Meaning-centered group psychotherapy: Live with sense. A pilot study

Introducción: Los pacientes con cáncer avanzado expresan sentimientos de desesperanza, deseo de adelantar la muerte, y niveles elevados de ansiedad y sintomatología depresiva asociada a la pérdida de sentido de vida. Objetivos: El principal objetivo de la Psicoterapia de Grupo Centrada en el Sentido (PGCS) es ayudar a los pacientes con cáncer a vivir con sentido, de una manera plena, manteniendo y ampliando el sentido de su vida, viviendo en paz y con un objetivo en la vida. Participantes y Método: Actualmente, estamos realizando el estudio piloto, como primer paso del proyecto de validación del Modelo de Psicoterapia Centrada en el Sentido. Hemos realizado dos de los tres grupos de pacientes con cáncer avanzado que corresponde al presente estudio piloto, y estamos realizando las trascripción de cada una de la sesiones de los grupos, para su posterior análisis cualitativo. Resultados: Los grupos de psicoterapia centrada en el sentido muestran una reducción de la sintomatología ansiosa y depresiva, desesperanza y deseo de adelantar la muerte en pacientes con cáncer avanzado, a la vez de aumentar el bienestar espiritual y la sensación de sentido.Introduction: The patients with advanced cancer express feelings of hopelessness, wish to advance the death, and high levels of anxiety and depression associated to the loss of sense of life. Aims: The main aim of the Meaning-Centered Group Psychotherapy is to help to the patients with cancer to live with sense, of a full way, keeping and expanding the sense of his life, living in peace and with an aim in the life. Participants and Method: At present, we are conducting the pilot study, as first step of the project of validation of the Meaning-Centered Group Psychotherapy Model. We have performance two of the three groups of patients with advanced cancer that corresponds to the present pilot study, and are doing the transcription of each one of the sessions of the groups, for his back qualitative analysis. Results: The Meaning-Centered Group Psychotherapy show a reduction of anxiety and depression, hopelessness and wish to advance the death in patients with advanced cancer, at the same time to increase the spiritual welfare and the feeling of sense

Psicoterapia centrada en el sentido: “vivir con sentido”. Estudio piloto

Introducción: Los pacientes con cáncer avanzado expresan sentimientos de desesperanza, deseo de adelantar la muerte, y niveles elevados de ansiedad y sintomatología depresiva asociada a la pérdida de sentido de vida. Objetivos: El principal objetivo de la Psicoterapia de Grupo Centrada en el Sentido (PGCS) es ayudar a los pacientes con cáncer a vivir con sentido, de una manera plena, manteniendo y ampliando el sentido de su vida, viviendo en paz y con un objetivo en la vida. Participantes y Método: Actualmente, estamos realizando el estudio piloto, como primer paso del proyecto de validación del Modelo de Psicoterapia Centrada en el Sentido. Hemos realizado dos de los tres grupos de pacientes con cáncer avanzado que corresponde al presente estudio piloto, y estamos realizando las trascripción de cada una de la sesiones de los grupos, para su posterior análisis cualitativo. Resultados: Los grupos de psicoterapia centrada en el sentido muestran una reducción de la sintomatología ansiosa y depresiva, desesperanza y deseo de adelantar la muerte en pacientes con cáncer avanzado, a la vez de aumentar el bienestar espiritual y la sensación de sentido

Meaning of work and personal protective factors among palliative care professionals

Objective.—Healthcare professionals who work in palliative care units face stressful life events on a daily basis, most notably death. For this reason, these professionals must be equipped with the necessary protective resources to help them cope with professional and personal burnout. Despite the well-recognized importance of the construct “meaning of work,” the role of this construct and its relationship with other variables is not well-understood. Our objective is to develop and evaluate a model that examines the mediating role of the meaning of work in a multidisciplinary group of palliative care professionals. Using this model, we sought to assess the relationships between meaning of work, perceived stress, personal protective factors (optimism, self-esteem, life satisfaction, personal growth, subjective vitality), and sociodemographic variables. Method.—Professionals (n = 189) from a wide range of disciplines (physicians, psychologists, nurses, social workers, nursing assistants, physical therapists, and chaplains) working in palliative care units at hospitals in Madrid and the Balearic Islands were recruited. Sociodemographic variables were collected and recorded. The following questionnaires were administered: Meaning of Work Questionnaire, Perceived Stress Questionnaire, Life Orientation Test-Revised, Satisfaction with Life Scale, Subjective Vitality Scale, Rosenberg Self-Esteem Scale, and the Personal Growth Scale. Result.—The explanatory value of the model was high, explaining 49.5% of the variance of life satisfaction, 43% of subjective vitality, and 36% of personal growth. The main findings of this study were as follow: (1) meaning of work and perceived stress were negatively correlated; (2) optimism and self-esteem mediated the effect of stress on the meaning attached to work among palliative care professionals; (3) the meaning of work mediated the effect of stress on subjective vitality, personal growth, and life satisfaction; and (4) vitality and personal growth directly influenced life satisfaction. Significance of results.—The proposed model showed a high explanatory value for the meaning professionals give to their work and also for perceived stress, personal protective factors, and sociodemographic variables. Our findings could have highly relevant practical implications for designing programs to promote the psychological well-being of healthcare professionals

Meaning-centered group psychotherapy in Portuguese cancer patients: A pilot exploratory trial

Spiritual well-being and a sense of meaning are important influences for quality of life (QoL) in patients with advanced cancer (Field and Cassel, 1997; Sinclair et al., 2006). The importance of the existential care lead to the emergence of meaning-focused interventions (Breitbart, 2002; Chochinov et al., 2005; Puchalski, 2013) in advanced cancer patients or terminally ill (Yalom and Greaves, 1977; Spiegel et al., 1981; Edelman et al., 1999; Edmonds et al., 1999; Classen et al., 2001; Kissane et al., 2003, 2007; Lee et al., 2006; Breitbart et al., 2010; Chochinov et al., 2011). In response to this need, Breitbart and his investigation group developed meaning-centered psychotherapy (MCP) to help patients with advanced cancer sustain or enhance a sense of meaning and purpose in their lives, even as they approach the end of life (Breitbart, 2000, 2002; Greenstein and Breitbart, 2000; Breitbart et al., 2010, 2015; Van der Spek et al., 2013; Applebaum et al., 2015). MCP was first developed in a group format (meaning-centered group psychotherapy — MCGP), which is a manualized eight-week intervention (each session: 1.5 h) that utilizes a combination of didactics, experiential exercises and discussion (Breitbart, 2002). The first randomized control trial (RCT) showed benefits in enhancing spiritual well-being and a sense of meaning (Breitbart et al., 2010). Further studies suggested that more severe forms of despair respond better to existential interventions (Breitbart et al., 2015).P30 CA008748info:eu-repo/semantics/publishedVersio

Cost-utility analysis of meaning-centered group psychotherapy for cancer survivors

Background: Meaning-centered group psychotherapy for cancer survivors (MCGP-CS) improves meaning, psychological well-being, and mental adjustment to cancer and reduces psychological distress. This randomized controlled trial was conducted to investigate the cost-utility of MCGP-CS compared with supportive group psychotherapy (SGP) and care-as-usual (CAU). Methods: In total, 170 patients were randomized to MCGP-CS, SGP, or CAU. Intervention costs, direct medical and nonmedical costs, productivity losses, and health-related quality of life were measured until 6 months follow-up, using the TIC-P, PRODISQ, data from the hospital information system, and the EQ-5D. The cost-utility was calculated by comparing mean cumulative costs and quality-adjusted life years (QALYs). Results: Mean total costs ranged from €4492 (MCGP-CS) to €5304 (CAU). Mean QALYs ranged.507 (CAU) to.540 (MCGP-CS). MCGP-CS had a probability of 74% to be both less costly and more effective than CAU, and 49% compared with SGP. Sensitivity analyses showed these findings are robust. If society is willing to pay €0 for one gained QALY, MCGP-CS has a 78% probability of being cost-effective compared with CAU. This increases to 85% and 92% at willingness-to-pay thresholds of €10 000 and €30 000, which are commonly accepted thresholds. Conclusions: MCGP-CS is highly likely a cost-effective intervention, meaning that there is a positive balance between the costs and gains of MCGP-CS, in comparison with SGP and CAU

An International Consensus Definition of the Wish to Hasten Death and Its Related Factors

Background: The desire for hastened death or wish to hasten death (WTHD) that is experienced by some patients with advanced illness is a complex phenomenon for which no widely accepted definition exists. This lack of a common conceptualization hinders understanding and cooperation between clinicians and researchers. The aim of this study was to develop an internationally agreed definition of the WTHD. Methods: Following an exhaustive literature review, a modified nominal group process and an international, modified Delphi process were carried out. The nominal group served to produce a preliminary definition that was then subjected to a Delphi process in which 24 experts from 19 institutions from Europe, Canada and the USA participated. Delphi responses and comments were analysed using a pre-established strategy. Findings: All 24 experts completed the three rounds of the Delphi process, and all the proposed statements achieved at least 79% agreement. Key concepts in the final definition include the WTHD as a reaction to suffering, the fact that such a wish is not always expressed spontaneously, and the need to distinguish the WTHD from the acceptance of impending death or from a wish to die naturally, although preferably soon. The proposed definition also makes reference to possible factors related to the WTHD. Conclusions: This international consensus definition of the WTHD should make it easier for clinicians and researchers to share their knowledge. This would foster an improved understanding of the phenomenon and help in developing strategies for early therapeutic intervention

Germ Warfare in a Microbial Mat Community: CRISPRs Provide Insights into the Co-Evolution of Host and Viral Genomes

CRISPR arrays and associated cas genes are widespread in bacteria and archaea and confer acquired resistance to viruses. To examine viral immunity in the context of naturally evolving microbial populations we analyzed genomic data from two thermophilic Synechococcus isolates (Syn OS-A and Syn OS-B′) as well as a prokaryotic metagenome and viral metagenome derived from microbial mats in hotsprings at Yellowstone National Park. Two distinct CRISPR types, distinguished by the repeat sequence, are found in both the Syn OS-A and Syn OS-B′ genomes. The genome of Syn OS-A contains a third CRISPR type with a distinct repeat sequence, which is not found in Syn OS-B′, but appears to be shared with other microorganisms that inhabit the mat. The CRISPR repeats identified in the microbial metagenome are highly conserved, while the spacer sequences (hereafter referred to as “viritopes” to emphasize their critical role in viral immunity) were mostly unique and had no high identity matches when searched against GenBank. Searching the viritopes against the viral metagenome, however, yielded several matches with high similarity some of which were within a gene identified as a likely viral lysozyme/lysin protein. Analysis of viral metagenome sequences corresponding to this lysozyme/lysin protein revealed several mutations all of which translate into silent or conservative mutations which are unlikely to affect protein function, but may help the virus evade the host CRISPR resistance mechanism. These results demonstrate the varied challenges presented by a natural virus population, and support the notion that the CRISPR/viritope system must be able to adapt quickly to provide host immunity. The ability of metagenomics to track population-level variation in viritope sequences allows for a culture-independent method for evaluating the fast co-evolution of host and viral genomes and its consequence on the structuring of complex microbial communities

The Two-Domain LysX Protein of Mycobacterium tuberculosis Is Required for Production of Lysinylated Phosphatidylglycerol and Resistance to Cationic Antimicrobial Peptides

The well-recognized phospholipids (PLs) of Mycobacterium tuberculosis (Mtb) include several acidic species such as phosphatidylglycerol (PG), cardiolipin, phosphatidylinositol and its mannoside derivatives, in addition to a single basic species, phosphatidylethanolamine. Here we demonstrate that an additional basic PL, lysinylated PG (L-PG), is a component of the PLs of Mtb H37Rv and that the lysX gene encoding the two-domain lysyl-transferase (mprF)-lysyl-tRNA synthetase (lysU) protein is responsible for L-PG production. The Mtb lysX mutant is sensitive to cationic antibiotics and peptides, shows increased association with lysosome-associated membrane protein–positive vesicles, and it exhibits altered membrane potential compared to wild type. A lysX complementing strain expressing the intact lysX gene, but not one expressing mprF alone, restored the production of L-PG and rescued the lysX mutant phenotypes, indicating that the expression of both proteins is required for LysX function. The lysX mutant also showed defective growth in mouse and guinea pig lungs and showed reduced pathology relative to wild type, indicating that LysX activity is required for full virulence. Together, our results suggest that LysX-mediated production of L-PG is necessary for the maintenance of optimal membrane integrity and for survival of the pathogen upon infection

Cell‐ and Gene‐Based Therapeutic Strategies for Periodontal Regenerative Medicine

Peer Reviewedhttps://deepblue.lib.umich.edu/bitstream/2027.42/142086/1/jper1223.pd

An International Consensus Definition of the Wish to Hasten Death and Its Related Factors

Abstract Backgroun