Genealogies of recovery: The framing of therapeutic ambitions

The notion of recovery has become prominent in mental healthcare discourse in the UK, but it is often considered as if it were a relatively novel notion, and as if it represented an alternative to conventional treatment and intervention. In this paper, we explore some of the origins of the notion of recovery in the early 20th century in movements such as Alcoholics Anonymous and Recovery Inc. Whilst these phenomena are not entirely continuous with recovery in the present day, some important antecedents of the contemporary notion can be detected. These include the focus on the sufferers’ interior space as a key theatre of operations and the reinforcement and consolidation of medical ways of seeing the condition without any immediate medical supervision of the actors being necessary. This has resonance with many contemporary examples of recovery in practice where the art of living with a mental health condition is emphasised without the nature of the psychopathological condition itself being challenged.     

Non-response for health-related quality of life outcomes in ICU patients: A systematic review of the reporting in randomised trials

Background

Health-related quality of life (HRQoL) is frequently assessed in randomised clinical trials (RCTs) in the intensive care unit (ICU), but data are limited regarding the proportions of patients without responses or not surviving to HRQoL follow-up and the handling of this. We aimed to describe the extent and pattern of missing HRQoL data in intensive care trials and describe how these data and deaths were handled statistically.

Methods

We conducted a systematic review and meta-analysis following a published protocol. We searched PubMed, EMBASE, CINAHL and Cochrane Library for RCTs involving adult ICU patients reporting HRQoL as an outcome and excluded RCTs unobtainable in full text. We performed risk of bias assessment independently and in duplicate.

Results

We included 196 outcomes from 88 RCTs published in the years 2002–2022; the numbers of patients alive and eligible to respond HRQoL were reported in 76% of trials. At follow-up, median 27% (interquartile range 14%–39%) of patients had died, and median 20% (9%–38%) of survivors did not respond across outcomes. Analyses of 80% of outcomes were restricted to complete cases only. The handling of non-survivors in analyses were reported for 46% of outcomes, with 26% of all outcomes reported as including non-survivors (using the value zero or the worst possible score).

Conclusion

For HRQoL outcomes in ICU trials, we found that mortality at time of follow-up was high and non-response among survivors frequent. The reporting and statistical handling of these issues were insufficient, which may have biased results.     

Report of 7 Uterine Rupture Cases After Laparoscopic Myomectomy: Update of the Literature

The objective of this article is to report 7 previously unpublished uterine rupture cases in pregnancy after laparoscopic myomectomy and to update the medical literature. All cases were reported to the Board of Endoscopic Gynecologic Surgery (Athens, Greece) from 1998 to 2011. Myomas were single in 85.7% of patients, subserosal or pedunculated in 85.7%, and ≤5 cm in 71.4%. Bipolar diathermy was the sole method used for hemostasis in 28.6%, and could be characterized as excessive in 85.7%. A 2-layer closure with stitches of the myometrium was performed in just 14.3% of cases. Mean (SD) time between surgery and pregnancy was 1.4 (0.5) years. Uterine rupture occurred at 34 weeks of gestation or later in 85.7%, and during labor in 14.3% of cases. All women survived. Fetal demise was reported in 1 twin pregnancy (both fetuses) with rupture at 24 weeks of gestation. Laparoscopic myomectomy should be performed by adequately trained and experienced surgeons. Excessive use of diathermy for hemostasis should be avoided, and multiple-layer suturing should always be used for repairing the myometrial defect in cases of intramural and subserosal myomas with deep intrusion.     

Interpreting the results of Parkinson's disease clinical trials: Time for a change

Randomized clinical trials testing putative disease‐modifying agents in Parkinson's disease (PD) have yielded controversial results that have not influenced evidence‐based recommendations for the treatment of PD. We argue that the failure of these clinical trials may be linked to end point‐based statistical analyses that must make prior assumptions about the magnitude and the time course of wash‐in and wash‐out of drug effects. Many of these shortcomings may be avoided with quantitative modeling of the entire time course of the clinical trial and examining evidence for three concomitant processes, disease progression, symptomatic drug effects and disease modifying effects. The power of this approach is illustrated by modeling of DATATOP and ELLDOPA trial data. © 2010 Movement Disorder Society     

Versorgungssituation von Kindern,Jugendlichen und Erwachsenen mit sexuellen Gewalterfahrungen in Deutschland

Bundesgesundheitsblatt - Gesundheitsforschung - Gesundheitsschutz - In Deutschland ist seit 2010 die Auseinandersetzung um sexuelle Gewalterfahrungen, auch über die umfangreichen...