Examining clinical judgment in an adaptive intervention design: The fast track program

Although clinical judgment is often used in assessment and treatment planning, rarely has research examined its reliability, validity, or impact in practice settings. This study tailored the frequency of home visits in a prevention program for aggressive- disruptive children (n = 410; 56% minority) on the basis of 2 kinds of clinical judgment: ratings of parental functioning using a standardized multi-item scale and global assessments of family need for services. Stronger reliability and better concurrent and predictive validity emerged for the 1st kind of clinical judgment than for the 2nd. Exploratory analyses suggested that using ratings of parental functioning to tailor treatment recommendations improved the impact of the intervention by the end of 3rd grade but using more global assessments of family need did not.     

Multimodal Cognitive Therapy: Combining Treatments That Bypass Cognitive Deficits and Deal With Reasoning and Appraisal Biases

The process of recovery in schizophrenia involves resolving persistent symptoms, addressing cognitive impairments, and improving functional outcomes. Our research group has demonstrated the efficacy of cognitive adaptation training (CAT)—a home-based psychosocial treatment utilizing environmental supports such as medication containers, signs, checklists, and the organization of belongings to bypass deficits in cognitive functioning and cue and sequence adaptive behavior) for improving adherence to medications and functional outcomes in schizophrenia. Early CAT pilot studies utilizing some therapists with training in cognitive behavior therapy (CBT) techniques for psychosis found significant improvements in positive symptoms. More recent larger scale randomized clinical trials failed to replicate this finding with CAT therapists not trained in CBT techniques. Persistent psychotic symptoms substantially impair patients’ ability to adapt to life in the community. Cognitive behavior therapy for psychosis (CBTp) is an evidence-based practice for addressing persistent positive symptoms and the distress associated with them. CBTp decreases symptomatology and minimizes the negative effect of persisting symptoms upon individuals with this disorder. We now describe a home-delivered, multimodal cognitive treatment targeting functional outcomes and persistent positive symptoms for individuals with schizophrenia by utilizing both CAT and CBT techniques. We discuss the advantages and challenges of combining these 2 interventions, present a small retrospective data analysis to support their combination into a multimodal treatment, and describe the design of an ongoing randomized trial to investigate efficacy.     

2009年美国血液病学年会造血干细胞移植热门临床研究报告

<正>2009年美国血液病学年会上研究者对异基因造血干细胞移植(allogeneic hematopoietic stem cell transplantation,allo-HSCT)予以极大的关注,相关会议摘要超过1200篇。本文就一些涉及重要的、被反