Post-treatment Status Research Articles

Cessation of enzyme replacement therapy in Gaucher disease.

Enzyme replacement therapy (ERT) is a promising therapeutic intervention for lysosomal storage diseases. Posttranslationally engineered human beta-glucocerebrosidase (Ceredase/Cerezyme) is commercially available and is the standard ERT for Type I Gaucher disease. Cessation of therapy is sometimes necessary for personal or financial reasons, but the consequences of discontinuation are unknown. This study reports results of discontinuing therapy in four patients with Type I Gaucher disease with different genotypes and varying degrees of clinical involvement. Patient genotypes were as follows: N370S/L444P (Patients 1 and 2), K79N/K79N (Patient 3), and N370S/N370S (Patient 4). All were evaluated before, during, and after withdrawal from ERT. Patients 1, 2, and 3 were studied after reinstituting ERT. The following parameters were documented at 3- to 12-month intervals in all patients: hemoglobin, platelet count, angiotensin-converting enzyme, spleen volume, liver volume, femoral magnetic resonance imaging, bone density, and urinary pyridinium crosslinks. After cessation of therapy, Patients 1, 2, and 3 had more dramatic regression in hematological and visceral parameters than Patient 4 and required reinstitution of ERT within 2 years. All three patients recovered posttreatment status within 4 years of reinstituting ERT. Patient 4 remained stable 6 years after cessation of ERT. Regression of disease status in patients with Type I Gaucher disease after cessation of ERT conformed to the genotype-phenotype relationships of disease onset. Careful monitoring and reinstitution of ERT enabled previously attained treatment status.

Sexually abused women after multimodal group therapy: A long-term follow-up study

This study reports a long-term follow-up of 38 of 54 (70%) women who had participated in time-limited multimodal group treatment for the psychological sequelae of sexual abuse. The women had been highly symptomatic at the onset and were generally improved following treatment and at follow-up ( M = 4.7, SD = 2.0 years). Nonetheless, many remained moderately symptomatic. Previous therapy and pre-therapy level of symptoms predicted a higher level of post-treatment symptoms, while better post-treatment status and younger age predicted fewer symptoms at the time of follow-up. Interpersonal functioning at follow-up was predicted by post-treatment interpersonal functioning. On the whole, clients perceived their interpersonal functioning as better at follow-up than it had been after treatment. Their use of any mental health services was modest in the follow-up period. In general, the long-term follow-up status of these women was encouragingly positive.

Interpretation of change and longitudinal validity of the quality of life for respiratory illness questionnaire in inpatient pulmonary rehabilitation

The quality of life for respiratory illness questionnaire (QoLRIQ) is an outcome measure for patients with asthma or chronic obstructive pulmonary disease (COPD). This study assessed the longitudinal validity, reliability of the change score and the interpretation of changes on the QoLRIQ in inpatient pulmonary rehabilitation, completed by 108 patients with moderate to severe asthma (39) or COPD (69). Domains and total score of the QoLRIQ changed significant (all p < 0.0002) with standardized response means from 0.46 to 0.90. All QoLRIQ-change scores were significantly correlated with self-rated change in health and in disease symptoms and with change in self-assessed health status (r from 0.2 to 0.61). There were several significant correlations between QoLRIQ-change scores and change in experienced invalidity, emotional well-being, anxiety, depressive symptoms and Rand-36-domains (r from 0.2 to 0.68). The intraclass correlation coefficient of change was 0.90. The size of a minimal important difference (MID), computed from a retrospective global rating of change by the patients and with the standard error of measurement, was 0.5 points on a 7-point response scale. Computation of the MID from retrospective assessment of change may not be valid because this change was significantly correlated to post-treatment health status and significantly higher than serial assessment of change. We conclude that the QoLRIQ is sensitive to change, longitudinally valid and reliable, with a MID of 0.5 points. These results enable the use of the QoLRIQ as an outcome measure in clinical trials with patients with moderate to severe asthma or COPD. The longitudinal measurement properties in less severe patients still need to be studied.

Adolescents in Therapeutic Communities: One-Year Posttreatment Outcomes

Given the dearth of information concerning outcomes for adolescents who have been in treatment for substance abuse and related problems, the purpose of the present article is to examine the posttreatment status of adolescents who have been in residential therapeutic communities (TCs). One-year posttreatment outcome data are described for 485 adolescents, and separately for treatment “completers” and “noncompleters.” The majority of the sample had been mandated to treatment by the criminal justice system. Most reported marijuana as their main drug of abuse. There were significant reductions in drug use and criminal activity, and the most consistent predictors of positive outcomes were completion of treatment and not associating with deviant peers posttreatment. The findings were obtained on a treatment sample for whom there is relatively little research to date; they provide important evidence for the effectiveness of the therapeutic community for this population.

Results of 55 AVM Cases Treated by Embolization and/or Surgery

In order to build a data base for future comparison, we summarized the treatment results of cerebral arteriovenous malformation (AVM) patients in our hospital. Fifty five AVM patients who had been treated at Nagoya University Hospital from 1988 to 1995 were enrolled in the study. The patient characteristics were nearly the same as other reported series. Trend of treatment modality was changing in this period and embolization was increasing in its role. Karnofsky score was used to follow the patients' clinical status. It was useful to assess pretreatment clinical status and post treatment status. The results showed the improvement of the embolization procedure.

Behavioral treatment of panic disorder: A two-year follow-up

Forty-one patients with panic disorder with mild or no agoraphobic avoidance, who participated in one of three cognitive-behavioral treatment conditions, were assessed six months and twenty-four months following treatment completion. Treatment consisted of either progressive muscle relaxation, interoceptive exposure therapy plus cognitive restructuring, or a combination of relaxation and interoceptive exposure therapy plus cognitive restructuring. Assessments included semi-structured diagnostic interviews, self-report inventories, and self-monitoring. The post-treatment results, presented in an earlier report, showed that panic attacks were more effectively controlled by interoceptive exposure and cognitive restructuring treatments than by relaxation training. Relative to the other treatment conditions, subjects in the relaxation condition evidenced less favorable response on measures of panic and general psychopathology across the follow-up periods as well. In contrast, patients in the interoceptive exposure plus cognitive therapy condition tended to either maintain or improve upon their post-treatment status over the two-year follow-up interval. Fully 81% of the patients in the latter condition remained panic-free at the 24-month assessment.

A 10‐year follow‐up of patients treated for dental fear

Different types of treatment have been used in trying to reduce dental anxiety in adult patients with severe fear and avoidance behavior. However, there is an obvious shortage in long-term treatment follow-up. The present investigation reports results over a period of 10 yr of 14 patients treated for dental fear in a specialized dental fear treatment and research clinic. The aims of this project were to evaluate patients' regularity in dental behavior between 1977 and 1987, changes in and present level of dental fear and other long-standing positive/negative effects of the respective initial treatments. The 14 dental phobic patients were assigned to two treatment groups, one receiving Systematic Desensitization and one Premedication with valium before dental treatment. Pre- and posttreatment status as well as the 10-yr follow-up were evaluated by psychometric (Corah's Dental Anxiety Scale and a Mood Adjective Checklist) and physiological (Skin Conductance Response) measurements. A majority of patients (100% SD, 63% P) reported regular dental care during the period 1977-87. Positive side-effects were reported by seven patients. A significant reduction of dental fear (DAS) was found with a better effect for the SD-group. This was paralleled by a rise in mood (MACL). The SCR figures were non-significant. In conclusion, the results revealed long-standing effects with regard to a high degree of regular dental care and reduction of dental fear. In addition, positive side-effects were reported.

Alcoholism: abstinence, improvement, and no improvement in general population.

Traditionally, in the field of alcoholism research, abstinence has been considered the sole measure of treatment success and patients found to be drinking at follow-up were automatically considered to be treatment failures. In recent years this dichotomous approach has been criticized in light of studies on post-treatment status that reveal patients to be drinking and functioning at an improved level. Although there has been a convergence of evidence indicating that some treated alcoholics progress toward an improved but not abstinent status, such improvement in drinking status had apparently not previously been investigated in a general population. Such was the purpose of the present study with 529 subjects. Of the persons who reported previous alcoholic drinking level from 49% to 63% reported current subcriterion drinking. It was inferred that these findings combine with the findings from treated alcoholic and other special populations to form a more pervasive perspective of movement from alcoholic to subalcoholic drinking levels. Although the authors see some overlap with the topic of moderate drinking oriented treatment programs, they view specific recommendations as premature.

New Parents as Teachers: Evaluation of an early parent education program

A structural equation, latent trait model was used to identify treatment effects for a quasi-experimental design based on post-treatment status alone. This evaluation concluded that a high quality parent education and support program during a child's first three years increases the child's intellectual development at age three. Staff assessments indicated that high quality parental involvement with the parent educator during home visits was the key to the program's success. The relationship of background characteristics and socioeconomic advantage to children's abilities was not significant. The consistent relationships between observed at-risk characteristics and outcomes provide support for the theory that stress-producing situations can have direct impact on children's language development and achievement—even by age three.

Demographic variables as predictors of alcoholism treatment outcome.

Interactions of 18 demographic factors with alcoholism treatment outcome and with aftercare participation were studied. For 2 years subsequent to discharge from a 30-day inpatient program, 1210 alcoholic men veterans were followed up and grouped with regard to (1) posttreatment status (abstainers, improved, unimproved, unclassified, deceased) and (2) in terms of responders (abstainers and improved) and nonresponders (unimproved). Classifications were based on comparing each subject's 2-year posthospital drinking status with his 2-year prehospital drinking pattern. Seven variables were found to discriminate between the groups in both analyses. Those responding to treatment tended to be older, married and employed at admission, had more days of prehospital abstinence, were less likely to have had prior hospitalizations, and were more likely to participate in aftercare and to visit more frequently. In multivariate analyses, however, only the last two variables showed promising predictive ability, whereas the variables of days sober, age and married contributed only slightly to the prediction of treatment outcome. An effort to find variables that might predict aftercare participation was unsuccessful; the combined contribution of four factors amounted to only 5% of the total variance.

Agreement between alcoholics and relatives when reporting follow-up status.

Forty-five patients and their relatives were interviewed by telephone regarding their posttreatment status. Questions were asked concerning such areas as drinking, health, employment, family relationships, legal trouble, and AA involvement. In 80% of the cases, there was almost exact agreement between the alcoholic and his relative in all areas. In the remaining cases, the relative described the alcoholic as engaging in excessive drinking and disruptive behavior while the alcoholic denied or minimized these behaviors. The discrepancy between the alcoholic's and the relative's report varied according to area asked about.

Pulmonary function tests after mantle field irradiation vs. low dose whole lung and mantle field irradiation

In the past, a high incidence of regional recurrence (79%) has been seen in patients with a large mediastinal mass (MT ratio ', .35) following treatment with regular mantle field irradiation. Therefore, since 1975 the mantle field portal utilized in Hodgkin's disease patients with a large mediastinal mass and/or hilar disease has been modified to include low dose (1200-2000 rads) whole lung irradiation. The new approach has resulted in much less regional recurrence (1 out of 15), with minimal follow up time of 24 months (median 53 months). Many questions and concerns arose regarding the changes in lung function after whole lung irradiation compared with the changes in lung function after regular mantle field irradiation alone. The preliminary results of serial pulmonary function tests in two groups of Hodgkin's disease patients will be used to supply some answers to these questions. Group I includes those patients without a large mediastinal mass, and who received regular mantle field irradiation. Group II includes those patients with a large mediastinal mass and/or hilar disease, and who received low dose whole lung irradiation as part of the mantle field. . Serial pulmonary function tests were obtained on seven patients in Group I and on ten patients in Group II. Most of the patients participated in control studies prior to radiotherapy and at two months, six months, twelve months, etc. after treatment with radiotherapy. Each of the control studies consisted of spirometry, lung volumes and arterial blood gases. Changes of lung volumes and mechanics will be compared in preand posttreatment status, and between Groups I and II. The Roentgenographic changes in the lung will also be evaluated by serial chest x-rays.

New methods for the assessment of the clinical significance of non-compliance with prescribed schedules of irradiation in cancer patients

The significance of non-compliance with a prescribed schedule of irradiation is discussed in terms of the effects cf small excursions in dose and time from those values initially prescribed upon the likelihood of the occurrence of those events of mutual and acute concern to the radiation oncologist and to his patient. These events are, first, those primary, simple, events by which the post-treatment status of the neoplastic and normal tissues of the target volume are evaluated: control (El) and recurrence (ET); necrosis (E2) and no necrosis (E2), respectively. Next are the joint binary events by which the status of the treatment regimen is recognized as either success, 5, or failure, S, and which are derived from the primary simple events S = ET JVJ E2

Carrier Rates of Staphylococci in Preschool and School-Age Children-Reply

<h3>To the Editor:—</h3> 1. As the study took place over a 9-month period, not all children were treated with antibiotics at one time. At any one time, some children were in pretreatment status, some were undergoing treatment, and some were in post-treatment status. The largest number were under treatment during the height of the respiratory disease season. It was the fact of antibiotic therapy which led to "seasonal variation," as the carrier rates of staphylococci did not vary during the year among children not receiving antibiotics. 2. The data presented do show a greater number of persistent carriers among school-aged children than among preschool-aged children. It might be true, therefore, that antibiotics tend to produce greater or lesser effects upon one particular age group than upon another, but such could not be demonstrated in the present study. There did seem to be greater acquisition rates following the use of antibiotics

Penicillin treatment of asymptomatic central nervous system syphilis. II. Results of therapy as measured by laboratory findings.

During the past several years, the Venereal Disease Program, in cooperation with a number of well-known clinics and hospitals throughout the country, has conducted a study to determine the effectiveness of penicillin in the treatment of asymptomatic neurosyphilis. A preceding report 1 has shown that factors such as age, race, sex, previous treatment, and re-treatment status have little or no relationship to clinical prognosis in penicillin-treated asymptomatic central nervous system (CNS) syphilis. The present report deals with the pretreatment and post-treatment status of the patient group in terms of results of blood and spinal fluid examinations. This study consists of 765 patients with asymptomatic neurosyphilis, whose histories were selected from the records of eight cooperating clinics in accordance with the following criteria: (1) reactive spinal fluid, i.e., abnormalities in the spinal fluid test for syphilis, colloidal test, total protein, or cell count, or