Why is self-help neglected in the treatment of emotional disorders? A meta-analysis

2004 ◽  
Vol 34 (6) ◽  
pp. 959-971 ◽  
Author(s):  
P. C. A. M. DEN BOER ◽  
D. WIERSMA ◽  
R. J. VAN DEN BOSCH
Keyword(s):  
Emotional Disorders ◽  
Psychiatric Treatment ◽  
Meta Analysis ◽  
Treatment Protocols ◽  
Self Help ◽  
Treatment Conditions ◽  
The Mean ◽  
Clinically Significant ◽  
Self Help Groups

Background. Although the burden of emotional disorders is very high, mental health care is only available to a minority of patients. The literature suggests that self-help strategies, both bibliotherapy and self-help groups alike, are effective for various, less serious complaints but it is unclear whether available data support a role for self-help in treatment protocols for patients with clinically significant emotional disorders.Method. We searched the literature with a focus on ‘anxiety’ and/or ‘depressive disorder’. Standardized assessment of diagnosis or symptoms and randomized controlled trials were inclusion criteria for a meta-analysis.Results. The mean effect size of self-help (mainly bibliotherapy) v. control conditions is 0·84, and 0·76 for follow-up; the effect sizes of self-help v. treatment are −0·03 and −0·07 respectively. A longer treatment period is more effective.Conclusions. Bibliotherapy for clinically significant emotional disorders is more effective than waiting list or no treatment conditions. The dearth of studies on self-help groups for emotional disorders does not permit an evidence-based conclusion concerning the effects of self-help groups. No difference was found between bibliotherapy and psychiatric treatment of relatively short duration.

The impact of therapeutic relatives’ groups on the course of illness of schizophrenic patients

1995 ◽  
Vol 10 (1) ◽  
pp. 17-27 ◽  
Author(s):  
G Buchkremer ◽  
H Schulze Mönking ◽  
R Holle ◽  
WP Hornung
Keyword(s):  
Control Group ◽  
Course Of Illness ◽  
Self Help ◽  
Before And After ◽  
Schizophrenic Patients ◽  
Clinically Significant ◽  
Self Help Groups ◽  
The Impact ◽  
Relapse Rates

SummaryThis study considers the question of whether relapse rates among schizophrenic patients can be reduced by means of relatives' groups. In a randomized, controlled intervention study, two therapeutic strategies (therapeutic relatives' groups, initiated relatives' self-help groups) were compared with each other and with a control group. Interventions were confined to the relatives, with the patients continuing their standard treatment. The study involved 151 relatives of 99 chronic DSMIII schizophrenics. Data were collected before and after a 1-year intervention phase and in a 2-year follow-up. No difference existed between the groups with respect to rehospitalization data. However, numerous differences recorded in the psychopathological findings and in living and working circumstances suggest that therapeutic work with relatives is of clinically significant benefit.

scholarly journals Sporting participation following the operative management of chondral defects of the knee at mid-term follow up: a systematic review and meta-analysis

2020 ◽  
Vol 7 (1) ◽  
Author(s):  
P. G. Robinson ◽  
T. Williamson ◽  
I. R. Murray ◽  
K. Al-Hourani ◽  
T. O. White
Keyword(s):  
Systematic Review ◽  
Autologous Chondrocyte Implantation ◽  
Platelet Rich Plasma ◽  
Meta Analysis ◽  
Osteochondral Allograft ◽  
Chondral Defects ◽  
Chondrocyte Implantation ◽  
The Mean ◽  
Autologous Chondrocyte

Abstract Purpose The purpose of this study was to perform a systematic review of the reparticipation in sport at mid-term follow up in athletes who underwent biologic treatment of chondral defects in the knee and compare the rates amongst different biologic procedures. Methods A search of PubMed/Medline and Embase was performed in May 2020 in keeping with Preferred Reporting Items for Systematic Review and Meta-Analysis (PRISMA) guidelines. The criteria for inclusion were observational, published research articles studying the outcomes and rates of participation in sport following biologic treatments of the knee with a minimum mean/median follow up of 5 years. Interventions included microfracture, osteochondral autograft transfer (OAT), autologous chondrocyte implantation (ACI), matrix-induced autologous chondrocyte implantation (MACI), osteochondral allograft, or platelet rich plasma (PRP) and peripheral blood stem cells (PBSC). A random effects model of head-to-head evidence was used to determine rates of sporting participation following each intervention. Results There were twenty-nine studies which met the inclusion criteria with a total of 1276 patients (67% male, 33% female). The mean age was 32.8 years (13–69, SD 5.7) and the mean follow up was 89 months (SD 42.4). The number of studies reporting OAT was 8 (27.6%), ACI was 6 (20.7%), MACI was 7 (24.1%), microfracture was 5 (17.2%), osteochondral allograft was 4 (13.8%), and one study (3.4%) reported on PRP and PBSC. The overall return to any level of sport was 80%, with 58.6% returning to preinjury levels. PRP and PBSC (100%) and OAT (84.4%) had the highest rates of sporting participation, followed by allograft (83.9%) and ACI (80.7%). The lowest rates of participation were seen following MACI (74%) and microfracture (64.2%). Conclusions High rates of re-participation in sport are sustained for at least 5 years following biologic intervention for chondral injuries in the knee. Where possible, OAT should be considered as the treatment of choice when prolonged participation in sport is a priority for patients. However, MACI may achieve the highest probability of returning to the same pre-injury sporting level. Level of evidence IV

scholarly journals Comparable outcome for autografts and allografts in primary medial patellofemoral ligament reconstruction for patellofemoral instability: systematic review and meta-analysis

2021 ◽  
Author(s):  
Filippo Migliorini ◽  
Andromahi Trivellas ◽  
Jörg Eschweiler ◽  
Matthias Knobe ◽  
Markus Tingart ◽  
...  
Keyword(s):  
Medial Patellofemoral Ligament ◽  
Meta Analysis ◽  
Patellofemoral Instability ◽  
Mpfl Reconstruction ◽  
Current Evidence ◽  
Level Of Evidence ◽  
Feasible Alternative ◽  
The Mean ◽  
Persistent Instability

Abstract Purpose This study updates the current evidence on the role of allografts versus autografts for medial patellofemoral ligament (MPFL) reconstruction in patients with patellofemoral instability. Methods The study was performed according to the PRISMA guidelines. In March 2021, a literature search in the main online databases was performed. Studies reporting quantitative data concerning primary MPFL reconstruction using an allograft were considered for inclusion. The Coleman Methodology Score was used to assess the methodological quality of the selected articles. Results Data from 12 studies (474 procedures) were retrieved. The mean follow-up was 42.2 (15–78.5) months. The mean age was 21.1 ± 6.2 years. 64.9% (285 of 439) of patients were female. At the last follow-up, the Tegner (p < 0.0001), Kujala (p = 0.002) and the Lysholm (p < 0.0001) scores were minimally greater in the autografts. The similarity was found in the rate of persistent instability sensation and revision. The allograft group evidenced a lower rate of re-dislocations (p = 0.003). Conclusion Allografts may represent a feasible alternative to traditional autograft for MPFL reconstruction in selected patients with patellofemoral instability. Allograft tendons yielded similar PROMs, rates of persistent instability, and revision. Allograft reconstructions tended to have modestly lower re-dislocation rates. Level of evidence IV.

scholarly journals Ultrasound Surveillance of Ectatic Abdominal Aortas

2008 ◽  
Vol 90 (6) ◽  
pp. 477-482 ◽  
Author(s):  
S Devaraj ◽  
SR Dodds
Keyword(s):  
Growth Rate ◽  
Growth Rates ◽  
Screening Programme ◽  
T Test ◽  
Aortic Aneurysms ◽  
Aortic Diameter ◽  
Ultrasound Screening ◽  
The Mean ◽  
Clinically Significant

INTRODUCTION Some studies have considered abdominal aortas of 2.6–2.9 cm diameter (ectatic aortas) at age 65 years as being abnormal and have recommended surveillance, whereas others have considered these normal and surveillance unnecessary. It is, therefore, not clear how to manage patients with an initial aortic diameter between 2.6–2.9 cm detected at screening. The aim of this study was to evaluate growth rates of ectatic aortas detected on initial ultrasound screening to determine if any developed into clinically significant abdominal aortic aneurysms (AAAs; > 5.0 cm) and clarify the appropriate surveillance intervals for these patients. PATIENTS AND METHODS Data were obtained from a prospective AAA screening programme which commenced in 1992. The group of patients with initial aortic diameters of 2.6–2.9 cm with a minimum of 1-year follow-up were included in this study (Group 2). This was further divided into two subgroups (Groups 3a and 3b) based on a minimum follow-up interval obtained from outcome analysis. Mean growth rate was calculated as change in aortic diameter with time. The comparison of growth rates in Groups 3a and 3b was performed using the t-test. The number and proportion of AAAs that expanded to ≥ 3.0 cm and ≥ 5.0 cm in diameter were also calculated. RESULTS Out of 999 patients with AAA ≥ 2.6 cm with minimum 1-year follow-up, 358 (36%) were classified as ectatic aortas (2.6–2.9 cm) at initial ultrasound screening with the mean growth rate of 1.69 mm/year (95% CI, 1.56–1.82 mm/year) with a mean follow-up of 5.4 years. Of these 358 ectatic aortas, 314 (88%) expanded into ≥ 3.0 cm, 45 (13%) expanded to ≥ 5.0 cm and only 8 (2%) expanded to ≥ 5.5 cm over a mean follow-up of 5.4 years (range, 1–14 years). No ectatic aortas expanded to ≥ 5.0 cm within the first 4 years of surveillance. Therefore, the minimum follow-up interval was set at 4 years and this threshold was then used for further analysis. The mean growth rate in Group 3a (< 5.0 cm at last scan) was 1.33 mm/year (95% CI, 1.23–1.44 mm/year) with a mean follow-up of 7 years compared to Group 3b (≥ 5.0 cm at last scan) with the mean growth rate of 3.33 mm/year (95% CI 3.05–3.61 mm/year) and a mean follow-up of 8 years. The comparison of mean growth rates between Groups 3a and 3b is statistically significant (t-test; T = 13.00; P < 0.001). CONCLUSIONS One-third of patients undergoing AAA screening will have ectatic aortas (2.6–2.9 cm) and at least 13% of these will expand to a size of ≥ 5.0 cm over a follow-up of 4–14 years. A threshold diameter of 2.6 cm for defining AAAs in a screening programme is recommended and ectatic aortas detected at age 65 years can be re-screened at 4 years after the initial scan. A statistically significant difference was found in the growth rates of ectatic aortas with minimum 4 years follow-up, expanding to ≥ 5.0 cm compared to those less than 5.0 cm at last surveillance scan. Further studies are required to test the hypothesis of whether growth rate over the first 4 years of surveillance will identify those who are most likely to expand to a clinically significant size (> 5.0 cm).

scholarly journals Mindfulness-based interventions for psychiatric disorders: A systematic review and meta-analysis

2019 ◽  
Author(s):  
Simon Goldberg ◽  
Raymond P. Tucker ◽  
Preston A. Greene ◽  
Richard J Davidson ◽  
Bruce E. Wampold ◽  
...  
Keyword(s):  
Active Control ◽  
Meta Analysis ◽  
Evidence Based ◽  
Addictive Disorders ◽  
Treatment Conditions ◽  
Evidence Based Treatments ◽  
Minimal Treatment ◽  
Specific Symptoms ◽  
Active Controls

Despite widespread scientific and popular interest in mindfulness-based interventions, questions regarding the empirical status of these treatments remain. We sought to examine the efficacy of mindfulness-based interventions for clinical populations on disorder-specific symptoms. To address the question of relative efficacy, we coded the strength of the comparison group into five categories: no treatment, minimal treatment, non-specific active control, specific active control, and evidence-based treatment. A total of 142 non-overlapping samples and 12,005 participants were included. At post-treatment, mindfulness-based interventions were superior to no treatment (d = 0.55), minimal treatment (d = 0.37), non-specific active controls (d = 0.35), and specific active controls (d = 0.23). Mindfulness conditions did not differ from evidence-based treatments (d = -0.004). At follow-up, mindfulness-based interventions were superior to no treatment conditions (d = 0.50), non-specific active controls (d = 0.52), and specific active controls (d = 0.29). Mindfulness conditions did not differ from minimal treatment conditions (d = 0.38) and evidence-based treatments (d = 0.09). Effects on specific disorder subgroups showed the most consistent evidence in support of mindfulness for depression, pain conditions, smoking, and addictive disorders. Results support the notion that mindfulness-based interventions hold promise as evidence-based treatments.

scholarly journals Arthroscopic Bristow: 12-Year Experience, Assessments of Safety and Effectiveness

2019 ◽  
Author(s):  
Jose Carlos Garcia
Keyword(s):  
Los Angeles ◽  
Shoulder Instability ◽  
De Novo ◽  
Mean Value ◽  
Anterior Shoulder Instability ◽  
Simple Shoulder Test ◽  
The Mean ◽  
Lateral Rotation ◽  
Clinically Significant

Abstract Objective The open Bristow procedure is a long established and effective method for treating anterior shoulder instability. Following the trends of minimally-invasive surgeries, these procedures were performed arthroscopically, and their outcomes were evaluated. Methods A total of 43 shoulders of patients submitted to Bristow procedures by arthroscopy, using a graft positioned horizontally and a screw, with at least two years of postoperative follow-up, were evaluated regarding quality of life, de novo dislocation index, and loss of lateral rotation. Results The mean follow-up time was of 76 months (range: 129 to 24 months). The University of California at Los Angeles (UCLA) score varied from 25.56 ± 0.50 (standard deviation [SD] = 3.25) to 33.23 ± 0.44 (SD = 2.91) (p < 0.0001). Two or more years after surgery, the mean Rowe score was of 94.25 ± 1.52 (SD = 1.34), whereas the good results standard is 75 (p < 0.0001). The mean value for the simple shoulder test was of 11.35 ± 0.21 (SD = 1.34), while the mean value of the lateral rotation loss was of 10.37° ± 1.36° (SD = 8.58°). There were no de novo dislocations.In total, there were 12 complications, 8 of which had no clinical repercussions. The clinically-significant complications included an infection six months after surgery with a potential hematogenous origin, a coracoid fracture that required an intraoperatively procedure change, and two patients with previous impingement who required synthesis material removal more than six months after surgery. Conclusion Although the arthroscopic Bristow procedure was effective in treating anterior shoulder instability, it is not a complication-free surgery.

Significantly lower annual rates of neoplastic progression in short- compared to long-segment non-dysplastic Barrett’s esophagus: a systematic review and meta-analysis

Endoscopy ◽  
2019 ◽  
Vol 51 (07) ◽  
pp. 665-672 ◽  
Author(s):  
Viveksandeep Thoguluva Chandrasekar ◽  
Nour Hamade ◽  
Madhav Desai ◽  
Tarun Rai ◽  
Venkata Subhash Gorrepati ◽  
...  
Keyword(s):  
Systematic Review ◽  
Barrett’S Esophagus ◽  
Barrett's Esophagus ◽  
Meta Analysis ◽  
Significant Heterogeneity ◽  
Neoplastic Progression ◽  
Number Of Patients ◽  
The Mean ◽  
Surveillance Endoscopy

Abstract Background Although shorter lengths of Barrett’s esophagus (BE) have been associated with a lower risk of neoplastic progression, precise estimates have varied, especially for non-dysplastic BE (NDBE) only. Therefore, current US guidelines do not provide specific recommendations on surveillance intervals based on BE length. We performed a systematic review and meta-analysis of the published literature to examine neoplastic progression rates of NDBE based on BE length. Methods PubMed, Cochrane, Google Scholar, and Embase were comprehensively searched. Studies reporting progression rates in patients with NDBE and > 1 year of follow-up were included. The number of patients progressing to esophageal adenocarcinoma (EAC) and high grade dysplasia (HGD)/EAC in individual studies and the mean follow-up were recorded to derive person-years of follow-up. Pooled rates of progression to EAC and HGD/EAC based on BE length (< 3 cm vs. ≥ 3 cm) were calculated. Results Of the 486 initial studies identified, 10 met the inclusion/exclusion criteria. These included a total of 4097 NDBE patients; 1979 with short-segment BE (SSBE; 10 773 person-years of follow-up) and 2118 with long-segment BE (LSBE; 12 868 person-years). The annual rates of progression to EAC were significantly lower for SSBE compared with LSBE: 0.06 % (95 % confidence interval 0.01 % – 0.10 %) vs. 0.31 % (0.21 % – 0.40 %), respectively; odds ratio (OR) 0.25 (0.11 – 0.56); P < 0.001, as were the rates for the combined endpoint (HGD/EAC): 0.24 % (0.09 % – 0.32 %) vs. 0.76 % (0.43 % – 0.89 %), respectively; OR 0.35 (0.21 – 0.58); P < 0.001. There was no significant heterogeneity among studies. Conclusion The results demonstrate significantly lower rates of neoplastic progression in NDBE patients with SSBE compared with LSBE. BE length can easily be used for risk stratification purposes for NDBE patients undergoing surveillance endoscopy and consideration should be given to tailoring surveillance intervals based on BE length in future US guidelines.

scholarly journals The efficacies and limitations of fasciectomy and collagenase clostridium histolyticum in Dupuytren’s contracture management: A meta-analysis

2020 ◽  
Vol 28 (2) ◽  
pp. 230949902092174 ◽  
Author(s):  
Tokai B Cooper ◽  
Keshav Poonit ◽  
Chenglun Yao ◽  
Zeyuan Jin ◽  
Jingwei Zheng ◽  
...  
Keyword(s):  
Meta Analysis ◽  
Treatment Algorithm ◽  
Cochrane Library ◽  
Dupuytren’S Contracture ◽  
Collagenase Clostridium Histolyticum ◽  
Dupuytren's Contracture ◽  
Clostridium Histolyticum ◽  
Palmar Aponeurosis ◽  
The Mean

Background: We intend to assess the efficacies and limitations of collagenase clostridium histolyticum (CCH) and fasciectomy in treating Dupuytren’s contracture, and the associated complications and rate of recurrences aiming to present a treatment algorithm. Methods: A literature search within the PubMed, Web of Sciences, Cochrane Library, and EMBASE databases was performed using the combined key words ‘Dupuytren, palmar aponeurosis contracture, collagenase clostridium histolyticum and fasciectomy’, including all possible studies with a set of predefined inclusion and exclusion criteria. Results: Thirty studies were assessed for eligibility from 215 identified records. Seventeen publications satisfied the inclusion criteria including 2142 joints in 1784 patients. The mean follow-up time was 18.0 months (3–60). Conclusion: Acceptable contractures release was obtained in both techniques. Severe complications associated with fasciectomy outrank those of CCH, whereas the low rate of recurrence favors the fasciectomy technique.

scholarly journals Real-World Results of Aflibercept versus Ranibizumab for the Treatment of Exudative AMD Using a Fixed Regimen

2018 ◽  
Vol 2018 ◽  
pp. 1-7 ◽  
Author(s):  
Joana Providência ◽  
Tiago M. Rodrigues ◽  
Mariana Oliveira ◽  
João Bernardes ◽  
João Pedro Marques ◽  
...  
Keyword(s):  
Real World ◽  
Age Related Macular Degeneration ◽  
Treatment Protocols ◽  
Corrected Visual Acuity ◽  
Age Related ◽  
Significant Difference ◽  
Clinical Practice Setting ◽  
The Mean ◽  
Endothelial Growth Factors

Intravitreal injections of antivascular endothelial growth factors have been considered a milestone in the treatment of neovascular age-related macular degeneration (nAMD). However, the increasing incidence of AMD and the burden of visits and injections overcharge both the patient and the healthcare systems. Real-world solutions depend on treatment protocols aimed at optimizing the number of clinical visits while guaranteeing good functional outcomes. We performed a retrospective analysis of 72 eyes from 63 naïve patients diagnosed with nAMD that underwent a fixed intravitreal protocol consisting of bimonthly injections after a three-month loading dose, with either Aflibercept or Ranibizumab (no predefined criteria for treatment selection). Best corrected visual acuity (BCVA) and optical coherence tomography were analyzed at baseline and during follow-up clinical visits (months 3, 6, 12, and 18). From the included participants, 42 followed a fixed regimen with Aflibercept and 30 with Ranibizumab. At the 12-month visit, there was not a statistically significant difference in the mean change of BCVA between the two groups (p=0.121); however, the mean difference in the central retinal thickness was significantly superior in the Aflibercept group (-142.2 versus -51.5, p=0.011). The described fixed regimen seems to be efficient in the treatment of nAMD in a clinical practice setting.

Forefoot Adductus Correction in Clubfoot Deformity with Cuboid-Cuneiform Osteotomy

2007 ◽  
Vol 97 (2) ◽  
pp. 126-133 ◽  
Author(s):  
Daniel K. Lee ◽  
Marc Benard ◽  
Nicholas Grumbine ◽  
Mitchell Pokrassa ◽  
Stan Weinstein
Keyword(s):  
Treatment Delay ◽  
Idiopathic Clubfoot ◽  
Inclusion Criteria ◽  
Residual Deformity ◽  
First Metatarsal ◽  
Average Patient ◽  
The Mean ◽  
Clinically Significant ◽  
Medial Release

Background: Forefoot adduction is the most common residual deformity in the treatment of pediatric clubfoot. Little documentation exists regarding its late occurrence and early detection. A retrospective analysis was conducted to determine the effect of primary posterior medial release for idiopathic clubfoot that had failed to improve with conservative treatment or had presented after a treatment delay and a subsequent forefoot adduction correction with a cuboid-cuneiform osteotomy. Methods: Radiographic evaluations were conducted of all of the surgical procedures performed at our institution for idiopathic clubfoot during a specified period. Preoperative and postoperative talo–first metatarsal and talocalcaneal angles were measured radiographically. Of 138 patients with clubfoot deformity who met the inclusion criteria, 51 underwent a primary posterior medial release; of these patients, 18 (26 feet) underwent a subsequent cuboid-cuneiform osteotomy. Results: The average preoperative and postoperative talo–first metatarsal anteroposterior angles for patients who underwent primary posterior medial release were 44.6° and 26.8°, respectively. The mean reduction in forefoot adduction was 17.8° (P &lt; .05). After the osteotomy, the average talo–first metatarsal anteroposterior angle was 16°, with an average reduction of 10.8° (P &lt; .05). Mean follow-up was 61.2 months. The average patient age was 3.2 years. Conclusions: Eighteen (35%) of 51 patients who underwent a posterior medial release required a subsequent cuboid-cuneiform osteotomy. The average reduction of 10.8° was statistically significant and has also proved to be clinically significant in the overall correction of the deformity. (J Am Podiatr Med Assoc 97(2): 126–133, 2007)

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