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PubMed2000

The question of phonetic balance in word recognition testing.

Twenty subjects with normal hearing and 15 subjects with mild-to-moderate sensorineural hearing losses were tested with eight lists of words using monosyllabic pronunciation to determine word recognition scores. Four of the lists were taken from Northwestern University Test No. 6 and four were simply made up by randomly selecting words from a dictionary. All of the word lists were used to determine performance-intensity functions. No clinically meaningful differences were observed among the lists.

Adult↗

PubMed2006

Use of vancomycin-containing lock or flush solutions for prevention of bloodstream infection associated with central venous access devices: a meta-analysis of prospective, randomized trials.

BACKGROUND: Prolonged exposure to central venous access devices carries significant risk of device-associated bloodstream infection (BSI), which is associated with morbidity, added health care costs, and attributable mortality. We aimed to determine the efficacy of vancomycin-heparin lock or flush solution in preventing BSI in patients being treated with long-term central venous intravascular devices (IVDs). METHODS: We collected data from January 1966 to January 2006 from multiple computerized databases and compiled reference lists of identified articles. We identified prospective, randomized controlled trials comparing a vancomycin-heparin lock or flush solution with heparin alone for prevention of BSI associated with long-term central venous IVDs. Using a standardized form, we abstracted data regarding study quality, patient characteristics, and incidence of BSI. RESULTS: Seven randomized, controlled trials involving a total of 463 patients being treated with IVDs met the inclusion criteria; 5 studies were conducted among patients with cancer, 1 among a critically ill neonatal population, and 1 among patients with cancer or who required parenteral nutrition. We could not detect publication bias. The summary risk ratio with a vancomycin heparin-lock solution for IVD-associated BSI was 0.49 (95% confidence interval [CI], 0.26-0.95; P = .03). Results of the test for heterogeneity were statistically significant; however, when a single study was removed from the analysis, heterogeneity was no longer present. Use of vancomycin as a true lock solution--instilling it for a defined period, rather than simply flushing it directly through the device--conferred a much greater benefit, with a risk ratio of 0.34 (95% CI, 0.12-0.98; P = .04). The 2 studies that performed prospective surveillance cultures to identify colonization or infection by vancomycin-resistant organisms did not find an increased risk. CONCLUSIONS: Use of a vancomycin lock solution in high-risk patient populations being treated with long-term central IVDs reduces the risk of BSI. The use of an anti-infective lock solution warrants consideration for patients who require central access but who are at high risk of BSI, such as patients with malignancy or low-birthweight neonates.

Adult↗

PubMed2005

Referrals to hospital-based rheumatology and orthopaedic services: seeking direction.

OBJECTIVES: While both community and hospital-based services strive to cope with the considerable burden posed by musculoskeletal disorders, multidisciplinary-led, integrated approaches are frequently lacking. It has been suggested that referrals to musculoskeletal services are frequently misdirected to an orthopaedic surgeon when non-surgical advice/intervention is warranted, reducing the efficiency of hospital-based services and potentially affecting quality of care. Triage of referrals may help to prevent this, but this system is dependent upon accurate and thorough information being provided in the referral letter. Our aim was to assess the feasibility of triage of musculoskeletal referrals to rheumatology and orthopaedic services at a large teaching hospital. METHODS: One thousand and eighty-seven consecutive referral letters to orthopaedic and rheumatology services were reviewed by a consultant rheumatologist. Letters were assessed for both basic content and the appropriate destination for that referral. In order to evaluate the accuracy of the assessor's prediction of the most appropriate destination of the referrals, the number of patients who were ultimately listed for surgical intervention was calculated in a random sample of orthopaedic referrals, 1 yr after the initial hospital appointment was requested. RESULTS: Six hundred and eighty-two referrals were to orthopaedics and 393 to rheumatology. Referrals relating to spinal pain were excluded. The content of letters was scant and no diagnosis was volunteered in 63.4% of referrals. Fifty-eight per cent of referrals to orthopaedics were considered appropriate; 27% of referrals to orthopaedics were defined as 'should definitely see a rheumatologist' (12%) or 'should probably see a rheumatologist' (15%). Fifteen per cent of referrals to orthopaedics were defined as 'could see either a surgeon or a rheumatologist'. Ninety-four per cent of referrals to rheumatology were defined as appropriate, 2% were not and 4% were defined as 'could see either a surgeon or a rheumatologist'. One year later, in a random sample of 373 of the orthopaedic referrals, 42.2% of those who were categorized as 'should see surgeon' and 9.7% of the 'should see a physician' group were listed for surgical intervention. CONCLUSIONS: Many referrals to hospital-based musculoskeletal services are likely to be misdirected. Integrated referral and care pathways are required for efficient and optimal care of patients with musculoskeletal diseases. The development of such pathways will require significant support, education and training for general practitioners.

Correspondence as Topic↗

PubMed2006

Discomfort on injection: a comparison between two formulations of propofol.

BACKGROUND AND OBJECTIVE: A randomized double-blind controlled trial was performed to determine if there was a difference in discomfort on injection between two preparations of propofol. A long-chain triglyceride preparation (LCT-propofol (Fresenius)) was compared against a medium- and long-chain triglyceride preparation (MCT/LCT-propofol (BBraun)). METHODS: One hundred and twenty ASA I-II patients listed for elective procedures were consented and randomized to receive either induction agent. A standard rate of infusion was used for induction of anaesthesia and subjects were questioned about discomfort until contact was lost. Discomfort was recorded as none, mild, moderate or severe. Incidence of postoperative nausea and vomiting and anti-emetic requirements were recorded in the postanaesthetic care unit. RESULTS: There was seen to be a 54% reduction in moderate/severe discomfort with MCT/LCT-propofol compared with LCT-propofol (P < 0.006). There was a 70% reduction in severe discomfort with MCT/LCT-propofol compared with LCT-propofol (P < 0.04). The term discomfort was used during the study because there is a wide array of unpleasant sensations felt by patients during propofol induction which are not always reported as pain. There was no significant difference in the incidence of postoperative nausea and vomiting or anti-emetic use between the two groups. CONCLUSIONS: There is a significant decrease in the incidence of discomfort with MCT/LCT-propofol compared with LCT-propofol. This difference is more marked in subjects reporting severe discomfort.

Adolescent↗

PubMed2000

Early administration of inhaled corticosteroids for preventing chronic lung disease in ventilated very low birth weight preterm neonates.

BACKGROUND: Chronic lung disease remains a common complication amongst preterm infants. There is increasing evidence that inflammation play an important role in the pathogenesis of CLD. Due to their strong anti-inflammatory properties corticosteroids is an attractive intervention strategy. However, there are growing concerns regarding short and long term effects of systemic corticosteroids. Theoretically, administration of inhaled corticosteroids may allow for beneficial effects on the pulmonary system with a lower risk of undesirable systemic side effects. OBJECTIVES: To determine the impact of inhaled corticosteroids administered to ventilated very low birth weight preterm neonates in the first two weeks of life for the prevention of chronic lung disease(CLD). SEARCH STRATEGY: Systematic search in accordance with Cochrane Neonatal Review Group. Randomized and quasi-randomized trials were identified by searching MEDLINE, Embase, CINAHL, the Cochrane Library, reference lists of published trials and abstracts published in Pediatric Research. SELECTION CRITERIA: Randomized controlled trials of inhaled corticosteroid therapy initiated within the first 2 weeks of life in ventilated preterm infants with birth weight 1500 grams or less were included in this review. DATA COLLECTION AND ANALYSIS: Data regarding clinical outcomes including chronic lung disease at 28 days or 36 weeks corrected gestational age (CGA), mortality, combined outcome of death or CLD at 28 days of age and at 36 weeks CGA, the need for systemic corticosteroids, failure to extubate within 14 days and adverse effects of corticosteroids were evaluated. All data were analyzed using Revman 3.1. When possible, meta-analysis was performed using relative risk (RR), risk difference (RD), along with their 95% confidence intervals (CI). If RD was significant, number needed to treat (NNT) was calculated. MAIN RESULTS: Eight trials assessing the impact of inhaled corticosteroid for the prevention of CLD were identified. The study by Kovacs 1998 was excluded as investigators evaluated the impact of a combination of systemic and inhaled corticosteroid for prevention of CLD. Seven trials qualified for inclusion in this review but data from two of these studies are awaiting assessment. Thus, the present review includes data analyses based on five qualifying trials. There was no statistically significant effect of inhaled steroids on CLD either at 28 days or at 36 weeks CGA, when analyzed either for all randomized infants or amongst survivors. No statistically significant differences were noted for mortality or for the combined outcome of mortality and CLD either at 28 days of age or at 36 weeks CGA. The meta-analysis supports a reduction in the need for systemic steroids, RR 0.78 (95% CI 0.62, 0.99), RD -0. 097 (95% CI -0.187, -0.008); however statistical heterogeneity was noted. The number needed to treat (NNT) to reduce the need for systemic steroid was 10 (95% CI 5.3, 125). There were no statistically significant differences in adverse events between groups. REVIEWER'S CONCLUSIONS: There is no evidence from the trials reviewed that early administration (in the first 2 weeks of life) of inhaled steroids to ventilated preterm neonates was effective in reducing the incidence of CLD. There was a reduction in the need for systemic steroids. Although this difference was statistically significant, there was significant heterogeneity between studies and the upper limit of the 95% CI for this outcome was very close to no effect. Currently, use of inhaled steroids in this population cannot be recommended. Studies are needed to identify the risk/benefit ratio of different delivery techniques and dosing schedules for the administration of these medications. Studies need to address both the short-term and long-term benefits and adverse effects of inhaled steroids with particular attention to neurodevelopmental outcome.

Administration, Inhalation↗

PubMed2003

At what price? The current state of subject payment in adolescent research.

PURPOSE: To examine how subject payment was associated with study features, such as investigator characteristics and project specifics, among randomly selected studies using adolescent subjects. METHODS: Using Psychinfo we gathered a list of original research studies published in 1999 that used adolescent subjects. We randomly selected corresponding authors and mailed confidential questionnaires on subject payment. We gathered complete data from 127 authors of adolescent research. While our main outcome was subject payment, we also examined the monetary value and form of the payment. Predictor variables included the principal investigator's demographics and professional information and the project's design and sample. Data were analyzed using Student's t-tests, Pearson correlations, and logistic regression. RESULTS: Of the studies using adolescent subjects, 55% (n=61) involved payment. Total payment varied (range $1 to $600, mean=$82.35) and the mean value per session was $26.61. Investigator characteristics associated with payment were a principal investigator's current discipline area and the decade, level and area of highest educational degree obtained. Funding and protocol complexity were related to payment, as was the sample's size, gender composition, ethnic makeup, SES distribution, and at-risk status. Logistic regression analyses found that researchers using payment were 7.2 times more likely to have funding, 2.8 times more likely to work with at-risk youth, and for every unit increase in positive attitude toward compensation, there was a 1.1-fold increase in the likelihood of using payment. CONCLUSIONS: Of those who responded to our questionnaire, slightly more than one-half the 1999 published studies done with adolescents used payment; however, the amount paid varied tremendously.

Adolescent↗

PubMed1991

Long-term effects of exercise on psychological functioning in older men and women.

The purpose of this study was to determine the psychological, behavioral, and cognitive changes associated with up to 14 months of aerobic exercise training. For the first 4 months of the study, 101 older (greater than 60 years) men and women were randomly assigned to one of three conditions: Aerobic exercise, Yoga, or a Waiting List control group. Before and following the intervention, all subjects completed a comprehensive assessment battery, including measures of mood and cognitive functioning. A semi-crossover design was employed such that, following completion of the second assessment, all subjects completed 4 months of aerobic exercise and underwent a third assessment. Subjects were given the option of participating in 6 additional months of supervised aerobic exercise (14 months total), and all subjects, regardless of their exercise status, completed a fourth assessment. Results indicated that subjects experienced a 10-15% improvement in aerobic capacity. In general, there were relatively few improvements in cognitive performance associated with aerobic exercise, although subjects who maintained their exercise participation for 14 months experienced improvements in some psychiatric symptoms. However, the healthy subjects in this study were functioning at a relatively high level to begin with, and exercise training may produce greater improvements among elderly with concomitant physical or emotional impairments.

Affect↗

PubMed2005

Dropout rates in placebo-controlled and active-control clinical trials of antipsychotic drugs: a meta-analysis.

CONTEXT: Dropout rates in randomized clinical trials of antipsychotic drugs have consistently been reported to be high, and the use of a placebo-controlled design is hypothesized to be one of the reasons for this. OBJECTIVE: To investigate this hypothesis in a meta-analysis of available data from pertinent clinical trials. DATA SOURCES: Comprehensive search of PubMed- and MEDLINE-listed journals. STUDY SELECTION: Double-blind randomized controlled clinical trials of the second-generation antipsychotics risperidone, olanzapine, quetiapine, amisulpride, ziprasidone, and aripiprazole meeting the following criteria: unselected patient population with a diagnosis of schizophrenia or schizoaffective disorder, change in psychopathologic symptoms as the primary end point, and trial duration of 12 weeks or less. DATA EXTRACTION: Sample size, mean age, baseline disease severity, dropout rate, trial design, trial duration, and publication year. DATA SYNTHESIS: Thirty-one trials meeting the inclusion criteria were found, comprising 10 058 subjects. Weighted mean dropout rates in the active treatment arms were significantly higher in placebo-controlled trials (PCTs) than in active-control trials: 48.1% (PCTs) vs 28.3% (active-control trials) for second-generation antipsychotics (odds ratio, 2.34; 95% confidence interval, 1.58-3.47) and 55.4% (PCTs) vs 37.2% (active-control trials) for classical antipsychotics (odds ratio, 2.10; 95% confidence interval, 1.29-3.40). Within PCTs, attrition rates were significantly higher in the placebo arms than with second-generation antipsychotics (60.2% vs 48.1%; odds ratio, 1.63; 95% confidence interval, 1.37-1.94). Within the subset of trials in which both second-generation and classical antipsychotics were used, dropout rates were significantly higher with classical antipsychotics. CONCLUSIONS: Use of a placebo-controlled design had a major effect on the dropout rates observed. Because high dropout rates affect the generalizability of such studies, it is suggested that, in addition to the PCTs, studies with alternative designs need to be considered when evaluating an antipsychotic's clinical profile.

Antipsychotic Agents↗

PubMed1997

Effectiveness of a short-term group psychotherapy program on endocrine and immune function in breast cancer patients: an exploratory study.

Cancer patients who had been treated for early stage breast cancer and were diagnosed with either positive axillary lymph nodes or distant metastases were randomly assigned to either a 13-week experiential-existential group psychotherapy (EEGP) program or a waiting list control (WLC) condition. Endocrine and immune measures were obtained before and after the intervention period. The findings of this study are that, after the 13 weeks of the experiment, patients in the EEGP group showed lower levels of plasma cortisol and lower levels of prolactin as well as lower percentages of natural killer cells, CD8 cells, and CD4 cells in addition to a lower proliferative response to pokeweed mitogen than patients in the WLC group. Importantly, this was only found in those breast cancer patients presenting relatively high endocrine and immune baseline levels, suggesting that the patients' profile with regard to endocrine and immune function at the start of a program can have an important effect. If replicated on a larger scale, the current results may be relevant for the treatment of breast cancer.

Adrenocorticotropic Hormone↗

PubMed1993

Effects of aerobic exercise on cognitive and psychosocial functioning in patients with mild hypertension.

The effects of 16 weeks of physical exercise training on the psychological functioning of 90 patients with mild hypertension were examined. At baseline and after 16 weeks of training, patients completed a psychometric test battery that included objective measures of neuropsychological performance and standardized self-report measures of psychosocial functioning. Patients were randomly assigned to one of three groups: aerobic exercise, strength training and flexibility exercise, or a waiting list control group. After training, there were no group differences on any of the psychological measures, even though patients who engaged in exercise perceived themselves as functioning better in a number of psychological domains.

Adult↗

PubMed2002

Are older people willing to give up their place in the queue for cardiac surgery to a younger person?

OBJECTIVES: to measure whether people aged 65 and over living in Britain would be willing to give up their place on the cardiac surgery waiting list for someone younger than them. METHODS: two British surveys, based on random types of people sampled for the Office for National Statistics Omnibus Surveys, identified respondents aged 65 and over for a module on waiting lists. They were asked to imagine they had a heart condition that required surgery, and that they were on an NHS waiting list. They were then asked if they would be prepared to give up their place on the cardiac surgery waiting list to a younger person (aged 45). The study compared responses to one of two relative waiting list time frames (6 and 12 months). SETTING: two national random samples of the British public aged 65 and over. RESULTS: fifty eight per cent and 62% of Omnibus respondents aged 65 and over responded that it was not right to give up their place on the cardiac surgery waiting list for someone younger in relation to a 6 and 12 month wait respectively. Thirty seven per cent and 34% of each group of Omnibus respondents aged 65+ said it was right to give up their place on the cardiac surgery waiting list for someone younger than them, in relation to a 6 and 12 month relative waiting period respectively. Thus the length of the wait had little effect on response among British respondents. The proportions who were willing to cede priority are far less than that reported in a comparable Italian survey. Consistent with the Italian survey, willingness to cede priority increased with age. CONCLUSIONS: most older people in Britain do not wish to cede priority on the waiting list for cardiac surgery to people younger than themselves, although willingness to give up one's place increased with age. The specific time frame did not have an impact on people's responses. The increase in willingness to cede priority with older age could be interpreted as older people valuing themselves less, or that they feel that they have had their 'fair innings' and are willing to give younger people the chance of reaching their age. It could even reflect a cohort effect. It is likely that ageing 'baby boomers' may be even less willing to give up their place in the health service queue and will be more assertive about their right to equity in health care provision.

Aged↗

PubMed1990

Peer review audit in occupational medicine.

There is an increasing awareness of the need for medical audit. A method for peer review medical audit that has been applied to two large industries is described. Occupational physicians act as auditors of randomly selected case notes from their colleagues' list of consultations using an agreed proforma as a guideline. Open discussion by the occupational physician of the auditor's comments identifies needs, such as for a change on policy or further education. Implementation of the agreed changes and subsequent review completes a cycle of audit.

Humans↗

PubMedDate not supplied

Psychological group support attenuates distress of waiting in couples scheduled for assisted reproduction.

The aim of the study is to determine whether a cognitive-behavioral group treatment could lead to a decrease of psychological distress in couples waiting for assisted reproduction. Fifty consecutive couples included in the waiting list for IVF-ET or ICSI were randomly allocated either to receive Cognitive-Behavioral Treatment (CBT Group) or just waiting (Observation Group). The group is formed by 8-10 couples; 12 meetings are provided for a period of 4 months. Two psychometric test have been administered (Symptom Rating Test and Westbrook Coping Scales) at baseline and after 4 months. At baseline, females showed a higher level of SRT than males (F= 16.6+/-14.1; M = 10.2+/-9.0; p=0.01). This became evident for anxiety (F= 5.6+/-4.9; M =3.3+/-3.0, p = 0.004), somatization (F= 3.0+/-2.5; M = 1.8+/-2.1, p = 0.01) and feelings of inadequacy (F = 3.9+/-3.7; M = 2.3+/-2.7, p = 0.01). After 4 months in the males of Observation Group (from 2.3+/-2.0 to 4.0+/-2.8, p=0.01) there was an increase of the level of anxiety. No other meaningful differences in other variables were found. In females of CBT Group a trend towards a significant decrease in the total value of psychological uneasiness (the SRT) (from 17.7+/-13.7 to 14.1+/-14.0, p = 0.07) was found. A long wait before the scheduled intervention of assisted reproduction increased anxiety levels, namely in male partners. CBT avoids such a 'waiting stress' and could be useful for stimulating discussion and awareness inside the couple. Shortening the waiting list and psychological support would be provided by infertility centres

Adaptation, Psychological↗

PubMed2005

Hair removal policies in clean surgery: systematic review of randomized, controlled trials.

OBJECTIVE: To determine whether certain hair removal policies are better than others to prevent surgical-site infections in patients undergoing clean surgery. METHODS: Publications were retrieved by a systematic search of Medline, the Cochrane Library, and EMBASE up to February 2005. Additionally, the reference lists of all identified trials were examined. All randomized trials, quasi-randomized trials, and systematic reviews or meta-analyses of randomized or quasi-randomized trials comparing hair removal policies in clean surgery were selected. Trials involving patients undergoing cranial neurosurgery were excluded. Two reviewers independently assessed trial quality and extracted data. Disagreements were resolved by discussion with a third reviewer. Data from the original publications were used to calculate the relative risk or risk difference of surgical-site infection. Data for similar outcomes were combined in the analysis, where appropriate, with the use of a random effects model. RESULTS: Four trials were included in the review. No eligible systematic review or meta-analysis of randomized or quasi-randomized trials was found. The quality of the trials and how they were reported were generally unsatisfactory. Evidence regarding whether preoperative hair removal has any effect was inconclusive. When hair removal was considered necessary, evidence about the best time for removal was inconclusive. There was some evidence that hair removal by clipper is superior to removal by razor. CONCLUSIONS: Because of insufficient evidence as a basis for recommendations, the practical consequences for ward management were essential when the Dutch Working Party on Infection Prevention formulated its recommendations for hair removal policies. Large randomized, controlled trials are needed to determine the optimal policy for preoperative hair removal.

Hair Removal↗

PubMed1993

New Zealand general practitioner referral patterns.

AIM: The aim of this study was to describe the referral patterns of general practitioners in New Zealand, for a defined list of medical conditions. METHODS: A postal questionnaire was sent to a random sample of 200 general practitioners, selected from the Medical Council of New Zealand list. Responses were made on five point scales to indicate general practitioners' views on the appropriateness of referral. For each medical condition, derived from An Educational Guide for General Practice, respondents also indicated favoured agencies for referral. Cluster analysis was used on an SPSSX dataset. RESULTS: A response rate of 87% (91.5% of eligible contacts) was achieved. The conditions for which referrals were least often made included mild hypertension, rheumatoid arthritis not requiring second line therapy, hypothyroidism, and obesity. Referral was common for rheumatoid arthritis requiring second line therapy, insulin dependent diabetes mellitus, altered bowel habit with rectal bleeding, multiple sclerosis, and postmenopausal bleeding. Seventy seven different referral agencies were indicated by respondents: the most common was the general physician (13% of all agencies indicated). CONCLUSIONS: Although there are a large number of conditions which are routinely managed only in general practice, general practitioners need to be able to refer patients to other health carers, even if only occasionally. There is a high degree of consensus as to the conditions for which referral is usually appropriate. They tend to be conditions requiring well defined investigation, treatment or management procedures which are commonly provided by centralised secondary or tertiary institutions.

Attitude of Health Personnel↗

PubMed1984

Statistical considerations in the design, analysis, and interpretation of comparative clinical studies.

Comparative clinical studies are extensively used as a basis of support for the potential approval of treatments by the Food and Drug Administration and also for other general health policy decisions. The purpose of this paper is to review statistical principles that are relevant to the design, analysis, and interpretation of comparative clinical studies. Three general criteria are emphasized: clarity, comparability, and generalizability. These criteria are discussed in terms of their implications to such considerations as scope of patient population, sample size, randomization, and covariance analysis. Also, an extensive reference list further addressing these topics is presented.

Analysis of Variance↗

PubMed2005

An evaluation of cognitive processing therapy for the treatment of posttraumatic stress disorder related to childhood sexual abuse.

This study compared the effectiveness of cognitive processing therapy for sexual abuse survivors (CPT-SA) with that of the minimal attention (MA) given to a wait-listed control group. Seventy-one women were randomly assigned to 1 of the 2 groups. Participants were assessed at pretreatment and 3 times during posttreatment: immediately after treatment and at 3-month and 1-year follow-up, using the Clinician-Administered Posttraumatic Stress Disorder (PTSD) Scale (D. Blake et al., 1995), the Beck Depression Inventory (A. T. Beck, R. A. Steer, & G. K. Brown, 1996), the Structured Clinical Interview for the DSM-IV (R. L. Spitzer, J. B. W. Williams, & M. Gibbon, 1995; M. B. First et al., 1995), the Dissociative Experiences Scale-II (E. M. Bernstein & F. W. Putnam, 1986), and the Modified PTSD Symptom Scale (S. A. Falsetti, H. S. Resnick, P. A. Resick, & D. G. Kilpatrick, 1993). Analyses suggested that CPT-SA is more effective for reducing trauma-related symptoms than is MA, and the results were maintained for at least 1 year.

Adaptation, Psychological↗

PubMedDate not supplied

An exploratory study into the effect of group psychotherapy on cardiovascular and immunoreactivity to acute stress in breast cancer patients.

BACKGROUND: : Previous studies of cancer patients investigated the effect of psychological treatment on basal endocrine and immune values. Using a randomized experiment, we explored the effect of a 13-week experiential-existential group psychotherapy (EEGP) program on the reactivity to a speech task in breast cancer patients. We explored whether changes in cardiovascular and immune reactivity to a speech task over the 3-month period correlated with changes in psychological distress and emotional expression. METHODS: Patients who had been treated for early-stage breast cancer and who were diagnosed as having either positive axillary lymph nodes or distant metastases were randomly assigned to either EEGP or a waiting list control (WLC) condition. We continuously recorded heart rate (HR), diastolic (DBP) and systolic blood pressure (SBP) in response to the speech task before and after treatment. We also measured lymphocyte proliferation to pokeweed (PWM) and phytohemagglutinin (PHA), and natural killer cell activity (NKCA) as well as peripheral blood lymphocyte distributions in blood samples that were drawn before, during and after the speech task. RESULTS: Patients in EEGP had smaller increases in natural killer (NK) cells induced by the speech task after treatment versus task-induced values observed at study entry and greater than pre-/posttreatment changes seen in patients randomized to the WLC. A similar pattern emerged with respect to NKCA over the intervention period, which was independent of the changes in NK cells. There were no differences between patients assigned to EEGP and WLC in HR, DBP and SBP responses as well as in changes in PWM- and PHA-induced lymphocyte proliferation in response to the speech task measured before and after the 3-month intervention period. Individual differences in pre-/posttreatment increases in emotional expression but not in psychological distress were significantly associated with smaller changes in the number and function of NK cells over the 3-month period. CONCLUSIONS: These findings may indicate that emotional expression during EEGP may render breast cancer patients more comfortable expressing their emotional responses to the speech challenge, which, in turn, results in smaller stress-induced changes in NK cells and function.

Aged↗