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https://www.readbyqxmd.com/read/28806196/the-costs-of-hiv-treatment-and-care-in-ghana-a-longitudinal-multi-site-analysis
#1
Evelinn Mikkelsen, Jan Hontelez, Justice Nonvignon, Sam Amon, Felix A Asante, Moses K Aikins, Julie van de Haterd, Rob Baltussen
OBJECTIVE: To determine cost-functions that describe the dynamics of costs of HIV treatment and care in Ghana by CD4 cell count at treatment initiation and over time on antiretroviral therapy (ART). DESIGN: We used detailed longitudinal healthcare utilization data from clinical health records of HIV-infected patients at seven Ghanaian ART clinics to estimate cost-functions of treatment and care by CD4 cell count at treatment initiation and time on ART. METHODS: We developed two linear regression models; one with individual random effects to determine the relationship between CD4 cell count at ART initiation and costs of treatment and care, and one with individual fixed effects to determine the causal effect of time in care on costs of treatment and care...
August 12, 2017: AIDS
https://www.readbyqxmd.com/read/28805777/-accelerated-postoperative-rehabilitation-in-patients-undergoing-pancreatoduodenectomy
#2
Z A Kovalenko, V K Lyadov, K V Lyadov
AIM: To assess safety and clinical-economic effectiveness of complex postoperative rehabilitation after pancreatoduodenectomy. MATERIAL AND METHODS: 73 patients were included in the study. Main group consisted of 39 patients who underwent accelerated postoperative rehabilitation that was developed in our clinic. In the control group of 34 patients this protocol was not applied. The main components of rehabilitation were multicomponent analgesia, early enteral nutrition, physical rehabilitation by using of exercise therapy and physiotherapy...
2017: Khirurgiia
https://www.readbyqxmd.com/read/28805581/nonmotor-parkinson-s-and-future-directions
#3
Nataliya Titova, K Ray Chaudhuri
Nonmotor symptoms (NMS) of Parkinson's disease (PD) are integral to the condition largely regarded as a motor syndrome. A range of NMS underpin the prodromal stage of Parkinson's and are present with variable frequency, range, and nature across the whole journey of a patient with Parkinson's from the onset of the motor disease to palliative stage. These symptoms also are key determinants of quality of life of the patient as well as the carer. Despite this, recognition management and focused treatment of NMS of PD remain poor...
2017: International Review of Neurobiology
https://www.readbyqxmd.com/read/28805568/complementary-and-alternative-medicine-and-exercise-in-nonmotor-symptoms-of-parkinson-s-disease
#4
Indu Subramanian
The use of complementary and alternative medicine (CAM) therapy in nonmotor symptoms (NMS) for Parkinson disease (PD) is growing worldwide. Well-performed, systematic evidence-based research is largely lacking in this area and many studies include various forms of CAM with small patient numbers and a lack of standardization of the approaches studied. Taichi, Qigong, dance, yoga, mindfulness, acupuncture, and other CAM therapies are reviewed and there is some evidence for the following: Taichi in sleep and PDQ39; dance in cognition, apathy, and a mild trend to improved fatigue; yoga in PDQ39; and acupuncture in depression, PDQ39, and sleep...
2017: International Review of Neurobiology
https://www.readbyqxmd.com/read/28805528/pace-investigators-response-is-misleading-regarding-patient-survey-results
#5
Karen D Kirke
The PACE investigators' citation of a patient survey might mislead readers into thinking that the experience of people with myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS) supports PACE findings. In fact, patient survey evidence directly contradicts the results of the PACE trial. A review of survey data published between 2001 and 2015 reveals that for most patients, graded exercise therapy leads to worsening of symptoms, cognitive behavioural therapy leads to no change in symptoms, and pacing leads to improvement...
August 2017: Journal of Health Psychology
https://www.readbyqxmd.com/read/28805527/bias-misleading-information-and-lack-of-respect-for-alternative-views-have-distorted-perceptions-of-myalgic-encephalomyelitis-chronic-fatigue-syndrome-and-its-treatment
#6
Ellen Goudsmit, Sandra Howes
The PACE trial is one of the most recent studies evaluating cognitive behavioural therapy and graded exercise therapy for myalgic encephalomyelitis/chronic fatigue syndrome. These interventions are based on a model which assumes that symptoms are perpetuated by factors such as misguided beliefs and a lack of activity. Our analysis indicates that the researchers have shown significant bias in their accounts of the literature and may also have overstated the effectiveness of the above treatments. We submit that their approach to criticisms undermines the scientific process and is inconsistent with best practice...
August 2017: Journal of Health Psychology
https://www.readbyqxmd.com/read/28805526/the-problem-of-bias-in-behavioural-intervention-studies-lessons-from-the-pace-trial
#7
Carolyn Wilshire
Geraghty's recent editorial on the PACE trial for chronic fatigue syndrome has stimulated a lively discussion. Here, I consider whether the published claims are justified by the data. I also discuss wider issues concerning trial procedures, researcher allegiance and participant reporting bias. Cognitive behavioural therapy and graded exercise therapy had modest, time-limited effects on self-report measures, but little effect on more objective measures such as fitness and employment status. Given that the trial was non-blinded, and the favoured treatments were promoted to participants as 'highly effective', these effects may reflect participant response bias...
August 2017: Journal of Health Psychology
https://www.readbyqxmd.com/read/28805525/pace-gate-an-alternative-view-on-a-study-with-a-poor-trial-protocol
#8
Bart Stouten
The controversies surrounding the effectiveness of cognitive behavioural therapy and graded exercise therapy for chronic fatigue syndrome are explained using Cohen's d effect sizes rather than arbitrary thresholds for 'success'. This article shows that the treatment effects vanish when switching to objective outcomes. The preference for subjective outcomes by the PACE trial team leads to false hope. This article provides a more realistic view, which will help patients and their doctors to evaluate the pros and cons...
August 2017: Journal of Health Psychology
https://www.readbyqxmd.com/read/28805524/response-to-the-editorial-by-dr-geraghty
#9
Peter D White, Trudie Chalder, Michael Sharpe, Brian J Angus, Hannah L Baber, Jessica Bavinton, Mary Burgess, Lucy V Clark, Diane L Cox, Julia C DeCesare, Kimberley A Goldsmith, Anthony L Johnson, Paul McCrone, Gabrielle Murphy, Maurice Murphy, Hazel O'Dowd, Laura Potts, Rebacca Walwyn, David Wilks
This article is written in response to the linked editorial by Dr Geraghty about the adaptive Pacing, graded Activity and Cognitive behaviour therapy; a randomised Evaluation (PACE) trial, which we led, implemented and published. The PACE trial compared four treatments for people diagnosed with chronic fatigue syndrome. All participants in the trial received specialist medical care. The trial found that adding cognitive behaviour therapy or graded exercise therapy to specialist medical care was as safe as, and more effective than, adding adaptive pacing therapy or specialist medical care alone...
August 2017: Journal of Health Psychology
https://www.readbyqxmd.com/read/28805522/pace-trial-claims-for-recovery-in-myalgic-encephalomyelitis-chronic-fatigue-syndrome-true-or-false-it-s-time-for-an-independent-review-of-the-methodology-and-results
#10
Charles Bernard Shepherd
The PACE trial set out to discover whether cognitive behaviour therapy and graded exercise therapy are safe and effective forms of treatment for myalgic encephalomyelitis/chronic fatigue syndrome. It concluded that these interventions could even result in recovery. However, patient evidence has repeatedly found that cognitive behaviour therapy is ineffective and graded exercise therapy can make the condition worse. The PACE trial methodology has been heavily criticised by clinicians, academics and patients...
August 2017: Journal of Health Psychology
https://www.readbyqxmd.com/read/28805520/pace-team-response-shows-a-disregard-for-the-principles-of-science
#11
Jonathan Edwards
The PACE trial of cognitive behavioural therapy and graded exercise therapy for chronic fatigue syndrome/myalgic encephalomyelitis has raised serious questions about research methodology. An editorial article by Geraghty gives a fair account of the problems involved, if anything understating the case. The response by White et al. fails to address the key design flaw, of an unblinded study with subjective outcome measures, apparently demonstrating a lack of understanding of basic trial design requirements. The failure of the academic community to recognise the weakness of trials of this type suggests that a major overhaul of quality control is needed...
August 2017: Journal of Health Psychology
https://www.readbyqxmd.com/read/28805519/pace-trial-authors-continue-to-ignore-their-own-null-effect
#12
Mark Vink
Protocols and outcomes for the PACE trial were changed after the start of the trial. These changes made substantial differences, leading to exaggerated claims for the efficacy of cognitive behavior therapy and graded exercise therapy in myalgic encephalomyelitis/chronic fatigue syndrome. The small, self-reported improvements in subjective measures cannot be used to say the interventions are effective, particularly in light of the absence of objective improvement. Geraghty's criticism of the trial was reasonable and supported by the evidence...
August 2017: Journal of Health Psychology
https://www.readbyqxmd.com/read/28805516/do-graded-activity-therapies-cause-harm-in-chronic-fatigue-syndrome
#13
Tom Kindlon
Reporting of harms was much better in the PACE (Pacing, graded Activity, and Cognitive behavioural therapy: a randomised Evaluation) trial than earlier chronic fatigue syndrome trials of graded exercise therapy and cognitive behavioural therapy. However, some issues remain. The trial's poor results on objective measures of fitness suggest a lack of adherence to the activity component of these therapies. Therefore, the safety findings may not apply in other clinical contexts. Outside of clinical trials, many patients report deterioration with cognitive behavioural therapy and particularly graded exercise therapy...
August 2017: Journal of Health Psychology
https://www.readbyqxmd.com/read/28805514/investigator-bias-and-the-pace-trial
#14
Steven Lubet
The PACE investigators reject Geraghty's suggestion that the cognitive behavior therapy/graded exercise therapy trial could have been better left to researchers with no stake in the theories under study. The potential sources and standards for determining researcher bias are considered, concluding that the PACE investigators "impartiality might reasonably be questioned."
August 2017: Journal of Health Psychology
https://www.readbyqxmd.com/read/28805512/chronic-fatigue-syndrome-patients-have-no-reason-to-accept-the-pace-trial-results-response-to-keith-j-petrie-and-john-weinman
#15
Susanna Agardy
Petrie and Weinman urge chronic fatigue syndrome patients to move on from their beliefs about their illness and accept the findings of thePACE trial. This is unreasonable in view of the failure of PACE to achieve evidence of recovery through cognitive behaviour therapy and graded exercise therapy in either self-reports or the objective measure of the 6-minute walking test. Contrary to their suggestion, the Institute of Medicine describes chronic fatigue syndrome not as psychological but as a serious, chronic, systemic disease, with post-exertional malaise as its main feature which inhibits exercise...
August 2017: Journal of Health Psychology
https://www.readbyqxmd.com/read/28803675/the-yale-fitness-intervention-trial-in-female-cancer-survivors-cardiovascular-and-physiological-outcomes
#16
M Tish Knobf, Sangchoon Jeon, Barbara Smith, Lyndsay Harris, Siobhan Thompson, Mitchel R Stacy, Karl Insogna, Albert J Sinusas
BACKGROUND: Induced premature menopause and cardio-toxic therapy increase cardiovascular disease risk in female cancer survivors. OBJECTIVE: To compare the effects of a 12 month aerobic-resistance fitness center intervention to home based physical activity on cardiovascular function and metabolic risk factors. METHODS: Subjects (N = 154) who had completed primary and/or adjuvant chemotherapy (past 3 years) were randomized to a fitness center intervention or a home based group...
August 10, 2017: Heart & Lung: the Journal of Critical Care
https://www.readbyqxmd.com/read/28803497/exploring-the-potential-value-of-improved-care-for-secondary-hyperparathyroidism-with-a-novel-calcimimetic-therapy
#17
Björn Stollenwerk, Sergio Iannazzo, Kerry Cooper, Vasily Belozeroff
AIMS: This study explored the use of a value-based pricing approach for the new calcimimetic etelcalcetide indicated for the treatment of secondary hyperparathyroidism (SHPT) in patients receiving hemodialysis. It used the US payer perspective and applied the cost-effectiveness framework. Because etelcalcetide is an intravenous therapy that can be titrated for individual patients, and because its utilization is yet to be assessed in real world settings, a range of plausible doses were estimated for etelcalcetide to define a range of prices...
August 14, 2017: Journal of Medical Economics
https://www.readbyqxmd.com/read/28802469/complementary-and-integrative-medicine-for-neurologic-conditions
#18
REVIEW
Rebecca Erwin Wells, Vanessa Baute, Helané Wahbeh
Although many neurologic conditions are common, cures are rare and conventional treatments are often limited. Many patients, therefore, turn to complementary and alternative medicine (CAM). The use of selected, evidence-based CAM therapies for the prevention and treatment of migraine, carpal tunnel syndrome, and dementia are presented. Evidence is growing many of modalities, including nutrition, exercise, mind-body medicine, supplements, and acupuncture.
September 2017: Medical Clinics of North America
https://www.readbyqxmd.com/read/28801068/lepr-polymorphism-may-affect-energy-balance-during-weight-loss-among-brazilians-obese-adolescents
#19
Flávia Campos Corgosinho, Sandro Soares Almeida, Lian Tock, João Bosco Pesquero, Ronaldo Carvalho Araújo, Ana Paula Grotti Clemente, Bárbara Dal'Molin Netto, Raquel Munhoz da Silveira Campos, Deborah Cristina Landi Masquio, Joana Pereira de Carvalho Ferreira, Priscila de Lima Sanches, Aline de Piano Ganen, Marcelo Macedo Rogero, Lila Missae Oyama, Sergio Tufik, Marco Túlio de Mello, Ana Raimunda Dâmaso
OBJECTIVE: Leptin is an adipokine released mainly by adipose tissue, with many functions including regulation of energy balance. However, little is known about the effect of LEPR polymorphism on orexigenic and anorexigenic neuropeptides. Thus, the aim of the present study is to verify the influence of LEPR polymorphism (rs2767485) on serum orexigenic (NPY, MCH and AgRP) and anorexigenic (Leptin and α-MSH) neuropeptides levels among obese adolescents submitted to 1year of multicomponent weight loss therapy...
August 2, 2017: Neuropeptides
https://www.readbyqxmd.com/read/28801055/therapy-with-mesenchymal-stromal-cells-or-conditioned-medium-reverse-cardiac-alterations-in-a-high-fat-diet-induced-obesity-model
#20
P S Daltro, B C Barreto, P G Silva, P Chenaud Neto, P H F Sousa Filho, D Santana Neta, G B Carvalho, D N Silva, B D Paredes, A C de Alcantara, L A R Freitas, R D Couto, R R Santos, B S F Souza, M B P Soares, S G Macambira
BACKGROUND: Obesity is associated with numerous cardiac complications, including arrhythmias, cardiac fibrosis, remodeling and heart failure. Here we evaluated the therapeutic potential of mesenchymal stromal cells (MSCs) and their conditioned medium (CM) to treat cardiac complications in a mouse model of high-fat diet (HFD)-induced obesity. METHODS: After obesity induction and HFD withdrawal, obese mice were treated with MSCs, CM or vehicle. Cardiac function was assessed using electrocardiography, echocardiography and treadmill test...
August 8, 2017: Cytotherapy
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