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Giuliana Trucco - One of the best experts on this subject based on the ideXlab platform.
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effectiveness of inpatient and Outpatient Treatment strategies for women with pelvic inflammatory disease results from the pelvic inflammatory disease evaluation and clinical health peach randomized trial
American Journal of Obstetrics and Gynecology, 2002Co-Authors: Roberta B Ness, Robert L Holley, Jeffrey Peipert, Hugh Randall, Steven J Sondheimer, Susan L Hendrix, Antonio J Amortegui, Davison E. Soper, Giuliana TruccoAbstract:OBJECTIVE: Pelvic inflammatory disease (PID) is a common and morbid intraperitoneal infection. Although most women with pelvic inflammatory disease are treated as Outpatients, the effectiveness of this strategy remains unproven. STUDY DESIGN: We enrolled 831 women with clinical signs and symptoms of mild-to-moderate pelvic inflammatory disease into a multicenter randomized clinical trial of inpatient Treatment initiated by intravenous cefoxitin and doxycycline versus Outpatient Treatment that consisted of a single intramuscular injection of cefoxitin and oral doxycycline. Long-term outcomes were pregnancy rate, time to pregnancy, recurrence of pelvic inflammatory disease, chronic pelvic pain, and ectopic pregnancy. RESULTS: Short-term clinical and microbiologic improvement were similar between women randomized to the inpatient and Outpatient groups. After a mean follow-up period of 35 months, pregnancy rates were nearly equal (42.0% for Outpatients and 41.7% for inpatients). There were also no statistically significant differences between Outpatient and inpatient groups in the outcome of time to pregnancy or in the proportion of women with pelvic inflammatory disease recurrence, chronic pelvic pain, or ectopic pregnancy. CONCLUSION: Among women with mild-to-moderate pelvic inflammatory disease, there was no difference in reproductive outcomes between women randomized to inpatient Treatment and those randomized to Outpatient Treatment.
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effectiveness of inpatient and Outpatient Treatment strategies for women with pelvic inflammatory disease results from the pelvic inflammatory disease evaluation and clinical health peach randomized trial
American Journal of Obstetrics and Gynecology, 2002Co-Authors: Roberta B Ness, Robert L Holley, Jeffrey Peipert, Hugh Randall, Steven J Sondheimer, Susan L Hendrix, Antonio J Amortegui, Davison E. Soper, Giuliana TruccoAbstract:Abstract Objective: Pelvic inflammatory disease (PID) is a common and morbid intraperitoneal infection. Although most women with pelvic inflammatory disease are treated as Outpatients, the effectiveness of this strategy remains unproven. Study Design: We enrolled 831 women with clinical signs and symptoms of mild-to-moderate pelvic inflammatory disease into a multicenter randomized clinical trial of inpatient Treatment initiated by intravenous cefoxitin and doxycycline versus Outpatient Treatment that consisted of a single intramuscular injection of cefoxitin and oral doxycycline. Long-term outcomes were pregnancy rate, time to pregnancy, recurrence of pelvic inflammatory disease, chronic pelvic pain, and ectopic pregnancy. Results: Short-term clinical and microbiologic improvement were similar between women randomized to the inpatient and Outpatient groups. After a mean follow-up period of 35 months, pregnancy rates were nearly equal (42.0% for Outpatients and 41.7% for inpatients). There were also no statistically significant differences between Outpatient and inpatient groups in the outcome of time to pregnancy or in the proportion of women with pelvic inflammatory disease recurrence, chronic pelvic pain, or ectopic pregnancy. Conclusion: Among women with mild-to-moderate pelvic inflammatory disease, there was no difference in reproductive outcomes between women randomized to inpatient Treatment and those randomized to Outpatient Treatment. (Am J Obstet Gynecol 2002;186:929-37.)
John R Weisz - One of the best experts on this subject based on the ideXlab platform.
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when youth mental health care stops therapeutic relationship problems and other reasons for ending youth Outpatient Treatment
Journal of Consulting and Clinical Psychology, 2002Co-Authors: Joe Albert Garcia, John R WeiszAbstract:Child and adolescent Treatment ends for a variety of reasons, but little is known about the underlying factors or about whether any such factors are linked to premature dropout. To address these gaps, the authors administered their Reasons for Ending Treatment Questionnaire (RETQ) to the parents of 344 referred youth (aged 7-18 years), from 10 clinics, who had ended Outpatient Treatment. A factor analysis identified six factors, all showing good test-retest reliability and internal consistency. One of these, Therapeutic Relationship Problems, accounted for the most variance (16%) and was the only factor, other than Money Issues, that distinguished therapy dropouts from completers. The findings highlight major themes underlying decisions to end child therapy, and they highlight the importance of the therapeutic relationship.
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when youth mental health care stops therapeutic relationship problems and other reasons for ending youth Outpatient Treatment
Journal of Consulting and Clinical Psychology, 2002Co-Authors: Joe Albert Garcia, John R WeiszAbstract:Child and adolescent Treatment ends for a variety of reasons, but little is known about the underlying factors or about whether any such factors are linked to premature dropout. To address these gaps, the authors administered their Reasons for Ending Treatment Questionnaire (RETQ) to the parents of 344 referred youth (aged 7–18 years), from 10 clinics, who had ended Outpatient Treatment. A factor analysis identified six factors, all showing good test–retest reliability and internal consistency. One of these, Therapeutic Relationship Problems, accounted for the most variance (16%) and was the only factor, other than Money Issues, that distinguished therapy dropouts from completers. The findings highlight major themes underlying decisions to end child therapy, and they highlight the importance of the therapeutic relationship. Children 1 who begin Outpatient mental health care end it for a variety of reasons, with parents (or guardians) typically playing the most significant role in the decision (Cohen & Richardson, 1970; Weisz & Weiss, 1993; Weisz, Weiss, & Langmeyer, 1987, 1989). Previous research on Treatment termination has focused primarily on demographic and clinical factors (e.g., ethnicity, family structure, child symptom severity—see, e.g., Kendall & Sugarman, 1997; Weisz et al., 1987) and referral and Treatment characteristics (e.g., Farley, Peterson, & Spanos, 1975). This research, although very useful, neither illuminates the actual decision process that leads to ending Treatment nor suggests remedies in cases of premature termination. Understanding the decision process requires documenting specific reasons for ending Treatment. A few investigative teams have done this by questioning parents: (a) Gould, Shaffer, and Kaplan (1985) focused on dropouts from a university-based research clinic; (b) Kazdin and colleagues (e.g., Kazdin, Holland, Crowley & Breton, 1997) focused on children in a university research clinic for conduct problems; and (c) Kendall and Sugarman (1997) focused on children in a university research clinic for anxiety disorders. Several reasons for termination noted in these studies fit some categories of the Kazdin et al. (1997) barriers to Treatment model— especially (a) practical obstacles, (b) a perception that Treatment is demanding or not relevant to the child’s problems, and (c) a poor relationship with the therapist. In the present study, we built on previous work by interviewing parents after their children had ended Outpatient Treatment. We too asked about reasons for ending Treatment, but our approach differed from previous studies in that (a) unlike some previous research focused only on Treatment dropouts, we sampled the full range of children who had applied and been accepted for Treatment, regardless of when they had stopped; (b) unlike all previous parent questionnaire studies, which have focused on university-based research clinics, we studied community clinics, which are arguably more representative of most everyday child Treatment, and we included 10 such clinics (vs. 1, in each previous study) in an effort to further increase representativeness; and (c) we used factor analysis to probe for dimensions underlying Treatment termination decisions. 2
Roberta B Ness - One of the best experts on this subject based on the ideXlab platform.
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effectiveness of Treatment strategies of some women with pelvic inflammatory disease a randomized trial
Obstetrics & Gynecology, 2005Co-Authors: Roberta B Ness, Jeffrey Peipert, Hugh Randall, Holly E Richter, Deborah B Nelson, Diane Schubeck, Gene S Mcneeley, Wayne Trout, Gail Trautmann, Debra C BassAbstract:Objective Among all women with pelvic inflammatory disease (PID), prevention of adverse reproductive consequences appears to be similarly achieved by Outpatient Treatment and inpatient Treatment. We assessed whether Outpatient is as effective as inpatient Treatment in relevant age, race, and clinical subgroups of women with PID. Methods Women with clinical signs and symptoms of mild-to-moderate pelvic inflammatory disease (n = 831) were randomized into a multicenter trial of inpatient Treatment, initially employing intravenous cefoxitin and doxycycline compared with Outpatient Treatment consisting of a single intramuscular injection of cefoxitin and oral doxycycline. Comparisons between Treatment groups during a mean of 84 months of follow-up were made for pregnancies, live births, time to pregnancy, infertility, PID recurrence, chronic pelvic pain, and ectopic pregnancy. Results Outpatient Treatment assignment did not adversely impact the proportion of women having one or more pregnancies, live births, or ectopic pregnancies during follow-up; time to pregnancy; infertility; PID recurrence; or chronic pelvic pain among women of various races; with or without previous PID; with or without baseline Neisseria gonorrhoeae and/or Chlamydia trachomatis infection; and with or without high temperature/white blood cell count/pelvic tenderness score. This was true even in teenagers and women without a previous live birth. Ectopic pregnancies were more common in the Outpatient than the inpatient Treatment group, but because these were so rare, the difference did not reach statistical significance (5 versus 1, odds ratio 4.91, 95% confidence interval 0.57-42.25). Conclusion Among all women and subgroups of women with mild-to-moderate PID, there were no differences in reproductive outcomes after randomization to inpatient or Outpatient Treatment. Level of evidence I.
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effectiveness of inpatient and Outpatient Treatment strategies for women with pelvic inflammatory disease results from the pelvic inflammatory disease evaluation and clinical health peach randomized trial
American Journal of Obstetrics and Gynecology, 2002Co-Authors: Roberta B Ness, Robert L Holley, Jeffrey Peipert, Hugh Randall, Steven J Sondheimer, Susan L Hendrix, Antonio J Amortegui, Davison E. Soper, Giuliana TruccoAbstract:OBJECTIVE: Pelvic inflammatory disease (PID) is a common and morbid intraperitoneal infection. Although most women with pelvic inflammatory disease are treated as Outpatients, the effectiveness of this strategy remains unproven. STUDY DESIGN: We enrolled 831 women with clinical signs and symptoms of mild-to-moderate pelvic inflammatory disease into a multicenter randomized clinical trial of inpatient Treatment initiated by intravenous cefoxitin and doxycycline versus Outpatient Treatment that consisted of a single intramuscular injection of cefoxitin and oral doxycycline. Long-term outcomes were pregnancy rate, time to pregnancy, recurrence of pelvic inflammatory disease, chronic pelvic pain, and ectopic pregnancy. RESULTS: Short-term clinical and microbiologic improvement were similar between women randomized to the inpatient and Outpatient groups. After a mean follow-up period of 35 months, pregnancy rates were nearly equal (42.0% for Outpatients and 41.7% for inpatients). There were also no statistically significant differences between Outpatient and inpatient groups in the outcome of time to pregnancy or in the proportion of women with pelvic inflammatory disease recurrence, chronic pelvic pain, or ectopic pregnancy. CONCLUSION: Among women with mild-to-moderate pelvic inflammatory disease, there was no difference in reproductive outcomes between women randomized to inpatient Treatment and those randomized to Outpatient Treatment.
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effectiveness of inpatient and Outpatient Treatment strategies for women with pelvic inflammatory disease results from the pelvic inflammatory disease evaluation and clinical health peach randomized trial
American Journal of Obstetrics and Gynecology, 2002Co-Authors: Roberta B Ness, Robert L Holley, Jeffrey Peipert, Hugh Randall, Steven J Sondheimer, Susan L Hendrix, Antonio J Amortegui, Davison E. Soper, Giuliana TruccoAbstract:Abstract Objective: Pelvic inflammatory disease (PID) is a common and morbid intraperitoneal infection. Although most women with pelvic inflammatory disease are treated as Outpatients, the effectiveness of this strategy remains unproven. Study Design: We enrolled 831 women with clinical signs and symptoms of mild-to-moderate pelvic inflammatory disease into a multicenter randomized clinical trial of inpatient Treatment initiated by intravenous cefoxitin and doxycycline versus Outpatient Treatment that consisted of a single intramuscular injection of cefoxitin and oral doxycycline. Long-term outcomes were pregnancy rate, time to pregnancy, recurrence of pelvic inflammatory disease, chronic pelvic pain, and ectopic pregnancy. Results: Short-term clinical and microbiologic improvement were similar between women randomized to the inpatient and Outpatient groups. After a mean follow-up period of 35 months, pregnancy rates were nearly equal (42.0% for Outpatients and 41.7% for inpatients). There were also no statistically significant differences between Outpatient and inpatient groups in the outcome of time to pregnancy or in the proportion of women with pelvic inflammatory disease recurrence, chronic pelvic pain, or ectopic pregnancy. Conclusion: Among women with mild-to-moderate pelvic inflammatory disease, there was no difference in reproductive outcomes between women randomized to inpatient Treatment and those randomized to Outpatient Treatment. (Am J Obstet Gynecol 2002;186:929-37.)
Roxane Hellerbaan - One of the best experts on this subject based on the ideXlab platform.
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efficacy and safety of Outpatient Treatment based on the hestia clinical decision rule with or without n terminal pro brain natriuretic peptide testing in patients with acute pulmonary embolism a randomized clinical trial
American Journal of Respiratory and Critical Care Medicine, 2016Co-Authors: Paul Den L Exter, Frederikus Albertus Klok, W Zondag, R E Brouwer, Janneke Dolsma, Laura M Faber, Marijke Van Gerwen, Marco J J H Grootenboers, Michiel Eijsvogel, Roxane HellerbaanAbstract:Rationale: Outpatient Treatment of pulmonary embolism (PE) may lead to improved patient satisfaction and reduced healthcare costs. However, trials to assess its safety and the optimal method for patient selection are scarce.Objectives: To validate the utility and safety of selecting patients with PE for Outpatient Treatment by the Hestia criteria and to compare the safety of the Hestia criteria alone with the Hestia criteria combined with N-terminal pro–brain natriuretic peptide (NT-proBNP) testing.Methods: We performed a randomized noninferiority trial in 17 Dutch hospitals. We randomized patients with PE without any of the Hestia criteria to direct discharge or additional NT-proBNP testing. We discharged the latter patients as well if NT-proBNP did not exceed 500 ng/L or admitted them if NT-proBNP was greater than 500 ng/L. The primary endpoint was 30-day adverse outcome defined as PE- or bleeding-related mortality, cardiopulmonary resuscitation, or intensive care unit admission. The noninferiority marg...
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efficacy and safety of Outpatient Treatment based on the hestia clinical decision rule with or without n terminal pro brain natriuretic peptide testing in patients with acute pulmonary embolism a randomized clinical trial
American Journal of Respiratory and Critical Care Medicine, 2016Co-Authors: Paul Den L Exter, Frederikus Albertus Klok, W Zondag, R E Brouwer, Janneke Dolsma, Laura M Faber, Marijke Van Gerwen, Marco J J H Grootenboers, Michiel Eijsvogel, Roxane HellerbaanAbstract:Rationale Outpatient Treatment of pulmonary embolism (PE) may lead to improved patient satisfaction and reduced healthcare costs. However, trials to assess its safety and the optimal method for patient selection are scarce. Objectives To validate the utility and safety of selecting patients with PE for Outpatient Treatment by the Hestia criteria and to compare the safety of the Hestia criteria alone with the Hestia criteria combined with N-terminal pro-brain natriuretic peptide (NT-proBNP) testing. Methods We performed a randomized noninferiority trial in 17 Dutch hospitals. We randomized patients with PE without any of the Hestia criteria to direct discharge or additional NT-proBNP testing. We discharged the latter patients as well if NT-proBNP did not exceed 500 ng/L or admitted them if NT-proBNP was greater than 500 ng/L. The primary endpoint was 30-day adverse outcome defined as PE- or bleeding-related mortality, cardiopulmonary resuscitation, or intensive care unit admission. The noninferiority margin for the primary endpoint was 3.4%. Measurements and main results We randomized 550 patients. In the NT-proBNP group, 34 of 275 (12%) had elevated NT-proBNP values and were managed as inpatients. No patient (0 of 34) with an elevated NT-proBNP level treated in hospital (0%; 95% confidence interval [CI], 0-10.2%), versus no patient (0 of 23) with a post hoc-determined elevated NT-proBNP level from the direct discharge group (0%; 95% CI, 0-14.8%), experienced the primary endpoint. In both trial cohorts, the primary endpoint occurred in none of the 275 patients (0%; 95% CI, 0-1.3%) subjected to NT-proBNP testing, versus in 3 of 275 patients (1.1%; 95% CI, 0.2-3.2%) in the direct discharge group (P = 0.25). During the 3-month follow-up, recurrent venous thromboembolism occurred in two patients (0.73%; 95% CI, 0.1-2.6%) in the NT-proBNP group versus three patients (1.1%; 95% CI, 0.2-3.2%) in the direct discharge group (P = 0.65). Conclusions Outpatient Treatment of patients with PE selected on the basis of the Hestia criteria alone was associated with a low risk of adverse events. Given the low number of patients with elevated NT-proBNP levels, this trial was unable to draw definite conclusions regarding the incremental value of NT-proBNP testing in patients who fulfill the Hestia criteria. Clinical trial registered with www.trialregister.nl/trialreg/admin/rctview.asp?TC=2603 (NTR2603).
Jeffrey Peipert - One of the best experts on this subject based on the ideXlab platform.
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effectiveness of Treatment strategies of some women with pelvic inflammatory disease a randomized trial
Obstetrics & Gynecology, 2005Co-Authors: Roberta B Ness, Jeffrey Peipert, Hugh Randall, Holly E Richter, Deborah B Nelson, Diane Schubeck, Gene S Mcneeley, Wayne Trout, Gail Trautmann, Debra C BassAbstract:Objective Among all women with pelvic inflammatory disease (PID), prevention of adverse reproductive consequences appears to be similarly achieved by Outpatient Treatment and inpatient Treatment. We assessed whether Outpatient is as effective as inpatient Treatment in relevant age, race, and clinical subgroups of women with PID. Methods Women with clinical signs and symptoms of mild-to-moderate pelvic inflammatory disease (n = 831) were randomized into a multicenter trial of inpatient Treatment, initially employing intravenous cefoxitin and doxycycline compared with Outpatient Treatment consisting of a single intramuscular injection of cefoxitin and oral doxycycline. Comparisons between Treatment groups during a mean of 84 months of follow-up were made for pregnancies, live births, time to pregnancy, infertility, PID recurrence, chronic pelvic pain, and ectopic pregnancy. Results Outpatient Treatment assignment did not adversely impact the proportion of women having one or more pregnancies, live births, or ectopic pregnancies during follow-up; time to pregnancy; infertility; PID recurrence; or chronic pelvic pain among women of various races; with or without previous PID; with or without baseline Neisseria gonorrhoeae and/or Chlamydia trachomatis infection; and with or without high temperature/white blood cell count/pelvic tenderness score. This was true even in teenagers and women without a previous live birth. Ectopic pregnancies were more common in the Outpatient than the inpatient Treatment group, but because these were so rare, the difference did not reach statistical significance (5 versus 1, odds ratio 4.91, 95% confidence interval 0.57-42.25). Conclusion Among all women and subgroups of women with mild-to-moderate PID, there were no differences in reproductive outcomes after randomization to inpatient or Outpatient Treatment. Level of evidence I.
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effectiveness of inpatient and Outpatient Treatment strategies for women with pelvic inflammatory disease results from the pelvic inflammatory disease evaluation and clinical health peach randomized trial
American Journal of Obstetrics and Gynecology, 2002Co-Authors: Roberta B Ness, Robert L Holley, Jeffrey Peipert, Hugh Randall, Steven J Sondheimer, Susan L Hendrix, Antonio J Amortegui, Davison E. Soper, Giuliana TruccoAbstract:OBJECTIVE: Pelvic inflammatory disease (PID) is a common and morbid intraperitoneal infection. Although most women with pelvic inflammatory disease are treated as Outpatients, the effectiveness of this strategy remains unproven. STUDY DESIGN: We enrolled 831 women with clinical signs and symptoms of mild-to-moderate pelvic inflammatory disease into a multicenter randomized clinical trial of inpatient Treatment initiated by intravenous cefoxitin and doxycycline versus Outpatient Treatment that consisted of a single intramuscular injection of cefoxitin and oral doxycycline. Long-term outcomes were pregnancy rate, time to pregnancy, recurrence of pelvic inflammatory disease, chronic pelvic pain, and ectopic pregnancy. RESULTS: Short-term clinical and microbiologic improvement were similar between women randomized to the inpatient and Outpatient groups. After a mean follow-up period of 35 months, pregnancy rates were nearly equal (42.0% for Outpatients and 41.7% for inpatients). There were also no statistically significant differences between Outpatient and inpatient groups in the outcome of time to pregnancy or in the proportion of women with pelvic inflammatory disease recurrence, chronic pelvic pain, or ectopic pregnancy. CONCLUSION: Among women with mild-to-moderate pelvic inflammatory disease, there was no difference in reproductive outcomes between women randomized to inpatient Treatment and those randomized to Outpatient Treatment.
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effectiveness of inpatient and Outpatient Treatment strategies for women with pelvic inflammatory disease results from the pelvic inflammatory disease evaluation and clinical health peach randomized trial
American Journal of Obstetrics and Gynecology, 2002Co-Authors: Roberta B Ness, Robert L Holley, Jeffrey Peipert, Hugh Randall, Steven J Sondheimer, Susan L Hendrix, Antonio J Amortegui, Davison E. Soper, Giuliana TruccoAbstract:Abstract Objective: Pelvic inflammatory disease (PID) is a common and morbid intraperitoneal infection. Although most women with pelvic inflammatory disease are treated as Outpatients, the effectiveness of this strategy remains unproven. Study Design: We enrolled 831 women with clinical signs and symptoms of mild-to-moderate pelvic inflammatory disease into a multicenter randomized clinical trial of inpatient Treatment initiated by intravenous cefoxitin and doxycycline versus Outpatient Treatment that consisted of a single intramuscular injection of cefoxitin and oral doxycycline. Long-term outcomes were pregnancy rate, time to pregnancy, recurrence of pelvic inflammatory disease, chronic pelvic pain, and ectopic pregnancy. Results: Short-term clinical and microbiologic improvement were similar between women randomized to the inpatient and Outpatient groups. After a mean follow-up period of 35 months, pregnancy rates were nearly equal (42.0% for Outpatients and 41.7% for inpatients). There were also no statistically significant differences between Outpatient and inpatient groups in the outcome of time to pregnancy or in the proportion of women with pelvic inflammatory disease recurrence, chronic pelvic pain, or ectopic pregnancy. Conclusion: Among women with mild-to-moderate pelvic inflammatory disease, there was no difference in reproductive outcomes between women randomized to inpatient Treatment and those randomized to Outpatient Treatment. (Am J Obstet Gynecol 2002;186:929-37.)
