Evaluation of haptotherapy for patients with cancer treated with chemotherapy at a day clinic

OBJECTIVE: The purpose of this study was to evaluate a haptotherapeutic treatment and its effects on the perceived well-being of patients with cancer treated with chemotherapy in day care. METHODS: The study had a pre-test-post-test semi-experimental design, with 31 patients in the intervention group and 26 in the control group. Patients in the control group were matched with patients in the experimental condition with respect to age, gender, type of cancer, type of chemotherapy, prognosis and the period between pre- and post-test. Standardized questionnaires were used measuring perceived well-being and satisfaction with care (haptotherapy). Indicators of well-being measured were quality of life, mood, meaning in life, general functioning, physical and psychological symptoms, sleep quality and body awareness. The intervention consisted of five haptotherapy sessions of 45 minutes each. Patients in the control condition received standard medical care. RESULTS: Patients were highly satisfied with the haptotherapy treatment, and especially valued the personal attention and the relaxation they experienced. The haptotherapy treatment improved both the perceived general quality of life and the perceived cognitive and social functioning of patients. No improvement was found for mood, meaning in life, general functioning, physical symptoms, sleep quality and body awareness. CONCLUSION: It may be concluded that haptotherapy positively contributes to several indicators of perceived well-being of patients with cancer during the period they receive chemotherapy. More rigorous experimental studies are necessary in this field, especially concerning randomization, number of participants and homogeneity of the sample. PRACTICE IMPLICATIONS: Haptotherapy as a type of complementary medicine is a potentially valuable and effective intervention to raise the well-being of patients with cancer undergoing invasive treatments like chemotherapy.     

个体及集体干预对维持性血液透析患者生存质量的影响

背景：随着血液透析技术的不断改进,维持性血液透析患者的长期生存率亦不断上升,如何提高其生存质量,已经引起患者乃至全社会的广泛关注,也逐渐成为综合评价透析效果的可靠指标。 目的：探讨个体化干预与集体化干预对维持性血液透析患者生存质量的影响。 方法：选择透析时间大于3个月的维持性血液透析患者80例,采用随机数字表法分为试验组和对照组,每组40例。对照组患者在血液透析常规护理的基础上,按预先制定的周计划进行个体化护理干预,为期6周;试验组患者在对照组干预基础上,按预先制定的周计划进行集体化护理干预,为期6周。干预前后,均采用简明健康状况调查表(MOS 36-item short form health survey,SF-36)和终末期肾脏疾病透析患者调查简表(kidney disease quality of life short form,KDQOL-SFTM)评价2组患者生存质量变化。 结果与结论：干预后2组患者SF-36及KQQOL-SF评分均高于干预前(P < 0.01);试验组患者SF-36体能影响、整体健康、情感状态、情感影响、社会功能、精力等6个维度评分高于对照组干预后水平(P < 0.01);试验组患者KQQOL-SF社交质量、睡眠、社会支持、患者满意度4个维度评分高于对照组同期水平(P < 0.01)。提示个体化干预及在个体化干预基础上进行集体化干预均能提高维持性血液透析患者的生存质量,同时后者能从生理、心理、社会等多个方面更好的改善患者生存质量。     

Psychosocial aspects of changes in cigarette-smoking behavior.

This paper examines the relationships between patients' perceptions of susceptibility to illness, self-efficacy, anxiety, social support and subsequent changes in cigarette-smoking behavior through a prospective study involving 213 patients using a Veterans Administration Medical Center (VAMC). During an inpatient or outpatient visit to the VAMC, veterans received a questionnaire and were then enrolled in a smoking cessation intervention trial wherein some patients received a practitioner-initiated minimal-contact intervention and other patients received usual care. Smoking status was assessed 3 months following hospital discharge. Analyses revealed that patients most likely to have reduced their smoking, whether in the intervention or control group, were those reporting both high perceived susceptibility and high expectations of efficacy. Those least likely to have reduced their smoking were those reporting high susceptibility but low efficacy--what has been characterized as a 'learned helplessness' mode. Expectations of efficacy were inversely associated with general level of anxiety; that is, those reporting high levels of anxiety tended to report lower levels of self-efficacy. This relationship was powerfully buffered by a measure of social support. The results of this study suggest a number of potentially effective counseling strategies for practitioners who are trying to get their patients to quit smoking.     

Nurse administered telephone intervention for blood pressure control: a patient-tailored multifactorial intervention

OBJECTIVES: A randomized controlled trial involving a nurse administered patient-tailored intervention is being conducted to improve blood pressure (BP) control. METHODS: Veterans with hypertension from an outpatient primary care clinic completed a baseline assessment and were randomly allocated to either a nurse administered intervention or to usual care. In this ongoing study, intervention patients receive the tailored intervention bi-monthly for 2 years via telephone; the goal of the intervention is to promote adherence with medication and improve health behaviors. Patient factors targeted for intervention include perceived risk of hypertension, memory, literacy, social support, patients' relationship with their health care provider, side effects of therapy, pill refill, missed appointments, and health behaviors. RESULTS: The sample randomized to the nurse intervention consisted of 294 veterans with hypertension (average age = 63 years; 41% African-American). A comparable sample of veterans was assigned to usual care (n = 294). We have maintained a 97% retention rate for the first 12 months of the study. The average phone call has lasted 3.7 min ranging from less than 1 to 40 min. At 6-month post-enrollment, individuals receiving the nurse intervention had a greater increase in confidence with following hypertension treatment (P < 0.007) than the usual care group. DISCUSSION: The intervention is easily implemented and is designed to enhance adherence with prescribed hypertension regimen. The study includes both general and patient-tailored information based upon need assessment. The study design ensures internal validity as well as the ability to generalize study findings to the clinic settings.     

深圳移居者心理健康水平及有关因素的初步研究

以 SCL—90总症状指数为指标,发现深圳移居者的心理健康水平高于原当地居民。影响移居者心理健康的主要因素是:(1)过去一年里经历的负性生活事件;(2)在深圳居住时间;(3)对工作满意的程度;(4)对移居的态度;(5)移居后的社会支持水平。     

团体心理干预对老年冠心病患者焦虑情绪的影响

目的:探讨心理评估及团体心理干预在缓解老年冠心病患者焦虑情绪中的应用效果。方法:将心内科2016年2—6月收治的90例老年冠心病患者分为观察组和对照组各45例,两组治疗方法均衡,对照组采用常规心理干预,观察组心理评估后实施团体心理干预,均干预12周。比较两组患者的焦虑、抑郁情绪及社会支持度。结果:观察组干预12周后的焦虑、抑郁评分低于对照组,差异有统计学意义(t=-6.389,-9.453;P0.05)。观察组干预12周后主观支持、客观支持、支持利用度评分高于对照组,差异有统计学意义(t=5.161,7.733,11.530;P0.05)。结论:心理评估及团体心理干预能够显著缓解老年冠心病患者焦虑、抑郁情绪,提高患者的社会支持度。     

Take Control of Your Blood Pressure (TCYB) study: a multifactorial tailored behavioral and educational intervention for achieving blood pressure control

OBJECTIVE: Evaluating a randomized controlled trial involving a tailored behavioral intervention conducted to improve blood pressure control. METHODS: Adults with hypertension from two outpatient primary care clinics were randomly allocated to receive a nurse-administered behavioral intervention or usual care. In this ongoing study, patients receive the tailored behavioral intervention bi-monthly for 2 years via telephone; the goal of the intervention is to promote medication adherence and improve hypertension-related health behaviors. Patient factors targeted in the tailored behavioral intervention include perceived risk of hypertension and knowledge, memory, medical and social support, patients' relationship with their health care provider, adverse effects of medication therapy, weight management, exercise, diet, stress, smoking, and alcohol use. RESULTS: The sample randomized to the behavioral intervention consisted of 319 adults with hypertension (average age=60.5 years; 47% African-American). A comparable sample of adults was assigned to usual care (n=317). We had a 96% retention rate for the overall sample for the first 6 months of the study (93% at 12 months). The average phone call has lasted 18min (range 2-51min). From baseline to 6 months, self-reported medication adherence increased by 9% in the behavioral group vs. 1% in the non-behavioral group. CONCLUSION: The intervention is easily implemented and is designed to enhance adherence with prescribed hypertension regimen. The study includes both general and patient-tailored information based upon need assessment. The study design ensures internal validity as well as the ability to generalize study findings to the clinic settings. PRACTICE IMPLICATIONS: Despite knowledge of the risks and acceptable evidence, a large number of hypertensive adults still do not have their blood pressure under effective control. This study will be an important step in evaluating a tailored multibehavioral intervention focusing on improving blood pressure control.     

Exploratory cluster randomised controlled trial of shared care development for long-term mental illness.

BACKGROUND: Primary care clinicians have a considerable amount of contact with patients suffering from long-term mental illness. The United Kingdom's National Health Service now requires general practices to contribute more systematically to care for this group of patients. AIMS: To determine the effects of Mental Health Link, a facilitation-based quality improvement programme designed to improve communication between the teams and systems of care within general practice. Design of study: Exploratory cluster randomised controlled trial. SETTING: Twenty-three urban general practices and associated community mental health teams. METHOD: Practices were randomised to service development as usual or to the Mental Health Link programme. Questionnaires and an audit of notes assessed 335 patients' satisfaction, unmet need, mental health status, processes of mental and physical care, and general practitioners' satisfaction with services and beliefs about service development. Service use and intervention costs were also measured. RESULTS: There were no significant differences in patients' perception of their unmet need, satisfaction or general health. Intervention patients had fewer psychiatric relapses than control patients (mean = 0.39 versus 0.71, respectively, P = 0.02) but there were no differences in documented processes of care. Intervention practitioners were more satisfied and services improved significantly for intervention practices. There was an additional mean direct cost of pound 63 per patient with long-term mental illness for the intervention compared with the control. CONCLUSION: Significant differences were seen in relapse rates and practitioner satisfaction. Improvements in service development did not translate into documented improvements in care. This could be explained by the intervention working via the improvements in informal shared care developed through better link working. This type of facilitated intervention tailored to context has the potential to improve care and interface working.     

Shared decision-making and patient engagement program during acute exacerbation of COPD hospitalization: A randomized control trial

ObjectiveTo evaluate the effectiveness of a shared decision-making and patient engagement (SDM-PE) program concerning in-hospital stay during acute exacerbation of COPD and determine its impact on patients’ perceived health status.MethodsPatients were randomly allocated to a control group that received standard treatment or an intervention group that received an individualized SDM-PE program in addition to standard treatment. The SDM-PE program included personalized health care focused on information about the disease, healthcare management, and reinforcement of behaviors regarding nutrition and exercise taking into account patients’ preferences.ResultsA comparative analysis between groups showed a significant improvement in perceived health status at discharge in patients included in the experimental group compared to those in the control group (60.28 ± 21.65 vs. 54.13 ± 22.69, p = 0.036). In addition, perceived health status, COPD knowledge, adherence to pharmacological treatment, general functionality, and healthy lifestyle measures were significantly better at 3-month follow-up in the intervention group.ConclusionAn SDM-PE program significantly enhanced all the clinical measures assessed during hospitalization at 3-month follow-up.Practice implicationsCOPD patients and professionals need to work together to select the best care and treatment model for patients, taking into account individual values and preferences.     

Primary care support for tackling obesity: a qualitative study of the perceptions of obese patients

BACKGROUND: Obesity has become a major public health issue and there is concern about the response of health services to patients who are obese. The perceptions of obese patients using primary care services have not been studied in depth. AIM: To explore obese patients' experiences and perceptions of support in primary care. DESIGN OF STUDY: Qualitative study with semi-structured interviews conducted in participants' homes. SETTING: Five general practices contrasting in socioeconomic populations in Sheffield. METHOD: Purposive sampling and semi-structured interviewing of 28 patients with a diverse range of ages, backgrounds, levels of obesity and experiences of primary care services. RESULTS: Participants typically felt reluctance when presenting with concerns about weight and ambivalence about the services received. They also perceived there to be ambivalence and a lack of resources on the part of the health services. Participants showed a strong sense of personal responsibility about their condition and stigma-related cognitions were common. These contributed to their ambivalence about using services and their sensitivity to its features. Good relationships with primary care professionals and more intensive support partly ameliorated these effects. CONCLUSION: The challenges of improving access to and quality of primary care support in tackling obesity are made more complex by patients' ambivalence and other effects of the stigma associated with obesity.     

社区随访干预对精神分裂症患者生活质量的影响

目的探讨社区随访干预对精神分裂症患者生活质量和社会功能康复的影响。方法将出院的精神分裂症患者152例随机分成干预组和对照组,对干预组患者及其家属、社区居民实施群体随访干预和个别指导,对照组针对患者个体给予一般健康指导,共干预1年。采用家庭关怀度指数问卷(APGAR)、社会功能缺陷量表(SDSS)和生活质量综合评定问卷(GQOL I-74)对干预效果进行评定。结果实施社区随访干预后,干预组患者的社会功能缺陷程度明显降低,与干预前及两组间比较,均有显著统计学意义(P<0.01)。患者得到较多的家庭、社会支持,家庭社会关怀度显著提高(P<0.05)。患者生活质量与家庭社会支持度的相关性分析,除物质生活维度,其余3个维度即躯体功能(r=0.37,P<0.01)、心理功能(r=0.35,P<0.01)、社会功能(r=0.27,P<0.05)均与家庭社会关怀度呈正相关。患者生活质量明显提高。结论社区随访干预可有效提高精神分裂症患者的生活质量和社会功能。     

Social Support,Dysfunctional Coping,and Community Reintegration as Predictors of PTSD Among Human Trafficking Survivors

Human trafficking exerts psychological effects on survivors that persist after intervention, and even after community reintegration. Effects include anxiety, depression, alienation, disorientation, aggression, suicidal ideation, attention deficit, and posttraumatic stress disorder (PTSD). Community supports and coping mechanisms may mitigate these effects. The report presented here is part of a long-term program of research to develop and test evidence-informed mental health and human capacity-building intervention programs for women and girls who are victims of trafficking. Structural equation modeling was used to assess a conditional process model (moderated mediation) of the effect of social support, coping, and community reintegration on PTSD among n = 144 girls and women. Participants received psychosocial intervention at a residential care facility for trafficking survivors. Results indicate model fit was excellent. Results indicate community reintegration indirectly influenced PTSD through its effect on perceived social support. Survivors who reported more difficulty reintegrating back into the community perceived less social support than those that reported easier community reintegration, and trafficking survivors who perceived less social support indicated more PTSD. Survivors with more PTSD symptoms tended to report using more dysfunctional coping mechanisms.     

Clinical psychology in general practice: a controlled trial evaluation

A controlled trial study is described in which 50 consecutive potential referrals for psychological treatment from one general practice were randomly allocated either to behavioural treatment or no-treatment conditions. Treatment-group patients received treatment from a clinical psychologist working within the practice; the control-group patients continued to be managed by their general practitioner. The patients' use of NHS resources was assessed during the treatment period (or its equivalent for the control group) and at a follow-up comparison point, when the patients' subjective ratings of their progress were also obtained. Between referral and the end of treatment the treated group received significantly less psychotropic medication than the control group. This difference was not, however, maintained at the longer-term follow-up. No differences in general practice consultation rates, in the subjective ratings of psychological distress, in control orientation or life satisfaction were found between the two groups, but the level of patient satisfaction was high. Implications for the design of future studies and for psychological health care delivery systems are discussed.     

心理干预对乳腺癌患者应对方式及社会支持的影响

目的探讨综合性心理干预对化疗期间乳腺癌患者应对方式及社会支持的影响方法将83例化疗期乳腺癌患者随机分为实验组和对照组，实验组除接受常规化疗及护理外，还进行为期8周的综合性心理干预，对照组仅接受常规化疗及护理，以乳腺癌患者防御方式（DSQ），社会支持（SSRS）为指标，评价心理干预对乳腺癌患者防御方式及社会支持的影响。结果心理干预后，对两组进行比较显示，实验组比对照组更多地采取积极防御方式，较少地采取消极的防御方式（P〈0.05）。心理干预后，实验组在社会支持总分、主观支持得分、支持利用度等方面较心理干预前均有明显提高（P〈0.05），而对照组前后无明显变化（P〉0.05）。结论综合性的心理干预能够使乳腺癌患者的积极应对方式增加，对社会支持的利用度增加，从而降低负性情绪的影响，提高其生存质量。     

Effectiveness of an education programme by a general practice assistant for asthma and COPD patients: results from a randomised controlled trial

In this study a randomised controlled trial was carried out to investigate the effectiveness of an education programme for patients with asthma or chronic obstructive pulmonary disease (COPD). All asthma and COPD patients using medication and experiencing pulmonary symptoms were randomly assigned to the intervention (n=139) or usual-care group (n=137). The intervention consisted of taylor-made education conducted by a general practice assistant and focussing on a patients' technical skills and coping with the disease. Measurements took place at baseline, and after 1 and 2 years of follow-up. After 1 and 2 years the inhalation technique was significantly better in the intervention group compared to the usual-care group. No significant differences were observed regarding disease symptoms, health related quality of life, compliance, smoking cessation, self-efficacy, and coping. The results only support the implementation of the intervention regarding the technical skills (inhalation technique). However, given the importance of improvement of patients' coping and the need for more efficient care, we recommend further exploration of the possibilities of a more structured and intensive education programme.     

心理干预对提升精神科医院护士生活质量的影响

目的:探讨系统心理干预对提升精神科医院护士生活质量的影响效果。方法:选取唐山市第五医院的护士56名,随机分为两组,采用对照研究,选取其中一组作为干预组,另一组作为对照组。干预组护士接受连续8周的系统心理干预,对照组护士不接受任何心理干预。干预前后对干预组和对照组护士均采用SF-36健康调查量表进行问卷调查。结果:干预后干预组总体健康状况、活力、社会功能、情感职能、精神健康等生活质量维度得分显著高于对照组(t=2.140,2.162,2.102,2.046,2.333;P0.05)。结论:系统心理干预可以有效提升精神科医院护士的生活质量。     

Relationship of Stereotypic Beliefs About Physicians to Health Care-Relevant Behaviors and Cognitions Among African American Women

A great deal of basic social psychological research has demonstrated that stereotypes affect judgments, behaviors, and decisions with respect to individual group members. However, almost no research has applied social psychological theories of stereotypes to understanding health behavior. The purpose of the present study was to examine the relationship between stereotypic beliefs about physicians and health care-relevant behaviors and cognitions. Fifty-nine African American women were recruited from community venues to complete self-report, anonymous questionnaires measuring beliefs about physicians and health care utilization, satisfaction, and intentions. Participants who perceived physicians positively overall, and as competent and warm, reported greater health care utilization and higher satisfaction with their current health care, controlling for perceived general health status. These results suggest that interpersonal social cognitive expectancies play a role in health care-related behaviors and cognitions.     

心理社会干预对乳腺癌患者生存质量影响的对照研究

目的 采用前瞻性随机对照研究,以乳腺癌术后化疗患者为研究对象,探讨心理社会干预对其生存质量的影响.方法 120例病人被随机分配到干预组(60例)和对照组(60例),干预组除常规药物治疗外,接受系统的心理社会干预,如健康教育、放松训练及集体心理干预,对照组只有药物治疗.采用中国癌症化疗患者生活质量量表(QLQ-CCC)及症状自评量表(SCL-90)作为乳腺癌化疗患者生存质量和心理状况的测查指标.结果 乳腺癌化疗患者的生存质量状况以化疗中最差,而治疗结束后,干预组患者的SCL-90总分(131.9士13.7)与对照组(192.5士15.4)相比,P＜0.01;而躯体、心理、社会、总体方面评分分别为:26.7士2.6 分、13.7士1.5 分、8.5士0.8 分、46.9士3.5 分,P＜0.05或0.01,表明干预组患者的不良情绪明显改善,生存质量明显提高.结合对乳腺癌术后化疗患者实施系统的心理社会干预,是改善不良情绪,提高生存质量的有效方法之一,值得推广应用.     

Controlled evaluation of brief intervention by general practitioners to reduce chronic use of benzodiazepines.

BACKGROUND: It is recommended that long-term users of benzodiazepines in general practice be withdrawn from their medication where possible. AIM: A study was undertaken to assess the effectiveness of minimal intervention delivered by general practitioners in helping chronic users of benzodiazepines to withdraw from their medication, and to determine the psychological sequelae on patients of such intervention. METHOD: Patients taking benzodiazepines regularly for at least one year were recruited by their general practitioner and allocated either to a group receiving brief advice during one consultation supplemented by a self-help booklet or to a control group who received routine care. The patients completed the 12-item general health questionnaire and a benzodiazepine withdrawal symptom questionnaire at the outset of the study and at three and six months after this. RESULTS: Eighteen per cent of patients in the intervention group (9/50) had a reduction in benzodiazepine prescribing recorded in the notes compared with 5% of the 55 patients in the control group (P < 0.05). In the intervention group, 63% of patients had a score of two or more on the general health questionnaire at baseline compared with 52% at six months. Of the 20 intervention patients reporting benzodiazepine reduction, 60% had a score of two or more at baseline compared with 40% at six months. Intervention patients had significantly more qualitative, but not quantitative, withdrawal symptoms at six months compared with baseline. Consultation rates were not increased in the intervention group. CONCLUSION: The study indicates that some chronic users can successfully reduce their intake of benzodiazepines with simple advice from the general practitioner and a self-help booklet. This type of intervention does not lead to psychological distress or increased consultation.     

心理干预对首发青少年精神病患者亲属心理健康状况影响的对照研究

目的调查青少年精神病患者亲属心理健康状况，探讨心理干预对其心理状态影响。方法对入组132例陪护亲属随机分为干预组和对照组各66例，采用症状自评量表（SCL-90）、焦虑自评量表（SAS）及自编一般状况调查表，心理干预前后对两组亲属进行测评和对照研究，并与国内常模对比分析。结果干预前两组亲属SCL-90、SAS评分均高于国内常模（P均〈0．01）．具有统计学意义。干预后干预组SCL-90、SAS评分均显著下降（P均〈0．01），均低于对照组（P均〈0．05），具有统计学意义。结论青少年精神病患者亲属心理健康状况较差，心理干预能有效的提高亲属的心理健康水平，促进患者早日康复。