Effectiveness of Group CBT on Internalizing and Externalizing Symptoms in Children with Mixed Psychiatric Disorders

Background: Our study addressed the gap in research on the effectiveness of cognitive behavioral therapy (CBT) in treating children with mixed psychiatric disorders. We examined the immediate and long-term effects of group CBT (GCBT), delivered in naturalistic clinical settings, on reducing internalizing and externalizing symptoms in children with mixed psychiatric disorders. Further, we compared the effectiveness of cost-effective, manualized GCBT to treatment as usual (TAU) consisting of individually tailored psychiatric outpatient services delivered by mental health care specialists. Methods: Children aged 6–12 years (n = 103) diagnosed with psychiatric disorders, more than 70% with psychiatric comorbidity, were assigned either directly to GCBT (GCBT group; n = 52) or TAU for approximately 3 months, after which they received GCBT (TAU + GCBT group; n = 51). Internalizing and externalizing symptoms were assessed using parent- and teacher-report questionnaires (Child Behavior Checklist and Teacher Report Form) at referral to treatment, pre-treatment, post-treatment, and six-month follow-up. Results: Parent- and teacher-rated internalizing symptoms and parent-rated externalizing symptoms were reduced immediately after GCBT. Long-term GCBT gains were prominent for parent-rated externalizing symptoms. No differences were observed between the effectiveness of GCBT and TAU. Conclusions: Our results suggest that GCBT and TAU services are equally effective in treating internalizing and externalizing symptoms in children with mixed psychiatric disorders, providing support for the broader use of cost-effective manualized GCBT. Manualized GCBT, which requires relatively short training, can also be delivered at primary healthcare levels. Our results are of relevance to cost-effectiveness and global mental health staff shortages

The use of bile salt micelles for the prediction of human intestinal absorption

Human intestinal absorption (HIA) will dictate biopharmaceutical performance through its influence on absorption, distribution, metabolism, and elimination and can vary significantly depending upon the nature of the compound under consideration. In this study, an in vitro assay method is proposed for the prediction of HIA through the measurement of drug solubility in an aqueous phase containing micellar bile salt, namely sodium deoxycholate. A series of twenty compounds, displaying a range of physicochemical properties and known HIA values, were analyzed using UV spectroscopy to determine a solubilization ratio for each compound. A micelle/water partition coefficient (Kxm/a) was calculated and then used to develop an equation through simple linear regression; logit HIA = −0.919 + 0.4618 logKxm/a (R2 = 0.85). From this equation, a value for % HIA was determined which compared well with literature. Furthermore, 4 additional drugs were then analyzed using the developed equation and found to match well with literature, confirming the suitability of the method. Using a simple, economic, and robust UV bile salt assay allows prediction of HIA and avoids many of the disadvantages of other techniques, such as animal-based methods

Incorporating physiologically relevant mobile phases in micellar liquid chromatography for the prediction of human intestinal absorption

Micellar liquid chromatography (MLC) is a popular method used in the determination of a compounds lipophilicity. This study describes the use of the obtained micelle/water partition coefficient (log Pmw) by such a method in the prediction of human intestinal absorption (HIA). As a result of the close resemblance of the novel composition of the micellar mobile phase to that of physiological intestinal fluid, prediction was deemed to be highly successful. The unique micellar mobile phase consisted of a mixed micellar mixture of lecithin and six bile salts, i.e. a composition matching that found in the human intestinal environment, prepared in ratios resembling those in the intestine. This is considered to be the first method to use a physiological mixture of biosurfactants in the prediction of HIA. As a result, a mathematical model with high predictive ability (R2PRED= 81 %) was obtained using multiple linear regression. The micelle/water partition coefficient (log Pmw) obtained from MLC was found to be a successful tool for prediction where the final optimum model included (log Pmw) and polar surface area (PSA) as key descriptors with high statistical significance for the prediction of HIA. This can be attributed to the nature of the mobile phase used in this study which contains the lecithin-bile salt complex, thus forming a bilayer system therefore mimicking absorption across the intestinal membrane

Pharmacokinetic aspects of retinal drug delivery

Drug delivery to the posterior eye segment is an important challenge in ophthalmology, because many diseases affect the retina and choroid leading to impaired vision or blindness. Currently, intravitreal injections are the method of choice to administer drugs to the retina, but this approach is applicable only in selected cases (e.g. anti-VEGF antibodies and soluble receptors). There are two basic approaches that can be adopted to improve retinal drug delivery: prolonged and/or retina targeted delivery of intravitreal drugs and use of other routes of drug administration, such as periocular, suprachoroidal, sub-retinal, systemic, or topical. Properties of the administration route, drug and delivery system determine the efficacy and safety of these approaches. Pharmacokinetic and pharmacodynamic factors determine the required dosing rates and doses that are needed for drug action. In addition, tolerability factors limit the use of many materials in ocular drug delivery. This review article provides a critical discussion of retinal drug delivery, particularly from the pharmacokinetic point of view. This article does not include an extensive review of drug delivery technologies, because they have already been reviewed several times recently. Instead, we aim to provide a systematic and quantitative view on the pharmacokinetic factors in drug delivery to the posterior eye segment. This review is based on the literature and unpublished data from the authors' laboratory.Peer reviewe

Purkukeskustelu eristyksen jälkeen somaattisella osastolla - Ohjeistus

TIIVISTELMÄ Idea opinnäytetyöhön tuli käytännön työn kautta. Työskentelen sairaalan sisätautiosastolla, jossa potilaita joudutaan eristämään tahdosta riippumat-tomista syistä esimerkiksi infektioiden vuoksi. Eristäminen saatetaan ko-kea kielteisenä toimenpiteenä. Tämän työn tarkoituksena oli luoda purku-keskusteluohjeistus somaattiselle osastolle. Tarkoituksena oli laatia pur-kukeskustelulomake, jonka avulla voidaan käydä keskustelu potilaan ja hoitajan kesken potilaan eristämisen jälkeen. Työn tavoitteena oli purku-keskustelulomakkeen laatimisen jälkeen haastatella sisätautiosaston hoita-jia ja saada palautetta lomakkeesta. Työn tavoitteena oli myös antaa lisä-tietoutta potilaan eristämiseen liittyvistä asioista. Opinnäytetyön teoreettisiin aihealueisiin valikoituivat: potilaan asema ja oikeudet, tahdosta riippumaton hoito, eristäminen ja purkukeskustelu. Lähdemateriaalina toimivat tutkimukset, kirjallisuus ja artikkelit. Teorian aiheet rajattiin käsittelemään potilaan huone-eristämistä. Toiminnallinen osuus toteutettiin haastattelemalla viittä sisätautisosaston hoitajaa. Haas-tatteluissa selvitettiin hoitajien mielipiteitä purkukeskustelulomakkeesta ja sen soveltuvuudesta käytäntöön osastotyössä. Haastatteluiden tulosten mukaan voidaan todeta, että purkukeskustelulo-make ideana on hyvä, mutta käytännön toteuttamisessa voi ilmetä haastei-ta. Osaston ajoittainen hektisyys ja huonokuntoiset potilaat tuovat lisä-haasteita purkukeskustelukäytännön toteuttamiselle. Purkukeskustelu voi olla potilaalle merkittävä tilaisuus, jossa hän tulee kuulluksi. Jatkotutki-musaiheena purkukeskustelun voisi ottaa käyttöön somaattisilla osastoilla ja sen jälkeen pohtia sen merkitystä ja kehittää käytänteen toimivuutta.ABSTRACT The idea to thesis came through work in practice. The author is working on a medical ward, where the patients sometimes have to be isolated against their own will because of infections for example. Seclusion may be experienced as a negative procedure. The purpose of this study was to de-velop a post-seclusion debriefing guidance for a somatic ward. The pur-pose was to develop post-seclusion debriefing form. With the help of this form the discussion between the nurse and the patient is held after seclu-sion. The aim was to interview the nurses of the medical ward and get feedback of the form. The aim was also to increase knowledge of the facts concerning seclusion. The theoretical basis was covered from the status and the rights of the pa-tient, the care without own will, seclusion and post-seclusion debriefing. Background information of the thesis was collected from inquiries, litera-ture and articles. The study of background information was limited to deal with the patient room seclusion. The practice part of the thesis was carried through interviewing five nurses from the medical ward. The purpose of the interviews was to clarify the nurses’ opinions of the post-seclusion form and it’s applicability to practice on ward. According to the results of the interviews the idea of post-seclusion form is good, but using it in practice may be challenging. Occasionally the ward can be so hectic and the patients in so poor condition that debriefing is challenging. Debriefing may be remarkable opportunity to patient have their voices heard. For the further development the author suggests to take the debriefing in practice on somatic wards and afterwards consider its significance and developing practices