EMDR Group Protocol With Children: A Field Study

2020 ◽  
Vol 14 (1) ◽  
pp. 13-30
Author(s):  
Ümran Korkmazlar ◽  
Berfin Bozkurt ◽  
Deniz Tan Tunca
Keyword(s):  
Early Intervention ◽  
Response To Treatment ◽  
Older Children ◽  
Child Report ◽  
Posttraumatic Stress Disorder Symptoms ◽  
Posttraumatic Symptoms ◽  
Late Intervention ◽  
Different Populations ◽  
Marmara Earthquake

The Eye Movement Desensitization and Reprocessing Group Protocol with Children (EMDR-GP/C) was first developed by Korkmazlar following the Marmara earthquake in Turkey in 1999 and can be adapted for different populations. This study focused on EMDR-GP with children who lost their fathers in the mine explosion that occurred in 2014 in Soma, Turkey. The EMDR-GP/C was used with 41 children (7–12 years old) in the early intervention, 3 weeks after the disaster, and used with 25 other children (6–13 years old) in the late intervention, 18 months after the disaster, when posttraumatic stress disorder symptoms had developed. The differences between the early and late implementations of EMDR-GP/C are presented in this article. In the early intervention, children processed the trauma by focusing on the “events” as they saw or heard them; however, 18 months after the disaster, children processed their “emotions” about the event in the desensitization phase. Results show a significant decrease in scores of subjective units of disturbance (SUDs) for both intervention periods. An analysis was also conducted, comparing decreases in SUD scores for younger and older children, with no differences found in their response to treatment. Pre and follow-up data were collected for the late intervention condition, using the Child Report of Posttraumatic Symptoms (CROPS), and showed a significant decrease at 18-month follow-up. Further studies are suggested to determine effectiveness of EMDR-GP/C with other populations.

scholarly journals P660 Evaluating the effectiveness of disease assessment at 2 weeks following a course of oral steroids: Does early intervention affect outcomes?

2020 ◽  
Vol 14 (Supplement_1) ◽  
pp. S544-S545
Author(s):  
J Slater ◽  
A ALGIEDER ◽  
J Jones ◽  
B Bates ◽  
S De Silva
Keyword(s):  
Early Intervention ◽  
Biological Therapy ◽  
Oral Prednisolone ◽  
Response To Treatment ◽  
Disease Assessment ◽  
Early Introduction ◽  
Mayo Score ◽  
Oral Steroids ◽  
To Receive

Abstract Background Early intervention in those patients not responding to a course of oral steroids following an Acute flare of their IBD is essential for improved outcomes. It enables re-assessment and escalation of treatment in those that are non-responders. We present our data on the effectiveness of an IBD nurse-led telephone follow-up appointment two weeks after commencing a course of oral steroids and its impact on outcomes. Methods Data collected prospectively on all patients treated with oral prednisolone between March and November 2019. Partial Mayo score for ulcerative colitis (UC) and clinical assessment of symptoms for Crohn’s disease (CD) patients were used to assess response to treatment at 2 weeks. Results 57 patients were treated with a Prednisolone reducing regime during the 8 months period. Patient demographics included 27 males and 30 females,19 CD and 38 UC patients with a median age of 48 (range 16–88). Following 2 weeks of treatment, 54% (31) of patients reported an improvement in symptoms-19 UC patients (Partial Mayo 0–4) and 12 CD patients. However, 45% (26) patients did not have a clinical improvement at week 2, 19 UC (Partial Mayo 2–9) and 7 CD were still symptomatic. In those patients who had not responded 3 were commenced on Azathioprine, 6 on Methotrexate and one patient had a slow response to steroids. Seven patients were escalated to receive biological therapy (3 vedolizumab, 2 infliximab, 1 ustekinumab and 1 adalimumab). Two other patients had their dose of vedolizumab increased, one patient was switched to another class of biologics. Three patients had a Flexible Sigmoidoscopy and following that 2 were admitted to receive IV steroids and escalated to biological therapy and Methotrexate. One patient was directly admitted for biological therapy, and 2 patients had an alternative diagnosis of Bile Salt Malabsorption which was treated. At the 3 months follow-up period all patients were well and had avoided further admissions or surgery, with only one patient electively opting for surgery. Conclusion Our data show that following a course of oral steroids for a flare of IBD, 45% are still symptomatic after 2 weeks. In this cohort, optimisation of treatment occurred in 23 patients (88%) with either the introduction of biological agents, or early introduction of immunomodulatory therapy. We believe that These data supports the implementation of an early review with appropriate intervention, demonstrating improved patient outcomes.

Telepractice Training for Early Intervention with Children who are Deaf/Hard-of-Hearing

2016 ◽  
Vol 1 (9) ◽  
pp. 60-67
Author(s):  
Kristina M. Blaiser ◽  
Diane Behl
Keyword(s):  
Early Intervention ◽  
Hard Of Hearing ◽  
Communication Disorders ◽  
Staff Support ◽  
Early Intervention Services ◽  
Part C ◽  
Training Courses ◽  
Part C Early Intervention ◽  
Training Opportunities

Telepractice is an increasingly popular service delivery model for serving individuals with communication disorders, particularly infants and toddlers who are Deaf/Hard-of-Hearing (DHH) served under Part C Early Intervention programs (Behl, Houston, & Stredler-Brown, 2012). Recent studies have demonstrated that telepractice is effective for providing children who are DHH and their families with access to high quality early intervention services (Behl et al., 2016; Blaiser, Behl, Callow-Heusser, & White, 2013). While telepractice has grown in popularity, there continues to be a lack of formalized training opportunities to help providers become more familiar with telepractice (Behl & Kahn, 2015). This paper outlines online training courses for providers, families, and administrators of programs for children who are DHH. Recommendations for follow up training and staff support are included.

Effect of early intervention on infantile postural asymmetry: a prospective 2 years follow-up

2006 ◽  
Vol 37 (06) ◽  
Author(s):  
H Philippi ◽  
K Bauer ◽  
T Jung ◽  
H Bergmann ◽  
S Müller ◽  
...  
Keyword(s):  
Early Intervention ◽  
Postural Asymmetry

Response to Treatment of Alcoholism; a Follow-Up Study

1968 ◽  
Vol 29 (2) ◽  
pp. 364-381 ◽  
Author(s):  
Alex D. Pokorny ◽  
Byron A. Miller ◽  
Sidney E. Cleveland
Keyword(s):  
Response To Treatment ◽  
Follow Up Study

Instruction Helps and Hinders Young Children’s Feature Learning

2018 ◽  
Author(s):  
Charles Kalish ◽  
Nigel Noll
Keyword(s):  
Young Children ◽  
Feature Learning ◽  
Irrelevant Information ◽  
Diagnostic Feature ◽  
Older Children ◽  
Prediction Task ◽  
Feature Correlation ◽  
The Future

Existing research suggests that adults and older children experience a tradeoff where instruction and feedback help them solve a problem efficiently, but lead them to ignore currently irrelevant information that might be useful in the future. It is unclear whether young children experience the same tradeoff. Eighty-seven children (ages five- to eight-years) and 42 adults participated in supervised feature prediction tasks either with or without an instructional hint. Follow-up tasks assessed learning of feature correlations and feature frequencies. Younger children tended to learn frequencies of both relevant and irrelevant features without instruction, but not the diagnostic feature correlation needed for the prediction task. With instruction, younger children did learn the diagnostic feature correlation, but then failed to learn the frequencies of irrelevant features. Instruction helped older children learn the correlation without limiting attention to frequencies. Adults learned the diagnostic correlation even without instruction, but with instruction no longer learned about irrelevant frequencies. These results indicate that young children do show some costs of learning with instruction characteristic of older children and adults. However, they also receive some of the benefits. The current study illustrates just what those tradeoffs might be, and how they might change over development.

scholarly journals A206 EVOLUTION OF PEDIATRIC AUTOIMMUNE CHOLANGITIS AND PRIMARY SCLEROSING CHOLANGITIS INTO ADULTHOOD

2021 ◽  
Vol 4 (Supplement_1) ◽  
pp. 234-236
Author(s):  
P Willems ◽  
J Hercun ◽  
C Vincent ◽  
F Alvarez
Keyword(s):  
Primary Sclerosing Cholangitis ◽  
Sclerosing Cholangitis ◽  
Response To Treatment ◽  
Similar Proportion ◽  
Autoimmune Cholangitis ◽  
Significant Difference ◽  
One Year ◽  
Liver Tests

Abstract Background The natural history of primary sclerosing cholangitis (PSC) in children seems to differ from PSC in adults. However, studies on this matter have been limited by short follow-up periods and inconsistent classification of patients with autoimmune cholangitis (AIC) (or overlap syndrome). Consequently, it remains unclear if long-term outcomes are affected by the clinical phenotype. Aims The aims of this is study are to describe the long-term evolution of PSC and AIC in a pediatric cohort with extension of follow-up into adulthood and to evaluate the influence of phenotype on clinical outcomes. Methods This is a retrospective study of patients with AIC or PSC followed at CHU-Sainte-Justine, a pediatric referral center in Montreal. All charts between January 1998 and December 2019 were reviewed. Patients were classified as either AIC (duct disease on cholangiography with histological features of autoimmune hepatitis) or PSC (large or small duct disease on cholangiography and/or histology). Extension of follow-up after the age of 18 was done for patients followed at the Centre hospitalier de l’Université de Montréal. Clinical features at diagnosis, response to treatment at one year and liver-related outcomes were compared. Results 40 patients (27 PSC and 13 AIC) were followed for a median time of 71 months (range 2 to 347), with 52.5% followed into adulthood. 70% (28/40) had associated inflammatory bowel disease (IBD) (78% PSC vs 54% AIC; p=0.15). A similar proportion of patients had biopsy-proven significant fibrosis at diagnosis (45% PSC vs 67% AIC; p=0.23). Baseline liver tests were similar in both groups. At diagnosis, all patients were treated with ursodeoxycholic acid. Significantly more patients with AIC (77% AIC vs 30 % PSC; p=0.005) were initially treated with immunosuppressive drugs, without a significant difference in the use of Anti-TNF agents (0% AIC vs 15% PSC; p= 0.12). At one year, 55% (15/27) of patients in the PSC group had normal liver tests versus only 15% (2/13) in the AIC group (p=0.02). During follow-up, more liver-related events (cholangitis, liver transplant and cirrhosis) were reported in the AIC group (HR=3.7 (95% CI: 1.4–10), p=0.01). Abnormal liver tests at one year were a strong predictor of liver-related events during follow-up (HR=8.9(95% CI: 1.2–67.4), p=0.03), while having IBD was not (HR=0.48 (95% CI: 0.15–1.5), p=0.22). 5 patients required liver transplantation with no difference between both groups (8% CAI vs 15% CSP; p=0.53). Conclusions Pediatric patients with AIC and PSC show, at onset, similar stage of liver disease with comparable clinical and biochemical characteristics. However, patients with AIC receive more often immunosuppressive therapy and treatment response is less frequent. AIC is associated with more liver-related events and abnormal liver tests at one year are predictor of bad outcomes. Funding Agencies None

scholarly journals POS0677 THE ROLE OF MUSCULOSKELETAL ULTRASOUND IN PREDICTING THE RESPONSE TO JAK INHIBITORS: RESULTS FROM A LARGE MONOCENTRIC COHORT

2021 ◽  
Vol 80 (Suppl 1) ◽  
pp. 583-583
Author(s):  
C. Garufi ◽  
F. Ceccarelli ◽  
F. R. Spinelli ◽  
S. Mancuso ◽  
C. Pirone ◽  
...  
Keyword(s):  
Rheumatoid Arthritis ◽  
Disease Activity ◽  
Structural Damage ◽  
Power Doppler ◽  
Response To Treatment ◽  
Jak Inhibitors ◽  
Inflammatory Score ◽  
Inflammatory Status

Background:In the management of chronic arthritis, such as Rheumatoid Arthritis (RA), Ultrasound (US) assessment can provide relevant information about the joint inflammatory status in the diagnostic phase and even more in the monitoring of disease activity and structural damage1,2.Objectives:In this longitudinal study, we aimed to assesse the role of US in predicting the efficacy of JAK-inhibitors (JAKi) in RA patients.Methods:We enrolled RA patients starting baricitinib or tofacitinib. All patients were evaluated at baseline and after 4, 12, 24, 48 weeks. Disease activity was calculated by DAS28CRP. US examination in 22 joints (I–V MCPs and PIPs, wrists) aimed at evaluating inflammatory features (synovial effusion and hypertrophy, power Doppler-PD), through a semi-quantitative scale (0-3). The total US (0-198) and PD (0-66) scores were calculated. We scanned bilateral flexor (I–V fingers of hands) and extensor compartments (1-6) tendons: tenosynovitis was scored as absent/present (0/1), resulting in a total score (0-22).Results:We studied 102 patients (M/F 15/87; median age 59.2 years, IQR 17.75; median disease duration 144 months, IQR 126), 61 treated with baricitinib and 41 with tofacitinib. At baseline, the median total US score was 18 (IQR 19) and the median PD score 2 (4). We observed a significant reduction in both total and PD US scores at all time-points (p<0.0001) (Figure 1). At baseline, 75.4% of patients showed tenosynovitis involving at least one tendon, with a median score of 2 (IQR 3.5) significantly decreasing after 24 weeks (p=0.02). Multivariate analysis, adjusted for baseline DAS28CRP and other concomitant treatments (including glucocorticoids and methotrexate treatment), confirmed the independent association between baseline US (PD and tenosynovitis) scores and the reduction of disease activity at follow-up evaluations.Conclusion:The present study confirmed the early efficacy of JAKi in RA patients by using US evaluation. Furthermore, power doppler and tenosynovitis scores could play a predictive role in response to treatment.References:[1]MUELLER RB, HASLER C, POPP F, et al. Effectiveness, Tolerability, and Safety of Tofacitinib in Rheumatoid Arthritis: A Retrospective Analysis of Real-World Data from the St. Gallen and Aarau Cohorts. J Clin Med. 2019;8(10):1548.[2]COLEBATCH AN, EDWARDS CJ, ØSTERGAARD M, et al. EULAR recommendations for the use of imaging of the joints in the clinical management of rheumatoid arthritis. Ann Rheum Dis. 2013;72(6):804-14.Figure 1.Ultrasound inflammatory score (a) and Ultrasound Power Doppler (PD) score (b) at baseline and follow-up.Table 1.Baseline characteristics of 414 RA patients.WEEKS04122448US inflammatory score18 (19)11 (15.5)9.5 (11.7)7.5 (8)6 (11)US PD score2 (4)0 (2)0 (1)0 (1)0 (0.7)Disclosure of Interests:Cristina Garufi: None declared, Fulvia Ceccarelli: None declared, Francesca Romana Spinelli Speakers bureau: Abbvie, Eli Lilly, Consultant of: Gilead/Galapagos, Eli Lilly, Grant/research support from: Pfizer, Silvia Mancuso: None declared, Carmelo Pirone: None declared, Fabrizio Conti Speakers bureau: Abbvie, Eli Lilly, Sanofi, Pfizer, Consultant of: Gilead/Galapagos

scholarly journals Effect of early intervention for anxiety on sleep outcomes in adolescents: a randomized trial

2021 ◽  
Author(s):  
Bente Storm Mowatt Haugland ◽  
Mari Hysing ◽  
Asle Hoffart ◽  
Åshild Tellefsen Haaland ◽  
Jon Fauskanger Bjaastad ◽  
...  
Keyword(s):  
Early Intervention ◽  
Standard Length ◽  
Sleep Problems ◽  
Sleep Onset ◽  
Cognitive Behavioral ◽  
Control Group ◽  
Sleep Onset Latency ◽  
Post Intervention ◽  
Clinical Trial Registration

AbstractThe potential effect of early intervention for anxiety on sleep outcomes was examined in a sample of adolescents with anxiety (N = 313, mean 14.0 years, SD = 0.84, 84% girls, 95.7% Norwegians). Participants were randomized to one of three conditions: a brief or a standard-length cognitive-behavioral group-intervention (GCBT), or a waitlist control-group (WL). Interventions were delivered at schools, during school hours. Adolescents with elevated anxiety were recruited by school health services. Questionnaires on self-reported anxiety symptoms, depressive symptoms, and sleep characteristics were administered at pre- and post-intervention, post-waitlist, and at 1-year follow-up. Adolescents reported reduced insomnia (odds ratio (OR) = 0.42, p < 0.001) and shorter sleep onset latency (d = 0.27, p <  0.001) from pre- to post-intervention. For insomnia, this effect was maintained at 1-year follow-up (OR = 0.54, p = 0.020). However, no effect of GCBT on sleep outcomes was found when comparing GCBT and WL. Also, no difference was found in sleep outcomes between brief and standard-length interventions. Adolescents defined as responders (i.e., having improved much or very much on anxiety after GCBT), did not differ from non-responders regarding sleep outcomes. Thus, anxiety-focused CBT, delivered in groups, showed no effect on sleep outcomes. Strategies specifically targeting sleep problems in adolescents should be included in GCBT when delivered as early intervention for adolescents with elevated anxiety.Trial registry Clinical trial registration: School Based Low-intensity Cognitive Behavioral Intervention for Anxious Youth (LIST); http://clinicalrials.gov/; NCT02279251, Date: 11.31. 2014

scholarly journals Response to treatment with intra-articular triamcinolone hexacetonide and triamcinolone acetonide in oligo articular juvenile idiopathic arthritis

2021 ◽  
Vol 19 (1) ◽  
Author(s):  
Rana Harhay ◽  
Wajiha Jeelani ◽  
Barbine Tchamba Agbor Agbor ◽  
Teresa Hennon ◽  
Brian H. Wrotniak ◽  
...  
Keyword(s):  
Juvenile Idiopathic Arthritis ◽  
Side Effects ◽  
Triamcinolone Acetonide ◽  
The United States ◽  
Response To Treatment ◽  
Joint Injection ◽  
Triamcinolone Hexacetonide ◽  
Active Arthritis ◽  
General Response

Abstract Background Oligo-articular juvenile idiopathic arthritis (Oligo JIA) is the most common subtype of juvenile idiopathic arthritis. Intra-articular corticosteroid (IAC) injection is a mainstay treatment of oligo JIA providing pain relief, improving mobility and preventing further joint destruction in the majority of patients. In 2015, production of triamcinolone hexacetonide (TH) an intra-articular corticosteroid was discontinued in the United States leading to use of triamcinolone acetonide (TA) as an alternative. In this study, we compared response to treatment in children with oligo JIA who underwent therapy with intra-articular TA and TH injection. Methods Our study is a retrospective chart review of children with oligo JIA who were treated with IAC injections with TH between January 2012 and June 2015 and TA between J uly 2015 and December 2018. The two groups were followed at John R. Oishei Children’s Hospital of Buffalo and were evaluated for response to treatment, side effects and predictors of response including duration of disease before treatment, erythrocyte sedimentation rate (ESR), and c-reactive protein (CRP). Response to treatment was defined as at least 6 months follow up without evidence of active arthritis in injected joints. Patients were considered to be non-responders if they continued to show active arthritis during their first follow up after joint injection. The primary objective was to evaluate whether there was a significant difference in rate of response between TH and TA. Results Forty-nine patients, 38 female and 11 male with oligo JIA were included in the study. The average age was 6.7 years. A total of 111 joints were injected includin g 78 knees, 13 ankles, 9 wrists, 4 hips, 4 elbows, 2 TMJ and one subtalar joint. In the TA group, 49% (29/59) did not show response to injection compared to 27% (14/52) in the TH group. After 6 months, response rates were better for individuals injected with TH compared to TA (73% vs. 51%). In general, response to intra-articular TH was superior to TA with P = .016 using chi-square test of independence. This difference in outcome was not influenced by other variables such as duration of illness before treatment (P value 0.784) or elevated ESR and CRP. No difference in side effects between the two groups were noted. Conclusion Our results in conjunction with prior published data suggests that TH intra-articular joint injection in oligo JIA is superior to TA, although future controlled trials are necessary for confirmation. An effective, long lasting treatment can have a great impact on the outcome of these children.

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