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At least 1,261 records · Page 70Linked to original sources
PubMed1998

Tramadol versus hydrocodone-acetaminophen in acute musculoskeletal pain: a randomized, double-blind clinical trial.

STUDY OBJECTIVE: To evaluate the efficacy of an oral tramadol preparation versus that of an oral hydrocodone-acetaminophen preparation in acute musculoskeletal pain. METHODS: A randomized, prospective, double-blind clinical trial was conducted in an urban teaching emergency department with an annual census of 41,000. Participants comprised a convenience sample of 68 adult ED patients with acute musculoskeletal pain caused by minor trauma. Thirty-three patients received tramadol (100 mg), and 35 patients received hydrocodone-acetaminophen (5 mg hydrocodone with 500 mg acetaminophen). The drugs were prepared in identical-appearing capsules. Pain was evaluated by a 100-mm visual analog scale (VAS) at baseline and at 30, 60, 90, 120, and 180 minutes after dosing. VAS scores were analyzed by 2-way repeated-measures ANOVA, and nominal data were analyzed by Fisher's exact test. RESULTS: Mean pain scores did not differ at baseline (tramadol, 68.3+/-21.8; hydrocodone-acetaminophen, 69.1+/-17.8; P=NS) but were significantly lower in the hydrocodone-acetaminophen group beginning at 30 minutes through 180 minutes. There were 6 dropouts as a result of reported inadequate analgesia, 3 in each group (P=NS). The discharge diagnoses and prevalence of side effects did not differ significantly between groups. CONCLUSION: Tramadol provides inferior analgesia to hydrocodone-acetaminophen in ED patients with acute musculoskeletal pain.

Acetaminophen↗
PubMed1984

Health-related behavior of adolescents: change over time.

A longitudinal study of the changes in health-related behavior in Israeli adolescents was undertaken in a large, comprehensive secondary school. The incidence of starting to smoke and its relationship to the development of sexual behavior was assessed. Smoking, use of drugs, sexual behavior, and drinking of alcoholic beverages at the age of 16 years was related to dropout from secondary school during the 2-year study period. The possibility of developing a model of adolescent risk behavior and its relevance to planning of health and educational services is discussed.

Adolescent↗
PubMedDate not supplied

Cultural, social, and intrapersonal factors associated with substance use among alternative high school students.

The purpose of this study was to identify cultural, social, and intrapersonal factors associated with tobacco, alcohol, and illicit drug use among students attending dropout prevention/recovery high schools. Four mutually exclusive categories of substance use were used as outcome measures, and religiosity, educational achievement, educational aspiration, family caring, others caring, self-esteem, optimism, coping, depression, loneliness, and self-efficacy were used as predictor variables. In the final multivariate model more family caring and loneliness were inversely associated with marijuana use; young age, more family caring, less coping ability, church attendance, and low educational aspirations were significantly associated with cocaine use. This study demonstrates the importance of health education and health promotion programs for students attending alternative high schools which include prevention of initiation, as well as treatment.

Adaptation, Psychological↗
PubMed1997

A cocaine-positive baseline urine predicts outpatient treatment attrition and failure to attain initial abstinence.

The primary study objective was to ascertain whether a prior finding that the baseline cocaine urine toxicology predicted treatment dropout for cocaine dependent outpatients could be extended to three additional cocaine dependent outpatient treatment samples and whether the urine toxicology also predicted attainment of initial abstinence for the four samples. A secondary objective was to ascertain the extent to which other baseline variables accounted for additional outcome variance over and above that afforded by urine toxicology. To evaluate the first objective, the relationships between the baseline cocaine urine and each of two measures of within treatment response--the completion of treatment or the attainment of initial abstinence--were determined for each of the treatment samples. The second objective was evaluated by a stepwise, hierarchical logistic regression analysis, with the urine toxicology entered in the first step, baseline Addiction Severity Index (ASI) variables in the second step, and achievement of initial abstinence as the outcome. In all four samples, patients with a urine indicative of recent cocaine use were less than half as likely to complete treatment or achieve initial abstinence. Individual ASI baseline variables did not contribute statistically significant variance over and above that predicted by the cocaine urine toxicology. The findings confirm the utility of the initial cocaine urine as a predictor of unfavorable outpatient treatment response.

Adult↗
PubMedDate not supplied

Dynamic Recovery: comparative study of therapeutic communities in homeless shelters for men.

The Dynamic Recovery Project examined relationships between homelessness, substance abuse, and recovery, and investigated the effectiveness of the therapeutic community (TC) treatment model in helping homeless drug users move toward stable, drug-free living. This project compared two short-term TCs that were situated within pre-existing homeless shelters with a clean and sober dormitory. In a separate condition, peer counselors and staff were provided additional training in TC philosophy and practice to reduce program dropout. Dramatic decreases in drug and alcohol use at follow-up were verified by urinalysis. Length of time in treatment rather than specific program accounted for decreased alcohol and drug use. Important decreases in posttreatment criminality for both treatment programs were documented. The comparison group, starting with low criminality, experienced smaller, nonsignificant decreases unrelated to type of program or time in treatment. Major declines in Beck Depression Scores were evident, but were unrelated to groups or time in treatment. Training had no measurable impact on client retention or outcomes and there were no significant differences between TCs and the comparison group on posttreatment drug use, criminality, or depression. This report documents that short-term therapeutic communities can be successfully implemented in public shelters for homeless men.

Adolescent↗
PubMed2000

An open-label study of a functional opioid kappa antagonist in the treatment of opioid dependence.

Several lines of evidence, including the well-established observation that kappa opiate agonists produce dysphoria and psychotomimetic effects in humans, suggest that dysfunction of the endogenous kappa opioid system may contribute to opioid and cocaine addiction. The objective of this open-label study was to determine the effectiveness of a functional kappa antagonist as a treatment for opioid dependence. This was accomplished by combining a partial mu agonist/kappa antagonist (buprenorphine, 4 mg, sublingual) with a mu antagonist (naltrexone, 50 mg by mouth), theoretically leaving kappa antagonism as the major medication effect. Subjects were treatment-seeking heroin-dependent (as per Diagnostic and Statistical Manual of Mental Disorders, 4th ed.) men (41 +/- 7 years old; 19 +/- 8 years heroin use) eligible for methadone maintenance. After inpatient detoxification and a naloxone-challenge test to verify that they were not physically dependent on opioids, subjects received naltrexone. Starting on the fourth day, patients also received liquid buprenorphine. All patients received medication at the clinic 6 days per week and a full program of psychosocial treatment. The major endpoints of the study were: pupil diameter to determine if the mu agonist effects of buprenorphine were blocked by naltrexone, urine toxicology, and retention in treatment. Five patients (33%) completed the 3-month study. Four were abstinent from opioids and cocaine for the entire study, and one was abstinent from opioids and cocaine for the last 9 weeks. Six subjects dropped out due to either minor side effects or disliking the sensation of sublingual buprenorphine. There were no significant changes in pupillary diameter. The positive response to treatment exceeds that expected from naltrexone alone (90% dropout). These promising results suggest that controlled studies of this medication combination should be conducted.

Administration, Sublingual↗
PubMed1998

The Gloucestershire Longitudinal Study of Disability: outcomes in nonresponders, responders, and subsequent defaulters.

Routine health checks of older adults (age > 75 years) are a potential source of disability data to inform general practitioners, trusts, and health authorities. The value of the data heavily depends on the representativeness of those agreeing to the checks. The aim of this study was to determine the outcomes of responders, subjects who refused the offer of a health check, and those who defaulted from regular health checks after the first year. A sample of 1815 subjects more than 75 years old, drawn from seven general practices, who started an annual routine health check in 1990. All were interviewed by their practice nurse using the Elderly At Risk Rating Scale. Survival and hospital admission rates were ascertained for responders and refusers. The average age of the responders was 81.1 (standard deviation [SD] 4.7); for refusers, 80.5 (SD = 7.7); and for dropouts, 80.2 (SD = 4.2). In women, the age-adjusted survival was 37.6 months (95% confidence interval [CI] 36.3-38.9) in refusers (70% survival) and 39.5 months (95% CI 38.4-40.6) in responders (73% survival); the respective figures in men were 37.4 months (95% CI 35.6-39.1, 67% survival) and 36.8 months (95% CI 34.9-38.7, 66% survival). Crude mortality rates of responders and the inhabitants of areas that matched the locations of the practices were similar. Hospital admission rates and mean length of stay were similar in responders and refusers. Similarly, those who defaulted did not differ from continued responders in their mortality or hospital admission rates. Nonresponders to elderly health checks and defaulters have similar health outcomes to responders.

Aged↗
PubMed2004

Saving clinicians' time by delegating routine aspects of therapy to a computer: a randomized controlled trial in phobia/panic disorder.

BACKGROUND: The demand for time-consuming psychotherapy of phobia/panic exceeds the supply of trained therapists. Delegating routine therapy aspects to a computer might ease this problem. METHOD: Ninety-three out-patients with phobia or panic disorder were randomized in a 2: 2 : 1 ratio to have self-exposure therapy guided either mainly by a stand-alone computer system (FearFighter) or entirely face-to-face by a clinician, or to have mainly computer-guided self-relaxation as a placebo. Both computer groups (FearFighter and relaxation) had brief back-up advice from a clinician. Primary outcome measures were self- and blind-assessor ratings of Main Problem and Goals, and Global Phobia. RESULTS: Drop-outs occurred significantly more often in the two self-exposure groups (43% if mainly computer-guided, 24% if entirely clinician-guided) than with self-relaxation (6%); the difference between the two self-exposure groups was not significant. Even with all drop-outs included, the mainly computer-guided exposure group and the relaxation group had 73% less clinician time per patient than did the entirely clinician-guided exposure group. The two self-exposure groups had comparable improvement and satisfaction at post-treatment and at 1-month follow-up, while relaxation was ineffective. Mean improvement on the primary outcome measures (self- and assessor-rated) was 46% computer, 49% clinician, 9% relaxation at post-treatment (week 10) and 58% computer, 53% clinician and -4% relaxation at 1-month follow-up (week 14). Mean effect sizes on the primary outcome measures were 2.9 computer, 3.5 clinician and 0.5 relaxation at post-treatment; and 3.7 computer, 3.5 clinician and 0.5 relaxation at 1-month follow-up. The assessor did not rate patients at follow-up. CONCLUSIONS: Despite its (non-significantly) higher dropout rate, self-exposure therapy for panic/ phobia cut clinician time per patient by 73% without losing efficacy when guided mainly by a computer rather than entirely by a clinician. The finding needs confirmation at a follow-up that is longer and includes a blind assessor. Self-relaxation had the highest rate of completers but was ineffective.

Analysis of Variance↗
PubMed2001

Antidepressant efficacy and safety of low-dose sertraline and standard-dose imipramine for the treatment of depression in older adults: results from a double-blind, randomized, controlled clinical trial.

This study compared the efficacy and tolerability of 150 mg/day imipramine and 50 mg/day sertraline for the treatment of a major depressive episode (DSM-IV) in older adults (N = 55) in an 8-week, randomized, double-blind, controlled clinical trial. Intention-to-treat analysis (last observation carried forwards) showed a reduction of 50% or more on the baseline scores of the Montgomery-Asberg Rating Scale (MADRS) in 60.7% and 55.6% of patients receiving imipramine and sertraline, respectively (p = .698). Full remission of symptoms (MADRS < 9) was observed in 50.0% and 51.8% of patients, respectively (p = .891). Side effects were more frequent among patients treated with imipramine (86.7%) than among patients treated with sertraline (42.1%) (p = .008). Dropout rates were high in both groups (46.4% and 29.6% respectively, p =.200). These results indicate that imipramine and sertraline are equally effective for the treatment of major depression in later life, although adverse reactions are more frequent among subjects treated with imipramine than with sertraline.

Aged↗
PubMed1992

Panel attrition and external validity in adolescent substance use research.

Panel attrition threatens external validity in adolescent substance use research. A 7-year adolescent panel was examined to determine whether attrition effects varied by (a) type of substance assessed and (b) method of measurement and type of statistical analysis. Chi-squares and multivariate analyses of variance revealed that study dropouts were more likely to use substances and reported higher mean use of substances at baseline than stayers; attrition effects varied by substance; and mean use comparisons were more likely to detect attrition effects than use-nonuse comparisons. Implications of these findings for adolescent substance use research are discussed.

Adolescent↗
PubMed2003

Navigating disrupted transitions: getting back on track after dropping out of high school.

Using ecological-developmental and resilience perspectives, this study utilizes quantitative and qualitative methods to examine the role of family, community, and individual variables in reestablishing school and work pathways for a diverse sample of 182 Boston-area high school dropouts. Extra familial involvement and individual coping style prove the best predictors of on-track status.

Adolescent↗
PubMed1997

Academic success among students at risk for school failure.

A sample of 1,803 minority students from low-income homes was classified into 3 groups on the basis of grades, test scores, and persistence from grade 8 through Grade 12; the classifications were academically successfully school completers ("resilient" students), school completers with poorer academic performance (nonresilient completers), and noncompleters (dropouts). Groups were compared in terms of psychological characteristics and measures of "school engagement." Large, significant differences were found among groups on engagement behaviors, even after background and psychological characteristics were controlled statistically. The findings support the hypothesis that student engagement is an important component of academic resilience. Furthermore, they provide information for designing interventions to improve the educational prognoses of students at risk.

Achievement↗
PubMed2002

Incidence and determinants of sildenafil (dis)continuation: the Dutch cohort of sildenafil users.

Sildenafil utilization was prospectively evaluated among 153 men with a history of erectile dysfunction (ED)-prescription drug use prior to starting sildenafil and 164 men who were new starters of ED-prescription drugs. Further, some determinants of sildenafil discontinuation were identified. During a median follow-up period of 18 months 45% of all patients discontinued sildenafil treatment, regardless of earlier treatment history. However, patients with a history of drug treatment for ED were nearly eight times as likely to switch or re-start another ED-prescription drug after discontinuing sildenafil compared to previously untreated users. Age >60 y, diabetes medication, nitrate use, and use of incontinence pads (a proxy for disease/surgery in the pelvic region) were associated with an increased likelihood of discontinuing sildenafil. Although the introduction of sildenafil reduced the barrier to seek medical help for erectile problems, sildenafil treatment failure in previously untreated patients results in a high dropout rate from further ED drug treatment of any kind.

Aged↗
PubMedDate not supplied

Compliance of sildenafil treatment for erectile dysfunction and factors affecting it.

To assess the compliance of treatment, its affecting factors, and reasons for dropout, a questionnaire was mailed to a cohort of 2139 subjects who received sildenafil prescriptions for erectile dysfunction (ED) at our institution from 1999 to 2002. A total of 726 subjects (34%) with a mean age of 67 years answered the questionnaires. The response rate for sildenafil treatment was 67%. Of these sildenafil responders, 43% reported that they continued using sildenafil while 57% did not, in a mean follow-up of 3 years. Common reasons for discontinuation were effect below expectations, high cost, loss of interest in sex, and inconvenience in obtaining sildenafil. The continuers showed a higher rate than the discontinuers (P < 0.05) of having tried other treatments, dose titration, and a dose higher than 50 mg. The discontinuers reported having a lower mean responding dose and improvement score post sildenafil treatment than the continuers. In conclusion, effect below expectations was the leading reason for discontinuation of sildenafil treatment. How ED subjects tried the medication and the adequacy of education in the initial treatment period may impact the compliance of sildenafil treatment.

Aged↗
PubMedDate not supplied

Intracavernosal prostaglandin E1 self vs office injection therapy in patients with erectile dysfunction.

We have investigated the reliability of intracavernosal prostaglandin E1 (PGE1) office vs self-injection therapy in patients with erectile dysfunction (ED). A total of 298 male patients with ED were enrolled in this study. In all patients, intracavernosal titration of the PGE1 dose was performed. A total of 106 patients were enrolled in the self-injection program, and 192 patients were enrolled in the office injection program. There were significant differences between number of injections and amount of PGE1 per month, total number of injections, and total amount of PGE1 on office and self-injection programs (P < 0.05 for each). There was a significant increase in the dropout rate in the office injection group compared with the self-injection group (P < 0.05). There was an increase in penile fibrosis in the self-injection program compared with the office program (P < 0.05). A self-injection program is reliable. Office injection program can be reserved for a subset of ED patients with special preferences.

Adult↗
PubMed2003

Modern statistical methods for handling missing repeated measurements in obesity trial data: beyond LOCF.

This paper brings together some modern statistical methods to address the problem of missing data in obesity trials with repeated measurements. Such missing data occur when subjects miss one or more follow-up visits, or drop out early from an obesity trial. A common approach to dealing with missing data because of dropout is 'last observation carried forward' (LOCF). This method, although intuitively appealing, requires restrictive assumptions to produce valid statistical conclusions. We review the need for obesity trials, the assumptions that must be made regarding missing data in such trials, and some modern statistical methods for analysing data containing missing repeated measurements. These modern methods have fewer limitations and less restrictive assumptions than required for LOCF. Moreover, their recent introduction into current releases of statistical software and textbooks makes them more readily available to the applied data analyses.

Clinical Trials as Topic↗
PubMed1998

Peritoneal dialysis in nondiabetic patients older than 70 years: comparison with patients aged 40 to 60 years.

In all industrial countries, the number of elderly patients who need dialysis has increased in recent years. In the present study, we retrospectively analyzed two different age groups of nondiabetic peritoneal dialysis patients treated at the same unit by the same team of physicians and nurses with the same protocols. However, our purpose was to study possible differences in technique and survival rates, causes of dropout, complications, hospitalization rate, and everyday needs between the two groups. The results of 63 consecutive nondiabetic patients older than 70 years treated with continuous ambulatory peritoneal dialysis (CAPD) were compared with those of 86 nondiabetic patients aged 40 to 60 years treated during the same period. Patient survival was significantly worse in the elderly patients, but the observed to expected survival ratio with respect to age was similar. Technique survival was comparable in the two groups. Total hospitalization was 5,501 days (32 d/yr) in the elderly patients and 4,511 days (18 d/yr; P < 0.05) in the younger group. The peritonitis rate was 0.52 episodes/patient-year in the elderly patients and 0.37 episodes/patient-year in the younger patients (P < 0.002). The exit site infection rate was similar in the two groups (0.30 episodes/yr v0.29 episodes/yr). Other complications related to CAPD did not differ between the elderly and younger patients. Rehabilitation and biochemical data after 1 year of CAPD were similar in the two groups of patients. After 1 year of treatment, 12% of the younger patients and 43% of the elderly patients (P < 0.005) needed a partner for dialysis. Twenty-nine of 39 (74%) of the elderly patients and 30 of 53 (57%) of the younger patients considered their lifestyle acceptable after 1 year of dialysis. Thirty-four of 39 (87%) of the elderly patients and 32 of 53 (60%) of the younger patients (P < 0.02) rated their physical and social state after rehabilitation as better or comparable to that they had before terminal uremia.

Adult↗
PubMed2003

Adherence and mental side effects during hepatitis C treatment with interferon alfa and ribavirin in psychiatric risk groups.

Psychiatric disorders or drug addiction are often regarded as contraindications against the use of interferon alfa (IFN-alpha) in patients with chronic hepatitis C. Our aim was to obtain prospective data on adherence to as well as efficacy and mental side effects of treatment with IFN-alpha in different psychiatric risk groups compared with controls. In a prospective trial, 81 patients with chronic hepatitis C (positive hepatitis C virus[HCV] RNA and elevated alanine aminotransferase[ALT] level) and psychiatric disorders (n = 16), methadone substitution (n = 21), former drug addiction (n = 21), or controls without a psychiatric history or drug addiction (n = 23) were treated with a combination of IFN-alpha-2a 3 MU 3 times weekly and ribavirin (1,000-1,200 mg/d). Sustained virologic response (overall, 37%) did not differ significantly between subgroups. No significant differences between groups were detected with respect to IFN-alpha-related development of depressions during treatment. However, in the psychiatric group, significantly more patients received antidepressants before and during treatment with IFN-alpha (P <.001). Most of those who dropped out of the study were patients with former drug addiction (43%; P =.04) compared with 14% in the methadone group, 13% in the control group, and 18% in the psychiatric group. No patient in the psychiatric group had to discontinue treatment because of psychiatric deterioration. In conclusion, our data do not confirm the supposed increased risk for IFN-alpha-induced mental side effects and dropouts in psychiatric patients if interdisciplinary care and antidepressant treatment are available. Preexisting psychiatric disorders or present methadone substitution should no longer be regarded as contraindications to treatment of chronic hepatitis C with IFN-alpha and ribavirin in an interdisciplinary setting.

Adult↗