In-person cognitive behavioural therapy vs. usual care after surgical management of extremity fractures: an unsuccessful feasibility trial
Kyle GouveiaSheila SpragueJodi GallantGina Del FabbroJordan LeonardSofia BzovskyPaula McKayJason W. BusseMohit BhandariGerard P. SlobogeanLehana ThabaneRandi E. McCabeEmil H. SchemitschGordon GuyattP.J. DevereauxI. Leah GitajnMatilda E. NowakowskiEleni G. HapidouDelia ChiaramonteHenrick KehletJames S. KhanAresh SepehriNatalie FlemingChristy ShibuDiane Heels‐AnsdellBrad PetrisorDale WilliamsBill RistevskiJamal Al-AsiriHerman JohalMatthew DenkersKris RajaratnamSarah MacRaeKaitlyn PusztaiSara RenaudNicki JohalSteven PappKarl‐André LalondeBradley MeulenkampAllan LiewManisha MistryBraden GammonWade GoftonGeoffrey WilkinMelanie Dodd-MoherDávid PuskásTravis MarionTina LefrancoisJubin PayandehClaude CullinanTracy WilsonKurt DrollMichael RiedigerRabail SiddiquiShalyn LittlefieldSimrun ChahalPaige WagarPrism S. SchneiderTosin OgunleyeTanya CherppukaranKarin LienhardNicholas SmithSarah AnthonyKrista ButtLaShann SelbyMurali KovvurJoshua LawrenceSkyler SampsonKristin TurnerTodd JaeblonHaley K. DemyanovichSneh TalwarCaroline BenzelTheresa A. ChockbengbounDevin S. MullinPaul J. AppletonJohn J. WixtedEdward K. RodriguezMichael F. McTagueKatiri WagnerKristina BrackpoolKate HegermillerNhi NguyenRoman M. NatoliCourteney L. FentzMaricela DiazJill NiceleyTammy GarrettKyle J. JerayThomas M. SchallerMichael S. SridharJohn D. AdamsRichard W. GurichStephanie L. TannerKyle AdamsMichelle DonohueEmily BrayCalleigh BrignullHarper SprouseChristina TieszerTrevor StoneDarius G. ViskontasMauri Zomar
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Abstract Background Extremity fractures are common, and most are managed operatively; however, despite successful reduction, up to half of patients report persistent post-surgical pain. Furthermore, psychological factors such as stress, distress, anxiety, depression, catastrophizing, and fear-avoidance behaviors have been associated with the development of chronic pain. The purpose of this pilot study was to examine the feasibility of a randomized controlled trial to determine the effect of in-person cognitive behavioral therapy (CBT) vs. usual care on persistent post-surgical pain among patients with a surgically managed extremity fracture. Methods Eligible patients were randomized to either in-person CBT or usual care. We used four criteria to judge the composite measure of feasibility: 1) successful implementation of CBT at each clinical site, 2) 40 patients recruited within 6 months, 3) treatment compliance in a minimum 36 of 40 participants (90%), and 4) 32 of 40 participants (80%) achieving follow-up at one year. The primary clinical outcome was persistent post-surgical pain at one year after surgery. Results Only two of the four participating sites were able to implement the CBT regimen due to difficulties with identifying certified therapists who had the capacity to accommodate additional patients into their schedule within the required timeframe (i.e., 8 weeks of their fracture). Given the challenges associated with CBT implementation, only one site was able to actively recruit patients. This site screened 86 patients and enrolled 3 patients (3.5%) over a period of three months. Participants were unable to comply with the in-person CBT, with no participants attending an in-person CBT session. Follow-up at one year could not be assessed as the pilot study was stopped early, three months into the study, due to failure to achieve the other three feasibility criteria. Conclusion Our pilot trial failed to demonstrate the feasibility of a trial of in-person CBT versus usual care to prevent persistent pain after surgical repair of traumatic long-bone fractures and re-enforces the importance of establishing feasibility before embarking on definitive trials. Protocol modifications to address the identified barriers include the delivery of our intervention as a therapist-guided, remote CBT program. Trial registration ClinicalTrials.gov (Identifier NCT03196258); Registered June 22, 2017, https://clinicaltrials.gov/ct2/show/NCT03196258Keywords:
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To evaluate the advantages and disadvantages of regimens of 2E3H3R3Z3/4H3R3(EMB regimen) and 2S3H3R3Z3/4H3R3(SM regimen) in tuberculosis control program.Retrospective, cross-sectional and prospective studies were carried out in Shijiazhuang city, Hebei province from January 1994 to June 1996.There was no significant difference between the two regimens in efficacy, relapse rate and full course supervision. The EMB regimen was found more applicable than the SM regimen, and the SM regimen caused more side effects than the EMB regimen. Streptomycin skin test had a 4.5% positive rate, and using SM costs 84% more than using EMB. One of the drawbacks found in the SM regimen was that only in 42.9% of the rural sanitation units the disinfection standard could be fulfilled, and the patients preferred the EMB regimen to the SM regimen.The EMB regimen is more applicable than the SM regimen in the tuberculosis control program.
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Three regimens containing rifampin have been tried in paucibacillary leprosy patients. The patients were selected according to the criteria laid down by the World Health Organization (WHO). In Regimen I, rifampin 600 mg is given once a month for 6 months with dapsone 100 mg daily. Treatment is stopped at the end of 6 months. Regimen II is the same as Regimen I, and is supplemented with an additional 6 months' treatment with dapsone 100 mg daily. Regimen III is the same as Regimen II, except that rifampin is administered daily for the first 7 days. At the end of the scheduled treatment period, 72.2% of the patients in Regimen I, 94.9% of the patients in Regimen II, and 97.1% in Regimen III became inactive. Eighteen out of the 25 active cases at the time Regimen I treatment was stopped had to be restarted on drug therapy since they showed a worsening of their disease, as indicated by an increase in their bacterial index, the appearance of new lesions, renewed activity in old lesions, an increase in the size of old lesions, or development of nerve abscesses. The remaining seven cases regressed without further treatment. All four Regimen II patients and two Regimen III patients who had evidence of activity at the time treatment was stopped did not require any further treatment. On follow-up for 1 1/2 years, three Regimen I patients and none of the Regimen II or Regimen III patients showed relapses. It is thus apparent that rifampin helps to shorten the time duration and to increase the cost effectiveness of treatment of paucibacillary leprosy cases.(ABSTRACT TRUNCATED AT 250 WORDS)
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Objective:To explore more effective treatment regimen for multiple myeloma (MM).Methods:Randomized clinical trial was conducted to determine whether the outcome of MM patients treated with the MVDA regimen was better than that with VDA regimen.Results:The remission rate of cases treated with MVDA regimen ( 60.8 %) was significantly higher than that of cases treated with VDA regimen ( 23.5 %) (P 0.025 );The granulocyte decreasing (GD) rate and platelet decreasing (PD) rate of cases treated with MVDA regimen were higher than that of cases treated with VDA regimen,but the time of the GD and the time of the PD were shorter than 2 weeks.Conclusion:The treatment outcome of MM was better with MVDA regimen than that with VDA regimen,The MVDA is a effective treatment regimen for MM.
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Introduction: Magnesium sulphate is the anticonvulsant of choice in prevention and control of eclamptic convulsions.Pritchard's regimen is the most popular time-tested regimen used.However, owing to concerns of toxicity, several low dose regimens have been introduced considering the lower body mass index of Asian women.Aim: To compare the efficacy and safety of a single loading low dose MgSo 4 regimen with the Pritchard's regimen. Materials and Methods:Seventy cases of eclampsia and imminent eclampsia were allocated to the control and study groups each.The former received the Pritchard's regimen while the latter was treated with single loading low dose of magnesium sulphate.Recurrent convulsion rates, maternal and perinatal outcomes of both regimens were evaluated and compared using unpaired t-test and Chi-square test for continuous and categorical variables, respectively. Results:The mean serum magnesium levels were significantly lower in the study group at 30 minutes and 4 hours of initiation of therapy.The single loading low dose regimen was equally efficacious in prevention (96.6% vs 100%, p = 0.934) and control (97.6% vs 97.8%, p = 0.358) of eclamptic fits as compared to the Pritchard's regimen.The feto-maternal outcomes were also comparable. Conclusion:The single loading low dose MgSo 4 regimen is an effective and safe alternative to the Pritchard's regimen, especially tailored to the small built Indian women.
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Objective To evaluate the efficacy and toxicity of ELFP and EFP regimen in the treatment of advanced gastric cancer.Method 63 patients treated with ELFP regimen were equally divided into three groups [the low-dose CF (leucovorin) group, the median-dose CF group and the high-dose CF group];21 patients were treated with EFP regimen. Results Response rates were 65.1% (41/63) and 42.9%(9/21),respectively for these two regimens. Besides, response rates were 61.9%(13/21), 66.6%(14/21) and 66.6%(14/21),separataly for these three gruops in ELFP regimen. There was notable statistical difference between ELFP regimen and EFP regimen, but no statstical difference among these three groups.Conclusion ELFP regimen is regarded as a better regimen for advanved gastric cancer.
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Purpose: The purpose of this article is to investigate how age-related macular degeneration (AMD) is associated with anxiety and depression. Methods: An online repository of deidentified patient data was queried to identify and retrospectively analyze patients with AMD, depression, or anxiety via ICD-9 and ICD-10 codes. Odds ratios were calculated between AMD and anxiety and depression, respectively. Results: Of the 51 019 patients analyzed in this study, 11 681 (22.9%) had depression, 8727 (17.1%) had anxiety, and 2752 (5.4%) had AMD. The prevalence of anxiety among AMD patients was 18.2%, and the prevalence of depression among AMD patients was 25.0%. The odds of a patient with AMD carrying a diagnosis of anxiety are 1.3 (95% CI 1.2, 1.5) times higher than a patient without AMD, and the odds of carrying a diagnosis of depression are also 1.3 (95% CI 1.1, 1.4) times more likely. Conclusions: Patients with AMD have increased odds of suffering from comorbid anxiety and depression. Ophthalmologists should consider mental health screens and appropriate referrals as new diagnoses of AMD are made or as the disease progresses.
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Objective To investigate the incidence of type 2 diabetic inpatients' anxiety and depression,and discuss the treatment effect of health education.Methods We investigated the anxiety and depression of type 2 diabetic inpatients between January 2009 and May 2012,gave health education to the anxious and depressed patients,and reevaluation was carried out when the patients were discharged from the hospital.Results The result showed that 22.45% of the type 2 diabetic inpatients had anxiety,and 11.37% of them had depression.After the health education,the number of anxious patients was markedly reduced(P 0.05),especially in patients with mild and moderate anxiety,but it had no distinct improvement in severely anxious patients.To all the depressed patients,health education had bad curative effect,especially in those with moderate and serious depression.Conclusion Anxiety and depression have high incidence in type 2 diabetic inpatients,and health education is an effective treatment for patients with mild and moderate anxiety.
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Three multidrug regimens all containing rifampin and dapsone have been tried for the treatment of 278 cases of paucibacillary leprosy. Regimen I was the one recommended by the WHO Study Group. Regimen II was the same as Regimen I with depsone alone continued for a further 6 months. Regimen III was the same as Regimen II but rifampin was given daily for the first 7 days. The patients were comparable with regard to disease classification, lepromin status, bacteriological status, and number of lesions. As reported earlier, the disease inactivity rates by 1 year of treatment were much greater with Regimens II and III than with Regimen I (94% and 97% vs 76%). Early reaction was seen in 6% of those in Regimen III and in none in Regimens I and II. Late reaction was observed in 9% of those in Regimen I and none in Regimens II and III. During 3 1/2 years of follow up, 13% of the cases in Regimen I, 1% in Regimen II, and 2% in Regimen III relapsed. Since the patients in the three regimens were otherwise comparable, it is concluded that the high inactivity rate, low relapse rate (1%-2%), and no early or late reaction as observed in Regimen II patients were because of adequate treatment.
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Objective To evaluate the curative effects of EP (oral Vp 16 capsule+DDP)regimen and CAP(CTX+ADM+DDP)regimen on non small cell lung Cancer of older patient.Methods 60 cases of advanced non small cell lung cancer were randomly divided into two groups.Each group has 30 cases.Results Response rates of EP regimen and CAP regimen were 38 8% and 33 3% respectively.There was no statistical significant difference between them ( P 0 05).Gastrointestinal tract reaction and epilation reaction of CAP regimen were more serious than that of EP regimen( P 0 05).Mylos suppression had no statistical difference between two regimens.Conclusion Both EP regimen an CAP regimen can be used as first line regimens for treatment of non small cell lung cancer of older patient.The EP regimen is regarded as a better,convenient and tolerable regimen.
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