Mostrando las entradas con la etiqueta pubmed. Mostrar todas las entradas
Mostrando las entradas con la etiqueta pubmed. Mostrar todas las entradas
22 noviembre, 2013
Accediendo a revisiones sistemáticas desde Pubmed
22 junio, 2013
Integrated management of type 2 diabetes mellitus and depression treatment to improve medication adherence
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| English: The blue circle is the global symbol for diabetes, introduced by the International Diabetes Federation with the aim of giving diabetes a common identity, supporting existing efforts to raise awareness of diabetes and placing the diabetes epidemic firmly in the public spotlight. (Photo credit: Wikipedia) |
PURPOSE Depression commonly accompanies diabetes, resulting in reduced adherence to medications and increased risk for morbidity and mortality. The objective of this study was to examine whether a simple, brief integrated approach to depression and type 2 diabetes mellitus (type 2 diabetes) treatment improved adherence to oral hypoglycemic agents and antidepressant medications, glycemic control, and depression among primary care patients. METHODS We undertook a randomized controlled trial conducted from April 2010 through April 2011 of 180 patients prescribed pharmacotherapy for type 2 diabetes and depression in primary care. Patients were randomly assigned to an integrated care intervention or usual care. Integrated care managers collaborated with physicians to offer education and guideline-based treatment recommendations and to monitor adherence and clinical status. Adherence was assessed using the Medication Event Monitoring System (MEMS). We used glycated hemoglobin (HbA(1c)) assays to measure glycemic control and the 9-item Patient Health Questionnaire (PHQ-9) to assess depression. RESULTS Intervention and usual care groups did not differ statistically on baseline measures. Patients who received the intervention were more likely to achieve HbA(1c) levels of less than 7% (intervention 60.9% vs usual care 35.7%; P <.001) and remission of depression (PHQ-9 score of less than 5: intervention 58.7% vs usual care 30.7%; P <.001) in comparison with patients in the usual care group at 12 weeks. CONCLUSIONS A randomized controlled trial of a simple, brief intervention integrating treatment of type 2 diabetes and depression was successful in improving outcomes in primary care. An integrated approach to depression and type 2 diabetes treatment may facilitate its deployment in real-world practices with competing demands for limited resources.
29 mayo, 2013
The Psychoterapy is alive
Comparative Efficacy of Seven Psychotherapeutic Interventions for Patients with Depression: A Network Meta-Analysis
Source: PLOS MEDICINE
Authors:
Abstract
Background
Previous meta-analyses comparing the efficacy of psychotherapeutic interventions for depression were clouded by a limited number of within-study treatment comparisons. This study used network meta-analysis, a novel methodological approach that integrates direct and indirect evidence from randomised controlled studies, to re-examine the comparative efficacy of seven psychotherapeutic interventions for adult depression.Methods and Findings
We conducted systematic literature searches in PubMed, PsycINFO, and Embase up to November 2012, and identified additional studies through earlier meta-analyses and the references of included studies. We identified 198 studies, including 15,118 adult patients with depression, and coded moderator variables. Each of the seven psychotherapeutic interventions was superior to a waitlist control condition with moderate to large effects (range d = −0.62 to d = −0.92). Relative effects of different psychotherapeutic interventions on depressive symptoms were absent to small (range d = 0.01 to d = −0.30). Interpersonal therapy was significantly more effective than supportive therapy (d = −0.30, 95% credibility interval [CrI] [−0.54 to −0.05]). Moderator analysis showed that patient characteristics had no influence on treatment effects, but identified aspects of study quality and sample size as effect modifiers. Smaller effects were found in studies of at least moderate (Δd = 0.29 [−0.01 to 0.58]; p = 0.063) and large size (Δd = 0.33 [0.08 to 0.61]; p = 0.012) and those that had adequate outcome assessment (Δd = 0.38 [−0.06 to 0.87]; p = 0.100). Stepwise restriction of analyses by sample size showed robust effects for cognitive-behavioural therapy, interpersonal therapy, and problem-solving therapy (all d>0.46) compared to waitlist. Empirical evidence from large studies was unavailable or limited for other psychotherapeutic interventions.Conclusions
Overall our results are consistent with the notion that different psychotherapeutic interventions for depression have comparable benefits. However, the robustness of the evidence varies considerably between different psychotherapeutic treatments.Please see later in the article for the Editors' Summary
Editors' Summary
Background
Depression is a very common condition. One in six people will experience depression at some time during their life. People who are depressed have recurrent feelings of sadness and hopelessness and might feel that life is no longer worth living. The condition can last for months and often includes physical symptoms such as headaches, sleeping problems, and weight gain or loss. Treatment of depression can include non-drug treatments (psychotherapy), antidepressant drugs, or a combination of the two. Especially for people with mild or intermediate depression, psychotherapy is often considered the preferred first option. Psychotherapy describes a range of different psychotherapies, and a number of established types of psychotherapies have all shown to work for at least some patients.Why Was This Study Done?
While it is broadly accepted that psychotherapy can help people with depression, the question of which type of psychotherapy works best for most patients remains controversial. While many scientific studies have compared one psychotherapy with control conditions, there have been few studies that directly compared multiple treatments. Without such direct comparisons, it has been difficult to establish the respective merits of the different types of psychotherapy. Taking advantage of a recently developed method called “network meta-analysis,” the authors re-examine the evidence on seven different types of psychotherapy to see how well they have been shown to work and whether some work better than others.What Did the Researchers Do and Find?
The researchers looked at seven different types of psychotherapy, which they defined as follows. “Interpersonal psychotherapy” is short and highly structured, using a manual to focus on interpersonal issues in depression. “Behavioral activation” raises the awareness of pleasant activities and seeks to increase positive interactions between the patient and his or her environment. “Cognitive behavioral therapy” focuses on a patient's current negative beliefs, evaluates how they affect current and future behavior, and attempts to restructure the beliefs and change the outlook. “Problem solving therapy” aims to define a patient's problems, propose multiple solutions for each problem, and then select, implement, and evaluate the best solution. “Psychodynamic therapy” focuses on past unresolved conflicts and relationships and the impact they have on a patient's current situation. In “social skills therapy,” patients are taught skills that help to build and maintain healthy relationships based on honesty and respect. “Supportive counseling” is a more general therapy that aims to get patients to talk about their experiences and emotions and to offer empathy without suggesting solutions or teaching new skills.The researchers started with a systematic search of the medical literature for relevant studies. The search identified 198 articles that reported on such clinical trials. The trials included a total of 15,118 patients and compared one of the seven psychotherapies either with another one or with a common “control intervention”. In most cases, the control (no psychotherapy) was deferral of treatment by “wait-listing” patients or continuing “usual care.” With network meta-analysis they were able to summarize the results of all these trials in a meaningful way. They did this by integrating direct comparisons of several psychotherapies within the same trial (where those were available) with indirect comparisons across all trials (using no psychotherapy as a control intervention).
Based on the combined trial results, all seven psychotherapies tested were better than wait-listing or usual care, and the differences were moderate to large, meaning that the average person in the group that received therapy was better off than about half of the patients in the control group. When comparing the therapies with each other, the researchers saw small or no differences, meaning that none of them really stood out as much better or much worse than the others. They also found that the treatments worked equally well for different patient groups with depression (younger or older patients, or mothers who had depression after having given birth). Similarly, they saw no big differences when comparing individual with group therapy, or person-to-person with internet-based interactions between therapist and patient.
However, they did find that smaller and less rigorous studies generally found larger benefits of psychotherapies, and most of the studies included in the analysis were small. Only 36 of the studies had at least 50 patients who received the same treatment. When they restricted their analysis to those studies, the researchers still saw clear benefits of cognitive-behavioral therapy, interpersonal therapy, and problem-solving therapy, but not for the other four therapies.
What Do these Findings Mean?
Similar to earlier attempts to summarize and make sense of the many study results, this one finds benefits for all of the seven psychotherapies examined, and none of them stood as being much better than some or all others. The scientific support for being beneficial was stronger for some therapies, mostly because they had been tested more often and in larger studies.Treatments with proven benefits still do not necessarily work for all patients, and which type of psychotherapy might work best for a particular patient likely depends on that individual. So overall this analysis suggests that patients with depression and their doctors should consider psychotherapies and explore which of the different types might be best suited for a particular patient.
The study also points to the need for further research. Whereas depression affects large numbers of people around the world, all of the trials identified were conducted in rich countries and Western societies. Trials in different settings are essential to inform treatment of patients worldwide. In addition, large high-quality studies should further explore the potential benefits of some of therapies for which less support currently exists. Where possible, future studies should compare psychotherapies with one another, because all of them have benefits, and it would not be ethical to withhold such beneficial treatment from patients.
Additional Information
Please access these Web sites via the online version of this summary at http://dx.doi.org/10.1371/journal.pmed.1001454.- The US National Institute of Mental Health provides information on all aspects of depression (in English and Spanish); information on psychotherapy includes information on its most common forms
- The UK National Health Service Choices website also provides detailed information about depression and includes personal stories about depression
- The UK nonprofit Mind provides information on depression, including an explanation of the most common psychotherapies in the UK
- MedlinePlus provides links to other resources about depression (in English and Spanish)
- The UK nonprofit healthtalkonline.org has a unique database of personal and patient experiences on depression
Citation: Barth J, Munder
T, Gerger H, Nüesch E, Trelle S, et al. (2013) Comparative Efficacy of
Seven Psychotherapeutic Interventions for Patients with Depression: A
Network Meta-Analysis. PLoS Med 10(5):
e1001454.
doi:10.1371/journal.pmed.1001454
Academic Editor: Alexander C. Tsai, Massachusetts General Hospital, United States of America
Received: March 11, 2012; Accepted: April 9, 2013; Published: May 28, 2013
Copyright: © 2013 Barth et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
Funding: This research was supported by a Swiss National Science Foundation Grant (no. 105314-118312/1) awarded to JB, HJZ, and PJ. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.
Competing interests: PJ is an unpaid member of steering group or executive committee of trials funded by Abbott Vascular, Biosensors, Medtronic and St. Jude Medical. CTU Bern, which is part of the University of Bern, has a staff policy of not accepting individual honoraria or consultancy fees. However, CTU Bern is involved in design, conduct, or analysis of clinical studies funded by Abbott Vascular, Ablynx, Amgen, AstraZeneca, Biosensors, Biotronic, Boehrhinger Ingelheim, Eisai, Eli Lilly, Exelixis, Geron, Gilead Sciences, Nestlé, Novartis, Novo Nordisc, Padma, Roche, Schering-Plough, St. Jude Medical, and Swiss Cardio Technologies. The other authors declare that no competing interests exist.
Abbreviations: ACT, behavioural activation; CBASP, cognitive behavioural-analysis system of psychotherapy; CBT, cognitive-behavioural therapy; CI, confidence interval; CrI, credibility interval; d, effect size; D, Somer's D; DYN, psychodynamic therapy; ES, d effect size; IPT, interpersonal therapy; k, number of comparisons; M, mean; p, p-value; PLA, placebo; PST, problem solving therapy; SD, standard deviation; SST, social skills training; SUP, supportive counselling; UC, usual care; WL, waitlist; T2, tau square
Academic Editor: Alexander C. Tsai, Massachusetts General Hospital, United States of America
Received: March 11, 2012; Accepted: April 9, 2013; Published: May 28, 2013
Copyright: © 2013 Barth et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
Funding: This research was supported by a Swiss National Science Foundation Grant (no. 105314-118312/1) awarded to JB, HJZ, and PJ. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.
Competing interests: PJ is an unpaid member of steering group or executive committee of trials funded by Abbott Vascular, Biosensors, Medtronic and St. Jude Medical. CTU Bern, which is part of the University of Bern, has a staff policy of not accepting individual honoraria or consultancy fees. However, CTU Bern is involved in design, conduct, or analysis of clinical studies funded by Abbott Vascular, Ablynx, Amgen, AstraZeneca, Biosensors, Biotronic, Boehrhinger Ingelheim, Eisai, Eli Lilly, Exelixis, Geron, Gilead Sciences, Nestlé, Novartis, Novo Nordisc, Padma, Roche, Schering-Plough, St. Jude Medical, and Swiss Cardio Technologies. The other authors declare that no competing interests exist.
Abbreviations: ACT, behavioural activation; CBASP, cognitive behavioural-analysis system of psychotherapy; CBT, cognitive-behavioural therapy; CI, confidence interval; CrI, credibility interval; d, effect size; D, Somer's D; DYN, psychodynamic therapy; ES, d effect size; IPT, interpersonal therapy; k, number of comparisons; M, mean; p, p-value; PLA, placebo; PST, problem solving therapy; SD, standard deviation; SST, social skills training; SUP, supportive counselling; UC, usual care; WL, waitlist; T2, tau square
22 mayo, 2013
Changes in Tripdatabase
I receive an e-mail this morning and now I can see the changes in the blog of Tripdatabase
See mor resoursces in http://resourcesandlinks.blogspot.com.ar/ in the middle of the left bar.
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See mor resoursces in http://resourcesandlinks.blogspot.com.ar/ in the middle of the left bar.
We've released a bunch of upgrades to the site, some really powerful others simply useful!
The screengrab below (click on it to enlarge) highlights the major changes.
Full-text links: We've used two methods for this. Firstly, we've started cross-checking our records with PubMed Central and linking accordingly. Secondly, we're working with institutions to allow the easy linking between Trip and the institutions full-text holdings. For this to work a user needs to alter they profile (via the 'Setting' button), about half-way down there are a series of drop-downs, select your institution from there and it should work straight away. If your institution is not there then send us an email (jon.brassey@tripdatabase.com) and we'll tell you the simple steps needed.
DynaMed integration: Click on the DynaMed tab and you'll see the results. Access to the actual content is only available for those with subscription access - alas we do not provide that!
Controlled trials database: This has actually been out for a while, but I'm including it here as it was planned with the rest of these changes and is a fairly recent addition. Click herefor further details.
Case Reports: Working with BioMedCentral's Cases Database we're really pleased to see this interesting collection added to the site.
Developing World Filter: Working with a slightly modified filter from a Norwegian Cochrane site we have created a specific and sensitive filter. If you would like to know the difference then email us via the email above.
Minor changes
The screengrab below (click on it to enlarge) highlights the major changes.
Full-text links: We've used two methods for this. Firstly, we've started cross-checking our records with PubMed Central and linking accordingly. Secondly, we're working with institutions to allow the easy linking between Trip and the institutions full-text holdings. For this to work a user needs to alter they profile (via the 'Setting' button), about half-way down there are a series of drop-downs, select your institution from there and it should work straight away. If your institution is not there then send us an email (jon.brassey@tripdatabase.com) and we'll tell you the simple steps needed.
DynaMed integration: Click on the DynaMed tab and you'll see the results. Access to the actual content is only available for those with subscription access - alas we do not provide that!
Controlled trials database: This has actually been out for a while, but I'm including it here as it was planned with the rest of these changes and is a fairly recent addition. Click herefor further details.
Case Reports: Working with BioMedCentral's Cases Database we're really pleased to see this interesting collection added to the site.
Developing World Filter: Working with a slightly modified filter from a Norwegian Cochrane site we have created a specific and sensitive filter. If you would like to know the difference then email us via the email above.
Minor changes
- Ability to delete items from the timeline
- Move from eternal scrolling on timeline to pagination
- Number each result
- Ability to change password
07 mayo, 2013
Buscadores Médicos en un sólo enlace
Buscadores Médicos
LiveBinder es una aplicación web que nos permite crear fácilmente nuestros propios PLE, entornos personales de aprendizaje, y compartir varias páginas web en un solo link.Podemos compartir con nuestros contactos un solo link que incluya varias páginas sobre algún tema de interés.
En este PLE: Buscadores Médicos, reuno los buscadores más utilizados en las búsquedas de información médica. Inicio con DeCS , una página que nos permite traducir las palabras en castellano al Inglés o al portugués para luego pegarlas en PubMed. En esta pestaña de PubMed, hay 4 subpestañas con buscadores a temas a texto complet: JURN, JANE, PubJet y FullFreePdf. Además podemos consultar sin salir de la ventana na LILACS, COCHRANE, SCIELO, Biblioteca Virtual Salud (BVS), y el buscador de Guias de práctica Médica; PUBGLE.
Una aplicación de la Web 2.0 realmente muy útil.
17 abril, 2013
Glucocorticoids for acute viral bronchiolitis in infants and young children
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| English: An x ray of a child with RSV showing the typical bilateral perifular fullness. (Photo credit: Wikipedia) |
Abstract BACKGROUND: Previous systematic reviews have not shown clear benefit of glucocorticoids for acute viral bronchiolitis, but their use remains considerable. Recent large trials add substantially to current evidence and suggest novel glucocorticoid-including treatment approaches.
OBJECTIVES: To review the efficacy and safety of systemic and inhaled glucocorticoids in children with acute viral bronchiolitis.
SEARCH STRATEGY: We searched the Cochrane Central Register of Controlled Trials (The Cochrane Library 2009, issue 4); MEDLINE (1950 to November 2009); EMBASE (1980 to Week 47 2009); LILACS (1982 to November 2009); Scopus(R) (1823 to November 2009); and IRAN MedEx (1998 to November 2009).
SELECTION CRITERIA: Randomised controlled trials (RCTs) comparing short-term systemic or inhaled glucocorticoids versus placebo or another intervention in children < 24 months with acute bronchiolitis (first episode with wheezing). Our primary outcomes were: admissions by days 1 and 7 for outpatient studies; and length of stay (LOS) for inpatient studies. Secondary outcomes included clinical severity parameters, healthcare use, pulmonary function, symptoms, quality of life and harms.
DATA COLLECTION AND ANALYSIS: Two authors independently extracted data on study and participant characteristics, interventions and outcomes. We assessed risk of bias and graded strength of evidence. Inpatient and outpatient results were meta-analysed separately using random-effects models. We pre-specified subgroup analyses, including the combined use of protocolised bronchodilators.
MAIN RESULTS: We included 17 trials (2596 participants); only two had low overall risk of bias. Baseline severity, glucocorticoid schemes, comparators and outcomes were heterogeneous. Glucocorticoids did not significantly reduce outpatient admissions by days 1 and 7 when compared to placebo (pooled risk ratios (RRs) 0.92; 95% CI 0.78 to 1.08; and 0.86; 95% CI 0.7 to 1.06, respectively). There was no benefit in LOS for inpatients (mean difference -0.18 days; 95% CI -0.39 to 0.04). Unadjusted results from a large factorial low risk of bias RCT found combined high-dose systemic dexamethasone and inhaled epinephrine reduced admissions by day 7 (baseline risk of admission 26%; RR 0.65, 95% CI 0.44 to 0.95; number needed to treat 11, 95% CI 7 to 76), with no differences in short-term adverse effects. No other comparisons showed relevant differences in primary outcomes.
AUTHORS' CONCLUSIONS: Current evidence does not support a clinically relevant effect of systemic or inhaled glucocorticoids on admissions or length of hospitalization. Combined dexamethasone and epinephrine may reduce outpatient admissions, but results are exploratory and safety data limited. Future research should further assess the efficacy, harms and applicability of combined therapy.
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