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Substance use disorder treatment faces challenges such as dropout, relapse, and readmission. This study aims to identify factors associated with readmission and those influencing dropout among dual diagnosis (DD) patients (those with both a substance use disorder and another psychiatric disorder) attending outpatient addiction centers. Retrospective cohort study using the electronic health records of 8383 outpatients diagnosed with DD. Bivariate analysis and regression analysis were applied to control for the variables. Age, incarceration for 30 days prior to admission, and specific patterns of consumption increased the likelihood of readmission. Specifically, individuals who reported no substance use in the 30 days before admission or those diagnosed with an opioid or cocaine use disorder were particularly susceptible to readmission. Of the dual diagnoses, patients with personality disorders were more likely to be readmitted. In relation to dropout, opioid dependence and frequency of use were associated with a higher probability of dropout. Patients with poorer adherence to treatment and previous readmissions were also more likely to drop out. Enhancing treatment adherence and reducing dropout and readmission rates poses a challenge in managing patients with DD. Leveraging electronic health records offers enhanced ecological validity concerning the outpatient treatment requirements for such patients. Therapeutic adherence, alongside specific sociodemographic variables and consumption patterns, emerges as pivotal factors in this context. Identifying and understanding these variables facilitates the customization of outpatient treatment strategies to better meet the needs of patients with comorbidities. [ABSTRACT FROM AUTHOR]

Purpose: To compare biochemical and tumor response rates between two reference centers for pituitary diseases in Brazil after primary and adjuvant therapy with somatostatin receptor ligands (SRL) in acromegaly. Methods: Patients were classified as non-responders (NR), partial responders (PR), and full responders (FR) to 12-month SRL therapy according to: [criteria A] normal IGF-I and random GH (rGH) < 1 ng/mL (FR); ≥ 50% decrease of IGF-I and/or rGH (PR); < 50% decrease of IGF-I and rGH (NR); [criteria B] normal IGF-I (FR); ≥ 50% decrease of IGF-I (PR); < 50% decrease of IGF-I (NR). Tumor shrinkage <20% defined poor responders (tPR) and ≥ 20% good responders (tGR). Results: We studied 219 acromegaly patients (59% women, age 43.1 ± 13.9 years; 73 from Center I and 146 from Center II). After SRL therapy, the proportion of FR, PR, and NR by criteria A and B was 30.2 vs 49.1%, 52.8 vs 21.2% and 17 vs 29.7%, respectively (p < 0.001). Considering criteria A or B separately, there was no difference in the proportion of FR, PR and NR between two centers. However, when comparing criteria A and B, the Center I showed a difference of 30.9% in classification of FR in relation to 13.2% observed in Center II (p = 0.006). tGR were 51.4% of patients, with no differences between the centers. Conclusions: IGF-I alone significantly increased positive response rates to SRLs, whereas the inclusion of rGH levels into therapeutic decision might lead to a significant increment on the costs of acromegaly management. [ABSTRACT FROM AUTHOR]

Background: Early response to treatment is a robust predictor of outcome in cognitive behavioral therapy (CBT) for depression. When clients show a poor early response, therapists may understandably be concerned. We examine how early CBT skill development might be used to help inform therapists about patients' prognoses in such circumstances. Methods: In a sample of 95 clients participating in CBT for depression, we examine the role of the development of CBT skills by asking whether a client's prognosis depends not only on early response, but on its interaction with CBT skill development. Results: We found support for the hypothesized interaction in predicting posttreatment depression and anxiety symptoms. For those who experienced modest early CBT skill improvements, early symptom improvement was strongly predictive of posttreatment outcome. However, for those who experienced more substantial early CBT skill improvements, early symptom change was not as strongly related to their posttreatment symptoms. Conclusions: Our findings extend the literature on early response predicting outcome by showing that when clients experience more limited early symptom change, outcome depends considerably on the degree to which they are learning CBT skills. For clients with greater CBT skill improvements, a relatively positive treatment outcome is still common. [ABSTRACT FROM AUTHOR]

Background: Although chronically constipated patients usually respond to medical treatment, there is a subgroup with scarce/no response, generally labeled as refractory or intractable. However, whether this lack of response is real or due to ancillary causes (suboptimal dosage, lack of compliance etc.) is unknown.Aims: To see whether a pharmacologic test (bisacodyl colonic intraluminal infusion during manometric assessment) may predict the therapeutic outcome.Methods: Data of patients undergoing 24/h colonic manometry for severe intractable constipation in whom the bisacodyl test (10 ml of drug dissolved into saline and injected through the more proximal recording port) had been carried out were retrieved and analysed, and correlations with the therapeutic outcome made.Results: Overall, charts from 38 patients (5 men) were available; of these, only 21% displayed naive high-amplitude propagated contractions (average, less than 2/24 h), mostly meal-induced, during the recordings. A bisacodyl response was present in 31.6% patients, with a mean number of events of 1.8 per patient. After bisacodyl testing, 47.3% patients underwent intensive medical treatment, 44.7% surgery (medical failures), and 8% transanal irrigation, a procedure employed to treat refractory patients. The presence of naive propulsive contractions significantly correlated with the response to bisacodyl infusion (p < 0.0001), and with a favourable outcome to intensive medical treatment (p < 0.0001).Conclusions: The bisacodyl test may be clinically useful to better categorize constipated patients erroneously labelled as intractable and to exclude true colonic inertia, thus avoiding surgery in more than 30% of these subjects. [ABSTRACT FROM AUTHOR]

Wilderness therapy is becoming a more widely used intervention for adolescents, but there have not been any meta-analyses focused solely on its clinical effectiveness for private pay clients. This study's objective was to conduct outcome-based meta-analyses of private-pay wilderness therapy programs, benchmark primary features of this approach, and educate the clinical community as to its effectiveness. The authors conducted a review of all available databases, as well as manual searches. Searches resulted in a meta-analysis based on 36 studies, totaling 2399 participants receiving wilderness therapy. Our meta-analyses found medium effect sizes for all six constructs assessed: self-esteem (g = 0.49), locus of control (g = 0.55), behavioral observations (g = 0.75), personal effectiveness (g = 0.46), clinical measures (g = 0.50) and interpersonal measures (g = 0.54). Subgroup analyses included age of participants, duration of program, open or closed model, presence of a mental health practitioner, and publication year. [ABSTRACT FROM AUTHOR]

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Background/aim: Recent studies have suggested that periportal location of percutaneous radiofrequency ablation (RFA) for hepatocellular carcinoma (HCC) is considered as one of the independent risk factors for local tumor progression (LTP). However, the long-term therapeutic outcomes of percutaneous RFA as the first-line therapy for single periportal HCCand corresponding impacts on tumor recurrence or progression are still unclear., Materials and Methods: From February 2011 to October 2020, a total of 233 patients with single nodular HCC ≤ 5 cm who underwent RFA ± transarterial chemoembolization (TACE) as first-line therapy was enrolled and analyzed, including 56 patients in the periportal group and 177 patients in the nonperiportal group. The long-term therapeutic outcomes between the two groups were compared, risk factors of tumor recurrence or progression were evaluated., Results: The LTP rates at 1, 3, and 5 years were significantly higher in the periportal group than those in the nonperiportal group (15.7, 33.7, and 46.9% vs 6.0, 15.7, and 28.7%, respectively, P = 0.0067). The 1-, 3- and 5-year overall survival (OS) rates in the periportal group were significantly worse than those in the nonperiportal group (81.3, 65.1 and 42.9% vs 99.3, 90.4 and 78.1%, respectively, P<0.0001). In the subgroup of single HCC ≤ 3 cm, patients with periportal HCC showed significantly worse LTP P = 0.0006) and OS (P<0.0001) after RFA than patients with single nonperiportal HCC; The univariate and multivariate analyses revealed that tumor size, periportal HCC and AFP ≥ 400ug/ml were independent prognostic factors for tumor progression after RFA. Furthermore, patients with single periportal HCC had significantly higher risk for IDR(P = 0.0012), PVTT(P<0.0001) and extrahepatic recurrence(P = 0.0010) after RFA than those patients with single nonperiportal HCC. ., Conclusion: The long-term therapeutic outcomes of RFA as the first-line therapy for single periportal HCC were worse than those for single nonperiportal HCC, an increased higher risk of tumor recurrence or progression after RFA was significantly associated with periportal HCC., (© 2021. The Author(s).)