Indicator Of Treatment Success Research Articles

Outcomes from Multisystemic Therapy in a Statewide System of Care

We examined client outcomes from the implementation of Multisystemic Therapy (MST) in a statewide child and adolescent mental health system. Specifically, we examined (1) the validity of therapist-rated MST outcome measures by comparing them to ratings of functional impairment and level of service needs by CAMHD care coordinators, who provide case management and care coordination services, (2) potential client and service predictors of therapist-rated outcomes, and (3) improvement in youth functioning around the time of entry to and exit from MST compared with rates of improvement reported in randomized controlled trials (RCTs) by the developers of MST. Results suggested that therapist-rated MST outcomes were valid indicators of treatment success. Similar to other findings in the MST literature, few client or service characteristics predicted these outcomes. Finally, although MST entry–exit effect sizes were lower than the mean derived from RCTs published by the developers, they were within the 95% confidence interval. Together, these findings support the implementation of MST in complex systems of care with continued attention to quality assurance and ongoing use of data for evaluation.

Diffusion magnetic resonance imaging as an evaluation of the response of brain metastases treated by stereotactic radiosurgery

Background Loss of tumor cell results in a relative increase in extracellular space that may lead to alteration of ADC. Our purpose was to see if the ADC could be used, rather than methods depending on changes in tumor size, to predict treatment success after treatment of brain metastases with SRS. Methods In a prospective study, the ADCs of 21 patients with 32 solid or solid-dominated brain metastases were taken before and 1 week, 1 month, and at 3-month intervals after SRS. Mean ADC values at the various time intervals were compared with each other to see whether or not the ADC might be used as an early indicator of treatment success or failure. Results The mean pretreatment value of the ADC in the metastatic tumors was 1.05 ± 0.12 × 10 −3 mm 2/s (mean ± SD). This value for the tumors rose significantly ( P = .009) 7 days after SRS and continued to rise with time. Magnetic resonance imaging showed that 91% of these tumors had been controlled by the SRS. The ADC values in cystic/necrotic tumor tissue (2.13 ± 0.18 × 10 −3 mm 2/s) were significantly ( P < .001) higher than those in noncentral necrotic tumor tissue (1.61 ± 0.14 × 10 −3 mm 2/s). Conclusions The ADC values might eventually be useful to evaluate treatment success—and in some patients, detected even at early time points—and to distinguish radiation-induced central necrosis from tumor regrowth in cases where other imagery is not definitive.

Clinical indicators for success of misoprostol treatment after early pregnancy failure

Objective To identify clinical indicators for success of misoprostol treatment after early pregnancy failure. Methods A total of 473 women with early pregnancy failure received 800 μg of vaginal misoprostol on treatment day 1. At the follow-up visit on day 3, a second dose was given if expulsion was incomplete. On day 8, vacuum aspiration was offered if expulsion had not occurred. Ultrasonography was used as gold standard for success. A Classification and Regression Tree analysis was undertaken to derive two decision trees for the success of misoprostol treatment on study days 3 and 8. Results Heavy bleeding after the first dose and an open cervical os were identified as clinical indicators of treatment success on day 3. Treatment success occurred in 84% of women with either or both indicators. Reporting passage of tissue after a second misoprostol dose and old blood in the vagina were potential indicators of treatment success or failure on day 8. A woman with either of these indicators has a 65% chance of treatment success after the second dose. Conversely, a woman with neither indicator on day 8 has a 94% chance of treatment failure. Conclusion Standard clinical findings may be useful as indicators for success or failure of medical management of early pregnancy failure in settings with limited or no access to ultrasonography. More research to identify even better indicators is warranted.

Botulinum toxin A injection under electromyographic guidance for treatment of spasmodic dysphonia

Spasmodic dysphonia is a disabling voice condition caused by a chronic neurological disorder of central motor processing. Present therapy is directed at relief of symptoms rather than cure. Botulinum toxin type A injection into the thyroarytenoid muscle has become the pre-eminent approach for treatment of adductor spasmodic dysphonia. Botulinum toxin A injections can be performed in an out-patient setting under electromyographic guidance. We present our experience with 153 injections in 14 patients with adductor spasmodic dysphonia over a 10-year period. We demonstrate that the electromyography signal is a reliable prognostic indicator in terms of efficacy, and that patients' subjective opinion is a valid indicator of treatment success and future treatment strategy.

Physical activity in the treatment of obesity: beyond body weight reduction

The prevalence of obesity is high and continues to increase. Obesity is a leading risk factor for premature mortality and numerous chronic health conditions. The role of physical activity as a treatment and (or) preventive strategy for combating obesity has been the subject of substantial research. Most of this research has focused solely on reductions in total body weight and (or) fat mass as the indicator of treatment success. Because the deposition of fat in the abdomen and nonadipose tissues of the liver and muscle plays a major role in the development of obesity-related health risk, these depots have emerged as alternative targets for obesity treatment. Absent from previous reviews is a detailed consideration of the influence of physical activity on these treatment outcomes. The purpose of this review is to evaluate the independent role of physical activity in the treatment of obesity in a broader context; that is, through its effects on abdominal obesity and liver and muscle fat, in addition to its established effects on body weight and (or) total fat mass. Consideration is also given to the utility of physical activity with minimal or no weight loss in the treatment of obesity.

Evaluation of specific antibodies for early diagnosis and management of syphilis

For many years, tests for cardiolipin antibodies Tp15, Tp17, Tp45, Tp47, and other specific Treponema pallidum antibodies, have been used to diagnose syphilis, but the timing and rates of antibody detection differ in primary and secondary syphilis. Our objective was to determine the value of the rapid plasma reagin (RPR) test, T. pallidum passive particle agglutination (TPPA) assay and Western blotting (WB) in the diagnosis of early syphilis, by studying 67 patients (20 with primary and 47 with secondary syphilis) over a recent 5-year period. All patients were tested before and 21/67 were tested after treatment. Western blotting showed that while there was a difference within the study group in terms of the number of bands detected, all patients with primary syphilis demonstrated the 47-kDa antibody, but RPR and TPPA were negative in some patients. Eighteen to 24 months after treatment, 21/67 patients were tested by WB and TPPA; antibodies to T. pallidum became undetectable within 24 months after treatment in 29% of patients. By RPR, 29% patients had negative titers within 6 months of treatment, and 86% returned to normal within 24 months. We conclude that detection of specific 47-kDa T. pallidum antibodies can be used to diagnose primary syphilis. By RPR, antibodies disappear in 6-24 months after treatment in many patients, suggesting that a change in titer may be an indicator of treatment success.

IN-HOME FAMILY THERAPY: INDICATORS OF SUCCESS

In this study, we explore how specific individual, family, and family-within-community characteristics, as well as aspects of in-home family therapy, relate to responses to treatment. The Child and Adolescent Functional Assessment Scale scores and Global Assessment of Functioning scores were used as outcome measures. Results revealed significant differences between pre- and post-scores for clients receiving in-home family therapy services, providing an initial indicator of treatment success. In addition, primary family caregiver social support, role performance in school/work, and self-harmful behavior were indicative of successful outcomes. Clients with higher problem levels had the greatest rates of change, and clients receiving more hours of services fared better in therapy.

Treatment motives as predictors of acquisition and transfer of relaxation methods to everyday life

This article presents results from four studies of the significance of type and number of initial treatment motives for acquisition and transfer to everyday life of progressive relaxation (PR) and autogenic training (AT). On the basis of theories of treatment motivation and compliance, we hypothesize that motives for participation are determinants of learning and transfer. Results are reported from (1) two studies with 113 participants in introductory courses on AT and 94 participants in introductory courses on PR and (2) two replication studies with 94 (AT) and 101 participants (PR). Participants indicated their motives for participation. Short-term indicators of treatment success include number of dropouts and subjective evaluations of relaxation exercises; long-term outcomes include transfer of relaxation exercises to everyday life and evaluations of exercise evaluations at follow-up 3 to 6 months after the end of course. Results suggest that for both AT and PR, dropout and subjective relaxation exercise evaluations can be predicted from participation motives. Long-term outcomes can be predicted only for AT. However, for both PR and AT it is shown that for up to four motives, the number of initial course motives is correlated with short-term and long-term predictors of course outcome. We conclude that motivation for participation is highly relevant to client-course matching and adaptive indication of relaxation therapies. Results lead to a threshold hypothesis about the relationship between the number of participation motives and short-term as well as long-term learning and transfer outcome.

Rehabilitation following anterior cruciate ligament injury: current recommendations for sports participation.

Knee ligament injuries often result in a premature end to a career in sports. The treatment after rupture of the anterior cruciate ligament (ACL) may be operative or conservative. In both cases, the goal is to reach the best functional level for the patient without risking new injuries or degenerative changes in the knee. Return to high level of athletic activity has been an indicator of treatment success. Rehabilitation is an important part of the treatment. Knowledge of healing processes and biomechanics in the knee joint after injury and reconstruction, together with physiological aspects on training effects is important for the construction of rehabilitation programmes. Current rehabilitation programmes use immediate training of range of motion. Weight bearing is encouraged within the first week after an ACL reconstruction. Commonly, the patients are allowed to return to light sporting activities such as running at 2-3 months after surgery and to contact sports, including cutting and jumping, after 6 months. In many cases, the decisions are empirically based and the rehabilitation programmes are adjusted to the time selected for returning to sports. In this article, some criteria that should be fulfilled in order to allow the patient to return to sports are presented. Surgery together with completed rehabilitation and sport-specific exercises should result in functional stability of the knee joint. In addition, adequate muscle strength and performance should be used as a critical criterion. Other factors, such as associated injuries and social and psychological hindrances may also influence the return to sports and must be taken into consideration, both during the rehabilitation and at the evaluation of the treatment.

Chrysotherapy: a synoptic review.

Chrysotherapy - the treatment of rheumatoid arthritis (RA) patients with monovalent gold drugs possessing anti-inflammatory and other properties - has been used with some success for more than 70 years; however, the metabolites generated from gold drugs have not been identified positively and the mechanisms of action are not known with certainty. This account selectively reviews recent available literature on the history of gold in medicine, with emphasis on RA; the role of Au(+) and Au(+) metabolites (Au(CN)(2)(-), Au(+3), Au(o)) and other mechanisms in chrysotherapy; current treatment regimes for RA using gold drugs; chrysotherapy case histories based on 2166 RA patients; and adverse effects of chrysotherapy, mainly various forms of dermatitis. More research seems needed on the role of gold metabolites in the treatment of RA, the use of more sensitive and uniform indicators of treatment success, improved routes of drug administration for maximum efficacy, and the development of gold drugs with minimal side effects.

Simultaneous Analysis of Nicotine, Nicotine Metabolites, and Tobacco Alkaloids in Serum or Urine by Tandem Mass Spectrometry, with Clinically Relevant Metabolic Profiles

Assessment of nicotine metabolism and disposition has become an integral part of nicotine dependency treatment programs. Serum nicotine concentrations or urine cotinine concentrations can be used to guide nicotine patch dose to achieve biological concentrations adequate to provide the patient with immediate relief from nicotine withdrawal symptoms, an important factor in nicotine withdrawal success. Absence of nicotine metabolites and anabasine can be used to document abstinence from tobacco products, an indicator of treatment success. The procedure was designed to quantify nicotine, cotinine, trans-3'-hydroxycotinine, anabasine, and nornicotine in human serum or urine. The technique required simple extraction of the sample with quantification by HPLC-tandem mass spectrometry. The procedure for simultaneous analysis of nicotine, its metabolites, and tobacco alkaloids simultaneously quantified five different analytes. Test limit of quantification, linearity, imprecision, and accuracy were adequate for clinical evaluation of patients undergoing treatment for tobacco dependency. The test readily distinguished individuals who had no exposure to tobacco products from individuals who were either passively exposed or were abstinent past-tobacco users from those who were actively using a tobacco or nicotine product. Nicotine, cotinine, trans-3'-hydroxycotinine, nornicotine, and anabasine can be simultaneously and accurately quantified in either serum or urine by HPLC-tandem mass spectrometry with imprecision <10% at physiologic concentrations and limits of quantification ranging from 0.5 to 5 micro g/L. Knowledge of serum or urine concentrations of these analytes can be used to guide nicotine replacement therapy or to assess tobacco abstinence in nicotine dependency treatment. These measurements are now an integral part of the clinical treatment and management of patients who wish to overcome tobacco dependence.

Analysis of Radiographic Measurements as Prognostic Indicators of Treatment Success in Patients With Developmental Dysplasia of the Hip

Analysis of Radiographic Measurements as Prognostic Indicators of Treatment Success in Patients With Developmental Dysplasia of the Hip

Analysis of Radiographic Measurements as Prognostic Indicators of Treatment Success in Patients With Developmental Dysplasia of the Hip

Measurements were taken and statistically analyzed from the initial radiographs, the 1-year follow-up radiographs, and the most recent radiographs of 81 patients (103 hips) to determine which measurements could predict the success of treatment. The average follow-up was 49 months (range, 12-139 months), and the average age of the patients at the last follow-up was 65 months (range, 15-190 months). Analysis of the data showed that the measurement with statistically significant predictive value was the Tonnis grade of dislocation determined from the initial radiograph. A single unit increase in the Tonnis grade was associated with a doubling of the odds of failure in patients treated with a Pavlik harness (P < 0.04, odds ratio = 2.2) or a closed reduction (odds ratio = 2.0).

Laparoscopic endometriosis treatment: is it better?

To assess the hypothesis that pregnancy rates (PRs) after operative laparoscopy (Laparoscopy Group) for endometriosis treatment would be equal to or greater than diagnostic laparoscopy only (No Treatment Group), diagnostic laparoscopy with medical treatment (Medical Treatment Group), and laparotomy (Laparotomy Group). Prospectively recorded data were analyzed to identify significant variables affecting PRs. These variables were statistically controlled for using survival analysis with multiple fixed covariates to compare operative laparoscopy PRs versus other treatment PRs. Treatment was performed by the senior author in a referral reproductive endocrinology and surgery private practice. Five hundred seventy-nine infertile women were diagnosed with endometriosis. A subset (n = 258) considered to have endometriosis only was evaluated separately (Endometriosis-Only Subset). Treatment groups included: No Treatment Group, Medical Treatment Group, Laparoscopy Group, and Laparotomy Group. Pregnancy was used as the indicator of treatment success. Laparoscopy Group PRs were at least equal to all other treatment groups and were significantly higher than some other treatment groups in some comparisons. Operative laparoscopy is the treatment of choice for infertile women with endometriosis unless they have severe tubal and/or fimbrial disease.

Dose-Response Study and Long Term Effect of the Somatostatin Analog Octreotide in Patients with Therapy-Resistant Acromegaly*

Twelve acromegalic patients in whom standard therapy was unsuccessful were evaluated with 24-h serum GH profiles (hourly sampling) and oral glucose tests (oGTT) while being treated with octreotide, a long-acting somatostatin analog. During a dose-response study (300, 600, and 1500 micrograms/day sc, for 4 weeks), serum GH decreased significantly after 300 micrograms/day in 8 of 12 patients [from 14.5 +/- 6.2 (+/- SE) to 4.9 +/- 1.9 micrograms/L]. Higher doses further reduced serum GH concentrations in 3 (600 micrograms/day) and 1 (1500 micrograms/day) patients, respectively. Four patients did not respond to any dose. Serum GH concentrations declined normally (GH nadir, less than 2 micrograms/L) after glucose ingestion in 4 of the 10 nondiabetic acromegalic patients. In 4 patients, including 2 of the initial nonresponders, serum GH further declined during long term treatment (12 and 18 months). In the latter 2 patients, serum insulin-like growth factor I (IGF-I) concentrations had decreased during the dose-response study despite the absence of measurable GH suppression. Eight patients attained normal serum IGF-I concentrations during treatment. Serum IGF-I and GH correlated significantly before, but not during, treatment. Retrospective comparison suggested that in 5 of 6 patients, serum GH was more effectively suppressed by octreotide than by bromocriptine. The 24-h serum octreotide concentration varied greatly among the patients. Although the 24-h serum octreotide and GH concentrations did not correlate with one another, the serum octreotide and IGF-I concentrations when the patients were receiving 300 micrograms/day tended to be negatively correlated (r = -0.496; P = 0.118). The 24-h serum insulin values decreased and those of glucose increased during treatment; after oral glucose, serum insulin was lower and glucose was higher. However, after 12 months of treatment, the 8-h serum insulin profile and peak serum insulin after oral glucose administration had returned to pretreatment values, while serum glucose remained abnormal. We conclude that 1) octreotide lowers serum GH in many, but not all, acromegalic patients resistant to other forms of treatment; 2) doses in excess of 300 micrograms/day should be tested in those patients in whom lower doses are ineffective; 3) serum IGF-I measurement may be a better indicator of treatment success than GH measurement; 4) octreotide concentrations do not correlate with GH suppression; and 5) deterioration of carbohydrate tolerance does occur but tends to improve during chronic treatment.

Long-term monitoring of treatment with recombinant human growth hormone by serial determinations of type III procollagen-related antigens in serum.

Inasmuch as recombinant human growth hormone is now more generally available for the treatment of different types of short stature, there is a need for better short-term indicators of treatment success. In healthy children, serum concentrations of antigens related to the aminoterminal propeptide of type III procollagen (P-III-NP) closely follow the growth velocity curve. P-III-NP was measured longitudinally in 20 children with growth hormone deficiency during 6 months of human growth hormone substitution therapy. Two different radioimmunoassay systems were used; one recognizes predominantly the intact propeptide showing a lesser affinity to a smaller monomeric peptide (RIAgnost assay), while the other assay detects both forms equally (FAB assay). These results were compared to the growth response [median 5.6 (0.4 to 13.9) cm in 6 months] and to other established growth correlated parameters (somatomedin C, alkaline phosphatase). A relatively better growth response correlated significantly with high pretreatment P-III-NP (RIAgnost assay) values (r = 0.56) and delayed bone age (r = -0.70). A combination of these parameters in multiple regression analysis increased the cumulative prediction value to above 60% (r2 = 0.61). On the other hand, P-III-NP (FAB assay) values proved to be best in monitoring treatment, correlating with the individual growth rate during the first 3 months (r = 0.40; p less than 0.05), during the consecutive 3 months (r = 0.66; p less than 0.001), and during the total 6-month period (r = 0.46; p less than 0.05). All other parameters showed associations to growth only during some treatment periods.(ABSTRACT TRUNCATED AT 250 WORDS)

Management of Sand Shinnery Oak for Control of the Boll Weevil (Coleoptera: Curculionidae) in the Texas Rolling Plains

Sand shinnery oak, Quercus havardii Rydb., occurs on ca. 230.2 thousand ha in the Texas rolling plains. Litter deposited by this range shrub provides one of the best overwintering habitats for the boll weevil, Anthonomus grandis grandis Boheman, in the region. Several sand shinnery oak management strategies were compared to evaluate methods for elimination of the shrub and associated litter. Overwinter survival rates for boll weevils caged in the litter were used as a biological indicator of treatment success. Tebuthiuron herbicide, applied at 1.1 kg (AI)/ha, provided a 98% reduction in shinnery oak cover and litter, but 3 years elapsed from treatment application to a significant reduction in boll weevil overwinter survival rates. The addition of fire and shredding to the tebuthiuron treatment did not hasten the rate of habitat disappearance, and boll weevil winter mortality rates were not increased in comparison to the tebuthiuron-only treatment. The herbicide glyphosate did not provide adequate control of the shinnery oak, and litter was not reduced enough to affect boll weevil survival. Fire alone was the least effective approach for shinnery oak management. The litter layer began to reaccumulate 8 months after the fire. Three years after the fire, boll weevil survival was significantly ( P < 0.05) higher and emergence continued longer into the summer compared to survival and emergence in the untreated plots. There was a significant ( P < 0.05) increase in percentage of frequency of grasses and forbs in the tebuthiuron-only treatment compared to the untreated check. Tebuthiuron seems to be the best currently available option for reduction of sand shinnery oak and the associated litter layer.