Active Participation In Treatment Research Articles

Secondary analyses of sex differences in attention improvements across three clinical trials of a digital therapeutic in children, adolescents, and adults with ADHD

BackgroundAttention-deficit/hyperactivity disorder (ADHD) remains underdiagnosed and undertreated in girls. Inattentive symptoms, often predominant in girls with ADHD, represent a key driver of impairment and often persist into adulthood. AKL-T01 is a regulated digital therapeutic targeting inattention. We examined potential sex differences in the efficacy of AKL-T01 in three separate trials for 1) children, 2) adolescents, and 3) adults.MethodsWe conducted secondary analyses of clinical outcomes by sex in three AKL-T01 randomized clinical trials in ADHD (n1 = 180 children 30.6% female, M(SD) age = 9.71 (1.32); n2 = 146 adolescents; 41.1% female, M(SD) age = 14.34 (1.26); n3 = 153 adults; 69.9% female, M(SD) age = 39.86 (12.84)). Active treatment participants used AKL-T01 for 25 min/day over 4–6 weeks. Primary outcomes included change in attention on the Test of Variables of Attention (TOVA) and symptom change on the clinician-rated ADHD Rating Scale (ADHD-RS). To evaluate study hypotheses, we conducted a series of robust linear regressions of TOVA and ADHD-RS change scores by sex, adjusting for baseline scores.ResultsIn children, girls demonstrated greater improvement in objective attention relative to boys following AKL-T01 (TOVA Attentional Composite Score; Cohen’s d = .36 and Reaction Time Mean Half; Cohen’s d = .54), but no significant sex differences in ADHD rating scale change. We did not observe significant sex differences in outcomes in the adolescent or adult trials. Limitations include binary sex categorization and slight study design variation across the three samples.ConclusionAKL-T01 might notably improve attentional functioning in girls with ADHD relative to boys. Objective attention measures may be particularly important in the assessment of attentional improvement in childhood, given known gender biases in ADHD symptom reporting. We emphasize the importance of considering sex and gender-specific factors in ADHD treatment evaluation.Trial registrationsSTARS ADHD CHILD: ClinicalTrials.gov ID NCT03649074;STARS ADHD ADOLESCENT: ClinicalTrials.gov ID NCT04897074;STARS ADHD ADULT: ClinicalTrials.gov ID NCT05183919.

Knowledge of Chronic Inflammatory Bowel Disease Patients about Their Disease in the North Moroccan Region

Patients' level of knowledge about their disease plays an essential role in therapeutic management, by facilitating patients' acceptance of the diagnosis, their active participation in treatment and improved compliance. Few studies have been conducted in Morocco to assess the level of knowledge of IBD patients. The aim of this study was to assess the level of knowledge of IBD patients in the northern region of Morocco. Materials and methods: We conducted a cross-sectional study over a period of 5 months in the hepato-gastroenterology department of the Mohammed VI University Hospital in Tangiers. Our study involved a series of 100 patients with confirmed IBD. A questionnaire was drawn up and given to the patients. Results: The main results of our study reveal a considerable lack of knowledge among our patients about their disease, covering all areas of the disease and more specifically the treatment and complications aspect. This lack of knowledge can be attributed in part to the high rate of illiteracy in our setting. Conclusion: These results underline the importance of raising patients' awareness of their disease by setting up educational workshops tailored to their level of understanding. These workshops aim to improve patients' knowledge, encourage adherence to treatment and, ultimately, improve their quality of life. Keywords: Inflammatory bowel diseases, patient knowledge

The Experience of Caring a Hemodialysis Patient with Hopelessness

<p>本文個案因透析低血壓影響生活，感到失去對身體的控制感，加上長期慢性病與需終生依賴透析產生無望感引起筆者動機。筆者於2019年9月2日至10月28日護理期間，運用Gordon十一項功能性健康評估工具，收集主、客觀資料，確立個案有體液容積過量、便秘及無望感的健康問題。在生理層面讓個案瞭解適當攝水量之計算，並每日測量體重，有效控制兩次透析間增加的體重，使用藥物及非藥物的方式，協助個案養成每日排便的習慣；在心理層面以貝克無望感量表作為評估工具，運用家庭支持、腎友經驗分享，協助個案面對血液透析帶來的挑戰，建立有效策略面對疾病，提升個案對生活的控制感並積極參與治療，成功適應血液透析的生活，並表達對未來的期待與規劃。</p> <p> </p><p>This article describes the patient’s poor quality of life owing to hemodialysis hypotension. He felt a sense of loss of motor control. Because of his chronic disease that mandated continued hemodialysis, the patient felt hopeless. Have caused the author’s motivation. During the nursing period from September 2 to October 28, 2019, the author used Gordon’s 11 functional health assessment tools to collect subjective and objective data to establish the patient’s health complications, such as excess fluid volume, constipation, and hopelessness. For physiological improvement, the patient was educated of water intake regulation, daily weight measurement for effective weight control between 2 dialysis sessions, and use of drug- and non-drug methods to help develop a daily bowel habit. For psychological support, the Beck Hopelessness Scale was used as a mental state assessment tool. Family support and nephrologist’s sharing of their experience were used to help the patient overcome the challenges from hemodialysis. Basis this study, we recommend establishing effective strategies to cope with disease, improving the individual’s sense of control over life and encouraging active participation in treatment, successfully adapting to the changes in daily life effected by hemodialysis, and expressing expectations and plans for the future.</p> <p> </p>

An integrated model of psychotherapeutic support in the system of therapy for COVID-19 patients

Introduction. To date, it has been already established that COVID-19 has a negative impact not only on the physical condition, but also on the mental health of the population in every country of the world. Many people have a fear of coronavirus, which is usually associated with the possible risk of infection, the lack of pathogenetic treatment, unpredictable course of the disease, as well as total uncertainty. All of the above causes negative psychological reactions. according to a scientific review published by the World Health Organization, global prevalence of anxiety and depression increased by a quarter of a percent in the first year of the COVID-19 pandemic. The aim of the study was to develop an integrated model of psychotherapeutic support for patients with COVID-19. Materials and Methods: а comprehensive clinical-psychopathological and psychodiagnostic examination of 125 patients with COVID-19 and non-psychotic mental disorders, of both sexes, with an average age of 36.0±3.4 years, was conducted. Results. The findngs of the clinical-psychopathological study suggest that the clinical picture of non-psychotic mental disorders in the examined patients is represented by astheno-neurotic, anxious, depressive and cognitive syndromes. The psychotherapeutic program included indivi­dual and group psychotherapy and psychoeducation. An important component of the psychothe­rapeutic support program was psychoeducation aimed at developing an adequate system of ideas about the neurotoxic impact and consequences of COVID-19, understanding the main psychopathological syndromes caused by the disease, involving patients in active participation in treatment, and teaching methods of overcoming immersion in the disease. Conclusions. The analysis of the clinical findings of using the developed program showed a positive dynamic of the emotional state, a decrease in the expressiveness of anxiety-depressive symptoms, a positive transformation of coping strategies, the transition of non-constructive types of attitudes to the disease into adaptive, constructive ones, and an increase in the quality of life. Keywords: professionally important qualities, nuclear terrorism, hostages, performance of professional functions, neuropsychological stability, NPP control panel operators.

The effect of smartphone-based education on self-efficacy of women with gestational diabetes: A controlled clinical trial

"Background and Aim: Women with gestational diabetes are at risk for type 2 diabetes. Development of self-efficacy is an important tool for active participation in treatment and behavioral change and can have a significant effect on type 2 diabetes-preventative behaviors. Therefore, it is necessary to search for an effective teaching method to improve the self-efficacy of these individuals. Accordingly, the aim of the present article is to determine the effect of smartphone-based education on self-efficacy in women with gestational diabetes (GDM). Materials and Methods: This randomized clinical trial was conducted on 90 women with GDM (n=45 individuals per group) at Yas Medical Center, Tehran. GDM software was installed on the cell phone of the intervention group. The control group only received the prenatal routine training. The self-efficacy questionnaire was completed before and 6 weeks after the intervention by the two groups. Data analysis was carried out using Chi-square, t-test, independent t-test, and Fisher exact test in SPSS ver. 16. P-value 0.05 was considered as the significance level. Results: There was a statistically significant difference between the two groups in terms of self-efficacy changes before and 6 weeks after the intervention (p 0.001), meaning that these changes were significantly higher in the experimental group than the control group. Conclusion: Smartphone-based education can increase self-efficacy in women with GDM as an effective and low-cost method "

Perioperative attitudes of breast cancer patients towards the complementary and alternative medicine based on a survey conducted at the National Institute of Oncology in Hungary.

The popularity of complementary and alternative medicine (CAM) is increasing among cancer patients worldwide. 45% of women diagnosed with breast cancer use CAM, 62.5% of younger patients do so. So far, only one study has been published in Hungary, according to which 84.4% of Hungarian women with breast cancer use some form of complementary medicine. The utilization of some CAM modalities carries risks due to drug interactions. It is important to get to know the needs and habits of Hungarian patients in relation to CAM, which knowledge can be directly used in clinical practice. The aim of our study was to assess the extent of CAM utilization among Hungarian breast cancer patients, to examine the reasons behind this choice, and to see the relating/connecting demographic, psychological and clinical factors. In a cross-sectional survey, a self-administered questionnaire was used among inpatients at the Department of Breast and Soft Tissue Surgery in the National Institute of Oncology (n = 146). We assessed socio-demographic data, characteristics of CAM use, attitudes toward CAM, and the need for health control. Clinical data were added to the questionnaire data. 36% of the respondents visited some CAM providers, 71% used CAM preparation and 64% utilized self-help practices. Most patients are informed about these by a healthcare professional. The holistic approach is dominant in the sample as well as internal and social external control. Visitors to CAM providers and CAM preparation users have a stronger need for internal control. Visitors to CAM providers and self-help practitioners judge their own health status more favorable. The information that patients receive from people who are important to them, especially the caregiver, is crucial in their health-related behavior, including the choice of CAM. It is important to see such a high level of patient trust in health professionals and a strong need to discuss information about CAM, as well as a sense of responsibility for their health and active participation in treatment. Orv Hetil. 2022; 163(9): 350-361.

Personalized model of psychotherapeutic support for patients with COVID-19

The study of mental disorders resulting from COVID-19 has high social and medical significance. At present, there is a need for comprehensive research aimed at studying the psychopathogenesis of mental disorders that develop on the background of COVID-19. It is also necessary to develop personalized programs of pathogenetically based therapy and rehabilitation for patients who have recovered from COVID-19. It was examined 125 patients with COVІD-19 with non-psychotic mental disorders, both sexes (68 women and 57 men) with a mean age of (36.0±3.4) years. In the clinical picture of non-psychotic mental disorders in the examined patients are depressive (29.1%), anxious (33.4% of patients), astheno-neurotic (24.2%) and cognitive (13.3%) syndromes, as shown by results of clinical and psycho­pathological study. Taking into account data obtained during the comprehensive examination of psychological, pathopsychological and clinical-psychopathological features of patients with COVID-19, it was developed a model of personalized psychotherapeutic support for patients who have recovered from COVID-19, which includes psychotherapy and psychoeducation. The psychotherapeutic program consisted of three consecutive stages: stage I – formation of compliance, stage II – corrective, stage III – consolidation and maintenance of results. An important component of the psychotherapeutic support program is psychoeducation, which aims to form an adequate system of ideas about the impact and consequences of COVID-19, and to involve patients in active participation in treatment. According to study results on the background of personalized psychotherapeutic support program of patients who have recovered from COVID-19, there was a stable therapeutic effect in examined patients, positive dynamics of psychopathological symptoms, increased psychophysical activity, improved cognitive performance and significant reduction of anxiety and depression. Keywords: nonpsychotic mental disorders, coronavirus disease 2019, psycho­the­rapy, psychoeducation.

Incorporating a Usual Care Comparator into a Study of Meditation and Music Listening for Older Adults with Subjective Cognitive Decline: A Randomized Feasibility Trial.

Background:Recent studies suggest meditation and music listening (ML) may improve cognitive and psychosocial outcomes in adults with subjective cognitive decline (SCD). However, lack of a usual care group has limited conclusions.Objective:To assess the: 1) feasibility of incorporating an enhanced usual care (EUC) comparator in a trial of Kirtan Kriya meditation (KK) and ML for adults experiencing SCD; and 2) preliminary effects of active treatment (KK/ML) versus an EUC program.Methods:Forty participants with SCD were randomized 1:1:2 to a 12-week KK, ML, or EUC program. KK and ML participants were asked to practice 12 minutes/day; EUC participants were given a comprehensive educational packet regarding healthy aging and strategies for improving/maintaining brain health and asked to record any activities or strategies used. Feasibility was assessed using measures of retention, adherence, treatment expectancies, and participant satisfaction, as well as information from exit questionnaires and daily practice/activity logs. Cognitive functioning, stress, mood, sleep-quality, and health-related quality of life (QOL) were measured pre- and post-intervention using well-validated instruments.Results:Thirty-two participants (80%) completed the 3-month study, with retention highest in the EUC group (p < 0.05). Active treatment participants averaged 6.0±0.4 practice sessions/week, and EUC participants, 7.5±0.6 brain health activities/week. Treatment expectancies were similar across groups. EUC participants indicated high satisfaction with the program and study. Despite limited study power, the active treatment group showed significantly greater gains in subjective memory functioning (ps≤0.025) and nonsignificant improvements in cognitive performance (TMT-B), perceived stress, QOL, and mood (ps≤0.08) compared to the EUC group.Conclusion:Findings of this pilot feasibility trial suggest incorporation of an EUC program is feasible, and that participation in a simple 12-week relaxation program may be helpful for adults with SCD versus engagement in an EUC program.

Implementing a connected health intervention for remote patient monitoring in Saudi Arabia and Pakistan: explaining \u2018the what\u2019 and \u2018the how\u2019

BackgroundRecent developments in connected health technology provide an opportunity to remotely monitor and provide health care to the patient needing long-term medical care. However, information about how any connected health interventions should be implemented for remote patient monitoring, and how patients should be educated and enabled for active participation in treatment is still not available to a sufficient degree.DiscussionIn this paper, we discussed what the components of a connected health intervention, entitled Remotely Accessible Health Care at Home (RAHAH), are, and how this intervention has been implemented in Saudi Arabia and Pakistan. The aim of this intervention is to remotely monitor, treat and educate patients needing long-term medical care. The description of the intervention is presented based on the Template for Intervention Description and Replication (TIDieR) checklist for the transparent, comprehensive and explicit reporting.ConclusionWe believe, successful implementation of RAHAH would be crucial to monitor and manage growing chronic care populations more effectively and efficiently in Saudi Arabia and Pakistan.

A patient-derived conceptual framework of lung cancer care priorities.

206 Background: Patient-centric healthcare delivery, where patients are the ultimate decision-makers, warrants care evaluated based on patient priorities. A heterogeneous lung cancer patient population fosters variation in care priorities. This study identified care concept domains in a wholly patient-driven manner. Methods: Group concept mapping was used to assess priorities among patients invited from the PatientsLikeMe online community aged ≥18, US residents, and self-reporting lung cancer. In Phase I, 26 patients generated ideas based on the focus prompt: “ What do you want to achieve when it comes to the treatment you are receiving or are considering receiving for your lung cancer?”. 78 ideas were generated over 2 weeks. Supplementation from literature, editing for relatability, independence, and consistency yielded 78 concepts. In Phase II 67 patients used CSGlobalMax® (Concept Systems, 2018) to rate the concepts for importance (1 = not important to 5 = very important); 64 of which grouped and named the ideas into categories of unrestricted size. Multidimensional scaling and hierarchical cluster analysis generated visual maps, average importance, and categorized concept domains. Domains were compared across all patients and by treatment experience (≤1 or &gt; 1 systemic regimens) and stage at diagnosis. Results: Patients were female (78%), white (93%), and mean age of 62 (SD 8.9). 93% reported non-small cell lung cancer, 70% reported Stage III or IV diagnosis, and 58% were classified as early in treatment experience. 11 unique domains were visually represented. In order of average importance the domains were: managing lifestyle (4.52), care team quality, active participation in treatment, treatment goals, treatment options, side effects, social well-being, physical well-being, future options, fulfillment in daily living, and supportive environment (4.01). There was strong correlation between treatment subgroups (r = 0.89), although relative importance of domains shifted. Generalizability is limited. Conclusions: In this patient-driven research approach, patients developed the focus prompt, generated ideas, and structured concepts. The unique domains may help evaluate care value in patient-centric healthcare delivery.

A Web-Based Transdiagnostic Intervention for Affective and Mood Disorders: Randomized Controlled Trial.

BackgroundResearch increasingly supports a transdiagnostic conceptualization of emotional disorders (ie applying the same underlying treatment principles across mental disorders, without tailoring the protocol to specific diagnoses), and many international researchers are currently investigating this issue.ObjectiveThe aim of this study was to evaluate the efficacy and acceptability of a Web-based transdiagnostic program using a sample of Romanian adults diagnosed with anxiety and/or depression.MethodsVolunteer participants registered for the study and completed a series of online self-report measures. Participants who fulfilled basic inclusion criteria on these measures were contacted for a telephone diagnostic interview using the Structural Clinical Interview for Diagnostic and Statistical Manual of Mental Disorders, 4th Edition Axis I Disorders (SCID-I). Enrolled participants were randomized to either the active treatment group (N=69) or the wait-list control group (N=36) using a 2:1 ratio. The transdiagnostic treatment was based on the Unified Protocol for Transdiagnostic Treatment of Emotional Disorders (UP; Barlow et al, 2011) that addresses common underlying mechanisms of anxiety and depression. Participants randomized to the active treatment condition received 10 weeks of Web-based treatment based on the UP. Throughout treatment, graduate students in clinical psychology provided guidance that consisted of asynchronous written communication on a secure Web platform. After the intervention, participants in both study conditions were invited to complete a set of self-report measures and a postintervention SCID-I interview conducted by a different team of graduate students blinded to participants’ group and diagnostic status. Six months later, participants in the active treatment group were invited to complete an online follow-up assessment.ResultsDuring the intervention, active treatment participants completed on average 19 homework assignments (SD 12.10), and we collected data from 79.0% (83/105) at postintervention and 51% (35/69) at follow-up for self-report measures. Postintervention SCID-I interviews were collected from 77.1% (81/105) participants. Relative to the wait-list control group, the transdiagnostic intervention yielded overall medium to large effect sizes for the primary outcome measures (within-group Hedges g=0.52-1.34 and between-group g=0.39-0.86), and also for anxiety sensitivity (g=0.80), symptom interference (g=0.48), and quality of life (g=0.38). Significant within-groups effects only were reported for the active treatment group on Panic Disorder Severity Scale-Self Report (PDSS-SR, g=0.58-0.65) and Yale-Brown Obsessive Compulsive Scale (Y-BOCS, g=0.52-0.58).ConclusionsInsignificant between-group differences for the Y-BOCS and PDSS-SR could be explained by the small number of participants with the associated primary diagnostic (eg, only 3 participants with obsessive compulsive disorder) by the choice of outcome measure (PDSS-SR was not rated among the evidence-based measures) and by the fact that these disorders may be more difficult to treat. However, the overall results suggest that the transdiagnostic intervention tested in this study represents an effective treatment option that may prove easier to disseminate through the use of Web-based delivery systems.Trial RegistrationClinicalTrials.gov CT02739607; https://clinicaltrials.gov/ct2/show/study/NCT02739607 (Archived by WebCite at http://www.webcitation.org/6yY1VeYIZ)

Effect Size in Efficacy Trials of Women With Decreased Sexual Desire.

Regarding hypoactive sexual desire disorder (HSDD) in women, some reviewers judge the effect size small for medications vs placebo, but substantial for cognitive behavior therapy (CBT) or mindfulness meditation training (MMT) vs wait list. However, we lack comparisons of the effect sizes for the active intervention itself, for the control treatment, and for the differential between the two. For efficacy trials of HSDD in women, compare effect sizes for medications (testosterone/testosterone transdermal system, flibanserin, and bremelanotide) and placebo vs effect sizes for psychotherapy and wait-list control. We conducted a literature search for mean changes and SD on main measures of sexual desire and associated distress in trials of medications, CBT, or MMT. Effect size was used as it measures the magnitude of the intervention without confounding by sample size. Cohen d was used to determine effect sizes. For medications, mean (SD) effect size was 1.0 (0.34); for CBT and MMT, 1.0 (0.36); for placebo, 0.55 (0.16); and for wait list, 0.05 (0.26). Recommendations of psychotherapy over medication for treatment of HSDD are premature and not supported by data on effect sizes. Active participation in treatment conveys considerable non-specific benefits. Caregivers should attend to biological and psychosocial elements, and patient preference, to optimize response. Few clinical trials of psychotherapies were substantial in size or utilized adequate control paradigms. Medications and psychotherapies had similar, large effect sizes. Effect size of placebo was moderate. Effect size of wait-list control was very small, about one quarter that of placebo. Thus, a substantial non-specific therapeutic effect is associated with receiving placebo plus active care and evaluation. The difference in effect size between placebo and wait-list controls distorts the value of the subtraction of effect of the control paradigms to estimate intervention effectiveness. Pyke RE, Clayton AH. Effect Size in Efficacy Trials of Women With Decreased Sexual Desire. Sex Med Rev 2018;6:358-366.

Text messaging and activity tracker motivation program to increase physical activity in cancer survivors.

92 Background: Cancer survivors have high rates of sedentary behavior leading to obesity and cardiovascular disease. Physical activity improves quality of life (QOL) and reduces morbidity and mortality. However, cancer survivors commonly cite motivation as a barrier to increasing physical activity. We hypothesized that a motivational text-messaging feedback system linked to a Fitbit Flex activity tracker would increase the activity level of survivors and those undergoing cancer treatment. Methods: 29 participants were enrolled in an IRB-approved single-institution study. Eligibility allowed any cancer/stage, ≤2 days of exercise per week, life expectancy of 12+ months, and smartphone access. After baseline fitness/QOL testing, participants were provided a Fitbit Flex activity tracker. A text-messaging program automatically uploaded data from the tracker via an application programming interface and provided personalized text message feedback to subject’s smartphone daily for 3 months. Primary endpoint was change in step count from baseline to 3 months, with additional endpoints of change in 6 minute walk/QOL measures at 3 months, and continued exercise/use of tracker at 6 months. Results: To date, 24 have completed the 3 month program. Both academic and community sites participated, including areas with limited internet access. Most participants were female (71%) and white (63%). Eight cancer types and all stages were represented. Three participants withdrew – one because of lost tracker, one cancer death, and one “disappointed” with tracker function. Median daily steps at baseline were 3773 (IQR 2928) and 4365 at 3 months (IQR 4864). 42% had at least a 20% increase in median step count at 3 months. Improvement was noted in 45% of survivors and 38% of active treatment participants. Participants frequently used research nurses for guidance on use of wearable tracker (e.g. syncing, charging, features). Conclusions: Activity tracker with personalized daily feedback via text message successfully motivates cancer patients to increase daily activity. Patients are interested in health technology, but require technical support and coaching to maintain use. Clinical trial information: NCT02627079.

Comparison of effect of Nursing Education and Peer Education Methods on Self-Efficacy in Patients with Myocardial Infarction

Background and Objectives: Following a doctor’s orders in regards to diet and activity is very important for patients with myocardial infarction. Self-efficacy is an important tool for active participation in treatment and change in behavior. Thus, this study aims to compare the effects of nursing education and peer education on cardiac self-efficacy in patients with acute myocardial infarction. Methods: The present study is a randomized clinical trial (RCT) performed on 60 patients with acute myocardial infarction. These patients were randomly divided into 2 groups of control (nurse education) and interaction (peer education). The cardiac self-efficacy rate in the two groups was investigated by filling out the cardiac self-efficacy questionnaire after the intervention (3 days after a heart attack) as well as 5 days and 4 weeks after the heart attack. Data was analyzed using independent t-test, chi-square, Fisher’s exact test, and RM-ANOVA. Results: A significant difference was found in self-efficacy between the nursing routine education and peer education after the intervention (P ≤ 0.004). The results of this study showed that patients who have received peer education had higher self-efficacy compared to patients who received nursing education. Conclusions: Considering the shortage of nurses in hospitals, it is recommended that it is better to use this training method instead of the training of nurses.

Doxylamine-pyridoxine for nausea and vomiting of pregnancy randomized placebo controlled trial: Prespecified analyses and reanalysis.

BackgroundDoxylamine-pyridoxine is recommended as a first line treatment for nausea and vomiting during pregnancy and it is commonly prescribed. We re-analysed the findings of a previously reported superiority trial of doxylamine-pyridoxine for the treatment of nausea and vomiting during pregnancy using the clinical study report obtained from Health Canada.Methods and findingsWe re-analysed individual level data for a parallel arm randomized controlled trial that was conducted in six outpatient obstetrical practices in the United States. Pregnant women between 7 and 14 weeks of gestation with moderate nausea and vomiting of pregnancy symptoms. The active treatment was a tablet containing both doxylamine 10 mg and pyridoxine 10 mg taken between 2 and 4 times per day for 14 days depending on symptoms. The control was an identical placebo tablet taken using the same instructions. The primary outcome measure was improvement in nausea and vomiting of symptoms scores using the 13-point pregnancy unique quantification of emesis scale between baseline and 14 days using an ANCOVA. 140 participants were randomized into each group. Data for 131 active treatment participants and 125 control participants were analysed. On the final day of the trial, 101 active treatment participants and 86 control participants provided primary outcome measures.There was greater improvement in symptoms scores with doxylamine-pyridoxine compared with placebo (0.73 points; 95% CI 0.21 to 1.25) when last observation carried forward imputation was used for missing data but the difference is not statistically significant using other approaches to missing data (e.g. 0.38; 95% CI -0.08 to 0.84 using complete data).ConclusionsThere is a trend towards efficacy for nausea and vomiting symptoms with doxylamine-pyridoxine compared with placebo but the statistical significance of the difference depends on the method of handling missing data and the magnitude of the difference suggests that there is no clinically important benefit employing the prespecified minimal clinically important difference or “expected difference” of 3 points.Trial registrationClinical Trial NCT00614445

Medscheme Mental Health Programme

Medscheme Mental Health Programme

PERSONAL RESPONSE TO DISEASE IN PARAFUNCTIONS OF MASTICATORY MUSCLES

Introduction. Particularities of personality of a sick person play an important role in providing effective treatment and prevention of relapse in various pathologies. Therefore, the position of the patient in relation to his/her health and ongoing treatment, as well as to doctors and auxiliary medical personnel are important factors in the success of rehabilitation.Parafunctions of masticatory muscles, which are understood as an impractical inappropriate activity, are known to be often found. They are poorly amenable to treatment and very painful for patients. The use of psychopharmaceutical and psychotherapeutic methods aimed at changing the patient’s attitude to the disease can help to cure such dental patient. This can change the patient’s response to the disease and create realistic settings for treatment. At the same time, the study of the attitude of dental patients to the disease is practically not covered in the accessible domestic and foreign literature. The purpose of study is researchthe attitude to the disease of adults suffering from various forms of parafunctions of the masticatory muscles. Material and methods. The work was carried out to study the attitude of 29 adults suffering from various forms of parafunctions of the masticatory muscles to the disease. To determine the type of attitude to the patient’s disease,we used the TOBOL clinical test method (type of attitude to the disease), which implements the clinical and psychological typology of patient attitude and provides for the possibility of defining one of the twelve types of responses. Results. It was found that before treatment, regardless of age in individuals suffering from parafunction of the masticatory muscles,there were more common types of attitude to the disease, in which the observed maladaptive behavior with predominantly intrapsychic oriented response to the disease manifested the characteristic reactions of the type of irritable weakness, anxiety, depressed and oppressed condition. The performed complex treatment with the use of complex dental treatment and preventive measures, physical therapy exercises and antispasmodic of skeletal muscles allowed to achieve treatment efficiency of 95.8 %. Thus, it changed patients’ inadequate response to the disease, eliminated significant signs of mental maladjustment, as well as createdrealistic attitude to treatmentin patients, helped to restore broad social relations and active participation in treatment. Conclusions. The obtained data about the type of attitude of patients with such chronic, severe and painful pathology as parafunct ions of masticatory muscles are of practical value, as the achievement of a positive therapeutic result and successful rehabilitation are possible only if the patient’s attitude toward the disease changes, especially in the second and third types in the framework of the test «Type of attitude towards the disease» (TOBOL), therefore the involvement of a clinical pharmacologist or psychiatrist is necessary for rehabilitation of such patients.

Adolescentes, Familias y Grupos. ¿Cómo enfrentarse a la enfermedad?

Las intervenciones familiares psicoeducativas impactan positivamente en las familias y reducen las tasas de recaída en las personas con trastornos psicóticos. Serán eficaces en la prevención de recaídas y mejorar el funcionamiento social y ocupacional pero hasta ahora se han utilizado fundamentalmente en adultos. Sin embargo la aparición de los trastornos psicóticos es cada vez más temprana, pero las intervenciones en este grupo de pacientes más jóvenes no tienen una evidencia tan amplia como en los adultos, es ahora cuando comienzan a estar en auge. Además al ser adolescentes, el impacto en las familias será mayor, y no solo les afectará a ellos sino que tienen un papel importante en el sistema de atención de salud y la sociedad. La gran mayoría de los pacientes adolescentes reside con sus familia que asumen de forma automática las responsabilidades de cuidado y pueden encontrar el grupo como un medio para aliviar sus actuales responsabilidades. La adaptación de grupos para adolescentes está diseñado para ayudar a mejorar las vidas de los padres o cuidadores mediante la educación y el apoyo social para ayudar a desestigmatizar la enfermedad mental, engendrar esperanza, reducir la carga familiar, y apoyar su participación activa en el tratamiento de su hijo. En consecuencia, la utilidad puede ser más apropiado con niños y adolescentes y sus familias que los adultos, ya que aborda directamente muchos de los posibles obstáculos.

The information needs of adolescent patients and their parents to inpatient treatment in pediatric oncology-hematology

Background. High importance of problem of patient’s informing, especially in a question of informational wants, is connected with influence of expression of disease and treatment on observance of medical recommendations. Discussions on a problem of information disclosure both for parents/caregivers and patients (according theirs age features) are very important topic nowadays. Results of our previous study on information disclosure agreement between parents and physicians showed some distrust and difference in opinion between physicians and parents/caregivers. These results showed actuality of study of informational wants of children. Adolescents were chosen for this study due to permission for informed consent beginning from 15 years old. Materials and methods. A special questionnaires for revelation of wants for information, expected and real ways of informing and information demands (form, volume, contents, sources, participants of informational process) were created by authors with the help of prof Elena V. Polevichenko for adolescents and theirs parents. Study respondents: 1. Parents of adolescents (n = 54, age – 32–63 years old; М = 43,7; SD = 9,1; 53 females and 1 male); 2) Adolescents (n = 49; 14–18 years old; 16,4; SD = 2; 23 females and 26 males). Results. Article showed high level of satisfaction of informing both for parents and adolescents. Parent’s condition connected with theirs own informing which significantly improves theirs satisfaction of informing of adolescents and allows them to ask physician to give information to theirs children. From parent’s point of view it’s important to receive information from physicians in proper time, regularly, clarify but in step-by-step regimen, in doses and in the conditions of privacy and support. Parent’s wants of adolescent’s informing are ambiguous and discrepant. From one side, fullness of informing of patients on parent’s opinion is connected with the age – they say about “child needs” beginning from the age of 13 years old. From another side parent’s of adolescents (after 15 year old) thinks that full informing of theirs children must be limited. In majority of cases parents are ready to inform children on diagnosis but don’t rule out to say about length and heaviness of treatment, side effects. In majority of cases adolescents showed active interest for disease and treatment, as well as good contact with physician setting up. In contrast with parents they would like to have full information in majority of cases. The most frequent questions for adolescents are the origin of disease and personal hygiene. Satisfaction of adolescents of good contact and permanent interaction with physician is significantly correlated with theirs readiness for receiving of information and active participation in treatment. Conclusion. The most complicated topics for discussion with parents and adolescents are not diagnosis, but information on legth and side effects of therapy. Adolescents from theirs side declaring the readiness for bigger participation in receiving of information on treatment and have less level of requirements for intermediaries (parents/psychologists) then adults thinks. Complex approach for studying of information needs both parents and children allows to give physicians more exact and detailed recommendations for informing according the age features.

The Nursing Students' Views About the Patient's Rights at the West Black Sea Universities in Turkey.

The members of healthcare team have an important role in implementation and protection of patient's rights. Contemporary nursing entails an ethical responsibility to advocate and protect the patients' rights. This study was designed to evaluate how ready nursing students, at the end of their education, were to play the role of patient's rights advocates and to discuss ethics education in nursing. This descriptive study was performed on nursing students at Black Sea Universities in the academic year 2010-2011. Data were collected using a structured questionnaire about students' attitudes regarding patients' rights including patient's rights regulations. The association between gender and students' attitudes was analyzed using Chi-square test. The mean age of the 238 participants was 22.11 ± 1.21 years and 82.8% of them were female. The majority of the nursing students held desirable attitudes toward patient information, truth telling, and protection of patients' privacy and medical records. However, the students' views about the rights of patients to refuse treatment, children's active participation in treatment, prioritization of the quality of life in treatment, and respect for the rights of dying patients were less satisfactory. The results of this study was concerning with regard to nursing students' readiness for duties such as patient's rights advocacy. Therefore, it proposes ethics education that covers both patient's rights and the obligations of nurses to defend these rights.