Efficacy Of Different Treatment Approaches Research Articles

A New Approach to Postoperative Rehabilitation Following Mosaicplasty and Bone Marrow Aspiration Concentrate (BMAC) Augmentation

Background: Chondral defects in the knee present a significant challenge due to their limited self-healing capacity, often leading to joint degeneration and functional disability. Current treatments, including surgical approaches like mosaicplasty and regenerative therapies such as bone marrow aspirate concentrate (BMAC) augmentation, aim to address these defects and improve patient outcomes. Materials and Methods: This study conducted a single-center, randomized controlled trial to evaluate the efficacy of different treatment approaches and rehabilitation protocols for chondral defects. Thirty-seven subjects presenting with symptomatic chondral or osteochondral defects (>3 cm2) in the weight-bearing region of the femoral condyle were partitioned into three groups, and underwent mosaicplasty with or without BMAC augmentation, followed by either a 6-week or 12-week rehabilitation program. Group 1 (n = 10) received mosaicplasty combined with BMAC augmentation and engaged in a twelve-week two-phase rehabilitation protocol. Group 2 (n = 15) underwent mosaicplasty alone and participated in the same twelve-week two-phase rehabilitation regimen. Meanwhile, Group 3 (n = 12) underwent mosaicplasty and underwent a shorter six-week one-phase rehabilitation program. Clinical assessments were performed using the visual analog scale (VAS) for pain, goniometry for the knee’s range of motion (ROM), manual muscle testing (MMT) for quadricep strength, and the Western Ontario and McMaster University Arthritis Index (WOMAC) for functional evaluation in three test phases. Results: Significant differences in WOMAC scale scores were observed between the three groups at the intermediate (F(2, 34) = 5.24, p < 0.010) and final (F(2, 34) = 111, p < 0.000) stages, with post hoc Tukey tests revealing variations shared among all three groups. The between-group analysis of the VAS scale demonstrated no statistically significant difference initially (F(2, 34) = 0.18, p < 0.982), but significant differences emerged following the intermediate (F(2, 34) = 11.40, p < 0.000) and final assessments (F(2, 34) = 59.87, p < 0.000), with post hoc Tukey tests revealing specific group variations, notably between Group 1 and both Group 2 and Group 3, and also between Group 3 and Group 2. The between-group analysis of quadricep muscle strength using MMT scores revealed no statistically significant differences initially (F(2, 34) = 0.376, p < 0.689) or following the intermediate assessment (F(2, 34) = 2.090, p < 0.139). The one-way ANOVA analysis showed no significant difference in the knee ROM initially (F(2, 34) = 1.037, p < 0.366), but significant differences emerged following intermediate (F(2, 34) = 9.38, p < 0.001) and final assessments (F(2, 34) = 11.60, p < 0.000). Post hoc Tukey tests revealed significant differences between Groups 1 and 2, Groups 1 and 3, and Groups 2 and 3 at intermediate and final assessments. Conclusions: The patients who received BMAC augmentation and completed a 12-week rehabilitation protocol had significantly better outcomes in pain relief, knee function, and ROM when compared to those who did not receive BMAC augmentation or those who completed a shorter rehabilitation period. Our findings suggest that combining mosaicplasty with BMAC augmentation and a comprehensive rehabilitation program can lead to superior clinical outcomes for patients with chondral defects in the knee.

Systematic review of cellular, acellular and matrix-like products (CAMPs) and indirect treatment comparison between cellular/acellular and amniotic/non-amniotic grafts in the management of diabetic foot ulcers.

This Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA)-compliant review focuses on the efficacy of cellular, acellular and matrix-like products (CAMPs) in the management of diabetic foot ulcers based on published randomized control trials (RCTs). While CAMPs have been incorporated into the clinical algorithm for chronic wounds, evidence is lacking to comparatively evaluate the efficacy of these products. Level 1 RCT studies are the gold standard to evaluate efficacy of different treatment approaches, however, due to differences in surgical techniques, patient demographics and compliance, standard of care outcomes in the wound care space can vary significantly between different randomized controlled trials, making it difficult to compare them against each other. To mitigate variability between different RCTs, wound closure outcomes can be reported as risk ratios. This review of all currently published RCTs (with similar trial design) in diabetic foot ulcer (DFU) patients and risk ratios, confirms that CAMPs adjunct to standard of care result in statistically superior wound closure outcome in diabetic foot ulcers, when compared to standard of care alone, with a Risk Ratio (RR) of 1.72 [1.56, 1.90], p< 0.00001. Enough evidence is still lacking to determine a statistical difference between broad categories of cellular/acellular and amniotic/non-amniotic CAMPs; and hence decision makers should consider published head-head comparative studies, real-world evidence and cost-effectiveness evidence between individual CAMPs to decide on which to use in practice.

The Effectiveness of Polyhexanide in Treating Wound Infections Due to Methicillin-Resistant Staphylococcus Aureus: A Prospective Analysis.

Polyhexanide is a safe and effective wound care antiseptic commonly used in clinics as wound rinsing solution and gel. However, the efficacy of Polyhexanide in treatment of wound infected with MRSA (methicillin-resistant Staphylococcus aureus) is unknown. The aim of this study is to assess the effectiveness of polyhexanide with povidone iodine in treating wound infected with MRSA. A prospective analysis of 62 patients with wound infections, who were admitted to our department from 2016 to 2020, was conducted in order to assess the efficacy of different treatment approaches. The patients were divided into two groups: the experimental group and the control group. In the experimental group, 30 patients underwent treatment with a combination of diluted povidone iodine and polyhexanide immersion. Conversely, in the control group, 32 patients received treatment with diluted povidone iodine along with systemic antibiotic therapy. The time required for dressing changes, bacterial clearance rates, and the Bates-Jasen wound assessment tool (BWAT) scores were utilized as indicators to evaluate the effectiveness of the treatments. In our study, the findings indicated that the experimental group exhibited a lesser number of days for the bacteria culture to turn negative compared to the control group, with statistical significance (p<0.05). Furthermore, the decline in the BWAT score was significantly greater in the experimental group than in the control group (p<0.05). However, no significant differences were observed in terms of dressing times and wound coverage between the two groups (p>0.05). Polyhexanide combined with povidone iodine can effectively remove MRSA infection in wounds and reduce antibiotic dosages.

Efficacy of Different Treatment Approaches (Insulin and Metformin) in Women with Gestational Diabetes Mellitus (GDM)

Background and Purpose: The pharmacotherapy options in patients with gestational diabetes mellitus (GDM) are insulin or oral antihyperglycemic agents. Insulin is the preferred medication for treating hyperglycemia, but in recent years, metformin has been increasingly used in the treatment of GDM. Aim: The aim is to assess the efficacy of different treatments (insulin and metformin) in women with GDM. Methods: Screening for GDM was performed in 2422 pregnant women and revealed GDM in 119 women [75 g oral glucose tolerance test (OGTT) was performed at 24–28 weeks of gestation]. All patients started treatment at 24–29 weeks of gestation. The patients were divided into two groups (Gr.): Gr. 1 had 68 patients treated with diet and insulin therapy. Gr. 2 had 51 patients treated with diet and metformin. Results: In the 2nd trimester, HbA1c (%) levels for Gr. 1 and Gr. 2 were 6.7 (0.05) and 6.4 (0.6), respectively. By term, HbA1c levels statistically decreased in both groups, but we did not find a statistical difference between the groups. Women from Gr. 2 gained less weight compared to Gr. 1 (1.89 ± 3.88 vs. 4.53 ± 3.67 kg; P = 0.003). In Gr. 1, the percentage of preeclampsia was 2.9%, and in Gr. 2, 3.9% (P = 0.7773, OR – 1.33). We did not find a statistical difference between the groups. The incidence of preterm delivery before 37 weeks of gestation in Gr. 1 was lower than in Gr. 2 (P = 0.7311, OR – 1.33), and we also did not find a statistical difference between the groups. Perinatal mortality was observed in Gr. 1 – 1.4% and in Gr. 2 – 1.9% (P = 0.8402, OR – 1.33). In both groups, we observed a high percentage of cesarean section (Gr. 1 – 32.3% and Gr. 2 – 29.4% (P = 0.7651, OR -1.0909), but we did not find a statistical difference between the groups. In both groups, the percentage of macrosomia was high, despite good glycemic control maintained through pregnancies: 20.0% and 23.0% for Gr. 1 and Gr. 2, respectively (P = 0.9236, OR – 1.0256), and again no statistical difference was found between the groups. Percent of neonatal hypoglycemia was lower in Gr. 2 (1.9%) than in Gr. 1 (4.41%) (P = 0.9236, OR – 1.0256). Percent of respiratory distress syndrome was 2.94% and 3.92% for Gr. 1 and Gr. 2, respectively (P = 0.9694, OR – 0.9893), with no statistical difference between the groups. Conclusion: We did not find differences between patients treated with diet and insulin therapy and patients treated with diet and metformin. The percentage of preeclampsia, preterm delivery, macrosomia, and perinatal death were similar in both groups; only maternal weight gain was lower in the metformin group.

A Holistic Perspective towards Perils of and Pathways to Addiction Recovery in Pakistan: Exploring Indigenous Factors

A multi-angled approach and formation of a holistic body of insights about drug addiction relapse and recovery is the key objective of this qualitative study. Based on a Constructivist Grounded Theory methodology, a total 40 semi-structured interviews were conducted from 10 recovering persons, 10 relapsed person and 10 chief caregivers of each set of recovering and relapsed persons. Out 20 recovering and relapsed persons, 7 were within age of 18-25, 10 were within 26-35 years of age and 3 respondents were over 35 years of age. Their respective 20 chief caregivers included their parents, siblings, spouses and case managers. Furthermore, 2 Focus Group Discussions (FGDs) were conducted having 4 participants i.e., Psychiatrists, Psychologists, Psychotherapists and Case Managers hailing from Drug Rehab Centers in each group. The digitally recorded interviews were transcribed/translated and further analyzed in NVIVO – Windows. Following the processes of Open, Axial and Selective Coding, five core categories of Familial, Personal, Socio-cultural, Psycho-emotive and Treatment Factors emerged to form the theoretical framework of the substantive grounded theory titled as Perils of and Pathways to Addiction Recovery. The theory connects various dimensions of the causal factors and recovery-assuring remedial measures. This framework serves as an indigenous work for developing policy, interventions and treatment. This study reveals contributing factors for the efficacy of different treatment approaches and practices in Pakistan. This five factor theoretical model has high-resolution data driven insights collected from all possible stakeholders of the eco system of falling prey to addiction and recovering from it.

The efficacy of different treatment approaches for pediatric OSAHS patients with mandibular retrognathia: study protocol for a multicenter randomized controlled trial

BackgroundPediatric obstructive sleep apnea/hypopnea syndrome (OSAHS) is a multifactorial syndrome caused by many risk factors, such as craniofacial anomalies, adenotonsillar hypertrophy, obesity, and airway inflammation. Although new treatment patterns have recently been proposed, treatment methods for children remain particularly challenging and controversial. This randomized controlled trial was designed to investigate the efficacy of adenotonsillectomy and/or orthodontic treatment for children who have mild OSAHS with mandibular retrognathia.MethodsA sample of 352 children with mild OSAHS and mandibular retrognathia, who are aged between 7 and 10 years, will be enrolled in the study. They will be randomized into four groups: the drug treatment group, the surgical treatment group, the orthodontic treatment group, or the surgery and postoperative orthodontic group. After randomization the children will receive treatments within 4 weeks. Outcome assessment will take place at the following points: (1) baseline, (2) 7 months after the treatment starting point, (3) 12 months after the treatment starting point, and (4) 24 months after the treatment starting point. The primary endpoint of the trial is the mean change in obstructive apnea/hypopnea index. Other endpoints will consist of the lowest oxygen saturation, apnea index, and hypopnea index assessed by polysomnography, subjective symptoms (assessed by the OSA-20 questionnaire), cephalometric measurements, and morphologic analysis of the upper airway.DiscussionThe results of this study will provide valuable evidence for the merits and long-term efficacy of different treatment approaches and contribute to facilitating the multidisciplinary treatment of pediatric OSAHS.Trial registrationClinicalTrials.gov: NCT03451318. Registered on 2 March 2018 (last update posted 19 April 2018).

Abstract WP335: Intracranial Mycotic Aneurysms in Infective Endocarditis: Incidence, Predictors and Outcome

Introduction: Intracranial mycotic aneurysms (IMA) are rare but serious complications of infective endocarditis (IE). Methods and Results: In this retrospective study (1980-2011) we used original Duke criteria to diagnose IE in 1149 episodes (1081 patients; 81% definite, 80% native valve). Neuro complications occurred in 28%, stroke in 22% (202 infarcts, 53 hemorrhages) and 1% had TIA/TMB. N=33 IMA were detected in 23 (2%) patients. IMA were detected in 8% with focal neuro deficits, 13% with seizures, and 3% with encephalopathy. IMA-related symptoms were present in 22 of 23 cases: headache 48%, seizure 13%, altered sensorium 35% and focal deficits 61%. IMA were detected in 0/885 without stroke, 5.4% with infarcts and 22.6% with hemorrhages (p&lt;0.001); the latter included 9/36 (25%) with ICH, 3/13 (23%) with SAH, and 0/4 with SDH. Of the 23 IMA patients 61% had hemorrhage, 30% had SAH and 57% had infarcts. IMAs were detected by DSA in 21/166 (12.7%). The mean size was 3.6±2.4 mm; 30% multiple; 61% located in distal segments; and 67% in MCA branches. On MRI, 31 had any SAH and 45 had any ICH; IMA detected in 6/9 with diffuse SAH, 2/22 with convexal SAH, 11/45 with ICH, and 11/202 with infarcts. Patients with IMA had higher rates of women, hypertension, known cardiac valve disease, mitral regurgitation, mitral vegetation and S.viridians infection (all p&lt;0.05). On multivariable analysis, mitral regurgitation with vegetation (OR 5.9, 95% CI 2.5-14.0, p&lt;0.001) was the only independent predictor of IMA. Clipping was performed in 8 (all pre-2000); endovascular treatment in 7 (all post-1997); 2 died pre- treatment; 1 detected on autopsy; 1 no follow-up available, and 4 regressed/disappeared with antibiotics. Patients with and without IMA showed no difference in rates of in-hospital mortality (22% v. 19%, p=0.93), and length of stay (32d v. 24d, p=0.28). IMA rates did not decrease during the study period (2.2% in 784 episodes 1980-2000 vs. 1.6% of 365 episodes 2001-2011, p=0.653). Conclusion: IMA are invariably heralded by neurological symptoms and stroke (especially hemorrhages) on brain imaging. Mitral IE has the highest risk for IMA. IMAs can resolve with antibiotics however studies are needed to determine the efficacy of different treatment approaches.

Correlates of Pediatric CPAP Adherence.

Obstructive sleep apnea (OSA) is a common pediatric condition characterized by recurrent partial or complete cessation of airflow during sleep, typically due to inadequate upper airway patency. Continuous positive airway pressure (CPAP) is a therapeutic option that reduces morbidity. Despite efforts to promote use, CPAP adherence is poor in both pediatric and adult populations. We sought to determine whether demographics, insurance status, OSA severity, therapeutic pressure, or comorbid conditions were associated with pediatric CPAP adherence. A retrospective review of adherence download data was performed on all pediatric patients with initiation or adjustment of CPAP treatment over a one-year period with documented in-laboratory CPAP titration. Patients were grouped as CPAP adherent or non-adherent, where adherence was defined as > 70% nightly use and average usage ≥ 4 hours per night. Differences between the groups were analyzed by χ(2) test. Overall, nearly half of participants were CPAP adherent (49%, 69/140). Of the demographic data collected (age, ethnicity, sex, insurance status), only female sex was associated with better adherence (60.9% vs 39.5% of males adherent; odds ratio [OR] = 2.41, 95%CI = 1.20-4.85; p = 0.01). Severity of OSA (diagnostic apnea-hypopnea index [AHI] and degree of hypoxemia), therapeutic pressure, and residual AHI did not impact CPAP adherence (p > 0.05). Patients with developmental delay (DD) were more likely to be adherent with CPAP than those without a DD diagnosis (OR = 2.55, 95%CI = 1.27-5.13; p = 0.007). Female patients with trisomy 21 tended to be more adherent, but this did not reach significance or account for the overall increased adherence associated with female sex. Our study demonstrates that adherence to CPAP therapy is poor but suggests that female sex and developmental delay are associated with better adherence. These findings support efforts to understand the pathophysiology of and to develop adherence-promoting and alternative interventions for pediatric OSA.

Depression in HIV infected patients: a review.

Depression is the most common neuropsychiatric complication in HIV-infected patients and may occur in all phases of the infection. Accurately, diagnosing major depressive disorder in the context of HIV is an ongoing challenge to clinicians and researchers, being complicated by the complex biological, psychological, and social factors associated with the HIV illness. Evidences exist to support the importance of improving the identification of depressive symptoms and their adequate treatment. Depression has long been recognized as a predictor of negative clinical outcomes in HIV-infected patients, such as reducing medication adherence, quality of life, and treatment outcome, and possibly worsening the progression of the illness and increasing mortality. By analyzing the most relevant studies (MEDLINE, EMBASE, PsycLit, Cochrane Library), the review discusses the epidemiology and the main clinical features of depression in HIV-infected patients, the causal pathways linking depression and HIV infection, the validity of screening tools, and the efficacy of different treatment approaches, including psychosocial interventions, psychopharmacology as well as HIV-specific health psychology health service models.

Treatment of pathological gambling

This paper highlights the development of pharmacological and nonpharmacological treatments for pathological gambling and is based on a review of the literature published in the past 12 months. The efficacy of naltrexone treatment for pathological gambling has been replicated in a double-blind, placebo-controlled, confirmatory study. For mood stabilizers, whereas carbamazepine and topiramate continued to produce positive results, olanzapine failed to show superior outcomes compared with placebo control. Two new pharmacological agents for pathological gambling, N-acetyl cysteine and modafinil, produced significant improvement for pathological gamblers. Several studies examined the outcomes of nonpharmacological treatments. Recent studies showed that cognitive-behavioral therapy failed to produce superior outcomes compared with other less costly methods such as brief interventions. Two new nonpharmacological treatment methods have been reported, including the use of videoconferencing in delivering ongoing supervisions after exposure therapy and the congruence couple therapy, which aims to heal the person as a system whole. Recent treatment outcomes studies address not only the effectiveness, but also the efficacy of different treatment approaches. Results of two meta-analysis studies showed that nonpharmacological treatments have a larger overall effect size than pharmacological treatments; however, owing to the diversity in study designs, it is unclear whether nonpharmacological treatments are more effective than pharmacological treatments at this point.

Effektivität psychosozialer Behandlungsmethoden zur medizinischen Rehabilitation alkoholabhängiger Patienten

Treatment approaches which are used in the context of inpatient alcoholism treatment are frequently neither theoretically justified nor empirically examined. In view of the enormous method variety the necessity exists for the development of treatment guidelines in order to offer indicators of promising treatment achievement for practitioners and pension funds. In a first step, it must be examined which treatments are effective, which are ineffective and which are possibly even counter-productive. This article aims to give a comprehensive review of randomized-controlled studies/meta-analysis on the efficacy of different treatment approaches. This article reporting the literature review is part of a larger programme to develop clinical practice guidelines for rehabilitation which is supported in form, content and finance by the German Pension Institute for Salaried Employees (Bundesversicherungsanstalt für Angestellte, BfA). Summing up, treatment is effective compared to no treatment. Cognitive behavioural therapy included in a multimodal treatment program is effective. There are a number of treatment protocols for which controlled research has consistently found positive results like social skills training, community reinforcement approaches, behaviour contracting, motivation-enhancing treatment, and family/marital therapy. There is also a number of commonly used treatment approaches that brought neither a positive result or were counter productive like relapse prevention, non-behavioural marital therapy, and insight psychotherapy, confrontational counseling, education, relaxation training, and milieu therapy. Support for matching to a specific treatment is weak, but interventions against alcohol problems should be differentiated according to the severity of the alcohol problem. Since treatment evaluation is mainly accomplished in the US and supplying structures with respect to the US and Germany are substantially different, a generalized transmission of US-American research results on Germany is to be evaluated carefully. Randomized-controlled studies are needed in Germany.

Site of care for the treatment of CYSTIC FIBROSIS exacerbations: Does it matter?

Site of care for the treatment of CYSTIC FIBROSIS exacerbations: Does it matter?

Analysis and treatment of different types of neuropathic cancer pain

Neuropathic pain is a major problem in the treatment of cancer pain. We performed a retrospective analysis of 213 cancer patients with neuropathic pain treated by a pain service following the World Health Organization guidelines for relief of cancer pain. Of these, 79% presented with nerve compression pain, 16% with nerve injury pain, and 5% with sympathetically-maintained pain. Whereas nerve compression and nerve injury pain were caused most frequently by cancer growth, sympathetically-maintained pain was caused most frequently by cancer treatment. There were no significant differences in the use of analgesics, the mean pain intensity, or the efficacy of analgesic treatment among the three groups. Nerve injury pain and sympathetically-maintained pain were treated more frequently with adjuvant analgesics, especially antidepressants and anticonvulsants. The variety of different neuropathic pain syndromes should be separated in future studies of the efficacy of different treatment approaches.

The effects of cognitive restructuring on assertive behavior

Studies of the relative efficacy of cognitive restructuring and behavioral rehearsal for assertion problems have generally shown that both are effective treatments though neither is of demonstrated superiority. However, the typical research methodology that utilizes standardized but often irrelevant training situations, as well as outcome measures that rely on videotaped role-plays in the laboratory, may have obscured some real differences in treatment effectiveness. In the present study, participants were randomly assigned to either behavioral rehearsal training or behavioral rehearsal in conjunction with cognitive restructuring as a treatment for assertion difficulties. Target behaviors for training were personally relevant, and an in vivo self-monitoring procedure of behavioral performance in the individual chosen problem situation constituted the main outcome measure at posttest and 6-week follow-up. Results support the superiority of the combination of cognitive restructuring and behavioral rehearsal as opposed to behavioral rehearsal alone. Results are discussed in terms of the need to both treat and measure problems relevant to clients when comparing the efficacy of different treatment approaches.