Group cognitive analytic therapy for female survivors of childhood sexual abuse.

OBJECTIVES: The effectiveness of cognitive analytic therapy delivered in groups has been under-researched considering the popularity of the approach. This study sought to investigate the effectiveness of 24 sessions of group cognitive analytic therapy (GCAT) delivered in routine practice for female survivors of childhood sexual abuse (CSA). METHODS: In a longitudinal cohort design, N = 157 patients were treated with 24 sessions of GCAT. Validated outcome measures were administered at assessment, pre-GCAT, and post-GCAT. This enabled rates of reliable and clinically significant change to be compared between wait time and active group treatment. The uncontrolled treatment effect size was then benchmarked against outcomes from matched studies. RESULTS: On the primary outcome measure, GCAT facilitated a moderate effect size of 0.34 with 11% of patients completing treatment meeting 'recovery' criteria. The dropout rate was 19%. Significant improvements in interpersonal functioning, anxiety, and well-being occurred during GCAT in comparison with wait time on secondary outcome measures. CONCLUSIONS: Group cognitive analytic therapy appears a promising intervention for adult female CSA survivors, with further controlled evaluation indicated. PRACTITIONER POINTS: Group cognitive analytic therapy appears a promising and acceptable intervention for female CSA survivors experiencing high levels of psychological distress. Long-term follow-up studies are required with CSA survivors to index the clinical durability of GCAT. A GCAT treatment fidelity measure needs to be developed and evaluated.

Psychological/social factors associated with transfer readiness in young people with juvenile idiopathic arthritis.

The aim of this study is to investigate the relationships between psychological/social factors and transfer readiness from paediatric to adult rheumatology services in pre- and post-transfer young people (YP) with juvenile idiopathic arthritis (JIA). Participants completed questionnaires measuring a broad range of psychological/social factors (generalised anxiety, pain-specific anxiety, pain-related thoughts, depression, prosocial behaviours, problem behaviours, arthritis-related quality of life (QoL), social support, family functioning) and transfer readiness (transfer-related knowledge and skills, health-related self-efficacy). JIA disease activity was measured on the same day as the questionnaires. This study received all relevant ethical and regulatory approvals, and informed consent was received from or on behalf of all participants. In total, 40 pre-transfer YP with JIA aged 10-16 years (M = 13.54 years, 26 females) and their parents/guardians participated at Sheffield Children's NHS Foundation Trust, and 40 post-transfer YP with JIA aged 16-24 years (M = 20.16 years, 26 females) participated at Sheffield Teaching Hospitals NHS Foundation Trust. For both pre- and post-transfer YP, greater transfer readiness was associated with lower generalised anxiety levels, lower pain-specific anxiety levels, fewer pain-related thoughts, lower depression levels, fewer problem behaviours, better arthritis-related QoL, better social support, and better family functioning. Greater transfer readiness was also associated with less JIA disease activity for post-transfer YP only. A broad range of psychological/social factors were associated with transfer readiness in pre- and post-transfer YP with JIA. This highlights the importance of assessing and addressing YP's psychological/social well-being during their transition to adult services. Key Points • A wide range of psychological and social factors may be associated with how ready young people with juvenile idiopathic arthritis feel to move from paediatric to adult rheumatology services. • Transition outcomes may be improved by comprehensively assessing and addressing young people's psychological and social well-being.

Stigma from medication use: an under recognised burden of care.

Children with respiratory diseases take treatments for the self-management of symptoms and to maintain disease control. Often, these treatments need to be taken in social environments like school. Respiratory treatments can foster a feeling of difference and stigmatisation, which negatively impact on the quality of life and adherence to treatment. Such perceptions can lead to a less than optimal disease control, a vicious cycle leading to further social exclusion and stigma. This aspect of "burden of treatment" is poorly recognised by clinicians. Recognition of how treatments and clinical practice can contribute to stigma, can help address this burden of care. EDUCATIONAL AIMS: To understand the meaning of the term "stigma" within the context of respiratory health conditions and how medication or treatments can contribute to stigma in children and young people.To understand the potential impact of stigma on adherence, disease control and quality of life.To consider strategies to manage the stigma associated with health treatments across spheres of influence.

Video-assisted thoracic surgery micro pneumonectomy, a new approach.

BACKGROUND: Video-assisted thoracic surgery (VATS) pneumonectomy is normally limited due to the difficulty to remove the whole lung via the utility incision. We present our technique of VATS pneumonectomy, this we call micropneumonectomy. METHODS: A 75-year-old male current smoker with a right hilar mass, invading both upper and lower lobe bronchi to segmental level on CT scan and PET scan, pathology from CT guided biopsy showed squamous cell carcinoma. The patient had a mediastinoscopy just prior to pneumonectomy, primarily to remove station 7 lymph nodes and to mobilize the carina to facilitate the VATS pneumonectomy. RESULTS: Smooth postoperative course, and patient was fit for discharge two and half days post operatively. CONCLUSIONS: Our technique showed an effective way of doing pneumonectomy via VATS technique, which expands the use of VATS technique into pneumonectomies, with three intercostals incisions smaller than 5 mm, in addition to a single sub-xiphoid incision which can take 12 mm instruments.

Cognitive analytic therapy: a review of the outcome evidence base for treatment.

PURPOSE: This study reviews the quality of the extant outcome evidence for cognitive analytic therapy (CAT) to inform clinical practice and to stimulate a future CAT research strategy. METHOD: An electronic search identified CAT efficacy and effectiveness studies and these were subject to systematic review. The methodological quality of studies meeting inclusion criteria were appraised using two validated research study quality checklists and studies were fitted to an established model of psychotherapy evaluation. RESULTS: Twenty-five outcome studies met the inclusion criteria, including five randomized controlled trials. The CAT evidence base is predominated by small-scale practice-based studies, in typically complex and severe clinical populations - 44% were focal to the treatment of personality disorder. Although the quality of extant CAT evidence is generally sound (52% of studies were high quality), the depth and breadth of the evidence base is currently limited. Where comparisons with other modalities are available, CAT appears largely equivocal. CONCLUSIONS: Cognitive analytic therapy is a popular and promising intervention for complex presentations. However, the evidence base currently lacks wider credibility due to having largely bypassed the rigours of the controlled phase of the hourglass model of psychotherapy evaluation. There is a particular need for further CAT outcome research with common mental health problems. PRACTITIONER POINTS: CAT can be an effective intervention across a range of mental health difficulties. Consider a 24-session CAT contract for those patients presenting with complex and severe difficulties. Practice research networks could make a significant contribution to the CAT evidence base.

Is incentive spirometry effective following thoracic surgery?

A best evidence topic in thoracic surgery was written according to a structured protocol. The question addressed was whether incentive spirometry is a useful intervention for patients after thoracic surgery. Altogether 255 papers were found using the reported search, of which seven represented the best evidence to answer the clinical question. The authors, journal, date and country of publication, patient group studied, study type, relevant outcomes and results of these papers are tabulated. We conclude that incentive spirometry is a relatively good measure of lung function and may be used to assess respiratory recovery in the days after thoracic surgery. Physiotherapy either with or without incentive spirometry reduces the incidence of postoperative complications and improves lung function but there is currently no evidence that incentive spirometry in itself could either replace or significantly augment the work of the physiotherapists. Clinicians should be aware that while incentive spirometry can provide an assessment of lung recovery, well-organised and regular physiotherapy remains the most effective mechanism to augment their patient's recovery and avoid postoperative complications.