Therapists’ professional and personal characteristics as predictors of outcome in long-term psychodynamic psychotherapy and psychoanalysis

2014 ◽  
Vol 29 (5) ◽  
pp. 265-274 ◽  
Author(s):  
E. Heinonen ◽  
P. Knekt ◽  
T. Jääskeläinen ◽  
O. Lindfors
Keyword(s):  
Psychiatric Symptoms ◽  
Personal Characteristics ◽  
Severity Index ◽  
Therapist Characteristics ◽  
Work Experiences ◽  
Global Severity Index ◽  
Quasi Experimental ◽  
Pre Treatment

AbstractBackground:Whether long-term psychodynamic therapy (LPP) and psychoanalysis (PA) differ from each other and require different therapist qualities has been debated extensively, but rarely investigated empirically.Methods:In a quasi-experimental design, LPP was provided for 128 and PA for 41 outpatients, aged 20–46 years and suffering from mood or anxiety disorder, with a 5-year follow-up from start of treatment. Therapies were provided by 58 experienced therapists. Therapist characteristics, measured pre-treatment, were assessed with the Development of Psychotherapists Common Core Questionnaire (DPCCQ). General psychiatric symptoms were assessed as the main outcome measure at baseline and yearly after start of treatment with the Symptom Check List, Global Severity Index (SCL-90-GSI).Results:Professionally less affirming and personally more forceful and less aloof therapists predicted less symptoms in PA than in LPP at the end of the follow-up. A faster symptom reduction in LPP was predicted by a more moderate relational style and work experiences of both skillfulness and difficulties, indicating differences between PA and LPP in the therapy process.Conclusions:Results challenge the benefit of a classically “neutral” psychoanalyst in PA. They also indicate closer examinations of therapy processes within and between the two treatments, which may benefit training and supervision of therapists.

Long-term, Prospective, Multicenter Study of Isolated Bankart Repair for a Patient Selection Method Based on the Instability Severity Index Score

2019 ◽  
Vol 47 (5) ◽  
pp. 1057-1061 ◽  
Author(s):  
Hervé Thomazeau ◽  
Tristan Langlais ◽  
Alexandre Hardy ◽  
Jonathan Curado ◽  
Olivier Herisson ◽  
...  
Keyword(s):  
Recurrence Rate ◽  
Severity Index ◽  
Index Score ◽  
Bankart Repair ◽  
Prospective Multicenter Study ◽  
Severity Index Score ◽  
Bony Lesions ◽  
Long Term Recurrence Rate

Background: An isolated arthroscopic Bankart repair carries a high mid- and long-term risk of recurring instability. Preoperative patient selection based on the Instability Severity Index Score should improve outcomes. Purpose: To report the overall long-term recurrence rate for isolated Bankart repair, investigate the predictive factors for recurrence, analyze time to recurrence, and determine a quantitative cutoff point for recurrence in terms of Instability Severity Index Score. Study Design: Cohort study; Level of evidence, 2. Methods: This was a prospective multicenter study. Inclusion criteria were recurring anterior instability and an Instability Severity Index Score of 4 or less. Of the 125 patients included, 20 patients had a score of 0, 31 patients scored 1, 29 patients scored 2, 34 patients scored 3, and 11 patients scored 4. All centers used the same arthroscopic technique and rehabilitation protocol. Follow-up data were collected at 3, 6, 12, and 24 months and 3 and 9 years. The primary endpoint was recurrence of instability (total or partial dislocation). The statistical analysis was performed by use of the software package SAS 9.4. Results: We initially identified 328 patients, of whom 125 patients were prospectively included. The main reason for excluding the 202 patients was the presence of bony lesions, which carry 2 points each in the Instability Severity Index Score (humeral head notch and/or glenoid lesion visible on standard radiographs). Of the 125 eligible patients, 73% were athletes and 22.5% competitors; 16% were lost at the last follow-up. At the endpoint, 23% had experienced a recurrence after a mean interval of 35 months (range, 5.5-103 months). No statistical differences were found between patients with and without bony lesions in the overall group of 125 patients or in the subgroup with an Instability Severity Index Score of 3 or 4 points ( P = .4). According to univariate analysis, the only predictive factor for recurrence was age less than 20 years at the time of surgery, with a 42% rate of recurrence in this group ( P = .03). Multivariate analysis showed that the Instability Severity Index Score was the only predictive factor with a quantitative cutoff point (namely, a score of ≤2 points) that was statistically associated with a decreased long term recurrence rate ( P = .02). The recurrence rate was 10% for a preoperative Instability Severity Index Score of 2 or less compared with 35.6% for a score of 3 or 4. The survival curves demonstrated no new dislocations after year 4 for patients with an Instability Severity Index Score of up to 2 points. Conclusion: In a preselected population, mainly without bony lesions, the Instability Severity Index Score cutoff value that provides an acceptable recurrence rate at 9 years after isolated Bankart repair is 2 out of 10.

Attempt to Discontinue Imatinib Following Interferon Alfa Pre-Treatment In Chronic Phase CML Patients Achieving Stable Complete Cytogentic Responses (CCyR)

Blood ◽  
2010 ◽  
Vol 116 (21) ◽  
pp. 4898-4898
Author(s):  
Izhar Hardan ◽  
Yulia Volchek ◽  
Tali Tohami ◽  
Ninette Amariglio ◽  
Luba Trakhtenbrot ◽  
...  
Keyword(s):  
Conflicts Of Interest ◽  
Chronic Phase ◽  
Interferon Alfa ◽  
Cytotoxic T Cell ◽  
Molecular Response ◽  
Molecular Remission ◽  
Line Therapy ◽  
Pre Treatment

Abstract Abstract 4898 Imatinib (IM) has been shown to induce sustained clinical responses and stable remissions resulting in improved survival in chronic phase (CP) CML patients (pts.). Currently the state of the art is life long continuation of IM therapy which raises issues like the emergence of drug resistance, long-term safety and tolerability, compliance and costs. Interferon Alfa (IFNα), which has anti-CML activity and may induce major cytogenetic responses (MCyR), has in contrast to IM, immunoregulatory properties including the induction of anti-CML cytotoxic T-cell activity. Moreover, in initial studies of IM discontinuation it seemed that previous IFNα exposure was beneficial for the maintenance of molecular remission after IM cessation. We, therefore, hypothesized that adding IFNα to IM prior to IM discontinuation will increase the proportion of pts. remaining in continuous molecular response. We report on the long term, median follow up of 40 months (range, 33–41), outcome of CP CML pts. who discontinued IM after the addition of IFNα. CP CML pts. in CCyR for ≥2 years on IM were included. Study pts. received a combination of PegIFN (Pegasys, Roche) (180 μg/week, sc) and IM (400 mg) for 9 months followed by 3 months of PegIFN monotherapy, and were followed up thereafter without any anti leukemia therapy. Twelve CP CML pts. were included, 9 males and 3 females. Median age was 50.5 years (range, 33–67). Disease duration was 67 (18-96) months. Eight of the pts. (67%) received IFNα prior to IM as first line therapy. Eight of the patients had a major molecular response (MMR), 2 were in complete molecular response (CMR) (of 48 and 10 months duration) and 2 had less than a MMR. Of the evaluable pts. only 1 had a BCR ABL KD mutation (E373D). IFNα dose had to be reduce to 90–135 μg/week, sc due to intolerance in 10/12 pts. Median duration of CCyR (n=12) and MMR (n=8) at the time of IM discontinuation was 47.5 (21-86) months and 19.5 (9-84) months, respectively. Cytogenetic relapse occurred in 8 pts. 8 (2-38) months after IM discontinuation. Loss of molecular responses could be detected in all 8 pts. during follow up, and prior to the cytogenetic relapse at 8 (1-25) months post IM discontinuation. An additional 1 pt. had a molecular relapse but has maintained his CCyR 20 months post IM discontinuation. IM (400 mg/day) was reintroduced in all 8 pts. with loss of CCyR and they all re-achieved a CCyR 3.5 (3-7) months after IM re initiation. Five of the 8 pts. (62%) achieved also a MMR at 5, 7, 8, 10, and 11 months post IM re- administration, respectively. After a median follow up of 40 (range 33–41) months, 4 of the 12 study pts. (33.3%) are in persistent molecular remission. These 4 pts. achieved a CMR (n=1) (of 10 months duration) or MMR (n=3) (of 8, 14 and 19 months, respectively) prior to IM discontinuation. Notably, 2 of these 4 pts. had IFNα exposure as front line therapy pre-IM initiation. In summary, only a minority of CML pts. with stable MMR or CMR have a long lasting remission and will not relapse following IM discontinuation. Pts. having a cytogenetic relapse after IM discontinuation respond to IM re-administration by re-achieving CCyR and mostly MMR. The role of IFNα pre treatment, as well as the depth of molecular response needed to be achieved pre-IM discontinuation, should be further evaluated in a well designed 2 arms controlled randomized studies. Disclosures: No relevant conflicts of interest to declare.

High-dose imatinib mesylate treatment in patients (Pts) with untreated early chronic phase (CP) chronic myeloid leukemia (CML): 2.5-year follow-up

2006 ◽  
Vol 24 (18_suppl) ◽  
pp. 6535-6535 ◽  
Author(s):  
E. Aoki ◽  
H. Kantarjian ◽  
S. O’Brien ◽  
M. Talpaz ◽  
F. Giles ◽  
...  
Keyword(s):  
Standard Dose ◽  
Chronic Phase ◽  
High Dose ◽  
Hematologic Toxicity ◽  
Molecular Response ◽  
Molecular Responses ◽  
Pre Treatment ◽  
Grade 3

6535 Background: The standard dose (SD) of imatinib for CP CML is currently 400 mg daily, but higher doses (HD) may be more effective. We conducted 2 consecutive trials using HD imatinib (i.e., 400mg twice daily) in previously untreated early CP CML pts. This is an updated analysis of the longer follow-up. Methods: A total of 175 previously untreated pts received HD imatinib. We compared the results with a previous study using SD imatinib (400mg/day) in untreated pts with early CP CML (N=50). Results: Cytogenetic and molecular responses were evaluable in 222 pts (N=49 at SD, 173 at HD) and 217 pts (N=46 at SD, 171 at HD), respectively. In HD group, Sokal risk classification was good in 69%, intermediate in 29%, and poor in 11% of pts. There were no differences in pre-treatment characteristics between two groups. The median age was 48 years in both groups. Median follow-up is 53 months for SD and 30 months for HD group. Patients treated with HD had a higher rate of complete cytogenetic responses (90% vs 78% with SD, p=0.03) and these occurred earlier, with 69% achieving this response after 6 months of therapy vs 45% with SD (p=0.001). The cumulative incidence of major molecular response was significantly better in HD group (p=0.03), and this response was also observed earlier in HD group: at 12 months 54% in HD and 24% in SD group had achieved this response (p=0.001). At 24 months, 19/70 (27%) evaluable pts with HD versus 3/31 (10%) of pts in SD group achieved complete molecular remission. Four pts (2%) in HD group and 4 pts (8%) in SD group have progressed to advanced phases (p=0.05). There was a trend in favor of the HD group for transformation-free-survival but it was not statistically significant (p=0.07). Overall survival is excellent in both groups (24 month survival, 99% with HD vs 98% with SD; p=0.24). Grade 3 or 4 hematologic toxicity was more frequent in HD group whereas extramedullary toxicity was similar in two groups. The median actual dose in HD group was 800 mg at 12 months, with 39% patients requiring dose reduction at some point. Conclusions: High-dose imatinib provides higher rates of complete cytogenetic responses and earlier molecular responses with some increase myelosupression. The long-term benefit of earlier responses remains to be demonstrated. [Table: see text]

Antitumor activity of MDV3100 in pre- and post-docetaxel advanced prostate cancer: Long-term follow-up of a phase I/II study.

2011 ◽  
Vol 29 (7_suppl) ◽  
pp. 134-134 ◽  
Author(s):  
C. S. Higano ◽  
T. M. Beer ◽  
M. Taplin ◽  
E. Efstathiou ◽  
A. Anand ◽  
...  
Keyword(s):  
Prostate Cancer ◽  
Median Time ◽  
Radiographic Progression ◽  
Long Term Follow Up ◽  
Psa Progression ◽  
Previously Treated ◽  
Pre Treatment ◽  
Anti Tumor Activity

134 Background: MDV3100 is a novel androgen receptor (AR) antagonist selected for potent AR activity and devoid of partial agonist effects. A preliminary report of the phase I/II study described anti-tumor activity and adverse events (Scher HI et al. Lancet. 2010;375:1437). This abstract provides long-term follow-up on time to PSA and radiographic progression in this trial. Methods: Patients (pts) with progressive castration resistant prostate cancer (CRPC) were enrolled in sequential cohorts of 3-6 pts at MDV3100 doses of 30, 60, 150, 240, 360, 480 and 600 mg/day. Once the tolerability of a dose was established, enrollment was expanded at doses ≥60 mg/day to include approximately 12 chemotherapy naïve (naïve) pts and 12 pts previously treated with docetaxel (post-chemo) per cohort. Results: 140 pts were enrolled of which 18 (13%) pts continue on active treatment (16 naive and 2 post-chemo). The median time on treatment is 51 weeks for naïve and 17 weeks for post-chemo groups. Median time on treatment for the 18 patients still on study is 131 weeks. The median time to PSA progression, defined per-protocol as a ≥25% increase in PSA from baseline, was not met for naïve and was 33 weeks for post-chemo groups. Median time to PSA progression by Prostate Cancer Clinical Trials Working Group 2 criteria was 41 weeks for naïve and 20 weeks for post-chemo groups. Median time to radiographic progression was 56 weeks for naive and 24 weeks for post-chemo groups. Circulating tumor cell counts available for 128 of 140 pts showed 91% (70/77) with favorable pre-treatment counts (<5 cells/7.5 mL blood) remaining favorable post-treatment, while 49% (25/51) converted from unfavorable pre-treatment to favorable post-treatment. Conclusions: MDV3100 demonstrates durable anti-tumor activity in pts with CRPC both before and after chemotherapy. Based on these promising results MDV3100 is currently being evaluated in two global phase III studies in pts with metastatic CRPC, the AFFIRM study in pts previously treated with docetaxel and the PREVAIL study in chemotherapy-naïve pts who have progressed on androgen deprivation therapy. [Table: see text]

Ensuring head and neck oncology patients receive recommended pretreatment dental evaluations.

2014 ◽  
Vol 32 (30_suppl) ◽  
pp. 100-100
Author(s):  
Danielle Nina Margalit ◽  
Stephanie Losi ◽  
Roy B. Tishler ◽  
Jonathan Daniel Schoenfeld ◽  
JoAnn Fugazzotto ◽  
...  
Keyword(s):  
Head And Neck ◽  
Dental Care ◽  
Care Plan ◽  
Community Based ◽  
Pareto Chart ◽  
Care Plans ◽  
Primary Responsibility ◽  
Pre Treatment

100 Background: Pre-treatment dental evaluations are recommended for head and neck (H&N) cancer patients (pts) prior to radiation therapy (RT) to minimize the risk of acute and long-term side effects of treatment. We previously created a dental instructional guide (DIG) outlining the necessary components of the pre-radiation dental evaluation for pts undergoing community-based dental evaluation. Yet our program did not have a system for documenting which pts received the DIG. We aimed to create a system to ensure that pts are given the DIG early in their care-plan and that such pts are readily identifiable so we can follow-up and confirm that the recommended dental care is complete prior to starting RT. Methods: Chart review was performed to determine the percentage of eligible pts with documented provision of the DIG. A diagnostic survey of H&N oncology clinicians was analyzed with a Pareto chart to determine common barriers to DIG provision and documentation. Clinicians were surveyed on potential ways to document DIG provision to eligible pts. The Model for Improvement and DMAIC (Six Sigma) methodologies were used and multiple Plan-Do-Study-Act (PDSA) cycles were performed to implement the intervention and monitor change. Change data was analyzed using a P-chart, 3-sigma. Results: We used a process map to identify 3 potential care-plans within the H&N oncology program and assist in defining which providers had primary responsibility for providing the DIG. We then designed and implemented a template within the electronic medical record that documents the clinician who gave the DIG and the date it was given. There was an improvement in the rate of DIG documentation from a baseline of 0% (range 0-0%) to a mean of 40% (range 0-100%) over 3-months (p<0.01). This improvement was sustained through last follow-up at 5 months. Conclusions: Through a multidisciplinary approach, we implemented an intervention to identify pts undergoing community-based dental evaluation prior to RT for H&N cancer. Further efforts are focused on increasing the DIG documentation rate and increasing our interaction with community dentists to promote expeditious pre-radiation dental care.

Developing a cardiac monitoring plan in at-risk cancer survivors.

2017 ◽  
Vol 35 (5_suppl) ◽  
pp. 133-133
Author(s):  
Aubri Veneruso ◽  
Megan Rae Slocum ◽  
Sheetal Mehta Kircher ◽  
Nausheen Akhter ◽  
Gillian Murtagh ◽  
...  
Keyword(s):  
Cancer Survivors ◽  
Treatment Phase ◽  
Cardiac Risk ◽  
Treatment Setting ◽  
Cancer Therapies ◽  
Long Term Effects ◽  
Consensus Statements ◽  
Pre Treatment

133 Background: Improvements in early detection, screening, and treatment of cancer translate into survivors living longer, highlighting the need for guidelines to address the late and long-term effects of cancer treatment. A particularly concerning effect is Cancer Therapeutics-Related Cardiac Dysfunction (CTRCD). Cancer treatments can result in a range of cardiovascular toxicity including left ventricular dysfunction, heart failure and radiation-induced heart disease (RIHD). Various consensus statements related to cardiovascular care for adult cancer survivors exist; however there are no globally accepted follow-up guidelines. Our purpose is to create a protocol to stratify a survivor’s cardiac risk and provide a basis for follow-up recommendations. Methods: We first evaluated existing resources within our institution and identified key stakeholders who were recruited to form a multidisciplinary workgroup (2 survivorship advanced practice providers, an oncologist, a radiation oncologist, and 2 cardio-oncologists). We then reviewed current research and literature on cardiotoxic cancer therapies and identified two consensus statements from the American Society of Echocardiography and the European Association of Cardiovascular Imaging which helped inform our protocol. Finally, we created a cardiac assessment that could be applied in the pre-treatment phase and extend into the post-treatment phase. Results: Two assessment tools were developed. The first is an algorithm initiated in the pre-treatment setting by an oncologist when a Type I or Type II cardiotoxic agent is planned. The second is a risk assessment tool that is initiated in the post-treatment setting to stratify cardiac risk and provide follow-up recommendations. Conclusions: Development of standardized guidelines for assessment and treatment of late and long-term effects of treatment is critical. This protocol has been developed to account for the many factors that contribute to overall cardiac risk after various anti-cancer therapies. Further data is needed to evaluate long-term cardiac and survival outcomes based on this protocol.

scholarly journals Subconjunctival Bevacizumab as an Adjunct to 5-Fluorouracil Enhanced Trabeculectomy: 1 Year Outcomes

2021 ◽  
Vol 37 (3) ◽  
Author(s):  
Sana Nadeem
Keyword(s):  
Intraocular Pressure ◽  
Primary Open Angle Glaucoma ◽  
Open Angle Glaucoma ◽  
Exclusion Criteria ◽  
Quasi Experimental ◽  
Added Benefit ◽  
Bleb Formation ◽  
The Mean

Purpose:  To compare the results of trabeculectomy with subconjunctival Bevacizumab and 5-Fluorouracil (5-FU); with trabeculectomy with 5-FU alone; in terms of intraocular pressure (IOP) lowering, bleb formation, and complications, in the long term. Study Design:  Quasi experimental study. Place and Duration of Study:  Fauji Foundation Hospital, Rawalpindi, from December 2013 to August, 2019. Methods:  A total of 30 eyes (15 in each group) with glaucoma were recruited. Exclusion criteria were previous trabeculectomy, congenital, traumatic, uveitic, neovascular glaucomas, aphakia, or ocular surface disease. Trabeculectomy with 5FU was performed in both groups. In one group, subconjunctival Bevacizumab was injected into the bleb at the end of surgery. The patients were observed for IOP control, bleb configuration, and complications for 1 year. Results:  Primary open angle glaucoma was the predominant diagnosis in 17 (56.7%) eyes. The mean pre-operative IOP in the 5-FU group was 30.8 ± 17.03 mmHg, & in the 5-FU+Bevacizumab group it was 28.9 ± 18.9 mmHg. The mean IOPs of the 5-FU group at 1 Year was 14.5 ± 5.04 mmHg. In 5-FU+Bevacizumab group, mean IOPs at 1 year was 12.7 ± 4.38 mmHg. The differences between pre-operative and post-operative IOPs in both groups at 6, 9 and 12 months were statistically significant. However, differences in mean IOPs between the two groups, bleb morphology and complications were not statistically significant. Conclusion:  No added benefit of subconjunctival Bevacizumab used as an adjunct to 5-FU enhanced trabeculectomy was found at the end of 1 year follow-up. Key Words:  Trabeculectomy, 5-Fluorouracil, Bevacizumab, Glaucoma, Intraocular pressure.

scholarly journals Ketamine in the treatment of cocaine use disorders

2021 ◽  
Vol 43 ◽  
pp. e22-44077
Author(s):  
Ronaldo Cascelli Schelb Scalla Pereira ◽  
Emanuelle Emília Ferreira Parreiras ◽  
Davi Cascelli Schelb Scalla Pereira ◽  
João Eduardo Schelb Scalla Pere Cascelli ◽  
Thaila Vidal de Oliveira ◽  
...  
Keyword(s):  
Mental Health ◽  
Health Status ◽  
Psychiatric Symptoms ◽  
Severity Index ◽  
Slight Reduction ◽  
Single Administration ◽  
Global Severity Index ◽  
Stimulant Use ◽  
Before And After ◽  
Motivation For Change

Introduction: ketamine is a dissociative anesthetic and, recently, its antidepressant properties has been described. Besides, its safety has been proven in the treatment of Stimulant Use Disorders. Objective: to evaluate the use of ketamine in the treatment of Stimulant Use Disorders (specially cocaine and its byproducts). Methods: patient's motivation for change was measured by URICA scale and psychiatric symptoms by EAS-40 score, both before and after the intervention. Results: it was verified, after the comparison between the Readiness Score means, an increase in the motivation for change after ketamine’s single administration, when compared to the moments before and after the intervention. Analyzing the Global Severity Index before and after ketamine administration, by EAS-40 score, we noticed a slight reduction of the psychiatric symptoms before and after the intervention. Conclusion: it was proven that ketamine's single administration led to a quick and lasting improvement on the user's motivation without worsening the mental health status.

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