Incidence de certains facteurs sur l’issue d’une psychothérapie dans un essai clinique randomisé auprès de patients avec trouble de personnalité limite (TPL)

Au Personality Disorders Institute, nous avons étudié l’efficacité de la psychothérapie focalisée sur le transfert (PFT), une psychothérapie psychodynamique manualisée qui se déroule deux fois par semaine à l’intention de personnes souffrant de troubles de personnalité limite (TPL). Nous avons comparé la PFT à la thérapie dialectique comportementale (TDC) et à la psychothérapie psychodynamique de soutien (PPS) dans un essai clinique randomisé auprès de 90 patients ayant un TPL. Dans un premier temps, nous présentons certains fondements à l’origine du développement des TPL, suivis d’une discussion des bases théoriques de la PFT. Nous abordons ensuite les caractéristiques des patients qui influent sur les résultats du traitement. Nous présentons des données à la fois cliniques et empiriques dans une discussion de cas individuels représentatifs de l’échantillon de patients borderline traités en PFT.At the Personality Disorders Institute we have been investigating the efficacy of Transference-Focused Psychotherapy (TFP), a twice weekly manualized psychodynamic psychotherapy for borderline personality disorder compared to Dialectical Behavior Therapy (DBT) and Supportive Psychotherapy (SP) in a randomized clinical trial of 90 borderline patients. We will first present some developmental foundations of BPD, followed by a discussion of the theoretical foundations of TFP. We will then discuss patient characteristics that have an impact on outcome. We will present both clinical and empirical data in a discussion of individual cases that were representative of a sample of borderline patients treated in Transference-Focused Psychotherapy (TFP).En el Personality Disorders Institute estudiamos la eficacia de la psicoterapia focalizada en la transferencia (PFT), una psicoterapia psicodinámica hecha manual, que se lleva a cabo dos veces por semana para las personas que sufren de trastornos de personalidad límite (TPL). Comparamos la PFT con la terapia dialéctica comportamental (TDC) y la psicoterapia psicodinámica de apoyo (PPS) en una prueba clínica aleatoria en 90 pacientes con TPL. En un primer momento, presentamos ciertos fundamentos al origen del desarrollo de las TPL, seguidos de una discusión de las bases teóricas de la PFT. Enseguida abordamos las características de los pacientes que influyen en los resultados del tratamiento. Presentamos los datos, a la vez clínicos y empíricos, en una discusión de casos individuales representativos de la muestra de pacientes límite tratados por medio de PFT.No Personality Disorders Institute, estudamos a eficácia da psicoterapia focalizada na transferência (PFT), uma psicoterapia psicodinâmica manualizada que é realizada duas vezes por semana com pessoas que sofrem de transtornos de personalidade borderline (TPB). Comparamos a PFT com a terapia comportamental dialética (TCD) e com a psicoterapia psicodinâmica de apoio (PPA) em um teste clínico randomizado junto a 90 pacientes que sofrem de um TPB. Primeiramente, apresentamos alguns fundamentos originários do desenvolvimento dos TPB, seguidos de uma discussão sobre as bases teóricas da PFT. Abordamos, em seguida, as características dos pacientes que influenciam os resultados do tratamento. Apresentamos dados, ao mesmo tempo clínicos e empíricos em uma discussão de casos individuais representativos da amostragem de pacientes borderline tratados em PFT

Evaluation of the Wellspring Model for Improving Nursing Home Quality

Examines how successfully the Wellspring model improved the quality of care for residents of eleven nonprofit nursing homes in Wisconsin. Looks at staff turnover, and evaluates the impact on facilities, employees, residents, and cost

Nurses\u27 Alumnae Association Bulletin, December 1968

President\u27s Message Officers and Committee Chairman Financial Report Report to Alumnae Association Annual Report to Alumnae Association School of Practical Nursing Report Student Activities Nursing Service Staff Association Letter from Vietnam Resume of Alumnae Meetings Ways and Means Report Social Committee Building Fund Report Bulletin Committee Report Class News Notice

Perceived barriers to infection prevention and control for nursing home certified nursing assistants: a qualitative study.

Healthcare-associated infections, while preventable, result in increased morbidity and mortality in nursing home (NH) residents. Frontline personnel, such as certified nursing assistants (CNAs), are crucial to successful implementation of infection prevention and control (IPC) practices. The purpose of this study was to explore barriers to implementing and maintaining IPC practices for NH CNAs as well as to describe strategies used to overcome these barriers. We conducted a multi-site qualitative study of NH personnel important to infection control. Audio-recorded interviews were transcribed verbatim and transcripts were analyzed using conventional content analysis. Five key themes emerged as perceived barriers to effective IPC for CNAs: 1) language/culture; 2) knowledge/training; 3) per-diem/part-time staff; 4) workload; and 5) accountability. Strategies used to overcome these barriers included: translating in-services, hands on training, on-the-spot training for per-diem/part-time staff, increased staffing ratios, and inclusion/empowerment of CNAs. Understanding IPC barriers and strategies to overcome these barriers may better enable NHs to achieve infection reduction goals

Understanding infection prevention and control in nursing homes: A qualitative study.

Infections have been identified as a priority issue in nursing homes (NHs). We conducted a qualitative study purposively sampling 10 NHs across the country where 6-8 employees were recruited (N = 73). Semi-structured, open-ended guides were used to conduct in-depth interviews. Data were audiotaped, transcribed and a content analysis was performed. Five themes emerged: \u27Residents\u27 Needs\u27, \u27Roles and Training\u27 \u27Using Infection Data,\u27 \u27External Resources\u27 and \u27Focus on Hand Hygiene.\u27 Infection prevention was a priority in the NHs visited. While all sites had hand hygiene programs, other recommended areas were not a focus and many sites were not aware of available resources. Developing ways to ensure effective, efficient and standardized infection prevention and control in NHs continues to be a national priority

Genetic-Based Susceptibility of a Foundation Tree to Herbivory Interacts With Climate to Influence Arthropod Community Composition, Diversity, and Resilience

Understanding how genetic-based traits of plants interact with climate to affect associated communities will help improve predictions of climate change impacts on biodiversity. However, few community-level studies have addressed such interactions. Pinyon pine (Pinus edulis) in the southwestern U.S. shows genetic-based resistance and susceptibility to pinyon needle scale (Matsucoccus acalyptus). We sought to determine if susceptibility to scale herbivory influenced the diversity and composition of the extended community of 250+ arthropod species, and if this influence would be consistent across consecutive years, an extreme drought year followed by a moderate drought year. Because scale insects alter the architecture of susceptible trees, it is difficult to separate the direct influences of susceptibility on arthropod communities from the indirect influences of scale-altered tree architecture. To separate these influences, scales were experimentally excluded from susceptible trees for 15 years creating susceptible trees with the architecture of resistant trees, hereafter referred to as scale-excluded trees. Five patterns emerged. (1) In both years, arthropod abundance was 3-4X lower on susceptible trees compared to resistant and scale-excluded trees. (2) Species accumulation curves show that alpha and gamma diversity were 2-3X lower on susceptible trees compared to resistant and scale-excluded trees. (3) Reaction norms of arthropod richness and abundance on individual tree genotypes across years showed genotypic variation in the community response to changes in climate. (4) The genetic-based influence of susceptibility on arthropod community composition is climate dependent. During extreme drought, community composition on scale-excluded trees resembled susceptible trees indicating composition was strongly influenced by tree genetics independent of tree architecture. However, under moderate drought, community composition on scale-excluded trees resembled resistant trees indicating traits associated with tree architecture became more important. (5) One year after extreme drought, the arthropod community rebounded sharply. However, there was a much greater rebound in richness and abundance on resistant compared to susceptible trees suggesting that reduced resiliency in the arthropod community is associated with susceptibility. These results argue that individual genetic-based plant-herbivore interactions can directly and indirectly impact community-level diversity, which is modulated by climate. Understanding such interactions is important for assessing the impacts of climate change on biodiversity

Chemocoding as an identification tool where morphological- and DNA-based methods fall short:Inga as a case study

This is the author accepted manuscript. The final version is available from Wiley via the DOI in this recordThe need for species identification and taxonomic discovery has led to the development of innovative technologies for large‐scale plant identification. DNA barcoding has been useful, but fails to distinguish among many species in species‐rich plant genera, particularly in tropical regions. Here, we show that chemical fingerprinting, or ‘chemocoding’, has great potential for plant identification in challenging tropical biomes. Using untargeted metabolomics in combination with multivariate analysis, we constructed species‐level fingerprints, which we define as chemocoding. We evaluated the utility of chemocoding with species that were defined morphologically and subject to next‐generation DNA sequencing in the diverse and recently radiated neotropical genus Inga (Leguminosae), both at single study sites and across broad geographic scales. Our results show that chemocoding is a robust method for distinguishing morphologically similar species at a single site and for identifying widespread species across continental‐scale ranges. Given that species are the fundamental unit of analysis for conservation and biodiversity research, the development of accurate identification methods is essential. We suggest that chemocoding will be a valuable additional source of data for a quick identification of plants, especially for groups where other methods fall short

Choice of activity-intensity classification thresholds impacts upon accelerometer-assessed physical activity-health relationships in children

It is unknown whether using different published thresholds (PTs) for classifying physical activity (PA) impacts upon activity-health relationships. This study explored whether relationships between PA (sedentary [SED], light PA [LPA], moderate PA [MPA], moderate-to-vigorous PA, vigorous PA [VPA]) and health markers differed in children when classified using three different PTs

Detecting T-cell Reactivity to Whole Cell Vaccines

BCR-ABL$^+$ K562 cells hold clinical promise as a component of cancer vaccines, either as bystander cells genetically modified to express immunostimulatory molecules, or as a source of leukemia antigens. To develop a method for detecting T-cell reactivity against K562 cell-derived antigens in patients, we exploited the dendritic cell (DC)-mediated cross-presentation of proteins generated from apoptotic cells. We used UVB irradiation to consistently induce apoptosis of K562 cells, which were then fed to autologous DCs. These DCs were used to both stimulate and detect antigen-specific CD8+ T-cell reactivity. As proof-of-concept, we used cross-presented apoptotic influenza matrix protein-expressing K562 cells to elicit reactivity from matrix protein-reactive T cells. Likewise, we used this assay to detect increased anti-CML antigen T-cell reactivity in CML patients that attained long-lasting clinical remissions following immunotherapy (donor lymphocyte infusion), as well as in 2 of 3 CML patients vaccinated with lethally irradiated K562 cells that were modified to secrete high levels of granulocyte macrophage colony-stimulating factor (GM-CSF). This methodology can be readily adapted to examine the effects of other whole tumor cell-based vaccines, a scenario in which the precise tumor antigens that stimulate immune responses are unknown

A phase 1/2 study of the oral FLT3 inhibitor pexidartinib in relapsed/refractory FLT3-ITD-mutant acute myeloid leukemia.

FMS-like tyrosine kinase 3 (FLT3) tyrosine kinase inhibitors (TKIs) have activity in acute myeloid leukemia (AML) patients with FLT3 internal tandem duplication (ITD) mutations, but efficacy is limited by resistance-conferring kinase domain mutations. This phase 1/2 study evaluated the safety, tolerability, and efficacy of the oral FLT3 inhibitor PLX3397 (pexidartinib), which has activity against the FLT3 TKI-resistant F691L gatekeeper mutation in relapsed/refractory FLT3-ITD-mutant AML. Ninety patients were treated: 34 in dose escalation (part 1) and 56 in dose expansion (part 2). Doses of 800 to 5000 mg per day in divided doses were tested. No maximally tolerated dose was reached. Plasma inhibitory assay demonstrated that patients dosed with ≥3000 mg had sufficient levels of active drug in their trough plasma samples to achieve 95% inhibition of FLT3 phosphorylation in an FLT3-ITD AML cell line. Based on a plateau in drug exposure, the 3000-mg dose was chosen as the recommended phase 2 dose. The most frequently reported treatment-emergent adverse events were diarrhea (50%), fatigue (47%), and nausea (46%). Based on modified response criteria, the overall response rate to pexidartinib among all patients was 21%. Twenty-three percent of patients treated at ≥2000 mg responded. The overall composite complete response rate for the study was 11%. Six patients were successfully bridged to transplantation. Median overall survival (OS) of patients treated in dose expansion was 112 days (90% confidence interval [CI], 77-150 days), and median OS of responders with complete remission with or without recovery of blood counts was 265 days (90% CI, 170-422 days). This trial was registered at www.clinicaltrials.gov as #NCT01349049