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PubMed1988

Personality, drug use, and early attrition from substance abuse treatment.

This study examined the relationships among demographics, personality variables, drug use, and early attrition from substance abuse treatment. Attrition was considered at two time intervals; immediately (after one visit) and after 2 months. One hundred consecutive admissions to a community drug-abuse treatment center were given the MCMI and the SCL-90R following a standard intake interview. Subjects were classified according to their primary drug of abuse, yielding 16 opiate, 16 amphetamine, 34 cocaine, and 29 marijuana abusers. ANOVA's, ANCOVA's, and chi-squares were performed to compare characteristics of the different groups. Immediate Dropouts were less likely to be court mandated than Remainers, but were not different on any other demographic or drug use variable. Remainers had higher scores than Immediate Dropouts on 7 MCMI scales. A significant interaction between drug type, symptom severity, and early attrition was found for amphetamine abusers with high levels of subjective distress as measured by the SCL-90R. These clients dropped out earlier than amphetamine abusers without elevated SCL-90R scores. Analysis also indicated that Long-Term Remainers were less likely to be employed than Dropouts. All other comparisons between these groups failed to produce significant differences. This study confirms earlier research which found a high rate of early attrition from treatment with substance-abusing clients. Results also indicate that severity of psychopathology is not key in predicting attrition; it is more the nature of the disorder that influences client dropout. It is argued that continuation in community treatment is problematic for most substances abusers, and treatment facilities should routinely employ attrition prevention procedures.

Adult↗
PubMed1976

Criminality and addiction.

This follow-up study describes the criminal activity of samples of 112 dropouts and 110 active patients from one of the largest methadone maintenance programs in New York City. Certain refinements in the categorization of "dropouts" and in the calculation of crime rates are proposed that appear necessary if different drug treatment modalities are to be compared. Considering the rates for property offenses committed during the year following admission to the program, the highest rates are among the court cases included in the sample of active patients, followed by the dropouts who were in institutions at the time of the interviews, and the dropouts who went to other methadone programs. The data suggest that methadone alone, without adequate supportive services, will not solve the crime problem and may even exacerbate it, at least for some groups of addicts. The need to monitor, alter, and improve treatment programs is emphasized.

Crime↗
PubMed1985

Who goes and who stays: subject loss in a multicenter, longitudinal follow-up study.

Subject loss in a cohort of 645 infants and their families, enrolled in a multicenter clinical trial, was described. Medical/biologic, socioeconomic and social support (Environmental Quality Index [EQI] composite), and developmental outcome data were obtained. Dropout was evaluated by comparing infants who withdrew at any time throughout the study to those who remained, as well as at four different time periods between 40 weeks conceptional age and 36 months. A dropout profile was also developed. Overall dropout was predicted by EQI score, clinical center, gestational age category, and 18-month developmental status. In addition to these variables, the dropout profile included race, but not 18-month developmental status. Medical/biologic variables, environmental quality, and race and center were most influential in the first, second and third, and fourth time periods, respectively. The identification of factors which are associated with increased subject loss can help researchers project needed sample sizes in future studies.

Black or African American↗
PubMed1998

Early identification of treatment failures in short-term psychotherapy. An assessment of therapeutic alliance and interpersonal behavior.

Early sessions of patients categorized as dropouts (n = 25), good outcome (n = 28), and poor outcome (n = 20) completers of a 40-session protocol of short-term psychotherapy were compared to determine predictive validity of in-session measures of therapeutic alliance and interpersonal behavior (Working Alliance Inventory, Session Evaluation Questionnaire, and Interpersonal Adjective Scale). A number of significant differences were found among the three groups: both patients and therapists in the dropout group rated the relationship as more problematic than those in the good outcome group, and patients in the dropout group also rated the relationship as more problematic than those in the poor outcome group, while therapists' ratings did not distinguish dropouts from poor outcome. Differences between good and poor outcome groups were nonsignificant. These findings have clinical significance, particularly in early identification of patients at risk for treatment failure.

Adult↗
PubMed1998

Alcohol use and academic status among Mexican American and White non-Hispanic adolescents.

In this study, Mexican American and White non-Hispanic school dropouts and students in good academic standing were compared on their use of alcohol. Results indicated that dropouts were at higher risk for alcohol use and misuse. Dropouts were 2.53 times more likely to report frequent alcohol use, 3.16 times more likely to classify themselves as heavy drinkers, and 3.00 times more likely to report frequent drunkenness when compared with their in-school counterparts. Gender, but not ethnicity, was also associated with alcohol use and misuse. The implications regarding greater risk of alcohol use and misuse among dropouts are discussed in terms of prevalence and prevention.

Adolescent↗
PubMed1995

Ocular surface changes and discomfort in patients with meibomian gland dysfunction.

OBJECTIVE: To determine the importance of meibomian gland dysfunction (MGD) on the ocular surface. DESIGN: Prospective study. SETTING: A university-based referral practice. PATIENTS: Patients with ocular discomfort (147 eyes) and without ocular discomfort (54 eyes) were examined. In the total 201 eyes, MGD was defined as the presence of an obstruction of the meibomian orifices (obstruction group [n = 54]) or the absence of a gland structure (gland dropout group [n = 36]), or both of these findings (combined group [n = 38]). There were not any findings of MGD in 73 eyes (non-MGD group). MAIN OUTCOME MEASURES: Scores that were obtained from fluorescein and rose bengal staining, the breakup time of the tear film, the rates of tear evaporation and tear production, and meibography. RESULTS: Of the 147 eyes with ocular discomfort, 95 (64.6%) had either an obstruction of an orifice or gland dropout, or both. The combined group had higher scores for staining with fluorescein (P = .002) and rose bengal (P = .021) compared with that in the non-MGD group. The rate of tear production was increased more in the gland dropout group than in the non-MGD group (P = .002). The rate of tear evaporation was significantly increased in the gland dropout group (P = .017). CONCLUSION: Meibomian gland dysfunction is a major cause of ocular surface abnormalities and ocular discomfort.

Adult↗
PubMedDate not supplied

Mixture models for the joint distribution of repeated measures and event times.

Many long-term clinical trials collect both a vector of repeated measurements and an event time on each subject; often, the two outcomes are dependent. One example is the use of surrogate markers to predict disease onset or survival. Another is longitudinal trials which have outcome-related dropout. We describe a mixture model for the joint distribution which accommodates incomplete repeated measures and right-censored event times, and provide methods for full maximum likelihood estimation. The methods are illustrated through analysis of data from a clinical trial for a new schizophrenia therapy; in the trial, dropout time is closely related to outcome, and the dropout process differs between treatments. The parameter estimates from the model are used to make a treatment comparison after adjusting for the effects of dropout. An added benefit of the analysis is that it permits using the repeated measures to increase efficiency of estimates of the event time distribution.

Algorithms↗
PubMed2000

Antibiotics for acute maxillary sinusitis.

OBJECTIVES: For adults seeking care in ambulatory practices, sinusitis is the most common diagnosis treated with antibiotics. We examined whether antibiotics are indicated for acute sinusitis, and if so, which antibiotic classes are most effective. SEARCH STRATEGY: Relevant studies were identified from searches of MEDLINE and EMBASE in October 1998, contacts with pharmaceutical companies and bibliographies of included studies. SELECTION CRITERIA: Randomized trials were eligible that compared antibiotic to control or antibiotics from different classes for acute maxillary sinusitis. Additional criteria were diagnostic confirmation by radiograph or sinus aspiration, outcomes that included clinical cure or improvement and a sample size of 30 or more adults. Of 1784 potentially relevant studies, two or more reviewers identified 32 studies meeting selection criteria. DATA COLLECTION AND ANALYSIS: Data were abstracted independently by 2 persons and synthesized descriptively. Some data were analyzed quantitatively using a random effects model. Primary outcomes were a) clinical cure and b) clinical cure or improvement. Secondary outcomes were radiographic improvement, relapse rates, and dropouts due to adverse effects. MAIN RESULTS: Thirty-two trials, involving 7,330 subjects evaluated antibiotic treatment for acute maxillary sinusitis. Major comparisons were antibiotic vs. control (n=5); newer, non-penicillin antibiotic vs. penicillin class (n=10); and amoxicillin-clavulanate vs. other extended spectrum antibiotics (n=10). Most trials were conducted in otolaryngology settings. Only 5 trials described adequate allocation and concealment procedures; 10 were double-blind. Compared to control, penicillin improved clinical cures [relative risk (RR) 1.72, 95% CI 1.00 to 2.96]. Treatment with amoxicillin did not significantly improve cure rates (RR 2.06; 95% CI 0.65 to 6.53), but there was significant variability between studies. Radiographic outcomes were improved by antibiotic treatment. Comparisons between classes of antibiotics showed no significant differences: newer non-penicillins vs. penicillins (RR for cure 1.07; 95% CI 0.99 to 1.17); newer non-penicillins vs. amoxicillin-clavulanate (RR for cure 1.01, 95% CI 0.97 to 1.04). Compared to amoxicillin-clavulanate, dropouts due to adverse effects were significantly lower for cephalosporin antibiotics. Relapse rates within one month of successful therapy were 5%. REVIEWER'S CONCLUSIONS: For acute maxillary sinusitis confirmed radiographically or by aspiration, current evidence is limited but supports penicillin or amoxicillin for 7 to 14 days. Clinicians should weigh the moderate benefits of antibiotic treatment against the potential for adverse effects.

Acute Disease↗
PubMed2000

Quetiapine for schizophrenia.

BACKGROUND: Quetiapine is a novel atypical antipsychotic with low propensity for movement disorder adverse effects. It is used for treatment of schizophrenia and other psychoses. OBJECTIVES: To determine the effects of quetiapine for schizophrenia in comparison to placebo, classical and other atypical antipsychotics. SEARCH STRATEGY: Electronic searches of Biological Abstracts (1982-1997), CINAHL (1982-1997), the Cochrane Library (1998, Issue 1), the Cochrane Schizophrenia Group's Register of trials (1998), EMBASE (1980-1998), MEDLINE (1966-1998), PsycLIT (1974-1997), SocioFile (1974-1997) and many conference proceedings and hand searches of specific journals were undertaken. Zeneca Pharmaceuticals was contacted for information regarding unpublished trials. SELECTION CRITERIA: All controlled trials where adults with schizophrenia or similar illnesses were randomised to quetiapine, placebo or other neuroleptic drugs and where clinically relevant outcomes were reported. DATA COLLECTION AND ANALYSIS: Citations and, where possible, abstracts were independently inspected by reviewers, papers ordered, re-inspected and quality assessed. Data were also independently extracted. For homogeneous dichotomous data the Peto odds ratio (OR), 95% confidence interval (CI) and, where appropriate, the number needed to treat (NNT) was calculated on an intention-to-treat basis. MAIN RESULTS: Seven trials of short duration are included (31 reports) and seven are excluded (15 reports). Apart from that of 'leaving the study early', all other results may be prone to bias and should be viewed with caution since dropout rates are high (48-61%) in each arm of all studies. There are data suggesting less people allocated quetiapine leave the study early (53%) than those in the placebo group (61%) (OR 0.67 CI 0.48-0. 95). Data incorporating considerable assumptions about the many people who left early suggest that global state and psychotic symptoms - both positive and negative - may be more helped by quetiapine than placebo. Although some of these data reach statistical significance their clinical importance is difficult to interpret. While the incidences of extrapyramidal side effects are not different between quetiapine and placebo, side effects such as dizziness and dry mouth are more prevalent in the quetiapine treated group. High proportions of trial participants also leave when quetiapine is compared to chlorpromazine or haloperidol (57% by six weeks). Quetiapine is as potent as chlorpromazine and haloperidol as regards global and mental state but it may cause higher incidences of dry mouth and sleepiness. Extrapyramidal side effects are the same as those of chlorpromazine but may be less than haloperidol. High dose quetiapine is better than low dose quetiapine with regard to leaving the study early, and limited data suggest that the higher dose is also better at marginally improving global state (n = 1, OR 0.70, CI 0.50-0.99, NNT 11). There are no clear differences between high and low dose groups in respect of extrapyramidal side effects. REVIEWER'S CONCLUSIONS: The high dropout rates are a large problem in interpreting any results other than 'leaving the study early' since about half the data were not available at the end of studies. Before quetiapine's use can be recommended, we need more large, well conducted trials that provide short, medium and long term outcomes relevant to carers and clinicians.

Adult↗
PubMed2001

Antidepressants for cocaine dependence.

BACKGROUND: Cocaine dependence is a common and serious condition, which has become nowadays a substantial public health problem. The past decade has witnessed a sustained search for an effective pharmacotherapeutic agent for the treatment of cocaine dependence. While administration of cocaine acutely increases intercellular dopamine, serotonin, and norepinephrine levels by blocking their presynaptic reuptake, chronic cocaine abuse leads to down-regulation of monoamine systems. Post-cocaine use depression and cocaine craving may be linked to this down-regulation. Antidepressant pharmacotherapy, by augmenting monoamine levels, may alleviate cocaine abstinence symptomatology, as well as relieving dysphoria and associated craving by general antidepressant action. OBJECTIVES: To conduct a systematic review of all RCTs on the use of antidepressants for treating cocaine dependence. SEARCH STRATEGY: We searched the Cochrane Controlled Trials Register (Cochrane Library, issue 4, 2000), MEDLINE (from 1966 - 2000), EMBASE (from 1980 - 2000), LILACS (from 1982 - 2000), PsycLIT (from 1974 - 2000), Biological Abstracts (1982 to 2000). Other searches:reference searching; personal communication; conference abstracts; unpublished trials from pharmaceutical industry; book chapters on treatment of cocaine dependence. SELECTION CRITERIA: The inclusion criteria for all randomised controlled trials were that they should focus on the use of antidepressants on the treatment of cocaine dependence. Trials including patients with additional diagnosis such as opiate dependence were also eligible. DATA COLLECTION AND ANALYSIS: The reviewers extracted the data independently and Relative Risks, weighted mean difference and number needed to treat were estimated. The reviewers assumed that people who died or dropped out had no improvement and tested the sensitivity of the final results to this assumption. MAIN RESULTS: 18 studies were included in the review, with 1177 people randomised. Positive urine sample for cocaine metabolites was the main efficacy outcome, with no significant results obtained regardless the type of antidepressant. Compared to other drugs, desipramine performed better but showing just a non significant trend with heterogeneity present as revealed by the chi-square test (8.6, df=3; p=0.04). One single trial showed imipramine performed better than placebo in terms of clinical response according to patient's self-report. A similar rate of patients remaining in treatment was found for both patients taking desipramine or placebo. Results from one single trial suggest fluoxetine patients on SSRIs are less likely to dropout. Similar results were obtained for trials where patients had additional diagnosis of opioid dependence and/or were in methadone maintenance treatment. REVIEWER'S CONCLUSIONS: There is no current evidence supporting the clinical use of antidepressants in the treatment of cocaine dependence. Given the high rate of dropouts in this population, clinicians may consider adding psychotherapeutic supportive measures aiming to keep patients in treatment.

Antidepressive Agents↗
PubMed2003

Low dosage tricyclic antidepressants for depression.

BACKGROUND: Tricyclic antidepressants are still extensively prescribed worldwide. Evidence for the recommended dosage of tricyclics, however, is poor. OBJECTIVES: To compare the effects and side effects of low dosage tricyclic antidepressants with placebo and with standard dosage tricyclics in acute phase treatment of depression. SEARCH STRATEGY: Electronic search of the Cochrane Collaboration Depression, Anxiety and Neurosis Controlled Trials Register (CCDANCTR), incorporating results of group searches of MEDLINE (1966-), EMBASE (1980-), CINAHL (1982-), PsycLIT (1974-), PSYNDEX (1977-) and LILACS (1982-1999) and hand searches of major psychiatric and medical journals. Reference search and SciSearch of the identified studies. Personal contact with authors of significant papers. SELECTION CRITERIA: All randomised controlled trials 1) comparing low dosage TCA (=< 100 mg/d on average at the end of trial) with placebo or 2) comparing low and standard dosages of the same TCA, in acute phase treatment of depressive disorder DATA COLLECTION AND ANALYSIS: Two independent reviewers examined eligibility of the identified studies, and extracted data for outcomes at 1 week, 2 weeks, 4 weeks, 6-8 weeks and later. Main outcome measures were relative risk of response in depression (random effects model), according to the original authors' definition but usually defined as 50% or greater reduction in severity of depression according to the last-observation-carried-forward intention-to-treat method, and relative risks of overall dropouts and dropouts due to side effects. Other outcome measures included worst-case-scenario intention-to-treat analysis of response as defined above (in which dropouts were considered non-responders in the active treatment group and as responders in the comparison group), and standardised weighted mean scores of continuous depression severity scales (usually calculated by last-observation-carried-forward method). MAIN RESULTS: 35 studies (2013 participants) compared low dosage tricyclics with placebo, and six studies (551 participants) compared low dosage tricyclics with standard dosage tricyclics. Low dosage tricyclics, mostly between 75 and 100 mg/day, were 1.65 (95% confidence interval 1.36 to 2.0) and 1.47 (1.12 to 1.94) times more likely than placebo to bring about response at 4 weeks and 6-8 weeks, respectively. Standard dosage tricyclics failed, however, to bring about more response but produced more dropouts due to side effects than low dosage tricyclics. REVIEWER'S CONCLUSIONS: Treatment of depression in adults with low dose tricyclics is justified. However, more rigorous studies are needed to definitively establish the relative benefits and harms of varying dosages.

Antidepressive Agents, Tricyclic↗
PubMed1998

Treatment of cervical dystonia: a comparison of measures for outcome assessment.

UNLABELLED: There is little agreement on which outcome measures to use to express the efficacy of treatments for cervical dystonia. We analyzed change scores on various scales of 64 new patients with cervical dystonia before and after repeated injections with botulinum toxin. METHOD: The association between change in impairment (Tsui), and change in pain (TWSTRS-Pain) and functional health (TWSTRS-D, MOS-20) was expressed in percentages of variance explained. Effect sizes of the outcome measures from patients who continued botulinum treatment and dropouts were compared. Performance of outcome measures to distinguish patients who continued treatment and dropouts was analyzed with ROC curves and areas under the curve (AUC). RESULTS: Impairments explained < or =7% of the score variance in functional health. There were no differences between the effect sizes of impairment and pain of patients who continued treatment and dropouts (p > 0.60). This suggests a poor reflection of the treatment efficacy by these outcome measures. Conversely, there were significant differences between the effect sizes of the functional status scales of the patients who continued treatment and the dropouts (p < or = 0.01). ROC curve analysis showed that the disability, handicap, and global disease burden scale accurately distinguished between the two groups (AUCs > 0.80). Impairments showed no discriminative accuracy (AUC = 0.46). CONCLUSION: Neurologic impairments have a small impact on the functional health of cervical dystonia patients. Disability, handicap, and a global measure of disease burden were the most suitable outcome parameters to express the clinical efficacy of botulinum therapy.

Adult↗
PubMed2001

Spiral-in/out BOLD fMRI for increased SNR and reduced susceptibility artifacts.

BOLD fMRI is hampered by dropout of signal in the orbitofrontal and parietal brain regions due to magnetic field gradients near air-tissue interfaces. This work reports the use of spiral-in trajectories that begin at the edge of k-space and end at the origin, and spiral in/out trajectories in which a spiral-in readout is followed by a conventional spiral-out trajectory. The spiral-in trajectory reduces the dropout and increases the BOLD contrast. The spiral-in and spiral-out images can be combined in several ways to simultaneously achieve increased signal-to-noise ratio (SNR) and reduced dropout artifacts. Activation experiments employing an olfaction task demonstrate significantly increased activation volumes due to reduced dropout, and overall increased SNR in all regions.

Amygdala↗
PubMed2026

Does impulsivity predict treatment outcomes in PTSD with borderline personality disorder features? Results from a randomized clinical trial.

BACKGROUND: Trauma-focused psychotherapies are first-line treatments for posttraumatic stress disorder (PTSD). However, a substantial proportion of clients do not respond adequately or drop out of therapy prematurely. This has sparked interest in identifying individual-level predictors of treatment outcomes, including improvement in PTSD severity and dropout. Impulsivity may be a predictor because it may interfere with key therapeutic processes, such as cognitive restructuring and emotional processing. Consequently, we present a hypothesis-driven secondary analysis of a 15-month randomized clinical trial comparing Dialectical Behavior Therapy for PTSD (DBT-PTSD) and Cognitive Processing Therapy (CPT) in women with childhood abuse-related PTSD and borderline personality disorder features to test whether impulsivity, assessed at baseline, predicts PTSD improvement and dropout. We further explore whether the dimensions of impulsivity (non-planning, attentional impulsivity, and motor impulsivity) differentially affect the outcomes in DBT-PTSD vs. CPT. METHODS: A total of 193 cis women with PTSD related to childhood abuse and borderline personality disorder features were assessed using the Clinician-Administered PTSD Scale (CAPS) and the Barratt Impulsiveness Scale (BIS-10). Separate probit models and general linear models were applied to predict dropout and pre-to-post changes in PTSD severity (&#x394;CAPS) from total impulsivity and subscale scores, i.e. non-planning, attentional and motor impulsivity. RESULTS: Overall, dropout rates were higher for participants with higher baseline impulsivity scores (p&#x202f;=&#x202f;0.049), particularly for those with higher non-planning impulsivity (p&#x202f;=&#x202f;0.012). In participants randomized to CPT improvement in PTSD symptom severity (&#x394;CAPS) was negatively related to baseline total impulsivity (p&#x202f;=&#x202f;0.021). In participants randomized to DBT-PTSD this relation was not significant. CONCLUSIONS: The results suggest that impulsivity may predict treatment outcomes. Specifically, patients with elevated impulsivity may be less likely to respond adequately to CPT. If replicated, these findings have implications for personalization of treatment.

Humans↗
PubMed2006

Optimal EPI parameters for reduction of susceptibility-induced BOLD sensitivity losses: a whole-brain analysis at 3 T and 1.5 T.

Most functional magnetic resonance imaging (fMRI) studies record the blood oxygen level-dependent (BOLD) signal using fast gradient-echo echo-planar imaging (GE EPI). However, GE EPI can suffer from substantial signal dropout caused by inhomogeneities in the static magnetic field. These field inhomogeneities occur near air/tissue interfaces, because they are generated by variations in magnetic susceptibilities. Thus, fMRI studies are often limited by a reduced BOLD sensitivity (BS) in inferior brain regions. Recently, a method has been developed which allows for optimizing the BS in dropout regions by specifically adjusting the slice tilt, the direction of the phase-encoding (PE), and the z-shim moment. However, optimal imaging parameters were only reported for the orbitofrontal cortex (OFC) and inferior temporal lobes. The present study determines the optimal slice tilt, PE direction, and z-shim moment at 3 T and 1.5 T, otherwise using standard fMRI acquisition parameters. Results are reported for all brain regions, yielding a whole-brain atlas of optimal parameters. At both field strengths, optimal parameters increase the BS by more than 60% in many voxels in the OFC and by at least 30% in the other dropout regions. BS gains are shown to be more widespread at 3 T, suggesting an increased benefit from the dropout compensation at higher fields. Even the mean BS of a large brain region, e.g., encompassing the medial OFC, can be increased by more than 15%. The maps of optimal parameters allow for assessing the feasibility and improving fMRI of brain regions affected by susceptibility-induced BS losses.

Adult↗
PubMed1995

Adequacy of implantable cardioverter-defibrillator lead placement for tachyarrhythmia detection by sinus rhythm electrogram amplitude.

This study examines whether the current clinical practice of using a 5 mV minimum amplitude during normal sinus rhythm (NSR) ensures adequate detection during subsequent episodes of ventricular fibrillation (VF) at the time of the implantable cardioverter-defibrillator (ICD) threshold testing. Risk of nondetection occurs with ICDs when a substantial portion of the individual cardiac events on an electrogram goes undetected. Detection risk was assessed by 2 methods: percentage of missed cardiac events (incidence of signal dropout), and mean electrogram amplitude. During ICD implantation and testing in 27 patients utilizing 41 lead positions, 135 episodes of VF were induced and analyzed. On 64 occasions, the countershock was not successful in achieving cardioversion, and the continuing electrical activity was analyzed as a separate group of postshock waveforms. Thresholds of 1 and 2 mV were applied to each individual cardiac depolarization in a VF episode. Significant risk of nondetection was assumed when > or = 10% of individual events displayed dropout. Underdetection by signal dropout occurred in 11 of 135 preshock arrhythmia signals (8.1%) from 3 patients at a 2 mV threshold, and in 6 of 135 signals (4.4%) at a 1 mV threshold. A mean NSR amplitude > or = 5 mV was associated with significantly lower risk of nondetection during subsequent VF episodes at both 1 and 2 mV thresholds (largest p < 0.001). Similar results were observed in analysis of postshock arrhythmia signals. Further examination of signal dropout and linear regression criteria suggest that in order to eliminate the possibility of nondetection at a 1 mV threshold, minimum NSR amplitudes of 8.5 and 10.0 mV, respectively, are required.

Defibrillators, Implantable↗
PubMed2000

Therapeutic communities. Enhancing retention in treatment using "Senior Professor" staff.

Evaluation research documents a firm relationship between retention and treatment outcomes among substance abusers in therapeutic communities (TCs). However, most admissions leave treatment prematurely, particularly in the first months after admission. This paper reports findings from a controlled study that assessed the efficacy of an intervention to reduce early dropout in a residential TC. In the "Senior Professor" (SP) intervention, the most experienced clinical and managerial staff in a TC program were utilized to conduct program induction seminars during the first weeks of admissions, traditionally the period of the highest rate of dropout. Rates of short-term retention (30 days of treatment) were compared for the experimental cohort (N=362), who received the intervention, and a cohort of admissions (N=243), who received standard or non-enhanced treatment. Findings showed that the SP intervention significantly reduced the likelihood of early dropout compared with controls. The enhanced effects are most evident for the new inductees with the lowest levels of motivation. Some theoretical and clinical implications are discussed as to the utilization of experienced staff to increase retention among new inductees with relatively lower motivational levels, who are at greatest risk for early dropout.

Humans↗
PubMed1991

Adinazolam, diazepam, imipramine, and placebo in major depressive disorder: a controlled study.

In summary, the clinical results of this double-blind study clearly show that imipramine, as expected, demonstrated significant antidepressive properties in outpatients suffering from major depressive disorders. In contrast, adinazolam showed rather mild and weak antidepressive properties, and in no measures did its response differ significantly from that of diazepam. These findings are quite in contrast to those obtained by the authors in an earlier study with alprazolam (Rickels et al., 1987) in which alprazolam and imipramine produced rather similar results and both were significantly better than placebo, while diazepam was not. While the rather high dropout rate may well be considered a limitation of the study, the dropout rate is equally distributed between all four treatments. And since both decreasing sample size and endpoint analyses which include all patients with at least one week data, provide rather similar results, the findings can be considered as robust despite the high dropout rate. While the authors consider those findings the most robust in which endpoint and completer analyses results are rather similar, when high dropout rates occur, endpoint analyses should be given more weight than completer analyses as they are more representative of actual clinical practice. The present findings therefore suggest that adinazolam clearly possesses less antidepressive properties than imipramine and not more than diazepam and these findings are in agreement with other studies which found lack of significant antidepressant activity for such benzodiazepines as diazepam (Covi et al., 1974) and chlordiazepoxide (Lipman et al., 1986). The presence of only borderline antidepressive effects combined with rebound symptoms occurring already after only 6 weeks of therapy does not recommend adinazolam for use in depression.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗