Completion Of Treatment Patients Research Articles

Leveraging observational data to identify in-session patient and therapist predictors of cognitive processing therapy response and completion.

Cognitive processing therapy (CPT) is an evidence-based treatment for posttraumatic stress disorder (PTSD), but little is known about in-session process variables that predict symptom reduction and treatment completion during CPT. Examining potentially malleable factors that may promote or impede recovery can inform care delivery and enhance outcomes. The current study used observational ratings of CPT session recordings to examine in-session patient and therapist factors in cognitive, affective, and interpersonal domains to identify their relative contributions to predicting symptom outcomes and treatment completion. Participants were 70 adult survivors of interpersonal violence who received CPT. Predictors of better posttreatment PTSD outcomes included less patient fear, β = .32, and less patient avoidance of engaging with the therapist, β = .35. When using the last available PTSD score, less fear, β = .23, and avoidance, β = .28, continued to predict better outcomes, and more patient cognitive flexibility emerged as a stronger predictor of outcome, β = -.33. Predictors of a higher likelihood of treatment completion included more therapist use of Socratic dialogue, OR = 6.75, and less therapist encouragement of patient affect, OR = 0.11. Patient sadness and anger and therapist expression of empathy did not predict symptom outcomes or treatment completion versus dropout. The results highlight the importance of patients' cognitions, emotions, and engagement with their therapist in CPT as well as the role of therapist behaviors in patient completion of treatment.

Bismuth-based quadruple therapy modified with moxifloxacin for Helicobacter pylori eradication.

The aim of this study was to evaluate the efficacy, tolerability and safety of modified bismuth-based quadruple therapy for the second-line eradication treatment of Helicobacter pylori (H. pylori) infection. Out of 758 patients treated between January 2010 and December 2015, 155 patients (20.45%) remained H. pylori positive after the first line treatment and received the second-line treatment consisting of colloidal bismuth subcitrate (240 mg twice daily), pantoprazole (40 mg twice daily), metronidazole (500 mg twice daily) and moxifloxacin (400 mg once daily) for 14 days. Six weeks after the completion of treatment patients were retested for the presence of H. pylori infection with 13C urea breath test. Out of 155 patients, 142 patients completed their second-line regimens. 13 patients were excluded from the study: 4 experienced adverse effects that have led to discontinuation of treatment, 5 were lost to follow-up and 4 complied poorly with medication. The eradication rates were 80.64% (125/155) and 88.02% (125/142) according to intention-to-treat and per-protocol analyses. Compliance with the therapy was 89%. Moxifloxacin in modified bismuth-based quadruple therapy was found to be effective and safe with good drug compliance; therefore it may be an acceptable alternative to other second-line eradication protocols.

Collision tumor consisting of primary follicular lymphoma and adenocarcinoma in the cecum: A case report and literature review.

The present study reports the case of a collision tumor consisting of follicular lymphoma (FL) and adenocarcinoma in the cecum of a 73-year-old man. To the best of our knowledge, the present study is the 11th case of a collision tumor consisting of colon adenocarcinoma and lymphoma to be reported in the literature, and the first case of cecum adenocarcinoma with low grade FL in the same segment of the cecum and the same regional lymph node to be reported. The present study reviewed the literature to determine treatment options for patients with collision tumors. The present patient was administered with adjuvant chemotherapy for T3N1M0 colon cancer following surgery, due to the dominance of colon adenocarcinoma in the collision tumor. Following the completion of treatment, progression of the untreated FL was observed. In the literature, patients with collision tumors are administered with chemotherapy for stage IV FL, and following the completion of treatment patients have presented with a recurrence of early stage colon adenocarcinoma. The recommended treatment for collision tumors is dependent on the dominant tumor; however, the treatment options for collision tumors in the literature appeared to exacerbate the other tumor. The characteristics of the tumors altered following chemotherapy, and immunological alterations in the tumors due to chemotherapy appear to have contributed to the exacerbation of the tumors. Therefore, patients with early-stage tumors should be considered at risk of recurrence of other malignancies, which are present in collision tumors.

A Prospective Comparative Study of the Toxicity Profile of 5-Flurouracil, Adriamycin, Cyclophosphamide Regime VS Adriamycin, Paclitaxel Regime in Patients with Locally Advanced Breast Carcinoma.

A 5-flurouracil, Adriamycin, Cyclophosphamide (FAC) and Adriamycin, Paclitaxel (AT) are two popular chemotherapeutic regimens for treatment of breast carcinoma. The most time tested and popular regimen is FAC. It is extensively studied for efficacy and toxicity. But data regarding toxicity profile and efficacy of AT regimen is sparse. To study the toxicity profile, severity of toxicities and clinical response rate of FAC and AT regimens in patients with locally advanced breast carcinoma. A prospective observational study with 50 patients in each treatment arm. Study duration was 12 months from November 2012 to October 2013. Consecutive patients with locally advanced breast carcinoma receiving treatment with either FAC or AT regimen, satisfying inclusion criteria were enrolled into the study after getting informed written consent. Prior to initiation of treatment detailed medical history was taken from all patients. General clinical examination, examination of organ systems and local examination of breast lump were done. After each cycle of chemotherapy and after completion of treatment patients were interviewed and examined for clinical response and toxicities. Toxicities were graded with WHO toxicity grading criteria. All data were entered in a structured proforma. At least 50% reduction in tumour size was taken as adequate clinical response. Data was analysed using Chi-square test with help of Excel 2007 and SPSS-16 statistical software. Different pattern of toxicities were seen with FAC and AT regimens. Anaemia, thrombocytopenia, stomatitis, hyperpigmentation, photosensitivity and diarrhoea were more common with patients receiving FAC regimen. Leucopenia, peripheral neuropathy, myalgia, arthralgia, vomiting and injection site reactions were more common in AT regimen. Both FAC and AT regimens gave 100% clinical response. FAC and AT regimens are equally efficacious but have different toxicity profiles. Patient's predisposition to toxicities may govern the selection of a particular regime.

A CLINICAL STUDY ON EFFECT OF PEETVARATIKA CHURNA IN THE CALLUS FORMATION AND EARLY MOBILIZATION IN THE MANAGEMENT OF ASTHIBHAGNA WITH SPECIAL REFERENCE TO COLLES’ FRACTURE

Colle s ’s fracture is the commonest fra cture in elderly people and is predominantl y common in women after the age of 45 because of post - menopausal osteoporosis particularly affecting the cancellous bone present in the lower end of radius. Standard treatment for the colle’ s fracture is post reduction below elbow immobilization of the wri st joint in plaster of Paris cast for six weeks. This immobilization leads to a common complication i.e. post - traumatic stiffness affecting mainly the wrist along with elbow and shoulder joint of the affected side accompanied by other immobil ization induce d complications. So in concern to this a clinical study was planned to evaluate the effect of early discontinuation the plaster of Paris cast af ter 4 week (instead of 6 weeks) along with the Varatika Bha sma in Colles’ fracture Type I / Type II (Universal C lassification Fracture Colle’s). For this study 30 patients were selected and randomly divided in 2 groups i.e. Group A and B. Group A patients were treated with Varatika Bhasma orally along with post reduction immobilization in below elbow Plaster of Pari s colle’s cast for 4 weeks. Group B patients were treated with post reduction immobilization in below elbow Plaster of Paris Colle’s cast for 6 weeks and a Placebo orally. After completion of the clinical study results were analyzed on various objective par ameters and it was observed that Varatika Bhasma possesses potential of promoting fracture healing by enhancing the rate of callus formation. It was also observed that after the completion of tre atment patients in group A showed regaining of early and bett er movements in the affected wrist joint along with elbow and shoulder joint of affected side .

Neoadjuvant chemotherapy in patients with stages III/IV breast cancer disease surgical experience at Muhimbili National Hospital, Dar es Salaam, Tanzania

Background: Breast cancer disease is a health problem of public importance worldwide. In developing countries where majority of patients present late with locally advanced disease: further creates management difficulties to surgeons, oncologists and other medical personnel as to what management protocol suits a particular patient. The aim of this study was to determine disease response, recurrence and development of distant metastasis with the use of chemotherapy in the form of neoadjuvant chemotherapy. Patients and methods: This was a prospective study that had enrolled a total of 57 patients with locally advanced breast cancer disease between January 2003 and December 2005. After completion of treatment patients were followed at 6months interval for 2 years. Patients who fulfilled inclusion criteria at their initial presentation had baseline data including patient’s demography, size of the tumor, node status, presence of distant metastasis and finally stage of the tumor were established. 43 patients of the study group were given chemotherapy in the form of neoadjuvant chemotherapy at 3 weeks interval based on haematological stability until they had completed 4 cycles of dosages before they underwent surgical operation. They were given cyclophosphamide and adriamycin (CA-regime). During subsequent visits of chemotherapy; reassessment was done and recorded. After surgery patient were followed at 6 months interval to assess presence of local recurrence, distant metastasis or death. 14 patients of the study group had surgical treatment before they were given chemotherapy and these formed the adjuvant chemotherapy group. In this group chemotherapy was also given at 3 weeks intervals based on haematological stability and after completion were followed at 6 months interval to determine presence of local recurrence, distant metastasis or death. Radiotherapy was given to any patient in either group where suspicion of residual tumor was present. Patients’ data were entered in an SPSS window 11.5 program and data were analyzed. Results: Patient had mean age of 44.14±8.42 years, with age ranging from 29 to 65 years. 81.5% of patients were 50 years and below and were premenopausal. The mean duration of symptoms at presentation was 3.3±1.3 months with minimum and maximum of 1 and 7 months respectively. 19.3% of the study patients had family history of breast cancer disease to their first degree relatives. Ductal carcinoma was the commonest histopathological finding in 82.5% of all cases. Neoadjuvant chemotherapy was found to be effective in down staging locally advanced breast cancer disease and the response rate was 50-83.3%. During follow up period local recurrence occurred more on the 12 and 18 months in the adjuvant chemotherapy group as compared to the neoadjuvant chemotherapy group and this difference was statistically significant ( ρ <0.05). A relatively higher incidence of distant metastasis was also noted on the 24 month of follow up in the adjuvant chemotherapy group as compared to the neoadjuvant chemotherapy group and the difference was statistically significant ( ρ <0.05). No statistical difference was noted with regards to death in either of the treatment groups. Conclusion: This study has shown that neoadjuvant chemotherapy is associated with high response rate in down staging of locally advanced breast cancer and hence improving patient management from palliative to more definitive surgical management. It has further shown that use of neoadjuvant chemotherapy is associated with low recurrence and late emergence of distant metastasis when compared to patients who undergoes first surgery and then chemotherapy in a form of adjuvant chemotherapy. We therefore highly recommend the use of neoadjuvant chemotherapy in patients with locally advanced breast cancer disease before surgery is undertaken. Keywords: locally advanced breast cancer disease, neoadjuvant chemotherapy, adjuvant chemotherapy, and response rate.