BACKGROUND: Psychotherapy outcomes are typically measured in terms of symptom relief. However, this method might overlook important changes from clients' perspectives when they are asked to report on them. A more client-centred approach might bring a deeper understanding of psychotherapy outcomes. We aimed to evaluate the outcomes identified by clients within qualitative psychotherapy research. METHODS: The PsycArticles, PsycInfo, and MEDLINE Complete databases were searched for English language studies published until Nov 11, 2023. Additional studies were identified through references in the primary studies and previous meta-analyses or systematic reviews. Search terms were related to psychotherapy and counselling, clients' or patients' experiences, psychotherapy outcomes and changes, post-treatment perspectives, and types of qualitative methods. Qualitative studies on client-identified outcomes of individual psychotherapy were included. Findings related to clients' perceptions of psychotherapy outcomes were extracted (by ML and checked by TR and LT) and analysed (by all authors) using the descriptive-interpretative meta-analytic approach. All authors have personally experienced psychotherapy as clients. This study was pre-registered with PROSPERO (CRD42021277330). FINDINGS: We included 177 studies in the qualitative meta-analysis, from 24 countries, including descriptions from 2908 clients. Most of the studies were of good quality; they covered a wide range of therapeutic approaches and diagnoses. The descriptions of psychotherapy outcomes were classified into 60 meta-categories and grouped into ten clusters. These clusters related to clients' relational and social functioning; their emotional functioning; self-awareness, self-understanding, and more adaptive cognitive processing; behavioural functioning; developing their own resources; clients' attitudes towards themselves; generally embracing life; symptom and problem change; and more general wellbeing. The tenth cluster was outcomes that could not be clearly attributed to psychotherapy, which was considered outside the scope of this study. INTERPRETATION: The meta-analysis showed that clients value outcome dimensions beyond symptom reduction, such as deeper self-understanding, enhanced self-agency, and greater social engagement. By examining psychotherapy outcomes across various diagnoses and therapeutic approaches, we highlight limitations in traditional outcome measures, showing the need for more comprehensive, client-centred assessment tools and the value of incorporating qualitative methods into understanding dimensions of change. FUNDING: European Union.
- MeSH
- Mental Disorders therapy psychology MeSH
- Qualitative Research MeSH
- Humans MeSH
- Psychotherapy * methods MeSH
- Treatment Outcome MeSH
- Check Tag
- Humans MeSH
- Publication type
- Journal Article MeSH
- Meta-Analysis MeSH
- Research Support, Non-U.S. Gov't MeSH
OBJECTIVES: This study aims to explore the lasting effects of stress experienced by pregnant women during World War II (WWII) on body and head measurements of their adult daughters. METHODS: The research sample consists of 336 female university students born in Poland between 1925 and 1951. The data include body measurements and socioeconomic information (parental occupation and number of siblings) acquired from questionnaires collected between the 1950s and 1970s. Student's t-test, Mann-Whitney test and Analysis of Variance were used to analyze differences in body measurements between groups of women born before and during the war, as well as the possible influences of socioeconomic variables. RESULTS: The mean measurements of body height, symphysion height, and waist circumference were lower in women conceived and born during the war compared to those born in the pre-war period. In contrast, the mean measurements of biacromial (shoulder) width, trunk length, and three head dimensions were higher in women conceived and born during the war. Additionally, the number of siblings appeared to be a significant factor that may have influenced the body measurements of women in both groups. For instance, a higher number of living siblings, particularly sisters, was associated with reduced body dimensions, such as body height and waist circumference, while a greater number of deceased siblings was linked to an increase in certain body dimensions. CONCLUSION: The results suggest that war-related prenatal conditions may have influenced the postnatal growth and development of women conceived and born during the war. Notably, the direction of these changes varied, which indicates that the growth response to the war-related conditions was a complex adaptation, reflecting both positive and negative changes in different body parts, rather than a uniform pattern of growth suppression.
- MeSH
- World War II * MeSH
- Adult MeSH
- Humans MeSH
- Young Adult MeSH
- Stress, Psychological MeSH
- Socioeconomic Factors MeSH
- Pregnancy MeSH
- Check Tag
- Adult MeSH
- Humans MeSH
- Young Adult MeSH
- Pregnancy MeSH
- Female MeSH
- Publication type
- Journal Article MeSH
- Geographicals
- Poland MeSH
INTRODUCTION: In a previously published randomised, placebo-controlled trial, 800 mg/day of pharmaceutical-grade chondroitin sulfate (CS) was shown to be superior to placebo in reducing pain and improving function over 6 months in patients with symptomatic knee osteoarthritis (OA). The aim of the current post hoc analyses was to evaluate the cost-effectiveness of CS compared with placebo in a European perspective using individual patient data from this clinical trial. METHODS: Patients with knee OA randomised to CS or placebo were followed up at 1, 3 and 6 months. The algo-functional Lequesne index was used to derive the EuroQol Five-Dimension Five-Level (EQ-5D-5L) score based on a validated formula. The EQ-5D-5L scores at each time point were used to calculate the changes in quality-adjusted life years (QALYs) with the area under the curve method. Costs were assessed using the average price of CS in the countries where the original study took place and where CS is currently marketed. The costs of CS in three countries were then used (i.e. the Czech Republic, Italy and Switzerland). The incremental cost-effectiveness ratio (ICER) threshold for CS to be considered cost-effective was set at 91,870 EUR per QALY (equivalent to the usually recommended threshold of US $100,000). The study used an intention-to-treat population, i.e. patients who received one dose of the study drug, and imputed missing values using the basal observation carried forward method. RESULTS: No significant differences in baseline characteristics were observed between the CS group (N = 199) and the placebo group (N = 205). The mean cost of CS for 6 months of treatment was 194.74 EUR. After 6 months of treatment, CS showed a mean ICER of 33,462 (95% CI 5130-61,794) EUR per QALY gained, indicating cost-effectiveness compared with placebo. The acceptability curve for cost-effectiveness shows that the CS treatment is likely to be cost-effective compared with placebo, with a 93% probability when the ceiling ratio is set at 91,870 EUR per QALY gained. CONCLUSIONS: These results highlight the role of CS as a cost-effective therapeutic option in the management of OA. However, further studies taking into account the use of other healthcare resources are warranted for a more complete understanding.
- MeSH
- Cost-Effectiveness Analysis MeSH
- Cost-Benefit Analysis * MeSH
- Osteoarthritis, Knee * drug therapy economics MeSH
- Chondroitin Sulfates * therapeutic use economics MeSH
- Quality-Adjusted Life Years * MeSH
- Middle Aged MeSH
- Humans MeSH
- Aged MeSH
- Check Tag
- Middle Aged MeSH
- Humans MeSH
- Male MeSH
- Aged MeSH
- Female MeSH
- Publication type
- Journal Article MeSH
- Multicenter Study MeSH
- Randomized Controlled Trial MeSH
- Geographicals
- Czech Republic MeSH
- Italy MeSH
- Switzerland MeSH
Human migration is an increasingly common phenomenon and migrants are at risk of disadvantageous treatment. We reasoned that migrants may receive differential treatment by locals based on the closeness of their facial features to the host average. Residents of Türkiye, the country with the largest number of refugees currently, served as participants. Because many of these refugees are of Arabic origin, we created target facial stimuli varying along the axis connecting Turkish and Arabic morphological prototypes (excluding skin colour) computed using geometric morphometrics and available databases. Participants made judgements of two universal dimensions of social perception-warmth and competence-on these faces. We predicted that participants judging faces manipulated towards the Turkish average would provide higher warmth and competence ratings compared to judging the same faces manipulated towards the Arabic average. Bayesian statistical tools were employed to estimate parameter values in multilevel models with intercorrelated varying effects. The findings did not support the prediction and revealed raters (as well as target faces) to be an important source of variation in social judgements. In the absence of simple cues (e.g. skin colour, group labels), the effect of facial morphology on social judgements may be much more complex than previously assumed.
- MeSH
- Bayes Theorem MeSH
- Adult MeSH
- Humans MeSH
- Judgment * MeSH
- Adolescent MeSH
- Young Adult MeSH
- Face anatomy & histology MeSH
- Facial Recognition physiology MeSH
- Social Perception * MeSH
- Stereotyping * MeSH
- Refugees psychology MeSH
- Check Tag
- Adult MeSH
- Humans MeSH
- Adolescent MeSH
- Young Adult MeSH
- Male MeSH
- Female MeSH
- Publication type
- Journal Article MeSH
- Geographicals
- Turkey MeSH
BACKGROUND: Optimal management of outpatients with heart failure (HF) requires serially updating the estimates of their risk for adverse clinical outcomes to guide treatment. Patient-reported outcomes (PROs) are becoming increasingly used in clinical care. The purpose of this study was to determine whether the inclusion of PROs can improve the risk prediction for HF hospitalization and death in ambulatory patients with HF. METHODS AND RESULTS: We included consecutive patients with HF with reduced ejection fraction (HFrEF) and HF with preserved EF (HFpEF) seen in a HF clinic between 2015 and 2019 who completed PROs as part of routine care. Cox regression with a least absolute shrinkage and selection operator regularization and gradient boosting machine analyses were used to estimate risk for a combined outcome of HF hospitalization, heart transplant, left ventricular assist device implantation, or death. The performance of the prediction models was evaluated with the time-dependent concordance index (Cτ). Among 1165 patients with HFrEF (mean age 59.1 ± 16.1, 68% male), the median follow-up was 487 days. Among 456 patients with HFpEF (mean age 64.2 ± 16.0 years, 55% male) the median follow-up was 494 days. Gradient boosting regression that included PROs had the best prediction performance - Cτ 0.73 for patients with HFrEF and 0.74 in patients with HFpEF, and showed very good stratification of risk by time to event analysis by quintile of risk. The Kansas City Cardiomyopathy Questionnaire overall summary score, visual analogue scale and Patient Reported Outcomes Measurement Information System dimensions of satisfaction with social roles and physical function had high variable importance measure in the models. CONCLUSIONS: PROs improve risk prediction in both HFrEF and HFpEF, independent of traditional clinical factors. Routine assessment of PROs and leveraging the comprehensive data in the electronic health record in routine clinical care could help more accurately assess risk and support the intensification of treatment in patients with HF.
- MeSH
- Risk Assessment methods MeSH
- Patient Reported Outcome Measures * MeSH
- Hospitalization statistics & numerical data MeSH
- Quality of Life * psychology MeSH
- Middle Aged MeSH
- Humans MeSH
- Follow-Up Studies MeSH
- Retrospective Studies MeSH
- Aged MeSH
- Heart Failure * physiopathology psychology therapy diagnosis mortality MeSH
- Stroke Volume physiology MeSH
- Check Tag
- Middle Aged MeSH
- Humans MeSH
- Male MeSH
- Aged MeSH
- Female MeSH
- Publication type
- Journal Article MeSH
G protein-coupled receptors (GPCRs) play a crucial role in cell function by transducing signals from the extracellular environment to the inside of the cell. They mediate the effects of various stimuli, including hormones, neurotransmitters, ions, photons, food tastants and odorants, and are renowned drug targets. Advancements in structural biology techniques, including X-ray crystallography and cryo-electron microscopy (cryo-EM), have driven the elucidation of an increasing number of GPCR structures. These structures reveal novel features that shed light on receptor activation, dimerization and oligomerization, dichotomy between orthosteric and allosteric modulation, and the intricate interactions underlying signal transduction, providing insights into diverse ligand-binding modes and signalling pathways. However, a substantial portion of the GPCR repertoire and their activation states remain structurally unexplored. Future efforts should prioritize capturing the full structural diversity of GPCRs across multiple dimensions. To do so, the integration of structural biology with biophysical and computational techniques will be essential. We describe in this review the progress of nuclear magnetic resonance (NMR) to examine GPCR plasticity and conformational dynamics, of atomic force microscopy (AFM) to explore the spatial-temporal dynamics and kinetic aspects of GPCRs, and the recent breakthroughs in artificial intelligence for protein structure prediction to characterize the structures of the entire GPCRome. In summary, the journey through GPCR structural biology provided in this review illustrates how far we have come in decoding these essential proteins architecture and function. Looking ahead, integrating cutting-edge biophysics and computational tools offers a path to navigating the GPCR structural landscape, ultimately advancing GPCR-based applications. LINKED ARTICLES: This article is part of a themed issue Complexity of GPCR Modulation and Signaling (ERNST). To view the other articles in this section visit http://onlinelibrary.wiley.com/doi/10.1111/bph.v182.14/issuetoc.
- MeSH
- Protein Conformation MeSH
- Humans MeSH
- Receptors, G-Protein-Coupled * chemistry metabolism MeSH
- Animals MeSH
- Check Tag
- Humans MeSH
- Animals MeSH
- Publication type
- Journal Article MeSH
- Review MeSH
Východiska: Akutní mozkový infarkt (acute cerebral infarction; ACI) je časté cerebrovaskulární onemocnění charakterizované akutním nástupem a závažným stavem. Cíl: Naším cílem bylo posoudit vliv empatie a psychologické intervence win-win na ošetřovatelskou péči o pacienty s ACI v důsledku psychického stresu a vliv různých způsobů zvládání stresu. Metody: Pacienti s ACI (n = 50), kteří byli od června 2021 do prosince 2022 podrobeni rutinní ošetřovatelské intervenci, byli zařazeni do kontrolní skupiny, zatímco pacienti (n = 50), kteří byli od ledna 2023 do června 2024 podrobeni rutinní ošetřovatelské intervenci kombinované s empatií a psychickou intervencí win-win, byli zařazeni do studijní skupiny. Výsledky: Studijní skupina měla vyšší skóre v dimenzi konfrontace, ale nižší skóre v dimenzích vyhýbání se a rezignace než kontrolní skupina (p < 0,05). Skóre General Self-Efficacy Scale (GSES) se zvýšilo, zatímco skóre Fear of Progression Questionnaire-Short Form (FoP-Q-SF) se snížilo ve srovnání s hodnotami před intervencí v obou skupinách. Studijní skupina měla vyšší skóre GSES, ale nižší skóre FoP-Q-SF než kontrolní skupina (p < 0,05). Skóre Stroke-Specific Quality of Life Scale se v obou skupinách zvýšilo ve srovnání s hodnotami před intervencí (p < 0,05). Závěr: Empatie a psychologická intervence win-win mohou zmírnit psychický stres pacientů s ACI a jejich příbuzných a zlepšit způsoby, jak pacienti zvládají situaci.
Background: Acute cerebral infarction (ACI) is a common cerebrovascular disease characterized by acute onset and severe condition. Aim: We aimed to assess the effect of empathy and win- -win psychological intervention on the nursing of patients with ACI based on psychological stress and coping styles. Methods: ACI patients (N = 50) who were given routine nursing intervention from June 2021 to December 2022 were enrolled as a control group, while patients (N = 50) who were given routine nursing intervention combined with empathy and win-win psychological intervention from January 2023 to June 2024 were enrolled as a study group. Results: The study group had a higher score in the confrontation dimension, but lower scores in the avoidance and resignation dimensions than those from the control group (P < 0.05). The General Self-Efficacy Scale (GSES) score increased, while the Fear of Progression Questionnaire-Short Form (FoP-Q-SF) score decreased in both groups compared with those before intervention. The study group had a higher GSES score, but a lower FoP-Q-SF score than those from the control group (P < 0.05). The Stroke-Specific Quality of Life Scale score increased in both groups compared with that before intervention (P < 0.05). Conclusion: Empathy and win-win psychological intervention can alleviate the psychological stress in ACI patients and their relatives, improve patients‘ coping styles.
- Keywords
- psychologická intervence,
- MeSH
- Empathy MeSH
- Humans MeSH
- Brain Infarction * nursing psychology MeSH
- Nursing MeSH
- Surveys and Questionnaires MeSH
- Resilience, Psychological MeSH
- Check Tag
- Humans MeSH
Celý koncept SpA je nesmírně dynamicky se vyvíjející, a to ve všech jeho aspektech, jako jsou časná diagnostika, hodnocení aktivity a prognózy nemoci, prediktivní faktory odpovědi, nové léky, nové strategie léčby, aspekty strukturální progrese, uplatnění zobrazovacích metod a bezpečnost léčby. Paleta léků pro léčbu axiálních spondyloartritid se značně rozšířila a lze je rozdělit na tři skupiny. První jsou inhibitory TNF-α, druhou inhibitory IL-17 a třetí inhibitory Janusových kináz. Při výběru léku hodnotíme formu axSpA, aktivitu nemoci, postižení jednotlivých domén, extraskeletální manifestace a komorbidity. Strategie léčby je prezentována v doporučeních EULAR z roku 2022. V první linii biologické léčby se doporučují v jedné rovině inhibitory TNF-α a inhibitory IL-17, přičemž anti-TNF preparáty jsou vhodnější u pacientů s extraskeletálními manifestacemi (uveitidy, idiopatické střevní záněty) a inhibitory IL-17 u pacientů s výraznější psoriázou. Inhibitory JAK jsou doporučovány ve druhé linii po selhání linie první. Důvodem je menší dostupnost bezpečnostních dat o inhibitorech JAK při dlouhodobé léčbě. Novými léky registrovanými v indikaci axSpA jsou duální inhibitor IL-17 A-F – bimekizumab, inhibitor JAK 1–3 – tofacitinib a inhibitor JAK 1 – upadacitinib.
The concept of spondyloarthritis (SpA) continues to evolve rapidly across all dimensions, including early diagnosis, disease activity assessment, prognostic evaluation, predictive markers of therapeutic response, novel pharmacologic agents, treatment strategies, structural progression, imaging modalities, and treatment safety. The therapeutic landscape for axial spondyloarthritis (axSpA) has significantly expanded and now includes three major classes of agents: tumor necrosis factor (TNF) inhibitors, interleukin-17 (IL-17) inhibitors, and Janus kinase (JAK) inhibitors. Drug selection is based on the specific form of axSpA, disease activity, domain involvement, extra-musculoskeletal manifestations, and comorbid conditions. The 2022 EULAR recommendations guide current treatment strategies. For first-line biologic therapy, both TNF and IL-17 inhibitors are considered equally effective. TNF inhibitors are generally preferred in patients with extra-musculoskeletal manifestations such as uveitis or inflammatory bowel disease, whereas IL-17 inhibitors are more suitable for patients with prominent psoriasis. JAK inhibitors are typically recommended as second-line therapy following inadequate response to first-line agents, primarily due to limited long-term safety data. Recently approved therapies for axSpA include the dual IL-17A/F inhibitor bimekizumab, the pan-JAK inhibitor tofacitinib (JAK1–3), and the selective JAK1 inhibitor upadacitinib.
- MeSH
- Axial Spondyloarthritis * drug therapy pathology MeSH
- Biological Therapy * MeSH
- Molecular Targeted Therapy MeSH
- Drug Evaluation MeSH
- Janus Kinase Inhibitors administration & dosage pharmacology therapeutic use MeSH
- Interleukin-17 antagonists & inhibitors administration & dosage therapeutic use MeSH
- Humans MeSH
- Tumor Necrosis Factor-alpha antagonists & inhibitors therapeutic use MeSH
- Check Tag
- Humans MeSH
- Publication type
- Review MeSH
This study explored how the human cortical folding pattern composed of convex gyri and concave sulci affected single-subject morphological brain networks, which are becoming an important method for studying the human brain connectome. We found that gyri-gyri networks exhibited higher morphological similarity, lower small-world parameters, and lower long-term test-retest reliability than sulci-sulci networks for cortical thickness- and gyrification index-based networks, while opposite patterns were observed for fractal dimension-based networks. Further behavioral association analysis revealed that gyri-gyri networks and connections between gyral and sulcal regions significantly explained inter-individual variance in Cognition and Motor domains for fractal dimension- and sulcal depth-based networks. Finally, the clinical application showed that only sulci-sulci networks exhibited morphological similarity reductions in major depressive disorder for cortical thickness-, fractal dimension-, and gyrification index-based networks. Taken together, these findings provide novel insights into the constraint of the cortical folding pattern to the network organization of the human brain.
- MeSH
- Depressive Disorder, Major pathology diagnostic imaging MeSH
- Adult MeSH
- Connectome * MeSH
- Humans MeSH
- Magnetic Resonance Imaging * MeSH
- Young Adult MeSH
- Cerebral Cortex * diagnostic imaging anatomy & histology MeSH
- Nerve Net * diagnostic imaging anatomy & histology MeSH
- Check Tag
- Adult MeSH
- Humans MeSH
- Young Adult MeSH
- Male MeSH
- Female MeSH
- Publication type
- Journal Article MeSH
Úvod: Lipómy patria k najčastejším nádorom mäkkých tkanív. Ak dosahujú aspoň 10 cm alebo vážia min. 1 000 g, označujú sa ako „obrovské“ lipómy. Takéto lézie môžu vyvolávať diagnostické rozpaky pri bioptickom vyšetrení. Kazuistika: Opísaný je prípad 58-ročného muža, ktorý pozoroval 2 roky nárast podkožného tumorózneho útvaru na pravej strane chrbta. Ultrasonograficky imponoval ako fibrolipóm. Chirurgicky bol kompletne exstirpovaný. Makroskopicky išlo o opuzdrený laločnatý lipomatózny nádor rozmerov 12 × 10 × 4 cm. Histologicky pozostával z kompozitného klasického a vretenobunkového lipómu. Vretenobunkovú zložku bolo potrebné odlíšiť od atypického lipomatózneho tumoru, ktorý je prognosticky nepriaznivejšou onkologickou jednotkou. Záver: Subkutánne lipómy presahujúce 10 cm sú zriedkavé a pre klinikov aj patológov predstavujú diagnostickú výzvu. V príspevku sme sa snažili poukázať, že lipomatózne nádory väčších rozmerov a najmä s rôznorodejším morfologickým vzhľadom by mali patológa nútiť uvažovať o potenciálnej malignite a vyžadujú si komplexnejší diferenciálno-diagnostický prístup.
Introduction: Lipomas belong to the most common soft tissue tumors. If they reach at least 10 cm or weigh at least 1,000 g, they are referred to as giant lipomas. Such lesions can cause diagnostic quandaries at a biopsy examination. Case report: The article describes a 58-year-old man who observed the progression of a subcutaneous tumor mass in the right side of the back for two years. It looked like a fibrolipoma on an ultrasound. Complete surgical extirpation was performed. Grossly, it was an encapsulated lobulated lipomatous tumor measuring 12 × 10 × 4 cm. It consisted of a composite classical and spindle cell lipoma. The spindle cell component required differentiation from an atypical lipomatous tumor, which is an oncological entity with a worse prognosis. Conclusion: Subcutaneous lipomas over 10 cm are rare and represent a diagnostic challenge for both clinicians and pathologists. We tried to point out that lipomatous tumors of larger dimensions and especially those with a heterogeneous morphological appearance should urge the pathologist to think about a potential malignancy and require more complex differential-diagnostic approach.
