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PubMed1999

Viral and host factors in determining response of relapsers with chronic hepatitis C to retreatment with interferon.

In chronic hepatitis C the rate of relapse after an end-of-treatment response to interferon may exceed 50%. The usefulness of retreatment of relapsers with interferon in obtaining a complete sustained response and the role of clinical, virological and immunological features in determining long-term efficacy of retreatment are unclear. We aimed to assess the efficacy of interferon retreatment in obtaining a complete sustained response, to evaluate whether increasing the dose may enhance responsiveness, and to identify possible predictors of sustained response. We enrolled 42 patients with biopsy-proven chronic hepatitis C without cirrhosis who had previously responded to a six-month course of Interferon-alpha2b (total dose: group A, 22 patients, 234 MU; group B, 20 patients, 468 MU) and then relapsed. All, except one, were HCV-RNA negative at the end of first cycle of interferon; most (31/42, 74%) were infected by HCV 1b. Subjects were randomly allocated to receive another cycle of interferon either at the original dose (group A1: 234 MU, 11 patients; group B1 468 MU, 10 patient) or twice the original dose (group A2: 468 MU, 11 patients; group B2: 936 MU, 10 patients). At the end of the second cycle of interferon, 24 subjects (57%) had normal ALT and were HCV-RNA negative, and 16 (39%) had normal ALT, but were HCV-RNA positive. A complete sustained response was obtained in eight patients (19%), at a similar rate in all treatment groups. Complete sustained responders were different from the other patients in terms of age (35.9 +/- 10.4 vs 44.1 +/- 8.8, P = 0.027), rate of infection with non-1b HCV (6/8 vs 5/34, P = 0.0005), serum HCV-RNA (74,016 vs 321,428 median copies/ml, P = 0.037) and serum levels of 90K/MAC-2 BP (5.76 +/- 3.01 vs 10.25 +/- 5.16 units/ml, P = 0.02), an N-glycoprotein implicated in cellular defense functions. Multivariate logistic analysis validated age and HCV genotype as independent predictors of CSR. Among noncirrhotic relapsers who received a total interferon dose > or = 234 MU in the first cycle, retreatment usually induced end-of-treatment response. A complete sustained response was obtained in only one of every five subjects. Increasing the dose of interferon above that of the first cycle did not enhance the rate of sustained response. In conclusion we might assert that young subjects infected by non-1b HCV and with low levels of HCV-RNA and of 90K/MAC-2 BP are the best candidates for retreatment.

Adult↗
PubMed2000

Willingness to pay for the retreatment of mosquito nets with insecticide in four communities of south-eastern Nigeria.

OBJECTIVES: To determine the willingness to pay (WTP) for the retreatment of insecticide-treated nets (ITN) in four malaria holoendemic communities of Nigeria. METHODS: Contingent valuation method. The study tool was a pretested interviewer-administered questionnaire. Randomly selected households were the study units and household heads or their representatives were interviewed by locally trained interviewers. RESULTS: Most households were willing to pay for annual ITN retreatment in all four communities. The proportion of those willing to pay ranged from 79% to 91%. WTP amounts ranged from $0.05 to $5.26. The median from the aggregated data from the four communities was $0.21. Multivariate analysis showed that many explanatory variables were statistically significantly related to WTP for ITN retreatment. CONCLUSION: WTP for ITN retreatment exists. The difficulty lies in implementing this. One possibility would be a community-based ITN retreatment programme.

Cross-Sectional Studies↗
PubMed1989

Time course of loss of residual radiation damage in murine skin assessed by retreatment.

The amount of radiation damage remaining in mouse foot skin has been assessed by retreatment from 10 days to 6 months after a range of first doses. The acute skin reaction was used as the endpoint. Mice hind feet were first irradiated with a range of single doses (15-37.5 Gy) covering zero to near full effect. Feet were retreated with a full range of single doses together with groups of non-previously treated age-matched control mice. No age-related changes in radiation sensitivity were observed. Dose-response curves were constructed for all retreatment times for each priming dose, and isoeffect doses were calculated for both peak and average skin reactions. If 2-6 months were allowed to elapse before retreatment, the skin could be reirradiated as if it were previously untreated. However, if only 1 month was allowed to pass before retreatment, damage was 'remembered' after all first doses. The amount of damage 'remembered' in terms of dose was 11 Gy after a first dose of 37.5 Gy, and was less after the lower first doses.

Animals↗
PubMed2000

The pediatric intern retreat: 20-year evolution of a continuing investment.

For the past 22 years the interns in pediatrics at the University of Washington and Children's Hospital and Regional Medical Center have been relieved of all clinical duties in order to participate in a five-day retreat. The retreat provides an opportunity for the interns to learn more about their classmates, build stronger bonds, and provide mutual support. This retreat has been supported by the hospital, the department of pediatrics, faculty, fellows, and community physicians. The authors describe the history of the Intern Retreat, present its goals, daily activities, and faculty, and discuss how the retreat is funded and supported by the hospital and the medical community.

Humans↗
PubMed1994

Retreatment of intracranial gliomas.

Although intracranial gliomas carry a poor long-term prognosis, retreatment at the time of tumor progression may prolong survival and maintain or improve the quality of life. Thirty-three patients who underwent retreatment with surgery, radiotherapy, and chemotherapy were reviewed retrospectively. Median survival after initiation of retreatment was 8 months for glioblastoma, 13 months for anaplastic astrocytoma, 22 months for astrocytoma, and 47 months for oligodendroglioma/mixed glioma. Survival was significantly better for younger patients and for those with better functional status. One third of patients were neurologically improved by surgery. Surgical morbidity was minimal (2.1%); there was no surgical mortality. Chemotherapy and radiotherapy produced expected adverse reactions. Retreatment of intracranial gliomas carries acceptable risk and is beneficial in selected patients. Decisions regarding retreatment must be carefully individualized with consideration of the quality of life and the wishes of the patient and family.

Adult↗
PubMed1979

Retreatment of endodontic fillings.

Effects of endodontic retreatment on quality of seal and periapical healing were assessed among 660 previously root-filled roots. The roots were divided into either of two groups according to presence or absence of pathologic alterations in the periapical area. The retreatments, which were carried out by dental students, involved a thorough chemomechanical debridement of the root-canal system aiming to control infection. Following a 2-year observation period 556 roots were reexamined clinically and radiographically. The results showed that root-fillings with technical shortcomings could, following retreatment, be markedly improved as regards effectiveness of seal and distance to the apex. A large number of lumina discernible apical to root-filling could also be treated and filled. Seventy-eight percent of the cases with pathologic lesion present periapically prior to retreatment either completely healed or displayed an obvious size-reduction of the process. Retreatments carried out because of technical inadequacies alone were successful in 94% of the cases. It was concluded that renewed endodontic treatment whenever possible is the method of choice when treating defective endodontic fillings complicated with pathologic processes periapically. Apical surgery may be attempted if no signs of healing are apparent following observation.

Adult↗
PubMed2005

Retreating glacier fronts on the Antarctic Peninsula over the past half-century.

The continued retreat of ice shelves on the Antarctic Peninsula has been widely attributed to recent atmospheric warming, but there is little published work describing changes in glacier margin positions. We present trends in 244 marine glacier fronts on the peninsula and associated islands over the past 61 years. Of these glaciers, 87% have retreated and a clear boundary between mean advance and retreat has migrated progressively southward. The pattern is broadly compatible with retreat driven by atmospheric warming, but the rapidity of the migration suggests that this may not be the sole driver of glacier retreat in this region.

Journal Article↗
PubMed2005

Optical coherence tomography guided retreatment of photodynamic therapy.

AIM: To evaluate the results of a retreatment modality of photodynamic therapy (PDT) based on optical coherence tomography (OCT) and fluorescein angiography (FA). To quantify the effect of PDT with the help of measurement of the retinal thickness. METHODS: Eyes with predominantly classic subfoveal choroidal neovascularisation (CNV) due to age related macular degeneration were included. PDT was performed every three months, when needed. OCT, FA, and measures of distance acuity were performed at baseline, after 6 weeks, 3 months, and from then on every 3 months. A control group of a consecutive series of eyes that had been retreated based only on FA results was installed. RESULTS: Forty eyes of 38 patients were included. The average age was 73 years. The maximum retinal thickness decreased from 404 mum at baseline to 281.6 mum at month 12. Furthermore there was a significant decrease of retinal thickness in both subgroups. The number of retreatments was reduced, when activity was diagnosed using OCT and FA. (2.4 v 4.0). The distance acuity correlated significantly with the maximum retinal thickness (p=0.0042). CONCLUSION: Information about the activity of a neovascular lesion can be obtained with the help of OCT. The retreatment modalities can be optimised by using OCT and FA and the number of retreatments can be reduced.

Aged↗
PubMed2001

A randomized trial of lansoprazole, amoxycillin, and clarithromycin versus lansoprazole, bismuth, metronidazole and tetracycline in the retreatment of patients failing initial Helicobacter pylori therapy.

BACKGROUND/AIM: 10-30% of the patients treated for Helicobacter pylori fail to clear the infection after initial therapy. Little is known as to the efficacy of retreatment regimens in these patients. Proton pump inhibitor (PPI) -based triple and quadruple therapies demonstrate efficacies of 80-90% as initial therapy for H. pylori infection, but whether these regimens are as effective when used for retreatment is unknown. The efficacy of a metronidazole-containing regimen in this situation is also unknown. Our aim was to compare the efficacy of a nonmetronidazole-containing PPI-based triple versus a PPI-based quadruple therapy containing metronidazole in patients failing previous H. pylori therapy. METHODS: 48 patients were enrolled in this study at two sites after failure of previous H. pylori therapy as determined by a positive (14)C-urea breath test. Patients were stratified by prior treatment with a metronidazole-containing regimen and were then randomized to either lansoprazole (L) 30 mg twice daily, amoxycillin (A) 1,000 mg twice daily, and clarithromycin (C) 500 mg twice daily for 14 days (LAC) or L 30 mg four times daily, bismuth subsalicylate (B) 2 tablets four times daily, metronidazole (M) 250 mg four times daily and tetracycline (T) 250 mg four times daily for 14 days (LBMT). Side effects and compliance (pill count) were assessed at the completion of therapy. A repeat (14)C-urea breath test was performed 4 or more weeks after completion of therapy, and cure was defined as a negative test result. RESULTS: 48 patients (16 males and 32 females) were enrolled in this study. 20 patients received LAC (18 prior M), and 28 received LBMT (23 prior M). Per protocol and intention-to-treat efficacies were 82% (95% CI 64-100%) and 75% (95% CI 56-94%) for LAC and 80% (96% CI 64-96%) and 71% (95% CI 54-88%) for LBMT (p = 0.85 per protocol and p = 0.78 intention to treat between LAC and LBMT), respectively. The compliance (> or =80% of pills taken) was found to be 89% in both treatment groups. Side effects were noted in 84% for LAC and in 82% for LBMT, but were mild and did not cause discontinuation of therapy. CONCLUSIONS: PPI-based triple and quadruple therapy with both LAC and LBMT are effective in retreating patients failing initial metronidazole-based H. pylori therapies. LAC was not statistically superior to LBMT as a 'retreatment' regimen in this clinical situation, but the small sample size and wide confidence limits do not preclude the possibility of a smaller but significant difference in efficacy between the regimens. To determine whether LAC or LBMT is as effective for retreating patients failing non-metronidazole-containing regimens requires further study.

2-Pyridinylmethylsulfinylbenzimidazoles↗
PubMed1981

Should isoniazid be used in retreatment of tuberculosis despite acquired isoniazid resistance?

The use of high-dose isoniazid in retreatment regimens for tuberculosis, despite acquired isoniazid resistance, could possibly improve therapeutic results if all or part of the organisms were resistant to only low concentrations of that drug. Furthermore, organisms resistant to low concentrations of isoniazid have been shown, on occasion, to be resistant to 2 of the retreatment drugs, ethionamide and pyrazinamide, whereas higher degrees of isoniazid resistance are associated with susceptibility to these drugs. Use of high-dose isoniazid might improve results in retreatment with ethionamide and pyrazinamide by eliminating any organisms with low degrees of isoniazid resistance that have associated ethionamide and pyrazinamide resistance. Two clinical trials concerning this topic have been reported. A controlled retreatment trial with various combinations of ethionamide, cycloserine, and pyrazinamide with and without conventional "low" doses of isoniazid (300 mg per day) showed no benefit when isoniazid was added. However, a noncontrolled trial using ethionamide and pyrazinamide with and without high doses of isoniazid, 1 to 1.5 g per day, showed marked benefit with the added isoniazid. In view of these conflicting data, the use of high-dose isoniazid in retreatment regimens needs further study, which could probably be carried out in the developing countries.

Dose-Response Relationship, Drug↗
PubMed2003

Humanities in full retreat.

BACKGROUND: Professionalism is a crucial component that sustains the status and practice of clinical medicine. DESCRIPTION: At the Penn State College of Medicine, Milton S. Hershey Medical Center, the Department of Humanities has developed a cross-disciplinary, annual retreat for resident leaders to help them reflect on the nature of professionalism and on what it means to be a role model. The retreat also provides resident leaders the opportunity to discuss common challenges such as dealing with the stress of residency, giving bad news, working with "difficult" patients, dealing with one's mistakes, and finding meaning and purpose in medicine. EVALUATION: The retreat is evaluated by resident participants using a Likert scale and open-ended responses and has received consistently excellent evaluations. CONCLUSION: We have developed an effective, consistently successful retreat for providing residents across the spectrum of medical training with an enriching humanities experience. Such a retreat could be easily exported to other institutions to promote professionalism during residency.

Humanities↗
PubMed2000

Helicobacter pylori eradication in clinical practice: retreatment rates and costs of competing regimens.

OBJECTIVE: To measure outcomes for eradication regimens for Helicobacter pylori infection in routine clinical practice. DESIGN: Retrospective analysis of an integrated medical and pharmacy claims database identified patients treated from June 1, 1995 through May 31, 1996, and followed the patients' claims until December 31, 1996. SETTING: The database represented multiple health plans throughout the US. PATIENTS: Patients were > or = 16 years old, continuously enrolled from April 1, 1995, to December 31, 1996, and met clinical (diagnostic or procedural) criteria. INTERVENTION: Patient cohorts were treated with bismuth-based triple (n = 98), proton-pump inhibitor (PPI)-based triple (n = 180), or PPI-based dual (n = 337) regimens. OUTCOME MEASURES: Retreatment; monthly postregimen medical expense, controlling for preregimen expense; and drug cost per successfully treated patient. Cox regression (retreatment analysis) and ANCOVA (postregimen expense analysis) adjusted for age, gender, diagnostic/procedural criteria met by patient, and specialty physician use. RESULTS: Retreatment rates were higher (p < 0.05) for PPI-based dual than bismuth-based or PPI-based triple-therapy cohorts. Retreatment rates for bismuth- and PPI-based triple-therapy cohorts were not significantly different. Total and follow-up (excluding the first 2 wk of treatment) expenses were higher for retreated than nonretreated patients (p < 0.01). Total expenses were higher for the PPI-dual cohort (p < 0.05) than for triple cohorts. Drug costs per successfully treated patient were $30 for bismuth-based, $172 for PPI-based triple, and $208 for PPI-based dual-therapy regimens. CONCLUSIONS: PPI-based dual-therapy regimens are not cost-effective in H. pylori treatment. Further study should compare more costly (PPI-based) versus less costly (bismuth-based) triple-therapy regimens.

Adolescent↗
PubMedDate not supplied

Four techniques for retreatment after excimer laser photorefractive keratectomy.

BACKGROUND: Retreatment should be considered for patients unsatisfied because of undercorrection and/or haze following excimer laser photorefractive keratectomy (PRK) for myopia. It is unclear if any specific type of retreatment is superior to another, especially in terms of post-treatment myopic shift and haze. METHODS: After a mean follow-up of 12.4 +/- 5.5 months, we retreated 10 eyes by four different techniques following failed PRK: only PRK, PRK with phototherapeutic keratectomy (PTK), only PTK, and mechanical scraping. RESULTS: After a mean follow-up of 11.4 +/- 7.8 months (range, 6 to 28 mos), the final mean refraction was 2.40 +/- 2.00 D (range, 0 to -6.00 D). Corneal clarity improved in 70% of eyes. The mean uncorrected visual acuity improved from 20/200 to 20/40. Of the four retreatment techniques, only scraping proved ineffective, due to unstable outcome. CONCLUSIONS: PRK alone, PRK with PTK, and PTK alone appeared safe and effective methods of retreatment, with no worsening of corneal clarity.

Adult↗
PubMedDate not supplied

Retreatment to enlarge small excimer laser optical zones using combined myopic and hyperopic ablations.

PURPOSE: We describe a retreatment technique using a combination of large-diameter myopic and hyperopic excimer laser ablations of a near equivalent diopter value to enlarge previous small ablation zones without altering the refractive result obtained by the initial surgery. METHODS: Eight eyes of six patients were retreated with a Technolas Keracor 217 laser in order to enlarge the optical zone. All patients had a good refractive result after the initial surgery, but reported halos under low light conditions. Retreatment consisted of a combination of myopic and hyperopic ablations of near equivalent value, eg, -1.00 D and +1.00 D treatment. These opposite value ablations should neutralize their respective refractive effect, but by removing a larger diameter of tissue, actually displace the transition zones further toward the corneal periphery. Although the initial treatment used photorefractive keratectomy in four of the eight eyes, LASIK was used for retreatment in all eyes. Improvement was assessed subjectively by the patient and was measured objectively with a Technomed C-Scan ray-tracing program. RESULTS: In six of eight eyes, patients experienced moderate or marked improvement. This improvement was objectively correlated on postoperative corneal topography. CONCLUSION: Combined larger diameter myopic and hyperopic retreatment seems to be safe and effective for enlarging previous small treatment zones, reducing symptoms such as halos in selected patients.

Cornea↗
PubMed2002

Results of combined myopic astigmatic LASIK treatment and retreatments.

PURPOSE: A study of combined LASIK treatment and retreatment results for both myopia and myopic-astigmatic correction. METHODS: Three hundred fifty-three consecutive eyes underwent LASIK surgery using the VISX Star excimer laser. Preoperative mean sphere was -6.37 +/- 2.93 D with mean cylinder of +1.01 +/- 0.9 D. The initial refraction of the 40 patients needing retreatment was -7.42 +/- 2.49 D with a mean cylinder of +1.0 +/- 0.61 D. RESULTS: Data were analyzed in the following way: Group I: Primary treatment (all); Group II: Group I excluding retreatment; Group III: Retreatment; and Group IV: Groups II and III combined. Postoperative uncorrected visual acuity (UCVA) data at 1, 3, and 6 months were: Group I: 20/40 or better 90.5%, 87.2%, and 89.5%; 20/20 or better 52.0%, 48.9% and 59.6%; Group II: 20/40 or better 95.0%, 95.2%, and 95.7%: 20/20 or better 52.0%, 62.6% and 63.8%; Group III: 20/40 or better 97.5%, 97.5%, and 100%; 20/20 or better 80%, 76% and 77%; and Group IV. 20/40 or better 97%; 20/20 or better 63% at six months. Pretreatment degree-of-myopia comparison in Group I was (0-3 D) 90% 20/20 UCVA after 6 months; (-6 - -9 D) 60% 20/20; and (> -12 D) 44% 20/20. Complications included 1 free flap, 1 partial flap, and 4 epithelial ingrowths. CONCLUSIONS: These results demonstrate myopic-astigmatic LASIK treatment to be safe, effective, and predictable in correcting myopia and associated astigmatisms. For patients requiring retreatment, results are excellent. Results should be reviewed after all treatments have been completed. The success rate for LASIK surgery seems to be directly related to the degree of myopia. As myopia increases, the chance of achieving 20/20 vision decreases.

Adult↗
PubMedDate not supplied

Changes in spirituality and well-being in a retreat program for cardiac patients.

CONTEXT: Many epidemiological studies indicate that spirituality or religion are positively correlated with health measures, but research is needed on interventions that change spirituality to verify that it actually affects health and to justify suggestions that changes in spiritual practices or beliefs may have health benefits. However, it is not clear that health interventions can influence spirituality or which techniques are effective. OBJECTIVE: To evaluate whether participation in a retreat program for cardiac patients and their partners resulted in changes in spirituality and whether changes in spirituality were related to changes in well-being meaning in life, anger, and confidence in handling problems. DESIGN: Participants filled out questionnaires before and after participating in the retreat. SETTING: Retreats were sponsored by the Health Promotion and Wellness Program, University of Wisconsin-Stevens Point, and were held in a remote training center. PARTICIPANTS: Notices were sent to cardiac rehabilitation programs and directly to heart patients, resulting in the enrollment of 72 first-time participants. INTERVENTION: The 2.5-day educational retreats included discussion and opportunities to experience healthy lifestyle options. Exercise, nutrition, stress management techniques, communication skills that enhance social support, and spiritual principles of healing were incorporated. Experiential practices included yoga, meditation, visualization, and prayer. RESULTS: Of the participants, 78% reported increased spirituality after the retreat. Changes in spirituality were positively associated with increased well-being meaning in life, confidence in handling problems, and decreased tendency to become angry. CONCLUSIONS: Programs that explore spirituality in a health context can result in increased spirituality that is associated with increased well-being and related measures. Many patients and their families want to integrate the spiritual and health dimensions of their lives. Further work is needed to develop healthcare settings that can support this integration.

Adaptation, Psychological↗
PubMedDate not supplied

Organizing a practice retreat.

Medical practices are often so busy that physicians and their staff have difficulty seeing the big picture. A well-organized practice retreat can provide needed time and space for tackling large practice management problems and establishing new goals. In addition, a practice retreat can enable staff members to get to know each other better and learn new ways to function as a cohesive team. In this article, the author describes the similarities and differences between single-task and team-building retreats. In addition, the author shares practical do's and don'ts for organizing worthwhile medical practice retreats and makes suggestions about possible locations for retreats, recommended follow-up, and team-building exercises.

Group Processes↗
PubMed2003

[A study on pulmonary tuberculosis retreatment cases].

OBJECTIVE: To investigate the factors leading to the retreatment for tuberculosis. MATERIALS: Forty-seven retreatment cases with pulmonary tuberculosis, who were discharged from the National Chiba Higashi Hospital from 2000 to 2002. METHODS: Data on all retreatment cases were studied as to the condition of the original treatment and factors leading to the retreatment. RESULTS: Of the 47 cases, 33 cases received the original treatment in our hospital. Of the 33 cases, 24 cases were relapsed cases and 9 cases were defaulters. Most relapsed cases were male aged 50s and 12 cases (50%) were jobless. As the factors leading to retreatment, the delay in the negative conversion of sputum culture accounted for 11 cases (45.8%) out of 24 cases. No specific factors were found in three cases (12.5%). Among the defaulters, no bias was seen as to age and occupation of cases, but all the cases were male, and they defaulted during the maintenance phase of treatment at the out-patient department. CONSIDERATION: The delay in the negative conversion of sputum culture was the main factor relating to the relapse. Diabetes mellitus (DM) is one of the factors leading to the relapse, but many factors were observed in DM patients. Male cases aged 50s had many factors leading to the relapse. An intensive management for out-patients and involvement of welfare department aiming at the completion of treatment for the socially vulnerable groups might be necessary as the measure to prevent defaulting. CONCLUSION: The delay in the negative conversion of sputum culture was the main factor leading to relapse, and intensive management for out-patients aiming at the completion of treatment is necessary to prevent the defaulting.

Adult↗