Cognitive-behaviour therapy for post-traumatic stress in schizophrenia. A randomized controlled trial.

BACKGROUND: There is limited evidence for effective interventions in the treatment of post-traumatic stress symptoms within individuals diagnosed with schizophrenia. Clinicians have concerns about using exposure treatments with this patient group. The current trial was designed to evaluate a 16-session cognitive restructuring programme, without direct exposure, for the treatment of post-traumatic stress symptoms specifically within individuals diagnosed with schizophrenia. METHOD: A multicentre randomized controlled single-blinded trial with assessments at 0 months, 6 months (post-treatment) and 12 months (follow-up) was conducted. A total of 61 participants diagnosed with schizophrenia and exhibiting post-traumatic stress symptoms were recruited. Those randomized to treatment were offered up to 16 sessions of cognitive-behaviour therapy (CBT, including psychoeducation, breathing training and cognitive restructuring) over a 6-month period, with the control group offered routine clinical services. The main outcome was blind rating of post-traumatic stress symptoms using the Clinician Administered PTSD Scale for Schizophrenia. Secondary outcomes were psychotic symptoms as measured by the Positive and Negative Symptom Scale and the Psychotic Symptom Rating Scale. RESULTS: Both the treatment and control groups experienced a significant decrease in post-traumatic stress symptoms over time but there was no effect of the addition of CBT on either the primary or secondary outcomes. CONCLUSIONS: The current trial did not demonstrate any effect in favour of CBT. Cognitive restructuring programmes may require further adaptation to promote emotional processing of traumatic memories within people diagnosed with a psychotic disorder.

A platelet and granulocyte membrane defect in paroxysmal nocturnal hemoglobinuria: usefulness for the detection of platelet antibodies.

The tendency of platelets and leukocytes to lyse after their interaction with antibody and complement was studied by measuring the release of (51)Cr from cells labeled with this isotope. Platelets from six patients with paroxysmal nocturnal hemoglobinuria (PNH) were 15-230 times more sensitive to antibodies and 10-32 times more sensitive to complement than normal platelets or platelets from patients with other types of thrombocytopenic or hemolytic disorders. Mixed white blood cell (WBC) preparations from patients with PNH were 3-20 times more sensitive to anti-WBC antibodies and 5-10 times more sensitive to C' than were WBC preparations from normal subjects, but PNH lymphocytes showed normal immunologic reactivity. PNH platelets, like PNH erythrocytes, lysed more readily than normal platelets in acidified serum and in media of reduced ionic strength, but these characteristics were not demonstrable with PNH WBC's under the conditions of study. In PNH, platelets appear to comprise a single population with respect to their sensitivity to immune lysis, yet their survival time as measured with (51)Cr falls within normal limits. PNH granulocytes likewise appear to consist of a single, uniformly sensitive population. It is concluded that, in PNH, platelets and granulocytes share the membrane defect characteristic of erythrocytes in this disorder. These observations support the concept that PNH arises as the result of a somatic mutation in a primitive cell capable of differentiating into erythroblast, myeloblast, and megakaryoblast lines. PNH platelets or enzymatically treated normal platelets permit the detection of some types of platelet antibodies in dilutions up to 2000-fold greater than is possible with currently available methods, a finding suggesting that the immune lysis technique will prove useful for the study of platelet immunology.

Survival following amniotic fluid embolism and cardiac arrest complicated by sub-capsular liver haematoma.

We describe the anaesthetic and intensive care management of a 38-year-old mother with presumed amniotic fluid embolism who suffered cardiorespiratory collapse following delivery of a normal baby by caesarean section. After initial resuscitation, her recovery was complicated by development of disseminated intravascular coagulation and a large sub-capsular hepatic haematoma. We describe the initial resuscitative efforts and subsequent intensive therapy to full neurological recovery and discharge from hospital.

Breastfeeding and the risk of sudden infant death syndrome.

The New Zealand Cot Death Study, a multicentre case-control study, was set up to identify risk factors associated with sudden infant death syndrome (SIDS). In the 3 years of the study there were 485 infant deaths classified as SIDS in the study areas and 1800 infants who were randomly selected as controls. Data were collected by parent interviews and from obstetric notes. A full set of data for this analysis was available from 356 cases and 1529 control infants. The relationship between length of any breastfeeding and SIDS was examined: 92% of the controls were initially breastfed compared to 86% of the cases. As time went by, cases stopped breastfeeding sooner than controls: by 13 weeks, 67% controls were breastfed versus 49% cases. A reduced risk for SIDS in breastfed infants persisted during the first 6 months after controlling for confounding demographic, maternal and infant factors. Infants exclusively breastfed 'at discharge from the obstetric hospital' (odds ratio [OR] = 0.52, 95% confidence interval (CI): 0.35-0.71) and during the last 2 days (OR = 0.65, 95% CI: 0.46-0.91) had a significantly lower risk of SIDS than infants not breastfed after controlling for potential confounders. We have shown a substantial association of breastfeeding with a lowered risk for SIDS. This supports the need for more positive promotion and active community support to further enhance the level and length of exclusive breastfeeding.

Reduced cognitive inhibition in obsessive-compulsive disorder.

On a semantic negative priming task designed to investigate putative inhibitory mechanisms of selective attention, obsessive-compulsive disordered (OCD) subjects were distinguished from all other sub-categories of anxiety disorder (OAD). OCD subjects failed to show any priming effects in the repetition priming condition and exhibited facilitation in the semantic priming condition (i.e. shorter reaction times to previously ignored stimuli). OAD subjects demonstrated negative priming (i.e. longer reaction times to previously ignored stimuli) in both experimental conditions. These results are interpreted in terms of reduced cognitive inhibition in OCD and the implications of this hypothesis are discussed. Parallels are also drawn with previous studies regarding the results of high schizotypes and schizophrenic subjects using negative priming tasks.

How to play by H.S.A. rules and still win.

Instead of placing themselves in an adversarial relationship with the local Health Systems Agencies (H.S.A.), physicians in Minnesota have formed committees to monitor and cooperate with each of the state's local H.S.A.s. Funded by the Minnesota Medical Association, the Physicians Health Force (P.H.F.) is organized along the same lines as each H.S.A. When an H.S.A. forms a committee or task force, the local P.H.F. does the same. In addition, each physician that is a member of the H.S.A. is also an ex-officio member of the Physicians Health Force. Although the physician groups were viewed with some skepticism when they first were formed in 1974, many H.S.A. staffers now believe that the groups help foster a spirit of cooperation and communication between physicians and the rest of the community.

A prognostic tool to predict fatigue in women with early-stage breast cancer undergoing radiotherapy.

BACKGROUND: Fatigue during and after radiotherapy impacts negatively on normal functioning and quality of life. A pre-treatment estimate of the risk of fatigue would facilitate the targeting of timely interventions to limit consequential behavioural symptoms arising. We have developed a prognostic tool to predict the risk of fatigue in women with early-stage breast cancer undergoing radiotherapy. METHODS: Socio-demographic, clinical and self-reported characteristics were recorded for 100 women prescribed adjuvant radiotherapy for stages Tis-T2N1 breast cancer. Multiple logistic regression was used to develop a parsimonious prognostic model. The performance of the model when predicting fatigue for individuals not in the study was estimated by a leave-one-out cross-validation. A statistical weighting was assigned to the model variables to render a Fatigue Propensity Score of between 0 and 15. The ability of the Propensity Score to discriminate fatigued participants was estimated via receiver operating characteristic curve analysis. RESULTS: 38% of participants reported significant fatigue during radiotherapy. Fatigue risk was predicted by elevated pre-treatment fatigue and anxiety, and diagnoses other than invasive ductal carcinoma (ductal carcinoma in-situ, invasive lobular and rarer carcinoma subtypes). The positive predictive value of the prognostic model was 80%. A Propensity Score threshold of ≥6 corresponded to a specificity of 90.3% and a sensitivity of 76.3%. The area under the receiver operating characteristic curve was 0.83 for the cross-validation sample. CONCLUSIONS: Application of the Fatigue Propensity Score in the patient pathway can help direct fatigue management resources at those patients most likely to benefit.

Management of respiratory problems in people with neurodegenerative conditions: a narrative review.

BACKGROUND: Respiratory failure and dysfunction are common problems in many neurodegenerative conditions. Although physiotherapists manage these problems, it is not known which treatments have been studied and their efficacy. OBJECTIVE: To review evidence on the management of respiratory problems in people with neurodegenerative conditions using the PRISMA approach. DATA SOURCES: Comprehensive searches were conducted using the following electronic databases from inception to May 2010: HUGEnet, SIGLE, British Library Direct, CINAHL, Medline, AMED and Web of Knowledge. Bibliographies of all studies and systematic reviews were searched by hand. STUDY SELECTION: Studies were selected based on: self-ventilating participants with neurodegenerative conditions; interventions aimed at improving respiratory function; and any valid and reliable measures of respiratory function as outcomes. STUDY APPRAISAL: Studies were appraised by one reviewer using the Critical Appraisal Skills Programme. Data were synthesised using a narrative approach. RESULTS: Thirty-five studies were included in the review. The strongest evidence was for the use of non-invasive ventilation for people with amyotrophic lateral sclerosis, although this was weak. The evidence for the use of respiratory muscle training and methods to increase peak cough flow showed a positive effect, but was also weak. CONCLUSION: There is weak evidence for the positive effects of physiotherapeutic interventions for respiratory problems in people with neurodegenerative conditions. Further work is necessary in specific neurodegenerative conditions to identify why respiratory problems occur, and larger scale studies should be undertaken to investigate management of these problems.

A pilot investigation of quality of life and lung function following choral singing in cancer survivors and their carers.

BACKGROUND: The diagnosis of cancer creates a wide range of social and emotional problems to patients and carers. However, delivering effective psychological, emotional, and social support remains a challenge. This pilot study evaluated quality of life (QoL) and lung function before and after three months of choral singing in cancer survivors and their carers. METHODS: At baseline, 30 cancer survivors and their carers, mean (standard deviation) age 60 (10), completed questions about QoL (SF-36), anxiety and depression, and the multidimensional fatigue score. Lung function was measured by spirometry, and respiratory musclestrength (maximal inspiratory pressure, MIP; maximal expiratory pressure, MEP) was also measured. Assessments were repeated after three months of singing in the choir, and 10 participants completed semi-structured interviews to explore their experience of the choir. RESULTS: After three months of choral singing, 20 subjects repeated the assessments. Several domains of the SF-36 improved, including vitality, social functioning, mental health, and bodily pain. There was also a trend of reduced anxiety and depression, despite no change in fatigue. Spirometric measures of lung function were unchanged; however, there was a trend of increased MEP. Themes from the interviews revealed that the choir provided a focus, so the future participants felt uplifted and had greater confidence and self-esteem. CONCLUSIONS: This pilot project provides preliminary data which suggest choral singing may improve QoL and depression, despite no physiological change in cancer survivors and their carers. Choral groups offer a support mechanism applicable to cancer patients, carers, and supporters, and may be relevant to other chronic conditions. Further research examining the efficacy of this intervention in a larger controlled study is warranted.