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  • Telephone-supported computerised cognitive–behavioural therapy: REEACT-2 large-scale pragmatic randomised controlled trial
  • Simon Gilbody, Sally Brabyn, Karina Lovell, David Kessler, Thomas Devlin, Lucy Smith, Ricardo Araya, Michael Barkham, Peter Bower, Cindy Cooper, Sarah Knowles, Elizabeth Littlewood, David A. Richards, Debbie Tallon, David White, Gillian Worthy, on behalf of the REEACT collaborative
  • Journal: The British Journal of Psychiatry / Volume 210 / Issue 5 / May 2017
  • Published online by Cambridge University Press: 02 January 2018, pp. 362-367
  • Print publication: May 2017
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    Background

    Computerised cognitive–behavioural therapy (cCBT) for depression has the potential to be efficient therapy but engagement is poor in primary care trials.

    Aims

    We tested the benefits of adding telephone support to cCBT.

    Method

    We compared telephone-facilitated cCBT (MoodGYM) (n = 187) to minimally supported cCBT (MoodGYM) (n = 182) in a pragmatic randomised trial (trial registration: ISRCTN55310481). Outcomes were depression severity (Patient Health Questionnaire (PHQ)-9), anxiety (Generalized Anxiety Disorder Questionnaire (GAD)-7) and somatoform complaints (PHQ-15) at 4 and 12 months.

    Results

    Use of cCBT increased by a factor of between 1.5 and 2 with telephone facilitation. At 4 months PHQ-9 scores were 1.9 points lower (95% CI 0.5–3.3) for telephone-supported cCBT. At 12 months, the results were no longer statistically significant (0.9 PHQ-9 points, 95% CI −0.5 to 2.3). There was improvement in anxiety scores and for somatic complaints.

    Conclusions

    Telephone facilitation of cCBT improves engagement and expedites depression improvement. The effect was small to moderate and comparable with other low-intensity psychological interventions.

The Haskins Society Journal 23
  • The Haskins Society Journal 23
  • 2011. Studies in Medieval History
  • Edited by William L. North
  • Published by: Boydell & Brewer
  • Published online: 05 November 2014
  • Print publication: 17 April 2014
  • View description
    This volume of the Haskins Society Journal furthers the Society's commitment to historical and interdisciplinary research on the early and central Middle Ages, especially in the Anglo-Saxon, Anglo-Norman, and Angevin worlds but also on the continent. The topics of the essays it contains range from the curious place of Francia in the historiography of medieval Europe to strategies of royal land distribution in tenth-century Anglo-Saxon England to the representation of men and masculinity in the works of Anglo-Norman historians. Essays on the place of polemical literature in Frutolf of Michelsberg's Chronicle, exploration of the relationship between chivalry and crusading in Baudry of Bourgeuil's History, and Cosmas of Prague's manipulation of historical memory in the service of ecclesiastical privilege and priority each extend the volume's engagement with medieval historiography, employing rich continental examples to do so. Investigations of comital personnel in Anjou and Henry II's management of royal forests and his foresters shed new light on the evolving nature of secular governance in the twelfth centuries and challenge and refine important aspects of our view of medieval rule in this period. The volume ends with a wide-ranging reflection on the continuing importance of the art object itself in medieval history and visual studies. Contributors: H.F. Doherty, Kathryn Dutton, Kirsten Fenton, Paul Fouracre, Herbert Kessler, Ryan Lavelle, Thomas J.H. McCarthy, Lisa Wolverton, Simon Yarrow.
  • Cost-effectiveness of cognitive–behavioural therapy as an adjunct to pharmacotherapy for treatment-resistant depression in primary care: economic evaluation of the CoBalT Trial
  • Sandra Hollinghurst, Fran E. Carroll, Anna Abel, John Campbell, Anne Garland, Bill Jerrom, David Kessler, Willem Kuyken, Jill Morrison, Nicola Ridgway, Laura Thomas, Katrina Turner, Chris Williams, Tim J. Peters, Glyn Lewis, Nicola Wiles
  • Journal: The British Journal of Psychiatry / Volume 204 / Issue 1 / January 2014
  • Published online by Cambridge University Press: 02 January 2018, pp. 69-76
  • Print publication: January 2014
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    Background

    Depression is expensive to treat, but providing ineffective treatment is more expensive. Such is the case for many patients who do not respond to antidepressant medication.

    Aims

    To assess the cost-effectiveness of cognitive–behavioural therapy (CBT) plus usual care for primary care patients with treatment-resistant depression compared with usual care alone.

    Method

    Economic evaluation at 12 months alongside a randomised controlled trial. Cost-effectiveness assessed using a cost-consequences framework comparing cost to the health and social care provider, patients and society, with a range of outcomes. Cost-utility analysis comparing health and social care costs with quality-adjusted life-years (QALYs).

    Results

    The mean cost of CBT per participant was £910. The difference in QALY gain between the groups was 0.057, equivalent to 21 days a year of good health. The incremental cost-effectiveness ratio was £14 911 (representing a 74% probability of the intervention being cost-effective at the National Institute of Health and Care Excellence threshold of £20 000 per QALY). Loss of earnings and productivity costs were substantial but there was no evidence of a difference between intervention and control groups.

    Conclusions

    The addition of CBT to usual care is cost-effective in patients who have not responded to antidepressants. Primary care physicians should therefore be encouraged to refer such individuals for CBT.

  • Symposium ‘The politics of international recognition’
  • Hans Agné, Jens Bartelson, Eva Erman, Thomas Lindemann, Benjamin Herborth, Oliver Kessler, Christine Chwaszcza, Mikulas Fabry, Stephen D. Krasner
  • Journal: International Theory / Volume 5 / Issue 1 / March 2013
  • Published online by Cambridge University Press: 21 March 2013, pp. 94-107
  • Print publication: March 2013
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    Recognition plays a multifaceted role in international theory. In rarely communicating literatures, the term is invoked to explain creation of new states and international structures; policy choices by state and non-state actors; and normative justifiability, or lack thereof, of foreign and international politics. The purpose of this symposium is to open new possibilities for imagining and studying recognition in international politics by drawing together different strands of research in this area. More specifically, the forum brings new attention to controversies on the creation of states, which has traditionally been a preserve for discussion in International Law, by invoking social theories of recognition that have developed as part of International Relations more recently. It is suggested that broadening imagination across legal and social approaches to recognition provides the resources needed for theories with this object to be of maximal relevance to political practice.

  • Chapter 16 - Spina bifida and tethered cord syndrome
    • from Section 3 - Specific conditions
  • Edited by Clare J. Fowler, Jalesh N. Panicker, Anton Emmanuel, University College London
  • Book: Pelvic Organ Dysfunction in Neurological Disease
  • Published online: 06 December 2010
  • Print publication: 04 November 2010, pp 255-265
  • View abstract

    Summary

    This chapter describes the different surgical procedures for managing a neurogenic bladder. The procedures include electrical stimulation, bladder and urethral reconstructive surgery, bladder outlet obstruction management and the treatment of stress urinary incontinence. Electrical stimulation to manage bladder dysfunction in patients with neurological disorders has been used since 1950. Electrical stimulation therapies include intravesical electrostimulation, sacral neuromodulation and sacral anterior root stimulation with selective sacral rhizotomy. Cutaneous continent diversions may be performed in neurological patients, mainly in the young myelomeningocele patient or those with spinal cord injury (SCI) who cannot perform clean intermittent self-catheterization (CISC) via the urethra because of congenital abnormalities, urethral pain, obesity, strictures or poor hand mobility. Finally, the chapter describes the suprapubic catheter (SPC), and sphincter surgery, which relieves bladder outlet obstruction due to external urethral sphincter contraction.
  • Chapeter 10 - Evaluation and management of neurogenic sexual dysfunction
    • from Section 2 - Evaluation and management
  • Edited by Clare J. Fowler, Jalesh N. Panicker, Anton Emmanuel, University College London
  • Book: Pelvic Organ Dysfunction in Neurological Disease
  • Published online: 06 December 2010
  • Print publication: 04 November 2010, pp 153-166
  • View abstract

    Summary

    There are a number of neurological diseases which have an effect on bowel function. This chapter provides an overview of gastrointestinal (GI) physiology, with reference to the hindgut and pelvic floor. It addresses the problems caused by common neurological diseases. The intra-abdominal GI tract is varied, and divided into the organs of stomach, small intestine and large intestine. Bowel dysfunction affects approximately 80% of those with spinal cord injury (SCI) and causes more of a problem than urinary and sexual dysfunction in a third of individuals with SCI. Neurological diseases such as SCI or MS frequently impair CNS control of the gut. The difference between the neural control systems for bowel and bladder is underlined by the differing effects of such diseases on the two systems. Supraconal SCI tends to cause difficulty with evacuation of feces in addition to fecal incontinence, but predominantly difficulty with urinary continence.

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