Your browser doesn't support javascript.
loading
Mostrar: 20 | 50 | 100
Resultados 1 - 18 de 18
Filtrar
Mais filtros

Métodos Terapêuticos e Terapias MTCI
Base de dados
País/Região como assunto
Tipo de documento
Intervalo de ano de publicação
1.
Psychother Res ; 34(1): 54-67, 2024 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-36630684

RESUMO

OBJECTIVE: Few studies have investigated the role of generic relational factors, such as group cohesion and working alliance, in group cognitive behaviour therapy (CBT) for social anxiety disorder (SAD). The aim of this study was to examine the temporal associations among working alliance, group cohesion, and an index of a CBT-specific factor, homework engagement, as correlates of fear of negative evaluation and symptoms of social anxiety in group CBT for SAD. METHOD: There were 105 participants with a diagnosis of social anxiety disorder who were randomly assigned to 12 sessions of group imagery-enhanced or standard CBT. Participants completed measures at various time points during the 12-session interventions, and the relationship among variables was examined through random-intercept cross-lagged panel models. RESULTS: Group cohesion was significantly associated with social anxiety symptoms at the end of treatment, however there was no significant relationship with working alliance. Greater homework engagement predicted lower social interaction anxiety, but only during mid-treatment. CONCLUSION: The results highlight the importance of supporting group cohesion and maximising homework engagement during core components of social anxiety treatment such as behavioural experiments.


Assuntos
Terapia Cognitivo-Comportamental , Fobia Social , Humanos , Fobia Social/terapia , Fobia Social/psicologia , Coesão Social , Terapia Cognitivo-Comportamental/métodos , Transtornos de Ansiedade/terapia , Transtornos de Ansiedade/psicologia , Ansiedade/terapia , Resultado do Tratamento
2.
IEEE Comput Graph Appl ; 43(3): 94-101, 2023.
Artigo em Inglês | MEDLINE | ID: mdl-37195829

RESUMO

Aesthetics for the visualization of biomolecular structures have evolved over the years according to technological advances, user needs, and modes of dissemination. In this article, we explore the goals, challenges, and solutions that have shaped the current landscape of biomolecular imagery from the overlapping perspectives of computer science, structural biology, and biomedical illustration. We discuss changing approaches to rendering, color, human-computer interface, and narrative in the development and presentation of biomolecular graphics. With this historical perspective on the evolving styles and trends in each of these areas, we identify opportunities and challenges for future aesthetics in biomolecular graphics that encourage continued collaboration from multiple intersecting fields.


Assuntos
Gráficos por Computador , Software , Humanos , Interface Usuário-Computador , Biologia Molecular
3.
Behav Ther ; 53(5): 1050-1061, 2022 09.
Artigo em Inglês | MEDLINE | ID: mdl-35987535

RESUMO

Recurrent, negative self-imagery is common in social anxiety disorder (SAD). Imagery rescripting (ImRs) is an effective therapeutic technique that aims to target past aversive memories to modify their associated meanings, and update the encapsulated negative schematic beliefs. The current study aimed to extend previous research by investigating the cognitive and affective shifts during each phase of ImRs delivered within a group cognitive behavioral therapy protocol. Participants (N = 32) retrieved an aversive memory associated with social anxiety and were guided through brief cognitive restructuring, prior to completing ImRs. Core beliefs associated with the memory (strength and valence) and fear of negative evaluation were assessed before and after ImRs and affect was assessed following each phase. Strength and affective valence of encapsulated core beliefs about the self, others, the world, and the image itself significantly reduced following ImRs, and core beliefs were updated to become more positive. Participants reported large affective shifts early in the process, with smaller shifts in the later stages. Fear of negative evaluation did not significantly reduce following ImRs. Outcomes provide some support for cognitive and affective changes during group ImRs for SAD and suggest future research directions to investigate longer-term impacts and to better understand the underlying mechanisms of the technique.


Assuntos
Terapia Cognitivo-Comportamental , Fobia Social , Cognição , Terapia Cognitivo-Comportamental/métodos , Medo/psicologia , Humanos , Imagens, Psicoterapia/métodos , Fobia Social/psicologia , Fobia Social/terapia , Resultado do Tratamento
4.
Psychol Med ; 52(7): 1277-1286, 2022 05.
Artigo em Inglês | MEDLINE | ID: mdl-32912351

RESUMO

BACKGROUND: Cognitive behavior therapy (CBT) is effective for most patients with a social anxiety disorder (SAD) but a substantial proportion fails to remit. Experimental and clinical research suggests that enhancing CBT using imagery-based techniques could improve outcomes. It was hypothesized that imagery-enhanced CBT (IE-CBT) would be superior to verbally-based CBT (VB-CBT) on pre-registered outcomes. METHODS: A randomized controlled trial of IE-CBT v. VB-CBT for social anxiety was completed in a community mental health clinic setting. Participants were randomized to IE (n = 53) or VB (n = 54) CBT, with 1-month (primary end point) and 6-month follow-up assessments. Participants completed 12, 2-hour, weekly sessions of IE-CBT or VB-CBT plus 1-month follow-up. RESULTS: Intention to treat analyses showed very large within-treatment effect sizes on the social interaction anxiety at all time points (ds = 2.09-2.62), with no between-treatment differences on this outcome or clinician-rated severity [1-month OR = 1.45 (0.45, 4.62), p = 0.53; 6-month OR = 1.31 (0.42, 4.08), p = 0.65], SAD remission (1-month: IE = 61.04%, VB = 55.09%, p = 0.59); 6-month: IE = 58.73%, VB = 61.89%, p = 0.77), or secondary outcomes. Three adverse events were noted (substance abuse, n = 1 in IE-CBT; temporary increase in suicide risk, n = 1 in each condition, with one being withdrawn at 1-month follow-up). CONCLUSIONS: Group IE-CBT and VB-CBT were safe and there were no significant differences in outcomes. Both treatments were associated with very large within-group effect sizes and the majority of patients remitted following treatment.


Assuntos
Terapia Cognitivo-Comportamental , Fobia Social , Ansiedade , Transtornos de Ansiedade/terapia , Terapia Cognitivo-Comportamental/métodos , Humanos , Fobia Social/psicologia , Fobia Social/terapia
5.
Int J Eat Disord ; 54(9): 1689-1695, 2021 09.
Artigo em Inglês | MEDLINE | ID: mdl-34184797

RESUMO

BACKGROUND: The coronavirus pandemic (COVID-19) has required telehealth to be integrated into the delivery of evidence-based treatments for eating disorders in many services, but the impact of this on patient outcomes is unknown. OBJECTIVE: The present study examined the impact of the first wave of COVID-19 and rapid transition to telehealth on eating disorder symptoms in a routine clinical setting. METHOD: Participants were 25 patients with a confirmed eating disorder diagnosis who had commenced face-to-face treatment and rapidly switched to telehealth during the first wave of COVID-19 in Western Australia. Eating disorder symptoms, clinical impairment and mood were measured prospectively before and during lockdowns imposed due to COVID-19. HYPOTHESES: We predicted that patients would experience poorer treatment outcomes during COVID-19 and would perceive poorer therapeutic alliance and poorer quality of treatment compared to face-to-face therapy. RESULTS: Our hypotheses were not supported. On average, patients achieved large improvements in eating disorder symptoms and mood, and the magnitude of improvement in eating disorder symptoms was comparable to historical benchmarks at the same clinic. Patients rated the quality of treatment and therapeutic alliance highly. DISCUSSION: Providing evidence-based treatment for eating disorders via telehealth during COVID-19 lockdown is acceptable to patients and associated with positive treatment outcomes.


Assuntos
COVID-19 , Prestação Integrada de Cuidados de Saúde , Transtornos da Alimentação e da Ingestão de Alimentos , Telemedicina , COVID-19/epidemiologia , Transtornos da Alimentação e da Ingestão de Alimentos/terapia , Humanos , Telemedicina/organização & administração , Resultado do Tratamento , Austrália Ocidental/epidemiologia
6.
Am J Epidemiol ; 189(1): 8-26, 2020 01 31.
Artigo em Inglês | MEDLINE | ID: mdl-31712803

RESUMO

The Folic Acid and Zinc Supplementation Trial (FAZST) was a multicenter, double-blind, block-randomized, placebo-controlled trial to determine whether folic acid and zinc supplementation in men improves semen quality and increases livebirth rate among couples seeking infertility treatment (2013-2017). Eligible men were aged 18 years or older with female partners aged 18-45 years, seeking infertility treatment. Men were randomized (1:1) to 5 mg folic acid and 30 mg elemental zinc daily or matching placebo for 6 months. Randomization was stratified by site and intended infertility treatment (in vitro fertilization (IVF), non-IVF/study site, and non-IVF/outside clinic). Follow-up of men continued for 6 months, and female partners were passively followed for a minimum of 9 months. Women who conceived were followed throughout pregnancy. Overall, 2,370 men were randomized during 2013-2017 (1,185 folic acid and zinc, 1,185 placebo); they had a mean age of 33 years and body mass index (weight (kg)/height (m)2) of 29.8. Most participants were white (82%), well educated (83% with some college), and employed (72%). Participant characteristics were balanced across intervention arms. Study visits were completed by 89%, 77%, and 75% of men at months 2, 4, and 6, respectively. Here we describe the study design, recruitment, data collection, lessons learned, and baseline participant characteristics.


Assuntos
Suplementos Nutricionais , Ácido Fólico/administração & dosagem , Infertilidade Masculina/terapia , Nascido Vivo , Zinco/administração & dosagem , Adolescente , Adulto , Método Duplo-Cego , Feminino , Fertilização in vitro , Humanos , Recém-Nascido , Masculino , Pessoa de Meia-Idade , Gravidez , Projetos de Pesquisa , Análise do Sêmen , Resultado do Tratamento , Adulto Jovem
7.
N Engl J Med ; 381(10): 912-922, 2019 09 05.
Artigo em Inglês | MEDLINE | ID: mdl-31483962

RESUMO

BACKGROUND: Endovenous laser ablation and ultrasound-guided foam sclerotherapy are recommended alternatives to surgery for the treatment of primary varicose veins, but their long-term comparative effectiveness remains uncertain. METHODS: In a randomized, controlled trial involving 798 participants with primary varicose veins at 11 centers in the United Kingdom, we compared the outcomes of laser ablation, foam sclerotherapy, and surgery. Primary outcomes at 5 years were disease-specific quality of life and generic quality of life, as well as cost-effectiveness based on models of expected costs and quality-adjusted life-years (QALYs) gained that used data on participants' treatment costs and scores on the EuroQol EQ-5D questionnaire. RESULTS: Quality-of-life questionnaires were completed by 595 (75%) of the 798 trial participants. After adjustment for baseline scores and other covariates, scores on the Aberdeen Varicose Vein Questionnaire (on which scores range from 0 to 100, with lower scores indicating a better quality of life) were lower among patients who underwent laser ablation or surgery than among those who underwent foam sclerotherapy (effect size [adjusted differences between groups] for laser ablation vs. foam sclerotherapy, -2.86; 95% confidence interval [CI], -4.49 to -1.22; P<0.001; and for surgery vs. foam sclerotherapy, -2.60; 95% CI, -3.99 to -1.22; P<0.001). Generic quality-of-life measures did not differ among treatment groups. At a threshold willingness-to-pay ratio of £20,000 ($28,433 in U.S. dollars) per QALY, 77.2% of the cost-effectiveness model iterations favored laser ablation. In a two-way comparison between foam sclerotherapy and surgery, 54.5% of the model iterations favored surgery. CONCLUSIONS: In a randomized trial of treatments for varicose veins, disease-specific quality of life 5 years after treatment was better after laser ablation or surgery than after foam sclerotherapy. The majority of the probabilistic cost-effectiveness model iterations favored laser ablation at a willingness-to-pay ratio of £20,000 ($28,433) per QALY. (Funded by the National Institute for Health Research; CLASS Current Controlled Trials number, ISRCTN51995477.).


Assuntos
Procedimentos Endovasculares , Terapia a Laser , Qualidade de Vida , Escleroterapia , Varizes/terapia , Adulto , Análise Custo-Benefício , Procedimentos Endovasculares/economia , Feminino , Seguimentos , Humanos , Análise de Intenção de Tratamento , Terapia a Laser/economia , Masculino , Pessoa de Meia-Idade , Anos de Vida Ajustados por Qualidade de Vida , Escleroterapia/economia , Escleroterapia/métodos , Inquéritos e Questionários , Resultado do Tratamento , Ultrassonografia de Intervenção , Varizes/cirurgia
8.
Ann Clin Biochem ; 56(3): 310-325, 2019 05.
Artigo em Inglês | MEDLINE | ID: mdl-30813740

RESUMO

It is increasingly easy for the general public to access a wide range of laboratory tests. Tests can be ordered online with little or no input from a health professional. The complementary and alternative medicine (CAM) community promote and sell a wide range of tests, many of which are of dubious clinical significance. Many have little or no clinical utility and have been widely discredited, whilst others are established tests that are used for unvalidated purposes. They range from the highly complex, employing state of the art technology, e.g. heavy metal analysis using inductively coupled plasma-mass spectrometry, to the rudimentary, e.g. live blood cell analysis. Results of 'CAM tests' are often accompanied by extensive clinical interpretations which may recommend, or be used to justify, unnecessary or harmful treatments. There are now a small number of laboratories across the globe that specialize in CAM testing. Some CAM laboratories operate completely outside of any accreditation programme whilst others are fully accredited to the standard of established clinical laboratories. In this review, we explore CAM testing in the United States, the United Kingdom and Australia with a focus on the common tests on offer, how they are reported, the evidence base for their clinical application and the regulations governing their use. We will also review proposed changed to in-vitro diagnostic device regulations and how these might impact on CAM testing.


Assuntos
Técnicas de Laboratório Clínico/métodos , Terapias Complementares/métodos , Medicina Baseada em Evidências , Humanos
9.
Eur J Obstet Gynecol Reprod Biol ; 218: 39-48, 2017 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-28934714

RESUMO

OBJECTIVE: To evaluate the effect of DHEA supplementation on In-Vitro Fertilisation (IVF) outcome as assessed by ovarian response, oocyte developmental competence and live birth rates in women predicted to have poor ovarian reserve (OR). The feasibility of conducting a large trial is also assessed by evaluating the recruitment rates and compliance of the recruited participants with DHEA/placebo intake and follow-up rates. STUDY DESIGN: A single centre, double blinded, placebo controlled, randomized trial was performed over two years with 60 women undergoing in-vitro fertilisation (IVF). Subjects were randomized, based on a computer-generated pseudo-random code to receive either DHEA or placebo with both capsules having similar colour, size and appearance. 60 women with poor OR based on antral follicle count or anti-Mullerian hormone thresholds undergoing IVF were recruited. They were randomised to receive DHEA 75mg/day or placebo for at-least 12 weeks before starting ovarian stimulation. They had long protocol using hMG 300 IU/day. Data analysed by "intention to treat". Ovarian response, live birth rates and molecular markers of oocyte quality were compared between the study and control groups. RESULTS: The recruitment rate was 39% (60/154). A total of 52 participants (27 versus 25 in the study and placebo groups) were included in the final analysis after excluding eight. While the mean (standard deviation) DHEA levels were similar at recruitment (9.4 (5) versus 7.5 (2.4) ng/ml; P=0.1), the DHEA levels at pre-stimulation were higher in the study group than in the controls (16.3 (5.8) versus 11.1 (4.5) ng/ml; P<0.01). The number (median, range) of oocytes retrieved (4, 0-18 versus 4, 0-15 respectively; P=0.54) and live birth rates (7/27, 26% versus 8/25, 32% respectively; RR (95% CI): 0.74 (0.22-2.48) and mRNA expression of developmental biomarkers in granulosa and cumulus cells were similar between the groups. CONCLUSION: Pre-treatment DHEA supplementation, albeit statistical power in this study is low, did not improve the response to controlled ovarian hyperstimulation or oocyte quality or live birth rates during IVF treatment with long protocol in women predicted to have poor OR.


Assuntos
Androgênios/farmacologia , Desidroepiandrosterona/farmacologia , Oócitos/metabolismo , Reserva Ovariana , Ovário/efeitos dos fármacos , Indução da Ovulação/métodos , Adulto , Envelhecimento/efeitos dos fármacos , Androgênios/administração & dosagem , Desidroepiandrosterona/administração & dosagem , Método Duplo-Cego , Feminino , Fertilização in vitro/métodos , Humanos , Análise de Intenção de Tratamento , Nascido Vivo , Recuperação de Oócitos , Ovário/metabolismo , Gravidez
10.
Health Technol Assess ; 19(27): 1-342, 2015 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-25858333

RESUMO

BACKGROUND: Foam sclerotherapy (foam) and endovenous laser ablation (EVLA) have emerged as alternative treatments to surgery for patients with varicose veins, but uncertainty exists regarding their effectiveness in the medium to longer term. OBJECTIVES: To assess the clinical effectiveness and cost-effectiveness of foam, EVLA and surgery for the treatment of varicose veins. DESIGN: A parallel-group randomised controlled trial (RCT) without blinding, and economic modelling evaluation. SETTING: Eleven UK specialist vascular centres. PARTICIPANTS: Seven hundred and ninety-eight patients with primary varicose veins (foam, n = 292; surgery, n = 294; EVLA, n = 212). INTERVENTIONS: Patients were randomised between all three treatment options (eight centres) or between foam and surgery (three centres). PRIMARY OUTCOME MEASURES: Disease-specific [Aberdeen Varicose Vein Questionnaire (AVVQ)] and generic [European Quality of Life-5 Dimensions (EQ-5D), Short Form questionnaire-36 items (SF-36) physical and mental component scores] quality of life (QoL) at 6 months. Cost-effectiveness as cost per quality-adjusted life-year (QALY) gained. SECONDARY OUTCOME MEASURES: Quality of life at 6 weeks; residual varicose veins; Venous Clinical Severity Score (VCSS); complication rates; return to normal activity; truncal vein ablation rates; and costs. RESULTS: The results appear generalisable in that participants' baseline characteristics (apart from a lower-than-expected proportion of females) and post-treatment improvement in outcomes were comparable with those in other RCTs. The health gain achieved in the AVVQ with foam was significantly lower than with surgery at 6 months [effect size -1.74, 95% confidence interval (CI) -2.97 to -0.50; p = 0.006], but was similar to that achieved with EVLA. The health gain in SF-36 mental component score for foam was worse than that for EVLA (effect size 1.54, 95% CI 0.01 to 3.06; p = 0.048) but similar to that for surgery. There were no differences in EQ-5D or SF-36 component scores in the surgery versus foam or surgery versus EVLA comparisons at 6 months. The trial-based cost-effectiveness analysis showed that, at 6 months, foam had the highest probability of being considered cost-effective at a ceiling willingness-to-pay ratio of £20,000 per QALY. EVLA was found to cost £26,107 per QALY gained versus foam, and was less costly and generated slightly more QALYs than surgery. Markov modelling using trial costs and the limited recurrence data available suggested that, at 5 years, EVLA had the highest probability (≈ 79%) of being cost-effective at conventional thresholds, followed by foam (≈ 17%) and surgery (≈ 5%). With regard to secondary outcomes, health gains at 6 weeks (p < 0.005) were greater for EVLA than for foam (EQ-5D, p = 0.004). There were fewer procedural complications in the EVLA group (1%) than after foam (7%) and surgery (8%) (p < 0.001). Participants returned to a wide range of behaviours more quickly following foam or EVLA than following surgery (p < 0.05). There were no differences in VCSS between the three treatments. Truncal ablation rates were higher for surgery (p < 0.001) and EVLA (p < 0.001) than for foam, and were similar for surgery and EVLA. CONCLUSIONS: Considerations of both the 6-month clinical outcomes and the estimated 5-year cost-effectiveness suggest that EVLA should be considered as the treatment of choice for suitable patients. FUTURE WORK: Five-year trial results are currently being evaluated to compare the cost-effectiveness of foam, surgery and EVLA, and to determine the recurrence rates following each treatment. This trial has highlighted the need for long-term outcome data from RCTs on QoL, recurrence rates and costs for foam sclerotherapy and other endovenous techniques compared against each other and against surgery. TRIAL REGISTRATION: Current Controlled Trials ISRCTN51995477. FUNDING: This project was funded by the National Institute for Health Research (NIHR) Health Technology Assessment programme and will be published in full in Health Technology Assessment; Vol. 19, No. 27. See the NIHR Journals Library website for further project information.


Assuntos
Análise Custo-Benefício , Terapia a Laser , Avaliação de Processos e Resultados em Cuidados de Saúde/estatística & dados numéricos , Anos de Vida Ajustados por Qualidade de Vida , Escleroterapia , Varizes/terapia , Atividades Cotidianas , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Gastos em Saúde/estatística & dados numéricos , Humanos , Terapia a Laser/efeitos adversos , Terapia a Laser/economia , Terapia a Laser/métodos , Terapia a Laser/estatística & dados numéricos , Masculino , Pessoa de Meia-Idade , Avaliação de Processos e Resultados em Cuidados de Saúde/economia , Recidiva , Escleroterapia/efeitos adversos , Escleroterapia/economia , Escleroterapia/métodos , Escleroterapia/estatística & dados numéricos , Índice de Gravidade de Doença , Medicina Estatal/economia , Avaliação da Tecnologia Biomédica , Reino Unido , Varizes/economia , Varizes/cirurgia , Adulto Jovem
11.
Trials ; 16: 88, 2015 Mar 11.
Artigo em Inglês | MEDLINE | ID: mdl-25873096

RESUMO

BACKGROUND: Recruitment to pragmatic randomised controlled trials (RCTs) is acknowledged to be difficult, and few interventions have proved to be effective. Previous qualitative research has consistently revealed that recruiters provide imbalanced information about RCT treatments. However, qualitative research can be time-consuming to apply. Within a programme of research to optimise recruitment and informed consent in challenging RCTs, we developed a simple technique, Q-QAT (Quanti-Qualitative Appointment Timing), to systematically investigate and quantify the imbalance to help identify and address recruitment difficulties. METHODS: The Q-QAT technique comprised: 1) quantification of time spent discussing the RCT and its treatments using transcripts of audio-recorded recruitment appointments, 2) targeted qualitative research to understand the obstacles to recruitment and 3) feedback to recruiters on opportunities for improvement. This was applied to two RCTs with different clinical contexts and recruitment processes. Comparisons were made across clinical centres, recruiters and specialties. RESULTS: In both RCTs, the Q-QAT technique first identified considerable variations in the time spent by recruiters discussing the RCT and its treatments. The patterns emerging from this initial quantification of recruitment appointments then enabled targeted qualitative research to understand the issues and make suggestions to improve recruitment. In RCT1, presentation of the treatments was balanced, but little time was devoted to describing the RCT. Qualitative research revealed patients would have considered participation, but lacked awareness of the RCT. In RCT2, the balance of treatment presentation varied by specialists and centres. Qualitative research revealed difficulties with equipoise and confidence among recruiters presenting the RCT. The quantitative and qualitative findings were well-received by recruiters and opportunities to improve information provision were discussed. A blind coding exercise across three researchers led to the development of guidelines that can be used to apply the Q-QAT technique to other difficult RCTs. CONCLUSION: The Q-QAT technique was easy to apply and rapidly identified obstacles to recruitment that could be understood through targeted qualitative research and addressed through feedback. The technique's combination of quantitative and qualitative findings enabled the presentation of a holistic picture of recruitment challenges and added credibility to the feedback process. Note: both RCTs in this manuscript asked to be anonymised, so no trial registration details are provided.


Assuntos
Agendamento de Consultas , Seleção de Pacientes , Ensaios Clínicos Controlados Aleatórios como Assunto/métodos , Atitude do Pessoal de Saúde , Retroalimentação Psicológica , Humanos , Consentimento Livre e Esclarecido , Entrevistas como Assunto , Pesquisa Qualitativa , Pesquisadores/psicologia , Fatores de Tempo
12.
BMJ Open ; 4(10): e005767, 2014 Oct 08.
Artigo em Inglês | MEDLINE | ID: mdl-25296654

RESUMO

INTRODUCTION: Dehydroepiandrosterone (DHEA) has been proposed to improve pregnancy rates in women with diminished ovarian reserve undergoing in vitro fertilisation (IVF) treatment. However, evidence regarding its efficacy is supported by a limited number of randomised controlled trials (RCTs). This double-blinded RCT aims to measure the effect of DHEA supplementation prior to and during controlled ovarian hyperstimulation on ovarian response prior to IVF treatment in women predicted to have poor ovarian reserve. METHODS AND ANALYSIS: Sixty women with ovarian antral follicle count ≤10 and serum anti-Mullerian hormone ≤5 pmol/L undergoing IVF/intracytoplasmic sperm injection (ICSI) treatment at the Nurture fertility clinic, Nottingham will be recruited. They will be randomised to either receive DHEA capsule 75 mg/day or placebo for at least 12 weeks before egg collection. All participants will undergo standard long down regulation protocol using human menopausal gonadotropin 300 IU/day. Serum samples and follicular fluids at the time of egg collection will be collected for hormonal immunoassays. For ICSI participants, cumulus cells stripped from oocyte will be collected for cumulus gene expression analyses regarding oocyte competence. Microdrops of oocyte culture media before the time of ICSI will be assessed for glucose, pyruvate and lactate utilisation. Embryo transfer will be performed on day 2, 3 or 5 based on the number and quality of the embryos available. Pregnancy will be defined as urine pregnancy test positive (biochemical pregnancy) and 6-8 weeks ultrasound scan with fetal heart beat (clinical pregnancy) and live birth. It is planned to perform the molecular and nutritional fingerprint analyses in batches after finishing the clinical phase of the study. ETHICS AND DISSEMINATION: The approval of the study was granted by the NHS Research Ethics Committee (Ref number NRES 12/EM/0002), the Medicines and Healthcare products Regulatory Agency (MHRA), and the Nottingham University Hospitals Trust Research and Development department. All participants shall provide written informed consent before being randomised into allocated treatment groups. TRIAL REGISTRATION NUMBER: Protocol V.2.0; EudraCT number: 2011-002425-21; http://www.clinicaltrials.gov; NCT01572025; CTA reference: 03057/0053/001-0002.


Assuntos
Desidroepiandrosterona/uso terapêutico , Hormônios/uso terapêutico , Oócitos/metabolismo , Reserva Ovariana , Indução da Ovulação/métodos , Adulto , Método Duplo-Cego , Feminino , Fertilização in vitro/métodos , Perfilação da Expressão Gênica , Humanos , Recuperação de Oócitos , Projetos Piloto , Resultado do Tratamento , Adulto Jovem
13.
14.
Reprod Biol Endocrinol ; 11: 44, 2013 May 16.
Artigo em Inglês | MEDLINE | ID: mdl-23680224

RESUMO

Women with diminished ovarian reserve often respond poorly to controlled ovarian stimulation resulting in retrieval of fewer oocytes and reduced pregnancy rates. It has been proposed that pre-IVF Dehydroepiandrosterone (DHEA) adjuvant therapy may improve ovarian response and pregnancy rates in women with diminished ovarian reserve. This meta-analysis aims to investigate efficacy of DHEA as an adjuvant to improve ovarian response and IVF outcome in women with diminished ovarian reserve. Electronic databases were searched under the following terms: (DHEA) and (diminished ovarian reserve) and/or (poor response). Studies were included if they reported at least one of the following outcomes; clinical pregnancy rate, number of oocytes retrieved, miscarriage rate. We identified 22 publications determining effects of DHEA in clinical trials. Only 3 controlled studies were eligible for meta-analysis. There was no significant difference in the clinical pregnancy rate and miscarriage rates between women pre-treated with DHEA compared to those without DHEA pre-treatment (RR 1.87, 95% CI 0.96-3.64; and RR 0.59, 95% CI 0.21-1.65, respectively). The number of oocytes retrieved (WMD -1.88, 95% CI -2.08, 1.67; P < 0.001) was significantly lower in the DHEA group. In conclusion, based on the limited available evidence from a total of approximately 200 IVF cycles, there are insufficient data to support a beneficial role of DHEA as an adjuvant to controlled ovarian stimulation in IVF cycle. Well-designed, randomised controlled trials as well as more exact knowledge about DHEA mechanisms of action are needed to support use of DHEA in standard practice for poor-responders.


Assuntos
Adjuvantes Imunológicos/uso terapêutico , Desidroepiandrosterona/uso terapêutico , Ovário/efeitos dos fármacos , Indução da Ovulação/métodos , Feminino , Fertilização in vitro , Humanos , Ovário/fisiologia , Gravidez , Taxa de Gravidez , Resultado do Tratamento
15.
J Health Commun ; 15(4): 445-63, 2010 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-20574881

RESUMO

Previous research has indicated that treatment staff often underestimate the informational needs of cancer patients. In this study, the authors determined the total number of information sources obtained and used to influence treatment decisions, and the clinical and demographic factors associated with the use of specific sources of information in cancer patients. Participants were identified by the statewide cancer registry and diagnosed in 2004 with breast, colorectal, lung, or prostate cancer. A self-administered mailed questionnaire elicited cancer treatments, demographics, and information sources used to make treatment decisions. Of those surveyed, 1,784 (66%) participated and responded to all questions regarding information use. Over 69% of study participants reported obtaining information from a source other than the treatment staff. Significant predictors of using additional information sources included younger age, higher income, higher education, complementary and alternative medicine (CAM) use, and reporting shared decision making (all p values <.01). Participants with a college degree were more likely to use the Internet (OR 3.7; 95% CI 1.5-9.0) and scientific research reports (OR 3.3; 95% CI 1.6-6.9) to influence treatment decisions compared with those without a high school degree. Support group use to influence treatment decisions was not associated with socioeconomic variables but did vary by cancer type and CAM use. The sources of information study participants obtained and used to influence treatment decisions varied strongly by socioeconomic and demographic variables. These findings provide a deeper understanding of the information needs of cancer patients and have implications for dissemination strategies that can minimize disparities in access to cancer information.


Assuntos
Informação de Saúde ao Consumidor/estatística & dados numéricos , Conhecimentos, Atitudes e Prática em Saúde , Internet/estatística & dados numéricos , Neoplasias/terapia , Participação do Paciente , Fatores Etários , Idoso , Idoso de 80 Anos ou mais , Terapias Complementares/estatística & dados numéricos , Feminino , Humanos , Modelos Logísticos , Masculino , Pessoa de Meia-Idade , Sistema de Registros , Grupos de Autoajuda/estatística & dados numéricos , Fatores Socioeconômicos , Inquéritos e Questionários
17.
Langmuir ; 20(26): 11402-13, 2004 Dec 21.
Artigo em Inglês | MEDLINE | ID: mdl-15595763

RESUMO

The accuracy of the recently reported low-resolution NMR method (Goudappel, G. J. W.; et al. J. Colloid Interface Sci. 2001, 239, 535) for the determination of drop-size distribution in oil-in-water emulsions is evaluated by comparing the NMR results with precise data from video-enhanced optical microscopy. A series of 27 soybean-oil-in-water emulsions, differing in their mean drop size, polydispersity, oil volume fraction, and emulsifier, is studied. Soybean oil is selected as a typical component of food emulsions. The experimental error of our optical procedure for drop-size determination is estimated to be around 0.3 microm, which allows us to use the microscopy data as a reference for the mean drop-size and distribution width of the studied emulsions, with known experimental error. The main acquisition parameters in the NMR experiment are varied to find their optimal values and to check how the experimental conditions affect the NMR results. Comparison of the results obtained by the two methods shows that the low-resolution NMR method underestimates the mean drop size, d33, by approximately 20%. For most of the samples, NMR measures relatively precisely the distribution width (+/-0.1 to 0.2 dimensionless units), but for approximately 20% of the samples, larger systematic deviation was registered (underestimate by 0.3-0.4 units). No correlation is found between the emulsion properties and the relative difference between the microscopy and NMR data. Possible reasons for the observed discrepancy between NMR and optical microscopy are discussed, and some advantages and limitations of the low-resolution NMR method are considered.


Assuntos
Emulsões/química , Óleo de Soja/química , Água/química , Espectroscopia de Ressonância Magnética , Sensibilidade e Especificidade
SELEÇÃO DE REFERÊNCIAS
DETALHE DA PESQUISA