Protocol for the saMS trial (supportive adjustment for multiple sclerosis): a randomized controlled trial comparing cognitive behavioral therapy to supportive listening for adjustment to multiple sclerosis

BackgroundMultiple Sclerosis (MS) is an incurable, chronic, potentially progressive and unpredictable disease of the central nervous system. The disease produces a range of unpleasant and debilitating symptoms, which can have a profound impact including disrupting activities of daily living, employment, income, relationships, social and leisure activities, and life goals. Adjusting to the illness is therefore particularly challenging. This trial tests the effectiveness of a cognitive behavioural intervention compared to supportive listening to assist adjustment in the early stages of MS.MethodsThis is a two arm randomized multi-centre parallel group controlled trial. 122 consenting participants who meet eligibility criteria will be randomly allocated to receive either Cognitive Behavioral Therapy or Supportive Listening. Eight one hour sessions of therapy (delivered over a period of 10 weeks) will be delivered by general nurses trained in both treatments. Self-report questionnaire data will be collected at baseline (0 weeks), mid-therapy (week 5 of therapy), post-therapy (15 weeks) and at six months (26 weeks) and twelve months (52 weeks) follow-up. Primary outcomes are distress and MS-related social and role impairment at twelve month follow-up. Analysis will also consider predictors and mechanisms of change during therapy. In-depth interviews to examine participants’ experiences of the interventions will be conducted with a purposively sampled sub-set of the trial participants. An economic analysis will also take place. DiscussionThis trial is distinctive in its aims in that it aids adjustment to MS in a broad sense. It is not a treatment specifically for depression. Use of nurses as therapists makes the interventions potentially viable in terms of being rolled out in the NHS. The trial benefits from incorporating patient input in the development and evaluation stages. The trial will provide important information about the efficacy, cost-effectiveness and acceptability of the interventions as well as mechanisms of psychosocial adjustment.Trial registrationCurrent Controlled Trials ISRCTN91377356<br/

What are the roles involved in establishing and maintaining informational continuity of care within family practice? A systematic review

<p>Abstract</p> <p>Background</p> <p>Central to establishing continuity of care is the development of a relationship between doctor and patient/caregiver. Transfer of information between these parties facilitates the development of continuity in general; and specifically informational continuity of care. We conducted a systematic review of published literature to gain a better understanding of the roles that different parties – specifically doctors, patients, family caregivers, and technology – play in establishing and maintaining informational continuity of care within family practice.</p> <p>Methods</p> <p>Relevant published articles were sought from five databases. Accepted articles were reviewed and appraised in a consistent way. Fifty-six articles were retained following title and abstract reviews. Of these, 28 were accepted for this review.</p> <p>Results</p> <p>No articles focused explicitly on the roles involved in establishing or maintaining informational continuity of care within family practice. Most informational continuity of care literature focused on the transfer of information between settings and not at the first point of contact. Numerous roles were, however, were interpreted using the data extracted from reviewed articles. Doctors are responsible for record keeping, knowing patients' histories, recalling accumulated knowledge, and maintaining confidentiality. Patients are responsible for disclosing personal and health details, transferring information to other practitioners (including new family doctors), and establishing trust. Both are responsible for developing a relationship of trust. Technology is an important tool of informational continuity of care through holding important information, providing search functions, and providing a space for recorded information. There is a significant gap in our knowledge about the roles that family caregivers play.</p> <p>Conclusion</p> <p>The number of roles identified and the interrelationships between them indicates that establishing and maintaining informational continuity of care within family practice is a complex and multifaceted process. This synthesis of roles provided serves as an important resource for continuity of care researchers in general, for the development of continuity of care quality indicators, and for the practice of family medicine.</p

Attention processes in chronic fatigue syndrome : health-threat related attentional biases and the role of attentional control

Attentional bias is a psychological mechanism that has been extensively explored within the anxiety literature and more recently in chronic illnesses, such as chronic pain and chronic fatigue syndrome (CFS). The literature review explores research into attentional bias to pain-related information in chronic pain, with a particular focus on whether an attentional bias in chronic pain exists. The findings suggest an attentional bias to sensory pain-related stimuli, particularly in people with fear avoidance. These findings are explored in relation to theoretical models of chronic pain. The review stresses that further research into factors that might impact upon the consistency of findings is vital to further the understanding of attentional bias in chronic pain. Cognitive behavioural models of CFS and chronic pain suggest there is some overlap in the mechanisms of these chronic conditions. This study investigates whether individuals with CFS (n = 27), compared to a control group (n = 35), possess an attentional bias to health-threat words and pictures, across two exposure durations (500ms and 1250ms) and whether this attentional bias is related to poor executive control. Participants completed a visual probe task and Attention Network Test (ANT). Results suggested that CFS participants with poor executive control showed an attentional bias to word stimuli regardless of exposure duration when compared to controls and CFS participants with good executive attention. These findings suggest that attentional biases are dependent on, or moderated by, an individual's capacity to voluntarily control their attention. Clinical implications are discussed and suggestions made for future research.EThOS - Electronic Theses Online ServiceGBUnited Kingdo

Attention processes in chronic fatigue syndrome : health-threat related attentional biases and the role of attentional control

Attentional bias is a psychological mechanism that has been extensively explored within the anxiety literature and more recently in chronic illnesses, such as chronic pain and chronic fatigue syndrome (CFS). The literature review explores research into attentional bias to pain-related information in chronic pain, with a particular focus on whether an attentional bias in chronic pain exists. The findings suggest an attentional bias to sensory pain-related stimuli, particularly in people with fear avoidance. These findings are explored in relation to theoretical models of chronic pain. The review stresses that further research into factors that might impact upon the consistency of findings is vital to further the understanding of attentional bias in chronic pain. Cognitive behavioural models of CFS and chronic pain suggest there is some overlap in the mechanisms of these chronic conditions. This study investigates whether individuals with CFS (n = 27), compared to a control group (n = 35), possess an attentional bias to health-threat words and pictures, across two exposure durations (500ms and 1250ms) and whether this attentional bias is related to poor executive control. Participants completed a visual probe task and Attention Network Test (ANT). Results suggested that CFS participants with poor executive control showed an attentional bias to word stimuli regardless of exposure duration when compared to controls and CFS participants with good executive attention. These findings suggest that attentional biases are dependent on, or moderated by, an individual's capacity to voluntarily control their attention. Clinical implications are discussed and suggestions made for future research.EThOS - Electronic Theses Online ServiceGBUnited Kingdo