Comparative effectiveness of Pilates and yoga group exercise interventions for chronic mechanical neck pain: quasi-randomised parallel controlled study.

OBJECTIVES: To determine the effectiveness of Pilates and yoga group exercise interventions for individuals with chronic neck pain (CNP). DESIGN: Quasi-randomised parallel controlled study. SETTING: Community, university and private practice settings in four locations. PARTICIPANTS: Fifty-six individuals with CNP scoring ≥3/10 on the numeric pain rating scale for >3 months (controls n=17, Pilates n=20, yoga n=19). INTERVENTIONS: Exercise participants completed 12 small-group sessions with modifications and progressions supervised by a physiotherapist. MAIN OUTCOME MEASURES: The primary outcome measure was the Neck Disability Index (NDI). Secondary outcomes were pain ratings, range of movement and postural measurements collected at baseline, 6 weeks and 12 weeks. Follow-up was performed 6 weeks after completion of the exercise classes (Week 18). RESULTS: NDI decreased significantly in the Pilates {baseline: 11.1 [standard deviation (SD) 4.3] vs Week 12: 6.8 (SD 4.3); mean difference -4.3 (95% confidence interval -1.64 to -6.7); P<0.001} and yoga groups [baseline: 12.8 (SD 7.4) vs Week 12: 8.1 (SD 5.6); mean difference -4.7 (95% confidence interval -2.1 to -7.4); P<0.00], with no change in the control group. Pain ratings also improved significantly. Moderate-to-large effect sizes (0.7 to 1.8) and low numbers needed to treat were found. There were no differences in outcomes between the exercise groups or associated adverse effects. No improvements in range of movement or posture were found. CONCLUSIONS: Pilates and yoga group exercise interventions with appropriate modifications and supervision were safe and equally effective for decreasing disability and pain compared with the control group for individuals with mild-to-moderate CNP. Physiotherapists may consider including these approaches in a plan of care. CLINICAL TRIAL REGISTRATION NUMBER: ClinicalTrials.gov NCT01999283.

The psychiatric clinical specialist's impact on psychiatric emergency services.

Psychiatric emergency services have evolved into more comprehensive programs during the past two decades. With this evolution other disciplines have gained access to the services and integrated their expertise and philosophy into the daily care of patients. Nursing has been an integral part of this process and contributed its perspective in nursing care. This paper outlines the development of psychiatric emergency services with a special emphasis on the contribution of nursing specialists who have developed their role within the psychiatric emergency service. What has been unique about the nursing contribution is the attention to individualizing patient care and modifying treatment approaches to meet the patients' needs and interests in psychiatric treatment. Additionally, nursing has complemented the physician's role by developing expertise in assessment that is both psychologically and biologically oriented. Nursing's future contribution to psychiatric emergency services should address mechanisms for tracking patients who enter the psychiatric emergency service system with an emphasis on linkage with other programs or resolution of the crisis episode.

Psychiatric consultation and collaboration.

Overcoming resistance to the stigma of psychiatric care is a first step in merging mental health care with primary care. The practitioner's role in socializing clients who could potentially benefit from psychiatric care is vital in gaining acceptance for mental health care. The socialization process should address reasons for mental health care, elaborate on the client's choices in selecting a suitable therapist and reassure the client that the primary care provider will maintain a collaborative relationship with the therapist. For those clients or situations that cannot be referred to a specialist, psychiatric consultation models are useful alternatives for the primary care provider. Regularly scheduled meetings with a psychiatric consultant provide time to discuss clients, assessment techniques, intervention strategies or impediments to the delivery of mental health care. Increased knowledge of mental health practices will improve case finding and implementation of psychotherapeutic plans.

Prescribing practices of advanced practice psychiatric nurses: Part I--Demographic, educational, and practice characteristics.

This study was designed to identify and describe the prescribing practices of advanced practice psychiatric nurses. Part I describes the demographic, educational, and clinical setting characteristics. A survey method was used with N = 88 nurses representing seven different states. Nurse prescribers were: younger than nonprescribers, employed in community mental health settings, and voluntarily using a consulting physician arrangement. Limitations on practice included: statute formulary, controlled substances, and formulary/protocols with a consulting physician. Results suggest nurses' prescribing practices are used in outpatient settings, viewed as conservative, with a value on physician collaboration even in the absence of legal mandates.

Prescriptive authority for psychiatric clinical specialists: framing the issues.

Prescriptive authority is of increasing interest to advanced practice psychiatric nurses. A growing number of states have passed legislation authorizing prescriptive authority for this specialty group. In preparing for an orderly assimilation of this intervention into psychiatric nursing's existing scope of practice, it is important to understand some of the unique issues facing the specialty. This report provides an overview of prescriptive practice legislation, legal issues associated with prescribing psychotropic medication to psychiatric clientele, and prescriptive activities common to the specialty practice of psychiatry. Issues for the specialty of psychiatric nursing are reviewed and recommendations are offered for an action plan.

Effect of psychiatric liaison nurse specialist consultation on the care of medical-surgical patients with sitters.

One hundred seven patients in an acute care setting who had lay sitters to provide the constant observation judged necessary to meet their safety needs were studied to determine the effect of psychiatric liaison nurse specialist (PLNS) consultation on nursing care and the use of sitters. After placement in either a suicidal or nonsuicidal group, subjects were randomly assigned to receive consultation or not. Outcome variables of number of sitter shifts, number of nursing note observations, number of patient and sitter incidents and length of hospital stay were considered. Multiple analysis of variance indicated no significant differences among the groups for number of sitter shifts or number of nursing note observations. A significant main effect for group on length of hospital stay was found with suicidal patients having a significantly shorter hospital stay. Number of patients and sitter incidents were too small for analysis.

Psychological distress is linked to gastrointestinal symptoms in diabetes mellitus.

OBJECTIVE: Gastrointestinal (GI) symptoms are common in patients with long-standing diabetes mellitus, but the pathogenesis is controversial. We aimed to determine if GI symptoms are linked to psychological distress in diabetes. METHODS: A consecutive sample of outpatients with diabetes mellitus (n = 209) and a random sample of community diabetics (n = 892) completed a validated questionnaire measuring GI symptoms, the Hospital Anxiety and Depression (HAD) Scale for anxiety and depression, and the Eysenck short neuroticism scale. RESULTS: Overall, 42% reported one or more GI symptoms: bloating, abdominal pain, loose stools, and urgency were most common. The mean HAD and neuroticism scores were significantly higher for most GI symptoms (11 of 14, all p < 0.05), and a dose-response relationship was observed. GI symptoms were, in general, approximately twice as frequent in cases with anxiety or depression (HAD > or = 11). Anxiety, depression, and neuroticism were each independently associated with the number of GI symptoms, adjusting for age, gender, duration and type of diabetes, and self-reported glycemic control. CONCLUSIONS: Increased levels of state anxiety and depression and neuroticism are associated with upper and lower GI symptoms in diabetes mellitus. It is uncertain whether psychological distress is causally linked to symptoms, or whether GI symptoms per se increase levels of anxiety and depression.