When is sequential and parallel treatment most appropriate?
For example, sequential and parallel treatment may be most appropriate for patients who have a very severe problem with one disorder, but a mild problem with the other. In this way they can be properly treated by the professionals, according to the level and severity of problem.
Should analyses comparing multiple treatments be used routinely?
Rather than asking whether analyses comparing multiple treatments should be used routinely, it is more appropriate to ask whether they can be avoided. Methods for comparing multiple treatments will have increasing scope as new treatments proliferate.
What is sequential treatment for addiction?
The term sequential treatment describes the serial or nonsimultaneous participation in both mental health and addiction treatment settings.
What is the best strategy for sequencing first-and second-line therapies?
Various strategies for sequencing first- and second-line therapies are under investigation in prospective studies, including those using agents with the same MOA (eg, VEGFr-TKI → VEGFr-TKI) and those that incorporate agents with distinct MOAs (eg, mTOR → VEGFr-TKI).
In a nutshell
This study investigated if concurrent (cCRT) or sequential chemoradiotherapy (sCRT) was more effective in non-small cell lung cancer (NSCLC).
Some background
Non-small cell lung cancer (NSCLC) is a common cancer. It is usually diagnosed at an advanced stage. Standard treatment involves removing solid tumors and chemoradiotherapy (CRT). CRT involves administering both chemotherapy (CT) and performing radiation therapy (RT). Some patients are only treated with radiation.
Methods & findings
This study included 1924 patients with NSCLC. 1115 underwent sCRT and 809 underwent cCRT. Survival was the main outcome of interest. The average follow-up for patients was 32 months.
The bottom line
The authors concluded that sCRT was associated with better survival than cCRT in patients with NSCLC.
The fine print
Data on CT regimens or RT protocols were not available. This is important as it can have an impact on adverse effects or toxicities. The database did not record toxicities in these patients so we cannot conclude if sCRT is better tolerated. More investigation is needed.
How do epigenetic changes affect drug resistance?
These epigenetic changes lead to silencing of tumor suppressor genes involved in key DNA damage-response pathways, making drug-resistant cancer cells nonresponsive to conventional anticancer drug therapies. Our hypothesis is that treating drug-resistant cells with epigenetic drugs could restore the sensitivity to anticancer drugs by reactivating previously silenced genes. To test our hypothesis, we used drug-resistant breast cancer cells (MCF-7/ADR) and two epigenetic drugs that act via different mechanisms--5-aza-2'-deoxycytidine (decitabine, DAC), a demethylating agent, and suberoylanilide hydroxamic acid (SAHA), a histone deacetylase inhibitor--in combination with doxorubicin. We show that the sequential treatment of resistant cells, first with an epigenetic drug (DAC), and then with doxorubicin, induces a highly synergistic effect, thus reducing the IC (50) of doxorubicin by several thousand fold. The sequential treatment caused over 90% resistant cells to undergo G2/M cell cycle arrest, determined to be due to upregulation of p21 (WAF1/CIP1) expression, which is responsible for cell-cycle regulation. The induction of p21 (WAF1/CIP1) correlated well with the depletion of DNA methyltransferase1 (DNMT1), an enzyme that promotes methylation of DNA, suggesting that the p21 (WAF1/CIP1) gene may have been methylated and hence is inactive in MCF-7/ADR cells. Microarray analysis shows expression of several tumor suppressor genes and downregulation of tumor promoter genes, particularly in sequentially treated resistant cells. Sequential treatment was found to be significantly more effective than simultaneous treatment, and DAC was more effective than SAHA in overcoming doxorubicin resistance. Synergistic effect with sequential treatment was also seen in drug-sensitive breast cancer cells, but the effect was significantly more pronounced in resistant cells. In conclusion, the sequential treatment of an epigenetic drug in combination with doxorubicin induces a highly synergistic effect that overcomes doxorubicin resistance in breast cancer cells.
Is sequential treatment more effective than simultaneous treatment?
Sequential treatment was found to be significantly more effective than simultaneous treatment, and DAC was more effective than SAHA in overcoming doxorubicin resistance. Synergistic effect with sequential treatment was also seen in drug-sensitive breast cancer cells, but the effect was significantly more pronounced in resistant cells. ...
Why do people with dual disorders need to engage in treatment?
Different problems require addiction treatment by different professionals and different medical systems. So that is why people with dual disorders who want to engage in the treatment process (or who need to do so) frequently encounter not one but several treatment systems, each having its own strengths and weaknesses. These treatment systems have different clinical approaches.
Why is abstinence important in dual disorders?
For some patients with dual disorders, requiring abstinence as a condition of entering addiction treatment may hinder or discourage engagement in the treatment process. For these patients, abstinence may be redefined as a goal, with encouragement provided for incremental steps in the reduction of amount and frequency of drug use. For example, patients who experience homelessness and housing instability likely do not live in drug-free environments. For such patients, it may be unrealistic to mandate abstinence as a requirement for treatment. Describes some of the addiction treatment strategy differences for managing patients in mental health, addiction, and dual disorder treatment approaches.
What is the role of case management in mental health?
Another strength of the mental health system is the growing recognition at all system levels of the role of case management as a means to individualize and coordinate services and secure entitlements in relation with addiction treatment.
Can you have more than one mental disorder at a time?
Professionals mostly find it easy to addiction treatment for people who have a single disorder. But this does not happen in some cases. Some people have more than one disorders at a time. Like some people consume alcohol and use drugs as well as suffer from different mental health disorders at the same time.
Who provides addiction treatment?
As with mental health treatment, addiction treatment is provided by a diverse group of practitioners, including physicians, psychiatrists, psychologists, certified addiction counselors, MFCCs, and other therapists, counselors, and recovering paraprofessionals.
Is there a mental health system?
Actually, there is no single mental health system related to addiction treatment, although most States have a set of public mental health centers. Rather, mental health services are provided by a variety of mental health professionals including psychiatrists; psychologists; clinical social workers; clinical nurse specialists; other therapists and counselors including marriage, family, and child counselors (MFCCs); and paraprofessionals.
Is there a single addiction treatment system?
As with mental health treatment, no single addiction treatment system exists. Rather, there is a collection of different types of addiction treatment services such as social and medical model detoxification programs, short- and long-term treatment programs, methadone detoxification and maintenance programs, long-term therapeutic communities, and self-help adjuncts such as the 12-step programs that aim at helping the patients in their recovery from different problems like substance addictions, compulsions and addiction-related to behaviour These programs can vary greatly with respect to treatment goals and philosophies. For example, abstinence is a prerequisite for entry into some programs, while it is a long-term goal in other programs. Some AOD treatment programs are not abstinence oriented. For example, some methadone maintenance programs have the overt goal of eventual abstinence for all patients, while others addiction treatment programs promote continued methadone use to encourage psychosocial stabilization.
How often do you get etoposide and cisplatin?
All patients received four cycles of cisplatin plus etoposide every 3 weeks (sequential arm) or 4 weeks (concurrent arm). TRT was begun on day 2 of the first cycle of chemotherapy in the concurrent arm and after the fourth cycle in the sequential arm.
Is cisplatin effective for LS-SCLC?
This study strongly suggests that cisplatin plus etoposide and concurrent radiotherapy is more effective for the treatment of LS-SCLC than cisplatin plus etoposide and sequential radiotherapy. This study strongly suggests that cisplatin plus etoposide and concurrent radiotherapy is more effective for the treatment of LS-SCLC than cisplatin ...
How much diazepam is needed for therapeutic use?
Therapeutic use of a benzodiazepine greater than the equivalent of more than 40 mg of diazepam (see chart) at the time of randomization.
What is an active engagement in addiction treatment?
Actively engaged is defined as any visit in the program in the prior month and pending future appointments for the treatment of addictions
What is motivational enhancement therapy?
Motivational enhancement therapy for addiction is combined with Prolonged exposure therapy for PTSD from the beginning of treatment. Both are delivered by the same provider throughout treatment.
Is there any psychotherapy for PTSD?
Although almost every form of psychotherapy has been advocated for PTSD, all evidence-based psychotherapies for PTSD are CBT programs that include variants of exposure therapy (Prolonged Exposure), cognitive therapy (CT), stress inoculation training (SIT), eye movement desensitization and reprocessing (EMDR), or combinations of these procedures. Exposure therapy involves helping PTSD sufferers to gradually confront distressing trauma-related memories and reminders to facilitate successful emotional processing of the trauma memory and reduction of associated distress. Most exposure therapy programs include both imaginable confrontation with the traumatic memories and in vivo exposure to trauma reminders.
How does VEGF therapy affect cross resistance?
Shared mechanistic approaches between currently approved VEGF-targeted therapies have important clinical implications for development of cross-resistance. Most patients treated with VEGF-targeted therapies show transient improvement (ie, tumor stasis or shrinkage) but ultimately develop resistance (typically within months), regardless of initial response. 15,16 Relapse (also termed “evasive resistance”) is thought to occur through escape mechanisms that allow for continued angiogenesis despite VEGF signaling blockade, including activation/upregulation of alternative proangiogenic pathways (within the tumor itself and through recruitment of proangiogenic cells from the bone marrow), increased non–VEGF-based support of tumor vasculature through recruitment of pericytes, and enhanced aggressiveness of migration into normal cells. 34
Is mRCC a third line treatment?
No targeted agents are approved as third-line treatment of mRCC, as reflected by lack of guidance in this area in current clinical practice guidelines. This setting needs robust clinical data to help inform treatment decisions.
What is simultaneous treatment?
The same is true for simultaneous-treatment designs; a design that is appropriate for situations where one wishes to evaluate the concurrent or simultaneous application of two or more treatments in a single case. Rapid or random alteration of treatment is not required with simultaneous-treatment design.
How to implement alternating treatment?
To implement an alternating treatments design, begin as usual with a brief baseline, simply to ensure that the client actually needs intervention to eat those foods. You then alternate meals back and forth between the two different treatments that you want to evaluate.
How to detect multiple treatment interference?
Several procedures exist to help detect multiple treatment interference (Sidman, 1960). A simple phase change where one treatment condition is preceded by a baseline phase, when compared to another AB design containing the other treatment, and finally compared to an ATD combining both conditions, could be used to parse out the separate and interactive effects of the treatment conditions. Alternatively, the intensity of one treatment condition could be increased, with any subsequent changes in the following conditions (as compared to changes already witnessed in an ATD containing both conditions) attributable to carry-over effects.
What are the advantages of ATD?
ATDs hold several other advantages over standard within-series designs. First, treatment need not be withdrawn in an ATD—if treatment is periodically withdrawn, it can be for relatively short periods of time. Second, comparisons between components can be made more quickly. If a clear favorite emerges early in a well-conducted ATD, the clinician can be reasonably sure that its comparative efficacy will be maintained McCullough, Cornell, McDaniel, and Mueller (1974), for example, compared the relative efficacy of two treatments in four days using an ATD. ATDs can be used without collecting baseline data, or with baseline data through the creation of a concurrent baseline data series. Any background within-series trends (such as those due to maturation of the client or etiology of the disorder) are unlikely to obscure interpretation of the data because the source of data comparisons are purely between series, not within.
Why was the supplement of self-management to standard coaching in Wolko et al. (1993)?
The supplement of self-management to standard coaching in Wolko et al. (1993) improved balance beam performance of the gymnasts. This improvement was gradual, possibly because “the time span allotted for each condition to show its effect may have been too brief” (p. 220). The results also suggested that the private self-goal setting and self-monitoring combination was marginally more effective than the publically implemented procedures. This study also reported social validity assessment indicating that the gymnasts liked both self-management interventions more than standard coaching.
What are the shortcomings of ATD?
One of the shortcomings of the ATD is that observed effects in the design can be due to the way in which conditions are presented and combined. Three areas of concern in this domain of multiple treatment interference are sequential confounding, carry-over effects, and alternation effects ( Barlow & Hayes, 1979; Ulman & Sulzer-Azaroff, 1975 ).
How can a statistical design be improved?
In general, these designs can be improved by structuring various forms of randomization into the design structure, thereby improving the internal validity of the design and allowing certain forms of statistical analysis, such as randomization tests, to be conducted (see Kratochwill and Levin, in press ).
How much money has been spent on monoclonal antibody treatment?
The US has spent more than $2 billion on monoclonal antibody treatment doses. But as of now, the treatment is free to patients, although there may be an administration fee.
How much did GlaxoSmithKline reduce hospitalization?
GlaxoSmithKline's resulted in an 85% reduction in risk of hospitalization or death in high-risk patients compared to placebo.
Is Regneron antibody therapy a preventative treatment?
The antibody therapy made by Regneron is also authorized to be used as a preventative treatment, or what's known as a post-exposure prophylaxis.
Do monoclonal antibodies work when sick?
Studies show monoclonal s don't seem to work when people are sicker and already in the hospital or on oxygen.