Metacognitive awareness and prevention of relapse in depression: empirical evidence

Metacognitive awareness is a cognitive set in which negative thoughts/feelings are experienced as mental events, rather than as the self. The authors hypothesized that (a) reduced metacognitive awareness would be associated with vulnerability to depression and (b) cognitive therapy (CT) and mindfulness-based CT (MBCT) would reduce depressive relapse by increasing metacognitive awareness. They found (a) accessibility of metacognitive sets to depressive cues was less in a vulnerable group (residually depressed patients) than in nondepressed controls; (b) accessibility of metacognitive sets predicted relapse in residually depressed patients; (c) where CT reduced relapse in residually depressed patients, it increased accessibility of metacognitive sets; and (d) where MBCT reduced relapse in recovered depressed patients, it increased accessibility of metacognitive sets. CT and MBCT may reduce relapse by changing relationships to negative thoughts rather than by changing belief in thought content.     

Role of self-efficacy and behaviour change

Behaviour change is an important concept in relation to health promotion and disease prevention. Self-efficacy has been identified as an important determinant of health behaviour, future health behaviour and health behaviour change. In order to effectively facilitate behaviour change, it is essential that interventions are research based, and emphasize the utility of theory in practice. The effective practice of health promotion and disease prevention requires a full understanding of the processes of patient behaviour. This article presents the role of the nurse in influencing health-related behaviour change. Self-efficacy and related but distinct theories that underpin behaviour change are discussed. The empirical evidence that supports the link between self-efficacy and predictions of health behaviours is also examined.     

Estimation of premotor synaptic drives to simulated abducens motoneurons for control of eye position

The firing rate of an abducens motoneuron (AbMN) is linearly related to eye position with slope K, above recruitment threshold theta. Within the AbMN population K increases as theta increases. It is possible that these properties depend on the synaptic drives generated by the major premotor inputs to AbMNs, namely position-vestibular-pause (PVP) cells and eye and head velocity (EHV) cells in the medial vestibular nucleus, and eye-position and burst-position cells in the nucleus prepositus hypoglossi (NPH). Premotor inputs to AbMNs were therefore modelled by a two-layer net, in which the output nodes represented the AbMNs (with fixed intrinsic properties) and the input nodes the three classes of premotor units ( n=20/class). Conjugate eye-position commands were used to generate the firing rates in premotor units found experimentally. The output of the net was compared with observed AbMN firing rates, and the resultant error used to adjust the magnitude and sign of the connection weights between premotor units and AbMNs. To provide additional constraints on permitted weights, the net was also trained under simulated smooth pursuit, cancellation of the vestibular-ocular reflex, and the vestibulo-ocular reflex itself (all at 0.5 Hz). Since the projections of EHV cells have not been clearly characterized, two versions of the model were trained, corresponding to different assumptions about these projections. In both versions, position-related AbMN firing rates were derived mainly from an excitatory drive from PVP cells and an inhibitory drive from NPH cells with the opposite ON direction. Variation in AbMN threshold theta and position sensitivity K depended on the strength of the drive from the NPH: the stronger the drive, the higher both K and theta. This arrangement was observed in six variants of the basic model with different parameter values, and in a simplified form (constant PVP drive and varying NPH drive) was able to generate qualitatively the observed relationship between K and theta even in the absence of input from EHV cells. It appears to be a robust mechanism for producing the experimentally observed variation in position-related firing of AbMNs, even without a contribution from their intrinsic properties, and predicts that local blocking of the inhibitory drive from cells in the NPH should lower both the position threshold and sensitivity of an individual AbMN. The model also indicates that if EHV cells have ipsilateral inhibitory projections, as has been proposed on the basis of their similarity with cells receiving input from the flocculus, then their role in eye-position control would reinforce that of cells in the NPH.     

Attribution and the effects of expectancy: how beliefs can influence the experiences of smoking cessation

Research on smoking cessation has found consistencies and similarities during abstinence, but also that the specific signs and symptoms and their intensity vary greatly from individual to individual. One possible source of this variation is the cognitions associated with quitting. We investigated the experiences and associated cognitions in normal cessation by asking quitting smokers to rate their experiences on a questionnaire and to indicate the most likely reason for each experience. Statistical analyses confirmed that attributions to abstinence were significantly higher for increased negative experiences, and there were significantly more reattributions than would be found by chance for items associated with smoking abstinence. Significantly more attributions to abstinence were made by clinic attendees and significantly more attributions of negative experiences to abstinence were made by unaided quitters using self-help materials. These results can be interpreted in the context of attribution theory; quitters may use the cognitions available to them to attribute their negative experiences to quitting. Consequently, counsellors could use cognitive therapy to alter their clients' expectations and explanations of their experiences, and emphasise the positive outcomes of cessation.     

Ethical issues in end-of-life geriatric care: the approach of three monotheistic religions-Judaism,Catholicism, and Islam

Ethical dilemmas pervade modern geriatric medicine. What is considered right or wrong will differ depending on, among other things, the patient's religion. The three Abrahamic monotheistic religions, Judaism, Christianity (its Catholic variant), and Islam all have carefully considered positions on medical ethics. Although much is held in common, there are significant differences. The authors present three clinical cases, each of which presents ethical dilemmas typical of geriatric care, especially at the end of life. On the basis of these scenarios, the normative ethical position of each religion is compared and contrasted. It is hoped that this approach will offer the geriatrician a useful approach to treating patients in an increasingly multicultural society.     

Preliminary report of a NeuroPage service within a health care system

NeuroPage, a paging service designed to reduce the everyday memory and/or planning problems of people with neurological deficits, is described. Following several research studies carried out to evaluate the system, a British local health authority set up a nationwide commercial NeuroPage service. A report on the first 40 clients recruited to the service is provided. The age range was 14-81 years, the majority of clients were men and the most frequent diagnosis was traumatic brain injury although a number of different diagnostic groups were represented. The types of messages sent and the group's satisfaction with NeuroPage are considered. Three brief case studies to illustrate the different ways clients used the system are presented.     

Using clinical research summaries to aid research nurses

The National Cancer Research Network was introduced in 2001 with the aim of doubling the number of cancer patients undergoing clinical trials. Clinical trial summaries are an invaluable tool for busy research staff, providing a precis of current research taking place in an organisation. They can be used in research in any clinical area and in hospital or community.