Stakeholder-Generated Implementation Strategies to Promote Evidence-Based ADHD Treatment in Community Mental Health

Community implementation of evidence-based practices (EBPs) for Attention Deficit/Hyperactivity Disorder (ADHD) is greatly lacking. A recent randomized community-based trial of an EBP for ADHD (Supporting Teens’ Autonomy Daily; STAND) demonstrated suboptimal implementation and effectiveness outcomes. In the present study, we conducted an Innovation Tournament (IT) with agency staff stakeholders (N?=?26) to identify barriers to successful implementation of STAND and implementation strategies for a revised service delivery model. We conducted member-checking of agency staff-generated ideas with parents (N?=?226) and subsequent querying of additional parent (N?=?226) and youth-generated (N?=?205) strategies to improve care. Go-Zone plots were utilized to identify strategies with the highest feasibility and importance. Practical barriers (i.e., transportation, scheduling difficulties) and parent/youth engagement were the most commonly cited obstacles to successful implementation of STAND in community contexts. Eighteen “winning” implementation strategies were identified that survived member checking. These were classified as train and educate stakeholders (n?=?5; e.g., train agency supervisors to deliver supervision, digitize treatment materials and trainings), engage consumers (n?=?9; e.g., begin treatment with rapport building sessions, increase psychoeducation), provide interactive assistance (n?=?2; e.g., add group supervision, increase roleplay in supervision), and use of evaluative/iterative strategies (n?=?2; e.g., perform fidelity checks, supervisor review of session recordings). Parents and youth desired longer duration of treatment and increased focus on maintenance. Strategies will be developed and tested as part of a pilot effectiveness trial designed to refine STAND’s service delivery model.

Trial Registration NCT02694939 www.clinicaltrials.gov

     

The Transcallosal Anterior Interfoniceal Approach: A Microsurgical Anatomy Study

Objectives A plethora of surgical strategies have been described to reach deep-seated lesions situated within the third ventricle including the Rosenfeld, or transcallosal anterior interfoniceal (TAIF), approach. First introduced in 2001, it consists of a small callosotomy followed by the midline transseptal dissection of fornices to enter the roof of the third ventricle. The aim of this microsurgical anatomy study is to describe and show each stage of the surgical procedure, focusing on the possible trajectories to anatomical landmarks. Participants A total of 20 adult cadaveric specimens were used in this study. Using ×3 to ×40 magnifications, the surgical dissection was performed in a stepwise fashion, and the transcallosal anterior interforniceal approach was performed, analyzed, and described. Results In 5 specimens of 10, a cavum septum pellucidum was depicted. In 5 cases of 20 after the callosotomy ,the lateral ventricular cavities were reached. Different orientation of the microscope allowed us to define three surgical trajectories to visualize the region of interest without exposing important functional areas. Conclusion The TAIF represents a minimally invasive approach to the third ventricle; its tricky surgical steps make appropriate anatomical dissection training essential to become confident and skilled in performing this approach.     

Behavioral Parent Training in Infancy: What About the Parent–Infant Relationship?

Behavioral parent training (BPT) and attachment interventions have demonstrated efficacy in improving outcomes for young children. Despite theoretical overlap in these approaches, the literature has evolved separately, particularly with respect to outcome measurement in BPT. We examined the impact of the Infant Behavior Program (IBP), a brief home-based adaptation of Parent–Child Interaction Therapy, on changes in attachment-based caregiving behaviors (sensitivity, warmth, and intrusiveness) at postintervention and 3- and 6-month follow-ups during a videotaped infant-led play. Sixty mother–infant dyads were randomly assigned to receive the IBP (n = 28) or standard care (n = 30). Infants were an average age of 13.52 months and predominately from ethnic or racial minority backgrounds (98%). We used bivariate correlations to examine the association between attachment-based caregiving behaviors and behaviorally based parenting do and don’t skills and structural equation modeling to examine the direct effect of the IBP on attachment-based caregiving behaviors and the indirect effect of behaviorally based parenting skills on the relation between intervention group and attachment-based caregiving behaviors. Behaviorally based parenting do and don’t skills were moderately correlated with attachment-based caregiving behaviors. Results demonstrated a direct effect of the IBP on warmth and sensitivity at postintervention and 3- and 6-month follow-ups. The direct effect of the IBP on warmth and sensitivity at the 3- and 6-month follow-ups was mediated by increases in parenting do skills at postintervention. Findings suggest that behaviorally based parenting skills targeted in BPT programs have a broader impact on important attachment-based caregiving behaviors during the critical developmental transition from infancy to toddlerhood.     

Quantitative X-ray Computed Tomography Peritoneography in Malignant Peritoneal Mesothelioma Patients Receiving Intraperitoneal Chemotherapy

Background

Intraperitoneal chemotherapy is used to treat peritoneal surface-spreading malignancies. We sought to determine whether volume and surface area of the intraperitoneal chemotherapy compartments are associated with overall survival and posttreatment glomerular filtration rate (GFR) in malignant peritoneal mesothelioma (MPM) patients.

Methods

Thirty-eight MPM patients underwent X-ray computed tomography peritoneograms during outpatient intraperitoneal chemotherapy. We calculated volume and surface area of contrast-filled compartments by semiautomated computer algorithm. We tested whether these were associated with overall survival and posttreatment GFR.

Results

Decreased likelihood of mortality was associated with larger surface areas (p = 0.0201) and smaller contrast-filled compartment volumes (p = 0.0341), controlling for age, sex, histologic subtype, and presence of residual disease >0.5 cm postoperatively. Larger volumes were associated with higher posttreatment GFR, controlling for pretreatment GFR, body surface area, surface area, and the interaction between body surface area and volume (p = 0.0167).

Discussion

Computed tomography peritoneography is an appropriate modality to assess for maldistribution of intraperitoneal chemotherapy. In addition to identifying catheter failure and frank loculation, quantitative analysis of the contrast-filled compartment’s surface area and volume may predict overall survival and cisplatin-induced nephrotoxicity. Prospective studies should be undertaken to confirm and extend these findings to other diseases, including advanced ovarian carcinoma.

     

An examination of the ability of d-tubocurarine to evoke contraction and mediator release from superfused trachea and parenchymal strips isolated from the guinea pig

The relationship between curare-induced mediator release and contraction in superfused guinea pig trachea and parenchymal strips was examined. In trachea, curare produced histamine release and contraction with peak release occurring in the first 90 sec (collection period 1) after challenge. Peak contraction developed later (collection periods 4-6). Curare-induced contraction of parenchymal strips was inconsistent and smaller than that found in trachea. No histamine could be detected in parenchymal strip superfusate samples. Curare also was selective in releasing histamine from monodispersed airway cells vs. peripheral lung cells. No leukotriene bioactivity or immunoreactivity could be detected after curare challenge of tissues or cell suspensions. Tracheal contractions, but not histamine release, occurring early (first 5 or 6 collection periods) after challenge were antagonized by mepyramine, 10(-6) M, and phenoxybenzamine, 3 X 10(-5) M. Combination of FPL55712, 10(-5) M, with mepyramine did not further alter tracheal contraction. Contractions occurring later after challenge and total histamine release were enhanced by indomethacin, 5 X 10(-6) M. Indomethacin also increased contractions in the presence of mepyramine. With mepyramine and indomethacin, LY171883, 1 and 3 X 10(-6) M, and nordihydroguaiaretic acid, 3 X 10(-5) M, antagonized tracheal contractions to curare, 3 X 10(-3) M, but not to 1 X 10(-3) M, without altering histamine release. Indomethacin prolonged return to base line of tracheal tension after challenge with exogenous histamine. After addition of LY171883 or nordihydroguaiaretic acid, the return of tracheal tension after histamine was not different from that seen without drug pretreatment.(ABSTRACT TRUNCATED AT 250 WORDS)     

Diffuse idiopathic skeletal hyperostosis: an uncommon case of dysphagia in an older adult

Diffuse idiopathic skeletal hyperostosis (DISH) is a common disorder among older adults. It is characterized by ossification of the anterior longitudinal ligament of the spine and various extra-spinal ligaments. Although stiffness and decreased range of motion of the spine are the most common clinical presentations of DISH, extra-skeletal manifestations may also be present. We report the case of a 65-year-old man complaining of progressive dysphagia due to DISH. Barium swallow showed compression and lateral displacement of the cervical tract of the esophagus, secondary to compression by a large osteophyte. The patient received medical treatment with COX-2 inhibitors and liquid diet. In conclusion, DISH should be considered an important, although rare, cause of dysphagia among older adults. However, it should not be accepted as the cause of dysphagia until all other causes have been ruled out.