In this project we investigated the difference between efficacy (treatment outcome investigated in randomized clinical trials, RCTs) and effectiveness (treatment outcome when these treatments are... Show moreIn this project we investigated the difference between efficacy (treatment outcome investigated in randomized clinical trials, RCTs) and effectiveness (treatment outcome when these treatments are applied in daily psychiatric practice) for major depressive disorder. Treatment outcome and patient features in daily practice were assessed with routine outcome monitoring. We found that effectiveness is significantly lower than efficacy. In RCTs, a stringent patient selection is applied bij inclusion/exclusion criteria. We found that patients in daily practice do differ significantly from participants in RCTs with respect to baseline severity, comorbid disorders, suicidality and employment status. However, we found that these differences have very little influence on treatment outcome. In other words, if, hypothetically, only patients who are eligible for participation in RCTs for major depressive disorder would be tre ated, treatment success would not improve dramatically. Show less
This thesis describes a study on primary diffuse large B cell lymphoma of bone with large patient numbers in chapter 2. The tumor presents mostly in the long bones. The clinical outcome is usually... Show moreThis thesis describes a study on primary diffuse large B cell lymphoma of bone with large patient numbers in chapter 2. The tumor presents mostly in the long bones. The clinical outcome is usually favorable. We found a trend towards worse survival for the immunoblastic tumor subtype. In chapter three, We studied the MRI characteristics of 29 bone lymphoma patients. The majority of the patients displayed a combination of definite cortical abnormalities and extension to the soft tissue, but up to 31% of the patients showed MRI features that looked radiologically non-aggressive or even benign. In chapter four, we determined the prognostic significance of BCL-6, CD10, MUM1, BCL-2, p53, CD30 and CD44. Applying the Hans__ algorithm, we concluded that 19 out of a cohort of 36 cases displayed a germinal center-like phenotype. No significant influence on survival was found. In chapter five, we investigated genomic alterations in nine cases. We found several recurrent genomic aberrations, but none had statistically significant prognostic influence. The most frequent finding was five cases with gain of 1q (five out of nine cases) and 2p16.1 amplification (four out of nine cases). In chapter six we investigated 50 cases for involvement of aberrant NF-_B activation by performing immunohistochemical stainings. In a minority (19%) of cases, we found substantial nuclear staining of p50. The nuclear expression of p50 was not preferentially detected in non-germinal center or germinal center type cases, or related to an inferior prognosis. Show less
This thesis describes the outcomes of a randomized controlled trial of a Cognitive Behavioural Therapy (CBT) intervention for patients who engage in Deliberate Self-Harm (DSH). The CBT intervention... Show moreThis thesis describes the outcomes of a randomized controlled trial of a Cognitive Behavioural Therapy (CBT) intervention for patients who engage in Deliberate Self-Harm (DSH). The CBT intervention was designed to supplement usual care following an episode of DSH. The study involved 90 people (95% females), aged 15–35 years, who were randomly assigned to CBT in addition to treatment as usual (TAU) or to treatment as usual only. The main study hypothesis, that CBT in addition to TAU would be more effective in reducing repetition of DSH than TAU only, was supported. Furthermore, those who received CBT in addition to TAU were shown to have significantly greater reductions in depression, anxiety and suicidal cognitions, and significantly greater improvements in self-esteem and problem solving ability. It is reasonable to assume that these positive findings are attributable to the effect of the CBT, given the random assignment as well as the absence of between group differences with respect to demographics, DSH, history of DSH, psychopathology and use of health care services. It is encouraging that these results are found for people with recurrent and chronic DSH, with high risk of repetition, and with high levels of psychiatric co-morbidity. Show less
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