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PubMed1997

The use of bibliometric data in evaluating research on therapeutic community for addictions and in psychiatry.

The purpose of this study is to describe the publication characteristics associated with therapeutic community research and illustrate differences between addiction studies and other types of therapeutic community papers. A total of 223 published reports on research pertaining to the therapeutic community in a variety of treatment settings from 1987 to 1992 were analyzed. The articles consisted mainly of addiction studies (38%) and hospital psychiatry (36%) studies. Collaborative authorship was scanty. Quantitative studies (systematic data presented and analyzed statistically) were performed more often in addiction papers than in psychiatric therapeutic community papers. Addiction studies were also cited slightly more often. Addictions are often a rather simple and distinct focus for research, as well as a major public health problem. This may lead to the smoother use of traditional quantitative research strategies and standard publication channels than in other psychiatric therapeutic community studies.

Alcoholism↗
PubMed2003

Therapeutic response evaluation of malignant hepatic masses treated by interventional procedures with contrast-enhanced agent detection imaging.

OBJECTIVE: To assess the usefulness of microbubble contrast-enhanced agent detection imaging in evaluating the therapeutic response of malignant hepatic masses to treatment with interventional procedures. METHODS: Fifty-eight patients with 68 hepatocellular carcinomas and 6 metastases who were treated with interventional procedures were evaluated with SH U 508A-enhanced agent detection imaging and helical computed tomography. Helical computed tomography was also performed to help establish the outcome of therapy with unenhanced computed tomography 2 weeks after transcatheter arterial chemoembolization and with dynamic contrast-enhanced computed tomography 1 day after radio frequency ablation or percutaneous ethanol injection. The studies were reviewed separately and randomly, and the sensitivity and specificity of agent detection imaging for detection of viable tumor residue were determined by follow-up imaging performed at least 3 months later. RESULTS: Follow-up computed tomography or magnetic resonance imaging revealed complete tumor responses in 44 (59.5%) of 74 cases after the therapeutic procedures. The sensitivity of agent detection imaging was 94.7% after transcatheter arterial chemoembolization and 72.7% after radio frequency ablation and percutaneous ethanol injection. The specificity of agent detection imaging for the detection of residual tumors was 80% after transcatheter arterial chemoembolization and 79.2% after radio frequency ablation and percutaneous ethanol injection. The false-positive rate for agent detection imaging in cases of radio frequency ablation or percutaneous ethanol injection was 20.8% (5 of 24), resulting from reactive hyperemia or vascularity within the safety margin. In the assessment of the therapeutic effects, the concordance of contrast-enhanced agent detection imaging with helical computed tomography was statistically significant after transcatheter arterial chemoembolization (P < .00001) and radio frequency ablation or percutaneous ethanol injection (P < .02). CONCLUSIONS: Contrast-enhanced agent detection imaging proved useful and as effective as helical computed tomography for evaluating the therapeutic effects of interventional therapeutic procedures for malignant hepatic masses.

Adult↗
PubMed1984

Therapeutic substitution: has its time arrived?

Therapeutic substitution refers to substitution by the dispenser of a drug product that is not chemically identical but is therapeutically equivalent to the product prescribed, pursuant to guidelines established by the hospital P & T Committee. Until recently, the extent to which this concept has been adopted by hospitals across the country was unknown. Late in 1980, we conducted a nationwide survey of hospital pharmacies to learn more about therapeutic substitution. This paper reviews some of the issues involved, some of the findings of our study, and the pros and cons of therapeutic interchange. It also provides an update as to some of the recent changes that are occurring in therapeutic substitution procedures.

Data Collection↗
PubMed1975

Social integration and the therapeutic community.

The therapeutic community should be defined as an environment which is enabling but not directive. The staff need to become aware of their therapeutic as well as anti-therapeutic potential. Conflict should be overt rather than covert. That society now sees the delinquent as 'sick' is two-edged: Abdication of responsibility is encouraged, and the sick role rewarded. This paper shows how the therapeutic community is effective in encouraging the delinquent to take responsibility for himself and for others. It shows what features make the therapeutic community effective for neurotics for schizophrenics.

Humans↗
PubMed2003

Treating heroin addiction: comparison of methadone therapy, hospital therapy without methadone, and therapeutic community.

AIM: To analyze the success of three different treatment modalities for heroin addiction: methadone therapy, hospital therapy without methadone, and therapeutic community. METHODS: Ninety heroin addicts from the city of Split, Croatia, were systematically allocated to three groups, with 30 participants each, according to the addiction treatment modality they underwent or treatment that resulted in the longest abstinence. All participants were heroin addicts for at least 2 years before the treatment. The first group was treated by methadone, the second by hospital therapy, and the third in a therapeutic community. The criterion of the treatment success was minimum two-year heroin abstinence after therapy. RESULTS: After methadone therapy, only a single participant abstained from heroin for more than 2 years, but continued to use soft drugs and alcohol. After hospital therapy, none of the participants abstained from heroin. After therapy in a therapeutic community, 9 participants abstained from heroin; 5 of them continued to use soft drugs and/or alcohol. There was a statistically significant relation between heroin abstinence and therapeutic method (chi-square=16.4236, p<0.001; Fisher's exact test=14.246, p<0.001). CONCLUSION: Treating heroin addiction in a therapeutic community may be a better treatment modality than methadone or hospital therapy.

Adult↗
PubMed2002

[Sanitary safety of GMOs used in therapeutics].

The recent progress in human therapeutics has been made possible thanks to molecular biology and its use in producing proteins having the same sequence and structure as that of human proteins. The use of GMOs allows production of proteins with high added value in therapeutics, which are of satisfactory quality. GMOs may also be directly administered to patients as gene therapy vectors. However, the use of GMOs in therapeutics must take into consideration some risks, particularly those of microbiological contamination, of neo-antigenicity as well as environmental risks with regard to the way of use of the GMO. Nevertheless, those risks are taken in due consideration in the development of those new medicinal products; solutions have been found to allow their use in therapeutics with a very positive benefit/risk ratio. Medicinal products from biotechnology have permitted considerable therapeutic progress without compromising health security.

Consumer Product Safety↗
PubMed2003

[Influential factors to therapeutic efficacy of uterine artery embolization in the treatment of uterine fibroids].

OBJECTIVE: To investigate the therapeutic efficacy of uterine artery embolization in the treatment of uterine fibroids and to analyse the influential factors to the therapeutic efficacy. METHODS: Thirty-two patients with symptomatic uterine myomas were treated by superselective catheterization and embolization of bilateral uterine arteries using PVA particles. Patients were followed for 6 months after uterine artery embolization. Baseline symptoms and the volume of the fibroids were used as parameters to evaluate the therapeutic efficacy. Influential factors to therapeutic efficacy were analyzed. RESULTS: The clinical symptoms, especially heavy menstrual bleeding, were improved markedly. An average of 55.6% volume reduction of the fibroids was achieved during the 6 month follow-up. The submucosal and intramural location of the myomas reduced more in the volume compared with that of the subserosal location. CONCLUSION: Selective uterine artery embolization is effective for uterine myoma. Influential factors to the therapeutic efficacy may include: postprocedural vascular reconstruction in the fibroid, location of the fibroid, hemodynamic status of the fibroid, and the mode of embolization (unilateral or bilateral).

Adult↗
PubMedDate not supplied

The effect of therapeutic touch on behavioral symptoms of persons with dementia.

BACKGROUND: Approximately 80% of nursing home residents who suffer from Alzheimer's disease and related dementia develop behavioral symptoms of dementia. Given the deleterious side effects of pharmacologic therapy in this population there is an urgent need for clinical trials of nonpharmacologic interventions. OBJECTIVE: To examine the effect of therapeutic touch on the frequency and intensity of behavioral symptoms of dementia. METHOD: A randomized, double-blind, three-group experimental study: experimental (therapeutic touch), placebo (placebo therapeutic touch), and control (usual care). Fifty-seven residents, aged 67 to 93 years, exhibiting behavioral symptoms of dementia, were randomized to one of the three groups within each of three Special Care Units within three Long-Term Care facilities in a western Canadian province. Behavioral observation was completed every 20 minutes from 8:00AM to 6:00PM for three days pre-intervention and for three days post-intervention by trained observers who were blind to group assignment. The intervention consisted of therapeutic touch given twice daily for 5-7 minutes for three days between 10:00AM and 11:30PM and between 3:00PM and 4:30PM (N = 57). The main outcome variable was overall behavioral symptoms of dementia, consisting of six categories of behaviors: manual manipulation (restlessness), escape restraints, searching and wandering, tapping and banging, pacing and walking, and vocalization. RESULTS: Analysis of variance (ANOVA) (F = 3.331, P = .033) and the Kruskal-Wallis test (chi2 = 6.661, P = .036) indicated a significant difference in overall behavioral symptoms of dementia, manual manipulation and vocalization when the experimental group was compared to the placebo and control groups. The experimental (significant) was more effective in decreasing behavioral symptoms of dementia than usual care, while the placebo group indicated a decreasing trend in behavioral symptoms of dementia compared to usual care. CONCLUSIONS: Therapeutic touch offers a nonpharmacological, clinically relevant modality that could be used to decrease behavioral symptoms of dementia, specifically manual manipulation (restlessness) and vocalization, two prevalent behaviors.

Aged↗
PubMed1988

Opinions of pharmacy, medicine, and pharmaceutical industry leaders about hypothetical therapeutic-interchange legislation.

The beliefs of representatives of organized pharmacy and medicine and the pharmaceutical industry about the effect of hypothetical therapeutic-interchange legislation on various health-care issues were studied. Questionnaires designed to gauge respondents' beliefs about the impact of two hypothetical bills (A and B) concerning selection of therapeutic alternates by pharmacists were mailed to the directors of 307 organizations in April 1986. Bill A would permit pharmacists in any setting to select therapeutic alternates. Bill B would permit therapeutic interchange by pharmacists within organized health-care settings in accordance with guidelines approved by physicians. Issues addressed included the efficient delivery of health care, professional liability, interprofessional and pharmacist-patient relationships, and competition and profitability in the pharmaceutical industry. The response rate was 63% (194 usable responses). Bill A received some support from representatives of state pharmaceutical associations only. However, bill B was supported by respondents from state pharmaceutical associations, state hospital pharmacy societies, boards of pharmacy, and generic manufacturers. Respondents from medical associations and member companies of the Pharmaceutical Manufacturers Association (PMA) were concerned about the impact of the hypothetical bills on the quality of drug therapy and the efficiency of health-care delivery. Respondents from medical associations also were concerned about the impact of the bills on physician liability. The responses from the medical associations and the PMA-member companies suggest that a program should be developed to educate physicians about the process used by pharmacists and physicians to develop guidelines for therapeutic interchange in various practice settings.

Attitude of Health Personnel↗
PubMed1986

Critical therapeutic categories: a contraindication to generic substitution?

All 50 states either permit or require a pharmacist to substitute a generic drug for a prescribed brand-name drug unless the physician specifically notes on the prescription form that substitution is not to be made. In certain critical therapeutic categories and for certain patient populations, each substitution poses the risks of treatment failure and of increased toxicity. The therapeutic categories include cardiovascular drugs, psychotropic agents, and anticonvulsants. Additional potential therapeutic categories include cardiovascular drugs, psychotropic agents, and anticonvulsants. Additional potential therapeutic categories include low-dose oral contraceptives, bronchodilating agents, oral diuretics, and oral anticoagulants. The populations at risk include debilitated or elderly patients with abnormal gastrointestinal, renal, or hepatic function. The FDA's approach to approval of generic drugs, based primarily on the demonstration of bioequivalence, is considered by many professionals as likely to result in excessive variability among treated patients. Depending on the particular rule defining bioequivalence, indiscriminate switching among generic versions of a brand-name drug potentially could result in 40% to 60% differences in rate or extent of absorption. For drugs that require careful titration to assure efficacy and lack of toxicity, such variability can have important consequences. The FDA is now reviewing its policies for approval of generic drugs. Until the matter is resolved, however, caution should be exercised when prescribing or dispensing drugs that can be substituted. Indiscriminate switching among generic products should be avoided, especially for drugs in the critical therapeutic categories and for drugs prescribed for elderly or debilitated patients.

Aged↗
PubMed1983

[Lessons from the history of therapy--therapeutic optimism and its pitfalls].

If we are to help patients effectively, our understanding of diseases and our therapeutic potential should, again and again, just be somewhat better than they actually are. Throughout the ages this has been the fundamental situation in medical practice. The response on the physician's part has nearly always been an attitude of therapeutic optimism. At all times physicians--and patients also--have relied on therapeutic principles and remedies based on professional experience and medical theory. In conjunction with the (generally recognized) healing powers of nature, and of (unrecognized) autosuggestion, this has led to many satisfactory and even remarkable cures. Examples from antiquity to the 19th century are quoted, and the snags of an over-optimistic attitude become evident, viz. a rational therapy is no better than the underlying pathogenetic theory; exaggerated therapeutic activity may cause useless torment to the patient (a point already made by Hippocrates); the optimistic physician or the enthusiastic pioneer of a new remedy may be blind to toxic side effects or the development of addiction. To sum up: therapeutic optimism is fine--but don't overdo it!

Bloodletting↗
PubMed1981

State regulatory positions concerning therapeutic substitutions in hospitals.

State regulatory agencies were surveyed to determine their views concerning hospital policies that allow therapeutic substitution. A questionnaire consisting of 10 close-ended questions was sent to the executive secretary of each board of pharmacy in the 50 states and District of Columbia. Agencies were contacted by telephone in four weeks if they did not respond. Of the 51 jurisdictions surveyed, 34 answered all of the questions, 13 answered some, and 4 did not respond. None of the 13 partial respondents expressed their views concerning the legality of therapeutic substitution in the institutional setting. Fifteen agencies indicated they would view this practice as illegal, 17 said it is in accordance with policies established by the P & T committee and therefore not subject to state or federal regulation, and two agencies gave qualified responses. Seven agencies indicated enforcement procedures would be initiated if they were to learn that therapeutic substitution was being practiced in a hospital within their jurisdiction. Three states were uncertain about what action would likely be taken, 23 indicated no action would be taken, and two gave qualified responses. All 39 agencies responding to the question indicated they had never taken action against the practice of a formulary system that allows therapeutic substitution. Few state laws address the practice of therapeutic substitution, and opinions of regulatory agencies vary. Moreover, the opinions rendered have not been tested in the courts.

Government Agencies↗
PubMed1996

The impact of diagnostic testing on therapeutic interventions.

OBJECTIVE: To gain insight into the usefulness of managing the earlier phase of decision making, we examined the relationship between selected diagnostic tests and the therapeutic interventions they might trigger. DESIGN: Medicare's National Claims History and Part B files were used to obtain summary information on 100% of all physician claims submitted from 1987 through 1993. We regressed the annual rates of selected therapeutic interventions on selected diagnostic tests, which had been previously paired based on the clinical expectation that the test might drive subsequent intervention. POPULATION AND SETTING: These data represent the physician services received by approximately 30 million elderly Americans in each of 7 years. MAIN OUTCOME MEASURE: Coefficient of determination (R2). RESULTS: The annual rate for the diagnostic tests increased rapidly during the period (range, 1.4- to 3.0-fold increase) and accounted for the bulk of the variance in therapeutic intervention rates (R2>0.80, P<.01) for five diagnostic-therapeutic pairs: cardiac catheterization with cardiac revascularization procedures, imaging of the spine with back surgery, swallowing studies with percutaneous gastrostomy, mammography with breast biopsy and excision, and prostate biopsy with prostatectomy. Although the rate of abdominal ultrasound increased during the period, it was not related with either cholecystectomy or abdominal aortic aneurysm repair. CONCLUSION: There has been a substantial increase in diagnostic testing in the United States that closely tracked the increase of clinically relevant downstream procedures. Managing diagnostic testing could be an important strategy for controlling the increase of therapeutic interventions.

Diagnostic Tests, Routine↗
PubMed2002

Prophylactic and therapeutic inferior vena cava filters to prevent pulmonary emboli in trauma patients.

HYPOTHESIS: Insertion of inferior vena cava filters (IVCFs) can prophylactically reduce pulmonary embolism (PE) in trauma patients. DESIGN: Retrospective review. SETTING: Urban, level I trauma center. PATIENTS: Two hundred blunt trauma patients undergoing IVCF placement. INTERVENTIONS: In 122 patients who had already been diagnosed as having deep vein thrombosis (DVT) (112 patients) and/or PE (22 patients), the insertion of the IVCF was considered "therapeutic." In 78 patients who had no evidence of DVT or PE but who were considered to be at high risk for a PE, the IVCF was considered "prophylactic." MAIN OUTCOME MEASURES: Incidence of PE and related mortality and morbidity in therapeutic vs prophylactic IVCFs. RESULTS: The number of prophylactic IVCFs inserted increased significantly from only 4% (3/68 cases) from 1991 through 1996, up to 57% (75/132 cases) from 1997 to June 2001. Although the mean +/- SD age (51 +/- 20 years vs 41 +/- 15 years; P<.001) was higher in the therapeutic group, there was no difference in the mean +/- SD Injury Severity Scores (20 +/- 12 vs 21 +/- 11). Therapeutic filters were placed much later after injury (mean +/- SD time, 11 +/- 7 vs 3 +/- 2 days; P<.001). The mortality rate was 11% (13/122 patients) in patients having a therapeutic IVCF, as compared with only 3% (2/78 patients) in those placed prophylactically (P =.07). None of the patients who had placement of a prophylactic IVCF developed subsequent PE. The incidence of PE decreased in all blunt trauma patients from 0.29% before 1997 to 0.15% after January 1, 1997, when 57% of the IVCF inserted were prophylactic (P =.06). CONCLUSIONS: Prophylactic IVCFs should be inserted within 48 hours of injury in specific trauma patients at high risk for PE and with contraindications to anticoagulation.

Adult↗
PubMed2003

Prolonged therapeutic hypothermia after traumatic brain injury in adults: a systematic review.

CONTEXT: The benefits of therapeutic hypothermia as a treatment for traumatic brain injury (TBI) remain unclear. OBJECTIVE: To explore the effects of depth, duration, and rate of rewarming after discontinuation of hypothermia on mortality and neurologic outcome in adults after TBI. DATA SOURCES: An electronic search of MEDLINE (OVID), EMBASE, Current Contents, the Cochrane library and a hand search of key journals were performed. Corresponding authors of identified studies were contacted for additional unpublished or ongoing clinical trials. STUDY SELECTION: All randomized controlled trials of therapeutic hypothermia for at least 24 hours vs normothermia in adults with TBI. DATA EXTRACTION: Demographic and clinical data, hypothermia interventions and cointerventions, mortality and neurologic outcomes, and methodological quality were abstracted by 2 independent reviewers. DATA SYNTHESIS: Twelve trials met eligibility criteria and were included in the analysis. We also performed subanalyses by different hypothermia interventions (ie, depth, duration, and rapidity of rewarming after hypothermia) and methodological quality. Therapeutic hypothermia was associated with a 19% reduction in the risk of death (95% confidence interval [CI], 0.69-0.96) and a 22% reduction in the risk of poor neurologic outcome (95% CI, 0.63-0.98) compared with normothermia. Hypothermia longer than 48 hours was associated with a reduction in the risks of death and of poor neurologic outcome (relative risk [RR], 0.70; 95% CI, 0.56-0.87 and RR, 0.65; 95% CI, 0.48-0.89, respectively) compared with normothermia. Hypothermia to a target temperature between 32 degrees C and 33 degrees C, a duration of 24 hours, and rewarming within 24 hours were all associated with reduced risks of poor neurologic outcome compared with normothermia. Assessment of methodological quality did not reveal evidence of bias. CONCLUSIONS: Therapeutic hypothermia may reduce the risks of mortality and poor neurologic outcome in adults with TBI. Outcomes were influenced, however, by depth and duration of hypothermia as well as rate of rewarming (<or=24 hours) after discontinuation of hypothermia. Nonetheless, the evidence is not yet sufficient to recommend routine use of therapeutic hypothermia for TBI outside of research settings.

Adult↗
PubMed2000

The therapeutic alliance in couples and family therapy.

The therapeutic alliance is central to couples and family therapy. Although the formal concept of therapeutic alliance has not been used widely within the family therapy field, virtually every prominent clinical theorist has addressed the importance of establishing and maintaining a positive therapeutic relationship with the family. The alliance in couples and family treatment differs from the alliance in individual psychotherapy in that the couples and family therapist must establish and maintain multiple alliances. They also must adopt a conceptual framework that accounts for the interactions within triangles or three-person systems, recognize the influence of the system operating on him or her, and appreciate how different models of family therapy define the position of the therapist in relation to the couple or family. An integrative review of the therapeutic alliance in couples and family therapy is followed by a discussion of problems in the therapeutic relationship. Two general clinical strategies for managing difficulties in the alliance then are illustrated through case vignettes.

Adult↗
PubMed2006

Stable expression of soluble therapeutic peptides in eukaryotic cells by multimerisation: application to the HIV-1 fusion inhibitory peptide C46.

A major drawback of therapeutic peptides is their short half-life, which results in the need for multiple applications and high synthesis costs. To overcome this, we established a eukaryotic expression system that allows the stable expression of small therapeutic peptides by multimerisation. By inserting the sequence encoding the therapeutic peptide between a signal peptide and the multimerising domain of the alpha-chain from the human C4bp plasma protein, therapeutic peptides as small as 5 kDa are secreted as multimers from transfected cells; this allows easy purification. As proof of principle, we show that the T20-derived HIV-1 fusion inhibitory peptide C46 in its multimeric form: i) was efficiently secreted, ii) was more stable than the current antiviral drug T20 in vitro and in vivo, and iii) inihibited HIV-1 entry with similar efficiency in vitro. Besides the gain in stability, multimerisation also leads to increased valency and allows the combination of several therapeutic functions. Furthermore, by expressing the multimers from cells, post-translational modifications could easily be introduced.

Amino Acid Sequence↗
PubMed2002

Therapeutic ultrasound: its application in drug delivery.

Ultrasound is best known for its imaging capability in diagnostic medicine. However, there have been considerable efforts recently to develop therapeutic uses for it. The purpose of this review is to summarize some of the recent advances made in the area of therapeutic ultrasound as they relate to drug delivery. In particular, this review will focus on the applications of ultrasound to enhance the delivery and effect of three distinctive therapeutic drug classes: chemotherapeutic, thrombolytic, and gene-based drugs. In addition, ultrasound contrast agents have been recently developed for diagnostic ultrasound. New experimental evidence suggests that these contrast agents can be used as exogenous cavitation nuclei for enhancement of drug and gene delivery. Thus, brief review of this new class of agents and their roles in drug delivery will also be provided. By comparison to diagnostic ultrasound, progress in therapeutic use of ultrasound has been somewhat limited. The recent successes in ultrasound-related drug delivery research positions ultrasound as therapeutic tool for drug delivery in the future.

Animals↗