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At least 595 records · Page 33Linked to original sources

PubMed1993

High-osmolar and low-osmolar contrast media. An update on frequency of adverse drug reactions.

During the past 3 years a great number of papers about adverse drug reactions to intravascular injection of high-osmolar and low-osmolar iodinated contrast media (CM) have been published. They include observational studies, randomized trials, meta-analyses and committee reports. Thorough analysis of this material substantiates an improvement in safety of at least 6-fold using nonionic low-osmolar CM compared with ionic high-osmolar CM. The point where only a small minority is continuing to argue effectively that low-osmolar CM are not better than conventional high-osmolar CM has now been reached. High-osmolar CM are used less and less for intravascular purposes, and, in fact, have been totally replaced by low-osmolar CM in 4 countries.

Clinical Trials as Topic↗

PubMed1993

Effect of antibiotic therapy and etiologic microorganism on the risk of bacterial meningitis in children with occult bacteremia.

OBJECTIVE: To quantify the effect of antibiotic therapy on the probability of subsequent bacterial meningitis in children with fever without source treated as outpatients. DESIGN: Bayesian meta-analyses. REPORTS INCLUDED: All reports of the organism-specific prevalence of occult bacteremia in children with fever without source treated as outpatients, and the organism-specific prevalence of subsequent meningitis in children with occult bacteremia initially treated as outpatients stratified by type of antibiotic therapy. RESULTS: The mean probabilities of subsequent meningitis in children with occult bacteremia were 9.8%, 8.2%, and 0.3% in the no antibiotic, oral antibiotic, and parenteral antibiotic therapy groups, respectively. All cases of bacterial meningitis in children with occult bacteremia treated with oral antibiotics were due to Haemophilus influenzae. There were no cases of culture-positive bacterial meningitis in 139 bacteremic children treated with ceftriaxone (mean probability, 0.3%; 95% confidence interval, 0.0% to 1.5%). The mean probabilities of bacterial meningitis in a child with fever without source treated as an outpatient without antibiotics were: Streptococcus pneumoniae, 0.21%; and H influenzae, 0.06%. CONCLUSIONS: Antibiotic therapy is effective in preventing meningitis in children at risk of occult bacteremia.

Administration, Oral↗

PubMed1995

Clinical efficacy of sulphasalazine--a review.

This review of the use of sulphasalazine (SASP) in the therapy of rheumatoid arthritis refers to the placebo-controlled trials of SASP and the randomized comparative studies with other second-line drugs that have been published over the past decade. The questions relating to appropriate selection of patients for this treatment and the possible relevance of drug interactions are addressed. The favourable effect of SASP on functional, radiological and extra-articular outcome measures is highlighted, as is the reproducibility of published studies. Finally, the results from combination studies and meta-analyses are outlined.

Antirheumatic Agents↗

PubMed1996

Cost efficacy of the diagnosis and therapy of renovascular hypertension.

UNLABELLED: Numerous competing diagnostic modalities and the lack of data about therapeutic benefit result in controversy concerning the identification and treatment of renovascular hypertension. METHODS: Meta-analyses were used to examine the cost efficacy of renovascular hypertension diagnosis and treatment. Sensitivity, specificity and predictive value were calculated for captopril renography, Doppler, the captopril test and arteriography. Sensitivities and specificities were used to project cost per patient cured or improved for each modality. This was compared with the lifetime cost of medical therapy. Cost efficacy was calculated using a hypothetical population (1000 patients, a prevalency rate of 30% for renal artery stenosis, expected cure or improvement rate of 0.77 after angioplasty). RESULTS: The sensitivity, specificity and positive predictive values were similar for all modalities except the captopril test, which had a significantly lower sensitivity. The specificity was similar for all procedures; Doppler was highest but was mitigated by a 17% technical failure rate. The cost per patient cured or improved is greatest for arteriography and lowest for the captopril test. The relationship between cost per patient cured and the number of patients diagnosed in the population was calculated (relative value = (1/cost) x number patients detected). The relative value of captopril renography and arteriography is similar. Doppler and the captopril test have the lowest relative value. If angioplasty reduces medication by three drugs, the savings is $5807 to $8046 per patient. Surgical therapy is not cost-effective. CONCLUSION: Screening for renovascular hypertension is not cost-effective at a prevalence less than 30%, but captopril renography is equally cost-effective as arteriography and obviates the need for an arteriogram in many patients.

Captopril↗

PubMed1996

Efficacy of insulin and sulfonylurea combination therapy in type II diabetes. A meta-analysis of the randomized placebo-controlled trials.

BACKGROUND: Numerous studies demonstrate the efficacy of the combination therapy of insulin and sulfonylurea in subjects with type II diabetes mellitus. However, two recent meta-analyses of randomized trials during the last decade provided inconsistent conclusions and failed to resolve the controversy. OBJECTIVE: To assess the efficacy of insulin and sulfonylurea combination therapy in type II diabetes mellitus by performing meta-analysis of only the controlled studies selected according to specific strict criteria. METHODS: A computerized literature survey was conducted using the MEDLINE database from January 1980 through March 1992 with the search headings of "sulfonylurea" and "insulin" and "combination therapy in diabetes mellitus. "A manual search was also performed using references from each retrieved report. Case reports, review articles, editorials, and citations reported in non-English-language journals without English translations were excluded. Forty-three citations were obtained. Four strict inclusion criteria were used to select studies: randomized, placebo-controlled trials (oral agent plus insulin vs placebo plus insulin); homogeneous target population (subjects with type II diabetes); intervention using the same sulfonylurea agent in a combination therapy; and uniform outcome measures to evaluate efficacy such as body weight; values for serum glucose, glycohemoglobin, and C peptide; daily insulin dosage; and lipid concentrations. More stringent qualitative subcriteria were then used to eliminate bias in the final unanimous selection by two blinded reviewers. Data were pooled and analyzed using Student's t test and Winer's combined test. RESULTS: Sixteen studies satisfied the inclusion criteria. Metabolic control improved with the combination therapy as reflected by a significant lowering of fasting serum glucose values (P < .01) and glycohemoglobin concentrations (P < .025). Moreover, improved metabolic control was achieved with a significantly smaller daily insulin dose (P < .01) and without a significant change in body weight. Finally, the combination therapy enhanced the endogenous insulin secretion as expressed by an increase in fasting serum C peptide concentration (P < .05). CONCLUSIONS: Combination therapy with insulin and sulfonylurea may be a more appropriate and a suitable option to insulin monotherapy in subjects with non-insulin-dependent diabetes in whom primary or secondary failure to sulfonylurea developed. It may also be a more cost-effective way of long-term management in this group of subjects, especially in the elderly.

Blood Glucose↗

PubMed1996

The role of BCG vaccine in the prevention and control of tuberculosis in the United States. A joint statement by the Advisory Council for the Elimination of Tuberculosis and the Advisory Committee on Immunization Practices.

This report updates and replaces previous recommendations regarding the use of Bacillus of Calmette and Guerin (BCG) vaccine for controlling tuberculosis (TB) in the United States (MMWR 1988;37:663-4, 669-75). Since the previous recommendations were published, the number of TB cases have increased among adults and children, and outbreaks of multidrug-resistant TB have occurred in institutions. In addition, new information about the protective efficacy of BCG has become available. For example, two meta-analyses of the published results of BCG vaccine clinical trials and case-control studies confirmed that the protective efficacy of BCG for preventing serious forms of TB in children is high (i.e., > 80%). These analyses, however, did not clarify the protective efficacy of BCG for preventing pulmonary TB in adolescents and adults; this protective efficacy is variable and equivocal. The concern of the public health community about the resurgence and changing nature of TB in the United States prompted a re-evaluation of the role of BCG vaccination in the prevention and control of TB. This updated report is being issued by CDC, the Advisory Committee for the Elimination of Tuberculosis, and the Advisory Committee on Immunization Practices, in consultation with the Hospital Infection Control Practices Advisory Committee, to summarize current considerations and recommendations regarding the use of BCG vaccine in the United States. In the United States, the prevalence of M. tuberculosis infection and active TB disease varies for different segments of the population; however, the risk for M. tuberculosis infection in the overall population is low. The primary strategy for preventing and controlling TB in the United States is to minimize the risk for transmission by the early identification and treatment of patients who have active infectious TB. The second most important strategy is the identification of persons who have latent M. tuberculosis infection and, if indicated, the use of preventive therapy with isoniazid to prevent the latent infection from progressing to active TB disease. Rifampin is used for preventive therapy for persons who are infected with isoniazid-resistant strains of M. tuberculosis. The use of BCG vaccine has been limited because a) its effectiveness in preventing infectious forms of TB is uncertain and b) the reactivity to tuberculin that occurs after vaccination interferes with the management of persons who are possibly infected with M. tuberculosis. In the United States, the use of BCG vaccination as a TB prevention strategy is reserved for selected persons who meet specific criteria. BCG vaccination should be considered for infants and children who reside in settings in which the likelihood of M. tuberculosis transmission and subsequent infection is high, provided no other measures can be implemented (e.g., removing the child from the source of infection). In addition, BCG vaccination may be considered for health-care workers (HCWs) who are employed in settings in which the likelihood of transmission and subsequent infection with M. tuberculosis strains resistant to isoniazid and rifampin is high, provided comprehensive TB infection-control precautions have been implemented in the workplace and have not been successful. BCG vaccination is not recommended for children and adults who are infected with human immunodeficiency virus because of the potential adverse reactions associated with the use of the vaccine in these persons. In the United States, the use of BCG vaccination is rarely indicated. BCG vaccination is not recommended for inclusion in immunization or TB control programs, and it is not recommended for most HCWs. Physicians considering the use of BCG vaccine for their patients are encouraged to consult the TB control programs in their area.

Adult↗

PubMed1996

Psychosocial interventions for patients with coronary artery disease: a meta-analysis.

BACKGROUND: Narrative review strategies and meta-analyses have shown that drug treatment and exercise rehabilitation regimens can reduce psychological distress and postmyocardial infarction mortality and recurrence. OBJECTIVE: To question whether the addition of psychosocial interventions improves the outcome of a standard rehabilitation regimen for patients with coronary artery disease. METHODS: We performed a statistical meta-analysis of 23 randomized controlled trials that evaluated the additional impact of psychosocial treatment of rehabilitation from documented coronary artery disease. Anxiety, depression, biological risk factors, mortality, and recurrence of cardiac events were the clinical end points that were studied. Mortality data were available from 12 studies, and recurrence data were available from 10 of the 23 studies. RESULTS: The studies had evaluated 2024 patients who received psychosocial treatment vs 1156 control subjects. The psychosocially treated patients showed greater reductions in psychological distress, systolic blood pressure, heart rate, and cholesterol level (with effect size differences of -0.34 [corrected], -0.24, -0.38, and -1.54, respectively). Patients who did not receive psychosocial treatment showed greater mortality and cardiac recurrence rates during the first 2 years of follow-up with log-adjusted odds ratios of 1.70 for mortality (95% confidence interval [CI], 1.09 to 2.64) and 1.84 for recurrence (CI, 1.12 to 2.99). CONCLUSIONS: The addition of psychosocial treatments to standard cardiac rehabilitation regimens reduces mortality and morbidity, psychological distress, and some biological risk factors. The benefits were clearly evident during the first 2 years and were weaker thereafter. At the clinical level, it is recommended to include routinely psychosocial treatment components in cardiac rehabilitation. The findings also suggest an urgent need to identify the specific, most effective types of psychosocial interventions via controlled research.

Coronary Disease↗

PubMed1996

The importance of quality of primary studies in producing unbiased systematic reviews.

BACKGROUND: Traditional and largely qualitative reviews of evidence are now giving way to much more structured systematic overviews that use a quantitative method to calculate the overall effect of treatment. The latter approach is dependent on the quality of primary studies, which may introduce bias if they are of poor methodologic quality. OBJECTIVE: To test the hypothesis that the inclusion of poor-quality trials in meta-analyses would bias the conclusions and produce incorrect estimates of treatment effect. METHODS: An overview of randomized trials of antiestrogen therapy in subfertile men with oligospermia was performed to test the hypothesis. Data sources included online searching of MEDLINE and Science Citation Index databases between 1966 and 1994, scanning the bibliography of known primary studies and review articles, and contacting experts in the field. After independent, blind assessment, nine of 149 originally identified studies met the inclusion criteria and were selected. We assessed study quality independently. Outcome data from each study were pooled and statistically summarized. RESULTS: There was a marginal improvement in pregnancy rate with antiestrogen treatment (odds ratio, 1.6; 95% confidence interval, 0.9 to 2.6). Sensitivity analyses on the basis of methodologic quality demonstrated that poor-quality studies produced a positive effect with treatment, whereas no benefit was observed with high-quality studies. CONCLUSION: The results of a meta-analysis are influenced by the quality of the primary studies included. Methodologically, poor studies tend to exaggerate the overall estimate of treatment effect and may lead to incorrect inferences.

Bias↗

PubMed1996

Meta-analysis, clinical trials, and transferability of research results into practice. The case of cholesterol-lowering interventions in the secondary prevention of coronary heart disease.

OBJECTIVE: To evaluate, in the comprehensive scenario of "evidence-based" medicine, the transferability of the results of published randomized clinical trials and meta-analyses on cholesterol-lowering interventions to clinical practice. METHOD: Overview of randomized clinical trials on cholesterol-lowering interventions in the secondary prevention of coronary heart disease. RESULTS: The present overview on secondary prevention of coronary heart disease included 34 trials with cholesterol-lowering interventions in 24968 individuals. There was a 12.5% mortality in the group that was allocated active intervention and a 17.2% mortality in the control group (risk reduction, 13%; 95% confidence interval, -19% to -6%). Coronary and cardiovascular odds of deaths were significantly reduced. No clear association was found between noncoronary mortality and cholesterol-lowering interventions. Baseline total cholesterol levels had no clear influence on total mortality. Intermediate (10%-20%) and high ( > 20%) total cholesterol reductions were associated with similar reductions in the odds of death (-23% and -30%, respectively). No conclusion could be reached for patients who were less represented in the studies (ie, women and elderly persons). Patients with more complicated baseline clinical conditions (eg, congestive heart failure) had little nonsignificant benefit from cholesterol-lowering interventions. CONCLUSIONS: The effect of cholesterol-lowering interventions at least in the secondary prevention of coronary heart disease can be considered as established, but the transferability of such results to real-life patients remains the critical, unanswered question.

Anticholesteremic Agents↗

PubMed1996

Lung cancer.

In small cell lung cancer, combination chemotherapy including platinum compounds (cisplatin and carboplatin) and the podophyllotoxins (teniposide and etoposide) continues to be the backbone of therapy. Complete plus partial responses to combination chemotherapy occur in 80-90% of all patients. Median survival is at present 11-17 months depending on the initial tumour stage. Overall 5-year survival is approximately 5%. The duration of treatment has been shortened to 5-6 months. The results of the use of hematopoietic growth factors have hitherto been disappointing with respect to survival, while a definite effect on the degree and number of infections has been documented, when aggressive chemotherapy is administered. For epidermoid-, adenoid- and large cell carcinoma, results are emerging indicating that preoperative and preirradiatory chemotherapy in stage IIIa non-small cell lung cancer might have a substantial role in the overall management based on results from phase III trials. The studies are, however, rather modest in number and longer follow-up is necessary before recommendations for general use can be made. For patients with advanced non-small cell lung cancer (stage IIIb and IV), meta-analyses have yielded a small survival benefit (6 weeks) in favour of patients receiving chemotherapy vs. best supportive care. The treatment of this type of NSCLC should, however, still be considered to be experimental in order to define new innovative treatments. No improvement of the therapy of mesotheliomas has been reported.

Carcinoma, Non-Small-Cell Lung↗

PubMed1995

[How far should blood pressure be lowered in essential hypertension to optimize the results?].

Early studies of the seventies and eighties showed an inverse relationship between blood pressure reduction and incidence of complications and death. Afterwards, in the late eighties, some authors showed that reductions of diastolic blood pressure beyond 85 or 90 mm Hg increased coronary heart disease mortality (J shaped curve). Meta-analyses and recent epidemiological studies have shown that cardiovascular morbidity decreases along with reductions in diastolic blood pressure, if it is kept within normal limits (70-89 mm Hg). Cardiovascular mortality decreases significantly with blood pressure reductions of 7 to 8 mmHg. Some authors have suggested that diastolic blood pressure should be reduced to 85 mmHg or less in individuals with several cardiovascular risk factors, to obtain a better risk reduction. This hypothesis waits for confirmation from follow-up studies.

Blood Pressure↗

PubMed1996

Efficacy of glucose-based oral rehydration therapy.

OBJECTIVE: This article reviews and synthesizes evidence in the published literature on the safety and efficacy of oral rehydration therapy (ORT) among young children with pediatric gastroenteritis in developed nations. METHODOLOGY: We searched the literature for randomized, controlled trials comparing the safety and efficacy of ORT with intravenous (IV) rehydration treatment and/or oral rehydration solutions (ORSs) of different sodium content. We combined the failure rates of each set of studies in statistical meta-analyses and conducted tests of homogeneity of treatment effect over all the studies and for subgroups of children defined by the trial type, the sodium content of the ORS, and the setting of care. We also conducted a multivariate logistic regression on the probability of failure to determine the relative importance of these factors, controlling for other characteristics of the trials. Other outcomes were also tabulated and discussed. These include the relative incidence of hypernatremia and hyponatremia induced by treatment; weight gain; the volume, frequency, and duration of diarrhea; for inpatient trials, the length of stay; and for outpatient trials, rates of hospitalization. RESULTS: The evidence suggests that among pediatric patients with gastroenteritis in developed countries, failure of ORT, defined as the need to rehydrate children intravenously, is infrequent. We found a combined overall ORT failure rate of 3.6%. We found no statistically significant difference in failure rates by trial type or the sodium content of the ORS. However, we did find some supporting evidence for a lower failure rate among children treated in outpatient settings. In addition, compared with patients rehydrated intravenously, pediatric patients treated with ORT were not found to be at higher risk of iatrogenic hypernatremia or hyponatremia. The evidence from the literature fails to show a consistent trend in favor of either high- or low-sodium solutions for rehydration of pediatric patients. CONCLUSIONS: There seems to be a great potential for improving the medical treatment of children with acute gastroenteritis by the greater use of ORT.

Adolescent↗

PubMed1996

Implications of the links between hypertension and myocardial infarction for choice of drug therapy in patients with hypertension.

Meta-analyses of major outcome trials have demonstrated that the benefits of antihypertensive treatment for reduction of the incidence of stroke are entirely consistent with the benefits predicted from epidemiologic data; however, there remains a shortfall in the expected reduction of the incidence of coronary heart disease. Several explanations have been proffered to account for this shortfall, including the potential deleterious metabolic effects of long-term antihypertensive treatment; this has led to the speculation that antihypertensive agents with beneficial ancillary properties might confer additional significant advantage. However, with the exception of the angiotensin-converting enzyme inhibitors, few of these agents have translated into clinical benefit for humans. In addition, sound reasons exist to justify a focus on maintaining and improving the "quality" of blood pressure control. Current evidence suggests that optimal benefit is likely to result from the use of pharmacologic strategies that lower blood pressure consistently over a 24-hour period while at the same time maintaining the "normal" circadian pattern of blood pressure. This result will only be achieved with drugs and drug regimens that genuinely offer long duration of action with the additional potential benefit of maintaining a significant blood pressure lowering effect beyond the end of the dosage interval. This factor is particularly important because many patients with hypertension demonstrate poor adherence to prescribed dosage regimens.

Antihypertensive Agents↗

PubMed1995

[Magnesium sulfate in acute myocardial infarction].

Magnesium sulphate has antiarrhythmic and antithrombotic properties, a coronary and systemic vasodilating action, a direct myocardial protective effect in experimental and clinical models of ischemia-reperfusion injury. Two meta-analyses have pooled the results of several small studies that had analyzed the effect of controlled hypermagnesiemia in acute myocardial infarction before the advent of thrombolytic and antithrombotic therapies. The results have shown a more than 50% mortality reduction, with a minimum estimated benefit of about 30%, and a reduction in ventricular arrhythmias of about 50%. In LIMIT-2, a double-blind trial of 2,316 patients where magnesium was administered as a 8 mMol bolus followed by a 24-hour infusion of 65 mMol, a 24% reduction in mortality was observed. However, these data have not been confirmed in the more than 58,000 patients of the ISIS-4 trial. In this study magnesium, at the same dose of the LIMIT trial, did not reduce 5-week mortality, neither in the general population (7.64% versus 7.24% in control patients, p = n.s.) nor in specific subgroups. The results of ISIS-4 have excluded the routine use of magnesium sulphate in acute myocardial infarction in the era of fibrinolysis and aspirin, beta-blockers and ACE-inhibitors. Nevertheless, magnesium administration could still be considered in certain clinical situations, such as 1) the presence of contraindications to fibrinolysis and aspirin, 2) the treatment of ventricular tachyarrhythmias unresponsive (or as an alternative) to lidocaine, 3) severe hypertension when beta-blockers are not indicated.

Adrenergic beta-Antagonists↗

PubMed1995

Integration of vinorelbine into chemotherapy strategies for non-small-cell lung cancer.

Meta-analyses of randomized clinical studies comparing combination chemotherapy versus "best supportive care" for advanced non-small-cell lung cancer have revealed a small, but statistically significant survival advantage for patients who receive chemotherapy. However, overall increases in lifespan have been short, and the great majority of patients die within 1 year of diagnosis. In the last few years, several new drugs with promising activity have been identified. Of these, vinorelbine has already been shown to increase survival rates in randomized clinical trials. In particular, one such trial showed the combination of vinorelbine and cisplatin to result in statistically superior survival rates, compared with "standard" therapy of cisplatin and vindesine, and with single-agent vinorelbine. A second study comparing vinorelbine to fluorouracil/leucovorin also demonstrated a survival benefit for patients treated with vinorelbine. Therefore, the combination of vinorelbine and cisplatin represents one new option for initial therapy of newly diagnosed stage IV non-small-cell lung cancer.

Antineoplastic Agents↗

PubMed1996

The importance of diet and physical activity in the treatment of conditions managed in general practice.

Evidence from meta-analyses, physiological data and individual studies suggests that diet and exercise are important in the aetiology and treatment of many of the conditions that are managed predominantly in primary care (hypercholesterolaemia, hypertension, diabetes, obesity and excess alcohol intake). However, much of the evidence comes from outside primary care, and it is doubtful whether those studies done in primary care used optimal intervention strategies. A priority for future research should be to demonstrate the feasibility, efficacy and efficiency of lifestyle interventions in a general practice setting.

Adult↗

PubMed1996

Adjuvant drug therapy for operable breast cancer.

Breast cancer-the most common malignancy of lethal potential for women in the developed world-presents as two interrelated problems: (1) local disease in the breast and axillary lymph nodes, and (2) micrometastatic disease in distant sites. During the last century, advances in surgery and radiotherapy have led to high rates of control over local disease. In addition, heightened public awareness and the more widespread use of mammography have led to the more frequent detection of smaller cancers with better prognosis. Nevertheless, the problem of distant recurrence, leading almost inevitably to death, persists. Hence, there is considerable interest in integrating systemic therapy, which since mid-century has been shown to be active against advanced disease, into the treatment of primary breast cancer. The long-standing theoretical prediction of benefit from drug therapy as an adjunct to local control procedures has now been confirmed by several decades of clinical investigation. Long-term follow-up of seminal trials and the conduct of a crucial series of meta-analyses have established the ability of both hormonal therapies and chemotherapy to prolong disease-free and overall survival in nearly all groups of patients. Although the relative and absolute influences of drug therapies remain modest, if these were properly applied to the hundreds of thousands of patients diagnosed worldwide per year, the potential impact on public health would be significant. In addition, recent laboratory advances and clinical trial data have indicated several new directions that promise greater impact against occult disseminated disease. These include novel dosing and scheduling strategies, newer active agents, fresh biochemical targets, and different combinations of chemotherapy with hormonal therapy.

Age Distribution↗

PubMedDate not supplied

[Psychotherapy in children and youths].

Child and adolescent psychotherapy form a large proportion of the total amount of psychotherapeutic efforts. Because of the age of the patients, the positive or negative impact is considerable. From the literature we learn that the efforts made to evaluate psychotherapy effects are not in balance with the amount of executed therapies. Meta-analyses of the available controlled therapy-evaluation studies offer a limited but rather encouraging view on the effectiveness of child and adolescent psychotherapy. Also on the differences in effectiveness according to the therapeutic orientation or the treated disturbance some interesting conclusions can be drawn. Unfortunately, these conclusions are based on a limited number of studies, because few clinicians conduct systematic research on therapy effectiveness. Systematic therapy evaluation requires some explicit decisions. The clinician has to decide on the description of the disturbance and the use of a diagnostic system, on the choice of standardized assessment procedures, on the operationalization of his therapeutic techniques and on the availability of norm groups and/or appropriate control conditions. In our psychology and psychotherapy training programs, attention for therapy evaluation is rather limited. Only a small number of students or trainees is explicitly trained in this aspect of therapeutic work. The available literature offers some interesting suggestions to enhance the quantity and the quality of the research in this area.

Adolescent↗