Clinical Effectiveness of Comprehensive Psychological Intervention for Nonadherence to Medical Treatment: A Case Series

Background: Depression in adolescence is a common and serious mental health problem. In the UK, access to evidence-based psychological treatments is limited, and training and employing therapists to deliver these is expensive. Brief behavioural activation for the treatment of depression (BATD) has great potential for use with adolescents and to be delivered by a range of healthcare professionals, but there is limited empirical investigation with this group. Aims: To adapt BATD for depressed adolescents (Brief BA) and conduct a pilot study to assess feasibility, acceptability and clinical effectiveness. Method: Twenty depressed adolescents referred to the local NHS Child and Adolescent Mental Health service (CAMHs) were offered eight sessions of Brief BA followed by a review around one month later. Self- and parent-reported routine outcome measures (ROMs) were collected at every session. Results: Nineteen of the 20 young people fully engaged with the treatment and all reported finding some aspect of Brief BA helpful. Thirteen (65%) required no further psychological intervention following Brief BA, and both young people and parents reported high levels of acceptability and satisfaction with the approach. The pre–post effect size of Brief BA treatment was large. Conclusions: Brief BA is a promising innovation in the treatment of adolescent depression. This approach requires further evaluation to establish effectiveness and cost effectiveness compared with existing evidence-based treatments for adolescent depression. Other questions concern the effectiveness of delivery in other settings and when delivered by a range of professionals.

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Electrophysiological effects and clinical utility of propafenone in children

Cardiology in the Young ◽

10.1017/s1047951121002857 ◽

2021 ◽

pp. 1-5

Author(s):

Manavotam Singh ◽

Keore McKenzie ◽

Mark L. Hudak ◽

Anil K. Gehi ◽

Sunita J. Ferns

Keyword(s):

Case Series ◽

Clinical Effectiveness ◽

Retrospective Case ◽

Cardiac Side Effects ◽

Cardiac Depression ◽

Case Series Study ◽

Baseline Characteristics ◽

Antiarrhythmic Medication ◽

Electrophysiological Effects ◽

Series Study

Abstract Aim: This retrospective case series study sought to describe the safety and clinical effectiveness of propafenone for the control of arrhythmias in children with and without CHD or cardiomyopathy. Methods: We reviewed baseline characteristics and subsequent outcomes in a group of 63 children treated with propafenone at 2 sites over a 15-year period Therapy was considered effective if no clinically apparent breakthrough episodes of arrhythmias were noted on the medication. Results: Sixty-three patients (29 males) were initiated on propafenone at a median age of 2.3 years. CHD or cardiomyopathy was noted in 21/63 (33%). There were no significant differences between demographics, clinical backgrounds, antiarrhythmic details, side effect profiles, and outcomes between children with normal hearts and children with CHD or cardiomyopathy. Cardiac depression at the initiation of propafenone was more common amongst children with CHD or cardiomyopathy compared to children with normal hearts. Systemic ventricular function was diminished in 15/63 patients (24%) prior to starting propafenone and improved in 8/15 (53%) of patients once better rhythm control was achieved. Other than one child in whom medication was stopped due to gastroesophageal reflux, no other child experienced significant systemic or cardiac side effects during treatment with propafenone. Propafenone achieved nearly equal success in controlling arrhythmias in both children with normal hearts and children with congenital heart disease or cardiomyopathy (90% versus 86%, p = 0.88). Conclusion: Propafenone is a safe and effective antiarrhythmic medication in children.

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Current Advances in Robotics for Head and Neck Surgery—A Systematic Review

Cancers ◽

10.3390/cancers13061398 ◽

2021 ◽

Vol 13 (6) ◽

pp. 1398

Author(s):

Felix Boehm ◽

Rene Graesslin ◽

Marie-Nicole Theodoraki ◽

Leon Schild ◽

Jens Greve ◽

...

Keyword(s):

Systematic Review ◽

Head And Neck ◽

Large Scale ◽

Case Series ◽

Clinical Effectiveness ◽

Neck Surgery ◽

Head And Neck Surgery ◽

Daily Routine ◽

Surgical Robots ◽

Standard Procedures

Background. In the past few years, surgical robots have recently entered the medical field, particularly in urology, gynecology, and general surgery. However, the clinical effectiveness and safety of robot-assisted surgery (RAS) in the field of head and neck surgery has not been clearly established. In this review, we evaluate to what extent RAS can potentially be applied in head and neck surgery, in which fields it is already daily routine and what advantages can be seen in comparison to conventional surgery. Data sources. For this purpose, we conducted a systematic review of trials published between 2000 and 2021, as well as currently ongoing trials registered in clinicaltrials.gov. The results were structured according to anatomical regions, for the topics “Costs,” “current clinical trials,” and “robotic research” we added separate sections for the sake of clarity. Results. Our findings show a lack of large-scale systematic randomized trials on the use of robots in head and neck surgery. Most studies include small case series or lack a control arm which enables a comparison with established standard procedures. Conclusion. The question of financial reimbursement is still not answered and the systems on the market still require some specific improvements for the use in head and neck surgery.

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Clinical Effectiveness of Cardiocytoprotective Therapy in Patients with Acute Coronar Syndrome (ACS) – Myocardial Infarction (MI), Who Were Performed Balloon Angioplasty and Coronary Artery Stenting

Archive of Clinical Medicine ◽

10.21802/acm.2019.1.2 ◽

2019 ◽

Vol 25 (1) ◽

Author(s):

Mykola Shved ◽

Lesia Tsuglevych ◽

Svitlana Heryak

Keyword(s):

Medical Treatment ◽

Clinical Effectiveness ◽

Coronary Intervention ◽

Left Ventricular ◽

Additional Treatment ◽

Functional Improvement ◽

Control Group ◽

Restorative Treatment ◽

Coronary Syndrome ◽

Standard Medical Treatment

The aim of the study was to increase the efficiency of restorative treatment of patients with Acute Coronary Syndrome (Miocardial Infarction) by incorporating the protocol therapy for the course of parenteral use of L-arginine and L-carnitine (Tivorel). It has been determined that patients with ACS (MI) after percutaneous coronary intervention often develop reperfusion syndrome with manifestations of left ventricular insufficiency and rhythm disturbances. Substantial clinical and functional improvement was noted under the influence of standard medical treatment in patients of control group. At the same time postinfarction remodeling with systolic and diastolic function of the heart, with the development of heart failure syndrome and endothelial dysfunction of blood vessels, and also remained resistant to extrasystole therapy, progressed. Patients in the experimental group under the influence of complex medical treatment with the inclusion of L-arginine and L-carnitine marked a significant decrease in the frequency of violations of rhythm and conduction for the second day of observation, as well as a decrease in the manifestations of post-infarction remodeling of LV, which ultimately manifested a significant improvement in myocardial contractility (EF increased by 13%) and decreased diastolic dysfunction. Improvement of the inotropic function of the heart and a significant reduction in the frequency and severity of reperfusion arrhythmias was achieved precisely due to cardiometabolic effects of L-carnitine. In addition, in patients undergoing additional treatment with L-arginine and L-carnitine after 10 days of treatment, the activity of ET-1 was significantly lowered and the concentration of nitrogen oxide metabolites in the blood plasma increased and reach the level of healthy subjects (p>0.05). So, they recovered the endothelial function of the vessels.

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Case Series of Hwa-Byung Patients with Facial Spasm - by Using Oriental Medical Treatment with Melonis Calyx Vomiting Therapy

Journal of Oriental Neuropsychiatry ◽

10.7231/jon.2012.23.4.183 ◽

2012 ◽

Vol 23 (4) ◽

pp. 183-198 ◽

Cited By ~ 8

Author(s):

Ho-Sun Ryu ◽

Hyo-Jin Ahn ◽

Su-Bin Lee ◽

Se-Jin Park

Keyword(s):

Medical Treatment ◽

Case Series ◽

Facial Spasm

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A Literature Review of Painful Hashimoto Thyroiditis: 70 Published Cases in the Past 70 Years

Journal of the Endocrine Society ◽

10.1210/jendso/bvz008 ◽

2019 ◽

Vol 4 (2) ◽

Author(s):

Carol Chiung-Hui Peng ◽

Rachel Huai-En Chang ◽

Majorie Pennant ◽

Huei-Kai Huang ◽

Kashif M Munir

Keyword(s):

Medical Treatment ◽

Total Thyroidectomy ◽

Low Dose ◽

Case Reports ◽

Corticosteroid Injection ◽

Oral Prednisone ◽

Case Series ◽

Hashimoto Thyroiditis ◽

Upper Respiratory Tract ◽

Dose Oral

Abstract Painful Hashimoto thyroiditis (pHT) is a rare diagnosis, and optimal treatment remains unclear. To better characterize pHT, PubMed, Embase, Scopus, and Web of Science indexes were searched for case reports or case series reporting pHT, published between 1951 and February 2019. Seventy cases reported in 24 publications were identified. Female predominance (91.4%) and a median age of 39.00 years (interquartile range, 32.50-49.75 years) were observed. Among reported cases, 50.8% had known thyroid disease (including Hashimoto thyroiditis, Graves disease, and seronegative goiters), 83.3% had positive antithyroid peroxidase antibodies, and 71.2% had antithyroglobulin antibodies. Most cases did not have preceding upper respiratory tract symptoms or leukocytosis. Ultrasound features were consistent with Hashimoto thyroiditis. Thyroid function at initial presentation was hypothyroid (35.9%), euthyroid (28.1%), or thyrotoxic (35.9%). Cases evolved into hypothyroidism (55.3%) and euthyroidism (44.7%), whereas none became hyperthyroid after medical treatment. Thyroid size usually decreased after medical treatment. Most cases were empirically treated as subacute thyroiditis with corticosteroids, levothyroxine, or nonsteroidal anti-inflammatory drugs. However, no therapy provided sustained pain resolution. In subgroup analysis, low-dose oral prednisone (<25 mg/d) and intrathyroidal corticosteroid injection showed more favorable outcomes. Total thyroidectomy yielded 100% sustained pain resolution. Diagnosis of pHT is based on clinical evidence of Hashimoto thyroiditis and recurrent thyroid pain after medical treatment. The reference standard of diagnosis is pathology. Total thyroidectomy or intrathyroidal glucocorticoid injection should be considered if low-dose oral prednisone fails to achieve pain control.

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Clinical effectiveness of the START (STrAtegies for RelaTives) psychological intervention for family carers and the effects on the cost of care for people with dementia: 6-year follow-up of a randomised controlled trial

The British Journal of Psychiatry ◽

10.1192/bjp.2019.160 ◽

2019 ◽

Vol 216 (1) ◽

pp. 35-42 ◽

Cited By ~ 7

Author(s):

Gill Livingston ◽

Monica Manela ◽

Aidan O'Keeffe ◽

Penny Rapaport ◽

Claudia Cooper ◽

...

Keyword(s):

Health Research ◽

Psychological Intervention ◽

Care Home ◽

Clinical Effectiveness ◽

Cost Of Care ◽

Research Centre ◽

Family Carers ◽

People With Dementia ◽

The Impact

BackgroundThe START (STrAtegies for RelaTives) intervention reduced depressive and anxiety symptoms of family carers of relatives with dementia at home over 2 years and was cost-effective.AimsTo assess the clinical effectiveness over 6 years and the impact on costs and care home admission.MethodWe conducted a randomised, parallel group, superiority trial recruiting from 4 November 2009 to 8 June 2011 with 6-year follow-up (trial registration: ISCTRN 70017938). A total of 260 self-identified family carers of people with dementia were randomised 2:1 to START, an eight-session manual-based coping intervention delivered by supervised psychology graduates, or to treatment as usual (TAU). The primary outcome was affective symptoms (Hospital Anxiety and Depression Scale, total score (HADS-T)). Secondary outcomes included patient and carer service costs and care home admission.ResultsIn total, 222 (85.4%) of 173 carers randomised to START and 87 to TAU were included in the 6-year clinical efficacy analysis. Over 72 months, compared with TAU, the intervention group had improved scores on HADS-T (adjusted mean difference −2.00 points, 95% CI −3.38 to −0.63). Patient-related costs (START versus TAU, respectively: median £5759 v. £16 964 in the final year; P = 0.07) and carer-related costs (median £377 v. £274 in the final year) were not significantly different between groups nor were group differences in time until care home (intensity ratio START:TAU was 0.88, 95% CI 0.58–1.35).ConclusionsSTART is clinically effective and this effect lasts for 6 years without increasing costs. This is the first intervention with such a long-term clinical and possible economic benefit and has potential to make a difference to individual carers.Declarations of interestG.L., Z.W. and C.C. are supported by the UCLH National Institute for Health Research (NIHR) Biomedical Research Centre. G.L. and P.R. were in part supported by the National Institute for Health Research (NIHR) Collaboration for Leadership in Applied Health Research and Care (CLAHRC) North Thames at Bart's Health NHS Trust. The views expressed are those of the author(s) and not necessarily those of the NHS, the NIHR or the Department of Health. Z.W. reports during the conduct of the study; personal fees from GE Healthcare, grants from GE Healthcare, grants from Lundbeck, other from GE Healthcare, outside the submitted work.

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