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Explore indexed PubMed citations for clinical trials, systematic reviews and public health research. Read source abstracts and follow each citation to its original PubMed record.

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At least 307 records · Page 17Linked to original sources
PubMed2003

Attention-deficit/hyperactivity disorder in children and adolescents: interventions for a complex costly clinical conundrum.

Management of a child or adolescent with attention-deficit/hyperactivity disorder (ADHD) is reviewed, including psychological and pharmacologic approaches. Psychological treatment includes psychotherapy, cognitive-behavior therapy, support groups, parent training, educator/teacher training, biofeedback, meditation, and social skills training. Medications are reviewed that research has revealed can improve the core symptomatology of a child or adolescent with ADHD. These medications include stimulants, antidepressants, alpha-2 agonists, and a norepinephrine reuptake inhibitor. Management of ADHD should include a multi-modal approach, involving appropriate educational interventions, appropriate psychological management of the patient (child or adolescent), and judicious use of medications. Parents, school officials, and clinicians must work together to help all children and adolescents with ADHD achieve their maximum potential.

Adolescent↗
PubMed1999

Pragmatic randomised controlled trials in psychiatry.

BACKGROUND: Randomised controlled trials (RCTs) are the most important method of evaluating new treatments and treatment policies. Despite this, there are relatively few large pragmatic RCTs in psychiatry. AIMS: To explore the main advantages of large pragmatic RCTs and the obstacles to performing them in psychiatry. METHOD: A narrative review of literature on pragmatic RCTs with examples drawn from psychiatry and other medical specialities. RESULTS: Obstacles to performing pragmatic RCTs in psychiatry include the complexity of psychiatric interventions, the complexity of outcomes used in psychiatry and the difficulties of blinding subjects and investigators to some psychiatric interventions. CONCLUSIONS: Researchers need to frame questions in a form that is relevant to clinicians and to convince clinicians to cooperate in simple large pragmatic trials.

Cluster Analysis↗
PubMed2006

A "grapple hook" technique using a deflectable tip catheter to facilitate complex proximal circumflex interventions.

We present two patients with angulated, proximal left circumflex lesions, one a chronic total occlusion and one an acute subtotal occlusion. In both cases, use of the deflectable tip Venture Catheter (Velocimed, Minneapolis, MN) facilitated guide wire passage and successful percutaneous coronary intervention (PCI) after prior attempts at guide wire passage with standard wires were unsuccessful.

Cardiac Catheterization↗
PubMed2006

Mechanical thrombectomy options in complex percutaneous coronary interventions.

Percutaneous coronary interventions (PCI) of thrombus-containing lesions are associated with an increased risk of acute complications and poorer long term vessel patency. Dealing with these vessels provides many technical challenges, especially with the significant risk of coronary no reflow and distal embolization. Pharmacological strategies, including intravenous and intracoronary glycoprotein IIbIIIa inhibitors reduce intracoronary thrombus propagation, improve TIMI flow and are associated with a reduction in adverse event rates. Mechanical strategies (particularly embolic protection and thrombectomy catheters) help to improve coronary blood flow and myocardial perfusion. However, their impact on clinical outcomes is less clear. The use of embolic protection devices is associated with better perfusion, blood flow, and clinical outcomes among patients undergoing saphenous vein graft (SVG) PCI. However, the role for these devices in primary PCI and native coronary artery interventions is uncertain. This study examines the current approaches to manage thrombotic lesions during PCI and reviews the evidence in support of the different mechanical thrombectomy options that are available to the interventional cardiologist.

Angioplasty, Balloon, Coronary↗
PubMed2005

Complex pharmaceutical care intervention in pulmonary care: part A. The process and pharmacists' professional satisfaction.

OBJECTIVE: In the IPMP study (Interventions on the principle of Pulmonary Medication Profiles), tailored pharmaceutical care interventions were provided to pulmonary patients selected because of drug use that deviates from Dutch guidelines. The aims were to solve drug-related problems and to improve patients' drug use. This article describes the pharmaceutical care process tailored to the individual problems of patients in the intervention arm of a randomized controlled trial and defines the package of care. METHODS: After a preliminary selection of the patients with the help of the algorithmic IPMP computer instrument, instructed Dutch community pharmacists had structured consultations with patients (aged 13-70 years) in the intervention arm to identify behaviour and specific problems with their medication. Based on this identification process, a tailored intervention was constructed that could comprise one or more of six pharmaceutical care modules. Modules were clustered in sets describing the complete programme of care provided to one patient. If necessary, pharmacists consulted the patients' physicians to improve the prescribed therapy. After the interventions, medication changes were evaluated with the patients. The prescribed medication and the refill rate were monitored in the pharmacy computer during 1 year. All activities and results were extensively monitored and documented. MAIN OUTCOME MEASURE: Process description, i.e. number of provided pharmaceutical care modules and medication changes. Pharmacists' satisfaction. RESULTS: Tailored interventions were provided to 199 patients at risk of sub-optimal drug therapy. In all 813 pharmaceutical care modules were performed and documented, and clustered in four different programmes. In addition to education and motivation to adhere to prescribed medication for all 199 patients, a medication change was suggested in 124 cases. Patients and physicians agreed upon a change in 94 cases. Device change was agreed upon in 58 of 64 cases, often simultaneously with medication change. Pharmacists consulted physicians concerning 100 patients. Pharmacists reported satisfaction with the pharmaceutical care approach. CONCLUSION: Because of the extensive documentation, interventions could be described completely. Pharmacists observed a better drug use after educating patients or by solving their drug-related problems. In collaboration with physicians drug treatment could be improved.

Adolescent↗
PubMedDate not supplied

Self-management interventions for chronic illness.

An increasing number of interventions have been developed for patients to better manage their chronic illnesses. They are characterised by substantial responsibility taken by patients, and are commonly referred to as self-management interventions. We examine the background, content, and efficacy of such interventions for type 2 diabetes, arthritis, and asthma. Although the content and intensity of the programmes were affected by the objectives of management of the illness, the interventions differed substantially even within the three illnesses. When comparing across conditions, it is important to recognise the different objectives of the interventions and the complexity of the issues that they are attempting to tackle. For both diabetes and asthma, the objectives are concerned with the underlying control of the condition with clear strategies to achieve the desired outcome. By contrast, strategies to deal with symptoms of pain and the consequences of disability in arthritis can be more complex. The interventions that were efficacious provide some guidance as to the components needed in future programmes to achieve the best results. But to ensure that these results endure over time remains an important issue for self-management interventions.

Arthritis, Rheumatoid↗
PubMed2004

Clinical experiences using the FilterWire EX for distal embolic protection during complex percutaneous coronary interventions.

BACKGROUND: Distal embolization during coronary angioplasty may result in vessel occlusion, no reflow and myonecrosis. This study tested the authors' clinical experiences using a guidewire system designed to preserve distal flow during angioplasty. METHODS AND RESULTS: The FilterWire EX trade mark (Boston Scientific, Natick, MA, USA) consists of a 0.014-inch guidewire on which an expandable loop structure is attached to a porous polyurethane membrane. The assembly is delivered across the target lesion, followed by deployment of the filter distal to the lesion. Procedural and angiographic outcome data were obtained from patients undergoing saphenous vein grafts (SVGs) (n = 16) or native coronary (n = 4) interventions. The mean age was 62 +/- 10 years. All four patients with native coronary lesions sustained acute myocardial infarction while 15/16 patients with degenerated SVGs presented with accelerated angina pectoris. The mean proximal reference diameter was 3.62 +/- 0.32 mm, percentage diameter stenosis was 72 +/- 13%, and lesion length was 16.3 +/- 5.7 mm. Angiographic visible thrombus was detected in 12/20 (60%) cases. Stents were used in 19/20 patients (95%) with average stent diameter/length equal to 3.81 +/- 0.42/23 +/- 7 mm. Overall procedural success was obtained in 93.3% as no-reflow and total CK elevation occurred in 1/16 treated patients (6.7%) despite distal embolic filtration. In-hospital and 30-day survival was 100% with no episodes of target vessel thrombosis and/or myocardial infarction. CONCLUSIONS: The use of the FilterWire EX seems to be feasible and safe in suitable lesion subsets and in relatively large-sized vessels among patients who are at high risk for distal embolization.

Angioplasty, Balloon, Coronary↗
PubMedDate not supplied

[Early surgical intervention in the complex treatment of odontogenic osteomyelitis of the lower jaw].

The incision of the soft tissues is an approbated method for the surgical treatment of the acute odontogenic osteomyelitis of the lower jaw and for the chronic--the sequestrectomy after the complete detachment of the sequestra. In the paper the authors share their experience in the surgical treatment of acute osteomyelitis and chronic odontogenic osteomyelitis as early as the phase of demarcation of the sequestra, with special attention paid to the extraoral drainage and local effect on the operated bone. In all other cases the operation wound in the oral cavity is sutured without drainage for healing by first intention. To some of the patients with developed acute osteomyelitis of the lower jaw, the authors applied the rarely practiced method of trephination of the bone, aiming at the reduction of the intraosseous pressure induced by the inflammatory process. Thirty nine patients have been treated according to the methods described and the results so far are a good evidence for their recommendation for the practice.

Drainage↗