Service providers' views of psychiatric mutual support groups

Despite evidence that mutual support groups can be beneficial for those with serious mental illnesses, professionals have been reluctant to utilize this resource. We surveyed over 400 providers across several disciplines and settings within the state of Connecticut's public mental health system to assess their attitudes and practices regarding the use of mutual support groups for their patients. We found that being a rehabilitation worker and possessing more advanced training, greater numbers of years in their setting and discipline, and personal experience with psychiatric disorders or mutual support were associated with more favorable attitudes and behaviors toward mutual support. In addition, traditional 12‐step groups (e.g., Alcoholics Anonymous) were viewed more favorably than psychiatric mutual support groups. Implications for educational efforts about the benefits of mutual support for those with serious mental illnesses are discussed. © 2002 Wiley Periodicals, Inc.     

Effects of metabolic control, patient education and initiation of insulin therapy on the quality of life of patients with type 2 diabetes mellitus

OBJECTIVE: The objective of this study was to evaluate the impact of initiation of insulin therapy, metabolic control and structured patient education on the diabetes-related quality of life (QoL) in insulin-treated patients with type 2 diabetes mellitus. METHODS: This prospective study was conducted with 71 consecutively recruited patients with insulin-treated diabetes at the University hospital. All patients participated an inpatient diabetes treatment and teaching program (DTTP) for conventional insulin therapy (mean age 68.9 years, HbA1c 10.1+/-1.4%, diabetes duration 11.2 years (range: 0-25.5 years), body-mass-index 28.7+/-5.7kg/m(2). Diabetes-related quality of life was assessed before and 6 months after participation in the DTTP using the standardized questionnaire of Lohr analysing the subscales: social relations, physical complaints, worries about the future, dietary restrictions, fear of hypoglycaemia, and daily struggles. RESULTS: Only patients switched on insulin therapy showed significant improvement in diabetes-related quality of life 6 months after participation in the DTTP (p=0.03), fewer physical complaints (p=0.03), fewer worries about the future (p=0.02), fewer daily struggles (p=0.01) and less fear of hypoglycaemia (p<0.001), while patients, who were already on insulin therapy showed no improvements in diabetes-related quality of life. Though, residual analysis reveals that effects on patients' QoL are mainly caused by improvements in metabolic control. CONCLUSIONS: Improvements in metabolic control have a significant effect on different diabetes-related quality of life domains in patients with diabetes mellitus. PRACTICE IMPLICATIONS: Appropriate interventions resulting in better metabolic control, such as starting on insulin therapy within a structured patient education program seem to be an effective approach to improve patients' diabetes-related quality of life.     

Assessment of myocardial triglyceride oxidation with PET and 11C-palmitate

Background  The goal of this study was to test whether myocardial triglyceride (TG) turnover including oxidation of TG-derived fatty acids (FA) could be assessed with PET and ¹¹C-palmitate. Methods and Results  A total of 26 dogs were studied fasted (FAST), during Intralipid infusion (IL), during a hyperinsulinemic-euglycemic clamp without (HIEG), or with Intralipid infusion (HIEG + IL). ¹¹C-palmitate was injected, and 45 minutes were allowed for labeling of myocardial TG pool. 3D PET data were then acquired for 60 minutes, with first 15 minutes at baseline followed by 45 minutes during cardiac work stimulated with constant infusion of either phenylephrine (FAST, n = 6; IL, n = 6; HIEG + IL, n = 6) or dobutamine (FAST, n = 4; HIEG, n = 4). Myocardial ¹¹C washout during adrenergic stimulation (AS) was fitted to a mono-exponential function (Km(PET)). To determine the source of this ¹¹C clearance, Km(PET) was compared to direct coronary sinus-arterial measurements of total ¹¹C activity, ¹¹C-palmitate, and ¹¹CO₂. Before AS, PET curves in all groups were flat indicating absence of net clearance of ¹¹C activity from heart. In both FAST groups, AS resulted in negligible net ¹¹C activity and ¹¹CO₂ production higher than net ¹¹C-palmitate uptake. AS with phenylephrine resulted in net myocardial uptake of total ¹¹C activity and ¹¹C-palmitate in IL and HIEG + IL, and ¹¹CO₂ production lower than ¹¹C-palmitate uptake. In contrast, AS with dobutamine in HIEG resulted in net clearance of all ¹¹C metabolites (total ¹¹C activity, ¹¹C-palmitate and ¹¹CO₂) with ¹¹CO₂ contributing 66% to endogenous FA oxidation. The AS resulted in significant Km(PET) in all the groups, except HIEG + IL. However, positive correlation between Km(PET) and ¹¹CO₂ was observed only in HIEG (R ² = 0.83, P = .09). Conclusions  This is the first study to demonstrate that using PET and pre-labeling of intracardiac TG pool with ¹¹C-palmitate, noninvasive assessment of myocardial TG use is feasible under metabolic conditions that favor endogenous TG use such as increased metabolic demand (β-adrenergic stimulation of cardiac work) with limited availability of exogenous substrate (HIEG).     

Visualization of the lenticulostriate artery with flow‐sensitive black‐blood acquisition in comparison with time‐of‐flight MR angiography

Purpose

To evaluate the capability of flow‐sensitive black blood (FSBB) acquisition to visualize the lenticulostriate artery (LSA) in comparison with time‐of‐flight (TOF) angiography.

Materials and Methods

Twenty‐one healthy subjects (13 males and 8 females, 19–44 years old) were enrolled in this study after obtaining written informed consent. Magnetic resonance imaging (MRI) examinations were performed with FSBB and TOF to visualize the LSA using a 1.5T MRI unit. In FSBB acquisition a motion probing gradient of b = 4 sec/mm² was applied to dephase blood flow. Images were reconstructed into coronal sections and were evaluated in terms of number, length, and image quality at origins and distal areas of visualized LSA branches with a four‐point scale.

Results

In all, 145 LSA branches were visualized with FSBB and 66 branches with TOF. There was no LSA visualized only with TOF. In all evaluated terms, FSBB was significantly better than TOF.

Conclusion

We could better visualize the LSA with FSBB than with TOF, both quantitatively and qualitatively. FSBB is a promising method, although it remains to be evaluated in clinical cases. J. Magn. Reson. Imaging 2009;29:65–69. © 2008 Wiley‐Liss, Inc.     

Non‐contrast‐enhanced MR portography with time‐spatial labeling inversion pulses: Comparison of imaging with three‐dimensional half‐fourier fast spin‐echo and true steady‐state free‐precession sequences

Purpose

To compare and evaluate images acquired with two different MR angiography (MRA) sequences, three‐dimensional (3D) half‐Fourier fast spin‐echo (FSE) and 3D true steady‐state free‐precession (SSFP) combined with two time‐spatial labeling inversion pulses (T‐SLIPs), for selective and non‐contrast‐enhanced (non‐CE) visualization of the portal vein.

Materials and Methods

Twenty healthy volunteers were examined using half‐Fourier FSE and true SSFP sequences on a 1.5T MRI system with two T‐SLIPs, one placed on the liver and thorax, and the other on the lower abdomen. For quantitative analysis, vessel‐to‐liver contrast (Cv‐l) ratios of the main portal vein (MPV), right portal vein (RPV), and left portal vein (LPV) were measured. The quality of visualization was also evaluated.

Results

In both pulse sequences, selective visualization of the portal vein was successfully conducted in all 20 volunteers. Quantitative evaluation showed significantly better Cv‐l at the RPVs and LPVs in half‐Fourier FSE (P < 0.0001). At the MPV, Cv‐l was better in true SSFP, but was not statistically different. Visualization scores were significantly better only at branches of segments four and eight for half‐Fourier FSE (P = 0.001 and 0.03, respectively).

Conclusion

Both 3D half‐Fourier FSE and true SSFP scans with T‐SLIPs enabled selective non‐CE visualization of the portal vein. Half‐Fourier FSE was considered appropriate for intrahepatic portal vein visualization, and true SSFP may be preferable when visualization of the MPV is required. J. Magn. Reson. Imaging 2009;29:1140–1146. © 2009 Wiley‐Liss, Inc.     

Whole heart magnetization‐prepared steady‐state free precession coronary vein MRI

Purpose

To compare two coronary vein imaging techniques using whole‐heart balanced steady‐state free precession (SSFP) and a targeted double‐oblique spoiled gradient‐echo (GRE) sequences in combination with magnetization transfer (MT) preparation sequence for tissue contrast improvement.

Materials and Methods

Nine healthy subjects were imaged with the proposed technique. The results are compared with optimized targeted MT prepared GRE acquisitions. Both quantitative and qualitative analyses were performed to evaluate each imaging method.

Results

Whole‐heart images were successfully acquired with no visible image artifact in the vicinity of the coronary veins. The anatomical features and visual grading of both techniques were comparable. However, the targeted small slab acquisition of the left ventricular lateral wall was superior to whole‐heart acquisition for visualization of relevant information for cardiac resynchronization therapy (CRT) lead implantation.

Conclusion

We demonstrated the feasibility of whole‐heart coronary vein MRI using a 3D MT‐SSFP imaging sequence. A targeted acquisition along the lateral left ventricular wall is preferred for visualization of branches commonly used in CRT lead implantation. J. Magn. Reson. Imaging 2009;29:1293–1299. © 2009 Wiley‐Liss, Inc.