Alprazolam and Exposure Alone and Combined in Panic Disorder with Agoraphobia

1993 ◽  
Vol 162 (6) ◽  
pp. 776-787 ◽  
Author(s):  
Isaac M. Marks ◽  
Richard P. Swinson ◽  
Metin Başoǧlu ◽  
Klaus Kuch ◽  
Homa Noshirvani ◽  
...  
Keyword(s):  
Panic Disorder ◽  
Combined Treatment ◽  
Randomised Trial ◽  
Treatment Groups ◽  
End Of Treatment ◽  
Group A ◽  
Contrast Group ◽  
Drop Outs ◽  
Cross National

A cross-national randomised trial of alprazolam for chronic panic disorder with agoraphobia was run. Compared with previous trials it had three new features: an exposure therapy contrast group, a six-month treatment-free follow-up, and a low rate of early placebo drop-outs (‘non-evaluables’). The dose of alprazolam was high (5 mg/day). The 154 patients had eight weeks of: alprazolam and exposure (combined treatment); or alprazolam and relaxation (a psychological placebo); or placebo and exposure; or placebo and relaxation (double placebo). Drug taper was from weeks 8 to 16. Follow-up was to week 43. Results were similar at both sites. Treatment integrity was good. All four treatment groups, including double placebo, improved well on panic throughout. On non-panic measures, by the end of treatment, both alprazolam and exposure were effective, but exposure had twice the effect size of alprazolam. During taper and follow-up, gains after alprazolam were lost, while gains after exposure were maintained. Combining alprazolam with exposure marginally enhanced gains during treatment, but impaired improvement thereafter. The new features put previous trials in a fresh light. By the end of treatment, though gains on alprazolam were largely as in previous studies, on phobias and disability they were half those with exposure. Relapse was usual after alprazolam was stopped, whereas gains persisted to six-month follow-up after exposure ceased. Panic improved as much with placebo as with alprazolam or exposure.

scholarly journals OSTEOARTHRITIS;

2014 ◽  
Vol 21 (03) ◽  
pp. 471-476
Author(s):  
Malik Muhammad Yasin Awan ◽  
Ijaz Ahmad ◽  
Amer Aziz
Keyword(s):  
Case Report Form ◽  
Inclusion Criteria ◽  
Double Blind ◽  
Treatment Groups ◽  
End Of Treatment ◽  
Womac Questionnaire ◽  
Group A ◽  
Vas Scores ◽  
Group B

Objective: To assess the efficacy and safety of aceclofenac in the treatment ofosteoarthritis. Study design: Randomized double blind Phase IV trial. Place and Duration ofstudy: This study was conducted in the department of Orthopaedics & Spine Surgery, GhurkiTrust Teaching Hospital, Lahore. The duration was eight weeks. Methodology: A total of 90subjects, fulfilling the inclusion criteria and willing to give free informed consent were enrolled inthis trial. All these subjects were randomized into two treatment groups (A & B). Subjects eitherreceived Aceclofenac 100 mg twice daily or Diclofenac 75 mg twice daily for 08 weeks. During thescreening visit, information on their demographic characteristics, medical history and previousand current medications were collected. A thorough physical examination and necessarylaboratory investigations were carried out before drug administration and after the completion oftreatment (end of week 8). Clinical examination was done at baseline visit, randomization and 2, 4and 8 weeks. Gastrointestinal (GI) safety was assessed using adverse drug reaction (ADR)reports. WOMAC questionnaire was used to see improvement in activities of daily living and painwas assessed using visual analogue scale (VAS). All data was collected in the case report form(CRF). Statistical evaluation was performed at the end of the trial and results were analyzed usingSPSS. Results: 70 subjects completed the study while 20 were lost in follow-up. There were 28males and 34 females in the study with mean age of 56 years. There was a significant decrease inWOMAC and VAS scores in both groups. In group A (Diclofenac group) VAS decreased from7.107 to 2.538 (p= 0.000) and WOMAC decreased from 32.75 to 7.38 (p=0.000). In group B(Aceclofenac group), VAS decreased from 7.912 to 6.0 (p=0.001) while WOMAC decreased from37.29 to 21.50 (p=0.000) showing the efficacy of both drugs. There was also significant decreasein the disease severity in both groups at the end of treatment. But the safety profile of (Diclofenac)group A was not significant (p=0.767) as compared to (Aceclofenac) group B (p=0.022).Conclusions: Aceclofenac is efficacious and safe drug for the treatment of osteoarthritis in adultsas compared to Diclofenac.

scholarly journals Combination of Alarm-intervention and Reboxetine in Therapy- Resistant Enuresis

2018 ◽  
Vol 37 (3) ◽  
pp. 213-219
Author(s):  
Kirill Kosilov ◽  
Irina Kuzina ◽  
Yuliya Gainullina ◽  
Vladimir Kuznetsov ◽  
Liliya Kosilova ◽  
...  
Keyword(s):  
Combined Treatment ◽  
Intervention Group ◽  
Monotherapy Group ◽  
First Line ◽  
Duration Of Treatment ◽  
End Of Treatment ◽  
Before And After ◽  
Group A ◽  
Group B

Introduction: The first-line treatments of primary monosymptomatic night enuresis (PMNE) are alarm intervention and desmopressin. Some patients are resistant to these modes of treatment. Therefore Reboxetine has been used to treat PMNE in these scenarios in recent years and published in many studies. The aim of the study was to determine effectiveness and safety of combination of Alarm intervention and Reboxetine, to treat patients with therapyresistant enuresis.Material and Methods: Two hundred and nineteen children of both sexes were participated in the experiment (average age, 11.3 years). Participants were divided into three groups: Group A (71 patients, Alarm intervention), Group B (79 patients, Reboxetine as monotherapy), Group C (69 patients, Alarm intervention + Reboxetine). The duration of treatment was twelve weeks, followed by follow-up period of twelve weeks to see efficacy.Result: There was no significant change in number of enuresis episodes per week before and after treatment in a group B. The number of enuresis episodes per a week (weekly) in a group C reached: before treatment 5.3 (1.5), after treatment 1.0 (0.8), 3 three months after the end of treatment 0.7 (0.7). The percentage of patients with PMNE in a group C was significantly less immediately after the course of treatment (17.4%), and three months after treatment (24.6%).Conclusion: Combined treatment of therapy-resistant enuresis with use of Alarm Intervention and Reboxetine gives a high percentage of cured patients both immediately after therapy (82.6%) and three months after the end (75.4%).

Alprazolam and Exposure for Panic Disorder with Agoraphobia

1994 ◽  
Vol 164 (5) ◽  
pp. 652-659 ◽  
Author(s):  
Metin Başoglu ◽  
Isaac M. Marks ◽  
Cengiz Kiliç ◽  
Richard P. Swinson ◽  
Homa Noshirvani ◽  
...  
Keyword(s):  
Side Effects ◽  
Panic Disorder ◽  
Drug Treatment ◽  
Psychological Treatment ◽  
Illness Severity ◽  
Withdrawal Symptoms ◽  
Severe Withdrawal ◽  
End Of Treatment

Patients with panic disorder plus agoraphobia had 8 weeks of drug treatment (alprazolam or placebo) plus psychological treatment (exposure or relaxation). At the end of treatment at week 8, 40 patients who had become much/very much improved rated how much their gains were attributable to medication or to their own efforts. During the tapering-off to week 16, and treatment-free follow-up to week 43, patients who at week 8 had attributed their gains to medication and felt less confident in coping without tablets had more severe withdrawal symptoms and greater loss of gains than did patients who at week 8 had attributed their gains to their own efforts during treatment. Baseline illness severity, greater age, higher expectations from drug treatment, and more side-effects of drugs during treatment all predicted more external attributions (i.e. to the effect of drugs) but did not independently predict relapse. Patients on alprazolam compared with placebo had more drug attributions. Though drug attributions predicted relapse in both alprazolam and placebo groups, predictions were stronger in the alprazolam group.

Video Tutorials Increase Precision in Minimally Invasive Surgery Training – a Prospective Randomised Trial and Follow-up Study

2018 ◽  
Vol 144 (02) ◽  
pp. 153-162
Author(s):  
Michael Thomaschewski ◽  
Hamed Esnaashari ◽  
Anna Höfer ◽  
Lotta Renner ◽  
Claudia Benecke ◽  
...  
Keyword(s):  
Minimally Invasive Surgery ◽  
Minimally Invasive ◽  
Invasive Surgery ◽  
Randomised Trial ◽  
Prospective Randomised Trial ◽  
Simulation Based ◽  
Video Tutorials ◽  
Group A ◽  
Group B

Abstract Background Simulation-based practice has become increasingly important in minimally invasive surgery (MIS) training. Nevertheless, personnel resources for demonstration and mentoring simulation-based practice are limited. Video tutorials could be a useful tool to overcome this dilemma. However, the effect of video tutorials on MIS training and improvement of MIS skills is unclear. Methods A prospective randomised trial (n = 24 MIS novices) was conducted. A video-trainer with three different tasks (#1 – 3) was used for standardised goal-directed MIS training. The subjects were randomised to two groups with standard instructional videos (group A, n = 12) versus comprehensive video tutorials for each training task watched at specific times of repetition (group B, n = 12). Performance was analysed using the MISTELS score. At the beginning and following the curriculum, an MIS cholecystectomy (CHE) was performed on a porcine organ model and analysed using the GOALS score. After 18 weeks, participants performed 10 repetitions of tasks #1 – 3 for follow-up analysis. Results More participants completed tasks #1 and #2 in group B (83.3 and 75%) than in group A (66.7 and 50%, ns). For task #2, there was a significant improvement in precision in group B (p < 0.001). For the entire cohort, the GOALS-Scores were 12.9 before and 18.9 after the curriculum (p < 0.001), with no significant difference between groups. Upon follow-up, 84.2% (task#1), 26.3% (task#2) and 100% (task#3) of MIS novices were able to reach the defined goals (A vs. B ns). There was a trend for a better MISTELS score in group B upon follow-up. Conclusions Standardised comprehensive video tutorials watched frequently throughout practice can significantly improve precision in MIC training. This aspect should be incorporated in MIS training.

High Skp2 Expression Is an Independent Predictor of Unfavorable Outcome in 333 Patients with Diffuse Large B Cell Lymphoma (DLBCL).

Blood ◽  
2007 ◽  
Vol 110 (11) ◽  
pp. 1560-1560
Author(s):  
Ritsuko Seki ◽  
Koichi Ohshima ◽  
Fumio Kawano ◽  
Toshihiko Murayama ◽  
Yukiyoshi Moriuchi ◽  
...  
Keyword(s):  
Clinical Stage ◽  
Combined Treatment ◽  
B Cell Lymphoma ◽  
Similar Distribution ◽  
Prognostic Impact ◽  
Advanced Clinical Stage ◽  
Treatment Groups ◽  
Skp2 Expression ◽  
New Treatment

Abstract The addition of rituximab to CHOP (CHOP-R) chemotherapy has resulted in an improved outcome for patients with DLBCL and has recently been shown to diminish the prognostic impact of several recognized biomarkers. S-phase kinase-associated protein 2 (Skp2) is a proto-oncogene that has been shown to be expressed in a number of tumors. We have reported that Skp2 expression in tumor cells is an unfavorable prognostic factor in DLBCL. In the present study, we investigated the significance of Skp2 expression in the patients with DLBCL treated with CHOP or CHOP-R. DLBCL patients (333 cases) were entered into this study, based on the availability of paraffin blocks for interpretable immunohistochemistry for all antigens (CD10, Bcl-6, MUM1, Bcl-2, Skp2). All patients were treated with either CHOP (201) or CHOP-R (132) from 1996 to 2005, and were diagnosed as having DLBCL at the twenty different hospitals. All specimens were histopathologically reviewed before entering into this study. Their clinical characteristics, including either the IPI or R-IPI factors, were evenly matched. The median follow-up of living patients was 3.7 and 2.1 y for CHOP vs CHOP-R, respectively. DLBCL were assigned to GCB subtype (40.8%: 136/333) or non-GCB subtype (59.2%: 197/333) based on the method of Hans et al., Blood 103: 275–82 (2004), with similar distribution in both treatment groups. Expression of bcl-6 (p&lt;0.05) or GCB subtypes (p&lt;0.05) was associated with better overall survival (OS), whereas expression of bcl-2 (p&lt;0.05) was associated with worse OS in CHOP treatment group. The addition of R was associated with an improved survival in the non-GCB subtype and resulted in same as that of GCB subtype. The survival benefit of both low Bcl-2 and high Bcl-6 expressions diminished in combined treatment with R to CHOP. There were 97 patients with high Skp2 expression (&gt;60% positive cells) (97/333: 29.1%). High Skp2 expression was found in both GCB subtype (28.6%) and non-GCB subtype (30.3%). In advanced clinical stage or extranodal involvement (&gt;2), the patients with high Skp2 expression had worse survival than those with low Skp2 expression (p&lt;0.05). Interestingly, in CHOP-R group, high Skp2 expression was the strong biomarker of worse prognosis (p&lt;0.05). DLBCL patients with high Skp2 expression did not benefit from the addition of R to CHOP. Therefore, Skp2 may be a useful prognostic marker in recent rituximab era. The new treatment strategy is necessary for the DLBCL patients with high Skp2 expression. Figure Figure

scholarly journals A comparative study for the effectiveness of Tamsulosin alone versus Tamsulosin plus Tadalafil combination as an expulsive medical treatment in the management of lower ureteric calculous in Al-Diwaniyah teaching hospital

2019 ◽  
Vol 10 (2) ◽  
pp. 1551-1555
Author(s):  
Ahmed Abdulameer Alwan ◽  
Hussain T. Ajeel ◽  
Ahmed Hamza Abd
Keyword(s):  
Medical Treatment ◽  
Equal Treatment ◽  
Expulsion Rate ◽  
Treatment Groups ◽  
Ureteric Calculi ◽  
Group A ◽  
Male Patients ◽  
Group B ◽  
Urology Clinic

To evaluate the efficacy & safety of tamsulosin alone versus tamsulosin plus tadalafil combination as expulsive medical treatment of distal ureteric calculus. From March 2015 utile March 2017, two hundred patients (one hundred thirty males and seventy females), who attended the outpatient urology clinic and presented with stones size 5 to 10 mm in distal ureteric part, have been randomly allocated into two equal treatment groups. Group A treated with tamsulosin alone, and group B treated with tamsulosin plus tadalafil. Both treatments were given for a maximum of six weeks’ duration. The rate and time to the calculous passage, type of analgesic use, adverse effects of the drugs, number of outpatient urology clinic visits for pain, and follow-up were noted. Both treatment groups have higher expulsion rate with a lower time to expulsion with no statistically significant differences between them (p=0.350, p=0.074, respectively). Group B showed a significantly lower rate in admission to the hospital for pain and need for analgesia than in group A. no dangerous adverse events had been observing in both groups. Additional benefit seen in group B was the improvement in erectile function regarding male patients. Using tamsulosin and tadalafil as an expulsive medical treatment for distal ureteric calculous is safe and efficacious. Such combination therapy may provide additional advantages in cases of erectile dysfunction co-exist with distal ureteric calculi.

A Comparison of Acupuncture with Advice and Exercises on the Symptomatic Treatment of Osteoarthritis of the Hip – a Randomised Controlled Trial

2001 ◽  
Vol 19 (1) ◽  
pp. 19-26 ◽  
Author(s):  
Roisin Haslam
Keyword(s):  
Controlled Trial ◽  
Randomised Trial ◽  
Symptomatic Treatment ◽  
Post Treatment ◽  
Control Group ◽  
Group A ◽  
Pre Treatment ◽  
Group B ◽  
Randomised Controlled

Acupuncture is becoming a common technique within the physiotherapy profession as a treatment modality for pain relief; however, few randomised controlled trials have been undertaken to assess the effectiveness of acupuncture, particularly in the treatment of osteoarthritis (OA) of the hip. Therefore, a randomised trial to compare the effectiveness of acupuncture with advice and exercises on the symptomatic treatment of OA of the hip was carried out. Thirty-two patients awaiting a total hip arthroplasty were randomly allocated to either the experimental group, (A), to have six sessions of acupuncture each lasting up to 25 minutes, or the control group, (B), to be given advice and exercises for their hip over a six week period. Group A consisted of three men and 13 women, and group B consisted of four men and eight women. The average age in group A was 66 years and in group B it was 68 years. Patients were assessed for pain and functional ability, using a modified version of the WOMAC questionnaire, pre-treatment, immediately post-treatment and at eight weeks post-treatment. The pre-treatment WOMAC scores in the two groups were similar (p=0.85). There was a significant improvement in group A (decrease in WOMAC score) immediately post-treatment (p=0.002) and this was maintained at the eight-week follow-up (p=0.03). There were no significant changes in group B. When the changes in WOMAC scores were compared between groups, a significantly greater improvement was found between pre-treatment and immediately post-treatment in group A, compared with group B (p=0.02). The changes between pre-treatment and the eight-week follow-up also showed a significant improvement in group A compared with group B (p=0.03). In conclusion, this trial supports the hypothesis that acupuncture is more effective than advice and exercises in the symptomatic treatment of OA of the hip.

Ziv-aflibercept versus bevacizumab administration prior to diabetic vitrectomy: a randomised and controlled trial

2019 ◽  
pp. bjophthalmol-2018-313313
Author(s):  
Isaac Aleman ◽  
Javier Castillo Velazquez ◽  
Sloan W Rush ◽  
Ryan B Rush
Keyword(s):  
Postoperative Period ◽  
Controlled Trial ◽  
Intraoperative Complications ◽  
Secondary Outcome ◽  
Interval Group ◽  
Treatment Groups ◽  
Study Interval ◽  
Group A ◽  
Group B

PurposeTo compare the effectiveness of intravitreal ziv-aflibercept (IVZ) to intravitreal bevacizumab (IVB) administered preoperatively to patients undergoing pars plana vitrectomy (PPV) for severe manifestations of proliferative diabetic retinopathy (PDR).DesignRandomised clinical trial (RCT).MethodsTwo hundred and six patients with PDR-related complications requiring PPV were randomised into one of two treatment groups: Group A received IVZ (1.25 mg/0.05 mL) 1–10 days before PPV, while Group B received IVB (1.25 mg/0.05 mL) 1–10 days before PPV. The primary outcome was best-corrected visual acuity (BCVA) at 6 months follow-up. Secondary outcome measures were perioperative tractional retinal detachment (TRD) rates, surgical times, intraoperative and postoperative complications and incidence of unplanned PPV during the 6 month study interval.ResultsOne hundred and seventy three subjects underwent PPV and completed the 6-month follow-up interval. Group A subjects had better BCVA at 6 months (p=0.0035), shorter surgical times (p=0.0013) and were less likely to have a recurrence of vitreous haemorrhaging in the postoperative period (p=0.0101) when compared with subjects in Group B. There were no significant differences among the treatment groups with regards to baseline characteristics, perioperative TRD development, intraoperative complications and incidence of unplanned PPV during the 6 month study interval.ConclusionsThis RCT demonstrated better final visual outcomes, shorter operating times and less vitreous haemorrhage recurrences in the postoperative period when subjects received IVZ compared to IVB prior to PPV for the treatment of PDR-related complications.

BRIEF PSYCHOLOGICAL TREATMENT FOR THE RELIEF OF PANIC DISORDER

2002 ◽  
Vol 30 (4) ◽  
pp. 423-430 ◽  
Author(s):  
Karin Elsesser ◽  
Angelika Mosch ◽  
Gudrun Sartory
Keyword(s):  
Treatment Outcome ◽  
Panic Disorder ◽  
Cognitive Therapy ◽  
Psychological Treatment ◽  
Management Training ◽  
Clinical Change ◽  
Treatment Groups ◽  
Cognitive Behavioural ◽  
Before And After

This study compared complaints management training and cognitive therapy (reattribution) in treating panic disorder. Both treatment groups received three sessions with initial psychoeducation. Thirty patients with panic disorder took part in the study. Assessments were carried out before and after treatment and again at a 4-week follow-up. Both groups showed similarly significant improvements and maintenance of the clinical change over the follow-up period. It is concluded that the initial psychoeducation, which conveyed to patients the cognitive-behavioural model of panic disorder, contributed to the treatment outcome.

scholarly journals Effectiveness of Ponseti Versus Kite Method for the Management of Club Foot- A Quasi Experimental Trial

2021 ◽  
Vol 15 (6) ◽  
pp. 1871-1873
Author(s):  
Shabana Sharif ◽  
Rehan Ramzan Khan ◽  
Saima Riaz ◽  
Sajid Rashid ◽  
Zaigham Rasool Athar ◽  
...  
Keyword(s):  
Club Foot ◽  
Rapid Improvement ◽  
Treatment Groups ◽  
Experimental Trial ◽  
Score Difference ◽  
Pirani Score ◽  
Quasi Experimental ◽  
Group A ◽  
Group B

Objective: To determine the effectiveness of ponseti versus kite method for the management of club foot among children. Methods: A quasi experimental trial was conducted to determine the most effective conservative method for managing idiopathic club foot. This study was carried out in District Head Quarter Hospital, Layyah. A total of 46 children (60 Feet) aged less than six months of both genders were included in this study using convenience sampling technique. The study sample was divided into Group A (Ponseti) and Group B (Kite). Each treatment group comprises of 30 feet. Patients were called for weekly follow up till ten weeks consecutively. At every follow-up visit, patients were assessed to check the improvement of deformity with the help of the Pirani scoring system for the foot. Pirani score difference was measured in both treatment groups from the baseline until the last follow-up interval until the 10th Week. Pirani score difference was measured in both treatment groups from the baseline until the last follow-up interval until the 10th Week. A greater negative value signified better correction. SPSS 23 was used for data entry and analysis. Results: Children's mean age in both treatment groups (A and B) was 10.83±4.59 and 10.20±4.75 weeks. At presentation mean Pirani score in both treatment groups (A and B) was 5.85±0.67 and 5.86±0.45, respectively, while at 10th follow up it was 1.42±0.39 and 2.35±0.54 for group A and group B, respectively. Conclusion: This study demonstrates that the Ponseti technique significantly improved the management of club foot as that of the Kites method. Ponseti's method is more effective in terms of rapid improvement in the involved group. Key words: Non operative Management, Idiopathic Club foot, Kites method, Ponseti method.

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