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ObjectiveTo evaluate broad-spectrum intravenous antibiotic use before and after the implementation of a revised febrile neutropenia management algorithm in a population of adults with hematologic malignancies.DesignQuasi-experimental study.Setting and populationPatients admitted between 2014 and 2018 to the Adult Malignant Hematology service of an acute-care hospital in the United States.MethodsAggregate data for adult malignant hematology service were obtained for population-level antibiotic use: days of therapy (DOT), C. difficile infections, bacterial bloodstream infections, intensive care unit (ICU) length of stay, and in-hospital mortality. All rates are reported per 1,000 patient days before the implementation of an febrile neutropenia management algorithm (July 2014-May 2016) and after the intervention (June 2016-December 2018). These data were compared using interrupted time series analysis.ResultsIn total, 2,014 patients comprised 6,788 encounters and 89,612 patient days during the study period. Broad-spectrum intravenous (IV) antibiotic use decreased by 5.7% with immediate reductions in meropenem and vancomycin use by 22 (P = .02) and 15 (P = .001) DOT per 1,000 patient days, respectively. Bacterial bloodstream infection rates significantly increased following algorithm implementation. No differences were observed in the use of other antibiotics or safety outcomes including C. difficile infection, ICU length of stay, and in-hospital mortality.ConclusionsReductions in vancomycin and meropenem were observed following the implementation of a more stringent febrile neutropenia management algorithm, without evidence of adverse outcomes. Successful implementation occurred through a collaborative effort and continues to be a core reinforcement strategy at our institution. Future studies evaluating patient-level data may identify further stewardship opportunities in this population.

Experiential education is a well documented approach to engaging student learners. This manuscript presents findings from a qualitative inquiry, specifically focus group discussions, investigating the perceptions of 28 student participants in a learning opportunity provided to a kinesiology class involving structured group exercise (marathon training). Findings revealed participants' gains in holistic wellness development, general and specified efficacy, and understanding and integration of course content.

This article defines process observation and how it can be used by professional school counselors to assist classroom teachers in enhancing the learning environment for students. Further, this article elucidates the skills used by process observers. A case illustration is provided to demonstrate application of this service. Finally, practical strategies for implementing this service in the school setting are given as well as implications for counselors and counselor educators.

Counseling children requires specific skills and techniques, such as play therapy and expressive arts, to address developmental manifestations and to facilitate the understanding of presenting problems. This article outlines an adapted eco-mapping activity that can be used as a creative counseling technique with children in order to promote counselor understanding of the client's perceived support system. A case illustration is provided to demonstrate how this technique may be used in conceptualizing, planning, and evaluating client treatment.

Objectives: Relationships with other people are important determinants of the course of psychosis, yet social isolation is common. This study sought to learn about the patient experience of being around other people when hearing derogatory and threatening voices (DTVs). Design: A qualitative interview study. Methods: Fifteen participants with experience of hearing DTVs in the context of non‐affective psychosis were recruited from NHS services. Data were obtained by semi‐structured interviews and analysed using thematic analysis. Results: Three themes were identified: (1) reasons why interacting with people is difficult when hearing DTVs; (2) the relationship between social connection and DTVs; and (3) factors which enable voice hearers to connect with others. A further ten sub‐themes are outlined as reasons why hearing DTVs led to lower social connection, including difficulties during conversations (e.g., theconcentration required is hard), negative expectations of interactions (e.g., fearing negative judgement from others), and difficulties sharing experiences of voices (e.g., people will be hurt or upset if I tell them about the voices). Isolation was a common response to hearing DTVs but also a time of vulnerability for hearing voices. Managing the challenges of interacting with people led to some improvements in DTVs. Conclusions: There are understandable reasons why hearing DTVs leads to lower social connection. Yet isolating oneself can also be a time of vulnerability for DTVs. Social connection might be one vehicle for disengaging from and disputing derogatory and threatening voice content. The effect on voice hearing of social recovery interventions warrants further investigation. Practitioner points: Participants shared 10 reasons why being around people is challenging when hearing derogatory and threatening voices. These typically affected both daily social experiences and contact with clinicians.Common initial responses to hearing DTVs were to reduce contact with people, experience difficulties connecting during conversations and to avoid sharing the experience of voice hearing.However, social isolation was a time of vulnerability to DTVs, and hence, increasing social connection might be a target for interventions.A range of factors enabled voice hearers to manage social situations, for example: the fostering of trust, self‐acceptance, learning when it is better to stay at home, and developing a narrative to explain voice hearing to others.Addressing the barriers to connecting with others might have an important role in personal recovery from voice hearing. [ABSTRACT FROM AUTHOR]

Background: Grandiose delusions are arguably the most neglected psychotic experience in research. Objectives: We aimed to discover from patients: whether grandiose delusions have harmful consequences; the psychological mechanisms that maintain them; and what help patients may want from clinical services. Design: A qualitative interview design was used to explore patients' experiences of grandiose delusions. Method: Fifteen patients with past or present experiences of grandiose delusions who were attending psychiatric services were interviewed. Thematic analysis and grounded theory were used to analyse the data. Results: Participants reported physical, sexual, social, occupational, and emotional harms from grandiose delusions. All patients described the grandiose belief as highly meaningful: it provided a sense of purpose, belonging, or self‐identity, or it made sense of unusual or difficult events. The meaning from the belief was not synonymous with extreme superiority or arrogance. The meaning obtained appeared to be a key driver of the persistence of the beliefs. Other maintenance factors were subjectively anomalous experiences (e.g., voices), symptoms of mania, fantasy elaboration, reasoning biases, and immersive behaviours. Participants described insufficient opportunities to talk about their grandiose beliefs and related experiences and were generally positive about the possibility of a psychological therapy. Conclusions: We conclude that grandiosity is a psychologically rich experience, with a number of maintenance factors that may be amenable to a targeted psychological intervention. Importantly, the term 'grandiose delusion' is an imprecise description of the experience; we suggest 'delusions of exceptionality' may be a credible alternative. Practitioner points: Harm from grandiose delusions can occur across multiple domains (including physical, sexual, social, occupational, and emotional) and practitioners should assess accordingly.However, grandiose delusions are experienced by patients as highly meaningful: they provide a sense of purpose, belonging, or self‐identity, or make sense of unusual or difficult events.Possible psychological maintenance mechanisms that could be a target for intervention include the meaning of the belief, anomalous experiences, mania, fantasy elaboration, reasoning biases, and immersive behaviours.Patients are keen to have the opportunity to access talking therapies for this experience. Taking extra time to talk at times of distress, 'going the extra mile', and listening carefully can help to facilitate trust. [ABSTRACT FROM AUTHOR]

Background: Around two-thirds of patients with auditory hallucinations experience derogatory and threatening voices (DTVs). Understandably, when these voices are believed then common consequences can be depression, anxiety and suicidal ideation. There is a need for treatment targeted at promoting distance from such voice content. The first step in this treatment development is to understand why patients listen to and believe voices that are appraised as malevolent. Aims: To learn from patients their reasons for listening to and believing DTVs. Method: Theoretical sampling was used to recruit 15 participants with non-affective psychosis from NHS services who heard daily DTVs. Data were obtained by semi-structured interviews and analysed using grounded theory. Results: Six higher-order categories for why patients listen and/or believe voices were theorised. These were: (i) to understand the voices (e.g. what is their motive?); (ii) to be alert to the threat (e.g. prepared for what might happen); (iii) a normal instinct to rely on sensory information; (iv) the voices can be of people they know; (v) the DTVs use strategies (e.g. repetition) to capture attention; and (vi) patients feel so worn down it is hard to resist the voice experience (e.g. too mentally defeated to dismiss comments). In total, 21 reasons were identified, with all participants endorsing multiple reasons. Conclusions: The study generated a wide range of reasons why patients listen to and believe DTVs. Awareness of these reasons can help clinicians understand the patient experience and also identify targets in psychological intervention. [ABSTRACT FROM AUTHOR]

Children exposed to caregivers with alcohol abuse disorder (AUD) are often subjected to a psychologically destabilising home environment. These caregivers may demonstrate behaviours that compromise their children's sense of safety and security and lead to a range of trauma-related symptoms. A trauma-focused treatment approach may assist with the reduction of children's trauma-related symptoms as well as the prevention of, for example, posttraumatic stress disorder (PTSD), depression, behavioural problems, and pathological shame. In this article, the authors discuss the incorporation of tenets of cognitive behavioural play therapy into a trauma-focused cognitive behavioural therapy (TF-CBT) approach for children affected by a caregiver with AUD. Additionally, the authors discuss the effects of caregiver AUD on children and outline an integrative play-based treatment approach for treating the trauma these children experience. A case example is presented to illustrate the integration of TF-CBT and cognitive behavioural play therapy (CBPT) for children with caregivers with AUD. [ABSTRACT FROM AUTHOR]