Achievement of therapeutic objectives : an analysis of micro-processes within a single-case observational design

Objective: This study uses data from a single subject based on the previously published Randomized Control Trial of Brief Cognitive and Dynamic Therapy (Svartberg, Stiles & Seltzer, 2005). The present study investigates the change of four process variables: Insight, Motivation, Activating affects and Inhibitory affects, both within and across sessions. The study also inquires into whether there are sequential relationships between these four variables. Method: the patient in this study received Short-Term Dynamic Psychotherapy for 40 weeks. The patient met the criteria for a Cluster-C personality disorder. The data consists of process measures from the Achievement of Therapeutic Objectives Scale (ATOS), outcome measures from SCL-90, MCMI-C and IIP, in addition to qualitative observations. Results: The data was analyzed by a two-way Analysis of Variance design, linear regression and a Cross Lagged Correlation design. Variance, trends and the sequential relationships between the process variables were investigated. Results show only small changes in the process variables during the course of therapy. Within a therapy session there were found two small trends of sequential relationships: 1. Affective activation predicted Insight. 2. Inhibition predicted Insight. Conclusion: The overall results showed small changes during treatment. Such finding needs to be interpreted in light of that the patient‘s symptoms and functioning at treatment end and at a 2-year follow-up were unimproved

Safety of Epidural Corticosteroid Injections

BACKGROUND AND OBJECTIVE: Epidural corticosteroid injections (ESIs) have been used for several decades and now represent the most common intervention performed for the management of back pain with a radicular component. However, several reports have presented devastating complications and adverse effects, which fuelled concerns over the risk versus clinical effectiveness. The authors offer a comprehensive review of the available literature and analyse the data derived from studies and case reports. METHODS: Studies were identified by searching PubMed MEDLINE, Ovid MEDLINE, EMBASE, Scopus, Google Scholar and the Cochrane Library to retrieve all available relevant articles. Publications from the last 20 years (September 1994 to September 2014) were considered for further analysis. Studies selected were English-language original articles publishing results on complications related to the technique used for cervical and lumbar ESIs. The studies had to specify the approach used for injection. All studies that did not fulfil these eligibility criteria were excluded from further analysis. RESULTS: Overall, the available literature supports the view that serious complications following injections of corticosteroid suspensions into the cervical and lumbar epidural space are uncommon, but if they occur they can be devastating. CONCLUSIONS: The true incidence of such complications remains unclear. Direct vascular injury and/or administration of injectates intra-arterially represent a major concern and could account for the vast majority of the adverse events reported. Accurate placement of the needle, use of a non-particulate corticosteroid, live fluoroscopy, digital subtraction angiography, and familiarisation of the operator with contrast patterns on fluoroscopy should minimise these risks. The available literature has several limitations including incomplete documentation, unreported data and inherent bias. Large registries and well-structured observational studies are needed to determine the true incidence of adverse events and address the safety concerns