Assessment Of Therapy Outcomes Research Articles

Need to assess the effect of therapy? Ask the patient!

Achieving a good treatment outcome in rheumatic diseases (RD) requires regular, dynamic patient monitoring and therapy correction if it is not effective or intolerant. The patient assessment must be based on clear criteria to objectify the main manifestations of the disease. For this purpose, the calculation of standard activity and severity indices (DAS28, CDAI, SDAI, BASDAI, ASDAS, DAPSA, PsARC, PASI, etc.) is used. However, this methodology does not always allow the assessment of the fundamentally important parameters of treatment outcome – patient satisfaction and well-being. According to a series of studies, poor therapy satisfaction may be observed in ≈25% of patients with systemic RD who are in remission/low disease activity according to standard indices. Moreover, in 20–30% of cases there is a major discrepancy in the assessment of therapy outcome between the patient and physician. Therefore, a more accurate assessment of the patient’s condition requires, in addition to the calculation of standard indices, the mandatory analysis of patient-reported outcomes – pain, functional impairment, general assessment of disease activity, fatigue, etc. A valuable tool for determining well-being and good therapy outcome from the patient’s point of view is the PASS (“patient acceptable symptom state”). This simple and quite informative index correlates well with core symptoms and indicators of remission/low disease activity. PASS analysis can be used in telemedicine follow-up of patients when an objective examination is not possible. The combined use of PASS and standardized indices can better assess treatment outcomes and improve the quality of life of patients with RD.

LB-456091-2 DYNAMIC DATA DRIVEN MANAGEMENT OF ATRIAL FIBRILLATION USING IMPLANTABLE CARDIAC MONITORS – THE MONITOR AF STUDY

Management of atrial fibrillation (AF) is often complex and dynamic. Clinical decisions related to initiation of rate control, rhythm control strategies, stroke prophylaxis measures depend on the assessment of the presence and the burden of AF. Assessment of therapy outcomes and withdrawl of drugs and anticoagulation are guided by AF monitoring. Implantable cardiac monitors (ICM) are excellent tools to detect and monitor AF burden in a dynamic fashion. We prospectively studied if the presence of an ICM impacts the management of AF and there by clinical outcomes.

Abstract No. 481 Chemosaturation with percutaneous hepatic perfusion in patients with metastasized uveal melanoma: assessment of therapy outcome and safety

Chemosaturation percutaneous hepatic perfusion (CS-PHP) with melphalan provides selective intrahepatic delivery of high dose cytotoxic melphalan while limiting systemic toxicity through hemofiltration of the hepatic venous blood. The aim of this study was to investigate safety, therapy response and survival of CS-PHP in patients with curatively untreatable liver-dominant metastatic uveal melanoma (UM).

Autologous platelet-rich plasma therapy — a promising method for tissue repair/ /regeneration in many medical fields

Platelet-rich plasma (PRP) is commonly used in many medicinal fields and the interest in its application for management of numerous pathologies is recently growing. Platelets (PLT) contain physiologically active proteins called growth factors (GFs) that accelerate tissue regeneration. This process of tissue regeneration is stimulated through application of PRP prepared from autologous blood according to special protocol. The purpose of the protocol is to achieve high concentration of platelets within a small volume of plasma. PRP is a biological product with a platelet concentration above the baseline for the patient’s peripheral blood. The PRP therapy is based on autologous procedures therefore the risk of infection is remote although some clinical conditions preclude the use of PRP as it may induce adverse reactions. The procedure of PRP preparation is relatively inexpensive and can be performed quickly in the patient’s presence. In the literature of the subject there are wide variations in PRP definitions with reference to protocols of preparation, platelet concentration and activation as well as in the manner of application to injured tissue and finally in the assessment of therapy outcome. It is therefore difficult to compare and confirm the efficacy of PRP therapy used for the management of various diseases. Authors clearly emphasize the urgent need for standardizing protocols of PRP preparation and application in various disorders. Although in general PRP therapy is considered a promising method for treatment of tissue injuries, the lack of standardized preparation procedures and ways of PRP application raises numerous questions and controversies. The aim was to present review of literature related to the use of PRP and the mechanism of action of this blood derivative.

Predicting couple therapy outcomes based on speech acoustic features.

Automated assessment and prediction of marital outcome in couples therapy is a challenging task but promises to be a potentially useful tool for clinical psychologists. Computational approaches for inferring therapy outcomes using observable behavioral information obtained from conversations between spouses offer objective means for understanding relationship dynamics. In this work, we explore whether the acoustics of the spoken interactions of clinically distressed spouses provide information towards assessment of therapy outcomes. The therapy outcome prediction task in this work includes detecting whether there was a relationship improvement or not (posed as a binary classification) as well as discerning varying levels of improvement or decline in the relationship status (posed as a multiclass recognition task). We use each interlocutor’s acoustic speech signal characteristics such as vocal intonation and intensity, both independently and in relation to one another, as cues for predicting the therapy outcome. We also compare prediction performance with one obtained via standardized behavioral codes characterizing the relationship dynamics provided by human experts as features for automated classification. Our experiments, using data from a longitudinal clinical study of couples in distressed relations, showed that predictions of relationship outcomes obtained directly from vocal acoustics are comparable or superior to those obtained using human-rated behavioral codes as prediction features. In addition, combining direct signal-derived features with manually coded behavioral features improved the prediction performance in most cases, indicating the complementarity of relevant information captured by humans and machine algorithms. Additionally, considering the vocal properties of the interlocutors in relation to one another, rather than in isolation, showed to be important for improving the automatic prediction. This finding supports the notion that behavioral outcome, like many other behavioral aspects, is closely related to the dynamics and mutual influence of the interlocutors during their interaction and their resulting behavioral patterns.

Relationship Evaluation Inventory: Development, Reliability, and Validity

ABSTRACTThe purpose of this study is to investigate the reliability and validity of the Relationship Evaluation Inventory for a Turkish adult population. This study’s sample included 514 married couples from different regions of Turkey. In terms of reliability analysis, internal consistency and test–retest correlations were calculated and validity analysis construct, criterion, and content validity were examined. Results indicated that the Relationship Evaluation Inventory is a valid and reliable instrument which can be used for several clinical purposes, such as assessing problems, planning treatment, monitoring, following-up, and therapy outcome assessment. The findings of the study are discussed in light of the literature.

Clinical application of optical coherence tomography in combination with functional diagnostics: advantages and limitations for diagnosis and assessment of therapy outcome in central serous chorioretinopathy.

PurposeWhile identifying functional and structural parameters of the retina in central serous chorioretinopathy (CSCR) patients, this study investigated how an optical coherence tomography (OCT)-based diagnosis can be significantly supplemented with functional diagnostic tools and to what degree the determination of disease severity and therapy outcome can benefit from diagnostics complementary to OCT.MethodsCSCR patients were evaluated prospectively with microperimetry (MP) and spectral domain optical coherence tomography (SD-OCT) to determine retinal sensitivity function and retinal thickness as outcome measures along with measures of visual acuity (VA). Patients received clinical care that involved focal laser photocoagulation or pharmacotherapy targeting inflammation and neovascularization.ResultsCorrelation of clinical parameters with a focus on functional parameters, VA, and mean retinal sensitivity, as well as on the structural parameter mean retinal thickness, showed that functional measures were similar in diagnostic power. A moderate correlation was found between OCT data and the standard functional assessment of VA; however, a strong correlation between OCT and MP data showed that diagnostic measures cannot always be used interchangeably, but that complementary use is of higher clinical value.ConclusionThe study indicates that integrating SD-OCT with MP provides a more complete diagnosis with high clinical relevance for complex, difficult to quantify diseases such as CSCR.

Pulmonary function after total laryngectomy.

To present data on pulmonary function in 59 laryngectomees using a specially designed silicone adapter for connection of the stoma to the bodyplethysmograph. Prospective assessment of pulmonary function in 59 patients, and comparison of lung function before and after bronchodilator testing in selected cases. The usefulness of the adapter was examined. Data of patients with airway obstruction were tabulated according to large airway obstruction (LAO), peripheral airway obstruction (PAO), and small airway disease (SAD) types. Findings show that pulmonary airway obstruction was present in 81% of patients and normal pulmonary function was present in only 11 of the 59 participants (19%). LAO was found in 25%, PAO in 17%, and SAD in 39% of cases. Emphysema was diagnosed in 14% of cases within the above-mentioned LAO and PAO groups. Improvement of pulmonary function was achieved in 12 of 16 laryngectomees with airway obstruction, when a bronchodilator aerosol was administered. In 60% of cases with LAO and PAO, the laryngectomees did not know of any marked obstruction of their airways, and only 10% of those knowing about their obstruction received appropriate medical treatment. These results suggest that 42% of the laryngectomees tested may have benefited from further medical treatment. After laryngectomy, pulmonary function assessment was performed elsewhere in 1 of 59 cases. In light of the high prevalence of airway obstruction in laryngectomees, more frequent postoperative assessments of pulmonary function should be offered to prevent or to reduce impairment of respiratory function in this postlaryngectomy vulnerable pulmonary status. Further studies are also needed to determine the effects of therapeutic intervention, e.g., assessment of therapy outcome and influence on quality of life.

Assessment of therapy outcome within the scope of quality assurance in a psychiatric clinic. A report of experiences

A recent modification of German law requires quality assurance of inpatient treatment, i.e., of the quality of therapy, allowing comparison of different hospitals. In this paper a program developed to assess the outcome by means of international, frequently applied psychopathometric scales is presented. This program was evaluated in a study of 258 psychiatric inpatients. This study emphasized the identification of patients with long-term hospitalization and/or worse outcome. A concept to disclose these so-called 'problematic' patients by means of easily administered scales like the SCL90-R, GAF and WHO-Disability-Diagnostic-Scale (DDS) has been developed. Patients with a very long hospital stay (> 70 days) show a higher number and more severe symptoms in the self-rating (SCL90-R) at admission than the subjects with a short hospital stay. This pilot study demonstrated that a routine outcome analysis can be used for quality management in psychiatry.

Four Studies Toward and Empirical Foundation for Group Therapy

In the first of four studies reported here, it was demonstrated that employing randomly selected client disclosures as goals in a Goal Attainment Scale method of assessing outcome in group therapy yielded positive outcome results, adding support to the use of this method of therapy outcome assessment. In the second study, employing the GAS method it was demonstrated that the percentage of positive and negative statements per minute had more impact on outcome than the number of minutes spent discussing the problem. In the third study, employing the same outcome assessment methodology, it was shown that the greater the discloser's difference in emotional induction versus subsequent reduction when discussing his or her disclosure, the greater the positive therapeutic outcome from the group. In the final study, a new method of global improvement based on the DSM III was compared with the GAS outcome. It was shown that the DSM III global assessment methodology was sensitive to the same outcome measured by the ...

On paradigms and recycled ideologies: Analogue research revisited

Bandura discusses how the traditional disease model, explicitly rejected by proponents of behavior modification, has been unwittingly endorsed in several different ways. The dichotomization of clinical and nonclinical populations, the global assessment of therapy outcome, and the methods of treatment delivery all embrace the traditional approach toward deviant behavior. Bandura illustrates how the notion of “analogue research” implies an adherence to the disease model. Analogue research ordinarily is viewed as a distinct category of research secondary to investigations with clinical populations in treatment settings. Yet, controlled research has several unique advantages, well illustrated by Bandura, and is central to developing effective therapy techniques. The present paper uses Bandura's position as a point of departure to elaborate the nature of so-called analogue research. The problems seemingly peculiar to analogue research are considered to characterize all experimental research. To criticize analogue studies in behavior modification is to fail to appreciate the purposes of experimental research in general. Moreover, laboratory investigation of a particular phenomenon does not entail any inherent restrictions on the external validity of the findings. External validity, or the generalizability of the results, is always an empirical question.