A qualitative analysis of patient-identified adaptive behaviour changes following interdisciplinary Acceptance and Commitment Therapy for chronic pain.

BACKGROUND: Interdisciplinary treatment programmes for chronic pain have strong evidence of treatment effect both immediately after treatment and at follow-up. However, despite strong outcome evidence, it is less clear which specific changes in behaviour are most relevant to patients or to outcomes. Indeed, it is not unknown for clinicians and patients to have different views with regard to goals of treatment. This study sought to evaluate the patients' perspective regarding important behavioural changes that occurred while they were enrolled in a 4-week interdisciplinary programme of Acceptance and Commitment Therapy (ACT) for chronic pain. METHODS: Qualitative data were collected during a treatment session towards the end of treatment. In total, 104 completers from 16 consecutive treatment groups contributed to a data set consisting of 315 unique qualitative comments. RESULTS: Thematic analysis resulted in a theme hierarchy including overarching themes, midlevel themes and subthemes. Three overarching themes were identified as follows: (1) interacting with self - describing an interplay between various aspects of the individual, (2) activity - concerning how individuals practically and sustainably undertook activities and (3) interacting with others - exploring relationships with other people. The results section further describes the midlevel and subthemes that cluster under the overarching themes. CONCLUSIONS: These data provide initial insights into the patient's perspective of adaptive behavioural changes gained as part of an interdisciplinary programme of chronic pain rehabilitation. Overall, the data suggest the importance of a mix of both ACT-specific and more universal coping/pain rehabilitation elements. Future research may examine how these processes relate more directly to treatment outcome. SIGNIFICANCE: This study provides new qualitative insights into the patient's perspective of adaptive behavioural changes gained as part of interdisciplinary pain rehabilitation. This and future work may help provide a more detailed understanding of the processes and behaviours that result in successful rehabilitation outcomes.

A comparison of the macrophyte cover and macroinvertebrate fauna at three sites on the River Kennet in the mid 1970s and late 1990s.

In 1974-1976, baseline studies were carried out on the flora and macroinvertebrate fauna of the R. Kennet at two sites downstream of Marlborough (Savernake Upper and Lower) and at one site upstream of Hungerford (Littlecote). Simplified maps of each site, showing the cover of macrophytes, were obtained monthly between April 1974 and April/June 1976, and replicated quantitative samples of the macroinvertebrates were collected on the dominant macrophyte and on gravel in June 1974, and also in June and December 1975. As a consequence of two major droughts and increasing concern over water quality in the Upper Kennet in the 1990s, the studies recommenced in the summer of 1997 using the same sites and methodologies. Maps and macroinvertebrate samples were obtained in early July and December 1997 and in June of both 1998 and 1999. At the Savernake sites, mapping in summer 1997 confirmed what had been apparent for some years. That is, macrophyte cover (both Ranunculus and Schoenoplectus) was much lower than in the 1970s. In contrast, the site downstream at Littlecote retained a relatively high cover of Ranunculus, despite the drought. In late autumn 1997, phosphate stripping commenced at Marlborough Sewage Treatment Works, the drought ended and in addition, the spring of 1998 was unusually wet. Ranunculus recolonised both Savernake sites with remarkable speed by summer 1998 and retained this dominant position in 1999. Quantitative samples of macroinvertebrates collected on gravel and the dominant macrophyte at each of the three study sites indicated that there was no evidence of major loss of family richness between the 1970s and 1990s as a result of the low flows or enrichment. However, at Savernake (but not Littlecote) in summer 1997, the macroinvertebrate assemblage was affected by low flows and/or enrichment. This took the form of changes in the abundance of some families, with lentic forms being favoured in relation to some lotic families. Following the end of the drought, many macroinvertebrate families at Savernake showed a rapid response to the new conditions and the assemblages reverted to those expected in a fast-flowing cretaceous chalk stream. Continued monitoring through the next drought is advisable to provide a greater understanding of the interplay between water quality, the discharge regime, habitat quality (including macrophyte growth) and the response of the macroinvertebrate fauna.

Fluorouracil in chemoprophylaxis of colorectal cancer. Results of a controlled clinical trial.

In a randomized prospective clinical trial in 128 patients undergoing radical surgical resection of primary colorectal cancer, 63 patients received intravenous fluorouracil (5-FU) in two courses, four and eight weeks after surgery; 65 controls received no chemotherapy. The duration of follow-up exceeded five years in all cases, and 28 patients have died in each group. Recurrent disease was present in 26 5-FU patients (41.2 percent) and in 22 controls (33.9 percent). There is no evidence that short-term 5-FU therapy was of significant value in the chemoprophylaxis of colorectal cancer.

Multiple and recurrent inflammatory fibroid polyps in three generations of a Devon family: a new syndrome.

The recurrence of multiple inflammatory fibroid polyps is reported in three generations of a Devon family. Only one female in each has been affected in a direct line of descent. The grandmother has had nine polyps resected over 11 years, the mother seven over 18 years, and the daughter six over six years. None of the patients or their relatives are known to have any allergies, dietary fads, or gastrointestinal infections. Chromosome studies have been normal in two patients. No cancer risk has been identified. Conventional histology, electron microscopy, and immunohistology suggest that the lesion is a self-limiting proliferation of histiocytes; the initiating event or stimulus remains unknown. A genetic factor is likely to operate in this unique family which is probably polygenic and multifactorial in nature.

Appendicitis in external herniae.

Seven patients are reported with acute appendicitis occurring in an external hernial sac. The average age was 69 years. In 4 cases the site was a right femoral hernia and in 3 a right indirect inguinal hernia. In no case was the correct diagnosis made before operation. Recovery was uneventful apart from wound infection in 3 cases.

Aorto-duodenal and subsequent aorto-colonic fistula following operation for ruptured aortic aneurysm.

Direct communication between aorta and intestinal lumen, whether spontaneous (primary) or postoperative (secondary), is a rate and frequently lethal cause of gastrointestinal haemorrhage. This paper records what is believed to be a unique occurrence in the survival of a patient who following surgery for ruptured aortic aneurysm, not only developed an aorto-duodenal but subsequently an aorto-colonic fistula over a span of 5 years.

Spontaneous rupture of a liver cell adenoma after long term methyltestosterone: report of a case successfully treated by emergency right hepatic lobectomy.

A case of spontaneous rupture of a liver cell adenoma is reported in a female transexual treated with methyltestosterone 150 mg daily for 7 years. Emergency right hepatic lobectomy was performed successfully. Histology showed peliosis hepatis also. Emergency resection of a liver cell adenoma has been reported in a young woman taking oral contraceptives, and an elective resection in another female transexual treated with methyltestosterone. However, to the best of our knowledge this is the first case of emergency resection of a spontaneously ruptured liver cell adenoma in a transexual treated with long term methyltestosterone. Since there are numerous other patients similarly treated, it may be expected that this complication will be seen again.