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PubMed1998

Differential effects of interventions on the therapeutic alliance with patients with personality disorders.

The goal of this study was to examine the relationship between clearly defined therapist interventions and the therapeutic alliance with personality-disordered patients. Transcripts of one psychotherapy session for each of 5 subjects taking part in a long-term psychotherapy research project were rated for therapist interventions and therapeutic alliance to determine if specific interventions were followed by enhanced or diminished therapeutic work. Transference interpretations were followed by a deterioration in the therapeutic alliance when the alliance was weak, but by enhanced work when the alliance was solid. In patients with both strong and weak alliances, defense interpretations and supportive interventions enhanced therapeutic work without increasing defensiveness. Supportive interventions seemed to prepare the way for exploration and to repair ruptured alliances.

Adult↗

PubMed1998

[Therapeutic approach of French practitioners to rectal cancer].

OBJECTIVES: Improvements in treatment of rectal cancer have enabled a better control of locoregional disease. Our objective was to describe the therapeutic decisions of different specialists implied through clinical cases and the influence of their professional characteristics. METHODS: In spring 1996, a questionnaire was mailed to a random sample of 621 French physicians, presenting 3 clinical cases of rectal cancer at different stages. The present analysis deals with a clinical case concerning a 46 year-old man bearing a T3N0 tumor, at 7 cm from the anal verge. Statistical analysis (uni and multivariate, by logistic regression) was performed with SPSS software. RESULTS: Three hundred fifty two exploitable responses were returned (response rate: 57%). Half of the physicians chose a pluridisciplinary decision modality. There were differences according to the speciality (P < 0.003), to the type of practice (public/private) (P < 10(-4)) and to the proximity of specialized units (P = 0.03). Therapeutic attitudes consisted in a combination of radiotherapy and surgery (RT-SU) for 95% of the physicians. The therapeutic choice was in agreement with the French consensus conference for 71% of physicians. Two main attitudes emerged for this clinical case: exclusive RT-SU combination (43.5%) and RT-SU with optional or systematic chemotherapy (CT) (52%). The latter choice appeared to be closely dependent on medical speciality (P = 0.0004) and background (P = 0.002). CONCLUSION: Decision making is mainly related to the place of work, whereas the therapeutic attitude depends on physicians' own characteristics. Until 1990, multiple therapeutic options for rectal cancer were performed in France. Nowadays, for a T3N0 tumor, the argumentation is rather focused on the indication of CT combined with the standard RT-SU treatment. Results from ongoing controlled studies will help update consensual recommendations.

Adult↗

PubMedDate not supplied

Therapeutic play for hospitalized preschoolers in Lebanon.

Therapeutic play in the form of an interactive puppet show was administered to 50 preschool children one day before surgery in a hospital in Lebanon. A control group of 50 preschool children received routine care but no therapeutic play. Physiological and behavioral measures were assessed on admission, at the time of a stressful procedure (preoperative injection), after surgery, and after discharge. Although on admission there had been on significant differences between the means on physiological measures for the two groups, the children who received the therapeutic play intervention manifested markedly less anxiety and more cooperation and had significantly lower mean blood pressures and pulse rates during the injection than the control group. Following surgery, the experimental group took less time to void their bladders, another physiological indication of lower stress level. After hospital discharge, the children who had received therapeutic play had significantly lower scores on all six factors of the Post Hospital Behavior Questionnaire. This study demonstrates that therapeutic play is a valid means of reducing stressful responses to hospitalization and surgery among children in Lebanon.

Anxiety↗

PubMed1999

Therapeutic paralysis of critically ill trauma patients: perceptions of patients and their family members.

BACKGROUND: Neuromuscular blocking agents are used in critically ill patients to induce therapeutic paralysis. These drugs leave patients fully immobile but conscious. Analgesics and sedatives are concomitantly administered with the paralytic agents. Little is known about what patients remember when they receive these combinations of drugs. Even less is known about the experiences and needs of the patients' family members during the patients' paralysis. OBJECTIVES: To obtain recollections of therapeutic paralysis in critically ill adult trauma patients and to determine the psychological, emotional, and educational needs of the patients' family members during the time the patients were paralyzed. METHODS: A qualitative phenomenological approach was used to investigate the "lived" experience of therapeutic paralysis of 11 pairs of subjects. Each pair consisted of one critically ill adult trauma patient and one member of the patient's family. RESULTS: The patients recalled their experience of therapeutic paralysis with vagueness, as if they had been dreaming. Few recalled pain or painful procedures. Patients remembered having nurses and family members provide emotional support and encouragement. Family members understood the rationale for use of the drugs. They remembered being encouraged to touch and talk with patients. The subjects suggested providing additional education about events that occur when paralysis is being reversed. CONCLUSIONS: Two confounding variables may have affected these findings: a liberalized visiting policy and use of effective pain and sedation protocols. Healthcare professionals and patients' family members should monitor bedside conversations and use touch and words of encouragement to support patients during therapeutic paralysis.

Adaptation, Psychological↗

PubMedDate not supplied

The use of therapeutic touch with rehabilitation clients.

Therapeutic touch is a holistic nursing strategy that can be incorporated as an adjunctive therapy in rehabilitation nursing practice. Therapeutic touch is a derivative of "laying on of hands" that is based on doctoral nursing research and involves the intentionally therapeutic interaction of energy between the nurse and client. Research has demonstrated its effectiveness in eliciting the relaxation response. In this article, specific case studies are used to illustrate when therapeutic touch may be used, how it is implemented as an adjunctive therapy in a nursing process framework, and how it is documented in the nursing care plan.

Aged↗

PubMed2006

Therapeutic biology: checkpoint pathway activation therapy, HIV Tat, and transkingdom RNA interference.

Therapeutic biology is an exciting new frontier in the post-genomic era with the mission to better human health. The explosive increase in the understanding of molecular and regulatory biology has enabled the identification of a plethora of potential targets and pathways for the discovery of new medicines. Conversely, molecularly based therapeutic intervention of biological aberrations in human diseases offers a test of the depth of our understanding of biology. This article discusses three examples of therapeutic biology research. The first concerns the treatment of cancer by activating genome surveillance circuitry, namely checkpoint-pathway activation therapy. The second example is the identification of the HIV Tat protein as both a cause of immune cell activation and apoptosis, and as a vaccine candidate against HIV infection. The third example describes transkingdom RNA interference and its application in the investigational and therapeutic silencing of disease genes.

AIDS Vaccines↗

PubMed2003

Risk assessment of drugs, biologics and therapeutic devices: present and future issues.

PURPOSE: The current US system for detecting adverse effects of therapeutics (drugs, devices and biological products) is suboptimal. This report presents the results of an expert workshop on assessing therapeutic risks. This is the second of five workshops coordinated by the Centers for Education and Research on Therapeutics (CERTs) to address the management of therapeutic risks relative to potential benefits. METHODS: The workshop included academic, industry, government and constituency-based leaders. The focus was on the post-approval phase and procedures in the US, but relevant international issues and attendees were included. RESULTS: Substantial deficiencies in the current US system for risk assessment were delineated. Improving the system will involve research into methods to improve risk assessment, enhancement and consolidation of data-handling systems, education of healthcare workers, allocation of financial resources and building of constituencies. CONCLUSIONS: We need leadership on multiple levels for global coordination of risk assessment. We can then begin to fill gaps and produce benefits for industry, health authorities, government agencies, healthcare providers, and most important, the public.

Adverse Drug Reaction Reporting Systems↗

PubMed1978

[Development of therapeutic neuroradiology (author's transl)].

While therapeutic endovascular occlusions date from as early as 1904, it is in the last 20 years that therapeutic neutroradiology has come into its own. Progress has been made in four directions. (1) Embolization has developed from the original technique involving arteriotomy, through percutaneous methods, to present-day superselective catheterization. Concurrently, the materials used have been improved: from nonmalleable muscle and Silastic balls, to malleable Spongel and dura mater, and most recently to polymerizable fluid plastic substances. The possibility of obstructing very narrow vessels extends the range of indications of embolization. (2) Balloon catheters have been developed, first with nondetachable balloons (1971), more recently with detachable ones (1974). (3) Other techniques may be used to produce a therapeutic thrombosis, e.g., endovascular electrocoagulation and thermocoagulation. (4) Foreign bodies may be extracted safely by catheterization. Further development of techniques should ensure a growing importance for therapeutic neuroradiology in the future.

Embolization, Therapeutic↗

PubMed1981

Moral treatment and the therapeutic community.

History can serve as a useful tool for better understanding contemporary mental health programs. At present, much interest is directed at apparent parallels between 19th century moral treatment and modern milieu therapies, especially the therapeutic community. A common emphasis on a humane living environment is typically cited as the major parallel between the treatments. However, on closer examination, it appears that moral treatment and the therapeutic community exemplify different conceptions of what constitutes a humane living environment. Moreover, the two overall treatment philosophies differ significantly. These differences are tied to the historical contexts and responses to cultural stress in the mid-19th and mid-20th centuries, and consequent conceptions of mental well-being. A heretofore overlooked, but suggestive parallel between the treatments, which may help explain their efficacy, is the importance of peer self-help as a therapeutic tool. However, whereas the therapeutic community actively encourages peer self-help, 19th century asylum superintendents were unaware of its value.

Humans↗

PubMed1996

Social model treatment and individuals with dual diagnoses: an ethnographic analysis of therapeutic practice.

Concurrent substance and psychiatric problems have been shown to significantly reduce the probability of successful treatment outcomes while increasing vulnerability to a range of troubles including homelessness, incarceration, physical health problems, and criminal victimization. This article presents an ethnographic analysis of treatment processes in a residential social model treatment program specifically designed for individuals with dual diagnoses in an effort to inform current debates with empirically grounded knowledge regarding therapeutic practice itself. The article focuses on four fundamental themes bearing on therapeutic practice in this residential program: social model treatment; the formulation of clinical identities; recovery, personal responsibility, and authority; and the measurement of therapeutic success. In conclusion, the article suggests that the central role played by program residents in the therapeutic process deserves particular attention and makes recommendations regarding mental health services delivery that, if followed, might invigorate treatment efficacy.

Adult↗

PubMed2026

Synthesis of Padina boergesenii-Derived Zinc Oxide Nanoparticles and their Therapeutic Potential Against Oral Squamous Cell Carcinoma: A Transcriptomic and in Vitro Evaluation.

Cancer remains a major health challenge, with oral squamous cell carcinoma (OSCC) being an high aggressive subtype of head and neck squamous cell carcinoma that lacks effective therapeutic options. Current study integrates the synthesis of zinc oxide nanoparticles (ZnO-NPs) from the marine brown algae Padina boergesenii with the OSCC gene expression profile to evaluate their potential therapeutic effects against OSCC. Herein, the ZnO-NPs from Padina boergesenii were prepared through the green synthesis method. The obtained ZnO-NPs were characterized through spectroscopic methods, the UV spectrophotometer shows maximum absorbance at 372 nm, FT-IR presents Zn-O functional band at 516 cm- 1, HR-TEM confirms average particle size of 55.70 nm and the Zetasizer shows zeta potential of + 12.9 mV, indicating colloidal stability. The cytotoxicity assay with ZnO-NPs against oral cancer cell lines exhibited a reduction in cell viability at IC₅₀ value of 20 µg/mL. Meanwhile, the transcriptome analysis of OSCC highlights that MYC, STAT3, BRCA1, and AKT1 are the OSCC therapeutic targets involved in proliferation, immune evasion, genomic instability, and cancer signalling pathways. Further, qRT-PCR based gene expression analysis demonstrates significant down-regulation of these targets upon ZnO-NPs treatment in KB cell lines. Overall, this study emphasizes the anticancer potential of Padina boergesenii-derived ZnO-NPs that could effectively modulate the therapeutic targets and may benefit the treatment of OSCC cancer.

Cytotoxicity↗

PubMed1994

The concept of therapeutic 'emplotment'.

This paper considers the narrative structure of clinical action. I argue that clinical encounters involve clinician and patient in the creation and negotiation of a plot structure within clinical time. This clinical plot gives meaning to particular therapeutic actions by placing them within a larger therapeutic story. No therapeutic plot is completely pre-ordained, however. Improvisation and revision are necessary to its creation. In making a case for the narrative construction of lived time, of narratives that are created before they are told, this paper departs from the predominant mode of narrative analysis within medical anthropology that has focused on narrative discourse. Therapeutic emplotment is concretely considered through an interpretation of a single case, a clinical interaction between an occupational therapist and a head-injured patient.

Anecdotes as Topic↗

PubMed1992

Maintenance of therapeutic community principles in an age of biopharmacology and economic restraints.

The therapeutic community has changed significantly since its development in England more than 40 years ago. However, the hallmarks of the therapeutic milieu, such as patient participation in decision making, a multidisciplinary staff, and a belief that the environment is the treatment agent, remain part of many psychiatric settings. The therapeutic community will continue to undergo alteration to adapt to changes in society. It will continue to be a viable treatment modality as long as the value system of the organizational culture and the internal structure of the community are included as basic concepts. Systems theory and organizational culture concepts are used to explore the factors that enhance the functioning of a therapeutic community in an era of biological treatment and rising health care costs.

Biological Psychiatry↗

PubMed2006

Mega-prizes in medicine: big cash awards may stimulate useful and rapid therapeutic innovation.

Following Horrobin's suggestion of 1986, I argue that offering very large prizes (tens of millions of US dollars, or more) for solving specific therapeutic problems, would be an excellent strategy for promoting the rapid development of effective new treatments. The two mainstream ways of paying for medical research are funding the process with grants or funding the outcome via patent protection. When grants are used to fund the process of research the result tends to be 'pure' science, guided by intrinsic scientific objectives. Practical results, such as useful therapeutic advances, are a by-product. Patent-seeking research, by contrast, is more focused on technology than science. It seeks practical results; and aims to pay for itself (and make a profit) in the long term by generating a patentable product or procedure. Prize-seeking research is subject to different incentives and applicable to different situations than either process-funded or patent-seeking research. Prize seeking researchers have a strong incentive to solve the specified problem as rapidly as possible, but the problem may be solved using old ideas that are scientifically mundane or unpatentable technologies and methods. Prizes therefore seem to generate solutions which are incremental extensions, new applications or novel combinations of already-existing technologies. The main use of mega-prizes in medicine would be to accelerate therapeutic progress in stagnant fields of research and to address urgent problems. For example, medical charities focused on specific diseases should consider accumulating their resources until they can offer a mega-prize for solving a clinical problem of special concern to their patients. Prize money should be big enough to pay for the research and development, the evaluation of the new treatment in a clinical trial, and with a large profit left-over to compensate for the intrinsic risk of competing. Sufficiently large amounts of money, and the prestige and publicity derived from winning a mega-prize, could rapidly mobilize research efforts to discover a whole range of scientifically un-glamorous but clinically-useful therapeutic breakthroughs.

Awards and Prizes↗

PubMedDate not supplied

Therapeutic communities: AIDS/HIV risk and harm reduction.

The limited survey data available suggest that therapeutic communities have increasingly organized themselves to develop HIV prevention programs and to integrate HIV-infected and AIDS clients into the treatment community while providing specialized program as necessary. Nonetheless, there remains a need for a comprehensive survey of the response of therapeutic communities to AIDS and the risk of HIV infection. There is need as well for studies that can build on findings linking retention in the therapeutic community to strategies that focus on clients' motivation or readiness for treatment. In addition, therapeutic community programs can ally with outreach programs both to provide priority admission to seropositive clients, women with children, adolescents, and criminal justice clients, and to provide harm reduction services to those unwilling to enter treatment while also taking incremental steps to engage those clients in ever increasing behavior change initiatives.

Acquired Immunodeficiency Syndrome↗

PubMed1996

A reflection of a Therapeutic Touch experience: case study I.

The purpose of this case study was to explore the experiences of giving and receiving Therapeutic Touch. Attempts were made to capture the subjective qualities of the experience by providing a description of the Therapeutic Touch interaction that took place. The central theme of this study is the process of reflection-in-action. This process is shown to facilitate learning; it is an effective vehicle for expanding and developing the knowledge and skills of Therapeutic Touch. This case study provides valuable qualitative information on a Therapeutic Touch experience. It has been possible to analyse this information in a more critical way through reflective thinking.

Female↗

PubMed2004

The therapeutic community as an adaptable treatment modality across different settings.

Simple core statements of the therapeutic community as a treatment modality are given, including a "living-learning situation" and "culture of enquiry." Applications are described in work with children and adolescents, chronic and acute psychoses, offenders, and learning disabilities. In each area the evolution of different therapeutic community models is outlined. In work with young people the work of Homer Lane and David Wills is highlighted. For long term psychosis services, the early influence of "moral treatment" is linked to the revitalisation of asylums and the creation of community based facilities; acute psychosis services have been have been run as therapeutic communities in both hospital wards and as alternatives to hospitalisation. Applications in prison are illustrated through an account of Grendon prison. The paper also outlines the geographical spread of therapeutic communities across many countries.

Acute Disease↗

PubMed1998

Treatment level progress and time spent in treatment in the prediction of outcomes following drug-free therapeutic community treatment.

UNLABELLED: Previous research has suggested that time spent in treatment is the most important predictor of therapeutic community treatment outcomes. Although level divisions or treatment stages represent the basic structure for segmenting responsibility and authority within traditional therapeutic communities, the relationship of this treatment component to treatment outcome has not previously been investigated. AIM: To test the hypothesis that higher treatment level attainment, more time spent in treatment and additional time spent within a treatment level has a linear association with improvements at outcome. DESIGN: Retrospective quasi-experimental. PARTICIPANTS: Four hundred and twenty-seven ex-residents, stratified according to their highest level of treatment in the Melbourne Odyssey House therapeutic community between 1984 and 1988 were targeted for follow-up and 60% were successfully located and interviewed an average of 5.6 years after their first Odyssey entry. Analysis of official records of methadone treatment, convictions and incarcerations demonstrated no post-treatment differences comparing those interviewed with those not interviewed. MEASUREMENTS: Drug use, criminal involvement and employment. FINDINGS. Although both level attainment and time spent in treatment had a linear relationship to improved outcomes, level attainment was a better predictor of outcomes at treatment exit. An unexpected finding was that those who had spent the median time or longer in particular levels demonstrated worse outcomes on official conviction records and on self-reports of employment compared to those remaining for less than the median time. CONCLUSION: The results suggest that it may be level progress rather than simply time spent in treatment that best explains improved functioning following exit from the therapeutic community.

Adult↗