Yvonne Michel

Durability of improvement in post-traumatic stress disorder symptoms and absence of harmful effects or drug dependency after 3,4-methylenedioxymethamphetamine-assisted psychotherapy: a prospective long-term follow-up study:

We report follow-up data evaluating the long-term outcomes for the first completed trial of 3,4-methylenedioxymethamphetamine (MDMA)-assisted psychotherapy for chronic, treatment-resistant post-traumatic stress disorder (PTSD) (Mithoefer et al., 2011). All of the 19 subjects who received MDMA-assisted treatment in the original trial participated in the long-term follow-up (LTFU), with 16 out of 19 completing all of the long-term outcome measures, which were administered from 17 to 74 months after the original study’s final MDMA session (mean = 45.4; SD = 17.3). Our primary outcome measure used was the Clinician-Administered PTSD Scale (CAPS). Secondary outcome measures were the Impact of Events Scale-Revised (IES-R) and the Neuroticism Extroversion Oppenness Personality Inventory-Revised (NEO PI-R) Personality Inventory. We also collected a long-term follow-up questionnaire. Results for the 16 CAPS completers showed there were no statistical differences between mean CAPS score at LTFU (mean = 23.7; SD = 22.8) (t matched = 0.1; df = 15, p = 0.91) and the mean CAPS score previously obtained at Study Exit (mean = 24.6, SD = 18.6). On average, subjects maintained statistically and clinically-significant gains in symptom relief, although two of these subjects did relapse. It was promising that we found the majority of these subjects with previously severe PTSD who were unresponsive to existing treatments had symptomatic relief provided by MDMA-assisted psychotherapy that persisted over time, with no subjects reporting harm from participation in the study.

Safety and efficacy of lysergic acid diethylamide-assisted psychotherapy for anxiety associated with life-threatening diseases.

Abstract A double-blind, randomized, active placebo-controlled pilot study was conducted to examine safety and efficacy of lysergic acid diethylamide (LSD)-assisted psychotherapy in 12 patients with anxiety associated with life-threatening diseases. Treatment included drug-free psychotherapy sessions supplemented by two LSD-assisted psychotherapy sessions 2 to 3 weeks apart. The participants received either 200 &mgr;g of LSD (n = 8) or 20 &mgr;g of LSD with an open-label crossover to 200 &mgr;g of LSD after the initial blinded treatment was unmasked (n = 4). At the 2-month follow-up, positive trends were found via the State-Trait Anxiety Inventory (STAI) in reductions in trait anxiety (p = 0.033) with an effect size of 1.1, and state anxiety was significantly reduced (p = 0.021) with an effect size of 1.2, with no acute or chronic adverse effects persisting beyond 1 day after treatment or treatment-related serious adverse events. STAI reductions were sustained for 12 months. These results indicate that when administered safely in a methodologically rigorous medically supervised psychotherapeutic setting, LSD can reduce anxiety, suggesting that larger controlled studies are warranted.

Life review : Preventing despair in newly relocated nursing home residents short- and long-term effects

Relocation to a nursing home places frail elders at risk for developing depression and suicide ideation. This study followed two hundred and fifty-six newly relocated nursing home residents for five years. Using a Solomon Four research design, participants were divided into four groups, two control and two experimental, one each with pretesting and all with posttesting. Participants in the control groups received a friendly visit and those in the experimental groups received the intervention of life review. Immediate short-term results showed the life review to be an effective preventive intervention for clinical depression (p = .05). Additionally, when looking at long-term effects at one year, there were significant decreases in depression (p = .05), hopelessness (p = .01), and psychological well-being (p = .02) with measurable increases in life satisfaction (p = .08). These findings support the hypothesis that life review prevents despair in frail elders newly admitted to a nursing home.

Examining lateral violence in the nursing workforce.

The decision to examine the phenomenon of lateral violence within the nursing workforce of a southeastern tertiary care medical center evolved from the strong response of attendees to a nursing presentation on lateral violence. This paper describes the development and testing of the Lateral Violence in Nursing Survey. This questionnaire, designed to measure perceived incidence and severity of lateral violence, was administered online to 663 nursing staff participants. Forty-six percent of the study participants reported lateral violence as a “very serious” or “somewhat serious” problem, and 65% reported frequently observing lateral violence behaviors among coworkers. Education and effective leadership were found to mediate oppressive and negative behaviors, whereas ineffective leadership was found to exacerbate lateral violence.

The extended effects of the life review in nursing home residents

To date, there is little information on the therapeutic effects of the life review beyond one year. This analysis followed fifty-two of 256 subjects who lived for at least three years in a nursing home. These participants received either a life review or friendly visit and took part in four repeated testings to determine the lasting effects of the life review at two and three years. Measures of integrity (life satisfaction, psychosocial well being, self-esteem) and despair (depression, hopelessness, and sucide intent) were used as pretest, posttest, and retest. Results showed a trend toward continued and by year three significant improvement over time in those who received the life review on measures of depression (t = −2.20, p < .03), life satisfaction (t = 2.51, p < .02), and self-esteem (t = −2.31, p < .03).

Coordination of swallowing and respiration in normal sequential cup swallows

Objectives: To establish normative data on laryngeal vestibular closure patterns and respiratory phase patterns during sequential cup swallows in healthy adults.

Dissemination and Use of Research Findings in Nursing Practice.

This study built on two previous studies (Brett, 1987; Coyle & Sokop, 1990) that found no significant relationships between use of nursing research and nursing education level. These two studies had fewer than 5 per cent of their subjects with masters degrees in nursing. The new population studied had 49 per cent masters prepared nurses, which provided the necessary foundation to expand the examination of the relationship of higher education and use of research findings among nurses. Whereas the overall extent of dissemination and use of research findings among nurses in the sample was similar to that of the two previous studies, it was found that nurses with a masters degree reported higher utilization than those with a bachelors degree. This finding suggests a unique and critical role for the masters-prepared nurse in the dissemination and use of research findings in the practice setting.

Physiologic model of oropharyngeal swallowing revisited

Objective: The purposes of this investigation were to determine whether the temporal onsets of swallow events segment into oral and pharyngeal phases, to test the interdependence of temporal onsets of swallow events, and to determine the influence of age on total swallow duration. Study Design and Setting: The onsets of swallowing and respiratory measures were studied in 76 healthy normal individuals. Results: Confirmatory factor analysis revealed a 2-factor solution but did not support the hypothesized 2-phase structure (ie, oral and pharyngeal). Two of the onsets, apnea onset and apnea offset, formed a single factor that explained 12.6% of the variation among the 11 onset times. The other 9 onsets formed a second factor that explained 66.4% of the variation. Age accounted for modest variation in total swallow duration. Conclusions: The two factors, oropharyngeal and respiratory, explained 79% of the variation among the 11 onset times. Significance: This finding speaks to the overlap between the initiation of oral and pharyngeal components of swallowing in adults and highlights the artificiality of separating the swallowing continuum into isolated phases.

The Northern Ireland life review/life storybook project for people with dementia.

There are few interventions that help people with dementia retain or regain a sense of self. Thus, a controlled pilot study examined a life review/life storybook intervention, delivered by familiar care assistants to 30 people with dementia residing in assisted living facilities in Northern Ireland. A multivariate analysis of covariance showed significant change by group (F = 5.01, p < 0.014), particularly on depression (F = 7.54, p < 0.015), communication (F = 23.36, p < 0.005), positive mood (F = 9.47, p < 0.008), and cognition (F = 20.77, p < 0.005), suggesting a potentially promising technique to assist people with dementia.

A descriptive study of skin temperature, tissue perfusion, and tissue oxygen in patients with chronic venous disease.

Chronic inflammation and microcirculatory disturbances of the skin have been implicated as causative factors of complications associated with chronic venous disease (CVD). The purpose of this study is to describe the mean differences between and correlations among three measures of microcirculation: skin temperature (Tsk), tissue perfusion/blood flow (BF), and tissue oxygen (tcPO2) of CVD-inflamed skin compared to normal controls. In a convenience sample of 55 patients with CVD (n = 31) and without CVD (n = 24), Tsk was measured with an infrared thermometer, BF with a laser Doppler flowmeter, and tcPO 2 with a transcutaneous oximeter across three measurements periods 1 week apart (Times 1, 2, and 3) at the medial aspect of both lower legs. Tsk was higher (1.2°C) across all measurement periods (p < .05), BF was higher at Times 1 and 3 (p = .002 and .012, respectively), and tcPO2 was lower at Times 1 and 3 (p = .013 and .050, respectively) in the CVD group as compared to the non-CVD group. BF and Tsk were positively correlated at Times 1 and 2 (r = .516, p < .005; r = 0.278, p = .04) but not at Time 3 (r = 0.235, p > .05). No consistently significant correlations were found between tcPO2 and BF or tcPO2 and Tsk (p > .05). Tsk and BF were higher in the skin of lower legs affected by CVD than in those not affected. Pathological processes in the skin produce heat detectable by an infrared thermometer. Measurement and monitoring of Tsk can augment clinical findings and guide treatment when localized inflammation is suspected. Future studies of Tsk should be directed toward the usefulness of infrared technology to develop a CVD leg ulcer prediction model.