Professionally-led support groups for cancer patients: an intervention in search of a model

OBJECTIVE: The objective of this review was to evaluate the clinical and research literature on professionally-led support groups for cancer patients and to propose an approach that would address patients' needs from diagnosis through survivorship. METHOD: Computerized and manual searches, including Medline and Psychlit searches, were completed for reviews of the literature. Twelve research studies were identified that met our criteria for in-depth review. A clinical model emerged from discussions of an oncology study group based on theoretical formulations and clinical experience with oncology patients. RESULTS: We found that recent research suggests that professionally-led support groups are increasing in number and that participation in such groups seems to enhance patients' quality, and possibly even quantity, of survival. Despite this, little effort has been made to determine what type of group may be appropriate for which patients and when in their course of care. CONCLUSIONS: If psychosocial intervention, in the form of professionally-led support groups for cancer patients, is to be more effective, it should be guided by a model which takes into consideration the changing needs and concerns of patients over the course of illness and, in many cases, recovery. The authors present an outline delineating what such a model might entail.     

Management of psychiatric symptoms in medically ill patients in the homecare setting

Nurses with critical care knowledge and experience increasingly provide technologically advanced care to patients at home who often present comorbid psychiatric symptoms. Failure to accurately recognize and provide appropriate intervention can be devastating for patients because these symptoms can exacerbate the medical condition and may lead to mortality. The Biopsychosocial Model and the Transactional Model of Stress were presented as guides for nursing practice. Practice is directed at 1) understanding the patient's perception of events, 2) involving the caregiver(s) in the patient's recovery, and 3) enhancing the individual's adaptive coping efforts and resources. The article attempts to guide nurses in making decisions on when to consult and collaborate with an APPN to achieve desired patient outcomes.     

Generalizability of treatment studies utilizing solicited patients.

States that although clinical researchers have turned increasingly to media advertisements in recent years to obtain sufficiently large and homogeneous samples for psychotherapy and psychopharmacological treatment outcome studies, it has not been clear to what extent it is possible to generalize from solicited to traditionally referred patient populations. A review of 14 studies that compared solicited and nonsolicited patient groups treated or studied in clinical settings suggests that it may be possible to generate relatively comparable samples of solicited and nonsolicited patients, in terms of pretreatment symptomatology, provided there is adequate screening. Although the existing data suggest that treatment response may also be similar across these groups, these data are too limited to permit conclusions regarding generalizability of treatment efficacy findings based in solicited patient samples. Possible implications for treatment outcome of differences found on 2 variables (presence of precipitants and duration of illness) are discussed. (40 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Beta-arrestin acts as a clathrin adaptor in endocytosis of the beta2-adrenergic receptor

The ability of a system to regulate its responsiveness in the presence of a continuous stimulus, often termed desensitization, has been extensively characterized for the beta2-adrenergic receptor (beta2AR). beta2AR signalling is rapidly attenuated through receptor phosphorylation and subsequent binding of the protein beta-arrestin. Ultimately the receptor undergoes internalization, and although the molecular mechanism is unclear, receptor phosphorylation and beta-arrestin binding have been implicated in this processs. Here we report that beta-arrestin and arrestin-3, but not visual arrestin, promote beta2AR internalization and bind with high affinity directly and stoichiometrically to clathrin, the major structural protein of coated pits. Moreover, beta-arrestin/arrestin chimaeras that are defective in either beta2AR or clathrin binding show a reduced ability to promote beta2AR endocytosis. Immunofluorescence microscopy of intact cells indicates an agonist-dependent colocalization of the beta2AR and beta-arrestin with clathrin. These results show that beta-arrestin functions as an adaptor in the receptor-mediated endocytosis pathway, and suggest a general mechanism for regulating the trafficking of G-protein-coupled receptors.     

Patterns of guilt in children of depressed and well mothers.

Expressions of guilt were examined in 87 children, 5–9 years old, in a psychiatric interview and in a semiprojective procedure using vignettes to elicit children's narratives about interpersonal conflict and distress. Psychiatric assessments yielded similar patterns for children of depressed and well mothers, but semiprojective representations differed for the two groups. Children of well mothers showed prototypic expressions of adaptive guilt involving themes of responsibility and reparation, especially at the older ages. In contrast, themes of children of depressed mothers often were aberrant, distorted, and unresolved, indicating possible differences in the etiology and functions of their guilt. Guilt is considered in relation to other dimensions of affect, theories of moral development, patterns of adaptation and maladaptation, and processes of social transmission of emotional problems. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

The role of the therapeutic alliance in psychotherapy and pharmacotherapy outcome: Findings in the National Institute of Mental Health Treatment of Depression Collaborative Research Program.

The relationship between therapeutic alliance and treatment outcome was examined for depressed outpatients who received interpersonal psychotherapy, cognitive-behavior therapy, imipramine with clinical management, or placebo with clinical management. Clinical raters scored videotapes of early, middle, and late therapy sessions for 225 cases (619 sessions). Outcome was assessed from patients' and clinical evaluators' perspectives and from depressive symptomatology. Therapeutic alliance was found to have a significant effect on clinical outcome for both psychotherapies and for active and placebo pharmacotherapy. Ratings of patient contribution to the alliance were significantly related to treatment outcome; ratings of therapist contribution to the alliance and outcome were not significantly linked. These results indicate that the therapeutic alliance is a common factor with significant influence on outcome. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Distribution of distant metastases from newly diagnosed non-small cell lung cancer

BACKGROUND: The purpose of our study was to determine the incidence and locations of M1 disease at presentation in patients with non-small cell lung cancer to help design appropriate preoperative imaging algorithms. METHODS: All patients with non-small cell lung cancer seen between 1991 and 1993 were identified, and records were reviewed. For patients with M1 disease, the sites of distant metastases and the methods of diagnosis were recorded. RESULTS: Of 348 patients identified, 276 (79%) had M0 disease and 72 (21%) had M1 disease. In 40 of 72 patients (56%), M1 disease was detected via chest or abdominal computed tomography (CT). Brain, bone, liver, and adrenal glands were the most common sites of metastatic disease, in decreasing order. Brain metastases often occurred as an isolated finding, although isolated liver metastases were uncommon. CONCLUSIONS: M1 disease was common at presentation, and was often detectable via chest CT. The incremental yield of abdominal CT over chest CT was very small, and therefore abdominal CT is not an effective method of screening for metastases if chest CT has been performed.     

Increased traffic accident rates associated with shale gas drilling in Pennsylvania

Objectives

We examined the association between shale gas drilling and motor vehicle accident rates in Pennsylvania.

Methods

Using publicly available data on all reported vehicle crashes in Pennsylvania, we compared accident rates in counties with and without shale gas drilling, in periods with and without intermittent drilling (using data from 2005 to 2012). Counties with drilling were matched to non-drilling counties with similar population and traffic in the pre-drilling period.

Results

Heavily drilled counties in the north experienced 15–23% higher vehicle crash rates in 2010–2012 and 61–65% higher heavy truck crash rates in 2011–2012 than control counties. We estimated 5–23% increases in crash rates when comparing months with drilling and months without, but did not find significant effects on fatalities and major injury crashes. Heavily drilled counties in the southwest showed 45–47% higher rates of fatal and major injury crashes in 2012 than control counties, but monthly comparisons of drilling activity showed no significant differences associated with drilling.

Conclusions

Vehicle accidents have measurably increased in conjunction with shale gas drilling.     

Some gender effects in a brief psychotherapy.

Two studies investigated the influence of therapist gender as well as patient age and pretreatment distress level on process and outcome in a brief 12-session psychodynamic psychotherapy. Pre- and posttherapy assessments disclosed that patients treated by female therapists experienced more symptomatic improvement and reported more satisfaction with treatment than those treated by male therapists. However, patient age accounted for twice, and patient pretreatment level of disturbance more than three times, the outcome variance contributed by gender. In Study 2 female therapists were judged to arouse less negative affect in women patients and to arouse fewer interpersonal difficulties. (PsycINFO Database Record (c) 2010 APA, all rights reserved)