Objective: To assess the efficacy of cognitive behaviour therapy delivered in primary care for treating irritable bowel syndrome. Design: Randomised controlled trial. Setting: 10 general practices in London. Participa...Objective: To assess the efficacy of cognitive behaviour therapy delivered in primary care for treating irritable bowel syndrome. Design: Randomised controlled trial. Setting: 10 general practices in London. Participants: 149 patients with moderate or severe irritable bowel syndrome resistant to the antispasmodic mebeverine. Interventions: Cognitive behaviour therapy delivered by trained primary care nurses plus 270 mg mebeverine taken thrice daily compared with mebeverine treatment alone. Main outcome measures: Primary measures were patients’ scores on the irritable bowel syndrome symptom severity scale. Secondary measures were scores on the work and social adjustment scale and the hospital anxiety and depression scale. Results: Of 334 referred patients, 72 were randomised to mebeverine plus cognitive behaviour therapy and 77 to mebeverine alone. Cognitive behaviour therapy had considerable initial benefit on symptom severity compared with mebeverine alone, with a mean reduction in score of 68 points (95% confidence interval 103 to 33), with the benefit persisting at three months and six months after therapy (mean reductions 71 points (109 to 32) and 11 points (20 to 3)) but not later. Cognitive behaviour therapy also showed significant benefit on the work and social adjustment scale that was still present 12 months after therapy (mean reduction 2.8 points (5.2 to 0.4)), but had an inconsistent effect on the hospital anxiety and depression scale. Conclusion: Cognitive behaviour therapy delivered by primary care nurses offered additional benefit over mebeverine alone up to six months, although the effect had waned by 12 months. Such therapy may be useful for certain patients with irritable bowel syndrome in primary care.展开更多
Aircraft metal components and structures are susceptible to environmental degradation throughout their original design life and in many cases their extended lives.This paper summarizes the results of an experimental p...Aircraft metal components and structures are susceptible to environmental degradation throughout their original design life and in many cases their extended lives.This paper summarizes the results of an experimental program to evaluate the ability of Supersonic Particle Deposition(SPD),also known as cold spray,to extend the limit of validity(LOV)of aircraft structural components and to restore the structural integrity of corroded panels.In this study the potential for the SPD to seal the mechanically fastened joints and for this seal to remain intact even in the presence of multi-site damage(MSD)has been evaluated.By sealing the joint the onset of corrosion damage in the joint can be significantly retarded,possibly even eliminated,thereby dramatically extending the LOV of mechanically fastened joints.The study also shows that SPD can dramatically increase the damage tolerance of badly corroded wing skins.展开更多
文摘Objective: To assess the efficacy of cognitive behaviour therapy delivered in primary care for treating irritable bowel syndrome. Design: Randomised controlled trial. Setting: 10 general practices in London. Participants: 149 patients with moderate or severe irritable bowel syndrome resistant to the antispasmodic mebeverine. Interventions: Cognitive behaviour therapy delivered by trained primary care nurses plus 270 mg mebeverine taken thrice daily compared with mebeverine treatment alone. Main outcome measures: Primary measures were patients’ scores on the irritable bowel syndrome symptom severity scale. Secondary measures were scores on the work and social adjustment scale and the hospital anxiety and depression scale. Results: Of 334 referred patients, 72 were randomised to mebeverine plus cognitive behaviour therapy and 77 to mebeverine alone. Cognitive behaviour therapy had considerable initial benefit on symptom severity compared with mebeverine alone, with a mean reduction in score of 68 points (95% confidence interval 103 to 33), with the benefit persisting at three months and six months after therapy (mean reductions 71 points (109 to 32) and 11 points (20 to 3)) but not later. Cognitive behaviour therapy also showed significant benefit on the work and social adjustment scale that was still present 12 months after therapy (mean reduction 2.8 points (5.2 to 0.4)), but had an inconsistent effect on the hospital anxiety and depression scale. Conclusion: Cognitive behaviour therapy delivered by primary care nurses offered additional benefit over mebeverine alone up to six months, although the effect had waned by 12 months. Such therapy may be useful for certain patients with irritable bowel syndrome in primary care.
文摘Aircraft metal components and structures are susceptible to environmental degradation throughout their original design life and in many cases their extended lives.This paper summarizes the results of an experimental program to evaluate the ability of Supersonic Particle Deposition(SPD),also known as cold spray,to extend the limit of validity(LOV)of aircraft structural components and to restore the structural integrity of corroded panels.In this study the potential for the SPD to seal the mechanically fastened joints and for this seal to remain intact even in the presence of multi-site damage(MSD)has been evaluated.By sealing the joint the onset of corrosion damage in the joint can be significantly retarded,possibly even eliminated,thereby dramatically extending the LOV of mechanically fastened joints.The study also shows that SPD can dramatically increase the damage tolerance of badly corroded wing skins.
