Clinical implications Sample Clauses

Clinical implications. It is unlikely that variation between expected and observed differences in FEV1 and FVC could account for the lack of a difference between segmentectomy and lobectomy in the two large clinical trials [JCOG 0802 (1) and CALGB 140503 (2)]. This is because the degree of error would be expected to be the same on both sides of the randomisation arms. The more likely explanation would be that the amount of lung tissue resected in the sublobar arms would be similar to “lobectomy” to achieve cancer clearance as the 2 cm lesions do not usually sit nicely within the centre of one segment or peripherally to allow a wedge with minimal tissue clearance (as expected when the trials were designed). Also, the concept of a lobectomy is often misinterpreted as a larger resection given left upper division segmentectomy is the same amount of tissue as right upper lobectomy and left lingula segmentectomy is the same amount of tissue as a right middle lobectomy. Our results suggest that when consenting patients in clinic prior to lung resection, it is no longer accurate to simply estimate the amount of lung tissue loss if FEV1 is used as a yardstick measure, as it overestimates postoperative losses, and prohibits patients proceeding to surgery or alters the extent of resection recommended on inaccurate measures (12). Future clinical guidelines also need to be aware of our findings to allow for better recommendations for both surgeons and patients. For example, the use of 40% postoperative predicted value is often used as a yardstick for patient selection for lung resection (12) and our results suggest that on average the actual values are expected to be approximately 10% higher.

Clinical implications. Physical activity (PA), health and quality of life are closely interconnected: the human body is designed to move and therefore needs regular PA in order to function optimally and avoid illness. Regular PA can increase general wellbeing, improve psychological and physical health, help to maintain self-sufficiency, and prevent specific metabolic disorders, such as type 2 diabetes, metabolic syndrome, and hypercholesterolemia. On the contrary, it has been observed in literature [1] [2] that a sedentary lifestyle is a risk factor for the development of many chronic illnesses. The psychological discomfort linked with aging can be modified or minimized by engaging in pleasant and shared PA. Sedentary people who become more physically active report feeling better from both a physical and a mental point of view, and enjoy a better quality of life. Based on the epidemiological studies carried out in Europe, it is evident that those who would highly benefit from regular physical activity (e.g., adults over 65 years of age) are generally the most sedentary [4]. For this purpose, the implementation of a European wide policy to improve active living and prevent physical and mental diseases is strongly needed. More specifically, methodologies and technologies which aim to make physical activity easier and promote personal responsibility in individuals aged over 65 years are warranted [3]. For adults aged over 65 years, the same goals as for healthy younger adults should be achieved with additional exercises like strength training and balance exercises to prevent falls. These are in addition to the routine daily activities (e.g., cleaning rooms, walking to go shopping, climbing stairs)[6]. PA, which causes a noticeable increase in heart rate, is beneficial for disease prevention. Some studies show that walking briskly for even one to two hours a week (15 to 20 minutes a day) starts to decrease the chances of having a heart attack or stroke, developing diabetes, or dying prematurely [7]. Walking is an ideal exercise for many people—it does not require any special equipment, can be done any time, any place, and is generally very safe. Several studies [8] [9] [10] [11] [12] [13] have demonstrated that this simple form of exercise substantially reduces the chances of developing heart disease, stroke, and diabetes in different populations. To obtain significant effects of physical activity interventions in the elderly, the typical dose of physical activity prescribed is 20–6...

Clinical implications. In terms of the clinical relevance of these data, a large effect was observed for reduced ratings of unpleasantness for normatively negative stimuli in participants with meditation experience. Perceiving stimuli as unpleasant or aversive is a key process in both anxiety and depression, and if emotional experience is appraised as less aversive then it is less likely to lead to experiential avoidance (▇▇▇▇, 2007; ▇▇▇▇▇▇▇▇ et al., 2009), a transdiagnostic process involved in the maintenance of several psychological conditions (▇▇▇▇, 2007). A medium sized effect was observed for group differences in arousal and SCR. For positive stimuli, differences were observed in both self-reported arousal and physiological responding, and these data suggest less engagement with potentially rewarding stimuli in those with meditation experience. These data may be of relevance to psychological conditions wherein the reward system is emphasised such as addictions, and it is of note that mindfulness-based interventions have had some success in this area (▇▇▇▇▇▇▇▇ et al., 2009). For negative stimuli, no differences were observed on a physiological level, but self- reported arousal was reduced in meditators. These data suggest differences at the level of cognitive appraisal and perceived arousal when responding to negative stimuli. Both reduced physiological arousal in the case of positive stimuli, and perceived arousal in the case of negative stimuli are likely to confer advantages in terms of wellbeing, and are consistent with an account that emphasises contentment as a means of affect regulation (▇▇▇▇▇▇▇, 2009). Overall these data fit with transdiagnostic conceptualisations of mental health. Mindfulness-based approaches also emphasise self-regulation, and so self-efficacy, with few reported side effects (▇▇▇▇▇▇, ▇▇▇▇▇▇, & ▇▇▇▇, 2012). However, a related issue is the usefulness of these approaches for different service users. Mindfulness-based approaches have been shown to reduce mental distress in many different psychological and physical health conditions, which could be viewed as a lack of specificity. It is likely to be of most use in targeting transdiagnostic processes with a theoretical basis such as overengagement with mental contents through processes such as rumination, and/or experiential avoidance (▇▇▇▇, 2007). That said, mindfulness practice is not always easy and requires an ongoing commitment which is a further consideration when assessing suitability for mindfuln...

Clinical implications. The findings from the review support the inclusion of social factors in explanatory models both as causal and maintaining features (▇▇▇▇▇▇▇ & Treasure, 2006; Treasure et al., 2012; Treasure & ▇▇▇▇▇▇▇, 2013). The mechanism by which these problems contribute to the maintenance of the disorder remains unclear. Interventions which target problematic aspects of social processing may be of particular benefit or enhance existing treatments. For instance oxytocin might be used to improve the therapeutic alliance in forms of ED in which this social processing system is perturbed (▇▇▇▇▇-▇▇▇▇▇▇▇▇▇▇, Domes, Kirsch, & ▇▇▇▇▇▇▇▇▇, 2011). There is potential to improve the functioning of these circuits by using forms of brain training to encourage plastic changes in these circuits, such as attentional bias modification (Renwick, Campbell, & ▇▇▇▇▇▇▇, 2013). It is important to involve partners (Bulik, Baucom, Kirby, & Pisetsky, 2011) and families (▇▇▇▇▇▇▇ et al., 2011) in the treatment of ED.

Clinical implications. The findings summarised in the current systematic review have important clinical implications. Firstly, they highlight the relevance and role of social rank in the EDs field. This adds to the growing interest in the role of interpersonal difficulties in the aetiology, maintenance and treatment of EDs, suggesting the importance of considering social rank and the related cognitive, affective and interpersonal correlates of it. Most of the studies included in the current review are cross-sectional, therefore, there is lack of definitive evidence about causation. However, interpersonal difficulties could be a trait-vulnerability factor for EDs and could be considered at the heart of ED symptomatology, with the function of restoring or maintaining social rank, as well as coping with the difficult emotions arising from perceiving oneself as low social rank and generate a sense of achievement. Importantly, the current review has highlighted that social rank is relevant to all the different types of EDs. Therefore, this could set the ground for developing transdiagnostic approaches and treatments, which could be applied to all EDs in a cost-effective manner (▇▇▇▇▇▇, ▇▇▇▇▇▇▇▇ & ▇▇▇▇▇- ▇▇▇▇▇▇▇, 2016). Given this role of social rank, interpersonal treatments for ED aimed at reducing eating disorder pathology by improving interpersonal functioning could be important. The current findings may inform existing therapies such as Interpersonal Psychotherapy for EDs (▇▇▇▇▇▇ et al., 2010) and Cognitive Behaviour Therapy for EDs (CBT-E; ▇▇▇▇▇▇▇▇, 2008) in supporting individuals challenging negative automatic thoughts associated with social rank as well as finding alternative contexts in which to achieve status (▇▇ ▇▇▇▇▇ et al., 2017; ▇▇▇▇▇ et al., 2014). Supporting individuals finding personal qualities and skills as well as successful areas of their lives that go beyond the ED could be helpful to improve their rank perception and challenge the role of the ED. This should go alongside a recognition of the potential contribution of environmental factors, such as childhood experiences or traumatic experiences, in the development of low social rank mentality and maintenance of the disorder. Additionally, improving individuals’ ability to be more assertive and dominant in interpersonal relationship may also be very important (▇▇▇▇▇▇▇▇▇ et al., 2012; Brugnera et al., 2018). An assertive interpersonal style is at the heart of positive and healthy interpersonal relationship and to m...

Clinical implications. This study has a number of important clinical implications. Firstly, COCD have impaired general functioning and higher levels of anxiety that are unidentified in most families, and children are not known to their Child and Adolescent Mental Health Services. In the course of this study, two referrals of COCD children to local services were facilitated. This suggests that a vertical integration approach, where family level assessment and intervention is practiced may be appropriate from families where the father has OCD of the severity seen in this study, particularly as there is an obligation to consider the needs of dependent children in any adult mental health setting (Royal College of Psychiatrists 2002). It may be important to emphasize to fathers in the engagement phase of treatment that their children’s problems do not appear to be related in any specific way to their parenting despite their perception of this being the case, rather there may be a general negative effect of living with OCD on the whole family that could be helped by treating the whole family alongside individual CBT based treatment for the parent. A systemic treatment approach may also help fathers develop more positive relationships with their children and become less critical of them, two factors that this study did highlight as a difference between OCD and control fathers. At an individual level for the COCD, their social deficits may be helped by social skills work in addition to family intervention, which may serve a preventative intervention to decrease future internalising and anxiety problems and increase social integration. Finally there is a need amongst mental health professionals and social workers to understand the nature of OCD in parents, particularly fathers who in this study were experiencing highly distressing intrusive thoughts about harming their children and family. This had prevented most of them from seeking professional help due to fear of their children being removed from their care, or social services involvement. Additionally the levels of shame associated with these thoughts (particularly when they were sexual in content) highlights the need for particular knowledge and skills in assessing these fathers so that they feel comfortable enough to disclose the nature of their most distressing thoughts. It is notable that in the course of this research many fathers had never revealed the content of their intrusions to anyone before, and expressed their relief in ...

Clinical implications. The young offender population under investigation showed high levels of childhood adversity, as measured by the ACEs, and a greater propensity to respond to hypothetical ambiguous scenarios that had the potential to elicit distress, with negative intent. In line with previous research (▇.▇. ▇▇▇ ▇▇▇▇▇▇▇▇▇▇, ▇▇▇▇▇▇▇▇▇ & ▇▇▇▇▇▇▇▇-▇▇▇▇▇▇▇▇▇▇, 1999; ▇▇▇▇▇▇ et al., 2000) this is suggestive of individuals with avoidant attachment patterns. Within the current study ACEs also correlated with attachment avoidance, as measured by the ▇▇▇ (▇▇▇▇▇ et al., 2006) and as such does not suggest there is added value of using the simulation task within this population as a measurement of working models of attachment. However, the literature suggests that those who have an avoidant attachment style have been shown to use deactivating strategies such as suppression (▇.▇. ▇▇▇▇▇▇▇▇▇▇ et al., 2002) and regulate attachment by diverting attention away from attachment-related issues (▇.▇. ▇▇▇▇▇▇ et al., 2001). When interviewed, avoidant individuals have also been shown to dismiss attachment experiences as unimportant and unperturbing (▇▇▇▇▇, 1999). Furthermore, avoidant clients have been rated by treatment providers as seeming less committed and engaged (▇▇▇▇▇▇, 1990; ▇▇▇▇▇▇▇▇▇▇ et al., 1997). Therefore, as has been suggested by researchers within other disciplines (e.g. probationary services: ▇▇▇▇▇▇, 2008; psychosis: ▇▇▇▇▇▇ et al., 2014) an attachment framework may be useful in considering how to engage and adapt interventions to best meet the needs of a young offender population. For instance, although not exclusive to their approach and based on their experience of working with adult sexual offenders, ▇▇▇▇ and ▇▇▇▇▇▇▇▇ (2011) have put forward an attachment-based model to working with adults who present with insecure attachment styles. This approach suggests that exploring relational dynamics and patterns of interaction within the therapeutic relationship can improve outcomes when working with individuals who may otherwise be seen to be resistant to therapeutic change (▇▇▇▇▇▇ & ▇▇▇▇▇▇, 2014). From the researchers own experience, there are many skilled professionals working with young offenders across the varying disciplines (e.g. probation, prison staff, mental health and forensic practitioners). However, with an emphasis on evidence-based approaches being applied across prison settings (▇▇▇▇▇▇▇▇ & ▇▇▇▇▇▇▇ 2012) and services working directly with offenders (e.g. social work/probatio...

Clinical implications. The present findings add to the growing body of evidence (▇▇▇▇▇▇▇▇▇ et al., 2009; ▇▇▇▇▇▇▇▇▇▇ et al., 2008; ▇▇▇▇▇▇▇▇ & ▇▇▇▇▇▇, 2006; ▇▇▇▇▇ & ▇▇▇▇▇▇▇▇, 2007) that mindfulness can be used in the treatment of current depression, and may be a valuable therapeutic intervention in the amelioration of symptoms. Mindfulness has been used as a clinical intervention as part of the full MBCT programme, which was initially indicated only for remitted depressed patients with a history of 3 or more previous depressive episodes. The current study suggests that mindfulness can also be effective as an intervention in itself (i.e., not as part of the MBCT programme), and that it has beneficial effects for a broader range of depression presentations (i.e., not just patients in remission). The study showed that brief mindfulness and relaxation interventions led to the amelioration of depressive symptoms. Therefore, the provision of such interventions whilst patients are on the waitlist to receive psychological therapy could become available within relevant NHS services. In the current study, patients had two face-to-face sessions (although only one was an intervention session), but most of their practice was done on their own, thus the interventions were predominantly self-help with the use of audio recording. In clinical services, these interventions could potentially be provided through online therapy (e-therapy) and self-help. E-therapy and self-help have become important resources, and have shown high rates of patients’ and clinicians’ satisfaction (▇▇▇▇▇ et al., 2000), as well as symptom reduction (▇▇▇▇▇▇▇▇ et al., 2010). In addition to potential patient benefit, provision of such interventions would likely be cost-effective. Considering that the ability to decenter predicted changes in depressive symptoms during the active stage of treatment, clinical interventions for depression may incorporate a specific focus on improving decentering skills (for example, by emphasising letting go of negative thoughts and feelings) through mindfulness training (as in the current study), or other therapeutic interventions (such as CBT). The findings of the study showed that both mindfulness and relaxation had comparable amount of change in self-compassion. Emerging theory on self- compassion (e.g., ▇▇▇▇▇▇▇, 2009) suggests that compassion is adaptive in the face of negative thoughts and feelings, and thus plays an important role in symptom change. Moreover, depressed patients seem to hav...

Clinical implications. The administration of PROMs to capture personal perceptions of activity limitations and participation restrictions following impairment is central in guiding clinical goal setting and assessing outcomes that are valued by the individual. However, accurate interpretation of PROM measures is crucial to ensure proper goal setting and outcome measurement. Results of the present study suggest that scores supplied by informants and PWA are not consistently interchangeable, and like previous studies, informants are more likely to rate PWA more negatively than PWA rate themselves. Results of this study also suggest that informants may rate PWA more positively on constructs relating to social roles than PWA themselves. Clinicians must be aware of the unobservable constructs that may guide an individual’s attitude towards their own participation and activity restrictions but may evade informant recognition according to our findings. Results of the present study may indicate a greater need for speech language pathologists to provide greater aphasia education and communication skills training to caregivers. Providing caregivers with a better understanding of the concomitant psychosocial effects aphasia may have on their loved ones, as well as the less salient components of language as reported by ▇▇▇▇▇▇▇▇ and ▇▇▇▇▇ (2015) could help bridge the discrepancies between perspectives on measures of quality of life. The present research provides evidence that PWA with less severe language deficits are likely to perceive themselves as having worse activity limitations and participation restrictions than individuals with more severe language deficits. Clinically, it is critical to ensure that patients have adequate emotional support to navigate the new normality of living with aphasia. The implementation of psychosocial support to bolster emotional support and redirect negative images of self may be warranted for these individuals with aphasia. ▇▇▇▇▇▇▇▇▇ and colleagues (2018) operationalized psychosocial support to help manage negative reactions through counseling and address the participation and activity consequences associated with aphasia. Through implementation of interventions targeting psychosocial support, individuals across all aphasia severities may learn to accept their new normality and perceive one’s capabilities and functioning through a more positive lens. However, the implementation of psychosocial interventions for people with aphasia presents with numerous ba...