The termination process in open-ended psychotherapy: Guidelines for clinical practice.

Presents observations from survey and clinical material from 20 psychotherapists concerning how they handle termination. It is noted that countertransference frequently creates complex reactions in therapists that can confuse and prolong the therapeutic process. Suggested guidelines for termination in open-ended therapy are discussed, including overt discussions at the outset of therapy regarding how termination will be identified and handled, awareness of cues that indicate the therapeutic relationship is changing, provision for a final review of treatment, and continued availability of the therapist following termination of treatment. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Guidelines for clinical use of drugs for involutional osteoporosis

Guidelines for clinical use of drugs for involutional osteoporosis will be released soon in Japan. Seven different types of drugs for osteoporosis are in market for clinical use in Japan. Those includes calcium, estrogens, anabolic steroids, calcitonins, active vitamin D3, ipriflavon, and etidronate. The guidelines recommend to clarify the risk factors in each patient before to start administration of drug. Patients with osteopenia are basically recommended to be followed without any drug treatment, but, patients with osteoporosis are generally recommended to be treated with drug after evaluation of risk factors. After menopause, inhibitors of bone resorption would be recommended as a first choice drug. For monitoring effects of treatment, bone mass measurement is so far the first choice, but bone metabolic markers would be used as well.     

Existential theory: Guidelines for practice in child therapy.

One reason for the limited attention to existential psychology in child treatment is the assumption that children are restricted in the amount of freedom and responsibility they can assume. However, current research on child development reveals that children actively influence their social and physical environment and hence begin from birth the process of self-determination. This article presents guidelines for implementing existential psychology with children derived from theoretical tenets and case study findings. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Guidelines for dyspepsia management in general practice using focus groups

BACKGROUND: There is a paucity of published guidelines on managing dyspepsia in general practice. Existing guidelines emphasize the role of investigations and drugs rather than management approaches. Focus groups are a means of uncovering the way in which the participants think and work in the pragmatic-setting, and have not previously been formally used in creating guidelines. AIM: To develop guidelines for the management of dyspepsia and to assess the use of focus groups of general practitioners (GPs) in order to do so. METHOD: Initial evidence-based guidelines were proposed by a group of four GPs with an audit facilitator, and used for discussion in three focus groups using a standard format. An anthropological analysis of the proceedings led to modifications of the original guidelines, based on knowledge, perceptions and attitudes. The study was set in three distinct locations involving 30 GPs. The outcome measures consisted of feedback, categorized by types of responses, from the analysis of the focus groups and the creation of guidelines. RESULTS: The resulting guidelines were patient centred and based on the principles of good consultation. They encompassed patients' fears and doctors' clinical uncertainties, and allowed flexibility in the individual patient's management. The focus group methodology exposed a substantial number of GPs to guideline development, and had the added benefits of dissemination, peer review and educational challenge. CONCLUSION: It was possible to develop guidelines for dyspepsia using focus groups. The methodology had the added benefits of ownership, peer review, exposure of educational gaps and locality factors, and dissemination of good practice. It included steps from evidence review to implementation strategies. The development of this technique could lead to a strategy towards the creation and application of evidence-based and professionally acceptable clinical guidelines and practice on a locality basis nationally.     

Logotherapy for clinical practice.

Logotherapy is based on the meaning-focused existential philosophy of Viktor E. Frankl (1905-1997). Numerous mental health professionals have been inspired by his most popular book, Man's Search for Meaning; however, many are unfamiliar with the depth of Frankl's work. The purpose of this article is to discuss the tenets of logotherapy, including fundamental concepts, applicability and techniques, roles of the therapist, and assessment tools and new research findings. Logotherapy can readily be integrated with techniques that mental health professionals frequently use, and thus it has much to offer mental health professionals regardless of their theoretical orientation. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Guidelines and practice of evidence based medicine

This is a review paper with pedagogic goals in essence. The concept of guidelines is defined and the function and types of guidelines described. Different types of guidelines, such as normative, methodological and practice-motivated, are considered. The most common methods for the drafting of guidelines are presented. The difference between evidence-based guidelines and consensus-based guidelines is established and the importance of grading the strength of recommendations in guidelines, on basis of the validity of the evidence, is stressed. Finally, an update of the role of guidelines in the practice of EBM is put forward.     

Paradigms for clinical ethics consultation practice

The effects of lipoproteins on ion channel-mediated catecholamine secretion were investigated in cultured bovine adrenal medullary cells. Low density lipoprotein (LDL: 20-80 mg/dl) and lipoprotein(a) [Lp(a); 10-80 mg/dl] inhibited catecholamine secretion induced by carbachol, an activator of nicotinic acetylcholine receptor-ion channels. LDL and Lp(a) suppressed carbachol-induced 22Na+ influx as well as 45Ca2+ influx in a concentration-dependent manner similar to that of catecholamine secretion. The inhibition of catecholamine secretion by Lp(a) was not overcome by increasing the concentration of carbachol. On the other hand, high density lipoprotein (HDL; < 150 mg/dl) had no effect on 22Na+ influx, 45Ca2+ influx, and catecholamine secretion. Like LDL and Lp(a), a synthetic peptide homologous to human plasma apolipoprotein B (apoB), apoB fragment(3358-3372)-amide (3-60 microM), attenuated 22Na+ influx, 45Ca2+ influx, and catecholamine secretion caused by carbachol. The apoB fragment also suppressed 22Na+ influx induced by veratridine (an activator of voltage-dependent Na+ channels) and 45Ca2+ influx induced by 56 mM K+ (an indirect activator of voltage-dependent Ca2+ channels). These findings suggest that atherogenic lipoproteins such as LDL and Lp(a) suppress catecholamine secretion by interfering with Na+ influx through nicotinic acetylcholine receptor-ion channels, in which apoB, a structural component common to both LDL and Lp(a), plays an important role. The inhibition by atherogenic lipoproteins of catecholamine secretion may influence the progression of atherosclerosis induced by these lipoproteins.     

Good clinical practice

Nine new phenylpropanoids (2-7, 10, 12, and 14) and two compounds representing novel structural classes of 7-O-8' and 7-O-8'.8-O-7' lignans (8 and 9, respectively) have been isolated from Illicium verum and their structures established by two-dimensional NMR. Most of these compounds appear to be biogenetically derived from threo-anethole glycol: relative stereochemistries for some members of this series were established by NOESY; absolute stereochemistries of others were determined by formation of Mosher esters.     

Screening for psychopathology in the clinical practice

Different instruments are used in clinical practice to assess comorbid psychopathology in addicted individuals. This study is aimed at comparing two of those instruments. In total, 327 heroin- and methadone-addicted individuals were interviewed in three treatment settings and outside treatment. Instruments used are the Addiction Severity Index (ASI) and the Composite International Diagnostic Interview (CIDI). The former instrument results in a general measure of severity of psychopathology, while the latter results in categorical DSM-III-R diagnoses. A comparison of the results show, however, that the two types of data do not agree to a large extent. By using the DSM-III-R data as golden standard, it appeared that a part of the psychopathology cases was missed out by the ASI severity measures. The results, that are especially of interest for clinicians using the ASI, are presented for various disorders.     

Sabbatical leaves for nurse-midwives in clinical practice

The demands of clinical practice seldom allow for time to pursue academic writing, teaching, or the development of individual advanced skills. The burnout rate in professions such as nurse-midwifery cannot be ignored. This article describes how one nurse-midwifery clinical practice implemented a short, rotating sabbatical; specific goals and guidelines are presented. It concludes that a sabbatical leave can be considered as one of many job-related benefits.     

Guidelines for the design and conduct of clinical trials on dentine hypersensitivity

Clinical trials on dentine hypersensitivity have been numerous and protocols varied. To date there is little consensus as to the conduct of studies on this poorly-understood yet common and painful dental condition. A committee of interested persons from academia and industry was convened to discuss the subject of clinical trials on dentine hypersensitivity and a consensus report is presented. A double-blind randomized parallel groups design is recommended, although cross-over designs may be used for the preliminary screening of agents. Subjects may have multiple sites scored. Sample size will be determined by estimating the variability in the study population, the effect to be detected and the power of the statistical test to be used. Subject selection is based on a clinical diagnosis of dentine hypersensitivity, excluding those with conflicting characteristics such as currently-active medical or dental therapy. The vestibular surfaces of incisors, cuspids and bicuspids are preferred as sites to be tested. A range of sensitivity levels should be included. Tactile, cold and evaporative air stimuli should be applied. Negative and benchmark controls should be incorporated. Most trials should last 8 weeks. Sensitivity may be assessed either in terms of the stimulus intensity required to evoke pain or the subjective evaluation of pain produced by a stimulus using a visual analog or other appropriate scale. The subject's overall assessment may be determined by questionnaire. Outcomes should be expressed in terms of clinically significant changes in symptoms. Follow-up evaluation is required to determine the persistence of changes. At least 2 independent trials should be conducted before a product receives approval.     

Guidelines for reporting results of quality of life assessments in clinical trials

BACKGROUND: Current guidelines on the management of asthma advocate the use of anti-inflammatory treatment in all but mild disease. They define disease control in terms of clinical criteria such as lung function and symptoms. However, the relationship between the clinical control of the disease and inflammation of the airways is not clear. A cross sectional study was therefore undertaken to investigate the relationship between airways inflammation and measures of clinical control and bronchial hyperresponsiveness in asthmatic patients treated with inhaled steroids. METHODS: Twenty six atopic adults (19-45 years) with mild to moderate asthma (baseline forced expiratory volume in one second (FEV1) > or = 50% predicted, concentration of histamine causing a 20% fall in FEV1 (PC20) 0.02-7.6 mg/ml) on regular treatment with inhaled steroids entered the study. Diary card recordings during the two weeks before a methacholine challenge test and bronchoscopic examination were used to determine peak flow variability, symptom scores, and use of beta 2 agonists. Biopsy specimens were taken by fibreoptic bronchoscopy from the carina of the right lower and middle lobes, and from the main carina. Immunohistochemical staining was performed on cryostat sections with monoclonal antibodies against: eosinophil cationic protein (EG1, EG2), mast cell tryptase (AA1), CD45, CD22, CD3, CD4, CD8, CD25, and CD45RO. The number of positively stained cells in the lamina propria was counted twice by using an interactive display system. RESULTS: There were no differences in cell numbers between the three sites from which biopsy specimens were taken. The PC20 for methacholine was inversely related to the average number of total leucocytes, EG1+, and EG2+ cells, mast cells, CD8+, and CD45RO+ cells in the lamina propria. These relationships were similar for each of the biopsy sites. Symptom scores, beta 2 agonist usage, FEV1, and peak flow variability were not related to any of the cell counts. CONCLUSIONS: Infiltration of inflammatory cells in the lamina propria of the airways seems to persist in asthmatic outpatients despite regular treatment with inhaled steroids. The number of infiltrating leucocytes such as mast cells, (activated) eosinophils, CD8+, and CD45RO+ cells in bronchial biopsy specimens from these patients appears to be reflected by airway hyperresponsiveness to methacholine, but not by symptoms or lung function. These findings may have implications for the adjustment of anti-inflammatory treatment of patients with asthma.     

A family practice model for clinical psychology.

Contends that the profession of clinical psychology is plagued by problems of role confusion in the public mind, which arises directly from current methods of service delivery. Present psychological service delivery methods are analyzed and found to contain several assumptions that contribute to a poor public image. An alternative model of practice, based on continuous involvement with families over time is described. Adaptive and healthy qualities of consumers of service are stressed. (9 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Immunomodulators in clinical practice

Immunomodulators have opened new vistas in the management of the immunocompromised patient. They have been shown to enhance the efficacy of vaccines in infections, head and neck malignancy, the immunosuppressed and recently in AIDS. The mechanism of their action is discussed. They hold promise of further advances in immunotherapy.