The Role of Practitioner Resilience and Mindfulness in Effective Practice: A Practice-Based Feasibility Study

Abstract

A growing body of literature attests to the existence of therapist effects with little explanation of this phenomenon. This study therefore investigated the role of resilience and mindfulness as factors related to practitioner wellbeing and associated effective practice. Data comprised practitioners (n = 37) and their patient outcome data (n = 4980) conducted within a stepped care model of service delivery. Analyses employed benchmarking and multilevel modeling to identify more and less effective practitioners via yoking of therapist factors and nested patient outcomes. A therapist effect of 6.7 % was identified based on patient depression (PHQ-9) outcome scores. More effective practitioners compared to less effective practitioners displayed significantly higher levels of mindfulness as well as resilience and mindfulness combined. Implications for policy, research and practice are discussed.

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The Relationship Between Therapist Effects and Therapy Delivery Factors: Therapy Modality, Dosage, and Non-completion

Abstract

To consider the relationships between, therapist variability, therapy modality, therapeutic dose and therapy ending type and assess their effects on the variability of patient outcomes. Multilevel modeling was used to analyse a large sample of routinely collected data. Model residuals identified more and less effective therapists, controlling for case-mix. After controlling for case mix, 5.8 % of the variance in outcome was due to therapists. More sessions generally improved outcomes, by about half a point on the PHQ-9 for each additional session, while non-completion of therapy reduced the amount of pre-post change by six points. Therapy modality had little effect on outcome. Patient and service outcomes may be improved by greater focus on the variability between therapists and in keeping patients in therapy to completion.

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A Systematic Review of Health-related Work Outcome Measures, and Quality Criteria based Evaluations of their Psychometric Properties

Publication date: Available online 15 July 2016
Source:Archives of Physical Medicine and Rehabilitation
Author(s): B.A. Mateen, C. Doogan, K. Hayward, S. Hourihan, J. Hurford, E.D. Playford
ObjectiveTo examine the state of psychometric validation in the health-related work outcome literature.Data SourcesWe searched Pubmed, PMC, CINAHL, EMBASE [+ EMBASE Classic], and PsycINFO, from inception to January 2016., using the search terms: Stroke, Multiple Sclerosis, Epilepsy, Spinal Cord Injury, Brain Injury, Musculoskeletal Disease, Work, Absenteeism, Presenteeism, Occupation, Employment, Job, Outcome measure, Assessment, Work Capacity Evaluation, Scale, and Questionnaire.Study Selection & Data Extraction597 outcome measures were identified from the 22,676 retrieved abstracts. Inclusion was based on content analysis. 95 health-related work outcome measures were retained, of which two were treated as outliers and therefore are discussed separately. All six authors individually organized the 93 remaining scales based on their content. A follow-up search using the same sources, and time period, with the name of the outcome measures and the following terms: Psychometric, Reliability, Validity, Responsiveness, identified 263 unique Classical Test Theory (CTT) psychometric property datasets for the 93 tools. An assessment criterion for psychometric properties was applied to each manuscript, and where consensus was not achieved, the rating delivered by the majority of the assessors was reported.Data Synthesis18 of the manuscripts reporting psychometric data were not accessible and therefore could not be assessed. 39 scored less than 20% of the maximum achievable score, 106 between 20-40%, 82 between 40- 60%, 15 scored between 60-80%, and only 1 scored above 80%. The three outcome measures associated with the highest scoring datasets were the Sheehan Disability Scale, the Fear Avoidance Beliefs Questionnaire, and the Assessment of Subjective Handicap of Epilepsy scales. And finally, only 2 psychometric validation datasets reported the complete set of baseline psychometric properties.ConclusionThis systematic review highlights the current limitations of the health-related work outcome measure literature, including the limited number of robust tools available.



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Goal Management Training combined with external cuing as a means to improve emotional regulation, psychological functioning, and quality of life in patients with acquired brain injury: A randomized controlled trial

Publication date: Available online 15 July 2016
Source:Archives of Physical Medicine and Rehabilitation
Author(s): Sveinung Tornås, Cand Psychol, Marianne Løvstad, Anne-Kristin Solbakk, Anne-Kristine Schanke, Jan Stubberud
ObjectiveTo investigate whether Goal Management Training (GMT) expanded to include external cuing and an emotional regulation module is associated with improved emotional regulation, psychological functioning, and quality of life after chronic acquired brain injury.DesignA randomized controlled trial with blinded outcome assessment at baseline, post-training and six-month follow-up.SettingOutpatientParticipantsPersons with acquired brain injury and executive dysfunction (N=70; 64% traumatic brain injury; 52% males; mean age 43 ± 13 years; mean time since injury 8.1 ± 9.4 years).InterventionEight sessions of GMT in groups, including a new module addressing emotional regulation, and external cuing. A psychoeducative control condition (Brain Health Workshop) was matched on amount of training, therapist contact and homework.Main outcome measuresEmotional regulation was assessed with the Brain Injury Trust Regulation of Emotions Questionnaire, the Emotional Control subscale and the Emotion Regulation factor (Behavior Rating Inventory of Executive Function-Adult), and the Positive and Negative Affect subscales from the Dysexecutive Questionnaire. Secondary outcome measures included Psychological Distress (Hopkins Symptom Checklist 25) and Quality of Life (Quality of Life after Brain Injury scale).ResultsFindings indicated beneficial effects of GMT on emotional regulation skills in everyday life and in quality of life six months post-treatment. No intervention effects on measures of psychological distress were registered.ConclusionGoal Management Training is a promising intervention for improving emotional regulation following ABI, even in the chronic phase. More research using objective measures of emotional regulation is needed to investigate the efficacy of this type of training.



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Evaluation of micronucleus frequency in oral exfoliated buccal mucosa cells of smokers and tobacco chewers: a comparative study

2016-07-16T08-04-51Z
Source: International Journal of Research in Medical Sciences
Vandana Agrawal, Ishan Dubey, K. B. Mishra.
Background: Oral cancer is one of the tenth most common cancers in the world and constitutes the third most important group of malignancies in India. Majority of these cancers are diagnosed at an advanced stage resulting in poor prognosis and survival rates among patients. Hence early diagnosis of oral cancers seems to be the need of the hour. Analysis of exfoliated buccal cell micronuclei (MN) is a sensitive method of monitoring genetic damage. The present study aims to compare the frequency of micronucleus in tobacco chewers and smokers and thus evaluate the genotoxic potential of these habits. Methods: The study was conducted on 60 subjects, divided into 3 groups each of 20 subjects. Group 1: with history of chewing tobacco, group 2: with history of chewing tobacco and smoking, group 3: healthy subjects without any habits as controls. Oral exfoliated cells were obtained from buccal mucosa of the subjects, 2 slides were prepared from each subject stained with Giemsa and H&E stain respectively. Atleast 1000 cells were examined for each subject and micronuclei frequency was scored according to criteria of Tolbert et al. Results: The mean number of micronuclei was 18.5±9.5 in tobacco chewers, 19.1±9.2 in chewers with smoking habit and 8.2±5.6 in controls. Bonferroni multiple comparisons amongst these three groups showed the mean difference of micronuclei to be highly significant when chewers and chewers with smoking habit were compared to controls. Similarly based on the duration of addiction, a highly significant difference was noted in no. of micronucleated cells in subjects addicted to tobacco for more than 15 years. Conclusions: Tobacco can cause and increase the rate of nuclear anomalies in both smoking and smokeless forms. Thus oral mucosal micronuclei frequency can be used as a marker of epithelial carcinogenic progression.


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Rare sacral lytic lesions presenting as Low back ache – A report of three cases

2016-07-15T20-05-01Z
Source: Case Study and Case Report
shyamasunder bhat N, vishnu senthil.
We report three cases of sacral tuberculosis, Intra-osseous sacral schwannoma and Aneurysmal bone cyst presenting as refractory low back pain with non-specific clinical features delaying in diagnosis of these rare tumors. All three tumours presented to us as intervertebral disc prolapse and upon failure of conservative treatment led to further detailed radiological evaluation. Awareness of these rare tumours as differential diagnosis and along with other common benign and malignant tumours of the sacral region helps in pre-operative planning regarding surgical approach and clearance. Intra-operative good clearance and biopsy is mandatory for accurate management and to prevent recurrence.


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Taste coding of complex naturalistic taste stimuli and traditional taste stimuli in the parabrachial pons of the awake, freely licking rat

Several studies have shown that taste-responsive cells in the brainstem taste nuclei of rodents respond to sensory qualities other than gustation. Such data suggest that cells in the classical gustatory brainstem may be better tuned to respond to stimuli that engage multiple sensory modalities than to stimuli that are purely gustatory. Here, we test this idea by recording the electrophysiological responses to complex, naturalistic stimuli in single neurons in the parabrachial pons (PbN, the second neural relay in the central gustatory pathway) in awake, freely licking rats. Following electrode implantation and recovery, we presented both prototypical and naturalistic taste stimuli and recorded the responses in the PbN. Prototypical taste stimuli (NaCl, sucrose, citric acid, and caffeine) and naturalistic stimuli (clam juice, grape juice, lemon juice, and coffee) were matched for taste quality and intensity (concentration). Umami (monosodium glutamate + inosine monophosphate) and fat (diluted heavy cream) were also tested. PbN neurons responded to naturalistic stimuli as much or more than to prototypical taste stimuli. Furthermore, they convey more information about naturalistic stimuli than about prototypical ones. Moreover, multidimensional scaling analyses showed that across unit responses to naturalistic stimuli were more widely separated than responses to prototypical taste stimuli. Interestingly, cream evoked a robust and widespread response in PbN cells. Collectively, these data suggest that natural foods are more potent stimulators of PbN cells than purely gustatory stimuli. Probing PbN cells with pure taste stimuli may underestimate the response repertoire of these cells.

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