Cardiac post-surgical pain ratings with various activities
Dr. Lesley B. Milgrom and colleagues studied 711 adult patients who underwent cardiac surgery and found that their pain ratings were highest soon after surgery and were associated with the following activities in order of intensity: coughing, moving, turning in the bed, getting up, deep breathing, using the incentive spirometer and resting. Dr. Milgrom and colleagues partly conclude, “…Pain relief is an important outcome of care. A comprehensive, individualized assessment of pain that incorporates activity levels is necessary to promote satisfactory management of pain.”
American Journal of Critical Care (2004, 13: 116-125)
Dr. K.H. McVeigh and colleagues at the New York City Department of Health and Mental Hygiene found that after studying 9,590 people in a general health survey, adults with diabetes are considerably more likely to experience depression, anxiety and other serious emotional stress than those without diabetes. In addition, those with diabetes were more likely to be divorced, separated or widowed, lacked private insurance, and were more likely to have a household income below $25,000. Dr. McVeigh and colleagues partly conclude by writing, “…persons with comorbid diabetes and SPD face formidable economic and social obstacles to receiving appropriate health care…increased use of more effective methods for detecting and managing depression and other mental disorders might be particularly beneficial for persons with diabetes.”
Center for Disease Control (CDC) Morbidity and Mortality Weekly Report, (2004, 53: 1089-1092)
Group therapy interventions for people with cancer & HIV/AIDS
Dr. Allen C. Sherman and colleagues reviewed the current research literature pertaining to group therapy interventions for patients at risk for developing or those patients already diagnosed with either cancer or HIV/AIDS and found that among healthy subjects at heightened risk, evidence supports the efficacy of cognitive-behavioral group interventions for reducing HIV-related sexual risk behaviors and that for patients with limited disease, there is very strong evidence of the efficacy of skills-oriented groups for enhancing adjustment and coping. For patients with advanced cancer or HIV/AIDS, the research review showed that longer-term existentially oriented, supportive-expressive psychotherapy or group interventions were most efficacious for this sub-population compared to short-term skills or CBT groups. Dr. Allen and colleagues partly conclude, “…One area for further study concerns the differential effects of various treatment models. In the prevention literature, skills-focused, cognitive-behavioral groups have, for the most part, consistently outperformed educational groups. As cognitive-behavioral groups continue to evolve, other approaches are being developed as well… the current literature generally supports brief, skills-oriented groups at early phases of cancer or HIV infection and longer-term, more interactive groups at later phases of cancer...”
International Journal of Group Psychotherapy, (2004; 54: 29-82)
Dr. S. Sandberg and colleagues at the University College in London studied 60 children with verified chronic asthma and followed them prospectively and found that stressful life events increased the likelihood of new asthma attacks in children within two days of moderately stressful events and within five to seven weeks after a severe stressful events. Dr. Sandberg and colleagues partly conclude by writing, “…Many of the same autonomic mechanisms thought to have a role in asthma are involved in the activation and regulation of physiological responses to stress.... Future studies will also need to distinguish between stimuli or events that cause stress and those more likely to be temporarily increasing physiological arousal, and to consider factors such as duration of the stress and levels of chronic adversity."
Dr. Hans-Christoph Diener and colleagues at the University of Essen in Germany found that after conducting a three-fold, multicenter cross-over, double-blind, randomized trial, with 312 migraine patients from 16 centers in Germany, Italy and Spain, that 1000mg of effervescent acetylsalicylic acid was as effective as 50mg of sumatriptan or 400mg of ibuprofen for the treatment of migraine headaches. Dr. Diener and colleagues conclude that effervescent aspirin can achieve comparable results to sumatriptan and ibuprofen in the “…acute treatment of migraine attacks and offers high efficacy and good tolerability."
Physician self-disclosure and patient satisfaction – a mixed bag
Dr. Mary Catherine Beach and colleagues surveyed 1,265 patients who visited 59 primary care physicians and 65 surgeons and found that in 17% of the primary care visits and 14% of the surgical visits, physicians self-disclosed something about themselves. The primary care patients reported fewer feelings of warmth, friendliness and reassurance after the primary care physicians self-disclosed as opposed to the surgical patients who reported greater feelings on the same measures. Dr. Beach and colleagues partly conclude, “…Physician self-disclosure is significantly associated with higher patient satisfaction ratings for surgical visits and lower patient satisfaction ratings for primary care visits. Further study is needed to explore these intriguing findings and to define the circumstances under which physician self-disclosure is either well or poorly received.”
Journal of General Internal Medicine (2004: 19: 905)
Dr. Kathryn Rost and colleagues studied the effects of depression treatment in a group of 326 full- or part-time workers who were diagnosed with depression. The workers were randomly assigned to receive either standard depression treatment or "enhanced" treatment from specially trained health care providers. Those workers assigned to "enhanced" depression treatment received their interventions from specially trained primary care providers who encouraged workers to consider antidepressant medication and/or counseling. Patients on the enhanced treatment plan were regularly contacted by a care manager who discussed their symptoms and provided extra information about depression treatment. The care manager also encouraged the patients to stick with their treatments and adjusted the treatments if necessary. The intervention of the enhanced treatment improved productivity by 8.2 percent among consistently employed depressed workers. The annual economic benefit associated with this improvement in consistently employed workers is $1,982 per depressed full-time employee. Dr. Rost and colleagues partly conclude by writing ".Corporations employing stable workforces whose business interests are served by present and productive workers have reason to encourage health plans to improve primary care depression treatment. In ensuring benefits for themselves, corporations may also contribute to improving their employees' lives."
Some Ayurvedic herbal medicines contain heavy metals
Dr. Robert Saper and colleagues write that in randomly purchasing Ayurvedic herbal medicine products at 20 stores in the Boston area over a six month period, they found that after measuring concentrations of lead, mercury and arsenic through x-ray fluorescence spectroscopy that 20% of the preparations contained lead (median concentration, 40 µg/g; range, 5-37 000), mercury (median concentration, 20 225 µg/g; range, 28-104 000) and arsenic (median concentration, 430 µg/g; range, 37-8130) which ingested as recommended by the product, would produce heavy metal intakes above regulatory standards for safety. Dr. Saper and colleagues partly conclude by writing." Users of Ayurvedic medicine may be at risk for heavy metal toxicity, and testing of Ayurvedic HMPs for toxic heavy metals should be mandatory."
Journal of American Medical Association (2004: 292; 2868-2873)
Larry Lachman, PsyD is a Licensed Clinical Psychologist with Inner Dimensions Group in Monterey, California, who specializes in Psycho-Oncology, Cardiac Psychology, Pain Management and Grief and Loss. Dr. Lachman is the co-author with Carmel Poet/Philosopher Ric Masten of a book on coping with cancer entitled, "Parallel Journeys." Dr. Lachman is also the Program Manager for the Graduate Psychology Program at Chapman University College in Monterey. www.ParallelJourneys-Cancer.com
P. O. Box 22151 Carmel, Ca. 93922 Ph: (831) 643-2635 Fx: (734) 448-4724
![International Journal of Healing and Caring [IJHC] facebook page](sitegraphics/facebook_icon.png "International Journal of Healing and Caring [IJHC] facebook page"){kind=icon}
Cardiac post-surgical pain ratings with various activities
