Literature Collection

3981

Efficacy and Safety of Screening for Postpartum Depression

Type: Journal Article

Authors: E. R. Myers, N. Aubuchon-Endsley, L. A. Bastian, J. M. Gierisch, A. R. Kemper, G. K. Swamy, M. F. Wald, A. J. McBroom, K. R. Lallinger, R. N. Gray, C. Green, G. D. Sanders

Year: 2013

Publication Place: Rockville (MD)

Abstract: To describe the benefits and harms of specific tools and strategies for screening for postpartum depression. We searched PubMed(R), Embase(R), PsycINFO(R), and the Cochrane Database of Systematic Reviews for relevant English-language studies published from January 1, 2004, to July 24, 2012, that evaluated the performance of screening instruments for postpartum depression, potential benefits and harms of screening, and impact on appropriate postscreening actions. Two investigators screened each abstract and full-text article for inclusion; abstracted data; and performed quality ratings, applicability ratings, and evidence grading. A simulation model was used to estimate the effects of screening for postpartum depression on the overall balance of benefits and harms. Forty studies (represented by 45 articles) were identified as relevant to this review. Eighteen studies provided sensitivity and specificity data on 9 screening instruments: 11 on the Edinburgh Postnatal Depression Scale, 4 on the Postpartum Depression Screening Scale, 4 on different versions of the Beck Depression Inventory, 2 on a "two-question" screen, and 1 each on 5 other instruments. Heterogeneity in setting, patient population, and choice of threshold prevented formal synthesis. For most tests in most studies, sensitivity and specificity were in the 80-90 percent range, with higher sensitivity associated with lower specificity; the two-question screen had 100 percent sensitivity but specificities of 45-65 percent. Fifteen studies analyzed the association between risk factors and postpartum depression. Although adverse pregnancy outcomes and chronic medical conditions (low strength of evidence) and past history of depression, poor relationship quality, and poor social support (moderate strength of evidence) were all associated with an increased risk of postpartum depression, only two studies directly reported an effect on test results. (Sensitivity was nonsignificantly increased in primigravidas compared with multigravidas.) Based on two studies, there was insufficient evidence to evaluate whether timing relative to delivery, setting, or provider affected test characteristics of screening instruments. Based on five studies, there was low to moderate strength of evidence that screening resulted in decreased depressive symptoms and improved mental health; in four of these studies, improvement in depressive symptoms was not accompanied by improvement in measures of parenting stress. Rates of referral and treatment for women with positive screening results were substantially higher in two studies where screening, diagnosis, and treatment were provided in the same setting; referral rates in other studies were all 50 percent or less. Modeling suggests that serial testing with a two-question screen followed by a second more specific instrument for those who have a positive result may be a reasonable strategy to reduce false positives while minimizing false negatives. The potential effectiveness of screening for postpartum depression appears to be related to the availability of systems to ensure adequate followup of women with positive results. The ideal characteristics of a screening test for postpartum depression, including sensitivity, specificity, timing, and frequency, have not been defined. Because the balance of benefits and harms, at both the individual level and health system level, is highly dependent on these characteristics, broad consensus on these characteristics is needed.

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3982

Efficacy of a systematic depression management program in high utilizers of primary care: a randomized trial

Type: Journal Article

Authors: A. Berghofer, A. Hartwich, M. Bauer, J. Unutzer, S. N. Willich, A. Pfennig

Year: 2012

Publication Place: England

Abstract: BACKGROUND: Approximately 25% of so-called high utilizers of medical care are estimated to suffer from depression. A large proportion of these individuals remain undiagnosed and untreated. This study aims to examine the effects of a systematic screening and collaborative treatment program on depression severity in small primary care practices of the German outpatient health care system. METHOD: High utilizers of primary care who screened positive for depressive symptoms on the Brief Psychiatric Health Questionnaire (B-PHQ) were further diagnosed using the DIA-X, a standardized diagnostic interview, performed by trained and supervised interviewers. Patients with major depression were randomized (cluster randomization by practice) to (a) a six-month treatment program of pharmacotherapy, standardized patient and provider education, and physician and patient counseling or (b) six months of usual medical care. All subjects were followed for a 12-month observation period using the 17-item Hamilton Depression Rating scale (HAMD-17) rated by the treating physicians and the B-PHQ-9 rated by the patients. RESULTS: A total of 63 high utilizer patients were included in the trial (17 male, 46 female), 19 randomized to intervention, 44 to usual care. The mean age was 49.7 (SD 13.8). Most patients had one or more somatic co-morbidities. There was no significant difference in response (defined as a decrease in the HAMD-17 sum score of at least 50%) after six months of treatment (50% vs. 42%, p = 0.961, all analyses adjusted for age) and after 12 months of treatment (83% vs. 54%, p = 0.282) between groups. Using patient self-rating assessments with the B-PHQ-9 questionnaire the intervention was superior to treatment as usual at six months (83% vs. 16%, p = 0.000).There was no significant difference in HAMD-17 depression severity at six months between the groups (10.5 (SD 7.6) vs. 12.3 (SD 7.8), p = 0.718), but a trend at 12 months (4.7 (SD 8.0) vs. 11.2 (SD 7.4), p = 0.083). Again, using B-PHQ-9 sum scores depression severity was significantly lower in the intervention group than in the treatment as usual group after six months (6.4 (SD 5.2) vs. 11.5 (SD 5.8), p = 0.020), but not at 12 months (7.9 (SD 8.7) vs. 9.0 (SD 5.2), p = 0.858). CONCLUSION: A systematic collaborating treatment program for depression in high utilizers in primary care showed superiority to treatment as usual only in terms of patients' self-assessment but not according to physicians' assessment. The advance of the intervention group at 6 months was lost after 12 months of follow-up. Overall, positive results from similar trials in the US health care systems could not be confirmed in a German primary care setting.

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3983

Efficacy of brief intervention for drug misuse in primary care facilities: systematic review and meta-analysis protocol

Type: Journal Article

Authors: E. Sahker, M. Sakata, R. Toyomoto, C. Hwang, K. Yoshida, Y. Luo, N. Watanabe, T. A. Furukawa

Year: 2020

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3984

Efficacy of continuing medical education to reduce the risk of buprenorphine diversion

Type: Journal Article

Authors: M. R. Lofwall, M. J. Wunsch, P. A. Nuzzo, S. L. Walsh

Year: 2011

Publication Place: United States

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3985

Efficacy of integrated interventions combining psychiatric care and nursing home care for nursing home residents: a review of the literature

Type: Journal Article

Authors: J. Collet, M. E. de Vugt, F. R. Verhey, J. M. Schols

Year: 2010

Publication Place: England

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3986

Efficacy of Motivational Interviewing to Improve Utilization of Mental Health Services Among Youths With Chronic Medical Conditions: A Cluster Randomized Clinical Trial

Type: Journal Article

Authors: Christina Reinauer, Anna Lena Platzbecker, Rabea Viermann, Matthias Domhardt, Harald Baumeister, Katharina Foertsch, Hannah Linderskamp, Lisa Krassuski, Doris Staab, Kirsten Minden, Reinhold Kilian, Reinhard W. Holl, Petra Warschburger, Thomas Meißner

Year: 2021

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3987

Efficacy of nurse telehealth care and peer support in augmenting treatment of depression in primary care

Type: Journal Article

Authors: E. M. Hunkeler, J. F. Meresman, W. A. Hargreaves, B. Fireman, W. H. Berman, A. J. Kirsch, J. Groebe, S. W. Hurt, P. Braden, M. Getzell, P. A. Feigenbaum, T. Peng, M. Salzer

Year: 2000

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3988

Efficacy of the Marlatt cognitive-behavioral model on decreasing relapse and craving in women with methamphetamine dependence: A clinical trial

Type: Journal Article

Authors: Nasrin Abdoli, Vahid Farnia, Safora Salemi, Faezeh Tatari, Touraj Ahmadi Juibari, Mostafa Alikhani, Behrad Basanj

Year: 2019

Publication Place: Philadelphia, Pennsylvania

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3989

Efficacy of the Opioid Compliance Checklist to Monitor Chronic Pain Patients Receiving Opioid Therapy in Primary Care

Type: Journal Article

Authors: R. N. Jamison, M. O. Martel, C. C. Huang, D. Jurcik, R. R. Edwards

Year: 2016

Publication Place: United States

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3990

Efficacy of three low-intensity, internet-based psychological interventions for the treatment of depression in primary care: Randomized controlled trial

Type: Journal Article

Authors: Margalida Gili, Adoración Castro, Azucena García-Palacios, Javier Garcia-Campayo, Fermin Mayoral-Cleries, Cristina Botella, Miquel Roca, Alberto Barceló-Soler, María M. Hurtado, Ma Teresa Navarro, Amelia Villena, Ángeles Pérez-Ara, Pau Riera-Serra, Rosa Ma Baños

Year: 2020

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3991

Efficacy of Tramadol Extended-Release for Opioid Withdrawal: A Randomized Clinical Trial

Type: Journal Article

Authors: K. E. Dunn, D. A. Tompkins, G. E. Bigelow, E. C. Strain

Year: 2017

Publication Place: United States

Abstract: Importance: Opioid use disorder (OUD) is a significant public health problem. Supervised withdrawal (ie, detoxification) from opioids using clonidine or buprenorphine hydrochloride is a widely used treatment. Objective: To evaluate whether tramadol hydrochloride extended-release (ER), an approved analgesic with opioid and nonopioid mechanisms of action and low abuse potential, is effective for use in supervised withdrawal settings. Design, Setting, and Participants: A randomized clinical trial was conducted in a residential research setting with 103 participants with OUD. Participants' treatment was stabilized with morphine, 30 mg, administered subcutaneously 4 times daily. A 7-day taper using clonidine (n = 36), tramadol ER (n = 36), or buprenorphine (n = 31) was then instituted, and patients were crossed-over to double-blind placebo during a post-taper period. The study was conducted from October 25, 2010, to June 23, 2015. Main Outcomes and Measures: Retention, withdrawal symptom management, concomitant medication utilization, and naltrexone induction. Results were analyzed over time and using area under the curve for the intention-to-treat and completer groups. Results: Of the 103 participants, 88 (85.4%) were men and 43 (41.7%) were white; mean (SD) age was 28.9 (10.4) years. Buprenorphine participants (28 [90.3%]) were significantly more likely to be retained at the end of the taper compared with clonidine participants (22 [61.1%]); tramadol ER retention was intermediate and did not differ significantly from that of the other groups (26 [72.2%]; chi2 = 8.5, P = .01). Time-course analyses of withdrawal revealed significant effects of phase (taper, post taper) for the Clinical Opiate Withdrawal Scale (COWS) score (taper mean, 5.19 [SE, .26]; post-taper mean, 3.97 [SE, .23]; F2,170 = 3.6, P = .03) and Subjective Opiate Withdrawal Scale (SOWS) score (taper mean,8.81 [SE, .40]; post-taper mean, 4.14 [SE, .30]; F2,170 = 15.7, P < .001), but no group effects or group x phase interactions. Analyses of area under the curve of SOWS total scores showed significant reductions (F2,159 = 17.7, P < .001) in withdrawal severity between the taper and post-taper periods for clonidine (taper mean, 13.1; post-taper mean, 3.2; P < .001) and tramadol ER (taper mean, 7.4; post-taper mean, 2.8; P = .03), but not buprenorphine (taper mean, 6.4; post-taper mean, 7.4). Use of concomitant medication increased significantly (F2,159 = 30.7, P < .001) from stabilization to taper in the clonidine (stabilization mean, 0.64 [SE, .05]; taper mean, 1.54 [SE, .10]; P < .001) and tramadol ER (stabilization mean, 0.53 [SE, .05]; taper mean, 1.19 [SE, .09]; P = .003) groups and from stabilization to post taper in the buprenorphine group (stabilization mean, 0.46 [SE, .05] post-taper mean, 1.17 [SE, .09]; P = .006), suggesting higher withdrawal for those groups during those periods. Naltrexone initiation was voluntary and the percentage of participants choosing naltrexone therapy within the clonidine (8 [22.2%]), tramadol ER (7 [19.4%]), or buprenorphine (3 [9.7%]) groups did not differ significantly (chi2 = 2.5, P = .29). Conclusions and Relevance: The results of this trial suggest that tramadol ER is more effective than clonidine and comparable to buprenorphine in reducing opioid withdrawal symptoms during a residential tapering program. Data support further examination of tramadol ER as a method to manage opioid withdrawal symptoms. Trial Registration: Clinicaltrials.gov Identifier: NCT01188421.

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3992

Efficacy of treatment for somatoform disorders: a review of randomized controlled trials

Type: Journal Article

Authors: K. Kroenke

Year: 2007

Publication Place: United States

Abstract: OBJECTIVE: To review the evidence from randomized clinical trials (RCTs) that have focused on the treatment of patients with Diagnostic and Statistical Manual of Mental Disorders, 4(th) Edition (DSM-IV) somatoform disorders. Although somatoform disorders are among the most common mental disorders presenting in the general medical setting, the strength of evidence for specific treatments has not been well synthesized. METHODS: MEDLINE search of articles published in English from 1966 to 2006, using the following search terms: randomized clinical trial, somatoform disorders, somatization disorder, undifferentiated somatoform disorder, hypochrondriasis, conversion disorder, pain disorder, and body dysmorphic disorder. RESULTS: A total of 34 RCTs involving 3922 patients were included. Two thirds of the studies involved somatization disorder (n = 4 studies) and lower threshold variants, such as abridged somatization disorder (n = 9) and medically unexplained symptoms (n = 10). Cognitive behavioral therapy (CBT) was effective in most studies (11 of 13), as were antidepressants in a small number (4 of 5) of studies. RCTs examining a variety of other treatments showed benefit in half (8 of 16) of the studies, the most consistent evidence existing for a consultation letter to the primary care physician. Effective treatments have been established for all somatoform disorders except conversion disorder (1 of 3 studies showing benefit) and pain disorder (no studies reported). CONCLUSION: CBT is the best established treatment for a variety of somatoform disorders, with some benefit also demonstrated for a consultation letter to the primary care physician. Preliminary but not yet conclusive evidence exists for antidepressants.

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3993

Efficacy of treatment in an opioid -dependent population group using the Maudsley Addiction Profile (MAP) tool

Type: Journal Article

Authors: R. Collins, B. Boggs, N. Taggart, M. Kelly, A. Drillington, I. Swanton, D. Patterson

Year: 2009

Publication Place: Northern Ireland

Abstract: A pilot study was performed to assess the effectiveness of treatment in an opioid dependent population using the Maudsley Addiction Profile (MAP) tool1.The primary outcome of the study was to assess if treatment had an effect on 1. Substance use (quantity and frequency of use), 2. Health risk behaviour (injecting and sharing injecting equipment), 3. Health symptoms (physical and psychological) and 4. Personal /Social functioning (relationships, employment and crime). A secondary outcome was also sought.The study took place in 2007 in an inner city Belfast hospital specialising in the treatment of addiction, over a two month period. Fifteen patients, all opioid dependent and receiving outpatient community treatment, were interviewed at baseline (prior to the commencement of treatment) and at eight weeks follow up.Three patients were lost to follow up. Two patients stopped using altogether. Of the remaining patients, improvements were seen in most areas. There was a decrease in the use of heroin (71.28%), cocaine (99.72%), crack cocaine (100%), cannabis (99.94%) and alcohol (33.17%). There was a reduction in injecting behaviour (60.93%). Improvements were observed in health with a reduction in physical (41.35%) and psychological (35%) symptoms. Overall personal and social functioning improved regarding interactions with family and friends. A reduction in crime was also observed (75%).Opinions and views of staff involved in the study were generally positive.This patient population presents with multiple and complex needs. Effective treatment needs to address these needs and not just drug addiction alone. The Maudsley Addiction Profile tool highlights this.

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3994

Efficacy versus effectiveness of buprenorphine and methadone maintenance in pregnancy.

Type: Journal Article

Authors: Robert G. Newman, Susan G. Gevertz

Year: 2011

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3995

Efficacy, tolerability, and preference of mirtazapine orally disintegrating tablets in depressed patients: a 17-week naturalistic study in Lithuania

Type: Journal Article

Authors: V. Danileviciute, A. Sveikata, V. Adomaitiene, G. Gumbrevicius, V. Fokas, R. Sveikatiene

Year: 2009

Publication Place: Lithuania

Abstract: Mirtazapine is an established antidepressant with well-documented efficacy demonstrated in controlled clinical trials. However, the gap between the results obtained in controlled clinical trials and everyday clinical practice exists. Therefore, the importance of naturalistic studies in psychiatry is becoming recognized. The aim of present naturalistic study was to acquire data on efficacy, safety, and preference of mirtazapine orally disintegrating tablets during a 17-week treatment of depression. This prospective, open-label, multicenter study in patients with mild to severe depression was conducted at 47 mental health centers of Lithuania by 78 psychiatrists. Patients were initially given 15 mg or 30 mg of mirtazapine orally disintegrating tablets; the maximum allowed dose was 45 mg per day. The primary efficacy measure was the total score on the Hamilton Depression Rating Scale-17 (HAMD-17), the Clinical Global Impression-Severity (CGI-S), and Clinical Global Impression-Improvement (CGI-I) scales. Tolerability was primarily measured by assessing the incidence of treatment-emergent adverse events. Patients were evaluated at baseline, at weeks 1, 5, 9, 13, and 17. A total of 779 patients (595 women [76.4%] with a mean [SD] age of 50.2 [13.65] and 184 men [23.6%] with a mean [SD] age of 52.4 [14.6] years) were enrolled into the study; 687 (88.2%) patients completed the study. The mean (SD) daily dose of mirtazapine orally disintegrating tablets was 29.0 (3.8) mg. The mean total (SD) HAMD-17 score improved significantly from 25.7 (4.6) to 7.3 (4.3) (P<0.005). At each visit, the mean HAMD-17 score was significantly lower than that at the preceding visit. At week 17, remission (HAMD-17 score < or =7) was observed in 436 (56%) patients. The mean (SD) CGI-S score improved significantly from 4.9 (1.0) at baseline to 1.5 (0.6) at endpoint (P<0.001). According to the CGI-I assessments, 621 patients (89.4%) improved and improved very much. The vast majority of patients (80%) preferred the new formulation of mirtazapine - mirtazapine orally disintegrating tablet. Treatment-emergent adverse events occurred in 106 patients (13.6%). The most frequent adverse events were weight gain, sedation, dizziness, and dry mouth. In this study conducted in Lithuania with depressed patients, a significant improvement was shown in all efficacy measures. In addition, mirtazapine orally disintegrating tablet was a well-tolerated and preferable formulation for the treatment of depressed patients.

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3996

Efficient and effective measurement of provider competence in community-based substance use treatment settings: Performance of the Motivational Interviewing Coach Rating Scale (MI-CRS)

Type: Journal Article

Authors: S. Naar, J. E. Chapman, G. A. Aarons

Year: 2023

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3997

Efficient, but separate behavioral, physical healthcare is 'a delusion'

Type: Web Resource

Authors: D. Grantham

Year: 2013

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3998

eHealth Familias Unidas Mental Health: Protocol for an effectiveness-implementation hybrid Type 1 trial to scale a mental health preventive intervention for Hispanic youth in primary care settings

Type: Journal Article

Authors: Yannine Estrada, Alyssa Lozano, Devina Boga, Maria I. Tapia, Tatiana Perrino, Maria Rosa Velazquez, Lourdes Forster, Nicole Torres, Cecilia V. Morales, Lisa Gwynn, William R. Beardslee, Hendricks Brown, Guillermo Prado

Year: 2023

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3999

Eight principles for safer opioid prescribing and cautions with benzodiazepines

Type: Journal Article

Authors: L. R. Webster, G. M. Reisfield, N. Dasgupta

Year: 2015

Publication Place: England

Abstract: The provision of long-term opioid analgesic therapy for chronic pain requires a careful risk/benefit analysis followed by clinical safety measures to identify and reduce misuse, abuse, and addiction and their associated morbidity and mortality. Multiple data sources show that benzodiazepines, prescribed for comorbid insomnia, anxiety, and mood disorders, heighten the risk of respiratory depression and other adverse outcomes when combined with opioid therapy. Evidence is presented for hazards associated with coadministration of opioids and benzodiazepines and the need for caution when initiating opioid therapy for chronic pain. Clinical recommendations follow, as drawn from 2 previously published literature reviews, one of which proffers 8 principles for safer opioid prescribing; the other review presents risks associated with benzodiazepines, suggests alternatives for co-prescribing benzodiazepines and opioids, and outlines recommendations regarding co-prescribing if alternative therapies are ineffective.

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4000

Eight ways to overcome resistance to medication-assisted treatment

Type: Report

Authors: Maureen Fitzgerald

Year: 2016

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