Issues in the Debriefing Debate for the Emergency Services: Moving Research Outcomes Forward

Despite over 20 years of research, the efficacy of group psychological debriefing remains unresolved. The present review outlines a clear strategy to answer this empirical question. Rather than critically evaluating individual studies, the critique focuses on methodological and conceptual shortcomings that have prevented research in this area from progressing. An organizing framework is provided within which the key issues are identified, clarified, and linked to guidelines for future research, which should foster greater understanding about the empirical side of the debriefing debate. Together, promoting clarity and understanding, as well as specifying guidelines for future research, represent the foundation for a path forward in this area.     

Vasculitis: Current Status and Future Directions

Vasculitides represent such a heterogeneous group of disorders that difficulties arise in their classification. Although biopsy examination of involved tissues remains essential, new serological markers have been developed. Therapeutic strategies have been refined, and B lymphocyte-targeted drugs may prove a satisfactory alternative.     

Outcome of Early Intervention for Children With Autism

Since 1980, 12 peer-reviewed outcome studies (nine on behavior analytic programs, one on Project TEACCH, and two on Colorado Health Sciences) have focused on early intervention for children with autism. Mean IQ gains of 7-28 points were reported in studies of behavior analytic programs, and 3-9 in studies on TEACCH and Colorado. Cains were also reported on other measures in some studies. Individual children varied greatly in treatment responsivtty. No fully randomized studies have been published, and studies with features such as large sample sizes and blind examiners have been rare. Further progress is likely to require more rigorous clinical trials, more comprehensive pretreatment and follow-up assessments, and greater attention to brain-behavior relationships.     

Cognitive Behavior Therapies for Psychotic Disorders: Current Empirical Status and Future Directions

Although cognitive behavior therapy (CBT) has strong empirical support for treating a diverse array of psychological conditions, only recently has research begun to examine its efficacy in treating the symptoms associated with schizophrenia and other psychotic disorders. Several randomized controlled trials have been conducted on CBT for psychosis with some positive results, but trials comparing CBT to other nonspecific interventions have yielded less impressive findings. No well-controlled trial to date has attempted to dismantle the components of CBT for psychosis, to compare it to another empirically supported psychosocial intervention for this population, or to identify the specific mechanisms responsible for treatment effectiveness. In this paper, a review of the empirical status of CBT for psychosis is presented. In addition, promising but preliminary new research in this area is reviewed, including prevention and early intervention approaches and acceptance/mindfulness-based strategies. Within this context, limitations in the current literature are reviewed, and recommendations for future research are discussed.     

Treatment for Children With Posttraumatic Stress Disorder: Current Status and Future Directions

Although the treatment-efficacy literature for adults with posttraumatic stress disorder (PTSD) has advanced considerably with the publication of several methodologically rigorous contributions during the past decade, the child-focused PTSD literature has yet to extend beyond case illustrations and open trials. Central to this article is a review of the treatment-outcome literature for children with PTSD. Because few treatment studies have targeted trauma-exposed children relative to their adult counterparts, results of some methodologically rigorous investigations with adults are also cited in this review. From these investigations and from the available treatment-outcome data with children, we derive suggestions for future research.     

Content-Based Image Retrieval in Radiology: Current Status and Future Directions

Diagnostic radiology requires accurate interpretation of complex signals in medical images. Content-based image retrieval (CBIR) techniques could be valuable to radiologists in assessing medical images by identifying similar images in large archives that could assist with decision support. Many advances have occurred in CBIR, and a variety of systems have appeared in nonmedical domains; however, permeation of these methods into radiology has been limited. Our goal in this review is to survey CBIR methods and systems from the perspective of application to radiology and to identify approaches developed in nonmedical applications that could be translated to radiology. Radiology images pose specific challenges compared with images in the consumer domain; they contain varied, rich, and often subtle features that need to be recognized in assessing image similarity. Radiology images also provide rich opportunities for CBIR: rich metadata about image semantics are provided by radiologists, and this information is not yet being used to its fullest advantage in CBIR systems. By integrating pixel-based and metadata-based image feature analysis, substantial advances of CBIR in medicine could ensue, with CBIR systems becoming an important tool in radiology practice.     

Internet-Based Early Intervention to Prevent Posttraumatic Stress Disorder in Injury Patients: Randomized Controlled Trial

Background

Posttraumatic stress disorder (PTSD) develops in 10-20% of injury patients. We developed a novel, self-guided Internet-based intervention (called Trauma TIPS) based on techniques from cognitive behavioral therapy (CBT) to prevent the onset of PTSD symptoms.

Objective

To determine whether Trauma TIPS is effective in preventing the onset of PTSD symptoms in injury patients.

Methods

Adult, level 1 trauma center patients were randomly assigned to receive the fully automated Trauma TIPS Internet intervention (n=151) or to receive no early intervention (n=149). Trauma TIPS consisted of psychoeducation, in vivo exposure, and stress management techniques. Both groups were free to use care as usual (nonprotocolized talks with hospital staff). PTSD symptom severity was assessed at 1, 3, 6, and 12 months post injury with a clinical interview (Clinician-Administered PTSD Scale) by blinded trained interviewers and self-report instrument (Impact of Event Scale—Revised). Secondary outcomes were acute anxiety and arousal (assessed online), self-reported depressive and anxiety symptoms (Hospital Anxiety and Depression Scale), and mental health care utilization. Intervention usage was documented.

Results

The mean number of intervention logins was 1.7, SD 2.5, median 1, interquartile range (IQR) 1-2. Thirty-four patients in the intervention group did not log in (22.5%), 63 (41.7%) logged in once, and 54 (35.8%) logged in multiple times (mean 3.6, SD 3.5, median 3, IQR 2-4). On clinician-assessed and self-reported PTSD symptoms, both the intervention and control group showed a significant decrease over time (P<.001) without significant differences in trend. PTSD at 12 months was diagnosed in 4.7% of controls and 4.4% of intervention group patients. There were no group differences on anxiety or depressive symptoms over time. Post hoc analyses using latent growth mixture modeling showed a significant decrease in PTSD symptoms in a subgroup of patients with severe initial symptoms (n=20) (P<.001).

Conclusions

Our results do not support the efficacy of the Trauma TIPS Internet-based early intervention in the prevention of PTSD symptoms for an unselected population of injury patients. Moreover, uptake was relatively low since one-fifth of individuals did not log in to the intervention. Future research should therefore focus on innovative strategies to increase intervention usage, for example, adding gameplay, embedding it in a blended care context, and targeting high-risk individuals who are more likely to benefit from the intervention.

Trial Registration

International Standard Randomized Controlled Trial Number (ISRCTN): 57754429; http://www.controlled-trials.com/ISRCTN57754429 (Archived by WebCite at http://webcitation.org/6FeJtJJyD).     

Program Use and Outcome Change in a Web-Based Trauma Intervention: Individual and Social Factors

BackgroundInsight into user adherence to Web-based intervention programs and into its relationship to intervention effect is needed.ObjectiveThe objective of this study was to examine use of a Web-based self-help intervention program, the Chinese version of My Trauma Recovery (CMTR), among Chinese traumatized individuals, and to investigate the relationship between program use and user characteristics before the intervention and change in outcomes after the intervention and at 3-months’ follow-up.MethodsThe sample consisted of 56 urban survivors of different trauma types and 90 rural survivors of the 2008 Sichuan earthquake, who used the CMTR in 1 month on their own or guided by volunteers in a counseling center. Predictors were demographics (sex, age, highest education, marital status, and annual family income), health problems (trauma duration, posttraumatic symptoms, and depression), psychological factors (coping self-efficacy), and social factors (social functioning impairment and social support). Program use was assessed by general program usage (eg, number of visiting days) and program adherence (eg, webpages completed in modules). Outcome measures were the Posttraumatic Diagnostic Scale (PDS), Symptom Checklist 90-Depression (SCL-D), Trauma Coping Self-Efficacy scale (CSE), Crisis Support Scale (CSS), and Social Functioning Impairment questionnaire (SFI) adopted from the CMTR.Results(1) Program use: rural participants had a larger total number of visiting days (F_1,144=40.50, P<.001) and visited more program modules in 1 month (χ²₃=73.67, P<.001) than urban participants. (2) Predictors and program use: total number of visiting days was correlated with CSS at pretest (r=.22, P=.009), and total number of completed webpages was associated with SFI at pretest (r=.19, P=.02). Number of webpages completed in modules was correlated with all demographic, disease severity, psychological, and social factors at pretest. (3) Program use and outcomes change: in general, use of the triggers and self-talk modules showed a consistent positive association with improvement in PDS, SCL-D, SFI, and CSE. The relaxation module was associated with positive change in PDS, but with negative change in CSS and SFI. The professional help module was associated with positive change in SCL-D, but its use on the first day was associated with negative change in CSS and CSE. The unhelpful coping module was associated with negative change in SFI. The mastery tools module showed a consistent association with negative change in PDS and SCL-D.ConclusionsThese findings suggest that both individual (eg, demographic, health problems, psychological) and social factors (eg, social functioning, social support) should be considered when delivering Web-based interventions, particularly in collectivist cultures. Specific program adherence indicators (eg, webpages completed in each module, activity types completed), rather than general program usage indicators (eg, total number or time of visiting), should be developed to examine the effectiveness of various program modules or elements.

Clinical Trial

Australian New Zealand Clinical Trials Registry: ACTRN12611000951954; https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=343399 (Archived by WebCite at http://www.webcitation.org/6G7WyNODk)     

Reproductive Immunology: Current Status and Future Directions (Part I)

Extensive research work over the past couple of decades has indicated a series of intricate relations between immune and reproductive systems. A range of reproductive immunology topics including the roles of adoptive and innate immunity in infertility and pregnancy, the immune system’s role in induction of labor and preterm delivery, and immuno-modulatory effects of the female sex hormones will be discussed in this and the next issue of the Journal. The implications of this research on the development of novel therapeutic approaches are also addressed.     

Predictors of Developmental Outcomes for Medically Fragile Early Intervention Participants

Little is documented about the determinants of developmentaloutcomes for medically fragile infants who receive early intervention.In this controlled longitudinal study 65 premature infants withintraventricular hemorrhage (IVH) were randomly assigned tointervention groups beginning at 3 months adjusted age (Early)or 12 months adjusted age (Delayed). The sample was 65% AfricanAmerican and 35% Caucasian, and over half the youngsters werebeing raised by single mothers. Although cost analyses revealedthat it was almost twice as expensive to begin sensorimotorintervention at the earlier age, annual comprehensive assessmentsrevealed no significant differences in developmental outcomesbased on age at start. Stepwise multiple regression analysesrevealed that Maternal Education and Neonatal Medical Problemswere significant predictors of outcomes at years 1, 3, 5, and7 regardless of age at start. Related findings from other studiesare discussed along with implications for policy and futureresearch.     

Current Status and Future Directions of Gene and Cell Therapy for Cystic Fibrosis

Although the development of gene therapy for cystic fibrosis (CF) was high priority for many groups in academia and industry in the first 10-15 years after cloning the cystic fibrosis transmembrane conductance regulator (CFTR) gene, more recently active research into CF gene therapy is only being performed by a small number of committed groups. However, despite the waning enthusiasm, which is largely due to the realization that gene transfer into lungs is more difficult than originally thought, and the fact that meaningful clinical trials are expensive and difficult to perform, gene therapy continues to hold promise for the treatment of CF lung disease. Problems related to repeat administration of adenovirus and adeno-associated virus-based vectors led to a focus on non-viral vectors in clinical trials. However, the recent evidence that lentiviral vectors may be able to evade the immune system and, thereby, allow for repeat administration and long-lasting expression opens new doors for the use of viral vectors in the context of CF gene therapy. In addition, early pre-clinical studies have recently been initiated to address cell therapy-based approaches for CF. In this review, we discuss recent developments with viral and non-viral vectors and cell therapy, and provide an update on clinical gene therapy studies.     

危险及有害饮酒的早期干预

目的 :对危险及有害饮酒者进行干预教育 ,随访观察干预后的效果。方法 :对 1 4 5例危险及有害饮酒者进行有关饮酒危害性的早期干预教育 ,发放自助手册 ,3个月后随访干预效果。结果 :(1 )干预后饮酒量较干预前下降了约 35% ,日饮 4标准杯的人数较干预前明显下降 (P <0 0 0 0 1 )。干预后饮酒频度从每周平均 4 - 5次降至 2 - 3次。每周饮酒大于 5次的人从 47 5 %降至 2 2 5 % ,下降差异有显著性 (P <0 0 0 0 1 )。干预后AUDIT总分和各因子分均较干预前明显下降 (P均小于 0 0 0 1 )。 (2 )干预后躯体损害、精神损害和社会问题总发生的情况 ,均较干预前明显减少 (P均 <0 0 0 1 )。结论 :对危险及有害饮酒者进行早期简短干预 ,可以明显减少饮酒量和饮酒频度 ,继而减少与酒相关的各种损害的发生     

Chimeric Antigen Receptors in Cancer Immuno-Gene Therapy: Current Status and Future Directions

The concept of chimeric antigen receptors (CARs) as molecules able to redirect T lymphocytes toward tumor cells is currently being exploited in the field of cancer immunotherapy. Despite promising preliminary results, some clinical trials evidenced limitations for this technology that must be overcome for more extensive application of CARs in tumor immunotherapy. We describe here the fundaments of these molecules in terms of structure, function, possible targets and pre-clinical and clinical applications. We also discuss strategies that can potentially overcome the limitations seen so far, paving the road to a wider application of this exciting new technology.     

Developing Psychosocial Interventions for Depression in Dementia: Beginnings and Future Directions

Teri, McKenzie, and LaFazia's (this issue) review of outcome studies suggests that a number of psychosocial interventions have shown positive benefits relative to depression in dementia. However, considerably more research will be required to marshal convincing and practice-relevant evidence for the efficacy of particular intervention techniques in producing clinically significant amelioration of depression in older adults with dementia. This commentary discusses risk-benefit considerations surrounding the use of interventions in vulnerable older adults, as well as suggesting issues to be addressed in intervention development studies on this class of interventions.     

我国临床心理学工作现状调查与展望

对３０个省市和所属地市中有心理学系、心理学教研室的高等院校和精神病医院和儿保等机构共１，４３４个寄发了调查表，回收４５７份，回收率为３２％，调查心理测验、心理咨询与治疗和从业人员情况。结果表明常用心理测验共２２种，其中用得最广的前五种为ＷＩＳＣ，ＥＰＱ，ＷＡＩＳ－ＲＣ，ＭＭＰＩ和ＷＰＰＳＩ，各测验应用最多的是医院（占全体的７０．６％），用途最多的为医疗方面（５０％），其次为教育和科研（各占２３．７％）。常用心理治疗方法有行为、认知、支持、精神分析和森田疗法等９种，常治的心理障碍有强迫症、恐怖症、焦虑症等２２种。在调查４５７个单位中有３３５个开展了心理咨询服务，近一年的求助者计８８，１９０人。求助的问题计１８种，依次为个人健康问题（２１．８％），一般人际关系（１５．３％），爱情问题（１０．５％）等。现在从业人员从测验、心理治疗至咨询三项工作来看，专业原为心理学的少（分别为８．３％，２．３％和７．２％），为临床医学的占最大多数（分别为７６．３％，８７．３％和７９．４％）。接受了临床心理系统训练的人数在１０％以内，接受短期专业训练占最大多数（９０％左右）。根据调查结果对这些工作作了展望。     

Early Intervention with Mentally Handicapped Children: A Critical Appraisal of Applied Research

Research on the impact of early intervention with mentally handicappedchildren and their families has placed too much emphasis uponchild develop mental progress to the neglect of several importantparental and environmental variables upon which the child'sultimate development depends. Studies have also tended not toinclude process measures in their pro gram evaluation procedures.These two major issues and others related to the appropriatenessof traditional group research designs for the early interventionfield are examined through an analysis of 20 studies carriedout in five countries in the last 10 years.     

Risk Factor Effect Sizes in PTSD: What This Means for Intervention

SUMMARY

This paper reviews evidence concerning the major risk factors for posttraumatic stress disorder. Although there are a number of consistent risk factors, their effects tend to be small and to vary according to the nature of the study. This suggests that they are not well suited to identifying individuals who require early intervention following a traumatic event. In contrast, methods based on symptom reports offer a much more sensitive and practicable approach to screening. A recent instrument, the Trauma Screening Questionnaire, is brief, simple to administer, and highly efficient at identifying survivors in need of intervention.     

Depends on Who You Ask: What Maximizes Participation of Families in Early Intervention Programs

This two-part study was a preliminary investigation of the typesof procedures that could be useful in maximizing the participationof families in early intervention programs for their special-needsinfants, toddlers, and preschoolers. In Study 1, 64 professionalsin the early intervention field completed a survey that described29 potential techniques for maximizing participation of families.For each technique, the respondents endorsed whether they employedthe procedure, or would if they could. In addition, they ratedthe expected effectiveness of each procedure. Verbal praiseand encouragement were highly rated and almost universally inuse, as were various types of written and resource materials.Tangible reinforcement was seldom employed and professionalrespondents tended to indicate that they did not expect thatsuch techniques would be useful. In Study 2, 29 mothers of high-riskinfants and toddlers currently in early intervention rated thesame 29 procedures, but were significantly more likely to endorsethe use of tangible reinforcers and logistical support. Comparisonsamong respondents from professional and parent samples werediscussed, along with implications of the findings and necessarydirections for future research in this area.