Investigating Physician-Directed Chemotherapy Handouts to Improve Patient Knowledge of Chemotherapy

Blood ◽  
2015 ◽  
Vol 126 (23) ◽  
pp. 5575-5575
Author(s):  
George Zacharia ◽  
Ali M. Ameri
Keyword(s):  
Side Effects ◽  
Conflicts Of Interest ◽  
Small Sample Size ◽  
Symptom Control ◽  
Chemotherapeutic Agents ◽  
Small Sample ◽  
Cancer Drug ◽  
Chemotherapy Patients ◽  
To Receive ◽  
Improve Patient

Abstract Background: One of the basic goals of an oncologist is to educate patients as to the purpose of treatment and possible side effects of chemotherapy. Evidence suggests that patients who gain knowledge perform better self-care, cope better, and have better symptom control (Dodd, Res Nurs Health 1984; Williams et al, Oncol Nurs Forum 2004). However, we have found that in our clinic, patients frequently misunderstand the information presented to them regarding cancer treatment. This can lead to difficulties on both ends of the patient-physician spectrum. In our institution, it is standard policy for patients commencing chemotherapy as an outpatient to have a lengthy discussion with their oncologist regarding their diagnosis, type of chemotherapy, and side effects of chemotherapy 1-2 weeks before treatment. These patients then receive a handout in our outpatient infusion center from a nurse which contains the names of all the chemotherapeutic agents and possible side effects. The nurse also personally reviews the medications with the patients prior to administration. We have observed that despite receiving verbal and written education, cancer patients often cannot recall the names of the chemotherapeutic agents and side effects of treatment. We are investigating whether physician-directed handouts (PDH), in addition to education provided by nurses, prior to commencement of chemotherapy compared to our current practice could improve cancer drug education in our patients. Methods: We randomized 13 patients starting chemotherapy to receive either PDH or no PDH. The PDH included the name of the chemotherapy as well as 3-5 major and common side effects, which were highlighted. The handouts also contained the patient's chemotherapy cycle (i.e. how often they would be receiving chemotherapy). Patients then continued to receive handouts and education from the nurses at the outpatient infusion center as previously described. Four to six weeks after starting chemotherapy, patient took a multiple choice quiz which tested knowledge in three areas: names of the chemotherapeutic drugs or regimen they received, major side effects, and how often they were receiving chemotherapy. Eight to ten weeks after starting chemotherapy, patients again took the same quiz. Results: Of 13 patients randomized (6 to PDH and 7 to no PDH), 12 completed the study (5 PDH patients, 7 no PDH patients). Demographics: median age 63 years (20-89 years); 5 male; 8 female. At 4-6 weeks, patients in the PDH group and in the no PDH group scored 86% and 77%, respectively. At 8-10 weeks, patients in the PDH group and in the no PDH group scored 84% and 77%, respectively. With the exception of knowledge of chemotherapy cycles at 8-10 weeks (80% vs 100%), patients in the PDH group scored the same or better across all three of the main areas tested in the quizzes (first quiz: chemotherapy names 83% vs 73%, side effects 82% vs 71%, chemotherapy cycles 100% vs 100%; second quiz: chemotherapy names 91% vs 81%, side effects 78% vs 64%, chemotherapy cycles 80% vs 100%). Conclusions: Patients receiving PDH scored higher overall compared to patients that did not receive PDH. Dedicated education by physicians with handouts highlighting the most important aspects of treatment, in addition to education provided by chemotherapy nurses, may be beneficial to patients undergoing chemotherapy. Given the limitations of this small sample size, larger studies are warranted to evaluate these findings. Figure 1. Patients were either given a physician-directed handout (PDH) or no PDH prior to commencement of chemotherapy. Four to six weeks after starting chemotherapy, they took their first quiz. Eight to ten weeks after initiation of chemotherapy, patients took a second quiz. Figure 1. Patients were either given a physician-directed handout (PDH) or no PDH prior to commencement of chemotherapy. Four to six weeks after starting chemotherapy, they took their first quiz. Eight to ten weeks after initiation of chemotherapy, patients took a second quiz. Disclosures No relevant conflicts of interest to declare.

scholarly journals Randomized Double-blind Placebo-controlled Proof-of-concept Trial of Resveratrol for Outpatient Treatment of Mild Coronavirus Disease (COVID-19)

2021 ◽  
Author(s):  
Marvin R. McCreary ◽  
Patrick M. Schnell ◽  
Dale A. Rhoda
Keyword(s):  
Pulmonary Embolism ◽  
Adverse Events ◽  
Small Sample Size ◽  
Primary Outcome Measure ◽  
Small Sample ◽  
Double Blind ◽  
Phase 2 Study ◽  
Clinically Significant ◽  
Low Incidence ◽  
To Receive

Abstract Resveratrol is a polyphenol that has been well studied and has demonstrated anti-viral and anti-inflammatory properties that might mitigate the effects of COVID-19. Outpatients (N=105) were recruited from central Ohio in late 2020. Participants were randomly assigned to receive placebo or resveratrol. Both groups received a single dose of Vitamin D3 which was used as an adjunct. The primary outcome measure was hospitalization within 21 days of symptom onset; secondary measures were ER visits, incidence of pneumonia and pulmonary embolism. Five patients chose not to participate after randomization. Twenty-one day outcome was determined of all one hundred participants (mean [SD] age 55.6 [8.8] years; 61% female) (or their surrogates). There were no clinically significant adverse events attributed to resveratrol. Outpatients in this phase 2 study treated with resveratrol had a lower incidence compared to placebo of: hospitalization (2% vs. 6%, RR 0.33, 95% CI 0.04-3.10), COVID-related ER visits (8% vs. 14%, RR 0.57, 95% CI 0.18-1.83), and pneumonia (8% vs. 16%, RR 0.5, 95% CI 0.16-1.55). One patient (2%) in each group developed pulmonary embolism (RR 1.00, 95% CI: 0.06-15.55). This underpowered study was limited by small sample size and low incidence of primary adverse events. A larger trial could determine efficacy.TRIAL REGISTRATIONS: ClinicalTrials.gov NCT04400890 26/05/2020; FDA IND #150033 05/05/2020

scholarly journals Effects of a web-based preoperative education program for patients undergoing ambulatory surgery: a preliminary study

2012 ◽  
Vol 1 (1) ◽  
pp. 21 ◽  
Author(s):  
Eun-Shim Nahm ◽  
Lena Stevens ◽  
Pamela Scott ◽  
Kristy Gorman
Keyword(s):  
Usual Care ◽  
Small Sample Size ◽  
Day Surgery ◽  
Small Sample ◽  
Preoperative Education ◽  
Convenience Sample ◽  
Web Based ◽  
Teaching Satisfaction ◽  
Preliminary Study ◽  
Improve Patient

Increasing numbers of surgical procedures that were once done in hospitals are now being performed in ambulatory care settings. Provision of quality preoperative education in those settings has become a challenge. This article reports findings from a practice-based study where the nurses in a preoperative preparation center implemented a supplemental, web-based educational program for same-day surgery patients and assessed its outcomes (N = 69). The patients who used the web-based program in addition to usual care achieved significantly higher scores for anesthesia knowledge (t = 2.15, p = 0.04) and teaching satisfaction (t = 2.13, p = 0.04) than those who received usual care only. The findings demonstrate a great potential for use of web-based programs to improve patient education in busy preoperative care areas. A convenience sample with a small sample size was a major limitation. Further studies with large samples are needed to demonstrate tangible clinical outcomes.

Targeting Bcl-2 Family Proteins in Adult T-Cell Leukemia/Lymphoma: In Vitro and In Vivo Effects of a Novel Bcl-2 Family Inhibitor ABT-737.

Blood ◽  
2009 ◽  
Vol 114 (22) ◽  
pp. 1685-1685
Author(s):  
Kenji Ishitsuka ◽  
Chie Ishikawa ◽  
Fusanori Yotsumoto ◽  
Hiroo Katsuya ◽  
Naoko Kunami ◽  
...  
Keyword(s):  
Patient Outcome ◽  
T Cell ◽  
Conflicts Of Interest ◽  
Interleukin 2 ◽  
Chemotherapeutic Agents ◽  
Improve Patient Outcome ◽  
Type I ◽  
Induced Apoptosis ◽  
Improve Patient

Abstract Abstract 1685 Poster Board I-711 Adult T-cell lymphoma/leukemia (ATLL) is a T-cell malignancy caused by human T-lymphotrophic virus type I (HTLV-I), and its therapeutic outcome is still remains very poor. Therefore, novel therapeutic strategies are needed to improve patient outcome. In this study, we elucidated the therapeutic potential to target anti-apoptotic Bcl-2 family proteins for the treatment of ATLL by using ABT-737 (Abbott Laboratories, Abbott Park, IL, USA), a small molecule inhibitor of Bcl-2, Bcl-XL and Bcl-w. We first validated the rationale of this study by assessing the expression of Bcl-2 family proteins among 25 lymph-node specimens derived from ATLL patients by using immunohistochemistory. Both or either of Bcl-2 and Bcl-XL proteins was highly expressed in 80% of specimens. We next examined the cytotoxicity of ABT-737 against ATLL cell lines. ABT-737 significantly inhibited growth of MT-1, MT-2 and HuT 102 cells with a concentration of 50 percent inhibition (IC50) at 72 h of 2.4, 0.23 and 0.008μM, respectively. We then elucidated the mechanism of growth inhibition induced by ABT-737 using MT-1 and MT-2 cells. ABT-737 induced apoptosis in MT-1, MT-2 cells with cleavage of caspase 9, 3 and PARP. ABT-737 also induced apoptosis in fresh tumor cells derived from patients with ATLL. We next elucidated the potential of ABT-737 to enhance the cytotoxicity induced by conventional chemotherapeutic agents. The interaction between them was evaluated using the Chou-Talalay method by determining the combination index. ABT-737 synergistically enhanced the cytotoxicity and apoptosis induced by either of doxorubicin, vincristine or etoposide, which is a current key drug to treat ATLL. Most importantly, ABT-737 significantly inhibited tumor growth of in vivo ATLL model using SCID mice inoculated by HuT 102 cells subcutaneously. The mean tumor volume, weight and serum level of soluble interleukin-2 receptor á of ABT-737 (100mg/kg/day)-treated mice were significantly lower than those of vehicle-treated mice after treatment for 21 days. Moreover, massive induction of apoptosis in tumors treated by ABT-737 was observed by immunofluorescent TUNEL assay. These results suggest that ABT-737 used either alone or in combination with conventional cytotoxic drugs, represents a promising novel targeted approach to overcome drug resistance and improve patient outcome in ATLL. Disclosures No relevant conflicts of interest to declare.

Use of Plerixafor in Predicted and Proven Poor Mobilizer (according to GITMO criteria). Experience of Policlinico Universitario Tor Vergata

Blood ◽  
2012 ◽  
Vol 120 (21) ◽  
pp. 4415-4415
Author(s):  
Massimiliano Postorino ◽  
Alessandro Lanti ◽  
Eleonora Fiorelli ◽  
Angelo Salvatore Ferraro ◽  
Oana Marilena Chiru ◽  
...  
Keyword(s):  
Side Effects ◽  
Conflicts Of Interest ◽  
Minimum Requirement ◽  
Correct Definition ◽  
Cd34 Cells ◽  
Minimum Number ◽  
Poor Mobilizer ◽  
Operational Criteria ◽  
Definition Of ◽  
To Receive

Abstract Abstract 4415 BACKGROUND. Autologous stem cell transplantation (ASCT) of PBSCs has become a widely applied treatment for Multiple Mieloma (MM), non- Hodgking's lymphoma (NHL) and Hodgking's lymphoma (HL). Successful engraftment correlates with the number of CD34 hemopoietic progenitors cells infused. However, a part of MM or lymphoma patients (5% to 40%) fail to mobilize adequate numbers of PBSCs and thus cannot undergo to ASCT. The success of PBSCs mobilization is usually assessed by the total number of CD34+ stem cells collected, with a cutoff of 2.0–2.5 ×106 CD34+ cells/kg recipient body weight being considered as a minimum requirement for transplant. Poor mobilization of PBSCs is a major limitation to ASCT. Recently GITMO Working Group worked to define operational criteria for the identification/prediction of the poor mobilizer (PM) patients (Olivieri et al. 2011). Plerixafor, a CXCR4 chemochine antagonist, has been showed to improve significantly PBSC mobilization in PM patients. We present our experience using Plerixafor in PM patients classified according to GITMO criteria. METHODS. Between September 2009 and June 2012, a total of 17 patients (9F-8M) were enrolled. The diagnosis were: 10 MM (5F-5M), 1HL (1M), 6 NHL (4F-2M). The median age was 57 (range 15–66). 7 patients (3MM, 4NHL) were defined “Proven PM” and 10 patients (7MM, 2NHL, 1HL) “Predicted PM” according to GITMO criteria. The mobilization protocol included G-CSF, administered at a dose of 10μg/kg daily on 4 consecutive days. In the evening of the fourth day, patients received subcutaneous plerixafor at a dose of 0,24 mg/kg. Apheresis was initiated on the fifth day, 10–12 h after plerixafor and 1 h after G-CSF administration. Apheresis and daily administration of G-CSF and plerixafor continued until the patient collected enough CD34+ cells for auto- HSCT (> 2 ×106/kg; max 7 plerixafor injections if required). PBSC collection was initiated if peripheral CD34+ cells count was >10μl. A successful mobilization was defined as a total yeld of > 2×106/kg. RESULTS. 13 patients (76,5%) collected the minimum number of CD34 cells > 2×106/kg. The diagnosis were: 8MM, 1HL,1 NHL. 7 patients (2NHL; 4 MM; 1 LH; 7 predicted) were able to collect > 5×106/Kg. Only 4 patients (3 MM; 1 LNH; 4 proven) failed the mobilization because the numbers of cells CD34 were < 10μL and these patients did not undergo to apheresis procedures. The collection target of 2×106/Kg was reached in a median of 2 apheresis session (range 1–3). The technical characteristics of the procedures were (median value): blood volume processed 12 L (range 9–14), total CD34+/Kg collected 3,06 × 106(range 2,21-8,62), procedure efficiency 47,5% (range 35,3–79), duration of the procedure 261 minutes (range 210–309). Plerixafor was well tolerated and mild side effects were: reactions in the injection site, gastrointestinal disturbs, muscle pain. During administration of plerixafor we did not observe any significant laboratory abnormalities of liver or renal function. CONCLUSION. Unsuccessful mobilization represents an important limitation to ASCT in lymphoma and MM. In our experience plerixafor allowed to collect an appropriate amount of CD34 also in patients defined “proven PM” significantly reducing the percentage of patients that could not undergo ASCT (target value obtained in 43% of “proven PM”). Confirming the recent literature plerixafor is well tolerated with minimal side effects. We retrospectively applied GITMO criteria for PM patients and our experience, although limited, confirm that the use of a correct definition of PM allows the appropriate use of new mobilizing agents like plerixafor increasing significantly the therapeutic options also in patients who had no possibilities to receive an ASCT with the traditional mobilizing therapy. Disclosures: No relevant conflicts of interest to declare.

Periodic Evaluation Of The Clone Size Is Mandatory In PNH: Study Of The Spanish Cohort Of The International PNH Registry

Blood ◽  
2013 ◽  
Vol 122 (21) ◽  
pp. 3715-3715
Author(s):  
Ana Villegas ◽  
Ana Gaya ◽  
Emilio Ojeda ◽  
Ataulfo Gonzalez ◽  
Alvaro Urbano ◽  
...  
Keyword(s):  
Conflicts Of Interest ◽  
Small Sample Size ◽  
Small Sample ◽  
Additional Patient ◽  
Clone Size ◽  
Hematopoietic Stem ◽  
Future Analysis ◽  
Group I ◽  
Group Ii ◽  
Pnh Clone

Abstract Background Paroxysmal nocturnal hemoglobinuria (PNH) is a chronic, life threatening hematopoietic stem cell disorder with chronic hemolytic anemia, peripheral blood cytopenias and thrombosis Aims To observe the PNH clone and LDH evolution of the Spanish patients enrolled in the International PNH Registry, the thrombotic events and the role of eculizumab Methods We analyzed the 117 patients enrolled in the Registry until Dec. 31st 2012, classified in 3 groups: Classic/ hemolytic (group I, n 59), PNH with another bone marrow disorder (group II, n 42) and Subclinical (group III, n 14). The variables analyzed were PNH clone size, LDH levels, and incidence of thrombosis. Medians and percentages should be taken with caution due to the relatively small sample size. In addition to data collected in the Registry, additional patient information was obtained from local physicians. Results The median (range) age at presentation was 36.6 yrs. (16-83); 48 patients (41.0%) were women. Median (range) time from disease start to enrollment was 11.3 years in group I (0.1-41.2), 3.5 in II (0.1-33.8) and 3.4 (0.3-20.8) in III. A total of 49 patients (39 in group I) were started on eculizumab, 38 prior to enrollment (31 in group I) and 11 on or after enrollment; 3 were treated prior to enrollment but discontinued for different reasons (pregnancy, ending trial, access problems). Clone evolution (Table 1). In group I the median clone size remained stable during the follow-up period in the Registry; however, 4 patients in group II evolved to group I, with granulocyte clones > 50% and LDH levels >2000 U/L, while 3 initially in group I evolved to group II at 6, 12 and 18 months respectively. At enrollment 64 patients had a clone ≥30% and 31<30%; 7 patients in group II had a clone ≥30% despite hypoplasia, and they were treated with eculizumab. In groups I and II median clone size increased from Diagnosis to Enrollment in line with the physiopathology of the disease. LDH evolution (Table 2). Median LDH levels at diagnosis were higher in group I. In this group the decrease in LDH level between Diagnosis and Enrollment could be attributed to the start of treatment in 31 patients before the enrollment visit, but that hypothesis will need confirmation in future analysis. Thrombotic episodes (Table 3). Twenty six patients (22.6%) presented 52 TEs along the study period, 41 in group I and 11 in group II. Of the 26, fourteen presented 1 TE, six 2, one 3, four 2 and one 5. Twenty five patients presented 51 TEs since the moment of diagnosis while they were not being treated with eculizumab. Only one patient in the treated group presented a TE (CVA), of which he recovered well; after 30 months of the episode continues with the treatment and scores 90 in the Karnofsky index. Fifty eight percent of the patients presenting TEs were male, showing they may be more prone to TE than women. Conclusions These data show the dynamic features of the disease in some patients, which justifies the necessity of regularly monitoring the clone size LDH levels are higher in patients with classical PNH at diagnostic; the effect of the treatment in the whole cohort will require future analysis Thrombosis is highly prevalent in PNH; 22.6% of the patients in this sample had at least 1 episode along their time in the study. Disclosures: No relevant conflicts of interest to declare.

scholarly journals What People with Newly Diagnosed MS (and their Families and Friends) Need to Know

2000 ◽  
Vol 2 (3) ◽  
pp. 29-39 ◽  
Author(s):  
Judy Wollin ◽  
Helen Dale ◽  
Nancy Spenser ◽  
Anne Walsh
Keyword(s):  
Multiple Sclerosis ◽  
Small Sample Size ◽  
Cross Sectional Study ◽  
Small Sample ◽  
Newly Diagnosed ◽  
Cross Sectional ◽  
Wide Range ◽  
Study Participants ◽  
To Receive ◽  
Depth Interviews

Abstract The aim of this retrospective study was to determine from people with multiple sclerosis (MS) and their families what information would assist a person with newly diagnosed MS — in which format, when, and from whom it should be delivered. Thirty-four Queensland, Australia, residents with MS and 18 family members and friends participated in the main study. Participants were self-selected for this purposive, statewide, cross-sectional study. Nine of the respondents answered open-ended questions in addition to the standard questionnaires, and seven respondents gave in-depth interviews. The respondents recommended that people with a recent MS diagnosis and their families be given a wide range of information reflective of their personal needs. The information should be provided in person (in both group and individual sessions). They preferred to receive the information from their physicians and the staff of the Multiple Sclerosis Society. Research aimed at cures and therapies, as well as counseling and support services, should be discussed early in the course of the disease. Because of the small sample size and retrospective design, additional studies with larger populations are suggested to confirm these results and their cross-cultural applicability.

Elevated Neutrophil: Lymphocyte Ratio Does Not Predict Survival In Multiple Myeloma Patients

Blood ◽  
2013 ◽  
Vol 122 (21) ◽  
pp. 5336-5336
Author(s):  
Jean Paul Atallah ◽  
Basem Azab ◽  
Abhirami Vivekanandarajah ◽  
Ali Naboush ◽  
Houssein Abdul Sater ◽  
...  
Keyword(s):  
Multiple Myeloma ◽  
Conflicts Of Interest ◽  
Small Sample Size ◽  
Predictive Ability ◽  
Continuous Variable ◽  
Small Sample ◽  
University Hospital ◽  
Neutrophil Lymphocyte Ratio ◽  
Lymphocyte Ratio ◽  
Significant Difference

Abstract Background Cancer associated inflammation is one of the key determinants of outcome in patients with cancer. An elevated neutrophil: lymphocyte ratio (NLR) has been identified as a predictor of worse survival in patients with various solid tumors compared to hematologic malignancies but no reports yet examined its impact on multiple myeloma. The aim of this study was to examine the prognostic value of an elevated NLR in multiple myeloma. Methods We had approval by our institutional review board to collect the data on patients diagnosed with multiple myeloma at Staten Island University Hospital between year 2000 and 2012 identified from our local cancer database. Data on demographics, conventional prognostic markers, laboratory analyzes including blood count results, and histopathology were collected and analyzed. A cox proportional survival analysis was carried out to assess the relationship between NLR and mortality. NLR was assessed as a continuous variable as well as categorical variable (quartile 0.5-1.5, 1.6-2.2, 2.3-3.8, and 3.9-22.3). Results A total of 96 patients were identified with a median age at diagnosis of 70 (IQR of 61 to 79) years. The median neutrophil count was 3.5 (2.5—5.1) x 10-9/liters, median lymphocyte count 1.5 (1.05-2.4) × 10-9/liters, while the NLR was 2.28 (1.53-3.88). The median overall survival was 147.5 weeks, IQR (88.5-320). NLR did not prove to be a significant predictor of death as a continuous variable (0.95 (0.85-1.06), p =0.35). Furthermore, there was no significant difference in survival with any of the quartiles of NLR. Compare to lowest quartile of NLR, Hazards ratio for the consecutive quartiles were 1.25 (0.56-2.79, p 0.55), 1.36 (0.61-3.04, p=0.45) and 0.89 (0.36-2.22, p=0.80). Conclusion NLR does not appear to offer useful predictive ability for outcome and survival in multiple myeloma patients. Our study is limited with small sample size, further studies are needed to validate our results. Disclosures: No relevant conflicts of interest to declare.

scholarly journals Effectiveness of Ondansetron versus Metoclopramide in Hyperemesis Gravidarum

2014 ◽  
Vol 9 (2) ◽  
pp. 27-32
Author(s):  
M Chhetry ◽  
A Thakur ◽  
P Basnet ◽  
R Joshi ◽  
H Sangraula ◽  
...  
Keyword(s):  
Hyperemesis Gravidarum ◽  
Small Sample Size ◽  
Supportive Therapy ◽  
Small Sample ◽  
Controlled Study ◽  
P Value ◽  
Weight Changes ◽  
Randomized Controlled ◽  
To Receive ◽  
Intravenous Medication

Aims: The aim was to evaluate the effectiveness of intravenous ondansetron as compared to intravenous metoclopramide in hyperemesis gravidarum. Methods: Sixty-eight patients with hyperemesis gravidarum were randomized to receive either intravenous ondansetron or intravenous metoclopramide according to randomization group, till they started tolerating orally along with supportive therapy and various treatment parameters were compared. Results: No statistically significant differences were found in the number of doses of intravenous medication used (three doses of ondansetron vs four doses of metoclopramide; p value 0.77), weight changes (ondansetron - 0 kg vs. metoclopramide – 1 kg; p value 0.11) during treatment, duration of intravenous fluids (ondansetron – 24 hours vs. metoclopramide- 24 hours; p value 0.48) in the two groups. The duration of hospital stay of the patients in the two groups was comparable (ondansetron - 3 days vs. metoclopramide - 3 days; p value 0.83).Conclusions: Metoclopramide and ondansetron appear to be equally effective to treat hyperemesis gravidarum. Although this was a prospective randomized controlled study, it had a small sample size and the results should be confirmed in a larger and powered study.DOI:http://dx.doi.org/10.3126/njog.v9i2.11753

scholarly journals Does Adjunctive Tigecycline Improve Outcomes in Severe-Complicated, Nonoperative Clostridium difficile Infection?

2017 ◽  
Vol 4 (1) ◽  
Author(s):  
Mary T. LaSalvia ◽  
Westyn Branch-Elliman ◽  
Graham M. Snyder ◽  
Monica V. Mahoney ◽  
Carolyn D. Alonso ◽  
...  
Keyword(s):  
Clostridium Difficile ◽  
Clostridium Difficile Infection ◽  
Surgical Intervention ◽  
Small Sample Size ◽  
Severity Of Illness ◽  
Small Sample ◽  
High Rate ◽  
Limited Power ◽  
Severe Clostridium Difficile Infection ◽  
To Receive

Abstract Severe Clostridium difficile infection is associated with a high rate of mortality; however, the optimal treatment for severe- complicated infection remains uncertain for patients who are not candidates for surgical intervention. Thus, we sought to evaluate the benefit of adjunctive tigecycline in this patient population using a retrospective cohort adjusted for propensity to receive tigecycline. We found that patients who received tigecycline had similar outcomes to those who did not, although the small sample size limited power to adjust for comorbidities and severity of illness.

Pilot study comparing telephone to in-person delivery of cognitive-behavioural therapy for trauma-related insomnia for rural veterans

2017 ◽  
Vol 24 (9) ◽  
pp. 629-635 ◽  
Author(s):  
C Laurel Franklin ◽  
Jessica L Walton ◽  
Amanda M Raines ◽  
Jessica L Chambliss ◽  
Sheila A Corrigan ◽  
...  
Keyword(s):  
Cognitive Behavioural Therapy ◽  
Small Sample Size ◽  
Meta Analysis ◽  
Mode Of Delivery ◽  
Behavioural Therapy ◽  
Small Sample ◽  
Post Treatment ◽  
Cognitive Behavioural ◽  
To Receive

Introduction It is estimated that 70% of patients with posttraumatic stress disorder (PTSD) have chronic insomnia. A recent meta-analysis examined cognitive-behavioural therapy for insomnia (CBT-I) in veterans with and without PTSD, and suggested that most studies had questionable methodology, but generally supported its effectiveness in this population. Further, while CBT-I via telehealth (i.e. using telecommunication and information technology to deliver health services) has shown effectiveness for primary insomnia, it has not been applied to PTSD-related insomnia. Methods Veterans with insomnia who were diagnosed with PTSD ( n = 12) or having significant subthreshold PTSD symptoms ( n = 6) on the Clinician Administered PTSD Scale were randomly assigned to receive CBT-I in-person ( n = 7) or by telephone ( n = 11), to pilot test the potential effectiveness, acceptability, and feasibility of administering CBT-I in rural veterans. A six-week CBT-I protocol was delivered, and the veteran’s insomnia was assessed at post-treatment and follow-up. Results Given the small sample size, Cohen’s d was used to detect group differences, finding large effect sizes favouring the in-person delivery, until three-months post-treatment when this difference diminished. Most veterans found the treatment acceptable, regardless of mode of delivery. Based on the results, a larger project is feasible. Feasibility for a larger project is favourable. Discussion In summary, our findings uphold and extend previous research. Specifically, current pilot data suggest that telephone-delivered CBT-I may be able to reduce trauma-related insomnia symptoms. Future trials are needed to assess the effectiveness of CBT-I delivered to rural veterans with posttraumatic insomnia.

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