Weeks Of Treatment In Group Research Articles

Comparative efficacy of 1% terbinafine hydrochloride cream and 1% ciclopirox olamine cream alone and in combination for the treatment of dermatophytosis

Background: Various antifungal agents, both in oral and topical forms, have been developed for the treatment of dermatophytosis. Aims and Objectives: The aims of this study were to evaluate the efficacy of 1% terbinafine hydrochloride cream and 1% ciclopirox olamine cream alone and in combination in the treatment of dermatophytosis. Materials and Methods: A randomized and comparative study was done at the Department of Dermatology, Government Medical College and Hospital, Chandigarh. Sixty patients of clinically diagnosed tinea corporis/tinea cruris/tinea faciei, attending the outpatient department will be allocated to three therapeutic groups of 20 patients each using random tables. Group 1: Topical 1% terbinafine hydrochloride cream twice daily for 6 weeks. Group 2: Topical 1% ciclopirox olamine cream twice daily for 6 weeks. Group 3: Topical 1% terbinafine hydrochloride cream once daily in the morning and 1% ciclopirox olamine cream once daily in the evening for 6 weeks. Inclusion criteria: (i) Body Surface Area – <10%, not requiring systemic therapy. Exclusion criteria: (i) Patients with coexisting dermatophytosis, any antifungal drugs, or pregnant, and lactating women. All the patients were assessed for therapeutic results by clinical evaluation at 3 and 6 weeks of initiation of therapy. Approved by Ethics Committee. Data collected on a pre-tested structured questionnaire and analyzed by Statistical Package for the Social Sciences. Results: After 6 weeks of treatment in Group 2, there was no erythema in 1 (6.7%) patient, moderate in 2 (13.3%) patients, mild in 12 (80%) patients, and no severity in any patient. After 6 weeks of treatment in Group 1, erythema was mild in 17 (45%) patients. After 6 weeks of treatment in Group 3, erythema was moderate in 1 (5.3%) patients, mild in 15 (78.9%) patients, and three patients had no erythema. None of the patient had severe erythema. P = 0.209 and Chi-square was 5.875. Conclusion: The combination therapy with both terbinafine hydrochloride and ciclopirox olamine group showed better response with lesser relapse rate with no significant side effects.

Evaluation of blood glucose controlling efficacy of various oral hypoglycemic drugs in Type 2 diabetes mellitus patients: A prospective, randomized, and control study

Background: This study was conducted to evaluate the effect of various oral hypoglycemic agents in the control of plasma blood glucose levels among Type 2 diabetes mellitus (T2DM) patients. Aims and Objectives: This study is aimed to evaluate the blood glucose controlling efficacy of various oral hypoglycemic drugs in T2DM patients. Materials and Methods: This randomized and control study was conducted among the cases attending Department of General Medicine at Research cell of Chennai Medical College Hospital and Research Centre, during the period of June 2014 to July 2015. A total of 180 cases were randomly allotted to six groups. Group I was treated with Glibenclamide, Group-II was treated with Glibenclamide + Sitagliptin, Group-III was treated with Glibenclamide + Vildagliptin, Group-IV was treated with Metformin, Group-V was treated with Metformin + Sitagliptin, and Group-VI was treated with Metformin + Vildagliptin. Fasting, postprandial, and glycated hemoglobin (HbA1c) levels were assessed before and at 4, 8, and 12th weeks and the data were analyzed using Statistical Package for the Social Sciences. Results: Fasting and postprandial sugars were significantly reduced in Group V and Group VI during 4th, 8th, and 12th weeks. However, HbA1c levels were significantly reduced after 12 weeks of treatment in Group III, Group V, and Group VI. Conclusion: We conclude that metformin in combination with either Vildagliptin or Sitagliptin can help to reduce fasting, postprandial, and HbA1c levels (both in short-term and in long-term); however, Glibenclamide along with Vildagliptin could reduce only HbA1c levels (long-term alone).

The place of diltiazem in the treatment of patients with stable angina in concomitant bronchial asthma

Introduction. In the treatment of stable angina in patients with concomitant bronchial asthma (BA), the bronchopulmonary system may be adversely affected by a number of drugs. Diltiazem may be the drug of choice when antianginal therapy with a pulseslowing effect is required, but β-blockers are contraindicated.Aim of the study. To compare the antianginal, pulse-slowing and vasoprotective effects of the calcium antagonist (CA) diltiazem, the calcium antagonist verapamil and the cardioselective beta-adrenoblocker (BAB) bisoprolol in the treatment of stable angina (SA) patients with concomitant BA.Materials and methods. The study included 60 patients with stable angina II-III FC with concomitant mild or moderate persistent BA. The patients were divided into three groups of 20 patients depending on antianginal drugs: Group 1 received betaadrenoblocker bisoprolol, Group 2 – calcium antagonist verapamil, Group 3 – calcium antagonist diltiazem. All patients underwent cardiography (Doppler EchoCG), external respiration function (ERF), endothelium-dependent vasodilation (EDVD) study at baseline and after 2, 4, 6 weeks of treatment.Results. No negative dynamics of FEV1 was found in patients of all groups during the study of ERF after 6 weeks of treatment. There was a statistically significant increase in FEV1 after 6 weeks of treatment in group 3 patients receiving diltiazem (p = 0.032). There was a statistically significant decrease in HR in all three groups during treatment, but in group 2 the dynamics were significantly lower when treated with verapamil. Analysis of mPAP of patients showed that it decreased in all groups after 6 weeks of treatment, but significant dynamics was noted only in Group 3. EDVD test after 6 weeks of treatment revealed positive dynamics, with a statistically significant increase in the index registered in patients of groups 1 and 3.Conclusions. In treatment of patients with stable angina with mild and intermediate persistent disease without exacerbation, antianginal therapy with the calcium antagonist diltiazem has marked antianginal, pulse-slowing action, has vasoprotective effect on the small and large circulatory vessels, improves the parameters of bronchial permeability.

Effect of intradermal needling combined with oral motor therapy for salivation in children with cerebral palsy: a randomized controlled trial

To compare the effect of combination of intradermal needling with oral motor therapy and simple oral motor therapy on salivation in children with cerebral palsy. A total of 60 children with salivation in cerebral palsy were randomized into an observation group and a control group, 30 cases in each group. The observation group was treated with intradermal needling (kept for 24 hours each time at Jiache [ST 6], Dicang [ST 4], tongue three needles, etc. ) and oral motor therapy, while the control group was only given oral motor therapy. The intradermal needling was performed 3 times a week, and oral motor therapy was performed 5 times a week, 4 weeks as a course, totally 3 courses of treatment were required. The classification of teacher drooling scale (TDS), drooling severity and Kubota water swallow test, dysphagia disorders survey (DDS) score were compared before treatment and after 4, 8 and 12 weeks of treatment in both groups, and the clinical efficacy was evaluated. After 8 weeks of treatment in the observation group and after 12 weeks of treatment in the two groups, the classification of TDS and drooling severity were improved (P<0.05), and the observation group was better than the control group after 12 weeks of treatment (P<0.05). After 8 and 12 weeks of treatment, the DDS scores of oral period in the observation group were lower than those before treatment (P<0.05). The total effective rate in the observation group was 83.3% (25/30), which was higher than 53.3% (16/30) in the control group (P<0.05). The combination of intradermal needling with oral motor therapy can improve salivation symptoms and swallowing function in children with cerebral palsy, the effect is better than oral motor therapy alone, and the effect is earlier.

Efficacy of Magnesium Sulfate in Addition to Melatonin Therapy in Neonates With Hypoxic-Ischemic Encephalopathy.

Background: One of the most important causes of neonatal deaths in developing nations is birth asphyxia. Though the probability of a complete recovery is very low, hypoxic-ischemic encephalopathy (HIE) associated with asphyxia can be managed with multiple treatment options. The study evaluated the efficacy of the addition of magnesium sulfate (MgSO4) to melatonin therapy in neonates with HIE.Methodology: A prospective, observational study was conducted in the department of neonatal intensive care, Pakistan Institute of Medical Sciences Hospital, Islamabad, Pakistan from October 2020 to March 2021. All neonates with an Appearance, Pulse, Grimace, Activity, and Respiration (APGAR) score of less than five at five minutes, umbilical blood pH of less than 7.0, and moderate neonatal encephalopathy as detected on the modified Sarnat score which is a clinical tool used for the assessment of the severity of HIE were included in the study. Neonates with congenital abnormalities, intrauterine growth retardation, neonatal sepsis, and infants born to mothers with diabetes mellitus type 2 were excluded from the study. The infants were randomly assigned to either of the groups, i.e., i) group 1 included neonates who were administered at least three doses of magnesium sulfate (MgSO4) infusion in addition to melatonin, or ii) group 2 included neonates who were administered melatonin only. Blood samples of all neonates were evaluated and compared between the two groups.Results: A total of 90 neonates with HIE were included in the study. There was a predominance of female neonates. The mean ages of babies in group 1 and group 2 were 37.2 ± 0.43 and 37.3 ± 0.59 weeks, respectively. The mean weight on the term was 2.88 ± 0.11 and 2.89 ± 0.10, respectively. The Apgar score at 5 mins in group 1 was 1.73 ± 0.81 while in group 2, 1.82 ± 0.94. It was found that there was a more significant improvement in pH after 3 days and after one week of treatment in group 1 as compared to group 2. The mean pH in babies after three days of intervention was 7.23 ± 0.03 in group 1 which was significantly better than group 2 (p<0.0001). After seven days, the mean normalized to 7.39 ± 0.04 in group 1 (p < 0.0001). It was found that in patients in group 1, the mortality was lower than in group 2 (p < 0.0001).Conclusion: HIE patients who were administered melatonin in combination with magnesium sulfate yielded better patient outcomes. Thus, it was concluded that the use of magnesium sulfate as dual therapy with melatonin improved patient outcomes for HIE. However, it is recommended that similar studies are conducted with a wider range of parameters, such as duration of hospital stay and assessment of the neurological outcomes of the patients.

A PROSPECTIVE SINGLE-BLINDED STUDY ON THE SAFETY AND EFFICACY OF ZINC SUPPLEMENTATION IN PULMONARY TUBERCULOSIS

Aim and Objectives: The aim of the study was to study the serum zinc (Zn) levels, safety, and efficacy of Zn supplementation in pulmonary tuberculosis (PTB) patients.Methods: A randomized single-blinded study of two groups: Group A received conventional TB therapy while Group B received conventional TB therapy along with 15 mg of Zn tablet. 40 patients were assigned in each group by randomized permuted blocks.Results: After 8 weeks of treatment in Group A 27 patients and Group B 36 patients were found to be sputum negative with p=0.0421 and 0.0629. After 24 weeks of treatment in Group A 37 patients and Group B 40 patients were found to be sputum negative with p=0.00976 and 0.00971. By this, the given treatment was effective in the patients with PTB.Conclusion: Zn supplementation improves the effect of TB medication treatment and results in earlier sputum smear conversion.

Propranolol Versus corticosteroids for Infantile Hemangiomas: A Randomized Control Trial in a Tertiary care Hospital

Infantile hemangiomas are the most common vascular tumor of infancy and childhood. Sometimes these lesions interfere with normal function &amp; produce serious disfigurement that is unlikely to resolve on its own and then treatment is required. While evidence most supports the use of corticosteroids, there is no well- studied or Federal Drug Administration (FDA) approved systemic therapy for haemangiomas of Infancy. Dramatic improvement of complicated haemangioma by propranolol has recently been reported, but to date, details for initiating therapy, monitoring and potential risks in relation to Corticosteroids were not compared in a large scale. This research was designed to observe the effectiveness of oral propranolol compared to oral corticosteroid aimed at treatment of clinically important groups of infantile hemangiomas that require aggressive treatment. We conducted a randomized control study among the diagnosed case of infantile hemangiomas, age of &lt;10 years. The total sample size was 60 (30 for propranolol group i.e. in group A, and 30 for corticosteroid group i.e. in group B) &amp; grouping was done with the simple random technique. A clinical &amp; photograph based VAS (Visual Analogue Scale) scale with a defined monitoring schedule was used for evaluation of treatment response. Our study result showed, (3.33%) patients of group A, response to color change (red-purple-grey) within 1st month of treatment whereas none of the patient (0.00%) of group B had any response to color by this time. Patients response to propranolol therapy was also continued even up to 5th month (3.33%) but it was absent (0.00%) in corticosteroid therapy even after 4th month &amp; p= 0.025, that was statistically significant. Regarding the mean size (diameter) of the tumor, most of the tumor size reduced and near to stabilize at 4th month in group A, but in group B, the rate was slower and needed longer time (5-6 month), the p value was 0.030. Again 60% of tumor became non-palpable at 3rd week of treatment in group A patients, but in group B, 70% of tumor was still remain palpable on that time &amp; p=0.001, that was statistically significant. Again, in Propranolol therapy group, the rate of complications was (24%) whereas in Corticosteroid therapy group, it was (76%).The p value was 0.020 that was also statistically significant. Hence, the present study results denote that, oral propranolol can be considered as an emerging and effective treatment over oral corticosteroid therapy for infantile hemangiomas.

SITAGLIPTIN;

The objective of this stidy is to compare the mean reduction of HbA1c in patientstaking sitagliptin insulin combination with insulin alone in patients of type II Diabetes mellitus.Study Design: Randomized control trial (RCT). Setting: Medicine Department, Allied Hospital,Faisalabad. Period: August 2013 to February 2014. Methodology: Patients of both genderswith ages between 18 and 60 years having uncontrolled type 2 diabetes mellitus with HbA1ctaking insulin were included in the study while Pregnant or lactating mothers, patients withchronic liver disease and patients with renal insufficiency (creatinine &gt;3.0mg/dl) were excludedfrom study. Patients were randomly divided into two groups (A &amp;B) using computer generatedrandom number table. Group A was given Sitagliptin 50mg per day and dose was increasedto 100mg per day after 2 weeks if fasting blood sugar was more than 110mg/dl or 2 hourspostprandial blood sugar more than 140mg/dl. Dose of insulin in group A remained same asbefore start of study. Group B was kept on same regimen of insulin they were already taking anddose remained same. HbA1c was done at start of study and after 24 weeks. Primary outcomemeasure was mean reduction in HbA1c levels at 24 weeks from baseline. Results: 60 patientswere included in the study. Mean age was 52.7+8.43 years. 36(60%) were male and 24(40%)were female. Mean HbA1c at baseline was 8.361+0.523% in Group A on Sitagliptin-insulincombination and 8.187+0.432% in group B on insulin alone. Mean HbA1c at 24 weeks was7.767+0.428% in group A on Sitagliptin-insulin combination and 7.69+0.407% in group B oninsulin alone.Independent sample t-test was applied to change in HbA1c in Group A and Bduring 24 weeks of treatment. Mean change in HbA1c after 24 weeks in Group A was 0.600+ 0.315 and 0.49+ 0.19 in Group B after 24 weeks treatment (p-value 0.002) which is highlysignificant. Paired sample t-test was applied to HbA1c at baseline and 24 weeks of treatmentin group A and group B. There was a significant change in both groups after 24 weeks oftreatment in both groups (p-value &lt;0 .000) which is highly significant. Chi Square test wasapplied on efficacy in group A and B. 22(73.33%) patients in group A and 14(46.67%) patientsin group B which achieved significant reduction in HbA1c. 8(26.67%) patients in group A and16(53.33%) patients in group B failed to achieve significant reduction in HbA1c. (P-value &lt;0.032). Conclusion: It has been concluded from this study that insulin and sitagliptin-insulincombination both significantly reduce HbA1c in type 2 diabetes mellitus. However addition ofsitagliptin to uncontrolled diabetic patients already taking insulin, is more effective than insulinfor glycemic control of patients with type 2 diabetes mellitus.

Influence of interferon-α therapy on height and weight of chronic hepatitis B children

Objective Retrospectively study of the effects of interferon-α therapy on height and weight of children with chronic hepatitis B (CHB). Methods Total of 116 hospitalized cases of CHB children in Adolescent Liver Centre, 302 Military Hospital of China from January 2010 to December 2011 were respectively studied. Heights and weights of all the subjects at baseline, 24 weeks, 48 weeks, 72 weeks and 96 weeks of treatment, and 24 weeks, 48 weeks and 96 weeks of follow-up were measured. The weight Z score (WAZ), height Z score (HAZ) and body mass index (BMI) Z score of subjects with hepatic fibrosis (S) <3 and S≥3 were compared. The differences of HAZ and WAZ between baseline and treatment or follow-up in groups of subjects aged 1—6 years and 6—16 years were also compared. T test or rank sum test was used for comparison between groups. Results Among the study of all 116 patients studied, median baseline values of HAZ, WAZ and BMI Z score were 0.76, 0.38 and -0.04, respectively. For patients with hepatic fibrosis S 0.05). At 48 weeks of treatment, the median HAZ was 0.50, and the median WAZ was 0.20; after a follow-up period of 24 weeks, the median HAZ was -0.32, and the median WAZ was -0.18; after a follow-up period of 48 weeks, the median HAZ was 0.09 and the median WAZ was 0.06. All the above median values of HAZ and WAZ were significantly different from those at baseline (all P<0.05). The difference of HAZ at baseline and 96 weeks of treatment in group aged 6-16 years was significantly different from that in group aged 1-6 years (-0.74±0.69 vs -0.53±0.35, t=1.85, P<0.05). Also, the difference of WAZ at baseline and 96 weeks of treatment in group aged 6-16 years was significantly different from that in group aged 1-6 years (-0.69±0.41 vs -0.17±0.75, t=3.74, P<0.05). The difference of HAZ at baseline and 96 weeks after treatment in group aged 6-16 years was significantly different from that in groups aged 1-6 years (-1.12±0.81 vs -0.05±0.69, t=2.06, P=0.022). Conclusions Interferon-α treatment for children with chronic hepatitis B does have influence on their height and weight, which restores to some degree after the treatment finished. Physicians should pay more attention to the influence of interferon-α treatment on height and weight in children aged 6-16 years. Key words: Child; Hepatitis B, chronic; Interferon-alpha; Body height; Body weight

Mindfulness-Oriented Recovery Enhancement versus CBT for co-occurring substance dependence, traumatic stress, and psychiatric disorders: Proximal outcomes from a pragmatic randomized trial

In many clinical settings, there is a high comorbidity between substance use disorders, psychiatric disorders, and traumatic stress. Novel therapies are needed to address these co-occurring issues efficiently. The aim of the present study was to conduct a pragmatic randomized controlled trial comparing Mindfulness-Oriented Recovery Enhancement (MORE) to group Cognitive-Behavioral Therapy (CBT) and treatment-as-usual (TAU) for previously homeless men residing in a therapeutic community. Men with co-occurring substance use and psychiatric disorders, as well as extensive trauma histories, were randomly assigned to 10 weeks of group treatment with MORE (n = 64), CBT (n = 64), or TAU (n = 52). Study findings indicated that from pre-to post-treatment MORE was associated with modest yet significantly greater improvements in substance craving, post-traumatic stress, and negative affect than CBT, and greater improvements in post-traumatic stress and positive affect than TAU. A significant indirect effect of MORE on decreasing craving and post-traumatic stress by increasing dispositional mindfulness was observed, suggesting that MORE may target these issues via enhancing mindful awareness in everyday life. This pragmatic trial represents the first head-to-head comparison of MORE against an empirically-supported treatment for co-occurring disorders. Results suggest that MORE, as an integrative therapy designed to bolster self-regulatory capacity, may hold promise as a treatment for intersecting clinical conditions.

Development and evaluation of a behavioral pain management treatment program in a Veterans Affairs Medical Center.

Chronic pain complaints are highly prevalent among Veterans seeking Veterans Affairs health care, and the implementation of effective behavioral health interventions is vital to meet patient needs. Research supports the use of cognitive behavioral therapy for the treatment of chronic pain; however, varying guidelines regarding length of treatment and modality (i.e., group vs. individual) complicate clinical planning and program development. This study aimed to evaluate treatment outcomes and equivalence of 3 variations (12, 10, and 6 weeks of group treatment) of cognitive behavioral therapy for chronic pain using clinical program data collected from Veterans enrolled in Veterans Affairs health services in a large tertiary care setting. Across groups, Veterans showed improvements in negative pain-related thinking and decreases in pain-related disability and distress. In general, patient outcomes regarding pain-related distress and disability for the 6-week group were equivalent or better than the 12- and 10-week groups. Preliminary results support the effectiveness of brief behavioral interventions for chronic pain. The findings have important practical implications, as briefer treatments may offer comparable therapeutic impact as longer, more time-intensive treatment protocols. This study offers a unique examination of treatment development and evaluation processes informed by real-world clinical needs and patient feedback.

The Impact of Inosine Triphosphatase Variants on Hemoglobin Level and Sustained Virologic Response of Chronic Hepatitis C in Korean

Two variants of the inosine triphosphatase (ITPA: rs1127354, rs7270101) gene cause ITPA deficiency and protect against the hemolytic toxicity of ribavirin. We investigated the clinical significance of ITPA variants in Korean patients treated with pegylated interferon (PEG-IFN) plus ribavirin. Of the 133 patients, 108 were CC and 25 were non-CC at rs1127354 (groups A and B, respectively). On the other hand, at rs7270101 all 133 were AA. The mean values of Hemoglobin (Hgb) after 4, 8, and 12 weeks of treatment in groups A and B were 12.2 and 14.0, 11.8 and 13.2, and 11.5 and 12.9, respectively (P=0.001, 0.036, 0.036). Sustained virologic response (SVR) was achieved in 67.8% (40/59) of genotype 1 patients and in 75% (27/36) of non-genotype 1 patients. Regarding ITPA variants, SVR was achieved by 66% and 80% of genotype 1 (P=0.282), and by 78% and 71% (P=0.726) of non-genotype 1. SVR was not significantly different in groups A and B. In conclusion, non-CC at rs1127354 without involvement of rs7270101 is strongly associated with protection from ribavirin-induced anemia, however, ITPA genotype is not associated with SVR.

Efficacy of Mouth Rinses and Toothpaste on Tooth Whitening

People increasingly desire tooth whitening. Considering the wide range of whitening products on the market, this study evaluated the efficacy of whitening toothpastes and mouth rinses compared with the 10% carbamide peroxide (CP) whitening gel. We obtained 120 cylindrical specimens from bovine teeth, which were darkened for 24 hours in a coffee solution. The color measurement was performed by a spectrophotometer using the CIE L*a*b* system, and specimens were divided into six groups according to the use of the following agents: group 1, conventional fluoridated toothpaste; group 2, Close Up White Now; group 3, Listerine Whitening; group 4, Colgate Plax Whitening; group 5, experimental mouth rinse with Plasdone; and group 6, 10% CP Whiteness Perfect. After the simulation of 12 weeks of treatment for groups 1 to 5 and 14 days of treatment for group 6, the specimens were subjected to a new color reading. Data were subjected to one-way analysis of variance (α=0.05), which showed significant differences among groups after 12 weeks for ΔE (p=0.001). Results of the Tukey test revealed that groups 3, 4, and 6 presented significantly higher color alteration than groups 1, 2, and 5. The whitening toothpaste Close Up White Now and the experimental mouth rinse with Plasdone showed similar color alteration as conventional toothpaste after a 12-week treatment simulation. These groups presented significantly lower color alteration compared with whitening mouth rinses Listerine and Colgate Plax Whitening, which showed similar results to those observed after 14 days of bleaching with 10% CP treatment.

Additional clinical benefit of enoxaparin in COPD patients receiving salmeterol and fluticasone propionate in combination

It is now well recognised that heparin possesses numerous anti-inflammatory properties in addition to its anticoagulant properties. Thus, the aim of this study was to investigate the effects of the low molecular weight heparin, enoxaparin (ENX), as an add-on therapy for a period of 12 weeks, to inhaled salmeterol/fluticasone propionate (SLM/FP) combination in patients with stable chronic obstructive pulmonary disease (COPD). Forty-six patients were randomised to receive 12 weeks of treatment in one of two treatment groups: (1) fixed combination of SLM 50 μg and FP 500 μg Diskus, one inhalation twice daily; or (2) as group 1 plus 20 mg ENX administered subcutaneously once daily for 12 weeks. Patients attended the clinic before and after 4, 8 and 12 weeks of treatment for evaluations of lung function, blood gas tensions, dyspnoea and supplemental salbutamol use. Thirty-six patients completed the 12-week treatment period, 20 from group 1 and 16 from group 2. A significant increase in forced expiratory volume in 1 s (FEV 1) over baseline was observed after 12 weeks of treatment in group 1 (0.145 L, 95% CI: 0.994–1.406, p < 0.01 ), whilst significant increases in FEV 1 over baseline were observed in group 2 after 4, 8 and 12 weeks of treatment with a maximum increase at 12 weeks of 0.244 L (95% CI: 1.175–1.596, p < 0.01 ). Both treatment groups experienced similar improvements in blood gas tensions, dyspnoea and supplemental salbutamol use. Our results suggest that addition of ENX to conventional therapy of COPD may provide additional clinical benefit and must be further investigated as a treatment for COPD.

Coping skills and treatment outcomes in cognitive-behavioral and interactional group therapy for alcoholism.

In the present study 128 alcohol dependent men and women received 26 weeks of group treatment in one of two modalities: Cognitive-behavioral treatment (CBT) intended specifically to develop coping skills or interactional therapy intended to examine interpersonal relationships. Coping skills and drinking were assessed prior to and after treatment and up to 18 months after intake. Results indicated that both treatments yielded very good drinking outcomes throughout the follow-up period. Increased coping skills was a significant predictor of outcome. However, neither treatment effected greater increases in coping than the other. Specific coping-skills training was not essential for increasing the use of coping skills. The results raise questions about the efficacy of specific treatment elements of CBT in treatment of alcohol dependence.

EFFICACY OF DESMOPRESSIN COMBINED WITH ALARM THERAPY FOR MONOSYMPTOMATIC NOCTURNAL ENURESIS

We evaluated the combination of alarm and desmopressin versus alarm monotherapy for the treatment of nocturnal enuresis. A double-blind, placebo controlled study of alarm therapy combined with desmopressin for children with nocturnal enuresis is described. Of 93 patients 47 were randomized to receive alarm therapy and 40 microg. intranasal desmopressin for 3 weeks followed by 20 microg. desmopressin for 3 weeks (group 1) and 46 received alarm therapy and placebo (group 2). After 6 weeks on alarm therapy and medication or placebo, both groups received an additional 3 weeks of alarm monotherapy. A specialized nurse practitioner advised patients and families of the treatment to be given at home and in the outpatient department. Bed-wetting frequency was evaluated before during and 2 weeks and 6 months after treatment. A significantly greater reduction in the number of wet nights was observed after the first 3 weeks of treatment in group 1. However, after long-term followup no significant differences in bed-wetting frequency were noted. There is a temporary, positive effect on enuresis using desmopressin combined with alarm therapy. However, both treatment modalities have a low long-term success rate of 36% to 37%.

Relationship between language impairment and pragmatic behavior in aphasic adults

We explored the relationship between language impairment and pragmatic performance in aphasic adults during the first 48 weeks postonset. Twenty patients, ten fluent and ten nonfluent, who had suffered a single left hemisphere stroke participated in the study. Half of the patients received 44 weeks of individual treatment and half received 44 weeks of group treatment. Language impairment—auditory comprehension, reading, oral-expressive language, and writing—was determined with the Porch Index of Communicative Ability at four weeks postonset, pretreatment, and at 15, 26, 37, and 48 weeks postonset. Pragmatic performance—verbal aspects, paralinguistic aspects, and nonverbal aspects—was assessed during conversation with a pragmatic protocol at the same points in time. The patients made significant improvement in both language impairment and pragmatic performance between 4 and 48 weeks postonset, and there were no significant differences in improvement between the fluent and nonfluent groups or between patients receiving individual or group treatment. In our fluent aphasic patients, language impairment and pragmatic performance were significantly related at four weeks postonset but not thereafter. Conversely, in our nonfluent aphasic patients, language impairment and pragmatic performance were not significantly related at four weeks postonset, but they were significantly related at 15, 26, 37, and 48 weeks postonset. The significance of the relationship between language impairment and pragmatic performance was sporadic over time in the individual and group treatment groups.

Do higher doses of carbimazole improve remission in Graves' disease?

The aim of this study was to determine whether a course of carbimazole therapy in higher than normal doses could improve remission rates in Graves' disease, 77 patients were randomly allocated to one of two treatment groups. Group 1 (n = 33) received a 12-month course of 60 mg/day carbimazole. Group 2 (n = 44) received 45 mg/day for the first month, 30 mg/day for the second month, and 20 mg/day for the remaining 10 months. All patients were started on T3 between 2 and 4 months after commencing therapy, to maintain euthyroidism. After carbimazole/T3 therapy was withdrawn, patients were followed for either 12 months or until they relapsed. A total of 14 patients (five Group 1, nine Group 2) were withdrawn from the study. There was no significant difference in mean thyroid hormone levels between the two treatment groups during treatment. TT4 concentrations fell significantly faster during the first 4 weeks of treatment in Group 1 patients. Of the 63 patients who completed the study, 30 relapsed and 33 remained in remission. Of those who relapsed, 10 (33%) were from Group 1 and 20 (67%) from Group 2. Of those in remission, 18 (54%) were from Group 1 and 15 (45%) from Group 2. High doses of carbimazole were associated with few adverse side-effects and an improved remission rate.

Group Counseling for Codependence

Currently there exists a proliferation of self-help literature on codependence and a lack of scientific inquiry on this topic. This paper examines the use of group counseling with self-identified codependent individuals. Following 16 weeks of group treatment, participants changed significantly on a measure of codependence, the Spann-Fischer Codependence Scale (Fischer, Spann, & Crawford, 1991), and on four personality scales from the Millon Cliical Multiaxial Inventory-I1 (Millon. 1987). These preliminary results indicate that group counseling appears to reduce dependence. Also the Spann-Fischer Codependence Scale appears to assess codependence adequately and could be used with caution in pychotherapeutic practice.

A study of group communication intervention with chronically aphasic persons

Abstract Aten et al (1982) demonstrated that a group of mild moderate chronically aphasic individuals made statistically significant improvement on the CADL subsequent to group treatment emphasizing functional communication skills. However, no improvement was apparent on the PICA. The present study investigated the effects of a relatively more structured group treatment programme on the communication ability of chronically aphasic patients. Ten aphasics, a minimum of 18 months post-onset, participated in a 60-week programme that included two series of 20 weeks of group treatment and 10 weeks of treatment withdrawal. The chronic aphasic subjects in this study did make gains in overall communication ability after 20 weeks of structured group treatment, and initial gains were retained throughout treatment withdrawals. Reinitiation of structured treatment after a no-treatment interval resulted in a significant gain in communication ability as measured by the PICA. Significant CADL gains were limited to the fi...