A Summary Look at Studies of Cranial Electrotherapy Stimulation by Ray B. Smith, Ph.D. The mechanism of action, research... Cranial Electrotherapy Stimulation provides small pulses of electric current across the head of patients for the FDA recognized treatment of depression, anxiety and insomnia. CES has been in clinical use in the U.S.A. since 1963 and in Europe since 1953. Hundreds of thousands of patients have been treated with CES over the years, and thousands presently use these prescription devices in their homes.
This document provides guidance on how to display data in summaries, tables, and graphs for research publications and presentations. It discusses which types of data are qualitative versus quantitative, and how to present numbers, percentages, and measures of central tendency and dispersion. Recommendations are given for constructing tables, such as ordering rows and columns clearly and minimizing lines. Guidelines for different types of graphs are outlined, including bar charts, pie charts, and line graphs. The document emphasizes principles from Tufte for maximizing information while minimizing ink in data displays.
This document summarizes several journal articles on treatment-resistant bipolar depression. It describes a randomized controlled trial that compared electroconvulsive therapy to algorithm-based pharmacological treatment. It also reviews evidence-based treatment strategies for treatment-resistant bipolar depression from previous systematic reviews. Additional sources included are a study protocol for a Norwegian randomized controlled trial of ECT for treatment-resistant depression in bipolar disorder, a systematic review on new treatment guidelines for acute bipolar depression, and an article on definitions and evidence-based treatment of refractoriness in bipolar disorder. The results section indicates the document analyzes treatment variables and methods of assessing outcomes in trials of interventions for treatment-resistant bipolar depression.
American journal of psychotherapy 2013 vol 67 pp 23 -46 (2) by paul clementScott Miller
This summarizes a study that analyzed outcome data from 1,599 psychotherapy patients seen by a private practitioner over 45 years. It found that 65.15% of patients were rated as improved or much improved after treatment, with a mean pre-/post-treatment effect size of 1.90. Patients and their parents rated outcomes more positively than the therapist. There was a positive relationship between length of treatment and better outcomes.
Critical appraisal of randomized clinical trialsSamir Haffar
The document discusses key concepts in randomized clinical trials (RCTs), including:
1) RCTs are considered the gold standard for evaluating the effectiveness of interventions due to their ability to minimize bias through randomization and blinding.
2) Proper randomization aims to create comparable treatment and control groups, conceal allocation to prevent bias, and may involve simple, stratified or blocked methods.
3) Blinding (masking) of participants, investigators and assessors can decrease observation bias and is important for RCT validity, though full blinding is not always possible.
4) Intention-to-treat analysis includes all randomized patients to preserve comparable groups and prevent bias from non-compliance.
This document summarizes a meta-analysis of cognitive-behavioral therapy (CBT) for symptoms of schizophrenia. The meta-analysis included 34 studies examining overall symptoms, 33 examining positive symptoms, and 34 examining negative symptoms. It found small effect sizes favoring CBT across symptoms. However, effect sizes were larger in studies that masked outcome assessments, indicating masking reduced bias. The analysis also examined potential biases from randomization, incomplete data, and type of control group, but found little effect of these factors on results. While meta-analyses have found CBT effective for schizophrenia, biases like lack of masking in some studies may inflate apparent benefits.
This document provides information about conducting and appraising a meta-analysis on the use of prophylactic antibiotics for pancreatic necrosis. It outlines the steps of formulating the clinical question using PICO, acquiring relevant studies through database searches and hand searches, appraising study quality, collecting and recording study data, analyzing results using both individual and pooled treatment effects, and reporting findings in a forest plot. Key aspects of meta-analysis methodology are discussed including biases that can affect results.
This meta-analysis examined delay discounting, which measures impulsive preferences for immediate rewards over larger delayed rewards, across 8 psychiatric disorders. It found robust differences in delay discounting between individuals with psychiatric disorders and controls. Specifically, it found that individuals with depression, bipolar disorder, schizophrenia, borderline personality disorder, bulimia nervosa, and binge-eating disorder exhibited steeper discounting compared to controls, indicating more impulsive decision-making. In contrast, individuals with anorexia nervosa exhibited shallower discounting compared to controls. The results provide empirical support for delay discounting as a transdiagnostic process across most of the psychiatric disorders examined.
This document provides guidance on how to display data in summaries, tables, and graphs for research publications and presentations. It discusses which types of data are qualitative versus quantitative, and how to present numbers, percentages, and measures of central tendency and dispersion. Recommendations are given for constructing tables, such as ordering rows and columns clearly and minimizing lines. Guidelines for different types of graphs are outlined, including bar charts, pie charts, and line graphs. The document emphasizes principles from Tufte for maximizing information while minimizing ink in data displays.
This document summarizes several journal articles on treatment-resistant bipolar depression. It describes a randomized controlled trial that compared electroconvulsive therapy to algorithm-based pharmacological treatment. It also reviews evidence-based treatment strategies for treatment-resistant bipolar depression from previous systematic reviews. Additional sources included are a study protocol for a Norwegian randomized controlled trial of ECT for treatment-resistant depression in bipolar disorder, a systematic review on new treatment guidelines for acute bipolar depression, and an article on definitions and evidence-based treatment of refractoriness in bipolar disorder. The results section indicates the document analyzes treatment variables and methods of assessing outcomes in trials of interventions for treatment-resistant bipolar depression.
American journal of psychotherapy 2013 vol 67 pp 23 -46 (2) by paul clementScott Miller
This summarizes a study that analyzed outcome data from 1,599 psychotherapy patients seen by a private practitioner over 45 years. It found that 65.15% of patients were rated as improved or much improved after treatment, with a mean pre-/post-treatment effect size of 1.90. Patients and their parents rated outcomes more positively than the therapist. There was a positive relationship between length of treatment and better outcomes.
Critical appraisal of randomized clinical trialsSamir Haffar
The document discusses key concepts in randomized clinical trials (RCTs), including:
1) RCTs are considered the gold standard for evaluating the effectiveness of interventions due to their ability to minimize bias through randomization and blinding.
2) Proper randomization aims to create comparable treatment and control groups, conceal allocation to prevent bias, and may involve simple, stratified or blocked methods.
3) Blinding (masking) of participants, investigators and assessors can decrease observation bias and is important for RCT validity, though full blinding is not always possible.
4) Intention-to-treat analysis includes all randomized patients to preserve comparable groups and prevent bias from non-compliance.
This document summarizes a meta-analysis of cognitive-behavioral therapy (CBT) for symptoms of schizophrenia. The meta-analysis included 34 studies examining overall symptoms, 33 examining positive symptoms, and 34 examining negative symptoms. It found small effect sizes favoring CBT across symptoms. However, effect sizes were larger in studies that masked outcome assessments, indicating masking reduced bias. The analysis also examined potential biases from randomization, incomplete data, and type of control group, but found little effect of these factors on results. While meta-analyses have found CBT effective for schizophrenia, biases like lack of masking in some studies may inflate apparent benefits.
This document provides information about conducting and appraising a meta-analysis on the use of prophylactic antibiotics for pancreatic necrosis. It outlines the steps of formulating the clinical question using PICO, acquiring relevant studies through database searches and hand searches, appraising study quality, collecting and recording study data, analyzing results using both individual and pooled treatment effects, and reporting findings in a forest plot. Key aspects of meta-analysis methodology are discussed including biases that can affect results.
This meta-analysis examined delay discounting, which measures impulsive preferences for immediate rewards over larger delayed rewards, across 8 psychiatric disorders. It found robust differences in delay discounting between individuals with psychiatric disorders and controls. Specifically, it found that individuals with depression, bipolar disorder, schizophrenia, borderline personality disorder, bulimia nervosa, and binge-eating disorder exhibited steeper discounting compared to controls, indicating more impulsive decision-making. In contrast, individuals with anorexia nervosa exhibited shallower discounting compared to controls. The results provide empirical support for delay discounting as a transdiagnostic process across most of the psychiatric disorders examined.
Outcomes from 45 Years of Clinical Practice (Paul Clement)Scott Miller
Paul Clement is one of my heroes. He's been tracking the outcome of his clinical services for decades. I was stunned when, in 1994, he published results from his private work over a two decades long period. Now, we have the data from 45 years. Read it!
This study evaluated the relationship between Emergency Severity Index (ESI) triage scores, pain medication selection, and timeliness of pain medication administration. The records of 1,966 emergency department patients who received opioid pain medication were analyzed. While there were no significant differences in time to pain medication across ESI levels, patients given higher ESI scores (greater acuity) received stronger opioids more often than those with lower scores. The type of opioid administered differed significantly based on ESI level. However, ESI level was not related to timeliness of pain medication administration.
What Are the Different Types of Clinical Research or who can participate in it?Vial Trials
Participation in a clinical trial is an option for many people with serious illnesses, especially when no suitable treatments are available. Please read this blog here to know about the different types of clinical research or who can participate in it!
1. The document discusses types of data and statistical analysis methods used in clinical research. It describes numerical and categorical data, as well as measures used to summarize and describe central tendency, variability, and distributions of data.
2. Hypothesis testing is introduced as a way to evaluate research questions through null hypotheses. The process involves selecting an appropriate statistical test to calculate a p-value to determine if the null hypothesis can be rejected or not.
3. Confidence intervals provide a range of values that is likely to include the true population estimate based on sample data, with a specified confidence level, most commonly 95%.
Dose response and efficacy of spinal manipulation for care of chronic low bac...Younis I Munshi
This randomized controlled trial studied the dose-response relationship between spinal manipulation therapy (SMT) sessions and chronic low back pain outcomes. 400 participants with chronic low back pain were randomized to receive 0, 6, 12, or 18 SMT sessions over 6 weeks from a chiropractor, with additional non-SMT light massage sessions to control for provider attention. The primary outcomes of pain and disability were evaluated at 12 and 24 weeks. Results showed modest linear dose-response effects, with 12 SMT sessions producing the greatest reduction in pain and disability at 12 weeks and 18 sessions producing the greatest effects at 52 weeks. Overall, SMT produced clinically meaningful improvements in pain and disability that were sustained to 52 weeks, with 12 visits appearing
This document provides an overview of evidence-based medicine and how to critically appraise clinical papers. It discusses how evidence-based medicine involves using both clinical expertise and the best available external evidence in decision making. The origins of evidence-based medicine in the 1970s and 1990s are also reviewed. The document then focuses on how to critically read clinical papers, including the key things to assess for diagnostic tests, clinical course/prognosis, causation, and therapy papers. It provides guidance on an appraisal format and emphasizes the need to both evaluate the study and summarize what it was about. Evidence-based medicine is positioned as an important guide but not a replacement for clinical expertise and judgment.
This document discusses evidence-based medicine (EBM) and key concepts in evaluating medical evidence. It defines EBM as the conscientious use of current best evidence in patient care. Randomized controlled trials are considered the gold standard for evaluating new therapies or tests. However, observational studies can also provide valuable evidence when RCTs are not possible or ethical. Systematic reviews provide a critical summary of all relevant randomized trials on a topic to determine the state of evidence and guide clinical practice and policy.
2014-10-22 EUGM | WEI | Moving Beyond the Comfort Zone in Practicing Translat...Cytel USA
1. The document discusses moving beyond conventional practices in translational statistics to obtain more robust and clinically meaningful results from clinical studies.
2. Several methodology issues are discussed, including how to define primary endpoints when there are multiple outcomes, how to handle dropouts and competing risks, and how to quantify treatment contrasts in a model-free way.
3. Alternative approaches are proposed for various types of studies, such as using restricted mean survival times instead of hazard ratios for survival analyses and performing meta-analyses for evaluating safety issues using large amounts of data.
This document discusses clinical prediction rules (CPRs), which are decision tools used by clinicians to predict outcomes. It covers the development, validation, and functions of CPRs. Specifically, it outlines 8 standards for developing a CPR, including clearly defining outcomes and predictors, ensuring reliability of predictors, having an adequate sample size, and accurately measuring a CPR's performance. An example CPR for ankle fractures is used to illustrate the development process. The document emphasizes the importance of prospectively validating CPRs in new populations before implementation, to assess their accuracy outside the initial study.
Clinical prediction rule in spinal painNityal Kumar
This lecture is on spinal pain and the clinical methods used in treating the pain. Clinical prediction rules is a research method done systematically describing when to use which method of treatment approach
Body temperature of trauma patients on admission to hospitalnswhems
This study investigated the incidence of hypothermia in prehospital trauma patients and compared the rates of hypothermia between anaesthetized and non-anaesthetized patients. The study found that anaesthetized patients had significantly lower admission body temperatures than non-anaesthetized patients. No significant seasonal variation in body temperature was found. However, the validity of the findings may be limited due to potential biases and confounding factors between the anaesthetized and non-anaesthetized patient groups that were not fully accounted for.
Body temperature of trauma patients on admission to hospitalnswhems
This study investigated the incidence of hypothermia in prehospital trauma patients and compared the rates of hypothermia between anaesthetized and non-anaesthetized patients. The study found that anaesthetized patients had significantly lower admission body temperatures than non-anaesthetized patients. No significant seasonal variation in body temperature was found. However, the validity of the findings may be limited due to potential biases and confounding factors between the anaesthetized and non-anaesthetized patient groups that were not fully accounted for.
Statistical Methods for Removing Selection Bias In Observational StudiesNathan Taback
The slide deck is from a talk I delivered at a Dana Farber / Harvard Cancer Center outcomes seminar. It presents an overview of currently available statistical methods to remove bias in observational studies.
This document outlines the steps involved in conducting a systematic review and meta-analysis on the prevalence of elder abuse. It discusses how 52 studies from around the world were analyzed using comprehensive meta-analysis software. The key findings were that the pooled prevalence of elder abuse was 15.7%. While systematic reviews have strengths like being comprehensive and transparent, they also have limitations such as reliance on the quality of primary studies and risk of publication bias.
This document summarizes a presentation on evidence-based practice and searching for information to answer clinical questions. It introduces frameworks for asking clinical questions using PICO (Patient, Intervention, Comparison, Outcome) and finding the best sources of evidence. It discusses searching databases and filters as well as using mobile devices. The goal is to help clinicians structure questions and find relevant evidence efficiently to support clinical decision making.
Common statistical pitfalls in basic science researchRamachandra Barik
This document discusses common statistical pitfalls in basic science research. It notes that while clinical studies undergo rigorous statistical review, basic science studies are often handled less uniformly. Some key issues it identifies include: treating repeated measurements of the same unit as independent observations, underestimating required sample sizes, lack of consideration for control groups and randomization in study design, and improper presentation of data through unclear reporting of sample sizes, use of standard deviations instead of standard errors, and inappropriate graphical displays. The document provides guidance on how to properly determine sample sizes, design studies, analyze data, and present results to address these common pitfalls.
This thesis examines the impact of gender and age on the efficacy of electroconvulsive therapy (ECT) for treating major depressive disorder (MDD). The author conducted a chart review of 157 MDD patients who received ECT at Providence Care. Statistical analyses found no significant differences in response rates based on gender or age. Limitations in study design prevented definitive conclusions. Future research is needed to further understand how patient characteristics influence ECT outcomes.
This document discusses how to critically appraise therapy articles to determine the validity of their conclusions. It provides an overview of key concepts for critically evaluating randomized controlled trials (RCTs), including study design, outcomes, biases, and validity. The RABI mnemonic is introduced as a tool for assessing the validity of RCTs by evaluating whether patients were randomized, allocated concealment was maintained, patients and assessors were blinded, and intention-to-treat analysis was used. Checklists are also provided for appraising different types of studies. The goal is to help practitioners determine which trial results are applicable to their patients.
Treating Insomnia in Depression Insomnia Related Factors Pred.docxturveycharlyn
Treating Insomnia in Depression: Insomnia Related Factors Predict
Long-Term Depression Trajectories
Bei Bei
Monash University and Royal Women’s Hospital, University of
Melbourne
Lauren D. Asarnow
Stanford University
Andrew Krystal
University of California, San Francisco
Jack D. Edinger
National Jewish Health, Denver, Colorado, and Duke University
Medical Center
Daniel J. Buysse
University of Pittsburgh
Rachel Manber
Stanford University
Objective: Insomnia and major depressive disorders (MDD) often co-occur, and such comorbidity has
been associated with poorer outcomes for both conditions. However, individual differences in depressive
symptom trajectories during and after treatment are poorly understood in comorbid insomnia and
depression. This study explored the heterogeneity in long-term depression change trajectories, and
examined their correlates, particularly insomnia-related characteristics. Method: Participants were 148
adults (age M � SD � 46.6 � 12.6, 73.0% female) with insomnia and MDD who received antidepressant
pharmacotherapy, and were randomized to 7-session Cognitive Behavioral Therapy for Insomnia or
control conditions over 16 weeks with 2-year follow-ups. Depression and insomnia severity were
assessed at baseline, biweekly during treatment, and every 4 months thereafter. Sleep effort and beliefs
about sleep were also assessed. Results: Growth mixture modeling revealed three trajectories: (a)
Partial-Responders (68.9%) had moderate symptom reduction during early treatment (p value � .001)
and maintained mild depression during follow-ups. (b) Initial-Responders (17.6%) had marked symptom
reduction during treatment (p values � .001) and low depression severity at posttreatment, but increased
severity over follow-up (p value � .001). (c) Optimal-Responders (13.5%) achieved most gains during
early treatment (p value � .001), continued to improve (p value � .01) and maintained minimal
depression during follow-ups. The classes did not differ significantly on baseline measures or treatment
received, but differed on insomnia-related measures after treatment began (p values � .05): Optimal-
Responders consistently endorsed the lowest insomnia severity, sleep effort, and unhelpful beliefs about
sleep. Conclusions: Three depression symptom trajectories were observed among patients with comorbid
insomnia and MDD. These trajectories were associated with insomnia-related constructs after commenc-
ing treatment. Early changes in insomnia characteristics may predict long-term depression outcomes.
What is the public health significance of this article?
This study identified three distinct depression trajectories in patients with comorbid major depression
and insomnia disorders during treatment and 2-year follow-up. Those with the largest and most
sustained improvements in depression consistently scored the lowest on postbaseline insomnia and
insomnia-related cognitions. Early changes in insomnia symptoms and insomnia-related character ...
This meta-analysis reviewed 16 randomized controlled trials comparing the effectiveness of motor control exercises (MCE) to other treatments for chronic or recurrent low back pain. The analysis found that MCE was superior to general exercise in reducing both disability in the short, intermediate, and long term, and pain in the short and intermediate term. MCE was also superior to minimal interventions like advice or placebo for both pain and disability outcomes at all time periods. Compared to spinal manual therapy, MCE demonstrated superior results for reducing disability but not pain. The studies varied in quality but provided evidence that MCE can better improve pain and disability for low back pain over the short to long term compared to other common treatments.
Guide for conducting meta analysis in health researchYogitha P
This document discusses meta-analysis and its role in evidence-based dentistry. It defines meta-analysis as the statistical analysis and synthesis of data from multiple scientific studies. Meta-analysis enhances the reliability of conclusions by increasing statistical power and limiting bias compared to individual studies. It can help resolve scientific controversies by establishing whether findings are consistent across studies. The document reviews the steps in conducting a meta-analysis, including developing a clear question and protocol, performing comprehensive literature searches, assessing study quality, extracting outcome data, conducting statistical analyses, and drawing conclusions. It also discusses potential biases and strengths and limitations of meta-analysis.
Outcomes from 45 Years of Clinical Practice (Paul Clement)Scott Miller
Paul Clement is one of my heroes. He's been tracking the outcome of his clinical services for decades. I was stunned when, in 1994, he published results from his private work over a two decades long period. Now, we have the data from 45 years. Read it!
This study evaluated the relationship between Emergency Severity Index (ESI) triage scores, pain medication selection, and timeliness of pain medication administration. The records of 1,966 emergency department patients who received opioid pain medication were analyzed. While there were no significant differences in time to pain medication across ESI levels, patients given higher ESI scores (greater acuity) received stronger opioids more often than those with lower scores. The type of opioid administered differed significantly based on ESI level. However, ESI level was not related to timeliness of pain medication administration.
What Are the Different Types of Clinical Research or who can participate in it?Vial Trials
Participation in a clinical trial is an option for many people with serious illnesses, especially when no suitable treatments are available. Please read this blog here to know about the different types of clinical research or who can participate in it!
1. The document discusses types of data and statistical analysis methods used in clinical research. It describes numerical and categorical data, as well as measures used to summarize and describe central tendency, variability, and distributions of data.
2. Hypothesis testing is introduced as a way to evaluate research questions through null hypotheses. The process involves selecting an appropriate statistical test to calculate a p-value to determine if the null hypothesis can be rejected or not.
3. Confidence intervals provide a range of values that is likely to include the true population estimate based on sample data, with a specified confidence level, most commonly 95%.
Dose response and efficacy of spinal manipulation for care of chronic low bac...Younis I Munshi
This randomized controlled trial studied the dose-response relationship between spinal manipulation therapy (SMT) sessions and chronic low back pain outcomes. 400 participants with chronic low back pain were randomized to receive 0, 6, 12, or 18 SMT sessions over 6 weeks from a chiropractor, with additional non-SMT light massage sessions to control for provider attention. The primary outcomes of pain and disability were evaluated at 12 and 24 weeks. Results showed modest linear dose-response effects, with 12 SMT sessions producing the greatest reduction in pain and disability at 12 weeks and 18 sessions producing the greatest effects at 52 weeks. Overall, SMT produced clinically meaningful improvements in pain and disability that were sustained to 52 weeks, with 12 visits appearing
This document provides an overview of evidence-based medicine and how to critically appraise clinical papers. It discusses how evidence-based medicine involves using both clinical expertise and the best available external evidence in decision making. The origins of evidence-based medicine in the 1970s and 1990s are also reviewed. The document then focuses on how to critically read clinical papers, including the key things to assess for diagnostic tests, clinical course/prognosis, causation, and therapy papers. It provides guidance on an appraisal format and emphasizes the need to both evaluate the study and summarize what it was about. Evidence-based medicine is positioned as an important guide but not a replacement for clinical expertise and judgment.
This document discusses evidence-based medicine (EBM) and key concepts in evaluating medical evidence. It defines EBM as the conscientious use of current best evidence in patient care. Randomized controlled trials are considered the gold standard for evaluating new therapies or tests. However, observational studies can also provide valuable evidence when RCTs are not possible or ethical. Systematic reviews provide a critical summary of all relevant randomized trials on a topic to determine the state of evidence and guide clinical practice and policy.
2014-10-22 EUGM | WEI | Moving Beyond the Comfort Zone in Practicing Translat...Cytel USA
1. The document discusses moving beyond conventional practices in translational statistics to obtain more robust and clinically meaningful results from clinical studies.
2. Several methodology issues are discussed, including how to define primary endpoints when there are multiple outcomes, how to handle dropouts and competing risks, and how to quantify treatment contrasts in a model-free way.
3. Alternative approaches are proposed for various types of studies, such as using restricted mean survival times instead of hazard ratios for survival analyses and performing meta-analyses for evaluating safety issues using large amounts of data.
This document discusses clinical prediction rules (CPRs), which are decision tools used by clinicians to predict outcomes. It covers the development, validation, and functions of CPRs. Specifically, it outlines 8 standards for developing a CPR, including clearly defining outcomes and predictors, ensuring reliability of predictors, having an adequate sample size, and accurately measuring a CPR's performance. An example CPR for ankle fractures is used to illustrate the development process. The document emphasizes the importance of prospectively validating CPRs in new populations before implementation, to assess their accuracy outside the initial study.
Clinical prediction rule in spinal painNityal Kumar
This lecture is on spinal pain and the clinical methods used in treating the pain. Clinical prediction rules is a research method done systematically describing when to use which method of treatment approach
Body temperature of trauma patients on admission to hospitalnswhems
This study investigated the incidence of hypothermia in prehospital trauma patients and compared the rates of hypothermia between anaesthetized and non-anaesthetized patients. The study found that anaesthetized patients had significantly lower admission body temperatures than non-anaesthetized patients. No significant seasonal variation in body temperature was found. However, the validity of the findings may be limited due to potential biases and confounding factors between the anaesthetized and non-anaesthetized patient groups that were not fully accounted for.
Body temperature of trauma patients on admission to hospitalnswhems
This study investigated the incidence of hypothermia in prehospital trauma patients and compared the rates of hypothermia between anaesthetized and non-anaesthetized patients. The study found that anaesthetized patients had significantly lower admission body temperatures than non-anaesthetized patients. No significant seasonal variation in body temperature was found. However, the validity of the findings may be limited due to potential biases and confounding factors between the anaesthetized and non-anaesthetized patient groups that were not fully accounted for.
Statistical Methods for Removing Selection Bias In Observational StudiesNathan Taback
The slide deck is from a talk I delivered at a Dana Farber / Harvard Cancer Center outcomes seminar. It presents an overview of currently available statistical methods to remove bias in observational studies.
This document outlines the steps involved in conducting a systematic review and meta-analysis on the prevalence of elder abuse. It discusses how 52 studies from around the world were analyzed using comprehensive meta-analysis software. The key findings were that the pooled prevalence of elder abuse was 15.7%. While systematic reviews have strengths like being comprehensive and transparent, they also have limitations such as reliance on the quality of primary studies and risk of publication bias.
This document summarizes a presentation on evidence-based practice and searching for information to answer clinical questions. It introduces frameworks for asking clinical questions using PICO (Patient, Intervention, Comparison, Outcome) and finding the best sources of evidence. It discusses searching databases and filters as well as using mobile devices. The goal is to help clinicians structure questions and find relevant evidence efficiently to support clinical decision making.
Common statistical pitfalls in basic science researchRamachandra Barik
This document discusses common statistical pitfalls in basic science research. It notes that while clinical studies undergo rigorous statistical review, basic science studies are often handled less uniformly. Some key issues it identifies include: treating repeated measurements of the same unit as independent observations, underestimating required sample sizes, lack of consideration for control groups and randomization in study design, and improper presentation of data through unclear reporting of sample sizes, use of standard deviations instead of standard errors, and inappropriate graphical displays. The document provides guidance on how to properly determine sample sizes, design studies, analyze data, and present results to address these common pitfalls.
This thesis examines the impact of gender and age on the efficacy of electroconvulsive therapy (ECT) for treating major depressive disorder (MDD). The author conducted a chart review of 157 MDD patients who received ECT at Providence Care. Statistical analyses found no significant differences in response rates based on gender or age. Limitations in study design prevented definitive conclusions. Future research is needed to further understand how patient characteristics influence ECT outcomes.
This document discusses how to critically appraise therapy articles to determine the validity of their conclusions. It provides an overview of key concepts for critically evaluating randomized controlled trials (RCTs), including study design, outcomes, biases, and validity. The RABI mnemonic is introduced as a tool for assessing the validity of RCTs by evaluating whether patients were randomized, allocated concealment was maintained, patients and assessors were blinded, and intention-to-treat analysis was used. Checklists are also provided for appraising different types of studies. The goal is to help practitioners determine which trial results are applicable to their patients.
Treating Insomnia in Depression Insomnia Related Factors Pred.docxturveycharlyn
Treating Insomnia in Depression: Insomnia Related Factors Predict
Long-Term Depression Trajectories
Bei Bei
Monash University and Royal Women’s Hospital, University of
Melbourne
Lauren D. Asarnow
Stanford University
Andrew Krystal
University of California, San Francisco
Jack D. Edinger
National Jewish Health, Denver, Colorado, and Duke University
Medical Center
Daniel J. Buysse
University of Pittsburgh
Rachel Manber
Stanford University
Objective: Insomnia and major depressive disorders (MDD) often co-occur, and such comorbidity has
been associated with poorer outcomes for both conditions. However, individual differences in depressive
symptom trajectories during and after treatment are poorly understood in comorbid insomnia and
depression. This study explored the heterogeneity in long-term depression change trajectories, and
examined their correlates, particularly insomnia-related characteristics. Method: Participants were 148
adults (age M � SD � 46.6 � 12.6, 73.0% female) with insomnia and MDD who received antidepressant
pharmacotherapy, and were randomized to 7-session Cognitive Behavioral Therapy for Insomnia or
control conditions over 16 weeks with 2-year follow-ups. Depression and insomnia severity were
assessed at baseline, biweekly during treatment, and every 4 months thereafter. Sleep effort and beliefs
about sleep were also assessed. Results: Growth mixture modeling revealed three trajectories: (a)
Partial-Responders (68.9%) had moderate symptom reduction during early treatment (p value � .001)
and maintained mild depression during follow-ups. (b) Initial-Responders (17.6%) had marked symptom
reduction during treatment (p values � .001) and low depression severity at posttreatment, but increased
severity over follow-up (p value � .001). (c) Optimal-Responders (13.5%) achieved most gains during
early treatment (p value � .001), continued to improve (p value � .01) and maintained minimal
depression during follow-ups. The classes did not differ significantly on baseline measures or treatment
received, but differed on insomnia-related measures after treatment began (p values � .05): Optimal-
Responders consistently endorsed the lowest insomnia severity, sleep effort, and unhelpful beliefs about
sleep. Conclusions: Three depression symptom trajectories were observed among patients with comorbid
insomnia and MDD. These trajectories were associated with insomnia-related constructs after commenc-
ing treatment. Early changes in insomnia characteristics may predict long-term depression outcomes.
What is the public health significance of this article?
This study identified three distinct depression trajectories in patients with comorbid major depression
and insomnia disorders during treatment and 2-year follow-up. Those with the largest and most
sustained improvements in depression consistently scored the lowest on postbaseline insomnia and
insomnia-related cognitions. Early changes in insomnia symptoms and insomnia-related character ...
This meta-analysis reviewed 16 randomized controlled trials comparing the effectiveness of motor control exercises (MCE) to other treatments for chronic or recurrent low back pain. The analysis found that MCE was superior to general exercise in reducing both disability in the short, intermediate, and long term, and pain in the short and intermediate term. MCE was also superior to minimal interventions like advice or placebo for both pain and disability outcomes at all time periods. Compared to spinal manual therapy, MCE demonstrated superior results for reducing disability but not pain. The studies varied in quality but provided evidence that MCE can better improve pain and disability for low back pain over the short to long term compared to other common treatments.
Guide for conducting meta analysis in health researchYogitha P
This document discusses meta-analysis and its role in evidence-based dentistry. It defines meta-analysis as the statistical analysis and synthesis of data from multiple scientific studies. Meta-analysis enhances the reliability of conclusions by increasing statistical power and limiting bias compared to individual studies. It can help resolve scientific controversies by establishing whether findings are consistent across studies. The document reviews the steps in conducting a meta-analysis, including developing a clear question and protocol, performing comprehensive literature searches, assessing study quality, extracting outcome data, conducting statistical analyses, and drawing conclusions. It also discusses potential biases and strengths and limitations of meta-analysis.
The document discusses choosing appropriate statistical tests for analyzing medical research studies. It provides an overview of commonly used statistical tests such as the t-test, chi-square test, Fisher's exact test, analysis of variance, and Wilcoxon rank sum test. The document outlines the key factors to consider when selecting a statistical test, such as the scale of measurement (continuous, categorical, binary) and study design (paired or unpaired). Algorithms and tables are provided to help readers identify the proper statistical test based on these characteristics.
This document discusses evidence-based laboratory medicine (EBLM) and its key components. It explains that EBLM involves the conscientious, explicit and judicious use of current best evidence in making well-informed decisions in laboratory medicine. The main components of EBLM are individual expertise, best external evidence, and patient values and expectations. It also discusses how to practice EBLM by asking questions, acquiring evidence, critically appraising the evidence, and applying the information while evaluating the process.
Measure CritiqueCritiqued byDateName of measure FAD- .docxARIV4
Measure Critique
Critiqued by:
Date:
Name of measure: FAD- Family Assessment Devise
Developer(s):
Source reference (provide the complete citation, using correct APA format, of the article, book or website that contains the key information on the measure you are critiquing here):
Construct(s) assessed (e.g., depression, relationship satisfaction, stress):
Method of administration:
Summary of reliability evidence (this includes internal consistency reliability, usually Cronbach’s alpha and often test-retest reliability as well):
Summary of validity evidence (this may include discussions of content, criterion-related [concurrent and/or predictive], and construct [convergent and/or divergent] validity):
Describe the number of participants used to develop the measure and their demographic characteristics (e.g., age, gender, race/ethnicity):
Provide a brief summary of how clinicians have used this measure in therapy:
Recommendations for effective clinical use:
With what populations has this measure been used with (either clinically or in research) (e.g., age, gender, race/ethnicity, setting)
Find and briefly mention the purpose of 2-3 few research studies that have used the measure:
Provide a summary of the findings from one study that used this measure using this template:
Objective:
Method/Design:
Results:
What future research is needed on this measure?
Overall impression of measure:
References
Sample Measure Critique
Critiqued by: KL
Date: January 25, 2016
Name of measure: PHQ9
Developer(s): Kurt Kroenke, Robert L. Spitzer, & Janet B.W. Williams
Source reference:https://www.communitycarenc.org/media/related-downloads/depression-toolkit.pdf
Construct(s) assessed: Criteria-based diagnosis of depression in individuals seen in primary care and other medical and mental health facilities
Method of administration: Nine symptom checklist that can be professionally or self-administered (paper and pencil, electronically, or over the phone).
Summary of reliability evidence:
· Internal reliability was excellent, with a Cronbach’s alpha of 0.89 in a Primary Care Study and 0.86 in an OB-Gyn Study (Kroenke, Spitzer, & Williams, 2001).
· Test-retest reliability was very high at a 0.96 in a longitudinal study (Draper et al., 2008).
Summary of validity evidence:
In a study done by Kroenke et al. (2001), both criterion and construct validity were established as well as external validity. Construct validity was demonstrated in a sample of 580 primary care patients who underwent an independent re-interview. Criterion validity was shown by the strong association between PHQ-9 scores and functional status disability days and symptoms related difficulty. External validity was achieved by replicating the findings from 3,000 primary care patients in a second sample of 3,000 Ob-gyn patients.
· The PHQ-9 had a sensitivity of 88% and a specificity of 88% for major depression. PHQ-9 sores of 5, 10, 15, 20 fully represented mild, moderate, moderatel ...
Brain Derived Neurotrophic Factor increases during recovery from psychologica...inventionjournals
Objective: To study the levels of plasma BDNF during recovering from psychological stress. Methods: Blood samples from thirty eight participants in a stress treatment project were analyzed for BDNF in plasma before and after 3 months treatment. Symptom levels were assessed by SCL92, work ability index and a question on stress. Physiological and behavioral measures were collected, all at baseline and after treatment. Results: BDNF increased significantly during the follow up, but the levels of BDNF were not correlated to blood pressure, se-cholesterol, HbA1C, se-fibrinogen or salivary cortisol even if the two latter decreased significantly. BDNF increase was inversely associated with improvement in depression symptoms contrary to the expected. Conclusion: Plasma BDNF increased during treatment for psychological stress, but was not associated with physiological stressmarkers or improvement of stress symptoms
Brain Derived Neurotrophic Factor increases during recovery from psychologica...inventionjournals
Objective: To study the levels of plasma BDNF during recovering from psychological stress. Methods: Blood samples from thirty eight participants in a stress treatment project were analyzed for BDNF in plasma before and after 3 months treatment. Symptom levels were assessed by SCL92, work ability index and a question on stress. Physiological and behavioral measures were collected, all at baseline and after treatment. Results: BDNF increased significantly during the follow up, but the levels of BDNF were not correlated to blood pressure, se-cholesterol, HbA1C, se-fibrinogen or salivary cortisol even if the two latter decreased significantly. BDNF increase was inversely associated with improvement in depression symptoms contrary to the expected. Conclusion: Plasma BDNF increased during treatment for psychological stress, but was not associated with physiological stressmarkers or improvement of stress symptoms.
Poster: Test-Retest Reliability and Equivalence of PRO MeasuresCRF Health
This literature review examined administration intervals used in test-retest reliability and equivalence studies for patient-reported outcome measures. The review found a large variance in intervals, ranging from immediate to 7 years for test-retest studies and from immediate to 1 month for equivalence studies. The most common intervals were 2 weeks for test-retest studies and 1 hour or less for equivalence studies. Intervals varied depending on the medical condition and type of study, with shorter intervals used for equivalence studies compared to test-retest studies for the same conditions.
REVIEW Open AccessWhat happens after treatment Asystema.docxmichael591
This systematic review examined definitions of relapse, remission, and recovery from anorexia nervosa (AN) in previous studies. The review found that definitions varied substantially between studies, with some using weight criteria alone, others using symptom-based criteria alone, and some combining both. Relapse rates reported in studies ranged from 9-52% depending on the definition used and length of follow-up. There was consensus that risk of relapse is highest in the first year following treatment. The review proposes standardized criteria for defining relapse, remission, and recovery in AN to facilitate comparisons between studies.
1) Researchers have compiled a database tracking transcranial magnetic stimulation (TMS) studies for treating depression. It includes variables like coil type, location, dose and frequency.
2) The authors updated the database by reviewing 234 references from 2007-2010, adding 40 new studies. The updated database is available online and includes 141 studies from 23 countries.
3) Analysis of the database shows that over time, TMS treatment has involved delivering more pulses per day, with a range of 30 to 3600 pulses daily across studies. Total pulses delivered over a study ranges from 30 to 150,000.
Published Research, Flawed, Misleading, Nefarious - Use of Reporting Guidelin...John Hoey
Much published health sciences literature is misleading and biased
Efforts to correct this include use of reporting guidelines- criteria for doing science and reporting the results properly
Also discussion of conflicts of interest - how to report them.
Relation between motor recovery and level of stress in stroke survivers a cor...Rajneesh Hbk
This document provides details regarding Tanya Fondekar's dissertation synopsis submitted to Rajiv Gandhi University of Health Sciences, Karnataka, Bangalore for her Master of Physiotherapy degree. The proposed study will examine the relationship between motor recovery and stress levels in stroke survivors using a correlation research design. Motor recovery will be evaluated using the Fugl-Meyer Assessment and stress will be measured using the Perceived Stress Scale. It is hypothesized that there will be a significant relationship between motor recovery and stress levels in stroke survivors.
Relation between motor recovery and level of stress in stroke survivers a cor...Rajneesh Hbk
This document provides details regarding Tanya Fondekar's dissertation synopsis submitted to Rajiv Gandhi University of Health Sciences, Karnataka, Bangalore for her Master of Physiotherapy degree. The proposed study will examine the relationship between motor recovery and stress levels in stroke survivors using a correlation research design. Motor recovery will be evaluated using the Fugl-Meyer Assessment and stress will be measured using the Perceived Stress Scale. It is hypothesized that there will be a significant relationship between motor recovery and stress levels in stroke survivors.
This document discusses research methodology and how it can be applied to homeopathy. It defines different types of study designs including observational studies, treatment studies, randomized controlled trials, and meta-analyses. It explains how to apply these research methodologies to homeopathy through drug provings, clinical research studies, and disease-related studies while respecting homeopathic principles. Randomized controlled trials and meta-analyses are important for providing evidence but must be designed carefully to fit within homeopathic individualization and philosophy.
This document discusses research methodology and how it can be applied to homeopathy. It defines different types of study designs including observational studies, treatment studies, randomized controlled trials, and meta-analyses. It explains how to apply research methodologies like randomized controlled trials and meta-analyses to homeopathic drug provings and clinical research while respecting homeopathic principles. Clinical research in homeopathy should involve screening and confirming diagnoses, individualized case taking and prescribing for all patients regardless of group allocation in a blinded manner.
This report updates a 2006 review by the International League Against Epilepsy (ILAE) on the level of evidence for long-term efficacy or effectiveness of antiepileptic drugs (AEDs) as initial monotherapy for newly diagnosed epilepsy. The methodology from the previous review was used with three modifications. The report identified new randomized controlled trials and combined evidence from 2005-2012. Key findings include: levetiracetam and zonisamide now have Level A evidence for adults with partial onset seizures, and ethosuximide and valproic acid have Level A evidence for children with childhood absence epilepsy. Overall there were no major changes to levels of evidence for other subgroups. The review reinforces the need for more
The document summarizes a systematic review on the use of beta-blockers in patients undergoing non-cardiac surgery. The systematic review included randomized trials investigating beta-blockers and searched medical literature databases without restrictions. Individual studies were assessed for validity and either individual patient data or aggregate data were used in the analysis. The results found beta-blockers decreased non-fatal heart attacks but increased the risk of stroke, with inconsistent effects on mortality. The magnitude of effects was described. The conclusion indicated uncertainty around some outcomes and need for more evidence.
The document presents the second edition of the "PMR Buzz" which provides abstract summaries from current rehabilitation medicine journals, and includes contributions from several rehabilitation experts. It contains a systematic review and meta-analysis comparing the effectiveness of autologous blood products and steroid injections for plantar fasciitis, and a randomized controlled trial comparing the effects of balance training and aerobic training for patients with degenerative cerebellar disease. The document aims to disseminate practice-changing research and receive feedback to improve the quality of information presented in future editions.
The document summarizes a study that examined the impact of gender and age on the efficacy of electroconvulsive therapy (ECT) for treating major depressive disorder (MDD). The study analyzed data from 157 patients who received ECT and found that neither gender nor age significantly influenced treatment outcomes. Specifically, gender did not affect the rate of response to ECT or patient receptivity to treatment, and age was also not related to these measures of efficacy. The study had some limitations but provides initial evidence that gender and age may not be determinants of ECT effectiveness for MDD.
Similar to Cranial electrotherapy stimulation (20)
Mercurius is named after the roman god mercurius, the god of trade and science. The planet mercurius is named after the same god. Mercurius is sometimes called hydrargyrum, means ‘watery silver’. Its shine and colour are very similar to silver, but mercury is a fluid at room temperatures. The name quick silver is a translation of hydrargyrum, where the word quick describes its tendency to scatter away in all directions.
The droplets have a tendency to conglomerate to one big mass, but on being shaken they fall apart into countless little droplets again. It is used to ignite explosives, like mercury fulminate, the explosive character is one of its general themes.
Kosmoderma Academy, a leading institution in the field of dermatology and aesthetics, offers comprehensive courses in cosmetology and trichology. Our specialized courses on PRP (Hair), DR+Growth Factor, GFC, and Qr678 are designed to equip practitioners with advanced skills and knowledge to excel in hair restoration and growth treatments.
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share - Lions, tigers, AI and health misinformation, oh my!.pptxTina Purnat
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These lecture slides, by Dr Sidra Arshad, offer a simplified look into the mechanisms involved in the regulation of respiration:
Learning objectives:
1. Describe the organisation of respiratory center
2. Describe the nervous control of inspiration and respiratory rhythm
3. Describe the functions of the dorsal and respiratory groups of neurons
4. Describe the influences of the Pneumotaxic and Apneustic centers
5. Explain the role of Hering-Breur inflation reflex in regulation of inspiration
6. Explain the role of central chemoreceptors in regulation of respiration
7. Explain the role of peripheral chemoreceptors in regulation of respiration
8. Explain the regulation of respiration during exercise
9. Integrate the respiratory regulatory mechanisms
10. Describe the Cheyne-Stokes breathing
Study Resources:
1. Chapter 42, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 36, Ganong’s Review of Medical Physiology, 26th edition
3. Chapter 13, Human Physiology by Lauralee Sherwood, 9th edition
5-hydroxytryptamine or 5-HT or Serotonin is a neurotransmitter that serves a range of roles in the human body. It is sometimes referred to as the happy chemical since it promotes overall well-being and happiness.
It is mostly found in the brain, intestines, and blood platelets.
5-HT is utilised to transport messages between nerve cells, is known to be involved in smooth muscle contraction, and adds to overall well-being and pleasure, among other benefits. 5-HT regulates the body's sleep-wake cycles and internal clock by acting as a precursor to melatonin.
It is hypothesised to regulate hunger, emotions, motor, cognitive, and autonomic processes.
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Does Over-Masturbation Contribute to Chronic Prostatitis.pptxwalterHu5
In some case, your chronic prostatitis may be related to over-masturbation. Generally, natural medicine Diuretic and Anti-inflammatory Pill can help mee get a cure.
DECLARATION OF HELSINKI - History and principlesanaghabharat01
This SlideShare presentation provides a comprehensive overview of the Declaration of Helsinki, a foundational document outlining ethical guidelines for conducting medical research involving human subjects.
8 Surprising Reasons To Meditate 40 Minutes A Day That Can Change Your Life.pptxHolistified Wellness
We’re talking about Vedic Meditation, a form of meditation that has been around for at least 5,000 years. Back then, the people who lived in the Indus Valley, now known as India and Pakistan, practised meditation as a fundamental part of daily life. This knowledge that has given us yoga and Ayurveda, was known as Veda, hence the name Vedic. And though there are some written records, the practice has been passed down verbally from generation to generation.