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PubMed1988

Effect of a CVIS instructional program regarding therapeutic communication on student learning and anxiety.

This quasi-experimental, pretest-posttest design study explored the effect of a computer video-interactive system (CVIS) instructional program regarding therapeutic communication on senior baccalaureate nursing students' learning and anxiety as they anticipated interaction with patients in psychiatric settings. The 75 subjects were randomly divided into two groups. Group I received a basic lecture and a supplementary CVIS instructional program on therapeutic communication, while Group II received the same lecture discussion on therapeutic communication and a videotape. Two hypotheses were tested, using analyses of covariance. Hypothesis I, that Group I would score significantly higher on a therapeutic communication posttest than would Group II, was supported (P less than .001). This finding validates previous observations that computer-video interaction programs do enhance learners' application of knowledge. Hypothesis II, that Group I would evidence significantly less state anxiety at posttest than would Group II, was not supported. Although there were no significant differences for state anxiety scores between the groups at either pretest or posttest, these scores remained higher than reported normative state anxiety scores. This finding suggests that anticipated interaction with psychiatric patients is an anxiety-inducing situation for nursing students.

Anxiety↗
PubMed1990

Therapeutic ritual. Helping families grow.

1. Family development can be inhibited by lack of social or family rituals to facilitate life cycle transitions. Therapeutic rituals can be used to help families mobilize their resources for healing, growth, and change. 2. A therapeutic ritual can help a family to resolve conflicts and resentments, to negotiate new roles and relational boundaries, and to develop new shared meanings among its members about their ongoing life together. 3. The success of a therapeutic intervention is influenced by the nurse-therapist's understanding of the family's culture, values, and needs, as well as familiarity with the directive nature of strategic therapy concepts on which therapeutic rituals are based.

Ceremonial Behavior↗
PubMed1992

Therapeutic listening: developing the concept.

1. Therapeutic listening is an art that all nurses, especially psychiatric nurses, must possess to be effective. Listening has been listed as the most effective therapeutic technique available. 2. Therapeutic listening is an interpersonal confirmation process, involving all the senses, in which the therapist attends with empathy to the client's verbal and nonverbal messages to facilitate the understanding, synthesis, and interpretation of the client's situation. 3. The therapeutic listening process includes maintaining eye contact; an attending posture; staying within conversational distance; responding with facial expressions, touch, gestures, and encouraging words; asking relevant questions; and interpreting and summarizing key points using specific words spoken by the client.

Communication↗
PubMed2006

Superior protective and therapeutic effects of IL-12 and IL-18 gene-transduced dendritic neuroblastoma fusion cells on liver metastasis of murine neuroblastoma.

Fusion vaccine of dendritic cells (DCs) and tumor cells has the advantage of inducing an immune response against multiple tumor Ags, including unknown tumor Ags. Using the liver metastasis model of C1300 neuroblastoma cells, we assessed the protective and therapeutic effects of fusion cells transduced with the IL-12 gene and/or the IL-18 gene. Improving the fusion method by combining polyethylene glycol and electroporation increased loading efficiency. In the A/J mice vaccinated with fusion cells modified with the LacZ gene (fusion/LacZ), IFN-gamma production and CTL activity increased significantly compared with that of DCs/LacZ, C1300/LacZ, or a mixture of the two (mixture/LacZ). With the transduction of IL-12 and IL-18 genes into the fusion cells (fusion/IL-12/IL-18), the level of IFN-gamma increased more than five times that of other fusion groups. In addition, NK cell activity and CTL activity increased significantly compared with that of mixture/LacZ, fusion/LacZ, DC/LacZ, or C1300/LacZ. In the protective and therapeutic studies of fusion cell vaccine, mice vaccinated with fusion/LacZ, fusion/IL-12, fusion/IL-18, or fusion/IL-12/IL-18 showed a significant decrease in liver metastasis and a significant increase in survival compared with mice given a mixture/LacZ, DCs/LacZ, or C1300/LacZ. In particular, the mice receiving fusion/IL-12/IL-18 vaccine showed a complete protective effect and the highest therapeutic effects. The present study investigates the improved loading efficiency of fusion cells and suggests that the introduction of IL-12 and IL-18 genes can induce extremely strong protective and therapeutic effects on liver metastasis of neuroblastoma.

Animals↗
PubMed2005

The patient relationship and therapeutic techniques of the South Sotho traditional healer.

Until 1996 the practice of traditional healers was outlawed in South Africa and not afforded a legal position in the community of health care providers. In 1978 the World Health Organization (WHO) identified traditional healers as those people forming an essential core of primary health care workers for rural people in the Third World Countries. However in 1994 the new South African government identified traditional healers as forming an essential element of primary health care workers. It is estimated that 80% of the black population uses traditional medicine because it is deeply rooted in their culture, which is linked to their religion. The traditional healer shares with the patient a world view which is completely alien to biomedical personnel. Therapeutic techniques typically used in traditional healing conflict with the therapeutic techniques used in biomedicine. The patients' perceptions of traditional healing, their needs and expectations, may be the driving force behind their continuous persistence to consult a traditional healer, even after these patients may have sought the therapeutic techniques of biomedical personnel. The operation of both systems in the same society creates a problem to both providers and recipients of health care. Confusion then arises and the consumer consequently chooses the services closer to her. The researcher aimed at investigating the characteristics of the relationship between the traditional healers and the patients, explored the therapeutic techniques that are used in the South Sotho traditional healing process, and investigated the views of both the traditional healers and the patients about the South -Sotho traditional healing process, to facilitate incorporation of the traditional healers in the National Health Care Delivery System. A qualitative research design was followed. Participants were identified by means of a non-probable, purposive voluntary sample. Data was collected by means of a video camera and semi-structured interviews with the six traditional healers and twelve patients, as well as by taking field notes after each session. Data analysis was achieved by means of using a checklist for the video recordings, and decoding was done for the interviews. A co-coder and the researcher analysed the data independently, after which three consensus discussions took place to finalise the analysed data. The researcher made conclusions, identified shortcomings, and made recommendations for application to nursing education, nursing research and nursing practice. The recommendations for nursing are reflected in the form of guidelines for the incorporation of the traditional healers in the National Health Care Delivery System.

Adult↗
PubMedDate not supplied

Chloroquine treatment of uncomplicated Plasmodium falciparum malaria in Mali: parasitologic resistance versus therapeutic efficacy.

Whether and when to replace chloroquine with other antimalarial drugs is an urgent public health question in much of Africa, where Plasmodium falciparum, which is increasingly resistant to chloroquine, continues to kill millions each year. Antimalarial drug efficacy has traditionally been measured as parasitologic resistance, but recent guidelines use both clinical and parasitologic criteria to monitor therapeutic efficacy. To assess the new efficacy protocol, we measured parasitologic and therapeutic outcomes in 514 patients treated with chloroquine for uncomplicated P. falciparum malaria in Mali. There was a general agreement between parasitologic and therapeutic outcomes at two sites, with 13-17% parasitologic resistance rates and 10-15% treatment failure rates. However, the new protocol overestimated early treatment failure rates (21-71% of cases classified as early treatment failure had sensitive or RI parasitologic responses), particularly where resistance was rare, and missed low-level parasitologic resistance. Modifications of the protocol for monitoring antimalarial therapeutic efficacy are recommended.

Adolescent↗
PubMed2000

Kinetic alteration of theophylline at therapeutic doses.

OBJECTIVE: To report a case of a patient diagnosed as having bronchial asthma treated with intravenous infusion of theophylline, who presented an episode of altered theophylline metabolism with a disproportionately increase in serum concentrations together with tachycardia and symptoms of intoxication. CASE SUMMARY: A 51-year-old white woman with a history of bronchial asthma was treated with intravenous infusion of theophylline in an Intensive Care Unit. Bayesian pharmacokinetic approach for dose individualization was done and linear kinetics of theophylline were observed. At therapeutic dose, an alteration of theophylline metabolism had happened, that induced a decrease on the theophylline clearance coinciding with an increase of dose. The serum concentration at this dose was 23.9 microg/ml and this was associated with symptoms compatible with intoxication by theophylline. All factors that could change theophylline elimination were analyzed. A possible drug interaction, hypothyroidism and cardiac failure were ruled out. Clinical hepatic insufficiency was not determined, but an increase of hepatic enzymes was observed. Theophylline infusion was suspended during 5 hours, the serum levels returned to therapeutic values and hepatic enzymes returned to their initial values. DISCUSSION: Episodes of anormal theophylline kinetics may occur, even with doses and serum concentrations considered to be therapeutic, especially in critically ill patients or those whose physical condition has deteriorated. This makes it necessary to carry out therapeutic drug monitoring of theophylline in this group of the population.

Asthma↗
PubMed2005

Factors influencing neonatal therapeutic effect of anti-MRSA drugs.

OBJECTIVE: Factors influencing the neonatal therapeutic effect of anti-MRSA (methicillin-resistant Staphylococcus aureus) drugs are investigated. METHODS: This study took place over a two-year period from April 1998 to March 2000. We calculated the non-adjusted odds ratio for each influential factor to determine the therapeutic effect of anti-MRSA drugs. RESULTS: Significant factors for therapeutic effect were found to be platelet count, urea nitrogen, creatinine, and CRP, each measured before starting administration of anti-MRSA drugs; whether blood drug concentration was measured; and whether pneumonia or septicemia was present. There was a tendency where a better therapeutic effect was gained when the total protein and albumin values were high. We applied multivariate logistic regression analysis to these factors, and found the following independent significant factors: CRP (odds ratio (OR) = 1.582), albumin (OR = 3.079), Cre (OR -0.213), whether blood drug concentration was measured (OR = 3.767), and presence of pneumonia or septicemia (OR = 0.216). This result suggests that consideration should be given to these five important factors when treating MRSA patients.

Alanine Transaminase↗
PubMed2006

Developmental therapeutics for myelodysplastic syndromes.

The management strategy for patients with myelodysplastic syndromes (MDS) has evolved from sole reliance on supportive measures to active treatment guided by disease risks. Recent progress in understanding the molecular pathogenesis of MDS has accelerated the discovery of new therapeutic targets, and consequently launched the development of several novel therapeutics that are currently in varied stages of clinical testing. One such agent is lenalidomide, which has shown remarkable effectiveness in the cytogenetically defined subset of MDS with the chromosome 5q31 deletion. The advent of new and effective targeted therapeutics may beneficially affect outcomes of an ever-increasing number of patients with MDS. This discussion summarizes the preliminary results of selected novel therapeutics.

Amifostine↗
PubMed2026

The Triad of NF-κB, HIF-1α, and Oxidative Stress in Hepatocellular Carcinoma: Pathogenesis, Clinical Challenges, and Therapeutic Potential of CIGB-552 in Liver Transplantation.

Hepatocellular carcinoma (HCC) represents a formidable oncological challenge characterized by complex molecular pathogenesis and limited therapeutic outcomes, particularly in the context of liver transplantation. As the sixth most commonly diagnosed cancer and the third leading cause of cancer-related mortality worldwide, HCC poses significant clinical challenges that demand innovative therapeutic approaches. Central to HCC development and progression is a pathogenic triad comprising nuclear factor-kappa B (NF-κB), hypoxia-inducible factor-1α (HIF-1α), and oxidative stress-three interconnected pathways that drive inflammation, angiogenesis, metabolic reprogramming, and cell survival. This comprehensive review examines the molecular mechanisms underlying this triad in HCC pathogenesis across different etiological contexts, including viral hepatitis and non-alcoholic fatty liver disease (NAFLD)/non-alcoholic steatohepatitis (NASH). We critically analyse the unique clinical challenges posed by HCC in liver transplantation recipients, particularly the paradoxical requirement for immunosuppression alongside antitumor immunity, and constraints surrounding immunotherapy application. Furthermore, we present CIGB-552, a novel peptide therapeutic targeting COMMD1 (Copper Metabolism MURR1 Domain-containing protein 1), as a promising dual-function agent capable of simultaneously disrupting the pathogenic triad through NF-κB inhibition, HIF-1α suppression, and strategic modulation of oxidative stress via SOD1 regulation. The multimodal mechanism of CIGB-552 offers a theoretically rational therapeutic approach for HCC management in both pre-transplant and post-transplant settings. Clinical validation in the transplantation setting is required.

Humans↗
PubMed1998

[Interindividual differences in efficacy and toxicity induced by therapeutic drugs and xenobiotics in relation to genetic polymorphisms in xenobiotic metabolizing enzymes].

Humans incessantly ingest wide-variety of chemicals through the administration of therapeutic drugs, diets and beverages. Humans are also exposed to environmental mutagens and carcinogens and substances causing endocrine disruption. Metabolism and disposition have been regarded as one of the most important determinants of efficacy and toxicity induced by ingested chemicals, since remarkable individual difference was observed in the plasma concentration and/or urinary excretion after the administration of wide variety of therapeutic drugs such as isoniazid, sulfamethazine, debrisoquin, sparteine, mephenytoin and so on. This variability is resulted from pharmacogenetically regulated difference in the activities of xenobiotic metabolizing enzymes (so called genetic polymorphisms). Polymorphic appearance of xenobiotic metabolism has also been observed with various toxic substances such as ethanol, acetaldehyde, benzene, organic phosphates and environmental mutagens and carcinogens. Enzymes which show genetic polymorphisms include cytochrome P450s (CYP1A1, CYP1A2, CYP2A6, CYP2C19, CYP2D6 and CYP2E1) and phase II drug metabolizing enzymes (arylamine N-acetyltransferases, glutathione S-transferases and UDP-glucuronosyl transferases). A number of mutations on the genes encoding polymorphic xenobiotic metabolizing enzymes have been associated with the remarkable individual difference in the metabolism and disposition in vivo. Individuals with distinct alleles of genes which encode defective enzymes have been shown to be at higher risk to toxic side effects by therapeutic drugs and more susceptible to certain malignant diseases. Research has to be conducted for each human race concerning risk assessment of chemicals, since ethnic differences in frequency of distinct alleles of genes encoding xenobiotic metabolizing enzymes are reported. In case of type 1 Crigler-Najjar syndrome causing unconjugated hyperbilirubinemia, complete loss of bilirubin-detoxifing UDP-glucuronosyl transferase has been attributed to nonsense, missense, and/or frameshift mutations that occurred at various sites on UGT1 gene. Thus, genetic polymorphisms of xenobiotic metabolizing enzymes are one of the most important factors influencing efficacy of therapeutic drugs and toxicity by wide-variety of chemicals.

Alleles↗
PubMed1999

[Congestive heart failure in the aged. Therapeutic management].

TOWARDS OPTIMAL CARE: It is essential to distinguish between systolic and diastolic dysfunction to achieve optimal management of patients with congestive heart failure. Data is lacking in the literature for validation of the guidelines usually applied in the elderly population. A specific analysis of therapeutic management of diastolic heart failure has never been performed. Altered response to drugs and associated disease states argue for an assessment of therapeutic options. The therapeutic objectives to test are different in the elderly population where quality of life and morbidity are more important than mortality criteria. In clinical practice, the empirical approach still predominates over evidence based medicine. THERAPEUTIC GOALS: At the acute phase, volume overload requires rapid action diuretics and a treatment of the triggering cause. For chronic situations, diet and lifestyle play a major role (reduced salt intake, regular exercise). Drug therapy, particularly converting enzyme inhibitors have been found to be quite effective. Rehabilitation and secondary preventive measures are the only validated methods proven to improve quality of life.

Aged↗
PubMed1999

Impact of therapeutic interchange from pravastatin to lovastatin in a Veterans Affairs Medical Center.

OBJECTIVE: To evaluate the impact of a therapeutic interchange from pravastatin to lovastatin on treatment outcomes, quality of life, patient satisfaction, and costs. STUDY DESIGN: A prospective cohort study of 170 patients switched from pravastatin to lovastatin from September 1997 through November 1997. PATIENTS AND METHODS: The therapeutic interchange program promoting lovastatin as the preferred agent went into effect June 2, 1997 after Merck & Co. was awarded the Veterans Health Administration national contract for 3-hydroxy-3-methylglutaryl coenzyme A reductase inhibitors. Patients were switched to lovastatin by either their primary care physician during routine clinic visits or the pharmacist by mail. The following outcomes were measured before and after conversion to lovastatin: lipid values, liver function tests, National Cholesterol Education Program (NCEP) low-density cholesterol (LDL-C) goals achieved, quality of life (QOL) (measured by the Medical Outcomes Study 36-item short-form health survey [SF-36]), medication tolerance (measured with a global symptom survey), patient satisfaction, and cost-minimization analysis. RESULTS: Lipid values and liver function test results were similar for pravastatin and lovastatin treatment. Forty percent of patients achieved NCEP LDL-C goals before and after formulary conversion. There were no significant differences between pravastatin and lovastatin in QOL, medication tolerance, and patient satisfaction. The projected cost savings from this therapeutic interchange was approximately $211,000 annually. CONCLUSION: Therapeutic interchange from pravastatin to lovastatin resulted in substantial cost savings. QOL, patient satisfaction, and achievement of NCEP LDL-C goals were maintained.

Anticholesteremic Agents↗
PubMed1999

Psychodynamic perspective on therapeutic boundaries: creative clinical possibilities.

Discussion of boundaries in therapeutic work most often focuses on boundary maintenance, risk management factors, and boundary violations. The psychodynamic meaning and clinical management of boundaries in therapeutic relationships remains a neglected area of discourse. Clinical vignettes will illustrate a psychodynamic, developmental-relational perspective using boundary dilemmas to deepen and advance the therapeutic process. This article contributes to the dialogue about the process of making meaning and constructing therapeutically useful and creative boundaries that further the psychotherapeutic process.

Adult↗
PubMed1999

Variability of adenovirus receptor density influences gene transfer efficiency and therapeutic response in head and neck cancer.

Despite encouraging preclinical studies in many tumor types including head and neck squamous cell carcinoma (HNSCC), initial clinical trials with adenovirus-mediated gene therapy have been disappointing. Although the adenovirus is a "highly efficient vector," it is still limited by the extent of effective in vivo transduction. In our studies with multiple human HNSCC cell lines, we have noted a variation in both in vitro and in vivo responses to the same recombinant adenovirus therapeutic construct. We hypothesize that adenovirus receptor density among tumor cell populations, even of the same histology, greatly influences transduction efficiency and therapeutic results of a variety of adenovirus-based gene therapy strategies. To investigate this hypothesis, the numbers of adenovirus receptors on three well-characterized HNSCC cell lines were determined. Marker and cytokine gene transfer efficiencies as well as therapeutic outcomes after adenovirus-mediated tumor suppressor gene and suicide gene therapies were evaluated and correlated with receptor status. A 5-fold variation in adenovirus receptor density was identified among the HNSCC cell lines (P < 0.002, t test). This variation directly correlated with adenovirus type 5 (Ad5)-mediated green fluorescent protein marker gene and Ad5-interleukin 2 cytokine gene transfer efficiency and resulting protein expression in each individual cell line. The receptor density also directly correlated with therapeutic response after Ad5-thymidine kinase or Ad5-p16 gene transfer in each HNSCC line. The role of the adenovirus receptor in gene transfer efficiency was further supported by recombinant Ad5 fiber knob blocking experiments. The marker gene transfer was increasingly blocked by the same concentration of Ad5 recombinant fiber knob in relation to decreasing levels of adenovirus receptor in the HNSCC lines. An Ad5 recombinant construct that carries the shared coxsackie and adenovirus receptor (CAR) was created and used to up-regulate receptors on each cell line. Ad5-CAR infection significantly increased Ad5-beta-Gal gene transfer efficiency and expression (P = 0.0003, Mann-Whitney test). This increased marker gene expression remained consistent with the established pattern of gene transfer efficiency among the HNSCC cell lines. These data confirm the importance of the adenovirus receptor on individual tumor cell lines with respect to investigating novel adenovirus-mediated gene therapy strategies. This work further supports consideration of assaying adenovirus receptor status, even in tumors of the same histology from patients enrolled in gene therapy clinical trials. Adenovirus receptor status may prove valuable for selecting or stratifying patients as well as assessing outcomes among patients within adenovirus-based cancer gene therapy trials.

Adenoviruses, Human↗
PubMedDate not supplied

[The place of a new drug in the therapeutic strategy].

A therapeutic strategy is a hierarchical set of appropriate measures to provide an answer to a pathological state. A drug is a part of this set (together with the diagnosis, the environment and the other medicinal interventions or not). A new drug's place in a therapeutic strategy can be evaluated according to one or several referential(s) when it (or they) exist, referentials which express the state of knowledge before launch of the new drug. The drug's profile (indication or contraindication, etc.), at the point when the marketing authorization is given, is purely theoretical. One must evaluate the real place of the drug under its real conditions of use (pragmatic trials, observable surveys). A new drugs' place in a therapeutic strategy can only be evaluated in the course of time unless a therapeutic revolution occurs.

Case Management↗
PubMedDate not supplied

[The clinical usefulness of cyclosporine therapeutic monitoring].

PURPOSE: To review the cyclosporine therapy indications and evaluate determine the incidence of cyclosporine blood levels outside the therapeutic range in patients under treatment, to evaluate the practical utility of the drug monitoring. PATIENTS AND METHODS: The blood concentration of monoclonal cyclosporine was monitored in 225 patients by FPIA method, using the trough concentration. RESULTS: 58% of patients had a drug blood level within the therapeutic range, 26% and 16% of them had respectively, a value below and down this range. After correcting the drug dosage, 75% and 68% of the patients of the two subgroups had a cyclosporine blood value within the therapeutic range. CONCLUSIONS: Cyclosporine is increasingly used in transplant recipients as well as in patients with other immunological diseases. Since the number of patients, with inappropriate serum levels of cyclosporine is high, therapeutic monitoring of blood levels of the drug are of paramount importance.

Cyclosporine↗
PubMed2000

[Therapeutic advances for indolent lymphomas].

New therapeutic strategies for indolent lymphomas are described. Relapsed or advanced staged follicular lymphoma is assumed to have an indolent course when compared with intermediate- and high-grade NHL. Although treatment of low-grade follicular lymphomas with standard chemotherapeutic regimens is characteristically associated with a high initial response rate, the clinical course consists of a pattern of repeated relapse. Subsequent remissions occur, but at a progressively lower rate and with a shorter duration. Patients eventually succumb to the disease or its complications with a median survival of approximately 6.2 years. For these reasons, novel therapeutic agents and strategies need to be evaluated in this group of patients. Recently, high-dose chemoradiotherapy with autologous hematopoietic stem cell transplantation with ex vivo purging method was reported to be very effective therapeutic strategy. Very promising reports of chimeric anti-CD20 monoclonal antibody(rituximab), radioimmunotherapy by radioisotope-conjugated monoclonal antibodies, interferon, and allogeneic mini-transplantation followed by non-myeloablative preconditioning regimens are reviewed. Recent therapeutic approaches for other subtypes of indolent lymphomas including MALT and mantle cell lymphoma are also reviewed.

Antibodies, Monoclonal↗