Joel Marcus

Noncompliance with Behavioral Recommendations Following Bariatric Surgery

Background: Bariatric surgery has been increasingly utilized for treatment of severe obesity. Although initial weight loss following surgery is almost completely assured, little is known about long-term out-come and patient compliance with post-surgical behavioral recommendations for diet and exercise that would improve outcome. The purpose of this study was to examine the rate of noncompliance with behavioral recommendations and to identify the incidence of psychological concerns following bariatric surgery. Method: Subjects were identified from an active clinical data-base of prospective clinical follow-up of all bariatric surgery patients. 100 consecutive patients who underwent Roux-en-Y gastric bypass were identified, and a chart review was conducted at 6 and 12 months postoperatively to gather demographic data and identify the prevalence of noncompliance identified in monthly follow-up visits. Also, patients were asked about depression, relationship/sexual concerns, and medical complications. Results: 81 women and 19 men were followed for 1 year. The majority of patients reported noncompliance in at least one area, with lack of exercise and snacking being most frequently cited (41%, 37% respectively overall). Most patients were compliant with eating protein first and avoiding sodas. At 12 months follow-up, 12% reported depression, 4% reported sexual concerns and 2% reported relationship problems. Also, 9% reported having experienced some medical complication related to their surgery. Conclusion: Noncompliance with behavioral recommendations is pervasive following bariatric surgery, with lack of exercise being the most likely area of noncompliance. Because of the importance of compliance with behavioral recommendations for the successful outcome of bariatric surgery, further research is warranted to further clarify the factors that impact long-term outcome and to design interventions to improve compliance.

Randomized Trial of a Hypnosis Intervention for Treatment of Hot Flashes Among Breast Cancer Survivors

PURPOSE Hot flashes are a significant problem for many breast cancer survivors. Hot flashes can cause discomfort, disrupted sleep, anxiety, and decreased quality of life. A well-tolerated and effective mind-body treatment for hot flashes would be of great value. On the basis of previous case studies, this study was developed to evaluate the effect of a hypnosis intervention for hot flashes. PATIENTS AND METHODS Sixty female breast cancer survivors with hot flashes were randomly assigned to receive hypnosis intervention (five weekly sessions) or no treatment. Eligible patients had to have a history of primary breast cancer without evidence of detectable disease and 14 or more weekly hot flashes for at least 1 month. The major outcome measure was a bivariate construct that represented hot flash frequency and hot flash score, which was analyzed by a classic sums and differences comparison. Secondary outcome measures were self-reports of interference of hot flashes on daily activities. RESULTS Fifty-one randomly assigned women completed the study. By the end of the treatment period, hot flash scores (frequency x average severity) decreased 68% from baseline to end point in the hypnosis arm (P < .001). Significant improvements in self-reported anxiety, depression, interference of hot flashes on daily activities, and sleep were observed for patients who received the hypnosis intervention (P < .005) in comparison to the no treatment control group. CONCLUSION Hypnosis appears to reduce perceived hot flashes in breast cancer survivors and may have additional benefits such as reduced anxiety and depression, and improved sleep.

Complementary and alternative medicine use by psychiatric inpatients.

82 psychiatric inpatients hospitalized for acute care were interviewed about their use of complementary and alternative medicine (CAM) modalities. The clinical diagnoses of respondents included Depressive Disorder (61%), Substance Abuse (26%), Schizophrenia (9%), and Anxiety Disorders (5%). Analysis indicated that 63% used at least one CAM modality within the previous 12 mo. The most frequently used modality was herbal therapies (44%), followed by mind-body therapies such as relaxation or mental imagery, hypnosis, meditation, biofeedback (30%), and spiritual healing by another (30%). Physical modalities such as massage, chiropractic treatment, acupuncture, and yoga were used by 21% of respondents. CAM therapies were used for a variety of reasons ranging from treatment of anxiety and depression to weight loss. However, most respondents indicated they did not discuss such use with their psychiatrist or psychotherapist.

Hypnosis to Manage Anxiety and Pain Associated with Colonoscopy for Colorectal Cancer Screening: Case Studies and Possible Benefits

Abstract This study explored using hypnosis for pain and anxiety management in 6 colonoscopy patients (5 men, 1 woman), who received a hypnotic induction and instruction in self-hypnosis on the day of their colonoscopy. Patients’ levels of anxiety were obtained before and after the hypnotic induction using Visual Analogue Scales (VAS). Following colonoscopy, VASs were used to assess anxiety and pain during colonoscopy, perceived effectiveness of hypnosis, and patient satisfaction with medical care. Hypnotizability was assessed at a separate appointment. The authors also obtained data (time for procedure, number of vasovagal events, and recovery time) for 10 consecutive patients who received standard care. Results suggest that hypnosis appears to be a feasible method to manage anxiety and pain associated with colonoscopy, reduces the need for sedation, and may have other benefits such as reduced vasovagal events and recovery time.

Use of a Numeric Visual Analog Anxiety Scale Among Patients Undergoing Colorectal Surgery

The aim of this study was to evaluate the utility of a Numeric Visual Analog Anxiety Scale (NVAAS) as a potentially accurate and efficient way to determine presurgery anxiety among patients undergoing colorectal surgery. A secondary aim was to determine the relationship between NVAAS ratings of anxiety and postsurgery pain. Thirty-six patients scheduled for colorectal surgery were asked to rate their state anxiety on the NVAAS and to complete the State-Trait Anxiety Inventory (STAI). The NVAAS correlated significantly with STAI-state anxiety (0.64,p < .0001). The NVAAS measure of presurgery anxiety also correlated significantly with STAI-trait anxiety (0.46,p < .005) and postsurgery Visual Analog Scale pain ratings (0.35,p <.038). The NVAAS appears to be a valid and sensitive measure of anxiety among patients undergoing colorectal surgery. The NVAAS also has the advantage of being convenient and easy to use at bedside, increasing its clinical utility in medical nursing care.

Intensive hypnotherapy for smoking cessation : A prospective study

Abstract This study reports on a prospective pilot trial of intensive hypnotherapy for smoking cessation. The hypnotherapy involved multiple individual sessions (8 visits) over approximately 2 months, individualization of hypnotic suggestions, and a supportive therapeutic relationship. Twenty subjects were randomly assigned to either an intensive hypnotherapy condition or to a wait-list control condition. The target quitting date was 1 week after beginning treatment. Patients were evaluated for smoking cessation at the end of treatment and at Weeks 12 and 26. Self-reported abstinence was confirmed by a carbon-monoxide concentration in expired air of 8 ppm or less. The rates of point prevalence smoking cessation, as confirmed by carbon-monoxide measurements for the intensive hypnotherapy group, was 40% at the end of treatment; 60% at 12 weeks, and 40% at 26 weeks (p < .05). 1The authors wish to thank Paul Cinciripini at University of Texas M.D. Anderson Cancer Center for his guidance in selection of outcome measures and study design. Also, appreciation is expressed to Matthew Ridley and Jennifer Gibbons-Rameriz who served as study coordinators.

Can hypnosis reduce hot flashes in breast cancer survivors? A literature review.

Abstract Hot flashes are a significant problem for many breast cancer survivors and can cause discomfort, insomnia, anxiety, and decreased quality of life. In the past, the standard treatment for hot flashes has been hormone replacement therapy. However, recent research has found an increased risk of breast cancer in women receiving hormone replacement therapy. As a result, many menopausal women and breast cancer survivors reject hormone replacement therapy and many women want non-pharmacological treatment. In this critical review we assess the potential use of hypnosis in reducing the frequency and intensity of hot flashes. We conclude that hypnosis is a mind-body intervention that may be of significant benefit in treatment of hot flashes and other benefits may include reduced anxiety and improved sleep. Further, hypnosis may be a preferred treatment because of the few side-effects and the preference of many women for a non-hormonal therapy. Two case studies are included to illustrate hypnosis for hot flashes. However this intervention has not been adequately studied. We discuss an NIH-funded randomized clinical trial of hypnosis for hot flashes in breast cancer survivors that is presently being conducted.

Perceived stress among nursing and administration staff related to accreditation.

Background: Nurses in hospital administration and management positions may experience workplace stress, which can have important consequences on the health and well-being. Purpose: The aim of this study was to examine the effects of perceived stress on nursing hospital management and administrative employees of a large health care organization before and after a review by The Joint Commission on the Accreditation of Healthcare Organizations. Methods: A total of 100 hospital employees were randomly selected to complete questionnaires assessing their perception of stress and its effect on their well-being before and after the site review. They were also asked to rate their subjective experience of sleep, anxiety, depression, and job satisfaction. Results: Perceived stress was significantly related to employees’ increased health concerns, symptoms of depression and anxiety, interpersonal relationships, and job satisfaction (p = .003). Conclusions: Hospital accreditation reviews may increase perceived stress and appears to be related to emotional and physical well-being. Application: The implications include evidence there is a need for organizations to initiate corrective action to help nurses in administrative roles to cope with increased levels of job strain, minimize potential psychological and physiological consequences, and preserve job satisfaction.

The Integration of Hypnosis into a Model of Palliative Care

There exists a need for a broad and inclusive model of integration of mind-body interventions for palliative care. Symptoms relating to psychological distress and existential concerns are even more prevalent than pain and other physical symptoms among those with life-limiting conditions. The hypnotic model’s purpose is to improve the patient’s total psychological, social, and spiritual well-being. A 4-stage model of interventions is offered to assist the clinician in developing and implementing appropriate hypnotherapeutic treatment for noncurative patients. The focus of the hypnotherapy is to ameliorate the effects of pain and dyspnea to restore a level of psychological and physical wellbeing. Within this model of therapy for patients with active, progressive, far-advanced disease and a short life expectancy, the goals of the hypnotic intervention are to provide relief from pain and shortness of breath. Other focuses include assisting the patient with the psychological adjustment to their noncurative and ultimately final state.

Evaluation of relative thrombocytopenia, identification of neuropathy, and bleeding risk secondary to utilization of neuromodulating agents in multiple myeloma patients receiving autologous stem cell transplant treated with melphalan, bortezomib, and lenalidomide.

212 Background: Chemotherapy-induced polyneuropathy (CIPN) is a crippling manifestation in multiple myeloma (MM) patients that requires attentiveness to safety and quality of life.2 Bortezomib, lenalidomide, and melphalan are commonly utilized chemotherapy agents that can cause both CIPN3,4 and significant myelosuppression. Within this subset of patients we wish to insure efficacy and minimization of neuropathic pain while being mindful of bleeding risks. METHODS IRB approval was obtained for a retrospective study of patients with MM who received a bone marrow transplant (BMT). Criteria included those who have undergone treatment with melphalan, bortezomib, and lenalidomide who experienced CIPN and placed on gabapentin, pregabalin, or duloxetine with thrombocytopenia defined by a platelet count less than 100,000 K/ul. We identified all patients seen on the BMT service at Ochsner Medical Center who received an autologous BMT for MM and treated with melphalan, bortezumib, and lenalidomide. Demographic data included age at diagnosis, gender, height, and weight. We examined characteristics including date of diagnosis and progression free survival. Endpoints included signs of peripheral neuropathy, onset of thrombocytopenia, initiation of therapy with gabapentin, pregabalin, or duloxetine. RESULTS 62 patients were selected with data capture. A preliminary chart review shows of patients meeting selection criteria, 53% of patients identified had shown undocumented or undertreated neuropathy, significant bleeding risk, or low platelet function assays. Complete breakdown of individual factors to be provided graphically. CONCLUSIONS The standard treatment practices for MM patients with CIPN has placed patients at higher risk for development of thrombocytopenia and adverse bleeding risks, requiring more stringent institutional documentation practices.