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Massey D, Sawano M, Baker AD, Güthe DB, Güthe N, Shidlovsky SP, Fisher L, Grady CB, Caraballo C, Zhou T, Sharma R, Krumholz HM. Characterisation of internal tremors and vibration symptoms. BMJ Open 2023; 13:e077389. [PMID: 38154880 PMCID: PMC10759066 DOI: 10.1136/bmjopen-2023-077389] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/06/2023] [Accepted: 11/16/2023] [Indexed: 12/30/2023] Open
Abstract
OBJECTIVES To describe the experiences of patients who have postacute sequelae SARS-CoV-2 infection with internal vibrations and tremors as a prominent component, we leveraged the efforts by Survivor Corps, a grassroots COVID-19 patient advocacy group, to gather information from individuals belonging to its Facebook group with a history of COVID-19 suffering from vibrations and tremors. SETTING AND DESIGN A narrative analysis was performed on 140 emails and 450 social media comments from 140 individuals collected as a response to a call to >180 000 individuals participating in Survivor Corps between 15 July and 27 July 2021. We used common coding techniques and the constant comparative method for qualitative data synthesis and categorising emails. Coded data were entered into NVivo V.12 to identify recurrent themes, theme connections and supporting quotations. Comments were analysed using Word Clouds, generated with R V.4.0.3 using quanteda, wordcloud and tm packages. MAIN OUTCOME MEASURES Patient-reported long COVID symptom themes and domains related to internal tremors and vibration. RESULTS The respondents' emails represented 22 themes and 7 domains pertaining to their experience with internal tremor and vibrations. These domains were as follows: (1) symptom experience, description and anatomic location; (2) initial symptom onset; (3) symptom timing; (4) symptom triggers or alleviators; (5) change from baseline health status; (6) experience with medical establishment and (7) impact on individuals' lives and livelihood. There were 22 themes in total, each corresponding to one of the broader domains. Among the responses, many described symptoms that varied in location, timing and triggers, occurred soon after their COVID-19 infection, and were markedly debilitating. There were often frustrating experiences with the healthcare system. CONCLUSIONS This study describes key themes and experiences among a group of people reporting long COVID and having a prolonged and debilitating symptom complex that prominently features internal tremors and vibrations.
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Affiliation(s)
- Dorothy Massey
- Center for Outcomes Research and Evaluation, Yale University, New Haven, Connecticut, USA
- Section of Cardiovascular Medicine, Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut, USA
| | - Mitsuaki Sawano
- Center for Outcomes Research and Evaluation, Yale University, New Haven, Connecticut, USA
- Section of Cardiovascular Medicine, Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut, USA
| | - Anna D Baker
- Section of Stroke and Vascular Neurology, Department of Neurology, Yale School of Medicine, New Haven, Connecticut, USA
| | | | - Nick Güthe
- Survivor Corps, Washington, DC, Washington, USA
| | | | - Liza Fisher
- Survivor Corps, Washington, DC, Washington, USA
| | - Connor B Grady
- Department of Biostatistics, Epidemiology, and Informatics, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA
| | - Cesar Caraballo
- Center for Outcomes Research and Evaluation, Yale University, New Haven, Connecticut, USA
- Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut, USA
| | - Tianna Zhou
- Yale School of Medicine, New Haven, Connecticut, USA
| | - Richa Sharma
- Department of Neurology, Yale School of Medicine, New Haven, Connecticut, USA
| | - Harlan M Krumholz
- Center for Outcomes Research and Evaluation, Yale University, New Haven, Connecticut, USA
- Section of Cardiovascular Medicine, Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut, USA
- Center for Infection and Immunity, Yale School of Medicine, New Haven, Connecticut, USA
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2
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McInerney CD, Kotzé A, Bacon S, Cutting JE, Fisher L, Goldacre B, Johnson OA, Kua J, McGuckin D, Mehrkar A, Moonesinghe SR. Postoperative mortality and complications in patients with and without pre-operative SARS-CoV-2 infection: a service evaluation of 24 million linked records using OpenSAFELY. Anaesthesia 2023; 78:692-700. [PMID: 36958018 DOI: 10.1111/anae.16001] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/20/2023] [Indexed: 03/25/2023]
Abstract
Surgical decision-making after SARS-CoV-2 infection is influenced by the presence of comorbidity, infection severity and whether the surgical problem is time-sensitive. Contemporary surgical policy to delay surgery is informed by highly heterogeneous country-specific guidance. We evaluated surgical provision in England during the COVID-19 pandemic to assess real-world practice and whether deferral remains necessary. Using the OpenSAFELY platform, we adapted the COVIDSurg protocol for a service evaluation of surgical procedures that took place within the English NHS from 17 March 2018 to 17 March 2022. We assessed whether hospitals adhered to guidance not to operate on patients within 7 weeks of an indication of SARS-CoV-2 infection. Additional outcomes were postoperative all-cause mortality (30 days, 6 months) and complications (pulmonary, cardiac, cerebrovascular). The exposure was the interval between the most recent indication of SARS-CoV-2 infection and subsequent surgery. In any 6-month window, < 3% of surgical procedures were conducted within 7 weeks of an indication of SARS-CoV-2 infection. Mortality for surgery conducted within 2 weeks of a positive test in the era since widespread SARS-CoV-2 vaccine availability was 1.1%, declining to 0.3% by 4 weeks. Compared with the COVIDSurg study cohort, outcomes for patients in the English NHS cohort were better during the COVIDSurg data collection period and the pandemic era before vaccines became available. Clinicians within the English NHS followed national guidance by operating on very few patients within 7 weeks of a positive indication of SARS-CoV-2 infection. In England, surgical patients' overall risk following an indication of SARS-CoV-2 infection is lower than previously thought.
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Affiliation(s)
- C D McInerney
- Academic Unit of Primary Medical Care, University of Sheffield, UK
- School of Computing, University of Leeds, UK
- National Institute for Health Research Yorkshire and Humber Patient Safety Translational Research Centre, Bradford, UK
| | - A Kotzé
- Leeds Teaching Hospitals NHS Trust, Leeds, UK
- School of Medicine, University of Leeds, UK
| | - S Bacon
- Bennett Institute for Applied Data Science, Nuffield Department of Primary Care Health Sciences, University of Oxford, UK
| | - J E Cutting
- Gloucestershire Royal Hospitals NHS Foundation Trust, Gloucester, UK
| | - L Fisher
- Bennett Institute for Applied Data Science, Nuffield Department of Primary Care Health Sciences, University of Oxford, UK
| | - B Goldacre
- Bennett Institute for Applied Data Science, Nuffield Department of Primary Care Health Sciences, University of Oxford, UK
| | - O A Johnson
- School of Computing, University of Leeds, UK
- National Institute for Health Research Yorkshire and Humber Patient Safety Translational Research Centre, Bradford, UK
| | - J Kua
- Division of Surgery and Interventional Science, Department of Targeted Intervention, Centre for Peri-operative Medicine, University College London, UK
| | - D McGuckin
- Division of Surgery and Interventional Science, Department of Targeted Intervention, Centre for Peri-operative Medicine, University College London, UK
| | - A Mehrkar
- Bennett Institute for Applied Data Science, Nuffield Department of Primary Care Health Sciences, University of Oxford, UK
| | - S R Moonesinghe
- Division of Surgery and Interventional Science, Department of Targeted Intervention, Centre for Peri-operative Medicine, University College London, UK
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Fisher L, Ahmed O, Chalchal H, Deobald R, El-Gayed A, Graham P, Groot G, Haider K, Iqbal N, Johnson K, Le D, Mahmood S, Manna M, Meiers P, Pauls M, Salim M, Sami A, Wright P, Younis M, Ahmed S. P058 Outcomes of Rural Men With Breast Cancer: A Multicenter Population Based Retrospective Cohort Study. Breast 2023. [DOI: 10.1016/s0960-9776(23)00177-7] [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: 03/15/2023] Open
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4
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Bonilla H, Peluso MJ, Rodgers K, Aberg JA, Patterson TF, Tamburro R, Baizer L, Goldman JD, Rouphael N, Deitchman A, Fine J, Fontelo P, Kim AY, Shaw G, Stratford J, Ceger P, Costantine MM, Fisher L, O’Brien L, Maughan C, Quigley JG, Gabbay V, Mohandas S, Williams D, McComsey GA. Therapeutic trials for long COVID-19: A call to action from the interventions taskforce of the RECOVER initiative. Front Immunol 2023; 14:1129459. [PMID: 36969241 PMCID: PMC10034329 DOI: 10.3389/fimmu.2023.1129459] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2022] [Accepted: 02/06/2023] [Indexed: 03/11/2023] Open
Abstract
Although most individuals recover from acute SARS-CoV-2 infection, a significant number continue to suffer from Post-Acute Sequelae of SARS-CoV-2 (PASC), including the unexplained symptoms that are frequently referred to as long COVID, which could last for weeks, months, or even years after the acute phase of illness. The National Institutes of Health is currently funding large multi-center research programs as part of its Researching COVID to Enhance Recover (RECOVER) initiative to understand why some individuals do not recover fully from COVID-19. Several ongoing pathobiology studies have provided clues to potential mechanisms contributing to this condition. These include persistence of SARS-CoV-2 antigen and/or genetic material, immune dysregulation, reactivation of other latent viral infections, microvascular dysfunction, and gut dysbiosis, among others. Although our understanding of the causes of long COVID remains incomplete, these early pathophysiologic studies suggest biological pathways that could be targeted in therapeutic trials that aim to ameliorate symptoms. Repurposed medicines and novel therapeutics deserve formal testing in clinical trial settings prior to adoption. While we endorse clinical trials, especially those that prioritize inclusion of the diverse populations most affected by COVID-19 and long COVID, we discourage off-label experimentation in uncontrolled and/or unsupervised settings. Here, we review ongoing, planned, and potential future therapeutic interventions for long COVID based on the current understanding of the pathobiological processes underlying this condition. We focus on clinical, pharmacological, and feasibility data, with the goal of informing future interventional research studies.
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Affiliation(s)
- Hector Bonilla
- Department of Medicine and Infectious Diseases, Stanford University, Palo Alto, CA, United States
| | - Michael J. Peluso
- Department of Medicine and Infectious Diseases, University of California, San Francisco, San Francisco, CA, United States
| | - Kathleen Rodgers
- Center for Innovations in Brain Science, University of Arizona, Tucson, AZ, United States
| | - Judith A. Aberg
- Department of Medicine, Infectious Diseases, Icahn School of Medicine at Mount Sinai, Chief, Division of Infectious Disease, New York, NY, United States
| | - Thomas F. Patterson
- Department of Medicine, Infectious Diseases, The University of Texas Health Science Center at San Antonio, San Antonio, TX, United States
| | - Robert Tamburro
- Division of Intramural Research, National Institute of Health, Bethesda, MD, United States
| | - Lawrence Baizer
- National Heart Lung and Blood Institute, Division of Lung Diseases, National Institutes of Health, Bethesda, MD, United States
| | - Jason D. Goldman
- Department of Medicine, Organ Transplant and Liver Center, Swedish Medical Center, Seattle, WA, United States
- Division of Allergy and Infectious Diseases, University of Washington, Seattle, WA, United States
| | - Nadine Rouphael
- Department of Medicine, Division of Infectious Diseases, Emory University School of Medicine, Atlanta, GA, United States
| | - Amelia Deitchman
- Department of Clinical Pharmacy, University of California, San Francisco, San Francisco, CA, United States
| | - Jeffrey Fine
- Department of Rehabilitation Medicine at New York University (NYU) Grossman School of Medicine, Physical Medicine and Rehabilitation Service, New York University (NYU), New York University Medical Center, New York, NY, United States
| | - Paul Fontelo
- Applied Clinical Informatics Branch, National Library of Medicine, National Institutes of Health, Bethesda, MD, United States
| | - Arthur Y. Kim
- Department of Medicine at Harvard Medical School, Division of Infectious Disease, Boston, MA, United States
| | - Gwendolyn Shaw
- Research Triangle Institute (RTI), International, Durham, NC, United States
| | - Jeran Stratford
- Research Triangle Institute (RTI), International, Durham, NC, United States
| | - Patricia Ceger
- Research Triangle Institute (RTI), International, Durham, NC, United States
| | - Maged M. Costantine
- Department of Obstetrics and Gynecology, The Ohio State University, Columbus, OH, United States
| | - Liza Fisher
- Long COVID Families, Houston, TX, United States
| | - Lisa O’Brien
- Utah Covid-19 Long Haulers, Salt Lake City, UT, United States
| | | | - John G. Quigley
- Department of Medicine, University of Illinois at Chicago, Chicago, IL, United States
| | - Vilma Gabbay
- Department of Medicine, Albert Einstein College of Medicine, New York, NY, United States
| | - Sindhu Mohandas
- Department of Pediatrics, Keck School of Medicine, University of Southern California, Los Angeles, CA, United States
| | - David Williams
- Department of Medicine, University of Michigan, Ann Arbor, MI, United States
| | - Grace A. McComsey
- Department of Pediatrics and Medicine, Case Western Reserve University, Cleveland, OH, United States
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5
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Fisher L, Mack JM. Reducing the time of antibiotic administration to febrile neutropenic patients in the emergency room. Am J Med Sci 2023. [DOI: 10.1016/s0002-9629(23)00186-6] [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: 01/28/2023]
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Fisher L, Polonsky WH, Perez-Nieves M, Desai U, Strycker L, Hessler D. A new perspective on diabetes distress using the type 2 diabetes distress assessment system (T2-DDAS): Prevalence and change over time. J Diabetes Complications 2022; 36:108256. [PMID: 35810147 DOI: 10.1016/j.jdiacomp.2022.108256] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/27/2022] [Revised: 06/29/2022] [Accepted: 06/29/2022] [Indexed: 11/29/2022]
Abstract
AIMS To establish cut-points and thresholds for elevated diabetes distress; document change over time; and define minimal clinically important differences (MCID) using the new Type 2 Diabetes Distress Assessment System (T2-DDAS). METHODS A national sample of adults with type 2 diabetes completed the T2-DDAS CORE distress scale and the 7 T2-DDAS SOURCE distress scales at baseline and 6-months. Scores were computed separately for insulin- and non-insulin users. Spline regression models defined CORE cut-points and SEM formulas defined MCID. A rational "threshold" approach defined elevated SOURCE scores. RESULTS 471 participants (205 insulin, 266 non-insulin) completed both assessments. Analyses yielded ≥2.0 as the cut-point for both elevated CORE and elevated SOURCE. Prevalence of elevated CORE was 61.8 % (69.9 % over 6 months). Elevated SOURCE scores varied from 30.6 % (Stigma/Shame) to 76.4 % (Management); 87.5 % indicated at least 1 elevated SOURCE score. Most (77.1 %) reported multiple elevated SOURCES. 81.8 % with elevated CORE distress at baseline remained elevated at 6 months. MCID analyses yielded +/- 0.25 as significant change. Few differences between insulin- and non-insulin users occurred. CONCLUSIONS Elevated CORE distress is highly prevalent and persistent over time; most participants reported multiple SOURCES of distress. Findings highlight the need for comprehensive assessment of diabetes distress.
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Affiliation(s)
- L Fisher
- University of California, San Francisco, CA, USA.
| | - W H Polonsky
- Behavioral Diabetes Institute, San Diego, CA, USA; University of California, San Diego, CA, USA
| | | | - U Desai
- Analysis Group, Boston, MA, USA
| | - L Strycker
- Oregon Research Institute, Eugene, OR, USA
| | - D Hessler
- University of California, San Francisco, CA, USA
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7
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Obando D, Hill J, Sharp H, Pickles A, Fisher L, Wright N. Synergy between callous-unemotional traits and aggression in preschool children: Cross-informant and cross-cultural replication in the UK Wirral Child Health and Development Study, and the Colombian La Sabana Parent-Child Study. Dev Psychopathol 2022; 34:1079-1087. [PMID: 33752771 DOI: 10.1017/s0954579420002114] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Incremental prediction of aggression from callous-unemotional (CU) traits is well established, but cross-cultural replication and studies of young children are needed. Little is understood about the contribution of CU traits in children who are already aggressive. We addressed these issues in prospective studies in the United Kingdom and Colombia. In a UK epidemiological cohort, CU traits and aggression were assessed at age 3.5 years, and aggression at 5.0 years by mothers (N = 687) and partners (N = 397). In a Colombian general population sample, CU traits were assessed at age 3.5 years and aggression at 3.5 and 5.0 years by mother report (N = 220). Analyses consistently showed prediction of age-5.0 aggression by age-3.5 CU traits controlling for age-3.5 aggression. Associations between age-3.5 CU traits and age-5.0 aggression were moderated by aggression at 3.5 years, with UK interaction terms, same informant, β = .07 p = .014 cross-informant, β = .14 p = .002, and in Colombia, β = .09 p = .128. The interactions arose from stronger associations between CU traits and later aggression in those already aggressive. Our findings with preschoolers replicated across culturally diverse settings imply a major role for CU traits in the maintenance and amplification of already established aggression, and cast doubt on their contribution to its origins.
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Affiliation(s)
- D Obando
- Department of Psychology, Universidad de La Sabana, Chia, Colombia
| | - J Hill
- Department of Psychology and Clinical Language Sciences, University of Reading, Reading, UK
| | - H Sharp
- School of Psychology, Institute of Health & Life Sciences, University of Liverpool, Liverpool, UK
| | - A Pickles
- Department of Biostatistics & Health Informatics, Institute of Psychiatry, Psychology & Neuroscience, Kings College London, London, UK
| | - L Fisher
- School of Psychology, Institute of Health & Life Sciences, University of Liverpool, Liverpool, UK
| | - N Wright
- Department of Biostatistics & Health Informatics, Institute of Psychiatry, Psychology & Neuroscience, Kings College London, London, UK
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Polonsky WH, Fortmann AL, Price D, Fisher L. "Hyperglycemia aversiveness": Investigating an overlooked problem among adults with type 1 diabetes. J Diabetes Complications 2021; 35:107925. [PMID: 33836966 DOI: 10.1016/j.jdiacomp.2021.107925] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/25/2021] [Revised: 03/18/2021] [Accepted: 03/22/2021] [Indexed: 11/15/2022]
Abstract
AIMS To investigate the problem of adults with type 1 diabetes (T1D) who purposefully keep their glucose levels low, and to explore contributors to, and possible impact of, this potentially dangerous phenomenon. METHODS We developed three self-report items as a means to identify individuals who endorse a consistent preference for hypoglycemia over hyperglycemia ("Hyperglycemia Aversives"). In a large T1D survey (n = 219), validated measures of well-being, emotional distress and hypoglycemic awareness, and glycemic metrics derived from the past 14-day period, were used to examine whether Hyperglycemia Aversives could be characterized as a distinct group. RESULTS Hyperglycemia Aversives comprised 16.4% of the sample. This unique group demonstrated significantly higher mean %TIR (71.6% vs. 63.6%) and %TBR (5.1% vs. 2.2%), lower mean %TAR > 250 mg/dL (6.0% vs. 10.1%), and higher rates of impaired hypoglycemic awareness and recurrent severe hypoglycemia episodes than the remaining study sample ("Non-Aversives") (all ps < 0.01). The two groups did not demonstrate significant differences on psychosocial outcomes. CONCLUSIONS We identified a group of T1D adults reporting a consistent preference for hypoglycemia over hyperglycemia. These individuals achieve significantly greater %TIR and less %TAR, but at the cost of greater %TBR and more frequent severe hypoglycemia episodes.
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Affiliation(s)
- W H Polonsky
- Behavioral Diabetes Institute, San Diego, CA, United States of America; Department of Medicine, University of California, San Diego, CA, United States of America.
| | - A L Fortmann
- Scripps Whittier Diabetes Institute, Scripps Health, La Jolla, CA, United States of America
| | - D Price
- Dexcom, Inc., San Diego, CA, United States of America
| | - L Fisher
- Department of Family and Community Medicine, University of California, San Francisco, CA, United States of America
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Polonsky WH, Fisher L, Hessler D, Liu J, Fan L, McAuliffe-Fogarty AH. Worries and concerns about hypoglycemia in adults with type 1 diabetes: An examination of the reliability and validity of the Hypoglycemic Attitudes and Behavior Scale (HABS). J Diabetes Complications 2020; 34:107606. [PMID: 32354623 DOI: 10.1016/j.jdiacomp.2020.107606] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/20/2020] [Revised: 04/10/2020] [Accepted: 04/19/2020] [Indexed: 11/26/2022]
Abstract
AIMS To examine the factor structure, validity and reliability of the Hypoglycemic Attitudes and Behavior Scale (HABS) in T1D adults (previously examined only in T2D adults), and to determine if it has unique value, after controlling for hypoglycemic fear. METHODS The original 14 HABS items were submitted to a confirmatory factor analysis (CFA) with T1D participants. Construct validity criteria included diabetes distress, generalized anxiety, well-being, hypoglycemic fear, hypoglycemia history and self-reported glycemic control. RESULTS A CFA yielded a similar 3-factor solution, with all items loading on the same factors as in the analyses with T2D adults: Hypoglycemia Anxiety, Avoidance and Confidence. Higher levels of Anxiety and Avoidance were significantly associated with poorer well-being and higher levels of generalized anxiety, diabetes distress and hypoglycemic fear, with correlations in the reverse direction for Confidence. After controls (including hypoglycemic fear), the HABS subscales were significantly linked to several criterion variables. CONCLUSIONS Though originally developed and validated with T2D adults, the HABS demonstrates sufficient validity and reliability for use with a T1D population; and it captures unique critical elements of hypoglycemic concerns. Thus, it may contribute to a greater understanding of hypoglycemia management and more targeted clinical interventions in a T1D population.
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Affiliation(s)
- W H Polonsky
- Department of Medicine, University of California, San Diego, United States of America; Behavioral Diabetes Institute, San Diego, CA, United States of America.
| | - L Fisher
- Department of Family and Community Medicine, University of California, San Francisco, CA, United States of America
| | - D Hessler
- Department of Family and Community Medicine, University of California, San Francisco, CA, United States of America
| | - J Liu
- T1D Exchange, Boston, MA, United States of America
| | - L Fan
- Eli Lilly and Company, Lilly Diabetes, Indianapolis, IN, United States of America
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Hessler D, Fisher L, Polonsky W, Strycker L, Parra J, Bowyer V, Dedhia M, Masharani U. There is value in treating elevated levels of diabetes distress: the clinical impact of targeted interventions in adults with Type 1 diabetes. Diabet Med 2020; 37:71-74. [PMID: 31314907 DOI: 10.1111/dme.14082] [Citation(s) in RCA: 11] [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] [Accepted: 07/16/2019] [Indexed: 11/28/2022]
Abstract
AIM To compare the effect of targeted interventions to reduce high diabetes distress among adults with Type 1 diabetes with a comparison sample of similar but untreated individuals, and to document the stability of untreated diabetes distress over time. METHODS A total of 51 adults with Type 1 diabetes with elevated baseline diabetes distress (distress score ≥ 2.0) and HbA1c levels (≥ 58 mmol/mol) were identified from a longitudinal, non-intervention study, and compared with a similar sample of 51 participants in an intervention study. Both groups completed the T1-DDS diabetes distress questionnaire at baseline and 9 months. RESULTS Large and significant reductions in diabetes distress scores were recorded in the intervention group (mean ± sd change = -0.6 ± 0.6), while minimal change was found in the non-intervention group (-0.2 ± 0.6, group effect P = 0.002; effect size d = 0.67). Additional analyses using the established minimal clinically important difference for the T1-DDS showed that diabetes distress increased significantly (minimal clinically important difference ≥ 1) or persisted at high levels for 51% of participants in the non-intervention group, compared with 23.5% in the intervention group. CONCLUSION Our results showed that targeted interventions led to dramatic reductions in diabetes distress compared with a lack of treatment. We also conclude that elevated diabetes distress, when left unaddressed, does not resolve over time and often remains chronic. (Clinical Trials Registry no.: NCT02175732).
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Affiliation(s)
- D Hessler
- Department of Family and Community Medicine, University of California, San Francisco, San Francisco, CA, USA
| | - L Fisher
- Department of Family and Community Medicine, University of California, San Francisco, San Francisco, CA, USA
| | - W Polonsky
- Behavioural Diabetes Institute, Department of Psychiatry, University of California, San Diego, CA, USA
| | - L Strycker
- Oregon Research Institute, Eugene, OR, USA
| | - J Parra
- Department of Family and Community Medicine, University of California, San Francisco, San Francisco, CA, USA
| | - V Bowyer
- Department of Family and Community Medicine, University of California, San Francisco, San Francisco, CA, USA
| | - M Dedhia
- Department of Family and Community Medicine, University of California, San Francisco, San Francisco, CA, USA
| | - U Masharani
- Department of Medicine, University of California, San Francisco, CA, USA
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11
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Skinner T, Byrne M, Dickinson JK, Fisher L, Funnell M, Guzman S, Hendrieckx C, Hermanns N, Kanc K, Lloyd C, Mocan A, Nouwen A, Pouwer F, Saleh-Stattin N, Snoek F, Speight J, Sturt J, Vallis M, Wagner J, Willaing I, Young-Hyman D, Zoffmann V. Comment on the consensus report on the management of hyperglycaemia in Type 2 diabetes by the American Diabetes Association and the European Association for the Study of Diabetes. Diabet Med 2019; 36:911-912. [PMID: 30785642 DOI: 10.1111/dme.13934] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- T Skinner
- University of Copenhagen, Denmark
- Steno Diabetes Centre Copenhagen, Denmark
| | - M Byrne
- School of Psychology, National University of Ireland, Galway, Ireland
| | - J K Dickinson
- Diabetes Education and Management, Teachers College Columbia University, New York, NY, USA
| | - L Fisher
- Family and Community Medicine, University of California San Francisco, San Francisco, LA, USA
| | - M Funnell
- University of Michigan Medical School, Ann Arbor, MI, USA
| | - S Guzman
- Behavioural Diabetes Institute, San Diego, CA, USA
| | - C Hendrieckx
- Australian Centre for Behavioural Research in Diabetes, Melbourne, Victoria, Australia
- Deakin University, Australia
| | - N Hermanns
- Jazindiabetes, (Diabetes & Me), Slovenia
| | - K Kanc
- Forschungsinstitut Diabetes-Akademie, Bad Mergentheim, Germany
| | - C Lloyd
- Open University, Milton Keynes, UK
| | - A Mocan
- Emergency Clinical County Hospital, Cluj-Napoca, Romania
| | - A Nouwen
- Middlesex University, London, UK
| | - F Pouwer
- University of Southern Denmark, Odense, Denmark
| | | | - F Snoek
- Amsterdam UMC, Amsterdam, Netherlands
| | - J Speight
- Australian Centre for Behavioural Research in Diabetes, Melbourne, Victoria, Australia
- Deakin University, Australia
| | - J Sturt
- Florence Nightingale Faculty of Nursing and Midwifery, Kings College London, London, UK
| | - M Vallis
- Dalhousie University, Halifax, Canada
| | - J Wagner
- Behavioral Sciences and Community Health, University of Connecticut Health Center, Farmington, CT, USA
| | - I Willaing
- Steno Diabetes Centre Copenhagen, Denmark
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Abstract
Addressing the emotional side of diabetes and its management has received considerable attention in recent years. At the centre of most of these efforts is the concept of 'diabetes distress', a generic term that captures the primary sources and intensity of emotional distress associated with diabetes and its management over time. As interest in diabetes distress has grown, however, it has been difficult to integrate and translate the various strands of clinical research in a manner that can guide diabetes distress intervention efforts in the real world of clinical care. The aim of this paper is to fill this gap by outlining practical strategies for intervention in clinical settings and to assist diabetes healthcare professionals in thinking through how diabetes distress might be addressed practically in their clinics. To address these goals, this review is divided into five sections: a definition of diabetes distress, ways diabetes distress can be assessed and monitored, information about diabetes distress for use in intervention planning, topics to be considered for inclusion in diabetes distress interventions, and alternatives for where in the care process a diabetes distress intervention might be considered. We focus on diabetes distress experienced by adults with both Type 1 and Type 2 diabetes.
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Affiliation(s)
- L Fisher
- Department of Family & Community Medicine, University of California, San Francisco, Ca, USA
| | - W H Polonsky
- University of California, San Diego, Behavioral Diabetes Institute, San Diego, Ca, USA
| | - D Hessler
- Department of Family & Community Medicine, University of California, San Francisco, Ca, USA
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13
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Joensen L, Fisher L, Skinner T, Doherty Y, Willaing I. Integrating psychosocial support into routine diabetes care: perspectives from participants at the Self-Management Alliance meeting 2016. Diabet Med 2019; 36:847-853. [PMID: 30315608 DOI: 10.1111/dme.13836] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [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] [Accepted: 10/11/2018] [Indexed: 01/09/2023]
Abstract
AIMS To identify challenges and solutions to integrating psychosocial support into routine diabetes care from the perspective of stakeholders with expertise in diabetes self-management education and support. METHODS Ninety-four people attended the annual international Diabetes Self-Management Alliance meeting in 2016, which included plenary sessions and workshops on self-management education, support and prevention. One workshop focused on how to integrate psychosocial support into routine diabetes care; this was run four times consecutively, allowing all conference participants to attend the workshops in groups of 20-25 people. RESULTS Challenges and solutions associated with integrating psychosocial support into routine diabetes care concern the patient-provider relationship, the healthcare system and the community. Challenges identified were: lack of time, skills and resources to deal with psychological well-being; a culture of patient blame and care expectations; the complexity of person-centred assessment of psychological issues; and the substantial healthcare system focus on productivity and biomedical indicators. Lack of involvement of local communities and of inclusion of social determinants of health were also highlighted as challenging. Solutions identified were more patient-provider dialogue; more training and better skills among care providers; system incentives for psychosocial outcomes; and targeting social determinants of health and involvement of family and peers. CONCLUSIONS From the perspective of international stakeholders with an expertise in diabetes self-management and support attending the conference in Denmark, substantial new incentives and systematic cultural changes are needed in healthcare systems to integrate psychosocial support into routine diabetes care, as recommended in international guidelines.
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Affiliation(s)
- L Joensen
- Department of Health Promotion, Steno Diabetes Center Copenhagen, Copenhagen, Denmark
| | - L Fisher
- Department of Family and Community Medicine, University of California, San Francisco, CA, USA
| | - T Skinner
- Department of Psychology, Faculty of Social Sciences, University of Copenhagen, Denmark
| | - Y Doherty
- Department of Psychological Medicine, York Teaching Hospitals NHS Foundation Trust, York, UK
| | - I Willaing
- Department of Health Promotion, Steno Diabetes Center Copenhagen, Copenhagen, Denmark
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14
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Trief PM, Fisher L, Sandberg J, Hessler DM, Cibula DA, Weinstock RS. Two for one? Effects of a couples intervention on partners of persons with Type 2 diabetes: a randomized controlled trial. Diabet Med 2019; 36:473-481. [PMID: 30485516 PMCID: PMC6408270 DOI: 10.1111/dme.13871] [Citation(s) in RCA: 15] [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] [Accepted: 11/26/2018] [Indexed: 11/30/2022]
Abstract
AIMS To compare the outcomes of partners who participated in a telephone couples behavioural intervention to improve glycaemic control in persons with Type 2 diabetes with those of untreated partners of participants in an individual intervention or education; to explore 'ripple effects', i.e. positive behaviour changes seen in untreated partners. METHODS The Diabetes Support Project was a three-arm randomized telephone intervention trial comparing outcomes of couples calls (CC), individual calls (IC) and diabetes education calls (DE). Couples included one partner with Type 2 diabetes and HbA1c ≥ 58 mmol/mol (7.5%). All arms received self-management education (two calls). CC and IC arms participated in 10 additional behaviour change calls. CC included partners, emphasizing partner communication, collaboration and support. Blinded assessments were performed at 4, 8 and 12 months. Partner outcomes were psychosocial (diabetes distress, relationship satisfaction, depressive symptoms), medical (BMI, blood pressure) and behavioural (fat intake, activity). RESULTS Partners' (N = 268) mean age was 55.8 years, 64.6% were female and 29.9% were from minority ethnic groups. CC (vs. IC and DE) partners had greater reductions in diabetes distress, greater increases in marital satisfaction (4 and 8 months), and some improvements in diastolic BP. There were no consistent differences among arms in other outcomes. There was no evidence of a dietary or activity behaviour ripple effect on untreated partners, i.e. comparing partners in the IC and DE arms. CONCLUSIONS A collaborative couples intervention resulted in significant improvements in partner diabetes distress and relationship satisfaction. There were no consistent effects on behavioural or medical partner outcomes, and no evidence of diet or activity behaviour ripple effects, suggesting that partners should be targeted directly to achieve these changes. (Clinical Trial Registry No: NCT01017523).
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Affiliation(s)
- P M Trief
- Department of Psychiatry & Behavioral Sciences, SUNY Upstate Medical University, Syracuse, NY, USA
- Department of Medicine, SUNY Upstate Medical University, Syracuse, NY, USA
| | - L Fisher
- Department of Family Medicine, University of California, San Francisco, CA, USA
| | - J Sandberg
- School of Family Life, Brigham Young University, Provo, UT, USA
| | - D M Hessler
- Department of Family Medicine, University of California, San Francisco, CA, USA
| | - D A Cibula
- Department of Public Health & Preventive Medicine, SUNY Upstate Medical University, Syracuse, NY, USA
| | - R S Weinstock
- Department of Medicine, SUNY Upstate Medical University, Syracuse, NY, USA
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15
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Khan AJ, Pedrelli P, Shapero BG, Fisher L, Nyer M, Farabaugh AI, MacPherson L. The Association between Distress Tolerance and Alcohol Related Problems: The Pathway of Drinking to Cope. Subst Use Misuse 2018; 53:2199-2209. [PMID: 29708456 DOI: 10.1080/10826084.2018.1464027] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
Binge drinking (BD) and alcohol related problems (ARP) are highly prevalent among college students. However, current models examining ARP suggest drinking quantity only accounts for a portion of the variance, suggesting other variables contribute to ARP. Distress tolerance (DT), or the ability to withstand negative affect, is associated with alcohol misuse and may be an important mechanism related to ARP. However, studies have reported inconsistent findings on this association, which may be due to the use of only global scores to measure DT rather than specific DT components. Furthermore, the mechanisms underlying this association remain unknown. Drinking to cope with negative affect has been associated with both DT and ARP, suggesting it may be a mechanism explaining the relationship between DT and ARP. The current study examined the association between specific proposed DT components (i.e., tolerance, absorption, appraisal, and regulation) and drinking to cope and ARP in 147 college students who BD. A hierarchical linear regression was performed in order to examine which DT component best predicted ARP. Four follow-up mediation models were then tested to examine whether drinking to cope mediated the relationship between each DT component and ARP. Appraisal of DT was the only DT component that significantly predicted ARP, in the model controlling for drinking quantity and sex differences. Drinking to cope mediated the relationship between ARP and tolerance, absorption, and regulation, but not appraisal of DT. Implications for furthering our understanding of DT and treatment of BD as it relates to DT are explored.
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Affiliation(s)
- A J Khan
- a Emotion and Learning Lab, Department of Psychology , Suffolk University , Boston , Massachusetts , USA
| | - P Pedrelli
- b Depression Clinical Research Program, Massachusetts General Hospital , Boston , Massachusetts , USA.,c Department of Psychiatry , Harvard Medical School , Boston , Massachusetts , USA
| | - B G Shapero
- b Depression Clinical Research Program, Massachusetts General Hospital , Boston , Massachusetts , USA.,c Department of Psychiatry , Harvard Medical School , Boston , Massachusetts , USA
| | - L Fisher
- b Depression Clinical Research Program, Massachusetts General Hospital , Boston , Massachusetts , USA.,c Department of Psychiatry , Harvard Medical School , Boston , Massachusetts , USA
| | - M Nyer
- b Depression Clinical Research Program, Massachusetts General Hospital , Boston , Massachusetts , USA.,c Department of Psychiatry , Harvard Medical School , Boston , Massachusetts , USA
| | - A I Farabaugh
- b Depression Clinical Research Program, Massachusetts General Hospital , Boston , Massachusetts , USA.,c Department of Psychiatry , Harvard Medical School , Boston , Massachusetts , USA
| | - L MacPherson
- d Greenebaum Comprehensive Cancer Center, University of Maryland , Baltimore , Maryland , USA
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16
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Hessler DM, Fisher L, Polonsky WH, Bowyer V, Potter M. Motivation and attitudes toward changing health (MATCH): A new patient-reported measure to inform clinical conversations. J Diabetes Complications 2018; 32:665-669. [PMID: 29887299 PMCID: PMC6867057 DOI: 10.1016/j.jdiacomp.2018.04.009] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/08/2018] [Revised: 04/19/2018] [Accepted: 04/20/2018] [Indexed: 11/18/2022]
Abstract
OBJECTIVE To identify and assess patient motivation to initiate or maintain behavior changes. METHODS Attitudinal statements were developed from structured patient interviews and translated into 18 survey items. Items were analyzed with exploratory factor analysis (EFA). RESULTS An EFA with 340 type 2 diabetes patients identified three areas of patient attitudes toward changing health behaviors: (1) willingness to make changes (3 items; α = 0.69), (2) perceived ability to make or maintain changes (3 items; α = 0.74), and (3) and feeling changes are worthwhile (3 items; α = 0.61). Greater perceived ability and feelings of worthwhileness were associated with positive psychosocial and behavioral management indicators. All three areas were associated with confidence and attitudes toward making a specific behavioral change (e.g., improve diet). CONCLUSIONS MATCH is an internally consistent and valid 9-item scale that provides a profile of factors influencing motivation that can be used in clinical and research settings.
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Affiliation(s)
- Danielle M Hessler
- Department of Family & Community Medicine, University of California-, San Francisco, United States.
| | - L Fisher
- Department of Family & Community Medicine, University of California-, San Francisco, United States
| | | | - V Bowyer
- Department of Family & Community Medicine, University of California-, San Francisco, United States
| | - M Potter
- Department of Family & Community Medicine, University of California-, San Francisco, United States
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17
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Polonsky WH, Fisher L, Hessler D. The impact of non-severe hypoglycemia on quality of life in patients with type 2 diabetes. J Diabetes Complications 2018; 32:373-378. [PMID: 29496364 DOI: 10.1016/j.jdiacomp.2018.01.014] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/21/2017] [Revised: 01/26/2018] [Accepted: 01/28/2018] [Indexed: 01/08/2023]
Abstract
AIMS To determine the impact of frequency of non-severe hypoglycemic events (NSHE) and the perceived burden of NSHE on quality of life (QOL) over time. METHODS T2D adults (n = 424) were re-contacted two years after initial QOL assessment. Responding subjects (n = 290) reported the frequency and burden of NSHE over time and completed six generic and diabetes-specific QOL measures. RESULTS Most subjects (86%) reported ≥ one NSHE over time. Higher frequency of NSHE was significantly associated with decrements in QOL. Greater perceived burden of NSHE was significantly linked to decreases in QOL over time for all six QOL measures. Interaction terms indicated that participants with a higher frequency of NSHE and higher perceived burden reported the greatest decrease in QOL; participants who experienced frequent NSHE but did not perceive these events as burdensome evidenced little worsening in QOL over time. CONCLUSIONS NSHE have a negative impact on QOL over time in T2D adults. However, it is not just the occurrence of NSHE that affects QOL; it is the individual's felt burden of these events that is critical. The greatest reductions in QOL are seen among those subjects reporting a higher frequency of NSHE and indicating that such events are burdensome.
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Affiliation(s)
- W H Polonsky
- Department of Psychiatry, University of California, San Diego, USA; Behavioral Diabetes Institute, San Diego, USA.
| | - L Fisher
- Department of Family and Community Medicine, University of California, San Francisco
| | - D Hessler
- Department of Family and Community Medicine, University of California, San Francisco
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18
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Dennis S, Fisher L, Ware C, Giraldo C. Preliminary study of the effect of gamma irradiation on the vase life of Iridaceae Hollandica. Radiat Phys Chem Oxf Engl 1993 2018. [DOI: 10.1016/j.radphyschem.2017.12.003] [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: 11/24/2022]
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Abstract
A wide range of diabetes-directed interventions - including novel medications, devices and comprehensive education programmes - have been shown to be effective in clinical trials. But in the real world of diabetes care their efficacy is often dependent upon on how well a clinician is able to support personal engagement and motivation of the person with diabetes to use these new tools and knowledge consistently, and as directed. Although many person-centred motivational and behavioural strategies have been developed, for example, action planning, motivational interviewing and empowerment-based communication, the sheer number and apparent lack of clear differences among them have led to considerable confusion. The primary goal of this review, therefore, is to provide a practical framework that organizes and structures these programmes to enhance their more systematic use in clinical care. Its purpose is to enhance clinician efforts to respectfully encourage and support engagement and motivation for behaviour change in people with diabetes. The three-step framework for organizing and describing the specific clinical processes involved is based on self-determination theory and includes: clinician preparation for a different type of clinical encounter, clinician/person with diabetes relationship building, and clinician utilization of specific behavioural tools. We conclude with practical considerations for application of this framework to the real world of clinical care.
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Affiliation(s)
- L Fisher
- Department of Family & Community Medicine, University of California, San Francisco
| | - W H Polonsky
- Behavioral Diabetes Institute, University of California, San Diego, USA
| | - D Hessler
- Department of Family & Community Medicine, University of California, San Francisco
| | - M B Potter
- Department of Family & Community Medicine, University of California, San Francisco
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20
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Hessler DM, Fisher L, Polonsky WH, Masharani U, Strycker LA, Peters AL, Blumer I, Bowyer V. Diabetes distress is linked with worsening diabetes management over time in adults with Type 1 diabetes. Diabet Med 2017; 34:1228-1234. [PMID: 28498610 PMCID: PMC5561505 DOI: 10.1111/dme.13381] [Citation(s) in RCA: 94] [Impact Index Per Article: 13.4] [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] [Accepted: 05/08/2017] [Indexed: 12/20/2022]
Abstract
AIM To determine the cross-sectional and longitudinal associations between diabetes distress and diabetes management. METHODS In a non-interventional study, 224 adults with Type 1 diabetes were assessed for diabetes distress, missed insulin boluses, hypoglycaemic episodes, and HbA1c at baseline and 9 months. RESULTS At baseline, greater distress was associated with higher HbA1c and a greater percentage of missed insulin boluses. Longitudinally, elevated baseline distress was related to increased missed insulin boluses, and decreases in distress were associated with decreases in HbA1c . In supplementary analyses, neither depression symptoms nor a diagnosis of major depressive disorder was associated with missed insulin boluses, HbA1c or hypoglycaemic episodes in cross-sectional or longitudinal analyses. CONCLUSIONS Significant cross-sectional and longitudinal associations were found between diabetes distress and management; in contrast, no parallel associations were found for major depressive disorder or depression symptoms. Findings suggest that elevated distress may lead to more missed insulin boluses over time, suggesting a potential intervention target. The covarying association between distress and HbA1c points to the complex and likely interactive associations between these constructs. Findings highlight the need to address distress as an integral part of diabetes management in routine care.
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Affiliation(s)
- D M Hessler
- Department of Family & Community Medicine, San Francisco, USA
| | - L Fisher
- Department of Family & Community Medicine, San Francisco, USA
| | - W H Polonsky
- Behavioral Diabetes Institute, San Francisco, USA
| | - U Masharani
- Department of Medicine, University of California-San Francisco, San Francisco, USA
| | | | - A L Peters
- University of Southern California, Los Angeles, USA
| | - I Blumer
- Charles H. Best Diabetes Centre, Ontario, Canada
| | - V Bowyer
- Department of Family & Community Medicine, San Francisco, USA
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21
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Khan S, Evans P, Fisher L. Gastrointestinal: Biliary tubulovillous adenoma. J Gastroenterol Hepatol 2017; 32:1423. [PMID: 28752689 DOI: 10.1111/jgh.13660] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/04/2016] [Revised: 10/23/2016] [Accepted: 11/17/2016] [Indexed: 12/09/2022]
Affiliation(s)
- S Khan
- Department of Gastroenterology and Liver Transplant Unit, Austin Health, Melbourne, Victoria, Australia.,Department of Gastroenterology, Peninsula Health, Melbourne, Victoria, Australia
| | - P Evans
- Department of Surgery, Peninsula Health, Melbourne, Victoria, Australia
| | - L Fisher
- Department of Gastroenterology, Peninsula Health, Melbourne, Victoria, Australia
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22
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Dempster N, Gajarski R, Fisher L, Missler H, Cole T, Nandi D. Psychosocial Determinants of Health in Young Heart Transplant Recipients: Thinking Outside the Box. J Heart Lung Transplant 2017. [DOI: 10.1016/j.healun.2017.01.272] [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: 10/19/2022] Open
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23
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Silveira MSVM, Bovi TG, Oliveira PF, Pavin EJ, Fisher L. Translation and cultural adaptation into Brazilian culture of type 1 diabetes distress scale. Diabetol Metab Syndr 2017; 9:61. [PMID: 28794803 PMCID: PMC5545833 DOI: 10.1186/s13098-017-0260-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/20/2017] [Accepted: 08/02/2017] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND Diabetes related distress is common in type 1 diabetes patients (T1D). High levels of diabetes distress are related to poor metabolic control. An instrument to evaluate diabetes distress in T1D patients is "type 1 diabetes scale-T1DDS". The aim of this study was to translate and culturally adapt the T1DDS into Brazilian culture. METHODS T1DDS scale was translated into Portuguese. Back translation was performed and evaluated by a specialists committee. Pre-test was performed with 40 T1D outpatients at State University of Campinas hospital. Internal consistency, external consistency and re-test were performed. RESULTS 72% women, mean age: 32, 1 ± 9, 7 years, mean diabetes duration: 15, 8 ± 9, 1 years, mean scholarity: 11, 5 ± 3, 6, glycosylated hemoglobin mean: 9 ± 2%. Internal consistency: Cronbach alpha of T1DDS Brazilian version was 0.93. External consistency: Spearman's coefficient between T1DDS and PAID, Brazilian version, was 0.7781; (p < 0.0001). CONCLUSIONS The T1DDS Brazilian version is a reliable tool to evaluate diabetes distress in T1D patients in the Brazilian Population. This tool can be useful in clinical care and to identify patiens at risk and in need for psychosocial intervention.
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Affiliation(s)
- M. S. V. M. Silveira
- Internal Medicine Postgraduate Program, Faculty of Medical Sciences-Unicamp, Campinas, Brazil
- Endocrinology Division, Department of Internal Medicine, Faculty of Medical Sciences-Unicamp, Rua Vital Brasil, 251, Barão Geraldo, Campinas, São Paulo CEP: 13083970 Brazil
| | - T. G. Bovi
- Internal Medicine Postgraduate Program, Faculty of Medical Sciences-Unicamp, Campinas, Brazil
| | - P. F. Oliveira
- Statistical Research Center, Faculty of Medical Sciences-Unicamp, Campinas, Brazil
| | - E. J. Pavin
- Endocrinology Division, Department of Internal Medicine, Faculty of Medical Sciences-Unicamp, Rua Vital Brasil, 251, Barão Geraldo, Campinas, São Paulo CEP: 13083970 Brazil
| | - L. Fisher
- Department of Family and Community Medicine, University of California San Francisco-UCSF, San Francisco, USA
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Affiliation(s)
- G W Judge
- Senior Scientific Officer, Department of Health and Social Security, 14 Russell Square, London WC1
| | - L Fisher
- Design Engineer, Biomechanical Research and Development Unit, Roehampton, London SW15
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25
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Fisher L, Hessler DM, Polonsky WH, Masharani U, Peters AL, Blumer I, Strycker LA. Prevalence of depression in Type 1 diabetes and the problem of over-diagnosis. Diabet Med 2016; 33:1590-1597. [PMID: 26433004 DOI: 10.1111/dme.12973] [Citation(s) in RCA: 66] [Impact Index Per Article: 8.3] [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] [Accepted: 09/28/2015] [Indexed: 12/19/2022]
Abstract
AIMS To determine the prevalence of depression and diabetes distress in adults with Type 1 diabetes and the rate of false-positives when compared with rates of major depressive disorder. METHODS The sample consisted of 368 individuals with Type 1 diabetes, aged > 19 years. Individuals completed: the eight-item Patient Health Questionnaire depression scale (PHQ8), which was coded using four scoring criteria (scores > 10, >12 and >15, and Diagnostic and Statistical Manual of Mental Disorders 5 (DSM) algorithm scores); the Type 1 Diabetes Distress Scale; and the Structured Clinical Interview for DSM Disorders (SCID) to assess major depressive disorder. RESULTS The prevalence rates of depression according to the eight-item Patient Health Questionnaire were: score >10, 11.4%; score >12, 7.1%; score >15, 3.8%; and positive algorithm result, 4.6%. The prevalence of major depressive disorder was 3.5%; and the prevalence of at least moderate diabetes distress was 42.1%. Depending on the criterion used, the false-positive rate when using the Patient Health Questionnaire compared with the results when using the SCID varied from 52 to 71%. Of those classified as depressed on the PHQ-8 or Structured Clinical Interview for DSM Disorders, between 92.3 and 96.2% also reported elevated diabetes distress. No significant association was found between any group classed as having depression according to the PHQ8 or the SCID and HbA1c concentration. Depression was significantly associated with more other life stress, more complications and a lower level of education. CONCLUSIONS We found an unexpectedly low rate of current depression and major depressive disorder in this diverse sample of adults with Type 1 diabetes, and a very high rate of false-positive results using the Patient Health Questionnaire. Considering the high prevalence of diabetes distress, much of what has been considered depression in adults with Type 1 diabetes may be attributed to the emotional distress associated with managing a demanding chronic disease and other life stressors and not necessarily to underlying psychopathology.
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Affiliation(s)
- L Fisher
- Department of Family and Community Medicine, UCSF, San Francisco, USA.
| | - D M Hessler
- Department of Family and Community Medicine, UCSF, San Francisco, USA
| | | | - U Masharani
- Department of Medicine, UCSF, San Francisco, USA
| | - A L Peters
- University of Southern California, Los Angeles, CA, USA
| | - I Blumer
- Charles H. Best Diabetes Centre, Ontario, Canada
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26
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May PW, Clegg M, Silva TA, Zanin H, Fatibello-Filho O, Celorrio V, Fermin DJ, Welch CC, Hazell G, Fisher L, Nobbs A, Su B. Diamond-coated 'black silicon' as a promising material for high-surface-area electrochemical electrodes and antibacterial surfaces. J Mater Chem B 2016; 4:5737-5746. [PMID: 32263865 DOI: 10.1039/c6tb01774f] [Citation(s) in RCA: 54] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
This report describes a method to fabricate high-surface-area boron-doped diamond (BDD) electrodes using so-called 'black silicon' (bSi) as a substrate. This is a synthetic nanostructured material that contains high-aspect-ratio nano-protrusions, such as spikes or needles, on the Si surface produced via plasma etching. We now show that coating a bSi surface composed of 15 μm-high needles conformably with BDD produces a robust electrochemical electrode with high sensitivity and high electroactive area. A clinically relevant demonstration of the efficacy of these electrodes is shown by measuring their sensitivity for detection of dopamine (DA) in the presence of an excess of uric acid (UA). Finally, the nanostructured surface of bSi has recently been found to generate a mechanical bactericidal effect, killing both Gram-negative and Gram-positive bacteria at high rates. We will show that BDD-coated bSi also acts as an effective antibacterial surface, with the added advantage that being diamond-coated it is far more robust and less likely to become damaged than Si.
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Affiliation(s)
- P W May
- School of Chemistry, University of Bristol, Bristol BS8 1TS, UK.
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27
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Khan S, Fisher L. Gastrointestinal: A rare case of polysplenia syndrome presenting with biliary obstruction in adulthood. J Gastroenterol Hepatol 2016; 31:1071. [PMID: 26699089 DOI: 10.1111/jgh.13276] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2015] [Accepted: 12/16/2015] [Indexed: 12/09/2022]
Affiliation(s)
- S Khan
- Department of Gastroenterology, Peninsula Health, Frankston, Victoria, Australia
| | - L Fisher
- Department of Gastroenterology, Peninsula Health, Frankston, Victoria, Australia
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Fisher L, Lapointe AK, Gilliet M, Di Lucca-Chrisment J. Efficacité du lenalidomide (Revlimid®) dans un cas d’infiltrat lymphocytaire cutané de Jessner-Kanof réfractaire. Ann Dermatol Venereol 2015. [DOI: 10.1016/j.annder.2015.10.285] [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: 11/25/2022]
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Polonsky WH, Fisher L, Hessler D, Edelman SV. Identifying the worries and concerns about hypoglycemia in adults with type 2 diabetes. J Diabetes Complications 2015; 29:1171-6. [PMID: 26338296 DOI: 10.1016/j.jdiacomp.2015.08.002] [Citation(s) in RCA: 47] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/21/2015] [Revised: 08/01/2015] [Accepted: 08/04/2015] [Indexed: 10/23/2022]
Abstract
AIMS To identify the hypoglycemic concerns of adults with type 2 diabetes (T2D) and examine how these concerns are associated with key patient characteristics. METHODS Qualitative interviews with 16 T2D adults and 11 diabetes care providers were conducted. Survey items were then developed and submitted to exploratory factor analyses (EFAs). Construct validity was assessed by correlations with diabetes distress, anxiety and depressive symptoms, well-being, hypoglycemic fear, hypoglycemia history and glycemic control (A1C). RESULTS An EFA with 226 insulin users and 198 non-insulin users yielded 3 factors (14 items): Hypoglycemia Anxiety, Avoidance and Confidence. For both T2D groups, higher Anxiety and Avoidance were significantly associated with more hypoglycemia, lower well-being, and greater diabetes distress, depressive symptoms and hypoglycemic fear. Similar associations, in the converse direction, were found for Confidence. Among insulin users only, Anxiety was independently associated with greater emotional distress and more hypoglycemia, while Confidence was independently linked to less emotional distress and lower A1C. Avoidance was independently associated with greater emotional distress in both groups. CONCLUSIONS Using the new 14-item Hypoglycemic Attitudes and Behavior Scale (HABS), we found that hypoglycemic concerns are significant in T2D adults, are linked to emotional distress and A1C, and merit attention in clinical practice.
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Affiliation(s)
- W H Polonsky
- Department of Psychiatry, University of CA, San Diego, USA; Behavioral Diabetes Institute, San Diego, USA.
| | - L Fisher
- Department of Family and Community Medicine, University of California, San Francisco
| | - D Hessler
- Department of Family and Community Medicine, University of California, San Francisco
| | - S V Edelman
- Division of Endocrinology and Metabolism, University of California, San Diego, and Veterans Affairs Medical Center, San Diego
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Fisher L, Matthews D. PEDIATRICSB-104The Neuropathology of Disruptive Mood Dysregulation Disorder: Preliminary Hypothesis. Arch Clin Neuropsychol 2015. [DOI: 10.1093/arclin/acv047.199] [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: 11/13/2022] Open
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Dong B, Belkhair S, Zaarour M, Fisher L, Verran J, Tosheva L, Retoux R, Gilson JP, Mintova S. Silver confined within zeolite EMT nanoparticles: preparation and antibacterial properties. Nanoscale 2014; 6:10859-10864. [PMID: 25117582 DOI: 10.1039/c4nr03169e] [Citation(s) in RCA: 22] [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: 06/03/2023]
Abstract
The preparation of pure zeolite nanocrystals (EMT-type framework) and their silver ion-exchanged (Ag(+)-EMT) and reduced silver (Ag(0)-EMT) forms is reported. The template-free zeolite nanocrystals are stabilized in water suspensions and used directly for silver ion-exchange and subsequent chemical reduction under microwave irradiation. The high porosity, low Si/Al ratio, high concentration of sodium and ultrasmall crystal size of the EMT-type zeolite permitted the introduction of a high amount of silver using short ion-exchange times in the range of 2-6 h. The killing efficacy of pure EMT, Ag(+)-EMT and Ag(0)-EMT against Escherichia coli was studied semi-quantitatively. The antibacterial activity increased with increasing Ag content for both types of samples (Ag(+)-EMT and Ag(0)-EMT). The Ag(0)-EMT samples show slightly enhanced antimicrobial efficacy compared to that of Ag(+)-EMT, however, the differences are not substantial and the preparation of Ag nanoparticles is not viable considering the complexity of preparation steps.
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Affiliation(s)
- B Dong
- Laboratoire Catalyse & Spectrochimie, University of Caen, CNRS, 6, boulevard du Maréchal Juin, 14050 Caen Cedex, France.
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Fisher L, Ostovapour S, Kelly P, Whitehead KA, Cooke K, Storgårds E, Verran J. Molybdenum doped titanium dioxide photocatalytic coatings for use as hygienic surfaces: the effect of soiling on antimicrobial activity. Biofouling 2014; 30:911-919. [PMID: 25184432 DOI: 10.1080/08927014.2014.939959] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
Titanium dioxide (TiO2) surfaces doped with molybdenum (Mo) were investigated to determine if their photocatalytic ability could enhance process hygiene in the brewery industry. Doping TiO2 with Mo showed a 5-log reduction in bacterial counts within 4 to 24 h and a 1-log reduction in yeast numbers within 72 h. The presence of a dilute brewery soil on the surface did not interfere with antimicrobial activity. The TiO2-Mo surface was also active in the dark, showing a 5-log reduction in bacteria within 4 to 24 h and a 1-log reduction in yeast numbers within 72 h, suggesting it could have a novel dual function, being antimicrobial and photocatalytic. The study suggests the TiO2-Mo coating could act as a secondary barrier in helping prevent the build-up of microbial contamination on surfaces within the brewery industry, in particular in between cleaning/disinfection regimes during long production runs.
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Affiliation(s)
- L Fisher
- a School of Healthcare Science , Manchester Metropolitan University , Manchester , UK
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Fisher L, Gonzalez JS, Polonsky WH. The confusing tale of depression and distress in patients with diabetes: a call for greater clarity and precision. Diabet Med 2014; 31:764-72. [PMID: 24606397 PMCID: PMC4065190 DOI: 10.1111/dme.12428] [Citation(s) in RCA: 274] [Impact Index Per Article: 27.4] [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] [Received: 10/07/2013] [Revised: 12/20/2013] [Accepted: 03/04/2014] [Indexed: 01/05/2023]
Abstract
Studies have identified significant linkages between depression and diabetes, with depression associated with poor self-management behaviour, poor clinical outcomes and high rates of mortality. However, findings are not consistent across studies, yielding confusing and contradictory results about these relationships. We suggest that there has been a failure to define and measure 'depression' in a consistent manner. Because the diagnosis of depression is symptom-based only, without reference to source or content, the context of diabetes is not considered when addressing the emotional distress experienced by individuals struggling with diabetes. To reduce this confusion, we suggest that an underlying construct of 'emotional distress' be considered as a core construct to link diabetes-related distress, subclinical depression, elevated depression symptoms and major depressive disorder (MDD). We view emotional distress as a single, continuous dimension that has two primary characteristics: content and severity; that the primary content of emotional distress among these individuals include diabetes and its management, other life stresses and other contributors; and that both the content and severity of distress be addressed directly in clinical care. We suggest further that all patients, even those whose emotional distress rises to the level of MDD or anxiety disorders, can benefit from consideration of the content of distress to direct care effectively, and we suggest strategies for integrating the emotional side of diabetes into regular diabetes care. This approach can reduce confusion between depression and distress so that appropriate and targeted patient-centred interventions can occur.
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Affiliation(s)
- L Fisher
- University of California, San Francisco, San Francisco, CA
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Kong LM, Fok KC, Tsui A, Qian C, Fisher L. Peripheral T-cell lymphoma mimicking 5-aminosalicylate hypersensitivity in ulcerative colitis. Intern Med J 2014; 43:1137-40. [PMID: 24134170 DOI: 10.1111/imj.12240] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2012] [Accepted: 07/03/2013] [Indexed: 01/20/2023]
Abstract
5-aminosalicylates (5-ASA) remain an important strategy in the induction and maintenance of remission of inflammatory bowel diseases especially in ulcerative colitis. The prototypical drug of this class, sulfasalazine is generally well tolerated with severe hypersensitivity reactions and hepatotoxicity also described within the literature. When approaching a patient with an adverse reaction to 5-ASA, it can be difficult to differentiate clinically between a sulfa allergy versus a 5-ASA allergy versus a malignancy. We report on a case with initial signs and symptoms suggestive of a sulfa/5-ASA allergy that was subsequently found to be malignant in nature.
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Affiliation(s)
- L M Kong
- Department of Gastroenterology, Frankston Hospital, Frankston, Victoria, Australia
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Fisher L, Hessler D, Masharani U, Strycker L. Impact of baseline patient characteristics on interventions to reduce diabetes distress: the role of personal conscientiousness and diabetes self-efficacy. Diabet Med 2014; 31:739-46. [PMID: 24494593 PMCID: PMC4028368 DOI: 10.1111/dme.12403] [Citation(s) in RCA: 28] [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] [Received: 08/27/2013] [Revised: 12/13/2013] [Accepted: 01/28/2014] [Indexed: 11/29/2022]
Abstract
AIMS To improve patient-centred care by determining the impact of baseline levels of conscientiousness and diabetes self-efficacy on the outcomes of efficacious interventions to reduce diabetes distress and improve disease management. METHODS Adults with Type 2 diabetes with diabetes distress and self-care problems (N = 392) were randomized to one of three distress reduction interventions: computer-assisted self-management; computer-assisted self-management plus problem-solving therapy; and health education. The baseline assessment included conscientiousness and self-efficacy, demographics, diabetes status, regimen distress, emotional burden, medication adherence, diet and physical activity. Changes in regimen distress, emotional burden and self-care between baseline and 12 months were recorded and ancova models assessed how conscientiousness and self-efficacy qualified the significant improvements in distress and management outcomes. RESULTS Participants with high baseline conscientiousness displayed significantly larger improvements in medication adherence and emotional burden than participants with low baseline conscientiousness. Participants with high baseline self-efficacy showed greater improvements in diet, physical activity and regimen distress than participants with low baseline self-efficacy. The impact of conscientiousness and self-efficacy were independent of each other and occurred across all three intervention groups. A significant interaction indicated that those with both high self-efficacy and high conscientiousness at baseline had the biggest improvement in physical activity by 12 months. CONCLUSIONS Both broad personal traits and disease-specific expectations qualify the outcomes of efficacious interventions. These findings reinforce the need to change from a one-size-fits-all approach to diabetes interventions to an approach that crafts clinical interventions in ways that fit the personal traits and skills of individual people.
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Affiliation(s)
- L Fisher
- Departments of Family and Community Medicine, San Francisco, CA, USA
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Asif I, Price D, Fisher L, Zakrajsek R, Raabe J, Bejar M, Larsen L, Rao A, Harmon K, Drezner J. SCREENING FOR SUDDEN CARDIAC DEATH IN ATHLETES: THE PSYCHOLOGICAL IMPACT OF BEING DIAGNOSED WITH POTENTIALLY LETHAL DISEASE. Br J Sports Med 2014. [DOI: 10.1136/bjsports-2014-093494.8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [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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Matsumoto A, Angle J, Secic M, Carlson G, Fisher L, Fairman R. Secondary procedures after TEVAR in the first 3 years of the valor test and VALOR II trials. J Vasc Interv Radiol 2014. [DOI: 10.1016/j.jvir.2013.12.028] [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: 11/30/2022] Open
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Polonsky WH, Fisher L, Hessler D, Edelman SV. What is so tough about self-monitoring of blood glucose? Perceived obstacles among patients with Type 2 diabetes. Diabet Med 2014; 31:40-6. [PMID: 23819529 DOI: 10.1111/dme.12275] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.3] [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] [Accepted: 06/27/2013] [Indexed: 11/27/2022]
Abstract
AIMS To identify patient-reported obstacles to self-monitoring of blood glucose among those with Type 2, both insulin users and non-insulin users, and to investigate how obstacles are associated with frequency of self-monitoring and use of self-monitoring data. METHODS Patients with Type 2 diabetes (n = 886, 65% insulin users) who attended a 1-day diabetes education conference in cities across the USA completed a survey on current and recommended self-monitoring of blood glucose frequency, how they used self-monitoring results and perceived obstacles to self-monitoring use. Exploratory factor analysis examined 12 obstacle items to identify underlying factors. Regression analyses examined associations between self-monitoring of blood glucose use and the key obstacle factors identified in the exploratory factor analysis. RESULTS Three obstacle factors emerged: Avoidance, Pointlessness and Burden. Avoidance was the only significant independent predictor of self-monitoring frequency (β = -0.23, P < 0.001). Avoidance (β = -0.12, P < 0.01) and Pointlessness (β = -0.15, P < 0.001) independently predicted how often self-monitoring data were shared with healthcare professionals and whether or not data were used to make management adjustments (Avoidance: odds ratio = 0.74, P < 0.001; Pointlessness: odds ratio = 0.75, P < 0.01). Burden was not associated with any of the self-monitoring behavioural measures. Few differences between insulin users and non-insulin users were noted. CONCLUSIONS Obstacles to self-monitoring of blood glucose use, both practical and emotional, were common. Higher levels of Avoidance and Pointlessness, but not Burden, were associated with less frequent self-monitoring use. Addressing patients' self-monitoring-related emotional concerns (Avoidance and Pointlessness) may be more beneficial in enhancing interest and engagement with self-monitoring of blood glucose than focusing on day-to-day, behavioural issues (Burden).
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Affiliation(s)
- W H Polonsky
- Department of Psychiatry, University of California, San Diego, CA, USA; Behavioral Diabetes Institute, San Diego, CA, USA
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Abstract
BACKGROUND Using conscious subjects, measurement of the effects of low concentrations of anaesthetic agents can allow the dynamics of onset and offset of the agent to be measured and kinetic values estimated. However, the tests have to be rapid and preferably assess cerebral function. METHODS We used a short version of the digit symbol substitution test (DSST) that allowed frequent measurement of the impairment caused by nitrous oxide. We compared 10 min of onset and offset of breathing 5% and 30% nitrous oxide in 30% oxygen, compared with 30% oxygen only. End-tidal nitrous oxide concentrations were used to predict the concentration in a central compartment, according to a range of T(1/2) values chosen to be consistent with possible cerebral blood flow values. RESULTS We studied 19 volunteers and estimated a mean response. Only 30% nitrous oxide decreased the DSST. When DSST scores were related to the values in the predicted central compartment, the best dose-effect relationship was found when the T(1/2) was 37 s, consistent with a regional blood flow of about 120 ml 100 g(-1) min(-1). CONCLUSIONS The onset of nitrous oxide effect on DSST is rapid, consistent with the perfusion of metabolically active cerebral cortical tissues. The rate of onset is greater than previous measures based on a motor test which involved the function of subcortical structures in the central nervous system.
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Affiliation(s)
- G B Drummond
- Department of Anaesthesia and Pain Medicine, University of Edinburgh, Royal Infirmary, 51 Little France Crescent, Edinburgh, UK.
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Saifee TA, Kassavetis P, Pareés I, Kojovic M, Fisher L, Morton L, Foong J, Price G, Joyce EM, Edwards MJ. Inpatient treatment of functional motor symptoms: a long-term follow-up study. J Neurol 2012; 259:1958-63. [DOI: 10.1007/s00415-012-6530-6] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2012] [Revised: 04/16/2012] [Accepted: 04/18/2012] [Indexed: 10/28/2022]
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Fisher L, Polonsky W, Parkin CG, Jelsovsky Z, Amstutz L, Wagner RS. The impact of blood glucose monitoring on depression and distress in insulin-naïve patients with type 2 diabetes. Curr Med Res Opin 2011; 27 Suppl 3:39-46. [PMID: 21916532 DOI: 10.1185/03007995.2011.619176] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.7] [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: 11/23/2022]
Abstract
OBJECTIVE To test whether a structured self-monitoring of blood glucose (SMBG) protocol reduces depressive symptoms and diabetes distress. RESEARCH DESIGN AND METHODS A 12-month, cluster-randomised, clinical trial compared patients who received a collaborative, structured SMBG, physician/patient intervention with an active control. Studied were 483 insulin naïve type 2 diabetes patients (experimental = 256, control = 227) (≥ 7.5% HbA1c) from 34 primary care practices (experimental = 21, control = 13). Experimental patients used a paper tool to record a 7-point SMBG profile on each of three consecutive days prior to their quarterly physician visit. Patients and physicians interpreted SMBG results to make medication and lifestyle changes. CLINICAL TRIAL REGISTRATION NIH Trial Registry Number: NCT00674986. MAIN OUTCOME MEASURES Depressive symptoms (Patient Health Questionnaire: PHQ-8), diabetes-related distress (Diabetes Distress Scale: DDS). HbA1c and SMBG frequency were assessed quarterly; data were analysed using Linear Mixed Models (LMM) for intent-to-treat (ITT) and per protocol (PP) analyses. RESULTS ITT analyses showed significant improvement in depression and disease-related distress among experimental and control patients from baseline to 12 months (p < 0.01 in both cases) with no between-group differences. Experimental patients displayed significantly greater reductions in distress related to regimen adherence than controls. Also, experimental patients with elevated diabetes distress or depressive symptoms at baseline showed significantly greater reductions in distress and depressive symptoms than control patients at 12 months. The greater improvement in mood in the experimental than control group was independent of improvements in glycaemic control and changes in SMBG frequency. CONCLUSIONS Using well standardised measures, collaborative, structured SMBG leads to reductions, not increases, in depressive symptoms and diabetes distress over time, for the large number of moderately depressed or distressed type 2 patients in poor glycaemic control. Changes in affective status are independent of improvements in glycaemic control and changes in SMBG frequency for these patients.
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Affiliation(s)
- L Fisher
- University of California, San Francisco, San Francisco, CA, USA
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Bristow K, Edwards S, Funnel E, Fisher L, Gask L, Dowrick C, Chew Graham C. Help Seeking and Access to Primary Care for People from "Hard-to-Reach" Groups with Common Mental Health Problems. Int J Family Med 2011; 2011:490634. [PMID: 22312546 PMCID: PMC3268206 DOI: 10.1155/2011/490634] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/14/2010] [Revised: 02/15/2011] [Accepted: 04/13/2011] [Indexed: 05/31/2023]
Abstract
Background. In the UK, most people with mental health problems are managed in primary care. However, many individuals in need of help are not able to access care, either because it is not available, or because the individual's interaction with care-givers deters or diverts help-seeking. Aims. To understand the experience of seeking care for distress from the perspective of potential patients from "hard-to-reach" groups. Methods. A qualitative study using semi-structured interviews, analysed using a thematic framework. Results. Access to primary care is problematic in four main areas: how distress is conceptualised by individuals, the decision to seek help, barriers to help-seeking, and navigating and negotiating services. Conclusion. There are complex reasons why people from "hard-to-reach" groups may not conceptualise their distress as a biomedical problem. In addition, there are particular barriers to accessing primary care when distress is recognised by the person and help-seeking is attempted. We suggest how primary care could be more accessible to people from "hard-to-reach" groups including the need to offer a flexible, non-biomedical response to distress.
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Affiliation(s)
- K. Bristow
- Mental Health and Wellbeing, Institute of Psychology, Health and Society, University of Liverpool, Waterhouse Building, Liverpool L69 3GL, UK
| | - S. Edwards
- Mental Health and Wellbeing, Institute of Psychology, Health and Society, University of Liverpool, Waterhouse Building, Liverpool L69 3GL, UK
| | - E. Funnel
- Mental Health and Wellbeing, Institute of Psychology, Health and Society, University of Liverpool, Waterhouse Building, Liverpool L69 3GL, UK
| | - L. Fisher
- School of Community-Based Medicine, Primary Care Research Group and National School of Primary Care Research, University of Manchester, Williamson Building, Manchester M13 9PL, UK
| | - L. Gask
- School of Community-Based Medicine, Primary Care Research Group and National School of Primary Care Research, University of Manchester, Williamson Building, Manchester M13 9PL, UK
| | - C. Dowrick
- Mental Health and Wellbeing, Institute of Psychology, Health and Society, University of Liverpool, Waterhouse Building, Liverpool L69 3GL, UK
| | - C. Chew Graham
- School of Community-Based Medicine, Primary Care Research Group and National School of Primary Care Research, University of Manchester, Williamson Building, Manchester M13 9PL, UK
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Mast O, Polonsky W, Fisher L, Jelsovsky Z, Weissmann J, Wagner R. Reduzierung von HbA1c-Wert und Teststreifenverbrauch durch strukturierte Blutzuckerselbstkontrolle bei schlecht eingestelltem, nicht mit Insulin behandeltem Typ-2-Diabetes: Ergebnisse der STeP-Studie. DIABETOL STOFFWECHS 2011. [DOI: 10.1055/s-0031-1277314] [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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Schnell O, Fisher L, Schikman C, Hinnen D, Jelsovsky Z, Schweitzer M, Amann-Zalan I, Polonsky W. Strukturierte Blutzuckerselbstkontrolle führt zu signifikanter Verbesserung der Stoffwechsellage bei schlecht eingestellten, nicht mit Insulin behandelten Patienten mit Typ-2-Diabetes: Ergebnisse der STeP-Studie. DIABETOL STOFFWECHS 2011. [DOI: 10.1055/s-0031-1277313] [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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Kulzer B, Fisher L, Polonsky W, Moritz A, Jelsovsky Z, Petersen B, Wagner R. Blutzuckerselbstkontrolle bei nicht mit Insulin behandelten Typ-2-Diabetikern verbessert das Wohlbefinden, vermindert die Depressivität und reduziert das Ausmaß diabetesspezifischer Belastungen: Ergebnisse der STeP Studie. DIABETOL STOFFWECHS 2011. [DOI: 10.1055/s-0031-1277539] [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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Abstract
AIM to examine patient beliefs, preferences and concerns regarding a once-weekly (QW) glucose-lowering medication option. METHODS a total of 1516 adults with type 2 diabetes drawn from a national Chronic Illness Panel completed an anonymous online survey that assessed perceived attributes of QW therapy, willingness to take an injectable QW medication and patient characteristics that might influence their willingness, such as current perceived glycaemic control and diabetes quality of life (DQOL). RESULTS positive attitudes regarding QW medication were common, with current injection users significantly more likely than non-injection users to view beneficial aspects: greater convenience, better medication adherence, improved quality of life (QOL) and a less overwhelming sense of treatment (in all cases, p < 0.001). In all, 46.8% reported that they would likely take an injectable QW medication if recommended by their physician, with current injection users more than twice as likely as non-injection users (73.1 vs. 31.5%; p < 0.001). Greater willingness to take QW medications was associated with poorer DQOL [injection users only; odds ratio (OR) = 1.37, p < 0.01] and poorer perceived glycaemic control (non-injection users only; OR = 1.24, p < 0.05). Concerns arose about consistency of dosage over time, potential forgetfulness and cost. CONCLUSIONS QW glucose-lowering medications are viewed positively by patients with type 2 diabetes, especially if they are current injection users or are dissatisfied with their current treatments or outcomes. Greater convenience, better medication adherence and improved QOL are commonly endorsed attributes. Clinicians may need to review both the positive attributes of QW medications as well as common patient concerns, when considering this option.
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Affiliation(s)
- W H Polonsky
- Department of Psychiatry, University of California, San Diego, CA 92014, USA.
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Abstract
This report describes studies of calcium kinetics in ten normal young men. Serum, urinary, and fecal radioactivity was measured from 1 minute to 20 days after intravenous tracer (47)Ca injection, and these results were analyzed jointly with data obtained from a simultaneous metabolic balance study, using digital computer techniques. Surface radioactivity measurements were also obtained to gain further insight into the anatomic correlates of the tracer distribution. The data were satisfied by a model with four exchanging compartments. Series, branching, and mammillary models were analyzed. Several parameters of physiologic interest were independent of the model, but two were dependent on the duration of the study. Individual and mean values for these kinetic analyses are presented with their statistical uncertainties. These studies present detailed analyses in a healthy, normal population and provide a reference for future studies of skeletal metabolism and serum calcium homeostasis.
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Affiliation(s)
- R Neer
- Metabolism Branch, National Cancer Institute, and the Mathematical Research Branch, National Institute of Arthritis and Metabolic Diseases, National Institutes of Health, Bethesda, Md
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Abstract
AIMS Diabetes distress (DD) is a condition distinct from depression that is related to diabetes outcomes. In those without distress initially, little is known about what indicators place patients at risk for subsequent distress over time. METHODS From a community-based, three-wave, 18-month study of Type 2 diabetic patients (n = 506), we identified patients with no DD at T1 who displayed DD at T2, T3 or both (n = 57). Using logistic regression with full and trimmed models, we compared them with patients with no DD at all three time points (n = 275) on three blocks of variables: patient characteristics (demographics, depression, extra-disease stress), biological (HbA(1c), body mass index, comorbidities, complications, blood pressure, non-high-density lipoprotein-cholesterol), and behavioural variables (diet, exercise). Selected interactions with stress and major depressive disorder (MDD) were explored. RESULTS The odds of becoming distressed over time were higher for being female, previously having had MDD, experiencing more negative events or more chronic stress, having more complications, and having poor diet and low exercise. Negative life events increased the negative effects of both high HbA(1c) and high complications on the emergence of distress over time. CONCLUSIONS We identified a list of significant, independent direct and interactive predictors of high DD that can be used for patient screening to identify this high-risk patient cohort. Given the impact of high DD on diabetes behavioural and biological indicators, the findings suggest the usefulness of regularly appraising both current life and disease-related stressors in clinical care.
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Affiliation(s)
- L Fisher
- Departments of Family and Community Medicine, UCSF, PO Box 0900, San Francisco, CA 94143, USA.
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Moorey S, Cort E, Kapari M, Monroe B, Hansford P, Mannix K, Henderson M, Fisher L, Hotopf M. A cluster randomized controlled trial of cognitive behaviour therapy for common mental disorders in patients with advanced cancer. Psychol Med 2009; 39:713-723. [PMID: 18761755 DOI: 10.1017/s0033291708004169] [Citation(s) in RCA: 77] [Impact Index Per Article: 5.1] [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: 01/10/2023]
Abstract
BACKGROUND Cognitive behaviour therapy (CBT) has been shown to reduce psychological morbidity in people with cancer, but no randomized controlled trial (RCT) exists in palliative care. We aimed to determine whether home care nurses could be taught to deliver basic cognitive behavioural techniques and so reduce symptoms of anxiety and depression. METHOD Clinical nurse specialists (CNSs) at St Christopher's Hospice were randomly allocated to receive training in CBT or continue their usual practice. At the end of the trial, nurses were rated on the Cognitive Therapy First Aid Rating Scale (CTFARS) for CBT competence. Home care patients who scored as possible cases on the Hospital Anxiety and Depression Scale (HADS) entered the trial. Participants received home care nursing visits. Assessments were carried out at baseline, 6, 10 and 16 weeks. RESULTS Eight nurses received CBT training and seven continued practice as usual. The mean CTFARS scores were 35.9 for the CBT nurses and 19.0 for the controls (p=0.02). A total of 328 patients (54%) were possible cases and 80 entered the trial; most of those excluded were too ill to participate. There was an interaction between group and time: individuals receiving CBT had lower anxiety scores over time [coefficient -0.20, 95% confidence interval (CI) -0.35 to -0.05, p=0.01]. No effect of the training was found for depression. CONCLUSIONS It is possible to conduct a randomized trial of psychological interventions in palliative care but there is considerable attrition from physical morbidity and mortality. Nurses can learn to integrate basic CBT methods into their clinical practice. This training may be associated with better outcomes for symptoms of anxiety.
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Affiliation(s)
- S Moorey
- South London and Maudsley NHS Foundation Trust, UK.
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