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Lyons M. Group sessions: experimental approach to support patients using rectal irrigation. ACTA ACUST UNITED AC 2013. [DOI: 10.12968/gasn.2013.11.9.42] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Monica Lyons
- Pelvic Floor Unit of Guy's and St Thomas' NHS Foundation Hospital, London, England
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2
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Abstract
Diabetes affects 25.8 million persons in the United States, and these persons make more than 35 million ambulatory care visits annually. Yet, less than half of persons with diabetes meet the recommended levels of A1C, blood pressure and lipid control. One innovative approach is to use mobile health technologies to help patients better manage their diabetes and related conditions, and 85% to 90% of patients have access to mobile health technology. A brief review of the guidelines for diabetes care and mobile health technology that can support the guidelines are reported related to (1) glycemic control and self-monitoring of blood glucose, (2) pharmacological approaches and medication management, (3) medical nutrition therapy, (4) physical activity and resistance training, (5) weight loss, (6) diabetes self-management education and (7) blood pressure control and hypertension. The patient and provider are encouraged to explore possibilities for mobile health technologies that can support behavior change.
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Hodges LJ, Walker J, Kleiboer AM, Ramirez AJ, Richardson A, Velikova G, Sharpe M. What is a psychological intervention? A metareview and practical proposal. Psychooncology 2011; 20:470-8. [PMID: 20878870 DOI: 10.1002/pon.1780] [Citation(s) in RCA: 55] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECTIVE What do we mean by a 'psychological intervention' in the context of cancer care? It is critical to know what treatments are included under this term, if data from diverse treatment trials are to be summarized in order to inform clinical practice. We, therefore, aimed to determine how the term 'psychological intervention' has been defined and used to group and compare interventions in reviews of cancer care. METHODS We conducted a review of existing reviews (a metareview). These included systematic and narrative reviews and meta-analyses of interventions that were described as 'psychological', with the aim of determining: (a) the definitions for 'psychological interventions' that were used and (b) the treatments that were included within this category. RESULTS We identified 66 relevant reviews. Surprisingly, we were unable to find any explicit definition of the term 'psychological intervention' in these reviews. The reviews included 79 different treatments with little consistency between reviews in which treatments were included. CONCLUSIONS There is confusion about what 'psychological intervention' means in the cancer review literature. A clearer definition is essential to summarize research findings. We propose that rather than simply grouping interventions as 'psychological', it would be more useful if reviews focussed on specified domains of the interventions, namely content, proposed mechanism, target outcome, and methods of delivery. This would enable greater specificity in the review question, more meaningful comparisons, and would hopefully provide clearer answers for the readers of the reviews. A checklist for the summarizing of reports of interventions for review is provided.
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Stiefel F, Zdrojewski C, Bel Hadj F, Boffa D, Dorogi Y, So A, Ruiz J, de Jonge P. Effects of a multifaceted psychiatric intervention targeted for the complex medically ill: a randomized controlled trial. PSYCHOTHERAPY AND PSYCHOSOMATICS 2008; 77:247-56. [PMID: 18443391 DOI: 10.1159/000129658] [Citation(s) in RCA: 53] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
BACKGROUND This study evaluated a multifaceted psychiatric intervention targeted at the complex medically ill identified by means of the INTERMED, an instrument to assess case complexity. METHODS Of 885 rheumatology inpatients and diabetes outpatients who were assessed for eligibility, 247 were identified as complex (INTERMED score >20) and randomized to the intervention (n = 125, 84 rheumatology and 41 diabetes patients) or care as usual (n = 122, 78 rheumatology and 44 diabetes patients). For the majority of the cases the multifaceted intervention consisted of an intervention conducted by a psychiatric liaison nurse and/or of referral to a liaison psychiatrist, followed by advice to the treating physician or organization of a multidisciplinary case conference. Baseline and follow-up at months 3, 6, 9 and 12 measured prevalence of major depression (Mini-International Neuropsychiatric Interview), depressive symptoms (Center for Epidemiological Studies Depression Rating Scale), physical and mental health (SF-36), quality of life (EuroQol), health care utilization and HbA(1c) levels (diabetic patients). RESULTS Prevalence of major depression was reduced from 61% (T0) to 28% (T4) in the intervention group and remained stable in care as usual (57% at T0 to 50% at T4). Compared to care as usual, significant improvement over time was observed in the intervention group with regard to depressive symptoms (F = 11.9; p = 0.001), perception of physical (F = 5.7; p = 0.018) and mental health (F = 3.9; p = 0.047) and quality of life (F = 21.8; p < 0.001). Effects tended to be stronger in diabetes patients, in patients with baseline major depression and in patients with moderate INTERMED scores. Finally, hospital admissions occurred less often in the intervention group, reaching statistical significance for the period between 6 and 9 months of follow-up (p = 0.02). CONCLUSIONS The results suggest that a psychiatric intervention targeted for complex medical patients can improve health outcomes.
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Affiliation(s)
- F Stiefel
- Service de Psychiatrie de Liaison, University Hospital of Lausanne, Lausanne, Switzerland.
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van Weert E, Hoekstra-Weebers J, Grol B, Otter R, Arendzen HJ, Postema K, Sanderman R, van der Schans C. A multidimensional cancer rehabilitation program for cancer survivors: effectiveness on health-related quality of life. J Psychosom Res 2005; 58:485-96. [PMID: 16125515 DOI: 10.1016/j.jpsychores.2005.02.008] [Citation(s) in RCA: 64] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
OBJECTIVE A multidimensional rehabilitation program for cancer survivors was developed to overcome cancer-related problems and to improve quality of life. The two purposes of the study were to describe the effectiveness of the program and to obtain information about patient preferences for multi or mono dimensional rehabilitation programs. SUBJECTS cancer survivors with different diagnoses, and cancer-related physical and psychosocial problems. INTERVENTION a 15-week rehabilitation program including individual exercise, sports, psycho-education, and information. Group-wise randomization was implemented by assigning one half of the patients to the complete program while the other half were allowed to choose which program components they considered relevant. MEASURES Health-Related Quality of Life [RAND-36 and Rotterdam Symptom Check List (RSCL)], exercise capacity (symptom limited bicycle ergometry), muscle force (hand-held dynamometry), and patient preferences. Measurements were performed before (T0) and after the rehabilitation program (T1), and at a 3-month follow-up (T2). RESULTS After the rehabilitation program, cancer survivors (n=63) displayed statistically significant improvements on health-related quality of life with effect sizes (ES) varying from 0.38 to 0.99 (RAND-36) and from -0.34 to -0.57 (RSCL), most persistent at 3-month follow-up. Furthermore, statistically significant improvements in exercise capacity and muscle force of upper and lower extremities were displayed after rehabilitation. If offered a choice, 80% of the patients prior to start and 58% of the patients after completion of the program indicated that they preferred the entire multidimensional program. CONCLUSION A multidimensional rehabilitation program has statistically and clinically relevant beneficial effects on health-related quality of life, exercise capacity, and muscle force in cancer patients with different diagnoses. Furthermore, if offered the choice, the majority of cancer survivors seem to prefer multidimensional programs to programs with only one component.
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Affiliation(s)
- Ellen van Weert
- Centre of Rehabilitation, University Hospital Groningen, The Netherlands.
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Sotile WM. Biopsychosocial care of heart patients: Are we practicing what we preach? ACTA ACUST UNITED AC 2005. [DOI: 10.1037/1091-7527.23.4.400] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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van Weert E, Hoekstra-Weebers JEHM, Grol BMF, Otter R, Arendzen JH, Postema K, van der Schans CP. Physical functioning and quality of life after cancer rehabilitation. Int J Rehabil Res 2004; 27:27-35. [PMID: 15097167 DOI: 10.1097/00004356-200403000-00004] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
In order to overcome cancer-related problems and to improve quality of life, an intensive multi-focus rehabilitation programme for cancer patients was developed. We hypothesised that this six-week intensive rehabilitation programme would result in physiological improvements and improvement in quality of life. Thirty-four patients with cancer-related physical and psychosocial problems were the subjects of a prospective observational study. A six-week intensive multi-focus rehabilitation programme consisted of four components: individual exercise, sports, psycho-education, and information. Measurements (symptom-limited bicycle ergometry performance, muscle force and quality of life [RAND-36, RSCL, MFI]) were performed before (T0) and after six weeks of rehabilitation (T1). After the intensive rehabilitation programme, statistically significant improvements were found in symptom-limited bicycle ergometry performance, muscle force, and several domains of the RAND-36, RSCL and MFI. The six-week intensive multi-focus rehabilitation programme had immediate beneficial effects on physiological variables, on quality of life and on fatigue.
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Affiliation(s)
- E van Weert
- Department of Rehabilitation, University Hospital Groningen, The Netherlands.
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Jolly K, Lip GYH, Sandercock J, Greenfield SM, Raftery JP, Mant J, Taylor R, Lane D, Lee KW, Stevens AJ. Home-based versus hospital-based cardiac rehabilitation after myocardial infarction or revascularisation: design and rationale of the Birmingham Rehabilitation Uptake Maximisation Study (BRUM): a randomised controlled trial [ISRCTN72884263]. BMC Cardiovasc Disord 2003; 3:10. [PMID: 12964946 PMCID: PMC200974 DOI: 10.1186/1471-2261-3-10] [Citation(s) in RCA: 36] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2003] [Accepted: 09/10/2003] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND Cardiac rehabilitation following myocardial infarction reduces subsequent mortality, but uptake and adherence to rehabilitation programmes remains poor, particularly among women, the elderly and ethnic minority groups. Evidence of the effectiveness of home-based cardiac rehabilitation remains limited. This trial evaluates the effectiveness and cost-effectiveness of home-based compared to hospital-based cardiac rehabilitation. METHODS/DESIGN A pragmatic randomised controlled trial of home-based compared with hospital-based cardiac rehabilitation in four hospitals serving a multi-ethnic inner city population in the United Kingdom was designed. The home programme is nurse-facilitated, manual-based using the Heart Manual. The hospital programmes offer comprehensive cardiac rehabilitation in an out-patient setting. PATIENTS We will randomise 650 adult, English or Punjabi-speaking patients of low-medium risk following myocardial infarction, coronary angioplasty or coronary artery bypass graft who have been referred for cardiac rehabilitation. MAIN OUTCOME MEASURES Serum cholesterol, smoking cessation, blood pressure, Hospital Anxiety and Depression Score, distance walked on Shuttle walk-test measured at 6, 12 and 24 months. Adherence to the programmes will be estimated using patient self-reports of activity.In-depth interviews with non-attendees and non-adherers will ascertain patient views and the acceptability of the programmes and provide insights about non-attendance and aims to generate a theory of attendance at cardiac rehabilitation. The economic analysis will measure National Health Service costs using resource inputs. Patient costs will be established from the qualitative research, in particular how they affect adherence. DISCUSSION More data are needed on the role of home-based versus hospital-based cardiac rehabilitation for patients following myocardial infarction and revascularisation, which would be provided by the Birmingham Rehabilitation Uptake Maximisation Study (BRUM) study and has implications for the clinical management of these patients. A novel feature of this study is the inclusion of non-English Punjabi speakers.
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Affiliation(s)
- Kate Jolly
- Department of Public Health & Epidemiology, Public Health Building, University of Birmingham, Edgbaston, Birmingham, B15 2TT, United Kingdom
| | - Gregory YH Lip
- University Department of Medicine, City Hospital, Dudley Road, Birmingham, B18 7QH, United Kingdom
| | - Josie Sandercock
- Department of Public Health & Epidemiology, Public Health Building, University of Birmingham, Edgbaston, Birmingham, B15 2TT, United Kingdom
| | - Sheila M Greenfield
- Department of Primary Care & General Practice, University of Birmingham, Edgbaston, Birmingham, B15 2TT, United Kingdom
| | - James P Raftery
- Health Services Management Centre, Park House, University of Birmingham, Edgbaston, Birmingham, B15 2TT, United Kingdom
| | - Jonathan Mant
- Department of Primary Care & General Practice, University of Birmingham, Edgbaston, Birmingham, B15 2TT, United Kingdom
| | - Rod Taylor
- Department of Public Health & Epidemiology, Public Health Building, University of Birmingham, Edgbaston, Birmingham, B15 2TT, United Kingdom
| | - Deirdre Lane
- University Department of Medicine, City Hospital, Dudley Road, Birmingham, B18 7QH, United Kingdom
| | - Kaeng Wai Lee
- University Department of Medicine, City Hospital, Dudley Road, Birmingham, B18 7QH, United Kingdom
| | - AJ Stevens
- Department of Public Health & Epidemiology, Public Health Building, University of Birmingham, Edgbaston, Birmingham, B15 2TT, United Kingdom
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Sherman AM, Shumaker SA, Kancler C, Zheng B, Reboussin DM, Legault C, Herrington DM. Baseline health-related quality of life in postmenopausal women with coronary heart disease: the Estrogen Replacement and Atherosclerosis (ERA) trial. J Womens Health (Larchmt) 2003; 12:351-62. [PMID: 12804342 DOI: 10.1089/154099903765448862] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
OBJECTIVES This study examined the baseline health-related quality of life (HRQL) of 301 postmenopausal women with heart disease enrolled in the Estrogen Replacement and Atherosclerosis (ERA) trial. METHODS The primary measure of HRQL was the Medical Outcomes Study Short Form-36 (MOS SF-36). The SF-36 was augmented with secondary assessments, including measures of depressive symptoms, life satisfaction, urinary incontinence, sleep disturbance, and physical symptoms. Multiple regression analyses were used to test hypotheses regarding the contribution of positive (social support) and negative (social strain) aspects of social relations after accounting for other correlates of HRQL and heart disease. RESULTS Results indicate that social support was positively associated with better functioning for all measured outcomes (all p < 0.05) except symptom frequency and severity. Social strain was negatively associated with HRQL functioning (all p < 0.05) except overall physical functioning, sleep disturbance, and urinary incontinence. In addition, several comorbid conditions were negatively associated with HRQL outcomes. In particular, chest pain was significantly associated with worse functioning on all HRQL outcomes except urinary incontinence. CONCLUSIONS These data suggest that both clinical status variables (particularly chest pain) and the psychosocial context (represented by dimensions of relationship quality) influenced HRQL in this cohort. Thus, interventions that combine medical treatments with psychosocially based interventions may be most effective for women at risk for impaired HRQL.
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Affiliation(s)
- Aurora M Sherman
- Department of Public Health Services, Wake Forest University School of Medicine, Medical Center Boulevard, Winston-Salem, NC 27157-1045, USA
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Daugherty J, Saarmann L, Riegel B, Sornborger K, Moser D. Can we talk? Developing a social support nursing intervention for couples. CLIN NURSE SPEC 2002; 16:211-8. [PMID: 12172491 DOI: 10.1097/00002800-200207000-00011] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Social support is an important influence on success during lifestyle modification attempts. According to the theory of expressed emotion, support that is perceived by the recipient as critical or overprotective is unhelpful and perhaps harmful. This article describes an intervention for couples and preliminary assessment of its feasibility and acceptability by the nurses who trialed it. Four staff nurses and 2 advanced practice nurses administered the intervention to 15 couples and reported on the benefits and limitations of the intervention. One individual in each couple had a chronic or an acute cardiac illness. The nurses perceived the intervention as valuable; even a single session stimulated discussion between the couple about important issues. Complexity, logistic barriers, and time constraints limited the technique. The authors conclude that this intervention may be most useful to clinical nurse specialists who have additional education, training in communication, and teaching and consulting skills.
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Affiliation(s)
- Joann Daugherty
- School of Nursing, San Diego State University, CA 92182-4158, USA
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Marcus AC, Garrett KM, Kulchak-Rahm A, Barnes D, Dortch W, Juno S. Telephone counseling in psychosocial oncology: a report from the Cancer Information and Counseling Line. PATIENT EDUCATION AND COUNSELING 2002; 46:267-275. [PMID: 11932126 DOI: 10.1016/s0738-3991(01)00163-x] [Citation(s) in RCA: 47] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/23/2023]
Abstract
Providing psychosocial counseling services to cancer patients and their significant others by telephone is emerging as an alternative to traditional (in-person) counseling programs in psychooncology. In this paper, data are reported describing the clients of such a program that has been in continuous operation since 1981: the Cancer Information and Counseling Line (CICL) of the AMC Cancer Research Center. An examination of call record forms completed between 1 June 1998 and 30 May 1999 (N = 1627) revealed that the vast majority of callers were female (77%), non-Hispanic White (77%), with at least some college education (62%). Only 27% were cancer patients/survivors, compared to 43% who were spouses, other relatives and friends of cancer patients/survivors, and 16% who were symptomatic callers. Breast cancer was by far the most frequently mentioned cancer site (30%). Although initial topics of inquiry were dominated by requests for medical information (77%), with only a small percentage of callers initially requesting psychosocial support and counseling (12%), by the time, the call was completed, 67% had received some form of psychosocial support and/or counseling. Recommendations for future research are discussed within the context of this review.
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Affiliation(s)
- Alfred C Marcus
- AMC Cancer Research Center, 1600 Pierce Street, Denver, CO 80214, USA.
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Schneiderman N, Antoni MH, Saab PG, Ironson G. Health psychology: psychosocial and biobehavioral aspects of chronic disease management. Annu Rev Psychol 2001; 52:555-80. [PMID: 11148317 DOI: 10.1146/annurev.psych.52.1.555] [Citation(s) in RCA: 61] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Psychosocial factors appear to impact upon the development and progression of such chronic diseases as coronary heart disease, cancer, and HIV/AIDS. Similarly, psychosocial interventions have been shown to improve the quality of life of patients with established disease and seem to influence biological processes thought to ameliorate disease progression. Small-scale studies are useful for specifying the conditions under which psychosocial factors may or may not impact quality of life, biological factors, and disease progression. They are also useful for informing us about the conditions under which psychosocial interventions can serve as adjuvants (e.g. adherence training) to medical treatments. Only large-scale clinical trials, however, can determine the extent to which these psychosocial interventions may impact morbidity and mortality.
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Affiliation(s)
- N Schneiderman
- Department of Psychology, University of Miami, Coral Gables, Florida 33124-2070, USA.
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Cardiac rehabilitation efforts for patients with ischaemic heart disease – a 5-year comparative review in five counties in western Sweden. ACTA ACUST UNITED AC 2001. [DOI: 10.1054/chec.2000.0106] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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Jolliffe JA, Rees K, Taylor RS, Thompson D, Oldridge N, Ebrahim S. Exercise-based rehabilitation for coronary heart disease. Cochrane Database Syst Rev 2001:CD001800. [PMID: 11279730 DOI: 10.1002/14651858.cd001800] [Citation(s) in RCA: 379] [Impact Index Per Article: 16.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
BACKGROUND The burden of cardiovascular disease world-wide is one of great concern to patients and health care agencies alike. Cardiac rehabilitation aims to restore patients with heart disease to health through exercise only based rehabilitation or comprehensive cardiac rehabilitation. OBJECTIVES To determine the effectiveness of exercise only or exercise as part of a comprehensive cardiac rehabilitation programme on the mortality, morbidity, health-related quality of life (HRQoL) and modifiable cardiac risk factors of patients with coronary heart disease. SEARCH STRATEGY Electronic databases were searched for randomised controlled trials, using standardised trial filters, from the earliest date available to December 31st 1998. SELECTION CRITERIA Men and women of all ages, in hospital or community settings, who have had myocardial infarction, coronary artery bypass graft or percutaneous transluminal coronary angioplasty, or who have angina pectoris or coronary artery disease defined by angiography. DATA COLLECTION AND ANALYSIS Studies were selected independently by two reviewers, and data extracted independently. Authors were contacted where possible to obtain missing information. MAIN RESULTS This systematic review has allowed analysis of an increased number of patients from approximately 4500 in earlier meta-analyses to 8440 (7683 contributing to the total mortality outcome). The pooled effect estimate for total mortality for the exercise only intervention shows a 27% reduction in all cause mortality (random effects model OR 0.73 (0.54, 0.98)). Comprehensive cardiac rehabilitation reduced all cause mortality, but to a lesser degree (OR 0.87 (0.71, 1.05)). Total cardiac mortality was reduced by 31% (random effects model OR 0.69 (0.51, 0.94)) and 26% (random effects model OR 0.74 (0.57, 0.96)) in the exercise only and comprehensive cardiac rehabilitation groups respectively. Neither intervention had any effect on the occurrence of non-fatal myocardial infarction. There was a significant net reduction in total cholesterol (pooled WMD random effects model -0.57 mmol/l (-0.83, -0.31)) and LDL (pooled WMD random effects model -0.51 mmol/l (-0.82, -0.19) in the comprehensive cardiac rehabilitation group. REVIEWER'S CONCLUSIONS Exercise-based cardiac rehabilitation is effective in reducing cardiac deaths. It is not clear from this review whether exercise only or a comprehensive cardiac rehabilitation intervention is more beneficial. The population studied in this review is still predominantly male, middle aged and low risk. Identification of the ethnic origin of the participants was seldom reported. It is possible that patients who would have benefited most from the intervention were excluded from the trials on the grounds of age, sex or co-morbidity.
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Affiliation(s)
- J A Jolliffe
- Research and Development Support Unit, Noy Scott House, Haldon View terrace, Exeter, Devon, UK, EX2 5EQ.
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Abstract
OBJECTIVE In this review, the place of psychological interventions in cardiac rehabilitation and differences in underlying rationales are presented. Treatment approaches vary in that some practitioners favor biobehavioral approaches with strong relaxation/breathing components, whereas others offer unstructured support, psychoeducation to maximize compliance, or psychological interventions directed at reducing emotional distress. METHODS The effectiveness of psychosocial rehabilitation for endpoints like mortality, recurrence, emotional distress, and intermediate hard endpoints is reviewed by integrating conclusions from narrative and meta-analytic reviews as well as recent major clinical trials. RESULTS The aggregated findings support the use of psychosocial interventions and they also help to explain critical differences in outcome in that studies which fail to reduce distress also fail to lead to reduced mortality or reduced event recurrence. CONCLUSION Gender differences in outcome and recent trends in cardiology are discussed because both have distinct consequences for the effective delivery of psychological services to cardiac patients.
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Affiliation(s)
- W Linden
- Department of Psychology, University of British Columbia, 2136 West Mall, V6T 1Z4, Vancouver, BC, Canada.
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Affiliation(s)
- J Dinnes
- NHS Centre for Reviews and Dissemination, University of York, USA
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Beausang P, Syyed R. Screening for anxiety and depression in adult general medical in-patients in a Scottish District General Hospital. Scott Med J 1998; 43:177-80. [PMID: 9924755 DOI: 10.1177/003693309804300606] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
We prospectively screened for anxiety and depression by administering the HAD scale to consecutive general medical patients admitted to a Scottish District General Hospital (DGH) over a calendar month. Age, gender, and use of psychotropic medications were also recorded. Of 119 patients (49 male) aged 16 to 92 years, "Probable presence of anxiety" was recorded in 23%, and "Probable presence of depression" in 19%. There was no significant difference between male and female patients or between different age groups. Formal psychological management was not available on site. Sixty-seven per cent of patients with "Probable presence of anxiety" and 61% with "Probable presence of depression" received no psychotropic medications. Despite a high prevalence of psychological distress amongst general medical in-patients, anxiety and depression are consistently under-diagnosed and under-treated. Screening for psychological distress, followed, where indicated, by psychological and/or pharmacological intervention, should be a fundamental element of holistic, patient-centred care in general medicine.
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Affiliation(s)
- P Beausang
- Department of Medicine for the Elderly, Gartnavel General Hospital, Glasgow
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Bunston T, Mings D. Planning psychosocial care for cancer patients: if at first you don't succeed, shift your paradigm. SOCIAL WORK IN HEALTH CARE 1998; 27:67-87. [PMID: 9579017 DOI: 10.1300/j010v27n01_05] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/22/2023]
Abstract
Concerned with our capacity to bridge the gap between patients' and families' psychosocial needs and the services provided, we developed a psychosocial intake and referral service. This paper will describe the lessons learned in trying to introduce an innovation whose time had not yet come and, after analyzing the outcome, to present a new approach to planning. The service was not approved and, on reflection, eight factors were identified as contributing to the failure of the service to reach fruition. In light of what we learned, we developed a new planning model that reflects planning as a circular, iterative process rather than as a linear process.
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Affiliation(s)
- T Bunston
- Ontario Cancer Institute/Princess Margaret Hospital, Toronto, Canada
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Abstract
The purpose of this article is to recommend future directions for behavioral research to enhance adjustment and quality of life for adults diagnosed with cancer. As context for the recommendations, the domain of behavioral research in psychosocial oncology is briefly described, the state of the science measuring quality of life is summarized, and research results from behavioral research on quality of life are reviewed.
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Affiliation(s)
- F M Lewis
- University of Washington, Seattle 98195, USA.
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Abstract
Preserving the best possible quality of life for cancer patients and their families has become a major goal in cancer care. However, the cumulative effect of stressors related to cancer care, many of which involve communicating with patients and relatives, may lead to the development of burnout in staff. Many health care professionals lack the psychosocial knowledge and communications skills needed to identify patients' problems because general professional training focuses on technical care. Teaching strategies known as psychological training programs (PTP) are therefore being developed to help improve health care professionals' sensitivity to communication problems with patients and relatives. Cognitive (e.g. theoretical information), experiential (e.g. case-history discussions), behavioural (e.g. role-playing exercise) and supportive (e.g. stressor identification) training techniques are used to teach the essential skills of good communication, i.e. listening, empathy, response to cues and appropriate use of reassurance. PTP range from one-day courses and residential workshops to full-time 1- or 2-year curricula. However, one of the main obstacles to implementing PTP is scepticism among health care professionals about its usefulness. Research on training effectiveness should therefore be developed to assess the impact of communication skills on quality of care and patients' quality of life.
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Affiliation(s)
- D Razavi
- Service Médico-Psychologique (Unité de Psycho-Oncologie), Hôpital Universitaire Saint-Pierre, Brussels, Belgium
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Delvaux N, Razavi D. Psychological training for health-care professionals in oncology. A way to improve communication skills. Ann N Y Acad Sci 1997; 809:336-49. [PMID: 9103585 DOI: 10.1111/j.1749-6632.1997.tb48097.x] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Affiliation(s)
- N Delvaux
- Unité de Psycho-Oncologie, Institut Jules Bordet, Brussels, Belgium
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Abstract
Psychodynamic psychotherapy is effective as an approach to understanding the psychological conflicts and the psychiatric symptoms of cancer patients as well as to planning useful psychological interventions. The author recommends that the psychotherapist who treats cancer patients be familiar with the following: 1) the natural course and treatment of the illness, 2) a flexible approach in accord with the medical status of the patient, 3) a common sense approach to defenses, 4) a concern with quality-of-life issues, and 5) counter-transference issues as they relate to the treatment of very sick patients. Case reports illustrate the unique problems facing psychotherapists who are treating cancer patients. Further, these cases show the effective use of psychodynamic principles to inform the therapist of successful psychotherapeutic interventions.
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Affiliation(s)
- N Straker
- Memorial Sloan-Kettering Cancer Center, New York, NY, USA
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25
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Konstam V, Salem D, Pouleur H, Kostis J, Gorkin L, Shumaker S, Mottard I, Woods P, Konstam MA, Yusuf S. Baseline quality of life as a predictor of mortality and hospitalization in 5,025 patients with congestive heart failure. SOLVD Investigations. Studies of Left Ventricular Dysfunction Investigators. Am J Cardiol 1996; 78:890-5. [PMID: 8888661 DOI: 10.1016/s0002-9149(96)00463-8] [Citation(s) in RCA: 271] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
This study examined the independent relation of health-related quality of life (HRQL) to mortality and congestive heart failure (CHF)-related hospitalizations in patients with an ejection fraction of < 0.35 followed for a mean of 36.5 months. A brief HRQL questionnaire was administered at baseline to patients randomized to placebo or enalapril in the Studies of Left Ventricular Dysfunction (SOLVD) trial. Participants had an ejection fraction of < 0.35 and either symptomatic CHF (treatment trial, n = 2,465) or asymptomatic CHF (prevention trial, n = 2,560). Baseline assessment of HRQL predicted mortality and CHF-related hospitalizations in symptomatic and asymptomatic patients randomized to enalapril and placebo treatment. Domains that were the stronger univariate predictors of mortality and CHF-related hospitalizations were activities of daily living (relative risk [RR] for mortality: 1.163, p < 0.000; for hospitalization: 1.215, p < 0.000), general health (RR for mortality: 1.205, p < 0.000; for hospitalization: 1.188, p < 0.000), and social functioning (RR for mortality 1.098, p < 0.000; for hospitalization: RR 1.156, p < 0.000). In the multivariate model, activities of daily living (RR for mortality 1.41, p < 0.000; for hospitalization: RR 1.43, p < 0.002), general health (RR for mortality 1.21, p < 0.000; for hospitalization RR 1.16, p < 0.013) and heart failure symptoms (RR for mortality 1.02, p < 0.025; for hospitalization RR 1.03, p < 0.004) were found to be independent risk factors. HRQL independently predicted mortality and CHF-related hospitalizations after adjustment for ejection fraction, age, treatment, and New York Heart Association classification in patients with an ejection fraction of < 0.35, randomized to enalapril and placebo treatment. HRQL provides additional clinical information regarding disease course and outcome that is not captured by traditional indexes of clinical status.
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Affiliation(s)
- V Konstam
- University of Massachusetts, Boston, USA
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26
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Abstract
This article reviews the current status and emerging trends of outcome data from research studies of psychiatric and psychosocial interventions for mental disorders in patients in the general medical sector. Although data from such studies have had limited success to date in influencing health policy, legislators and administrators are increasingly likely to turn to outcome data to inform their decisions. The impact of psychiatric disorders, the recognition and treatment or referral of psychiatric-disordered patients by general medical practitioners, and the outcome results of psychiatric intervention programs are examined for both the inpatient and outpatient general medical sectors.
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Affiliation(s)
- S M Saravay
- Department of Psychiatry, Long Island Jewish Medical Center, New Hyde Park, New York, USA
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27
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Bottomley A. Group cognitive behavioural therapy interventions with cancer patients: a review of the literature. Eur J Cancer Care (Engl) 1996; 5:143-6. [PMID: 9117047 DOI: 10.1111/j.1365-2354.1996.tb00225.x] [Citation(s) in RCA: 20] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
At present there is considerable evidence that suggests cancer patients, once diagnosed, experience significant and long-term psychosocial problems. Several studies have evaluated group interventions, but only a few have used group cognitive behavioural therapy (GCBT) with cancer patients. The following paper represents a review of the literature of GCBT, illustrating the key findings from these studies.
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Affiliation(s)
- A Bottomley
- Cancer Research Center of Hawaii, University of Hawaii, Honolulu, USA
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28
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Abstract
OBJECTIVES To provide a framework for considering home nursing care of the cancer patient within the context of cancer rehabilitation and to briefly review various aspects of cancer rehabilitation. DATA SOURCES Review articles and reference books of current and classic works that discuss cancer rehabilitation. CONCLUSIONS Rehabilitation is an important concept that should transcend cancer care in all settings, and one that naturally fits with home care. The effects of cancer and cancer treatment on the individual's quality of life, eg, psychological and social factors, sexual functioning, nutrition, fitness and exercise, symptom management, and physical disabilities are important considerations in the rehabilitation needs of persons with cancer. IMPLICATIONS FOR NURSING PRACTICE It is the challenge of the home health nurse to promote optimal functioning of cancer patients in their home environment. Assessment of the cancer patient's rehabilitation needs, skilled interventions, establishment of realistic goals, and coordinating care between members of the rehabilitation team are major responsibilities.
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Affiliation(s)
- K S Blesch
- Department of Epidemiology and Biostatistics, School of Public Health, University of Illinois at Chicago 60612-7620, USA
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29
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Bottomley A. Group cognitive behavioural therapy: an intervention for cancer patients. Int J Palliat Nurs 1996; 2:131-137. [PMID: 29324126 DOI: 10.12968/ijpn.1996.2.3.131] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
There is considerable evidence to suggest that cancer patients, including those with advanced disease, experience significant and long-term psychosocial problems. Work using group cognitive behavioural therapy with cancer patients has recently demonstrated a way in which it may be possible to treat emotionally distressed individuals effectively. This article reviews the literature on group cognitive behavioural psychotherapy and discusses for practitioners of all disciplines the important techniques, the value of time-limited interventions, the type of patients who may benefit, and where and how to facilitate successful interventions. Health workers with an interest in the emotional care of patients are thus provided with some understanding of the value that group cognitive behavioural psychotherapy may hold for them.
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Affiliation(s)
- Andrew Bottomley
- Research Associate at Cancer Research Centre of Hawaii, University of Hawaii at Manoa, 1236 Lauhala Street, Honolulu, Hawaii 96813, USA
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30
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Kiss A. On organizing an international workshop on psychotherapeutic interventions in cancer patients. A virtual coffeebreak communication. Support Care Cancer 1995; 3:227-34. [PMID: 7551624 DOI: 10.1007/bf00335894] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
This paper is an unusual summary of my thoughts on the International Workshop on Psychotherapeutic Interventions in Cancer Patients in Flims, Switzerland, in 1995. Based upon virtual coffeebreak communications, I try to explain to my virtual partner how the idea of the workshop developed, how I came to select participants and experts, and why the workshop was structured in such a specific way. Concerning the workshop itself I shall quote personal feedback statements from participants, drawing upon the impressions they took with them from demonstration workshops prepared by the leading experts in the field. During the workshop the impact of psychosocial interventions upon survival was critically evaluated, whereas it was unanimously agreed that the most important target of psychosocial interventions in cancer patients is the improvement in quality of life. After the workshop I personally decided to enhance my professional engagement in the area of helping clinical oncologists and nurses to improve on the psychosocial skills they need in caring for cancer patients.
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Affiliation(s)
- A Kiss
- Department of Internal Medicine, University Hospital Basel, Switzerland
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31
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Abstract
Complementary therapies are frequently used by cancer patients, yet the area is a minefield of hazards and hopes. A distinction between cure and care seems helpful. There are no effective complementary cures and most options that are promoted carry a distinct and, in certain cases, fatal risk. Complementary cancer care is more acceptable and there are options that can be shown to ease suffering. Vis a vis the popularity of complementary cancer treatments, the lack of scientific evidence for most therapies seems unacceptable. The call for more rigorous research is loud and clear.
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32
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Abstract
The aim of this study was to gather information on the immediate and long-term effects of six sessions of group Progressive Muscle Relaxation with Guided Imagery on the psychological distress of self-referred cancer patients. Patients' psychological distress and coping with cancer were assessed by three self-reports: the Multiple Locus of Control, the Impact of Events Scale (IES), and the Brief Symptom Inventory (BSI). Of the 123 patients who started group therapy, 37 dropped out during its course. The 86 patients who completed the intervention showed marked improvement on both BSI and IES, an improvement maintained over the next 6 months in 58 patients who continued assessment through the followup period.
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Affiliation(s)
- L Baider
- Department of Oncology, Hadassah University Hospital, Jerusalem, Israel
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33
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Affiliation(s)
- H C Bucher
- Medizinische Universitäts-Poliklinik, Kantonsspital Basel, Switzerland
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34
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Saravay SM, Lavin M. Psychiatric comorbidity and length of stay in the general hospital. A critical review of outcome studies. PSYCHOSOMATICS 1994; 35:233-52. [PMID: 8036253 DOI: 10.1016/s0033-3182(94)71772-2] [Citation(s) in RCA: 155] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
The authors critically reviewed 26 international and American outcome studies that assessed the effect of psychiatric comorbidity on length of stay for medical/surgical inpatients. Three generations of American studies were defined according to the rigorousness of the methodology. Eighty-nine percent of all studies with sample sizes greater than 110 and 75% of the prospective, rigorously controlled, American studies found a significant association between psychiatric comorbidity and increased length of stay. The findings lead to the conclusion that impaired cognition associated with delirium and dementia, depressed mood, and other personality variables contributes to prolonged hospital stays and greater utilization of hospitals and other health resources after discharge. Recommendations for future research are suggested.
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Affiliation(s)
- S M Saravay
- Department of Psychiatric Consultation-Liaison Services, Long Island Jewish Medical Center (LIJMC), New Hyde Park, New York 11042
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35
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Iverson GL, Anderson KW. The etiology of psychiatric symptoms in patients with systemic lupus erythematosus. Scand J Rheumatol 1994; 23:277-82. [PMID: 7973483 DOI: 10.3109/03009749409103729] [Citation(s) in RCA: 28] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
The purpose of this review was to explore the probable etiologies of psychiatric problems in patients with SLE. Although instances of psychosis generally are attributed to disease pathophysiology, the precise mechanism for this problem remains speculative. The etiology of non-psychotic psychiatric complaints is even less clear. Overall, it is likely that psychiatric complaints in patients with SLE are attributable to numerous factors including acquired brain dysfunction, organ system dysfunction, iatrogenic effects of corticosteroid treatment, learning history, psychosocial stressors, and current coping strategies. Additional research is needed to explore the bi-directional, synergistic, and dynamic interactions among diverse physiological and psychological variables as they impact an individual's psychiatric status.
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Affiliation(s)
- G L Iverson
- Department of Psychiatry and Behavioral Sciences, University of Oklahoma Health Sciences Center, Oklahoma City 73190
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36
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Abstract
Previous studies have shown that psychopathology is common in the medically ill, affects the course of medical illness, and is associated with increased health care costs. Recent controlled trials have demonstrated that psychosocial interventions in the medically ill can improve both psychosocial and medical outcomes. Although an important aim of current research is to assess the cost effectiveness of such interventions, the meaning and significance of "cost effectiveness," "cost benefit," and "cost offset" are frequently misunderstood. An overview of outcome research will be used to illuminate the promise and the limitations of such studies, with special attention to bias in research design.
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Affiliation(s)
- J L Levenson
- Department of Psychiatry and Medicine, Medical College of Virginia/Virginia Commonwealth University, Richmond
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