The utility of group narrative therapy to facilitate psychological adjustment in multiple sclerosis

Section A reviews and critically evaluates the empirical literature on psychosocial interventions for multiple sclerosis (MS), the determinants of adjustment to MS, and the theoretical frameworks to account for these. Further, a conceptual and empirical review of the literature on narrative therapy is provided and an argument advanced for the utility of narrative therapy in facilitating adjustment to MS. Possible areas for further research are outlined. Section B describes a feasibility study which aimed to begin to test a theoretical argument for the application of group narrative therapy to facilitate psychosocial adjustment to MS, and to ascertain the feasibility of a larger scale randomised controlled trial. Fourteen MS patients received 8 weekly sessions of group narrative therapy delivered at two sites in England. Quality of life, coping processes, and illness representations were assessed at two time points prior to the intervention and immediately after the intervention, and analysed using Wilcoxon Matched-Pairs tests. Additional qualitative measures were taken and analysed using content analysis. The feasibility of a larger scale study was, in part, assessed by means of semi-structured interviews with health professionals involved in the study, and analysed using thematic analysis. Although none of the findings reached statistical significance upon correcting for multiple comparisons, positive trends were revealed for the mental health component of quality of life, confrontive coping, and the consequences component of illness representations. With respect to the feasibility of this study, several issues pertaining to recruitment and data collection emerged from the data that can inform future research. Taken together, the results of this pilot study are promising and warrant further investigation using a sufficiently large sample. Section C provides a reflection on the skills and abilities developed and learning needs identified whilst undertaking the research. It further offers a critical reflection on the study‟s methodology and the potential implications for clinical practice. Further potential lines of enquiry are outlined

Awareness, requirements and barriers to use of Assistive Technology designed to enable independence of people suffering from Dementia (ATD)

This article is available through the Brunel Open Access Publishing Fund. Copyright @ 2012 IOS PressThis study investigated the awareness and use of assistive technology for people with dementia. The aim of the study was to explore barriers to the uptake of, and the unmet needs for, assistive technology for dementia (ATD) The work was carried out with family carers of people with dementia because carers are often the purchasers, end users and main beneficiaries of this type of technology. Focus groups were used to explore carers’ views on ATD use, and the problems that might be addressed by ATD, in order to develop a questionnaire for dementia carers. The questionnaire was administered at Alzheimer’s Society carer support groups in South Bucks and in Hillingdon Borough (UK). None of the 16 focus group participants or the 42 respondents to the questionnaire had any personal experience of ATD. The dementia carers reported a number of concerns, problems and unmet needs that could be addressed by existing, commercially available ATD products. Some needs for new technology development were identified in the study, but the lack of awareness of ATD appears to be the most important barrier to technology adoption

Transcriptional Control During Hematopoietic Development

A cell’s identity is primarily determined by the proteins it produces and therefore by the genes it expresses. During development, correct cel

Changes in symptoms and pain intensity of cancer patients after enrollment in palliative care at home

This study describes the activities and interventions carried out by an at-home palliative care team treating cancer patients who died within two years of being enrolled in a palliative care program. It analyzes which changes in symptoms and pain occurred and which sociodemographic and medical characteristics were related to these changes. The analysis is based on 102 cancer patients. Data were collected through systematic registration during the palliative care process. At enrollment, patients were interviewed by the coordinating general practitioner concerning their sociodemographic background, medical history, psychological status, and symptoms. During the palliative care process, symptoms and functioning of the patients were recorded by the physician and nurses. The results show that cancer patients enrolled in palliative care at home have many symptoms, often associated with metastatic disease and comorbidities. The palliative care teams delivered frequent and various interventions. The number of symptoms decreased considerably, as did pain intensity and the intensity of other symptoms. Patients living in urban areas and with low income particularly benefited from a reduction in the number of symptoms they displayed. Cancer patients who needed palliative care benefited significantly from this at-home palliative care service

The Peculiar Evolutionary History of IGR J17480-2446 in Terzan 5

The low mass X-ray binary (LMXB) IGR J17480-2446 in the globular cluster Terzan 5 harbors an 11 Hz accreting pulsar. This is the first object discovered in a globular cluster with a pulsar spinning at such low rate. The accreting pulsar is anomalous because its characteristics are very different from the other five known slow accreting pulsars in galactic LMXBs. Many features of the 11 Hz pulsar are instead very similar to those of accreting millisecond pulsars, spinning at frequencies >100 Hz. Understanding this anomaly is valuable because IGR J17480-2446 can be the only accreting pulsar discovered so far which is in the process of becoming an accreting millisecond pulsar. We first verify that the neutron star (NS) in IGR J17480-2446 is indeed spinning up by carefully analyzing X-ray data with coherent timing techniques that account for the presence of timing noise. We then study the present Roche lobe overflow epoch and the two previous spin-down epochs dominated by magneto dipole radiation and stellar wind accretion. We find that IGR J17480-2446 is very likely a mildly recycled pulsar and suggest that it has started a spin-up phase in an exceptionally recent time, that has lasted less than a few 10^7 yr. We also find that the total age of the binary is surprisingly low (<10^8 yr) when considering typical parameters for the newborn NS and propose different scenarios to explain this anomaly.Comment: Accepted by ApJ, in pres

Effectiveness of continence promotion for older women via community organisations: A cluster randomised trial

This is an Open Access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 3.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/3.0/Objectives: The primary objective of this cluster randomised controlled trial was to compare the effectiveness of the three experimental continence promotion interventions against a control intervention on urinary symptom improvement in older women with untreated incontinence recruited from community organisations. A second objective was to determine whether changes in incontinence-related knowledge and new uptake of risk-modifying behaviours explain these improvements. Setting: 71 community organisations across the UK. Participants: 259 women aged 60 years and older with untreated incontinence entered the trial; 88% completed the 3-month follow-up. Interventions: The three active interventions consisted of a single 60 min group workshop on (1) continence education (20 clusters, 64 women); (2) evidence-based self-management (17 clusters, 70 women); or (3) combined continence education and self-management (17 clusters, 61 women). The control intervention was a single 60 min educational group workshop on memory loss, polypharmacy and osteoporosis (17 clusters, 64 women). Primary and secondary outcome measures: The primary outcome was self-reported improvement in incontinence 3 months postintervention at the level of the individual. The secondary outcome was change in the International Consultation on Incontinence Questionnaire (ICIQ) from baseline to 3-month follow-up. Changes in incontinence-related knowledge and behaviours were also assessed. Results: The highest rate of urinary symptom improvement occurred in the combined intervention group (66% vs 11% of the control group, prevalence difference 55%, 95% CI 43% to 67%, intracluster correlation 0). 30% versus 6% of participants reported significant improvement respectively (prevalence difference 23%, 95% CI 10% to 36%, intracluster correlation 0). The number-needed-to-treat was 2 to achieve any improvement in incontinence symptoms, and 5 to attain significant improvement. Compared to controls, participants in the combined intervention reported an adjusted mean 2.05 point (95% CI 0.87 to 3.24) greater improvement on the ICIQ from baseline to 3-month follow-up. Changes in knowledge and self-reported risk-reduction behaviours paralleled rates of improvement in all intervention arms. Conclusions: Continence education combined with evidence-based self-management improves symptoms of incontinence among untreated older women. Community organisations represent an untapped vector for delivering effective continence promotion interventions.Canadian Institutes of Health Research – Institute on Aging and the Economic and Social Research Council (UK