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Zhao J, Zhang X, Li X, Zhang R, Chang Y, Li Y, Lu H. Unraveling the mediation role of frailty and depression in the relationship between social support and self-management among Chinese elderly COPD patients: a cross-sectional study. BMC Pulm Med 2024; 24:66. [PMID: 38302898 PMCID: PMC10835951 DOI: 10.1186/s12890-024-02889-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2023] [Accepted: 01/28/2024] [Indexed: 02/03/2024] Open
Abstract
BACKGROUND Self-management (SM) is the key factor in controlling the progression of chronic obstructive pulmonary disease (COPD). Previous studies have reported that majority of COPD patients later presented with frailty and mental health diseases, which affect self-management. This study attempted to explore the mediation role of depression and frailty between social support and self-management in elderly COPD population. METHODS Six hundred twenty-seven stable elderly COPD patients admitted to 5 public hospitals in Ningxia, China were selected as study subjects by convenience sampling method. Self-management, frailty, depression and social support were assessed using the COPD Self-management Scale (COPD-SMS), Frail Scale (FS), 15-item Geriatric Depression Scale (GDS-15), and Social Support Rating Scale (SSRS) respectively. The Pearson correlation analysis was used to assess the correlation between variables. Additionally, SPSS25.0 PROCESS plugin Model 6 was used to explore the mediating effects of frailty and depression in the relationship between social support and self-management. RESULTS The mean participant age was 72.87 ± 7.03 years, 60.4% of participants were male. The mean total score of the COPD-SMS was 156.99 ± 25.15. Scores for the SSRS, FS, and GDS-15 were significantly correlated with COPD-SMS (p < 0.05). The analysis of the mediation effect demonstrated that social support has a direct predictive effect on self- management (β = 1.687, 95%CI: 1.359 to 2.318). Additionally, social support can also predict self- management indirectly through the mediation of depression (β = 0.290, 95%CI: 0.161 to 0.436) and frailty-depression (β = 0.040, 95%CI: 0.010 to 0.081). However, the mediation effect of frailty alone was not found to be statistically significant (β =-0.010, 95%CI: -0.061 to 0.036). The direct effect accounted for 84.06% of the total effect, while the indirect effect accounted for 15.94% of the total effect. CONCLUSION Self-management among elderly COPD patients was relatively moderate to low. Furthermore, frailty and depression were found to have a partially mediation role in the relationship between social support and self-management. Therefore, healthcare professionals need to comprehensively consider the frailty and depression status of patients, and implement targeted intervention measures as part of their care, which can improve the self-management of elderly COPD patients.
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Affiliation(s)
- Jie Zhao
- Department of Master's Training Station, General Hospital of Ningxia Medical University, Yinchuan, 750004, China
| | - Xiaona Zhang
- Department of Nursing, General Hospital of Ningxia Medical University, Yinchuan, 750004, China
| | - Xindan Li
- Department of Master's Training Station, General Hospital of Ningxia Medical University, Yinchuan, 750004, China
| | - Rui Zhang
- Department of Nursing, General Hospital of Ningxia Medical University, Yinchuan, 750004, China
| | - Yan Chang
- Department of Nursing, General Hospital of Ningxia Medical University, Yinchuan, 750004, China
| | - Yongju Li
- Department of Nursing, General Hospital of Ningxia Medical University, Yinchuan, 750004, China
| | - Hongyan Lu
- Department of Nursing, General Hospital of Ningxia Medical University, Yinchuan, 750004, China.
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Anderson E, Wiener RS, Molloy-Paolillo B, McCullough M, Kim B, Harris JI, Rinne ST, Elwy AR, Bokhour BG. Using a person-centered approach in clinical care for patients with complex chronic conditions: Perspectives from healthcare professionals caring for Veterans with COPD in the U.S. Veterans Health Administration's Whole Health System of Care. PLoS One 2023; 18:e0286326. [PMID: 37352241 PMCID: PMC10289382 DOI: 10.1371/journal.pone.0286326] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2023] [Accepted: 05/13/2023] [Indexed: 06/25/2023] Open
Abstract
BACKGROUND The largest nationally integrated health system in the United States, the Veterans Health Administration (VHA), has been undergoing a transformation toward a Whole Health (WH) System of Care. WH Clinical Care, a component of this system, includes holistically assessing the Veteran's life context, identifying what really matters to the Veteran, collaboratively setting and monitoring personal health and well-being goals, and equipping the Veteran with access to conventional and complementary and integrative health resources. Implementation of WH Clinical Care has been challenging. Understanding healthcare professionals' perspectives on the value of and barriers and facilitators to practicing WH Clinical Care holds relevance for not only VHA's efforts but also other health systems, in the U.S. and internationally, that are engaged in person-centered care implementation. OBJECTIVES We sought to understand perspectives of healthcare professionals at VHA on providing WH Clinical Care to Veterans with COPD, as a lens to understand the broader issue of WH Clinical Care for Veterans living with complex chronic conditions. DESIGN We interviewed 25 healthcare professionals across disciplines and services at a VA Medical Center in 2020-2021, including primary care providers, pulmonologists, palliative care providers, and chaplains. Interview transcripts were analyzed using qualitative content analysis. KEY RESULTS Each element of WH Clinical Care raised complex questions and/or concerns, including: (1) the appropriate depth/breadth of inquiry in person-centered assessment; (2) the rationale for elicitation of what really matters; (3) the feasibility and appropriate division of labor in personal health goal setting and planning; and (4) challenges related to referring Veterans to a broad spectrum of supportive services. CONCLUSIONS Efforts to promote person-centered care must account for healthcare professionals' existing comfort with its elements, advocate for a team-based approach, and continue to grapple with the conflicting structural conditions and organizational imperatives.
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Affiliation(s)
- Ekaterina Anderson
- Center for Healthcare Organization and Implementation Research (CHOIR), VA Bedford Healthcare System, Bedford, Massachusetts, United States of America
- Department of Population and Quantitative Health Sciences, University of Massachusetts Chan Medical School, Worcester, Massachusetts, United States of America
| | - Renda Soylemez Wiener
- Center for Healthcare Organization and Implementation Research (CHOIR), VA Boston Healthcare System, Boston, Massachusetts, United States of America
- The Pulmonary Center and Department of Medicine, Chobanian and Avedisian School of Medicine, Boston University, Boston, Massachusetts, United States of America
| | - Brianne Molloy-Paolillo
- Center for Healthcare Organization and Implementation Research (CHOIR), VA Bedford Healthcare System, Bedford, Massachusetts, United States of America
| | - Megan McCullough
- Center for Healthcare Organization and Implementation Research (CHOIR), VA Bedford Healthcare System, Bedford, Massachusetts, United States of America
- Department of Public Health, Zuckerberg School of Health Sciences, University of Massachusetts, Lowell, Massachusetts, United States of America
| | - Bo Kim
- Center for Healthcare Organization and Implementation Research (CHOIR), VA Boston Healthcare System, Boston, Massachusetts, United States of America
- Department of Psychiatry, Harvard Medical School, Boston, Massachusetts, United States of America
| | - J. Irene Harris
- VA Maine Healthcare System, Lewiston, Maine, United States of America
- Department of Psychiatry, University of Minnesota Medical School, Minneapolis, Minnesota, United States of America
| | - Seppo T. Rinne
- Center for Healthcare Organization and Implementation Research (CHOIR), VA Bedford Healthcare System, Bedford, Massachusetts, United States of America
- Division of Pulmonary and Critical Care Medicine, Chobanian and Avedisian School of Medicine, Boston University, Boston, Massachusetts, United States of America
| | - A. Rani Elwy
- Center for Healthcare Organization and Implementation Research (CHOIR), VA Bedford Healthcare System, Bedford, Massachusetts, United States of America
- Department of Psychiatry and Human Behavior, Warren Alpert Medical School of Brown University, Providence, Rhode Island, United States of America
| | - Barbara G. Bokhour
- Center for Healthcare Organization and Implementation Research (CHOIR), VA Bedford Healthcare System, Bedford, Massachusetts, United States of America
- Department of Population and Quantitative Health Sciences, University of Massachusetts Chan Medical School, Worcester, Massachusetts, United States of America
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Tao TJ, Lim TK, Yeung ETF, Liu H, Shris PB, Ma LKY, Lee TMC, Hou WK. Internet-based and mobile-based cognitive behavioral therapy for chronic diseases: a systematic review and meta-analysis. NPJ Digit Med 2023; 6:80. [PMID: 37117458 PMCID: PMC10141870 DOI: 10.1038/s41746-023-00809-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2022] [Accepted: 03/30/2023] [Indexed: 04/30/2023] Open
Abstract
Positive adjustment to chronic diseases reduces psychiatric comorbidity and enhances quality of life. Very little is known about the benefit of internet-based and mobile-based Cognitive Behavioral Therapy (IM-CBT) on physical outcomes and its reciprocal interactions with psychiatric outcomes, the active therapeutic elements, and effect moderators among people with major chronic medical conditions. In this systematic review and meta-analysis (PROSPERO: CRD42022265738), CINAHL of Systematic Reviews, MEDLINE, PsycINFO, PubMed, Web of Science are systematically searched up to 1 June 2022, for randomized controlled trials (RCTs) comparing IM-CBT against non-CBT control condition(s) among people with chronic disease(s). Primary outcomes include improvements in psychiatric symptoms (depressive, anxiety, PTSD symptoms, general psychological distress) from baseline to post-intervention and follow-ups. Secondary outcomes include improvements in physical distress (physical symptoms, functional impairment, self-rated ill health, objective physiological dysfunction). Among 44 RCTs (5077 patients with seven different chronic diseases), IM-CBT improves depressive symptoms, anxiety symptoms, and general psychological distress at post-intervention and across follow-ups, and improves physical distress and functional impairment at post-intervention. Preliminary evidence suggests that behavioral modification and problem-solving could be necessary components to reduce psychiatric symptoms in IM-CBT, whereas cognitive restructuring, psychoeducation, and mindfulness elements relate to reduced physical distress. IM-CBT shows stronger benefits in chronic pain, cancer, arthritis, and cardiovascular disease, relative to other conditions. Changes in psychiatric symptoms and physical distress prospectively predict each other over time. IM-CBT is an effective intervention for comprehensive symptom management among people with chronic diseases.
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Affiliation(s)
- Tiffany Junchen Tao
- Centre for Psychosocial Health, The Education University of Hong Kong, Hong Kong SAR, China
| | - Teck Kuan Lim
- Centre for Psychosocial Health, The Education University of Hong Kong, Hong Kong SAR, China
| | - Ernest Tsun Fung Yeung
- Centre for Psychosocial Health, The Education University of Hong Kong, Hong Kong SAR, China
| | - Huinan Liu
- Centre for Psychosocial Health, The Education University of Hong Kong, Hong Kong SAR, China
- Department of Special Education and Counselling, The Education University of Hong Kong, Hong Kong SAR, China
| | - Phoenix Bibha Shris
- Department of Psychology, The Education University of Hong Kong, Hong Kong SAR, China
| | - Lawrence Ka Yin Ma
- Centre for Psychosocial Health, The Education University of Hong Kong, Hong Kong SAR, China
- Department of Psychology, The Education University of Hong Kong, Hong Kong SAR, China
| | - Tatia Mei Chun Lee
- State Key Laboratory of Brain and Cognitive Sciences, The University of Hong Kong, Hong Kong SAR, China
- Laboratory of Neuropsychology & Human Neuroscience, The University of Hong Kong, Hong Kong SAR, China
| | - Wai Kai Hou
- Centre for Psychosocial Health, The Education University of Hong Kong, Hong Kong SAR, China.
- Department of Psychology, The Education University of Hong Kong, Hong Kong SAR, China.
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The Effect of Progressive Relaxation Exercises on Dyspnea and Anxiety Levels in Individuals With COPD: A Randomized Controlled Trial. Holist Nurs Pract 2023; 37:E14-E23. [PMID: 36378093 DOI: 10.1097/hnp.0000000000000563] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Dyspnea is a common symptom and anxiety is a common comorbidity of chronic obstructive pulmonary disease (COPD). They affect individuals with COPD in a multifaceted way, causing many disabilities. Progressive relaxation exercises (PREs) are an important intervention in reducing symptoms and comorbidity. The aim of this study was to determine the effects of PREs on dyspnea and anxiety levels in individuals with COPD. A pretest-posttest randomized controlled trial was conducted at the chest diseases clinic of a university hospital in Turkey. Forty-four patients with COPD who met the inclusion criteria for participation in the study were assigned either to an intervention or a control group, with 22 patients in each group. In the intervention group, the patients performed PREs once a day for 4 weeks in addition to the standard treatment. The patients in the control group received the standard treatment. In the data collection stage of the study, questionnaire forms, namely, the Modified Borg Scale (MBS), Modified British Medical Research Council Dyspnea Scale, COPD Assessment Test (CAT), and Beck Anxiety Inventory (BAI), were used. Data were collected before (the first follow-up) and after the intervention (the second follow-up). In the second follow-up, the MBS, BAI, and CAT scores decreased significantly in the intervention group (P < .05) but showed no significant changes in the control group (P > .05). This study demonstrates that PREs can reduce dyspnea and anxiety levels in individuals with COPD.
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Ge L, Liu S, Li S, Yang J, Hu G, Xu C, Song W. Psychological stress in inflammatory bowel disease: Psychoneuroimmunological insights into bidirectional gut–brain communications. Front Immunol 2022; 13:1016578. [PMID: 36275694 PMCID: PMC9583867 DOI: 10.3389/fimmu.2022.1016578] [Citation(s) in RCA: 33] [Impact Index Per Article: 16.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2022] [Accepted: 09/20/2022] [Indexed: 11/13/2022] Open
Abstract
Inflammatory bowel disease (IBD), mainly including ulcerative colitis (UC) and Crohn’s disease (CD), is an autoimmune gastrointestinal disease characterized by chronic inflammation and frequent recurrence. Accumulating evidence has confirmed that chronic psychological stress is considered to trigger IBD deterioration and relapse. Moreover, studies have demonstrated that patients with IBD have a higher risk of developing symptoms of anxiety and depression than healthy individuals. However, the underlying mechanism of the link between psychological stress and IBD remains poorly understood. This review used a psychoneuroimmunology perspective to assess possible neuro-visceral integration, immune modulation, and crucial intestinal microbiome changes in IBD. Furthermore, the bidirectionality of the brain–gut axis was emphasized in the context, indicating that IBD pathophysiology increases the inflammatory response in the central nervous system and further contributes to anxiety- and depression-like behavioral comorbidities. This information will help accurately characterize the link between psychological stress and IBD disease activity. Additionally, the clinical application of functional brain imaging, microbiota-targeted treatment, psychotherapy and antidepressants should be considered during the treatment and diagnosis of IBD with behavioral comorbidities. This review elucidates the significance of more high-quality research combined with large clinical sample sizes and multiple diagnostic methods and psychotherapy, which may help to achieve personalized therapeutic strategies for IBD patients based on stress relief.
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Affiliation(s)
- Li Ge
- Shandong Provincial Key Laboratory for Rheumatic Disease and Translational Medicine, The First Affiliated Hospital of Shandong First Medical University & Shandong Provincial Qianfoshan Hospital, Jinan, China
- School of Clinical and Basic Medical Sciences, Shandong First Medical University & Shandong Academy of Medical Sciences, Jinan, China
| | - Shuman Liu
- School of Clinical and Basic Medical Sciences, Shandong First Medical University & Shandong Academy of Medical Sciences, Jinan, China
| | - Sha Li
- School of Clinical and Basic Medical Sciences, Shandong First Medical University & Shandong Academy of Medical Sciences, Jinan, China
| | - Jing Yang
- Department of Gastroenterology, The First Affiliated Hospital of Shandong First Medical University & Shandong Provincial Qianfoshan Hospital, Jinan, China
| | - Guangran Hu
- School of Clinical and Basic Medical Sciences, Shandong First Medical University & Shandong Academy of Medical Sciences, Jinan, China
| | - Changqing Xu
- Department of Gastroenterology, The First Affiliated Hospital of Shandong First Medical University & Shandong Provincial Qianfoshan Hospital, Jinan, China
| | - Wengang Song
- Shandong Provincial Key Laboratory for Rheumatic Disease and Translational Medicine, The First Affiliated Hospital of Shandong First Medical University & Shandong Provincial Qianfoshan Hospital, Jinan, China
- School of Clinical and Basic Medical Sciences, Shandong First Medical University & Shandong Academy of Medical Sciences, Jinan, China
- *Correspondence: Wengang Song,
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Wu S, Liu W, Zhang M, Wang K, Liu J, Hu Y, She Q, Li M, Shen S, Chen B, Wu J. Preventive measures significantly reduced the risk of nosocomial infection in elderly inpatients during the COVID-19 pandemic. Exp Ther Med 2022; 24:562. [PMID: 35978917 PMCID: PMC9366284 DOI: 10.3892/etm.2022.11499] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2021] [Accepted: 01/25/2022] [Indexed: 12/15/2022] Open
Abstract
In December 2019, there was an outbreak of pneumonia of unknown causes in Wuhan, China. The etiological pathogen was identified to be a novel coronavirus, named severe acute respiratory syndrome coronavirus type 2 (SARS-CoV-2), which causes coronavirus disease 2019 (COVID-19). The number of infected patients has markedly increased since the 2019 outbreak and COVID-19 has also proven to be highly contagious. In particular, the elderly are among the group of patients who are the most susceptible to succumbing to COVID-19 within the general population. Cross-infection in the hospital is one important route of SARS-CoV-2 transmission, where elderly patients are more susceptible to nosocomial infections due to reduced immunity. Therefore, the present study was conducted to search for ways to improve the medical management workflow in geriatric departments to ultimately reduce the risk of nosocomial infection in elderly inpatients. The present observational retrospective cohort study analysed elderly patients who were hospitalised in the Geriatric Department of the First Affiliated Hospital with Nanjing Medical University (Nanjing, China). A total of 4,066 elderly patients, who were admitted between January and March in 2019 and 2020 and then hospitalised for >48 h were selected. Among them, 3,073 (75.58%) patients hospitalised from January 2019 to March 2019 were allocated into the non-intervention group, whereas the remaining 933 (24.42%) patients hospitalised from January 2020 to March 2020 after the COVID-19 outbreak were allocated into the intervention group. Following multivariate logistic regression analysis, the risk of nosocomial infections was found to be lower in the intervention group compared with that in the non-intervention group. After age stratification and adjustment for sex, chronic disease, presence of malignant tumour and trauma, both inverse probability treatment weighting and standardised mortality ratio revealed a lower risk of nosocomial infections in the intervention group compared with that in the non-intervention group. To rule out interference caused by changes in the community floating population and social environment during this 1-year study, 93 long-stay patients in stable condition were selected as a subgroup based on 4,066 patients. The so-called floating population refers to patients who have been in hospital for <2 years. Patients aged ≥65 years were included in the geriatrics program. The incidence of nosocomial infections during the epidemic prevention and control period (24 January 2020 to 24 March 2020) and the previous period of hospitalisation (24 January 2019 to 24 March 2019) was also analysed. In the subgroup analysis, a multivariate analysis was also performed on 93 elderly patients who experienced long-term hospitalisation. The risk of nosocomial and pulmonary infections was found to be lower in the intervention group compared with that in the non-intervention group. During the pandemic, the geriatric department took active preventative measures. However, whether these measures can be normalised to reduce the risk of nosocomial infections among elderly inpatients remain unclear. In addition, the present study found that the use of an indwelling gastric tube is an independent risk factor of nosocomial pulmonary infection in elderly inpatients. However, nutritional interventions are indispensable for the long-term wellbeing of patients, especially for those with dysphagia in whom an indwelling gastric tube is the most viable method of providing enteral nutrition. To conclude, the present retrospective analysis of the selected cases showed that enacting preventative and control measures resulted in the effective control of the incidence of nosocomial infections.
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Affiliation(s)
- Shuangshuang Wu
- Jiangsu Provincial Key Laboratory of Geriatrics, Department of Geriatrics, The First Affiliated Hospital of Nanjing Medical University, Nanjing, Jiangsu 210029, P.R. China
| | - Wen Liu
- Jiangsu Provincial Key Laboratory of Geriatrics, Department of Geriatrics, The First Affiliated Hospital of Nanjing Medical University, Nanjing, Jiangsu 210029, P.R. China
| | - Mingjiong Zhang
- Jiangsu Provincial Key Laboratory of Geriatrics, Department of Geriatrics, The First Affiliated Hospital of Nanjing Medical University, Nanjing, Jiangsu 210029, P.R. China
| | - Kai Wang
- Jiangsu Provincial Key Laboratory of Geriatrics, Department of Geriatrics, The First Affiliated Hospital of Nanjing Medical University, Nanjing, Jiangsu 210029, P.R. China
| | - Jin Liu
- Clinical Research Institute, The First Affiliated Hospital of Nanjing Medical University, Nanjing, Jiangsu 210029, P.R. China
| | - Yujia Hu
- Department of Business Analytics, Management School, Lancaster University, Lancaster, LA1 4YW, UK
| | - Quan She
- Jiangsu Provincial Key Laboratory of Geriatrics, Department of Geriatrics, The First Affiliated Hospital of Nanjing Medical University, Nanjing, Jiangsu 210029, P.R. China
| | - Min Li
- Jiangsu Provincial Key Laboratory of Geriatrics, Department of Geriatrics, The First Affiliated Hospital of Nanjing Medical University, Nanjing, Jiangsu 210029, P.R. China
| | - Shaoran Shen
- Jiangsu Provincial Key Laboratory of Geriatrics, Department of Geriatrics, The First Affiliated Hospital of Nanjing Medical University, Nanjing, Jiangsu 210029, P.R. China
| | - Bo Chen
- Jiangsu Provincial Key Laboratory of Geriatrics, Department of Geriatrics, The First Affiliated Hospital of Nanjing Medical University, Nanjing, Jiangsu 210029, P.R. China
| | - Jianqing Wu
- Jiangsu Provincial Key Laboratory of Geriatrics, Department of Geriatrics, The First Affiliated Hospital of Nanjing Medical University, Nanjing, Jiangsu 210029, P.R. China
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Anlló H, Larue F, Herer B. Anxiety and Depression in Chronic Obstructive Pulmonary Disease: Perspectives on the Use of Hypnosis. Front Psychol 2022; 13:913406. [PMID: 35664144 PMCID: PMC9161213 DOI: 10.3389/fpsyg.2022.913406] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2022] [Accepted: 04/22/2022] [Indexed: 11/13/2022] Open
Abstract
Chronic Obstructive Pulmonary Disease (COPD) is a highly prevalent and debilitating respiratory condition, characterized by chronic airflow limitation, breathlessness, and other persistent respiratory symptoms. Critically, patients suffering from COPD often find themselves trapped in a vicious comorbidity cycle: while breathlessness and increased respiratory rate are known inducers of anxiety, the latter have been shown in turn to exacerbate breathlessness and chest discomfort. Hypnosis holds great potential for the simultaneous complementary management of anxiety and breathlessness in COPD. It is an inexpensive psychological intervention tailored to the patient's own experience, convenient in terms of logistics and implementation. In this short qualitative review, we present hypnosis' structural, cognitive, and neural fundamentals, and assess existing instances of hypnosis use in the treatment of anxiety, depression, and respiratory disease. We then discuss its potential as a tool for improving health-related quality of life and the self-management of COPD within (and beyond) pulmonary rehabilitation.
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Affiliation(s)
- Hernán Anlló
- Laboratory of Cognitive and Computational Neuroscience, Department of Cognitive Studies, École Normale Supérieure de Paris, PSL University, Paris, France
- Complementary Care and Behavior Research Team, Bligny Hospital Center, Briis-sous-Forges, France
| | - François Larue
- Complementary Care and Behavior Research Team, Bligny Hospital Center, Briis-sous-Forges, France
- Palliative Care Unit, Bligny Hospital Center, Briis-sous-Forges, France
| | - Bertrand Herer
- Complementary Care and Behavior Research Team, Bligny Hospital Center, Briis-sous-Forges, France
- Pneumology Unit, Bligny Hospital Center, Briis-sous-Forges, France
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Volpato E, Banfi P, Pagnini F. Promoting Acceptance and Adherence to Noninvasive Ventilation in Chronic Obstructive Pulmonary Disease: A Randomized Controlled Trial. Psychosom Med 2022; 84:488-504. [PMID: 35149638 PMCID: PMC9071031 DOI: 10.1097/psy.0000000000001053] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/28/2020] [Revised: 09/04/2021] [Indexed: 11/25/2022]
Abstract
OBJECTIVE People with chronic obstructive pulmonary disease (COPD) may suffer from anxiety, depression, low quality of life, and cognitive deficits that could play a role in their clinical conditions. These situations could be worsened during the adaptation process to a new treatment such as noninvasive ventilation (NIV), which is often rejected or inappropriately used. The study aimed to analyze the impact of a brief psychological support intervention on adherence to NIV among patients with COPD. METHODS A two-branch randomized controlled trial was conducted on 90 patients with COPD who had an indication for NIV. The experimental group received cognitive behavioral therapy support, including counseling, relaxation, and mindfulness-based exercises. Controls received standard care and watched educational videos. The course had been structured for four to eight meetings at the hospital, at home, and/or via telemedicine. RESULTS The psychological intervention was related to improvements in both adherence to NIV (F(304) = 19.054, p < .001) and quality of life (F(156) = 10.264, p = .002) after eight meetings from baseline compared with the control group. Results indicated a significant change in the quality of life also over time (F(71.480) = 8.114, p = .006). CONCLUSIONS The findings suggest that the psychological intervention is an appropriate treatment for acceptance of and adherence to NIV in COPD in clinical practice and highlight the importance of determining the underlying reasons for NIV use.Trial Registration:ClinicalTrials.gov identifier NCT02499653.
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Farver-Vestergaard I, Danielsen JTT, Løkke A, Zachariae R. Psychosocial Intervention in Chronic Obstructive Pulmonary Disease: Meta-Analysis of Randomized Controlled Trials. Psychosom Med 2022; 84:347-358. [PMID: 35067652 DOI: 10.1097/psy.0000000000001043] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE Many patients with chronic obstructive pulmonary disease (COPD) experience persistent interrelated psychological and physical symptoms despite optimal treatment. Several studies of psychosocial intervention in COPD have been published in recent years. The present study aimed to conduct a quantitative summary of the efficacy of such interventions on psychological and physical outcomes. METHODS Two independent raters screened PubMed, PsycINFO, Embase, Web of Science, Cochrane Library, and CINAHL for eligible studies. In all, 35 independent, randomized controlled trials with a total of 3,120 patients with COPD were included, assessed for their methodological quality, and subjected to meta-analytic evaluation. RESULTS Meta-analyses revealed small, statistically significant effects of psychosocial intervention on combined psychological (Hedges's g = 0.28; 95%CI: 0.16-0.41) and physical outcomes (g = 0.21; 95%CI: 0.07-0.35) with no indications of publication bias. Supplementary Bayesian meta-analyses provided strong evidence for a non-zero overall effect on psychological outcomes (Bayes factor (BF) = 305) and moderate support for physical outcomes (BF = 6.1). Exploring sources of heterogeneity with meta-regression indicated that older age of patients and longer duration of interventions were associated with smaller effects on psychological outcomes. CONCLUSIONS The results support psychosocial intervention as an additional, useful tool in multidisciplinary respiratory care with the potential to improve both psychological and physical outcomes. Future studies are recommended to monitor adverse effects, apply blinding of active control conditions, and determine sample sizes with a priori power calculations. REGISTRATION Registered with Prospero (www.crd.york.ac.uk/prospero/) prior to initiation of the literature search (Reg. ID: CRD42020170083).
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Affiliation(s)
- Ingeborg Farver-Vestergaard
- From the Department of Medicine (Farver-Vestergaard, Løkke), Vejle Hospital, Lillebaelt Hospital, Vejle, Denmark; and Unit for Psychooncology and Health Psychology (Tingdal Taube Danielsen, Zachariae), Aarhus University Hospital and Aarhus University, Aarhus, Denmark
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Wan X, Huang H, Liang D, Jia RY, Chen CR. Effect of remote mindfulness-based interventions on symptoms of anxiety and depression in patients with chronic obstructive pulmonary disease: a protocol for systematic review and meta-analysis. BMJ Open 2022; 12:e055369. [PMID: 35190437 PMCID: PMC8889443 DOI: 10.1136/bmjopen-2021-055369] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND The incidence of chronic obstructive pulmonary disease (COPD) is high worldwide, and patients with COPD commonly suffer from mood disorders, such as symptoms of anxiety and depression. However, it is difficult to communicate with patients face to face to solve these psychological problems in the case of the fluctuations in symptoms of COPD and COVID-19 prevalence, which may lead to the fact that patients with COPD are more likely to suffer exacerbations, frequent readmissions and worse survival. Mindfulness-based interventions are a stress-reducing therapy with mindfulness at its core. Remote mindfulness-based interventions combine the advantages of high availability, accessibility, low cost and anonymity and can solve the barriers to access that many patients face when attending face-to-face programmes. Therefore, remote mindfulness-based interventions may be an effective way to improve the mental health of patients with COPD. METHODS AND ANALYSIS We will search PubMed, Embase, Cochrane Library, CNKI, PsycNET, MEDLINE, Psychology & Behavioral Sciences Collection and Web of Science to select eligible studies that were published. The eligible studies will be screened, extracted and then the methodological quality will be evaluated independently by two reviewers. Review manager software V.5.3 software and Stata V.14.0 software will be used for meta-analysis. ETHICS AND DISSEMINATION Ethical approval is not required for a systematic review protocol. Findings of the proposed systematic review will be disseminated through conference presentations and publication in a peer-reviewed journal. PROSPERO REGISTRATION NUMBER CRD42021265286.
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Affiliation(s)
- Xiao Wan
- Insitute of Nursing and Health, Henan University, Kaifeng, Henan, China
| | - Haitao Huang
- Insitute of Nursing and Health, Henan University, Kaifeng, Henan, China
| | - Dandan Liang
- Insitute of Nursing and Health, Henan University, Kaifeng, Henan, China
| | - Rui-Ying Jia
- Insitute of Nursing and Health, Henan University, Kaifeng, Henan, China
| | - Chao-Ran Chen
- Insitute of Nursing and Health, Henan University, Kaifeng, Henan, China
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11
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Anlló H, Herer B, Delignières A, Ghergan A, Bocahu Y, Segundo I, Moulin C, Larue F. Hypnosis for the Management of COPD-related anxiety and dyspnea in Pulmonary Rehabilitation - rationale and design for a cluster-randomised, active-control trial [HYPNOBPCO_2]. ERJ Open Res 2022; 8:00565-2021. [PMID: 35141317 PMCID: PMC8819244 DOI: 10.1183/23120541.00565-2021] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2021] [Accepted: 12/20/2021] [Indexed: 11/17/2022] Open
Abstract
Complementary psychological care is recommended for COPD, as it significantly reduces anxiety and boosts the pulmonary rehabilitation efficacy. In a precedent trial (HYPNOBPCO_1, ISRCTN10029862), administering a single hypnosis session was linked to reduced anxiety and improved breathing mechanics in intermediate and advanced COPD patients. However, whether hypnosis could improve self-management of anxiety and dyspnoea in COPD during pulmonary rehabilitation is yet to be investigated. This is the protocol for HYPNOBPCO_2, a 2-arm, cluster-randomised, statistician-blinded superiority monocentre trial (NCT04868357). Its aim is to assess the efficacy of hypnosis as a tool to manage anxiety and dyspnoea during a pulmonary rehabilitation programme (PRP). Clusters of COPD patients eligible for the conventional hospital-based PRP at the Centre Hospitalier de Bligny (CHB) will be randomised and evenly allocated into two parallel arms: “Hypnosis” (treatment) and “Relaxation” (active control). “Hypnosis” will consist of the CHB's conventional 4-week group PRP, supplemented by two educational sessions for teaching self-hypnosis. “Relaxation” will be identical, except standard relaxation exercises will be taught instead. Primary end-point will consist of assessing weekly changes in anxiety throughout the PRP, additional to total anxiety change after treatment completion. Anxiety will be determined by the six-item version of the State-Trait Anxiety Inventory (STAI-6). Secondary outcomes will include change in the 6-min walk test and the COPD assessment test (CAT). Further follow-up outcomes will include CAT and STAI-6 retests, re-hospitalisation rate, action plan use and persistence in self-hypnosis use, throughout the 12 weeks ensuing PRP completion. Rationale for HYPNOBPCO_2 (NCT04868357), a trial investigating whether self-hypnosis (fast, low-cost, effortless) reliably improves breathlessness-related anxiety and breathing mechanics, during and after pulmonary rehabilitation in COPDhttps://bit.ly/3JF2vCW
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12
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Zuo X, Lou P, Zhu Y, Chen B, Zhu X, Chen P, Dong Z, Zhu X, Li T, Zhang P. Effects of expressive art therapy on health status of patients with chronic obstructive pulmonary disease: a community-based cluster randomized controlled trial. Ther Adv Respir Dis 2022; 16:17534666221111876. [PMID: 35850588 PMCID: PMC9340361 DOI: 10.1177/17534666221111876] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
Background and objective: This study was performed to investigate the effect of expressive art therapy
(EAT) on the health status of patients with chronic obstructive pulmonary
disease (COPD). Methods: This community-based cluster randomized controlled trial involved patients
with COPD from 16 communities in China. Participants received either EAT
plus usual care (UC) or UC only. General practitioners were trained in EAT
before the intervention. The primary outcomes were depression and anxiety
symptoms, measured with the Hospital Anxiety and Depression Scale (HADS) and
expressed as the HADS score for depression or anxiety (HADS-D or HADS-A,
respectively). The secondary outcomes were the quality of life and dyspnoea,
measured with the COPD assessment test (CAT). Dyspnoea was assessed using
the modified Medical Research Council (mMRC) dyspnoea scale. Lung function
was expressed as the forced expiratory volume in 1 s as a percentage of the
predicted value [FEV1 (% pred)]. Outcome data were collected from
all participants at baseline, 2 and 6 months. Results: In total, 360 participants with COPD and comorbid depression were included in
the analysis with the control group of 181 receiving UC only and the
intervention group of 179 receiving EAT plus UC. The EAT group showed
significantly greater improvement in the HADS-D and HADS-A scores than the
UC group at 2 months (p < 0.0001 and
p < 0.001, respectively) and 6 months
(p < 0.001 for both). The CAT and mMRC scores were
significantly lower in the EAT group than in the UC group at 2 and 6 months
(p < 0.001 for all). The FEV1 (% pred)
was significantly higher in the EAT group than in the UC group at 6 months
(p < 0.01). Conclusion: General practitioners can deliver EAT interventions. EAT can effectively
reduce anxiety and depression symptoms and dyspnoea, improve quality of life
and improve the pulmonary function of patients with COPD.
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Affiliation(s)
- Xiaowei Zuo
- Department of Psychiatry, The Affiliated Xuzhou Oriental Hospital of Xuzhou Medical University, Xuzhou, China
| | - Peian Lou
- Department of Control and Prevention of Chronic Non-Communicable Diseases, Xuzhou Center for Disease Control and Prevention, Xuzhou, China
| | - Yanan Zhu
- Department of Respiratory Medicine, The Affiliated Hospital of Xuzhou Medical University, Xuzhou, China
| | - Bi Chen
- Department of Respiratory Medicine, The Affiliated Hospital of Xuzhou Medical University, Xuzhou, China
| | - Xianghua Zhu
- Department of Psychiatry, The Affiliated Xuzhou Oriental Hospital of Xuzhou Medical University, Xuzhou, China
| | - Peipei Chen
- Department of Control and Prevention of Chronic Non-Communicable Diseases, Xuzhou Center for Disease Control and Prevention, Xuzhou, China
| | - Zongmei Dong
- Department of Control and Prevention of Chronic Non-Communicable Diseases, Xuzhou Center for Disease Control and Prevention, Xuzhou, China
| | - Xuan Zhu
- Department of Control and Prevention of Chronic Non-Communicable Diseases, Xuzhou Center for Disease Control and Prevention, Xuzhou, China
| | - Ting Li
- Department of Control and Prevention of Chronic Non-Communicable Diseases, Xuzhou Center for Disease Control and Prevention, Xuzhou, China
| | - Pan Zhang
- Department of Control and Prevention of Chronic Non-Communicable Diseases, Xuzhou Center for Disease Control and Prevention, 142 West Erhuan Road, Xuzhou 221006, China
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13
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The Role of Palliative Care in COPD. Crit Care Nurs Q 2021; 44:113-120. [PMID: 33234864 DOI: 10.1097/cnq.0000000000000344] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Chronic obstructive pulmonary disease is a highly symptomatic disease that may lead to significant morbidity. Even with optimal therapy, the patient's quality of life can be severely affected. These symptoms include dyspnea, anxiety, depression, and malnourishment. Palliative care is a branch of medicine that specializes in the care of patients with a terminal illness no matter what stage of the disease they are in. It implements a family-centered approach to help patients deal with their symptoms. It also helps with shared decision-making and advanced care planning.
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14
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Gilliam EA, Cheung T, Kraemer K, Litrownik D, Wayne PM, Moy ML, Yeh GY. The impact of Tai Chi and mind-body breathing in COPD: Insights from a qualitative sub-study of a randomized controlled trial. PLoS One 2021; 16:e0249263. [PMID: 33831022 PMCID: PMC8031883 DOI: 10.1371/journal.pone.0249263] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2020] [Accepted: 03/12/2021] [Indexed: 11/19/2022] Open
Abstract
PURPOSE Chronic obstructive pulmonary disease (COPD) is associated with multiple psychosocial and behavioral factors. Prior research suggests that mind-body interventions may support the development and maintenance of healthy behaviors and improve health-related quality-of-life in such patients. We sought to qualitatively explore cognitive, psychosocial, and behavioral changes in patients with COPD who participated in two different mind-body interventions compared to an education control. METHODS We analyzed semi-structured qualitative exit interviews from a prospective, randomized pilot trial (N = 123) investigating 12-weeks of Tai Chi (TC) vs. mind-body breathing (MBB) vs. education (EDU) control in patients with moderate-severe COPD. TC involved traditional movements, that integrate meditative breathing, while MBB focused mainly on meditative breathing techniques alone. Interviews were audio-recorded and transcribed verbatim. Qualitative analysis of randomly selected transcripts was performed by two independent reviewers using an iterative process to identify emergent themes informed by grounded theory methods until thematic saturation was reached. RESULTS A total of 66 transcripts were reviewed (N = 22 TC, N = 22 MBB, N = 22 EDU). Participants were mean age = 68.1 years, GOLD Stage = 2.3, baseline FEV11 percent predicted mean (SD): 58% (13.4), 42.4% female. We identified six frequently mentioned themes: 1) overall awareness and understanding, 2) self-care knowledge, skills and behaviors, 3) behavior-related neurocognitive concepts, 4) physical function, 5) psychological well-being, and 6) social support/social function. Compared to EDU, more participants in TC and MBB noted improvements in awareness of self and the mind-body connection (e.g., body and breath awareness), knowledge of breathing techniques and integration of self-care skills with daily activities, self-efficacy for symptom management (particularly managing anxiety and dyspnea), acceptance of disease, physical function improvements (e.g., endurance, dyspnea, fatigue), and psychological well-being (particularly relaxation, emotion regulation and decreased reactivity). Compared to MBB, those in TC shared more intention to continue with self-care behaviors, physical activity self-efficacy, and improved flexibility. All three groups, including EDU, noted increased social support and knowledge of disease. Those in EDU, however, had fewer mentions of processes related to behavior change, and less concrete changes in neurocognitive, psychological, and physical function domains. CONCLUSIONS Mind-body interventions including meditative breathing may impact behavior-related neurocognitive and emotional factors that improve self-care management and support positive behavioral changes in patients with COPD. TRIAL REGISTRATION This trial is registered in Clinical Trials.gov, ID number NCT01551953.
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Affiliation(s)
- Elizabeth A. Gilliam
- Division of General Medicine, Department of Medicine, Beth Israel Deaconess Medical Center, Brookline, MA, United States of America
| | - Tina Cheung
- Division of General Medicine, Department of Medicine, Beth Israel Deaconess Medical Center, Brookline, MA, United States of America
| | - Kristen Kraemer
- Division of General Medicine, Department of Medicine, Beth Israel Deaconess Medical Center, Brookline, MA, United States of America
- Harvard Medical School, Boston, MA, United States of America
| | - Daniel Litrownik
- Division of General Medicine, Department of Medicine, Beth Israel Deaconess Medical Center, Brookline, MA, United States of America
| | - Peter M. Wayne
- Harvard Medical School, Boston, MA, United States of America
| | - Marilyn L. Moy
- Harvard Medical School, Boston, MA, United States of America
- Pulmonary and Critical Care Medicine Section, Department of Medicine, Veterans Administration Boston Healthcare System, Boston, MA, United States of America
| | - Gloria Y. Yeh
- Division of General Medicine, Department of Medicine, Beth Israel Deaconess Medical Center, Brookline, MA, United States of America
- Harvard Medical School, Boston, MA, United States of America
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15
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Wang J, She Y, Wang M, Zhang Y, Lin Y, Zhu X. Relationships among hope, meaning in life, and post-traumatic growth in patients with chronic obstructive pulmonary disease: A cross-sectional study. J Adv Nurs 2020; 77:244-254. [PMID: 33058188 DOI: 10.1111/jan.14605] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2020] [Revised: 08/18/2020] [Accepted: 09/28/2020] [Indexed: 01/10/2023]
Abstract
AIM This study aimed to investigate the relationships among hope, meaning in life, and post-traumatic growth (PTG) in patients with chronic obstructive pulmonary disease. DESIGN A cross-sectional study design. METHODS Between October 2018-September 2019, 221 chronic obstructive pulmonary disease patient completed the questionnaires including sociodemographic information, Chinese Version of Herth Hope Index, Meaning in Life Questionnaire, and Post-traumatic Growth Inventory. Descriptive analysis, Spearman's correlation analysis, the Kruskal-Wallis H test, the Mann-Whitney U test, and the ridge regression analysis were used for analysis. RESULTS Spearman's correlation analysis showed that hope and meaning in life were positively interrelated with PTG (r = 0.20-0.45, r = 0.36-0.54, p < 0.01). Ridge regression analysis results showed that hope, meaning in life, time since diagnosis, habitation, medical insurance, and monthly income could explain 47.30% of the variance in PTG (F = 33.863, p < 0.001). CONCLUSION Chinese patients with chronic obstructive pulmonary disease experienced a slightly positive change in meaning in life and a moderate degree of hope and PTG. Results suggested that hope and meaning in life were positively connected with PTG. Therefore, enhancing hope and meaning in life might be crucial for patients with chronic obstructive pulmonary disease to promote PTG. IMPACT The findings added better understanding of relationships among hope, meaning in life, and post-traumatic growth in patients with chronic obstructive pulmonary disease which can help nurse give interventions in the early stage of disease diagnosis.
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Affiliation(s)
- Jizhe Wang
- School of Nursing, Qingdao University, Qingdao, Shandong Province, China
| | - Yiying She
- School of Nursing, Qingdao University, Qingdao, Shandong Province, China
| | - Meiya Wang
- School of Nursing, Qingdao University, Qingdao, Shandong Province, China
| | - Yuting Zhang
- School of Nursing, Qingdao University, Qingdao, Shandong Province, China
| | - Yuanxin Lin
- School of Nursing, Qingdao University, Qingdao, Shandong Province, China
| | - Xiuli Zhu
- School of Nursing, Qingdao University, Qingdao, Shandong Province, China
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16
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Zhang X, Yin C, Tian W, Lu D, Yang X. Effects of cognitive behavioral therapy on anxiety and depression in patients with chronic obstructive pulmonary disease: A meta-analysis and systematic review. THE CLINICAL RESPIRATORY JOURNAL 2020; 14:891-900. [PMID: 32510764 DOI: 10.1111/crj.13226] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/10/2019] [Revised: 04/27/2020] [Accepted: 05/22/2020] [Indexed: 12/21/2022]
Abstract
OBJECTIVE Symptoms such as depression and anxiety are common psychiatric symptoms in patients with chronic obstructive pulmonary disease (COPD). Cognitive behavioral therapy (CBT) is still controversial in the treatment of anxiety and depression in patients with COPD. We conducted a meta-analysis and systematic review to evaluate the effect of CBT on anxiety and depression in patients with COPD, with a view to providing some guidance for clinical application. MATERIALS AND METHODS Computer search Web of Science, EMbase, PubMed, Cochrane Library, search time limit from the establishment of the library to August 2019. Collect the randomized controlled trial (RCT) for this topic. Two investigators independently screened the literature according to inclusion and exclusion criteria, extracted the data and assessed the risk of bias in the included studies. Meta-analysis using RevMan5.3 software. RESULTS A total of 10 studies were included in a total of 1278 patients. Meta-analysis shows that CBT can improve depression and anxiety in patients with COPD. Subgroup analysis showed that intervention time ≥8 weeks had significant differences in improving anxiety, while intervention time <8weeks had significant differences in improving depression. CONCLUSIONS Cognitive behavioral therapy may possibly relieve depression in COPD patients in a short period of time, and it takes longer to improve anxiety. Therefore, clinical practice can choose the appropriate intervention time according to the patient's psychological condition.
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Affiliation(s)
- Xuemei Zhang
- School of Nursing, Graduate School of Bengbu Medical College, Bengbu, China
- Department of Respiratory Medicine, Chongqing People's Hospital, Chongqing, China
| | - Changchun Yin
- Department of Respiratory Medicine, Chongqing People's Hospital, Chongqing, China
| | - Wuguo Tian
- Department of Breast and Thyroid Surgery, Land Force Featured Medical Center of the Chinese People's Liberation Army, Chongqing, China
| | - Dongbing Lu
- School of Nursing, Graduate School of Bengbu Medical College, Bengbu, China
| | - Xiumu Yang
- School of Nursing, Graduate School of Bengbu Medical College, Bengbu, China
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17
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Lee AHY, Snowden CP, Hopkinson NS, Pattinson KTS. Pre-operative optimisation for chronic obstructive pulmonary disease: a narrative review. Anaesthesia 2020; 76:681-694. [PMID: 32710678 DOI: 10.1111/anae.15187] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/13/2020] [Indexed: 12/26/2022]
Abstract
Chronic obstructive pulmonary disease is a condition commonly present in older people undergoing surgery and confers an increased risk of postoperative complications and mortality. Although predominantly a respiratory disease, it frequently has extra-pulmonary manifestations and typically occurs in the context of other long-term conditions. Patients experience a range of symptoms that affect their quality of life, functional ability and clinical outcomes. In this review, we discuss the evidence for techniques to optimise the care of people with chronic obstructive pulmonary disease in the peri-operative period, and address potential new interventions to improve outcomes. The article centres on pulmonary rehabilitation, widely available for the treatment of stable chronic obstructive pulmonary disease, but less often used in a peri-operative setting. Current evidence is largely at high risk of bias, however. Before surgery it is important to ensure that what have been called the 'five fundamentals' of chronic obstructive pulmonary disease treatment are achieved: smoking cessation; pulmonary rehabilitation; vaccination; self-management; and identification and optimisation of co-morbidities. Pharmacological treatment should also be optimised, and some patients may benefit from lung volume reduction surgery. Psychological and behavioural factors are important, but are currently poorly understood in the peri-operative period. Considerations of the risk and benefits of delaying surgery to ensure the recommended measures are delivered depends on patient characteristics and the nature and urgency of the planned intervention.
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Affiliation(s)
- A H Y Lee
- Nuffield Department of Clinical Neurosciences, University of Oxford, UK
| | - C P Snowden
- Newcastle Hospitals NHS Trust, Newcastle, UK.,Newcastle University, Newcastle, UK
| | - N S Hopkinson
- National Heart and Lung Institute, Imperial College, London, UK.,The Royal Brompton Hospital, London, UK
| | - K T S Pattinson
- Nuffield Department of Clinical Neurosciences, University of Oxford, UK.,Nuffield Department of Anaesthetics, John Radcliffe Hospital, Oxford, UK
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18
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Williams MT, Johnston KN, Paquet C. Cognitive Behavioral Therapy for People with Chronic Obstructive Pulmonary Disease: Rapid Review. Int J Chron Obstruct Pulmon Dis 2020; 15:903-919. [PMID: 32425516 PMCID: PMC7186773 DOI: 10.2147/copd.s178049] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2019] [Accepted: 02/21/2020] [Indexed: 12/30/2022] Open
Abstract
Cognitive behavioral therapy (CBT) is increasingly recommended in the management of people living with chronic obstructive pulmonary disease (COPD). This rapid review presents the evidence base for CBT for people with COPD and describes 1) the nature of CBT interventions and comparators in controlled trials (high or low resource intensity); and 2) factors influencing intervention effects on health outcomes (anxiety, depression, breathlessness, quality of life and exercise capacity). Primary studies reporting CBT interventions in adults with COPD were identified with data extracted by a single reviewer (20% of studies checked for data accuracy). Studies were synthesized descriptively with meta-analyses (random effects models) of controlled trials undertaken to report mean standardized effect sizes (95% CI) for health outcomes. Random effects meta-regression models explored whether CBT target, intervention dosage, intensity, facilitator profession, delivery mode, clinically significant anxiety/depression, trial design/quality and sample size predicted effect size. The search identified 33 primary studies published between 1996 and 2019 (controlled trials n=24, single group cohort n=6, case exemplars n=2, phenomenological n=1). Controlled trials frequently compared high-intensity CBT interventions against enhanced/usual care (n=12) or high-intensity CBT interventions against high-intensity comparators (n=11). When all controlled studies were included, small, significant improvements favoring CBT were evident across all health outcomes (SMD ranged from -0.27 to 0.35, p<0.05). When intensity dyads were considered, significant improvements were evident only when high-intensity CBT interventions were compared to enhanced usual care/usual care (SMDs ranged from -0.45 to 0.54, p <0.05). No other variable consistently predicted intervention effect sizes across all health outcomes. Overall, the evidence base supports the use of CBT for a range of health outcomes in people with COPD. Consistent benefits were evident when high-resource-intensive CBT interventions were compared to usual care. Low-resource-intensity CBT warrants further investigation in settings where cost of comprehensive care is prohibitive.
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Affiliation(s)
- Marie T Williams
- Innovation, Implementation and Clinical Translation in Health (IIMPACT), School of Health Sciences, University of South Australia, Adelaide, SA 5000, Australia
| | - Kylie N Johnston
- Innovation, Implementation and Clinical Translation in Health (IIMPACT), School of Health Sciences, University of South Australia, Adelaide, SA 5000, Australia
| | - Catherine Paquet
- Australian Centre of Precision Health, School of Health Sciences, University of South Australia, Adelaide, SA 5000, Australia
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Ma RC, Yin YY, Wang YQ, Liu X, Xie J. Effectiveness of cognitive behavioural therapy for chronic obstructive pulmonary disease patients: A systematic review and meta-analysis. Complement Ther Clin Pract 2019; 38:101071. [PMID: 31743870 DOI: 10.1016/j.ctcp.2019.101071] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2019] [Revised: 11/11/2019] [Accepted: 11/11/2019] [Indexed: 02/04/2023]
Abstract
BACKGROUND and purpose: Cognitive behavioural therapy (CBT) has gained increasing attention for the treatment of psychological disorders. This study aims to establish the effectiveness of CBT on psychological and physical outcomes in patients with chronic obstructive pulmonary disease (COPD). METHODS Two waves of electronic searches of the PubMed, Cochrane library, EMBASE, Web of Science and China National Knowledge Infrastructure databases were conducted. Statistical analyses were performed using Revman Manager 5.3 and Stata 12.0 software. RESULTS Sixteen randomized controlled trials were eligible. There were significant improvements in anxiety (SMD = -0.23; 95% CI: -0.42 to -0.04; P = 0.02), depression (SMD = -0.29, 95% CI: -0.40 to -0.19, P < 0.01), quality of life (MD = -5.21; 95% CI: -10.25 to -0.17; P = 0.04), and mean visits to emergency departments in the CBT groups. No statistically significant differences were observed in fatigue (SMD = 0.88, 95% CI: -0.58 to 2.35, P = 0.24), exercise capacity (MD = 28.75, 95% CI: -28.30 to 85.80, P = 0.32), self-efficacy (SMD = 0.15, 95% CI: -0.05 to 0.34, P = 0.14), or sleep quality (MD = 1.21, 95% CI: -0.65 to 3.06, P = 0.20). CONCLUSION This meta-analysis suggests that CBT can serve as a complementary therapy to improve anxiety, depression, and quality of life in COPD patients and deserves more widespread application in clinical practice.
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Affiliation(s)
- Rui-Chen Ma
- School of Nursing, Jilin University, No. 965 Xinjiang Street, Changchun, Jilin Province, 130021, PR China
| | - Ying-Ying Yin
- School of Nursing, Jilin University, No. 965 Xinjiang Street, Changchun, Jilin Province, 130021, PR China
| | - Ya-Qing Wang
- School of Nursing, Jilin University, No. 965 Xinjiang Street, Changchun, Jilin Province, 130021, PR China
| | - Xin Liu
- School of Nursing, Jilin University, No. 965 Xinjiang Street, Changchun, Jilin Province, 130021, PR China
| | - Jiao Xie
- School of Nursing, Jilin University, No. 965 Xinjiang Street, Changchun, Jilin Province, 130021, PR China.
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Psychosocial Interventions for Patients with Severe COPD-An Up-to-Date Literature Review. ACTA ACUST UNITED AC 2019; 55:medicina55090597. [PMID: 31527553 PMCID: PMC6780939 DOI: 10.3390/medicina55090597] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2019] [Revised: 08/31/2019] [Accepted: 09/09/2019] [Indexed: 12/26/2022]
Abstract
Background and Objectives: Chronic obstructive pulmonary disease (COPD) is a life limiting condition with a long list of serious psychosocial consequences, aggravating with illness progression. In advanced stages, chronic respiratory failure often develops, which might undermine mental health and reduce activity. The study objective was to review the recent studies concerning psychosocial interventions dedicated to patients with severe COPD. Materials and Methods: The PubMed database was searched for terms, such as ‘COPD and long-term oxygen therapy, non-invasive ventilation, severe or respiratory failure’ and ‘psychological or psychosocial or mental health and intervention.’ Studies were included that described patients with stable, severe COPD and the outcomes of psychosocial interventions. Results and Conclusions: Thirty-four studies were identified and divided into four thematic groups: home medical support, exercise, self-management and mental health. The number of studies that focused on mental health preservation in severe COPD was very limited; i.e., none refer directly to those treated with respiratory failure. Improving patients’ self-efficacy gave promising effects to the acceptance of palliative care, pulmonary rehabilitation completion and mental health. Physical activity might be recommended to be included in interventions for mental health enhancement, although little is known about the role of the particular forms of exercise. An increasing beneficial use of new technologies for psychosocial interventions was noted. Psychosocial interventions applied in advanced COPD underline the roles of self-efficacy, telehealth and physical activity in physical and mental health preservation. However, all of the above elements need to be independently tested on more homogenous groups of patients and have the possible modes of their treatment analysed.
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Hussain FA, Williams S. COPD: a proposed multidisciplinary approach to psychological issues. ACTA ACUST UNITED AC 2019; 26:1109-1115. [PMID: 29125348 DOI: 10.12968/bjon.2017.26.20.1109] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
Patients with chronic obstructive pulmonary disease (COPD) form a sizeable part of the ill-health demographic, both internationally and nationally, impacting markedly on hospital admissions. While prevalence rates of psychological comorbidity vary, there appears to be a consistent presence of depression and anxiety, and additional COPD symptom-related psychological distress. The research evidence base is limited, with seemingly little potential for expansion. Based on the available evidence, this study proposes a multidisciplinary team working model to support the integration of psychological input into the care of inpatients with COPD.
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Affiliation(s)
- Feryad A Hussain
- Clinical Psychologist, Health Psychology Department, Queen Elizabeth Hospital, Birmingham
| | - Sam Williams
- Counselling Psychologist, Health Psychology Department, Queen Elizabeth Hospital, Birmingham
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22
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Lunn S, Dharmagunawardena R, Lander M, Sweeney J. It's hard to talk about breathlessness: a unique insight from respiratory trainees . Clin Med (Lond) 2019; 19:344-347. [PMID: 31308122 PMCID: PMC6752249 DOI: 10.7861/clinmedicine.19-4-344] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
This paper describes how difficult it can be to discuss the experience of breathlessness with patients, as identified by respiratory trainees in a psychology-led workshop. The reasons why it is considered an essential role for clinicians to facilitate conversations about patients' breathlessness are outlined within the context of the challenges of respiratory care. The benefits for both patient and clinician are described including rapport building, more focused and targeted consultations, and increasing a patient's receptivity to interventions. The value of preparing a patient to actively engage with their breathlessness management is highlighted. As a way to support clinicians to initiate talk about breathlessness, a 'five-step guide to talking' is presented.
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Affiliation(s)
- Sarah Lunn
- Whittington Health NHS Trust, London, UK
| | | | - Mark Lander
- University College London Hospitals NHS Foundation Trust, London, UK
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Lin F, Yeh M, Lai Y, Lin K, Yu C, Chang J. Two‐month breathing‐based walking improves anxiety, depression, dyspnoea and quality of life in chronic obstructive pulmonary disease: A randomised controlled study. J Clin Nurs 2019; 28:3632-3640. [DOI: 10.1111/jocn.14960] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2018] [Revised: 05/03/2019] [Accepted: 05/03/2019] [Indexed: 01/27/2023]
Affiliation(s)
- Feng‐Lien Lin
- Department of Nursing National Taiwan University Hospital Taipei Taiwan, ROC
| | - Mei‐Ling Yeh
- Department of Nursing National Taipei University of Nursing and Health Sciences Taipei Taiwan, ROC
| | - Yeur‐Hur Lai
- School of Nursing National Taiwan University Taipei Taiwan, ROC
- Department of Nursing National Taiwan University Cancer Center Taipei Taiwan, ROC
| | - Kuan‐Chia Lin
- Institute of Hospital and Health Care Administration National Yang Ming University Taipei Taiwan, ROC
| | - Chong‐Jen Yu
- National Taiwan University Hospital Taipei Taiwan, ROC
- Department of Internal Medicine, College of Medicine National Taiwan University Taipei Taiwan, ROC
| | - Jung‐San Chang
- Department of Renal Care Kaohsiung Medical University Kaohsiung Taiwan, ROC
- Department of Internal Medicine Kaohsiung Medical University Hospital Kaohsiung Taiwan, ROC
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Trajectories of Anxiety and Depression After Liver Transplantation as Related to Outcomes During 2-Year Follow-Up: A Prospective Cohort Study. Psychosom Med 2019; 80:174-183. [PMID: 29112588 DOI: 10.1097/psy.0000000000000539] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
OBJECTIVE The aims of the study were to examine whether distinct trajectories of anxious and depressive symptoms are present among liver transplant recipients from before transplantation to 2 years afterward, to identify associated demographic, clinical, and individual characteristics, and to examine the influence of distinct trajectories on outcomes. METHODS A prospective, multicenter cohort study was performed among 153 liver transplant recipients. Data were retrieved using questionnaires administered before transplantation and at 3, 6, 12, and 24 months after transplantation. Clinical data were retrieved by medical record review. Latent class growth analysis was used to identify distinct trajectories. χ test, analyses of variance, and multinomial logistic regression were used to identify associated variables and the impact of the distinct trajectories on outcomes. RESULTS Three distinct trajectories for symptoms of anxiety (State-Trait Anxiety Inventory-short form) as well as depression (Center for Epidemiological Studies Depression Scale) were identified: "no symptoms," "resolved symptoms," and "persistent symptoms." The trajectories of persistent anxiety and depression comprised, respectively, 23% and 29% of the transplant recipients. Several clinical and individual variables were associated with the trajectories of persistent anxiety and/or depression: experiencing more adverse effects of the immunosuppressive medication, lower level of personal control, more use of emotion-focused coping, less disclosure about the transplant, and more stressful life events. The trajectories of persistent symptoms were associated with worse outcomes regarding medication adherence and health-related quality of life, but not with mortality. CONCLUSIONS A significant subset of transplant recipients showed persistent symptoms of anxiety and depression from before to 2 years after transplantation. These results emphasize the importance of psychosocial care in the transplant population.
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Hilton LG, Marshall NJ, Motala A, Taylor SL, Miake-Lye IM, Baxi S, Shanman RM, Solloway MR, Beroesand JM, Hempel S. Mindfulness meditation for workplace wellness: An evidence map. Work 2019; 63:205-218. [PMID: 31156202 PMCID: PMC6598008 DOI: 10.3233/wor-192922] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2017] [Accepted: 12/14/2017] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND Mindfulness interventions aim to foster greater attention and awareness of present moment experiences. Uptake of mindfulness programs in the workplace has grown as organizations look to support employee health, wellbeing, and performance. OBJECTIVE In support of evidence-based decision making in workplace contexts, we created an evidence map summarizing physical and mental health, cognitive, affective, and interpersonal outcomes from systematic reviews of randomized controlled trials (RCTs) of mindfulness interventions. METHODS We searched nine electronic databases to July 2017, dually-screened all reviews, and consulted topic experts to identify systematic reviews on mindfulness interventions. The distribution of evidence is presented as an evidence map in a bubble plot. RESULTS In total, 175 systematic reviews met inclusion criteria. Reviews included a variety of mindfulness-based interventions. The largest review included 109 randomized controlled trials. The majority of these addressed general health, psychological conditions, chronic illness, pain, and substance use. Twenty-six systematic reviews assessed studies conducted in workplace settings and with healthcare professionals, educators, and caregivers. The evidence map shows the prevalence of research by the primary area of focus. An outline of promising applications of mindfulness interventions is included. CONCLUSIONS The evidence map provides an overview of existing mindfulness research. It shows the body of available evidence to inform policy and organizational decision-making supporting employee wellbeing in work contexts.
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Affiliation(s)
- Lara G. Hilton
- Evidence-Based Practice Center (EPC), RAND Corporation, Santa Monica, CA, USA
- Deloitte Consulting LLP, Los Angeles, CA, USA
| | - Nell J. Marshall
- Evidence-Based Synthesis Program (ESP) Center, West Los Angeles VA Medical Center, Los Angeles, CA, USA
- VA Palo Alto Healthcare System, Palo Alto, CA, USA
| | - Aneesa Motala
- Evidence-Based Practice Center (EPC), RAND Corporation, Santa Monica, CA, USA
| | - Stephanie L. Taylor
- VA Greater Los Angeles Healthcare System, Los Angeles, CA, USA
- Department of Health Policy, UCLA, Los Angeles, CA, USA
| | - Isomi M. Miake-Lye
- Evidence-Based Synthesis Program (ESP) Center, West Los Angeles VA Medical Center, Los Angeles, CA, USA
| | - Sangita Baxi
- Evidence-Based Practice Center (EPC), RAND Corporation, Santa Monica, CA, USA
| | - Roberta M. Shanman
- Evidence-Based Practice Center (EPC), RAND Corporation, Santa Monica, CA, USA
| | - Michele R. Solloway
- Child and Adolescent Health Measurement Initiative, Department of Population, Family and Reproductive Health, Johns Hopkins School of Public Health, Baltimore, MD, USA
| | - Jessica M. Beroesand
- Evidence-Based Synthesis Program (ESP) Center, West Los Angeles VA Medical Center, Los Angeles, CA, USA
| | - Susanne Hempel
- Evidence-Based Practice Center (EPC), RAND Corporation, Santa Monica, CA, USA
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26
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Halpin DMG. Palliative Care for Chronic Obstructive Pulmonary Disease. Signs of Progress, but Still a Long Way to Go. Am J Respir Crit Care Med 2018; 198:1356-1358. [DOI: 10.1164/rccm.201805-0955ed] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Affiliation(s)
- David M. G. Halpin
- Department of Respiratory MedicineRoyal Devon and Exeter HospitalExeter, United Kingdom
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O'Toole MS, Bovbjerg DH, Renna ME, Lekander M, Mennin DS, Zachariae R. Effects of psychological interventions on systemic levels of inflammatory biomarkers in humans: A systematic review and meta-analysis. Brain Behav Immun 2018; 74:68-78. [PMID: 29630988 DOI: 10.1016/j.bbi.2018.04.005] [Citation(s) in RCA: 38] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/13/2017] [Revised: 02/27/2018] [Accepted: 04/04/2018] [Indexed: 12/12/2022] Open
Abstract
The purpose of the present investigation was to systematically review randomized controlled trials examining the effects of psychological interventions on inflammatory biomarkers in adult populations and to quantitatively analyze those effects by meta-analysis. Two researchers independently searched key electronic databases, selected eligible publications, extracted data, and evaluated methodological quality. Nineteen randomized controlled trials examining a total of 1510 participants were included. The overall combined effect size from pre to post psychological intervention on pro-inflammatory biomarker levels was statistically significant, showing an attenuating effect, although of a small magnitude (s' g = 0.15, p = .008, CI [0.04-0.26]). However, this effect was not maintained into the follow-up period (g < -0.01, p = .964, CI [-0.19-0.18]). Looking at the individual biomarkers assessed across studies, only C-reactive protein (CRP) was found to significantly decrease following psychological intervention. A number of moderation analyses were conducted, none of which reached statistical significance. However, the numerically largest - and significant - within-group effect size was obtained for the group of studies that had preselected participants based on elevated psychological distress (g = 0.29, p = .047). In conclusion, psychological interventions appear efficacious in reducing pro-inflammatory biomarker levels. Future studies are recommended to carefully select individuals based on inflammatory (e.g., the presence of low-grade inflammation) and/or psychological (e.g., psychological distress) criteria.
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Affiliation(s)
- M S O'Toole
- Unit for Psychooncology and Health Psychology, Department of Psychology and Behavioral Sciences, Aarhus University, Denmark.
| | - D H Bovbjerg
- Biobehavioral Oncology Program, Hillman Cancer Center; Departments of: Psychiatry, Psychology, Behavioral & Community Health Sciences, and Health & Community Systems, University of Pittsburgh, Pittsburgh, PA, USA
| | - M E Renna
- Department of Counseling and Clinical Psychology, Teachers College, Columbia University, USA
| | - M Lekander
- Department of Clinical Neuroscience, Karolinska Institutet, Sweden; Stress Research Institute, Stockholm University, Sweden
| | - D S Mennin
- Department of Counseling and Clinical Psychology, Teachers College, Columbia University, USA
| | - R Zachariae
- Unit for Psychooncology and Health Psychology, Department of Psychology and Behavioral Sciences, Aarhus University, Denmark
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Similowski T. Treat the lungs, fool the brain and appease the mind: towards holistic care of patients who suffer from chronic respiratory diseases. Eur Respir J 2018; 51:51/2/1800316. [DOI: 10.1183/13993003.00316-2018] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2018] [Accepted: 02/13/2018] [Indexed: 12/13/2022]
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Halpin DMG. Palliative care for people with COPD: effective but underused. Eur Respir J 2018; 51:51/2/1702645. [PMID: 29444923 DOI: 10.1183/13993003.02645-2017] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2017] [Accepted: 01/03/2018] [Indexed: 11/05/2022]
Affiliation(s)
- David M G Halpin
- Dept of Respiratory Medicine, Royal Devon and Exeter Hospital, Exeter, UK
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30
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Farver-Vestergaard I, O'Toole MS, O'Connor M, Løkke A, Bendstrup E, Basdeo SA, Cox DJ, Dunne PJ, Ruggeri K, Early F, Zachariae R. Mindfulness-based cognitive therapy in COPD: a cluster randomised controlled trial. Eur Respir J 2018; 51:51/2/1702082. [DOI: 10.1183/13993003.02082-2017] [Citation(s) in RCA: 43] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2017] [Accepted: 10/31/2017] [Indexed: 11/05/2022]
Abstract
A considerable proportion of patients with chronic obstructive pulmonary disease (COPD) entering pulmonary rehabilitation (PR) report psychological distress, which is often accompanied by poor physical health status. Mindfulness-based cognitive therapy (MBCT) has been shown to improve psychological and physical outcomes in other chronic diseases. We therefore evaluated the efficacy of MBCT as an add-on to a standard PR programme in COPD.COPD patients eligible for PR were cluster randomised to receive either an 8-week, group-based MBCT programme as an add-on to an 8-week PR programme (n=39), or PR alone (n=45). The primary outcomes of psychological distress and physical health status impairment were measured with the Hospital Anxiety and Depression Scale (HADS) and the COPD Assessment Test (CAT) before randomisation (T1), mid- (T2) and post-intervention (T3), and at 3 (T4) and 6 (T5) months’ follow-up .A statistically significant time×arm effect was found for the HADS (Cohen'sd=0.62, 95% CIs (d)=0.18–1.06, p=0.010). The treatment effect on the CAT failed to reach statistical significance (d=0.42, 95% CIs (d)=−0.06–0.90, p=0.061).MBCT showed a statistically significant and durable effect on psychological distress, indicating that MBCT may be an efficacious add-on to standard PR programmes in COPD.
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Rogliani P, Brusasco V, Fabbri L, Ungar A, Muscianisi E, Barisone I, Corsini A, De Angelis G. Multidimensional approach for the proper management of a complex chronic patient with chronic obstructive pulmonary disease. Expert Rev Respir Med 2017; 12:103-112. [PMID: 29241393 DOI: 10.1080/17476348.2018.1417041] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
INTRODUCTION Chronic obstructive pulmonary disease (COPD) is frequently associated with comorbidities occurring either independently or as consequences of COPD. Areas covered: This review examines the interactions between the pathophysiology of COPD and the most frequent comorbidities, and highlights the need for multidimensional clinical strategies to manage COPD patients with comorbidities. Expert commentary: Most COPD patients need to be approached in a complex and multifactorial scenario. The diagnosis of COPD is necessarily based on the presence of chronic respiratory symptoms and poorly reversible airflow obstruction, but exacerbations and comorbidities need to be considered in the evaluation of disease severity and prognosis in individual patients. More importantly, defining the precise relationship between COPD and comorbidities for each patient is the basis for a correct therapeutic approach.
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Affiliation(s)
- Paola Rogliani
- a Department of Experimental Medicine and Surgery , University of Rome "Tor Vergata" , Rome , Italy
| | - Vito Brusasco
- b Department of Internal Medicine , University of Genoa , Genova , Italy
| | - Leonardo Fabbri
- c Department of Endocrinology, Metabolism and Geriatric , Sant'Agostino Hospital , Modena , Italy
| | - Andrea Ungar
- d Geriatric and Intensive Care Medicine , AO Careggi and University of Florence , Florence , Italy
| | - Elisa Muscianisi
- e Novartis Farma Spa, Respiratory Franchise , Origgio , VA , Italy
| | - Ilaria Barisone
- e Novartis Farma Spa, Respiratory Franchise , Origgio , VA , Italy
| | - Alberto Corsini
- f Department of Pharmacological and Biomolecular Sciences , University of Milan , Milan , Italy.,g Multimedica IRCCS , Milan Italy
| | - Giuseppe De Angelis
- h Department of Cardiovascular Medicine , University of Milan , Milan , Italy
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De Giorgio A, Dante A, Cavioni V, Padovan AM, Rigonat D, Iseppi F, Graceffa G, Gulotta F. The IARA Model as an Integrative Approach to Promote Autonomy in COPD Patients through Improvement of Self-Efficacy Beliefs and Illness Perception: A Mixed-Method Pilot Study. Front Psychol 2017; 8:1682. [PMID: 29062286 PMCID: PMC5640890 DOI: 10.3389/fpsyg.2017.01682] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2017] [Accepted: 09/12/2017] [Indexed: 01/09/2023] Open
Abstract
Chronic obstructive pulmonary disease (COPD) is one of the most deadly and costly chronic diseases in the world characterized by many breathing problems. The management of COPD and the prevention of exacerbations are a priority goals to improve the quality of life in patients affected by this illness. In addition, it is also crucial to improve the patients' adherence to care which, in turn, depends on their knowledge and understanding of some factors such as the prescribed medical treatment, changes in dailylife, and the process of breathing. In turn, the adherence to care leads to greater autonomy for the patient who is thus able to better manage his illness. Here we presented the application of the Model IARA in patients affected by COPD in order to achieve their autonomy in illness management which, in turn, leads to a better quality of life. IARA is an intervention program which improve the awareness and knowledge of patients with respect to both the disease and symptoms through health education. Moreover, through IARA the patients are encouraged to become more actively involved in COPD care process, also regarding drug therapy adherence. Using St. George's Respiratory Questionnaire combined with qualitative analysis, we demonstrated that IARA could be considered a useful approach in COPD management.
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Affiliation(s)
- Andrea De Giorgio
- Psychology, Università Cattolica del Sacro Cuore, Milan, Italy
- Kiara Association, Turin, Italy
- Psychology, Università degli Studi eCampus, Novedrate, Italy
| | - Angelo Dante
- Department of Medicine, Surgery and Health Sciences, Nursing School, University of Trieste, Trieste, Italy
- Department of Health, Life and Environmental Sciences, University of L'Aquila, L'Aquila, Italy
| | - Valeria Cavioni
- Brain and Behavioral Sciences, University of Pavia, Pavia, Italy
| | | | - Desiree Rigonat
- Engineering and Architecture, University of Trieste, Trieste, Italy
| | - Francesca Iseppi
- Department of Medicine, Surgery and Health Sciences, Nursing School, University of Trieste, Trieste, Italy
| | - Giuseppina Graceffa
- Department of Medicine, Surgery and Health Sciences, Nursing School, University of Trieste, Trieste, Italy
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Yeh GY, Horwitz R. Integrative Medicine for Respiratory Conditions: Asthma and Chronic Obstructive Pulmonary Disease. Med Clin North Am 2017; 101:925-941. [PMID: 28802471 PMCID: PMC5654539 DOI: 10.1016/j.mcna.2017.04.008] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
Asthma and chronic obstructive pulmonary disease are 2 common chronic respiratory disorders in primary care that cause considerable morbidity and mortality. This article reviews disease pathophysiology and outlines an integrative, multidimensional approach to the evaluation and management of these conditions, including pharmacotreatment, nutrition, supplements, self-care strategies, mind-body therapies, and other integrative modalities.
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Affiliation(s)
- Gloria Y Yeh
- Division of General Medicine and Primary Care, Beth Israel Deaconess Medical Center, Harvard Medical School, 1309 Beacon Street, Brookline, MA 02446, USA.
| | - Randy Horwitz
- Arizona Center for Integrative Medicine, Department of Medicine, University of Arizona College of Medicine, PO Box 245153, Tucson, AZ 85724-5153, USA
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Fava GA, Cosci F, Sonino N. Current Psychosomatic Practice. PSYCHOTHERAPY AND PSYCHOSOMATICS 2017; 86:13-30. [PMID: 27884006 DOI: 10.1159/000448856] [Citation(s) in RCA: 160] [Impact Index Per Article: 22.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/10/2016] [Accepted: 08/03/2016] [Indexed: 11/19/2022]
Abstract
Psychosomatic research has advanced over the past decades in dealing with complex biopsychosocial phenomena and may provide new effective modalities of patient care. Among psychosocial variables affecting individual vulnerability, course, and outcome of any medical disease, the role of chronic stress (allostatic load/overload) has emerged as a crucial factor. Assessment strategies include the Diagnostic Criteria for Psychosomatic Research. They are presented here in an updated version based on insights derived from studies carried out so far and encompass allostatic overload, type A behavior, alexithymia, the spectrum of maladaptive illness behavior, demoralization, irritable mood, and somatic symptoms secondary to a psychiatric disorder. Macroanalysis is a helpful tool for identifying the relationships between biological and psychosocial variables and the individual targets for medical intervention. The personalized and holistic approach to the patient includes integration of medical and psychological therapies in all phases of illness. In this respect, the development of a new psychotherapeutic modality, Well-Being Therapy, seems to be promising. The growth of subspecialties, such as psychooncology and psychodermatology, drives towards the multidisciplinary organization of health care to overcome artificial boundaries. There have been major transformations in health care needs in the past decades. From psychosomatic medicine, a land of innovative hypotheses and trends, many indications for changes in the current practice of medicine are now at hand. The aim of this critical review is to outline current and potential clinical applications of psychosomatic methods.
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Affiliation(s)
- Giovanni A Fava
- Department of Psychology, University of Bologna, Bologna, Italy
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35
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Mirza S, Benzo R. Chronic Obstructive Pulmonary Disease Phenotypes: Implications for Care. Mayo Clin Proc 2017; 92:1104-1112. [PMID: 28688465 PMCID: PMC5587116 DOI: 10.1016/j.mayocp.2017.03.020] [Citation(s) in RCA: 44] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/06/2016] [Revised: 03/27/2017] [Accepted: 03/28/2017] [Indexed: 11/23/2022]
Abstract
Chronic obstructive pulmonary disease (COPD) phenotyping can help define clusters of patients with common characteristics that relate to clinically meaningful outcomes. In this review, we describe 7 clinically meaningful COPD phenotypes that can be identified by primary care physicians as well as specialists and that have specific management and prognostic implications: (1) asthma-COPD overlap phenotype, (2) frequent exacerbator phenotype, (3) upper lobe-predominant emphysema phenotype, (4) rapid decliner phenotype, (5) comorbid COPD phenotype, (6) physical frailty phenotype, and (7) emotional frailty phenotype.
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Affiliation(s)
- Shireen Mirza
- Division of Pulmonary and Critical Care Medicine, Mayo Clinic, Rochester, MN
| | - Roberto Benzo
- Division of Pulmonary and Critical Care Medicine, Mayo Clinic, Rochester, MN.
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Ouellette DR, Lavoie KL. Recognition, diagnosis, and treatment of cognitive and psychiatric disorders in patients with COPD. Int J Chron Obstruct Pulmon Dis 2017; 12:639-650. [PMID: 28243081 PMCID: PMC5317263 DOI: 10.2147/copd.s123994] [Citation(s) in RCA: 52] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023] Open
Abstract
COPD is highly prevalent and associated with substantial morbidity and mortality. Clinicians have long been aware that patients with COPD have problems with cognition and are susceptible to mood (depression) and anxiety disorders. With the increasing awareness of COPD as a multisystem disorder, many studies have evaluated the prevalence of neuropsychiatric conditions in patients with COPD. This review presents evidence regarding the prevalence of neuropsychiatric conditions (cognitive disorders/impairment, depression/anxiety) in COPD, their risk factors, and their impact on relevant outcomes. It also discusses both assessment and treatment of neuropsychiatric conditions and makes recommendations for improved screening and treatment. The findings suggest that clinicians caring for patients with COPD must become familiar with diagnosing these comorbid conditions and that future treatment has the potential to impact these patients and thereby improve COPD outcomes.
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Affiliation(s)
- Daniel R Ouellette
- Department of Pulmonary and Critical Care Medicine, Henry Ford Hospital, Detroit, MI, USA
| | - Kim L Lavoie
- Montreal Behavioral Medicine Center (MBMC), Research Center, Integrated University Health and Social Services Center - Sacred Heart Hospital of Montreal, Montreal, QC, Canada
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Abstract
The diverse and evolving role of a psychologist within a respiratory multidisciplinary team (MDT) is described, providing a working model for service provision. The rationale for appointing a psychologist within a respiratory MDT is presented first, citing relevant policy and research and outlining the wider psychosocial impact of respiratory disease. This is followed by an insight into the psychologist's role by highlighting important areas, including key therapy themes and the challenge of patient engagement. The way in which the psychologist supports the collective aims and aspirations of respiratory colleagues to provide a more holistic package of care is illustrated throughout.
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Affiliation(s)
- Sarah Lunn
- Chartered Clinical Psychologist, Department of Respiratory Medicine, Whittington Health, Whittington Hospital, London, UK
| | - Louise Restrick
- Integrated Respiratory Consultant Physician, Department of Respiratory Medicine, Whittington Health, Whittington Hospital, London, UK
- Islington Clinical Commissioning Group, London, UK
- London Respiratory Network Lead, London, UK
| | - Myra Stern
- Integrated Respiratory Consultant Physician, Department of Respiratory Medicine, Whittington Health, Whittington Hospital, London, UK
- Islington Clinical Commissioning Group, London, UK
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McNamara C, Johnson M, Read L, Vander Velden H, Thygeson M, Liu M, Gandrud L, McNamara J. Yoga Therapy in Children with Cystic Fibrosis Decreases Immediate Anxiety and Joint Pain. EVIDENCE-BASED COMPLEMENTARY AND ALTERNATIVE MEDICINE : ECAM 2016; 2016:9429504. [PMID: 28077950 PMCID: PMC5204083 DOI: 10.1155/2016/9429504] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/27/2016] [Revised: 10/12/2016] [Accepted: 11/21/2016] [Indexed: 12/17/2022]
Abstract
This study was designed to determine whether yoga might alleviate symptoms of pain, sleep disturbance, anxiety, and depression in children with cystic fibrosis (CF). CF is the most common genetic, life-limiting chronic disease among Caucasian populations. It primarily affects the lungs but also many other secretory organs and consequently leads to significant morbidities. Research has shown that children with CF have significantly increased depression, anxiety, and pain compared to their healthy counterparts. Subjects participated in six one-on-one sessions over a 10-week period with a certified instructor who designed each yoga practice based on a preestablished list of 30 yoga asanas. Questionnaires evaluating pain, sleep disturbance, sustained anxiety, immediate anxiety, and depression were administered. Differences between premeasures and postmeasures were evaluated using a two-sided test. Twenty subjects were assessed (12 females/8 males), median age of 11 (7-20) years. Mean immediate anxiety scores decreased (before session to after session 29 to 23.6, respectively, p < 0.001). Joint pain improved (3.25 to 3.65, p = 0.028). CFQ-R emotion subscale improved from 79.2 to 85 (p = 0.073), and the respiratory subscale improved from 66.7 to 79.2 (p = 0.076). Other results were less notable. We conclude that yoga may reduce immediate anxiety and joint pain in patients with CF.
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Affiliation(s)
| | - Mahrya Johnson
- Children's Hospitals and Clinics of Minnesota, Minneapolis, MN, USA
| | - Lisa Read
- Children's Hospitals and Clinics of Minnesota, Minneapolis, MN, USA
| | | | - Megan Thygeson
- Children's Hospitals and Clinics of Minnesota, Minneapolis, MN, USA
| | - Meixia Liu
- Children's Hospitals and Clinics of Minnesota, Minneapolis, MN, USA
| | - Laura Gandrud
- Children's Hospitals and Clinics of Minnesota, Minneapolis, MN, USA
| | - John McNamara
- Children's Respiratory and Critical Care Specialists, PA, Minneapolis, MN, USA
- Children's Hospitals and Clinics of Minnesota, Minneapolis, MN, USA
- Department of Pediatrics, University of Minnesota, Minneapolis, MN, USA
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Barley E, Lawson V. Using health psychology techniques to manage chronic physical symptoms. ACTA ACUST UNITED AC 2016; 25:1258-1262. [PMID: 27935345 DOI: 10.12968/bjon.2016.25.22.1258] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Chest pain and palpitations, non-malignant pain, breathlessness and fatigue often endure despite the receipt of appropriate nursing and medical care. This is distressing for patients, impacts on their quality of life and ability to function and is associated with high healthcare usage and costs. The cognitive behavioural approach offers nurses a model to understand how people's perceptions and beliefs and their emotional, behavioural and physiological reactions are linked. Common 'thinking errors' which can exacerbate symptom severity and impact are highlighted. Understanding of this model may help nurses to help patients cope better with their symptoms by helping them to come up with alternative more helpful beliefs and practices. Many Improving Access to Psychological Therapy services offer support to people with chronic physical symptoms and nurses are encouraged to sign post patients to them.
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Affiliation(s)
- Elizabeth Barley
- Professor in Health and Wellbeing, College of Nursing, Midwifery and Healthcare, University of West London
| | - Victoria Lawson
- Principal Health Psychologist, Southwark Talking Therapies Service, London
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Ho HCY, Mui M, Wan A, Ng YL, Stewart SM, Yew C, Lam TH, Chan SS. Happy Family Kitchen II: a cluster randomized controlled trial of a community-based positive psychology family intervention for subjective happiness and health-related quality of life in Hong Kong. Trials 2016; 17:367. [PMID: 27473842 PMCID: PMC4966601 DOI: 10.1186/s13063-016-1508-9] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2016] [Accepted: 07/15/2016] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Most positive psychology interventions conducted in the West have been focused on the individual. Family relationships are highly valued in the Chinese collectivist culture, and it is of interest to know whether family-focused interventions can improve the well-being of Chinese people. We have previously reported the effectiveness of a positive psychology family intervention in terms of family well-being. Based on the data derived from the Happy Family Kitchen II project, this paper examines the effectiveness of a community-based positive psychology family intervention on subjective happiness and health-related quality of life. METHODS Thirty-one social service units and schools organized intervention programs for 2070 participants in Hong Kong. In a cluster randomized controlled trial, participants were randomly assigned on the basis of computer-generated numbers into the intervention group or the control group. The intervention programs emphasized one of five positive psychology themes: joy, gratitude, flow, savoring, and listening. The control group engaged in activities unrelated to the intervention, such as arts and crafts workshops. Subjective happiness and mental and physical quality of life were assessed at baseline and at 4 weeks and 12 weeks postintervention. RESULTS Data of 1261 participants were analyzed. The results showed that the intervention was more effective than the control condition in improving subjective happiness, with a small effect size, at 12 weeks postintervention (β = .15, p = .020, Cohen's d = .16). However, there were no improvements in mental and physical quality of life in the intervention group compared with the control group at 4 weeks (β = .39, p = .494, d = .05; β = -.10, p = 1.000, d = -.01, respectively) and 12 weeks postintervention (β = .71, p = .233, d = .08; β = -.05, p = 1.000, d = -.01, respectively). Furthermore, the booster session was no more effective than the tea gathering session in improving subjective happiness (β = .00, p = .990, d = .00) or mental (β = 1.20, p = 1.000, d = -.04) and physical quality of life (β = .15, p = 1.000, d = -.01). CONCLUSIONS The analyses extend previous findings of salutary effects on family well-being by showing that positive psychology family interventions can improve subjective happiness. Suggestions for future research are proposed. TRIAL REGISTRATION ClinicalTrials.gov NCT01796275 . Retrospectively registered 19 February 2013.
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Affiliation(s)
- Henry C Y Ho
- School of Public Health, The University of Hong Kong, 5/F William M. W. Mong Block, 21 Sassoon Road, Pokfulam, Hong Kong
| | - Moses Mui
- Service Development, The Hong Kong Council of Social Service, Wanchai, Hong Kong
| | - Alice Wan
- School of Public Health, The University of Hong Kong, 5/F William M. W. Mong Block, 21 Sassoon Road, Pokfulam, Hong Kong
| | - Yin-Lam Ng
- School of Public Health, The University of Hong Kong, 5/F William M. W. Mong Block, 21 Sassoon Road, Pokfulam, Hong Kong
| | - Sunita M Stewart
- Department of Psychiatry, The University of Texas Southwestern Medical Center at Dallas, Dallas, TX, USA
| | - Carol Yew
- United Centre of Emotional Health and Positive Living, United Christian Nethersole Community Health Service, Kowloon, Hong Kong
| | - Tai Hing Lam
- School of Public Health, The University of Hong Kong, 5/F William M. W. Mong Block, 21 Sassoon Road, Pokfulam, Hong Kong.
| | - Sophia S Chan
- School of Nursing, The University of Hong Kong, 4/F William M. W. Mong Block, 21 Sassoon Road, Pokfulam, Hong Kong
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Connolly MJ, Yohannes AM. The impact of depression in older patients with chronic obstructive pulmonary disease and asthma. Maturitas 2016; 92:9-14. [PMID: 27621232 DOI: 10.1016/j.maturitas.2016.07.005] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2016] [Accepted: 07/07/2016] [Indexed: 11/30/2022]
Abstract
Respiratory diseases are common in older people. However, the impact of comorbid depression in older patients with chronic obstructive pulmonary disease (COPD) and asthma has not been fully explored. This narrative review examines the impact of comorbid depression and its management in COPD and asthma in older adults. The causes of depression in patients with COPD and asthma are multifactorial and include physical, physiological and behavioural factors. Depression is associated with hospital readmission in older adults with asthma and COPD. We focus on the most current literature that has examined the efficacy of pulmonary rehabilitation (PR), cognitive behavioural therapy (CBT) and antidepressant drug therapy for patients with depression in the context of COPD and asthma. Our findings indicate that PR and CBT are beneficial in improving depressive symptoms and quality of life in short-term intervention studies. However, the long-term efficacy of CBT and PR is unknown. To date, the efficacy of antidepressant drug therapy for depression in patients with COPD and asthma is inconclusive. In addition, there has been no clear evidence that antidepressants can induce remission of depression or ameliorate dyspnoea or physiological indices of COPD. Factors that contribute to 'inadequate' assessment and treatment of depression in patients with COPD and asthma may include misconception of the disease by patients and their caregivers and stigma attached to depression. Thus, well-controlled randomized controlled trials are needed.
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Affiliation(s)
- M J Connolly
- Freemasons' Department of Geriatric Medicine, University of Auckland, New Zealand
| | - A M Yohannes
- Department of Health Professions, Manchester Metropolitan University, Manchester, United Kingdom.
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Chan MC, Lin CH, Kou YR. Hyperlipidemia in COPD is associated with decreased incidence of pneumonia and mortality: a nationwide health insurance data-based retrospective cohort study. Int J Chron Obstruct Pulmon Dis 2016; 11:1053-9. [PMID: 27274227 PMCID: PMC4876799 DOI: 10.2147/copd.s102708] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
PURPOSE COPD is often associated with various comorbidities that may influence its outcomes. Pneumonia, cardiovascular disease (CVD), and cancer are the major causes of death in COPD patients. The objective of this study is to investigate the influence of comorbidities on COPD by using the Taiwan National Health Insurance database. PATIENTS AND METHODS We retrospectively analyzed the database in 2006 of one million sampling cohort. Newly diagnosed patients with COPD with a controlled cohort that was matched by age, sex, and Charlson comorbidity index (CCI) were included for analysis. RESULTS In total, 1,491 patients with COPD were included for analysis (61.8% male). Patients with COPD had higher incidences of pneumonia (25.7% vs 10.4%; P<0.0001), CVD (15.1% vs 10.5%; P<0.0001), and mortality rate (26.6% vs 15.8%; P<0.001) compared with the control group in the 4-year follow-up. In patients with COPD, CCI ≥3 have a higher incidence of pneumonia (hazard ratio [HR] 1.61; 95% confidence interval [CI] 1.23-2.09; P<0.0001), CVD (HR 1.73; 95% CI 1.24-2.41; P=0.001), and mortality (HR 1.12; 95% CI 1.12-1.83; P=0.004). Among the major comorbidities of COPD, hyperlipidemia was associated with decreased incidence of pneumonia (HR 0.68; 95% CI 0.5-0.93; P=0.016) and mortality (HR 0.64; 95% CI 0.46-0.90; P=0.009), but was not associated with increased risk of CVD (HR 1.10; 95% CI 0.78-1.55; P=0.588). CONCLUSION Our results demonstrate that COPD is associated with increased incidence of pneumonia, CVD, and mortality. In patients with COPD, higher CCI is associated with increased incidence of pneumonia, CVD, and mortality. However, COPD with hyperlipidemia is associated with decreased incidence of pneumonia and mortality.
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Affiliation(s)
- Ming-Chen Chan
- Institute of Physiology, National Yang-Ming University, Taipei, Taiwan; Division of Chest Medicine, Department of Internal Medicine, Taichung Veterans General Hospital, Taichung, Taiwan; College of Nursing, Central Taiwan University of Science and Technology, Taichung, Taiwan
| | - Ching-Heng Lin
- Department of Medical Research, Taichung Veterans General Hospital, Taichung, Taiwan
| | - Yu Ru Kou
- Institute of Physiology, National Yang-Ming University, Taipei, Taiwan
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Jacobs C, Clemons M, Joy AA. Oncologist heal thyself: hallmarks of happiness. Curr Oncol 2015; 22:e415-8. [PMID: 26715878 DOI: 10.3747/co.22.2706] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
It is 18h30 on a Friday; clinic ran late again. [...]
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Affiliation(s)
- C Jacobs
- Department of Medicine, Division of Medical Oncology, The Ottawa Hospital Cancer Centre, and University of Ottawa, Ottawa, ON
| | - M Clemons
- Department of Medicine, Division of Medical Oncology, The Ottawa Hospital Cancer Centre, and University of Ottawa, Ottawa, ON
| | - A A Joy
- Department of Oncology, Division of Medical Oncology, University of Alberta, Cross Cancer Institute, Edmonton, AB
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Bove DG, Overgaard D, Lomborg K, Lindhardt BØ, Midtgaard J. Efficacy of a minimal home-based psychoeducative intervention versus usual care for managing anxiety and dyspnoea in patients with severe chronic obstructive pulmonary disease: a randomised controlled trial protocol. BMJ Open 2015; 5:e008031. [PMID: 26152326 PMCID: PMC4499678 DOI: 10.1136/bmjopen-2015-008031] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
INTRODUCTION In its final stages, chronic obstructive pulmonary disease is a severely disabling condition that is characterised by dyspnoea, which causes substantial anxiety. Anxiety is associated with an impaired quality of life and increased hospital admissions. Untreated comorbid anxiety can have devastating consequences for both patients and their relatives. Non-pharmacological interventions, including cognitive-behavioural therapy, have been effective in managing anxiety and dyspnoea in patients with chronic obstructive pulmonary disease. However, the majority of existing interventions have tested the efficacy of relatively intensive comprehensive programmes and primarily targeted patients who have moderate pulmonary disease. We present the rationale and design for a trial that focused on addressing the challenges experienced by severe pulmonary disease populations. The trial investigates the efficacy of a minimal home-based psychoeducative intervention versus usual care for patients with severe chronic obstructive pulmonary disease. METHODS AND ANALYSIS The trial is a randomised controlled trial with a 4-week and 3-month follow-up. 66 patients with severe chronic obstructive pulmonary disease and associated anxiety will be randomised 1:1 to either an intervention or control group. The intervention consists of a single psychoeducative session in the patient's home in combination with a telephone booster session. The intervention is based on a manual, with a theoretical foundation in cognitive-behavioural therapy and psychoeducation. The primary outcome is patient-reported anxiety as assessed by the Hospital and Anxiety and Depression Scale (HADS). ETHICS AND DISSEMINATION This trial complies with the latest Declaration of Helsinki, and The Ethics Committee of the Capital Region of Denmark (number H-1-2013-092) was queried for ethical approval. Trial results will be disseminated in peer-reviewed publications and presented at scientific conferences. TRIAL REGISTRATION NUMBER NCT02366390.
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Affiliation(s)
- Dorthe Gaby Bove
- Department of Pulmonary and Infectious Diseases, Copenhagen University Hospital, Nordsjælland, Hillerød, Denmark
| | - Dorthe Overgaard
- Research Unit, Copenhagen University Hospital, Nordsjælland and Metropolitan, Department of Nursing, Copenhagen, Denmark
| | - Kirsten Lomborg
- Faculty of Health Sciences, Department of Clinical Medicine and Department of Public Health, Section for Nursing, Aarhus University, Palle Juul-Jensens Boulevard, Aarhus, Denmark
| | - Bjarne Ørskov Lindhardt
- Department of Infectious Diseases, Copenhagen University Hospital, Hvidovre, Hvidovre, Denmark
| | - Julie Midtgaard
- Institute of Public Health, University of Copenhagen and Senior Researcher, The University Hospital Centre for Health Research, Copenhagen University Hospital, Rigshospitalet, København, Denmark
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