Comparison of the effectiveness of medical, psychological, educational psychology and combined interventions in the treatment of children and adolescents with ADHD: a theoretical review

Recepción: 29 de julio de 2016 | Revisión: 6 de septiembre de 2016 | Aceptado: 17 octubre de 2016Correspondencia: Pilar Sanz Cervera. Universidad de Santiago de CompostelaEmail: [email protected] ID: 0000-0001-6919-6150El trastorno por déficit de atención e hiperactividad (TDAH) es un trastorno del neurodesarrollo con implicaciones importantes en el contexto educativo, al ser uno de los más frecuentes en la población infanto-juvenil. Son muchas las diferentes intervenciones propuestas para su tratamiento (médica, psicológica, psicopedagógica y combinada). En el presente estudio se ha realizado una revisión teórica para poder comparar la eficacia de los diferentes tratamientos para el TDAH en esta edad, analizando un total de once artículos, los cuales comparan la eficacia de dos o más tratamientos. Los resultados indican la efectividad de todos los tratamientos, diferenciándose sólo los unos de los otros en el tratamiento de los diferentes síntomas que presenta el TDAH y el grado de severidad del trastorno, siendo en estos casos unos más efectivos que otros. Estos resultados se discuten y se confrontan con la literatura previa, así como se consideran futuras líneas de investigación.The attention deficit hyperactivity disorder (ADHD) is a neurodevelopmental disorder with important implications in the educational context as it is one of the most common disorders in the childhood and adolescence. There are many different interventions for the ADHD treatment (medical, psychological, educational psychology and combined). In this study, it is carried out a theoretical review to compare the effectiveness of the different treatments for ADHD at this age, analyzing a total of eleven articles, which compare two or more treatments. The results indicate the effectiveness of all treatments, only differing from one another in the treatment of the different ADHD symptoms and the severity of the disorder; being in these cases ones more effectives than others. These results are discussed and confronted with previous literature and future research lines are considered.Universidad de Granada. Departamento de Psicología Social. Proyecto de Innovación Docente ReiDoCre

Clinical Management of COVID-19 in Cancer Patients with the STAT3 Inhibitor Silibinin

COVID-19 pathophysiology is caused by a cascade of respiratory and multiorgan failures arising, at least in part, from the SARS-CoV-2-driven dysregulation of the master transcriptional factor STAT3. Pharmacological correction of STAT3 over-stimulation, which is at the root of acute respiratory distress syndrome (ARDS) and coagulopathy/thrombosis events, should be considered for treatment of severe COVID-19. In this perspective, we first review the current body of knowledge on the role of STAT3 in the pathogenesis of severe COVID-19. We then exemplify the potential clinical value of treating COVID-19 disease with STAT3 inhibitors by presenting the outcomes of two hospitalized patients with active cancer and COVID-19 receiving oral Legalon(R)-a nutraceutical containing the naturally occurring STAT3 inhibitor silibinin. Both patients, which were recruited to the clinical trial SIL-COVID19 (EudraCT number: 2020-001794-77) had SARS-CoV-2 bilateral interstitial pneumonia and a high COVID-GRAM score, and showed systemic proinflammatory responses in terms of lymphocytopenia and hypoalbuminemia. Both patients were predicted to be at high risk of critical COVID-19 illness in terms of intensive care unit admission, invasive ventilation, or death. In addition to physician's choice of best available therapy or supportive care, patients received 1050 mg/day Legalon(R) for 10 days without side-effects. Silibinin-treated cancer/COVID-19+ patients required only minimal oxygen support (2-4 L/min) during the episode, exhibited a sharp decline of the STAT3-regulated C-reactive protein, and demonstrated complete resolution of the pulmonary lesions. These findings might inspire future research to advance our knowledge and improve silibinin-based clinical interventions aimed to target STAT3-driven COVID-19 pathophysiology

Implementing stakeholder engagement to explore alternative models of consent: An example from the PREP-IT trials

Introduction: Cluster randomized crossover trials are often faced with a dilemma when selecting an optimal model of consent, as the traditional model of obtaining informed consent from participant's before initiating any trial related activities may not be suitable. We describe our experience of engaging patient advisors to identify an optimal model of consent for the PREP-IT trials. This paper also examines surrogate measures of success for the selected model of consent. Methods: The PREP-IT program consists of two multi-center cluster randomized crossover trials that engaged patient advisors to determine an optimal model of consent. Patient advisors and stakeholders met regularly and reached consensus on decisions related to the trial design including the model for consent. Patient advisors provided valuable insight on how key decisions on trial design and conduct would be received by participants and the impact these decisions will have. Results: Patient advisors, together with stakeholders, reviewed the pros and cons and the requirements for the traditional model of consent, deferred consent, and waiver of consent. Collectively, they agreed upon a deferred consent model, in which patients may be approached for consent after their fracture surgery and prior to data collection. The consent rate in PREP-IT is 80.7%, and 0.67% of participants have withdrawn consent for participation. Discussion: Involvement of patient advisors in the development of an optimal model of consent has been successful. Engagement of patient advisors is recommended for other large trials where the traditional model of consent may not be optimal