Developing a systematic evaluation approach for training programs within a train-the-trainer model for youth cognitive behavior therapy.

The purpose of this small pilot study was three-fold: (a) to begin development of a coding scheme for supervisor and therapist skill acquisition, (b) to preliminarily investigate a pilot train-the-trainer paradigm for skill development, and (c) to evaluate self-reported versus observed indicators of skill mastery in that pilot program. Participants included four supervisor-therapist dyads (N = 8) working with public mental health sector youth. Master trainers taught cognitive-behavioral therapy techniques to supervisors, who in turn trained therapists on these techniques. Supervisor and therapist skill acquisition and supervisor use of teaching strategies were repeatedly assessed through coding of scripted role-plays with a multiple-baseline across participants and behaviors design. The coding system, the Practice Element Train the Trainer - Supervisor/Therapist Versions of the Therapy Process Observational Coding System for Child Psychotherapy, was developed and evaluated though the course of the investigation. The coding scheme demonstrated excellent reliability (ICCs [1,2] = 0.81-0.91) across 168 video recordings. As calculated through within-subject effect sizes, supervisor and therapist participants, respectively, evidenced skill improvements related to teaching and performing therapy techniques. Self-reported indicators of skill mastery were inflated in comparison to observed skill mastery. Findings lend initial support for further developing an evaluative approach for a train-the-trainer effort focused on disseminating evidence-based practices.

Prospective cohort study of effects of infliximab on rheumatoid factor, anti-cyclic citrullinated peptide antibodies and antinuclear antibodies in patients with long-standing rheumatoid arthritis.

BACKGROUND: Antibodies to cyclic citrullinated peptide (anti-CCP) and IgM rheumatoid factor (IgM-RF) are well-established serological markers for rheumatoid arthritis (RA). Lupus-like disease with antinuclear antibodies (ANA) has been reported during TNFalpha antagonist therapy. Our objectives were to investigate the effect of infliximab therapy on these three autoantibodies in patients with established RA and to look for correlations linking IgM-RF and anti-CCP titres to a treatment response (defined as a good or moderate EULAR response) after 48 weeks of infliximab therapy. METHODS: Thirty-six patients with long-standing RA not responding to disease-modifying anti-rheumatic drugs (DMARDs) received intravenous infliximab (starting dose: 3mg/kg) at 0, 2, and 6 weeks then at 8-week intervals, in combination with a DMARD. At baseline, week 24, and week 48, C-reactive protein (CRP) and the erythrocyte sedimentation rate (ESR) were determined and the disease activity score (DAS28) was calculated. Serum samples collected at the same time points were used to measure anti-CCP (commercial second-generation ELISA), IgM-RF (quantitative nephelometric assay), and ANA (indirect immunofluorescence in HEp2 cells). Correlations linking baseline autoantibody titres to changes in autoantibody levels were examined. RESULTS: At baseline, tests were positive for anti-CCP in 31/36 (94.6%) patients, IgM-RF in 29/36 (80.5%) patients, and ANA in 16/36 (44%) patients. IgM-RF titres decreased significantly (p<0.001), whereas anti-CCP showed little change (p=0.053). ANA titres increased significantly (p<0.001). The treatment response was not associated with changes in anti-CCP or IgM-RF titres during infliximab therapy (OR for a response in patients with a 50% anti-CCP decrease, 0.77 [95%CI, 0.16-3.58]; OR for a response in patients with a 50% IgM-RF decrease, 0.82 [95%CI, 0.16-4.13]). CONCLUSIONS: During infliximab therapy used to treat established RA, IgM-RF titres showed larger decreases than anti-CCP titres. Changes in IgM-RF and anti-CCP failed to correlate with the 48-week treatment response.

Excessive acquisition in hoarding.

Compulsive hoarding (the acquisition of and failure to discard large numbers of possessions) is associated with substantial health risk, impairment, and economic burden. However, little research has examined separate components of this definition, particularly excessive acquisition. The present study examined acquisition in hoarding. Participants, 878 self-identified with hoarding and 665 family informants (not matched to hoarding participants), completed an Internet survey. Among hoarding participants who met criteria for clinically significant hoarding, 61% met criteria for a diagnosis of compulsive buying and approximately 85% reported excessive acquisition. Family informants indicated that nearly 95% exhibited excessive acquisition. Those who acquired excessively had more severe hoarding; their hoarding had an earlier onset and resulted in more psychiatric work impairment days; and they experienced more symptoms of obsessive-compulsive disorder, depression, and anxiety. Two forms of excessive acquisition (buying and free things) each contributed independent variance in the prediction of hoarding severity and related symptoms.