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BACKGROUND | This study assessed the effectiveness of a training program for primary health care professionals designed to reduce burnout and mood disturbance , increase empathy , and develop mindfulness . |
METHODS | Pragmatic randomized controlled trial with pre - and postintervention measurements of 68 primary health care professionals ( 43 in the intervention and 25 in the control group ) in Spain . |
METHODS | The intervention consisted of presentations of clinically relevant topics , mindfulness-based coping strategies , mindfulness practice , yoga , and group discussions ( 8 sessions of 2.5 hours per week plus a 1-day session of 8 hours ) . |
METHODS | Outcome measures included the Maslach Burnout Inventory , Profile of Mood States , Jefferson Scale of Physician Empathy , Baer 's Five Facets Mindfulness Questionnaire , and a questionnaire on changes in personal habits and mindfulness practice . |
METHODS | Measurements were performed at baseline and after 8 weeks . |
RESULTS | The intervention group improved in the 4 scales measured . |
RESULTS | The magnitude of the change was large in total mood disturbance ( difference between groups -7.1 ; standardized effect-size [ SES ] 1.15 ) and mindfulness ( difference between groups 11 ; SES 0.9 ) and moderate in the burnout ( difference between groups -7 ; SES 0.74 ) and empathy scales ( difference between groups 5.2 ; SES 0.71 ) . |
RESULTS | No significant differences were found in the control group . |
CONCLUSIONS | Our study supports the use of mindfulness-based programs as part of continuing professional education to reduce and prevent burnout , promote positive attitudes among health professionals , strengthen patient-provider relationships , and enhance well-being . |
###25922903 | null |
OBJECTIVE | Anogenital warts are a common disorder associated with significant physical and mental distress and a substantial cause of health care costs . |
OBJECTIVE | To assess the efficacy of the topical application of nitric oxide delivered using acidified nitrite . |
METHODS | A multicenter , randomized , controlled , dose-ranging clinical trial was conducted in European genitourinary medicine clinics between December 20 , 2001 , and January 14 , 2003 . |
METHODS | Analysis was by intent to treat for all individuals initiating therapy . |
METHODS | Participants included male and female volunteers older than 18 years with between 2 and 50 external anogenital warts . |
METHODS | A total of 299 individuals from 40 centers were randomized to a control arm and a treatment arm that received 3 doses of acidified nitrite applied topically for 12 weeks with an additional 12 weeks of follow-up , with the final follow-up visit on January 14 , 2003 . |
METHODS | Placebo nitrite cream and placebo citric acid cream were applied twice daily . |
METHODS | Active treatment was divided as low dose ( sodium nitrite , 3 % , with citric acid , 4.5 % , creams applied twice daily ) , middle dose ( sodium nitrite , 6 % , with citric acid , 9 % , creams applied once daily at night , with placebo applied in the morning ) , and high dose ( sodium nitrite , 6 % , with citric acid , 9 % , creams applied twice daily ) . |
METHODS | The primary outcome was proportion of patients with complete clinical clearance of target warts ; secondary outcomes were reduction in target wart area and safety . |
RESULTS | Complete clinical clearance at 12 weeks occurred in 10 of 74 patients ( 14 % ; 95 % CI , 6 % -21 % ) with placebo ; 11 of 72 ( 15 % ; 95 % CI , 7 % -24 % ) with low-dose treatment ; 17 of 74 ( 23 % ; 95 % CI , 13 % -33 % ) with middle-dose treatment ; and 22 of 70 ( 31 % ; 95 % CI , 21 % -42 % ) with high-dose treatment ( P = .01 ) . |
RESULTS | Reduction in target wart area , time to clearance , and patient and investigator assessments supported the superiority of the high-dose therapy vs placebo . |
RESULTS | There were no systemic or serious adverse events associated with treatment . |
RESULTS | However , there was a dose-related increase in itching , pain , edema , and staining of the anogenital skin associated with the active treatment . |
RESULTS | Overall , 21 patients withdrew from active treatment because of adverse events compared with none using placebo . |
CONCLUSIONS | Use of sodium nitrite , 6 % , with citric acid , 9 % , twice daily is more effective than placebo in the treatment of anogenital warts . |
CONCLUSIONS | Treatment was associated with local irritant adverse effects . |
BACKGROUND | clinicaltrials.gov Identifier : NCT02015260 . |
###24967410 | null |
OBJECTIVE | Noncardiac chest pain ( NCCP ) is seen more frequently in young population and in these patients loss of function is evolving in social and professional areas . |
OBJECTIVE | The aim of the study is to evaluate the levels of anxiety and somatic perception in patients with chest pain presenting to cardiology clinic . |
METHODS | Fifty-one patients with noncardiac chest pain and 51 healthy controls were included in the study . |
METHODS | All participants performed self-report based health anxiety inventory ( HAI ) , somatosensory amplification scale ( SAS ) , and Toronto alexithymia scale ( TAS ) . |
RESULTS | The patient group had significantly higher scores on the SAS , HAI-1 , and HAI-T scales compared to controls ( P < 0.001 , P = 0.006 , and P = 0.038 , resp . ) |
RESULTS | SAS , HAI-1 , and HAI-T scores were significantly higher in female patients than male ( P = 0.002 , 0.036 , and 0.039 , resp . ) |
RESULTS | There were significant differences in all TAS subscale scores between two groups . |
RESULTS | Patients , who had total TAS score more than 50 , also presented higher levels of health anxiety ( P = 0.045 ) . |
CONCLUSIONS | Anxiety , somatic symptoms , and the exaggerated sense of bodily sensations are common in patients with NCCP . |
CONCLUSIONS | These patients unnecessarily occupy the cardiology outpatient clinics . |
CONCLUSIONS | These negative results can be eliminated when consultation-liaison psychiatry evaluates these patients in collaboration with cardiology departments . |
###25876339 | null |
OBJECTIVE | To compare the differences in the clinical efficacy on Alzheimer 's disease between acupuncture and medicine . |
METHODS | One hundred and forty-one patients were randomized into an acupuncture group ( 72 cases ) and a medicine group ( 69 cases ) . |
METHODS | In the acupuncture group , the needling technique for benefiting qi , promoting blood circulation , regulating mind and improving intelligence was used at Shenting ( GV 24 ) , Baihui ( GV 20 ) , Fengchi ( GB 20 ) , Wangu ( GB 12 ) , Danzhong ( CV 17 ) , Zhangwan ( CV 12 ) , Qihai ( CV 6 ) , Xuehai ( SP 10 ) and Zusanli ( ST 36 ) . |
METHODS | The supplementary acupoints were selected according to the symptoms and physical signs . |
METHODS | Acupuncture was given once a day and 6 treatments were required for a week . |
METHODS | In the medicine group , the choline sterase inhibitor , donepezil ( aricept ) was prescribed for oral administration , 1 tablet ( 5 mg ) each time , once every night . |
METHODS | Four weeks later , the dose was increased to 2 tablets ( 10 mg ) each time . |
METHODS | In the two groups , the treatment of 4 weeks made one session and 4 sessions were required . |
METHODS | The changes of scores before and after treatment in the minimum mental state examination ( MMSE ) , the activity of daily living scale ( ADL ) , Alzheimer 's disease assessment scale-cognition ( ADAS-cog ) and the digit span ( DS ) were observed . |
RESULTS | After treatment , scores of MMSE and DS were increased as compared with those before treatment ( both P < 0.05 ) and scores of ADL and ADAS-cog were reduced as compared with those before treatment . |
RESULTS | The score differences in MMSE , ADL , ADAS-cog and DS before and after treatment were significant in the two groups ( all P < 0.01 ) . |
CONCLUSIONS | The needling technique for benefiting qi , promoting blood circulation , regulating mind and improving intelligence significantly improves the overall function , cognition and activity of daily life in the patients of Alzheimer 's disease and the efficacy is better than donepezil . |
###24946799 | null |
OBJECTIVE | There is little evidence available on the use of robot-assisted therapy in subacute stroke patients . |
OBJECTIVE | A randomized controlled trial was carried out to evaluate the short-time efficacy of intensive robot-assisted therapy compared to usual physical therapy performed in the early phase after stroke onset . |
METHODS | Fifty-three subacute stroke patients at their first-ever stroke were enrolled 307days after the acute event and randomized into two groups , both exposed to standard therapy . |
METHODS | Additional 30 sessions of robot-assisted therapy were provided to the Experimental Group . |
METHODS | Additional 30 sessions of usual therapy were provided to the Control Group.The following impairment evaluations were performed at the beginning ( T0 ) , after 15 sessions ( T1 ) , and at the end of the treatment ( T2 ) : Fugl-Meyer Assessment Scale ( FM ) , Modified Ashworth Scale-Shoulder ( MAS-S ) , Modified Ashworth Scale-Elbow ( MAS-E ) , Total Passive Range of Motion-Shoulder/Elbow ( pROM ) , and Motricity Index ( MI ) . |
RESULTS | Evidence of significant improvements in MAS-S ( p = 0.004 ) , MAS-E ( p = 0.018 ) and pROM ( p < 0.0001 ) was found in the Experimental Group . |
RESULTS | Significant improvement was demonstrated in both Experimental and Control Group in FM ( EG : p < 0.0001 , CG : p < 0.0001 ) and MI ( EG : p < 0.0001 , CG : p < 0.0001 ) , with an higher improvement in the Experimental Group . |
CONCLUSIONS | Robot-assisted upper limb rehabilitation treatment can contribute to increasing motor recovery in subacute stroke patients . |
CONCLUSIONS | Focusing on the early phase of stroke recovery has a high potential impact in clinical practice . |
###24668328 | null |
BACKGROUND | In advanced gastric cancer ( AGC ) , no globally accepted prognostic scoring system has been developed . |
BACKGROUND | Therefore , we explored baseline prognostic factors in Japanese AGC patients using the data from a randomized controlled trial , Japan Clinical Oncology Group ( JCOG ) 9912 , which investigated the efficacy of systemic chemotherapy as a first-line treatment . |
METHODS | Prognostic factors and prognostic indices for overall survival were screened and evaluated in patients enrolled in JCOG9912 using the Cox proportional hazard model . |
METHODS | The Royal Marsden Hospital prognostic model was also applied to the JCOG9912 trial . |
RESULTS | A total of 650 ( 92.3 % ) of the 704 patients randomized in the JCOG9912 trial , for whom complete data were available for multivariate analyses , was included in the present study ( 5-fluorouracil arm , n = 215 ; irinotecan plus cisplatin arm , n = 216 ; S-1 arm , n = 219 ) . |
RESULTS | The median survival time ( MST ) for all patients was 11.8 months . |
RESULTS | To construct a prognostic index , we selected four risk factors by multivariate analysis : performance status 1 , number of metastatic sites 2 , no prior gastrectomy , and elevated alkaline phosphatase . |
RESULTS | MSTs were 17.0 months for patients categorized into the low-risk group , who had zero or one risk factor ( n = 225 ) ; 10.4 months for patients in the moderate-risk group , who had two or three risk factors ( n = 368 ) ; and 5.0 months for patients in the high-risk group , who had all four risk factors ( n = 57 ) . |
CONCLUSIONS | In the present study , we propose a new prognostic index for patients with AGC . |
CONCLUSIONS | This can be used for more appropriate patient stratification in future clinical trials . |
###24834773 | null |
BACKGROUND | Treatment of food allergy essentially consists of food avoidance , but immunotherapy with food is emerging as a new therapeutic option . |
OBJECTIVE | To evaluate clinical improvement and immunological changes in patients with peach allergy following sublingual immunotherapy ( SLIT ) with a Prup3 quantified peach extract . |
METHODS | A randomized , double-blind , placebo-controlled clinical trial with peach SLIT was conducted . |
METHODS | We assessed clinical efficacy after 6 months of treatment by means of double-blind , placebo-controlled oral challenges with peach and also evaluated immunological changes ( basophil activation test [ BAT ] and determination of sulphidoleukotriene production ) following stimulation with peach peel and pulp , rPrup3 , rMald 1 , and rMal d 4 stimulation . |
METHODS | We also measured specific IgE and IgG4 to Pru p3 . |
RESULTS | After 6 months of SLIT ( T6 ) , the active group showed a 3-fold improvement in tolerance to Prup3 and a significant increase in IgE to rPrup3 and in sLT production following stimulation with peach peel and rPrup3 . |
RESULTS | There was also a significant increase in BAT results after stimulation with rPrup3 at 1 month of SLIT ( T1 ) . |
RESULTS | Statistically significant between-group differences were only observed for BAT with peach peel and pulp at T1 and T6 and for BAT with rPru p3 at T6 . |
RESULTS | No changes were observed in BAT with rMal d 1 or rMal d 4 or in IgG4 levels to nPrup3 . |
CONCLUSIONS | SLIT with a Pru p 3 quantified peach extract is clinically effective and leads to an increase in basophil activation and sulphidoleukotriene production following stimulation with rPru p3 and peach peel in the first months of treatment . |
###24777223 | null |
OBJECTIVE | Pharmacogenetics ( PGx ) promises to optimize patient response to therapy . |
OBJECTIVE | However , the public 's acceptance of PGx is not well known , notably when this applies to children . |
OBJECTIVE | Our objective was to explore perceptions of PGx testing among individuals , who differ from each other by either parental status or educational exposure to PGx , and to explore parents ' views between PGx testing for oneself and PGx testing for their children . |
METHODS | An exploratory survey was conducted among parents and other adults . |
METHODS | Surveys P and C were completed by parents , survey NP by middle-aged nonparents , and survey MS by medical students . |
RESULTS | Proper explanation before PGx testing appeared to be the most important issue to the respondents ( eg , P = 1.55 10 ( -38 ) for survey NP ) . |
RESULTS | Respondents who were more knowledgeable about PGx were also more comfortable with PGx testing ( eg , P = 2.53 10 ( -7 ) in case of mild disease ) . |
RESULTS | When PGx testing was for one 's child , parents valued their own understanding more than their child 's assent ( P = 1.57 10 ( -17 ) ) . |
CONCLUSIONS | The acceptability of PGx testing , either for oneself or for one 's child , seemed to depend on baseline PGx knowledge , but not on parenthood . |
###24320560 | null |
OBJECTIVE | Dilatation and curettage ( D&C ) is a common day-care procedure in obstetrics and gynecology , with patients discharged after a brief hospital stay on the same day of the surgery . |
OBJECTIVE | Although it has a short duration , severe pain occurs during the procedure . |
OBJECTIVE | Therefore , this surgical procedure requires an anesthetic to provide adequate analgesia , rapid onset , and rapid recovery . |
OBJECTIVE | The main objective of the present study was to compare the analgesic effectiveness and safety of tramadol with those of fentanyl during D&C . |
METHODS | The study comprised 100 women with American Society of Anesthesiologists classification I-II who were scheduled for a D&C procedure . |