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The other area where psychologists at times assist is the selection and preparation of patients for surgery discount propranolol 40mg overnight delivery cardiovascular system process. Although there is lots of evidence for psychological preparation for surgery helping a range of outcomes (e cheap 80 mg propranolol fast delivery heart disease usa. Carragee (2001) reviewed the literature and concluded that psychological screening prior to disc surgery is of limited value in many cases, and can be viewed as useful only when less pathol- ogy is present, there have been longer periods of disability, and economic issues are present. Other variables, such as internal locus of con- trol and lower catastrophic cognitions, have also been associated with better outcomes, such as shorter time to achieve a straight leg raise follow- ing total knee replacement (Kendell, Saxby, Malcolm, & Naisby, 2001). The research is correlational in nature and does not rule out the possibility that patient anxiety reflects a realistic interpretation of the circumstances sur- rounding surgery. It is also possible, however, that anxiety serves to limit activity and thus reduces the probability of a positive outcome. In line with this interpretation, concurrent psychological intervention with surgery may serve to enhance surgical outcome. That is, psychological interventions specifically aimed at anxiety reduction and improving self-efficacy and con- trol may serve to facilitate recovery in some patients. In particular, usage of imagery and relaxation strategies following surgery was associated with significantly greater knee strength, and less pain anxiety about reinjury. Overall, there appears to be increasing support for psycho- logical interventions in improving outcomes following surgery, but clearly more research is needed in this area. PAIN IN CHILDREN Prior to concluding, it must be acknowledged that this chapter, due largely to space constraints, has focused on psychological interventions for adults with chronic pain. We recognize that psychological interventions are also used to manage pain among children and adolescents (McGrath & Hillier, 1996; see also chap. Cognitive interventions with children typically focus on modifying thoughts and coping abilities related to pain (e. McGrath (1987), in particular, strongly advocated a multistrategy approach (both pharmaco- logical and nonpharmacological) for optimal management of recurrent per- 10. PSYCHOLOGICAL INTERVENTIONS AND CHRONIC PAIN 295 sistent pain that is tailored to the child and follows from the needs identi- fied through a multidimensional pain assessment. The interested reader is encouraged to review Eccleston, Morley, Williams, Yorke, and Mastroyan- nopoulou (2002), who conducted a recent systematic review and meta- analysis that shows good efficacy, but only really for headache, and second- arily for abdominal pain and sickle cell where there has been some prelimi- nary research. There is no controlled research on several major childhood chronic problems such as juvenile rheumatoid arthritis. CONCLUSION Although psychological treatments for chronic pain have been shown to be valuable, there is far greater support for CB interventions than any other form of treatment. Even with this form of treatment, however, there is a need for further research evaluations. A number of valuable recommenda- tions in this regard have been made (e. Morley and Williams (2002) most recently highlighted some of the issues that deserve reflection for those considering conducting and evaluating psychological treatments for chronic pain. A significant chal- lenge, for instance, is to understand why patients vary in their response to treatment and to develop interventions that are sensitive to individual needs. They further noted that there are severe limits to the extensive test- ing of all the parameters of treatment such as length and intensity. In this regard, they suggested that the way to move forward is through articula- tion of theories of change, of both specific and process components, to guide research on efficacy and effectiveness of treatment. In the selection and development of outcome measures they suggested that we need to ex- amine the needs of various stakeholders and that both qualitative and quantitative approaches to this research are required. Schwartz and colleagues (Schwartz, Cheney, Irvine, & Keefe, 1997) cau- tioned that clinical research on psychosocial interventions has flourished in the past two decades, and that due to the wide availability of interven- tions, reliance on standard no-treatment control conditions is really no lon- ger possible. A new design for randomized clinical trials is described by Schwartz’s group (1997) that does not require a no-treatment control group, and that potentially identifies dose-response relationships between inter- ventions and treatment outcomes. They proposed use of a three-arm varia- tion of a standard crossover trial.

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Researchers should feel free to discuss their presentations with the media but should not offer more detail than they included in the presentation buy generic propranolol 40 mg on line cardiovascular keywords. Fortunately buy propranolol 80 mg with amex coronary artery ectasia definition, press reports are not usually regarded as breaches, as long as they do not contravene embargo regulations and as long as they are fairly general and do not include exact replicas of the tables or figures that you submit in your paper. It pays to be very conservative about where you publicise any early results. Despite the fact that the press often reports new findings from scientific meetings, any research results should be considered preliminary until the full report of the study undergoes peer review and is considered worthy of publication. For this reason, some journals have strict policies regarding prepublication of research results to overcome the conflict between the news media, who strive to publish any new information as quickly as possible, and the journal editors, who prefer to disseminate research information only after validation by peer review. Although journals have been 136 Review and editorial processes criticised for exerting too much control over the release of research results to the media, they go to great lengths to ensure the accuracy and validity of the information they publish. This policy, which is commonly known as the “Ingelfinger rule”, dates back to the 1960s. Franz Ingelfinger, who was the editor of the Lancet at that time, objected to papers being reported in the free press before they were published in the subscription based journal. The Ingelfinger rule, which covers embargoes on prepublication, has been adopted by many journals despite ongoing controversy about its influence on delaying the release of important research results to the public. In response, researchers may decide to withhold their full results at conferences where information is available to the media to ensure that their work is publishable. Many journals will place an embargo on your paper prior to publication and will include details of their embargo in your contract. In practice, an embargo limits prepublication publicity and protects both the authors and the publishers. In essence, the embargo allows you to prepare for the impact of the release of your results to the public and thus to avoid misinterpretation. When embargoes are broken, people who have a vested interest in the study results are not able to obtain the information that they expect and the researchers who plan to disseminate results in a careful and responsible manner are undermined. For example the BMJ lifts its embargo at 00·01 hours on Fridays and the JAMA typically holds its embargoes until 15·00 hours on the day before the cover date of the journal. Becoming a reviewer Serving as a reviewer or editor allows you to shape your field – publishing good work and keeping bad science out of the literature. McCabe and McCabe20 Once you have started publishing, it is fun to start reviewing. Although this honorary position rarely brings financial rewards, it is exciting to be invited to be an external reviewer by a journal. However, reviewing is a serious undertaking and can be time-consuming when done properly. In being a good reviewer, you need time to read the paper carefully from beginning to end, think about it, read it a second time, write a review, revise your review, and then check back with the paper again. The rewards for this are that you are sent the most current research work to read and that your reviewing skills have a currency that help to foster good science in the journals as well as your career. You should only accept papers for review if you have no conflict of interest and if you can complete the review within the suggested time frame, which can be as little as 2 weeks. I would be very grateful to receive your confidential comments about the suitability of this work for inclusion in our journal. I enclose two sets of referee sheets, one of which will be sent to the authors and the other retained by the journal. I would appreciate it if I could receive your comments within the next 3 weeks. Please complete the enclosed referee checklist (it is a guide only, not all aspects will be applicable to all manuscripts) and provide detailed comments based on the referee checklist that will help us to make a decision about the article. These comments may be sent to authors in order to help them revise the manuscript. We should appreciate receiving your review by email or fax in the next 2 weeks. Thank you very much for undertaking this work for our journal; it is very much appreciated.

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