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https://www.readbyqxmd.com/read/27922448/the-second-randomised-evaluation-of-the-effectiveness-cost-effectiveness-and-acceptability-of-computerised-therapy-reeact-2-trial-does-the-provision-of-telephone-support-enhance-the-effectiveness-of-computer-delivered-cognitive-behaviour-therapy-a-randomised
#1
Sally Brabyn, Ricardo Araya, Michael Barkham, Peter Bower, Cindy Cooper, Ana Duarte, David Kessler, Sarah Knowles, Karina Lovell, Elizabeth Littlewood, Richard Mattock, Stephen Palmer, Jodi Pervin, David Richards, Debbie Tallon, David White, Simon Walker, Gillian Worthy, Simon Gilbody
BACKGROUND: Computerised cognitive behaviour therapy (cCBT) is an efficient form of therapy potentially improving access to psychological care. Indirect evidence suggests that the uptake and effectiveness of cCBT can be increased if facilitated by telephone, but this is not routinely offered in the NHS. OBJECTIVES: To compare the clinical effectiveness and cost-effectiveness of telephone-facilitated free-to-use cCBT [e.g. MoodGYM (National Institute for Mental Health Research, Australian National University, Canberra, ACT, Australia)] with minimally supported cCBT...
November 2016: Health Technology Assessment: HTA
https://www.readbyqxmd.com/read/27922167/cost-effectiveness-of-primarily-surgical-versus-primarily-conservative-treatment-of-acute-and-subacute-radiculopathies-due-to-intervertebral-disc-herniation-from-the-swiss-perspective
#2
Zanfina Ademi, Viktoria Gloy, Dominik Glinz, Heike Raatz, Joris Van Stiphout, Heiner C Bucher, Matthias Schwenkglenks
AIMS OF THE STUDY: To assess the cost-effectiveness of primarily surgical treatment (PST) versus primarily conservative treatment (PCT) in adults with intermediate severity, acute or subacute, lumbar radicular syndrome due to intervertebral disc herniation. METHODS: A decision analytic model from healthcare system and societal perspectives was used to compare outcomes and costs of PST with those of PCT (physiotherapy, epidural injection and medication). Treatment pathways and quality of life were obtained from published clinical trials...
2016: Swiss Medical Weekly
https://www.readbyqxmd.com/read/27921140/cocaine-administration-dose-dependently-increases-sexual-desire-and-decreases-condom-use-likelihood-the-role-of-delay-and-probability-discounting-in-connecting-cocaine-with-hiv
#3
Matthew W Johnson, Evan S Herrmann, Mary M Sweeney, Robert S LeComte, Patrick S Johnson
OBJECTIVES: Although cocaine use has been linked to sexual HIV risk behavior for decades, the direct effects of cocaine on sexual desire and sexual decision-making are unexamined. Research suggests delay discounting (devaluation of future outcomes) and probability discounting (devaluation of uncertain outcomes) play roles in condom use decisions. This study examined the effect of cocaine administration on sexual desire, hypothetical condom use, and discounting tasks. METHODS: This double-blind, within-subjects study compared the effects of 0, 125, and 250 mg/70 kg oral cocaine HCl in 12 cocaine users...
December 5, 2016: Psychopharmacology
https://www.readbyqxmd.com/read/27920164/epistemic-injustice-in-healthcare-encounters-evidence-from-chronic-fatigue-syndrome
#4
Charlotte Blease, Havi Carel, Keith Geraghty
Chronic fatigue syndrome or myalgic encephalomyelitis (CFS/ME) remains a controversial illness category. This paper surveys the state of knowledge and attitudes about this illness and proposes that epistemic concerns about the testimonial credibility of patients can be articulated using Miranda Fricker's concept of epistemic injustice. While there is consensus within mainstream medical guidelines that there is no known cause of CFS/ME, there is continued debate about how best to conceive of CFS/ME, including disagreement about how to interpret clinical studies of treatments...
December 5, 2016: Journal of Medical Ethics
https://www.readbyqxmd.com/read/27919760/proton-therapy-present-and-future
#5
REVIEW
Radhe Mohan, David Grosshans
In principle, proton therapy offers a substantial clinical advantage over the conventional photon therapy. This is because of the unique depth-dose characteristics of protons, which can be exploited to achieve significant reductions in normal tissue doses proximal and distal to the target volume. These may, in turn, allow escalation of tumor doses, greater sparing of normal tissues, thus potentially improving local control and survival while at the same time reducing toxicity and improving quality of life. Protons, accelerated to therapeutic energies ranging from 70 to 250MeV, typically with a cyclotron or a synchrotron, are transported to the treatment room where they enter the treatment head mounted on a rotating gantry...
December 2, 2016: Advanced Drug Delivery Reviews
https://www.readbyqxmd.com/read/27919186/economic-evaluation-for-the-us-of-nab-paclitaxel-plus-gemcitabine-versus-folfirinox-versus-gemcitabine-in-the-treatment-of-metastatic-pancreas-cancer
#6
Mahdi Gharaibeh, Ali McBride, J Lyle Bootman, Hitendra Patel, Ivo Abraham
BACKGROUND: Nab-paclitaxel plus gemcitabine (NAB-P+GEM) and FOLFIRINOX have shown superior efficacy over gemcitabine (GEM) in the treatment of metastatic pancreatic ductal adenocarcinoma (mPDA). Though the incremental clinical benefits are modest, both treatments represent significant advances in the treatment of a high-mortality cancer. In this independent economic evaluation for the US, we aimed to estimate the comparative cost-utility and cost-effectiveness of these three regimens from the payer perspective...
December 6, 2016: Journal of Medical Economics
https://www.readbyqxmd.com/read/27917777/the-identification-and-treatment-of-women-with-hyperglycaemia-in-pregnancy-an-analysis-of-individual-participant-data-systematic-reviews-meta-analyses-and-an-economic-evaluation
#7
Diane Farrar, Mark Simmonds, Susan Griffin, Ana Duarte, Debbie A Lawlor, Mark Sculpher, Lesley Fairley, Su Golder, Derek Tuffnell, Martin Bland, Fidelma Dunne, Donald Whitelaw, John Wright, Trevor A Sheldon
BACKGROUND: Gestational diabetes mellitus (GDM) is associated with a higher risk of important adverse outcomes. Practice varies and the best strategy for identifying and treating GDM is unclear. AIM: To estimate the clinical effectiveness and cost-effectiveness of strategies for identifying and treating women with GDM. METHODS: We analysed individual participant data (IPD) from birth cohorts and conducted systematic reviews to estimate the association of maternal glucose levels with adverse perinatal outcomes; GDM prevalence; maternal characteristics/risk factors for GDM; and the effectiveness and costs of treatments...
November 2016: Health Technology Assessment: HTA
https://www.readbyqxmd.com/read/27914319/intolerance-of-uncertainty-scale-measurement-invariance-among-adolescent-boys-and-girls-and-relationships-with-anxiety-and-risk-taking
#8
Laura M S Dekkers, Brenda R J Jansen, Elske Salemink, Hilde M Huizenga
BACKGROUND AND OBJECTIVES: Adolescence-related increases in both anxiety and risk taking may originate in variability in Intolerance of Uncertainty (IU), rendering the study of IU of importance. We therefore studied the psychometric properties of the Intolerance of Uncertainty Scale-Short version (IUS-12), including its associations with trait anxiety and risk taking, among adolescents. METHODS: A sample of 879 Dutch adolescents, from diverse educational levels, and with an equal distribution of boys and girls, was classically tested...
November 21, 2016: Journal of Behavior Therapy and Experimental Psychiatry
https://www.readbyqxmd.com/read/27913940/cost-analysis-and-cost-benefit-analysis-of-a-medication-review-with-follow-up-service-in-aged-polypharmacy-patients
#9
Amaia Malet-Larrea, Estíbaliz Goyenechea, Miguel A Gastelurrutia, Begoña Calvo, Victoria García-Cárdenas, Juan M Cabases, Aránzazu Noain, Fernando Martínez-Martínez, Daniel Sabater-Hernández, Shalom I Benrimoj
BACKGROUND: Drug related problems have a significant clinical and economic burden on patients and the healthcare system. Medication review with follow-up (MRF) is a professional pharmacy service aimed at improving patient's health outcomes through an optimization of the medication. OBJECTIVE: To ascertain the economic impact of the MRF service provided in community pharmacies to aged polypharmacy patients comparing MRF with usual care, by undertaking a cost analysis and a cost-benefit analysis...
December 2, 2016: European Journal of Health Economics: HEPAC: Health Economics in Prevention and Care
https://www.readbyqxmd.com/read/27911489/palliative-care-interventions-in-advanced-dementia
#10
REVIEW
Edel Murphy, Katherine Froggatt, Sheelah Connolly, Eamon O'Shea, Elizabeth L Sampson, Dympna Casey, Declan Devane
BACKGROUND: Dementia is a chronic, progressive and ultimately fatal neurodegenerative disease. Advanced dementia is characterised by profound cognitive impairment, inability to communicate verbally and complete functional dependence. Usual care of people with advanced dementia is not underpinned universally by a palliative approach. Palliative care has focused traditionally on care of people with cancer but for more than a decade, there have been increased calls worldwide to extend palliative care services to include all people with life-limiting illnesses in need of specialist care, including people with dementia...
December 2, 2016: Cochrane Database of Systematic Reviews
https://www.readbyqxmd.com/read/27909957/adaptive-radiation-therapy-in-head-and-neck-cancer-for-clinical-practice-state-of-the-art-and-practical-challenges
#11
REVIEW
Ovidiu Veresezan, Idriss Troussier, Alexis Lacout, Sarah Kreps, Sophie Maillard, Aude Toulemonde, Pierre-Yves Marcy, Florence Huguet, Juliette Thariat
Modern radiation therapy techniques are characterized by high conformality to tumor volumes and steep dose gradients to spare normal organs. These techniques require accurate clinical target volume definitions and rigorous assessment of set up uncertainties using image guidance, a concept called image-guided radiation therapy. Due to alteration of patient anatomy, changes in tissue density/volumes and tumor shrinkage over the course of treatment, treatment accuracy may be challenged. This may result in excessive irradiation of organs at risk/healthy tissues and undercoverage of target volumes with a significant risk of locoregional failure...
December 1, 2016: Japanese Journal of Radiology
https://www.readbyqxmd.com/read/27908616/spinocerebellar-ataxia-15-a-phenotypic-review-and-expansion
#12
REVIEW
Philip W Tipton, Kimberly Guthrie, Audrey Strongosky, Ronald Reimer, Zbigniew K Wszolek
Spinocerebellar ataxia 15 (SCA15) is a clinically heterogeneous movement disorder characterized by the adult onset of slowly progressive cerebellar ataxia. ITPR1 is the SCA15 causative gene. However, despite numerous reports of genetically-confirmed SCA15, phenotypic uncertainty persists. We reviewed the phenotypes of 60 patients for whom SCA15 was confirmed by the presence of a genetic deletion involving ITPR1. The most prevalent symptoms were gait ataxia (88.3%), dysarthria (75.0%), nystagmus (73.3%), and limb ataxia (71...
November 10, 2016: Neurologia i Neurochirurgia Polska
https://www.readbyqxmd.com/read/27908345/determining-when-to-add-nonstatin-therapy-a-quantitative-approach
#13
Jennifer G Robinson, Roeland Huijgen, Kausik Ray, Jane Persons, John J P Kastelein, Michael J Pencina
BACKGROUND: Costs and uncertainty about the benefits of nonstatin therapies limit their use. OBJECTIVES: The authors sought to identify patients who might benefit from the addition of a nonstatin to background statin therapy. METHODS: We performed systematic reviews of subgroup analyses from randomized trials and observational studies with statin-treated participants to determine estimated 10-year absolute risk of atherosclerotic cardiovascular disease (ASCVD) and to define high-risk and very high-risk patients...
December 6, 2016: Journal of the American College of Cardiology
https://www.readbyqxmd.com/read/27908334/antimicrobial-stewardship-in-the-management-of-sepsis
#14
REVIEW
Michael S Pulia, Robert Redwood, Brian Sharp
Sepsis represents a unique clinical dilemma with regard to antimicrobial stewardship. The standard approach to suspected sepsis in the emergency department centers on fluid resuscitation and timely broad-spectrum antimicrobials. The lack of gold standard diagnostics and evolving definitions for sepsis introduce a significant degree of diagnostic uncertainty that may raise the potential for inappropriate antimicrobial prescribing. Intervention bundles that combine traditional quality improvement strategies with emerging electronic health record-based clinical decision support tools and rapid molecular diagnostics represent the most promising approach to enhancing antimicrobial stewardship in the management of suspected sepsis in the emergency department...
February 2017: Emergency Medicine Clinics of North America
https://www.readbyqxmd.com/read/27908181/defining-and-assessing-an-anisotropic-delineation-margin-for-modern-radiotherapy
#15
L R Bell, E M Pogson, P E Metcalfe, L C Holloway
PURPOSE: Uncertainty in target volume delineation for modern radiotherapy impacts dosimetry and patient outcomes. Delineation uncertainty is generally overlooked in practice as a source of error, potentially since historically, other uncertainties have been the main focus. This work defined and assessed an anisotropic delineation margin in both polar and spherical coordinate systems in order to account for the spatially varying nature of this uncertainty using a whole breast radiotherapy cohort as a proof of concept...
December 2016: Medical Physics
https://www.readbyqxmd.com/read/27908176/activity-cross-calibration-of-unsealed-radionuclides-utilizing-a-portable-ion-chamber
#16
Hans-Sonke Jans
PURPOSE: To present and evaluate an ion chamber-based method for the cross-calibration between sites of activity measurements of unsealed radionuclides. Notably, the method allows direct comparison of short lived (i.e., clinically used) radioisotopes and the cross-calibration of radionuclide activity meters (also known as "dose calibrators"). METHODS: A portable ion chamber has been designed which is easily shipped between sites, e.g., between a standards laboratory and a nuclear medicine department...
December 2016: Medical Physics
https://www.readbyqxmd.com/read/27908157/volumetry-of-low-contrast-liver-lesions-with-ct-investigation-of-estimation-uncertainties-in-a-phantom-study
#17
Qin Li, Yongguang Liang, Qiao Huang, Min Zong, Benjamin Berman, Marios A Gavrielides, Lawrence H Schwartz, Binsheng Zhao, Nicholas Petrick
PURPOSE: To evaluate the performance of lesion volumetry in hepatic CT as a function of various imaging acquisition parameters. METHODS: An anthropomorphic abdominal phantom with removable liver inserts was designed for this study. Two liver inserts, each containing 19 synthetic lesions with varying diameter (6-40 mm), shape, contrast (10-65 HU), and both homogenous and mixed-density were designed to have background and lesion CT values corresponding to arterial and portal-venous phase imaging, respectively...
December 2016: Medical Physics
https://www.readbyqxmd.com/read/27905926/understanding-clinical-and-non-clinical-decisions-under-uncertainty-a-scenario-based-survey
#18
Vlad V Simianu, Margaret A Grounds, Susan L Joslyn, Jared E LeClerc, Anne P Ehlers, Nidhi Agrawal, Rafael Alfonso-Cristancho, Abraham D Flaxman, David R Flum
BACKGROUND: Prospect theory suggests that when faced with an uncertain outcome, people display loss aversion by preferring to risk a greater loss rather than incurring certain, lesser cost. Providing probability information improves decision making towards the economically optimal choice in these situations. Clinicians frequently make decisions when the outcome is uncertain, and loss aversion may influence choices. This study explores the extent to which prospect theory, loss aversion, and probability information in a non-clinical domain explains clinical decision making under uncertainty...
December 1, 2016: BMC Medical Informatics and Decision Making
https://www.readbyqxmd.com/read/27904451/the-ratio-of-weight-loss-to-planning-target-volume-significantly-impacts-setup-errors-in-nasopharyngeal-cancer-patients-undergoing-helical-tomotherapy-with-daily-megavoltage-computed-tomography
#19
Wei-Hsien Hou, Chun-Wei Wang, Chiao-Ling Tsai, Feng-Ming Hsu, Jason Chia-Hsien Cheng
BACKGROUND: Changes in head and neck anatomy during radiation therapy (RT) produce setup uncertainties of nasopharyngeal cancer (NPC) irradiation. We retrospectively analyzed image guidance data to identify clinical predictors of setup errors. PATIENTS AND METHODS: The data of 217 NPC patients undergoing definitive RT on a helical tomotherapy (HT) unit were analyzed. Factors including tumor stage, body mass index, weight loss, and planning target volume (PTV) were assessed as predictors of daily megavoltage computed tomography (MVCT) setup displacements, which were automatically registered using software...
December 1, 2016: Radiology and Oncology
https://www.readbyqxmd.com/read/27903565/improving-care-for-heart-failure-patients-in-primary-care-gps-perceptions-a-qualitative-evidence-synthesis
#20
Miek Smeets, Sara Van Roy, Bert Aertgeerts, Mieke Vermandere, Bert Vaes
OBJECTIVES: General practitioners (GPs) play a key role in heart failure (HF) management. Despite multiple guidelines, the management of patients with HF in primary care is suboptimal. Therefore, all the qualitative evidence concerning GPs' perceptions of managing HF in primary care was synthesised to identify barriers and facilitators for optimal care, and ideas for improvement. DESIGN: Qualitative evidence synthesis. METHODS: Searches of MEDLINE, EMBASE, Web of Science and CINAHL databases up to 20/12/2015 were conducted...
November 30, 2016: BMJ Open
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