Comparisons between group- and individual-based interventions to support recovery from stroke and ischaemic heart disease in the community: a scoping review

PURPOSE

To map and summarise available literature on the effectiveness or other benefits of group- and individual-based interventions provided for adults living with stroke or ischaemic heart disease (IHD) in the community.

MATERIAL AND METHODS

The review was conducted based on JBI methodology and reported using Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for Scoping Reviews. Articles were retrieved from: Medline, PsychInfo, Embase, Scopus, and CINAHL from 2002-2022. Extracted data from eligible studies included type of health outcomes (e.g., impairments), retention and adherence, social connectedness, and the costs associated with group- and individual-based interventions.

RESULTS

After screening, five articles (representing 4 unique studies) comparing a group- and individual-based intervention were included (total sample size n = 87). Three types of interventions were assessed: exercise (3/5), communication (1/5), and occupational therapy (1/5). Effectiveness of group- and individual-based interventions at improving health outcomes (i.e. physical ability, communication, motivation, and quality of life) is unclear. Currently there is insufficient evidence to guide clinical practice.

CONCLUSIONS

There is limited evidence comparing interventions delivered in a group and individual modality for adults living with stroke or IHD. Adequately powered studies are needed to determine if mode of delivery is equivalent or more cost effective.

Effects of UGT1A, CYP2C9/19 and ABAT polymorphisms on plasma concentration of valproic acid in Chinese epilepsy patients

Aim: To evaluate the association between genetic polymorphisms and plasma concentration-to-dose ratio of valproic acid (CDRV) in Chinese epileptic patients. Methods: A total of 46 epileptic patients treated with valproic acid therapy were enrolled. 18 SNPs in nine genes related to valproic acid were directly sequenced with Sanger methods. Results: Patients carrying UGT1A6 heterozygous genotypes had significantly lower CDRV than those carrying the wild-type genotypes. In contrast, patients with the homozygote genotypes of CYP2C9 and ABAT had higher CDRV than those with the wild-type genotypes and patients with the heterozygous genotypes of CYP2C19 had higher CDRV. Conclusion: Detection of genetic polymorphism in these genes might facilitate an appropriate dose of valproic acid for epileptic patients. Further studies with larger cohorts are necessary to underpin these observations.

Personalized Medicine: Advanced Treatment Strategies to Revolutionize Healthcare

Personalized medicine (PM) is about developing an individualized approach to each patient's illness. Understanding how a patient's genomic portfolio renders them prone to various diseases may be enhanced by discovering genetic, epigenetic, and medical evidence. Medical therapy that is safe and effective for specific individuals may be predicted using the PM approach, which is a complete expansion of an older methodology (One-Size-Fits-All). Patient's well-being and longevity may improve and costs are reduced if PM is used. Using existing biomarkers and early genome and epigenomic processes to better understand PM may lead to earlier diagnosis of the disease, including carcinogenesis. A key focus of the PM technique is preventative medicine, which emphasizes proactive actions rather than depending only on reactive ones. More intrusive procedures may be avoided or postponed using this technique, resulting in a higher quality of life and lower financial burdens for patients. End-of-life care costs are putting a strain on governmentfunded healthcare systems across the globe, notably in the United States. When used in conjunction with present treatments, PM may help them work better and lessen the disadvantages of just non-PM methods. Using genetic profiling, doctors may choose a drug based on a participant's genetic profile that minimizes unwanted side effects and ensures a better result while also being less costly than a 'trial-and-error' approach to sickness treatment. The less effective non- PM ('trial-and-error') strategy leads to drug toxicity, severe adverse effects, reactive treatment, and misdiagnosis. PM and proactive therapeutic regimens should be used more often to save costs and enhance overall well-being.

Development of a Psychological Intervention to Improve Depressive Symptoms and Enhance Adherence to Antiretroviral Therapy among Adolescents and Young People Living with HIV in Dar es Salaam Tanzania

Background: Interventions that simultaneously target depression and antiretroviral therapy (ART) medication adherence are recommended for improving HIV treatment outcomes and quality of life for adolescents living with HIV. However, evidence is scarce on culturally feasible and acceptable interventions that can be implemented for HIV-positive adolescents in Tanzania. We, therefore, developed a manualized brief psychological intervention that utilizes evidence-based strategies to address depression and ART adherence in adolescents living with HIV in Tanzania. Methods: We used the Theory of Change Enhanced Medical Research Council framework (TOCMRC) for developing complex interventions in health care to develop the intervention in five phases. First, the literature was reviewed to identify potential intervention components. Second, we conducted a situational analysis using qualitative interviews with adolescents living with HIV, health care providers, and caregivers. Third, we conducted a mental health expert workshop; and fourth, theory of change workshops with representatives from the Ministry of Health, mental health professionals, HIV implementing partners, adolescents, and healthcare providers. Lastly, we synthesized results to finalize the intervention and a theory of change map showing the causal pathway for how we expect the developed intervention to achieve its impact. Results: Adolescents living with HIV in Tanzania experience several unmet mental health needs ranging from overwhelming depressive symptoms to not feeling understood by healthcare providers who lack mental health knowledge. Participants perceived psychological intervention that utilizes a task-shifting approach to be acceptable and beneficial to addressing those problems. The novel components of the NITUE intervention included incorporating evidence-based intervention components, namely, cognitive-behavioral therapy, motivational interviewing, and problem solving. In addition, caregiver inclusion in the treatment was essential to ensure access to care, compliance, and improved outcomes. Conclusions: A culturally appropriate brief psychological intervention that utilizes a task-shifting approach to address depression and medication adherence for adolescents living with HIV in Dar es Salaam, Tanzania, was developed. The intervention will be piloted for appropriateness, feasibility, and acceptability and will provide material for a future trial to determine its effectiveness.

Efficacy of second-line ICIs combined with TKIs among patients with metastatic renal cell carcinoma: a real-world study

Aim: To evaluate the efficacy of immune checkpoint inhibitors (ICIs) plus tyrosine kinase inhibitors (TKIs) as second-line treatment in patients with metastatic renal cell carcinoma (mRCC). Patients & methods: Baseline and follow-up data from patients with mRCC treated with second-line ICIs plus TKIs or TKIs alone from a single institution were retrospectively gathered. Results: A total of 110 patients were included. The objective response rate was higher among patients treated with ICIs plus TKIs than those treated with TKIs alone (36.5 vs 12.1%; p = 0.002). Treatment with ICIs plus TKIs was associated with longer progression-free survival (15.0 vs 9.0 months; p = 0.009) and overall survival (not reached vs 16.0 months; p = 0.018) than TKI monotherapy. The survival rates at 2 (83.0 vs 74.4%; p = 0.426) and 3 years (58.1 vs 47.5%; p = 0.214) between the two groups were not statistically different. Notably, patients with certain clinicopathological features tended to gain more survival benefits with combined therapy. Conclusion: ICIs plus TKIs showed superior progression-free survival time and tumor response rate over TKIs alone as second-line treatment in patients with mRCC. Future randomized prospective trials are necessary to validate these preliminary findings.

A Deep-Learning Model With the Attention Mechanism Could Rigorously Predict Survivals in Neuroblastoma

BACKGROUND

Neuroblastoma is one of the most devastating forms of childhood cancer. Despite large amounts of attempts in precise survival prediction in neuroblastoma, the prediction efficacy remains to be improved.

METHODS

Here, we applied a deep-learning (DL) model with the attention mechanism to predict survivals in neuroblastoma. We utilized 2 groups of features separated from 172 genes, to train 2 deep neural networks and combined them by the attention mechanism.

RESULTS

This classifier could accurately predict survivals, with areas under the curve of receiver operating characteristic (ROC) curves and time-dependent ROC reaching 0.968 and 0.974 in the training set respectively. The accuracy of the model was further confirmed in a validation cohort. Importantly, the two feature groups were mapped to two groups of patients, which were prognostic in Kaplan-Meier curves. Biological analyses showed that they exhibited diverse molecular backgrounds which could be linked to the prognosis of the patients.

CONCLUSIONS

In this study, we applied artificial intelligence methods to improve the accuracy of neuroblastoma survival prediction based on gene expression and provide explanations for better understanding of the molecular mechanisms underlying neuroblastoma.

A feasibility randomised control trial of individual cognitive stimulation therapy for dementia: impact on cognition, quality of life and positive psychology

OBJECTIVES

This study aimed to evaluate the feasibility of a 14-session programme of individual Cognitive Stimulation Therapy (iCST) for people with dementia (PWD). It addressed potential limitations in previous literature of iCST and evaluated possible impact on cognition, quality of life (QoL) and positive psychology.

METHOD

The 14-session iCST programme was developed using existing manuals for group and individual CST and consultation with experts in the field. Thirty-three PWD were recruited from care homes and randomly assigned to iCST (14, 45-min sessions) or treatment as usual (TAU) over seven weeks. Outcomes measures were assessed at baseline and follow-up after the intervention.

RESULTS

The intervention appeared feasible with high attendance to sessions, minimal levels of attrition, and ease of recruitment. Analysis of covariance indicated significant improvements in cognition (Alzheimer's Disease Assessment Scale-Cognitive subscale) for PWD receiving iCST compared to TAU. There were no significant differences between groups on follow-up scores on the standardised Mini Mental State Examination, measures of positive psychology or self- and proxy- reported QoL.

CONCLUSION

A 14-session programme of iCST delivered by professionals was feasible and acceptable to PWD and may provide benefits to cognition. A larger randomised control trial would be necessary to fully evaluate intervention impact on cognition, as well as QoL and positive psychology.

Multicentre randomised controlled trial about the effect of individual reminiscence therapy in older adults with neurocognitive disorders

OBJECTIVES

To evaluate the effectiveness of a 13-week individual reminiscence therapy (RT) intervention to improve the overall cognitive function, memory, executive function, mood and quality of life (QoL) of people with neurocognitive disorders.

METHODS

A single-blind, multicentre, randomised parallel two-arm controlled trial recruited 251 people with neurocognitive disorders attending 24 institutions providing care and support services for older adults in Portugal. The primary outcome measure was cognitive function (Mini-Mental State Examination [MMSE]). Secondary outcomes were memory (Memory Alteration Test [MAT]), executive function (Frontal Assessment Battery [FAB]), mood (Geriatric Depression Scale-15 [GDS-15]) and self-reported QoL-Alzheimer's disease AD). Participants in the intervention group (n = 131) received 26 individual RT sessions, twice a week, over the course of 13 weeks. Participants in the control group (n = 120) maintained their treatment as usual.

RESULTS

Intention-to-treat analysis showed that, at endpoint assessment, the intervention group had significantly improved in relation to the control group in MMSE (mean difference 1.84, 95% CI [0.80, 2.89], p = .001, d = .44), MAT (mean difference 2.82, 95% CI [0.72, 4.91], p = .009, d = .34) and QoL-AD (mean difference 1.78, 95% CI [0.17, 3.39], p = .031, d = .28). Non-significant improvements were found on FAB (mean difference 0.74, 95% CI [-0.04, 1.52], p = .062, d = .24) and GDS-15 (mean difference -0.63, 95% CI [-1.45, 0.19], p = .130, d = .19).

CONCLUSIONS

For people with neurocognitive disorders attending social care and support services, the individual RT designed for this trial should be considered an intervention with the potential to improve cognition, memory and QoL.

Perceived helpfulness of depression treatments among young adults with autism

Currently available treatments for depression show limited effectiveness in adults with autism spectrum disorders (ASD) based on measures of symptom changes and clinician impressions. Perceived helpfulness is another metric that has been found to be useful for understanding treatment outcomes in the general population, but it has not yet been explored in adults with ASD. Thus, the current study collected online survey data to examine patient-perceived treatment helpfulness in a sample of 144 adults with ASD who reported that they were currently receiving community-based treatment for depression. Findings indicate that while there was variability in the levels of perceived helpfulness for both medication and individual therapy, most adults with ASD perceived treatment to be at least moderately helpful. Notably, adults with ASD reported having been in treatment for a prolonged duration (5 to 6 years). Ordinal logistic regression models showed that adults with more depressive symptoms perceived treatments to be less helpful (i.e., medications: odds ratio [OR] = 0.92, 95% confidence interval[CI] = 0.89-0.95; individual therapy: OR = 0.95, 95% CI = 0.92-0.99). Moreover, women perceived medication as more helpful than men (OR = 2.33, 95% CI = 1.13-4.82). Other individual (i.e., age, race, education level) and treatment (i.e., treatment length, concurrent treatment) characteristics were not significantly associated with perceived helpfulness. These findings suggest that future studies may want to use perceived helpfulness, in addition to traditionally used objective outcomes, to understand patients' treatment experience and evaluate depression treatments for adults with ASD. LAY SUMMARY: Adults with autism are much more likely to be depressed than those without autism; therefore, effective depression treatments are necessary to improve mental health outcomes in this group. This online survey study found that most adults with autism felt that the depression treatments they were receiving in the community (i.e., medication and individual therapy) were helpful. Females and those with fewer symptoms of depression felt treatments were more helpful compared with males and those with more symptoms of depression. Our findings suggest that when examining whether treatments for depression are effective, it may be important to measure adults' feelings about the helpfulness of the treatments in addition to measuring changes in symptoms of depression.

An Activatable Theranostic Nanoprobe for Dual-Modal Imaging-Guided Photodynamic Therapy with Self-Reporting of Sensitizer Activation and Therapeutic Effect

Intelligent systems that offer traceable cancer therapy are highly desirable for precision medicine. Although photodynamic therapy (PDT) has been approved in the clinic for decades, determining where the tumor is, when to irradiate, and how long to expose to light still confuse the clinicians. Patients are always suffering from the phototoxicity of the photosensitizer in nonmalignant tissues. Herein, an activatable theranostic agent, ZnPc@TPCB nanoparticles (NPs), is prepared by doping a photosensitizer, ZnPc, with an aggregation-induced emission probe, TPCB. The assembled or disassembled ZnPc@TPCB NPs in various phases have behaved differently in fluorescence intensity, photoacoustic (PA) signals, and PDT efficiency. The intact nanoparticles are non-emissive in aqueous media while showing strong PA signals and low PDT efficiency, which can eliminate the phototoxicity and self-monitor their distribution and image the tumors' location. Disassembling of the NPs leads to the release of ZnPc and its red fluorescence turn-on to self-report the photosensitizer's activation. Upon light irradiation, the reactive oxygen species (ROS) generated by ZnPc can induce cell apoptosis and activate the ROS sensor, TPCB, which will yield intense orange-red fluorescence and instantly predict the therapeutic effect. Moreover, enhanced PDT efficacy is achieved via the GSH-depleting adjuvant quinone methide produced by the activated TPCB. The well-designed ZnPc@TPCB NPs have shown promising potential for finely controlled PDT with good biosafety and broad application prospects in individual therapy, which may inspire the development of precision medicine.

Comparing the effectiveness of individual and group therapy for students with symptoms of anxiety and depression: A randomized pilot study

Objective: To examine the effectiveness of individual versus group therapy for anxiety and depression among university students. Participants: Forty-one university students experiencing moderate to severe symptoms of anxiety and/or depression participated during one of three academic semesters from 2015 to 2016. Methods: Participants were randomly assigned to either 6-weeks of individual or group therapy and completed outcome measures at pre-and-post-treatment. Results: Significant reductions in both depression and anxiety scores were found across time, with no significant difference between group and individual therapy outcomes. Exploratory analysis of attitudes toward therapy found that while individual therapy was rated more favorably than group therapy overall, attitudes toward therapy became more favorable from pre to post-treatment for all participants. An interaction showed differences in attitudes toward individual and group therapy according to participants' randomly assigned treatment. Conclusions: These findings support the increased usage of group therapy within university counseling centers, with implications for stepped care discussed.

Social support and resilience in persons with severe haemophilia: An interpretative phenomenological analysis

Introduction

Haemophilia is a hereditary haemorrhagic disorder characterized by deficiency or dysfunction of coagulation factors. Recurrent joint and muscle bleeds lead to progressive musculoskeletal damage. Haemophilia affects patients physically but also socially and psychologically. Traumatic experiences, chronic stress and illnesses can lead to mental disorders, but many persons with haemophilia maintain a highly positive outlook.

Aim

To explore qualitatively which coping mechanisms persons with haemophilia use and in what way they help them to live with their diagnosis.

Methods

We recruited five adults with haemophilia and conducted semi‐structured face‐to‐face interviews. Transcripts were analysed using interpretative phenomenological analysis (IPA).

Results

Two core themes emerged from the analysis: social support as an external factor and resilience as an internal factor of coping with the disease. Persons with haemophilia usually need help with health‐related complications, and this affects the social support they require. Their wider support network tends to involve family and friends but also healthcare professionals and other specialists. This network provides practical help but also functions as an important psychological protective factor. An unexpected finding was that persons with haemophilia want not only to receive support but are also keen to offer support to others.

Conclusion

These findings can help identify persons who provide most support to people suffering from haemophilia. Haemophilic centres should include in their teams psychologists and social workers and offer individual and group therapy to their clients, group meetings for friends and families of persons with haemophilia, provide learning resources to teachers aiming to incorporate children with haemophilia in their peer group, and organize Balint groups for physicians, psychologists and other healthcare professionals.

[The progress on diagnosis and treatment of larynx cancer]

SummaryLaryngeal cancer remains one of the most common tumors of head and neck. While significant advancements have been made over the last several decades, diagnosis and treatment of laryngeal cancer presents an unique challenge given its complexity. It is essential to perform a thorough preoperative assessment by the dedicated multidisciplinary team（MDT）, including confirmed diagnosis, accurate staging, surgical selection, rehabilitation and reconstruction, supportive care and postoperative follow-up. Surgery has been the historical mainstay for localized disease and still is an integral part of treatment, while transoral CO2 laser microsurgery is being increasingly popularised in early stage tumors and occasionally in more advanced forms of the disease. Nonsurgical methods like radiation and systemic therapy have emerged as viable options in patients considered unfit for surgery or those who refuse it. In addition, novel targeted agents are showing promise for the population with metastases. Currently, a multimodal approach is preferred in advanced cases, but the optimal strategy remains under debate. Close follow-up is crucial in achieving early detection and being able to treat the recurrence with curative intention. In summary, all patients should have a comprehensive evaluation and treatment plan in a multidisciplinary setting. This highlights the need for further research and innovation in the field.

Individual psychological therapy in an acute inpatient setting: Service user and psychologist perspectives

OBJECTIVES

The acute inpatient setting poses potential challenges to delivering one-to-one psychological therapy; however, there is little research on the experiences of both receiving and delivering therapies in this environment. This qualitative study aimed to explore service users' and psychologists' experiences of undertaking individual therapy in acute inpatient units. It focused on the relationship between service users and psychologists, what service users found helpful or unhelpful, and how psychologists attempted to overcome any challenges in delivering therapy.

DESIGN

The study used a qualitative, interview-based design.

METHODS

Eight service users and the six psychologists they worked with were recruited from four acute inpatient wards. They participated in individual semi-structured interviews eliciting their perspectives on the therapy. Service users' and psychologists' transcripts were analysed together using Braun and Clarke's (2006, Qualitative Research in Psychology, 3, 77) method of thematic analysis.

RESULTS

The accounts highlighted the importance of forming a 'human' relationship - particularly within the context of the inpatient environment - as a basis for therapeutic work. Psychological therapy provided valued opportunities for meaning-making. To overcome the challenges of acute mental health crisis and environmental constraints, psychologists needed to work flexibly and creatively; the therapeutic work also extended to the wider context of the inpatient unit, in efforts to promote a shared understanding of service users' difficulties.

CONCLUSIONS

Therapeutic relationships between service users and clinicians need to be promoted more broadly within acute inpatient care. Psychological formulation can help both service users and ward staff in understanding crisis and working collaboratively. Practice-based evidence is needed to demonstrate the effectiveness of adapted psychological therapy models.

PRACTITIONER POINTS

Developing 'human' relationships at all levels of acute inpatient care continues to be an important challenge for clinical practice. Due to the distress of individuals and the constraints of the acute inpatient environment, psychologists need to be flexible and adaptable in delivering individual therapy. Making meaning and psychological formulation can give service users a sense of hope and empowerment, and can contribute to a shared understanding within the ward team of service users' difficulties.

A new perspective on perioperative coagulation management in a patient with congenital factor VII deficiency: A case report

RATIONALE

Congenital factor VII (FVII) deficiency is a rare coagulopathy. There are little clinical data for congenital FVII deficiency and no evidence-based medicine guidelines for treatment.

PATIENT CONCERNS

A 48-year-old woman with gallbladder stones suffered from intermittent abdominal pain for 2 months that was accompanied by an abnormally prolonged prothrombin time.

DIAGNOSES

The woman was diagnosed as having cholecystolithiasis with cholecystitis and congenital FVII deficiency.

INTERVENTION

Preoperative evaluation confirmed the necessity of recombinant activated factor VII (rFVIIa) replacement therapy. We monitored the plasma factor VII activity (FVII:C) and coagulation function, determined the half-life of rFVIIa in the patient, and administered personalized rFVIIa replacement therapy.

OUTCOMES

Laparoscopic cholecystectomy was performed successfully, and the patient recovered well without any complications.

LESSONS

The clinical manifestations and severity of bleeding in patients with congenital FVII deficiency can vary widely. The history of massive bleeding and plasma FVII:C are the decisive factors when implementing a replacement therapy. The actual half-life of rFVIIa can be determined from intensive monitoring results of plasma FVII:C at the beginning of replacement therapy, which could further guide the personalization of rFVIIa replacement therapy.

Afatinib treatment for her-2 amplified metastatic colorectal cancer based on patient-derived xenograft models and next generation sequencing

BACKGROUND

Substantial progress has been made in metastatic colorectal cancer (mCRC) treatment, but there is still a fraction of patients cannot find any effective therapeutic strategy after guideline-recommended standard chemotherapy and molecular targeted therapy.

CASE PRESENTATION

Here we present a KRAS/NRAS/BRAF wild-type mCRC patient who has been previously treated with FOLFIRI (fluorouracil, leucovorin, and irinotecan), XELOX (capecitabine and oxaliplatin), cetuximab and bevacizumab, and then received the next generation sequencing (NGS) and whose metastatic subcutaneous nodule was resected to generate patient-derived xenograft (PDX) models. The NGS revealed HER-2 amplification as well as an activating mutation S310F and PDX models tested several drugs finding that afatinib was the optimal agent with notable efficacy and well tolerance among 6 regimens. Therefore, this patient started to take afatinib orally and achieved 3 months progression-free survival (PFS) and relief of clinical symptoms without severe adverse effects.

CONCLUSIONS

NGS and PDX models have great significance for precision and individualized medicine in the mCRC treatment, especially for patients whose diseases have been progressed after multiline standard therapies.

Factors associated with stress in families of children with autism spectrum disorder

PURPOSE

The purpose of this study was to identify key factors associated with severe stress in families raising a child with autism spectrum disorder (ASD).

METHODS

Questionnaires were mailed to families with one or more children with a diagnosis of ASD. Data from 543 surveys were analyzed using univariate and multivariate logistic regression.

RESULTS

Forty-four percent (n = 241) of the caregivers reported severe family stress related to raising a child with ASD. Severe family stress was associated with (1) reduced ability to socialize; (2) not having accessed individual therapy; (3) negative co-parent relationships; and (4) high out of pockets costs due to the child's ASD. The specific ASD diagnosis, comorbid conditions, socio-demographic variables, and social support were not associated with severe family stress.

CONCLUSION

The findings of the current study highlight the importance of a systemic approach to family stress, whereby individual, family, and ecological factors are investigated.

Could Homeopathy Become An Alternative Therapy In Dengue Fever? An example Of 10 Case Studies

Background:Dengue fever is one of the most rampant epidemics in India of late and any therapy that may help limit the sickness and hospital admissions is worth considering. In India complementary and alternative medicine physicians are medically trained and hence have a role to play in delivery of public health. Case Series:We present a retrospective case series of 10 Indian patients who were diagnosed with dengue fever and treated exclusively with homeopathic remedies at Bangalore, India. This case series demonstrates with evidence of laboratory reports that even when the platelets dropped considerably there was good result without resorting to any other means. Conclusions:A need for further, larger studies is indicated by this evidence, to precisely define the role of homeopathy in treating dengue fever. This study also emphasises the importance of individualised treatment during an epidemic for favourable results with homeopathy. Abbreviations:DF: dengue fever, NS1: non-structural protein 1 antigen, IgG: immunoglobulin G, IgM: immunoglobulin M, +ve: positive, -ve: negative, WBC: white blood cells, RBC: red blood cells, ESR: erythrocyte sedimentation rate.

Assessment of the impact of individual therapy on upper limb function in patients diagnosed with painful shoulder syndrome

INTRODUCTION

Functional disorders of the shoulder girdle affect 1/3 of the population. The diagnosis of "painful shoulder" or shoulder impingement syndrome is vague and imprecise. It can relay to so tissue pathology as well as to limitation of mobility of the joint. In this case an appropriate diagnosis, followed by a quick and effective treatment, is crucial. A physiotherapy assessment, performed during an individual therapy session sets out a way forward for targeted rehabilitation. Objectives and purpose of the article: The aim of this publication is to assess the impact of individual therapy on the function of the shoulder girdle in patients subject to health resort treatment.

METHODS AND MATERIALS

The study included 30 patients diagnosed with shoulder joint conditions before and a er individual therapy with a physical therapist. The clinical study involved basic measurements of the range of mobility and standardized functional tests. The patients were surveyed to evaluate changes in the performance of daily activities before and a er the therapy. Pain assessment was conducted using the Visual Analogue Scale (VAS). The results were subjected to statistical analysis.

RESULTS

The use of individual health resort treatment therapy significantly improved individual functional capacity of the patients. Self-evaluation of the patients on the performance of daily activities has shown improvement of the quality of those activities. According to VAS scale, a difference between the level of perceived pain before (mean = 6.2) and a er physical therapy treatment (mean = 3.7) as well as an improvement of the range of mobility have been observed.

CONCLUSIONS

The results of the study confirmed that the treatment has significantly reduced the pain. Individual work with a physical therapist, focused on the improvement of the range of mobility of the shoulder girdle and functional tasks, clearly reduces limitations of daily activities of the patients and can improve the quality of their life.

Targeting the SR-B1 Receptor as a Gateway for Cancer Therapy and Imaging

Malignant tumors display remarkable heterogeneity to the extent that even at the same tissue site different types of cells with varying genetic background may be found. In contrast, a relatively consistent marker the scavenger receptor type B1 (SR-B1) has been found to be consistently overexpressed by most tumor cells. Scavenger Receptor Class B Type I (SR-BI) is a high density lipoprotein (HDL) receptor that facilitates the uptake of cholesterol esters from circulating lipoproteins. Additional findings suggest a critical role for SR-BI in cholesterol metabolism, signaling, motility, and proliferation of cancer cells and thus a potential major impact in carcinogenesis and metastasis. Recent findings indicate that the level of SR-BI expression correlate with aggressiveness and poor survival in breast and prostate cancer. Moreover, genomic data show that depending on the type of cancer, high or low SR-BI expression may promote poor survival. This review discusses the importance of SR-BI as a diagnostic as well as prognostic indicator of cancer to help elucidate the contributions of this protein to cancer development, progression, and survival. In addition, the SR-B1 receptor has been shown to serve as a potential gateway for the delivery of therapeutic agents when reconstituted high density lipoprotein nanoparticles are used for their transport to cancer cells and tumors. Opportunities for the development of new technologies, particularly in the areas of cancer therapy and tumor imaging are discussed.

Measurement of red blood cell 6-thioguanine nucleotide is beneficial in azathioprine maintenance therapy of Chinese Crohn's disease patients

OBJECTIVE

It remains controversial whether 6-thioguanine nucleotide (6-TGN)-based dose adjusting can be beneficial in azathioprine (AZA) therapy. This study is designed to assess the role of 6-TGN concentrations in maintaining clinical remission in Chinese patients with Crohn's disease (CD).

MATERIAL AND METHOD

We performed a prospective observational study and collected data of CD patients in the First Affiliated Hospital of Anhui Medical University from June 2013 to April 2014. Demographic material, CD activity index, 6-TGN concentration, and laboratory tests were recorded at baseline and at each visit. In addition, 6-TGN was measured when drug adverse effects occurred. All patients achieved maintenance stage were administered a stable AZA dose at least 3 months before enrollment and were followed up at least 12 months. Thiopurine S-methyltransferase (TPMT) genotype was measured before AZA treatment.

RESULTS

Sixty-nine patients receiving maintenance therapy were analyzed. A positive correlation was found between 6-TGN levels and AZA dose (r = 0.258, p = 0.032). The mean 6-TGN concentration was 302.06 ± 115.84 in the remission group vs. 264.94 ± 164.53 pmol/8 × 10(8) RBC in those with active disease (t = 0.847, p = 0.40), and 197.74 ± 66.54 pmol/8 × 10(8) RBC in patients who relapsed vs. 310.26 ± 122.38 pmol/8 × 10(8) RBC for those in sustained remission (t= -2.541, p = 0.013). In the leukopenia group, the 6-TGN concentration was 469.11 ± 115.53 pmol/8 × 10(8) RBC vs. 257.31 ± 83.74 pmol/8 × 10(8) RBC in the non-leukopenia group (t = 7.622, p < 0.001). There was a significant negative correlation between leukocyte count and 6-TGN concentration (r= -0.326, p = 0.006).

CONCLUSIONS

6-TGN measurement is a helpful method of preventing disease relapse and avoiding leukopenia in individual azathioprine maintenance therapy.

Individual Versus Individual and Group Therapy Regarding a Cognitive-Behavioral Treatment for Battered Women in a Community Setting

The current study aimed to test the clinical effectiveness of a cognitive-behavioral therapy (CBT) program for battered women in a community setting and to find out whether effectiveness of individual therapy can be improved in conjunction with group therapy. One hundred sixteen treatment-seeking battered women were assigned either to CBT on an individual basis or an individual and group basis. Psychological treatment, focused on post-traumatic stress disorder (PTSD), emotional discomfort, and impaired functioning, comprised a 17-session program, including emotional expression, psychoeducation, trauma re-exposure, coping skills, and problem-solving training. Although most treated patients in both groups improved in all variables (PTSD, emotional discomfort, and impaired functioning) at all assessments, the combined individual and group therapy did better than the individual therapy regarding PTSD symptoms and impaired functioning at follow-up assessments. These findings partially support the beneficial effects of group CBT as adjunctive therapy to individual CBT. Implications of this study for clinical practice and future research in this field are commented on.

Outpatient psychotherapy practice with adolescents following psychiatric hospitalization for suicide ideation or a suicide attempt

Outpatient treatment is standard care for adolescents discharged following a psychiatric hospitalization. There is little research, however, on the amount and types of psychotherapy these clients receive in the community. We examined therapy attendance and therapist report of outpatient therapy practice with adolescents discharged from psychiatric hospitalization following either a suicide attempt or severe suicidal ideation in the Northeastern USA. Therapists (n = 84) completed a packet of self-report questionnaires regarding treatment of these adolescents in the first six months after discharge from the hospital. Information on number of sessions attended, primary presenting problem, therapist orientation, therapy techniques, and therapeutic relationship was collected. The findings indicated that therapists met their clients in both private and community outpatient settings. The most common modality of treatment was individual therapy, but almost all types of therapeutic techniques were endorsed. Adolescents attended an average of 8.1 therapy sessions (SD = 4.7), with 18% terminating treatment against therapist advice within the first three months. Psychologists, psychiatrists, and social workers used cognitive-behavioral, psychodynamic, and family system techniques about equally. Social workers used humanistic techniques more than their counterparts. The variability in number of therapy sessions attended suggests that many adolescents discharged after a psychiatric hospitalization will not receive adequate care. Short-term therapy protocols designed for community practice emphasizing cognitive techniques may be useful to test in future community-based research trials based on the high percentage of adolescents attending relatively few sessions.

Behavioral therapy across the spectrum

Numerous effective behavioral therapies have been developed that can bring the treatment to the patient rather than bringing the patient to treatment. These behavioral therapy techniques, which can provide effective treatment across the spectrum of severity of alcohol abuse disorders, include facilitated self-change, individual therapies, couples and family approaches, and contingency management. New methods of delivery and successful adjuncts to existing behavioral treatments also have been introduced, including computerized cognitive-behavioral treatments, Web-based guided self-change, and mindfulness-based approaches. Although a wide variety of behavioral approaches have been shown to have good efficacy, choosing the treatment most appropriate for a given patient remains a challenge.