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Results for “medication efficacy”

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PubMed2005

Consistency of medical abortion efficacy from 5 through 14 weeks' gestation.

OBJECTIVE: To assess the efficacy of medical abortion performed according to a single protocol from 5 through 14 weeks. STUDY DESIGN: Retrospective observational study of medical abortions through 14 weeks performed from January 2000 through August 2001. The protocol combined 400mg of mifepristone orally, followed 48 h later by 800 microg of misoprostol, administered vaginally, and repeated after 4 h if the patient did not begin to abort. Outcome measures were the abortion rate, the rates of immediate manual uterine revision and of secondary vacuum aspiration, the time to expulsion, the misoprostol dose, and analgesic use. RESULTS: The study included 512 medical abortions. The abortion rate was 98.4% and the secondary vacuum aspiration rate 8.2%. The uterine exploration rate was 1.4%, but these occurred only at gestations above 13 weeks. The mean time to expulsion was 4.4+/-1.9 h (1-28), and the mean misoprostol dose 860+/-180 microg (0-2000). None of the characteristics studied differed significantly as a function of gestation. 1.6% of patients had complications. CONCLUSION: Medical abortion was consistently effective through 14 weeks and can be offered as an alternative to the surgical technique.

Abortifacient Agents, Nonsteroidal↗

PubMed1999

Estimating the efficacy of medical abortion.

Comparisons of the efficacy of different regimens of medical abortion are difficult because of the widely varying protocols (even for testing identical regimens), divergent definitions of success and failure, and lack of a standard method of analysis. In this article we review the current efficacy literature on medical abortion, highlighting some of the most important differences in the way that efficacy has been analyzed. We then propose a standard conceptual approach and the accompanying statistical methods for analyzing clinical trials of medical abortion and to explain how clinical investigators can implement this approach. Our review reveals that research on the efficacy of medical abortion has closely followed the conceptual model used for analysis of surgical abortion. The problem, however, is that, whereas surgical abortion is a discrete event occurring in the space of a few minutes or less, medical abortion is a process typically lasting from several days to several weeks. In this process, two events may occur that are not possible with surgical abortion. First, the woman can opt out of the process before a fair determination of efficacy can be made. Second, the process of medical abortion allows time for surgical interventions that may be convenient for the clinician but not strictly necessary from a medical perspective. Another difference from surgical abortions is that, for medical abortions, different medical abortion protocols specify different waiting periods, giving the drugs less time to work in some studies than in others before a determination of efficacy is made. We argue that, when analyzing efficacy of medical abortion, researchers should abandon their close reliance on the analogy to surgical abortion. In fact, medical abortion is more appropriately analyzed by life table procedures developed for the study of another fertility regulation technology; contraception. As with medical abortion, a woman initiating use of a contraceptive method can change her mind after some period of exposure and opt out. Also, as with medical abortion, a contraceptive can fail, usually with the risk of failure depending heavily on whether or not the woman follows the protocol for that method precisely. Finally, as with medical abortion, medical conditions may arise that necessitate discontinuing use of the contraceptive method. In both cases, these medical conditions are sometimes open to interpretation or subject to the skill, judgment, or experience of the clinician involved. The appropriate information to collect for a multiple decrement life table analysis of medical abortion includes data on compliance with the protocol, timing of the event of interest (abortion) when it is observable, and, because we argue that these should be regarded as events of interest, a typology of any surgical interventions that are conducted during the woman's participation in the study.

Abortion, Incomplete↗

PubMed2000

Medical hypnosis for temporomandibular disorders: treatment efficacy and medical utilization outcome.

AIM: The aim of this study was to examine the effectiveness of a particular behavioral medicine treatment modality, medical hypnosis, on reducing the pain symptoms of temporomandibular disorders (TMD). METHODS: Twenty-eight patients who were recalcitrant to conservative treatment for TMD participated in a medical hypnosis treatment program and completed measures of their pain symptoms on 4 separate occasions: during wait list, before treatment, after treatment, and at a 6-month follow-up. In addition, pretreatment and posttreatment medical use were examined. RESULTS: Statistical analysis of this open trial suggests that medical hypnosis is a potentially valuable treatment modality for TMD. Patients reported a significant decrease in pain frequency (F [3, 87] = 14.79, P<.001), pain duration (F [3, 87] = 9.56, P<.001), and pain intensity (F [3, 87] = 15.08, P<. 001), and an increase in daily functioning. Analysis suggests that their symptoms did not simply spontaneously improve, and that their treatment gains were maintained for 6 months after hypnosis treatment. Further, after hypnosis treatment, patients exhibited a significant reduction in medical use. CONCLUSION: Medical hypnosis appears to be an effective treatment modality for TMD, in terms of reducing both symptoms and medical use.

Adult↗

PubMed2000

The efficacy of medical abortion: a meta-analysis.

Multiple clinical studies demonstrate the efficacy of medical abortion with mifepristone or methotrexate followed by a prostaglandin analogue. However, assessing predictors of success, including regimen, is difficult because of regimen variability and a lack of direct comparisons. This meta-analysis estimates rates of primary clinical outcomes of medical abortion (successful abortion, incomplete abortion, and viable pregnancy) and compares them by regimen and gestational age. We identified 54 studies published from 1991 to 1998 using mifepristone with misoprostol (18), mifepristone with other prostaglandin analogues (23), and methotrexate with misoprostol (13). Data abstracted from studies included regimen details and clinical outcomes by gestational age. We found that efficacy decreases with increasing gestational age (p<0.001), and differences by regimen are not statistically significant except at gestational age > or =57 days. For gestations < or =49 days, mean rates of complete abortion were 94-96%, incomplete abortion 2-4%, and ongoing (viable) pregnancy 1-3%. For gestations of 50-56 days, the mean rate of complete abortion was 91% (same for all regimens), incomplete abortion 5-8%, and ongoing pregnancy 3-5%. For > or =57 days, success was lower for mifepristone/misoprostol (85%, 95% confidence interval 78-91%) than for mifepristone/other prostaglandin analogues 95% (CI 91-98%, p = 0.006). For mifepristone/misoprostol, using > or =2 prostaglandin analogue doses seems to be better than a single dose for certain outcomes and gestational ages. We conclude that both mifepristone and methotrexate, when administered with misoprostol, have high levels of success at < or =49 days gestation but may have lower efficacy at longer gestation.

Abortifacient Agents↗

PubMed2002

The efficacy of medical and surgical treatment of endometriosis-associated infertility and pelvic pain.

This article is a review of the efficacy of medical and surgical treatment of endometriosis-associated infertility and pelvic pain. Endometriosis is the cause of pelvic pain (dysmenorrhea, dyspareunia) and infertility in more than 35% of women of reproductive age. Complete resolution of endometriosis is not yet possible but therapy has essentially three main objectives: (1) to reduce pain; (2) to increase the possibility of pregnancy; (3) to delay recurrence for as long as possible. It could be concluded that a consensus will probably never be reached on minimal and mild endometriosis. Nevertheless, because the Canadian study reported a large number of cases, we strongly support the view that visible endometriosis must be removed at the time of surgery. In cases of moderate and severe endometriosis-associated infertility, the combined approach (operative laparoscopy with GnRH-a) must be considered as 'first-line' treatment. The mean pregnancy rate of 50% reported in the literature following surgery provides scientific proof that operative treatment should be undertaken first to give our patients the best chance of conceiving naturally.

Endometriosis↗

PubMed2000

The COPE program: treatment efficacy and medical utilization outcome of a chronic pain management program at a major military hospital.

This study presents a treatment efficacy and medical utilization evaluation of a cognitive-behavioral, outpatient, chronic pain management program in a military hospital setting. A total of 61 nonmalignant chronic pain patients with heterogeneous pain syndromes who participated in sequential group programs were included in the study. Comprehensive and multi-dimensional outcome criteria were used, including pain ratings, relaxation skills, quality of life, satisfaction ratings, and medical utilization. The findings demonstrated improvements on all general indices. Military status had no effect on any of the outcome measures. Most significant was an 87% reduction in outpatient clinic visits in the first 3 months after treatment. This reduction amounts to a projected net annual saving of $78,960 in the first year after behavioral medicine intervention. In light of the increasing cost of health care for chronic pain patients, psychological approaches as an adjunct to traditional medical care seem to present a sound solution for cost savings. This study also supports the notion that a strategic biopsychosocial pain program, which targets the multiple dimensions of persistent pain, provides effective treatment and increases patient satisfaction.

Adaptation, Psychological↗

PubMed2004

[The consulting of internal medicine in primare care improves the efficacy of medical care].

BACKGROUND AND OBJECTIVE: Our aim was to evaluate the efficacy of the consulting of internal medicine (CIM) in primary care (PC) on the resolution of medical processes. PATIENTS AND METHOD: Prospective case-control study of a population of 87,016 inhabitants during a 1-year period. Patients (2,167) jointly attended by family physicians (FP) and consulting internists (CI) who go weekly to the primary care center (PCC) to attend patients who otherwise would have been referred to specialized consultation (SC). As the control group 1,470 patients were randomly and simultaneously chosen among the total of 14.687 first medical referrals during the period of the study. RESULTS: We observed a significant reduction in: referrals to SC (22%; CI 95%, 18-26%); mean time for SC (23.6 days; CI 95%, 17.3-29.9 days); mean number of tests per patient ordered by FP (0.53; CI 95%, 0.31-0.75) or by CIM (1.22; CI 95%, 1.02-1.40); mean time for patient information on those tests ordered by CIM (21.2 days; CI 95%, 8.5-33.9 days); mean time for the resolution of processes (39.4 days; CI 95%, 35.5-43.3 days); crossed SC rate (23.7%; CI 95%, 20.3-27.1%); and specialized follow-up visits (28.8%; CI 95%, 24.5-33.1%) (p < 0.005 in all cases). The resolution rate of processes (15%; CI 95%, 11-19%) and the discharge rate (41.6%; CI 95%, 35.5-47.7%) were significantly higher for the CIM (p < 0.01 in both cases). The referral rate to SC showed a negative correlation (r = 0.81; p < 0.01) with the management quality, and it related to type of training, age and years of medical practice of the general practitioner (GP). The satisfaction of patients and GPs with the CIM was very high. CONCLUSIONS: CIM in PC improves the efficacy of specialized outpatient medical care.

Adolescent↗

PubMed2000

Diary cards and the assessment of cough symptoms in community pharmacies.

The aim of this study is to compare cough symptom assessment and medication efficacy as recorded in a diary card with that obtained through direct questioning by a pharmacist. Clients visiting six pharmacies, purchasing a cough medication and meeting the inclusion criteria were recruited. They were asked to fill out diary cards to obtain a daily retrospective assessment of symptoms and medication efficacy. After three days the subjects returned to the pharmacy and were asked to recall their symptoms through a structured questionnaire administered by the pharmacist. 48 clients were recruited to the study and of these 44 (92%) completed the study. A good correlation was obtained between ratings of medication efficacy as recorded by diary cards and recall. Symptom assessment also showed a statistically significant correlation for days two and three only. For studies assessing symptoms over a 48 hour period, detailed post-study assessments may not be required. The study provides further evidence for the viability of clinical trials conducted through community pharmacies.

Adult↗

PubMed2004

Accounting for time: insights from a life-table analysis of the efficacy of medical abortion.

OBJECTIVE: Previously published analyses have ignored the temporal nature of medical abortion and calculated effectiveness as the proportion of abortions that succeed. By using life tables, we incorporate the important element of time to produce unbiased efficacy rates as well as afford insight into the medical abortion process. STUDY DESIGN: Using data on 6568 women from 6 previously published mifepristone-misoprostol medical abortion studies, we generated multidecrement life table efficacy curves and evaluated the cumulative probability of successful medical abortion. RESULTS: Efficacy rates calculated using proportions are biased because of loss to follow-up. Compliance with the medical abortion regimen was high. More than 80% of abortions were complete within a week of receiving mifepristone. Success continued to improve thereafter. Most surgical interventions were unnecessary. CONCLUSION: Follow-up visits can be scheduled within a week of receiving mifepristone; however, aspirations should not be performed routinely if the abortion is not complete.

Abortifacient Agents↗

PubMed1998

The influence of obsessive-compulsive neurosis patients' premorbid personality on obsessive-compulsive symptoms and efficacy of medication.

We conducted a survey with the Lynfield obsessive-compulsive symptom questionnaire (revised version) on 48 obsessive-compulsive neurotic patients as the survey subjects. In the factor analysis five factors of obsessions, were identified: (i) the desire for perfection; (ii) compulsive checking; (iii) washing; (iv) feelings of uncleanliness; and (v) anthropophobia. High correlations were noted between these factors. We also investigated the premorbid personalities of obsessive-compulsive neurotic patients with a multidimensional personality scale and obtained an extroversion dimension and neuroticism dimension. The influence of these premorbid personality dimensions on obsessive-compulsive symptoms became clear; (i) neuroticism is related to the levels of obsession after onset, but not related to compulsive behaviors; and (ii) No differences in premorbid personality dimensions were noted between compulsive checking and compulsive washing behaviors. We also studied whether it was possible to predict the efficacy of pharmacotherapy upon obsessive-compulsive symptoms. It was elucidated that the obsessions of those whose premorbid personalities are emotionally stable and extroversive are susceptible to antidepressants. Based on these results, we discussed the usefulness of premorbid personalities in predicting diversity of obsessive-compulsive symptoms, as well as in prediction the efficacy of medication.

Adolescent↗

PubMedDate not supplied

The efficacy of medical and surgical treatment of endometriosis-associated infertility: arguments in favour of a medico-surgical aproach.

This review discusses the efficacy of a combined, medical (GnRH agonist) and surgical, therapy in endometriosis-associated infertility. Because of the limited information currently available on the activity of lesions in minimal and mild endometriosis, any absolute statement is inappropriate at this time, although some arguments exist in favour of treating endometriosis at laparoscopy. In moderate and severe endometriosis, this review provides arguments in favour of a medico-surgical approach and discusses the possibility of combining medical and surgical therapy.

Endometriosis↗

PubMed1989

Efficacy of medical therapy tailored for severe congestive heart failure in patients transferred for urgent cardiac transplantation.

Cardiac transplantation can only be performed in a few patients with severe congestive heart failure (CHF), due to the shortage of donor hearts. The efficacy of current medical therapy tailored for severe CHF, which has not previously been determined for transplant candidates, is of particular importance in patients considered for urgent cardiac transplantation. In this study, 50 consecutive in-patients transferred from other hospitals for urgent transplantation underwent intensive afterload reduction therapy, initially with intravenous and subsequently with oral vasodilators and diuretics tailored to hemodynamic goals. Oral regimens allowed hospital discharge without surgery for 40 of 50 patients. Nineteen of these patients had arrived on inotropic infusions and 32 had received oral vasodilators in the previous month. Cardiac index increased from 1.9 +/- 0.6 to 2.8 +/- 0.7 liters/min/m2, while pulmonary capillary wedge pressure decreased from 30 +/- 8 to 15 +/- 4 mm Hg and systemic vascular resistance decreased from 1,800 +/- 800 to 1,100 +/- 200 dynes-s-cm-5. Despite poor initial hemodynamics, ejection fraction 16 +/- 4%, serum sodium 131 +/- 6 mEq/liter, and apparent failure of previous medical therapy, actuarial survival for 24 discharged patients receiving sustained medical therapy alone was 67% at 1 year, with 67% of survivors employed full- or part-time, and 14 of 16 (88%) discharged transplant candidates survived until transplantation. By decreasing the need for transplantation to be performed urgently, increased emphasis on the design of medical therapy may allow more effective distribution of limited donor hearts.

Actuarial Analysis↗

PubMed2001

[Management of chronic cough in high volume medical offices: efficacy of a sequential protocol].

INTRODUCTION: Chronic cough is one of the main causes of medical consultation. There is not however an homogeneous attitude regarding its management. A prospective evaluation was performed of a simple therapeutic protocol based on the anatomical approach of the cough reflex. METHODS: A total of 110 patients with chronic cough for longer than four weeks were studied. The exclusion criteria were: non-smoking during the last year, not to have diseases compromising the immune system and not to have received inhibitors of the angiotensing converting enzyme. A three-visit stepwise approach was performed with specific diagnostic tests ordered and a specific therapy instituted according to the clinical suspicion. RESULTS: At the third visit, 97% of patients were free from cough or had improved markedly. Cough causes were identified in 105 cases (95%) and the most common were: asthma (33%), postnasal dripping (29%), gastroesophageal reflux (10%), and asthma with associated gastroesophageal reflux (16%). Patients with asthma had a longer duration of tos compared with those who had postnasal dripping (p < 0.05) as the only differential feature. CONCLUSIONS: The diagnostic-therapeutic diagram based on the anatomic reflex of cough is useful for the management of chronic cough in a highly demanded medical office. With this protocol, the cause of cough can be identified and treated successfully in almost every patient with a small number of diagnostic tests and medical visits.

Adult↗

PubMed2001

The collaborative practice model for bipolar disorder: design and implementation in a multi-site randomized controlled trial.

Bipolar disorder remains a high morbidity and costly illness in general clinical practice, despite the availability of efficacious medications. This 'efficacy-effectiveness gap' may be addressed by better organizing systems of care. One type of intervention is the 'collaborative practice model' which can be defined as an organization of care that a) emphasizes development in the patient of illness management skills, and b) supports provider capability and availability in order to c) engage patients in timely, joint decision-making regarding their illness. This article describes such a collaborative practice model for bipolar disorder, designed to be widely adoptable and sustainable in general clinical practice. The first part of the article describes the theoretical background from which the collaborative practice approach developed, emphasizing its origins in the lithium clinics of the 1970s, in nursing theory and practice, and more recently in the management of chronic medical diseases. The second part describes the structure of one such intervention, the Bipolar Disorders Program (BDP) developed in the Veterans Affairs health care system. The third part summarizes results from single-site studies of the intervention. The fourth part describes several key issues in its implementation in an ongoing multi-site randomized controlled trial, VA Cooperative Study Program (CSP) # 430. Data to date indicate that such collaborative practice interventions may improve important process and intermediate outcome variables for bipolar disorder. The BDP provides an example of a multi-faceted collaborative practice model that can be manualized and implemented across multiple sites in a randomized controlled trial.

Adult↗

PubMed2002

Canadian survey of postsurgical pain and pain medication experiences.

PURPOSE: To assess the postoperative pain and pain medication experiences of Canadians. METHODS: Three hundred and five general population subjects from across Canada who had surgery in the previous three years were retrospectively questioned regarding pain experiences in the surgical facility and at home, pain medication efficacy and pain medication satisfaction. RESULTS: While in the surgical facility, pain was experienced by 68% of patients who expected overnight admission ("inpatients") and 49% of patients who expected same-day discharge ("outpatients"). Overall, 47% of inpatients and 15% of outpatients reported that their highest experience of pain was severe or extreme; 25% of inpatients and 9% of outpatients reported that their average pain was severe or extreme. In the two weeks post-discharge, 79% and 74% respectively of inpatients and outpatients experienced pain. Severe or extreme pain occurred at home in 25% of inpatients and 28% of outpatients; average pain was severe or extreme for 9% of inpatients and 12% of outpatients. Complete or a lot of pain relief was experienced by 54% to 72% patients who received pain medication; higher rates of pain medication satisfaction were reported than rates of pain relief from pain medication. CONCLUSION: Severe or extreme pain was experienced by many surgical patients. Improvements could be made to patients' postsurgical pain experience in Canada, both in the surgical facility and subsequent to discharge.

Adolescent↗

PubMed2004

Assessing the efficacy of medical treatments for alcohol use disorders.

Alcohol use disorders (AUDs) are common health problems that have a significant impact on society as a whole. There is a need for more effective treatments. In the last two decades, evidence for the efficacy of pharmacological approaches to treatment has increased. Although it has long been clear that medications are needed for the treatment of the alcohol withdrawal syndrome, the important role of medications in the longer-term treatment of AUDs has only recently been appreciated. In particular, naltrexone, acamprosate and topiramate appear to be efficacious treatments, especially when combined with psychosocial interventions that emphasise compliance with medication and encourage treatment retention. The goal of this review is to bring together the existing literature supporting the usefulness of pharmacological treatments for the alcohol withdrawal syndrome, for longer-term treatment of AUDs, and for comorbid AUDs and other psychiatric disorders. In addition, opportunities for future research will be identified.

Alcohol Deterrents↗

PubMed2001

[Tobacco detoxication at a primary care clinic: efficacy of medical counseling, minimal intervention and nicotine replacement therapy at the one-year follow-up].

OBJECTIVE: The main objective was to compare the efficacy of one-off tobacco counselling and of the systematic minimum intervention on making people give up smoking. A secondary aim was to evaluate the efficacy of nicotine replacement therapy (NRT) in the context of a primary care consultation. DESIGN: Controlled and randomised clinical trial. SETTING: Primary care. PARTICIPANTS: Smokers who over 12 months attended a primary care clinic at an urban health centre (304 patients). INTERVENTIONS: Two kinds of intervention were conducted at random on patients with low nicotine dependence (one-off medical counselling and counselling integrated into what is known as the minimal intervention, but conducted systematically). NRT was administered through nicotine patches (11% nicotine) to patients with moderate-to-high nicotine dependence. MEASUREMENTS AND MAIN RESULTS: Short-term cessation a year after the minimal intervention was 39% (29.4-49.3%), and maintained cessation 30.9% (29.4-49.3%), as against 11% (5.6-18.8%) short-term cessation in the group that received one-off counselling (p < 0.0001). Short-term tobacco cessation in the NRT group was 35.3% (24.1-47.8%), and maintained cessation 30.8%. CONCLUSIONS: Primary care is a suitable context for an intervention against tobacco dependency, through the use of any of the established interventions: one-off medical counselling, systematic minimal intervention, or specialist drug treatment through NRT. Therefore, these kinds of intervention must form part of PC clinics' daily activity.

Adult↗

PubMed1987

Seasonal allergic rhinitis and depot injection of a corticosteroid. Evaluation of the efficacy of medication early and late in the season based on detailed symptom recording.

It was the aim of this investigation to study the efficacy of a corticosteroid given as a depot injection in seasonal allergic rhinitis, the efficacy profile with regard to specific symptoms, and whether the injection is best given early in the season or later at the peak of the pollen count. An injection of 80 mg methylprednisolone showed a marked effect on nasal blockage lasting more than 4 weeks, and a moderate effect on eye symptoms, while the effect on nasal hypersecretion and sneezing could not be demonstrated. It is concluded that systemic corticosteroids may be indicated in severe hay fever, when symptoms, especially blockage, occur in spite of other types of therapy. If the physician prefers to give the corticosteroid as a depot injection, it is preferably given in the first half of the season when the pollen count is increasing.

Adolescent↗