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Subject:
From:
Tom Kindlon <[log in to unmask]>
Reply To:
Tom Kindlon <[log in to unmask]>
Date:
Wed, 26 Dec 2012 15:06:14 +0000
Content-Type:
text/plain
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text/plain (146 lines)
["In the Barts service, an outcome of improvement in 75 per cent of
patients is expected, with a third of those (25 per cent) expected to
recover if given sufficient treatment."

 - yet Peter White and the other PACE Trial investigators are not
planning to publish the recovery outcome measure (a secondary outcome
measure) from the £5m PACE Trial, nor will they give it in response to
a Freedom of Information Act request.

---
"The PACE trial showed outcomes of approximately 60 per cent of
patients making a clinically useful improvement* in both symptoms and
disability with either CBT or graded exercise therapy."

The definition was broad: 42% in the SMC (control-type group) also
satisfied the post-hoc criteria for a clinically useful improvement.
The more strict primary outcome "overall improvers" has never been
published and they do not intend to publish it or release it in
response to a Freedom of Information request] Tom]


=====================

http://bit.ly/RieusW  i.e.

http://www.nhsconfed.org/Publications/Documents/Investing%20in%20emotional%20and%20psychological%20wellbeing%20for%20patients%20with%20long-tern%20conditions%2018%20April%20final%20for%20website.pdf


"Chronic fatigue syndrome service: St Bartholomew's (Barts) Hospital, London

The chronic fatigue syndrome service at St Bartholomew's (Barts)
Hospital, jointly provided by Barts & The London NHS Trust and East
London NHS Foundation Trust, and managed by the latter, is unique in
that it is clinically led by a consultant physician (infectious

diseases) and a consultant liaison psychiatrist (see
http://bartscfs.eastlondon.nhs.uk). This allows it to properly assess
patients, referred mainly by GPs, since three service audits from
different NHS services have shown that around

40 per cent of such patients are found not to have chronic fatigue
syndrome, with half of these having an alternative medical diagnosis
(for example, sleep apnoea) and the other half having an alternative
psychiatric diagnosis (for example, depressive illness). Assessment is
therefore crucial to a good outcome.

Once a diagnosis of chronic fatigue syndrome is made, patients are
referred to one of the multidisciplinary team for further assessment,
with a view to rehabilitative therapy. The NICE
guidelines162 suggest that the two therapies with the best research
evidence of effectiveness are individually delivered cognitive
behaviour therapy (CBT) and graded exercise therapy.

The recently published PACE trial (see www.pacetrial.org) showed that
these therapies were both moderately effective and safe, when added to
specialist medical care, and when individually delivered by
appropriately qualified therapists who had received appropriate
training and supervision. Receipt of specialist medical care alone and
specialist medical care supplemented by pacing therapy (staying within
limits imposed by the illness) were less effective at helping both
symptoms and disability. The aims of therapy are to provide
amelioration of maintaining factors that are keeping a patient unwell.
These are known to be illness beliefs, inactivity (or extremes of
activity) as well as deconditioning, sleep and mood problems.

The Barts service provides patient choice, in that both individually
delivered CBT and graded exercise therapy are available, as well as
individually delivered occupational therapy (providing graded activity
therapy and occupational support). A recent audit of group-delivered
rehabilitation therapy (combining all the above) showed high levels of
patient satisfaction, but limited effectiveness.

This is now being reviewed. Complementary to this, all patients
receive specialist medical care, which consists of generic advice
about managing the illness as well as prescribed medicines to treat
associated symptoms (such as insomnia) and co-morbid illnesses (such
as depressive illness). An information session has recently been
introduced for all newly diagnosed patients to educate about the
illness and treatment options. The session is available to patients,
their families and carers.

The PACE trial showed outcomes of approximately 60 per cent of
patients making a clinically useful improvement* in both symptoms and
disability with either CBT or graded exercise therapy.  In clinical
practice, slightly less impressive results would be expected, as
demonstrated by the National Outcome Database of 26 NHS services (see
www.bacme.info/document_uploads/ NOD/NODpres.pdf). These services are
equally effective at reducing symptoms, but less effective at
improving disability. In the Barts service, an outcome of improvement
in 75 per cent of patients is expected, with a third of those (25 per
cent) expected to recover if given sufficient treatment. A normal
course of treatment is composed of 30 sessions, including medical
care. In the PACE trial, participants received up to 15 sessions of
therapy and about four medical consultations in a year.


For further details, contact:

Professor Peter White, Professor of Psychological Medicine, Wolfson
Institute of Preventive Medicine, Barts and The London School of
Medicine and Dentistry [log in to unmask]"

====================
Taken from:

http://www.nhsconfed.org/Publications/reports/Pages/InvestinginEmotionalandPsychologicalWellbeingLongTermPatients.aspx
Investing in emotional and psychological wellbeing for patients with
long-term conditions.

Date: 18/04/2012 (i.e. April 18th, 2012)

Stock Code: BOK60053

Format: Electronic

A guide to service design and productivity improvement for
commissioners, clinicians and managers in primary care, secondary care
and mental health.

For many patients, several physical illnesses will coexist at any one
time, and for some a mental health disorder will also be present. In
the face of such multi-morbidity and need, focus on the patient
journey across the lifespan and across the care system will maximise
effective service design and delivery.

The collation of evidence and emerging economic analysis, together
with examples of service design and delivery in this guide, will
assist commissioners, clinicians and managers in primary care,
secondary care and mental health in designing services, improving
productivity and learning across disease-specific groups.

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