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Can ventilation-feedback training augment exercise tolerance in patients with chronic obstructive pulmonary disease?

Am J Respir Crit Care Med. 2008 Apr 15;177(8):844-52

Authors: Collins EG, Langbein WE, Fehr L, O’Connell S, Jelinek C, Hagarty E, Edwards L, Reda D, Tobin MJ, Laghi F

RATIONALE: Exercise-induced dynamic hyperinflation contributes to decreased exercise tolerance in chronic obstructive pulmonary disease (COPD). It is unknown whether respiratory retraining (ventilation-feedback [VF] training) can affect exercise-induced dynamic hyperinflation and increase exercise tolerance. Objectives: To determine whether patients with COPD would achieve longer exercise duration if randomized to a combination of exercise training plus VF training than either form of training on its own. METHODS: A total of 64 patients randomized to 1 of 3 groups: VF plus exercise (n = 22), exercise alone (n = 20), and VF alone (n = 22). MEASUREMENTS AND MAIN RESULTS: Exercise duration before and after 36 training sessions and exercise-induced dynamic hyperinflation and respiratory pattern before and after training were measured. In the 49 patients who completed training, duration of constant work-rate exercise was 40.0 (+/- 20.4) minutes (mean +/- SD) with VF plus exercise, 31.5 (+/- 17.3) minutes with exercise alone, and 16.1 (+/- 19.3) minutes with VF alone. Exercise duration was longer in VF plus exercise than in VF alone (P < 0.0001), but did not reach predetermined statistical significance when VF plus exercise was compared with exercise alone (P = 0.022) (because of multiple comparisons, P </= 0.0167 was used for statistical significance). After training, exercise-induced dynamic hyperinflation, measured at isotime, in VF plus exercise was less than in exercise alone (P = 0.014 for between-group changes) and less than in VF alone (P = 0.019 for between-group changes). After training, expiratory time was longer in VF plus exercise training (P < 0.001), and it was not significantly changed in the other two groups. CONCLUSIONS: The combination of VF plus exercise training decreases exercise-induced dynamic hyperinflation and increases exercise duration more than VF alone. An additive effect to exercise training from VF was not demonstrated by predetermined statistical criteria.

PMID: 18202351 [PubMed - indexed for MEDLINE]

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How does violence potential relate to crisis intervention team responses to emergencies?

Psychiatr Serv. 2008 Feb;59(2):201-4

Authors: Skeem J, Bibeau L

OBJECTIVE: This study explored whether a crisis intervention team (CIT) promotes public safety and diversion from jail to treatment. METHODS: Police reports (N=655) were analyzed for CIT events that occurred between March 2003 and May 2005 to determine each subject’s potential for violence to self or others. RESULTS: Some 45% of CIT events involved suicide crises, 26% involved a threat to others, and average violence potential ratings suggested minor to moderate risk. Officers’ use of force related strongly to violence potential (eta of .54). Nevertheless, officers used force in only 15% of 189 events posing serious to extreme risk of violence and used low-lethality methods. Of events, 74% were resolved through hospitalization, whereas only 4% were resolved through arrest. CONCLUSIONS: Although the study lacked a comparison group, the results are consistent with some studies suggesting that CIT holds promise in meeting safety and jail diversion goals.

PMID: 18245166 [PubMed - indexed for MEDLINE]

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How many forensic assertive community treatment teams do we need?

Psychiatr Serv. 2008 Feb;59(2):205-8

Authors: Cuddeback GS, Morrissey JP, Cusack KJ

Despite the growing interest in forensic assertive community treatment (FACT), there is no standardized definition of FACT eligibility and no guidelines for how many FACT teams communities may need. In this brief report a definition for FACT eligibility is proposed-severe and persistent mental illness and three jail detentions in a one-year period-and modeled by using 5.5 years of administrative data (July 1, 1993, through December 31, 1998) from a large, urban county in the western United States. Findings suggest that large, urban communities should develop enough FACT teams to serve approximately 44% of their populations of persons with severe mental illness, or roughly .05% of their adult populations. Developing standardized eligibility criteria for FACT is an important first step toward developing its evidence base.

PMID: 18245167 [PubMed - indexed for MEDLINE]

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A randomized controlled trial of cognitive behavior therapy for multiple sclerosis fatigue.

Psychosom Med. 2008 Feb;70(2):205-13

Authors: van Kessel K, Moss-Morris R, Willoughby E, Chalder T, Johnson MH, Robinson E

BACKGROUND: The purpose of this study was to assess the efficacy of cognitive behavior therapy (CBT) as a treatment for multiple sclerosis (MS) fatigue. METHODS: A randomized controlled design was used where 72 patients with MS fatigue were randomly assigned to eight weekly sessions of CBT or relaxation training (RT). RT was designed to control for therapist time and attention. Participants were assessed before and after treatment, and at 3 and 6 months posttreatment. The primary outcome was the Fatigue Scale. Secondary outcomes included measures of stress, mood, and fatigue-related impairment. RESULTS: Analysis was by intention-to-treat. A group by time interaction showed that the CBT group reported significantly greater reductions in fatigue across the 8 months compared with the RT group (p < .02). Calculated effect sizes for fatigue from baseline to the end of treatment were 3.03 [95% confidence interval, 2.22-3.68] for the CBT group and 1.83 [95% confidence interval, 1.26-2.34] for the RT group. Results also indicted that both groups showed clinically significant decreases in fatigue defined as fatigue levels equivalent or less than those reported by a non-fatigued healthy comparison group. There were no significant interactions between group and any of the secondary outcome variables, with both groups showing improvements over time on all measures. INTERPRETATION: Both CBT and RT appear to be clinically effective treatments for fatigue in MS patients, although the effects for CBT are greater than those for RT. Even 6 months after treatment, both treatment groups reported levels of fatigue equivalent to those of the healthy comparison group.

PMID: 18256342 [PubMed - indexed for MEDLINE]

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Putting evidence into practice: interventions for depression.

Clin J Oncol Nurs. 2008 Feb;12(1):131-40

Authors: Fulcher CD, Badger T, Gunter AK, Marrs JA, Reese JM

Depression and depressive symptoms are prevalent in people with cancer, yet interventions for depression are a low priority for most oncology care providers. Barriers to diagnosis and treatment include beliefs by patients and providers that depression is an expected correlate of cancer diagnosis, the reluctance of patients to share psychological concerns, and the reticence of some professionals to assess patients with cancer for depressive symptoms in the midst of busy oncology settings. Intervening to diminish depressive symptoms in people with cancer is important because depression has been associated with poorer quality of life, recovery, and possibly survival. This article reviews and summarizes the evidence for pharmacologic and nonpharmacologic interventions for people with cancer and depression and identifies opportunities for future research and practice change.

PMID: 18258583 [PubMed - indexed for MEDLINE]

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Essential oils for management of symptoms in critically ill patients.

Am J Crit Care. 2008 Mar;17(2):160-3

Authors: Halm MA

PMID: 18310655 [PubMed - indexed for MEDLINE]

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Five-year followup of a cognitive-behavioral intervention for patients with recently-diagnosed rheumatoid arthritis: effects on health care utilization.

Arthritis Rheum. 2008 Mar 15;59(3):311-6

Authors: Sharpe L, Allard S, Sensky T

OBJECTIVE: To investigate whether cognitive-behavioral therapy (CBT) administered early in the course of rheumatoid arthritis (RA) has long-term effects on health care use. METHODS: We reviewed the files of 47 of the original 53 patients with early RA who volunteered for a randomized controlled trial comparing CBT with no psychological intervention. Occasions of service provision associated with RA were documented and health care use was compared between groups. RESULTS: The CBT group used fewer health care resources than the control group in the 5 years following intervention. Significant differences were observed for the number of inpatient nights, physiotherapy referrals, injections, and for total health care use. There was a trend that closely approached significance toward fewer episodes of surgery and orthopedic referrals in the CBT group. CONCLUSION: These results suggest that CBT administered early in the course of RA can reduce health care use for the first 5 years after treatment. This is a stringent test of the efficacy of a brief psychological intervention, and supports the fact that brief psychological treatments can have long-term effects.

PMID: 18311768 [PubMed - indexed for MEDLINE]

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[The effectiveness of anxiety treatment on alcohol-dependent patients with a comorbid phobic disorder: a randomised controlled trial]

Tijdschr Psychiatr. 2008;50(3):137-48

Authors: Schadé A, Marquenie LA, van Balkom AJ, Koeter MM, van den Brink W, van Dyck R

BACKGROUND: There is evidence that the post-treatment relapse rate for alcohol-dependent patients with a comorbid anxiety disorder is higher than for alcohol-dependent patients without this disorder. aim To discover whether the post-treatment relapse rate in alcohol-dependent patients who suffer from both alcohol-dependence and a comorbid anxiety disorder can be lowered by giving them additional treatment specifically for the comorbid anxiety disorder. METHOD: A 32-week randomised controlled trial among 96 abstinent patients with a primary diagnosis of alcohol dependence and a comorbid anxiety disorder involving agoraphobia or social phobia. The patients were randomly assigned either to an intensive psychosocial relapse-prevention programme only (n = 49) or to a combined programme in which the aforementioned programme was supplemented by an anxiety treatment programme comprising cognitive behavioural therapy and optional pharmacotherapy in the form of an SSRI (n = 47). The primary outcome measure was the percentage of patients who suffered an alcohol relapse during a 32-week period. The secondary outcome measures were: total abstinence, a reduction in the number of days of heavy drinking and a reduction in anxiety symptoms. results Although the anxiety symptoms in the group receiving cognitive behavioural therapy diminished more than in the group not receiving this therapy, the alcohol relapse rates in the former group were not significantly lower than in the latter group. CONCLUSION: Anxiety treatment for alcohol-dependent patients with a comorbid anxiety disorder can alleviate anxiety symptoms but has no significant effect on the outcome of alcohol treatment programmes.

PMID: 18324601 [PubMed - indexed for MEDLINE]

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Balint groups as a means to increase job satisfaction and prevent burnout among general practitioners.

Ann Fam Med. 2008 Mar-Apr;6(2):138-45

Authors: Kjeldmand D, Holmström I

PURPOSE: General practitioners (GPs) occupy a central position in health care and often have demanding working situations. This corps shows signs of exhaustion, and many consider quitting their job or plan to retire early. It is therefore urgent to find ways of improving GP’s satisfaction with their work. One approach might be Balint group participation. The aim of this study was to explore GPs’ experience of participating in Balint groups and its influence on their work life. METHODS: We conducted a descriptive, qualitative study. Nine GPs who had participated in Balint groups for 3 to 15 years were interviewed. A phenomenologic analysis was carried out to describe the phenomenon of Balint group participation. RESULTS: The GPs perceived that their Balint group participation influenced their work life. Analyses revealed several interrelating themes: competence, professional identity, and a sense of security, which increased through parallel processes, creating a base of endurance and satisfaction, thus enabling the GPs to rediscover the joy of being a physician. CONCLUSIONS: The GPs in this study described their Balint group participation as beneficial and essential to their work life as physicians in several ways. It seemed to increase their competence in patient encounters and enabled them to endure in their job and find joy and challenge in their relationships with patients. Balint groups might thus help GPs handle a demanding work life and prevent burnout. These groups might not suit all GPs, however, and additional ways to reduce stress and increase job satisfaction should be offered.

PMID: 18332406 [PubMed - indexed for MEDLINE]

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Regarding “Systematic review: pharmacological and behavioral treatment for trichotillomania”.

Biol Psychiatry. 2008 May 1;63(9):e33; author reply e34-5

Authors: Chamberlain S, Ipser J, Stein D, Fineberg N

PMID: 18336796 [PubMed - indexed for MEDLINE]

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