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PubMed2000

Enhancing therapeutic impact and therapeutic alliance through electronic mail homework assignments.

Homework assignments can enhance therapeutic impact and increase therapy effectiveness by encouraging patients to focus on therapy-related issues between sessions. Computer technology provides a new avenue for reporting, monitoring, and feedback of patient homework assignments through electronic mail (e-mail). In two case examples, e-mail was used as an extension of therapy to enhance patient involvement in treatment. In both cases, patient reports suggest that therapeutic alliance and therapeutic impact improved with the use of e-mail homework reporting. The costs and benefits of the use of e-mail as an adjunct to therapy are discussed.

Adult↗
PubMed2001

[Therapeutic aspects of HIV/AIDS infected patients and evaluation of therapeutic protocols].

The first HIV-infected patients were treated in 1986, however, at that time medicines inhibiting HIV replication were not available. Solely the complications of AIDS and opportunistic infections could be treated. The HIV replication inhibition capacity of antiretroviral nucleoside and ribavirin were tested in Hungary in 1987, an early date even in international practice. The first nucleoside reverse transcriptase inhibitor (NRTI), azidothymidine, presently called zidovudine (ZDV), was introduced in 1989. By giving patients the appropriate dosage of this, the progression of the disease could be delayed by approximately 6 months to one year. In 1991, the application of two new NRTI was commenced, namely zalcitabine (DDC) and didanosine (DDI). These medicines were applied partly in case of ZDV intolerance and as a part of the sequential monotherapy. In 1994 and 1995 two new NRTI's were introduce, namely stavudine (d4T) and lamivudine (3 TC). At that same time, to obtain a more effective replication inhibition method, a double NRTI combination became part of the therapeutic protocol. The year 1996 resulted in significant changes. At the beginning of the year, two compounds belonging to two new therapeutic procedures. These are saquinavir (SQV) and delavirdine (DLV) belonging to the groups of protease inhibitors and non-nucleoside reverse transcriptase, respectively. The so-called virus cocktails and the effective active antiretroviral therapy (HAART) were applied and, later, to monitor the efficiency of the treatment, the opportunity was provided to measure the copy number of HIV-RNS. The treatment of the HIV disease entails a number of unanswered questions. The maximum result that can be achieved by using today's therapeutic methods is to prolong that particular phase of the HIV disease, which secures the patient a fairly good quality of life. The new combination of the antiretroviral compounds produced by the pharmaceutical industry provides better changes to prolong said period by years, sometimes decades. However, the real solutions to the problem are only theoretically known treatment procedures (gene therapy, cytokins) today.

Acquired Immunodeficiency Syndrome↗
PubMedDate not supplied

[Therapeutic systems and drug delivery. 3. Transdermal therapeutic systems].

Following a short review of penetration of drugs through the skin (a bilayer membrane which consists of the stratum corneum and the viable epidermis), transdermal therapeutic systems (TTS) are described. These systems are special pharmaceutical preparations capable of delivery of some drugs (e.g. very potent drugs, with narrow therapeutic index, short biological half-life) via skin under well controlled conditions. After their application drug passes directly into the systemic circulation avoiding the effect of first-pass hepatic metabolism. At the same time, their advantages and disadvantages are presented. Finally, currently existing TTS in the market containing e.g. scopolamine (motion sickness), nitroglycerin (angina pectoris), estradiol (postmenopause), clonidine (hypertension) and systems in the development are briefly reported. These transdermal therapeutic systems are considered as a new approach to improve the usage of drugs in terms of better dosage control, increased safety and easier application.

Administration, Cutaneous↗
PubMed1993

[Influential factors on the therapeutic response in the conditioning treatment of enuresis with an original therapeutic machine].

The conditioning treatment of enuresis with our original therapeutic machine, that is to awake the patient before enuresis may occur, has been performed since 1987. Influential factors on the therapeutic response were investigated. Twenty two patients with enuresis Type I were admitted and were treated for 5 nights with the therapeutic machine. Seven patients were cured (the cured group) and a certain effectiveness (decrease of the frequency of enuresis of more than 50%) was observed in 8 patients (the effective group). No effectiveness was obtained in 7 patients (the no change group). The average age of the cured group was higher than that of the no change group, and the difference was significant. No significant differences were found among the three groups in sex, the frequency of enuresis or the past experience of awakening before enuresis. Significant differences among the three groups were found in the average awakening score (how easily the patient awoke when a nurse called the patient after the machine alarmed) and the change of awakening score during treatment. The average awakening score of the cured group was the highest and that of the no change group was the lowest. The change of awakening score during treatment of the no change group was significantly lower than that of the cured group or that of the effective group. The desire to cure, scored 0-2 points at the time of discharge, was significantly stronger in the cured group than in the no change group. No significant differences were noticed among the three groups in the sleeping condition and the remembrance of awakening at the next morning.

Adolescent↗
PubMed1997

[Therapeutic trial, clinical research and therapeutic freedom--legal boundaries].

Clinical research can be therapeutic or purely scientific. The therapeutic trial is usually chosen to obtain treatment liberty. On the other hand, the physicians in controlled clinical trials have relatively little choice of treatments. In Germany, special statutes and the general law limit clinical trials. The sec. 41 AMG, 18 MPG allow therapeutical trials under special circumstances. There are requirements for clinically controlled trials, especially the provision to seek the approval of an ethic commission.

Clinical Trials as Topic↗
PubMedDate not supplied

The "new" drug-free therapeutic community. Challenging encounter of classic and open therapeutic communities.

In view of a rapidly changing society, reflected in many changes within the drug-free Therapeutic Communities (TCs), the question has been raised: "What can and cannot be changed in this modality?" This question was addressed at a European conference of experienced therapeutic community workers, who concluded that many changes have occurred and will continue to occur, but some basic concepts should be preserved. The changes inherent in postmodern society are examined here in an effort to foresee their impact on the evolution of the TC. Necessary changes and additions are discussed.

Congresses as Topic↗
PubMed2004

Therapeutic communities: a therapeutic bridge.

The original therapeutic community movement has seen a variety of interpretations that may bear little resemblance to the original model. The democratic model concept of social learning offers one approach to further social maturation and personality change. The programmatic or concept model offers another approach based on a behavior code and behavioral concepts. Both of these communities are human groups and appear to share the hereditary behavior of such groups. A Darwinian approach is used to facilitate understanding of both communities. A generic biosocial therapeutic community is described.

Cultural Evolution↗
PubMed1990

Relationship between involuntary admission and the therapeutic process in a closed ward functioning as a therapeutic community.

In a therapeutic community for acute psychiatric patients, the relationship between involuntary admission (13.6% of the episodes) and some patient and program characteristics was analyzed, using a total of 1586 treatment episodes in 838 patients between 1978-1987. Based on a logistic regression model, an elevated relative risk of involuntary admission was seen in the diagnostic groups of schizophreniform psychosis, unspecific psychosis, paranoid psychosis, and borderline psychosis. Also, the association with involuntary admission increased in the first or second treatment episode, or for patients that had a controversial or negative immediate outcome, for young patients under 21 years, and for patients who were passive in individual therapy. Still, the difference in outcome was minimal, and there were no differences in group or milieu therapy activity. The results suggest that involuntary admission is not necessarily a traumatic, negative experience in subsequent treatment episodes or in the patient career. The modified therapeutic community model presented contains peer and family support and ample opportunity to discuss and negotiate, which may alleviate the possible narcissistic pain of involuntary admission.

Adolescent↗
PubMed1981

Therapeutic paradox - the patient culture and the formal treatment programme in a therapeutic community.

Data collected by participant observation in a day hospital are used to examine the complex relationship between informal patient interaction and the formal group therapy programme of this therapeutic community. It was evident that staff might view apparently similar informal patient activities in quite different lights, as either complementary or as detrimental to the work of the formal groups. This apparent inconsistency in staff prescriptions was turned to a therapeutic purpose. Staff would point out to patients the "paradox" of the constant inconsistency of prescriptions for behaviour in daily life: parallels were drawn with the contingent and defeasible prescriptions to which patients were subject in most spheres of human activity. In learning to cope with incipiently contradictory prescriptions inside the day hospital it was felt that patients might learn to cope with incipiently contradictory prescriptions in their relationships outside the day hospital.

Day Care, Medical↗
PubMed2001

Heat shock proteins in health and disease: therapeutic targets or therapeutic agents?

For many years, heat shock or stress proteins have been regarded as intracellular molecules that have a range of housekeeping and cytoprotective functions, only being released into the extracellular environment in pathological situations such as necrotic cell death. However, evidence is now accumulating to indicate that, under certain circumstances, these proteins can be released from cells in the absence of cellular necrosis, and that extracellular heat shock proteins have a range of immunoregulatory activities. The capacity of heat shock proteins to induce pro-inflammatory responses, together with the phylogenetic similarity between prokaryotic and eukaryotic heat shock proteins, has led to the proposition that these proteins provide a link between infection and autoimmune disease. Indeed, both elevated levels of antibodies to heat shock proteins and an enhanced immune reactivity to heat shock proteins have been noted in a variety of pathogenic disease states. However, further evaluation of heat shock protein reactivity in autoimmune disease and after transplantation has shown that, rather than promoting disease, reactivity to self-heat shock proteins can downregulate the disease process. It might be that self-reactivity to heat shock proteins is a physiological response that regulates the development and progression of pro-inflammatory immunity to these ubiquitously expressed molecules. The evolving evidence that heat shock proteins are present in the extracellular environment, that reactivity to heat shock proteins does not necessarily reflect adverse, pro-inflammatory responses and that the promotion of reactivity to self-heat shock proteins can downregulate pathogenic processes all suggest a potential role for heat shock proteins as therapeutic agents, rather than as therapeutic targets.

Journal Article↗
PubMed2002

Combination of therapeutic apheresis and therapeutic ventricular assistance for end-stage heart failure patients.

Dilated cardiomyopathy is a cardiac disease of unknown origin which is characterized by the gradual development of cardiac failure associated with four-chamber dilatation of the heart. Heart transplantation has been considered as the last resort for this disease. However, some patients who received support with a ventricular assist device (VAD) as a bridge-to-transplantation and then recovered without transplantation have been reported. This new concept of treating heart failure is termed bridge-to-recovery. A VAD can inhibit the heart failure compensatory mechanisms by extreme ventricular unloading. Also, heart failure is a complex neurohormonal/autocrine-paracrine syndrome, and these mechanisms consecutively lead to inflammatory response by proinflammatory cytokines; interleukin-1 alpha (IL-1 alpha), interleukin-1 beta (IL-1 beta), interleukin-2 (IL-2), interleukin-6 (IL-6), and tumor necrosis factor-alpha (TNF-alpha). Furthermore, the existence of anti-beta1-adrenoceptor autoantibodies (A-beta1-AABs) in a patient with dilated cardiomyopathy has been reported. These proinflammatory cytokines and this antibody accelerate a ventricular remodeling and a contractile dysfunction over the long term. Apheresis can also inhibit the vicious cycle in heart failure by removing the factors that are produced by activated neurohormonal/autocrine-paracrine compensatory mechanisms. Therefore, we propose that the combined therapies, therapeutic VAD and therapeutic apheresis, will provide a prominent outcome for a patient who is suffering from end-stage heart failure.

Blood Component Removal↗
PubMed2003

Therapeutic plasma exchange: an underutilized therapeutic modality?

Since its clinical availability approximately 25 years ago, therapeutic plasma exchange (TPE) has become recognized as appropriate primary therapy for many diverse medical conditions. In some aspects TPE has been constrained in its use according to schedules of efficacy. Expansion of TPE to other indications is likely once attention is focused on its ability to enable patients to avoid potentially toxic pharmacologic interventions if employed as a chronic therapy, and especially when it is accepted that adjunctive use, not only a curative role, is a valuable use of this therapeutic modality.

Humans↗
PubMedDate not supplied

Comparison of therapeutic gain with therapeutic ratio for the assessment of selective 5HT(1B/1D) agonist efficacy in migraine.

OBJECTIVE: Comparison of use of therapeutic gain (TG) and therapeutic ratio (TR) for relative assessments of selective 5HT(1B/1D) agonist efficacy in the acute treatment of migraine. BACKGROUND: Comparison of selective 5HT(1B/1D) agonist efficacy in the acute treatment of migraine is complicated by the impracticality of conducting high-quality head-to-head active comparator trials for all permutations of drug, dose, and route of administration; the clinical trials that are available are usually noncontemporaneous, and have fluctuating active and placebo response rates (ARR and PRR, respectively) for the necessarily subjective endpoints. The standard primary endpoint is conversion of headache score 2 (moderate pain) or score 3 (severe pain) into score 0 (no pain) or score 1 (mild pain) at a single timepoint (usually 2 or 4 hours postdose). Two principal methods have been used for comparison of ARR between studies: TG = ARR - PRR and TR = ARR/PRR. Secondary endpoints can be treated in the same way, although the 24-hour remedication rate is the only secondary endpoint that is subject to regulatory authority standardization. Does either TG or TR have an advantage over the other? METHODS: Efficacy data were collected from published sources and included pain score conversion at 2- and 4-hour, as well as 24-hour remedication rates. TG and TR were calculated for each endpoint, as shown above. The ranges of these variables were found from all observed measures. Correlations between TG and TR were found using least squares methods. The 95% confidence intervals (CI) for TG and TR were then found for all clinical trials, and for the whole range of observed PRR. RESULTS: Values for TR and TG generally were well correlated for pain score conversion at 2 hours postdose (n = 51 clinical trials). Deviations from this correlation were greatest for drugs that were evidently very efficacious. When standardized for the observed ranges of PRR and ARR, the 95% CI for TR were narrower than for TG. A subset of these studies also reported 4-hour data (n = 23 clinical trials), but the correlation between TR and TG was again good, with narrower 95% CI for TR than TG. For the 24-hour remedication data (n = 18 trials), PRR was less variable; TR and TG again correlated well, but there was little difference in their relative 95% CI. CONCLUSIONS: For comparison of drugs in noncontemporaneous studies, when PRR fluctuates, relative ranges for TR are narrower than for TG. For assessing single clinical trial results (ie, point estimates of efficacy) TR will generally be relatively nearer to its mean than TG. For both these reasons, TR is a more robust statistic than TG.

Acute Disease↗
PubMed2005

The spectrum of therapeutic influences and integrative health care: classifying health care practices by mode of therapeutic action.

The growing popularity of complementary and alternative medicine (CAM) and integrative medicine (IM) highlight the need for a clinically relevant system for classifying health care practices. All systems, modalities, and techniques of health care (conventional, complementary, alternative, and traditional) can be organized in categories of "primary mode of therapeutic action." This results in six categories: biochemical; biomechanical; mind-body; energy; psychological (symbolic); and nonlocal. In each category, there are subdivisions. Organizing health care by primary mode of therapeutic action has numerous benefits: (1) conventional and CAM practitioners, and the public, can readily see some of the general similarities and differences among practices; (2) health care educators gain a common foundation and shared language for explaining CAM and IM; (3) professionals and the public, wishing to combine dissimilar practices, gain a common framework for evaluating the meaning of integration; and (4) the crossover problem can be understood as a natural occurrence in health care, not a confusing intellectual dilemma. The National Center for Complementary and Alternative Medicine (NCCAM) system of categories for CAM is briefly critiqued.

Complementary Therapies↗
PubMed2005

TDM: therapeutic drug measuring or therapeutic drug monitoring?

The third round of the International Interlaboratory Quality Control Program for Therapeutic Drug Monitoring in HIV infection (QC-program) consisted of the analysis not only of plasma samples but also of patient cases. The case was composed of different topics related to the therapeutic drug monitoring of antiretroviral drugs. The participants were asked to give recommendations concerning dose adjustments, changes to the regimen, and drug-drug interactions to observe whether the expert recommendations were comparable. Of the 30 participants of the QC-program, 16 returned their comments and recommendations with regard to the patient case. The drug level was easy to judge: approximately 90% were able to correctly do so. Almost half of the recommendations (44%) given were satisfactory. Levels of knowledge regarding HIV treatment appeared to be variable among the respondents and for this reason were partly incomparable.

Anti-Retroviral Agents↗
PubMed2003

Therapeutic communities and prison management: an examination of the effects of operating an in-prison therapeutic community on levels of institutional disorder.

There is a growing emphasis in corrections on the treatment of inmates with drug problems. The typical method of evaluating drug treatment programs is to examine how the treatment affects the inmate in terms of relapse and recidivism. This study examines the institutional consequences of operating a therapeutic community located in a medium/high-security male institution. The effect on management is examined from a perspective of institutional disorder. Disorders, from less severe inmate rule violations to more serious assaults, and rates of grievance filing are examined within the treatment unit and compared with rates in the general population. The inmate's perception of the environment, whether in treatment or non-treatment, is also examined. Findings indicate that in-prison therapeutic communities have lower levels of disorder than nontreatment housing units and tend to produce more positive perceptions of the living environment among the inmates living there. The impact of these findings for prison management is discussed.

Attitude↗
PubMed1988

Therapeutic factors within in-patient and out-patient psychotherapy groups. Implications for therapeutic techniques.

Therapeutic factors operative in in-patient and out-patient therapy groups were compared. These settings differ greatly, both in terms of the patient population they serve and the overall systems within which they operate. The study revealed significant differences between the therapeutic factors operative in these two settings, and suggested that clinicians should modify their techniques for running psychotherapy groups across settings, to take account of these findings.

Altruism↗