PubMed Health⌕ Search

Biomedical subjects

B K Bruce

Publications and source records attributed to B K Bruce.

17 recordsLinked to original sources
PubMed2000

Psychological disorders in patients with evacuation disorders and constipation in a tertiary practice.

OBJECTIVE: We aimed to evaluate the prevalence of psychological impairment in patients with rectal evacuation disorders and the influence of psychological disorder on the early outcome of behavioral treatment. METHODS: We retrospectively reviewed the medical records of patients with rectal evacuation disorders referred for biofeedback retraining at a tertiary referral center. The psychological disorder was classified using the DSM IV criteria. Outcome of biofeedback treatment of evacuation at 2 wk was based on symptoms or on the ability to spontaneously expel a balloon placed in the rectum. Improvements in the groups without versus with a psychological disorder or an eating disorder were compared by Fisher's exact test. RESULTS: In the 60 patients (55 women; 5 men; mean age, 38 yr), psychological disorders were identified in 39 (65%); also noted were eating disorder (n = 5), rumination syndrome (n = 3), pain disorder (n = 6), anxiety-depression (n = 10), a combination of depression and pain disorder (n = 3), and a combination of eating disorder with anxiety-depression and pain disorder (n = 12). There was an association between psychological status and outcome at 2 wk of behavioral treatment for evacuation disorder (p = 0.03). The coexistence of eating disorder and psychological disorder resulted in an unfavorable outcome (p = 0.02), compared with those without psychological disorder. CONCLUSION: Psychological impairment was identified in 65% of the patients with evacuation disorder and constipation in a tertiary care practice, and has a significant negative impact on the outcome of behavioral treatment. These data reinforce the importance of a multidisciplinary approach in the management of these patients.

Adolescent↗
PubMed1996

Odor aversion of multiple chemical sensitivities: recommendation for a name change and description of successful behavioral medicine treatment.

Patients with odor-triggered symptoms, meeting the case definition of multiple chemical sensitivities (MCS), continue to be seen in our institution and other health science centers [Amundsen, Mayo Clinic Dept. Intern. Med. Newslett. 9(1) (1986)]. The term MCS, unfortunately, feeds the thesis that symptoms are allergic-immune system in origin, a theory that has not withstood scientific scrutiny [American College of Physicians, Ann. Intern. Med. 111, 168-178 (1989); Terr, Ann. Intern. Med. 119, 163-164 (1993)]. It has been proposed that some of these cases may be examples of classical (Pavlovian) conditioning: many MCS patients meet diagnostic criteria for psychiatric illnesses, especially mood, anxiety, and somatoform disorders. Attention is turning to the complex relationship between olfactory stimulation, memory, and mood (psyche) in an attempt to understand why some individuals develop odor aversion symptoms and how to best manage these, frequently, severely disabled patients. Two subjects with typical odor-triggered symptoms have been treated, using behavioral medicine techniques, with marked improvement in both cases. The term "odor aversion" is proposed rather than MCS to describe patients with these symptoms.

Behavior Therapy↗
PubMed1996

A rehabilitation approach to chronic pain in rheumatologic practice.

There have been several recent studies of the epidemiology and costs attributable to the chronic pain and chronic fatigue syndromes. Although investigations of the putative mechanisms of these disorders continue, there remains a poor understanding of their underlying pathophysiology. Four studies are reviewed that further support the commonality of both physical symptoms and psychological distress in chronic pain and chronic fatigue syndromes. By considering these commonalities, a comprehensive behavioral-rehabilitative approach can be undertaken to assist patients in addressing their adaptive difficulties. An overview of admission criteria for pain rehabilitation services is provided. Finally, recent empirical studies of both treatment process and outcome provide further support for the effectiveness and long-term benefits of this approach.

Behavior↗
PubMed1995

The rumination syndrome: clinical features rather than manometric diagnosis.

BACKGROUND/AIMS: Rumination is infrequent in adults of normal mental capacity. Upper gastrointestinal manometry reportedly confirms the diagnosis. Clinical characteristics, treatment(s), and outcomes of these patients are unclear. METHODS: We assessed 38 adults and adolescents with rumination between 1987 and 1994. Esophagogastroduodenal manometric recordings (n = 36; 3-hour fasting and 2-hour postprandially) were reviewed; follow-up information was obtained from mailed questionnaires. RESULTS: Patients saw a mean of five physicians and had symptoms for a mean of 2.75 years before diagnosis. Features included daily, effortless regurgitation of undigested food starting within minutes of meals. Weight loss was substantial (mean, 29 lb) in 42% of patients. Seventeen percent of female patients had a history of bulimia. Manometry confirmed the clinical diagnosis in 33% but was otherwise normal in all. Of 16 patients who responded to our questionnaires of 29 with > 6 months of follow-up (average, 35 months), 12 reported subjective improvement. In 14, the behavior persists. CONCLUSIONS: The rumination syndrome is underdiagnosed. With typical clinical features, gastroduodenal manometry seems unnecessary to confirm the diagnosis. Diagnosis and reassurance are important in management to avoid unnecessary tests and treatments.

Adolescent↗
PubMed1994

Self-administered Nicotine-Dependence Scale (SANDS): item selection, reliability estimation, and initial validation.

The Self-Administered Nicotine-Dependence Scale (SANDS) is a questionnaire to assist in the determination of the most appropriate intervention for the nicotine-dependent individual. Six content domains included are: (1) self-efficacy; (2) social skills deficit; (3) loss of control; (4) consequences of use; (5) social support for smoking; and (6) concern for healthy life-style. A preliminary set of 79 items was reduced to a 32-item scale, which, in turn, was divided into two non-overlapping subscales of 16 items each. Logistic regression analyses of an additional sample of subjects indicated that the SANDS added predictive power to knowledge of sex and transdermal-patch status for predictions of smoking status 6 months later.

Adult↗
PubMed1994

How compliant is compliant? Evaluating adherence with breast self-exam positions.

The present study examined compliance with the three recommended breast self-examination (BSE) positions over a 6-month follow-up period. An ongoing behavioral measure that provided information about the type of exam performed during each BSE occasion was employed. Results indicated that adherence to all three position types was obtained in only 40% of the exams. Forty-two percent of exams were comprised of only one position, with the supine position being the most frequently practiced exam type. Implications of these results with regard to BSE research and current breast cancer screening recommendations are discussed.

Adult↗
PubMed1994

Nicotine dependence treatment during inpatient treatment for other addictions: a prospective intervention trial.

This study assessed the effect of treating nicotine dependence in smokers undergoing inpatient treatment for other addictions. It was a prospective, nonrandomized, controlled trial with a 1-year outcome. The subjects were smoking patients (50 controls, 51 in intervention group) in an inpatient addictions treatment unit in a medical center. The enrollment of subjects was sequential: controls were enrolled first; after a 6-week washout period, intervention subjects were enrolled. Controls received usual care, and the intervention group received nicotine dependence treatment consisting of a consultation, 10 intervention sessions, and a structured relapse prevention program. Smoking cessation rate and abstinence from alcohol or other drug use were the main outcome measures. The confirmed smoking cessation rate at 1 year was 11.8% in the intervention group and 0.0% in the control group (p = 0.027). Nicotine dependence intervention did not seen to interfere with abstinence from alcohol or other drugs (1-year relapse rate was 31.4% in the intervention group and 34.0% in controls). In this study, nicotine dependence treatment provided as part of addictive disorders treatment enhanced smoking cessation and did not have a substantial adverse effect on abstinence from the nonnicotine drug of dependence.

Adult↗
PubMed1993

Contingent social reinforcement for fluid compliance in a hemodialysis patient.

Two approaches, (a) patient education and (b) compliance-contingent social reinforcement, were employed to improve compliance with fluid restrictions in a chronically noncompliant hemodialysis patient of borderline intellectual functioning. Results indicated that only social reinforcement led to improved compliance (i.e., decreased intersession weight gain). Treatment effects were well maintained at both 3- and 6-month follow-ups. Contingency management strategies are recommended as a potentially cost effective treatment for noncompliance in hemodialysis patients.

Adult↗
PubMed1992

Inpatient treatment of severe nicotine dependence.

The most severely nicotine-dependent patients who have tried traditional treatment programs without success may require maximal intervention to achieve abstinence. In the Clinical Research Center at the Mayo Clinic, we assessed the feasibility of an inpatient treatment program for 24 such subjects, who were hospitalized (in groups of 6) for 2 consecutive weeks. A combination of behavioral, chemical-dependence, and transdermal nicotine-replacement therapy was provided in a smoke-free, protected milieu. Components of the program included group therapy, management of stress, exercise, daily lectures, and supervised activities. The mean age of the 18 women and 6 men was 51.3 years (range, 29 to 69 years). The mean duration of smoking was 33.7 years, and the number of cigarettes smoked per day at the time of admission averaged 33.2. The most frequent tobacco-related medical illnesses were chronic obstructive pulmonary disease, arteriosclerosis obliterans, and coronary artery disease. All subjects but two--each smoked part of a cigarette--remained abstinent from the use of cigarettes while in the Clinical Research Center, and all completed the 2-week inpatient program. The subjects underwent follow-up for 10 weeks after dismissal and were contacted periodically thereafter. At 1 year, 7 of the 24 subjects (29%) had maintained continuous abstinence from smoking, and their self-reported status at 1 year was verified biochemically.

Adult↗
PubMed1992

A comprehensive model for the treatment of nicotine dependence in a medical setting.

We have summarized the basic components of a comprehensive model for the treatment of nicotine addiction in a medical setting. It is a labor-intensive program with emphasis on individual assessment and the development of individual treatment programs adaptable to all levels of nicotine dependence. We anticipate that this model will be increasingly used by medical centers in the future. As more traditional programs successfully treat the less severely nicotine-dependent patients, more severely dependent smokers are left in need of more intensive services. We have already begun to see this trend in our practice, requiring more counselor time for individual follow-up and referral into our group therapy programs. Adjunctive pharmacologic therapy is an exciting and promising area, but best results include associated behavioral intervention. Reimbursement remains a major impediment to patient involvement in many of these programs. This impediment will be overcome when third-party payers begin to cover these services as endorsed by the Surgeon General and the United States Department of Health and Human Services.

Counseling↗
PubMed1990

Efficacy of behavioral management and patient education on vascular access cleansing compliance in hemodialysis patients.

Compared four treatment conditions to test their ability to enhance compliance with vascular access cleansing (VAC) procedures in a group of 56 hemodialysis patients. The conditions were patient education, behavioral management with monetary incentive, patient education/behavioral management, and attention control. Behavioral observers rated VAC behavior at pretreatment, posttreatment 1-month follow-up, and 1-year follow-up. Knowledge of VAC procedures was also assessed via a questionnaire at pretreatment and posttreatment. Data were analyzed using repeated-measures multivariate analyses of variance. Results indicated that the patients in the education/behavioral, behavioral, and education groups gave significantly more correct answers on our VAC knowledge questionnaires at posttreatment than did patients in the attention control group. Further, patients in the education/behavioral and behavioral groups completed significantly more VAC steps at posttreatment and 1-month follow-up than did patients in the education group and in the attention control group. Differences were not maintained at 1-year follow-up, although more than 50% of the patients were lost to follow-up. Implications of the present findings for behavioral and educational interventions are discussed.

Adult↗
PubMed1989

Behavior therapy: a clinical update.

Through refinements from research and judicious combination with other therapies, behavior therapy has become increasingly relevant in the treatment of psychiatric disorders. After outlining the four models that serve as a framework for behavior therapy (classical conditioning, operant conditioning, social learning theory, and cognitive behavior modification), the authors provide an update for clinicians on developments in the behavioral treatment of anxiety disorders, sexual disorders, depression, and schizophrenia. Most advances have been made in the treatment of anxiety disorders, including definition of variables for successful use of exposure to phobic stimuli in the treatment of phobic disorders and the use of flooding for post-traumatic stress disorder. By becoming better acquainted with cognitive and behavioral therapies, clinicians may be able to offer their patients more effective treatment options.

Anxiety Disorders↗
PubMed1983

Hypothalamic hyperinsulinemia and obesity: role of adrenal glucocorticoids.

The effects of adrenalectomy on the obesity and hyperinsulinemia induced by ventromedial hypothalamic (VMH) lesions were studied in female rats. Plasma insulin and glucose levels were assayed after a 4-h fast and 17 min after the initiation of a meal (6 ml sweetened milk in 7 min). The development of hypothalamic obesity was prevented by prior adrenalectomy and restored by administration of corticosterone. Adrenalectomy abolished both the basal and postabsorptive hyperinsulinemia observed in sham-adrenalectomized rats with VMH lesions. Corticosterone treatment of adrenalectomized animals enhanced both basal and postabsorptive insulin levels, but adrenalectomized rats with VMH lesions were hyperinsulinemic compared with animals with sham lesions only under the postabsorptive condition. Postabsorptive glucose levels were unaffected by either the lesion or adrenal ablation. The results support our previous conclusion that postabsorptive hyperinsulinemia is of greater importance than is basal hyperinsulinemia in the pathogenesis of hypothalamic obesity. Although the results are consistent with a stimulatory role of corticosterone on food intake mediating the postabsorptive hyperinsulinemia, a primary effect on CNS loci involved with the regulation of insulin secretion is also possible.

Adrenalectomy↗
PubMed1982

Effects of adrenalectomy and corticosterone administration on hypothalamic obesity in rats.

The present experiment was designed to assess the role of adrenal hormones in hypothalamic hyperphagia and obesity. Ventromedial hypothalamic (VMH) or sham lesions were produced either 15 days before or after adrenalectomy (ADX) or sham adrenalectomy in rats in a completely counterbalanced design (experiment 1). Body weight and food intake were recorded for 30 days after the second surgery. Adrenalectomy in obese VMH animals eliminated all excess weight gain and decreased food intake to below the level of all control groups. VMH lesions in ADX animals did not produce the characteristic weight gain associated with ventromedial hypothalamic damage, and this group was not significantly different from animals with sham lesions in body weight or food intake. In experiment 2, the administration of corticosterone resulted in a marked increase in the rate of weight gain in ADX-VMH animals, and the withdrawal of the hormones was followed by weight loss. It is concluded that adrenal glucocorticoid hormones are necessary for the development and maintenance of VMH hyperphagia and obesity.

Adrenal Glands↗
PubMedDate not supplied

An integrated approach to the treatment of nicotine dependence in a medical center setting: description of the initial experience.

A nicotine-dependence treatment program can be implemented in a medical center setting by using a model that involves physician, patient, and nicotine-dependence counselor. The physician-referred and counselor-directed consultations are followed by a systematic relapse-prevention program. The counselors utilize behavioral approaches, the philosophy and principles of the addictive disorders field, and adjunctive pharmacologic therapy. The patients are chronic, heavy smokers who have had many previous quit attempts and are highly nicotine-dependent. Important factors include: 1) referral by physicians, 2) physicians' active role in the intervention, 3) expertise of the counselors, 4) structured relapse-prevention program, and 5) provision of services in a smoke-free medical center.

Adult↗
PubMedDate not supplied

Randomized trial of dietician counseling to try to prevent weight gain associated with breast cancer adjuvant chemotherapy.

This study was developed to test whether prospective dietician counseling could abrogate the unwanted weight gain seen among women receiving adjuvant chemotherapy for resected breast cancer. It was also designed to examine predictive factors for weight gain in an exploratory manner. Premenopausal women starting adjuvant chemotherapy for primary breast cancer were recruited for this trial. After appropriate stratification, they were randomized to a group which received monthly dietician counseling primarily aimed at weight maintenance versus a control group (whose attending physicians and nurses told them about possible weight gain but provided no formalized dietician counseling). One hundred and seven evaluable women were equally divided between the two protocol arms. The median weight changes 6 months after start of chemotherapy were gains of 2.0 kg in the dietician counseling group versus 3.5 kg in the control group. The median changes in average calorie consumption were reductions of 120 versus 46 cal/day on weekdays and 196 versus 20 cal/day on weekends for the counseling and control groups, respectively. Study data suggest that more weight was gained by patients with higher Quetelet's indices (p = 0.01) and patients who had been on a diet in the preceding 6 months (p = 0.02). Routine prospective dietician counseling aimed at weight maintenance appeared to produce small but statistically insignificant reductions in both calorie consumption and weight gain in this group of patients.

Adult↗