Successful Treatment Completion Research Articles

COMBINED SPECIFIC IGG – AND IGA-BASED DIAGNOSIS OF TUBERCULOSIS IN AFRICAN PRIMARY HEALTHCARE CLINIC ATTENDEES WITH SIGNS AND SYMPTOMS SUGGESTIVE OF TUBERCULOSIS

BackgroundIgG-based tests for the diagnosis of active tuberculosis disease (TB) often show a lack of specificity in TB endemic regions, which is mainly due to a high background prevalence of...

A Post-Hurricane Katrina Examination of Substance Abuse Treatment Discharges With Co-Occurring Psychiatric and Substance Use Disorders

ABSTRACTObjectives: There is increasing literature supporting the adverse effects of disasters on substance use and psychiatric disorders. The co-occurrence of psychiatric disorders with substance use intensifies the challenge of treatment delivery. Thus the aim of this study was to examine the prevalence of substance use, treatment characteristics, and demographics of discharges from substance abuse treatment in New Orleans, post–Hurricane Katrina. Trends associated with discharges that have a co-occurring psychiatric and substance use disorder (COD) were also assessed. The secondary aim of this study was to examine the association of successful substance abuse treatment completion among those with a COD post–Hurricane Katrina. Methods: Substance abuse treatment discharge data (N = 16,507) from New Orleans, Louisiana, for years 2006 through 2011 were obtained from the Treatment Episode Data Set–Discharge. Multiple logistic regression analysis was employed to examine the association of discharges with a COD and completion of substance abuse treatment. Demographic, psychiatric, and treatment characteristics of discharges in 2006 were compared to characteristics in 2011. Trends of characteristics were also assessed through the study period. Results: Roughly a third (35.2%) of all discharges in New Orleans from 2006 to 2011 had a COD. After controlling for race, employment, treatment service setting at discharge, primary substance problem, and the discharge's principal source of referral, discharges with a COD were 29% less likely to complete treatment as compared to those with no COD (AOR = 0.71, 95% CI [0.56, 0.90], p = .004). Treatment completion among discharges with a COD has significantly declined from 36.8% in 2006 to 18.7% in 2011 (p < .0001). Notable significant trends in homelessness, criminality, and heroin use were identified among discharges with a COD. Conclusions: Substance abuse treatment undergoes various changes in the event of a natural disaster. These changes may increase challenges for successful treatment completion for vulnerable populations such as those with a COD. Results of this study demonstrate that discharges with a COD are less likely to complete treatment as compared to those with no COD disorder. Unmet treatment needs may also increase odds of criminalization and homelessness.

The Implementation of State-Mandated Standards for Batterer Intervention Programs: The Colorado Experience.

The current research examines Colorado's experience implementing evidence-based mandated treatment Standards, which use a uniform risk assessment, differentiated treatment levels, offender competencies, and a multidisciplinary treatment team (MTT) composed of a victim advocate, probation officer, and treatment provider to manage offender treatment. Using data from MTT member surveys (n = 107) and follow-up interviews (n = 14), the study investigates perceptions of implementation and treatment fidelity, MTT decision making and communication, and the process of successful treatment completion. Results demonstrate that full implementation of Colorado's standards for domestic violence treatment has not yet been achieved and that many MTT members report challenges to communication and decision making regarding offender treatment plans and successful achievement of competencies. Recommendations for further improvements in Colorado's domestic violence treatment model are made and directions for future research are discussed.

Modulation of dendritic cell and monocyte subsets in tuberculosis-diabetes co-morbidity upon standard tuberculosis treatment

Type 2 diabetes mellitus (DM) is a major risk factor for the development of active pulmonary tuberculosis (PTB), with development of DM pandemic in countries where tuberculosis (TB) is also endemic. However, the effect of anti-TB treatment on the changes in dentritic cell (DC) and monocyte subset phenotype in TB-DM co-morbidity is not well understood. In this study, we characterized the frequency of DC and monocyte subsets in individuals with PTB with (PTB-DM) or without coincident diabetes mellitus (PTB-NDM) before, during and after completion of anti-TB treatment. PTB-DM is characterized by diminished frequencies of plasmacytoid and myeloid DCs and classical and intermediate monocytes at baseline and 2 months of anti-TB treatment but not following 6 months of treatment completion in comparison to PTB-NDM. DC and monocyte subsets exhibit significant but borderline correlation with fasting blood glucose and glycated hemoglobin levels. Finally, while minor changes in the DC and monocyte compartment were observed at 2 months of treatment, significantly increased frequencies of plasmacytoid and myeloid DCs and classical and intermediate monocytes were observed at the successful completion of anti-TB treatment. Our data show that coincident diabetes alters the frequencies of innate subset distribution of DC and monocytes in TB-DM co-morbidity and suggests that most of these changes are reversible following anti-TB therapy.

Measuring and Facilitating Client Engagement with Financial Incentives: Implications for Improving Clinical Outcomes in a Mental Health Setting.

Significant numbers of individuals with severe mental illnesses are difficult to engage in treatment services, presenting challenges for care. To be able to assess the relationship between engagement and discharge outcomes, we modified the "Milestones of Recovery Scale". This scale was modified for content to match the current clinical setting, evaluated for inter-rater reliability after modification in a sample of 233 cases receiving psychiatric rehabilitation, and then was administered to 423 additional psychiatric rehabilitation clients over a 24-month study period. In an effort to determine whether provision of financial incentives lead to sustained increases in client engagement, a cut off for client eligibility for financial incentives was evaluated on the basis of the reliability study and the course of engagement was related to receipt of this incentive and successful completion of treatment in a new sample of 423 patients. Of this sample, 78 % received an initial financial incentive during treatment (were initially engaged), and 93.3 % of that subgroup sustained this level of engagement it over their entire course of treatment. Of the 22 % of cases not receiving an initial incentive, only 5.4 % improved in their engagement to levels required for the incentive. Longitudinal analysis demonstrated that individuals who maintained or increased their level of engagement over time were more likely to complete treatment in accordance with planned treatment goals. The initial engagement and the course of engagement in treatment predicted successful completion, but incentives did not lead to increased engagement in initially poorly engaged patients. These data are interpreted in terms of the likely success of extrinsic rewards to increase engagement in mental health services.

The Application of Liquid Nitrogen Spray Cryotherapy in Treatment of Bronchial Stenosis.

Spray cryotherapy (SCT), the application of liquid nitrogen in a noncontact form, has been demonstrated to have efficacy in treating various types of pathologic lesions of the airway when used as an adjunct with bronchoscopy. The purpose of the study was to evaluate the results of the use of bronchoscopic SCT on the airway in a single institution. We performed a retrospective review of data collected on all patients who underwent SCT to re-establish or improve airway patency in an 11-month period. Patients were classified based on the nature of their disease into benign or malignant. Demographic data, change in luminal patency, and clinical outcomes were recorded. The percent of stenosis was divided into grades according to the following classification: 1, ≤25%; 2, 26% to 50%; 3, 51% to 75%; and 4, ≥76%. We defined successful completion of treatment as obtaining a final patency of grade 1. Twenty-two patients met inclusion criteria, with 45.5% (10 patients) having benign stenosis and 54.5% (12 patients) malignant. At initial bronchoscopic evaluation, the median grade of stenosis was 4 for malignant disease and 3.5 for benign disease. The median final posttreatment grade of stenosis was 2 for malignant disease and 1 for benign. The median improvement in grade of stenosis after treatment was 2 for both malignant and benign causes (Wilcoxon test, P = 0.92). Final patency of grade 1 was achieved in 42% of malignant stenosis and 80% of benign. Overall, 86.4% of patients had an improvement in grade of stenosis after treatment. The rate of morbidity was 4.5% (1/22) of all patients. The median change in grade after treatment was 2 grades of improvement for both the benign and malignant groups. These results provide evidence that the use of SCT is equally efficacious for both types of stenosis with an expectation of overall improvement in luminal patency, offering a safe and effective method of achieving airway patency in a minimally invasive fashion. This study contributes to the small but growing body of literature supporting the use of SCT in benign and malignant disease.

When Exposures Go Right: Effective Exposure-Based Treatment for Obsessive–Compulsive Disorder

Cognitive behavioral therapy with exposure and response prevention (CBT-E/RP) is the first-line treatment for obsessive–compulsive disorder (OCD). Several CBT-E/RP treatment manuals exist, yet clinicians still struggle to implement this evidence-based form of therapy. This article aims to help clinicians implement exposure-based treatment for OCD by providing practical treatment-enhancing strategies. In particular, literature and treatment recommendations related to effective hierarchy formation, strategic exposure design, and optimal exposure implementation is reviewed. Clinical case examples are provided throughout the paper to illustrate important principles, concepts, and recommendations. This paper aims to enhance the delivery of CBT-E/RP and address common questions and concerns that both new and advanced clinicians encounter when learning and applying this form of psychotherapy. Improving the integrity of CBT-E/RP delivery can improve therapeutic outcomes, patient compliance, and successful treatment completion.

A Century of Cleft Treatment- An Orthodontic Perspective

Orofacial clefting is the most common congenital deformity. Its treatment is a long drawn process with various challenges. However, successful completion of treatment is highly satisfying not just to the patient but also the team of specialists involved with it. The following article provides an overview of the evolution of cleft treatment over the past century. It briefly describes the changing views of the orthodontic specialty towards the diagnosis and treatment of this deformity over the past century. Its gradual process from the rudimentary treatment protocols of the early 20th century to the holistic approach followed currently.

Oral Macrolide Therapy Following Short-term Combination Antibiotic Treatment of Mycobacterium massiliense Lung Disease

Although Mycobacterium massiliense lung disease is increasing in patients with cystic fibrosis and non-cystic fibrosis bronchiectasis, optimal treatment regimens remain largely unknown. This study aimed to evaluate the efficacy of oral macrolide therapy after an initial 2-week course of combination antibiotics for the treatment of M massiliense lung disease. Seventy-one patients received oral macrolides, along with an initial 4-week (n=28) or 2-week (n= 43) IV amikacin and cefoxitin (or imipenem) treatment. These patients were treated for 24months (4-week IV group) or for at least 12months after negative sputum culture conversion (2-week IV group). Total treatment duration was longer in the 4-week IV group (median, 23.9months) than in the 2-week IV group (15.2months; P< .001). The response rates after 12months of treatment were 89%for symptoms, 79%for CT scanning, and 100%for negative sputum culture results in the 4-week IV group. In the 2-week IV group, these values were 100%(P=.057), 91%(P= .177), and 91%(P= .147), respectively. Acquired macrolide resistance developed in two patients in the 2-week IV group. Genotyping analyses of isolates from patients who did not achieve negative sputum culture conversion during treatment and from those with positive culture results after successful treatment completion revealed that most episodes were due to reinfection with different genotypes of M massiliense. Oral macrolide therapy after an initial 2-week course of combination antibiotics might be effective in most patients with M massiliense lung disease. ClinicalTrials.gov; No.: NCT00970801; URL: www.clinicaltrials.gov.

Impact of Hepatitis C on Quality of Life

Hepatitis means inflammation of the liver causing destruction of liver tissues and it can be caused by various etiological factors, including hepatitis C. There is marked decline in the quality of life of hepatitis C patients which has been established by number of studies conducted worldwide. A prospective study was carried out among three thousand patients of hepatitis C. In it patients were regularly assessed physically & psychologically, before starting of treatment, during treatment, at end of treatment and when they came after six month of completion of treatment i.e. sustained virological response (SVR). The major aims of this study were to assess the quality of life of the patients suffering from hepatitis C, estimation of the patient compliance with the management methods, assessment of the patient satisfaction with the medicines, comparison of the quality of life of the suffering patients with their optimum health state and the comparison of the quality of life of the patients during and after the management/treatment of the disease. The study showed that the patients were not satisfied with their quality of life during their ailment whereas majority expressed that their quality of life improved after receiving medical treatment. In few patients who developed psychological symptoms like depression and anxiety due to Pegylated Interferon, required long term antidepressants and antianxiety drugs, even after successful completion of treatment and achievement of SVR.

Is treatment for alcohol use disorder associated with reductions in criminal offending? A national data linkage cohort study in England

BackgroundThis is the first English national study of change in criminal offending following treatment for alcohol use disorder (AUD). MethodsAll adults treated for AUD by all publicly funded treatment services during April 2008-March 2009 (n=53,017), with data linked to the Police National Computer (April 2006-November 2011). Pre-treatment offender sub-populations were identified by Latent Profile Analysis. The outcome measure was the count of recordable criminal offences during two-year follow-up after admission. A mixed-effects, Poisson regression modelled outcome, adjusting for demographics and clinical information, the latent classes, and treatment exposure covariates. ResultsTwenty-two percent of the cohort committed one or more offences in the two years pre-treatment (n=11,742; crude rate, 221.5 offenders per 1000). During follow-up, the number of offenders and offences fell by 23.5% and 24.0%, respectively (crude rate, 69.4 offenders per 1000). During follow-up, a lower number of offences was associated with: completing treatment (adjusted incident rate ratio [IRR] 0.82; 95% confidence interval [CI] 0.79–0.85); receiving inpatient detoxification (IRR 0.84; CI 0.80–0.89); or community pharmacological therapy (IRR 0.89; CI 0.84–0.96). Reconviction was reduced in the sub-population characterised by driving offences (n=1,140; 11.7%), but was relatively high amongst acquisitive (n=768; 58.3% reconvicted) and violent offending sub-populations (n=602; 77.6% reconvicted). ConclusionsReduced offending was associated with successful completion of AUD treatment and receiving inpatient and pharmacological therapy, but not enrolment in psychological and residential interventions. Treatment services (particularly those providing psychological therapy and residential care) should be alert to offending, especially violent and acquisitive crime, and enhance crime reduction interventions.

Comparison of different injection sites effects for recombinant human interleukin

Objective To explore the efficacy and side effects of recombinant human interleukin by adopting abdominal subcutaneous injection method and the traditional deltoid subcutaneous injection method. Methods A total of 106 patients were admitted to either intervention group or control group by course of treatment. The patient of control group (5-8 course of treatment) adopted traditional deltoid injection method and the intervention group (1-4 course of treatment) received abdominal injection method (1 times a day and 14 days per course of treatment). Then we observed the incidence of pain and local adverse reactions in patients with injection sites. Results In the intervention group patients was 22.6% in the incidence of moderate to severe pain, and 14.2% subcutaneous scleroma rate, 18.9% local redness and swelling occurred rate, that all were lower than those of the control group (χ2=2.80, 4.71, 5.22; P<0.05). Conclusions The implementation of abdominal subcutaneous injection can reduce the patient′s pain, promote successful completion of treatment and deserve further clinical dissemination. Key words: Recombinant human interleukin; Subcutaneous injection; Pain; Adverse reaction

Reductions in Craving and Negative Affect Predict 3-Month Post-Discharge Alcohol Use Following Residential Treatment

Craving and negative affect are two factors consistently included in prominent models of relapse. The aim of this study was to examine the relationship between craving, negative affect and multiple alcohol use outcomes in participants undergoing residential treatment for an alcohol use disorder. One hundred and seventy-one participants from eight Salvation Army residential drug and alcohol treatment programs were administered measures at treatment entry and 3-months post-discharge follow-up. Regression analyses indicated that craving and negative affect measured at baseline did not predict relapse, or the severity of alcohol problems at 3-months post-discharge. The most consistent finding was that change in craving predicted both alcohol use outcomes, while change in negative affect only predicted the severity of alcohol problems. This study provides preliminary evidence that effective management of craving for alcohol use may facilitate successful treatment completion and long term abstinence.

Therapeutic Efficacy of Nigella Sativa Linn. against Antituberculosis Drug-Induced Hepatic Injury in Wistar Rats

Antituberculosis drug (ATD)-induced hepatotoxicity is a major impediment for the effective treatment of tuberculosis (TB). All first-line anti-TB medications have adverse effects that interrupt the successful completion of TB treatment. This investigation focuses on the evaluation of the protective role of Nigella sativa (NS) against liver injury caused by ATDs. Female rats were treated with ATDs for 8 weeks (3 d/wk) followed by NS for 8 weeks (3 d/wk). The antioxidant activity of NS was estimated with a 1,1-diphenyl-2-picrylhydrazyl (DPPH) assay and by analyzing total phenolic contents. Qualitative characterization of active compounds of the plant was done by high-performance liquid chromotography (HPLC). ATD-induced adverse effects were associated with sharp elevation in levels of serum transaminases, albumin, cholesterol, urea, uric acid, creatinine, and blood urea nitrogen (BUN). ATDs significantly increased lipid peroxidation (LPO) and decreased enzyme activities (superoxide dismutase [SOD], catalase [CAT], adenosine triphosphatase [ATPase], and glucose-6-phosphatase [G6Pase]) in liver, indicating oxidative stress. Conjoint treatment with NS could reverse the serological biochemistry and inhibit oxidative stress by suppressing LPO and augmenting antioxidant enzyme activity toward that of the control. Histological studies support the above biochemical findings. Results indicate that NS exerts excellent hepatoprotective abilities and can be used as a supplement to improve patient adherence and reduce interruptions in treatment due to ATD-related liver injury.

P1-6-14 - Oral supportive care for cancer patients receiving chemotherapy

Background: Perioperative oral management received medical insurance coverage in 2012 in Japan. Management includes not only prevention of wound infection and perioperative pneumonia but also management of oral complications during chemotherapy and radiotherapy in cancer patients. Methods: Clinical records for 293 patients treated with chemotherapy from April 2013 to December 2014 were analyzed. Result: Patients were 168 males and 125 females aged 23-92 years (median 66). Primary site of cancer was esophagus in 62, lung in 50, head and neck in 36, colon in 28, pancreas in 22, breast in 11, hematological cancer in 38, and others in 46. Treatment was chemotherapy in 158, and concurrent chemoradiotherapy in 135. Before beginning chemotherapy, most patients received a dental check and acquired tooth brushing techniques. Oral supportive care was continued to maintain good oral hygiene, detect oral complications early and manage them with mouthwash and topical ointment. Oral complications of ≥G3 (NCI-CTC AE) were medication-related osteonecrosis of the jaw, teeth infections, and oral mucositis occurred during treatment. All agents could be continued as scheduled without dose reduction for oral complications, apart from interruption of denosumab due to osteonecrosis in one patient. With regard to 12 infected teeth extracted during the treatment, treatment with bevacizumab was rested to prevent bleeding during extraction in one patient, but this did not result in a delay in treatment. The oral mucositis induced by molecular targeted therapy seemed to be due to physical damage to the oral mucosa, indicating the need for shaping of sharp teeth and adjustment of dentures. Conclusions: Oral supportive care for cancer patients receiving chemotherapy begins before the start of treatment and continues until the successful completion of treatment without the withdrawal of drugs.

Communicable and non-communicable diseases: connections, synergies and benefits of integrating care.

Communicable and non-communicable diseases: connections, synergies and benefits of integrating care.

O10.2 Trichomonas vaginalisnucleic acid clearance following treatment of hiv negative women

Background Rescreening women for Trichomonas vaginalis (TV) post treatment is important as repeat infections are common, ranging from 5%–31%. Nucleic acid amplification testing (NAAT) too soon after treatment may result in false positive results due to detection of remnant TV nucleic acids. The goal of this study was to determine the rate of false positive NAAT results at weeks 1–4 post treatment completion using culture as the gold standard. Methods Women attending an STI clinic in New Orleans who were InPouch culture positive and treated with metronidazole (MTZ) were included. Participants were scheduled for 4 weekly follow up visits beginning one week post-treatment completion. They provided self-obtained vaginal swabs (SOVS) and information regarding sexual exposure at each visit. SOVS were tested using InPouch culture and the Gen-Probe AptimaTV (GPATV) assay which targets ribosomal RNA. Women who were culture positive at follow-up were considered re-infected/treatment failure and were not followed further. Results 39 women were InPouch+ at baseline and were followed. Of these, 3 (7.7%) were InPouch TV+ at follow-up (1 at 1 week and 2 at 2 weeks) and reported no sexual exposure. Thus, these women were considered to be treatment failures and were no longer followed. Of the remaining cases, 5/29 (17.2%) were GPATV+ at the 1 week follow up visit, and 1/34 (2.9%) was GPATV+ at 2 weeks. The six positive women denied vaginal sexual re-exposure. None of the women were InPouch TV culture positive at any of the follow up visits and no woman was GPATV+ at 3 and 4 weeks post treatment. Conclusions These data demonstrate that TV ribosomal RNA is cleared from the vagina by 3 weeks post completion of successful MTZ treatment and that the GPATV assay can be relied on as a test-of-cure at this point and beyond. Disclosure Drs Martin and Taylor have served as consultants for Hologic Inc.

Collaborative Research in Childhood Cancer Survivorship: The Current Landscape.

Survivors of childhood cancer carry a substantial burden of morbidity and are at increased risk for premature death. Furthermore, clear associations exist between specific therapeutic exposures and the risk for a variety of long-term complications. The entire landscape of health issues encountered for decades after successful completion of treatment is currently being explored in various collaborative research settings. These settings include large population-based or multi-institutional cohorts and single-institution studies. The ascertainment of outcomes has depended on self-reporting, linkage to registries, or clinical assessments. Survivorship research in the cooperative group setting, such as the Children's Oncology Group, has leveraged the clinical trials infrastructure to explore the molecular underpinnings of treatment-related adverse events, and to understand specific complications in the setting of randomized risk-reduction strategies. This review highlights the salient findings from these large collaborative initiatives, emphasizing the need for life-long follow-up of survivors of childhood cancer, and describing the development of several guidelines and efforts toward harmonization. Finally, the review reinforces the need to identify populations at highest risk, facilitating the development of risk prediction models that would allow for targeted interventions across the entire trajectory of survivorship.

Efficacy of early switch from intravenous to oral antimicrobials in patients with aspiration pneumonia: A prospective observational study.

Previous reports have documented the efficacy of an early switch from intravenous to oral antimicrobials in community-acquired pneumonia, but not aspiration pneumonia. Therefore, we assessed the feasibility and efficacy of these newly developed criteria for community-acquired pneumonia in patients with aspiration pneumonia. This prospective observational study included consecutive patients admitted with aspiration pneumonia over a 10-month period at St. Luke's International Hospital; we excluded patients that required intensive care. The criteria for an early switch were stability of vital signs (temperature ≤ 38 °C; respiratory rate ≤ 24 breaths/min; pulse rate ≤ 100 beats/min for >24 h) and a successful swallow evaluation (repetitive saliva swallowing test score ≥ 2; modified water swallowing test score ≥ 4). Our primary endpoint was successful completion of antimicrobial treatment 30 days after the switch, without reversion to intravenous antimicrobials. Our anticipated success rate was set as 60-75%, based on a previous study. Of the 70 patients admitted with aspiration pneumonia, 32 (45.7%) were excluded, and 38 (54.3%) met the inclusion criteria. Of these 38 patients, 29 (76.3%) met the switch criteria. The median duration of hospital stay for the included patients was 16 (5-30) days and 30 (12-68) days, respectively (P=0.03). Among patients who met the switch criteria, 26 (89.7%) completed oral treatment successfully while 3 (10.3%) reverted to intravenous antimicrobials. Approximately 75% of patients met the switch criteria; of these, nearly 90% underwent safe conversion to oral therapy. These results demonstrate the efficacy and feasibility of our switch criteria.

Missed Canals can Never be Missed-CT In Endodontics: A Series of Case Reports

AbstractAberrations in the root canal anatomy are a commonly occurring phenomenon. A thorough knowledge of the basic root canal anatomy and its variations is necessary for successful completion of the endodontic treatment. The maxillary molars has fascinated researchers and clinicians for a variety of reasons. Endodontically, these are the most misunderstood teeth, and presents a variety of considerations for the treating practitioner. This case report presents the endodontic management of a maxillary first molar with five roots and five canals and another case of maxillary third molar with four canals. The clinical detection of the five canals was made using loupes and confirmed using computed tomography (CT) scanning. This report serves to remind clinicians that such anatomical variations should be taken into account during endodontic treatment of the maxillary molars.