Predictors Of Treatment Success Research Articles

¿Son suficientes los nomogramas actuales para predecir los resultados de la litotricia por ondas de choque?

Introduction and objectivesTo investigate factors affecting SWL outcomes, validate three current nomograms (Kim JK, Triple D and S3HoCKwave) and compare the predictive ability of the nomograms for SWL outcomes in upper urinary tract stones. Patients and methodsMedical records of patients with renal and proximal ureteral stones treated with SWL between March 2013 and October 2020 were retrospectively reviewed. Factors affecting SWL success were analyzed with multivariate logistic regression analysis and the three predictive scoring systems compared with the area under the curve (AUC). ResultsA total of 580 patients were included in our study. The overall stone free rate was 61% and 144/580 patients (24.8%) were stone free after one session. In multivariate logistic regression analysis, stone location at upper calyx (OR:2.988; 95%Cl: 1.350–6.612; p=0.007), middle calyx (OR:3.036; 95%Cl: 1.472–6.258; p=0.003), and lower calyx (OR:2.131; 95%Cl: 1.182–3.839; p=0.012), as well as number of stones (OR:1.663; 95%Cl: 1.140–2.425; p=0.008), maximum diameter of stone (OR:1.156; 95%Cl: 1.098–1.217; p<0.001) and maximum Hounsfield Unit (OR:1.001; 95%Cl: 1.001–1.002; p<0.001) were independent risk factors of SWL failure. The AUCs of the Kim JK, Triple D and S2HoCKwave scores for predicting SWL success were 0.678, 0.548, and 0.626 respectively. ConclusionsStone location, number, maximal diameter, and maximum HU were independent predictive factors for SWL outcome in the treatment of upper urinary tract stones. Current nomograms, Kim JK nomogram, Triple D score and S3HoCKwave score can predict treatment success after SWL, but all of them have poor discrimination according to AUC analysis.

Delaying Invasive Treatment in Unilateral Head and Neck Lymphatic Malformation Improves Outcomes.

Large (De Serres stage [IV-V]) head and neck lymphatic malformations (HNLMs) often have multiple, high-risk, invasive treatments (ITs) to address functional compromise. Logically reducing HNLM ITs should reduce treatment risk. We tested whether delaying HNLM ITs reduces total IT number. Consecutive HNLM patients (n= 199) between 2010 and 2017, aged 0-18 years. ITs (surgery or sclerotherapy) were offered for persistent or dysfunction causing HNLMs. Treatment effectiveness categorized by IT number: optimal (0-1), acceptable (2-5), or suboptimal (>5). Clinical data were summarized, and outcome associations tested (χ2 ). Relative risk (RR) with a Poisson working model tested whether HNLM observation or IT delay (>6 months post-diagnosis) predicts treatment success (i.e., ≤1 IT). Median age at HNLM diagnosis was 1.3 months (interquartile range [IQR] 0-45 m) with 107/199(54%) male. HNLM were stage I-III (174 [88%]), IV-V (25 [13%]). Initial treatment was observation (70 [35%]), invasive (129 [65%]). Treatment outcomes were optimal (137 [69%]), acceptable (36 [18%]), and suboptimal (26 [13%]). Suboptimal outcome associations: EXIT procedure, stage IV-V, oral location, and tracheotomy (p< 0.001). Stage I-III HNLMs were initially observed compared with stage I-III having ITs within 6 months of HNLM diagnosis, had a 82% lower relative treatment failure risk ([i.e., >1 IT], RR=0.09, 95% CI 0.02-0.36, p< 0.001). Stage I-III HNLMs with non-delayed ITs had reduced treatment failure risk compared with IV-V (RR=0.47, 95% CI 0.33-0.66, p< 0.001). Observation and delayed IT in stage I-III HNLM ("Grade 1") is safe and reduces IT (i.e., ≤1 IT). Stage IV-V HNLMs ("Grade 2") with early IT have a greater risk of multiple ITs. 4 Laryngoscope, 133:956-962, 2023.

Coupling gamified continuing education with confidence-based assessment to address knowledge gaps and assess attitudes towards liquid biopsy for cancer screening among primary care providers.

11012 Background: Blood-based liquid biopsy assays offer a simplified approach to detect cancer early, guide clinical decision making, and predict treatment success. Given their novelty, primary care providers need education to improve knowledge and confidence regarding their use. The use of gamification in continuing medical education (CME) has been shown to increase engagement and knowledge transfer, and confidence-based learning can improve the educational experience by identified areas in which learners lack comfort. Methods: We provided a gamified CME activity based on the principles of confidence-based learning designed to educate primary care providers (PCPs) on the latest advances regarding the use of liquid biopsy for cancer screening. The game coupled knowledge questions with self-assessment of confidence to gage awareness of these topics. Pre- and post-test was used to quantify the impact of the education. The CE activity was available for credit from March 31, 2021 to March 31, 2022. Results: As of January 2022, 389 PCPs have participated. Overall, participants scored an average 76% on gaming questions related to the rationale behind the use of cell free DNA (cfDNA) for cancer screening and the benefits of liquid biopsy over tissue biopsy, demonstrating relatively high baseline knowledge on these topics. Self-reported confidence among those who answered correctly, however, was only 3.4 out of 5.0, suggesting a lack of comfort with the concepts despite answering correctly. On topics related to specific studies that demonstrated the clinical utility of liquid biopsy, participants scored only 59% and confidence scored averaged 3.17 out of 5.0, demonstrating a lack of knowledge and comfort on these topics. Across all topics, providers scored a 61% on a pre-test. Post-learning, providers scored 89%, highlighting the impact of the education on knowledge gaps. Moreover, while 52% of participants had never ordered a liquid biopsy for cancer screening prior to the education, 69% report being likely or extremely likely to do so because of the education provided. Conclusions: Integration of gamified and confidence-based learning into CE activities is an impactful way to identify and address knowledge gaps while also informing the need for future education. In this study, while self-report of confidence generally correlated with knowledge scores, confidence scores were only average even among those who answered correctly, demonstrating the need for skills-based learning that may improve comfort with liquid biopsy in the clinical setting.

Equal effect of a noncustom vs a custom mandibular advancement device in treatment of obstructive sleep apnea.

Numerous types of mandibular advancement devices (MADs) are available to treat patients with obstructive sleep apnea, varying from noncustom to custom devices. Only a limited number of studies have been performed to determine whether a noncustom MAD could be used to predict treatment success of a custom MAD. In this study, we investigated the potential of a new-generation noncustom MAD, by comparing its effectiveness with a custom MAD. We hypothesized that the effectiveness of the devices is similar with regard to both objective (polysomnography) and self-reported (questionnaires, adherence, and patient satisfaction) outcomes. This was a single-center prospective randomized crossover study including a consecutive series of patients with obstructive sleep apnea. Patients were randomized to start either with the noncustom or custom MAD. Both MADs were applied for 12 weeks, followed by polysomnography with MAD in situ and questionnaires. After the first 12 weeks of follow-up, a washout period of 1 week was applied. Equal effectiveness was defined as no significant differences in both objective and self-reported outcomes between both devices. Fifty-eight patients were included; 40 completed the full follow-up. The median apnea-hypopnea index significantly decreased from 16.3 (7.7, 24.8) events/h to 10.7 (5.6, 16.6) events/h with the custom MAD (P = .010) and to 7.8 (2.9, 16.1) events/h with the noncustom MAD (P < .001). Self-reported outcomes significantly improved in both groups. No significant differences were found between both devices. The effectiveness of a noncustom and custom MAD is comparable, which suggests that a noncustom MAD can be used as a selection tool for MAD treatment eligibility to improve MAD treatment outcome. Registry: Netherlands Trial Register; Name: The Use of a Boil and Bite Mandibular Advancement Device vs a Custom Mandibular Advancement Device in Obstructive Sleep Apnea Management; URL: https://www.trialregister.nl/trial/7249; Identifier: NL64738.100.18. Bosschieter PFN, Uniken Venema JAM, Vonk PE, etal. Equal effect of a noncustom vs a custom mandibular advancement device in treatment of obstructive sleep apnea. J Clin Sleep Med. 2022;18(9):2155-2165.

PO-669-01 LONG-TERM ADHERENCE TO FLECAINIDE AS A RHYTHM CONTROL THERAPY IN RECURRENT ATRIAL FIBRILLATION - A RETROSPECTIVE COHORT STUDY

The choice of rhythm control drugs for recurrent atrial fibrillation (AF) remains empirical and is based on the safety profile rather than predicted efficacy. Flecainide is recommended for prevention of AF recurrence in patients without structural heart disease however predictors of treatment success are insufficiently studied.

Fecobionics Evaluation of Biofeedback Therapy in Patients With Fecal Incontinence.

INTRODUCTION:Biofeedback therapy (BFT) is a well-known treatment for functional anorectal disorders. The effect of BFT was monitored in fecal incontinence (FI) patients with the Fecobionics test and with the conventional technologies, anorectal manometry (ARM) and balloon expulsion test (BET).METHODS:Studies were performed in 12 patients before and after 8 weeks of biofeedback training. The Fecal Incontinence Severity Index (FISI) score was obtained. Anal resting and squeeze pressures were measured before the bag was distended in the rectum until urge to defecate. Pressure recordings were made during Fecobionics evacuation.RESULTS:BFT resulted in 24% reduction in FISI scores (P < 0.01). Seven patients were characterized as responders. Anal pressures, the urge-to-defecate volume, and defecatory parameters did not change significantly during BFT. For ARM-BET, the maximum anal squeeze pressure, the urge-to-defecate volume, and the expulsion time were lower after BFT compared with those before BFT (P < 0.05). For Fecobionics, the change in urge volume (r = 0.74, P < 0.05) and the change in defecation index (r = 0.79, P < 0.01) were associated with the change in FISI score. None of the ARM-BET parameters were associated with the change in FISI score. It was studied whether any pre-BFT data could predict treatment success. The Fecobionics expulsion duration and the defecation index predicted the outcome (P < 0.05). The defecation index had a sensitivity of 100% and a specificity of 72%. None of the ARM-BET parameters predicted the outcome (all P > 0.2).DISCUSSION:Fecobionics was used as a tool to monitor the effect of BFT and proved better than conventional technologies for monitoring and predicting the outcome in the FISI score.

Review of the Clinical Pharmacokinetics, Efficacy and Safety of Pembrolizumab.

Treatment of various types of cancer has been improved significantly with the discovery of biological drugs that act as immune checkpoint inhibitors (ICIs). Pembrolizumab is a humanized monoclonal anti- PD-1 antibody currently approved for the treatment of a wide range of tumors, with more indications still being investigated in ongoing clinical trials. The aim of this paper is to present all currently available data regarding pembrolizumab pharmacokinetic and pharmacodynamic characteristics. Also, the possibility of using predictive biomarkers to monitor patients during cancer treatment is discussed. Database research was carried out (PubMed, ScienceDirect). Information was gathered from original articles, the European Medicines Agency datasheets and results from clinical trials. This review summarizes present-day knowledge about the pharmacokinetics, different modeling approaches and dosage regimens, efficacy and safety of pembrolizumab and therapeutic monitoring of disease progression. This review points out consistent pharmacokinetic characteristics of pembrolizumab in various cancer patients, the lack of pharmacokinetic-pharmacodynamic/outcome relationships, and the need for adequate biomarkers to predict treatment success. Hence, there is a clear necessity for more data and experience in order to optimize pembrolizumab treatment for each individual patient.

ПРЕДИКТОРЫ ЭФФЕКТИВНОСТИ ЛЕЧЕНИЯ ПУЗЫРНО-МОЧЕТОЧНИКОВОГО РЕФЛЮКСА У ДЕТЕЙ

The article presents a modern view on the prognostic factors of spontaneous resolution and effectiveness of treatment of children with vesicoureteral reflux (VUR). The most frequently used predictors of successful treatment of VUR (grades of reflux, distal ureteral diameter ratio to the distance of the lumbar vertebrae, reflux induction phase on mictional cystourthrography), delayed removal of contrast from the upper urinary tract, gender, age, antenatal hydronephrosis). Methodology, statistical significance, advantages, disadvantages of the described prognostic factors are analyzed.

Prediction of treatment outcome in patients suffering from chronic tinnitus – from individual characteristics to early and long-term change

Background and objectiveDespite the availability of successful treatment approaches for chronic tinnitus, it has proven difficult to predict who profits from treatment and it is still an open question if it is possible at all. We tried to overcome methodological shortcomings and to predict treatment outcome indicated by questionnaires measuring tinnitus distress. MethodsThis is an observational, prospective cohort study. Lasso and post-selection inference methods were used to predict treatment outcome in patients suffering from chronic tinnitus (N = 747). Patients were treated for five consecutive days in an interdisciplinary setting according to guidelines. ResultsEarly change, i.e. a positive response after the screening day, as well as change due to treatment was predicted by several psychopathological variables, but also tinnitus-related factors. Female gender as an example was a predictor for change due to treatment. In general, therapy success both for early change and change due to treatment cannot be predicted satisfactorily as indicated by a high mean cross-validation error (for early change: 9.83, for change due to treatment: 14.40). Analyzing sub-groups separated by tinnitus severity to reduce heterogeneity did not improve the situation and for patients with high tinnitus severity no predictors at all could be reported (cross-validated error: 11.62 for the low quartile, 13.38 for the low-medium quartile, and 15.61 for the medium-high quartile). ConclusionSeveral psychopathological and tinnitus-related variables predicted early and long-term change. Nevertheless, also overcoming methodological shortcomings to predict treatment success did not lead to satisfactory results, but rather emphasizes the high heterogeneity of chronic tinnitus.

Does nephrolithometry scoring systems predict success and complications in miniPCNL?

Auxiliary nephrolithometric scoring systems (NSSs) have been developed to predict complications and treatment success of conventional percutaneous nephrolithotomy (PCNL). However, to our knowledge, there is no study comparing these NSSs in patients undergoing miniPCNL. This study aimed to compare the NSSs in terms of their ability to predict miniPCNL-related complications and treatment success. The data of patients undergoing PCNL between September 2016 and May 2018 were retrospectively reviewed through the electronic medical record system, and 140 patients were included in our study. Stone-free status was evaluated using non-contrast computed tomography between 1 and 3months after the procedure. PCNL was considered successful if the patient was completely stone free. The postsurgical complications were classified according to the modified Clavien-Dindo classification system. The Clinical Research Office of the Endourological Society (CROES) and STONE NSSs significantly predicted miniPCNL treatment success (p = 0.043, p = 0.018). However, the Guy's NSS did not significantly predict the treatment success (p = 0.415). Guy's, CROES and STONE NSSs were not found to significantly predict postsurgical complications (p = 0.584, p = 0.823, p = 0.189). To the best of our knowledge, our study is the first of its kind to investigate the ability of NSSs to predict treatment success and postsurgical complications in patients undergoing miniPCNL. The study found that STONE and CROES NSSs are independent parameters for predicting stone-free status after miniPCNL. In addition, our study found that none of the NSSs were useful in predicting postsurgical complications in patients undergoing miniPCNL.

Trauma-focused EMDR for Personality disorders among Outpatients (TEMPO): study protocol for a multi-centre, single-blind, randomized controlled trial

BackgroundExisting recommended treatment options for personality disorders (PDs) are extensive and costly. There is emerging evidence indicating that trauma-focused treatment using eye movement desensitization and reprocessing (EMDR) therapy aimed at resolving memories of individuals’ adverse events can be beneficial for this target group within a relatively short time frame. The primary purpose of the present study is to determine the effectiveness of EMDR therapy versus waiting list in reducing PD symptom severity. Furthermore, the effects of EMDR therapy on trauma symptom severity, loss of diagnosis, personal functioning, quality of life, and mental health outcomes will be determined. In addition, the cost-effectiveness of EMDR therapy in the treatment of PDs is investigated. Moreover, predictors of treatment success, symptom deterioration and treatment discontinuation will be assessed. Lastly, experiences with EMDR therapy will be explored.MethodIn total, 159 patients with a PD will be included in a large multicentre single-blind randomized controlled trial. The Structured Clinical Interview for DSM-5 Personality Disorders will be used to determine the presence of a PD. Participants will be allocated to either a treatment condition with EMDR therapy (ten biweekly 90-min sessions) or a waiting list. Three months after potential treatment with EMDR therapy, patients can receive treatment as usual for their PD. All participants are subject to single-blinded baseline, post-intervention and 3-, 6- and 12-month follow-up assessments. The primary outcome measures are the Assessment of DSM-IV Personality Disorders and the Clinician-Administered PTSD Scale for DSM-5. For cost-effectiveness, the Treatment Inventory of Costs in Patients with psychiatric disorders, EuroQol-5D-3L, and the Mental Health Quality of Life Questionnaire will be administered. The PTSD Checklist for DSM-5, Brief State Paranoia Checklist and Difficulties in Emotion Regulation Scale will be used to further index trauma symptom severity. Type of trauma is identified at baseline with the Childhood Trauma Questionnaire-SF and Life Events Checklist for the DSM-5. Personal functioning and health outcome are assessed with the Level of Personality Functioning Scale-BF 2.0, Outcome Questionnaire-45 and Mental Health Quality of Life Questionnaire. Experiences with EMDR therapy of patients in the EMDR therapy condition are explored with a semi-structured interview at post-intervention.DiscussionIt is expected that the results of this study will contribute to knowledge about the effectiveness, and cost-effectiveness of trauma-focused treatment using EMDR therapy in individuals diagnosed with a PD. Follow-up data provide documentation of long-term effects of EMDR therapy on various outcome variables, most importantly the reduction of PD symptom severity and loss of diagnoses.Trial registrationNetherlands Trial Register NL9078. Registered on 31 November 2020

Early improvement in bowel wall thickness on transperineal ultrasonography predicts treatment success in active ulcerative colitis.

Bowel ultrasonography is a non-invasive imaging tool that can repeatedly monitor ulcerative colitis (UC) activity. This study aimed to determine whether early transabdominal or transperineal ultrasonography changes can predict subsequent clinical response to induction therapy in patients with UC. This single-centre prospective study explored ultrasonographic predictors for clinical remission (patient-reported outcome-2≤1 with no rectal bleeding subscore) at week 8 in patients with active UC who underwent induction therapy, in comparison with faecal calprotectin and C-reactive protein (measured at baseline, week 1 and week 8). Predictive factors were assessed using multivariable regression models and receiver-operating-characteristic curve analysis. A total of 100 patients were analysed, of which 54 achieved remission at week 8. Baseline biomarker and ultrasonographic-parameter values were not predictive of remission. Contrastingly, change from baseline to week 1 in rectal bowel wall thickness measured using transperineal ultrasonography was an independent predictor of remission by week 8 (adjusted odds ratio is associated with a 1-mm decrease: 1.90 [95% confidence interval, 1.22-2.95]). In a subgroup analysis of the patients who did not achieve remission in 1week, the predictive value of change in rectal bowel wall thickness remained high (AUC=0.77 [95% confidence interval, 0.61-0.88]). Improvement in rectal bowel wall thickness measured using transperineal ultrasonography at week 1 predicts treatment success and potentially facilitates decision making during the early course of induction therapy in UC.

Predictors of Treatment Success After Periprosthetic Joint Infection: 24-Month Follow up From a Multicenter Prospective Observational Cohort Study of 653 Patients.

BackgroundPeriprosthetic joint infection (PJI) is a devastating condition and there is a lack of evidence to guide its management. We hypothesized that treatment success is independently associated with modifiable variables in surgical and antibiotic management.MethodsThe is a prospective, observational study at 27 hospitals across Australia and New Zealand. Newly diagnosed large joint PJIs were eligible. Data were collected at baseline and at 3, 12, and 24 months. The main outcome measures at 24 months were clinical cure (defined as all of the following: alive, absence of clinical or microbiological evidence of infection, and not requiring ongoing antibiotic therapy) and treatment success (clinical cure plus index prosthesis still in place).ResultsTwenty-four-month outcome data were available for 653 patients. Overall, 449 patients (69%) experienced clinical cure and 350 (54%) had treatment success. The most common treatment strategy was debridement and implant retention (DAIR), with success rates highest in early postimplant infections (119 of 160, 74%) and lower in late acute (132 of 267, 49%) and chronic (63 of 142, 44%) infections. Selected comorbidities, knee joint, and Staphylococcus aureus infections were independently associated with treatment failure, but antibiotic choice and duration (including rifampicin use) and extent of debridement were not.ConclusionsTreatment success in PJI is associated with (1) selecting the appropriate treatment strategy and (2) nonmodifiable patient and infection factors. Interdisciplinary decision making that matches an individual patient to an appropriate management strategy is a critical step for PJI management. Randomized controlled trials are needed to determine the role of rifampicin in patients managed with DAIR and the optimal surgical strategy for late-acute PJI.

P497 Early improvement in bowel wall thickness on transperineal ultrasonography predicts treatment success in active ulcerative colitis

Abstract Background Bowel ultrasonography is a non-invasive imaging tool that can repeatedly monitor the activity of ulcerative colitis (UC). This study aimed to determine whether early changes in bowel ultrasonographic findings could predict subsequent clinical response to induction treatment in patients with ulcerative colitis. Methods This single-center prospective study compared ultrasonographic findings with fecal calprotectin, and C-reactive protein (measured at baseline, week 1, and week 8) in predicting remission (patient-reported outcome-2 ≤ 1 with no rectal bleeding subscore) at week 8 in active UC patients who initiated the remission-induction treatments. Predictive factors were assessed using multivariate regression models and a receiver operating curve analysis. Results A total of 100 patients were analysed, of which 54 achieved remission at week 8. Baseline values of biomarkers, and ultrasonographic parameters were not predictive of remission. Bowel wall thickness and bowel wall flow at baseline and week 1 were also not sufficiently predictive. By contrast, changes from baseline to week 1 in bowel wall thickness in the rectum measured by transperineal ultrasonography was an independent predictor of remission by week 8 (adjusted odds ratio associated with 1 mm decrease: 1.90 (95% confidence interval 1.22–2.95)). Predictive value of changes in rectal bowel wall thickness remained high for clinical improvement even among patients who did not achieve remission in 1 week. Conclusion Improvement in rectal bowel wall thickness measured by transperineal ultrasonography at week 1 predicts treatment success and thus would help decision making during the early course of induction treatment in UC.

Usefulness of intraoperative voiding cystourethrogram as an indicator of success in the endoscopic treatment of vesicoureteral reflux.

Up until now, serial voiding cystourethrogram (SVCU) has been regarded as the gold standard technique in the diagnosis of vesicoureteral reflux (VUR). The aim of intraoperative SVCU during endoscopic treatment is to detect those patients eligible to receive more biosynthetic material as a result of persistent VUR. The objective of this study was to assess the usefulness of SVCU as a predictor of treatment success. An analytical, retrospective study of patient medical records was carried out. Patients included had undergone endoscopic VUR surgery from 2000 to 2019, and they were measured in ureteral units. VUR persistence at intraoperative SVCU following treatment was compared with SVCU results after 3 months. Of a total of 167 ureteral units undergoing surgery, persistent reflux immediately after surgery was observed in 17 cases (10% of the sample). Only 3 cases had other urological malformations. In the SVCU carried out after 3 months, reflux was found in 38% of the sample (64 cases). When comparing the results, intraoperative SVCU demonstrated a specificity of 92.6%, and a sensitivity of 15.6%. Given the low sensitivity (15.6%) of intraoperative SVCU to detect cases of persistent reflux in the mid-term, and considering the risks associated with radiation in the pediatric population - which is extremely sensitive to it -, intraoperative SVCU should be ruled out as a useful indicator of endoscopic treatment success.

Effectiveness of the Fast Track Surgery Program for Patients with Planned Cholecystectomy.

This study analyzed the effectiveness of minimizing surgical trauma, reducing the severity of the stress reaction, and restoring the normal functioning of the body after planned gallbladder operations under an enhanced recovery program. This prospective comparison study included 30 patients from the surgical department of Irkutsk Clinical Hospital No. 1 who had been diagnosed with cholelithiasis in 2019-2020. All 30 patients completed the study and were randomly assigned to one of two groups: the FTS group (group I, n = 15) and the standard group (group II, n = 15). The comparison groups were statistically homogeneous in terms of preoperative parameters. All patients underwent prescribed surgeries. In the early and late postoperative period, there were no cases of mortality or significant complications. A comparison of the groups with respect to the effectiveness of treatment according to established criteria showed good treatment results for 13 (86.6%) patients in group I and 2 (13.3%) patients in group II (p = 0.016). The FTS treatment protocol was a significant predictor of treatment success (OR 3.1; 95% CI 0.2; 6.0; p = 0.033). The fast track surgery protocol gave superior results for surgical treatment in comparison with the standard protocol in patients with cholelithiasis.

What patient characteristics predict treatment success or failure in short- and long-term psychotherapies?

Background Patient factors make a strong contribution to psychotherapy outcome. Pre-treatment patient characteristics – demographic, pathology and personal – may either facilitate achievement of recovery and lasting benefits or constitute a risk for different kinds of treatment failure. Methods A narrative review focused on evaluating the role of pre-treatment patient characteristics on the success or failure of short- and long-term psychotherapy for mood and anxiety disorders. Success was conceptualized as significant improvement or recovery and failure as non-improvement, deterioration, or non-attendance/dropout. Results There is no consistent evidence of demographic variables as predictors of treatment failure, except for lower socioeconomic status, being male and ethnic minority status for therapy non-attendance. Patients’ pathology, i.e. severity of psychiatric symptoms, greater functional impairment, personality disorder and other comorbidities, have been shown to be mostly associated with lesser recovery across different types of disorders, especially in short-term therapies, but it does not consistently predict treatment failure. Some pre-treatment personal characteristics (e.g. secure attachment style) and capacities (e.g. motivation, self-observing capacity and good overall psychological suitability) mostly increase the likelihood of therapy success whereas some vulnerabilities and poor psychological suitability, or overall complexity (i.e. combination of demographic, clinical and personality factors), increase the risk of poor outcome mostly in short-term but not in long-term therapy, or moderate dropout. Likewise, the subsequent match between therapy type and patient’s pre-treatment expectations and preferences may account for different aspects of treatment failure. Conclusions The relative importance of pre-treatment patient characteristics on treatment failure is not known. Meta-analyses on this issue are needed.

REVISED PREDICTIVE BIOMARKER FOR OCRIPLASMIN THERAPY IN VITREOMACULAR TRACTION DISORDERS.

To determine a statistically optimal limit of adhesion size in vitreomacular traction (VMT) syndrome for ocriplasmin treatment. In this retrospective, consecutive, interventional study, we included 106 patients treated with ocriplasmin injection because of VMT between July 2013 and January 2018. A univariate and multivariate risk analysis was performed with grouped factors and continuous factors. We used a receiver operating characteristic curve to measure the prognostic relevance of each continuous factor for therapy success and determined the statistically optimal cutoff value at which specificity and sensitivity are simultaneously maximized. Among the grouped factors, only a phakic lens status showed a highly significant positive influence on the resolution of the VMT. For the continuous factors, only the adhesion diameter before injection was a good predictor of anatomical success. The statistically optimal threshold value for the adhesion size was calculated to be 480 µm. Eyes below this limit had a 6.84-fold better chance of VMT resolution compared with eyes with a larger adhesion diameter. The threshold value of the VMT diameter for ocriplasmin therapy could be statistically defined as 480 µm and may thus be a new quantitative biomarker to predict treatment success.

Narrative Exposure Therapy in Patients With Posttraumatic Stress Disorder and Borderline Personality Disorder in a Naturalistic Residential Setting: A Randomized Controlled Trial.

Background: Comorbid Posttraumatic Stress Disorder (PTSD) increases the already high symptom burden of patients with Borderline Personality Disorder (BPD). As the gold standard for BPD treatment, Dialectical Behavior Therapy (DBT), does not focus on PTSD, other treatment approaches are needed. Narrative Exposure Therapy (NET) was designed to address multiple traumatic events and may be especially useful in this patient group. The aim of the present study was to determine the efficacy of NET compared to DBT based treatment (DBT-bt) in a randomized controlled trial.Methods: Female patients (n = 60) with BPD and comorbid PTSD were randomized to either a 10-week residential NET or DBT-bt. The primary outcome was change in PTSD severity as assessed by the Clinician Administered PTSD Scale (CAPS). Mixed linear models as well as reliable change, remission, and response rates were used to compare improvement across treatment groups.Results: Mixed linear model showed that patients in both treatments improved significantly over time across all outcome measures. This improvement was not more pronounced in NET (no significant time × type of treatment effect). However, NET resulted in a higher remission rate as compared to DBT-bt. PTSD remission was accompanied by BPD remission in all cases.Conclusions: This study shows the value of trauma-focused therapy in patients with BPD and PTSD for recovery in both disorders. To shorten the duration of both illnesses as much as possible, future studies should focus on the factors predicting treatment success and enabling patients to benefit from trauma-focused treatment as soon as possible.Trial registration: ClinicalTrials.gov, identifier: NCT02517723.

The methodology of a “living” COVID-19 registry development in a clinical context

ObjectiveThe aim of this study was to describe an innovative methodology of a registry development, constantly updated for the scientific assessment and analysis of the health status of the population with COVID-19. Study Design and SettingA methodological study design to develop a multi-site, Living COVID-19 Registry of COVID-19 patients admitted in Fondazione Don Gnocchi centres started in March 2020. ResultsThe integration of the living systematic reviews and focus group methodologies led to a development of a registry which includes 520 fields filled in for 748 COVID-19 patients recruited from 17 Fondazione Don Gnocchi centres. The result is an evidence and experience-based registry, according to the evolution of a new pathology which was not known before outbreak of March 2020 and with the aim of building knowledge to provide a better quality of care for COVID-19 patients. ConclusionA Living COVID-19 Registry is an open, living and up to date access to large-scale patient-level data sets that could help identifying important factors and modulating variable for recognising risk profiles and predicting treatment success in COVID-19 patients hospitalized. This innovative methodology might be used for other registries, to be sure which the data collected is an appropriate means of accomplishing the scientific objectives planned. Clinical trial registration numbernot applicable