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PubMed1997

Contrast sensitivity loss is coupled with capillary dropout in patients with diabetes.

PURPOSE: To assess the relationship of foveal microcirculation to contrast sensitivity function in early diabetes mellitus. METHODS: Twenty patients with diabetes with visual acuity of 20/25 or better without clinically significant macular edema were evaluated. Measurements of contrast sensitivity at four spatial frequencies (3, 6, 12, and 18 cycles/degree [c/deg]), macular capillary blood velocity (CBV), capillary density (PIA: perifoveal intercapillary area), foveal avascular zone (FAZ), and microaneurysm count were performed. Contrast sensitivity data collected from age-matched normal subjects and previously published normal angiographic data were used for comparison with our cohort with diabetes. RESULTS: The CBV was significantly reduced (P < 0.0001) and PIA and FAZ were significantly enlarged (P < 0.0001) when compared with healthy subjects. Contrast sensitivity was significantly lower in the group with diabetes at 6 (P = 0.01) and 12 (P = 0.002) c/deg as compared with healthy control values. FAZ and PIA correlated significantly (FAZ; r = -0.60, P = 0.005; PIA; r = -0.54, P = 0.02) with contrast sensitivity at 12 c/deg. CONCLUSIONS: The alterations of the perifoveal network are related to selective disturbances of central visual function as measured by contrast sensitivity. In patients with diabetes measurement of contrast sensitivity may provide a clinical adjunct in further identifying early ischemic diabetic maculopathy.

Adult↗
PubMed2000

[Termination of inpatient treatment for anorexia nervosa].

BACKGROUND: Dropout is a neglected area of research; patients with anorexia nervosa are a group with high risk for dropout. RESEARCH QUESTIONS: 1. What are the frequency and type of dropout in disorder-specific, integrated treatment programs for anorexic patients? 2. What are the predictors for dropout? METHOD: Analysis of 80 prospectively documented, consecutive treatment episodes of anorexic inpatients, based on multimodal clinical and psychometric parameters. RESULTS: Twenty percent of patients terminated on their own initiative, often after reaching target weight; 10% were discharged by the treatment team. At least 43% of dropouts continued with some sort of psychotherapy within the 3 months after discharge. Previous dropout was a predictor for dropout in the present episodes. Patients with no comorbidity had a higher risk of dropout. Patients discharged by the team had personality disorders more often. Patients with comorbid depression stayed in treatment. CONCLUSIONS: The form of termination of treatment should be routinely assessed. Previous dropout and comorbidity are indicators of the risk of dropout.

Adolescent↗
PubMed2000

Antidepressants for depression in people with physical illness.

OBJECTIVES: To determine whether antidepressants are clinically effective and acceptable for the treatment of depression in people who also have a physical illness. SEARCH STRATEGY: Medline, Cochrane Library Trials Register and Cochrane Depression and Neurosis Group Trials Register were all systematically searched, supplemented by hand searches of two journals and reference searching. SELECTION CRITERIA: All relevant randomised trials comparing any antidepressant drug (as defined in the British National Formulary) with placebo or no treatment, in patients of either sex over 16, who have been diagnosed as depressed by any criterion, and have a specified physical disorder (for example cancer, myocardial infarction). "Functional" disorders where there is no generally agreed physical pathology (e.g. irritable bowel syndrome) were excluded. The main outcome measures are numbers of individuals who recover/improve at the end of the trial and, as a proxy for treatment acceptability, numbers who complete treatment. DATA COLLECTION AND ANALYSIS: Data was extracted independently by the reviewers onto data collection forms and differences settled by discussion. MAIN RESULTS: 18 studies were included, covering 838 patients with a range of physical diseases (cancer 2, diabetes 1, head injury 1, heart 1, HIV 5, lung 1, multiple sclerosis 1, renal 1, stroke 3, mixed 2). Depression was diagnosed clinically in 3 studies, otherwise by structured interview or checklist. Only 5 studies described how they performed randomisation. 1 study compared drug with no treatment, and the rest with placebo: all of the latter said they were double blind. 6 studies used SSRIs, 3 atypical antidepressants, and the remainder tricyclics. Patients treated with antidepressants were significantly more likely to improve than those given placebo (13 studies, OR 0.37, 95% CI 0.27-0.51) or no treatment (1 study, OR 3.45, 95% CI 11.1-1.10). About 4 patients would need to be treated with antidepressants to produce one recovery from depression which would not have occurred had they been given placebo (NNT 4.2, 95% CI 3.2-6.4). Most antidepressants (tricyclics and SSRIs together, 15 trials ) produced a small but significant increase in dropout (OR 1.66, 95% CI 1.14-2.40. NNH 9.8, 95% CI 5.4-42.9). The "atypical" antidepressant mianserinproduced significantly less dropout than placebo. Only 2 studies used numerical scales designed to measure effects on function and quality of life; in HIV (Karnofsky scale), drug was better than no treatment; in lung disease (Sickness Impact Profile), drug was not significantly different from placebo. Only 7 studies reported looking for changes in the physical disease. Antidepressants produced no change in immune function in HIV relative to placebo (2 studies) or no treatment (1 study). Relative to placebo, antidepressants produced no change in cardiovascular function in heart disease, in respiratory function in lung disease, or in vital signs or laboratory tests in cancer (1 study each). Nortriptyline produced worse control in diabetes. Trends towards tricyclics being more effective than SSRIs, but also more likely to produce dropout were noted, but these are based on non-randomised comparisons between trials. REVIEWER'S CONCLUSIONS: The review provides evidence that antidepressants, significantly more frequently than either placebo or no treatment, cause improvement in depression in patients with a wide range of physical diseases. About 4 patients would need to be treated with antidepressants to produce one recovery from depression which would not have occurred had they been given placebo (NNT 4.2, 95% CI 3.2-6.4). Antidepressants seem reasonably acceptable to patients, in that about 10 patients would need to be treated with antidepressants to produce one dropout from treatment which would not have occurred had they been given placebo (NNH 9.8, 95% CI 5.4-42.9). (ABSTRACT TRUNCATED)

Antidepressive Agents↗
PubMed1999

Methods to maximize retention in weight loss studies.

OBJECTIVE: Dropouts from clinical trials decrease quality and increase costs. Free participation, paid participation, and contingency contracting are three study retention methods. Contingency contracting, or depositing a fee to be refunded contingent upon attendance in a clinical trial, has been reported to decrease dropouts without affecting weight loss. These three methods of retention were compared with a commercial weight loss clinic's practice of charging nonrefundable fees. METHODS AND PROCEDURES: Dropouts were compared in two studies testing mazindol, with one study using free care and the other using contingency contracting; two studies testing phenylpropanolamine, one using free care and the other using contingency contracting; and in studies with phenylpropanolamine on file with Thompson Medical Company using free care, paid participation, and contingency contracting. RESULTS: The dropout rate was 50% at 8 weeks in a trial of mazindol with free care vs. 7% for contingency contracting (p<0.001). The two phenylpropanolamine studies gave the same weight losses, but the dropouts were 37% at 8 weeks for free care vs. 11% for contingency contracting (p<0.001). The studies of phenylpropanolamine on file at the Thompson Medical Company had 28% dropouts at 8 weeks using free care vs. 19% for paid participation (p<0.001), and 11% for contingency contracting (p<0.005). Dropouts with contingency contracting (11%) were not different from the commercial weight loss program (13%). DISCUSSION: Contingency contracting can decrease dropouts, improve quality, and decrease costs without affecting weight loss in clinical trials for obesity.

Appetite Depressants↗
PubMed2005

Clinical use of new-generation pulse oximeters in the neonatal intensive care unit.

Continuous monitoring by pulse oximetry is a common practice for preterm and critically ill newborns. A new generation of motion-tolerant pulse oximeters have been designed for improved clinical performance with a substantial reduction in alarm frequency. However, little is known about the differences among these new-generation pulse oximeters in the neonatal intensive care unit (NICU). The purpose of this study is to assess the clinical performance of two new-generation pulse oximeters in the NICU. Two new-generation pulse oximeters were used simultaneously to monitor 36 patients in the NICU. The two devices studied were the Philips FAST and the Masimo SET. Patients were randomly assigned for their digit selection and data were collected only when waveforms were of good quality and/or the pulse oximeter's pulse rate (PR) correlated with the electrocardiogram heart rate (HR). The data for oxygen saturation measurements, number of true and false alarms, and number of dropouts as well as the duration of dropouts for each pulse oximeter were recorded by the primary investigator at 5-minute intervals for a period of 2 hours on each patient. Dropouts are instances when the pulse oximeter alarm sounds due to its inability to identify the arterial pulse and provide an oxygen saturation reading. The mean gestational age for the study group was 32 weeks (rang, 24 to 42 weeks). Repeated-measures analysis of variance indicated no difference between the two devices across all time measurements (p=0.357). In addition, paired t-tests for true alarms and false alarms were not significant, with p-values of 0.151 and 0.869, respectively. There was a difference in the number of data dropouts (p<0.001): the Philips device had a nearly six-fold increase in the number of dropouts (Philips 247 versus Masimo 38). The duration of dropouts was also significant; the Philips device had three times longer duration of dropouts. Physiologic monitoring in the critical care setting requires accurate data measurements. The two new-generation pulse oximeters, the Philips FAST and Masimo SET, are equally sensitive in their ability to identify true and false alarms. Masimo pulse oximeter with its signal extraction technology, however, provides more consistent and accurate reporting of SpO2 values as demonstrated by its markedly decreased incidence of data dropouts. The Masimo unit appears to be more resistant to the effects of motion artifact.

Humans↗
PubMed2003

Predictors of attrition in a large clinic-based weight-loss program.

OBJECTIVE: Identifying client factors that predict dropout is critical for the development of effective weight-loss programs. Although demographic predictors are studied, there are few consistent findings. The purpose of this study was to identify predictors of dropout in a large clinic-based weight-loss program using readily attainable demographic variables. RESEARCH METHODS AND PROCEDURES: All 866 weight-loss patients in a clinic-based weight-loss program enrolled during 1998 to 1999 were followed. Attrition and retention rates were measured at 8 and 16 weeks. Six variables (sex, race, marital status, age, BMI, and treatment protocol) were evaluated using bivariate and multivariable statistics for relative association with dropout. RESULTS: The overall attrition rate for the 16-week program was 31%. The retention rate was 69%. Significant risk for dropout, measured as bivariate relative risk (95% confidence interval), was found among patients who were: females, 1.32 (1.01 to 1.73); divorced, 1.54 (1.13 to 2.09); African Americans, 1.68 (1.26 to 2.23); age < 40, 1.66 (1.27 to 2.18); and ages 40 to 50, 1.33 (1.01 to 1.76). There were no significant differences in retention rates by BMI group or program protocol. After logistic regression analysis to control for all variables, young age < 50 years had the only significant association with dropout [odds ratio = 1.39 (1.02 to 1.90)]. DISCUSSION: Multivariable modeling was helpful for prioritizing risk factors for program dropout. These findings have important implications for improving weight-loss program effectiveness and reducing attrition. By knowing the groups at risk for dropout, we can improve or target program treatments to these populations.

Adult↗
PubMed1985

The treatment of mild hypertension in the elderly, a prospective study using multiple regression analysis.

In order to examine the effect of treatment of mild hypertension of the aged, a 4 year prospective trial was performed in 41 placebo and 38 drug-treated patients with an average age of 76.5 years. Patients were matched for blood pressure, sex and age. Patients with cardiovascular complications or blood pressure elevation above 200/110 were categorized as dropouts and totaled 17 cases (41.5%) in the placebo group, and 4 cases (10.5%) in the drug-treated group (p less than 0.01). In diastolic hypertension, dropouts formed 63.6% of the placebo group (mean BP, 170/92), and 9.5% of the drug group (mean BP, 179/94) (p less than 0.001). In systolic hypertension, dropouts were of 15.8% in the placebo group (mean BP, 164/79), and of 11.8% in the drug group (mean BP, 167/79), and no significant difference was observed. In the placebo group, dropouts were significantly higher in patients with pretreatment systolic blood pressure over 170 mmHg or diastolic blood pressure over 90 mmHg. In patients of 75 years of age or more, dropouts were 46.4% in the placebo group, and 13.0% in the drug treated group showing the beneficial effect of drug treatment even in those over the age of 75. However, no beneficial effect was observed over the age of 85. Stepwise multiple regression analysis of total case revealed that the greatest predictor for dropout was the presence of placebo (i.e. no treatment), explaining 12.2% of the variation in future dropout. Similarly, diastolic hypertension explained 7.5%, creatinine 6.7%, and age 4.6% of this variation.(ABSTRACT TRUNCATED AT 250 WORDS)

Aged↗
PubMed2005

[Frequent return as a novel strategy for tuberculosis treatment adherence].

OBJECTIVE: Treatment dropout is one of the major obstacles to the control of tuberculosis. The aim of the present study was to evaluate the frequent return strategy instituted at the Tuberculosis Control Program, as well as the program as a whole, identifying and quantifying potential risk factors for dropout. METHODS: The present study was conducted in Ubatuba, Southeastern Brazil. All patients (n=244) notified by the Tuberculosis Control Program in the two years preceding and the two years following the introduction of the frequent return strategy in 1999 were included. We carried out a descriptive analysis of the data and analyzed treatment results and program evaluation indicators. We performed univariate and multivariate analysis in order to identify potential risk factors associated with dropout. We also analyzed the frequent return strategy using chi-squared tests. RESULTS: The strategy reduced the risk of treatment dropout from 12.3% to 4.9%. Risk factors associated with dropout were lack of schooling (OR=3.01; p=0.051), unemployment (OR=3.36; p=0.046), and alcohol dependence (OR=3.56; p=0.014). CONCLUSIONS: The frequent return strategy reduced the risk of treatment dropout, although results did not reach statistical significance due to the small number of dropouts. This strategy may be an alternative for the supervised treatment for all patients recommended by the World Health Organization.

Adolescent↗