scholarly journals THU0579 “EVOLVING THE MANAGEMENT OF RA” PROGRAMME: EDUCATIONAL TOOLS TO SUPPORT DAILY PRACTICE

2020 ◽  
Vol 79 (Suppl 1) ◽  
pp. 531.1-531
Author(s):  
G. R. Burmester ◽  
J. M. Alvaro-Gracia ◽  
N. Betteridge ◽  
J. Calvo ◽  
B. Combe ◽  
...  
Keyword(s):  
Unmet Needs ◽  
Psychosocial Interventions ◽  
Steering Committee ◽  
Self Management ◽  
Pharmacological Interventions ◽  
Research Support ◽  
Educational Tools ◽  
Pharmacological Management ◽  
Web Platform ◽  
Hand Exercises

Background:The eRA (evolving the management of RA) programme was initiated in Europe to provide practical educational tools that address unmet needs in the management of rheumatoid arthritis (RA). Several eRA tools – covering early access to care, management of comorbidities, treat-to-target strategies, and patient empowerment – are available to the rheumatology community. Through ongoing activities, the eRA Steering Committee (SC) identified a need for tools on non-pharmacological management of RA.Objectives:To improve accessibility to eRA tools for rheumatology professionals; to review the evidence base of non-pharmacological interventions to create new eRA resources that may support management decisions.Methods:A web platform providing information on eRA programme and tools was developed in 2019. The platform collects survey-based metrics to quantify perception of eRA and use of eRA tools in clinical practice. Platform and tools are translated to further support access and use across Europe.To address unmet needs in non-pharmacological patient management, the eRA SC reviewed the core literature on agreed priority interventions, including physical activity, diet, patient education and self-management, psychosocial interventions, occupational therapy and orthotics, hand exercises, and hydrotherapy/balneotherapy. Available evidence for each intervention was assessed and graded according to the Oxford Centre for Evidence-based Medicine Levels of Evidence.Results:The eRA web platform is now live in 3 countries (www.evolvingthemanagementofRA.com), hosting translated copies of the eRA tools, with additional countries launching throughout 2020.From a review of core literature on non-pharmacological interventions, the eRA SC determined that strong evidence exists to support use of physical activity, patient education and self-management, psychosocial interventions, and occupational therapy and orthotics. Evidence was lacking or conflicting for diet and nutrition, hand exercises, and balneotherapy/hydrotherapy. A set of educational slides was produced by the eRA SC to summarise the evidence (Fig. 1) and provide top-line guidance on use of interventions in practice that should engage relevant members of the multi-disciplinary team. These slides are available through eRA dissemination activities.Conclusion:The eRA programme content is now freely available to health care professionals in several countries on a web platform, supported by translations of the eRA tools. An additional slide set on non-pharmacological management serves to further increase the practical guidance of this programme’s educational offering.Acknowledgments:The eRA programme is funded by Sanofi Genzyme. Programme direction and content creation are driven by an independent Steering CommitteeDisclosure of Interests:Gerd Rüdiger Burmester Consultant of: AbbVie Inc, Eli Lilly, Gilead, Janssen, Merck, Roche, Pfizer, and UCB Pharma, Speakers bureau: AbbVie Inc, Eli Lilly, Gilead, Janssen, Merck, Roche, Pfizer, and UCB Pharma, Jose-Maria Alvaro-Gracia Grant/research support from: Abbvie, Elli-Lilly, MSD, Novartis, Pfizer, Consultant of: Abbvie, BMS, Janssen-Cilag, Elli-Lilly, MSD, Novartis, Pfizer, Sanofi, Tigenix, Roche, UCB, Paid instructor for: Elli-Lilly, Pfizer, Roche, Speakers bureau: Abbvie, BMS, Janssen-Cilag, Elli-Lilly, Gedeon Richter, MSD, Novartis, Pfizer, Sanofi, Tigenix, Roche, UCB, Neil Betteridge Consultant of: Amgen, Eli Lilly and Company, Grunenthal, GSK, Sanofi Genzyme, Jaime Calvo Grant/research support from: Lilly, UCB, Consultant of: Abbvie, Jansen, Celgene, Bernard Combe Grant/research support from: Novartis, Pfizer, Roche-Chugai, Consultant of: AbbVie; Gilead Sciences, Inc.; Janssen; Eli Lilly and Company; Pfizer; Roche-Chugai; Sanofi, Speakers bureau: Bristol-Myers Squibb; Gilead Sciences, Inc.; Eli Lilly and Company; Merck Sharp & Dohme; Pfizer; Roche-Chugai; UCB, Patrick Durez Speakers bureau: AbbVie, Bristol-Myers Squibb, Celltrion, Eli Lilly, Pfizer, Sanofi, Ricardo J. O. Ferreira Grant/research support from: Abbvie, Consultant of: Sanofi Genzyme, Amgen, MSD, Paid instructor for: UCB, Bruno Fautrel Grant/research support from: AbbVie, Lilly, MSD, Pfizer, Consultant of: AbbVie, Biogen, BMS, Boehringer Ingelheim, Celgene, Lilly, Janssen, Medac MSD France, Nordic Pharma, Novartis, Pfizer, Roche, Sanofi Aventis, SOBI and UCB, Annamaria Iagnocco Grant/research support from: Abbvie, MSD and Alfasigma, Consultant of: AbbVie, Abiogen, Alfasigma, Biogen, BMS, Celgene, Eli-Lilly, Janssen, MSD, Novartis, Sanofi and Sanofi Genzyme, Speakers bureau: AbbVie, Alfasigma, BMS, Eli-Lilly, Janssen, MSD, Novartis, Sanofi, Carlomaurizio Montecucco: None declared, Mikkel Ǿstergaard Grant/research support from: AbbVie, Bristol-Myers Squibb, Celgene, Merck, and Novartis, Consultant of: AbbVie, Bristol-Myers Squibb, Boehringer Ingelheim, Celgene, Eli Lilly, Hospira, Janssen, Merck, Novartis, Novo Nordisk, Orion, Pfizer, Regeneron, Roche, Sandoz, Sanofi, and UCB, Speakers bureau: AbbVie, Bristol-Myers Squibb, Boehringer Ingelheim, Celgene, Eli Lilly, Hospira, Janssen, Merck, Novartis, Novo Nordisk, Orion, Pfizer, Regeneron, Roche, Sandoz, Sanofi, and UCB, Sofia Ramiro Grant/research support from: MSD, Consultant of: Abbvie, Lilly, Novartis, Sanofi Genzyme, Speakers bureau: Lilly, MSD, Novartis, Andrea Rubbert-Roth Consultant of: Abbvie, BMS, Chugai, Pfizer, Roche, Janssen, Lilly, Sanofi, Amgen, Novartis, Tanja Stamm Grant/research support from: AbbVie, Roche, Consultant of: AbbVie, Sanofi Genzyme, Speakers bureau: AbbVie, Roche, Sanofi, Zoltán Szekanecz Grant/research support from: Pfizer, UCB, Consultant of: Sanofi, MSD, Abbvie, Pfizer, Roche, Novertis, Lilly, Gedeon Richter, Amgen, Peter C. Taylor Grant/research support from: Celgene, Eli Lilly and Company, Galapagos, and Gilead, Consultant of: AbbVie, Biogen, Eli Lilly and Company, Fresenius, Galapagos, Gilead, GlaxoSmithKline, Janssen, Nordic Pharma, Pfizer Roche, and UCB, Mart van de Laar Consultant of: Sanofi Genzyme, Speakers bureau: Sanofi Genzyme

scholarly journals Effectiveness of self-management interventions in inflammatory arthritis: a systematic review informing the 2021 EULAR recommendations for the implementation of self-management strategies in patients with inflammatory arthritis

RMD Open ◽  
2021 ◽  
Vol 7 (2) ◽  
pp. e001647
Author(s):  
Andréa Marques ◽  
Eduardo Santos ◽  
Elena Nikiphorou ◽  
Ailsa Bosworth ◽  
Loreto Carmona
Keyword(s):  
Systematic Review ◽  
Full Text ◽  
Inflammatory Arthritis ◽  
Data Extraction ◽  
Management Strategies ◽  
Psychosocial Interventions ◽  
Behavioural Therapy ◽  
Self Management ◽  
Cochrane Library ◽  
Management Interventions

ObjectiveTo perform a systematic review (SR) on the effectiveness of self-management interventions, in order to inform the European League Against Rheumatism Recommendations for its implementation in patients with inflammatory arthritis (IA).MethodsThe SR was conducted according to the Cochrane Handbook and included adults (≥18 years) with IA. The search strategy was run in Medline through PubMed, Embase, Cochrane Library, CINAHL Plus with Full Text, and PEDro. The assessment of risk of bias, data extraction and synthesis were performed by two reviewers independently. A narrative Summary of Findings was provided according to the Grading of Recommendations, Assessment, Development and Evaluation.ResultsFrom a total 1577 references, 57 were selected for a full-text review, and 32 studies fulfilled the inclusion criteria (19 randomised controlled trials (RCTs) and 13 SRs). The most studied self-management components were specific interactive disease education in ten RCTs, problem solving in nine RCTs, cognitive–behavioural therapy in eight RCTs, goal setting in six RCTs, patient education in five RCTs and response training in two RCTs. The most studied interventions were multicomponent or single exercise/physical activity in six SRs, psychosocial interventions in five SRs and education in two SRs. Overall, all these specific components and interventions of self-management have beneficial effects on IAs-related outcomes.ConclusionsThe findings confirm the beneficial effect of the self-management interventions in IA and the importance of their implementation. Further research should focus on the understanding that self-management is a complex intervention to allow the isolation of the effectiveness of its different components.

scholarly journals A systematic review of behavioural and exercise interventions for the prevention and management of chemotherapy-induced peripheral neuropathy symptoms

2021 ◽  
Author(s):  
Mary Anne Lagmay Tanay ◽  
Jo Armes ◽  
Rona Moss-Morris ◽  
Anne Marie Rafferty ◽  
Glenn Robert
Keyword(s):  
Peripheral Neuropathy ◽  
Health Management ◽  
Experimental Studies ◽  
Self Management ◽  
Cochrane Library ◽  
Pharmacological Interventions ◽  
Behavioural Interventions ◽  
Exercise Interventions ◽  
Beneficial Effects ◽  
Recommended Treatment

Abstract Background Chemotherapy-induced peripheral neuropathy (CIPN) can result in functional difficulties. Pharmacological interventions used to prevent CIPN either show low efficacy or lack evidence to support their use and to date, duloxetine remains the only recommended treatment for painful CIPN. Non-pharmacological interventions such as exercise and behavioural interventions for CIPN exist. Purpose The aims were to (1) identify and appraise evidence on existing behavioural and exercise interventions focussed on preventing or managing CIPN symptoms, (2) describe psychological mechanisms of action by which interventions influenced CIPN symptoms, (3) determine the underpinning conceptual models that describe how an intervention may create behaviour change, (4) identify treatment components of each intervention and contextual factors, (5) determine the nature and extent of patient and clinician involvement in developing existing interventions and (6) summarise the relative efficacy or effectiveness of interventions to lessen CIPN symptoms and to improve quality of life, balance and muscle strength. Methods A systematic search of Ovid Medline, Cochrane Library, EMBASE, PsycINFO, Health Management Information Consortium, Global Health and CINAHL was performed to identify articles published between January 2000 to May 2020, followed by OpenGrey search and hand-searching of relevant journals. Studies that explored behavioural and/or exercise interventions designed to prevent or improve symptoms of CIPN in adults who had received or were receiving neurotoxic chemotherapy for any type of cancer, irrespective of when delivered within the cancer pathway were included. Results Nineteen randomised controlled trials and quasi-experimental studies which explored behavioural (n=6) and exercise (n=13) interventions were included. Four studies were rated as methodologically strong, ten were moderate and five were weak. Ten exercise and two behavioural interventions, including those that improved CIPN knowledge and self-management resources and facilitated symptom self-reporting, led to reduced CIPN symptoms during and/or after chemotherapy treatment. Conclusions The extent of potential benefits from the interventions was difficult to judge, due to study limitations. Future interventions should incorporate a clear theoretical framework and involve patients and clinicians in the development process. Implications for Cancer Survivors Our findings show exercise interventions have beneficial effects on CIPN symptoms although higher quality research is warranted. Behavioural interventions that increase patient’s CIPN knowledge, improve self-management capacity and enable timely access to symptom management led to reduced CIPN symptoms.

FRI0562 THE PERSPECTIVE OF YOUNG PEOPLE WITH INFLAMMATORY ARTHRITIS ON PATIENT REPORTED OUTCOME MEASURES: RESULTS OF A EUROPE-WIDE SURVEY

2020 ◽  
Vol 79 (Suppl 1) ◽  
pp. 883-883
Author(s):  
A. Alunno ◽  
E. Mosor ◽  
T. Stamm ◽  
P. Studenic
Keyword(s):  
Young People ◽  
Qualitative Study ◽  
Personal Experience ◽  
Large Scale ◽  
Young Patients ◽  
Patient Reported Outcome Measures ◽  
Patient Reported Outcome ◽  
Self Management ◽  
Research Support ◽  
Patient Reported

Background:Although patient-reported outcome measures (PROMs) are widely used in clinical practice and research, it is unclear if these instruments adequately cover the perspective of young people (18-35 years) with inflammatory arthritis (IA). We recently performed focus groups on PROMs with 53 young IA patients from 4 European countries, but the perspective of these patients has never been explored on a large scale.Objectives:To explore personal experience, opinions and beliefs of young people with IA across Europe concerning PROMs content, characteristics and ways of administration in order to inform EULAR points to consider (PtC) for including the perspective of young patients with IA into PROMs.Methods:Based on the results of our previous qualitative study, a task force including patients, rheumatologists and health professionals developed an online survey. The survey covered personal experience, preferences and opinions concerning PROMs. After being pilot tested and revised accordingly, the survey was distributed through the EULAR people with arthritis and rheumatism in Europe (PARE), Young PARE networks and the Emerging EULAR Network (EMEUNET).Results:547 people (88% females) from 29 countries aged 18-35 years with a diagnosis of juvenile idiopathic arthritis, rheumatoid arthritis, Still’s disease, psoriatic arthritis or spondyloarthritis completed the survey (Figure 1). Thirty-seven percent of respondents reported they never filled a PROM. A North-South and West-East Europe gradient was observed (30.4% vs 56.3% and 25.5% vs 58.8% respectively). Figure 2 outlines key findings of our survey. Among respondents having filled PROMs (n=313), two thirds perceived their access to PROM results useful for self-management of their health. Discomfort while filling PROMs was an issue for nearly half of the respondents, as questions were perceived as scaring or not relevant. This discomfort, the fear of judgement, or inadequate assessed time frames were major reasons for difficulties in translating the health experience into a rating scale. Still 75% use their own experience in the past as reference. Among several reasons, people scored differently from what they felt to emphasize how much better or worse they felt from previous assessment. Concerning preferences of numerical rating scales (NRS) or visual analogue scales (VAS) explored in all respondents regardless having ever filled in PROMs, those in favour of VAS mainly reasoned this by having more possibilities to select and those favouring NRS by better readability and interpretation. Maintaining a sitting position, preparing food, doing physical activity, intimacy and sleep problems were the items selected most frequently in the survey as in the qualitative study to be included in PROMs. The implementation of discussion on self-management, education/work and support possibilities at regular clinic visits was considered important by over 60% of responders. Overall, electronic capturing of PROMs was preferred over paper-based questionnaires (57% vs 13%).Conclusion:Our survey explored for the first time the personal experience and opinions of young people with IA concerning PROMs on a large scale and confirmed the results obtained in the qualitative study. This survey informed the EULAR PtC for including the perspective of young patients with IA into PROMs.References:[1] Mosor E et al. Arthritis Rheumatol. 2019; 71 (suppl 10)Disclosure of Interests:Alessia Alunno: None declared, Erika Mosor: None declared, Tanja Stamm Grant/research support from: AbbVie, Roche, Consultant of: AbbVie, Sanofi Genzyme, Speakers bureau: AbbVie, Roche, Sanofi, Paul Studenic Grant/research support from: Abbvie

scholarly journals The role of Dietitian in cardiac rehabilitation and prevention

2016 ◽  
Vol 70 (3) ◽  
Author(s):  
Susanna Agostini ◽  
Barbara Biffi ◽  
Silvia Brazzo ◽  
Letizia Da Vico ◽  
Maria Luisa Masini ◽  
...  
Keyword(s):  
Risk Factors ◽  
Cardiovascular Disease ◽  
Cardiac Rehabilitation ◽  
Serum Lipids ◽  
Scientific Literature ◽  
Psychosocial Interventions ◽  
Pharmacological Interventions ◽  
Nutritional Interventions ◽  
Reduction Of Mortality

Rehabilitation and secondary prevention programs are recognized as an essential part of the overall care of patients with cardiovascular disease. They consist of multidisciplinary strategies aiming at the reduction of modifiable risk factors for cardiovascular disease. Cardiac rehabilitation includes non-pharmacological interventions as: Patients’ evaluation. Nutritional counseling. Risk factors management (serum lipids, blood pressure, weight, diabetes, smoking). Psychosocial interventions. Physical activity and cardiovascular physical training counseling. Their effectiveness in the reduction of mortality through the decrease of risk factors has been proven in the last twenty years. Guidelines on appropriate and well-framed interventions have been released and nutritional interventions have a ringside seat in all programs. During 2007, the Italian Association of Dietitians, ANDID, created a working group of expert dietitians, with the goals of making a review of available scientific literature and of elaborating a Professional Position Papers on the role of Dietitian in cardiac rehabilitation and prevention. This Position Paper retrieves and remarks the available evidence that are important for the dietitians, according to their professional role and their contribution in the management of the topic.

scholarly journals Participants and developers experiences with a chronic pain self-management intervention under development: A qualitative study

2018 ◽  
Vol 6 ◽  
pp. 205031211881742 ◽  
Author(s):  
Kjersti Grønning ◽  
Torunn Hatlen Nøst ◽  
Toril Rannestad ◽  
Ola Bratås
Keyword(s):  
Chronic Pain ◽  
Qualitative Study ◽  
Behavioural Change ◽  
User Involvement ◽  
Social Needs ◽  
Self Management ◽  
Pharmacological Interventions ◽  
Healthy Life ◽  
Management Intervention ◽  
Cognitive Techniques

Background: Non-pharmacological interventions aim to promote health and self-management for people with chronic pain. Objective: The aim of this study was to explore if the participants’ experiences with a self-management intervention under development were aligned with the developers’ rationale and desired outcome of the intervention. Methods: This was a qualitative study interviewing both participants and developers of a chronic pain self-management intervention. Seven participants, six females and one male in the age from early thirties to mid-seventies attended the chronic pain self-management intervention developed by the staff at a Healthy Life Centre. The data were analysed by the systematic text condensation method. Results: The analyses showed that the participants evaluated the intervention as valuable. They described using coping techniques to manage their chronic pain better, and the developers stated that the aim with the intervention was to provide the participants with coping techniques. The intervention was built upon the developers’ professional knowledge and experience in cognitive techniques, health theories, models for behavioural change, and service user involvement. Conclusion: This study found that the chronic pain self-management intervention was in concordance with theory of health promotion and empowerment. The participants experienced the intervention as targeting their resources, capacities, and fulfilling social needs, which aligned with the developers aim with the intervention. The participants found the intervention evocative; they learned new ways to manage their pain through theory/education, movement exercises, homework, and sharing their experiences with each other.

Non-pharmacological interventions in care homes, with particular emphasis on the treatment of people with dementia

2020 ◽  
pp. 265-280
Author(s):  
Ian A. James ◽  
Alan Howarth
Keyword(s):  
Psychosocial Interventions ◽  
Care Homes ◽  
Future Research ◽  
Pharmacological Interventions ◽  
Cognitive Health ◽  
Care Plans ◽  
People With Dementia ◽  
The Individual ◽  
The Uk ◽  
Preventative Interventions

In the UK there are over 22,000 care homes, largely run by the private and charitable sectors, caring for 416,000 people. The residents in care homes present with a range of needs linked to physical health, cognitive health, and mental health. A large proportion of residents in care homes have dementia and many of them exhibit Behaviours that Challenge (BtC). This chapter focuses on the non-pharmacological interventions available in care homes to help treat BtC that occur in the context of dementia. It discusses preventative interventions designed to promote the wellbeing of people with dementia, and reviews the evidence. Formulation-led interventions identify the needs of the individual and lead to the development of person-centred care plans and the evidence strongly supports that these are needed to deliver effective psychosocial interventions in care homes. Finally, the chapter discusses the implications for future research.

scholarly journals Nursing and no Drug for the Management of Insomnia Treatment

2019 ◽  
Vol 18 (2) ◽  
pp. 512-532 ◽  
Author(s):  
Raquel Baides Noriega ◽  
Sara Noriega Camporro ◽  
Alicia Maria Inclán Rodríguez
Keyword(s):  
Complementary Therapy ◽  
Pharmacological Interventions ◽  
First Line ◽  
Pharmacological Management ◽  
Cognitive Behavioural ◽  
Management Procedures ◽  
Hygiene Measures ◽  
Insomnia Treatment ◽  
And Training ◽  
Primary Care Nursing

Introducción: El insomnio es definido como la incapacidad para iniciar y/o mantener el sueño. Es el trastorno del sueño más frecuente y puede producir consecuencias para la salud en todas las dimensiones. Las medidas no farmacológicas han mostrado mejor efecto a largo plazo para el manejo del insomnio, por lo que el uso de fármacos debe restringirse como segunda línea de tratamiento.Metodología: Con objeto de conocer procedimientos no farmacológicos para el manejo del insomnio desde Enfermería de Atención Primaria, se realizó una revisión bibliográfica a través de fuentes primarias y secundarias. Resultados: Como primera línea de tratamiento destacan las terapias conductuales y cognitivo-conductuales asociadas a la educación para la salud y medidas de higiene de sueño. Según algunos estudios, nueve consultas de 30 minutos, con intervenciones no farmacológicas, reducirían el insomnio crónico con efectividad del 70 al 80%. Además existen terapias alternativas que asociadas como terapias complementarias pueden ayudar al manejo del insomnio con nivel de evidencia suficiente.Conclusiones: Las medidas no farmacológicas deben utilizarse como primera línea de tratamiento. Sin embargo, en nuestro país, apenas se prescriben y existe un alto consumo de fármacos destinados a solucionar este problema, con las consiguientes consecuencias para la salud que producen. Para poder abordar la situación se considera fundamental una mejora de los recursos humanos profesionales y formación al respecto. Introduction: Insomnia is defined as the inability to initiate or maintain sleep. It is the most common sleep disorder and can produced consequences for health in all aspect. Non-pharmacological measures have shown better effect in the long management of insomnia, so the use of drugs should be restricted as a second-line treatment.Methodology: In order to learn about non-pharmacological management procedures of insomnia from primary care nursing, we conducer a literature review through primary and secondary sources.Results: As first line treatment include therapies behavioural and cognitive-behavioural associated with education for health and the sleep hygiene measures. According to some studies, nine 30-minute, non-pharmacological interventions queries, reduce chronic insomnia with effectiveness of 70 to 80%. Also there are alternative therapies such as the use of valerian to associate as complementary therapy can help the Management of insomnia with good level of evidence.Conclusions: Non- pharmacological measures should be used as a first line of treatment. However in our country to penalties are prescribed and there is high consumption of drugs for this problem, with the resulting consequences for the health of tolerance and dependence producing the maintained consumption of these dugs. Addressing the situation is considered essential to an improvement of the professional human resources and training.

scholarly journals Insights from Australians with respiratory disease living in the community with experience of self-managing through an emergency department ‘near miss’ for breathlessness: a strengths-based qualitative study

BMJ Open ◽  
2017 ◽  
Vol 7 (12) ◽  
pp. e017536 ◽  
Author(s):  
Tim Luckett ◽  
Jane Phillips ◽  
Miriam Johnson ◽  
Maja Garcia ◽  
Priyanka Bhattarai ◽  
...  
Keyword(s):  
Emergency Department ◽  
Self Efficacy ◽  
Near Miss ◽  
Self Management ◽  
Integrative Approach ◽  
Future Research ◽  
Management Approach ◽  
Chronic Obstructive ◽  
Pharmacological Management ◽  
Near Misses

ObjectivesBreathlessness ‘crises’ in people with chronic respiratory conditions are a common precipitant for emergency department (ED) presentations, many of which might be avoided through improved self-management and support. This study sought insights from people with experience of ED ‘near misses’ where they considered going to the ED but successfully self-managed instead.Design and methodsA qualitative approach was used with a phenomenological orientation. Participants were eligible if they reported breathlessness on most days from a diagnosed respiratory condition and experience of ≥1 ED near miss. Recruitment was through respiratory support groups and pulmonary rehabilitation clinics. Semistructured interviews were conducted with each participant via telephone or face-to-face. Questions focused on ED-related decision-making, information finding, breathlessness management and support. This analysis used an integrative approach and independent coding by two researchers. Lazarus and Cohen’s Transactional Model of Stress and Coping informed interpretive themes.ResultsInterviews were conducted with 20 participants, 15 of whom had chronic obstructive pulmonary disease. Nineteen interviews were conducted via telephone. Analysis identified important factors in avoiding ED presentation to include perceived control over breathlessness, self-efficacy in coping with a crisis and desire not to be hospitalised. Effective coping strategies included: taking a project management approach that involved goal setting, monitoring and risk management; managing the affective dimension of breathlessness separately from the sensory perceptual and building three-way partnerships with primary care and respiratory services.ConclusionsIn addition to teaching non-pharmacological and pharmacological management of breathlessness, interventions should aim to develop patients’ generic self-management skills. Interventions to improve self-efficacy should ensure this is substantiated by transfer of skills and support, including knowledge about when ED presentation is necessary. Complementary initiatives are needed to improve coordinated, person-centred care. Future research should seek ways to break the cyclical relationship between affective and sensory-perceptual dimensions of breathlessness.

Treatment of Depression

2017 ◽  
Author(s):  
Martin Steinberg
Keyword(s):  
Suicide Attempts ◽  
Antidepressant Treatment ◽  
Severe Depression ◽  
Poor Response ◽  
Psychosocial Interventions ◽  
The Elderly ◽  
Psychotic Symptoms ◽  
Pharmacological Interventions ◽  
Multiple Risk Factors ◽  
Treatment Of Depression

Most depression in the elderly can be effectively treated in the primary care setting. Psychiatric referral should be considered in the setting of severe depression, suicidal ideation, prior suicide attempts, multiple risk factors, psychotic symptoms, bipolar disorder, poor response to prior treatment, or high medical comorbidity. Combining pharmacological and psychosocial interventions is most likely to be effective. Available antidepressants include serotonin-specific reuptake inhibitors, serotonin norepinephrine reuptake inhibitors, novel mechanism agents, tricyclic antidepressants, and monoamine oxidase inhibitors. Antidepressant selection should take into account adverse effects, medical comorbidities, potential medication interactions, and patient preferences. Additional strategies (e.g. augmentation) are available for treatment resistant depression. Available psychotherapies include supportive, cognitive-behavioral, interpersonal, and problem solving. Lifestyle interventions (e.g. exercise) may be helpful adjuncts. Given limited evidence for antidepressant treatment in cognitive impairment, for those with mild to moderate depression severity, non-pharmacological interventions should be attempted first.

Psychosocial Treatments for Major Depressive Disorder

2015 ◽  
Author(s):  
W. Edward Craighead ◽  
Benjamin N. Johnson ◽  
Sean Carey ◽  
Boadie W. Dunlop
Keyword(s):  
Major Depressive Disorder ◽  
Depressive Disorder ◽  
Rating Scales ◽  
Behavioral Therapy ◽  
Psychosocial Interventions ◽  
Pharmacological Interventions ◽  
Major Depressive ◽  
Psychosocial Treatments ◽  
Major Depressive Episodes ◽  
Depressive Episodes

Behavior therapy, cognitive-behavioral therapy, and interpersonal psychotherapy have each been shown by at least two randomized controlled trials, as well as by numerous meta-analytic reports, to be effective psychosocial interventions for patients meeting criteria for major depressive disorder. All three psychosocial treatments have yielded substantial reductions in scores on the two major depression rating scales, significant decreases in percentage of patients meeting depression criteria at posttreatment, and substantial maintenance of effects well after treatment has ended. The data for outcomes of psychosocial and pharmacological interventions for major depressive episodes suggest that the two treatment modes are equally efficacious.

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