scholarly journals A Natural Experiment Created by Pandemic Restriction: Comparing In-Person, Hybrid, & Teletherapy Formats

2021 ◽  
Vol 5 (Supplement_1) ◽  
pp. 806-806
Author(s):  
Tracy Wharton ◽  
Daniel Paulson
Keyword(s):  
Household Income ◽  
Culturally Responsive ◽  
Early Stage ◽  
Evidence Base ◽  
Reach Ii ◽  
Trade School ◽  
Intervention Dosage ◽  
Age Range ◽  
Unique Study ◽  
Online Group

Abstract The FL-REACH intervention for families in early stage post-dementia diagnosis was originally adapted from the REACH II program for use in an outpatient clinic. Pandemic restrictions forced an adaptation to a teletherapy format. The timing of changes allowed comparison of caregivers who participated in clinic (n=10), switched modalities mid-treatment (n=7), and participated as teletherapy (n=14). Groups were similar in age range, gender, and relationship, with both spouses and adult children participating. Participants in the fully online group were more likely than others to have high school or trade school education than to have graduated from college. All participants in the in-person and hybrid groups had incomes over $40,000/year, while 36% of the online sample had less household income, were more likely to be Hispanic-identifying (43% versus 6%), and had higher burden scores (M=41.43 versus M=32.56 in person, M=29.86 hybrid) and lower preparedness scores (M=19.86 versus M=22.90 in person, M=28.14 hybrid) at baseline (p<.05). The intervention proceeded with the same intervention dosage (8 hours total), and outcomes were essentially comparable, with all groups showing statistically significant improvement on measures of preparedness, burden, and risk. While in-person intervention helped strengthen relationships with the medical team, inclusion of family via telehealth provided opportunity for a more culturally responsive and inclusive engagement, although there remain questions regarding reasons for differences at baseline. Identification of differences in key outcomes for direct comparisons between in-person, hybrid, and teletherapy interventions are limited in the evidence base, making this a unique study at an important moment in time.

scholarly journals Romantic Love and Attentional Biases Toward Attractive Alternatives and Rivals: Long-Term Relationship Maintenance Among Female Chinese College Students

2019 ◽  
Vol 17 (4) ◽  
pp. 147470491989760
Author(s):  
Yidan Ma ◽  
Weifeng Xue ◽  
Guang Zhao ◽  
Shen Tu ◽  
Yong Zheng
Keyword(s):  
College Students ◽  
Romantic Relationships ◽  
Cultural Context ◽  
Chinese Women ◽  
Early Stage ◽  
Romantic Love ◽  
Relationship Maintenance ◽  
Attentional Biases ◽  
Age Range

Studies about heterosexual individuals’ long-term relationship maintenance have indicated that committed individuals possess evolved psychological mechanisms that help protect their ongoing romantic relationships against threats from attractive others during early stage attentional processing when mating-related motivation is activated. In this study, two experiments tested the relationship maintenance mechanism among committed female college students in the Chinese cultural context under different love priming conditions. Committed Chinese women displayed inattention to attractive alternatives in positive love-scenario priming (Study 1: 114 female undergraduates, age range = 18–26 years), subliminal semantic love priming (Study 2: 110 female undergraduates, age range = 18–25 years), and baseline conditions (Studies 1 and 2). Those with high levels of chronic jealousy showed significantly increased attention to and difficulty disengaging attention from attractive rivals when subliminally primed with love. This provides further evidence, from an Eastern cultural context, for the existence of attentional biases toward attractive alternatives and rivals in early stage attentional processes for relationship maintenance. This research also illustrates the important role of romantic love in maintaining long-term romantic relationships.

Feasibility study of a self-guided cognitive behaviour therapy Internet intervention for cancer carers

2013 ◽  
Vol 19 (4) ◽  
pp. 270 ◽  
Author(s):  
Karen Scott ◽  
Lisa Beatty
Keyword(s):  
Feasibility Study ◽  
Cognitive Behaviour Therapy ◽  
Early Stage ◽  
Evidence Base ◽  
Behaviour Therapy ◽  
Attrition Rates ◽  
Qualitative Feedback ◽  
Cognitive Behaviour ◽  
Study Participants ◽  
Changes Over Time

Despite the evidence base for Internet-delivered self-help programmes, their application to cancer carers has not been reported. This feasibility study evaluated a 6-week internet cognitive behaviour therapy (CBT) programme for early stage cancer carers. The study participants comprised 13 carers who were recruited over a 17-month period. Measures included distress, quality of life and programme engagement. Changes over time were measured using effect sizes (Cohen’s d), whereas acceptibility was assessed using qualitative feedback. Low enrolment and high attrition rates resulted in a failure to demonstrate feasibility. Large improvements in negative affect (d = 0.88) and emotional functioning (d = 0.62) were found. For treatment completers, the intervention holds promise in reducing distress. However, in light of the serious challenges with recruitment and retention, further research is needed to resolve participation barriers.

OP135 CAR T-cell Therapy HTA Informs Australian Policy

2019 ◽  
Vol 35 (S1) ◽  
pp. 30-31
Author(s):  
Paul Fennessy ◽  
Vanessa Clements
Keyword(s):  
T Cell ◽  
Cell Therapy ◽  
Early Stage ◽  
Evidence Base ◽  
T Cell Therapy ◽  
Car T Cell ◽  
Early Results ◽  
Car T Cell Therapy ◽  
Car T ◽  
Manufacturing Facilities

IntroductionChimeric antigen receptor (CAR) T-cell therapy is offered as a once-only treatment for patients with certain cancers that are not responsive to standard treatment. While clinicians, patients and their families increasingly seek access to CAR T-cell therapy, there is no revenue stream to support access through public or private health systems.MethodsThe New South Wales (NSW) Ministry of Health and Victorian Department of Health and Human Services oversighted a health technology assessment (HTA) to explore the status and geography of regulatory frameworks supporting delivery of CAR T-cell therapy, evidence for the safety, efficacy and cost, clinical trials conducted or underway and manufacturing aspects.ResultsCAR T-cell therapies are approved in the European Union and United States of America, and being considered in Australia, Canada, China and Japan. Efficacy, safety and cost-effectiveness is limited by the size and single-arm design of early stage trials and variation between them. While overall response ranges from 36–93 percent, early results for some cancers are less favorable. Durability of treatment effect is unknown, adverse events are common and can be life-threatening and risk of delayed onset toxicity remains unknown. Treatment requires access to approved manufacturing facilities (none in Australia) and specialist clinical staff.ConclusionsCAR T-cell therapy is promising and demand is increasing, but the limited safety profile and evidence base should mitigate policy and investment decisions. Broader consideration should be given to developing, or identifying access to, manufacturing and clinical workforce capability and capacity to meet national demand. Australia is likely to encounter similar issues in other jurisdictions, such as limited evidence base and complex safety issues. Factors to be considered on a local and national basis for assessment and implementation include: (i) Regulatory support for industry; (ii) Strategies to manage uncertainties in long-term risks, benefits and costs; (iii) Access to accredited manufacturing facilities; (iv) Developing clinical and manufacturing workforce capability and capacity.

What is the evidence for rechallenging with anthracyclines or taxanes in metastatic breast cancer? A review of the data

2009 ◽  
Vol 27 (15_suppl) ◽  
pp. 1072-1072
Author(s):  
J. Krell ◽  
C. Harper-Wynne ◽  
D. Miles ◽  
V. Misra ◽  
S. Cleator ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Metastatic Breast Cancer ◽  
Early Stage ◽  
Safety Data ◽  
Metastatic Breast ◽  
Evidence Base ◽  
Current Evidence ◽  
Optimal Sequence ◽  
Pubmed Database ◽  
Current Evidence Base

1072 Background: Anthracyclines and taxanes are widely used in the adjuvant setting for high risk, early stage breast cancer. This raises the issue of what is the optimal therapy for those patients who relapse, and what the potential role, if any, there is for rechallenge with these agents. The current evidence base for rechallenging with anthracyclines/anthracediones and taxanes in metastatic breast cancer (MBC) is examined in this study. Methods: Medline/Pubmed database searches were performed upto October 2008 to identify studies in which patients (pts) were rechallenged with anthracyclines/anthracediones or taxanes in MBC. Results: The efficacy data, as well as the safety data relating to neurotoxicity and cardiotoxicity from these studies, are summarized in the Table. Twenty-seven studies were identified (20=anthracycline/anthracedione, 7= taxane) of which only two were prospective studies. Both were small (n= 74 & 51) and related to anthracycline rechallenging. Conclusions: Evidence exists to support rechallenging with anthracyclines and taxanes. However, there are few prospective data on reexposure to taxanes and no data comparing anthracyclines versus taxanes following adjuvant exposure to both agents, supporting the need for clinical trials in this area. Such trials should ideally incorporate a cross-over design at treatment failure, which would shed light on the optimal sequence in which these agents should be administered. [Table: see text] No significant financial relationships to disclose.

scholarly journals Neuropalliative care

Neurology ◽  
2018 ◽  
Vol 91 (5) ◽  
pp. 217-226 ◽  
Author(s):  
Claire J. Creutzfeldt ◽  
Benzi Kluger ◽  
Adam G. Kelly ◽  
Monica Lemmon ◽  
David Y. Hwang ◽  
...  
Keyword(s):  
Palliative Care ◽  
Early Stage ◽  
Research Priorities ◽  
Evidence Base ◽  
Models Of Care ◽  
Decision Quality ◽  
Management Communication ◽  
Palliative Care Education ◽  
Mind And Body ◽  
Effective Models

Neuropalliative care is an emerging subspecialty in neurology and palliative care. On April 26, 2017, we convened a Neuropalliative Care Summit with national and international experts in the field to develop a clinical, educational, and research agenda to move the field forward. Clinical priorities included the need to develop and implement effective models to integrate palliative care into neurology and to develop and implement informative quality measures to evaluate and compare palliative approaches. Educational priorities included the need to improve the messaging of palliative care and to create standards for palliative care education for neurologists and neurology education for palliative specialists. Research priorities included the need to improve the evidence base across the entire research spectrum from early-stage interventional research to implementation science. Highest priority areas include focusing on outcomes important to patients and families, developing serious conversation triggers, and developing novel approaches to patient and family engagement, including improvements to decision quality. As we continue to make remarkable advances in the prevention, diagnosis, and treatment of neurologic illness, neurologists will face an increasing need to guide and support patients and families through complex choices involving immense uncertainty and intensely important outcomes of mind and body. This article outlines opportunities to improve the quality of care for all patients with neurologic illness and their families through a broad range of clinical, educational, and investigative efforts that include complex symptom management, communication skills, and models of care.

scholarly journals Age-Adjusted Associations Between Comorbidity and Outcomes of COVID-19: A Review of the Evidence From the Early Stages of the Pandemic

2021 ◽  
Vol 9 ◽  
Author(s):  
Kate E. Mason ◽  
Gillian Maudsley ◽  
Philip McHale ◽  
Andy Pennington ◽  
Jennifer Day ◽  
...  
Keyword(s):  
Early Stage ◽  
Severe Disease ◽  
Evidence Base ◽  
Population Based ◽  
Control Measures ◽  
International Evidence ◽  
Early Stages ◽  
Hospitalised Patients ◽  
Adjusted Association ◽  
Obesity And Cancer

Objectives: Early in the COVID-19 pandemic, people with underlying comorbidities were overrepresented in hospitalised cases of COVID-19, but the relationship between comorbidity and COVID-19 outcomes was complicated by potential confounding by age. This review therefore sought to characterise the international evidence base available in the early stages of the pandemic on the association between comorbidities and progression to severe disease, critical care, or death, after accounting for age, among hospitalised patients with COVID-19.Methods: We conducted a rapid, comprehensive review of the literature (to 14 May 2020), to assess the international evidence on the age-adjusted association between comorbidities and severe COVID-19 progression or death, among hospitalised COVID-19 patients – the only population for whom studies were available at that time.Results: After screening 1,100 studies, we identified 14 eligible for inclusion. Overall, evidence for obesity and cancer increasing risk of severe disease or death was most consistent. Most studies found that having at least one of obesity, diabetes mellitus, hypertension, heart disease, cancer, or chronic lung disease was significantly associated with worse outcomes following hospitalisation. Associations were more consistent for mortality than other outcomes. Increasing numbers of comorbidities and obesity both showed a dose-response relationship. Quality and reporting were suboptimal in these rapidly conducted studies, and there was a clear need for additional studies using population-based samples.Conclusions: This review summarises the most robust evidence on this topic that was available in the first few months of the pandemic. It was clear at this early stage that COVID-19 would go on to exacerbate existing health inequalities unless actions were taken to reduce pre-existing vulnerabilities and target control measures to protect groups with chronic health conditions.

scholarly journals Giant Euthyroid Goitre: Clinical Profile as Seen in Otorhinolaryngology Department of a Tertiary Health Institution, in Northwestern Nigeria

2019 ◽  
pp. 1-9
Author(s):  
Daniel Aliyu ◽  
Kufre Robert Iseh ◽  
Yikawe Stephen Semen ◽  
Stanley Baba Amutta ◽  
Joseph Hassan Solomon ◽  
...  
Keyword(s):  
Early Stage ◽  
Adult Population ◽  
Geographical Location ◽  
Tertiary Hospital ◽  
Recurrent Laryngeal Nerve Injury ◽  
Clinical Profile ◽  
Thyroid Function Tests ◽  
High Prevalence ◽  
A Prospective Study ◽  
Age Range

Background: Goiter refers to a diffuse enlargement of thyroid gland. It has a high prevalence in adult population in endemic areas where iodized salt is not part of the regular diet. Aim: We report the clinical profile of giant goiters seen in a tertiary hospital in Northwestern Nigeria. Methods: A prospective study of all surgically operated cases of goiter carried out in a tertiary health hospital in Northwestern Nigeria, over a period of 6 years between January 2011 and December 2016. Bio data, duration of goiter, symptoms, geographical location, thyroid function tests, radiological reports and treatment were recorded and analyzed. Results: Ninety-Seven patients were operated for goitre during the study period. Out of these 19 (19.6%) were giant goitres weighing between 900g-3200g. There were 13 (68.4%) females and 6 (31.6%) males with M: F ratio of 1:2.2. Age range was between 39 – 71 years with a mean age of 53.2 years. Prevalence was high in the 41-60 year age group. Duration of goiter in 13 (68.4%) of patients was between 11-20years. Retrosternal extension was observed in 7 (36.8%) patients. Tracheal deviation was the most common risk factor for respiratory complication in all the patients followed by tracheomalacia in 8(42.1%). Postoperative temporary Tracheostomy was carried out in 4(21.1%) of patients. Recurrent laryngeal nerve injury occurred in 2(10.5%). No mortality was recorded. Conclusion: Respiratory complications are commonly associated with giant goiters, a pathology that is entirely preventive if diagnosed and managed at an early stage.

A review of policy and provision of emotional support for people living with early-stage dementia in the Republic of Ireland and call for specialist counselling and psychotherapy services

Dementia ◽  
2020 ◽  
pp. 147130122097771
Author(s):  
Ashley Morgan
Keyword(s):  
Public Policy ◽  
Emotional Support ◽  
Early Stage ◽  
Emotional Health ◽  
Healthcare Delivery ◽  
Psychosocial Interventions ◽  
Evidence Base ◽  
Anxiety And Depression ◽  
National Guidelines ◽  
Diagnosis Of Dementia

Public policy in Ireland recognises that people living with early-stage dementia are likely to require considerable emotional support following diagnosis; anxiety and depression are very common within this population. Yet psychosocial interventions to support emotional health of people who receive a diagnosis of dementia are sparse; there is no mention of counselling and psychotherapy for people living with early dementia in national guidelines, despite a promising evidence base that has amassed internationally in recent decades. This article explores the psychological impact of receiving a diagnosis and the scant offering of emotional and psychological post-diagnostic support that is available for people living with early-stage dementia in Ireland. The author draws attention to the curious tension between the widely recognised psychological benefits of early diagnosis of dementia and the jarring delay in disclosure that continues to prevail across Irish healthcare delivery. The evidence base for counselling and psychotherapy for people living with mild to moderate dementia in regard to anxiety and depression is discussed. Recommendations are made for further research into specialist counselling and psychotherapy interventions with a strong involvement from people living with dementia embedded in both research and design. The author also calls for public policy to reflect the preference of people living with dementia for earlier diagnosis and to highlight the appetite and ability of people living with dementia to engage in psychotherapeutic interventions.

Speech Therapy for Children Who Stutter

2018 ◽  
pp. 321-344
Author(s):  
Divya Seth ◽  
Santosh Maruthy
Keyword(s):  
Behavioral Intervention ◽  
Speech Therapy ◽  
Rating Scales ◽  
Evidence Base ◽  
Long Term Effects ◽  
Popular Approach ◽  
Severity Rating ◽  
Treatment Research ◽  
Age Range

This chapter aims to investigate and evaluate the evidence available for stuttering treatment research in children who stutter (CWS) and provide a qualitative review of the same. Studies were considered for review if (1) they were behavioral intervention of stuttering for children, (2) participants were in the age range of 2-18 years, and (3) the outcomes reported assessed stuttering. Twenty-seven studies were obtained through an electronic search of databases covering two approaches and 10 techniques. The analysis of these studies revealed that direct approaches have a stronger evidence base in comparison to the indirect approaches. The most popular approach with maximum studies is the early intervention Lidcombe program. The commonly used outcome measures included the percentage of syllables stuttered, syllables per minute, and severity rating scales. The conclusion drawn from the review suggest that evidence base to support behavioral intervention of CWS exists for a limited number of intervention techniques and among them very few exploring the long-term effects of the intervention.

Intrasentential binding and extrasentential binding in child and adult Korean

2019 ◽  
Vol 39 (6) ◽  
pp. 633-651
Author(s):  
Kum-Jeong Joo ◽  
Kamil Ud Deen
Keyword(s):  
Early Stage ◽  
Long Distance ◽  
Binding Properties ◽  
Korean Children ◽  
Preceding Sentence ◽  
Age Range ◽  
Local Binding

This article investigates the binding properties of the Korean reflexive caki. Korean caki allows a local antecedent, a long-distance sentence-internal antecedent, and (unusually) an extrasentential antecedent. Two experiments were conducted with Korean-speaking child participants (mean age = 5;8; age range = 5;1–6;4) and adult controls. The first tested local binding versus long-distance intrasentential binding, and the second tested extrasentential binding. The results show, first, that the children allowed both a local and a long-distance antecedent for caki, with a preference for the long-distance reading (counter to many claims that children show a robust preference for local antecedents crosslinguistically). Second, the children allowed caki to refer to an antecedent in a preceding sentence. These results indicate that, at an early stage, Korean children have acquired adult-like knowledge of the complex properties of caki, including what might be considered the computationally taxing option of extrasentential binding.

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