An International Survey of the Concept of Effective Psychodynamic Treatment During the Pandemic

2021 ◽  
Vol 49 (3) ◽  
pp. 453-462
Author(s):  
Robert M. Gordon ◽  
Zhenyu Shi ◽  
David E. Scharff ◽  
Ralph E. Fishkin ◽  
R. Dennis Shelby
Keyword(s):  
Treatment Effectiveness ◽  
Patient Factors ◽  
High Functioning ◽  
Psychodynamic Treatment ◽  
Level Of Functioning ◽  
Therapist Factors ◽  
Patient Variables ◽  
Survey Responses ◽  
Treatment Use ◽  
Cultural Similarity

Introduction: Most psychotherapists had no choice during the COVID-19 pandemic but to offer teletherapy in order to provide needed treatment. Several psychoanalytic theorists wondered if the very concept of treatment would change without an embodied relationship in an office setting. Methods: To attempt to understand the current concept of effective psychodynamic treatment in the new norm of teletherapy, we surveyed practitioners from 56 countries and regions who remotely treated patients psychodynamically during the beginning months of the pandemic. We asked the practitioners to rank six factors felt to be important to psychodynamic treatment: use of the couch during sessions, session in-office or via teletherapy, cultural similarity between therapist and patient, number of sessions a week, patient factors (motivation, insightfulness, and high functioning) and therapist factors (empathy, warmth, wisdom, and skillfulness). Results: We received 1,490 survey responses. As predicted, we found that the therapist and patient variables were considered much more important (both tied as highest rankings) to effective treatment than any of the other variables, including if the therapy was in-office or by teletherapy. Discussion: Psychodynamic practitioners worldwide confirmed that the empathy, warmth, wisdom, and skillfulness of the therapist and the motivation, insightfulness, and level of functioning of the patient are most important to treatment effectiveness regardless if the treatment is remote or embodied.

scholarly journals Peer Perceptions of Students With Autism Spectrum Disorders

2018 ◽  
Vol 34 (3) ◽  
pp. 183-192 ◽  
Author(s):  
Whitney B. Griffin
Keyword(s):  
Behavioral Intentions ◽  
Autism Spectrum ◽  
Essential Elements ◽  
Typically Developing ◽  
High Functioning ◽  
Level Of Functioning ◽  
Perceptions Of Students ◽  
Quasi Experimental ◽  
Students With Autism ◽  
Spectrum Disorders

This quasi-experimental study investigated behavioral intentions of 70 middle school participants toward engaging in activities with a student displaying characteristics of autism spectrum disorder (ASD) in a video vignette. Three video conditions were investigated: moderate to severe ASD, high-functioning ASD, and a typically developing control. Results of an analysis of variance indicated that participants reported significantly higher behavioral intentions toward the typically developing student and the student displaying more severe ASD symptomatology as compared to the student depicting high-functioning ASD. Participants were also able to differentially rate the behaviors they observed across the three conditions. These findings suggest that peers are capable of distinguishing among different behaviors typically displayed by students with ASD but may be less willing to socially engage with a student with mild or subtler characteristics. Implications regarding essential elements of interventions for peers based on the target student’s level of functioning are discussed.

scholarly journals Nursing-Home Patient Functional and Microbiota Status Drive Environmental Contamination with Vancomycin-Resistant Enterococci

2021 ◽  
Vol 1 (S1) ◽  
pp. s68-s68
Author(s):  
Joyce Wang ◽  
Betsy Foxman ◽  
A. Krishna Rao ◽  
Lona Mody ◽  
Evan Snitkin
Keyword(s):  
Nursing Homes ◽  
Gut Microbiota ◽  
Functional Status ◽  
Environmental Contamination ◽  
Functional Dependence ◽  
Patient Factors ◽  
High Functioning ◽  
Vancomycin Resistant Enterococci ◽  
Environmental Surfaces ◽  
Vancomycin Resistant

Background: Patient colonization and shedding of vancomycin-resistant enterococci (VRE) is a major source of environmental contamination leading to VRE transmission in nursing homes. We hypothesize that we can inform mitigation strategies by identifying patient clinical and microbiota features associated with environmental contamination with VRE. Methods: During a 6-month period of active surveillance in 6 Michigan nursing homes, 245 patients (with 806 follow-up visits) were enrolled. Patient clinical data and swabs for VRE were collected from multiple body sites and high-touch environmental surfaces. In total, 316 perirectal swabs were collected from 137 patients for gut microbiota analysis and community status type (CST) assignment based on taxonomic composition. The associations between VRE colonization pattern, gut microbial CST, and patient factors were examined using multivariable generalized estimating equations, adjusting for patient-and facility-level clustering. We used VRE colonization patterns to group study visits: “uncolonized” (patient−/environment−); “environment-only” (patient−/environment+); “patient-only” (patient+/environment−); “both” (patient+/environment+). Results: Across all study visits, VRE colonization on patient hand and groin/perirectal area was positively correlated with VRE contamination of high-touch environmental surfaces, suggesting direct transfer of VRE between patient and environment via patient hands (Figure 1A). We next set out to identify patient factors associated with patient colonization and environmental contamination. At baseline, while patients in the “both” group had anticipated risk factors such as longer prior hospitalization and more frequent broad-spectrum antibiotic use, they were unexpectedly younger than “uncolonized” patients and had similar functional status. This last feature contrasted with the “patient-only” group, characterized by higher urinary catheter use and higher functional dependence, suggestive of lower functional dependence facilitating patient contamination of their environment. No clinical features distinguished “uncolonized” and “environment-only” patients (Table 1). Lastly, in multivariable analyses, we determined the contribution of patient functional status and gut microbiota features to environmental contamination. Low-diversity CST, characterized by reduced anaerobic taxa, was weakly associated with “patient-only” and significantly associated with “both.” Notably, high functional dependence was significantly associated with “environment-only” and “patient-only” but not “both,” indicating high-functioning patients with disrupted gut microbiota as drivers of environmental contamination (Figure 1B). Conclusions: Our findings suggest that antimicrobial exposure disrupts patient gut microbiota, a significant mediator of colonization dynamics between patients and their environment, and that high-functioning patients may be more likely to spread VRE between their body sites and high-touch environmental surfaces (Figure 2). These findings highlight both antibiotic stewardship and patient hand hygiene as important targets for interrupting transmission mediated by environmental contamination.Funding: NoDisclosures: None

scholarly journals Time Trends and Local Variation in Primary Treatment of Localized Prostate Cancer

2010 ◽  
Vol 28 (7) ◽  
pp. 1117-1123 ◽  
Author(s):  
Matthew R. Cooperberg ◽  
Jeanette M. Broering ◽  
Peter R. Carroll
Keyword(s):  
Prostate Cancer ◽  
Cancer Risk ◽  
Prostate Cancer Risk ◽  
Primary Treatment ◽  
Localized Prostate Cancer ◽  
Substantial Variation ◽  
Patient Factors ◽  
Cancer Of The Prostate ◽  
Treatment Use ◽  
Over Time

Purpose In the absence of high-level evidence or clinical guidelines supporting any given active treatment approach over another for localized prostate cancer, clinician and patient preferences may lead to substantial variation in treatment use. Methods Data were analyzed from 36 clinical sites that contributed data to the Cancer of the Prostate Strategic Urologic Research Endeavor (CaPSURE) registry. Distribution of primary treatment use was measured over time. Prostate cancer risk was assessed using the D'Amico risk groups and the Cancer of the Prostate Risk Assessment (CAPRA) score. Descriptive analyses were performed, and a hierarchical model was constructed that controlled for year of diagnosis, cancer risk variables, and other patient factors to estimate the proportion of variation in primary treatment selection explicable by practice site. Results Among 11,892 men analyzed, 6.8% elected surveillance, 49.9% prostatectomy, 11.6% external-beam radiation, 13.3% brachytherapy, 4.0% cryoablation, and 14.4% androgen deprivation monotherapy. Prostate cancer risk drives treatment selection, but the data suggest both overtreatment of low-risk disease and undertreatment of high-risk disease. The former trend appears to be improving over time, while the latter is worsening. Treatment varies with age, comorbidity, and socioeconomic status. However, treatment patterns vary markedly across clinical sites, and this variation is not explained by case-mix variability or known patient factors. Practice site explains a proportion of this variation ranging from 13% for androgen deprivation monotherapy to 74% for cryoablation. Conclusion Substantial variation exists in management of localized prostate cancer that is not explained by measurable factors. A critical need exists for high-quality comparative effectiveness research in localized prostate cancer to help guide treatment decision making.

Clarity and contradictions: speech and language therapists' insights regarding thickened liquids for post-stroke aspiration

2020 ◽  
Vol 27 (6) ◽  
pp. 1-15
Author(s):  
Arlene McCurtin ◽  
Ronan Brady ◽  
Katherine Coffey ◽  
Anne O'Connor
Keyword(s):  
Clinical Decision Making ◽  
Treatment Effectiveness ◽  
Oropharyngeal Dysphagia ◽  
Empirical Support ◽  
Clinical Decision ◽  
Thickened Liquids ◽  
Speech And Language ◽  
Post Stroke ◽  
Treatment Use ◽  
Safety First

Background/Aims Oropharyngeal dysphagia is a common condition following stroke, with adverse consequences including aspiration pneumonia. Internationally, aspiration risk is typically managed using thickened liquids, an intervention with limited empirical support and associated treatment adherence issues. This study explores speech and language therapists' perceptions of and reasons for employing this intervention. Methods A total of 22 speech and language therapists working with people with dysphagia post-stroke in hospital settings participated in three focus groups. Participants were recruited through gatekeeper managers and data were analysed using inductive thematic analysis. Results Three themes were identified: primary justifications for treatment use, acute implementation issues, and having doubts. Use of thickened liquids is pivoted on safety-first reasoning, employed as a first step on the treatment ladder and in the context of limited perceived alternatives. Both clarity and contradictions are revealed by therapists, who acknowledge multiple factors that impact treatment effectiveness, including hospital, patient and product issues. Conclusions The findings from this study provide a basis for understanding clinical decision making for a widely-used gateway treatment that requires further empirical support. The data suggest that, similar to other professions, safety-first reasoning is paramount for speech and language therapists. The dominance of thickened liquids in treating aspiration is reflected internationally and warrants ongoing discussion.

scholarly journals The influence of patient variables on polypharmacy and combined high dose of antipsychotic drugs prescribed for in-patients

2002 ◽  
Vol 26 (11) ◽  
pp. 411-414 ◽  
Author(s):  
Paul Lelliott ◽  
Carol Paton ◽  
Maria Harrington ◽  
Maria Konsolaki ◽  
Tom Sensky ◽  
...  
Keyword(s):  
Mental Health ◽  
Antipsychotic Medication ◽  
Antipsychotic Drugs ◽  
Clinical Implications ◽  
High Dose ◽  
Patient Factors ◽  
Younger Age ◽  
Patient Variables ◽  
Unexplained Variance ◽  
High Doses

Aims and MethodA1-day census, involving 3576 psychiatric in-patients prescribed antipsychotic medication, was conducted as a prelude to a multi-centre audit. The aim was to explore the extent to which a number of patient variables explain antipsychotic polypharmacy and the use of high doses of these drugs.ResultsPrescriptions of more than one type of antipsychotic drug were made for 50.5% of patients. Patient factors that influenced the probability of polypharmacy were: younger age, being male, detained under the Mental Health Act and on a rehabilitation or forensic ward, and a diagnosis of schizophrenia. The effect of ethnicity was not significant. Polypharmacy was the most powerful factor influencing the probability of being prescribed a high dose. Identified patient variables accounted for only 18% of the variance in dose prescribed.Clinical ImplicationsThe patient and clinician factors that account for the unexplained variance need to be identified.

Differences In Perceptions Of Disease and Treatment Effectiveness and Adherence Between Physicians and Patients With Myelodysplastic Syndromes (MDS)

Blood ◽  
2013 ◽  
Vol 122 (21) ◽  
pp. 724-724
Author(s):  
David P. Steensma ◽  
Richard M. Stone ◽  
John Huber ◽  
Betsy Dennison ◽  
Mikkael A. Sekeres
Keyword(s):  
Treatment Effectiveness ◽  
Conflicts Of Interest ◽  
Healthcare Providers ◽  
Community Setting ◽  
Repeated Administration ◽  
Refractory Anemia ◽  
Cell Transplant ◽  
Us States ◽  
Survey Responses ◽  
The Impact

Abstract Background and Methods MDS are complex conditions, described with sometimes confusing terminology (e.g., “refractory anemia”), and contemporary drug therapies (tx) for MDS require repeated administration cycles to achieve clinical effect. Lack of disease understanding or premature tx discontinuation may result in poorer outcomes for patients (pts). To better understand physician (MD) and pt perceptions about MDS and tx decisions, we conducted two online surveys: one for pts with MDS and one for healthcare providers (HCP) registered with the non-profit Aplastic Anemia & MDS International Foundation. The protocol and consent were approved by a central Institutional Review Board. Pt and HCP surveys consisted of 57 and 49 questions, respectively, and assessed understanding of MDS, perceptions of specific tx, barriers to tx adherence, and overall tx experience. Data were analyzed using proportions, means, and medians; groups were compared using a Chi-squared test. Results Of 4,039 pts invited to participate via e-mail, 477 (12%) complete responses were received from 42 US States. Of responders, 247 (52%) were men; 63% were ≥age 60; pts were diagnosed with MDS a median of 5 years prior to the survey (range, 0-32 years). Of 4,594 HCPs invited to participate, 120 (3%) complete responses were received. Due to low participation among other HCP groups, only MD responses were examined. Of the 61 MDs (from 23 US states), 35 (57%) practice in an academic setting and 26 (43%) in the community setting. Survey responses from self-designated academic and community MDs did not differ significantly. Among MDs, 48% reported they see 5-19 new MDS pts per year. Only 10% of pts reported MDS was described to them as “cancer”, compared to how 59% of MDs stated they described it (p<.001). Only 29% of pts reported that MDS is “curable”, compared to 52% of MDs (p<.001). Forty-two percent of pts had received at least one disease-modifying tx: azacitidine (AZA, 58%), decitabine (DAC, 27%), lenalidomide (LEN, 35%) or hematopoetic stem cell transplant (HSCT, 26%) (total >100% due to multiple answers). MD and pt perceptions of active tx were significantly different, with MDs overestimating quality of life (QOL) benefits and underestimating the burden of tx on pt activities. [Table 1] MDs interpreted the benefit of active tx significantly higher than pts, however pts perceived the actual tx experience more positively than MDs. [Table 2] Most pts (81%) reported that MDs had the most influence on their tx decisions. Sixty-nine percent of MDs reported recommending stopping tx prior to the completion of tx regimen. Reported reasons diverged between pts and MDs, including burden of tx exceeding the benefit to the pt, as well as perceptions that the impact on the pt and family was too great. [Table 3] Conclusion Physicians and pts with MDS have distinct views of the value of tx for MDS, with MDs underestimating the impact of tx on pt QOL while overestimating it as justification for stopping tx. Improved communication may improve understanding of disease and impact of active treatment and achieve better tx adeherence and responses. Disclosures: No relevant conflicts of interest to declare.

Social Communication and Structural Language of Girls With High-Functioning Autism Spectrum Disorder

2020 ◽  
Vol 51 (4) ◽  
pp. 1139-1155
Author(s):  
Jenny M. Burton ◽  
Nancy A. Creaghead ◽  
Noah Silbert ◽  
Allison Breit-Smith ◽  
Amie W. Duncan ◽  
...  
Keyword(s):  
Autism Spectrum Disorder ◽  
Adaptive Behavior ◽  
Social Communication ◽  
High Functioning Autism ◽  
Autism Spectrum ◽  
Vineland Adaptive Behavior Scales ◽  
High Functioning ◽  
Expressive Communication ◽  
Vineland Adaptive Behavior ◽  
Structural Language

Purpose The purpose of this study was to characterize social communication and structural language of school-age girls with high-functioning autism spectrum disorder (HF-ASD) compared to a matched group of girls who are typically developing (TD). Method Participants were 37 girls between 7;5 and 15;2 (years;months)—18 HF-ASD and 19 TD. Children completed the Test of Pragmatic Language–Second Edition (TOPL-2) and Clinical Evaluation of Language Fundamentals–Fifth Edition. Parents completed the Children's Communication Checklist–2 United States Edition (CCC-2) and Receptive and Expressive Communication subdomains of the Vineland Adaptive Behavior Scales–Second Edition. Results In the area of social communication, girls with HF-ASD earned significantly lower scores and were more often classified as having an impairment on the TOPL-2 and the CCC-2. However, 28% and 33% earned average scores on the TOPL-2 and the CCC-2, respectively. In the area of structural language, no significant differences were found between groups on Clinical Evaluation of Language Fundamentals–Fifth Edition indexes. In contrast, girls with HF-ASD earned significantly lower scores and were more often classified as having an impairment on the Vineland Adaptive Behavior Scales–Second Edition. Sixty-one percent and 83% scored below average on the Receptive and Expressive Communication subdomains, respectively. Conclusions It has been argued that girls with HF-ASD, when compared to boys with HF-ASD, may have advantages for social communication and structural language that mask their impairments. However, when compared to girls who are TD, girls with HF-ASD demonstrated impaired social communication and structural language. Clinicians should include and carefully examine multiple sources of information when assessing girls with HF-ASD.

Preliminary Findings on the Use of Session Questionnaires to Improve Clinician-Client Alliance With Special Consideration to Clinical Education

2015 ◽  
Vol 25 (1) ◽  
pp. 50-60
Author(s):  
Anu Subramanian
Keyword(s):  
Graduate Students ◽  
Clinical Education ◽  
Clinical Decision Making ◽  
Rating Scale ◽  
Treatment Effectiveness ◽  
Clinical Decision ◽  
Added Value ◽  
Therapeutic Outcomes ◽  
Specific Feedback ◽  
Stakeholder Perspective

ASHA's focus on evidence-based practice (EBP) includes the family/stakeholder perspective as an important tenet in clinical decision making. The common factors model for treatment effectiveness postulates that clinician-client alliance positively impacts therapeutic outcomes and may be the most important factor for success. One strategy to improve alliance between a client and clinician is the use of outcome questionnaires. In the current study, eight parents of toddlers who attended therapy sessions at a university clinic responded to a session outcome questionnaire that included both rating scale and descriptive questions. Six graduate students completed a survey that included a question about the utility of the questionnaire. Results indicated that the descriptive questions added value and information compared to using only the rating scale. The students were varied in their responses regarding the effectiveness of the questionnaire to increase their comfort with parents. Information gathered from the questionnaire allowed for specific feedback to graduate students to change behaviors and created opportunities for general discussions regarding effective therapy techniques. In addition, the responses generated conversations between the client and clinician focused on clients' concerns. Involving the stakeholder in identifying both effective and ineffective aspects of therapy has advantages for clinical practice and education.

Sign in / Sign up

Export Citation Format

Share Document