Mudanças na capacidade de mentalização na psicoterapia psicodinâmica de crianças / Changes in mentalization ability in child psychodynamic psychotherapy / Cambios en la capacidad de mentalización en la psicoterapia psicodinámica de niños

A mentalização tem sido considerada um elemento importante no processo de mudança na psicoterapia psicodinâmica. No entanto, há uma escassez de instrumentos disponíveis para avaliar o constructo com a população infantil. O Método de Rorschach tem sido sugerido como um procedimento capaz de avaliar a mentalização. Assim, o objetivo deste estudo foi analisar possíveis mudanças no funcionamento psíquico global e na capacidade de mentalização na psicoterapia psicodinâmica de crianças, de acordo com o Método de Rorschach (Sistema Exner). Foi realizado um estudo descritivo e longitudinal baseado no procedimento de Estudo de Caso Sistemático, do qual participaram três crianças em idade escolar. O Método de Rorschach foi aplicado no início e ao final do tratamento. As crianças apresentaram deficit na capacidade de mentalização no início do tratamento, associado a prejuízos no funcionamento psíquico global. Foi possível identificar mudanças na mentalização, ao final da psicoterapia, que se caracterizaram por avanços e retrocessos. O Método de Rorschach provou ser capaz de identificar mudanças na capacidade de mentalização das crianças analisadas.

Mentalization has been considered an important element in the process of change in psychodynamic psychotherapy. However, there is a shortage of available instruments to assess the construct in children. The Rorschach Method has been suggested as a procedure capable of evaluating mentalization. Thus, the aim of this study was to analyze possible changes in the global psychic functioning and in mentalization ability in child psychodynamic psychotherapy, according to the Rorschach Method (Exner System). A descriptive and longitudinal study based on the Systematic Case Study procedure was performed, in which three school-age children took part. The Rorschach Method was applied at the beginning and at the end of the treatment. The children presented impairments in their ability to mentalize at the beginning of the treatment, and it was possible to identify changes in this ability at the end of the psychotherapy. In addition, there was an association between deficits in mentalization and impairments in global psychic functioning. The changes in psychotherapy did not show a steady progress, but were marked by advances and setbacks. The Rorschach Method proved able to detect changes in the mentalization ability of the children.

La mentalización ha sido considerada un elemento importante en el proceso de cambio en la psicoterapia psicodinámica. Sin embargo, hay una escasez de instrumentos disponibles para evaluar el constructo con la población infantil. El método de Rorschach ha sido sugerido como un procedimiento capaz de evaluar la mentalización. Así, el objetivo de este estudio fue analizar posibles cambios en el funcionamiento psíquico global y en la capacidad de mentalización en la psicoterapia psicodinámica de niños, de acuerdo con el Método de Rorschach (Sistema Exner). Se realizó un estudio descriptivo y longitudinal basado en el procedimiento de Estudio de Caso Sistemático, en el que participaron tres niños en edad escolar. El método de Rorschach se aplicó al principio y al final del tratamiento. Los niños presentaron déficit en la capacidad de mentalización al inicio del tratamiento, que estuvieron asociados a pérdidas en el funcionamiento psíquico global. Fue posible identificar cambios en la mentalización, al final de la psicoterapia, que se caracterizaron por avances y retrocesos. El Método de Rorschach demostró ser capaz de identificar cambios en la capacidad de mentalización de los niños analizados.

Standard of care of patients with Chronic Myeloid Leukemia (CML) treated in community based oncology group practices between 2001-2015 in Rhineland- Palatinate (Germany)

Background: The aim of this study was to assess retrospectively treatment and outcome of CML-patients in community based oncology practices in Germany and whether European LeukemiaNET (ELN) recommendations were followed. Method: All Ph+, BCR-ABL1+ CML-patients who were treated between 11/2001 and 12/2015 in nine oncology group practices were analyzed retrospectively. Results: Two hundred sixty patients with a median age of 60 (18­90) were analyzed. 254 (98%) were in chronic phase, 5 (2%) in accelerated and 1 (0.4%) in blast crisis. 248 patients (95%) received some form of TKI-therapy. 1st line TKI was imatinib in 197 patients (79%), 51 (21%) received a second generation TKI. 75% of TKI-therapies were monitored by PCR. Overall survival after 10 years according to Charlson comorbidity index (CCI) was: CCI 2: 100%; CCI 3­4: 83%; CCI 5­6: 52%; CCI ≥7: 39%. More patients died from comorbidities (8%) than from CML (5%). Whether patients died was strongly correlated to CCI at diagnosis: CCI 2: 3% of patients died, CCI 3­4: 16% of patients died, CCI 5­6: 38% of patients died, CCI ≥ 7: 42% of patients died. Conclusion: CML-patients treated in oncology group practices receive standard of care as recommended by ELN. Overall survival in routine care is comparable to international studies. Molecular monitoring should be improved (AU)

Instrumental Variable Methods and Its Applications in Outcome Research of Traditional Chinese Medicine / 世界科学技术-中医药现代化

This paper was aimed to discuss the feasibility and attentions of application of instrumental variable (IV) methods in traditional Chinese medicine (TCM) outcome research. First, the application of IV was introduced, which included the basic principles and hypothesis, statistical model, estimator of IV and weak IV. Then, an example was given to illustrate the evaluation criteria and attentions of IV. The resultsshowed that IV method was proposed as a potential approach to the problems of confounding in statistics. But using IV methods should be based on a series of statistical hypotheses. It was concluded that the IV analysis was a method controlling confounding bias, but generally it was not chosen as the preferred analytical method. The issue of searching for valid and plausible IV seemed to be the biggest obstacle in the outcome of TCM researches.

Impact of a bleeding care pathway in the management of acute upper gastrointestinal bleeding.

Objectives Upper gastrointestinal (UGI) bleeding carries high morbidity and mortality. The use of a bleeding care pathway (BCP) may improve outcomes, but the results are inconsistent in various studies. Methods A BCP for patients with UGI bleed with admission in a bleeding care unit (BCU) has been in use at our hospital since 2005. Prior to this, a high dependency unit was used for management of all emergencies including UGI bleeding. We compared the length of stay in the bleeding care/high dependency unit, total hospital stay, time to UGI endoscopy after admission, and survival between pre-2005 and post-2005 patients. Results Five hundred and fifty-one patients were admitted with acute UGI bleed in the last 5 years; 121 belonged to pre- BCP (2004) period and 430 after implementation of the pathway (2005–2008). The mean (SD) time to UGI endoscopy improved from 21.3 (7.4) hours in the pre-BCU era to 9.4 (9.9) hours in BCU, p<0.001. BCU stay was shorter from 2.41 (1.4) days pre-BCP to 1.93 (1.32) days post-BCP, (p<0.001). The total hospital stay in pre-BCU (4.0 [2.08] days) as compared to BCU (4.13 [2.62] days; p=0.58) was similar; there was no impact of BCU on survival. Conclusion A BCU implementation showed improvement in time to UGI endoscopy, and did not reduce BCU stay or impact survival.

Costs of Diabetes Mellitus in Korea

Outcome research focusing on the economics of the medical field began in the mid-1990s and has included studies about costs, cost effectiveness, and policies. According to the American Diabetes Association, the total estimated cost of diabetes in 2007 was $174 billion. The economic burden of patients with diabetes in Canada is expected to be about $12.2 billion in 2010. Recent Korean studies have analyzed the expenses associated with type 2 diabetes for patients in selected general hospitals. Type 2 diabetic patients without complications cost approximately 1,184,563 won (the equivalent of US $1,184) per patient for healthcare annually. In contrast, patients with microvascular disease due to diabetic complications cost up to 4.7 times that amount, and patients with macrovascular disease incur up to 10.7 times the annual costs for patients without diabetic complications. Diabetic complications ultimately impact the quality of life for patients and patient mortality, and are associated with higher direct medical expenses for patients. To avoid increased medical costs, appropriate management techniques must be implemented to ensure timely care for patients with diabetes.

Outcome Research in Diabetes / 임상당뇨병

Economic development has lead to increased life expectancy, population growth, and spread of the Western life style, resulting in a gradual increase of diabetic patients during the last three decades. Outcome research focusing on the economics of the medical field began in mid the 1990s, including publications about costs, cost-effectiveness analysis, and policy reflection. According to the ADA, direct cost spending on diabetes was $91.8 billion in 2002 and is projected to be $156 billion in 2010 and $192 billion in 2020. In Canada, research found that the direct cost of diabetic care was $2.6 million (American dollars) in 1998, 7.8% of the total Canadian medical expenditure. Half of this cost was incurred in hospitals (IPD: 19%, medication: 31%). Recent domestic studies have analyzed the expenses associated with type 2 diabetes in some general hospitals. Type 2 diabetic patients, without complication, spend about 1,184,563 won annually on healthcare. On the other hand, patients with microvascular diseases spend up to 4.7 times as much, and patients with macrovascular disease incur up to 10.7 times greater costs. Patients with both complications have been shown to pay 8.8 times more than do those with no complications. The increased costs charged to kidney transplant patients was about 23.1 times greater than for those with no complications, while dialysis increased costs by 21 times, macrovascular disease with PTCA or CABG resulted in a 12.4-fold increase, and BKA was 11.8-fold more expensive. The total medical costs have soared with the treatment progress of diabetic retinopathy or nephropathy. In diabetic treatments, complication occurrence ultimately has an effect on the QOL, the patient mortality, and is associated with the direct medical expenses. Thus it is critical not to delay care in diabetic patients in order to avoid increased direct medical costs. Therefore, in diabetic care, as outlined in the medical care plan policy, it is most critical to adequately control blood sugar, blood pressure, and cholesterol in conjunction with the early discovery of any complications through the appropriate management techniques.

Medición de resultados en evaluaciones económicas / Measuring outcomes in economic evaluations

Beginning with the concept of evaluation, several approaches to outcomes or results evaluation are reviewed: clinical measurement, quality of life, and willing-ness to pay. Clinical measurement is the simplest and most available, but is limited when 1) establishing the effects of comparable interventions for different pathologies, 2) detecting different degrees of improvement achieved, and 3) identifying the result of interventions measured in variables associated to patient lifestyle and quality of life. When the health services measure the quality of life, the results of the intervention are subjectively evaluated by the patient with respect to wellbeing and satisfaction. The measurement of quality of life can be considered specific, generic or based on utility to the extent that it is based on the estimation of a specific variable such as the perception of pain, the patient’s general state of health, or the estimation of uses normative values based in preference studies at the population level, respecti-vely. The method of willingness to pay values the life according to the amount that individuals are willing to pay for a change that reduces the possibility of sickness and death, assuming that patients prefer those procedures to which they assigned the highest value. This evaluation of outcomes incorporates more than just strictly health considerations and expresses results in monetary terms, which facilitates cost-beneft analysis. Additionally, the results can be measured at a macro, national level; at a meso-scale, referring to the health systems of a determined territory; and at the level of the users. Finally, evaluating results or outcomes in order to determine the intervention’s effectiveness should be associated to its cost and must be studied using research designs that guarantee that the changes have sufficient time to appear and are observables. The monitoring period should be sufficiently long to explain the different results observed in the studies.

A partir del concepto de evaluación, se revisan distintas aproximaciones a los procesos de evaluación de resultados. Éstas incluyen la medición desde el punto de vista clínico, de calidad de vida, y de disponibilidad de pago. El punto de vista clínico resulta más simple y disponible, pero limitado al momento de establecer efectos de intervenciones comparables entre distintas patologías, de detectar los distintos grados de “mejoría” alcanzados y de dar cuenta del resultado de intervenciones medidas en variables asociadas al estilo y calidad de vida de los pacientes. Desde la perspectiva de calidad de vida relativa a la salud se busca evaluar los resultados que las intervenciones sanitarias tienen sobre la percepción subjetiva relacionada con bienestar y satisfacción. La calidad de vida puede ser considerada específica, genérica o basada en la utilidad. En el primer caso, la medida se basa en una variable específica, como la percepción de dolor; si la aproximación es genérica apunta al estado de salud general del paciente; y si se basa en la utilidad usa valores normativos basados en estudios de preferencia de nivel poblacional. La aproximación de disponibilidad de pago permite valorar la vida según lo que los individuos están dispuestos a pagar por un cambio que reduce la probabilidad de enfermedad o la muerte, asumiendo que aquellos procedimientos a los que se asigna mayor valor son los que el usuario prefere. Permite incorporar valores que van más allá de lo sanitario y expresar resultados en términos monetarios, lo que facilita el análisis de costo-beneficio. Desde otra perspectiva, las medidas de resultados pueden incluir un nivel macro, nacional; una perspectiva meso, referida a los sistemas sanitarios de un determinado territorio; y la perspectiva de los usuarios. Finalmente, el estudio de resultados como derivado de la efectividad de la intervención debe asociarse al costo de ésta y ha de ser estudiado usando diseños de investigación que aseguren un tiempo de seguimiento suficiente que garantice que los cambios puedan ocurrir y sean observables. La longitud del seguimiento explica las diferencias observadas en los resultados de algunos estudios.

Depth of counseling process:exploring of a three-dimension model / 中国心理卫生杂志

Objective:To test Jiang Guangrong's(2005)three-dimension model on the depth of counseling process.Methods:In this process-outcome research,28 sessions in a university counseling center were videotaped and coded in terms of the model.Structure Equation Model(SEM)was used to examine the relations between the coding and counselors and clients' evaluation of the session depth.Results:(1)Clients and counselors evaluated differently on the session depth,and clients' evaluation was more positive than counselors' [(4.95±1.12)vs.(4.23±0.94),P<0.05];(2)The model was significantly correlated with counselors' session depth evaluation(path coefficient = 0.55,P<0.01),but not with the clients';(3)The session curves describing each dimension changing over time had different patterns in sessions of different depth level,through which more about the counseling process could be known.Conclusion:The three-dimension model on the depth of counseling process has got some empirical evidences.

Efectividad de la psicoterapia y su relación con la alianza terapéutica / Effectiveness of the psychotherapy and its relation with the therapeutic alliance

En este estudio se evalúa la efectividad de la psicoterapia individual realizada por terapeutas noveles en la Clínica Psicológica de la Universidad de La Frontera (Temuco - Chile) y su relación con la alianza terapéutica. La investigación es de carácter cuantitativo, con diseño de grupo único y evaluaciones al inicio y término de la terapia. En el estudio participaron 23 consultantes, cuyos procesos psicoterapéuticos eran conducidos por 11 estudiantes de los últimos niveles de la Carrera de Psicología, que realizaban su primera experiencia en atención psicoterapéutica supervisada, o se encontraban efectuando su práctica profesional. Los instrumentos utilizados fueron las versiones adaptadas para Chile del Outcome Questionnaire (OQ-45.2) de De la Parra y Von Bergen (2000, 2002) que permite evaluar el nivel de cambio en el curso de la terapia y sus resultados finales y del Working Alliance Inventory (Inventario de Alianza de Trabajo, IAT-P) de Santibáñez (2001) que evalúa la alianza terapéutica desde la perspectiva del paciente. Los resultados informan diferencias significativas entre la primera y última aplicación del OQ-45.2. Los puntajes obtenidos en el IAT-P están ubicados en los dos tercios superiores de la escala, observándose una restricción de rango con sesgo positivo. Se evidencia una asociación significativa entre la alianza terapéutica percibida por el paciente y el resultado de la psicoterapia, tanto en el puntaje total de la escala OQ-45.2, como en la Subescala de Síntomas. Estos resultados son discutidos considerando la investigación actual en el área y el trabajo realizado por terapeutas noveles.

The present study was aimed to assess the effectiveness of individual psychotherapy undertaken at the Psychological Clinic of the Universidad de La Frontera (Temuco, Chile) and its relationship with the therapeutic alliance. The investigation involved 23 adult patients with neurotic symptoms. Their therapeutic processes were carried out by 11 trainee students from the regular psychology training program. Out of these, 4 therapists were performing their first supervised psychotherapeutic experience, and 7 therapists were undertaking their professional training using either a psychodynamic or a humanistic- experiential approach. The therapeutic processes considered in this study lasted between 5 and 42 sessions, comprising the following closure modalities: agreed closure between the patient and therapist because of the fulfillment of objectives, closure requested by the patient, and withdrawal of the therapeutic process. The instruments used were the Outcome Questionnaire (OQ-45.2) adapted for Chilean population by De la Parra and Von Bergen (2000, 2002), an instrument that allows to evaluate the level of change in the final course of the therapy and its outcomes; and the Working Alliance Inventory (Inventario de Alianza Terapéutica, IAT-P) adapted for Chilean population by Santibánez (2001), an instrument that evaluates the level of therapeutic alliance from the perspective of the patient. The study was quantitative in nature, with a unique group design and evaluations at the beginning and at the end of the therapy. For each patient, the OQ-45.2 was administered at the end of the first, and after the last psychotherapy session. In addition, the IAT-P was administered once, at the fourth session. In order to assess the pre-post psychotherapy differences, a samples-related t test was performed. In addition, a Reliable Change Index was calculated using scores of the first and final OQ-45.2 administration; and finally, the percentage of patients with clinically significant change, was estimated. The administration of the IAT-P showed a restriction of range with positive bias both, on overall total scale scores as well on each subscale score. For this reason, using the median, two subgroups for the overall IAT were created. Also, two subgroups were generated for each subscale: a subgroup of subjects with scores higher than the median and a subgroup of subjects with scores below the median. Then, by using the Mann-Whitney U test, the Reliable Change Index from the groups with high or low levels of alliance were compared. Results of this study showed significant differences between the first and last application of the OQ-45.2. In order to estimate whether the change was clinically significant, cut-off scores and Reliable Change Index were used. In the OQ-45.2 scale, 17 patients left the clinical group, 12 people met the Reliable Change Index criterion, and 8 people showed a clinically significant change. In relation to the closure modality, 7 patients with clinically significant change ended the psychotherapy with a discharge given by the therapist, while one requested the closure of the therapy. Scores from the IAT-P were located in the upper two thirds of the scale. The Bond Subscale had the highest mean, while Tasks and Goals got a slightly lower value. With respect to the main issue, it was found a significant association between therapeutic alliance and the outcome of the psychotherapy both, on overall total scale scores of the OQ-45.2 as well Symptoms Scale of the same instrument. Results showed that the alliance between therapist and the patient especially helped to reduce patient's symptoms. In addition, it was evident that students in training were able to establish good alliance with their patients, and thus to promote the achievement of the therapeutic outcome. These results are discussed taking into account current research on this topic.

¿Vale la pena hospitalizar a las mujeres depresivas con riesgo suicida?: características socio-demográficas, clínicas y resultados del tratamiento de mujeres depresivas con riesgo suicida tratadas en forma ambulatoria y hospitalizadas en un servicio de psiquiatría de un hosptial general en Santiago de Chile / Is it better top hospitaliza suicidal depressive women?: compared socio-demographic, clinical characteristics and results of their ambulatory and inpatient treatment in a psychiatric service in a general hospital in Santiago de Chile

With the objective of determining prognostic factors, we analyzed a database of 751 cases treated at the Affective Disorders Unit, Psychiatric Service, Hospital del Salvador, that fulfilled the following three conditions: female gender, suicidal risk (ideation or attempt), and three measurements of the Outcome Questionnaire (OQ 45-2) of Lambert et al. (M1 at intake, M2 early during treatment, and M3 at three to six months of treatment). Among the 751 cases between the years 2004 and 2008, 583 were women. Among them, 161 had three measurements of OQ 45.2, and 68 had suicidal risk. We compared this sample, that represents 9 percent of women requesting treatment at the Unit, with the women that fulfilled the criteria and were hospitalized during the same time. Using the methodology suggested by Jacobson and Truax, we compared the socio-demographic, clinical and outcome characteristics of the groups classified with a significant clinical change, improvement, no change and worsening.

Introducción: Este trabajo compara las características de pacientes tratadas ambulatoriamente o bien hospitalizadas en hospitales públicos. Método: Se analizan la base de datos de mujeres depresivas con riesgo suicida tratadas entre 2004 y 2008 en la Unidad de Trastornos Afectivos (UTA) del Servicio de Psiquiatría del Hospital del Salvador, con 3 mediciones del OQ 45-2 (M1 al ingreso, M2 al mes de tratamiento y M3 a los tres a seis meses), y se comparan con las hospitalizadas Se estudian muestras de 68 casos ambulatorios, equivalente al 9 por ciento de las mujeres hospitalizadas, de 58 mujeres hospitalizadas, que equivale al 15 por ciento de las mujeres depresivas hospitalizadas con riesgo suicida. Se analizan estos casos con la metodología de Jacobson y Truax, y comparando sus características socio-demográficas, diagnósticos clínicos y evaluación de resultados en las pacientes con cambio clínicamente significativo (CCS), mejoría, sin cambio, y empeoramiento. Resultados: Las mujeres hospitalizadas eran mas jóvenes (x = 38,1 años) que las ambulatorias (x = 42,1 años), con más cesantes y menos dueñas de casa. No hubo diferencias por tipo de ocupación, estado civil ni profesión religiosa entre ambos grupos. Ambos grupos bajaron sus puntajes en el OQ 45.2, tanto global como sub escalas. Hubo más mejoría y CCS entre las pacientes hospitalizadas (77,4 por ciento) que entre las ambulatorias (47,9 por ciento). Al analizar los tipos de trastorno afectivo, el CCS fue mayor en los pacientes bipolares, los episodios y los trastornos depresivos hospitalizados, que en los casos ambulatorios. Conclusiones: Las mujeres suicidas con riesgo afectivo mejoran en porcentaje importante, especialmente si son hospitalizadas. En estudios posteriores, es importante aumentar el tamaño de la muestra, y seguir a los casos que no vuelven a control post-alta.

Abandono de psicoterapia com crianças / Child psychotherapy dropout

OBJETIVO: Comparar uma amostra de 24 crianças que completaram 12 meses de psicoterapia psicanalítica com uma amostra de 38 crianças que interromperam prematuramente o tratamento. MÉTODO: Trata-se de um estudo quantitativo em dois grupos de crianças; tratamento quase-experimental de medida única antes do início da psicoterapia psicanalítica individual. RESULTADOS: Foram encontradas diferenças estatisticamente significantes nas seguintes variáveis: sexo, sintomas, frequência dos atendimentos, capacidade da criança de controlar as emoções e os impulsos, medida pelo teste Rorschach e nas escalas de sociabilidade, queixas somáticas e comportamentos internalizantes, tais como ansiedade e depressão, medidas pelo Child Behavior Checklist. CONCLUSÕES: Este estudo revelou que a psicoterapia psicanalítica é efetiva no tratamento da criança do sexo feminino que apresenta transtornos internalizantes, tais como ansiedade e depressão, tem maior descontrole de emoções e impulsos e recebe atendimento com uma frequência de duas vezes por semana por pelo menos 12 meses.

OBJECTIVE: To compare a sample of 24 children who completed 12 months of psychoanalytical psychotherapy with a sample of 38 children who dropped out from treatment before 12 months of intervention. METHOD: Quantitative study involving two groups of children. Quasi-experimental treatment of single measure before the beginning of individual psychoanalytical psychotherapy. RESULTS: Statistically significant differences were found in the following variables: gender, symptoms, frequency of sessions, child's impulse and emotion control (measured using the Rorschach test and sociability scales), somatic complaints and internalizing behaviors, such as anxiety and depression (measured using the Child Behavior Checklist). CONCLUSIONS: CThe results revealed that child psychoanalytical psychotherapy is effective in the treatment of female children with internalizing disorders, such as anxiety and depression, who have little control of impulses and emotions and attend at least 12 months of psychoanalytical psychotherapy twice a week.

Investigação em psicoterapia com crianças: uma revisão: [revisão] / Investigation in child psychotherapy: a review: [revision]

O objetivo deste estudo foi realizar uma revisão bibliográfica sobre as pesquisas mais recentes em psicoterapia com crianças, com ênfase na psicoterapia psicanalítica infantil. Procedeu-se à revisão de todos os trabalhos encontrados na consulta às publicações científicas indexadas de acesso on-line e aos livros-textos das áreas de avaliação de resultados de psicoterapia psicanalítica com crianças, avaliando e discutindo os aspectos metodológicos. Os resultados demonstraram que, apesar dos avanços alcançados, ainda existe uma escassez de pesquisas na área, principalmente no que diz respeito às pesquisas que comprovem a efetividade das psicoterapias de orientação psicanalítica com crianças. Por último, conclui-se que existe uma necessidade de desenvolver estudos com metodologias mais sofisticadas para avaliar os resultados de psicoterapia com crianças.

The objective of this study was to review the literature on recent research in child psychotherapy, focusing on child psychoanalytic psychotherapy. All articles addressing outcome research in child psychoanalytic psychotherapy obtained from online scientific publications and textbooks were included and discussed in the review. The study revealed that, although important advances can be identified in outcome research, there is still a lack of research in this field, especially concerning the effectiveness of psychoanalytic-oriented psychotherapies in children. In conclusion, further studies using more sophisticated methodology are needed to assess outcome in child psychotherapy.

Cardiovascular Diseases and Pharmacoepidemiology : Present and Future / 薬剤疫学

The history of pharmacoepidemiology in Japan is short, and despite its importance for physicians in prescribing medicine in daily clinical work, their interest in this evidence-based science has been far from social acceptance. Pharmacoepidemiology itself especially in Japan must be firmly established with systematically constructed harmonious features defined by pharmaceutical health promotion consisting of four independent facets ; health professionals, consumer, industry and regulatory faces. Also, pharmacoepidemiology has to be developed on a scientific basis for outcome research focusing on the clinical and economic consequences of drug therapy decisions. Persuing this aim, pharmacoepidemiology will need to simultaneously invoke principles in other scientific fields such as molecular biology, biostatistics and genetic epidemiology. Ultimately, these interdisciplinary synergies can contribute to intelligent and hopefully more efficient drug development, and a better understanding of what will happen when the drug goes to market. In the clinical field of cardiology, on the other hand, numerous facets are involved in pharmacoepidemiology ; PMDS, polypharmacy and genetic aspects in gene polymorphism with special regard to LQT syndrome and anticoagulation with warfarin. These clinical factors associated with pharmacoepidemiology are summarized and discussed in detail.

Relationship between Outcome Management and Pharmacoeconomics / 薬剤疫学

The necessity of the methodology to manage and objectively evaluate outcomes is recognized for practicing cost-effective quality care. When outcome management is applied to pharmaceutical therapy, it is important to understand the relationship between outcome management and pharmacoeconomics. Pharmacoeconomics is a tool not only to evaluate the economical efficiency of pharmaceuticals themselves but also to evaluate the efficiency of clinical pharmaceutical interventions by medical staff. To apply outcome management and pharmacoeconomics in practice, it is necessary to systemize the contents of pharmaceutical care linkied to related outcomes and to continuously document the required information for the analysis and evaluation of outcomes.

Quality of Life Assessments in Patients Treated with Anticancer Drugs / 薬剤疫学

Health-related quality of life (HR-QOL) has become one of the important endpoints in cancer clinical trials. However, a relatively small proportion of oncologists truly understand the concepts and uses of QOL assessments. In this article, I discuss in detail the psychometric properties that should be verified with QOL instruments, the range of QOL concepts that should be assessed in oncology, how to choose the appropriate QOL instruments, cross-cultural issues and statistical problems. Several examples of QOL assessments in cancer clinical trials are also introduced.