WorldWideScience

Sample records for maintenance therapy influences

  1. Budesonide/formoterol maintenance plus reliever therapy

    DEFF Research Database (Denmark)

    Bisgaard, Hans; Le Roux, Pascal; Bjåmer, Ditlef

    2006-01-01

    on ICS investigated whether a novel regimen using budesonide/formoterol for maintenance and reliever therapy (Symbicort maintenance and relief therapy [SMART]) [Symbicort; AstraZeneca R&D, Lund, Sweden] could reduce exacerbations. METHODS: Patients received SMART (budesonide/formoterol 80/4.5 microg qd...... maintenance plus additional inhalations for symptom relief), budesonide/formoterol 80/4.5 microg qd for maintenance (fixed combination), or higher-dose budesonide 320 microg qd (fixed-dose budesonide). Blinded as-needed medication (terbutaline 0.4 microg) was provided in both fixed-dose groups. RESULTS: SMART...... prolonged the time to first exacerbation vs fixed-dose budesonide (p = 0.02) and fixed-dose combination (p SMART vs fixed-dose budesonide and fixed-dose combination (0.08/patient vs 0.28/patient and 0.40/patient...

  2. The Circadian Schedule for Childhood Acute Lymphoblastic Leukemia Maintenance Therapy does not Influence Event-Free Survival in the NOPHO ALL92 Protocol

    DEFF Research Database (Denmark)

    Clemmensen, Kim K. B.; Christensen, Regitse H.; Shabaneh, Diana N.

    2014-01-01

    BACKGROUND: The event-free survival of childhood acute lymphoblastic leukemia (ALL) has been reported to be superior when oral methotrexate (MTX) and 6-mercaptopurine (6MP) maintenance therapy (MT) is administered in the evening compared to the morning. PROCEDURE: In the ALL92 MT study we prospec...

  3. Influences of hand dominance on the maintenance of benefits after home-based modified constraint-induced movement therapy in individuals with stroke

    Directory of Open Access Journals (Sweden)

    Renata C. M. Lima

    2014-10-01

    Full Text Available Objective: To investigate the influence of hand dominance on the maintenance of gains after home-based modified constraint-induced movement therapy (mCIMT. Method: Aprevious randomized controlled trial was conducted to examine the addition of trunk restraint to the mCIMT. Twenty-two chronic stroke survivors with mild to moderate motor impairments received individual home-based mCIMT with or without trunk restraints, five times per week, three hours daily over two weeks. In this study, the participants were separated into dominant group, which had their paretic upper limb as dominant before the stroke (n=8, and non-dominant group (n=14 for analyses. The ability to perform unimanual tasks was measured by the Wolf Motor Function Test (WMFT and the Motor Activity Log (MAL, whereas the capacity to perform bimanual tasks was measured using the Bilateral Activity Assessment Scale (BAAS. Results: Analysis revealed significant positive effects on the MAL amount of use and quality of the movement scales, as well as on the BAAS scores after intervention, with no differences between groups. Both groups maintained the bimanual improvements during follow-ups (BAAS-seconds 0.1, 95% CI -10.0 to 10.0, however only the dominant group maintained the unilateral improvements (MAL-amount of use: 1.5, 95% CI 0.7 to 2.3; MAL-quality: 1.3, 95% CI 0.5 to 2.1. Conclusions: Upper limb dominance did not interfere with the acquisition of upper limb skills after mCIMT. However, the participants whose paretic upper limb was dominant demonstrated better abilities to maintain the unilateral gains. The bilateral improvements were maintained, regardless of upper limb dominance.

  4. Methotrexate/6-mercaptopurine maintenance therapy influences the risk of a second malignant neoplasm after childhood acute lymphoblastic leukemia: results from the NOPHO ALL-92 study

    DEFF Research Database (Denmark)

    Schmiegelow, Kjeld; Al-Modhwahi, Ibrahim; Andersen, Mette Klarskov

    2009-01-01

    Among 1614 children with acute lymphoblastic leukemia (ALL) treated with the Nordic Society for Paediatric Haematology and Oncology (NOPHO) ALL-92 protocol, 20 patients developed a second malignant neoplasm (SMN) with a cumulative risk of 1.6% at 12 years from the diagnosis of ALL. Nine of the 16...... acute myeloid leukemias or myelodysplastic syndromes had monosomy 7 (n = 7) or 7q deletions (n = 2). In Cox multivariate analysis, longer duration of oral 6-mercaptopurine (6MP)/methotrexate (MTX) maintenance therapy (P = .02; longest for standard-risk patients) and presence of high hyperdiploidy (P...

  5. Neurally mediated syncope in electroconvulsive therapy maintenance.

    Science.gov (United States)

    Arbaizar, Beatriz; Llorca, Javier

    2012-03-01

    Electroconvulsive therapy (ECT) is especially necessary to revert some types of depressive disease; nevertheless, it has some widely recognized adverse effects, such as short-term memory loss. Moreover, some articles have reported its potential association with falls; this literature is, however, scanty and mainly consists of case reports. We present the case of a man who has a diagnosis of neurally mediated syncope at the age of 79 years, during the maintenance ECT. The patient had a significant increase in syncope frequency in the period he was treated with ECT, followed by a dramatic decrease when ECT was discontinued.

  6. Pneumocystis jiroveci pneumonia prophylaxis during maintenance therapy influences methotrexate/6-mercaptopurine dosing but not event-free survival for childhood acute lymphoblastic leukemia

    DEFF Research Database (Denmark)

    Levinsen, Mette; Shabaneh, Diana; Bohnstedt, Cathrine

    2012-01-01

    of maintenance therapy. The TMP/SMX2–7 group received lower oral 6MP doses than TMP/SMXnever patients (50.6 vs. 63.9 mg/m2/d; P ANC) (median 1.7 vs. 2.0 × 109/L; P ANC levels (P = 0.04) and male gender (P = 0.......06) were related to reduced EFS. ANC had no effect on EFS among TMP/SMX2–7 patients (P = 0.40) but did for TMP/SMXnever patients (P = 0.02). The difference in the effect on EFS between TMP/SMX2–7 and TMP/SMXnever patients was not significant (P = 0.46). EFS did not differ between TMP/SMX2–7 and TMP...

  7. Influence of macrolide maintenance therapy and bacterial colonisation on exacerbation frequency and progression of COPD (COLUMBUS: Study protocol for a randomised controlled trial

    Directory of Open Access Journals (Sweden)

    Uzun Sevim

    2012-06-01

    Full Text Available Abstract Background Chronic obstructive pulmonary disease (COPD is characterised by progressive development of airflow limitation that is poorly reversible. Because of a poor understanding of COPD pathogenesis, treatment is mostly symptomatic and new therapeutic strategies are limited. There is a direct relationship between the severity of the disease and the intensity of the inflammatory response. Besides smoking, one of the hypotheses for the persistent airway inflammation is the presence of recurrent infections. Macrolide antibiotics have bacteriostatic as well as anti-inflammatory properties in patients with cystic fibrosis and other inflammatory pulmonary diseases. There is consistent evidence that macrolide therapy reduces infectious exacerbations, decreases the requirement for additional antibiotics and improves nutritional measures. Because of these positive effects we hypothesised that maintenance macrolide therapy may also have beneficial effects in patients with COPD who have recurrent exacerbations. The effects on development of bacterial resistance to macrolides due to this long-term treatment are unknown. Until now, studies investigating macrolide therapy in COPD are limited. The objective of this study is to assess whether maintenance treatment with macrolide antibiotics in COPD patients with three or more exacerbations in the previous year decreases the exacerbation rate in the year of treatment and to establish microbial resistance due to the long-term treatment. Methods/design The study is set up as a prospective randomised double-blind placebo-controlled single-centre trial. A total of 92 patients with COPD who have had at least three exacerbations of COPD in the previous year will be included. Subjects will be randomised to receive either azithromycin 500 mg three times a week or placebo. Our primary endpoint is the reduction in the number of exacerbations of COPD in the year of treatment. Discussion We investigate whether

  8. Retention Rate in Methadone Maintenance Therapy

    Directory of Open Access Journals (Sweden)

    G Dastjerdi

    2010-08-01

    Full Text Available Introduction: Methadone maintenance therapy is a well-known approach to the treatment of drug use disorders and harm reduction. But the main challenge is retention rate in MMT Methods: Through simple random sampling, 155 addicts aged between 18-60 years who referred to drug addiction center of university and underwent MMT were followed for at least one year and up to two and half years. Results: Of the total, 3.9% female, 62% married, 37.4% workers and 27.1% were jobless. 80% had education level of less than diploma, 43.2% abused marijuana, 54.2% abused alcohol and 49.7% were living in rented houses. 60% referred to this center because of economical problems, 15.5% because of legal issues and 67.7% because of family pressure. 31.6% were opium and opium resin addicts, 60% were heroin addicts, 8.4% were crack addicts and 21.9% were IV abusers. 76.8% had at least one high risk behavior. Average dose of methadone was 86.5+35 mg/day. Mean survival time was 80 weeks. Relapse rate was 3.3% in the first month, 13.9% in three months, 23.2% in six months, 31.7% in first year and 41. 7% was a total relapse rate. Survival rate had a direct significant statistical relationship with the age, type of drug and method of use. Conclusion: According to the results of the present study that indicate a survival rate of 68.2% in a year and 58.3% after a year and also considering the results of other studies, we can conclude that MMP could be an effective method in the treatment of opiate drug disorders.

  9. Tofacitinib as Induction and Maintenance Therapy for Ulcerative Colitis

    NARCIS (Netherlands)

    Sandborn, William J.; Su, Chinyu; Sands, Bruce E.; D'Haens, Geert R.; Vermeire, Séverine; Schreiber, Stefan; Danese, Silvio; Feagan, Brian G.; Reinisch, Walter; Niezychowski, Wojciech; Friedman, Gary; Lawendy, Nervin; Yu, Dahong; Woodworth, Deborah; Mukherjee, Arnab; Zhang, Haiying; Healey, Paul; Panés, Julian

    2017-01-01

    Tofacitinib, an oral, small-molecule Janus kinase inhibitor, was shown to have potential efficacy as induction therapy for ulcerative colitis in a phase 2 trial. We further evaluated the efficacy of tofacitinib as induction and maintenance therapy. We conducted three phase 3, randomized,

  10. Successful treatment of recurrent cholangitis with antibiotic maintenance therapy

    NARCIS (Netherlands)

    van den Hazel, S. J.; Speelman, P.; Tytgat, G. N.; van Leeuwen, D. J.

    1994-01-01

    The impact of antibiotic maintenance therapy on the incidence of biliary tract infection was evaluated in patients with recurrent cholangitis after resection of a malignancy at the hepatic confluence. Thirty-eight of 54 patients (70%) experienced episodes of cholangitis. In 14 of the 38 patients

  11. Methadone maintenance therapy as evidence based drug abuse ...

    African Journals Online (AJOL)

    Methadone maintenance therapy as evidence based drug abuse planning in ... drugs are being used as artificial problem-solvers such as frustrations, stress or ... Drug use is a problem to users when it begins to cause some damage to their ...

  12. Mercaptopurine/Methotrexate Maintenance Therapy of Childhood Acute Lymphoblastic Leukemia

    DEFF Research Database (Denmark)

    Schmiegelow, K.; Nielsen, Stine N; Frandsen, Thomas L

    2014-01-01

    implementation of pharmacogenomics into treatment, the sole exception being dramatic 6MP dose reductions in patients who are homozygous deficient for thiopurine methyltransferase, the enzyme that methylates 6MP and several of its metabolites. In conclusion, maintenance therapy is as important as the more...

  13. Tofacitinib as Induction and Maintenance Therapy for Ulcerative Colitis.

    Science.gov (United States)

    Sandborn, William J; Su, Chinyu; Sands, Bruce E; D'Haens, Geert R; Vermeire, Séverine; Schreiber, Stefan; Danese, Silvio; Feagan, Brian G; Reinisch, Walter; Niezychowski, Wojciech; Friedman, Gary; Lawendy, Nervin; Yu, Dahong; Woodworth, Deborah; Mukherjee, Arnab; Zhang, Haiying; Healey, Paul; Panés, Julian

    2017-05-04

    Tofacitinib, an oral, small-molecule Janus kinase inhibitor, was shown to have potential efficacy as induction therapy for ulcerative colitis in a phase 2 trial. We further evaluated the efficacy of tofacitinib as induction and maintenance therapy. We conducted three phase 3, randomized, double-blind, placebo-controlled trials of tofacitinib therapy in adults with ulcerative colitis. In the OCTAVE Induction 1 and 2 trials, 598 and 541 patients, respectively, who had moderately to severely active ulcerative colitis despite previous conventional therapy or therapy with a tumor necrosis factor antagonist were randomly assigned to receive induction therapy with tofacitinib (10 mg twice daily) or placebo for 8 weeks. The primary end point was remission at 8 weeks. In the OCTAVE Sustain trial, 593 patients who had a clinical response to induction therapy were randomly assigned to receive maintenance therapy with tofacitinib (either 5 mg or 10 mg twice daily) or placebo for 52 weeks. The primary end point was remission at 52 weeks. In the OCTAVE Induction 1 trial, remission at 8 weeks occurred in 18.5% of the patients in the tofacitinib group versus 8.2% in the placebo group (P=0.007); in the OCTAVE Induction 2 trial, remission occurred in 16.6% versus 3.6% (Ptofacitinib group and 40.6% in the 10-mg tofacitinib group versus 11.1% in the placebo group (Ptofacitinib than with placebo. In the OCTAVE Sustain trial, the rate of serious infection was similar across the three treatment groups, and the rates of overall infection and herpes zoster infection were higher with tofacitinib than with placebo. Across all three trials, adjudicated nonmelanoma skin cancer occurred in five patients who received tofacitinib and in one who received placebo, and adjudicated cardiovascular events occurred in five who received tofacitinib and in none who received placebo; as compared with placebo, tofacitinib was associated with increased lipid levels. In patients with moderately to severely

  14. Influence Diagrams for Optimal Maintenance Planning

    DEFF Research Database (Denmark)

    Friis-Hansen, Andreas

    2000-01-01

    Over the last two decades Bayesian networks and influence diagrams have received notable attention within the field of artificial intelligence and expert systems. During the last few years the technology has been further developed for problem solving within other engineering fields. The objective...... of this study is to present a conceptual bayesian network model for probabilistic prediction of fatigue crack growth in welded steel tubes. It is shown that despite discretization of the variable domain, the prediction is in good agreement with results obtained by the well-established structural reliability...

  15. Effects of maintenance electroconvulsive therapy on cognitive functions

    NARCIS (Netherlands)

    Vothknecht, S.; Kho, K. H.; van Schaick, H. W.; Zwinderman, A. H.; Middelkoop, H.; Blansjaar, B. A.

    2003-01-01

    Background: This study examined cognitive side effects of maintenance electroconvulsive (ECT) in comparison with maintenance pharmacotherapy after index ECT. Method: Clinical outcome data and neuropsychological measurements were compared in 11 maintenance ECT patients and 13 control patients treated

  16. Maintenance therapy in advanced non-small cell lung cancer: current status and future implications.

    Science.gov (United States)

    Stinchcombe, Thomas E; Socinski, Mark A

    2011-01-01

    Maintenance therapy for patients with advanced non-small cell lung cancer has been an area of intense investigation. Maintenance therapy has been divided into two broad categories: continuation maintenance when the chemotherapy or targeted agent was part of a defined number of cycles of combination therapy and in the absence of disease progression is continued as a single agent or switch maintenance when a third agent is initiated after four cycles of platinum-based double-agent chemotherapy in the absence of disease progression. Two monoclonal antibodies, cetuximab and bevacizumab, are used as continuation maintenance, but the incremental benefit of the maintenance therapy with these agents is undetermined. Phase III trials have not revealed an overall survival benefit for continuation maintenance chemotherapy, and this approach should be considered investigational. Phase III trials have demonstrated an improvement in overall survival with switch maintenance therapy with pemetrexed compared with placebo in patients with nonsquamous histology and erlotinib compared with placebo. Phase III trials have not revealed an improvement in quality of life with maintenance therapy. In the trials of maintenance therapy, 30 to 40% of patients enrolled in the observation or placebo arm did not receive second-line therapy, and among the patients who did receive second-line therapy, there was significant heterogeneity in the therapy. The development of maintenance therapy has raised issues about the role of treatment-free intervals in routine clinical care, trial design issues such as the optimal endpoint, the ethics of a placebo arm, and the implications of maintenance therapy for first-line trials.

  17. Modeling of preventive maintenance changes influence upon flight safety indexes

    Directory of Open Access Journals (Sweden)

    А.В. Гончаренко

    2004-03-01

    Full Text Available  It is considered a simplified model of connection between the catastrophic events flow frequency and both preventive maintenance changes periodicity and diagnosis depth of aviation equipment. It is deduced specific formulas for computing the changes and diagnostics parameters influence upon the values of both the catastrophic events flow frequency and technical-economical control factor criterion of flight safety levels.

  18. Opiate Users' Perceived Barriers Against Attending Methadone Maintenance Therapy: A Qualitative Study in China

    Science.gov (United States)

    Lin, Chunqing; Wu, Zunyou; Detels, Roger

    2012-01-01

    Methadone maintenance therapy (MMT) in China is facing challenges such as high relapse rates and low coverage. The study assessed factors influencing MMT utilization among opiate users. In-depth interviews were conducted among 30 opiate users in 2008 to ascertain the barriers against seeking MMT. Data were analyzed using ATLAS.ti. Barriers to the treatment included requirement of registration with police, perceived discrimination, logistic difficulties, side effects, fear of being addicted to another drug, lack of additional services, and economic burden. The result suggests the need for structural changes such as improving comprehensive services, simplifying application procedure, and enhancing referral system. The study's limitations are noted. PMID:21417558

  19. Concurrent immunomodulator therapy is associated with higher adalimumab trough levels during scheduled maintenance therapy.

    Science.gov (United States)

    Bond, Ashley; Dodd, Susanna; Fisher, Gareth; Skouras, Thomas; Subramanian, Sreedhar

    2017-02-01

    Combination therapy with infliximab and immunomodulators is superior to monotherapy, resulting in better outcomes and higher trough levels of infliximab. The role of concurrent immunomodulatory therapy on adalimumab trough levels has not been adequately investigated. We evaluated the impact of concomitant immunomodulation on adalimumab trough levels in patients on scheduled maintenance therapy. We conducted a prospective observational, cross-sectional study of all inflammatory bowel disease patients on maintenance therapy who had adalimumab trough levels measured between January 2013 and January 2016. Drug level and anti-drug antibody measurements were performed on sera using a solid phase assay. Pairwise comparison of means was used to compare trough levels in patients with and without concomitant immune modulator therapy. In total, 79 patients were included. Twenty-three patients (29.1%) were on weekly dosing whereas 56 (70.9%) were on alternate weeks. Median adalimumab trough levels were comparable in patients with and without clinical remission (6.8 μg/ml (IQR 5.6-8.1) versus 6.7 μg/ml (IQR 3.9-8.1), respectively. Patients with an elevated faecal calprotectin >250 μg/g had lower adalimumab trough levels (median 6.7, IQR 3.9-8) compared to patients with faecal calprotectin <250 μg/g (median 7.7, IQR 6.1-8.1) though this did not achieve statistical significance (p = .062). Median adalimumab trough levels among patients on concurrent immunomodulators was 7.2 μg/ml (IQR 5.7-8.1) compared to those not on concurrent immunomodulator, 6.1 μg/ml (IQR 2.7-7.7, p = .0297). Adalimumab trough levels were significantly higher in patients on concurrent immunomodulators during maintenance therapy. There was a trend towards a lower adalimumab trough level in patients with elevated calprotectin.

  20. Continuing competence assessment and maintenance in occupational therapy: Scoping review with stakeholder consultation.

    Science.gov (United States)

    Myers, Christine T; Schaefer, Nancy; Coudron, Ashley

    2017-12-01

    Continuing competence activities hold the promise of improving health-care service quality, especially given concerns about system inefficiencies and fragmentation. The aim of this scoping review was to describe the assessment and maintenance of occupational therapists' continuing competence and identify knowledge gaps for future research. A secondary aim was comparing scoping review findings with those from other health-care fields and considering possible impact of varying international regulations. A series of database searches retrieved peer-reviewed and grey literature on assessment and maintenance of occupational therapy continuing competence from 1995 to 2015. Themes were developed and findings shared with stakeholders, whose comments drove a second phase: searching for reviews related to continuing competence from allied health, medicine, and nursing, and reviewing websites and documents concerning regulatory requirements for occupational therapy continuing competence in seven English-speaking nations. Twenty-seven sources from the scoping review search met inclusion criteria. Stakeholder consultation validated the themes and preliminary knowledge gaps. Research into other health-care specialties corresponded to findings from the scoping review. The website/document review of occupational therapy regulatory requirements revealed wide variation on both the state/province and national levels. This scoping review highlights gaps in research on effective methods and assessment of occupational therapy continuing competence. Findings suggest a need for research on approaches to continuing competence that incorporate the translation of evidence to practice and address the influence of external factors. Regulatory agencies may address the quality of occupational therapy services by incorporating a variety of professional development options into requirements. © 2017 Occupational Therapy Australia.

  1. Patients' Adherence in the Maintenance Therapy of Children and Adolescents with Acute Lymphoblastic Leukemia.

    Science.gov (United States)

    Kremeike, K; Juergens, C; Alz, H; Reinhardt, D

    2015-11-01

    Acute lymphoblastic leukemia (ALL) is the most common form of paediatric cancer. Maintenance therapy as last treatment phase includes oral chemotherapy with methotrexate (MTX) and mercaptopurine (6-MP), self- or parent-administered at home, given for about 1 ½ years, and qualified as decisive for an optimum therapy outcome. The aim of our study was to analyze factors influencing the adherence of patients with ALL undergoing maintenance therapy and their families. A multi-method study was undertaken between 11/2011 and 10/2014 with patients surveyed by the Hannover Medical School outpatient clinic, including a questionnaire survey and qualitative interviews with parents as well as blood samples of the patients. 33 questionnaires, 27 interviews and blood samples of 26 patients could be analyzed. Only one third of the blood samples showed concentrations of the 6-MP active metabolite within the therapeutic reference range. Parents named the clinical doctor as their main advisor on medication intake. 36% (12/33) of the participants stated that medication intake has not always occurred the way medication was prescribed. Drug formulation and drug intake information could be identified as determinants of adherence. Parents' problems to obtain information are partly caused by different study results concerning the correct timing of the drug intake and drug interactions with milk products. Parents' information on drug therapy should be more consistent and the pharmaceutical formulations have to be adapted to patients' needs to improve adherence and thereby the chance of long-term remission. © Georg Thieme Verlag KG Stuttgart · New York.

  2. Hepatotoxicity During Maintenance Therapy and Prognosis in Children With Acute Lymphoblastic Leukemia

    DEFF Research Database (Denmark)

    Ebbesen, Maria S.; Nygaard, Ulrikka; Rosthøj, Susanne

    2017-01-01

    Hepatotoxicity is a known toxicity to treatment of childhood acute lymphoblastic leukemia. Hepatotoxicity occurs during maintenance therapy and is caused by metabolites of 6-Mercaptopurine (6 MP) and Methotrexate (MTX). Our objective was to investigate the association between alanine...

  3. Maintenance immunosuppression with intermittent intravenous IL-2 receptor antibody therapy in renal transplant recipients.

    LENUS (Irish Health Repository)

    Gabardi, Steven

    2011-09-01

    To report what we believe to be the first 2 cases of long-term (>24 months) intermittent intravenous interleukin-2 receptor antibody (IL-2RA) therapy for maintenance immunosuppression following renal transplantation.

  4. Electroconvulsive therapy in the continuation and maintenance treatment of depression: Systematic review and meta-analyses.

    Science.gov (United States)

    Elias, Alby; Phutane, Vivek H; Clarke, Sandy; Prudic, Joan

    2018-05-01

    Acute course of electroconvulsive therapy is effective in inducing remission from depression, but recurrence rate is unacceptably high following termination of electroconvulsive therapy despite continued pharmacotherapy. Continuation electroconvulsive therapy and maintenance electroconvulsive therapy have been studied for their efficacy in preventing relapse and recurrence of depression. The purpose of this meta-analysis was to examine the efficacy of continuation electroconvulsive therapy and maintenance electroconvulsive therapy in preventing relapse and recurrence of depression in comparison to antidepressant pharmacotherapy alone. We searched MEDLINE, Embase, PsycINFO, clinicaltrials.gov and Cochrane register of controlled trials from the database inception to December 2016 without restriction on language or publication status for randomized trials of continuation electroconvulsive therapy and maintenance electroconvulsive therapy. Two independent Cochrane reviewers extracted the data in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines for systematic reviews and meta-analyses. The risk of bias was assessed using four domains of the Cochrane Collaboration Risk of Bias Tool. Outcomes were pooled using random effect model. The primary outcome was relapse or recurrence of depression. Five studies involving 436 patients were included in the meta-analysis. Analysis of the pooled data showed that continuation electroconvulsive therapy and maintenance electroconvulsive therapy, both with pharmacotherapy, were associated with significantly fewer relapses and recurrences than pharmacotherapy alone at 6 months and 1 year after a successful acute course of electroconvulsive therapy (risk ratio = 0.64, 95% confidence interval = [0.41, 0.98], p = 0.04, risk ratio = 0.46, 95% confidence interval = [0.21, 0.98], p = 0.05, respectively). There was insufficient data to perform a meta-analysis of stand

  5. Downregulation of telomerase maintenance-related ACD expression in patients undergoing immunosuppresive therapy following kidney transplantation.

    Science.gov (United States)

    Witkowska, Agnieszka; Strzalka-Mrozik, Barbara; Owczarek, Aleksander; Gola, Joanna; Mazurek, Urszula; Grzeszczak, Wladyslaw; Gumprecht, Janusz

    2015-12-01

    Chronic administration of immunosuppressants has been associated with long-term consequences, including a higher risk of neoplasm development. The processes regulating telomere function exert a major influence on human cancer biology. The present study aimed to assess the effect of immunosuppressive therapy on the expression of genes associated with telomere maintenance and protection in patients following renal transplantation. A total of 51 patients that had undergone kidney transplantation and 54 healthy controls were enrolled in the study. The 51 transplant patients received a three-drug immunosuppressive regimen consisting of cyclosporine A, prednisone and mycophenolate mofetil. In stage 1 of the study, the expression profiles of 123 transcripts, which represented 70 genes, were assessed in peripheral mononuclear blood cells using an oligonucleotide microarray technique in 8 transplant recipients and 4 healthy control subjects. Among the analyzed transcripts, the expression levels of 4 differed significantly between the studied groups; however, only the ACD (adrenocortical dysplasia homolog) gene, encoding the telomere-binding protein POT1-interacting protein 1 (TPP1), was sufficiently specific for telomere homeostasis. The expression of ACD was downregulated in transplant recipients (fold change, 2.11; P=0.006). In stage 2 of the study, reverse transcription-quantitative polymerase chain reaction analysis of ACD , DKC1 and hTERT mRNA was conducted for all transplant patients and control subjects. The results confirmed the downregulation of the ACD gene in patients that had received immunosuppressive therapy (P=0.002). The results of the present study indicate that the downregulation of ACD gene transcription, and thus TPP1 protein expression, may enhance the capacity for cell immortalization, despite normal levels of other key telomere maintenance factors, in patients undergoing immunosuppressive therapy. Furthermore, the results indicate that TPP1 has

  6. Safe interruption of maintenance therapy against previous infection with four common HIV-associated opportunistic pathogens during potent antiretroviral therapy

    DEFF Research Database (Denmark)

    Kirk, Ole; Reiss, Peter; Uberti-Foppa, Caterina

    2002-01-01

    maintenance therapy for cytomegalovirus (CMV) end-organ disease, disseminated Mycobacterium avium complex (MAC) infection, cerebral toxoplasmosis, and extrapulmonary cryptococcosis in patients receiving antiretroviral therapy. DESIGN: Observational study. SETTING: Seven European HIV cohorts. PATIENTS: 358...... identified: 162 for CMV disease, 103 for MAC infection, 75 for toxoplasmosis, and 39 for cryptococcosis. During 781 person-years of follow-up, five patients had relapse. Two relapses (one of CMV disease and one of MAC infection) were diagnosed after maintenance therapy was interrupted when the CD4 lymphocyte....... One relapse (toxoplasmosis) was diagnosed after maintenance therapy interruption at a CD4 lymphocyte count greater than 200 x 10(6) cells/L for 15 months. The overall incidences of recurrent CMV disease, MAC infection, toxoplasmosis, and cryptococcosis were 0.54 per 100 person-years (95% CI, 0.07 to 1...

  7. [PARAMOUNT trial: clinical meaning of continuous maintenance therapy in lung cancer].

    Science.gov (United States)

    Gridelli, Cesare

    2015-05-01

    Non-small cell lung cancer (NSCLC) remains one of the leading causes of cancer related deaths worldwide across both sex. Patients with Advanced -NSCLC (A-NSCLC) do not have curative treatment options, so the primary endpoint of every therapeutic decision aims to prolong survival, improving or maintain a good Quality of Life (QoL). Histology could represent a positive predictive factor for patients with Non squamous NSCLC (Nsq-NSCLC) respect to pemetrexed treatment. Pemetrexed is an antifolate that inhibits primarily thymidylate synthase (TS), together with dihydrofolate reductase and glycinamide ribonucleotide formyl transferase. Pemetrexed in combination with cisplatin is approved in the first line setting and as monotherapy in the switch or continuous maintenance of Non Squamous A-NSCLC. Maintenance therapy is a widely used therapeutic option in other solid and hematologic malignancies, but in the A-NSCLC represent an innovative approach. The rationale in this new setting of patients is based on the evidence that patients who benefit from an initial induction therapy platinum based may benefit from maintenance therapy with the third generation agent dropping the platinum drug after four to six cycles. We can define two types of maintenance therapy: continuation maintenance and switch maintenance. Major results in prolonging Overall Survival (OS) was reported with the continuation maintenance strategy as in the PARAMOUNT trial.

  8. Medicaid Coverage of Methadone Maintenance and the Use of Opioid Agonist Therapy Among Pregnant Women in Specialty Treatment.

    Science.gov (United States)

    Bachhuber, Marcus A; Mehta, Pooja K; Faherty, Laura J; Saloner, Brendan

    2017-12-01

    Opioid agonist therapy (OAT) is the standard of care for pregnant women with opioid use disorder (OUD). Medicaid coverage policies may strongly influence OAT use in this group. To examine the association between Medicaid coverage of methadone maintenance and planned use of OAT in the publicly funded treatment system. Retrospective cross-sectional analysis of treatment admissions in 30 states extracted from the Treatment Episode Data Set (2013 and 2014). Medicaid-insured pregnant women with OUD (n=3354 treatment admissions). The main outcome measure was planned use of OAT on admission. The main exposure was state Medicaid coverage of methadone maintenance. Using multivariable logistic regression models adjusting for sociodemographic, substance use, and treatment characteristics, we compared the probability of planned OAT use in states with Medicaid coverage of methadone maintenance versus states without coverage. A total of 71% of pregnant women admitted to OUD treatment were 18-29 years old, 85% were white non-Hispanic, and 56% used heroin. Overall, 74% of admissions occurred in the 18 states with Medicaid coverage of methadone maintenance and 53% of admissions involved planned use of OAT. Compared with states without Medicaid coverage of methadone maintenance, admissions in states with coverage were significantly more likely to involve planned OAT use (adjusted difference: 32.9 percentage points, 95% confidence interval, 19.2-46.7). Including methadone maintenance in the Medicaid benefit is essential to increasing OAT among pregnant women with OUD and should be considered a key policy strategy to enhance outcomes for mothers and newborns.

  9. Adjunctive Non-Surgical Therapy of Inflamed Periodontal Pockets During Maintenance Therapy Using Diode Laser: A Randomized Clinical Trial.

    Science.gov (United States)

    Nguyen, Naomi-Trang; Byarlay, Matthew R; Reinhardt, Richard A; Marx, David B; Meinberg, Trudy A; Kaldahl, Wayne B

    2015-10-01

    Numerous studies have documented the clinical outcomes of laser therapy for untreated periodontitis, but very few have reported on lasers treating inflamed pockets during maintenance therapy. The aim of this study is to compare the effectiveness of scaling and root planing (SRP) plus the adjunctive use of diode laser therapy to SRP alone on changes in the clinical parameters of disease and on the gingival crevicular fluid (GCF) inflammatory mediator interleukin-1β (IL-1β) in patients receiving regular periodontal maintenance therapy. This single-masked and randomized, controlled, prospective study includes 22 patients receiving regular periodontal maintenance therapy who had one or more periodontal sites with a probing depth (PD) ≥ 5 mm with bleeding on probing (BOP). Fifty-six sites were treated with SRP and adjunctive laser therapy (SRP + L). Fifty-eight sites were treated with SRP alone. Clinical parameters, including PD, clinical attachment level (CAL), and BOP, and GCF IL-1β levels were measured immediately before treatment (baseline) and 3 months after treatment. Sites treated with SRP + L and SRP alone resulted in statistically significant reductions in PD and BOP and gains in CAL. These changes were not significantly different between the two therapies. Similarly, differences in GCF IL-1β levels between SRP + L and SRP alone were not statistically significant. In periodontal maintenance patients, SRP + L did not enhance clinical outcomes compared to SRP alone in the treatment of inflamed sites with ≥ 5 mm PD.

  10. Niraparib Maintenance Therapy in Platinum-Sensitive, Recurrent Ovarian Cancer

    NARCIS (Netherlands)

    Mirza, M. R.; Monk, B. J.; Herrstedt, J.; Oza, A. M.; Mahner, S.; Redondo, A.; Fabbro, M.; Ledermann, J. A.; Lorusso, D.; Vergote, I.; Ben-Baruch, N. E.; Marth, C.; Madry, R.; Christensen, R. D.; Berek, J. S.; Dorum, A.; Tinker, A. V.; du Bois, A.; Gonzalez-Martin, A.; Follana, P.; Benigno, B.; Rosenberg, P.; Gilbert, L.; Rimel, B. J.; Buscema, J.; Balser, J. P.; Agarwal, S.; Matulonis, U. A.; van der Zee, A.G.J.

    2016-01-01

    BACKGROUND Niraparib is an oral poly(adenosine diphosphate [ADP]-ribose) polymerase (PARP) 1/2 inhibitor that has shown clinical activity in patients with ovarian cancer. We sought to evaluate the efficacy of niraparib versus placebo as maintenance treatment for patients with platinum-sensitive,

  11. Successful maintenance electroconvulsive therapy for more than seven years

    NARCIS (Netherlands)

    Wijkstra, J; Nolen, WA

    We report on a patient with recurrent major depressive episodes with psychotic features who was successfully treated with maintenance electroconvulsive treatment (M-ECT) over a long period without the need for concurrent treatment with an antidepressant or mood stabilizer. She started ECT in 1996

  12. Niraparib Maintenance Therapy in Platinum-Sensitive, Recurrent Ovarian Cancer

    DEFF Research Database (Denmark)

    Mirza, Mansoor R; Monk, Bradley J; Herrstedt, Jørn

    2016-01-01

    Background Niraparib is an oral poly(adenosine diphosphate [ADP]-ribose) polymerase (PARP) 1/2 inhibitor that has shown clinical activity in patients with ovarian cancer. We sought to evaluate the efficacy of niraparib versus placebo as maintenance treatment for patients with platinum-sensitive, ......Background Niraparib is an oral poly(adenosine diphosphate [ADP]-ribose) polymerase (PARP) 1/2 inhibitor that has shown clinical activity in patients with ovarian cancer. We sought to evaluate the efficacy of niraparib versus placebo as maintenance treatment for patients with platinum...... or 4 adverse events that were reported in the niraparib group were thrombocytopenia (in 33.8%), anemia (in 25.3%), and neutropenia (in 19.6%), which were managed with dose modifications. Conclusions Among patients with platinum-sensitive, recurrent ovarian cancer, the median duration of progression...

  13. Recent advances in post autologous transplantation maintenance therapies in B-cell non-Hodgkin lymphomas

    Science.gov (United States)

    Epperla, Narendranath; Fenske, Timothy S; Hari, Parameswaran N; Hamadani, Mehdi

    2015-01-01

    Lymphomas constitute the second most common indication for high dose therapy (HDT) followed by autologous hematopoietic cell transplantation (auto-HCT). The intent of administering HDT in these heterogeneous disorders varies from cure (e.g., in relapsed aggressive lymphomas) to disease control (e.g., most indolent lymphomas). Regardless of the underlying histology or remission status at transplantation, disease relapse remains the number one cause of post auto-HCT therapy failure and mortality. The last decade has seen a proliferation of clinical studies looking at prevention of post auto-HCT therapy failure with various maintenance strategies. The benefit of such therapies is in turn dependent on disease histology and timing of transplantation. In relapsed, chemosensitive diffuse large B-cell lymphoma (DLBCL), although post auto-HCT maintenance rituximab seems to be safe and feasible, it does not provide improved survival outcomes and is not recommended. The preliminary results with anti- programmed death -1 (PD-1) antibody therapy as post auto-HCT maintenance in DLBCL is promising but requires randomized validation. Similarly in follicular lymphoma, maintenance therapies including rituximab following auto-HCT should be considered investigational and offered only on a clinical trial. Rituximab maintenance results in improved progression-free survival but has not yet shown to improve overall survival in mantle cell lymphoma (MCL), but given the poor prognosis with post auto-HCT failure in MCL, maintenance rituximab can be considered on a case-by-case basis. Ongoing trials evaluating the efficacy of post auto-HCT maintenance with novel compounds (e.g., immunomodulators, PD-1 inhibitors, proteasome inhibitors and bruton’s tyrosine kinase inhibitors) will likely change the practice landscape in the near future for B cell non-Hodgkin lymphomas patients following HDT and auto-HCT. PMID:26421260

  14. Influence of Non-safety Important Component on Maintenance Rule

    International Nuclear Information System (INIS)

    Ju, Tae Young; Kim, Wang Bae

    2016-01-01

    The Maintenance Rule (MR) programs in KHNP have been implemented since Jan 2009. KHNP is currently developing MR program for new built plant which has been constructed from December 2011. It is required to utilize plant-specific probabilistic safety analysis (PSA) result as risk significant criteria to determine which components are significantly important to safety. The criteria consist of three PSA risk values which are risk reduction worth (RRW), risk achievement worth (RAW) and core damage frequency (CDF) contribution. Most safety related components are classified as high risk significant, and non-safety related components as low safety significant in MR program. This paper presents the influence of the non-safety related component which has high PSA risk value on MR program of new built plant. It is considered that safety related system has at least one or more safety functions and some non-safety functions, but non-safety system doesn't have any safety function. The safety functions are defined as three functions which are required to maintain 1) integrity of reactor coolant pressure boundary, 2) capability to shut-down the reactor and maintain it in a safe shutdown, and 3) capability to prevent or mitigate the accident that could result in potential offsite exposure. The Maintenance Rule program is developed based on PSA result. Safety functions have high risk value in PSA program and considered HSS function in MR program. On the contrary, non-safety functions are generally has low risk value in PSA program and they are determined as LSS function in MR program. The AAC DG and its supporting systems are designed as non-safety systems which mean they don't have any safety function. But, AAC DG is treated as an important measure to mitigate accident in PSA program. It is determined as HSS function in MR program because it has high risk value in PSA program. AAC DG supporting systems does not have high risk value in operating plant's PSA program

  15. Continuation maintenance therapy with S-1 in chemotherapy-naïve patients with advanced squamous cell lung cancer.

    Science.gov (United States)

    Suzuki, Seiichiro; Karayama, Masato; Inui, Naoki; Fujisawa, Tomoyuki; Enomoto, Noriyuki; Nakamura, Yutaro; Kuroishi, Shigeki; Matsuda, Hiroyuki; Yokomura, Koshi; Koshimizu, Naoki; Toyoshima, Mikio; Imokawa, Shiro; Asada, Kazuhiro; Masuda, Masafumi; Yamada, Takashi; Watanabe, Hiroshi; Suda, Takafumi

    2016-08-01

    Objectives Maintenance therapy is a standard therapeutic strategy in non-squamous non-small-cell lung cancer. However, there is no consensus regarding the benefit of maintenance therapy for patients with squamous cell lung cancer. We assessed maintenance therapy with S-1, an oral fluoropyrimidine agent, following induction therapy with carboplatin and S-1 in patients with squamous cell lung cancer. Methods In this phase II trial, chemotherapy-naïve patients with squamous cell lung cancer were enrolled to induction therapy with four cycles of carboplatin (at an area under the curve of 5 on day 1) and S-1 (80 mg/m(2)/day on days 1-14) in a 28-day cycle. Patients who achieved disease control after induction therapy received maintenance therapy with S-1 in a 21-day cycle until disease progression or unacceptable toxicity. The primary endpoint was progression-free survival after administration of maintenance therapy. Results Fifty-one patients were enrolled in the study. The median progression-free survival from the start of maintenance therapy was 3.0 months (95 % confidence interval, 2.5-3.5). The most common toxicities associated with maintenance therapy were anemia, thrombocytopenia, and fatigue, but they were not severe. Conclusion S-1 maintenance therapy might be a feasible treatment option in patients with squamous cell lung cancer.

  16. Possibilities and shortcomings of maintenance therapy in gastroesophageal reflux disease

    NARCIS (Netherlands)

    Tytgat, G. N.

    1999-01-01

    An overview is given of the current possibilities and shortcomings of medical therapy in reflux disease. With H2-receptor antagonists and prokinetics, roughly 60% of the patients can be maintained in remission; with proton pump inhibitors, remission can be maintained in approximately 90%. Whether

  17. Acute lymphoblastic leukemia: Are Egyptian children adherent to maintenance therapy?

    Directory of Open Access Journals (Sweden)

    Elhamy Rifky Abdel Khalek

    2015-01-01

    Full Text Available Background, Aims, Settings and Design: Poor adherence to oral maintenance chemotherapy can cause relapse of acute lymphoblastic leukemia (ALL. A multicenter study for the evaluation of adherence to oral 6-mercaptopurine (6-MP maintenance chemotherapy for childhood ALL in Egypt to identify contributing factors and possible steps to promote adherence. Materials and Methods: The study included 129 children with ALL in complete remission receiving 6-MP single daily oral dose in the evening. Evaluation was done through specific questionnaires for the patients as well as serum 6-MP measurements. Results: Nonadherence was detected in around 56% by questionnaires and around 50% by serum 6-MP level measurement. There was a highly significant correlation between nonadherence as found by the questionnaire and 6-MP level (P - 0.001. Nonadherence was significantly associated with low socioeconomic standard, noneducation and low educational level and large family size by both methods. High cost to come for follow-up visits was significant by questionnaire but not by 6-MP measurement. Adolescent age, the higher number of siblings, lack of written instructions, long time spent per visit, were all associated with higher rates of nonadherence, although none reached statistical significance. Conclusions: Nonadherence is a real problem in pediatric patients. Specific questionnaires can be an excellent reliable method for the routine follow-up of these children, and drug level assay can be requested only for confirmation. This protocol is especially effective in developing countries where financial resources may be limited. Every effort should be made to uncover its true incidence, contributing factors, and best methods of intervention.

  18. Budesonide/formoterol maintenance and reliever therapy versus conventional best practice

    DEFF Research Database (Denmark)

    Demoly, Pascal; Louis, Renaud; Søes-Petersen, Ulrik

    2009-01-01

    Budesonide/formoterol maintenance and reliever therapy (Symbicort SMART) reduces asthma exacerbations and symptoms versus fixed-dose regimens plus short-acting beta(2)-agonists (SABA) in double-blind trials. Information is lacking regarding its effectiveness versus conventional best practice (CBP...

  19. Measures to reduce maintenance therapy with oral corticosteroid in adults with severe asthma

    DEFF Research Database (Denmark)

    Nguyen, Vivi Q; Ulrik, Charlotte S

    2016-01-01

    BACKGROUND: Maintenance therapy with oral corticosteroid (OCS) is used, although not based on evidence, for patients with severe asthma, but OCS is associated with serious adverse effects; therefore, management strategies aimed at steroid sparing are important. OBJECTIVE: To provide an update...

  20. Effects of short-acting Bronchodilators added to maintenance tiotropium therapy

    NARCIS (Netherlands)

    Kerstjens, Huib A. M.; Bantje, Theo A.; Luursema, Peter B.; Sinninghe, Henk E. J.; de Jong, Jan W.; Lee, Angela; Wijker, Stella P. C.; Cornelissen, Piet J. G.

    Background: Combining bronchodilators has been shown to be beneficial in patients with COPD. The additive effects of short-acting bronchodilators added to maintenance tiotropium therapy, however, are unknown. Methods: Following 3 weeks of tiotropium pretreatment, 60 patients with COPD (FEV1 40% of

  1. Measures of 6-mercaptopurine and methotrexate maintenance therapy intensity in childhood acute lymphoblastic leukemia

    DEFF Research Database (Denmark)

    Nielsen, Stine Nygaard; Grell, Kathrine; Nersting, Jacob

    2016-01-01

    PURPOSE: Normal white blood cell counts (WBC) are unknown in children with acute lymphoblastic leukemia (ALL). Accordingly, 6-mercaptopurine (6MP) and methotrexate (MTX) maintenance therapy is adjusted by a common WBC target of 1.5-3.0 × 10(9)/L. Consequently, the absolute degree...

  2. Physicians compliance during maintenance therapy in children with Down syndrome and acute lymphoblastic leukemia

    DEFF Research Database (Denmark)

    Bohnstedt, C; Levinsen, M; Rosthøj, S

    2013-01-01

    Children with Down syndrome (DS) and acute lymphoblastic leukemia (ALL) have an inferior prognosis compared with non-DS ALL patients. We reviewed methotrexate (MTX)/mercaptopurine (6MP) maintenance therapy data for children with DS treated according to the Nordic Society of Pediatric Hematology...

  3. Influencing factors for condition-based maintenance in railway tracks using knowledge-based approach

    NARCIS (Netherlands)

    Jamshidi, A.; Hajizadeh, S.; Naeimi, M.; Nunez Vicencio, Alfredo; Li, Z.

    2017-01-01

    In this paper, we present a condition-based maintenance decision method using
    knowledge-based approach for rail surface defects. A railway track may contain a considerable number of surface defects which influence track maintenance decisions. The proposed method is based on two sets of

  4. Terbutaline pump maintenance therapy after threatened preterm labour for reducing adverse neonatal outcomes.

    Science.gov (United States)

    Chawanpaiboon, Saifon; Laopaiboon, Malinee; Lumbiganon, Pisake; Sangkomkamhang, Ussanee S; Dowswell, Therese

    2014-03-23

    After successful inhibition of threatened preterm labour women are at high risk of recurrent preterm labour. Terbutaline pump maintenance therapy has been used to reduce adverse neonatal outcomes. This review replaces an earlier Cochrane review, published in 2002, which is no longer being updated by the team. To determine the effectiveness of terbutaline pump maintenance therapy after threatened preterm labour in reducing adverse neonatal outcomes. We searched the Cochrane Pregnancy and Childbirth Group's Trials Register (31 January 2014) and reference lists of retrieved studies. Randomised controlled trials comparing terbutaline pump therapy with alternative therapy, placebo, or no therapy after arrest of threatened preterm labour. Two review authors independently assessed the studies for inclusion and then extracted data as eligible for inclusion in qualitative and quantitative synthesis (meta-analysis). Four studies were included with a total of 234 women randomised. The overall methodological quality of the included studies was mixed; two studies provided very little information on study methods, there was high sample attrition in one study and in three studies the risk of performance bias was high. We found no strong evidence that terbutaline maintenance therapy offered any advantages over saline placebo or oral terbutaline maintenance therapy in reducing adverse neonatal outcomes by prolonging pregnancy among women with arrested preterm labour. The mean difference (MD) for gestational age at birth was -0.14 weeks (95% confidence interval (CI) -1.66 to 1.38) for terbutaline pump therapy compared with saline placebo pump for two trials combined. One trial reported a risk ratio (RR) of 1.17 (95% CI 0.79 to 1.73) for preterm birth (less than 37 completed weeks) and a RR of 0.97 (95% CI 0.51 to 1.84) of very preterm birth (less than 34 completed weeks) for terbutaline pump compared with saline placebo pump. We found no evidence that terbutaline pump therapy was

  5. Mercaptopurine/Methotrexate Maintenance Therapy of Childhood Acute Lymphoblastic Leukemia: Clinical Facts and Fiction

    Science.gov (United States)

    Nielsen, Stine N.; Frandsen, Thomas L.; Nersting, Jacob

    2014-01-01

    The antileukemic mechanisms of 6-mercaptopurine (6MP) and methotrexate (MTX) maintenance therapy are poorly understood, but the benefits of several years of myelosuppressive maintenance therapy for acute lymphoblastic leukemia are well proven. Currently, there is no international consensus on drug dosing. Because of significant interindividual and intraindividual variations in drug disposition and pharmacodynamics, vigorous dose adjustments are needed to obtain a target degree of myelosuppression. As the normal white blood cell counts vary by patients’ ages and ethnicity, and also within age groups, identical white blood cell levels for 2 patients may not reflect the same treatment intensity. Measurements of intracellular levels of cytotoxic metabolites of 6MP and MTX can identify nonadherent patients, but therapeutic target levels remains to be established. A rise in serum aminotransferase levels during maintenance therapy is common and often related to high levels of methylated 6MP metabolites. However, except for episodes of hypoglycemia, serious liver dysfunction is rare, the risk of permanent liver damage is low, and aminotransferase levels usually normalize within a few weeks after discontinuation of therapy. 6MP and MTX dose increments should lead to either leukopenia or a rise in aminotransferases, and if neither is experienced, poor treatment adherence should be considered. The many genetic polymorphisms that determine 6MP and MTX disposition, efficacy, and toxicity have precluded implementation of pharmacogenomics into treatment, the sole exception being dramatic 6MP dose reductions in patients who are homozygous deficient for thiopurine methyltransferase, the enzyme that methylates 6MP and several of its metabolites. In conclusion, maintenance therapy is as important as the more intensive and toxic earlier treatment phases, and often more challenging. Ongoing research address the applicability of drug metabolite measurements for dose adjustments

  6. Prelimanary Investigation on The Factors That Influencing The Maintenance Cost of Apartment

    Directory of Open Access Journals (Sweden)

    Salleh Nor Aini

    2016-01-01

    Full Text Available Housing is a basic need for all. The increasing numbers of population and income had increase in housing demand. Thus, it has led to the construction of apartments to meet the needs of people and to reduce the use of land to build residential buildings. From year to year, maintenance costs of the building are increased. To ensure the maintenance cost for apartment residence maintenance can be reduced, it is important to determine the factor that influence the maintenance cost of the apartment. This paper is to investigate and identify the factors contributing the increase of maintenance costs. The first objective of this study is to determine the factors that affect the cost of maintaining the apartment and meanwhile the second objective is to rank the factors that influence the maintenance cost of the apartment at Johor Baharu Tengah. To achieve the objectives of the study, the questionnaires were distributed to the parties involved in the management of building. Results of this study concluded that there are five factors that influence maintenance cost are the expectations of tenants, building age, building material, failure to execute maintenance at the right time and budget constraints.

  7. Body mass index influences infliximab post-infusion levels and correlates with prospective loss of response to the drug in a cohort of inflammatory bowel disease patients under maintenance therapy with Infliximab.

    Directory of Open Access Journals (Sweden)

    Franco Scaldaferri

    Full Text Available Infliximab is an effective treatment for inflammatory bowel disease (IBD. Studies differ regarding the influence of body mass index (BMI on the response to infliximab, with the majority of studies indicating that increased BMI may be associated with a poorer response to Infliximab. However, the pharmacokinetic mechanisms causing this have not yet been reported.Examine the correlation between BMI/immunosuppressant use with clinical response, trough and post-infusion levels of infliximab, tumour necrosis factor-α(TNF-α and anti-drug antibodies(ATI, and determine if these factors can predict future response.We collected serum from 24 patients receiving Infliximab before and 30 minutes following infusion. Clinical parameters were collected retrospectively and prospectively. ELISA measurements of infliximab, TNF-α and ATI were performed.We confirmed that patients with higher infliximab trough levels have a better response rate and that patients with an elevated BMI display a higher rate of loss of response (20%. Patients with a higher BMI had elevated post-infusion levels of infliximab. Additionally, the ratio of IFX/TNF-α trough levels correlated with clinical response to the following infusion.This study confirms that an elevated BMI is associated with a poorer response to infliximab. For the first time, we describe that a higher BMI correlates with higher post-infusion levels, however this does not correlate with a higher rate of response to the drug, suggesting that circulating drug levels do not correlate with tissue levels. Furthermore, in our small cohort of patients, we identified a possible predictive marker of future response to treatment which may be used to guide dose escalation and predict non-response to infliximab.

  8. Maintenance Electroconvulsive Therapy in a Patient with Treatment-Resistant Paranoid Schizophrenia and Comorbid Epilepsy

    Directory of Open Access Journals (Sweden)

    Beppe Micallef-Trigona

    2012-01-01

    Full Text Available The treatment of choice for acute schizophrenia is antipsychotic drug treatment and electroconvulsive therapy (ECT and should only be considered as an option for treatment-resistant schizophrenia, where treatment with clozapine has already proven ineffective or intolerable. The use of ECT as a maintenance treatment for patients with schizophrenia and comorbid epilepsy is uncommon as scant evidence exists to support this. We describe a patient with a serious case of paranoid schizophrenia and comorbid epilepsy who had not responded to typical and atypical antipsychotic medication, but responded remarkably to acute ECT and required maintenance ECT to sustain a positive therapeutic response.

  9. The influence of VKORC1 and CYP2C9 gene sequence variants on the stability of maintenance phase warfarin treatment

    DEFF Research Database (Denmark)

    Skov, Jane; Bladbjerg, Else-Marie; Leppin, Anja

    2013-01-01

    alleles require lower doses and have increased risk of overanticoagulation. METHODS: We investigated the influence of the above sequence variants on stability of maintenance phase warfarin therapy in a prospective study of 300 consecutive patients followed for one year at an anticoagulant clinic. RESULTS...... of common gene sequence variants in CYP2C9 and VKORC1 on stability of maintenance phase warfarin therapy. Patients attending an anticoagulant clinic using computer-assisted dosage were safely monitored regardless of these sequence variants, but for the small subgroup of patients with the CYP2C9 genotype *2...

  10. [Multidimensional family therapy: which influences, which specificities?].

    Science.gov (United States)

    Bonnaire, C; Bastard, N; Couteron, J-P; Har, A; Phan, O

    2014-10-01

    Among illegal psycho-active drugs, cannabis is the most consumed by French adolescents. Multidimensional family therapy (MDFT) is a family-based outpatient therapy which has been developed for adolescents with drug and behavioral problems. MDFT has shown its effectiveness in adolescents with substance abuse disorders (notably cannabis abuse) not only in the United States but also in Europe (International Cannabis Need of Treatment project). MDFT is a multidisciplinary approach and an evidence-based treatment, at the crossroads of developmental psychology, ecological theories and family therapy. Its psychotherapeutic techniques find its roots in a variety of approaches which include systemic family therapy and cognitive therapy. The aims of this paper are: to describe all the backgrounds of MDFT by highlighting its characteristics; to explain how structural and strategy therapies have influenced this approach; to explore the links between MDFT, brief strategic family therapy and multi systemic family therapy; and to underline the specificities of this family therapy method. The multidimensional family therapy was created on the bases of 1) the integration of multiple therapeutic techniques stemming from various family therapy theories; and 2) studies which have shown family therapy efficiency. Several trials have shown a better efficiency of MDFT compared to group treatment, cognitive-behavioral therapy and home-based treatment. Studies have also highlighted that MDFT led to superior treatment outcomes, especially among young people with severe drug use and psychiatric co-morbidities. In the field of systemic family therapies, MDFT was influenced by: 1) the structural family therapy (S. Minuchin), 2) the strategic family theory (J. Haley), and 3) the intergenerational family therapy (Bowen and Boszormenyi-Nagy). MDFT has specific aspects: MDFT therapists think in a multidimensional perspective (because an adolescent's drug abuse is a multidimensional disorder), they

  11. Budesonide/formoterol combination therapy as both maintenance and reliever medication in asthma

    DEFF Research Database (Denmark)

    O'Byrne, Paul M; Bisgaard, Hans; Godard, Philippe P

    2005-01-01

    with as-needed bud/form would provide rapid symptom relief and simultaneous adjustment in antiinflammatory therapy, thereby reducing exacerbations. In this double-blind, randomized, parallel-group study, 2,760 patients with asthma aged 4-80 years (FEV1 60-100% predicted) received either terbutaline 0.4 mg...... as SABA with bud/form 80/4.5 microg twice a day (bud/form + SABA) or bud 320 microg twice a day (bud + SABA) or bud/form 80/4.5 microg twice a day with 80/4.5 microg as-needed (bud/form maintenance + relief). Children used a once-nocte maintenance dose. Bud/form maintenance + relief prolonged time...... to first severe exacerbation (p relief also prolonged...

  12. Azithromycin maintenance therapy in patients with cystic fibrosis : A dose advice based on a review of pharmacokinetics, efficacy, and side effects

    NARCIS (Netherlands)

    Wilms, Erik B.; Touw, Daniel J.; Heijerman, Harry G.M.; Van Der Ent, Cornelis K.

    Azithromycin maintenance therapy results in improvement of respiratory function in patients with cystic fibrosis (CF). In azithromycin maintenance therapy, several dosing schemes are applied. In this review, we combine current knowledge about azithromycin pharmacokinetics with the dosing schedules

  13. Treatment readiness, attitudes toward, and experiences with methadone and buprenorphine maintenance therapy among people who inject drugs in Malaysia.

    Science.gov (United States)

    Vijay, Aishwarya; Bazazi, Alexander R; Yee, Ilias; Kamarulzaman, Adeeba; Altice, Frederick L

    2015-07-01

    Little is known about attitudes toward and experiences with opioid maintenance therapy (OMT) among people who inject drugs in Malaysia, a country where people who inject drugs comprise 1.3% of the adult population. In 2010, 460 people who inject drugs in Greater Kuala Lumpur, Malaysia were surveyed to evaluate attitudes toward and experiences with OMT and treatment readiness. Attitudes towards OMT with both methadone and buprenorphine were assessed using an opinions scale. Multivariable linear regression was used to assess correlates of treatment readiness, measured with the 19-item Stages of Change Readiness and Treatment Eagerness Scale (SOCRATES). All 460 participants used opioids and nearly all (99.1%) met criteria for opioid dependence. Few had had previous experience with methadone (9.3%) or buprenorphine (12.6%) maintenance therapy, yet many had used methadone (55.2%) or buprenorphine (51.7%) outside of treatment settings. Fifteen percent had injected buprenorphine in the past month, and of the few that were currently receiving buprenorphine maintenance therapy, almost all were injecting it. The majority of subjects exhibited a moderate level of treatment readiness and a preference for methadone over buprenorphine. Those with low treatment readiness scores were more likely to have previous experience with compulsory drug detention centers (polder age (ppeople who inject drugs that may be improved by addressing factors that influence patient attitudes. Those individuals with moderate treatment readiness may be targeted by brief motivational and cognitive interventions in primary care, prisons or OMT clinics aimed at improving entry into and retention in treatment. Copyright © 2015 Elsevier Inc. All rights reserved.

  14. Treatment readiness, attitudes toward, and experiences with methadone and buprenorphine maintenance therapy among people who inject drugs in Malaysia

    Science.gov (United States)

    Vijay, Aishwarya; Bazazi, Alexander R.; Yee, Ilias; Kamarulzaman, Adeeba; Altice, Frederick L.

    2016-01-01

    Background Little is known about attitudes toward and experiences with opioid maintenance therapy (OMT) among people who inject drugs in Malaysia, a country where people who inject drugs comprise 1.3% of the adult population. Methods In 2010, 460 people who inject drugs in Greater Kuala Lumpur, Malaysia were surveyed to evaluate attitudes toward and experience with OMT and treatment readiness. Attitudes towards OMT with both methadone and buprenorphine were assessed using an opinions scale. Multivariable linear regression was used to assess correlates of treatment readiness, measured with the 19-item Stages of Change Readiness and Treatment Eagerness Scale (SOCRATES). Results All 460 participants used opioids and nearly all (99.1%) met criteria for opioid dependence. Few had had previous experience with methadone (9.3%) or buprenorphine (12.6%) maintenance therapy, yet many had used methadone (55.2%) or buprenorphine (51.7%) outside of treatment settings. Fifteen percent had injected buprenorphine in the past month, and of the few that were currently receiving buprenorphine maintenance therapy, almost all were injecting it. The majority of subjects exhibited a moderate level of treatment readiness and a preference for methadone over buprenorphine. Those with low treatment readiness scores were more likely to have previous experience with compulsory drug detention centers (p<0.01), needle/syringe exchange programs (p<0.005), or be of Indian ethnicity (p<0.001). Past use of methadone (p<0.01), older age (p<0.001), stress symptom severity (p<0.001), and sharing of needles or syringes (p<0.05) were associated with higher treatment readiness scores. Conclusion There are suboptimal levels of OMT experience among people who inject drugs that may be improved by addressing factors that influence patient attitudes. Those individuals with moderate treatment readiness may be targeted by brief motivational and cognitive interventions in primary care, prisons or OMT clinics

  15. Maintenance electroconvulsive therapy for depression with catatonia in a young woman with Down syndrome.

    Science.gov (United States)

    Torr, Jennifer; D'Abrera, Juan Carlos

    2014-12-01

    To describe and discuss the use of maintenance electroconvulsive therapy (ECT) in a young woman with Down syndrome and depression with catatonia. Clinical case report. A 23-year-old woman with Down syndrome (mosaic type) and a 4-year history of depressed mood triggered by adverse life events presented with mutism, psychomotor retardation, and compromised oral intake. Multiple trials of antidepressant medications were either ineffective or complicated by adverse reactions. She improved rapidly with a course of bilateral ECT but required maintenance ECT to sustain recovery. A series of premorbid, morbid, and post-treatment drawings by the young woman highlight the efficacy of treatment. Electroconvulsive therapy was found to be a safe and effective treatment for life-threatening mental illness in a young woman with Down syndrome who had failed multiple trials of antidepressant medications. This case highlights the importance of considering catatonia as a diagnosis in persons with Down syndrome and the effectiveness of electroconvulsive treatment.

  16. Varicella Vaccination of Children With Leukemia Without Interruption of Maintenance Therapy

    DEFF Research Database (Denmark)

    Smedegaard, Lotte Møller; Poulsen, Anja; Kristensen, Ines Ackerl

    2016-01-01

    Background: Varicella-zoster virus (VZV) can be fatal or cause severe complications in children with acute lymphoblastic leukemia (ALL). This analysis set out to investigate the morbidity and mortality of VZV vaccination without interruption of maintenance therapy in children with ALL. Methods......: Files of 73 seronegative children with ALL were examined for data regarding VZV vaccination and infection, and long-term seroconversion was measured. Criteria before VZV vaccination were (1) seronegative, (2) in complete remission, (3) age >= 1.0 year, (4) lymphocyte count >= 0.6 × 109/L at time...... of vaccination and (5) receiving maintenance therapy. Results: Forty-five children were vaccinated. No child died or experienced serious adverse events due to VZV vaccination. Nine children developed late chickenpox despite vaccination. Long-term protection was found in 86% of children not receiving acyclovir...

  17. Attitudes and actions of asthma patients on regular maintenance therapy: the INSPIRE study

    Directory of Open Access Journals (Sweden)

    Myrseth Sven-Erik

    2006-06-01

    Full Text Available Abstract Background This study examined the attitudes and actions of 3415 physician-recruited adults aged ≥ 16 years with asthma in eleven countries who were prescribed regular maintenance therapy with inhaled corticosteroids or inhaled corticosteroids plus long-acting β2-agonists. Methods Structured interviews were conducted to assess medication use, asthma control, and patients' ability to recognise and self-manage worsening asthma. Results Despite being prescribed regular maintenance therapy, 74% of patients used short-acting β2-agonists daily and 51% were classified by the Asthma Control Questionnaire as having uncontrolled asthma. Even patients with well-controlled asthma reported an average of 6 worsenings/year. The mean period from the onset to the peak symptoms of a worsening was 5.1 days. Although most patients recognised the early signs of worsenings, the most common response was to increase short-acting β2-agonist use; inhaled corticosteroids were increased to a lesser extent at the peak of a worsening. Conclusion Previous studies of this nature have also reported considerable patient morbidity, but in those studies approximately three-quarters of patients were not receiving regular maintenance therapy and not all had a physician-confirmed diagnosis of asthma. This study shows that patients with asthma receiving regular maintenance therapy still have high levels of inadequately controlled asthma. The study also shows that patients recognise deteriorating asthma control and adjust their medication during episodes of worsening. However, they often adjust treatment in an inappropriate manner, which represents a window of missed opportunity.

  18. Opioid dependence and substitution therapy: thymoquinone as potential novel supplement therapy for better outcome for methadone maintenance therapy substitution therapy

    Science.gov (United States)

    Adnan, Liyana Hazwani Mohd; Bakar, Nor Hidayah Abu; Mohamad, Nasir

    2014-01-01

    Methadone is widely being used for opioid substitution therapy. However, the administration of methadone to opioid dependent individual is frequently accompanied by withdrawal syndrome and chemical dependency develops. Other than that, it is also difficult to retain patients in the treatment programme making their retention rates are decreasing over time. This article is written to higlights the potential use of prophetic medicines, Nigella sativa, as a supplement for opioid dependent receiving methadone. It focuses on the potential role of N. sativa and its major active compound, Thymoquinone (TQ) as a calcium channel blocking agent to reduce withdrawal syndrome and opioid dependency. PMID:25859295

  19. Opioid dependence and substitution therapy: thymoquinone as potential novel supplement therapy for better outcome for methadone maintenance therapy substitution therapy

    Directory of Open Access Journals (Sweden)

    Liyana Hazwani Mohd Adnan

    2015-12-01

    Full Text Available Methadone is widely being used for opioid substitution therapy. However, the administration of methadone to opioid dependent individual is frequently accompanied by withdrawal syndrome and chemical dependency develops. Other than that, it is also difficult to retain patients in the treatment programme making their retention rates are decreasing over time. This article is written to higlights the potential use of prophetic medicines, Nigella sativa, as a supplement for opioid dependent receiving methadone. It focuses on the potential role of N. sativa and its major active compound, Thymoquinone (TQ as a calcium channel blocking agent to reduce withdrawal syndrome and opioid dependency.

  20. Factors associated with residual gastroesophageal reflux disease symptoms in patients receiving proton pump inhibitor maintenance therapy.

    Science.gov (United States)

    Kawara, Fumiaki; Fujita, Tsuyoshi; Morita, Yoshinori; Uda, Atsushi; Masuda, Atsuhiro; Saito, Masaya; Ooi, Makoto; Ishida, Tsukasa; Kondo, Yasuyuki; Yoshida, Shiei; Okuno, Tatsuya; Yano, Yoshihiko; Yoshida, Masaru; Kutsumi, Hiromu; Hayakumo, Takanobu; Yamashita, Kazuhiko; Hirano, Takeshi; Hirai, Midori; Azuma, Takeshi

    2017-03-21

    To elucidate the factors associated with residual gastroesophageal reflux disease (GERD) symptoms in patients receiving proton pump inhibitor (PPI) maintenance therapy in clinical practice. The study included 39 GERD patients receiving maintenance PPI therapy. Residual symptoms were assessed using the Frequency Scale for Symptoms of GERD (FSSG) questionnaire and the Gastrointestinal Symptom Rating Scale (GSRS). The relationships between the FSSG score and patient background factors, including the CYP2C19 genotype, were analyzed. The FSSG scores ranged from 1 to 28 points (median score: 7.5 points), and 19 patients (48.7%) had a score of 8 points or more. The patients' GSRS scores were significantly correlated with their FSSG scores (correlation coefficient = 0.47, P reflux-related symptom scores: 12 ± 1.9 vs 2.5 ± 0.8, P reflux disease patients were significantly lower than those of the other patients (total scores: 5.5 ± 1.0 vs 11.8 ± 6.3, P < 0.05; dysmotility symptom-related scores: 1.0 ± 0.4 vs 6.0 ± 0.8, P < 0.01). Approximately half of the GERD patients receiving maintenance PPI therapy had residual symptoms associated with a lower quality of life, and the CYP2C19 genotype appeared to be associated with these residual symptoms.

  1. The effect of supragingival glycine air polishing on periodontitis during maintenance therapy: a randomized controlled trial

    Directory of Open Access Journals (Sweden)

    Hongye Lu

    2018-02-01

    Full Text Available Background Glycine air polishing has been proved to be safe, comfortable and time-saving. Whether it could substitute ultrasonic scaling to remove dental plaque biofilm during periodontal maintenance remains unclear. The purposes of this study were to evaluate the effect of supragingival glycine air polishing (SGAP on the subgingival periodontal pathogens during maintenance therapy and to check the association of periodontal pathogens and clinical parameters. Methods Twenty-three chronic periodontitis patients during their maintenance therapy were enrolled in the 12-week study. According to randomized split-mouth design, the test side was treated with SGAP (65 μm, while the control side was treated with supragingival ultrasonic scaling and polishing (SUSP with rubber cup. Clinical examination including plaque index (PLI, probing depth (PD, bleeding index (BI were performed at baseline and 12 weeks post-treatment. Sampling of the subgingival plaque at each investigational site (mesiobuccal site of the mandibular first molar was performed at baseline and 2, 4, 8, 12 weeks after maintenance treatment. Four periodontal pathogens including Porphyromonas gingivalis, Tannerella forsythia, Treponema denticola and Fusobacterium nucleatum were detected by 16S rDNA polymerase chain reaction. Results Clinical status generally improved after treatment in both groups. PLI in both groups, PD in SGAP group and bleeding on probing (% in SUSP group significantly decreased after treatment (p < 0.05. There was no significant difference of clinical parameters between two groups before and after treatment. The detection rates of P. gingivalis, T. denticola in both groups, T. forsythia in SUSP group and F. nucleatum in SGAP group decreased after maintenance treatment in both groups, although no significant difference was found, and it rebound to baseline level at 12 weeks after maintenance treatment. There was no significant difference between SGAP group and SUSP

  2. The role of maintenance thalidomide therapy in multiple myeloma: MRC Myeloma IX results and meta-analysis.

    Science.gov (United States)

    Morgan, Gareth J; Gregory, Walter M; Davies, Faith E; Bell, Sue E; Szubert, Alexander J; Brown, Julia M; Coy, Nuria N; Cook, Gordon; Russell, Nigel H; Rudin, Claudius; Roddie, Huw; Drayson, Mark T; Owen, Roger G; Ross, Fiona M; Jackson, Graham H; Child, J Anthony

    2012-01-05

    Thalidomide maintenance has the potential to modulate residual multiple myeloma (MM) after an initial response. This trial compared the effect of thalidomide maintenance and no maintenance on progression-free survival (PFS) and overall survival (OS) in MM patients. After intensive or nonintensive induction therapy, 820 newly diagnosed MM patients were randomized to open-label thalidomide maintenance until progression, or no maintenance. Interphase FISH (iFISH) analysis was performed at study entry. Median PFS was significantly longer with thalidomide maintenance (log-rank P < .001). Median OS was similar between regimens (log-rank P = .40). Patients with favorable iFISH showed improved PFS (P = .004) and a trend toward a late survival benefit. Patients with adverse iFISH receiving thalidomide showed no significant PFS benefit and worse OS (P = .009). Effective relapse therapy enhanced survival after progression, translating into a significant OS benefit. Meta-analysis of this and other studies show a significant late OS benefit (P < .001, 7-year difference hazard ratio = 12.3; 95% confidence interval, 5.5-19.0). Thalidomide maintenance significantly improves PFS and can be associated with improved OS. iFISH testing is important in assessing the clinical impact of maintenance therapy. Overview analysis demonstrated that thalidomide maintenance was associated with a significant late OS benefit. This trial was registered at www.isrctn.org as #ISRCTN68454111.

  3. Overall asthma control achieved with budesonide/formoterol maintenance and reliever therapy for patients on different treatment steps

    Directory of Open Access Journals (Sweden)

    Östlund Ollie

    2011-04-01

    Full Text Available Abstract Background Adjusting medication for uncontrolled asthma involves selecting one of several options from the same or a higher treatment step outlined in asthma guidelines. We examined the relative benefit of introducing budesonide/formoterol (BUD/FORM maintenance and reliever therapy (Symbicort SMART® Turbuhaler® in patients previously prescribed treatments from Global Initiative for Asthma (GINA Steps 2, 3 or 4. Methods This is a post hoc analysis of the results of five large clinical trials (>12000 patients comparing BUD/FORM maintenance and reliever therapy with other treatments categorised by treatment step at study entry. Both current clinical asthma control during the last week of treatment and exacerbations during the study were examined. Results At each GINA treatment step, the proportion of patients achieving target levels of current clinical control were similar or higher with BUD/FORM maintenance and reliever therapy compared with the same or a higher fixed maintenance dose of inhaled corticosteroid/long-acting β2-agonist (ICS/LABA (plus short-acting β2-agonist [SABA] as reliever, and rates of exacerbations were lower at all treatment steps in BUD/FORM maintenance and reliever therapy versus same maintenance dose ICS/LABA (P Conclusions BUD/FORM maintenance and reliever therapy may be a preferable option for patients on Steps 2 to 4 of asthma guidelines requiring a more effective treatment and, compared with other fixed dose alternatives, is most effective in the higher treatment steps.

  4. Tamibarotene as maintenance therapy for acute promyelocytic leukemia: results from a randomized controlled trial.

    Science.gov (United States)

    Shinagawa, Katsuji; Yanada, Masamitsu; Sakura, Toru; Ueda, Yasunori; Sawa, Masashi; Miyatake, Junichi; Dobashi, Nobuaki; Kojima, Minoru; Hatta, Yoshihiro; Emi, Nobuhiko; Tamaki, Shigehisa; Gomyo, Hiroshi; Yamazaki, Etsuko; Fujimaki, Katsumichi; Asou, Norio; Matsuo, Keitaro; Ohtake, Shigeki; Miyazaki, Yasushi; Ohnishi, Kazunori; Kobayashi, Yukio; Naoe, Tomoki

    2014-11-20

    The introduction of all-trans-retinoic acid (ATRA) has significantly improved outcomes for acute promyelocytic leukemia (APL), although a subset of patients still suffer relapse. The purpose of this study was to evaluate the role of maintenance therapy with the synthetic retinoid tamibarotene in APL. Patients with newly diagnosed APL in molecular remission at the end of consolidation therapy were randomly assigned to receive ATRA or tamibarotene, both orally, for 14 days every 3 months for up to 2 years. A total of 347 patients were enrolled. Of the 344 eligible patients, 319 (93%) achieved complete remission. After completing three courses of consolidation therapy, 269 patients underwent maintenance random assignment. The relapse-free survival (RFS) rate at 4 years was 84% for the ATRA arm and 91% for the tamibarotene arm (hazard ratio [HR], 0.54; 95% CI, 0.26 to 1.13). When the analysis was restricted to 52 high-risk patients with an initial WBC count ≥ 10.0 × 10(9)/L, the intergroup difference was statistically significant, with 4-year RFS rates of 58% for the ATRA arm and 87% for the tamibarotene arm (HR, 0.26; 95% CI, 0.07 to 0.95). For patients with non-high-risk disease, the HR was 0.82 (95% CI, 0.32 to 2.01). The test for interaction between treatment effects and these subgroups resulted in P = .075. Both treatments were generally well tolerated. In this trial, no difference was detected between ATRA and tamibarotene for maintenance therapy. In an exploratory analysis, there was a suggestion of improved efficacy of tamibarotene in high-risk patients, but this requires further study. © 2014 by American Society of Clinical Oncology.

  5. Maintenance immunosuppression with intermittent intravenous IL-2 receptor antibody therapy in renal transplant recipients.

    Science.gov (United States)

    Gabardi, Steven; Catella, Jennifer; Martin, Spencer T; Perrone, Ronald; Chandraker, Anil; Magee, Colm C; McDevitt-Potter, Lisa M

    2011-09-01

    To report what we believe to be the first 2 cases of long-term (>24 months) intermittent intravenous interleukin-2 receptor antibody (IL-2RA) therapy for maintenance immunosuppression following renal transplantation. The first patient is a 52-year-old female with a history of intolerance to calcineurin inhibitors (CNIs) and sirolimus. Following her second transplant, the patient received mycophenolate mofetil 100 mg twice daily, a tapering corticosteroid regimen (initial dose of methylprednisolone 500 mg tapered over 1 week to prednisone 30 mg/day), and biweekly intravenous daclizumab 1-1.2 mg/kg/dose; 33 months after transplant the IL-2RA was changed to intravenous basiliximab 40 mg once a month. At 40 months after transplant, the patient continued to have stable renal function (estimated glomerular filtration rate 48 mL/min/1.73 m²) with excellent tolerability. The second patient is a 59-year-old female also intolerant to CNIs and sirolimus who required intermittent maintenance therapy with intravenous basiliximab 20 mg/dose. Despite an initial rejection episode, the patient tolerated more than 2 years of basiliximab therapy with good renal function (estimated glomerular filtration rate 103 months after transplant 69 mL/min/1.73 m²) and no adverse events. The IL-2RAs basiliximab and daclizumab possess several characteristics of ideal maintenance immunosuppressive agents (ie, nondepleting, long half-lives, limited adverse events). Based on a MEDLINE search (through December 31, 2010) using the search terms basiliximab, daclizumab, organ transplant, immunosuppression, and/or maintenance immunosuppression, and an advanced search in the published abstracts from the American Transplant Congress and World Transplant Congress (2000-2010), it appears that IL-2RAs have been used successfully as short-term therapy in both renal and extrarenal transplant recipients to allow for renal recovery following CNI-induced nephrotoxicity. In heart transplant recipients, the IL-2

  6. [Subcutaneous bortezomib as a new promising way to successful maintenance therapy in multiple myeloma].

    Science.gov (United States)

    Grosicki, Sebastian

    2012-01-01

    Multiple myeloma (MM) despite the introduction to clinical practice of a new drugs in the last years, and still searching of new points of the handle for targeting treatment, remaining incurable disease. Even most intensive and most modern induction-consolidation regimens is not in the state to eradicate of the clone of myeloma, and even complete remission in immunofixation the most often after some time ends progression. Optimal way of maintenance treatment is still searching, which would be maximally effective near acceptable toxicity. Now hypothesis about possible successful maintenance therapy, which may prolong survival of MM patients became more actual in the face of the introduction to the studies with maintenance of a new drugs as: thalidomide, lenalidomide and bortesomib. The expectations on the essential progress to establish the optimal bortesomib-based regimen of the maintenance treatment in MM cause the results of the studies with its subcutaneous administration, which proved comparable efficacy with advantage in toxicity profile, especially neurological in comparison to classic intravenous way.

  7. Personality Patterns in Narcotics Anonymous Members versus Individuals with Addiction Receiving Methadone Maintenance Therapy.

    Science.gov (United States)

    Akhondzadeh, Shahin; Shabrang, Moslem; Rezaei, Omid; Rezaei, Farzin

    2014-07-01

    Therapeutic interventions can be classified into two distinct approaches: abstinent and maintenance method. Currently, there are no clear criteria for referring addicted patients to one of these modalities. We aimed to compare the personality characteristics of individuals with addiction who attended narcotics anonymous sessions with those who received methadone maintenance therapy. This was a cross- sectional study. The participants were NA members and patients who were undergoing methadone maintenance treatment in outpatient clinics. Using the randomized cluster sampling method, 200 individuals with opioid dependence were selected (each group 100 persons). Data were collected through a demographic questionnaire and the five-factor personality inventory (NEO-FFI). Comparison of the mean scores of NEO-PPI in the two groups was performed by independent t test, and qualitative variables were compared using the Chi-square test. We found a significant difference between the MMT and NA groups with respect to neuroticism, extroversion, and agreeableness. No significant difference was found in the subscales of conscientious and openness. People who regularly attended the NA sessions had lower neuroticism and higher agreeableness than patients who were under the maintenance modality. Whether this is the cause or effect of attending NA sessions requires future large-scale cohort studies.

  8. Personality Patterns in Narcotics Anonymous Members versus Individuals with Addiction Receiving Methadone Maintenance Therapy.

    Directory of Open Access Journals (Sweden)

    Shahin Akhondzadeh

    2014-09-01

    Full Text Available Therapeutic interventions can be classified into two distinct approaches: abstinent and maintenance method. Currently, there are no clear criteria for referring addicted patients to one of these modalities. We aimed to compare the personality characteristics of individuals with addiction who attended narcotics anonymous sessions with those who received methadone maintenance therapy.This was a cross- sectional study. The participants were NA members and patients who were undergoing methadone maintenance treatment in outpatient clinics. Using the randomized cluster sampling method, 200 individuals with opioid dependence were selected (each group 100 persons. Data were collected through a demographic questionnaire and the five-factor personality inventory (NEO-FFI. Comparison of the mean scores of NEO-PPI in the two groups was performed by independent t test, and qualitative variables were compared using the Chi-square test.We found a significant difference between the MMT and NA groups with respect to neuroticism, extroversion, and agreeableness. No significant difference was found in the subscales of conscientious and openness.People who regularly attended the NA sessions had lower neuroticism and higher agreeableness than patients who were under the maintenance modality. Whether this is the cause or effect of attending NA sessions requires future large-scale cohort studies.

  9. Shorter maintenance therapy in childhood Acute Lymphoblastic Leukemia. The experience of the prospective, randomized Brazilian GBTLI ALL-93 protocol.

    Directory of Open Access Journals (Sweden)

    Silvia Regina Brandalise

    2016-10-01

    Full Text Available Maintenance therapy is an important phase of the childhood ALL treatment, requiring 2-year long therapy adherence of the patients and families. Weekly methotrexate (MTX with daily 6-mercaptopurine (6MP constitutes the backbone of maintenance therapy. Reduction in the maintenance therapy could overweight problems related with poverty of children with ALL living in Limited-Income countries (LIC. Objective: To compare, prospectively, the EFS rates of children with ALL treated according to two maintenance regimens: 18 vs 24 months duration. Materials and Methods: From October 1993 to September 1999, 867 consecutive untreated ALL patients 10 years and high WBC at diagnosis. Overall death in remission rate was 6.85% (56 patients. Deaths during maintenance were 13 in group 1 and 12 in group 2, all due to infection. Over 15 years of follow-up, two patients both from Group 2 presented a second malignancy (Hodgkin’s disease and thyroid carcinoma after 8.3 and 11 years off therapy, respectively. Conclusion: Six-month reduction of maintenance therapy in ALL children treated according to the GBTLI ALL-93 protocol, provided the same overall outcome as 2-year duration regimen.

  10. Capecitabine maintenance therapy in patients with recurrent or metastatic breast cancer

    International Nuclear Information System (INIS)

    Si, W.; Zhu, Y.Y.; Li, Y.; Gao, P.; Han, C.; You, J.H.; Linghu, R.X.; Jiao, S.C.; Yang, J.L.

    2013-01-01

    Our objective was to investigate the efficacy and safety of capecitabine maintenance therapy (CMT) after capecitabine-based combination chemotherapy in patients with metastatic breast cancer. The clinical data of 139 metastatic breast cancer patients treated from March 2008 to May 2012 with capecitabine-based combination chemotherapy were retrospectively analyzed. When initial disease control was achieved by the combination chemotherapy, we used CMT for 50 patients, while 37 patients were treated with a different (non-CMT) maintenance therapy. We compared time to progression (TTP), objective response rate, disease control rate, clinical benefit rate, and safety of the two groups, and a sub-group analysis was performed according to pathological characteristics. Sixty-four percent of the patients received a median of six cycles of a docetaxel+capecitabine combination chemotherapy regimen (range 1-45); the median TTP (MTTP) for the complete treatment was 9.43 months (95%CI=8.38-10.48 months) for the CMT group and 4.5 months (95%CI=4.22-4.78 months; P=0.004) for the non-CMT group. The MTTPs for the maintenance therapies administered after the initial capecitabine combined chemotherapy were 4.11 months (95%CI=3.34-4.87 months) for the CMT group and 2.0 months (95%CI=1.63-2.38 months) for the non-CMT group. Gastrointestinal side effects, decreased white blood cells and palmar-plantar erythrodysesthesia were the main adverse reactions experienced with the combination chemotherapies, CMT and non-CMT treatments. No significant differences in the incidence of adverse reactions were detected in the CMT and non-CMT patients. After initial disease control was achieved with the capecitabine-based combination chemotherapy, CMT can significantly prolong TTP rates with a favorable safety profile

  11. Capecitabine maintenance therapy in patients with recurrent or metastatic breast cancer

    Energy Technology Data Exchange (ETDEWEB)

    Si, W. [General Hospital of the Chinese People' s Liberation Army, Department of Medical Oncology, Haidian District, Beijing, China, Department of Medical Oncology, General Hospital of the Chinese People’s Liberation Army, Haidian District, Beijing (China); School of Medicine, Nankai University, Tianjin (China); Zhu, Y.Y.; Li, Y.; Gao, P.; Han, C.; You, J.H.; Linghu, R.X.; Jiao, S.C.; Yang, J.L. [General Hospital of the Chinese People' s Liberation Army, Department of Medical Oncology, Haidian District, Beijing, China, Department of Medical Oncology, General Hospital of the Chinese People’s Liberation Army, Haidian District, Beijing (China)

    2013-11-25

    Our objective was to investigate the efficacy and safety of capecitabine maintenance therapy (CMT) after capecitabine-based combination chemotherapy in patients with metastatic breast cancer. The clinical data of 139 metastatic breast cancer patients treated from March 2008 to May 2012 with capecitabine-based combination chemotherapy were retrospectively analyzed. When initial disease control was achieved by the combination chemotherapy, we used CMT for 50 patients, while 37 patients were treated with a different (non-CMT) maintenance therapy. We compared time to progression (TTP), objective response rate, disease control rate, clinical benefit rate, and safety of the two groups, and a sub-group analysis was performed according to pathological characteristics. Sixty-four percent of the patients received a median of six cycles of a docetaxel+capecitabine combination chemotherapy regimen (range 1-45); the median TTP (MTTP) for the complete treatment was 9.43 months (95%CI=8.38-10.48 months) for the CMT group and 4.5 months (95%CI=4.22-4.78 months; P=0.004) for the non-CMT group. The MTTPs for the maintenance therapies administered after the initial capecitabine combined chemotherapy were 4.11 months (95%CI=3.34-4.87 months) for the CMT group and 2.0 months (95%CI=1.63-2.38 months) for the non-CMT group. Gastrointestinal side effects, decreased white blood cells and palmar-plantar erythrodysesthesia were the main adverse reactions experienced with the combination chemotherapies, CMT and non-CMT treatments. No significant differences in the incidence of adverse reactions were detected in the CMT and non-CMT patients. After initial disease control was achieved with the capecitabine-based combination chemotherapy, CMT can significantly prolong TTP rates with a favorable safety profile.

  12. Maintenance therapy with oxytocin antagonists for inhibiting preterm birth after threatened preterm labour.

    Science.gov (United States)

    Papatsonis, Dimitri N M; Flenady, Vicki; Liley, Helen G

    2013-10-13

    In some women, an episode of preterm labour settles and does not result in immediate preterm birth. Subsequent treatment with tocolytic agents such as oxytocin receptor antagonists may then have the potential to prevent the recurrence of preterm labour, prolonging gestation, and preventing the adverse consequences of prematurity for the infant. To assess the effects of maintenance therapy with oxytocin antagonists administered by any route after an episode of preterm labour in order to delay or prevent preterm birth. We searched the Cochrane Pregnancy and Childbirth Group's Trials Register (31 July 2013), sought ongoing and unpublished trials by contacting experts in the field and searched the reference lists of relevant articles. Randomised controlled trials comparing oxytocin antagonists with any alternative tocolytic agent, placebo or no treatment, used for maintenance therapy after an episode of preterm labour. We used the standard methods of The Cochrane Collaboration and the Cochrane Pregnancy and Childbirth Group. Two review authors independently undertook evaluation of methodological quality and extracted trial data. This review includes one trial of 513 women. When compared with placebo, atosiban did not reduce preterm birth before 37 weeks (risk ratio (RR) 0.89; 95% confidence intervals (CI) 0.71 to 1.12), 32 weeks (RR 0.85; 95% CI 0.47 to 1.55), or 28 weeks (RR 0.75; 95% CI 0.28 to 2.01). No difference was shown in neonatal morbidity, or perinatal mortality. There is insufficient evidence to support the use of oxytocin receptor antagonists to inhibit preterm birth after a period of threatened or actual preterm labour. Any future trials using oxytocin antagonists or other drugs as maintenance therapy for preventing preterm birth should examine a variety of important infant outcome measures, including reduction of neonatal morbidity and mortality, and long-term infant follow-up. Future research should also focus on the pathophysiological pathways that

  13. Review of cancer pain management in patients receiving maintenance methadone therapy.

    LENUS (Irish Health Repository)

    Rowley, Dominic

    2011-05-01

    Methadone is commonly used in the treatment of heroin addiction. Patients with a history of opioid misuse or on methadone maintenance therapy (MMT) with cancer often have difficult to manage pain. We studied 12 patients referred to the palliative care service with cancer pain who were on MMT. All had difficult to control pain, and a third required 5 or more analgesic agents. Two patients had documented \\'\\'drug-seeking\\'\\' behavior. Methadone was used subcutaneously as an analgesic agent in 1 patient. We explore why patients on MMT have difficult to manage pain, the optimal management of their pain, and the increasing role of methadone as an analgesic agent in cancer pain.

  14. Adalimumab for maintenance therapy for one year in Crohn's disease: results of a Latin American single-center observational study.

    Science.gov (United States)

    Kotze, Paulo Gustavo; Abou-Rejaile, Vinícius Rezende; Uiema, Luciana Aparecida; Olandoski, Marcia; Sartor, Maria Cristina; Miranda, Eron Fábio; Kotze, Lorete Maria da Silva; Saad-Hossne, Rogério

    2014-01-01

    Adalimumab is a fully-human antibody that inhibits TNF alpha, with a significant efficacy for long-term maintenance of remission. Studies with this agent in Latin American Crohn's disease patients are scarce. The objective of this study was to outline clinical remission rates after 12 months of adalimumab therapy for Crohn's disease patients. Retrospective, single-center, observational study of a Brazilian case series of Crohn's disease patients under adalimumab therapy. Variables analyzed: demographic data, Montreal classification, concomitant medication, remission rates after 1, 4, 6 and 12 months. Remission was defined as Harvey-Bradshaw Index ≤ 4, and non-responder-imputation and last-observation-carried-forward analysis were used. The influence of infliximab on remission rates was analyzed by Fischer and Chi-square tests (Panalysis. After 12 months, remission on patients with previous infliximab occurred in 69.23% as compared to 94.59% in infliximab-naïve patients (P = 0.033). Adalimumab was effective in maintaining clinical remission after 12 months of therapy, with an adequate safety profile, and was also more effective in infliximab naïve patients.

  15. The Influence of Academic Culture on Quality Management System ISO 9001 Maintenance within Malaysian Universities

    Science.gov (United States)

    Basir, Siti Arni; Davies, John; Douglas, Jacqueline; Douglas, Alexander

    2017-01-01

    This study investigates the influence of the elements of academic culture on quality management system ISO 9001 maintenance within Malaysian universities. There is a dearth of empirical studies on maintaining ISO 9001, particularly in the higher education context. From the literature review, academic culture was classified according to four…

  16. Developmental Differences in the Influence of Distractors on Maintenance in Spatial Working Memory

    Science.gov (United States)

    Schutte, Anne R.; Keiser, Brian A.; Beattie, Heidi L.

    2017-01-01

    This study examined whether attention to a location plays a role in the maintenance of locations in spatial working memory in young children as it does in adults. This study was the first to investigate whether distractors presented during the delay of a spatial working-memory task influenced young children's memory responses. Across 2…

  17. Population-Level Density Dependence Influences the Origin and Maintenance of Parental Care

    OpenAIRE

    Reyes, Elijah; Thrasher, Patsy; Bonsall, Michael B.; Klug, Hope

    2016-01-01

    Parental care is a defining feature of animal breeding systems. We now know that both basic life-history characteristics and ecological factors influence the evolution of care. However, relatively little is known about how these factors interact to influence the origin and maintenance of care. Here, we expand upon previous work and explore the relationship between basic life-history characteristics (stage-specific rates of mortality and maturation) and the fitness benefits associated with the...

  18. Maintenance electroconvulsive therapy for comorbid pharmacotherapy-refractory obsessive-compulsive and schizoaffective disorder

    Directory of Open Access Journals (Sweden)

    Hanisch F

    2009-08-01

    Full Text Available Abstract Objective There is a high comorbidity of schizophrenia and obsessive-compulsory disorder (OCD associated with more severe symptoms. Standard pharmacotherapy achieve symptom improvement in approximately 60% only. Results We report about a 48-old women treated for depression which developed successively psychotic symptoms (ideas of reference, psychotic worries, negative symptoms (blunted affect, impoverished thinking, difficulties in planning, and obsessive-compulsive symptoms (mainly repeating rituals, avoidance behaviour, collecting and hoarding. She did not respond to combined treatment with neuroleptics and high dose selective serotonin re-uptake inhibitors. She acutely improved during a course of electroconvulsive therapy (ECT and was maintained on outpatient ECTs fortnightly together with 12 mg sertindol and 45 mg mirtazapine for 42 weeks. Conclusion Maintenance ECT is not an approved therapy in OCD but might be an option in pharmacotherapy refractory cases of comorbid OCD and schizophrenic/schizoaffective disorder.

  19. Medicaid Coverage for Methadone Maintenance and Use of Opioid Agonist Therapy in Specialty Addiction Treatment.

    Science.gov (United States)

    Saloner, Brendan; Stoller, Kenneth B; Barry, Colleen L

    2016-06-01

    This study examined differences in opioid agonist therapy (OAT) utilization among Medicaid-enrolled adults receiving public-sector opioid use disorder treatment in states with Medicaid coverage of methadone maintenance, states with block grant funding only, and states without public coverage of methadone. Person-level treatment admission data, which included information on reason for treatment and use of OAT from 36 states were linked to state-level Medicaid policies collected in a 50-state survey. Probabilities of OAT use among Medicaid enrollees in opioid addiction treatment were calculated, with adjustment for demographic characteristics and patterns of substance use. In adjusted analysis, 45.0% of Medicaid-enrolled individuals in opioid addiction treatment in states with Medicaid coverage for methadone maintenance used OAT, compared with 30.1% in states with block grant coverage only and 17.0% in states with no coverage. Differences were widest in nonintensive outpatient settings. Medicaid methadone maintenance coverage is critical for encouraging OAT among individuals with opioid use disorders.

  20. Durvalumab: a potential maintenance therapy in surgery-ineligible non-small-cell lung cancer

    Directory of Open Access Journals (Sweden)

    Shafique MR

    2018-05-01

    Full Text Available Michael R Shafique, Lary A Robinson, Scott Antonia Department of Thoracic Oncology, H Lee Moffitt Cancer Center and Research Institute, Tampa, FL, USA Abstract: Lung cancer is the most common cancer worldwide and the most common cause of cancer-related death. Non-small-cell lung cancer comprises ~87% of newly diagnosed cases of lung cancer, and nearly one-third of these patients have stage III disease. Despite improvements in the treatment of stage IV lung cancer, particularly with the introduction and dissemination of checkpoint inhibitors, very little progress has been made in the treatment of stage III lung cancer. In this article, we discuss the general staging criteria and treatment options for stage III lung cancer. We review how concurrent radiation and chemotherapy can have immunomodulatory effects, supporting the rationale for incorporating immunotherapy into existing treatment paradigms. Finally, we discuss the results of the PACIFIC trial and implications for the treatment of stage III lung cancer. In the PACIFIC trial, adding durvalumab as a maintenance therapy following the completion of chemoradiotherapy improved progression-free survival in patients with locally advanced unresectable stage III lung cancer. On the strength of these results, durvalumab has been approved by the US Food and Drug Administration for use in this setting, representing the first advance in the treatment of stage III lung cancer in nearly a decade. Keywords: non-small-cell lung cancer, maintenance therapy, staging, immunotherapy, chemoradiation, surgery-ineligible, durvalumab

  1. Design of the randomized, Phase III, QUAZAR AML Maintenance trial of CC-486 (oral azacitidine) maintenance therapy in acute myeloid leukemia.

    Science.gov (United States)

    Roboz, Gail J; Montesinos, Pau; Selleslag, Dominik; Wei, Andrew; Jang, Jun-Ho; Falantes, Jose; Voso, Maria T; Sayar, Hamid; Porkka, Kimmo; Marlton, Paula; Almeida, Antonio; Mohan, Sanjay; Ravandi, Farhad; Garcia-Manero, Guillermo; Skikne, Barry; Kantarjian, Hagop

    2016-02-01

    Older patients with acute myeloid leukemia (AML) have worse rates of complete remission and shorter overall survival than younger patients. The epigenetic modifier CC-486 is an oral formulation of azacitidine with promising clinical activity in patients with AML in Phase I studies. The Phase III, randomized, double-blind, placebo-controlled QUAZAR AML Maintenance trial (CC-486-AML-001) examines CC-486 maintenance therapy (300 mg/day for 14 days of 28-day treatment cycles) for patients aged ≥55 years with AML in first complete remission. The primary end point is overall survival. Secondary end points include relapse-free survival, safety, health-related quality of life and healthcare resource utilization. This trial will investigate whether CC-486 maintenance can prolong remission and improve survival for older patients with AML.

  2. Use of Influence Diagrams and Fuzzy Theory to Develop Assessment Method of Organizational Influences on Component Maintenance

    International Nuclear Information System (INIS)

    Yoonik Kim; Kwang-Won Ahn; Chang-Hyun Chung; Kil Yoo Kim; Joon-Eon Yang

    2002-01-01

    Organization can make influences on all the systems. Especially in case of nuclear power plants in which safety is established to be one of the most important operating goals, there have been a lot of research efforts for the hardware advancement. However in recent years, it has been widely recognized that organizational factors in nuclear power plants have an important influence on the safety attitudes and the safe behavior of individuals. Until now, any means to include assessments of organizational structure in probabilistic risk assessments have not been universally accepted. The objective of this work is to develop a method to assess organizational influences on component maintenance. Influence diagrams are introduced in this method as a decision making tool and fuzzy theory is used to reflect the vagueness in considering relevance of human activities in maintenance tasks. Introducing fuzzy theory to assess the organizational factors is deemed to a somewhat new trial, which makes it possible to convert linguistic vague descriptions into mathematical ones. Fuzzy linguistic descriptions offer an alternative and often complementary language to conventional, i.e., analytic approaches to modeling systems. Among the existing methodologies to assess organizational factors, the concept of the ω-factor model is utilized and the mechanism that organizational factors have influences on component maintenance is evaluated through composing influence diagrams. These influences go to failure rates and eventually affect component unavailability. Further study will make it possible that the influences of organizational factors on human error probabilities are incorporated into human reliability analysis and furthermore probabilistic safety assessment. (authors)

  3. Influence of Genotype on Warfarin Maintenance Dose Predictions Produced Using a Bayesian Dose Individualization Tool.

    Science.gov (United States)

    Saffian, Shamin M; Duffull, Stephen B; Roberts, Rebecca L; Tait, Robert C; Black, Leanne; Lund, Kirstin A; Thomson, Alison H; Wright, Daniel F B

    2016-12-01

    A previously established Bayesian dosing tool for warfarin was found to produce biased maintenance dose predictions. In this study, we aimed (1) to determine whether the biased warfarin dose predictions previously observed could be replicated in a new cohort of patients from 2 different clinical settings, (2) to explore the influence of CYP2C9 and VKORC1 genotype on predictive performance of the Bayesian dosing tool, and (3) to determine whether the previous population used to develop the kinetic-pharmacodynamic model underpinning the Bayesian dosing tool was sufficiently different from the test (posterior) population to account for the biased dose predictions. The warfarin maintenance doses for 140 patients were predicted using the dosing tool and compared with the observed maintenance dose. The impact of genotype was assessed by predicting maintenance doses with prior parameter values known to be altered by genetic variability (eg, EC50 for VKORC1 genotype). The prior population was evaluated by fitting the published kinetic-pharmacodynamic model, which underpins the Bayesian tool, to the observed data using NONMEM and comparing the model parameter estimates with published values. The Bayesian tool produced positively biased dose predictions in the new cohort of patients (mean prediction error [95% confidence interval]; 0.32 mg/d [0.14-0.5]). The bias was only observed in patients requiring ≥7 mg/d. The direction and magnitude of the observed bias was not influenced by genotype. The prior model provided a good fit to our data, which suggests that the bias was not caused by different prior and posterior populations. Maintenance doses for patients requiring ≥7 mg/d were overpredicted. The bias was not due to the influence of genotype nor was it related to differences between the prior and posterior populations. There is a need for a more mechanistic model that captures warfarin dose-response relationship at higher warfarin doses.

  4. Music therapy-induced changes in salivary cortisol level are predictive of cardiovascular mortality in patients under maintenance hemodialysis.

    Science.gov (United States)

    Hou, Yi-Chou; Lin, Yen-Ju; Lu, Kuo-Cheng; Chiang, Han-Sun; Chang, Chia-Chi; Yang, Li-King

    2017-01-01

    Music therapy has been applied in hemodialysis (HD) patients for relieving mental stress. Whether the stress-relieving effect by music therapy is predictive of clinical outcome in HD patients is still unclear. We recruited a convenience sample of 99 patients on maintenance HD and randomly assigned them to the experimental (n=49) or control (n=50) group. The experimental group received relaxing music therapy for 1 week, whereas the control group received no music therapy. In the experimental group, we compared cardiovascular mortality in the patients with and without cortisol changes. The salivary cortisol level was lowered after 1 week of music therapy in the experimental group (-2.41±3.08 vs 1.66±2.11 pg/mL, P 0.6 pg/mL (83.8% vs 63.6%, P predict cardiovascular mortality in patients under maintenance HD.

  5. The Comparison of the Effectiveness of Group Cognitive-Behavior Therapy and Methadone Maintenance Therapy on Changing Beliefs Related to Substance and Relapse Prevention

    Directory of Open Access Journals (Sweden)

    Taherh Ghorbani

    2012-08-01

    Full Text Available Introduction: This study was aimed to compare of the effectiveness of group cognitive-behavioral therapy and methadone maintenance therapy on changing beliefs toward substance abuse among addicted people. Method: The research method was a quasi-experimental pretest-posttest with witness group. 30 addicted people who were referred to the addiction treatment centers selected by available sampling, and they randomly assigned to three groups namely: cognitive-behavioral therapy, methadone maintenance therapy and witness groups. Substance abuse beliefs questionnaire was administered among all participants before and after intervention. Results: Results showed that in both experimental groups, beliefs toward drug was reduced significantly in comparison with witness group. Conclusion: Cognitive-behavioral therapy can be changed on cognitive mediator variables, like beliefs toward substance therefore, it can reduce the risk of relapse. However, the programs of treatment of substance abuse should be targeted this type of intermediate variables.

  6. Organizational Culture Influence on Total Productive Maintenance (TPM) and Operational Performance Using RASCH Model Analysis

    OpenAIRE

    Mohd Asaad, Mohd Norhasni; Yusoff, Rushami Zien

    2013-01-01

    Abstract. Market globalization, competitive product and services, high economic crises are the most critical factors that influence the success of the manufacturing companies in global market. Therefore it is critical to the manufacturing companies to be efficient in production and lean tool may used to achieve that.  The most frequently used is the Total Preventive Maintenance (TPM), even though there are many studies have been conducted in relation to the TPM but there is limited research i...

  7. The Effect of Cognitive Behavior Therapy in Insomnia due to Methadone Maintenance Therapy: A Randomized Clinical Trial

    Directory of Open Access Journals (Sweden)

    Robabeh Soleimani

    2015-09-01

    Full Text Available Background: Sleep disturbance is a common complaint of patients undergoing methadone maintenance therapy (MMT. There are limited studies about the effect of different treatments on insomnia due to MMT. In this study, we evaluated the effect of cognitive-behavioral treatment for insomnia (CBTI on sleep disorders in patients undergoing MMT. Methods: Twenty-two patients with insomnia due to MMT (aged 18-60 years participated in this randomized double-blind clinical trial. The intervention group received CBTI from a clinical psychologist for 8 weeks, whereas the control group received behavioral placebo therapy (BPT. The duration of individual sessions was 45 minutes, which was conducted once a week. The primary outcome was sleep disturbance assessed with Pittsburgh Sleep Quality Index (PSQI. Data were analyzed using SPSS software version 19. Results: Eleven patients were assigned to each group. Two groups were matched according to demographic characteristics (age, marital status, education, and daily methadone doses. Although PSQI score was significantly reduced during weeks 5 and 8 after both interventions, there was a significant difference in intervention versus time interaction (P<0.02. The effects of CBTI versus placebo were significantly different (P<0.001. The time course was also significant (P<0.001. Conclusion: This study showed that CBTI is more effective than BPT in overall sleep quality. We recommend further studies, with a larger sample, on CBTI in patients undergoing MMT.

  8. [Effect of the frequency of maintenance therapy on patients treated for gingivitis and incipient marginal periodontitis].

    Science.gov (United States)

    Rojas, I F; Zepeda, M S; Zúñiga, H P

    1990-11-01

    The effectiveness of maintenance care program applied at different period of time was evaluate in patients treated for gingivitis and incipiente marginal periodontitis. Fifty six patients were divided in three groups, each one controlled three times (each 2, 4 and 6 months respectively), to evaluate periodontal health. At each control, gingival index and plaque index was registered and patients had profilaxis and reinforcement of dental care instructions. All patients knew and practiced a control plaque control during active treatment. Results demonstrated that maintenance care program applied each 2 months, could get better clinical healthy periodontal conditions, without influence of patient's control plaque. Those patients with good hygiene could provide for an acceptable level of periodontal health even in patients controlled each 4 and 6 months. Positive correlations between controls in each index are indicative for that. Age seemingly do not have influence like etiological factor of recurrence inflammation. High correlation between plaque index and gingival index was found in every control mainly in the groups controlled each 4 and 6 months.

  9. Budesonide/formoterol maintenance and reliever therapy in adolescent patients with asthma

    DEFF Research Database (Denmark)

    Jorup, Carin; Lythgoe, Dan; Bisgaard, Hans

    2018-01-01

    Asthma control is often suboptimal in adolescents, but few studies have evaluated asthma treatments in this population.This post hoc analysis assessed the efficacy and safety of budesonide/formoterol (BUD/FORM) maintenance and reliever therapy (MART) for treatment of persistent asthma in adolescent...... (age 12-17 years) subgroups within six randomised, double-blind trials. The primary end-point was time to first severe exacerbation. Secondary end-points included number of severe exacerbations, asthma-related symptoms, night-time awakenings, morning peak expiratory flow, forced expiratory volume in 1...... s, as-needed medication use and five-item asthma control questionnaire scores.In adolescents (n=1847), BUD/FORM MART was similar to or more effective than comparators across each of the studies in reducing the risk of a first severe exacerbation (hazard ratios (HR) BUD/FORM MART versus comparators 0...

  10. Does body image influence the relationship between body weight and breastfeeding maintenance in new mothers?

    Science.gov (United States)

    Swanson, Vivien; Keely, Alice; Denison, Fiona C

    2017-09-01

    been studied in relation to breastfeeding maintenance. What does this study add This article examines the influence of body image on obese and healthy-weight women's breastfeeding maintenance at 6-8 weeks. Different aspects of body image mediated but did not moderate the relationship between weight status and breastfeeding maintenance, but in multivariate regression, maternal education level was the most significant predictor. Obese women had poorer body image and were less likely to maintain breastfeeding; however, for all women, body image became more negative in this postpartum period. Interventions should normalize positive aspects of women's postnatal bodies, including function rather than form. Addressing body concerns could encourage new mothers to maintain breastfeeding, irrespective of weight status. © 2017 The British Psychological Society.

  11. Population-Level Density Dependence Influences the Origin and Maintenance of Parental Care.

    Directory of Open Access Journals (Sweden)

    Elijah Reyes

    Full Text Available Parental care is a defining feature of animal breeding systems. We now know that both basic life-history characteristics and ecological factors influence the evolution of care. However, relatively little is known about how these factors interact to influence the origin and maintenance of care. Here, we expand upon previous work and explore the relationship between basic life-history characteristics (stage-specific rates of mortality and maturation and the fitness benefits associated with the origin and the maintenance of parental care for two broad ecological scenarios: the scenario in which egg survival is density dependent and the case in which adult survival is density dependent. Our findings suggest that high offspring need is likely critical in driving the origin, but not the maintenance, of parental care regardless of whether density dependence acts on egg or adult survival. In general, parental care is more likely to result in greater fitness benefits when baseline adult mortality is low if 1 egg survival is density dependent or 2 adult mortality is density dependent and mutant density is relatively high. When density dependence acts on egg mortality, low rates of egg maturation and high egg densities are less likely to lead to strong fitness benefits of care. However, when density dependence acts on adult mortality, high levels of egg maturation and increasing adult densities are less likely to maintain care. Juvenile survival has relatively little, if any, effect on the origin and maintenance of egg-only care. More generally, our results suggest that the evolution of parental care will be influenced by an organism's entire life history characteristics, the stage at which density dependence acts, and whether care is originating or being maintained.

  12. Population-Level Density Dependence Influences the Origin and Maintenance of Parental Care.

    Science.gov (United States)

    Reyes, Elijah; Thrasher, Patsy; Bonsall, Michael B; Klug, Hope

    2016-01-01

    Parental care is a defining feature of animal breeding systems. We now know that both basic life-history characteristics and ecological factors influence the evolution of care. However, relatively little is known about how these factors interact to influence the origin and maintenance of care. Here, we expand upon previous work and explore the relationship between basic life-history characteristics (stage-specific rates of mortality and maturation) and the fitness benefits associated with the origin and the maintenance of parental care for two broad ecological scenarios: the scenario in which egg survival is density dependent and the case in which adult survival is density dependent. Our findings suggest that high offspring need is likely critical in driving the origin, but not the maintenance, of parental care regardless of whether density dependence acts on egg or adult survival. In general, parental care is more likely to result in greater fitness benefits when baseline adult mortality is low if 1) egg survival is density dependent or 2) adult mortality is density dependent and mutant density is relatively high. When density dependence acts on egg mortality, low rates of egg maturation and high egg densities are less likely to lead to strong fitness benefits of care. However, when density dependence acts on adult mortality, high levels of egg maturation and increasing adult densities are less likely to maintain care. Juvenile survival has relatively little, if any, effect on the origin and maintenance of egg-only care. More generally, our results suggest that the evolution of parental care will be influenced by an organism's entire life history characteristics, the stage at which density dependence acts, and whether care is originating or being maintained.

  13. Organizational Culture Influence On Total Productive Maintenance (TPM and Operational Performance Using RASCH Model Analysis

    Directory of Open Access Journals (Sweden)

    Mohd Norhasni Mohd Asaad

    2014-02-01

    Full Text Available Abstract. Market globalization, competitive product and services, high economic crises are the most critical factors that influence the success of the manufacturing companies in global market. Therefore it is critical to the manufacturing companies to be efficient in production and lean tool may used to achieve that.  The most frequently used is the Total Preventive Maintenance (TPM, even though there are many studies have been conducted in relation to the TPM but there is limited research in investigating the effects of the TPM on operational performance. However, the result of the studies was not consistent, where TPM practice may have positive and negative impact on operational performance. Among the reason is the culture of the organization that influenced the implementation of TPM and operational performance. Due to that this study attempts to investigate the influence of organizational culture on the TPM implementation and operational performance.  Rasch model is used in this study due to its ability in interpreting and analyzing the ability of respondents in performing the difficult items. The online questionnaires were distributed to 63 randomly selected automotive companies located at Northern Region of Malaysia.  Results of the study revealed that the organizational culture has influenced on the successful implementation of TPM and operational performance. Therefore by the implementation of TPM in outstanding organizational culture can improve operational performance.   Keyword: Total Preventive Maintenance (TPM, Lean manufacturing, Operational performance, Organizational culture, Rasch modeldoi:10.12695/ajtm.2013.6.2.2How to cite this article:Mohd Asaad, M.N and Yusoff, R.Z. (2013. Organizational Culture Influence On Total Productive Maintenance (TPM and Operational Performance Using RASCH Model Analysis . The Asian Journal of Technology Management 6 (2: 72-81. Print ISSN: 1978-6956; Online ISSN: 2089-791X.  doi:10.12695/ajtm

  14. Interferon alpha 2 maintenance therapy may enable high rates of treatment discontinuation in chronic myeloid leukemia.

    Science.gov (United States)

    Burchert, A; Saussele, S; Eigendorff, E; Müller, M C; Sohlbach, K; Inselmann, S; Schütz, C; Metzelder, S K; Ziermann, J; Kostrewa, P; Hoffmann, J; Hehlmann, R; Neubauer, A; Hochhaus, A

    2015-06-01

    A minority of chronic myeloid leukemia (CML) patients is capable of successfully discontinuing imatinib. Treatment modalities to increase this proportion are currently unknown. Here, we assessed the role of interferon alpha 2a (IFN) on therapy discontinuation in a previously reported cohort of 20 chronic phase CML patients who were treated upfront with IFN alpha plus imatinib followed by IFN monotherapy to maintain cytogenetic or molecular remission (MR) after imatinib discontinuation. After a median follow-up of 7.9 years (range, 5.2-12.2), relapse-free survival was 73% (8/11 patients) and 84% (5/6 patients) for patients who discontinued imatinib in major MR (MMR) and MR4/MR4.5, respectively. Ten patients discontinued IFN after a median of 4.5 years (range, 0.24-9.3). After a median of 2.8 years (range, 0.7-5.1), nine of them remain in ongoing treatment-free remission with MR5 (n=6) and MR4.5 (n=3). The four patients who still administer IFN are in stable MR5, MR4.5, MR4, and MMR, respectively. In conclusion, an IFN/imatinib induction treatment followed by a temporary IFN maintenance therapy may enable a high rate of treatment discontinuation in CML patients in at least MMR when stopping imatinib.

  15. Using adaptive model predictive control to customize maintenance therapy chemotherapeutic dosing for childhood acute lymphoblastic leukemia.

    Science.gov (United States)

    Noble, Sarah L; Sherer, Eric; Hannemann, Robert E; Ramkrishna, Doraiswami; Vik, Terry; Rundell, Ann E

    2010-06-07

    Acute lymphoblastic leukemia (ALL) is a common childhood cancer in which nearly one-quarter of patients experience a disease relapse. However, it has been shown that individualizing therapy for childhood ALL patients by adjusting doses based on the blood concentration of active drug metabolite could significantly improve treatment outcome. An adaptive model predictive control (MPC) strategy is presented in which maintenance therapy for childhood ALL is personalized using routine patient measurements of red blood cell mean corpuscular volume as a surrogate for the active drug metabolite concentration. A clinically relevant mathematical model is developed and used to describe the patient response to the chemotherapeutic drug 6-mercaptopurine, with some model parameters being patient-specific. During the course of treatment, the patient-specific parameters are adaptively identified using recurrent complete blood count measurements, which sufficiently constrain the patient parameter uncertainty to support customized adjustments of the drug dose. While this work represents only a first step toward a quantitative tool for clinical use, the simulated treatment results indicate that the proposed mathematical model and adaptive MPC approach could serve as valuable resources to the oncologist toward creating a personalized treatment strategy that is both safe and effective. Copyright (c) 2010 Elsevier Ltd. All rights reserved.

  16. Gene-guided Gefitinib switch maintenance therapy for patients with advanced EGFR mutation-positive Non-small cell lung cancer: an economic analysis

    International Nuclear Information System (INIS)

    Zhu, Jun; Li, Te; Wang, Xiaohui; Ye, Ming; Cai, Jian; Xu, Yuejuan; Wu, Bin

    2013-01-01

    Maintenance therapy with gefitinib notably improves survival in patients with advanced non-small cell lung cancer (NSCLC) and EGFR mutation-positive tumors, but the economic impact of this practice is unclear. A decision-analytic model was developed to simulate 21-day patient transitions in a 10-year time horizon. The clinical data were primarily obtained from the results of a pivotal phase III trial that assessed gefitinib maintenance treatment in patients with advanced NSCLC. The cost data were derived from the perspective of the Chinese health care system. The primary outcome was the incremental cost-effectiveness ratio (ICER) at a willingness-to-pay (WTP) threshold of 3 times the per capita GDP of China. Sensitivity analyses were used to explore the impact of uncertainty regarding the results. The impact of the gefitinib patient assistance program (GPAP) was evaluated. After EGFR genotyping, gefitinib maintenance treatment for advanced NSCLC with EGFR mutations increased the life expectancy by 0.74 years and 0.46 QALYs compared with routine follow-up at an additional cost of $26,149.90 USD ($7,178.20 with the GPAP). The ICER for gefitinib maintenance was $57,066.40 and $15,664.80 per QALY gained (at a 3% discount rate) without and with the GPAP, respectively. The utility of progression free survival, the hazard ratio of progression-free survival for gefitinib treatment and the cost of gefitinib per dose were the three factors that had the greatest influence on the results. These results indicate that gene-guided maintenance therapy with gefitinib with the GPAP might be a cost-effective treatment option

  17. Gene-guided Gefitinib switch maintenance therapy for patients with advanced EGFR mutation-positive Non-small cell lung cancer: an economic analysis

    Directory of Open Access Journals (Sweden)

    Zhu Jun

    2013-01-01

    Full Text Available Abstract Background Maintenance therapy with gefitinib notably improves survival in patients with advanced non-small cell lung cancer (NSCLC and EGFR mutation-positive tumors, but the economic impact of this practice is unclear. Methods A decision-analytic model was developed to simulate 21-day patient transitions in a 10-year time horizon. The clinical data were primarily obtained from the results of a pivotal phase III trial that assessed gefitinib maintenance treatment in patients with advanced NSCLC. The cost data were derived from the perspective of the Chinese health care system. The primary outcome was the incremental cost-effectiveness ratio (ICER at a willingness-to-pay (WTP threshold of 3 times the per capita GDP of China. Sensitivity analyses were used to explore the impact of uncertainty regarding the results. The impact of the gefitinib patient assistance program (GPAP was evaluated. Results After EGFR genotyping, gefitinib maintenance treatment for advanced NSCLC with EGFR mutations increased the life expectancy by 0.74 years and 0.46 QALYs compared with routine follow-up at an additional cost of $26,149.90 USD ($7,178.20 with the GPAP. The ICER for gefitinib maintenance was $57,066.40 and $15,664.80 per QALY gained (at a 3% discount rate without and with the GPAP, respectively. The utility of progression free survival, the hazard ratio of progression-free survival for gefitinib treatment and the cost of gefitinib per dose were the three factors that had the greatest influence on the results. Conclusions These results indicate that gene-guided maintenance therapy with gefitinib with the GPAP might be a cost-effective treatment option.

  18. Maintenance or non-maintenance therapy in the treatment of advanced non-small cell lung cancer: that is the question.

    Science.gov (United States)

    Galetta, D; Rossi, A; Pisconti, S; Millaku, A; Colucci, G

    2010-11-01

    Lung cancer is the most common cancer worldwide with non-small cell lung cancer (NSCLC), including squamous carcinoma, adenocarcinoma and large cell carcinoma, accounting for about 85% of all lung cancer types with most of the patients presenting with advanced disease at the time of diagnosis. In this setting first-line platinum-based chemotherapy for no more than 4-6 cycles are recommended. After these cycles of treatment, non-progressing patients enter in the so called "watch and wait" period in which no further therapy is administered until there is disease progression. In order to improve the advanced NSCLC outcomes, the efficacy of further treatment in the "watch and wait" period was investigated. This is the "maintenance therapy". Recently, the results coming from randomized phase III trials investigating two new agents, pemetrexed and erlotinib, in this setting led to their registration for maintenance therapy. Here, we report and discuss these results. Copyright © 2010 Elsevier Ltd. All rights reserved.

  19. Budesonide/formoterol maintenance and reliever therapy in primary care asthma management : effects on bronchial hyperresponsiveness and asthma control

    NARCIS (Netherlands)

    Riemersma, Roland A.; Postma, Dirkje; van der Molen, Thys

    Background: The management of asthma has changed since the introduction of budesonide/formoterol (Symbicort (R)) as both maintenance and reliever therapy (SMART). SMART and its effects on bronchial hyperresponsiveness (BHR) have not been studied in primary care. Aims: To compare the effects of SMART

  20. Improvement of quality of life following 6 months of methadone maintenance therapy in Malaysia.

    Science.gov (United States)

    Baharom, Nizam; Hassan, Mohd Rohaizat; Ali, Norsiah; Shah, Shamsul Azhar

    2012-08-01

    Methadone Maintenance Therapy (MMT) is one of the popular choices for drug substitution therapy and is fairly new in Malaysia. Aside from its role in harm reduction against HIV infection, MMT programme may potentially enhances clients' quality of life. This study aims to identify the impact of MMT programme on clients' quality of life after 6 months in treatment and to explore factors that may be associated with changes in their quality of life. In this retrospective report review, 122 subjects from 2 government MMT clinics were selected from the district of Tampin, Negeri Sembilan, Malaysia. The raw score from the WHO Quality of Life questionnaire (WHOQOL-BREF), at baseline and 6 months after therapy were collected and converted to 0-100 scale form to give quality of life scores for four domains; physical, psychological, social relationships and environment. Other variables of interest were socio-demography, age when joining MMT programme, age and duration of illicit drug use, HIV and Hepatitis C status, and the Opiate Treatment Index (OTI) score on drug use, sexual and social aspect at the baseline. Statistical analysis used the SPSS version 16. There was significant improvement in all four domains of quality of life, after 6 months of MMT. The largest improvement was for psychological domain (mean score difference 15.54 ± 20.81). Multivariable linear regression analysis showed that, for the physical domain, there was no significant predictor. For both the psychological and social domains, having tertiary education is a significant predictor for improvement in both aspects of quality of life. Negative HIV status is associated with improvement for the environment domain. There was a significant short term improvement in the quality of life of MMT clients who stayed in the programme for at least 6 months in the district of Tampin, Negeri Sembilan, Malaysia.

  1. Effect of Maintenance Therapy with Isoxsuprine in the Prevention of Preterm Labor: Randomized controlled trial

    Science.gov (United States)

    Alavi, Azin; Rajaee, Minoo; Amirian, Malihe; Mahboobi, Hamidreza; Jahanshahi, Keramat Allah; Faghihi, Armaghan

    2015-01-01

    Background: Isoxsuprine (Vasodilan) is a beta-adrenergic that directly affects the vascular smooth muscle and results in peripheral vascular dilation. Isoxsuprine relaxes the uterine smooth muscles and is used for treatment of pre-term labor and dysmenorrhea. Isoxsuprine is used extensively in hospitals and private clinics in Iran; however, few studies have reported its safety and efficacy in the prevention of pre-term labor. Objective: The aim of this study was to assess the effect of maintenance therapy with oral isoxsuprine for the prevention of pre-term labor. Methods: We undertook a blinded prospective randomized trial of 70 women with singleton pregnancies who presented in pre-term labor between 26 to 34 weeks of gestation. After arresting the contractions with intravenous magnesium sulfate, the patients were randomized into two groups, with the treatment group receiving oral isoxsuprine until 34 weeks of gestation. Response to treatment was assessed by the progression of the pregnancies in both groups. The data were analyzed using SPSS software. Results: Our results showed that 14 (40%) of the patients in the case group and 12 (34.29%) of patients in the control group had pre-term births, and there was no significant difference between the two groups (P=0.621). Also four women (11.43%) in the case group and five women (14.29%) in the control group delivered before 34 weeks (P=0.721). Conclusion: Oral isoxsuprine was not effective as a maintenance treatment in preventing pre-term births or in delaying delivery until after 34 weeks. Larger studies are needed to identify the best treatment for pre-term labor. PMID:26396726

  2. Maintenance Electroconvulsive Therapy in Severe Bipolar Disorder: A Retrospective Chart Review.

    Science.gov (United States)

    Santos Pina, Laura; Bouckaert, Filip; Obbels, Jasmien; Wampers, Martien; Simons, Wim; Wyckaert, Sabien; Sienaert, Pascal

    2016-03-01

    The aim of this study was to evaluate the effectiveness of continuation and maintenance electroconvulsive therapy (C/M-ECT) in patients with bipolar or schizoaffective disorder. We reviewed the charts of all patients diagnosed with a bipolar or schizoaffective disorder treated with C/M-ECT from August 2009 until December 2013. We gathered demographic data and treatment variables (electrode placement, stimulus dose, and concomitant use of medication; number of C/M-ECT sessions; and number of new ECT courses). Primary outcome measure was the number of hospitalization days during C/M-ECT as compared with an equal period before starting the index course. Twenty women (64.5%) and 11 men (35.5%) with a Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition bipolar disorder (n = 22, 71%) or schizoaffective disorder (n = 9, 29%) received C/M-ECT. The mean (SD) age was 51.23 (14.86; range, 28-74) years. Before the start of the index ECT, patients had a mean of 290 hospitalization days (248.4 days, full hospitalization; 41.6 days, partial hospitalization), whereas during C/M-ECT, they had a mean of 214.7 hospitalization days (85.4 days, full hospitalization; 129.3 days, partial hospitalization). The number of readmissions before ECT was 2.13, whereas during C/M-ECT, it decreased to 1.48. Only the decrease in number of full hospitalization days was significant. Most patients (n = 23, 74.19%) needed an acute course of ECT during M-ECT. Maintenance ECT seems to significantly reduce the number of full hospitalization days in patients with severe bipolar or schizoaffective disorder.

  3. Estimation of dynamic treatment strategies for maintenance therapy of children with acute lymphoblastic leukaemia: an application of history-adjusted marginal structural models

    DEFF Research Database (Denmark)

    Rosthøj, Susanne; Keiding, Niels; Schmiegelow, Kjeld

    2012-01-01

    Childhood acute lymphoblastic leukaemia is treated with long-term intensive chemotherapy. During the latter part of the treatment, the maintenance therapy, the patients receive oral doses of two cytostatics. The doses are tailored to blood counts measured on a weekly basis, and the treatment is t...... of the methods in relation to the formulation of alternative dosing strategies for the maintenance therapy....

  4. Sustained Complete Response after Maintenance Therapy with Topotecan and Erlotinib for Recurrent Cervical Cancer with Distant Metastases

    Directory of Open Access Journals (Sweden)

    Donato Callegaro-Filho

    2014-01-01

    Full Text Available Introduction: Recurrent cervical cancer is associated with a poor prognosis. Most treatment responses are partial and of short duration. The development of new therapies is vital to improve treatment for recurrent disease. Epidermal growth factor receptor (EGFR inhibitors may have a role in this setting. Case Description: A 53-year-old woman with stage IB2 squamous cell carcinoma of the cervix was initially treated with chemoradiation. Six months after completing treatment, she developed a recurrence in the common iliac and para-aortic lymph nodes above the previous radiation field and was treated with additional radiation therapy. Two years later, she developed recurrent disease in the left supraclavicular lymph nodes and was treated with chemoradiation followed by 3 cycles of adjuvant cisplatin and topotecan. She had a complete response and was placed on maintenance therapy with topotecan and erlotinib, which was well tolerated and produced minimal side effects. After 20 months of maintenance therapy, it was discontinued given the long interval without evidence of disease. The patient is currently without evidence of disease 5 years after completing the topotecan-erlotinib treatment. Conclusion: We noted a sustained response in a patient with recurrent metastatic cervical cancer treated with radiotherapy, cisplatin, and topotecan followed by maintenance therapy with topotecan and erlotinib. Further evaluation of the role of EGFR inhibitors in this setting should be considered given their favorable toxicity profile and biological relevance.

  5. Opioid maintenance therapy in Switzerland: an overview of the Swiss IMPROVE study.

    Science.gov (United States)

    Besson, J; Beck, T; Wiesbeck, G; Hämmig, R; Kuntz, A; Abid, S; Stohler, R

    2014-01-01

    Switzerland's drug policy model has always been unique and progressive, but there is a need to reassess this system in a rapidly changing world. The IMPROVE study was conducted to gain understanding of the attitudes and beliefs towards opioid maintenance therapy (OMT) in Switzerland with regards to quality and access to treatment. To obtain a "real-world" view on OMT, the study approached its goals from two different angles: from the perspectives of the OMT patients and of the physicians who treat patients with maintenance therapy. The IMPROVE study collected a large body of data on OMT in Switzerland. This paper presents a small subset of the dataset, focusing on the research design and methodology, the profile of the participants and the responses to several key questions addressed by the questionnaires. IMPROVE was an observational, questionnaire-based cross-sectional study on OMT conducted in Switzerland. Respondents consisted of OMT patients and treating physicians from various regions of the country. Data were collected using questionnaires in German and French. Physicians were interviewed by phone with a computer-based questionnaire. Patients self-completed a paper-based questionnaire at the physicians' offices or OMT treatment centres. A total of 200 physicians and 207 patients participated in the study. Liquid methadone and methadone tablets or capsules were the medications most commonly prescribed by physicians (60% and 20% of patient load, respectively) whereas buprenorphine use was less frequent. Patients (88%) and physicians (83%) were generally satisfied with the OMT currently offered. The current political framework and lack of training or information were cited as determining factors that deter physicians from engaging in OMT. About 31% of OMT physicians interviewed were ≥60 years old, indicating an ageing population. Diversion and misuse were considered a significant problem in Switzerland by 45% of the physicians. The subset of IMPROVE data

  6. Long-Term Efficacy of Maintenance Therapy for Multiple Myeloma: A Quantitative Synthesis of 22 Randomized Controlled Trials

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    Jie-Li Li

    2018-04-01

    Full Text Available We aimed to quantitatively synthesize data from randomized controlled trials (RCTs concerning maintenance for multiple myeloma (MM. We searched electronic literature databases and conference proceedings to identify relevant RCTs. We selected eligible RCTs using predefined selection criteria. We conducted meta-analysis comparing maintenance containing new agents and conventional maintenance, and subgroup analysis by transplantation status and mainstay agent as well. We performed trial sequential analysis (TSA to determine adequacy of sample size for overall and subgroup meta-analyses. We performed network meta-analysis (NMA to compare and rank included regimens. A total of 22 RCTs involving 9,968 MM patients and 15 regimens were included, the overall quality of which was adequate. Significant heterogeneity was detected for progression-free survival (PFS but not overall survival (OS. Meta-analyses showed that maintenance containing new agents significantly improved PFS but not OS [PFS: Hazard Ratio (HR = 0.59, 95% Confidence Interval (CI = 0.54 to 0.64; OS: HR = 0.93, 95% CI = 0.87 to 1.00], compared with controls. Subgroup analyses revealed lenalidomide (Len-based therapies better than thalidomide-based ones (HR = 0.50 and 0.66, respectively; P = 0.001. NMA revealed that most of the maintenance regimens containing new agents were significantly better than simple observation in terms of PFS but not OS. Len single agent was the most effective, considering PFS and OS both. We concluded that conventional maintenance has very limited effect. Maintenance containing new agents is highly effective in improving PFS, but has very limited effect on OS. Maintenance with Len may have the largest survival benefits. Emerging strategies may further change the landscape of maintenance of MM.

  7. Competitive Position of Dependent Passenger Car Maintenance Companies – Influences, Developments and Challenges in the German Market

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    Werdich Karl

    2015-06-01

    Full Text Available The presented paper concerns itself with passenger car maintenance companies and their competitiveness. Internal and external influences, change drivers and general changes in the companies and their organisation were identified and analysed. The influence of the development of technology and the diffusion of innovations are highlighted in particular. Under consideration of the competitiveness factors, current and future challenges for the passenger car maintenance companies were worked out. Based on these analyses, future tasks, problem statements and challenges were compiled for passenger car maintenance companies from which other subjects of scientific investigation in area of strategic and economic importance arose.

  8. Effect of compliance during periodontal maintenance therapy on levels of bacteria associated with periodontitis: A 6-year prospective study.

    Science.gov (United States)

    Costa, Fernando Oliveira; Vieira, Thaís Riberal; Cortelli, Sheila Cavalca; Cota, Luís Otávio Miranda; Costa, José Eustáquio; Aguiar, Maria Cássia Ferreira; Cortelli, José Roberto

    2018-05-01

    It is well established that regular compliance during periodontal maintenance therapy (PMT) maintains the stability of periodontal clinical parameters obtained after active periodontal therapy (APT). However, compliance during PMT has not yet been related to subgingival bacterial levels. Thus, this study followed individuals in PMT over 6 years and longitudinally evaluated the effects of compliance on periodontitis-associated bacterial levels and its relation to periodontal status. From a 6-year prospective cohort study with 212 individuals in PMT, 91 were determined to be eligible. From this total, 28 regular compliers (RC) were randomly selected and matched for age and sex with 28 irregular compliers (IC). Complete periodontal examination and microbiological samples were obtained 5 times: T1 (prior to APT), T2 (after APT), T3 (2 years), T4 (4 years), and T5 (6 years). Total bacteria counts and levels of Actinomyces naeslundii, Porphyromonas gingivalis, Tannerella forsythia, and Treponema denticola were evaluated through quantitative polymerase chain reaction. RC had less tooth loss and better clinical and microbiological conditions over time when compared with IC. IC had higher total bacterial counts and higher levels of T. denticola. Moreover, among IC, total bacterial counts were positively associated with plaque index and bleeding on probing, while levels of A. naeslundii, T. forsythia, and T. denticola were negatively associated with clinical attachment loss (4 to 5 mm) among RC. Compliance positively influenced subgingival microbiota and contributed to stability of periodontal clinical status. Regular visits during PMT sustained microbiological benefits provided by APT over a 6-year period. © 2018 American Academy of Periodontology.

  9. The influence of stakeholder groups in operation and maintenance services of offshore wind farms

    DEFF Research Database (Denmark)

    Ahsan, Dewan; Pedersen, Søren

    2018-01-01

    One of the prime challenges in offshore wind is to manage and coordinate with the various stakeholders involved in the operation and maintenance (O&M) phase. Therefore the aims of this paper are: i) to map the stakeholder groups involved in O&M of Offshore Wind Farm (OWF), ii) to assess...... the identified stakeholder group's interest and power to influence O&M, iii) to evaluate the relationship between different stakeholder groups and iv) to highlight potential strategies to manage the stakeholder groups. In this article, the stakeholder analysis approach is used. The results reveal that eleven key...

  10. Homeopathy and Isopathy in the periodontal maintenance therapy of aggressive periodontitis patients - doi:10.5020/18061230.2007.p243

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    Edivaldo Barbosa da Silva

    2012-01-01

    Full Text Available Periodontal maintenance care is an essential part of periodontal therapy for patients diagnosed with Aggressive Periodontitis, being, however, hard to instruct and to motivate these patients to follow a careful and effective program of maintenance for all their lives. A literature review was done, by means of relevant papers published on the last four decades, pointing out the importance of individual susceptibility for the appearance of aggressive periodontitis and to discuss the importance of a maintenance therapy on its treatment, applying Homeopathy and Isopathy. Homeopathy consists on a complex therapeutic system mainly based on the “Law of Similarity”, that is, the illness may be healed by drugs that produce similar symptoms in a healthy organism and, in this conception, the disease is understood as an energetic unbalance, in which internal and external factors acting on the subject’s susceptibility are considered and can be expressed by an individual symptomathology that goes from the rational sphere to the somatic sphere. On the other hand, Isopathy is the method of treatment with therapeutic agent, which actions on a healthy subject consist on pharmacodynamic manifestations similar to those observed in a sick person. Based on these concepts, the authors establish a hypothesis of the effectiveness of Homeopathy and Isopathy, the latter through auto-medications or auto-biotherapies, that are products which the active principal is obtained from the patient himself (gingival tissue and secretions, and that may be used as auxiliary treatments in the maintenance therapy of Aggressive Periodontitis.

  11. Maintenance Therapy in Ovarian Cancer with Targeted Agents Improves PFS and OS: A Systematic Review and Meta-Analysis.

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    Xinyu Qian

    Full Text Available Maintenance therapy with targeted agents for prolonging remission for ovarian cancer patients remains controversial. As a result, a meta-analysis was conducted to assess the effectiveness and safety of using maintenance therapy with targeted agents for the treatment of ovarian cancer.From inception to January 2015, we searched for randomized, controlled trials (RCTs using the following databases: PubMed, ScienceDirect, the Cochrane Library, Clinicaltrials.gov and EBSCO. Eligible trials included RCTs that evaluated standard chemotherapy which was either followed or not followed by targeted maintenance in patients with ovarian cancer who had been previously receiving adjunctive treatments, such as cytoreductive surgery and standard chemotherapy. The outcome measures included progression-free survival (PFS, overall survival (OS and incidence of adverse events.A total of 13 RCTs, which were published between 2006 and 2014, were found to be in accordance with our inclusion criteria. The primary meta-analysis indicated that both PFS and OS were statistically and significantly improved in the targeted maintenance therapy group as compared to the control group (PFS: HR = 0.84, 95%CI: 0.75 to 0.95, p = 0.001; OS: HR = 0.91, 95%CI: 0.84 to 0.98, p = 0.02. When taking safety into consideration, the use of targeted agents was significantly correlated with increased risks of fatigue, diarrhea, nausea, vomiting, and hypertension. However, no significant differences were found in incidence rates of abdominal pain, constipation or joint pain.Our results indicate that targeted maintenance therapy clearly improves the survival of ovarian cancer patients but may also increase the incidence of adverse events. Additional randomized, double-blind, placebo-controlled, multicenter investigations will be required on a larger cohort of patients to verify our findings.

  12. Influence of radiation therapy on T-lymphocyte subpopulations

    International Nuclear Information System (INIS)

    Job, G.

    1984-01-01

    The author claims this to be the first time where monoclonal antibodies are used in a long-term study in order to determine the influence of radiation therapy on T-lymphozyte-subpopulations in patients suffering from malignant growths. The influence of radiation therapy on B-cells, T-cells and macrophages was also checked. Two groups of patients were given two different radiation doses, and examined separately in order to discover possible effects of the dosage. Radiation therapy reduced B- and T-lymphocytes to the same degree as the total lymphozyte population so that their shares in percent remained unchanged. The same was also found for macrophages. Determination of clones and suppressor T-lymphozytes before, during and after radiation showed T-lymphozytes to have a higher resistance against the influence of radiation than clones. Suppressor cells also regenerated more quickly than clones after the end of the therapy. While radiation therapy was applied the clone/suppressor cell ratio dropped to values lower than those of the healthy reference group. After the end of the therapy this quotient dropped even further in some cases while in others it began to rise slowly, but even 6 months after the end of the therapy it was still lower than normal. As a number of diseases show an increased 'immunoregulatory quotient' it would be conceivable to influence this quotient with radiation therapy in order to achieve a therapeutic effect. (orig./MG) [de

  13. Comparison of the effect of Olanzapine and Sertraline on patients suffering from personality disorder, receiving methadone maintenance therapy

    Directory of Open Access Journals (Sweden)

    mozhgan Jariani

    2009-03-01

    Full Text Available Background: Borderline Personality disorder is a disabling disease affecting 2% of general population. Various drugs have been suggested for treatment of borderline Personality disorder. If a drug could alleviate a wide range of symptoms, it would be more suitable. In these disorders drug addiction is very common. This fact makes the symptoms complicated and the treatment more difficult. This study is designed to evaluate the effect of Olanzapine and Sertraline in patients suffering from personality disorders who are on methadone maintenance therapy. Materials and Methods: This clinical trial study was carried out on 120 male and female cases chosen for methadone maintenance therapy through interview by a psychiatrist based on DSM-IV-TR diagnostic criteria for BPD. Afterwards they were randomly divided into two groups. These groups separately received Olanzapine (5-10 mg daily and Sertraline (50-100 mg daily therapy. The SCL-90 questionnaire was filled out by the participants before treatment and at the 4th, 8th and 12th weeks of the treatment. Results: According to this clinical trial, Olanzapine and Sertraline were effective in ameliorating symptoms of depression, anxiety and aggression, reducing sensitivity in interpersonal relationship and alleviating obsessive symptoms, pessimistic behaviors and somatization disorders in patients with personality disorders on methadone maintenance therapy. Conclusion: As results of this study stated that Olanzapine and Sertraline are definitely effective in alleviating symptoms of patients with personality disorder, prescribing theses drugs are highly recommended for these patients. .

  14. Randomized Phase II trial of paclitaxel and carboplatin followed by gemcitabine switch-maintenance therapy versus gemcitabine and carboplatin followed by gemcitabine continuation-maintenance therapy in previously untreated advanced non-small cell lung cancer

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    Minami Seigo

    2013-01-01

    Full Text Available Abstract Background In recent years, maintenance chemotherapy is increasingly being recognized as a new treatment strategy to improve the outcome of advanced non-small cell lung cancer (NSCLC. However, the optimal maintenance strategy is still controversial. Gemcitabine is a promising candidate for single-agent maintenance therapy because of little toxicity and good tolerability. We have conducted a randomized phase II study to evaluate the validity of single-agent maintenance chemotherapy of gemcitabine and to compare continuation- and switch-maintenance. Methods Chemonaïve patients with stage IIIB/IV NSCLC were randomly assigned 1:1 to either arm A or B. Patients received paclitaxel (200 mg/m2, day 1 plus carboplatin (AUC 6 mg/mL/min, day 1 every 3 weeks in arm A, or gemcitabine (1000 mg/m2, days 1 and 8 plus carboplatin (AUC 5 mg/mL/min, day1 every 3 weeks in arm B. Non-progressive patients following 3 cycles of induction chemotherapy received maintenance gemcitabine (1000 mg/m2, days 1 and 8 every 3 weeks. (Trial registration: UMIN000008252 Results The study was stopped because of delayed accrual at interim analysis. Of the randomly assigned 50 patients, 49 except for one in arm B were evaluable. Median progression-free survival (PFS was 4.6 months for arm A vs. 3.5 months for arm B (HR = 1.03; 95% CI, 0.45–2.27; p = 0.95 and median overall survival (OS was 15.0 months for arm A vs. 14.8 months for arm B (HR = 0.79; 95% CI, 0.40–1.51; p = 0.60, showing no difference between the two arms. The response rate, disease control rate, and the transit rate to maintenance phase were 36.0% (9/25, 64.0% (16/25, and 48% (12/25 for arm A vs. 16.7% (4/24, 50.0% (12/24, and 33% (8/24 for arm B, which were also statistically similar between the two arms (p = 0.13, p = 0.32, and p = 0.30, respectively. Both induction regimens were tolerable, except that more patients experienced peripheral neuropathy in arm A. Toxicities during

  15. Maintenance therapy with second generation antipsychotics for bipolar disorder - A systematic review and meta-analysis.

    Science.gov (United States)

    Lindström, Leif; Lindström, Eva; Nilsson, Mikael; Höistad, Malin

    2017-04-15

    Second generations antipsychotics (SGA) are frequently used for maintenance treatment in bipolar disorder. We systematically reviewed the efficacy and long-term effects of treatment with SGA, regardless of treatment strategy (SGA administered either as monotherapy or as adjunctive therapy), in comparison to placebo, lithium or valproate. Primary outcomes were relapses (mood episode recurrence) and discontinuation. Clinical studies were identified through database searching in PubMed, Embase, PsychInfo and Cochrane Library and critically appraised based on the Cochrane Handbook. Full data extraction of raw data was performed and analyzed with meta-analyses, and level of evidence graded using GRADE. Only randomized controlled studies (RCT) and observational studies were included, with a minimum follow-up of 6 months. Comparators used were restricted to placebo, lithium, valproate or other anti-epileptic drugs. We identified 15 RCTs on SGA in bipolar disorder with follow-up-time of 6 months up to 2 years, and one observational study reporting long-term effects of up to 4 years. A total of 6142 patients were included in the randomized trials. No long-term RCTs beyond 2 years follow-up was identified. All RCTs except for one included patients with bipolar disorder type I only. All RCTs except for two included patients pre-stabilized on the drug under investigation prior to randomization (enrichment design). For SGA as adjunctive therapy to lithium or valproate, meta-analyses showed that treatment with either aripiprazole (RR: 0.65, 95% CI 0.50-0.85), quetiapine (RR: 0.38, 95% CI 0.32-0.46) or ziprasidone (RR: 0.62, 95% CI 0.40-0.96) reduced the overall risk of relapses in patients that had responded during the stabilization phase. Adjunctive therapy with quetiapine was the only drug that reduced both manic and depressive episodes. For SGA as monotherapy, only quetiapine was shown to be better than lithium/ valproate for both manic and depressive relapses, but only for

  16. ADALIMUMAB FOR MAINTENANCE THERAPY FOR ONE YEAR IN CROHN?S DISEASE: results of a Latin American single-center observational study

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    Paulo Gustavo KOTZE

    2014-03-01

    Full Text Available Context Adalimumab is a fully-human antibody that inhibits TNF alpha, with a significant efficacy for long-term maintenance of remission. Studies with this agent in Latin American Crohn’s disease patients are scarce. Objectives The objective of this study was to outline clinical remission rates after 12 months of adalimumab therapy for Crohn’s disease patients. Methods Retrospective, single-center, observational study of a Brazilian case series of Crohn’s disease patients under adalimumab therapy. Variables analyzed: demographic data, Montreal classification, concomitant medication, remission rates after 1, 4, 6 and 12 months. Remission was defined as Harvey-Bradshaw Index ≤4, and non-responder-imputation and last-observation-carried-forward analysis were used. The influence of infliximab on remission rates was analyzed by Fischer and Chi-square tests (P<0.05. Results Fifty patients, with median age of 35 years at therapy initiation, were included. Remission rates after 12 months of therapy were 54% under non-responder-imputation and 88% under last-observation-carried-forward analysis. After 12 months, remission on patients with previous infliximab occurred in 69.23% as compared to 94.59% in infliximab-naïve patients (P = 0.033. Conclusions Adalimumab was effective in maintaining clinical remission after 12 months of therapy, with an adequate safety profile, and was also more effective in infliximab naïve patients.

  17. Long-Term Maintenance Therapy Using Rituximab-Induced Continuous B-Cell Depletion in Patients with ANCA Vasculitis

    Science.gov (United States)

    Pendergraft, William F.; Cortazar, Frank B.; Wenger, Julia; Murphy, Andrew P.; Rhee, Eugene P.; Laliberte, Karen A.; Niles, John L.

    2014-01-01

    Background and objectives Remission in the majority of ANCA vasculitis patients is not sustained after a single course of rituximab, and risk of relapse warrants development of a successful strategy to ensure durable remission. Design, setting, participants, & measurements A retrospective analysis of ANCA vasculitis patients who underwent maintenance therapy using rituximab-induced continuous B-cell depletion for up to 7 years was performed. Maintenance therapy with rituximab was initiated after achieving remission or converting from other prior maintenance therapy. Continuous B-cell depletion was achieved in all patients by scheduled rituximab administration every 4 months. Disease activity, serologic parameters, adverse events, and survival were examined. Results In the study, 172 patients (mean age=60 years, 55% women, 57% myeloperoxidase–ANCA) treated from April of 2006 to March of 2013 underwent continuous B-cell depletion with rituximab. Median remission maintenance follow-up time was 2.1 years. Complete remission (Birmingham Vasculitis Activity Score [BVAS]=0) was achieved in all patients. Major relapse (BVAS≥3) occurred in 5% of patients and was associated with weaning of other immunosuppression drugs. Remission was reinduced in all patients. Survival mirrored survival of a general age-, sex-, and ethnicity-matched United States population. Conclusion This analysis provides evidence for long-term disease control using continuous B-cell depletion. This treatment strategy in ANCA vasculitis patients also seems to result in survival rates comparable with rates in a matched reference population. These findings suggest that prospective remission maintenance treatment trials using continuous B-cell depletion are warranted. PMID:24626432

  18. Efficacy of Group Cognitive–behavioral Therapy in Maintenance Treatment and Relapse Prevention for Bipolar Adolescents

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    Soroor Arman

    2018-01-01

    Full Text Available Background: Despite conducting wide-ranging of pharmacotherapy for bipolar adolescents, many of them are showing a deficit in functioning with high relapse rate. The aim of the current study was to develop a manual and investigate the efficacy of group cognitive–behavioral therapy (G-CBT for female bipolar adolescents. Materials and Methods: During the first qualitative phase of a mixed-methods study, a manual of G-CBT was developed. Then, 32 female bipolar adolescents aged 12–19 years old, receiving usual maintenance medications (UMM, were selected. Participants were randomized to the control (UMM and intervention group (5, 2 h weekly sessions based on G-CBT manual with UMM. The parents in intervention group participated in three parallel sessions. All participants filled the following questionnaires before 1, 3, and 6 months after the initiation of the study: Young Mania Rating Scale, Children Depression Inventory and Global Assessment of Functioning. The results were analyzed using SPSS 21 software. The concurrent qualitative phase was analyzed through thematic analysis. Results: The results showed no significant differences in all questionnaires' scores through intervention and follow-up sessions (P > 0.05. However, using cutoff point of CDI, G-CBT was effective for intervention group (relapse rate: 25% vs. 44.4%. Two themes were extracted from the second qualitative phase: emotion recognition and emotion regulation, especially in anger control. Conclusions: The results showed that the addition of G-CBT to UMM leads to decrease in the depressive scores but has no effect on manic symptoms and relapse rate.

  19. Efficacy of Group Cognitive-behavioral Therapy in Maintenance Treatment and Relapse Prevention for Bipolar Adolescents.

    Science.gov (United States)

    Arman, Soroor; Golmohammadi, Farnaz; Maracy, Mohammadreza; Molaeinezhad, Mitra

    2018-01-01

    Despite conducting wide-ranging of pharmacotherapy for bipolar adolescents, many of them are showing a deficit in functioning with high relapse rate. The aim of the current study was to develop a manual and investigate the efficacy of group cognitive-behavioral therapy (G-CBT) for female bipolar adolescents. During the first qualitative phase of a mixed-methods study, a manual of G-CBT was developed. Then, 32 female bipolar adolescents aged 12-19 years old, receiving usual maintenance medications (UMM), were selected. Participants were randomized to the control (UMM) and intervention group (5, 2 h weekly sessions based on G-CBT manual with UMM). The parents in intervention group participated in three parallel sessions. All participants filled the following questionnaires before 1, 3, and 6 months after the initiation of the study: Young Mania Rating Scale, Children Depression Inventory and Global Assessment of Functioning. The results were analyzed using SPSS 21 software. The concurrent qualitative phase was analyzed through thematic analysis. The results showed no significant differences in all questionnaires' scores through intervention and follow-up sessions ( P > 0.05). However, using cutoff point of CDI, G-CBT was effective for intervention group (relapse rate: 25% vs. 44.4%). Two themes were extracted from the second qualitative phase: emotion recognition and emotion regulation, especially in anger control. The results showed that the addition of G-CBT to UMM leads to decrease in the depressive scores but has no effect on manic symptoms and relapse rate.

  20. Factors associated with interest in receiving prison-based methadone maintenance therapy in Malaysia.

    Science.gov (United States)

    Mukherjee, Trena I; Wickersham, Jeffrey A; Desai, Mayur M; Pillai, Veena; Kamarulzaman, Adeeba; Altice, Frederick L

    2016-07-01

    Methadone maintenance therapy (MMT) is crucial for HIV prevention and treatment in people who inject opioids. In Malaysia, a large proportion of the prison population is affected by both HIV and opioid use disorders. This study assessed individual preferences and factors associated with interest in receiving MMT among male prisoners meeting criteria for opioid dependence in Malaysia. A convenience sample of 96 HIV-positive and 104 HIV-negative incarcerated men who met pre-incarceration criteria for opioid dependence was interviewed using a structured questionnaire to examine participant characteristics and attitudes toward MMT. Factors associated with interest in prison-based MMT initiation were identified using logistic regression analysis. Among all participants, 85 (42.5%) were interested in receiving MMT within prison. Independent correlates of interest in prison-based MMT were being previously married (AOR=4.15, 95% CI: 1.15, 15.02), previously incarcerated (AOR=5.68, 95% CI: 1.54, 21.02), depression (AOR=3.66, 95% CI: 1.68, 7.98), daily heroin use in the 30days prior to incarceration (AOR=5.53, 95% CI: 1.65, 18.58), and more favorable attitudes toward MMT (AOR=19.82, 95% CI: 6.07, 64.74). Overall, interest in receiving prison-based MMT was low, and was associated with adverse social, mental health, and drug use consequences. Incarceration provides a unique opportunity to initiate MMT for those who need it, however, optimal scale-up efforts must be systemic and address modifiable factors like improving attitudes toward and motivation for MMT. Informed or shared decision-making tools may be useful in improving expectations and acceptability of MMT. Copyright © 2016 Elsevier Ireland Ltd. All rights reserved.

  1. Hepatic sinusoidal obstruction syndrome during maintenance therapy of childhood acute lymphoblastic leukemia is associated with continuous asparaginase therapy and mercaptopurine metabolites

    DEFF Research Database (Denmark)

    Toksvang, Linea Natalie; De Pietri, Silvia; Nielsen, Stine N.

    2017-01-01

    BACKGROUND: Hepatic sinusoidal obstruction syndrome (SOS) during treatment of childhood acute lymphoblastic leukemia (ALL) has mainly been associated with 6-thioguanine. The occurrence of several SOS cases after the introduction of extended pegylated asparaginase (PEG-asparaginase) therapy...... in the Nordic Society of Paediatric Haematology and Oncology (NOPHO) ALL2008 protocol led us to hypothesize that PEG-asparaginase, combined with other drugs, may trigger SOS during 6-thioguanine-free maintenance therapy. PROCEDURE: In children with ALL treated in Denmark according to the NOPHO ALL2008 protocol...... children receiving PEG-asparaginase biweekly, 29 developed SOS (≥2 criteria: hyperbilirubinemia, hepatomegaly, ascites, weight gain ≥2.5%, unexplained thrombocytopenia

  2. The Comparison of Effectiveness of Cognitive-Behavioral Group Therapy Based on Coping Skills and Methadone Maintenance Treatment in Improvement of Emotional Regulation Strategies and Relapse Prevention

    Directory of Open Access Journals (Sweden)

    Tahereh Ghorbany

    2011-05-01

    Full Text Available Purpose: This study compared the effectiveness of group cognitive-behavioral therapy based on coping skills (CBT and methadone maintenance therapy (MMT in improvement of emotional regulation strategies and prevention of relapse. Method: The method of the present study was semi-experimental research design (pre-test-post-test with witness group. For sampling 45 substance abuse people who had referred to addiction treatment centers were selected and assigned to three groups of cognitive behavior therapy, methadone maintenance treatment and witness group randomly. The participants in all three groups completed the emotional intelligence questionnaire before and after the intervention. Data were analyzed by covariance method. Results: The results showed that cognitive-behavior therapy in comparison to methadone maintenance therapy and witness group led to significant improvement of emotional regulation in substance abusers, but there was no significant difference between the methadone maintenance treatment group and control group. Also, the rate of relapse in individuals who assigned to cognitive-behavior therapy group in comparison to methadone maintenance therapy and the witness group was significantly lower, but there was no significant difference between methadone therapy and witness. Conclusion: Cognitive-behavior therapy was an effective treatment that can change the cognitive and behavioral variables related to substance abuse, such as emotional regulation strategies. Thus, results suggested that drug abuse treatment programs must target these mediator variables.

  3. Influence of Different Implant Geometry in Clinical Longevity and Maintenance of Marginal Bone: A Systematic Review.

    Science.gov (United States)

    Lovatto, Sabrina Telles; Bassani, Rafaela; Sarkis-Onofre, Rafael; Dos Santos, Mateus Bertolini Fernandes

    2018-03-26

    To assess, through a systematic review, the influence of different implant geometries on clinical longevity and maintenance of marginal bone tissue. An electronic search was conducted in MEDLINE, Scopus, and Web of Science databases, limited to studies written in English from 1996 to 2017 using specific search strategies. Only randomized controlled trials (RCTs) that compared dental implants and their geometries were included. Two reviewers independently selected studies, extracted data, and assessed the risk of bias of included studies. From the 4006 references identified by the search, 24 were considered eligible for full-text analysis, after which 10 studies were included in this review. A similar behavior of marginal bone loss between tapered and cylindrical geometries was observed; however, implants that had micro-threads in the neck presented a slight decrease of marginal bone loss compared to implants with straight or smooth neck. Success and survival rates were high, with cylindrical implants presenting higher success and survival rates than tapered ones. Implant geometry seems to have little influence on marginal bone loss (MBL) and survival and success rates after 1 year of implant placement; however, the evidence in this systematic review was classified as very low due to limitations such as study design, sample size, and publication bias. Thus, more well-designed RCTs should be conducted to provide evidence regarding the influence of implant geometry on MBL and survival and success rates after 1 year of implant placement. © 2018 by the American College of Prosthodontists.

  4. Cost-effectiveness of budesonide/formoterol for maintenance and reliever asthma therapy in Denmark--cost-effectiveness analysis based on five randomised controlled trials

    DEFF Research Database (Denmark)

    Wickstrøm, Jannie; Dam, Nanna; Malmberg, Irena

    2009-01-01

    Budesonide/formoterol maintenance and reliever therapy (Symbicort SMART) is an effective asthma-management regime where patients use budesonide/formoterol both as maintenance treatment and as additional doses as needed to improve overall asthma control by reducing symptoms and exacerbations...

  5. Influencing programmable pacemakers by radiation therapy

    International Nuclear Information System (INIS)

    Wilm, M.; Kronholz, H.L.; Schuetz, J.; Koch, T.

    1994-01-01

    More than 300,000 pacemakers are implanted worldwide. During radiation therapy a damage of the pacemaker elektronic is possible. Twenty pacemakers have been irradiated with photons or electrons experimentally in three different situations: a) pacemaker and pacemaker electrode outside of the irradiation field; b) pacemaker outside, pacemaker electrode inside the irradiation field; c) all things inside the irradiation field. The voltage in the pacemaker electrode produced by the electric field of the accelerator did not exceed 0.8 mV if the electrode was outside the irradiation field. Induced voltage was up to 1.2 mV during irradiation with electrons (18 MeV) and the electrode being inside the treatment field with more than two thirds of its length. After delivering of not more than 10 Gy (photons) to the pacemaker, a decreasing amplitude of the pacemaker pulse occurred. The pulse frequency did not show any deviation. This seems to signal a severe early irreversible damage of the pacemaker that may cause sudden breakdown days or weeks after radiation. Two pacemakers showed a complete breakdown after irradiation with not more than 10 Gy. The others had a complete breakdown beyond doses of 50 Gy. (orig./MG) [de

  6. Effects of cognitive behavioral therapy on insomnia of maintenance hemodialysis patients.

    Science.gov (United States)

    Hou, Yongmei; Hu, Peicheng; Liang, Yanping; Mo, Zhanyu

    2014-07-01

    The objective of the study was to evaluate the effects of cognitive behavioral therapy [sleep-related behavior modification and progressive muscle relaxation on insomnia of maintenance hemodialysis (MHD) patients] on improving insomnia of MHD patients. 103 MHD patients complicated with insomnia were randomly assigned to treatment (n = 52) and control (n = 51) groups. The control group was treated with conventional hemodialysis, and the treatment group was additionally treated with cognitive behavioral therapy for 3 months (sleep-related behavior modification and progressive muscle relaxation). All cases were assessed by Symptom Checklist 90 (SCL-90) and Pittsburgh Sleep Quality Index (PSQI) before and 2, 4, 6, 8, 10, and 12 weeks after treatment. Fifty-one patients in the treatment group and 47 patients in the control group completed the experiments. After treatment, the total mean scores were (1.94 ± 0.50/2.29 ± 0.31); scores of somatization, depression, anxiety, hostility, and additional items were (1.87 ± 0.58/2.56 ± 0.26), (2.25 ± 0.80/2.79 ± 0.50), (1.79 ± 0.26/2.37 ± 0.34), (1.71 ± 0.46/2.25 ± 0.43), and (1.91 ± 0.67/2.26 ± 0.59) in SCL-90, respectively. The total scores for PSQI were (12.63 ± 2.27/16.40 ± 2.16); scores of subjective sleep quality, sleep latency, sleep duration, habitual sleep efficiency, sleep disturbance, hypnotics, and daytime dysfunction which were (1.98 ± 0.76/2.57 ± 0.58), (1.75 ± 0.59/2.60 ± 0.50), (2.10 ± 0.50/2.62 ± 0.53), (2.06 ± 0.47/2.57 ± 0.54), (2.04 ± 0.69/2.45 ± 0.72), (1.02 ± 0.79/1.51 ± 0.98), and (1.69 ± 0.55/2.09 ± 0.58), respectively, were significantly lower in the treatment group compared with the control group. However, there were no significant differences in the scores of factors of obsessive-compulsive (2.26 ± 0.62/2.32 ± 0.38), interpersonal sensitivity (2.23 ± 0.64/2.43 ± 0.47), phobic anxiety (1.98 ± 0.62/2.01 ± 0.67), paranoid ideation (1.55 ± 0.43/1.69 ± 0.39), and

  7. Eye Movement Evidence of Attentional Bias for Substance-Related Cues in Heroin Dependents on Methadone Maintenance Therapy.

    Science.gov (United States)

    Zhao, Hui; Yang, Bo; Zhu, Qian; Zhang, Guangqun; Xiao, Yuqin; Guo, Xiao; Huang, Xiu; Zhang, Zhuo

    2017-03-21

    Attentional biases toward substance-related stimuli might play a contributing role in addictive behaviors. This study investigated the selective attention to substance-related stimuli in heroin dependents receiving methadone maintenance therapy. Thirty outpatients receiving methadone maintenance treatment for heroin dependence and 38 healthy controls completed a visual probe task with concurrent eye movement monitoring. The results showed that the heroin group reacted faster to probes associated with substance-related pictures than neutral pictures, and they directed more initial fixations and maintained longer initial fixation durations toward substance-related pictures than neutral pictures. However, attentional bias was not correlated with addiction severity in the heroin group. These findings suggest that attentional bias towards substance-related cues occurs in heroin dependents, although this bias might not be associated with the severity of drug-using behavior.

  8. Maintenance Management Update.

    Science.gov (United States)

    Sternloff, Robert E.

    1987-01-01

    Current trends in park maintenance are overviewed, including maintenance impact statements, avoidance of cost through efficient use and national resource conservation, horticultural accomplishments that influence maintenance management, and vandalism prevention. (CB)

  9. The Key Points of Maintenance Therapy for Dental Implants: A Literature Review.

    Science.gov (United States)

    Pirc, Miha; Dragan, Irina F

    2017-04-01

    Dental implants require lifelong maintenance and care. Success is defined by biologic factors (presence of inflamed soft tissues surrounding dental implants and radiographic changes in the crestal bone levels) and mechanical factors (stability of the implant fixture and implant supported restoration, etc). Most implant failures are initiated by incipient stages of inflammatory processes, which lead to peri-mucositis and peri-implantitis. The evidence regarding the value of maintenance protocol regarding implants is sparse compared with the one for teeth. This article addresses the existing literature on processes for oral hygiene for implant care.

  10. The influence of hormone therapies on colon and rectal cancer.

    Science.gov (United States)

    Mørch, Lina Steinrud; Lidegaard, Øjvind; Keiding, Niels; Løkkegaard, Ellen; Kjær, Susanne Krüger

    2016-05-01

    Exogenous sex hormones seem to play a role in colorectal carcinogenesis. Little is known about the influence of different types or durations of postmenopausal hormone therapy (HT) on colorectal cancer risk. A nationwide cohort of women 50-79 years old without previous cancer (n = 1,006,219) were followed 1995-2009. Information on HT exposures was from the National Prescription Register and updated daily, while information on colon (n = 8377) and rectal cancers (n = 4742) were from the National Cancer Registry. Potential confounders were obtained from other national registers. Poisson regression analyses with 5-year age bands included hormone exposures as time-dependent covariates. Use of estrogen-only therapy and combined therapy were associated with decreased risks of colon cancer (adjusted incidence rate ratio 0.77, 95 % confidence interval 0.68-0.86 and 0.88, 0.80-0.96) and rectal cancer (0.83, 0.72-0.96 and 0.89, 0.80-1.00), compared to never users. Transdermal estrogen-only therapy implied more protection than oral administration, while no significant influence was found of regimen, progestin type, nor of tibolone. The benefit of HT was stronger for long-term hormone users; and hormone users were at lower risk of advanced stage of colorectal cancer, which seems supportive for a causal association between hormone therapy and colorectal cancer.

  11. Gender Differences in the Maintenance of Response to Cognitive Behavior Therapy for Posttraumatic Stress Disorder

    Science.gov (United States)

    Felmingham, Kim L.; Bryant, Richard A.

    2012-01-01

    Objective: To examine potential differential responses in men and women to cognitive behavior therapy for posttraumatic stress disorder (PTSD). Method: Fifty-two men and 56 women diagnosed with PTSD participated in randomized controlled trials of cognitive behavior therapy for PTSD. Participants were randomly allocated to either (a) exposure-only…

  12. Effectiveness of maintenance therapy of lithium vs other mood stabilizers in monotherapy and in combinations

    DEFF Research Database (Denmark)

    Kessing, Lars Vedel; Bauer, Michael; Nolen, Willem A.

    2018-01-01

    Objectives: For the first time to present a systematic review of observational studies on the efficiency of lithium monotherapy in comparison with other maintenance mood stabilizers in monotherapy and in combination. Methods: As part of the International Society for Bipolar Disorders (ISBD) Task...... Force on Lithium Treatment, we undertook a systematic literature search of non-randomized controlled observational studies on (i) lithium monotherapy vs treatment with another maintenance mood stabilizer in monotherapy and (ii) lithium in combination with other mood stabilizers vs monotherapy. Results......: In eight out of nine identified studies including a total of lithium monotherapy was associated with improved outcome compared with another mood stabilizer in monotherapy, including valproate, lamotrigine, olanzapine, quetiapine, unspecified anticonvulsants, carbamazepine...

  13. Successful leukocytapheresis therapy in a patient with rheumatoid arthritis on maintenance hemodialysis.

    Science.gov (United States)

    Maeshima, Keisuke; Torigoe, Masataka; Iwakura, Mikako; Yamanaka, Kunitoshi; Ishii, Koji

    2015-01-01

    We report the case of a 44-year-old female undergoing maintenance hemodialysis in whom early-phase rheumatoid arthritis (RA) was successfully treated by leukocytapheresis (LCAP). The effects of prednisone, tacrolimus, and etanercept were limited, but LCAP was highly effective and its efficacy continued even after cessation of LCAP. Moreover, remission was maintained for 2 years after discontinuation of medication. LCAP may be an important treatment option for RA patients with end-stage renal failure who are on hemodialysis.

  14. Maintenance therapy is associated with better long-term outcomes in adult patients with primary angiitis of the central nervous system.

    Science.gov (United States)

    de Boysson, Hubert; Parienti, Jean-Jacques; Arquizan, Caroline; Boulouis, Grégoire; Gaillard, Nicolas; Régent, Alexis; Néel, Antoine; Detante, Olivier; Touzé, Emanuel; Aouba, Achille; Bienvenu, Boris; Guillevin, Loïc; Naggara, Olivier; Zuber, Mathieu; Pagnoux, Christian

    2017-10-01

    We aimed to analyse the effect of maintenance therapy after induction on the outcomes of adult patients with primary angiitis of the CNS (PACNS). We analysed long-term outcomes (relapse, survival and functional status) of patients enrolled in the French multicentre PACNS cohort who achieved remission after induction treatment and with ⩾12 months' follow-up, according to whether or not they received maintenance therapy. Good outcome was defined as relapse-free survival and good functional status (modified Rankin scale ⩽ 2) at last follow-up. Ninety-seven patients [46 (47%) female, median age: 46 (18-78) years at diagnosis] were followed up for a median of 55 (5-198) months. Induction treatment consisted of glucocorticoids in 95 (98%) patients, combined with an immunosuppressant in 80 (83%) patients, mostly CYC. Maintenance therapy was prescribed in 48 (49%) patients, following CYC in 42 of them. Maintenance therapy was started 4 (3-18) months after glucocorticoid initiation. At last follow-up, good outcomes were observed in 32 (67%) patients who had received maintenance therapy vs 10 (20%) who had not (P adults with PACNS is associated with better functional outcomes and lower relapse rates. Further studies are needed to confirm these findings. © The Author 2017. Published by Oxford University Press on behalf of the British Society for Rheumatology. All rights reserved. For Permissions, please email: journals.permissions@oup.com

  15. Music therapy-induced changes in salivary cortisol level are predictive of cardiovascular mortality in patients under maintenance hemodialysis

    Directory of Open Access Journals (Sweden)

    Hou YC

    2017-02-01

    Full Text Available Yi-Chou Hou,1 Yen-Ju Lin,2 Kuo-Cheng Lu,1 Han-Sun Chiang,3 Chia-Chi Chang,4 Li-King Yang1 1Department of Internal Medicine, Cardinal Tien Hospital, School of Medicine, Fu-Jen Catholic University, 2Department of Nursing, Taipei Medical University, 3Graduate Institute of Basic Medicine, College of Medicine, Fu Jen Catholic University, New Taipei City, 4School of Gerontology Health Management, College of Nursing, Taipei Medical University, Taipei, Taiwan, Republic of China Background: Music therapy has been applied in hemodialysis (HD patients for relieving mental stress. Whether the stress-relieving effect by music therapy is predictive of clinical outcome in HD patients is still unclear.Methods: We recruited a convenience sample of 99 patients on maintenance HD and randomly assigned them to the experimental (n=49 or control (n=50 group. The experimental group received relaxing music therapy for 1 week, whereas the control group received no music therapy. In the experimental group, we compared cardiovascular mortality in the patients with and without cortisol changes.Results: The salivary cortisol level was lowered after 1 week of music therapy in the experimental group (−2.41±3.08 vs 1.66±2.11 pg/mL, P<0.05, as well as the frequency of the adverse reaction score (−3.35±5.76 vs −0.81±4.59, P<0.05, the severity of adverse reactions score (−1.93±2.73 vs 0.33±2.71, P<0.05, and hemodialysis stressor scale (HSS score (−6.00±4.68 vs −0.877±7.08, P<0.05. The difference in salivary cortisol correlated positively with HD stress score scales (r=0.231, P<0.05, systolic blood pressure (r=0.264, P<0.05, and respiratory rates (r=0.369, P<0.05 and negatively with finger temperature (r=−0.235, P<0.05 in the total study population. The 5-year cardiovascular survival in the experimental group was higher in patients whose salivary cortisol lowered by <0.6 pg/mL than that in patients whose salivary cortisol lowered by >0.6 pg/mL (83.8% vs

  16. Radioiodine (I-131) therapy and the influence of antithyroid medication

    International Nuclear Information System (INIS)

    Duldulao, M.

    2007-01-01

    Full text: Radioiodine therapy began to play a major role in the management of hyperthyroidism as early as 1941. It later evolved to become what it is today, the treatment of choice for majority of patients who are suffering from Graves' disease and toxic nodular goiter. It is generally considered safe, inexpensive, effective, and devoid of major side effects. Despite the extensive experience with radioactive therapy, the adjunctive role of antithyroid medication remains controversial. Some authors claim that it has a positive influence on the outcome of radioiodine therapy while others insist otherwise. The reasons behind the adjunctive use of antithyroid medication include a more rapid attainment of euthyroid state and a decrease in the rise of developing thyroid crisis. However, a higher treatment failure rate is observed compared to radioiodine alone. This is due to the reputed radioprotective effect of the antithyroid medication. As a result, higher doses of I-131 are needed in order to obtain the desired effect but, unfortunately, that would also increase the radiation exposure to the rest of the body. The majority of clinicians would require discontinuation of the medication a few days before therapy to overcome these undesirable effects but the question is, is this safe? The issue of when antithyroid medication is warranted is a big question to the clinician. For optimal use of radioiodine therapy, appropriate selection criteria and good clinical judgment concerning pretreatment with antithyroid medication are required. Otherwise, we may put some patients into unnecessary increased risk and added cost. (author)

  17. Effectiveness of Cognitive-Behavioral Group Therapy on Improving Quality of Life in Opiate Addicts under Methadone Maintenance Treatment

    Directory of Open Access Journals (Sweden)

    Fereshteh Momeni

    2013-04-01

    Full Text Available Objective: This study was aimed to assess the effectiveness of cognitive- behavioral group therapy on improvement of quality of life in opiate patients under methadone maintenance treatment. Method: This was a semi experimental study using control group also pre-test, post-test and follow-up. Thirty six patients on MMT were selected between the entire opiate addicts referred to Iranian national center for addiction studies within judgmental sampling and were randomly assigned into experimental and control groups. They were all administered the WHOQOL-BREF. In experimental group, cognitive behavior group therapy was performed in 8 sessions and the control group was registered in the waiting list for the CBGT. Findings: Data analysis revealed that the mean WHOQOL-BREF score in the experimental group had significant higher increase when compared with that of the control group. But it wasn’t significant in follow up. Conclusion: Results demonstrated the effectiveness of cognitive–behavior group therapy On improvement of quality of life of opiate addicts on MMT in short term but didn’t seem to be effective in long term.

  18. Comparison of outcomes twelve years after antireflux surgery or omeprazole maintenance therapy for reflux esophagitis

    DEFF Research Database (Denmark)

    Lundell, Lars; Miettinen, Pekka; Myrvold, Helge E

    2009-01-01

    with esophagitis enrolled from outpatient clinics in Nordic countries. Of the 155 patients randomly assigned to each arm of the study, 154 received omeprazole (1 withdrew before therapy began), and 144 received surgery (11 withdrew before surgery). In patients who remained in remission after treatment, post....... Heartburn and regurgitation were significantly more common in patients given omeprazole, whereas dysphagia, rectal flatulence, and the inability to belch or vomit were significantly more common in surgical patients. The therapies were otherwise well-tolerated. CONCLUSIONS: As long-term therapeutic...

  19. The long-term effects of switching from active intravenous bisphosphonate treatment to low-dose maintenance therapy in children with osteogenesis imperfecta.

    Science.gov (United States)

    Biggin, Andrew; Zheng, Linda; Briody, Julie N; Coorey, Craig P; Munns, Craig F

    2015-01-01

    Intravenous bisphosphonate therapy is the first-line treatment in moderate-to-severe osteogenesis imperfecta (OI), but there are varied treatment protocols with little data on long-term efficacy. This study evaluates the clinical outcomes when transitioning from active bisphosphonate treatment to maintenance therapy. A retrospective review was conducted on 17 patients before treatment, following active treatment (zoledronate 0.05 mg/kg 6-monthly or pamidronate 6-9 mg/kg/year) and after establishment on maintenance treatment for more than 2 years (zoledronate 0.025 mg/kg 6-monthly or pamidronate lean tissue mass increased during active treatment. These improvements were maintained during the period of maintenance treatment. Vertebral height improved in fractured thoracic vertebrae from pre-treatment to active therapy and improved further during maintenance treatment. Metacarpal cortical thickness and relative cortical area also increased over the treatment periods. Maintenance intravenous bisphosphonate therapy preserved the beneficial effects of active treatment at the doses stated above. Further studies are required to determine the optimal bisphosphonate treatment regimen in the management of children with OI. © 2015 S. Karger AG, Basel.

  20. The degree of myelosuppression during maintenance therapy of adolescents with B-lineage intermediate risk acute lymphoblastic leukemia predicts risk of relapse

    DEFF Research Database (Denmark)

    Schmiegelow, K; Donovan, Martin Heyman; Sherson, Maiken Gustafsson

    2010-01-01

    Drug doses, blood levels of drug metabolites and myelotoxicity during 6-mercaptopurine/methotrexate (MTX) maintenance therapy were registered for 59 adolescents (10 years) and 176 non-adolescents (leukemia (ALL) and a white blood cell count (WBC......) diagnosis. Event-free survival was lower for adolescents than non-adolescents (pEFS12y:0.71 vs 0.83, P=0.04). For adolescents staying in remission, the mean WBC during maintenance therapy (mWBC) was related to age (rS=0.36, P=0.02), which became nonsignificant for those who relapsed (r...

  1. Cost-effectiveness of budesonide/formoterol for maintenance and reliever asthma therapy in Denmark--cost-effectiveness analysis based on five randomised controlled trials

    DEFF Research Database (Denmark)

    Wickstrøm, Jannie; Dam, Nanna; Malmberg, Irena

    2009-01-01

    Budesonide/formoterol maintenance and reliever therapy (Symbicort SMART) is an effective asthma-management regime where patients use budesonide/formoterol both as maintenance treatment and as additional doses as needed to improve overall asthma control by reducing symptoms and exacerbations....... The aim of this study was to determine the cost-effectiveness of the Symbicort SMART regime in Denmark vs higher dose inhaled corticosteroid (ICS) plus reliever medication, similar dose inhaled corticosteroid/long-acting beta(2)-agonist (ICS/LABA) combination therapy plus reliever medication or higher...

  2. Factors influencing radiation therapy student clinical placement satisfaction

    International Nuclear Information System (INIS)

    Bridge, Pete; Carmichael, Mary-Ann

    2014-01-01

    Introduction: Radiation therapy students at Queensland University of Technology (QUT) attend clinical placements at five different clinical departments with varying resources and support strategies. This study aimed to determine the relative availability and perceived importance of different factors affecting student support while on clinical placement. The purpose of the research was to inform development of future support mechanisms to enhance radiation therapy students’ experience on clinical placement. Methods: This study used anonymous Likert-style surveys to gather data from years 1 and 2 radiation therapy students from QUT and clinical educators from Queensland relating to availability and importance of support mechanisms during clinical placements in a semester. Results: The study findings demonstrated student satisfaction with clinical support and suggested that level of support on placement influenced student employment choices. Staff support was perceived as more important than physical resources; particularly access to a named mentor, a clinical educator and weekly formative feedback. Both students and educators highlighted the impact of time pressures. Conclusions: The support offered to radiation therapy students by clinical staff is more highly valued than physical resources or models of placement support. Protected time and acknowledgement of the importance of clinical education roles are both invaluable. Joint investment in mentor support by both universities and clinical departments is crucial for facilitation of effective clinical learning

  3. Factors influencing radiation therapy student clinical placement satisfaction

    Science.gov (United States)

    Bridge, Pete; Carmichael, Mary-Ann

    2014-01-01

    Introduction: Radiation therapy students at Queensland University of Technology (QUT) attend clinical placements at five different clinical departments with varying resources and support strategies. This study aimed to determine the relative availability and perceived importance of different factors affecting student support while on clinical placement. The purpose of the research was to inform development of future support mechanisms to enhance radiation therapy students’ experience on clinical placement. Methods: This study used anonymous Likert-style surveys to gather data from years 1 and 2 radiation therapy students from QUT and clinical educators from Queensland relating to availability and importance of support mechanisms during clinical placements in a semester. Results: The study findings demonstrated student satisfaction with clinical support and suggested that level of support on placement influenced student employment choices. Staff support was perceived as more important than physical resources; particularly access to a named mentor, a clinical educator and weekly formative feedback. Both students and educators highlighted the impact of time pressures. Conclusions: The support offered to radiation therapy students by clinical staff is more highly valued than physical resources or models of placement support. Protected time and acknowledgement of the importance of clinical education roles are both invaluable. Joint investment in mentor support by both universities and clinical departments is crucial for facilitation of effective clinical learning. PMID:26229635

  4. Factors influencing radiation therapy student clinical placement satisfaction

    Energy Technology Data Exchange (ETDEWEB)

    Bridge, Pete; Carmichael, Mary-Ann [School of Clinical Sciences, Queensland University of Technology, Brisbane (Australia)

    2014-02-15

    Introduction: Radiation therapy students at Queensland University of Technology (QUT) attend clinical placements at five different clinical departments with varying resources and support strategies. This study aimed to determine the relative availability and perceived importance of different factors affecting student support while on clinical placement. The purpose of the research was to inform development of future support mechanisms to enhance radiation therapy students’ experience on clinical placement. Methods: This study used anonymous Likert-style surveys to gather data from years 1 and 2 radiation therapy students from QUT and clinical educators from Queensland relating to availability and importance of support mechanisms during clinical placements in a semester. Results: The study findings demonstrated student satisfaction with clinical support and suggested that level of support on placement influenced student employment choices. Staff support was perceived as more important than physical resources; particularly access to a named mentor, a clinical educator and weekly formative feedback. Both students and educators highlighted the impact of time pressures. Conclusions: The support offered to radiation therapy students by clinical staff is more highly valued than physical resources or models of placement support. Protected time and acknowledgement of the importance of clinical education roles are both invaluable. Joint investment in mentor support by both universities and clinical departments is crucial for facilitation of effective clinical learning.

  5. Restoration and maintenance of spermatogenesis by HCG therapy in patients with hypothalamo-hypophyseal damage.

    Science.gov (United States)

    Levalle, O; Bokser, L; Pacenza, N; Aszenmil, G; Fiszlejder, L; Chervin, A; Guitelman, A

    1984-01-01

    Both gonadotropins are necessary to induce spermatogenesis in man and to recover hypophysectomized males. The patients who suffer from tumoral or traumatic hypothalamo-hypophyseal lesion use to have low endogenous gonadotropins (opposite to hypophysectomized patients), which can produce a minor involution of spermatogenesis. Three patients with postpubertal hypogonadotropic hypogonadism and oligozoospermia were studied. Two of them were operated on for chromophobous adenoma of pituitary, and the other patient had traumatic hypothalamo-hypophyseal lesion. The three patients were treated with 5000 IU HCG/week, associated with testosterone enanthate, in two cases and with bromocryptine in the remaining one. All the patients had normalized spermiogram, but when HCG was interrupted, the sperm count regressed to pretreatment levels in spite of the maintenance of treatment with testosterone or bromocryptine. Minimal amounts of FSH together the testosterone supplied by Leydig cell under the HCG stimulus, are able to recover and maintain the spermatogenesis in these patients.

  6. Rituximab as maintenance therapy for ANCA associated vasculitis: how, when and why?

    Science.gov (United States)

    Alba, Marco A; Flores-Suárez, Luis Felipe

    2016-01-01

    ANCA-associated vasculitides (AAV) are chronic autoimmune diseases characterized by inflammation and destruction of small vessels. Rituximab is now licensed for use as a remission-induction agent in the treatment of these disorders. During recent years, several non-controlled studies have suggested that rituximab may be of value in maintaining disease remission in AAV. In these series, 3 techniques have been tried: "watch-and-wait", repeated cycles in fixed intervals, or administration based on proposed biomarkers. More importantly, the results of the MAINRITSAN trial showed that this anti-CD20 agent is superior to azathioprine for preventing major relapses in AAV. This review summarizes current information regarding the effectiveness, timing, dosing, duration and safety of rituximab as a valid option for remission maintenance. Copyright © 2015 Elsevier España, S.L.U. y Sociedad Española de Reumatología y Colegio Mexicano de Reumatología. All rights reserved.

  7. P2X7-Regulated Protection from Exacerbations and Loss of Control Is Independent of Asthma Maintenance Therapy

    Science.gov (United States)

    Manthei, David M.; Seibold, Max A.; Ahn, Kwangmi; Bleecker, Eugene; Boushey, Homer A.; Calhoun, William J.; Castro, Mario; Chinchili, Vernon M.; Fahy, John V.; Hawkins, Greg A.; Icitovic, Nicolina; Israel, Elliot; Jarjour, Nizar N.; King, Tonya; Kraft, Monica; Lazarus, Stephen C.; Lehman, Erik; Martin, Richard J.; Meyers, Deborah A.; Peters, Stephen P.; Sheerar, Dagna; Shi, Lei; Sutherland, E. Rand; Szefler, Stanley J.; Wechsler, Michael E.; Sorkness, Christine A.; Lemanske, Robert F.

    2013-01-01

    Rationale: The function of the P2X7 nucleotide receptor protects against exacerbation in people with mild-intermittent asthma during viral illnesses, but the impact of disease severity and maintenance therapy has not been studied. Objectives: To evaluate the association between P2X7, asthma exacerbations, and incomplete symptom control in a more diverse population. Methods: A matched P2RX7 genetic case-control was performed with samples from Asthma Clinical Research Network trial participants enrolled before July 2006, and P2X7 pore activity was determined in whole blood samples as an ancillary study to two trials completed subsequently. Measurements and Main Results: A total of 187 exacerbations were studied in 742 subjects, and the change in asthma symptom burden was studied in an additional 110 subjects during a trial of inhaled corticosteroids (ICS) dose optimization. African American carriers of the minor G allele of the rs2230911 loss-of-function single nucleotide polymorphism were more likely to have a history of prednisone use in the previous 12 months, with adjustment for ICS and long-acting β2-agonists use (odds ratio, 2.7; 95% confidence interval, 1.2–6.2; P = 0.018). Despite medium-dose ICS, attenuated pore function predicted earlier exacerbations in incompletely controlled patients with moderate asthma (hazard ratio, 3.2; confidence interval, 1.1–9.3; P = 0.033). After establishing control with low-dose ICS in patients with mild asthma, those with attenuated pore function had more asthma symptoms, rescue albuterol use, and FEV1 reversal (P < 0.001, 0.03, and 0.03, respectively) during the ICS adjustment phase. Conclusions: P2X7 pore function protects against exacerbations of asthma and loss of control, independent of baseline severity and the maintenance therapy. PMID:23144325

  8. Parasites and deleterious mutations: interactions influencing the evolutionary maintenance of sex.

    Science.gov (United States)

    Park, A W; Jokela, J; Michalakis, Y

    2010-05-01

    The restrictive assumptions associated with purely genetic and purely ecological mechanisms suggest that neither of the two forces, in isolation, can offer a general explanation for the evolutionary maintenance of sex. Consequently, attention has turned to pluralistic models (i.e. models that apply both ecological and genetic mechanisms). Existing research has shown that combining mutation accumulation and parasitism allows restrictive assumptions about genetic and parasite parameter values to be relaxed while still predicting the maintenance of sex. However, several empirical studies have shown that deleterious mutations and parasitism can reduce fitness to a greater extent than would be expected if the two acted independently. We show how interactions between these genetic and ecological forces can completely reverse predictions about the evolution of reproductive modes. Moreover, we demonstrate that synergistic interactions between infection and deleterious mutations can render sex evolutionarily stable even when there is antagonistic epistasis among deleterious mutations, thereby widening the conditions for the evolutionary maintenance of sex.

  9. Maintenance of nutritional status in patients with cystic fibrosis: new and emerging therapies

    Directory of Open Access Journals (Sweden)

    Kalnins D

    2012-06-01

    Full Text Available Daina Kalnins,1 Michael Wilschanski21Clinical Dietetics, Respiratory Medicine, The Hospital for Sick Children, Toronto, ON, Canada; 2Pediatric Gastroenterology Unit, Hadassah University Hospitals, Jerusalem, IsraelAbstract: Poor clinical outcomes in cystic fibrosis are often associated with undernutrition. Normal growth and development should be achieved in cystic fibrosis, and nutritional counseling is paramount at all ages. Prevention and early detection of growth failure is the key to successful nutritional intervention. The advance in nutritional management is certainly one factor that has contributed to the improved survival in recent decades. This review outlines the major nutritional parameters in the management of the patient with cystic fibrosis, including recent advances in pancreatic enzyme replacement therapy and fat-soluble vitamin therapy. There are sections on complicated clinical situations which directly affect nutrition, for example, before and after lung transplantation, cystic fibrosis-related diabetes, and bone health.Keywords: cystic fibrosis, nutrition, fat-soluble vitamins, pancreatic enzymes

  10. Frequency, predictors, and consequences of maintenance infliximab therapy intensification in ulcerative colitis

    Directory of Open Access Journals (Sweden)

    Luis Fernández-Salazar

    2015-09-01

    Full Text Available Introduction: Infliximab (IFX therapy intensification in ulcerative colitis (UC is more common than established in pivotal studies. Objectives: To establish the frequency and form of intensification for UC in clinical practice, as well as predictors, and to compare outcomes between intensified and non-intensified treatment. Methods: A retrospective study of 10 hospitals and 144 patients with response to infliximab (IFX induction. Predictive variables for intensification were analyzed using a Cox regression analysis. Outcome, loss of response to IFX, and colectomy were compared between intensified and non-intensified therapy. Results: Follow-up time from induction to data collection: 38 months [interquartile range (IQR, 20-62]. Time on IFX therapy: 24 months (IQR, 10-44. In all, 37% of patients required intensification. Interval was shortened for 36 patients, dose was increased for 7, and 10 subjects received both. Concurrent thiopurine immunosuppressants (IMM and IFX initiation was an independent predictor of intensification [Hazard ratio, 0.034; p, 0.006; CI, 0.003-0.371]. In patients on intensified therapy IFX discontinuation for loss of response (30.4% vs. 10.2%; p, 0.002, steroid reintroduction (35% vs. 18%; p, 0.018, and colectomy (22% vs. 6.4%; p, 0.011 were more common. Of patients on intensification, 17% returned to receiving 5 mg/kg every 8 weeks. Conclusions: Intensification is common and occasionally reversible. IMM initiation at the time of induction with IFX predicts non-intensification. Intensification, while effective, is associated with poorer outcome.

  11. Use of maintenance endocrine therapy after chemotherapy in metastatic breast cancer.

    Science.gov (United States)

    Sutherland, S; Miles, D; Makris, A

    2016-12-01

    For women with oestrogen receptor+ metastatic breast cancer (MBC), the options for systemic treatment include endocrine therapy (ET) and chemotherapy. For women whose disease is also HER2+, anti-HER2 therapies are also routinely used either with chemotherapy or less commonly with ET. Where chemotherapy is used as initial therapy, treatment is often discontinued due to cumulative toxicity in the absence of disease progression. In this setting, there is the option of introducing ET with the aim of prolonging response and delaying relapse. Literature review revealed four trials addressing the question of whether there is a benefit from introducing ET following chemotherapy for MBC. We also sought evidence for alternative approaches, including concurrent chemotherapy and ET and continuing chemotherapy until disease progression. The evidence for the use of ET after chemotherapy in MBC is limited, and the trials done were small. Furthermore, they were performed at a time when both the chemotherapy regimens and ET were different from those used currently. Despite these limitations, there is probably a modest improvement in time to progression for the sequential use of ET after chemotherapy but with no overall survival benefit. An alternative approach, particularly considering agents with relatively low toxicity, such as orally bioavailable fluoropyrimidines, is to continue chemotherapy until disease progression. Where chemotherapy for MBC is discontinued due to toxicity, in the absence of progression, the use of ET, with its relatively low toxicity, is a reasonable approach with the aim of delaying relapse. Copyright © 2016. Published by Elsevier Ltd.

  12. Genetic influence on methadone treatment outcomes in patients undergoing methadone maintenance treatment for opioid addiction: a pilot study

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    Samaan Z

    2014-08-01

    Full Text Available Zainab Samaan,1–4 Monica Bawor,3,4 Brittany B Dennis,2,3 Carolyn Plater,5 Michael Varenbut,5 Jeffrey Daiter,5 Andrew Worster,5,6 David C Marsh,5,7 Charlie Tan,8 Dipika Desai,3 Lehana Thabane,2,9,10 Guillaume Pare11 1Department of Psychiatry and Behavioural Neurosciences, 2Department of Clinical Epidemiology and Biostatistics, 3Population Genomics Program, Chanchlani Research Centre, 4MiNDS Neuroscience Program, McMaster University, Hamilton, Ontario, Canada; 5Ontario Addiction Treatment Centres, Richmond Hill, Ontario, Canada; 6Department of Medicine, McMaster University, Hamilton, Ontario, Canada; 7Northern Ontario School of Medicine, Laurentian University, Sudbury, Ontario, Canada; 8Michael G. DeGroote School of Medicine, McMaster University, 9Biostatistics Unit, Centre for Evaluation of Medicine, 10System Linked Research Unit, 11Department of Pathology and Molecular Medicine, McMaster University, Hamilton, Ontario, Canada Introduction: Treatment of opioid addiction with methadone is effective; however, it is known to produce interindividual variability. This may be influenced in part by genetic variants, which can increase the initial risk of developing opioid addiction as well as explain differences in response to treatment. This pilot study aimed to assess the feasibility of conducting a full-scale genetic analysis to identify genes that predict methadone treatment outcomes in this population. Methods: This was a cross-sectional observational study of patients admitted to a methadone maintenance treatment program for opioid addiction. We obtained demographic and clinical characteristics in addition to blood and urine samples, for the assessment of treatment outcomes. Results: The recruitment process yielded 252 patients, representing a 20% recruitment rate. We conducted genetic testing based on a 99.6% rate of provision of DNA samples. The average retention in treatment was 3.4 years, and >50% of the participants reported psychiatric and

  13. Methadone Maintenance Therapy in Vietnam: An Overview and Scaling-Up Plan

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    Tam T. M. Nguyen

    2012-01-01

    Full Text Available Vietnam is among the countries with the highest rate of HIV transmission through injecting drug users. HIV prevalence among injecting drug users is 20% and up to 50% in many provinces. An estimated number of drug users in the country by the end of 2011 were 171,000 in which the most common is heroin (85%. Detoxification at home, community, and in rehabilitation centers have been the main modalities for managing heroin addiction until Methadone Maintenance Treatment (MMT was piloted in 2008. Recent reports have demonstrated positive treatment outcomes. Incidence of HIV was found remarkably low among patients on MMT. Treatment has significantly improved the quality of life as well as stability for society. The government has granted the Ministry of Health (MoH to expand Methadone treatment to at least 30 provinces to provide treatment for more than 80,000 drug users by 2015. The Vietnam Administration for HIV/AIDS Control (VAAC and MOH have outlined the role and responsibility of key departments at the central and local levels in implementing and maintaining MMT treatment. This paper will describe the achievements of the MMT pilot program and the scaling-up plan as well as strategies to ensure quality and sustainability and to overcome the challenges in the coming years.

  14. Improvements for extending the time between maintenance periods for the Heidelberg ion beam therapy center (HIT) ion sources

    Energy Technology Data Exchange (ETDEWEB)

    Winkelmann, Tim, E-mail: tim.winkelmann@med.uni-heidelberg.de; Cee, Rainer; Haberer, Thomas; Naas, Bernd; Peters, Andreas; Schreiner, Jochen [Heidelberger Ionenstrahl-Therapie Centrum (HIT), D -69120 Heidelberg (Germany)

    2014-02-15

    The clinical operation at the Heidelberg Ion Beam Therapy Center (HIT) started in November 2009; since then more than 1600 patients have been treated. In a 24/7 operation scheme two 14.5 GHz electron cyclotron resonance ion sources are routinely used to produce protons and carbon ions. The modification of the low energy beam transport line and the integration of a third ion source into the therapy facility will be shown. In the last year we implemented a new extraction system at all three sources to enhance the lifetime of extraction parts and reduce preventive and corrective maintenance. The new four-electrode-design provides electron suppression as well as lower beam emittance. Unwanted beam sputtering effects which typically lead to contamination of the insulator ceramics and subsequent high-voltage break-downs are minimized by the beam guidance of the new extraction system. By this measure the service interval can be increased significantly. As a side effect, the beam emittance can be reduced allowing a less challenging working point for the ion sources without reducing the effective beam performance. This paper gives also an outlook to further enhancements at the HIT ion source testbench.

  15. Assertiveness training: Effects of treatment, maintenance of change and therapists' contribution in therapy outcome

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    Tovilović Snežana

    2005-01-01

    Full Text Available In this research is shown part of results concerning evaluation study of group assertiveness training. Treatment, which has been organized as structured program of assertiveness training, has been applied on 18 groups of subjects during 9 group sessions. This treatment has been adjusted to non-psychiatric clients from our country. Groups were lead by two therapists. During 20 months of our research 215 voluntary participants of full age have joined training groups. Final sample consisted of 158 subjects who had finished treatment and who had fulfilled criteria for taking repeated measurement. Subjects had taken battery of questionnaires before the treatment and eight weeks after they had completed treatment. Subsample, which included 35 subjects from one therapist’s groups, took retest after twice longer time period. Results of conducted research have confirmed the hypothesis concerning the potentiality of assertiveness training to produce expected and significant improvements of treated subjects. Therapy effect is found on symptomatic level through reduction of symptoms of non-assertive behaviors, which were target of the treatment. Contrary to expectation interactive effect of treatment and therapist to reduction of symptoms of non-assertive behavior has been found, which implies need for further investigation of variables that are related to therapists. Through the medium of treatment therapeutic changes in structural level, in domain of general assertiveness, social anxiety and treated subjects' self-concept are produced. The effect of therapy we might consider stabled and maintained after 16 weeks of finishing the treatment.

  16. Influence of MR imaging in radiation therapy of chest lymphoma

    International Nuclear Information System (INIS)

    Carlsen, S.E.; Hoppe, R.; Bergin, C.J.

    1991-01-01

    This paper evaluates the influence of MR detection of additional sites of chest lymphoma on radiation therapy. Chest MR images and CT scans of 56 patients with new or recurrent mediastinal lymphoma obtained within 1 month of each other were retrospectively reviewed. MR images included T1- and T2-weighted SE and STIR sequences. Images were assessed for pleural and extrapleural disease. Radiation portals of patients with pleural or chest wall disease were reevaluated and compared with portals originally designed with CT. MR imaging demonstrated chest wall disease in 15 patients (21 sites). Ten patients also had pleural disease (13 sites). CT identified chest wall disease in four of these patients (five sites) and pleural disease in three patients (five sites). Seven of the 15 patients with chest wall disease were treated with radiation therapy alone. Two of the seven patients had significant modification of radiation portals based on MR findings. Retrospectively, therapy would have been altered in an additional two patients in whom pleural disease was identified at MR. The increased sensitivity of MR in detecting chest wall or pleural disease has important implications for treatment planning in chest wall lymphoma

  17. DNA-thioguanine nucleotide concentration and relapse-free survival during maintenance therapy of childhood acute lymphoblastic leukaemia (NOPHO ALL2008)

    DEFF Research Database (Denmark)

    Nielsen, Stine Nygaard; Grell, Kathrine; Nersting, Jacob

    2017-01-01

    BACKGROUND: Adjustment of mercaptopurine and methotrexate maintenance therapy of acute lymphoblastic leukaemia by leucocyte count is confounded by natural variations. Cytotoxicity is primarily mediated by DNA-incorporated thioguanine nucleotides (DNA-TGN). The aim of this study was to establish w...

  18. Maintenance therapy with peginterferon alfa-2b does not prevent hepatocellular carcinoma in cirrhotic patients with chronic hepatitis C.

    Science.gov (United States)

    Bruix, Jordi; Poynard, Thierry; Colombo, Massimo; Schiff, Eugene; Burak, Kelly; Heathcote, Elizabeth J L; Berg, Thomas; Poo, Jorge-Luis; Mello, Carlos Brandao; Guenther, Rainer; Niederau, Claus; Terg, Ruben; Bedossa, Pierre; Boparai, Navdeep; Griffel, Louis H; Burroughs, Margaret; Brass, Clifford A; Albrecht, Janice K

    2011-06-01

    Several studies have reported that low doses of interferon can delay the development of hepatocellular carcinoma (HCC) and progression of chronic hepatitis C. We investigated the incidence of clinical events among participants of the Evaluation of PegIntron in Control of Hepatitis C Cirrhosis (EPIC)3 program. Data were analyzed from an open-label randomized study of patients with chronic hepatitis C who had failed to respond to interferon alfa plus ribavirin. All patients had compensated cirrhosis with no evidence of HCC. Patients received peginterferon alfa-2b (0.5 μg/kg/week; n=311) or no treatment (controls, n=315) for a maximum period of 5 years or until 98 patients had a clinical event (hepatic decompensation, HCC, death, or liver transplantation). The primary measure of efficacy was time until the first clinical event. There was no significant difference in time to first clinical event among patients who received peginterferon alfa-2b compared with controls (hazard ratio [HR], 1.452; 95% confidence interval [CI]: 0.880-2.396). There was no decrease in the development of HCC with therapy. The time to disease progression (clinical events or new or enlarged varices) was significantly longer for patients who received peginterferon alfa-2b compared with controls (HR, 1.564; 95% CI: 1.130-2.166). In a prospectively defined subanalysis of patients with baseline portal hypertension, peginterferon alfa-2b significantly increased the time to first clinical event compared with controls (P=.016). There were no new safety observations. Maintenance therapy with peginterferon alfa-2b is not warranted in all patients and does not prevent HCC. However, there is a potential clinical benefit of long-term suppressive therapy in patients with preexisting portal hypertension. Copyright © 2011 AGA Institute. Published by Elsevier Inc. All rights reserved.

  19. Maintenance Therapy with Trastuzumab in Her2 Positive Metastatic Parotid Ductal Adenocarcinoma

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    Muhammad Shahid Iqbal

    2014-01-01

    Full Text Available Salivary ductal carcinomas (SDCs are extremely rare and aggressive malignancies, accounting for approximately 6% of all salivary gland malignancies. One distinct feature is their resemblance to ductal carcinomas of breast. A significant percentage of SDCs overexpress Her2 and the use of targeted therapy with trastuzumab can be considered in these patients. We report a rare case of long term disease control with trastuzumab in Her2 positive metastatic parotid ductal carcinoma. Our case also highlights that isolated brain metastasis should be managed aggressively to allow optimal local control when systemic disease is under remission with trastuzumab. We have also reviewed the published literature on the use of trastuzumab in SDCs.

  20. Factors influencing visual rehabilitation after occlusion therapy in unilateral amblyopia in children.

    Science.gov (United States)

    Menon, Vimla; Chaudhuri, Zia; Saxena, Rohit; Gill, Kulwant; Sachdeva, M M

    2005-12-01

    Amblyopia is one of the most common causes of visual impairment in adults and children, and visual loss may be permanent if not treated in time. Though many studies have been done on occlusion therapy which is the mainstay in the treatment of unilateral amblyopia, discrepancies exist in literature about quantification of treatment and follow up measures. The present study was undertaken to evaluate the factors responsible for the successful outcome of treatment and the optimum time required for the same in children with unilateral amblyopia. Baseline characteristics of 63 verbal patients with unilateral amblyopia (strabismic, anisometropic, mixed) referred to the Strabismus and Amblyopia Clinic at the Dr Rajendra Prasad Centre for Ophthalmic Sciences, New Delhi between September 2001 to December 2002 who improved to the desired level of visual acuity after treatment for amblyopia in the mentioned time period, were analyzed to assess for factors that directly or indirectly influenced the optimum visual rehabilitation and the average duration of therapy required for the same. The evaluation included assessment of the baseline best-corrected visual acuity (BCVA) and refractive status in both eyes, the age at presentation, the type of amblyopia present, fixation pattern in the amblyopic eye, inter-eye visual acuity difference, and evaluation of compliance through a parental diary system. Baseline BCVA in the amblyopic eye was similar in all the three groups. Patients with anisometropic amblyopia showed a quicker response to therapy. Compliance to treatment was the major factor affecting the overall time required for a successful outcome in most cases. The overall time required for the treatment to be successful (including the period of maintenance) was about 1,089 h. This hospital-based study showed that the average duration of occlusion therapy to achieve stable isoacuity was 7.2 months with an average occlusion of 6-7 h/day. Compliance to therapy was the most

  1. Evaluation of Sociodemographic Determinants in Narcotic Users Referring to Center for Methadone Maintenance Therapy of Yazd, Iran

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    M.H. Lotfi

    2012-07-01

    Full Text Available Introduction: Addiction is a habit or behavior that is often hard to quit. It is estimated that 190 million persons are substance users around the world. Substance abuse creates tolerance after a while. Shortly after taking the drug, a person will not enjoy as the beginning of its use; that is why the amount of substance used is gradually increased. The purpose of this study was to find the reasons of tendency to narcotics among addicted individuals referred to methadone maintenance therapy (MMT center in Yazd. Materials & Methods: This study was a descriptive-analytic study on 100 addicts referred to methadone maintenance treatment center (MMT in Yazd. Data was collected by a pre-designed questionnaire with acceptable validity and reliability. Data was analyzed using SPSS statistical software and employing descriptive statistics such as percentage, ratio, mean, standard deviation and statistical tests such as t-test and chi- square was performed. Results: 41.9 % of addicts were unemployed, 4.77% married and 5.64% had elementary education. The most common method of substance consumption was inhalation (2.40%. Heroin was the most frequent type of substance used (1/51% The relationship between marital status and type of substance used, and age of onset of drug use was significant. The frequency of substance consumption was significantly different regarding the history of drug use in father, brother and spouses of patients in both sexes. Conclusion: Results of the current study showed that subjects at an early age (adolescence and early adulthood, individuals with low educational status, those with unstable jobs and low income, presence of addicted individuals among first-degree relatives can be the causes leading to addiction in the community.

  2. Maintenance nifedipine therapy for preterm symptomatic placenta previa: A randomized, multicenter, double-blind, placebo-controlled trial.

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    Eric Verspyck

    Full Text Available To assess the impact of maintenance nifedipine therapy on pregnancy duration in women with preterm placenta previa bleeding.PPADAL was a randomized, double-blind, placebo-controlled trial conducted between 05/2008 and 05/2012 in five French hospitals. The trial included 109 women, aged ≥ 18 years, with at least one episode of placenta previa bleeding, intact membranes and no other pregnancy complication, at gestational age 24 to 34 weeks and after 48 hours of complete acute tocolysis. Women were randomly allocated to receive either 20 mg of slow-release nifedipine three times daily (n = 54 or placebo (n = 55 until 36 + 6 weeks of gestation. The primary outcome for the trial was length of pregnancy measured in days after enrolment. Main secondary outcomes were rates of recurrent bleeding, cesarean delivery due to hemorrhage, blood transfusion, maternal side effects, gestational age at delivery and adverse perinatal outcomes (perinatal death, chronic lung disease, neonatal sepsis, intraventricular hemorrhage > grade 2, perventricular leukomalacia > grade 1, or necrotizing enterocolitis. Analysis was by intention to treat.Mean (SD prolongation of pregnancy was not different between the nifedipine (n = 54 and the placebo (n = 55 group; 42.5 days ± 23.8 versus 44.2 days ± 24.5, p = 0.70. Cesarean due to hemorrhage performed before 37 weeks occurred more frequently in the nifedipine group in comparison with the placebo group (RR, 1.66; 95% confidence interval, 1.05-2.72. Adverse perinatal outcomes were comparable between groups; 3.8% for nifedipine versus 5.5% for placebo (relative risk, 0.52; 95% confidence interval 0.10-2.61. No maternal mortality or perinatal death occurred.Maintenance oral nifedipine neither prolongs duration of pregnancy nor improves maternal or perinatal outcomes.ClinicalTrials.gov NCT00620724.

  3. Comparison of health-related quality of life of children during maintenance therapy with acute lymphoblastic leukemia versus siblings and healthy children in India.

    Science.gov (United States)

    Bansal, Minakshi; Sharma, Kamlesh K; Vatsa, Manju; Bakhshi, Sameer

    2013-05-01

    Data on quality of life (QOL) specifically in maintenance therapy of acute lymphoblastic leukemia (ALL) are minimal. This study was done to assess various items listed in domains of QOL (physical, emotional, social and school health domains) of children with ALL during maintenance therapy, and compare the same with those of their siblings and other healthy children. Forty children on maintenance therapy of ALL, 40 siblings and 40 healthy children were assessed for QOL by child self-report using PedsQL 4.0 Generic Core in the local language. Means were computed and compared for each domain with one-way analysis of variance (ANOVA), wherein higher values reflected better QOL. Overall QOL of children with ALL in maintenance therapy (77.16 ± 10.98) was significantly poorer than that of siblings (93.56 ± 4.41) and healthy children (93.02 ± 3.76) (p fear, anger, sleeping problems) among children with ALL. In the social health domain, children with ALL reported difficulty in maintaining friendships and competing. QOL of siblings was as good as that of healthy children in physical, social and school health domains, but they had increased emotional problems such as anger and sadness. Healthy children reported significantly higher future worries and bullying than children with ALL and siblings. This study validated that the QOL of children with ALL during maintenance therapy was significantly poorer than that of siblings and healthy children. The study identified various items in each domain of QOL that were affected in these children, and thus would assist in guiding healthcare professionals to focus on these specific items so as to improve their overall QOL.

  4. Clinical usefulness and economic implications of continuation/maintenance electroconvulsive therapy in a Spanish National Health System public hospital: A case series.

    Science.gov (United States)

    Rodriguez-Jimenez, Roberto; Bagney, Alexandra; Torio, Iosune; Caballero, Montserrat; Ruiz, Pedro; Rivas, Francisco de Paula Jose; Jimenez-Arriero, Miguel Angel

    2015-01-01

    Continuation/maintenance electroconvulsive therapy has been shown to be effective for prevention of relapse in affective and psychotic disorders. However, there is a limited nubber of studies that investigate clinical management, associated costs, and perceived quality variables. A series of 8 cases included during the first 18 months of the Continuation/Maintenance Electroconvulsive Therapy Program of the Psychiatry Department at 12 de Octubre University Hospital is presented. Clinical variables (Clinical Global Impression-Improvement Scale, length of hospitalization, number of Emergency Department visits, number of urgent admissions) before and after inclusion in the continuation/maintenance electroconvulsive therapy program were compared for each patient, as well as associated costs and perceived quality. After inclusion in the program, 50.0% of patients reported feeling « much better » and 37.5% « moderately better » in the Clinical Global Impression-Improvement Scale. In addition, after inclusion in the continuation/maintenance electroconvulsive therapy program, patients were hospitalized for a total of 349 days, visited the Emergency Department on 3 occasions, and had 2 urgent admissions, compared to 690 days of hospitalization (P = .012), 26 Emergency Department visits (P = .011) and 22 urgent admissions (P = .010) during the same period before inclusion in the program. Associated direct costs per day of admission were reduced to 50.6% of the previous costs, and costs associated with Emergency Department visits were reduced to 11.5% of the previous costs. As regards perceived quality, 87.5% of patients assessed the care and treatment received as being « very satisfactory », and 12.5% as « satisfactory ». This continuation/maintenance electroconvulsive therapy program has shown to be clinically useful and to have a favourable economic impact, as well as high perceived quality. Copyright © 2014 SEP y SEPB. Published by Elsevier España. All rights

  5. Receipt of maintenance therapy is most predictive of survival in older acute lymphoblastic leukemia patients treated with intensive induction chemotherapy regimens.

    Science.gov (United States)

    Landsburg, Daniel J; Stadtmauer, Edward; Loren, Alison; Goldstein, Steven; Frey, Noelle; Nasta, Sunita D; Porter, David L; Tsai, Donald E; Perl, Alexander E; Hexner, Elizabeth O; Luger, Selina

    2013-08-01

    While the prognosis for older adults diagnosed with acute lymphoblastic leukemia (ALL) is frequently poor, long-term survival can be achieved in patients treated with curative intent. We reviewed the outcomes of 37 patients age ≥60 treated at our institution with either DVP- or hyperCVAD-based chemotherapy regimens from 2003-2011. In this patient population, a complete response rate of 92%, relapse rate of 56% and median overall survival of 18.1 months was experienced. Univariate analysis revealed that receipt of maintenance therapy vs. no maintenance therapy was associated with a statistically-significant impact on overall survival (p = 0.001, HR 0.15 for death), while disease-related characteristics including high-risk white blood cell count at diagnosis and Philadelphia chromosome status as well as treatment-related factors including chemotherapy regimen or completion of intensive therapy were not. Many patients were unable to initiate or remain on maintenance therapy due to toxicities including infections and cytopenias. Our analysis reveals the benefit of prolonged therapy in the treatment of older adults with ALL as well as the high incidence of treatment-related toxicity experienced by these patients. Copyright © 2013 Wiley Periodicals, Inc.

  6. Influence of Employee Involvement in Total Productive Maintenance Practices on Job Characteristics: The Malaysian Scenario

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    Aizzat Mohd. Nasurdin

    2005-09-01

    Full Text Available The main goal of this study is to examine whether the extent of involvement in Total Productive Maintenance (TPM practices has a positive effect on job characteristics. Data was gathered from a sample of 184 respondents derived from manufacturing companies in Malaysia. Results from the regression analyses revealed that the extent of employee’s involvement in TPM practices is positively related to the five core job dimensions (skill variety, task identity, task significance, autonomy, and feedback. Theoretical and managerial implications of the findings are discussed.

  7. The Possible Effects of Methadone Maintenance Therapy on Erectile Dysfunction in Male Addicts Visiting MMT Centers of Rasht

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    Morteza Rahbar Taramsari

    2014-06-01

    Full Text Available Background: Methadone is considered a long-acting opioid agonist which is widely used in the treatment of drug addiction. It is believed that opioids can cause erectile dysfunction (ED by inhibiting gonadotropin and testosterone release. This study is aimed at defining the possible effects of conservative treatment with methadone on erectile dysfunction in the addicts. Methods: A total of 382 male addicts visiting methadone maintenance therapy (MMT centers in Rasht, Iran, during 2010 were enrolled in this study. International Index of Erectile Function (IIEF questionnaire and patients' profiles were the main means of collecting data on demographic information, methadone dose intake, and erectile function status before and after the two months of therapy with methadone. Erectile function status was defined by the total score from questions 1, 2, 3, 4, 5, and 15 of the questionnaire. The data was analyzed by X2, McNemer’s test, and paired t-test using SPSS software 18. Results: The mean age of patients was 37.6 ± 8.9 years (range: 18-72 years. Most of the patients were married (79.3% and they were citizens of Rasht (72.3%. The most frequent substances were opium (188 patients, 49.2% and crack (129 patients, 33.8%, respectively. Most of the patients received low dose methadone (286 patients, 74.9%. No significant relationship was indicated comparing the average scores of erectile function before and after taking methadone (18.53±6.978 vs. 19.03±5.819 (P=0.138. However, the severity of erectile dysfunction was significantly related to the methadone intake dose (P<0.001. Conclusion: Although MMT increases the frequency of erectile dysfunction, appropriate doses of methadone minimize this effect.

  8. [Acupuncture therapy for the improvement of sleep quality of outpatients receiving methadone maintenance treatment: a randomized controlled trial].

    Science.gov (United States)

    Li, Yi; Liu, Xue-bing; Zhang, Yao

    2012-08-01

    To study the efficacy and safety of acupuncture therapy for the improvement of sleep quality of outpatients receiving methadone maintenance treatment (MMT). Using randomized double-blinded controlled design, seventy-five MMT outpatients with low sleep quality [score of Pittsburgh sleep quality index (PSQI) > or = 8], were randomly assigned to the acupuncture group (38 cases) and the sham-acupuncture group (37 cases). All patients maintained previous MMT. Acupuncture was applied to Baihui (GV20), Shenmen (bilateral, TF4), Shenting (GV24), Sanyinjiao (bilateral, SP6), and Sishencong (EX-HN1) in the acupuncture group. The same procedures were performed in the sham-acupuncture group, but not to the acupoints (5 mm lateral to the acupoints selected in the acupuncture group) with shallow needling technique. The treatment was performed 5 times each week for 8 successive weeks. The PSQI was assessed before treatment, at the end of the 2nd, 4th, 6th, and 8th week of the treatment. The detection ratio of low sleep quality and the incidence of adverse acupuncture reactions were compared between the two groups at the end of the 8th week. The overall PSQI score was obviously higher in the acupuncture group than in the sham-acupuncture group with statistical difference (P acupuncture group (60.53%, 23/38 cases) than in the sham-acupuncture group (83.78%, 31/37 cases) with statistical difference (P acupuncture reaction was 5.26% (2/38 cases) in the acupuncture group and 2.70% (1/37 cases) in the sham-acupuncture group respectively, showing no statistical difference (P > 0.05). Acupuncture therapy could effectively and safely improve the sleep quality of outpatients receiving MMT.

  9. Impact of maintenance immunosuppressive therapy on the fecal microbiome of renal transplant recipients: Comparison between an everolimus- and a standard tacrolimus-based regimen.

    Directory of Open Access Journals (Sweden)

    Gianluigi Zaza

    Full Text Available The gut microbiome is the full set of microbes living in the gastrointestinal tract and is emerging as an important dynamic/fluid system that, if altered by environmental, dietetic or pharmacological factors, could considerably influence drug response. However, the immunosuppressive drug-induced modifications of this system are still poorly defined.We employed an innovative bioinformatics approach to assess differences in the whole-gut microbial metagenomic profile of 20 renal transplant recipients undergoing maintenance treatment with two different immunosuppressive protocols. Nine patients were treated with everolimus plus mycophenolate mofetil (EVE+MMF group, and 11 patients were treated with a standard therapy with tacrolimus plus mycophenolate mofetil (TAC+MMF group.A statistical analysis of comparative high-throughput data demonstrated that although similar according to the degree of Shannon diversity (alpha diversity at the taxonomic level, three functional genes clearly discriminated EVE+MMF versus TAC+MMF (cutoff: log2 fold change≥1, FDR≤0.05. Flagellar motor switch protein (fliNY and type IV pilus assembly protein pilM (pilM were significantly enriched in TAC+MMF-treated patients, while macrolide transport system mrsA (msrA was more abundant in patients treated with EVE+MMF. Finally, PERMANOVA revealed that among the variables analyzed and included in our model, only the consumption of sugar significantly influenced beta diversity.Our study, although performed on a relatively small number of patients, showed, for the first time, specific immunosuppressive-related effects on fecal microbiome of renal transplant recipients and it suggested that the analysis of the gut microbes community could represent a new tool to better understand the effects of drugs currently employed in organ transplantations. However, multicenter studies including healthy controls should be undertaken to better address this objective.

  10. Impact of maintenance immunosuppressive therapy on the fecal microbiome of renal transplant recipients: Comparison between an everolimus- and a standard tacrolimus-based regimen.

    Science.gov (United States)

    Zaza, Gianluigi; Dalla Gassa, Alessandra; Felis, Giovanna; Granata, Simona; Torriani, Sandra; Lupo, Antonio

    2017-01-01

    The gut microbiome is the full set of microbes living in the gastrointestinal tract and is emerging as an important dynamic/fluid system that, if altered by environmental, dietetic or pharmacological factors, could considerably influence drug response. However, the immunosuppressive drug-induced modifications of this system are still poorly defined. We employed an innovative bioinformatics approach to assess differences in the whole-gut microbial metagenomic profile of 20 renal transplant recipients undergoing maintenance treatment with two different immunosuppressive protocols. Nine patients were treated with everolimus plus mycophenolate mofetil (EVE+MMF group), and 11 patients were treated with a standard therapy with tacrolimus plus mycophenolate mofetil (TAC+MMF group). A statistical analysis of comparative high-throughput data demonstrated that although similar according to the degree of Shannon diversity (alpha diversity) at the taxonomic level, three functional genes clearly discriminated EVE+MMF versus TAC+MMF (cutoff: log2 fold change≥1, FDR≤0.05). Flagellar motor switch protein (fliNY) and type IV pilus assembly protein pilM (pilM) were significantly enriched in TAC+MMF-treated patients, while macrolide transport system mrsA (msrA) was more abundant in patients treated with EVE+MMF. Finally, PERMANOVA revealed that among the variables analyzed and included in our model, only the consumption of sugar significantly influenced beta diversity. Our study, although performed on a relatively small number of patients, showed, for the first time, specific immunosuppressive-related effects on fecal microbiome of renal transplant recipients and it suggested that the analysis of the gut microbes community could represent a new tool to better understand the effects of drugs currently employed in organ transplantations. However, multicenter studies including healthy controls should be undertaken to better address this objective.

  11. Impact of maintenance immunosuppressive therapy on the fecal microbiome of renal transplant recipients: Comparison between an everolimus- and a standard tacrolimus-based regimen

    Science.gov (United States)

    Dalla Gassa, Alessandra; Felis, Giovanna; Granata, Simona; Torriani, Sandra; Lupo, Antonio

    2017-01-01

    Background The gut microbiome is the full set of microbes living in the gastrointestinal tract and is emerging as an important dynamic/fluid system that, if altered by environmental, dietetic or pharmacological factors, could considerably influence drug response. However, the immunosuppressive drug-induced modifications of this system are still poorly defined. Methods We employed an innovative bioinformatics approach to assess differences in the whole-gut microbial metagenomic profile of 20 renal transplant recipients undergoing maintenance treatment with two different immunosuppressive protocols. Nine patients were treated with everolimus plus mycophenolate mofetil (EVE+MMF group), and 11 patients were treated with a standard therapy with tacrolimus plus mycophenolate mofetil (TAC+MMF group). Results A statistical analysis of comparative high-throughput data demonstrated that although similar according to the degree of Shannon diversity (alpha diversity) at the taxonomic level, three functional genes clearly discriminated EVE+MMF versus TAC+MMF (cutoff: log2 fold change≥1, FDR≤0.05). Flagellar motor switch protein (fliNY) and type IV pilus assembly protein pilM (pilM) were significantly enriched in TAC+MMF-treated patients, while macrolide transport system mrsA (msrA) was more abundant in patients treated with EVE+MMF. Finally, PERMANOVA revealed that among the variables analyzed and included in our model, only the consumption of sugar significantly influenced beta diversity. Conclusions Our study, although performed on a relatively small number of patients, showed, for the first time, specific immunosuppressive-related effects on fecal microbiome of renal transplant recipients and it suggested that the analysis of the gut microbes community could represent a new tool to better understand the effects of drugs currently employed in organ transplantations. However, multicenter studies including healthy controls should be undertaken to better address this

  12. Effect of Helicobacter pylori eradication and antisecretory maintenance therapy on peptic ulcer recurrence in cirrhotic patients: a prospective, cohort 2-year follow-up study.

    Science.gov (United States)

    Tzathas, Charalambos; Triantafyllou, Konstantinos; Mallas, Elias; Triantafyllou, George; Ladas, Spiros D

    2008-07-01

    The role of Helicobacter pylori eradication to cure peptic ulcer disease in patients with cirrhosis is not clear. To investigate the course of peptic ulcer disease in cirrhotics, first after healing with either H. pylori eradication or omeprazole therapy and second while on omeprazole maintenance therapy after recurrence. Prospective cohort study in a tertiary-care hospital in Greece. Out of 365 consecutive cirrhotic patients who underwent endoscopy, 67 had peptic ulcer and 30 were enrolled. H. pylori positive patients received eradication therapy and H. pylori negative patients received omeprazole treatment. Follow-up endoscopies were performed at 12 and 24 months or when symptoms recurred. Patients with ulcer recurrence were treated with omeprazole maintenance therapy. The main outcome measurement of the study was peptic ulcer relapse rate during follow-up. Twenty-eight patients with healed ulcers were followed for up to 2 years. During follow-up, ulcer relapsed in 17 patients (8/18 H. pylori positive and 9/10 H. pylori negative at study entry, P=0.041), including 2 patients who died from ulcer bleeding. No further ulcer relapse was observed in the remaining 15 patients who received omeprazole maintenance therapy for the rest of follow-up. H. pylori negative status (P=0.002) and severity of cirrhosis (P=0.015) at study entry were independently related to shorter peptic ulcer relapse-free time. H. pylori eradication does not protect all cirrhotics from ulcer recurrence and the majority of ulcers recur in H. pylori negative patients. Therefore, omeprazole maintenance treatment is mandatory, irrespectively of H. pylori status.

  13. Dose-related difference in progression rates of cytomegalovirus retinopathy during foscarnet maintenance therapy. AIDS Clinical Trials Group Protocol 915 Team.

    Science.gov (United States)

    Holland, G N; Levinson, R D; Jacobson, M A

    1995-05-01

    A previous dose-ranging study of foscarnet maintenance therapy for cytomegalovirus retinopathy showed a positive relationship between dose and survival but could not confirm a relationship between dose and time to first progression. This retrospective analysis of data from that study was undertaken to determine whether there was a relationship between dose and progression rates, which reflects the amount of retina destroyed when progression occurs. Patients were randomly given one of two foscarnet maintenance therapy doses (90 mg/kg of body weight/day [FOS-90 group] or 120 mg/kg of body weight/day [FOS-120 group] after induction therapy. Using baseline and follow-up photographs and pre-established definitions and methodology in a masked analysis, posterior progression rates and foveal proximity rates for individual lesions, selected by prospectively defined criteria, were calculated in each patient. Rates were compared between groups. The following median rates were greater for the FOS-90 group (N = 8) than for the FOS-120 group (N = 10): greatest maximum rate at which lesions enlarged in a posterior direction (43.5 vs 12.5 microns/day; P = .002); posterior progression rate for lesions closest to the fovea (42.8 vs 5.5 microns/day; P = .010); and maximum foveal proximity rate for either eye (32.3 vs 3.4 microns/day; P = .031). Patients receiving higher doses of foscarnet have slower rates of progression and therefore less retinal tissue damage during maintenance therapy. A foscarnet maintenance therapy dose of 120 mg/kg of body weight/day instead of 90 mg/kg of body weight/day may help to preserve vision in patients with cytomegalovirus retinopathy.

  14. Influence of accompanying immunocorrecting therapy on the quality of life of breast cancer patients at post-operative radiation therapy

    International Nuclear Information System (INIS)

    Prokhach, N.E.

    2013-01-01

    To investigate the influence of accompanying immunotherapy on the parameters of the quality of life of the patients with breast cancer with various profiles of cytokines at post-operative radiation therapy. The study was performed on 30 breast cancer patients at stages of combination therapy

  15. Maintenance based Bevacizumab versus complete stop or continuous therapy after induction therapy in first line treatment of stage IV colorectal cancer: A meta-analysis of randomized clinical trials.

    Science.gov (United States)

    Tamburini, Emiliano; Rudnas, Britt; Santelmo, Carlotta; Drudi, Fabrizio; Gianni, Lorenzo; Nicoletti, Stefania V L; Ridolfi, Claudio; Tassinari, Davide

    2016-08-01

    In stage IV colorectal cancer, bevacizumab-based maintenance therapy, complete stop therapy and continuous therapy are considered all possible approaches after first line induction chemotherapy. However, there are no clear data about which approach is preferable. All randomized phase III trials comparing bevacizumab-based maintenance therapy (MB) with complete stop therapy (ST) or with continuous therapy (CT) were considered eligible and included into the analysis. Primary endpoint was the Time to failure strategies (TFS). Secondary endpoints were Overall Survival (OS) and Progression free survival (PFS). Meta-analysis was performed in line with the PRISMA statement. 1892 patients of five trials were included into the analysis. A significant improvement in TFS (HR 0.79; CI 95% 0.7-0.9 p=0.0005) and PFS (HR 0.56; CI 95% 0.44-0.71 p<0.00001) were observed in favour of MB versus ST. A trend, but not statistically significant, in favour of MB versus ST was also observed for OS (HR 0.88; CI 95% 0.77-1.01, p=0.08). Comparing maintenance therapy versus continuous therapy no statistically differences were observed in the outcomes evaluated (OS 12 months OR 1.1 p=0.62, OS 24 months OR 1 p=1, OS 36 months OR 0.54 p=0.3, TFS 12 months OR 0.76 p=0.65). Our meta-analysis suggests that use of MB approach increases TFS, PFS compared to ST. Although without observing any statistically advantage, it should be highlighted that MB versus ST showed a trend in favour of MB. We observed no difference between MB and CT. MB should be considered the standard regimen in patients with stage IV colorectal cancer after first line induction therapy. Copyright © 2016 Elsevier Ireland Ltd. All rights reserved.

  16. Police bribery and access to methadone maintenance therapy within the context of drug policy reform in Tijuana, Mexico.

    Science.gov (United States)

    Werb, D; Wagner, K D; Beletsky, L; Gonzalez-Zuniga, Patricia; Rangel, Gudelia; Strathdee, S A

    2015-03-01

    In 2009, Mexico passed legislation to decriminalize drug possession and improve access to addiction treatment. We undertook research to assess the implementation of the reform among a cohort of people who inject drugs (PWID) in Tijuana. This study specifically sought to determine whether discretionary policing practices like extortion impact access to methadone maintenance therapy (MMT) in Tijuana, a city characterized by high levels of drug-related harms. Generalized estimating equation analyses were used to construct longitudinal confounding models to determine the association between paying a police bribe and MMT enrolment among PWID in Tijuana enrolled in a prospective cohort study. Outcome of interest was MMT enrolment in the past six months. Data on police interactions and MMT enrolment were also obtained. Between October, 2011 and September, 2013, 637 participants provided 1825 observations, with 143 (7.8%) reports of MMT enrolment during the study period. In a final confounding model, recently reporting being forced to pay a bribe to police was significantly associated with an increased likelihood of accessing MMT (adjusted odds ratio=1.69, 95% confidence interval: 1.02-2.81, p=0.043). However, in 56 (39.2%) cases, MMT enrolment ceased within six months. The majority of participant responses cited the fact that MMT was too expensive (69.1%). Levels of MMT access were low. PWID who experienced police extortion were more likely to access MMT at baseline, though this association decreased during the study period. Coupled with the costs of MMT, this may compromise MMT retention among PWID. Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.

  17. Efficacy of Cognitive Behavioral Therapy on Opiate Use and Retention in Methadone Maintenance Treatment in China: A Randomised Trial.

    Directory of Open Access Journals (Sweden)

    Shujun Pan

    Full Text Available Methadone maintenance treatment (MMT is widely available in China; but, high rates of illicit opiate use and dropout are problematic. The aim of this study was to test whether cognitive behavioral therapy (CBT in conjunction with MMT can improve treatment retention and reduce opiate use.A total of 240 opiate-dependent patients in community-based MMT clinics were randomly assigned to either weekly CBT plus standard MMT (CBT group, n=120 or standard MMT (control group, n=120 for 26 weeks. The primary outcomes were treatment retention and opiate-negative urine test results at 12 weeks and 26 weeks. The secondary outcomes were composite scores on the Addiction Severity Index (ASI and total scores on the Perceived Stress Scale (PSS at 12 weeks and 26 weeks.Compared to the control group in standard MMT, the CBT group had higher proportion of opiate-negative urine tests at both 12 weeks (59% vs. 69%, p<0.05 and 26 weeks (63% vs. 73%, p<0.05; however, the retention rates at 12 weeks (73.3% vs. 74.2%, p=0.88 and 26 weeks were not different (55.8% vs. 64.2%, p=0.19 between the two groups. At both 12 and 26 weeks, all of the ASI component scores and PSS total scores in the CBT group and control group decreased from baseline; but the CBT group exhibited more decreases in ASI employment scores at week 26 and more decrease in the PSS total score at week 12 and week 26.CBT counselling is effective in reducing opiate use and improving employment function and in decreasing stress level for opiate-dependent patients in MMT in China.ClinicalTrials.gov NCT01144390.

  18. Evaluation of the vaginal flora in pregnant women receiving opioid maintenance therapy: a matched case-control study.

    Science.gov (United States)

    Farr, Alex; Kiss, Herbert; Hagmann, Michael; Holzer, Iris; Kueronya, Verena; Husslein, Peter W; Petricevic, Ljubomir

    2016-08-05

    Vaginal infections are a risk factor for preterm delivery. In this study, we sought to evaluate the vaginal flora of pregnant women receiving opioid maintenance therapy (OMT) in comparison to non-dependent, non-maintained controls. A total of 3763 women with singleton pregnancies who underwent routine screening for asymptomatic vaginal infections between 10 + 0 and 16 + 0 gestational weeks were examined. Vaginal smears were Gram-stained, and microscopically evaluated for bacterial vaginosis, candidiasis, and trichomoniasis. In a retrospective manner, data of 132 women receiving OMT (cases) were matched for age, ethnicity, parity, education, previous preterm delivery, and smoking status to the data of 3631 controls. The vaginal flora at antenatal screening served as the primary outcome measure. Secondary outcome measures were gestational age and birth weight. In the OMT group, 62/132 (47 %) pregnant women received methadone, 39/132 (29.5 %) buprenorphine, and 31/132 (23.5 %) slow-release oral morphine. Normal or intermediate flora was found in 72/132 OMT women (54.5 %) and 2865/3631 controls [78.9 %; OR 0.49 (95 % CI, 0.33-0.71); p Candidiasis occurred more frequently in OMT women than in controls [OR 2.11 (95 % CI, 1.26-3.27); p candidiasis) and trichomoniasis. Compared to infants of the control group, those of women with OMT had a lower mean birth weight [MD -165.3 g (95 % CI, -283.6 to -46.9); p = 0.006]. Pregnant women with OMT are at risk for asymptomatic vaginal infections. As recurrent candidiasis is associated with preterm delivery, the vulnerability of this patient population should lead to consequent antenatal infection screening at early gestation.

  19. Practice of Acute and Maintenance Electroconvulsive Therapy in the Psychiatric Clinic of a University Hospital from Turkey: between 2007 and 2013

    Science.gov (United States)

    Sengul, Melike Ceyhan Balci; Kenar, Ayse Nur Inci; Hanci, Ezgi; Sendur, İbrahim; Sengul, Cem; Herken, Hasan

    2016-01-01

    Objective Electroconvulsive therapy (ECT) can be given as the form of acute, continuation or maintenance ECT according to the process of administration. We report our 7 years’ observation with acute and maintenance ECT in a university hospital in Turkey. Methods The medical records of the hospitalized patients treated with acute or maintenance ECT between the years 2007 and 2013 was retrospectively analyzed. The sociodemographic characteristics, diagnosis, data of ECT and the co-administered psychotropic drugs were recorded. The frequency of ECT was calculated by identifying the total number of the hospitalized patients during the study period from the hospital records. Results A total number of 1,432 female and 1,141 male patients hospitalized in a period of 7 years, with a total number of 111 patients treated with ECT. The ratio of ECT was 4%, maintenance/acute ECT 11%. For acute ECT, affective disorders (65.3%) and psychotic disorders (21.6%) were among the leading diagnoses. Maintenance ECT, the diagnosis was; 6 affective disorders, 4 psychotic disorders and 1 obsessive compulsive disorder. There was a significant difference between the patients receiving acute and maintenance ECT in terms of age, duration of illness, and number of previous hospitalizations and ECTs. Conclusion The percentage of patients treated with acute ECT is lower in our institution than that in many other institutions from our country. Acute and maintenance ECT should be considered as an important treatment option particularly for patients with long disease duration, a high number of hospitalizations and a history of benefiting from previous ECTs. PMID:26792041

  20. Maintenance Therapy in IBD

    Science.gov (United States)

    ... also found to be safe and well tolerated. Immunomodulators 6-MP and Azathioprine 6-mercaptopurine (6-MP, ... to a tumor necrosis factor (TNF) blocker or immunomodulator; or had an inadequate response with, were intolerant ...

  1. Improved inflammatory activity with peginterferon alfa-2b maintenance therapy in non-cirrhotic prior non-responders: a randomized study.

    Science.gov (United States)

    Poynard, Thierry; Bruix, Jordi; Schiff, Eugene R; Diago, Moises; Berg, Thomas; Moreno-Otero, Ricardo; Lyra, Andre C; Carrilho, Flair; Griffel, Louis H; Boparai, Navdeep; Jiang, Ruiyun; Burroughs, Margaret; Brass, Clifford A; Albrecht, Janice K

    2013-03-01

    Therapeutic options for patients failing hepatitis C retreatment are limited. EPIC(3) included a prospective trial assessing long-term peginterferon alfa-2b (PegIFNα-2b) maintenance therapy in patients with METAVIR fibrosis scores (MFS) of F2 or F3 who previously failed hepatitis C retreatment. Patients with F2/F3 MFS who failed retreatment were randomized to PegIFNα-2b (0.5 μg/kg/week, n=270) or observation (n=270) for 36 months. Blinded liver biopsies obtained before retreatment and after maintenance therapy were evaluated using MFS and activity scores, and confirmatory testing was performed using FibroTest and ActiTest. In total, 348 patients had paired biopsies: 192 patients had missing post-treatment biopsies and were considered as having no change in fibrosis/activity scores. In total, 16% of patients receiving PegIFNα-2b and 11% of observation patients had improvement in MFS (p=0.32). More PegIFNα-2b than observation patients had improvement in activity score (20% vs. 9%; p 2.5 years, improvement in MFS or activity score was more common with PegIFNα-2b than observation (21% vs. 14%, p=0.08 and 26% vs. 10%, p 2.5 years. Both FibroTest and ActiTest were significantly improved during maintenance therapy. Copyright © 2012 European Association for the Study of the Liver. Published by Elsevier B.V. All rights reserved.

  2. Perceptions That Influence the Maintenance of Scientific Integrity in Community-Based Participatory Research

    Science.gov (United States)

    Kraemer Diaz, Anne E.; Spears Johnson, Chaya R.; Arcury, Thomas A.

    2015-01-01

    Scientific integrity is necessary for strong science; yet many variables can influence scientific integrity. In traditional research, some common threats are the pressure to publish, competition for funds, and career advancement. Community-based participatory research (CBPR) provides a different context for scientific integrity with additional and…

  3. Nuclear HMGA1 nonhistone chromatin proteins directly influence mitochondrial transcription, maintenance, and function

    International Nuclear Information System (INIS)

    Dement, Gregory A.; Maloney, Scott C.; Reeves, Raymond

    2007-01-01

    We have previously demonstrated that HMGA1 proteins translocate from the nucleus to mitochondria and bind to mitochondrial DNA (mtDNA) at the D-loop control region [G.A. Dement, N.R. Treff, N.S. Magnuson, V. Franceschi, R. Reeves, Dynamic mitochondrial localization of nuclear transcription factor HMGA1, Exp. Cell Res. 307 (2005) 388-401.] [11]. To elucidate possible physiological roles for such binding, we employed methods to analyze mtDNA transcription, mitochondrial maintenance, and other organelle functions in transgenic human MCF-7 cells (HA7C) induced to over-express an HA-tagged HMGA1 protein and control (parental) MCF-7 cells. Quantitative real-time (RT) PCR analyses demonstrated that mtDNA levels were reduced approximately 2-fold in HMGA1 over-expressing HA7C cells and flow cytometric analyses further revealed that mitochondrial mass was significantly reduced in these cells. Cellular ATP levels were also reduced in HA7C cells and survival studies showed an increased sensitivity to killing by 2-deoxy-D-glucose, a glycolysis-specific inhibitor. Flow cytometric analyses revealed additional mitochondrial abnormalities in HA7C cells that are consistent with a cancerous phenotype: namely, increased reactive oxygen species (ROS) and increased mitochondrial membrane potential (ΔΨ m ). Additional RT-PCR analyses demonstrated that gene transcripts from both the heavy (ND2, COXI, ATP6) and light (ND6) strands of mtDNA were up-regulated approximately 3-fold in HA7C cells. Together, these mitochondrial changes are consistent with many previous reports and reveal several possible mechanisms by which HMGA1 over-expression, a common feature of naturally occurring cancers, may affect tumor progression

  4. Acute electroconvulsive therapy followed by maintenance electroconvulsive therapy decreases hospital re-admission rates of older patients with severe mental illness.

    Science.gov (United States)

    Shelef, Assaf; Mazeh, Doron; Berger, Uri; Baruch, Yehuda; Barak, Yoram

    2015-06-01

    Electroconvulsive therapy (ECT) is a highly effective treatment for patients with severe mental illness (SMI). Maintenance ECT (M-ECT) is required for many elderly patients experiencing severe recurrent forms of mood disorders, whereas M-ECT for schizophrenia patients is a poorly studied treatment. We report on the outcomes in aged patients with SMI: schizophrenia and severe affective disorders treated by M-ECT of varying duration to prevent relapse after a successful course of acute ECT. The study measured the effectiveness of M-ECT in preventing hospital readmissions and reducing admission days. A retrospective chart review of 42 consecutive patients comparing the number and length of psychiatric admissions before and after the start of M-ECT was used. We analyzed diagnoses, previous ECT treatments, number of ECT treatments, and number and length of psychiatric admissions before and after M-ECT. Mean age in our sample was 71.5 (6.9) years. Twenty-two (52%) patients experienced severe affective disorders and 20 (48%) experienced schizophrenia. Patients were administered 92.8 (85.9) M-ECT treatments. Average duration of the M-ECT course was 34 (29.8) months. There were on average 1.88 admissions before M-ECT and only 0.38 admissions in the M-ECT period (P < 0.001). Duration of mean hospitalization stay decreased from 215.9 to 12.4 days during the M-ECT (P < 0.01). Our findings suggest that acute ECT followed by M-ECT is highly effective in selected elderly patients with SMIs.

  5. [Current situation related to antiretroviral therapy and related influential factors on HIV infected injection drug users in the methadone maintenance treatment clinics].

    Science.gov (United States)

    Cheng, Xiao-Qing; Pang, Lin; Cao, Xiao-Bin; Wang, Chang-He; Luo, Wei; Zhang, Bo; Wang, Hua; Li, Rong-Jian; Rou, Ke-Ming; Wu, Zun-You

    2013-08-01

    To find out the current coverage of antiretroviral therapy (ART) among HIV positive subjects and to identify the major influential factors associated with the participation in ART among them. 291 HIV positive subjects from 6 methadone maintenance treatment (MMT) clinics in Guangxi and Yunnan province were surveyed by questionnaires. 217 males (74.6%) and 74 females (25.4%) were under investigation, with the average age of 38.4 +/- 5.9. Most of them received less than senior high school education, married and unemployed. Results from the single factor logistic regression analysis showed that: working status, living alone, self-reported history of drinking alcohol in the last month, negative attitude towards MMT among family members,poor self-reported compliance to MMT in the last month,lack of incentives in the MMT clinics, reluctance on disclosure of their own HIV status, good self-perception on their health status, lack of communication on ART related topics among family members in the last 6 months, lack of correct attitude and knowledge on ART etc. appeared as the main factors that influencing the participation in ART program among the patients. Data from the multivariate logistic regression analysis showed that factors as: living alone, unwilling to tell others about the status of HIV infection, poor self-perception on HIV infection, lack of discussion of ART related topics within family members in the last 6 months and poor awareness towards ART among the family members etc., were associated with the low participation rate of ART. Conclusion Strengthening the publicity and education programs on HIV positive patients and their family members at the MMT clinics seemed to be effective in extending the ART coverage. Attention should also be paid to increase the family support to the patients.

  6. Influence of CYP3A5 genetic variation on everolimus maintenance dosing after cardiac transplantation.

    Science.gov (United States)

    Lesche, Dorothea; Sigurdardottir, Vilborg; Setoud, Raschid; Englberger, Lars; Fiedler, Georg M; Largiadèr, Carlo R; Mohacsi, Paul; Sistonen, Johanna

    2015-12-01

    Everolimus (ERL) has become an alternative to calcineurin inhibitors (CNIs) due to its renal-sparing properties, especially in heart transplant (HTx) recipients with kidney dysfunction. However, ERL dosing is challenging due to its narrow therapeutic window combined with high interindividual pharmacokinetic variability. Our aim was to evaluate the effect of clinical and genetic factors on ERL dosing in a pilot cohort of 37 HTx recipients. Variants in CYP3A5, CYP3A4, CYP2C8, POR, NR1I2, and ABCB1 were genotyped, and clinical data were retrieved from patient charts. While ERL trough concentration (C0 ) was within the targeted range for most patients, over 30-fold variability in the dose-adjusted ERL C0 was observed. Regression analysis revealed a significant effect of the non-functional CYP3A5*3 variant on the dose-adjusted ERL C0 (p = 0.031). ERL dose requirement was 0.02 mg/kg/d higher in patients with CYP3A5*1/*3 genotype compared to patients with CYP3A5*3/*3 to reach the targeted C0 (p = 0.041). ERL therapy substantially improved estimated glomerular filtration rate (28.6 ± 6.6 mL/min/1.73 m(2)) in patients with baseline kidney dysfunction. Everolimus pharmacokinetics in HTx recipients is highly variable. Our preliminary data on patients on a CNI-free therapy regimen suggest that CYP3A5 genetic variation may contribute to this variability. © 2015 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

  7. Influence of building maintenance, environmental factors, and seasons on airborne contaminants of swine confinement buildings.

    Science.gov (United States)

    Duchaine, C; Grimard, Y; Cormier, Y

    2000-01-01

    Eight swine confinement buildings, selected to cover the widest possible range of cleanliness, were visited twice during winter and once during summer to verify the range, seasonal variations, and correlations between biological and chemical contaminants. Physical aspects were graded for dirtiness (1 = clean, 10 = dirty), ventilation, air temperature, number of animals, building, and room size. Air samples were taken to measure relative humidity, CO2, ammonia, total dust, and microbiological counts and/or identification (bacteria and molds); endotoxin levels also were measured. During winter, average measurements and ranges were: CO2 = 0.304% (0.254 to 0.349%); ammonia = 19.6 ppm (1.9 to 25.9 ppm); dust = 3.54 mg/m3 (2.15 to 5.60 mg/m3). There were 883 cfu/m3 (547 to 2862 cfu/m3) of molds, 4.25 x 10(5) cfu/m3 (1.67 x 10(5) to 9.30 x 10(5) cfu/m3) of total bacteria, 29 cfu/m3 (3 to 94 cfu/m3) of thermophilic actinomycetes). A significant decrease in bacterial levels (p = 0.04), dust (p = 0.0008), ammonia (p = 0.005), and CO2 (p < 0.0001) was observed during summer sampling when compared with winter levels. Mold counts were positively correlated (p = 0.03) with dirtiness scores, while bacterial counts were negatively correlated with this parameter (p < 0.002), whereas bacteria and endotoxins were correlated with the number of animals (p < 0.05). Ambient gases (CO2 and ammonia) correlated with each other (p = 0.006). Bacteria were the most important contaminant in swine confinement buildings, and endotoxin levels found were also very high (mean = 4.9 x 10(3) EU/m3). We conclude that a wide range of air contamination exists in swine confinement buildings of different maintenance. There is a decrease in some of these contaminants during summer. Observed dirtiness of the swine confinement buildings has a poor predictive value concerning air quality.

  8. Improving Naval Aviation Maintenance Quality Management Processes at the Organizational Maintenance Level: The Influences of the International Standards Organization (ISO) 9000 Quality Management System on the Naval Aviation Maintenance Program (NAMP)

    National Research Council Canada - National Science Library

    Couch, Christopher

    1999-01-01

    ... to make them consistent with the ISO 9000 QMS. The NAMP is Naval aviation's overall guiding document that outlines command, administrative, and management relationships, and assigns maintenance policy and procedure responsibilities...

  9. Assessing the influence of sustainable trail design and maintenance on soil loss

    Science.gov (United States)

    Marion, Jeff; Wimpey, Jeremy

    2017-01-01

    Natural-surfaced trail systems are an important infrastructure component providing a means for accessing remote protected natural area destinations. The condition and usability of trails is a critical concern of land managers charged with providing recreational access while preserving natural conditions, and to visitors seeking high quality recreational opportunities and experiences. While an adequate number of trail management publications provide prescriptive guidance for designing, constructing, and maintaining natural-surfaced trails, surprisingly little research has been directed at providing a scientific basis for this guidance. Results from a review of the literature and three scientific studies are presented to model and clarify the influence of factors that substantially influence trail soil loss and that can be manipulated by trail professionals to sustain high traffic while minimizing soil loss over time. Key factors include trail grade, slope alignment angle, tread drainage features, and the amount of rock in tread substrates. A new Trail Sustainability Rating is developed and offered as a tool for evaluating or improving the sustainability of existing or new trails.

  10. Assessing the influence of sustainable trail design and maintenance on soil loss.

    Science.gov (United States)

    Marion, Jeffrey L; Wimpey, Jeremy

    2017-03-15

    Natural-surfaced trail systems are an important infrastructure component providing a means for accessing remote protected natural area destinations. The condition and usability of trails is a critical concern of land managers charged with providing recreational access while preserving natural conditions, and to visitors seeking high quality recreational opportunities and experiences. While an adequate number of trail management publications provide prescriptive guidance for designing, constructing, and maintaining natural-surfaced trails, surprisingly little research has been directed at providing a scientific basis for this guidance. Results from a review of the literature and three scientific studies are presented to model and clarify the influence of factors that substantially influence trail soil loss and that can be manipulated by trail professionals to sustain high traffic while minimizing soil loss over time. Key factors include trail grade, slope alignment angle, tread drainage features, and the amount of rock in tread substrates. A new Trail Sustainability Rating is developed and offered as a tool for evaluating or improving the sustainability of existing or new trails. Published by Elsevier Ltd.

  11. Influence of the Mesh Geometry Evolution on Gearbox Dynamics during Its Maintenance

    Science.gov (United States)

    Dąbrowski, Z.; Dziurdź, J.; Klekot, G.

    2017-12-01

    Toothed gears constitute the necessary elements of power transmission systems. They are applied as stationary devices in drive systems of road vehicles, ships and crafts as well as airplanes and helicopters. One of the problems related to the toothed gears usage is the determination of their technical state or its evolutions. Assuming that the gear slippage velocity is attributed to vibrations and noises generated by cooperating toothed wheels, the application of a simple cooperation model of rolled wheels of skew teeth is proposed for the analysis of the mesh evolution influence on the gear dynamics. In addition, an example of utilising an ordinary coherence function for investigating evolutionary mesh changes related to the effects impossible to be described by means of the simple kinematic model is presented.

  12. What Predicts Exercise Maintenance and Well-Being? Examining The Influence of Health-Related Psychographic Factors and Social Media Communication.

    Science.gov (United States)

    Zhou, Xin; Krishnan, Archana

    2018-01-26

    Habitual exercising is an important precursor to both physical and psychological well-being. There is, thus, a strong interest in identifying key factors that can best motivate individuals to sustain regular exercise regimen. In addition to the importance of psychographic factors, social media use may act as external motivator by allowing users to interact and communicate about exercise. In this study, we examined the influence of health consciousness, health-oriented beliefs, intrinsic motivation, as willingness to communicate about health on social media, social media activity on exercise, and online social support on exercise maintenance and well-being on a sample of 532 American adults. Employing structural equation modeling, we found that health-oriented beliefs mediated the effect of health consciousness on intrinsic motivation which in turn was a significant predictor of exercise maintenance. Exercise maintenance significantly predicted both physical and psychological well-being. Extrinsic motivators, as measured by willingness to communicate about health on social media, social media activity on exercise, and online social support did not however significantly influence exercise maintenance. These findings have implications for the design and implementation of exercise-promoting interventions by identifying underlying factors that influence exercise maintenance.

  13. Retrospective study of various conservative treatment options with bacille Calmette-Guérin in bladder urothelial carcinoma T1G3: Maintenance therapy.

    Science.gov (United States)

    Palou-Redorta, J; Solsona, E; Angulo, J; Fernández, J M; Madero, R; Unda, M; Martínez-Piñeiro, J A; Portillo, J; Chantada, V; Moyano, J L

    2016-01-01

    To compare various conservative treatment options for high-grade T1 nonmuscle-invasive bladder cancer (NMIBC). Bacille Calmette-Guérin (BCG) is the preferred intravesical treatment for high-grade T1 tumours; however, a number of experts still question the need for maintenance BCG. We retrospectively analysed data from 1039 patients with primary and recurrent T1G3 NMIBC. All patients underwent complete transurethral resection of the bladder tumour (TURBT), with muscle in the sample and multiple bladder biopsies. The patients were treated with the following: only one initial TURBT (n=108), re-TURBT (n=153), induction with 27mg of BCG (Connaught strain) (n=87), induction with 81mg of BCG (n=489) or induction with 81mg of BCG+maintenance (n=202). The time to first recurrence, progression (to T2 or greater or to metastatic disease) and specific mortality of the disease was assessed using the Kaplan-Meier survival function and were compared using the log-rank test and the Cox multivariate regression model of proportional risks. The mean follow-up was 62±39 months. The risk of recurrence was significantly lower for the patients treated with maintenance therapy of 81mg of BCG than in the other treatment groups (P<.001). The risk of tumour progression was also significantly lower for the patients treated with maintenance BCG than for the patients treated only with one TURBT, re-TURBT and with induction therapy with 27mg of BCG (P=.0003). The specific disease mortality was significantly lower with BCG maintenance (9.4%) than with only one TURBT (27.8%; P=.003). In the case of T1G3 NMIBC, a complete dose of BCG with maintenance is associated with better recurrence results than are other conservative treatment modalities. The results of progression and survival specific to the disease were also better with induction BCG, with or without maintenance. Copyright © 2016 AEU. Publicado por Elsevier España, S.L.U. All rights reserved.

  14. VERSHINA – A POLISH VILLAGE IN SIBERIA. FACTORS INFLUENCING LANGUAGE MAINTENANCE UNDER CHANGING SOCIAL, CULTURAL, ECONOMIC AND POLITICAL CONDITIONS

    Directory of Open Access Journals (Sweden)

    Michał Głuszkowski

    2011-01-01

    Full Text Available The article discusses factors influencing language maintenance under changing social, cultural, economic and political conditions of Polish minority in Siberia. The village of Vershina was founded in 1910 by Polish voluntary settlers from Little Poland.During its first three decades Vershina preserved Polish language,traditions, farming methods and machines and also the Roman Catholic religion. The changes came to a village in taiga in the1930s. Vershina lost its ethnocultural homogeneity because of Russian and Buryat workers in the local kolkhoz. Nowadays the inhabitants of Vershina regained their minority rights: religious, educational and cultural. However, during the years of sovietization and ateization, their culture and customs became much more similar to other Siberian villages. Polish language in Vershina is under strong influence of Russian, which is the language of education,administration, and surrounding villages. Children from Polish-Russian families become monolingual and use Polish very rare, only asa school subject and in contacts with grandparents. The process of abandoning mother tongue in Vershina is growing rapidly. However,there are some factors which may hinder the actual changes:the activity of local Polish organisations and Roman Catholic parish as well as folk group “Jazhumbek”.

  15. Influence of technical maintenance measures on ecological status of agricultural lowland rivers - Systematic review and implications for river management.

    Science.gov (United States)

    Bączyk, Anna; Wagner, Maciej; Okruszko, Tomasz; Grygoruk, Mateusz

    2018-06-15

    Intensification of agriculture and ongoing urban sprawl exacerbate pressures on rivers. Small rivers in agricultural landscapes are especially exposed to excessive technical actions implemented in order to allow for harvesting river water for irrigation, draining agricultural water and receiving sewage. Regular dredging and macrophyte removal strongly interfere with the global need for preserving river biodiversity that allows agricultural lowland rivers to remain refuges for a variety of species, and-accordingly-to keep water bodies resilient for the benefit of society. In order to provide a comprehensive look at the influence of agricultural lowland river management on the ecological status of these water bodies, we conducted a literature review and a meta-analysis. For the structured literature review we selected 203 papers reflecting on the response of aquatic ecosystems to dredging and macrophyte management actions. The database of scientific contributions developed for our study consists of papers written by the authors from 33 countries (first authorship) addressing dredging, macrophyte removal, status of fish and macroinvertebrates as well as the general ecological status of lowland agricultural rivers. We revealed that 96% of the analyzed papers indicated unilateral, negative responses of aquatic ecosystems, particularly macroinvertebrates, ichthyofauna and macrophyte composition, to maintenance measures. We revealed that studies conducted in the European Union on the ecological status of rivers appeared to significantly increase in quantity after the implementation of the Water Framework Directive. Finally, we concluded that day-to-day management of lowland agricultural rivers requires revision in terms of compliance with environmental conservation requirements and the recurrent implementation of technical measures for river maintenance. Copyright © 2018 Elsevier B.V. All rights reserved.

  16. The Application of Family Therapy Concepts to Influencing Organizational Behavior.

    Science.gov (United States)

    Hirschhorn, Larry; Gilmore, Tom

    1980-01-01

    Explores, through an action research project, the possible contributions--in theory, diagnosis, and intervention--of structural family therapy to organizational change. Reports that successful transfer of family therapy techniques to organizations is contingent on understanding four differences between organizations and families. (Author/IRT)

  17. Influencing factors of radioiodine therapy in hyperthyroidism in adults

    International Nuclear Information System (INIS)

    Xu Jiehua; Zhang Zikang; Cheng Muhua; Wu Chunxing; Wang Ping; Shan Hong

    2007-01-01

    The study was to evaluate factors affecting outcome of 131 I therapy in hyperthyroidism for optimizing the method. Data from 213 patients who received 131 I treatment from July 2003 to July 2005 in our department were retrospectively analyzed. Factors possibly contributing to the outcome of the 1311 therapy were analyzed, including gender, age, history of antithyroid drag, thyroid volume, duration of disease and radioactive iodine uptake rate. Multivariate analysis was done. The rates of euthyroidism and hypothyroidism were 69% and 8.5%, respectively, after one time 131 I therapy. Multivariate analysis of the patients showed no statistically significant factors affecting the outcome of 131 I therapy. The study showed that 131 I dose can be directly calculated, and this simplifies the dose-determined method and individualizes the therapy. (authors)

  18. Perceptions that influence the maintenance of scientific integrity in community-based participatory research.

    Science.gov (United States)

    Kraemer Diaz, Anne E; Spears Johnson, Chaya R; Arcury, Thomas A

    2015-06-01

    Scientific integrity is necessary for strong science; yet many variables can influence scientific integrity. In traditional research, some common threats are the pressure to publish, competition for funds, and career advancement. Community-based participatory research (CBPR) provides a different context for scientific integrity with additional and unique concerns. Understanding the perceptions that promote or discourage scientific integrity in CBPR as identified by professional and community investigators is essential to promoting the value of CBPR. This analysis explores the perceptions that facilitate scientific integrity in CBPR as well as the barriers among a sample of 74 professional and community CBPR investigators from 25 CBPR projects in nine states in the southeastern United States in 2012. There were variations in perceptions associated with team member identity as professional or community investigators. Perceptions identified to promote and discourage scientific integrity in CBPR by professional and community investigators were external pressures, community participation, funding, quality control and supervision, communication, training, and character and trust. Some perceptions such as communication and training promoted scientific integrity whereas other perceptions, such as a lack of funds and lack of trust could discourage scientific integrity. These results demonstrate that one of the most important perceptions in maintaining scientific integrity in CBPR is active community participation, which enables a co-responsibility by scientists and community members to provide oversight for scientific integrity. Credible CBPR science is crucial to empower the vulnerable communities to be heard by those in positions of power and policy making. © 2015 Society for Public Health Education.

  19. Breast Conservation Therapy: The Influence of Molecular Subtype and Margins

    International Nuclear Information System (INIS)

    Demirci, Senem; Broadwater, Gloria; Marks, Lawrence B.; Clough, Robert; Prosnitz, Leonard R.

    2012-01-01

    Purpose: To evaluate treatment results and prognostic factors, especially margin status and molecular subtype, in early-stage breast cancer patients treated with breast conservation therapy (BCT). Methods and Materials: The records of 1,058 Stage I or II breast cancer patients treated with BCT (surgical excision plus radiotherapy) at Duke University Medical Center, Durham, North Carolina, from 1985–2005 were retrospectively reviewed. Conventional receptor analyses were used as surrogate markers for molecular subtype classification (luminal A, luminal B, Her2 positive, and basal like). Actuarial estimates of overall survival (OS), cause-specific survival (CSS), failure-free survival, and locoregional control (LRC) were computed by use of Kaplan-Meier plots. We analyzed prognostic variables for significance using Cox proportional hazards univariate and multivariate analysis. The study was approved by the Duke University Medical Center Institutional Review Board. Results: The median age of the patients was 56 years (range, 18–89 years). Of the patients, 80% had T1 disease and 66% N0 disease pathologically. With a median follow-up of 9.8 years, an in-breast recurrence developed in 53 patients and 10 patients had nodal failure. For all patients, the 10-year CSS rate was 94%; LRC rate, 94%; and failure-free survival rate, 88%. Luminal A patients had a CSS rate of 95% and LRC rate of 99%. Basal-type patients appeared to do worse, with regard to both CSS rate (74%) and LRC rate (76%), but the numbers were small and the difference was not statistically significant. LRC rates of patients with negative margins (widely negative, close, and extent of margin not known) were virtually identical (93%, 96%, and 94%, respectively). Those with positive margins appeared to fare slightly worse based on LRC rate (88%), but again, the numbers were small and the difference was not statistically significant. Conclusions: BCT remains the treatment of choice for early-stage breast cancer

  20. Breast Conservation Therapy: The Influence of Molecular Subtype and Margins

    Energy Technology Data Exchange (ETDEWEB)

    Demirci, Senem, E-mail: senem.demirci@ege.edu.tr [Department of Radiation Oncology, Duke University Medical Center, Durham, NC (United States); Department of Radiation Oncology, Ege University Faculty of Medicine, Izmir (Turkey); Broadwater, Gloria [Department of Biostatistics and Bioinformatics, Duke Cancer Institute, Durham, NC (United States); Cancer and Leukemia Group B Statistical Center, Duke Cancer Institute, Durham, NC (United States); Marks, Lawrence B. [Department of Radiation Oncology, University of North Carolina School of Medicine, Chapel Hill, NC (United States); Clough, Robert; Prosnitz, Leonard R. [Department of Radiation Oncology, Duke University Medical Center, Durham, NC (United States)

    2012-07-01

    Purpose: To evaluate treatment results and prognostic factors, especially margin status and molecular subtype, in early-stage breast cancer patients treated with breast conservation therapy (BCT). Methods and Materials: The records of 1,058 Stage I or II breast cancer patients treated with BCT (surgical excision plus radiotherapy) at Duke University Medical Center, Durham, North Carolina, from 1985-2005 were retrospectively reviewed. Conventional receptor analyses were used as surrogate markers for molecular subtype classification (luminal A, luminal B, Her2 positive, and basal like). Actuarial estimates of overall survival (OS), cause-specific survival (CSS), failure-free survival, and locoregional control (LRC) were computed by use of Kaplan-Meier plots. We analyzed prognostic variables for significance using Cox proportional hazards univariate and multivariate analysis. The study was approved by the Duke University Medical Center Institutional Review Board. Results: The median age of the patients was 56 years (range, 18-89 years). Of the patients, 80% had T1 disease and 66% N0 disease pathologically. With a median follow-up of 9.8 years, an in-breast recurrence developed in 53 patients and 10 patients had nodal failure. For all patients, the 10-year CSS rate was 94%; LRC rate, 94%; and failure-free survival rate, 88%. Luminal A patients had a CSS rate of 95% and LRC rate of 99%. Basal-type patients appeared to do worse, with regard to both CSS rate (74%) and LRC rate (76%), but the numbers were small and the difference was not statistically significant. LRC rates of patients with negative margins (widely negative, close, and extent of margin not known) were virtually identical (93%, 96%, and 94%, respectively). Those with positive margins appeared to fare slightly worse based on LRC rate (88%), but again, the numbers were small and the difference was not statistically significant. Conclusions: BCT remains the treatment of choice for early-stage breast cancer

  1. Influence of radioiodine therapy on urinary iodine excretion

    International Nuclear Information System (INIS)

    Meller, B.; Lauer, I.; Baehre, M.; Richter, E.

    1998-01-01

    In 214 patients with benign thyroid diseases the time-course of urinary iodine excretion (UIE) was investigated in order to identify changes after radioiodine therapy (RITh). Method: UIE was measured photometrically (cerium-arsenite method) and related to urinary creatinine on the first and last day of the radioiodine test and the three days, seven days, four weeks, and six months after 131 I administration. Results: As compared with the level found immediately before radioiodine therapy, median UIE had almost doubled four weeks after therapy and was still significantly elevated six months after therapy. This increase correlated significantly with the target volume as measured by scintigraphy and sonography. Conclusions: The persistent elevation of UIE for months after RITh is a measure of treatment-induced damage to thyrocytes. Therefore, in view of the unfavourable kinetics of iodine that follow it, RITh should if possible be given via a single-dose regime. (orig.) [de

  2. Maintenance therapy of childhood acute lymphoblastic leukemia revisited-Should drug doses be adjusted by white blood cell, neutrophil, or lymphocyte counts?

    Science.gov (United States)

    Schmiegelow, Kjeld; Nersting, Jacob; Nielsen, Stine Nygaard; Heyman, Mats; Wesenberg, Finn; Kristinsson, Jon; Vettenranta, Kim; Schrøeder, Henrik; Weinshilboum, Richard; Jensen, Katrine Lykke; Grell, Kathrine; Rosthoej, Susanne

    2016-12-01

    6-Mercaptopurine (6MP) and methotrexate (MTX) based maintenance therapy is a critical phase of childhood acute lymphoblastic leukemia treatment. Wide interindividual variations in drug disposition warrant frequent doses adjustments, but there is a lack of international consensus on dose adjustment guidelines. To identify relapse predictors, we collected 28,255 data sets on drug doses and blood counts (median: 47/patient) and analyzed erythrocyte (Ery) levels of cytotoxic 6MP/MTX metabolites in 9,182 blood samples (median: 14 samples/patient) from 532 children on MTX/6MP maintenance therapy targeted to a white blood cell count (WBC) of 1.5-3.5 × 10 9 /l. After a median follow-up of 13.8 years for patients in remission, stepwise Cox regression analysis did not find age, average doses of 6MP and MTX, hemoglobin, absolute lymphocyte counts, thrombocyte counts, or Ery levels of 6-thioguanine nucleotides or MTX (including its polyglutamates) to be significant relapse predictors. The parameters significantly associated with risk of relapse (N = 83) were male sex (hazard ratio [HR] 2.0 [1.3-3.1], P = 0.003), WBC at diagnosis (HR = 1.04 per 10 × 10 9 /l rise [1.00-1.09], P = 0.048), the absolute neutrophil count (ANC; HR = 1.7 per 10 9 /l rise [1.3-2.4], P = 0.0007), and Ery thiopurine methyltransferase activity (HR = 2.7 per IU/ml rise [1.1-6.7], P = 0.03). WBC was significantly related to ANC (Spearman correlation coefficient, r s  = 0.77; P best hematological target for dose adjustments of maintenance therapy. © 2016 Wiley Periodicals, Inc.

  3. Maintenance therapy of childhood acute lymphoblastic leukemia revisited—Should drug doses be adjusted by white blood cell, neutrophil, or lymphocyte counts?

    DEFF Research Database (Denmark)

    Schmiegelow, Kjeld; Nersting, Jacob; Nielsen, Stine Nygaard

    2016-01-01

    BACKGROUND: 6-Mercaptopurine (6MP) and methotrexate (MTX) based maintenance therapy is a critical phase of childhood acute lymphoblastic leukemia treatment. Wide interindividual variations in drug disposition warrant frequent doses adjustments, but there is a lack of international consensus on dose...... levels of 6-thioguanine nucleotides or MTX (including its polyglutamates) to be significant relapse predictors. The parameters significantly associated with risk of relapse (N = 83) were male sex (hazard ratio [HR] 2.0 [1.3-3.1], P = 0.003), WBC at diagnosis (HR = 1.04 per 10 × 10(9) /l rise [1...

  4. The Influence of Photodynamic Therapy on Tumor Cell S180

    Directory of Open Access Journals (Sweden)

    Pouran Sadat Tayebi

    2017-05-01

    Full Text Available Today cancer is the second important factor of the death in the world. Most of the cancer patients are treated with standard therapies, including surgery, radiation and/or chemotherapy. These standard therapies are most efficient on the primary tumor, but in the case of disseminated disease, they are often not effective. Treatment of disease that has disseminated from the primary tumor and metastasized to distant sites has promoted the investigation of immunotherapeutic strategies for cancer, and has been a major area of research over the last couple of decades. Chemotherapy and radiotherapy, standard therapies, are the main treatments for majority of cancer patients. Our studies demonstrate that ALA-HMME-PDT has a role in enhanced the quality of life and lengthens survival in mice infected by sarcoma 180. The reported method is hardly implemented but it possible in any clinical situation where PDT is needed. These therapies are most efficient in bearing the tumor in its first process of formation. Currently, the hot topic of discussion and research in the cancer arena is photodynamic Therapy (PDT. This type of therapy is an emerging channel of treatment that is very successful in eradicating cancer, with few side effects. The effectiveness of photodynamic therapy on the sarcoma treating process in mice by using ALA and HMME photosensitizers is investigated by this study. Many factors help us determine effectiveness of PDT including concentration of the sensitizer, absorption of light energy and accessibility of molecular oxygen in the target tissue during light irradiation, besides intrinsic sensitivity of target tissue.

  5. Corrigendum - Influence of Tiamulin Therapy on Weight Gain in Brachyspira Dysentery in Piglets

    OpenAIRE

    Alexandru O. Doma; Andreia B. Chirila; Eugenia Dumitrescu; Florin Muselin; ROMEO TEODOR CRISTINA

    2014-01-01

    In the article Influence of Tiamulin Therapy on Weight Gain in Brachyspira Dysentery in Piglets first published in Vol 47, No 1 in Scientific Papers: Animal Science and Biotechnologies, by a clerical error instead Novartis was presented Dopharma as producer of Tiamutin 10% oily injectable solution (1ml of solution containing 100 mg of tiamulin fumarate). This article corrects: Influence of Tiamulin Therapy on Weight Gain in Brachyspira Dysentery in Piglets Vol. 47, Issue 1, p....

  6. Tofacitinib for induction and maintenance therapy of Crohn's disease: results of two phase IIb randomised placebo-controlled trials

    NARCIS (Netherlands)

    Panés, Julian; Sandborn, William J.; Schreiber, Stefan; Sands, Bruce E.; Vermeire, Séverine; D'Haens, Geert; Panaccione, Remo; Higgins, Peter D. R.; Colombel, Jean-Frederic; Feagan, Brian G.; Chan, Gary; Moscariello, Michele; Wang, Wenjin; Niezychowski, Wojciech; Marren, Amy; Healey, Paul; Maller, Eric

    2017-01-01

    Tofacitinib is an oral, small-molecule Janus kinase inhibitor that is being investigated for IBD. We evaluated the efficacy and safety of tofacitinib for induction and maintenance treatment in patients with moderate-to-severe Crohn's disease (CD). We conducted two randomised, double-blind,

  7. Factors influencing cosmetic results after conservation therapy for breast cancer

    International Nuclear Information System (INIS)

    Taylor, Marie E.; Perez, Carlos A.; Halverson, Karen J.; Kuske, Robert R.; Philpott, Gordon W.; Garcia, Delia M.; Mortimer, Joanne E.; Myerson, Robert J.; Radford, Diane; Rush, Carol

    1995-01-01

    Purpose: Host, tumor, and treatment-related factors influencing cosmetic outcome are analyzed for patients receiving breast conservation treatment. Methods and Materials: Four-hundred and fifty-eight patients with evaluable records for cosmesis evaluation, a subset of 701 patients treated for invasive breast cancer with conservation technique between 1969 and 1990, were prospectively analyzed. In 243 patients, cosmetic evaluation was not adequately recorded. Cosmesis evaluation was carried out from 3.7 months to 22.3 years, median of 4.4 years. By pathologic stage, tumors were 62% T1N0, 14% T1N1, 15% T2N0, and 9% T2N1. The majority of patients were treated with 4-6 MV photons. Cosmetic evaluation was rated by both patient and physician every 4-6 months. A logistic regression analysis was completed using a stepwise logistic regression. P-values of 0.05 or less were considered significant. Excellent cosmetic scores were used in all statistical analyses unless otherwise specified. Results: At most recent follow-up, 87% of patients and 81% of physicians scored their cosmetic outcome as excellent or good. Eighty-two percent of physician and patient evaluations agreed with excellent-good vs. fair-poor rating categories. Analysis demonstrated a lower proportion of excellent cosmetic scores when related to patient age > 60 years (p = 0.001), postmenopausal status (p = 0.02), black race (p = 0.0034), and T2 tumor size (p = 0.05). Surgical factors of importance were: volume of resection > 100 cm 3 (p = 0.0001), scar orientation compliance with the National Surgical Adjuvant Breast Project (NSABP) guidelines (p = 0.0034), and > 20 cm 2 skin resected (p = 0.0452). Extent of axillary surgery did not significantly affect breast cosmesis. Radiation factors affecting cosmesis included treatment volume (tangential breast fields only vs. three or more fields) (p = 0.034), whole breast dose in excess of 50 Gy (p = 0.0243), and total dose to tumor site > 65 Gy (p = 0.06), as well as

  8. Tofacitinib for induction and maintenance therapy of Crohn's disease: results of two phase IIb randomised placebo-controlled trials.

    Science.gov (United States)

    Panés, Julian; Sandborn, William J; Schreiber, Stefan; Sands, Bruce E; Vermeire, Séverine; D'Haens, Geert; Panaccione, Remo; Higgins, Peter D R; Colombel, Jean-Frederic; Feagan, Brian G; Chan, Gary; Moscariello, Michele; Wang, Wenjin; Niezychowski, Wojciech; Marren, Amy; Healey, Paul; Maller, Eric

    2017-06-01

    Tofacitinib is an oral, small-molecule Janus kinase inhibitor that is being investigated for IBD. We evaluated the efficacy and safety of tofacitinib for induction and maintenance treatment in patients with moderate-to-severe Crohn's disease (CD). We conducted two randomised, double-blind, placebo-controlled, multicentre phase IIb studies. Adult patients with moderate-to-severe CD were randomised to receive induction treatment with placebo, tofacitinib 5 or 10 mg twice daily for 8 weeks. Those achieving clinical response-100 or remission were re-randomised to maintenance treatment with placebo, tofacitinib 5 or 10 mg twice daily for 26 weeks. Primary endpoints were clinical remission at the end of the induction study, and clinical response-100 or remission at the end of the maintenance study. 180/280 patients randomised in the induction study were enrolled in the maintenance study. At week 8 of induction, the proportion of patients with clinical remission was 43.5% and 43.0% with 5 and 10 mg twice daily, respectively, compared with 36.7% in the placebo group (p=0.325 and 0.392 for 5 and 10 mg twice daily vs placebo). At week 26 of maintenance, the proportion of patients with clinical response-100 or remission was 55.8% with tofacitinib 10 mg twice daily compared with 39.5% with tofacitinib 5 mg twice daily and 38.1% with placebo (p=0.130 for 10 mg twice daily vs placebo). Compared with placebo, the change in C-reactive protein from baseline was statistically significant (ptofacitinib. NCT01393626 and NCT01393899. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/.

  9. Influence of reinforcement behavioral therapy and Ellis cognitive therapy on derelict children’s aggression

    Directory of Open Access Journals (Sweden)

    Habibollah Khazaie

    2012-01-01

    Full Text Available Background: Control of angry in effective manner is very important. In present study we compared the effect of reinforcement behavioral therapy and Ellis cognitive therapy on decreasing of aggression in derelict children aged 10 to 18 years old at hostelry care center of Welfare Organization of Kermanshah. Methods: Fifty-seven out of 89 children (31 male, 26 female was diagnosed as aggressive according to the AGQ results from six hostelry care center of welfare organization of Kermanshah, were selected and participated in the study. Participants allocated in to reinforcement behavioral therapy, Ellis cognitive therapy or control group randomly. Each groups received two hours therapeutic teaching for 10 sessions during 10 weeks. The control group had not been received any intervention. After 10 weeks, the posttest AGQ was performed on participant. The results of pretest and posttest were compared using T-test and ANOVA.Results: The posttest aggression score in reinforcement behavioral therapy group was decreased significantly after intervention (P=0.011. We didn’t find significant differences between pre and post tests aggression score in Ellis cognitive therapy (P=0.258. Result of ANOVA show that there was no significant difference between three group after intervention (P=0.691Conclusion: Reinforcement behavioral therapy and Ellis cognitive therapy did not change the aggression score in derelict children. This may relate to specific hard and stressful life of these children due to ineffectiveness of these short-term methods.

  10. Influence of highly active antiretroviral therapy (HAART) on the ...

    African Journals Online (AJOL)

    This report is part of the ongoing highly active antiretroviral therapy (HAART) trial, 167 patients were enlisted, but current analysis was restricted to 107 patients that were about a year old on the programme. The baseline weight, CD4+ cell count and serum albumin of 59 males and 48 females age 15-60 years, were ...

  11. Co-relationship between sexual dysfunction and high-risk sexual behavior in patients receiving buprenorphine and naltrexone maintenance therapy for opioid dependence.

    Science.gov (United States)

    Ramdurg, Santosh; Ambekar, Atul; Lal, Rakesh

    2015-01-01

    People suffering from substance dependence suffer from various sexual dysfunctions and are at risk for indulging in various high-risk sexual behaviors and thus are vulnerable to acquire various infections such as HIV/AIDS and other sexually transmitted infections. The aim of the study was to evaluate the correlation between sexual dysfunction and high-risk sexual behavior in opioid-dependent men receiving buprenorphine and naltrexone maintenance therapy. Semi-structured questionnaire, brief male sexual functioning inventory and HIV-risk taking behavior scale was administered to a sample of 60 sexually active men, receiving buprenorphine (n = 30) and naltrexone (n = 30) maintenance therapy for opioid dependence. The main outcomes are correlation between severity of sexual dysfunction and HIV-risk taking behavior. The study results showed 83% of the men on buprenorphine and 90% on naltrexone reported at least one of the sexual dysfunction symptoms. There was a negative correlation between sexual dysfunction and HIV-risk taking behavior that suggest severe the dysfunction, higher the risk taking behavior. Significant correlation was present with overall sexual dysfunction and HIV-risk taking behavior (P = 0.028 and in naltrexone receiving group premature ejaculation versus HIV-risk taking behavior however, (P = 0.022, P sexual dysfunctions and HIV-risk taking behavior, which has clinical implication. Future research should explore this further using biochemical analyses.

  12. Treatment of faecal impaction with polyethelene glycol plus electrolytes (PGE + E) followed by a double-blind comparison of PEG + E versus lactulose as maintenance therapy.

    Science.gov (United States)

    Candy, David C A; Edwards, Diane; Geraint, Mike

    2006-07-01

    To assess the efficacy of polyethylene glycol 3350 plus electrolytes (PEG + E; Movicol) as oral monotherapy in the treatment of faecal impaction in children, and to compare PEG + E with lactulose as maintenance therapy in a randomised trial. An initial open-label study of PEG + E in the inpatient treatment of faecal impaction (phase 1), followed by a randomised, double-blind comparison between PEG + E and lactulose for maintenance treatment of constipation over a 3-month period (phase 2) in children aged 2 to 11 years with a clinical diagnosis of faecal impaction. Disimpaction on PEG + E was achieved in 58 (92%) of 63 of children (89% of 2-4 year olds and 94% of 5-11 year olds) without additional interventions. A maximum dose of 4 sachets (for 2-4 year olds) or 6 sachets (for 5-11 year olds) was required; median time to disimpaction was 6 days (range, 3-7 days). Seven children (23%) reimpacted whilst taking lactulose, whereas no children reimpacted while taking PEG + E (P = 0.011). The total incidence rate of adverse events seen was higher in the lactulose group (83%) than in the PEG + E group (64%). PEG + E is safe and highly effective in the management of childhood constipation. It allows a single orally administered laxative to be used for disimpaction without recourse to invasive interventions. It is significantly more effective than lactulose as maintenance therapy, both in efficacy in treating constipation and efficacy in preventing the recurrence of faecal impaction.

  13. Is non-response to fluconazole maintenance therapy for recurrent Candida vaginitis related to sensitization to atopic reactions?

    Science.gov (United States)

    Donders, Gilbert G G; Grinceviciene, Svitrigaile; Bellen, Gert; Jaeger, Martin; Ten Oever, Jaap; Netea, Mihai G

    2018-04-01

    Is sensitization to atopic reaction related to treatment response of recurrent Candida vulvovaginal (RVVC)? Analysis of ReCiDiF trial data of optimal (OR) and non-responders (NR) to fluconazole maintenance treatment, to explore medical history, physical status, family history, and vaginal immune response for potential sensitization to atopic reaction. Sociodemographic characteristics of 33 NR women were not different from 38 OR. NR had received higher number of different treatments (mean difference 1.6 different treatments (95% CI: 0.20-2.97), P = .03) and had more episodes of disease (P predictive factor for non-response in multivariate analysis with specificity 77.8% and sensitivity 51.6%. Women with RVVC with vulvar excoriation, longer duration of disease, and family history of atopic disease are at increased risk not to respond to maintenance fluconazole treatment. © 2017 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

  14. Influence of Forest Therapy on Cardiovascular Relaxation in Young Adults

    OpenAIRE

    Lee, Juyoung; Tsunetsugu, Yuko; Takayama, Norimasa; Park, Bum-Jin; Li, Qing; Song, Chorong; Komatsu, Misako; Ikei, Harumi; Tyrväinen, Liisa; Kagawa, Takahide; Miyazaki, Yoshifumi

    2014-01-01

    Background. Despite increasing attention toward forest therapy as an alternative medicine, very little evidence continues to be available on its therapeutic effects. Therefore, this study was focused on elucidating the health benefits of forest walking on cardiovascular reactivity. Methods. Within-group comparisons were used to examine the cardiovascular responses to walking in forest and urban environments. Forty-eight young adult males participated in the two-day field research. Changes in ...

  15. Patterns of 6-mercaptopurine and azathioprine maintenance therapy among a cohort of commercially insured individuals diagnosed with Crohn's disease in the United States

    Directory of Open Access Journals (Sweden)

    Lund JL

    2013-12-01

    Full Text Available Jennifer L Lund,1 Suzanne F Cook,2 Jeffery K Allen,2 Charlotte F Carroll,2 Michael D Kappelman3 1Department of Clinical Epidemiology, Aarhus University, Aarhus, Denmark; 2Worldwide Epidemiology, GlaxoSmithKline, Research Triangle Park, NC, USA; 3Department of Pediatrics, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA Background and aims: Thiopurines, including 6-mercaptopurine (6-MP and azathioprine (AZA, are the mainstay of maintenance therapy for Crohn's disease (CD. However, studies examining their effectiveness in routine practice among diverse patient populations are lacking. Among a cohort of new users of 6MP/AZA, we described treatment patterns and changes in subsequent therapy. Methods: Using the Truven Health Analytics databases, we identified all individuals diagnosed with CD and initiating 6-MP/AZA monotherapy from 2001–2008 (n=3,657. We estimated the proportion of CD patients remaining on 6-MP/AZA monotherapy, using Kaplan–Meier methods, and identified predictors of treatment noncontinuation, using multivariable Cox regression. Among the “noncontinuers,” we described subsequent patterns of maintenance therapy and summarized the diagnosis and procedure codes and prescription drug claims preceding treatment discontinuation. Results: The 1-year 6-MP/AZA treatment continuation rate was 42%. Children (age ≤18 years and individuals with no prior anti-tumor necrosis factor (TNF use were more likely to continue 6-MP/AZA, while those dispensed more (>4 outpatient prescriptions for any drug before initiation of 6-MP/AZA were less likely to continue maintenance treatment. Overall, 1,128 (39% and 105 (4% individuals experienced a clinical event potentially indicating active disease or 6-MP/AZA-intolerance prior to discontinuation, respectively. Most patients discontinued therapy; among the remaining patients who failed to continue 6-MP/AZA, most augmented with an anti-TNF. Conclusion: Most patients initiating 6-MP

  16. The influence of punctural millimeter wave therapy on clinical presentation of patients with essential hypertention

    Directory of Open Access Journals (Sweden)

    Kotenko К.V.

    2013-12-01

    Full Text Available Aim: to estimate the influence of punctural millimeter wave therapy on clinical presentation. Material and methods. This study includes 102 patients with essential hypertension the I and II stage. Patients were divided into three equal groups depending on the method of treatment: some of them received procedures of punctural millimeter wave therapy, some of them received these procedures as the "placebo" and those who had not received specified procedures. Dynamics of clinical symptomatology and condition of eye bottom vessels was estimated. It was shown that addition of punctural millimeter wave therapy in complex therapy of patients with essential hypertension promotes the expressed regress of clinical symptomatology and state normalization the retinal vessels at these patients. Results. Addition of punctural millimeter wave therapy into the complex therapy was shown to lead to pronounced regress of clinical symptoms. Conclusion. The received results allow to recommend this method to be used in clinical practice for treating patients with essential hypertension.

  17. Accuracy of Consecutive Fecal Calprotectin Measurements to Predict Relapse in Inflammatory Bowel Disease Patients Under Maintenance With Anti-TNF Therapy: A Prospective Longitudinal Cohort Study.

    Science.gov (United States)

    Ferreiro-Iglesias, Rocio; Barreiro-de Acosta, Manuel; Lorenzo-Gonzalez, Aurelio; Dominguez-Muñoz, Juan E

    2018-03-01

    Predicting relapse in inflammatory bowel disease (IBD) patients could allow early changes in therapy. We aimed at evaluating the accuracy of consecutive fecal calprotectin (FC) measurements to predict flares in IBD patients under maintenance treatment with anti-tumor necrosis factor (TNF) drugs. A prospective longitudinal cohort study with 16-month follow-up period was designed. IBD patients in clinical remission for at least 6 months under anti-TNF therapy were included. FC was quantified at 4-month intervals for 1 year, and patients were clinically evaluated for relapse at 2-month intervals. Diagnostic accuracy of FC for predicting relapse was evaluated by receiver-operating characteristic curve analysis. In total, 95 of 106 included patients finalized the study and were analyzed (median age 44 y, 50.5% female, 75% with Crohn's disease). A total of 30 patients (31.6%) had a relapse over follow-up. FC concentration was significantly higher in patients who relapsed (477 μg/g) than in patients who maintained in remission (65 μg/g) (Ppredict remission was 130 μg/g (negative predictive value of 100%), and 300 μg/g to predict relapse (positive predictive value of 78.3%). FC is a good predictor of clinical relapse and a particularly good predictor of remission over the following 4 months in patients with IBD on maintenance therapy with anti-TNF drugs. FC levels 300 μg/g allow predicting relapse with a high probability at any time over the following 4 months.

  18. Exposure to occupational therapy as a factor influencing recruitment to the profession.

    Science.gov (United States)

    Byrne, Nicole

    2015-08-01

    This article provides insight into the impact that exposure to an occupational therapist, in personal capacity or via a professional interaction, has on the decision to enter an occupational therapy undergraduate programme. A quantitative survey was completed by 139 occupational therapy students. The survey tool focussed on the students' exposure to a range of allied health professions (e.g. occupational therapy, physiotherapy, psychology) and investigated how exposure to occupational therapy had influenced their decision to enter the programme. The results indicated that over 70% of respondents had personal professional exposure to occupational therapy prior to making a career decision. Exposure most frequently involved occupational therapy intervention of a friend or family member. The majority of students who had professional exposure to occupational therapy (e.g. family, self, friend received occupational therapy) identified that it was the most influential factor in their career choice. Forty per cent of the occupational therapy students did not enter the programme straight from school and the influence of 'working with an occupational therapist' was noteworthy for mature aged students. Occupational therapists need to consider that every interaction they have with the community provides valuable information regarding the profession and gives insight into occupational therapy as a potential career path for other people. Additionally, the current research identifies there were differences in the impact, type and number of exposures for different student groups, and this potentially offers some insight into ways in which occupational therapy could target specific groups within the community to increase future diversity in the profession. © 2015 Occupational Therapy Australia.

  19. The influence of integrative play therapy on children

    Directory of Open Access Journals (Sweden)

    Flora Lamçja (Zeqaj

    2015-11-01

    Full Text Available The integration of theory, technique and common factors in psychotherapy has gained prominence since the 1990s. Previously, it was called eclecticism, but integration has become the preferred term to describe the blending of theory, technique and common factors (Norcross 2005. In the past, eclecticism meant to choose from various theories and techniques a therapeutic strategy that appears best for a particular client (Schaefer 2003 p.308. However, Norcross (1987 explains eclecticism as a further integration through which various theories are applied on interactive and coordinated explanations of the therapy. Because of psychological disorders, especially for children and adolescents are multilayered, complex and multi determined a multifaceted treatment approach is needed (Schaefer 2003. Indeed, many clients do not come with a clearly defined diagnosis, but rather several overlapping problems due to the co morbidity of issues (such as in the cases of complex trauma resulting in overlapping attention problems, along with phobias and sexualized behaviors. The clinicians trained in one theoretical and treatment approach is finding the “one size” cannot fit in all the presenting problems that are being faced today. Due to this multidimensional aspect the play child/play therapy calls for the unique demand that the therapist should wear a lot of different hats and should be skillful in changing from one therapeutic stance to another, in order to meet the needs of the child and of the various members in the child’s life (Coonerty, 1993. In one moment, the play therapist is intensively involved in deeply evocative and conflicted play therapy the child client. At that moment, the therapist needs to deal with the child’s internal struggles, setting limits and being an educator or mediator with the child, while in the next moment the therapist should engaged with the role of a parent, or school psychologist, or classroom teacher to assess the

  20. Tony’s influence on the music therapy doctoral programme

    DEFF Research Database (Denmark)

    Ridder, Hanne Mette Ochsner

    2011-01-01

    The first important initiatives to establish international collaboration in music therapy research were taken in 1995 by Inge Nygaard Pedersen, Lars Ole Bonde and Tony Wigram. In 1997 Tony was given the task of leading, developing and creating a doctoral programme. The faculty of humanities granted...... the necessary resources, so that the first five PhD students could be enrolled. Under Tony’s leadership of the doctoral programme, the number of PhD students grew from the initial 5, to 10 in 2001 and 25 in 2010....

  1. Influence of gallstones and ursodeoxycholic acid therapy on gallbladder emptying

    International Nuclear Information System (INIS)

    Forgacs, I.C.; Maisey, M.N.; Murphy, G.M.; Dowling, R.H.

    1984-01-01

    Altered gallbladder motility could predispose to, or result from, gallstone formation and could also explain the alleged relief of biliary colic seen during bile acid therapy. Therefore, in 14 controls, 25 patients with radiolucent gallstones, and 14 patients with radiopaque gallstones, the authors used two techniques to measure gallbladder contraction--radionuclide imaging and real-time ultrasound--in response to one of two stimuli--a Lundh meal or intravenous cholecystokinin-octapeptide. Using the radionuclide technique, postprandial gallbladder emptying (t1/2) was prolonged both in patients with radiopaque and radiolucent gallstones when compared with controls. In patients with radiolucent stones, the t1/2 of gallbladder emptying became further prolonged after 1 mo of therapy with ursodeoxycholic acid. A similar pattern of results was seen after cholecystokinin-octapeptide and also with real-time ultrasound. Thus, after both stimuli and using two independent techniques, gallbladder contraction was reduced in patients with gallstones. The slower and less complete gallbladder emptying with ursotherapy might explain the reduction in biliary colic noted during treatment

  2. Single-inhaler combination therapy for maintenance and relief of asthma: a new strategy in disease management.

    Science.gov (United States)

    Peters, Matthew

    2009-01-01

    When an adequate standard of asthma control is not achieved with maintenance treatment of inhaled corticosteroids, the addition of a long-acting beta(2)-adrenergic receptor agonist (LABA) bronchodilator is recommended. Using a combination product, salmeterol/fluticasone propionate (Seretide or Advair) or budesonide/formoterol (Symbicort) is preferred for convenience and avoids any risk that LABA might be used as monotherapy. As formoterol has a rapid onset of bronchodilator effect, the budesonide/formoterol combination can be used for both the maintenance and reliever components of asthma treatment (Symbicort SMART) and this is endorsed as an effective treatment by the Global Initiative for Asthma. The efficacy of this approach has been evaluated in a series of well conducted, controlled studies. Current control of asthma symptoms is improved or achieved with reduced total dose administration with Symbicort SMART compared with any reasonable alternate option. In every study, the risk of severe exacerbations was lower with Symbicort SMART than comparator treatment. Patients who benefit to the greatest extent are those with evidence of more severe asthma and greater exacerbation risk. When initiated in suitable patients in conjunction with appropriate education, Symbicort SMART is dominant in pharmacoeconomic terms. Symbicort SMART delivers improved asthma outcomes with lower treatment and social costs than any alternative.

  3. The influence of cognitive reserve on memory following electroconvulsive therapy.

    Science.gov (United States)

    Legendre, Susan A; Stern, Robert A; Solomon, David A; Furman, Martin J; Smith, Kristin E

    2003-01-01

    Cognitive reserve (CR) theory proposes that certain genetic and nonacquired variables, such as larger head size and greater neuronal density, and some life experiences, such as higher educational and occupational attainment, provide a buffer against brain dysfunction in the face of acquired central nervous system (CNS) dysfunction. This study examined CR in the pseudoexperimental paradigm of electroconvulsive therapy (ECT). Subjects included fifty (N = 50) depressed patients treated with bilateral ECT. Subjects were placed in high (n = 27) or low (n = 23) CR groups based on years of education and occupational attainment. At baseline, no significant differences were observed between the groups in the amount of information forgotten on a verbal memory measure (Randt stories) after a 30-minute delay. Following three ECT treatments, however, the high CR group forgot significantly less information after a 30-minute delay, as compared to the low CR group (p memory loss in ECT.

  4. Influence of the First Consultation on Adherence to Antiretroviral Therapy for HIV-infected Patients

    OpenAIRE

    Peyre, Marion; Gauchet, Aur?lie; Roustit, Matthieu; Leclercq, Pascale; Epaulard, Olivier

    2016-01-01

    Background: Physician attitude influences the way patients cope with diagnosis and therapy in chronic severe diseases such as cancer. Previous studies showed that such an effect exists in HIV care; it is likely that it begins with the first contact with a physician. Objective: We aimed to explore in HIV-infected persons their perception of the first consultation they had with an HIV specialist (PFC-H), and whether this perception correlates with adherence to antiretroviral therapy. Method: Th...

  5. DNA incorporation of 6-thioguanine nucleotides during maintenance therapy of childhood acute lymphoblastic leukaemia and non-Hodgkin lymphoma

    DEFF Research Database (Denmark)

    Hedeland, Rikke L; Hvidt, Kristian; Nersting, Jacob

    2010-01-01

    To explore the DNA incorporation of 6-thioguanine nucleotide levels (DNA-6TGN) during 6-mercaptopurine (6MP) therapy of childhood acute lymphoblastic leukaemia (ALL) and non-Hodgkin lymphoma (NHL) and its relation to erythrocyte levels of their metabolites: 6-thioguanine-nucleotides (E-6TGN...

  6. Pharmacokinetics of and short-term virologic response to low-dose 400-milligram once-daily raltegravir maintenance therapy.

    NARCIS (Netherlands)

    Ananworanich, J.; Gorowara, M.; Avihingsanon, A.; Kerr, S.J.; Heesch, N. van; Khongpetch, C.; Uanithirat, A.; Hill, A.; Ruxrungtham, K.; Burger, D.M.

    2012-01-01

    Because studies showed similar viral suppression with lower raltegravir doses and because Asians usually have high antiretroviral concentrations, we explored low-dose raltegravir therapy in Thais. Nineteen adults on raltegravir at 400 mg twice daily (BID) with HIV RNA loads of <50 copies/ml were

  7. Buprenorphine/Naloxone Maintenance Therapy: an Observational Retrospective Report on the Effect of Dose on 18 months Retention in an Office-Based Treatment Program

    Directory of Open Access Journals (Sweden)

    Theodore V Parran

    2017-10-01

    Full Text Available Context and objective: Buprenorphine has been available with few reports of the dose range necessary to adequately maintain patients. We report on the effect of 8 mg/d versus 16 mg/d of buprenorphine on long-term patient retention in office-based opioid maintenance (OBOMT. Design, setting, and participants: Case series, at an urban hospital-based primary care clinic providing OBOMT to 157 opiate-dependent, low socioeconomic status, uninsured, nonhomeless patients. Intervention: The OBOMT program operated by a comprehensive sobriety treatment program experienced State funding cuts. Thus, after 2 years, the program was required by the State funder to decrease the buprenorphine maintenance dose from 16 to 8 mg/d for all new admissions. We report on patient retention before and after dose reduction. Main outcome measures: The primary outcomes of this study were to measure and compare patient retention in the 2 cohorts at each point of treatment transition over the 18 months following OBOMT initiation. Results: No significant differences in patient retention were observed between the 16 and 8 mg/d patient cohorts. Lower dose buprenorphine maintenance (8 mg/d in uninsured patients enrolled in publicly funded long-term OBOMT combined with comprehensive sobriety counseling was as effective as higher dose therapy (16 mg/d in promoting patient retention throughout the study period. This lower dose resulted in a substantial saving to the public funding agency. Conclusions: In an observational retrospective report, retention in treatment of opiate-addicted patients was the same at 8 and 16 mg/d buprenorphine doses after 18 months. These data have implications for public and managed care funding of OBOMT, for the general prescribing of buprenorphine in outpatient care, and may be instructive in the ongoing debate about the relationship between buprenorphine dose.

  8. Oral methotrexate/6-mercaptopurine may be superior to a multidrug LSA2L2 Maintenance therapy for higher risk childhood acute lymphoblastic leukemia: results from the NOPHO ALL-92 study

    DEFF Research Database (Denmark)

    Schmiegelow, Kjeld; Heyman, Mats; Kristinsson, Jon

    2009-01-01

    The importance of maintenance therapy for higher risk childhood acute lymphoblastic leukemia (ALL) is uncertain. Between 1992 and 2001 the Nordic Society for Pediatric Haematology/Oncology compared in a nonrandomized study conventional oral methotrexate (MTX)/6-mercaptopurine (6MP) maintenance...... therapy (P=0.04) were both related to an increased risk of an event (overall P value of the Cox model: 0.003), whereas neither sex, age at diagnosis, administration of central nervous system irradiation, nor presence of a day 15 bone marrow with > or =25% versus

  9. [The influence of general magnetic therapy on the psychological status of the patients presenting with osteoarthrosis].

    Science.gov (United States)

    Degtiarev, V K; Aleksandrov, A V; Nenasheva, N V; Cherkashina, I V; Nikitin, M V

    2013-01-01

    The present study was designed to estimate the influence of general magnetic therapy on the psychical conditions of 151 patients presenting with degenerative joint diseases including osteoarthritis (OA). It was shown that the application of general magnetic therapy for the rehabilitative treatment of osteoarthrosis promotes the improvement of the psycho-emotional state of the patients. It is concluded that prescription of general magnetic therapy to the patients with OA suffering from serious psycho-emotional disorders brings about beneficial changes in their anxiety- and depression-related personality traits.

  10. The influence of radiation therapy on cardiac pacemakers

    International Nuclear Information System (INIS)

    Coles, J.R.; Ciddor, G.S.

    1980-01-01

    The results of an investigation to determine the influence on pacemaking of ionizing radiation and electromagnetic radiation from a number of radiotherapy machines are reported. In vitro tests were carried out on unipolar cardiac pacemakers of the ventricular inhibited type. The pacemakers were largely unaffected by the environment of clinical radiotherapy machines. Ionizing radiation had no detrimental effect on the pacemakers and electromagnetic interference caused only temporary single-beat inhibition at most. With the betatron used, malfunction of the pacemakers regularly occurred whilst in their inhibited made of operation. The demand function became disabled allowing competitive asynchronous pulses to be produced

  11. What is the influence of hormone therapy on homocysteine and crp levels in postmenopausal women?

    Directory of Open Access Journals (Sweden)

    Eli Marcelo Lakryc

    Full Text Available OBJECTIVE: To evaluate the influence of estrogen therapy and estrogen-progestin therapy on homocysteine and C-reactive protein levels in postmenopausal women. METHODS: In total, 99 postmenopausal women were included in this double-blind, randomized clinical trial and divided into three groups: Group A used estrogen therapy alone (2.0 mg of 17β-estradiol, Group B received estrogen-progestin therapy (2.0 mg of 17 β-estradiol +1.0 mg of norethisterone acetate and Group C received a placebo (control. The length of treatment was six months. Serum measurements of homocysteine and C-reactive protein were carried out prior to the onset of treatment and following six months of therapy. RESULTS: After six months of treatment, there was a 20.7% reduction in homocysteine levels and a 100.5% increase in C-reactive protein levels in the group of women who used estrogen therapy. With respect to the estrogen-progestin group, there was a 12.2% decrease in homocysteine levels and a 93.5% increase in C-reactive protein levels. CONCLUSION: Our data suggested that hormone therapy (unopposed estrogen or estrogen associated with progestin may have a positive influence on decreasing cardiovascular risk due to a significant reduction in homocysteine levels.

  12. Factors influencing the degree and pattern of parental involvement in play therapy for sexually abused children.

    Science.gov (United States)

    Hill, Andrew

    2009-01-01

    Although much has been written about the role of therapists in children's recovery from child sexual abuse, relatively little attention has been paid to the role of nonoffending parents. This study investigated the work of a team of therapists who sometimes included such parents in therapy sessions with children. The study sought to understand what factors were influencing the degree and pattern of parental involvement and to understand what effect these patterns of parental involvement were having on the process and outcomes of therapy. The study successfully identified a range of factors influencing the patterns of parental involvement, but more research will be needed to understand the effect on outcomes.

  13. Corrigendum - Influence of Tiamulin Therapy on Weight Gain in Brachyspira Dysentery in Piglets

    Directory of Open Access Journals (Sweden)

    Alexandru O. Doma

    2014-05-01

    Full Text Available In the article Influence of Tiamulin Therapy on Weight Gain in Brachyspira Dysentery in Piglets first published in Vol 47, No 1 in Scientific Papers: Animal Science and Biotechnologies, by a clerical error instead Novartis was presented Dopharma as producer of Tiamutin 10% oily injectable solution (1ml of solution containing 100 mg of tiamulin fumarate. This article corrects: Influence of Tiamulin Therapy on Weight Gain in Brachyspira Dysentery in Piglets Vol. 47, Issue 1, p. 372-376. Article first published online: 30 May 2014

  14. Efficacy and safety of sublingual ramelteon as an adjunctive therapy in the maintenance treatment of bipolar I disorder in adults: A phase 3, randomized controlled trial.

    Science.gov (United States)

    Mahableshwarkar, Atul R; Calabrese, Joseph R; Macek, Thomas A; Budur, Kumar; Adefuye, Adedeji; Dong, Xinxin; Hanson, Elizabeth; Sachs, Gary S

    2017-10-15

    The optimal long-term management strategy for bipolar I disorder patients is not yet established. Evidence supports the rationale for circadian rhythm regulation to prevent mood episode relapse in bipolar patients. This study evaluated the efficacy and safety of a new sublingual formulation of the melatonin receptor agonist ramelteon (ramelteon SL) as adjunctive therapy in the maintenance treatment of bipolar I patients. In a double-blinded trial in the United States and Latin America, adult bipolar I disorder patients stable for ≥ 8 weeks before baseline and with a mood episode 8 weeks to 9 months before screening, were randomized to once-daily ramelteon SL 0.1mg (n = 164), 0.4mg (n = 160), or 0.8mg (n = 154), or placebo (n = 164), in addition to their existing treatment. The primary endpoint was time from randomization to relapse of symptoms. The prespecified futility criterion in a planned, unblinded, independent interim analysis was the failure of all ramelteon SL doses to achieve a conditional power ≥ 30% compared with placebo. No significant differences between any dose of ramelteon SL and placebo were observed. The study was terminated after meeting the futility criteria. Ramelteon SL was well tolerated, with a safety profile consistent with that for oral ramelteon. A low rate of relapse events precluded detection of any statistically significant difference between groups. The study failed to demonstrate the efficacy of ramelteon SL as adjunctive maintenance therapy for bipolar disorder. Interim analyses for futility in clinical studies are valuable in preventing unnecessary exposure of subjects to interventions. Copyright © 2017. Published by Elsevier B.V.

  15. Co-relationship between sexual dysfunction and high-risk sexual behavior in patients receiving buprenorphine and naltrexone maintenance therapy for opioid dependence

    Directory of Open Access Journals (Sweden)

    Santosh Ramdurg

    2015-01-01

    Full Text Available Introduction: People suffering from substance dependence suffer from various sexual dysfunctions and are at risk for indulging in various high-risk sexual behaviors and thus are vulnerable to acquire various infections such as HIV/AIDS and other sexually transmitted infections. AIM: The aim of the study was to evaluate the correlation between sexual dysfunction and high-risk sexual behavior in opioid-dependent men receiving buprenorphine and naltrexone maintenance therapy. Materials and Methods: Semi-structured questionnaire, brief male sexual functioning inventory and HIV-risk taking behavior scale was administered to a sample of 60 sexually active men, receiving buprenorphine (n = 30 and naltrexone (n = 30 maintenance therapy for opioid dependence. Results: The main outcomes are correlation between severity of sexual dysfunction and HIV-risk taking behavior. The study results showed 83% of the men on buprenorphine and 90% on naltrexone reported at least one of the sexual dysfunction symptoms. There was a negative correlation between sexual dysfunction and HIV-risk taking behavior that suggest severe the dysfunction, higher the risk taking behavior. Significant correlation was present with overall sexual dysfunction and HIV-risk taking behavior (P = 0.028 and in naltrexone receiving group premature ejaculation versus HIV-risk taking behavior however, (P = 0.022, P < 0.05 there were no significant differences among both the groups except above findings. Conclusion: Conclusion was treatment is associated with sexual dysfunctions and HIV-risk taking behavior, which has clinical implication. Future research should explore this further using biochemical analyses.

  16. Predictors of improvement in subjective sleep quality reported by older adults following group-based cognitive behavior therapy for sleep maintenance and early morning awakening insomnia.

    Science.gov (United States)

    Lovato, Nicole; Lack, Leon; Wright, Helen; Kennaway, David J

    2013-09-01

    Cognitive behavior therapy is an effective nonpharmacologic treatment for insomnia. However, individualized administration is costly and often results in substantial variability in treatment response across individual patients, particularly so for older adults. Group-based administration has demonstrated impressive potential for a brief and inexpensive answer to the effective treatment of insomnia in the older population. It is important to identify potential predictors of response to such a treatment format to guide clinicians when selecting the most suitable treatment for their patients. The aim of our study was to identify factors that predict subjective sleep quality of older adults following group-based administration of cognitive behavior therapy for insomnia (CBT-I). Eighty-six adults (41 men; mean age, 64.10 y; standard deviation [SD], 6.80) with sleep maintenance or early morning awakening insomnia were selected from a community-based sample to participate in a 4-week group-based treatment program of CBT-I. Participants were required to complete 7-day sleep diaries and a comprehensive battery of questionnaires related to sleep quality and daytime functioning. Hierarchical multiple regression analyses were used to identify factors predicting subjective sleep quality immediately following treatment and at 3-month follow-up. Sleep diaries reported average nightly sleep efficiency (SE), which was used as the outcome measure of sleep quality. Participants with the greatest SE following treatment while controlling for pretreatment SE were relatively younger and had more confidence in their ability to sleep at pretreatment. These characteristics may be useful to guide clinicians when considering the use of a group-based CBT-I for sleep maintenance or early morning awakening insomnia in older adults. Copyright © 2013 Elsevier B.V. All rights reserved.

  17. Defining predictive values using three different platelet function tests for CYP2C19 phenotype status on maintenance dual antiplatelet therapy after PCI.

    Science.gov (United States)

    Zhang, Hong-Zhe; Kim, Moo Hyun; Han, Jin-Yeong; Jeong, Young-Hoon

    2014-01-01

    Published data suggests that the presence of CYP2C19*2 or *3 loss of function (LOF) alleles is indicative of increased platelet aggregation and a higher risk of adverse cardiovascular events after clopidogrel administration. We sought to determine cut-off values using three different assays for prediction of the CYP2C19 phenotype in Korean percutaneous coronary intervention (PCI) patients. We enrolled 244 patients with drug-eluting stent implantation who were receiving clopidogrel and aspirin maintenance therapy for one month or more. Platelet reactivity was assessed with light transmittance aggregometry (LTA), multiple electrode aggregometry (MEA) and the VerifyNow P2Y12 assay (VN). The CYP2C19 genotype was analyzed by polymerase chain reaction (PCR) and snapshot method. The frequency of CYP2C19 LOF allele carriers was 58.6%. The cut-off values from LTA, MEA and VerifyNow for the identification of LOF allele carriers were as follows: 10 µM ADP-induced LTA ≥ 48 %, VN>242 PRU and MEA ≥ 37 U. Between the three tests, correlation was higher between LTA vs. VN assays (r=0.69) and LTA vs. MEA (r=0.56), with moderate agreement (κ=0.46 and κ=0.46), but between VN assay and MEA, both devices using whole blood showed a lower correlation (r=0.42) and agreement (κ=0.3). Our results provide guidance regarding cut-off levels for LTA, VerifyNow and MEA assays to detect the CYP2C19 LOF allele in patients during dual antiplatelet maintenance therapy.

  18. Challenges in economic modeling of anticancer therapies: an example of modeling the survival benefit of olaparib maintenance therapy for patients with BRCA-mutated platinum-sensitive relapsed ovarian cancer.

    Science.gov (United States)

    Hettle, Robert; Posnett, John; Borrill, John

    2015-01-01

    The aim of this paper is to describe a four health-state, semi-Markov model structure with health states defined by initiation of subsequent treatment, designed to make best possible use of the data available from a phase 2 clinical trial. The approach is illustrated using data from a sub-group of patients enrolled in a phase 2 clinical trial of olaparib maintenance therapy in patients with platinum-sensitive relapsed ovarian cancer and a BRCA mutation (NCT00753545). A semi-Markov model was developed with four health states: progression-free survival (PFS), first subsequent treatment (FST), second subsequent treatment (SST), and death. Transition probabilities were estimated by fitting survival curves to trial data for time from randomization to FST, time from FST to SST, and time from SST to death. Survival projections generated by the model are broadly consistent with the outcomes observed in the clinical trial. However, limitations of the trial data (small sample size, immaturity of the PFS and overall survival [OS] end-points, and treatment switching) create uncertainty in estimates of survival. The model framework offers a promising approach to evaluating cost-effectiveness of a maintenance therapy for patients with cancer, which may be generalizable to other chronic diseases.

  19. Impact of Toceranib/Piroxicam/Cyclophosphamide Maintenance Therapy on Outcome of Dogs with Appendicular Osteosarcoma following Amputation and Carboplatin Chemotherapy: A Multi-Institutional Study.

    Directory of Open Access Journals (Sweden)

    Cheryl A London

    Full Text Available We hypothesized that the addition of toceranib to metronomic cyclophosphamide/piroxicam therapy would significantly improve disease-free interval (DFI and overall survival (OS in dogs with appendicular osteosarcoma (OSA following amputation and carboplatin chemotherapy.This was a randomized, prospective clinical trial in which dogs with OSA free of gross metastatic disease (n = 126 received carboplatin chemotherapy (4 doses following amputation. On study entry, dogs were randomized to receive piroxicam/cyclophosphamide with or without toceranib (n = 63 each after completing chemotherapy. Patient demographics were not significantly different between both groups. During or immediately following carboplatin chemotherapy, 32 dogs (n = 13 toceranib; n = 19 control developed metastatic disease, and 13 dogs left the study due to other medical conditions or owner preference. Following carboplatin chemotherapy, 81 dogs (n = 46 toceranib; n = 35 control received the metronomic treatment; 35 dogs (n = 20 toceranib; n = 15 control developed metastatic disease during the maintenance therapy, and 26 dogs left the study due to other medical conditions or owner preference. Nine toceranib-treated and 11 control dogs completed the study without evidence of metastatic disease 1-year following amputation. Toceranib-treated dogs experienced more episodes of diarrhea, neutropenia and weight loss than control dogs, although these toxicities were low-grade and typically resolved with supportive care. More toceranib-treated dogs (n = 8 were removed from the study for therapy-associated adverse events compared to control dogs (n = 1. The median DFI for control and toceranib treated dogs was 215 and 233 days, respectively (p = 0.274; the median OS for control and toceranib treated dogs was 242 and 318 days, respectively (p = 0.08. The one year survival rate for control dogs was 35% compared to 38% for dogs receiving toceranib.The addition of toceranib to metronomic

  20. Impact of Toceranib/Piroxicam/Cyclophosphamide Maintenance Therapy on Outcome of Dogs with Appendicular Osteosarcoma following Amputation and Carboplatin Chemotherapy: A Multi-Institutional Study.

    Science.gov (United States)

    London, Cheryl A; Gardner, Heather L; Mathie, Tamra; Stingle, Nicole; Portela, Roberta; Pennell, Michael L; Clifford, Craig A; Rosenberg, Mona P; Vail, David M; Williams, Laurel E; Cronin, Kim L; Wilson-Robles, Heather; Borgatti, Antonella; Henry, Carolyn J; Bailey, Dennis B; Locke, Jennifer; Northrup, Nicole C; Crawford-Jakubiak, Martin; Gill, Virginia L; Klein, Mary K; Ruslander, David M; Thamm, Doug H; Phillips, Brenda; Post, Gerald

    2015-01-01

    We hypothesized that the addition of toceranib to metronomic cyclophosphamide/piroxicam therapy would significantly improve disease-free interval (DFI) and overall survival (OS) in dogs with appendicular osteosarcoma (OSA) following amputation and carboplatin chemotherapy. This was a randomized, prospective clinical trial in which dogs with OSA free of gross metastatic disease (n = 126) received carboplatin chemotherapy (4 doses) following amputation. On study entry, dogs were randomized to receive piroxicam/cyclophosphamide with or without toceranib (n = 63 each) after completing chemotherapy. Patient demographics were not significantly different between both groups. During or immediately following carboplatin chemotherapy, 32 dogs (n = 13 toceranib; n = 19 control) developed metastatic disease, and 13 dogs left the study due to other medical conditions or owner preference. Following carboplatin chemotherapy, 81 dogs (n = 46 toceranib; n = 35 control) received the metronomic treatment; 35 dogs (n = 20 toceranib; n = 15 control) developed metastatic disease during the maintenance therapy, and 26 dogs left the study due to other medical conditions or owner preference. Nine toceranib-treated and 11 control dogs completed the study without evidence of metastatic disease 1-year following amputation. Toceranib-treated dogs experienced more episodes of diarrhea, neutropenia and weight loss than control dogs, although these toxicities were low-grade and typically resolved with supportive care. More toceranib-treated dogs (n = 8) were removed from the study for therapy-associated adverse events compared to control dogs (n = 1). The median DFI for control and toceranib treated dogs was 215 and 233 days, respectively (p = 0.274); the median OS for control and toceranib treated dogs was 242 and 318 days, respectively (p = 0.08). The one year survival rate for control dogs was 35% compared to 38% for dogs receiving toceranib. The addition of toceranib to metronomic piroxicam

  1. Does Age Influence Cardiac Resynchronization Therapy Use and Outcome?

    Science.gov (United States)

    Heidenreich, Paul A; Tsai, Vivian; Bao, Haikun; Curtis, Jeptha; Goldstein, Mary; Curtis, Lesley; Hernandez, Adrian; Peterson, Pamela; Turakhia, Mintu P; Masoudi, Frederick A

    2015-06-01

    This study sought to describe the use of CRT-D and its association with survival for older patients. Many patients who receive cardiac resynchronization therapy with defibrillator (CRT-D) in practice are older than those included in clinical trials. We identified patients undergoing ICD implantation in the National Cardiovascular Disease Registry (NCDR) ICD registry from 2006 to 2009, who also met clinical trial criteria for CRT, including left ventricular ejection fraction (LVEF) ≤35%, QRS ≥120 ms, and New York Heart Association (NYHA) functional class III or IV. NCDR registry data were linked to the social security death index to determine the primary outcome of time to death from any cause. We identified 70,854 patients from 1,187 facilities who met prior trial criteria for CRT-D. The mean age of the 58,147 patients receiving CRT-D was 69.4 years with 6.4% of patients age 85 or older. CRT use was 80% or higher among candidates in all age groups. Follow-up was available for 42,285 patients age ≥65 years at 12 months. Receipt of CRT-D was associated with better survival at 1 year (82.1% vs. 77.1%, respectively) and 4 years (54.0% vs. 46.2% , respectively) than in those receiving only an ICD (p different for different age groups (p = 0.86 for interaction). More than 80% of older patients undergoing ICD implantation who were candidates for a CRT-D received the combined device. Mortality in older patients undergoing ICD implantation was high but was lower for those receiving CRT-D. Copyright © 2015 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.

  2. Influence of titration schedule and maintenance dose on the tolerability of adjunctive eslicarbazepine acetate: An integrated analysis of three randomized placebo-controlled trials.

    Science.gov (United States)

    Krauss, Gregory; Biton, Victor; Harvey, Jay H; Elger, Christian; Trinka, Eugen; Soares da Silva, Patrício; Gama, Helena; Cheng, Hailong; Grinnell, Todd; Blum, David

    2018-01-01

    To examine the influence of titration schedule and maintenance dose on the incidence and type of treatment-emergent adverse events (TEAEs) associated with adjunctive eslicarbazepine acetate (ESL). Data from three randomized, double-blind, placebo-controlled trials were analyzed. Patients with refractory partial-onset seizures were randomized to maintenance doses of ESL 400, 800, or 1200mg QD (dosing was initiated at 400 or 800mg QD) or placebo. The incidence of TEAEs was analyzed during the double-blind period (2-week titration phase; 12-week maintenance phase), according to the randomized maintenance dose and the titration schedule. 1447 patients were included in the analysis. During the first week of treatment, 62% of patients taking ESL 800mg QD had ≥1 TEAE, vs 35% of those taking 400mg QD and 32% of the placebo group; dizziness, somnolence, nausea, and headache were numerically more frequent in patients taking ESL 800mg than those taking ESL 400mg QD. During the double-blind period, the incidences of common TEAEs were lower in patients who initiated ESL at 400mg vs 800mg QD. For the 800 and 1200mg QD maintenance doses, rates of TEAEs leading to discontinuation were lower in patients who began treatment with 400mg than in those who began taking ESL 800mg QD. Initiation of ESL at 800mg QD is feasible. However, initiating treatment with ESL 400mg QD for 1 or 2 weeks is recommended, being associated with a lower incidence of TEAEs, and related discontinuations. For some patients, treatment may be initiated at 800mg QD, if the need for more immediate seizure reduction outweighs concerns about increased risk of adverse reactions during initiation. Copyright © 2017 The Authors. Published by Elsevier B.V. All rights reserved.

  3. Successful maintenance on sulphonylurea therapy and low diabetes complication rates in a HNF1A-MODY cohort.

    Science.gov (United States)

    Bacon, S; Kyithar, M P; Rizvi, S R; Donnelly, E; McCarthy, A; Burke, M; Colclough, K; Ellard, S; Byrne, M M

    2016-07-01

    HNF1A gene mutations are the most common cause of maturity-onset diabetes of the young (MODY) in the UK. Persons with HNF1A-MODY display sensitivity to sulphonylurea therapy; however, the long-term efficacy is not established. There is limited literature as to the prevalence of micro- and macrovascular complications in this unique cohort. The aim of this study was to determine the natural progression and clinical management of HNF1A-MODY diabetes in a dedicated MODY clinic. Sixty patients with HNF1A-MODY and a cohort of 60 BMI-, age-, ethnicity- and diabetes duration-matched patients with Type 1 diabetes mellitus participated in the study. All patients were phenotyped in detail. Clinical follow-up of the HNF1A-MODY cohort occurred on a bi-annual basis. Following a genetic diagnosis of MODY, the majority of the cohort treated with sulphonylurea therapy remained insulin independent at 84-month follow-up (80%). The HbA1c in the HNF1A-MODY group treated with sulphonylurea therapy alone improved significantly over the study period [from 49 (44-63) mmol/mol, 6.6 (6.2-7.9)% to 41 (31-50) mmol/mol, 5.9 (5-6.7)%; P = 0.003]. The rate of retinopathy was significantly lower than that noted in the Type 1 diabetes mellitus group (13.6 vs. 50%; P = 0.0001).There was also a lower rate of microalbuminuria and cardiovascular disease in the HNF1A-MODY group compared with the Type 1 diabetes mellitus group. This study demonstrates that the majority of patients with HNF1A-MODY can be maintained successfully on sulphonylurea therapy with good glycaemic control. We note a significantly lower rate of micro- and macrovascular complications than reported previously. The use of appropriate therapy at early stages of the disorder may decrease the incidence of complications. © 2015 Diabetes UK.

  4. The influence of music therapy on quality of life after a stroke

    Directory of Open Access Journals (Sweden)

    Ilona Poćwierz-Marciniak

    2017-01-01

    Full Text Available Background A stroke is an interruption in the course of one’s life. It often results in physical disability, cognitive or executive disorders, emotional problems and, as a consequence, the decrease of one’s quality of life. The goal of this research was to determine whether music therapy during neurorehabilitation can positively influence the assessment of one’s quality of life after a stroke. Participants and procedure Sixty-one people who had had strokes and were in the early stages of neurorehabilitation in a hospital took part in the research (n = 31 in the control group and n = 30 in the experimental group. All of them were physically disabled and had either minor cognitive and executive disabilities or none at all. People were randomly assigned to groups. Those in the experimental group participated in a one-on-one music therapy programme divided into 10 sessions based on guided imagery music therapy and cognitive music therapy. The first measurement of quality of life took place at the beginning of the hospital stay at the department of neurorehabilitation (about 1 month after the stroke and the second took place about 1.5 months later. Results Analysis of the results showed that participation in the music therapy programme was associated with a higher assessment of quality of life in the following aspects: general health, vitality, mental health, communication, emotional condition, and alertness. However, taking part in the music therapy had no influence on the assessment of quality of life in the areas of pain, limitation of social roles, relationships, self-care, mobility, and taking care of the house. Conclusions Stroke survivors who took part in music therapy assess their quality of life as higher compared to patients who did not take part in music therapy. Music therapy could constitute a supplementary method of treatment for patients during neurorehabilitation after a stroke, thus improving their quality of life.

  5. Maintenance methods

    International Nuclear Information System (INIS)

    Sanchis, H.; Aucher, P.

    1990-01-01

    The maintenance method applied at the Hague is summarized. The method was developed in order to solve problems relating to: the different specialist fields, the need for homogeneity in the maintenance work, the equipment diversity, the increase of the materials used at the Hague's new facilities. The aim of the method is to create a knowhow formalism, to facilitate maintenance, to ensure the running of the operations and to improve the estimation of the maintenance cost. One of the method's difficulties is the demonstration of the profitability of the maintenance operations [fr

  6. Anxiety, depression, stress, and cortisol levels in mothers of children undergoing maintenance therapy for childhood acute lymphoblastic leukemia.

    Science.gov (United States)

    Neu, Madalynn; Matthews, Ellyn; King, Nancy A; Cook, Paul F; Laudenslager, Mark L

    2014-01-01

    The purpose of this study was to compare anxiety, depression, and stress between mothers of children during maintenance treatment for acute lymphoblastic leukemia (ALL) and matched controls. Twenty-six mothers were recruited from the hematology unit at a children's hospital, and 26 mothers were recruited from the community. Participants were matched to their child's age and gender. Mothers completed the Hospital Anxiety and Depression Scale, the Perceived Stress Sale, and collected salivary cortisol 4 times a day for 3 consecutive days. Compared with mothers of healthy children, anxiety scores did not differ (P=.10), but depression scores were higher (P=.003) in mothers of children with ALL. More mothers in the ALL group scored above the cutoff of 7 indicating clinical anxiety (46%) and depressive symptoms (27%). A trend toward increased stress was found in mothers in the ALL group. No difference was found in overall daily cortisol (area under the curve), daily decrease in cortisol (slope), and cortisol awakening response. Mothers of children with ALL experienced emotional symptoms many months after the initial diagnosis.

  7. Relapses in recurrent depression 1 year after maintenance cognitive-behavioral therapy: the role of therapist adherence, competence, and the therapeutic alliance.

    Science.gov (United States)

    Weck, Florian; Rudari, Visar; Hilling, Christine; Hautzinger, Martin; Heidenreich, Thomas; Schermelleh-Engel, Karin; Stangier, Ulrich

    2013-11-30

    The prevention of relapse in recurrent depression is considered a central aim in cognitive-behavioral therapy, given the high risk of relapse. In this study, patients with recurrent major depressive disorder (currently remitted) received 16 sessions of Maintenance Cognitive-Behavioral Therapy (M-CBT) over a period of 8 months, in order to prevent relapse. Therapist adherence and competence, as well as the therapeutic alliance, were investigated as predictors for reducing the risk of recurrence in depression. Videotapes of 80 participants were analyzed in order to evaluate therapist adherence and competence. Additionally, the therapeutic alliance was assessed by questionnaire. No associations were found between therapist adherence or competence, and the risk of relapse 1 year after treatment. By contrast, the therapeutic alliance was a significant predictor of the time to relapse. Moreover, we found that the number of previous depressive episodes (≥ 5 vs. ≤ 4) was a significant moderator variable. This indicates that the alliance-outcome relationship was particularly important when patients with five or more previous depressive episodes were taken into account, in comparison to patients with four or fewer episodes. For the psychotherapeutic treatment of recurrent depression and the prevention of relapse, sufficient attention should be paid to the therapeutic alliance. Copyright © 2013 Elsevier Ireland Ltd. All rights reserved.

  8. Memory Retrieval Has a Dynamic Influence on the Maintenance Mechanisms That Are Sensitive to ζ-Inhibitory Peptide (ZIP).

    Science.gov (United States)

    Levitan, David; Fortis-Santiago, Yaihara; Figueroa, Joshua A; Reid, Emily E; Yoshida, Takashi; Barry, Nicholas C; Russo, Abigail; Katz, Donald B

    2016-10-12

    In neuroscientists' attempts to understand the long-term storage of memory, topics of particular importance and interest are the cellular and system mechanisms of maintenance (e.g., those sensitive to ζ-inhibitory peptide, ZIP) and those induced by memory retrieval (i.e., reconsolidation). Much is known about each of these processes in isolation, but less is known concerning how they interact. It is known that ZIP sensitivity and memory retrieval share at least some molecular targets (e.g., recycling α-amino-3-hydroxy-5-methyl-4-isoxazolepropionic acid, AMPA, receptors to the plasma membrane); conversely, the fact that sensitivity to ZIP emerges only after consolidation ends suggests that consolidation (and by extension reconsolidation) and maintenance might be mutually exclusive processes, the onset of one canceling the other. Here, we use conditioned taste aversion (CTA) in rats, a cortically dependent learning paradigm, to test this hypothesis. First, we demonstrate that ZIP infusions into gustatory cortex begin interfering with CTA memory 43-45 h after memory acquisition-after consolidation ends. Next, we show that a retrieval trial administered after this time point interrupts the ability of ZIP to induce amnesia and that ZIP's ability to induce amnesia is reengaged only 45 h after retrieval. This pattern of results suggests that memory retrieval and ZIP-sensitive maintenance mechanisms are mutually exclusive and that the progression from one to the other are similar after acquisition and retrieval. They also reveal concrete differences between ZIP-sensitive mechanisms induced by acquisition and retrieval: the latency with which ZIP-sensitive mechanisms are expressed differ for the two processes. Memory retrieval and the molecular mechanisms that are sensitive to ζ-inhibitory peptide (ZIP) are the few manipulations that have been shown to effect memory maintenance. Although much is known about their effect on maintenance separately, it is unknown how they

  9. Comparative cost-effectiveness of a fluticasone-propionate/salmeterol combination versus anticholinergics as initial maintenance therapy for chronic obstructive pulmonary disease

    Directory of Open Access Journals (Sweden)

    An

    2010-12-01

    Full Text Available Anand A Dalal1, Melissa H Roberts2, Hans V Petersen2, Christopher M Blanchette3, Douglas W Mapel41US Health Outcomes, GlaxoSmithKline, Research Triangle Park, NC; 2Division of Clinical and Outcomes Research, Lovelace Respiratory Research Institute, Albuquerque, NM; 3Kannapolis, North Carolina; 4Lovelace Clinic Foundation, Albuquerque, NM, USAPurpose: Relative costs and utilization-related outcomes of a fluticasone propionate 250 µg + salmeterol 50 µg combination (FSC, tiotropium bromide, and ipratropium as initial maintenance therapy in COPD have not been compared in a commercially-insured population.Methods: This retrospective, observational cohort study used health care claims data from January 2004 to June 2009 from a large administrative database for patients aged ≥40 years with COPD. Time-to-first COPD-related health care event beginning 30 days following therapy initiation with FSC (n = 16,684, ipratropium alone or in fixed dose combination with albuterol (n = 14,449, or tiotropium (n = 12,659 was estimated using Cox proportional hazard models that controlled for differences in patient demographic characteristics, health care utilization, and comorbidities at baseline. Mean adjusted costs and numbers of COPD-related health care encounters and prescription medication fills were compared among patients with 12 months of follow-up (FSC, n = 12,595; ipratropium, n = 10,617; tiotropium, n = 9126.Results: With FSC as the reference, risk for a COPD-related hospitalization and/or emergency department visit was significantly higher for ipratropium (hazard ratio [HR] 1.64, 95% confidence interval [CI] 1.50–1.79 and tiotropium (HR 1.29, CI 1.17–1.41. Mean adjusted 12-month COPD-related total health care costs were lower for FSC ($2068, standard deviation [SD] $1190 than for ipratropium ($2841, SD $1858 and tiotropium ($2408, SD $1511, both P < 0.05. Mean number of COPD-related hospitalizations, emergency department visits, and outpatient

  10. Treatment of Children With Central Nervous System Primitive Neuroectodermal Tumors/Pinealoblastomas in the Prospective Multicentric Trial HIT 2000 Using Hyperfractionated Radiation Therapy Followed by Maintenance Chemotherapy

    Energy Technology Data Exchange (ETDEWEB)

    Gerber, Nicolas U., E-mail: nicolas.gerber@kispi.uzh.ch [Department of Pediatric Oncology, University Children' s Hospital, Zurich (Switzerland); Hoff, Katja von; Resch, Anika [Department of Pediatric Hematology and Oncology, University Medical Center Hamburg-Eppendorf, Hamburg (Germany); Ottensmeier, Holger [Department of Pediatric Oncology, University of Wuerzburg, Wuerzburg (Germany); Kwiecien, Robert; Faldum, Andreas [Institute of Biostatistics and Clinical Research, University of Muenster (Germany); Matuschek, Christiane [Department of Radiation Oncology, Medical Faculty, Heinrich Heine University of Duesseldorf, Duesseldorf (Germany); Hornung, Dagmar [Department of Radiotherapy and Radio-Oncology, University Medical Center Hamburg-Eppendorf, Hamburg (Germany); Bremer, Michael [Institute for Radiation Therapy and Special Oncology, Hannover Medical School, Hannover (Germany); Benesch, Martin [Division of Pediatric Hematology and Oncology, Department of Pediatrics and Adolescent Medicine, Medical University of Graz, Graz (Austria); Pietsch, Torsten [Department of Neuropathology, University of Bonn, Bonn (Germany); Warmuth-Metz, Monika [Department of Neuroradiology, University of Wuerzburg, Wuerzburg (Germany); Kuehl, Joachim [Department of Pediatric Oncology, University of Wuerzburg, Wuerzburg (Germany); Rutkowski, Stefan [Department of Pediatric Hematology and Oncology, University Medical Center Hamburg-Eppendorf, Hamburg (Germany); Kortmann, Rolf D. [Department of Radiation Oncology, University of Leipzig, Leipzig (Germany)

    2014-07-15

    Purpose: The prognosis for children with central nervous system primitive neuroectodermal tumor (CNS-PNET) or pinealoblastoma is still unsatisfactory. Here we report the results of patients between 4 and 21 years of age with nonmetastatic CNS-PNET or pinealoblastoma diagnosed from January 2001 to December 2005 and treated in the prospective GPOH-trial P-HIT 2000-AB4. Methods and Materials: After surgery, children received hyperfractionated radiation therapy (36 Gy to the craniospinal axis, 68 Gy to the tumor region, and 72 Gy to any residual tumor, fractionated at 2 × 1 Gy per day 5 days per week) accompanied by weekly intravenous administration of vincristine and followed by 8 cycles of maintenance chemotherapy (lomustine, cisplatin, and vincristine). Results: Twenty-six patients (15 with CNS-PNET; 11 with pinealoblastoma) were included. Median age at diagnosis was 11.5 years old (range, 4.0-20.7 years). Gross total tumor resection was achieved in 6 and partial resection in 16 patients (indistinct, 4 patients). Median follow-up of the 15 surviving patients was 7.0 years (range, 5.2-10.0 years). The combined response rate to postoperative therapy was 17 of 20 (85%). Eleven of 26 patients (42%; 7 of 15 with CNS-PNET; 4 of 11 with pinealoblastoma) showed tumor progression or relapse at a median time of 1.3 years (range, 0.5-1.9 years). Five-year progression-free and overall survival rates (±standard error [SE]) were each 58% (±10%) for the entire cohort: CNS-PNET was 53% (±13); pinealoblastoma was 64% (±15%; P=.524 and P=.627, respectively). Conclusions: Postoperative hyperfractionated radiation therapy with local dose escalation followed by maintenance chemotherapy was feasible without major acute toxicity. Survival rates are comparable to those of a few other recent studies but superior to those of most other series, including the previous trial, HIT 1991.

  11. Influence of Cognitive Ability on Therapy Outcomes for Anomia in Adults with Chronic Poststroke Aphasia

    Science.gov (United States)

    Dignam, Jade; Copland, David; O'Brien, Kate; Burfein, Penni; Khan, Asaduzzaman; Rodriguez, Amy D.

    2017-01-01

    Purpose: The relationship between cognitive abilities and aphasia rehabilitation outcomes is complex and remains poorly understood. This study investigated the influence of language and cognitive abilities on anomia therapy outcomes in adults with aphasia. Method: Thirty-four adults with chronic aphasia participated in Aphasia Language Impairment…

  12. Influence of transoesophageal echocardiography on therapy and prognosis in young patients with TIA or ischaemic stroke

    NARCIS (Netherlands)

    Rettig, T. C. D.; Bouma, B. J.; van den Brink, R. B. A.

    2009-01-01

    Objective. To determine the influence of transoesophageal echocardiography (TEE) on therapy and prognosis in patients with cryptogenic transient ischaemic attack (TIA) or ischaemic stroke under the age of 50 years.Methods and results. We evaluated all patients aged 50 and under who were referred to

  13. Teaching evidence-based speech and language therapy: Influences from formal and informal curriculum

    NARCIS (Netherlands)

    Spek, B.

    2015-01-01

    This dissertation focuses on influences from formal and informal curriculum on the effectiveness of teaching evidence-based speech and language therapy. A study showed that while EBP knowledge and skills increase during the years of study, motivational beliefs such as EBP task value and

  14. Voices of Family Therapy Doctoral Students of Color: Aspirations and Factors Influencing Careers in Academia

    Science.gov (United States)

    Miller, John K.; Stone, Dana J.

    2011-01-01

    The authors examined factors influencing career aspirations of doctoral students of color in family therapy doctoral programs across the country, with a special focus on careers in the professoriate. Qualitative interviews were conducted with students at varying levels of degree completion. Respondents discussed barriers to careers in academia as…

  15. The study of Influencing Maintenance Factors on Failures of Two gypsum Kilns by Failure Modes and Effects Analysis (FMEA

    Directory of Open Access Journals (Sweden)

    Iraj Alimohammadi

    2014-06-01

    Full Text Available Developing technology and using equipment in Iranian industries caused that maintenance system would be more important to use. Using proper management techniques not only increase the performance of production system but also reduce the failures and costs. The aim of this study was to determine the quality of maintenance system and the effects of its components on failures of kilns in two gypsum production companies using Failure Modes and Effects Analysis (FMEA. Furthermore the costs of failures were studied. After the study of gypsum production steps in the factories, FMEA was conducted by the determination of analysis insight, information gathering, making list of kilns’ component and filling up the FMEA’s tables. The effects of failures on production, how to fail, failure rate, failure severity, and control measures were studied. The evaluation of maintenance system was studied by a check list including questions related to system components. The costs of failures were determined by refer in accounting notebooks and interview with the head of accounting department. It was found the total qualities of maintenance system in NO.1 was more than NO.2 but because of lower quality of NO.1’s kiln design, number of failures and their costs were more. In addition it was determined that repair costs in NO.2’s kiln were about one third of NO.1’s. The low severity failures caused the most costs in comparison to the moderate and low ones. The technical characteristics of kilns were appeared to be the most important factors in reducing of failures and costs.

  16. Maintenance Therapy by Vaginal Progesterone after Threatened Idiopathic Preterm Labor: A Randomized Placebo-Controlled Double-blind Trial

    Directory of Open Access Journals (Sweden)

    Seyede Hajar Sharami

    2010-01-01

    Full Text Available Background: Patients with arrested preterm labor (PTL are at increased risk for recurrence ofpreterm birth (PTB. Maintenance tocolysis after arrest of acute PTL is of questionable value. Theobjective of this study was to evaluate the efficacy of 200 mg vaginal progesterone in order toprevent PTB in women with episodes of threatened PTL.Materials and Methods: This is a randomized double blind clinical trial study.Women with singletonpregnancies between 28-36 weeks of gestation, who were hospitalized for PTL were included. Atotal of 173 pregnant patients were randomly allocated to receive 200 mg vaginal progesteronesuppositories (n=86 or placebo (n=87 daily until the 36th gestational week. The two groups werecompared relative to demographic characteristics, incidence of PTB before 34 and 37 weeks, andmaternal and neonatal complications. Data were analyzed by chi-square and Fisher’s exact tests.Results: Mean latency until delivery in the cases was longer than the control group (23.88 ± 18.01vs. 16.67 ± 12.9; p=0.004.Treatment with progesterone was not associated with a reduction inthe rate of PTB before 34 weeks [cases: 9 (10.8% vs. controls: 8 (10%] and 37 weeks [cases: 45(54.2% vs. controls: 33 (41.2%]. Log rank analysis revealed a significant difference for mean timeto delivery between the two groups (p=0.028. There were no significant differences for neonataland maternal complications in the two groups.Conclusion: Prophylactic administration of 200 mg vaginal progesterone suppositories aftersuccessful tocolysis in patients with threatened idiopathic PTL is associated with a longer latencyto delivery, but failed to reduce the rate of PTB (Registeration Number: IRCT138706051096N1.

  17. Influence of abutment type and esthetic veneering on preload maintenance of abutment screw of implant-supported crowns.

    Science.gov (United States)

    Delben, Juliana Aparecida; Barão, Valentim Adelino Ricardo; Dos Santos, Paulo Henrique; Assunção, Wirley Gonçalves

    2014-02-01

    The effect of veneering materials on screw joint stability remains inconclusive. Thus, this study evaluated the preload maintenance of abutment screws of single crowns fabricated with different abutments and veneering materials. Sixty crowns were divided into five groups (n = 12): UCLA abutment in gold alloy with ceramic (group GC) and resin (group GR) veneering, UCLA abutment in titanium with ceramic (group TiC) and resin (group TiR) veneering, and zirconia abutment with ceramic veneering (group ZiC). Abutment screws made of gold were used with a 35 Ncm insertion torque. Detorque measurements were obtained initially and after mechanical cycling. Data were analyzed by ANOVA and Fisher's exact test at a significance level of 5%. For the initial detorque means (in Ncm), group TiC (21.4 ± 1.78) exhibited statistically lower torque maintenance than groups GC (23.9 ± 0.91), GR (24.1 ± 1.34), and TiR (23.2 ± 1.33) (p abutment type and veneering material. More irregular surfaces in the hexagon area of the castable abutments were observed. The superiority of any veneering material concerning preload maintenance was not established. © 2013 by the American College of Prosthodontists.

  18. A Human Error Analysis Procedure for Identifying Potential Error Modes and Influencing Factors for Test and Maintenance Activities

    International Nuclear Information System (INIS)

    Kim, Jae Whan; Park, Jin Kyun

    2010-01-01

    Periodic or non-periodic test and maintenance (T and M) activities in large, complex systems such as nuclear power plants (NPPs) are essential for sustaining stable and safe operation of the systems. On the other hand, it also has been raised that human erroneous actions that might occur during T and M activities has the possibility of incurring unplanned reactor trips (RTs) or power derate, making safety-related systems unavailable, or making the reliability of components degraded. Contribution of human errors during normal and abnormal activities of NPPs to the unplanned RTs is known to be about 20% of the total events. This paper introduces a procedure for predictively analyzing human error potentials when maintenance personnel perform T and M tasks based on a work procedure or their work plan. This procedure helps plant maintenance team prepare for plausible human errors. The procedure to be introduced is focusing on the recurrent error forms (or modes) in execution-based errors such as wrong object, omission, too little, and wrong action

  19. Motor programme activating therapy influences adaptive brain functions in multiple sclerosis: clinical and MRI study.

    Science.gov (United States)

    Rasova, Kamila; Prochazkova, Marie; Tintera, Jaroslav; Ibrahim, Ibrahim; Zimova, Denisa; Stetkarova, Ivana

    2015-03-01

    There is still little scientific evidence for the efficacy of neurofacilitation approaches and their possible influence on brain plasticity and adaptability. In this study, the outcome of a new kind of neurofacilitation approach, motor programme activating therapy (MPAT), was evaluated on the basis of a set of clinical functions and with MRI. Eighteen patients were examined four times with standardized clinical tests and diffusion tensor imaging to monitor changes without therapy, immediately after therapy and 1 month after therapy. Moreover, the strength of effective connectivity was analysed before and after therapy. Patients underwent a 1-h session of MPAT twice a week for 2 months. The data were analysed by nonparametric tests of association and were subsequently statistically evaluated. The therapy led to significant improvement in clinical functions, significant increment of fractional anisotropy and significant decrement of mean diffusivity, and decrement of effective connectivity at supplementary motor areas was observed immediately after the therapy. Changes in clinical functions and diffusion tensor images persisted 1 month after completing the programme. No statistically significant changes in clinical functions and no differences in MRI-diffusion tensor images were observed without physiotherapy. Positive immediate and long-term effects of MPAT on clinical and brain functions, as well as brain microstructure, were confirmed.

  20. Predicting and influencing voice therapy adherence using social-cognitive factors and mobile video.

    Science.gov (United States)

    van Leer, Eva; Connor, Nadine P

    2015-05-01

    Patient adherence to voice therapy is an established challenge. The purpose of this study was (a) to examine whether adherence to treatment could be predicted from three social-cognitive factors measured at treatment onset: self-efficacy, goal commitment, and the therapeutic alliance, and (b) to test whether the provision of clinician, self-, and peer model mobile treatment videos on MP4 players would influence the same triad of social cognitive factors and the adherence behavior of patients. Forty adults with adducted hyperfunction with and without benign lesions were prospectively randomized to either 4 sessions of voice therapy enhanced by MP4 support or without MP4 support. Adherence between sessions was assessed through self-report. Social cognitive factors and voice outcomes were assessed at the beginning and end of therapy. Utility of MP4 support was assessed via interviews. Self-efficacy and the therapeutic alliance predicted a significant amount of adherence variance. MP4 support significantly increased generalization, self-efficacy for generalization, and the therapeutic alliance. An interaction effect demonstrated that MP4 support was particularly effective for patients who started therapy with poor self-efficacy for generalization. Adherence may be predicted and influenced via social-cognitive means. Mobile technology can extend therapy to extraclinical settings.

  1. Radioiodine therapy in toxic multinodular goiter- the influence of carbimazole therapy and dietary iodine on relapse rates

    International Nuclear Information System (INIS)

    Mitra, S.; Muthu, G.S.

    2007-01-01

    Full text: The relapse rate of radioiodine therapy in toxic multinodular goiter (TMNG) is reported to be around 34% at one year. The effect of antithyroid drugs on the response rate is controversial with studies reporting a higher relapse rate in patients pretreated with antithyroid drugs. Other studies report no influence of pretreatment with antithyroid drugs. The thyroid clinic at Tata Main Hospital is a referral center for thyroid disorders in Jamshedpur. 63 patients of TMNG (Group A) were treated with Radioiodine between 1995-2003. The demographic profile of these patients was as follows: M/F- 38%: 62%, 76% of patients were above 40 years, 85% had been on anti-thyroid drugs for more than 18 months. Fixed dose radioiodine in an oral dose varying from 5-10 mCi was given in all patients of Group A. 32.4 % of patients continued to be toxic or relapsed after a period of euthyroid status within 1 year of Radioiodine therapy. A change in protocol for radioiodine therapy was introduced in 2003. This included withdrawal of antithyroid drugs for one month before radioiodine therapy and the use of noniodized salt and abstinence from seafood in diet during this period. 33 TMN Goiter patients (Group B) followed this protocol before receiving Radioiodine. The dose of Radioiodine remained 5-10 mCi. The age and sex profile of Group A and B were comparable. However, Group B patients had been on antithyroid drugs for a shorter period (p< 0.001). The dose of Radioiodine in 94% of Group B patients was between 7-10mCi, whereas this was 63.4% in Group A. The rest of the patients had received a dose between 5-7 mCi. The relapse rate in Group B was 9.1% compared to 32.4% in Group A. Improvement in response rates with increase in Radioiodine dose remains controversial.P PThe better response rate in Group B patients may be attributed to the withdrawal of antithyroid drugs for one month before therapy and the reduction in dietary intake of Iodine for a month before therapy. However, a

  2. Impact of depression on treatment effectiveness and gains maintenance in social phobia: a naturalistic study of cognitive behavior group therapy.

    Science.gov (United States)

    Marom, Sofi; Gilboa-Schechtman, Eva; Aderka, Idan M; Weizman, Abraham; Hermesh, Haggai

    2009-01-01

    The impact of depression on cognitive behavioral group therapy (CBGT) for social phobia (SP) in a naturalistic outpatient setting was examined after treatment termination and at 1-year follow-up. Consecutive SP outpatients (N=219) were diagnosed using a structured interview. CBGT was provided in 18 1.5-hr weekly sessions. At pretreatment and posttreatment questionnaires and clinician ratings were administered. Self-report measures were obtained at 1-year follow-up. The main outcome measure was the Liebowitz Social Anxiety Scale. CBGT was found to be effective in reducing both social anxiety (effect size=1.23) as well as depression (effect size=0.94). Individuals with generalized social phobia (GSP) and individuals with specific social phobia (SSP) differed in their presenting psychopathology and in their response to CBGT. Among treatment completers, 44% GSPs and 37% SSPs achieved at least 50% improvement, and 44% GSPs and 87% SSPs reported distress and functioning within the normal range at the end of treatment. Among SPs diagnosed with major depressive disorder (MDD) at the onset of treatment, SP symptoms aggravated during the follow-up period, whereas SPs not diagnosed with MDD experienced a further alleviation of SP symptoms during follow-up. CBGT provided in a public clinic to non-selected, mostly unmedicated and comorbid patients, is an effective treatment for the majority of SP sufferers. MDD at the onset of CBGT was not associated with poorer treatment response, but predicted exacerbation of SP symptoms following treatment termination. Depressed SPs may need additional intervention to maintain CBGT gains. SSPs may benefit from less intensive CBGT than GSPs. (c) 2009 Wiley-Liss, Inc.

  3. Triggers of Substance Abuse Slip and Relapse During Outpatient Treatment in Methadone/Buprenorphine Maintenance Therapy Clinics: A Predictive Model with Emphasis on Treatment-Related Factors

    Directory of Open Access Journals (Sweden)

    Saeid Komasi

    2017-07-01

    Full Text Available Background Most addicts relapse in the first year of treatment especially in the first 3 - 6 months, which is the most vulnerable period. Objectives The present study aimed to assess the predictors of substance abuse slip and relapse among addicts in the first 6 months of treatment with an emphasis on treatment related factors. Methods The data of this cross-sectional study collected through assessment of 148 patients who were referred to the Methadone/Buprenorphine maintenance therapy clinics of Kermanshah city during April to September of 2015. Demographic, history, treatment checklist, comorbidity index, and medical records were used for collecting data. Data was analyzed through chi-square, t-test, and Binary logistic regression analysis. Results The mean age of total participants was 42.4 ± 11.3 years and 98% of them were male. 27% and 35.1% of the patients, respectively, had a slip and relapse during the first 6 months of treatment. After adjustment for all demographic data, it was indicated that self-employment (P = 0.037, more treatment costs (P = 0.049, previous treatment history (P = 0.027, not satisfied dose of medication (P = 0.012, and lack of medical therapy history under physicians supervision (P = 0.046 can increase the possibility of a slip significantly. Conclusions Despite the fact that prevention of re-abuse and relapse of disease includes multi-factorial approach, it seems that the treatment-related factors are as the most major factors in relapse and slip during the first 6 months of treatment. Health practitioners’ special attention to treatment related factors in addiction, especially previous treatment history as the most important predictor of relapse, are probably effective in the control and decrease of a slip and relapse.

  4. Tofacitinib induction and maintenance therapy in East Asian patients with active ulcerative colitis: subgroup analyses from three phase 3 multinational studies

    Directory of Open Access Journals (Sweden)

    Satoshi Motoya

    2018-04-01

    Full Text Available Background/Aims : Tofacitinib is an oral, small-molecule Janus kinase inhibitor being investigated for ulcerative colitis (UC. In OCTAVE Induction 1 and 2, patients with moderately to severely active UC received placebo or tofacitinib 10 mg twice daily (BID for 8 weeks. Clinical responders in OCTAVE Induction were re-randomized to 52 weeks' therapy with placebo, tofacitinib 5 mg BID, or tofacitinib 10 mg BID. Methods : We conducted post-hoc efficacy and safety analyses of East Asian patients in OCTAVE Induction 1 and 2 and OCTAVE Sustain. Results : A total of 121 East Asian (Japan, Korea, and Taiwan patients were randomized in OCTAVE Induction 1 and 2 (placebo, n=26; tofacitinib 10 mg BID, n=95, and 63 in OCTAVE Sustain (placebo, n=20; tofacitinib 5 mg BID, n=22; tofacitinib 10 mg BID, n=21. At week 8 of OCTAVE Induction 1 and 2, 18.9% of patients (18/95 achieved remission with tofacitinib 10 mg BID versus 3.8% (1/26 with placebo. In OCTAVE Sustain, the week 52 remission rates were 45.5% (10/22, 47.6% (10/21, and 15.0% (3/20 with 5 mg BID, 10 mg BID, and placebo, respectively. Adverse event rates were similar between groups in OCTAVE Induction and numerically higher with tofacitinib in OCTAVE Sustain. Serious adverse event rates were similar across groups in all studies. Infections were numerically more frequent with tofacitinib than placebo. Increases in serum lipid levels were observed with tofacitinib. Conclusion : In East Asian patients with UC, tofacitinib demonstrated numerically greater efficacy versus placebo as induction and maintenance therapy, with a safety profile consistent with the global study population. ClinicalTrials.gov: NCT01465763; NCT01458951; NCT01458574.

  5. Tofacitinib induction and maintenance therapy in East Asian patients with active ulcerative colitis: subgroup analyses from three phase 3 multinational studies.

    Science.gov (United States)

    Motoya, Satoshi; Watanabe, Mamoru; Kim, Hyo Jong; Kim, Young Ho; Han, Dong Soo; Yuasa, Hirotoshi; Tabira, Junichi; Isogawa, Naoki; Arai, Shoko; Kawaguchi, Isao; Hibi, Toshifumi

    2018-04-01

    Tofacitinib is an oral, small-molecule Janus kinase inhibitor being investigated for ulcerative colitis (UC). In OCTAVE Induction 1 and 2, patients with moderately to severely active UC received placebo or tofacitinib 10 mg twice daily (BID) for 8 weeks. Clinical responders in OCTAVE Induction were re-randomized to 52 weeks' therapy with placebo, tofacitinib 5 mg BID, or tofacitinib 10 mg BID. We conducted post-hoc efficacy and safety analyses of East Asian patients in OCTAVE Induction 1 and 2 and OCTAVE Sustain. A total of 121 East Asian (Japan, Korea, and Taiwan) patients were randomized in OCTAVE Induction 1 and 2 (placebo, n=26; tofacitinib 10 mg BID, n=95), and 63 in OCTAVE Sustain (placebo, n=20; tofacitinib 5 mg BID, n=22; tofacitinib 10 mg BID, n=21). At week 8 of OCTAVE Induction 1 and 2, 18.9% of patients (18/95) achieved remission with tofacitinib 10 mg BID versus 3.8% (1/26) with placebo. In OCTAVE Sustain, the week 52 remission rates were 45.5% (10/22), 47.6% (10/21), and 15.0% (3/20) with 5 mg BID, 10 mg BID, and placebo, respectively. Adverse event rates were similar between groups in OCTAVE Induction and numerically higher with tofacitinib in OCTAVE Sustain. Serious adverse event rates were similar across groups in all studies. Infections were numerically more frequent with tofacitinib than placebo. Increases in serum lipid levels were observed with tofacitinib. In East Asian patients with UC, tofacitinib demonstrated numerically greater efficacy versus placebo as induction and maintenance therapy, with a safety profile consistent with the global study population. ClinicalTrials.gov: NCT01465763; NCT01458951; NCT01458574.

  6. Effect of computerized cognitive behavioral therapy on acquisition of coping skills among cocaine-dependent individuals enrolled in methadone maintenance.

    Science.gov (United States)

    Kiluk, Brian D; DeVito, Elise E; Buck, Matthew B; Hunkele, Karen; Nich, Charla; Carroll, Kathleen M

    2017-11-01

    The acquisition of coping skills has long been considered one of the putative mechanisms of cognitive behavioral therapy (CBT) for substance use disorders, yet consistent statistical support is lacking. This study sought to replicate and extend prior findings regarding the quality of coping skills as a mediator of abstinence outcomes from a computerized CBT program for substance users. Participants were methadone-maintained, cocaine dependent individuals enrolled in a clinical trial evaluating the efficacy of computer-based training for CBT ('CBT4CBT') as an add-on to treatment as usual (TAU+CBT4CBT) compared to TAU only. A subsample (N=71) completed a role play assessment to measure coping skills, the Drug Risk Response Test (DRRT), which was administered before, during (week 4), and after the 8-week treatment period. Participants' verbal responses to various high-risk situations for cocaine use were recorded and independent evaluators rated the quality of the coping responses. Results of repeated measures analyses revealed a main effect of time for the quality of overall responses [F(1, 141.26)=4.29, pskills across groups, yet no differential effect of treatment. Despite the significant association between coping responses and abstinence outcomes, analyses did not support the quality of coping skills as a mediator of treatment effects. However, among the high-risk situations wherein individuals provided lower quality responses at baseline, those assigned to TAU+CBT4CBT showed greater improvement compared to those assigned to TAU only [F(1, 697.65)=6.47, p=0.01]. This study failed to replicate the quality of coping skills as a mediator of CBT4CBT's effect on reducing drug use previously shown in a mixed outpatient substance use sample. However, in this methadone maintained sample, those with poorer quality skills in response to certain high-risk situations at baseline appeared to improve their coping strategies following CBT4CBT compared to standard methadone

  7. A televideo exercise and nutrition program for children with acute lymphoblastic leukemia in maintenance therapy: design and methods

    Directory of Open Access Journals (Sweden)

    Gibson CA

    2015-07-01

    Full Text Available Cheryl A Gibson,1 Keith J August,2 Jerry L Greene,3 Stephen D Herrmann,4 Jaehoon Lee,5 Susan P Harvey,6 Kate Lambourne,3 Debra K Sullivan7 1Department of Internal Medicine, Division of General and Geriatric Medicine, University of Kansas Medical Center, KS, USA; 2Children's Mercy Hospital, MO, USA; 3Department of Health, Sport, and Exercise Sciences, University of Kansas, KS, USA; 4Children's Health Research Center, Sanford Research, SD, USA; 5Institute for Measurement, Methodology, Analysis and Policy, Texas Tech University, TX, USA; 6Center for Research on Learning, University of Kansas, KS, USA; 7Department of Dietetics and Nutrition, University of Kansas Medical Center, KS, USA Abstract: Changes in nutrient intake and decreased exercise resulting from cancer therapies as well as their side effects may be contributing factors in the increased body weight and differences in physical fitness observed in survivors of childhood acute lymphoblastic leukemia (ALL. This article will describe the study protocol for an intervention program designed to improve the physical activity and nutrition behaviors of ALL survivors. Twenty-four children aged between 4 years and 12 years with ALL will be randomized to a 6-month technology-based exercise and nutrition program (TLC4ALLKids or to enhanced usual care (eUC. The participants randomized to the TLC4ALLKids will participate in weekly, 1-hour coaching sessions on nutrition and physical activity and 1-hour physical activity classes delivered by group video conferencing. Participants will be provided with iPad tablets loaded with video conferencing software and the Healthy Lifestyle Tracking calendar to track daily nutrition and physical activity goals and weight. Both groups will be provided with Fitbit™ Zip to monitor physical activity. To assess feasibility, participant recruitment (achievement of proposed sample size, attendance (per weekly online sessions/assessment sessions, and adherence (number of

  8. Preventative Maintenance.

    Science.gov (United States)

    Migliorino, James

    Boards of education must be convinced that spending money up front for preventive maintenance will, in the long run, save districts' tax dollars. A good program of preventive maintenance can minimize disruption of service; reduce repair costs, energy consumption, and overtime; improve labor productivity and system equipment reliability; handle…

  9. Cost-effectiveness of methadone maintenance therapy as HIV prevention in an Indonesian high-prevalence setting: a mathematical modeling study.

    Science.gov (United States)

    Wammes, Joost J G; Siregar, Adiatma Y; Hidayat, Teddy; Raya, Reynie P; van Crevel, Reinout; van der Ven, André J; Baltussen, Rob

    2012-09-01

    Indonesia faces an HIV epidemic that is in rapid transition. Injecting drug users (IDUs) are among the most heavily affected risk populations, with estimated prevalence of HIV reaching 50% or more in most parts of the country. Although Indonesia started opening methadone clinics in 2003, coverage remains low. We used the Asian Epidemic Model and Resource Needs Model to evaluate the long-term population-level preventive impact of expanding Methadone Maintenance Therapy (MMT) in West Java (43 million people). We compared intervention costs and the number of incident HIV cases in the intervention scenario with current practice to establish the cost per infection averted by expanding MMT. An extensive sensitivity analysis was performed on costs and epidemiological input, as well as on the cost-effectiveness calculation itself. Our analysis shows that expanding MMT from 5% coverage now to 40% coverage in 2019 would avert approximately 2400 HIV infections, at a cost of approximately US$7000 per HIV infection averted. Sensitivity analyses demonstrate that the use of alternative assumptions does not change the study conclusions. Our analyses suggest that expanding MMT is cost-effective, and support government policies to make MMT widely available as an integrated component of HIV/AIDS control in West Java. Copyright © 2012 Elsevier B.V. All rights reserved.

  10. Ten month outcome of cognitive behavioural therapy v. interpersonal psychotherapy in patients with major depression: a randomised trial of acute and maintenance psychotherapy.

    Science.gov (United States)

    Mulder, R; Boden, J; Carter, J; Luty, S; Joyce, P

    2017-10-01

    Cognitive behaviour therapy (CBT) and interpersonal psychotherapy (IPT) are the most studied psychotherapies for treatment of depression, but they are rarely directly compared particularly over the longer term. This study compares the outcomes of patients treated with CBT and IPT over 10 months and tests whether there are differential or general predictors of outcome. A single centre randomised controlled trial (RCT) of depressed outpatients treated with weekly CBT or IPT sessions for 16 weeks and then 24 weeks of maintenance CBT or IPT. The principle outcome was depression severity measured using the MADRS. Pre-specified predictors of response were in four domains: demographic depression, characteristics, comorbidity and personality. Data were analysed over 16 weeks and 40 weeks using general linear mixed effects regression models. CBT was significantly more effective than IPT in reducing depressive symptoms over the 10 month study largely because it appeared to work more quickly. There were no differential predictors of response to CBT v. IPT at 16 weeks or 40 weeks. Personality variables were most strongly associated with overall outcome at both 16 weeks and 40 weeks. The number of personality disorder symptoms and lower self-directness and reward dependence scores were associated with poorer outcome for both CBT and IPT at 40 weeks. CBT and IPT are effective treatments for major depression over the longer term. CBT may work more quickly. Personality variables are the most relevant predictors of outcome.

  11. Influence of the physical environment on treatment effect in exercise therapy for knee or hip pain

    DEFF Research Database (Denmark)

    Sandal, Louise Fleng

    treatment outcomes in other health-care settings, such as rehabilitation and exercise therapy settings. The aim of this thesis was to investigate the role of the physical environment as a contributor to context effects in the treatment response from exercise therapy as treatment for muskuloskeletal pain......Context effects are defined as the effects of a given treatment, not directly caused by the treatment itself, but, rather, caused by the context in which the treatment is delivered. The patient-practitioner relationship is a known context factor, but it is hard to standardize across health-care...... settings. The physical environment is easier to standardize and may act as a context factor and influence treatment outcomes. Studies from hospital environments have shown that the physical environment influences health outcomes, patients, and clinicians. It is unknown if the physical environment affects...

  12. Influence of preceding diagnostic and therapeutic procedures on the radioiodine therapy of benign thyroid diseases

    International Nuclear Information System (INIS)

    Rendl, J.; Boerner, W.

    1991-01-01

    Before and until 3 weeks after application of nonionic CA iodine and the 20-min-technetium-thyroid-uptake was measured in serum and urine in 23 euthyroid patients, which were given intravenously nonionic CA during heart catheterization. Concerning the possible influence of iodine contamination on a subsequent radioiodine therapy the following aspects result from the study: the time interval between application of CA and therapy has to be at least 4-6 weeks to avoid dilution of the radioiodine by iodine being released from the contrast agents. The thyroid-uptake of Technetium or Iodine after administration of CA is not constant over time but reaches its original value only in a gradual way (60% of the initial value 3 weeks after the CA were given); that means, the iodine-uptake during, radioiodine therapy can be higher than it was at the time the dose was calculated. Concerning the possible influence of preceding therapeutic procedures on the therapy with radioiodine the pretreatment with antithyroid drugs plays the most important role. Antithyroid drugs of the thiourylene group have been shown by many study groups to have a radioprotective effect. Other large studies however could not demonstrate any effect of antithyroid medication on the results of radioiodine therapy. All studies so far existing have in common that they are not strongly randomized with regard to the patient groups, because generally only in severe cases of hyperthyroidism additional antithyroid drug treatment has been employed, therefore it might be the case that the radioprotective effect of antithyroid drugs may be caused only by selection artifacts. The contradictory results of the different studies justify the practical way in so far as there are no reasonable objections against the pretreatment with antithyroid drugs to restore euthyroidism before starting the therapy with radioiodine. (orig./MG) [de

  13. Exploring the influence of gestalt therapy training on psychiatric nursing practice: stories from the field.

    Science.gov (United States)

    Kelly, Teresa; Howie, Linsey

    2011-08-01

    Psychiatric nurses interested in extending their interpersonal and psychotherapeutic skills sometimes undertake postgraduate training in gestalt therapy. Little is known about how this new knowledge and psychotherapeutic skill base informs their practice. This paper presents the findings of a qualitative study that aimed to explore the influence of gestalt therapy training on psychiatric nursing practice. Within a framework of narrative inquiry, four psychiatric nurses trained in gestalt therapy were invited to tell their stories of training in a gestalt approach to therapy, and recount their experiences of how it influenced their practice. In keeping with narrative analysis methods, the research findings were presented as a collection of four stories. Eight themes were derived from a thematic analysis conducted within and across the four stories. The discussion of the themes encapsulates the similarities and differences across the storied collection, providing a community and cultural context for understanding the individual stories. © 2011 The Authors. International Journal of Mental Health Nursing © 2011 Australian College of Mental Health Nurses Inc.

  14. How does race/ethnicity influence pharmacological response to asthma therapies?

    Science.gov (United States)

    Cazzola, Mario; Calzetta, Luigino; Matera, Maria Gabriella; Hanania, Nicola A; Rogliani, Paola

    2018-04-01

    Our understanding of whether and/or how ethnicity influences pharmacological response to asthma therapies is still very scarce. A possible explanation for the increased asthma treatment failures observed in ethnic and racial minorities receiving asthma therapies is that some of these groups may have a pharmacogenomic predisposition to either nonresponse or to adverse response with a specific class of drugs. However, the effects of ethnicity on pharmacological response to asthma therapies are also, and mainly, determined by socioeconomic and environmental factors to a varying extent, depending on the ethnic groups. Areas covered: Genetic, socioeconomic and environmental factors that can affect the pharmacotherapeutic responses to asthma medications and their link(s) to race/ethnicity have been examined and critically discussed. Expert opinion: Differences in genetic ancestry are definitely non-modifiable factors, but socioeconomic and environmental disadvantages are all factors that can be modified. It is likely that improved outcomes may be achieved when tailored and multifaceted approaches that include home, school, and clinician-based interventions are implemented. Consequently, it is critical to determine if a clinical intervention programme combined with implementation strategies that attempt to reduce inequalities can reduce asthma disparities, including the influence of ethnicity and race on pharmacological response to asthma therapies.

  15. The influence of music therapy on quality of life after a stroke

    OpenAIRE

    Ilona Poćwierz-Marciniak; Mariola Bidzan

    2017-01-01

    Background A stroke is an interruption in the course of one’s life. It often results in physical disability, cognitive or executive disorders, emotional problems and, as a consequence, the decrease of one’s quality of life. The goal of this research was to determine whether music therapy during neurorehabilitation can positively influence the assessment of one’s quality of life after a stroke. Participants and procedure Sixty-one people who had had strokes and were in the ...

  16. Randomized, phase III study of gemcitabine or erlotinib maintenance therapy versus observation, with predefined second-line treatment, after cisplatin-gemcitabine induction chemotherapy in advanced non-small-cell lung cancer.

    Science.gov (United States)

    Pérol, Maurice; Chouaid, Christos; Pérol, David; Barlési, Fabrice; Gervais, Radj; Westeel, Virginie; Crequit, Jacky; Léna, Hervé; Vergnenègre, Alain; Zalcman, Gérard; Monnet, Isabelle; Le Caer, Hervé; Fournel, Pierre; Falchero, Lionel; Poudenx, Michel; Vaylet, Fabien; Ségura-Ferlay, Céline; Devouassoux-Shisheboran, Mojgan; Taron, Miquel; Milleron, Bernard

    2012-10-01

    This phase III study investigated whether continuation maintenance with gemcitabine or switch maintenance with erlotinib improves clinical outcome compared with observation in patients with advanced non-small-cell lung cancer (NSCLC) whose disease was controlled after cisplatin-gemcitabine induction chemotherapy. Four hundred sixty-four patients with stage IIIB/IV NSCLC without tumor progression after four cycles of cisplatin-gemcitabine were randomly assigned to observation or to gemcitabine (1,250 mg/m(2) days 1 and 8 of a 3-week cycle) or daily erlotinib (150 mg/day) study arms. On disease progression, patients in all three arms received pemetrexed (500 mg/m(2) once every 21 days) as predefined second-line therapy. The primary end point was progression-free survival (PFS). PFS was significantly prolonged by gemcitabine (median, 3.8 v 1.9 months; hazard ratio [HR], 0.56; 95% CI, 0.44 to 0.72; log-rank P benefit was consistent across all clinical subgroups. Both maintenance strategies resulted in a nonsignificant improvement in overall survival (OS); patients who received second-line pemetrexed or with a performance status of 0 appeared to derive greater benefit. Exploratory analysis showed that magnitude of response to induction chemotherapy may affect the OS benefit as a result of gemcitabine maintenance. Maintenance gemcitabine and erlotinib were well tolerated with no unexpected adverse events. Gemcitabine continuation maintenance or erlotinib switch maintenance significantly reduces disease progression in patients with advanced NSCLC treated with cisplatin-gemcitabine as first-line chemotherapy. Response to induction chemotherapy may affect OS only for continuation maintenance.

  17. Advanced gastric adenocarcinoma. Influence of preoperative radiation therapy on toxicity and long-term survival rates

    International Nuclear Information System (INIS)

    Malzoni, Carlos Eduardo

    1996-01-01

    The surgical treatment of gastric cancer has better long-term survival rates when performed in patients with early gastric cancer. Worse results are obtained in treatment of advanced gastric cancer. Most patients in west centers are treated in advanced stages. A great number of them go through a surgical treatment unable by itself to cure them. the frequent local recurrence caused by failure of the surgical treatment has been keeping poor survival rates in patients with advanced gastric cancer for decades. The desire of improving survival is the reason of the use of adjuvant therapies. This paper achieved the retrospective study of the influence of preoperative radiation therapy (2000 cGy) in long-term survival rates (120 months) of patients with advanced gastric cancer on stages IIIa, IIIb and IV. The possible injuries caused in the liver and kidney were observed also as well as first group was treated by surgical and radiation therapies and the second received surgical treatment only. There was no statistical difference between the two groups when sex, age, race, occurrence of other diseases, nutritional assessment, TNM stage, occurrence of obstruction or bleeding caused by tumor, surgical procedure and hepatic and renal function were considered. Survival rates and changes on hepatic and renal function were statistically compared. The results showed a statistic improvement on the long-term survival rates of stage IIIa patients treated by preoperative radiation therapy. No statistic difference was observed on hepatic or renal function between the groups. No adverse influence of radiation therapy method was detected by the used parameters. There was no statistical difference between the two groups when immediate surgical complications were considered. (author)

  18. Maintenance Mentor

    National Research Council Canada - National Science Library

    Jacobs, John

    2003-01-01

    Maintenance Mentor (MXM) is a research effort conducted by a joint AFRL/HESR and Northrop Grumman Information Technology team to identify the basic, high-level requirements necessary for improving flight line diagnostic capabilities...

  19. The influence of travel time on breast cancer characteristics, receipt of primary therapy, and surveillance mammography.

    Science.gov (United States)

    Onega, Tracy; Cook, Andrea; Kirlin, Beth; Shi, Xun; Alford-Teaster, Jennifer; Tuzzio, Leah; Buist, Diana S M

    2011-08-01

    Travel time has been shown to influence some aspects of cancer characteristics at diagnosis and care for women with breast cancer, but important gaps remain in our understanding of its impact. We examined the influence of travel time to the nearest radiology facility on breast cancer characteristics, treatment, and surveillance for women with early-stage invasive breast cancer. We included 1,012 women with invasive breast cancer (stages I and II) who had access to care within an integrated health care delivery system in western Washington State. The travel times to the nearest radiology facility were calculated for all the U.S. Census blocks within the study area and assigned to women based on residence at diagnosis. We collected cancer characteristics, primary and adjuvant therapies, and surveillance mammography for at least 2.5 years post diagnosis and used multivariable analyses to test the associations of travel time. The majority of women (68.6%) lived within 20 min of the nearest radiology facility, had stage I disease (72.7%), received breast conserving therapy (68.7%), and had annual surveillance mammography the first 2 years after treatment (73.7%). The travel time was not significantly associated with the stage or surveillance mammography after adjusting for covariates. Primary therapy was significantly related to travel time, with greater travel time (>30 min vs. ≤ 10 min) associated with a higher likelihood of mastectomy compared to breast conserving surgery (RR = 1.53; 95% CI, 1.16-2.01). The travel time was not associated with the stage at diagnosis or surveillance mammography receipt. The travel time does seem to influence the type of primary therapy among women with breast cancer, suggesting that women may prefer low frequency services, such as mastectomy, if geographic access to a radiology facility is limited.

  20. THE INFLUENCE OF LANGUAGE USE AND LANGUAGE ATTITUDE ON THE MAINTENANCE OF COMMUNITY LANGUAGES SPOKEN BY MIGRANT STUDENTS

    Directory of Open Access Journals (Sweden)

    Leni Amalia Suek

    2014-05-01

    Full Text Available The maintenance of community languages of migrant students is heavily determined by language use and language attitudes. The superiority of a dominant language over a community language contributes to attitudes of migrant students toward their native languages. When they perceive their native languages as unimportant language, they will reduce the frequency of using that language even though at home domain. Solutions provided for a problem of maintaining community languages should be related to language use and attitudes of community languages, which are developed mostly in two important domains, school and family. Hence, the valorization of community language should be promoted not only in family but also school domains. Several programs such as community language school and community language program can be used for migrant students to practice and use their native languages. Since educational resources such as class session, teachers and government support are limited; family plays significant roles to stimulate positive attitudes toward community language and also to develop the use of native languages.

  1. Instrumentation maintenance

    International Nuclear Information System (INIS)

    Mack, D.A.

    1976-09-01

    It is essential to any research activity that accurate and efficient measurements be made for the experimental parameters under consideration for each individual experiment or test. Satisfactory measurements in turn depend upon having the necessary instruments and the capability of ensuring that they are performing within their intended specifications. This latter requirement can only be achieved by providing an adequate maintenance facility, staffed with personnel competent to understand the problems associated with instrument adjustment and repair. The Instrument Repair Shop at the Lawrence Berkeley Laboratory is designed to achieve this end. The organization, staffing and operation of this system is discussed. Maintenance policy should be based on studies of (1) preventive vs. catastrophic maintenance, (2) records indicating when equipment should be replaced rather than repaired and (3) priorities established to indicate the order in which equipment should be repaired. Upon establishing a workable maintenance policy, the staff should be instructed so that they may provide appropriate scheduled preventive maintenance, calibration and corrective procedures, and emergency repairs. The education, training and experience of the maintenance staff is discussed along with the organization for an efficient operation. The layout of the various repair shops is described in the light of laboratory space and financial constraints

  2. Design and implementation of a factorial randomized controlled trial of methadone maintenance therapy and an evidence-based behavioral intervention for incarcerated people living with HIV and opioid dependence in Malaysia.

    Science.gov (United States)

    Bazazi, Alexander R; Wickersham, Jeffrey A; Wegman, Martin P; Culbert, Gabriel J; Pillai, Veena; Shrestha, Roman; Al-Darraji, Haider; Copenhaver, Michael M; Kamarulzaman, Adeeba; Altice, Frederick L

    2017-08-01

    Incarcerated people living with HIV and opioid dependence face enormous challenges to accessing evidence-based treatment during incarceration and after release into the community, placing them at risk of poor HIV treatment outcomes, relapse to opioid use and accompanying HIV transmission risk behaviors. Here we describe in detail the design and implementation of Project Harapan, a prospective clinical trial conducted among people living with HIV and opioid dependence who transitioned from prison to the community in Malaysia from 2010 to 2014. This trial involved 2 interventions: within-prison initiation of methadone maintenance therapy and an evidence-based behavioral intervention adapted to the Malaysian context (the Holistic Health Recovery Program for Malaysia, HHRP-M). Individuals were recruited and received the interventions while incarcerated and were followed for 12months after release to assess post-release HIV transmission risk behaviors and a range of other health-related outcomes. Project Harapan was designed as a fully randomized 2×2 factorial trial where individuals would be allocated in equal proportions to methadone maintenance therapy and HHRP-M, methadone maintenance therapy alone, HHRP-M alone, or control. Partway through study implementation, allocation to methadone maintenance therapy was changed from randomization to participant choice; randomization to HHRP-M continued throughout. We describe the justification for this study; the development and implementation of these interventions; changes to the protocol; and screening, enrollment, treatment receipt, and retention of study participants. Logistical, ethical, and analytic issues associated with the implementation of this study are discussed. Copyright © 2017 Elsevier Inc. All rights reserved.

  3. The efficacy of hypotonic and near-isotonic saline for parenteral fluid therapy given at low maintenance rate in preventing significant change in plasma sodium in post-operative pediatric patients: protocol for a prospective randomized non-blinded study

    Directory of Open Access Journals (Sweden)

    Stigzelius Shayarina

    2011-07-01

    Full Text Available Abstract Background Hyponatremia is the most frequent electrolyte abnormality observed in post-operative pediatric patients receiving intravenous maintenance fluid therapy. If plasma sodium concentration (p-Na+ declines to levels below 125 mmol/L in vs. restricted rate of infusion and the composition of solutions used for parenteral maintenance fluid therapy (hypotonic vs. isotonic solutions contribute to the development of hyponatremia. So far, there is no definitive pediatric data to support a particular choice of parenteral fluid for maintenance therapy in post-surgical patients. Methods/Design Our prospective randomized non-blinded study will be conducted in healthy children and adolescents aged 1 to 14 years who have been operated for acute appendicitis. Patients will be randomized either to intravenous hypotonic (0.23% or 0.40% sodium chloride in glucose, respectively or near-isotonic (0.81% sodium chloride in glucose solution given at approximately three-fourths of the average maintenance rate. The main outcome of interest from this study is to evaluate 24 h post-operatively whether differences in p-Na+ between treatment groups are large enough to be of clinical relevance. In addition, water and electrolyte balance as well as regulatory hormones will be measured. Discussion This study will provide valuable information on the efficacy of hypotonic and near-isotonic fluid therapy in preventing a significant decrease in p-Na+. Finally, by means of careful electrolyte and water balance and by measuring regulatory hormones our results will also contribute to a better understanding of the physiopathology of post-operative changes in p-Na+ in a population at risk for hyponatremia. Trial registration The protocol for this study is registered with the current controlled trials registry; registry number: ISRCTN43896775.

  4. The efficacy and safety of standardized allergen-removed Rhus verniciflua extract as maintenance therapy after first-line chemotherapy in patients with advanced non-small cell lung cancer.

    Science.gov (United States)

    Lee, Jinsoo; Chae, Jean; Lee, Sookyung; Kim, Kyungsuk; Eo, Wankyu; Kim, Sehyun; Choi, Woncheol; Cheon, Seong Ha

    2013-01-01

    Chemotherapy improves the survival of patients with advanced non-small cell lung cancer (NSCLC), but tumor progression is often inevitable. Strategies are needed to improve the therapeutic efficacy of chemotherapy. Over recent years, there has been increasing interest in the role of maintenance therapy after first-line chemotherapy. We investigated the efficacy and safety of standardized allergen-removed Rhus verniciflua Stokes extract (aRVS) as maintenance therapy in patients with non-progressive disease following first-line chemotherapy. We reviewed the medical records of 33 patients with advanced NSCLC, who started treatment with aRVS in a state of tumor regression or stable disease after completion of four or six cycles of induction chemotherapy at the Integrative Cancer Center, Kyung Hee University Hospital at Gangdong from June 2006 to April 2012. The primary objective of this study was progression-free survival (PFS) of aRVS as maintenance therapy. Secondary objectives included assessments of disease control rate (DCR), overall survival (OS), and the safety of aRVS treatment. The median PFS was 5.2 months with a 6- and 12-month PFS rate of 40.6% and 12.9%, respectively. The DCR was 93.9% and the median OS was 34.8 months. The overall survival rates at 12, 24, and 36 months were 84.2%, 76.7% and 49.9%, respectively. We observed no hematologic toxicity, nephrotoxicity, or hepatotoxicity during aRVS treatment. In conclusion, maintenance therapy with aRVS for patients with advanced NSCLC is well-tolerated and offers encouraging improved PFS and OS compared with historical controls. Our data provide further evidence that aRVS may be used beyond disease progression in this clinical setting.

  5. Factors influencing the use of outcome measures in physical therapy practice.

    Science.gov (United States)

    Wedge, Frances M; Braswell-Christy, Jennifer; Brown, Cynthia J; Foley, Kathleen T; Graham, Cecilia; Shaw, Sharon

    2012-02-01

    Use of outcome measures in physical therapy practice is central to evaluating the effectiveness of treatment interventions, providing accountability and addressing quality of physical therapy programs. There is limited discussion on barriers and facilitators to using outcome measures in physical therapy practice. The purpose of this study was to identify factors that influence a physical therapist when deciding to use outcome measures in clinical practice. Participants were 21 physical therapists, seven each from skilled nursing facilities, outpatient clinics, and inpatient rehabilitation facilities. A grounded theory approach was used for interview and data collection. Common themes were determined from the data and a theory developed to explain the rationale behind physical therapists' decisions to use or not use outcome measures in clinical practice. Three overlapping themes related to (1) concepts of time, (2) knowledge, and (3) facility culture were indentified as factors influencing the use of outcome measures. A fourth encompassing theme, professionalism, identified the value placed on the use of outcome measures in practice. Data revealed that therapists require more information on the outcome measures available, and this information needs to be easily accessible within the workplace. Therapists value information generated by using outcome measures in the clinical setting, but need information on what measures are available and psychometric properties. Information must be easily accessible and measures easy to use. Newer graduates and recent learners have a foundation in the use of outcome measures, but more needs to be done in the clinic and through continuing education to promote increased use and understanding.

  6. Maintenance of Remission with Etanercept-DMARD Combination Therapy Compared with DMARDs Alone in African and Middle Eastern Patients with Active Rheumatoid Arthritis.

    Science.gov (United States)

    Bassiouni, Hassan; Spargo, Catherine Elizabeth; Vlahos, Bonnie; Jones, Heather E; Pedersen, Ron; Shirazy, Khalid

    2018-06-01

    To compare etanercept (ETN) and placebo (PBO) for maintaining low disease activity (LDA) achieved with ETN in patients with rheumatoid arthritis (RA) from Africa and the Middle East. In this subset analysis of the Treat-to-Target trial (ClinicalTrials.gov identifier NCT01981473), 53 adult patients with moderate-to-severe RA nonresponsive to methotrexate were treated with 50 mg ETN/week for 24 weeks (Period 1). Patients achieving LDA were randomized to continue ETN treatment or switched to PBO for an additional 28 weeks (Period 2). The proportion of patients maintaining LDA or remission in each arm at the end of Period 2 was determined. Additional efficacy and patient-reported outcomes (PROs) were also evaluated. During Period 1, 51 patients achieved LDA according to the disease activity score-28 joints-erythrocyte sedimentation rate (DAS28-ESR LDA) and 30 achieved remission. At week 52, nine of 22 and eight of 29 in the ETN and PBO groups, respectively, remained in DAS28-ESR LDA without experiencing a flare. Additionally, six of 14 and five of 16 in the ETN and PBO groups, respectively, remained in remission. Among patients experiencing a flare during Period 2, 13 of 22 and 21 of 29 received ETN or PBO, respectively. The median time to flare was 193 and 87 days in the ETN and PBO groups, respectively. At week 52, consistently more patients in the ETN group than in the PBO group achieved predetermined efficacy and PRO endpoints. These data suggest continuing ETN maintenance therapy is beneficial to patients after they have achieved their treatment target. However, this subset analysis is limited by the small patient population and must be interpreted with caution. Pfizer. ClinicalTrials.gov identifier, NCT0198147.

  7. In-group and role identity influences on the initiation and maintenance of students' voluntary attendance at peer study sessions for statistics.

    Science.gov (United States)

    White, Katherine M; O'Connor, Erin L; Hamilton, Kyra

    2011-06-01

    Although class attendance is linked to academic performance, questions remain about what determines students' decisions to attend or miss class. In addition to the constructs of a common decision-making model, the theory of planned behaviour, the present study examined the influence of student role identity and university student (in-group) identification for predicting both the initiation and maintenance of students' attendance at voluntary peer-assisted study sessions in a statistics subject. University students enrolled in a statistics subject were invited to complete a questionnaire at two time points across the academic semester. A total of 79 university students completed questionnaires at the first data collection point, with 46 students completing the questionnaire at the second data collection point. Twice during the semester, students' attitudes, subjective norm, perceived behavioural control, student role identity, in-group identification, and intention to attend study sessions were assessed via on-line questionnaires. Objective measures of class attendance records for each half-semester (or 'term') were obtained. Across both terms, students' attitudes predicted their attendance intentions, with intentions predicting class attendance. Earlier in the semester, in addition to perceived behavioural control, both student role identity and in-group identification predicted students' attendance intentions, with only role identity influencing intentions later in the semester. These findings highlight the possible chronology that different identity influences have in determining students' initial and maintained attendance at voluntary sessions designed to facilitate their learning. ©2010 The British Psychological Society.

  8. Neuropsychological Outcome of Children Treated for Standard Risk Medulloblastoma in the PNET4 European Randomized Controlled Trial of Hyperfractionated Versus Standard Radiation Therapy and Maintenance Chemotherapy

    International Nuclear Information System (INIS)

    Câmara-Costa, Hugo; Resch, Anika; Kieffer, Virginie; Lalande, Clémence; Poggi, Geraldina; Kennedy, Colin; Bull, Kim; Calaminus, Gabriele; Grill, Jacques; Doz, François; Rutkowski, Stefan; Massimino, Maura; Kortmann, Rolf-Dieter; Lannering, Birgitta; Dellatolas, Georges; Chevignard, Mathilde

    2015-01-01

    Purpose: In the European HIT-SIOP PNET4 randomized controlled trial, children with standard risk medulloblastoma were allocated to hyperfractionated radiation therapy (HFRT arm, including a partially focused boost) or standard radiation therapy (STRT arm), followed, in both arms, by maintenance chemotherapy. Event-free survival was similar in both arms. Previous work showed that the HFRT arm was associated with worse growth and better questionnaire-based executive function, especially in children <8 years of age at diagnosis. Therefore, the aim of this study was to compare performance-based cognitive outcomes between treatment arms. Methods and Materials: Neuropsychological data were collected prospectively in 137 patients. Using the Wechsler Intelligence Scales, Kaufman Assessment Battery for Children, and Raven's Progressive Matrices, we estimated full-scale intelligence quotient (FSIQ) and, when available, verbal IQ (VIQ), performance IQ (PIQ), working memory index (WMI), and processing speed index (PSI). Results: Among the 137 participants (HFRT arm n=71, STRT arm n=66, 63.5% males), mean (±SD) ages at diagnosis and assessment respectively were 9.3 (±3.2) years of age (40.8% < 8 years of age at diagnosis) and 14.6 (±4.3) years of age. Mean (±SD) FSIQ was 88 (±19), and mean intergroup difference was 3.88 (95% confidence interval: −2.66 to 10.42, P=.24). No significant differences were found in children >8 years of age at diagnosis. In children <8 years of age at diagnosis, a marginally significant trend toward higher VIQ was found in those treated in the HFRT arm; a similar trend was found for PSI but not for PIQ, WMI, or FSIQ (mean intergroup differences were: 12.02 for VIQ [95% CI: 2.37-21.67; P=.02]; 3.77 for PIQ [95% CI: −5.19 to 12.74; P>.10]; 5.20 for WMI [95% CI: −2.07 to 12.47; P>.10]; 10.90 for PSI [95% CI: −1.54 to 23.36; P=.08]; and 5.28 for FSIQ [95% CI: −4.23 to 14.79; P>.10]). Conclusions: HFRT was associated with

  9. Neuropsychological Outcome of Children Treated for Standard Risk Medulloblastoma in the PNET4 European Randomized Controlled Trial of Hyperfractionated Versus Standard Radiation Therapy and Maintenance Chemotherapy

    Energy Technology Data Exchange (ETDEWEB)

    Câmara-Costa, Hugo, E-mail: hugocamaracosta@gmail.com [National Institute of Health and Medical Research, INSERM U1178, Paris (France); Resch, Anika [University Medical Center Hamburg-Eppendorf, Hamburg (Germany); Kieffer, Virginie [Saint Maurice Hospitals, Saint Maurice (France); Lalande, Clémence [Institut Gustave Roussy, Villejuif (France); Poggi, Geraldina [Scientific Institute, IRCCS Eugenio Medea, Bosisio Parini, Lecco (Italy); Kennedy, Colin; Bull, Kim [University of Southampton, Faculty of Medicine, Southampton (United Kingdom); Calaminus, Gabriele [Paediatric Oncology, University of Muenster, Muenster (Germany); Grill, Jacques [Institut Gustave Roussy, Villejuif (France); Doz, François [Institut Curie and University Paris Descartes, Sorbonne Paris Cité, Paris (France); Rutkowski, Stefan [University Medical Center Hamburg-Eppendorf, Hamburg (Germany); Massimino, Maura [Fondazione IRCCS, Istituto Nazionale Tumori, Milan (Italy); Kortmann, Rolf-Dieter [Department of Radiation Therapy, University of Leipzig, Leipzig (Germany); Lannering, Birgitta [Paediatric Oncology, University of Gothenburg, Gothenburg (Sweden); Dellatolas, Georges [National Institute of Health and Medical Research, INSERM U1178, Paris (France); Chevignard, Mathilde [Rehabilitation Department for Children With Acquired Neurological Injury, Saint Maurice Hospitals, Saint Maurice, and Sorbonne Universités, UPMC Universités Paris, INSERM CNRS, Paris (France)

    2015-08-01

    Purpose: In the European HIT-SIOP PNET4 randomized controlled trial, children with standard risk medulloblastoma were allocated to hyperfractionated radiation therapy (HFRT arm, including a partially focused boost) or standard radiation therapy (STRT arm), followed, in both arms, by maintenance chemotherapy. Event-free survival was similar in both arms. Previous work showed that the HFRT arm was associated with worse growth and better questionnaire-based executive function, especially in children <8 years of age at diagnosis. Therefore, the aim of this study was to compare performance-based cognitive outcomes between treatment arms. Methods and Materials: Neuropsychological data were collected prospectively in 137 patients. Using the Wechsler Intelligence Scales, Kaufman Assessment Battery for Children, and Raven's Progressive Matrices, we estimated full-scale intelligence quotient (FSIQ) and, when available, verbal IQ (VIQ), performance IQ (PIQ), working memory index (WMI), and processing speed index (PSI). Results: Among the 137 participants (HFRT arm n=71, STRT arm n=66, 63.5% males), mean (±SD) ages at diagnosis and assessment respectively were 9.3 (±3.2) years of age (40.8% < 8 years of age at diagnosis) and 14.6 (±4.3) years of age. Mean (±SD) FSIQ was 88 (±19), and mean intergroup difference was 3.88 (95% confidence interval: −2.66 to 10.42, P=.24). No significant differences were found in children >8 years of age at diagnosis. In children <8 years of age at diagnosis, a marginally significant trend toward higher VIQ was found in those treated in the HFRT arm; a similar trend was found for PSI but not for PIQ, WMI, or FSIQ (mean intergroup differences were: 12.02 for VIQ [95% CI: 2.37-21.67; P=.02]; 3.77 for PIQ [95% CI: −5.19 to 12.74; P>.10]; 5.20 for WMI [95% CI: −2.07 to 12.47; P>.10]; 10.90 for PSI [95% CI: −1.54 to 23.36; P=.08]; and 5.28 for FSIQ [95% CI: −4.23 to 14.79; P>.10]). Conclusions: HFRT was associated with

  10. Mechanical configuration and maintenance

    International Nuclear Information System (INIS)

    Brown, T.G.; Casini, G.; Churakov, G.F.

    1982-01-01

    The INTOR engineering design has been strongly influenced by considerations for assembly and maintenance. A maintenance philosophy was established at the outset of the conceptual design to insure that the tokamak configuration would be developed to accommodate maintenance requirements. The main features of the INTOR design are summarized in this paper with primary emphasis on the impact of maintenance considerations. The most apparent configuration design feature is the access provided for torus maintenance. Particular attention was given to the size and location of superconducting magnets and the location of vacuum boundaries. All of the poloidal field (PF) coils are placed outside of the bore of the toroidal field (TF) coils and located above and below an access opening between adjacent TF coils through which torus sectors are removed. A magnet structural configuration consisting of mechanically attached reinforcing members has been designed which facilitates the open access space for torus sector removal. For impurity control, a single null poloidal divertor was selected over a double null design in order to maintain sufficient access for pumping and maintenance of the collector. A double null divertor was found to severely limit access to the torus with the addition of divertor collectors and pumping at the top. For this reason, a single null concept was selected in spite of the more difficult design problems associated with the required asymmetric PF system and higher particle loadings

  11. DNA-thioguanine nucleotide concentration and relapse-free survival during maintenance therapy of childhood acute lymphoblastic leukaemia (NOPHO ALL2008): a prospective substudy of a phase 3 trial.

    Science.gov (United States)

    Nielsen, Stine Nygaard; Grell, Kathrine; Nersting, Jacob; Abrahamsson, Jonas; Lund, Bendik; Kanerva, Jukka; Jónsson, Ólafur Gísli; Vaitkeviciene, Goda; Pruunsild, Kaie; Hjalgrim, Lisa Lyngsie; Schmiegelow, Kjeld

    2017-04-01

    Adjustment of mercaptopurine and methotrexate maintenance therapy of acute lymphoblastic leukaemia by leucocyte count is confounded by natural variations. Cytotoxicity is primarily mediated by DNA-incorporated thioguanine nucleotides (DNA-TGN). The aim of this study was to establish whether DNA-TGN concentrations in blood leucocytes during maintenance therapy are associated with relapse-free survival. In this substudy of the NOPHO ALL2008 phase 3 trial done in 23 hospitals in seven European countries (Denmark, Estonia, Finland, Iceland, Lithuania, Norway, and Sweden), we analysed data from centralised and blinded analyses of 6-mercaptopurine and methotrexate metabolites in blood samples from patients with non-high-risk childhood acute lymphoblastic leukaemia. Eligible patients were aged 1·0-17·9 years; had been diagnosed with non-high-risk precursor B-cell or T-cell leukaemia; had been treated according to the Nordic Society of Pediatric Hematology and Oncology ALL2008 protocol; and had reached maintenance therapy in first remission. Maintenance therapy was (mercaptopurine 75 mg/m 2 once per day and methotrexate 20 mg/m 2 once per week, targeted to a leucocyte count of 1·5-3·0 × 10 9 cells per L). We measured DNA-TGN and erythrocyte concentrations of TGN nucleotides, methylated mercaptopurine metabolites, and methotrexate polyglutamates. The primary objective was the association of DNA-TGN concentrations and 6-mercaptopurine and methotrexate metabolites with relapse-free survival. The secondary endpoint was the assessment of DNA-TGN concentration and 6-mercaptopurine and methotrexate metabolites during maintenance therapy phase 2. Between Nov 26, 2008 and June 14, 2016, 1509 patients from the NOPHO ALL2008 study were assessed for eligibility in the DNA-TGN substudy, of which 918 (89%) of 1026 eligible patients had at least one DNA-TGN measurement and were included in the analyses. Median follow-up was 4·6 years (IQR 3·1-6·1). Relapse-free survival was

  12. Effectiveness and cost-effectiveness of mindfulness-based cognitive therapy compared with maintenance antidepressant treatment in the prevention of depressive relapse or recurrence (PREVENT): a randomised controlled trial.

    Science.gov (United States)

    Kuyken, Willem; Hayes, Rachel; Barrett, Barbara; Byng, Richard; Dalgleish, Tim; Kessler, David; Lewis, Glyn; Watkins, Edward; Brejcha, Claire; Cardy, Jessica; Causley, Aaron; Cowderoy, Suzanne; Evans, Alison; Gradinger, Felix; Kaur, Surinder; Lanham, Paul; Morant, Nicola; Richards, Jonathan; Shah, Pooja; Sutton, Harry; Vicary, Rachael; Weaver, Alice; Wilks, Jenny; Williams, Matthew; Taylor, Rod S; Byford, Sarah

    2015-07-04

    Individuals with a history of recurrent depression have a high risk of repeated depressive relapse or recurrence. Maintenance antidepressants for at least 2 years is the current recommended treatment, but many individuals are interested in alternatives to medication. Mindfulness-based cognitive therapy (MBCT) has been shown to reduce risk of relapse or recurrence compared with usual care, but has not yet been compared with maintenance antidepressant treatment in a definitive trial. We aimed to see whether MBCT with support to taper or discontinue antidepressant treatment (MBCT-TS) was superior to maintenance antidepressants for prevention of depressive relapse or recurrence over 24 months. In this single-blind, parallel, group randomised controlled trial (PREVENT), we recruited adult patients with three or more previous major depressive episodes and on a therapeutic dose of maintenance antidepressants, from primary care general practices in urban and rural settings in the UK. Participants were randomly assigned to either MBCT-TS or maintenance antidepressants (in a 1:1 ratio) with a computer-generated random number sequence with stratification by centre and symptomatic status. Participants were aware of treatment allocation and research assessors were masked to treatment allocation. The primary outcome was time to relapse or recurrence of depression, with patients followed up at five separate intervals during the 24-month study period. The primary analysis was based on the principle of intention to treat. The trial is registered with Current Controlled Trials, ISRCTN26666654. Between March 23, 2010, and Oct 21, 2011, we assessed 2188 participants for eligibility and recruited 424 patients from 95 general practices. 212 patients were randomly assigned to MBCT-TS and 212 to maintenance antidepressants. The time to relapse or recurrence of depression did not differ between MBCT-TS and maintenance antidepressants over 24 months (hazard ratio 0·89, 95% CI 0·67-1·18

  13. Retreatment and maintenance therapy with infliximab in fistulizing Crohn' disease Retratamiento y tratamiento de mantenimiento con infliximab en la enfermedad de Crohn fistulizante

    Directory of Open Access Journals (Sweden)

    L. Rodrigo

    2004-08-01

    Full Text Available Objectives: infliximab has clearly demonstrated its efficacy in the short-term treatment of fistulizing Crohn' disease. We present here the results of retreatment and long-term maintenance therapy. Patients and methods: eighty one consecutive patients with active fistulizing Crohn' disease, in whom previous treatments had failed, were treated with infliximab. All patients received as the initial treatment of 5 mg/kg i.v. infusions (weeks 0, 2, and 6. Those patients who failed to respond after the initial cycle (group 1, n= 25, or those who relapsed after having responded (group 2, n=13, received retreatment with three similar doses (weeks 0,2, and 6. Those who responded to retreatment were included in a long-term maintenance programme (n=44, with repeated doses (5 mg/kg i.v. infusions every eight weeks for 1-2 years. Results: in the initial treatment 56% of the patients responded partially; this response being complete in 44%. In the retreatment, 28% of group 1 (non-responders presented a complete response, compared to 77% in group 2 (relapsers (pObjetivos: el infliximab ha demostrado su eficacia en el tratamiento a corto plazo de la enfermedad de Crohn (EC fistulosa. En este trabajo presentamos los resultados del retratamiento y del tratamiento de mantenimiento a largo plazo. Pacientes y métodos: se trataron con infliximab un total de 81 pacientes consecutivos con EC fistulosa activa, en los cuales, habían fallado tratamientos previos. Todos los pacientes recibieron como tratamiento inicial infusiones a dosis de 5 mg/kg i.v. en las semanas 0, 2 y 6. Aquellos pacientes que no respondieron después del ciclo inicial (grupo 1, n=25, o los que recayeron después de haber respondido (grupo 2, n=13, recibieron retratamiento con 3 dosis similares (semanas 0, 2 y 6. Aquellos que respondieron a la terapia de retratamiento fueron incluidos en un programa de mantenimiento a largo plazo (n=44, con dosis repetidas (infusiones con 5 mg/kg i.v. cada 8

  14. Locoregional Tumor Progression After Radiation Therapy Influences Overall Survival in Pediatric Patients With Neuroblastoma

    International Nuclear Information System (INIS)

    Pai Panandiker, Atmaram S.; McGregor, Lisa; Krasin, Matthew J.; Wu Shengjie; Xiong Xiaoping; Merchant, Thomas E.

    2010-01-01

    Purpose: There is renewed attention to primary site irradiation and local control for patients with high-risk neuroblastoma (NB). We conducted a retrospective review to identify factors that might predict for locoregional tumor control and its impact on overall survival. Methods and Materials: Between July 2000 through August 2006, a total of 44 pediatric patients with NB received radiation therapy (RT) with curative intent using computed tomography (CT)-based treatment planning. The median age was 3.4 years and the median cumulative dose was 23.4 Gy. Overall survival and locoregional tumor control were measured from the start of RT to the date of death or event as determined by CT/magnetic resonance imaging/meta-iodobenzylguanidine. The influence of age at irradiation, gender, race, cumulative radiation dose, International Neuroblastoma Staging System stage, treatment protocol and resection status was determined with respect to locoregional tumor control. Results: With a median follow-up of 34 months ± 21 months, locoregional tumor progression was observed in 11 (25%) and was evenly divided between primary site and adjacent nodal/visceral site failure. The influence of locoregional control reached borderline statistical significance (p = 0.06). Age (p = 0.5), dose (p = 0.6), resection status (p = 0.7), and International Neuroblastoma Staging System stage (p = 0.08) did not influence overall survival. Conclusions: Overall survival in high-risk neuroblastoma is influenced by locoregional tumor control. Despite CT-based planning, progression in adjacent nodal/visceral sites appears to be common; this requires further investigation regarding target volume definitions, dose, and the effects of systemic therapy.

  15. Antithyroid drugs as a factor influencing the outcome of radioiodine therapy in Graves' disease and toxic nodular goitre?

    International Nuclear Information System (INIS)

    Koerber, C.; Schneider, P.; Koerber-Hafner, N.; Haenscheid, H.; Reiners, C.

    2001-01-01

    There is controversy over the factors that may influence the outcome of radioiodine therapy for benign thyroid diseases. Antithyroid medication has been claimed to negatively influence the effectiveness of radioiodine therapy in Graves' disease. In a longitudinal study, we assessed the influence of sex, age, antithyroid drugs, target radiation dose, target mass, applied activity, delivered dose, interval between last meal and application, and TSH, FT 3 and FT 4 levels on the outcome of radioiodine therapy. One hundred and forty-four patients (111 female, 33 male) suffering from Graves' disease (GD) and 563 patients (434 female, 129 male) with toxic nodular goitre (TNG) were entered in the study and followed up until 8 months after therapy. Treatment was defined as successful when the TSH level was found to be normal or elevated. Ninety-eight GD patients and 418 TNG patients were successfully treated. Forward stepwise multiple regression analysis models retained only the target mass in GD and the applied activity in TNG as significantly associated with the outcome of therapy. The predictive value of all variables involved was extremely low in both disease groups. Whereas concomitant antithyroid medication had no influence in GD, it adversely influenced radioiodine therapy of TNG. This effect may be attributed to a radioiodine ''steal phenomenon'' induced by TSH-stimulated normal thyroid tissue, which causes overestimation of the uptake in toxic nodules. (orig.)

  16. Antithyroid drugs as a factor influencing the outcome of radioiodine therapy in Graves' disease and toxic nodular goitre?

    Energy Technology Data Exchange (ETDEWEB)

    Koerber, C.; Schneider, P.; Koerber-Hafner, N.; Haenscheid, H.; Reiners, C. [Wuerzburg Univ. (Germany). Abt. fuer Nuklearmedizin

    2001-09-01

    There is controversy over the factors that may influence the outcome of radioiodine therapy for benign thyroid diseases. Antithyroid medication has been claimed to negatively influence the effectiveness of radioiodine therapy in Graves' disease. In a longitudinal study, we assessed the influence of sex, age, antithyroid drugs, target radiation dose, target mass, applied activity, delivered dose, interval between last meal and application, and TSH, FT{sub 3} and FT{sub 4} levels on the outcome of radioiodine therapy. One hundred and forty-four patients (111 female, 33 male) suffering from Graves' disease (GD) and 563 patients (434 female, 129 male) with toxic nodular goitre (TNG) were entered in the study and followed up until 8 months after therapy. Treatment was defined as successful when the TSH level was found to be normal or elevated. Ninety-eight GD patients and 418 TNG patients were successfully treated. Forward stepwise multiple regression analysis models retained only the target mass in GD and the applied activity in TNG as significantly associated with the outcome of therapy. The predictive value of all variables involved was extremely low in both disease groups. Whereas concomitant antithyroid medication had no influence in GD, it adversely influenced radioiodine therapy of TNG. This effect may be attributed to a radioiodine ''steal phenomenon'' induced by TSH-stimulated normal thyroid tissue, which causes overestimation of the uptake in toxic nodules. (orig.)

  17. Heat transfer due to electroconvulsive therapy: Influence of anisotropic thermal and electrical skull conductivity.

    Science.gov (United States)

    Menezes de Oliveira, Marilia; Wen, Peng; Ahfock, Tony

    2016-09-01

    This paper focuses on electroconvulsive therapy (ECT) and head models to investigate temperature profiles arising when anisotropic thermal and electrical conductivities are considered in the skull layer. The aim was to numerically investigate the threshold for which this therapy operates safely to the brain, from the thermal point of view. A six-layer spherical head model consisting of scalp, fat, skull, cerebro-spinal fluid, grey matter and white matter was developed. Later on, a realistic human head model was also implemented. These models were built up using the packages from COMSOL Inc. and Simpleware Ltd. In these models, three of the most common electrode montages used in ECT were applied. Anisotropic conductivities were derived using volume constraint and included in both spherical and realistic head models. The bio-heat transferring problem governed by Laplace equation was solved numerically. The results show that both the tensor eigenvalues of electrical conductivity and the electrode montage affect the maximum temperature, but thermal anisotropy does not have a significant influence. Temperature increases occur mainly in the scalp and fat, and no harm is caused to the brain by the current applied during ECT. The work assures the thermal safety of ECT and also provides a numerical method to investigate other non-invasive therapies. Copyright © 2016 Elsevier Ireland Ltd. All rights reserved.

  18. Impact factor, eigenfactor, article influence, scopus SNIP, and SCImage journal rank of occupational therapy journals.

    Science.gov (United States)

    Brown, Ted; Gutman, Sharon A

    2018-05-18

    Journals are currently assessed and ranked using a number of different quantitative performance metrics. To compare and correlate the publication metrics of English-language occupational therapy journals published in 2015. Bibliometric data was sourced for 14 English-language occupational therapy journals including the Journal Citations Report (JCR) 2-year impact factor (IF), Eigenfactor Score (EFS), Article Influence Score (AIS), Scopus Source Normalized Impact per Paper (SNIP), Scopus Citescore, and SCImago Journal Rank (SJR) score. The JCR, Scopus, and SJR 2015 bibliometric data were correlated. The top six English-language occupational therapy journals in relation to JCR IF, EFS, AIS, SNIP, Citescore, SJR score, and SJR IIF were AJOT, AOTJ, POPT, CJOT, SJOT, and BJOT. JCR IF, EFS, JCR AIS, SNIP, Citescore, SJR score and SJR IIF were all significantly correlated with coefficients ranging from 0.751 to 0.961 (p article rankings rather than the singular use of IF scores that currently and frequently occurs in many jurisdictions.

  19. The influence of I-131 therapy on FDG uptake in differentiated thyroid cancer

    International Nuclear Information System (INIS)

    Hung Guanguei; Lee Kwowhei; Liao Peiyung; Yang Liheng; Yang Kwangtao

    2008-01-01

    18F-fluorodeoxyglucose positron emission tomography (FDG-PET) [or PET/computed tomography (CT)] is more likely to show false-negative results when it is performed shortly after chemotherapy and/or radiotherapy because of ''metabolic stunning''. The present study aimed to evaluate the influence of I-131 therapy on FDG uptake and the detection of recurrence or metastasis of differentiated thyroid cancer (DTC). We retrospectively enrolled 16 consecutive FDG-PET/CT studies which had been performed in patients with DTC with elevated thyroglobulin (TG) but negative I-131 whole-body scan. All studies were performed under L-thyroxine suppression. The patients were divided into groups A and B for PET/CT performed within 4 months of I-131 therapy or no such therapy, respectively. Each lesion identified on PET/CT was characterized using a 5-point scale by visual analysis: 0=definitely benign, 1=probably benign, 2=equivocal, 3=probably malignant, and 4=definitely malignant. The maximum standardized uptake value (SUV max ) in each lesion was also measured for semiquantitative analysis. We compared the visual grading and SUV max of the lesion of highest FDG uptake between groups A and B. For visual analysis, group B had significantly more patients with an uptake score of 3 or 4 than group A (80% vs. 17%, P=0.01). In addition, there were significantly more equivocal results from group A than from group B (67% vs. 10%, P=0.02). If the patients with the highest uptake scores of 2, 3, and 4 were considered to be positive for local recurrence or metastasis, there would be no significant difference between the positive rates of groups A and B (83% vs. 90%, P=0.7). However, the mean SUV max of positive results was significantly lower for group A than for group B (3.1±0.9 and 6.6±3.5 respectively, P=0.02). The preliminary results suggested that FDG uptake in DTC may be negatively influenced by I-131 therapy within 4 months, resulting in lower FDG uptake and more equivocal results

  20. Changes in pulmonary function and influencing factors after high-dose intrathoracic radio(chemo)therapy

    Energy Technology Data Exchange (ETDEWEB)

    Schroeder, Christina [University Clinic Giessen and Marburg, Clinic for Radiotherapy and Radiation Oncology, Marburg (Germany); Ruppiner Kliniken GmbH, Clinic for Radiotherapy and Radiation Oncology, Neuruppin (Germany); Engenhart-Cabillic, Rita; Vorwerk, Hilke [University Clinic Giessen and Marburg, Clinic for Radiotherapy and Radiation Oncology, Marburg (Germany); Schmidt, Michael; Huhnt, Winfried; Blank, Eyck; Sidow, Dietrich; Buchali, Andre [Ruppiner Kliniken GmbH, Clinic for Radiotherapy and Radiation Oncology, Neuruppin (Germany)

    2017-02-15

    Using prospectively collected patient-related, dose-related, and pulmonary function test (PFT) data before radiotherapy (RT) and at several follow-up visits after RT, the time course of PFT changes after high-dose radio(chemo)therapy and influencing factors were analyzed. From April 2012 to October 2015, 81 patients with non-small-cell lung carcinoma (NSCLC), small cell lung carcinoma (SCLC), or esophageal carcinoma where treated with high-dose radio(chemo)therapy. PFT data were collected before treatment and 6 weeks, 12 weeks, and 6 months after RT. The influence of patient- and treatment-related factors on PFT was analyzed. Mean forced expiratory volume in 1 s (FEV1) constantly declined during follow-up (p = 0.001). In total, 68% of patients had a reduced FEV1 at 6 months. Mean vital capacity (VC) didn't change during follow-up (p > 0.05). Mean total lung capacity (TLC) showed a constant decline after RT (p = 0.026). At 6 months, 60% of patients showed a decline in VC and 73% in TLC. The mean diffusion capacity for carbon monoxide (DLCO) declined at 6 and 12 weeks, but recovered slightly at 6 months (p < 0.0005). At 6 months, 86% of patients had a reduced DLCO. After treatment, the partial pressure of CO{sub 2} in the blood (pCO{sub 2}) was increased and pO{sub 2} was decreased (p > 0.05). Only the pretreatment PFT classification had a significant influence on the post-RT FEV1. DLCO seems to be the most reliable indicator for lung tissue damage after thoracic RT. Ventilation parameters appear to be less reliable. Concerning patient- or treatment-related factors, no reliable conclusion can be drawn regarding which factors may be relevant. (orig.) [German] Patientenbezogene, therapiebezogene und Lungenfunktionsdaten (''pulmonary function test'', PFT) wurden vor Radiotherapie (RT) und an verschiedenen Nachsorgeterminen nach RT prospektiv gesammelt, um PFT-Veraenderungen sowie Einflussfaktoren nach Hochdosis-Radio(chemo)therapie zu

  1. Influence of irradiation on therapy-associated psychological distress in breast carcinoma patients

    International Nuclear Information System (INIS)

    Mose, Stephan; Budischewski, Kai Michael; Rahn, Angelika Notburga; Zander-Heinz, Anja Christina; Bormeth, Sabine; Boettcher, Heinz Dietrich

    2001-01-01

    Purpose: To confirm our assumptions regarding factors that apparently cause psychological distress related to adjuvant radiotherapy in breast cancer patients and to evaluate variables that can predict therapy-associated distress. Methods and Materials: Between January 1997 and April 1998, 111 women (33-84 years) with early-stage breast cancer were irradiated (56 Gy) after breast-conserving surgery. Patients were given self-assessment questionnaires on the first and last day of radiotherapy. Statistical analysis was performed using the structural equation model LISREL, variance analysis, and regression analysis. Results: The internal subject-related factors (coping, radiation-related anxiety, physical distress, psychological distress) reciprocally influenced each other, whereas external radiotherapy-specific factors (environmental influence, confidence in the medical staff) were causally related to coping, anxiety, and distress. Fifty-three percent of the women felt distressed because cancer affected the breast; 48% were initially afraid of radiotherapy. For 36%, anxiety was not reduced during treatment. Highly distressed women were identified by the following parameters: ≤58 years; initial anxiety; they were affected by having breast cancer, were negatively affected by environmental factors, and did not find distraction helpful. Conclusion: Despite considerable individual variability in breast cancer patients, it seems possible to identify women who run a high risk of therapy-associated distress. In these patients, psychosocial support is necessary to reduce treatment-related anxiety and to stabilize confidence in the medical staff

  2. Influence of dance therapy on the functional mobility of children with spastic hemiparetic cerebral palsy

    Directory of Open Access Journals (Sweden)

    D.C. Garção

    2011-01-01

    Full Text Available The aim of this study was to investigate the influence of dance therapy on the functional mobility of children with spastic hemiparetic cerebral palsy. Ten female children (mean age 7.2 ± 1.2 years diagnosed with cerebral palsy were included. In order to evaluate their functional mobility, standing (D and walking, running and jumping (E dimensions from GMFM were applied, and measurements were carried out in two phases: 1 control, six weeks without any motor intervention, and 2 activity, 18 sessions of dancing. Children were assessed three times: first, before the control phase, second, after the control phase, and third, at the end of the dancing phase. Kruskal-Wallis (p < .05 and Dunn tests (p < .05 were used. There were no changes in performance between the two first phases of evaluation (p = 1.00, however, at the end of the dancing phase a significant increase was measured in relation to D (p < .01 and E dimensions (p < .01. Results showed that dance therapy influences children's functional mobility.

  3. Influence of dance therapy on the functional mobility of children with spastic hemiparetic cerebral palsy

    Directory of Open Access Journals (Sweden)

    Diogo Costa Garção

    2011-09-01

    Full Text Available The aim of this study was to investigate the influence of dance therapy on the functional mobility of children with spastic hemiparetic cerebral palsy. Ten female children (mean age 7.2 ± 1.2 years diagnosed with cerebral palsy were included. In order to evaluate their functional mobility, standing (D and walking, running and jumping (E dimensions from GMFM were applied, and measurements were carried out in two phases: 1 control, six weeks without any motor intervention, and 2 activity, 18 sessions of dancing. Children were assessed three times: first, before the control phase, second, after the control phase, and third, at the end of the dancing phase. Kruskal-Wallis (p < .05 and Dunn tests (p < .05 were used. There were no changes in performance between the two first phases of evaluation (p = 1.00, however, at the end of the dancing phase a significant increase was measured in relation to D (p < .01 and E dimensions (p < .01. Results showed that dance therapy influences children's functional mobility.

  4. Influence of the First Consultation on Adherence to Antiretroviral Therapy for HIV-infected Patients.

    Science.gov (United States)

    Peyre, Marion; Gauchet, Aurélie; Roustit, Matthieu; Leclercq, Pascale; Epaulard, Olivier

    2016-01-01

    Physician attitude influences the way patients cope with diagnosis and therapy in chronic severe diseases such as cancer. Previous studies showed that such an effect exists in HIV care; it is likely that it begins with the first contact with a physician. We aimed to explore in HIV-infected persons their perception of the first consultation they had with an HIV specialist (PFC-H), and whether this perception correlates with adherence to antiretroviral therapy. The study was conducted in Grenoble University Hospital, France, a tertiary care center. Every antiretroviral-experienced patient was asked to freely complete a self-reported, anonymous questionnaire concerning retrospective PFC-H, present adherence (Morisky scale), and present perceptions and beliefs about medicine (BMQ scale). One hundred and fifty-one questionnaires were available for evaluation. PFC-H score and adherence were correlated, independently from age, gender, and numbers of pill(s) and of pill intake(s) per day. BMQ score also correlated with adherence; structural equation analysis suggested that the effect of PFC-H on adherence is mediated by positive beliefs. These results suggest that for HIV-infected persons, the perceptions remaining from the first consultation with an HIV specialist physician influence important issues such as adherence and perception about medicine. Physicians must be aware of this potentially long-lasting effect.

  5. Physicians’ attitudes towards office-based delivery of methadone maintenance therapy: results from a cross-sectional survey of Nova Scotia primary-care physicians

    Directory of Open Access Journals (Sweden)

    Dooley Jessica

    2012-06-01

    Full Text Available Abstract Background Approximately 90,000 Canadians use opioids each year, many of whom experience health and social problems that affect the individual user, families, communities and the health care system. For those who wish to reduce or stop their opioid use, methadone maintenance therapy (MMT is effective and supporting evidence is well-documented. However, access and availability to MMT is often inconsistent, with greater inequity outside of urban settings. Involving community based primary-care physicians in the delivery of MMT could serve to expand capacity and accessibility of MMT programs. Little is known, however, about the extent to which MMT, particularly office-based delivery, is acceptable to physicians. The aim of this study is to survey physicians about their attitudes towards MMT, particularly office-based delivery, and the perceived barriers and facilitators to MMT delivery. Methods In May 2008, facilitated by the College of Physicians and Surgeons of Nova Scotia, a cross-sectional, e-mail survey of 950 primary-care physicians practicing in Nova Scotia, Canada was administered via the OPINIO on-line survey software, to assess the acceptability of office-based MMT. Logistic regressions, adjusted for physician sociodemographic characteristics, were used to examine the association between physicians’ willingness to participate in office-based MMT, and a series of measures capturing physician attitudes and knowledge about treatment approaches, opioid use, and methadone, as well as perceived barriers to MMT. Results Overall, 19.8% of primary-care physicians responded to the survey, with 56% who indicated that they would be willing to be involved in MMT under current or similar circumstances; however, willingness was associated with numerous attitudinal and systemic factors. The barriers to involvement in MMT that were frequently cited included a lack of training or experience in MMT, lack of support services, and potential

  6. Influence of aspirin therapy in the ulcer associated with chronic venous insufficiency.

    Science.gov (United States)

    del Río Solá, Ma Lourdes; Antonio, Jose; Fajardo, González; Vaquero Puerta, Carlos

    2012-07-01

    To determine the effect of aspirin on ulcer healing rate in patients with chronic venous insufficiency, and to establish prognostic factors that influence ulcer evolution. Between 2001 and 2005, 78 patients with ulcerated lesions of diameter >2 cm and associated with chronic venous insufficiency were evaluated in our hospital. Of these, 51 patients (22 men, 29 women) with mean age of 60 years (range: 36-86) were included in a prospective randomized trial with a parallel control group. The treatment group received 300 mg of aspirin and the control group received no drug treatment; in both groups, healing was associated with standard compression therapy. During follow-up, held weekly in a blinded fashion, there was ulcer healing as well as cases of recurrence. Results were analyzed by intention-to-treat approach. Cure rate was estimated using Kaplan-Meier survival analysis, and the influence of prognostic factors was analyzed by applying the Cox proportional hazards model. In the presence of gradual compression therapy, healing occurred more rapidly in patients receiving aspirin versus the control subjects (12 weeks in the treated group vs. 22 weeks in the control group), with a 46% reduction in healing time. The main prognostic factor was estimated initial area of injury (P = 0.032). Age, sex, systemic therapy, and infection showed little relevance to evolution. The administration of aspirin daily dose of 300 mg shortens the healing time of ulcerated lesions in the chronic venous insufficiency (CVI). The main prognostic factor for healing of venous ulcerated lesions is the initial surface area of the ulcer. Copyright © 2012 Annals of Vascular Surgery Inc. Published by Elsevier Inc. All rights reserved.

  7. Lower Choline-Containing Metabolites/Creatine (Cr) Rise and Failure to Sustain NAA/Cr Levels in the Dorsolateral Prefrontal Cortex Are Associated with Depressive Episode Recurrence under Maintenance Therapy: A Proton Magnetic Resonance Spectroscopy Retrospective Cohort Study.

    Science.gov (United States)

    Henigsberg, Neven; Šarac, Helena; Radoš, Marko; Radoš, Milan; Ozretić, David; Foro, Tamara; Erdeljić Turk, Viktorija; Hrabač, Pero; Bajs Janović, Maja; Rak, Benedict; Kalember, Petra

    2017-01-01

    The aim of this study was to evaluate the relationship between changes in proton magnetic resonance spectroscopy (1H-MRS) parameters at the start of the index episode recovery phase and at recurrence in patients with recurrent depression who were treated with prolonged maintenance therapy. 1H-MRS parameters were analyzed in 48 patients with recurrent depression who required maintenance therapy with antidepressant medication prescribed by a psychiatrist and who continued with the same antidepressant during the maintenance phase, either to recurrence of depression, completion of the 10-year observation period, or the start of the withdrawal phase (tapering-off antidepressant). N-acetylaspartate (NAA), choline-containing metabolites (Cho), creatine (Cr), and glutamine/glutamate were measured at the start of the recovery phase and 6 months later. Recurrent depressive episodes occurred in 20 patients. These individuals had a smaller increase in Cho/Cr after the beginning of the recovery phase compared to the non-recurrent patient group and also exhibited a decreased NAA/Cr ratio. Sustainable NAA and increased Cho levels at the onset of the recovery phase of the index episode are early markers of antidepressant effectiveness associated with a lower risk of major depressive disorder recurrence. The NAA and Cho changes in the non-recurrent group may be attributable to increased brain resilience, contrary to the transient temporal effect observed in subjects who experienced a depressive episode.

  8. Influence of low- and high-dose radioiodine therapy on oxidative modification of fibrinogen

    International Nuclear Information System (INIS)

    Schweeger-Exeli, I.J.

    2001-10-01

    levels were significantly elevated above 300 mg/dl (p 0.05) and did not change to a significant extent after treatment in both subgroups. Conclusion: Purification of fibrinogen out of small volumes of plasma is feasible in a short period of time and requires only little technical effort. High - dose radioiodine therapy, applied in differentiated thyroid cancer, leads to significantly increased incorporation of carbonyl groups into the fibrinogen molecule. It remains to be elucidated, whether thyroid hormone status itself influences oxidative damage of fibrinogen. Key words: fibrinogen; radioiodine therapy; oxidative modification; isolation techniques; 2,4-dinitrophenylhydrazine. (author)

  9. Application of influence diagrams to prostate intensity-modulated radiation therapy plan selection

    International Nuclear Information System (INIS)

    Meyer, Juergen; Phillips, Mark H; Cho, Paul S; Kalet, Ira; Doctor, Jason N

    2004-01-01

    The purpose is to incorporate clinically relevant factors such as patient-specific and dosimetric information as well as data from clinical trials in the decision-making process for the selection of prostate intensity-modulated radiation therapy (IMRT) plans. The approach is to incorporate the decision theoretic concept of an influence diagram into the solution of the multiobjective optimization inverse planning problem. A set of candidate IMRT plans was obtained by varying the importance factors for the planning target volume (PTV) and the organ-at-risk (OAR) in combination with simulated annealing to explore a large part of the solution space. The Pareto set for the PTV and OAR was analysed to demonstrate how the selection of the weighting factors influenced which part of the solution space was explored. An influence diagram based on a Bayesian network with 18 nodes was designed to model the decision process for plan selection. The model possessed nodes for clinical laboratory results, tumour grading, staging information, patient-specific information, dosimetric information, complications and survival statistics from clinical studies. A utility node was utilized for the decision-making process. The influence diagram successfully ranked the plans based on the available information. Sensitivity analyses were used to judge the reasonableness of the diagram and the results. In conclusion, influence diagrams lend themselves well to modelling the decision processes for IMRT plan selection. They provide an excellent means to incorporate the probabilistic nature of data and beliefs into one model. They also provide a means for introducing evidence-based medicine, in the form of results of clinical trials, into the decision-making process

  10. Dual Therapy With Darunavir and Ritonavir Plus Lamivudine vs Triple Therapy With Darunavir and Ritonavir Plus Tenofovir Disoproxil Fumarate and Emtricitabine or Abacavir and Lamivudine for Maintenance of Human Immunodeficiency Virus Type 1 Viral Suppression: Randomized, Open-Label, Noninferiority DUAL-GESIDA 8014-RIS-EST45 Trial.

    Science.gov (United States)

    Pulido, Federico; Ribera, Esteban; Lagarde, María; Pérez-Valero, Ignacio; Palacios, Rosario; Iribarren, José A; Payeras, Antoni; Domingo, Pere; Sanz, José; Cervero, Miguel; Curran, Adrián; Rodríguez-Gómez, Francisco J; Téllez, María J; Ryan, Pablo; Barrufet, Pilar; Knobel, Hernando; Rivero, Antonio; Alejos, Belén; Yllescas, María; Arribas, José R

    2017-11-29

    Our objective was to assess the therapeutic noninferiority of dual therapy with darunavir/ritonavir and lamivudine compared to triple therapy with darunavir/ritonavir plus 2 nucleos(t)ides for maintenance of human immunodeficiency virus type 1 (HIV-1) suppression. This was a multicenter, open-label, noninferiority trial (margin 12%). Patients with HIV-1 RNA dual- and triple-therapy arms was 88.9% (112/126) and 92.7% (114/123; difference, -3.8%; 95% confidence interval, -11.0 to 3.4), respectively. Four participants in the dual-therapy arm and 2 in the triple-therapy arm developed protocol-defined virological failure. Switching to dual therapy was associated with a significant increase in total, low-density lipoprotein, and high-density lipoprotein (HDL) cholesterol, but not in the total-to-HDL cholesterol ratio. Serious adverse events and study drug discontinuations due to adverse events occurred in 4.8% vs 4.9%P = .97) and in 0.8% (1/126) vs 1.6% P = .55) in dual therapy vs triple therapy, respectively. Dual therapy with darunavir/ritonavir and lamivudine demonstrated noninferior therapeutic efficacy and similar tolerability compared to triple therapy. NCT02159599. © The Author 2017. Published by Oxford University Press for the Infectious Diseases Society of America. All rights reserved. For permissions, e-mail: journals.permissions@oup.com.

  11. Long-term maintenance therapy for vulvar lichen sclerosus: the results of a randomized study comparing topical vitamin E with an emollient.

    Science.gov (United States)

    Virgili, Annarosa; Minghetti, Sara; Borghi, Alessandro; Corazza, Monica

    2013-04-01

    The chronic and relapsing nature of vulvar lichen sclerosus (VLS) represents a challenge for its long-term management after an effective treatment with topical corticosteroids. To compare the effect of topical vitamin E with that of an emollient in reducing the risk of VLS relapse over a 52-week maintenance treatment. 156 patients with VLS were enrolled in a 12-week active treatment phase on topical 0.1% mometasone furoate ointment once daily. Those who achieved disease remission entered a 52-week maintenance phase in which patients were randomized to apply either an emollient or topical vitamin E once daily. 80 patients entered the maintenance phase. At 52 weeks, for the vitamin E maintenance group, the cumulative crude relapse rate was 27.8% and the cumulative modified crude relapse rate was 55.6%. For the emollient maintenance group, the cumulative crude relapse rate was 22.7% and the cumulative modified crude relapse rate was 50.0%. The median time to relapse was 20 weeks for the vitamin E group and 18.7 weeks for the emollient group. Once VLS has been stabilized with topical corticosteroids, long-term treatment with both vitamin E and emollients may be considered in maintain LS remission.

  12. Analysis of influence of dosimetric factors on the outcome of I-131 therapy in patients with hyperthyroidism

    International Nuclear Information System (INIS)

    Knapska-Kucharska, M.; Oszukowska, L.; Makarewicz, J.; Lewinski, A.

    2012-01-01

    The influence of dosimetric factors on the outcome of 131 I therapy has been examined in hyperthyroid patients submitted to 131 I treatment. The following factors - which could have influence on the effects of therapy with radioiodine - were analysed: the goitre volume, the thyroid radioiodine uptake after 24 h, and the effective half-life time of 131 I (EHL). Five hundred (500) randomly selected patients with hyperthyroidism, treated with 131 I, were studied. They were divided into three groups (based on clinical examination, hormonal and immunological tests, thyroid scintigraphy and ultrasound imaging). The study shows that the effectiveness of 131 I therapy depends on the thyroid volume and absorbed dose in all the groups of patients and on the thyroid radioiodine uptake and EHL in patients with a single autonomously functioning thyroid nodule. We have failed to determine the borderline D, distinguishing between effective and ineffective therapy. The treatment outcome can be predicted with approximately 70% accuracy, based on minimal absorbed dose

  13. Maintenance planning for nuclear power plants

    International Nuclear Information System (INIS)

    Mattu, R.K.; Cooper, S.E.; Lauderdale, J.R.

    2004-01-01

    Maintenance planning for nuclear power plants is similar to that in other industrial plants but it is heavily influenced by regulatory rules, with consequent costs of compliance. Steps by the nuclear industry and the Nuclear Regulatory Commission to address that problem include development of guidelines for maintenance of risk-critical equipment, using PRA-based techniques to select a set of equipment that requires maintenance and reliability-centered maintenance (RCM) approaches for determining what maintenance is required. The result of the process is a program designed to ensure effective maintenance of the equipment most critical to plant safety. (author)

  14. Flight Crew Health Maintenance

    Science.gov (United States)

    Gullett, C. C.

    1970-01-01

    The health maintenance program for commercial flight crew personnel includes diet, weight control, and exercise to prevent heart disease development and disability grounding. The very high correlation between hypertension and overweight in cardiovascular diseases significantly influences the prognosis for a coronary prone individual and results in a high rejection rate of active military pilots applying for civilian jobs. In addition to physical fitness the major items stressed in pilot selection are: emotional maturity, glucose tolerance, and family health history.

  15. Adolescents with Functional Somatic Symptoms: The influence of family therapy on empowerment and illness beliefs

    DEFF Research Database (Denmark)

    Hulgaard, Ditte Roth; Rask, Charlotte; Dehlholm-Lambertsen, Birgitte

    psychological treatment and the significance of illness beliefs and empowerment in children and adolescents with severe FSS is scarce. Aims: To conduct a qualitative study which aims to examine how specific illness beliefs and a sense of empowerment evolve and change during specialized family-based treatment......Background: Young patients with Functional Somatic Symptoms (FSS) are common and may present in all clinical settings. Psychological treatment targeting dysfunctional illness beliefs and poor sense of empowerment has been shown effective for FSS in adults. In comparison current knowledge about...... (IPA). Results: Preliminary data from a pilotstudy with 2 families, from interviews conducted prior to family therapy, indicate that illness beliefs and sense of empowerment may be diverging for children and their parents, and are influenced by many factors, such as health professionals, family history...

  16. Opportune maintenance and predictive maintenance decision support

    OpenAIRE

    Thomas , Edouard; Levrat , Eric; Iung , Benoît; Cocheteux , Pierre

    2009-01-01

    International audience; Conventional maintenance strategies on a single component are being phased out in favour of more predictive maintenance actions. These new kinds of actions are performed in order to control the global performances of the whole industrial system. They are anticipative in nature, which allows a maintenance expert to consider non-already-planned maintenance actions. Two questions naturally emerge: when to perform a predictive maintenance action; how a maintenance expert c...

  17. Influence of surgical or propylthiouracil pretreatment on the efficacy of iodine-131 therapy in hyperthyroidism

    International Nuclear Information System (INIS)

    Shi Genming; Xu Qin; Yang Yili; Ye Anfang; Zhu Chengyi

    2006-01-01

    Objective: To investigate the influence of surgical or propylthiouracil(PTU) pretreatment on the efficacy of radioactive iodine therapy in hyperthyroidism. Methods: A group (group 1) of 41 hyperthyroidism patients relapsed after surgery were treated with 131 I in our department from 2003 through 2004. During that period, another group (group 2) of 41 cases were selected randomly from patients untreated either surgically or chemically before oral administration of 131 I, and a third group (group 3) of 41 cases were selected randomly from those pretreated only with PTU. We analysed the results of these three groups of patients after followed-up for 3 and 6 months separately after 131 I therapy. Results: Approximately 90.24% (37/41 cases) and 92.68% (38/ 41 cases) of patients in group 2 without any pretreatment were cured 3 months and 6 months after 131 I treatment, respectively, and 9.76% (4/41 cases) and 7.32% (3/41 cases) of them did not respond to 131 I treatment. About 43.90% (18/41 cases) and 53.66 % (22/41 cases) of patients pretreated with PTU (group 3) were cured at 3 and 6 months, respectively, and approximately 56.10% (23/41 cases) and 46.34% (19/41 cases) of this group patients did not respond to 131 I treatment at 3 and 6 months, respectively (P 131 I treatment, respectively, and 31.71% (13/41) and 29.27% (12/ 41) of them did not respond to 131 I treatment (P 131 I treatment can affect the efficacy of 131 I therapy, resulting in reduction of the cure rate. (authors)

  18. Influence of planning time and treatment complexity on radiation therapy errors.

    Science.gov (United States)

    Gensheimer, Michael F; Zeng, Jing; Carlson, Joshua; Spady, Phil; Jordan, Loucille; Kane, Gabrielle; Ford, Eric C

    2016-01-01

    Radiation treatment planning is a complex process with potential for error. We hypothesized that shorter time from simulation to treatment would result in rushed work and higher incidence of errors. We examined treatment planning factors predictive for near-miss events. Treatments delivered from March 2012 through October 2014 were analyzed. Near-miss events were prospectively recorded and coded for severity on a 0 to 4 scale; only grade 3-4 (potentially severe/critical) events were studied in this report. For 4 treatment types (3-dimensional conformal, intensity modulated radiation therapy, stereotactic body radiation therapy [SBRT], neutron), logistic regression was performed to test influence of treatment planning time and clinical variables on near-miss events. There were 2257 treatment courses during the study period, with 322 grade 3-4 near-miss events. SBRT treatments had more frequent events than the other 3 treatment types (18% vs 11%, P = .04). For the 3-dimensional conformal group (1354 treatments), univariate analysis showed several factors predictive of near-miss events: longer time from simulation to first treatment (P = .01), treatment of primary site versus metastasis (P < .001), longer treatment course (P < .001), and pediatric versus adult patient (P = .002). However, on multivariate regression only pediatric versus adult patient remained predictive of events (P = 0.02). For the intensity modulated radiation therapy, SBRT, and neutron groups, time between simulation and first treatment was not found to be predictive of near-miss events on univariate or multivariate regression. When controlling for treatment technique and other clinical factors, there was no relationship between time spent in radiation treatment planning and near-miss events. SBRT and pediatric treatments were more error-prone, indicating that clinical and technical complexity of treatments should be taken into account when targeting safety interventions. Copyright © 2015 American

  19. Comparative evaluation of antioxidant drug influence on a radio therapy efficiency and oxidative status in mice

    Directory of Open Access Journals (Sweden)

    Alexander V. Siprov

    2013-09-01

    Full Text Available The aim of the study is a comparative analysis of the effect of melatonin (Melaxen and 3-hydroxypyridine (Mexidol on antitumor and antimetastatic influence of chemoradiotherapy and oxidative status at mice with Lewis lung carcinoma. Material — Experiments have been organized on 95 mice of C57Bl/6 line and of 20–22 g in weight. Cyclophosphan has been abdominally administered two times in a dosage of 60 mg/kg within the interval of 120 hours — 20-30 min before radiotherapy. It has been located on the area of initial tumor in a dosage of 2 g at the same time as cyclophosphan injection. Melaxen and Mexidol have been intramuscularly injecting in the dosage of 45 and 50 mg/ kg for 14 days. Antitumor and antimetastatic effect of the applied therapy and changes in the oxidative status of the animals have been estimated. Results — Melaxen and Mexidol do not decrease antitumour and antimetastatic effects of radiotherapy and prevent the activation of free radical processes at animals with tumors. Mexidol was more effective than Melaxen in correction of superoxide dismutase activity in liver. The drugs under the study do not decrease radiotherapy-induced lipid peroxidation in the initial tumor. Conclusion — Melaxen and Mexidol do not decrease the radio therapy efficiency and oxidative status at mice with tumor (on the background of antitumor treatment.

  20. Pharmacological therapy of chronic obstructive pulmonary disease

    African Journals Online (AJOL)

    patients with COPD require pharmacological therapy. ... pulmonary dysfunction. Clearly the patient's tolerance to the various drugs will influence the choice of long-term maintenance treatment. The other important factor in the .... blocking cervical immune responses might leave her less protected against other infections.

  1. Study protocol, rationale and recruitment in a European multi-centre randomized controlled trial to determine the efficacy and safety of azithromycin maintenance therapy for 6 months in primary ciliary dyskinesia

    DEFF Research Database (Denmark)

    Kobbernagel, Helene Elgaard; Buchvald, Frederik F; Haarman, Eric G

    2016-01-01

    maintenance therapy in PCD. METHODS: The BESTCILIA trial is a European multi-centre, double-blind, randomized, placebo-controlled, parallel group study. The intervention is tablets of azithromycin 250/500 mg according to body weight or placebo administered three times a week for 6 months. Subjects...... prescribed in other chronic respiratory disorders. Furthermore, the trial will utilize the Lung clearance index and new, PCD-specific quality of life instruments as outcome measures for PCD. Recruitment is hampered by frequent occurrence of Pseudomonas aeruginosa infection, exacerbations at enrolment...

  2. Physiotherapists' attitudes toward circuit class therapy and 7 day per week therapy is influenced by normative beliefs, past experience, and perceived control: A qualitative study.

    Science.gov (United States)

    Van Kessel, Gisela; Hillier, Susan; English, Coralie

    2017-11-01

    Attitudes are recognized as influencing research implementation. However, little is known about the process by which physiotherapists' attitudes and beliefs shape their use of 7-day per week therapy and circuit class therapy research findings. Understanding beliefs may assist in addressing barriers to research uptake. Fifteen physiotherapists from six rehabilitation centers who ranged in seniority, experience, and education levels consented to be interviewed. The transcribed interviews were analyzed using a qualitative content analysis drawing on the Theory of Planned Behavior. Participants felt that they had autonomy in adopting new approaches when the evidence was supported by social norms. Participants believed that 7-day per week therapy delivers a seamless service that increases physiotherapy time, which helps maintain patient improvement, but needs to accommodate patient choice and expectations. Circuit class therapy was viewed positively as it provides more physiotherapy time, increases patient social interaction, and motivation. However, this was qualified by a belief that patients would not receive individualized, quality of movement focused therapy, particularly for patients with limited capacities. Implementation of a new approach depends on the past experience, coherence with individual beliefs regarding important elements of therapy content, and opportunities to control barriers to implementation.

  3. Network maintenance

    CERN Multimedia

    GS Department

    2009-01-01

    A site-wide network maintenance operation has been scheduled for Saturday 28 February. Most of the network devices of the general purpose network will be upgraded to a newer software version, in order to improve our network monitoring capabilities. This will result in a series of short (2-5 minutes) random interruptions everywhere on the CERN sites throughout the day. This upgrade will not affect the Computer Centre itself, Building 613, the Technical Network and the LHC experiments, dedicated networks at the pits. For further details of this intervention, please contact Netops by phone 74927 or e-mail mailto:Netops@cern.ch. IT/CS Group

  4. Network maintenance

    CERN Multimedia

    IT Department

    2009-01-01

    A site wide network maintenance has been scheduled for Saturday 28 February. Most of the network devices of the General Purpose network will be upgraded to a newer software version, in order to improve our network monitoring capabilities. This will result in a series of short (2-5 minutes) random interruptions everywhere on the CERN sites along this day. This upgrade will not affect: the Computer centre itself, building 613, the Technical Network and the LHC experiments dedicated networks at the pits. Should you need more details on this intervention, please contact Netops by phone 74927 or email mailto:Netops@cern.ch. IT/CS Group

  5. QT response after a test dose and during maintenance therapy with AZD1305 in patients with atrial fibrillation: a double-blind, randomized, placebo-controlled trial

    DEFF Research Database (Denmark)

    Egstrup, Kenneth; Bergfeldt, Lennart; Duris, Tibor

    2011-01-01

    AZD1305 is an investigational antiarrhythmic agent that prolongs refractoriness through combined potassium and sodium channel inhibition. This study aimed to explore the utility of a test dose in predicting QT interval corrected according to Fridericia's formula (QTcF) during subsequent maintenance...

  6. The influence of radioiodine therapy in 1470 patients with subclinical hyperthyroidism

    International Nuclear Information System (INIS)

    Abdelrazek, S.; Szumowski, P.; Mysliwiec, J.; Mojsak, M.; Kraszynska, A.; Amelian-Filonowicz, A.

    2015-01-01

    Full text of publication follows. The aim of our study was to assess the influence of radioiodine ( 131 I) therapy on the achievement of euthyroidism, prevention of adverse effects on the cardiovascular and prevent evolvement to overt hyperthyroidism. Material and methods: we treated 1470 patients sent to our department during the last 7 years, aged 24-76 years; 88% of them were female and 12% male; 490 patients with multi-nodular goitre (MNG), and 980 patients with autonomous nodule (ATN). Some of the patients were treated with antithyroid drugs for 1 to 3 months before 131 I therapy (140 patients). Malignant changes were excluded in all nodules by fine needle aspiration biopsy. All the patients had serum TSH levels <0.1 mU/l and effective T-half was more than 3 days at the time of treatment. The activity dose was calculated by the use of Marinelli's formula and ranged between 200 and 800 MBq. The absorbed dose (Gy) ranged between 180 and 300, and was proportional to thyroid volume. Follow up control was done every 6 weeks. Results: euthyroidism achieved in 99% of patient with ATN and 94% of MNG; 1% of patients with ATN and 5% of patients with MNG develop hypothyroidism. 1% of patients with MNG were in subclinical hyperthyroidism and received second dose of radioiodine therapy. In all of the patients, the symptoms and signs of subclinical hyperthyroidism disappeared (palpitation, tachycardia, atrial fibrillation, exercise tolerance improved, the blood pressure normalised and the quality of life improved). Conclusions: our result is good and is in the range of the existing literature. The achievement of euthyroidism and the remission of the symptoms and signs of subclinical hyperthyroidism, were due to good diagnosis, well preparation of the patients; accurate measurement of administered activity, effective half-life, and well-organised follow up. We recommend early treatment of subclinical hyperthyroidism, and long period of follow up visits in our department

  7. INFLUENCES OF HORMONE REPLACEMENT THERAPY ON OLFACTORY AND COGNITIVE FUNCTION IN THE MENOPAUSE

    Science.gov (United States)

    Doty, Richard L.; Tourbier, Isabelle; Ng, Victoria; Neff, Jessica; Armstrong, Deborah; Battistini, Michelle; Sammel, Mary D.; Gettes, David; Evans, Dwight L.; Mirza, Natasha; Moberg, Paul J.; Connolly, Tim; Sondheimer, Steven J.

    2015-01-01

    Olfactory dysfunction can be an early sign of Alzheimer’s disease (AD). Since hormone replacement therapy (HRT) may protect against developing AD in postmenopausal women, the question arises as to whether it also protects against olfactory dysfunction in such women. Three olfactory and 12 neurocognitive tests were administered to 432 healthy postmenopausal women with varied HRT histories. Serum levels of reproductive hormones were obtained for all subjects; APOE-ε4 haplotype was determined for 77. National Adult Reading Test and Odor Memory/Discrimination Test (OMT) scores were positively influenced by HRT. Odor identification and OMT test scores were lower for women who scored poorly on a delayed recall test, a surrogate for mild cognitive impairment. WAIS-R NI Spatial Span Backwards Test scores were higher in women receiving estrogen plus progestin HRT and directly correlated with serum testosterone levels, the latter implying a positive effect of testosterone on spatial memory. APOE-ε4 was associated with poorer odor threshold test scores. These data suggest that HRT positively influences a limited number of olfactory and cognitive measures in the menopause. PMID:25850354

  8. The influence of antithyroid drugs on the results of radioiodine therapy of thyroid functional autonomy

    International Nuclear Information System (INIS)

    Valuevich, V.V.

    2005-01-01

    The purpose of the given research was the estimation of the influence of antithyroid medication on efficiency of radioiodine therapy (RIT) of nonimmune hyperthyroidism in patients with thyroid functional autonomy (FA). 100 patients with various clinical variants of thyroid FA were included in research and received treatment with radioactive iodine. From surveyed 2 groups of patients were formed. The first group consisted from 50 persons initially accepting during 4 months (2.5; 6) antithyroid drugs (ATD) which cancellation had been made, as a rule, 2 day prior to RIT, and the second included 50 persons not accepting ATD neither up to nor after RIT. 9 elderly and multimorbid patients from the first group continued to accept ATD within several months after RIT. Carbimazole (n=45) or methimazole (n=5) in a doze of 10 mg (5; 10) were used as antithyroid drugs. In 4 months (4; 5) after RIT the successful result (euthyrosis or hypothyroidism) was achieved in 48 (96%) patients accepting ATD, and in 47 (94%) patients who were not accepting last. The conclusion that antithyroid medication does not influence on efficiency of RIT of thyroid FA is made. It is revealed that frequency of hypothyroidism after RIT in patients of the first group was higher (36%), than in patients of the second group (20%). (authors)

  9. Pazopanib Maintenance Therapy in East Asian Women With Advanced Epithelial Ovarian Cancer: Results From AGO-OVAR16 and an East Asian Study.

    Science.gov (United States)

    Kim, Jae-Weon; Mahner, Sven; Wu, Ling-Ying; Shoji, Tadahiro; Kim, Byoung-Gie; Zhu, Jian-Qing; Takano, Tadao; Park, Sang-Yoon; Kong, Bei-Hua; Wu, Qiang; Wang, Kung-Liahng; Ngan, Hextan Ys; Liu, Ji-Hong; Wei, Li-Hui; Mitrica, Ionel; Zhang, Pingkuan; Crescenzo, Rocco; Wang, Qiong; Cox, Charles J; Harter, Philipp; du Bois, Andreas

    2018-01-01

    The recent phase 3 trial AGO-OVAR16 demonstrated that pazopanib maintenance improved median progression-free survival in patients with ovarian cancer whose disease did not progress during first-line treatment. However, this improvement was not seen in the subset of East Asian patients. The current analysis evaluated the efficacy and safety of pazopanib maintenance in East Asian patients from AGO-OVAR16 and a separate East Asian study. East Asian patients from AGO-OVAR16 (n = 209) and the East Asian study (N = 145) were randomized 1:1 to receive pazopanib 800 mg/d or placebo for up to 24 months. The primary end point for each study was progression-free survival by RECIST (Response Evaluation Criteria in Solid Tumors) based on investigator assessment. Clinical and genetics data were analyzed separately by study or pooled according to separate predetermined statistical plans. Pazopanib maintenance had a detrimental effect on median progression-free survival versus placebo in East Asian patients from the combined studies (n = 354; 17.9 vs 21.5 months; hazard ratio, 1.114; 95% confidence interval, 0.818-1.518; P = 0.4928). Pazopanib maintenance showed a disadvantage in overall survival in East Asian patients from AGO-OVAR16 versus placebo (hazard ratio, 1.706; 95% confidence interval, 1.010-2.883; P = 0.0465); overall survival analysis was not performed in the East Asian study because of insufficient event numbers. Pazopanib-treated patients had a significantly higher incidence of grade 3 or higher hypertension (27%) and neutropenia (13%) versus placebo. The treatment effect of maintenance pazopanib in East Asian patients seemed to differ from that in non-Asian patients. In study-specific and pooled analyses, none of the potential factors analyzed could satisfactorily explain the different efficacy results of pazopanib in East Asian patients.

  10. Eradication rate of Helicobacter Pylori infection is directly influenced by adherence to therapy in children.

    Science.gov (United States)

    Kotilea, Kallirroi; Mekhael, Joyce; Salame, Assaad; Mahler, Tania; Miendje-Deyi, Veronique Yvette; Cadranel, Samy; Bontems, Patrick

    2017-08-01

    Current commonly accepted strategies to eradicate Helicobacter pylori in children are a 10-day sequential treatment or a triple therapy for 7-14 days. To avoid further expensive and possibly risky investigations as well as induction of secondary antimicrobial resistance, a success rate of elimination strategies over 90% in a per-protocol analysis is the target goal but rates observed in clinical trials are lower. Antimicrobial resistance is a well-recognized risk factor for treatment failure; therefore, only a treatment tailored to susceptibility testing should be recommended. Adherence to therapy is also a risk factor for treatment failure but that has been poorly studied. The purpose of this study was to evaluate the influence of adherence to therapy on the elimination rates obtained with different treatment regimens. Cohort study analysis of children, aged 2-17 years, treated for Helicobacter pylori infection between October 2011 and December 2013. As a routine clinical practice, children infected with a strain susceptible to clarithromycin and to metronidazole received either a sequential regimen or a 10-day triple therapy while children infected with a strain resistant to clarithromycin or metronidazole received a 10-day triple regimen tailored to antimicrobial susceptibility. The eradication rate was assessed by a negative 13 C-urea breath test performed at least 8 weeks after the end of the treatment and adherence evaluated using a diary. One hundred forty-five children (67 girls/78 boys, median age 9.7 years) fulfilled the inclusion criteria, 118 being infected with a strain susceptible to both clarithromycin and metronidazole, 10 with a clarithromycin resistant, and 17 with a metronidazole resistant strain. A sequential regimen was prescribed in 44, a triple therapy containing clarithromycin in 84 and containing metronidazole in 17. Follow-up data were available for 130/145 and clearance of the infection observed in 105 of them. A concordance of more than

  11. Safety and maintenance of response for tofacitinib monotherapy and combination therapy in rheumatoid arthritis: an analysis of pooled data from open-label long-term extension studies

    NARCIS (Netherlands)

    Fleischmann, Roy; Wollenhaupt, Jürgen; Takiya, Liza; Maniccia, Anna; Kwok, Kenneth; Wang, Lisy; van Vollenhoven, Ronald F.

    2017-01-01

    Tofacitinib is an oral Janus kinase inhibitor for the treatment of rheumatoid arthritis. This post hoc analysis evaluated patients receiving tofacitinib monotherapy or combination therapy, as well as those who switched from monotherapy to combination therapy (mono→combo) or vice versa (combo→mono)

  12. Influence of diuretic therapy on the features of heart rhythm variability changes in chronic heart failure patients

    Directory of Open Access Journals (Sweden)

    K R Alyeva

    2018-02-01

    Full Text Available Aim. To study comparative influence of furosemide and torasemide on heart rhythm variability in patients with chronic heart failure of ischemic origin. Methods. The study included 48 patients (29 males and 19 females with ischemic heart disease complicated by chronic heart failure, NYHA functional classes II-IV. All patients were randomized into two groups: group 1 (25 patients received furosemide as diuretic therapy, and group 2 (23 patients received torasemide. All patient underwent clinical examination including assessment of complaints and physical examination, laboratory and instrumental tests (electrocardiography, echocardiography, 6-minute walk test, 24 Hour Holter ECG monitoring before and 30 days after starting diuretic therapy. Results. Against the background of one-month diuretic therapy, positive dynamics of clinical parameters was registered in both main groups of patients receiving both furosemide and torasemide. In furosemide group deterioration of heart rhythm variability was observed. Torasemide treatment resulted in considerable improvement of vegetative regulation of heart activity. Conclusion. Diuretic therapy with furosemide is characterized by changes of time and spectral parameters of vegetative regulation of heart rhythm towards strengthening of sympathetic and attenuation of parasympathetic influence; diuretic therapy with torasemide resulted in considerable improvement of heart rhythm variability parameters, attenuation of sympathetic and strengthening of parasympathetic influence on heart rhythm that provides additional cardioprotection in the treatment of patients with chronic heart failure of ischemic origin.

  13. Influence of balneophysical therapy on activity, functional capacity, and quality of life in patients with rheumatoid arthritis

    Directory of Open Access Journals (Sweden)

    Stojanović Sonja

    2009-01-01

    Full Text Available Introduction It has been well known that balneophysical therapy has a therapeutic effect on clinical and biological parameters of disease activity in the patients with rheumatoid arthritis (RA. Objective. To determine the influence of balneophysical therapy on functional capacity, activity and quality of life of the patients with RA primarily treated with some of disease modifying antirheumatic drugs. Methods. The study enrolled 73 patients with RA treated with some of disease modifying antirheumatic drugs (Methotrexate in 85% of patients. During hospitalization at the Clinical Rheumatologic Department of the Institute 'Niska Banja', the patients were treated, beside the medicamentous therapy, by hydrotherapy (oligomineral, homeothermic, low radioactive water, mineral peloid therapy, electrotherapy and kinesiotherapy. Before and after balneotherapy, the patients filled in the Health Assessment Questionnaire (HAQ and the Quality of Life Rheumatoid Arthritis (QOL-RA scale. The Disease Activity Score (DAS 28 was used to measure the disease activity before and after balneotherapy. A possible value of HAQ was from 0 to 3, and QOL-RA from 0 to 10. Results. The mean value of the duration of balneophysical therapy was 14.7±4.8 days. We found significant improvement of functional capacity in the patients with RA. The average HAQ score before balneotherapy was 1.07±0.61, and 0.86±0.55 after balneotherapy, which was statistically significantly lower (p<0.05. DAS 28 after balneotherapy was also statistically significantly lower than DAS 28 before balneotherapy: the mean value of DAS 28 before therapy was 6.30±0.81 and after therapy 5.48±0.75 (p<0.001. The quality of life significantly improved after balneophysical therapy: the mean value of QOL-RA scale before therapy was 5.38±1.62 and after therapy 7.35±1.81 (p<0.05. Conclusion. Balneophysical therapy, when properly dosed, is an effective, adjuvant therapy in the patients with RA of mild disease

  14. Optimizing preventive maintenance with maintenance templates

    International Nuclear Information System (INIS)

    Dozier, I.J.

    1996-01-01

    Rising operating costs has caused maintenance professionals to rethink their strategy for preventive maintenance (PM) programs. Maintenance Templates are pre-engineered PM task recommendations for a component type based on application of the component. Development of the maintenance template considers the dominant failure cause of the component and the type of preventive maintenance that can predict or prevent the failure from occurring. Maintenance template development also attempts to replace fixed frequency tasks with condition monitoring tasks such as vibration analysis or thermography. For those components that have fixed frequency PM intervals, consideration is given to the maintenance drivers such as criticality, environment and usage. This helps to maximize the PM frequency intervals and maximize the component availability. Maintenance Templates have been used at PECO Energy's Limerick Generating Station during the Reliability Centered Maintenance (RCM) Process to optimize their PM program. This paper describes the development and uses of the maintenance templates

  15. The influence of hormone replacement therapy on the aging-related change in cognitive performance. Analysis based on a Danish cohort study

    DEFF Research Database (Denmark)

    Løkkegaard, E; Pedersen, A T; Laursen, P

    2002-01-01

    A maintenance and/or improvement of cognitive performance with postmenopausal hormone replacement therapy (HRT) is biological plausible. The objectives of this study were to analyze the impact of HRT on aging-related changes in cognitive performances, and to assess whether women who choose HRT have...... better cognitive performance prior to HRT....

  16. Maintenance fluid therapy and fluid creep impose more significant fluid, sodium, and chloride burdens than resuscitation fluids in critically ill patients: a retrospective study in a tertiary mixed ICU population.

    Science.gov (United States)

    Van Regenmortel, Niels; Verbrugghe, Walter; Roelant, Ella; Van den Wyngaert, Tim; Jorens, Philippe G

    2018-04-01

    Research on intravenous fluid therapy and its side effects, volume, sodium, and chloride overload, has focused almost exclusively on the resuscitation setting. We aimed to quantify all fluid sources in the ICU and assess fluid creep, the hidden and unintentional volume administered as a vehicle for medication or electrolytes. We precisely recorded the volume, sodium, and chloride burdens imposed by every fluid source administered to 14,654 patients during the cumulative 103,098 days they resided in our 45-bed tertiary ICU and simulated the impact of important strategic fluid choices on patients' chloride burdens. In septic patients, we assessed the impact of the different fluid sources on cumulative fluid balance, an established marker of morbidity. Maintenance and replacement fluids accounted for 24.7% of the mean daily total fluid volume, thereby far exceeding resuscitation fluids (6.5%) and were the most important sources of sodium and chloride. Fluid creep represented a striking 32.6% of the mean daily total fluid volume [median 645 mL (IQR 308-1039 mL)]. Chloride levels can be more effectively reduced by adopting a hypotonic maintenance strategy [a daily difference in chloride burden of 30.8 mmol (95% CI 30.5-31.1)] than a balanced resuscitation strategy [daily difference 3.0 mmol (95% CI 2.9-3.1)]. In septic patients, non-resuscitation fluids had a larger absolute impact on cumulative fluid balance than did resuscitation fluids. Inadvertent daily volume, sodium, and chloride loading should be avoided when prescribing maintenance fluids in view of the vast amounts of fluid creep. This is especially important when adopting an isotonic maintenance strategy.

  17. The influence of metronidazole resistance on the efficacy of ranitidine bismuth citrate triple therapy regimens for Helicobacter pylori infection

    NARCIS (Netherlands)

    Van der Wouden, EJ; Thijs, JC; Van Zwet, AA; Kooy, A; Kleibeuker, JH

    Aim: To assess the influence of metronidazole resistance on the efficacy of ranitidine bismuth citrate-based triple therapy regimens in two consecutive studies. Methods: In the first study, patients with a culture-proven Helicobacter pylori infection were treated with ranitidine bismuth citrate 400

  18. Influence of antibacterial therapy on bone scan indices at foot inflammation in diabetes mellitus accompanied by diabetic foot syndrome

    International Nuclear Information System (INIS)

    Slavnov, V.M.; Bolgars'ka, S.V.; Taran, E.V.; Markov, V.V.

    2004-01-01

    The influence of antibacterial therapy on bone scan indices at foot inflammation in patients with diabetes mellitus (DM) accompanied by diabetic foot syndrome was studied. Bone scan was performed using scintillation tomographic gamma-camera hours after intravenous injection of 99m Tc-methylene diphosphonate

  19. Do Sex, Sex-Role Orientation, and Exposure to Gender-Congruent Therapy Models Influence Receptivity to Psychotherapy?

    Science.gov (United States)

    Park, Heather L.; Hatchett, Gregory T.

    2006-01-01

    This study had two objectives. The first objective was to evaluate how well sex and sex-role orientation predicted receptivity to psychotherapy. The second objective was to evaluate whether exposure to gender-congruent therapy videos influenced participants' receptivity to psychotherapy. Participants were randomly assigned to three conditions: (1)…

  20. INFLUENCE OF MILDRONATE ON EFFICIENCY OF ANTIANGINAL THERAPY IN PATIENTS WITH STABLE BURDEN ANGINA

    Directory of Open Access Journals (Sweden)

    N. P. Kutishenko

    2005-01-01

    Full Text Available Aim. To study influence of mildronate (M on treatment efficiency of patients with ischemic heart disease (IHD, receiving standard antianginal therapy (AATMaterials and methods. Double-blind, randomized, placebo-controlled study was carried out in parallel groups. All patients continued the earlier prescribed AAT without changes. After control period (10-14 days was over, randomization of patients either to the treatment group (M 500mg twice per day, or to the control group (placebo (Pl twice per day was made for 6 weeks therapy. Criterion of treatment efficiency: increase in duration of trial with burden on treadmill (TB, decrease in angina attack frequency (AA and reduction in nitroglycerin taking (NTT. TB was carried out at the beginning (TB-1, at the end of the control period (TB-2, and at the end of the treatment (TB-3.Results. TB-1 and TB-2 had good reproducibility, their duration didn’t differ. At the end of the treatment additionally with M, growth in duration of TB-3 (p=0,002 was registered, while there was no growth of TB duration with the Pl treatment (p=0,07. During the treatment decrease in AA number both with M (p=0,002, and with Pl (p=0,02 was noted. With M treatment decrease in NTT treatment (p=0.02 was observed, while NTT with Pl didn’t change (p=0,7. Number of side effects, registered with M and Pl, didn’t differ.Conclusion. Mildronate provides additional benefits for patients with IHD with stable burden angina, when they do not reach desired effect with the prescribed AAT.

  1. Influence of metals on cytokines production in connection with successful implantation therapy in dentistry.

    Science.gov (United States)

    Podzimek, Stepan; Tomka, Milan; Nemeth, Tibor; Himmlova, Lucie; Matucha, Petr; Prochazkova, Jarmila

    2010-01-01

    In most of patients in need of implantation treatment in the oral cavity, implants heal well, nevertheless, there are some individuals, in whom titanium implants fail for reasons, which remain unclear. The aim of our study was to determine if there is a difference between metal influenced IL-1β, IL-4, IL-6, TNF-α and IFN-γ cytokines production in patients with successfully healed implants compared to those, whose implant therapy was unsuccessful. The two study groups included 12 patients with failed dental titanium implants and 9 patients with successfully healed implants. In the subjects, cytokine production was established after lymphocyte cultivation with mercury, nickel and titanium antigens. IL-1β levels were significantly increased in all patients after stimulation with titanium and in patients with accepted implants compared to patients with failed implants after the stimulation with mercury and titanium. Titanium caused significantly increased IL-6 production in all patients. TNF-α and IFN-γ levels were also significantly increased after the stimulation with titanium. Significantly increased TNF-α levels were found in patients with accepted implants as compared to patients with failed implants. Increased production of IL-1β a IL-6 cytokines in reaction to titanium and increased production of TNF-α and IFN-γ cytokines in reaction to mercury, which is very often present in the form of amalgam in the oral cavity of persons in need of implant therapy, can play an important role in immune reactions during implant healing process. In patients with failed titanium implants, decreased production of these cytokines may participate in implant failure.

  2. Influence of oral rinsing on the exposure of salivary glands during radioiodine therapy

    International Nuclear Information System (INIS)

    Luetzen, U.; Silvia, P.; Zhao, Y.; Marx, M.; Winkler, C.; Zuhayra, M.

    2015-01-01

    salivary gland function was detected (p<0.03). However, in all groups there was no difference in salivary gland function between the intervention and control group. The analysis of WB scintigrams also showed no significant reduction in residual activity in the gastrointestinal tract in the intervention group compared to the control group (p-value = 0.47). Conclusion: this study showed that repeated rinsing of the mouth with water had no significant influence on the radiation exposure of patients receiving radioiodine therapy and did not significantly protect their SG's. (authors)

  3. Maintenance in sustainable manufacturing

    Directory of Open Access Journals (Sweden)

    Vladimir Stuchly

    2014-09-01

    Full Text Available Background: Sustainable development is about reaching a balance between economic, social, and environmental goals, as well as people's participation in the planning process in order to gain their input and support. For a company, sustainable development means adoption of such business strategy and actions that contribute to satisfying present needs of company and stakeholders, as well as simultaneous protection, maintenance and strengthening of human and environmental potential which will be needed in the future. This new approach forces manufacturing companies to change their previous management paradigms. New management paradigm should include new issues and develop innovative methods, practices and technologies striving for solving problem of shortages of resources, softening environment overload and enabling development of environment-friendly lifecycle of products. Hence, its realization requires updating existing production models as they are based on previously accepted paradigm of unlimited resources and unlimited regeneration capabilities. Maintenance plays a crucial role because of its impact on availability, reliability, quality and life cycle cost, thus it should be one of the main pillars of new business running model.  Material and methods: The following paper is a result of research on the literature and observation of practices undertaken by a company within maintenance area. Results and conclusions: The main message is that considering sustainable manufacturing requires considerable expanding range of analysis and focusing on supporting processes. Maintenance offers numerous opportunities of decreasing influence of business processes on natural environment and more efficient resources utilization. The goal of maintenance processes realizing sustainable development strategy is increased profitability of exploitation and optimization of total lifecycle cost without disturbing safety and environmental issues. 

  4. Influence of radiation therapy on oral Candida albicans colonization: a quantitative assessment

    International Nuclear Information System (INIS)

    Rossie, K.M.; Taylor, J.; Beck, F.M.; Hodgson, S.E.; Blozis, G.G.

    1987-01-01

    An increase in quantity of oral Candida albicans was documented in patients receiving head and neck radiation therapy during and after therapy, as assessed by an oral-rinse culturing technique. The amount of the increase was greater in denture wearers and directly related to increasing radiation dose and increasing volume of parotid gland included in the radiation portal. A significant number of patients who did not carry C. albicans prior to radiation therapy developed positive cultures by 1 month after radiation therapy. The percentage of patients receiving head and neck radiation therapy who carried C. albicans prior to radiation therapy did not differ significantly from matched dental patient controls

  5. Determination of the influence of fluid therapy on hematological and urinary parameters in dogs

    Directory of Open Access Journals (Sweden)

    Mariah Gois Ceregatti

    2016-09-01

    Full Text Available ABSTRACT. Ceregatti M.G., Volpato J., Mattoso C.R.S., da Costa A., Weinert N.C., Tocheto R., Comasseto F. & Saito M.E. [Determination of the influence of fluid therapy on hematological and urinary parameters in dogs.] Determinação da influência da fluidoterapia nos parâmetros hematológicos e urinários em cães. Revista Brasileira de Medicina Veterinária, 38(3:292-298, 2016. Departamento de Medicina Veterinária, Universidade do Estado de Santa Catarina, Avenida Luiz de Camões, 2090, Conta Dinheiro, Lages, SC 88520-000, Brasil. E-mail: jully_volps@hotmail.com The aim of the present study was to evaluate the effects of different fluid infusion rates on hematologic and urinary parameters in dogs. A total of 30 mixed-breed, male dogs were distributed into three groups. Fluid (0.9% NaCl was administered during a one-hour period at rates: G5 (5 mL/ kg; G10 (10 mL/ kg; G50 (50 mL/kg. Blood samples for erythrogram, and urine to perform urine specific gravity were taken over the following time points studied. Urinary volume produced was also evaluated during the same time points. Erythrogram values were statistically lower between T10 and T240 in G10 and G50, compared to T0, and the lowest values were found in G50. Urine specific gravity decreased statistically between all time points only in G50. Statistical differences were found in urinary output between groups, with higher volumes in G50 in most of the time points studied, it can be concluded that fluid therapy changes hematologic indices in rates of 10 and 50 mL/ kg for one hour. At least a four hour period must be respected after the end of infusion to collect blood for erythrogram samples. Fluid therapy affects the urine specific gravity only at high infusion rates (50 mL/kg for 1 hour, and in this case urine samples should be collected after more than 4 hours after the end of infusion, although lower rates (5 and 10 mL / kg for 1 hour do not interfere with urine specific gravity.

  6. Will long acting insulin analogs influence the use of insulin pump therapy in type 1 diabetes?

    NARCIS (Netherlands)

    DeVries, J. Hans

    2005-01-01

    Insulin pump therapy enjoys a steadily growing number of users and is associated with an approximately 0.5% lower A1c as compared to flexible insulin injection therapy in type 1 diabetes patients. An important question is whether superiority of insulin pump therapy persists in the era of rapid

  7. Inherited Variants in Wnt Pathway Genes Influence Outcomes of Prostate Cancer Patients Receiving Androgen Deprivation Therapy

    Directory of Open Access Journals (Sweden)

    Jiun-Hung Geng

    2016-11-01

    Full Text Available Aberrant Wnt signaling has been associated with many types of cancer. However, the association of inherited Wnt pathway variants with clinical outcomes in prostate cancer patients receiving androgen deprivation therapy (ADT has not been determined. Here, we comprehensively studied the contribution of common single nucleotide polymorphisms (SNPs in Wnt pathway genes to the clinical outcomes of 465 advanced prostate cancer patients treated with ADT. Two SNPs, adenomatous polyposis coli (APC rs2707765 and rs497844, were significantly (p ≤ 0.009 and q ≤ 0.043 associated with both prostate cancer progression and all-cause mortality, even after multivariate analyses and multiple testing correction. Patients with a greater number of favorable alleles had a longer time to disease progression and better overall survival during ADT (p for trend ≤ 0.003. Additional, cDNA array and in silico analyses of prostate cancer tissue suggested that rs2707765 affects APC expression, which in turn is correlated with tumor aggressiveness and patient prognosis. This study identifies the influence of inherited variants in the Wnt pathway on the efficacy of ADT and highlights a preclinical rationale for using APC as a prognostic marker in advanced prostate cancer.

  8. The influence of personality type on decision making in the physical therapy admission process.

    Science.gov (United States)

    Bezner, J R; Boucher, B K

    2001-01-01

    The purpose of this study was to identify the personality types of physical therapy (PT) interviewers and applicants, using the Personality Styles (PS) assessment tool, and to determine whether an interview team's personality type influences the rating score given. The PS was validated in a study of 298 students who completed the Myers-Briggs Type Indicator (MBTI) Form G and a PS assessment. By chi-square analysis the PS model appears to be a valid representation of the MBTI (chi 2 = 86.62, p personality type in relation to faculty/clinician team (same, different from both, like one) and 2) applicant personality type as the independent variables. Internal consistency of the interview rating form was alpha = 0.89. Mean interview score was 33.97/42 (SD 4.59). Interview scores were not significantly different between applicants who interviewed with clinician/faculty teams that were "like" compared with "not like" the applicants (F0.864; p = 0.423), but were significantly different between applicants with different PS personality types (F3.159; p = 0.026). Although personality type of the interview team did not impact the score given, thereby refuting the presence of interviewer bias, the rating scores did vary according to personality type of the applicant, suggesting a possible stereotyping bias in the criteria used to rate applicants.

  9. Factors influencing response to ingenol mebutate therapy for actinic keratosis of face and scalp

    Science.gov (United States)

    Skroza, Nevena; Proietti, Ilaria; Bernardini, Nicoletta; Balduzzi, Veronica; Mambrin, Alessandra; Marchesiello, Anna; Tolino, Ersilia; Zuber, Sara; La Torre, Giuseppe; Potenza, Concetta

    2017-01-01

    AIM To determine factors independently influencing response to ingenol mebutate therapy and assess efficacy on clinical setting of non-hypertrophic non-hyperkeratotic actinic keratosis (AK). METHODS Consecutive patients affected by non-hypertrophic non-hyperkeratotic AKs of the face or scalp were enrolled to receive ingenol mebutate 0.015% gel on a selected skin area of 25 cm2 for 3 consecutive days. Local skin reactions were calculated at each follow up visit using a validated composite score. Efficacy was evaluated by the comparison of clinical and dermoscopic pictures before the treatment and at day 57, and classified as complete, partial and poor response. RESULTS A number of 130 patients were enrolled, of which 101 (77.7%) were treated on the face, while 29 (22.3%) on the scalp. The great majority of our study population (n = 119, 91.5%) reached at least a 75% clearance of AKs and, in particular, 58 patients (44.6%) achieved a complete response while 61 (46.9%) a partial one. Logistic backward multivariate analysis showed that facial localization, level of local skin reaction (LSR) at day 2, the highest LSR values and level of crusts at day 8 were factors independently associated with the achievement of a complete response. CONCLUSION Ingenol mebutate 0.015% gel, when properly applied, is more effective on the face than on the scalp and efficacy is directly associated to LSR score. PMID:29067277

  10. Topical treatment of psoriasis: questionnaire results on topical therapy accessibility and influence of body surface area on usage.

    Science.gov (United States)

    Iversen, L; Lange, M M; Bissonette, R; Carvalho, A V E; van de Kerkhof, P C; Kirby, B; Kleyn, C E; Lynde, C W; van der Walt, J M; Wu, J J

    2017-07-01

    Topical treatment of mild to moderate psoriasis is first-line treatment and exhibits varying degrees of success across patient groups. Key factors influencing treatment success are physician topical treatment choice (high efficacy, low adverse events) and strict patient adherence. Currently, no formalized, international consensus guidelines exist to direct optimal topical treatment, although many countries have national guidelines. To describe and analyse cross-regional variations in the use and access of psoriasis topical therapies. The study was conducted as an observational cross-sectional study. A survey was distributed to dermatologists from the International Psoriasis Council (IPC) to assess topical therapy accessibility in 26 countries and to understand how body surface area (BSA) categories guide clinical decisions on topical use. Variation in the availability of tars, topical retinoids, dithranol and balneotherapy was reported. The vast majority of respondents (100% and 88.4%) used topical therapy as first-line monotherapy in situations with BSA 10%, the number of respondents who prescribe topical therapy decreased considerably. In addition, combination therapy of a topical drug and a systemic drug was frequently reported when BSA measured >10%. This physician survey provides new evidence on topical access and the influence of disease severity on topical usage in an effort to improve treatment strategies on a global level. © 2017 European Academy of Dermatology and Venereology.

  11. Influence of radiation dose on positive surgical margins in women undergoing breast conservation therapy

    International Nuclear Information System (INIS)

    DiBiase, Steven J.; Komarnicky, Lydia T.; Heron, Dwight E.; Schwartz, Gordon F.; Mansfield, Carl M.

    2002-01-01

    Purpose: Positive surgical margins adversely influence local tumor control in breast conservation therapy (BCT). However, reports have conflicted regarding whether an increased radiation dose can overcome this poor prognostic factor. In this study, we evaluated the influence of an increased radiation dose on tumor control in women with positive surgical margins undergoing BCT. Methods and Materials: Between 1978 and 1994, 733 women with pathologic Stage I-II breast cancer and known surgical margin status were treated at Thomas Jefferson University Hospital with BCT. Of these 733 patients, 641 women had a minimal tumor bed dose of 60 Gy and had documentation of their margin status; 509 had negative surgical margins, and 132 had positive surgical margins before definitive radiotherapy. Complete gross excision of the tumor and axillary lymph node sampling was obtained in all patients. The median radiation dose to the primary site was 65.0 Gy (range 60-76). Of the women with positive margins (n=132), the influence of higher doses of radiotherapy was evaluated. The median follow-up time was 52 months. Results: The local tumor control rate for patients with negative margins at 5 and 10 years was 94% and 88%, respectively, compared with 85% and 67%, respectively, for those women with positive margins (p=0.001). The disease-free survival rate for the negative margin group at 5 and 10 years was 91% and 82%, respectively, compared with 76% and 71%, respectively, for the positive margin group (p = 0.001). The overall survival rate of women with negative margins at 5 and 10 years was 95% and 90%, respectively. By comparison, for women with positive surgical margins, the overall survival rate at 5 and 10 years was 86% and 79%, respectively (p=0.008). A comparison of the positive and negative margin groups revealed that an increased radiation dose (whether entered as a dichotomous or a continuous variable) >65.0 Gy did not improve local tumor control (p=0.776). On Cox

  12. The efficacy of tramadol/acetaminophen combination tablets (Ultracet®) as add-on and maintenance therapy in knee osteoarthritis pain inadequately controlled by nonsteroidal anti-inflammatory drug (NSAID).

    Science.gov (United States)

    Park, Kyung-Su; Choi, Jin-Jung; Kim, Wan-Uk; Min, June-Ki; Park, Sung-Hwan; Cho, Chul-Soo

    2012-02-01

    The purpose of this study is to compare the efficacy of tramadol 37.5 mg/acetaminophen 325 mg combination tablets (tramadol/APAP) with that of nonsteroidal anti-inflammatory drugs (NSAIDs) as maintenance therapy following tramadol/APAP and NSAID combination therapy in knee osteoarthritis (OA) pain which was inadequately controlled by NSAIDs. Subjects with knee OA for over 1 year and moderate pain (numerical rating scale [NRS] ≥5) despite at least 4 weeks' NSAID therapy (meloxicam 7.5 mg or 15 mg qd or aceclofenac 100 mg bid) received tramadol/APAP add-on (combination with NSAID) for 4 weeks. Thereafter, subjects with significant pain improvement (NRS pain intensity (NRS), pain relief score, and subjects' and investigators' overall medication assessments. Of 143 subjects enrolled, 112 completed the 4-week tramadol/APAP and NSAID combination phase and 97 (67.8%) experienced significant pain improvement. Of the 97 subjects randomized, 36 in tramadol/APAP group and 47 in NSAID group completed the 8-week comparator study. On days 29 and 57, WOMAC scores and pain intensities did not increase in both groups compared to measurements immediately after the combination therapy. At these two time points, there were no significant differences in WOMAC scores, pain intensities, and other secondary measures between the two groups. Overall adverse event rates were similar in both groups. Tramadol/APAP add-on significantly improved knee OA pain which had been inadequately controlled by NSAIDs. In those subjects who showed favorable response to tramadol/APAP and NSAID combination therapy, both tramadol/APAP and NSAIDs were effective at maintaining the pain-reduced state and there was no significant difference in efficacy between tramadol/APAP and NSAIDs.

  13. The Influence of Hepatitis C Virus Therapy on the DNA Base Excision Repair System of Peripheral Blood Mononuclear Cells.

    Science.gov (United States)

    Czarny, Piotr; Merecz-Sadowska, Anna; Majchrzak, Kinga; Jabłkowski, Maciej; Szemraj, Janusz; Śliwiński, Tomasz; Karwowski, Bolesław

    2017-07-01

    Hepatitis C virus (HCV) can infect extrahepatic tissues, including lymphocytes, creating reservoir of the virus. Moreover, HCV proteins can interact with DNA damage response proteins of infected cells. In this article we investigated the influence of the virus infection and a new ombitasvir/paritaprevir/ritonavir ± dasabuvir ± ribavirin (OBV/PTV/r ± DSV ± RBV) anti-HCV therapy on the PBMCs (peripheral blood mononuclear cells, mainly lymphocytes) DNA base excision repair (BER) system. BER protein activity was analyzed in the nuclear and mitochondrial extracts (NE and ME) of PBMC isolated from patients before and after therapy, and from subjects without HCV, using modeled double-strand DNA, with 2'-deoxyuridine substitution as the DNA damage. The NE and ME obtained from patients before therapy demonstrated lower efficacy of 2'-deoxyuridine removal and DNA repair polymerization than those of the control group or patients after therapy. Moreover, the extracts from the patients after therapy had similar activity to those from the control group. However, the efficacy of apurinic/apyrimidinic site excision in NE did not differ between the studied groups. We postulate that infection of lymphocytes by the HCV can lead to a decrease in the activity of BER enzymes. However, the use of novel therapy results in the improvement of glycosylase activity as well as the regeneration of endonuclease and other crucial repair enzymes.

  14. Does hormonal therapy influence sexual function in men receiving 3D conformal radiation therapy for prostate cancer?

    International Nuclear Information System (INIS)

    Chen, Christopher T.; Valicenti, Richard K.; Lu Jiandong; Derose, Troy; Dicker, Adam P.; Strup, Stephen E.; Mulholland, S. Grant; Hirsch, Irvin H.; McGinnis, David E.; Gomella, Leonard G.

    2001-01-01

    Purpose: We evaluated the effect of three-dimensional conformal radiation therapy (3D-CRT) with or without hormonal therapy (HT) on sexual function (SF) in prostate cancer patients whose SF was known before all treatment. Methods and Materials: Between March 1996 and March 1999, 144 patients received 3D-CRT (median dose = 70.2 Gy, range 66.6-79.2 Gy) for prostate cancer and had pre- and post-therapy SF data. All SF data were obtained with the O'Leary Brief SF Inventory, a self-administered, multidimensional, validated instrument. We defined total sexual potency as erections firm enough for penetration during intercourse. Mean follow-up time was 21 months (SD ± 11 months). The Wilcoxon signed-rank test was used to test for significance of the change from baseline. Results: Before 3D-CRT, 87 (60%) of 144 men were totally potent as compared to only 47 (47%) of 101 at 1-year follow-up. Of the 60 men totally potent at baseline and followed for at least 1 year, 35 (58%) remained totally potent. These changes corresponded to a significant reduction in SF (p<0.05). Patients who had 3D-CRT alone were more likely to be totally potent at 1 year than those receiving 3D-CRT with HT (56% vs. 31%, p=0.012); however, they were also more likely to be potent at baseline (71% vs. 44%, p=0.001). Although these two groups had a significant reduction in SF from baseline, their change was not significantly different from each other. Conclusion: These data indicate that 3D-CRT causes a significant reduction in total sexual potency as compared to pretreatment baseline. The addition of HT does not appear to increase the risk of sexual dysfunction

  15. Maintenance Business Plans.

    Science.gov (United States)

    Adams, Matt

    2002-01-01

    Discusses maintenance business plans, statements which provide accountability for facilities maintenance organizations' considerable budgets. Discusses the plan's components: statement of plan objectives, macro and detailed description of the facility assets, maintenance function descriptions, description of key performance indicators, milestone…

  16. Influence of race on outcome in patients treated with breast conserving therapy

    Energy Technology Data Exchange (ETDEWEB)

    Campbell, T; Heimann, R; Powers, C; Vijayakumar, S; Ewing, C; Halpern, H; Michel, A; Rubin, S; Weichselbaum, R

    1995-07-01

    PURPOSE: Race is reported to correlate with outcome in breast cancer with African Americans (AA) having worse outcome compared to whites. However, little data is available from large standardized series of patients with early stage breast cancer. We report here the influence of race on local control (LC), disease free survival (DFS), cause specific survival (CSS) and overall survival (OS) for patients treated at our center with breast conserving therapy (BCT). MATERIALS AND METHODS: From a database of 925 patients treated between 1977 and 1993 with BCT for early stage invasive breast cancer, a total of 892 patients were available for study after excluding non-AA/non-white patients. Median age of patients was 56 years. Median follow-up was 35 months (range, 2 to 166). All patients underwent lumpectomy and radiation therapy(RT). Seven hundred eighty-six (88%) patients had axillary dissection. Median RT dose was 6000cGy with 90% of patients receiving 6000cGy or more. Two hundred fifty (28%) had chemotherapy, 327(37%) had tamoxifen and 64(7%) had both. T stage distribution was as follows: 632 T1 (71%), 244 T2 (27%), 12 T3 (1%) and 4 unknown (<1%). One hundred eighty six (21%) patients were pathologically node positive. There were 354 AA (40%) and 538 white (60%) patients. The chi-square test was used to compare distribution of prognostic factors between races. Outcome was evaluated by Kaplan-Meier actuarial method and logrank test. Sub-groups analyzed for outcome differences by race included T stage, tumor size, nodal status, grade, receptor status, age, menopausal status and family history. Multivariate analysis was performed by Cox proportional hazard model. RESULTS: No significant differences between AA and whites were seen in age, menopausal status, family history, T stage, N stage, number of nodes involved, histologic grade, total RT dose or chemotherapy. However, a larger percentage of whites received tamoxifen (43 vs 27%)(p<0.001), had low nuclear grade (19 vs 9

  17. The influence of intraoperative radiation therapy (IORT) on outcome of surgically resectable adenocarcinoma of the pancreas

    International Nuclear Information System (INIS)

    Ono, Mark K.; Ahmad, Neelofur; Huq, M. Saiful; Vernick, Jerome; Rosato, Francis E.

    1996-01-01

    Purpose/Objective: Surgical resection offers an opportunity for long term survival for patients with cancer of the pancreas. Unfavorable pathologic prognostic factors following resection of these lesions include positive surgical margins and positive lymph nodes. The purpose of this study was to analyze the influence of IORT on survival of completely resected adenocarcinomas of the pancreas in patients with these poor pathologic features. Materials and Methods: From 1988 to 1994, 391 newly diagnosed patients with carcinoma of the pancreas were seen at Thomas Jefferson University Hospital. Pre-operative work-up identified 166 patients with clinically localized disease. These patients were evaluated by the Department of Radiation Oncology for possible treatment with IORT. These patients underwent exploratory laparotomy and 26 had a complete surgical resection (i.e. Whipple procedure or total pancreatectomy) and received IORT. Mean patient age was 66 ± 2 years (range: 43-80) with 15 male and 11 female patients. All patients had histologically proven adenocarcinoma of the pancreas. IORT was delivered to the surgical tumor bed and regional lymph nodes with a median dose of 15.0 Gy (range: 10.0-20.0 Gy). Technique, field size, and energy of the electron radiation beam varied with the clinical situation and were determined by the radiation oncologist. All 26 patients received post-operative external beam radiation therapy (EBRT) with concurrent weekly 5-FU chemotherapy. Follow-up times ranged from one to 84 months (median: 15 months). Actuarial survival rates were calculated by the Life-Table Method. Patient outcome was evaluated with respect to surgical margin and pathological lymph node status. Results: The overall actuarial 2-year survival rate was 44%. The overall median survival time (MST) was 19 months. At pathological review, five of the 26 patients (19%) were found to have positive surgical margins, four of whom also had involved lymph nodes. Thus, only one

  18. Influence of race on outcome in patients treated with breast conserving therapy

    International Nuclear Information System (INIS)

    Campbell, T.; Heimann, R.; Powers, C.; Vijayakumar, S.; Ewing, C.; Halpern, H.; Michel, A.; Rubin, S.; Weichselbaum, R.

    1995-01-01

    PURPOSE: Race is reported to correlate with outcome in breast cancer with African Americans (AA) having worse outcome compared to whites. However, little data is available from large standardized series of patients with early stage breast cancer. We report here the influence of race on local control (LC), disease free survival (DFS), cause specific survival (CSS) and overall survival (OS) for patients treated at our center with breast conserving therapy (BCT). MATERIALS AND METHODS: From a database of 925 patients treated between 1977 and 1993 with BCT for early stage invasive breast cancer, a total of 892 patients were available for study after excluding non-AA/non-white patients. Median age of patients was 56 years. Median follow-up was 35 months (range, 2 to 166). All patients underwent lumpectomy and radiation therapy(RT). Seven hundred eighty-six (88%) patients had axillary dissection. Median RT dose was 6000cGy with 90% of patients receiving 6000cGy or more. Two hundred fifty (28%) had chemotherapy, 327(37%) had tamoxifen and 64(7%) had both. T stage distribution was as follows: 632 T1 (71%), 244 T2 (27%), 12 T3 (1%) and 4 unknown ( 4cm (5 vs 1%)(p=0.001) or were unknown size (10 vs 6%)(p=.001). Comparing AA and whites yielded 5 yr actuarial LC (94 vs 94%)(p=0.380), DFS (83 vs 85%)(p=0.120), CSS (84 vs 85%)(p=0.201) and OS (77 vs 80%)(p=0.112). Multivariate analysis demonstrated that the number of positive nodes was the strongest predictor of OS (p<.001) and although race did not reach statistical significance as an independent prognostic factor, a trend was demonstrated (p=.106). Sub-group analysis of 186 patients with ER/PR negative tumors showed significantly worse DFS (75 vs 93%)(p=0.005), CSS (79 vs 91%)(p=0.021) and OS (76 vs 89%)(p=0.011) for AA patients. Race was demonstrated to be an independent prognostic factor by multivariate analysis in this sub-group (p=.024). No significant differences by race were apparent in patients grouped by tumor size

  19. Influence of Immune Responses in Gene/Stem Cell Therapies for Muscular Dystrophies

    Directory of Open Access Journals (Sweden)

    Andrea Farini

    2014-01-01

    Full Text Available Muscular dystrophies (MDs are a heterogeneous group of diseases, caused by mutations in different components of sarcolemma, extracellular matrix, or enzymes. Inflammation and innate or adaptive immune response activation are prominent features of MDs. Various therapies under development are directed toward rescuing the dystrophic muscle damage using gene transfer or cell therapy. Here we discussed current knowledge about involvement of immune system responses to experimental therapies in MDs.

  20. Whether antithyroid drugs influence on the outcome of radioiodine therapy of thyroid functional autonomy?

    International Nuclear Information System (INIS)

    Valuyevich, Viktar V.; Danilova, Larisa I.; Kaiser, Klaus P.; Ostwald-Lenz, Elisabeth; Wieler, Helmut

    2005-01-01

    Full text: The purpose of research was an estimation of the influence of antithyroid medication on efficiency of radioiodine therapy (RIT) in patients with thyroid functional autonomy (FA). 100 patients with various clinical variants of FA were included in research and received treatment with radioiodine. From them uni-focal autonomy (UFA) was diagnosed in 65 person, multifocal (MFA) in 14 and disseminated (DA) in 21. Among the patients included in research 8 had relapse of hyperthyroidism after initial operative treatment and 1 after RIT. The data in work are submitted as a median (1-st and 3-rd quartiles). The age of surveyed was 65.5 (54; 72.5), from them 63 persons were a female, 37 were a male. From surveyed 2 groups of patients were formed. The first group consisted from 50 person, initially accepting during 4 months (2.5; 6) antithyroid drugs (ATD) which cancellation had been made as a rule 2 day prior to RIT, and the second one included 50 person, not accepting ATD neither up to nor after RIT. 9 elderly and multi morbid patients from the first group continued to accept ATD within several months after RIT. Carbimazole (n=45) or methimazole (n=5) in a dose of 10 mg (5; 10) were used as ATD. Therapeutic activity of 131 I was calculated by means of Marinelli's formula. The target dose for UFA has made 400 Gy, for MFA and DA - 150 Gy. For calculation of thyroid uptake 24-hour radioiodine test was carried 2-3 day prior to RIT. Used activity of I-131 have made from 4.08 up to 58.89 mCi. Duration of inpatient stay has made 3 days (2; 5). In 4 months (4; 5) after RIT the successful result (euthyroidism or hypothyroidism) has been achieved in 48 (96 %) patients accepting ATD, and in 47 (94 %) patients who were not accepting last. Conclusion: The conclusion that antithyroid medication does not influence on the efficiency of RIT of FA was made. It was revealed that frequency of hypothyroidism after RIT in patients of the first group was higher (36 %) than in patients

  1. Electroconvulsive therapy clinical database: Influence of age and gender on the electrical charge.

    Science.gov (United States)

    Salvador Sánchez, Javier; David, Mónica Delia; Torrent Setó, Aurora; Martínez Alonso, Montserrat; Portella Moll, Maria J; Pifarré Paredero, Josep; Vieta Pascual, Eduard; Mur Laín, María

    The influence of age and gender in the electrical charge delivered in a given population was analysed using an electroconvulsive therapy (ECT) clinical database. An observational, prospective, longitudinal study with descriptive analysis was performed using data from a database that included total bilateral frontotemporal ECT carried out with a Mecta spECTrum 5000Q ® in our hospital over 6 years. From 2006 to 2012, a total of 4,337 ECT were performed on 187 patients. Linear regression using mixed effects analysis was weighted by the inverse of the number of ECT performed on each patient per year of treatment. The results indicate that age is related with changes in the required charge (P=.031), as such that the older the age a higher charge is needed. Gender is also associated with changes in charge (P=.014), with women requiring less charge than men, a mean of 87.3mC less. When the effects of age and gender are included in the same model, both are significant (P=.0080 and P=.0041). Thus, for the same age, women require 99.0mC less charge than men, and in both genders the charge increases by 2.3mC per year. From our study, it is concluded that the effect of age on the dosage of the electrical charge is even more significant when related to gender. It would be of interest to promote the systematic collection of data for a better understanding and application of the technique. Copyright © 2015 SEP y SEPB. Publicado por Elsevier España, S.L.U. All rights reserved.

  2. What is access to radiation therapy? A conceptual framework and review of influencing factors.

    Science.gov (United States)

    Sundaresan, Puma; Stockler, Martin R; Milross, Christopher G

    2016-02-01

    Optimal radiation therapy (RT) utilisation rates (RURs) have been defined for various cancer indications through extensive work in Australia and overseas. These benchmarks remain unrealised. The gap between optimal RUR and actual RUR has been attributed to inadequacies in 'RT access'. We aimed to develop a conceptual framework for the consideration of 'RT access' by examining the literature for existing constructs and translating it to the context of RT services. We further aimed to use this framework to identify and examine factors influencing 'RT access'. Existing models of health care access were reviewed and used to develop a multi-dimensional conceptual framework for 'RT access'. A review of the literature was then conducted to identify factors reported to affect RT access and utilisation. The electronic databases searched, the host platform and date range of the databases searched were Ovid MEDLINE, 1946 to October 2014 and PsycINFO via OvidSP,1806 to October 2014. The framework developed demonstrates that 'RT access' encompasses opportunity for RT as well as the translation of this opportunity to RT utilisation. Opportunity for RT includes availability, affordability, adequacy (quality) and acceptability of RT services. Several factors at the consumer, referrer and RT service levels affect the translation of this opportunity for RT to actual RT utilisation. 'Access' is a term that is widely used in the context of health service related research, planning and political discussions. It is a multi-faceted concept with many descriptions. We propose a conceptual framework for the consideration of 'RT access' so that factors affecting RT access and utilisation may be identified and examined. Understanding these factors, and quantifying them where possible, will allow objective evaluation of their impact on RT utilisation and guide implementation of strategies to modify their effects.

  3. Factors Influencing Enrollment in the Medication Therapy Management Clinic at an Academic Ambulatory Care Clinic.

    Science.gov (United States)

    Shah, Mansi; Tilton, Jessica; Kim, Shiyun

    2016-04-01

    In 2001, the University of Illinois Hospital and Health Sciences System (UI Health) established a pharmacist-run, referral-based medication therapy management clinic (MTMC). Referrals are obtained from any UI Health provider or by self-referral. Although there is a high volume of referrals, a large percentage of patients do not enroll. This study was designed to determine the various factors that influence patient enrollment in the MTMC. This study was a retrospective chart review of demographic and patient variable data during years 2010 and 2011. Disabilities, distance from MTMC, mode of transportation, past medical history, and appointment dates were extracted from the medical records. Results were analyzed using descriptive statistics and logistic regression analysis. A total of 103 referrals were made; however, only 17% of patients remain enrolled in MTMC. The baseline demographics included a mean age of 63 years, 68% female, 70% African American, and 81% English speaking. Patients lived an average of 8 miles from MTMC; most utilized public or government-supplemented transport services; 24% of patients reported some type of disability, most commonly utilizing a walker or a wheelchair. On average, patients were prescribed 13 medications with hypertension (70%), diabetes (56%), and hyperlipidemia (48%) being the most common chronic disease states. The reason for referral included medication management, education, medication reconciliation, and disease state management. Five patients were unable to be contacted to schedule an initial appointment. Additionally, 18 patients failed their scheduled initial appointment and did not reschedule. Logistic regression analysis demonstrated distance traveled for clinic visit, age, and history of hypertension affected the probability of patients showing for their appointments (chi-square = 19.7, P < .001). This study demonstrated that distance from MTMC is the most common barrier in patient enrollment; therefore, strategies

  4. First-Line XELOX Plus Bevacizumab Followed by XELOX Plus Bevacizumab or Single-Agent Bevacizumab as Maintenance Therapy in Patients with Metastatic Colorectal Cancer: The Phase III MACRO TTD Study

    Science.gov (United States)

    Gómez-España, Auxiliadora; Massutí, Bartomeu; Sastre, Javier; Abad, Albert; Valladares, Manuel; Rivera, Fernando; Safont, Maria J.; Martínez de Prado, Purificación; Gallén, Manuel; González, Encarnación; Marcuello, Eugenio; Benavides, Manuel; Fernández-Martos, Carlos; Losa, Ferrán; Escudero, Pilar; Arrivi, Antonio; Cervantes, Andrés; Dueñas, Rosario; López-Ladrón, Amelia; Lacasta, Adelaida; Llanos, Marta; Tabernero, Jose M.; Antón, Antonio; Aranda, Enrique

    2012-01-01

    Purpose. The aim of this phase III trial was to compare the efficacy and safety of bevacizumab alone with those of bevacizumab and capecitabine plus oxaliplatin (XELOX) as maintenance treatment following induction chemotherapy with XELOX plus bevacizumab in the first-line treatment of patients with metastatic colorectal cancer (mCRC). Patients and Methods. Patients were randomly assigned to receive six cycles of bevacizumab, capecitabine, and oxaliplatin every 3 weeks followed by XELOX plus bevacizumab or bevacizumab alone until progression. The primary endpoint was the progression-free survival (PFS) interval; secondary endpoints were the overall survival (OS) time, objective response rate (RR), time to response, duration of response, and safety. Results. The intent-to-treat population comprised 480 patients (XELOX plus bevacizumab, n = 239; bevacizumab, n = 241); there were no significant differences in baseline characteristics. The median follow-up was 29.0 months (range, 0–53.2 months). There were no statistically significant differences in the median PFS or OS times or in the RR between the two arms. The most common grade 3 or 4 toxicities in the XELOX plus bevacizumab versus bevacizumab arms were diarrhea, hand–foot syndrome, and neuropathy. Conclusion. Although the noninferiority of bevacizumab versus XELOX plus bevacizumab cannot be confirmed, we can reliably exclude a median PFS detriment >3 weeks. This study suggests that maintenance therapy with single-agent bevacizumab may be an appropriate option following induction XELOX plus bevacizumab in mCRC patients. PMID:22234633

  5. Group therapy for somatization disorders in primary care: maintenance of treatment goals of short cognitive-behavioural treatment one-and-a-half-year follow-up.

    Science.gov (United States)

    Lidbeck, J

    2003-06-01

    The objective of this study was to evaluate the maintenance of treatment goals of a short cognitive-behavioural group treatment programme for the management of somatization disorders in primary care. In a previous controlled 6-month follow-up study, patients with somatization disorders (n=32) improved with respect to illness and somatic preoccupation, hypochondriasis, and medication usage. In the present report the same group of patients were also investigated one-and-a-half year after initial treatment. The long-term follow-up manifested maintained improvement with respect to hypochondriasis. There was additional reduction of anxiety and psychosocial preoccupation, whereas somatization and depression-anxiety scores improved progressively. A short cognitive-behavioural group treatment of psychosomatic patients can be useful in primary care and may manifest maintained or progressive beneficial outcome.

  6. Dynamics of cardiovascular parameters in combined aortic malformations under the influence of a physical therapy program during the rehabilitation process

    Directory of Open Access Journals (Sweden)

    Serhii Kalmykov

    2017-12-01

    Full Text Available Purpose: to study hemodynamic parameters and the reaction of the cardiovascular system to the dosed physical load of patients combined aortic defect with heart failure of the I degree under the influence of the complex physical therapy program developed by us during the rehabilitation process. Material & Methods: the study involved 26 middle-aged men with a diagnosis: combined aortic valve disease, HF I st. Result: dynamics of functional parameters of the cardiovascular system of patients under the influence of the physical therapy program is analyzed. Conclusion: the combination of morning hygienic gymnastics, therapeutic gymnastics, independent activities and dosed walking with a therapeutic massage contributes to the normalization of vascular tone, motor-vascular reflexes and blood pressure, increasing the tolerance of the cardiovascular system to physical activity.

  7. The influence of the anesthesia-to-stimulation time interval on seizure quality parameters in electroconvulsive therapy

    DEFF Research Database (Denmark)

    Jorgensen, A; Christensen, S J; Jensen, A E K

    2018-01-01

    BACKGROUND: Electroconvulsive therapy (ECT) continues to be the most efficacious treatment for severe depression and other life-threatening acute psychiatric conditions. Treatment efficacy is dependent upon the induced seizure quality, which may be influenced by a range of treatment related factors....... Recently, the time interval from anesthesia to the electrical stimulation (ASTI) has been suggested to be an important determinant of seizure quality. METHODS: We measured ASTI in 73 ECT sessions given to 22 individual patients, and analyzed its influence on five seizure quality parameters (EEG seizure...

  8. Analysis of influence of dosimetric factors on the outcome of I-131 therapy in patients with hyperthyroidism

    Energy Technology Data Exchange (ETDEWEB)

    Knapska-Kucharska, M.; Oszukowska, L.; Makarewicz, J. [Department of Nuclear Medecine and Oncological Endocrinology, Province Hospital, Zgierz (Poland); Lewinski, A. [Chair and Department of Endocrinology and Metabolic Diseases, Medical University, Lodz (Poland)

    2012-07-01

    The influence of dosimetric factors on the outcome of {sup 131}I therapy has been examined in hyperthyroid patients submitted to {sup 131}I treatment. The following factors - which could have influence on the effects of therapy with radioiodine - were analysed: the goitre volume, the thyroid radioiodine uptake after 24 h, and the effective half-life time of {sup 131}I (EHL). Five hundred (500) randomly selected patients with hyperthyroidism, treated with {sup 131}I, were studied. They were divided into three groups (based on clinical examination, hormonal and immunological tests, thyroid scintigraphy and ultrasound imaging). The study shows that the effectiveness of {sup 131}I therapy depends on the thyroid volume and absorbed dose in all the groups of patients and on the thyroid radioiodine uptake and EHL in patients with a single autonomously functioning thyroid nodule. We have failed to determine the borderline D, distinguishing between effective and ineffective therapy. The treatment outcome can be predicted with approximately 70% accuracy, based on minimal absorbed dose

  9. What Influences Patient-Therapist Interactions in Musculoskeletal Physical Therapy? Qualitative Systematic Review and Meta-Synthesis.

    Science.gov (United States)

    O'Keeffe, Mary; Cullinane, Paul; Hurley, John; Leahy, Irene; Bunzli, Samantha; O'Sullivan, Peter B; O'Sullivan, Kieran

    2016-05-01

    Musculoskeletal physical therapy involves both specific and nonspecific effects. Nonspecific variables associated with the patient, therapist, and setting may influence clinical outcomes. Recent quantitative research has shown that nonspecific factors, including patient-therapist interactions, can influence treatment outcomes. It remains unclear, however, what factors influence patient-therapist interaction. This qualitative systematic review and meta-synthesis investigated patients' and physical therapists' perceptions of factors that influence patient-therapist interactions. Eleven databases were searched independently. Qualitative studies examining physical therapists' and patients' perceptions of factors that influence patient-therapist interactions in musculoskeletal settings were included. Two reviewers independently selected articles, assessed methodological quality using the Critical Appraisal Skills Programme (CASP), and performed the 3 stages of analysis: extraction of findings, grouping of findings (codes), and abstraction of findings. Thirteen studies were included. Four themes were perceived to influence patient-therapist interactions: (1) physical therapist interpersonal and communication skills (ie, presence of skills such as listening, encouragement, confidence, being empathetic and friendly, and nonverbal communication), (2) physical therapist practical skills (ie, physical therapist expertise and level of training, although the ability to provide good education was considered as important only by patients), (3) individualized patient-centered care (ie, individualizing the treatment to the patient and taking patient's opinions into account), and (4) organizational and environmental factors (ie, time and flexibility with care and appointments). Only studies published in English were included. A mix of interpersonal, clinical, and organizational factors are perceived to influence patient-therapist interactions, although research is needed to identify

  10. The Influence of Integrative Gestalt Therapy on Acquisition of Daily Life Skills and Habits.

    Science.gov (United States)

    Zic, Anamarija; And Others

    This study evaluated the effects of Integrative Gestalt Therapy on the intellectual aspects of social competence in 13 children, ages 7 to 11, living in Zagreb, Croatia. These children had intellectual disabilities (IQ 54 to 84) as well as psychological and/or behavior problems. Integrative Gestalt Therapy emphasizes the wholeness of a person's…

  11. CLINICAL AND ECONOMIC ANALYSIS OF THE LONG-TERM MAINTENANCE THERAPY BY COMBINED DRUGS OF BRONCHIAL ASTHMA IN SCHOOL CHILDREN, RESIDENTS OF THE RURAL REGIONS

    Directory of Open Access Journals (Sweden)

    I.N. Ermakova

    2011-01-01

    Full Text Available The purpose of the study: selection of the supporting anti-asthma therapy (SAAT of the moderate asthma in school children, residents of the village with the lowest ratio of price and efficiency. The maximum frequency of achieving control of asthma was 64%. The spectrum of asthma medicines (drugs used in outpatient phase is represented. For 7 years, the proportion of the inhaled corticosteroid (ICS therapy in children with asthma has increased moderately by 5.5 times and was 66%, of which 2/3 was the combination of inhaled glucocorticosteroids. When using the combined drug salmeterol/fluticasone propionate (50/100 mkg during 3 months, after that fluticasone proionat during next 3 months as a level-controlled asthma the SAAT controlling BA increased 2 times. The cost of drugs accounted for 86% of direct medical costs (DMC, the cost of hospitalization decreased from 80 to 56% (DMC savings — 24%. The results of the analysis of «cost–effectiveness» SAAT allow to review the financial resources for health in favor of providing children with mild asthma inhaled high-performance combination that will improve the quality of medical care for children, residents of the rural regions.Key words: asthma, children, inhaled glucocorticosteriods, combined therapies, pharmacoeconomic analysis.

  12. INFLUENCE OF COMBINED ANTIHYPERTENSIVE AND ANTIDEPRESSANT THERAPY ON LEFT VENTRICULAR REMODELING IN PATIENTS WITH ARTERIAL HYPERTENSION, ANXIETY AND DEPRESSION

    Directory of Open Access Journals (Sweden)

    Y. A. Vasyuk

    2008-01-01

    Full Text Available Aim. To assess influence of combined antihypertensive (captopril or metoprolol and antidepressant (thianeptin or sertralin therapy on clinical status, blood pressure (BP and myocardial function in patients with arterial hypertension (HT and affective disorders (AD.Material and methods. 106 patients with HT were involved in the study. 64 patients (60,4% had concomitant AD. All patients were divided into 3 groups. 46 patients with HT and AD were included in the 1-st group. They received metoprolol or captopril in combination with tianeptine or sertaline. The 2-nd group included 18 patients with HT and AD who received only antihypertensive therapy. The 3-rd group consisted of 42 patients with HT without AD. They also received only antihypertensive therapy.Results. After 6 month therapy patients of the 1-st and the 3-rd groups had more significant clinical improvement and BP reduction (according to 24- hour BP monitoring as well as more farourable structural and functional changes of left ventricular in comparison with patients of the 2-nd group.Conclusion. In patients with HT and concomitant AD combined antihypertensive and antidepressant therapy result in favourable clinical changes, effectively reduce BP, improve left ventricular structure and function.

  13. Major drivers influencing adherence and quality of life during antiviral triple therapy in patients with chronic hepatitis C

    Directory of Open Access Journals (Sweden)

    Suceveanu Andra I.

    2016-05-01

    Full Text Available Background & Aims. Triple therapy with Peg-IFNs, Ribavirin and protease inhibitors raise the treatment success for hepatitis C up to 83%, but also bring together with the significantly higher rates of sustained virologic response (SVR more side effects, interfering with patient’s quality of life (QoL and work productivity. We aimed to analyze the factors influencing the adherence and the QoL during triple therapy using Peg-IFNs, Ribavirin and protease inhibitors in 50 patients diagnosed with chronic hepatitis C with first line therapy failure. Multivariate Cox proportional hazards regression was used to analyze determinants of retreatment initiation and treatment compliance, according to patient features. Results: We identified as major drivers of retreatment initiation the younger age, the female gender, the urban provenience, the high income, and the psychiatric and alcohol or drugs abuse history. The adherence and the QoL during retreatment therapy were similar, despite the regimen used, and obvious lower in patients with history of previous abandon, drugs and alcohol abuse or hematologic/ psychiatric decompensation. A lower capacity to work and a temporary withdrawal from job necessary to continue the therapy were seen similar in patients taking Boceprevir/Telaprevir. Abandon of therapy without a known reason was more frequent in males, with alcohol and drugs intake history, from rural region, with low income, and with psychiatric disturbances in personal history. Conclusion. Physicians should focus to develop medical strategies or drugs to increase the adherence and to provide a better QoL for patients with chronic hepatitis C making antiviral therapy.

  14. The potential influence of cell protectors for dose escalation in cancer therapy: an analysis of amifostine

    International Nuclear Information System (INIS)

    McCumber, Linda M.

    2004-01-01

    The attempt to increase the therapeutic ratio in an effort to improve survival or quality of life is the goal of modern cancer therapy. It is commonly accepted that local and systemic tumor control would increase if the dose intensity of antineoplastic drugs, radiation therapy, or the combination were increased. Radiation dose escalation using intensity-modulated radiation therapy (IMRT), accelerated or hypofractionated radiation schemes, and multidrug chemotherapy regimens are being used to try to increase tumor kill while inflicting minimal injury to normal tissue. Modern chemoradiation techniques have led to improved local regional control and increased cure rates, but the potentially severe and debilitating adverse effects of the therapies prevent them from reaching the ultimate goal of curing the disease while leaving the patient with a good quality of life. Cell protectants such as amifostine function by reducing the effects of therapy on normal cells while maintaining tumor sensitivity to the therapy. In various studies, amifostine has been analyzed and appears to be a potentially powerful adjuvant to current cancer therapy. Administering amifostine may allow dose escalation with less or equal risk to surrounding normal tissues. This could improve therapeutic efficacy, survival, and quality of life for cancer patients

  15. The influence of radium therapie on the yeast contamination of the vagina

    International Nuclear Information System (INIS)

    Mendling, W.; Schnell, J.D.; Spiecker, R.; Sankt Franziskus-Hospital, Bielefeld

    1979-01-01

    Before the beginning of radium therapy a vaginal yeast contamination of 9,7% was found of 113 patients with various genital carcinomas. However, the incidence of vaginal yeast contamination increased suddenly to 30,9% under the contac irradiation therapy with radium. The radiation effect of radium is not sufficient for a 'selfsterilisation' of the radium-carrier in the case of yeast contamination. Therefore, a chemic desinfection of the radium-carriers is principly necessary. The significance is discussed and the recommendation is made that routine mycological supervision be carried out on all patients with gynaecological carcinomas and appropriate antimycotic therapy initiated where necessary. (orig.) [de

  16. A Situational Maintenance Model

    DEFF Research Database (Denmark)

    Luxhoj, James T.; Thorsteinsson, Uffe; Riis, Jens Ove

    1997-01-01

    An overview of trend in maintenance management and presentation of a situational model and an analytical tools for identification of managerial efforts in maintenance.......An overview of trend in maintenance management and presentation of a situational model and an analytical tools for identification of managerial efforts in maintenance....

  17. Study protocol for a randomized controlled trial comparing mindfulness-based cognitive therapy with maintenance anti-depressant treatment in the prevention of depressive relapse/recurrence: the PREVENT trial

    Directory of Open Access Journals (Sweden)

    Hayes Rachel

    2010-10-01

    Full Text Available Abstract Background Depression is a common and distressing mental health problem that is responsible for significant individual disability and cost to society. Medication and psychological therapies are effective for treating depression and maintenance anti-depressants (m-ADM can prevent relapse. However, individuals with depression often express a wish for psychological help that can help them recover from depression in the long-term. We need to develop psychological therapies that prevent depressive relapse/recurrence. A recently developed treatment, Mindfulness-based Cognitive Therapy (MBCT, see http://www.mbct.co.uk shows potential as a brief group programme for people with recurring depression. In two studies it has been shown to halve the rates of depression recurring compared to usual care. This trial asks the policy research question, is MBCT superior to m-ADM in terms of: a primary outcome of preventing depressive relapse/recurrence over 24 months; and, secondary outcomes of (a depression free days, (b residual depressive symptoms, (c antidepressant (ADM usage, (d psychiatric and medical co-morbidity, (e quality of life, and (f cost effectiveness? An explanatory research question asks is an increase in mindfulness skills the key mechanism of change? Methods/Design The design is a single blind, parallel RCT examining MBCT vs. m-ADM with an embedded process study. To answer the main policy research question the proposed trial compares MBCT plus ADM-tapering with m-ADM for patients with recurrent depression. Four hundred and twenty patients with recurrent major depressive disorder in full or partial remission will be recruited through primary care. Depressive relapse/recurrence over two years is the primary outcome variable. The explanatory question will be addressed in two mutually informative ways: quantitative measurement of potential mediating variables pre/post-treatment and a qualitative study of service users' views and experiences

  18. [Influence of Saccharomyces boulardii Sachets combined with bismuth quadruple therapy for initial Helicobacter pylori eradication].

    Science.gov (United States)

    Zhu, X Y; Du, J; Wu, J; Zhao, L W; Meng, X; Liu, G F

    2017-08-08

    Objective: To evaluate the efficacy and safety of Saccharomyces boulardii Sachets combined with bismuth quadruple therapy for initial Helicobacter pylori ( H . pylori ) eradication. Methods: From March 2014 to March 2015, 240 participants from the third hospital of Hebei medical university with H . pylori infection were recruited and randomized into three groups: Quadruple therapy group received bismuth potassium citrate 220 mg bid + Rabeprazole 10 mg bid + amoxicillin 1 000 mg bid+ furazolidone 100 mg bid for 10 days. Short-term group and long-term group received the same quadruple therapy for 10 days as above, as well as Saccharomyces boulardii Sachets 500 mg bid for 14 days and 28 days, respectively. H . pylori eradication was confirmed by (13)C/(14)C-UBT at least 4 weeks after completion of therapy. And side effects were investigated during the therapy. Results: The H . pylori eradication rates in quadruple therapy, short-term and long-term group were 80%, 87.5% and 87.5% by ITT analysis ( P =0.321) and 92.8%, 94.6% and 95.9% by PP analysis ( P =0.717), respectively. The overall side effect rate and occurrence of diarrhea and abdominal distension were significantly lower in short-term or long-term group as compared with quadruple therapy group( P =0.007, 0.003, 0.004), but there was no significant difference between the two probiotics groups. Conclusions: Both short and long-term Saccharomyces boulardii Sachets reduced the overall side effect rate and occurrence of diarrhea or abdominal distension when combined with bismuth quadruple therapy for initial H . pylori eradication and no difference was observed in efficacy or safety between the two groups.

  19. Preventive maintenance and reliability-centered maintenance

    International Nuclear Information System (INIS)

    Anderson, J.G.

    1989-01-01

    In the recent past, the primary function of the preventive maintenance program at a nuclear power plant was to maintain the operability and reliability of the plant. Reducing overall maintenance costs by performing effective preventive maintenance, instead of more costly and disruptive corrective maintenance, instead of more costly and disruptive corrective maintenance, was a secondary consideration. In today's operating environment, the preventive maintenance program must meet the test of cost-effectiveness as well as many new standards for performance that are being required by rate regulators. The preventive maintenance program must be able to withstand the challenge of independent audit to a new standard of technical adequacy and compliance with recommendations from component vendors. In this new environment, the standard that is being applied at the San Onofre nuclear generating station (SONGS) is that the preventive maintenance program must meet the test of cost-effectiveness, improve equipment performance, support increased plant availability, and (a) literally implement the recommendations of the vendor, (b) provide other compensation for the vendor recommendation, or (c) provide technical justification for the deviation. The subject of this paper is the way that reliability-centered maintenance (RCM) is helping SONGS meet these challenges

  20. A randomized study of KRAS-guided maintenance therapy with bevacizumab, erlotinib or metronomic capecitabine after first-line induction treatment of metastatic colorectal cancer

    DEFF Research Database (Denmark)

    Hagman, H; Frödin, J-E; Berglund, Å

    2016-01-01

    without progression were eligible for randomization to mt; KRAS wild-type (wt) patients were randomized to bev ± erlo (arms wt-BE, N = 36 versus wt-B, N = 35), KRAS mutated (mut) patients were randomized to bev or metronomic cap (arms mut-B, N = 34 versus mut-C, N = 33). Primary end point was progression...... to influence the outcome of treatment with erlotinib. Metronomic cap warrants further investigation in mt strategies, given our explorative results. CLINICALTRIALSGOV: NCT01229813....

  1. Ventilator-associated pneumonia: the influence of bacterial resistance, prescription errors, and de-escalation of antimicrobial therapy on mortality rates

    Directory of Open Access Journals (Sweden)

    Ana Carolina Souza-Oliveira

    2016-09-01

    Conclusion: Prescription errors influenced mortality of patients with Ventilator-associated pneumonia, underscoring the challenge of proper Ventilator-associated pneumonia treatment, which requires continuous reevaluation to ensure that clinical response to therapy meets expectations.

  2. The influence of ageism, experience, and relationships with older adults on physical therapy students' perception of geriatrics.

    Science.gov (United States)

    Blackwood, Jennifer; Sweet, Christina

    2017-01-01

    Increased exposure to geriatrics throughout a student's professional education has been reported to improve the desire to work in this area; however, factors that influence the perception of geriatric physical therapy may prohibit students from actively seeking those experiences. The purpose of this study was to examine the perceptions of geriatric physical therapy by first-year graduate physical therapy students. A qualitative case study research approach was performed. Three focus groups were completed using students enrolled in their second semester of a graduate-level physical therapy program. Dialogue was reviewed and coded by three raters. Twenty-five subcategories of open-coding terms were triangulated and grouped into 4 themes via axial coding. Four themes emerged: (1) ageism exists in health care, (2) personal and professional experiences serve as a framework for students' perception of geriatrics, (3) interpersonal relationships formed within geriatric practice are highly valued, and (4) additional contextual barriers exist in geriatrics. To meet the needs of a highly skilled geriatric workforce, students should participate in enhanced geriatric experiences in didactic coursework as well as within interprofessional geriatric clinics throughout their education.

  3. Influence of antibiotic therapy prior to admission on the efficacy of classical methods for the diagnosis of meningococcal disease.

    Science.gov (United States)

    Nemescu, Roxana Elena; Iancu, Luminiţa Smaranda; Dorneanu, Olivia Simona; Ursu, Ramona Gabriela; Dorobăţ, Carmen Mihaela

    2014-01-01

    To assess the influence of preadmission antibiotic therapy on the results of the classical methods for bacteriological confirmation of meningococcal disease (MD). Retrospective study of the MD cases diagnosed in the "St. Parascheva" Universitary Clinical Infectious Diseases Iaşi between 1994 and 2011. The etiological diagnosis was made by identifying the meningococcus in the CSF (cerebrospinal fluid) in 71.9% of the 323 patients and by blood culture in 8%. Preadmission antibiotic therapy received 39% of the patients, thus the sensitivity of test was significantly reduced: direct examination from 64.6% to 43.2% (p antibiotic therapy significantly increased the ratio of cases in which meningococcus was not detected in CSF by any of the classical methods (44% compared to 17.9% in the cases without prior treatment). The proportion of cases in which meningococcal isolation was done by two methods decreased from 38.5% to 19.2%, and of those by all three methods from 16.9% to 5.6% (p antibiotic therapy also decreased the rate of positive blood cultures from 14.7% to 3.5% (Fisher's exact test, p = 0.009). Antibiotic treatment prior to admission significantly decreases the percentage of patients with MD in which meningococcal isolation can be done; this requires the use of a more sensitive diagnosis method (ex. qPCR).

  4. Dominican Children with HIV Not Receiving Antiretrovirals: Massage Therapy Influences their Behavior and Development

    Directory of Open Access Journals (Sweden)

    Maria Hernandez-Reif

    2008-01-01

    Full Text Available Forty-eight children (M age = 4.8 years infected with HIV/AIDS and living in the Dominican Republic were randomly assigned to a massage therapy or a play session control group. The children in the massage therapy group received two weekly 20-min massages for 12 weeks; the children in the control group participated in a play session (coloring, playing with blocks for the same duration and length as the massage therapy group. Overall, the children in the massage therapy group improved in self-help abilities and communication, suggesting that massage therapy may enhance daily functioning for children with HIV/AIDS. Moreover, the HIV infected children who were six or older also showed a decrease in internalizing behaviors; specifically depressive/anxious behaviors and negative thoughts were reduced. Additionally, baseline assessments revealed IQ equivalence below normal functioning for 70% of the HIV infected children and very high incidences of mood problems (depression, withdrawn for 40% of the children and anxiety problems for 20% of the children, suggesting the need for better monitoring and alternative interventions in countries with limited resources to improve cognition and the mental health status of children infected with HIV/AIDS.

  5. Pilot, randomized study assessing safety, tolerability and efficacy of simplified LPV/r maintenance therapy in HIV patients on the 1 PI-based regimen.

    Science.gov (United States)

    Cahn, Pedro; Montaner, Julio; Junod, Patrice; Patterson, Patricia; Krolewiecki, Alejandro; Andrade-Villanueva, Jaime; Cassetti, Isabel; Sierra-Madero, Juan; Casiró, Arnaldo David; Bortolozzi, Raul; Lupo, Sergio Horacio; Longo, Nadia; Rampakakis, Emmanouil; Ackad, Nabil; Sampalis, John S

    2011-01-01

    To compare the efficacy and safety of an individualized treatment-simplification strategy consisting of switching from a highly-active anti-retroviral treatment (HAART) with a ritonavir-boosted protease inhibitor (PI/r) and 2 nucleoside reverse-transcriptase inhibitors (NRTIs) to lopinavir/ritonavir (LPV/r) monotherapy, with intensification by 2 NRTIs if necessary, to that of continuing their HAART. This is a one-year, randomized, open-label, multi-center study in virologically-suppressed HIV-1-infected adults on their first PI/r-containing treatment, randomized to either LPV/r-monotherapy or continue their current treatment. Treatment efficacy was determined by plasma HIV-1 RNA viral load (VL), time-to-virologic rebound, patient-reported outcomes (PROs) and CD4+T-cell-count changes. Safety was assessed with the incidence of treatment-emergent adverse events (AE). Forty-one patients were randomized to LPV/r and 39 to continue their HAART. No statistically-significant differences between the two study groups in demographics and baseline characteristics were observed. At day-360, 71(39:LPV/r;32:HAART) patients completed treatment, while 9(2:LPV/r;7:HAART) discontinued. In a Last Observation Carried Forward Intent-to-Treat analysis, 40(98%) patients on LPV/r and 37(95%) on HAART had VL<200 copies/mL (P = 0.61). Time-to-virologic rebound, changes in PROs, CD4+ T-cell-count and VL from baseline, also exhibited no statistically-significant between-group differences. Most frequent AEs were diarrhea (19%), headache (18%) and influenza (16%). Four (10%) patients on LPV/r were intensified with 2 NRTIs, all regaining virologic control. Eight serious AEs were reported by 5(2:LPV/r;3:HAART) patients. At day-360, virologic efficacy and safety of LPV/r appears comparable to that of a PI+2NRTIs HAART. These results suggest that our individualized, simplified maintenance strategy with LPV/r-monotherapy and protocol-mandated NRTI re-introduction upon viral rebound, in

  6. Pilot, Randomized Study Assessing Safety, Tolerability and Efficacy of Simplified LPV/r Maintenance Therapy in HIV Patients on the 1st PI-Based Regimen

    Science.gov (United States)

    Cahn, Pedro; Montaner, Julio; Junod, Patrice; Patterson, Patricia; Krolewiecki, Alejandro; Andrade-Villanueva, Jaime; Cassetti, Isabel; Sierra-Madero, Juan; Casiró, Arnaldo David; Bortolozzi, Raul; Lupo, Sergio Horacio; Longo, Nadia; Rampakakis, Emmanouil; Ackad, Nabil; Sampalis, John S.

    2011-01-01

    Objectives To compare the efficacy and safety of an individualized treatment-simplification strategy consisting of switching from a highly-active anti-retroviral treatment (HAART) with a ritonavir-boosted protease inhibitor (PI/r) and 2 nucleoside reverse-transcriptase inhibitors (NRTIs) to lopinavir/ritonavir (LPV/r) monotherapy, with intensification by 2 NRTIs if necessary, to that of continuing their HAART. Methods This is a one-year, randomized, open-label, multi-center study in virologically-suppressed HIV-1-infected adults on their first PI/r-containing treatment, randomized to either LPV/r-monotherapy or continue their current treatment. Treatment efficacy was determined by plasma HIV-1 RNA viral load (VL), time-to-virologic rebound, patient-reported outcomes (PROs) and CD4+T-cell-count changes. Safety was assessed with the incidence of treatment-emergent adverse events (AE). Results Forty-one patients were randomized to LPV/r and 39 to continue their HAART. No statistically-significant differences between the two study groups in demographics and baseline characteristics were observed. At day-360, 71(39:LPV/r;32:HAART) patients completed treatment, while 9(2:LPV/r;7:HAART) discontinued. In a Last Observation Carried Forward Intent-to-Treat analysis, 40(98%) patients on LPV/r and 37(95%) on HAART had VL<200copies/mL (P = 0.61). Time-to-virologic rebound, changes in PROs, CD4+ T-cell-count and VL from baseline, also exhibited no statistically-significant between-group differences. Most frequent AEs were diarrhea (19%), headache (18%) and influenza (16%). Four (10%) patients on LPV/r were intensified with 2 NRTIs, all regaining virologic control. Eight serious AEs were reported by 5(2:LPV/r;3:HAART) patients. Conclusion At day-360, virologic efficacy and safety of LPV/r appears comparable to that of a PI+2NRTIs HAART. These results suggest that our individualized, simplified maintenance strategy with LPV/r-monotherapy and protocol-mandated NRTI re

  7. Pilot, randomized study assessing safety, tolerability and efficacy of simplified LPV/r maintenance therapy in HIV patients on the 1 PI-based regimen.

    Directory of Open Access Journals (Sweden)

    Pedro Cahn

    Full Text Available To compare the efficacy and safety of an individualized treatment-simplification strategy consisting of switching from a highly-active anti-retroviral treatment (HAART with a ritonavir-boosted protease inhibitor (PI/r and 2 nucleoside reverse-transcriptase inhibitors (NRTIs to lopinavir/ritonavir (LPV/r monotherapy, with intensification by 2 NRTIs if necessary, to that of continuing their HAART.This is a one-year, randomized, open-label, multi-center study in virologically-suppressed HIV-1-infected adults on their first PI/r-containing treatment, randomized to either LPV/r-monotherapy or continue their current treatment. Treatment efficacy was determined by plasma HIV-1 RNA viral load (VL, time-to-virologic rebound, patient-reported outcomes (PROs and CD4+T-cell-count changes. Safety was assessed with the incidence of treatment-emergent adverse events (AE.Forty-one patients were randomized to LPV/r and 39 to continue their HAART. No statistically-significant differences between the two study groups in demographics and baseline characteristics were observed. At day-360, 71(39:LPV/r;32:HAART patients completed treatment, while 9(2:LPV/r;7:HAART discontinued. In a Last Observation Carried Forward Intent-to-Treat analysis, 40(98% patients on LPV/r and 37(95% on HAART had VL<200 copies/mL (P = 0.61. Time-to-virologic rebound, changes in PROs, CD4+ T-cell-count and VL from baseline, also exhibited no statistically-significant between-group differences. Most frequent AEs were diarrhea (19%, headache (18% and influenza (16%. Four (10% patients on LPV/r were intensified with 2 NRTIs, all regaining virologic control. Eight serious AEs were reported by 5(2:LPV/r;3:HAART patients.At day-360, virologic efficacy and safety of LPV/r appears comparable to that of a PI+2NRTIs HAART. These results suggest that our individualized, simplified maintenance strategy with LPV/r-monotherapy and protocol-mandated NRTI re-introduction upon viral rebound, in

  8. A longitudinal study of risk factors for community-based home help services in Alzheimer’s disease: the influence of cholinesterase inhibitor therapy

    Directory of Open Access Journals (Sweden)

    Wattmo C

    2013-03-01

    Full Text Available Carina Wattmo, Elisabeth Paulsson, Lennart Minthon, Elisabet LondosClinical Memory Research Unit, Department of Clinical Sciences, Malmö, Lund University, Malmö, SwedenBackground: To investigate the long-term effects of cholinesterase inhibitor (ChEI therapy and the influence of sociodemographic and clinical factors on the use of community-based home help services (HHS by patients with Alzheimer’s disease (AD.Methods: This 3-year, prospective, multicenter study included 880 AD patients treated with donepezil, rivastigmine, or galantamine in a routine clinical setting. At baseline and every 6 months, the patients were assessed with several rating scales, including the Mini-Mental State Examination, Instrumental Activities of Daily Living (IADL, and Physical Self-Maintenance Scale. Doses of ChEI and amounts of HHS per week were recorded. Cox regression models were used to predict the time to HHS, and multiple linear regression was used to predict the volume of HHS used.Results: During the study, 332 patients (38% used HHS. Factors that both postponed HHS use and predicted lower amounts of HHS were higher doses of ChEIs, better IADL ability, and living with family. Men, younger individuals, and those with a slower IADL decline showed a longer time to HHS, whereas female sex, a lower cognitive status, or more medications at baseline predicted fewer hours of HHS.Conclusions: Higher doses of ChEI might reduce the use of HHS, possibly reducing the costs of community-based care. Female spouses provide more informal care than do male spouses, so the likelihood of using HHS is greater among women with AD. The "silent group" of more cognitively impaired and frail elderly AD patients receives less HHS, which might precipitate institutionalization.Keywords: cognition, activities of daily living, treatment effect, gender, predictors

  9. Advanced maintenance research programs

    International Nuclear Information System (INIS)

    Marston, T.U.; Gelhaus, F.; Burke, R.

    1985-01-01

    The purpose of this paper is to provide the reader with an idea of the advanced maintenance research program at the Electric Power Research Institute (EPRI). A brief description of the maintenance-related activities is provided as a foundation for the advanced maintenance research projects. The projects can be divided into maintenance planning, preventive maintenance program development and implementation, predictive (or conditional) maintenance, and innovative maintenance techniques. The projects include hardware and software development, human factors considerations, and technology promotion and implementation. The advanced concepts include: the incorporation of artificial intelligence into outage planning; turbine and pump maintenance; rotating equipment monitoring and diagnostics with the aid of expert systems; and the development of mobile robots for nuclear power plant maintenance

  10. Influence of lavage therapy on the distribution patterns of inhaled, relatively insoluble particles in the lung

    International Nuclear Information System (INIS)

    Snipes, M.B.; Runkle, G.E.; Muggenburg, B.A.

    1977-01-01

    Four Beagle dogs were exposed by inhalation to a polydisperse fused aluminosilicate aerosol labeled with 147 Pm and 169 Yb. The left or right lung of each dog was lavaged one or five times to remove a portion of the lung burden. Autoradiographic and computer techniques were combined to determine the dispersion pattern of radioactive particles still in the lung after lavage therapy. For all four dogs the dispersion pattern of particles in the lung was the same for the lavaged and non-lavaged lung lobes. Examination of the autoradiograms indicated that lavage therapy did not preferentially remove particles from some areas of the lung. The similarity of particle dispersion patterns suggests that a minimal relocation of particles in lung results from lavage therapy

  11. Spontaneous chronic subdural hematoma development in chronic myeloid leukemia cases at remission phase under maintenance therapy, management strategy - a series with literature review

    Directory of Open Access Journals (Sweden)

    Raheja Amol

    2016-09-01

    Full Text Available Chronic subdural hematoma (CSDH is common squeal of trauma and rarely associated with anticoagulant therapy, antiplatelet, chemotherapeutic drugs, arteriovenous malformation, aneurysms and post-craniotomy. However its occurrence is very unusual with systemic haematological malignancy and mostly reported with acute myeloid leukemia; however incidence of SDH occurrence in chronic myelogenous leukemia (CML is very rare. CML is a haematological malignancy characterized by chromosomal alteration, pathologically represents increased proliferation of the granulocytic cell line without loss of capacity to differentiate. CML has three phases - remission phase, accelerated phase and blast crisis. About 85 % of patients present in remission phase of disease and carries a favorable prognosis. As intracranial, subdural hematoma usually occur in the accelerated phase or blast crisis phase or extremely uncommon during chronic remission phase, although only those affected, who are neglecting therapeutic medication or discontinued therapy or rarely as an adverse effect of medications. However, important role of neurosurgeon lies in early detection and correction of platelet count and associated hematological abnormality as quite sizeable proportion of cases may not need surgical intervention instead can be managed conservatively under regular supervision in association with oncologist colleague, but few cases may need urgent surgical intervention. So, selecting a subgroup of CML cases in the remission phase requiring surgical intervention, presenting with CSDH is not only challenging, as failure to make an informed and timely precise decision can lead to catastrophic worse outcome and even mortality. So, purpose of current article is to formulate the management therapeutic plan. Authors report three cases of CML in chronic remission phase, receiving treatment under guidance of Haemto-oncologist at our institute presented with spontaneous chronic SDH. The mean

  12. Combination therapy of leflunomide and glucocorticoids for the maintenance of remission in patients with IgG4-related disease: a retrospective study and literature review.

    Science.gov (United States)

    Wang, Yiwen; Li, Kunpeng; Gao, Dai; Luo, Gui; Zhao, Yurong; Wang, Xiuru; Zhang, Jie; Jin, Jingyu; Zhao, Zheng; Yang, Chunhua; Zhu, Jian; Zhang, Jianglin; Huang, Feng

    2017-06-01

    Although glucocorticoids are effective in IgG4-related disease (IgG4-RD), patients may relapse during or after glucocorticoid tapering. Immunosuppressive agents, including leflunomide (LEF), are regarded as steroid-sparing agents in other autoimmune disorders and need to be discussed in the management of IgG4-RD. To identify the efficacy and safety of combination therapy of LEF and glucocorticoids in IgG4-RD. We retrospectively summarised data of patients diagnosed with IgG4-RD between November 2012 and November 2015. Only patients treated with LEF plus glucocorticoids and had been followed up for more than three visits and 6 months were analysed with clinical symptoms, laboratory and imaging findings, treatment protocol, LEF-related adverse events and disease activity reflected by IgG4-RD Responder Index (IgG4-RD RI). A total of 18 patients, including 14 untreated patients and 4 relapsing patients, was included. The mean (SD) onset age was 54.0 (9.6) years. The mean (SD) follow-up period was 12.1 (7.4) months. All patients had active disease with mean (SD) IgG4-RD RI of 15.0 (5.6) at baseline and experienced improvements at 1 month. At the last follow up, the mean (SD) IgG4-RD Responder Index declined to 3.1 (1.7) in all patients and to 2.5 (1.2) in patients without relapse. The mean (SD) dose of GC declined to 6.9 (2.7) mg/day. A total of 12 (66.7%) and 11 (61.1%) patients were in remission at 6 months and the last follow up respectively. Three (16.7%) patients relapsed in clinical course. Two reversible adverse events were observed. The combination therapy of LEF and glucocoticoids is effective and safe in IgG4-RD. © 2017 Royal Australasian College of Physicians.

  13. Influence of manual therapy on functional mobility after joint injury in a rat model.

    Science.gov (United States)

    Ruhlen, Rachel L; Snider, Eric J; Sargentini, Neil J; Worthington, Bart D; Singh, Vineet K; Pazdernik, Vanessa K; Johnson, Jane C; Degenhardt, Brian F

    2013-10-01

    Animal models can be used to investigate manual therapy mechanisms, but testing manipulation in animal models is problematic because animals cannot directly report their pain. To develop a rat model of inflammatory joint injury to test the efficacy of manual therapy in reducing nociception and restoring function. The authors induced acute inflammatory joint injury in rats by injecting carrageenan into the ankle and then measured voluntary running wheel activity in treated and untreated rats. Treatments included manual therapy applied to the ankle and knee of the injured limb and several analgesic medications (eg, morphine, ketorolac, prednisone). Intra-articular injection of carrageenan to the ankle produced significant swelling (diameter of the ankle increased by 64% after injection; P=.004) and a robust reduction in voluntary running wheel activity (running distance reduced by 91% compared with controls; Pmanual therapy nor analgesic medications increased running wheel activity relative to untreated rats. Voluntary running wheel activity appears to be an appropriate functional measure to evaluate the impact of an acute inflammatory joint injury. However, efforts to treat the injury did not restore running relative to untreated rats.

  14. Early stage cognitive impairment in Parkinson’s disease and the influence of dopamine replacement therapy

    NARCIS (Netherlands)

    Miah, I.P.; Olde Dubbelink, K.T.E.; Stoffers, D.; Deijen, J.B.; Berendse, H.W.

    2012-01-01

    Background and purpose: The aim of this study was to establish the cognitive profile of newly diagnosed untreated (de novo) patients with Parkinson's disease (PD) and more advanced, treated patients, and to determine the effects of dopamine (DA) replacement therapy. Methods: A cohort of 23 de novo

  15. The influence of blood pressure management on neurological outcome in endovascular therapy for acute ischaemic stroke.

    Science.gov (United States)

    Rasmussen, M; Espelund, U S; Juul, N; Yoo, A J; Sørensen, L H; Sørensen, K E; Johnsen, S P; Andersen, G; Simonsen, C Z

    2018-06-01

    Observational studies have suggested that low blood pressure and blood pressure variability may partially explain adverse neurological outcome after endovascular therapy with general anaesthesia (GA) for acute ischaemic stroke. The aim of this study was to further examine whether blood pressure related parameters during endovascular therapy are associated with neurological outcome. The GOLIATH trial randomised 128 patients to either GA or conscious sedation for endovascular therapy in acute ischaemic stroke. The primary outcome was 90 day modified Rankin Score. The haemodynamic protocol aimed at keeping the systolic blood pressure >140 mm Hg and mean blood pressure >70 mm Hg during the procedure. Blood pressure related parameters of interest included 20% reduction in mean blood pressure; mean blood pressure blood pressure blood pressure; mean blood pressure at the time of groin puncture; postreperfusion mean blood pressure; blood pressure variability; and use of vasopressors. Sensitivity analyses were performed in the subgroup of reperfused patients. Procedural average mean and systolic blood pressures were higher in the conscious sedation group (Pblood pressure blood pressure blood pressure variability, and use of vasopressors were all higher in the GA group (Pblood pressure related parameters and the modified Rankin Score in the overall patient population, and in the subgroup of patients with full reperfusion. We found no statistically significant association between blood pressure related parameters during endovascular therapy and neurological outcome. NCT 02317237. Copyright © 2018 British Journal of Anaesthesia. Published by Elsevier Ltd. All rights reserved.

  16. The association between early menopause and risk of ischaemic heart disease: Influence of Hormone Therapy

    DEFF Research Database (Denmark)

    Løkkegaard, Ellen Christine Leth; Andersen, Zorana Jovanovic; Heitmann, Berit Lilienthal

    2006-01-01

    Randomised clinical trials find no protection against development of ischaemic heart disease by use of Hormone Therapy (HT) after the age of 50 years. Observational studies suggest that early menopause is a risk factor for ischaemic heart disease. Yet, a clinical very relevant question is whether...... HT reduces this risk associated with early menopause....

  17. Breast Cancer Risk After Radiation Therapy for Hodgkin Lymphoma : Influence of Gonadal Hormone Exposure

    NARCIS (Netherlands)

    Krul, Inge M; Opstal-van Winden, Annemieke W J; Aleman, Berthe M P; Janus, Cécile P M; van Eggermond, Anna M; De Bruin, Marie L; Hauptmann, Michael; Krol, Augustinus D G; Schaapveld, Michael; Broeks, Annegien; Kooijman, Karen R; Fase, Sandra; Lybeert, Marnix L; Zijlstra, Josée M; van der Maazen, Richard W M; Kesminiene, Ausrele; Diallo, Ibrahima; de Vathaire, Florent; Russell, Nicola S; van Leeuwen, Flora E

    2017-01-01

    BACKGROUND: Young women treated with chest radiation therapy (RT) for Hodgkin lymphoma (HL) experience a strongly increased risk of breast cancer (BC). It is unknown whether endogenous and exogenous gonadal hormones affect RT-associated BC risk. METHODS: We conducted a nested case-control study

  18. Influence of Interferon-Alpha Combined with Chemo (Radio Therapy on Immunological Parameters in Pancreatic Adenocarcinoma

    Directory of Open Access Journals (Sweden)

    Svetlana Karakhanova

    2014-03-01

    Full Text Available Prognosis of patients with carcinoma of the exocrine pancreas is particularly poor. A combination of chemotherapy with immunotherapy could be an option for treatment of pancreatic cancer. The aim of this study was to perform an immunomonitoring of 17 patients with pancreatic cancer from the CapRI-2 study, and tumor-bearing mice treated with combination of chemo (radio therapies with interferon-2α. Low doses of interferon-2α led to a decrease in total leukocyte and an increase in monocyte counts. Furthermore, we observed a positive effect of interferon-2α therapy on the dendritic cells and NK (natural killer cell activation immediately after the first injection. In addition, we recorded an increased amount of interferon-γ and IL-10 in the serum following the interferon-2α therapy. These data clearly demonstrate that pancreatic carcinoma patients also show an immunomodulatory response to interferon-2α therapy. Analysis of immunosuppressive cells in the Panc02 orthotopic mouse model of pancreatic cancer revealed an accumulation of the myeloid-derived suppressor cells in spleens and tumors of the mice treated with interferon-2α and 5-fluorouracil. The direct effect of the drugs on myeloid-derived suppressor cells was also registered in vitro. These data expose the importance of immunosuppressive mechanisms induced by combined chemo-immunotherapy.

  19. Does performance status influence the outcome of Nd:YAG laser therapy of proximal esophageal tumors?

    NARCIS (Netherlands)

    Alexander, G. L.; Wang, K. K.; Ahlquist, D. A.; Viggiano, T. R.; Gostout, C. J.; Balm, R.

    1994-01-01

    The value of endoscopic palliative therapy for malignant obstruction in the proximal esophagus has been questioned. To assess the importance of pre-treatment performance status on treatment outcome, we reviewed the records of patients with tumors of the proximal esophagus undergoing endoscopic laser

  20. Original paper Influence of biologic therapy on growth in children with chronic inflammatory connective tissue diseases

    Directory of Open Access Journals (Sweden)

    Joanna Świdrowska

    2015-04-01

    Full Text Available Objectives: Connective tissue diseases (CTD are a heterogeneous group of chronic inflammatory conditions. One of their complications in children is the inhibition of growth velocity. Due to direct inflammation within the musculoskeletal system as well as glucocorticoid therapy, this feature is the most essential and is mainly expressed in the course of juvenile spondyloarthropathies and juvenile idiopathic arthritis (JIA. Duration of the disease, but predominantly the activity of the inflammatory process, seems to have a significant impact on the abnormal growth profile in children. Effective biological therapy leads to improvement of the patient’s clinical condition and also, through the extinction of disease activity and reduction of daily doses of glucocorticosteroids (GCS, it gradually accelerates and normalizes the growth rate in children with CTD. Our objective was to evaluate the impact of biological therapy on growth in children with chronic inflammatory CTD. Material and methods: Data from 24 patients with CTD treated with tumor necrosis factor--blockers (etanercept, adalimumab, golimumab and an interleukin-6 receptor blocker (tocilizumab were reviewed at the time of disease onset, biological treatment initiation and at least 12 up to 24 months onwards. The rate of growth was correlated with the daily doses of GCS, and the type and duration of biological therapy. Results : Patient median height, measured as the change in height standard deviation score, was 0.36 ±1.07 at disease onset and –0.13 ±1.02 at biologic therapy initiation. The growth velocity accelerated in 17 patients (70.1% during the biological treatment. Mean height-SDS improvement between biological treatment initiation up to two years was 0.51 ±0.58. In 47% of patients daily doses of GCS were reduced to 0 mg/kg/day. Conclusions : In the treatment of CTD, biological agents restore growth velocity not only by inflammation inhibition, but also through limiting GCS

  1. Patients' views toward knee osteoarthritis exercise therapy and factors influencing adherence - a survey in China.

    Science.gov (United States)

    Zhou, Zhiwei; Hou, Yunfei; Lin, Jianhao; Wang, Kai; Liu, Qiang

    2018-05-01

    To understand the views toward exercise therapy for knee osteoarthritis (KOA) in China and to analyze factors affecting treatment adherence. A survey-based study, which included multiple choice and open-ended questions on knee OA exercise therapy was conducted in a Chinese population. The content included the respondents' attitudes and beliefs, willingness to receive treatment, and reasons why they could or could not adhere to the treatment. We used Chi-squared tests to compare cognitive differences between the patients and non-patient groups. A total of 1,069 people responded to the questionnaire, and the response rate was 81.8%. A total of 93.6% of the patients thought that they could adhere to the exercise treatment if they received professional advice and prescriptions. The following questionnaire items achieved consensus: 'Increasing the strength of the muscles around the knee stops the knee pain from getting worse,' 'It is the person's own responsibility to continue doing their exercise program,' 'How helpful the exercise program will be determines how well a person sticks to it,' 'Health professionals should educate patients with knee pain about how to change their lifestyle for the better,' and 'Exercise for knee pain is most helpful when it is designed for each person, to suit their own particular needs.' Patient adherence was affected by multiple factors, and some negative factors included 'forgetfulness,' 'getting joint symptoms improved after therapy,' 'professional guidance, subsequent monitoring and supervision,' 'willing to enhance overall health and quality of life,' 'having no time,' 'occupational factors,' 'considering that the pain would worsen while/after exercise,' and 'family factors.' A general Chinese population accepted exercise therapy for treating KOA in our survey. Education is necessary because patients were uncertain and had misunderstandings regarding the potential benefits of exercise therapy. Some factors related to treatment

  2. Influence of hormone substitution therapy on postmenopausal uterus; Einfluss einer Hormonsubstitution auf den postmenopausalen Uterus

    Energy Technology Data Exchange (ETDEWEB)

    Otte, A.; Ruedisueli, A.; Goetze, M.; Leibundgut, U.; Mueller-Brand, J. [Inst. fuer Nuklearmedizin, Kantonsspital, Universitaetskliniken, Basel (Switzerland); Nitzsche, E.U. [Abt. Nuklearmedizin, Radiologische Universitaetsklinik, Freiburg (Germany)

    1997-12-01

    In a 58-year-old postmenopausal woman blood flow and blood pool images of bone scintigraphy showed a focus of increased activity in the right pelvic region. Computed tomography and ultrasound exhibited no abnormalities in the abdomen; especially the uterus and ovaries were normal. Careful anamnestic evaluation revealed that the patient received a long-term peroral estrogen/gestagen replacement therapy for the prevention of osteoporosis, but did not have menstruation-like bleedings for the last twelve months of therapy. At time of admission, the patient was on day 25 of hormone replacement therapy, and the uterus wash, therefore, in a premenstrual stage. Hence, despite cessation of bleedings in postmenopausal women, one should think of hormone replacement therapy as an explanation for vascular pelvic tumors seen by the first two phases of bone scintigraphy, before further diagnostic steps are undertaken. (orig.) [Deutsch] Bei der Skelettszintigraphie einer 58jaehrigen postmenopausalen Frau erkannte man in der Perfusions- und Blood-pool-Phase einen unklaren Fokus erhoehter Aktivitaet im rechten Becken. Computertomographie und Sonographie des Abdomens, insbesondere des Uterus und der Ovarien, waren unauffaellig. Nach eingehender anamnestischer Befragung stellte sich heraus, dass die Patientin unter einer mehrjaehrigen peroralen Oestrogen-/Gestagen-Hormonsubstitutionstherapie zur Osteoporose-Prophylaxe stand, jedoch seit den letzten zwoelf Monaten der Therapie ueber keine menstruationsaehnlichen Abbruchblutungen mehr berichten konnte. Bei ihrer Zuweisung befand sich die Patientin am 25. Tag der Hormonsubstitutionstherapie und ihr Uterus somit in einem praemenstruellen Stadium. Trotz Ausbleibens der Blutung bei postmenopausalen Frauen sollte somit an die Moeglichkeit der Hormonsubstitution gedacht und danach gefragt werden, wenn in den ersten beiden Phasen der Skelettszintigraphie eine unklare, gut vaskularisierte Struktur im kleinen Becken gefunden wird, bevor weitere

  3. Influence of fluid therapy for stabilization of dogs in shock caused with different etiology

    Directory of Open Access Journals (Sweden)

    Novakov Todor

    2009-05-01

    Full Text Available The aim of this work is the portrayal of shock in a small practice and its timely and proper treatment. This study included a total of 8 dogs that are numbered from 1 to 8. In all animals was performed complete general clinical index, the venous route was applyed, and are accompanied by clinical parameters during treatment. Research showing that all animals were received in shock. In all our study patients, fluid therapy was occurred to update and maintain lost volume, exception makes patient number one witch with respect to the diagnosis and classification of shock succumb on other therapy. All patients received fluid therapy in the form of one or multiple bolus colloid fluids Hydroxyethyl Starch 6% (HAES-a dosage of 3-15 ml/kg with a physiological solution in the dosage of 10-50 ml/kg. Our study showed a positive response after applications of bolus HAES and physiological solutions. Dogs 1, 2, 5 and 6 after therapy was stabilize body temperature (TT, CRT, and the frequency. The most relevant example is the dog number 2, who received value of TT 40.9, CRT 4 seconds, and the frequency was 222, which the value for 18 hours changed to TT 38.4, CRT 3 seconds and the frequency was 180th. Dogs (5, 6 gave a positive response to the protocol to stabilize shock. Dogs 3, 4, 7 and 8 have an initial positive reactions in some parameters, but etiological situation has led to deterioration and mortalities. We have concluded that the time of applications and attempt have significant role in the successible treatment to stabilize a patients. Significant results are possible only if treatment is timely and adequately (a combination of colloids and crystalloid. The basis of shock therapy is the correction hipovolemia appropriate liquid, intravenous applied in the fastest possible time.

  4. Long-Term Maintenance of Therapeutic Gains Associated With Cognitive-Behavioral Therapy for Insomnia Delivered Alone or Combined With Zolpidem.

    Science.gov (United States)

    Beaulieu-Bonneau, Simon; Ivers, Hans; Guay, Bernard; Morin, Charles M

    2017-03-01

    To document the long-term sleep outcomes at 12 and 24 months after patients with chronic insomnia were treated with cognitive-behavioral therapy (CBT), either singly or combined with zolpidem medication. Participants were 160 adults with chronic insomnia. They were first randomized for a six-week acute treatment phase involving CBT alone or CBT combined with nightly zolpidem, and randomized for a six-month extended treatment phase involving CBT, no additional treatment, CBT combined with zolpidem as needed, or CBT with zolpidem tapered. This paper reports results of the 12- and 24-month follow-ups on the main outcome measures derived from the Insomnia Severity Index and sleep diaries. Clinical improvements achieved 6 months following the end of treatment were well-maintained in all four conditions, with insomnia remission rates ranging from 48% to 74% at the 12-month follow-up, and from 44% to 63% at the 24-month follow-up. Participants receiving CBT with zolpidem taper in the extended treatment phase had significantly better results than those receiving CBT with continued zolpidem as needed. The magnitude of improvements on sleep diary parameters was similar between conditions, with a slight advantage for the CBT with zolpidem taper condition. The addition of extended CBT did not alter the long-term outcome over improvements obtained during the initial 6-week CBT. The results suggest that CBT for insomnia, when delivered alone or in combination with medication, produce durable sleep improvements up to two years after completion of treatment. These long-term results indicate that even if a combined CBT plus medication approach provide an added benefit immediately after treatment, extending CBT while tapering medication produce better sustained improvements compared to continued use of medication as needed. © Sleep Research Society 2017. Published by Oxford University Press on behalf of the Sleep Research Society. All rights reserved. For permissions, please e

  5. Lenalidomide-based maintenance therapy reduces TNF receptor 2 on CD4 T cells and enhances immune effector function in acute myeloid leukemia patients.

    Science.gov (United States)

    Govindaraj, Chindu; Madondo, Mutsa; Kong, Ying Ying; Tan, Peter; Wei, Andrew; Plebanski, Magdalena

    2014-08-01

    A major limitation to improved outcomes in acute myelogenous leukemia (AML) is relapse resulting from leukemic cells that persist at clinical remission. Regulatory T cells (Tregs), which are increased in AML patients, can contribute to immune evasion by residual leukemic cells. Tumor necrosis factor (TNF), a pro-inflammatory cytokine present at high levels within patients, can induce TNF receptor-2 (TNFR2) expression on Tregs. We hypothesized that since TNFR2 is required for Treg stabilization and TNFR2+ Tregs are potent suppressors, targeting TNFR2+ Tregs may restore the effectiveness of immune-surveillance mechanisms. In this pilot study, we report AML patients in clinical remission have substantially increased levels of TNFR2+ T cells, including TNFR2+ Tregs and impaired effector CD4 T cell function with reduced IL-2 and IFNγ production. The immunomodulatory drug, lenalidomide, and the demethylating agent, azacitidine have been moderately successful in treating AML patients, but their combined effects on TNFR2+ T cells, including Tregs are currently unknown. Our data indicates that although treatment with lenalidomide and azacitidine increased cytokine production by effector T cells in all patients, durable clinical remissions may be observed in patients with a concomitant reduction in TNFR2+ T cells and TNFR2+ Tregs. In vitro studies further demonstrated that lenalidomide can reduce TNFR2 expression and can augment effector cytokine production by T cells, which can be further enhanced by azacitidine. These results indicate that reduction of TNFR2+ T cells in AML postremission phase may result from combined azacitidine/lenalidomide therapy and may contribute to an improved clinical outcome. © 2014 Wiley Periodicals, Inc.

  6. Prognostic Factors Influencing the Patency of Hemodialysis Vascular Access: Literature Review and Novel Therapeutic Modality by Far Infrared Therapy

    Directory of Open Access Journals (Sweden)

    Chih-Ching Lin

    2009-03-01

    Full Text Available In Taiwan, more than 85% of patients with end-stage renal disease undergo maintenance hemodialysis (HD. The native arteriovenous fistula (AVF accounts for a prevalence of more than 80% of the vascular access in our patients. Some mechanical factors may affect the patency of hemodialysis vascular access, such as surgical skill, puncture technique and shear stress on the vascular endothelium. Several medical factors have also been identified to be associated with vascular access prognosis in HD patients, including stasis, hypercoagulability, endothelial cell injury, medications, red cell mass and genotype polymorphisms of transforming growth factor-β1 and methylene tetrahydrofolate reductase. According to our previous study, AVF failure was associated with a longer dinucleotide (GTn repeat (n ≥ 30 in the promoter of the heme oxygenase-1 (HO-1 gene. Our recent study also demonstrated that far-infrared therapy, a noninvasive and convenient therapeutic modality, can improve access flow, inflammatory status and survival of the AVF in HD patients through both its thermal and non-thermal (endothelial-improving, anti-inflammatory, antiproliferative, antioxidative effects by upregulating NF-E2-related factor-2-dependent HO-1 expression, leading to the inhibition of expression of E-selectin, vascular cell adhesion molecule-1, and intercellular adhesion molecule-1.

  7. Maintenance work management system

    International Nuclear Information System (INIS)

    Kanai, T.; Takahashi, Y.; Takahashi, K.; Nishino, M.; Takeshige, R.

    2000-01-01

    The maintenance work management system supports the efficient drawing up of various documents for the maintenance work at nuclear power stations and the speeding up of the permission procedure. In addition, it improves the quality assurance of the safety and reliability of the maintenance work. Key merits of the system are: 1. Efficiently drawing up various documents for the maintenance work by using the stored data for the previous maintenance work and the pipe and instrument diagram (P and ID) data. 2. Supporting the management work for the completion of maintenance work safety by using the isolation information stored on the computer system. 3. Speeding up the permission procedure by electronic mail and electronic permission. 4. Displaying additional information such as the specifications of equipment, maintenance result, and maintenance plan by linking up with the database of another system. 5. Reducing the cost of hardware devices by using client/server network configurations of personal computers and a personal computer server. (author)

  8. Unsurfaced Road Maintenance Management

    Science.gov (United States)

    1992-12-01

    This draft manual describes an unsurfaced road maintenance management system for use on military installations. This system is available in either a manual or computerized mode (Micro PAVER). The maintenance standards prescribed should protect Govern...

  9. Winter maintenance performance measure.

    Science.gov (United States)

    2016-01-01

    The Winter Performance Index is a method of quantifying winter storm events and the DOTs response to them. : It is a valuable tool for evaluating the States maintenance practices, performing post-storm analysis, training : maintenance personnel...

  10. Competence within Maintenance

    OpenAIRE

    Nerland, Annette Smørholm

    2010-01-01

    Maintenance can be a contributing factor to unwanted events, as well as desired events and states. Human competence can be defined as the ability to perform a specific task, action or function successfully, and is therefore a key factor to proper execution of maintenance tasks. Hence,maintenance will have negative consequences if done wrong, and give positive results when done right. The purpose of this report is to study the many aspects of maintenance competence. Endeavoring to improve ...

  11. Nuclear medicine - factors influencing the choice and use of radionuclides in diagnosis and therapy

    International Nuclear Information System (INIS)

    Anon.

    1983-01-01

    This report addresses the many factors which influence the choice of the proper radiopharmaceutical drug product for the diagnosis or treatment of a specific disease or condition in a human subject. The Report examines the historical factors that influence the choice of radionuclides, the factors that influence the localization of radionuclides in tissues, the factors that influence the choice of instruments, and include an evaluation of the nuclear medicine procedures that could be selected and their clinical usefulness. In examining these factors the desirable characteristics of the radiopharmaceutical drug products of the measurement systems are identified. The methods of dose determination and the assumptions used in determination of dose are developed. There is also a section on radiation effects. A chapter on guidelines for procedures in nuclear medicine and some general and specific recommendations for protection of patients conclude the body of the text

  12. Study Protocol: The influence of Running Therapy on executive functions and sleep of prisoners [version 1; referees: 2 approved

    Directory of Open Access Journals (Sweden)

    Jesse Meijers

    2015-06-01

    Full Text Available Background: Executive dysfunction appears to be related to increased recidivism. Of note is that sleep disturbances, which are highly prevalent in prisons, may attenuate executive functions. Thus, improving executive functions, either directly or indirectly through the improvement of sleep, may reduce recidivism. It is hypothesised that physical exercise, in the form of Running Therapy, has a direct positive effect on executive functions as well as an indirect effect through the improvement of sleep. Methods/Design: Seventy two (N = 72 detainees in various penitentiary institutions in the Netherlands will be recruited in this study. A baseline measurement, including six neuropsychological tests of the Cambridge Neuropsychological Test Automated Battery (CANTAB, an assessment of sleep quality and duration using the Actiwatch (Actiwatch 2, Philips Respironics, Murrysville, PA, USA and various other measurements will be administered before the start of the treatment. After 3 months of Running Therapy, participants will be assessed again with the same tests for neuropsychological and physical functioning. Primary outcomes are executive functioning and various sleep variables. Discussion: This study will be the first to investigate the possible influence of Running Therapy on the cognitive functioning, sleep and aggression in prisoners.

  13. Influence of Craniosacral Therapy on Anxiety, Depression and Quality of Life in Patients with Fibromyalgia

    OpenAIRE

    Matarán-Peñarrocha, Guillermo A.; Castro-Sánchez, Adelaida María; García, Gloria Carballo; Moreno-Lorenzo, Carmen; Carreño, Tesifón Parrón; Zafra, María Dolores Onieva

    2011-01-01

    Fibromyalgia is considered as a combination of physical, psychological and social disabilities. The causes of pathologic mechanism underlying fibromyalgia are unknown, but fibromyalgia may lead to reduced quality of life. The objective of this study was to analyze the repercussions of craniosacral therapy on depression, anxiety and quality of life in fibromyalgia patients with painful symptoms. An experimental, double-blind longitudinal clinical trial design was undertaken. Eighty-four patien...

  14. Sources of information influencing the state-of-the-science gap in hormone replacement therapy usage.

    Directory of Open Access Journals (Sweden)

    Fiona Chew

    Full Text Available Medical reviews and research comprise a key information source for news media stories on medical therapies and innovations as well as for physicians in updating their practice. The present study examined medical review journal articles, physician surveys and news media coverage of hormone replacement therapy (HT to assess the relationship between the three information sources and whether/if they contributed to a state-of-the-science gap (a condition when the evaluation of a medical condition or therapy ascertained by the highest standards of investigation is incongruent with the science-in-practice such as physician recommendations and patient actions.We content-analyzed 177 randomly sampled HT medical reviews between 2002 and 2014, and HT news valence in three major TV networks, newspapers and magazines/internet sites in 2002-2003, 2008-2009 and 2012-14. The focus in both analyses was whether HT benefits outweighed risks, risks outweighed benefits or both risks and benefits were presented. We also qualitatively content-analyzed all 19 surveys of US physicians' HT recommendations from 2002 to 2009, and 2012 to 2014.Medical reviews yielded a mixed picture about HT (40.1% benefits, 26.0% risks, and 33.9% both benefits and risks. While a majority of physician surveys were pro-HT 10/19, eight showed varied attitudes and one was negative. Newspaper and television coverage reflected a pro and con balance while magazine stories were more positive in the later reporting period.Medical journal review articles, physicians, and media reports all provide varying view points towards hormone therapy use thus leading to limited knowledge about the actual risks and benefits of HT among peri- and menopausal women and a state-of-the-science gap.

  15. THE INFLUENCE OF COMPLEX THERAPY ON THE INFLAMMATORY MARKERS OF PATIENTS WITH SECONDARY OSTEOARTHRITIS

    Directory of Open Access Journals (Sweden)

    I. A. Starodubtseva

    2015-01-01

    Full Text Available The aim of the study is to evaluate the efficacy of complex therapy of secondary osteoarthritis in patients with rheumatoid arthritis with the use of inhibitor of interleukin-1, including the dynamics of inflammatory markers.Materials and methods: 248 patients with secondary osteoarthritis in rheumatoid arthritis were involved in the trial. The participants were divided into 4 groups: patients of group I took inhibitor of interleukin-1 (diacerein in combination with laser therapy and methotrexate; inhibitor of interleukin-1 in complex with methotrexate took patients from group II; group 3 — laser therapy + methotrexate and patients of group IV took only methotrexate. The efficacy of therapy we estimated in 6 months.Results: The constructed model surfaces indicated the decreased levels of IL-1, COMP and DAS 28 in group 1 till 6,68±0,37 pg/ml (p<0,001, 16,92±0,8 ng/ml х 10² (p<0,001 и 2,06±1,19 (p<0,05 accordingly in comparison with groups III and IV. Also the model surfaces revealed the interdependency of all these indicators. The control group (IV reacted to the treatment by decreasing the indicators as well. However, the dynamics of the changes was significantly less. In patients of groups I and II the levels of ESR and CRP decreased to 13,95±0,52* (*p<0,001 and 10,97±0,43* (*p<0,001; 16,53±0,63* (*p<0,001 and 12,81±0,77* (*p<0,001 accordingly.Conclusions: In comparison analysis we noted statistical significant advantages (p<0,01 of the use of diacerein with methotrexate regarding the dynamic of IL-1 and COMP, ESR, CRP in patient’s serum, which is accompanied by the reduction of basic disease activity on DAS 28.

  16. Asphalt in Pavement Maintenance.

    Science.gov (United States)

    Asphalt Inst., College Park, MD.

    Maintenance methods that can be used equally well in all regions of the country have been developed for the use of asphalt in pavement maintenance. Specific information covering methods, equipment and terminology that applies to the use of asphalt in the maintenance of all types of pavement structures, including shoulders, is provided. In many…

  17. Optimization of surface maintenance

    International Nuclear Information System (INIS)

    Oeverland, E.

    1990-01-01

    The present conference paper deals with methods of optimizing the surface maintenance of steel-made offshore installations. The paper aims at identifying important approaches to the problems regarding the long-range planning of an economical and cost effective maintenance program. The methods of optimization are based on the obtained experiences from the maintenance of installations on the Norwegian continental shelf. 3 figs

  18. Dukovany NPP maintenance management

    International Nuclear Information System (INIS)

    Siegel, F.

    2005-01-01

    Maintenance planning and management for the technological equipment of the Dukovany NPP are described. A Maintenance Control and Evaluation System has been developed and is in use to help manage the complex maintenance issue. Practical examples of outputs of the System, with a comprehensive use of the cost, reliability and safety related data, are presented. (author)

  19. A randomized, double-blind, placebo-controlled phase 2 study of maintenance therapy with tasquinimod in patients with metastatic castration-resistant prostate cancer responsive to or stabilized during first-line docetaxel chemotherapy

    DEFF Research Database (Denmark)

    Fizazi, K; Ulys, A; Sengeløv, L

    2017-01-01

    ) to receive tasquinimod (0.25-1.0 mg/day orally) or placebo. The primary end point was radiologic progression-free survival (rPFS); secondary efficacy end points included: overall survival (OS); PFS on next-line therapy (PFS 2) and symptomatic PFS, assessed using the Brief Pain Inventory (BPI) questionnaire...... duration of treatment was 18.7 weeks (range 0.6-102.7 weeks) for the tasquinimod arm and 19.2 weeks (range 0.4-80.0 weeks) for the placebo arm. Median (90% CI) rPFS was 31.7 (24.3-53.7) and 22.7 (16.1-25.9) weeks in the tasquinimod and placebo arms, respectively [HR (90% CI) 0.6 (0.4-0.9), P = 0...... in the tasquinimod and placebo arms (97.2% versus 94.3%, respectively), whereas severe TEAEs (NCI-CTC Grade 3-5) incidence was higher in the tasquinimod group (50.7% versus 27.1%). Conclusions: Randomized trials testing new drugs as maintenance can be successfully conducted after chemotherapy in castrate...

  20. Influence of androgen deprivation therapy on the uptake of PSMA-targeted agents: Emerging opportunities challenges

    Energy Technology Data Exchange (ETDEWEB)

    Bakht, Martin K.; Oh, So Won; Youn, Hye Won; Cheon, Gi Jeong; Kwak, Cheol; Kang, Keon Wook [Seoul National University College of Medicine, Seoul (Korea, Republic of)

    2017-09-15

    Prostate-specific membrane antigen (PSMA) is an attractive target for both diagnosis and therapy because of its high expression in the vast majority of prostate cancers. Development of small molecules for targeting PSMA is important for molecular imaging and radionuclide therapy of prostate cancer. Recent evidence implies that androgen-deprivation therapy increase PSMA-ligand uptake in some cases. The reported upregulations in PSMA-ligand uptake after exposure to second-generation antiandrogens such as enzalutamide and abiraterone might disturb PSMA-targeted imaging for staging and response monitoring of patients undergoing treatment with antiandrogen-based drugs. On the other hand, second-generation antiandrogens are emerging as potential endoradio-/chemosensitizers. Therefore, the enhancement of the therapeutic efficiency of PSMA-targeted theranostic methods can be listed as a new capability of antiandrogens. In this manuscript, we will present what is currently known about the mechanism of increasing PSMA uptake following exposure to antiandrogens. In addition, we will discuss whether these above-mentioned antiandrogens could play the role of endoradio-/chemosensitizers in combination with the well-established PSMA-targeted methods for pre-targeting of prostate cancer.

  1. Influence of Craniosacral Therapy on Anxiety, Depression and Quality of Life in Patients with Fibromyalgia

    Directory of Open Access Journals (Sweden)

    Guillermo A. Matarán-Peñarrocha

    2011-01-01

    Full Text Available Fibromyalgia is considered as a combination of physical, psychological and social disabilities. The causes of pathologic mechanism underlying fibromyalgia are unknown, but fibromyalgia may lead to reduced quality of life. The objective of this study was to analyze the repercussions of craniosacral therapy on depression, anxiety and quality of life in fibromyalgia patients with painful symptoms. An experimental, double-blind longitudinal clinical trial design was undertaken. Eighty-four patients diagnosed with fibromyalgia were randomly assigned to an intervention group (craniosacral therapy or placebo group (simulated treatment with disconnected ultrasound. The treatment period was 25 weeks. Anxiety, pain, sleep quality, depression and quality of life were determined at baseline and at 10 minutes, 6 months and 1-year post-treatment. State anxiety and trait anxiety, pain, quality of life and Pittsburgh sleep quality index were significantly higher in the intervention versus placebo group after the treatment period and at the 6-month follow-up. However, at the 1-year follow-up, the groups only differed in the Pittsburgh sleep quality index. Approaching fibromyalgia by means of craniosacral therapy contributes to improving anxiety and quality of life levels in these patients.

  2. Influence of androgen deprivation therapy on the uptake of PSMA-targeted agents: Emerging opportunities challenges

    International Nuclear Information System (INIS)

    Bakht, Martin K.; Oh, So Won; Youn, Hye Won; Cheon, Gi Jeong; Kwak, Cheol; Kang, Keon Wook

    2017-01-01

    Prostate-specific membrane antigen (PSMA) is an attractive target for both diagnosis and therapy because of its high expression in the vast majority of prostate cancers. Development of small molecules for targeting PSMA is important for molecular imaging and radionuclide therapy of prostate cancer. Recent evidence implies that androgen-deprivation therapy increase PSMA-ligand uptake in some cases. The reported upregulations in PSMA-ligand uptake after exposure to second-generation antiandrogens such as enzalutamide and abiraterone might disturb PSMA-targeted imaging for staging and response monitoring of patients undergoing treatment with antiandrogen-based drugs. On the other hand, second-generation antiandrogens are emerging as potential endoradio-/chemosensitizers. Therefore, the enhancement of the therapeutic efficiency of PSMA-targeted theranostic methods can be listed as a new capability of antiandrogens. In this manuscript, we will present what is currently known about the mechanism of increasing PSMA uptake following exposure to antiandrogens. In addition, we will discuss whether these above-mentioned antiandrogens could play the role of endoradio-/chemosensitizers in combination with the well-established PSMA-targeted methods for pre-targeting of prostate cancer

  3. Renal function after unilateral nephrectomy for Wilms' tumour: the influence of radiation therapy

    International Nuclear Information System (INIS)

    Graaf, S.S.N. de; Gent, H. van; Reitsma-Bierens, W.Ch.C.; Luyk, W.H.J. van; Postma, A.; Dolsma, W.V.

    1996-01-01

    The effect of therapy on renal function after unilateral nephrectomy for Wilms' tumour was studied. In the second year following unilateral nephrectomy, glomerular filtration rate (GFR) and effective renal plasma flow (ERPF) were estimated simultaneously by measuring 125 I-iothalamate clearance and 131 I-hippurate clearance. Of 41 evaluable patients, 29 received chemotherapy as sole treatment modality following nephrectomy (group 1); 12 patients additionally received radiation therapy to a field that included the remaining kidney (group 2). Results were expressed as standard deviation scores (z-scores). In group 1, mean z-score for GFR was -0.27 (94.6% of normal) and in group 2 mean z-score was -1.51 (72.7% of normal for two kidneys) (P = 0.022, Mann-Whitney U-test). Mean z-score for ERPF was -0.09 (97.0%) in group 1 and -1.53 (73.8%) in group 2 (P 0.039). It was concluded that the combination of chemotherapy and radiation therapy, in contrast to chemotherapy alone, negatively affects the ability of the remaining kidney to adjust its function after the loss of its counterpart. (author)

  4. The influence of music and music therapy on pain-induced neuronal oscillations measured by magnetencephalography.

    Science.gov (United States)

    Hauck, Michael; Metzner, Susanne; Rohlffs, Fiona; Lorenz, Jürgen; Engel, Andreas K

    2013-04-01

    Modern forms of music therapy are clinically established for various therapeutic or rehabilitative goals, especially in the treatment of chronic pain. However, little is known about the neuronal mechanisms that underlie pain modulation by music. Therefore, we attempted to characterize the effects of music therapy on pain perception by comparing the effects of 2 different therapeutic concepts, referred to as receptive and entrainment methods, on cortical activity recorded by magnetencephalography in combination with laser heat pain. Listening to preferred music within the receptive method yielded a significant reduction of pain ratings associated with a significant power reduction of delta-band activity in the cingulate gyrus, which suggests that participants displaced their focus of attention away from the pain stimulus. On the other hand, listening to self-composed "pain music" and "healing music" within the entrainment method exerted major effects on gamma-band activity in primary and secondary somatosensory cortices. Pain music, in contrast to healing music, increased pain ratings in parallel with an increase in gamma-band activity in somatosensory brain structures. In conclusion, our data suggest that the 2 music therapy approaches operationalized in this study seem to modulate pain perception through at least 2 different mechanisms, involving changes of activity in the delta and gamma bands at different stages of the pain processing system. Copyright © 2012 International Association for the Study of Pain. Published by Elsevier B.V. All rights reserved.

  5. Socioeconomic and therapy factor influence on self-reported fatigue, anxiety and depression in rheumatoid arthritis patients

    Directory of Open Access Journals (Sweden)

    Mirjana Lapčević

    Full Text Available Abstract Introduction: Fatigue, anxiety and depression are very frequent symptoms in patients with rheumatoid arthritis (RA. Goals: In this study we evaluated the influence of socioeconomic characteristics, therapy and comorbidities on the self-reported high fatigue, anxiety and depression in patients with RA. Method: Multicenter cross-sectional study was performed in 22 health institutions in Serbia during the period from April-August 2014 in population of older RA patients. Self-reported patients health status was measured by: Fatigue Assessment Scale, Patient Health Questionnaire-9 and Generalized Anxiety Disorder-7. Treatment modalities were defined as: (1 non-steroidal anti-inflammatory drugs (NSAIDs and/or analgesics and/or corticosteroids; (2 synthetic disease-modifying antirheumatic drugs (DMARDs alone or in combination with corticosteroids and/or NSAIDs and (3 any RA treatment which includes biologic DMARDs. Results: There were significant predictors of high depression: synthetic DMARDs therapy in combination with corticosteroids and/or NSAIDs, physiotherapist self-payment, frequent taxi use, alternative treatment and employment status. The need for another person's assistance, supplemental calcium therapy and professional qualifications were the predictors of a high fatigue, whereas the age above 65 years had the protective effect on it. Anxiety was an independent high fatigue predictor. The predictors of a high anxiety were: gastroprotection with proton-pump inhibitors and patient occupation. Conclusion Socioeconomic predictors of self-reported high depression, anxiety or fatigue are different for each of the mentioned outcomes, while accompanied with the basic RA treatment they exclusively explain a high depression. The anxiety, jointed with the socioeconomic variables and supplemental therapy, is a significant fatigue predictor in RA patients.

  6. Chromatin replication and epigenome maintenance

    DEFF Research Database (Denmark)

    Alabert, Constance; Groth, Anja

    2012-01-01

    Stability and function of eukaryotic genomes are closely linked to chromatin structure and organization. During cell division the entire genome must be accurately replicated and the chromatin landscape reproduced on new DNA. Chromatin and nuclear structure influence where and when DNA replication...... initiates, whereas the replication process itself disrupts chromatin and challenges established patterns of genome regulation. Specialized replication-coupled mechanisms assemble new DNA into chromatin, but epigenome maintenance is a continuous process taking place throughout the cell cycle. If DNA...

  7. Clinical decision-making and health-related quality of life during first-line and maintenance therapy in patients with advanced non-small cell lung cancer (NSCLC): findings from a real-world setting.

    Science.gov (United States)

    Sztankay, Monika; Giesinger, Johannes Maria; Zabernigg, August; Krempler, Elisabeth; Pall, Georg; Hilbe, Wolfgang; Burghuber, Otto; Hochmair, Maximilian; Rumpold, Gerhard; Doering, Stephan; Holzner, Bernhard

    2017-08-23

    Maintenance therapy (MT) with pemetrexed has been shown to improve overall and progression-free survival of patients with non-squamous non-small cell lung cancer (NSCLC), without impairing patients' health-related quality of life (HRQOL) substantially. Comprehensive data on HRQOL under real-life conditions are necessary to enable informed decision-making. This study aims to (1) assess HRQOL during first-line chemotherapy and subsequent MT and (2) record patients' and physicians' reasons leading to clinical decisions on MT. Patients treated for NSCLC at three Austrian medical centres were included. HRQOL was assessed at every chemotherapy cycle using the EORTC QLQ-C30/+LC13 questionnaire. Semi-structured interviews were conducted before MT initiation and at the time of discontinuation to evaluate patients' and physicians' reasons for treatment decisions. Longitudinal QOL analysis was based on linear mixed models. Sixty-one (73%) out of 84 patients were considered for MT. Thirty-six patients (43%) received MT and 29 (35%) discontinued therapy. Decisions on MT initiation (in 20 cases by the physician vs 4 by the patient) and discontinuation (19 vs 10) were mainly voiced by the physician. Treatment toxicity of first-line chemotherapy was the main reason for rejection of MT in patients with stable disease and was more often indicated by patients than clinicians. HRQOL data were collected from 83 patients at 422 assessment time points and indicated significantly lower symptom severity during MT compared with first-line therapy for nausea and vomiting (p = 0.006), sleep disturbances (p loss (p = 0.043), constipation (p = 0.017) and chest pain (p = 0.022), and a deterioration in emotional functioning (p = 0.023) and cognitive functioning (p = 0.044) during MT. Our results indicate that HRQOL and symptom burden improve between first-line treatment to MT in some respects, although some late toxicity persists. Discrepancies between patients' and physicians

  8. EPR design for maintenance

    International Nuclear Information System (INIS)

    Krugmann, U.

    1998-01-01

    Preventive maintenance is very important in achieving high plant availability. For the European Pressurized Reactor (EPR) preventive maintenance has been carefully addressed in the design stage. This is particularly necessary because of the traditionally different maintenance strategies employed in France and Germany. This paper emphasizes the following features introduced in the ERP design to minimize the duration of the refueling outage: (1) containment accessibility during power operation; (2) overall plant layout to facilitate inspections and maintenances within the containment; and (3) safety system design for enabling preventive maintenance during power operation. (author)

  9. Modern electronic maintenance principles

    CERN Document Server

    Garland, DJ

    2013-01-01

    Modern Electronic Maintenance Principles reviews the principles of maintaining modern, complex electronic equipment, with emphasis on preventive and corrective maintenance. Unfamiliar subjects such as the half-split method of fault location, functional diagrams, and fault finding guides are explained. This book consists of 12 chapters and begins by stressing the need for maintenance principles and discussing the problem of complexity as well as the requirements for a maintenance technician. The next chapter deals with the connection between reliability and maintenance and defines the terms fai

  10. Managing nuclear maintenance

    International Nuclear Information System (INIS)

    Anon.

    1990-01-01

    For utilities operating nuclear powerplants, the rules of the game continue to change. Conflicting regulatory pressures and a tougher competitive environment will make management's job more complicated and difficult in the 1990s. Dealing with these pressures successfully requires greater attention to maintenance effectiveness. Utilities can help shape their future environment by developing a well-planned strategy to guide their actions. Parts of the strategy that are discussed include developing a sound maintenance philosophy, selecting a service company, radiation exposure, and managing spare parts. This article also addresses the Swedish experience in maintenance, German philosophy regarding maintenance and the current maintenance practices of the Electricite de France

  11. AIRCRAFT MAINTENANCE HANGAR

    Directory of Open Access Journals (Sweden)

    GEAMBASU Gabriel George

    2017-05-01

    Full Text Available The paper presents the maintenance process that is done on an airplane, at a certain period of time, or after a number of flight hours or cycles and describes the checks performed behind each inspection. The first part of research describes the aircraft maintenance process that has to be done after an updated maintenance manual according with aircraft type, followed by a short introduction about maintenance hangar. The second part of the paper presents a hangar design with a foldable roof and walls, which can be folded or extended, over an airplane when a maintenance process is done, or depending on weather condition.

  12. The main factors influencing canine demodicosis treatment outcome and determination of optimal therapy.

    Science.gov (United States)

    Arsenović, Milica; Pezo, Lato; Vasić, Nebojša; Ćirić, Rodoljub; Stefanović, Milan

    2015-07-01

    The main idea of this research was to evaluate the efficacy of canine demodicosis conventional treatments using mathematical analyses. All available papers published between 1980 and 2014 were used in this study. One hundred six clinical trials enrolling 3414 cases of generalized demodicosis in dogs are studied. Dogs entered in the analysis were only the ones in which the disease occurred naturally, excluding the studies in which transplantation of Demodex canis mites was done from other animals. In conventional acaricide treatments, sorted according to active substances (moxidectin, amitraz, doramectin, ivermectin, and milbemycin oxime), the way of application (spot-on, dips, orally, or subcutaneous), concentration, and interval of application were used as input parameters in mathematical modeling. Data of interest were the treatment outcome, the number of dogs that went into remission, the number of animals not responding to treatment microscopically, the average duration of therapy, the follow-up period, the number of patients with disease recurrence, the number of adverse effects, and the number of animals with side effects. Dogs lost to follow-up or when the treatment was discontinued, due to various reasons not in connection with the therapy protocol, were not considered. Statistical and mathematical analyses were applied for prediction of the drugs' effectiveness. Developed mathematical models showed satisfactorily r (2), higher than 0.87. Good evidence for recommending the use of milbemycin oxime PO (0.5 mg/kg, daily) and moxidectin spot-on (Advocate®, Bayer) weekly is found. A bit less effective therapies were based on ivermectin PO (0.5 mg/kg, daily), moxidectin PO (0.35 mg/kg, daily), and amitraz dips (0.05 % solution, weekly), respectively. It is important to keep in mind that Advocate® is recommended by the manufacturer for use in milder cases.

  13. Sialadenitis after radioiodine therapy. Analysis of factors that influence the response to medical treatment.

    Science.gov (United States)

    Geres, Alejandra E; Mereshian, Paula Szafryk; Fernández, Silvia; Rey Caro, Daniel Gonzalo; Castro, Ricardo; Podio, Ricardo; Ojeda, Silvia

    2015-12-01

    To assess the incidence of 131I-induced sialadenitis (SD) in patients with differentiated thyroid cancer (DTC), to analyze clinical and other factors related to metabolic radiotherapy that may predict the lack of response to conventional medical therapy (CMT), and to determine the effectiveness of intraductal steroid instillation in patients failing CMT. Fifty-two patients with DTC, 45 females (86.5%) and 7 males (13.5%) with a mean age of 44.21±13.3 years (r=17-74) who received ablation therapy with 131I after total thyroidectomy. Patients with diseases and/or medication causing xerostomia were excluded. Patients underwent salivary gland scintigraphy with 99Tc (10mCi). Eighteen patients (34.62%) had SD and received antibiotics, antispasmodics, and oral steroids for 15 days. They were divided into two groups: responders to medical therapy (n=12, age 44.3±14.4 years, 2 men [17%], 10 women [83%], cumulative dose 225±167.1 mCi) and non-responders to medical treatment, who underwent steroid instillation into the Stensen's duct (n=6 [33%], 2 men [33%], 4 women [67%], age 50±13.8 years, cumulative dose 138.3±61.7 mCi). Scintigraphy showed damage to the parotid and submaxillary glands. Incidence of 131I-induced sialadenitis was similar to that reported by other authors. Age, mean cumulative dose of 131I, and involvement of parotid and submaxillary glands did not condition response to CMT; however, male sex was a conditioning factor. Symptom persistence for more than 15 days makes instillation into the Stensen's duct advisable. This is an effective and safe method to avoid surgical excision of salivary glands. Copyright © 2015 SEEN. Published by Elsevier España, S.L.U. All rights reserved.

  14. Maintenance management systems

    International Nuclear Information System (INIS)

    Rohan, M. de

    1989-01-01

    This paper is concerned principally with Maintenance Management systems and their effective introduction into organisations. Maintenance improvement is basically a problem of managing the maintenance department in the broadest sense. Improvement does not only lie in the area of special techniques, systems or procedures; although they are valuable tools, but rather in a balanced attack, carefully guided by management. Over recent years, maintenance systems have received the major emphasis and in many instances the selection of the system has become a pre-occupation, whereas the importance of each maintenance function must be recognised and good management practices applied to all maintenance activities. The ingredients for success in the implementation of maintenance management systems are summarised as: having a management committee, clear objectives, project approach using project management techniques and an enthusiastic leader, user managed and data processing supported project, realistic budget and an understanding of the financial audit requirements. (author)

  15. Knowledge based maintenance

    Energy Technology Data Exchange (ETDEWEB)

    Sturm, A [Hamburgische Electacitaets-Werke AG Hamburg (Germany)

    1998-12-31

    The establishment of maintenance strategies is of crucial significance for the reliability of a plant and the economic efficiency of maintenance measures. Knowledge about the condition of components and plants from the technical and business management point of view therefore becomes one of the fundamental questions and the key to efficient management and maintenance. A new way to determine the maintenance strategy can be called: Knowledge Based Maintenance. A simple method for determining strategies while taking the technical condition of the components of the production process into account to the greatest possible degree which can be shown. A software with an algorithm for Knowledge Based Maintenance leads the user during complex work to the determination of maintenance strategies for this complex plant components. (orig.)

  16. Knowledge based maintenance

    Energy Technology Data Exchange (ETDEWEB)

    Sturm, A. [Hamburgische Electacitaets-Werke AG Hamburg (Germany)

    1997-12-31

    The establishment of maintenance strategies is of crucial significance for the reliability of a plant and the economic efficiency of maintenance measures. Knowledge about the condition of components and plants from the technical and business management point of view therefore becomes one of the fundamental questions and the key to efficient management and maintenance. A new way to determine the maintenance strategy can be called: Knowledge Based Maintenance. A simple method for determining strategies while taking the technical condition of the components of the production process into account to the greatest possible degree which can be shown. A software with an algorithm for Knowledge Based Maintenance leads the user during complex work to the determination of maintenance strategies for this complex plant components. (orig.)

  17. [The influence of drug liberation from drug forms on local therapy of infected bone cavities].

    Science.gov (United States)

    Süss, W; Wehr, M

    1984-09-01

    With regard to an optimum local pharmaco-therapy in infected bone cavities, in vitro examinations by means of a flow model based on the half-change method had been performed to liberate Gentamycin from globular embeddings in polymethylmethacrylate. The Gentamycin had been determined in a micro-biological manner. The release behaviour of the polymere carrier could be controlled by adding Polyethylenglycol 400 as softener or butane dioldimethacrylate as wettener. Adding 20 vol.-% of Polyethylenglycol 400, the Gentamycin release could be increased to the 8-fold, whereas the addition of 5 vol.-% of butane dioldimethacrylate resulted in a decrease amounting to 7/8 exit value.

  18. Influence of the Human Skin Tumor Type in Photodynamic Therapy Analysed by a Predictive Model

    Directory of Open Access Journals (Sweden)

    I. Salas-García

    2012-01-01

    Full Text Available Photodynamic Therapy (PDT modeling allows the prediction of the treatment results depending on the lesion properties, the photosensitizer distribution, or the optical source characteristics. We employ a predictive PDT model and apply it to different skin tumors. It takes into account optical radiation distribution, a nonhomogeneous topical photosensitizer spatial temporal distribution, and the time-dependent photochemical interaction. The predicted singlet oxygen molecular concentrations with varying optical irradiance are compared and could be directly related with the necrosis area. The results show a strong dependence on the particular lesion. This suggests the need to design optimal PDT treatment protocols adapted to the specific patient and lesion.

  19. Influence of smoking associated with stress on the outcome of radioiodine therapy in patients with Graves' disease

    International Nuclear Information System (INIS)

    Sekulic, V.; Rajic, M.; Vlajkovic, M.; Ilic, S.; Stevic, M.

    2015-01-01

    Full text of publication follows. Introduction: Graves' disease (GD) is characterized by activation of the immune system as a result of interactions between genetic predisposition and environmental factors such as iodine intake, stressful events or smoking. Currently, there are no sufficient data on influence of nicotine and other components of tobacco smoking on outcome of radioiodine therapy in GD. The aim of this study was to analyze a possible influence of cigarette smoking associated with stress on the outcome of radioiodine therapy (RIT) in the patients with Graves' disease. Patients and methods: the study included 29 patients (23 female) aged from 22 to 73 years, who were subjects of a follow-up within 12 months after RIT. The stressful events were presented in all patients prior to diagnosing the GD. Patients were divided into two groups: 1. smokers - 15 patients who smoked cigarettes before, at the moment and after RIT, and 2. non-smokers - 14 patients who were always non-smokers. Patients were treated using a sliding scale of fixed activity of radioiodine according to the goiter size. Antithyroid drugs were discontinued 7 days before radioiodine therapy. Therapy outcome was assessed by serum TSH and thyroid hormones levels, and clinical evaluation. A successful response (SR) to RIT was defined as euthyroidism and subclinical or clinical hypothyroidism, and unsuccessful response (UR) as persistent hyperthyroidism. Results: comparison of age (48.0±9.39 vs. 49.6±14.3 years, P=0.715), values of TRAb (2.25±0.91 vs. 2.75±1.32 U/l, P=0.560), administered activity of 131 I-NaI (365±75.8 vs. 360±44.4 MBq, P=0.832), and duration of ATDs therapy before RIT (3.34±3.41 vs. 5.06±5.81 years, P=0.397) between smokers and non-smokers showed no significant difference. There was no significant influence of smoking on UR at 3., 6., 9. and 12. month compared with UR in patients who did not smoke (P=0.597, P=0.837, P=0.876, P=0.812, χ 2 test). The cumulative

  20. Cytosolic calcium ions exert a major influence on the firing rate and maintenance of pacemaker activity in guinea-pig sinus node.

    Directory of Open Access Journals (Sweden)

    Rebecca Anne Capel

    2015-02-01

    Full Text Available The sino-atrial node (SAN provides the electrical stimulus to initiate every heart beat. Cellular processes underlying this activity have been debated extensively, especially with regards to the role of intracellular calcium. We have used whole-cell application of 1,2-bis(o-aminophenoxyethane-N,N,N',N'-tetraacetic acid (BAPTA, a rapid calcium chelator, to guinea pig isolated SAN myocytes to assess the effect of rapid reduction of intracellular calcium on SAN cell electrical activity. High-dose (10 mM BAPTA induced rapid and complete cessation of rhythmic action potential (AP firing (time to cessation 5.5±1.7 s. Over a range of concentrations, BAPTA induced slowing of action potential firing and disruption of rhythmic activity, which was dose-dependent in its time of onset. Exposure to BAPTA was associated with stereotyped action potential changes similar to those previously reported in the presence of ryanodine, namely depolarisation of the most negative diastolic potential, prolongation of action potentials and a reduction in action potential amplitude. These experiments are consistent with the view that cytosolic calcium is essential to the maintenance of rhythmic pacemaker activity.

  1. The Influence of Marriage and Family Therapy Training on Father-Son Relationships

    Science.gov (United States)

    Sowders, John Patrick

    2013-01-01

    The current literature available seeking to describe the influence of mental health professions on family life is minimal. An exhaustive review of empirical research revealed that sixteen articles are present with the majority of the focus on distinct mental health professions outside of MFT such as psychiatry, social work and psychology. Two of…

  2. Occupational therapy influence on a carer peer support model in a clinical mental health service.

    Science.gov (United States)

    Bourke, Cate; Sanders, Bronwyn; Allchin, Becca; Lentin, Primrose; Lang, Shannon

    2015-10-01

    Current policy frameworks call for the participation of consumers and carers in all levels of mental health service delivery in Australia. Such inclusion leads to better outcomes for all, however, it is recognised that carers have needs and occupations beyond their carer role. The aim of this article is to describe an innovative carer peer support program developed by a group of occupational therapists. The article describes the rationale, phases of development and the role that occupational therapists played in developing and sustaining the model. This is followed by an exploration of the occupational therapy attitudes, knowledge and skills that contributed to the conceptualisation and implementation of the model. Five occupational therapists engaged in a review process involving documentation, literature review, evaluation, reflection and discussion. Four of the occupational therapists had either coordinated or managed the service described. The fifth author facilitated the process. Review of the model indicates it equips carers to perform their caring occupation and helps carers recognise the need for occupations beyond caring, for their health and wellbeing. Employing carers as paid workers values their 'real life' experience in their caring occupation. Findings also illustrate that the attitudes, knowledge, skills and competency standards of occupational therapists are well suited in enabling this emerging area of service delivery. Although this model has been developed in a clinical mental health setting, the key principles could be applied with carers or consumers across a variety of settings in which occupational therapists are employed. © 2015 Occupational Therapy Australia.

  3. Influence of protoporphyrin IX loaded phloroglucinol succinic acid dendrimer in photodynamic therapy

    Science.gov (United States)

    Kumar, M. Suresh; Aruna, P.; Ganesan, S.

    2018-03-01

    One of the major problems reported clinically for photosensitizers (PS) in Photodynamic therapy (PDT) is, the cause of side-effects to normal tissue due to dark toxicity. The usefulness of photosensitizers can be made possible by reducing its dark toxicity nature. In such scenario, biocompatible carriers can be used as a drug delivery system to evade the problems that arises while using free (dark toxic) drugs. So in this study, we have developed a nano drug delivery system called Phloroglucinol Succinic acid (PGSA) dendrimer, entrapped a photosensitizer, protoporphyrin IX (PpIX) inside the system and investigated whether the photodynamic efficacy of the anionic surface charged dendrimer-PpIX nano formulation is enhanced than achieved by the free PpIX in HeLa cancer cell lines. Moreover, the Reactive oxygen species (ROS) production was monitored using 2‧,7‧-dichlorodihydrofluorescein diacetate (H2DCF-DA)- ROS Marker with phase contrast microscopy for the IC50 values of free and dendrimer-PpIX nano formulation. Similarly, the mode of cell death has been confirmed by cell cycle analysis for the same. For the in vitro PDT application, we have used a simple light source (Light Emitting Diode) with a power of 30-50 mW for 20 min irradiation. Hence, in this study we have taken steps to report this anionic drug delivery system is good to consider for the photodynamic therapy applications with the photosensitizer, PpIX which satisfied the prime requirement of PDT.

  4. Preoperative physical therapy treatment did not influence postoperative pain and disability outcomes in patients undergoing shoulder arthroscopy: a prospective study

    Directory of Open Access Journals (Sweden)

    Valencia C

    2016-07-01

    Full Text Available Carolina Valencia,1 Rogelio A Coronado,2 Corey B Simon,3,4 Thomas W Wright,5 Michael W Moser,5 Kevin W Farmer,5 Steven Z George3,6,7 1Department of Applied Medicine and Rehabilitation, Indiana State University, Terre Haute, IN, 2Department of Orthopaedic Surgery, Vanderbilt University Medical Center, Nashville, TN, 3Department of Physical Therapy, College of Public Health and Health Professions, University of Florida, Gainesville, FL, 4Department of Community Dentistry and Behavioral Science, College of Dentistry, University of Florida, Gainesville,FL, 5Department of Orthopaedics and Rehabilitation, University of Florida, Gainesville, FL, 6Center for Pain Research and Behavioral Health, University of Florida, Gainesville, FL, 7Brooks–PHHP Research Collaboration, Jacksonville, FL, USA Background: There is limited literature investigating preoperative physical therapy (pre-op PT treatment on pain intensity and disability after musculoskeletal surgery. The purposes of the present cohort study were to describe patient characteristics for those who had and did not have pre-op PT treatment and determine whether pre-op PT influenced the length of postoperative physical therapy (post-op PT treatment (number of sessions and 3-month and 6-month postsurgical outcomes, such as pain intensity and disability. Patients and methods: A total of 124 patients (mean age =43 years, 81 males with shoulder pain were observed before and after shoulder arthroscopic surgery. Demographic data, medical history, and validated self-report questionnaires were collected preoperatively and at 3 months and 6 months after surgery. Analysis of variance models were performed to identify differences across measures for patients who had pre-op PT treatment and those who did not and to examine outcome differences at 3 months and 6 months. Alpha was set at the 0.05 level for statistical significance. Results: Males had less participation in pre-op PT than females (P=0.01. In

  5. How gender, age, and geography influence the utilization of radiation therapy in the management of malignant melanoma

    International Nuclear Information System (INIS)

    French, John; McGahan, Colleen; Duncan, Graeme; Lengoc, Sonca; Soo, Jenny; Cannon, Jerry

    2006-01-01

    Purpose: Comparing radiation therapy utilization rates (RTUR) to those predicted by best evidence is a useful measure of the equity and accessibility of service delivery. In this study the RTUR for melanoma was established for British Columbia, Canada, and compared with the rate suggested by the evidence. Demographic variables, specifically age, gender, and geography that influenced the RTUR were examined with a view to identifying methods of improving underutilization. Methods and Materials: The RTUR in the management of malignant melanoma was taken from British Columbia Cancer registry data for 1986 to 1998. Variations in utilization based on age, gender, health authority, stage of disease, and referral patterns were analyzed. Results: An RTUR of 11% was identified. This was consistent over time. Referral rates decreased between 1986 and 1998. RT is used mostly for later stage disease. Males were more likely to receive RT than females, related to later stage of disease in men. Referral rates decreased, but RTUR for referred cases increased, in health authorities that did not have a cancer center. Conclusions: Use of RT is influenced by age and by stage of disease. Overall RTUR in British Columbia is lower than suggested by best evidence. Referral patterns are influenced by geography. RTUR was higher in males, consistent with a different pattern of disease in males compared with females

  6. Environmental favourable foundries through maintenance activities

    Directory of Open Access Journals (Sweden)

    A. Saniuk

    2015-10-01

    Full Text Available Maintenance today contributes to the aim of sustainable development in society, including environmental and energy saving, safety and economical aspects. The main purpose of the paper is to present the role of maintenance in the realization of sustainable developing practices in a foundry industry. Maintenance offers numerous opportunities to reduce the influence of foundry processes on the natural environment and utilize resources more efficiently. Maintenance activities can help to reduce losses and thereby improve the efficiency of the processes used in the production of resources (e.g. raw materials, energy, etc., especially in areas such as: the choice of an appropriate strategy for the maintenance of machinery and equipment (e.g. reactive, preventive, proactive; inventory management of spare parts; lubrication management and management of technology media.

  7. Pilot study of sexual dysfunction in patients with psoriasis: Influence of biologic therapy

    Directory of Open Access Journals (Sweden)

    Ricardo Ruiz-Villaverde

    2011-01-01

    Full Text Available Background: Psoriasis is a chronic skin disease that affects 1 to 3% of the population in most industrialized countries. It is commonly associated with a variety of psychological problems including low self-esteem, depression, suicidal thoughts, and sexual dysfunction. Materials and Methods : We have performed a pilot study in which we have tried to assess the impact on sexual dysfunction in patients with psoriasis who have started treatment with biological therapy using validated indexes in Spanish: International Index of Erectile Function for men and female sexual function index in women. Results : Considering the men and women from our study, an improvement in FSFI by an average of 9.5 and 6.3 points is observed, respectively. Conclusion: We considered our series as a first step for a more detailed approach to the study of sexual function in patients with psoriasis.

  8. Influence of macrolide maintenance therapy and bacterial colonisation on exacerbation frequency and progression of COPD (COLUMBUS): Study protocol for a randomised controlled trial

    NARCIS (Netherlands)

    S. Uzun (Sevim); R.S. Djamin (Remco); J.A.J.W. Kluytmans (Jan); N.E. van 't Veer (Nils); A.A.M. Ermens (Anton); A.J. Pelle (Aline); P.G.H. Mulder (Paul); M. van der Eerden (Menno); J.G.J.V. Aerts (Joachim)

    2012-01-01

    textabstractBackground: Chronic obstructive pulmonary disease (COPD) is characterised by progressive development of airflow limitation that is poorly reversible. Because of a poor understanding of COPD pathogenesis, treatment is mostly symptomatic and new therapeutic strategies are limited. There is

  9. In vivo study on influence of the heterogeneity of tissues in the dose distribution in high energy X ray therapy

    International Nuclear Information System (INIS)

    Aldred, M.A.

    1987-01-01

    Several authors investigated the effect of the heterogeneity of tissue in the dose distribution in a radiation-therapy. Practically all of them carried out ''in vitro'' measurements using a solid body immersed in a water phantom, in order to simulate the inhomogeneity, such as bone, air cavity, etc. In the present work, ''in vivo'' measurements were performed utilizing thermoluminescent dosimeters, whose appropriateness and convenience are well known. Eight patients at Instituto de Radioterapia Oswaldo Cruz were selected, that were under irradiation treatments in their pelvic region. The ratio between body entry radiation dose and the corresponding exit dose, when compared to the same ratio for a homogeneous phantom, gives the influence of the heterogeneity of the tissue the radiation crosses. The results found in those eight patients have shown that ''in vivo'' measurements present a ratio about 8% smaller that in homogeneous phantom case. (author) [pt

  10. Random maintenance policies

    CERN Document Server

    Nakagawa, Toshio

    2014-01-01

    Exploring random maintenance models, this book provides an introduction to the implementation of random maintenance, and it is one of the first books to be written on this subject.  It aims to help readers learn new techniques for applying random policies to actual reliability models, and it provides new theoretical analyses of various models including classical replacement, preventive maintenance and inspection policies. These policies are applied to scheduling problems, backup policies of database systems, maintenance policies of cumulative damage models, and reliability of random redundant systems. Reliability theory is a major concern for engineers and managers, and in light of Japan’s recent earthquake, the reliability of large-scale systems has increased in importance. This also highlights the need for a new notion of maintenance and reliability theory, and how this can practically be applied to systems. Providing an essential guide for engineers and managers specializing in reliability maintenance a...

  11. Framework for Maintenance Planning

    DEFF Research Database (Denmark)

    Soares, C. Guedes; Duarte, J. Caldeira; Garbatov, Y.

    2010-01-01

    the design and during the whole life span of operational use, within an integrated framework founded on risk and reliability based techniques. The document addresses designers, decision makers and professionals responsible for or involved in establishing maintenance plans. The purpose of this document......The present document presents a framework for maintenance planning. Maintenance plays a fundamental role in counteracting degradation effects, which are present in all infrastructure and industrial products. Therefore, maintenance planning is a very critical aspect to consider both during...... is to present maintenance as an integrated approach that needs to be planned, designed, engineered, and controlled by proper qualitative and quantitative techniques. This document outlines the basic premises for maintenance planning and provides the general philosophies that can be followed and points to a best...

  12. Suncor maintenance and reliability

    Energy Technology Data Exchange (ETDEWEB)

    Little, S. [Suncor Energy, Calgary, AB (Canada)

    2006-07-01

    Fleet maintenance and reliability at Suncor Energy was discussed in this presentation, with reference to Suncor Energy's primary and support equipment fleets. This paper also discussed Suncor Energy's maintenance and reliability standard involving people, processes and technology. An organizational maturity chart that graphed organizational learning against organizational performance was illustrated. The presentation also reviewed the maintenance and reliability framework; maintenance reliability model; the process overview of the maintenance and reliability standard; a process flow chart of maintenance strategies and programs; and an asset reliability improvement process flow chart. An example of an improvement initiative was included, with reference to a shovel reliability review; a dipper trip reliability investigation; bucket related failures by type and frequency; root cause analysis of the reliability process; and additional actions taken. Last, the presentation provided a graph of the results of the improvement initiative and presented the key lessons learned. tabs., figs.

  13. Pretreatment factors significantly influence quality of life in cancer patients: A Radiation Therapy Oncology Group (RTOG) analysis

    International Nuclear Information System (INIS)

    Movsas, Benjamin; Scott, Charles; Watkins-Bruner, Deborah

    2006-01-01

    Purpose The purpose of this analysis was to assess the impact of pretreatment factors on quality of life (QOL) in cancer patients. Methods and Materials Pretreatment QOL (via Functional Assessment of Cancer Therapy [FACT], version 2) was obtained in 1,428 patients in several prospective Radiation Therapy Oncology Group (RTOG) trials including nonmetastatic head-and-neck (n = 1139), esophageal (n = 174), lung (n = 51), rectal (n = 47), and prostate (n = 17) cancer patients. Clinically meaningful differences between groups were defined as a difference of 1 standard error of measurement (SEM). Results The mean FACT score for all patients was 86 (20.7-112) with SEM of 5.3. Statistically significant differences in QOL were observed based on age, race, Karnofsky Performance Status, marital status, education level, income level, and employment status, but not by gender or primary site. Using the SEM, there were clinically meaningful differences between patients ≤50 years vs. ≥65 years. Hispanics had worse QOL than whites. FACT increased linearly with higher Karnofsky Performance Status and income levels. Married patients (or live-in relationships) had a better QOL than single, divorced, or widowed patients. College graduates had better QOL than those with less education. Conclusion Most pretreatment factors meaningfully influenced baseline QOL. The potentially devastating impact of a cancer diagnosis, particularly in young and minority patients, must be addressed

  14. Influence of reminder therapy for controlling bacterial plaque in patients undergoing orthodontic treatment: A systematic review and meta-analysis.

    Science.gov (United States)

    Lima, Igor Felipe Pereira; de Andrade Vieira, Walbert; de Macedo Bernardino, Ítalo; Costa, Pedro Augusto; Lima, Anderson Paulo Barbosa; Pithon, Matheus Melo; Paranhos, Luiz Renato

    2018-04-17

    To assess the scientific evidence regarding the influence of reminder therapy on plaque index, gingival index, and white spots in patients subjected to orthodontic treatment. Randomized clinical trials were searched in the electronic databases LILACS, PubMed, SciELO, Scopus, Web of Science, Embase, LIVIVO, and Cochrane Library. The databases OpenThesis and OpenGrey were used to capture the "gray literature," preventing selection and publication biases. The risk of bias was assessed by the Joanna Briggs Institute Critical Appraisal Checklist for Randomized Controlled Trials tool. The software Review Manager was used for the meta-analysis. The heterogeneity among studies was assessed through the I 2 statistic. A summary of the overall strength of evidence available was assessed using the Grades of Recommendations Assessment, Development, and Evaluation tool. A total of 332 records were found, from which only 7 articles met the inclusion criteria and were subjected to analysis. Reminder therapy showed improved scores for the plaque index (standardized mean difference = -1.22; 95% confidence interval = -2.03 to -0.42; P = .003) and the gingival index (standardized mean difference = 1.49; 95% confidence interval = -2.61 to 0.37; P = .009). Moreover, there was lower occurrence of white spots (relative risk = 0.53; 95% confidence interval = 0.38 to 0.74; P plaque and gingival indices as well as to the lower occurrence of white spots in patients subjected to orthodontic treatment.

  15. Factors Influencing Acceptability and Perceived Impacts of a Mandatory ePortfolio Implemented by an Occupational Therapy Regulatory Organization.

    Science.gov (United States)

    Vachon, Brigitte; Foucault, Marie-Lyse; Giguère, Charles-Édouard; Rochette, Annie; Thomas, Aliki; Morel, Martine

    2018-01-01

    The use of ePortfolios has been implemented in several regulatory organizations to encourage clinicians' engagement in continuing professional development (CPD). However, their use has achieved mixed success, and multiple personal and contextual factors can influence their impacts on practice change. The aim of this study was to identify which factors influence the acceptability and perceived impacts of an ePortfolio implemented by an occupational therapy regulatory organization in one Canadian province. A cross-sectional online survey design was used. The survey was sent to registered occupational therapists in Quebec. Multiple regression analyses were conducted to identify factors influencing acceptability and outcomes: ease of use, satisfaction, impact on implementation of the CPD plan, and competence improvement. The survey was fully completed by 546 participants. Factors significantly influencing the ePortfolio acceptability and perceived impacts were attitude toward and familiarity with the portfolio, confidence in reflective skills, engagement in the CPD plan, and desire for feedback. Time spent completing the ePortfolio and the fact of completing it in teams were negatively associated with the outcomes. Shaping more favorable user attitudes, helping users recognize and experience the tool's benefits for their practice, and fostering confidence in their reflective skills are important factors that can be addressed to improve ePortfolio acceptability and outcomes. Contextual factors, such as time spent completing the ePortfolio and completing it in teams, seem to reflect greater difficulty with using the tool. Study findings can contribute to improving ePortfolio implementation in the CPD context.

  16. Software evolution and maintenance

    CERN Document Server

    Tripathy, Priyadarshi

    2014-01-01

    Software Evolution and Maintenance: A Practitioner's Approach is an accessible textbook for students and professionals, which collates the advances in software development and provides the most current models and techniques in maintenance.Explains two maintenance standards: IEEE/EIA 1219 and ISO/IEC14764Discusses several commercial reverse and domain engineering toolkitsSlides for instructors are available onlineInformation is based on the IEEE SWEBOK (Software Engineering Body of Knowledge)

  17. Status of fusion maintenance

    International Nuclear Information System (INIS)

    Fuller, G.M.

    1984-01-01

    Effective maintenance will be an essential ingredient in determining fusion system productivity. This level of productivity will result only after close attention is paid to the entire system as an entity and appropriate integration of the elements is made. The status of fusion maintenance is reviewed in the context of the entire system. While there are many challenging developmental tasks ahead in fusion maintenance, the required technologies are available in several high-technology industries, including nuclear fission

  18. Laboratory equipment maintenance contracts.

    Science.gov (United States)

    Boudreau, D A; Scheer, W D; Catrou, P G

    1985-12-01

    The increasing level of technical sophistication and complexity found in clinical laboratory instrumentation today more than ever demands careful attention to maintenance service needs. The time-worn caution for careful definition of requirements for acquisition of a system should also carry over to acquisition of maintenance service. Guidelines are presented for specifications of terms and conditions for maintenance service from the perspective of the laboratorian in the automated clinical laboratory.

  19. Interactive videodisc in maintenance

    International Nuclear Information System (INIS)

    Zwingelstein, G.; Nguyen Van Nghi, B.

    1986-01-01

    After a recall of the videodisc characteristics, this paper presents its utilization by Electricite de France in the framework of training and maintenance. The SICMA (Interactive Communication System in Maintenance) developed and tested by Electricte de France is presented as also its utilization. It has been tested on the sites of Dampierre and Paluel in the cases of training and maintenance (deconnexion of drive rods of control elements); the conclusions of this experimentation are finally given. 4 refs [fr

  20. Turbine maintenance and modernization

    Energy Technology Data Exchange (ETDEWEB)

    Unga, E. [Teollisuuden Voima Oy, Olkiluoto (Finland)

    1998-12-31

    The disturbance-free operation of the turbine plant plays an important role in reaching good production results. In the turbine maintenance of the Olkiluoto nuclear power plant the lifetime and efficiency of turbine components and the lifetime costs are taken into account in determining the turbine maintenance and modernization/improvement program. The turbine maintenance program and improvement/modernization measures taken in the plant units are described in this presentation. (orig.)

  1. Turbine maintenance and modernization

    Energy Technology Data Exchange (ETDEWEB)

    Unga, E [Teollisuuden Voima Oy, Olkiluoto (Finland)

    1999-12-31

    The disturbance-free operation of the turbine plant plays an important role in reaching good production results. In the turbine maintenance of the Olkiluoto nuclear power plant the lifetime and efficiency of turbine components and the lifetime costs are taken into account in determining the turbine maintenance and modernization/improvement program. The turbine maintenance program and improvement/modernization measures taken in the plant units are described in this presentation. (orig.)

  2. Influence of growth hormone therapy on selected dental and skeletal system parameters.

    Science.gov (United States)

    Partyka, Małgorzata; Chałas, Renata; Dunin-Wilczyńska, Izabella; Drohomyretska, Myroslava; Klatka, Maria

    2018-03-14

    Growth hormone deficiency (GHD) is one of the main indications for growth hormone therapy. One characteristic of this disease is bone age delay in relation to the chronological age. Pituitary dysfunction negatively affects the growth and development of the jaws and teeth of the child. The secretion of endocrine glands regulates growth, development, and gender differentiation. It also controls the growth of bones and teeth, regulates metabolism of calcium and phosphate, proteins, lipids and carbohydrates. The primary role in the endocrine system is played by the pituitary gland which is responsible for the production of somatotropin [1]. Dysfunction of the pituitary gland has a negative effect on the growth and development of long bones in the body, and may have an adverse effect on the development of maxilla, mandible and dentition of a child. There is some information in the literature that dental age is delayed in short stature children; the replacement of deciduous teeth by permanent teeth is also delayed, and newly erupted permanent teeth often require orthodontic treatment. Applying hormonal therapy positively affects the process of replacement of dentition [2, 3, 4, 5, 6]. The aim of the study was to assess bone and dental age, as well as analyze the state of dentition in children diagnosed with GH deficiency treated with growth hormone, depending on the duration of treatment. The study material consisted of 110 children (27 males, 83 females), hospitalized for somatotropin hypopituitarism in the Department of Paediatric Endocrinology and Diabetology at the Medical University of Lublin, Poland. The mean birth age was 13 years (156 months) with a standard deviation of 2 years and 6 months (30 months). 47 children (43%) started treatment with the growth hormone (group starting treatment) and 63 children (57%) whose treatment was started 2-3 years previously (group in the course of treatment). The control group consisted of 41 generally healthy children (15males

  3. Industrial Maintenance Strategies

    International Nuclear Information System (INIS)

    Sajjad Akbar

    2006-01-01

    Industrial plants have become more complex due to technological advancement. This has made the task of maintenance more difficult. The maintenance costs in terms of resources and downtime loss are so high that maintenance function has become a critical factor in a plant's profitability. Industry should devote as much forethought to the management of maintenance function as to production. Maintenance has grown from an art to a precise, technical engineering science. Planning, organizing scheduling and control of maintenance using modern techniques pays dividends in the form of reduced costs and increased reliability. The magnitude and the dimension of maintenance have multiplied due to development in the engineering technologies. Production cost and capacities are directly affected by the breakdown time. Total operating cost including the maintenance cost plays an important role in replacement dimension. The integrated system approach would bring forth the desired results of high maintenance standards. The standards once achieved and sustained, would add to the reliability of the plan and relieve heavy stresses and strains on the engineering logistic support. (author)

  4. Analysis of maintenance strategies

    International Nuclear Information System (INIS)

    Laakso, K.; Simola, K.

    1998-01-01

    The main topics of the presentation include: (1) an analysis model and methods to evaluate maintenance action programs and the support decision to make changes in them and (2) to understand the maintenance strategies in a systems perspective as a basis for future developments. The subproject showed how systematic models for maintenance analysis and decision support, utilising computerised and statistical tool packages, can be taken into use for evaluation and optimisation of maintenance of active systems from the safety and economic point of view

  5. Remote Maintenance Monitoring System -

    Data.gov (United States)

    Department of Transportation — The Remote Maintenance and Monitoring System (RMMS) is a collection of subsystems that includes telecommunication components, hardware, and software, which serve to...

  6. Army Maintenance System Transformation

    National Research Council Canada - National Science Library

    Gilbertson, Frank V

    2006-01-01

    .... Used in conjunction with pertinent historical data and developed with Army transformation goals in mind, General Systems thinking can provide the framework for guiding maintenance transformation...

  7. Influence of intensity-modulated radiation therapy on parotid function in nasopharyngeal carcinoma

    International Nuclear Information System (INIS)

    Cui Tiantian; Wu Shaoxiong; Han Fei; Lu Lixia; Huang Shaomin; Deng Xiaowu; Lu Taixiang; Zhao Chong

    2009-01-01

    Objective: To evaluate the effect of intensity-modulated radiation therapy (IMRT) on parotid function in nasopharyngeal carcinoma (NPC). Methods: Eighty-three NPC patients received prima- ry IMRT between 2001 and 2003. Xerostomia before radiotherapy, at the end of radiotherapy, at 6-month, 1-, 2-,3-,4- and 5-year after radiotherapy were investigated, respectively. The relation between xerostomia and parotid dose distribution was analyzed. Results: Of all the patients, 4, 31, 31 and 17 had stage I, II, III and IV A disease, respectively. Sixteen patients received chemo-radiotherapy. The median followed-up time was 65 months. The 5-year local control and regional control rate were 96% and 95%, respectively. The 5- year overall survival rate was 80%. The mild xerostomia rate at the seven time points was 42%, 51%, 71%, 77%, 58%, 38% and 26%. The corresponding moderate xerostomia rate was 52%, 53%, 21%, 8%, 3%, 2% and 2%, respectively. No serious xerostomia was observed. The mean dose of the bilateral parotid glands was 34.34 Gy. Xerostomia at 6-month after radiotherapy was positively correlated with the mean dose of the parotid glands, and D 50 was the independent factor in predicting the xerostomia. Parotid function was well protected when the mean dose and D 50 were no more than 33 Gy and 29 Gy, respectively. Conclusions: IMRT can improve the local-regional control of NPC and protect the parotid glands from radiation-induced injury. (authors)

  8. THE INFLUENCE OF PATHOGENETIC THERAPY ON THE LEVER OF CYTOKINES IN PATIENTS WITH ACUTE BRUCELLOSIS

    Directory of Open Access Journals (Sweden)

    N. I. Kovalevich

    2016-01-01

    Full Text Available The purpose of the study was to determine the level of proinflammatory cytokines: IL-12, IL-8 and IFNγ, neopterin and lipopolysaccharide-binding protein in the serum of patients with acute brucellosis before and after antibiotic therapy. The clinical data from 32 patients with laboratory-confirmed diagnosis — “acute brucellosis” admitted to the diagnosis, treatment and examination of occupational diseases brucellosis GBUZ SC “City Clinical Hospital No. 2”, the city of Stavropol were used in the study. The concentrations IL-12, IL-8, IFNγ cytokines and acute-phase proteins in serum was determined by ELISA. In the acute phase of brucellosis infection (before treatment had high levels of pro-inflammatory cytokines IL-8 and IFNγ, but despite holding a course of antibiotic treatment in the serum of patients with preserved high levels of IL-8, indicative of active inflammation in the absence of clinical manifestations. IL-12 level, a key cytokine in the initiation of lymphocyte-dependent immune response was lower than in the control group. Evaluation of the cytokine status (IL-8, IL-12, IL-18 and proteins of acute inflammation phase (neopterin and lipopolysaccharide-binding protein will provide valuable information for monitoring the effect of pharmacotherapy of acute brucellosis. Indicators of lipopolysaccharide-binding protein and neopterin in the serum of patients with brucellosis should be considered as a marker of inflammatory activity and as a predictor of outcome of acute brucellosis.

  9. Radioprotective action of carbimazole in radioiodine therapy for thyrotoxicosis - influence of the drug on iodine kinetics

    International Nuclear Information System (INIS)

    Connell, J.M.C.; Alexander, W.D.; Glasgow Univ.

    1987-01-01

    Pretreatment with carbimazole of patients given radioiodine ( 131 I) therapy for thyrotoxicosis reduces the incidence of early hypothyroidism. The possibility that this radioprotective effect might be a consequence of drug induced alteration in thyroidal iodide turnover, leading to a reduction in thyroid irradiation, was investigated in a prospective study of 24 thyrotoxic patients. Subjects were randomly assigned to receive 131 I alone or to be treated with carbimazole for a minimum of three months before 131 I. Thyroxine supplements were given in the latter group to prevent iatrogenic hypothyroidism. The effective half-life of therapeutic 131 I in the thyroid was measured using a gamma camera/computer system after oral administration of the dose, allowing the biological half life of the anion and estimated radiation dose to the thyroid to be derived. Effective half life of 131 I, biological half life of 131 I and estimated radiation dose to the thyroid were similar in the two groups of subjects. It is concluded that the radioprotective action of carbimazole is not a consequence of altered thyroidal iodide kinetics. (orig.)

  10. Radioprotective action of carbimazole