TREATMENT Effectiveness | Academic Articles

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Posts Tagged ‘TREATMENT effectiveness’

Directly observed antidepressant medication treatment and hiv outcomes among homeless and marginally housed hiv-positive adults: a randomized controlled trial

Objectives. We assessed whether directly observed fluoxetine treatment reduced depression symptom severity and improved HIV outcomes among homeless and marginally housed HIV-positive adults in San Francisco, California, from 2002 to 2008. Methods. We conducted a nonblinded, randomized controlled trial of once-weekly fluoxetine, directly observed for 24 weeks, then self-administered for 12 weeks (n = 137 persons with major or minor depressive disorder or dysthymia). Hamilton Depression Rating Scale score was the primary outcome. Response was a 50% reduction from baseline and remission a score below 8. Secondary measures were Beck Depression Inventory-II (BDI-II) score, antiretroviral uptake, antiretroviral adherence (measured by unannounced pill count), and HIV-1 RNA viral suppression (< 50 copies/mL). Results. The intervention reduced depression symptom severity (b = -1.97; 95% confidence interval [CI] = -0.85, -3.08; P < .001) and increased response (adjusted odds ratio [AOR] = 2.40; 95% CI = 1.86, 3.10; P < .001) and remission (AOR = 2.97; 95% CI = 1.29, 3.87; P < .001). BDI-II results were similar. We observed no statistically significant differences in secondary HIV outcomes. Conclusions. Directly observed fluoxetine may be an effective depression treatment strategy for HIV-positive homeless and marginally housed adults, a vulnerable population with multiple barriers to adherence. [ABSTRACT FROM AUTHOR]

October 21, 2012 Tags: ANTIDEPRESSANTS, ANTIRETROVIRAL agents, CHI-squared test, CONFIDENCE intervals, DATA analysis, DESCRIPTIVE statisticsTHERAPEUTIC use, DISEASE remission, DRUGS, EPIDEMIOLOGY, FLUOXETINE, HAMILTON Depression Inventory, HIV-positive persons, HOMELESS persons, MENTAL depression -- Chemotherapy, OBSERVATION (Scientific method), OUTCOME assessment (Medical care), PATIENT compliance, PSYCHOLOGICAL tests, RANDOMIZED controlled trials, RESEARCH -- Finance, SAMPLING (Statistics), SCALES (Weighing instruments), T-test (Statistics), TREATMENT effectiveness
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Menopost – calcium and vitamin d supplementation in postmenopausal osteoporosis treatment: a descriptive cohort study

Summary: Adequate vitamin D/calcium supplementation during osteoporosis (OP) treatments seems insufficient. This cohort study within a national claims database evaluated calcium/vitamin D co-prescription in postmenopausal women initiating an OP treatment. A high co-prescription rate was observed with three quarters of women supplemented with calcium and/or vitamin D in agreement with current recommendations. Introduction: Adequate calcium/vitamin D supplementation should be taken in combination with antiresorptive drugs in OP treatment. Despite guidelines, supplementation appears to be insufficient. The objective of this study was to describe and estimate co-prescription rates of calcium/vitamin D among postmenopausal women initiating an OP treatment. Methods: All women over 50 years with a first claim for a bisphosphonates, raloxifene, or strontium prescription filled between May and August 2010 were included in a retrospective cohort study. Data source was the health insurance claims database of the Rhône-Alpes area. Results: Among 4,415 women, 77.0 % had co-prescription of calcium or vitamin D with initial OP treatment, of which 2,150 (49.7 %) had both calcium and vitamin D. The proportion of women with calcium and/or vitamin D (81.7 %) was significantly higher when OP treatment was a bisphosphonate compared to strontium (70.9 %) or raloxifene (67.0 %) ( p < 0.05). Among women prescribed both calcium and vitamin D, 7.6 % received a bisphosphonate and vitamin D ± calcium fixed-combination pack. General practitioners prescribed two thirds of initial supplementation treatment (66.9 %). Patients were twice as likely to be prescribed supplementation when the prescriber was a rheumatologist (OR = 2; 95 % CI = 1.57-2.54). Conclusion: Three quarters of women initiating OP treatment were supplemented with calcium and/or vitamin D in agreement with current recommendations. This represents a high co-prescription rate. [ABSTRACT FROM AUTHOR]

October 17, 2012 Tags: ACADEMIC medical centers, CALCIUM, CHI-squared test, CONFIDENCE intervals, DATA analysis, DATA analysis -- Software, DESCRIPTIVE statisticsTHERAPEUTIC use, DIPHOSPHONATES, EPIDEMIOLOGY, LOGISTIC regression analysis, MULTIVARIATE analysis, OSTEOPOROSIS -- Prevention, OUTCOME assessment (Medical care), POSTMENOPAUSE, RETROSPECTIVE studies, TREATMENT effectiveness, VITAMIN D -- Therapeutic use, X-ray densitometry in medicine
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Evaluation of anti-emetic use in chemotherapy-induced nausea and vomiting in a third-world country (lebanon)

Rationale In Lebanon, the appropriateness of anti-emetic use is questionable in large measure because of the absence of published multicentre trials. Aim and objectives To evaluate the extent of appropriateness of anti-emetic use in patients on chemotherapy among several Lebanese hospitals. Appropriateness of chemotherapy-induced nausea and vomiting (CINV) prophylaxis was determined as per National Comprehensive Cancer Network guidelines. Methods A multicentre, cross-sectional study was conducted over a 3-month period. Data were collected from medical charts of cancer patients. The main outcome measure was to evaluate the appropriateness of prophylactic use of anti-emetics in CINV in terms of selected drug regimen, dosage and route of administration, and to investigate the role of several pre-specified variables (including hospital type and size, type of insurance coverage and patient-related factors) in influencing the appropriateness of anti-emetic practice. Results A total of 493 patients’ forms were analysed. The median age was 58.8 ± 13.9 years, 290 (58.8%) patients were female. Around 211 (42.8%) patients received inappropriate anti-emetic regimen, and only 17 (6%) patients of those receiving appropriate regimen received the appropriate dose, and just 55 (19.5%) patients were treated for the appropriate duration. Factors that may affect the relative effectiveness of treatment were identified. Conclusion This study reflected substantial flaws in CINV prophylaxis practice in Lebanon which should alert health care professionals of the adverse consequences resulting from non-adherence to guidelines. Our study also highlighted areas for improvement and suggested recommendations in order to minimize patient risk and optimize safe and effective CINV management. [ABSTRACT FROM AUTHOR]

October 16, 2012 Tags: ANTIEMETICS, ANTINEOPLASTIC agents, CANCER -- Patients, CONFIDENCE intervals, CROSS-sectional method, DATA analysis, DATA analysis -- Software, DESCRIPTIVE statisticsTHERAPEUTIC use, EPIDEMIOLOGY, EVALUATION, LOGISTIC regression analysis, MEDICAL cooperation, MEDICAL protocols, OUTCOME assessment (Medical care), RESEARCH, TREATMENT effectiveness
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Objective assessment of psoriasis lesion thickness for pasi scoring using 3d digital imaging

Psoriasis is a chronic inflammatory skin condition which affects 2-3% of population around the world. Psoriasis Area and Severity Index (PASI) is a gold standard to assess psoriasis severity as well as the treatment efficacy. Although a gold standard, PASI is rarely used because it is tedious and complex. In practice, PASI score is determined subjectively by dermatologists, therefore inter and intra variations of assessment are possible to happen even among expert dermatologists. This research develops an algorithm to assess psoriasis lesion for PASI scoring objectively. Focus of this research is thickness assessment as one of PASI four parameters beside area, erythema and scaliness. Psoriasis lesion thickness is measured by averaging the total elevation from lesion base to lesion surface. Thickness values of 122 3D images taken from 39 patients are grouped into 4 PASI thickness score using K-means clustering. Validation on lesion base construction is performed using twelve body curvature models and show good result with coefficient of determinant (R2) is equal to 1. [ABSTRACT FROM AUTHOR]

July 12, 2012 Tags: CHRONIC diseases, DERMATOLOGISTS, IMAGE analysis, INFLAMMATION, PSORIASIS, THICKNESS measurement, TREATMENT effectiveness
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Azacitidine-associated sweet’s syndrome

Purpose. Sweet’s syndrome (also known as acute febrile neutrophilic dermatosis) in two patients receiving azacitidine therapy is reported. Summary. The development of Sweet’s syndrome in association with azacitidine use is rare (three published case reports since the drug’s U.S. marketing approval in 2004), and the syndrome is not listed as a potential adverse reaction in the product packaging. In one of two cases of probable azacitidine-related Sweet’s syndrome reported here, a 64-year-old man with myelodysplastic syndrome (MDS) developed a severe erythematous and nodular rash with peeling on his arms, legs, and face after receiving the drug (75 mg/m2 subcutaneously daily) for three days; the second case involved a 67-year-old man with chronic myelomonocytic leukemia (CMML) who experienced a similar skin rash, as well as chills and an elevated body temperature, after five days of treatment with azacitidine. In both cases, the results of dermatologic or pathologic examination and skin biopsies were consistent with Sweet’s syndrome. Perhaps the strongest evidence of a drug-induced etiology in these cases was the close temporal relationship between the initiation of azacitidine use and the development of Sweet’s syndrome, with prompt symptom resolution after the discontinuation of azacitidine use and administration of appropriate corticosteroid therapy. Conclusion. Azacitidine was the apparent cause of Sweet’s syndrome in a patient with MDS and another with CMML. Both responded well to corticosteroid therapy. After resolution of the reaction, decitabine was given to the first patient and azacitidine to the second, without complications. [ABSTRACT FROM AUTHOR]

May 15, 2012 Tags: AMOXICILLIN, DIAGNOSIS, DRUGS -- Physiological effectTHERAPEUTIC use, EXANTHEMATA, FEVER, METHYLATION, MYELODYSPLASTIC syndromes, NUCLEOSIDES, OUTCOME assessment (Medical care), PREDNISONE, SWEET'S syndrome, TREATMENT effectiveness
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Influence of preceding length of anticoagulant treatment and initial presentation of venous thromboembolism on risk of recurrence after stopping treatment: analysis of individual participants’ data from seven trials

The article presents a study which aims to investigate the effect of anticoagulation treatment on the risk of recurrence of venous thromboembolism (VTE). Participants include 2925 patients with a first venous thromboembolism. Results showed that recurrence were higher in patients who have stopped anticoagulation for one and a half or less than six months. Moreover, it says that VTE were lower following isolated distal deep vein thrombosis (DVT) compared with proximal DVT.

March 10, 2012 Tags: ANTICOAGULANTS (Medicine), DISEASES -- Relapse, PATIENTS, RESEARCH, THROMBOEMBOLISM, THROMBOPHLEBITIS, TREATMENT effectiveness
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Bilateral wilms’ tumor: mansoura multi-centers 15 years experience

Purpose. Bilateral Wilms’ tumor (WT) is a challenge. Aggressive surgical resection is needed to prevent recurrence. We revised the clinico-epidemiological criteria of bilateral WT patients in our locality and relation to outcome.Subjects and methods. 462 WT patients were registered in three medical centers at Mansoura, Egypt. Twenty five patients had bilateral WT whose medical records were revised for all clinico-epidemiologic data plus treatment details, toxicity, and outcome.Results. The mean age was 34.5 months; 64% of cases were female. Abdominal mass was the commonest presentation (72%). Congenital anomalies were reported in two cases (one case showed hemihypertrophy and the other showed aniridia). About 60% had favorable pathology. Nineteen cases had synchronous bilateral WT (76%) and the remaining (six cases) had metachronous tumors. For the synchronous cases, the response rate to preoperative chemotherapy was 79% and nephron sparing surgery for the least involved kidney was possible in all. Survival rate was 74%. Metachronous tumor management included nephrectomy followed by chemotherapy for the initially diagnosed tumors. However, nephron sparing surgery of the contralateral tumors following preoperative chemotherapy was possible in two cases and the survival rate was 33%. No renal failure or any therapy-related complications were reported.Conclusions. Bilateral WT is predominantly synchronous with favorable histology, with female predilection and possibly congenital anomalies. Preoperative chemotherapy followed by nephron sparing surgery has a favorable outcome with preserved renal function especially in patients with synchronous WT. Response to preoperative chemotherapy had a statistically significant prognostic impact.

March 1, 2012 Tags: ACTINOMYCIN, ANATOMY, CHILDRENTREATMENT, COMBINED modality therapy, DESCRIPTIVE statistics, DISEASES -- Relapse, DRUGS -- Toxicology, KIDNEYS, MEDICAL records, NEPHRECTOMY, NEPHROBLASTOMA, OUTCOME assessment (Medical care), PREVENTION, PROGNOSIS, RESEARCH, RETROSPECTIVE studies, SEX distribution (Demography), TREATMENT effectiveness, TUMORS -- Classification, VINCRISTINE
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Adult wilms’ tumor: review of literature

Background. The most common renal tumors in adults is renal cell carcinoma. Wilms’ tumor in subjects older than 16 years is rare; only 3% of Wilms’ tumors are reported in adults, which explain the difficulties in diagnosis and treatment of this tumor entity in this age group.Methods. Patient with stage IV adult nephroblastoma with favorable histology was described, current treatment modalities were discussed, and the literature was reviewed.Results. Nineteen year old female patient is presented with renal mass, abdominal lymphadenopathy, and bilateral pulmonary deposits. Sonar guided biopsy from the renal mass was taken and pathology revealed nephroblastoma. Right nephrectomy was performed and the pathological examination revealed classic histology of nephroblastoma. The case diagnosed as stage IV adult Wilms’ tumor with favorable histology. According to National Wilms’ Tumor Study Group (NWTS-3), multimodal therapy was initiated immediately after surgery. The patient failed to respond to the first line therapy and died due to disease progression.Conclusion. Adult Wilms’ tumor has no specific guidelines and this may lead to improper or incorrect treatment.

March 1, 2012 Tags: ABDOMEN -- Radiography, ABDOMINAL pain, ACTINOMYCIN, ADULTHOODTREATMENT, AGE distribution (Demography), ANATOMY, COMBINED modality therapy, CYCLOPHOSPHAMIDE (Drug), DIAGNOSIS, Differential, DOXORUBICIN, DRUGS -- Toxicology, KIDNEYS, LUNGS, METASTASIS, NEEDLE biopsy, NEPHRECTOMY, NEPHROBLASTOMA, RENAL cell carcinoma, TREATMENT effectiveness, TUMORS, TUMORS -- Classification, VINCRISTINE
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Targeting macrophages in classical hodgkin’s lymphoma may seem rational, but is it safe?

A few reports have linked increased numbers of tissue macrophages with treatment failure and reduced lifespan in classical Hodgkin’s lymphoma (HL) patients. Some investigators even suggested to target the macrophages in HL with biologic therapy, thus eliminating them from the tumor microenvironment. This review explores the risk: benefit equation of such approach as well as what the author believes is the driving force behind the ‘great’ migration of macrophages in HL. This article unravels the inflammatory pathways and immune alterations in classical HL that lead to a complex network consisting of T-cells, numerous cytokines, macrophages, and other cells. Macrophages are thought to play a crucial role in tumor antigen processing and presentation tasks, Reed–Sternberg (RS) cell phagocytosis, and antibody-dependent cellular cytotoxicity, therefore their extinction may be hazardous. The author believes RS cells should be targeted by the biologics, not the macrophages, and links his hopes with the existing investigational anti-CD30 therapies in relapsed/refractory classical HL.

March 1, 2012 Tags: ANTIGENS, APOPTOSIS, BIOLOGICAL products -- Therapeutic use, CELLULAR immunity, CYTOKINES, CYTOTOXINS, DISEASES -- Relapse, DRUG development, Experimental, GENE expression, HODGKIN'S disease, INFLAMMATION, MACROPHAGES, OUTCOME assessment (Medical care), PHAGOCYTOSIS, THERAPEUTICS, TREATMENT effectiveness, TUMOR necrosis factor
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A pharmacoeconomic modeling approach to estimate a value-based price for new oncology drugs in europe

Background. Several European governments have recently mandated price cuts in drugs to reduce health care spending. However, such measures without supportive evidence may compromise patient care because manufacturers may withdraw current products or not launch new agents. A value-based pricing scheme may be a better approach for determining a fair drug price and may be a medium for negotiations between the key stakeholders. To demonstrate this approach, pharmacoeconomic (PE) modeling was used from the Spanish health care system perspective to estimate a value-based price for bevacizumab, a drug that provides a 1.4-month survival benefit to patients with metastatic colorectal cancer (mCRC). The threshold used for economic value was three times the Spanish per capita GDP, as recommended by the World Health Organization (WHO).Methods. A PE model was developed to simulate outcomes in mCRC patients receiving chemotherapy ± bevacizumab. Clinical data were obtained from randomized trials and costs from a Spanish hospital. Utility estimates were determined by interviewing 24 Spanish oncology nurses and pharmacists. A price per dose of bevacizumab was then estimated using a target threshold of €78,300 per quality-adjusted life year gained, which is three times the Spanish per capita GDP.Results. For a 1.4-month survival benefit, a price of €342 per dose would be considered cost effective from the Spanish public health care perspective. The price may be increased to €733 or €843 per dose if the drug were able to improve patient quality of life or enhance survival from 1.4 to 3 months.Conclusions. This study demonstrated that a value-based pricing approach using PE modeling and the WHO criteria for economic value is feasible and perhaps a better alternative to government mandated price cuts. The former approach would be a good starting point for opening dialog between European government payers and the pharmaceutical industry.

March 1, 2012 Tags: ANTINEOPLASTIC agents, CANCER -- Chemotherapy, CANCER -- Nursing, COLON (Anatomy), CONFIDENCE intervals, COST effectiveness, DATA analysis -- Software, DECISION making, DESCRIPTIVE statisticsTHERAPEUTIC useECONOMIC aspects, INTERVIEWING, MONOCLONAL antibodies, OUTCOME assessment (Medical care), PHARMACISTS, PHARMACY, QUESTIONNAIRES, RECTUM, TREATMENT effectiveness, TUMORS
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