Memory in depression

The memory of clinically depressed psychiatric patients was compared with that of anxious patients and control subjects. The depressed patients had impaired ability to learn new material and to remember past public events; they retained information in memory as well as controls and did not have a more conservative response bias. These impairments were not attributable to the psychotropic medication the patients were receiving or to the after-effects of ECT. The retarded depressed patients were most severely ill and most impaired; the neurotic patients were only impaired on the more difficult tests. The anxious patients' scores were not significantly different from those of either the depressed or control subjects. The relative effects of depression and anxiety on performance were assessed using regression analysis; depression was related to performance on the easier tests, whilst something common to both depression and anxiety was related to performance on the more difficult tests. The retarded depressed subjects reported more cognitive failures than the other subjects whilst both the depressed and anxious subjects complained of significant deterioration in memory. There were statistically significant, although modest, correlations between these self-assessments of memory and performance on the memory tests. Anxiety was related to self-assessments of memory but depression was not. The memory of depressed general practice patients for information given to them by their general practitioners was investigated directly; they did not in fact have impaired memories in this everyday situation. These results suggest that the degree of memory impairment shown in depression depends both on the severity of depression and the difficulty of the task. They are discussed In the light of the suggestion by Johnson and Magaro (1987) that memory Impairments may not be specific to depression but instead be related to the overall level of psychopathology. The working memory capacity model of memory in anxiety (Eysenck, 1982) is also discussed and extended to depression, as is a model developed by Williams and Teasdale (1982) which argues that effort expenditure is largely determined by perceived task difficulty. Finally, it is concluded that the best understanding of memory in depression will come from the concurrent use of experimental studies, metamemory questionnaires and studies of memory performance in everyday life

Life on the list: an exploratory study of the life world of individuals waiting for a kidney transplant

Kidney transplantation is the treatment of choice for many individuals with end stage renal disease (ESRD), as transplantation is reported to offer a greater quality of life than renal dialysis. At the end of March 2008 there were 6980 people on the active transplant list for kidney or kidney and pancreas transplants. However, during the previous year a total of 1453 deceased donor kidney transplants were carried out1, illustrating the mismatch between demand for and availability of kidneys for transplant. Whilst the Government has pledged to improve transplant services and to address the organ shortage, individuals on the kidney transplant list are currently facing an average wait of more than two years. Individuals waiting for a kidney transplant face complex challenges, which are currently poorly researched. An insight into the experience of waiting for a kidney transplant and how individuals interpret that wait could contribute to clinical knowledge and lead to improved support for these individuals. It could also raise public awareness about the issues involved in waiting for a kidney transplant, potentially encouraging donatio

Participant recruitment in sensitive surveys: a comparative trial of ‘opt in’ versus ‘opt out’ approaches

BACKGROUND: Although in health services survey research we strive for a high response rate, this must be balanced against the need to recruit participants ethically and considerately, particularly in surveys with a sensitive nature. In survey research there are no established recommendations to guide recruitment approach and an ‘opt-in’ system that requires potential participants to request a copy of the questionnaire by returning a reply slip is frequently adopted. However, in observational research the risk to participants is lower than in clinical research and so some surveys have used an ‘opt-out’ system. The effect of this approach on response and distress is unknown. We sought to investigate this in a survey of end of life care completed by bereaved relatives. METHODS: Out of a sample of 1422 bereaved relatives we assigned potential participants to one of two study groups: an ‘opt in’ group (n=711) where a letter of invitation was issued with a reply slip to request a copy of the questionnaire; or an ‘opt out’ group (n=711) where the survey questionnaire was provided alongside the invitation letter. We assessed response and distress between groups. RESULTS: From a sample of 1422, 473 participants returned questionnaires. Response was higher in the ‘opt out’ group than in the ‘opt in’ group (40% compared to 26.4%: χ(2) =29.79, p-value<.01), there were no differences in distress or complaints about the survey between groups, and assignment to the ‘opt out’ group was an independent predictor of response (OR=1.84, 95% CI: 1.45-2.34). Moreover, the ‘opt in’ group were more likely to decline to participate (χ(2)=28.60, p-value<.01) and there was a difference in the pattern of questionnaire responses between study groups. CONCLUSION: Given that the ‘opt out’ method of recruitment is associated with a higher response than the ‘opt in’ method, seems to have no impact on complaints or distress about the survey, and there are differences in the patterns of responses between groups, the ‘opt out’ method could be recommended as the most efficient way to recruit into surveys, even in those with a sensitive nature

The Cancer Experiences Collaborative (CECo) UK for the development of research capacity in supportive and palliative care: Narratives of cancer and life-limiting illness

Background The Cancer Experiences Collaborative (CECo) began in 2006 as a five year funded programme. It is a partnership between five UK universities to develop research capacity in supportive and palliative care. The narrative theme is independent and interdependent with two other themes: ‘older adults’ and ‘complex symptoms’. Narratives have much to teach us about living with life-limiting illness and experiences of care. Research designed to capture and explore narratives can inform changes to improve practice and policy.Aims 1) To promote the study of narratives to increase understanding of patient and carer experiences in life-limiting illness; 2) To assess how narrative analysis can be used for service improvement and practice development; 3) To build research skills and capacity in the use of narrative research; 4) To engage with researchers, clinicians and service users to develop innovative narrative research protocolsMethods Three approaches are being taken to build research capacity: i) tri-annual protocol development events bringing together researchers, clinicians, and service users to build methodological skills, develop research protocols and seek funding ii) annual ‘State of the Science’ meetings focusing on developing new initiatives and knowledge in narrative research iii) construction of web-based research resources and communication network.Outcomes A collaborative interdisciplinary research programme using a range of innovative narrative research methods which aim to build and sustain research excellence in palliative and supportive care

A cohort study of the recovery of health and wellbeing following colorectal cancer (CREW study): protocol paper

Background: the number of people surviving colorectal cancer has doubled in recent years. While much of the literature suggests that most people return to near pre-diagnosis status following surgery for colorectal cancer, this literature has largely focused on physical side effects. Longitudinal studies in colorectal cancer have either been small scale or taken a narrow focus on recovery after surgery. There is a need for a comprehensive, long-term study exploring all aspects of health and wellbeing in colorectal cancer patients. The aim of this study is to establish the natural history of health and wellbeing in people who have been treated for colorectal cancer. People have different dispositions, supports and resources, likely resulting in individual differences in restoration of health and wellbeing. The protocol described in this paper is of a study which will identify who is most at risk of problems, assess how quickly people return to a state of subjective health and wellbeing, and will measure factors which influence the course of recovery. Methods: this is a prospective, longitudinal cohort study following 1000 people with colorectal cancer over a period of two years, recruiting from 30 NHS cancer treatment centres across the UK. Questionnaires will be administered prior to surgery, and 3, 9, 15 and 24 months after surgery, with the potential to return to this cohort to explore on-going issues related to recovery after cancer. Discussion: outcomes will help inform health care providers about what helps or hinders rapid and effective recovery from cancer, and identify areas for intervention development to aid this process. Once established the cohort can be followed up for longer periods and be approached to participate in related projects as appropriate and subject to funding<br/

Home death for children dying in six European countries

Aim: Guidelines on pediatric palliative care underline that care at the end of life of chronically ill children should preferably be provided in the child’s home situation. Till present, no European data at population level are available for place of death of children. The aim of this study was to compare proportions of home death for children in six European countries and investigate relation between place of death and sociodemographic and clinical factors. Method: Data were collected from death certificates of all deceased children aged 1-17 in Belgium (BE), the Netherlands (NL), Norway (NO), England (E), Wales (W) (2003) and Italy (IT) (2002). Gender, cause (cancer, natural non-cancer and external) and place of death (home vs. outside home) and sociodemographic factors (socio-economic status (SES), degree of urbanization and number of hospital beds in the area) were included in the analyses. Data were analyzed using frequencies and multivariate logistic regression. Results: A total of 3.187 deaths were included in the analyses, 534 (16,8%) died from cancer. The proportion of home deaths was 19,6% (IT), 20,5% (E), 20,6% (W), 21,0% (NO), 23,8% (BE) and 28,6% (NL). Home death was more likely for children dying from cancer in BE, NL, E and W, for children with high SES in BE, in areas with low number of hospital beds in IT, and for boys in NL. Conclusion: The proportion of home deaths for children differs between studied countries. In most, but not all, countries children dying from cancer had better odds of dying at home than those not dying from cancer. Although acknowledging the influence of culture in the differences, studying care provisions in countries with higher proportions of home deaths, particularly in chronically ill children, can be helpful to identify factors facilitating terminally ill children to die at home. Early involvement of palliative care and equal access to these services can be important in this context. Funding: IWT-Flanders

Abnormal P300 in people with high risk of developing psychosis

Background Individuals with an “at-risk mental state” (or “prodromal” symptoms) have a 20–40% chance of developing psychosis; however it is difficult to predict which of them will become ill on the basis of their clinical symptoms alone. We examined whether neurophysiological markers could help to identify those who are particularly vulnerable. Method 35 cases meeting PACE criteria for the at-risk mental state (ARMS) and 57 controls performed an auditory oddball task whilst their electroencephalogram was recorded. The latency and amplitude of the P300 and N100 waves were compared between groups using linear regression. Results The P300 amplitude was significantly reduced in the ARMS group [8.6 ± 6.4 microvolt] compared to controls [12.7 ± 5.8 microvolt] (p < 0.01). There were no group differences in P300 latency or in the amplitude and latency of the N100. Of the at-risk subjects that were followed up, seven (21%) developed psychosis. Conclusion Reduction in the amplitude of the P300 is associated with an increased vulnerability to psychosis. Neurophysiological and other biological markers may be of use to predict clinical outcomes in populations at high risk