The atmosphere of treatment delivery.

Abstract Background This study examined the experiences of young people and their parents who attended an intensive day treatment programme for eating disorders online during the global COVID-19 pandemic. Methods Online questionnaires were completed by 14 adolescents (12–18 years) and their parents (n = 19). The questionnaires included a mixture of rating questions (Likert scale) and free text responses. Free text responses were analysed using reflexive thematic analysis. Results Three main themes were identified: 1) New discoveries, 2) Lost in translation and 3) The best of a bad situation. This study provides insight into the benefits and pitfalls of online treatment delivery in the adolescent day programme context, which has rapidly had to become part of the everyday therapeutic practice. Results indicate that there are advantages and disadvantages to this, and that parents and young people’s views differed. Conclusions This study suggests that the increased accessibility provided by online working does not necessarily translate to increased connection. Given the importance of therapeutic alliance in treatment outcomes, this will be an important consideration for future developments of online intensive treatments.

Download Full-text

Treatment barriers, preferences and histories of individuals with symptoms of body dysmorphic disorder

Behavioural and Cognitive Psychotherapy ◽

10.1017/s1352465820000843 ◽

2020 ◽

pp. 1-14

Author(s):

Jessica McCausland ◽

Josephine Paparo ◽

Bethany M. Wootton

Keyword(s):

Mental Health ◽

Best Practice ◽

Body Dysmorphic Disorder ◽

Psychological Treatment ◽

Behavioural Therapy ◽

Cross Sectional Study ◽

Treatment Barriers ◽

Treatment Access ◽

Cross Sectional ◽

Treatment Delivery

Abstract Background: Individuals with mental health concerns face many barriers when accessing psychological treatment. Even when patients overcome these barriers, they often do not receive an evidence-based treatment. Although the current literature highlights these issues clearly across psychological disorders, the research is limited in relation to body dysmorphic disorder (BDD). Aim: The aim of this study was to examine psychological treatment barriers, treatment delivery preferences and treatment histories of individuals with symptoms of BDD. Method: A total of 122 participants with clinically significant BDD symptoms (94% female; mean age = 34.19 years, SD = 10.86) completed the cross-sectional study. Results: The most frequently reported barriers to accessing psychological treatment for individuals with BDD symptoms were the cost of treatment (41%) and the belief that the symptoms did not warrant treatment (36%). Although 69% of treatment-seeking participants reported previously receiving cognitive behavioural therapy (CBT) for BDD, only 13% of participants appeared to receive best-practice CBT. The preferred modality of future psychological treatment delivery was face-to-face treatment with a therapist once a week (63%), rather than accelerated or remote treatment approaches. Conclusions: The study suggests that there are significant barriers to accessing CBT for BDD. Reducing these barriers, as well as increasing consumer mental health literacy, is required to improve treatment access and treatment outcomes for individuals with BDD.

Download Full-text

Impact of COVID-19 on workload burden of a complex radiotherapy facility

La radiologia medica ◽

10.1007/s11547-021-01338-8 ◽

2021 ◽

Vol 126 (5) ◽

pp. 717-721

Author(s):

Giulio Francolini ◽

Isacco Desideri ◽

Giulia Stocchi ◽

Lucia Pia Ciccone ◽

Viola Salvestrini ◽

...

Keyword(s):

Disease Transmission ◽

Daily Activity ◽

Preventive Measures ◽

Health Workers ◽

Treatment Delivery ◽

Actual Time ◽

Italian Government ◽

Significant Difference ◽

The Impact ◽

Observation Period

Abstract Background and purpose COVID-19 constitutes a worldwide threat, prompting Italian Government to implement specific measures on March 8, 2020, to protect patients and health workers from disease transmission. The impact of preventive measures on daily activity of a radiotherapy facility may hamper the ability to fulfill normal workload burden. Thus, we assessed the number of delivered treatments in a specific observation period after the adoption of preventive measures (since March 11 to April 24, 2020) and compared it with the corresponding period of the year 2019. Materials and methods Overall number of delivered fractions was related to actual time of platform daily activity and reported as a ratio between number of delivered fractions and activity hours (Fr/Hrs). Fr/Hrs were calculated and compared for two different periods of time, March 11–April 24, 2019 (Fr/Hrs1), and March 11–April 24, 2020 (Fr/Hrs2). Results Fr/Hrs1 and Fr/Hrs2 were 2.66 and 2.54 for year 2019 and 2020, respectively, for a Fr/Hrsratio of 1.07 (95% CI 1.03–1.12, p = 0.0005). Fr/Hrs1 was significantly higher than Fr/Hrs2 for SliR and PreciseR, with Fr/Hrsratio of 1.92 (95% CI 1.66–2.23, p < 0.0001) and 1.11 (95% CI 1.03–1.2, p = 0.003), respectively. No significant difference was reported for SynergyR and CyberknifeR with Fr/Hrsratio of 0.99 (95% CI 0.91–1.08, p = 0.8) and 0.9 (95% CI 0.77–1.06, p = 0.2), respectively. Fr/Hrs1 was significantly lower than Fr/Hrs2 for TomotherapyR, with Fr/Hrsratio of 0.88 (95% CI 0.8–0.96, p = 0.007). Conclusion Preventive measures did not influence workload burden performed. Automation in treatment delivery seems to compensate effectively for health workers number reduction.

Download Full-text

Dosimetric comparison of MR-linac-based IMRT and conventional VMAT treatment plans for prostate cancer

Radiation Oncology ◽

10.1186/s13014-021-01858-7 ◽

2021 ◽

Vol 16 (1) ◽

Author(s):

Vanessa Da Silva Mendes ◽

Lukas Nierer ◽

Minglun Li ◽

Stefanie Corradini ◽

Michael Reiner ◽

...

Keyword(s):

Prostate Cancer ◽

Target Volume ◽

Planning System ◽

Treatment Planning System ◽

Target Coverage ◽

Treatment Delivery ◽

Ptv Margin ◽

Delivery Times ◽

Low Field ◽

Treatment Plans

Abstract Background The aim of this study was to evaluate and compare the performance of intensity modulated radiation therapy (IMRT) plans, planned for low-field strength magnetic resonance (MR) guided linear accelerator (linac) delivery (labelled IMRT MRL plans), and clinical conventional volumetric modulated arc therapy (VMAT) plans, for the treatment of prostate cancer (PCa). Both plans used the original planning target volume (PTV) margins. Additionally, the potential dosimetric benefits of MR-guidance were estimated, by creating IMRT MRL plans using smaller PTV margins. Materials and methods 20 PCa patients previously treated with conventional VMAT were considered. For each patient, two different IMRT MRL plans using the low-field MR-linac treatment planning system were created: one with original (orig.) PTV margins and the other with reduced (red.) PTV margins. Dose indices related to target coverage, as well as dose-volume histogram (DVH) parameters for the target and organs at risk (OAR) were compared. Additionally, the estimated treatment delivery times and the number of monitor units (MU) of each plan were evaluated. Results The dose distribution in the high dose region and the target volume DVH parameters (D98%, D50%, D2% and V95%) were similar for all three types of treatment plans, with deviations below 1% in most cases. Both IMRT MRL plans (orig. and red. PTV margins) showed similar homogeneity indices (HI), however worse values for the conformity index (CI) were also found when compared to VMAT. The IMRT MRL plans showed similar OAR sparing when the orig. PTV margins were used but a significantly better sparing was feasible when red. PTV margins were applied. Higher number of MU and longer predicted treatment delivery times were seen for both IMRT MRL plans. Conclusions A comparable plan quality between VMAT and IMRT MRL plans was achieved, when applying the same PTV margin. However, online MR-guided adaptive radiotherapy allows for a reduction of PTV margins. With a red. PTV margin, better sparing of the surrounding tissues can be achieved, while maintaining adequate target coverage. Nonetheless, longer treatment delivery times, characteristic for the IMRT technique, have to be expected.

Download Full-text

PH-0362: Beam modeling variations and potential contributions to treatment delivery errors

Radiotherapy and Oncology ◽

10.1016/s0167-8140(21)00386-8 ◽

2020 ◽

Vol 152 ◽

pp. S194

Author(s):

M. Glenn ◽

D. Followill ◽

R. Howell ◽

J. Pollard-Larkin ◽

C. Peterson ◽

...

Keyword(s):

Treatment Delivery ◽

Beam Modeling

Download Full-text

Pilot evaluation of a group stabilisation intervention for refugees and asylum seekers with PTSD

Behavioural and Cognitive Psychotherapy ◽

10.1017/s135246582100028x ◽

2021 ◽

pp. 1-6

Author(s):

Mary Griggs ◽

Cheng Liu ◽

Kate Cooper

Keyword(s):

Repeated Measures ◽

Asylum Seekers ◽

Preliminary Evidence ◽

Behavioural Therapy ◽

Post Traumatic Stress ◽

Group Setting ◽

Post Intervention ◽

Treatment Delivery ◽

Cognitive Behavioural ◽

The Uk

Abstract Background: Post-traumatic stress disorder (PTSD) is commonly experienced by asylum seekers and refugees (ASR). Evidence supports the use of cognitive behavioural therapy-based treatments, but not in group format for this population. However, group-based treatments are frequently used as a first-line intervention in the UK. Aims: This study investigated the feasibility of delivering a group-based, manualised stabilisation course specifically developed for ASR. The second aim was to evaluate the use of routine outcome measures (ROMs) to capture psychological change in this population. Method: Eighty-two participants from 22 countries attended the 8-session Moving On After Trauma (MOAT) group-based stabilisation treatment. PHQ-9, GAD-7, IES-R and idiosyncratic outcomes were administered pre- and post-intervention. Results: Seventy-one per cent of participants (n = 58) attended five or more of the treatment sessions. While completion rates of the ROMs were poor – measures were completed at pre- and post-intervention for 46% participants (n = 38) – a repeated-measures MANOVA indicated significant improvements in depression (p = .001, ηp2 = .262), anxiety (p = .000, ηp2 = .390), PTSD (p = .001, ηp2 = .393) and idiosyncratic measures (p = .000, ηp2 = .593) following the intervention. Conclusions: Preliminary evidence indicates that ASR who attended a low-intensity, group-based stabilisation group for PTSD experienced lower mental health scores post-group, although the lack of a comparison group means these results should be interpreted with caution. There are significant challenges in administering ROMs to individuals who speak many different languages, in a group setting. Nonetheless, groups have benefits including efficiency of treatment delivery which should also be considered.

Download Full-text

Monitoring, implementation and reporting of interventions in a selection of trials assessing exercise therapy for the management of shoulder subacromial pain: a cross-sectional investigation

BMJ Open ◽

10.1136/bmjopen-2020-044462 ◽

2021 ◽

Vol 11 (2) ◽

pp. e044462

Author(s):

Daniel C Ribeiro ◽

Kate Spiers ◽

Laura Thomas ◽

Kiriffi Leilua ◽

Matthew Wilkes ◽

...

Keyword(s):

Manual Therapy ◽

Exercise Intervention ◽

Cochrane Review ◽

Health Behavior Change ◽

Cross Sectional ◽

Treatment Delivery ◽

Lack Of Information ◽

Intervention Trials ◽

Intervention Description ◽

Selection Of

ObjectivesTo review the reporting of monitoring and implementation of interventions in a selection of trials that assessed the effectiveness of manual therapy and exercise in the management of shoulder subacromial pain.DesignA review of trials assessing the effectiveness of manual therapy and exercise in the management of patients with shoulder subacromial pain.MethodsWe included in our review a selection of 10 trials that were included in a Cochrane review and compared manual therapy and exercise intervention with another intervention. Trials were assessed independently by two reviewers using two checklists: the Template for Intervention Description and Replication (TIDieR) and the Health Behavior Change Consortium treatment fidelity (National Institutes of Health Behaviour Change Consortium/NIHBCC).ResultsTIDieR overall scores for individual trials ranged from 11.1% to 45% and fidelity scores ranged from 7% to 50%. On average, trials scored the following within each domain of NIHBCC: study design 51%; training of providers 8%; treatment delivery 15%; treatment receipt 14% and treatment enactment 2.5%.ConclusionsLittle information about the monitoring, implementation and reporting of interventions was provided by trials and that is a barrier for implementing or replicating these interventions. The lack of information regarding the implementation of interventions needs to be taken into account when assessing whether effectiveness of interventions was impacted by their design or due to deviations from the protocol within trials.

Download Full-text

Using virtual reality to treat aggressive behavior problems in children: A feasibility study

Clinical Child Psychology and Psychiatry ◽

10.1177/13591045211026160 ◽

2021 ◽

pp. 135910452110261

Author(s):

Sophie C Alsem ◽

Anouk van Dijk ◽

Esmée E Verhulp ◽

Bram O De Castro

Keyword(s):

Virtual Reality ◽

Behavior Problems ◽

Aggressive Behavior ◽

Feasibility Study ◽

Treatment Method ◽

Parent Report ◽

Treatment Delivery ◽

Behavioral Therapies ◽

Technical Issues ◽

Practice Time

Evidence-based cognitive behavioral therapies (CBTs) for children with aggressive behavior problems have only modest effects. Research is needed into new methods to enhance CBT effectiveness. The aims of the present study were to (1) examine whether interactive virtual reality is a feasible treatment method for children with aggressive behavior problems; (2) investigate children’s appreciation of the method; and (3) explore whether children’s aggression decreased during the ten-session treatment. Six boys (8–12 years) participated at two clinical centers in the Netherlands. Newly developed weekly reports were collected on treatment feasibility (therapist-report), treatment appreciation (child report), and children’s aggression (child/parent report). Results supported treatment feasibility: therapists delivered on average 98% of the session content, provided more than the recommended practice time in virtual reality, experienced few technical issues, and were satisfied with their treatment delivery. Children highly appreciated the treatment. Parents reported decreases in children’s aggression over the treatment period (i.e., between week 1 and week 10), but children did not. The promising findings of this feasibility study warrant randomized controlled trials to determine whether interactive virtual reality enhances CBT effectiveness for children with aggressive behavior problems.

Download Full-text