Poor Outcome Cases Research Articles

To study the outcome of closed intramedullary flexible nailing in fracture shaft femur in children age more than 3 year and less than 13 year

Femoral shaft fractures account for 1.6% of all paediatric bony injuries. Spica casting remains the most popular accepted method for treatment of femoral shaft fracture in infants and toddlers. The aim of our study is to study the outcome of closed intramedullary flexible nailing in fracture shaft femur in children aged more than 3 years and less then 13 years. This is institutional based prospective study of 60 patients, aged 3 to 13 years, with fracture shaft of the femur were treated with retrograde flexible intramedullary (titanium elastic) nailing at Dr. Shankarrao Chavan Govt. Medical College Vishnupuri, Nanded. Statistical analysis done by chi-square test. In the present study, the final outcome was excellent in 40 (66.66%) cases, satisfactory in 10(33.33%) cases and there were no poor outcome cases. TENS is a simple, easy, rapid, reliable and effective method for management of paediatric femoral fractures between the age of 5 to 15 years, with shorter operative time, lesser blood loss, lesser radiation exposure, shorter hospital stay, and reasonable time to bone healing.

Influence of patient personality in the treatment of rheumatoid arthritis.

Individualized treatment of rheumatoid arthritis (RA) based on genetic/serologic factors is increasingly accepted. Moreover, patients are more actively involved in the management of their disease. However, personality has received little attention with respect to perception of the need and adherence to treatment. Our objective was to evaluate whether patient personality was associated with the acceptance or rejection of more aggressive early treatment. We performed a cross-sectional study in two hospitals with early arthritis clinics where sociodemographic, clinical, and therapeutic variables are systematically recorded. Patients completed Eysenck Personality Questionnaire, Multidimensional Health Locus of Control, Pain-Related Self-Statement Scale and Pain-Related Control Scale. Aggressive treatment was considered if patients received more than two DMARDs or biological agents during the first year of follow-up. Multivariate logistic regression analysis was performed to determine predictors of aggressive treatment. One hundred seventy-six RA patients were included (80% women, disease begin median age 55years). Treatment was considered aggressive in 57.9% of the sample. Scores were high in extraversion in 50.8% of patients, neuroticism in 29.5% and psychoticism in 14.7%. Neuroticism was the only factor associated with aggressive treatment, which was less probable (p=0.04, OR=0.40). Neuroticism also decreased the possibility of receiving a combination of biologics and DMARDs (p=0.04, OR=0.28). Patients with high scores on neuroticism are more worried, obsessive and hypochondriac, leading them to reject more aggressive therapy. It is important to educate about their disease so that they will accept more aggressive approaches in clear cases of poor outcome.

Therapist interventions and client ambivalence in two cases of narrative therapy for depression

Aim: We understand ambivalence as a cycle of opposing expressions by two internal voices. The emergence of a suppressed voice produces an innovative moment (IM), challenging the dominant voice, which represents the client’s problematic self-narrative. The emergence of the IM is opposed by the dominant voice, leading to a return to the problematic self-narrative. This study analyzed therapist and client responses to each other in episodes of ambivalence. Method: The therapeutic collaboration coding system (TCCS) assesses whether and how the therapeutic dyad is working within the therapeutic zone of proximal development (TZPD) by examining client responses to therapist interventions. We applied the TCCS to episodes in which a good- and a poor-outcome client in narrative therapy expressed ambivalence. Results: In both the good- and poor-outcome cases, the therapist responded to the emergence of ambivalence similarly, balancing challenging and supporting. The good-outcome case responded at the developmental level proposed by the therapist when challenged, while the poor-outcome case lagged behind the level proposed. Discussion: This supports the theoretical explanation that the therapist did not match client’s developmental level in the poor-outcome case, working beyond the client’s current TZPD and contributing to the maintenance of ambivalence.

Insight level in the assimilation process: A comparison of good- and poor-outcome cases in short-term dynamic psychotherapy of depressive inpatients

The present study aimed to investigate the association between treatment outcome and the assimilation of problematic experiences during psychotherapy. The assimilation process is described in an eight-level sequence, the Assimilation of Problematic Experiences Scale (APES); insight is conceived as one level in this developmental sequence. This level is considered central as related to decreases in distress and symptomatic improvements. Based on treatment outcome measures, two contrasting groups were selected from a randomized controlled trial. The cases, three successful and three unsuccessful, included clients hospitalized for moderate or severe depression who received a short-term dynamic psychotherapy. Thirty-six session transcripts (six per client) were rated for assimilation level using the APES. In an exploratory purpose, linear mixed effects models were performed to compare successful and unsuccessful cases on their assimilation evolution. Results were partially consistent with the observations of previous studies linking a successful treatment outcome with insight events. Two successful cases reached the insight level, while none of the unsuccessful cases did. The quantitative analyses revealed that both groups presented a significant and similar increase in assimilation during psychotherapy. This study raised different issues concerning the association between assimilation, insight events, and treatment outcome.

Setbacks in the process of assimilation of problematic experiences in two cases of emotion-focused therapy for depression

Objective: Research on the assimilation model has suggested that psychological change takes place in a sequence of stages punctuated by setbacks, that is, by transient reversals in the developmental course. This study analyzed such setbacks in one good outcome case and one poor outcome case of Emotion-focused therapy (EFT) for depression. Method: Intensive analyses of five transcribed sessions from each case identified 26 setbacks in the good outcome case and 27 in the poor outcome case. The reason for each setback was classified into one of four categories: balance strategy, exceeding the therapeutic zone of proximal development either induced by the therapist (ZPD-T) or induced by the client (ZPD-C), or spontaneous switches. Results: In the good outcome case the most frequent reasons for setbacks were balance strategy and spontaneous switches, whereas in the poor outcome case the most frequent reason for setbacks was ZPD-T. Conclusions: As in previously studied therapies, setbacks in EFT, usually represent productive work on relatively less advanced strands of the client's major problems. Results point to the importance of the therapist attending to the limits of the client's therapeutic ZPD.

Postoperative Clinical Outcome and Risk Factors for Poor Outcome of Foraminal and Extraforaminal Lumbar Disc Herniation.

ObjectiveWe evaluated postoperative outcomes in patients who have lumbar foraminal or extraforaminal disc herniation (FELDH) and suggested the risk factors for poor outcomes.MethodsA total of 234 patients were selected for this study. Pre- and post-operative Visual Analogue Scale (VAS) and Korean version Oswestry Disability Index (KODI) were evaluated and the changes of both score were calculated. Outcome was defined as excellent, good, fair, and poor based on Mcnab classification. The percentage of superior facetectomy was calculated by using the Maro-view 5.4 Picture Archiving Communication System (PACS).ResultsParamedian lumbar discectomy was performed in 180 patients and combined lumbar discectomy was performed in 54 patients. Paramedian lumbar discectomy group showed better outcome compared with combined discectomy group. p value of VAS change was 0.009 and KODI was 0.013. The average percentage of superior facetectomy was 33% (range, 0–79%) and it showed negative correlation with VAS and KODI changes (Pearson coefficient : -0.446 and -0.498, respectively). Excellent or good outcome cases (Group I) were 136 (58.1%) and fair or poor outcome cases (Group II) were 98 (41.9%). The percentage of superior facetectomy was 26.5% at Group I and 42.5% at Group II. There was significant difference in superior facetectomy percentage between Group I and II (p=0.000).ConclusionThis study demonstrated that paramedian lumbar discectomy with preservation of facet joints is an effective and good procedure for FELDH. At least 60% of facet should be preserved for excellent or good outcomes.

T19: The immune and vascular components of microenvironment in prognosis of the endometrioid endometrial adenocarcinoma

Background Endometrioid endometrial adenocarcimoma is the most frequent gynecologic malignancy in the western world. It is well known that inflammation plays a key role in the initiation and development of cancer as well as promotes both specific and innate immune response. There is no information on the status of the local anti-tumor cellular immunity in endometrioid adenocarcinoma of the corpus uteri microenvironment in the Russian and English language medical scientific literature. Various studies have shown that high intratumor microvessel density in endometrial cancer is associated with advanced stage, increased risk of recurrent disease and with poor prognosis. Vascular endothelial growth factor (VEGF) is a glycoprotein with potent mitogenic activity. It has been demonstrated to be a key component in the promotion of angiogenesis. Materials and methods There were singlet 24 cases of endometrioid adenocarcinoma with retrospectively known good (survival) and poor (death) outcomes. All cases were immunohistochemically stained for CD3, CD20, CD57, CD68, S100, CD34 and VEGF, expression of was evaluated by IHC-profiler. The number and the area of vessels was count in “hot spot” zones and calculated per 1 mm. For compare of the characteristics of signs was used comparison of two independent samples – U-Mann–Whitney test. The level of statistical significance was accepted by p Results T-lymphocytes cells were situated predominantly in desmoplastic stroma of the tumor. CD3 expression was significant higher in the group of good outcome (p = 0.00042), B-lymphocytes cells were predominantly in epithelial component of tumor. CD20 was expressed in endometriod adenocarcinoma with good and poor outcome without statistically significant difference (p = 0.976). NK-lymphocytes were predominantly in peritumoral stroma. CD57 expression was statistically significant higher in the group of good outcome (p = 0.000307). Tumor infiltrating macrophages can were frequent in tumor stroma than in tumor islets. CD68 expression cells number was higher in the group with good outcome (p = 0.000219). Dendric cells were predominantly in epithelial component of tumor. S100+ cells number did not have any difference (p = 0.105). Inside the tumor stroma, among pseudo-glands or solid beaches there was a positive reaction for anti-CD34 of numerous microvessels together with groups of endothelial cells (“hot spot”). The number of intratumoral vessels in patients with poor outcome was 141.9 ± 24.7 vessels/mm2, in good outcome patients – 93.8 ± 28.7 vessels/mm2. The number of the intratumoral vessels in this groups was with significant statistical different (p = 0.0014). The area of intratumoral vessels in good outcome cases was 2799.7 ± 535.7 μm2, poor outcome cases – 5455,2 ± 448,8 μm2. It was significant statistical different (p = 0.000014). VEGF was expressed in the cytoplasm of normal endometrial cells, neoplastic ones, endothelial cells and stroma. VEGF represents a mitogen for endothelial cells that induces the formation of lumen’s vessels and also increases vascular permeability and protein extravasation. Expression of VEGF by cancer cells had significant statistical difference in this groups of patients (p = 0.0411). Conclusion There was a significant reduction in T, NK-cells and macrophages from patients with poor outcome indicates the development of local immune deficiency that could certainly plays an important role in tumor progression endometrioid carcinoma. Our study demonstrates that the number and the area of vessels, as part of angiogenesis, represent an important prognostic factor in outcome of endometrioid endometrial adenocarcinoma. VEGF expression also is an angiogenic factor which plays a great role in the prognosis of this tumor.

Self-narrative reconstruction after dilemma-focused therapy for depression: A comparison of good and poor outcome cases

Objective: The aim of this study is to improve the understanding of self-changes after an intervention for depression focused on implicative dilemmas, a type of cognitive conflict related to identity. As recent research has highlighted the relevance of identity-related dilemmas in clients with depression, we sought to assess the way in which clients resolve such inner conflicts after a tailored dilemma-focused intervention and how this is reflected in the clients’ self-narratives. Method: We used three instruments to observe differences between good (n = 5) and poor (n = 5) outcome cases: (i) the Repertory Grid Technique to track the resolution of dilemmas, (ii) the Change Interview to compile clients’ accounts of changes at posttreatment, and (iii) the Innovative Moments Coding System to examine the emergence of clients’ novelties at the Change Interview. Results: Groups did not differ in terms of the number and relevance of client-identified significantly helpful events. However, between-group differences were found for the resolution of dilemmas and for the proportion of high-level innovative moment (IM) types. Furthermore, a greater self-narrative reconstruction was associated with higher levels of symptom improvement. Conclusions: Good outcome cases seem to be associated with the resolution of conflicts and high-level IMs.

Emotional Processing, Interaction Process, and Outcome in Clarification-Oriented Psychotherapy for Personality Disorders: A Process-Outcome Analysis

It is important to understand the change processes involved in psychotherapies for patients with personality disorders (PDs). One patient process that promises to be useful in relation to the outcome of psychotherapy is emotional processing. In the present process-outcome analysis, we examine this question by using a sequential model of emotional processing and by additionally taking into account a therapist's appropriate responsiveness to a patient's presentation in clarification-oriented psychotherapy (COP), a humanistic-experiential form of therapy. The present study involved 39 patients with a range of PDs undergoing COP. Session 25 was assessed as part of the working phase of each therapy by external raters in terms of emotional processing using the Classification of Affective-Meaning States (CAMS) and in terms of the overall quality of therapist-patient interaction using the Process-Content-Relationship Scale (BIBS). Treatment outcome was assessed pre- and post-therapy using the Global Severity Index (GSI) of the SCL-90-R and the BDI. Results indicate that the good outcome cases showed more self-compassion, more rejecting anger, and a higher quality of therapist-patient interaction compared to poorer outcome cases. For good outcome cases, emotional processing predicted 18% of symptom change at the end of treatment, which was not found for poor outcome cases. These results are discussed within the framework of an integrative understanding of emotional processing as an underlying mechanism of change in COP, and perhaps in other effective therapy approaches for PDs.

Mass Cytometry of Acute Myeloid Leukemia Captures Early Therapy Response in Rare Cell Subsets

Introduction: The plasticity and stemness of acute myeloid leukemia (AML) cells are thought to be driving factors in disease aggressiveness and poor patient survival. These factors also contribute to the challenge of designing analytical cytometry panels to study AML over time during treatment. A high content single cell approach was designed to pinpoint rare populations of AML cells present prior to treatment that emerge and dominate following therapy resistance or disease relapse. Twenty-seven diagnostic and differentiation markers were measured on AML cells in order to track rare cell subsets pre- and post- treatment, measure kinetics of early therapy response, and identify any novel leukemic cell populations.Methods: AML patients undergoing induction chemotherapy were identified and consented for this study according to a local Institutional Review Board-approved protocol. Samples of peripheral blood and bone marrow were collected and cryopreserved after mononuclear cell separation. Thawed samples were stained with a mass cytometry panel to quantify 27 AML biomarkers on every cell. From each patient, up to 12 samples of blood and marrow were obtained before, during, and after induction chemotherapy (n = 46 total samples; 14 marrow and 32 blood from 5 individual donors). Stained cells were analyzed by mass cytometry (CyTOF). Dimensionality reduction and visualization was performed using viSNE. Leukemic cell subsets and differentiated cells from healthy donors were characterized in terms of abundance in each sample, 27-marker expression phenotype, heterogeneity of marker expression within the subset, and differentiation status in each sample. A stem/progenitor index was created to quantify the phenotypic distance of cells in a population from the CD34+stem/progenitor cells.Results: In unsupervised viSNE analysis of 27-marker cellular phenotype, leukemic blasts formed phenotypically distinct groups of cells, were CD45lo, and had an expression profile that closely matched the diagnostic fluorescent flow cytometry immunophenotype. The 27-marker panel grouped cells into 11 major populations: CD34+ hematopoietic stem/progenitor cells (HSPCs), 5 differentiated non-malignant populations (myeloid, CD4+ T, CD8+ T, B, and NK cells), and 3 major populations of leukemia cells. Remission was apparent on viSNE when no more than 5% of leukemic blasts remained. The remaining cells were instead part of the non-malignant populations. In poor outcome cases, at-diagnosis bone marrow leukemia cells were initially close in 27-dimenional phenotype to the non-malignant stem/progenitor cells (i.e. higher stem/progenitor index). In a case of primary refractory disease, six therapy resistant cell (TRC) populations became dominant within the leukemic blast area. These same TRC populations were present but initially rare and constituted only 0.6% to 2% of total pre-treatment AML blasts at diagnosis. TRC populations displayed increased per-cell expression of markers associated with stemness and leukemia initiating ability, including CD34, CD38, and CXCR4/CD184 (respective increases of 0.7, 0.9, and 0.6 fold on the log-like asinh15 scale). In contrast, expression of CD34, CD38, and major cell type identity markers (e.g. HLA-DR, CD4, CD19) did not significantly change over time on non-AML cells (all <0.2 fold).Conclusion: These results demonstrate the ability of high-dimensional mass cytometry to reveal, characterize, and compare rare and highly plastic cell populations over time in primary human tissue samples. Use of 27 markers meant that cells that dramatically changed expression of a few markers could still be matched to phenotypically similar cells using the other 20+ markers. Such phenotypic similarities were captured well by viSNE computational analysis. This approach offers greatly expanded longitudinal monitoring of AML while 1) effectively capturing differentiation along with cellular abundance, 2) identifying biomarkers of therapy resistance for cell sorting and targeting, and 3) enabling the single cell analysis of signaling networks in concert with critical markers of cell identity. DisclosuresIrish:Cytobank, Inc. : Employment, Equity Ownership.

Comparing two methods of identifying alliance rupture events.

This study compared two methods of detecting ruptures in therapy sessions, a procedure based on a self-report measure, the Working Alliance Inventory (WAI), and an observational Rupture Resolution Rating System (3RS). We anticipated that the 3RS would detect more ruptures than the WAI. We examined the longitudinal data of 38 patient-therapist dyads in a cognitive-behavioral therapy condition. The sample included cases that did not complete treatment (dropped cases) as well as good-outcome and poor-outcome cases. At the end of each session, patients completed the WAI self-report questionnaire. Six judges were trained to observe and detect the occurrence of ruptures, and then rated 201 videotaped sessions. Longitudinal statistical models were applied to the data retrieved from the WAI questionnaires completed by patients. We found discrepancies in the ability of the two methods to detect rupture events with the observational 3RS detecting more ruptures than the WAI. Thus, the use of observational systems for the detection of alliance ruptures is crucial for effectively assessing the quality of the therapeutic alliance over the course of treatment. Furthermore, observational systems proven to detect ruptures can be used to improve clinical practice and training of new clinicians.

Generic change indicators in therapeutic processes with different outcomes

Objectives: This paper analyzes the relationship between ongoing change and final outcome in therapies carried out in natural settings with 39 clients. Method: Ongoing change was assessed through generic change indicators (GCIs), an observational method designed to label the content of change moments by selecting one specific GCI from the sequence of 19 that covers from more rudimentary and low complexity to more elaborated and complex changes. These GCIs can also be grouped into three broad stages of change, according to their level of complexity. Productivity indicators were generated to account for the number of GCIs (total and grouped by stage) adjusted by the length of therapy and the respective individual production of GCIs. Outcome, in turn, is understood as the final result of therapy and was measured by Lambert's Outcome Questionnaire (OQ 45.2). Results: Using the Reliable Change Index of this measure, which qualifies the difference between initial and final scores, therapies were grouped into “good outcome” and “poor outcome” cases. Findings indicate that therapies with good final outcome show a greater presence of Stage III GCIs during the process. Furthermore, in these therapies there is a significant association between Stage I GCI productivity and the productivity of Stages II and III GCIs. This is not the case for poor outcome cases, where results show a greater productivity of initial stage GCIs, mostly in the second half of therapy and no relation of this productivity with Stage II and Stage III GCIs. Conclusions: Results support the relation of ongoing change and final outcome. Possibilities for the clinical use of GCIs, specifically for monitoring ongoing therapies, are discussed.

Transient exposure to Chlamydia trachomatis can induce alteration of sperm function which cannot be stopped by sperm washing

Abstract Previous experiments have shown that Chlamydia trachomatis can directly affect sperm function and therefore may be an unrecognized contributor to male sub-fertility. However, the precise mechanism of sperm–chlamydial interaction remains unknown. Aim This experimental study attempted to replicate a transient exposure of sperm to C. trachomatis that might occur prior to assisted conception. Methods Six ejaculates from sperm donors were spiked with C. trachomatis serovar E and subjected to density centrifugation one hour later using a standard sperm washing technique. At 0, 6, and 24 h post-wash, the recovered motile suspension was evaluated for sperm motility, viability, phosphatidylserine externalization, DNA fragmentation and tyrosine phosphorylation. Results The results show that even after a relatively short exposure to C. trachomatis , changes in sperm motility, viability, phosphatidylserine externalization and sperm DNA fragmentation were detected up to 24 h later. Only tyrosine phosphorylation was unaffected. Conclusion These results suggest that sperm washing cannot protect sperm from the deleterious effects of C. trachomatis exposure and this may explain some cases of poor IVF outcome or fertilization failure. We suggest that all patients should be screened and treated for C. trachomatis prior to assisted conception. This is one of the current guidelines also recommended by the British Fertility Society.

Ambivalence in emotion-focused therapy for depression: The maintenance of problematically dominant self-narratives

Objective: Ambivalence can be understood as a cyclical movement between an emerging narrative novelty—an Innovative Moment (IM)—and a return to a problematically dominant self-narrative. The return implies that the IM, with its potential for change is devalued right after its emergence. Our goal is to test the hypothesis that the probability of the client expressing such form of ambivalence decreases across treatment in good-outcome cases but not in poor-outcome cases. Method: Return-to-the-Problem Markers (RPMs) signaling moments of devaluation of IMs were coded in passages containing IMs in six clients with major depression treated with emotion-focused therapy: three good-outcome cases and three poor-outcome cases. Results: The percentage of IMs with RPMs decreased across therapy in good-outcome cases, whereas it remained unchanged and high in the poor-outcome cases. Conclusions: These results were consistent with the theoretical suggestion that therapeutic failure may be associated with this form of ambivalence.

Management of cervical polyradiculopathy through multisegmental laminoforaminotomies

IntroductionPosterior cervical laminoforaminotomy and discectomy remain as viable options for the treatment of foraminal stenosis or lateral herniated discs with radiculopathy. In contrast to the anterior approach, it does not entail fusion. ObjectiveIs to assess the clinical outcome of multisegmental laminoforaminotomies in patients suffering cervical polyradiculopathy. MethodsThirty-six patients suffering from cervical polyradiculopathy were operated through multisegmental laminoforaminotomies. ResultsA total of a hundred-twenty-one laminoforaminotomies were performed with an average of 2.7 segments (range 2–4) and 3.36±1.3 laminoforaminotomies per patient (range 2–6). Bilateral foraminotomies on the same level were performed in 21 levels. An excellent and good outcome according to modified Odom’s criteria was reported in thirty patients (83.3%), while 5 patients (13%) had a fair outcome and finally with a case of poor outcome (2.7) due to the occurrence of C5 palsy. ConclusionCervical laminoforaminotomy is an effective technique in addressing multisegmental cervical radicular compression. Moreover, this technique eliminates the need of fusion and possible internal fixation, which are essential if the alternative anterior procedure was performed; thus, reducing the overall cost and morbidity.

An empirical investigation of analytic process: Contrasting a good and poor outcome case.

The aim of this article is to assess the difference in the analytic processes between two patients with similar personality profiles, who were in analysis during the same time, by two analysts with similar training and working in a similar setting. We explored patients' personality and changes with the Global Assessment of Functioning Scale (GAF; APA, 2000) and the Shedler-Westen Assessment Procedure-200 (SWAP-200; Westen & Shedler, 1999a, 1999b) applied by two pairs of independent raters in 16 sessions. In addition, we assessed therapeutic processes with the Analytic Process Scales (APS; Waldron, Scharf, Hurst, Firestein, & Burton, 2004b) and the Dynamic Interaction Scales (DIS; Waldron, Gazzillo, Genova, Lingiardi, 2013) applied by three independent raters to 20 sessions, as well as the Helping Alliance Rating Scale (HAR; Luborsky, Crits-Cristoph, Alexander, Margolis, & Cohen, 1983) applied to eight sessions from the beginning of each therapy. Our results showed striking differences between the outcomes of these two psychoanalyses that are paralleled by differences in their therapeutic process. We provide verbatim clinical interactions to illustrate these differences and explore the potential implications of these findings.

The Narrative Model of Therapeutic Change: An Exploratory Study Tracking Innovative Moments and Protonarratives Using State Space Grids

Despite the popularity of narrative approaches to the change in psychotherapy, a better understanding of how narrative transformation facilitates therapeutic change is needed. Research on innovative moments (IMs) has explored how IMs in psychotherapy evolve over time. We expand on past studies by exploring how IMs become aggregated in narrative threads, termed protonarratives, which come to constitute an alternative self-narrative at the conclusion of therapy. The results suggest that the good outcome case had a different pattern of IM integration within protonarratives, revealing greater flexibility than the poor outcome case. These results support the heuristic value of the concept of the protonarrative.

A 12-month follow-up study of people with dementia referred to general hospital liaison psychiatry services

new services for patients with dementia in general hospitals are being widely developed. Little is known of outcomes after hospital for such patients. to establish outcomes for patients with dementia referred to general hospital psychiatric services. prospective cohort study. two UK general hospitals. referrals with dementia to liaison psychiatric services. eligible referrals (n = 112), and their carers, were assessed during admission, and at 6 and 12 months, using battery of health measurements. mortality at 6 months was 31% and at 12 months 40%. At baseline, 13% lived in a care home, rising to 84% by 6 months. Quality of life scores remained stable over 12 months, while carer stress fell significantly. Baseline clinical and demographic variables did not predict quality of life or carer stress at 6 and 12 months. dementia liaison services in general hospitals currently focus on poor outcome cases.

The Innovative Moments Coding System and the Assimilation of Problematic Experiences Scale: A case study comparing two methods to track change in psychotherapy

The Assimilation of Problematic Experiences Scale (APES) and the Innovative Moments Coding System were applied to transcripts of a successful case of linguistic therapy of evaluation independently by different research groups. Assimilation theory and research suggest that higher APES scores reflect therapeutic gains, with a level of approximately 4.0 separating good from poor outcome cases. The innovative moments (IMs) model suggests that IMs classified as reconceptualization and performing change occur mainly in good outcome cases, whereas action, reflection and protest occur in both good and poor outcome cases. Passages coded as reconceptualization and performing change were rare in this case, but 100% of them were rated at or above APES 4. By contrast, 63% passages coded as action, reflection or protest were rated below APES 4 (Chi-square = 28.62, p < .001). Implications for research are discussed.

The Emergence of Innovative Moments in Narrative Therapy for Depression: Exploring Therapist and Client Contributions

According to the narrative framework, clients seek therapeutic help due to the constricting nature of problematic self-narratives and psychotherapy should contribute to the elaboration of narrative novelties and innovative self-narratives. We term these narrative novelties as innovative moments (IMs) and developed the Innovative Moments Coding System (IMCS) to study them in psychotherapeutic discourse, differentiating five types of IMs: action, reflection, protest, reconceptualization and performing change IMs. Previous research studies using the IMCS with narrative therapy, emotion-focused therapy and client-centered therapy show that action, reflection and protest IMs appear in good (GO) and also in poor outcome (PO) cases while, reconceptualization and performing change IMs are more typical of good outcome (GO) cases. In this study, we will address how these IMs are co-constructed in the therapeutic dialogue through the discussion of three particular forms of IMs’ emergence in psychotherapy. These forms of emergence refer to different degrees of client and therapist participation: (1) IMs produced by the therapist and accepted by the client; (2) IMs prompted by the therapist and developed by the client; and (3) IMs spontaneously produced by the client. The exploratory analysis of three initial, three middle and three final sessions of contrasting cases (a GO and a PO) of narrative therapy for depression showed that IMs produced by the therapist were more associated to the PO case, while IMs prompted by the therapist were more associated to the GO case.