scholarly journals The Leeds Risk Index: Field-Test of a Stratified Psychological Treatment Selection Algorithm

2020 ◽  
Vol 89 (3) ◽  
pp. 189-190 ◽  
Author(s):  
Jaime Delgadillo ◽  
Sarah Appleby ◽  
Sarah Booth ◽  
Georgie Burnett ◽  
Amy Carey ◽  
...  
Keyword(s):  
Field Test ◽  
Psychological Treatment ◽  
Risk Index ◽  
Treatment Selection ◽  
Selection Algorithm

scholarly journals Enhancing decision making in the selection of treatment for anxiety and related disorders

2021 ◽  
Author(s):  
Leorra Newman
Keyword(s):  
Decision Making ◽  
Rating Scales ◽  
Psychological Treatment ◽  
Selection Process ◽  
Informed Choice ◽  
Cost Effective ◽  
Behavioural Therapy ◽  
Relative Strength ◽  
Treatment Selection ◽  
Second Phase

Cognitive Behavioural Therapy (CBT) and pharmacotherapy are both effective treatments for anxiety and related disorders, with some evidence that CBT yields more durable gains and is more cost effective over the long term. Despite this, pharmacotherapy utilization rates have been on the rise in medical settings, while use of psychological treatments has declined. This bias suggests that patients may not be making informed choices about evidence based therapies, thereby increasing the suffering and economic burden associated with anxiety and related disorders. The purpose of this dissertation was to examine variables related to treatment choice in anxiety and related disorders, and to explore methods for improving the selection process to promote informed choice of therapy. The first phase of the project focused on considerations that may be unique to individuals selecting treatment for anxiety and related disorders, to examine variables that may be associated with past and present treatment choices. The second phase drew upon research on decision making and treatment selection from social psychology to formulate hypotheses about how treatment selection for anxiety and related disorders can be improved. Adults with significant anxiety symptoms (n= 105) were randomly assigned to one of three conditions in which they were presented with arguments in favour of psychological treatment and pharmacological treatment. The conditions varied on relative strength of argument combinations for each modality. In keeping with the Elaboration Likelihood Model (Petty & Cacioppo, 1981, 1986a), it was predicted that strong arguments would only be persuasive if participants had the ability and motivation to scrutinize them. The majority of participants rated arguments for psychological treatment as stronger, regardless of condition. Participants displayed a strong preference for psychological treatment, across forced choice measures and rating scales, and tended to endorse psychological attributions for their anxiety. Findings from this study could inform efforts aimed at promoting critical and informed decision making in treatment for anxiety and related disorders. In addition, findings could be of great importance to dissemination efforts aimed at meeting patient preferences for anxiety treatment and increasing the uptake of CBT.

scholarly journals Enhancing decision making in the selection of treatment for anxiety and related disorders

2021 ◽  
Author(s):  
Leorra Newman
Keyword(s):  
Decision Making ◽  
Rating Scales ◽  
Psychological Treatment ◽  
Selection Process ◽  
Informed Choice ◽  
Cost Effective ◽  
Behavioural Therapy ◽  
Relative Strength ◽  
Treatment Selection ◽  
Second Phase

Cognitive Behavioural Therapy (CBT) and pharmacotherapy are both effective treatments for anxiety and related disorders, with some evidence that CBT yields more durable gains and is more cost effective over the long term. Despite this, pharmacotherapy utilization rates have been on the rise in medical settings, while use of psychological treatments has declined. This bias suggests that patients may not be making informed choices about evidence based therapies, thereby increasing the suffering and economic burden associated with anxiety and related disorders. The purpose of this dissertation was to examine variables related to treatment choice in anxiety and related disorders, and to explore methods for improving the selection process to promote informed choice of therapy. The first phase of the project focused on considerations that may be unique to individuals selecting treatment for anxiety and related disorders, to examine variables that may be associated with past and present treatment choices. The second phase drew upon research on decision making and treatment selection from social psychology to formulate hypotheses about how treatment selection for anxiety and related disorders can be improved. Adults with significant anxiety symptoms (n= 105) were randomly assigned to one of three conditions in which they were presented with arguments in favour of psychological treatment and pharmacological treatment. The conditions varied on relative strength of argument combinations for each modality. In keeping with the Elaboration Likelihood Model (Petty & Cacioppo, 1981, 1986a), it was predicted that strong arguments would only be persuasive if participants had the ability and motivation to scrutinize them. The majority of participants rated arguments for psychological treatment as stronger, regardless of condition. Participants displayed a strong preference for psychological treatment, across forced choice measures and rating scales, and tended to endorse psychological attributions for their anxiety. Findings from this study could inform efforts aimed at promoting critical and informed decision making in treatment for anxiety and related disorders. In addition, findings could be of great importance to dissemination efforts aimed at meeting patient preferences for anxiety treatment and increasing the uptake of CBT.

scholarly journals Case complexity as a guide for psychological treatment selection.

2017 ◽  
Vol 85 (9) ◽  
pp. 835-853 ◽  
Author(s):  
Jaime Delgadillo ◽  
Dale Huey ◽  
Hazel Bennett ◽  
Dean McMillan
Keyword(s):  
Psychological Treatment ◽  
Treatment Selection ◽  
Case Complexity

scholarly journals Derivation and validation of a type 2 diabetes treatment selection algorithm for SGLT2-inhibitor and DPP4-inhibitor therapies based on glucose-lowering efficacy: cohort study using trial and routine clinical data

2021 ◽  
Author(s):  
John M Dennis ◽  
Katherine G Young ◽  
Andrew P McGovern ◽  
Bilal A Mateen ◽  
Sebastian J Vollmer ◽  
...  
Keyword(s):  
Clinical Data ◽  
Sglt2 Inhibitor ◽  
Trial Data ◽  
Treatment Selection ◽  
Inhibitor Therapy ◽  
Validation Sample ◽  
Selection Algorithm ◽  
Dpp4 Inhibitor ◽  
Type 2 Diabetes Treatment

Objective: To establish whether clinical patient characteristics routinely measured in primary care can identify people with differing short-term benefits and risks for SGLT2-inhibitor and DPP4-inhibitor therapies, and to derive and validate a treatment selection algorithm to identify the likely optimal therapy for individual patients. Design: Prospective cohort study. Setting: Routine clinical data from United Kingdom general practice (Clinical Practice Research Datalink [CPRD]), and individual-level clinical trial data from 14 multi-country trials of SGLT2-inhibitor and DPP4-inhibitor therapies. Participants: 26,877 new users of SGLT2-inhibitor and DPP4-inhibitor therapy in CPRD over 2013-2019, and 10,414 participants randomised to SGLT2-inhibitor or DPP4-inhibitor therapy in 14 clinical trials, including 3 head-to-head trials of the two therapies (n=2,499). Main outcome measures: The primary outcome was achieved HbA1c 6 months after initiating therapy. Clinical features associated with differential HbA1c outcomes with SGLT2-inhibitor and DPP4-inhibitor therapies were identified in routine clinical data, with associations then tested in trial data. A multivariable treatment selection algorithm to predict differential HbA1c outcomes was developed in a CPRD derivation cohort (n=14,069), with validation in a CPRD validation cohort (n=9,376) and the head-to-head trials. In CPRD, we further explored the relationship between model predictions and secondary outcomes of weight loss and treatment discontinuation. Results: The final treatment selection algorithm included HbA1c, eGFR, ALT, age, and BMI, which were identified as predictors of differential HbA1c outcomes with SGLT2-inhibitor and DPP4-inhibitor therapies using both routine and trial data. In validation cohorts, patient strata predicted to have a ≥5 mmol/mol HbA1c reduction with SGLT2-inhibitor therapy compared with DPP4-inhibitor therapy (38.8% of CPRD validation sample) had an observed greater reduction of 8.8 mmol/mol [95%CI 7.8-9.8] in the CPRD validation sample, a 5.8 mmol/mol (95%CI 3.9-7.7) greater reduction in the Cantata D/D2 trials, and a 6.6 mmol/mol [95%CI 2.2-11.0]) greater reduction in the BI1245.20 trial. In CPRD, there was a greater weight reduction with SGLT2-inhibitor therapy regardless of predicted glycaemic benefit. Strata predicted to have greater reduction in HbA1c on SGLT2-inhibitor therapy had a similar risk of discontinuation as on DPP4-inhibitor therapy. In contrast, strata predicted to have greater reduction in HbA1c with DPP4-inhibitor therapy were half as likely to discontinue DPP4-inhibitor therapy than SGLT2-inhibitor therapy. Conclusions: Routinely measured clinical features are robustly associated with differential glycaemic responses to SGLT2-inhibitor and DPP4-inhibitor therapies. Combining features into a treatment selection algorithm can inform clinical decisions concerning optimal type 2 diabetes treatment choices.

scholarly journals A demonstration of a multi-method variable selection approach for treatment selection: Recommending cognitive-behavioral versus psychodynamic therapy for mild to moderate adult depression

2017 ◽  
Author(s):  
Zachary Daniel Cohen ◽  
Thomas Kim ◽  
Henricus Van ◽  
Jack Dekker ◽  
Ellen Driessen
Keyword(s):  
Variable Selection ◽  
Rating Scale ◽  
Psychological Treatment ◽  
Selection Procedure ◽  
Patient Characteristics ◽  
Treatment Recommendations ◽  
Psychodynamic Therapy ◽  
Treatment Selection ◽  
Cognitive Behavioral ◽  
Treatment Needs

Objective: We use a new variable selection procedure for treatment selection which generates treatment recommendations based on pre-treatment characteristics for adults with mild-to-moderate depression deciding between cognitive behavioral (CBT) versus psychodynamic therapy (PDT).Method: Data are drawn from a randomized comparison of CBT versus PDT for depression (N=167, 71%-female, mean-age=39.6). The approach combines four different statistical techniques to identify patient characteristics associated consistently with differential treatment response. Variables are combined to generate predictions indicating each individual’s optimal-treatment. The average outcomes for patients who received their indicated treatment versus those who did not were compared retrospectively to estimate model utility.Results: Of 49 predictors examined, depression severity, anxiety sensitivity, extraversion, and psychological treatment-needs were included in the final model. The average post-treatment Hamilton-Depression-Rating-Scale score was 1.6 points lower (95%CI=[0.5:2.8]; d=0.21) for those who received their indicated-treatment compared to non-indicated. Among the 60% of patients with the strongest treatment recommendations, that advantage grew to 2.6 (95%CI=[1.4:3.7]; d=0.37). Conclusions: Variable selection procedures differ in their characterization of the importance of predictive variables. Attending to consistently-indicated predictors may be sensible when constructing treatment selection models. The small-N and lack of separate validation sample indicate a need for prospective tests before this model is used.

Field test for environmental correlates of dispersal in hedgehogs Erinaceus europaeus

2001 ◽  
Vol 70 (1) ◽  
pp. 33-46 ◽  
Author(s):  
Doncaster C. Patrick ◽  
Rondinini Carlo ◽  
Johnson Paul C. D.
Keyword(s):  
Field Test ◽  
Erinaceus Europaeus ◽  
Environmental Correlates

Chronic Pain: Fundamental Scientific Considerations, Specifically for Legal Claims

2013 ◽  
Vol 18 (1) ◽  
pp. 1-18 ◽  
Author(s):  
Robert J. Barth
Keyword(s):  
Health Outcomes ◽  
Pain Perception ◽  
Driving Forces ◽  
Psychological Treatment ◽  
Dominant Role ◽  
Meta Analysis ◽  
General Medicine ◽  
Pain Syndrome ◽  
Problematic Relationship

Abstract Scientific findings have indicated that psychological and social factors are the driving forces behind most chronic benign pain presentations, especially in a claim context, and are relevant to at least three of the AMA Guides publications: AMA Guides to Evaluation of Disease and Injury Causation, AMA Guides to Work Ability and Return to Work, and AMA Guides to the Evaluation of Permanent Impairment. The author reviews and summarizes studies that have identified the dominant role of financial, psychological, and other non–general medicine factors in patients who report low back pain. For example, one meta-analysis found that compensation results in an increase in pain perception and a reduction in the ability to benefit from medical and psychological treatment. Other studies have found a correlation between the level of compensation and health outcomes (greater compensation is associated with worse outcomes), and legal systems that discourage compensation for pain produce better health outcomes. One study found that, among persons with carpal tunnel syndrome, claimants had worse outcomes than nonclaimants despite receiving more treatment; another examined the problematic relationship between complex regional pain syndrome (CRPS) and compensation and found that cases of CRPS are dominated by legal claims, a disparity that highlights the dominant role of compensation. Workers’ compensation claimants are almost never evaluated for personality disorders or mental illness. The article concludes with recommendations that evaluators can consider in individual cases.

Serum Thiamine Values in End-Stage Renal Disease Patients under Maintenance Hemodialysis

2015 ◽  
Vol 85 (5-6) ◽  
pp. 348-355 ◽  
Author(s):  
Masamitsu Ubukata ◽  
Nobuyuki Amemiya ◽  
Kosaku Nitta ◽  
Takashi Takei
Keyword(s):  
Thiamine Deficiency ◽  
Risk Index ◽  
Nutritional Risk ◽  
Maintenance Hemodialysis ◽  
Dialysis Patients ◽  
Significant Difference ◽  
Nutritional Risk Index ◽  
Serum Aspartate Aminotransferase ◽  
Stage Renal Disease ◽  
End Stage

Abstract. Objective: Hemodialysis patients are prone to malnutrition because of diet or many uremic complications. The objective of this study is to determine whether thiamine deficiency is associated with regular dialysis patients. Methods: To determine whether thiamine deficiency is associated with regular dialysis patients, we measured thiamine in 100 patients undergoing consecutive dialysis. Results: Average thiamine levels were not low in both pre-hemodialysis (50.1 ± 75.9 ng/mL; normal range 24 - 66 ng/mL) and post-hemodialysis (56.4 ± 61.7 ng/mL). In 18 patients, post-hemodialysis levels of thiamine were lower than pre-hemodialysis levels. We divided the patients into two groups, the decrease (Δthiamine/pre thiamine < 0; - 0.13 ± 0.11) group (n = 18) and the increase (Δthiamine/pre thiamine> 0; 0.32 ± 0.21)) group (n = 82). However, there was no significance between the two groups in Kt/V or type of dialyzer. Patients were dichotomized according to median serum thiamine level in pre-hemodialysis into a high-thiamine group (≥ 35.5 ng/mL) and a low-thiamine group (< 35.4 ng/mL), and clinical characteristics were compared between the two groups. The low-thiamine value group (< 35.4 ng/ml; 26.8 ± 5.3 ng/ml) exhibited lower levels of serum aspartate aminotransferase and alanine aminotransferase than the high-thiamine value group (≥ 35.4 ng/ml; 73.5 ± 102.5 ng/ml) although there was no significance in nutritional marker, Alb, geriatric nutritional risk index , protein catabolic rate and creatinine generation rate. Conclusion: In our regular dialysis patients, excluding a few patients, we did not recognize thiamine deficiency and no significant difference in thiamine value between pre and post hemodialysis.

Are Individuals in Rorschach Nonpatient Samples Truly Psychologically Healthy?

2015 ◽  
Vol 36 (2) ◽  
pp. 112-155 ◽  
Author(s):  
Anna Maria Rosso ◽  
Andrea Camoirano ◽  
Gabriele Schiaffino
Keyword(s):  
Psychological Treatment ◽  
Coping Styles ◽  
Anxiety And Depression ◽  
Future Research ◽  
Extensive Form ◽  
Community Needs ◽  
Rorschach Comprehensive System ◽  
Form Quality ◽  
And Coping ◽  
Rorschach Variables

Abstract. The aim of this study was to collect a Rorschach Comprehensive System (RCS) adult nonpatient sample from Italy using more stringent exclusion criteria and controlling for psychopathology, taking into account the methodological suggestions of Ritzler and Sciara (2008) . The authors hypothesized that: (a) adult nonpatient samples are not truly psychologically healthy, in that a high number of psychopathological symptoms are experienced by participants, particularly anxiety and depression, although they have never been in psychological treatment; (b) significant differences emerge between healthy and nonhealthy groups on Rorschach variables, particularly on CS psychopathological indexes; (c) RCS psychopathological indexes are significantly correlated in the expected direction with scores on psychopathological scales. The results confirmed the hypotheses, indicating the need to collect psychologically healthy samples in addition to normative and nonpatient samples. Because differences were found in the comparison between Exner’s sample (2007) and the healthy group in this study regarding form quality and coping styles, the authors suggest that future research should investigate the construct validity of ambitent style and culturally specific influences on form quality. Moreover, the Rorschach scientific community needs to have more extensive form quality tables, enriched with objects that are currently not included.

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