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Selected AbstractsEvaluation of a treatment programme for alcohol-related aggressionCRIMINAL BEHAVIOUR AND MENTAL HEALTH, Issue 4 2008Anna McCulloch Background,The development of effective treatments for alcohol-related aggression and violence is important in binge drinking cultures, as in parts of the UK. Aim,The aim was to evaluate the progress and experience of 10 participants in Control of Violence for Angry Impulsive Drinkers (COVAID) using a single case methodology. Method,Participants completed 10 individual weekly sessions with trained facilitators following the COVAID manual. Change scores on psychometric questionnaires were examined by calculating clinical significance and reliability of change. Self-reports of alcohol consumption and aggression were examined. Follow-up data on convictions were collected. Participants were asked their opinions about COVAID. Results,Scores on the Alcohol-Related Aggression Questionnaire (ARAQ) improved for nine participants; change was both clinically significant and reliable in five cases. Nine participants improved on the Controlled Drinking Self-Efficacy Scale (CDSES), with seven showing clinically significant improvement. Six participants reported a reduction in alcohol consumption from the first to the second half of the programme. At a mean of 29 weeks post-treatment, none of the participants had been reconvicted for a violent offence. Participants reported finding COVAID useful and interesting. Conclusion,Overall, our findings support the possibility that COVAID may assist in reducing alcohol-related violence and violent offending. Copyright © 2008 John Wiley & Sons, Ltd. [source] Out-patient behaviour therapy in alcoholism: treatment outcome after 2 yearsACTA PSYCHIATRICA SCANDINAVICA, Issue 3 2002W. Burtscheidt Burtscheidt W, Wölwer W, Schwarz R, Strauss W, Gaebel W. Out-patient behaviour therapy in alcoholism: treatment outcome after 2 years. Acta Psychiatr Scand 2002: 106: 227,232. © Blackwell Munksgaard 2002. Objective:,The main aim of the study was the evaluation of out-patient behavioural approaches in alcohol dependence. Additionally, the persistence of treatment effects and the impact of psychiatric comorbidity in long-term follow-up was examined. Method:,A total of 120 patients were randomly assigned to non-specific supportive therapy or to two different behavioural therapy programmes (coping skills training and cognitive therapy) each comprising 26 weekly sessions; the follow-up period lasted 2 years. Results:,Patients undergoing behavioural therapy showed a consistent trend towards higher abstinence rates; significant differences between the two behavioural strategies could not be established. Moreover, the results indicate a reduced ability of cognitive impaired patients to cope with short-time abstinence violations and at a reduced benefit from behavioural techniques for patients with severe personality disorders. Conclusion:,Behavioural treatment yielded long-lasting effects and met high acceptance; yet, still in need of improvement is the development of specific programmes for high-risk patients. [source] Smoking cessation during alcohol treatment: a randomized trial of combination nicotine patch plus nicotine gumADDICTION, Issue 9 2009Ned L. Cooney ABSTRACT Aims The primary aim was to compare the efficacy of smoking cessation treatment using a combination of active nicotine patch plus active nicotine gum versus therapy consisting of active nicotine patch plus placebo gum in a sample of alcohol-dependent tobacco smokers in an early phase of out-patient alcohol treatment. A secondary aim was to determine whether or not there were any carry-over effects of combination nicotine replacement on drinking outcomes. Design Small-scale randomized double-blind placebo-controlled clinical trial with 1-year smoking and drinking outcome assessment. Setting Two out-patient substance abuse clinics provided a treatment platform of behavioral alcohol and smoking treatment delivered in 3 months of weekly sessions followed by three monthly booster sessions. Participants Participants were 96 men and women with a diagnosis of alcohol abuse or dependence and smoking 15 or more cigarettes per day. Intervention All participants received open-label transdermal nicotine patches and were randomized to receive either 2 mg nicotine gum or placebo gum under double-blind conditions. Findings Analysis of 1-year follow-up data revealed that patients receiving nicotine patch plus active gum had better smoking outcomes than those receiving patch plus placebo gum on measures of time to smoking relapse and prolonged abstinence at 12 months. Alcohol outcomes were not significantly different across medication conditions. Conclusions Results of this study were consistent with results of larger trials of smokers without alcohol problems, showing that combination therapy (nicotine patch plus gum) is more effective than monotherapy (nicotine patch) for smoking cessation. [source] ,I'm the Boss': testing the feasibility of an evidence-based patient education programme using problem-based learningEUROPEAN DIABETES NURSING, Issue 1 2004K Wikblad FEND Professor in Diabetes Nursing Abstract Patient education programmes have shown only small to modest effects on diabetes self-care and metabolic control. Despite that, almost all diabetes teams agree that patient education is an extremely important part of the treatment of diabetes. It is, therefore, important to identify components of successful patient education as a basis for creating and testing an evidence-based education programme. In a review of controlled studies evaluating patient education such components were identified and these were then used in building up the new programme. This programme, called ,I'm the Boss', is based on the notion that the patient is an active care participant, setting his own self-care goals, and is the one responsible for his own life. The content of the programme did not, therefore, focus on diabetes as such, but on life with diabetes. Six themes were explored during six three-hour weekly sessions. The educational method used was problem-based learning. This method is founded in cognitive theory and views the learner as active in seeking knowledge and able to solve the self-care problems identified. The aim of this study was to explore the feasibility of the programme which was tested in four small groups (five to eight participants) of diabetic patients together with two facilitators. After completing the programme, the patients participated in focus group interviews to evaluate the programme. They identified both positive and negative factors. After each session the two facilitators reflected upon the group dynamics. In particular, problems with allowing patients to be the experts should be highlighted. This programme has been modified according to the evaluation and it is now being tested in a randomised, controlled, multicentre study. Copyright © 2004 FEND. [source] Early Clinical Exposure to Geriatric Medicine in Second-Year Medical School Students,The McGill ExperienceJOURNAL OF AMERICAN GERIATRICS SOCIETY, Issue 4 2003Gustavo Duque MD This study examined the effect of a curriculum change on early clinical exposure to geriatrics for second-year medical students at McGill University and its effects on learning and students' appreciation of geriatrics as a subspecialty. Second-year medical students (N = 200) were exposed to a change in the curriculum involving the integration of 10 weekly sessions into one integrated week in geriatric medicine. Students participating in 10 weekly sessions were Group 1 and students participating in one integrated week were Group 2. Students rated their rotation using two different scales. The students completed 12-item questionnaires during their feedback sessions at the end of the 10-week session experience or the integrated week. The first six items assessed the students' appreciation of their improvement of knowledge in the subject of geriatrics and aging. The second and third part of the survey (questions 7 and 8) included the students' opinions about the quality of the instruction (teaching feedback) and evaluation. Students in Group 2 found their rotation more effective as a learning experience and expressed greater satisfaction with interaction with the tutors, community settings, and multidisciplinary team sessions. Grades obtained on final examinations showed a better and more-effective acquisition of knowledge by Group 2. The integrated week is a more-effective learning tool in the early clinical experience for medical students in geriatric medicine than 10 weekly sessions as the first introductory experience to the field of geriatric medicine. [source] Pressure,pain threshold determination in the oral mucosa: validity and reliabilityJOURNAL OF ORAL REHABILITATION, Issue 7 2002T. Ogimoto Fundamental knowledge of pain in the oral mucosa is lacking. We determined the validity and reliability of the pressure,pain threshold (PPT) measurement in the oral mucosa using a newly developed hand-held pressure algometer. Ten dentulous subjects were recruited, and the PPT was measured at the bilateral buccal (on the attached gingiva apical to the midline of the upper first premolars, 3 mm from the mucogingival junction) and the palatal sites (mid-point between the bilateral upper first molars). The PPT linearly increased with an increase in load-rate (P < 0·0001). The PPT yielded a high intra-individual stability both for the same-day consecutive trials and weekly sessions. The palatal site revealed a 4- to 4·65-fold greater PPT than the buccal sites (Bonferroni, P < 0·0001), whereas no difference was found between the bilateral buccal sites (P=0·663). Despite a great interindividual variation in the PPT, significant intra-individual correlations were found among the measurement sites. This suggested differences in individual sensitivity to pain in the oral mucosa, which may determine overall pain sensation specific to an individual. A pressure algometer described herein reliably assessed the PPT in the oral mucosa and sensitively discriminated PPT differences at different sites and at different load-rates, suggest-ing the reliability and validity of PPT measure-ments in the oral mucosa for clinical and research investigations. [source] TIME MATTERS IN TEAM PERFORMANCE: EFFECTS OF MEMBER FAMILIARITY, ENTRAINMENT, AND TASK DISCONTINUITY ON SPEED AND QUALITYPERSONNEL PSYCHOLOGY, Issue 3 2003DAVID A. HARRISON We compared the speed and quality of performance for familiar, initially unfamiliar but continuing, and one-shot (single session) teams. We also proposed and observed entrainment effects for task time limits. Over the course of weekly sessions with changing tasks, continuing teams reached speed levels of the initially familiar teams, but the one-shot teams were consistently slower. Continuing teams also tended to have higher-quality output than the one-shot teams. There were no differences in how quickly each type of group entrained to time limits on the tasks. Entrainment was not robust to task discontinuity (Task A, then B). However, entrainment on repeated trials of a task persisted even when a different type of task "interrupted" those repeated trials (Task A, then B, then A again). Results compel a richer incorporation of time as a medium for complex task sequences, and time-based constructs as a feature of team membership in the study of group effectiveness. [source] Ultraviolet A in vitiligoPHOTODERMATOLOGY, PHOTOIMMUNOLOGY & PHOTOMEDICINE, Issue 4 2006Medhat El-Mofty Both types of Ultraviolet (UV), UVB (290,320 nm) and UVA (320,400 nm), produce increased pigmentation or tanning. However, no evaluation of UVA alone in the treatment of vitiligo has been reported. Therefore, it was the purpose of this work to study the pigmentogenic effect of UVA (5 and 15 J/cm2) in vitiligo. The study included 20 randomly selected patients with vitiligo involving more than 30% of the body surface area with a bilateral/symmetrical distribution. They were equally divided into two groups each of 10 patients. All patients received three weekly sessions of UVA, 15 J/cm2 in group I and 5 J/cm2 in group II, a total of 48 sessions over 16 weeks. Overall pigmentation of 60% and above was recorded in 50% and 10% of patients in groups I and II, respectively. We conclude that broadband UVA alone, without psoralens, and in appropriate doses may be of important therapeutic value in vitiligo. [source] Evaluation of a group cognitive behavioural intervention for women suffering from menopausal symptoms following breast cancer treatmentPSYCHO-ONCOLOGY, Issue 5 2009Myra S. Hunter Abstract Objective: To evaluate a group cognitive behavioural intervention to alleviate menopausal symptoms in women who have had treatment for breast cancer. Methods: A single group design was used with pre- and post-treatment assessment and a 3-months follow-up. Seventeen women who had completed active breast cancer treatment were treated. Following a 2-week daily diary assessment they were offered 6 (90,min) weekly sessions of Group cognitive behaviour therapy (CBT). The CBT included information and discussion, relaxation and paced breathing and CBT to reduce stress and manage hot flushes (HF), night sweats (NS) and sleep. The primary outcome measure was Hot Flush Frequency and Hot Flush Problem Rating; secondary outcomes included the Women's Health Questionnaire (WHQ) and health-related quality of life (SF 36). Beliefs about HF were monitored in order to examine the effects of cognitive therapy. Results: HF and NS reduced significantly following treatment (38% reduction in frequency and 49% in problem rating) and improvements were maintained at 3 months follow-up (49% reduction in frequency and 59% in problem rating). Depressed mood, anxiety and sleep (WHQ) significantly improved, as did aspects of quality of life (SF 36) (emotional role limitation, energy/vitality and mental health). There was a significant reduction in negative beliefs about HF, NS and sleep following CBT. Conclusions: These results suggest that CBT delivered in groups might offer a viable option for women with troublesome menopausal symptoms following breast cancer treatment, but further controlled trials are needed. Copyright © 2008 John Wiley & Sons, Ltd. [source] Posterior tibial nerve stimulation in patients with intractable interstitial cystitisBJU INTERNATIONAL, Issue 1 2004Jimao Zhao OBJECTIVE To evaluate the efficacy of intermittent percutaneous posterior tibial nerve stimulation (PPTNS) in patients with refractory interstitial cystitis. PATIENTS AND METHODS One man and 13 women (mean age 58.3 years) with suprapubic or perineal pain were enrolled in a prospective open study, in which they had 10 weekly sessions of PPTNS. Their mean duration of symptoms was 8.3 years. All patients were previously diagnosed as having interstitial cystitis according to the National Institute of Diabetes and Digestive and Kidney Diseases criteria. The response to the treatment were assessed using voiding diary, visual analogue scale diary for a pain index, and the Interstitial Cystitis Problem Index (ICPI), O'Leary/Sant Interstitial Cystitis Symptom Index (ICSI) and the 36-item short-form health survey (SF-36) quality-of-life questionnaire. RESULTS Of the 14 patients, 13 completed the 10 weeks of treatment with no complications; 12 continued treatment for a short period after the study. There were no statistically significant changes in pain scores, voiding frequency and volumes, or in the ICPI, ICSI and SF-36 scores. However, there was an improvement in some patients, with one having complete resolution of the pain. CONCLUSION Intermittent PPTNS in patients with refractory interstitial cystitis has no significant clinical effect over 10 weeks of treatment. [source] 12 Highly Interactive Teaching: A "HIT" with ResidentsACADEMIC EMERGENCY MEDICINE, Issue 2008Linda Regan Covering the core content of emergency medicine during residency training is both a time consuming and challenging endeavor. One of the more significant challenges in graduate medical education is to develop more interactive, less didactic teaching modalities. In an attempt to develop a more interactive educational curriculum, we interspersed weekly sessions titled "Highly Interactive Teaching" (HIT) with standard formal lecture didactics. A primary focus of many educators in emergency medicine is teaching residents how to manage the undifferentiated patient. To this end, we revised our curriculum to include 34 four-hour symptom/chief complaint-based sessions. The first hour is an introductory lecture on the general approach to a patient with the specified complaint. Residents then divide into small groups which rotate through specific case-based sections covering varied diagnoses which might present with the symptom complaint. These faculty-run small groups use a case-based approach, either high or low simulation-based or oral boards-based format. Each faculty then is required to sum up the salient points of their section. The final hour of the day is an evidenced-based review of supporting literature. Residents are required to read and critique selected articles for the audience so that the basis for diagnosis and management decisions can be discussed as a large group discussion. We believe this change in format will help residents not only to become more active learners, but also to become more astute clinicians. [source] | |||||||||||||