Does psychotherapy work with school-aged youth? A meta-analytic examination of moderator variables that influence therapeutic outcomes.

The present study is a quantitative synthesis of the available literature to investigate the efficacy of psychotherapy for children's mental health outcomes. In particular, this study focuses on potential moderating variables-study design, treatment, client, and therapist characteristics-that may influence therapeutic outcomes for youth but have not been thoroughly accounted for in prior meta-analytic studies. An electronic search of relevant databases resulted in 190 unpublished and published studies that met criteria for inclusion in the analysis. Effect sizes differed by study design. Pre-post-test designs resulted in absolute magnitudes of treatment effects ranging from |-0.02| to |-0.76| while treatment versus control group comparison designs resulted in absolute magnitudes of treatment effects ranging from |-0.14| to |-2.39|. Changes in youth outcomes larger than 20% were found, irrespective of study design, for outcomes focused on psychosomatization (29% reduction), school attendance (25% increase), and stress (48% reduction). The magnitude of changes after psychotherapy ranged from 6% (externalizing problems) to 48% (stress). Several moderator variables significantly influenced psychotherapy treatment effect sizes, including frequency and length of treatment as well as treatment format. However, results did not support the superiority of a single type of intervention for most outcomes. Implications for therapy with school-aged youth and future research are discussed.

PO-61 - Patients' Experiences of LIving with CANcer associated thrOmbosis in Spain (PELICANOS).

INTRODUCTION: The Patients' Experiences of LIving with CANcer associated thrombosis (PELICAN) study has identified the experience of cancer-associated thrombosis (CAT) to be a distressing one, for which patients feel ill prepared for and receive insufficient support. However, such data was from a United Kingdom (UK) population and may not be representative of all nationalities, cultures and healthcare systems. AIM: To explore the experience of cancer associated thrombosis amongst patients living in Spain. MATERIALS AND METHODS: Twenty consecutive patients with CAT were recruited from a Spanish University Hospital. Where possible spouses were interviews in conjunction. Semi-structured qualitative interviews were undertaken, assited by a pre-agreed promt list. Interviews were audio recorded and transcribed verbatim. Preliminary data analysis was undertaken using thematic analysis. RESULTS: Several commonalities between UK and Spanish patients were identified including the traumatic nature of the experience, need for information and adaptive behaviors through ritualization. Three new major themes also emerged: Communication needs: over emphasis on heparin injection training, additional need for explanation of cause, response and prognosis The impact of CAT on the concept of self: CAT was considered defining watershed moment, confirmation of seriousness of the cancer, The impact of CAT on the family dynamic: distressing diagnosis for loved ones, exaggerated desire to help which could disempower patient independence. CONCLUSIONS: The experience of CAT is a distressing one which brings with it additional information needs through effective communication. Within the Spanish population, the role of family is of particular importance as well as the impact of CAT on the patient's feelings of worth and personal identity. Effective communication, support and access to information are essential in order to minimize distress and enhance treatment complicance.

Interventions before consultations for helping patients address their information needs.

BACKGROUND: Patients often do not get the information they require from doctors and nurses. To address this problem, interventions directed at patients to help them gather information in their healthcare consultations have been proposed and tested. OBJECTIVES: To assess the effects on patients, clinicians and the healthcare system of interventions which are delivered before consultations, and which have been designed to help patients (and/or their representatives) address their information needs within consultations. SEARCH STRATEGY: We searched: the Cochrane Central Register of Controlled Trials (CENTRAL, The Cochrane Library (issue 3 2006); MEDLINE (1966 to September 2006); EMBASE (1980 to September 2006); PsycINFO (1985 to September 2006); and other databases, with no language restriction. We also searched reference lists of articles and related reviews, and handsearched Patient Education and Counseling (1986 to September 2006). SELECTION CRITERIA: Randomised controlled trials of interventions before consultations designed to encourage question asking and information gathering by the patient. DATA COLLECTION AND ANALYSIS: Two researchers assessed the search output independently to identify potentially-relevant studies, selected studies for inclusion, and extracted data. We conducted a narrative synthesis of the included trials, and meta-analyses of five outcomes. MAIN RESULTS: We identified 33 randomised controlled trials, from 6 countries and in a range of settings. A total of 8244 patients was randomised and entered into studies. The most common interventions were question checklists and patient coaching. Most interventions were delivered immediately before the consultations.Commonly-occurring outcomes were: question asking, patient participation, patient anxiety, knowledge, satisfaction and consultation length. A minority of studies showed positive effects for these outcomes. Meta-analyses, however, showed small and statistically significant increases for question asking (standardised mean difference (SMD) 0.27 (95% confidence interval (CI) 0.19 to 0.36)) and patient satisfaction (SMD 0.09 (95% CI 0.03 to 0.16)). There was a notable but not statistically significant decrease in patient anxiety before consultations (weighted mean difference (WMD) -1.56 (95% CI -7.10 to 3.97)). There were small and not statistically significant changes in patient anxiety after consultations (reduced) (SMD -0.08 (95%CI -0.22 to 0.06)), patient knowledge (reduced) (SMD -0.34 (95% CI -0.94 to 0.25)), and consultation length (increased) (SMD 0.10 (95% CI -0.05 to 0.25)). Further analyses showed that both coaching and written materials produced similar effects on question asking but that coaching produced a smaller increase in consultation length and a larger increase in patient satisfaction. Interventions immediately before consultations led to a small and statistically significant increase in consultation length, whereas those implemented some time before the consultation had no effect. Both interventions immediately before the consultation and those some time before it led to small increases in patient satisfaction, but this was only statistically significant for those immediately before the consultation. There appear to be no clear benefits from clinician training in addition to patient interventions, although the evidence is limited. AUTHORS' CONCLUSIONS: Interventions before consultations designed to help patients address their information needs within consultations produce limited benefits to patients. Further research could explore whether the quality of questions is increased, whether anxiety before consultations is reduced, the effects on other outcomes and the impact of training and the timing of interventions. More studies need to consider the timing of interventions and possibly the type of training provided to clinicians.

Quality of life dimensions for adults with developmental disabilities: a comparative study.

The quality of life construct has gained prominent attention in human services over the last 20 years. We investigated whether quality of life differences exist between adults with developmental disabilities and the general population. Differences were found in scales measuring well-being and decision-making as well as other more specific variables. The two groups also differed in overall quality of life; those with developmental disabilities had lower quality of life. A logistic regression model comprised of the life dimensions differentiated between the groups with over 90% accuracy. Overall results of this static group comparison indicate that adults with developmental disabilities are at a significant disadvantage with regard to quality of life in comparison with the general population.

A literature and medicine special study module run by academics in general practice: two evaluations and the lessons learnt.

This paper describes the design, delivery and evaluation of a nine week special study module on literature and medicine for third year undergraduate medical students, by tutors from an academic department of general practice. Three weeks of taught seminars are followed by three weeks of one on one meetings between individual students and tutors, leading to a seminar led by, and based on, materials prepared by the student. The final three weeks of the course are dedicated to completion of essays about areas chosen by students for in depth study.The course was evaluated on two separate occasions, using two different techniques: the first evaluation used a focus group technique to identify and explore relevant themes; the second used nominal group theory to assess whether the course worked educationally, and how it could be improved.In the main, the course was judged to meets its aims, with generally positive student comments, albeit with caveats and reservations. The subject matter was intellectually challenging for students and tutors. Further research into the optimal size for such groups, and a more formal evaluation of tutors' experiences is required.

Psychotherapy with persons who have mental retardation: an evaluation of effectiveness.

Studies of psychotherapy with persons who have mental retardation were examined. Studies conducted during a 30-year period were rated by an expert consensus panel and classified with regard to the nature of the research and outcome and effectiveness domains. We conducted a meta-analysis on a small number of the studies and found a wide range of research designs, types of interventions, and participants. The evaluation also pointed to a moderate degree of change in outcome measures and moderate effectiveness in terms of benefit to clients with mental retardation. We conclude that psychotherapeutic interventions should be considered as part of overall treatment plans for persons with mental retardation.

Antibiotics and shared decision-making in primary care.

Antibiotics are often prescribed to patients with respiratory tract infections who are unlikely to benefit. Models of physician-patient interaction may help understanding of this problem and inform the design of communication skills interventions to enhance appropriate prescribing. The 'paternalistic model' of the consultation remains common in the setting of acute respiratory tract infections. However, the four assumptions that could support this model are not valid for most of these patients, because: best treatment is controversial; management is inconsistent; physicians are not in the best position to evaluate trade-offs between management options without understanding patients' perspectives; and many pressures (apart from patients' agendas) intrude into the consultation. One alternative is the 'informed model' of consulting, but this does not take society's interests into account. The 'shared decision-making model', however, provides a framework for addressing both clinicians' and patients' agendas, and could guide the development and evaluation of specific consultation strategies to promote more appropriate use of antibiotics in primary care.

Evidence that therapy works in clinically representative conditions.

This article reports a secondary analysis of past therapy outcome meta-analysis. Fifteen meta-analysis provided effect sizes from 56 studies in previous reviews that met 1 of 3 increasingly stringent levels of criteria for clinical representativeness. The effect sizes were synthesized and compared with results from the original meta-analyses. Effect sizes from more clinically representative studies are the same size at all 3 criteria levels as in past meta-analyses. Almost no studies exist that meet the most stringent level of criteria. Results are interpreted cautiously because of controversy about what criteria best capture the notion of clinical representativeness, because so few experiments have tested therapy in clinical conditions, and because other models for exploring the generalizability of therapy outcome research to clinical conditions might yield different results.

Service delivery patterns for adults with mild mental retardation at community mental health centers.

Results of a national survey on mental health services for adults with mild mental retardation sent to directors of psychological services at community mental health centers was discussed. In general, adults with mild mental retardation were less likely to receive the full array of available services. Individuals with mental retardation were not frequent consumers of community mental health services and received differential treatment at these Centers. Implications of these findings were discussed.

Testing the robustness of the diagnostic overshadowing bias.

The robustness of the diagnostic overshadowing bias was examined by (a) testing the relation of overshadowing to level of mental retardation, (b) reexamining the effect of clinical experience in a more sensitive analysis, and (c) extending previous results to rehabilitation counselors. Diagnostic overshadowing was found with individuals with an IQ of 58, but did not generalize to those with IQs 70 or 80. This finding does not support the saliency hypothesis proposed by Reiss and his colleagues. In contrast to earlier studies, experience was related to overshadowing, although results were mixed. Experience measured by number of clients seen was not significant, whereas longevity in the field of mental retardation was associated with increased overshadowing.

Self-reports of depression by community-based mildly mentally retarded adults.

Three self-report measures of depression were administered to mildly mentally retarded adults who lived in the community. The measures were significantly correlated, and on two of the measures subjects scored significantly higher than did nonretarded adults according to norms. Almost half of the subjects scored in the "clinically significant" range on the two measures. Results suggest that mildly retarded adults may experience depression at a higher rate than do nonretarded persons.

Validity of the Peabody Picture Vocabulary Test-Revised with mentally retarded adults.

Investigated the validity of using the PPVT -R with mildly mentally retarded adults. The PPVT -R, PPVT , and WAIS-R were administered to 21 Ss, and WAIS scores were obtained from client files. Results indicated that the revised Peabody tended to yield significantly lower estimates of functioning than did the other measures. Implications are discussed.