally to an inflammatory process involving the mucous membranes of the oral cavity and the gastrointestinal tract. In addition, differentiation is needed regarding mucositis involving the oral cavity and the remainder of the gastrointestinal tract that require use of a scope-type device for close examination. As a result, oral cavity mucositis has been the focus of the majority of the studies reported to date. The mucous membranes beyond the oral cavity are more challenging to view, so the mouth has been presented as revealing potential changes in the gastrointestinal tract. However, because of the variation in morphology, function of different locations, and risks associated with procedures to validate that speculation, evidence is limited. The purpose of this article is to review evidence-based interventions for mucositis, particularly in the oral cavity, and provide clinicians with guidelines for nursing interventions.
08-2-0076 TITLE: Telemedicine for Improved Delivery of Psychosocial Treatments for Post Traumatic Stress Disorder PRINCIPAL INVESTIGATOR...SUBTITLE Telemedicine for Improved Delivery of Psychosocial Treatments for Post-Traumatic Stress Disorder 5a. CONTRACT NUMBER 5b. GRANT...ABSTRACT: Background: Posttraumatic stress disorder (PTSD) is considered a major public health problem in the U.S. because it has fairly high prevalence
Stark, Kevin D.; Arora, Prerna; Funk, Catherine L.
Cognitive behavioral therapy is an effective approach to the treatment of depressive disorders within schools, due to its demonstrated efficacy, as well as its availability in manualized treatment form. When implemented by therapists with inadequate training, the treatment is often stilted, less engaging for participants, and aimlessly guided…
Richter, Holly E.
Fecal incontinence (FI) is a debilitating disorder which negatively impacts quality of life. The etiology is often multifactorial and although most women with FI are able to be treated, many remain untreated because a significant proportion of women do not report their symptoms and seek care. The evaluation and treatment of FI can be also hindered by a lack of understanding of the mechanisms and current options. This article provides a review on the evidence-based evaluation and management for FI. PMID:25505643
Elis, Ori; Caponigro, Janelle M.; Kring, Ann M.
Schizophrenia can be a chronic and debilitating psychiatric disorder. Though advancements have been made in the psychosocial treatment of some symptoms of schizophrenia, people with schizophrenia often continue to experience some level of symptoms, particularly negative symptoms, throughout their lives. Because negative symptoms are associated with poor functioning and quality of life, the treatment of negative symptoms is a high priority for intervention development. However, current psychosocial treatments primarily focus on the reduction of positive symptoms with comparatively few studies investigating the efficacy of psychosocial treatments for negative symptoms. In this article, we review and evaluate the existing literature on three categories of psychosocial treatments – cognitive behavioral therapy (CBT), social skills training (SST), and combined treatment interventions – and their impact on the negative symptoms of schizophrenia. Of the interventions reviewed, CBT and SST appear to have the most empirical support, with some evidence suggesting that CBT is associated with maintenance of negative symptom improvement beyond six months after treatment. It remains unclear if a combined treatment approach provides improvements above and beyond those associated with each individual treatment modality. Although psychosocial treatments show promise for the treatment of negative symptoms, there are many unanswered questions about how best to intervene. We conclude with a general discussion of these unanswered questions, future directions and methodological considerations, and suggestions for the further development of negative symptom interventions. PMID:23988452
Cortese, S; Rosello-Miranda, R
The evidence base from empirical studies is one of the elements, along with patients' preference and consideration of particular clinical state and circumstances, that should be taken into account in the process of clinical decision making. This paper provides an overview of the current evidence base for the treatment of attention-deficit-hyperactivity disorder (ADHD), drawing on the results of the most recent meta-analyses of randomized controlled trials assessing the pharmacological and non-pharmacological treatment of ADHD. Overall, available recent meta-analyses show that psychostimulants, and, although to a less extent, non psychostimulants, are efficacious in terms of control of core ADHD symptoms, at least in the short term; and although the efficacy of non-pharmacological treatments (behavioral interventions, diet, cognitive training and neurofeedback) for ADHD core symptoms remains uncertain, some non-pharmacological approach are efficacious for ADHD-related problems, such as behavioral interventions for oppositional problems and parenting skills, and cognitive training for working memory deficits. However, most of the available randomized controlled trials are short-term efficacy trials recruiting selected populations of patients and, as such, they are not fully informative for the daily clinical practice. Head-to-head trials, pragmatic trials, placebo-withdrawal trials, network meta-analyses and individual patient data meta-analyses are encouraged in the field to bridge the gap between theoretical evidence and daily clinical practice.
The presence of a gingival recession prior to orthodontic treatment is a real problem. Patients are concerned about losing their teeth but may also complain of their unpleasant appearance or root sensitivity in the exposed area. The orthodontist is not sure whether orthodontic treatment can be performed or whether the tooth movement will not aggravate the recession and whether periodontal surgery needs to be done before or after orthodontic treatment. The aim of this paper is to present recent data from the literature and several clinical situations in adults in order to submit a treatment sequence and clarify the role of different periodontal plastic surgery root coverage procedures.
Blake, Margaret Lehman; Frymark, Tobi; Venedictov, Rebecca
Purpose: The purpose of this review is to evaluate and summarize the research evidence related to the treatment of individuals with right hemisphere communication disorders. Method: A comprehensive search of the literature using key words related to right hemisphere brain damage and communication treatment was conducted in 27 databases (e.g.,…
Barlow, David H; Bullis, Jacqueline R; Comer, Jonathan S; Ametaj, Amantia A
Enormous progress in the field of clinical science has been made over the past 50 years, with advances in our understanding of psychopathology and more sophisticated research methodology leading to the development of more efficacious psychological treatments for a variety of behavioral disorders. Despite these advances, the public health impact of well-established psychological treatments is less than it should be. After an overview of the current status of the field, we identify barriers that must be overcome to maximize the public health impact and propose that to breach these barriers we must (a) augment the efficacy of treatments, (b) broaden the impact of treatments across diagnoses to include temperamental variables, (c) attend more closely to mechanisms of action of treatments, and (d) learn the best methods for disseminating and implementing psychological interventions. We conclude by proposing new directions in both research and clinical practice to accomplish these goals.
Contarino, Maria Fiorella; Van Den Dool, Joost; Balash, Yacov; Bhatia, Kailash; Giladi, Nir; Koelman, Johannes H.; Lokkegaard, Annemette; Marti, Maria J.; Postma, Miranda; Relja, Maja; Skorvanek, Matej; Speelman, Johannes D.; Zoons, Evelien; Ferreira, Joaquim J.; Vidailhet, Marie; Albanese, Alberto; Tijssen, Marina A. J.
Cervical dystonia (CD) is the most frequent form of focal dystonia. Symptoms often result in pain and functional disability. Local injections of botulinum neurotoxin are currently the treatment of choice for CD. Although this treatment has proven effective and is widely applied worldwide, many issues still remain open in the clinical practice. We performed a systematic review of the literature on botulinum toxin treatment for CD based on a question-oriented approach, with the aim to provide practical recommendations for the treating clinicians. Key questions from the clinical practice were explored. Results suggest that while the beneficial effect of botulinum toxin treatment on different aspects of CD is well established, robust evidence is still missing concerning some practical aspects, such as dose equivalence between different formulations, optimal treatment intervals, treatment approaches, and the use of supportive techniques including electromyography or ultrasounds. Established strategies to prevent or manage common side effects (including excessive muscle weakness, pain at injection site, dysphagia) and potential contraindications to this treatment (pregnancy and lactation, use of anticoagulants, neurological comorbidities) should also be further explored. PMID:28286494
Contarino, Maria Fiorella; Van Den Dool, Joost; Balash, Yacov; Bhatia, Kailash; Giladi, Nir; Koelman, Johannes H; Lokkegaard, Annemette; Marti, Maria J; Postma, Miranda; Relja, Maja; Skorvanek, Matej; Speelman, Johannes D; Zoons, Evelien; Ferreira, Joaquim J; Vidailhet, Marie; Albanese, Alberto; Tijssen, Marina A J
Cervical dystonia (CD) is the most frequent form of focal dystonia. Symptoms often result in pain and functional disability. Local injections of botulinum neurotoxin are currently the treatment of choice for CD. Although this treatment has proven effective and is widely applied worldwide, many issues still remain open in the clinical practice. We performed a systematic review of the literature on botulinum toxin treatment for CD based on a question-oriented approach, with the aim to provide practical recommendations for the treating clinicians. Key questions from the clinical practice were explored. Results suggest that while the beneficial effect of botulinum toxin treatment on different aspects of CD is well established, robust evidence is still missing concerning some practical aspects, such as dose equivalence between different formulations, optimal treatment intervals, treatment approaches, and the use of supportive techniques including electromyography or ultrasounds. Established strategies to prevent or manage common side effects (including excessive muscle weakness, pain at injection site, dysphagia) and potential contraindications to this treatment (pregnancy and lactation, use of anticoagulants, neurological comorbidities) should also be further explored.
Steketee, G; Perry, JC; Goisman, RM; Warshaw, MG; Massion, AO; Peterson, LG; Langford, L; Weinshenker, N; Farreras , IG; Keller , MB
The authors report on development, reliability, and findings of the Psychosocial Treatments Interview (PTI) to assess treatments reported by patients in a naturalistic study of the longitudinal course of anxiety disorders. The PTI ascertains frequency of different types of psychosocial treatments, based on patients' reports. The PTI showed good internal consistency and very good interrater reliability. At first 6-month follow-up, the most common modalities were supportive, medication discussion, and dynamic intervention. Combinations were common. Delivery of treatments differed by site. Overall, the PTI fills a methodological need for the assessment of the treatments reported by patients in naturalistic follow-up studies. PMID:9185065
Steketee, G; Perry, J C; Goisman, R M; Warshaw, M G; Massion, A O; Peterson, L G; Langford, L; Weinshenker, N; Farreras, I G; Keller, M B
The authors report on development, reliability, and findings of the Psychosocial Treatments Interview (PTI) to assess treatments reported by patients in a naturalistic study of the longitudinal course of anxiety disorders. The PTI ascertains frequency of different types of psychosocial treatments, based on patients' reports. The PTI showed good internal consistency and very good interrater reliability. At first 6-month follow-up, the most common modalities were supportive, medication discussion, and dynamic intervention. Combinations were common. Delivery of treatments differed by site. Overall, the PTI fills a methodological need for the assessment of the treatments reported by patients in naturalistic follow-up studies.
Younker, D.R.; Daniels, V.R.; Boyd, J.L.; Putcha, L.
An objective of this data compilation and analysis project is to examine incidence and treatment efficacy of common patho-physiological disturbances during spaceflight. Analysis of medical debriefs data indicated that astronauts used medications to alleviate symptoms of four major ailments for which astronauts received treatment for sleep disturbances, space motion sickness (SMS), pain (headache, back pain) and sinus congestion. In the present data compilation and analysis project on SMS treatment during space missions, subject demographics (gender, age, first-time or repeat flyer), incidence and severity of SMS symptoms and subjective treatment efficacy from 317 crewmember debrief records were examined from STS-1 through STS-89. Preliminary analysis of data revealed that 50% of crew members reported SMS symptoms on at least one flight and 22% never experienced it. In addition, there were 387 medication dosing episodes reported, and promethazine was the most commonly used medication. Results of analysis of symptom check lists, medication use/efficacy and gender and flight record differences in incidence and treatment efficacy will be presented. Evidence gaps for treatment efficacy along with medication use trend analysis will be identified.
Fox, Aaron D.; Masyukova, Mariya; Cunningham, Chinazo O.
Background Buprenorphine maintenance treatment is effective and has been successfully integrated into HIV and primary care settings. However, one key barrier to providers prescribing buprenorphine is their perception that they are unable to provide adequate counseling or psychosocial support to patients with opioid addiction. This qualitative study investigated supportive elements of office-based buprenorphine treatment that patients perceived to be most valuable. Methods We conducted five focus groups with 33 buprenorphine treatment-experienced participants. Focus groups were audio-recorded and transcribed. Iterative readings of transcripts and grounded theory analysis revealed common themes. Results Overall, participants perceived that buprenorphine treatment helped them to achieve their treatment goals and valued the flexibility, accessibility, and privacy of treatment. Participants identified interpersonal and structural elements of buprenorphine treatment that provided psychosocial support. Participants desired good physician-patient relationships, but also valued care delivery models that were patient-centered, created a safe place for self-disclosure, and utilized coordinated team-based care. Conclusions Participants derived psychosocial support from their prescribing physician, but were also open to collaborative or team-based models of care, as long as they were voluntary and confidential. Buprenorphine prescribing physicians without access to referral options for psychosocial counseling could focus on maintaining non-judgmental attitudes and shared decision making during patient encounters. Adding structure and psychosocial support to buprenorphine treatment through coordinated team-based care also seems to have great promise. PMID:26566712
Faherty, John K.
This paper presents a review of relevant medical and psychological literature that addresses the psychological characteristics of heroin addiction and addicts: dependence (both physical and psychological); explanations of the phenomenon of addiction (both medical and behavioral); and other psychosocial views of causation including escapism,…
Lack, Caleb W
Over the past three decades, obsessive-compulsive disorder (OCD) has moved from an almost untreatable, life-long psychiatric disorder to a highly manageable one. This is a very welcome change to the 1%-3% of children and adults with this disorder as, thanks to advances in both pharmacological and psychological therapies, prognosis for those afflicted with OCD is quite good in the long term, even though most have comorbid disorders that are also problematic. We still have far to go, however, until OCD can be described as either easily treatable or the effective treatments are widely known about among clinicians. This review focuses on the current state of the art in treatment for OCD and where we still are coming up short in our work as a scientific community. For example, while the impact of medications is quite strong for adults in reducing OCD symptoms, current drugs are only somewhat effective for children. In addition, there are unacceptably high relapse rates across both populations when treated with pharmacological alone. Even in the cognitive-behavioral treatments, which show higher effect sizes and lower relapse rates than drug therapies, drop-out rates are at a quarter of those who begin treatment. This means a sizable portion of the OCD population who do obtain effective treatments (which appears to be only a portion of the overall population) are not effectively treated. Suggestions for future avenues of research are also presented. These are primarily focused on (1) increased dissemination of effective therapies; (2) augmentation of treatments for those with residual symptoms, both for psychotherapy and pharmacotherapy; and (3) the impact of comorbid disorders on treatment outcome. PMID:24175173
Mitchell, Sandra A; Hoffman, Amy J; Clark, Jane C; DeGennaro, Regina M; Poirier, Patricia; Robinson, Carolene B; Weisbrod, Breanna L
Cancer-related fatigue (CRF) has deleterious effects on physical, social, cognitive, and vocational functioning, and causes emotional and spiritual distress for patients and their families; however, it remains under-recognized and undertreated. This article critically reviews and integrates the available empirical evidence supporting the efficacy of pharmacologic and nonpharmacologic treatment approaches to CRF, highlighting new evidence since 2007 and 2009 Putting Evidence Into Practice publications. Interventions that are recommended for practice or likely to be effective in improving fatigue outcomes include exercise; screening for treatable risk factors; management of concurrent symptoms; yoga; structured rehabilitation; Wisconsin ginseng; cognitive-behavioral therapies for insomnia, pain, and depression; mindfulness-based stress reduction; and psychoeducational interventions such as anticipatory guidance, psychosocial support, and energy conservation and activity management. This information can be applied to improve the management of CRF, inform health policy and program development, shape the design of clinical trials of new therapies for CRF, and drive basic and translational research.
de Oliveira, Márcio Moysés; Conti, Cristiane Fiquene; Valbuza, Juliana Spelta; de Carvalho, Luciane Bizari Coin; do Prado, Gilmar Fernandes
Restless legs syndrome (RLS) is a common and often misdiagnosed entity among the general population and it may be more common among dialysis patients, with an estimated prevalence of 6.6 to 21.5%. The treatment for uremic RLS has been controversial and therefore a systematic synthesis of the evidence is needed in order to evaluate the effectiveness and safety of treatments for uremic RLS. This was a systematic review of randomized or quasi-randomized double-blind trials on treatments for uremic RLS. The outcomes considered were relief of RLS symptoms marked on a validated scale, subjective sleep quality, sleep quality measured using night polysomnography and actigraphy, quality of life measured subjectively, and adverse events associated with these treatments. Six eligible clinical trials were included. The results from subjective analyses in these studies were divergent, although objective analyses in one trial showed that there was a statistically significant improvement in periodic leg movement while asleep in the treatment group. No combined analysis (meta-analysis) was performed. The most common adverse event seen was gastrointestinal symptoms. Only a few therapeutic trials on patients with uremia with RLS have been published, and there is insufficient scientific evidence to favor any specific therapeutic regimen for uremic-associated RLS. Therapy using levodopa, dopaminergic agonists, anticonvulsants, and clonidine tend to be effective, but further studies are needed.
Baumeister, Harald; Lin, Jiaxi; Ebert, David Daniel
Technology-based approaches for psychosocial diagnostics and interventions provide an attractive opportunity to optimize medical rehabilitation. Based on an Internet- and mobile-based assessment of existing functional health impairments, appropriate planning, implementation of corresponding courses of action as well as outcome assessment can take place. This can be implemented in the form of Internet- and mobile-based interventions (IMI).The present article provides an overview of the basic knowledge of IMI and their evidence base both in general and in particular for their use in medical rehabilitation. Important aspects of internet and mobile-based psycho-social diagnostics are discussed subsequently. Finally, an outlook for the use of Internet- and mobile-based diagnostics and interventions in medical rehabilitation is given.
Franklin, Rachel; Zorowitz, Sam; Corse, Andrew K; Widge, Alik S; Deckersbach, Thilo
Bipolar disorder (BD) is a debilitating and difficult-to-treat psychiatric disease that presents a serious burden to patients’ lives as well as health care systems around the world. The essential diagnostic criterion for BD is episodes of mania or hypomania; however, the patients report that the majority of their time is spent in a depressive phase. Current treatment options for this component of BD have yet to achieve satisfactory remission rates. Lurasidone is a drug in the benzisothiazole class approved by the US Food and Drug Administration in June 2013 for the acute treatment of bipolar depression. Its pharmacological profile features high-affinity antagonism at D2, 5-HT2A, and 5-HT7 receptors; moderate-affinity antagonism at α2C-adrenergic receptors; low- to very low-affinity antagonism at α1A-adrenergic, α2A-adrenergic, H1, M1, and 5-HT2C receptors; and high-affinity partial agonism at 5-HT1A. Preliminary findings from two recent double-blinded clinical trials suggest that lurasidone is efficacious in treating bipolar I depression, with clinical effects manifesting as early as the first 2–3 weeks of treatment (as measured by the Montgomery–Åsberg Depression Rating Scale and Clinical Global Impressions Scale for use in bipolar illness). Its therapeutic benefit appears to be comparable to the current US Food and Drug Administration-indicated treatments: quetiapine and olanzapine–fluoxetine, according to a measure of effect size known as number needed to treat. These studies reported relatively limited extrapyramidal and metabolic side effects as a result of treatment with lurasidone, with the most common side effect being nausea. Safety data drawn from these studies, as well as a more extensive body of schizophrenia research, indicate that in comparison with other atypical antipsychotics, treatment with lurasidone is less likely to result in metabolic side effects such as weight gain or disturbances of serum glucose or lipid levels. Lurasidone
Crabb, Rebecca M; Areán, Patricia A; Hegel, Mark T
Training models that incorporate case supervision in addition to didactic instruction appear to be effective in maximizing clinicians' proficiency in evidence-based treatments (EBTs). However, it is unknown the extent to which these models promote sustained adoption of EBTs. We describe the results of an online survey on post-training utilization of an EBT, problem-solving therapy (PST), among 40 clinicians highly trained in PST. Seventy-five percent of the survey's 40 respondents reported that they continued to use PST in their clinical practices. Many PST-trained clinicians reported that they had modified the PST protocol in their clinical practices according to patient characteristics or preferences. Considering these results, we recommend emphasizing patient variability and treatment tailoring throughout the training process as a means for promoting clinicians' sustained adoption of EBTs.
Kuhn, John E
A systematic review of the literature was performed to evaluate the role of exercise in treating rotator cuff impingement and to synthesize a standard evidence-based rehabilitation protocol. Eleven randomized, controlled trials (level 1 and 2) evaluating the effect of exercise in the treatment of impingement were identified. Data regarding demographics, methodology, and outcomes of pain, range of motion, strength, and function were recorded. Individual components of each rehabilitation program were catalogued. Effectiveness was determined by statistical and clinical significance. Although many articles had methodologic concerns, the data demonstrate that exercise has statistically and clinically significant effects on pain reduction and improving function, but not on range of motion or strength. Manual therapy augments the effects of exercise, yet supervised exercise was not different than home exercise programs. Information regarding specific components of the exercise programs was synthesized into a gold standard rehabilitation protocol for future studies on the nonoperative treatment of rotator cuff impingement.
The field of research and practice in psychotherapy has been deeply influenced by two different approaches: the empirically supported treatments (ESTs) movement, linked with the evidence-based medicine (EBM) perspective and the “Common Factors” approach, typically connected with the “Dodo Bird Verdict”. About the first perspective, since 1998 a list of ESTs has been established in mental health field. Criterions for “well-established” and “probably efficacious” treatments have arisen. The development of these kinds of paradigms was motivated by the emergence of a “managerial” approach and related systems for remuneration also for mental health providers and for insurance companies. In this article ESTs will be presented underlining also some possible criticisms. Finally complementary approaches, that could add different evidence in the psychotherapy research in comparison with traditional EBM approach, are presented. PMID:21833197
Owens, Joyce L; Hanson, Sheila J; McArthur, Jennifer A; Mikhailov, Theresa A
High survival rates for pediatric leukemia are very promising. With regard to treatment, children tend to be able to withstand a more aggressive treatment protocol than adults. The differences in both treatment modalities and outcomes between children and adults make extrapolation of adult studies to children inappropriate. The higher success is associated with a significant number of children experiencing nutrition-related adverse effects both in the short and long term after treatment. Specific treatment protocols have been shown to deplete nutrient levels, in particular antioxidants. The optimal nutrition prescription during, after and long-term following cancer treatment is unknown. This review article will provide an overview of the known physiologic processes of pediatric leukemia and how they contribute to the complexity of performing nutritional assessment in this population. It will also discuss known nutrition-related consequences, both short and long term in pediatric leukemia patients. Since specific antioxidants have been shown to be depleted as a consequence of therapy, the role of oxidative stress in the pediatric leukemia population will also be explored. More pediatric studies are needed to develop evidence based therapeutic interventions for nutritional complications of leukemia and its treatment.
McHugh, R. Kathryn; Barlow, David H.
Recognizing an urgent need for increased access to evidenced-based psychological treatments, public health authorities have recently allocated over $2 billion to better disseminate these interventions. In response, implementation of these programs has begun, some of it on a very large scale, with substantial implications for the science and…
Prochaska, Judith J.; Fromont, Sebastien C.; Leek, Desiree; Hudmon, Karen Suchanek; Louie, Alan K.; Jacobs, Marc H.; Hall, Sharon M.
Objective: Smokers with mental illness and addictive disorders account for nearly one in two cigarettes sold in the United States and are at high risk for smoking-related deaths and disability. Psychiatry residency programs provide a unique arena for disseminating tobacco treatment guidelines, influencing professional norms, and increasing access…
May, Anna C.; Rudy, Brittany M.; Davis, Thompson E., III; Matson, Johnny L.
Specific phobias are among the most common anxiety disorders, especially in children. Unfortunately, a paucity of literature exists regarding the treatment of specific phobia in young children, despite the knowledge that traditional techniques (i.e., cognitive-behavioral therapy [CBT]) may not be practical. Therefore, the purpose of this article…
Lundgren, Lena M.; Schilling, Robert F.; Peloquin, Susan D.
This article examined the extent to which methadone maintenance (MM) is considered a treatment alternative for drug-dependent parents, as reflected in the social work and child welfare literature and in child welfare policies. Findings were derived from a review of 15 social work journals published from 1996 through 2002 and from a review of child…
Odom, Samuel; Hume, Kara; Boyd, Brian; Stabel, Aaron
Professionals serving students with autism spectrum disorders (ASD) in inclusive classroom settings face the challenge of selecting and successfully implementing evidence-based intervention strategies. Many propose that Intensive Behavioral Treatment (IBT) is the most efficacious approach for learners with ASD. Evidence for this approach is often established by comparing the IBT model to a condition described as "eclectic". In this paper, authors examine the IBT vs. eclectic literature, acknowledge the potential efficacy of the IBT model with preschool-aged children, suggest concerns about efficacy studies that have compared IBT and eclectic programs, point out that most of the studies were restricted in the age range of their participants, and note that few were implemented in inclusive settings. The authors propose that a technical eclectic approach can be beneficial for children and youth with ASD if it is conceptually grounded, incorporates evidence-based focused intervention practices, and is well implemented. A detailed example of such a technical eclectic program model is provided and the practicality of such an approach in inclusive settings for children and youth with ASD and their families is discussed.
Gillespie, Erin F; Smith, Terry J; Douglas, Raymond S
Thyroid eye disease (TED) is the most common extrathyroidal manifestation of Graves' disease. Incomplete understanding of its pathogenesis has hindered development of targeted therapies that might alter the natural course of disease. Smoking cessation and maintenance of euthyroidism appear to reduce the rate of onset and severity of TED. Recent evidence suggests that selenium may lessen the inflammatory symptoms in mild disease. Corticosteroids remain the primary treatment for patients with moderate to severe active TED. Surgical decompression is commonly undertaken in the chronic stable phase, and only rarely in the active phase when vision is threatened by compressive optic neuropathy. Orbital radiotherapy remains an adjunctive strategy during active disease. Targeted immunotherapies have the potential to alter disease progression, but further evidence is needed to establish safety and efficacy. In this article, we review evidence from prospective therapeutic trials of several treatment modalities. We focus on moderate to severe active TED.
Brogan, P; Bose, A; Burgner, D; Shingadia, D; Tulloh, R; Michie, C; Klein, N; Booy, R; Levin, M; Dillon, M
This article proposes a clinical guideline for the diagnosis and treatment of Kawasaki disease in the UK based on the best available evidence to date, and highlights areas of practice where evidence is anecdotal or based on retrospective data. Future research as proposed by the London Kawasaki Disease Research Group is outlined, and clinicians are invited to prospectively enrol their suspected cases into this collaborative research project. PMID:11919108
Burke, Matthew J.; Fralick, Michael; Nejatbakhsh, Nasrin; Tartaglia, Maria C.; Tator, Charles H.
Abstract Objective: To assess the characteristics of current clinical trials investigating the treatment of concussion. Background: Recent systematic literature reviews have concluded that there is minimal evidence to support any specific treatment for concussion, including the principles of return-to-activity protocols such as type or duration of rest. Design/methods: Clinical trial data was extracted from Clinicaltrials.gov and seven additional World Health Organization primary registries. The trial databases were accessed up until 3 October 2013. This study used search terms of ‘concussion’ or ‘mild traumatic brain injury’ (mTBI) and filtered for interventional trials. Trials that were terminated, already published or not interventional trials of concussion/mTBI were excluded. Results: Of the 142 concussion/mTBI interventional clinical trials identified, 71 met inclusion criteria. Trials had a median estimated enrolment of 60 participants. There was a wide-range of treatments studied, including cognitive/behavioural therapies (28.2%), medications (28.2%), devices (11.3%), dietary supplements (8.5%), return-to-activity/rest (1.4%) and others (22.4%). Heterogeneity among trials for concussion identification/diagnosis and primary outcomes utilized was evident. Symptom-based questionnaires (39.4%) and neuropsychological tests (28.2%) were the most common outcome measures. Conclusions: Diverse, potentially promising therapeutics are currently being studied for the treatment of concussion. However, several deficiencies were identified including a paucity of trials addressing return-to-activity principles. Also, small sample size and trial heterogeneity may threaten scientific evaluation and subsequent clinical application. PMID:25383510
George, Mark S.; Taylor, Joseph J.; Short, E. Baron
Purpose of review Daily left prefrontal transcranial magnetic stimulation (TMS) for several weeks was first proposed as an acute treatment for depression in the early 1990’s, and was FDA approved in 2008. In the past year several important studies have been published that extend our understanding of this novel treatment approach. Recent findings The first round of multisite clinical trials with TMS addressed whether prefrontal rTMS has efficacy and were conducted in carefully selected depressed patients who were antidepressant medication free. Several more recent studies assess the clinical effectiveness of TMS and report that about 35–40% of real world patients who are commonly taking adjunctive antidepressants reach remission with a modest side effect profile. There are also new studies examining the durability of the TMS induced antidepressant effect. 58% of TMS remitters remain remitted at 3-month follow-up. Summary These recent studies suggest that daily left prefrontal TMS over several weeks as a treatment for depression appears to not only have efficacy in rigorous randomized controlled trials, but is effective in real world settings, with remission in 30–40% of patients. The TMS antidepressant effect, once achieved, appears to be as durable as with other antidepressant medications or interventions. Much more research is needed, particular with issues such as the TMS coil location, stimulation intensity and frequency, and dosing strategy. PMID:23154644
Narayanaswami, Pushpa; Weiss, Michael; Selcen, Duygu; David, William; Raynor, Elizabeth; Carter, Gregory; Wicklund, Matthew; Barohn, Richard J.; Ensrud, Erik; Griggs, Robert C.; Gronseth, Gary; Amato, Anthony A.
Objective: To review the current evidence and make practice recommendations regarding the diagnosis and treatment of limb-girdle muscular dystrophies (LGMDs). Methods: Systematic review and practice recommendation development using the American Academy of Neurology guideline development process. Results: Most LGMDs are rare, with estimated prevalences ranging from 0.07 per 100,000 to 0.43 per 100,000. The frequency of some muscular dystrophies varies based on the ethnic background of the population studied. Some LGMD subtypes have distinguishing features, including pattern of muscle involvement, cardiac abnormalities, extramuscular involvement, and muscle biopsy findings. The few published therapeutic trials were not designed to establish clinical efficacy of any treatment. Principal recommendations: For patients with suspected muscular dystrophy, clinicians should use a clinical approach to guide genetic diagnosis based on clinical phenotype, inheritance pattern, and associated manifestations (Level B). Clinicians should refer newly diagnosed patients with an LGMD subtype and high risk of cardiac complications for cardiology evaluation even if they are asymptomatic from a cardiac standpoint (Level B). In patients with LGMD with a known high risk of respiratory failure, clinicians should obtain periodic pulmonary function testing (Level B). Clinicians should refer patients with muscular dystrophy to a clinic that has access to multiple specialties designed specifically to care for patients with neuromuscular disorders (Level B). Clinicians should not offer patients with LGMD gene therapy, myoblast transplantation, neutralizing antibody to myostatin, or growth hormone outside of a research study designed to determine efficacy and safety of the treatment (Level R). Detailed results and recommendations are available on the Neurology® Web site at Neurology.org. PMID:25313375
Tonin, Fernanda S; Wiens, Astrid; Fernandez-Llimos, Fernando; Pontarolo, Roberto
Introduction Schizophrenia is a chronic and debilitating mental disorder that affects the patient’s and their family’s quality of life, as well as financial costs and health care settings. Despite the variety of available antipsychotics, optimal treatment outcomes are not always achieved. Novel drugs, such as iloperidone, can provide more effective, tolerable and safer strategies. Aim To review the evidence for the clinical impact of iloperidone on the treatment of patients with schizophrenia. Evidence review Clinical trials, observational studies and meta-analyses reached a common consensus that iloperidone is as effective as haloperidol, risperidone and ziprasidone in reducing schizophrenia symptoms. Similar amounts of adverse events and discontinuations were observed with iloperidone compared to placebo and active treatments. Common adverse events are mild and include dizziness, hypotension, dry mouth and weight gain. Iloperidone can induce extension of QTc interval, and clinicians should be aware of its contraindications. In long-term trials, iloperidone also showed promising safety and tolerability profiles. The low propensity to cause akathisia, extrapyramidal symptoms (EPS), increased prolactin levels or changes to metabolic laboratory parameters support its use in practice. Results showed that iloperidone prevents relapse in stabilized patients, with a time to relapse superior to placebo and similar to haloperidol. Patients using a prior antipsychotic (eg, risperidone and aripiprazole) can easily switch to iloperidone with no serious impact on safety or efficacy. However, the acquisition costs of iloperidone may hamper its use. Further evidence comparing iloperidone with other antipsychotics, and pharmacoeconomic studies would be welcome. Place in therapy Considering just the clinical profile of iloperidone, it represents a promising drug for treating schizophrenia, particularly in patients who are intolerant to previous antipsychotics, as well as being
Pringsheim, Tamara; Doja, Asif; Gorman, Daniel; McKinlay, Duncan; Day, Lundy; Billinghurst, Lori; Carroll, Alan; Dion, Yves; Luscombe, Sandra; Steeves, Thomas; Sandor, Paul
This article seeks to provide the practising clinician with guidance on the pharmacological management of tic disorders in children and adults. We performed a systematic review of the literature on the treatment of tic disorders. A multi-institutional group of 14 experts in psychiatry, child psychiatry, neurology, pediatrics, and psychology engaged in a consensus meeting. The evidence was presented and discussed, and nominal group techniques were employed to arrive at consensus on recommendations. A strong recommendation is made when the benefits of treatment clearly outweigh the risks and burdens, and can apply to most patients in most circumstances without reservation. With a weak recommendation, the benefits, risks, and burdens are more closely balanced, and the best action may differ depending on the circumstances. Based on these principles, weak recommendations were made for the use of pimozide, haloperidol, fluphenazine, metoclopramide (children only), risperidone, aripiprazole, olanzapine, quetiapine, ziprasidone, topiramate, baclofen (children only), botulinum toxin injections, tetrabenazine, and cannabinoids (adults only). Strong recommendations were made for the use of clonidine and guanfacine (children only). While the evidence supports the efficacy of many of the antipsychotics for the treatment of tics, the high rates of side effects associated with these medications resulted in only weak recommendations for these drugs. In situations where tics are not severe or disabling, the use of a medication with only a weak recommendation is not warranted. However, when tics are more distressing and interfering, the need for tic suppression to improve quality of life is stronger, and patients and clinicians may be more willing to accept the risks of pharmacotherapy.
Thomas, M; Jordan, M; Hamborg-Petersen, E
Ankle sprains are the most relevant injuries of the lower extremities and can lead to damage to ligaments and osteochondral lesions. Up to 50 % of patients with a sprained ankle later develop a lesion of the cartilage in the ankle joint or an osteochondral lesion of the talus. This can lead to osteoarthritis of the injured ankle joint. Spontaneous healing is possible in all age groups in cases of a bone bruise in the subchondral bone but in isolated chondral injuries is only useful in pediatric patients. In many cases chondral and osteochondral injuries lead to increasing demarcation of the affected area and can result in progressive degeneration of the joint if not recognized in time. There also exist a certain number of osteochondral changes of the articular surface of the talus without any history of relevant trauma, which are collectively grouped under the term osteochondrosis dissecans. Perfusion disorders are discussed as one of many possible causes of these alterations. Nowadays, chondral and osteochondral defects can be treated earlier due to detection using very sensitive magnetic resonance imaging (MRI) and computed tomography (CT) techniques. The use of conservative treatment only has a chance of healing in pediatric patients. Conservative measures for adults should only be considered as adjuvant treatment to surgery.Based on a comprehensive analysis of the current literature, this article gives an overview and critical analysis of the current concepts for treatment of chondral and osteochondral injuries and lesions of the talus. With arthroscopic therapy curettage and microfracture of talar lesions are the predominant approaches or retrograde drilling of the defect is another option when the chondral coating is retained. Implantation of autologous chondral cells or homologous juvenile cartilage tissue is also possible with arthroscopic techniques. Osteochondral fractures (flake fracture) are usually performed as a mini-open procedure supported by
Gadbois, Christine; Chin, Elizabeth D; Dalphonse, Lee
Community assessment and review of the literature indicate that individuals supported in opioid treatment programs are at a significant disadvantage for access to preventative and primary healthcare. In addition, this population faces increased comorbidities and chronic disease. Finally, access to housing, nutritious food, and other social determinants of health is also a challenge for these individuals. This project, aimed at addressing healthcare disparities and improving health outcomes for the opioid treatment program client, was undertaken at a large, private, not-for-profit, community mental health center in an urban area. An education-practice partnership was created between the center and the local university's College of Nursing, which includes undergraduate and graduate programs. Working with administration, nurses, medical staff, and clinicians, the advanced practice nurse guided nursing practice change within the context of an interdisciplinary team to increase attention to clients' health needs. Outcomes included a more comprehensive nursing health assessment and increased attention to nursing care coordination. The partnership between the university and the facility continues with the goal of addressing clients' unmet healthcare needs and improving wellness via on-site intervention, referral, and education.
Jose, Jaison; Zacharias, Jamie; Craig, Timothy
Hereditary angioedema (HAE) is a rare bradykinin-mediated disease that is characterized by recurrent attacks of subcutaneous or submucosal edema, which can be life threatening. HAE affects all ethnic groups equally and does not differentiate between age, sex, or race. However, the availability of therapies varies amongst countries resulting in a lack of uniformity of care. Not only is there a disparity of medication availability, but since HAE is a rare disease, it is frequently overlooked and the diagnosis is missed. Even with diagnosis, treatment and management is often less than optimal. For these reasons, it is essential to have practice parameters and guidelines. In this chapter, we focus on recent guidelines. These guidelines deal with recognition, diagnosis, medical care, patient management, and assessment, all which are essential to provide optimal care to people with a rare and orphan disease. The intent of the guidelines, and thus this chapter, is to reduce morbidity and mortality, and restore a normal quality of life for the patient with HAE. We will review the guidelines from various regions of the world as well as international group recommendations. In addition, specific patient populations such as the pregnant, elderly, and juvenile require modified treatment regimens, and for this reason, we have included these data as well. The intent of this chapter is to aid the practitioner in holistic care of the patient with HAE in order to ultimately provide the best standard of care possible.
Sanders, Jennifer E; Garcia, Sylvia E
Herpes simplex virus is a common virus that causes a variety of clinical presentations ranging from mild to life-threatening. Orolabial and genital herpes are common disorders that can often be managed in an outpatient setting; however, some patients do present to the emergency department with those conditions, and emergency clinicians should be aware of possible complications in the pediatric population. Neonatal herpes is a rare disorder, but prompt recognition and initiation of antiviral therapy is imperative, as the morbidity and mortality of the disease is high. Herpes encephalitis is an emergency that also requires a high index of suspicion to diagnose. Herpes simplex virus is also responsible for a variety of other clinical presentations, including herpes gladiatorum, herpetic whitlow, eczema herpeticum, and ocular herpes. This issue reviews the common clinical presentations of the herpes simplex virus, the life-threatening infections that require expedient identification and management, and recommended treatment regimens.
Puig, L; Carrascosa, J M; Daudén, E; Sánchez-Carazo, J L; Ferrándiz, C; Sánchez-Regaña, M; García-Bustinduy, M; Bordas, X; Moreno, J C; Hernanz, J M; Laguarda, S; García-Patos, V
Psoriasis vulgaris is an inflammatory skin disease that is generally chronic and that affects between 1 % and 2 % of the population in industrialized Western countries. It is associated with a marked decline in quality of life. A wide range of treatments are currently available, although surveys conducted before the advent of biologic agents reflected a strong degree of dissatisfaction with the treatments then available. Extensive scientific evidence has been gathered on the safety of biologic agents, and this has led to a review of the role of systemic treatment in general and has allowed new therapeutic goals and strategies to be contemplated in patients with moderate-to-severe psoriasis. In this new situation, there is a need for Spanish guidelines on the treatment of moderate-to-severe psoriasis with biologic agents, drafted by consensus among specialists and ratified by the Spanish Psoriasis Group of the Spanish Academy of Dermatology and Venereology (AEDV). These guidelines should be evidence-based with regard to the pharmacologic characteristics, mechanism of action, administration route and regimen, efficacy, contraindications, adverse effects, and cost estimates of biologic agents approved for the treatment of moderate-to severe psoriasis in Spain.
Low back pain is the most common musculoskeletal complaint that results in a visit to the emergency department, and it is 1 of the top 5 most common complaints in emergency medicine. Estimates of annual healthcare expenditures for low back pain in the United States exceed $90 billion annually, not even taking lost productivity and business costs into account. This review explores an evidence-based rationale for the evaluation of the patient with low back pain, and it provides guidance on risk stratification pertaining to laboratory assessment and radiologic imaging in the emergency department. Published guidelines from the American College of Physicians and American Pain Society are reviewed, with emphasis on best evidence for pharmacologic treatments, self-care interventions, and more invasive procedures and surgery in management of low back pain. Utilizing effective and proven strategies will avoid medical errors, provide better care for patients, and help manage healthcare resources and costs.
Andreescu, Carmen; Varon, Daniel
Anxiety disorders are frequently encountered in the elderly, but they are largely undetected and untreated. Epidemiological studies indicate a prevalence ranging from 1.2 to 15 %. With the exception of generalized anxiety disorder and agoraphobia, which can often start in late life, most anxiety disorders in older patients are chronic and have their onset earlier in life. Anxiety disorders are an often unrecognized cause of distress, disability, and mortality risk in older adults, and they have been associated with cardiovascular disease, stroke, and cognitive decline. The mechanisms of anxiety in older adults differ from that in younger adults due to age-related neuropathology, as well as the loss and isolation so prominent in late life. Our review intends to provide a comprehensive summary of the most recent research done in the field of anxiety disorders in the elderly. Recent findings in clinical research, neuroimaging, neuroendocrinology, and neuropsychology are covered. An update on treatment options is discussed, including pharmacological and non-pharmacological alternatives.
Lang, David M
Chronic urticaria/angioedema (CUA) continues to be a vexing condition for both patients and health care providers. Despite progress made in recent years to improve our understanding of the pathogenesis of CUA and its treatment, many patients continue to experience ongoing symptoms and impaired quality of life. In the overwhelming majority of cases, a definite etiology is not identified. Laboratory testing may be justified based on its "reassurance value"; however, extensive routine testing is not favorable from a cost-benefit standpoint and does not lead to improved patient care outcomes. The target for effective management is to control CUA with a combination of avoidance measures, lifestyle changes, and regular administration of medication. A step-care approach to pharmacologic management that is favorable from the standpoint of balancing the potential for benefit with the potential for harm can lead to substantial improvement in quality of life. This article will focus on achieving improved outcomes for patients with CUA based on evidence-directed recommendations for diagnosis and management.
Lacy, Brian E.; Chey, William D.; Chang, Lin
Irritable bowel syndrome (IBS) is the most common functional gastrointestinal disorder and affects up to 12% to 15% of adults in the United States, with a higher prevalence among women and those younger than 50 years. IBS adversely impacts quality of life and medical expenditures, with significant costs arising from healthcare visits and reduced workplace productivity. Recent studies have shown that the adverse effects of IBS are so significant that many patients are willing to accept risks of adverse events from effective treatment to gain symptom relief. Alosetron is a 5-HT3 receptor antagonist approved by the US Food and Drug Administration (FDA) for women with severe diarrhea-predominant IBS that has not responded to traditional therapies. Alosetron yields overall improvements in IBS symptoms in 51% of patients vs 36% treated with placebo, with efficacy continuing undiminished over the course of a 48-week randomized, controlled trial. In real-world clinical practice, patients receiving alosetron had significant improvements in multiple IBS-related clinical parameters, including the new FDA IBS-diarrhea composite endpoint, lower gastrointestinal symptoms, fecal incontinence, and quality of life. Ischemic colitis and complications of constipation have been rare in occurrence. After nearly a decade of alosetron use under the risk management plan, adjudication of ischemic colitis and complications of constipation cases indicate that their incidence rates have remained low and stable. PMID:24872792
Lacy, Brian E; Chey, William D; Chang, Lin
Irritable bowel syndrome (IBS) is the most common functional gastrointestinal disorder and affects up to 12% to 15% of adults in the United States, with a higher prevalence among women and those younger than 50 years. IBS adversely impacts quality of life and medical expenditures, with significant costs arising from healthcare visits and reduced workplace productivity. Recent studies have shown that the adverse effects of IBS are so significant that many patients are willing to accept risks of adverse events from effective treatment to gain symptom relief. Alosetron is a 5-HT3 receptor antagonist approved by the US Food and Drug Administration (FDA) for women with severe diarrhea-predominant IBS that has not responded to traditional therapies. Alosetron yields overall improvements in IBS symptoms in 51% of patients vs 36% treated with placebo, with efficacy continuing undiminished over the course of a 48-week randomized, controlled trial. In real-world clinical practice, patients receiving alosetron had significant improvements in multiple IBS-related clinical parameters, including the new FDA IBS-diarrhea composite endpoint, lower gastrointestinal symptoms, fecal incontinence, and quality of life. Ischemic colitis and complications of constipation have been rare in occurrence. After nearly a decade of alosetron use under the risk management plan, adjudication of ischemic colitis and complications of constipation cases indicate that their incidence rates have remained low and stable.
Fabbri, Carlo; Luigiano, Carmelo; Lisotti, Andrea; Cennamo, Vincenzo; Virgilio, Clara; Caletti, Giancarlo; Fusaroli, Pietro
The continued need to develop less invasive alternatives to surgical and radiologic interventions has driven the development of endoscopic ultrasound (EUS)-guided treatments. These include EUS-guided drainage of pancreatic fluid collections, EUS-guided necrosectomy, EUS-guided cholangiography and biliary drainage, EUS-guided pancreatography and pancreatic duct drainage, EUS-guided gallbladder drainage, EUS-guided drainage of abdominal and pelvic fluid collections, EUS-guided celiac plexus block and celiac plexus neurolysis, EUS-guided pancreatic cyst ablation, EUS-guided vascular interventions, EUS-guided delivery of antitumoral agents and EUS-guided fiducial placement and brachytherapy. However these procedures are technically challenging and require expertise in both EUS and interventional endoscopy, such as endoscopic retrograde cholangiopancreatography and gastrointestinal stenting. We undertook a systematic review to record the entire body of literature accumulated over the past 2 decades on EUS-guided interventions with the objective of performing a critical appraisal of published articles, based on the classification of studies according to levels of evidence, in order to assess the scientific progress made in this field. PMID:25024600
Sandhu, Bhupinder Kaur; Paul, Siba Prosad
Irritable bowel syndrome (IBS) is the commonest cause of recurrent abdominal pain (RAP) in children in both more developed and developing parts of the world. It is defined by the Rome III criteria for functional gastrointestinal disorders. It is characterized by abdominal pain that is improved by defecation and whose onset is associated with a change in stool form and or frequency and is not explained by structural or biochemical abnormalities. It is estimated that 10%-15% of older children and adolescents suffer from IBS. IBS can be considered to be a brain-gut disorder possibly due to complex interaction between environmental and hereditary factors. The diagnosis of IBS is made based on the Rome III criteria together with ruling out organic causes of RAP in children such as inflammatory bowel disease and celiac disease. Once the diagnosis of IBS is made, it is important to explain to the parents (and children) that there is no serious underlying disease. This reassurance may be effective treatment in a large number of cases. Lifestyle modifications, stress management, dietary interventions and probiotics may be beneficial in some cases. Although there is limited evidence for efficacy of pharmacological therapies such as antispasmodics and antidiarrheals; these have a role in severe cases. Biopsychosocial therapies have shown encouraging results in initial trials but are beset by limited availability. Further research is necessary to understand the pathophysiology and provide specific focused therapies. PMID:24876724
Lurie, Jon D.; Spratt, Kevin F.; Blood, Emily A.; Tosteson, Tor D.; Tosteson, Anna N. A.; Weinstein, James N.
Study Design Secondary analysis within a large clinical trial Objective To evaluate the changes in treatment preference before and after watching a video decision aid as part of an informed consent process. Summary of Background Data A randomized trial with a similar decision aid in herniated disc patients had shown decreased rate of surgery in the video group, but the effect of the video on expressed preferences is not known. Methods Subjects enrolling in the Spine Patient Outcomes Research Trial (SPORT) with intervertebral disc herniation (IDH), spinal stenosis (SPS), or degenerative spondylolisthesis (DS) at thirteen multidisciplinary spine centers across the US were given an evidence-based videotape decision aid viewed prior to enrollment as part of informed consent. Results Of the 2505 patients, 86% (n=2151) watched the video and 14% (n=354) did not. Watchers shifted their preference more often than non-watchers(37.9% vs. 20.8%, p < 0.0001) and more often demonstrated a strengthened preference (26.2% vs. 11.1%, p < 0.0001). Among the 806 patients whose preference shifted after watching the video, 55% shifted toward surgery (p=0.003). Among the 617 who started with no preference, after the video 27% preferred non-operative care, 22% preferred surgery, and 51% remained uncertain. Conclusion After watching the evidence-based patient decision aid (video) used in SPORT, patients with specific lumbar spine disorders formed and/or strengthened their treatment preferences in a balanced way that did not appear biased toward or away from surgery. PMID:21358485
Despite decades of experience treating heroin or prescription opioid dependence with methadone or buprenorphine— two forms of opioid substitution therapy—gaps remain between current practices and evidence-based standards in both Canada and the United States. This is largely because of regulatory constraints and pervasive suboptimal clinical practices. Less than 10 percent of all people dependent on opioids in the United States are receiving substitution treatment, although the proportion may increase with expanded health insurance coverage as a result of the Affordable Care Act. In light of the accumulated evidence, we recommend eliminating restrictions on office-based methadone prescribing in the United States; reducing financial barriers to treatment, such as varying levels of copayment in Canada and the United States; reducing reliance on less effective and potentially unsafe opioid detoxification; and evaluating and creating mechanisms to integrate emerging treatments. Taking these steps can greatly reduce the consequent harms of opioid dependence by maximizing the individual and public health benefits of treatment. PMID:23918492
The terms ‘mucositis’ and ‘stomatitis’ are often used interchangeably. Mucositis, however, pertains to pharyngeal-esophago-gastrointestinal inflammation that manifests as red, burn-like sores or ulcerations throughout the mouth. Stomatitis is an inflammation of the oral tissues proper, which can present with or without sores, and is made worse by poor dental hygiene. Mucositis is observed in a variety of immunosuppressed patients, but is most often consequential to cancer therapy. It appears as early as the third day of intervention, and is usually established by Day 7 of treatment. Mucositis increases mortality and morbidity and contributes to rising health care costs. The precise immune components involved in the etiology of mucositis are unclear, but evidence-based research (EBR) data has shown that applications of granulocyte–macrophage-colony stimulating factor prevent the onset or the exacerbation of oropharyngeal mucositis. The molecular implications of this observation are discussed from the perspective of future developments of complementary and alternative treatments for this condition. It must be emphasized that this article is meant to be neither a review on mucositis and the various treatments for it, nor a discussion paper on its underlying molecular immunology. It is a statement of the implications of EBR for CAM-based interventions for mucositis. It explores and discusses the specific domain of molecular immunology in the context of mucositis and its direct implications for EBR research in CAM-based treatments for mucositis. PMID:16322806
Klaus, Nicole M.; Fristad, Mary A.; Malkin, Catherine; Mackinaw-Koons, Barbara
Schizophrenia spectrum disorders are rare in childhood and little is known about their psychosocial treatment. Relevant findings from the adult and child literature are reviewed. The case of 10-year-old "Michael" is presented, who participated in a randomized clinical trial of a psychoeducational family treatment for mood disorders. Following…
Seppi, Klaus; Weintraub, Daniel; Coelho, Miguel; Perez-Lloret, Santiago; Fox, Susan H.; Katzenschlager, Regina; Hametner, Eva-Maria; Poewe, Werner; Rascol, Olivier; Goetz, Christopher G.; Sampaio, Cristina
The Movement Disorder Society (MDS) Task Force on Evidence-Based Medicine (EBM) Review of Treatments for Parkinson's Disease (PD) was first published in 2002 and was updated in 2005 to cover clinical trial data up to January 2004 with the focus on motor symptoms of PD. In this revised version the MDS task force decided it was necessary to extend the review to non-motor symptoms. The objective of this work was to update previous EBM reviews on treatments for PD with a focus on non-motor symptoms. Level-I (randomized controlled trial, RCT) reports of pharmacological and nonpharmacological interventions for the non-motor symptoms of PD, published as full articles in English between January 2002 and December 2010 were reviewed. Criteria for inclusion and ranking followed the original program outline and adhered to EBM methodology. For efficacy conclusions, treatments were designated: efficacious, likely efficacious, unlikely efficacious, non-efficacious, or insufficient evidence. Safety data were catalogued and reviewed. Based on the combined efficacy and safety assessment, Implications for clinical practice were determined using the following designations: clinically useful, possibly useful, investigational, unlikely useful, and not useful. Fifty-four new studies qualified for efficacy review while several other studies covered safety issues. Updated and new efficacy conclusions were made for all indications. The treatments that are efficacious for the management of the different non-motor symptoms are as follows: pramipexole for the treatment of depressive symptoms, clozapine for the treatment of psychosis, rivastigmine for the treatment of dementia, and botulinum toxin A (BTX-A) and BTX-B as well as glycopyrrolate for the treatment of sialorrhea. The practical implications for these treatments, except for glycopyrrolate, are that they are clinically useful. Since there is insufficient evidence of glycopyrrolate for the treatment of sialorrhea exceeding 1 week, the
Leenarts, Laura E W; Diehle, Julia; Doreleijers, Theo A H; Jansma, Elise P; Lindauer, Ramón J L
This is a systematic review of evidence-based treatments for children exposed to childhood maltreatment. Because exposure to childhood maltreatment has been associated with a broad range of trauma-related psychopathology (e.g., PTSD, anxiety, suicidal ideation, substance abuse) and with aggressive and violent behavior, this review describes psychotherapeutic treatments which focus on former broad range of psychopathological outcomes. A total of 26 randomized controlled clinical trials and seven non-randomized controlled clinical trials published between 2000 and 2012 satisfied the inclusionary criteria and were included. These studies dealt with various kinds of samples, from sexually abused and maltreated children in child psychiatric outpatient clinics or in foster care to traumatized incarcerated boys. A total of 27 studies evaluated psychotherapeutic treatments which used trauma-focused cognitive, behavioral or cognitive-behavioral techniques; only two studies evaluated trauma-specific treatments for children and adolescents with comorbid aggressive or violent behavior; and four studies evaluated psychotherapeutic treatments that predominantly focused on other mental health problems than PTSD and used non-trauma focused cognitive, behavioral or cognitive-behavioral techniques. The results of this review suggest that trauma-focused cognitive-behavioral therapy (TF-CBT) is the best-supported treatment for children following childhood maltreatment. However, in line with increased interest in the diagnosis of complex PTSD and given the likely relationship between childhood maltreatment and aggressive and violent behavior, the authors suggest that clinical practice should address a phase-oriented approach. This review concludes with a discussion of future research directions and limitations.
Lee, Todd A.; Valenstein, Marcia; Weiss, Kevin B.
Background Patients with chronic obstructive pulmonary disorder (COPD) frequently have co-occurring depressive disorders and are often seen in multiple-care settings. Existing research does not assess the impact of care setting on delivery of evidence-based depression care for these patients. Objective To examine the prevalence of guideline-concordant depression treatment among these co-morbid patients, and to examine whether the likelihood of receiving guideline-concordant treatment differed by care setting. Design Retrospective cohort study. Patients A total of 5,517 veterans with COPD that experienced a new treatment episode for major depressive disorder. Measurements and Main Results Concordance with VA treatment guidelines for depression; multivariate analyses of the relationship between guideline-concordant depression treatment and care setting. More than two-thirds of the sample was over age 65 and 97% were male. Only 50.6% of patients had guideline-concordant antidepressant coverage (defined by the VA). Fewer than 17% of patients received guideline recommended follow-up (≥3 outpatient visits during the acute phase), and only 9.9% of the cohort received both guideline-concordant antidepressant coverage and follow-up visits. Being seen in a mental health clinic during the acute phase was associated with a 7-fold increase in the odds of receiving guideline-concordant care compared to primary care only. Patients seen in pulmonary care settings were also more likely to receive guideline-concordant care compared to primary care only. Conclusions Most VA patients with COPD and an acute depressive episode receive suboptimal depression management. Improvements in depression treatment may be particularly important for those patients seen exclusively in primary care settings. PMID:17687614
Dorsey, Shannon; Pullmann, Michael D; Berliner, Lucy; Koschmann, Elizabeth; McKay, Mary; Deblinger, Esther
The goal of this study was to examine the impact of supplementing Trauma-focused Cognitive Behavioral Therapy (TF-CBT; Cohen et al., 2006) with evidence-based engagement strategies on foster parent and foster youth engagement in treatment, given challenges engaging foster parents in treatment. A randomized controlled trial of TF-CBT standard delivery compared to TF-CBT plus evidence-based engagement strategies was conducted with 47 children and adolescents in foster care and one of their foster parents. Attendance, engagement, and clinical outcomes were assessed 1 month into treatment, end of treatment, and 3 months post-treatment. Youth and foster parents who received TF-CBT plus evidence-based engagement strategies were more likely to be retained in treatment through four sessions and were less likely to drop out of treatment prematurely. The engagement strategies did not appear to have an effect on the number of canceled or no-show sessions or on treatment satisfaction. Clinical outcomes did not differ by study condition, but exploratory analyses suggest that youth had significant improvements with treatment. Strategies that specifically target engagement may hold promise for increasing access to evidence-based treatments and for increasing likelihood of treatment completion.
Pullmann, Michael D.; Berliner, Lucy; Koschmann, Elizabeth; McKay, Mary; Deblinger, Esther
The goal of this study was to examine the impact of supplementing Trauma-focused Cognitive Behavioral Therapy (TF-CBT; Cohen, Mannarino, & Deblinger, 2006) with evidence-based engagement strategies on foster parent and foster youth engagement in treatment, given challenges engaging foster parents in treatment. A randomized controlled trial of TF-CBT standard delivery compared to TF-CBT plus evidence-based engagement strategies was conducted with 47 children and adolescents in foster care and one of their foster parents. Attendence, engagement, and clinical outcomes were assessed 1 month into treatment, end of treatment, and 3 months post-treatment. Youth and foster parents who received TF-CBT plus evidence-based engagement strategies were more likely to be retained in treatment through four sessions and were less likely to drop out of treatment prematurely. The engagement strategies did not appear to have an effect on the number of cancelled or no-show sessions or on treatment satisfaction. Clinical outcomes did not differ by study condition, but exploratory analyses suggest that youth had significant improvements with treatment. Strategies that specifically target engagement may hold promise for increasing access to evidence-based practices and for increasing likelihood of treatment completion. PMID:24791605
Brzózka, Magdalena M; Havemann-Reinecke, Ursula; Wichert, Sven P; Falkai, Peter; Rossner, Moritz J
Chronic psychosocial stress is an important environmental risk factor of psychiatric diseases such as schizophrenia. Social defeat in rodents has been shown to be associated with maladaptive cellular and behavioral consequences including cognitive impairments. Although gene expression changes upon psychosocial stress have been described, a comprehensive transcriptome profiling study at the global level in precisely defined hippocampal subregions which are associated with learning has been lacking. In this study, we exposed adult C57Bl/6N mice for 3 weeks to "resident-intruder" paradigm and combined laser capture microdissection with microarray analyses to identify transcriptomic signatures of chronic psychosocial stress in dentate gyrus and CA3 subregion of the dorsal hippocampus. At the individual transcript level, we detected subregion specific stress responses whereas gene set enrichment analyses (GSEA) identified several common pathways upregulated upon chronic psychosocial stress related to proteasomal function and energy supply. Behavioral profiling revealed stress-associated impairments most prominent in fear memory formation which was prevented by chronic lithium treatment. Thus, we again microdissected the CA3 region and performed global transcriptome analysis to search for molecular signatures altered by lithium treatment in stressed animals. By combining GSEA with unsupervised clustering, we detected pathways that are regulated by stress and lithium in the CA3 region of the hippocampus including proteasomal components, oxidative phosphorylation, and anti-oxidative mechanisms. Our study thus provides insight into hidden molecular phenotypes of chronic psychosocial stress and lithium treatment and proves a beneficial role for lithium treatment as an agent attenuating negative effects of psychosocial stress on cognition.
Petrelli, Fausto; Cabiddu, Mary; Ghilardi, Mara; Barni, Sandro
Approximately 10 - 15% of breast carcinomas (BCs) are known to be 'triple-negative (TN) receptor' (i.e., not expressing ER or PR and not exhibiting overexpression and/or gene amplification of HER2-neu). Triple-negative BCs comprise approximately 85% of all basal-type tumours. Classically, basal-like BCs have been characterised by low expression of ER, PR, and HER2 neu and high expression of CK5, CK14, caveolin-1, CAIX, p63, and EGFR (HER1), which reflects the mammary gland basal/myoepithelial cell component. Although there is no standard first-line chemotherapy regimen for metastatic TN BCs, anthracycline- and taxane-containing regimens are acceptable treatments. A large number of agents, including DNA-damaging agents, EGFR inhibitors, antiangiogenic agents and novel taxane formulations are currently being tested in clinical trials for first-line and pretreated patients. Limited experiences with platinum salts, poly(ADP-ribose) polymerase (PARP) inhibitors, cetuximab, bevacizumab and ixabepilone have been published in recent years and will be reported. Novel immunohistochemistry analysis for identification of basal like/TN phenotype are awaited to correctly select this population. The clinical trials investigating new agents have to be designed for a specific (and possibly large) subset of patients with BC. In the future, a gene array platform with greater sensitivity for distinguishing the various BC subtypes, as well as having the power to predict the molecular biology of the disease, will be an indispensible tool for treatment selection. Currently, treatment of TN BC is more empirical than evidence-based. The cornerstone of treatment is chemotherapy, but in the near future, novel target agents will emerge as possible partners.
Baker-Ericzén, Mary J.; Jenkins, Melissa M.; Park, Soojin; Garland, Ann F.
Background: Mental health professionals' decision-making practice is an area of increasing interest and importance, especially in the pediatric research and clinical communities. Objective: The present study explored the role of prior training in evidence-based treatments (EBTs) on clinicians' assessment and treatment formulations using…
Gulliver, Wayne; Zouboulis, Christos C; Prens, Errol; Jemec, Gregor B E; Tzellos, Thrasivoulos
Hidradenitis suppurativa/acne inversa (HS) is a chronic inflammatory skin disease characterized by painful, recurrent nodules and abscesses that rupture and lead to sinus tracts and scarring. To date, an evidence-based therapeutic approach has not been the standard of care and this is likely due to the lack of evidence based treatment guidelines. The purpose of this study was to promote a holistic evidence-based approach which implemented Level of Evidence and Strength of Recommendation for the treatment of HS. Based upon the European Dermatology Forumguidelines for the management of HS, evidence-based approach was explored for the treatment of HS. The diagnosis of HS should be made by a dermatologist or other healthcare professional with expert knowledge in HS. All patients should be offered adjuvant therapy as needed (pain management, weight loss, tobacco cessation, treatment of super infections, and application of appropriate dressings). The treating physician should be familiar with disease severity scores, especially Hurley staging, physician global assessment and others. The routine use of patient'reported outcomesincluding DLQI, itch and pain assessment (Visual Analogue Scale) is strongly recommended. The need for surgical intervention should be assessed in all patients depending upon type and extent of scarring, and an evidence-based surgical approach should be implemented. Evidence-based medical treatment of mild disease consists of topical Clindamycin 1 % solution/gel b.i.d. for 12 weeks or Tetracycline 500 p.o. b.i.d. for 4 months (LOE IIb, SOR B), for more widespread disease. If patient fails to exhibit response to treatment or for a PGA of moderate-to-severe disease, Clindamycin 300 p.o. b.i.d. with Rifampicin 600 p.o. o.d. for 10 weeks (LOE III, SOR C) should be considered. If patient is not improved, then Adalimumab 160 mg at week 0, 80 mg at week 2; then 40 mg subcutaneously weekly should be administered (LOE Ib, SOR A). If improvement occurs
Martin, Gina; Macdonald, Scott; Ishiguro, Sonya
This study assessed the relative importance of problem gambling, cocaine use and selected psychosocial characteristics in predicting criminal convictions. A self-administered questionnaire was completed by clients when admitted to a treatment program for a primary problem with cocaine (n = 300), gambling (n = 199), or tobacco (n = 249). The…
Chong, Jenny; Lopez, Darlene
The relationship of social networks and social support to the psychosocial functioning (self-efficacy, self-esteem, anxiety, depression, and hostility) of 159 American Indian women undergoing residential substance abuse treatment at Native American Connections was assessed. Social support and active participation by clients' families during…
Sexton, Chris C.; Gelhorn, Heather L.; Bell, Jill A.; Classi, Peter M.
The co-occurrence of reading disorder (RD) and attention-deficit/hyperactivity disorder (ADHD) has received increasing attention. This review summarizes the epidemiology, treatment strategies, psychosocial impact, and economic burden associated with the co-occurrence of these conditions. Common genetic and neuropsychological deficits may partially…
LaForett, Dore R.; Murray, Desiree W.; Kollins, Scott H.
This article reviews the research literature on psychosocial treatments for preschool-aged children with Attention-Deficit Hyperactivity Disorder (ADHD) in the context of the developmental and contextual needs of this population (e.g., increased parenting demands, differences in classroom structure, and the child's emerging developmental…
Abikoff, Howard; Hechtman, Lily; Klein, Rachel G.; Weiss, Gabrielle; Fleiss, Karen; Etcovitch, Joy; Cousins, Lorne; Greenfield, Brian; Martin, Diane; Pollack, Simcha
Objective: To test the hypotheses that in children with attention-deficit/hyperactivity disorder (ADHD) (1) symptoms of ADHD, oppositional defiant disorder, and overall functioning are significantly improved by methylphenidate combined with intensive multimodal psychosocial treatment compared with methylphenidate alone and with methylphenidate…
Zalaquett, Carlos P.; Stens, Andrea N.
Older adults represent a growing segment of the population with the highest suicide rate and an increasing need of counseling services for major depression and dysthymia. The present study examined the literature with the purpose of identifying research addressing psychosocial treatments of depression in later life. A summary of treatments…
Hestbaek, Lise; Stochkendahl, Mette Jensen
Five to ten percent of chiropractic patients are children and adolescents. Most of these consult because of spinal pain, or other musculoskeletal complaints. These musculoskeletal disorders in early life not only affect the quality of children's lives, but also seem to have an impact on adult musculoskeletal health. Thus, this is an important part of the chiropractors' scope of practice, and the objective of this review is to assess the evidence base for manual treatment of musculoskeletal disorders in children and adolescents.Randomized, quasi-randomized and non-randomized clinical studies were included if they investigated the effect of manual therapy on musculoskeletal disorders in children and/or adolescents. The MEDLINE and MANTIS databases were searched, and studies published in English, Danish, Swedish or Norwegian were included.Only three studies were identified that in some way attempted to look at the effectiveness of manual therapy for children or adolescents with spinal problems, and none of these was a randomized controlled clinical trial. As for the rest of the musculoskeletal system, only one study of temporomandibular disorder was identified.With this review, we have detected a paradox within the chiropractic profession: Although the major reason for pediatric patients to attend a chiropractor is spinal pain, no adequate studies have been performed in this area. It is time for the chiropractic profession to take responsibility and systematically investigate the efficiency of joint manipulation of problems relating to the developing musculoskeletal system.
Wilson, S J; Nutt, D J; Alford, C; Argyropoulos, S V; Baldwin, D S; Bateson, A N; Britton, T C; Crowe, C; Dijk, D-J; Espie, C A; Gringras, P; Hajak, G; Idzikowski, C; Krystal, A D; Nash, J R; Selsick, H; Sharpley, A L; Wade, A G
Sleep disorders are common in the general population and even more so in clinical practice, yet are relatively poorly understood by doctors and other health care practitioners. These British Association for Psychopharmacology guidelines are designed to address this problem by providing an accessible up-to-date and evidence-based outline of the major issues, especially those relating to reliable diagnosis and appropriate treatment. A consensus meeting was held in London in May 2009. Those invited to attend included BAP members, representative clinicians with a strong interest in sleep disorders and recognized experts and advocates in the field, including a representative from mainland Europe and the USA. Presenters were asked to provide a review of the literature and identification of the standard of evidence in their area, with an emphasis on meta-analyses, systematic reviews and randomized controlled trials where available, plus updates on current clinical practice. Each presentation was followed by discussion, aimed to reach consensus where the evidence and/or clinical experience was considered adequate or otherwise to flag the area as a direction for future research. A draft of the proceedings was then circulated to all participants for comment. Key subsequent publications were added by the writer and speakers at draft stage. All comments were incorporated as far as possible in the final document, which represents the views of all participants although the authors take final responsibility for the document.
Doughty, Dorothy; Junkin, Joan; Kurz, Peter; Selekof, Joan; Gray, Mikel; Fader, Mandy; Bliss, Donna Z; Beeckman, Dimitri; Logan, Susan
In 2010, an international consensus conference was held to review current evidence regarding the pathology, prevention, and management of incontinence-associated dermatitis (IAD). The results of this literature review were published in a previous issue of this Journal. This article summarizes key consensus statements agreed upon by the panelists, evidence-based guidelines for prevention and management of IAD, and a discussion of the major challenges currently faced by clinicians caring for these patients. The panelists concur that IAD is clinically and pathologically distinct from pressure ulcers and intertriginous dermatitis, and that a consistently applied, structured, or defined skin care program is effective for prevention and management of IAD. They also agreed that differential assessment of IAD versus pressure ulceration versus intertriginous dermatitis remains a major challenge. Panel members also concur that evidence is lacking concerning which products and protocols provide the best outcomes for IAD prevention and treatment in individual patients. Issues related to differential assessment, product labeling and utilization, staff education, and cost of care are the primary focus of this article.
Davidow, Jason H.; Bothe, Anne K.; Bramlett, Robin E.
Purpose: This article presents, and explains the issues behind, the Stuttering Treatment Research Evaluation and Assessment Tool (STREAT), an instrument created to assist clinicians, researchers, students, and other readers in the process of critically appraising reports of stuttering treatment research. Method: The STREAT was developed by…
Long, Andrew F.; Xing, Mei; Morgan, Ken; Brettle, Alison
Ménière's syndrome is a long-term, progressive disease that damages the balance and hearing parts of the inner ear. To address the paucity of information on which evidence-based treatment decisions should be made, a systematic review of acupuncture for Ménière's syndrome was undertaken. The method used was a systematic review of English and Chinese literature, from six databases for randomized, non-randomized and observational studies. All studies were critically appraised and a narrative approach to data synthesis was adopted. Twenty-seven studies were included in this review (9 in English and 18 in Chinese languages): three randomized controlled trials, three non-randomized controlled studies and four pre-test, post-test designs. All but one of the studies was conducted in China. The studies covered body acupuncture, ear acupuncture, scalp acupuncture, fluid acupuncture point injection and moxibustion. The studies were of varying quality. The weight of evidence, across all study types, is of beneficial effect from acupuncture, for those in an acute phase or those who have had Ménière's syndrome for a number of years. The review reinforces the importance of searching for studies from English and Chinese literature. The transferability of the findings from China to a Western context needs confirmation. Further research is also needed to clarify questions around the appropriate frequency and number of treatment/courses of acupuncture. The weight of evidence suggests a potential benefit of acupuncture for persons with Ménière's disease, including those in an acute phase and reinforces the importance of searching for published studies in the Chinese language. PMID:19505974
Mahmoudi, Elham; Yuan, Frank; Aliu, Oluseyi; Chung, Kevin C
Background Despite equivalent outcomes among surgical treatments of thumb carpometacarpal (CMC) arthritis, little is known about variation in spending. Owing to its complexities, we hypothesized that trapeziectomy with ligament reconstruction and tendon interposition (LRTI) when compared to other surgical procedures incurs the greatest cost to Medicare. Methods Using a random 5% sample of Medicare beneficiaries diagnosed with thumb CMC arthritis, we examined total and out-of-pocket spending for 3,530 patients who underwent a surgical treatment, between 2001 and 2010. We used generalized linear regression models, controlling for patients’ characteristics and place of surgery to examine variation in spending. Results 89% of patients who underwent surgery received trapeziectomy with LRTI, with total and out-of-pocket spending of $2,576 (CI: $2,333 – $2,843, p < 0.001) and $436 (CI: $429 – $531, p < 0.001), respectively. Simple complete trapeziectomy was the least expensive procedure, performed only among 5% of patients, with total and out-of-pocket spending of $1,268 (CI: $1,089 – $1,476, p < 0.001) and $236 (CI: $180 – $258, p < 0.001), respectively. Owing to increasingly higher facility costs, performing the same procedure in a hospital outpatient setting compared with an ambulatory center would increase Medicare spending by more than two folds (p < 0.001). Conclusions With a consistent rise of healthcare spending, adherence to evidence-based approach in medicine is more important than ever. Most surgeons continue to perform trapeziectomy with LRTI, the most expensive surgical option. Medicare could potentially save $74 million annually if simple complete trapeziectomy was the procedure of choice. PMID:27219267
Fabiano, Gregory A.; Schatz, Nicole K.; Aloe, Ariel M.; Chacko, Anil; Chronis-Tuscano, Andrea
The present report synthesizes outcomes across meta-analyses of psychosocial (i.e., non-pharmacological) treatments for ADHD. A total of 12 meta-analyses were identified that met search criteria. The meta-analyses were notable in that there was surprisingly little overlap in studies included across them (range of overlap was 2%-46%). Further, there was considerable diversity across the meta-analyses in terms of the inclusion/exclusion criteria, types of psychosocial treatments reviewed, methodological characteristics, and magnitude of reported effect sizes, making it difficult to aggregate findings across meta-analyses or to investigate moderators of outcome. Effect sizes varied across the outcomes assessed, with meta-analyses reporting positive and significant effect sizes for measures of some areas of child impairment (e.g., social impairment) and small and more variable effect sizes for distal and/or untargeted outcomes (e.g., academic achievement). Results are reviewed in light of the larger literature on psychosocial interventions for ADHD, and specific recommendations for future meta-analyses of psychosocial treatments for ADHD are offered. PMID:25691358
Yi, Song; Zhang, Chuqin; Ni, Chulei; Qian, Ying; Zhang, Jun
Objective The objective of this study is to evaluate the psychosocial impact of dental aesthetics in undergraduate students in the People’s Republic of China and to investigate the association between normal orthodontic treatment needs, psychosocial impact of dental aesthetics, and desire for orthodontic treatment. Materials and methods A cross-sectional study was carried out in two universities in a city of the People’s Republic of China with 374 young adults aged between 19 years and 24 years. The students answered a Chinese version of the Psychosocial Impact of Dental Aesthetics Questionnaire (PIDAQ) and addressed their desire for orthodontic treatment. Objective malocclusion severity was assessed with the Index of Orthodontic Treatment Need (IOTN). Statistical analysis was performed by the SPSS software (Version 15.0). Results There was no statistical sex difference in relation to the dental health component of IOTN (P=0.893) and PIDAQ scores (P=0.06), but it was found that the desire for orthodontic treatment was significantly stronger among females. The total and subscale PIDAQ scores and malocclusion severity differed significantly among the five grades of desire (P<0.01). Significant positive correlation was found among desire for orthodontic treatment, IOTN-dental health component grades, and total or subscale PIDAQ scores (P<0.01). High correlation was found between desire and PIDAQ score (r=0.93). Conclusion The desire for orthodontic treatment is higher among female young adults who have the same orthodontic treatment needs compared to males. The desire for orthodontic treatment has high positive correlation with PIDAQ scores and increases with the increase in self-perceived psychosocial impacts of malocclusion and the needs for orthodontic treatment. PMID:27354773
Blum, Terry C; Davis, Carolyn D; Roman, Paul M
This paper examines the organizational adoption of medically assisted treatments (MAT) for substance use disorders (SUDs) in a representative sample of 555 US for-profit and not-for-profit treatment centers. The study examines organizational adoption of these treatments in an institutionally contested environment that traditionally has valued behavioral treatment, using sociological and resource dependence frameworks. The findings indicate that socialization of leadership, measured by formal clinical education, is related to the adoption of MAT. Funding patterns also affect innovation adoption, with greater adoption associated with higher proportions of earned income from third party fees for services, and less adoption associated with funding from criminal justice sources. These findings may generalize to other social mission-oriented organizations where innovation adoption may be linked to private and public benefit values inherent in the type of socialization of leadership and different patterns of funding support.
Karagiannis, Thomas; Bekiari, Eleni; Tsapas, Apostolos
Introduction Deciding on an optimal medication choice for type 2 diabetes is often challenging, due to the increasing number of treatment options. Canagliflozin is a novel glucose-lowering agent belonging to sodium–glucose co-transporter 2 (SGLT2) inhibitors. Aim The aim of this study was to examine and summarize the evidence based on the efficacy, safety, and cost-effectiveness of canagliflozin for type 2 diabetes. Evidence review Compared to placebo, canagliflozin 100 and 300 mg lower glycated hemoglobin (HbA1c) by ~0.6%–0.8%, respectively. Canagliflozin appears to be slightly more effective than dipeptidyl peptidase-4 (DPP-4) inhibitors in reducing HbA1c. It also has a favorable effect on body weight and blood pressure, both versus placebo and most active comparators. However, treatment with canagliflozin is associated with increased incidence of genital tract infections and osmotic diuresis-related adverse events. Based on short-term data, canagliflozin is not associated with increased risk for all-cause mortality and cardiovascular outcomes. Economic evaluation studies from various countries indicate that canagliflozin is a cost-effective option in dual- or triple-agent regimens. Place in therapy As monotherapy, canagliflozin could be used in patients for whom metformin is contraindicated or not tolerated. For patients on background treatment with metformin, canagliflozin appears to be superior to sulfonylureas with respect to body weight, blood pressure and risk for hypoglycemia, and to DPP-4 inhibitors in terms of lowering HbA1c, body weight, and blood pressure. Canagliflozin also seems to be cost-effective compared with sulfonylureas and DPP-4 inhibitors as add-on to metformin monotherapy, and compared with DPP-4 inhibitors as add-on to metformin and sulfonylurea. Conclusion Current evidence on intermediate efficacy outcomes, short-term safety and cost-effectiveness support the use of canagliflozin in patients on background treatment with metformin
Rieckmann, Traci R.; Kovas, Anne E.; Cassidy, Elaine F.; McCarty, Dennis
State public health authorities are critical to the successful implementation of science based addiction treatment practices by community-based providers. The literature to date, however, lacks examples of state level policy strategies that promote evidence-based practices (EBPs). This mixed-methods study documents changes in two critical…
Maliken, Ashley C.; Katz, Lynn Fainsilber
Parenting interventions, particularly those categorized as parent management training (PMT), have a large evidence base supporting their effectiveness with most families who present for treatment of childhood behavior problems. However, data suggest that PMTs are not effective at treating all families who seek services. Parental psychopathology…
Background Research shows that trauma-focused therapy and multimodal interventions are the two most often used strategies in treatment of refugees suffering from posttraumatic stress disorder (PTSD). While preliminary evidence suggests that trauma-focused approaches may have some efficacy, this could not be established for multimodal interventions. However, it may be that multimodal interventions have been studied in more treatment-resistant refugees with very high levels of psychopathology, disability, and chronicity. In the past decades, various models for understanding of the complex relationship between mental health problems and well-being have emerged. They aim at framing mental health problems in individualized, contextual, epigenetic, and culturally sensitive ways, and may be useful in tailoring content and timing of multimodal interventions. Objective To draw clinicians’ attention to the possibility of using the Integrative Contextual Model for understanding and assessment of posttrauma mental health sequelae while tailoring multimodal interventions; to present a possible way of combining multimodal with evidence-based trauma-focused approaches; and to improve the understanding and treatment of PTSD and other mental health problems in refugee survivors of prolonged and repeated trauma. Method Based on literature, clinical experience, and presentation of a fictional case, the use of the Integrative Contextual Model in tailoring the treatment of severe PTSD in a refugee patient is presented and discussed. Results The Integrative Contextual Model for understanding and assessing factors, which may play a role in causing and maintaining of PTSD and comorbidity in refugees, may help tailoring of multimodal interventions. These interventions can be combined with evidence-based trauma-focused treatments. Conclusion The field of refugee mental health intervention and clinical practice with traumatized refugees may be enriched with the use of contextual and
Burdon, William M.; St. De Lore, Jef; Dang, Jeff; Warda, Umma S.; Prendergast, Michael L.
Objective To assess the impact of a positive behavioral reinforcement intervention on psychosocial functioning of inmates over the course of treatment and on post-treatment self-reported measures of treatment participation, progress, and satisfaction. Method Male (n = 187) and female (n = 143) inmates participating in 12-week prison-based Intensive Outpatient (IOP) drug treatment were randomly assigned to receive standard treatment (ST) or standard treatment plus positive behavioral reinforcement (BR) for engaging in targeted activities and behaviors. Participants were assessed for psychosocial functioning at baseline and at the conclusion of treatment (post-treatment). Self-reported measures of treatment participation, treatment progress, and treatment satisfaction were also captured at post-treatment. Results The intervention affected female and male subjects differently and not always in a way that favored BR subjects, as compared to the ST subjects, most notably on measures of depression and criminal thinking. Conclusions Possible explanations for the results include differences in the male and female custody environments combined with the procedures that study participants had to follow to earn and/or receive positive reinforcement at the two study sites, as well as baseline differences between the genders and a possible floor effect among females on measures of criminality. Limitations of the study included the inability to make study participants blind to the study conditions and the possible over-branding of the study, which may have influenced the results. PMID:23626504
Bola, John R.
Objective: This article reviews evidence on the treatment of early episode schizophrenia spectrum disorders that contradicts, in some cases, the American Psychiatric Association's generic recommendation of antipsychotic medication treatment for at least a year. Method: Evidence on lack of diagnostic validity, absence of demonstrated long-term…
Fraser, J. Scott; Solovey, Andrew D.; Grove, David; Lee, Mo Yee; Greene, Gilbert J.
A moderate common factors approach is proposed as a synthesis or middle path to integrate common and specific factors in evidence-based approaches to high-risk youth and families. The debate in family therapy between common and specific factors camps is reviewed and followed by suggestions from the literature for synthesis and creative flexibility…
Mayton, Michael R.; Wheeler, John J.; Menendez, Anthony L.; Zhang, Jie
Horner et al. (2005) present a review substantiating how single-subject research methodology can be utilized to determine whether interventions are evidence-based practices (EBPs). The current study utilized the Horner et al. research piece to: (a) systematically identify a set of quality standards for the evaluation of single-case research…
Background A variety of forces are now shaping a passionate debate regarding the optimal approaches to improving the quality of substance abuse services for American Indian and Alaska Native communities. While there have been some highly successful efforts to meld the traditions of American Indian and Alaska Native tribes with that of 12-step approaches, some American Indian and Alaska Natives remain profoundly uncomfortable with the dominance of this Euro-American approach to substance abuse treatment in their communities. This longstanding tension has now been complicated by the emergence of a number of evidence-based treatments that, while holding promise for improving treatment for American Indian and Alaska Natives with substance use problems, may conflict with both American Indian and Alaska Native and 12-step healing traditions. Discussion We convened a panel of experts from American Indian and Alaska Native communities, substance abuse treatment programs serving these communities, and researchers to discuss and analyze these controversies in preparation for a national study of American Indian and Alaska Native substance abuse services. While the panel identified programs that are using evidence-based treatments, members still voiced concerns about the cultural appropriateness of many evidence-based treatments as well as the lack of guidance on how to adapt them for use with American Indians and Alaska Natives. The panel concluded that the efforts of federal and state policymakers to promote the use of evidence-based treatments are further complicating an already-contentious debate within American Indian and Alaska Native communities on how to provide effective substance abuse services. This external pressure to utilize evidence-based treatments is particularly problematic given American Indian and Alaska Native communities' concerns about protecting their sovereign status. Summary Broadening this conversation beyond its primary focus on the use of evidence-based
Emanu, Jessica C.; Avildsen, Isabelle K.; Nelson, Christian J.
Purpose of review This review will discuss erectile dysfunction (ED) in prostate cancer patients following radical prostatectomy (RP). It will focus on the prevalence and current treatments for ED as well as the emotional impact of ED and the current psychosocial interventions designed to help patients cope with this side effect. Recent findings While there is a large discrepancy in prevalence rates of ED after RP, several recent studies have cited rates as high as 85%. The concept of “penile rehabilitation” is now the standard of practice to treat ED following RP. However, many men avoid seeking help or utilizing ED treatments. This avoidance is related to the shame, frustration, and distress many men with ED and their partners experience. Recent psychosocial interventions have been developed to facilitate the use of treatments and help men cope with ED. These interventions have shown initial promise, however, continued intervention development is needed to reduce distress and improve long-term erectile function (EF) outcomes. Summary ED is a significant problem following prostate cancer surgery. While there are effective medical treatments, the development of psychosocial interventions should continue to evolve to maximize the assistance we can give to men and their partners. PMID:26808052
Bove, Marilisa; Cicero, Arrigo Francesco Giuseppe; Veronesi, Maddalena; Borghi, Claudio
Several studies suggest that chronic hyperuricemia, the main precursor of gout, is involved in the pathogenesis of different systemic disorders that affect cardiovascular and renal systems, such as hypertension, obesity, hypercholesterolemia, atherosclerosis, metabolic syndrome, chronic heart failure, and chronic kidney disease. Recent epidemiological evidence has shown an increasing trend in the prevalence of hyperuricemia and gout in the Western world: a number of population-based studies estimate a prevalence of up to 21% for hyperuricemia and 1%–4% for gout. As such, early detection and careful management of this pathological condition is required, starting from lifestyle changes (mainly based on a diet low in red meat, sugars, and alcoholic beverages, with increased intake of vegetables, water, and vitamin C sources), adding specific drugs to lead serum uric acid (SUA) levels under the target value of 7 mg/dL. In particular, nonselective and selective XO inhibitors (allopurinol, oxypurinol, febuxostat) reduce SUA levels and the overproduction of reactive oxygen species, mainly related to XO overactivity that often causes inflammatory damage to the vascular endothelium. The effect of lowering SUA levels via XO inhibition includes an attenuation of oxidative stress and related endothelial dysfunction that largely contribute to the pathophysiology of metabolic syndrome and cardiovascular diseases. Therefore, the inhibition of XO overactivation seems to be an excellent therapeutic option to limit the harmful effects of excess UA and reactive oxygen species. In conclusion, rapid diagnosis and correct therapy for hyperuricemia may also improve the prevention and/or treatment of serious and multifactorial diseases. The available evidence supports the importance of promoting new experimental clinical trials to confirm the emerging antioxidant role of XO inhibitors, which could effectively contribute to cardiovascular and chronic kidney disease prevention. PMID
Sexton, Chris C; Gelhorn, Heather L; Bell, Jill A; Classi, Peter M
The co-occurrence of reading disorder (RD) and attention-deficit/hyperactivity disorder (ADHD) has received increasing attention. This review summarizes the epidemiology, treatment strategies, psychosocial impact, and economic burden associated with the co-occurrence of these conditions. Common genetic and neuropsychological deficits may partially explain the high degree of overlap between RD and ADHD. Children who face the additive problems of both disorders are at greater risk for academic failure, psychosocial consequences, and poor long-term outcomes that persist into adulthood. However, few studies have evaluated interventions targeted to this patient population, underscoring the importance of identifying effective multimodal treatments that address the neuropsychological deficits of RD and ADHD through carefully planned clinical research.
Parental alienation occurs in divorces when one parent indoctrinates the child to dislike, fear, and avoid contact with the other parent. Mental health professionals who treat children and adolescents are likely to encounter victims of parental alienation in clinical practice, and it is important to identify and treat these youngsters earlier, when the condition is mild, rather than later, when the parental alienation is almost intractable. This article presents an overview of the treatment of parental alienation, which is called reunification therapy. All the parties involved in the case have a role in the prevention and treatment of parental alienation.
Weaver, Susan M.; Clifford, Ellen; Hay, Douglas M.; Robinson, John
Couples for whom in vitro fertilization (IVF) or gamete intrafallopian transfer (GIFT) treatment failed (N=20) were followed up and compared with successful couples. Current mental-health status, quality of life, and marital adjustment were assessed via questionnaires; experiences were explored by interview. Results and recommendations for…
Haack, Lauren M; Villodas, Miguel; McBurnett, Keith; Hinshaw, Stephen; Pfiffner, Linda J
We investigated whether parenting and child behavior improve following psychosocial treatment for Attention-Deficit/Hyperactivity Disorder, Predominantly Inattentive Presentation (ADHD-I) and whether parenting improvements mediate child outcomes. We analyzed data from a randomized clinical trial investigating the efficacy of a multicomponent psychosocial intervention (Child Life and Attention Skills, CLAS, n = 74) in comparison to Parent-Focused Treatment (PFT, n = 74) and treatment as usual (TAU, n = 51) for youth with ADHD-I (average child age = 8.6 years, range 7-11 years, 58 % boys). Child and parent/family functioning were assessed prior to treatment, immediately following treatment, and at follow-up into the subsequent school year using parent and teacher reports of inattention, organization, social skills, academic competency (teachers only), parenting daily hassles, and positive and negative parenting behaviors (parents only). Both treatment groups improved on negative parenting and home impairment, but only CLAS families also improved on positive parenting as well as academic impairment. Improvements in positive and negative parenting mediated treatment effects on child impairment independent of improvements in child inattention, implicating parenting as an important mechanism of change in psychosocial treatment for ADHD-I. Further, whereas parent-focused training produces improvements in negative parenting and impairment at home for children with ADHD-I, a multicomponent approach (incorporating child skills training and teacher consultation) more consistently produces improvements at school and in positive parenting, which may contribute to improvements in social skills into the next school year.
Tait, Raymond C; Chibnall, John T
Racial/ethnic disparities not only are prevalent throughout the U.S. health care system but also have proved refractory to change. Such disparities are evident and similarly persistent in the treatment of patients with chronic pain conditions, exacting high personal and societal costs. While psychosocial factors contribute significantly to this intractable problem, an integrated examination of the literature is lacking. This article provides an overview of psychosocial factors that contribute to disparities in the treatment of chronic pain patients and in their adjustment to pain. It focuses initially on aspects of pain assessment that can occasion disparate care. Because pain is a subjective phenomenon that often defies objective medical assessment, it is particularly susceptible to social psychological influences, such as stereotypes. We pay particular attention to negative racial/ethnic stereotypes as well as to the circumstances that are likely to trigger stereotype-driven judgments. Subsequent sections review psychosocial factors that can influence a patient's experience of pain, those that can influence the patient-provider interaction, and those that operate in the public health environment. After each section, we suggest actions that could address identified issues related to clinical care, research, and policy. Policy recommendations generally are linked to provisions of the Affordable Care Act. We conclude with a discussion of the role that psychology should play in future efforts to address the persistent problem of racial/ethnic disparities in pain care.
Birke-Sorensen, H; Malmsjo, M; Rome, P; Hudson, D; Krug, E; Berg, L; Bruhin, A; Caravaggi, C; Chariker, M; Depoorter, M; Dowsett, C; Dunn, R; Duteille, F; Ferreira, F; Francos Martínez, J M; Grudzien, G; Ichioka, S; Ingemansson, R; Jeffery, S; Lee, C; Vig, S; Runkel, N; Martin, R; Smith, J
Negative pressure wound therapy (NPWT) is becoming a commonplace treatment in many clinical settings. New devices and dressings are being introduced. Despite widespread adoption, there remains uncertainty regarding several aspects of NPWT use. To respond to these gaps, a global expert panel was convened to develop evidence-based recommendations describing the use of NPWT. In a previous communication, we have reviewed the evidence base for the use of NPWT within trauma and reconstructive surgery. In this communication, we present results of the assessment of evidence relating to the different NPWT treatment variables: different wound fillers (principally foam and gauze); when to use a wound contact layer; different pressure settings; and the impact of NPWT on bacterial bioburden. Evidence-based recommendations were obtained by a systematic review of the literature, grading of evidence and drafting of the recommendations by a global expert panel. Evidence and recommendations were graded according to the Scottish Intercollegiate Guidelines Network (SIGN) classification system. In general, there is relatively weak evidence on which to base recommendations for any one NPWT treatment variable over another. Overall, 14 recommendations were developed: five for the choice of wound filler and wound contact layer, four for choice of pressure setting and five for use of NPWT in infected wounds. With respect to bioburden, evidence suggests that reduction of bacteria in wounds is not a major mode of action of NPWT.
Symptoms of Conduct Disorder, Oppositional Defiant Disorder, Attention-Deficit/Hyperactivity Disorder, and Callous-Unemotional Traits as Unique Predictors of Psychosocial Maladjustment in Boys: Advancing an Evidence Base for DSM-V
Pardini, Dustin A.; Fite, Paula J.
Objective: The incremental utility of symptoms of conduct disorder (CD), oppositional defiant disorder (ODD), attention-deficit/hyperactivity disorder (ADHD), and callous-unemotional (CU) traits for predicting psychosocial outcomes across multiple domains was examined in a community sample of 1,517 boys. Method: Several outcomes were assessed…
Taylor, Steven; Abramowitz, Jonathan S
Dissemination methods are used to increase the likelihood that a given treatment or form of clinical practice is implemented by clinicians in the community. Therapist training in treatment methods is an important component of dissemination. Successful dissemination also requires that roadblocks to treatment implementation are identified and circumvented, such as misconceptions that clinicians might hold about a given treatment. The present article offers a commentary on the papers included in the special issue on treatment dissemination for anxiety disorders. Most papers focus on issues concerning the training and education of clinicians with regard to exposure therapy. Training and education is an important step but should be part of a broad, multifaceted approach. There are several other important methods of treatment dissemination, including methods developed and implemented with success by the pharmaceutical industry, might also be used to disseminate psychosocial therapies. Optimal dissemination likely requires a broad perspective in which multiple dissemination methods are considered for implementation.
This article presents an evidence-based reasoning, focusing on evidence of an Occupational Therapy input to lifestyle behaviour influences on panic disorder that also provides potentially broader application across other mental health problems (MHP). The article begins from the premise that we are all different. It then follows through a sequence of questions, examining incrementally how MHPs are experienced and classified. It analyses the impact of individual sensitivity at different levels of analysis, from genetic and epigenetic individuality, through neurotransmitter and body system sensitivity. Examples are given demonstrating the evidence base behind the logical sequence of investigation. The paper considers the evidence of how everyday routine lifestyle behaviour impacts on occupational function at all levels, and how these behaviours link to individual sensitivity to influence the level of exposure required to elicit symptomatic responses. Occupational Therapists can help patients by adequately assessing individual sensitivity, and through promoting understanding and a sense of control over their own symptoms. It concludes that present clinical guidelines should be expanded to incorporate knowledge of individual sensitivities to environmental exposures and lifestyle behaviours at an early stage. PMID:26095868
Murray, Greg; Leitan, Nuwan D; Thomas, Neil; Michalak, Erin E; Johnson, Sheri L; Jones, Steven; Perich, Tania; Berk, Lesley; Berk, Michael
Current adjunctive psychosocial interventions for bipolar disorder (BD) aim to impact illness course via information sharing/skill development. This focus on clinical outcomes contrasts with the emergent recovery paradigm, which prioritises adaptation to serious mental illness and movement towards personally meaningful goals. The aim of this review is to encourage innovation in the psychological management of BD by considering three recovery-oriented trends in the literature. First, the importance of quality of life as a target of recovery-oriented clinical work is considered. Second, the recent staging approach to BD is described, and we outline implications for psychosocial interventions tailored to stage. Finally, we review evidence suggesting that mindfulness-based psychosocial interventions have potential across early, middle and late stages of BD. It is concluded that the humanistic emphasis of the recovery paradigm provides a timely stimulus for development of a next generation of psychosocial treatments for people with BD.
Kelly, Brian C; Liu, Tieqiao; Zhang, Guanbai; Hao, Wei; Wang, Jichuan
Although substance abuse treatment has been considerably scaled up in China, impediments to accessing these services remain among drug users. The authors examine the primary psychosocial barriers to drug treatment in this population and evaluate factors associated with these barriers. Barriers to accessing drug treatment were measured using the Barriers to Treatment Inventory (BTI). A Structural Equation Model was used to examine whether the internal barriers were associated with treatment history and frequent methamphetamine use as well as how demographic characteristics influence such barriers. We found four primary factors of internal barriers to drug treatment – absence of problem, negative social support, fear of treatment, and privacy concerns – to fit well. Demographic factors, notably age and employment status, indirectly influence barriers to treatment via other factors. Frequency of methamphetamine use and drug treatment history are directly associated with the absence of problem and negative social support dimensions of the BTI, and it is through these pathways that demographic factors such as age and employment status shape barriers to treatment. The findings indicate that perceived absence of a problem and negative social support are the barriers most influenced by the personal domains of Chinese drug users’ lives. Efforts to engage drug users in China about drug treatment options may consider how these barriers are differentially perceived in order to effectively reach this population. PMID:24813554
Beecham, Jennifer; Sleed, Michelle; Knapp, Martin; Chiesa, Marco; Drahorad, Carla
This paper examines the costs and cost-effectiveness of psychosocial treatment for personality disorder in a controlled study. Using well-validated cost and outcome measures three groups are compared: the One-Stage group (n=32) received 12 months of inpatient treatment; the Step-Down group (n=29) received 6 months of inpatient treatment followed by 12 months of outpatient therapy; and the control group of 47 people used routinely available services. Both specialist programmes were more effective than routine psychiatric services but more costly. Using an extended dominance approach the incremental cost-effectiveness ratio showed that achieving one extra person with clinically relevant outcomes required an investment in the Step-Down programme of around 3400 pound sterling over 18 months. Small sample sizes and non-random allocation to programmes are limitations of this study but the costs and effectiveness findings consistently point to advantages for the shorter residential programme followed by community-based psychotherapeutic support.
Dugosh, Karen; Abraham, Amanda; Seymour, Brittany; McLoyd, Keli; Chalk, Mady; Festinger, David
Opioid use and overdose rates have risen to epidemic levels in the United States during the past decade. Fortunately, there are effective medications (ie, methadone, buprenorphine, and oral and injectable naltrexone) available for the treatment of opioid addiction. Each of these medications is approved for use in conjunction with psychosocial treatment; however, there is a dearth of empirical research on the optimal psychosocial interventions to use with these medications. In this systematic review, we outline and discuss the findings of 3 prominent prior reviews and 27 recent publications of empirical studies on this topic. The most widely studied psychosocial interventions examined in conjunction with medications for opioid addiction were contingency management and cognitive behavioral therapy, with the majority focusing on methadone treatment. The results generally support the efficacy of providing psychosocial interventions in combination with medications to treat opioid addictions, although the incremental utility varied across studies, outcomes, medications, and interventions. The review highlights significant gaps in the literature and provides areas for future research. Given the enormity of the current opioid problem in the United States, it is critical to gain a better understanding of the most effective ways to deliver psychosocial treatments in conjunction with these medications to improve the health and well-being of individuals suffering from opioid addiction.
Dugosh, Karen; Abraham, Amanda; Seymour, Brittany; McLoyd, Keli; Chalk, Mady; Festinger, David
Opioid use and overdose rates have risen to epidemic levels in the United States during the past decade. Fortunately, there are effective medications (ie, methadone, buprenorphine, and oral and injectable naltrexone) available for the treatment of opioid addiction. Each of these medications is approved for use in conjunction with psychosocial treatment; however, there is a dearth of empirical research on the optimal psychosocial interventions to use with these medications. In this systematic review, we outline and discuss the findings of 3 prominent prior reviews and 27 recent publications of empirical studies on this topic. The most widely studied psychosocial interventions examined in conjunction with medications for opioid addiction were contingency management and cognitive behavioral therapy, with the majority focusing on methadone treatment. The results generally support the efficacy of providing psychosocial interventions in combination with medications to treat opioid addictions, although the incremental utility varied across studies, outcomes, medications, and interventions. The review highlights significant gaps in the literature and provides areas for future research. Given the enormity of the current opioid problem in the United States, it is critical to gain a better understanding of the most effective ways to deliver psychosocial treatments in conjunction with these medications to improve the health and well-being of individuals suffering from opioid addiction. PMID:26808307
Larios, Sandra E.; Wright, Serena; Jernstrom, Amanda; Lebron, Dorothy; Sorensen, James L.
Substance abuse disproportionately impacts American Indian/Alaska Native (AI/AN) communities in the United States. For the increasing numbers of AI/AN individuals who enter and receive treatment for their alcohol or other drug problem it is imperative that the service they receive be effective. This study used qualitative methodology to examine attitudes toward evidence-based practices, also known as evidence-based treatments (EBTs) in minority-serving substance abuse treatment programs in the San Francisco Bay area. Twenty-two interviews were conducted in the study, of which seven were with program directors and substance abuse counselors at two urban AI/AN focused sites. These clinics were more likely than other minority-focused programs to have experience with research and knowledge about adapting EBTs. Only in the AI/AN specific sites did an issue arise concerning visibility, that is, undercounting AI/AN people in national and state databases. Similar to other minority-focused programs, these clinics described mistrust, fear of exploitation from the research community, and negative attitudes towards EBTs. The underutilization of EBTs in substance abuse programs is prevalent and detrimental to the health of patients who would benefit from their use. Future research should explore how to use this research involvement and experience with adaptation to increase the adoption of EBTs in AI/AN serving clinics. PMID:22400469
Lopata, Christopher; Lipinski, Alanna M.; Thomeer, Marcus L.; Rodgers, Jonathan D.; Donnelly, James P.; McDonald, Christin A.; Volker, Martin A.
This study examined the feasibility and initial outcomes of a comprehensive outpatient psychosocial treatment (MAXout) for children aged 7-12 years with high-functioning autism spectrum disorder. The 18-week treatment, two 90-minute sessions per week, included instruction and therapeutic activities targeting social/social communication skills,…
Quinlan, Nicole P.; Hoy, Melanie B.; Costanzo, Philip R.
This self-report and observational study explores the relationship between perceptions of different kinds of teasing experiences and psychosocial functioning in an overweight treatment-seeking adolescent population. Participants were 96 adolescents enrolled in a residential weight-loss camp program. Prior to the start of treatment, participants'…
Thomeer, Marcus L.; Lopata, Christopher; Volker, Martin A.; Toomey, Jennifer A.; Lee, Gloria K.; Smerbeck, Audrey M.; Rodgers, Jonathan D.; McDonald, Christin A.; Smith, Rachael A.
This replication randomized clinical trial examined the efficacy of a comprehensive psychosocial intervention for children aged 7 to 12 years with high-functioning autism spectrum disorders (HFASDs). Participants were randomly assigned to treatment or wait-list conditions. Treatment included instruction and therapeutic activities targeting social…
Allen, Daniel N.; Donohue, Brad; Sutton, Griffin; Haderlie, Michael; LaPota, Holly
Administrators of community-based treatment programs are increasingly being required to utilize psychometrically validated instruments to measure the effectiveness of their interventions. However, developers of psychometric measures have often failed to report strategies relevant to the administration of these measures in nontraditional settings outside the therapy office. Moreover, with few exceptions, developers of evidence-based treatments (EBTs) have insufficiently disseminated methods for integrating assessment measures into treatment planning. Therefore, the purpose of this article is to review an assessment methodology that may be utilized to support EBT for individuals who are identified for substance abuse or related problem behaviors. The application of this methodology is demonstrated utilizing Family Behavior Therapy to exemplify “real world” scenarios involving adolescent and adults. Although many of these strategies are evidence supported, most are based on clinical experiences occurring in clinical trials and dissemination efforts within community settings. PMID:19864319
Waddington, Lisa; Mesherry, Bernadette
This article examines the relevant international law relating to informed consent to treatment for individuals with psychosocial disabilities and reflects on the protection offered in this respect by the European Convention on Human Rights (ECHR) and the Council of Europe Convention on Human Rights and Biomedicine. The article argues that while the UN Convention on the Rights of Persons with Disabilities is beginning to influence case law of the European Court of Human Rights, only 'weak' protection has been afforded to people with psychosocial disabilities by the ECHR and the Court in relation to informed consent for medical treatment.
Härter, Martin; Klesse, Christian; Berger, Mathias; Bermejo, Isaac; Bschor, Tom; Gensichen, Jochen; Harfst, Timo; Hautzinger, Martin; Kühner, Christine; Mundt, Christoph; Niebling, Wilhelm; Richter, Rainer; Schulz, Holger; Schneider, Frank
The paper reflects central recommendations and methodological issues of the new German guidelines for the treatment of depression, as discussed in the article New German Guidelines for the Treatment of Depression - The Central Role of Psychotherapy (Schauenburg et al. 2009). Members of the steering group for these guidelines disagree with the authors' description in several points, especially with reference to the efficacy of pharmacotherapy with antidepressants and psychotherapy, as well as the relationship between both strategies of therapy and their combination in diverse phases of treatment (acute/maintenance). Furthermore, we try to clarify some misunderstandings in matters of the guideline's methodology which arose in the paper cited.
Barnes, Thomas R E
These guidelines from the British Association for Psychopharmacology address the scope and targets of pharmacological treatment for schizophrenia. A consensus meeting, involving experts in schizophrenia and its treatment, reviewed key areas and considered the strength of evidence and clinical implications. The guidelines were drawn up after extensive feedback from the participants and interested parties, and cover the pharmacological management and treatment of schizophrenia across the various stages of the illness, including first-episode, relapse prevention, and illness that has proved refractory to standard treatment. The practice recommendations presented are based on the available evidence to date, and seek to clarify which interventions are of proven benefit. It is hoped that the recommendations will help to inform clinical decision making for practitioners, and perhaps also serve as a source of information for patients and carers. They are accompanied by a more detailed qualitative review of the available evidence. The strength of supporting evidence for each recommendation is rated.
Dorrepaal, Ethy; Thomaes, Kathleen; Hoogendoorn, Adriaan W.; Veltman, Dick J.; Draijer, Nel; van Balkom, Anton J. L. M.
Introduction Effective first-line treatments for posttraumatic stress disorder (PTSD) are well established, but their generalizability to child abuse (CA)-related Complex PTSD is largely unknown. Method A quantitative review of the literature was performed, identifying seven studies, with treatments specifically targeting CA-related PTSD or Complex PTSD, which were meta-analyzed, including variables such as effect size, drop-out, recovery, and improvement rates. Results Only six studies with one or more cognitive behavior therapy (CBT) treatment conditions and one with a present centered therapy condition could be meta-analyzed. Results indicate that CA-related PTSD patients profit with large effect sizes and modest recovery and improvement rates. Treatments which include exposure showed greater effect sizes especially in completers’ analyses, although no differential results were found in recovery and improvement rates. However, results in the subgroup of CA-related Complex PTSD studies were least favorable. Within the Complex PTSD subgroup, no superior effect size was found for exposure, and affect management resulted in more favorable recovery and improvement rates and less drop-out, as compared to exposure, especially in intention-to-treat analyses. Conclusion Limited evidence suggests that predominantly CBT treatments are effective, but do not suffice to achieve satisfactory end states, especially in Complex PTSD populations. Moreover, we propose that future research should focus on direct comparisons between types of treatment for Complex PTSD patients, thereby increasing generalizability of results. PMID:25563302
Sibley, Margaret H; Kuriyan, Aparajita B; Evans, Steven W; Waxmonsky, James G; Smith, Bradley H
Smith, Waschbusch, Willoughby, and Evans (2000) reviewed a small treatment literature on ADHD in adolescents and concluded that methylphenidate stimulant medication was a well-established treatment and behavior therapy (BT) demonstrated preliminary efficacy. This review extends and updates the findings of the prior one based on the previous 15years of research. Studies published since 1999 were identified and coded using standard criteria and effect sizes were calculated where appropriate. Highlights of the last 15years of research include an expansion of pharmacological treatment options and developmentally appropriate psychosocial treatment packages for adolescents with ADHD. Additionally, nonstimulant medications (e.g., atomoxetine) are now approved for the treatment of ADHD in adolescence. The review concludes that medication and BT produce a similar range of therapeutic effects on the symptoms of adolescents with ADHD. However, results suggest that BT may produce greater overall benefits on measures of impairment. There was no evidence that cognitive enhancement trainings, such as working memory training or neurofeedback improved the functioning of adolescents with ADHD. Whether to use medication, BT, or their combination to treat an adolescent with ADHD is complicated and we provide evidence-informed guidelines for treatment selection. The reviewed evidence does not support current American Academy of Pediatrics and American Academy of Child and Adolescent Psychiatry professional guidelines, which state that stimulant medication is the preferred treatment for adolescents with ADHD. Recommendations for assessment, practice guidelines, and future research are discussed.
Lopez de Munain, L; Juan-Garcia, F J; Duarte, E; Martin-Mourelle, R; Rodriguez, S; Moraleda-Perez, S
Spasticity is a common complication that occurs in those patients that have suffered a stroke. To identify those patients at high risk of having post-stroke spasticity and to start treatment at early stages would probably benefit the patient. The key aspects in the early management of post-stroke spasticity were review and the clinical implications and strength of evidences were also considered. The document drafted by the study coordinators was subsequently reviewed and then a validated document was developed. The experts recommend defining early treatment of spasticity as one that begins before the first three months after stroke. The panel considers very important to identify the risk factors associated with the onset of spasticity, since this might reduce its impact. Additionally, the most common conditions subsidiaries of early treatment of both upper and lower limb are defined. The panel recommends that the treatment with botulinum toxin A must only be given by specialists with experience in diagnosis and management of spasticity. In conclusion, the treatment of focal spasticity in the first three months after stroke is indicated in certain situations. These recommendations help to standardize the early management of post-stroke spasticity, with the consequent support to clinicians and patients.
Gődény, Sándor; Csenteri, Orsolya Karola
Polycystic ovary syndrome is the most common hormonal and metabolic disorder likely to affect women. The syndrome is often associated with obesity, hyperinsulinemia and adversely affects endocrine, metabolic, and cardiovascular health. The complex feature of the syndrome requires an interdisciplinary approach to treatment, where cooperation of paediatrician, internist, gynaecologist, endocrinologist, dermatologist, psychologist and oncologist is essential. The prevention and the treatment should be based on the best available evidence. This should include physical examination, laboratory tests for hormones, serum insulin, glucose, lipids, in addition patient's preferences should be considered, too. To maximise health gain of polycystic ovarian syndrome, adequate, effective, efficient and safe treatment is necessary. This article summarises the highest available evidence provided by meta-analyses and systematic reviews of the prevention of metabolic and cardiovascular complications of the syndrome, and discusses the relevant evidence published in the literature.
Mandernach, Molly W; Beyth, Rebecca J; Rajasekhar, Anita
Venous thromboembolism (VTE) results in significant morbidity and mortality. The prevention and treatment of VTE is managed with anticoagulant therapy, historically parenteral anticoagulants such as unfractionated heparin, low molecular weight heparin, and fondaparinux, and oral vitamin K antagonists such as warfarin. In the last few years, several target-specific oral anticoagulants have been developed, including the direct thrombin inhibitor dabigatran and anti-Xa inhibitors rivaroxaban, apixaban, and edoxaban. The target-specific oral anticoagulants have proven to be noninferior to vitamin K antagonists and heparins in the prevention and treatment of VTE. This review will focus on the pharmacology, clinical trial data, and laboratory assessment of apixaban. Moreover, perioperative management, use in special populations, and management of bleeding complications in patients taking apixaban for the prevention and treatment of VTE will also be discussed. PMID:26345156
Friedberg, Robert D; Bayar, Hasan
The emergence of evidence-based psychological treatments (EVPTs) is a scientific success story, but unfortunately the application of these empirically supported procedures has been slow to gain ground in treatment-as-usual settings. This Open Forum commentary argues that direct-to-consumer (DTC) marketing, which has worked well in communicating the advantages of various medicines, should perhaps be considered for use in social marketing of EVPTs. DTC marketing of pharmaceuticals is a long-standing advertising strategy in the United States. In fact, DTC marketing of psychotropic medicines is quite a success story. The authors recommend various strategies for using marketing science to devise DTC advertising of EVPTs, discuss previous research on DTC campaigns, and describe initiatives launched in the United Kingdom and Europe to promote EVPTs. Suggestions for evaluating and regulating DTC marketing of EVPTs are included. Finally, the potential for DTC marketing of EVPTs to increase mental health literacy and reduce health disparities is explored.
Juel, Morgen Joray
In the present study, an attempt was made to determine the degree to which psychologists at college and university counseling centers (UCCs) utilized empirically supported treatments with their posttraumatic stress disorder (PTSD) clients. In addition, an attempt was made to determine how frequently UCC psychologists utilized a number of…
Asfar, Taghrid; Ward, Kenneth D.; Al-Ali, Radwan; Maziak, Wasim
The tobacco epidemic in Syria is characterized by high rates of cigarettes smoking in men and dramatic reemergence of waterpipe smoking, especially among youths and women. The Syrian Center for Tobacco Studies (SCTS), an NIH-funded pioneer research and capacity building institution, has developed a research infrastructure and conducted three randomized clinical trials to develop and rigorously test culturally-appropriate tobacco treatment programs integrated into primary healthcare (PHC) centers. This review aimed to discuss challenges and lessons learned from the Syrian experience. Addressing these challenges may inform future cessation research activities in Syria and other developing countries. To develop a research infrastructure, the SCTS has established Syria’s first IRB and trained physicians/medical students in both tobacco treatment and research methods. Main challenges to conduct the cessation trials were difficulties of coordination between the local and international collaborators; high Smoking Rates among PHC providers; lack of pharmacological agents used in tobacco treatment; and difficulties of conducting research in a politically volatile region. Strategies to overcome these challenges were ensuring an active and regular involvement of all investigator; and advocating for a national smoking-cessation plan that involves training health care providers in smoking cessation treatment and make pharmacological agents used in smoking cessation available. PMID:27563356
Beccari, Mario V; Meaney, Calvin J
Introduction Hyperkalemia is a serious medical condition that often manifests in patients with chronic kidney disease and heart failure. Renin–angiotensin–aldosterone system inhibitors are known to improve outcomes in these disease states but can also cause drug-induced hyperkalemia. New therapeutic options exist for managing hyperkalemia in these patients which warrant evidence-based evaluation. Aim The objective of this article was to review the efficacy and safety evidence for patiromer, sodium zirconium cyclosilicate (ZS9), and sodium polystyrene sulfonate (SPS) for the treatment of hyperkalemia. Evidence review Current treatment options to enhance potassium excretion are SPS and loop diuretics, which are complicated by ambiguous efficacy and known toxicities. Patiromer and ZS9 are new agents designed to address this treatment gap. Both unabsorbable compounds bind potassium in the gastrointestinal (GI) tract to facilitate fecal excretion. The capacity to bind other medications in the GI tract infers high drug–drug interaction potential, which has been demonstrated with patiromer but not yet investigated with ZS9 or SPS. Phase II and III clinical trials of patiromer and ZS9 demonstrated clear evidence of a dose-dependent potassium-lowering effect and the ability to initiate, maintain, or titrate renin–angiotensin–aldosterone system inhibitors. There is limited evidence base for SPS: two small clinical trials indicated potassium reduction in chronic hyperkalemia. All agents may cause adverse GI effects, although they are less frequent with ZS9. Concerns remain for SPS to cause rare GI damage. Electrolyte abnormalities occurred with patiromer and SPS, whereas urinary tract infections, edema, and corrected QT-interval prolongations were reported with ZS9. Conclusion Patiromer and ZS9 have improved upon the age-old standard SPS for the treatment of hyperkalemia. Additional research should focus on drug–drug interactions in patients on multiple
Saad, E D; Grunspun, H
Evidence-based medicine has been described as a new approach to teaching and practicing clinical medicine. Although the search for evidence is an established practice among physicians, what is being proposed is the systematic gathering and critical interpretation of data, which can then be used in the appropriate context. The main objective is to provide better care for patients. This is accomplished by transforming clinical problems in specific questions to be answered by searching the literature for the levels of evidence favoring the possible interventions for one particular case. This has to be done in a systematic and conscientious fashion. Through its method, evidence-based medicine places less value on clinical experience, the study understanding of pathophysiology, and common sense; instead, it emphasizes observation, levels of evidence, and critical interpretation of original literature. In this manner, evidence-based medicine may be seen by the authoritarian physician as a threat. Other obstacles to the acceptance of the method include lack of time and lack of familiarity with computers. One important limitation of evidence-based medicine is the incomplete or contradictory evidence available in many areas of clinical medicine, or the so-called "grey zones". We outline the main aspects of evidence-based medicine, expecting a growing interest among brazilian physicians for this useful clinical tool.
Shinnar, Shlomo; Gloss, David; Alldredge, Brian; Arya, Ravindra; Bainbridge, Jacquelyn; Bare, Mary; Bleck, Thomas; Dodson, W. Edwin; Garrity, Lisa; Jagoda, Andy; Lowenstein, Daniel; Pellock, John; Riviello, James; Sloan, Edward; Treiman, David M.
CONTEXT: The optimal pharmacologic treatment for early convulsive status epilepticus is unclear. OBJECTIVE: To analyze efficacy, tolerability and safety data for anticonvulsant treatment of children and adults with convulsive status epilepticus and use this analysis to develop an evidence-based treatment algorithm. DATA SOURCES: Structured literature review using MEDLINE, Embase, Current Contents, and Cochrane library supplemented with article reference lists. STUDY SELECTION: Randomized controlled trials of anticonvulsant treatment for seizures lasting longer than 5 minutes. DATA EXTRACTION: Individual studies were rated using predefined criteria and these results were used to form recommendations, conclusions, and an evidence-based treatment algorithm. RESULTS: A total of 38 randomized controlled trials were identified, rated and contributed to the assessment. Only four trials were considered to have class I evidence of efficacy. Two studies were rated as class II and the remaining 32 were judged to have class III evidence. In adults with convulsive status epilepticus, intramuscular midazolam, intravenous lorazepam, intravenous diazepam and intravenous phenobarbital are established as efficacious as initial therapy (Level A). Intramuscular midazolam has superior effectiveness compared to intravenous lorazepam in adults with convulsive status epilepticus without established intravenous access (Level A). In children, intravenous lorazepam and intravenous diazepam are established as efficacious at stopping seizures lasting at least 5 minutes (Level A) while rectal diazepam, intramuscular midazolam, intranasal midazolam, and buccal midazolam are probably effective (Level B). No significant difference in effectiveness has been demonstrated between intravenous lorazepam and intravenous diazepam in adults or children with convulsive status epilepticus (Level A). Respiratory and cardiac symptoms are the most commonly encountered treatment-emergent adverse events
Esene, Ignatius N.; Baeesa, Saleh S.; Ammar, Ahmed
Medical evidence is obtainable from approaches, which might be descriptive, analytic and integrative and ranked into levels of evidence, graded according to quality and summarized into strengths of recommendation. Sources of evidence range from expert opinions through well-randomized control trials to meta-analyses. The conscientious, explicit, and judicious use of current best evidence in making decisions related to the care of individual patients defines the concept of evidence-based neurosurgery (EBN). We reviewed reference books of clinical epidemiology, evidence-based practice and other previously related articles addressing principles of evidence-based practice in neurosurgery. Based on existing theories and models and our cumulative years of experience and expertise conducting research and promoting EBN, we have synthesized and presented a holistic overview of the concept of EBN. We have also underscored the importance of clinical research and its relationship to EBN. Useful electronic resources are provided. The concept of critical appraisal is introduced. PMID:27356649
Incorvaia, Lorena; Bronte, Giuseppe; Bazan, Viviana; Badalamenti, Giuseppe; Rizzo, Sergio; Pantuso, Gianni; Natoli, Clara; Russo, Antonio
The recent advances in identification of the molecular mechanisms related to tumorigenesis and angiogenesis, along with the understanding of molecular alterations involved in renal cell carcinoma (RCC) pathogenesis, has allowed the development of several new drugs which have revolutionized the treatment of metastatic renal cell carcinoma (mRCC).This process has resulted in clinically significant improvements in median overall survival and an increasing number of patients undergoes two or even three lines of therapy. Therefore, it is necessary a long-term perspective of the treatment: planning a sequential and personalized therapeutic strategy to improve clinical outcome, the potential to achieve long-term response, and to preserve quality of life (QOL), minimizing treatment-related toxicity and transforming mRCC into a chronically treatable condition.Because of the challenges still encountered to draw an optimal therapeutic sequence, the main focus of this article will be to propose the optimal sequencing of existing, approved, oral targeted agents for the treatment of mRCC using evidence-based data along with the knowledge available on the tumor behavior and mechanisms of resistance to anti-angiogenic treatment to provide complementary information and to help the clinicians to maximize the effectiveness of targeted agents in the treatment of mRCC.
Badalamenti, Giuseppe; Rizzo, Sergio; Pantuso, Gianni; Natoli, Clara; Russo, Antonio
The recent advances in identification of the molecular mechanisms related to tumorigenesis and angiogenesis, along with the understanding of molecular alterations involved in renal cell carcinoma (RCC) pathogenesis, has allowed the development of several new drugs which have revolutionized the treatment of metastatic renal cell carcinoma (mRCC). This process has resulted in clinically significant improvements in median overall survival and an increasing number of patients undergoes two or even three lines of therapy. Therefore, it is necessary a long-term perspective of the treatment: planning a sequential and personalized therapeutic strategy to improve clinical outcome, the potential to achieve long-term response, and to preserve quality of life (QOL), minimizing treatment-related toxicity and transforming mRCC into a chronically treatable condition. Because of the challenges still encountered to draw an optimal therapeutic sequence, the main focus of this article will be to propose the optimal sequencing of existing, approved, oral targeted agents for the treatment of mRCC using evidence-based data along with the knowledge available on the tumor behavior and mechanisms of resistance to anti-angiogenic treatment to provide complementary information and to help the clinicians to maximize the effectiveness of targeted agents in the treatment of mRCC. PMID:26872372
Hellerstein, David J; Flaxer, Joseph
Introduction It has clearly been demonstrated that depressive disorders constitute a major worldwide public health problem, with massive economic and quality-of-life consequences. Existing pharmacological treatments have limited efficacy, with only about a third of patients achieving remission on any one medication. Delayed onset of action and variable tolerability contribute to this limited efficacy. Vilazodone, introduced in the US in 2011, has been described as the first member of the serotonin partial agonist-reuptake inhibitor (SPARI) class of medications, combining serotonin-reuptake inhibition with 5-HT1A partial agonism. This agent could potentially have benefits for subgroups of depressed patients, including depressed patients with comorbid anxiety and patients with anxiety disorders, and might have fewer sexual side effects than selective serotonin-reuptake inhibitors (SSRIs). Aims We reviewed existing clinical trials that assess the benefits of vilazodone for treatment of major depression. Evidence review In clinical trials, including two Phase III studies and two Phase IV studies, vilazodone has been shown to have efficacy greater than placebo on the Montgomery–Åsberg Depression Rating Scale, comparable efficacy to citalopram, and continued benefit after 52 weeks of treatment. The safety profile for vilazodone is comparable to other SSRI medications, and tolerability also appears generally comparable to other SSRI medications. Place in therapy Vilazodone, which has been described as the first-of-class SPARI medication, may potentially have benefits for subgroups of patients, particularly those depressed individuals with coexisting anxiety symptoms or anxiety disorders. However, convincing evidence for these benefits has as yet not been published. PMID:25945081
Capal, Jamie K; Franz, David Neal
Tuberous sclerosis complex (TSC) is a relatively rare genetic disorder, affecting one in 6,000 births. Mammalian target of rapamycin (mTOR) inhibitors, such as everolimus, which have been previously used to prevent solid organ transplant rejection, augment anticancer treatment regimens, and prevent neovascularization of artificial cardiac stents, are now approved for treating TSC-related manifestations, such as subependymal giant cell astrocytomas and renal angiomyolipomas. The use of everolimus in treating subependymal giant cell astrocytomas is supported by long-term Phase II and III clinical trials. Seizures are a common feature in TSC, occurring in up to 96% of patients. While mTOR inhibitors currently do not have regulatory approval in treating this manifestation, small clinical studies have demonstrated beneficial outcomes with everolimus. Further evidence from a forthcoming Phase III clinical study may provide additional support for the use of everolimus for this indication. Also, there are no approved treatments for TSC-associated neuropsychiatric disorders, which include intellectual disability, behavioral difficulties, and autism spectrum disorder, but preclinical data and small studies have suggested that some neuropsychiatric symptoms may be improved through mTOR inhibition therapy. More evidence is needed, particularly regarding safety in young infants. This review focuses on the current evidence supporting the use of everolimus in neurologic and neuropsychiatric manifestations of TSC, and the place of everolimus in therapy. PMID:27601910
Logan, Jill K; Pantle, Hardin; Huiras, Paul; Bessman, Edward; Bright, Leah
When a previously healthy adult experiences atraumatic cardiac arrest, providers must quickly identify the etiology and implement potentially lifesaving interventions such as advanced cardiac life support. A subset of these patients develop cardiac arrest or periarrest due to pulmonary embolism (PE). For these patients, an early, presumptive diagnosis of PE is critical in this patient population because administration of thrombolytic therapy may significantly improve outcomes. This article reviews thrombolysis as a potential treatment option for patients in cardiac arrest or periarrest due to presumed PE, identifies features associated with a high incidence of PE, evaluates thrombolytic agents, and systemically reviews trials evaluating thrombolytics in cardiac arrest or periarrest. Despite potentially improved outcomes with thrombolytic therapy, this intervention is not without risks. Patients exposed to thrombolytics may experience major bleeding events, with the most devastating complication usually being intracranial hemorrhage. To optimize the risk-benefit ratio of thrombolytics for treatment of cardiac arrest due to PE, the clinician must correctly identify patients with a high likelihood of PE and must also select an appropriate thrombolytic agent and dosing protocol.
Capal, Jamie K; Franz, David Neal
Tuberous sclerosis complex (TSC) is a relatively rare genetic disorder, affecting one in 6,000 births. Mammalian target of rapamycin (mTOR) inhibitors, such as everolimus, which have been previously used to prevent solid organ transplant rejection, augment anticancer treatment regimens, and prevent neovascularization of artificial cardiac stents, are now approved for treating TSC-related manifestations, such as subependymal giant cell astrocytomas and renal angiomyolipomas. The use of everolimus in treating subependymal giant cell astrocytomas is supported by long-term Phase II and III clinical trials. Seizures are a common feature in TSC, occurring in up to 96% of patients. While mTOR inhibitors currently do not have regulatory approval in treating this manifestation, small clinical studies have demonstrated beneficial outcomes with everolimus. Further evidence from a forthcoming Phase III clinical study may provide additional support for the use of everolimus for this indication. Also, there are no approved treatments for TSC-associated neuropsychiatric disorders, which include intellectual disability, behavioral difficulties, and autism spectrum disorder, but preclinical data and small studies have suggested that some neuropsychiatric symptoms may be improved through mTOR inhibition therapy. More evidence is needed, particularly regarding safety in young infants. This review focuses on the current evidence supporting the use of everolimus in neurologic and neuropsychiatric manifestations of TSC, and the place of everolimus in therapy.
Schwartz, Robert P
This commentary reviews the limitations of the recent literature review by that examined the role of psychosocial interventions with medication for opioid addiction treatment. The commonly held belief that opioid agonist treatment alone is inferior treatment to such treatment combined with 'psychosocial' treatment (which many will understand to mean counseling) is not supported by the research evidence and it results in limitations on the use of these effective medications.
Brandt, Christian; May, Theodor W.; Bien, Christian G.
Brivaracetam (BRV) is a novel antiepileptic drug recently licensed for the treatment of partial epilepsy in adults and adolescents over 16 years old. Like levetiracetam (LEV), it is a ligand of the synaptic vesicle protein SV2A. BRV has been shown in animal models and in studies using human brain slices to have a higher SV2A affinity and faster penetration into the brain. Its efficacy and safety have been shown in several randomized, controlled studies. The recommended initial dose is 50–100 mg, divided into two daily doses. Up-titration to a 200 mg daily dose is possible. Dizziness and somnolence are frequent side effects. There are some hints that BRV may be less frequently associated with behavioural adverse events than LEV. Long-term efficacy and safety and BRV use in special patient groups have to be assessed in the future. PMID:27800023
van Zuuren, E J; Fedorowicz, Z; El-Gohary, M
Tinea cruris and tinea corporis are common fungal infections. Most can be treated with a variety of topical antifungals. This review aimed to assess the evidence for the effectiveness and safety of topical treatments for tinea cruris and tinea corporis. Searches included the Cochrane Skin Group Specialised Register, CENTRAL in The Cochrane Library, Medline, Embase, LILACS and ongoing trials registries (August 2013). One hundred and twenty-nine randomized controlled trials (RCTs) with 18 086 participants evaluated a range of interventions - mostly azoles. Pooling of data for several outcomes was only possible for two individual treatments. In five studies, terbinafine showed a statistically significant higher clinical cure rate compared with placebo [risk ratio (RR) 4·51, 95% confidence interval (CI) 3·10-6·56]. Data for mycological cure could not be pooled owing to substantial heterogeneity. Across three studies, mycological cure rates favoured naftifine (1%) compared with placebo (RR 2·38, 95% CI 1·80-3·14) but the quality of the evidence was low. Combinations of azoles with corticosteroids were slightly more effective than azoles for clinical cure, but there was no statistically significant difference with regard to mycological cure. Sixty-five studies were assessed as 'unclear' and 64 as being at 'high risk' of bias; many were over 20 years old, and most were poorly designed and inadequately reported. Although most active interventions showed sufficient therapeutic effect, this review highlights the need for further, high-quality, adequately powered RCTs to evaluate the effects of these interventions, which can ultimately provide reliable evidence to inform clinical decision making.
Wang, Jichuan; Kelly, Brian C; Liu, Tieqiao; Hao, Wei
Given the growth in methamphetamine use in China during the 21st century, we assessed perceived psychosocial barriers to drug treatment among this population. Using a sample of 303 methamphetamine users recruited via Respondent Driven Sampling, we use Latent Class Analysis (LCA) to identify possible distinct latent groups among Chinese methamphetamine users on the basis of their perceptions of psychosocial barriers to drug treatment. After covariates were included to predict latent class membership, the 3-step modeling approach was applied. Our findings indicate that the Chinese methamphetamine using population was heterogeneous on perceptions of drug treatment barriers; four distinct latent classes (subpopulations) were identified--Unsupported Deniers, Deniers, Privacy Anxious, and Low Barriers--and individual characteristics shaped the probability of class membership. Efforts to link Chinese methamphetamine users to treatment may require a multi-faceted approach that attends to differing perceptions about impediments to drug treatment.
Pfiffner, Linda J.; Hinshaw, Stephen P.; Owens, Elizabeth; Zalecki, Christine; Kaiser, Nina M.; Villodas, Miguel; McBurnett, Keith
Objective This study evaluated the efficacy of the Child Life and Attention Skills (CLAS) program, a behavioral psychosocial treatment integrated across home and school, for youth with Attention Deficit Hyperactivity Disorder-Inattentive Type (ADHD-I). Method In a two-site randomized controlled trial, 199 children (ages 7-11) were randomized to CLAS (N=74), parent-focused treatment (PFT, N=74), or treatment as usual (TAU, N=51). We compared groups on parent and teacher ratings of inattention symptoms, organizational skills, social skills, and global improvement at post-treatment, and also at follow-up during the subsequent school year. Results CLAS resulted in greater improvements in teacher-reported inattention, organizational skills, social skills, and global functioning relative to both PFT and TAU at post-treatment. Parents of children in CLAS reported greater improvement in organizational skills than PFT and greater improvements on all outcomes relative to TAU at post-treatment. Differences between CLAS and TAU were maintained at follow-up for most parent-reported measures but were not significant for teacher-reported outcomes. Conclusions These findings extend support for CLAS across two study sites, revealing that integrating parent, teacher, and child treatment components, specifically adapted for ADHD-I, is superior to parent training alone and to usual care. Direct involvement of teachers and children in CLAS appears to amplify effects at school and home and underscores the importance of coordinating parent, teacher, and child treatment components for cross-setting effects on symptoms and impairment associated with ADHD-I. PMID:24865871
Moran, Lisa J; Ko, Henry; Misso, Marie; Marsh, Kate; Noakes, Manny; Talbot, Mac; Frearson, Meredith; Thondan, Mala; Stepto, Nigel; Teede, Helena J
While lifestyle management is recommended as first-line treatment of polycystic ovary syndrome (PCOS), the optimal dietary composition is unclear. The aim of this study was to compare the effect of different diet compositions on anthropometric, reproductive, metabolic, and psychological outcomes in PCOS. A literature search was conducted (Australasian Medical Index, CINAHL, EMBASE, Medline, PsycInfo, and EBM reviews; most recent search was performed January 19, 2012). Inclusion criteria were women with PCOS not taking anti-obesity medications and all weight-loss or maintenance diets comparing different dietary compositions. Studies were assessed for risk of bias. A total of 4,154 articles were retrieved and six articles from five studies met the a priori selection criteria, with 137 women included. A meta-analysis was not performed due to clinical heterogeneity for factors including participants, dietary intervention composition, duration, and outcomes. There were subtle differences between diets, with greater weight loss for a monounsaturated fat-enriched diet; improved menstrual regularity for a low-glycemic index diet; increased free androgen index for a high-carbohydrate diet; greater reductions in insulin resistance, fibrinogen, total, and high-density lipoprotein cholesterol for a low-carbohydrate or low-glycemic index diet; improved quality of life for a low-glycemic index diet; and improved depression and self-esteem for a high-protein diet. Weight loss improved the presentation of PCOS regardless of dietary composition in the majority of studies. Weight loss should be targeted in all overweight women with PCOS through reducing caloric intake in the setting of adequate nutritional intake and healthy food choices irrespective of diet composition.
Gonzalez-Ruiz, Armando; Seaton, R Andrew; Hamed, Kamal
Infections caused by Gram-positive pathogens remain a major public health burden and are associated with high morbidity and mortality. Increasing rates of infection with Gram-positive bacteria and the emergence of resistance to commonly used antibiotics have led to the need for novel antibiotics. Daptomycin, a cyclic lipopeptide with rapid bactericidal activity against a wide range of Gram-positive bacteria including methicillin-resistant Staphylococcus aureus, has been shown to be effective and has a good safety profile for the approved indications of complicated skin and soft tissue infections (4 mg/kg/day), right-sided infective endocarditis caused by S. aureus, and bacteremia associated with complicated skin and soft tissue infections or right-sided infective endocarditis (6 mg/kg/day). Based on its pharmacokinetic profile and concentration-dependent bactericidal activity, high-dose (>6 mg/kg/day) daptomycin is considered an important treatment option in the management of various difficult-to-treat Gram-positive infections. Although daptomycin resistance has been documented, it remains uncommon despite the increasing use of daptomycin. To enhance activity and to minimize resistance, daptomycin in combination with other antibiotics has also been explored and found to be beneficial in certain severe infections. The availability of daptomycin via a 2-minute intravenous bolus facilitates its outpatient administration, providing an opportunity to reduce risk of health care-associated infections, improve patient satisfaction, and minimize health care costs. Daptomycin, not currently approved for use in the pediatric population, has been shown to be widely used for treating Gram-positive infections in children. PMID:27143941
Dialectical behavior therapy with American Indian/Alaska Native adolescents diagnosed with substance use disorders: combining an evidence based treatment with cultural, traditional, and spiritual beliefs.
Beckstead, D Joel; Lambert, Michael J; DuBose, Anthony P; Linehan, Marsha
This pilot study examined pre to post-change of patients in a substance use residential treatment center that incorporated Dialectical Behavior Therapy with specific cultural, traditional and spiritual practices for American Indian/Alaska Native adolescents. Specifically, the incorporation of cultural, spiritual and traditional practices was done while still maintaining fidelity to the evidence based treatment (DBT). 229 adolescents participated in the study and were given the Youth Outcome Questionnaire-Self-Report version at pre-treatment and post-treatment and the total scores were compared. The results of the research study showed that 96% of adolescents were either "recovered" or "improved" using clinical significant change criteria. Additionally, differences between the group's pre-test scores and post-test scores were statistically significant using a matched standard T-test comparison. Finally, the effect size that was calculated using Cohen's criteria was found to be large. The results are discussed in terms of the implication for integrating western and traditional based methods of care in addressing substance use disorders and other mental health disorders with American Indian/Alaska Native adolescents.
Petry, Nancy M.; Roll, John M.; Rounsaville, Bruce J.; Ball, Samuel A.; Stitzer, Maxine; Peirce, Jessica M.; Blaine, Jack; Kirby, Kimberly C.; McCarty, Dennis; Carroll, Kathleen M.
Human subjects protection policies developed for pharmaceutical trials are now being widely applied to psychosocial intervention studies. This study examined occurrences of serious adverse events (SAEs) reported in multicenter psychosocial trials of the National Institute on Drug Abuse Clinical Trials Network. Substance-abusing participants (N =…
Heron, Kristin E.; Smyth, Joshua M.
Purpose Psychosocial and health behavior treatments and therapies can be extended beyond traditional research or clinical settings by using mobile technology to deliver interventions to individuals as they go about their daily lives. These Ecological Momentary Interventions [EMI] are treatments that are provided to people during their everyday lives (i.e., in real time) and in natural settings (i.e., real world). The goal of the present review is to synthesize and critique mobile technology-based EMI aimed at improving health behaviors and psychological and physical symptoms. Methods Twenty-seven interventions using palmtop computers or mobile phones to deliver ambulatory treatment for smoking cessation, weight loss, anxiety, diabetes management, eating disorders, alcohol use, and healthy eating and physical activity were identified. Results There is evidence that EMI can be successfully delivered, are accepted by patients, and are efficacious for treating a variety of health behaviors and physical and psychological symptoms. Limitations of the existing literature were identified and recommendations and considerations for research design, sample characteristics, measurement, statistical analyses, and clinical implementation are discussed. Conclusions Mobile technology-based EMI can be effectively implemented as interventions for a variety of health behaviors and psychological and physical symptoms. Future research should integrate the assessment and intervention capabilities of mobile technology to create dynamically and individually tailored EMI that are ecologically sensitive. PMID:19646331
Curatolo, Paolo; Bjørnvold, Marit; Dill, Patricia E; Ferreira, José Carlos; Feucht, Martha; Hertzberg, Christoph; Jansen, Anna; Jóźwiak, Sergiusz; Kingswood, J Christopher; Kotulska, Katarzyna; Macaya, Alfons; Moavero, Romina; Nabbout, Rima; Zonnenberg, Bernard A
Tuberous sclerosis complex (TSC) is a genetic disorder arising from mutations in the TSC1 or TSC2 genes. The resulting over-activation of the mammalian target of rapamycin (mTOR) signalling pathway leaves patients with TSC susceptible to the growth of non-malignant tumours in multiple organs. Previously, surgery was the main therapeutic option for TSC. However, pharmacological therapy with mTOR inhibitors such as everolimus and sirolimus is now emerging as an alternate approach. Everolimus and sirolimus have already been shown to be effective in treating subependymal giant cell astrocytoma (SEGA) and renal angiomyolipoma (AML), and everolimus is currently being evaluated in treating TSC-related epilepsy. In November 2013 a group of European experts convened to discuss the current options and practical considerations for treating various manifestations of TSC. This article provides evidence-based recommendations for the treatment of SEGA, TSC-related epilepsy and renal AML, with a focus on where mTOR inhibitor therapy may be considered alongside other treatment options. Safety considerations regarding mTOR inhibitor therapy are also reviewed. With evidence of beneficial effects in neurological and non-neurological TSC manifestations, mTOR inhibitors may represent a systemic treatment for TSC.
Evidence based medicine is a systematic method employed to secure the best scientific available evidence when making clinical decisions. Several steps are taken in these process, describing a clinical scenario, formulating a specific clinical question, searching the literature for the pertinent studies, selecting the relevant articles using rules of evidence, understanding and calculating measures of effect, and finally incorporating the evidence and patients preferences in the clinical decision process.
Kuśnierkiewicz, Maria; Kędziora, Justyna; Jaroszyk-Pawlukiewicz, Joanna; Nowak-Jaroszyk, Monika
With society getting older and affected by many diseases, more and more people suffer from severe cognitive disorders. As practice shows, the legal situations of such people is often problematic. This is due to a number of factors, such as short time since the deterioration of patient's condition, initial symptoms ignored, social prejudice towards the idea of incapacitation or taking decisions for a patient, complicated procedures and, sometimes, insufficient knowledge of legal regulations. Cognitive disorders also occur in patients treated for cancer. To be effective, oncological treatment needs to be started as early as possible. This, however, does not meet the criteria of sudden threat to life. The present article relates to both the psychosocial and legal aspects of care of people suffering from intense disorders of memory, attention, problem solving, executive functions, and other. Surely, physicians know how to handle patients with the above dysfunctions. However, legal procedures aimed to protect patients’ rights are often unclear and time consuming. In practice, this often amounts to a dilemma whether to treat or follow the applicable law. Certainly, solutions in this regard should be clearer and better adapted to the needs arising from specific treatment needs of particular groups of patients. PMID:24936334
Dural tears (DT) and the consequent cerebral spinal fluid (CSF) leak are not rare in spine surgeries. CSF leak can be troublesome, leading to pseudomeningocele, cutaneous CSF fistula, and meningitis. Revision surgery is unavoidable in some cases. The reported incidences of DT and CSF leak are different according to the various pathologies. Ossification of the posterior longitudinal ligament, revision spine surgery and multi-segment laminectomy have higher risks for DT. Various techniques have been described to manage this complication, such as bed rest, repair with dural substitutes, fibrin glue, gelatin sponge, lumbar drain, muscle flap, etc.Through objective evaluation of the evidence and transparency in the process of making recommendations, it is Chinese Association of Orthopaedic Surgeons' goal to develop evidence-based clinical practice guidelines for the treatment of incidental DT and the consequent CSF leak during spine surgery. The current clinical guidelines focus on 9 clinical questions and the strength of recommendations were made based on the quality of the literature. The work group considers that this guideline recommendations aim to assist in delivering optimum, efficacious treatment and functional recovery from this complication.
Leibowitz, Scott F; Spack, Norman P
Few interdisciplinary treatment programs that tend to the needs of youth with gender nonconforming behaviors, expressions, and identities exist in academic medical centers with formal residency training programs. Despite this, the literature provides evidence that these youth have higher rates of poor psychosocial adjustment and suicide attempts. This article explores the logistical considerations involved in developing a specialized interdisciplinary service to these gender minority youth in accordance with the existing treatment guidelines.Demographic data will be presented and treatment issues will be explored. The impact that a specialized interdisciplinary treatment program has on clinical expansion, research development, education and training, and community outreach initiatives is discussed.
Kalra, Sanjay; Sridhar, G. R.; Balhara, Yatan Pal Singh; Sahay, Rakesh Kumar; Bantwal, Ganapathy; Baruah, Manash P.; John, Mathew; Unnikrishnan, Ambika Gopalkrishnan; Madhu, K.; Verma, Komal; Sreedevi, Aswathy; Shukla, Rishi; Prasanna Kumar, K. M.
Although several evidence-based guidelines for managing diabetes are available, few, if any, focus on the psychosocial aspects of this challenging condition. It is increasingly evident that psychosocial treatment is integral to a holistic approach of managing diabetes; it forms the key to realizing appropriate biomedical outcomes. Dearth of attention is as much due to lack of awareness as due to lack of guidelines. This lacuna results in diversity among the standards of clinical practice, which, in India, is also due to the size and complexity of psychosocial care itself. This article aims to highlight evidence- and experience-based Indian guidelines for the psychosocial management of diabetes. A systemic literature was conducted for peer-reviewed studies and publications covering psychosocial aspects in diabetes. Recommendations are classified into three domains: General, psychological and social, and graded by the weight they should have in clinical practice and by the degree of support from the literature. Ninety-four recommendations of varying strength are made to help professionals identify the psychosocial interventions needed to support patients and their families and explore their role in devising support strategies. They also aid in developing core skills needed for effective diabetes management. These recommendations provide practical guidelines to fulfill unmet needs in diabetes management, and help achieve a qualitative improvement in the way physicians manage patients. The guidelines, while maintaining an India-specific character, have global relevance, which is bound to grow as the diabetes pandemic throws up new challenges. PMID:23869293
Trivedi, Madhukar H.; Dunner, David L.; Kornstein, Susan G.; Thase, Michael E.; Zajecka, John M.; Rothschild, Anthony J.; Friedman, Edward S.; Shelton, Richard C.; Keller, Martin B.; Kocsis, James H.; Gelenberg, Alan
Background Psychosocial outcomes from the Prevention of Recurrent Episodes of Depression with Venlafaxine ER for Two Years (PREVENT) study were evaluated. Methods Adult outpatients with recurrent major depressive disorder (MDD) and response or remission following 6-month continuation treatment with venlafaxine extended release (ER) were randomized to receive venlafaxine ER or placebo for 1 year. Patients without recurrence on venlafaxine ER during year 1 were randomized to venlafaxine ER or placebo for year 2. Psychosocial functioning was assessed using the Quality of Life Enjoyment and Satisfaction Questionnaire—Short Form (Q-LES-Q), Life EnjoymentScale—Short Version (LES-S), Social Adjustment Scale—Self-Report (SAS-SR) total and individual factors, Short Form Health Survey (SF-36) (vitality, social functioning, and role function-emotional items), and Longitudinal Interval Follow-up Evaluation (LIFE). Results At year 1 end, better overall psychosocial functioning was seen among patients randomly assigned to venlafaxine ER (n=129) vs placebo (n=129), with significant differences at end point on SF-36 role function-emotional, Q-LES-Q, and SAS-SR total, and work, house work, social/leisure, and extended-family factor scores (p≤0.05). At year 2 end, significant differences favored venlafaxine ER (n=43) vs placebo (n=40)on SF-36 vitality and rolefunction-emotional, Q-LES-Q, LES-S, LIFE, and SAS-SR total, social/leisure, and extended-family factor scores (p≤0.05). Limitations Patients with chronic MDD or treatment resistance were excluded and long-term specialist care was a financial incentive for treatment compliance. Discontinuation-related adverse events may have compromised the integrity of the treatment blind. Conclusions For patients with recurrent MDD, 2 years’ maintenance therapy with venlafaxine ER may improve psychosocial functioning vs placebo. PMID:20510459
Mazerolle, Stephanie M.; Pinkus, Danielle E.; Casa, Douglas J.; McDermott, Brendon P.; Pagnotta, Kelly D.; Ruiz, Roberto C.; Armstrong, Lawrence E.; Maresh, Carl M.
Context: Exertional heat stroke (EHS) is one of the leading causes of death in athletes. Certified athletic trainers (ATs) demonstrate strong knowledge of recommended practices with EHS but are apprehensive in implementing 2 basic procedures: rectal temperature assessment and cold water immersion. This apprehension might lead to deaths from EHS that could have been prevented. Objective: To investigate why collegiate and high school ATs do not implement best practices for the recognition and treatment of EHS. Design: Qualitative study. Setting: In-person focus groups consisting of 3 to 6 collegiate or high school ATs. Patients or Other Participants: A total of 19 ATs (9 men, 10 women; age = 36 ± 10 years, length of certification = 12 ± 9 years) employed at either the collegiate (n = 10) or high school (n = 9) level participated in the study. Data Collection and Analysis: Interviews were transcribed verbatim, and data were analyzed using deductive data analysis. Peer review and multiple-analyst data triangulation were conducted to establish trustworthiness of the data. Results: Five emergent themes explained the lack of evidence-based practice (EBP) regarding recognition and treatment of EHS. Three themes (lack of knowledge, comfort level, lack of initiative) were common in both the collegiate and high school settings, and 2 separate themes (liability concerns, lack of resources) were present in the high school setting. Conclusions: Our findings are consistent with those in the literature on EBP and EHS. Regardless of clinical setting, ATs have basic information on recognition and treatment of EHS, but 5 themes act as barriers to implementing proper management in the clinical setting. Workshops or hands-on training sessions need to be made available to improve students' comfort levels so ATs will implement EBP into everyday settings. PMID:22488141
Haimerl, Peggy; Arlt, Sebastian; Heuwieser, Wolfgang
The objective of this study was to evaluate the quality and comparability of published literature, and to summarize the effect of prostaglandin F(2α) (PGF(2α)) for the treatment of endometritis. It has been postulated that there is a dearth of high-level evidence-based research results in veterinary medicine. Also, there is a marked variation in the quality of studies in veterinary and animal science. Post-partum uterine infections occur commonly in dairy cattle and are reported to have a negative impact on reproductive performance. A comprehensive literature search was conducted utilizing online databases revealing a total of 2723 references. After applying specific exclusion criteria, a total of 68 trials were eligible for further analysis. These articles were evaluated utilizing specific parameters listed in an evaluation form such as randomization and the involvement of control groups. The analysis revealed that more than half of the trials (51·5%) were at least 20 years old. Furthermore, we found that about one third (36·8%) of all trials were controlled and randomized, while 3 of those (4·4%) were also blinded. Of those trials which calculated a calving-to-conception interval (n=30), 50% of the authors claimed an improvement, which was statistically significant in 23·3% of the cases. We conclude that there is a wide discrepancy between research results investigating the efficacy of PGF(2α).
Chatterjee, Sudipto; Chowdhary, Neerja; Pednekar, Sulochana; Cohen, Alex; Andrew, Gracy; Andrew, Gracy; Araya, Ricardo; Simon, Gregory; King, Michael; Telles, Shirley; Verdeli, Helena; Clougherty, Kathleen; Kirkwood, Betty; Patel, Vikram
Common mental disorders, such as depression and anxiety, pose a major public health burden in developing countries. Although these disorders are thought to be best managed in primary care settings, there is a dearth of evidence about how this can be achieved in low resource settings. The MANAS project is an attempt to integrate an evidence based package of treatments into routine public and private primary care settings in Goa, India. Before initiating the trial, we carried out extensive preparatory work, over a period of 15 months, to examine the feasibility and acceptability of the planned intervention. This paper describes the systematic development and evaluation of the intervention through this preparatory phase. The preparatory stage, which was implemented in three phases, utilized quantitative and qualitative methods to inform our understanding of the potential problems and possible solutions in implementing the trial and led to critical modifications of the original intervention plan. Investing in systematic formative work prior to conducting expensive trials of the effectiveness of complex interventions is a useful exercise which potentially improves the likelihood of a positive result of such trials.
Psychosocial interventions improve cognitive abilities (cognitive stimulation, cognitive training), enhance emotional well-being (activity planning, reminiscence), reduce behavioral symptoms (aromatherapy, music therapy) and promote everyday functioning (occupational therapy). Through these effects they reinforce and augment pharmacological treatments for dementia. In addition, psychosocial interventions complement the treatment of patients by supporting family caregivers (educational groups, support programs). The potential of psychosocial interventions in dementia needs to be explored further in studies using improved methodology to determine effective components, clinical relevance and duration of effects, predictors of individual treatment response and health-economic implications.
Williamson, Heidi; Hamlet, Claire; White, Paul; Marques, Elsa M R; Cadogan, Julia; Perera, Rohan; Rumsey, Nichola; Hayward, Leighton; Harcourt, Diana
Introduction A significant number of adolescents suffer extensive and enduring difficulties such as social anxiety, body image dissatisfaction, low self-esteem and bullying as a result of conditions or injuries that affect their appearance (eg, craniofacial and skin conditions, treatment side effects and scarring). Evidence-based psychosocial interventions to meet their specific needs are currently lacking. YP Face IT, developed by the UK's Centre for Appearance Research in collaboration with clinical experts and young people, is an innovative online psychosocial intervention designed to offer this group immediate support, advice and coping strategies. It has been endorsed by young people, their parents/carers, GPs, clinical psychologists and health professionals working with those affected by appearance-related conditions. Methods and analysis Young people aged 12–17 with an appearance-altering condition/injury that self-identify as experiencing appearance-related distress, teasing or bullying will be invited to participate via GP practices and UK charities. Consenting participants will be randomised to the intervention (YP Face IT) or the treatment as usual (TAU) control group. Outcome measures will be completed by young people and their parents/carers at baseline, 13, 26 and 52 weeks. Primary outcome measures will be the Body Esteem Scale and the Social Anxiety Scale for Adolescents. Participants will complete other health-related outcome measures and resource use questionnaires for health economic analysis. We will assess recruitment rates, acceptability of the YP Face IT programme, adherence and retention to treatment, questionnaire completion rates, variation of TAU in Primary Care and the feasibility of GP practice staff supervising young people's use of YP Face IT. Ethics and dissemination This feasibility trial protocol (V.1, 3 March 2014), received a favourable ethical opinion from the NRES Committee South West-Frenchay (reference number 14/SW/0058
D’Souza, W; Zhang, B; Feigenberg, S; Prado, K; Regine, W; D’Souza, G
Purpose: To evaluate the compliance with evidence-based treatment planning organ-at-risk (OAR) guidelines in a single institution with four practice sites. Methods: Two hundred thirteen head and neck cancer patients treated between September 2009 and September 2013 were retrospectively selected. Consensus treatment planning guidelines, including OAR dose constraints, were established based on institutional experience and published data. Data spanned a time period of 2 years prior to (n=112) and 2 years post-enactment (n=101) of the guidelines. We investigated the differences in the frequency with which (1) OARs were contoured and (2) OAR DVH goals were met. Trends in the proportion with OAR contours over time was tested using linear regression. Trends in the proportion of contoured OARs achieving clinical DVH goals were similarly tested. The proportion of patients contoured and meeting DVH goals before and after guidelines was compared using a test of proportions. Results: When the proportion of cases with OAR contours before and after guidelines were compared, we observed an increase from 75% to 87% (p=0.02) for the brainstem, decrease from 97% to 88% (p=0.01) for the cord and increase from 47% to 77% (p<0.001) for the mandible. For the proportion of cases with OAR contours in which clinical goals were met, a significant decrease from 99% to 90% was observed for the cord V48<0.3% (p=0.001). A significant decrease in the proportion of cases with left parotid contours (from 92% to 73% (p=0.03)) was observed over 2 years after guideline enactment and the proportion meeting the clinical DVH goal of V30<50% increased significantly from 36% to 50% (p=0.007) over the 2 years after guidelines. Conclusion: The enactment of OAR planning guidelines resulted in an increase in OAR contour compliance, overall. In cases with OAR contours, there was little to no change in the proportion that met clinical goals.
Reeder, Kevin M.; TerBeek, Erin G.; Fiore, Michael C.; Baker, Timothy B.
Introduction: Individuals of low socioeconomic status (SES), smoke at very high rates but make fewer and less successful quit attempts than do other smokers. Low-SES smokers have specific beliefs about smoking and quitting that may serve as barriers to making quit attempts. The purpose of this study was to test the impact of a brief intervention addressing these beliefs on making calls to a telephone quit line. Methods: Of 522 smokers entering the study at 5 Wisconsin Salvation Army (SA) sites, 102 expressed motivation to quit and served as a comparison group. The remaining 420 smokers were not motivated to quit and were randomly assigned to 1 of 3 conditions: an intervention group who received brief counseling focused on cessation goals and beliefs, an attention-control group, and a low contact control group. The primary outcome was the rate at which smokers made a call to the Wisconsin tobacco quit line (WTQL) during their SA visit. Secondary outcome measures included motivational variables, stage of change, changes in beliefs about smoking and quitting, and self-reported abstinence. Results: Unmotivated participants in the intervention condition called the WTQL at a significantly higher rate (12.2%) than did those in the 2 control conditions (2.2% and 1.4%) (p < .01) and approached the rate of calling by participants who were initially motivated to quit (15.7%). Intervention condition participants also showed improved motivation to quit and stage of change. Conclusions: A brief, targeted motivational intervention focusing on cessation goals and beliefs increased the initiation of an evidence-based tobacco cessation treatment by low-SES smokers. PMID:26180226
Michelson, Daniel; Davenport, Clare; Dretzke, Janine; Barlow, Jane; Day, Crispin
Evidence-based interventions are often unavailable in everyday clinical settings. This may partly reflect practitioners' assumptions that research evidence does not reflect "real-world" conditions. To examine this further, we systematically assessed the clinical effectiveness of parent management training (PMT) for the treatment of child…
Chorpita, Bruce F.; Daleiden, Eric L.
This study applied the distillation and matching model to 322 randomized clinical trials for child mental health treatments. The model involved initial data reduction of 615 treatment protocol descriptions by means of a set of codes describing discrete clinical strategies, referred to as practice elements. Practice elements were then summarized in…
West, Amy E.; Henry, David B.; Pavuluri, Mani N.
Objective: The chronic and refractory course of pediatric bipolar disorder merits the study of adjunctive psychosocial interventions designed to facilitate long-term improvements. The objective of this study is to conduct a pilot study of a maintenance model of the child- and family-focused cognitive-behavioral therapy program (CFF-CBT), which…
Weltman, Karen; And Others
The move toward deinstitutionalization of chronic psychiatric patients has been hampered by inadequate community-based rehabilitation programs. To investigate whether psychosocial rehabilitation promotes higher levels of functioning in discharged psychiatric patients, assessments of social adjustment, recidivism, and a non-traditional measure of…
Casarico, Antonio; Fandella, Andrea; Galetti, Caterina; Hurle, Rodolfo; Mazzini, Elisa; Niro, Ciro; Perachino, Massimo; Sanseverino, Roberto; Pappagallo, Giovanni Luigi
these guidelines are evidence based, clinical decisions should also be informed by patients’ clinical and physical circumstances, as well as patients’ preferences and actions. Conclusions: These guidelines are intended to assist physicians and patients in the decision-making process regarding the management of LUTS/BPH, and support the process of continuous improvement of the quality of care and services to patients. PMID:23205056
Lobelo, Felipe; Garcia de Quevedo, Isabel; Holub, Christina K.; Nagle, Brian J.; Arredondo, Elva M.; Barquera, Simon; Elder, John P.
Background: Rapidly rising childhood obesity rates constitute a public health priority in Latin America which makes it imperative to develop evidence-based strategies. Schools are a promising setting but to date it is unclear how many school-based obesity interventions have been documented in Latin America and what level of evidence can be…
Painter, Kirstin; Scannapieco, Maria
One key step in the evidence-based practice process directs practitioners to pose client-oriented, practical, evidence-search questions (COPES), seeking the truth about what will help their client (Gibbs, 2003) and inform policy (Gambrill, 2006) and not to take a "one method fits all" position. Literature focusing on providing services to minority…
Lee, Matthew K; Most, Sam P
Evidence-based medicine has become increasingly prominent in the climate of modern day healthcare. The practice of evidence-based medicine involves the integration of the best available evidence with clinical experience and expertise to help guide clinical decision-making. The essential tenets of evidence-based medicine can be applied to both functional and aesthetic rhinoplasty. Current outcome measures in functional and aesthetic rhinoplasty, including objective, subjective, and clinician-reported measures, is summarized and the current data is reviewed.
Lopata, Christopher; Lipinski, Alanna M; Thomeer, Marcus L; Rodgers, Jonathan D; Donnelly, James P; McDonald, Christin A; Volker, Martin A
This study examined the feasibility and initial outcomes of a comprehensive outpatient psychosocial treatment (MAXout) for children aged 7-12 years with high-functioning autism spectrum disorder. The 18-week treatment, two 90-minute sessions per week, included instruction and therapeutic activities targeting social/social communication skills, facial emotion recognition, non-literal language skills, and interest expansion. A behavioral system was implemented to reduce autism spectrum disorder symptoms and problem behaviors and increase skills acquisition and maintenance. Feasibility was supported via high levels of treatment fidelity and parent, child, and staff satisfaction. Significant post-treatment improvements were found for the children's non-literal language skills and facial emotion recognition skills, and parent and staff clinician ratings of targeted social/social communication skills, broad social skills, autism spectrum disorder symptoms, and problem behaviors. Results suggested that MAXout was feasible and may yield positive outcomes for children with high-functioning autism spectrum disorder.
Mesibov, Gary B.; Shea, Victoria
Interventions for autism are increasing being held to standards such as "evidence-based practice" in psychology and "scientifically-based research" in education. When these concepts emerged in the context of adult psychotherapy and regular education, they caused considerable controversy. Application of the concepts to autism treatments and special…
Shaffer, Anne; Lindhiem, Oliver; Kolko, David J.; Trentacosta, Christopher J.
In the current study, we examined longitudinal changes in, and bidirectional effects between, parenting practices and child behavior problems in the context of a psychosocial treatment and 3-year follow-up period. The sample comprised 139 parent-child dyads (child ages 6-11) who participated in a modular treatment protocol for early-onset ODD or…
Vijayalakshmi, R.; Anitha, V.; Ramakrishnan, T.; Sudhakar, Uma
Dentists need to make clinical decisions based on limited scientific evidence. In clinical practice, a clinician must weigh a myriad of evidences every day. The goal of evidence-based dentistry is to help practitioners provide their patients with optimal care. This is achieved by integrating sound research evidence with personal clinical expertise and patient values to determine the best course of treatment. Periodontology has a rich background of research and scholarship. Therefore, efficient use of this wealth of research data needs to be a part of periodontal practice. Evidence-based periodontology aims to facilitate such an approach and it offers a bridge from science to clinical practice. The clinician must integrate the evidence with patient preference, scientific knowledge, and personal experience. Most important, it allows us to care for our patients. Therefore, evidence-based periodontology is a tool to support decision-making and integrating the best evidence available with clinical practice. PMID:20142947
Chung, Eric; Wittert, Gary; Hyde, Melissa K.
Prostate cancer (PC) treatment side-effects such as erectile dysfunction (ED) can impact men’s quality of life (QoL), psychosocial and psycho-sexual adjustment. Masculinity (i.e., men’s identity or sense of themselves as being a man) may also be linked to how men respond to PC treatment and ED however the exact nature of this link is unclear. This review aims to provide a snapshot of the current state of evidence regarding ED, masculinity and psychosocial impacts after PC treatment. Three databases (Medline/PsycINFO, CINHAL, and EMBASE) were searched January 1st 1980 to January 31st 2016. Study inclusion criteria were: patients treated for PC; ED or sexual function measured; masculinity measured in quantitative studies or emerged as a theme in qualitative studies; included psychosocial or QoL outcome(s); published in English language, peer-reviewed journal articles. Fifty two articles (14 quantitative, 38 qualitative) met review criteria. Studies were predominantly cross-sectional, North American, samples of heterosexual men, with localised PC, and treated with radical prostatectomy. Results show that masculinity framed men’s responses to, and was harmed by their experience with, ED after PC treatment. In qualitative studies, men with ED consistently reported lost (no longer a man) or diminished (less of a man) masculinity, and this was linked to depression, embarrassment, decreased self-worth, and fear of being stigmatised. The correlation between ED and masculinity was similarly supported in quantitative studies. In two studies, masculinity was also a moderator of poorer QoL and mental health outcomes for PC patients with ED. In qualitative studies, masculinity underpinned how men interpreted and adjusted to their experience. Men used traditional (hegemonic) coping responses including emotional restraint, stoicism, acceptance, optimism, and humour or rationalised their experience relative to their age (ED inevitable), prolonged life (ED small price to pay
Chambers, Suzanne K; Chung, Eric; Wittert, Gary; Hyde, Melissa K
Prostate cancer (PC) treatment side-effects such as erectile dysfunction (ED) can impact men's quality of life (QoL), psychosocial and psycho-sexual adjustment. Masculinity (i.e., men's identity or sense of themselves as being a man) may also be linked to how men respond to PC treatment and ED however the exact nature of this link is unclear. This review aims to provide a snapshot of the current state of evidence regarding ED, masculinity and psychosocial impacts after PC treatment. Three databases (Medline/PsycINFO, CINHAL, and EMBASE) were searched January 1st 1980 to January 31st 2016. Study inclusion criteria were: patients treated for PC; ED or sexual function measured; masculinity measured in quantitative studies or emerged as a theme in qualitative studies; included psychosocial or QoL outcome(s); published in English language, peer-reviewed journal articles. Fifty two articles (14 quantitative, 38 qualitative) met review criteria. Studies were predominantly cross-sectional, North American, samples of heterosexual men, with localised PC, and treated with radical prostatectomy. Results show that masculinity framed men's responses to, and was harmed by their experience with, ED after PC treatment. In qualitative studies, men with ED consistently reported lost (no longer a man) or diminished (less of a man) masculinity, and this was linked to depression, embarrassment, decreased self-worth, and fear of being stigmatised. The correlation between ED and masculinity was similarly supported in quantitative studies. In two studies, masculinity was also a moderator of poorer QoL and mental health outcomes for PC patients with ED. In qualitative studies, masculinity underpinned how men interpreted and adjusted to their experience. Men used traditional (hegemonic) coping responses including emotional restraint, stoicism, acceptance, optimism, and humour or rationalised their experience relative to their age (ED inevitable), prolonged life (ED small price to pay
Fillingim, Roger B.; Bruehl, Stephen; Dworkin, Robert H.; Dworkin, Samuel F.; Loeser, John D.; Turk, Dennis C.; Widerstrom-Noga, Eva; Arnold, Lesley; Bennett, Robert; Edwards, Robert R.; Freeman, Roy; Gewandter, Jennifer; Hertz, Sharon; Hochberg, Marc; Krane, Elliot; Mantyh, Patrick W.; Markman, John; Neogi, Tuhina; Ohrbach, Richard; Paice, Judith; Porreca, Frank; Rappaport, Bob A.; Smith, Shannon M.; Smith, Thomas J.; Sullivan, Mark D.; Verne, G. Nicholas; Wasan, Ajay D.; Wesselmann, Ursula
Current approaches to classification of chronic pain conditions suffer from the absence of a systematically implemented and evidence-based taxonomy. Moreover, existing diagnostic approaches typically fail to incorporate available knowledge regarding the biopsychosocial mechanisms contributing to pain conditions. To address these gaps, the Analgesic, Anesthetic, and Addiction Clinical Trial Translations Innovations Opportunities and Networks (ACTTION) public-private partnership with the US Food and Drug Administration and the American Pain Society (APS) have joined together to develop an evidence-based chronic pain classification system called the ACTTION-APS Pain Taxonomy (AAPT). This manuscript describes the outcome of an ACTTION-APS consensus meeting, at which experts agreed on a structure for this new taxonomy of chronic pain conditions. Several major issues around which discussion revolved are presented and summarized, and the structure of the taxonomy is presented. AAPT will include the following Dimensions: 1) Core Diagnostic Criteria, 2) Common Features, 3) Common Medical Comorbidities, 4) Neurobiological, Psychosocial and Functional Consequences, and 5) Putative Neurobiological and Psychosocial Mechanisms, Risk Factors & Protective Factors. In coming months, expert working groups will apply this taxonomy to clusters of chronic pain conditions, thereby developing a set of diagnostic criteria that have been consistently and systematically implemented across nearly all common chronic pain conditions. It is anticipated that the availability of this evidence-based and mechanistic approach to pain classification will be of substantial benefit to chronic pain research and treatment. Perspective The ACTTION-APS Pain Taxonomy is an evidence-based chronic pain classification system designed to classify chronic pain along the following Dimensions: 1) Core Diagnostic Criteria, 2) Common Features, 3) Common Medical Comorbidities, 4) Neurobiological, Psychosocial and
Lusk, Pamela; Melnyk, Bernadette Mazurek
TOPIC Evidence–based CBT skills building intervention – COPE -for depressed and anxious teens in brief 30 minute outpatient visits. PURPOSE Based on COPE training workshops, this paper provides an overview of the COPE program, it’s development, theoretical foundation, content of the sessions and lessons learned for best delivery of COPE to individuals and groups in psychiatric settings, primary care settings and schools. SOURCES Published literature and clinical examples CONCLUSION With the COPE program, the advanced practice nurse in busy outpatient practice can provide timely, evidence-based therapy for adolescents and use the full extent of his/her advanced practice nursing knowledge and skills. PMID:23351105
Gaudiano, Brandon A.; Weinstock, Lauren M.; Miller, Ivan W.
Treatment adherence is a frequent problem in bipolar disorder, with research showing that more than 60% of bipolar patients are at least partially nonadherent to medications. Treatment nonadherence is consistently predictive of a number of negative outcomes in bipolar samples, and the discontinuation of mood stabilizers places these patients at…
With the advances in the field of oncology, imaging is increasingly used in the follow-up of cancer patients, leading to concerns about over-utilization. Therefore, it has become imperative to make imaging more evidence-based, efficient, cost-effective and equitable. This review explores the strategies and tools to make diagnostic imaging more evidence-based, mainly in the context of follow-up of cancer patients. PMID:28096722
Weinert, Clarann; Hill, Wade G.; Winters, Charlene A.; Kuntz, Sandra W.; Rowse, Kimberly; Hernandez, Tanis; Black, Brad; Cudney, Shirley
A cross-sectional exploratory study was conducted to describe the psychosocial health status of persons seeking health care for exposure to Libby amphibole asbestos (LAA). Health indicators including depression, stress, acceptance of illness, and satisfaction with access and financial aspects of care were obtained via electronic and paper-pencil survey. The exposure pathway and demographic data were gleaned from the health record. Of the 386 participants, more than one-third (34.5%) demonstrated significant levels of psychological distress. The oldest group of women had the lowest levels of depression and stress and the highest acceptance of illness. Gender, age, and satisfaction with financial resources were significantly related to depression, stress, and acceptance of illness. Satisfaction with access to care was significant only for stress. No differences in depression, stress, and acceptance of illness were found based on residence, exposure pathway, or insurance status. PMID:22007326
Cleland, Joshua A; Noteboom, J Timothy; Whitman, Julie M; Allison, Stephen C
The process of evidence-based practice (EBP) guides clinicians in the integration of individual clinical expertise, patient values and expectations, and the best available evidence. Becoming proficient with this process takes time and consistent practice, but should ultimately lead to improved patient outcomes. The EBP process entails 5 steps: (1) formulating an appropriate question, (2) performing an efficient literature search, (3) critically appraising the best available evidence, (4) applying the best evidence to clinical practice, and (5) assessing outcomes of care. This first commentary in a 2-part series will review principles relating to steps 1, 2, and 3 of this 5-step model. The purpose of this commentary is to provide a perspective to assist clinicians in formulating foreground questions, searching for the best available evidence, and determining validity of results in studies of interventions for orthopaedic and sports physical therapy.
Noteboom, J Timothy; Allison, Stephen C; Cleland, Joshua A; Whitman, Julie M
The process of evidence-based practice (EBP) guides clinicians in the integration of individual clinical expertise, patient values and expectations, and the best available evidence. Becoming proficient with this process takes time and consistent practice, but should ultimately lead to improved patient outcomes. The EBP process entails 5 steps: (1) formulating an appropriate question, (2) performing an efficient literature search, (3) critically appraising the best available evidence, (4) applying the best evidence to clinical practice, and (5) assessing outcomes of care. This second commentary in a 2-part series will review principles relating to steps 3 through 5 of this 5-step model. The purpose of this commentary is to provide a perspective to assist clinicians in interpreting results, applying the evidence to patient care, and evaluating proficiency with EBP skills in studies of interventions for orthopaedic and sports physical therapy.
Mtaya, Matilda; Astrom, Anne N; Brudvik, Pongsri
Background studies on the relationship between children's malocclusion and its psycho-social impacts are so far largely unexplored in low-income countries. This study aimed to assess the prevalence of malocclusion, reported dental problems and dissatisfaction with dental appearance among primary school children in Tanzania. The relationship of dissatisfaction with socio-demographic characteristics, clinically defined malocclusion and psychosocial impacts of dental anomalies was investigated. Orthodontic treatment need was estimated using an integrated socio-dental approach. Method One thousand six hundred and one children (mean age 13 yr) attending primary schools in the districts of Kinondoni and Temeke completed face to face interviews and a full mouth clinical examination. The survey instrument was designed to measure a Kiswahili translated and culturally adapted Child Oral Impact on Daily Performance (Child-OIDP) frequency score, reported dental problems, dissatisfaction with dental appearance/function and socio-demographic characteristics. Results The prevalence of malocclusion varied from 0.9% (deep bite) to 22.5% (midline shift) with a total of 63.8% having at least one type of anomaly. Moderate proportions of children admitted dental problems; ranging from 7% (space position) to 20% (pain). The odds ratio of having problems with teeth position, spaces, pain and swallowing if having any malocclusion were, respectively 6.7, 3.9, 1.4 and 6.8. A total of 23.3% children were dissatisfied with dental appearance/function. Children dissatisfied with their dental appearance were less likely to be Temeke residents (OR = 0.5) and having parents of higher education (OR = 0.6) and more likely to reporting problem with teeth position (OR = 4.3) and having oral impacts (OR = 2.7). The socio-dental treatment need of 12% was five times lower than the normative need assessment of 63.8%. Conclusion Compared to the high prevalence of malocclusion, psycho social impacts and
Herschell, Amy D.; Kolko, David J.; Baumann, Barbara L.; Davis, Abigail C.
Evidence-based treatments (EBT) are underutilized in community settings, where consumers are often seen for treatment. Underutilization of EBTs may be related to a lack of empirically informed and supported training strategies. The goals of this review are to understand the state of the literature for training therapists in psychotherapy skills and to offer recommendations to improve research in this area. Results of this review of 55 studies evaluating six training methods indicate that multi-component trainings have been studied most often and have most consistently demonstrated positive training outcomes relative to other training methods. Studies evaluating utility of reading, self-directed trainings, and workshops have documented that these methods do not routinely produce positive outcomes. Workshop follow-ups help to sustain outcomes. Little is known about the impact of train-the-trainer methods. Methodological flaws and factors that may influence training outcome and future directions are also reviewed. PMID:20304542
Spanish evidence-based guidelines on the treatment of psoriasis with biologic agents, 2013. Part 1: on efficacy and choice of treatment. Spanish Psoriasis Group of the Spanish Academy of Dermatology and Venereology.
Puig, L; Carrascosa, J M; Carretero, G; de la Cueva, P; Lafuente-Urrez, R F; Belinchón, I; Sánchez-Regaña, M; García-Bustínduy, M; Ribera, M; Alsina, M; Ferrándiz, C; Fonseca, E; García-Patos, V; Herrera, E; López-Estebaranz, J L; Marrón, S E; Moreno, J C; Notario, J; Rivera, R; Rodriguez-Cerdeira, C; Romero, A; Ruiz-Villaverde, R; Taberner, R; Vidal, D
Biologic therapy is a well-established strategy for managing moderate and severe psoriasis. Nevertheless, the high cost of such therapy, the relatively short span of clinical experience with biologics, and the abundance of literature now available on these agents have made evidence-based and consensus-based clinical guidelines necessary. The ideal goal of psoriasis treatment is to achieve complete or nearly complete clearing of lesions and to maintain it over time. Failing that ideal, the goal would be to reduce involvement to localized lesions that can be controlled with topical therapy. Although current evidence allows us to directly or indirectly compare the efficacy or risk of primary or secondary failure of available biologics based on objective outcomes, clinical trial findings cannot be directly translated to routine practice. As a result, the prescribing physician must tailor the treatment regimen to the individual patient. This update of the clinical practice guidelines issued by the Spanish Academy of Dermatology and Venereology (AEDV) on biologic therapy for psoriasis incorporates information from the most recent publications on this topic.
Carruthers, David; Sherlock, Jonathan
The vasculitides associated with antineutrophil cytoplasmic antibodies (ANCAs) present to and are managed by a wide spectrum of physicians, reflecting the multi-organ nature of the conditions. Treatment strategies for these primary inflammatory vascular diseases have varied based on the outcomes of different clinical trials and practice reviews. The individual drugs used and their route of administration, dose, and duration of therapy have varied and have been the source of much debate. Advances in our understanding of disease immunopathogenesis, clinical assessment and outcome have formed the basis for several recent good-quality clinical trials. Now, with the results of these large-scale multicentre collaborative studies, there is a firmer evidence base to guide management decisions for individual patients. This evidence base, reviewed here, has led to the publication of treatment guidelines which importantly encompass many of the broader aspects of disease management.
Chen, Andrew C.H.; Davis, Christine M.; Kahler, Christopher W.; Kuerbis, Alexis N.; Covault, Jonathan; Kranzler, Henry R.; Morgenstern, Jon
Background A functional polymorphism (5-HTTLPR) in the promoter region of the serotonin transporter gene has been widely studied as a risk factor and moderator of treatment for a variety of psychopathologic conditions. To evaluate whether 5-HTTLPR moderates the effects of treatment to reduce heavy drinking, we studied 112 high-functioning European-American men who have sex with men (MSM). Subjects participated in a randomized clinical trial of naltrexone (NTX) and cognitive behavioral therapy (CBT) for problem drinking. Methods Subjects were treated for 12 weeks with 100 mg/day of oral NTX or placebo. All participants received medical management with adjusted Brief Behavioral Compliance Enhancement Treatment (BBCET) alone or in combination with Modified Behavioral Self-Control Therapy (MBSCT, an amalgam of motivational interviewing and CBT). Participants were genotyped for the tri-allelic 5-HTTLPR polymorphism (i.e., low-activity S′ or high-activity L′ alleles). Results During treatment, the number of weekly heavy drinking days (HDD, defined as 5 or more standard drinks per day) was significantly lower in subjects with the L′L′ (N=26, p=0.015) or L′S′ (N=52, p=0.016) genotype than those with the S′S′ (N=34) genotype regardless of treatment type. There was a significant interaction of genotype with treatment: For subjects with the S′S′ genotype, the effects of MBSCT or NTX on HDD were significantly greater than the minimal intervention (i.e., BBCET or placebo, p=0.007 and p=0.049, respectively). In contrast, for subjects with one or two L′ alleles, the effects of the more intensive psychosocial treatment (MBSCT) or NTX did not significantly differ from BBCET or placebo. Conclusions These preliminary findings support the utility of the 5-HTTLPR polymorphism for personalizing treatment selection in problem drinkers. PMID:25070809
Chaffin, Mark; Bard, David; Bigfoot, Dolores Subia; Maher, Erin J.
In a statewide implementation, the manualized SafeCare home–based model was effective in reducing child welfare recidivism and producing high client satisfaction. Concerns about the effectiveness and acceptability of structured, manualized models with American Indians have been raised in the literature, but have rarely been directly tested. This study tests recidivism reduction equivalency and acceptability among American Indian parents. A subpopulation of 354 American Indian parents was drawn from a larger trial that compared services with versus without modules of the SafeCare model. Outcomes were 6-year recidivism, pre/post/follow-up measures of depression and child abuse potential, and posttreatment consumer ratings of working alliance, service satisfaction, and cultural competency. Recidivism reduction among American Indian parents was found to be equivalent for cases falling within customary SafeCare inclusion criteria. When extended to cases outside customary inclusion boundaries, there was no apparent recidivism advantage or disadvantage. Contrary to concerns, SafeCare had higher consumer ratings of cultural competency, working alliance, service quality, and service benefit. Findings support using SafeCare with American Indians parents who meet customary SafeCare inclusion criteria. Findings do not support concerns in the literature that a manualized, structured, evidence-based model might be less effective or culturally unacceptable for American Indians. PMID:22927674
Cobb, Charles M; MacNeill, Simon R; Satheesh, Keerthana
Evidence-based practice involves complex and conscientious decision making based not only on the available evidence but also on patient characteristics, situations, and preferences. It recognizes that care is individualized and ever-changing and involves uncertainties and probabilities. The specialty of periodontics has abundant high-level evidence upon which treatment decisions can be determined. This paper offers a brief commentary and overview of the available evidence commonly used in the private practice of periodontics.
Mesibov, Gary B; Shea, Victoria
Interventions for autism are increasing being held to standards such as 'evidence-based practice' in psychology and 'scientifically-based research' in education. When these concepts emerged in the context of adult psychotherapy and regular education, they caused considerable controversy. Application of the concepts to autism treatments and special education has raised additional concerns. An analysis of the benefits and limitations of current approaches to empiricism in autism interventions is presented, and suggestions for future research are made.
Evidence-based pharmacological treatment of anxiety disorders, post-traumatic stress disorder and obsessive-compulsive disorder: a revision of the 2005 guidelines from the British Association for Psychopharmacology.
Baldwin, David S; Anderson, Ian M; Nutt, David J; Allgulander, Christer; Bandelow, Borwin; den Boer, Johan A; Christmas, David M; Davies, Simon; Fineberg, Naomi; Lidbetter, Nicky; Malizia, Andrea; McCrone, Paul; Nabarro, Daniel; O'Neill, Catherine; Scott, Jan; van der Wee, Nic; Wittchen, Hans-Ulrich
This revision of the 2005 British Association for Psychopharmacology guidelines for the evidence-based pharmacological treatment of anxiety disorders provides an update on key steps in diagnosis and clinical management, including recognition, acute treatment, longer-term treatment, combination treatment, and further approaches for patients who have not responded to first-line interventions. A consensus meeting involving international experts in anxiety disorders reviewed the main subject areas and considered the strength of supporting evidence and its clinical implications. The guidelines are based on available evidence, were constructed after extensive feedback from participants, and are presented as recommendations to aid clinical decision-making in primary, secondary and tertiary medical care. They may also serve as a source of information for patients, their carers, and medicines management and formulary committees.
O'Gorman, Neil; Wright, David; Rolnik, Daniel L; Nicolaides, Kypros H; Poon, Liona C
Introduction Pre-eclampsia (PE) affects 2–3% of all pregnancies and is a major cause of maternal and perinatal morbidity and mortality. Prophylactic use of low-dose aspirin in women at risk for PE may substantially reduce the prevalence of the disease. Effective screening for PE requiring delivery before 37 weeks (preterm PE) can be provided by a combination of maternal factors, uterine artery Doppler, mean arterial pressure, maternal serum pregnancy-associated plasma protein A and placental growth factor at 11–13 weeks' gestation, with a detection rate of 75% at a false-positive rate of 10%. We present a protocol (V.6, date 25 January 2016) for the ASpirin for evidence-based PREeclampsia prevention (ASPRE) trial, which is a double-blinded, placebo-controlled, randomised controlled trial (RCT) that uses an effective PE screening programme to determine whether low-dose aspirin given to women from 11 to 13 weeks' gestation will reduce the incidence of preterm PE. Methods and analysis All eligible women attending for their first trimester scan will be invited to participate in the screening study for preterm PE. Those found to be at high risk of developing preterm PE will be invited to participate in the RCT. Further scans will be conducted for assessment of fetal growth and biomarkers. Pregnancy and neonatal outcomes will be collected and analysed. The first enrolment for the pilot study was in April 2014. As of April 2016, 26 670 women have been screened and 1760 recruited to the RCT. The study is registered on the International Standard Randomised Controlled Trial Number (ISRCTN) registry. Trial registration number ISRCTN13633058. PMID:27354081
Mazerolle, Stephanie M.; Ruiz, Roberto C.; Casa, Douglas J.; Pagnotta, Kelly D.; Pinkus, Danielle E.; Armstrong, Lawrence E.; Maresh, Carl M.
Context: Athletic trainers (ATs) know to diagnose exertional heat stroke (EHS) via rectal thermometry (Tre) and to treat EHS via cold-water immersion (CWI) but do not implement these recommendations in clinical practice. Objective: To gain an understanding of educational techniques used to deliver content regarding EHS. Design: Qualitative study. Setting: In-person focus groups at the National Athletic Trainers' Association (NATA) Annual Meeting in June 2009 and 2 follow-up telephone interviews to confirm emergent themes. Patients or Other Participants: Thirteen AT educators (11 men, 2 women) from programs accredited by the Commission on Accreditation of Athletic Training Education, with an average of 22 ± 9 years of clinical experience and 16 ± 10 years of experience as educators. Five NATA districts were represented. Data Collection and Analysis: Data were analyzed using inductive content analysis. Peer review and data source triangulation also were conducted to establish trustworthiness. Results: Four themes emerged from the analysis: educational techniques, educational competencies, previous educational training, and privacy/public opinion. Educational techniques highlighted the lack of hands-on training for Tre and CWI. Educational competencies referred to the omission of Tre and CWI as psychomotor skills. Previous educational training addressed educators not having the skills or comfort with the skills necessary to properly educate students. Privacy/public opinion comprised external inputs from various groups (parents and coaches), legal considerations, and social bias. Conclusions: Educators supplied students with the appropriate didactic knowledge about EHS, but their lack of training and misgivings about Tre prevented them from allowing students to gain competence with this skill. Until the NATA competencies state the need to teach Tre and CWI and until educators are provided with their own learning opportunities, evidence-based practice regarding EHS
Can Early Intervention Have an Impact on Future Life? A Study of Life Events, Social Interaction, and Child Behavior among Mothers at Psychosocial Risk and Their Children Eight Years after Interaction Treatment
Forty-six mothers at psychosocial risk who had undergone interaction treatment when their children were babies were studied with respect to experienced negative life events, social network, and behavior problems in children. One reference group comprising 45 nontreated mothers at psychosocial risk and one comprising 56 mothers without psychosocial…
Achievement scores drive much of the effort in today's accountability system, however, there is much more that occurs in every school, every day. School Centered Evidence Based Accountability can be used from micro to macro giving School Boards and Administration a process for monitoring the results of the entire school operation effectively and…
Turner, Pauline; Kantaria, Rakesh; Young, Allan H
Previous comparative reviews of add-on therapies for patients with major depressive disorder (MDD) with an inadequate response to antidepressants have not used meta-analytic techniques to compare different drug classes and have included non-licensed therapies. This meta-analysis reviewed all published peer-reviewed evidence for the efficacy of EU-licensed therapies in patients with MDD and an inadequate response to antidepressant monotherapy. Papers concerning randomized clinical trials (RCTs) were identified using criteria from the Cochrane Handbook for Systematic Reviews of Interventions. Add-on therapies reviewed were antidepressants, quetiapine XR, lithium, and S-adenosyl-l-methionine (SAMe). Seven RCTs that reported response and remission in a way that allowed quantitative analysis were included in this meta-analysis. Comparison of the different drug classes indicated that most interventions had similar efficacy. The likelihood of response was significantly greater with SAMe versus placebo and lithium and with quetiapine XR versus placebo. Most add-on interventions demonstrated comparable efficacy in patients with MDD and an inadequate response to initial antidepressants. However, there is currently a paucity of high-quality data regarding the use of add-on treatments in patients with MDD who are inadequate responders to antidepressants, with quetiapine XR presenting the most comprehensive evidence base to date.
McGuinness, Niall J P
As a result of recent innovations and improvements, orthodontic treatment has become easier and more efficient to carry out, allowing greater numbers of patients to receive treatment. The main result of orthodontic treatment is improved dental alignment and aesthetics. Treatment has no effect on caries or periodontal disease, and the dental health gain is modest, apart from a very small percentage of destructive malocclusions. Psychological improvements using different psychological parameters show differing results and it is not clear that any psychological gains are long lasting. Social gain (greater willingness to smile, feeling good about oneself, satisfaction with dental appearance, etc.), and reported improved quality of life (QoL measures), are now becoming more important as consumer-related outcomes and may, ultimately, contribute to psychosocial and psychological status. Stability of orthodontic treatment results cannot be guaranteed and all patients need to be informed of this, and of the need for long-term retention. Malocclusion has little or no relationship to temporo-mandibular joint dysfunction and orthodontic treatment neither causes nor cures such problems. Extractions as part of orthodontic treatment do not cause TMD, nor do they cause collapse of the vertical dimension. The major improvements in dental health in the last 40 years have been accompanied by a great increase in demand for treatment. In any public health service that is free at the point of use, demand for treatment invariably exceeds the ability of resources to supply this. Indices of treatment need are widely used to determine treatment need and eligibility for treatment in public health systems. Demand for orthodontic treatment among adolescents can be as high as 60% in the general population, while the professionally-assessed need for treatment is approximately half this figure. Age, sex, socio-economic status, perceived unattractiveness of dental appearance, and availability of
Background Magnetic resonance–guided high-intensity focused ultrasound (MRgHIFU) is a noninvasive uterine-preserving treatment alternative to hysterectomy for women with symptomatic uterine leiomyomas (fibroids). Uterine fibroids commonly occur, have a broad impact on women's health and lifestyle, continue to be the main indication for hysterectomy, and represent a costly public health burden. Objectives The objectives of the analysis were to evaluate patients’ eligibility for MRgHIFU treatment of symptomatic uterine fibroids and the technical success, safety, effectiveness, and durability of this treatment. The review also compared the safety and effectiveness of MRgHIFU with other minimally invasive uterine-preserving treatments and surgeries for uterine fibroids. Methods A literature search was performed on March 27, 2014, using Ovid MEDLINE, Ovid MEDLINE In-Process and Other Non-Indexed Citations, Ovid EMBASE, EBSCO Cumulative Index to Nursing & Allied Health Literature (CINAHL), and EBM Reviews, for studies published from January 1, 2000, to March 27, 2014. Results The evidence review identified 2 systematic reviews, 2 RCTs, 45 cohort study reports, and 19 case reports involving HIFU treatment of symptomatic uterine fibroids. Eligibility for MRgHIFU treatment was variable, ranging from 14% to 74%. In clinical cohort studies involving 1,594 patients, 26 major complications (1.6%) were reported. MRgHIFU resulted in statistically and clinically significant reductions in fibroid-related symptoms in studies conducted in 10 countries, although few involved follow-up longer than 1 year. Retreatment rates following MRgHIFU were higher in early clinical studies involving regulated restrictions in the extent of fibroid ablation than in later reports involving near-complete ablation. Emergent interventions, however, were rare. Although a desire for fertility was an exclusion criteria for treatment, spontaneous term pregnancies did occur following HIFU. There were no
Dakanalis, Antonios; Bartoli, Francesco; Caslini, Manuela; Crocamo, Cristina; Zanetti, Maria Assunta; Riva, Giuseppe; Clerici, Massimo; Carrà, Giuseppe
A new "severity specifier" for bulimia nervosa (BN), based on the frequency of inappropriate weight compensatory behaviours (IWCBs), was added to the DSM-5 as a means of documenting heterogeneity and variability in the severity of the disorder. Yet, evidence for its validity in clinical populations, including prognostic significance for treatment outcome, is currently lacking. Existing data from 281 treatment-seeking patients with DSM-5 BN, who received the best available treatment for their disorder (manual-based cognitive behavioural therapy; CBT) in an outpatient setting, were re-analysed to examine whether these patients subgrouped based on the DSM-5 severity levels would show meaningful and consistent differences on (a) a range of clinical variables assessed at pre-treatment and (b) post-treatment abstinence from IWCBs. Results highlight that the mild, moderate, severe, and extreme severity groups were statistically distinguishable on 22 variables assessed at pre-treatment regarding eating disorder pathological features, maintenance factors of BN, associated (current) and lifetime psychopathology, social maladjustment and illness-specific functional impairment, and abstinence outcome. Mood intolerance, a maintenance factor of BN but external to eating disorder pathological features (typically addressed within CBT), emerged as the primary clinical variable distinguishing the severity groups showing a differential treatment response. Overall, the findings speak to the concurrent and predictive validity of the new DSM-5 severity criterion for BN and are important because a common benchmark informing patients, clinicians, and researchers about severity of the disorder and allowing severity fluctuation and patient's progress to be tracked does not exist so far. Implications for future research are outlined.
Meshkin, Brian; Lewis, Katrina; Kantorovich, Svetlana; Anand, Natasha; Davila, Lisa
Published guidelines for treating injured workers include the need for personalized treatment to manage chronic pain symptoms and increase functional status. However, they often fail to clarify how to objectively personalize these treatments. Further, certain patients need analgesic relief beyond the short term. In these cases, it is not sufficient or reasonable to utilize the typical broad protocol-based justifications for reduction of opioids and other medications in a haphazard manner based purely on poor response, without attempting to elucidate possible pharmacogenetic reasons for this. These guidelines acknowledge the problem of substance abuse and set forth methods for treatment and prevention. Although it has been established in the scientific community that an individual’s experience of pain and likelihood for addiction both have genetic components, genetic testing is not routinely included as part of the overall treatment plan for injured workers with chronic pain. Because decisions in cases of workplace injury should be based on scientific evidence, genetic testing results can add some objective information to the existing subjective and objective clinical data; help ascertain the efficacy and potential for toxicity of treatment; and therefore provide more information for accurate clinical decisions. We propose the addition of genetic testing to consensus guidelines for treating injured workers in order to improve patients’ functional status, increase productivity, improve safety of prescribing, decrease the likelihood of substance abuse, and save on overall healthcare costs. PMID:26759531
Karlsson, Patrik; Bergmark, Anders
Abstract Background and Aims A crucial, but under-appreciated, aspect in experimental research on psychosocial treatments of substance use disorders concerns what kinds of control groups are used. This paper examines how the distinction between different control-group designs have been handled by the Cochrane and the Campbell Collaborations in their systematic reviews of psychosocial treatments of substance abuse disorders. Methods We assessed Cochrane and Campbell reviews (n = 8) that were devoted to psychosocial treatments of substance use disorders. We noted what control groups were considered and analysed the extent to which the reviews provided a rationale for chosen comparison conditions. We also analysed whether type of control group in the primary studies influenced how the reviews framed the effects discussed and whether this was related to conclusions drawn. Results The reviews covered studies involving widely different control conditions. Overall, little attention was paid to the use of different control groups (e.g. head-to-head comparisons versus untreated controls) and what this implies when interpreting effect sizes. Seven of eight reviews did not provide a rationale for the choice of comparison conditions. Conclusions Cochrane and Campbell reviews of the efficacy of psychosocial interventions with substance use disorders seem to underappreciate that the use of different control-group types yields different effect estimates. Most reviews have not distinguished between different control-group designs and therefore have provided a confused picture regarding absolute and relative treatment efficacy. A systematic approach to treating different control-group designs in research reviews is necessary for meaningful estimates of treatment efficacy. PMID:25393504
Cherney, Leora R.; Patterson, Janet P.; Raymer, Anastasia; Frymark, Tobi; Schooling, Tracy
Purpose: This systematic review summarizes evidence for intensity of treatment and constraint-induced language therapy (CILT) on measures of language impairment and communication activity/participation in individuals with stroke-induced aphasia. Method: A systematic search of the aphasia literature using 15 electronic databases (e.g., PubMed,…
Holman, Gareth; Kohlenberg, Robert J.; Tsai, Mavis; Haworth, Kevin; Jacobson, Emily; Liu, Sarah
Depression and cigarette smoking are recurrent, interacting problems that co-occur at high rates and--especially when depression is chronic--are difficult to treat and associated with costly health consequences. In this paper we present an integrative therapeutic framework for concurrent treatment of these problems based on evidence-based…
Follow-up of patients who are clinically disease-free after primary treatment for fallopian tube, primary peritoneal, or epithelial ovarian cancer: a Program in Evidence-Based Care guideline adaptation
Le, T.; Kennedy, E.B.; Dodge, J.; Elit, L.
Background A need for follow-up recommendations for survivors of fallopian tube, primary peritoneal, or epithelial ovarian cancer after completion of primary treatment was identified by Cancer Care Ontario’s Program in Evidence-Based Care. Methods We searched for existing guidelines, conducted a systematic review (medline, embase, and cdsr, January 2010 to March 2015), created draft recommendations, and completed a comprehensive review process. Outcomes included overall survival, quality of life, and patient preferences. Results The Cancer Australia guidance document Follow Up of Women with Epithelial Ovarian Cancer was adapted for the Ontario context. A key randomized controlled trial found that the overall survival rate did not differ between asymptomatic women who received early treatment based on elevated serum cancer antigen 125 (ca125) alone and women who waited for the appearance of clinical symptoms before initiating treatment (hazard ratio: 0.98; 95% confidence interval: 0.80 to 1.20; p = 0.85); in addition, patients in the delayed treatment group reported good global health scores for longer. No randomized studies were found for other types of follow-up. We recommend that survivors be made aware of the potential harms and benefits of surveillance, including a discussion of the limitations of ca125 testing. Women could be offered the option of no formal follow-up or a follow-up schedule that is agreed upon by the woman and her health care provider. Education about the most common symptoms of recurrence should be provided. Alternative models of care such as nurse-led or telephone-based follow-up (or both) could be emerging options. Conclusions The recommendations provided in this guidance document have a limited evidence base. Recommendations should be updated as further information becomes available. PMID:27803599
therapy (which works by inviting people to revisit their memories of traumatic events and to face objectively safe situations they have avoided). However...revisit their memories of traumatic events and to face objectively safe situations they have avoided). However, individuals with PTSD may not get the...assessment. Learning and memory tests will be given before treatment begins to examine whether cognitive functioning influences treatment outcome, and
Stein-Shvachman, Ifat; Karpas, Dikla Segel; Werner, Perla
Depression is a common disease among young and older adults. Although it can be treated, non-adherence is very common among individuals of different ages. The aim of the present paper is to review and summarize research findings regarding depression among young and older adults, with a special focus on the phenomenon of treatment non-adherence among young and older adults with depression. The first section of the review focuses on describing the characteristics of depression in young and older adults. The second section focuses on treatment non-adherence of young and older adults, the prevalence of this phenomenon, and its consequences. The third section focuses on several factors (illness beliefs, treatment beliefs, self-stigma, and self-esteem) that were identified as having a significant association with treatment non-adherence of individuals with depression, with special attention focused on age differences. Results of the review of the literature reveal that research in the area of depression treatment non-adherence and its predictors among young and older adults has received, to date, very minor and limited attention. Thus, there is a need to expand the current body of knowledge and promote future interventions geared towards the unique characteristics of depression among young and older adults, in order to increase their treatment adherence.
Fernbach, Alison; Lockart, Barbara; Armus, Cheryl L; Bashore, Lisa M; Levine, Jennifer; Kroon, Leah; Sylvain, Genevieve; Rodgers, Cheryl
As survival rates improve for pediatric cancers, increased attention has been paid to late effects of cancer therapy, in particular, infertility. Fertility preservation options are available for pre- and postpubertal cancer patients; however, many providers lack knowledge regarding options. The aim of this article is to provide a comprehensive synthesis of current evidence and recommendations regarding fertility preservation options for children, adolescents, and young adults undergoing cancer treatment. A systematic search was performed to identify fertility preservation evidence. Fifty-three studies and 4 clinical guidelines were used for the review. Final recommendations consisted of 2 strong and 1 weak recommendation for both female and male fertility preservation options. The treatment team should be knowledgeable about fertility preservation so that they can educate patients and families about available fertility preservation options. It is important to consider and discuss all available fertility options with patients at the time of diagnosis.
Todo, Yukiharu; Watari, Hidemichi
Concurrent chemoradiotherapy (CCRT) is regarded as the standard treatment for locally advanced uterine cervical cancer (LACC), including stage Ib2-IVa disease [International Federation of Gynecology and Obstetrics (FIGO) staging]. However, approximately a third of eligible patients in previous studies died of LACC despite receiving CCRT. The therapeutic significance of CCRT alone in stage III-IVa disease has not yet been confirmed. Effective treatment of some LACC is beyond the scope of CCRT. The objective of the present review is to highlight some challenging work aimed at overcoming this seemingly intractable disease. CCRT with increased peak concentrations of cisplatin (CDDP), surgery following CCRT, adjuvant chemotherapy (CT) following CCRT, and neoadjuvant CT followed by CCRT are strategies expected to enhance the therapeutic efficacy of CCRT. If patients with LACC were divided into those with low-risk or high-risk systemic disease or prognoses, novel strategies should be assessed in the group with high-risk disease.
Todo, Yukiharu; Watari, Hidemichi
Concurrent chemoradiotherapy (CCRT) is regarded as the standard treatment for locally advanced uterine cervical cancer (LACC), including stage Ib2-IVa disease [International Federation of Gynecology and Obstetrics (FIGO) staging]. However, approximately a third of eligible patients in previous studies died of LACC despite receiving CCRT. The therapeutic significance of CCRT alone in stage III-IVa disease has not yet been confirmed. Effective treatment of some LACC is beyond the scope of CCRT. The objective of the present review is to highlight some challenging work aimed at overcoming this seemingly intractable disease. CCRT with increased peak concentrations of cisplatin (CDDP), surgery following CCRT, adjuvant chemotherapy (CT) following CCRT, and neoadjuvant CT followed by CCRT are strategies expected to enhance the therapeutic efficacy of CCRT. If patients with LACC were divided into those with low-risk or high-risk systemic disease or prognoses, novel strategies should be assessed in the group with high-risk disease. PMID:27199520
Poon, Siu Ling
A short-cut review was performed to evaluate whether steroids could be an effective therapy in hyper-emesis gravidarum. A database search revealed 9 papers relevant to this question and the details of each study methods and results were displayed in a table. The quality of these studies was generally low. There is only weak evidence that steroids could be an effective treatment for intractable hyper-emesis gravidarum.
Johansen, Ayna; Nesvåg, Sverre; Kok, Gerjo; Duckert, Fanny
Background Due to limited reporting of intervention rationale, little is known about what distinguishes a good intervention from a poor one. To support improved design, there is a need for comprehensive reports on novel and complex theory-based interventions. Specifically, the emerging trend of just-in-time tailoring of content in response to change in target behavior or emotional state is promising. Objective The objective of this study was to give a systematic and comprehensive description of the treatment rationale of an online alcohol intervention called Balance. Methods We used the intervention mapping protocol to describe the treatment rationale of Balance. The intervention targets at-risk drinking, and it is delivered by email, mobile phone text messaging, and tailored interactive webpages combining text, pictures, and prerecorded audio. Results The rationale of the current treatment was derived from a self-regulation perspective, and the overarching idea was to support continued self-regulation throughout the behavior change process. Maintaining the change efforts over time and coping adaptively during critical moments (eg, immediately before and after a lapse) are key factors to successful behavior change. Important elements of the treatment rationale to achieving these elements were: (1) emotion regulation as an inoculation strategy against self-regulation failure, (2) avoiding lapses by adaptive coping, and (3) avoiding relapse by resuming the change efforts after a lapse. Two distinct and complementary delivery strategies were used, including a day-to-day tunnel approach in combination with just-in-time therapy. The tunnel strategy was in accordance with the need for continuous self-regulation and it functions as a platform from which just-in-time therapy was launched. Just-in-time therapy was used to support coping during critical moments, and started when the client reports either low self-efficacy or that they were drinking above target levels
Van Winghem, Joelle; Telfer, Barbara; Reid, Tony; Ouko, Judith; Mutunga, Angela; Jama, Zaina; Vakil, Shobha
Background To achieve good clinical outcomes with HAART, patient adherence to treatment and care is a key factor. Since the literature on how to care for pediatric HIV patients is limited, we describe here adherence interventions implemented in our comprehensive care program in a resource-limited setting in Kenya. Methods We based our program on factors reported to influence adherence to HIV care and treatment. We describe, in detail, our program with respect to how we adapted our clinical settings, implemented psycho-social support activities for children and their caregivers and developed treatment literacy for children and teenagers living with HIV/AIDS. Results This paper focused on the details of the program, with the treatment outcomes as secondary. However, our program appeared to have been effective; for 648 children under 15 years of age who were started on HAART, the Kaplan-Meier mortality survival estimate was 95.27% (95%CI 93.16–96.74) at 12 months after the time of initiation of HAART. Conclusion Our model of pediatric HIV/AIDS care, focused on a child-centered approach with inclusion of caregivers and extended family, addressed the main factors influencing treatment adherence. It appeared to produce good results and is replicable in resource-limited settings. PMID:19025581
In this issue, Norwegian authors demonstrate that causes of early expulsion out the workforce are rooted in childhood. They reconstruct individual biographies in administrative databases linked by an unique national identification number, looking forward 15 years in early adulthood and looking back 20 years till birth with close to negligible loss to follow up. Evidence based bioethics suggest that it is better to live in a country that allows reconstructing biographies in administrative databases then in countries that forbid access by restrictive legislation based on privacy considerations. The benefits of gained knowledge from existing and accessible information are tangible, particularly for the weak and the poor, while the harms of theoretical privacy invasion have not yet materialised. The study shows once again that disadvantage runs in families. Low parental education, parental disability and unstable marital unions predict early disability pensions and premature expulsion out gainful employment. The effect of low parental education is mediated by low education of the index person. However, in a feast of descriptive studies of socio-economic causes of ill health we still face a famine of evaluative intervention studies. An evidence based social policy should be based on effective interventions that are able to break the vicious circles of disability handed down from generation to generation. PMID:17657572
Koerner-Rettberg, Cordula; Ballmann, Manfred
Chronic bacterial respiratory-tract infections are a major driving force in the pathogenesis of cystic fibrosis (CF) lung disease and promote chronic lung-function decline, destruction, and progression to respiratory failure at a premature age. Gram-negative bacteria colonizing the airways in CF are a major problem in CF therapy due to their tendency to develop a high degree of resistance to antibiotic agents over time. Pseudomonas aeruginosa is the dominating bacterial strain infecting the CF lung from early childhood on, and multiresistant strains frequently develop after years of therapy. Colistin has been used for treating pulmonary bacterial infections in CF for decades due to its very good Gram-negative activity. However, drawbacks include concerns regarding toxicity when being applied systemically, and the lack of approval for application by inhalation in the USA for many years. Other antibiotic substances for systemic use are available with good to excellent Gram-negative and anti-Pseudomonas activity, while there are only three substances approved for inhalation use in the treatment of chronic pulmonary infection with proven benefit in CF. The emergence of multiresistant strains leaving nearly no antibiotic substance as a treatment option, the limited number of antibiotics with high activity against P. aeruginosa, the concerns about increasing the risk of antibiotic resistance by continuous antibiotic therapy, the development of new drug formulations and drug-delivery devices, and, finally, the differing treatment strategies used in CF centers call for defining the place of this “old” drug, colistimethate, in today’s CF therapy. This article reviews the available evidence to reflect on the place of colistimethate sodium in the therapy of chronic pulmonary infection in CF. PMID:25278817
Bain, Kevin T; Weschules, Douglas J; Knowlton, Calvin H; Gallagher, Rollin
A comparative review of temazepam and zolpidem use in managing insomnia in the hospice patient was undertaken to determine whether treatment with temazepam is a more cost-effective approach for this patient population. A MEDLINE search was conducted to identify pertinent literature, including clinical trials and reviews that involved temazepam or zolpidem. Published data was used as background information and provided in the discussion. This retrospective analysis, conducted from June 2002 through November 2002, focused on the prescribing patterns of temazepam and zolpidem in our hospice practice setting. We examined the reasons for discontinuation of each agent, along with the frequency of therapeutic change from temazepam to zolpidem. The top 10 ICD-9 codes associated with each treatment modality were investigated to determine any prescribing patterns. A total of 4,752 participants were prescribed either temazepam or zolpidem during this six-month period. Of the 4,065 patients prescribed temazepam 9.9 percent had the agent discontinued, whereas, 13.0 percent of those taking zolpidem (n = 687) terminated therapy. Reasons for discontinuation included change in dose, incomplete efficacy, change in patient status, adverse drug reaction, cultural/social issues and "other." Analyses of prescribing patterns and the reasons for termination of each drug therapy were completed and compared with results found in the primary literature. Due to the limited financial resources available for hospice care, our goal is to provide the most clinically appropriate and cost-effective agents for hospice patients. With the lack of data pertaining to the hospice patient, physicians often are faced with challenges in deciding the most appropriate therapy. They may prefer one agent over another based on current medical opinion rather than sound clinical evidence. After review of the primary literature and the prescribing patterns in our setting, there is currently no evidence in our
Gómez-Outes, Antonio; Suárez-Gea, M Luisa; Lecumberri, Ramón; Terleira-Fernández, Ana Isabel; Vargas-Castrillón, Emilio
Pulmonary embolism (PE) is a relatively common cardiovascular emergency. PE and deep vein thrombosis (DVT) are considered expressions of the same disease, termed as venous thromboembolism (VTE). In the present review, we describe and meta-analyze the efficacy and safety data available with the direct oral anticoagulants (DOAC; dabigatran, rivaroxaban, apixaban, edoxaban) in clinical trials testing these new compounds in the acute/long-term and extended therapy of VTE, providing subgroup analyses in patients with index PE. We analyzed ten studies in 35,019 randomized patients. A total of 14,364 patients (41%) had index PE. In the acute/long-term treatment of VTE, the DOAC showed comparable efficacy in preventing recurrent VTE to standard treatment in patients with index PE (risk ratio [RR]: 0.88; 95% confidence interval [CI]: 0.70-1.11) and index DVT (RR: 0.93; 95% CI: 0.75-1.16) (P for subgroup differences =0.76). VTE recurrence depending on PE anatomical extension and presence/absence of right ventricular dysfunction was only reported in two trials, with results being consistent with those obtained in the overall study populations. In the single trial comparing extended therapy of VTE with DOAC versus warfarin, the point estimate for recurrent VTE tended to disfavor the DOAC in patients with index PE (RR: 2.05; 95% CI: 0.83-5.03) and in patients with index DVT (RR: 1.11; 95% CI: 0.49-2.50) (P for subgroup differences =0.32). In trials that compared DOAC versus placebo for extended therapy, the reduction in recurrent VTE was consistent in patients with PE (RR: 0.15; 95% CI: 0.01-1.82) and in patients with DVT (RR: 0.25; 95% CI: 0.10-0.61) (P for subgroup differences =0.71). The DOAC were associated with a consistently lower risk of clinically relevant bleeding (CRB) than standard treatment of acute VTE and higher risk of CRB than placebo for extended therapy of VTE regardless of index event. In summary, the DOAC were as effective as, and safer than, standard
Gómez-Outes, Antonio; Suárez-Gea, Mª Luisa; Lecumberri, Ramón; Terleira-Fernández, Ana Isabel; Vargas-Castrillón, Emilio
Pulmonary embolism (PE) is a relatively common cardiovascular emergency. PE and deep vein thrombosis (DVT) are considered expressions of the same disease, termed as venous thromboembolism (VTE). In the present review, we describe and meta-analyze the efficacy and safety data available with the direct oral anticoagulants (DOAC; dabigatran, rivaroxaban, apixaban, edoxaban) in clinical trials testing these new compounds in the acute/long-term and extended therapy of VTE, providing subgroup analyses in patients with index PE. We analyzed ten studies in 35,019 randomized patients. A total of 14,364 patients (41%) had index PE. In the acute/long-term treatment of VTE, the DOAC showed comparable efficacy in preventing recurrent VTE to standard treatment in patients with index PE (risk ratio [RR]: 0.88; 95% confidence interval [CI]: 0.70–1.11) and index DVT (RR: 0.93; 95% CI: 0.75–1.16) (P for subgroup differences =0.76). VTE recurrence depending on PE anatomical extension and presence/absence of right ventricular dysfunction was only reported in two trials, with results being consistent with those obtained in the overall study populations. In the single trial comparing extended therapy of VTE with DOAC versus warfarin, the point estimate for recurrent VTE tended to disfavor the DOAC in patients with index PE (RR: 2.05; 95% CI: 0.83–5.03) and in patients with index DVT (RR: 1.11; 95% CI: 0.49–2.50) (P for subgroup differences =0.32). In trials that compared DOAC versus placebo for extended therapy, the reduction in recurrent VTE was consistent in patients with PE (RR: 0.15; 95% CI: 0.01–1.82) and in patients with DVT (RR: 0.25; 95% CI: 0.10–0.61) (P for subgroup differences =0.71). The DOAC were associated with a consistently lower risk of clinically relevant bleeding (CRB) than standard treatment of acute VTE and higher risk of CRB than placebo for extended therapy of VTE regardless of index event. In summary, the DOAC were as effective as, and safer than
Wimberly, Sarah R.; Carver, Charles S.; Laurenceau, Jean-Philippe; Harris, Suzanne D.; Antoni, Michael H.
Two studies examined breast cancer patients' perceptions of their partners' reactions to their diagnosis and treatment as influences on 3 aspects of patients' well-being: psychosexual adjustment, emotional distress, and marital satisfaction. Study 1, cross-sectional, indicated that partner initiation of sex, frequency of sex, a positive 1st sexual…
Lagacé-Wiens, Philippe; Walkty, Andrew; Karlowsky, James A
Avibactam (NXL104, AVE1330A) is a semi-synthetic, non-β-lactam, β-lactamase inhibitor that is active against Ambler class A, class C, and some class D serine β-lactamases. In this review, we summarize the in vitro data, pharmacology, mechanisms of action and resistance, and clinical trial data relating to the use of this agent combined with ceftazidime for the treatment of Gram-negative bacterial infections. The addition of avibactam to ceftazidime improves its in vitro activity against Enterobacteriaceae and Pseudomonas aeruginosa. Avibactam does not improve the activity of ceftazidime against Acinetobacter spp., Burkholderia spp., or most anaerobic Gram-negative rods. Pharmacodynamic data indicate that ceftazidime—avibactam is bactericidal at concentrations achievable in human serum. Animal studies demonstrate that ceftazidime–avibactam is effective in ceftazidime-resistant Gram-negative septicemia, meningitis, pyelonephritis, and pneumonia. Limited clinical trials published to date have reported that ceftazidime–avibactam is as effective as therapy with a carbapenem in complicated urinary tract infection and complicated intra-abdominal infection (combined with metronidazole) including infection caused by cephalosporin-resistant Gram-negative isolates. Safety and tolerability of ceftazidime–avibactam in clinical trials has been excellent, with few serious drug-related adverse events reported. Given the abundant clinical experience with ceftazidime and the significant improvement that avibactam provides in its activity against contemporary β-lactamase-producing Gram-negative pathogens, it is likely this new combination agent will play a role in the empiric treatment of complicated urinary tract infections (monotherapy) and complicated intra-abdominal infections (in combination with metronidazole) caused or suspected to be caused by antimicrobial-resistant pathogens (eg, extended spectrum beta-lactamase-, AmpC-, or Klebsiella pneumoniae carbapenemase
Conte, Michael S
The Bypass versus Angioplasty in Severe Ischemia of the Leg (BASIL) trial is the only randomized controlled trial (RCT) to date comparing open surgical bypass with endovascular therapy for severe limb ischemia (SLI). In their initial 2005 publication, the BASIL investigators reported that the main clinical outcomes (overall survival and amputation-free survival) were no different at 2 years after randomization to angioplasty-first or bypass-first revascularization strategies. However, beyond 2 years there appeared to be a benefit for open bypass surgery, providing impetus for an extension study. The final analysis of the long-term outcomes from BASIL is now presented in a set of articles that are reviewed in this commentary. The benefit of initial randomization to open surgery for patients surviving > or =2 years (70% of the BASIL cohort) was confirmed. When outcomes were analyzed by treatment received, patients who had received prosthetic bypass grafts (25% of the surgical arm) fared much more poorly than those treated with a vein bypass. Patients who underwent surgical bypass after an initial failed angioplasty also fared significantly worse than those who were treated initially with bypass surgery. Health-related quality of life measures and costs were not significantly different overall. There are many controversies surrounding the BASIL trial and its interpretation, which are reviewed herein. These include the choice of study population, end points examined, and the nature of procedures performed. The BASIL trial confirms the primacy of open surgical bypass with vein for most patients with SLI and raises questions about the sequelae of failed endovascular interventions. Further multicenter trials are needed to address the large gap in evidence for treatment selection in this patient population.
Gone, Joseph P
The calls for evidence-based practice (EBP) and cultural competence (CC) represent two increasingly influential mandates within the mental health professions. Advocates of EBP seek to standardize clinical practice by ensuring that only treatment techniques that have demonstrated therapeutic outcomes under scientifically controlled conditions would be adopted and promoted in mental health services. Advocates of CC seek to diversify clinical practice by ensuring that treatment approaches are designed and refined for a multicultural clientele that reflects a wide variety of psychological orientations and life experiences. As these two powerful mandates collide, the fundamental challenge becomes how to accommodate substantive cultural divergences in psychosocial experience using narrowly prescriptive clinical practices and approaches, without trivializing either professional knowledge or cultural difference. In this Introduction to a special issue of Transcultural Psychiatry, the virtue of an interdisciplinary conversation between and among anthropologists, psychologists, psychiatrists, and social work researchers in addressing these tensions is extolled.
Waxmonsky, Jeanette; Kilbourne, Amy M.; Goodrich, David E.; Nord, Kristina M.; Laird, Christina; Lai, Zongshan; Clogston, Julia; Kim, Hyungjin Myra; Miller, Christopher J.; Bauer, Mark S.
Background We determined whether application of a novel implementation intervention (Enhanced Replicating Effective Programs-REP) versus its standard, dissemination-focused version (REP) improved fidelity to bipolar disorder treatment (Life Goals Collaborative Care- LGCC). Methods Five community practices from Michigan and Colorado were randomized to receive LGCC using Enhanced or standard REP. One provider at each practice implemented LGCC which included patient self-management support (4 group sessions focused on symptoms and behavior goals), guideline dissemination to providers, and ongoing phone care management focused on maintaining behavior goals and provider engagement. Standard REP included intervention packaging (i.e., translation of LGCC core components into user-friendly language), training, and as-needed technical assistance. Enhanced REP added customization of LGCC and ongoing, proactive technical assistance through an internal and external facilitator that focused on enhancing provider buy-in and uptake. Multiple and logistic regression analyses determined the impact on patient-level LGCC fidelity between Enhanced versus standard REP. Results Participants (N=384; mean age = 42 years, 67% women, 29% nonwhite) averaged 3.0 out of 4 LGCC group sessions and had 4.0 care management contacts. Enhanced REP implementation was associated with 2.6 (p<.001) greater total number of sessions/contacts than standard REP, which was driven by 2.5 (p<.01) more care management contacts, after adjusting for patient factors. Women and those with a history of homelessness received fewer sessions. Conclusions Enhanced REP implementation was associated with improved LGCC fidelity, primarily for care management contacts. Additional customization of interventions such as LGCC may be needed to ensure adequate treatment fidelity for key vulnerable populations. PMID:24129806
Rieckmann, Traci; Abraham, Amanda; Zwick, Janet; Rasplica, Caitlin; McCarty, Dennis
Objective To profile state agency efforts to promote implementation of three evidence-based practices (EBPs): screening and brief intervention (SBIRT), psychosocial interventions, and medication-assisted treatment (MAT). Data Sources/Study Setting Primary data collected from representatives of 50 states and the District of Columbia’s Single State Authorities from 2007 to 2009. Study Design/Data Collection The study used mixed methods, in-depth, semistructured interviews and quantitative surveys. Interviews assessed state and provider strategies to accelerate implementation of EBPs. Principal Findings Statewide implementation of psychosocial interventions and MAT increased significantly over 3 years. In the first two assessments, states that contracted directly with providers were more likely to link use of EBPs to reimbursement, and states with indirect contract, through counties and other entities, increased recommendations, and some requirements for provision of specific EBPs. The number of states using legislation as a policy lever to promote EBPs was unchanged. Conclusions Health care reform and implementation of parity in coverage increases access to treatment for alcohol and drug use. Science-based substance abuse treatment will become even more crucial as payers seek consistent quality of care. This study provides baseline data on service delivery, contracting, and financing as state agencies and treatment providers prepare for implementation of the Affordable Care Act. PMID:25532616
Zetin, Mark; Hoepner, Cara T; Bjornson, Lynda
Every clinician faces the daily question of which antidepressant is best for a particular depressed patient. Double-blind studies submitted for U.S. Federal Drug Administration marketing approval include only the "purest" population of patients, and the American Psychiatric Association and other treatment guidelines often do not adequately address the complexities of developmental, family history, psychosocial, medical, and psychiatric comorbidity, and treatment-refractory issues that are seen in routine clinical practice. Long-term trends in depression treatment include ever-expanding choices among drugs, highly specific psychotherapies, and attempts to treat chronic and/or mild cases, with the goal of remission for all patients. We performed literature reviews and attempted to synthesize factors that may be useful in the application of evidence-based medicine in office-based psychiatric practice. We have found that factors influencing antidepressant selection include drug factors (including tolerability, interactions, and cost), depression subtype, psychiatric and medical comorbidity, and stage of life. In addition, patient preference for avoiding certain side effects and personal and family history of treatment response are helpful information. Most patients in the community would not fit strict antidepressant study criteria. Biologic markers predicting treatment response are not yet widely available, so the optimal choice of medication must be guided by detailed history.
Liscia, T; Milleliri, J
Violence and armed conflict situations besetting numerous developing countries inflict a heavy toll on populations, especially in terms of posttraumatic mental disorders. In addition to upsetting the well-being and psychic balance of people, violent political instability prevents development of the country as a whole not only economically but also individually and socially. After being confronted with this reality for years, humanitarian workers have implemented actions aimed at treating and helping traumatized people to recover their mental health as a first step to achieving effective and durable development. However, despite the availability of effective low-cost treatment for post-traumatic mental disorders, officials in developing countries as well as in international organizations continue to ignore or neglect this crucial issue. This article is based on a study carried out by "Crisis prevention and post-conflict unit" of the Agence Française de Développement. The purpose is to underline the need and describe available methods for management of post-traumatic stress disorders in populations of post-conflict countries, as prerequisite for sustainable reconstruction and development.
Burmeister, Jacob M; Hinman, Nova; Koball, Afton; Hoffmann, Debra A; Carels, Robert A
The present study examined food addiction symptomology and its relationship to eating pathology and psychological distress among adults seeking weight loss treatment. A primary interest was an examination of the relationship between food addiction symptoms and short-term weight loss. Adults beginning a behavioral weight loss program (N=57) were given the Yale Food Addiction Scale (YFAS) as well as measures of psychological distress, disordered eating, weight bias, and weight-focused attitudes. Weight loss was measured after 7 weeks. Severity of food addiction was related to increased depression, emotional eating, binge eating, anti-fat attitudes, internalized weight bias, body shame, and low eating self-efficacy, but not body satisfaction. Increased food addiction symptomology was also related to less weight lost at 7 weeks. Findings suggest that individuals attempting to lose weight while combating symptoms of food addiction may be especially prone to eating-related pathologies, internalized weight bias, and body shame. Importantly, findings provide evidence that food addiction may undermine efforts to lose weight. The pathology associated with addiction (e.g., tolerance, withdrawal) could make the adoption of more healthful eating habits especially difficult.
This presentation will describe a concrete strategy for bridging the gap between the *science* of science communication and the practice of it. In recent years, social scientists have made substantial progress in identifying the psychological influences that shape public receptivity to scientific information relating to climate change and other public policy issues. That work, however, has consisted nearly entirely of laboratory experiments and public opinion surveys; these methods identify general mechanisms of information processing but do not yield concrete prescriptions for communication in field settings. In order to integrate the findings of the science of science communication with the practice of it, field communication must now be made into a meaningful site of science communication research. "Evidence-based science communication" will involve collaborative work between social scientists and practitioners aimed at formulating and testing scientifically informed communication strategies in real-world contexts.
Rosenberg, Anthony; Lenze, Eric J
Anxiety and depressive disorders are the most common psychiatric disorders, causing high personal and economic burden. Psychosocial approaches, such as psychotherapy or mind-body instruction, along with self-help approaches, exercise, and proper sleep hygiene are effective solo or additive (to pharmacotherapy) strategies. Many physicians are less familiar with these methods for treating anxiety/depressive disorders. This article seeks to illuminate psychosocial approaches for depression and anxiety that act additively or independently of pharmacotherapy and explain how physicians can utilize them.
American Psychologist, 2006
The evidence-based practice movement has become an important feature of health care systems and health care policy. Within this context, the APA 2005 Presidential Task Force on Evidence-Based Practice defines and discusses evidence-based practice in psychology (EBPP). In an integration of science and practice, the Task Force's report describes…
Efficient drug delivery systems are exceedingly important for novel drug discovery. The evidence-based personalized medicine (EBPM) promises to deliver the right drug at the right time to a right patient as it covers clinicallysignificant genetic predisposition and chronopharmacological aspects of nanotheranostics. Recently nanotechnology has provided clinically-significant information at the cellular, molecular, and genetic level to facilitate evidence-based personalized treatment. Particularly drug encapsulation in pegylated liposomes has improved pharmacodynamics of cancer, cardiovascular diseases, and neurodegenerative diseases. Long-circulating liposomes and block copolymers concentrate slowly via enhanced permeability and retention (EPR) effect in the solid tumors and are highly significant for the drug delivery in cancer chemotherapeutics. Selective targeting of siRNA and oligonucleotides to tumor cells with a potential to inhibit multi-drug resistant (MDR) malignancies has also shown promise. In addition, implantable drug delivery devices have improved the treatment of several chronic diseases. Recently, microRNA, metallothioneins (MTs), α-synuclein index, and Charnoly body (CB) have emerged as novel drug discovery biomarkers. Hence CB antagonists-loaded ROSscavenging targeted nanoparticles (NPs) may be developed for the treatment of neurodegenerative and cardiovascular diseases. Nonspecific induction of CBs in the hyper-proliferative cells may cause alopecia, gastrointestinal tract (GIT) symptoms, myelosuppression, neurotoxicity, and infertility. Therefore selective CB agonists may be developed to augment cancer stem cell specific CB formation to eradicate MDR malignancies with minimum or no adverse effects. This review highlights recent advances on safe, economical, and effective treatment of neurodegenerative diseases, cardiovascular diseases, and cancer by adopting emerging nanotheranostic strategies to accomplish EBPM.
Frías, Álvaro; Palma, Cárol; Farriols, Núria
Pediatric bipolar disorder (PBD) has emerged as a research field in which psychosocial treatments have provided a plethora of empirical findings over the last decade. We addressed this issue through a systematic review aimed of establishing their effectiveness and feasibility as adjunctive therapies for youth with PBD or at high-risk for PBD. A comprehensive search of databases was performed between 1990 and September 2014. Overall, 33 studies were specifically related to the issue and 20 of them were original articles. Evidence suggests that both "multi-family psychoeducational psychotherapy' and "family-focused therapy" are possible effective treatments for PBD. Likewise, "child and family-focused cognitive-behavioral therapy" may be characterized as a treatment in its experimental phase. The remaining therapies fail to obtain enough empirical support due to inconsistent findings among clinical trials or data solely based on case reports. Studies of psychosocial treatments provide concluding results concerning their feasibility and acceptability. Larger sample sizes and more randomized controlled trials are mandatory for diminishing methodological shortcomings encountered in the treatments displayed.
Stuart, Carol; Sanders, Larry; Gurevich, Maria; Fulton, Robert
This article describes the effect of a province-wide vision of evidence-based and outcome-based services for children and youth and the challenges of implementing evidence-based practice (EBP) and evidence-based treatment (EBT) approaches within group care settings. The paper is based on the results of a survey of group care settings in the…
Chen, Li-Li; Lin, Jun-Dai
Acupressure is a traditional Chinese medicine approach to disease prevention and treatment that may be operated by nurses independently. Therefore, acupressure is being increasingly applied in clinical nursing practice and research. Recently, the implementation of evidence-based nursing (EBN) in clinical practice has been encouraged to promote nursing quality. Evidence-based nursing is a method-ology and process of implementation that applies the best-available evidence to clinical practice, which is acquired through the use of empirical nursing research. Therefore, in this paper, we address the topic of acupressure within the context of empirical nursing practice. We first introduce the current status of acupressure research and provide the locations of common acupoints in order to guide future empirical nursing research and to help nurses use these acupoints in clinical practice. Finally, we describe the steps that are necessary to apply the current empirical information on acupressure as well as provide suggestions to promote safety and efficacy in order to guide nurses in the accurate application of acupressure in nursing practice.
Aurora, R. Nisha; Kristo, David A.; Bista, Sabin R.; Rowley, James A.; Zak, Rochelle S.; Casey, Kenneth R.; Lamm, Carin I.; Tracy, Sharon L.; Rosenberg, Richard S.
A systematic literature review and meta-analyses (where appropriate) were performed to update the previous AASM practice parameters on the treatments, both dopaminergic and other, of RLS and PLMD. A considerable amount of literature has been published since these previous reviews were performed, necessitating an update of the corresponding practice parameters. Therapies with a STANDARD level of recommendation include pramipexole and ropinirole. Therapies with a GUIDELINE level of recommendation include levodopa with dopa decarboxylase inhibitor, opioids, gabapentin enacarbil, and cabergoline (which has additional caveats for use). Therapies with an OPTION level of recommendation include carbamazepine, gabapentin, pregabalin, clonidine, and for patients with low ferritin levels, iron supplementation. The committee recommends a STANDARD AGAINST the use of pergolide because of the risks of heart valve damage. Therapies for RLS secondary to ESRD, neuropathy, and superficial venous insufficiency are discussed. Lastly, therapies for PLMD are reviewed. However, it should be mentioned that because PLMD therapy typically mimics RLS therapy, the primary focus of this review is therapy for idiopathic RLS. Citation: Aurora RN; Kristo DA; Bista SR; Rowley JA: Zak RS; Casey KR; Lamm CI; Tracy SL; Rosenberg RS. The treatment of restless legs syndrome and periodic limb movement disorder in adults—an update for 2012: practice parameters with an evidence-based systematic review and meta-analyses. SLEEP 2012;35(8):1039-1062. PMID:22851801
The guidelines of all international hernia societies recommend as procedures of choice the laparoendoscopic techniques total extraperitoneal patch plasty (TEP) and transabdominal preperitoneal patch plasty (TAPP) as well as the open Lichtenstein operation for elective inguinal hernia repair. The learning curve associated with the laparoendoscopic techniques, in particular TEP, is longer than that for the open Lichtenstein technique due to the complexity of the procedures. Accordingly, for laparoendoscopic techniques it is particularly important that the operations are conducted in a standardized manner in compliance with the evidence-based recommendations given for the technical details. When procedures are carried out in strict compliance with the guidelines of the international hernia societies, low rates of perioperative complications, complication-related reoperations, recurrences and chronic pain can be expected for TEP. Compliance with the guidelines can also positively impact mastery of the learning curve for TEP. The technical guidelines on TEP are based on study results and on the experiences of numerous experts; therefore, it is imperative that they are implemented in routine surgical practice.
The long-term treatment of restless legs syndrome/Willis-Ekbom disease: evidence-based guidelines and clinical consensus best practice guidance: a report from the International Restless Legs Syndrome Study Group.
Garcia-Borreguero, Diego; Kohnen, Ralf; Silber, Michael H; Winkelman, John W; Earley, Christopher J; Högl, Birgit; Manconi, Mauro; Montplaisir, Jacques; Inoue, Yuichi; Allen, Richard P
A Task Force was established by the International Restless Legs Syndrome Study Group (IRLSSG) to develop evidence-based and consensus-based recommendations for the long-term pharmacologic treatment of restless legs syndrome/Willis-Ekbom disease (RLS/WED). The Task Force reviewed the results of all studies of RLS/WED treatments with durations of 6 months or longer presented at meetings over the past 2 years, posted on Web sites of pharmaceutical companies, or published in peer-reviewed journals, asking the questions, "What is the efficacy of this treatment in patients with RLS/WED?" and "What is the safety of this treatment in patients with RLS/WED?" The Task Force developed guidelines based on their review of 61 papers meeting inclusion criteria, and using a modified evidence-grading scheme. Pregabalin has been established as effective for up to 1 year in treating RLS/WED (Level A evidence). Pramipexole, ropinirole, and rotigotine have been established as effective for up to 6 months in treating RLS/WED (Level A). The following drugs have been established as probably effective (Level B) in treating RLS/WED for durations ranging from 1 to 5 years: gabapentin enacarbil, pramipexole, and ropinirole (1 year); levodopa (2 years); and rotigotine (5 years). Because of associated safety concerns, pergolide and cabergoline should not be used in the treatment of RLS/WED unless the benefits clearly outweigh the risks. Other pharmacologic therapies have insufficient evidence to support their long-term use in treating RLS/WED. The IRLSSG Task Force also developed consensus-based strategies for the prevention and treatment of complications (such as augmentation, loss of efficacy, excessive daytime sleepiness, and impulse control disorders) that may develop with the long-term pharmacologic treatment of RLS/WED. The use of either a dopamine-receptor agonist or α2δ calcium-channel ligand is recommended as the first-line treatment of RLS/WED for most patients, with the choice of
Baig, Muhammad Akbar; Shahzad, Hira; Jamil, Bushra; Hussain, Erfan
The Surviving Sepsis Campaign (SSC) guidelines have outlined an early goal directed therapy (EGDT) which demonstrates a standardized approach to ensure prompt and effective management of sepsis. Having said that, there are barriers associated with the application of evidence-based practice, which often lead to an overall poorer adherence to guidelines. Considering the global burden of disease, data from low- to middle-income countries is scarce. Asia is the largest continent but most Asian countries do not have a well-developed healthcare system and compliance rates to resuscitation and management bundles are as low as 7.6% and 3.5%, respectively. Intensive care units are not adequately equipped and financial concerns limit implementation of expensive treatment strategies. Healthcare policy-makers should be notified in order to alleviate financial restrictions and ensure delivery of standard care to septic patients.
The contrast between the efficiency of Evidence-Based Medicine (EBM), a scientific fact, and the popularity of Complementary and Alternative Medicines (CAM) is a paradox of the art of healing. EBM is based on the paradigm of positivism and materialism while CAM are based on those of relativism and vitalism. These paradigms are diametrically opposed and the aim of an integrative medicine is aporetic. However, EBM is today in a dead end. The objective proof of a disease according to the rules of EBM is often lacking face to the expectations of patients demanding their illness to be taken into account. EBM and CAM have thus to coexist. Lessons can be drawn from CAM : patient expectations should be given a meaning and be integrated in his or her psychosocial context.
Michelson, Daniel; Davenport, Clare; Dretzke, Janine; Barlow, Jane; Day, Crispin
Evidence-based interventions are often unavailable in everyday clinical settings. This may partly reflect practitioners' assumptions that research evidence does not reflect "real-world" conditions. To examine this further, we systematically assessed the clinical effectiveness of parent management training (PMT) for the treatment of child disruptive behavior across different real-world practice contexts. We identified 28 relevant randomized controlled trials from a systematic search of electronic bibliographic databases and conducted a meta-analysis of child outcomes across trials. Planned subgroup analyses involved comparisons between studies grouped according to individual real-world practice criteria and total real-world practice criteria scores, reflecting the extent to which PMT was delivered by non-specialist therapists, to a clinic-referred population, in a routine setting, and as part of a routine service. Meta-analysis revealed a significant overall advantage for PMT compared with waitlist control conditions. Subgroup analyses did not demonstrate significant differences in effect size estimates according to the total number of real-world practice criteria met by studies. Moreover, no consistent relationships were found between specific practice criteria and effect size estimates. In conclusion, PMT appears to be an effective treatment for children with disruptive behavior problems. There was no clear evidence that conducting PMT in real-world practice contexts is a deterrent to achieving effective child behavior outcomes, although relative advantage to "usual care" was not directly examined and the power of the analysis was limited as a result of significant heterogeneity. More research is needed to investigate whether this finding is generalizable to other psychological interventions. Suggestions are also made for developing more differentiated criteria to assist with evaluating the specific applicability of research evidence to different care providers.
Amzel, Anouk; Toska, Elona; Lovich, Ronnie; Widyono, Monique; Patel, Tejal; Foti, Carrie; Dziuban, Eric J; Phelps, B Ryan; Sugandhi, Nandita; Mark, Daniella; Altschuler, Jenny
is still limited evidence demonstrating which interventions have positive effects on the well being of HIV-infected children. Interventions that improve the psychosocial well being of children living with HIV must be replicable in resource-limited settings, avoiding dependence on specialized staff for implementation.This paper advocates for combination approaches that strengthen the capacity of service providers, expand the availability of age appropriate and family-centred support and equip schools to be more protective and supportive of children living with HIV. The coordination of care with other community-based interventions is also needed to foster more supportive and less stigmatizing environments. To ensure effective, feasible, and scalable interventions, improving the evidence base to document improved outcomes and longer term impact as well as implementation of operational studies to document delivery approaches are needed.
Ladwig, Karl-Heinz; Lederbogen, Florian; Albus, Christian; Angermann, Christiane; Borggrefe, Martin; Fischer, Denise; Fritzsche, Kurt; Haass, Markus; Jordan, Jochen; Jünger, Jana; Kindermann, Ingrid; Köllner, Volker; Kuhn, Bernhard; Scherer, Martin; Seyfarth, Melchior; Völler, Heinz; Waller, Christiane; Herrmann-Lingen, Christoph
Background: The rapid progress of psychosomatic research in cardiology and also the increasing impact of psychosocial issues in the clinical daily routine have prompted the Clinical Commission of the German Heart Society (DGK) to agree to an update of the first state of the art paper on this issue which was originally released in 2008. Methods: The circle of experts was increased, general aspects were implemented and the state of the art was updated. Particular emphasis was dedicated to coronary heart diseases (CHD), heart rhythm diseases and heart failure because to date the evidence-based clinical knowledge is most advanced in these particular areas. Differences between men and women and over the life span were considered in the recommendations as were influences of cognitive capability and the interactive and synergistic impact of classical somatic risk factors on the affective comorbidity in heart disease patients. Results: A IA recommendation (recommendation grade I and evidence grade A) was given for the need to consider psychosocial risk factors in the estimation of coronary risks as etiological and prognostic risk factors. Furthermore, for the recommendation to routinely integrate psychosocial patient management into the care of heart surgery patients because in these patients, comorbid affective disorders (e.g. depression, anxiety and post-traumatic stress disorder) are highly prevalent and often have a malignant prognosis. A IB recommendation was given for the treatment of psychosocial risk factors aiming to prevent the onset of CHD, particularly if the psychosocial risk factor is harmful in itself (e.g. depression) or constrains the treatment of the somatic risk factors. Patients with acute and chronic CHD should be offered anti-depressive medication if these patients suffer from medium to severe states of depression and in this case medication with selective reuptake inhibitors should be given. In the long-term course of treatment with implanted
Aldred, Catherine; Green, Jonathan; Adams, Catherine
Background: Psychosocial treatments are the mainstay of management of autism in the UK but there is a notable lack of a systematic evidence base for their effectiveness. Randomised controlled trial (RCT) studies in this area have been rare but are essential because of the developmental heterogeneity of the disorder. We aimed to test a new…
This paper argues that the current conception of evidence-based medicine has its limitations in the promotion of research which effects the quality of service in any health care system. It also poses something of a difficulty for the development of evidence-based nursing in particular. This paper advocates the more broad based concept of evidence-based practice and discusses its potential for addressing theory/practice problems and the uptake of nursing research. The broader conceptualization of evidence-based practice focuses on the integration of available evidence and the tacit knowledge of the investigator. An evidence-based practice project undertaken in Hong Kong is outlined as this provided the basis of many of the conclusions made in this paper. Three vignettes are given in order to demonstrate the nature of the evidence-based practice projects which have been conducted. The critical elements of evidence-based practice projects are outlined. Finally issues concerning the process of generating evidence, the relationship to continuous quality improvement and the cost effectiveness of evidence-based practice are discussed in more detail.
Examines David Hargreaves' ideas about the nature of evidence-based practice and the future direction for educational research. States that one major theme is that current discourse about evidence-based teaching is uninformed by an articulate educational theory, therefore excluding thoughtful consideration of implications of such a theory for…
Brandt, Julie A; Reed Edwards, Donna; Cox Sullivan, Sheila; Zehler, Jean K; Grinder, Sandra; Scott, Karen J; Cook, Judy H; Roper, Debra; Dickey, Aurora; Maddox, Kathleen L
Using a systematic, evidence-based approach for developing a business plan allows nurse executives to forecast the needs of the organization, involve nursing staff at all levels, evaluate the direction of the profession, and present a plan with clear, concise goals. The authors describe 4 steps necessary in developing an effective evidence-based business plan.
Test, David W.; Fowler, Catherine H.; Richter, Sharon M.; White, James; Mazzotti, Valerie; Walker, Allison R.; Kohler, Paula; Kortering, Larry
A literature review was conducted to identify evidence-based practices in secondary transition using quality indicator checklists for experimental research. Practices were categorized by the Taxonomy for Transition Programming. Overall, 32 secondary transition evidence-based practices were identified. Two practices had a strong level of evidence,…
Marcilly, Romaric; Peute, Linda W; Beuscart-Zephir, Marie-Catherine; Jaspers, Monique W
In a Health Information Technology (HIT) regulatory context in which the usability of this technology is more and more a critical issue, there is an increasing need for evidence based usability practice. However, a clear definition of evidence based usability practice and how to achieve it is still lacking. This paper underlines the need for evidence based HIT design and provides a definition of evidence based usability practice as the conscientious, explicit and judicious use of current best evidence in making decisions in design of interactive systems in health by applying usability engineering and usability design principles that have proven their value in practice. Current issues that hamper evidence based usability practice are highlighted and steps needed to achieve evidence are presented.
Ebesutani, Chad; Bernstein, Adam; Chorpita, Bruce F; Weisz, John R
Current evidence-based assessment methods, such as structured interviews and lengthy assessment batteries, often require hours to administer, score, and interpret and thus are infrequently used in real-world practice. As evidence-based assessment tools are developed for implementation in real-world youth mental health settings, the transportability properties of assessment procedures (including administration and interpretation burden) need to be considered and improved. In the present study, we thus conducted an initial feasibility study using a clinical sample of community-based youths (N = 306) to develop an assessment protocol based on 2 child and 2 parent self-report questionnaires (thus low on administration burden). Using decision-tree analysis, we identified a series of cutoff scores across these scales that may be used to inform treatment need related to anxiety, depression, attention-deficit/hyperactivity disorder (ADHD), and disruptive behavior problems. This algorithm-based approach to interpreting assessment information provided clear and simple guidelines (thus low on interpretation burden) that matched the best estimate treatment determinations derived by trained assessors, supervisors, and expert consultants who integrated information provided by child and parent structured interviews and self-report scales. The present study demonstrated the feasibility of developing an assessment protocol to inform various treatment allocation decisions in a way that imposes little assessment administration and interpretation burden yet maintains adequate classification accuracy. These characteristics make the proposed protocol promising with regard to its transportability and suitability for adoption and implementation in real-world mental health settings.
Embry, Dennis D.; Biglan, Anthony
This paper describes evidence-based kernels, fundamental units of behavioral influence that appear to underlie effective prevention and treatment for children, adults, and families. A kernel is a behavior-influence procedure shown through experimental analysis to affect a specific behavior and that is indivisible in the sense that removing any of…
Schaeffer, Cindy M.; Bruns, Eric; Weist, Mark; Stephan, Sharon Hoover; Goldstein, Julie; Simpson, Yolanda
The Center for School Mental Health Assistance at the University of Maryland recently completed a review of evidence-based prevention and treatment programs that can be used by school mental health clinicians. Based on the review, a school-based program operating in 22 Baltimore City schools has purchased and trained clinicians in a number of…
Evidence-based medicine's (EBM) quantitative methodologies reflect medical science's long-standing mistrust of the imprecision and subjectivity of ordinary descriptive language. However, EBM's attempts to replace subjectivity with precise empirical methods are problematic when clinicians must negotiate between scientific medicine and patients' experience. This problem is evident in the case of bibliotherapy (patient reading as treatment modality), a practice widespread despite its reliance on anecdotal evidence. While EBM purports to replace such flawed practice with reliable evidence-based methods, this essay argues that its aversion to subjective language prevents EBM from effectively evaluating bibliotherapy or making it amenable to clinical and research governance.
National Center for Education in Maternal and Child Health, Washington, DC.
The directory is intended to aid patients and their families who are coping with the genetic disorder of Cooley's anemia. A brief review of the disease covers background, genetics, symptoms, effect on the patient, treatment, and current research. The next section looks at psychosocial needs at various times (time of diagnosis, infancy and toddler…
Dy, Sydney Morss; Apostol, Colleen C
Dyspnea, nausea and vomiting, anorexia, fatigue, and sleep disturbances are common and distressing in advanced cancer. We updated previous systematic reviews of how these symptoms can be alleviated with targeted literature searches. The approach to these symptoms requires comprehensive symptom assessment; treating underlying causes when benefits exceed risks; prioritizing treatment, as patients usually have many symptoms; and addressing psychosocial and spiritual distress. For dyspnea, evidence supports systemic opioids and nonpharmacological treatments such as a fan. The strongest evidence supports metoclopramide for cancer-related nausea and octreotide for bowel obstruction. For anorexia, enteral or parenteral nutrition is indicated with obstruction and expected prognosis of at least 6 weeks. Evidence supports several drugs for appetite affecting quality of life. For fatigue, evidence supports psychosocial interventions and methylphenidate. For insomnia, evidence supports cognitive-behavioral therapy in cancer; no sleep agents have superior effectiveness.
Barkhordarian, Andre; Hacker, Brett; Chiappelli, Francesco
Standards of care pertain to crafting and implementing patient-centered treatment interventions. Standards of care must take into consideration the patient's gender, ethnicity, medical and dental history, insurance coverage (or socioeconomic level, if a private patient), and the timeliness of the targeted scientific evidence. This resolves into a process by which clinical decision-making about the optimal patient-centered treatment relies on the best available research evidence, and all other necessary inputs and factors to provide the best possible treatment. Standards of care must be evidence-based, and not merely based on the evidence – the dichotomy being critical in contemporary health services research and practice. Evidence-based standards of care must rest on the best available evidence that emerges from a concerted hypothesis-driven process of research synthesis and meta-analysis. Health information technology needs to become an every-day reality in health services research and practice to ensure evidence-based standards of care. Current trends indicate that user-friendly methodologies, for the dissemination of evidence-based standards of care, must be developed, tested and distributed. They should include approaches for the quantification and analysis of the textual content of systematic reviews and of their summaries in the form of critical reviews and lay-language summaries. PMID:22355229
Dufour, J-C; Mancini, J; Fieschi, M
The foundation of evidence-based medicine is critical analysis and synthesis of the best data available concerning a given health problem. These factual data are accessible because of the availability on the Internet of web tools specialized in research for scientific publications. A bibliographic database is a collection of bibliographic references describing the documents indexed. Such a reference includes at least the title, summary (or abstract), a set of keywords, and the type of publication. To conduct a strategically effective search, it is necessary to formulate the question - clinical, diagnostic, prognostic, or related to treatment or prevention - in a form understandable by the research engine. Moreover, it is necessary to choose the specific database or databases, which may have particular specificity, and to analyze the results rapidly to refine the strategy. The search for information is facilitated by the knowledge of the standardized terms commonly used to describe the desired information. These come from a specific thesaurus devoted to document indexing. The most frequently used is MeSH (Medical Subject Heading). The principal bibliographic database whose references include a set of describers from the MeSH thesaurus is Medical Literature Analysis and Retrieval System Online (Medline), which has in turn become a subpart of a still more vast bibliography called PubMed, which indexes an additional 1.4 million references. Numerous other databases are maintained by national or international entities. These include the Cochrane Library, Embase, and the PASCAL and FRANCIS databases.
Washburn, Jason J.; West, Amy E.; Heil, Jennifer A.
Aim To review the diagnosis and the pharmacologic and psychosocial interventions for pediatric bipolar disorder (PBD). Methods A comprehensive literature review of studies discussing the diagnosis and treatment of PBD was conducted. Results A context for understanding controversies and difficulties in the diagnosis of PBD is provided. An evidence-based assessment protocol for PBD is reviewed. The evidence for the following three categories of pharmacologic interventions are reviewed: Lithium, antiepileptics, and second generation antipsychotics. Algorithms for medication decisions are briefly reviewed. Existing psychosocial treatments and the evidence for those treatments are also reviewed. Conclusion Despite recent developments in understanding the phenomenology of PBD and in identifying pharmacologic and psychosocial interventions, critical gaps remain. PMID:21822352
Social attitudes towards epilepsy cause more distress to the patient and his/her near and dear ones, than the disease itself. The major psychosocial issues related to epilepsy are: Quality of medical management, overprotection, education, employment, marriage and pregnancy. Inadequate treatment is the major reason involved in psychosocial issues. Constant overprotection and pampering leads to behavioural pattern which makes epileptic patient dependent for ever. Education is hampered in epileptic persons. Teachers and students should have proper information regarding seizures. If seizures are well controlled, job opportunities increase. Employers and employees need to be educated about epilepsy. Self-employment is the best in epileptic patients. Regarding marriage, each patient is to be judged on individual merits and type of epilepsy. Society needs to be educated about the facts and consequences of epilepsy. Risk of anti-epileptic drug's usage is very insignificant compared to risk of seizures in pregnancy. So girls are advised to seek medical advice before pregnancy and during follow-up. With more and more support from the society, persons with epilepsy will have the courage and confidence to speak about themselves and their illness. It is only then that we will realise that persons with epilepsy are 'normal' or 'near-normal' and this will break the vicious cycle of stigma.
Annesi, James J
Background: Behavioral weight-loss treatments have been overwhelmingly unsuccessful. Many inadequately address both behavioral theory and extant research—especially in regard to the lack of viability of simply educating individuals on improved eating and exercise behaviors. Objective: The aim was to synthesize research on associations of changes in exercise behaviors, psychosocial factors, eating behaviors, and weight; and then conduct further direct testing to inform the development of an improved treatment approach. Methods: A systematic program of health behavior-change research based on social cognitive theory, and extensions of that theory applied to exercise and weight loss, was first reviewed. Then, to extend this research toward treatment development and application, a field-based study of obese adults was conducted. Treatments incorporated a consistent component of cognitive-behaviorally supported exercise during 26 weeks that was paired with either standard nutrition education (n = 183) or cognitive-behavioral methods for controlled eating that emphasized self-regulatory methods such as goal setting and caloric tracking, cognitive restructuring, and eating cue awareness (n = 247). Results: Both treatment conditions were associated with improved self-efficacy, self-regulation, mood, exercise, fruit and vegetable consumption, weight, and waist circumference; with improvements in self-regulation for eating, fruit and vegetable consumption, weight, and waist circumference significantly greater in the cognitive-behavioral nutrition condition. Changes in exercise- and eating-related self-efficacy and self-regulation were associated with changes in exercise and eating (R2 = 0.40 and 0.17, respectively), with mood change increasing the explanatory power to R2 = 0.43 and 0.20. Improved self-efficacy and self-regulation for exercise carried over to self-efficacy and self-regulation for controlled eating (β= 0.53 and 0.68, respectively). Conclusions: Development
Shaffer, Anne; Lindhiem, Oliver; Kolko, David J; Trentacosta, Christopher J
In the current study, we examined longitudinal changes in, and bidirectional effects between, parenting practices and child behavior problems in the context of a psychosocial treatment and 3-year follow-up period. The sample comprised 139 parent-child dyads (child ages 6-11) who participated in a modular treatment protocol for early-onset ODD or CD. Parenting practices and child behavior problems were assessed at six time-points using multiple measures and multiple reporters. The data were analyzed using cross-lagged panel analyses. Results indicated robust temporal stabilities of parenting practices and child behavior problems, in the context of treatment-related improvements, but bidirectional effects between parenting practices and child behavior were less frequently detected. Our findings suggest that bidirectional effects are relatively smaller than the temporal stability of each construct for school-age children with ODD/CD and their parents, following a multi-modal clinical intervention that is directed at both parents and children. Implications for treatment and intervention are discussed.
A multifaceted intervention to narrow the evidence-based gap in the treatment of acute coronary syndromes: rationale and design of the Brazilian Intervention to Increase Evidence Usage in Acute Coronary Syndromes (BRIDGE-ACS) cluster-randomized trial.
Berwanger, Otávio; Guimarães, Hélio P; Laranjeira, Ligia N; Cavalcanti, Alexandre B; Kodama, Alessandra; Zazula, Ana Denise; Santucci, Eliana; Victor, Elivane; Flato, Uri A; Tenuta, Marcos; Carvalho, Vitor; Mira, Vera Lucia; Pieper, Karen S; Mota, Luiz Henrique; Peterson, Eric D; Lopes, Renato D
Translating evidence into clinical practice in the management of acute coronary syndromes (ACS) is challenging. Few ACS quality improvement interventions have been rigorously evaluated to determine their impact on patient care and clinical outcomes. We designed a pragmatic, 2-arm, cluster-randomized trial involving 34 clusters (Brazilian public hospitals). Clusters were randomized to receive a multifaceted quality improvement intervention (experimental group) or routine practice (control group). The 6-month educational intervention included reminders, care algorithms, a case manager, and distribution of educational materials to health care providers. The primary end point was a composite of evidence-based post-ACS therapies within 24 hours of admission, with the secondary measure of major cardiovascular clinical events (death, nonfatal myocardial infarction, nonfatal cardiac arrest, and nonfatal stroke). Prescription of evidence-based therapies at hospital discharge were also evaluated as part of the secondary outcomes. All analyses were performed by the intention-to-treat principle and took the cluster design into account using individual-level regression modeling (generalized estimating equations). If proven effective, this multifaceted intervention would have wide use as a means of promoting optimal use of evidence-based interventions for the management of ACS.
The call for evidence-based policy is often accompanied by rather uncritical references to the success of evidence-based medicine, leading to often unsuccessful translation attempts. In this paper, I reflect on the practice of evidence-based medicine in an attempt to sketch a more productive approach to translating evidence into the practice of policy making. Discussing three episodes in the history of evidence-based medicine - clinical trials, and the production and use of clinical guidelines - I conclude that the success of evidence-based medicine is based on the creation of reflexive practices in which evidence and practice can be combined productively. In the conclusion, I discuss the prospects of such a practice for evidence-based policy.
Ballini, A; Capodiferro, S; Toia, M; Cantore, S; Favia, G; De Frenza, G; Grassi, F R
The importance of evidence for every branch of medicine in teaching in order to orient the practitioners among the great amount of most actual scientific information's, and to support clinical decisions, is well established in health care, including dentistry. The practice of evidence-based medicine is a process of lifelong, self-directed, problem-based learning which leads to the need for clinically important information about diagnosis, prognosis, therapy and other clinical and health care issues. Nowadays the practice of dentistry is becoming more complex and challenging because of the continually changing in dental materials and equipments, an increasingly litigious society, an increase in the emphasis of continuing professional development, the information explosion and the consumer movement associated with advances on the Internet. The need for reliable information and the electronic revolution have come together to allow the "paradigm shift" towards evidence-based health care. Recent years have seen an increase in the importance of evidence-based dentistry, aiming to reduce to the maximum the gap between clinical research and real world dental practice. Aim of evidence-based practice is the systematic literature review, which synthesizes the best evidences and provides the basis for clinical practice guidelines. These practice guidelines give a brief review of what evidence-based dentistry is and how to use it.
Hood, Korey K.; Weissberg-Benchell, Jill; Aldred, Chris; Oliver, Nick; Laffel, Lori
Abstract Aim: This study aimed to systematically review the evidence base for the use of existing psychological and psychosocial measures suitable for use in artificial pancreas (AP) research. Materials and Methods: This systematic review of published literature, gray literature, previous systematic reviews, and qualitative and economic studies was conducted using terms and abbreviations synonymous with diabetes, AP, and quality of life (QoL). Results: Two hundred ninety-two abstracts were identified that reported psychosocial assessment of diabetes-related technologies. Of these, nine met the inclusion criteria and were included. Only four of 103 ongoing trials evaluated psychosocial aspects as an outcome in the trial. Of these, treatment satisfaction, acceptance and use intention of AP, fear of hypoglycemia episodes, satisfaction with AP, and an unspecified QoL measure were used. Conclusions: A better understanding of the psychosocial side of AP systems and the extent to which human factors play a role in the uptake and efficient use of these systems will ultimately lead to the most benefit for people with diabetes. PMID:25549042
Ramsey, Susan E.; Rounsaville, Dan; Hoskinson, Randall; Park, Tae Woo; Ames, Evan G.; Neirinckx, Victor D.; Friedmann, Peter
Given the increase of opioid dependence and opioid-related morbidity and mortality, improving treatment options for individuals with opioid dependence warrants increased attention. This article provides a concise review of work in this area. Remission from opioid dependence can be very difficult to sustain, particularly in the absence of opioid replacement or opioid antagonist therapy. For those who wish to transition from opioid use or opioid replacement therapy to opioid antagonist therapy, a significant challenge can be the period of withdrawal symptoms that must be endured prior to the initiation of opioid antagonist therapy. Studies that have incorporated psychosocial interventions into detoxification protocols have found that they can result in improved treatment outcomes. Interventions based on Acceptance and Commitment Therapy have shown promise in the treatment of clinical disorders that present with symptoms similar to those of opioid withdrawal and have been found to positively impact outcomes among those tapering from methadone. However, the use of an Acceptance and Commitment Therapy-based intervention has yet to be studied among opioid-dependent patients transitioning to XR-NTX, and its value to those transitioning to XR-NTX is currently unknown. PMID:27512336
The psychosocial rehabilitation of older persons is one of the main problems in health policy. About one quarter of the over 65-year-olds face psychic problems, without, to a large extent, receiving adequate treatment and rehabilitative care. Substantial deficits exist above all in the out-patient and non-residential service sectors. In in-patient care, existing methods for psychosocial intervention (such as psychoanalysis, behavioural, client-centered, family, Gestalt, milieu, or music and dance therapy, psychodrama, reality orientation training, or resensitization techniques) are hardly ever used. This absence of applied geronto-psychology is attributable to the shortcomings of available assessment methods, multiple methodical problems of intervention research, and--above all--to insufficient staff positions for psychosocial professions in the gerontological sector. Provision of further permanent posts for psychosocial workers; development of age-specific assessment methods; interdisciplinary and systematic interventional research; the development of ambulatory, community-based services as well as intensive support for existing self-help efforts are therefore called for.
The evidence-based practice movement has become an important feature of health care systems and health care policy. Within this context, the APA 2005 Presidential Task Force on Evidence-Based Practice defines and discusses evidence-based practice in psychology (EBPP). In an integration of science and practice, the Task Force's report describes psychology's fundamental commitment to sophisticated EBPP and takes into account the full range of evidence psychologists and policymakers must consider. Research, clinical expertise, and patient characteristics are all supported as relevant to good outcomes. EBPP promotes effective psychological practice and enhances public health by applying empirically supported principles of psychological assessment, case formulation, therapeutic relationship, and intervention. The report provides a rationale for and expanded discussion of the EBPP policy statement that was developed by the Task Force and adopted as association policy by the APA Council of Representatives in August 2005.
Brownson, Ross C; Chriqui, Jamie F; Stamatakis, Katherine A
Public health policy has a profound impact on health status. Missing from the literature is a clear articulation of the definition of evidence-based policy and approaches to move the field forward. Policy-relevant evidence includes both quantitative (e.g., epidemiological) and qualitative information (e.g., narrative accounts). We describe 3 key domains of evidence-based policy: (1) process, to understand approaches to enhance the likelihood of policy adoption; (2) content, to identify specific policy elements that are likely to be effective; and (3) outcomes, to document the potential impact of policy. Actions to further evidence-based policy include preparing and communicating data more effectively, using existing analytic tools more effectively, conducting policy surveillance, and tracking outcomes with different types of evidence.
Tofighi, B; Campbell, A N C; Pavlicova, M; Hu, M C; Lee, J D; Nunes, E V
The acceptability and clinical impact of a web-based intervention among patients entering addiction treatment who lack recent internet access are unclear. This secondary analysis of a national multisite treatment study (NIDA Clinical Trials Network-0044) assessed for acceptability and clinical impact of a web-based psychosocial intervention among participants enrolling in community-based, outpatient addiction treatment programs. Participants were randomly assigned to 12 weeks of a web-based therapeutic education system (TES) based on the community reinforcement approach plus contingency management versus treatment as usual (TAU). Demographic and clinical characteristics, and treatment outcomes were compared among participants with recent internet access in the 90 days preceding enrollment (N = 374) and without internet access (N = 133). Primary outcome variables included (1) acceptability of TES (i.e., module completion; acceptability of web-based intervention) and (2) clinical impact (i.e., self-reported abstinence confirmed by urine drug/breath alcohol tests; retention measured as time to dropout). Internet use was common (74 %) and was more likely among younger (18-49 years old) participants and those who completed high school (p < .001). Participants randomized to TES (n = 255) without baseline internet access rated the acceptability of TES modules significantly higher than those with internet access (t = 2.49, df = 218, p = .01). There was a near significant interaction between treatment, baseline abstinence, and internet access on time to dropout (χ (2)(1) = 3.8089, p = .051). TES was associated with better retention among participants not abstinent at baseline who had internet access (X (2)(1) = 6.69, p = .01). These findings demonstrate high acceptability of this web-based intervention among participants that lacked recent internet access.
Labrèze, Laurent; Dixmérias-Iskandar, Florence; Monnin, Dominique; Bussières, Emmanuel; Delahaye, Evelyne; Bernard, Dominique; Lakdja, Fabrice
A multidisciplinary expert group had reviewed all scientific data available of post mastectomy pain syndrome. Seventy six publications were retained and thirty evidence based diagnosis, treatment and follow-up recommendations are listed. Few of theses recommendations are classed level A. Datas analysis make possible to propose a strategy based on systematic association of drugs, kinesitherapy and psychological support. Evaluation and closer follow-up are necessary. Several decisional trees are proposed.
FPG Child Development Institute, 2006
Evidence-based practice emerged as a result of the gap often seen between research and practice and gained momentum with the standards and accountability movement. Yet it originates in medicine. Healthcare professionals using evidence-based medicine determine a patient's treatment based on an assessment of evidence from the literature and current…
Burkey, Matthew D; Hosein, Megan; Purgato, Marianna; Morton, Isabella
Introduction Disruptive behaviour disorders (DBDs) are among the most common forms of child psychopathology and have serious long-term academic, social, and mental health consequences worldwide. Psychosocial treatments are the first line of evidence-based treatments for DBDs, yet their effectiveness often varies according to patient sociodemographic characteristics, practice setting, and implementation procedures. While a large majority of the world's children live in low- and middle-income countries (LMIC), most studies have evaluated psychosocial treatments for DBDs in high-income Anglo countries. Methods and analysis The primary objective of this systematic review is to assess the effects of psychosocial treatments for DBDs in children and adolescents (under age 18) diagnosed with oppositional defiant disorder, conduct disorder, or other disruptive behavioural problems living in LMIC. The secondary objectives are to: (1) describe the range and types of psychosocial treatments used to address DBDs in LMIC and (2) identify key dissemination and implementation factors (adaptation processes, training/supervision processes, and financial costs). All controlled trials comparing psychosocial treatments versus waiting list, no treatment, or treatment as usual in children living in LMIC will be included. Studies will be identified using the methods outlined in the Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) guidelines without restrictions on language, publication type, status, or date of publication. The primary outcome measures will be disruptive behavioural problems (eg, oppositionality, defiance, aggression or deceit). Secondary outcomes will be positive mental health outcomes (eg, prosocial behaviour), function impairment, institutionalisation (or hospitalisation), academic outcomes and caregiver outcomes. Ethics and dissemination This study uses data from published studies; therefore ethical review is not required. Findings will be
Theory-and evidence-based development and process evaluation of the Move More for Life program: a tailored-print intervention designed to promote physical activity among post-treatment breast cancer survivors
Objective Several physical activity interventions have been effective in improving the health outcomes of breast cancer survivors. However, few interventions have provided detailed descriptions regarding how such interventions work. To develop evidence-based practice in this field, detailed descriptions of intervention development and delivery is needed. This paper aims to (1) describe the theory-and evidence-based development of the Move More for Life program, a physical activity program for breast cancer survivors; and (2) serve as an exemplar for theory-based applied research. Method The program-planning model outlined by Kreuter and colleagues was used to develop the computer-tailored intervention. Results The tailoring guide developed by Kreuter and colleagues served as a useful program planning tool in terms of integrating theory and evidence-based best practice into intervention strategies. Overall, participants rated the intervention positively, with the majority reporting that the tailored materials caught their attention, were personally relevant to them, and were useful for helping them to change their behaviour. However, there was considerable room for improvement. Conclusion The Move More for Life program is an example of a theory-based, low-cost and potentially sustainable strategy to physical activity promotion and may stand as an exemplar for Social Cognitive Theory-based applied research. By providing a detailed description of the development of the Move More for Life program, a critical evaluation of the working mechanisms of the intervention is possible, and will guide researchers in the replication or adaption and re-application of the specified techniques. This has potential implications for researchers examining physical activity promotion among cancer survivors and for researchers exploring distance-based physical activity promotion techniques among other populations. Trial registrations Australian New Zealand Clinical Trials Registry (ANZCTR
Woolf, S H
Research advances are generating a growing body of clinical trial and other data on the effects of tests and treatments on outcomes, but there is no information resource within the health care system that systematically puts that information in perspective. Policy makers, clinicians, and individuals lack a ready means to compare the relative effectiveness of various interventions in prolonging survival or preventing the occurrence or complications of a disease: information that is critical in setting priorities. A crude analysis of preventable deaths suggests that evidence-based primary prevention (getting the population to stop smoking, exercise, lower cholesterol levels, and control blood pressure) would prevent considerably more deaths per year than would various evidence-based treatments for cardiovascular disease. Examining evidence from this perspective calls attention to mismatched priorities-most health care expenditures in the United States go toward treatment of diseases and their late-stage complications and relatively few resources are devoted to primary prevention and health promotion. Similar analyses at the individual level can help patients put personal options in perspective. This article proposes a bibliographic evidence-collection center and simulation modeling program to estimate potential benefits and harms of competing interventions for populations and individuals. Such evidence-based projections would enable policy makers, clinicians, and patients to judge whether they give due priority to the interventions most likely to improve health. With the steady growth in research data, the need for a system that enables society and individuals to put evidence in perspective will become progressively more urgent.
Dea, Nicolas; Fisher, Charles G
Treatment modalities for metastatic spine disease have significantly expanded over the last two decades. This expansion occurred in many different fields. Improvement in surgical techniques and instrumentation now allow the oncologic spine surgeons to effectively circumferentially decompress the neural elements without compromising stability. Percutaneous techniques, both vertebral augmentation and pre-operative endovascular embolization procedures, also greatly benefit patients suffering from spinal column metastasis. Imaging technology advances has contributed to better pre-operative planning and the development of highly conformational radiation techniques, thus permitting the delivery of high-dose radiation to tumors, while avoiding radiotoxicity to the spinal cord and other vital structures. These new developments, combined with evidence-based stability and disease-specific quality of life scores now allow not only better treatment, but also a solid foundation for high-quality research. Spine oncology literature currently suffers from a lack of high-quality evidence due to low prevalence of the disease and complex methodological issues. However, when following evidence-based medicine principles, which incorporate best available evidence, clinical expertise and patient preference, sound, evidence-based recommendations can be made regarding the abovementioned treatment modalities.
TEACHING Exceptional Children, 2014
Evidence-based practices (EBPs) are supported as generally effective for populations of learners by bodies of high-quality and experimental research and, when aligned with stakeholder values and practical needs, should be prioritized for implementation. However, evidence-based practices are not currently available for all learner types in all…
Parsonson, Barry S.
This paper reviews a range of evidence-based strategies for application by teachers to reduce disruptive and challenging behaviours in their classrooms. These include a number of antecedent strategies intended to help minimise the emergence of problematic behaviours and a range of those which provide positive consequences for appropriate student…
This essay connects a number of recent books relating, in different ways, to the contentious issue of how teaching might be better guided by research evidence. In order to shed light on this problematic area, Terry Wrigley begins by pointing out that raising awkward questions about terms such as "evidence- based teaching" is not the same…
Hoppe, Daniel J; Bhandari, Mohit
Evidence-based medicine was recently noted as one of the top 15 most important medical discoveries over the past 160 years. Since the term was coined in 1990, EBM has seen unparalleled adoption in medicine and surgery. We discuss the early origins of EBM and its dissemination in medicine, especially orthopaedic surgery. PMID:19826513
Regional Educational Laboratory Southeast, 2009
This Evidence Based Education (EBE) request focused on research-supported vocabulary interventions for middle elementary students. Limited vocabulary is an important factor in underachievement of children in disadvantaged homes. Children with larger vocabularies find reading easier, read more widely, and do better in school (Lubliner & Smetana,…
Childs, Gary M.
Locating sources that are rich in evidence-based practice information can be more difficult for physical as well as occupational therapists in practice settings in which there is not direct access to a health sciences library. In addition, once information has been found, there may not be an easy way to access the data. This commentary will…
Evidence-based practice (EBP) is applying research to assist in the selection of interventions that result in increased client quality care. Recently the Commission on Accreditation of Allied Health Education Programs (2010), a new accreditation body for recreational therapy education, included standards that state students should obtain knowledge…
Ingraham, Colette L.; Oka, Evelyn R.
School psychologists involved in the delivery of psychological and educational interventions face the challenge of identifying interventions that will work within their schools. The evidence-based intervention (EBI) approach has received attention as a promising way to identify effective interventions. The national Task Force on Evidence Based…
Doherty, Christy B; Rosen, Ted
Although healthcare providers have arrived at a relatively comfortable zone of accepted clinical practice in the management of cutaneous sarcoidosis, virtually every treatment is based on minimal evidence-based data and relies almost exclusively on anecdotal information. Although it would be convenient to blame this state of affairs on the lack of certainty about disease aetiology, the unavoidable fact is that little has been executed, even in the realm of well designed comparative trials. Nonetheless, worldwide accepted standard therapies for sarcoidosis include the administration of corticosteroids, antimalarials and methotrexate. A stepwise approach to patient care is appropriate, and potent topical corticosteroids (e.g. clobetasol) or repeated intralesional injections of triamcinolone (3-10 mg/mL) may be all that is needed in mild skin-limited disease. In patients requiring systemic therapy for recalcitrant or deforming skin lesions (or for widespread disease), corticosteroids (e.g. prednisone 40-80 mg/day, tapered accordingly) used alone or in combination with antimalarials or methotrexate may be indicated. Antimalarials and methotrexate are considered second-line interventions and may be used as monotherapy for steroid-resistant sarcoidosis or in patients unable to tolerate steroids. Given the concern regarding ocular toxicity, the maximum dosages of chloroquine and hydroxychloroquine should not exceed 3.5 and 6.5 mg/kg/day, respectively. Methotrexate is given in weekly doses of 10-30 mg, with the caveat that haematological, gastrointestinal, pulmonary and hepatic toxicities are possible. Despite universal acceptance as standard care, the aforementioned treatments often result in an incomplete clinical response or unacceptable adverse events. In such situations, more innovative treatment options may be used. Treatments that may well gain widespread future use include the tumour necrosis factor-alpha inhibitors infliximab and adalimumab. Experience is limited
van Vulpen, Jonna K; Peeters, Petra H M; Velthuis, Miranda J; van der Wall, Elsken; May, Anne M
Cancer-related fatigue has a multidimensional nature and complaints typically increase during adjuvant treatment for breast cancer. Physical exercise might prevent or reduce cancer-related fatigue. So far, no meta-analysis has investigated the effects of physical exercise on different dimensions of fatigue. The aim of the present meta-analysis was to investigate the effects of physical exercise during adjuvant breast cancer treatment on physical and psychosocial dimensions of fatigue. We performed a systematic literature search in PubMed, Embase and the Cochrane Library in June 2015. Randomised controlled trials reporting the effects of physical exercise during adjuvant breast cancer treatment on different dimensions of fatigue were included. Pooled effects of 6 exercise programmes (including 784 patients) showed significant beneficial exercise effects on general fatigue (ES: -0.22, 95% CI -0.38; -0.05) and physical fatigue (ES: -0.35, 95% CI -0.49; -0.21). Effects on fatigue subscales 'reduced activity' (ES: -0.22, 95% CI -0.38; -0.05) and 'reduced motivation' (ES: -0.18, 95% CI -0.35; -0.01) were also in favour of physical exercise. No effects were found on cognitive and affective fatigue. Including only the supervised exercise programmes (n=4 studies), slightly larger pooled effect estimates were found on general fatigue (ES: -0.25, 95% CI -0.47; -0.04) and physical fatigue (-0.39, 95% CI -0.56; -0.23). In conclusion, physical exercise during adjuvant breast cancer treatment has beneficial effects on general fatigue, physical fatigue, 'reduced activity' and 'reduced motivation', but did not show effects on cognitive and affective fatigue. Largest effect sizes are found for physical fatigue, suggesting that this is the fatigue dimension most sensitive to physical exercise.
Rapp, Amy M.; Bergman, R. Lindsay; Piacentini, John; McGuire, Joseph F.
Obsessive–compulsive disorder (OCD) is a neuropsychiatric illness that often develops in childhood, affects 1%–2% of the population, and causes significant impairment across the lifespan. The first step in identifying and treating OCD is a thorough evidence-based assessment. This paper reviews the administration pragmatics, psychometric properties, and limitations of commonly used assessment measures for adults and youths with OCD. This includes diagnostic interviews, clinician-administered symptom severity scales, self-report measures, and parent/child measures. Additionally, adjunctive measures that assess important related factors (ie, impairment, family accommodation, and insight) are also discussed. This paper concludes with recommendations for an evidence-based assessment based on individualized assessment goals that include generating an OCD diagnosis, determining symptom severity, and monitoring treatment progress. PMID:27594793
Bradley, Gunilla; And Others
Discusses the effect of computerization of the work environment on psychosocial communication. The RAM program, developed at Stockholm University to explore the effect of computers on the structure of organizations and the psychosocial work environment, is described; theoretical models are explained; and the future use of knowledge-based systems…
Havlickova, B; Weyandt, G H
Aim To conduct a systematic review of treatments for anal eczema (AE). Methods We conducted a Medline search for clinical trial data for the treatment of perianal diseases including AE, including papers not published in the English language. We assessed the study reports using the system recommended by the Oxford Centre for Evidence-based Medicine. No meta-analysis was attempted. Results The evidence base for topical treatments used to treat AE is very poor: there are very few studies and many of those that exist are of poor quality. The best evidence was found for medications that are yet to be licensed for AE. Among products with existing licences for the treatment of eczema, our assessment found some evidence to support the continued use of mild-to-moderate corticosteroids first line in most patients. Discussion Features of the perianal region, and the fact that it is almost always occluded, mean that not all medications recommended in the general treatment guidelines for eczema are appropriate for AE. However, there are no specific treatment guidelines for these patients. This may in part be because of the lack of high-quality evidence-based medicine in this therapy area. Many frequently prescribed medications were developed and licensed many years ago, in an era when clinical trial design was not expected to be as rigorous as it is today. Conclusion This review highlights the need to conduct more high-quality clinical trials in patients with AE in order that specific guidelines for the management of this difficult proctological condition can be prepared. PMID:24898365
A single 5-6 hours manualized abreactive ego state therapy session has recently been subjected to two placebo-controlled investigations meeting evidence-based criteria. Ego state therapy was found to be a highly effective and durable treatment for posttraumatic stress disorder. Apparently, ego state therapy works because it is emotion focused, activates sub-cortical structures, and because the supportive, interpretive therapist reconstructs the patient's personality to be resilient and adaptive. In this article the author reviews the treatment procedures and presents the findings of both studies.
Dhillon, A S; Dollieslager, L P
Psychiatric rehabilitation begins during the acute stages of a psychiatric disorder and continues throughout the person's lifetime, with the types of services flexibly keyed to the person's phase of illness, needs, and personal goals. During periods of relapse and exacerbation of symptoms, when hospitalization is often required, psychiatric rehabilitation should include the following five objectives: * Clarify how the person's own goals in life, such as a desire for more self-control, freedom of choice, privacy, and time with friends and family, can be served by inpatient treatment and symptom stabilization. * Educate the patient about the nature of his or her illness and how medications work to restore self-control. * Teach the patient about side effects and self-monitoring and negotiating about medication and its effects in a collaborative way with the psychiatrist and other members of the treatment team. * Connect with the family or other natural supports that the person has in the community. * Enable the patient to make appropriate aftercare plans for residential and continuing treatment needs after discharge. When rehabilitation is viewed from the vantage point of these objectives, the inextricable interweaving of "treatment" with "rehabilitation" becomes clear. Treatment and rehabilitation are two sides of the same. It is much easier to integrate psychiatric rehabilitation into more traditional methods of treatment than it is to reorganize a treatment program or facility so that it blends rehabilitation with prevailing treatment imperatives of pharmacotherapy, supervision, and security and safety. In previous Rehab Rounds columns, we have described examples of creative methods for bringing the principles and practices of psychiatric rehabilitation into the treatment milieu (1,2,3). Faced with regulatory criticism from governmental agencies, Dr. Dhillon and his colleagues at Eastern State Hospital in Williamsburg, Virginia, launched a vigorous initiative to
e-Health is experiencing a difficult time. On the one side, the forecast is for a bright digital health future created by precision medicine and smart devices. On the other hand, most large scale e-health projects struggle to make a difference and are often controversial. Both futures fail because they are not evidence-based. Medical informatics should follow the example of evidence-based medicine, i.e. conduct rigorous research that gives us evidence to solve real world problems, synthesise that evidence and then apply it strictly. We already have the tools for creating a different universe. What we need is evidence, will, a culture of learning, and hard work.
Millen, Katherine Rodewald; Kuo, Kelly; Zhao, Lulu; Gecsi, Kimberly
Evidence-based care of women in labor requires a thorough understanding of both "normal" and abnormal labor progress. In response to the growing cesarean delivery rate for dystocia at our institution, a multidisciplinary team of attending physicians, nurse-midwives, resident physicians, and nurses was established to review the literature and create evidence-based guidelines. This article describes the background literature and consensus guidelines reached for the diagnosis of active phase labor, active phase arrest, second-stage arrest, protraction of the active phase, and failed induction of labor. Our review illustrates that slower labor patterns than traditionally described often result in a vaginal delivery without unacceptable increases in maternal or neonatal morbidity.
Critical thinking (CT) is vital to evidence-based nursing practice. Evidence-based practice (EBP) supports nursing care and can contribute positively to patient outcomes across a variety of settings and geographic locations. The nature of EBP, its relevance to nursing, and the skills needed to support it should be required components of baccalaureate education and must be introduced early in students' development as independent, self-directed learners and as professional nurses. Among the knowledge, skills, and processes needed to support EBP, CT is paramount. The development of CT can prepare nurses with the necessary skills and dispositions (habits of mind, attitudes, and traits) to support EBP. The intents of this study were to explore the importance of CT as an essential skill to support EBP and to describe some of the strategies and processes considered key to the ongoing development of CT.
Griffin, Kenneth W.; Botvin, Gilbert J.
Synopsis Substantial progress has been made in developing prevention programs for adolescent drug abuse. The most effective interventions target salient risk and protective factors at the individual, family, and/or community levels and are guided by relevant psychosocial theories regarding the etiology of substance use and abuse. This article reviews the epidemiology, etiologic risk and protective factors, and evidence-based approaches that have been found to be most effective in preventing adolescent substance use and abuse. Exemplary school and family-based prevention programs for universal (everyone in population), selected (members of at-risk groups), and indicated (at-risk individuals) target populations are reviewed, along with model community-based prevention approaches. Challenges remain in widely disseminating evidence-based prevention programs into schools, families, and communities. PMID:20682218
Eldredge, Jonathan D.
Objective: To demonstrate how the core characteristics of both evidence-based medicine (EBM) and evidence-based health care (EBHC) can be adapted to health sciences librarianship. Method: Narrative review essay involving development of a conceptual framework. The author describes the central features of EBM and EBHC. Following each description of a central feature, the author then suggests ways that this feature applies to health sciences librarianship. Results: First, the decision-making processes of EBM and EBHC are compatible with health sciences librarianship. Second, the EBM and EBHC values of favoring rigorously produced scientific evidence in decision making are congruent with the core values of librarianship. Third, the hierarchical levels of evidence can be applied to librarianship with some modifications. Library researchers currently favor descriptive-survey and case-study methods over systematic reviews, randomized controlled trials, or other higher levels of evidence. The library literature nevertheless contains diverse examples of randomized controlled trials, controlled-comparison studies, and cohort studies conducted by health sciences librarians. Conclusions: Health sciences librarians are confronted with making many practical decisions. Evidence-based librarianship offers a decision-making framework, which integrates the best available research evidence. By employing this framework and the higher levels of research evidence it promotes, health sciences librarians can lay the foundation for more collaborative and scientific endeavors. PMID:11055296
Arlt, S P; Heuwieser, W
With new knowledge being generated and published daily, the importance of evidence-based approaches in veterinary medicine is obvious. Clinicians must stay current or risk making poor decisions that clients may challenge. Especially in animal reproduction, several new substances and procedures to diagnose or treat reproductive disorders have been introduced in the last years. On the other hand, a closer look at the quality of published literature on animal reproduction reveals major deficits in methodology and reporting of many clinical trials. We strongly recommend systematically assessing the quality of scientific information when reading journal papers before using the given information in practice. The aim of evidence-based medicine (EBM) is to base the decisions in the practice of medicine on valid, clinically relevant research data. Therefore, we suggest that students should become familiar with the concepts of evidence-based veterinary medicine (EBVM) at the beginning of their veterinary education. Concepts and supporting tools such as checklists for literature assessment have been developed and validated. The purpose of this article is to review and discuss the importance of incorporating EBVM in animal reproduction. The need for further research that produces strong evidence in different fields of animal reproduction and better reporting of relevant study information is obvious.
Khong, T Y
The generation of a pathology test result must be based on criteria that are proven to be acceptably reproducible and clinically relevant to be evidence-based. This review de-constructs the umbilical cord coiling index to illustrate how it can stray from being evidence-based. Publications related to umbilical cord coiling were retrieved and analysed with regard to how the umbilical coiling index was calculated, abnormal coiling was defined and reference ranges were constructed. Errors and other influences that can occur with the measurement of the length of the umbilical cord or of the number of coils can compromise the generation of the coiling index. Definitions of abnormal coiling are not consistent in the literature. Reference ranges defining hypocoiling or hypercoiling have not taken those potential errors or the possible effect of gestational age into account. Even the way numerical test results in anatomical pathology are generated, as illustrated by the umbilical coiling index, warrants a critical analysis into its evidence base to ensure that they are reproducible or free from errors.
Although applied behavior analysts often say they engage in evidence-based practice, they express differing views on what constitutes “evidence” and “practice.” This article describes a practice as a service offered by a provider to help solve a problem presented by a consumer. Solving most problems (e.g., increasing or decreasing a behavior and maintaining this change) requires multiple intervention procedures (i.e., a package). Single-subject studies are invaluable in investigating individual procedures, but researchers still need to integrate the procedures into a package. The package must be standardized enough for independent providers to replicate yet flexible enough to allow individualization; intervention manuals are the primary technology for achieving this balance. To test whether the package is effective in solving consumers' problems, researchers must evaluate outcomes of the package as a whole, usually in group studies such as randomized controlled trials. From this perspective, establishing an evidence-based practice involves more than analyzing the effects of discrete intervention procedures on behavior; it requires synthesizing information so as to offer thorough solutions to problems. Recognizing the need for synthesis offers behavior analysts many promising opportunities to build on their existing research to increase the quality and quantity of evidence-based practices. PMID:25729130
Background There is on-going controversy in relation to the efficacy of naltrexone used for the treatment of heroin addiction, and the important covariates of that success. We were also interested to review our experience with two depot forms of implantable naltrexone. Methods A retrospective review of patients' charts was undertaken, patients were recalled by telephone and by letter, and urine drug screen samples were collected. Opiate free success (OFS) was the parameter of interest. Three groups were defined. The first two were treated in the previous 12 months and comprised "implant" and "tablet" patients. A third group was "historical" comprising those treated orally in the preceding 12 months. Results There were 102, 113 and 161 patients in each group respectively. Groups were matched for age, sex, and dose of heroin used, but not financial status or social support. The overall follow-up rate was 82%. The Kaplan Meier 12 month OFS were 82%, 58% and 52% respectively. 12 post-treatment variables were independently associated with treatment retention. In a Cox proportional hazard multivariate model social support, the number of detoxification episodes, post-treatment employment, the use of multiple implant episodes and spiritual belief were significantly related to OFS. Conclusion Consistent with the voluminous international literature clinically useful retention rates can be achieved with naltrexone, which may be improved by implants and particularly serial implants, repeat detoxification, meticulous clinical follow-up, and social support. As depot formulations of naltrexone become increasingly available such results can guide their clinical deployment, improve treatment outcomes, and enlarge the policy options for an exciting non-addictive pharmacotherapy for opiate addiction. PMID:18036213
American Journal on Mental Retardation, 2000
Twelve tables provide a breakdown of answers to a survey responded to by 48 experts in the psychosocial treatment of psychiatric and behavioral problems in people with mental retardation. Questions address treatment of self-injurious or aggressive behavior, specific psychiatric disorders, specific target symptoms, use of applied behavior analysis…
Fonagy, Peter; Luyten, Patrick; Allison, Elizabeth
A new developmental model of borderline personality disorder (BPD) and its treatment is advanced based on evolutionary considerations concerning the role of attachment, mentalizing, and epistemic trust in the development of psychopathology. We propose that vulnerability to psychopathology in general is related to impairments in epistemic trust, leading to disruptions in the process of salutogenesis, the positive effects associated with the capacity to benefit from the social environment. BPD is perhaps the disorder par excellence that illustrates this view. We argue that this conceptualization makes sense of the presence of both marked rigidity and instability in BPD, and has far-reaching implications for intervention.
Levine, Robert; Fink, Max
There is an organized movement by governmental, academic and commercial interests to make evidence-based practice the standard of care in the United States. There is little proof that this model can be adapted to psychiatry. We examine the diagnostic system, the validity of the data from clinical trials and how these are applied to clinical practice. The discipline of psychiatry relies on imprecise and unstable diagnostic criteria. It divides psychiatric disorders into discrete categories based on discussion and consultations among designated experts in the field. The diagnostic system is based on consensus and not experimental evidence. In fact, psychiatric disorders are not discrete. High co-morbidities between disorders and the propensity of one condition to change into another makes the present diagnostic system extremely questionable. Outcomes of clinical trials are defined by fractional reductions in the number and severity of symptoms measured by rating scales and not remission of illness. The data obtained from clinical trials are flawed in design, execution and the selective reporting of outcomes. There is substantial evidence to indicate that both investigators and patients can distinguish between active treatment and placebo in double blind studies. In addition, negative outcomes are frequently not reported. Such evidence impacts not only on the specific study, used as evidence, but invalidates the value of meta analyses. Financial considerations lead to the inclusion of inappropriate subjects into studies and favor newer, patented treatments. When the conclusions derived from evidence-based psychiatry are applied to clinical practice they have little to offer and often produce poor treatment outcomes. In fact, when the data used to support the principles of evidence-based psychiatry are examined, they are unsound. The system itself is best considered an untested hypothesis. The diagnostic system, the manner in which data are gathered, and financial
Glober, Nancy K.; Sporer, Karl A.; Guluma, Kama Z.; Serra, John P.; Barger, Joe A.; Brown, John F.; Gilbert, Gregory H.; Koenig, Kristi L.; Rudnick, Eric M.; Salvucci, Angelo A.
Introduction In the United States, emergency medical services (EMS) protocols vary widely across jurisdictions. We sought to develop evidence-based recommendations for the prehospital evaluation and treatment of a patient with a suspected stroke and to compare these recommendations against the current protocols used by the 33 EMS agencies in the state of California. Methods We performed a literature review of the current evidence in the prehospital treatment of a patient with a suspected stroke and augmented this review with guidelines from various national and international societies to create our evidence-based recommendations. We then compared the stroke protocols of each of the 33 EMS agencies for consistency with these recommendations. The specific protocol components that we analyzed were the use of a stroke scale, blood glucose evaluation, use of supplemental oxygen, patient positioning, 12-lead electrocardiogram (ECG) and cardiac monitoring, fluid assessment and intravenous access, and stroke regionalization. Results Protocols across EMS agencies in California varied widely. Most used some sort of stroke scale with the majority using the Cincinnati Prehospital Stroke Scale (CPSS). All recommended the evaluation of blood glucose with the level for action ranging from 60 to 80mg/dL. Cardiac monitoring was recommended in 58% and 33% recommended an ECG. More than half required the direct transport to a primary stroke center and 88% recommended hospital notification. Conclusion Protocols for a patient with a suspected stroke vary widely across the state of California. The evidence-based recommendations that we present for the prehospital diagnosis and treatment of this condition may be useful for EMS medical directors tasked with creating and revising these protocols. PMID:26973735
Chatman, Michelle C; Green, Rodney D
African-American women face a disproportionally high breast cancer mortality rate and a significantly low five-year survival rate after breast cancer treatment. This study investigated, through a series of focus groups, how 32 African-American women (N = 32) breast cancer patients and survivors managed their cancer-related health needs. Participants also reported important barriers to care including problematic interactions with medical professionals, challenges in intimate relations, difficulties in handling the stigma and myths about breast cancer, and the psychological challenges that they faced. A patient navigation model was implemented at an eastern urban hospital that emphasized integrative therapies such as meditation, nutritional instruction, and yoga. Follow-up telephone interviews with 37 additional African-American participants (N = 37) indicated the rating of effectiveness to be at 3.8 to 3.9 out of 4 for the integrative patient navigation program. Over half of the survivors reported using some complementary techniques after treatment was completed, thus suggesting a long-term improvement in their quality of life as a result of the integrative techniques.
Zeeman, Laetitia; Aranda, Kay; Grant, Alec
This paper aims to queer evidence-based practice by troubling the concepts of evidence, knowledge and mental illness. The evidence-based narrative that emerged within biomedicine has dominated health care. The biomedical notion of 'evidence' has been critiqued extensively and is seen as exclusive and limiting, and even though the social constructionist paradigm attempts to challenge the authority of biomedicine to legitimate what constitutes acceptable evidence or knowledge for those experiencing mental illness, biomedical notions of evidence appear to remain relatively intact. Queer theory offers theoretical tools to disrupt biomedical norms and challenges biomedical normativity to indicate how marginalisation occurs when normative truths about mental health classify those who differ from the norm as 'ill' or 'disordered'. Queer theory's emphasis on normativity serves the political aim to subvert marginalisation and bring about radical social and material change. Reference will be made to mental health subjects within each discourse by indicating how the body acts as a vehicle for knowing. Deleuzian notions of the rhizome are used as metaphor to suggest a relational approach to knowledge that does away with either/or positions in either biomedical, or queer knowledge to arrive at a both/and position where the biomedical, constructionist and queer are interrelated and entangled in needing the other for their own evolution. However, queer does not ask for assimilation but celebrates difference by remaining outside to disrupt that which is easily overlooked, assumed to be natural or represented as the norm. The task of queer knowledge is to do justice to the lives lived in the name of evidence-based practice and demands that we consider the relations of power where knowledge is produced. This pursuit creates different knowledge spaces where we identify new intersections that allow for socially just understandings of knowing or evidence to emerge.
Sir Arthur Conan Doyle, the creator of the fictional detective Sherlock Holmes, studied medicine at the University of Edinburgh between 1876 and 1881 under Doctor Joseph Bell who emphasised in his teaching the importance of observation, deduction and evidence. Sherlock Holmes was modelled on Joseph Bell. The modern notions of Evidence Based Medicine (EBM) are not new. A very brief indication of some of the history of EBM is presented including a discussion of the important and usually overlooked contribution of statisticians to the Popperian philosophy of EBM.
Bosteels, J.; Weyers, S.; Siristatidis, C.; Bhattacharya, S.; D’Hooghe, T.
The Consolidated Standards of Reporting Trials (CONSORT) was introduced in 1996 to improve the methodological quality of published reports of randomised controlled trials. By doing a systematic review of randomised controlled trials on reproductive surgery, our group can demonstrate that the overall quality of the published reports of randomised studies on reproductive surgical interventions has improved after CONSORT. Nevertheless, some problems still remain. By discussing the benefits and pitfalls of randomised trials in reproductive surgery, our opinion paper aims to stimulate the reader’s further interest in evidence-based practice in reproductive surgery. PMID:24753872
Thomas, Laurie Endicott
Medical students in the United States are taught little about nutrition and dietetics. Worse yet, their training biases them against the studies that show the power of dietary approaches to managing disease. The current approach to evidence-based medicine encourages physicians to ignore any information that does not come from a double-blind, randomized controlled trial. Yet human beings cannot be blinded to a dietary intervention. As a result, physicians are biased toward drug treatments and against dietary interventions for the management of chronic disease.
Hempel, Eliana V; Bollard, Edward R
Anemia is a prevalent disease with multiple possible etiologies and resultant complications. Iron deficiency anemia is a common cause of anemia and is typically due to insufficient intake, poor absorption, or overt or occult blood loss. Distinguishing iron deficiency from other causes of anemia is integral to initiating the appropriate treatment. In addition, identifying the underlying cause of iron deficiency is also necessary to help guide management of these patients. We review the key components to an evidence-based, cost-conscious evaluation of suspected iron deficiency anemia.
Winter-Pfändler, Urs; Morgenthaler, Christoph
Owing to the declining length of patients' hospital stay in recent years, chaplains need evidence-based criteria to decide which patients are likely to have the greatest psychosocial and/or religious-spiritual needs. Therefore, the present pilot study aims at sorting out evidence-based criteria to assess patients with lack of coping resources. A total of 610 patients in the German-speaking part of Switzerland were surveyed with regard to their psychosocial health. The results suggest that lack of vitality (including health condition), lack of support and lack of faith (including spiritual struggle) are valid and reliable criteria for chaplains as internal triggers for pastoral visitation.
Bernstein, Joseph; Morshed, Saam; Helfet, David L.; Bhandari, Mohit; Ahn, Jaimo
Bone has the capacity to regenerate and not scar after injury – sometimes leaving behind no evidence at all of a prior fracture. As surgeons capable of facilitating such healing, it becomes our responsibility to help choose a treatment that minimizes functional deficits and residual symptoms. And in the case of the geriatric hip fracture, we have seen the accumulation of a vast amount of evidence to help guide us. The best method we currently have for selecting treatment plans is by the practice of evidence-based medicine. According to the now accepted hierarchy, the best is called Level I evidence (e.g., well performed randomized controlled trials) – but this evidence is best only if it is available and appropriate. Lower forms of accepted evidence include cohort studies, case control studies, case series, and case reports, and last, expert opinion – all of which can be potentially instructive. The hallmark of evidence-based treatment is not so much the reliance on evidence in general, but to use the best available evidence relative to the particular patient, the clinical setting and surgeon experience. Correctly applied, varying forms of evidence each have a role in aiding surgeons offer appropriate care for their patients – to help them best fix the fracture. PMID:25593964
Ritz, Thomas; Meuret, Alicia E.; Trueba, Ana F.; Fritzsche, Anja; von Leupoldt, Andreas
Objective: This review examines the evidence for psychosocial influences in asthma and behavioral medicine approaches to its treatment. Method: We conducted a systematic review of the literature on psychosocial influences and the evidence for behavioral interventions in asthma with a focus on research in the past 10 years and clinical trials.…
Fricchione, G L; Jaghab, K; Lawson, W; Hui, J C; Jandorf, L; Zheng, Z S; Cohn, P F; Soroff, H
Enhanced external counterpulsation (EECP) is a noninvasive pantaloon device designed to increase coronary artery flow in the treatment of angina. This pilot study, conducted in 1992-1993, which used psychosocial testing pre- and posttreatment, yielded data suggesting that EECP is well tolerated psychosocially and produces improvement in the anginal syndrome. More comprehensive research is under way to test these preliminary conclusions.
Medina, L Santiago; Blackmore, C Craig
Evidence-based radiology (EBR) is an important tool for the practice of radiology. The user of the EBR approach identifies evidence in a systematic fashion and then assimilates information through in-depth, explicit critical review of the best-designed and most recent literature on the subject in question. Clinical decision making is then based on the best current evidence, clinical expertise, and patient values. Substantial progress has been made in the review and dissemination of EBR. Dissemination of EBR within radiology has two critical aspects. The first is increased understanding of the methods required for EBR and of the appropriate use of EBR. The second important component is the dissemination of the data and critical literature reviews necessary to allow use of the EBR approach. Resources available for both EBR methods and EBR data in radiology include societies, journals, medical meetings, Web sites, and textbooks. Although radiology has made important progress in this field in recent years, the specialty is still behind other specialties that have been at the forefront of evidence-based medicine in the past decade.
Lemanek, Kathleen; Blount, Ronald L.; Dahlquist, Lynnda M.; Lim, Crystal S.; Palermo, Tonya M.; McKenna, Kristine D.; Weiss, Karen E.
Objective To conduct an evidence-based review of pediatric pain measures. Methods Seventeen measures were examined, spanning pain intensity self-report, questionnaires and diaries, and behavioral observations. Measures were classified as “Well-established,” “Approaching well-established,” or “Promising” according to established criteria. Information was highlighted to help professionals evaluate the instruments for particular purposes (e.g., research, clinical work). Results Eleven measures met criteria for “Well-established,” six “Approaching well-established,” and zero were classified as “Promising.” Conclusions There are a number of strong measures for assessing children's pain, which allows professionals options to meet their particular needs. Future directions in pain assessment are identified, such as highlighting culture and the impact of pain on functioning. This review examines the research and characteristics of some of the commonly used pain tools in hopes that the reader will be able to use this evidence-based approach and the information in future selection of assessment devices for pediatric pain. PMID:18024983
Tsafrir, J; Grinberg, M
The vast amount of published material in clinical and biomedical sciences, and conflicting results on diagnostic and therapeutic procedures may introduce doubts in decision-making for patient care. Information retrieving skills and the critical appraisal of published literature, together with elaboration of practice guidelines based on epidemiological methodology, form the basis of the trend towards evidence-based health care, which aims to overcome these problems. A survey conducted by questionnaire at the Chaim Sheba Medical Center analyzed which types of information sources are considered most relevant and useful for patient care by a cross-section of physicians with varying degrees of experience. They considered review articles and meta-analyses extremely reliable for information purposes, while for practical patient-care purposes they tended to rely more on the opinions of peers and experts. As the requirements of evidence-based health care may influence the attitudes of clinicians to the published literature and its evaluation, they have implications for medical libraries and information centers. Specifically, information specialists will be called upon more and more to impart information-retrieval and critical appraisal skills to clinicians. The involvement of information specialists in information gathering and selection will provide added value to the expertise and knowledge of in-house experts for decision-making. PMID:9549011
Goldenberg, Maya J
Background The increase in empirical methods of research in bioethics over the last two decades is typically perceived as a welcomed broadening of the discipline, with increased integration of social and life scientists into the field and ethics consultants into the clinical setting, however it also represents a loss of confidence in the typical normative and analytic methods of bioethics. Discussion The recent incipiency of "Evidence-Based Ethics" attests to this phenomenon and should be rejected as a solution to the current ambivalence toward the normative resolution of moral problems in a pluralistic society. While "evidence-based" is typically read in medicine and other life and social sciences as the empirically-adequate standard of reasonable practice and a means for increasing certainty, I propose that the evidence-based movement in fact gains consensus by displacing normative discourse with aggregate or statistically-derived empirical evidence as the "bottom line". Therefore, along with wavering on the fact/value distinction, evidence-based ethics threatens bioethics' normative mandate. The appeal of the evidence-based approach is that it offers a means of negotiating the demands of moral pluralism. Rather than appealing to explicit values that are likely not shared by all, "the evidence" is proposed to adjudicate between competing claims. Quantified measures are notably more "neutral" and democratic than liberal markers like "species normal functioning". Yet the positivist notion that claims stand or fall in light of the evidence is untenable; furthermore, the legacy of positivism entails the quieting of empirically non-verifiable (or at least non-falsifiable) considerations like moral claims and judgments. As a result, evidence-based ethics proposes to operate with the implicit normativity that accompanies the production and presentation of all biomedical and scientific facts unchecked. Summary The "empirical turn" in bioethics signals a need for
A retrospective study concerning the psychosocial impact of voice disorders: Voice Handicap Index change in patients with benign voice disorders after treatment (measured with the Dutch version of the VHI).
Bouwers, Frans; Dikkers, Frederik G
The goal of this study was to gain better understanding of psychosocial effects of benign voice problems as measured with the Dutch version of the Voice Handicap Index (VHI). The effect of voice problems on daily life differs from person to person. Over the last few decades there has been a growing understanding of the fact that the psychosocial effect of this medical problem needs to be acknowledged. The VHI is a known voice specific Quality-of-Life measuring instrument, which is often used for this purpose. In the University Medical Center Groningen, Groningen, the Netherlands, patients with voice problems are analyzed at a Voice Clinic by a multidisciplinary team of voice specialists. In this study, we have analyzed patients with benign voice problems before and after treatment in the period of April 2004 to October 2006. The study group consisted of 68 patients (39 female). For comparison reason, we included a control group (n=68), matched for age and gender. The mean VHI score of the patient group before treatment was 48.9 (SD=20.9). After treatment, there was a significant improvement to 28.3 (SD=20.5) (P<0.001). There was no significant difference between the VHI scores of men and women. As could be expected, voice disorders of different etiology showed different VHI scores. Before and after treatment, the patient group showed a statistically significantly higher VHI score (P<0.001) compared with the control group (mean VHI score of 3.62, SD=3.82). Patients with different voice problems seem to have different results with the VHI. Treatment leads to statistically significant improvement in VHI scores. The VHI has proven to be a good instrument to evaluate the psychosocial consequences of voice problems.
Chambers, Suzanne K.; Grassi, Luigi; Hyde, Melissa K.; Holland, Jimmie; Dunn, Jeff
Approximately 256,000 cases of malignant brain and nervous system cancer were diagnosed worldwide during 2012 and 189,000 deaths, with this burden falling more heavily in the developed world. Problematically, research describing the psychosocial needs of people with brain tumors and their carers and the development and evaluation of intervention models has lagged behind that of more common cancers. This may relate, at least in part, to poor survival outcomes and high morbidity associated with this illness, and stigma about this disease. The evidence base for the benefits of psychosocial care in oncology has supported the production of clinical practice guidelines across the globe over the past decade, with a recent mandate to integrate the psychosocial domain and measurement of distress into routine care. Clinical care guidelines for people with brain tumors have emerged, with a building focus on psychosocial and survivorship care. However, researchers will need to work intensively with health care providers to ensure future practice is evidence-based and able to be implemented across both acute and community settings and likely within existing resources. PMID:25756038
Clarke, Amy L.; Yates, Thomas; Smith, Alice C.; Chilcot, Joseph
Patients with chronic kidney disease (CKD) form organized beliefs regarding their illness and treatment. These perceptions influence the coping strategies employed by an individual to manage his/her illness and may act as a predictor for his/her willingness to engage in self-management behaviours. While illness perceptions have been identified as predictors of non-adherence, depression and mortality in dialysis patients, there is a paucity of research in CKD patients not requiring renal replacement therapy. This narrative review synthesizes the existing literature regarding the role of illness perceptions and associated clinical and psychosocial outcomes in non-dialysis CKD patients. Studies were identified following database searches of AMED, BNI, CINAHL, EMBASE, Health Business Elite, HMIC, Medline, PsycINFO and Google Scholar in January 2016. Despite the small evidence base, existing studies indicate that negative illness perceptions are associated with disease progression and a number of psychosocial outcomes in non-dialysis CKD patients. Evidence from other clinical populations suggests that illness perceptions are modifiable through psychological intervention, which may be most effective if delivered early before beliefs have the chance to become more established. Therefore, targeting illness perceptions in the earlier stages of CKD may be optimal. Further studies are now required to ascertain the mechanisms through which illness perceptions predict psychosocial and clinical outcomes in CKD patients and to ultimately test the efficacy of illness perception–based interventions. PMID:27274839
Clarke, Amy L; Yates, Thomas; Smith, Alice C; Chilcot, Joseph
Patients with chronic kidney disease (CKD) form organized beliefs regarding their illness and treatment. These perceptions influence the coping strategies employed by an individual to manage his/her illness and may act as a predictor for his/her willingness to engage in self-management behaviours. While illness perceptions have been identified as predictors of non-adherence, depression and mortality in dialysis patients, there is a paucity of research in CKD patients not requiring renal replacement therapy. This narrative review synthesizes the existing literature regarding the role of illness perceptions and associated clinical and psychosocial outcomes in non-dialysis CKD patients. Studies were identified following database searches of AMED, BNI, CINAHL, EMBASE, Health Business Elite, HMIC, Medline, PsycINFO and Google Scholar in January 2016. Despite the small evidence base, existing studies indicate that negative illness perceptions are associated with disease progression and a number of psychosocial outcomes in non-dialysis CKD patients. Evidence from other clinical populations suggests that illness perceptions are modifiable through psychological intervention, which may be most effective if delivered early before beliefs have the chance to become more established. Therefore, targeting illness perceptions in the earlier stages of CKD may be optimal. Further studies are now required to ascertain the mechanisms through which illness perceptions predict psychosocial and clinical outcomes in CKD patients and to ultimately test the efficacy of illness perception-based interventions.
Besag, Frank; Ettinger, Alan B.; Mula, Marco; Gobbi, Gabriella; Comai, Stefano; Aldenkamp, Albert P.; Steinhoff, Bernhard J.
Antiepileptic drugs (AEDs) have many benefits but also many side effects, including aggression, agitation, and irritability, in some patients with epilepsy. This article offers a comprehensive summary of current understanding of aggressive behaviors in patients with epilepsy, including an evidence-based review of aggression during AED treatment. Aggression is seen in a minority of people with epilepsy. It is rarely seizure related but is interictal, sometimes occurring as part of complex psychiatric and behavioral comorbidities, and it is sometimes associated with AED treatment. We review the common neurotransmitter systems and brain regions implicated in both epilepsy and aggression, including the GABA, glutamate, serotonin, dopamine, and noradrenaline systems and the hippocampus, amygdala, prefrontal cortex, anterior cingulate cortex, and temporal lobes. Few controlled clinical studies have used behavioral measures to specifically examine aggression with AEDs, and most evidence comes from adverse event reporting from clinical and observational studies. A systematic approach was used to identify relevant publications, and we present a comprehensive, evidence-based summary of available data surrounding aggression-related behaviors with each of the currently available AEDs in both adults and in children/adolescents with epilepsy. A psychiatric history and history of a propensity toward aggression/anger should routinely be sought from patients, family members, and carers; its presence does not preclude the use of any specific AEDs, but those most likely to be implicated in these behaviors should be used with caution in such cases. PMID:27255267
Quinn, Ashley; Shera, Wes
As a result of the Youth Criminal Justice Act's increased focus on restorative justice, treatment, rehabilitation, and reintegration of youth, many more juvenile offenders require mental health services while resident in youth detention facilities [Youth Criminal Justice Act (2002, c.1). Ottawa: Department of Justice Canada. Retrieved September 19, 2008 from http://laws.justice.gc.ca/en/Y-1.5]. Several common characteristics such as violence, aggression, and other antisocial behaviors, associated with criminal behavior, have been identified among male and female offenders. Dialectical behavior therapy, originally developed by Linehan [Linehan, M. M., 1993a. Cognitive-behavioural treatment of borderline personality disorder. New York: Guildford Press] for chronically parasuicidal women diagnosed with borderline personality disorder, has been successfully modified for use with other populations, including violent and impulse-oriented male and female adolescents residing in correctional facilities. The intent of this article is to encourage the wider use of dialectical behavior therapy (DBT) with young offenders. It includes an extensive review of the evidence-base to date and describes some of the creative modifications that have been made to standard DBT program format to meet the particular needs of various groups in both Canada and the United States. In keeping with the movement toward more evidence-based practice, the authors argue that DBT is a promising approach in group work with incarcerated adolescents and should be more widely used.
Khan, Khalid S
Modern evidence-based medicine (EBM) and its predecessor 'Medecin d'Observation' both emphasise that potential advances in healthcare must be researched and proven to do more good than harm using the principles of clinical epidemiology before they are incorporated into medical practice. EBM is considered an important advance in improving clinical care in gynaecology but EBM skills have traditionally not been covered in undergraduate or postgraduate education. Therefore there is a perceived need to compile texts on various aspects of gynaecological practice using EBM principles. This is what these two issues of the Best Practice series hope to achieve. The various chapters will provide readers with clinical advice generated from critically appraised information that has been identified as addressing relevant questions.
Jeve, Yadava B.; Davies, William
Recurrent miscarriages are postimplantation failures in natural conception; they are also termed as habitual abortions or recurrent pregnancy losses. Recurrent pregnancy loss is disheartening to the couple and to the treating clinician. There has been a wide range of research from aetiology to management of recurrent pregnancy loss. It is one of the most debated topic among clinicians and academics. The ideal management is unanswered. This review is aimed to produce an evidence-based guidance on clinical management of recurrent miscarriage. The review is structured to be clinically relevant. We have searched electronic databases (PubMed and Embase) using different key words. We have combined the searches and arranged them with the hierarchy of evidences. We have critically appraised the evidence to produce a concise answer for clinical practice. We have graded the evidence from level I to V on which these recommendations are based. PMID:25395740
Racine, Eric; Bell, Emily; Di Pietro, Nina C; Wade, Lucie; Illes, Judy
Many neurodevelopmental disorders affect early brain development in ways that are still poorly understood; yet, these disorders can place an enormous toll on patients, families, and society as a whole and affect all aspects of daily living for patients and their families. We describe a pragmatic, evidence-based framework for engaging in empiric ethics inquiry for a large consortium of researchers in neurodevelopmental disorders and provide relevant case studies of pragmatic neuroethics. The 3 neurodevelopmental disorders that are at the focus of our research, cerebral palsy (CP), autism spectrum disorder (ASD), and fetal alcohol spectrum disorder (FASD), bring unique and intersecting challenges of translating ethically research into clinical care for children and neonates. We identify and discuss challenges related to health care delivery in CP; neonatal neurological decision making; alternative therapies; and identity, integrity, and personhood.
Kaderavek, Joan N.; Justice, Laura M.
Purpose: To provide a primer regarding treatment fidelity as it affects evidence-based practice (EBP) for speech-language pathologists. Method: This tutorial defines treatment fidelity, examines the role of treatment fidelity for speech-language pathologists, provides examples of fidelity measurement, and describes approaches for assessing…
Vardell, Emily; Malloy, Michele
The Joanna Briggs Institute Evidence-Based Practice Database offers systematic reviews, practice recommendations, and consumer information designed to support evidence-based practice. A sample search was conducted within the Ovid platform to demonstrate functionality and available tools.
Regehr, Cheryl; Stern, Susan; Shlonsky, Aron
Although evidence-based practice (EBP) has received increasing attention in social work in the past few years, there has been limited success in moving from academic discussion to engaging social workers in the process of implementing EBP in practice. This article describes the challenges, successes, and future aims in the process of developing a…
Knowledge and use of evidence-based practice are essential to ensure best practices and safe patient outcomes. Staff development specialists must be leaders in this initiative to support clinical nurses toward improved practice outcomes. This article describes the background for understanding the historical evolution from research utilization to evidence-based practice, defines some key concepts related to evidence-based practice, and suggests essential components for building evidence-based practice programs in healthcare institutions.
Objective: The development of evidence-based health policy is challenging. This study has attempted to identify some of the underpinning factors that promote the development of evidence based health policy. Methods: A preliminary systematic literature review of published reviews with "evidence based health policy" in their title was conducted…
Objective: Evidence-based medicine has an important place in the teaching and practice of psychiatry. Attempts to teach evidence-based medicine skills can be weakened by conceptual confusions feeding a false polarization between traditional clinical skills and evidence-based medicine. Methods: The author develops a broader conception of clinical…
JCTIC has used open source software to develop a unique school online environment that has made evidence based practice viable in their school. In this paper the proposition is made that eLearning enables evidence based practice which in turn leads to improved student outcomes. Much has been written about evidence based practice in schools, but…
Stretch, R H
A survey study was conducted on the psychosocial readjustment of 164 of the estimated 10,000-40,000 Canadians who served in Vietnam with the U.S. military. Results indicate significantly greater rates of posttraumatic stress disorder (PTSD) compared with U.S. Vietnam veterans. Evidence of other psychosocial adjustment problems such as depression, inability to handle frustration and anger, difficulty in getting along with and trusting others, and family and marital problems, as well as poor physical health, was also found. Results suggest these problems are due, in part, to prolonged isolation from other Vietnam veterans, lack of recognition, and no readily available treatment for PTSD in Canada.
Chung, Kevin C.; Swanson, Jennifer A.; Schmitz, DeLaine; Sullivan, Daniel; Rohrich, Rod J.
An effective healthcare system is one in which healthcare spending provides acceptable returns in terms of health outcomes and broad coverage for its citizens. By this measure, the United States healthcare system unfortunately falls short. Tremendous pressure for improvement has given rise to several initiatives designed to decrease healthcare expenditure and improve outcomes, access, and quality of care. The outcomes movement, which is revolutionary in American medicine, has heightened awareness about the need to critically examine our treatment outcomes. However, the early euphoria surrounding the outcomes movement was met with restraint at the realization of its limitations. Although the outcomes movement has verified the effectiveness of many existing treatments in plastic surgery, most of the investments in these projects unfortunately have resulted in few, if any, positive changes for the patient, physician or healthcare system (1). US healthcare is now moving towards the adoption of evidence-based medicine (EBM), which may potentially be another revolution in American healthcare (2). PMID:19337107
Stahmer, Aubyn C; Reed, Sarah; Lee, Ember; Reisinger, Erica M; Connell, James E; Mandell, David S
The purpose of this study was to examine the extent to which public school teachers implemented evidence-based interventions for students with autism in the way these practices were designed. Evidence-based practices for students with autism are rarely incorporated into community settings, and little is known about the quality of implementation. An indicator of intervention quality is procedural implementation fidelity (the degree to which a treatment is implemented as prescribed). Procedural fidelity likely affects student outcomes. This project examined procedural implementation fidelity of three evidence-based practices used in a randomized trial of a comprehensive program for students with autism in partnership with a large, urban school district. Results indicate that teachers in public school special education classrooms can learn to implement evidence-based strategies; however they require extensive training, coaching, and time to reach and maintain moderate procedural implementation fidelity. Procedural fidelity over time, and across intervention strategies is examined.
Stahmer, Aubyn C.; Reed, Sarah; Lee, Ember; Reisinger, Erica M.; Connell, James E.; Mandell, David S.
The purpose of this study was to examine the extent to which public school teachers implemented evidence-based interventions for students with autism in the way these practices were designed. Evidence-based practices for students with autism are rarely incorporated into community settings, and little is known about the quality of implementation. An indicator of intervention quality is procedural implementation fidelity (the degree to which a treatment is implemented as prescribed). Procedural fidelity likely affects student outcomes. This project examined procedural implementation fidelity of three evidence-based practices used in a randomized trial of a comprehensive program for students with autism in partnership with a large, urban school district. Results indicate that teachers in public school special education classrooms can learn to implement evidence-based strategies; however they require extensive training, coaching, and time to reach and maintain moderate procedural implementation fidelity. Procedural fidelity over time, and across intervention strategies is examined. PMID:25593374
Roberts, Rosemarie; Jones, Helen; Marsenich, Lynne; Sosna, Todd; Price, Joseph M.
The current paper describes three models of research-practice collaboration to scale-up evidence-based practices (EBP): (1) the Rolling Cohort model in England, (2) the Cascading Dissemination model in San Diego County, and (3) the Community Development Team model in 53 California and Ohio counties. Multidimensional Treatment Foster Care (MTFC) and KEEP are the focal evidence-based practices that are designed to improve outcomes for children and families in the child welfare, juvenile justice, and mental health systems. The three scale-up models each originated from collaboration between community partners and researchers with the shared goal of wide-spread implementation and sustainability of MTFC/KEEP. The three models were implemented in a variety of contexts; Rolling Cohort was implemented nationally, Cascading Dissemination was implemented within one county, and Community Development Team was targeted at the state level. The current paper presents an overview of the development of each model, the policy frameworks in which they are embedded, system challenges encountered during scale-up, and lessons learned. Common elements of successful scale-up efforts, barriers to success, factors relating to enduring practice relationships, and future research directions are discussed. PMID:21484449
Winters, Charlene A; Echeverri, Rebecca
Evidence-based practice is an expected core competency of all health care clinicians regardless of discipline. Use of evidence-based practice means integrating the best research with clinical expertise and patient values to achieve optimal health outcomes. Evidence-based practice requires nurses to access and appraise evidence rapidly before integrating it into clinical practice. Role modeling and integrating the skills necessary to develop evidence-based practice into clinical and nonclinical courses is an important part in developing positive attitudes toward evidence-based practice, an essential first step to using evidence to guide practice decisions. The step-by-step approach to evidence-based practice proposed by Melnyk and colleagues provides an excellent organizing framework for teaching strategies specifically designed to facilitate nurses' knowledge and skill development in evidence-based practice.
Schulman, Sam; Witt, Daniel M.; Vandvik, Per Olav; Fish, Jason; Kovacs, Michael J.; Svensson, Peter J.; Veenstra, David L.; Crowther, Mark; Guyatt, Gordon H.
Background: High-quality anticoagulation management is required to keep these narrow therapeutic index medications as effective and safe as possible. This article focuses on the common important management questions for which, at a minimum, low-quality published evidence is available to guide best practices. Methods: The methods of this guideline follow those described in Methodology for the Development of Antithrombotic Therapy and Prevention of Thrombosis Guidelines: Antithrombotic Therapy and Prevention of Thrombosis, 9th ed: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines in this supplement. Results: Most practical clinical questions regarding the management of anticoagulation, both oral and parenteral, have not been adequately addressed by randomized trials. We found sufficient evidence for summaries of recommendations for 23 questions, of which only two are strong rather than weak recommendations. Strong recommendations include targeting an international normalized ratio of 2.0 to 3.0 for patients on vitamin K antagonist therapy (Grade 1B) and not routinely using pharmacogenetic testing for guiding doses of vitamin K antagonist (Grade 1B). Weak recommendations deal with such issues as loading doses, initiation overlap, monitoring frequency, vitamin K supplementation, patient self-management, weight and renal function adjustment of doses, dosing decision support, drug interactions to avoid, and prevention and management of bleeding complications. We also address anticoagulation management services and intensive patient education. Conclusions: We offer guidance for many common anticoagulation-related management problems. Most anticoagulation management questions have not been adequately studied. PMID:22315259
With an estimated prevalence of 12% for preschool children and 3% for adults, atopic eczema is a serious public health problem. This disease severely jeopardizes quality of life and is associated with considerable costs. Since there is still no causal therapy, primary and secondary prevention are especially important. Here the evidence basis for recommendations on prevention of atopic eczema is discussed on the basis of the first evidence-based consensus guideline (S3) on allergy prevention. This recommends that babies should be breastfed exclusively for at least 4 months and exposure to passive smoking be avoided even during pregnancy; restriction of the maternal diet during pregnancy has no influence, though during breastfeeding it can lower the incidence of eczema among babies at risk. Thereby this measure should be balanced with potential consequences of malnutrition. There seems to be a positive correlation between keeping small rodents (rabbits, guinea pigs), and possibly cats, and the occurrence of atopic eczema, while keeping dogs has no effect or even a protective effect. Avoidance of an unfavorable indoor climate is probably also helpful in preventing eczema. There is no evidence to support deviating from the current recommendations of the standing committee for vaccination.
Milford, Jaime L.; Austin, Julia L.; Smith, Jane Ellen
The Community Reinforcement Approach (CRA) and Community Reinforcement and Family Training (CRAFT) are both highly effective and empirically validated psychosocial approaches to the treatment of addictions whose unique designs may help achieve certain public health objectives. Literature will be reviewed to examine the potential impact of CRA and…
Wright, Benjamin J.; Zhang, Sheldon X.; Farabee, David
In the past decade, the push for evidence-based programs has taken on unprecedented prominence in the fields of substance abuse and correctional treatment as a key determinant for intervention funding. The National Registry of Evidence-based Programs and Practices (NREPP), managed and funded by the Substance Abuse and Mental Health Services…
For a long time in France, readaptation and reinsertion have been considered separately. While readaptation focuses on the way the patient "adapts again", reintegration looks at the place of the readaptation, the society or the group. Today, psychosocial rehabilitation encompasses both of these notions by taking into account the medical and social aspects.
Bernal, Guillermo; Saez-Santiago, Emily
Over the last few decades, psychologists and other health professionals have called attention to the importance of considering cultural and ethnic-minority aspects in any psychosocial interventions. Although, at present, there are published guidelines on the practice of culturally competent psychology, there is still a lack of practical…
Chiappelli, Francesco; Prolo, Paolo; Rosenblum, Monica; Edgerton, Myeshia; Cajulis, Olivia S.
It is a common practice in contemporary medicine to follow stringently the scientific method in the process of validating efficacy and effectiveness of new or improved modes of treatment intervention. It follows that these complementary or alternative interventions must be validated by stringent research before they can be reliably integrated into Western medicine. The next decades will witness an increasing number of evidence-based research directed at establishing the best available evidence in complementary and alternative medicine (CAM). This second paper in this lecture series examines the process of evidence-based research (EBR) in the context of CAM. We outline the fundamental principles, process and relevance of EBR, and its implication to CAM. We underscore areas of future development in EBR. We note that the main problem of applying EBR to CAM at present has to do with the fact that the contribution of EBR can be significant only to the extent to which studies used in the process of EBR are of good quality. All too often CAM research is not of sufficient quality to warrant the generation of a consensus statement. EBR, nevertheless, can contribute to CAM by identifying current weaknesses of CAM research. We present a revised instrument to assess quality of the literature. PMID:16550218
Grassi, Luigi; Caruso, Rosangela; Sabato, Silvana; Massarenti, Sara; Nanni, Maria G; The UniFe Psychiatry Working Group Coauthors
Psychiatric and psychosocial disorders among cancer patients have been reported as a major consequence of the disease and treatment. The problems in applying a pure psychiatric approach have determined the need for structuring more defined methods, including screening for distress and emotional symptoms and a more specific psychosocial assessment, to warrant proper care to cancer patients with psychosocial problems. This review examines some of the most significant issues related to these two steps, screening and assessment of psychosocial morbidity in cancer and palliative care. With regard to this, the many different variables, such as the factors affecting individual vulnerability (e.g., life events, chronic stress and allostatic load, well-being, and health attitudes) and the psychosocial correlates of medical disease (e.g., psychiatric disturbances, psychological symptoms, illness behavior, and quality of life) which are possibly implicated not only in "classical" psychiatric disorders but more broadly in psychosocial suffering. Multidimensional tools [e.g., and specific psychosocially oriented interview (e.g., the Diagnostic Criteria for Psychosomatic Research)] represent a way to screen for and assess emotional distress, anxiety and depression, maladaptive coping, dysfunctional attachment, as well as other significant psychosocial dimensions secondary to cancer, such as demoralization and health anxiety. Cross-cultural issues, such as language, ethnicity, race, and religion, are also discussed as possible factors influencing the patients and families perception of illness, coping mechanisms, psychological response to a cancer diagnosis.
Dickinson, H D
A practical theory of argumentation is outlined and applied to a hypothetical clinical scenario to elucidate the use of research evidence in individual treatment decisions. The primary role of research evidence is to establish warrants as opposed to warrant using. Warrants are defined as the rules, principles or interpretive rationales used to justify an inference from observed data to conclusion, or clinical claim. Clarity on the appropriate use of research evidence in clinical decision-making can help resolve current debates over the nature and consequences of evidence-based medicine. The theory of argumentation has potential to inform both the design of decision support tools and to provide criteria for assessing decisional performance.
Yeun, Young Ran
Objectives This study was conducted to perform an effect size analysis of psychosocial interventions for internet addiction and to identify the intervention moderators applied to school-aged children. Methods For the meta-analysis, studies were included that were published in English or Korean until January 2015, without limitation in terms of the year. They were retrieved from 11 electronic databases and by manual searches according to predefined inclusion criteria. Results A total of 37 studies were selected, which included 11 treatment conditions and covered a total of 1,490 participants. The effect size estimates showed that psychosocial interventions had a large effect for reducing internet addiction (standardized mean difference [SMD], –1.19; 95% confidence interval [CI], –1.52 to –0.87) and improving self-control (SMD, 0.29; 95% CI, 0.11 to 0.47) and self-esteem (mean difference, 3.58; 95% CI, 2.03 to 5.12). The moderator analyses reveals that group treatments, a selective approach, a long duration, a community setting, or higher school grade had a larger effect. Conclusions The findings of this review suggest that psychosocial intervention may be used to prevent Internet addiction in school-aged children, although further research should be conducted using a randomized controlled trial design or diverse age groups to provide evidence-based recommendations. PMID:27525163
The treatment of restless legs syndrome and periodic limb movement disorder in adults--an update for 2012: practice parameters with an evidence-based systematic review and meta-analyses: an American Academy of Sleep Medicine Clinical Practice Guideline.
Aurora, R Nisha; Kristo, David A; Bista, Sabin R; Rowley, James A; Zak, Rochelle S; Casey, Kenneth R; Lamm, Carin I; Tracy, Sharon L; Rosenberg, Richard S
A systematic literature review and meta-analyses (where appropriate) were performed to update the previous AASM practice parameters on the treatments, both dopaminergic and other, of RLS and PLMD. A considerable amount of literature has been published since these previous reviews were performed, necessitating an update of the corresponding practice parameters. Therapies with a STANDARD level of recommendation include pramipexole and ropinirole. Therapies with a GUIDELINE level of recommendation include levodopa with dopa decarboxylase inhibitor, opioids, gabapentin enacarbil, and cabergoline (which has additional caveats for use). Therapies with an OPTION level of recommendation include carbamazepine, gabapentin, pregabalin, clonidine, and for patients with low ferritin levels, iron supplementation. The committee recommends a STANDARD AGAINST the use of pergolide because of the risks of heart valve damage. Therapies for RLS secondary to ESRD, neuropathy, and superficial venous insufficiency are discussed. Lastly, therapies for PLMD are reviewed. However, it should be mentioned that because PLMD therapy typically mimics RLS therapy, the primary focus of this review is therapy for idiopathic RLS.
Martínez, Rocío; Martínez-Lara, Ildefonso
Background Orthognathic surgery is a branch of maxillofacial surgery. It carries out the treatment of the facial skeleton asymmetries and deformities. The patients who ask for this surgery are often young people who usually refer symptoms related to dental malocclusion, difficulty eating and temporo-mandibular pain. These physical symptoms are often accompanied by psychological symptoms triggered by their physical appearance such as low self-esteem, self-confidence and negativism about their social and emotional future. Material and Methods Patients with skeletal malformation of facial bones, consisting in Class II, III, open bite and asymmetries, underwent to orthognathic surgery in our center agreed to participate voluntarily in this study. They answered a questionnaire regarding several psychosocial variables. Results Orthognathic surgery helps to improve patient’s psychosocial well-being. Conclusions Patients with dentofacial deformitiesexperience physical and psychological, oftentimes underestimated by society. A combination of orthodontic treatment and reconstructive surgery is often a necessity to restore function and psychosocial well-being. Key words:Orthogathic surgery, psychosocial consequences, mood, emotions, sense of power, motivation, satisfaction, social changes, satisfaction. PMID:27957267
Deighton, Jessica; Argent, Rachel; De Francesco, Davide; Edbrooke-Childs, Julian; Jacob, Jenna; Fleming, Isobel; Ford, Tamsin; Wolpert, Miranda
The effectiveness of evidence-based practice in the treatment of children with conduct disorder (n = 186) or emotional disorders (n = 490) in routine care was examined using naturalistic, previously collected data from 30 child and adolescent mental health services. Repeated measures analysis of covariance was used to compare the outcomes of children who received parent training for conduct disorder and cognitive behavioural therapy for emotional disorders (evidence-based practice) with children who did not receive these treatments (non-evidence-based practice). There was a relatively low occurrence of evidence-based practice, particularly for children with conduct disorder. Both the evidence-based practice and non-evidence-based practice groups improve over time, with moderate effect sizes, and there were greater improvements associated with evidence-based practice for children with emotional disorders, based on child self-reported symptoms but not on parent report. In the present sample, significant differences were not found for conduct disorder. Findings provide tentative support for evidence-based practice for the treatment of emotional disorders in routine care settings.
Topinková, Eva; Baeyens, Jean Pierre; Michel, Jean-Pierre; Lang, Pierre-Olivier
heterogeneity do not allow for comprehensive meta-analyses to determine the clinical value of individual approaches. In relation to drug adherence, a recent meta-analysis of 33 randomized clinical trials in older patients found behavioural interventions had significant effects, and these interventions were more effective than educational interventions. For patients with multiple conditions and polypharmacy, successful interventions included structured medication review, medication regimen simplification, administration aids and medication reminders, but no firm conclusion in favour of any particular intervention could be made. Interventions to optimize geriatric pharmacotherapy focused most commonly on pharmacological outcomes (drug appropriateness, adverse drug events, adherence), providing only limited information about clinical outcomes in terms of health status, morbidity, functionality and overall healthcare costs. Little attention was given to psychosocial and behavioural aspects of pharmacotherapy. There is sufficient potential for improvements in geriatric pharmacotherapy in terms of drug safety and effectiveness. However, just as we require evidence-based, age-specific, pharmacological information for efficient clinical decision making, we need solid evidence for strategies that consistently improve the quality of pharmacological treatments at the health system level to shape 'age-attuned' health and drug policy.
Residential Treatment for Children & Youth, 2009
This is the fifth in a series of papers being issued by the American Association of Children's Residential Centers (AACRC) regarding key program and policy issues facing the field of residential treatment. AACRC is the longest standing national association focused exclusively on the needs of children who require residential treatment and their…
PROSPECTS FOR EVIDENCE-BASED SOFTWARE ASSURANCE: MODELS AND ANALYSIS CARNEGIE MELLON UNIVERSITY SEPTEMBER 2015 FINAL TECHNICAL REPORT APPROVED...TITLE AND SUBTITLE PROSPECTS FOR EVIDENCE-BASED SOFTWARE ASSURANCE: MODELS AND ANALYSIS 5a. CONTRACT NUMBER FA8750-12-2-0139 5b. GRANT NUMBER N/A...assurance case, sandboxing, adaptive software 147 i Prospects for evidence-based software assurance: models and analysis Final Technical Report
Martinez, Angel Johann Solorzano
Workplace violence in health care settings is an occupational issue concerning nurses and other health care professionals. Patient aggression against nurses is often the most common form of violence in clinical settings, occurring in emergency departments, inpatient psychiatric settings, and nursing homes. Physical and verbal assaults are the major forms of workplace violence encountered by nurses. Current research has identified staff, environmental, and patient risk factors as the major precursors of workplace violence initiated by patients. Nurses often experience significant physical and psychological negative consequences after an episode of workplace violence. A review of the evidence was conducted to identify current evidence-based interventions that can help nurses minimize the incidence of workplace violence. [Journal of Psychosocial Nursing and Mental Health Services, 54(9), 31-36.].
Evidence-based medicine (EBM) is the conscientious, explicit, and judicious use of current best evidence in making decisions regarding the care of individual patients. This concept has gained popularity recently, and its applications have been steadily expanding. Nowadays, the term "evidence-based" is used in numerous situations and conditions, such as evidence-based medicine, evidence-based practice, evidence-based health care, evidence-based social work, evidence-based policy, and evidence-based education. However, many anesthesiologists and their colleagues have not previously been accustomed to utilizing EBM, and they have experienced difficulty in understanding and applying the techniques of EBM to their practice. In this article, the author discusses the brief history, definition, methods, and limitations of EBM. As EBM also involves making use of the best available information to answer questions in clinical practice, the author emphasizes the process of performing evidence-based medicine: generate the clinical question, find the best evidence, perform critical appraisal, apply the evidence, and then evaluate. Levels of evidence and strength of recommendation were also explained. The author expects that this article may be of assistance to readers in understanding, conducting, and evaluating EBM. PMID:27703623