Applied Transference-Focused Psychotherapy: An Overview and Update

Transference-focused psychotherapy (TFP), developed and studied as an extended individual psychotherapy for patients with borderline personality disorder (BPD), rests on a rich theoretical foundation informed by psychoanalytic object relations theory. “Applied TFP” is a developing initiative using TFP principles in multiple clinical situations other than the standard extended individual psychotherapy, which has been empirically validated and is detailed in the TFP treatment manual. The growing application of TFP principles in innovative, overlapping ways has been focused primarily in three spheres: (1) the integration of TFP principles in pluralistic theoretical approaches to treatment of patients with personality disorder pathology; (2) the use of TFP elements in multiple teaching situations as part of curricula for trainees and practicing clinicians, and (3) the employment of TFP theory and interventions in settings across a continuum of patient acuity, tailored for patients with varying diagnoses. The use of TFP principles in the situations described directly addresses needs emerging in particular contexts that reflect specific requirements of clinician practice and training and of broader public health missions.

To prescribe or not to prescribe for paediatric sore throat: a retrospective cohort study comparing clinician-led antibiotic prescriptions to FeverPAIN and Centor scoring in a tertiary paediatric emergency department and a national review of practice

BackgroundTonsillopharyngitis is a common presentation to paediatric emergency departments (PEDs). FeverPAIN (FP) and Centor scoring systems are recommended in the UK to help delineate bacterial aetiology, despite being primarily evidenced in adult populations. We investigate how the use of FP or Centor compares to actual clinician practice in guiding antibiotic prescription rates in PED. We establish current national practice in English PEDs.MethodsWe performed a retrospective cohort study of tonsillopharyngitis presentations to a tertiary PED in January–February 2020. Investigators retrospectively assigned each patient FP and Centor scores using documented symptoms. We compared antibiotic prescription rates guided by FP/Centor against the actual rate prescribed by clinicians, and assessed agreement between these strategies using kappa analysis. We contacted 153 English emergency departments to establish national practice.ResultsWe identified 632 consecutive patients aged 6 months to 15 years. Actual clinician-prescribed antibiotics numbered 116 (18.4%). Prescriptions predicted by FP score numbered 124 (19.6%) and Centor 112 (17.7%). Kappa (K) analysis indicated only moderate agreement between clinician choice versus FP (K=0.434) and clinician choice versus Centor (K=0.476). This was similar for cohorts aged under and over 3 years.National practice was reportedly heterogeneous, with 70 emergency departments (45.8%) not employing a specific system.ConclusionCurrent guidance is variably interpreted and inconsistently implemented in paediatric populations. FeverPAIN and Centor scoring systems may not rationalise antibiotics as much as previously reported compared with judicious clinician practice. Producing clear paediatric-specific national guidelines, especially for under-5s who are omitted from NICE sore throat guidance, may help further rationalise and standardise antibiotic use in paediatric tonsillopharyngitis.

VISUAL MEDIAL TEMPORAL ATROPHY SCALES IN CLINICIAN PRACTICE

Background: Visual atrophy scales from the medial temporal region are auxiliary biomarker methods in Alzheimer’s Disease(AD).They may correlated with progression from preclinical to clinical AD. Objective: We aimed to compare medial temporal lobe atrophy (MTA) and entorhinal cortex atrophy (ERICA) scales for magnetic resonance image as a useful tool for probable AD diagnosis and evaluate their accuracy, sensitivity and specificity, regarding clinical diagnosis and 11C-PIB-PET. Methods: 2 neurologists blinded to diagnosis classified 113 adults (over 65y) through MTA and ERICA scales and correlated with sociodemographic data, amyloid brain cortical burden through the 11C-PIB-PET and clinical cognitive status, divided into 30 cognitive unimpaired (CU) individuals, 52 MCI and 31 dementia compatible with AD (DCAD). Results: Inter-rater reliability of these atrophy scales was excellent (0.8- 1) by Cohen analysis. CU group had significantly lower MTA scores (median value 0) than ERICA (median value 1)for both hemispheres. 11C-PIB-PET was positive in 45% of the whole sample. In MCI and DCAD groups, ERICA depicted greater sensitivity and MTA greater specificity. Accuracy was under 70% for both scores in all clinical groups. Conclusion: Our study achieved a moderate sensitivity for ERICA score and could be a better screening tool for DCAD or MCI than MTA score. But, none of them could be considered a useful biomarker in preclinical AD.

Algorithm to detect pediatric provider attention to high BMI and associated medical risk

We developed and validated an algorithm that uses combinations of extractable electronic-health-record (EHR) indicators (diagnosis codes, orders for laboratories, medications, and referrals) that denote widely-recommended clinician practice behaviors: attention to overweight/obesity/body mass index alone (BMI Alone), with attention to hypertension/other comorbidities (BMI/Medical Risk), or neither (No Attention). Data inputs used for each EHR indicator were refined through iterative chart review to identify and resolve modifiable coding errors. Validation was performed through manual review of randomly selected visit encounters (n = 308) coded by the refined algorithm. Of 104 encounters coded as No Attention, 89.4% lacked any evidence (specificity) of attention to BMI/Medical Risk. Corresponding evidence (sensitivity) of attention to BMI Alone was identified in 96.0% (of 101 encounters coded as BMI Alone) and BMI/Medical Risk in 96.1% (of 103 encounters coded as BMI/Medical Risk). Our EHR data algorithm can validly determine provider attention to BMI alone, with Medical Risk, or neither.

Improving inpatient mental health medication safety through the process of obtaining HIMSS Stage 7: a case report

Although electronic health record systems have been implemented in many health settings globally, how organizations can best implement these systems to improve medication safety in mental health contexts is not well documented in the literature. The purpose of this case report is to describe how a mental health hospital in Toronto, Canada, leveraged the process of obtaining Healthcare Information Management Systems Society (HIMSS) Stage 7 on the Electronic Medical Record Adoption Model to improve clinical care specific to medication safety in its inpatient settings. Examples of how the organization met several of these HIMSS criteria are described as they relate to utilizing data from the system to support clinician practice and/or decision-making for medication safety.