What works for therapists conducting family meetings : Treatment integrity in family-focused grief therapy during palliative care and bereavement

- Chan, Eunice, O'Neill, Imogen, McKenzie, Maria, Love, Anthony, Kissane, David

  • Authors: Chan, Eunice , O'Neill, Imogen , McKenzie, Maria , Love, Anthony , Kissane, David
  • Date: 2004
  • Type: Text , Journal article
  • Relation: Journal of Pain and Symptom Management Vol. 27, no. 6 (2004), p. 502-512
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  • Description: The purpose of this study was to evaluate the treatment integrity of Family-focused Grief Therapy (FFGT), a preventive intervention designed for families at high risk of poor functioning during palliative care and bereavement. From the 81 families participating in a randomized controlled trial (53 assigned to therapy), 28 were randomly selected for this study of treatment fidelity using the ITGT integrity measure. A total of 109 family sessions were appraised. This represented a review of 62 % of treated families, 38 % of total therapy sessions, and 87% of the 15 participating therapists. Weighted mean percentage occurences therapist behaviors permitted trends in therapy application to be observed. Inter-rater reliability using the FFGT integrity measure was satisfactory, with 88 % overall agreement. Eighty-six percent of therapists adhered faithfully to core elements of the model. Therapist competence was evidenced by a strong therapeutic alliance (94 %), affirmation of family strengths in over 90%, and focus on agreed themes in 76 % of sessions. Therapists averaged 10 grief-related questions per session, 7 on communication-related issues during assessment, 7 on conflict late in therapy, and 4 on cohesiveness across the course of therapy. Consistent application of FFGT, with attention to its low-key themes of family communication, cohesiveness, conflict resolution, and shared grief has been demonstrated. The model is generalizable when applied by family therapists. (C) 2004 U.S. Cancer Pain Relief Committee. Published by Elsevier Inc. All rights reserved.

Impact of beta-blockers on cardiopulmonary exercise testingin patients with advanced liver disease

- Wallen, Matthew, Hall, Adrian, Dias, Katrin, Ramos, Joyce, Keating, Shelley, Woodward, Aidan, Skinner, Tina, Macdonald, Graeme, Arena, Ross, Coombes, Jeff

  • Authors: Wallen, Matthew , Hall, Adrian , Dias, Katrin , Ramos, Joyce , Keating, Shelley , Woodward, Aidan , Skinner, Tina , Macdonald, Graeme , Arena, Ross , Coombes, Jeff
  • Date: 2017
  • Type: Text , Journal article
  • Relation: Alimentary Pharmacology and Therapeutics Vol. , no. (2017), p. 1-7
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  • Description: Summary Background: Patients with advanced liver disease may develop portal hypertensionthat can result in variceal haemorrhage. Beta-blockers reduce portal pressure andminimise haemorrhage risk. These medications may attenuate measures of car-diopulmonary performance, such as the ventilatory threshold and peak oxygenuptake measured via cardiopulmonary exercise testing. Aim: To determine the effect of beta-blockers on cardiopulmonary exercise testingvariables in patients with advanced liver disease. Methods: This was a cross-sectional analysis of 72 participants who completed acardiopulmonary exercise test before liver transplantation. All participants remainedon their usual beta-blocker dose and timing prior to the test. Variables measuredduring cardiopulmonary exercise testing included the ventilatory threshold, peakoxygen uptake, heart rate, oxygen pulse, the oxygen uptake efficiency slope and theventilatory equivalents for carbon dioxide slope. Results: Participants taking beta-blockers (n = 28) had a lower ventilatory threshold(P <.01) and peak oxygen uptake (P = .02), compared to participants not takingbeta-blockers. After adjusting for age, the model of end-stage liver-disease score,liver-disease aetiology, presence of refractory ascites and ventilatory thresholdremained significantly lower in the beta-blocker group (P = .04). The oxygen uptakeefficiency slope was not impacted by beta-blocker use. Conclusions: Ventilatory threshold is reduced in patients with advanced liver dis-ease taking beta-blockers compared to those not taking the medication. This mayincorrectly risk stratify patients on beta-blockers and has implications for patientmanagement before and after liver transplantation. The oxygen uptake efficiencyslope was not influenced by beta-blockers and may therefore be a better measureof cardiopulmonary performance in this patient population.

Sustained activation of microglia in the hypothalamic PVN following myocardial infarction

- Dworak, Melissa, Stebbing, Martin, Kompa, Andrew, Rana, Indrajeetsinh, Krum, Henry, Badoer, Emilio

  • Authors: Dworak, Melissa , Stebbing, Martin , Kompa, Andrew , Rana, Indrajeetsinh , Krum, Henry , Badoer, Emilio
  • Date: 2012
  • Type: Text , Journal article
  • Relation: Autonomic Neuroscience Vol. 169, no. 2 (August 2012 2012), p. 70-76
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  • Description: Microglia are the immune cells in the central nervous system and can produce cytokines when they are activated by an insult or injury. In the present study, we investigated in detail the time frame of the activation of microglia in the hypothalamic paraventricular nucleus (PVN) following myocardial infarction in rats. Morphological changes and immunohistochemistry to detect CD11b (clone OX-42) were used to identify activated microglia. Compared to rats that had undergone sham surgical procedures, there was a significant increase of between 40 and 50% in the proportion of activated microglia in the PVN 4–16 weeks following myocardial infarction (P < 0.001, One way ANOVA). At 24 h or 1 week post myocardial infarction, however, there was no significant increase in the proportion of activated microglia. Echocardiography and haemodynamic parameters after myocardial infarction indicated significantly reduced left ventricular function. In conclusion, following myocardial infarction, activation of microglia in the PVN does not occur immediately but once manifested, activation is sustained. Thus, activated microglia may contribute to the chronic elevation in cytokine levels observed following myocardial infarction. Since cytokines elicit sympatho-excitatory effects when locally microinjected into the PVN, activated microglia may contribute to the mechanisms mediating the chronic increase in sympathetic nerve activity in animals with reduced left ventricular function induced following myocardial infarction.
  • Description: C1
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