Fifteen years after treatment: a follow-up study of comprehensive vocationally-oriented psychotherapy.

The fourth follow-up study of adolescent delinquent boys treated in a community-based program that combined job placement, remedial education, and psychotherapy indicates that the better overall adjustment of the treated group, compared to untreated controls, is maintained well into adulthood. It reaffirms the importance of developing sound, innovative means of reaching adolescents in crisis, and suggests the value of a full-scale replication of the original program.     

Fifteen years after the INSERM report. Psychoanalysis's efficacy reevaluated

ObjectiveSince the 2000s, “mental health” policies in France have to be based on evidence. A report on various forms of psychotherapy, published by the INSERM (the French National Institute of Health and Medical Research) in 2004, and whose conclusion was that there is no evidence of effectiveness for psychoanalysis, remains an important reference. The aim of this article is to re-examine its scientific value, fifteen years later.MethodAfter returning to the context in which this report was written and the controversies surrounding its publication, we propose a review of the efficacy studies that have since evaluated psychoanalysis. This recent literature, mostly international, remains relatively little known in France.ResultsThe INSERM's expert report – whose status could in part be promoted at the time of its publication – now appears to be relatively dated, both in terms of methodology and in its conclusions. The majority of current efficacy studies show that psychoanalytical and cognitive-behavioral therapies do not show any significant differences in efficacy for all known disorders.DiscussionThese results give rise to debate. Some scientists believe that they are only due to a lack of rigor in the experimental protocols. Others, on the contrary, maintain that the search for specific factors of efficacy is a dead end and promote studies in natural conditions, in order to assess the cumulative contextual factors of therapeutic effectiveness.ConclusionsWithout prejudging future research orientations and results, it nevertheless appears that the INSERM report can no longer be the dominant reference in France today for recommending psychotherapeutic “good practices.” Research has progressed considerably. In view of the international scientific literature available today, psychoanalysis is one offer of care to be advocated among others – a position to which many countries subscribe.     

Fifteen years of research with the Staff Observation Aggression Scale: a review

OBJECTIVE: Research on the prevalence and causes of in-patient aggression has been hindered by the use of different methods for measuring aggression. Since Palmstierna and Wistedt presented the Staff Observation Aggression Scale (SOAS) in 1987, this data collection method has been used in various studies, which may make comparisons more useful. METHOD: Studies with SOAS aggression data were compiled using MEDLINE, the Internet, and references from SOAS papers. RESULTS: Reviews of studies on psychometric properties suggest fair to good inter-rater reliability and validity for SOAS assessments. The number of aggressive incidents per patient per year found on acute admissions wards (n = 38) considerably varied, with a range of 0.4-33.2 incidents (mean = 9.3). CONCLUSION: Although the aggression data included in the present review were obtained in highly comparable ways, substantial differences in aggression rates between wards were still found. Some countries (e.g. the Netherlands) appear to have a relatively high incidence of aggression on acute wards.     

Fifteen years of experience with the midfacial distraction without maxillary osteotomy protocol

Purpose

Midfacial distraction for facial stenosis is minimizing the communication between cranial fossa and nasal fossa caused by the Le Fort III osteotomy during frontofacial advancement procedures. There are different types of distractors, such as internal and external devices. The aim of our study is to present a series of 22 consecutive distraction cases operated without any Le Fort osteotomy with external distraction frames. We completely avoid the gap between the skull and nose, thus avoiding related complications.

Patients and methods

Between 1997 and 2012, we operated on 22 patients presenting syndromes associating midfacial retrusion, maxillomandibular class III malocclusion and upper airway obstruction.

Methods

We perform a fronto-orbital advancement. We do not perform any maxillary osteotomy. A vertical cut in the lateral orbital wall is done towards the inferior orbital fissure and another cut on the zygomatic arch. We realise the fixation of the frame posteriorly with a folded K-wire and anteriorly with a transmaxillary pin. Aiming overcorrection, we distract on average 1 mm a day for a mean period of 26 days and with a horizontal distraction vector.

Results

No deaths or life-threatening complications were reported. All midfacial retrusions were corrected without relapse. The advancement ranged between 6 and 20 mm. Several complications were notified: one sphenopetrous dislocation, one ethmoidonasal dislocation, two device disassemblages and two cases of maxillary sinusitis. Some of these complications caused an incomplete distraction result.

Conclusions

Compared to other techniques, this method is safe, simple and efficient. By sparing major osteotomies, it avoids severe complications.     

Developing the master educator: cross disciplinary teaching scholars program for human and veterinary medical faculty.

OBJECTIVE: At the University of California, Davis (UCD), the authors sought to develop an institutional network of reflective educational leaders. The authors wanted to enhance faculty understanding of medical education's complexity, and improve educators' effectiveness as regional/national leaders. METHODS: The UCD Teaching Scholars Program is a half-year course, comprised of 24 weekly half-day small group sessions, for faculty in the School of Medicine and Veterinary Medicine. The program's philosophical framework was centered on personal reflection to enhance change: 1) understanding educational theory to build metacognitive bridges, 2) diversity of perspectives to broaden horizons, 3) colleagues as peer teachers to improve interactive experiences, and 4) reciprocal process of testing theory and examining practice to reinforce learning. The authors describe the program development (environmental analysis, marketing, teaching techniques), specific challenges, and failed experiments. The authors provide examples of interactive exercises used to enhance curricular content. The authors enrolled 7-10 faculty per year, from a diverse pool of current and near-future educational leaders. RESULTS: Four years of Teaching Scholars participants were surveyed about program experiences and short/longer term outcomes. Twenty-six (76%) respondents reported that they were very satisfied with the course (4.6/5), individual curricular blocks (4.2-4.6), and other faculty (4.7). They described participation barriers/facilitators. Participants reported positive impact on their effectiveness as educators (100%), course directors (84%), leaders (72%), and educational researchers (52%). They described specific acquired attitudes, knowledge, and skills. They described changes in their approach to education/career changed based on program participation. Combining faculty from different educational backgrounds significantly broadened perspectives, leading to greater/new collaboration. DISCUSSION: Developing a cadre of master educators requires careful program planning, implementation, and program/participant evaluation. Based on participant feedback, our program was a success at stimulating change. This open assessment of programmatic strengths and weaknesses may provide a template for other medical institutions that seek to enhance their institutional educational mission.     

Training a retarded child as a behavioral teaching assistant

After baseline observations were made of the classroom disruptive behavior of three retarded children, a behavior modification program was initiated. Hector, a 14-yr-old boy with an IQ of 42 distributed candy reinforcers to the best behaved pupils in a class for the severely retarded. The two most distruptive children in the class were made targets for behavior modification by Hector, who was first required to earn the privilege of being a teaching assistant by behaving well in his own classroom. Hector's appropriate behavior increased when he was reinforced by serving as a “helper” and the target children behaved more acceptably through the behavior modification program even though the reinforcers were delivered by a peer.     

Cognitive evolution of a girl submitted to right hemispherotomy when five years old

Since the age of three years the patient suffered from early drug-resistant partial epilepsy with electric status during slow sleep, owing to a micropolygyric malformation of the right fronto-temporo-parietal lobes. The hemispherotomy (when five years of age) was followed by immediate and persistent disappearance of the seizures and withdrawal of the treatment. The transfer of right hemispheric functions to the left hemisphere occurred very early; the child’s development was examined in relation to the restoration of these functions and the age at surgery. The early surgical intervention and the plasticity of the brain – along with an intensive cognitive rehabilitation – seem to be important in determining the favorable global cognitive outcome. Visuo-spatial abilities and multi-modal integration of these functions with memory, attention and language have been the most critical domains and are recently in progress. The rapidity of processing complex tasks is particularly lacking. This seems to be the expression of the defective development of the Central Executive System.