Comparison of the effectiveness of various comprehensive treatments for locally advanced breast cancer

OBJECTIVE: Auditory testing is not routinely performed within 4-6 weeks after stapedotomy, because hearing acuity is thought to be transiently depressed. In rare circumstances, postsurgical auditory and vestibular complaints may lead one to test hearing soon after stapedotomy. The early postoperative effects of carbon dioxide (CO2) and potassium titanyl phosphate (KTP) lasers, which now are routinely used to perform stapedotomies, have not been reported. The purpose of this report is to present normative data for auditory thresholds measured within 2 weeks of laser stapedotomy. STUDY DESIGN: The study design was a prospective, unblinded study. SETTING: The study was conducted at three academic medical centers. PATIENTS: Thirty-six subjects undergoing 38 stapedotomies for otosclerosis by 5 surgeons participated. MAIN OUTCOME MEASURES: Behavioral audiometry was performed using standard techniques beginning before surgery and continuing through > 1 year after surgery. RESULTS: The CO2 laser was used in 26 stapedotomies and the KTP laser was used in 12. Nine cases were revision procedures. Bone conduction pure-tone averages and speech discrimination scores did not worsen during the early postoperative period. Bone conduction at 250 and 4,000 Hz dropped slightly within the first 2 weeks (-4.3 and -6.7 dB) but recovered thereafter. Bone conduction at 1,000 Hz actually improved within the first week after surgery (+6.2 dB, p = 0.021). Significant improvements in air conduction thresholds (and air-bone gap) were seen at the second week and late audiometry. The results for CO2 and KTP laser-treated groups were not significantly different. CONCLUSIONS: Cochlear function is not significantly depressed in the early postoperative period after laser (CO2 or KTP) stapedotomy.     

Two studies of the clinical effectiveness of the nicotine patch with different counseling treatments

OBJECTIVE: To assess the effectiveness of transdermal nicotine therapy for smoking cessation and suppression of withdrawal severity in conjunction with two different adjuvant counseling treatments. DESIGN: Two independent randomized placebo-controlled double-blind trials. SETTING: Smoking cessation clinic. SUBJECTS: Eighty-eight (study 1) and 112 (study 2) adult volunteers motivated to quit smoking. INTERVENTIONS: Eight weeks of 22-mg transdermal nicotine therapy with group counseling (study 1); 4 weeks of 22 mg followed by 2 weeks of 11-mg transdermal nicotine therapy with brief individual counseling (study 2). MAIN OUTCOME MEASURES: Modified point prevalence (7 consecutive days of nonsmoking) at the end of patch treatment and 6 months after treatment initiation was assessed by self-report and biochemically confirmed; survival analyses were also conducted for both studies to compare treatment efficacy. Also, we examined the impact of the nicotine patch on specific withdrawal symptoms (anger, anxiety, awakening, difficulty concentrating, depression, hunger, impatience, and craving). RESULTS: Transdermal nicotine treatment produced higher cessation rates at the end of treatment than did placebo with both adjuvant counseling interventions: 59 percent vs 40 percent (p < 0.05 in study 1) and 37 percent vs 20 percent (p < 0.05 in study 2), respectively. Smoking cessation efficacy was maintained 6 months after initiation of treatment: 34 percent vs 21 percent (p = 0.08 in study 1) and 18 percent vs 7 percent (p = 0.05 in study 2). Survival analyses also revealed significant group differences in efficacy in both studies. Nicotine patches also suppressed a variety of withdrawal symptoms, including craving in the first weeks after patients quit smoking. CONCLUSION: Transdermal nicotine effectively augments smoking cessation rates with two different types of counseling treatment. Overall, the nicotine patch approximately doubles the sustained rate of smoking cessation. Additionally, the nicotine patch provides relief from some tobacco withdrawal symptoms.     

Anticonvulsant combination therapy: rational concepts versus real effectiveness

Primary drug treatment of epilepsies is usually a monotherapy with an antiepileptic drug. This procedure causes less side effects as polytherapy and probably shows the same efficacy. Two third of patients with focal epilepsies are sufficiently treated with a single antiepileptic drug: 60% of patients with Grand mal and 22-30% of patients with complex focal seizures remain seizures free. An alternative monotherapy will suppress seizures in another 30% of patients. With polytherapy this is achieved in only 12% of the remaining patients, furthermore, side effects increase in polytherapy. Generalized epilepsies are usually treated with valproate monotherapy. Patients remain seizure free from absence in 60-90%, from myoclonic-impulsive seizures in 75-97% and from Grand mal in about 85%. Alternative monotherapy is less common because of the limited efficacy and possible side effects of drugs: ethosuximide does not control Grand mal and phenobarbitone may cause sedation. Thus, polytherapy is commonly initiated when monotherapy fails to control seizures (lamotrigine is often chosen as comedication). Rational polypharmacy is a term suggesting rational concepts in planning antiepileptic polytherapy leading to a superior anticonvulsant effect. However, this consideration is not based on or supported by clinical data. Yet, a combination of drugs which have no or little pharmacokinetic interactions seems to be a clinically relevant recommendation. Thus, newly developed drugs such as vigabatrin, lamotrigine or gabapentin are more frequently used as comedication with standard antiepileptic drugs.     

Comparative effectiveness of guided mastery and exposure treatments for intractable phobias.

Compared the exposure model and the self-efficacy model by randomly assigning 32 18–76 yr old individuals with driving or height phobias to 1 of the treatment conditions or to a control condition. Results show that treatments were equivalent in duration of exposure and in degree of inducement to confront threats rapidly, but the self-efficacy (mastery) model was significantly more effective than exposure in restoring Ss' behavioral functioning and diminishing their anticipated anxiety and performance-related anxiety. Both treatments were more effective than the control condition. It is suggested that self-efficacy predicted therapeutic behavior change significantly better than did anxiety, exposure duration, or performance level achieved during treatment. (38 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Preliminary evidence on the effectiveness of psychological treatments delivered at a university counseling center.

Treatment data from a university counseling center (UCC) that utilized the Outcome Questionnaire–45.2 (OQ-45; M. J. Lambert et al., 2004), a self-report general clinical symptom measure, was compared against treatment efficacy benchmarks from clinical trials of adult major depression that utilized similar measures. Statistical analyses suggested that the treatment effect size estimate obtained at this counseling center with clients whose level of psychological distress was above the OQ-45 clinical cutoff score was similar to treatment efficacy observed in clinical trials. Analyses on OQ-45 items suggested that clients elevated on 3 items indicating problematic substance use resulted in poorer treatment outcomes. In addition, clients who reported their relational status as separated or divorced had poorer outcomes than did those who reported being partnered or married, and clients reporting intimacy issues resulted in greater numbers of sessions. Although differential treatment effect due to training level was found where interns and other trainees had better pre–post outcome than did staff, interpretation of this result requires great caution because clients perceived to have complicated issues are actively reassigned to staff. More effectiveness investigations at UCCs are warranted. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Antihypertensive effectiveness of a very low fixed-dose combination of moexipril and hydrochlorothiazide

Rest-redistribution 201Tl imaging is currently being used for myocardial viability detection, but the ideal parameters for territory classification have not yet been defined. The aim of this study was to define the optimal criteria for detecting viable myocardium and predicting postrevascularization recovery with rest-redistribution 201Tl SPECT. METHODS: In 29 patients with left ventricular dysfunction, tracer activity within asynergic segments was quantified on rest and redistribution 201Tl SPECT. Viability was defined by the presence of functional recovery, which was detected by comparing wall motion in baseline and follow-up echocardiography. Discriminant function analysis and receiver operating characteristic (ROC) curve analysis were used to evaluate the relationship between 201Tl data and viability. RESULTS: Of 214 dysfunctioning segments (135 a-/dyskinetic), viability was demonstrated in 115 (75 a-/dyskinetic). Both rest and redistribution 201Tl activity in these segments were significantly higher than they were in the nonviable segments (p < 0.0001). Significant (> 10%) reversibility was observed in 39% of the viable and in 36% of the nonviable segments (p = 0.81). Discriminant analysis identified redistribution activity, followed by rest activity, as the most effective predictors of functional recovery. Similar areas were found under the ROC curve for rest (0.68 +/- 0.037) and for redistribution activity (0.70 +/- 0.036) (p = 0.13). ROC curve analysis identified the optimal cutoff for redistribution activity at < 60%, with 147 of 214 (69%) segments correctly classified (sensitivity = 78% and specificity = 58%). In the subset of a-/dyskinetic segments, redistribution activity presented a significantly larger ROC curve area (0.81 +/- 0.038 compared to 0.77 +/- 0.042, p < 0.05), and 103 of 135 (76%) segments were correctly classified (sensitivity = 81% and specificity = 70%). CONCLUSION: Redistribution activity is the most important parameter to be considered in rest-redistribution 201Tl to differentiate viable from nonviable segments; rest activity is also valuable, whereas the meaning of reversibility appears limited. Cutoff values about 60% appear to give the most reasonable balance between sensitivity and specificity.     

Critical dimensions in the choice and maintenance of successful treatments: Strength, integrity, and effectiveness.

Argues that practicing clinicians can enhance the quality of judgments in choosing optimal treatments by attending more explicitly to the strength and integrity of treatment as well as to specific standards of treatment effectiveness. Examples from the psychological and evaluation literature are utilized to portray the practical considerations and problems inherent to this approach. By monitoring strength, integrity, and effectiveness for the duration of treatment, one can make appropriate midcourse corrections and determine the relationship among these 3 critical dimensions of treatment. (39 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Research-informed benchmarks for psychological treatments: Efficacy studies, effectiveness studies, and beyond.

To examine whether the results of effectiveness studies match those obtained for efficacy studies on the same treatments, we conducted a focused review of the published treatment effectiveness literature. A literature search yielded 35 effectiveness studies for adult disorders (N = 21) and child and adolescent disorders (N = 14). A comparison of data from these studies with benchmarks from recent reviews of efficacy trials revealed treatment completion rates comparable with those found in the efficacy benchmarks. The improvement rates were comparable in effectiveness studies with those reported in randomized clinical trials of treatment efficacy. Despite methodological limitations in many effectiveness studies, these initial data provide encouraging support for the transportability to clinical settings of treatments with established efficacy. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Preclinical studies of water-insoluble camptothecin congeners: cytotoxicity, development of resistance, and combination treatments

Water-insoluble camptothecin (CPT) congeners are rapidly establishing themselves as promising anticancer drugs. In vitro, they have exhibited: (a) insensitivity to elevated levels of P-glycoprotein that confers multidrug resistance; (b) selective killing of malignant cells traversing the S-phase of the cell cycle, while leaving viable normal cells, which either are arrested at the S-G2 boundary or continue to divide; (c) no cross-resistance with several other anticancer drugs; and (d) potentiation or enhancement of cytotoxicity when appropriately used in combination with tumor necrosis factor, ionizing radiation, and hyperthermia. In addition, development of cell resistance to water-insoluble CPT congeners in vitro is accompanied by increased sensitivity to other anticancer drugs. Furthermore, water-insoluble CPT congeners have exhibited an unprecedented activity against a wide variety of human tumors xenografted in nude mice by inhibiting growth and inducing regression of carcinomas of the lung, breast, ovary, colon, stomach, pancreas, and prostate, as well as malignant melanoma, lymphoma, and leukemia. More importantly, oral administration of the water-insoluble CPT congeners in clinical studies with cancer patients makes other route(s) of administration unnecessary.     

Comparative effectiveness of social problem-solving therapy and reminiscence therapy as treatments for depression in older adults.

Compared the effects of 2 psychotherapies based on divergent conceptualizations of depression in later life. 75 older adults diagnosed with major depressive disorder were assigned randomly to problem-solving therapy (PST), reminiscence therapy (RT), or a waiting-list control (WLC) condition. Participants in PST and RT were provided with 12 weekly sessions of group treatment. Dependent measures, taken at baseline, posttreatment, and 3-mo follow-up, included self-report and observer-based assessments of depressive symptomatology. At posttreatment, both the PST and the RT conditions produced significant reductions in depressive symptoms, compared with the WLC group, and PST Ss experienced significantly less depression than RT Ss. Moreover, a significantly greater proportion of Ss in PST vs RT demonstrated sufficient positive change to warrant classification of their depression as improved or in remission at the posttreatment and follow-up evaluations. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

The effectiveness of bone density measurement and associated treatments for prevention of fractures. An international collaborative review

This review assesses the evidence regarding the effectiveness of bone density measurement (BDM) screening and related interventions--hormone replacement therapy (HRT) and intranasal salmon calcitonin (SCT[N])--in menopausal women to prevent fractures in later life. Data sources included systematic reviews of evidence and relevant primary studies identified through literature searches on MEDLINE and EMBASE. Study selection included trials of BDM screening programs, prospective studies examining the predictive value of BDM, randomized controlled trials, cohort studies, and case-control studies of HRT and SCT (N). The evidence was evaluated using a classification system incorporating study design and quality. Outcomes were measured in terms of relative risk of fracture for a 1 SD decrease in bone mineral density below the age-adjusted mean, relative risks or odds ratios for fractures associated with treatments, and proportion of hip fractures potentially prevented by BDM screening linked to treatments. Fair evidence from prospective cohort studies suggests that BDM can predict the risk of fractures, but not with high accuracy. Fair evidence from low-quality randomized controlled trials and observational studies suggests that HRT and SCT(N) are efficacious in preventing fractures. Good evidence supports the efficacy of these treatments in preserving bone mass, but there is fair evidence that the effect wears off after cessation of therapy. There is little evidence on the impact of screening menopausal women with BDM in association with HRT or SCT(N) treatment. Estimates based on combining existing evidence regarding the predictive value of BDM and efficacy of HRT suggests that 1-7% of hip fractures might be prevented.     

厄贝沙坦氢氯噻嗪复方制剂治疗原发性高血压有效性及安全性的Meta分析

目的:利用Meta分析方法探讨厄贝沙坦氢氯噻嗪复方制剂治疗原发性高血压的有效性及安全性,为其临床应用提供依据.方法:计算机检索Cochrane图书馆临床对照试验资料库(2010年第03期)、Ovid-medline全文数据库(1966-2010.09)、PubMed数据库(1948-2010.09)、EMBASE数据库(1966-2010.09)、中国学术文献总库(CNKI)(1979-2010.09)、万方数字化期刊库(1981-2010.09)及维普数据库(VIP) (1989-2010.09),手工检索相关文献,按纳入与排除标准选择试验、评价质量,提取资料,并用RevMan 4.2软件对数据进行Meta分析.结果:共初检出516篇文献,经筛选最终纳入5篇6项关于厄贝沙坦氢氯噻嗪治疗原发性高血压的随机双盲对照研究.有效性:χ2=7.50,df=5,P=0.19,Z=7.23(P<0.00001),合并OR=2.26,95%CI [1.81,2.82];安全性:χ2=7.82,df=5,P=0.17,Z=1.11(P=0.27),合并OR=0.87,95%CI [0.68,1.11].结论:厄贝沙坦氢氯噻嗪复方制剂治疗原发性高血压与对照组比较具有较高的有效性及相似的安全性.     

The TEAM study--a study of the effectiveness and tolerance of treatment of essential hypertension with a fixed combination of trandolapril and verapamil

In the years 1988 to 1995 among 1355 cattle examined in the frame of iodine deficiency studies in the Czech Republic 404 animals (30%) showed congenital struma. Clinical and postmortal findings are described. A monitoring of iodine content in milk showed lower values in herds with struma prevalence. The insufficient supply of iodine in these animals results from low iodine content of feed or from the goitrogenic influence of nitrate in drinking water or high content of crucifera in feed or other stress factors. An increased iodination of mineral mix in feed is highly recommended.     

祛氟剂联合Beyond冷光美白技术治疗氟牙症的有效性及安全性评价

目的:观察氟牙症患者经祛氟剂联合Beyond冷光美白技术治疗后即刻效果及牙齿敏感性的变化情况,阐明该方法对氟牙症美白的有效性及安全性.方法:选取门诊氟牙症患者20例共139颗患牙,随机分为祛氟剂联合Beyond冷光美白组(联合治疗组,10例70颗)及单纯Beyond冷光美白组(单纯美白组,10例69颗),分别采用祛氟剂联合Beyond冷光美白技术及Beyond冷光美白技术对其进行美白治疗,治疗后1、3、7和14 d观察患者患牙的温度敏感性及化学敏感性.结果:联合治疗组显效率高于单纯美白组(P<0.05),有效率两组比较差异无统计学意义; 患者治疗后出现牙齿敏感患牙联合治疗组与单纯美白组分别是第1天35颗与34颗,第3天均为13颗,第7天均为2颗,各时间段间出现牙齿温度刺激与化学刺激敏感牙龄构成比差异无统计学意义(P>0.05),两组于治疗后第14天,所有患牙过敏现象均消失.结论:祛氟剂联合Beyond冷光美白技术治疗氟牙症疗效更显著,且不会造成牙齿不可逆性超敏感.