COPD education and cognitive behavioral therapy group treatment for clinically significant symptoms of depression and anxiety in COPD patients: a randomized controlled trial.

BACKGROUND: Chronic obstructive pulmonary disease (COPD) affects 14 to 20 million Americans and is associated with increased prevalence of affective disorders, contributing significantly to disability. This study compared cognitive behavioral therapy (CBT) group treatment for anxiety and depression with COPD education for COPD patients with moderate-to-severe anxiety and/or depressive symptoms. METHOD: A randomized controlled trial (RCT) was conducted between 11 July 2002 and 30 April 2005 at the Michael E. DeBakey VA Medical Center, Houston, TX. Participants were 238 patients treated for COPD the year before, with forced expiratory value in 1 second (FEV)1/forced vital capacity (FVC)<70% and FEV1<70% predicted, and symptoms of moderate anxiety and/or moderate depression, who were being treated by a primary care provider or pulmonologist. Participants attended eight sessions of CBT or COPD education. Assessments were at baseline, at 4 and 8 weeks, and 4, 8 and 12 months. Primary outcomes were disease-specific and generic quality of life (QoL) [Chronic Respiratory Questionnaire (CRQ) and Medical Outcomes Survey Short Form-36 (SF-36) respectively]. Secondary outcomes were anxiety [Beck Anxiety Inventory (BAI)], depressive symptoms [Beck Depression Inventory-II (BDI-II)], 6-minute walk distance (6MWD) and use of health services. RESULTS: Both treatments significantly improved QoL, anxiety and depression (p<0.005) over 8 weeks; the rate of change did not differ between groups. Improvements were maintained with no significant change during follow-up. Ratios of post- to pretreatment use of health services were equal to 1 for both groups. CONCLUSIONS: CBT group treatment and COPD education can achieve sustainable improvements in QoL for COPD patients experiencing moderate-to-severe symptoms of depression or anxiety.

Roe v. Wade. One step in the right direction.

PIP: In this commentary, the Executive Director of the Religious Coalition for Reproductive Choice, who is also a Baptist minister, notes that he has long been involved in supporting women as they made reproductive health decisions, including abortion, but only officially joined the pro-choice movement on becoming Director of the Coalition. Like many Black ministers, he became a social activist during the Civil Rights movement and has seen his life affected by many Supreme Court decisions. While his attitude towards abortion has remained the same since the Roe decision, he is increasingly committed to opening a dialogue in the religious community about all issues of sexuality and reproductive health. He is concerned that young adults may not be cognizant of the sacrifices made by previous generations to ensure protection of gains made in civil rights, reproductive rights, and women's rights. The pro-choice movement is beginning to be relevant to larger numbers of people through its education and legislative efforts, and such education is essential to avoid a repeat of the tragedies of the past.^ieng

Impaired motor skill learning in schizophrenia: implications for corticostriatal dysfunction.

We assessed skill learning in young and older schizophrenic patients using the rotary pursuit task. Schizophrenic patients displayed impaired learning on this task compared with normal control subjects, but older patients were not more impaired than young ones. The patients' rotary pursuit learning was not correlated to the severity of abnormal movements or to their treatment with medication, but it was associated to conceptual abilities assessed on the Dementia Rating Scale (Mattis 1988). An impairment in acquiring motor procedures in this task might reflect neuropsychological deficits associated with corticostriatal pathology.

Revascularization for severe limb ischemia.

Patients with rest pain or tissue necrosis (generally correlated with a tibial-brachial pressure index of less than 0.25) have a high probability of limb loss unless revascularization is done. These problems are usually associated with extensive and multiple segments of anatomical occlusive disease. A review of 359 patients with such problems indicates that revascularization was done in 86%, with initial success in 92% of patients. The durability of successful limb preservation proved good, with 90% of patients having a comfortable, useful limb to time of death or for one year or longer after operation. Cumulative patency rates were 90% at five years for aortofemoral reconstructions, 70% at five years for femoropopliteal bypasses, and 49% at five years for femorotibial grafts. Cumulative limb salvage rates were 93%, 81%, and 67% at five years in the same categories, respectively.

Preoperative aortography before abdominal aortic aneurysmectomy?

A review of 100 consecutive patients undergoing abdominal aortic aneurysmectomy was made to assess the value and necessity of preoperative aortography. Comparison of arteriography with physical examination, plain roentgenograms and ultrasonography suggests that angiography is required only for evaluation of specific problems. Indications for the selective use of preoperative aortography are proposed.

Primary hyperparathyroidism in a referral hospital.

A series of 46 patients had a tissue diagnosis of primary hyperparthyrodism. Forty (88%) had a single adenoma, one had multiple adenomas; four exhibited parathyroid hyperplasia and one had carcinoma of the parathyroid. The incidence establishing the diagnosis has increased in recent years because of routine multichemistry screening for calcium. The most reliable "diagnostic" laboratory finding was an elevated serum calcium: 96 per cent of our patients had serum calcium above the upper limit of normal. Forty-one patients had lesions removed; parathyroid carcinoma (1), hyperplasia (3), and adenomas (37). Only two patients have presistent disease postoperatively: one with hyperplasia who apparently had an inadequate resection of her involved glands and one who had biopsy of an adenoma without further surgical management.