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Biomedical subjects

R Swindle

Publications and source records attributed to R Swindle.

11 recordsLinked to original sources
PubMed2001

Similar effectiveness of paroxetine, fluoxetine, and sertraline in primary care: a randomized trial.

CONTEXT: Selective serotonin reuptake inhibitors (SSRIs) are the most commonly prescribed class of antidepressant, yet it is not known whether one SSRI is more effective than another. OBJECTIVE: To compare the effectiveness of 3 SSRIs (paroxetine, fluoxetine, and sertraline) in depressed primary care patients. DESIGN: Open-label, randomized, intention-to-treat trial, with patient enrollment occurring in April-November 1999. SETTING: Thirty-seven clinics in 2 US primary care research networks. PATIENTS: A total of 573 depressed adult patients for whom their primary care physician thought that antidepressant therapy was warranted and who completed a baseline interview. INTERVENTIONS: Patients were randomly assigned to receive paroxetine (n = 189), fluoxetine (n = 193), or sertraline (n = 191) for 9 months. Primary care physicians were allowed to switch patients to a different SSRI or non-SSRI antidepressant if they did not adequately respond to or tolerate the initial SSRI. MAIN OUTCOME MEASURES: The primary outcome measure was change in the Medical Outcomes Study 36-Item Short-Form Health Survey (SF-36) Mental Component Summary score (range, 0-100), compared across treatment groups at 1, 3, 6, and 9 months. Secondary outcomes included other depression and psychological measures, multiple measures of social and work functioning, and other domains of health-related quality of life, such as physical functioning, concentration and memory, vitality, bodily pain, sleep, and sexual functioning. RESULTS: Follow-up interviews were successfully completed in 94% of patients at 1 month, 87% at 3 months, 84% at 6 months, and 79% at 9 months. Responses to the 3 SSRIs were comparable on all measures and at all time points. The mean change in the SF-36 Mental Component Summary score at 9 months was + 15.8 in the paroxetine group, + 15.1 in the fluoxetine group, and + 17.4 in the sertraline group. The drugs were also associated with similar incidences of adverse effects and discontinuation rates. CONCLUSIONS: The SSRI antidepressants paroxetine, fluoxetine, and sertraline were similar in effectiveness for depressive symptoms as well as multiple domains of health-related quality of life over the entire 9 months of this trial.

Adult↗
PubMed2000

Responses to nervous breakdowns in America over a 40-year period. Mental health policy implications.

The 1957 and 1976 Americans View Their Mental Health surveys from the Institute of Social Research were partially replicated in the 1996 General Social Survey (GSS) to examine the policy implications of people's responses to feeling an impending nervous breakdown. Questions about problems in modern living were added to the GSS to provide a profile of the public's view of mental health problems. Results were compared for 1957, 1976, and 1996. In 1957, 19% of respondents had experienced an impending nervous breakdown; in 1996, 26% had had this experience. Between 1957 and 1996, participants increased their use of informal social supports, decreased their use of physicians, and increased their use of nonmedical mental health professionals. These findings support policies that strengthen informal support seeking and access to effective psychosocial treatments rather than current mental health reimbursement practices, which emphasize the role of primary care physicians.

Adaptation, Psychological↗
PubMed1999

Cost analysis in the Department of Veterans Affairs: consensus and future directions.

OBJECTIVES: In 1997, the Management Decision and Research Center of the Department of Veterans Affairs convened cost experts and health economists in a working meeting. Its goal was to provide consensus guidelines for conducting cost analyses in managed care systems, such as VA, that do not have encounter-level cost data or that do not prepare itemized patient bills. The impetus for the meeting was that too often computer-based cost data were proposed or used in studies that were inappropriate for the question being addressed. There was also a sense that often great effort was being expended by VA health economists "reinventing the wheel" in developing new cost components for each study. METHODS: A group of 45 VA and non-VA health economists, health researchers, and policy-makers attended a 2 day working meeting organized around a series of case vignettes to identify areas of consensus, controversy, and gaps in knowledge. RESULTS: Consensus emerged in the following four areas: (1) Cost Methods. A "hybrid model" was identified as the current standard of cost analysis in VA and entails mixing "micro-costing" primary data collection and "gross-cost" computer-based methods to reflect resource-use variations that are essential to the research question. (2) Cost Infrastructure. VA is developing a new, but unevaluated, costing system that could allow for computer-based cost analyses at much finer levels of detail than is currently possible. (3) Data Quality. Ongoing data validation of existing and developing cost databases is needed, especially concerning interfacility variation. (4) Dissemination. A new cost data center was recommended to provide training, information dissemination, and coordination. CONCLUSIONS: Consensus was reached about the hybrid model as the current paradigm for cost analysis in systems like VA.

Costs and Cost Analysis↗
PubMed1998

Life circumstances and personal resources as predictors of the ten-year course of depression.

A 10-year naturalistic study of 313 patients who entered treatment for unipolar depression and a community comparison group of 284 nondepressed adults was conducted. We compared life stressors, social resources, personal resources, and coping among patients who were remitted (N = 76), partially remitted (N = 146), or nonremitted (N = 91). Compared with the controls and the remitted patients, the partially remitted and nonremitted patients consistently experienced more life stressors and fewer social resources, were less easygoing, and relied more on avoidance coping. A less easygoing disposition, fewer close relationships, and more reliance on avoidance coping were associated with higher odds of experiencing a course of partial remission or nonremission. In addition, more depressive symptoms and medical conditions predicted nonremission.

Adaptation, Psychological↗
PubMed1991

The effect of post space preparation on the apical seal of root canal obturated teeth.

The dental literature is contradictory about the quality of the apical seal as it relates to the length of remaining gutta-percha following post-space preparation. The purpose of this study was to compare apical leakage with varying remaining lengths of gutta-percha in an in vitro system. Fifty disarticulated single canal human mandibular premolar teeth were used in five experimental groups. All root canals were prepared 1 mm short of the apical foramen through a size 50 k-file and sequentially flared through a size 70 k-file. Four groups were obturated using gutta-percha with lateral condensation and Roth's 801 Elite Grade root canal sealer. Post-space preparation was accomplished by removing gutta-percha with heated pluggers so that the lengths of the remaining filling varied by increments of one millimeter between 3 and 7 mm. Specimens were covered with enamel paint leaving only the apical foramen exposed. All roots were then submerged in 1 percent methylene blue dye for two weeks, sectioned longitudinally, and measured for depth of dye penetration. No significant difference was found between the 4 and 5 mm groups or between the 6 and 7 mm groups. Significant difference (p less than .05) in leakage did exist between the 3, 4-5, and 6-7 mm groups, showing the least in the latter groups. The best apical seal was obtained when the maximum of 6 mm of gutta-percha remained.

Analysis of Variance↗
PubMed1990

A serious complication following the inadvertent injection of sodium hypochlorite outside the root canal system.

During an attempt to negotiate a calcified root canal in a maxillary lateral incisor, a midroot distobuccal perforation was created, and sodium hypochlorite (NaClO) was extruded through the opening into the supporting tissues. This procedural accident caused an immediate burning sensation, severe pain, and marked facial swelling, with the subsequent loss of the tooth.

Calcinosis↗
PubMed1982

The "monitoring model" and the mortality X treatment interaction threat to validity in mental health outcome evaluation.

Symptom improvement rates among three cohorts of adult outpatients generated by a base-line monitoring model approach to outcome evaluation are presented. Follow-up questionnaire data were collected by mail. The cohorts represented approximately 40% self-selected samples from the parent populations of clients admitted for service. Efforts to interpret significant cohort improvement rate differences led to the conclusion that differences may have been the result of severely symptomatic clients differentially selecting themselves in/out of follow-up data collection. This Mortality X Treatment interaction threat to the validity of conclusions about service effectiveness is discussed in the context of Campbell and Stanley's recurrent institutional cycle design, with particular emphasis placed on reducing posttreatment data loss.

Community Mental Health Centers↗
PubMedDate not supplied

A symptom checklist to screen for somatoform disorders in primary care.

Current DSM-IV somatoform diagnoses may inadequately capture many somatizing patients in primary care. By using data from two studies (1,000 and 258 patients, respectively), the authors determined 1) the optimal threshold on a checklist of 15 physical symptoms to screen for a recently proposed somatoform diagnosis, multisomatoform disorder (MSD), and 2) the concordance between MSD and somatization disorder. The optimal threshold for pursuing a diagnosis of MSD was seven or more physical symptoms. The majority (88%) of the patients who met criteria for MSD had either full or abridged somatization disorder. MSD was intermediate between abridged and full somatization disorder in terms of its association with functional impairment, psychiatric comorbidity, family dysfunction, and health care utilization and charges.

Adolescent↗
PubMedDate not supplied

A 15-item short form of the psychological and interpersonal relationship scales.

Erectile dysfunction (ED) is a prevalent condition associated with complex psychological and interpersonal issues. The Psychological and Interpersonal Relationship Scales (PAIRS) is a valid and reliable measure of Sexual Self-Confidence, Spontaneity, and Time Concerns associated with ED and its treatment. This paper describes the development and validation of a 15-item, short form of PAIRS (SF-PAIRS). Domain scores and psychometric properties of SF-PAIRS were assessed using data from the validation studies of the full-length (23-item) PAIRS. Items in the two briefer scales (Spontaneity and Time Concerns) were identified using internal consistency analyses and crossvalidated during two multinational clinical trials and a community sample. The scales in SF-PAIRS showed good internal consistency, convergent and discriminant validity, were stable over a 2-week period, and showed sensitivity to treatment. SF-PAIRS is a valid, brief measure of psychological and interpersonal outcomes associated with ED.

Adult↗
PubMedDate not supplied

Cognitive-behavioral therapy for somatization and symptom syndromes: a critical review of controlled clinical trials.

OBJECTIVE: Few treatments for somatization have been proven effective. In the past decade, however, clinical trials of cognitive-behavioral therapy (CBT) have been promising. Our aim was to critically review and synthesize the evidence from these trials. METHODS: A search of the Medline database from 1966 through July 1999 was conducted to identify controlled trials designed to evaluate the efficacy of CBT in patients with somatization or symptom syndromes. RESULTS: A total of 31 controlled trials (29 randomized and 2 nonrandomized) were identified. Twenty-five studies targeted a specific syndrome (e.g. chronic fatigue, irritable bowel, pain) while 6 focused on more general somatization or hypochondriasis. Primary outcome assessment included physical symptoms, psychological distress and functional status in 28, 26 and 19 studies, respectively. Physical symptoms appeared the most responsive: CBT-treated patients improved more than control subjects in 71% of the studies and showed possibly greater improvement (i.e., a trend) in another 11% of the studies. A definite or possible advantage of CBT for reducing psychological distress was demonstrated in only 38 and 8% of studies, and for improving functional status in 47 and 26%. Group therapy and interventions as brief as 5 sessions proved efficacious. Benefits were sustained for up to 12 months. CONCLUSION: CBT can be an effective treatment for patients with somatization or symptom syndromes. Benefits can occur whether or not psychological distress is ameliorated. Since chronic symptoms are exceptionally common and most studies were conducted in referral populations, the optimal sequencing of CBT in treating primary care patients and the identification of those most likely to accept and respond to therapy should be further evaluated.

Cognitive Behavioral Therapy↗