Do behaviour-change techniques contribute to the effectiveness of exercise therapy in patients with intermittent claudication? A systematic review.

This systematic narrative review of randomised controlled trials (RCTs) identifies and evaluates the efficacy of behaviour-change techniques explicitly aimed at walking in individuals with intermittent claudication. An electronic database search was conducted up to December 2012. RCTs were included comparing interventions incorporating behaviour-change techniques with usual care, walking advice or exercise therapy for increasing walking in people with intermittent claudication. Studies were evaluated using the Cochrane Collaboration risk of bias tool. The primary outcome variable was maximal walking ability at least 3 months after the start of an intervention. Secondary outcome variables included pain-free walking ability, self-report walking ability and daily walking activity. A total of 3,575 records were retrieved. Of these, six RCTs met the inclusion criteria. As a result of substantial heterogeneity between studies, no meta-analysis was conducted. Overall, 11 behaviour-change techniques were identified; barrier identification with problem solving, self-monitoring and feedback on performance were most frequently reported. There was limited high-quality evidence and findings were inconclusive regarding the utility of behaviour-change techniques for improving walking in people with intermittent claudication. Rigorous, fully powered trials are required that control for exercise dosage and supervision in order to isolate the effect of behaviour-change techniques alongside exercise therapy.

'Why, why did you have me treated?': the psychotic experience in a literary narrative.

In this paper, the authors suggest an approach that may be helpful in teaching medical humanities to medical students. In the context of an honours class on medicine and literature, students (1) read a novel on an illness, (2) interviewed a patient with the medical condition described in the novel and (3) wrote an essay on the biomedical, narrative and literary aspects of these sources of information. The authors compared the story of Chekhov's literary protagonist Kovrin in The Black Monk with the personal story of patient H., who was diagnosed with schizophrenia. The narratives of the two patients were compared, based on Chekhov's literary narrative and the narrative of the patient. Both patients appeared to somehow regret losing their symptoms, following various psychiatric treatments. Both narratives show the ambivalence between the gain and loss that adequate psychiatric treatment may bring. Studying novels and other literary sources may help in understanding the story of the patient better, with associated improvements in various aspects of medical outcome. Reading literary fiction may help to increase an understanding of patients' emotions, experiences, cognitions and perspectives. It may also reduce the emotional distance between the self and the patient. The educational approach that was explored in the authors' honours class may be helpful to others when developing methods for teaching medical humanities to (medical) students.

Participation and drop-out in pulmonary rehabilitation: a qualitative analysis of the patient's perspective.

OBJECTIVE: To examine patients' pretreatment beliefs and goals regarding pulmonary rehabilitation. DESIGN: Qualitative study using semi-structured interviews. SETTING: Interviews conducted at participants' homes. SUBJECTS: Twelve patients with chronic obstructive pulmonary disease who had been referred to a rehabilitation clinic. MAIN MEASURES: Patients' beliefs about pulmonary rehabilitation, self-set treatment goals and anticipated reasons for drop-out. RESULTS: Patients' beliefs about pulmonary rehabilitation comprised positive aspects (participation as an opportunity for improvement, a safe and multidisciplinary setting, presence of motivating and supporting patients) and negative aspects of exercising in a rehabilitation centre (e.g. disruption of normal routine, being tired after training, transportation difficulties, limited privacy and confrontation with severely ill patients). Four types of treatment goals were formulated: increase in functional performance, weight regulation, reduction of dyspnoea, and improvement of psychosocial well being. Four clusters of anticipated reasons for drop-out were identified: the intensity of the programme, barriers to attending (e.g. transportation problems, sudden illness and other duties/responsibilities), lack of improvement and social factors. Four different attitudes towards pulmonary rehabilitation could be distinguished: optimistic, 'wait and see', sceptic and pessimistic. Follow-up data revealed that whereas a pessimistic attitude (high disability, low self-confidence, many concerns) was related to decline, the 'sceptic' patients had dropped out during the course. CONCLUSIONS: Uptake and drop-out may be related to patients' perceived disabilities, expected benefits and concerns with regard to rehabilitation, practical barriers and confidence in their own capabilities.

Derivation of atmospheric extinction profiles and wind speed over the ocean from a satellite-borne lidar.

A simulated analysis is presented that shows that returns from a single-frequency space-borne lidar can be combined with data from conventional visible satellite imagery to yield profiles of aerosol extinction coefficients and the wind speed at the ocean surface. The optical thickness of the aerosols in the atmosphere can be derived from visible imagery. That measurement of the total optical thickness can constrain the solution to the lidar equation to yield a robust estimate of the extinction profile. The specular reflection of the lidar beam from the ocean can be used to determine the wind speed at the sea surface once the transmission of the atmosphere is known. The impact on the retrieved aerosol profiles and surface wind speed produced by errors in the input parameters and noise in the lidar measurements is also considered.

Infrared radiation emerging from smoke produced by brush fires.

This study presents the IR radiative transport properties of brush fire smoke clouds computed for a model with finite horizontal dimensions as well as the more common plane-parallel model. The finite model is a 3-D version of the two-stream approximation applied to cubic clouds of steam, carbon, and silicates. Assumptions are made with regard to the shape and size distributions of the smoke particles. It is shown that 11.5-microm radiometry can detect fires beneath smoke clouds if the path integrated mass density of the smoke is less, similar3 g/m(2).

Aerosol size distributions: remote determination from air-borne measurements of the solar aureole.

Aerosol size distributions were determined remotely using an airborne scanning photometer. This instrument consists of a sunshade, optics, and a large dynamic range photodetector-amplifier system that scans about the vertical, recording both the direct attenuated solar beam and the diffuse sky radiance in the almucantar of the sun at an effective wavelength of 0.54 microm. The inversion of the measured radiances determined aerosol radii from approximately 0.2 microm to 8.0 microm. Data were taken during flights in May 1973 over western Lake Superior and southwestern Wisconsin. Inverted aerosol size distributions are compared with results obtained by other methods.

Teaching communication skills to pre-clinical medical students: a general practice based approach.

This paper describes a method of teaching communication skills to pre-clinical medical students in the setting of general practice. By focusing on the nature of the patient's problem this teaching tries to place interviewing and diagnostic procedures in their proper context in the doctor-patient relationship.

Physical and psychological correlates of functioning in patients with chronic obstructive pulmonary disease.

We studied the contribution of coping and illness perceptions to outcome in patients with chronic obstructive pulmonary disease (COPD). In a longitudinal study, 64 patients completed the Medical Outcomes Study Instrument and the Illness Perception Questionnaire. Data on coping and severity of illness (spirometry) were also collected. Regression analyses showed that first-time illness perceptions and coping significantly contributed to the prediction of social functioning, mental health, health perceptions, total functioning score, and prediction of visits to the outpatient clinic and prescribed medication 1 year later. These results have important implications for the medical management of patients with COPD.

Predicting functional status in patients with rheumatoid arthritis.

OBJECTIVE: To determine whether coping strategies and illness perceptions would be predictive of outcome in a longitudinal study of patients with rheumatoid arthritis (RA). METHODS: A group of 71 patients with RA was examined on 2 occasions, one year apart. Multiple regressions were used to examine which of the illness perceptions and coping strategies explained variance on the outcome variables: visits to the outpatient clinic, number of hospital admissions, Health Assessment Questionnaire, pain, tiredness, the Hospital Anxiety and Depression Scale. RESULTS: Belief in adverse consequences of the disease was associated with more visits to the outpatient clinic. more tiredness, and higher anxiety scores. Less perceived control and less expression of emotion were associated with more hospital admissions. High scores on coping involving fostering reassuring thoughts were associated with more functional disability. More passive coping was associated with more functional disability and higher anxiety scores. More perceived symptoms were associated with more pain, more tiredness, and more depression. More avoidant coping was associated with more tiredness. Belief that the illness will last a long time was associated with higher anxiety scores. CONCLUSION: Our longitudinal data show that, after statistically controlling for the potential effects of intervening medical variables, coping strategies and illness perceptions contribute to health outcome in patients with RA. Implications for patient management are discussed.

High spectral resolution lidar to measure optical scattering properties of atmospheric aerosols. 1: theory and instrumentation.

A high spectral resolution lidar technique to measure optical scattering properties of atmospheric aerosols is described. Light backscattered by the atmosphere from a narrowband optically pumped oscillator-amplifier dye laser is separated into its Doppler broadened molecular and elastically scattered aerosol components by a two-channel Fabry-Perot polyetalon interferometer. Aerosol optical properties, such as the backscatter ratio, optical depth, extinction cross section, scattering cross section, and the backscatter phase function, are derived from the two-channel measurements.