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| 1 | Client-level predictors of treatment engagement,outcome and dropout:moving beyond demographics显示文摘Background Despite the availability of evidence-based treatments for posttraumatic stress disorder(PTSD),significant heterogeneity in the effectiveness of PTSD treatment persists,especially in community settings.Client demographics used to understand this variability in treatment outcome and dropout have yielded mixed results.Despite increasing evidence for the importance of attending to treatment engagement in community settings,few studies have explored client-level predictors.Aim The purpose of this study is to explore client-level predictors of treatment outcome and dropout beyond client demographics,and to identify client-level predictors of treatment engagement in community settings.Method Secondary data analysis was conducted with data collected as part of an implementation-effectiveness hybrid study of cognitive processing therapy(CPT)for PTSD in a diverse community healthcentre.Providers(n=19)treated(n=52)clients as part of their routine clinical care.Non-demographic client-level predictors included barriers to treatment,quality of life,session-level language and employment history assessed at baseline.Treatment engagement included number of weeks in the study,number of sessions with repeated CPT content,number of unique CPT sessions attended,frequency of session attendance and consistency of session attendance.Results Results showed language as a significant predictor of treatment engagement.There were significant differences between Spanish and English-speaking clients,with the former having a tendency to repeat more session content than the latter(β=1.4 sessions,p=0.003),and also less likely to attend treatment frequently(r=0.62,p=0.009)and consistently(r=0.57,p=0.027)if high logistical and financial barriers were endorsed.Irrespective of language,clients who reported high quality of life at baseline were less likely to repeat CPT session content(β=-0.3,p=0.04),and those with increased baseline barriers to treatment had deceleration in PTSD symptom improvement over time(β=-0.62,p<0.05).In terms of treatment engagement moderators impacting treatment outcome,clients who repeated more session content were more likely to complete treatment(0R=1.84,p=0.037).Conclusion Identification of client-level predictors of treatment engagement,outcome and dropout is essential to optimise treatment,particularly in community settings. | Soo-jeong Youn Margaret-Anne Mackintosh Shannon Wiltsey Stirman Kay lie A Patrick Yesenia Aguilar Silvan Anna D Bartuska Derri L Shtasel Luana Marques | 2019 | General Psychiatry2019,32,6: | 2 |
| 2 | Cancer-associated fibroblast-derived secreted phosphoprotein 1 contributes to resistance of hepatocellular carcinoma to sorafenib and lenvatinib显示文摘Background:Cancer-associated fibroblasts(CAFs)play an important role in the induction of chemo-resistance.This study aimed to clarify the mechanism underlying CAF-mediated resistance to two tyrosine kinase inhibitors(TKIs),sorafenib and lenvatinib,and to identify a novel therapeutic target for overcoming TKI resistance in hepatocellular carcinoma(HCC).Methods:We performed a systematic integrative analysis of publicly available gene expression datasets and whole-transcriptome sequencing data from 9 pairs of CAFs and para-cancer fibroblasts isolated from human HCC and para-tumor tissues,respectively,to identify key molecules that might induce resistance to TKIs.We then performed in vitro and in vivo experiments to validate selected targets and related mechanisms.The associations of plasma secreted phosphoprotein 1(SPP1)expression levels before sorafenib/lenvatinib treatment with progression-free survival(PFS)and overall survival(OS)of 54 patients with advanced HCC were evaluated using Kaplan-Meier and Cox regression analysis.Results:Bioinformatic analysis identified CAF-derived SPP1 as a candidate molecule driving TKI resistance.SPP1 inhibitors reversed CAF-induced TKI resistance in vitro and in vivo.CAF-derived SPP1 activated rapidly accelerated fibrosarcoma(RAF)/mitogen-activated protein kinase(MAPK)and phosphatidylinositol 3-kinase(PI3K)/protein kinase B(AKT)/mammalian target of rapamycin(mTOR)through the integrin-protein kinase C-alpha(PKCα)signaling pathway and promoted epithelial-to-mesenchymal transition(EMT).A high plasma SPP1 level before TKI treatment was identified as an independent predictor of poor PFS(P=0.026)and OS(P=0.047)in patients with advanced HCC after TKI treatment.Conclusions:CAF-derived SPP1 enhances TKI resistance in HCC via bypass activation of oncogenic signals and EMT promotion.Its inhibition represents a promising therapeutic strategy against TKI resistance inHCC.Moreover,plasma SPP1 level before TKI treatment represents a potential biomarker for treatment response prediction. | JungWoo Eun Jung Hwan Yoon Hye Ri Ahn Seokhwi Kim Young Bae Kim Su Bin Lim Won Park TaeWook Kang Geum Ok Baek Moon Gyeong Yoon Ju A Son Ji HyangWeon Soon Sun Kim Hyo Jung Cho Jae Youn Cheong | 2023 | Cancer Communications2023,43,4: | 2 |
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