Implementing brief cognitive behavioral therapy in primary care: A pilot study.

Effective implementation strategies are needed to improve the adoption of evidence-based psychotherapy in primary care settings. This study provides pilot data on the test of an implementation strategy conducted as part of a multisite randomized controlled trial examining a brief cognitive-behavioral therapy versus usual care for medically ill patients in primary care, using a hybrid (type II) effectiveness/implementation design. The implementation strategy was multifaceted and included (1) modular-based online clinician training, (2) treatment fidelity auditing with expert feedback, and (3) internal and external facilitation to provide ongoing consultation and support of practice.

The impact of supervision on internal medicine residents' attitudes and management of depression in primary care: a pilot study.

Objective: The authors examined the effect of supervision on internal medicine residents' attitudes toward and management of depression.

Method: Internal medicine residents completed a survey during preclinical conferences. The survey included a published, validated questionnaire, the Depression Attitude Questionnaire, and items developed by the researchers.

Risk of obstructive sleep apnea lower in double reed wind musicians.

Study Objectives: Obstructive sleep apnea (OSA) is caused by a collapse of the upper airway. Respiratory muscle training with a wind instrument (didgeridoo) in patients with moderate OSA has been previously shown to improve OSA symptomology. However, a survey of orchestra members did not indicate a difference in OSA risk between wind and non-wind instrumentalist.

Usefulness of peripheral arterial tonometry in the detection of mental stress-induced myocardial ischemia.

Background: Mental stress-induced myocardial ischemia (MSIMI) identifies a subset of coronary arterial disease (CAD) patients at increased risk for adverse cardiovascular events. Peripheral arterial vasoconstriction has been consistently reported as an underlying mechanism for ischemia development in this setting and as such affords a unique opportunity for the noninvasive detection of this phenomenon.

Hypothesis: We studied the usefulness of a peripheral arterial tonometry (PAT) technique in the detection of MSIMI.

Variability of myocardial ischemic responses to mental versus exercise or adenosine stress in patients with coronary artery disease.

Background: Mental stress precipitates myocardial ischemia in a significant percentage of coronary artery disease (CAD) patients. Exercise or adenosine stresses produce different physiologic responses and cause myocardial ischemia via different mechanisms. Little is known about the comparative severity and location of myocardial ischemia provoked by these different stressors.

Depressive symptoms predict heart rate recovery after exercise treadmill testing in patients with coronary artery disease: results from the Psychophysiological Investigation of Myocardial Ischemia study.

Background: Depression is associated with increased risk of death among patients with coronary disease. Cardiovascular autonomic dysregulation may be one of the mechanisms by which depression exerts its effects on cardiovascular function. The purpose of this study was to determine whether depressive symptoms are associated with low heart rate variability (HRV) and prolonged HR recovery after exercise testing in patients with coronary artery disease (CAD).

Association of beta1-adrenergic receptor genetic polymorphism with mental stress-induced myocardial ischemia in patients with coronary artery disease.

Background: Mental stress is associated with sympathetic adrenergic stimulation and concomitant increases in blood pressure and heart rate. Heritable individual differences in cardiovascular functional response to mental stress may arise from genetic variations in adrenergic receptors, which might produce excessive hemodynamic response to mental stress or create other conditions favoring the development of myocardial ischemia.

Methods: We examined the relationship between hemodynamic response to mental stress and mental stress-induced myocardial ischemia (MSIMI) and 5 common functional polymorphisms of beta1-adrenergic receptors (ADRB1 [OMIM 109630, accession No.

Psychobiology of depression/distress in congestive heart failure.

Heart failure affects millions of Americans and new diagnosis rates are expected to almost triple over the next 30 years as our population ages. Affective disorders including clinical depression and anxiety are common in patients with congestive heart failure. Furthermore, the presence of these disorders significantly impacts quality of life, medical outcomes, and healthcare service utilization.

Do men and women differ on measures of mental stress-induced ischemia?

Objective: To consider the effects of gender on ischemia in a larger sample, with broadly defined coronary artery disease (CAD). Mental stress has been shown to cause transient myocardial ischemia in a significant percentage of people with CAD. However, little is known about the effects of mental stress on ischemic processes in women.

Coronary artery disease and depression: patients with more depressive symptoms have lower cardiovascular reactivity during laboratory-induced mental stress.

Objective: To investigate the relationship between symptoms of depression and cardiovascular reactivity during mental stress in patients with coronary artery disease (CAD). Depressive symptoms are common in patients with CAD and are related to an increased risk of cardiac events and death. Some researchers have proposed that negative outcomes in depressed patients with CAD may be related to exaggerated cardiovascular reactivity and psychological stress.

Mental stress-induced myocardial ischemia in coronary artery disease patients with left ventricular dysfunction.

Background: Reduced left ventricular ejection fraction (LVEF) is a risk factor for poor outcomes in patients with coronary artery disease (CAD). Mental stress-induced myocardial ischemia (MSIMI) also identifies a subset of CAD patients at increased risk for future cardiovascular events. Susceptibility to MSIMI in patients with CAD and reduced LVEF is unknown.

Initial heart rate and systolic blood pressure predict outcomes in chronic heart failure patients who are evaluated for cardiac transplant.

Background: Heart rate (HR) and systolic blood pressure (SBP) are currently not considered among common clinical indicators of prognosis in patients referred for heart transplant (Htx). We sought to determine whether an initial hemodynamic profile of HR and SBP could be used to predict outcomes in chronic heart failure patients evaluated for Htx.

Methods: We analyzed the medical records of patients evaluated for Htx and obtained demographic and clinical data collected at the initial transplant clinic visit or inpatient encounter.

Pediatric behavior management techniques: a survey of predoctoral dental students.

Dental schools are increasingly incorporating behavioral management strategies into the curriculum; however, little is known about the efficacy of this instruction. The purposes of this study were to evaluate student exposure to several categories of behavioral management techniques, assess student opportunity to observe faculty use of these techniques, and determine the extent of students' personal use of various behavioral management techniques. Third-year dental students (n=98, X age=26.

Modafinil facilitates performance on a delayed nonmatching to position swim task in rats.

Modafinil is a wake-promoting drug approved by the FDA for the treatment of narcolepsy. Recent evidence suggests that modafinil may improve learning and memory processes. To further evaluate possible cognitive properties associated with modafinil, male Sprague-Dawley rats were tested in a delayed nonmatching to position (DNMTP) task.