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At least 379 records · Page 21Linked to original sources
PubMed2005

Comparison of large versus smaller randomized trials for mental health-related interventions.

OBJECTIVE: The extent of disagreement between large and smaller randomized, controlled trials on mental health issues is unknown. The authors aimed to compare the results of large versus smaller trials on mental health-related interventions. METHOD: The authors screened 161 Cochrane and 254 Database of Abstracts of Reviews of Effectiveness systematic reviews on mental health-related interventions. They identified 16 meta-analyses with at least one "large" randomized trial with sample size >800 and at least one "smaller" trial. Effect sizes were calculated separately for large and smaller trials. Heterogeneity was assessed between all studies, within each group (large and smaller studies), and between large and smaller studies. RESULTS: Significant between-study heterogeneity was seen in five meta-analyses. By random-effects calculations, the results of large and smaller trials differed beyond chance in four meta-analyses (25%). In three of these disagreements (effect of day care on IQ, discontinuation of antidepressants, risperidone versus typical antipsychotics for schizophrenia), the smaller trials showed greater effect sizes than the large trials. The inverse was seen in one case (olanzapine versus typical antipsychotics for schizophrenia). With fixed-effects models, disagreements beyond chance occurred in five cases (31%). In four meta-analyses, the effect size differed over twofold between large and smaller trials. Various quality and design parameters were identified as potential explanations for some disagreements. CONCLUSIONS: Large trials are uncommon in mental health. Their results are usually comparable with the results of smaller studies, but major disagreements do occur. Both large and smaller trials should be scrutinized as they offer a continuum of randomized evidence.

Adult↗
PubMed1986

Late onset involuntary movements in chronic schizophrenia: relationship of 'tardive' dyskinesia to intellectual impairment and negative symptoms.

Intellectual impairment, negative symptoms, and medication history were assessed in chronic schizophrenic patients with and without abnormal involuntary movements (tardive dyskinesia). Patients with involuntary movements had received neither longer nor more intensive treatment with neuroleptics or anticholinergics. However, the presence or absence of involuntary movements was prominently associated with the presence or absence of intellectual impairment/negative symptoms; these features are characteristic of the defect state/type II syndrome of schizophrenia, in which structural abnormalities of the brain may be over-represented. The role of subtle organic changes in conferring vulnerability to the emergence of such involuntary movements should be re-evaluated.

Adult↗
PubMed1981

Cognitive improvement associated with tricyclic antidepressant treatment of childhood major depressive illness.

11 children fulfilling DSM-III criteria for major depressive illness were administered detailed neuropsychological batteries prior to and 3 to 6 mo. after starting tricyclic antidepressant treatment. Remission of depressive illness in children with melancholic major depression was associated with significant improvement in WISC-R Verbal IQ and Performance IQ, and on the Similarities, Comprehension, Block Design, and Coding subtests. In addition, there were significant improvements on the Halstead Categories test, on the Visual Reception subtest of the Illinois Test of Psycholinguistic Abilities, and in response latencies on the Matching Familiar Figures test. Two children with evidence of mild left hemiparesis showed amelioration of hemiparesis during tricyclic antidepressant treatment.

Adolescent↗
PubMed1999

The effect of benchmarking clinical practice with the clinical laboratory. An institutional case study.

The improvement of quality in clinical care can greatly benefit form continuous benchmarking with information based on laboratory data. To be most effective, the information is best provided in the form of real-time disease management decision support. Such an approach requires advances in the implementation of hospital information systems. This article describes ground-breaking work at LDS Hospital in Salt Lake City, Utah that provides examples of major well-documented impacts of the "intelligent laboratory report" on patient outcomes.

Anti-Bacterial Agents↗
PubMed2006

Craniopharyngioma radiotherapy: endocrine and cognitive effects.

Potential existing and treatment associated deficits in neurological, endocrine and cognitive function influence treatment decisions and the use of radiation therapy in children with craniopharyngioma. Neurological deficits are uncommon after radiation therapy, endocrine deficiencies are typically present prior to treatment, and cognitive effects depend on a wide range of clinical and treatment-related factors in addition to radiation dosimetry. Early and accurate evaluation of these functions should be considered for all patients to provide parents and caregivers with the information necessary to plan intervention and mitigate the consequences of tumor and treatment.

Adolescent↗
PubMed1978

[Physiological trials with MIF-I in Parkinson's disease (author's transl)].

The writers present some physiological (and not therapeutic) acute and sub-acute trials with tripeptide: L-propyl-L-leucyl-glycine amide (M.I.F.-I) in Parkinson's Disease. This work confirms the earlier observation that M.I.F.-I employed alone or in combination with Levodopa is active against Parkinson's disease. The writers evoke the hypothesis that this action takes place at the postsynaptic receptors, whose configuration may be modified in the sense of a hypersensitivity. These studies justify undertaking a series of controlled therapeutic trials when the cost of the product permits and as well instituting development work on analogues active orally.

Aged↗
PubMed2005

Do we need new treatment that goes beyond tumor necrosis factor blockers for rheumatoid arthritis?

Rheumatoid arthritis (RA) has a prevalence of approximately 1%, making it the most common inflammatory rheumatic disease. The outcome for RA patients has significantly improved during recent years. Factors include the introduction of new therapies such as tumor necrosis factor (TNF)-blocking agents and new treatment strategies, especially early and aggressive therapy, including combinations of several disease-modifying antirheumatic drugs (DMARDs). However, only 60-70% of RA patients respond to treatment with a TNF-blocking agent. In addition, most of these patients show only a partial response according to ACR20 criteria. Therefore, to ameliorate painful joint inflammation and prevent disability in RA patients, new treatment principles and more intelligent combination therapies are urgently needed. Interestingly, the strategy of switching patients who no longer respond to one of the TNF blockers to another has often turned out to be effective. Areas of ongoing research include combining TNF-blocking agents with DMARDs other than methotrexate. Also, several new biologics are being tested in clinical trials that promise to soon enhance the therapeutic armamentarium to fight RA. These biologics' mechanisms of action feature blockade of T cell costimulation by a CTLA4Ig fusion protein (abatacept); blockade of interleukin (IL)-6 signaling with an antibody to the IL-6 receptor (MRA); neutralizing IL-15 by a monoclonal antibody; and targeting B cells with an anti-CD20 antibody (rituximab). Other therapeutic approaches, such as blockade of chemokine receptors, adhesion molecules, complement components, and transcription factors regulating the inflammatory response, appear promising; however, they still need careful evaluation in placebo-controlled clinical studies.

Abatacept↗
PubMed2006

Neurocognitive functioning in patients with first-episode schizophrenia : results of a prospective 5-year follow-up study.

To assess the course of neuropsychological (NP) impairment in schizophrenia, 71 patients with first episode (FE) schizophrenia and 71 healthy controls were given a comprehensive battery of NP tests at index assessment, after a 2-year and after a 5-year follow-up period. By means of the z-score standardization, summary scores for verbal intelligence (VBI), spatial organisation (SPT), verbal fluency (VBF), Verbal learning (VBL), semantic memory (SEM), visual memory (VIM), delay/retention rate (DEL), short-term memory (STM), visuomotor processing and attention (VSM) and abstraction/flexibility (ABS) were constructed. FE schizophrenia patients showed a worse performance compared to controls in all areas investigated, most pronounced in VSM, SEM and VBL. In the majority of cognitive domains, an improvement was found over the 5-year follow-up period without differences between the two groups. However, in VBF patients slightly deteriorated whilst controls improved and in memory functions patients improved less compared to controls. When controlling for relevant confounders, neither conventional nor atypical neuroleptics showed a deleterious influence on NP performance, except on VBF. Our data suggest that NP impairment is already present at the onset of the illness and remains stable over the early course of schizophrenia.

Adult↗
PubMed2004

First steps of an interdisciplinary approach towards miniaturised cryopreservation for cellular nanobiotechnology.

The only widely used and accepted method for long-term cell preservation is storage below -130 degrees C. The biosciences will make increasing use of preservation and place new demands on it. Currently, cells are frozen in volumes greater than 1 ml but the new cell and implantation therapies (particularly those using stem cells) will require accurately defined freezing and storage conditions for each single cell. Broadly-based, routine freezing of biological samples allows the advantage of retrospective analysis and the possibility of saving genetic rights. For such applications, one billion is a modest estimation for the number of samples. Current cryotechniques cannot handle so many samples in an efficient and economic way, and the need for new cryotechnology is evident. The interdisciplinary approach presented here should lead to a new sample storage and operating strategy that fulfils the needs mentioned above. Fundamental principles of this new kind of smart sample storage are: (i) miniaturisation; (ii) modularisation; (iii) informationsample integration, i.e. freezing memory chips with samples; and (iv) physical and logical access to samples and information without thawing the samples. In contrast to current sample systems, the prototyped family of intelligent cryosubstrates allows the recovery of single wells (parts) of the substrate without thawing the rest of the sample. The development of intelligent cryosubstrates is linked to developments in high throughput freezing, high packing density storage and minimisation of cytotoxic protective agents.

Journal Article↗
PubMed1992

Dentists, drugs, and decisions: introduction to Part I--Therapeutic drugs.

Numerous dental therapeutic agents or drugs are available over the counter or with prescription for patient use at home or in a professional office. Knowledge of the processes by which these agents are evaluated for safety and efficacy by the FDA and ADA is necessary for dental professionals to make intelligent decisions concerning their use. Several examples of problems with drug/cosmetic evaluations are cited.

American Dental Association↗
PubMed1988

Brain abscesses in neonates. A study of 30 cases.

Since the introduction of ultrasonography and computerized tomography (CT) scanning, brain abscesses are found more frequently in cases of neonatal meningitis and septicemia, particularly when the offending pathogen is Proteus. Thirty cases of brain abscess in neonates are reported, 27 of which were caused by Proteus species infections. Twenty infants had meningitis and 13 had septicemia. Most of the abscesses were enormous, and multiple abscesses were observed in 17 cases. The frontal region was involved in 22 cases (12 unilaterally and 10 bilaterally). The ventricles were enlarged on the first CT scan in 13 cases. The abscesses were treated by aspiration and antibiotics in 25 cases, and by antibiotics alone in five. A shunt for hydrocephalus was necessary in 14 infants. Four infants died, three from the initial illness and one from a shunt complication. Sixteen children have seizures. Subsequent intelligence quotient (IQ) testing was performed in 22 children: eight (36%) have an IQ at or above 80 and eight have an IQ of less than 60. In the 17 children followed for more than 2 years, the proportion with an IQ at or above 80 fell to 24% (four cases). The absence of initial seizures, sterile cerebrospinal fluid, normal ventricles on CT scans, and early aspiration of the abscess seem to be factors portending a better prognosis in terms of epilepsy and mental sequelae.

Anti-Bacterial Agents↗
PubMed2001

Relationship between lesion location and the outcome of pallidotomy for Parkinson's disease.

The relationships between lesion location and clinical outcome following posteroventral pallidotomy for Parkinson's disease were studied. Forty-four patients were operated forty-six times and studied with neurological and psychological examinations before and after pallidotomy. Lesion location was confirmed using films with a coagulation electrode which were X-rayed during the operation. Changes of intelligence were observed in the patients with anteromedial lesions. Wearing-off phenomenon in four patients and dopa-induced dyskinesia in three patients were not improved following pallidotomy in twenty patients with severe wearing-off and dyskinesia. Lesions in the patients with no improvement of wearing off were located more lateral and those in the patients with sustained severe dyskinesia were located more dorsal in the internal part of the globus pallidus. It may be concluded that clinical outcome is related to lesion location.

Antiparkinson Agents↗
PubMed2005

Agent oriented approach to handling medical data.

Medical treatment of a patient could be represented as a circle of the following actions: examination, diagnostics, and therapy. The aims of the actions are to find out the patient's state of health and consequently to conclude about possible diseases and finally to choose a suitable therapy. In long term, the circle of actions repeat as long as the patient is not healthy. Efficiency of this treatment depends on the knowledge and the experiences of the physicians involved. Information technology offers many possibilities to help the physicians increase the efficiency and the quality of this work. In the article, we present an agent-oriented computer-based health care service, which uses information from different data sources that are physically distributed across several sites. Such a decentralized approach mirrors the organizational structure of a health service and it is very similar to an agent-oriented view of the world.

Artificial Intelligence↗
PubMedDate not supplied

Managing delirium and agitation in elderly hospitalized orthopaedic patients: Part 2--Interventions.

Delirium, a disorder of consciousness that may afflict over one-half of elderly surgical orthopaedic patients is a common sequela of surgery in the elderly. Agitation, either as an element of the delirium or dimension of a preexisting dementia, is another common behavioral problem that can confront the orthopaedic nurse in acute care. It is time now to tear down the barriers to intelligent and compassionate care of patients with agitation and delirium, including late or missed recognition and diagnosis, biases about what is "normal" and acceptable behavior in the elderly, and lack of familiarity with pharmacologic strategies. In Part 1 (Jan/Feb issue), current thinking about the phenomena was presented, including hypotheses about causation and pathophysiology. That foundation is intended to serve as the basis for the current discussion. The triad of interventions available to manage disorganized behavior in elderly orthopaedic patients is presented in Part 2. They include an extensive selection of pharmacologic options, a discussion of therapeutic use of self and environmental-organizational issues to address and consider on a case-by-case basis. Though it may be impossible to prevent behavioral decompensation during an acute orthopaedic admission, it is certainly possible to improve our performance to date, using a compassionate, intelligent, and inclusive approach with every patient.

Aged↗