Täällä saa kysyä jos joku tietäisi tai jollain olisi kokemuksia , terveyteen ja sairaanhoitoon liittyvissä asioissa.
Mitä tarkoittaa tällainen teksti?
Sivulöydöksenä näkyy mediaalisesti navicularen ja mediaalisen cuneiformen välisessä nivelessä rustovaurioon sopivaa luuödeemaa.
Terveyteen ja sairaudenhoitoon liittyviä kysymyksiä ja dileemoja
Terveyteen ja sairaudenhoitoon liittyviä kysymyksiä ja dileemoja
"Ikuisesti minun kuuni" syleilen kiireistä kuuta. "Ottakoon" he vain toteavat, kauniit aurinko ihmiset "jos se kerran on hänen kuunsa"
Re: Terveyteen ja sairaudenhoitoon liittyviä kysymyksiä ja dileemoja
Jalkapöydän luissa on luuturvotusta (luun paikallista nestepitoisuuden lisääntymistä), joka useimmiten johtuu rasituksesta ja saattaa johtaa rasitusmurtumaan.
Re: Terveyteen ja sairaudenhoitoon liittyviä kysymyksiä ja dileemoja
Että pitää amputoida. Onneksi mediaalinen tarkoittaa sisäosaa, joten riittää että jalkapöytääsi porataan iso reikä. Toki onhan se ikävää kun astuu paljain jaloin lätäkköön ja reiästä ruuttaa kuravedet naamalle, mutta on se varmasti parempi kuin ödeema.Kissatäti kirjoitti: ↑24 Kesä 2024, 20:00 Täällä saa kysyä jos joku tietäisi tai jollain olisi kokemuksia , terveyteen ja sairaanhoitoon liittyvissä asioissa.
Mitä tarkoittaa tällainen teksti?
Sivulöydöksenä näkyy mediaalisesti navicularen ja mediaalisen cuneiformen välisessä nivelessä rustovaurioon sopivaa luuödeemaa.
Ei vaan tulehdus jalkapöydän keskellä olevassa luussa, sopien rustovaurioon.
Re: Terveyteen ja sairaudenhoitoon liittyviä kysymyksiä ja dileemoja
Tää on kyllä huippu. VMP
Käyx tää?
Let’s take a peek at another meta-analysis from The Lancet. This time it’s
We can see that these “strong” and “weak” categories actually seem to hold up to some extent, but the absolute differences look pretty tiny no? What’s the difference between a SMD of -0.56 and a SMD of -0.42 really?
Statistics Time, Sorry
This comparison uses standard mean differences (SMDs) which you probably know better as Cohen’s d10, which you probably know even better as “effect size.”
I am not a Statistics Wizard, so thank god Stefan Leucht and his friend et al. wrote an article specifically to explain the 13 different ways we can conceptualize effect size for the antidopaminergics. They include this lovely figure that illustrates what a SMD change does to a standard distribution quite nicely.
The Positive And Negative Symptom Scale (PANSS), Briefly
The PANSS is the most commonly used clinical rating scale for evaluating symptoms in primary psychosis. It was created as an expansion to the Brief Psychiatric Rating Scale (BPRS) which is an 18 question inventory with relatively nebulous scoring requirements.
The PANSS consists of three subscales:
Positive Scale: 7 questions about the positive symptoms of schizophrenia (e.g. hallucinations, delusions, disorganization). Max score = 49
Negative Scale: 7 questions about the negative symptoms of schizophrenia (e.g. social withdrawal, apathy, difficulty with abstraction). Max score = 49
General Psychopathology Scale: 16 questions about symptoms that don’t neatly fall into either category. Some questions ask about general symptoms that are not necessarily related to psychosis (e.g. depression, attention, impulsivity), while others are more directly related (e.g. unusual thought content). Max score = 112.
Questions are given a score between 1 (not present) and 7. Each question has detailed explanations for each individual score, for example a score of 5 on question P3. “Hallucinatory behavior” is described as so:
5 Moderate severe - Hallucinations are frequent, may involve more than one sensory modality, and tend to distort thinking and/or disrupt behavior. Patient may have a delusional interpretation of these experiences and respond to them emotionally and, on occasion, verbally as well.
Scores range between 30 and 210, higher numbers indicate more severe symptoms. You can see a full version of the scale here.
The Leucht paper points out that, based on two big meta-analyses (Huhn et al. above and Leucht et al. 201711) the mean baseline PANSS score in these studies is 9512 with a standard deviation of 20.
To put it all together, that means we would expect to see the following changes in PANSS scores in the average patient based on the Huhn paper:
Clozapine: -17.8
Olanzapine: -11.2
Risperidone: -11
Quetiapine: -8.4
Aripiprazole: -8.2
Lurasidone: -7.2
That’s great, but I still haven’t explained what these deltas correspond to clinically. Stefan Leucht and et al. (who you may be familiar with by now) wrote a paper literally called What does the PANSS mean? in 2005. They compared changes in PANSS scores to ratings on the Clinical Global Impressions (CGI) scale.
The CGI, Briefly
The CGI has a symptom scale (The CGI-S) and an improvement scale (CGI-I). These scales are meant to identify how a physician seeing a patient outside of a study environment would evaluate them. We’re going to be talking about these scores a decent amount, so I’ve included two images below that describe what each CGI score (roughly) corresponds to.
Empiricists will probably shudder at the subjectivity here, but I think the CGI makes a lot of sense for subjective symptoms where you can’t trust the patient to reliably self-report. It also reflects how we evaluate drug efficacy in the real-world. Very few psychiatrists - if any - adjust treatment for schizophrenia based on closely monitored PANSS scores.
Anyway, back to the paper. Leucht and his co-authors matched up PANSS scores (range: 30-210) with CGI-S scores by asking clinicians to rate patients on the CGI-S and then comparing what PANSS scores correlated with CGI-S scores:
CGI-S 3 / Mild: 58
CGI-S 4 / Moderate: 75
CGI-S 5 / Marked: 95
CGI-S 6 & 7 / Severe: >115
Leucht et al. found that for patients to be considered “minimally improved” (i.e. to score a 3 on the CGI-I) they needed to show a decrease in their PANSS score of 19-28% depending on the timeframe. If we take our average study participant with a PANSS of 95 this means a decrease between 18-27 points. “Much improved” reflected between a 40-53% decrease in PANSS; 38-50 points. “Very much improved” reflected a 71-81% decrease; 67-77 points.
This means that even for clozapine - the most efficacious antidopaminergic we have available - the average patient is just barely getting into “minimally improved” territory, which - remember - means “no clinically meaningful reduction of symptoms.”
To be fair, there’s some odd stuff going on here with the correspondence between the rating scales. If we take the average PANSS change needed for “minimal” improvement on the CGI, that’s 22.5, which would knock our average patient with a ‘marked’ CGI-S score down to a 72.5, which would put them at a “moderate” CGI-S score. This represents a change from symptoms that “distinctly impair functioning… or cause intrusive levels of distress” to symptoms that cause “noticeable, but modest functional impairment or distress.” This seems pretty incompatible with the description of “minimal” improvement as “slightly better, with no clinically meaningful reduction of symptoms.”
(Yet another) Leucht et al. meta-analysis this time from Oct. 2017, has a nice table illustrating how just how few individuals are at least “much improved” (i.e. are judged to have a clinically significant improvement) with antidopaminergics.
Those “strong” and “weak” categories aren’t looking so clinically distinct anymore, are they?
https://polypharmacy.substack.com/p/wot ... ow-we-pick
Otsikossa masarit, joten en vain kokeillut googlea.
- psykoosi1.png (37.9 KiB) Katsottu 151 kertaa
Let’s take a peek at another meta-analysis from The Lancet. This time it’s
- Kuvakaappaus_2024-06-24_20-37-38.png (191.39 KiB) Katsottu 145 kertaa
Statistics Time, Sorry
This comparison uses standard mean differences (SMDs) which you probably know better as Cohen’s d10, which you probably know even better as “effect size.”
I am not a Statistics Wizard, so thank god Stefan Leucht and his friend et al. wrote an article specifically to explain the 13 different ways we can conceptualize effect size for the antidopaminergics. They include this lovely figure that illustrates what a SMD change does to a standard distribution quite nicely.
The Positive And Negative Symptom Scale (PANSS), Briefly
The PANSS is the most commonly used clinical rating scale for evaluating symptoms in primary psychosis. It was created as an expansion to the Brief Psychiatric Rating Scale (BPRS) which is an 18 question inventory with relatively nebulous scoring requirements.
The PANSS consists of three subscales:
Positive Scale: 7 questions about the positive symptoms of schizophrenia (e.g. hallucinations, delusions, disorganization). Max score = 49
Negative Scale: 7 questions about the negative symptoms of schizophrenia (e.g. social withdrawal, apathy, difficulty with abstraction). Max score = 49
General Psychopathology Scale: 16 questions about symptoms that don’t neatly fall into either category. Some questions ask about general symptoms that are not necessarily related to psychosis (e.g. depression, attention, impulsivity), while others are more directly related (e.g. unusual thought content). Max score = 112.
Questions are given a score between 1 (not present) and 7. Each question has detailed explanations for each individual score, for example a score of 5 on question P3. “Hallucinatory behavior” is described as so:
5 Moderate severe - Hallucinations are frequent, may involve more than one sensory modality, and tend to distort thinking and/or disrupt behavior. Patient may have a delusional interpretation of these experiences and respond to them emotionally and, on occasion, verbally as well.
Scores range between 30 and 210, higher numbers indicate more severe symptoms. You can see a full version of the scale here.
The Leucht paper points out that, based on two big meta-analyses (Huhn et al. above and Leucht et al. 201711) the mean baseline PANSS score in these studies is 9512 with a standard deviation of 20.
To put it all together, that means we would expect to see the following changes in PANSS scores in the average patient based on the Huhn paper:
Clozapine: -17.8
Olanzapine: -11.2
Risperidone: -11
Quetiapine: -8.4
Aripiprazole: -8.2
Lurasidone: -7.2
That’s great, but I still haven’t explained what these deltas correspond to clinically. Stefan Leucht and et al. (who you may be familiar with by now) wrote a paper literally called What does the PANSS mean? in 2005. They compared changes in PANSS scores to ratings on the Clinical Global Impressions (CGI) scale.
The CGI, Briefly
The CGI has a symptom scale (The CGI-S) and an improvement scale (CGI-I). These scales are meant to identify how a physician seeing a patient outside of a study environment would evaluate them. We’re going to be talking about these scores a decent amount, so I’ve included two images below that describe what each CGI score (roughly) corresponds to.
Empiricists will probably shudder at the subjectivity here, but I think the CGI makes a lot of sense for subjective symptoms where you can’t trust the patient to reliably self-report. It also reflects how we evaluate drug efficacy in the real-world. Very few psychiatrists - if any - adjust treatment for schizophrenia based on closely monitored PANSS scores.
Anyway, back to the paper. Leucht and his co-authors matched up PANSS scores (range: 30-210) with CGI-S scores by asking clinicians to rate patients on the CGI-S and then comparing what PANSS scores correlated with CGI-S scores:
CGI-S 3 / Mild: 58
CGI-S 4 / Moderate: 75
CGI-S 5 / Marked: 95
CGI-S 6 & 7 / Severe: >115
Leucht et al. found that for patients to be considered “minimally improved” (i.e. to score a 3 on the CGI-I) they needed to show a decrease in their PANSS score of 19-28% depending on the timeframe. If we take our average study participant with a PANSS of 95 this means a decrease between 18-27 points. “Much improved” reflected between a 40-53% decrease in PANSS; 38-50 points. “Very much improved” reflected a 71-81% decrease; 67-77 points.
This means that even for clozapine - the most efficacious antidopaminergic we have available - the average patient is just barely getting into “minimally improved” territory, which - remember - means “no clinically meaningful reduction of symptoms.”
To be fair, there’s some odd stuff going on here with the correspondence between the rating scales. If we take the average PANSS change needed for “minimal” improvement on the CGI, that’s 22.5, which would knock our average patient with a ‘marked’ CGI-S score down to a 72.5, which would put them at a “moderate” CGI-S score. This represents a change from symptoms that “distinctly impair functioning… or cause intrusive levels of distress” to symptoms that cause “noticeable, but modest functional impairment or distress.” This seems pretty incompatible with the description of “minimal” improvement as “slightly better, with no clinically meaningful reduction of symptoms.”
(Yet another) Leucht et al. meta-analysis this time from Oct. 2017, has a nice table illustrating how just how few individuals are at least “much improved” (i.e. are judged to have a clinically significant improvement) with antidopaminergics.
Those “strong” and “weak” categories aren’t looking so clinically distinct anymore, are they?
https://polypharmacy.substack.com/p/wot ... ow-we-pick
Otsikossa masarit, joten en vain kokeillut googlea.