Objective. Depressive symptoms are common among patients with fibromyalgia, and behavioral intervention has been recommended as a major treatment component for this illness. The objective of this study was to test the effects of the Mindfulness-Based Stress Reduction (MBSR) intervention on depressive symptoms in patients with fibromyalgia. Methods. This randomized controlled trial examined effects of the 8-week MBSR intervention on depressive symptoms in 91 women with fibromyalgia who were randomly assigned to treatment (n ؍ 51) or a waiting-list control group (n ؍ 40). Eligible patients were at least 18 years old, willing to participate in a weekly group, and able to provide physician verification of a fibromyalgia diagnosis. Of 166 eligible participants who responded to local television news publicizing, 49 did not appear for a scheduled intake, 24 enrolled but did not provide baseline data, and 2 were excluded due to severe mental illness, leaving 91 participants. The sample averaged 48 years of age and had 14.7 years of education. The typical participant was white, married, and employed. Patients randomly assigned to treatment received MBSR. Eight weekly 2.5-hour sessions were led by a licensed clinical psychologist with mindfulness training. Somatic and cognitive symptoms of depression were assessed using the Beck Depression Inventory administered at baseline, immediately postprogram, and at followup 2 months after the conclusion of the intervention. Results. Change in depressive symptoms was assessed using slopes analyses of intervention effects over time. Depressive symptoms improved significantly in treatment versus control participants over the 3 assessments. Conclusion. This meditation-based intervention alleviated depressive symptoms among patients with fibromyalgia.
Fibromyalgia is a stress-related disorder characterized by chronic pain, memory impairment, and neuroendocrine aberrations. With the hypothesis that biological and psychological symptoms may underlie the cognitive problems, the relative influences of neuroendocrine function and psychological factors on declarative memory were examined among 50 women with fibromyalgia. This within-group analysis controlled for age, education, pain, and relevant medications. Neuroendocrine function and depression had significant independent associations with memory function. Higher log-transformed mean salivary cortisol levels were associated with better performance on both immediate and delayed visual recall and with delayed verbal recall. Depressive symptoms were negatively associated with verbal recall. These findings suggest that a basic disorder of endocrine stress responses may contribute to the cognitive symptoms experienced by fibromyalgia patients.
A mphotericin B is a polyene antifungal indicated for the treatment of invasive fungal infections, including aspergillosis, candidiasis, cryptococcosis, and zygomycosis (1). Several generic formulations of this drug are available in the United States, including amphotericin B deoxycholate, or conventional amphotericin B (CAmB), amphotericin B colloidal dispersion (ABCD), and amphotericin B lipid complex (ABLC; Ablecet). The liposomal formulation of amphotericin B (LAmB; AmBisome) may be preferred over other formulations due to a more favorable side effect profile and enhanced tissue penetration, but it is still associated with hypokalemia, likely attributable to increased tubular permeability to monovalent cations, and hypomagnesemia, for which the mechanism is less certain (1-3). Although the drug is known to cause hypophosphatemia as well, several reports of hyperphosphatemia and pseudohyperphosphatemia have been published (1, 4-9).The first case of severe hyperphosphatemia was in a child with acute lymphocytic leukemia who was treated with LAmB for a mixed fungal infection (4). It was postulated that the electrolyte abnormality was caused by a sudden load of exogenous phosphorus coupled with inadequate clearance by the kidneys. Later, Bailey and Chan proposed the possibility of an artifactual elevation of serum phosphorus during LAmB therapy after two patients were found to have falsely elevated phosphorus levels subsequently shown to be normal by treating the serum samples with a lipemic cleansing agent (5). An ensuing case series described 4 pediatric patients who developed hyperphosphatemia while receiving LAmB (6). In that report, transitioning from LAmB to ABLC at the onset of hyperphosphatemia led to normalization of the serum phosphorus level, leading the authors to conclude that any interference with the PHOSm assay must be specific to the liposomal formulation. Another group reported that ultrafiltration of the serum may be an effective method to obtain a more accurate serum phosphorus measurement (7). Two in vitro studies demonstrated a dose-dependent, linear rise in phosphorus measurements when serum was spiked with LAmB. A 0.0072-to 0.0090-mmol/liter increase in phosphorus correlated with a 1-mg/liter increase in LAmB concentration (8,10). No effect was observed using a comparable placebo molecule without active drug, leading the authors to conclude that active drug in the liposomal formulation (LAmB) is involved in the assay interference (10). In 2008, pseudohyperphosphatemia caused by LAmB was detailed in a product corrective action statement released by Beckman and Coulter, Inc., to hospital laboratories that use Synchron chemistry systems to measure serum phosphorus by the PHOSm assay. The product information for AmBisome was updated in 2012 to reflect
Background: Cancer patients who self-report tobacco use within the past 30 days are at high risk for relapse and benefit from cessation support. However, there is little data on whether assessment of tobacco use within the past 30 days increases referral rates to a cessation program across cancer disease sites. Methods: Structured tobacco assessments were administered to 426 new adult patients in a Radiation Oncology clinic at a single institution. Multiple logistic regression was used to assess if clinical aspects of cancer diagnosis (age, gender, race, disease site [head/neck or thoracic {HNT} vs. other], stage [advanced vs. early], and purpose [curative vs. palliative]) affected cessation service referral rates identified using assessment of tobacco use within the past 30 days. Results: Complete medical and tobacco use data were compiled for 387 adult cancer patients (91%). Of these, 147 (38%) were women, 259 (67%) were Caucasian, 115 (30%) were black, 177 (46%) were diagnosed with HNT cancer, and 289 (74%) were being considered for curative cancer treatment. Ever smoking was reported in 273 patients (71%), and 83 (21%) reported current smoking everyday or some days. In 180 former smokers who reported time since last cigarette, 21 (12%) reported smoking within with past 30 days and 9 (7%) of these reported smoking within the past day or week. In 21 patients who were identified for cessation support through evaluation of smoking within the past 30 days, 6 (29%) were women, 7 (33%) were black, 15 (71%) were being considered for curative treatment, and 15 (71%) were diagnosed with a HNT cancer. Multiple logistic regression identified that younger age (10 yr OR 2.41, 95% CI 1.47 - 3.98) and HNT cancer (OR 8.13, 95% CI 2.2-30.3) but not gender, race, stage, and purpose were significantly associated with referral based on assessment of tobacco use within the past 30 days. Identification of smoking within the past 30 days increased cessation referrals by 25% from 83 to 114 patients. Conclusions: Assessment of tobacco use within the past 30 days increased referrals to a smoking cessation program from a Radiation Oncology clinic using a standardized tobacco assessment. In clinical trials and practice, including this question has particular benefit for younger patients and patients with head/neck or thoracic tumors. Citation Format: Samuel Lewis Cooper, Katherine Hoover, Elizabeth Garrett-Mayer, Kenneth Michael Cummings, Matthew J. Carpenter, Kelly Crowley, David T. Marshall, Graham W. Warren. Assessment of tobacco use within 30 days increases referral for cessation support. [abstract]. In: Proceedings of the 106th Annual Meeting of the American Association for Cancer Research; 2015 Apr 18-22; Philadelphia, PA. Philadelphia (PA): AACR; Cancer Res 2015;75(15 Suppl):Abstract nr 3736. doi:10.1158/1538-7445.AM2015-3736
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