Anxiety is an important comorbidity in chronic obstructive pulmonary disease (COPD). We investigated if cognitive behavioural therapy (CBT), delivered by respiratory nurses, reduced symptoms of anxiety and was cost-effective.Patients with COPD and anxiety were randomised to CBT or self-help leaflets. Anxiety, depression and quality of life were measured at baseline, 3, 6 and 12 months. A cost-effectiveness analysis was conducted from a National Health Service hospital perspective and quality-adjusted life-years estimated using the EuroQol-5D questionnaire.In total, 279 patients were recruited. Group mean change from baseline to 3 months in the Hospital Anxiety and Depression Anxiety Subscale was 3.4 (95% CI 2.62–4.17, p<0.001) for the CBT group and 1.88 (95% CI 1.19–2.55, p<0.001) in the leaflet group. The CBT group was superior to leaflets at 3 months (mean difference in the Hospital Anxiety and Depression Anxiety Subscale was 1.52, 95% CI 0.49–2.54, p=0.003). Importantly, the CBT intervention was more cost-effective than leaflets at 12 months, significantly lowering hospital admissions and attendance at emergency departments.CBT delivered by respiratory nurses is a clinically and cost-effective treatment for anxiety in patients with COPD relative to self-help leaflets.

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Objective: This article reviewed the literature and critically analysed the concept of preparation for parenthood. The analysis is mainly of a discursive nature with some theoretical underpinnings. Background: Preparation for parenthood is a concept that is generally used within psychology, sociology and health professional practice especially midwifery, in terms of preparation for birth and parenthood sessions. However, parents often report feeling unprepared during this period. In order to ensure appropriate delivery of support and education during this time it is important to fully understand what preparation for parenthood really means by unravelling its component elements and understanding its contemporary relevance. Methods: A number of sources were searched using the keywords 'preparation' and 'parenthood'. The concept analysis framework put forward by Walker and Avant was used to develop appropriate cases to further illustrate and explore meaning. Results: The literature search confirmed limited evidence with regards to an in-depth exploration of the concept and the separate elements that are related to each other. This investigation is the first of its kind considering the full range of meanings with regards to the concept and the contemporary evidence available. Law, gender, culture and spirituality all influence the concept and thus antecedents and consequences cannot always be applied to contexts which are fundamentally different. Conclusion: Preparation for parenthood is multi-faceted and changing, thus further research with regards to this concept is warranted. This analysis provides the groundwork for the development of measures that may be used within clinical practice.