Non-therapeutic Group Research Articles

Outcomes related to anticoagulation management for mechanical valve replacements.

BackgroundThis study evaluates anticoagulation management and its impact on longitudinal clinical outcomes in patients undergoing mechanical valve replacement.MethodsPatients undergoing mechanical mitral valve replacement (MVR) or aortic valve replacement (AVR) from 2010–2018 at a single center were included. Patients were stratified into therapeutic and non-therapeutic anticoagulation groups based on the median percentage of international normalized ratio (INR) values within the reference range (2.0–3.0 for AVR, 2.5–3.5 for MVR) during the first post-operative year. Using Cox regression analysis, comorbidity-adjusted survival and freedom from adverse events were compared.ResultsSix hundred and fifty-one patients underwent mechanical valve replacement (166 MVR, 485 AVR). Comorbidity-adjusted survival was similar in the MVR and AVR cohorts (P=0.23). There was a median of 27 [interquartile range (IQR): 14–42] INRs drawn per patient in the first post-operative year. The median percentage of INRs within the reference values during the first post-operative year was 42.85% (IQR: 30.77–53.95%), with the majority of non-therapeutic INRs being subtherapeutic (34.51%; n=6,864). There were no significant differences in adjusted survival between the therapeutic and non-therapeutic groups [hazard ratio (HR): 1.12, P=0.73]. Within the first post-operative year, there were no significant differences in stroke, major bleeding, peripheral non-stroke arterial thromboembolism, and readmission for intravenous heparin in the therapeutic and non-therapeutic groups.ConclusionsTaking into account relevant comorbidities and valve type, patients with a larger proportion of non-therapeutic INRs during the first post-operative year demonstrated no difference in longitudinal clinical outcomes. Further research into more standardized INR monitoring and potentially expanded INR target ranges for patients undergoing mechanical valve replacement is warranted.

The Effectiveness of Group Acceptance and Commitment Psychotherapy on Psychological Well-being of Breast Cancer Patients in Shiraz, Iran

Background: Breast cancer is among the most prevalent types of cancers. Patients who suffer from cancer undergo many problems, including psychological complications. Acceptance and commitment psychotherapy can be used for psychological support and rehabilitation of patients with cancer. The present study investigates the effectiveness of acceptance and commitment group psychotherapy in improving the affective and psychological welfare of breast cancer patients in comparison with control cases. Methods: This study enrolled 30 female patients with breast cancer. The patients were equally randomized to an experimental group and a control group. Acceptance and commitment psychotherapy group intervention consisted of eight, 2-h sessions per month. The control group received non-therapeutic group intervention. We assessed psychological well-being at 2 time points, before and at the end of intervention. All data were analyzed by the Statistical Package for the Social Sciences. P-values less than 0.05 were considered significant. Results: The results showed significant differences between the two groups in their mean scores of negative affect (F=18.91, P=0.000), positive affect (F=52.62, P=0.000), hope (F=59.10, P=0.000), and quality of life (F=22.12, P=0.001). Conclusion: Acceptance and commitment psychotherapy is a novel approach in group psychotherapy which can improve the psychological status of the patients who suffer from breast cancer.

Efficacy of group cognitive rehabilitation therapy in multiple sclerosis.

Cognitive impairment occurs in 40%-65% of patients with multiple sclerosis (MS). Several techniques for cognitive rehabilitation (CR) in these patients have been evaluated; however, the results have been controversial. In this study, we investigated the efficacy of group compensatory CR in patients with MS-related cognitive impairment. Thirty-four female patients with diagnosed relapsing-remitting MS and evidence of impaired cognitive function were included and randomized to intervention (n=17) and control (n=17) groups. CR intervention consisted of eight 2-hour sessions of comprehensive group CR over a 4-week period that focused on improvement of memory, attention, and executive function. As placebo, the control group received the same number of non-therapeutic group sessions. Assessment of cognitive function was performed before intervention (pretest), at the end of intervention (post-test), and 3months later (follow-up). The study population included 34 patients with a mean age of 35.5years. Statistical comparison of memory assessments at 3-month follow-up showed significantly higher scores in the CR group than in the control group (93.33 vs 86.40 for Addenbrooke's Cognitive Examination test and 16.58 vs 12.00 for visual memory, 19.32 vs 14.05 for verbal memory, and 51.28 vs 44.41 for general scores on the Memory Functioning Questionnaire test, respectively). Wisconsin card sorting test score comparison showed significantly lower total time consumption in the CR group than in the control group (308.1 vs 340.8seconds, respectively). Behavior rating inventory of executive function-adultscores in all four subtests were significantly higher in the CR group than in the control group (40.25 vs 55.4 for behavioral regulation index, 51.16 vs 68.6 for metacognition index, and 97.41 vs 124.00 for global executive composite, respectively). Attention was the only domain in which we did not observe any significant variation between groups in terms of post-test and follow-up scores. This study supports the efficacy of group CR in the improvement of cognitive function in patients with MS.

What is the Prevalence of a “Nontherapeutic” Thymectomy?

Thymectomy is often performed on the basis of computed tomography scan findings that are suspicious for thymoma. However, the final diagnosis may be a condition such as thymic hyperplasia or lymphoma for which thymectomy is not therapeutic. The present analysis was undertaken to determine the prevalence of a "nontherapeutic" thymectomy. The Nationwide Inpatient Sample from 2000 through 2009 was queried to identify patients who underwent a thymectomy. Only adult patients who underwent a total thymectomy without other associated procedures were analyzed. Patients with a diagnosis of myasthenia were excluded. A nontherapeutic thymectomy was defined as a patient who underwent thymectomy with an International Classification of Diseases, Ninth Revision diagnosis code of lymphoma, thymic hyperplasia, thymic cyst, or other benign diseases of the thymus. A total of 1,306 patients were identified. Overall, 72.2% (n = 943) of thymectomies were therapeutic and 27.8% (n = 363) were nontherapeutic. The most common diagnosis in the nontherapeutic group was thymic hyperplasia (n = 174). Mortality (0.32% versus 0%; p = 0.083) and overall complication rates (25% versus 17%; p < 0.001) were higher in the therapeutic group. Patients in the nontherapeutic group were younger (median age, 41 versus 56 years; p < 0.001) and more likely to undergo a video-assisted thoracoscopic surgery thymectomy (28% versus 19%; p = 0.085). In this study, 27.8% of thymectomies were nontherapeutic, and most patients underwent an open approach. The most common benign diagnosis was thymic hyperplasia, a condition for which magnetic resonance imaging has a high predictive value. Consequently, further studies are warranted to determine the optimal evaluation of patients undergoing thymectomy for presumed thymoma.

Enhancing strength-based therapy by focusing on client’s talents and concepts of learning

This research investigated how adults perceived their talents and whether adult clients (n = 132; average age = 35 years) entering therapy had a different perception of their talents than adults not attending therapy (n = 132; average age = 34 years. Establishing whether gender was associated with respondents’ talent ratings was also explored. Talents were measured using a questionnaire based on Gardner’s Multiple Intelligence Theory. Respondents were asked to compare each of nine talents with items representing seven concepts of learning thereby linking talent with the methods used to learn and maintain the talent. Results showed nine factors emerged in conjunction with the seven conceptions of learning. Males were higher rating on the talents of Construction and Spatial Design and Mathematical and Logical. The therapeutic group of adults rated talents significantly lower than the nontherapeutic group. The rank of the concepts of learning based on their average contribution to each talent showed that both groups of respondents focused on performance and then natural ability, and least on effort when defining their talents. These findings support the suggestion that the client’s talent is an appropriate subject to incorporate into therapy to maintain and expand their skills and competence.

Degree of Anticoagulation, but Not Warfarin Use Itself, Predicts Adverse Outcomes After Traumatic Brain Injury in Elderly Trauma Patients

The relationship between preinjury warfarin use and outcomes after traumatic brain injury in elderly trauma patients remains controversial. We hypothesized that, among elderly warfarin users, the degree of anticoagulation, rather than warfarin therapy itself, would predict the severity of traumatic brain injury. Retrospective study (2004-2006) of all elderly trauma patients (age >/=65 years) who were evaluated by the trauma service at a Level I trauma center and underwent computed tomography of the head for suspicion of an intracranial injury was performed. Three cohorts were grouped: (1) warfarin users with an admission International Normalized Ratio >/=2 (therapeutic group), (2) warfarin users with an admission International Normalized Ratio <2 (nontherapeutic group), and (3) warfarin nonusers. Main outcome variables were presenting with a Glasgow Coma Scale (GCS) score </=13 points, intracranial hemorrhage (ICH), overall mortality, and mortality after ICH. A total of 225 trauma patients were studied, including 40 warfarin users (17.3%), of whom 22 (55.0%) were in the therapeutic group. Age, gender, and mechanism of injury were similar among groups. Likelihood of Glasgow Coma Scale score </=13 (odds ratio [OR] = 5.13, 95% confidence interval [CI] 1.97-13.39, p = 0.001), ICH (OR = 2.59, 95% CI 0.92-7.32, p = 0.07), overall mortality (OR = 4.48, 95% CI 1.60-12.50, p = 0.004), and mortality after ICH (OR = 3.42, 95% CI 1.09-10.76, p = 0.03) was increased in the therapeutic as compared with the nonuser group. There was no difference in any measured outcome between the nonuser and nontherapeutic groups. Therapeutic anticoagulation with warfarin, rather than warfarin use itself, is associated with adverse outcomes after traumatic brain injury in elderly patients.

DOES HYPERGAMMAGLOBULINEMIA PREDISPOSE PATIENTS WITH CHRONIC LYMPHOCYTIC LEUKEMIA TO SECONDARY SOLID TUMORS?

Background Occurrence of second hematologic malignancies in patients with chronic lymphocytic leukemia (CLL) is well known, but development of secondary solid tumors has not been well documented. Isolated case reports indicate that CLL patients may have a predisposition to develop solid tumors. There is not enough literature available to support this hypothesis. We here intend to study the incidence of secondary solid tumors in CLL patients with regard to their treatment and immunoglobulin levels. Methods We reviewed the medical records of 323 CLL patients over the last 20 years at Veterans Affairs Medical Center, Kansas City. Broadly, the patients were divided into two groups, the group that received chemotherapy for CLL (74/323) versus the group that did not receive treatment (249/323), and their median immunoglobulin levels were also documented. Patients who developed secondary hematologic malignancies were excluded from this study. Results The overall incidence of solid tumors was found to be 14.8% (48/323). In the chemotherapy-treated CLL, the incidence of solid tumors was 18% (14/74) compared with 13.6% (34/249) in the nontherapeutic group (p value .12). The most common malignancies noted were gastrointestinal malignancies, genitourinary tumors, and skin cancers, including melanomas. Interestingly, CLL patients who developed secondary solid tumors had a higher median IgG levels (1,010 g/L) when compared with those who did not develop secondary tumors (738 g/L, p value Conclusion Our study shows that there is a higher overall incidence of secondary solid tumors in patients with CLL when compared with the incidence in the general population. There is no significant increase in the incidence of therapy-related solid tumors in CLL patients. Upward drift in immunoglobulin levels should raise a suspicion for diagnosis of secondary solid tumors in patients with CLL. More studies are warranted to confirm this finding.

Does Hypergammaglobulinemia Predispose to Secondary Solid Tumors in Patients with Chronic Lymphocytic Leukemia?.

Background:Occurrence of second hematological malignancies in patients with chronic lymphocytic leukemia (CLL) is well known but development of secondary solid tumors has not been well documented. Isolated case reports indicate, CLL patients may have a predisposition to develop solid tumors. There is not enough literature available to support this hypothesis. We here intend to study the incidence of secondary solid tumors in CLL patients with regard to their treatment and immunoglobulin levels.Methods: We reviewed the medical records of 323 CLL patients over the last 20 years at Veteran Affairs Medical Center, Kansas City. Broadly the patients were divided into two groups; the group who received chemotherapy for CLL(74/323) versus the group who did not receive treatment (249/323) and their median immunoglobulin levels were also documented. Patients who developed secondary hematological malignancies were excluded from this study.Results: The overall incidence of solid tumors was found to be 14.8% (48/323). In the chemotherapy treated CLL, the incidence of solid tumors was 18%(14/74) as compared to 13.6% (34/249) in the non-therapeutic group(P value 0.12). The most common malignancies noted were gastro-intestinal malignancies, genitor-urinary tumors and skin cancers including melanomas. Interestingly CLL patients who developed secondary solid tumors had a higher median IgG levels (1010 g/L) when compared to those who did not develop secondary tumors (738 g/L, P value <0.003)Conclusion: Our study shows that there is a higher overall incidence of secondary solid tumors in patients with CLL when compared with incidence in the general population. There is no significant increase in the incidence of therapy related solid tumors in CLL patients. Upward drift in immunoglobulin levels should raise a suspicion for diagnosis of secondary solid tumors in patients with CLL. More studies are warranted to confirm this finding.

Group Music Therapy with Women who have Experienced Intimate Partner Violence

ABSTRACT: The purpose of this study was to investigate the effect of group music therapy combined with other creative arts methods on the self-reported levels of anxiety, depression, and self-esteem in women who have experienced intimate partner violence. Assessments of dependent variables were made at entry, following the final session of the intervention, and 3 weeks later. Using a repeated measures design and post hoc analyses, participants (n = 7) reported a significant decrease in depression and a marginally significant decrease in anxiety. No significant effect was found for self-esteem. Most participants reported all interventions to be helpful and the series of sessions a positive experience. The findings suggest that active music therapy within a group context may be an effective intervention for ameliorating mood in women recovering from intimate partner violence. Intimate partner violence is one of the leading causes of injury and suffering for women in the United States today. The National Women's Health Information Center (2005) stated that intimate partner violence occurs when one person purposely causes either physical or mental harm to another, including physical abuse, psychological or emotional abuse, sexual assault, isolation, [or] controlling all of the victim's money, shelter, time, food, etc. Often, the violent person is a husband, former husband, boyfriend, or ex-boyfriend, but sometimes the abuser is female. Nationally, the U.S. Department of Justice (2003) reported that 691,710 incidences of nonfatal intimate partner violence occurred in 2001. A majority of these cases (85%) involved violence against women. In 2000, 1247 women and 440 men were murdered by an intimate. It should be noted that the actual number of incidences is expected to be larger than the number of reported incidences. Glicken and Sechrest (2003) estimated that the number of people who have experienced intimate partner violence may range anywhere between 1.8 to 4 million Americans per year. Intimate partner violence has become a major societal problem for people in all social, ethnic, and economic groups in the United States (Cassity & Theobold, 1990; Kakar, 1998; Wallace, 2002). Kakar stated that the effects of intimate partner violence on society include death, medical costs, mental health costs, loss in work productivity, property loss, law enforcement costs, shelter costs, foster care costs, criminal justice system costs, advocacy costs, offender's family's costs; birth defects; alcohol and substance abuse; decrease in selfesteem; fear of crime; and ultimately an acculturation to violence. Such a list does not even begin to address the disruption and devastation that intimate partner violence imposes on a personal level. Additionally, Forell and Mathews (2000) reasoned that intimate partner violence can escalate to murder and reported that one-third to one-half of all female homicide victims in the United States are killed by an intimate partner, most often after the woman leaves or decides to leave the relationship (p. 159). Group treatment has been an efficacious form of intervention chosen by shelter systems and therapists working to assist women who have experienced intimate partner violence (Dutton, 1992; Larance & Porter, 2004; Shostack, 2001; Walker, 1979). Shostack noted that many shelter systems utilize both group therapy and non-therapeutic group meetings as a means to convey information; promote peer support; and to address the feelings, attitudes, and behaviors of the residents. This type of work provides opportunities for peer feedback that supports the development of residents' assertiveness and determination. Larance and Porter stated that a supportive group environment can promote a redevelopment of a woman's social support system, feelings of trust, and promote the experience of empowerment. The creative arts therapies have been used to address needs of survivors of violence (Bass-Feld, 1994; Booker, 1999; Emerson & Shelton, 2001; Milliken, 2002). …

Group dynamics as an emotional turmoil precipitating psychotic manifestations.

Data on 23 patients developing a psychosis precipitated by group sessions (mainly nontherapeutic groups in a strict sense) are presented. Nearly 70% (16 patients) fulfilled the DSM-III criteria for major affective disorder, while only 4 patients met the criteria for schizophrenia. Possible factors for the development of psychotic symptomatology during group activities and the role of group dynamics acting as stress factors precipitating functional psychoses, especially bipolar manifestations, are discussed.

Quran and Singular: Protective Effects of Extract of Urtica dioica Leaf on Mucosa of Intestine in Diabetic Rats

Background: In Quran, the great, Surah Baghareh, Verse 255, it is stated: “ Who is he aware of everything and the limited knowledge of humankind originates in His unending and unlimited knowledge”. One of these sciences is the science of Pharmaceutical plants. Recognizing these plants plays an important role in the improvement of human society health. Herbal therapy is one of the supplement methods for improving the health rate. In Al-Rahman, verse 11, the significance of plants and fruits is mentioned. One of the mentioned plants is Urtica dioica, which is anti-diabetic. Objectives: The objective of this study is to determine the protective effect of extract of Urtica dioica leaf on small intestine structure in order to find its anti-diabetic effect. Materials and Methods: At first, the rats were injected 50 kg. mg-1ofStreptozotocin via their tail vane. The fasting animals with more than 250 mg dl-1 blood sugar was diagnosed as diabetic. One diabetic group was under therapy of blue extract of Urtica dioica leaf (daily injection of 4 cc kg -1 in Peritoneum). The blood sample and tissue of the intestine were prepared after two months of therapy and killing animals. The Histologist saw the samples tissue. The quality of parameters of tissue was assessed in both the therapeutic and non-therapeutic groups. Results: The blood sugar decreased from 400 ± 54.2 mg dl -1 to 78.9 ± 11.9 dl (P > 0.0004) in therapeuticgroup while the blood sugar was not found in diabetic group. The mononuclear cells and destructive tissues were found in necrosis and infiltration of diabetic group, also epithelium and Lieberkuhn glands were destructed and the villain became short and atrophy 9 and the high level of blood shedding and exudate were found. In contrast, necrosis were not found in therapeutic group and infiltration of mononuclear cells and inflammation tissues were found slightly. There were not shorted villain and atrophy. Consuming Urtica dioica prevents the intestinal side effects of diabetes. Conclusions: Urtica dioica protects themucosa of small intestine. This may lead to recovery of blood transfusion with decreasing end product mechanism (Advanced glicosylation end product) or improving the function of the nervous system by decreasing Sorbitol production. Further studies are needed for determining the major mechanisms. ARTICLE INFO