Impact of clinical severity on treatment response in a randomized controlled trial comparing day hospital and intensive outpatient mentalization-based treatment for borderline personality disorder.

This study examined the impact of clinical severity on treatment outcome in two programs that differ markedly in treatment intensity: day hospital mentalization-based treatment (MBT-DH) and intensive outpatient mentalization-based treatment (MBT-IOP) for borderline personality disorder (BPD). A multicenter randomized controlled trial was conducted. Participants include the full intention-to-treat sample of the original trial of N = 114 randomized BPD patients (MBT-DH n = 70, MBT-IOP n = 44), who were assessed at baseline and subsequently every 6 up to 36 months after start of treatment. Outcomes were general symptom severity, borderline features, and interpersonal functioning. Clinical severity was examined in terms of severity of BPD, general symptom severity, comorbid symptom disorders, comorbid personality disorders, and cluster C personality features. None of the severity measures was related to treatment outcome or differentially predicted treatment outcome in MBT-DH and MBT-IOP, with the exception of a single moderating effect of co morbid symptom disorders on outcome in terms of BPD features, indicating less improvement in MBT-DH for patients with more symptom disorders. Overall, patients with varying levels of clinical severity benefited equally from MBT-DH and MBT-IOP, indicating that clinical severity may not be a useful criterion to differentiate in treatment intensity.

Impact of low- and high-risk operators handling irinotecan on the blood contamination of health care workers in oncology day care units.

INTRODUCTION: Health care workers handling antineoplastic drugs (ADs) are at risk of mutagenicity and adverse reproductive effects. Despite protective equipment and AD handling guidelines, AD levels are still detected in caregivers in oncology units. This study attempted to assess blood contamination by irinotecan and its metabolites in all health care workers in oncology day hospital units according to activities specific to each employment category. METHODS: The study was performed at two different hospitals: a university hospital and a comprehensive cancer centre. Forty-four participants were categorized according to their daily activity as a high-risk operator (29 nurses/ward aides and 5 cleaning staff) and a low-risk operator (7 doctors and 3 secretaries). The collected blood samples were subjected to UHPLC-MS/MS. The plasma and red blood cell (RBC) levels of irinotecan and its metabolites (SN-38; APC) were determined using a validated analytical method detection test. RESULTS: Two hundred sixty-four assay results were collected (132 plasma results and 132 RBC results). The comparison between low- and high-risk operator-contaminated workers was not significant (18.33% positive results in low-risk operators vs. 25.98% positive results in high-risk operators; P = 0.22). This homogeneity showed overall contamination within the unit. Positive results were obtained in 21.43% of physicians, 11.11% of secretaries, 25.86% of nurses/ward aides and 26.67% of cleaning staff. These results could be explained by the lack or failure of personal and collective protective equipment. A lack of protection and inadequate decontamination procedures can result in surface contamination. CONCLUSIONS: This study evaluated blood contamination with irinotecan and its metabolites in health care workers from day hospital care units. Among the 24.24% of contaminations observed in care units, the difference between low- and high-risk operator contamination was not significant (P = 0.22). The impact on blood contamination found is the same between low- and high-risk caregivers. This implies that the protective precautions associated with the handling of anticancer drugs must therefore be followed by all staff, including those believed to be at low risk of exposure.

The added value of palliative day care centres: A full-population cross-sectional survey among clients and their family caregivers in Flanders, Belgium.

In addition to palliative care delivery at home or in hospital, palliative day care centres occupy an in-between position in palliative care. In palliative day care centres, multidisciplinary teams provide holistic care and support for people with (chronic) life-limiting conditions, or clients, in a homely surrounding, allowing them to remain living at home while attending a specialist palliative care service. This study aims to evaluate palliative day care centres from a user perspective. We conducted a full-population cross-sectional survey of clients (N = 86) and their family caregivers (N = 63) in all five palliative day care centres in Flanders, Belgium from January until December 2019. We used validated instruments supplemented with self-developed items to measure participants' reasons for use, support provided, unmet support needs and added value to other (palliative) care services across palliative care domains, i.e., physical, psychological, social and spiritual care. Response rate was 77% for clients and 81% for family caregivers. The most often indicated reasons for use were that the client needs social contacts (clients: 73%, caregivers: 65%), to enable the client to live at home as long as possible (resp. 58%, 55%) and to reduce the family caregiver's mental burden (resp. 42%, 65%). Three out of four family caregivers felt better able to combine daily activities with caring for the client (77%) and felt better able to perform their family care-giving tasks (77%) because the client attends the palliative day care centre. Thirty-six per cent of clients had received support for social needs exclusively in the palliative day care centre and not from any professionals outside palliative day care. Palliative day care centres seem to be of added value for those care domains to which often less attention is paid in other settings, particularly social and emotional support, both for clients and family caregivers.

The Benefit of Enhanced Daycare of Traditional Chinese Medicine for Cancer Treatment Related Adverse Events: A Retrospective Study of Medical Records.

OBJECTIVE: Cancer patients undergo therapies that might lead to severe adverse events. The enhanced daycare of Traditional Chinese medicine (TCM) we describe was intended to help cancer patients suffering from severe adverse events to obtain relief. We used the Taiwan brief version of the Common Terminology Criteria for Adverse Events Version 4.0 (Taiwan brief version questionnaire of CTCAE) as a primary measurement to evaluate the efficacy of the enhanced day care of TCM. The secondary measurements were the Taiwanese version of the Brief Fatigue Inventory (BFI-T) questionnaire and the World Health Organization Quality of Life-BREF (WHOQOL-BREF) questionnaire, which were used to quantify fatigue and quality of life (QOL), respectively. METHODS/DESIGN: This is a retrospective study of medical records. There were 401 patients treated with enhanced daycare of TCM from June 2017 to November 2019. RESULTS: Among 22 common adverse symptoms in the Taiwan brief version questionnaire of CTCAE4.0, 14 symptoms achieved a significant improvement, and the change of the total scores was also statistically significant (P < .001). Cancer stages II to IV showed significant improvement on the CTCAE and BFI-T; stage I only showed improvement on the BFI-T. On the WHOQOL questionnaire, there was a statistically significant difference in self-evaluation of the quality of life (P = .001) and self-evaluation of the total health condition aspect (P < .001). CONCLUSIONS: The enhanced TCM daycare program helped cancer patients decrease the severity of their adverse events and improve their fatigue and QOL. ClinicalTrials.gov identifier: NCT04606121.

Geriatric Social Workers in Adult Day Care Facilities: Meditation, Worker Resilience, and Job Satisfaction.

This article reports a wait list control design study on the influence of an online meditation training program for geriatric social workers (GSWs) in a range of adult day care facilities across eight Asian and African cities. Results indicated that the online program was effective in building resilience and promoting job satisfaction among the intervention group. The program was more effective for participants from Asian cities, women, Hindus, and Buddhists working in transitional day care facilities and regularly logging into the self-practice sessions. Self-practice was an important mediator determining the relationship between demographic predictors and outcomes. This synchronous and asynchronous online program can be used by GSWs with some modifications for participants from African cities; men; Muslims and Christians; and those working in active adult, palliative, and memory care facilities. Refinements may entail adding familiar spiritual ideologies, some activities for men involving greater verbalization of feelings and emotions linked to the work, and intensive exercises addressing specific challenges of workers in palliative and memory care facilities.

Categorizing Cannabis and Alcohol Use Patterns of Emerging Adults in Psychiatric Partial Hospitalization Treatment.

BACKGROUND: Emerging adulthood is a common and problematic time for alcohol and cannabis use. Emerging adulthood also represents a vulnerable time period for anxiety and depression. Substance use and mental health issues are highly comorbid, yet substance use is commonly neglected in psychiatric care. OBJECTIVE: The goal of this study was to categorize the cannabis and alcohol use patterns of emerging adults in psychiatric care and to evaluate relationships with use-related problems, psychiatric symptomatology, and motives for use. METHODS: Participants were emerging adults who were consecutive admissions to a young adult psychiatric partial hospital program from 2017 to 2018. Of 318 participants who completed questionnaires, 244 (76.7%) reported cannabis and/or alcohol use in the previous month. Cluster analyses and analysis of variance tests were conducted to categorize and differentiate between participants who reported use. RESULTS: Results from cluster analyses identified 4 categories of use: low cannabis/high alcohol (35.7%), low cannabis/low alcohol (17.6%), high cannabis/low alcohol (29.1%), and high cannabis/high alcohol (17.6%). Individuals in categories with the highest rates of use and co-use reported more alcohol problems (F=24.31, P<0.001), cannabis problems (F=36.75, P<0.001), depression (F=3.60, P=0.01), and motives: social (F=6.12, P<0.001), coping with anxiety (F=20.43, P<0.001), coping with depression (F=17.80, P<0.001), enhancement (F=7.85, P<0.001), and conformity (F=4.92, P<0.01). CONCLUSIONS/IMPORTANCE: Clear categories of substance use emerged. Participants who were heavier users were more likely to use to alleviate psychiatric symptomatology, yet they also reported greater psychiatric symptomatology and use-related problems. Among a psychiatric sample of emerging adults, cannabis and alcohol use was common and problematic. Thus, substance use should be evaluated for and, if present, targeted with interventions during psychiatric care.

[Experience of group art therapy with music improvisation in the integrated treatment at a psychiatric Day Hospital: preliminary results]. / Esperienza di arteterapia di gruppo con improvvisazione musicale nel trattamento integrato riabilitativo presso un Day Hospital psichiatrico: risultati preliminari.

AIM: The study aims at evaluating the resocializing effects of music therapy as add-on therapy in the course of integrated, pharmacological and psychological, treatment. METHODS: During a six months period, 24 patients belonging to a psychiatric Day Hospital were recruited and divided into 2 groups. An accurate music anamnesis was collected for each patient. Group 1 (n=11) received as add-on therapy 14 improvisational music therapy sessions on a weekly basis, while group 2 (n=13) received 7 improvisational music therapy sessions alternated with 7 listening music therapy sessions, on a weekly basis. The response to music therapy was evaluated at the beginning and at the end of the add-on therapeutic process through a music therapy observation form consisting of 9 variables. RESULTS: In both groups there was a good response from patients affected by mood disorders as well as obsessive-compulsive disorder, while schizophrenic patients response was either absent or reduced. The improvement of the variable interaction between the components, sharing of the instrument, facial expressions and tension was significantly higher in the group that received as add-on therapy both improvisational music therapy and listening music therapy. DISCUSSION AND CONCLUSIONS: The findings suggest a significant role of the improvisational music therapy in gaining a re-socializing effect within a therapeutic group. The effectiveness turns out to be greater if the improvisation is combined with a listening therapy, aimed at educating the patient to a greater openness to the expressive aspect of sound. The active-passive music therapy association could then bring a valuable contribution as an add-on rehabilitative treatment.

[Prospects and constraints of nursing home-based integrated adult day care : Viewpoints of experts]. / Möglichkeiten und Grenzen integrierter Tagespflege in Pflegeheimen : Sichtweisen von ExpertInnen.

BACKGROUND: Even when they are in need of care, old people prefer to stay in their community. An appropriate design of nonresidential and residential care services close to people's home is crucial for supporting them. In the model project "Pflege stationär-Weiterdenken!" (Nursing home care-think ahead!) nursing homes offer extended services to old people in the community. This includes integrated day care (ITP), which entails day guests spending the day with residents of the facilities. This article examines the opportunities and challenges arising when designing and implementing this type of cross-sectoral care model. METHOD: Guided interviews were carried out with 20 experts who were either professionals working at the model institutions or involved in the project at the planning and cooperation levels. The data collected were evaluated using thematic coding. RESULTS: The opportunities and challenges lie at two levels. (1) At the institutional level advantages are greater individual and flexible timeframes of usage and better accessibility of day care for care-dependent people through the integration into residential care settings. The challenges involve administrative and management issues as well as apprehensions among the employees concerning the increased workload. (2) At the level of interaction and social integration experts emphasized the importance of making allowances for the interests and needs of day guests and residents. Furthermore, they confirmed that if this is achieved then integrated day care can improve the social participation of both user groups. CONCLUSION: From the experts' point of view, the ITP holds the potential for cross-sectoral care for old people in need of care close to their homes. A final assessment will require further analysis, especially on users' views.

Effectiveness of a brief adjunctive yoga intervention for short-term mood and psychiatric symptom change during partial hospitalization.

OBJECTIVE: Evidence concerning the effectiveness of yoga in partial hospital programs is limited. Yet, partial hospitals provide treatment at a critical juncture by bridging inpatient and outpatient care. The present study tested the effectiveness of a single-session group yoga intervention for short-term mood and psychiatric symptom change in participants attending a 1- to 2-week partial hospital program. METHOD: Participants included 104 partial hospital patients who participated in the single-session yoga intervention and completed a measure of positive/negative affect before and after the group. Participants, as well as partial hospital patients who did not attend the yoga intervention (n = 438), completed measures of depression and anxiety symptoms at admission and discharge from the program. At discharge, they also rated their perceived improvement and the overall quality of the care they received. RESULTS: Participants who attended the yoga intervention experienced significant improvements in positive and negative affect during the group. They did not show greater improvements in symptoms of anxiety or depression over the course of treatment compared to individuals who did not attend the group. Yoga intervention participants nonetheless gave higher ratings to the quality of the care they received. CONCLUSIONS AND IMPLICATIONS FOR PRACTICE: Findings demonstrated that attending a single yoga session during partial hospitalization was associated with short-term mood benefits, and with enhanced overall perceptions of treatment. Further research is needed to determine the conditions under which participation in yoga during partial hospitalization could contribute to symptom change in this context. (PsycINFO Database Record (c) 2019 APA, all rights reserved).

[Psychomotricity and socio-aesthetics, physical therapy interventions for obese teenagers]. / Psychomotricité et socio-esthétique, des médiations corporelles pour l'adolescent obèse.

The project to lose weight is not simply a matter of changing behaviour. Obese teenagers must draw on other strategies, including those which require them to learn to love their body. In this respect, psychomotricity and socio-aesthetics are two complementary approaches which can be used as part of a teenager's care in the day hospital.

A simple care bundle to reduce unplanned admission rate for day case pediatric circumcision.

BACKGROUND: An electronic review of unplanned day case admission rates in our hospital demonstrated an average annual rate for pediatric circumcision of 2%-3% in recent years with high levels of perioperative strong opiate use. This lay above target unplanned admission rates (<2%) set out by the Royal College of Anaesthetists for day case surgery. A targeted quality improvement initiative was undertaken to improve patient flow through the pediatric day case surgery unit for elective circumcision. Among the reasons for unplanned admission, factors modifiable by the anesthetist (pain, postoperative nausea and vomiting, somnolence) are significant contributors. METHODS: A prospective audit was undertaken over a 3-month period. Our practice was compared with evidence-based analgesic and antiemetic interventions in accordance the Association of Paediatric Anaesthetists of Great Britain and Ireland. Perioperative strong opiate administration rates occurred in 44% of cases. Four strategic interventions were selected based on quality of evidence, ease of implementation, and low cost: selection of higher concentration local anesthetic use for penile blocks, intravenous dexamethasone, and preoperative paracetamol combined with maximum dose nonsteroidal anti-inflammatory. RESULTS: The audit was duplicated a year later demonstrating a significant increase in application of these interventions with a parallel fall in strong opiate use from 44% to 9% and an unprecedented zero unplanned admission rate in our unit for 10 months in a row after implementation. CONCLUSION: Regular scrutiny of patient electronic data helps identify high impact areas for audit and intervention. Unplanned admission in pediatric day case surgery is an area amenable to such targeted intervention.

Vivencias espirituales del adulto mayor en un hospital de día de la red almenara, en Lima, Perú / Spiritual experiences of the elderly in a day hospital of the almenara network, in Lima, Peru

Objetivo: analizar vivencias espirituales del adulto mayor en un Hospital de Día de la Red Almenara, en Lima. Introducción: las vivencias son experiencias que viven los adultos mayores, surgen de su interior y forman parte de su carácter, la espiritualidad basada en creencias y valores se caracteriza por la relación con el yo, con el otro, con la naturaleza y con la vida. Material y métodos: investigación cualitativa, descriptiva comprensiva, realizada con 10 adultos mayores, el muestreo fue definido por saturación de discursos. La técnica fue la entrevista a profundidad con una guía de entrevista semi estructurada, aplicada en dos sesiones, respetándose los principios bioéticos. Resultados: se identificaron tres categorías generales: re-creando las concepciones de la espiritualidad; la espiritualidad en la práctica de valores y la espiritualidad desde la religio-sidad del adulto mayor. Discusión: la primera categoría define el acercamiento a Dios a través de la oración y la religión, considerada una necesidad básica y humana para promover la calidad de vida. La segunda categoría, se refiere a la práctica de valores que es trascendente y se refleja principalmente en el amor y la solidaridad. La tercera categoría, señala que la espiritualidad brinda la oportunidad de estar en paz con uno mismo y con los demás. Conclusiones: las vivencias espirituales de los adultos mayores indican que ellos desean vivir mejor, usando lo que le resta de vida de la mejor manera posible. Por ello, se apoyan en la religiosidad y la práctica de valores para conservar la paz espiritual logrando así, un envejecimiento favorable.

Targeted palliative care day therapy interventions using modified MYMOP2 tool can improve outcomes for patients with non-malignant diseases.

BACKGROUND: There is a paucity of evidence supporting the benefits of palliative care day therapy services for patients with non-malignant diseases. Outcome measures in this setting are also lacking. AIM: To evaluate the use of the modified Measure Yourself Medical Outcome Profile 2 (MYMOP2) tool in tailoring day therapy services toward the needs of patients with non-malignant conditions Method: A single system, 'before and after' design quality improvement study was conducted. Data were collected regarding outcome measures, re-referral rates and mortality. RESULT: After the introduction of the modified MYMOP2 tool, there was an improvement in the mean outcome scores for patients with non-malignant disease. Re-referral rates for these patients dropped by 28% during the follow up period, with no change in mortality. IMPLICATIONS FOR PRACTICE: These findings suggest that using the modified MYMOP2 tool to tailor and measure the outcome of holistic day therapy services results in a more sustained improvement for patients with non-malignant disease.

Day hospital mentalization-based treatment v. specialist treatment as usual in patients with borderline personality disorder: randomized controlled trial.

BACKGROUND: Day hospital mentalization-based treatment (MBT-DH) is a promising treatment for borderline personality disorder (BPD) but its evidence base is still limited. This multi-site randomized trial compared the efficacy of MBT-DH delivered by a newly set-up service v. specialist treatment as usual (S-TAU) tailored to the individual needs of patients, and offered by a well-established treatment service. METHODS: Two mental healthcare institutes in The Netherlands participated in the study. Patients who met DSM-IV criteria for BPD and had a score of ⩾20 on the borderline personality disorder severity index (BPDSI) were randomly allocated to MBT-DH (N = 54) or S-TAU (N = 41). The primary outcome variable was the total score on the BPDSI. Secondary outcome variables included symptom severity, quality of life, and interpersonal functioning. Data were collected at baseline and every 6 months until 18-month follow-up, and were analyzed using multilevel analyses based on intention-to-treat principles. RESULTS: Both treatments were associated with significant improvements in all outcome variables. MBT-DH was not superior to S-TAU on any outcome variable. MBT-DH was associated with higher acceptability in BPD patients compared v. S-TAU, reflected in significantly higher early drop-out rates in S-TAU (34%) v. MBT-DH (9%). CONCLUSIONS: MBT-DH delivered by a newly set-up service is as effective as specialist TAU in The Netherlands in the treatment of BPD at 18-month follow-up. Further research is needed to investigate treatment outcomes in the longer term and the cost-effectiveness of these treatments.

[Effects of psychosomatic treatment for the elderly on cognition and quality of life : Naturalistic study at the psychosomatic day care hospital for the elderly in Nuremberg]. / Einfluss einer psychosomatischen Behandlung für Ältere auf Kognition und Lebensqualität : Naturalistische Studie an der Psychosomatischen Tagesklinik für Ältere am Klinikum Nürnberg.

BACKGROUND AND OBJECTIVE: In 2006 the psychosomatic day care hospital for the treatment of acute mental illness of elderly people opened as the first clinic of its kind in Germany. The aim of the study was to determine treatment effectiveness regarding quality of life and cognition. MATERIAL AND METHODS: Designed as a naturalistic study of a population sample of 116 patients, the cognitive capacity (memory performance and cognitive speed) and the subjective quality of life were measured by the Nuremberg aging inventory (NAI) and the World Health Organization quality of life for elderly persons (WHOQOL-OLD). The patients were surveyed at four points in time including at 8­month follow-up. A 5-week waiting time before admission to the 5­week therapy was implemented as a control condition. RESULTS: In comparison with the waiting time, after treatment significant improvement (<0.05) was found in cognitive capacity and quality of life. Effect sizes were partly small and mostly moderate (ES 0.2-1.0) with larger effect sizes in the quality of life than in the cognitive domain. Improvements of cognition and quality of life remained stable at follow-up (admission to follow-up ES 0.1-1.0). No correlation was found between cognitive improvement and reduction of depressive symptoms. CONCLUSION: The results indicate that the psychosomatic day care hospital treatment of the elderly improves subjective quality of life and cognitive capacity.

Effect of horticultural therapy on wellbeing among dementia day care programme participants: A mixed-methods study (Innovative Practice).

Fourteen people attending an adult day programme were recruited to a structured horticultural therapy programme which took place over 10 weeks. The effects were assessed using Dementia Care Mapping and questionnaires completed by family carers. High levels of wellbeing were observed while the participants were engaged in horticultural therapy, and these were sustained once the programme was completed. This study adds to the growing evidence on the benefits of horticultural therapy for people with dementia who have enjoyed gardening in the past.

Family-Based Integrated Care (FBIC) in a Partial Hospital Program for Complex Pediatric Illness: Fostering Shifts in Family Illness Beliefs and Relationships.

The heuristic model of family-based integrated care (FBIC) was developed from 1998 to 2016 in the context of the development of the Hasbro Children's Partial Hospital Program (HCPHP) along with the development of a family therapy training program for Brown University child psychiatry and triple board residents. The clinical experience of the HCPHP team in treating more than 2000 patients and families in combination with the authors' experience in training residents for diverse practice settings highlights the usefulness of the FBIC paradigm for interdisciplinary family-based treatment for a broad range of illnesses and levels of care.

Implementation of evidence-based treatments for borderline personality disorder: The impact of organizational changes on treatment outcome of mentalization-based treatment.

The quality of implementation of evidence-based treatment programs for borderline personality disorder (BPD) in routine clinical care is a neglected issue. The first aim of this mixed-method naturalistic study was to explore the impact of organizational changes on treatment effectiveness of a day-hospital programme of mentalization-based treatment. Consecutively referred BPD patients were divided into a pre-reorganization cohort (PRE-REORG) and a cohort during reorganization (REORG). Psychiatric symptoms (Brief Symptom Inventory) and personality functioning (Severity Indices of Personality Problems-118) before treatment and at 18- and 36-month follow-up were compared using multilevel modelling. Effect sizes in the PRE-REORG cohort were approximately twice as large at 18 months (PRE-REORG: range 0.81-1.22; REORG: range 0.03-0.71) and three times as large at 36 months (PRE-REORG: range 0.81-1.80; REORG: range 0.27-0.81). The quantitative results of this study suggest that even when mentalization-based treatment is successfully implemented and the structure of the programme remains intact, major organizational changes may have a considerable impact on its effectiveness. Second, we aimed to explore the impact of the reorganization on adherence at organizational, team and therapist level. The qualitative results of this study indicate that the organizational changes were negatively related to adherence to the treatment model at organizational, team and therapist level, which in turn was associated with a decrease in treatment effectiveness. The implications of these findings for the implementation of effective treatments for BPD in routine clinical practice are discussed. Copyright © 2017 John Wiley & Sons, Ltd.