24 research outputs found

    Methodological Analysis of Randomized Controlled Trials; + Low Risk of Bias; – High Risk of Bias; ? Unclear Risk of Bias.

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    <p>Methodological Analysis of Randomized Controlled Trials; + Low Risk of Bias; – High Risk of Bias; ? Unclear Risk of Bias.</p

    Systematic Review of the Efficacy of Cognitive-Behavior Therapy Related Treatments for Victims of Natural Disasters: A Worldwide Problem

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    <div><p>Natural disasters can have devastating consequences. Each year, about 225 million people are victims of natural disasters worldwide, and up to 13,5 million of these people can develop post-traumatic stress disorder (PTSD) in the first or second year following the disaster. Cognitive-behavior therapy (CBT) is the first-choice treatment for this disorder. In order to evaluate the efficacy of psychotherapeutic treatment based on cognitive-behavior therapy for people who developed post traumatic stress disorder after natural disasters we conducted a systematic search of published studies. We used the terms reported below in the electronic databases ISI Web of Science, PsycINFO, PubMed, PILOTS and Scopus with no restrictions of language or publication date. Articles that described randomized controlled, non-randomized controlled and non controlled studies on the efficacy of cognitive-behavior therapy for individuals diagnosed with post-traumatic stress disorder after exposure to a natural disaster were eligible for inclusion. The studies were required to use a standardized measure of effectiveness before and after the intervention and have a group of patients who had used cognitive-behavior therapy as the only intervention. Our search identified 820 studies, and 11 were selected for this review. These 11 studies involved 742 subjects, 10 related to earthquakes and 1 to a hurricane. The cognitive-behavior therapy techniques used were various: 7 studies used exposure therapy, 2 studies used problem solving, and the only 2 studies with adolescents used techniques including reconstructions and reprocessing of the traumatic experience. As limitations, the search involved only five electronic databases, no experts in the field were consulted, and the heterogeneity of the findings made it impossible to perform a meta-analysis. The results suggest the efficacy of cognitive-behavior therapy, particularly exposure techniques, for the treatment of post-traumatic stress disorder after earthquakes. However, further studies with stronger methodologies, i.e. randomized-control trials and non-randomized controlled trials, are needed.</p></div

    Description of studies.

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    <p>The studies of Zhang et. al. (2011), Jaycox et. al. (2010) and Oflaz et. al. (2008) are originally randomized studies, but for the purposes of this review and analysis of their results they were used as open trials. Abbreviations: IES-R = Impact of Event Scale – Revised; CPTSD-RI = Child Posttraumatic Stress Disorder Reaction Index; CAPS = Clinician-Administered PTSD Scale; CPTSD-SS = Child PTSD Symptom Scale; CRIES = Children's Revised Impact of Event Scale; TSSC = Traumatic Stress Symptom Checklist; SSBT = Single Session Behavioral Treatment; WL = Waiting List; RA = Repeated Assessments; NET = Narrative Exposure Therapy; CBITS = Cognitive-Behavioral Intervention for Trauma in Schools; TF-CBT = Trauma-Focused Cognitive-Behavioral Therapy; CBT = Cognitive-Behavioral Therapy.</p><p>Description of studies.</p

    Adherence to the 2012 American College of Rheumatology (ACR) Guidelines for Management of Gout: A Survey of Brazilian Rheumatologists

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    <div><p>Objective</p><p>To describe the current pharmacological approach to gout treatment reported by rheumatologists in Brazil.</p><p>Methods</p><p>We performed a cross-sectional survey study using an online questionnaire e-mailed to 395 rheumatologists, randomly selected, from among the members of the Brazilian Society of Rheumatology.</p><p>Results</p><p>Three hundred and nine rheumatologists (78.2%) responded to the survey. For acute gout attacks, combination therapy (NSAIDs or steroid + colchicine) was often used, even in monoarticular involvement, and colchicine was commonly started as monotherapy after 36 hours or more from onset of attack. During an acute attack, urate-lowering therapy (ULT) was withdrawn by approximately a third of rheumatologists. Anti-inflammatory prophylaxis (98% colchicine) was initiated when ULT was started in most cases (92.4%), but its duration was varied. Most (70%) respondents considered the target serum uric acid level to be less than 6 mg/dl. Approximately 50% of rheumatologists reported starting allopurinol at doses of 100 mg daily or less and 42% reported the initial dose to be 300 mg daily in patients with normal renal function. ULT was maintained indefinitely in 76% of gout patients with tophi whereas in gout patients without tophi its use was kept indefinitely in 39.6%.</p><p>Conclusion</p><p>This is the first study evaluating gout treatment in a representative, random sample of Brazilian rheumatologists describing common treatment practices among these specialists. We identified several gaps in reported gout management, mainly concerning the use of colchicine and ULT and the duration of anti-inflammatory prophylaxis and ULT. Since rheumatologists are considered as opinion leaders in this disease, a program for improving quality of care for gout patients should focus on increasing their knowledge in this common disease.</p></div