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Heron D, Gebhardt B, Beriwal S, Benson H, Lorinc Z, Barry A, Lokay K. The Benefits of Clinical Pathways (CP) for Radiation Oncology in a Large Cancer Care Network. Int J Radiat Oncol Biol Phys 2016. [DOI: 10.1016/j.ijrobp.2016.06.1653] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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2
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Wright T, Moss P, Will R, Benson H. SAT0348 Differences in Quantitative Sensory Testing and Functional Testing between Patients with Osteoarthrtis and Matched Controls. Ann Rheum Dis 2013. [DOI: 10.1136/annrheumdis-2013-eular.2073] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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3
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Denninger J, Dusek J, Bhasin M, Huffman J, Slipp L, Scult M, Mahoney B, Chang B, Zusman R, Benson H, Libermann T, Fricchione G. P02.117. Genomic expression changes underlying mind-body practices. BMC Complement Altern Med 2012. [PMCID: PMC3373438 DOI: 10.1186/1472-6882-12-s1-p173] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
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4
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Benson H, Blackburn R, Moehring J. Nursing Incivility in the BMT Nursing Practice Setting. Biol Blood Marrow Transplant 2011. [DOI: 10.1016/j.bbmt.2010.12.123] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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5
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Benson H, Costas R, Garcia-Palmieri MR, Feliberti M, Aixalá R, Blanton JH, Colón AA. Coronary heart disease risk factors: a comparison of two puerto rican populations. Am J Public Health Nations Health 2010; 56:1057-60. [PMID: 18018136 DOI: 10.2105/ajph.56.7.1057] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Abstract
Considerable emphasis has been placed upon the relation of behavioural factors to the development of coronary artery disease. There is, however, the opposite potential: behavioural processes may lead to the alleviation and reversal of some of the predisposing features of this illness. This paper presents evidence that specific behaviours and thought patterns are associated with the elicitation of an innate physiological capacity termed the relaxation response. It will discuss the history of this response, its physiological basis, clinical usefulness (particularly in prevention) and some recent findings concerning the underlying mechanism of its actions.
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Beard C, Dean-Clower E, Dusek J, Stason WB, DeCristofaro S, Keshaviah A, Purevjal I, Rosenthal D, Webster A, Benson H. A study of complementary therapies in men receiving radiation therapy for prostate cancer: A randomized feasibility trial. J Clin Oncol 2007. [DOI: 10.1200/jco.2007.25.18_suppl.15638] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
15638 Background: Prostate-cancer patients suffer from substantial distress with both their diagnosis and treatment. Several studies have looked at the use of complementary and alternative medicine (CAM) in patients with prostate cancer to alleviate their stress and effects of therapy. We elected to study Reiki and Relaxation Response Therapy (RRT) in prostate-cancer patients. Methods: Patients receiving an eight-week course of radiation for prostate cancer were eligible. Consented participants were randomly assigned to RRT, to Reiki, or to no CAM therapy during radiotherapy. Reiki was given twice weekly, RRT once weekly. The feasibility of enrolling 60 patients, their compliance with physiologic and psychological testing, and preliminary assessment of the effect of CAM are the study endpoints. Statistical analysis of feasibility is based on the assumption that at least 80% of patients would complete 14/16 Reiki sessions or 7/8 RRT sessions. Patients were tested for outcome measures at baseline, at randomization, halfway through radiation, at completion of radiation and 2 months later. The psychosocial outcome measures used were the STAI, CES-D, FACT-G, FACIT: Fatigue Scale, and EPIC: Hormone Section. Physiological assessment included salivary cortisol, blood samples for interleukin-6, tumor necrosis factor alpha, CD8, natural killer cells, heat shock protein 70 and a validated bowel-and-bladder-symptom questionnaire. Results: We have enrolled 62 of 108 eligible patients (60%) within 18 months. The number of enrollment has been increased to 62 as two patients changed their treatment location. To date five patients dropped out short of completion, 1 became ineligible, 32 have completed the study, 20 are still receiving CAM therapy or are in active follow-up and 2 are awaiting randomization and radiotherapy. Conclusions: Complementary therapy appears to be of much interest to prostate-cancer patients. At the completion of the trial, we will have more data on feasibility, compliance and preliminary results on the effect of CAM intervention in this population. No significant financial relationships to disclose.
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Affiliation(s)
- C. Beard
- Brigham and Women's Hospital, Boston, MA; Dana-Farber Cancer Institute, Boston, MA; Massachusetts General Hospital, Boston, MA; Harvard School of Public Health, Boston, MA
| | - E. Dean-Clower
- Brigham and Women's Hospital, Boston, MA; Dana-Farber Cancer Institute, Boston, MA; Massachusetts General Hospital, Boston, MA; Harvard School of Public Health, Boston, MA
| | - J. Dusek
- Brigham and Women's Hospital, Boston, MA; Dana-Farber Cancer Institute, Boston, MA; Massachusetts General Hospital, Boston, MA; Harvard School of Public Health, Boston, MA
| | - W. B. Stason
- Brigham and Women's Hospital, Boston, MA; Dana-Farber Cancer Institute, Boston, MA; Massachusetts General Hospital, Boston, MA; Harvard School of Public Health, Boston, MA
| | - S. DeCristofaro
- Brigham and Women's Hospital, Boston, MA; Dana-Farber Cancer Institute, Boston, MA; Massachusetts General Hospital, Boston, MA; Harvard School of Public Health, Boston, MA
| | - A. Keshaviah
- Brigham and Women's Hospital, Boston, MA; Dana-Farber Cancer Institute, Boston, MA; Massachusetts General Hospital, Boston, MA; Harvard School of Public Health, Boston, MA
| | - I. Purevjal
- Brigham and Women's Hospital, Boston, MA; Dana-Farber Cancer Institute, Boston, MA; Massachusetts General Hospital, Boston, MA; Harvard School of Public Health, Boston, MA
| | - D. Rosenthal
- Brigham and Women's Hospital, Boston, MA; Dana-Farber Cancer Institute, Boston, MA; Massachusetts General Hospital, Boston, MA; Harvard School of Public Health, Boston, MA
| | - A. Webster
- Brigham and Women's Hospital, Boston, MA; Dana-Farber Cancer Institute, Boston, MA; Massachusetts General Hospital, Boston, MA; Harvard School of Public Health, Boston, MA
| | - H. Benson
- Brigham and Women's Hospital, Boston, MA; Dana-Farber Cancer Institute, Boston, MA; Massachusetts General Hospital, Boston, MA; Harvard School of Public Health, Boston, MA
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Nakao M, Myers P, Fricchione G, Zuttermeister PC, Barsky AJ, Benson H. Somatization and symptom reduction through a behavioral medicine intervention in a mind/body medicine clinic. Behav Med 2001; 26:169-76. [PMID: 11409219 DOI: 10.1080/08964280109595764] [Citation(s) in RCA: 43] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
The authors assessed data from 1,148 outpatients in a 10-week medical symptom reduction program to determine the effectiveness of a behavioral medicine intervention among somatizing patients. The program included instruction in the relaxation response, cognitive restructuring, nutrition, and exercise. Before and after the intervention, the patients were evaluated on the Symptom Checklist-90 Revised (SCL-90R), the Medical Symptom Checklist, and the Stress Perception Scale. They were divided into high- and low-somatizing groups on the basis of the pretreatment SCL-90R somatization scale. At the end of the program, physical and psychological symptoms on the Medical Symptom Checklist and the SCL-90R were significantly reduced in both groups, with the reductions greater in the high-somatizing group. Improvements in stress perception were about the same in both groups, but the absence of an untreated control group precluded estimates of how much the improvements resulted from the behavioral medicine intervention and how much from natural healing over time.
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Affiliation(s)
- M Nakao
- Mind/Body Medical Institute, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, USA.
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9
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Nakao M, Fricchione G, Myers P, Zuttermeister PC, Barsky AJ, Benson H. Depression and education as predicting factors for completion of a behavioral medicine intervention in a mind/body medicine clinic. Behav Med 2001; 26:177-84. [PMID: 11409220 DOI: 10.1080/08964280109595765] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
The authors compared characteristics of 1,012 outpatients completing a 10-week behavioral medicine intervention with 300 outpatients who dropped out. They administered the Symptom Checklist-90 Revised (SCL-90R) before and after the program. Patients who completed the treatment, compared with dropouts, tended to be more highly educated, married, and gainfully employed. Their pretreatment scores on the SCL-90R were significantly lower than those of the dropouts on somatization, depression, and obsessive-compulsive scales and on the global severity index. Multiple logistic regression analysis indicated that lower depression and higher education marked the group who completed the intervention in contrast to the dropouts. After the intervention, all of the SCL-90R scores were significantly lower among patients who completed the treatment. Pre- to postintervention score changes were not significantly associated with the number of sessions attended. The findings suggest that the intervention had salutary effects in patients with mind/body distress and that its effectiveness was not diminished by a few absences. Depressed or less educated patients might benefit from preparatory interventions or from a modified approach to their treatment.
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Affiliation(s)
- M Nakao
- Mind/Body Medical Institute, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, USA.
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10
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Nakao M, Fricchione G, Zuttermeister PC, Myers P, Barsky AJ, Benson H. Effects of gender and marital status on somatic symptoms of patients attending a mind/body medicine clinic. Behav Med 2001; 26:159-68. [PMID: 11409218 DOI: 10.1080/08964280109595763] [Citation(s) in RCA: 36] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
To clarify the mechanisms of gender-related mind/body relationships, the authors analyzed the characteristics of 1,132 outpatients (848 women and 284 men) attending a mind/body medicine clinic. At entry in the program, the patients completed the Medical Symptom Checklist, Symptom Checklist-90 revised (SCL-90R), and Stress Perception Scale. Women reported 9 out of 12 symptoms (fatigue, insomnia, headache, back pain, joint or limb pain, palpitations, constipation, nausea, and dizziness) more frequently than the men did. Being a woman was a predictor of the total number of somatic symptoms endorsed. SCL-90R somatization scores were significantly higher in nonmarried women than in married women. Perceived stress ratings of family and health were higher in women than in men, despite the lower degree of perceived stress concerning work. Women, especially nonmarried women, were more likely to report somatic discomfort. Gender appears to be an important factor in relation to the report of somatic symptoms in stress-related conditions.
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Affiliation(s)
- M Nakao
- Mind/Body Medical Institute, Beth Israel Deaconess Medical Center, 1 Deaconess Road, Boston, MA 02215, USA.
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11
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Stefano GB, Fricchione GL, Slingsby BT, Benson H. The placebo effect and relaxation response: neural processes and their coupling to constitutive nitric oxide. Brain Res Brain Res Rev 2001; 35:1-19. [PMID: 11245883 DOI: 10.1016/s0165-0173(00)00047-3] [Citation(s) in RCA: 84] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
The placebo effect appears to be a real phenomenon as is the scientifically demonstrated and examined relaxation response. Given this, we attempt to understand how these phenomena work in light of our current understanding of central and peripheral nervous system mechanisms. Central to our hypothesis is the significance of norepinephrine, nitric oxide and opioid signaling both in the central and peripheral nervous system. In this regard, we find that nitric oxide controls norepinephrine processes on many levels, including synthesis, release and actions. In closing, we conclude that enough scientific information exists to support these phenomena as actual physical processes that can be harnessed to provide better patient care.
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Affiliation(s)
- G B Stefano
- The Mind/Body Medical Institute, CareGroup, Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, 02115, Boston, MA, USA.
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Stefano GB, Murga J, Benson H, Zhu W, Bilfinger TV, Magazine HI. Nitric oxide inhibits norepinephrine stimulated contraction of human internal thoracic artery and rat aorta. Pharmacol Res 2001; 43:199-203. [PMID: 11243723 DOI: 10.1006/phrs.2000.0765] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
The effect of nitric oxide (NO) on norepinephrine-induced vascular contraction was evaluated using segments of rat aorta and human internal thoracic artery (ITA) and the NO donor, SNAP. NO levels were measured directly using an amperometric probe. Concentrations of NO greater than 2 nM were required to reduce vascular contraction induced by 100 nM norepinephrine (NE). Exposure of the aortic rings to SNAP prior to, or after NE addition, resulted in a similar attenuation of NE-induced contraction. In contrast, increased relaxation of ITA segments in response to SNAP was observed relative to that of rat aorta and significant development of contractile tone following NE addition was not observed. Evaluation of cytoskeletal actin demonstrated marked loss of F-actin content in smooth muscle cells following NO exposure, suggesting that NO may have direct and indirect effects on contractile tone. These data taken together suggest that vascular responsiveness to contractile agents may be significantly attenuated by prior or subsequent exposure to NO, and mechanisms in addition to vascular relaxation are likely to contribute to this effect.
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Affiliation(s)
- G B Stefano
- Neuroscience Research Institute, State University of New York at Old Westbury, Westbury NY, 11568, USA
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13
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Nakao M, Fricchione G, Myers P, Zuttermeister PC, Baim M, Mandle CL, Medich C, Wells-Federman CL, Martin Arcari P, Ennis M, Barsky AJ, Benson H. Anxiety is a good indicator for somatic symptom reduction through behavioral medicine intervention in a mind/body medicine clinic. Psychother Psychosom 2001; 70:50-7. [PMID: 11150939 DOI: 10.1159/000056225] [Citation(s) in RCA: 51] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
BACKGROUND This study examined the effect of anxiety on symptom reduction through a behavioral medicine intervention in a Mind/Body Medicine Clinic. METHOD Participants were 1,312 outpatients attending a 10-week behavioral medicine intervention which included training in the relaxation response, cognitive restructuring, exercise and nutrition. All of the patients had physical symptoms and were referred to the clinic by their physician. The Medical Symptom Checklist (12 major symptoms), Symptom Checklist 90 Revised (SCL-90R), Stress Perception Scale and the Health-Promoting Lifestyle Profile were administered before and after the program. RESULTS Of the sample, 1,012 patients completed the program, and 911 completed the posttreatment assessment. Self-reported frequency of medical symptoms, degree of discomfort and interference with daily activities were significantly reduced as a result of the program. Anxiety and other psychological distress as measured by the SCL-90R and stress perception scales also showed significant reductions. Furthermore, health-promoting lifestyle functioning significantly improved. High levels of pretreatment anxiety predicted a decrease in the total number of medical symptoms endorsed. CONCLUSIONS Behavioral medicine interventions are effective in reducing medical symptoms coinciding with improvement in anxiety. High anxiety at program entry may predict better outcome.
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Affiliation(s)
- M Nakao
- Mind/Body Medical Institute, Division of Behavioral Medicine, Department of Medicine, Beth Israel Deaconess, Medical Center, Harvard Medical School, Boston, MA 02215, USA.
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14
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Tasiemski A, Salzet M, Benson H, Fricchione GL, Bilfinger TV, Goumon Y, Metz-Boutigue MH, Aunis D, Stefano GB. The presence of antibacterial and opioid peptides in human plasma during coronary artery bypass surgery. J Neuroimmunol 2000; 109:228-35. [PMID: 10996225 DOI: 10.1016/s0165-5728(00)00314-3] [Citation(s) in RCA: 19] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
Antibacterial peptides, found in both invertebrates and vertebrates, represent a potential innate defense mechanism against microbial infections. However, it is unknown whether this process occurs in humans during surgery. We looked for evidence of release of antibacterial peptides during coronary artery bypass grafting (CABG). We used immunological techniques and antibacterial assays combined with high-performance gel-permeation chromatography, reverse-phase HPLC, N-terminal sequencing and comparison with synthetic standards to characterize the peptide B/enkelytin. We show the presence of anionic antibacterial peptide, the peptide B/enkelytin which correspond to the C-terminal part of proenkephalin A, from the plasma of patients undergoing CABG. Our studies show that peptide B/enkelytin is initially present at low levels in plasma and is then released in increased amounts just after skin incision. Antibacterial assays confirmed that the peptides specifically target gram-positive bacteria. We also demonstrate that peptide B/enkelytin is metabolized in vivo to the opioid peptides methionine-enkephalin-Arg-Phe and methionine-enkephalin, peptides that we show have granulocyte chemotactic activity. These findings suggest that in humans, surgical incision leads to the release of antibacterial peptides. Furthermore, these antibacterial peptides can be metabolized into compounds that have immune-activating properties.
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Affiliation(s)
- A Tasiemski
- Laboratoire d'Endocrinologie des Annélides, UPRESA CNRS 8017, SN3, Université des Sciences et Technologies de Lille, F-59655 Cédex, Villeneuve d'Ascq, France
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15
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Lazar SW, Bush G, Gollub RL, Fricchione GL, Khalsa G, Benson H. Functional brain mapping of the relaxation response and meditation. Neuroreport 2000; 11:1581-5. [PMID: 10841380] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/16/2023]
Abstract
Meditation is a conscious mental process that induces a set of integrated physiologic changes termed the relaxation response. Functional magnetic resonance imaging (fMRI) was used to identify and characterize the brain regions that are active during a simple form of meditation. Significant (p<10(-7)) signal increases were observed in the group-averaged data in the dorsolateral prefrontal and parietal cortices, hippocampus/parahippocampus, temporal lobe, pregenual anterior cingulate cortex, striatum, and pre- and post-central gyri during meditation. Global fMRI signal decreases were also noted, although these were probably secondary to cardiorespiratory changes that often accompany meditation. The results indicate that the practice of meditation activates neural structures involved in attention and control of the autonomic nervous system.
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Affiliation(s)
- S W Lazar
- Department of Psychiatry, Harvard Medical School, Massachusetts General Hospital-East, NMR Center, Charlestown 02129, USA
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16
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Koenig HG, Idler E, Kasl S, Hays JC, George LK, Musick M, Larson DB, Collins TR, Benson H. Religion, spirituality, and medicine: a rebuttal to skeptics. Int J Psychiatry Med 1999; 29:123-31. [PMID: 10587810 DOI: 10.2190/c2fb-95vw-fkyd-c8rv] [Citation(s) in RCA: 85] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
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Abstract
A cross-sectional national telephone survey was used to determine whether Christian Scientists (N = 230), a religious group that uses mind/body (including spiritual) healing, self-report more or less illness than non-Christian Scientists (N = 589). The primary outcome measure was the proportion of Christian Scientists and non-Christian Scientists that, during the previous 12 months: a) experienced any of 13 common medical conditions or symptoms; and b) used conventional medicine, unconventional medicine, and mind/body (including spiritual) healing. Fewer Christian Scientists experienced an illness or symptom than non-Christian Scientists (73% vs. 80%, respectively, p = .05). A multivariate analysis showed that Christian Scientists were less likely to have experienced illness than non-Christian Scientists (odds ratio [OR] .66, 95% confidence interval [CI] .44 to .99, p = .04). Similar proportions of Christian Scientists and non-Christian Scientists used some type of conventional medicine (74% vs. 78%, respectively), although Christian Scientists were less likely to take prescription medications than non-Christian Scientists (p = .034). Although use of unconventional medicine was similar in both groups (52% vs. 45%), more Christian Scientists than non-Christian Scientists used at least one type of mind/body medicine (67% vs. 42% p < .00001), notably special religious services and spiritual healing. Additional studies are needed to determine whether there are health benefits associated with the use of conventional and unconventional medicine in combination with mind/body (including spiritual) healing.
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Affiliation(s)
- H Benson
- Mind/Body Medical Institute, Beth Israel Deaconess Medical Center, Department of Medicine, Harvard Medical School, Boston, Massachusetts 02215, USA
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18
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Abstract
We report extremely prominent heart rate oscillations associated with slow breathing during specific traditional forms of Chinese Chi and Kundalini Yoga meditation techniques in healthy young adults. We applied both spectral analysis and a novel analytic technique based on the Hilbert transform to quantify these heart rate dynamics. The amplitude of these oscillations during meditation was significantly greater than in the pre-meditation control state and also in three non-meditation control groups: i) elite athletes during sleep, ii) healthy young adults during metronomic breathing, and iii) healthy young adults during spontaneous nocturnal breathing. This finding, along with the marked variability of the beat-to-beat heart rate dynamics during such profound meditative states, challenges the notion of meditation as only an autonomically quiescent state.
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Affiliation(s)
- C K Peng
- Margaret and H.A. Rey Laboratory for Nonlinear Dynamics in Medicine, Beth Israel Deaconess Medical Center, Boston, MA 02215, USA
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Benson H. Using a key function approach to performance improvement: a case study. J Healthc Qual 1998; 20:29-35. [PMID: 10185720 DOI: 10.1111/j.1945-1474.1998.tb00282.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Assisting organizations with performance improvement planning is among the most important, challenging, and potentially rewarding responsibilities of the quality management professional. NorthCrest Medical Center, a 100-bed not-for-profit community hospital, developed a long-term vision for quality which was then supported through a unique model of performance improvement based on important functions. The resulting key function framework has helped the organization prepare for two successful Joint Commission surveys, relocate to a new facility, and survive in today's rapidly changing environment.
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Affiliation(s)
- H Benson
- NorthCrest Medical Center, Springfield, TN, USA
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Vicenzino B, Collins D, Benson H, Wright A. An investigation of the interrelationship between manipulative therapy-induced hypoalgesia and sympathoexcitation. J Manipulative Physiol Ther 1998; 21:448-53. [PMID: 9777544] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/09/2023]
Abstract
OBJECTIVE To investigate a proposed model in which manipulative therapy produces a treatment-specific initial hypoalgesic and sympathoexcitatory effect by activating a descending pain inhibitory system. The a priori hypothesis tested was that manipulative therapy produces mechanical hypoalgesia and sympathoexcitation beyond that produced by placebo or control. Furthermore, these effects would be correlated, thus supporting the proposed model. DESIGN A randomized, double-blind, placebo-controlled, repeated-measures study of the initial effect of treatment. SETTING Clinical neurophysiology laboratory. SUBJECTS Twenty-four subjects (13 women and 11 men; mean age, 49 yr) with chronic lateral epicondylalgia (average duration, 6.2 months). INTERVENTION Cervical spine lateral glide oscillatory manipulation, placebo and control. OUTCOME MEASURES Pressure pain threshold, thermal pain threshold, pain-free grip strength test, upper limb tension test 2b, skin conductance, pileous and glabrous skin temperature and blood flux. RESULTS Treatment produced hypoalgesic and sympathoexcitatory changes significantly greater than those of placebo and control (p < .03). Confirmatory factor-analysis modeling, which was performed on the pain-related measures and the indicators of sympathetic nervous system function, demonstrated a significant correlation (r = .82) between the latencies of manipulation-induced hypoalgesia and sympathoexcitation. The Lagrange Multiplier test and Wald test indicated that the two latent factors parsimoniously and appropriately represented their observed variables. CONCLUSION Manual therapy produces a treatment-specific initial hypoalgesic and sympathoexcitatory effect beyond that of placebo or control. The strong correlation between hypoalgesic and sympathoexcitatory effects suggests that a central control mechanism might be activated by manipulative therapy.
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Affiliation(s)
- B Vicenzino
- Department of Physiotherapy, University of Queensland, Australia
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Abstract
Health care concepts and practices are changing dramatically because of demographic and economic factors. The routine integration of behavioral and biomedical care is completely compatible with these changes and such integration would provide clinical and economic benefits to patients and to society.
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Affiliation(s)
- R Friedman
- Department of Psychiatry and Behavioral Science, State University of New York Stony Brook, Stony Brook, New York 11794, USA
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23
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Affiliation(s)
- H Benson
- Mind/Body Medical Institute, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA
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Abstract
The purpose of this study was to assess the central nervous system effects of the relaxation response (RR) in novice subjects using a controlled, within- subjects design and topographic EEG mapping as the dependent measure. Twenty subjects listened to a RR and control audiotape presented in a counterbalanced order while EEG was recorded from 14 scalp locations. The RR condition produced greater (p < .0164) reductions in frontal EEG beta activity relative to the control condition. No significant differences were observed for any other frequency band or scalp region. These findings suggest that elicitation of the RR produces significant reductions in cortical activation in anterior brain regions in novice subjects.
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Affiliation(s)
- G D Jacobs
- Mind/Body Medical Institute, Deaconess Hospital/Harvard Medical School, Boston, Massachusetts 02215, USA
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Benson H. Mind over maladies. Can yoga, prayer and meditation be adapted for managed care? Interview by Jim Montague. Hosp Health Netw 1996; 70:26-7. [PMID: 8605537] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
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26
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Affiliation(s)
- H Benson
- The Mind/Body Medical Institute, Division of Behavioral Medicine, Deaconess Hospital, Boston, Massachusetts, USA
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Abstract
The use of medical services is a function of several interacting psychological and social variables as well as a function of physical malfunction. The clinical significance of addressing patients' psychosocial issues has only occasionally been considered. However, the shift in health care economics toward health care maintenance is responsible for the increased interest in interventions in the domain of behavioral medicine and health psychology. Evidence is reviewed for 6 mechanistic pathways by which behavioral interventions can maximize clinical care and result in significant economic benefits. The rationale for further integration of behavioral and biomedicine interventions is also reviewed.
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Affiliation(s)
- R Friedman
- Department of Psychiatry and Behavioral Science, State University of New York at Stony Brook
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28
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Abstract
The placebo effect yields beneficial clinical results in 60-90% of diseases that include angina pectoris, bronchial asthma, herpes simplex, and duodenal ulcer. Three components bring forth the placebo effect: (a) positive beliefs and expectations on the part of the patient; (b) positive beliefs and expectations on the part of the physician or health care professional; and (c) a good relationship between the two parties. Because of the heavily negative connotations of the very words "placebo effect, " the term should be replaced by "remembered wellness." Remembered wellness has been one of medicine's most potent assets and it should not be belittled or ridiculed. Unlike most other treatments, it is safe and inexpensive and has withstood the test of time.
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Affiliation(s)
- H Benson
- Mind/Body Medical Institute, Harvard Medical School, Deaconess Hospital, Boston, Massachusetts 02215, USA
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29
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Abstract
PURPOSE This clinical replication series assessed the perceived outcome of individuals with chronic insomnia who spontaneously sought treatment at a hospital behavioral-medicine insomnia program. PATIENTS AND METHODS Chronic insomnia patients who were treated with a group multifactor behavioral intervention completed posttreatment (n = 102) and 6-month follow-up (n = 70) questionnaires that assessed improvement. RESULTS All patients reported improved sleep at posttreatment, with the majority (58%, 59) reporting significant improvement. Of sleep medication users, 91% (62/68) either eliminated or reduced medication use. At 6-month follow-up, 90% (63/70) of respondents rated improvement in sleep as either maintained or enhanced. CONCLUSION These results suggest that patients spontaneously seeking treatment for insomnia, including sleep medication users and those with psychological comorbidity, derive significant benefit from a group multifactor behavioral intervention. Several factors, including maintenance of therapeutic gains at long-term follow-up, the average pretreatment duration of insomnia, previous unsuccessful treatment with psychotherapy and pharmacotherapy, and previous research, argue against nonspecific effects playing a significant role in these results.
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Affiliation(s)
- G D Jacobs
- Division of Behavioral Medicine, Deaconess Hospital/Harvard Medical School, Boston, Massachusetts 02215, USA
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30
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Abstract
The use of medical services is a function of several interacting psychological and social variables as well as a function of physical malfunction. The clinical significance of addressing patients' psychosocial issues has only occasionally been considered. However, the shift in health care economics toward health care maintenance is responsible for the increased interest in interventions in the domain of behavioral medicine and health psychology. Evidence is reviewed for 6 mechanistic pathways by which behavioral interventions can maximize clinical care and result in significant economic benefits. The rationale for further integration of behavioral and biomedicine interventions is also reviewed.
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Affiliation(s)
- R Friedman
- Department of Psychiatry and Behavioral Science, State University of New York at Stony Brook
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31
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Mittleman MA, Maclure M, Sherwood JB, Mulry RP, Tofler GH, Jacobs SC, Friedman R, Benson H, Muller JE. Triggering of acute myocardial infarction onset by episodes of anger. Determinants of Myocardial Infarction Onset Study Investigators. Circulation 1995; 92:1720-5. [PMID: 7671353 DOI: 10.1161/01.cir.92.7.1720] [Citation(s) in RCA: 484] [Impact Index Per Article: 16.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
BACKGROUND Many anecdotes and several uncontrolled case series have suggested that emotionally stressful events, and more specifically, anger, immediately precede and appear to trigger the onset of acute myocardial infarction. However, controlled studies to determine the relative risk of myocardial infarction after episodes of anger have not been reported. METHODS AND RESULTS We interviewed 1623 patients (501 women) an average of 4 days after myocardial infarction. The interview identified the time, place, and quality of myocardial infarction pain and other symptoms, the estimated usual frequency of anger during the previous year, and the intensity and timing of anger and other potentially triggering factors during the 26 hours before the onset of myocardial infarction. Anger was assessed by the onset anger scale, a single-item, seven-level, self-report scale, and the state anger subscale of the State-Trait Personality Inventory. Occurrence of anger in the 2 hours preceding the onset of myocardial infarction was compared with its expected frequency using two types of self-matched control data based on the case-crossover study design. The onset anger scale identified 39 patients with episodes of anger in the 2 hours before the onset of myocardial infarction. The relative risk of myocardial infarction in the 2 hours after an episode of anger was 2.3 (95% confidence interval, 1.7 to 3.2). The state anger subscale corroborated these findings with a relative risk of 1.9 (95% confidence interval, 1.3 to 2.7). Regular users of aspirin had a significantly lower relative risk (1.4; 95% confidence interval, 0.8 to 2.6) than nonusers (2.9; 95% confidence interval, 2.0 to 4.1) (P < .05). CONCLUSIONS Episodes of anger are capable of triggering the onset of acute myocardial infarction, but aspirin may reduce this risk. A better understanding of the manner in which external events trigger the onset of acute cardiovascular events may lead to innovative preventive strategies aimed at severing the link between these external stressors and their pathological consequences.
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Affiliation(s)
- M A Mittleman
- Department of Medicine, Deaconess Hospital, Harvard Medical School, Boston, Mass, USA
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32
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Brown DR, Wang Y, Ward A, Ebbeling CB, Fortlage L, Puleo E, Benson H, Rippe JM. Chronic psychological effects of exercise and exercise plus cognitive strategies. Med Sci Sports Exerc 1995; 27:765-75. [PMID: 7674883] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
Psychological changes associated with 16-wk moderate and low intensity exercise training programs, two of which possessed a cognitive component, were evaluated. Subjects were healthy, sedentary adults, 69 women (mean age = 54.8 +/- 8.3 yr) and 66 men (mean age = 50.6 +/- 8.0 yr). Participants were randomly assigned to a control group (C), moderate intensity walking group (MW), low intensity walking group (LW), low intensity walking plus relaxation response group (LWR), or mindful exercise (ME) group-a Tai Chi type program. Women in the ME group experienced reductions in mood disturbance (tension, P < 0.01; depression, P < 0.05; anger, P < 0.008; confusion, P < 0.02; and total mood disturbance, P < 0.006) and an improvement in general mood (P < 0.04). Women in the MW group noted greater satisfaction with physical attributes (body cathexis, P < 0.03), and men in MW reported increased positive affect (P < 0.006). No other differences were observed between groups on measures of mood, self-esteem, personality, or life satisfaction. Equivocal support is provided for the hypothesis that exercise plus cognitive strategy training programs are more effective than exercise programs lacking a structured cognitive component in promoting psychological benefits.
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Affiliation(s)
- D R Brown
- Exercise Physiology and Nutrition Laboratory, University of Massachusetts Medical School, Worcester 01655, USA
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33
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Jacobs SC, Friedman R, Parker JD, Tofler GH, Jimenez AH, Muller JE, Benson H, Stone PH. Use of skin conductance changes during mental stress testing as an index of autonomic arousal in cardiovascular research. Am Heart J 1994; 128:1170-7. [PMID: 7985598 DOI: 10.1016/0002-8703(94)90748-x] [Citation(s) in RCA: 64] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
Mental stress testing is used to study the cardiovascular changes caused by psychologic stress. To examine the effects of cardiac drugs on mental stress-induced changes, it is useful to attain a degree of arousal that can be replicated in serial studies. Skin conductance level, a cholinergically mediated index of arousal, was assessed for its stability in serial studies and under conditions of beta-blockade. In normal subjects, skin conductance increased in response to mental stress (p < 0.001) and was stable across three sessions. In patients with mild hypertension, skin conductance was elevated during mental stress during both placebo and nadolol therapy (p < 0.001). As expected, nadolol reduced baseline and stress-induced peak arterial pressure and heart rate but had no significant effect on skin conductance. Thus skin conductance level can serve as a stable and useful index of autonomic arousal in clinical trials, even in patients using beta-blocking medications.
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Affiliation(s)
- S C Jacobs
- Mind/Body Medical Institute, Deaconess Hospital, Boston, Mass
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34
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35
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Benson H. Powers of the mind. Interview by Joe Flower. Healthc Forum J 1993; 36:64-9. [PMID: 10129751] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/11/2023]
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36
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Friedman R, Zuttermeister P, Benson H. Unconventional medicine. N Engl J Med 1993; 329:1201; author reply 1203-4. [PMID: 8377791] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
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37
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Jacobs GD, Rosenberg PA, Friedman R, Matheson J, Peavy GM, Domar AD, Benson H. Multifactor behavioral treatment of chronic sleep-onset insomnia using stimulus control and the relaxation response. A preliminary study. Behav Modif 1993; 17:498-509. [PMID: 8216184 DOI: 10.1177/01454455930174005] [Citation(s) in RCA: 38] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
Sleep latency changes following behavioral interventions for sleep-onset insomnia are only moderate because the majority of insomniacs do not achieve good sleeper status at posttreatment. This study evaluated the efficacy of a multifactor behavior intervention consisting of stimulus control and relaxation-response training (n = 10) compared to stimulus control alone (n = 10) for sleep-onset insomnia. Only the multifactor subjects' mean posttest sleep latency fell within the good sleeper range. They also exhibited a 77% improvement on mean sleep-onset latency compared to the stimulus control group (63%). Thus a multifactor intervention may be more effective than stimulus control alone for treatment of sleep-onset insomnia.
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38
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Horii SC, Levine BA, Goger G, Mun SK, Fielding R, Garra BS, Lo SC, Krasner B, Benson H. A comparison of case retrieval times: film versus picture archiving and communications systems. J Digit Imaging 1992; 5:138-43. [PMID: 1520739 DOI: 10.1007/bf03167762] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
One of the advantages that a picture archiving and communications system (PACS) is supposed to provide over a film-based operation is improved performance in retrieving images. Although it seems self-evident that this should be so, this experiment was intended to verify this and to provide some time comparisons for the two methods. The experiment consisted of randomly selecting ultrasound and computed tomography cases and determining how long it took to retrieve files at a PACS workstation or in person from the file room. To simulate actual retrieval volumes, a total of 40 cases from current to 6 months old, 20 cases from the past year, and 10 cases more than 1 year old was selected. Results indicate that PACS retrieval can indeed be faster than file room retrieval. However, the difference is less for recent cases than for older cases. For cases 6 or fewer months old, the workstation retrieval was approximately 2.5 minutes faster per case than the film file room. This time difference increased markedly when extended to the 1-year and older-than-1-year groups. This report details the results of this study and provides information about the reliability of the two archives.
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Affiliation(s)
- S C Horii
- Department of Radiology, Georgetown University Hospital, Washington, D.C
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39
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Friedman R, Siegel WC, Jacobs SC, Benson H. Distress over the noneffect of stress. JAMA 1992; 268:198; author reply 198-9. [PMID: 1608134 DOI: 10.1001/jama.268.2.198b] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
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40
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Domar AD, Zuttermeister PC, Seibel M, Benson H. Psychological improvement in infertile women after behavioral treatment: a replication. Fertil Steril 1992; 58:144-7. [PMID: 1623995] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
OBJECTIVE To replicate previously reported psychological improvements in infertile women attending a group behavioral treatment program. DESIGN Psychological and demographic data were collected before entering and again upon completion of a behavioral medicine program on a second cohort of patients. SETTING The program was offered in the Division of Behavioral Medicine, an outpatient clinic of the Department of Medicine at New England Deaconess Hospital. All patients were receiving care from infertility specialists not affiliated with this hospital. PATIENTS Fifty two self-referred women receiving medical treatment for infertility attended the program. INTERVENTION A 10-week group behavioral treatment program. MAIN OUTCOME MEASURES Three validated psychological instruments. RESULTS Psychological improvement was statistically significant (Profile of Mood States Tension/Anxiety: P less than 0.0001; Depression/Dejection: P less than 0.0122; Vigor/Activity: P less than 0.0431; Confusion/Bewilderment: P less than 0.0057; Spielberger Anger Expression: P less than 0.0013; Spielberger State Anxiety: P less than 0.0037, and Trait Anxiety: P less than 0.0001). CONCLUSIONS Behavioral treatment is associated with significant decreases in negative psychological symptoms.
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Affiliation(s)
- A D Domar
- Department of Medicine, New England Deaconess Hospital, Boston, Massachusetts 02215
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41
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Wang Y, Brown D, Ebbeling CB, Fortlage L, Samuels J, Ahlquist L, Wurd A, Rippe J, Benson H. ACUTE PSYCHOLOGICAL CHANCES FOLLOWING EXERCISE AND EXERCISE PLUS THE RELAXATION RESPONSE. Med Sci Sports Exerc 1992. [DOI: 10.1249/00005768-199205001-00898] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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42
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Affiliation(s)
- S S Myers
- Yale University School of Medicine, New Haven
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43
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Abstract
The treatment of chronic pain is costly and frustrating for the patient, health care provider, and health care system. This is due, in part, to the complexity of pain symptoms which are influenced by behavior patterns, socioeconomic factors, belief systems, and family dynamics as well as by physiological and mechanical components. Assessment of treatment outcomes is often limited to the patient's subjective, multidimensional, self-reports. Outcome measures based on data about return to work or clinic use can provide more objective assessments of intervention benefits. In this study, a 36% reduction in clinic visits in the first year postintervention was found among the 109 patients who participated in an outpatient behavioral medicine program. Decreased clinic use continued in the first 50 patients followed 2 years postintervention. Decreased use projected to an estimated net savings of $12,000 for the first year of the study posttreatment and $23,000 for the second year.
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Affiliation(s)
- M Caudill
- Hitchcock Clinic/Matthew Thornton Health Plan, Nashua, New Hampshire
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44
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Abstract
A comprehensive image management and communication (IMAC) network has been installed at Georgetown University Hospital (GUH) for an extensive clinical evaluation. The network is based on the AT&T CommView system and includes interfaces to 12 imaging devices, 15 workstations (inside and outside the radiology department), a teleradiology link to an imaging center, an optical jukebox, and a number of advanced image display and processing systems. Two years of clinical experience with the network enable us to develop a plan for future activities from an American perspective. The IMAC project is not just a technical challenge, but also a professional, organizational, and administrative one. Several obstacles remain, but they are gradually being overcome as more cost-effective and streamlined technologies become available and as users and developers gain more operational experience in managing diagnostic images in an electronic environment.
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Affiliation(s)
- S K Mun
- Department of Radiology, Georgetown University Hospital, Washington, DC. 20007
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45
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Kass JD, Friedman R, Leserman J, Caudill M, Zuttermeister PC, Benson H. An Inventory of Positive Psychological Attitudes with potential relevance to health outcomes: validation and preliminary testing. Behav Med 1991; 17:121-9. [PMID: 1932845 DOI: 10.1080/08964289.1991.9937555] [Citation(s) in RCA: 93] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
This article describes the validation of an Inventory of Positive Psychological Attitudes that has potential relevance to health outcomes and its preliminary testing with chronic pain patients. The inventory taps two attitudinal domains: (1) life purpose and satisfaction and (2) self-confidence during potentially stressful situations. It also provides a total score. The inventory scales, developed using factor analysis, were found to have a strong degree of internal reliability and concurrent validity. Preliminary testing suggested that positive change on these scales correlates with positive changes in the health status of chronic pain patients. Multiple regression analyses suggested that the interactions of these positive psychological attitudes with health status are not fully accounted for by the interactions of negative psychological attitudes with health status.
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Affiliation(s)
- J D Kass
- Department of Medicine, New England Deaconess Hospital, Boston
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46
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Goodale IL, Domar AD, Benson H. Alleviation of premenstrual syndrome symptoms with the relaxation response. Obstet Gynecol 1990; 75:649-55. [PMID: 2179779] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
During a 5-month study, we examined the effects of the relaxation response on premenstrual syndrome in 46 women who were randomly assigned to one of three groups: a charting group, a reading group, and a relaxation response group. The relaxation response group showed significantly greater improvement than the charting and the reading groups on physical symptoms (P less than .025 for both comparisons). There was a significant group-by-severity effect for charting versus relaxation response and for reading versus relaxation response on symptoms measured daily (P less than .01 for both comparisons), on emotional symptoms measured retrospectively (P less than .001 and P less than .025, respectively), and on symptoms of social withdrawal measured retrospectively (P less than .01 and P less than .025, respectively). Women with severe symptoms in the relaxation response group showed a 58.0% improvement, compared with a 27.2% improvement for the reading group and a 17.0% improvement for the charting group. We conclude that regular elicitation of the relaxation response is an effective treatment for physical and emotional premenstrual symptoms, and is most effective in women with severe symptoms.
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Affiliation(s)
- I L Goodale
- Department of Medicine, New England Deaconess Hospital, Harvard Medical School, Boston, Massachusetts
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47
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Abstract
Immediately before they underwent femoral angiography, 45 patients were given one of three types of audiotapes: a relaxation response tape recorded for this study, a tape of contemporary instrumental music, or a blank tape. All patients were instructed to listen to their audiotape during the entire angiographic procedure. Each audiotape was played through earphones. Radiologists were not told the group assignment or tape contents. The patients given the audiotape with instructions to elicit the relaxation response (n = 15) experienced significantly less anxiety (P less than .05) and pain (P less than .001) during the procedure, were observed by radiology nurses to exhibit significantly less pain (P less than .001) and anxiety (P less than .001), and requested significantly less fentanyl citrate (P less than .01) and diazepam (P less than .01) than patients given either the music (n = 14) or the blank (n = 16) control audiotapes. Elicitation of the relaxation response is a simple, inexpensive, efficacious, and practical method to reduce pain, anxiety, and medication during femoral angiography and may be useful in other invasive procedures.
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Affiliation(s)
- C L Mandle
- Department of Medicine, New England Deaconess Hospital, Harvard Medical School, Boston, MA 02215
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48
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Abstract
There is increasing evidence that a behavioral treatment approach might be efficacious in the treatment of the emotional aspects of infertility and may lead to increased conception rates. The first 54 women to complete a behavioral treatment program based on the elicitation of the relaxation response showed statistically significant decreases in anxiety, depression, and fatigue as well as increases in vigor. In addition, 34% of these women became pregnant within 6 months of completing the program. These findings established a role for stress reduction in the long-term treatment of infertility. They further suggest that behavioral treatment should be considered for couples with infertility before or in conjunction with reproductive technologies such as intrauterine insemination and gamete intrafallopian transfer.
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Affiliation(s)
- A D Domar
- New England Deaconess Hospital, Harvard Medical School, Boston, Massachusetts
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49
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Hellman CJ, Budd M, Borysenko J, McClelland DC, Benson H. A study of the effectiveness of two group behavioral medicine interventions for patients with psychosomatic complaints. Behav Med 1990; 16:165-73. [PMID: 2271802 DOI: 10.1080/08964289.1990.9934605] [Citation(s) in RCA: 102] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
This randomized, prospective study investigated the effectiveness of two group behavioral medicine interventions for primary care patients experiencing physical symptoms with a psychosocial component (eg, palpitations, gastrointestinal disturbances, headaches, malaise, sleep disorders). The subjects were 80 volunteers at a health maintenance organization (HMO) in the greater Boston area. Both interventions focused on the mind/body relationship and used didactic material, relaxation-response training, awareness training, and cognitive restructuring. The two behavioral medicine intervention groups were compared with a group that focused exclusively on information about stress management and its relation to illness. Measures of visits to the HMO and of distress from physical and psychological symptoms were obtained before the interventions and again 6 months afterward. At the 6-month follow-up, patients in the behavioral medicine groups showed significantly greater reductions in visits to the HMO and in discomfort from physical and psychological symptoms than did the patients in the information group. The results suggest that when the relationship among thoughts and behaviors and symptoms of patients with psychosomatic dysfunction is actively addressed, the patients' discomfort level and the cost of medical care can be reduced.
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Affiliation(s)
- C J Hellman
- Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, Boston
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50
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Benson H, Malhotra MS, Goldman RF, Jacobs GD, Hopkins PJ. Three case reports of the metabolic and electroencephalographic changes during advanced Buddhist meditation techniques. Behav Med 1990; 16:90-5. [PMID: 2194593 DOI: 10.1080/08964289.1990.9934596] [Citation(s) in RCA: 97] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
To examine the extent to which advanced meditative practices might alter body metabolism and the electroencephalogram (EEG), we investigated three Tibetan Buddhist monks living in the Rumtek monastery in Sikkim, India. In a study carried out in February 1988, we found that during the practice of several different meditative practices, resting metabolism (VO2) could be both raised (up to 61%) and lowered (down to 64%). The reduction from rest is the largest ever reported. On the EEG, marked asymmetry in alpha and beta activity between the hemispheres and increased beta activity were present. From these three case reports, we conclude that advanced meditative practices may yield different alterations in metabolism (there are also forms of meditation that increase metabolism) and that the decreases in metabolism can be striking.
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Affiliation(s)
- H Benson
- Department of Medicine, New England Deaconess Hospital, Boston
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