scholarly journals Production Shared Health in Surgery: Innovate to Improve the Quality of Therapy Paths

2017 ◽  
Vol 5 (2) ◽  
pp. 117
Author(s):  
Antonio Giacomo Rizzo
Keyword(s):  
Quality Of Therapy

GROUP COGNITIVE THERAPY: TREATMENT OF CHOICE OR SUB-OPTIMAL OPTION?

2001 ◽  
Vol 29 (3) ◽  
pp. 311-332 ◽  
Author(s):  
Norma Morrison
Keyword(s):  
Group Therapy ◽  
Cognitive Therapy ◽  
Large Scale ◽  
Cost Effective ◽  
Advantages And Disadvantages ◽  
Quality Of Therapy ◽  
Group Format ◽  
Cognitive Behavioural ◽  
Therapy Treatment

In the present climate of limited resources and long waiting lists, it is not surprising that there is more emphasis on making sure that psychological treatments are not only clinically sound but also cost-effective. One solution to this is to provide time-limited, focused interventions such as cognitive therapy. Another obvious solution is to deliver treatment in groups rather than individually. However, what evidence is there that therapy can be delivered as effectively in groups as individually? This review will look at which different formats have been tried, what the advantages and disadvantages of those formats might be, which client groups have been targeted for cognitive- behavioural group therapy (CBGT), and whether a group format in general offers any advantages over individual CBT. Outcome studies and their implications for the use of CBGT are considered. Results suggest that, in most client groups, there is little difference in efficacy between group and individual CBT, although there is some evidence that results for some types of patient can be disappointing in CBGT. It may be that the best compromise in terms of cost- effectiveness between quality of therapy and quantity of patients treated is offered by large-scale psychoeducational didactic group therapy.

scholarly journals TRUST Study: Participation in Randomized Controlled Trials and Subsequent Adherence to Visiting Medical Institutions and Taking Medications in Patients with Cardiovascular Diseases. Part II. Assessment of the Quality of Therapy

2020 ◽  
Vol 16 (6) ◽  
pp. 977-983
Author(s):  
N. O. Vasyukova ◽  
N. P. Kutishenko ◽  
Yu. V. Lukina ◽  
O. I. Zvonareva ◽  
S. Yu. Martsevich
Keyword(s):  
Blood Pressure ◽  
Coronary Artery Disease ◽  
Clinical Trials ◽  
Control Group ◽  
Controlled Trials ◽  
Study Group ◽  
Randomized Controlled ◽  
Quality Of Therapy ◽  
Artery Disease

Aim. Based on the data of the TRUST study (Influence of Participation in Randomized Controlled Trials on adheRence to Medicines' Intake and regUlar viSits to the docTor) to assess the quality of drug therapy and patients' awareness of achieving target blood counts and blood pressure (BP) among patients with coronary artery disease (CAD), diabetes mellitus (DM), hypertension.Material and methods. 102 patients are enrolled in the study group of the TRUST study who participated in one or more randomized clinical trials (RCT) in the period from 2011 to 2018. A control group (n=109) included patients who had never participated in an RCT was selected. From January to April 2020, face-to-face or telephone contact was established with patients from both groups. In the study group, the response was 86.3%, in the control group - 81.7%. The adherence to drug therapy accordingly to current clinical guidelines was analyzed in patients with coronary artery disease in both groups.Results. Patients with CAD who previously participated in RCTs take drugs with proven efficacy significantly more often than patients who did not participate in clinical trials. All groups of drugs intake was significantly more frequent in the study group than in the control group: angiotensin-converting-enzyme inhibitors/angiotensin receptor blockers (odds ratio [OR] 7.66, 95% confidence interval [CI] 2.5-22.6; p=0.006), statins (OR 5.12, 95%CI 1.8-14.5; p=0.002), beta-blockers (OR 2.96, 95%CI 1.03-8.5; p=0.038), antiplatelet agents (OR 2.94, 95%CI 1.1-7.7; p=0.026). In the main group, 54.3% of patients with CAD knew about their level of low-density lipoprotein cholesterol (LDL-c), and 68% of them had an LDL level of ≤ 1.8 mmol/l. Patients with DM in 92.9% of cases were aware of their glucose level, and in 76.9% of them had the fasting glucose level <7 mmol/L. Hypertensive patients in 92.8% of cases controlled their blood pressure twice a day and 89.2% of them had a target blood pressure level (<140/90 mm Hg).Conclusion. Patients who participated in RCTs showed better adherence to treatment and health awareness compared to the control group. Partly, the approach to patient management, as it takes place in the RCTs model, can be implemented in real clinical practice to improve the quality of therapy in patients with cardiovascular disease.

scholarly journals Impact of newborn screening and quality of therapy on the neurological outcome in glutaric aciduria type 1: a meta-analysis

2020 ◽  
Vol 23 (1) ◽  
pp. 13-21 ◽  
Author(s):  
Nikolas Boy ◽  
Katharina Mengler ◽  
Jana Heringer-Seifert ◽  
Georg F. Hoffmann ◽  
Sven F. Garbade ◽  
...  
Keyword(s):  
Newborn Screening ◽  
Motor Development ◽  
Neurological Outcome ◽  
Meta Analysis ◽  
Glutaric Aciduria Type ◽  
Glutaric Aciduria Type 1 ◽  
Glutaric Aciduria ◽  
Quality Of Therapy

Abstract Purpose Glutaric aciduria type 1 (GA1), a rare inherited neurometabolic disorder, results in a complex movement disorder (MD) with predominant dystonia if untreated. Implementation into newborn screening (NBS) programs and adherence to recommended therapy are thought to improve the neurological outcome. Methods Systematic literature search for articles published from 2000 to 2019 was performed using the PRISMA protocol. Studies reporting on more than one individual identified by NBS were included. We investigated effects of interventional and noninterventional variables on neurological outcome. Results Fifteen publications reporting on 647 GA1 patients were included. In the NBS group (n = 261 patients), 195 patients remained asymptomatic (74.7%), while 66 patients (25.3%) developed a MD. Compared with the NBS group, a much higher proportion of patients (349/386; 90.4%; p < 0.0001) diagnosed after the manifestation of neurologic symptoms had a MD and an abnormal motor development (285/349; 81.7%; p < 0.0001). For NBS patients, deviations from the recommended diet increased the risk of insidious onset MD, while delayed start of emergency treatment increased the risk of acute onset MD. Conclusions This meta-analysis demonstrates that NBS programs for GA1 have an overall positive effect on the neurological outcome of affected individuals but their success critically depends on the quality of therapy.

Better quality of therapy with 5-ASA colonic foam in active ulcerative colitis

1993 ◽  
Vol 38 (10) ◽  
pp. 1843-1850 ◽  
Author(s):  
Massimo Campieri ◽  
Paolo Paoluzi ◽  
Giuseppe D'Albasio ◽  
Gabriele Brunetti ◽  
Angelo Pera ◽  
...  
Keyword(s):  
Ulcerative Colitis ◽  
Active Ulcerative Colitis ◽  
Quality Of Therapy

scholarly journals Main Approaches to Assessing the Quality of Drug Therapy in Cardiology

2018 ◽  
Vol 14 (4) ◽  
pp. 558-566
Author(s):  
S. Yu. Martsevich ◽  
N. P. Kutishenko ◽  
Yu. V. Lukina ◽  
N. A. Komkova ◽  
N. A. Dmitrieva ◽  
...  
Keyword(s):  
Drug Therapy ◽  
Cardiovascular Diseases ◽  
Clinical Guidelines ◽  
Positive Impact ◽  
Drug Evaluation ◽  
Clinical Situation ◽  
Drug Formulation ◽  
Universal Method ◽  
Quality Of Therapy

A competent choice of drug therapy in a specific clinical situation is a difficult and important task that a practical doctor must regularly solve in everyday practice, and the consequences of errors in this decision can be quite serious. Therefore, evaluation of the quality of the prescribed therapy is extremely important.In the treatment of cardiovascular diseases, medicines that have a proven effect on the outcomes of the disease, primarily on mortality rates (so-called "life-saving drugs") acquire special significance. There are several classes of such drugs, and in different situations, their positive impact on the prognosis of the disease may be different. On the other hand, one should remember the so-called "drug-related problems" (DRP), which include contraindications to the prescription of certain drugs in a particular patient, the possibility of developing side effects of drug therapy, aggravated by polypharmacy, inter-drug interaction, improper dosage of drugs, etc.In this publication, an attempt is made to identify the main components by which the quality of the prescribed therapy can be evaluated in the treatment of cardiovascular diseases: compliance of prescriptions with official instructions for preparations, modern clinical guidelines, adequate selection of a specific drug within the class, drug formulation, salt of the drug, evaluation of important safety parameters and efficacy of the prescribed drug. In addition, a review of the methods and scales of the composite evaluation of the quality of drug therapy developed to date has been conducted, as well as attempts to improve them and create new ones that continue to the present day. Nevertheless, none of the currently known methods for assessing the quality of therapy is not universal or devoid of shortcomings.Most likely, a universal method of assessing the quality of the prescribed treatment may not exist. In its most general form, it can be said that treatment should be based on modern evidence-based medicine, which is usually reflected in the clinical guidelines, without contradicting the official instruction on the use of the drug, considering the presence of concomitant diseases, that are often the reasons of contraindications to prescribing those or other medicines.

scholarly journals An Attempt to Accord the Quality of Therapy of Stable Coronary Heart Disease Patients with Current Clinical Guidelines (ALIGN study): Design and the First Results

2020 ◽  
Vol 16 (1) ◽  
pp. 75-81
Author(s):  
S. Yu. Martsevich ◽  
E. D. Zharkova ◽  
N. P. Kutishenko ◽  
Yu. V. Lukina ◽  
S. N. Tolpygina ◽  
...  
Keyword(s):  
Coronary Heart Disease ◽  
Heart Disease ◽  
Clinical Guidelines ◽  
Ldl Cholesterol ◽  
Quality Of Therapy ◽  
Stable Coronary Heart Disease ◽  
Target Values ◽  
History Of ◽  
First Time

Aim. To assess the quality of therapy in stable coronary heart disease (CHD) patients, who first sought consultation in the specialized cardiology department of the research center, and try to adjust the therapy in accordance with current clinical guidelines, paying special attention to achieving the target levels of blood pressure, low-density lipoprotein cholesterol (LDL), and glycosylated hemoglobin (in patients with diabetes mellitus), increasing exercise tolerance and improving the quality of life (QL).Material and methods. The ALIGN study is an integral part of the PROFILE outpatient registry. ALIGN study included all patients with verified coronary heart disease who came for consultation to the specialized institution for the first time or for the first time in more than the last 3 years. Patients have been recruited from December 01, 2017 to December 31, 2019. The study consisted of 4 visits: the first-time visit – inclusion in the study (V0), when drug therapy, QL, and adherence were evaluated, and therapy correction was made in accordance with clinical guidelines. In 3 months (V1) the target values of clinical and laboratory parameters were estimated. The third visit (V2) was planned to take place 1 year after the first visit with reevaluation of QL and patients' adherence to treatment, and effectiveness of the therapy. The fourth visit (V3)/telephone contact was planned in 2 years after the first visit to assess life status, get information about complications and therapy.Results. 389 people were included in the PROFILE registry for the specified period of time, 79 had a verified diagnosis of CHD, and 71 patients were included in the ALIGN study: 55 men (aged of 68.7±8.96 years) and 16 women (aged of 67.5±8.08 years). Arterial hypertension was registered in 90.1% of patients, stable angina class I-III – in 62%, 47.9% of patients had a history of acute myocardial infarction (AMI), 52.1% had percutaneous coronary intervention, 15.5% of patients had coronary artery bypass graft, chronic heart failure was detected in 40.8%, diabetes mellitus – in 21.1%, atrial fibrillation – in 15.5% of patients. Lipid-lowering drugs were taken by 53 (74.6%) patients, but only 21 (29.6%) achieved the target values of LDL cholesterol. Angiotensin-converting enzyme inhibitors were taken by 34 patients (47.9%), and angiotensin receptor blockers by 15 (21%) of patients, 47 (66.2%) patients took beta-blockers, antiplatelet agents were taken by 61 people, and anticoagulants by 10 patients. Patients who had a history of AMI had been prescribed BB in 88%, statins – in 90%, and renin-angiotensin-aldosterone system (RAAS) blockers – in 80% of cases.Conclusions. Initial quality of therapy for patients with stable CHD did not fully match the clinical guidelines: a quarter of patients did not receive lipidlowering therapy, and target levels of LDL cholesterol were achieved only in one third of patients. Among patients who had a history of AMI, every fifth patient did not receive RAAS blockers.

UPDATE ON THE MANAGEMENT OF IRRITABLE BOWEL SYNDROME

2013 ◽  
pp. 126-132
Author(s):  
Van Huy Tran
Keyword(s):  
Quality Of Life ◽  
Irritable Bowel Syndrome ◽  
Guanylate Cyclase ◽  
Recent Progress ◽  
Specific Therapy ◽  
New Agents ◽  
Quality Of Therapy ◽  
Key Word ◽  
Irritable Bowel

Irritable Bowel syndrome (IBS) is one of the most common diseases in gastrointestinal practice which affect seriously on the quality of life of the patients. A radical and specific therapy is not available until now. Management of IBS needs a complete approach including symptomatic, psychological and physiopathological treatment. Some new agents affecting on the receptors 5-HT3, 5-HT4 and Guanylate Cyclase have recently received approve from FDA and contributed to improve the quality of therapy of IBS. This article aims to review the recent progress in the researches and management of the IBS. Key word: Irritable Bowel syndrome (IBS)

scholarly journals An Upper Limit to Youth Psychotherapy Benefit? A Meta-Analytic Copula Approach to Psychotherapy Outcomes

2019 ◽  
Vol 7 (6) ◽  
pp. 1434-1449
Author(s):  
Payton J. Jones ◽  
Patrick Mair ◽  
Sofie Kuppens ◽  
John R. Weisz
Keyword(s):  
Effect Size ◽  
Psychotherapy Outcomes ◽  
Quality Of Therapy ◽  
Improved Outcomes ◽  
General Quality ◽  
Copula Approach ◽  
Youth Psychotherapy ◽  
Bivariate Copula ◽  
Therapy Quality

Across 50 years of research, extensive efforts have been made to improve the effectiveness of psychotherapies for children and adolescents. Yet recent evidence shows no significant improvement in youth psychotherapy outcomes. In other words, efforts to improve the general quality of therapy models do not appear to have translated directly into improved outcomes. We used multilevel meta-analytic data from 502 randomized controlled trials to generate a bivariate copula model predicting effect size as therapy quality approaches infinity. Our results suggest that even with a therapy of perfect quality, achieved effect sizes may be modest. If therapy quality and therapy outcome share a correlation of .20 (a somewhat optimistic assumption given the evidence we review), a therapy of perfect quality would produce an effect size of Hedges’s g = 0.83. We suggest that youth psychotherapy researchers complement their efforts to improve psychotherapy quality by investigating additional strategies for improving outcomes.

Machine Learning-Based Anomaly Detection Algorithms to Alert Patients Using Sensor Augmented Pump of Infusion Site Failures

2021 ◽  
pp. 193229682199785
Author(s):  
Lorenzo Meneghetti ◽  
Eyal Dassau ◽  
Francis J. Doyle ◽  
Simone Del Favero
Keyword(s):  
Machine Learning ◽  
Anomaly Detection ◽  
Machine Learning Algorithms ◽  
Infusion Site ◽  
Detection Algorithms ◽  
Quality Of Therapy ◽  
Unsupervised Anomaly Detection ◽  
Novel Method

Background: Personal insulin pumps have shown to be effective in improving the quality of therapy for people with type 1 diabetes (T1D). However, the safety of this technology is limited by the possible infusion site failures, which are linked with hyperglycemia and ketoacidosis. Thanks to the large availability of collected data provided by modern therapeutic technologies, machine learning algorithms have the potential to provide new way to identify failures early and avert adverse events. Methods: A clinical dataset ( N = 20) is used to evaluate a novel method for detecting real-time infusion site failures using unsupervised anomaly detection algorithms, previously proposed and developed on in-silico data. An adapted feature engineering procedure is introduced to make the method able to operate in the absence of a closed-loop (CL) system and meal announcements. Results: In the optimal configuration, we obtained a performance of 0.75 Sensitivity (15 out of 20 total failures detected) and 0.08 FP/day, outperforming previously proposed literature algorithms. The algorithm was able to anticipate the replacement of the malfunctioning infusion sets by ~2 h on average. Conclusions: On the considered dataset, the proposed algorithm showed the potential to improve the safety of patients treated with sensor-augmented pump systems.

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