Among pediatric Occupational Therapists’ goals is to provide a holistic approach towards intervention planning which includes preparing the child’s social environment, especially in facilitating the carry-over of tasks in the child’s daily contexts. This model explores the factors contributing to the limited opportunities for family/caregiver participation during actual therapy sessions. It also discusses and integrates some of the best practice principles for family engagement that are based on the Phoenix Theory of Parent Attendance, Adlerian Play Therapy, and Discrimination model. This model was conceptualized in response to the growing need to increase family engagement during therapy in the Philippine setting, which could help them overcome barriers and strengthen their therapeutic skills and relationship with the child. Techniques and intervention processes that aim to engage the family during occupational therapy need to be further developed and studied. To fulfill this, this paper introduces a conceptual framework that maps out (1) five core elements, (2) five phases of family therapy engagement, and (3) a process checklist during the intervention process. The five core elements that affect family engagement are client, therapist, family, therapy-related, and environmental factors. This model explains how good collaboration between the family and therapists can be achieved if they undergo the preparation, consultation, planning, experiential activities, and re-education phase. The researchers suggest using this conceptual framework as a guide to understand and provide a systematic family engagement process during therapy sessions.
Occupational Therapy ; Family

OBJECTIVETo explore the effect of structural family therapy (SFT), which refers to the application of the theory and technology of SFT for improving the internal family environment of pediatric patients through reorganization of the family roles, tasks, and boundaries, on the family structure and function in children with hematological tumors.

METHODSForty children with hematological tumors were randomly divided into SFT and control groups (n=20 each). The control group received conventional chemotherapy. The SFT group received SFT by a trained therapist in addition to conventional chemotherapy; the family of each patient received SFT four times (once every two weeks). Both groups were assessed by the Family Assessment Device (FAD) and Family Environment Scale-Chinese Version (FES-CV) on admission and one month after the end of SFT.

RESULTSAfter treatment, the SFT group showed significant decreases in all factor scores of FAD (P<0.05); the SFT group had significantly lower scores of problem solving, communication, roles, affective involvement, behavior control, and general functioning than the control group (P<0.05). In addition, the SFT group had significantly increased FES-CV scores of cohesion, emotional expression, intellectual-cultural orientation, and active-recreational orientation and a significantly decreased score of conflict after treatment (P<0.05), and the SFT group was significantly superior to the control group in terms of these items (P<0.05).

CONCLUSIONSSFT could promote beneficial family changes in children with hematological tumors by improving the family function and internal environment, which would increase the long-term chemotherapy compliance of these children and their parents.

No abstract available.
Drug Therapy* ; Family Practice* ; Humans ; Tuberculosis, Pulmonary*

OBJECTIVE: The aim of this study was to find if systemic family therapy (SFT) does work in anxiety and depression with epilepsy in adolescents (ADAE). METHODS: 104 adolescents with epilepsy, aged 13-20 years old, were included from December 2009 to December 2010, the enrolled patients were with anxiety [Hamilton Anxiety Scale (HAMA) score ≥14 points] or depression [Hamilton Depression Scale (HAMD) score ≥20 points]. The patients were randomly divided into the control group (n=52) treated with antiepileptic drugs (AED) and the intervention group (n=52) undergone Systemic Family Therapy (SFT) as well as AED. The AED improvements, anxiety and depression scores, Social Support Rating Scale (SSRS), Family Assessment Device (FAD) and scale of systemic family dynamics (SSFD) were observed after 3-month treatment. RESULTS: The frequencies of epileptic seizures in intervention group was decreased much more significantly than the control group (4.22±3.54 times/month vs. 6.20±5.86 times/month, p=0.04); and the scores of anxiety (9.52±6.28 points vs. 13.48±8.47 points, p=0.01) and depression (13.86±9.17 points vs. 18.89±8.73 points, p=0.02) were significantly decreased than the control group; meanwhile, the family dynamics and family functions were significantly improved, and the social support was also increased (p<0.05). CONCLUSION: SFT combined with AEDs had better efficacies than AEDs alone, not only the frequency of epileptic seizures was decreased, but also the patients' anxiety and depression were improved, and the family dynamics, family functions and social support were improved.
Adolescent* ; Anticonvulsants ; Anxiety* ; Comorbidity* ; Depression* ; Epilepsy* ; Family Therapy* ; Humans

BACKGROUND: When research based evidence is not sufficient, clinical practice guidelines can be based on opinions. In such situations, formal consensus development methods, often based on the modified nominal group techniques are widely used. It can be used to evaluate consistency, generalizability, applicability of recommendation when evidence comes from other countries. METHODS: To develop evidence based guidelines for osterarthritis pharmacotherapy, a consensus expert panel consisting of internists, family physicians, methodologists, and orthopedic surgeons were convened. After an extensive structured literature searching and evaluation, evidence statements for key question were developed. Rating methods for consistency, generalizability, applicability of statement were adopted from those jointly developed by Rand and the University of California, Los Angeles. RESULTS: We developed 27 evidence statements in 17 question domains. Among 72 rating items, 62 items reached agreement. Among 15 recommendations, 10 recommendation grading were A, 2 were B, and 3 were C. CONCLUSION: When research based evidence is not sufficient, clinical practice guidelines can be based on formal consensus of experts, especially modified nominal group techniques. It can be used to evaluate consistency, generalizability, applicability of recommendation when evidence comes from other countries.
California ; Consensus ; Drug Therapy ; Humans ; Orthopedics ; Osteoarthritis ; Physicians, Family

Asthma ; prevention & control ; therapy ; Child ; Disease Management ; Family ; Humans

This paper depicted the whole-course care for an advanced cancer patient from hospital to home.In this case,telemedicine was employed to provide guidance on the symptom control,comfort care,psychotherapy,and bereavement counseling.The patient got the holistic care from the whole family and team.The holistic care finally gave a good death of the patient and aided in the recovery of the family members from grief.
Family ; Hospice Care ; Hospitals ; Humans ; Neoplasms/therapy* ; Palliative Care

Knowledge of an underlying genetic predisposition to cancer allows the use of personalised prognostic, preventive and therapeutic strategies for the patient and carries clinical implications for family members. Despite great progress, we identified six challenging areas in the management of patients with hereditary cancer predisposition syndromes and suggest recommendations to aid in their resolution. These include the potential for finding unexpected germline variants through somatic tumour testing, optimal risk management of patients with hereditary conditions involving moderate-penetrance genes, role of polygenic risk score in an under-represented Asian population, management of variants of uncertain significance, clinical trials in patients with germline pathogenic variants and technology in genetic counselling. Addressing these barriers will aid the next step forward in precision medicine in Singapore. All stakeholders in healthcare should be empowered with genetic knowledge to fully leverage the potential of novel genomic insights and implement them to provide better care for our patients.
Humans ; Singapore ; Genotype ; Neoplasms/therapy* ; Risk Factors ; Family

Attention-deficit hyperactivity disorder (ADHD) is a neuropsychiatric disorder that begins in early childhood and can persist throughout adulthood. ADHD causes difficulties in various area of life, such as academic achievement, peer relationships, family functioning, employment and marriage. Although ADHD is known to respond well to medication, such treatment is more effective when combined with psychosocial (non-pharmacologic) therapy in terms of alleviating the core symptoms and improving appropriate functions. Psychosocial treatment interventions are divided into psychoeducation, behavioral parent training, school intervention, cognitive behavior therapy, social skill training, parent-child interaction therapy, play therapy, other treatments (coaching, complementary and alternative medicine), neurofeedback and Cogmed. Adult ADHD cognitive behavioral therapy is described separately. These practice parameters summarize the evidence for psychosocial treatment. Based on this evidence, specific recommendations are provided for psychosocial interventions.
Adult ; Cognitive Therapy ; Employment ; Family Relations ; Humans ; Marriage ; Neurofeedback ; Parents ; Play Therapy ; Social Skills

Among the mood disorders in the elderly aged older than 65, dysthymia, major depression, and mania constitute the prototypes and depressed mood is the most frequent symptom. The mode of psychotherapy and psychosocial therapy for geriatric depression, which are similar throughout adulhood, include brief dynamic psychotherapy, interpersonal psychotherapy, psychoanalytic psychotherapy and psychoanalysis, supportive psychotherapy, cognitive therapy, family therapy, and group therapy. Psychotherapy alone is of value primarily in dysthymia and major depression. Short-term cognitive therapy, brief dynamic psychotherapy, and interpersonal psychothearapy have been found to be effective, without medications, in high-functioning elders suffering from major depression with minimal or no cognitive impairment. Cognitive-behavioral psychotherapy may be the treatment of choice in the depressed medically ill. Whatever technique is utilized, it is important to be aware of the dynamic issues that are prevalent in geriatric depression patients, as well as the transference and countertransferenc problems that may be aroused.
Aged ; Bipolar Disorder ; Cognitive Therapy ; Depression ; Family Therapy ; Humans ; Mood Disorders* ; Psychoanalysis ; Psychotherapy* ; Psychotherapy, Group