To successfully reduce overall invasive plant cover over time, an effective treatment plan must be established such that mortality exceeds new colonization and resprouting growth rates. However, few evaluations of the effects of long-term, consistent treatment at different intervals exist. We report the effects of treatment intensity on Old World climbing fern [Lygodium microphyllum (Cav.) R. Br.], Brazilian pepper (Schinus terebinthifolia Raddi), and punktree [Melaleuca quinquenervia (Cav.) S. F. Blake] as part of a large restoration project that has been underway for 6 yr in Telegraph Swamp at Babcock Ranch Preserve, a 27,520-hectare (68,000-acre) conservation area in Florida, USA. We found that at the end of the 6-yr period, for all three species, average live cover did not exceed 5% across all transects. In addition, dead foliar cover was higher than live cover for all three invasive plants, indicating progress toward restoration goals. We also found that percent live cover of L. microphyllum was significantly reduced only after four or more treatments were applied during the 6-yr period, as opposed to when three or fewer treatments were applied. Reductions in percent cover of live foliage were apparent only when the treatments were applied more often than biennially, as opposed to less often than biennially. Additionally, we found higher L. microphyllum cover in clear-cut and replanted cypress stands than in natural stands. Based on these findings, we conclude that treatments applied four or more times, or more often than biennially, were more effective at significantly reducing advanced invasions of L. microphyllum, S. terebinthifolia, and M. quinquenervia, especially where previous management activities or their effects may have increased the cover of invasive plants.

Background: Lesbian, gay and bisexual individuals experience more anxiety and depression than heterosexual people. Little is known about their comparative treatment response to psychological interventions. Aims: To compare sociodemographic/clinical characteristics and treatment outcomes across sexual orientation groups, for adults receiving primary care psychological interventions from Improving Access to Psychological Therapies (IAPT) services in London, adjusting for possible confounders. Method: Data from 188 lesbian women, 222 bisexual women, 6637 heterosexual women, 645 gay men, 75 bisexual men and 3024 heterosexual men were analysed from pre-treatment and last treatment sessions. Males and females were analysed separately. Results: Before treatment, lesbian and bisexual women were more likely to report clinical levels of impairment (Work and Social Adjustment Scale) than heterosexual women; there were no significant differences in depression (PHQ-9) or anxiety (GAD-7). Bisexual men were more likely to meet depression caseness than gay men but less likely to meet anxiety caseness than gay or heterosexual men. Compared with heterosexual women, lesbian and bisexual individuals showed smaller reductions in depression and impairment, controlling for age, ethnicity, employment, baseline symptoms, number of sessions and intervention type. Bisexual women experienced significantly smaller reductions in anxiety than heterosexual women and were less likely to show recovery or reliable recovery. There were no significant differences in treatment outcomes between gay, bisexual and heterosexual men. Conclusions: Reasons for poorer outcomes in lesbian and bisexual women require investigation, for example lifetime trauma or stigma/discrimination regarding gender or sexual orientation in everyday life or within therapy services.

Introduction: Low Back Pain (LBP) remains a condition with relatively high incidence and prevalence. It affects 70-85% of people at some point in their lives and causes significant disability. LBP management may be best suited to a primary care setting, yet it is one of the most common reasons for presentation to Emergency Departments (ED). Nationally representative data from the United States found that LBP related disorders are a frequent cause of ED visits, accounting for 2.7 million visits to US EDs annually. There are numerous treatment modalities for LBP, however the task is identifying those that have relevance in an ED setting. Although there is extensive research available on management of LBP in primary care settings, treatment outcomes differ from that in the ED setting. This makes management of LBP a challenge for ED physicians. Few studies and no systematic reviews focus on treatment of LBP in the ED setting. Methods: The objective of our study is to compare effectiveness of treatment modalities relevant for management of LBP in the ED setting. We conducted an Overview of Systematic Reviews following robust methods advocated by Cochrane. We included systematic reviews of randomized controlled trials (RCTs). A medical librarian assisted in completing of an extensive search of the Cochrane Library, PubMed, and EMBASE. We used transparent criteria to select relevant reviews and assess interventions for ED relevance. We collected key data points from the included reviews including pain and functional limitation outcomes. Evidence will be synthesized for important outcome measures following the approach of Jones et al (2012). Results: We screened 4740 citations and identified 346 likely relevant systematic reviews. Comparative effectiveness review synthesis will be completed before the conference. We will report effectiveness of each of the included interventions and as well as make head to head comparisons of said relevant interventions. Conclusion: Currently most LBP patients presenting to the ED are inundated with a variety of potential treatment modalities, all alleging efficacy in LBP management. Physicians may use the evidence from this synthesis, and related knowledge translation tools, to guide decisions in effectively treating patients presenting to the ED with LBP.

Objectives: When incorporating treatment effect estimates derived from a random-effect meta-analysis it is tempting to use the confidence bounds to determine the potential range of treatment effect. However, prediction intervals reflect the potential effect of a technology rather than the more narrowly defined average treatment effect. Using a case study of robot-assisted radical prostatectomy, this study investigates the impact on a cost-utility analysis of using clinical effectiveness derived from random-effects meta-analyses presented as confidence bounds and prediction intervals, respectively.

Methods: To determine the cost-utility of robot-assisted prostatectomy, an economic model was developed. The clinical effectiveness of robot-assisted surgery compared with open and conventional laparoscopic surgery was estimated using meta-analysis of peer-reviewed publications. Assuming treatment effect would vary across studies due to both sampling variability and differences between surgical teams, random-effects meta-analysis was used to pool effect estimates.

Results: Using the confidence bounds approach the mean and median ICER was €24,193 and €26,731/QALY (95%CI: €13,752 to €68,861/QALY), respectively. The prediction interval approach produced an equivalent mean and median ICER of €26,920 and €26,643/QALY (95%CI: -€135,244 to €239,166/QALY), respectively. Using prediction intervals, there is a probability of 0.042 that robot-assisted surgery will result in a net reduction in QALYs.

Conclusions: Using prediction intervals rather than confidence bounds does not affect the point estimate of the treatment effect. In meta-analyses with significant heterogeneity, the use of prediction intervals will produce wider ranges of treatment effect, and hence result in greater uncertainty, but a better reflection of the effect of the technology.

Aims: To measure the effectiveness of treatment in a low secure challenging behaviour unit and to identify predictors of change.

Method: Routine clinical data and outcome scores were collected on a case series of 86 patients admitted to and discharged from one low secure unit.

Results: Significant improvements were found on Health of the Nation Outcome Scale (HoNOS), Staff Observed Aggression Scale (SOAS) and the Global Assessment Scale (GAS). Improvements in GAS and HoNOS were associated with moves to a lower level of security. Patients with a history of conviction for property damage, cannabis use, who were admitted on a forensic section or with a diagnosis of personality disorder were more likely to move to a higher level of security. Increased length of stay was related to the presence of physical assault, physical health problems and anxiety symptoms.

Conclusions: Clinical outcomes and behaviour improve during admission to one low secure unit and characteristics of the type of patients who respond to this form of treatment are proposed.

Rosen, Lohr, McNally and Herbert’s (1998) arguments directed at the so-called “Power Therapies” and, in particular, Eye Movement Desensitization and Reprocessing (EMDR) are examined. It is suggested that their paper does not adequately review the available research data and, therefore, draws unwarranted conclusions. Based on published controlled studies it is concluded that there is evidence to support the use of EMDR in the treatment of post traumatic stress disorder (PTSD).

The debate conducted in this journal and elsewhere on the effectiveness of eye movement desensitization and reprocessing (EMDR) is characterized by incredulity, fervent belief and emotion. Theorists and clinical pragmatists, not to mention the “discovers” of EMDR, have often taken up oppositional stances that impede rationale debate. Whilst some may be offended by the overt commercialism and messianic fervour of the EMDR lobby, the best response is to engage in dialogue, collaboration and scientific experiment. These experiments should combine the best randomized clinical trial methods with experimental deconstruction of the complex mix that now comprises EMDR. Those who have developed EMDR should cease the commercial and empirical protectionism that has characterized the EMDR movement and open their methods to such investigation by the healthily sceptical.