What is the success rate of therapy?
If it is low, say 1%, the therapy increases successful outcomes by only one percentage point to 2%, a fairly small increase in absolute terms. In contrast, if the baseline rate of success is 30%, the treatment success rate is 60%, a much large increase in absolute terms.
Is the number needed to treat a clinically useful measure of treatment?
The number needed to treat: A clinically useful measure of treatment effect. BMJ. 1995;310(6977):452–454. [PMC free article][PubMed] [Google Scholar]
How is efficacy measured?
Efficacy can be assessed accurately only in ideal conditions (ie, when patients are selected by proper criteria and strictly adhere to the dosing schedule). Thus, efficacy is measured under expert supervision in a group of patients most likely to have a response to a drug, such as in a controlled clinical trial.
What is the absolute effect of the treatment?
The absolute effect of the treatment depends on the baseline (or control) probability of a successful outcome. If it is low, say 1%, the therapy increases successful outcomes by only one percentage point to 2%, a fairly small increase in absolute terms.
Do you need a prescription for Paxlovid?
Right now, only people with certain medical conditions can be prescribed the drug. Experts say people who test positive for COVID-19 and are eligible for Paxlovid should ask their doctor to prescribe it.
How common is Paxlovid rebound?
Currently, this type of rebounding appears to be rare. In Pfizers clinical trial, 1 to 2 percent of people treated with the antiviral had a positive COVID-19 test — or an increase in the amount of virus detected — after finishing the treatment.
Can COVID-19 be spread through sex?
The virus spreads by respiratory droplets released when someone with the virus coughs, sneezes or talks. These droplets can be inhaled or land in the mouth or nose of a person nearby. Coming into contact with a person's spit through kissing or other sexual activities could expose you to the virus.
What are some benefits of taking the COVID-19 treatment Paxlovid?
Paxlovid is an oral antiviral pill that can be taken at home to help keep high-risk patients from getting so sick that they need to be hospitalized. So, if you test positive for the coronavirus and a health care provider writes you a prescription, you can take pills at home and lower your risk of going to the hospital.
Can COVID-19 symptoms rebound after using Paxlovid?
The Centers for Disease Control and Prevention said in a statement on May 24 that some people treated with Paxlovid experience “COVID-19 rebound” between two and 8 days after their initial recovery. These people experience a return of their symptoms and/or a new positive COVID test after having tested negative.
Can you still be contagious with COVID-19 after taking Paxlovid?
(CNN) People who have a Covid-19 rebound after treatment with the antiviral drug Paxlovid can be contagious and may not know it because they might not have symptoms, researchers warn.
How safe is intimacy with a partner during the COVID-19 pandemic?
See full answerIf both of you are healthy and feeling well, are practicing social distancing and have had no known exposure to anyone with COVID-19, touching, hugging, kissing, and sex are more likely to be safe. Similarly, sharing a bed with a partner who is healthy should not be an issue.Be aware, though, that the CDC reports that some people may have the virus and not yet have symptoms during the early part of the incubation period (presymptomatic). Additionally, some people never develop obvious symptoms of COVID-19 (asymptomatic). In either case, it’s possible that the virus might spread through physical contact and intimacy.
When should you take a COVID-19 test after exposure?
YES: Get tested at least 5 days after exposure. Follow quarantine guidance while waiting to test.
How long could COVID-19 linger in your body?
But for most infected people, virus levels in the body peak between three and six days after the original infection, and the immune system clears the pathogen within 10 days. The virus shed after this period is generally not infectious.
How do you get Paxlovid?
“Paxlovid is now available at many pharmacies and is government funded during the public health crisis,” Cutler said. “With a prescription from your doctor, Paxlovid is now fairly easily accessible.”
Should I take Paxlovid if I have COVID-19?
The FDA has authorized Paxlovid for anyone age 12+ who is at high risk for developing a severe case of COVID-19. “If youre pregnant, if youre obese, if youre older, if you have comorbidities or if you have underlying health issues, you should talk to your doctor about taking Paxlovid,” says Kenney.
What is the effect of Actemra on patients with COVID-19?
In clinical trials of hospitalized patients with COVID-19, Actemra in addition to the routine care patients receive for treatment of COVID-19, which included corticosteroid therapy, was shown to reduce the risk of death through 28 days of follow-up and decrease the amount of time patients remained hospitalized.
When is efficacy measured?
Thus, efficacy is measured under expert supervision in a group of patients most likely to have a response to a drug, such as in a controlled clinical trial.
What should be used to judge efficacy and effectiveness?
Patient-oriented outcomes, rather than surrogate or intermediate outcomes, should be used to judge efficacy and effectiveness.
What is the NNT of a risk reduction?
NNT can be simply calculated as the inverse of the absolute risk reduction; if the absolute risk reduction is 5% (0.05), the NNT = 1/0.05 = 20. NNT can be calculated for adverse effects also, in which case it is sometimes called the number needed to harm (NNH).
What does numerical variables mean in clinical trials?
Numerical variables, unlike dichotomous outcomes, may indicate the magnitude of an effect. Thus, use of surrogate outcomes can often provide much more data for analysis than can patient-oriented outcomes, allowing clinical trials to be done using many fewer patients.
Why are adverse effects reported as absolute risk increases?
In contrast, adverse effects are usually reported as absolute risk increases because they make a drug appear safer. For example, if a drug increases the incidence of bleeding from 0.1% to 1%, the increase is more likely to be reported as 0.9% than 1000%.
What factors are considered when deciding if a drug is indicated?
In making such judgments, clinicians often consider factors that are somewhat subjective, such as personal experience, anecdotes, peer practices, and expert opinions.
Why are benefits reported as relative risk reductions?
Most often, benefits are reported in the literature as relative risk reductions because these make a drug look more effective than the absolute risk reductions (in the previous example, a 50% reduction in mortality sounds much better than a 5% reduction).
What are the data abstraction forms used in a study?
Data abstraction forms were used to describe the studies’ population, location (i.e., country), goals, methodology, and outcomes (Table 1); contextual factors influencing engagement (i.e. , leadership and specific barriers and facilitators to patient engagement) (Table 2); and patients’ experience with the engagement and evaluation of study quality (Tables 2and and3).3). Studies were then categorized by the level of patient engagement using Bate and Robert’s (2006) continuum of patient involvement [8]. Consistent with our aims to review strategies for actively engaging patients and families in improving or redesigning health care, we focused on studies using co-design or those consulting patients but also using elements of co-design—i.e., the more active levels of engagement on the Bates and Robert continuum. We classified changes or products of engaging patients as “quality of care outcomes” and the impact of the engagement on patients as “patients experience outcomes” (Table 1). Quality of care outcomes were categorized into one of the following: developing education or a service-related tool, informing policy or planning documents, and enhancing services or governance. Study quality was assessed by one person and two verifiers using a quality appraisal tool that systematically reviews disparate forms of evidence and methodologies on a scale from “very poor,” “poor,” “fair,” and “good” [38], which reflected the mixed methods articles in our review. Verification involved systematically checking and confirming the fit between each criterion of the assessment tool and the conceptual work of analysis and interpretation of study quality among a subset of studies. We also assessed the possible impact of study quality on the review’s findings (akin to a “sensitivity analysis” conducted for meta-analyses).
What is patient engagement?
Patient engagement has become a cornerstone of quality of care [1–6] and is a frequently stated goal for healthcare organizations. Traditionally, and most commonly, this engagement has focused on the relationship between patients and providers in making care decisions or how to improve patient efforts to manage their own care [7]. However, there are growing efforts to integrate patients in broader ways, including efforts to improve or redesign service delivery by incorporating patient experiences [8–12]. These efforts are due in part to an increased recognition and acceptance that users of health services have a rightful role, the requisite expertise, and an important contribution in the design and delivery of services [4]. While the nature of patient engagement may vary from including patients as members of a board to time-limited consultation with patients on service redesign, its aims are consistent—to improve the quality of care [11, 13, 14].
Why is screening important?
Screening is used to promote detection of diseases in their earliest stages, when treatment has the greatest chance of working, in order to reduce morbidity and mortality. Common Screening Tests. Papanicolaou test (Pap smear, Pap test, cervical smear, or smear test) Mammogram. Clinical breast exam.
What is clinical epidemiology?
Clinical epidemiology focuses on patients and the application of epidemiologic methods to assess the efficacy of screening, diagnosis, and treatment in clinical settings. Used to identify the health consequences of employing a test or administering a treatment. Questions AboutClinical Epidemiology.
What are the exclusion criteria for CBT?
Typical exclusion criteria consist of comorbid alcohol or other substance disorders, some psychotic disorders, organic brain syndrome, and learning difficulties, with many studies also specifying that participants who have depression not be at risk of suicide. More research on this issue is needed; many believe that individuals with these conditions may still benefit from CBT (Halverson, Bienenfeld, Leonard, & Riemann, 2014). Beyond the question of inclusion in research studies, there is the matter of whether the depressed clients of a clinician not participating in a study may find CBT useful even though the clients’ other issues may cause a smaller effect.
Why should we use CBT for depression?
In summary, the answer to the question of why we should employ CBT to treat depression is because it is proven efficacious: far superior to wait list, supportive “treatment as usual”, and controls, and at least as effective as other therapies and antidepressant medication, with more enduring effects than medication.
Why is CBT excluded from studies?
Researchers suspect, however, that many studies of CBT typically exclude certain conditions due to beliefs that these could lead to less improvement in symptoms over the course of treatment. To include individuals possessing such characteristics in a study might be to skew negatively the results, making CBT look less effective than it is with suitable clients; beyond that, such clients may be poorly served by beginning a therapy which can ultimately not achieve measurable results for them.
What is computer mediated CBT?
Computer-mediated CBT has the capacity to deliver structured input consistently with precision. Observing that it also offers low-cost, easily accessible, flexible therapy in a non-stigmatising environment, one study conducted an analysis of reviews of efficacy of “cCBT” (computerised CBT) published between 1999 and February, 2011. The search yielded 12 systematic reviews from ten studies covering depression. The meta-review concluded that the limited evidence available supported the efficaciousness of MoodGYM, Beating the Blues, and Colour Your Life, although it also stated that it was not possible to discern the relative effectiveness of one package over the other (Foroushani, Schneider, & Assareh, 2011).
Is CBT a computerised program?
In a similar vein, a number of studies listed on the United States Department of Health and Human Services SAMHSA National Registry of Evidence-based Programs and Practices consistently supports the finding of effectiveness of CBT either as a computerised CBT package (with or without minimal therapist help) or as an independent, guided self-help program.
Is CBT a treatment modality?
CBT is an acceptable treatment modality. A meta-analytic study by McHugh, Whitton, Peckham, Welge, & Otto (2013) identified 644 articles assessing adult patient preferences for the treatment of psychiatric disorders; in order to be included in the meta-analytic investigation, the studies had to include at least one psychological treatment and one pharmacologic treatment. Of the 34 studies which met inclusion criteria, there was a three-fold preference for psychological treatment. That is, the proportion of adult patients preferring psychological treatment was 0.75 (95% CI, 0.69–0.80), which was significantly higher than equivalent preference (i.e., higher than 0.50; P < .001). The authors noted that, given the mounting evidence for enhanced outcomes when clients are allowed to receive preferred psychiatric treatment, strategies should be developed to maximise the linkage of clients to their preferred treatment.
Is CBT good for anxiety?
As with computer-based CBT, the effectiveness of CBT guided self-help for anxiety and depression is not well established. One meta-analysis reported on the results of 13 studies of adults, aged 17 to 64, who used guided self-help CBT materials. The studies, conducted between 2003 and 2009 in the United States and other nations, evaluated the effectiveness of randomised, controlled trials of CBT for anxiety and depression. But while clinician and self-report measures found that depressive and anxiety symptoms had substantially reduced, researchers were able to draw only limited conclusions. This was because recruitment methods for the studies differed significantly (self-selected versus referral), many of the studies only partially addressed the issue of fidelity, and amount of therapist help varied widely: between 30 minutes and three hours (Coull & Morris, 2011).