Establishing a Treatment Focus

2022 ◽  
pp. 195-204
Author(s):  
Len Sperry
Keyword(s):  
Treatment Focus

scholarly journals Study Designs for Evaluation of Combination Treatment: Focus On Individual Patient Benefit

2022 ◽  
Author(s):  
Martin C. Michel ◽  
David Staskin
Keyword(s):  
Combination Treatment ◽  
Therapeutic Response ◽  
Single Patient ◽  
Patient Benefit ◽  
Reasonable Expectation ◽  
Treatment Focus ◽  
Urinary Tract Symptoms ◽  
Functional Urology ◽  
Study Designs ◽  
Lower Urinary

Combination treatment, i.e., the use of two or more drugs for the same condition, is frequent in medicine if monotherapy yields an insufficient therapeutic response. We here review and challenge clinical study designs and formats of reporting outcomes for the evaluation of the benefit/risk ratio of combination treatment over monotherapy. We demonstrate that benefits of combination treatment at the group level over-estimate the probability of benefit at the single patient level based on outcome simulations under almost any imaginable setting. Based on these findings we propose that studies testing combination treatment should always report on percentages of responders to monotherapy and combination treatment. We provide equations that allow calculation of the percentage of patients truly benefitting from combination (responders to both monotherapies) and that of patients exposed to risk of harm from adverse effects without a reasonable expectation of individual benefit. These considerations are explained based on real clinical data, mostly from the field of functional urology (male lower urinary tract symptoms).

Transitioning Concussion Care to Mental Health Care: A Case Study of an Elite Athlete

2021 ◽  
Vol 5 (1) ◽  
pp. 135-144
Author(s):  
Natalie S. Sherry ◽  
Abigail Feder ◽  
Raymond Pan ◽  
Shawn R. Eagle ◽  
Anthony P. Kontos
Keyword(s):  
Mental Health ◽  
Health Care ◽  
Mental Health Care ◽  
Biopsychosocial Model ◽  
Elite Athlete ◽  
Clinical Presentation ◽  
Health Changes ◽  
Memory Problems ◽  
Treatment Focus

Athletes with recent concussion experience a constellation of physical (e.g., headache, nausea), cognitive (e.g., memory problems, difficulty concentrating), sleep, and emotional (e.g., anxiety, depressed mood) symptoms after injury. Mental health changes may also be a product of typical maturation in adolescents/young adults, making mood disruption difficult to disentangle from concussion sequelae. In this case study, we present the case of a high-achieving 18-year-old female rower whose concussion clinical trajectory exhibits this type of difficulty. Specifically, we provide a detailed chronological summary of the athlete’s visits with a multidisciplinary concussion team. We highlight in this case study (a) an individualized, biopsychosocial model of concussion care and (b) subtle aspects of her clinical presentation that led the clinical team to transition her treatment focus from concussion specific to formal mental health care.

Bowel Endometriosis Presenting With Massive Ascites Relapses in Ovaries: a Case Report and Literature Review

2021 ◽  
Author(s):  
Yiting Bao ◽  
Wu Huang ◽  
Liangqing Yao ◽  
Lei Yuan
Keyword(s):  
Pelvic Mass ◽  
Lymph Node Involvement ◽  
Severe Form ◽  
High Dose ◽  
Massive Ascites ◽  
Bowel Endometriosis ◽  
Treatment Focus ◽  
Node Involvement ◽  
Resection And Anastomosis ◽  
Reproductive Aged Women

Abstract Background: About 10% reproductive aged women are affected by endometriosis. Deep infiltrative endometriosis (DIE) is the most severe form of endometriosis which has a high risk of recurrence. Bowel is the most common extragenital involved organ. The clinical features of bowel endometriosis vary by location, size, and infiltrative depth of lesions, which makes diagnosis and treatment difficult. Endometriosis presenting with massive ascites is rare and hard to diagnose before histopathology. There are no authoritative guidelines on the management of DIE at present. Case presentation: A 37-year-old woman presenting with massive ascites and pelvic mass was diagnosed with bowel endometriosis after laparoscopy. Bowel resection and anastomosis followed by gonadotropin-releasing hormone agonists (GnRH-a) therapy was performed. Two levonorgestrel-releasing intrauterine devices and two levonorgestrel-releasing subcutaneous silastic implants were inserted subsequently. Recurrence was found in bilateral ovaries 25 months after surgery. Cystectomy of bilateral ovarian cysts, bilateral salpingectomy and postoperative GnRH-a therapy was performed. The patient showed no recurrence at follow-up by May 2021 (22 months).Conclusions: In the presence of massive ascites and pelvic mass, DIE should be considered as a differential diagnosis for ovarian cancer. Endometriosis in different organs may have different pathogenesis, which leads to different treatment focus. On the basis of complete resection and postoperative GnRH-a therapy, our application of high dose levonorgestrel-releasing systems creatively improves the treatment effect of bowel endometriosis. The mechanism of recurrent endometriosis that occurs in different organs may relate to lymph node involvement and individual immune state.

scholarly journals An adaptation of the Interpersonal Problem Areas Rating Scale: pilot and interrater agreement study

2008 ◽  
Vol 30 (4) ◽  
pp. 353-357 ◽  
Author(s):  
Ana Claudia Fontes de Andrade ◽  
Ellen Frank ◽  
Francisco Lotufo Neto ◽  
Patricia R Houck
Keyword(s):  
Bipolar Disorder ◽  
Rating Scale ◽  
Treatment Method ◽  
Interpersonal Psychotherapy ◽  
Primary Treatment ◽  
Problem Area ◽  
Interrater Agreement ◽  
Interpersonal Problem ◽  
Treatment Focus ◽  
Agreement Study

OBJECTIVE: This article describes the adaptation of a rating scale of interpersonal psychotherapy problem areas to include a fifth problem area appropriate to bipolar disorder and an interrater agreement study in identifying interpersonal problem areas and selecting a primary treatment focus if patients were to engage in treatment. METHOD: Five research interpersonal psychotherapists assessed nine audiotapes of a single interview with five bipolar and four unipolar patients in which the interpersonal inventory and identification of problem areas were undertaken. RESULTS: Raters agreed on presence and absence of problem areas in seven tapes. Kappas for identification of problem areas were 1.00 (grief), 0.77 (role dispute), 0.61 (role transition), 0.57 (interpersonal deficits) and 1.00 (loss of healthy self). Kappa for agreement on a primary clinical focus if patients were to engage in interpersonal psychotherapy treatment was 0.64. CONCLUSIONS: The adaptation of the original scale to include an area pertinent to bipolar disorder proved to be applicable and relevant for use with this population. The results show substantial interrater agreement in identifying problem areas and potential treatment focus.

Therapeutic Advances in Myeloproliferative Neoplasms: The Role of New-Small Molecule Inhibitors

2012 ◽  
pp. 406-410 ◽  
Author(s):  
Srdan Verstovsek
Keyword(s):  
Molecular Mechanisms ◽  
Therapeutic Potential ◽  
Myeloproliferative Neoplasms ◽  
Janus Kinase ◽  
Treatment Focus ◽  
Rational Combination ◽  
Short And Long Term ◽  
Jak2 Inhibitors

Overview: The discovery that a somatic point mutation (JAK2V617F) in the Janus kinase 2 ( JAK2) is highly prevalent in patients with myeloproliferative neoplasms (MPNs) has been a crucial breakthrough in our understanding of the underlying molecular mechanisms of these diseases. Therefore, preclinical and clinical research in recent years has focused intensely on the development of new therapies targeted to JAK2. These efforts culminated in recent approval of ruxolitinib as the first official therapy for patients with intermediate- or high-risk myelofibrosis (MF). Therapy with JAK2 inhibitors substantially improves quality of life and reduces organomegaly in MF with or without JAKV617F mutation. Recent results suggest that patients with advanced MF may live longer when receiving therapy with ruxolitinib. However, JAK2 inhibitors do not eliminate the disease and new medications are needed to expand on the benefits seen with JAK2 inhibitors. Although many agents are still in the early stages of development, the wealth of publications and presentations has continued to support our growing understanding of the pathophysiology of MF as well as the potential short- and long-term outcomes of these new and diverse approaches to treatment. Focus of ongoing efforts is particularly on the improvements in anemia and fibrosis, as well as on rational combination trials of JAK2 inhibitors and other potentially active agents. Therapeutic potential and limitations of JAK2 inhibitors and other novel medications in clinical studies are reviewed.

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