A controlled comparative evaluation of conjoint counselling and self-help behavioural treatment for sexual dysfunction

Forty-eight couples representing four of the most commonly referred forms of sexual dysfunction in this country (viz. female sexual unresponsiveness, vaginismus, premature ejaculation and erectile impotence) were treated by either a modified form of Masters and Johnson's approach (i.e. directed practice and once weekly counselling with a single therapist) or a minimal contact bibliotherapy programme, based on the same behavioural lines. Half of the couples were randomly allocated to a no treatment control condition before receiving either therapy. Treatment effects with both approaches were evident but those of the self-help approach were more circumscribed with respect to not only the sexual but also the non-sexual relationship. Thus, some evidence was obtained in support of the hypotheses that practice plus counselling would be superior to self-help in facilitating change in the general relationship and in sexual attitudes. However, a wide range of significant pre-treatment differences among the four problem subgroups comprising the sample was found. In particular, the sexually unresponsive female complainants reported less satisfaction with the general relationship, whereas the reported difficulties of those with vaginismus were less generalised, being restricted mainly to coital fears. In general higher baseline levels, i.e. less disturbance of the sexual and marital relationship, were reported by each of the two male subgroups. There was also evidence that the differential response to the two treatments was not uniform across forms of sexual dysfunction. As hypothesised, guided practice plus counselling was significantly more effective than the self-help regime in enhancing marital and sexual adjustment for female unresponsiveness. On the other hand, in contrast to other problem subgroups, vaginismus was shown to respond favourably to both treatments. In general, few significant changes with either treatment and few notable differences between treatments, were observed within the male problem subgroups. The implications of these results for the design and analysis of future treatment outcome research in this field are discussed

A Comparison of Delivery Methods of Cognitive-Behavioral Therapy for Panic Disorder: An International Multicenter Trial

Cognitive-behavioral therapy (CBT) is the psychological treatment of choice for panic disorder (PD). However, given limited access to CBT, it must be delivered with maximal cost-effectiveness. Previous researchers have found that a brief computer-augmented CBT was as effective as extended therapist-delivered CBT. To test this finding, this study randomly allocated 186 patients with PD across 2 sites in Scotland and Australia to 12 sessions of therapist-delivered CBT (CBT12), 6 sessions of therapist-delivered (CBT6) or computer-augmented CBT (CBT6-CA), or a waitlist control. On a composite measure, at post-treatment, the outcome for CBT12 was statistically better than the outcome for CBT6. The outcome for CBT6-CA fell between CBT12 and CBT6, but could not be statistically distinguished from either treatment. The active treatments did not differ statistically at 6-month follow-up. The study provided some support for the use of computers as an innovative adjunctive-therapy tool and merits further investigation

Intelligent Liver Function Testing (iLFT):A trial of automated diagnosis and staging of liver disease in Primary Care

Background: Liver function tests (LFTs) are frequently requested blood tests which may indicate liver disease. LFTs are commonly abnormal, the causes of which can be complex and frequently under investigated. This can lead to missed opportunities to diagnose and treat liver disease at an early stage. We developed an automated investigation algorithm, which would maximise early diagnosis of liver related diseases. Our aim was to determine whether this new pathway of care, Intelligent Liver Function testing (iLFT) increased diagnosis of liver disease and was cost-effective. Methods: We developed an automated system that further investigated abnormal LFTs on initial testing samples to generate a probable diagnosis and management plan. We integrated an automated investigation algorithm into the laboratory management system, based on minimal diagnostic criteria, liver fibrosis estimation, and reflex testing for causes of liver disease. This algorithm then generated a diagnosis and/or management plan. A stepped-wedged trial design was utilised to compare LFT outcomes in General Practices in the 6 months before and after introduction of the iLFT system. Diagnostic outcomes were collated and compared. Results: Using iLFT, the diagnosis of liver disease was increased by 43%. It was cost-effective with a low initial incremental cost-effectiveness ratio (ICER) of £284 per correct diagnosis, and a saving to the NHS of £3,216 per patient lifetime. Conclusions: iLFT increases liver diagnosis, improves quality of care, and is highly cost-effective. This can be achieved with minor changes to working practices and exploitation of functionality existing within modern laboratory diagnostics systems. Lay Summary: There is a growing epidemic of advanced liver disease, this could be offset by early detection and management. Checking liver blood tests (LFTs) should be an opportunity diagnose liver problems, but abnormal results are often incompletely investigated. In this study we were able to substantially increase the diagnostic yield of the abnormal LFTs using the automated iLFT system. With the addition of referral recommendations and management plans, this strategy provides optimum investigation and management of LFTs and is cost saving to the NHS

Glycine reduces platelet aggregation

It has been demonstrated that a wide variety of white blood cells and macrophages (i.e. Kupffer cells, alveolar and peritoneal macrophages and neutrophils) contain glycine-gated chloride channels. Binding of glycine on the receptor stimulates Cl− influx causing membrane hyperpolarization that prevents agonist-induced influx of calcium. Since platelet-aggregation is calcium-dependent, this study was designed to test the hypothesis that glycine would inhibit platelet aggregation. Rats were fed diets rich of glycine for 5 days, while controls received isonitrogenous valine. The bleeding time and ADP- and collagen-induced platelet aggregation were measured. Dietary glycine significantly increased bleeding time about two fold compared to valine-treated controls. Furthermore, the amplitude of platelet aggregation stimulated with ADP or collagen was significantly decreased in whole blood drawn from rats fed 2.5 or 5 % dietary glycine by over 50 %. Addition of glycine in vitro (1–10 mM) also blunted rat platelet aggregation in a dose-dependent manner. Strychnine, a glycine receptor antagonist, abrogated the inhibitory effect of glycine on platelet-aggregation in vitro suggesting the glycine works via a glycine receptor. Glycine also blunted aggregation of human platelets. Further, the glycine receptor was detected in both rat and human platelets by western blotting. Based on these data, it is concluded that glycine prevents aggregation of platelets in a dose-dependent manner via mechanisms involving a glycine receptor

Impact of Daily Cotrimoxazole on Clinical Malaria and Asymptomatic Parasitemias in HIV-Exposed, Uninfected Infants

Background. Cotrimoxazole preventive therapy (CPT) is recommended for all human immunodeficiency virus (HIV)–exposed infants to avoid opportunistic infections. Cotrimoxazole has antimalarial effects and appears to reduce clinical malaria infections, but the impact on asymptomatic malaria infections is unknown

Effects of antiplatelet therapy on stroke risk by brain imaging features of intracerebral haemorrhage and cerebral small vessel diseases: subgroup analyses of the RESTART randomised, open-label trial

Background Findings from the RESTART trial suggest that starting antiplatelet therapy might reduce the risk of recurrent symptomatic intracerebral haemorrhage compared with avoiding antiplatelet therapy. Brain imaging features of intracerebral haemorrhage and cerebral small vessel diseases (such as cerebral microbleeds) are associated with greater risks of recurrent intracerebral haemorrhage. We did subgroup analyses of the RESTART trial to explore whether these brain imaging features modify the effects of antiplatelet therapy

Keeping the Board in the Dark: CEO Compensation and Entrenchment

We study a model in which a CEO can entrench himself by hiding information from the board that would allow the board to conclude that he should be replaced. Assuming that even diligent monitoring by the board cannot fully overcome the information asymmetry visà- vis the CEO, we ask if there is a role for CEO compensation to mitigate the inefficiency. Our analysis points to a novel argument for high-powered, non-linear CEO compensation such as bonus pay or stock options. By shifting the CEO’s compensation into states where the firm’s value is highest, a high-powered compensation scheme makes it as unattractive as possible for the CEO to entrench himself when he expects that the firm’s future value under his management and strategy is low. This, in turn, minimizes the severance pay needed to induce the CEO not to entrench himself, thereby minimizing the CEO’s informational rents. Amongst other things, our model suggests how deregulation and technological changes in the 1980s and 1990s might have contributed to the rise in CEO pay and turnover over the same period

A surveillance sector review applied to infectious diseases at a country level

<p>Abstract</p> <p>Background</p> <p>The new International Health Regulations (IHR) require World Health Organization (WHO) member states to assess their core capacity for surveillance. Such reviews also have the potential to identify important surveillance gaps, improve the organisation of disparate surveillance systems and to focus attention on <it>upstream </it>hazards, determinants and interventions.</p> <p>Methods</p> <p>We developed a <it>surveillance sector review </it>method for evaluating all of the surveillance systems and related activities across a sector, in this case those concerned with infectious diseases in New Zealand. The first stage was a systematic description of these surveillance systems using a newly developed framework and classification system. Key informant interviews were conducted to validate the available information on the systems identified.</p> <p>Results</p> <p>We identified 91 surveillance systems and related activities in the 12 coherent categories of infectious diseases examined. The majority (n = 40 or 44%) of these were disease surveillance systems. They covered all categories, particularly for more severe outcomes including those resulting in death or hospitalisations. Except for some notifiable diseases and influenza, surveillance of less severe, but important infectious diseases occurring in the community was largely absent. There were 31 systems (34%) for surveillance of <it>upstream </it>infectious disease hazards, including risk and protective factors. This area tended to have many potential gaps and lack integration, partly because such systems were operated by a range of different agencies, often outside the health sector. There were fewer surveillance systems for determinants, including population size and characteristics (n = 9), and interventions (n = 11).</p> <p>Conclusions</p> <p>It was possible to create and populate a workable framework for describing all the infectious diseases surveillance systems and related activities in a single developed country and to identify potential surveillance sector gaps. This is the first stage in a review process that will lead to identification of priorities for surveillance sector development.</p