Previous Treatment Attempts Research Articles

Treatment of rosacea-like demodicidosis with oral ivermectin and topical permethrin cream

A 32-year-old man presented with a chronic rosacea-like dermatitis of the facial skin and the eyelids. The skin disorder had been present for 4 years and was unresponsive to multiple previous treatment attempts. Skin scrapings and a histologic examination of a biopsy specimen from the affected area revealed the presence of numerous Demodex mites. The patient was treated with oral ivermectin and subsequent topical permethrin resulting in complete and rapid clearing of the folliculitis. We believe that this case supports the view that Demodex mites may be pathogenic when they are present in large numbers. Oral treatment with 200 μg/kg ivermectin with subsequent weekly topical permethrin showed impressive treatment efficacy in a case refractory to conventional treatment. (J Am Acad Dermatol 1999;41:775-7.)

The Protocol Deviation Patient: Characterization and Implications for Clinical Trials Research

This paper addresses those patients who neither complete treatment nor drop out from clinical trials but who deviate from the protocol treatment by seeking or receiving additional treatment. Psychotherapy researchers may be missing important information by withdrawing these patients from analyses or combining them with dropouts from treatment. In a multisite psychotherapy outcome study for patients with cocaine dependence, patients who deviated from protocol could be distinguished from completers and dropouts on pretreatment patient characteristics. Patients who deviated from protocol were more likely to be African American, to have higher psychiatric severity, and to have had more previous drug treatment attempts. Data indicate that there is a value in obtaining follow-up assessment after the protocol deviation and including these patients in data analysis to avoid bias in findings. Differential outcome for protocol deviation patients compared to dropouts and completers is discussed. In diesem Beitrag werden Patienten beschrieben, die in klinischen Studien weder die behandlung beenden noch abbrechen, die aber deren Einschlusskriterien nicht erfüllen, weil sie zusätzliche Behandlung erhalten oder suchen. Psychotherapieforschern gehen wichtige Informationen verloren, wenn sie diese Patienten nicht in ihre Analysen mit einbeziehen bzw. wenn sie sie als dropouts behandeln. In einer multizentrischen Untersuchung zum Psychotherapieergebnis bei kokainabhängigen Patienten konnten jene Patienten, die die Kriterien nicht erfüllten, deutlich von den anderen Gruppen im Hinblick auf Mermale vor Behandlungsbeginn differenziert werden. So waren bspw. unter den Patienten, die die Kriterien nicht erfüllten, häufiger Afro-Amerikaner; sie waren psychiatrisch auffälliger und waren im Vorfed häufiger medikamentös behandelt worden. Die Daten zeigen, dass es u. U. sinnvoll ist, diese Patienten katamnestisch mit zu untersuchen und sie ggf. in die Datenanalyse mit einzubeziehen, um Fehler zu vermeiden. Differentielle Therapieergebnisse für die Gruppe von Patienten, die die Kriterien nicht erfüllten, werden im Vergleich zu den dropouts und den Patienten, die die Therapie regulär beendeten, diskutiert. Cet article vise les patients qui ne terminent pas le traitement sans l'abndonner, mais qui dévient du protocole du traitement en cherchant ou en recevant une thérapie additionnelle. Les chercheurs en psychothérapie risquent de rater des informations importantes en retirant ces patients de l'analyse ou en les mêlant aux abandons du traitement. Dans une étude multicentrée au sujet des résultats de psychothérapies pour des patients dépendants à la cocaine, les patients déviant du protocole ont pu être différenciés des patients terminants et des abandons sur la base de caractéristiques relevés avant le traitement. Les patients déviant du protocole avaient plus de chances d'être Afro-Américains, d'être atteints plus gravement sur le plan psychiatrique, et d'avoir traversé déjà plusieurs cures précédentes. Les données indiquent qu'il est valable d'obtenir une évaluation suivie après la déviation du protocole et d'inclure ces patients dans l'analyse des données pour éviter un biais dans les résultats. Les résultats différentiels des des patients déviants du protocole par rapport à ceux qui terminent et aux abandons sont discutées. Este trabjo se refiere a pacientes que no completaron el tratamiento ni abandonaron los intentos clínicos pero que se desviaron del protocolo del tratamiento por buscar o recibir tratamiento adicional. os investigdores en psicoterapia pueden perder importante informatión si retiran a estos pacientes del anélisis o los mezclan con los que abandonaron el tratamienot. En un estudio multicéntrico sobre resultados de la psicoterapia en pacientes con dependencia cocaínca, se pudo diferenciar los que se desviaron del protocolo de los que completaron el tratamiento y de los que lo abandondaron, por medio del use de uso de características obtenidas ante del al tratamiento. Los que se desviaron del protocolo pertenecían en mayor grado al grupo afro-americano; padecín mayor severidad psiquiétrica y habían intentado previamente més tratamientos por drogas. Los datos indican que, para evitar sesgos en los resultados, sn útiles tanto los seguimientos posteriores a la desviación del protocolo como la inclusión de estos pacientes en los anélisis de datos. Se comparan los resultados de los pacientes que se desviaron del protocolo con los que lo abandonaron y los que lo completaron.

Adolescent suicides with adjustment disorders or no psychiatric diagnosis

Detailed characteristics of adolescent suicides (aged 13-19 years) with adjustment disorders (AD) (N=11) or no psychiatric diagnosis (N=3) in a nationwide adolescent suicide population (N=53) from Finland are presented. The data were collected in a psychological autopsy study of all suicides in Finland (N=1397) during a 12-month period in 1987-1988. Data collection included thorough interviews with the victims' family members and professionals, and information from official records. All the suicides with AD or no diagnosis were males. Most of these victims used highly lethal suicide methods. Previous psychiatric treatment and previous suicide attempts were rare. They were seldom under the influence of alcohol when committing suicide. The process leading to suicide seemed to be of relatively short duration. According to informant reports, withdrawn or narcissistic individual characteristics predominated in many cases. Psychosocial stressors preceding suicide often involved interpersonal losses or conflicts. Talking of suicidal intentions prior to the act was common, indicating the need to take seriously all adolescents' expressions of intended suicide, even in the absence of explicit psychopathology.

The efficacy of a new dentifrice in treating dentin sensitivity: effects of sodium citrate and sodium fluoride as active ingredients.

The purpose of this clinical trial was to study the effectiveness of three new test and one control dentifrice. A total of 120 subjects participated in the study. Measurement of dentin sensitivity consisted of three clinical tests (saturated sucrose solution, cold air blast, and tactile) and a subjective patient assessment. The patients were first stratified by previous treatment attempts and presence of a history of periodontal surgery. Patients were randomly assigned into four groups: 1) dentifrice containing precipitated silica abrasive; 2) dentifrice containing 0.2% sodium citrate buffer in a pluronic gel with precipitated silica abrasive; 3) dentifrice containing 0.2% NaF with precipitated silica abrasive; 4) a formula containing both the 0.2% NaF and the 2% citrate buffer. Neither patients nor examiners were aware of the group assignments. The patients were examined at baseline and after 2 and 4 wk, and 2 months. The efficacy of the new dentifrice system was not established in this investigation nor were the separate efficacies of the major components of the dentifrice. Although subjective and clinical assessments demonstrated a placebo effect, it was present to the same extent for all products, including the placebo.