Experience Of Therapy Research Articles

Impact of Disease Burden of Patients with Psoriasis on Biologic Therapy Switching: Real-World Evidence from the CorEvitas Psoriasis Registry.

Due to variable psoriasis symptoms, disease progression, and individual responses to therapy, patients may start, stop, or switch biologic therapies. Real-world data on the associated disease burden of patients with psoriasis who do and do not switch biologics are incomplete. This study compared disease burden among patients from the CorEvitas Psoriasis Registry (July 2017-December 2021) who switched biologics and those who did not within 4-12months following initiation. Disease-related patient-reported outcomes (PROs) were recorded, including skin pain, itching, activity impairment, and effects on health-related quality of life (HRQoL). Disease severity was measured by body surface area (BSA) and Psoriasis Area and Severity Index (PASI). Unadjusted and adjusted regression models were used to compare study outcome measures between the two groups. This study included 2145 patients, with 159 classified as switchers and 1986 as non-switchers. The most common reason for switching therapy was failure to maintain initial response (51.7%; n = 78). Moderate-to-severe disease (BSA ≥ 3) was found among 83.0% (n = 132) of switchers versus 26.1% (n = 516) of non-switchers. PASI > 5 was reported among 49.7% (n = 79) of switchers versus 8.6% (n = 171) of non-switchers. Differences in skin pain, itching, and effects on HRQoL between switchers and non-switchers were larger in magnitude for bio-experienced patients. Patients who switched biologic therapy experienced a greater disease burden of psoriasis across PROs than non-switchers. Patient-centered factors may be important drivers of biologic switching. Our findings suggest the association between switching and disease burden may be stronger among patients with prior biologic therapy experience.

Is Obesity a Problem in New Cystic Fibrosis Treatments?

Malnutrition has always been a problem in CF (cystic fibrosis) patients; however, new treatments with CFTR (cystic fibrosis transmembrane conductance regulator protein) modulators have led to weight gain, with some patients at risk of overweight and obesity. Our study aimed to analyze the evolution of BMI (body mass index) after one year of treatment with triple therapy and the factors associated with weight gain in CF patients undergoing treatment with triple therapy with CFTR protein modulators (ETI) (elexacaftor/tezacaftor/ivacaftor). We conducted a prospective, observational, longitudinal, multicenter study in patients diagnosed with cystic fibrosis, aged 18 years or older, with at least one F508del allele and who underwent ETI therapy for at least one year, from 2020 to 2023. One hundred and eight patients from two cystic fibrosis units in Spain, Princess University Hospital of Madrid (74 patients) and Central University Hospital of Asturias (HUCA) (34 patients), were included. Demographic data, anthropometric data, lung function, and exacerbations were collected, comparing the data in the previous year to the start of therapy with the results after one year of treatment. Multivariant models were developed to account for repeated weight and BMI measurements, using a mixed effects model approach and accounting for possible modifying factors Results: One hundred and eight patients were included in the study, 58 men (53.7%) and 50 women (46.3%) with a mean age of 29.5 ± 9.4 years (18-59). Patient weight and BMI were recorded at baseline and at 3-month intervals during the study period. The weight increased from 59.6 kg to 62.6 kg and BMI increased from 21.9 kg/m2 to 23.0 kg/m2 after one year of treatment (p < 0.0001 for both). The proportion of underweight individuals decreased after one year of ETI therapy, from 9.3% to 1.9%, while the proportion of overweight or obese individuals increased from 8.3% to 22.9 % at the same time (p < 0.001). In relation to exacerbations, there is a significant increase in the number of patients who did not have any exacerbations after one year of treatment, which increased from 10.2% to 46.2% (p < 0.001), while the number of patients who had >4 exacerbations decreased significantly, from 40.7% to 1.9% (p < 0.001). FEV1% (forced expiratory volume) increased from 63.9 ± 20.9 to 76.8 ± 21.4 (p < 0.001) and the VR/TLC (residual volume/total lung capacity) value decreased from 45.1 ± 10.9 to 34.9 ± 6.2 (p < 0.001). The proportion with FEV1% > 80% increased from 23.1% before ETI therapy to 49.1% one year after ETI therapy. We performed multivariate mixed models to evaluate the evolution of BMI changes with time, accounting for repeated measures and for possible modifying factors. After the introduction of the triple therapy, patients included in the study had significant weight gain during the 12 months, and when including different covariates in the multivariate mixed model, we found that lower baseline BMI, lower baseline FEV1 and FVC (forced vital capacity), and higher VR/TLC value and higher number of exacerbations were associated with higher BMI changes over the study period. CF patients treated with triple therapy experience significant weight gain, increasing the proportion of overweight patients. CF patients who experienced greater weight gain were those with worse BMI at the start of treatment, as well as patients with worse lung function and a greater number of exacerbations in the year before starting ETI therapy.

New learning technique based on real-time kinematic feedback from an inertial sensor for manual therapy in shoulder joint: a randomised trial

BackgroundReducing teacher subjectivity and checking skill corrections have an impact on the manual therapy learning, one of the most crucial components of physical therapy clinical practise. The aim of this study was to analyse the effectiveness of a kinematic real-time feedback strategy (KRTF) with an inertial sensor as a new methodology for the learning of glenohumeral joint mobilisation, comparing it with the traditional teaching method.MethodsThis study was a randomised trial. 59 undergraduate students without experience in manual therapy were randomised into two different groups (G1: Traditional methods group; G2: KRTF group). G1: students would practice the technique while an expert in manual therapy would supervise them. G2: could perform the mobilisation and observe the kinematic characteristics of the technique on a laptop. For the two movements that compose the mobilisation (angulation and translation), the result variables extracted were: maximum displacement, minimum displacement, area under the curve and the difference between the area under the curve of angulation and translation. In addition, the consistency of the measurement and reliability were calculated, too.ResultsSome significant differences were observed within groups, between groups and in the group x time interaction, the difference between the angulation and translation area. The synchronization of the movements in in the post comparison was better in G2 because the differences in the areas of both movements were significantly smaller (Mean Difference G1 vs. G2 = 1111.4°s (p > 0.05)).ConclusionsAfter comparing the kinematic variables recorded between the two intervention groups analysed in the present study, we observed that the kinematic registers were significantly different between the two groups, with a higher evolution in the KRTF group compared to the traditional learning method. The effectiveness of KRTF was proved over the traditional teaching methods in facilitating the learning process of the glenohumeral joint mobilisation.ClinicalTrials.gov IDNCT02504710, 22/07/2015.

Are Virtual Complementary and Integrative Therapies as Effective as In-Person Therapies? Examining Patient-Reported Outcomes Among Veterans with Chronic Musculoskeletal Pain.

Background: Virtual complementary and integrative health (CIH) therapy availability increased during the COVID-19 pandemic, but little is known about effectiveness. We examined the perceived effectiveness of in-person and virtual CIH therapies for patients with chronic musculoskeletal pain who recently started using CIH therapies. Methods: The sample included Veterans (n = 1,091) with chronic musculoskeletal pain, identified in the Veterans Health Administration's electronic health record based on initiation of CIH therapy use, who responded to VA's Patient Complementary and Integrative Health Therapy Experience Survey during March, 2021, to August, 2022. Using multivariable models with self-guided virtual (apps or videos) delivery as the reference, we compared patient-reported outcomes (pain, mental health, fatigue, and general well-being) associated with any yoga, Tai Chi/Qigong, or meditation use delivered: (1) only in-person, (2) only virtually with a live provider, (3) only virtually self-guided, (4) virtually self-guided + virtually provider-guided, or (5) hybrid in-person + virtual (self-or provider-guided). Results: Under 10% of Veterans reported only in-person use; 54% used only virtual formats and 36% a hybrid of in-person and virtual. Forty-one percent reported improvement in general well-being, 40.6% in mental health, 37.1% in pain, and 22.7% in fatigue. Compared with Veterans using only self-guided virtual CIH therapies, Veterans using only in-person therapies were more likely to report improvement in fatigue (odds ratio [OR]: 1.8, confidence interval [CI]: 1.1-3.1) and general well-being (OR: 1.7, CI: 1.0-2.6). Conclusions: Many patients perceived health improvements from CIH therapies, with in-person users reporting more improvement in fatigue and well-being than those using virtual sessions and similar improvements in pain and mental health for in-person and hybrid users.

A Prospective Qualitative Inquiry of Patient Experiences of Cognitive Functional Therapy for Chronic Low Back Pain During the RESTORE Trial.

Cognitive functional therapy (CFT) is a person-centered biopsychosocial physiotherapy intervention that has recently demonstrated large, durable effects in reducing pain and disability in people with chronic low back pain (CLBP). However, exploration of the treatment process from the patients' perspectives, including the process of gaining control and agency over CLBP, is relatively understudied in this patient population. This qualitative study explored the experiences of eight participants from the RESTORE trial through longitudinally following their experiences, including interviews during baseline, mid-treatment, end-treatment, and 12-month follow-up. Data were analyzed according to a narrative approach. Findings described the overarching narrative themes of "The Journey to Self-Management." Within this overarching narrative, four distinct narratives were identified, beginning with "Left High and Dry," capturing the experience of isolation and abandonment with CLBP before commencing CFT, and concluding with three narratives of the experience of CFT from the start of treatment through to the 12-month follow-up. These included "Plain, Smooth Sailing," describing a journey of relative ease and lack of obstacles; "Learning the Ropes and Gaining Sea Legs," capturing an iterative process of learning and negotiating setbacks; and "Sailing Through Headwinds," describing the experience of struggle to gain agency and control over CLBP through CFT. Clinicians treating individuals with CLBP can use these insights to more effectively facilitate self-management, and people living with CLBP may find resonance from the narrative themes to support their journeys.

Tumor angiogenesis and anti-angiogenic therapy.

Anti-angiogenic drugs (AADs), which mainly target the vascular endothelial growth factor-A signaling pathway, have become a therapeutic option for cancer patients for two decades. During this period, tremendous clinical experience of anti-angiogenic therapy has been acquired, new AADs have been developed, and the clinical indications for AAD treatment of various cancers have been expanded using monotherapy and combination therapy. However, improvements in the therapeutic outcomes of clinically available AADs and the development of more effective next-generation AADs are still urgently required. This review aims to provide historical and perspective views on tumor angiogenesis to allow readers to gain mechanistic insights and learn new therapeutic development. We revisit the history of concept initiation and AAD discovery, and summarize the up-to-date clinical translation of anti-angiogenic cancer therapy in this field.

Relevance of therapist feedback in the context of group‑based exercise programs in medical rehabilitation – Results from a qualitative study with patients and exercise therapists

Background Although group-based exercise programs account for nearly half of exercise therapy services provided in German medical rehabilitation facilities, information regarding the application and effects of therapist feedback in this setting is sparse. Therefore, the aim of this qualitative study was to develop an understanding of the relevance of therapist feedback in the context of group-based exercise programs from the patients’ and therapists’ perspective. Methods Semi-structured interviews were conducted with five rehabilitation patients as well as five exercise therapists with work experience in group-based exercise therapy. Data were analysed using structuring content analysis. Results Three types of therapist feedback with respective modalities and characteristics were identified. Besides corrective feedback to support the patients’ exercise instruction, motivational feedback and performance feedback were used to aid the strengthening of psychological resources. Although therapist feedback constituted an important component of patient-therapist-interaction, evidence suggesting a facilitation of coping strategies, participation or long-term physical activity adherence was sparse. Conclusions While therapist feedback in group-based exercise programs likely aids the recovery of physical and psychological functions, its potential to promote the long-term goals of exercise therapy in medical rehabilitation appears to be underutilised.

Narration of the Experience of Emotional Deprivation Disorder and Affirmation Therapy

Psychiatrists Anna Terruwe and Conrad Baars wrote of emotional deprivation disorder (EDD) and identified the challenges of the disorder. This article presents the specifics of what one individual with EDD experienced and how affirmation therapy (AT) was helpful. The patient is an educated, professional, middle-aged woman who shares her experiences of woundedness and healing, which helps her to make sense of her life experiences. A discussion of some events that led to the manifestation of EDD in her life, how it affected the fullness and quality of her life, especially without appropriate therapy, and a brief overview of affirmation therapy as perceived by the patient are presented. Following the major narratives of her life experiences and her therapy, a brief exploratory analysis of the content and context of her narration is provided. Her story provides excellent insight to those of us in the mental health field about what caused EDD in this patient's life and how affirmation therapy helped her to heal the wounds that caused her to develop EDD and to develop the fuller quality of life that she now enjoys.

Therapy and counselling experiences of queer adults in Germany

AbstractBackgroundMental health professionals play a crucial role in either alleviating or exacerbating stress among queer clients.AimsDrawing on minority stress theory, we conducted a study to examine the experiences of lesbian, gay, bisexual and/or consensually non‐monogamous clients with current or recent psychotherapy or counselling experiences in Germany.MethodA convenience sample of 492 queer individuals participated in an online survey, providing insights into their most recent experiences with psychotherapy or counselling and evaluating the success of these processes. Among the participants, 92% identified as lesbian, gay, bisexual, or another non‐heterosexual identity, while 8% identified as heterosexual. Additionally, 54% reported being in consensually non‐monogamous relationships, and 23% identified as gender‐diverse.ResultsThe majority (92%) had prior experience with psychotherapy, with over half reporting their last session within the last month. The remaining 8% reported counselling experience. Most participants rated their recent psychotherapy or counselling process as successful. Exemplary practices were more common than inappropriate ones. While overt discrimination by mental health professionals was rare, subtle inappropriate behaviours were still prevalent. Affirmative and actively reassuring practices were strongly linked to subjective therapy success.ConclusionThe study's findings warrant cautious optimism regarding a non‐discriminative stance in German mental health professionals while highlighting the need for further research, training and guidelines for therapists and counsellors.

Digital technologies and strategies in amputation medicine

Surgical techniques in amputation medicine did not change for a long time, while prosthesis technology underwent rapid development. The focus shifted to optimising the residual limb for prostheses use. At the same time, digital technologies such as gamification, virtual and mixed reality revolutionised rehabilitation. The use of gamification elements increases motivation and adherence to therapy, while immersive technologies enable realistic and interactive therapy experiences. This is particularly useful in the context of controlling modern prostheses and treating phantom pain. In addition, digital applications contribute to optimised documentation of symptoms and therapy successes. Overall, these technologies open up new, effective and personalised therapeutic approaches that can significantly improve the quality of life of amputation patients.

Single-Institution Experience of Larotrectinib Therapy for Patients With NTRK Fusion-Positive Thyroid Carcinoma.

The real world efficacy and tolerabiltiy of NTRK inhibitor larotrectinib has not yet been reported in the literature although trial data has shown promising results. We report a retrospective analysis of patients with thyroid cancer harboring NTRK fusions who underwent treatment with larotrectinib. A single-institution, retrospective case series of patients with NTRK fusion-positive thyroid cancers treated with neurotrophic tyrosine receptor kinase (NTRK) inhibitors from January 1, 2007, to January 1, 2023, was performed. This study was conducted at a single academic tertiary referral center. Patients with confirmed NTRK-fusion thyroid cancer who received larotrectinib were included. Larotrectinib was administered in accordance with clinical judgment from oncology providers. The primary end point was progression-free survival (PFS). Eight patients with NTRK fusion-positive thyroid cancer treated with larotrectinib were identified: 4 with papillary thyroid cancer (PTC) (50%), 3 with poorly differentiated thyroid cancer (PDTC) (38%), and 1 with anaplastic thyroid cancer (ATC) (12%). The median PFS (mPFS) for all patients was 24.7 months (95% CI, 11.3-38.1). mPFS in PTC was higher than PDTC (34.6 months [24.7-48.7 months] vs 17.5 [7.1-21.1 months]; P = .017). The median overall survival (OS) was 43.8 months (29.8-56.8 months) overall. The single patient with ATC had a PFS and OS of 23 months. Two patients remained on treatment/alive at data cutoff, with a duration of response of 33.5 months and a median follow-up of 52 months. Patients achieved 1 complete response (12%), 6 partial responses (75%), and 1 stable disease (12%). In this single-institution cohort of patients with NTRK fusion-positive thyroid cancer, NTRK inhibition led to an mPFS of 25 months, with survival surpassing historic benchmarks for ATC and PDTC.

Cisgender Sexual Minority Women's Interest in Telemental Health Services: A Latent Class Analysis.

Introduction: Telemental health is increasingly recognized for its potential to overcome barriers like cost and stigma, particularly for marginalized groups. Sexual minority women in particular may benefit from increased access to telemental health services, due to the unique health disparities faced by this population. However, very little research thus far has assessed the telemental health preferences of this group. Methods: The present study surveyed 1,092 cisgender sexual minority women regarding their demographic information, mental health, and telemental health preferences, using the Prolific.co research platform. Latent class analysis was conducted to identify subgroups within the sample based on their responses to the survey. Results: Results revealed diverse attitudes toward telemental health, with some that prefer in-person sessions, whereas others show a strong interest in virtual options. Latent class analysis identified five groups, termed the Neutral, Ambivalent, Inclined, Inclined Related to Travel, and Averse groups. There were statistically significant differences between groups on measures of rurality, socioeconomic status, previous therapy experience, and symptoms of depression and anxiety. Overall, sexual minority women demonstrated interest in telemental health, especially individuals with mobility challenges and those living in rural areas. Conclusion: This study underscores the importance of tailoring mental health services to diverse needs and suggests that telemental health could be a valuable tool in addressing health disparities among sexual minority women. Importantly, these data were conducted prior to the COVID-19 pandemic. Further research could examine how sexual minority women's attitudes toward telemental health have shifted since the COVID-19 pandemic and how telemental health services could be tailored for marginalized subgroups.

Examining change in the mental health of young people with epilepsy following a successful psychological intervention.

Evaluate the cognitive, behavioural and affective processes involved in therapeutic change for young people with epilepsy and mental health difficulties receiving an integrated mental health intervention. As part of a mixed methods convergent design, qualitative data were gathered in parallel to quantitative data at two timepoints in a randomised controlled trial testing the Mental Health Intervention for Children with Epilepsy in addition to usual care. Twenty-five young people and/or their families were interviewed before and after the intervention about the young person's mental and physical health, and their experience of therapy. Interview data were analysed inductively, idiographically and longitudinally using Interpretative Phenomenological Analysis combined with Framework Analysis. The young people's emotional and behaviour problems improved, mirroring the trial's quantitative outcomes. Their anxiety decreased and behaviour improved as they acquired tools and understanding through therapy. Problems, like aggressive behaviours and emotional outbursts, were also reduced, with young people gaining increased awareness and ability to self-regulate and parents learning to contain their child's impulsive behaviours. The qualitative findings complement the MICE trial's significant positive quantitative results by providing insight and context to the therapeutic change, providing vivid insight into the mechanisms of therapy for individual families.

Evaluation of a Dialectical Behavior Therapy Didactic for Medical Trainees in an Acute Adolescent Inpatient Psychiatric Unit.

Dialectical behavior therapy (DBT) is an evidence-based treatment for patients with suicidality and emotion dysregulation. There is increasing evidence of using DBT in psychiatric inpatient units for youth. On inpatient units, the majority of treatment is provided by psychiatry trainees, often with limited therapy experience. The study's objective was to assess the impact of a 1-h weekly DBT training for a range of medical trainees rotating through a child and adolescent acute inpatient unit. Participants were 55 medical students, psychiatry residents, and child and adolescent psychiatry fellows who rotated on an inpatient unit for youth and participated in a 1-h DBT didactic. There was one group who attended less than four sessions and the other attended 5 or more sessions. A pre- and post-method design was used to collect data on participants' confidence, competence, and knowledge of DBT and working with suicidal youth. Comparing pre- and post-data for all participants, the DBT training was found to lead to significant benefits for trainees' comfort with therapy, prioritizing therapy during inpatient care, knowledge of DBT, comfort with DBT, and confidence in treating children and adolescents with suicidality. There were no significant differences in the type of trainee or dose of training. This study supports the benefit of a brief DBT didactic to provide training to a wide range of trainees to improve therapeutic care in an inpatient psychiatric unit for youth.

Internet-delivered emotion regulation therapy for adolescents engaging in non-suicidal self-injury and their parents: A qualitative, online focus group study.

We explore adolescents' and their parents' experiences of internet-based emotion regulation therapy for non-suicidal self-injury (NSSI). A qualitative study nested within a controlled feasibility trial. Online, semi-structured focus group interviews were conducted with outpatient adolescents with NSSI aged 13-17 years (n = 9) and their parents (n = 8) who had received therapist-guided Internet-delivered Emotion Regulation Individual Therapy for Adolescents (IERITA). Transcripts were analysed using reflexive thematic analysis. Three main themes were generated: (1) Fatigue - barriers to and during treatment, comprised of two sub-themes 'Arriving to services exhausted, needing motivation, and leaving feeling abandoned' and 'the burden of IERITA and the consequences of fatigue', (2) inter- and intrapersonal insights as facilitators of change and (3) Online, written contact with the therapist is beneficial and contributes with less pressure, comprised of three sub-themes 'the therapist behind the screen is essential', 'less pressure sitting alone: the physical absence of a therapist' and 'engaging on your own terms, in your own tempo'. Themes were consistent among adolescents and parents. Fatigue due to therapeutic engagement and previous help-seeking processes created barriers for engagement. Emotion regulation therapy was experienced as beneficial leading to inter- and intra-personal insights, facilitating change of maladaptive patterns. Therapists were regarded as indispensable, and the internet-based format did not hinder therapeutic alliance. The written format allowed for reflection and alleviated the pressure of relating to the therapist. Further research should explore experiences of other online treatment formats (e.g. synchronous or video-based) with regard to benefits, fatigue and therapist interaction.

A Local Experience of Antibiotic Lock Therapy as an Adjunctive Treatment for Central Venous Catheter-Related Bloodstream Infections in Pediatric Oncology and Hematology Patients.

One of the main drawbacks of tunneled central venous catheters (CVCs) is catheter-related bloodstream infections (CRBSIs). Antibiotic lock therapy (ALT) can be combined with systemic antibiotics to achieve catheter salvage. Our objectives are to describe cases of CRBSI and our experience with ALT in a pediatric oncology-hematology ward. a retrospective descriptive study of pediatric CRBSI cases in a Spanish oncology-hematology unit from 2007 to 2017 was conducted. We collected demographic, clinical, and microbiological data from all patients. fifty-eight CRBSIs were diagnosed in thirty-nine patients; 72.9% of these patients were male, with a median age of 42.1 months. The main underlying diseases were leukemia/lymphoma (51.7%) and solid tumors (32.7%). Thirty-five (60.3%) CRBSIs were caused by Gram-positive cocci, of which 70.6% were coagulase-negative Staphylococci, and sixteen (27.6%) were caused by Gram-negative bacilli. We treated 41/58 (71%) cases with ALT. A total of 12/17 (71%) CVCs that were not treated with adjunctive ALT were removed, compared with 13/41 (32%) that were treated with ALT (relative risk (RR), 0.449; confidence interval (CI), 95%: 0.259-0.778, p = 0.004). Major reasons to remove the CVC in the CRBSI-ALT group were local insertion/pocket site infection (23%), persistent symptoms (23%), and infectious' relapses (15%). ALT was shown to be an effective approach to keeping the CVC in place, with no added adverse effects.

Comparison of real-world healthcare resource utilization among advanced therapy-naïve and advanced therapy-experienced patients with ulcerative colitis initiated on ustekinumab or vedolizumab

Objectives To describe and compare healthcare resource utilization (HRU) among advanced therapy-naïve and advanced therapy-experienced patients with ulcerative colitis (UC) initiating ustekinumab or vedolizumab in the United States. Methods Claims data from IQVIA PharMetrics Plus de-identified database (01/01/2015–06/30/2022) were used to identify adult patients with UC initiating ustekinumab or vedolizumab (index date) after 10/21/2019. Baseline characteristics were balanced using inverse probability of treatment weighting. All-cause and UC-related HRU (number of inpatient admissions, inpatient days, emergency department visits, and outpatient visits) were described during the post-index period, and Poisson regression models were used to evaluate associations between index therapy and HRU outcomes. Analyses were performed separately among advanced therapy-naïve or advanced therapy-experienced patients. Results A total of 444 (ustekinumab) and 1,917 (vedolizumab) advanced therapy-naïve patients, and 647 (ustekinumab) and 1,152 (vedolizumab) advanced therapy-experienced patients were identified. In advanced therapy-naïve patients, higher rates of UC-related inpatient days (rate ratio [95% confidence interval] = 1.84 [1.15, 3.58]; p = 0.004), emergency department visits (1.39 [1.01, 2.17]; p = 0.044), and outpatient visits (1.81 [1.61, 2.04]; p < 0.001) were observed among patients initiating vedolizumab relative to ustekinumab. In advanced therapy-experienced patients, higher rates of UC-related inpatient admissions (1.47 [1.06, 2.12]; p = 0.012), inpatient days (2.18 (1.44, 3.71); p < 0.001), and outpatient visits (1.50 (1.19, 1.82); p < 0.001) were observed among patients initiating vedolizumab relative to ustekinumab. Results were similar when all-cause HRU was examined. Conclusions Among patients with UC with and without advanced therapy experience, higher rates of all-cause and UC-related HRU were observed among those treated with vedolizumab relative to ustekinumab.

Feasibility and Favorable Responses Following Investigational CAR T-Cell Therapy for Relapsed and Refractory Infant ALL

Infants with B-cell acute lymphoblastic leukemia (B-ALL) continue to have significantly worse outcomes compared to older children with B-ALL, and those with relapsed or refractory (R/R) infant ALL have especially dismal outcomes with conventional treatment. CD19-targeting chimeric antigen receptor (CAR) T-cell therapy has demonstrated remarkable success in the treatment of R/R childhood B-ALL, though the majority of reports have been in non-infant patients. Barriers to the successful implementation of CAR T-cell therapy in infant B-ALL include challenges related to apheresis, product manufacturing and disease-specific considerations such as lineage switch. We describe our experience utilizing two experimental CD19-CAR T-cell products, SCRI-CAR19 or SCRI-CAR19x22, for 19 patients with R/R infant B-ALL enrolled on three clinical trials. CAR T-cell products were successfully manufactured in 18/19 (94.7%) patients, with a median age of 22.5 months at enrollment (range, 14.5-40.1 months). Sixteen of 17 (94.1%) treated patients achieved a complete remission without detectable minimal residual disease. The 1-year leukemia free survival was 75% and 1-year overall survival was 76.5%, with a median follow up time of 35.8 months (range, 1.7-83.6 months). Cytokine release syndrome (CRS) occurred in 14/17 (82.4%) patients, with only 1 patient experiencing Grade 3 CRS. Neurotoxicity occurred in 2/17 (11.8%) patients with all events ≤ Grade 2. With the successful early clinical experience of CAR T-cell therapy in this population, more systematic evaluation specific to infant ALL is warranted.

A Qualitative Case Study on the Experiences of Individual Art Therapy in Adolescents with Suicide Impulses

A Qualitative Case Study on the Experiences of Individual Art Therapy in Adolescents with Suicide Impulses

A Traumatology Case Study of an Indonesian Theological Student

Indonesian theological students often come to seminary with handful of problems from the onset of their life. The expectation from the traditional Christian family for their children to set the behavior right in the seminary is outdatedly common. This study explores a case of a 21-year-old theological male student who suffered verbal and physical abuse from his parents. During the initial four weeks of therapeutic alliance with the author, the student exhibited traumatic symptoms of severe hostility and somatic re-enactment of past adverse experiences. He had been known to possess talisman and some sacred relics for witchcraft in the past which contemporarily yield nightmare and terror at night. The qualitative case study explored the traumatic problem of the student through a 12-month observation and in-depth interview. Through experiential therapy of gestalt, CBT, and forgiveness therapy in the last seven months, the student showed reduced symptoms of hostility, somatic complaints, and impulse-behavior. The spiritual formation of prayer and meditation of the Scripture have been useful for the patient in dealing with his spiritual problems. Keywords: counselling, trauma, seminary, students, syncretism, theology, therapy