Therapeutic Space Research Articles

Therapeutic landscape of metabolic dysfunction-associated steatohepatitis (MASH).

Metabolic dysfunction-associated steatotic liver disease (MASLD)and its severe subgroup metabolic dysfunction-associated steatohepatitis (MASH) have become a global epidemic and are driven by chronic overnutrition and multiple genetic susceptibility factors. The physiological outcomes include hepatocyte death, liver inflammation and cirrhosis. The first therapeutic for MASLD and MASH, resmetirom, has recently been approved for clinical use and has energized this therapeutic space. However, there is still much to learn in clinical studies of MASH, such as the scale of placebo responses, optimal trial end points, the time required for fibrosis reversal and side effect profiles. This Review introduces aspects of disease pathogenesis related to drug development and discusses two main therapeutic approaches. Thyroid hormone receptor-β agonists, such as resmetirom, as well as fatty acid synthase inhibitors, target the liver and enable it to function within a toxic metabolic environment. In parallel, incretin analogues such as semaglutide improve metabolism, allowing the liver to self-regulate and reversing many aspects of MASH. We also discuss how combinations of therapeutics could potentially be used to treat patients.

Implementation strategies to support recovery support workers serving criminal legal involved people who use drugs

IntroductionRecovery support workers (RSWs) who provide social support interventions for people who use drugs (PWUD) often face challenges that can jeopardize the well-being, efficacy and sustainability of this essential workforce. To date, little has been reported on the types of implementation strategies used to support RSWs. We describe and evaluate a multifaceted implementation strategy package to support Reducing Opioid Mortality in Illinois (ROMI), a paired peer recovery coach and case manager (PRC-CM) intervention for PWUD with recent criminal-legal involvement in urban and rural settings. MethodsROMI utilized a remote, hub and spoke-administered multifaceted implementation strategy package to support PRCs-CMs to deliver evidence-based services to PWUD with criminal-legal involvement. The core strategies included: (a) comprehensive training; (b) individual clinical supervision; (c) group consultation; and (d) centralized technical assistance. We evaluated the implementation strategy package using a mixed-methods design including qualitative interviews with the intervention staff to explore their experiences with each strategy component, as well as a quantitative coding of topics discussed during supervision and group consultation meetings to estimate prioritization of issues and balance of topics between strategy type. ResultsBetween January 2019 and January 2024, the study interviewed 8 PRC-CMs and quantitatively coded 568 sessions (79 group consultations and 489 individual supervisory) for discussion themes. The hub-and-spoke model allowed for centralized access to highly skilled supervisory staff as well as knowledge sharing across geographically remote teams. The therapeutic space to process feelings and emotional support provided during individual supervision was noted to be an essential resource by PRC-CMs. Group consultation facilitated camaraderie, mutual support and continual learning through dynamic and responsive trainings. Frustrations around resource limitations and systemic barriers facing their clients remained a dominant concern for PRCs-CMs, and was incompletely addressed by the technical assistance strategy. ConclusionUnderstanding the practical components and individual strengths of the implementation strategies required to support the implementers of complex interventions such as social support and navigation for PWUD with criminal-legal involvement elucidates the organizational and professional capacities that may be required for real world implementation. Trial registrationNCT04925427

Staff Experiences of Working with Children and Adolescents Engaging in Behaviours That Challenge in Mental Health and Paediatric Inpatient Environments: A Qualitative Exploratory Study across Four European Countries

ABSTRACT There has been a recent global increase in the number of young people experiencing mental health challenges in both child and adolescent mental health settings and acute paediatric settings. In many of these settings, restrictive practices are used to manage behaviours that challenge, such as aggression and violence. However, little is known about staff’s experiences with responding to behaviours that challenge in these settings. A qualitative descriptive design was adopted, with participants engaging in 1:1 interviews or focus groups in Ireland, Finland, Germany, and Bulgaria. Data were analysed using reflexive thematic analysis. Four themes were identified: (1) the importance of establishing a safe, therapeutic environment, (2) identified antecedents to behaviours that challenge, (3) how staff respond to behaviours that challenge, and (4) the needs of staff when maintaining a safe, therapeutic environment. Consideration needs to be given to the environments where young people are cared for, with an emphasis placed on safe, comfortable, therapeutic spaces to reduce behaviours that challenge. Staff should be better trained in trauma-informed practice, and both staff and service users should be provided with opportunities to de-brief following episodes of restrictive practices, with a focus on enhancing and maintaining therapeutic relationships.

Reactions to and Impact of Survivor Online Disclosures: A Qualitative Analysis

ABSTRACT Social reactions to disclosure of sexual victimization play an important role in the process of recovery. The purpose of this qualitative study was to explore the impact of online disclosure of sexual victimization. The sample for this qualitative study (n = 17) focused on participants who shared their experiences with disclosing about their sexual victimization online and the reactions received in these spaces. Using applied thematic analysis, the research team identified three major themes from the data, each with respective subthemes, including helpful, harmful, and mixed reactions to online disclosure. Findings highlighted the nuances of disclosing online and the diverse reactions that were received. Participants provided in-depth descriptions of not only how the disclosure experience and resulting reactions could be helpful or harmful but also nuanced, mixed, and simultaneously harmful and helpful. This data is a crucial reminder that survivors’ stories are unique and that survivors experience many varying motivations for choosing if, when, where, to whom, or for whom they may disclose. The findings may help inform clinical recommendations for mental health practitioners working with survivors of sexual victimization and holding therapeutic space to process these decisions of disclosure. Future researchers should also consider further studying online interactions, especially within and between survivors, including when and how survivors choose to connect or disconnect.

Scalp condition improvement with botanical extracts possessing chemical and physical antioxidant activity.

Oxidative stress is implicated in scalp and hair health manifesting in several ways, including skin barrier, hair retention, healthy hair appearance and scalp sensation. We previously linked markers of oxidative damage to dandruff and skin barrier impairment and have linked key anti-dandruff technologies to the resolution of these issues. Here we expand the therapeutic space demonstrating many botanical extracts offer protective benefits against ROS stress via both chemical and biological antioxidant mechanisms. Chemical antioxidant activity of 10 botanical extracts was measured using oxygen radical absorbance capacity (ORAC) and biological antioxidant activity was measured using a Nrf-2 cell assay. A three-dimensional human keratinocyte skin equivalent model from MatTek was used to measure efficacy of reducing reactive oxygen species (ROS) from both the botanicals added as a solution and from a shampoo product. A 4-week consumer study with 56 panels was conducted with a leave-on treatment containing a botanical extract. Measurement of the oxidized lipids (9 and 13-Hydroxy-10E 12Z-octadecadienoic acid, HODE) extracted from scalp tape strips was made using gradient reversed-phase high-performance liquid chromatography with tandem mass spectrometry (HPLC/MS/MS). We demonstrated invitro that many botanical extracts exert antioxidant activity by quenching radicals in ORAC testing as well as activating biological antioxidant pathways via nrf-2 up-regulation in a cellular reporter system. Furthermore, we demonstrate these antioxidant activities for these botanicals in 3D skin models and ultimately show the reduction of lipid oxidation products in a consumer use context with a rosemary extract. Improved scalp condition can be achieved with incorporation of botanicals having the potential to exert antioxidant activity in hair/scalp care products.

Walking and talking for well‐being: Exploring the effectiveness of walk and talk therapy

AbstractDespite the rising trend of integrating nature and movement into talking therapy, the extent of empirical support remains limited. This study explored the effects of a walk and talk intervention on adult mood and well‐being using a multiple baseline design with pre, post and follow‐up assessments. Five adults (3 males and 2 females) from a technology company took part in a walk and talk intervention lasting approximately 6–8 sessions. They completed self‐report measures at baseline, post‐intervention and follow‐up, with semi‐structured interviews conducted at follow‐up. Results showed a reduction in psychological distress and an increase in well‐being for all participants from baseline to follow‐up. Qualitative data from a thematic analysis supported these findings: participants found the natural, calming effect of the outdoors, combined with the movement of walking, facilitated a sense of freedom to express themselves and, in doing so, maximise the benefits of the therapeutic space. These included gaining a broader perspective, heightened self‐awareness and greater acceptance of oneself, others and life's challenges. This study offers real‐world evidence supporting walk and talk therapy as an effective intervention for adult well‐being and mood.

Assessing the state of cognitive performance of employees and determining the range of thermal comfort of different genders in Ilam hospitals

Introduction: Thermal comfort is essential for a productive work environment and affects the well-being and performance of employees, so maintaining optimal levels of satisfaction, productivity, and efficiency, especially in indoor spaces, is essential. Therefore, the present study's aim is to evaluate the state of cognitive performance. Employees and determination of the thermal comfort range of different genders of employees in the hospitals of Ilam city were done. Methods and Materials: This research was conducted by survey and field method to identify the state of thermal comfort and cognitive performance of people in the real conditions of therapeutic spaces. For this purpose, the responses of 400 employees of five hospitals in Ilam City were recorded by simple sampling from the beginning of August to November 1402. The reliability status of the questionnaires was confirmed using Cronbach's alpha, and the thermal comfort status of the people was determined through the regression model. Linearity and correlation analysis between measured variables were analyzed through SPSS27 software. Results: The analysis of the linear regression model showed that the range of thermal comfort between men and women differs by 1.79 degrees Celsius, and this difference is a tendency for warmer temperatures in men and a tendency for colder temperatures in women, the average scores obtained at Zagros Hospital In the visual-spatial/executive component (7.00), attention (4.34), memory (3.08) has the best performance, Imam Khomeini Hospital (RA) has the best performance in the verbal component (2.95), Hazrat Qaim Hospital (A) In the abstraction component (2.02), it has the best performance and awareness of time and place in all hospitals equal to 6.00. Conclusion: The level of coverage and activity rate among women significantly affects the feeling of thermal comfort, cognitive performance, and productivity of employees at work. The results of this research show the need to revise the current standards of workplace clothing, attendance time, and employee activity rate. Moreover, changes in cognitive performance among hospital staff highlight the need to consider targeted cognitive enhancement strategies to increase staff efficiency.

Engaging Immigrants in Social Service Settings: Importance of Cultural Humility

It is critical for social service providers to understand the detrimental effects of racism and discrimination on the well-being of immigrants, emphasizing the complex interplay between cultural factors and racial stratification. Using a culturally humble approach to engagement there are four key cultural elements—familismo, marianismo, machismo, and spiritualismo—that are central to the gender identities of Latina immigrants. This conceptual review synthesizes existing research studies and theoretical models to provide an integrated, culturally responsive framework that helps professionals better understand and address the well-being of Latina immigrants in the United States. The intersectional complexities of race, ethnicity, culture, gender, and immigration in the therapeutic space provides for the tailoring of interventions to the unique needs of Latina immigrants. The meta synthesis reveals how cultural factors such as familismo, marianismo, machismo, and spiritualismo interact with racial stratification, exacerbating the challenges faced by Latina immigrants. The key takeaway of this dialogic is the necessity of integrating cultural humility and intersectional understanding to improve service delivery and support for Latina immigrants, highlighting its importance and implications for social service practices.

Growing sustainable therapeutic third spaces – a therapeutic sensory garden’s impact on university student self-reported quality of life and affect

Growing sustainable therapeutic third spaces – a therapeutic sensory garden’s impact on university student self-reported quality of life and affect

We exist and resist as woven patches: Collective narrative practices in an activist context challenging and responding to an anti-lesbian hate crime

This article describes a participatory process in which a group of feminist, lesbian feminist and dissident activists came together to respond therapeutically to the impacts of anti-lesbian hatred. The therapeutic context was created gradually with the deployment of a set of metaphors related to textile art, inspired by the re-authoring conversations proposed by Michael White. The process included the creation of a collective document that acknowledges and honours the participants’ wisdom, knowledge and particular ways of responding to anti-lesbian hatred. This work was embodied in three different forms: a patchwork quilt, a video and a fanzine. Collectivised through a definitional ceremony, these forms embraced manual-artistic creation and the materiality of fabric as valued means of expression, beyond the limits of the verbal. This work contributed to the visibility, externalisation and politicisation of acts of injustice, acknowledging forms of resistance, care and protest. The process invited us to reflect on the importance of collectivisation, fluidity and flexibility in structuring the therapeutic space, and allowed us to question the roles of therapist and activist as predefined identities.

Creative reflections on embodied filmmaking: in, through and between the senses and spaces of the medicalized body

ABSTRACT This artist’s reflection further explores the imagined and sensorial encounters of the body in medicine through a creative practice-led feminist, embodied, and intersubjective approach to filmmaking. It uses “corporeal parenthesis” as form and content to destabilize conventional readings associated with medicalization. The sensations we feel on the inside of the body shape our imagined anatomical understanding. This extension of proprioception is a sensorial way of seeing and experiencing the inside of one’s own body. The visceral body, which entwines our real and imagined bodily inside, is positioned as a site for sense-making. This emphasizes knowledge as imaginative, intuitive, and lived to resist the standardization experienced within medicine. However, the passive horizontal body in the clinical encounter and the presumed intimacy of the therapeutic space, assumes the body to be accessible and consenting. This alters the ways in which we experience senses associated with pleasure and non-pleasure. By focusing on the artist’s moving image work O (Symptom), creative practice is used to examine in, through, and between the spatial and sensorial boundaries of the medicalized body.

P35: Older adult’s dementia. Implementation of a multidisciplinary day care program in Argentina

Background: Day care programs for older adults with dementia is an effective strategy that allows prolonging the functionality of the elderly, their support and that of their family reducing home care costs and delaying the institutionalization of patients with cognitive impairment.Objectives: The aim of the present work is to describe the main goals and the implementation of a multidisciplinary day care program for patients with dementia and their family caregivers in Argentina.Methods: Design: Prospective cohort study. Subjects: 22 patients and their family caregivers, who attend a day care program in Argentina. Instruments: socio-demographic and psychosocial questionnaire of both patient and caregiver (built ad hoc) Patient: MMSE, GDS, HAD-A, PANAS- VRARG, EQ-5D and instrumental and basic abilities of daily living. Family caregiver: Zarit Burden Interview. Procedure: The intervention for patients consists of two different lines of work, one for the patient, and another for the family member. The activities are coordinated by a multidisciplinary group of professionals. Regarding the caregiver, individual orientation interviews and therapeutic group spaces and psycho-educational material are offered.Results: Preliminary data of 22 patients and caregivers, who have taken part in the program so far, indicate that: Patient: median age was years 75,27 old (ds = 9,28), % 63,6 of which are woman. The values obtain in the instrument are: MMSE 22,45 (ds = 4,78) GDS 4,47 (ds = 3,73), HAD-A 3,66 (ds = 3,39), (PANAS -E-VRARG) Negative items 7,70 (ds = 3,11) (PANAS -E-VRARG) Positive ítems 18,7 (ds = 3,13), EQ-5D 77,35 (ds = 16,21) and BHDL 93,63 (ds = 13,10), IHDL 9,1 (ds = 3,31). And for family caregivers the mean age was 65,27 old (ds = 11,37), % 66,71 of which are woman. Caregivers Zarit Burden Interview mean score was 40, 18 (ds = 11,35).Discussion: Our findings concur with those presented in scientific literature and support the WHO recommendations regarding the need to implement multidisciplinary programs for patients with dementia and family caregivers, in order to moderate the impact that providing care for an elderly relative with a neurological disease has on them.

치유적 모빌리티와 네트워크의 얽힘 - 서울시민 힐링 프로젝트 속마음버스를 사례로

Health geography has been developed through various concepts, ranging from therapeutic landscapes to therapeutic spaces, places, mobilities, networks, and assemblages. However, much of the research within health geography has predominantly analyzed therapeutic geographical phenomena using a single conceptual framework. This study argues that these concepts do not exist separately but rather intersect and coexist, as demonstrated through a case study of the Seoul Healing Bus. The research findings reveal that the Seoul Healing Bus exemplifies a case where therapeutic mobilities and therapeutic networks intertwine to create a synergistic therapeutic effect. These findings underscore the need to analyze therapeutic geographical phenomena from multiple perspectives rather than from a singular viewpoint, suggesting the importance of designing therapeutic geographical environments where different concepts intersect.

Evaluation and Development of Healing Garden Based on Biophilic Design Approach in Harapan Kita Cardiovascular Hospital

Abstract The need for gardens in health facilities became the concern of Harapan Kita Cardiovascular Center Hospital (RSJPDHK). Landscape architecture research has identified the importance of therapeutic green space as a rehabilitation strategy on the physical and psychological resilience that can affect health and work performance. Therefore, the possibility to develop green space need to be designed in conjunction with the restorative function through the healing garden concept with biophilic approach. This research aims to identify the potentials and constraints of 3 chosen sites on RSJPDHK building; evaluate the healing garden value on site 1, which is an existing roof garden; and develop a biophilic-based healing garden design on sites 2 and 3, which are undeveloped roof and corridor yard. The research stages were carried out with reference to modified Booth (1984). The results showed that site 1 is suitable as a healing garden with standard criteria. Meanwhile, design development was carried out on sites 2 and 3 with the concept of healing garden and biophilic approach, entitled ‘rejuvenate’ which produced the output of design recommendations for RSJPDHK.

Release: The acupuncture clinic as a therapeutic, health-enabling place

This paper critically reappraises the work of Wilbert Gesler (1992) on ‘therapeutic landscapes’ to explore the dual role of the acupuncture clinic as experienced by couples undergoing fertility treatment. Drawing on qualitative research in Ireland, I argue that the acupuncture clinic acts as a therapeutic space in two senses. First, the patient-acupuncturist relationship contributes to patient emotional support and wellbeing, with the clinic providing emotional sanctuary. Second, the clinic provides a therapeutic complement to allopathic approaches to fertility treatment, with the acupuncturist providing informational support which informs patient decision-making and, in some cases, arguably contributing to the treatment itself. In exploring the therapeutic and health-enabling importance of the acupuncture clinic, this paper adds important qualitative depth to an aspect of assisted reproduction that has become an essential complement to the medical process to many couples, but has arguably remained neglected in academic research.

Torture victims' perspective on dental treatment: "Every sign you make, every move you take" - A qualitative study.

Torture victims struggling with post-traumatic stress often experience elements in the dental treatment situation that may trigger trauma-related reactions. The aim of the study was to explore intervention strategies that will enable dental health workers to adapt dental treatment to the needs of torture survivors. Exploratory interviews were conducted with 10 torture-exposed resettled refugees with dental treatment experience in Norway. The data was analyzed using qualitative content analysis, which suggested that to minimize trauma-reactions, dental personnel should focus on creating a safe therapeutic space and strengthening the patient's sense of control. Four main categories of clinical advice were proposed: (i) Acquire knowledge about psychology, consequences of torture, cultural differences, trauma-informed care, and the patients' individual needs; (ii) Recognize the trigger-potential of busyness or delays; (iii) Avoid surprises, such as sudden moves or actions and explore triggers individually, but make sure not to evoke images of interrogation, and; (iv) Provide overview both with respect to visibility in the clinical room, and to predictability regarding the dental treatment. Although undergoing dental treatment may be challenging for torture-exposed individuals, it is possible to reduce the predicaments considerably by making feasible adaptions to the treatment and adopting a trauma-informed approach.

DESIGNING FOR THE SENSES: MULTISENSORY APPROACHES IN THERAPEUTIC CLINICAL SPACES

Spatial design significantly influences interactions with the built environment, engaging senses through visual, auditory, and tactile stimuli. However, in therapeutic clinical settings, the sensory experience is often overlooked in favor of aesthetic considerations, limiting the understanding of user responses to spatial cues. This study investigates the role and impact of multisensory design on user responses in therapeutic clinical environments. By analyzing design parameters such as lighting, acoustics, materials, and textures, the research aims to establish a framework for creating therapeutic clinical spaces that prioritize multisensory stimulation. Through case studies, interviews, and surveys, the study assesses user perceptions and psychological responses to different sensory stimuli in clinical settings. The findings indicate a preference for environments that engage multiple senses, with factors such as layout, color tones, forms, lighting, and finishes playing crucial roles in shaping user experiences. The proposed framework offers practical guidance for designers and architects, emphasizing the importance of sensory design in enhancing interactions between users and clinical environments, ultimately contributing to a more holistic and immersive therapeutic experience.

Controlled mitral valvuloplasty using steerable catheter- waist- formed balloon system: A clinical case series.

As the general population ages, the incidence of degenerative mitral stenosis (MS) among patients has increased. Percutaneous mitral valvuloplasty (PMV) has emerged as a well-established option for mitral rheumatic stenosis with specific characteristics. However, a blank therapeutic space must be filled with the treatment options for degenerative or rheumatic mitral stenosis in patients with many comorbidities and contraindication for valvuloplasty. We here present a comprehensive overview of the current possibilities, despite their scarce success. That is the reason why we propose a case series to facilitate a better understanding of our innovative technique in this challenging clinical context.

Therapeutic utilization in chronic lymphocytic leukemia: A cross-sectional analysis of the Lymphoma Coalition’s 2022 Global Patient Survey.

e19026 Background: Chronic Lymphocytic Leukemia (CLL) is a highly prevalent disease with heterogenous prognostic trajectories. With a multitude of treatment options, we sought to explore therapeutic utilization trends from a global perspective in order to gain a more in-depth understanding of how different treatment regimens are utilized in different health systems. Methods: In 2022, The Lymphoma Coalition designed and globally deployed a survey to patients with lymphoma and CLL in order to gather patient reported outcomes and patient reported experience measures. Data were collected and enumerated with relevant contingency analyses performed to determine associations with a particular treatment regimen in the context of CLL. Results: The entire cohort of patients with CLL was 1289. The median age of the cohort was 65 and ranged from 26 to 97 years old. Biological sex was equally distributed with 50.5% of respondent indicating that they were female. Respondents were derived from 29 countries. The top three contributors to each region were China (50%), Australia (25%) and New Zealand (18%) for Asia-Pacific (N = 227); France (50%), Italy (13%) and Sweden (7%) for Europe (N = 950); Canada (75%) and The United States (25%) for North America (N = 112). Of those, 636 indicated that they received at least one therapy. The use of chemo-immunotherapy was most common (42%) followed by targeted therapy (32%), immunotherapy alone (18%), and chemotherapy alone (16%). Neither age nor biological sex was a significant predictor of therapy. Europe had the highest rates of chemo-immunotherapy utilization (45%) with North America and Asia-Pacific indicating 32% respectively (p = 0.01). Targeted therapy was used at a higher rate in North America (45%) but failed to demonstrate a significant difference against Asia-Pacific and Europe (31%); (p=0.10). Both immunotherapy and chemotherapy alone failed to demonstrate significant differences across regions. Conclusions: The data support that the majority of patients with CLL who require treatment are most likely to receive combination chemo-immunotherapy utilizing rituximab. However, we acknowledge that the data presented here is two years old and that the use of targeted molecular therapy is likely increasing. We found it reassuring that we could not identify any biases in the administration of the therapeutic regimens across the demographics of age and biological sex. Our research in this space will continue as we have deployed the 2024 version of the Global Patient Survey and have focused on increasing respondent participation from North America. With this new data, we plan on producing a time-dependent model to investigate how emerging therapies enter and expand in the CLL therapeutic space.

COVID-19: When It Leaves Us Voiceless and Powerless.

Conversion disorder-called functional neurological symptom disorder in the DSM-5-has roots that trace back to antiquity. The term conversion, originating from psychoanalysis, signifies the appearance of physical symptoms as an effort to resolve or convey unconscious and distressing intrapsychic conflicts- "converting" them from manifesting in the mind to manifesting in the body. Despite efforts made in elucidating the neurobiological etiologies of functional neurological symptom disorder, a psychodynamic lens remains indispensable in understanding the patient. This article presents two patients who developed functional neurological symptom disorder, one after a COVID-19 vaccination and one in the context of long COVID. A discussion follows on the intrapersonal, interpersonal, and systemic etiological factors that predispose, precipitate, and perpetuate COVID-related functional neurological symptom disorder. We elaborate on psychodynamic psychological processes and conflicts that may unfold between patients with COVID-related functional neurological symptom disorder and their health care providers. We also share suggestions on how a consultation-liaison psychiatry team may offer support to the primary treating team to facilitate a therapeutic space within which patients with COVID-related functional neurological symptom disorder may recover.