Preoperative curves of greater magnitude (>70°) in adolescent idiopathic scoliosis are associated with increased surgical complexity, higher cost of surgical treatment and a delayed return to function.

BACKGROUND: Surgical procedures to correct larger curve magnitudes >70° in patients with adolescent idiopathic scoliosis (AIS) are still common; despite their increased complexity, limited research has assessed the effect of preoperative curve severity on outcomes. AIM: This study aimed to examine the impact of preoperative curves >70° vs. those ≤70° on perioperative, functional and financial outcomes in patients with AIS undergoing posterior spinal fusion (PSF). METHODS: Seventy seven eligible AIS patients who underwent PSF were prospectively followed-up, until return to preoperative function was reported. Preoperative curves >70° vs. ≤70° were analysed in relation to surgical duration, estimated blood loss, perioperative complications, length of hospitalisation, return to function and cost of surgical treatment per patient. RESULTS: Severe preoperative curves >70°, identified in 21 patients (27.3 %), were associated with significantly longer surgical duration (median 6.5 vs. 5 h, p = 0.001) and increased blood loss (median 1250 vs. 1000 ml, p = 0.005)-these patients were 2.1 times more likely to receive a perioperative blood product transfusion (Relative Risk 2.1, CI 1.4-2.7, p = 0.004). Curves >70° were also associated with a significantly delayed return to school/college, and an increased cost of surgical treatment (€33,730 vs. €28,620, p < 0.0001). CONCLUSION: Surgeons can expect a longer surgical duration, greater intraoperative blood loss and double the blood product transfusion risk when performing PSF procedures on AIS patients with curves greater than 70° vs. those ≤70°. Surgical correction for curves >70°, often as a result of lengthy surgical waiting lists, also incurs added expense and results in a partial delay in early functional recovery.

Influence of curve magnitude and other variables on operative time, blood loss and transfusion requirements in adolescent idiopathic scoliosis.

BACKGROUND: Posterior spinal instrumentation and fusion for correction of adolescent idiopathic scoliosis (AIS) typically requires lengthy operating time and may be associated with significant blood loss and subsequent transfusion. This study aimed to identify factors predictive of duration of surgery, intraoperative blood loss and transfusion requirements in an Irish AIS cohort. METHODS: A retrospective review of 77 consecutive patients with AIS who underwent single-stage posterior spinal instrumentation and fusion over a two-year period at two Dublin tertiary hospitals was performed. Data were collected prospectively and parameters under analysis included pre- and postoperative radiographic measurements, intraoperative blood loss, surgical duration, blood products required, laboratory blood values and perioperative complications. RESULTS: Mean preoperative primary curve Cobb angle was 62.3°; mean surgical duration was 5.6 h. The perioperative allogeneic red blood cell transfusion rate was 42.8 % with a median requirement of 1 unit. Larger curve magnitudes were positively correlated with longer fusion segments, increased operative time and greater estimated intraoperative blood loss. Preoperative Cobb angles greater than 70° [Relative Risk (RR) 4.42, p = 0.003] and estimated intraoperative blood loss greater than 1400 ml (RR 3.01, p = 0.037) were independent predictors of red blood cell transfusion risk. CONCLUSION: Larger preoperative curve magnitudes in AIS increase operative time and intraoperative blood loss; preoperative Cobb angles greater than 70(o) and intraoperative blood loss greater than 1400 ml are predictive of red blood cell transfusion requirement in this patient group.

Pulse sequences for uniform perfluorocarbon droplet vaporization and ultrasound imaging.

Phase-change contrast agents (PCCAs) consist of liquid perfluorocarbon droplets that can be vaporized into gas-filled microbubbles by pulsed ultrasound waves at diagnostic pressures and frequencies. These activatable contrast agents provide benefits of longer circulating times and smaller sizes relative to conventional microbubble contrast agents. However, optimizing ultrasound-induced activation of these agents requires coordinated pulse sequences not found on current clinical systems, in order to both initiate droplet vaporization and image the resulting microbubble population. Specifically, the activation process must provide a spatially uniform distribution of microbubbles and needs to occur quickly enough to image the vaporized agents before they migrate out of the imaging field of view. The development and evaluation of protocols for PCCA-enhanced ultrasound imaging using a commercial array transducer are described. The developed pulse sequences consist of three states: (1) initial imaging at sub-activation pressures, (2) activating droplets within a selected region of interest, and (3) imaging the resulting microbubbles. Bubble clouds produced by the vaporization of decafluorobutane and octafluoropropane droplets were characterized as a function of focused pulse parameters and acoustic field location. Pulse sequences were designed to manipulate the geometries of discrete microbubble clouds using electronic steering, and cloud spacing was tailored to build a uniform vaporization field. The complete pulse sequence was demonstrated in the water bath and then in vivo in a rodent kidney. The resulting contrast provided a significant increase (>15 dB) in signal intensity.

Effects of sequential changes from conventional ventilation to high-frequency oscillatory ventilation at increasing mean airway pressures in an ovine model of combined lung and head injury.

BACKGROUND: The objective of this study was to determine the intracranial, cardiovascular and respiratory changes induced by conversion to high-frequency oscillator ventilation from conventional mechanical ventilation at increasing airway pressures. METHODS: In this study, 11 anaesthetized sheep had invasive cardiovascular and intracranial monitors placed. Lung injury was induced by saline lavage and head injury was induced by inflation of an intracranial balloon catheter. All animals were sequentially converted from conventional mechanical ventilation to high-frequency oscillator ventilation at target mean airway pressures of 16, 22, 28, 34 and 40 cm H(2)O. The mean airway pressure was achieved by adjusting positive end expiratory pressure while on conventional mechanical ventilation, and continuous distending pressures while on high-frequency oscillator ventilation. Cerebral lactate production, oxygen consumption and venous oximetry were measured and analysed in relation to changes in transcranial Doppler flow velocity. Transcranial Doppler profiles together with other physiological parameters were measured at each airway pressure. RESULTS: Cerebral perfusion pressure was significantly lower during high-frequency oscillator ventilation than during conventional mechanical ventilation (CMV: 45, 34, 22, 6, 9 mmHg vs. HFOV: 33, 20, 19, 5, 5 mmHg at airway pressures mentioned above, P = 0.02). Intracranial pressure and cerebrovascular resistance increased with increasing intrathoracic pressures (P = 0.001). Cerebral metabolic indices demonstrated an initial increase in anaerobic metabolism followed by a decrease in cerebral oxygen consumption progressing to cerebral infarction as intrathoracic pressures were further increased in a stepwise fashion. Arterial PaCO(2) increased significantly after converting from conventional mechanical ventilation to high-frequency oscillator ventilation (P = 0.001). However, no difference was observed between conventional mechanical ventilation and high-frequency oscillator ventilation when intracranial pressure, metabolic and transcranial Doppler indices were compared at equivalent mean airway pressures. CONCLUSIONS: The use of high positive end expiratory pressure with conventional mechanical ventilation or high continuous distending pressure with high-frequency oscillator ventilation increased intracranial pressure and adversely affected cerebral metabolic indices in this ovine model. Transcranial Doppler is a useful adjunct to intracranial pressure and intracranial venous saturation monitoring when major changes in ventilation strategy are adopted.

Factors explaining the intention to give blood among the general population.

BACKGROUND AND OBJECTIVES: The aim of this study was to identify factors explaining the intention to donate blood. MATERIALS AND METHODS: A random sample of 4000 respondents drawn from the general population received a questionnaire by mail. This questionnaire assessed variables as defined by the most prominent social cognitive theories. RESULTS: Overall, the respondents expressed a neutral mean level of intention to give blood in the next 6 months (2.84 on a five-point scale); 56.2% had never given blood in the past. The variables explaining 74% of the variance of intention were: perceived behavioural control (beta = 0.39; P < 0.001); factors facilitating taking action (beta = 0.25; P < 0.001); anticipated regret (beta = 0.16; P < 0.001); moral norm (beta = 0.11; P < 0.001); attitude (beta = 0.08; P < 0.01); level of education (beta = -0.03; P < 0.05); and past experience in giving blood (beta = 0.09; P < 0.001). Nonetheless, the predictive power of perceived behavioural control and moral norm was higher among the ever donors (both at P < 0.01) compared to the never donors, whereas the reverse was observed for attitude (P < 0.05). CONCLUSIONS: People's intentions are mainly determined by perceived barriers and obstacles regarding blood donations. This suggests that promotional strategies should focus on the elimination of barriers to action as well as the development of a higher perception of control. Also, messages should be adapted to the targeted population, based on their previous blood donation behaviour (i.e. never donors vs. ever donors).

Rofecoxib administration to paediatric patients undergoing adenotonsillectomy.

BACKGROUND: Rofecoxib is a selective COX-2 inhibitor that does not interfere with platelet function and is associated with fewer bleeding complications than other nonsteroidal anti-inflammatory agents (NSAIDs). Our aims were to evaluate the safety and the efficacy of rofecoxib administration to paediatric patients undergoing adenotonsillectomy (T&A). METHODS: We conducted a double-blind, randomized, placebo-controlled study of rofecoxib in 45 ASA 1-2 patients > or = 4 years of age undergoing outpatient T&A. All patients received midazolam 0.5 mg x kg(-1) (max 15 mg) p.o. and either rofecoxib 1 mg x .kg(-1) (max 25 mg) or placebo p.o. 30 min preoperatively. All patients had a standardized anaesthetic and were extubated awake in the operating room at the conclusion of surgery. The Children's Hospital of Eastern Ontario Pain Scale (CHEOPS) scores were obtained on arrival in the postanaesthetic care unit (PACU). Morphine 25 microg x kg(-1) i.v. were administered up to six times for pain in the PACU. Wong-Baker FACES Scales were obtained at discharge from the PACU and the day surgery unit (DSU). Outcome measures included intraoperative estimated blood loss (EBL), pain scores, PACU morphine requirements and discharge times. RESULTS: There were 23 patients in the rofecoxib group and 22 patients in the placebo group. There were no differences between the rofecoxib and placebo groups in terms of bleeding, pain scores, PACU morphine requirements, PACU times or DSU times. CONCLUSION: Rofecoxib administration to paediatric patients undergoing T&A did not result in increased bleeding. Rofecoxib, however, was not found to decrease morphine use or improve pain scores prior to hospital discharge in T&A patients who received intraoperative morphine and acetaminophen.

Exploring the relationship between different psychosocial determinants of depression: a multidimensional scaling analysis.

BACKGROUND: The psychological literature concerned with the aetiology and maintenance of depression has generally been considered too diverse to allow for integration of concepts into a single comprehensive review. Moreover, there is little understanding of the original theorists' conceptualisation of the key themes underlying psychosocial theories of depression. This study aims to create a single framework of psychosocial depression concepts based on the opinions of key original theorists. METHOD: A quantitative integration of depression factors was conducted. Ninety-nine factors were identified from 27 theories. Fourteen of the original theorists sorted the factors into groups using a card sort task. RESULTS: Three-way multidimensional scaling (MDS) produced a four-dimensional solution with high explained variance and low stress. Dimension one describes cognitions resulting in a lack of positive intrapersonal and interpersonal communication. Dimension two emphasises behaviours and the impact of environmental stressors. Dimension three describes the individual's pursuit of unrealistic goals and a perceived lack of control. Finally, Dimension four describes concepts relating to self-focus and self-reinforcement. LIMITATIONS: future research could examine clinicians and depressed individuals' understandings of the literature. CONCLUSIONS: the MDS solution identifies the original theorists' collective understanding of the literature. Clinicians could usefully employ the framework to identify the underlying psychosocial themes involved in depression. Moreover the study highlights the need for clinicians to consider the relationships between different conceptual areas in order to challenge the chronic nature of the depressive experience and the high rates of relapse.

Can the theory of planned behavior explain patterns of health behavior change?

This article tested the ability of the theory of planned behavior (TPB) to predict patterns of behavior change associated with health screening. Attitudes, subjective norms, perceived behavioral control, and intentions were used to predict objective measures of attendance 1 month and 13 months later among participants who had never previously been screened (N = 389). Findings showed that the TPB predicted attendance on each occasion and also predicted frequency of attendance. However, the model was unable to reliably distinguish among consistent attendees, participants who delayed attending, and participants who initially attended but relapsed. Thus, the TPB needs to be extended to understand behaviors that must be performed promptly and repeatedly for health benefits to accrue.

Using implementation intentions to increase attendance for cervical cancer screening.

This article evaluates an intervention based on P. M. Gollwitzer's (1993) concept of implementation intentions. Women registered at a medical practice in rural England (N = 114) completed measures of the theory of planned behavior variables before a manipulation that induced one half of the sample to form implementation intentions specifying when, where, and how they would make the appointment. Subsequent attendance was determined from medical records. Findings show that the theory of planned behavior variables and previous delay behavior provided good prediction of attendance. However, despite equivalent motivation to attend, participants who formed implementation intentions were much more likely to attend for screening compared with controls (92% vs. 69%). Evidence also suggests that implementation intentions attenuated the relationship between previous delay behavior and subsequent attendance.

Temporal stability as a moderator of relationships in the Theory of Planned Behaviour.

Temporal stability of behavioural intentions and perceived behavioural control (PBC) within the Theory of Planned Behaviour were examined as moderators of the cognition-behaviour relationships in two studies. Study 1 (N = 201) examined attendance at health screening appointment (infrequently performed behaviour) using an objective measure of attendance. The impact of intentions and past behaviour on behaviour was moderated by intention stability. In addition, stable intentions were more strongly related to attitudes and past behaviour. Study 2 (N = 407) examined eating a low-fat diet (frequently performed behaviour) using a self-report measure of behaviour. The impact of intentions on behaviour was moderated by intention stability, while the impact of PBC and past behaviour on behaviour was moderated by PBC stability. Stable intentions were more strongly related to attitudes, subjective norms and PBC. Stable PBC was more strongly related to attitudes and past behaviour. The discussion considers the implications of the findings for furthering the understanding of the proximal determinants of behaviour and emphasizes the importance of temporal stability as a key measure of the strength of intentions and PBC.

Intraocular pressure changes and alterations in intracranial pressure.

We show that although there is a significant correlation between intraocular pressure and intracranial pressure in neurosurgical patients, changes in intraocular pressure are a poor predictor of changes in intracranial pressure.

The development and validation of the Visual Analogue Self-Esteem Scale (VASES).

OBJECTIVES: To develop a visual analogue measure of self-esteem and test its psychometric properties. DESIGN: Two correlational studies involving samples of university students and aphasic speakers. METHOD: Two hundred and forty-three university students completed multiple measures of self-esteem, depression and anxiety as well as measures of transitory mood and social desirability (Study 1). Two samples of aphasic speakers (N = 14 and N = 20) completed the Visual Analogue Self-Esteem Scale (VASES), the Rosenberg (1965) self-esteem scale and measures of depression and anxiety. (Study 2). RESULTS: Study 1 found evidence of good internal and test-retest reliability, construct validity and convergent and discriminant validity for a 10-item VASES. Study 2 demonstrated good internal reliability among aphasic speakers. CONCLUSION: The VASES is a short and easy to administer measure of self-esteem that possesses good psychometric properties.

Psychosocial correlates of heterosexual condom use: a meta-analysis.

Despite increasing incidence of HIV/AIDS, there has been no systematic review of correlates of condom use among heterosexual samples. To rectify this, the present study used meta-analysis to quantify the relationship between psychosocial variables and self-reported condom use. Six hundred sixty correlations distributed across 44 variables were derived from 121 empirical studies. Variables were organized in terms of the labeling, commitment, and enactment stages of the AIDS Risk Reduction Model (Catania, Kegeles, & Coates, 1990). Findings showed that demographic, personality, and labeling stage variables had small average correlations with condom use. Commitment and enactment stage variables fared better, with attitudes toward condoms, behavioral intentions, and communication about condoms being the most important predictors. Overall, findings support a social psychological model of condom use highlighting the importance of behavior-specific cognitions, social interaction, and preparatory behaviors rather than knowledge and beliefs about the threat of infection.

Elevated cytokine concentrations in the nasopharyngeal and tracheal secretions of children with respiratory syncytial virus disease.

BACKGROUND: Respiratory syncytial virus (RSV) is the most common cause of lower respiratory tract disease in infants. The role of inflammatory mediators in the pathogenesis of RSV disease is not well-understood. The present study was designed (1) to determine whether RANTES (regulated on activation, normal T cell expressed and presumably secreted), macrophage-inflammatory protein-1-alpha (MIP-1-alpha), interleukin (IL)-6, IL-8 and IL-10 can be detected in respiratory secretions of children with RSV infection and (2) to assess whether the concentrations of these cytokines in respiratory secretions correlate with white blood cell (WBC) counts and RSV concentrations and with disease severity. METHODS: During the 1996 to 1997 RSV season, we studied prospectively 14 intubated and 14 nonintubated children hospitalized with RSV disease. Nasal wash (NW) and tracheal aspirate (TA) samples were obtained from intubated patients on Hospital Days 1, 3 and 5. NW samples were obtained from nonintubated patients on hospital days 1 and 3. Seven healthy children undergoing elective surgery served as controls. All samples were analyzed for: (1) WBC and differential counts; (2) concentrations of RANTES, MIP-1-alpha, IL-6, IL-8 and IL-10; and (3) quantitative RSV cultures, except in control patients. RESULTS: RANTES, MIP-1-alpha, IL-6, IL-8 and IL-10 were detected in NW and TA samples from all children with RSV infection. The concentrations of these cytokines in samples obtained from children with RSV infection were significantly greater than those in samples obtained from control children. NW WBC counts significantly correlated with NW RANTES, IL-6, IL-8 and IL-10 concentrations, whereas TA WBC counts significantly correlated with TA IL-6, IL-8, IL-10 and MIP-1-alpha concentrations. NW RSV concentrations correlated with NW WBC counts and with NW cytokine concentrations. Among children with RSV infection nonintubated patients had greater NW WBC counts and NW RANTES concentrations than intubated patients. TA RANTES, IL-8 and IL-10 concentrations inversely correlated with clinical markers of RSV disease severity. CONCLUSION: The presence of cytokines in NW and TA samples of children with RSV infection suggests that they have a role in mediating the respiratory tract inflammation induced by RSV. These observations could have implications for designing new therapeutic strategies directed at immunomodulation of RSV disease.

Can social cognitive models contribute to the effectiveness of HIV-preventive behavioural interventions? A brief review of the literature and a reply to Joffe (1996; 1997) and Fife-Schaw (1997)

A recent debate in the British Journal of Medical Psychology has considered the role of social cognitive models, such as the theory of reasoned action and the theory of planned behaviour, in understanding HIV-preventive behaviour. In this paper we clarify some of the assumptions involved in applications of social cognitive models. We briefly review available evidence on the capacity of such models to predict HIV-preventive sexual behaviour and outline a number of criteria for judging their predictive success. The importance of behavioural prediction for the development of effective HIV-preventive behavioural interventions is discussed and recent evaluations of interventions based on these models are reviewed. We conclude that the models are effective in predicting HIV-preventive behaviours and provide empirically supported theoretical guidance on psychological changes likely to result in HIV-preventive behaviour change. In addition we argue that, to date, evaluations of theoretically specified interventions are encouraging. Further development and rigorous testing of HIV/AIDS interventions based on social cognitive models is recommended.

Aspiration pneumonia-induced sepsis increases cardiac dysfunction after burn trauma.

Pneumonia occurs in approximately 50% of incubated patients in burn intensive care units and carries a mortality as high as 40%. A model was developed to study altered cardiopulmonary function in burn complicated by pneumococcal pneumonia. Sprague-Dawley rats were given a 43% total body surface area scald burn or sham burn; 24 h later they were transtracheally inoculated with either 10(7) Streptococcus pneumoniae in 0.5 ml phosphate buffer solution (PBS) or 0.5 ml PBS alone. The four groups were: Sham (N = 7), Burn alone (N = 10), Pneumonia alone (N = 11), and Burn and Pneumonia ( N = 12). A fifth group of burned rats (N = 10), given an identical fluid resuscitation regimen, was sacrificed 24 h postburn to examine the early cardiac responses to burn injury alone. Shams and burned animals had normal lung histology, negative bronchoalveolar lavage (BAL) cultures, and negative blood cultures. Pneumonia and burn plus pneumonia animals had abnormal lung histology, positive BAL cultures, and positive blood cultures. Cardiac function was assessed 24 h after S.pneumoniae challenge (48 h after burn) (Langendorff preparation). Compared to the Sham group, Pneumonia group, and Burn group, the Burn plus Pneumonia group had the lowest left ventricular pressure (LVP: 94 +/- 4, 71 +/- 3, and 87 +/- 3 mm Hg vs 63 +/- 4 mm Hg, P < 0.05), the lowest maximal rate of LVP rise (+dP/dt[max]:1932 +/- 115, 1419 +/- 71, and 1772 +/- 96 mm Hg vs 1309 +/- 59 mm Hg/s, P < 0.05), and the lowest maximal rate of LVP fall (-dP/dt[max]:1704 +/- 120, 1263 +/- 73, and 1591 +/- 83 mm Hg vs 1025 +/- 98 mm Hg/s, P < 0.05). Cardiac contraction and relaxation deficits were confirmed in animals 24 h postburn (group 5), as indicated by a significantly lower LVP and +/-dP/dt(max) (62 +/- 3 mm Hg 1210 +/- 60, and 909 +/- 50 mm Hg/s, respectively, P < 0.05 compared to Sham group). Tumor necrosis factor-alpha (TNF-alpha) concentrations in serum, but not bronchoalveolar lavage, were greater in burned animals with aspiration pneumonia-induced sepsis than in animals with either burn alone or aspiration pneumonia-induced sepsis alone. While our data suggest that elevated circulating TNF-alpha levels may contribute, in part, to depressed cardiac function, further studies are needed to fully define the mechanisms underlying cardiac contractile deficits in this model. We speculate that depressed cardiopulmonary function due to burn complicated by pneumonia and sepsis contributes to the high mortality of this patient population.

'Inclined abstainers': a problem for predicting health-related behaviour.

A longitudinal test of the association between motivation to undertake a precautionary health action and subsequent behaviour was conducted on women's uptake of the cervical screening test. A sample of never-screened women (N = 166) completed measures derived from protection-motivation theory (PMT; Rogers, 1983). One year later, screening uptake was reliably determined from medical records. While regression analyses demonstrated that PMT variables predicted both motivation to undergo cervical screening and screening uptake, there was, nonetheless, a good deal of inconsistency between protection motivation and screening behaviour. Fifty-seven per cent of those who indicated they were willing to undergo the test did not do so within a one-year period. Discriminant analysis was therefore used to test the ability of cognitions specified by PMT to distinguish four patterns of association between motivation and behaviour: inclined actors, inclined abstainers, disinclined actors and disinclined abstainers. While PMT variables could successfully classify the four groups, it was not possible to derive a reliable discriminant function which distinguished between inclined actors and inclined abstainers. The results suggest that PMT provides a useful account of choice motivation but does not address the psychological processes by which intention is translated into action. Recent calls for the development of a social psychology of volition are discussed in the light of these findings.

Do intentions predict condom use? Meta-analysis and examination of six moderator variables.

This study used meta-analysis to quantify the relationship between intentions and behaviour in prospective studies of condom use. The effects of six moderator variables were also examined: sexual orientation, gender, sample age, time interval, intention versus expectation and condom use with 'steady' versus 'casual' partners. Literature searches revealed 28 hypotheses based on a total sample of 2532 which could be included in the review. Overall, there was a medium to strong sample-weighted average correlation between intentions and condom use (r+ = .44), and this correlation was similar to the effect sizes obtained in previous reviews. There were too few studies of gay men to permit meaningful comparison of effect sizes between homosexual versus heterosexual samples. Gender and measurement of intention did not moderate the intention-behaviour relationship. However, shorter time intervals, older samples and condom use with 'steady' rather than 'casual' partners were each associated with stronger correlations between intentions and condom use. Factors which might explain the significant effects of moderator variables are discussed and implications of the study for future research on intention-behaviour consistency are outlined.

An evaluation of short-term group therapy for people with aphasia.

This paper reports an evaluation of a group therapy intervention conducted with aphasic people (n = 6). The intervention comprised 10 sessions of approximately 90 min duration and included two participants with stuttering difficulties. The therapy programme consisted of communication activities within the group which encouraged sharing of personal experiences, videotaping of role-play activities for self- and group-evaluation and practice tasks completed outside the group. Measures of functional communicative ability, attitudes to communication and psychological adjustment were obtained before and after the intervention. Findings showed significant improvements in communicative competence and attitudes to communication over the course of the intervention. Before the intervention self-esteem and communicative competence were highly intercorrelated. By the end of the therapy sessions the correlation between self-esteem and communicative competence was significantly smaller and was non-significant. This indicates that communicative function was not related to feelings of self-worth by the end of the intervention. Improvements in attitude to communication, greater attendance and completion of assignments were each predictive of reduced levels of depression. There was also evidence that stronger beliefs about the role of personal effort in improving speech were predictive of improvements in communication attitudes. A measure of satisfaction showed extremely positive evaluation of the intervention by participants. It is concluded that shortterm group therapy can produce improvements in communicative abilities and attitudes, and have psychological benefits for participants. Several suggestions for future research are outlined.