583 Treating Insomnia in Youth Depression: A Randomized Controlled Trial of CBT for Depression vs. CBT for Insomnia

SLEEP ◽  
2021 ◽  
Vol 44 (Supplement_2) ◽  
pp. A230-A230
Author(s):  
Shirley Xin Li ◽  
Ngan Yin chan ◽  
Siu Ping Lam ◽  
Tsz Ting Lui ◽  
Joey W Chan ◽  
...  
Keyword(s):  
Depressive Symptoms ◽  
Post Intervention ◽  
Meaningful Improvement ◽  
Treatment Groups ◽  
Comorbid Insomnia ◽  
Cohen’S D ◽  
Significant Difference ◽  
Cohen's D ◽  
Group Cbt

Abstract Introduction Insomnia is often comorbid with depression in youths and both may reciprocally exacerbate clinical outcomes and lead to a constellation of detrimental consequences. The present study aimed to test the efficacy of cognitive behavioral therapy (CBT) for insomnia (CBT-I) and CBT for depression (CBT-D), when compared with waitlist control, in youths with comorbid insomnia and depression. Methods 112 participants aged 12–24 years old (67.9% female) with insomnia and depression according to DSM-5 diagnostic criteria were randomised to one of the following conditions: 8-week group CBT-I (n=33), 8-week group CBT-D (n=39), or waiting-list control (n=40). Insomnia (Insomnia Severity Index, ISI) and depressive symptoms (Hamilton Rating Scale for Depression, HAMD) were assessed at baseline and post-intervention. The two active treatment groups were additionally followed up at post-treatment one-month. Results Linear mixed model showed that both treatment groups (CBT-D: Cohen’s d = -0.44, p<.001; CBT-I: Cohen’s d =-0.56, p<.001) had significantly lower ISI scores at post-intervention follow-up, as compared to the waitlist group. There was a significant difference in clinically meaningful improvement in insomnia (a reduction of ISI score ≥ 6 from baseline to post-intervention follow-up) between the groups (CBT-I: 73.1%; CBT-D: 40.0%; WL: 28.6%; p=.002). Moreover, there was a significant difference in remission of depression (HAMD≤7) at post-intervention follow-up (CBT-D: 75.9%; CBT-I: 81.5%; WL: 22.9%) (p <.001). Both CBT-D and CBT-I resulted in comparable improvements in insomnia and depressive symptoms at one-month follow-up (p>.05). Conclusion Preliminary evidence from this study supports the efficacy of CBT-I for improving both sleep and mood in youths with comorbid insomnia and depression. Support (if any) This work was supported by Early Career Scheme, Research Grants Council, Hong Kong SAR (Ref. 27613017).

scholarly journals Managing cancer and living meaningfully (CALM): A randomized controlled trial of a psychological intervention for patients with advanced cancer.

2017 ◽  
Vol 35 (18_suppl) ◽  
pp. LBA10001-LBA10001 ◽  
Author(s):  
Gary Rodin ◽  
Christopher Lo ◽  
Anne Rydall ◽  
Rinat Nissim ◽  
Carmine Malfitano ◽  
...  
Keyword(s):  
Depressive Symptoms ◽  
Advanced Cancer ◽  
Health Care Providers ◽  
Psychological Intervention ◽  
Well Being ◽  
Comprehensive Cancer Center ◽  
Care Providers ◽  
Cohen’S D ◽  
Cohen's D

LBA10001 Background: Patients with advanced cancer experience substantial distress in response to the burden of disease and the challenge of living meaningfully in the face of impending mortality. We developed a novel, brief, manualized psychotherapeutic intervention called CALM designed to alleviate distress and facilitate adjustment in this population. CALM consists of 3-6 individual sessions delivered over 3-6 months and supports exploration in 4 broad domains: 1) symptom management and communication with health care providers; 2) changes in self and relations with close others; 3) sense of meaning and purpose; and 4) the future and mortality. Methods: Patients with advanced cancer were recruited from outpatient clinics at a comprehensive cancer center and randomized to receive either CALM or usual care (UC). Assessments of depressive symptoms (primary outcome), death-related distress and other secondary outcomes were conducted at baseline, 3 (primary endpoint) and 6 months. ANCOVA was used to test for outcome differences between groups at follow-up, controlling for baseline scores. Results: Three hundred and five participants were recruited and randomized (n = 151 CALM; n = 154 UC). Compliance with the intervention was 77.5% and attrition was 28% (16% deceased, 8% lost to follow-up, 4% withdrew). The CALM group reported less severe depressive symptoms compared to UC at 3 (ΔM1-M2 = 1.09, p < 0.04; Cohen’s d = 0.23) and 6 months (ΔM1-M2 = 1.33, p < 0.01; Cohen’s d = 0.29). Other statistically significant findings in psychological well-being and preparation for the end of life at 3- and 6- months also favored CALM vs UC. Conclusions: CALM is an effective intervention for patients with advanced cancer that provides a systematic approach to alleviate distress and to address predictable challenges. Clinical trial information: NCT01506492.

26 Brief Psychological Intervention for Distress Reduction in Inpatient Burn Survivors: A Pilot Study

2020 ◽  
Vol 41 (Supplement_1) ◽  
pp. S20-S20
Author(s):  
Sarah A Stoycos ◽  
Randye J Semple ◽  
Warren L Garner ◽  
Amelia P Tankersley ◽  
Haig A Yenikomshian ◽  
...  
Keyword(s):  
Missing Data ◽  
Posttraumatic Stress ◽  
Psychological Intervention ◽  
Drop Out ◽  
Post Intervention ◽  
Cohen’S D ◽  
Burn Survivors ◽  
D 12 ◽  
Cohen's D

Abstract Introduction It is estimated that 19–45% of hospitalized burns patients exhibit symptoms of posttraumatic stress (PTS) during hospitalization, and inpatient distress is linked with poorer functional, psychosocial, and medical prognosis. Despite this, research on psychological intervention for PTS during inpatient treatment for burns remains nascent. The current study developed and pilot-tested a six-session cognitive-behavioral therapy (CBT) for adult inpatients with acute burns. Methods After IRB approval, patients were enrolled in a single verified ABA burn center. Interventions consisted of 6, 50-minute CBT sessions over two weeks. Therapeutic techniques included mindfulness-focused relaxation training, titrated exposure, psychoeducation, and cognitive restructuring. Depression (Beck Depression Inventory II; [BDI]), anxiety (Beck Anxiety Inventory [BAI]), and PTS (Detailed Assessment of Posttraumatic Stress- PTS-T subscale) were assessed at baseline, 2 weeks, and 6 weeks post-intervention. All data were analyzed in SPSS using Student’s univariate t-tests and Last Observation Carried Forward analysis for missing data at T1. No missing data were imputed for T2 given the high drop-out rate. Results Seventeen adult participants were enrolled (13 female; Mage = 31.7 years, SD = 8.7, range 21–53 years; 35% Hispanic/Latinx; MTBSA = 21.6%, SD = 20.2). Analyses indicated no relation between demographic or study variables and drop-out. Average number of sessions was 4.8 (SD = 1.4). At baseline, participants reported moderate anxiety (M = 23, SD = 12.32), mild depression (M = 14.18, SD = 8.46), and clinically significant posttraumatic stress (M = 72.18, T score = 75, 99th percentile). Comparing baseline to post-intervention, BAI scores decreased, t(16) = 3.76, p = .002, Cohen’s d = .61, whereas BDI scores, t(16) = 1.06, ns, Cohen’s d = .19, and PTS scores, t(16) = 1.03, ns, Cohen’s d = .12, did not change. There were no changes from post-intervention to follow-up in BAI, t(5) = 1.48, ns, Cohen’s d = .43, BDI, t(5) = 1.06, ns, Cohen’s d = .54, or PTS scores (t(5) = .55, ns, Cohen’s d = .12) for the six participants who completed follow-up assessment. TBSA burn was not associated with anxiety, depression, or PTS symptoms at any timepoint. Conclusions Participants reported significant reductions in anxiety, but not PTS or depression symptoms, following a CBT distress-reduction intervention. More generally, the findings of this study point to the potential utility of implementing an early intervention of empirically-based treatment components to help burn survivors manage emotional symptoms following trauma. Applicability of Research to Practice Patients experiencing anxiety may benefit from short-term mindfulness or exposure interventions and more research is needed to understand the trajectory and heterogeneity of PTS symptom relief following acute burns.

scholarly journals Using the Life Story Book With Mentally Alert Residents of Nursing Homes

2020 ◽  
Vol 4 (Supplement_1) ◽  
pp. 487-487
Author(s):  
Theresa Chrisman
Keyword(s):  
Depressive Symptoms ◽  
Nursing Homes ◽  
Meaning In Life ◽  
Life Story ◽  
Well Being ◽  
Post Intervention ◽  
Significant Difference ◽  
Wilks Lambda ◽  
Potential Benefits ◽  
Hispanic White

Abstract Depression and lack of meaning in life (MIL) are common among residents of nursing homes (NHs) and contribute to a reduction in overall health and well-being. Life Story Book (LSB), a reminiscence intervention, is designed to provide a person with the opportunity to review their past and capture their life stories and photographs into a book. LSB has demonstrated positive outcomes for residents of NHs with dementia, yet little is known for residents without dementia. A switching replication design was used to examine the effects of LSB among 21 mentally alert residents from two NHs (NH-A and NH-B) in Houston, Texas. Participants in NH-A received three weeks of the LSB intervention, while NH-B received three weeks of care-as-usual; the intervention was then switched. The GDS-12R and the MIL questionnaire (MLQ) were used to measure depressive symptoms and MIL respectively. Participants from NH-A (n =11) and NH-B (n = 10) had a mean age of 75 years (SD =11.34); 81% female; 52% non-Hispanic white and 33% African American. Results from a one-way MANCOVA found no statistically significant difference on the GDS-12R and MLQ (F(3, 14) = 2.50, p = .102; Wilks’ Lambda = .652; η2 = .35). Further analyses comparing the pre-intervention and post-intervention scores for the entire sample (N =21) found a significant reduction in depressive symptoms (M = 2.67; SD = 2.52) and (M =1.67, SD = 2.29); (t (20) = 2.21, p = 0.039). The potential benefits of LSB for mentally alert residents of NHs warrants further research.

Development of a multimedia intervention to improve pneumoconiosis prevention in construction workers using RE-AIM framework

2021 ◽  
Author(s):  
Jieling Chen ◽  
Cho Lee Wong ◽  
Bernard Man Hin Law ◽  
Winnie Kwok Wei So ◽  
Doris Yin Ping Leung ◽  
...  
Keyword(s):  
South Asian ◽  
Educational Intervention ◽  
Self Efficacy ◽  
Intervention Mapping ◽  
Intervention Development ◽  
Educational Interventions ◽  
Construction Workers ◽  
Post Intervention ◽  
Cohen’S D ◽  
Cohen's D

Summary Pneumoconiosis is a common occupational lung disease among construction workers. Educational interventions targeting specific ethnic groups of construction workers are of benefit for pneumoconiosis prevention. The aim of this study was to develop a multimedia educational intervention for pneumoconiosis prevention for South Asian construction workers, and to evaluate its feasibility, acceptability and effectiveness in increasing knowledge of pneumoconiosis, modifying beliefs about pneumoconiosis, and enhancing intention to implement measures for its prevention among the workers. This evaluation was performed using the Reach-Effectiveness-Adoption-Implementation-Maintenance framework. A one-group design was adopted and intervention mapping was used to guide the process of intervention development, while the Health Belief Model guided the development of intervention content. The intervention was delivered at construction sites, ethnic minority associations and South Asian community centres. Data were collected via surveys completed at pre-intervention, post-intervention and 3 months after the intervention. A total of 1002 South Asian construction workers participated in the intervention. The participants reported a moderate-to-large increase in knowledge, perceived susceptibility, perceived severity, perceived benefits, cues to action and self-efficacy (Cohen’s d: 0.37–0.89), a small reduction in perceived barriers (Cohen’s d = 0.12) and a moderate improvement in attitudes and intention to practice (Cohen’s d: 0.45, 0.51) at post-intervention. A follow-up survey of 121 participants found that the implementation of preventive measures appeared to increase. Overall, the findings demonstrate that the implementation of a culturally adapted multimedia educational intervention could be an effective approach to improving knowledge, self-efficacy and intention regarding pneumoconiosis prevention among South Asian construction workers.

scholarly journals Association of biological antirheumatic therapy with risk for type 2 diabetes: a retrospective cohort study in incident rheumatoid arthritis

BMJ Open ◽  
2021 ◽  
Vol 11 (6) ◽  
pp. e042246
Author(s):  
Sanjoy K Paul ◽  
Olga Montvida ◽  
Jennie H Best ◽  
Sara Gale ◽  
Attila Pethö-Schramm ◽  
...  
Keyword(s):  
Rheumatoid Arthritis ◽  
Type 2 Diabetes ◽  
T Cell ◽  
Disease Modifying Antirheumatic Drugs ◽  
Antirheumatic Therapy ◽  
Treatment Groups ◽  
Significant Difference ◽  
Necrosis Factor

ObjectiveTo explore possible associations of treatment with biological disease-modifying antirheumatic drugs (bDMARDs), including T-cell-based and interleukin-6 inhibition (IL-6i)-based therapies, and the risk for type 2 diabetes mellitus (T2DM) in patients with rheumatoid arthritis (RA).Study design, setting and participantsFive treatment groups were selected from a United States Electronic Medical Records database of 283 756 patients with RA (mean follow-up, 5 years): never received bDMARD (No bDMARD, n=125 337), tumour necrosis factor inhibitors (TNFi, n=34 873), IL-6i (n=1884), T-cell inhibitors (n=5935) and IL-6i+T cell inhibitor abatacept (n=1213). Probability and risk for T2DM were estimated with adjustment for relevant confounders.ResultsIn the cohort of 169 242 patients with a mean 4.5 years of follow-up and a mean 641 200 person years of follow-up, the adjusted probability of developing T2DM was significantly lower in the IL-6i (probability, 1%; 95% CI 0.6 to 2.0), T-cell inhibitor (probability, 3%; 95% CI 2.3 to 3.3) and IL-6i+T cell inhibitor (probability, 2%; 95% CI 0.1 to 2.9) groups than in the No bDMARD (probability, 5%; 95% CI 4.6 to 4.9) and TNFi (probability, 4%; 95% CI 3.7 to 4.7) groups. Compared with No bDMARD, the IL-6i and IL-6i+T cell inhibitor groups had 37% (95% CI of HR 0.42 to 0.96) and 34% (95% CI of HR 0.46 to 0.93) significantly lower risk for T2DM, respectively; there was no significant difference in risk in the TNFi (HR 0.99; 95% CI 0.93 to 1.06) and T-cell inhibitor (HR 0.96; 95% CI 0.82 to 1.12) groups.ConclusionsTreatment with IL-6i, with or without T-cell inhibitors, was associated with reduced risk for T2DM compared with TNFi or No bDMARDs; a less pronounced association was observed for the T-cell inhibitor abatacept.

Capsular closure versus unrepaired interportal capsulotomy after hip arthroscopy in patients with femoroacetabular impingement, results of a patient-blinded randomised controlled trial

2021 ◽  
pp. 112070002110057
Author(s):  
Niels H Bech ◽  
Inger N Sierevelt ◽  
Sheryl de Waard ◽  
Boudijn S H Joling ◽  
Gino M M J Kerkhoffs ◽  
...  
Keyword(s):  
Randomised Controlled Trial ◽  
Femoroacetabular Impingement ◽  
Hip Arthroscopy ◽  
Controlled Trial ◽  
Poor Quality ◽  
Control Group ◽  
Treatment Groups ◽  
Significant Difference ◽  
Randomised Controlled

Background: Hip capsular management after hip arthroscopy remains a topic of debate. Most available current literature is of poor quality and are retrospective or cohort studies. As of today, no clear consensus exists on capsular management after hip arthroscopy. Purpose: To evaluate the effect of routine capsular closure versus unrepaired capsulotomy after interportal capsulotomy measured with NRS pain and the Copenhagen Hip and Groin Outcome Score (HAGOS). Materials and methods: All eligible patients with femoroacetabular impingement who opt for hip arthroscopy ( n = 116) were randomly assigned to one of both treatment groups and were operated by a single surgeon. Postoperative pain was measured with the NRS score weekly the first 12 weeks after surgery. The HAGOS questionnaire was measured at 12 and 52 weeks postoperatively. Results: Baseline characteristics and operation details were comparable between treatment groups. Regarding the NRS pain no significant difference was found between groups at any point the first 12 weeks after surgery ( p = 0.67). Both groups significantly improved after surgery ( p < 0.001). After 3 months follow-up there were no differences between groups for the HAGOS questionnaire except for the domain sport ( p = 0.02) in favour of the control group. After 12 months follow-up there were no differences between both treatment groups on all HAGOS domains ( p  > 0.05). Conclusions: The results of this randomised controlled trial show highest possible evidence that there is no reason for routinely capsular closure after interportal capsulotomy at the end of hip arthroscopy. Trial Registration: This trial was registered at the CCMO Dutch Trial Register: NL55669.048.15.

scholarly journals T157. THE COURSE OF SCHIZOPHRENIA-RELATED NEURAL FINGERPRINTS OVER NINE YEARS - A LONGITUDINAL POPULATION-BASED MACHINE LEARNING STUDY

2020 ◽  
Vol 46 (Supplement_1) ◽  
pp. S290-S291
Author(s):  
Johannes Lieslehto ◽  
Erika Jääskeläinen ◽  
Jouko Miettunen ◽  
Matti Isohanni ◽  
Dominic Dwyer ◽  
...  
Keyword(s):  
Machine Learning ◽  
Sensitivity And Specificity ◽  
Verbal Learning ◽  
Clinical Variable ◽  
Support Vector ◽  
Cohen’S D ◽  
Low Degree ◽  
Cohen's D ◽  
Over Time

Abstract Background Previous machine learning studies using structural MRI (sMRI) have been able to separate schizophrenia from controls with relatively high (about 80%) sensitivity and specificity (Kambeitz et al. Neuropsychopharmacology 2015). Interestingly, prediction accuracy in first-episode psychosis is lower compared to older and probably more chronic patients. One possibility is that the appearance of the neurodiagnostic fingerprints (NF) originated from the schizophrenia vs. controls classifier become more visible over time in schizophrenia due to the progressive nature of the disorder. Methods Using the Cobre sample (70 schizophrenia and 74 controls), we trained support vector machine (SVM) to differentiate schizophrenia from controls using sMRI. Next, we utilized the Northern Finland Birth Cohort 1966 (NFBC 1966) sample of 29 schizophrenia and 61 non-psychotic controls who participated in the nine-year follow-up. We applied the Cobre-trained SVM models at the baseline (participants 34 years old) and the follow-up (participants 43 years old) using out of sample cross-validation without any in-between retraining. Two independent schizophrenia datasets (the Neuromorphometry by Computer Algorithm Chicago [NMorphCH] and the Consortium for Neuropsychiatric Phenomics [CNP]) were utilized for replication analyses of the SVM generalizability. To address the possibility that the NF mainly capture some general psychopathology, we tested whether the NF generalize to depression using two independent MDD samples from Munich and Münster, Germany. Results Using the Cobre-trained SVM models for schizophrenia vs. controls differentiation in the NFBC 1966, we found balanced accuracy (i.e. mean of sensitivity and specificity, [BAC]) of 72.8% (sensitivity=58.6%, specificity=86.9%) at the baseline and BAC of 79.7% (sensitivity=75.9%, specificity=83.6%) at the follow-up. In the NFBC 1966 schizophrenia patients, we found that SVM decision scores varied as a function of timepoint into the direction of more schizophrenia-likeness at the follow-up (paired T-test, Cohen’s d=0.58, P=0.004). The same was not true in controls (Cohen’s d=0.09, P=0.49). The SVM decision score difference*timepoint interaction related to the decrease of hippocampus and medial prefrontal cortex. The SVM models’ performance was also validated at the two replication samples (BAC of 77.5% in the CNP and BAC of 69.1% in the NMorphCH). In the NFBC 1966 the strongest clinical variable correlating with the trajectory of SVM decision scores over the follow-up was poor performance in the California Verbal Learning Test. This finding was also replicated in the CNP dataset. Further, in the NFBC 1966, those schizophrenia patients with a low degree of SVM decision scores had a higher probability of being in remission, being able to work, and being without antipsychotic medication at the follow-up. The generalization of the SVM models to MDD was worse compared to schizophrenia classification (DeLong’s tests for the two ROC curves: P&lt;0.001). Discussion The degree of schizophrenia-related neurodiagnostic fingerprints appear to magnify over time in schizophrenia. By contrast, the discernibility of these fingerprints in controls does not change over time. This indicates that the NF captures some schizophrenia-related progressive neural changes, and not, e.g., normal aging-related brain volume loss. The fingerprints were also generalizable to other schizophrenia samples. Further, the fingerprints seem to have some disorder specificity as the SVM models do not generalize to depression. Lastly, it appears that a low degree of schizophrenia-related NF in schizophrenia might possess some value in predicting patients’ future remission and recovery-related factors.

Chronic Achilles Tendinopathy

2007 ◽  
Vol 35 (10) ◽  
pp. 1659-1667 ◽  
Author(s):  
Wolf Petersen ◽  
Robert Welp ◽  
Dieter Rosenbaum
Keyword(s):  
Synergistic Effect ◽  
Short Form ◽  
Achilles Tendinopathy ◽  
Eccentric Training ◽  
Treatment Groups ◽  
Alternative Treatment Option ◽  
Sf 36 ◽  
Significant Difference ◽  
Chronic Achilles Tendinopathy

Background Previous studies have shown that eccentric training has a positive effect on chronic Achilles tendinopathy. A new strategy for the treatment of chronic Achilles tendinopathy is the AirHeel brace. Hypothesis AirHeel brace treatment improves the clinical outcome of patients with chronic Achilles tendinopathy. The combination of the AirHeel brace and an eccentric training program has a synergistic effect. Study Design Randomized controlled clinical trial; Level of evidence, 1. Methods One hundred patients were randomly assigned to 1 of 3 treatment groups: (1) eccentric training, (2) AirHeel brace, and (3) combination of eccentric training and AirHeel brace. Patients were evaluated at 6, 12, and 54 weeks after the beginning of the treatment protocol with ultrasonography, visual analog scale (VAS) for pain, American Orthopaedic Foot and Ankle Society (AOFAS) ankle score, and Short Form-36 (SF-36). Results The VAS score for pain, AOFAS score, and SF-36 improved significantly in all 3 groups at all 3 follow-up examinations. At the 3 time points (6 weeks, 12 weeks, and 54 weeks) of follow-up, there was no significant difference between all 3 treatment groups. In all 3 groups, there was no significant difference in tendon thickness after treatment. Conclusions The AirHeel brace is as effective as eccentric training in the treatment of chronic Achilles tendinopathy. There is no synergistic effect when both treatment strategies are combined. Clinical Relevance The AirHeel brace is an alternative treatment option for chronic Achilles tendinopathy.

scholarly journals Analysis of saccular aneurysms in the Barrow Ruptured Aneurysm Trial

2018 ◽  
Vol 128 (1) ◽  
pp. 120-125 ◽  
Author(s):  
Robert F. Spetzler ◽  
Joseph M. Zabramski ◽  
Cameron G. McDougall ◽  
Felipe C. Albuquerque ◽  
Nancy K. Hills ◽  
...  
Keyword(s):  
Ruptured Aneurysm ◽  
Modified Rankin Scale ◽  
Clinical Trial Registration ◽  
Treatment Groups ◽  
Significant Difference ◽  
Initial Hospitalization ◽  
Intent To Treat ◽  
Post Hoc ◽  
Saccular Aneurysms

OBJECTIVEThe Barrow Ruptured Aneurysm Trial (BRAT) is a prospective, randomized trial in which treatment with clipping was compared to treatment with coil embolization. Patients were randomized to treatment on presentation with any nontraumatic subarachnoid hemorrhage (SAH). Because all other randomized trials comparing these 2 types of treatments have been limited to saccular aneurysms, the authors analyzed the current BRAT data for this subgroup of lesions.METHODSThe primary BRAT analysis included all sources of SAH: nonaneurysmal lesions; saccular, blister, fusiform, and dissecting aneurysms; and SAHs from an aneurysm associated with either an arteriovenous malformation or a fistula. In this post hoc review, the outcomes for the subgroup of patients with saccular aneurysms were further analyzed by type of treatment. The extent of aneurysm obliteration was adjudicated by an independent neuroradiologist not involved in treatment.RESULTSOf the 471 patients enrolled in the BRAT, 362 (77%) had an SAH from a saccular aneurysm. Patients with saccular aneurysms were assigned equally to the clipping and the coiling cohorts (181 each). In each cohort, 3 patients died before treatment and 178 were treated. Of the 178 clip-assigned patients with saccular aneurysms, 1 (1%) was crossed over to coiling, and 64 (36%) of the 178 coil-assigned patients were crossed over to clipping. There was no statistically significant difference in poor outcome (modified Rankin Scale score > 2) between these 2 treatment arms at any recorded time point during 6 years of follow-up. After the initial hospitalization, 1 of 241 (0.4%) clipped saccular aneurysms and 21 of 115 (18%) coiled saccular aneurysms required retreatment (p < 0.001). At the 6-year follow-up, 95% (95/100) of the clipped aneurysms were completely obliterated, compared with 40% (16/40) of the coiled aneurysms (p < 0.001). There was no difference in morbidity between the 2 treatment groups (p = 0.10).CONCLUSIONSIn the subgroup of patients with saccular aneurysms enrolled in the BRAT, there was no significant difference between modified Rankin Scale outcomes at any follow-up time in patients with saccular aneurysms assigned to clipping compared with those assigned to coiling (intent-to-treat analysis). At the 6-year follow-up evaluation, rates of retreatment and complete aneurysm obliteration significantly favored patients who underwent clipping compared with those who underwent coiling.Clinical trial registration no.: NCT01593267 (clinicaltrials.gov)

scholarly journals A comparison of screw versus drill and curettage epiphysiodesis to correct leg-length discrepancy

2018 ◽  
Vol 12 (5) ◽  
pp. 509-514 ◽  
Author(s):  
M. Troy ◽  
B. Shore ◽  
P. Miller ◽  
S. Mahan ◽  
D. Hedequist ◽  
...  
Keyword(s):  
Operative Time ◽  
Surgical Techniques ◽  
Leg Length Discrepancy ◽  
Complication Rates ◽  
Leg Length ◽  
Treatment Groups ◽  
Length Discrepancy ◽  
Baseline Activity ◽  
Significant Difference

Purpose To compare two common surgical techniques of epiphysiodesis: drill/curettage epiphysiodesis (PDED) versus cross screw epiphysiodesis (PETS). The hypothesis is that the two techniques have similar efficacy but demonstrate differences in length of hospital stay (LOS), time to return to activity and complication rates. Methods A retrospective review of growing children and adolescents less than 18 years old who required an epiphysiodesis with leg-length discrepancy (LLD) of 2 cm to 6 cm with minimum two years of follow-up was conducted. Characteristics including age at surgery, gender, epiphysiodesis location, side, operative time, LOS and hardware removal were compared across treatment groups. LLD, expected growth remaining (EGR) and bone age were determined preoperatively and at most-recent visit. The correction ratio (change in EGR) was calculated along with a 95% confidence interval (CI) to assess if correction in leg length was achieved. Results A total of 115 patients underwent epiphysiodesis in the femur (53%), tibia (24%) or a combination (24%). The cohort was 47% male, with a mean age of 12.6 years (7.7 to 17.7) at surgery. Median follow-up was 3.7 years (2.0 to 12.7). In all, 23 patients underwent PETS and 92 patients had PDED. Both treatment groups achieved expected LLD correction. There was no significant difference in median operative time, complication rates or LOS. PETS patients returned to activity at a mean 1.4 months (interquartile range (IQR) 0.7 to 2.1) while PDED patients returned at a mean 2.4 months (IQR 1.7 to 3) (p < 0.001). Conclusion Effectiveness in achieving expected correction, LOS and operative time are similar between screw and drill/curettage epiphysiodesis. Patients undergoing PETS demonstrated a faster return to baseline activity than patients with PDED. Level of Evidence: III

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