Long nocturnal home hemodialysis : An old therapy brought up to date

Home hemodialysis therapy orientation is rising since 2011 in France due to technical progress in dialysis machines, with a simplified use, an ultrapure and sparing dialysate delivery. The most frequent therapy is short daily dialysis sessions with performing results in terms of water and salt balance, depuration and mainly on autonomy and flexibility. In this article, we describe the organization of an alternative therapy with long nocturnal low flow hemodialysis in a dialyzed patient since 2006 after a graft failure. We discuss the benefits of this therapy, first results, eventual barriers to this method specially the occurrence of an adverse event, security and benefit of a telemonitoring and teleassistance that we develop for this occasion.

Quality of life and prevalence of osteoarticular pain in patients submitted to bariatric surgery

OBJECTIVE: To analyze quality of life and observe the prevalence of musculoskeletal pain in patients submitted to bariatric surgery. METHODS: A prospective, observational and comparative study with 26 individuals aged 18 to 60 years, 25 women, which included two evaluations, one preoperative and the other approximately 42 months after surgery. The Medical Outcomes Study 36-Item Short Form Health Survey (SF-36) and the Human Body Diagram with Visual Analogue Scale were employed. RESULTS: The individual samples showed grade III obesity, with a predominance of postoperative overweight, hypertension and diabetes in 65.4% and 42.3% of the samples, with remission of hypertension in 50% and of diabetes mellitus in 38.5% (p<0.001). The SF-36 demonstrated improved quality of life, especially in aspects related to motricity; vitality and mental health showed no significant changes. Osteoarticular pain was reported and identified in various sites by the subjects; however, 87.5% of patients in the preoperative period and 88.5% in the postoperative period reported not having any physical therapy orientation, while 65.4% reported being engaged in some type of regular physical activity after surgery (p<0.001). CONCLUSION: Morbidly obese individuals have a high probability of suffering from clinical, psychic, and musculoskeletal alterations, compromising their quality of life and showing improvement after bariatric surgery; on the other hand, the psycho-emotional manifestations did not progress in the same way.

Die Wirksamkeitsforschung von systemischer Therapie/Familientherapie: Zeitbezogene Trends und Unterschiede in der Qualität von Studien zu verschiedenen Behandlungsmodellen

Sixty-eight studies investigating the effectiveness of systemic/family therapy for children and adolescents (published from 1973 to 2004) were analyzed to determine whether quality differences exist between studies of more integrative versus classically-orien¬tat¬ed systemic family therapy. These differences were examined with respect to the type of therapy model investigated, publication year, and origin of publication. Results indicate that, based on the consideration of important methodological criteria (e.g., existence of a control group, randomized study design, registration of clinical outcome), integrative family therapy is more effective than classic family therapy. Additional ana¬lyses revealed that the year and origin of publication predicted a high methodological standard, independent of family therapy orientation. The analyses also revealed that although the number of evaluation studies on systemic/family therapy has considerably increased, especially in the USA, comparable studies on German samples are lacking. Zusammenfassung Grundlage dieser Analyse sind 68 Wirksamkeitsstudien zur systemischen Therapie/Fa¬milientherapie bei Kindern und Jugendlichen im Zeitraum von 1973 bis 2004. Es wird der Frage nachgegangen, welche Qualitätsunterschiede in der Wirksamkeitsforschung zwischen eher integrativ und eher klassisch orientierten Modellen systemischer Familientherapie bestehen, und ob diese Unterschiede mit der Art der untersuchten Therapiemodelle, dem Zeitpunkt der Erforschung und dem Herkunftsland der Studien zusammenhängen. Die Ergebnisse zeigen, dass systemisch-integrative Familientherapie in einigen wichtigen Kriterien der klassisch-systemischen Familientherapie in der methodischen Güte der Studien überlegen ist (z.B. Vorhandensein einer Kontrollgruppe, randomisiertes Studiendesign, Erhebung eines klinisch relevanten Outcomes). Allerdings konnten weitere Analysen belegen, dass die Konfundierung zwischen Publikationsjahr und dem Herkunftsland ein methodisch hohes Niveau der Wirksamkeitsprüfung vorhersagte, unabhängig von der familientherapeutischen Ausrichtung der Studien. Die Analyse verdeutlicht darüber hinaus einen gerade in den letzten Jahren stark angewachsenen Bestand an Wirkstudien zur systemischen Familientherapie insbesondere in den USA, allerdings auch einen Mangel deutscher Wirksamkeitsstudien.

No Brain, No Gain: The Role of Cognitive Processes in Irritable Bowel Syndrome

This article seeks to summarize research supporting the influence of psychological factors in general and cognitive factors in shaping the onset, expression, and outcome of irritable bowel syndrome (IBS). To this end, 6 lines of research are reviewed, with a focus on studies showing (a) the lack of correspondence between IBS symptoms and measured gut motility; (b) IBS patients as a group tend to label visceral sensations negatively and show a lower tolerance for visceral sensations; (c) neuroimaging studies showing abnormalities in central pain processing mechanisms in response to rectal stimuli among IBS vs. healthy controls; (d) high rates of psychiatric comorbidity among treatment seeking IBS patients, particularly of psychiatric disorders marked by cognitive dysfunction (e.g., depression, Generalized Anxiety Disorder); (e) the effects of cognitive factors on IBS and its outcome; and (f) frequency of comorbid functional somatic symptoms whose pathophysiology involves central processing abnormalities (e.g., fibromyalgia, headache). These data provide a strong conceptual foundation for formulating and treating IBS from a cognitive therapy orientation.