scholarly journals Expectancies as predictors of symptom improvement after antimicrobial therapy for persistent symptoms attributed to Lyme disease

2021 ◽  
Author(s):  
Henriët van Middendorp ◽  
Anneleen Berende ◽  
Fidel J. Vos ◽  
Hadewych H. M. ter Hofstede ◽  
Bart Jan Kullberg ◽  
...  
Keyword(s):  
Lyme Disease ◽  
Treatment Success ◽  
Symptomatic Improvement ◽  
Post Treatment ◽  
Symptom Improvement ◽  
Persistent Symptoms ◽  
Treatment Expectancies ◽  
End Of Treatment ◽  
Pre Treatment

Abstract Introduction/Objective Expectancies about symptom improvement or deterioration are reliable predictors of symptom progression and treatment outcomes (symptom resolution or symptomatic improvement) in many (non-)pharmacological studies and treatments. This study examined predictors of symptom improvement after antimicrobial therapy for persistent symptoms attributed to Lyme disease, hypothesizing particularly pre-treatment expectancies regarding symptom improvement to be predictive. Methods A predictive study was performed on pre-treatment and post-treatment individual characteristics, including expectancies, and physical and mental health–related quality of life (HRQoL) from the PLEASE-trial comparing randomized 12-weeks of doxycycline, clarithromycin-hydroxychloroquine, or placebo following 2 weeks of intravenous ceftriaxone. At end-of-treatment (14 weeks after trial start) and follow-up (52 weeks), complete data of 231 and 170 (of initial 280) patients with persistent symptoms temporally related to a history of erythema migrans or otherwise confirmed symptomatic Lyme disease, or accompanied by B. burgdorferi IgG or IgM antibodies, were examined through hierarchical regression analyses. Results In addition to pre-treatment HRQoL, pre-treatment expectancies regarding symptom improvement were consistently associated with stronger physical and mental HRQoL improvements at both end-of-treatment and follow-up (95% CI range: .09;.54, p < .01 to .27;.92, p < .001). Post-treatment expectancies regarding having received antibiotics vs. placebo was associated with more HRQoL improvement at end-of-treatment, but not at follow-up (95% CI-range 1.00;4.75, p = .003 to −7.34; −2.22, p < .001). Conclusions The present study shows that, next to pre-treatment functioning, patients’ pre-treatment and post-treatment expectancies regarding improvement of persistent symptoms attributed to Lyme disease relate to a more beneficial symptom course. Expectancies of patients may be relevant to explain and potentially improve patient outcomes (e.g., by optimized communication about treatment success). Trial registration ClinicalTrials.gov, NCT01207739 (Registration date: 23–09-2010) Key Points• As there is currently no sufficient symptom resolution or symptomatic improvement for many patients with persistent symptoms attributed to Lyme disease, it is relevant to know which factors determine symptom progression and predict heterogeneity in treatment response.• Next to pre-treatment functioning, expectancies regarding symptom improvement and having received antimicrobial study medication are associated with a more beneficial symptom course after both shorter-term and longer-term antimicrobial treatment.• Expectancies are relevant to consider in treatment studies and may be useful in clinical settings to improve symptom course and treatment outcome (e.g., by optimized communication about treatment success).

scholarly journals Internet-delivered eye movement desensitization and reprocessing (iEMDR): an open trial

F1000Research ◽  
2013 ◽  
Vol 2 ◽  
pp. 79
Author(s):  
Jay Spence ◽  
Nickolai Titov ◽  
Luke Johnston ◽  
Blake F Dear ◽  
Bethany Wootton ◽  
...  
Keyword(s):  
Eye Movement ◽  
Treatment Protocol ◽  
Behavioural Therapy ◽  
Post Treatment ◽  
Effect Sizes ◽  
Future Research ◽  
Symptom Improvement ◽  
Post Traumatic Stress ◽  
Pre Treatment

Recent research indicates internet-delivered cognitive behavioural therapy (iCBT) can reduce symptoms of post traumatic stress disorder (PTSD). This study examined the efficacy of an internet-delivered treatment protocol that combined iCBT and internet-delivered eye movement desensitization and reprocessing (iEMDR), in an uncontrolled trial. Eleven of the 15 participants completed post-treatment questionnaires. Large effect sizes were found from pre-treatment to 3-month follow-up (d = 1.03 – 1.61) on clinician-assessed and self-reported measures of PTSD, anxiety and distress, with moderate effect sizes (d = 0.59 – 0.70) found on measures of depression and disability. At post-treatment, 55% of the participants no longer met criteria for PTSD and this was sustained at follow-up. Symptom worsening occurred in 3 of 15 (20%) of the sample from pre- to post-treatment; however, these participants reported overall symptom improvement by follow-up. Future research directions for iEMDR are discussed.

scholarly journals Internet-delivered eye movement desensitization and reprocessing (iEMDR): an open trial

F1000Research ◽  
2013 ◽  
Vol 2 ◽  
pp. 79 ◽  
Author(s):  
Jay Spence ◽  
Nickolai Titov ◽  
Luke Johnston ◽  
Blake F Dear ◽  
Bethany Wootton ◽  
...  
Keyword(s):  
Eye Movement ◽  
Treatment Protocol ◽  
Behavioural Therapy ◽  
Post Treatment ◽  
Effect Sizes ◽  
Future Research ◽  
Symptom Improvement ◽  
Post Traumatic Stress ◽  
Pre Treatment

Recent research indicates internet-delivered cognitive behavioural therapy (iCBT) can reduce symptoms of post traumatic stress disorder (PTSD). This study examined the efficacy of an internet-delivered treatment protocol that combined iCBT and internet-delivered eye movement desensitization and reprocessing (iEMDR), in an uncontrolled trial. Eleven of the 15 participants completed post-treatment questionnaires. Large effect sizes were found from pre-treatment to 3-month follow-up (d = 1.03 – 1.61) on clinician-assessed and self-reported measures of PTSD, anxiety and distress, with moderate effect sizes (d = 0.59 – 0.70) found on measures of depression and disability. At post-treatment, 55% of the participants no longer met criteria for PTSD and this was sustained at follow-up. Symptom worsening occurred in 3 of 15 (20%) of the sample from pre- to post-treatment; however, these participants reported overall symptom improvement by follow-up. Future research directions for iEMDR are discussed.

Web-based Oral Reading for Language in Aphasia (Web ORLA®): A pilot randomized control trial

2021 ◽  
pp. 026921552098847
Author(s):  
Leora R Cherney ◽  
Jaime B Lee ◽  
Kwang-Youn A Kim ◽  
Sarel van Vuuren
Keyword(s):  
Oral Reading ◽  
Controlled Trial ◽  
Post Treatment ◽  
Control Group ◽  
Web Based ◽  
End Of Treatment ◽  
Significant Difference ◽  
Pre Treatment ◽  
The Web

Objective: To investigate an intensive asynchronous computer-based treatment delivered remotely with clinician oversight to people with aphasia. Design: Single-blind, randomized placebo-controlled trial. Setting: Free-standing urban rehabilitation hospital. Participants: Adults with aphasia (at least six months post-onset). Interventions: Experimental treatment was Web ORLA® (Oral Reading for Language in Aphasia) which provides repeated choral and independent reading aloud of sentences with a virtual therapist. Placebo was a commercially available computer game. Participants were instructed to practice 90 minutes/day, six days/week for six weeks. Main measures: Change in Language Quotient of the Western Aphasia Battery-Revised from pre-treatment to post-treatment and pre-treatment to six weeks following the end of treatment. Results: 32 participants (19 Web ORLA®, 13 Control) completed the intervention and post-treatment assessment; 27 participants (16 Web ORLA®, 11 Control) completed the follow-up assessment six weeks after treatment had ended. Web ORLA® treatment resulted in significant improvements in language performance from pre-treatment to immediately post-treatment ( X = 2.96; SD = 4.32; P < 0.01; ES = 0.68) and from pre-treatment to six weeks following the end of treatment ( X = 4.53; SD = 3.16; P < 0.001; ES = 1.43). There was no significant difference in the gain from pre-treatment to post-treatment for the Web ORLA® versus Control groups. However, the Web ORLA® group showed significantly greater gains at the six-week follow-up than the control group ( X = 2.70; SD = 1.01; P = 0.013; ES = 1.92). Conclusion: Results provide evidence for improved language outcomes following intensive, web-based delivery of ORLA® to individuals with chronic aphasia. Findings underscore the value of combining clinician oversight with the flexibility of asynchronous practice.

scholarly journals Relationship between metamorphopsia and inner retinal microstructure following intravitreal ranibizumab injection for branch retinal vein occlusion

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Yoshimi Sugiura ◽  
Fumiki Okamoto ◽  
Tomoya Murakami ◽  
Shohei Morikawa ◽  
Takahiro Hiraoka ◽  
...  
Keyword(s):  
Macular Edema ◽  
Retinal Vein Occlusion ◽  
Branch Retinal Vein Occlusion ◽  
Post Treatment ◽  
Intravitreal Ranibizumab ◽  
Vein Occlusion ◽  
Treatment Naïve ◽  
Pre Treatment ◽  
Number Of Injections

AbstractTo evaluate the effects of intravitreal ranibizumab injection (IVR) on metamorphopsia in patients with branch retinal vein occlusion (BRVO), and to assess the relationship between metamorphopsia and inner retinal microstructure and other factors. Thirty-three treatment-naïve eyes of 33 patients with macular edema caused by BRVO with at least 12 months of follow-up were included. The degree of metamorphopsia was quantified using the M-CHARTS. Retinal microstructure was assessed with spectral-domain optical coherence tomography. Disorganization of the retinal inner layers (DRIL) at the first month after resolution of the macular edema (early DRIL) and at 12 months after treatment (after DRIL) was studied. Central retinal thickness (CRT), and status of the external limiting membrane as well as ellipsoid zone were also evaluated. IVR treatment significantly improved best-corrected visual acuity (BCVA) and CRT, but the mean metamorphopsia score did not improve even after 12 months. Post-treatment metamorphopsia scores showed a significant correlation with pre-treatment metamorphopsia scores (P < 0.005), the extent of early DRIL (P < 0.05) and after DRIL (P < 0.05), and the number of injections (P < 0.05). Multivariate analysis revealed that the post-treatment mean metamorphopsia score was significantly correlated with the pre-treatment mean metamorphopsia score (P < 0.05). IVR treatment significantly improved BCVA and CRT, but not metamorphopsia. Post-treatment metamorphopsia scores were significantly associated with pre-treatment metamorphopsia scores, the extent of DRIL, and the number of injections. Prognostic factor of metamorphopsia was the degree of pre-treatment metamorphopsia.

Outcomes of surgical and/or medical treatment in patients with prolactinomas during long-term follow-up: a retrospective single-centre study

2020 ◽  
Vol 0 (0) ◽  
Author(s):  
Gamze Akkus ◽  
Barış Karagun ◽  
Hilal Nur Yaldız ◽  
Mehtap Evran ◽  
Murat Sert ◽  
...  
Keyword(s):  
Medical Treatment ◽  
Tumour Size ◽  
Optic Chiasm ◽  
Initial Therapy ◽  
Post Treatment ◽  
Surgical Removal ◽  
Average Dose ◽  
Single Centre Study ◽  
Pre Treatment

AbstractObjectivesProlactinoma is the most common cause of pituitary tumours. Current medical guidelines recommend dopamine agonists (cabergoline or bromocriptine) as the initial therapy for prolactinoma. However, surgical removal can also be considered in selected cases, such as patients with macroadenomas with local complications (bleeding or optic chiasm pressure) or those not responding to medical treatment.MethodsThe present retrospective study included patients with prolactinomas (n=43; female, 24; male, 19) who were primarily managed with medical (n=32) or surgical (n=11) treatment.ResultsMacroadenoma (n=29.67%) was commonly detected in both genders (female, 54%; male, 84%). Moreover, the mean pre-treatment prolactin levels were similar in both genders (female, 683.3 ± 1347 ng/mL; male, 685.4 ± 805 ng/mL; p=0.226). Surgically treated patients had a greater reduction in tumour size (27.7 ± 17.9 mm pre-treatment vs. 8.72 ± 14.2 mm post-treatment) than non-surgically treated ones (12.5 ± 7.5 mm pre-treatment vs. 4.1 ± 4.2 mm post-treatment; p=0.00). However, the decrease in prolactin levels was similar between the two patient groups (p=0.108). During the follow-up period (10.6 ± 7.0 years), the average cabergoline dose of the patients was 1.42 ± 1.47 mcg/week.ConclusionsAlthough a surgical approach was considered for selected cases of prolactinoma, the average dose used for medical treatment was highly inadequate for the patients in the present study.

scholarly journals Combined Cubital and Carpal Tunnel Release Results in Symptom Resolution Outside of the Median or Ulnar Nerve Distributions

2016 ◽  
Vol 10 (1) ◽  
pp. 111-119 ◽  
Author(s):  
Peter C. Chimenti ◽  
Allison W. McIntyre ◽  
Sean M. Childs ◽  
Warren C. Hammert ◽  
John C. Elfar
Keyword(s):  
Median Nerve ◽  
Ulnar Nerve ◽  
Carpal Tunnel ◽  
Carpal Tunnel Release ◽  
Symptomatic Improvement ◽  
Patient Counseling ◽  
Symptom Resolution ◽  
Persistent Symptoms ◽  
Validated Questionnaires

Background: Resolution of symptoms including pain, numbness, and tingling outside of the median nerve distribution has been shown to occur following carpal tunnel release. We hypothesized that a similar effect would be found after combined release of the ulnar nerve at the elbow with simultaneous release of the median nerve at the carpal tunnel. Methods: 20 patients with combined cubital and carpal tunnel syndrome were prospectively enrolled. The upper extremity was divided into six zones and the location of pain, numbness, tingling, or strange sensations was recorded pre-operatively. Two-point discrimination, Semmes-Weinstein monofilament testing, and validated questionnaires were collected pre-operatively and at six-week follow-up. Results: Probability of resolution was greater in the median nerve distribution than the ulnar nerve for numbness (71% vs. 43%), tingling (86% vs. 75%). Seventy percent of the cohort reported at least one extra-anatomic symptom pre-operatively, and greater than 80% of these resolved at early follow-up. There was a decrease in pain as measured by validated questionnaires. Conclusion: This study documents resolution of symptoms in both extra-ulnar and extra-median distributions after combined cubital and carpal tunnel release. Pre-operative patient counseling may therefore include the likelihood of symptomatic improvement in a non-expected nerve distribution after this procedure, assuming no other concomitant pathology which may cause persistent symptoms. Future studies could be directed at correlating pre-operative disease severity with probability of symptom resolution using a larger population.

scholarly journals Guideline-defined futility or patient-reported outcomes to assess treatment success after TAVI: what to use? Results from a prospective cohort study with long-term follow-up

Open Heart ◽  
2018 ◽  
Vol 5 (2) ◽  
pp. e000879 ◽  
Author(s):  
Martijn Stefan van Mourik ◽  
Jeroen Vendrik ◽  
Mohammad Abdelghani ◽  
Floortje van Kesteren ◽  
Jose P S Henriques ◽  
...  
Keyword(s):  
Symptom Relief ◽  
Treatment Success ◽  
Heart Association ◽  
Patient Reported Outcome Measures ◽  
Symptomatic Improvement ◽  
Low Flow ◽  
Chronic Obstructive ◽  
Transfemoral Approach ◽  
Patient Reported

ObjectiveTranscatheter aortic valve implantation (TAVI) provides a significant symptom relief and mortality reduction in most patients; however, a substantial group of patients does not experience the same beneficial results according to physician-determined outcomes.MethodsSingle-centre prospective design; the population comprises all consecutive patients undergoing TAVI in 2012–2017. TAVI futility was defined as the combined endpoint of either no symptomatic improvement or mortality at 1 year. We actively gathered telephone follow-up using a predefined questionnaire.ResultsGuideline defined TAVI futility was present in 212/741 patients. Multivariate regression showed lower albumin and non-transfemoral approach to be predictive for futility. In addition to these, chronic obstructive pulmonary disease, lower estimated glomerular filtration rate, atrial fibrillation, low-flow–low-gradient aortic stenosis and lower Body Mass Index were predictive for 1-year mortality. Patients who showed symptomatic benefit estimated the percentage in which their symptoms were remedied higher than patients who did not (80% vs 60%, p<0.001). Guideline-defined TAVI futility occurs frequently, contrasting with patient-reported outcome measures (PROMs). The vast majority in both groups would again choose for TAVI treatment.ConclusionLower albumin and non-transfemoral access route were predictors for guideline-defined TAVI futility, defined as mortality within 1 year or no objective symptomatic improvement in New York Heart Association class. Futility according to this definition occurred frequently in this study, contrasting with much more positive PROMs. The majority of patients would undergo a TAVI again, underlining the patients’ experienced value of TAVI and putting the definition of TAVI futility further on debate. In the near future, less-strict criteria for TAVI futility, that is, using a shorter warranted life expectancy and incorporating patients’ perceived outcomes, should be used.

Personalized attention control therapy for PTSD: effectiveness and moderators of outcome in a randomized controlled trial

2020 ◽  
pp. 1-11
Author(s):  
Adva Segal ◽  
Daniel S. Pine ◽  
Yair Bar-Haim
Keyword(s):  
Treatment Outcome ◽  
Clinical Symptoms ◽  
Controlled Trial ◽  
Post Treatment ◽  
Attention Control ◽  
Randomized Controlled ◽  
Control Therapy ◽  
Pre Treatment ◽  
Attentional Interference

Abstract Background Previous randomized controlled trials (RCTs) suggest that attention control therapy (ACT), targeting aberrant fluctuations of attention toward and away from threats in patients with PTSD, may be effective in reducing symptoms. The current RCT examined whether the use of personalized-trauma stimuli enhances ACT efficacy in patients with PTSD. Additional moderators of treatment outcome were tested on an exploratory basis. Methods Sixty patients with PTSD were randomly assigned to either personalized ACT, non-personalized ACT, or a control condition. Changes in symptoms were examined across pre-treatment, post-treatment, and a 3-month follow-up. Attentional interference was examined pre- and post-treatment. Baseline clinical and cognitive indices as well as the time elapsed since the trauma were tested as potential moderators of treatment outcome. Results A significant reduction in clinical symptoms was noted for all three conditions with no between-group differences. Attention bias variability decreased following ACT treatment. Personalized ACT was more effective relative to the control condition when less time had elapsed since the trauma. Baseline clinical and cognitive indices did not moderate treatment outcome. Conclusions In this RCT of patients with PTSD, ACT was no more effective in reducing PTSD symptoms than a control condition. The data also suggest a potential benefit of personalized ACT for patients who experienced their trauma more recently.

Treatment of Storm Fears Using Virtual Reality and Progressive Muscle Relaxation

2017 ◽  
Vol 46 (2) ◽  
pp. 251-256 ◽  
Author(s):  
Jessica Lima ◽  
Hanna McCabe-Bennett ◽  
Martin M. Antony
Keyword(s):  
Virtual Reality ◽  
Treatment Group ◽  
Exposure Therapy ◽  
Clinical Sample ◽  
Muscle Relaxation ◽  
Post Treatment ◽  
Progressive Muscle Relaxation ◽  
Exposure Condition ◽  
Pre Treatment

Background: The present study examined the efficacy of virtual reality (VR) exposure therapy for treating individuals with storm fears by comparing a one-session VR exposure treatment with a one-session progressive muscle relaxation (PMR) and psychoeducation session. Aims: It was predicted that there would be a reduction in storm-related fear post-treatment for individuals in both conditions, but that this reduction would be greater for those in the VR exposure condition. It was predicted that improvements would be maintained at 30-day follow-up only for those in the VR exposure condition. Method: Thirty-six participants each received one of the two treatment conditions. Those in the PMR treatment group received approximately 30 minutes of PMR and approximately 15 minutes of psychoeducation regarding storms. Those in the VR treatment group received approximately 1 hour of VR exposure. Additionally, participants were asked to complete a pre-treatment and post-treatment 5-minute behavioural approach test to assess changes in storm fears. They were also asked to complete a measure assessing storm phobia. Results: There was a significant interaction between treatment group and self-reported fear at post-treatment, such that fear decreased for both groups, although the reduction was stronger in the VR group. Results also showed that reductions in storm fear were maintained at 30-day follow-up for both groups. Conclusions: Although this study used a small non-clinical sample, these results offer preliminary support for the use of VR exposure therapy in the treatment of storm-related fear.

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