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This systematic literature review aimed to provide an overview of the characteristics and methods used in studies applying the disability-adjusted life years (DALY) concept for infectious diseases within European Union (EU)/European Economic Area (EEA)/European Free Trade Association (EFTA) countries and the United Kingdom. Electronic databases and grey literature were searched for articles reporting the assessment of DALY and its components. We considered studies in which researchers performed DALY calculations using primary epidemiological data input sources. We screened 3053 studies of which 2948 were excluded and 105 studies met our inclusion criteria. Of these studies, 22 were multi-country and 83 were single-country studies, of which 46 were from the Netherlands. Food- and water-borne diseases were the most frequently studied infectious diseases. Between 2015 and 2022, the number of burden of infectious disease studies was 1.6 times higher compared to that published between 2000 and 2014. Almost all studies (97%) estimated DALYs based on the incidence- and pathogen-based approach and without social weighting functions; however, there was less methodological consensus with regards to the disability weights and life tables that were applied. The number of burden of infectious disease studies undertaken across Europe has increased over time. Development and use of guidelines will promote performing burden of infectious disease studies and facilitate comparability of the results.
MBRP has become an established treatment in the field of addiction, but implementing the program in an outpatient setting remains a challenge.
We investigated the feasibility of MBRP in an naturalistic outpatient setting and the effect of mindfulness on underlying factors of addiction.
All patients treated between 2015 and 2019 in the MBRP program at Brugmann University Hospital and Addiction Center Enaden were eligible to participate. Patients were asked to fill in a questionnaire about underlying factors of SUD in the domains of pleasure, emotion regulation, stress, relationship with others and relationship with oneself as well as the effect of the completed training on these factors.
Of the 147(74 F) recruited patients; 32 patients completed the questionnaire. The study population differed in terms of substance (mainly alcohol but also cocaine, cannabis, heroine) as well in their aims towards the substance (reduce, stop or maintaining abstinence). Participation of at least 4 of the 8 sessions was 63 % and overall satisfaction of patients was high. We found a positive effect of mindfulness on all of the underlying factors for SUD. Underlying factors of SUD, as well as the effect of mindfulness on these factors showed strong individual variation. The most frequently observed negative effect was acute craving; 1 patient became acute suicidal.
MBRP is feasible and has a clinical relevant impact on underlying factors of SUD. Negative effects were also observed and should be carefully monitored.
Background: There is presently no cure for locomotor deficits after spinal cord injury (SCI). Very few therapies effectively target the brain due to poor understanding of the brain’s role post-SCI. Newly developed tissue clearing techniques have permitted unbiased three-dimensional circuit analysis, opening new opportunities for SCI-related brain interrogation. Methods: We established a novel brain interrogation pipeline by optimizing mouse brain clearing, imaging, and atlas registration. We leveraged a spontaneous recovery lateral hemisection model to analyze whole brain cell activity and connectivity with the lumbar cord using cFos immunolabelling and virus-mediated projection tracing. We identified a functionally and anatomically dynamic region correlating with recovery and interrogated its locomotor role with optogenetics. We assessed deep brain electrical stimulation (DBS) of this region in a more clinically relevant rat contusion SCI using an established bipedal robotic interface. Results: We unexpectedly uncovered the lateral hypothalamus (LH) to functionally and anatomically correlate with recovery. LHVglut2 optogenetic stimulation significantly augmented locomotor function. LH DBS in rats acutely robustly augmented bipedal locomotion post-SCI. Conclusions: This is the first demonstration of the LH’s role in locomotion post-SCI and is a novel DBS target that robustly augmented locomotor function, dependent on LH glutamatergic cells. LH DBS may be a promising intervention in humans.
There has been a growing body of literature and use cases for set-based design since its introduction in the 80s. Few studies or use cases involve highly complex systems, though, except for the hallmark work regarding Toyota in the late 90s. Over the last three years, the US Navy used set-based methods to design a complex system of systems: a warship. Their experience provides insight into the scalability of the method and design management considerations relevant to the start of similar projects.
Clinical psychologists may work in a variety of settings, but the challenges of working in private practice can be beyond the experience of a trainee. Thus the chapter outlines the conduct in a private practice. It describes the important role of promotion and community education to engage with key stakeholders. The chapter highlights the added value of an evidence-based approach to practice and quality improvement, as they improve accountability and allow the demonstration of effectiveness. The chapter discusses the impact of the need to monitor costs and to adopt a business mentality. It concludes by describing two models for maintaining research engagement while in private practice.
The chapter describes how the clinical psychologist can work in rural and remote settings. The specific rewards and challenges are outlined. The chapter reviews the effectiveness of therapy at a distance and developments in the delivery of clinical psychology services. Consideration is given to the relevant legislation and regulations, and provides a practical guide to providing therapy at a distance. These steps involve a consideration of privacy and security, risk management, telehealth, and adapting therapeutic skills to the digital and distance context. The chapter concludes with the unique elements of mental health services in rural communities and the impact on professional boundaries of life in small communities.
The science-informed approach to clinical practice is founded upon ongoing quality improvement and involves key skills that allow clinical psychologists to confidently provide services in a competitive health care market. Thus, programme evaluation is a core clinical psychology competency but needs to be provided via a co-design framework. The chapter outlines how co-designed programme evaluation addresses patients’ needs in five steps: (i) asking the right questions, (ii) developing an evaluation plan, (iii) collecting and analysing data to produce usable findings, (iv) translating the findings into recommendations for action, and (v) advocating and promoting change. The chapter illustrates how empirically-based programme evaluation supports accountable clinical practice, both at the level of the individual patient and at the aggregate level of the service provider or agency.
After assessing a client a treatment plan is required. The chapter outlines the practical steps in proceeding from a case formulation to a treatment plan. Since many techniques are modified for application in many different clinical problems and psychological disorders, we will concentrate on providing a description of particular procedures that are broadly applicable. The chapter provides practical illustrations of treatment planning with outlines of behaviour therapy, dialectical behaviour therapy, cognitive therapy, and interpersonal psychotherapy. It includes specific examples of clinical cases and explains how these approaches can be subsumed under a transdiagnostic framework of treatment planning. Consideration of transdiagnostic interventions involves targeting negative affect, intolerance of uncertainty, anxiety sensitivity, avoidance and safety behaviours, emotion regulation, and metacognitve therapy.
The chapter outlines low intensity psychological Interventions (LIPIs). These are treatments that have low usage of a specialist’s therapist time (e.g., 5–8 sessions), or uses the time in a manner that reaches a large number of people. Low intensity does not refer to the client’s experience. Even though the contact with the specialist is less, the client’s involvement in terms of time, effort and emotional investment can be intense. The chapter outlines in a practical manner stepped-care, how to offer choice to service users, and shared decision-making. Given that LIPIs can be challenging to master, the chapter provides an illustrative example of adapting case formulation and treatment planning to this mode of delivery.
The chapter outlines an evidence-based approach for clinical psychologists to select and provide group treatments. The process begins with selecting the appropriate treatment programme and then selecting the appropriate patients for the group. The chapter will identify principles for selection and assessment as well as how the use of interpersonal interaction as a therapeutic tool in the here-and-now context of a group can be an inherent advantage of group interventions. In addition, it outlines practical steps for implementation of a group that includes pre-group orientation, enlisting patients as informed allies, providing guidelines about how best to participate, clarifying the format and duration, setting ground rules, anticipating problems and instilling optimism among members. The chapter concludes with a consideration of how monitoring of process and outcomes can enhance outcomes.
Case management skills are critical to the effective, efficient and ethical delivery of clinical psychological services. The chapter will outline how case management involves the combination of practice-based evidence with management and documentation tasks. We outline the key management and documentation tasks associated with specific phases of the treatment process, framing them in a context of generating practice-based evidence. We illustrate good record keeping, maintainance of confidentiality, treatment planning, treatment implementation (including suicide risk assessment) and treatment termination.
Clinical psychology is at an exciting point in time. We describe the current state of clinical psychology, framing it in terms of a trajectory from the foundation of the scientist-practitioner model to present developments. The chapter outlines how the how core competencies of clinical psychology practice are framed by the question, “How would a scientist-practitioner think and act?” We present a model of science-informed practice of clinical psychology and illustrate how this model allows individual practitioners to provide value for money in a competitive health care market indelibly shaped by the forces of accountability and cost containment. The model illustrates how the client is viewed through a lens of evidence-based literature and clinical experience, and how a clinical psychologist collaborates with a client in assessment, case formulation, treatment planning, process-informed treatment delivery, treatment measurement and monitoring, to permit evaluation and accountability. It concludes with a consideration of the perspectives of the key stakeholders, namely the client, the therapist and the broader society, and how these perspectives shape interest in the monitoring of effectiveness, efficacy and understanding of the mechanisms and processes responsible for mental health problems.
Clinical psychology trainees embarking on a professional career are faced with the prospect of work that, daily, has ethical questions and challenges to respond to people from varied cultures and social groups. The chapter describes how to provide a culturally-sensitive clinical psychology practice. It evaluates the current evidence-base antecedences guiding practice. The chapter suggests how Structured Problem Solving can be applied to help acquire greater skills in engaging with people from different cultures and groups (e.g., the elderly). The same Structured Problem Solving approach is then applied to ethical decision-making and illustrated with a discussion on confidentiality and dual relationships. The chapter outlines how these approaches may help the clinical psychologist respect the humanity of their clients in all facets of their engagement.
Supervision is a critical opportunity for a clinical psychology trainee to receive feedback to develop their skills. The chapter begins by describing ways to make the most of this opportunity. Practical steps are outlined that include, goal setting for supervision sessions, planning agendas, ways to learn from sessions recordings, and accounting for supervisory outcomes and activities, and how to challenge yourself to advance beyond the familiar. The chapter also critiques recent developments in “reflective practitioner” approaches to supervision and outlines practical steps to remain evidence-based by using data-driven reflective practice. The chapter concludes with a discussion about how to begin to learn supervisory skills as the clinical psychology trainee anticipates one day moving into a supervisory role.
Case formulation links the client and his or her problems with the treatment. It captures both the strengths and the weaknesses in a complete summary of the client. The chapter introduces case formulation by first describing a behavioural case formulation and how a functional analysis can be conducted. The illustration of a behavioural formulation is then developed into a model that goes beyond identifying the antecedents and consequences of behaviours, and includes reference to the potential of mediation by thoughts and beliefs. Thus, a broader cognitive-behavioural model of case formulation distinguishes steps: (i) presenting problems, (ii) predisposing factors, (iii) precipitating variables, (iv) perpetuating cognitions and consequences, (v) provisional conceptualization, (vi) prescribed interventions and (vii) potential problems and client strengths. The chapter then provides two clinical examples of case formulation, beginning with a cognitive-behavioural case formulation then an example from the perspective of interpersonal psychotherapy. The chapter concludes with a discussion of transdiagnostic approaches to assessment and case formulation.