Therapeutic empathy and recovery from depression in cognitive-behavioral therapy: a structural equation model.

This study demonstrated that therapeutic empathy has a moderate-to-large causal effect on recovery from depression in a group of 185 patients treated with cognitive-behavioral therapy (CBT). The authors simultaneously estimated the reciprocal effect of depression severity on therapeutic empathy and found that this effect was quite small. In addition, homework compliance had a separate effect on clinical recovery, over and above the effect of therapeutic empathy. The patients of novice therapists improved significantly less than did the patients of more experienced therapists, when controlling for therapeutic empathy and homework compliance. Ss who terminated therapy prematurely were less likely to complete the self-help assignments between sessions, rated their therapists as significantly less empathic, and improved significantly less. Ss with borderline personality disorder improved significantly less, but they rated their therapists as just as empathic and caring as other patients. The significance of these findings for psychotherapy research, treatment, and clinical training is discussed.     

Cognitive‐Behavioral Treatment of Hoarding in Youth: A Case Illustration

Hoarding in children is associated with more severe ancillary psychopathology, and has poor treatment outcome. At present, there are no empirically established procedures for treating hoarding in youth. The present case illustration is of a 10‐year old child (“Grace”) who presented for treatment with significant hoarding related to academic concerns and additional unrelated symptoms of obsessive‐compulsive disorder (OCD). Grace was treated with cognitive behavior therapy (CBT) primarily comprising exposure with response prevention, behavioral experiments, and cognitive therapy, along with a program of reinforcement delivered by her parents to maintain her motivation for therapy. After 23 sessions and one booster session, Grace's symptoms improved significantly, with gains maintained at 1‐year follow‐up. In addition to the benefits of the specific interventions chosen, the role of therapist–patient/parent alliance as a contributory factor for good outcome is emphasized. As hoarding is underinvestigated in youth, suggestions for further investigation are offered.     

Treating a case of surface dyslexia after closed head injury.

We describe an original treatment program for surface dyslexia in a patient with a closed head injury. Addressing the question of whether the deficient lexical reading routes could be improved in this type of case. we designed three tasks and administered them over ten consecutive treatment sessions. Results indicate improved accuracy of responses as a function of presentation times or response times, or both, on all treatment tasks. Comparisons of standardized reading comprehension and oral reading tests before and after therapy disclosed increases in reading rate, with the patient's originally high level of accuracy remaining constant. This suggests that the patient incorporated the more rapid lexical reading strategy without compromising her level of accuracy.     

肝移植治疗肝豆状核变性

背景：肝移植能够为肝豆状核变性患者提供正常的肝组织以纠正其遗传缺陷,改善铜代谢、肝硬化所致的各种临床症状及神经精神症状。 目的：观察肝移植治疗肝豆状核变性的效果。 方法：选择17例肝豆状核变性患者,3例患者行尸体肝移植,14例患者行亲体肝移植,所有肝移植患者动脉重建采用供肝动脉与受者肝固有动脉端端吻合,胆道重建均采用胆道端端吻合,术中均未放置胆道支架管支撑引流。 结果与结论：围手术期死亡1例,生存时间超过1年15例,超过3年10例。8例伴有神经系统功能障碍患者中,6例症状得到不同程度改善。生存时间超过1年的15例患者移植后肝功能较移植前明显改善,血清铜蓝蛋白水平明显升高 (P < 0.05)。证实肝移植可改变肝豆状核变性患者的代谢缺陷,是治疗肝豆状核变性的有效方法。     

Malakoplakia and immunosuppressive therapy. Reversal of clinical and leukocyte abnormalities after withdrawal of prednisone and azathioprine.

Malakoplakia is a chronic granulomatous inflammatory disorder. It is suspected clinically by the presence of chronic infection and diagnosed by histologic examination of affected tissues. Studies of 4 patients with malakoplakia--2 renal transplant recipients, 1 patient with systemic lupus erythematosus, and 1 patient with polymyositis--are reported. All patients were receiving prednisone and azathioprine at the time of diagnosis and had an infection caused by Escherichia coli. Leukocytes from all patients failed to kill Staphylococcus aureus and E coli normally in vitro. Cholinergic agonists had no apparent effect on bacterial killing in vitro or in vivo in the 2 patients examined. Clinically, malakoplakia improved significantly when immunosuppressive therapy was tapered or discontinued, and leukocyte function returned to normal in all 4 patients. The cases reported here and those documented previously suggest that the pathogenesis of malakoplakia and its treatment may not be the same for all patients. Malakoplakia may be more common than previously thought, particularly with the increased use of immunosuppressive therapy.     

Measurement of the dose components of fast and thermal neutrons and photons from a 0.1 mg 252Cf source in water for brachytherapy treatment planning

The use of 252Cf in brachytherapy is expected to be more effective with the therapy of bulky tumors than the conventional therapy with photons. For treatment planning a code developed for calculation of gamma dose was used to generate the dose distributions of fast and 10B enhanced thermal neutrons and photons. Dose distributions of these components measured with ionization chambers and a GM counter were fitted to analytical functions as required by the modified treatment planning program. A comparison of these experimental results and the treatment planning output indicate good agreement. Therefore, the program may be used to optimize the brachytherapy procedure considering all three dose components. A realistic case of a patient being treated with conventional brachytherapy has been used to calculate the dose distribution that would be obtained by use of the 252Cf source.     

Effectiveness of behavioral therapy for chronic low back pain: a component analysis

The effects of outpatient group behavioral therapy including aerobic exercise (BE), behavioral therapy only (B), and aerobic exercise only (E) on pain and physical and psychosocial disability were evaluated and compared in a group of mildly disabled chronic low-back-pain patients. Ninety-six Ss were randomly assigned to the 3 treatments and a waiting-list control (WL) condition and assessed on a variety of patient self-report, spouse-rated, and direct observational measures at pretreatment, posttreatment, and 6- and 12-month follow-ups. Patients in the BE condition, but not the B or E conditions, improved significantly more pretreatment to posttreatment than did WL patients on the patient self-report and observer-rated measures. At both follow-ups, all 3 treatment groups remained significantly improved from pretreatment, with no significant differences among treatments.     

Peripheral blood stem cell transfusion for marrow replacement.

A patient is presented who was treated with ablative therapy for Hodgkin's disease and rescued by reinfusion of peripheral blood stem cells (PBSC). The PBSC were used because previous therapy (chemotherapy and radiation to the pelvis) had resulted in fatty hypocellular marrow which was inadequate for marrow transplantation. The PBSC were collected by leukapheresis before and after recovery of the marrow from suppression with cyclophosphamide to bring the stem cells into cohort cycle and to increase the proportion of stem cells in the peripheral blood for collection. The patient showed a successful recovery on a time scale somewhat longer cells administered, the absence of stimulation by granulocyte macrophage-colony stimulating factor or other cytokine, or potential damage done to stromal elements during previous radiation and chemotherapy. The patient remains in clinical complete remission, fully engrafted, more than one year since his autologous transplant.     

Plasmapheresis increases T4 lymphocytes in a patient with AIDS

Previously the authors demonstrated that most patients with AIDS have serum antilymphocyte antibodies. Therefore, in an attempt to decrease these antibodies and at least transiently increase blood lymphocytes, they treated one AIDS patient with three courses of plasmapheresis. During or after each course, his T4 lymphocytes rose significantly but subsequently fell to baseline values within two weeks after therapy. The increase in T4 lymphocytes was associated with removal of patient plasma rather than infusion of heterologous plasma. These results suggest the need for more investigation into plasmapheresis as adjunct therapy for AIDS.     

Assessing the integrated approach to diabetes patient education: a case study.

This article describes a nursing department quality assurance study involving a diabetes patient education program. The problem identified was whether staff nurses could teach diabetes education to their patients effectively rather than the diabetes educator doing all of the teaching. A two-phase pilot study was conducted. As a result, an improved audit tool was developed to gain more specific information to answering the question related to solving the problem. Implementation of the pilot, development of the audit tool, results and follow-up are described.     

The effects of patient education on patient cognition and dis-related anxiety.

A rheumatoid arthritis patient education program was developed with objectives of increasing patient knowledge base and improving health status. Forty-six rheumatoid arthritis outpatients entered a three-session multidisciplinary education program. Each client was given a cognitive test and the Arthritis Impact Measurement Scale (AIMS) before, immediately after, and at remote follow-up. Data were analyzed to determine the effect of age and disease duration on clients' ability to benefit from group education. The effect of the program on physical and psychosocial parameters was also assessed. There was a significant increase in average cognitive scores between pre- and post-tests which remained at one month follow-up testing. Pre-test cognitive scores correlated positively with disease duration. At immediate post-test a correlation between anxiety scores and physical parameters was seen, which was not present on pre- or follow-up testing. No correlation was found between increase in cognitive scores and overall health status. Multivariate analysis of the AIMS test showed significant improvement in total health score at remote testing. Depression scores significantly improved from post to remote follow-up testing. This study suggests that one 'side effect' of patient education may be a transient worsening of psychological status in patients with greatest disease involvement.     

Childhood non-Hodgkin's lymphoma. The results of a randomized therapeutic trial comparing a 4-drug regimen (COMP) with a 10-drug regimen (LSA2-L2)

Members of the Childrens Cancer Study Group treated 234 eligible patients in a randomized trial designed to study the relative effectiveness of two therapy programs for the treatment of childhood and adolescent non-Hodgkin's lymphoma. Two chemotherapeutic strategies were compared: a 4-drug regimen (COMP) and a 10-drug regimen (modified LSA2-L2). Failure-free survival for all patients was 60 per cent at 24 months. In patients with disseminated disease treatment success was influenced by both the histologic subtype of disease and the therapeutic regimen followed. The 10-drug program was more effective than the 4-drug program in patients with disseminated lymphoblastic disease (two-year failure-free survival rate, 76 vs. 26 per cent, respectively; P = 0.0002), whereas the 4-drug program was more effective than the 10-drug program in those with nonlymphoblastic disease (57 vs. 28 per cent, respectively, P = 0.008). The less toxic, more easily administered 4-drug regimen was as effective as the 10-drug regimen in patients with localized disease (89 vs. 84 per cent, respectively).     

Once-daily versus thrice-daily administration of netilmicin in combination therapy ofPseudomonas aeruginosa infection in a man-adapted neutropenic animal model

A granulocytopenic mouse model was used to elucidate the impact of dose spacing on the activity of netilmicin againstPseudomonas aeruginosa. A thigh infection was produced and then treated with netilmicin combined with azlocillin. Netilmicin was injected subcutaneously at decreasing doses every 20 min to result in plasma-concentration-time curves similar to those observed in patients on intravenous netilmicin treatment. A once-daily regimen was simulated and compared to a simulated conventional schedule of every 8 h. Identical total amounts of drug were used in both groups of comparatively treated mice. Therapeutic efficacy was quantitated by repeated determinations of surviving organisms in thigh homogenates. Combination therapy was significantly more effective than azlocillin treatment alone. In combination regimens the simulated once-daily netilmicin schedule killed the target organisms faster than the simulated thrice-daily regimen and was significantly more efficacious by 24 and 32 h in two out of three strains ofPseudomonas aeruginosa tested. It is concluded that the results of combination therapy of severePseudomonas aeruginosa infections in the immunocompromised host might be improved by choosing an aminoglycoside dosage interval of 24 h instead of the conventional 8 h.     

Patient knowledge of immunotherapy before and after an educational intervention: a comparison of 2 methods.

BACKGROUND: Immunotherapy is an invaluable therapy for allergic asthma, allergic rhinitis, and hymenoptera hypersensitivity. It is, however, not without risks. OBJECTIVES: To examine patient knowledge regarding immunotherapy and to determine the most effective educational method to improve their knowledge by answering the following questions: Before educational intervention, what is the current knowledge level regarding allergy vaccinations of patients receiving immunotherapy? What effect does an educational encounter have on that level of knowledge? Which educational intervention--a one-on-one session vs a handout--if either, increases patient knowledge more? METHODS: An original, self-administered patient questionnaire was distributed to all patients receiving immunotherapy. Patients were randomly assigned to a control group, an intervention group that received an educational handout monthly for 2 months, or an intervention group that had a one-on-one educational session with a physician or nurse practitioner. After 3 months, all patients completed an identical follow-up questionnaire. Pretest and posttest scores were compared for each group and among the different groups to determine which method was more effective. Repeated-measures analysis of variance was used to determine the effect of instruction type on differences in pretest and posttest scores. RESULTS: All 3 groups significantly improved their mean overall questionnaire scores (P < .001). The amount of change was greater in the intervention groups than in the control group, but it did not reach statistical significance (P = .59). CONCLUSIONS: Baseline immunotherapy knowledge of allergy vaccination patients was better than expected, and further educational interventions did not significantly improve this knowledge.     

A randomized trial comparing intravenous immune globulin and plasma exchange in Guillain-Barré syndrome. Dutch Guillain-Barré Study Group.

BACKGROUND. The subacute demyelinating polyneuropathy known as Guillain-Barré syndrome improves more rapidly with plasma exchange than with supportive care alone. We conducted a multicenter trial to determine whether intravenous immune globulin is as effective as the more complicated treatment with plasma exchange. METHODS. To enter the study, patients had to have had Guillain-Barré syndrome for less than two weeks and had to be unable to walk independently. They were randomly assigned to receive either five plasma exchanges (each of 200 to 250 ml per kilogram of body weight) or five doses of a preparation of intravenous immune globulin (0.4 g per kilogram per day). The predefined outcome measure was improvement at four weeks by at least one grade on a seven-point scale of motor function. RESULTS. After 150 patients had been treated, strength had improved by one grade or more in 34 percent of those treated with plasma exchange, as compared with 53 percent of those treated with immune globulin (difference, 19 percent; 95 percent confidence interval, 3 percent to 34 percent; P = 0.024). The median time to improvement by one grade was 41 days with plasma exchange and 27 days with immune globulin therapy (P = 0.05). The immune globulin group had significantly fewer complications and less need for artificial ventilation. CONCLUSIONS. In the acute Guillain-Barré syndrome, treatment with intravenous immune globulin is at least as effective as plasma exchange and may be superior.     

Effectiveness of prednisolone/aspirin therapy for recurrent aborters with antiphospholipid antibody.

Seventeen women with recurrent fetal loss associated with anti-phospholipid antibody were treated by prednisolone and low-dose aspirin (PSL/ASP) therapy from the early gestational period. The success rate of pregnancy in the treated patients was significantly higher than that in 12 untreated patients of similar background, including age, number of previous fetal losses and anti-cardiolipin titre (76.5 versus 8.3%, P less than 0.01). The degree of fetal growth retardation evident in previous pregnancies was also improved by the therapy, suggesting that PSL/ASP itself has a beneficial effect against placental damage. These clinical improvements were accompanied by a reduction in anti-phospholipid antibody titre, especially that of anti-phosphatidylserine antibody (anti-PS), to within the normal range within 8 weeks after PSL/ASP administration in most of the treated patients. There was no reduction of antibody titre in the untreated patients during pregnancy. It was concluded that PSL/ASP therapy, when started in the early gestational period (prior to 8 weeks gestation), was effective for the achievement of successful pregnancy and the prevention of fetal growth retardation and that the anti-PS titre was a good clinical marker for evaluating the effect of PSL/ASP therapy.     

Ternary cancer comprising prostatic cancer,esophageal cancer,and gastric cardia cancer: a case report and literature review

A 61-year-old male patient was admitted to our hospital with frequent urination, urgency, and increased nocturia for more than 3 months, and the symptoms were aggravated for 1 week. Prostate biopsy revealed prostatic adenocarcinoma. After 5 months, the patient developed dysphagia and gastroscopy showed a middle and lower esophageal cancer (squamous cell carcinoma). 12 months later, he returned to the hospital because of dysphagia. He was examined by gastroscopy which showed the cardia to have low-grade adenocarcinoma. The patient was given Casodex + Zoladex endocrine therapy, zoledronic acid inhibiting bone destruction, concurrent chemoradiotherapy, capecitabinen tablets at a dose of 1000 mg bid, 3 cycles of intravenous paclitaxel at 180 mg/d1 plus cisplatin 60 mg/d1-2, 4 cycles of intravenous paclitaxel at 150 mg/d1 plus cisplatin at 60 mg/d1 as systemic chemotherapy. The curative effect is was considerable after treatment, and the patient’s condition was stable. Since the onset of the disease in March 2018, the patient’s condition had not progressed significantly for 27 months. The diagnosis and treatment of this patient with ternary cancer in the hospital improved the clinician’s understanding of multiple primary cancers. Multidisciplinary treatment improved the patient’s prognosis and quality of life. We reviewed similar case reports and retrospective studies of multiple primary cancers and found that there is no specific treatment for multiple primary cancers, but a corresponding treatment program can be formulated for each tumor to control progression while screening for possible other primary tumors.     

The bias in psychotherapy research evaluation.

Using a 3 X 3 X 3 factorial design, clinical psychologists' (N = 204) evaluations were obtained of the methodology of a bogus psychotherapy outcome experiment that varied on the outpatient population treated and the results. Three types of neurotic outpatients were treated in the bogus study, and the experiment's results indicated that psychoanalytically oriented therapy was more effective than behavior therapy, behavior therapy was more effective than psychoanalytically oriented therapy, or psychoanalytically oriented therapy and behavior therapy were equally effective. The third independent variable was psychologists' theoretical orientation (psychodynamic, behavioral, or eclectic). A significant Orientation X Results interaction was obtained, and the results suggest that psychodynamic clinicians are biased against outcome research that demonstrates the superiority of behavior therapy.     

Cross-reactivity between deciduous trees during immunotherapy. I. In vivo results

Thirty-nine children with rhinoconjunctivitis due to birch pollinosis were given immunotherapy for 3 years with a potent, purified pollen preparation made from either birch alone or from a mixture of birch, alder and hazel. The therapy was evaluated with self-evaluation after each season, daily symptom score during the season, conjunctival provocation test and skin-prick test. All children but one considered that their condition had been improved by the treatment. Symptom scores decreased slightly more in the group treated with the mixture than in the group treated with birch only due to symptoms decreasing faster in the mixture treated group after each pollen peak (P< 0.001). The sensitivity of the conjunctiva and the skin decreased significantly in both groups but without any significant differences between the groups. After 3 years the conjunctival sensitivity correlated strongly to eye symptoms during the season. Immunotherapy with a mixture of birch, alder and hazel appears to be at least as effective as a preparation made from birch only when treating birch pollinosis even in a region where birch is totally dominating among the pollens from deciduous trees.     

Isolation of Mycobacterium chelonei with the lysis-centrifugation blood culture technique.

Mycobacterium chelonei was isolated from a patient by the lysis-centrifugation and the conventional two-bottle blood culture methods. The lysis-centrifugation method was significantly more sensitive and rapid than the conventional method in detecting and isolating this organism; quantitations done by this method were useful for monitoring response to therapy.