Current Trends In Treatment Research Articles

How do we treat generalized anxiety disorder?

In addition to significant prevalence of generalized anxiety disorder (GAD) and related consequences, it seems that this disorder has not been studied sufficiently in Serbia. The aim of this study was to investigate the understanding of psychopathology and the adequate treatment of patients with GAD by psychiatrists in Serbia. The study comprised 84 doctors - psychiatrists and neuropsychiatrists who were engaged in treatment of patients with GAD. Anonymous survey was used as the basic instrument, which collected information about the socio-demographic and professional data, experience in treating GAD and understanding psychopathology of GAD, as well as the first and the second choice therapy for patients with GAD. The majority of psychiatrists (62.2%) indicated the symptoms of distress/tension and slightly lower percent (36.6%) designated the symptoms of worry/anxiety as the key symptoms of GAD when it was diagnosed.The results showed that almost all patients (96.5%) had been treated with benzodiazepines before coming to psychiatrists. Most psychiatrists preferred the use of SSRI/SNRI antidepressants (76.2%), usually in combination with benzodiazepines (71.4%) for the treatment of patients with GAD; however, if these doctors got GAD, the preference of benzodiazepine use would be significantly lesser (45.2%) than for the treatment of their patients. Preference for the use of SSRI/SNRI antidepressants was significantly more frequent in physicians with completed residency. The understanding of psychopathology and treatment practice for patients with GAD in this sample of psychiatrists in Serbia is mostly consistent with the current trends for GAD treatment.

The Evolution of Surgery for Breast Cancer from Radical to Sublime: Historical Review

Breast cancer is one disease that has been dreaded for centuries. Cancer of the breast, was generally regarded as incurable, and those methods employed in the hope of a cure, or at least to relieve pain and prolong life, were often gruesome and dreadful. With regard to the surgical cure of this disease, there has been a giant paradigm shift, from the disfiguring and loathsome surgeries like amputation of breast, super-radical mastectomy to the sublime breast ‘conserving’ and ‘oncoplastic’ surgeries. In this article, we do a review of the literature and try to elucidate the factors that have led to this giant paradigm shift. Also, we review the current trends in the surgical treatment of breast cancer.

Management of PAH in Adults with Congenital Heart Disease: Impact and Dilemmas

Guest editor Richard Krasuski, MD, convened a group of experts by telephone on January 17, 2013, to discuss current trends in diagnosis and treatment of pulmonary hypertension among patients with congenital heart disease. Joining the call were Professor Maurice Beghetti, Head of Pediatric Subspecialties, Division Head of Pediatric Cardiology Unit, Children's University Hospital, Geneva, Switzerland; Curt Daniels, MD, Director, Adolescent and Adult Congenital Heart Disease Program Nationwide Children's Hospital, The Ohio State University, Columbus, Ohio; Wayne J. Franklin, MD, Texas Children's Hospital, Houston; and Michael J. Landzberg, MD, Associate Director, Adult Pulmonary Hypertension Program and Director, Boston Adult Congenital Heart Program, Boston Children's Hospital.

Multimodal therapy including liver transplantation for hepatic undifferentiated embryonal sarcoma

The outcomes of hepatic undifferentiated embryonal sarcoma (HUES) have historically been limited by persistent, unresectable disease and the subsequent development of disease resistance and dissemination. We present our institutional experience with HUES and assess current treatment trends and outcomes in the era of liver transplantation. We conducted a retrospective chart review of cases presenting with HUES at our institution over the past 10 years. The collected data included age, sex, presenting symptoms, imaging and the associated Pretreatment Extent of Disease (PRETEXT) score, pathology, chemotherapy, surgical interventions, and outcomes. Approval was obtained from the institutional review board of the Cincinnati Children's Hospital Medical Center. HUES was identified in 6 patients (4 males and 2 females) with a median age at diagnosis of 11 years (range = 7-13 years). Initial imaging was available for all but 1 patient. The PRETEXT stage for these patients ranged from II to III. One patient was diagnosed with lung metastases. Two patients underwent upfront resection, and 1 patient received neoadjuvant therapy and then conventional resection. Three patients were treated with orthotopic liver transplantation (OLT) after neoadjuvant chemotherapy (primary OLT in 2 cases and salvage OLT for local recurrence in 1 case). Two patients received posttransplant adjuvant chemotherapy. All 6 patients remained in clinical remission with a mean follow-up of 35 months (range = 12-84 months). In conclusion, OLT has rarely been reported as a treatment option for HUES. The addition of liver transplantation as a surgical option for treating patients with HUES can result in improved survival for patients whose tumors are initially unresectable or recur.

Cushing’s disease: current trends in treatment

SUMMARY Cushing’s disease (CD) is an uncommon endocrine disorder resulting from an adrenocorticotrophin-producing pituitary adenoma. Its clinical features and subsequent comorbidities are the consequence of hypercortisolism and may be life-threatening if untreated. Trans-sphenoidal selective adenomectomy or hypophysectomy remain recommended first-line treatments for CD and may be repeated if unsuccessful or following recurrence of the tumor. Pituitary radiotherapy, either conventional fractionated external beam or in the form of radiosurgery, is a second-line treatment option, but its effects are delayed for several years. Bilateral adrenalectomy is a valuable treatment option for acutely unwell patients or for those who are unable to take or tolerate medical therapy. Steroidogenesis inhibitors such as metyrapone, ketoconazole, etomidate and mitotane have their place at many stages in the management of CD and are usually very effective. Pituitary tumor-targeted agents, such as cabergoline or pasireotide, ...

Carpal Tunnel Syndrome: Current Trends in Diagnosis, Treatment, and Prognosis: Not a clinical study

Carpal Tunnel Syndrome: Current Trends in Diagnosis, Treatment, and Prognosis: Not a clinical study

Current treatment trends and long term prognostic value of revascularization in patients with severe ischemia by SPECT-myocardial perfusion imaging

Purpose: The best initial therapy for patients (pts) with coronary artery disease (CAD) and severe ischemia by SPECT-MPI is controvertial. Inspired by the ongoing ISCHEMIA Trial, designed to prospectively evaluate optimal medical treatment versus revascularization as the first line therapy in pts with high ischemic burden, we evaluated the current treatment trends, overall mortality and the long term prognostic value of revascularization in patients referred for SPECT-MPI. Methods: We retrospectively evaluated 18,892 pts referred for SPECT-MPI between Jan-2004 and Dec-2008, selecting pts with severe ischemia (SSS>13) and unknown CAD. Overall mortality and revascularization status were obtained by phone. Survival analysis and the prognostic value of revascularization, classical CAD risk factors and left ventricle ejection fraction (LVEF) on mortality were obtained by Kaplan-Meier and Cox multivariate analysis. Results: From 4096 ischemic pts, 715 had SSS>13 but only 255 had no previous known CAD. A mean follow-up time of 4.4 years (SD 1.8) was obtained in 227 (88.4%). Mortality rate was 18.5% (42/227). Management strategy data from 194 pts was obtained. Of these, 123 (63%) underwent percutaneous (70%) or surgical (30%) revascularization, while 71 (37%) were managed conservatively. The overall mortality curves stratified by treatment option were not statistically different (log-rank test p-value = 0.52). The multivariate analysis is presented on the Table. Revascularization did not changed mortality prognosis (HR 1.83; 95% CI 0.72–4.66). View this table: Multivariate analysis Conclusions: Mortality in severely ischemic patients is high. Revascularization was the main treatment option, although only age was predictive of mortality. Based on this limited retrospective analysis, clinical management may be a safe alternative to revascularization for this high risk population, making the ongoing prospective ISCHEMIA Trial essential to guide future first line treatment recommendations.

Current Trends for Biological Antibiotic Pharmaceutical Wastewater Treatment

The release of antibiotic pharmaceutical wastewater has caused a serious environmental problem. In order to provide a better guideline for the antibiotic wastewater treatment, this paper summarizes a critical review on the current biological technologies available for antibiotic wastewater degradation, including aerobic processes, anaerobic processes, anaerobic-aerobic processes, and other combined processes. Furthermore, applications of the antibiotic wastewater biological treatment processes are discussed as well.

Current concepts and trends for operative treatment of FAI: hip arthroscopy

There has been an increasing body of literature regarding arthroscopic management of femoroacetabular impingement (FAI). Refinement of arthroscopic techniques has allowed for more complete management of FAI, and meta-analysis and systematic reviews have shown comparable outcomes to surgical hip dislocation with appropriate indications. There are still, however, pathomorphologies that are not accessible or much more challenging to address arthroscopically, and open corrective procedures should be considered in these situations. Extra-articular FAI is receiving increased attention and can be secondary to anterior inferior iliac spine/subspine impingement, trochanteric-pelvic impingement, and ischio-femoral impingement. Femoral and acetabular version and their impact on hip stability as well as the concept of impingement induced instability are being increasingly recognized. Acetabular labral and capsular management and repair techniques have also received increased attention. Finally, 3-dimensional imaging and dynamic software analysis are beginning to emerge as potential tools to better evaluate hip pathomorphology.

Analysis of Rotator Cuff Repair Trends in a Large Private Insurance Population

The purpose of this study was to identify current trends in open and arthroscopic surgical treatment of rotator cuff tears across sex, age, and region in the United States. Using the PearlDiver Patient Record Database (PearlDiver, Fort Wayne, IN), a publicly available national database of insurance records, patients who underwent rotator cuff repair from 2004 through 2009 were identified. The number of open (CPT codes 23410, 23412, 23420) and arthroscopic (CPT code 29827) rotator cuff repairs were quantified in isolation and in combination with acromioplasty (CPT codes 23415, 29826). The type of procedure, date, sex, and region of the country was identified for each patient. Trend tests (χ(2) and Cochran-Armitage) were used to determine statistical significance. There were 151,866 rotator cuff repair procedures identified in the database from 2004 through 2009, which represented an incidence of 13.6 for every 1,000 patients assigned an orthopaedic International Classification of Diseases, Ninth Revision (ICD-9) or Current Procedural Terminology (CPT) code. Male patients accounted for 60% of the repairs and female patients for 40%. There were 98,174 arthroscopic cuff repairs (65%) and 53,692 open repairs (35%). The annual percentage of arthroscopic cases increased from 48.8% in 2004 to 74.3% in 2009, whereas the percentage of open cases decreased from 51.2% in 2004 to 25.7% in 2009 (P < .0001). Acromioplasty was also performed in 47.3% of cases, and the rate showed only a slight increase (from 46.6% to 47.8%) between 2004 and 2009 (P < .01). All regions of the United States showed similar surgical trends and trends for sex and age distributions. Our analysis shows that the majority of rotator cuff repairs in the United States are now performed arthroscopically (>74%) and there has been a recent steady decline in performance of open rotator cuff repair. Concomitant acromioplasty is performed approximately half the time, and this trend is increasing slightly. These findings were consistent across age, sex, and region in the United States. IV, cross-sectional study.

Pediatric intracranial aneurysms: current national trends in patient management and treatment

Pediatric intracranial aneurysms constitute a medical disease process with many unique features that present unique challenges in orchestrating their treatment. Conflicts exist in pediatric aneurysm literature as to whether endovascular therapy is equivalent to surgical therapy in assuring durable aneurysm obliteration in this population. The national Healthcare Cost and Utilization Project (HCUP) Kid's Inpatient Dataset was queried using the HCUPnet system. Overall trends in length of stay (LOS), associated charges, and in-hospital deaths were analyzed for both subarachnoid hemorrhage (SAH) and nonruptured aneurysms from 2000 to 2009. Trends in the type of procedure, associated LOS, and charges were analyzed for SAH from 2003 to 2009. A p value <0.05 was considered statistically significant. Mean LOS for SAH patients was an additional 7-10days compared to patients discharged with nonruptured aneurysms. Costs of surgery showed a slight increase, while endovascular procedures also rose 50% from 2006 to 2009. Interestingly, mean length of stay increased for endovascular procedures from 16.5 to 17.2days and decreased for surgical procedures from 20.4 to 14.7days (p < 0.001). First, in-hospital mortality and hospital length of stay for pediatric subarachnoid hemorrhage have not significantly declined since 1997. Second, in-hospital charges for the management of both ruptured and nonruptured aneurysms rose by over 200% from 2000 to 2009. Surgical procedures saw a 6% increase in price, while endovascular procedures sharply rose in costs by 50%. Finally, endovascular therapy has increased in utilization, while the frequency of surgical therapy has not changed significantly since 2003.

Current trends in glioblastoma multiforme treatment: radiation therapy and immune checkpoint inhibitors.

Glioblastoma multiforme (GBM) is the most common primary brain cancer. Even with aggressive combination therapy, the median life expectancy for patients with GBM remains approximately 14 months. In order to improve the outcomes of patients with GBM, the development of newer treatments is critical. The concept of using the immune system as a therapeutic option has been suggested for several decades; by harnessing the body's adaptive immune mechanisms, immunotherapy could provide a durable and targeted treatment against cancer. However, many cancers, including GBM, have developed mechanisms that protect tumor cells from being recognized and eliminated by the immune system. For new immunotherapeutic regimens to be successful, overcoming immunosuppression via immune checkpoint signaling should be taken into consideration.

Neurodevelopmental substrates of autism and current trends in evidence-based treatment of Autism Spectrum Disorders (ASDs)

Neurodevelopmental substrates of autism and current trends in evidence-based treatment of Autism Spectrum Disorders (ASDs)

Anti-malaria prescription in pregnancy among general practitioners in Enugu state, south east Nigeria

Background:The national policy on malaria control recommends use of intermittent preventive treatment with sulfadoxine/pyrimethamine (IPT-SP) for chemoprophylaxis against malaria in pregnancy; and use of quinine and arthemisinin-based combination therapy (ACT) for acute treatment of malaria in the first, and second/third trimesters, respectively. In Nigeria, a large proportion of pregnant women are seen by the general practitioners (GPs).Objective:To determine the pattern of anti-malaria prescription in pregnancy among GPs in Enugu state, and access the level of conformity with the national policy on malaria control.Materials and Methods:Questionnaires were administered to a cross-section of 147 GPs that attended the 2010 Enugu state branch of the Nigeria Medical Association Scientific Conference/Annual General Meeting/Election.Results:The mean age of the GPs was 37 ± 3.6 (range 27-70) years. Quinine was the commonly (45.6% (n = 67)) prescribed anti-malaria drug in the first trimester while in the second/third trimester ACT was commonly (48.3% (n = 71)) prescribed. Seventy-six (51.7%) practitioners prescribed IPT-SP for chemoprophylaxis against malaria while the rest (48.3%) prescribed other drugs. GPs who obtained MBBS qualification less than or equal to 5 years prior to the survey were more likely to comply with the national policy on malaria control in their prescriptions (P < 0.05).Conclusion:The pattern of anti-malaria prescription among GPs in Enugu state is varied, and conformed poorly to the evidence-based national policy on malaria control. There is need for continuing professional development to keep the GPs abreast with current trends in malaria treatment during pregnancy.

Therapeutic Controversies in Spondyloarthritis

Nonsteroidal anti-inflammatory drugs (NSAIDs) are considered a first-line therapy in patients with axial spondyloarthritis (axSpA), including ankylosing spondylitis. NSAIDs reduce pain and stiffness effectively in most patients, are able to reduce systemic and local inflammation, and can inhibit progression of structural damage in the spine. However, effective control of symptoms and retardation of radiographic progression often require continuous and long-term treatment, which raises safety concerns. This article discusses controversies related to the current role of NSAIDs in axSpA treatment, risks and benefits of this treatment, and current trends for individualized treatment.

Primary Treatment for Cleft Lip and/or Cleft Palate in Children in Japan

To investigate current trends in primary treatment for children with cleft lip and/or cleft palate in Japan. Nationwide, retrospective study under the direction of the Academic Survey Committee of the Japanese Cleft Palate Association based on analysis of data obtained via a booklet-style questionnaire completed by institutions providing primary treatment for cleft lip and/or palate patients. PARTICIPANTS, PATIENTS: Patients were 4349 children undergoing primary repair for cleft lip and/or palate at 107 participating institutions between 1996 and 2000. Cleft type, laterality; use of infant palatal plate; and timing and technique of primary repair for cleft lip and/or palate were evaluated by cleft surgeons at 107 participating institutions. Of a total of 2874 patients with cleft lip and palate or cleft palate only, infant palatal plates were used with 1087 (37.8%) and were not used with 1787 (62.2%). Primary unilateral lip repair was performed at the age of 2 to 6 months in more than 90% of patients. Bilateral cleft lip was treated by one-stage repair in 285 patients (44.5%) and by two-stage repair in 258 (40.2%). Primary one-stage palatal repair was performed in 2212 (76.9%) and two-stage palatal repair in 262 (9.1%) cleft palate patients. Information on treatment of the remaining 400 (14%) patients was unavailable. This investigation clarified current trends in primary treatment for cleft lip and/or palate in Japan. The results suggest the need for an increase in regional core hospitals and greater variation in treatment options.

Treatment trends for haemophilia A and haemophilia B in the United States: results from the 2010 practice patterns survey

Frequent evaluation of haemophilia treatment is necessary to improve patient care. The 2010 Practice Patterns Survey (PPS) investigated current trends in haemophilia treatment in the United States, as reported by nurses. The aim was to document practice patterns for haemophilia A and haemophilia B Survey questionnaires were sent to nurses at haemophilia treatment centres (HTCs) across the United States. Seventy-one of 126 HTCs (56%) responded to the survey. Factor dosage across treatment modalities ranged from 20 to 50 IU kg(-1) for severe haemophilia A. Dosage for severe haemophilia B was more variable (<40 to >100 IU kg(-1)). On-demand dosing regimens were inconsistent for haemophilia A and more so for haemophilia B. Rates of adherence to prescribed treatment were similar for both haemophilia types (∼80%). The main barrier to adherence was identified as inconvenience. More bleeding episodes occurred in adults (16.6 bleeding episodes per year) with severe haemophilia A than in younger patients (11.3 bleeding episodes per year) before switching patients to prophylaxis. For both haemophilia types, most patients who switched from prophylaxis to on-demand treatment were aged 13-24 years; these patients also had the lowest adherence (60-71%). More paediatric patients with severe haemophilia A and inhibitors (53%) received prophylactic bypassing therapy than their haemophilia B counterparts (38%). Adults with severe haemophilia A faced challenges in relation to co-morbidities and long-term care. This PPS provides insights into previously unexplored aspects of haemophilia care that will serve to increase awareness and promote discussion of current issues affecting haemophilia patient care.

The role of chemotherapy in the treatment of pediatric brain tumors

The past 20 to 30 years have seen significant developments in the diagnosis and treatment of pediatric brain tumors, the most common solid organ tumor in children. Advances have been made in imaging methodologies, such as magnetic resonance imaging, surgical approaches to treatment, classification of brain tumors according to pathological and molecular features, and overall understanding of pertinent prognostic factors. Translation of our knowledge into appropriate therapy for each type of brain tumor has resulted in an overall improved survival. However, subtypes of brain tumor that have actually shown enhanced survival are few, and the overall prognosis for children with brain tumors remains poor compared to that of patients treated for other pediatric malignancies. Recent clinical trials aim to minimize treatmentrelated toxicity for brain tumors with superior survival, while attempting to improve the cure rate for those tumors with continued poor prognosis through intensified treatment, introduction of novel chemotherapeutic drugs, or targeted treatment based on identified molecular markers. This review outlines the overall role of chemotherapy in the treatment of childhood brain tumors, with an emphasis on recently identified molecular markers and current trends in treatment.

RETRACTED ARTICLE: An evidence-based review of the most current treatment options and trends for carpal tunnel syndrome (CTS)

RETRACTED ARTICLE: An evidence-based review of the most current treatment options and trends for carpal tunnel syndrome (CTS)

Indications and Practice With Androgen Deprivation Therapy

The Cancer of the Prostate Strategic Urological Research Endeavor (CaPSURE) is an ongoing longitudinal observational study of current trends in prostate cancer staging and treatment across a spectrum of different treatment facilities in the United States. To date, the study has documented 2 principal findings: (a) a large variation exists in the treatment choices applied to similar patient presentations across the range of facility type, size, and geographic location in the United States; and (b) although it does not seem to make much difference in mortality outcomes which approach--hormonal therapy, radiotherapy, or surgery--is applied to men at low or intermediate risk, a survival benefit exists with surgery for men at high risk.