First Elderly Client in Therapy: Factors that Influence Student Interest in Geropsychology

In the coming decades, the elderly population in United States (U.S) is expected to grow significantly (U.S. Bureau of the Census, 1996). Consequently, the number of older individuals seeking mental health services will be greater than at any other time in the history of the U.S. The field of clinical psychology, however, is unable to meet the mental health needs of the current elderly population, and this gap is expected to widen in coming years. There is an ongoing discussion within the field of professional psychology as to how to train more clinicians to work with the elderly population (Gatz & Smyer, 2001; Hinrichsen & Zweig, 2005; Norman, Ishler, Ashcraft, & Patterson, 2000; Qualls, Segal, Benight, & Kenny, 2005), and the present study set out to understand factors that may influence clinical psychology graduate students’ interest in working with clients from this population. The direction of the research was informed by current aging theory, particularly life-span and successful aging theories, and was inspired by the ongoing multicultural competency movement. Currently enrolled PsyD students (N=7) in clinical psychology programs were interviewed regarding their experiences of working with their first elderly therapy client in a supervised setting (practicum or predoctoral internship). Semi-structured interviews paid particular attention to aspects of participants’ professional and personal experiences that they identified as influential on their interest to seek out (or not) future opportunities to work, or to learn more about working with, elderly individuals. Using the qualitative methodology of interpretive phenomenological analysis (IPA), interview transcriptions were analyzed to the point of saturation and distilled into common themes. These themes fell within six overarching domains: (a) Expectations vs. Reality, (b) Subjective Experience, (c) Resources Drawn upon During Treatment, (d) Interest in Geropsychology: Pre vs. Post, (e) Factors Associated with Future Interest in Geropsychology, and (f) What Would Have Made the Experience Better? These six domains comprised a total of 31 themes and subthemes (many themes stood on their own, while others contained two or more subthemes). While a majority of the themes confirmed what is already known in the literature, unique themes also emerged, as was expected from an IPA study, whose intent was to capture the subjective voices of individual clinician-trainees. One common theme already raised by previous researchers about clinical training in geropsychology was that having at least some experience with elderly individuals in a supervised training setting is a crucial avenue for nurturing trainees’ interest in working with the population (Cummings & Galambos, 2002; Hegeman, Horowitz, Tepper, Pillemer, & Schultz, 2002; Hinrichsen, 2000; Kropf, 2002). One theme unique to the present study about training, which was not found in the available literature and has clear implications for how academic programs approach training, was that some participants described experiencing a shift in their understanding of the elderly, from a population with very specialized needs to be treated by specialists, to a population that is a part of the larger, general population, which can be adequately treated by generalists. Themes are illustrated and discussed with quotations drawn directly from participant interviews, adding richness and voice to the study’s results and conclusions. On the basis of the study’s results and on the literature reviewed herein, implications of the current status of geropsychology training and recommendations that others have made to improve it are discussed. Additional recommendations, based on this study’s unique findings, are offered as well

First Elderly Client in Therapy: Factors that Influence Student Interest in Geropsychology

In the coming decades, the elderly population in United States (U.S) is expected to grow significantly (U.S. Bureau of the Census, 1996). Consequently, the number of older individuals seeking mental health services will be greater than at any other time in the history of the U.S. The field of clinical psychology, however, is unable to meet the mental health needs of the current elderly population, and this gap is expected to widen in coming years. There is an ongoing discussion within the field of professional psychology as to how to train more clinicians to work with the elderly population (Gatz & Smyer, 2001; Hinrichsen & Zweig, 2005; Norman, Ishler, Ashcraft, & Patterson, 2000; Qualls, Segal, Benight, & Kenny, 2005), and the present study set out to understand factors that may influence clinical psychology graduate students’ interest in working with clients from this population. The direction of the research was informed by current aging theory, particularly life-span and successful aging theories, and was inspired by the ongoing multicultural competency movement. Currently enrolled PsyD students (N=7) in clinical psychology programs were interviewed regarding their experiences of working with their first elderly therapy client in a supervised setting (practicum or predoctoral internship). Semi-structured interviews paid particular attention to aspects of participants’ professional and personal experiences that they identified as influential on their interest to seek out (or not) future opportunities to work, or to learn more about working with, elderly individuals. Using the qualitative methodology of interpretive phenomenological analysis (IPA), interview transcriptions were analyzed to the point of saturation and distilled into common themes. These themes fell within six overarching domains: (a) Expectations vs. Reality, (b) Subjective Experience, (c) Resources Drawn upon During Treatment, (d) Interest in Geropsychology: Pre vs. Post, (e) Factors Associated with Future Interest in Geropsychology, and (f) What Would Have Made the Experience Better? These six domains comprised a total of 31 themes and subthemes (many themes stood on their own, while others contained two or more subthemes). While a majority of the themes confirmed what is already known in the literature, unique themes also emerged, as was expected from an IPA study, whose intent was to capture the subjective voices of individual clinician-trainees. One common theme already raised by previous researchers about clinical training in geropsychology was that having at least some experience with elderly individuals in a supervised training setting is a crucial avenue for nurturing trainees’ interest in working with the population (Cummings & Galambos, 2002; Hegeman, Horowitz, Tepper, Pillemer, & Schultz, 2002; Hinrichsen, 2000; Kropf, 2002). One theme unique to the present study about training, which was not found in the available literature and has clear implications for how academic programs approach training, was that some participants described experiencing a shift in their understanding of the elderly, from a population with very specialized needs to be treated by specialists, to a population that is a part of the larger, general population, which can be adequately treated by generalists. Themes are illustrated and discussed with quotations drawn directly from participant interviews, adding richness and voice to the study’s results and conclusions. On the basis of the study’s results and on the literature reviewed herein, implications of the current status of geropsychology training and recommendations that others have made to improve it are discussed. Additional recommendations, based on this study’s unique findings, are offered as well

Correction to: Tocilizumab for patients with COVID-19 pneumonia. The single-arm TOCIVID-19 prospective trial (Journal of Translational Medicine, (2020), 18, 1, (405), 10.1186/s12967-020-02573-9)

Following publication of the original article [1] the authors identified that the collaborators of the TOCIVID-19 investigators, Italy were only available in the supplementary file. The original article has been updated so that the collaborators are correctly acknowledged. For clarity, all collaborators are listed in this correction article

Tocilizumab for patients with COVID-19 pneumonia. The single-arm TOCIVID-19 prospective trial

BackgroundTocilizumab blocks pro-inflammatory activity of interleukin-6 (IL-6), involved in pathogenesis of pneumonia the most frequent cause of death in COVID-19 patients.MethodsA multicenter, single-arm, hypothesis-driven trial was planned, according to a phase 2 design, to study the effect of tocilizumab on lethality rates at 14 and 30 days (co-primary endpoints, a priori expected rates being 20 and 35%, respectively). A further prospective cohort of patients, consecutively enrolled after the first cohort was accomplished, was used as a secondary validation dataset. The two cohorts were evaluated jointly in an exploratory multivariable logistic regression model to assess prognostic variables on survival.ResultsIn the primary intention-to-treat (ITT) phase 2 population, 180/301 (59.8%) subjects received tocilizumab, and 67 deaths were observed overall. Lethality rates were equal to 18.4% (97.5% CI: 13.6-24.0, P=0.52) and 22.4% (97.5% CI: 17.2-28.3, P<0.001) at 14 and 30 days, respectively. Lethality rates were lower in the validation dataset, that included 920 patients. No signal of specific drug toxicity was reported. In the exploratory multivariable logistic regression analysis, older age and lower PaO2/FiO2 ratio negatively affected survival, while the concurrent use of steroids was associated with greater survival. A statistically significant interaction was found between tocilizumab and respiratory support, suggesting that tocilizumab might be more effective in patients not requiring mechanical respiratory support at baseline.ConclusionsTocilizumab reduced lethality rate at 30 days compared with null hypothesis, without significant toxicity. Possibly, this effect could be limited to patients not requiring mechanical respiratory support at baseline.Registration EudraCT (2020-001110-38); clinicaltrials.gov (NCT04317092)