Therapist engagement in measurement-based care: The association between client outcomes and therapist viewing frequency.

Engagement in measurement-based care (MBC) has been shown to be an effective practice for optimizing psychotherapy outcomes. Best practices for MBC suggest that it is crucial for therapists to consistently review scores. However, the exact impact of this practice on MBC's effectiveness has yet to be fully elucidated. The current study examined the association between the frequency of therapists reviewing clients' depression scores and client psychotherapy outcomes. The sample consisted of 6182 clients diagnosed with depression who sought treatment from 2248 therapists through a practice research group. Patient Health Questionnaire-9 (PHQ-9) was administered prior to sessions, and therapists could access the scores via their therapist portal. The results based on multilevel modelling revealed that how often therapists view their clients' PHQ-9 results was not a significant predictor of therapy outcomes. However, therapists who, across their caseloads, viewed client PHQ-9 scores more frequently facilitated better treatment outcomes. These results suggest that therapists who routinely engage in MBC facilitate better therapy outcomes. Implications for practice and research are provided.

Measurement-based care professional practice guideline: Don't forget the therapists!

Boswell et al. (2022) professional practice guideline builds an excellent, evidence-driven argument in favor of the routine implementation of measurement-based care (MBC). Nonetheless, as learned from the attempted implementation of evidence-based psychotherapies, presenting empirical evidence does not affect therapist behavior. As such, we argue for an actionable and practical professional practice guideline. We review some of the most hindering barriers to the implementation of MBC, and we offer guidance introducing some of the efforts needed to overcome them. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Human Antibody Responses Following Vaccinia Immunization Using Protein Microarrays and Correlation With Cell-Mediated Immunity and Antibody-Dependent Cellular Cytotoxicity Responses.

BACKGROUND: There are limited data regarding immunological correlates of protection for the modified vaccinia Ankara (MVA) smallpox vaccine. METHODS: A total of 523 vaccinia-naive subjects were randomized to receive 2 vaccine doses, as lyophilized MVA given subcutaneously, liquid MVA given subcutaneously (liquid-SC group), or liquid MVA given intradermally (liquid-ID group) 28 days apart. For a subset of subjects, antibody-dependent cellular cytotoxicity (ADCC), interferon-γ release enzyme-linked immunospot (ELISPOT), and protein microarray antibody-binding assays were conducted. Protein microarray responses were assessed for correlations with plaque reduction neutralization titer (PRNT), enzyme-linked immunosorbent assay, ADCC, and ELISPOT results. RESULTS: MVA elicited significant microarray antibody responses to 15 of 224 antigens, mostly virion membrane proteins, at day 28 or 42, particularly WR113/D8L and WR101H3L. In the liquid-SC group, responses to 9 antigens, including WR113/D8L and WR101/H3L, correlated with PRNT results. Three were correlated in the liquid-ID group. No significant correlations were observed with ELISPOT responses. In the liquid-ID group, WR052/F13L, a membrane glycoprotein, correlated with ADCC responses. CONCLUSIONS: MVA elicited antibodies to 15 vaccinia strain antigens representing virion membrane. Antibody responses to 2 proteins strongly increased and significantly correlated with increases in PRNT. Responses to these proteins are potential correlates of protection and may serve as immunogens for future vaccine development. CLINICAL TRIALS REGISTRATION: NCT00914732.

A qualitative exploration of perceived key knowledge and skills in end-of-life care in dementia patients among medical, nursing, and pharmacy students.

BACKGROUND: The steady increase in the number of people living and dying with dementia, coupled with the recent focus on quality of care, has highlighted the importance of dementia training for health care professionals. This exploratory study aimed to discover which skills health care students felt were important in providing quality end-of-life care to dementia patients. METHODS: Ninety-four medicine, nursing, and pharmacy students participated in a larger study using open-ended and closed questions to explore attitudes related to caring for dementia patients at the end of life. This study looks at the student responses to an open-ended question regarding the skills and knowledge they believe are needed to provide end-of-life care to dementia patients. Individual responses were reviewed by the researchers, coded into key issues, and tabulated for frequency of occurrences and group differences. RESULTS: Several common issues emerged: knowledge, patience, empathy, understanding, family involvement, compassion, medication knowledge, respect/patient autonomy, communication, quality of life, and patient education. Significant differences were observed among the participant groups on the following issues: Patience and understanding (pharmacy students mentioned these issues less frequently than medical and nursing students), compassion (medical students mentioned this issue more frequently than pharmacy students), and medication knowledge (pharmacy students mentioned this issue more frequently than medical and nursing students). CONCLUSIONS: Different health care disciplines (in-training) value different skill sets for the provision of dementia care at the end-of-life. As health care education for dementia patients at the end of life is expanded, it will be important to understand which skills both patients and health care students value.

Oligodeoxynucleotide CpG 7909 delivered as intravenous infusion demonstrates immunologic modulation in patients with previously treated non-Hodgkin lymphoma.

Oligodeoxynucleotides containing CpG motifs (CpG ODN) can alter various immune cell subsets important in antibody therapy of malignancy. We undertook a phase I trial of CPG 7909 (also known as PF-3512676) in patients with previously treated lymphoma with the primary objective of evaluating safety across a range of doses, and secondary objectives of evaluating immunomodulatory effects and clinical effects. Twenty-three patients with previously treated non-Hodgkin lymphoma received up to 3 weekly 2-hour intravenous (IV) infusions of CPG ODN 7909 at dose levels 0.01 to 0.64 mg/kg. Evaluation of immunologic parameters and clinical endpoints occurred for 6 weeks. Infusion-related toxicity included grade 1 nausea, hypotension, and IV catheter discomfort. Serious adverse hematologic events observed more than once included anemia (2=Gr3, 2=Gr4), thrombocytopenia (4=Gr3), and neutropenia (2=Gr3), and were largely judged owing to progressive disease. Immunologic observations included: (1) The mean ratio of NK-cell concentrations compared with pretreatment at day 2 was 1.44 (95% CI=0.94-1.94) and at day 42 was 1.53 (95% CI=1.14-1.91); (2) NK activity generally increased in subjects; and (3) Antibody-dependent cellular cytotoxicity activity increased in select cohorts. No clinical responses were documented radiographically at day 42. Two subjects demonstrated late response. We conclude CpG 7909 can be safely given as a 2-hour IV infusion to patients with previously treated non-Hodgkin lymphoma at doses that have immunomodulatory effects.

Structural characterization of the inhibitory DNA motif for the type A (D)-CpG-induced cytokine secretion and NK-cell lytic activity in mouse spleen cells.

Oligodeoxynucleotides (ODN) with the CpG motif have been shown to be potent stimulators of innate immunity. A theoretical concern is that uncontrolled stimulation of the innate immune system through the TLR-9 receptor could induce, or worsen, some autoimmune diseases such as adjuvant arthritis or systemic lupus erythematosus. Safe therapeutic use of such ODN could be enhanced if one could regulate some of their stimulatory activities. We have designed a group of synthetic ODNs, which were able to inhibit the induction of NK lytic activity, IL-12p40 and IFN-gamma cytokine secretion by type A (D)-CpG-ODNs. Inhibition occurred in both DNA-sequence and dose-dependent fashion. Fifty percent inhibition was achieved with ~10-nM concentration of the most potent inhibitory ODNs. Delayed addition of these ODNs for up to 2 h was still able to profoundly affect CpG-induced IL-12p40 production at 18 h. Inhibitory DNA motif consists of two nucleotide triplets, a proximal pyrimidine-rich CCT sequence and a more distal GGG triplet. Optimal distance between these blocks is between three to five nucleotides. The linker sequence between the CCT and GGG blocks can additionally modify the activity of inhibitory ODNs, in both a positive and in negative way. When the order of CCT and GGG blocks is reversed, inhibition is completely lost. These findings suggest that CpG regulation of innate immunity can itself be regulated by particular motifs, which could be of therapeutic benefit in autoimmune diseases.

Deficient natural killer cell cytotoxicity in patients with IKK-gamma/NEMO mutations.

NF-kappaB essential modifier (NEMO), also known as IKK-gamma, is a member of the I-kappaB kinase complex responsible for phosphorylating I-kappaB, allowing the release and activation of NF-kappaB. Boys with an expressed NEMO mutation have an X-linked syndrome characterized by hypohidrotic ectodermal dysplasia with immune deficiency (HED-ID). The immunophenotype resulting from NEMO mutation is highly variable, with deficits in both T and B cell responses. We evaluated three patients with NEMO mutations (L153R, Q403X, and C417R) and HED-ID who had evidence of defective CD40 signaling. All three patients had normal percentages of peripheral blood NK cells, but impaired NK cell cytotoxic activity. This was not due to a generalized defect in cytotoxicity because antibody-dependent cellular cytotoxicity was intact. This abnormality was partially reversed by in vitro addition of IL-2, which was also able to induce NF-kappaB activation. In one patient with recurrent cytomegalovirus infections, administration of IL-2 partially corrected the NK cell killing deficit. These data suggest that NEMO participates in signaling pathways leading to NK cell cytotoxicity and that IL-2 can activate NF-kappaB and partially overcome the NK cell defect in patients with NEMO mutations.