Reliability of Therapist Effects in Practice-Based Psychotherapy Research : A Guide for the Planning of Future Studies

This paper aims to provide researchers with practical information on sample sizes for accurate estimations of therapist effects (TEs). The investigations are based on an integrated sample of 48,648 patients treated by 1800 therapists. Multilevel modeling and resampling were used to realize varying sample size conditions to generate empirical estimates of TEs. Sample size tables, including varying sample size conditions, were constructed and study examples given. This study gives an insight into the potential size of the TE and provides researchers with a practical guide to aid the planning of future studies in this field

Insuficiência hepática fulminante por intermação induzida por exercício Fulminant hepatic failure (FHF) by exercise-induced exertional heatstroke

Intermação induzida por exercício é uma condição potencialmente fatal causada pela elevação extrema da temperatura corporal central. Envolvimento hepático leve a moderado afeta todos os pacientes e manifesta-se pela elevação das enzimas hepáticas. A ocorrência de falência hepática no curso da intermação por exercício é rara e tem prognóstico reservado. Relata-se um caso de insuficiência hepática fulminante em um homem de 36 anos após correr 8km em corrida de rua (corrida rústica) na cidade de Manaus (AM). O paciente desenvolveu insuficiência renal aguda, rabdomiólise e achados compatíveis com insuficiência hepática fulminante (elevação importante das aminotransferases, coagulopatia, letargia e episódios de confusão). As funções hepáticas e renais apresentaram melhora gradual e espontânea sem necessidade de diálise. Três meses após o paciente encontrava-se bem, com enzimas hepáticas normais e com retorno gradual à prática de esportes. Embora rara, a falência hepática aguda deve ser incluída nas complicações da intermação induzida por exercício, a qual pode ter resolução espontânea com medidas conservadoras.<br>Exercise-induced exertional heatstroke (EHS) is a potentially fatal disorder caused by extreme elevation of the core body temperature. Mild to moderate liver involvement affects nearly all patients and it is manifested by increase of the serum liver enzymes. Liver failure occurring as a component of exertional heatstroke is rare and carries a poor prognosis. A case of acute liver failure in a healthy 36 year-old man after participation in an 8-km race in Manaus, located near the Amazon Tropical Forest in Brazil, is reported here. The patient presented renal failure, severe rhabdomyolysis and findings of fulminant hepatic failure (very high aminotransferases levels, elevated international normalized ratio (INR), lethargy and episodes of confusion). Hepatic and renal functions improved spontaneously with conservative measures and he was discharged within eight days. Three months later he was completely asymptomatic and gradually running again. Although rare, acute liver failure should be included in the complications associated with exertional heatstroke. Conservative management may be effective in some patients with this kind of acute liver failure