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The effects of occlusal loading on the margins of cervical restorations

FRANCISCONI, Luciana Favaro; GRAEFF, Marcia Sirlene Zardin; MARTINS, Leandro de Moura; FRANCO, Eduardo Batista; MONDELLI, Rafael Francisco Lia; FRANCISCONI, Paulo Afonso Silveira; PEREIRA, Jose Carlos
Fonte: AMER DENTAL ASSOC Publicador: AMER DENTAL ASSOC
Tipo: Artigo de Revista Científica
ENG
Relevância na Pesquisa
26.07%
Background. Researchers have proposed the restoration of abfraction lesions, but limited information is available about the effects of occlusal loading on the margins of such restorations. Because abfraction is a well-recognized problem, the authors conducted a study to assess the effects of occlusal loading on the margins of cervical restorations. Methods. The authors prepared 40 wedge-shaped cavities in extracted premolars and restored them with a resin-based composite. They subjected specimens to occlusal loading (150 newtons, 101 cycles) on the buccal cusp, on the central fossa or on the lingual cusp, and they stored 1 the control group, specimens in deionized water. The authors used fluorescein to delimit marginal defects and evaluated the defects by using laser scanning confocal microscopy. Results. Results of chi(2) and Kruskal-Wallis tests (P < .05) showed that specimens subjected to occlusal loading had a higher percentage of marginal gaps (53.3 percent) than did the control specimens (10.0 percent). There were no differences between groups in marginal defect formation or in defect location, length or width. Conclusions. Occlusal loading led to a significant increase in gap formation at the margins of cervical resin-based composite restorations. Clinical Implications. The clinician cannot underestimate the effects of occlusal loading When restoring teeth with cervical wedge-shaped lesions. If occlusal loading is the main factor contributing to lesion formation...

Estudo do impacto psicológico na intercorrência cirúrgica: trauma e seus efeitos pós-traumáticos; Study of the psychological impact in surgery: trauma and posttraumatic effects

Prado, Maria Angelica Pereira
Fonte: Biblioteca Digitais de Teses e Dissertações da USP Publicador: Biblioteca Digitais de Teses e Dissertações da USP
Tipo: Dissertação de Mestrado Formato: application/pdf
Publicado em 18/05/2012 PT
Relevância na Pesquisa
26.05%
O proposito deste estudo e avaliar o impacto psicologico da vivencia hospitalar de individuos que sofrem complicacoes pos-operatoria, partindo do pressuposto de que a intercorrencia agrava o quadro clinico com repercussoes na esfera psiquica destes pacientes. Teoricamente enfoca a evolucao do conceito de trauma na teoria freudiana, partindo do desamparo primordial (hilflosigkeit) ate a nova concepcao de angustia, levando em consideracao o fator economico, a nocao de a posteriori (nachträglichkeit) e a compulsao a repeticao. Com o intuito de ampliar a compreensao do fenomeno, o estudo percorre a etiologia do trauma para outros teoricos: Sandor Ferenczi, sobre o narcisismo da doenca; Donald W. Winnicott, que correlaciona o trauma a vivencia do fracasso do ambiente, a imprevisibilidade, ao excesso de tempo de exposicao a situacao desorganizadora, e a elevacao do nivel de dependencia. A constancia desta situacao leva ao que Maksud Khan nomeou de trauma cumulativo. A hipotese e a de que esta experiencia hospitalar pode promover um trauma psiquico, na medida em que o individuo se ve diante de uma situacao imprevisivel, que pode lhe causar transbordamento emocional pelo estado de desamparo, impotencia e risco da perda de sua integridade fisica -...

Avaliação da eficácia e efeitos colaterais de duas apresentações de toxina botulínica tipo A no tratamento da distonia cervical idiopática; Comparison of efficacy and side effects of two types of botulinum toxin A in the treatment of cervical dystonia

Barbosa, Pedro Melo
Fonte: Biblioteca Digitais de Teses e Dissertações da USP Publicador: Biblioteca Digitais de Teses e Dissertações da USP
Tipo: Dissertação de Mestrado Formato: application/pdf
Publicado em 15/09/2014 PT
Relevância na Pesquisa
26.05%
Introdução: A Distonia Cervical (DC) é o tipo mais comum de distonia focal primária e atualmente o tratamento padrão ouro consiste na aplicação periódica de toxina botulínica nos músculos afetados. Considerando que cada formulação de toxina botulínica é farmacologicamente distinta, nesta pesquisa foi realizada a comparação de dois tipos de toxina botulínica tipo A (TBA) disponíveis no Brasil: Dysport® (Abobotulinumtoxin A) e Prosigne® (Lanzhou botulinum toxin type A). Metodologia: Foi conduzido um estudo prospectivo, randomizado e duplo cego com dois braços em uso de substância ativa, Dysport® e Prosigne®. Foram recrutados 34 pacientes do ambulatório de toxina botulínica (ATXB) do Hospital das Clínicas da Faculdade de Medicina de Ribeirão Preto da Universidade de São Paulo (HCFMRP) de maio de 2010 a junho de 2011, foram incluídos apenas pacientes com diagnóstico de distonia cervical idiopática. Cada indivíduo foi acompanhado por um período de 13 meses, sendo que nesse período foram submetidos a 5 aplicações de TBA com intervalo de 3 meses entre cada procedimento. Como instrumento para aferir a melhora dos movimentos involuntários, aplicamos a Toronto Western Spasmodic Torticollis Rating Scale (TWSTRS)...

Tobacco use prevalence and correlates among adolescents in a clinician initiated tobacco prevention trial in California, USA.

Hovell, M F; Slymen, D J; Keating, K J; Jones, J A; Burkham-Kreitner, S; Hofstetter, C R; Noel, D; Rubin, B
Fonte: PubMed Publicador: PubMed
Tipo: Artigo de Revista Científica
Publicado em /06/1996 EN
Relevância na Pesquisa
26.04%
OBJECTIVES: Baseline data for the clinician initiated, tobacco prevention trial, the first non-school based clinician mediated tobacco prevention study, were used to explore the degree to which young people receiving orthodontic treatment use tobacco and the differences in use rates between national, California, and patient samples. Correlates of tobacco use were identified and these correlates were contrasted with findings from the published reports. DESIGN AND SETTING: A 26 item telephone survey assessed demographic information, tobacco use, selected health related behaviours, and variables based on social learning theory. The study was conducted among 11 to 18 year old orthodontic patients from San Diego, Orange, Riverside, San Bernardino, and Los Angeles Counties, California, USA. PARTICIPANTS: Of the 17925 patients who were eligible, 16915 (> 94%) completed the survey. MEASUREMENTS AND MAIN RESULTS: Multivariate analyses were conducted using a logistic mixed effects model. Although the 30 day prevalence rate of tobacco use (6%, n = 1010) proved lower than California and national samples, the rates for the age, gender, and race ethnicity subgroups showed trends similar to those seen in California and national samples. Ten variables were significantly associated with tobacco use (p < 0.05)...

Complementary and Alternative Medical Therapy Use Among Chinese and Vietnamese Americans: Prevalence, Associated Factors, and Effects of Patient–Clinician Communication

Ahn, Andrew C.; Ngo-Metzger, Quyen; Legedza, Anna T.R.; Massagli, Michael P.; Clarridge, Brian R.; Phillips, Russell S.
Fonte: © American Journal of Public Health 2006 Publicador: © American Journal of Public Health 2006
Tipo: Artigo de Revista Científica
Publicado em /04/2006 EN
Relevância na Pesquisa
25.94%
Objective. We examined the use of complementary and alternative medical (CAM) therapies among Chinese and Vietnamese Americans who had limited proficiency with the English language and explore the association between patient–clinician discussions about CAM therapy use and patient assessments of quality of care.

The importance of continuity of care in the likelihood of future hospitalization: is site of care equivalent to a primary clinician?

Mainous, A G; Gill, J M
Fonte: PubMed Publicador: PubMed
Tipo: Artigo de Revista Científica
Publicado em /10/1998 EN
Relevância na Pesquisa
26.15%
OBJECTIVES: This study examined the effect of continuity with clinicians and health care sites on likelihood of future hospitalization. METHODS: Delaware Medicaid patient data were analyzed. Logistic regression models supplied adjusted effects of continuity on hospitalization. RESULTS: Patients in the high clinician continuity group had lower odds of hospitalization than patients in the high site/low clinician continuity group (odds ratio [OR] = 0.75, 95% confidence interval [CI] = 0.66, 0.87). The latter group did not differ from the low site/low clinician continuity group (OR = 0.93, 95% CI = 0.80, 1.08). CONCLUSIONS: A location providing health care without clinician continuity may not be sufficient to ensure cost-effective care.

The effects of an Electronic Medical Record on patient care: clinician attitudes in a large HMO.

Marshall, P. D.; Chin, H. L.
Fonte: American Medical Informatics Association Publicador: American Medical Informatics Association
Tipo: Artigo de Revista Científica
Publicado em //1998 EN
Relevância na Pesquisa
26.15%
OBJECTIVE: The purpose of this study is to examine the attitudes of clinicians in a large HMO toward the effect of an outpatient Electronic Medical Record system on the quality of patient care. Attitudes toward a Results Reporting system and an online charting and ordering system are also compared. DESIGN: A cross-sectional study was performed using a survey of Kaiser Permanente Northwest clinicians. In addition, interviews were conducted with the physician leaders of the clinical departments at Kaiser Permanente Northwest. MEASUREMENTS: Clinician attitudes are measured regarding the effects of a Results Reporting system and an online charting and ordering system on the overall quality of patient care and other care-related indices. RESULTS: Most clinicians feel that the outpatient Electronic Medical Record has improved the overall quality of patient care, with 72% reporting an improvement with the use of the Results Reporting system, and 60% reporting an improvement with the use of the online charting and ordering system. On average, clinicians feel that the EMR has also improved the quality of the patient-clinician interaction, the ability to coordinate the care of patients with other departments, the ability to detect medication errors...

The effects on clinician ordering patterns of a computerized decision support system for neuroradiology imaging studies.

Sanders, D. L.; Miller, R. A.
Fonte: American Medical Informatics Association Publicador: American Medical Informatics Association
Tipo: Artigo de Revista Científica
Publicado em //2001 EN
Relevância na Pesquisa
26.04%
OBJECTIVE: To evaluate the impact of computerized ordering guidelines on clinician ordering patterns for neuroradiology imaging studies of the head. DESIGN: A retrospective analysis was performed using a pre-post design. A 9-week control period was followed by an 8-week intervention period. SUBJECTS: All clinicians who placed an order for either an MRI of the brain or a CT of the head on inpatients using a computerized order entry system. METHODS: We designed, implemented, and evaluated a decision support system for the implementation of test ordering guidelines. Changes in ordering patterns were evaluated with a Chi-square analysis. RESULTS: 742 tests were ordered in the pre-intervention period, while 704 studies were ordered after the intervention. A significant change in the distribution of tests ordered resulted from the intervention (p=0.048). Changes trended toward the guideline recommendations for all tests considered. 60% of users receiving a recommendation ordered the suggested study. DISCUSSION: Our intervention successfully influenced clinician ordering patterns. Examination of detailed usage patterns may aid in further quality improvement of both the guidelines and the decision support tool used to implement them.

A Randomized, Controlled Trial of Emotional Disclosure in Rheumatoid Arthritis: Can Clinician Assistance Enhance the Effects?

Keefe, Francis J.; Anderson, Timothy; Lumley, Mark; Caldwell, David; Stainbrook, David; Mckee, Daphne; Waters, Sandra J.; Connelly, Mark; Affleck, Glenn; Pope, Mary Susan; Weiss, Marianne; Riordan, Paul A.; Uhlin, Brian D.
Fonte: PubMed Publicador: PubMed
Tipo: Artigo de Revista Científica
EN
Relevância na Pesquisa
26.26%
Emotional disclosure by writing or talking about stressful life experiences improves health status in non-clinical populations, but its success in clinical populations, particularly rheumatoid arthritis (RA), has been mixed. In this randomized, controlled trial, we attempted to increase the efficacy of emotional disclosure by having a trained clinician help patients emotionally disclose and process stressful experiences. We randomized 98 adults with RA to one of four conditions: a) private verbal emotional disclosure; b) clinician-assisted verbal emotional disclosure; c) arthritis information control (all of which engaged in four, 30-minute laboratory sessions); or d) no-treatment, standard care only control group. Outcome measures (pain, disability, affect, stress) were assessed at baseline, 2 months following treatment (2-month follow-up), and at 5-month, and 15-month follow-ups. A manipulation check demonstrated that, as expected, both types of emotional disclosure led to immediate (post-session) increases in negative affect compared with arthritis information. Outcome analyses at all three follow-ups revealed no clear pattern of effects for either clinician-assisted or private emotional disclosure compared with the two control groups. There were some benefits in terms of a reduction in pain behavior with private disclosure versus clinician-assisted disclosure at the 2 month follow-up...

Patient–Clinician Relationships and Treatment System Effects on HIV Medication Adherence

Ingersoll, Karen S.; Heckman, Carolyn J.
Fonte: PubMed Publicador: PubMed
Tipo: Artigo de Revista Científica
Publicado em /03/2005 EN
Relevância na Pesquisa
26.23%
The study objectives were to determine the impact of the patient–clinician relationship on patient adherence to HIV medication, to identify which aspects of the patient–clinician relationship and the treatment system influenced adherence, and to determine which of these variables remained important when the impact of mental distress and substance abuse were considered. The design was a cross-sectional study using a sample of 120 HIV+ clinic patients. The Primary Care Assessment Survey (PCAS) assessed the clinician–patient relationship and the treatment system. The Composite International Diagnostic Inventory—Short Form (CIDI-SF) screened for mental disorders, and the Brief Substance Abuse History Form measured recent and remote substance use. Patient adherence was assessed using five markers including 3 interview-elicited self-reports, 1 medical chart review, and 1 summary score. Logistic regression analyses identified independent predictors of each adherence behavior. PCAS scores contributed to all five models, and their effects persisted when mental distress and substance abuse were considered. Adherence behaviors are explained by a variety of factors and should be assessed using multiple methods. Further study to illuminate the mechanisms of action of the clinician–patient relationship on adherence to HIV medication is warranted.

Cluster Effects in a National Dental PBRN Restorative Study

Litaker, M.S.; Gordan, V.V.; Rindal, D.B.; Fellows, J.L.; Gilbert, G.H.;
Fonte: SAGE Publications Publicador: SAGE Publications
Tipo: Artigo de Revista Científica
Publicado em /09/2013 EN
Relevância na Pesquisa
26.05%
Items in clusters, such as patients of the same clinician or teeth within the same patient, tend to be more similar than items from different groups. This within-group similarity, represented by the intraclass correlation coefficient (ICC), reduces precision, yielding less statistical power and wider confidence intervals, compared with non-clustered samples of the same size. This must be considered in the design of studies including clusters. We present ICC estimates from a study of 7,826 restorations placed in previously unrestored tooth surfaces of 4,672 patients by 222 clinicians in the National Dental Practice-Based Research Network, as a resource for sample size planning in restorative studies. Our findings suggest that magnitudes of ICCs in practice-based research can be substantial. These can have large effects on precision and the power to detect treatment effects. Generally, we found relatively large ICCs for characteristics that are influenced by clinician choice (e.g., 0.36 for rubber dam use). ICCs for outcomes within individual patients, such as tooth surfaces affected by a caries lesion, tended to be smaller (from 0.03 to 0.15), but were still sufficiently large to substantially affect statistical power. Clustering should be taken into account in the design of oral health studies and derivation of statistical power estimates for these studies (ClinicalTrials.gov...

Potential Spillover Educational Effects Of Cancer-Related Direct-To-Consumer Advertising On Cancer Patients’ Increased Information Seeking Behaviors: Results From A Cohort Study

Tan, Andy SL
Fonte: PubMed Publicador: PubMed
Tipo: Artigo de Revista Científica
Publicado em /06/2014 EN
Relevância na Pesquisa
26.29%
Spillover effects of exposure to direct-to-consumer advertising (DTCA) of cancer treatments on patients’ general inquiry about their treatments and managing their illness are not well understood. This study examines the effects of cancer patients’ exposure to cancer-related DTCA on subsequent health information seeking behaviors from clinician and non-clinician sources (lay media and interpersonal contacts). Using a longitudinal survey design over three years, data was collected from cancer survivors diagnosed with colorectal, breast, or prostate cancer who were randomly sampled from the Pennsylvania Cancer Registry. Study outcome measures include patients’ information engagement with their clinicians and information seeking from non-medical sources about cancer treatment and quality of life issues, measured in the second survey. The predictor variable is the frequency of exposure to cancer-related DTCA since diagnosis, measured at the round 1 survey. The analyses utilized lagged weighted multivariate regressions and adjusted for round 1 levels of patient-clinician engagement, information seeking from non-medical sources, and confounders. Exposure to cancer-related DTCA is associated with increased levels of subsequent patient-clinician information engagement (B=.023...

Formative Evaluation of Clinician Experience with Integrating Family History-Based Clinical Decision Support into Clinical Practice

Doerr, Megan; Edelman, Emily; Gabitzsch, Emily; Eng, Charis; Teng, Kathryn
Fonte: MDPI Publicador: MDPI
Tipo: Artigo de Revista Científica
Publicado em 26/03/2014 EN
Relevância na Pesquisa
25.94%
Family health history is a leading predictor of disease risk. Nonetheless, it is underutilized to guide care and, therefore, is ripe for health information technology intervention. To fill the family health history practice gap, Cleveland Clinic has developed a family health history collection and clinical decision support tool, MyFamily. This report describes the impact and process of implementing MyFamily into primary care, cancer survivorship and cancer genetics clinics. Ten providers participated in semi-structured interviews that were analyzed to identify opportunities for process improvement. Participants universally noted positive effects on patient care, including increases in quality, personalization of care and patient engagement. The impact on clinical workflow varied by practice setting, with differences observed in the ease of integration and the use of specific report elements. Tension between the length of the report and desired detail was appreciated. Barriers and facilitators to the process of implementation were noted, dominated by the theme of increased integration with the electronic medical record. These results fed real-time improvement cycles to reinforce clinician use. This model will be applied in future institutional efforts to integrate clinical genomic applications into practice and may be useful for other institutions considering the implementation of tools for personalizing medical management.

The Influence of the Patient-Clinician Relationship on Healthcare Outcomes: A Systematic Review and Meta-Analysis of Randomized Controlled Trials

Kelley, John M.; Kraft-Todd, Gordon; Schapira, Lidia; Kossowsky, Joe; Riess, Helen
Fonte: Public Library of Science Publicador: Public Library of Science
Tipo: Artigo de Revista Científica
EN_US
Relevância na Pesquisa
26.18%
Objective: To determine whether the patient-clinician relationship has a beneficial effect on either objective or validated subjective healthcare outcomes. Design: Systematic review and meta-analysis. Data Sources Electronic databases EMBASE and MEDLINE and the reference sections of previous reviews. Eligibility Criteria for Selecting Studies Included studies were randomized controlled trials (RCTs) in adult patients in which the patient-clinician relationship was systematically manipulated and healthcare outcomes were either objective (e.g., blood pressure) or validated subjective measures (e.g., pain scores). Studies were excluded if the encounter was a routine physical, or a mental health or substance abuse visit; if the outcome was an intermediate outcome such as patient satisfaction or adherence to treatment; if the patient-clinician relationship was manipulated solely by intervening with patients; or if the duration of the clinical encounter was unequal across conditions. Results: Thirteen RCTs met eligibility criteria. Observed effect sizes for the individual studies ranged from d = −.23 to .66. Using a random-effects model, the estimate of the overall effect size was small (d = .11), but statistically significant (p = .02). Conclusions: This systematic review and meta-analysis of RCTs suggests that the patient-clinician relationship has a small...

The Apathy Evaluation Scale: A Comparison of Subject, Informant, and Clinician Report in Cognitively Normal Elderly and Mild Cognitive Impairment

Guercio, Brendan John
Fonte: Harvard University Publicador: Harvard University
Tipo: Thesis or Dissertation; text Formato: application/pdf
EN
Relevância na Pesquisa
26.01%
Background: Apathy is a common symptom in Alzheimer’s disease (AD) dementia and mild cognitive impairment (MCI). The Apathy Evaluation Scale (AES) is a promising tool for measuring apathy in early AD. Objective: To compare the AES sub-scales—subject-reported (AES-S), informant-reported (AES-I), and clinician-reported (AES-C)—over time and investigate apathy’s relation to cortical atrophy in MCI and cognitively normal (CN) elderly. Methods: Symptom clusters driving AES scores were identified through factor analysis. Mixed effects longitudinal models were used to assess predictors of AES constructs. Cox proportional hazards models were used to assess which AES constructs predict progression to AD dementia. Finally, we used multivariate regression to evaluate the cross-sectional relationship between AES-C and regional cortical thickness. Results: Across the various mixed effects models, greater apathy was commonly associated with greater years in study, a diagnosis of MCI, and male sex. MCI subjects underreported apathy compared to CN elderly. Of the sub-scales, lower AES-C scores (indicating greater apathy) were most predictive of transition to AD dementia. Lower AES-C scores were also associated with lower inferior temporal cortical thickness. Conclusion: In individuals at risk for AD...

Clinical value of the cultural formulation interview in Pune, India

Paralikar, Vasudeo P; Patil, Kanak V; Nulkar, Amit D; Sarmukaddam, Sanjeev B; Weiss, Mitchell Gralnick
Fonte: Medknow Publicador: Medknow
Tipo: Artigo de Revista Científica
EN_US
Relevância na Pesquisa
46.32%
Context: Development of the cultural formulation interview (CFI) in DSM‑5 required validation for cross‑cultural and global use. Aims: To assess the overall value (OV) of CFI in the domains of feasibility, acceptability, and utility from the vantage points of clinician‑interviewers, patients and accompanying relatives. Settings and Design: We conducted cross‑sectional semi‑structured debriefing interviews in a psychiatric outpatient clinic of a general hospital. Materials and Methods: We debriefed 36 patients, 12 relatives and eight interviewing clinicians following the audio‑recorded CFI. We transformed their Likert scale responses into ordinal values – positive for agreement and negative for disagreement (range +2 to −2). Statistical Analysis: We compared mean ratings of patients, relatives and clinician‑interviewers using nonparametric tests. Clinician‑wise grouping of patients enabled assessment of clinician effects, inasmuch as patients were randomly interviewed by eight clinicians. We assessed the influence of the presence of relatives, clinical diagnosis and interview characteristics by comparing means. Patient and clinician background characteristics were also compared. Results: Patients, relatives and clinicians rated the CFI positively with few differences among them. Patients with serious mental disorders gave lower ratings. Rating of OV was lower for patients and clinicians when relatives were present. Clinician effects were minimal. Clinicians experienced with culturally diverse patients rated the CFI more positively. Narratives clarified the rationale for ratings. Conclusions: Though developed for the American DSM‑5...

A Narrative Study of Patient Encounter Accounts of Physicians, Nurses, and Medical Receptionists after Two Decades of a Paradigm of Patient-Centered Care

Akseer, Riaz
Fonte: Brock University Publicador: Brock University
Tipo: Electronic Thesis or Dissertation
ENG
Relevância na Pesquisa
25.94%
Despite recent well-known advancements in patient care in the medical fields, such as patient-centeredness and evidence-based medicine and practice, there is rather less known about their effects on the particulars of clinician-patient encounters. The emphasis in clinical encounters remains mostly on treatment and diagnosis and less on communicative competency or engagement for medical professionals. The purpose of this narrative study was to explore interactive competencies in diagnostic and therapeutic encounters and intake protocols within the context of the physicians’, nurses’, and medical receptionists’ perspectives and experiences. Literature on narrative medicine, phenomenology and medicine, therapeutic relationships, cultural and communication competency, and non-Western perspectives on human communication provided the guiding theoretical frameworks for the study. Three data sets including 13 participant interviews (5 physicians, 4 nurses, and 4 medical receptionists), policy documents (physicians, nurses, and medical receptionists) and a website (Communication and Cultural Competency) were used. The researcher then engaged in triangulated analyses, including N-Vivo, manifest and latent, Mishler’s (1984, 1995) narrative elements and Charon’s (2005...

THE EFFECT OF EXEMESTANE ON MENOPAUSE-SPECIFIC HEALTH-RELATED QUALITY OF LIFE AND A COMPARISON WITH CLINICIAN-REPORTED TOXICITIES: AN ANALYSIS OF THE NCIC CTG MAP.2 CHEMOPREVENTION TRIAL

Causarano, Natalie Cristina
Fonte: Quens University Publicador: Quens University
Tipo: Tese de Doutorado
EN; EN
Relevância na Pesquisa
26.04%
Background: Exemestane is a drug of great interest for breast cancer prevention, because it inhibits estrogen production. Estrogen may operate by increasing breast density, a well-established biomarker for increased breast cancer risk. The NCIC CTG MAP.2 trial examined the efficacy of exemestane in decreasing breast density. Menopausal health-related quality of life (HRQL) and adverse events were also carefully monitored during the study. Purpose: To elucidate the impact of exemestane on menopausal HRQL and to examine the relationship between clinician and participant methods of reporting side effects. Methods: 98 postmenopausal women with increased breast density were randomized to exemestane or placebo daily for one year. HRQL was measured with the MENQOL questionnaire, which has four domains. Mean changes in MENQOL domain scores from baseline were compared between treatment groups using the Wilcoxon rank-sum test. The difference between groups in the proportion of women with a clinically meaningful decline was compared by domain with the Chi-square test; change scores were considered worsened if increased by ≥ 0.5 points. The association between time-to-decline in menopausal HRQL and treatment was evaluated using Cox PH regression. The kappa statistic quantified the level of agreement between participant-reported and clinician-reported symptoms. Kaplan-Meier estimates of time-to-decline as communicated by clinicians and participants were compared...

Glycine Transporter Inhibitor Attenuates the Psychotomimetic Effects of Ketamine in Healthy Males: Preliminary Evidence

D'Souza, Deepak Cyril; Singh, Nagendra; Elander, Jacqueline; Carbuto, Michelle; Pittman, Brian; de Haes, Joanna Udo; Sjogren, Magnus; Peeters, Pierre; Ranganathan, Mohini; Schipper, Jacques
Fonte: Nature Publishing Group Publicador: Nature Publishing Group
Tipo: Artigo de Revista Científica
EN
Relevância na Pesquisa
26.12%
Enhancing glutamate function by stimulating the glycine site of the NMDA receptor with glycine, -serine, or with drugs that inhibit glycine reuptake may have therapeutic potential in schizophrenia. The effects of a single oral dose of cis-N-methyl-N-(6-methoxy-1-phenyl-1,2,3,4-tetrahydronaphthalen-2-ylmethyl) amino-methylcarboxylic acid hydrochloride (Org 25935), a glycine transporter-1 (GlyT1) inhibitor, and placebo pretreatment on ketamine-induced schizophrenia-like psychotic symptoms, perceptual alterations, and subjective effects were evaluated in 12 healthy male subjects in a randomized, counter-balanced, within-subjects, crossover design. At 2.5 h after administration of the Org 25935 or placebo, subjects received a ketamine bolus and constant infusion lasting 100 min. Psychotic symptoms, perceptual, and a number of subjective effects were assessed repeatedly before, several times during, and after completion of ketamine administration. A cognitive battery was administered once per test day. Ketamine produced behavioral, subjective, and cognitive effects consistent with its known effects. Org 25935 reduced the ketamine-induced increases in measures of psychosis (Positive and Negative Syndrome Scale (PANSS)) and perceptual alterations (Clinician Administered Dissociative Symptoms Scale (CADSS)). The magnitude of the effect of Org 25935 on ketamine-induced increases in Total PANSS and CADSS Clinician-rated scores was 0.71 and 0.98 (SD units)...

A systematic review of parent and clinician views and perceptions that influence prescribing decisions in relation to acute childhood infections in primary care

Lucas, Patricia J.; Cabral, Christie; Hay, Alastair D.; Horwood, Jeremy
Fonte: Informa Healthcare Publicador: Informa Healthcare
Tipo: Artigo de Revista Científica
EN
Relevância na Pesquisa
25.94%
Objectives. To investigate the views of parents, clinicians, and children pertaining to prescribing decisions for acute childhood infection in primary care. Methods. A systematic review of qualitative studies. Meta-ethnographic methods were used, with data drawn from the primary studies in an interpretive analysis. Results. A total of 15 studies met the inclusion criteria. The literature was dominated by concerns about antibiotic over-prescription. Children's views were not reported. Clinicians prescribed antibiotics when they felt pressured by parents or others (e.g. employers) to do so, when they believed there was a clear clinical indication, but also when they felt uncertain of clinical or social outcomes they prescribed “just in case”. Parents wanted antibiotics when they felt they would improve the current illness, and when they felt pressure from daycare providers or employers. Clinicians avoided antibiotics when they were concerned about adverse reactions or drug resistance, when certain they were not indicated, and when there was no perceived pressure from parents. Parents also wished to avoid adverse effects of antibiotics, and did not want antibiotics when they would not relieve current symptoms. Some parents preferred to avoid medication altogether. Within paediatric consultations...