Case Series Pilot Research Articles

A case series pilot study on the combination of 5-aminolevulinic acid and photodynamic therapy (ALA-PDT) for treatment of vitiligo

Background:To study the effective therapeutic concentration, drug application duration, irradiation duration and irradiation dosage of 5-aminolevulinic acid photodynamic therapy (ALA-PDT) for treating vitiligo and observe its clinical efficacy. Objective:To assess the clinical efficacy of ALA-PDT for treating vitiligo. Methods:ALA with different drug concentrations, drug application durations, irradiation durations and irradiation dosages were adopted to treat skin lesions caused by vitiligo to determine the effective drug concentration, drug application duration, irradiation duration and irradiation dosage for treating three vitiligo volunteers and observe the therapeutic results. Results:The clinical trial suggested that ALA at a drug concentration of 1.5%, drug application duration for 3 hours, irradiation dosage of 80mw/cm2 and irradiation duration for 20 min was effective in treating vitiligo. Under these parameters, ALA-PDT was effective to the three vitiligo volunteers, with mild pain and feeling of burning but no other adverse reaction during treatment. Study limitations:Due to the small sample size in this study for the effectiveness of PDT in treating vitiligo and the potential variations in the efficacy for treating the disease at different areas, further studies shall be conducted for confirmation. Conclusions:ALA with a drug concentration at 1.5%, drug application duration for 3 hours, irradiation dosage of 80 mw/cm2 and irradiation duration for 20 min is effective in treating vitiligo. Therefore, ALA-PDT is safe and effective in treating the disease, with minor adverse events, providing a new method for treating vitiligo in the future.

Treating amblyopia in adults with prosthetic occluding contact lenses.

To investigate the feasibility, effectiveness and acceptability of using prosthetic occluding contact lenses (OCLs) to treat moderate amblyopia in adults and of the role of the multifocal visual evoked potential (mfVEP) as a predictor of postamblyopic therapy. A comparative, prospective, interventional, case series pilot study with amblyopic adults (mean age: 40years, range 20-50years) allocated into two intervention groups: eye patching and OCL. The primary outcome variable was logarithm of the minimum angle of resolution (logMAR) best-corrected visual acuity (BCVA), and secondary outcomes were mfVEP amplitude and latency and patients' health-related quality of life National Eye Institute Visual Function Questionnaire (NEI VFQ-25). Significant improvements in pre- to postamblyopic therapy BCVA were seen at 1.5months in the OCL group [0.29 logMAR, 95% confidence interval (CI): 0.10-0.47 versus 0.11 logMAR, 95% CI: 0.02-0.19; p<0.001] and eye patching group (0.29 logMAR, 95% CI: 0.17-0.40 versus 0.18 logMAR, 95% CI: 0.12-0.23; p<0.01). Post-treatment BCVA was inversely related to age (R: 0.009, 95% CI: -0.02 to -0.001; p=0.04) and the presence of strabismus (R: -0.3, 95% CI: -0.434 to -0.17; p=0.001). No significant changes in the number and size of the abnormal mfVEP amplitude and latency defects were observed after occlusion. The NEI VFQ-25 composite score showed significant improvement in the OCL users at 12months compared to eye patching. Significant vision improvement can be achieved, making occlusion with OCLs an effective and more acceptable therapy for adults with amblyopia.

The Effect of Combination of Red, Infrared and Blue Wavelengths of Low-Level Laser on Reduction of Abdominal Girth: A Before-After Case Series.

Introduction: The objective of this study was to assess the efficacy of a combination of 3 wavelengths (including red, infra-red, and blue) of low-level laser (LLL) as a non-invasive therapeutic method to reduce abdominal girth. To achieve biochemical activity on adipocytes, a red laser was used in our selective laser combination. Near-infrared laser was used to increase depth of penetration. Nitrosyl complexes of hemoglobin (NO-Hb) are sensitive to blue light, thereby leading to increase in release of biologically active nitric oxide (NO), which can affect tissue perfusion. Thus, a blue LED was added to the laser combination. Methods: Eighteen females participated in the study. Twelve sessions of laser therapy were performed, 2 sessions per week for each subject. Continuous wave diode lasers, including red (630 nm), infra-red (808 nm), and a blue LED (450 nm) were applied and were all designed by the Canadian Optic and Laser Center. Results: Statistical analyses revealed that upper abdomen size significantly decreased from pre- (91.86 ± 11.16) to post- (87.41 ± 10.52) low-level laser therapy (LLLT) (P<0.001). Middle abdomen size showed significant reduction from pre- (97.02 ± 8.82) to post- (91.97 ± 8.49) LLLT (P<0.001). Lower abdomen size significantly decreased from pre- (100.36 ± 9.45) to post- (95.80 ± 8.52) LLLT (P<0.001). Conclusion: Based on this case series pilot investigation, the combination of 3 different wavelengths of LLL was effective for abdominal girth reduction in 100% of our subjects (P<0.001), without any side effects. Future studies will assess the long-term benefits of this laser combination for reduction of subcutaneous fat deposits.

Motivation-Matched Approach to the Treatment of Problem Gambling: A Case Series Pilot Study

The aim of the present case series was to provide a preliminary assessment of the utility of a motivation-matched treatment for problem gamblers. On the basis of their primary underlying motivations for gambling, 6 problem gamblers received either action-motivated (n = 4) or escape-motivated (n = 2) treatment. Drawing upon a cognitive-behavioural framework, this 6-session motivation-matched treatment was designed to address gamblers' maladaptive motivations for gambling (i.e., the need or desire for "escape" or "action"), as well as the effects of conditioning and maladaptive thinking patterns unique to each gambling motive subtype. Assessments were conducted at pre-treatment, post-treatment, and 3- and 6-month follow-up. Primary outcome measures included gambling behaviour (i.e., gambling frequency, time, and money spent gambling), severity of gambling problems, and gambling-related impairment or disability; secondary outcome measures included gambling-related craving, gambling abstinence self-efficacy, positively and negatively reinforcing gambling situations, and gambling outcome expectancies. Overall, participants showed pre- to post-treatment improvements on the majority of these measures, with relatively less immediate post-treatment treatment gains observed on measures that assessed positively and negatively reinforcing gambling situations and gambling-related impairment or disability. However, treatment gains at the 3- and 6-month follow-up were shown for most participants on these latter measures as well. Findings suggest promise for this novel treatment approach. The next step in this line of research is to conduct a randomized, controlled trial to compare the efficacy of this motivation-matched treatment for disordered gambling with treatment as usual.

Evaluating Access and Mobility within a New Model of Supported Housing for People with Neurotrauma: A Pilot Study

Objectives: (1) Evaluate the features of purpose-built apartment living on access, environmental control, and home and community mobility of people living with neurotrauma and (2) Examine tenant perceptions of those features.Research design: Observational case series pilot study.Setting:Three apartments within a residential development in Melbourne, Australia.Participants:Three males (aged 30–55 years) with traumatic brain and/or spinal cord injury living in the three separate apartments.Method and procedures:Measures:Two-published measures of user experience of built and technology environments, coupled with customised interdisciplinary post-occupancy evaluation (POE) methods and GPS-enabled mobility tracking.Analysis:Measures completed per manual guidelines and data reported descriptively. Customised measured drawings produced to represent tenants’ physical access and mobility. GPS community mobility data plotted on Google Earth.Results: Built design features which enabled access and mobility included linear paths of travel, well-located furnishings, and joinery design that allowed approach from either side using a wheelchair. Personal home furnishing choices posed barriers to physical access. Home automation technologies positively influenced participants’ sense of control and independence, but posed learning challenges. Close proximity of housing to accessible public transport and services enabled community travel options.Conclusion: Findings from this pilot study indicate the combination of housing location, design and technologies used, together with availability of local community services, provides an acceptable level of environmental control, access, mobility and tenant experience. Further research is required to determine validity of the novel measures used, and deliver rigorous research design to evaluate those features most important in achieving optimal outcomes.

Laparoscopic Pyloroduodenal Wrap Utilizing the Lesser Omentum

It has been a long time since Roscoe Graham in 1938 started his technique using the greater omentum patching perforated peptic ulcers. The traditional technique was suitable for the open surgical access but not for the laparoscopic one. The lesser omentum offers a more readily potent tissue flap that is both anatomically and surgically optimistic to the laparoscopic technique. This is a preliminary case series pilot study describing a new surgical technique for repair of perforated peptic ulcer. Between February 2013 and April 2014, 27 adult patients were recruited for the study. All patients were operated by laparoscopy with no case conversion to open. Patient's data and results are scheduled in tables. Neither postoperative complication nor reperforation was recorded. Gastroduodenal wrap utilizing the lesser omentum is a novel technique based on solid concepts that suits laparoscopic specialty as a separate identity from open surgery.

Closed-tube thoracostomy: a novel emergency surgery technique.

The practice of tube thoracostomy entails high risk as it is a closed technique. Open thoracostomy and closed minithoracostomy techniques have been approved worldwide as safe modalities. Applying the concept of a new closed thoracostomy technique with high safety and simplicity is a major advancement in this regard. This was a case series pilot study introducing a new technique for closed-tube thoracostomy. Thirty-one patients with primary unilateral pneumothorax were selected for the study. All patients coming to the Emergency Department at Security Forces Hospital, Dammam City, Kingdom of Saudi Arabia, between January and August 2012, matching the study criteria were recruited to undergo the new technique. The surgical set required for the technique was defined and prepared sterile. Preinsertion and postinsertion chest x-ray and chest computed tomography scans were obtained for the entire study sample. We recruited the first 31 patients requiring tube thoracostomy who visited the Emergency Department. All procedures were performed by the author, assisted by on-call registrars. No complications were observed with the new technique. Moreover, advantages of the technique were demonstrated and documented. The new technique provides safe tube introduction and precise tube positioning, saves time, and involves no technical precautions. The technique has been applied on selected simple cases as the first trial and requires further testing in cases of hemothorax, empyema thoracis, traumatic chest injuries, and complicated pulmonary diseases that require drainage. Further evaluation of the technique by randomized studies is required.

Autologous blood injections for chronic plantar fasciitis – a pilot case-series study shows promising results

ObjectivesPlantar fasciitis is a common condition with a small number of people having symptoms that are challenging to treat. This prospective case series pilot study paper reports the patient outcomes following ultrasound-guided autologous blood injections (ABI) for the treatment of chronic plantar fasciitis symptoms.Methods and patientsProspective case-series study of 35 consecutive patients who have undergone ultrasound-guided ABI for recalcitrant plantar fasciitis symptoms in a National Health Service Sports Medicine Clinic in Leicester, UK. Patients treated had suffered with symptoms of plantar fasciitis for an average of more than 4 years pre-ABI. Patients had an average follow-up of 6 months and with a maximum of over 800 days. The outcome measures include visual analogue scale (VAS) for pain, and 7-part patient satisfaction outcome scale.ResultsThere was an average reduction of VAS of more than 85% post-ABI for all enrolled patients, increasing to nearly 90% in patients with at least 2 months follow-up data. At the latest follow-up appointment 53% of all patients were pain-free following the ABI procedure, increasing to 71% of patients with at least 2 months of follow-up data.DiscussionWhile causality is not proved in this study design, ultrasound-guided ABI appear to be successful in the treatment of recalcitrant plantar fasciitis. Further studies with greater methodological rigour using a control group or alternative interventions should be conducted.

Efficacy of cryospray ablation for the treatment of chronic radiation proctitis in a pilot study

Radiation proctitis, a common condition associated with radiotherapy for the treatment of pelvic cancers, is characterized by difficult to manage rectal pain and bleeding. Cryotherapy is a novel technique, previously used in the treatment of vascular ectasias in the upper gastrointestinal tract. The aim of the present study was to determine the efficacy of cryospray application in the treatment of radiation proctitis. This is a prospective case-series pilot study. Ten patients with symptomatic chronic radiation proctitis were consecutively enrolled over a 2-year period. Baseline clinical data were collected and an endoscopic score was calculated based on the density of ectasias and circumferential involvement. Subjects underwent up to four cryospray ablation treatment sessions at approximately 4-week intervals or until resolution of the proctitis. The endpoints of the study were endoscopic and clinical improvement in radiation proctitis. Ten patients (nine males and one female) with a mean age of 74 ± 7 years underwent cryospray treatment; sessions ranged from one to four (six patients had one session, three patients had two sessions, and one patient underwent four sessions). Endoscopic score significantly decreased from a mean of 10.2 ± 3.0 to 4.0 ± 2.8 (P = 0.016). Rectal pain significantly decreased from a mean of 3.1 ± 3.0 to 1.2 ± 1.7 (P = 0.042) and rectal bleeding improved in 86% (six out of seven) of patients. Nine patients reported improvement in overall well-being. No major complications were encountered. Cryotherapy is an effective method in the management of chronic radiation proctitis with minimal complications.

Game-Based, Portable, Upper Extremity Rehabilitation in Chronic Stroke

Purpose: This case series pilot study evaluates the efficacy of the Core:Tx gaming device on 2 chronic stroke survivors. Methods: Intervention was provided 3 times a week for 3 weeks. Outcome measures, administered 1 week before and 1 week after intervention, included the Stroke Impact Scale (SIS), the Canadian Occupational Performance Measure (COPM), the Fugl-Meyer Assessment of Motor Recovery (Fugl-Meyer [FM]), and the Box and Block Test (BB). Results: Participant A exhibited an 11-point increase on the SIS, a 1.2-point change on each of the performance and satisfaction scores of the COPM, a 1-point increase on the FM, and no change on the BB. Participant B exhibited a 3-point increase on the SIS and no change on the COPM, FM, or BB. Conclusions: The participants experienced increased quality of life, a greater propensity to use their affected arm, and enhanced task performance without exhibiting motor changes. Additionally, the Core:Tx gaming device was reported by the participants to be a motivating modality in the therapy setting.

Treatment of chronic radiation proctitis with cryoablation

Chronic radiation proctitis (CRP) is a common problem in patients receiving pelvic radiation. Current therapies have the potential for deep tissue injury with ulcerations, perforation, and fistula formation. Cryospray ablation therapy offers superficial ablation of mucosa and is a potential method to endoscopically treat CRP safely and effectively. To determine tolerability of and response to cryotherapy in patients with radiation proctitis. Prospective case-series pilot study. Baylor College of Medicine, Michael E. DeBakey Medical Center, Houston, Texas. Ten patients were prospectively recruited with chronic hemorrhagic radiation proctitis. Endoscopic cryoablation of CRP. Symptom severity of CRP was obtained by using the Radiation Proctitis Severity Assessment Scale (RPSAS). Endoscopic assessment was obtained using the rectal telangiectasia density grade. The primary endpoint of the study was endoscopic improvement of CRP based on the change in rectal telangiectasia density at 3-month follow-up. Secondary endpoints included symptomatic improvement based on RPSAS and adverse events at 3 months. Ten patients with hemorrhagic radiation proctitis were treated with endoscopic cryoablation. Endoscopic severity improved as measured by rectal telangiectasia density from 2.7 to 1.7 (P=.004). Overall subjective clinical scores improved as determined by the Radiation Proctitis Severity Assessment Scale from 27.7 to 13.6 (P=.003). Endoscopic improvement correlated with symptom improvement. Nonpowered case series pilot study. Cryoablation improved clinical and endoscopic indices in CRP. Further controlled studies are needed to identify the safety and efficacy of cryoablation for CRP.

The Role of Cognitive-Behavioural Therapy for Patients with Depression in Parkinson's Disease

Depression is a common complication of Parkinson's disease (PD) with considerable impact on patients' quality of life. However, at present the most appropriate treatment approach is unclear. There are limited data on antidepressant medications in PD-associated depression (dPD) and those available suggest limited efficacy and tolerability of these drugs. Cognitive behavioural therapy (CBT) has been shown to be an effective treatment of depressive disorders. Treatment of dPD with CBT may pose particular challenges, including possible different pathophysiology, physical and mental comorbidities, and barriers to treatment through disability, which do not allow simple transfer of these results to patients with dPD. However, a number of case reports, case series, and small pilot studies suggest that this is a promising treatment for patients with PD. We here summarise the published evidence on this treatment in dPD.

Análisis morfométrico del endotelio corneal tras ranibizumab intravítreo en la degeneración macular asociada a la edad

Purpose To determine the effect of intravitreal injection of 0.5 mg ranibizumab on the corneal endothelium in patients with age-related macular degeneration (AMD). Methods Observational, prospective case series pilot study. Twenty-six eyes of 26 consecutive patients with AMD were evaluated. All participants received one monthly intravitreal injections of 0.5 mg ranibizumab for three consecutive months. The follow-up period was 6 months. Central corneal specular microscopy was performed before injection and at 7 days and 6 months after the first intravitreal injection. The endothelial cell density, coefficient of variation of cell size, and percentage of hexagonal cells were analyzed and the central corneal thickness was measured. Results There were no significant differences in the endothelial cell densities, coefficients of variation of cell size and percentages of hexagonal cells before injection and at 7 days and 6 months after the first intravitreal ranibizumab injection ( P > 0.5). There was also no significant difference in central corneal thickness measurements through the follow-up period ( P > 0.5). Conclusions Repeated intravitreal injections of 0.5 mg ranibizumab do not seem to cause substantial changes in the corneal endothelium.

The ‘Standard’ for Poststroke Aphasia Recovery

See related article, pages 1485–1488. The past 2 decades may be remembered as the decades of metrics in medicine. All aspects of our work have been measured and charted by relative value units, H-indices, case mix indices, mean lengths of stay, mean patient satisfaction scores, and so on. Some metrics are important, some less so. However, 1 important measure is the degree to which a patient with stroke will be able to improve in the next 90 days. Decisions need to be made about whether to apply for disability, move to assisted living, or whether to wait for improvement to occur. We as stroke neurologists think we know the answers, but we all give different answers based on very little data; we often say it depends on the size of the stroke, the patient’s age and education, the severity and type of the deficit, the quality and duration of therapy, and so on. However, seemingly within a wide range of these variables, Lazar and colleagues1 have found that that there is a single answer that does not depend on any of these variables; by 90 days, patients improve by approximately 70% of the maximum potential recovery (the maximum potential language score minus their initial score) as long as they receive at …

Morphometric analysis of corneal endothelium after intravitreal ranibizumab (Lucentis®) in age-related macular degeneration treatment

PurposeTo determine the effect of intravitreal injection of 0.5mg ranibizumab on the corneal endothelium in patients with age-related macular degeneration (AMD). MethodsObservational, prospective case series pilot study. Twenty-six eyes of 26 consecutive patients with AMD were evaluated. All participants received one monthly intravitreal injections of 0.5mg ranibizumab for three consecutive months. The follow-up period was 6 months. Central corneal specular microscopy was performed before injection and at 7 days and 6 months after the first intravitreal injection. The endothelial cell density, coefficient of variation of cell size, and percentage of hexagonal cells were analyzed and the central corneal thickness was measured. ResultsThere were no significant differences in the endothelial cell densities, coefficients of variation of cell size and percentages of hexagonal cells before injection and at 7 days and 6 months after the first intravitreal ranibizumab injection (P>0.5). There was also no significant difference in central corneal thickness measurements through the follow-up period (P>0.5). ConclusionsRepeated intravitreal injections of 0.5mg ranibizumab do not seem to cause substantial changes in the corneal endothelium.

Vitrectomía enzimática por inyección intravítrea de plasmina autóloga como tratamiento inicial de las membranas epirretinianas maculares y el síndrome de tracción vitreomacular

To determine the effectiveness of intravitreal plasmin injection in the treatment of macular epiretinal membranes (MEM) and vitreomacular traction syndrome (VMTS) without associated pars plana vitrectomy. Interventional, prospective, case series pilot study. Seven patients were enrolled in the study, 4 with MEM and 3 with VMTS. 0.2 ml of autologous plasmin intravitreally injected under topical anesthesia was administered to all patients. The plasmin was obtained by a simplified method with urokinase. Degree of detachment of the MEM and the VMTS measured by optical coherence tomography (OCT), and the best corrected visual acuity (Snellen scale) before and one month after the plasmin injection. The follow-up period was completed by all the patients. The MEM remained attached to the retina in all cases, as measured either by biomicroscopy or OCT. The VMTS was completely detached from the foveal area in all cases, with the disappearance of secondary tractional retinal folds and recovery of the normal macular anatomic architecture as measured by OCT. Visual acuity was not modified in any of the MEM patients, and improved in all VMTS patients. No adverse effects were observed. In our case series, intravitreally injected autologous plasmin was not effective in the treatment of MEM, but resolved VMTS successfully, improving the visual acuity and releasing the retinal traction without the need for associated pars plana vitrectomy. Larger studies to confirm the efficacy of this technique and the possibility of success after repeated injections are warranted.

O.005 A three level system for the assessment of idiopathic normal pressure hydrocephalus

This case series pilot study assessed the safety of intraventricular urokinase administration, alternating with cerebrospinal fluid (CSF) drainage. A secondary objective was to comment on whether this therapy achieves fibrinolysis, and whether this fibrinolysis is sufficient to prevent progression of hydrocephalus to requirement for ventriculoperitoneal shunt. Six preterm infants with progressive posthemorrhagic hydrocephalus requiring treatment with a ventricular drain received an infusion of intraventricular urokinase alternating with CSF drainage for 3 days. Of the 6 treated patients, the median gestation at birth was 26.5 weeks and the median age at treatment was 30 days. One patient had an elevation in CSF erythrocyte count most likely due to successful clot lysis. One patient had an elevated CSF leukocyte count consistent with transient meningeal irritation. No other side effects were noted. Fibrinolysis was achieved in the CSF, as documented by markedly elevated D-dimer levels. Clot size diminished ultrasonographically. However, all 6 patients eventually required a ventriculoperitoneal shunt. We conclude that intermittent infusion of intraventricular urokinase alternating with periods of CSF drainage is probably a safe way to achieve a fibrinolytic state. However, when administered at the relatively late point in the neonatal course when a ventricular drain is required, this fibrinolytic state is not sufficient to decrease the requirement for ventriculoperitoneal shunt.

O.098 Navigation- and laser assisted neuroendoscopy for stent placement in complex hydrocephalus

This case series pilot study assessed the safety of intraventricular urokinase administration, alternating with cerebrospinal fluid (CSF) drainage. A secondary objective was to comment on whether this therapy achieves fibrinolysis, and whether this fibrinolysis is sufficient to prevent progression of hydrocephalus to requirement for ventriculoperitoneal shunt. Six preterm infants with progressive posthemorrhagic hydrocephalus requiring treatment with a ventricular drain received an infusion of intraventricular urokinase alternating with CSF drainage for 3 days. Of the 6 treated patients, the median gestation at birth was 26.5 weeks and the median age at treatment was 30 days. One patient had an elevation in CSF erythrocyte count most likely due to successful clot lysis. One patient had an elevated CSF leukocyte count consistent with transient meningeal irritation. No other side effects were noted. Fibrinolysis was achieved in the CSF, as documented by markedly elevated D-dimer levels. Clot size diminished ultrasonographically. However, all 6 patients eventually required a ventriculoperitoneal shunt. We conclude that intermittent infusion of intraventricular urokinase alternating with periods of CSF drainage is probably a safe way to achieve a fibrinolytic state. However, when administered at the relatively late point in the neonatal course when a ventricular drain is required, this fibrinolytic state is not sufficient to decrease the requirement for ventriculoperitoneal shunt.

Relationship between the Duplex Doppler Ultrasound and a Questionnaire Screening for Positional Tolerance of the Cervical Spine in Subjects with Suspected Vascular Pathology: A Case Series Pilot Study

Manual therapy healthcare practitioners routinely perform the vertebral artery test (VAT) to determine cervical positional tolerance and to screen for vertebrobasilar insufficiency (VBI) prior to manipulating the cervical spine. Because the safety and validity of the VAT has been questioned in the literature, the purpose of this study was to determine if a relationship existed between a new tool, the cervical positional tolerance questionnaire (CPTQ), and the duplex Doppler ultrasound findings for patients with suspected VBI. Subjects were 39 consecutive patients referred by their physician for a duplex Doppler ultrasound with suspicion of VBI. On the CPTQ, patients reported whether they avoided certain cervical positions due to symptoms consistent with VBI prior to undergoing the ultrasound. The CPTQ had a sensitivity = 1.00 (95% CI: 0.34–1.00); specificity = 0.78 (95% CI: 0.64–0.92); negative likelihood ratio = 0.00 (95% CI: 0.02–2.73); and positive likelihood ratio = 4.50 (95% CI: 1.67–7.89). The results of this case series study, while preliminary, are encouraging. Further research with larger sample sizes is warranted in the development of the CPTQ regarding pre-cervical manipulation clinical decision-making. Inclusion of subjects from a cohort including asymptomatic people (no suspicion of VBI) would also strengthen the screening ability of the CPTQ. In addition to duplex Doppler ultrasound, using a gold standard test of vertebral artery testing by way of magnetic resonance angiography (MRA) would further improve data on the diagnostic utility of the CPTQ.

Cognitive Behavioural Therapy and Homelessness: A Case Series Pilot Study

This paper describes a project set up to treat four homeless men using cognitive behavioural therapy (CBT). The referral criteria were that individuals had alcohol and/or substance misuse problems, were roofless (i.e. sleeping rough) immediately before the intervention began and found it difficult or impossible to access hostel places in Southampton. Excessive alcohol use, violence (against self, others and property) and prison sentences were all features of their presentation. The project involved three levels of CBT intervention provided by the clinical psychologist: 1) training for the staff to enable them to work within this model; 2) continued supervision within model to ensure consistency and sustainability; 3) individual formulation (description of the problem within the CBT framework) and psychotherapy. The house itself was also run on a collaborative basis. A number of measures including mental health and social functioning constructs were used to evaluate the project, in addition to some qualitative data. All residents reduced incidents of theft, violence and alcohol consumption. Risk to self and others was also reduced for all residents. Perceived self-efficacy increased slightly for all residents, and staff perceived that they could be more effective, less hopeless, and therefore possibly less stressed as a result of training. More data will be gathered over time.