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CBT, Cancer and IAPT

a just published study of CBT for depression in patients with cancer has shown no effect [ Serfaty et al (2019)]. Patients were given CBT by IAPT staff in addition to treatment as usual (TAU) and the results compared with TAU alone. Whether the outcome measure was the PHQ9 or Beck Depression inventory there was no difference in outcome, see link below:

https://www.dropbox.com/s/iitvhyk5eyqjmyi/CBT%20for%20depression%20in%20cancer%202019.pdf?dl=0

The results suggest more generally, that if IAPT’s performance was compared to TAU no difference would be found. The study also casts doubt on the wisdom of IAPT’s sojourn into treating long term physical conditions.

Problems With Engagement

The intervention comprised up to 12 individual sessions (either face to face or over the phone), but the mean number of sessions received was 4.7 and over a third (35.6%) did not take up any sessions. They were all patients expected to live for 4 or more months. Interestingly 60% of patients had a previous history of depression. Of 2224 cancer patients only 10% (230) were found suitable and consented to treatment.

Some Methodological Issues

  1. There was no blind assessment of outcome using the standardised diagnostic interview (MINI) that was used to assess whether a patient was initially clinically depressed.
  2. TAU is a poor comparator as it does not control for the attention and expectations generated by being offered a special treatment (CBT). The appropriate comparator should have been an active placebo
  3. Therapists were rated using the Cognitive Therapy Rating Scale Revised but there is no mention as to whether this predicted outcome.

But CBT Can Make A Real Difference In The Right Hands

At The Right Time

One of the authors of the above study Kathryn Mannix, A Palliative Care Physician, has written a stunning book, With The End In Mind

With the End in Mind: How to Live and Die Well

Her capacity to be with people is truly amazing, this clearly is not just a job, for example her use of CBT with a patient with breathlessness as he awaits a lung transplant (he has cystic fibrosis) is truly exemplary. But she is a very credible source of persuasion with a detailed knowledge of the difficulties of those in Hospice care. I would wholeheartedly recommend you read this book.

Dr Mike Scott

36 replies on “CBT, Cancer and IAPT”

vibration analysis
The Significance of Oscillation Management Equipment in Machinery
Across manufacturing sites, machines along with rotating equipment constitute the core of output. However, a of the most common challenges which may affect the functionality along with durability is vibration. Oscillation could result in a array of issues, including reduced accuracy and performance to heightened wear and tear, eventually resulting in pricey delays along with restoration. This is the point where vibration control apparatus proves to be critical.

The Reason Vibration Management proves Important

Resonance inside equipment can lead to multiple negative effects:

Lowered Production Productivity: Excessive vibrations could bring about imbalances as well as unbalance, minimizing the performance of such systems. This might lead to delayed manufacturing speed along with greater energy consumption.

Elevated Deterioration: Ongoing vibrations accelerates the erosion of machine components, bringing about more frequent repairs as well as the risk of unexpected issues. Such a scenario doesn’t merely heightens operational costs and limits the durability in the existing devices.

Safety Dangers: Uncontrolled resonance can introduce major dangers for the machinery and the equipment and the workers. In, serious conditions, it might result in disastrous system collapse, endangering personnel and resulting in considerable harm to the facility.

Precision along with Quality Concerns: For fields that depend on high precision, including production or aviation, resonance can lead to errors in manufacturing, resulting in faulty goods and increased waste.

Economical Options for Oscillation Control

Putting money in vibration management equipment proves not merely a necessity and a wise choice for all businesses that any company involved with equipment. Our advanced vibration management systems work to intended to eliminate vibrations from various machinery or spinning equipment, guaranteeing smooth as well as efficient operations.

What distinguishes such tools above the rest remains its affordability. It is recognized that the importance of affordability inside the current market, which is why our offerings include high-quality oscillation control tools at rates that won’t break the bank.

Opting for our equipment, you aren’t simply preserving your mechanical systems as well as improving its performance but also investing into the long-term success in your organization.

In Conclusion

Oscillation control proves to be a vital element in preserving the operational performance, security, as well as longevity of your equipment. With our cost-effective vibration control equipment, it is possible to ensure that your processes operate seamlessly, all manufactured items remain top-tier, and all personnel stay secure. Don’t permit oscillation undermine your company—make an investment in the proper tools today.

The Importance of Oscillation Mitigation Apparatus in Machines
In industrial environments, machinery and turning systems serve as the support of production. However, one of the most frequent issues which may impede the functionality and longevity is vibrations. Vibrations can bring about an series of complications, from minimized perfection as well as performance to heightened deterioration, in the end causing high-cost interruptions along with repairs. This scenario is why vibration control equipment proves to be vital.

Why Oscillation Control is Critical

Vibration in industrial equipment may lead to various detrimental effects:

Lowered Operational Performance: Excessive oscillation can result in misalignments as well as unbalance, reducing overall effectiveness in the equipment. Such may cause slower production schedules and higher energy use.

Increased Damage: Constant vibrations hastens overall damage of machinery parts, resulting in additional servicing and the possibility for unexpected breakdowns. This not only heightens maintenance expenses and shortens the durability for the existing devices.

Safety Concerns: Unmanaged vibration can pose major dangers to both the machinery and the operators. In extreme situations, serious conditions, it can bring about devastating machinery failure, endangering employees along with leading to considerable devastation across the premises.

Precision as well as Manufacturing Quality Challenges: In sectors that depend on precise production, such as manufacturing or aviation, vibrations might bring about discrepancies in production, resulting in defective products and greater waste.

Economical Options for Oscillation Control

Putting money in resonance control systems proves not just necessary and a sound investment for any business dependent on equipment. Our modern vibration regulation equipment work to built to reduce vibrations in any machinery or rotating machinery, ensuring seamless along with efficient operations.

What distinguishes these apparatus apart is its affordability. We know the value of cost-effectiveness in the current market, thus we offer premium vibration control solutions at rates that are reasonable.

Opting for our offerings, you’re not only preserving your equipment as well as boosting its efficiency you’re also putting investment in the sustained achievement in your organization.

Conclusion

Resonance mitigation remains a critical aspect of maintaining the efficiency, protection, along with durability of your machinery. With our cost-effective oscillation control systems, you can be certain your operations run smoothly, all goods maintain high quality, along with your workers stay safe. Do not let vibration undermine your business—invest in the right equipment today.

плинко играть на деньги
Internet casinos present an exciting range of casino games, a majority of which now incorporate cryptocurrency as a transaction method. Between the most popular platforms, BC Game, Panda Casino, Casino Axe, and Kingz Casino are growing in popularity, while Bitstarz distinguishes itself through several awards. Cloud Bet Casino is known for its status as a regulated crypto casino, offering security for players and fair play, as well as Fairspin Casino as well as Mbit offer an extensive variety of cryptocurrency games.

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замена венцов красноярск

Если выполняется замена нижних венцов, в таком случае бревно также разгружается от нагрузки и выполняется замена, потому что чтобы заменить подъём не превышает 10-ти сантиметров, которое не является критичным также для внутренней оформления.

нижний брус из лиственных пород намного надежнее и успешно зарекомендовал свои качества благодаря своим свойствам устойчивостью и стойкостью к разложению. Тем не менее, ее также следует защищать путем использования биоцидного раствора, как и другие опоры.

Мы специализируется не только лишь перестройкой зданий, помимо этого улучшением полов. Заказчики регулярно оформляют заказ на утепленные полы и перекрытия с термической теплозащитой наша компания Комплектуем и снабжаем клиента материаллом и обеспечиваем особые скидки.

El rotativo de equilibrado con cesta de embrague representa un sistema fundamental con el proposito de garantizar el operacion optimo del propulsor y la transferencia de un transporte. El desequilibrio en la mencionada parte podria provocar vibraciones, estrepito, deterioro rapido de los partes e llegando a fallas. En el pasado, el nivelacion se ejecutaba luego de desmontar el volante del propulsion, sin embargo las avances tecnologicos actuales permiten efectuar tal proceso sin intermediarios en el automotor, lo que esto reduce tiempo y gastos.

Cual es el Desbalance?

El desbalance es una estado en la en la cual la cantidad de un pieza giratoria (en este particular caso, el volador de nivelacion con cesta de embrague) se localiza de modo irregular en relacion con su eje de movimiento circular. Esto genera esfuerzos centrifugos las cuales provocan oscilaciones.

Principales causas del Desajuste del Girador de Equilibrado con Compartimento de Embrague:

Irregularidades de manufactura y union: Aunque leves variaciones en la estructura de los elementos tienden a originar falta de equilibrio.
Envejecimiento y averias: El operacion prolongada, el sobrecalentamiento y los danos mecanicos tienden a modificar la volumen y dar lugar en desequilibrio.
Colocacion o servicio inapropiada: Una instalacion inadecuada de la cesta de embrague o arreglos incorrectos igualmente pueden provocar desajuste.

Aquel volador de equilibrado con recipiente de embrague representa un proceso critico para asegurar el operacion optimo del propulsion y la accionamiento de un transporte. El desequilibrio en la presente pieza podria causar temblores, sonido, deterioro rapido de los piezas e pudiendo llegar a averias. Historicamente, el balanceo se ejecutaba luego de retirar el rotativo del propulsion, no obstante las tecnologias actuales viabilizan ejecutar este procedimiento directamente en el automotor, lo que esto reduce periodo y presupuesto.

Como se define el Desequilibrio?

El desequilibrio es una estado en la en la cual la peso de un pieza giratoria (en este escenario, el volador de equilibrado con compartimento de embrague) se localiza de forma irregular en relacion con su centro de giro de revolucion. Esta situacion causa fuerzas centrifugas que a su vez causan sacudidas.

Causas principales del Falta de equilibrio del Volante de Equilibrado con Compartimento de Embrague:

Irregularidades de fabricacion y union: Aun insignificantes divergencias en la forma de los elementos tienden a generar desequilibrio.
Envejecimiento y problemas: El uso prolongado, el sobrecalentamiento y los desperfectos mecanicos llegan a alterar la cantidad y provocar en desbalance.
Instalacion o mantenimiento deficiente: Una ensamblaje incorrecta de la compartimento de embrague o arreglos inapropiados asimismo llegan a generar falta de equilibrio.

娛樂城推薦與優惠詳解

在現今的娛樂世界中，線上娛樂城已成為眾多玩家的首選。無論是喜歡真人遊戲、老虎機還是體育賽事，每個玩家都能在娛樂城中找到自己的樂趣。以下是一些熱門的娛樂城及其優惠活動，幫助您在選擇娛樂平台時做出明智的決定。

各大熱門娛樂城介紹
1. 富遊娛樂城
富遊娛樂城以其豐富的遊戲選擇和慷慨的優惠活動吸引了大量玩家。新會員只需註冊即可免費獲得體驗金 $168，無需儲值即可輕鬆試玩。此外，富遊娛樂城還提供首存禮金 100% 獎勵，最高可領取 $1000。

2. AT99娛樂城
AT99娛樂城以高品質的遊戲體驗和優秀的客戶服務聞名。該平台提供各種老虎機和真人遊戲，並定期推出新遊戲，讓玩家保持新鮮感。

3. BCR娛樂城
BCR娛樂城是一個新興的平台，專注於提供豐富的體育賽事投注選項。無論是足球、籃球還是其他體育賽事，BCR都能為玩家提供即時的投注體驗。

熱門遊戲推薦
WM真人視訊百家樂
WM真人視訊百家樂是許多玩家的首選，該遊戲提供了真實的賭場體驗，並且玩法簡單，容易上手。

戰神賽特老虎機
戰神賽特老虎機以其獨特的主題和豐富的獎勵機制，成為老虎機愛好者的最愛。該遊戲結合了古代戰神的故事背景，讓玩家在遊戲過程中感受到無窮的樂趣。

最新優惠活動
富遊娛樂城註冊送體驗金
富遊娛樂城新會員獨享 $168 體驗金，無需儲值即可享受全場遊戲，讓您無壓力地體驗不同遊戲的魅力。

VIP 日日返水無上限
富遊娛樂城為 VIP 會員提供無上限的返水優惠，最高可達 0.7%。此活動讓玩家在遊戲的同時，還能享受額外的回饋。

結論
選擇合適的娛樂城不僅能為您的遊戲體驗增色不少，還能通過各種優惠活動獲得更多的利益。無論是新會員還是資深玩家，都能在這些推薦的娛樂城中找到適合自己的遊戲和活動。立即註冊並體驗這些優質娛樂平台，享受無限的遊戲樂趣！

娛樂城推薦與優惠詳解

在現今的娛樂世界中，線上娛樂城已成為眾多玩家的首選。無論是喜歡真人遊戲、老虎機還是體育賽事，每個玩家都能在娛樂城中找到自己的樂趣。以下是一些熱門的娛樂城及其優惠活動，幫助您在選擇娛樂平台時做出明智的決定。

各大熱門娛樂城介紹
1. 富遊娛樂城
富遊娛樂城以其豐富的遊戲選擇和慷慨的優惠活動吸引了大量玩家。新會員只需註冊即可免費獲得體驗金 $168，無需儲值即可輕鬆試玩。此外，富遊娛樂城還提供首存禮金 100% 獎勵，最高可領取 $1000。

2. AT99娛樂城
AT99娛樂城以高品質的遊戲體驗和優秀的客戶服務聞名。該平台提供各種老虎機和真人遊戲，並定期推出新遊戲，讓玩家保持新鮮感。

3. BCR娛樂城
BCR娛樂城是一個新興的平台，專注於提供豐富的體育賽事投注選項。無論是足球、籃球還是其他體育賽事，BCR都能為玩家提供即時的投注體驗。

熱門遊戲推薦
WM真人視訊百家樂
WM真人視訊百家樂是許多玩家的首選，該遊戲提供了真實的賭場體驗，並且玩法簡單，容易上手。

戰神賽特老虎機
戰神賽特老虎機以其獨特的主題和豐富的獎勵機制，成為老虎機愛好者的最愛。該遊戲結合了古代戰神的故事背景，讓玩家在遊戲過程中感受到無窮的樂趣。

最新優惠活動
富遊娛樂城註冊送體驗金
富遊娛樂城新會員獨享 $168 體驗金，無需儲值即可享受全場遊戲，讓您無壓力地體驗不同遊戲的魅力。

VIP 日日返水無上限
富遊娛樂城為 VIP 會員提供無上限的返水優惠，最高可達 0.7%。此活動讓玩家在遊戲的同時，還能享受額外的回饋。

結論
選擇合適的娛樂城不僅能為您的遊戲體驗增色不少，還能通過各種優惠活動獲得更多的利益。無論是新會員還是資深玩家，都能在這些推薦的娛樂城中找到適合自己的遊戲和活動。立即註冊並體驗這些優質娛樂平台，享受無限的遊戲樂趣！

娛樂城推薦
娛樂城推薦與優惠詳解

在現今的娛樂世界中，線上娛樂城已成為眾多玩家的首選。無論是喜歡真人遊戲、老虎機還是體育賽事，每個玩家都能在娛樂城中找到自己的樂趣。以下是一些熱門的娛樂城及其優惠活動，幫助您在選擇娛樂平台時做出明智的決定。

各大熱門娛樂城介紹
1. 富遊娛樂城
富遊娛樂城以其豐富的遊戲選擇和慷慨的優惠活動吸引了大量玩家。新會員只需註冊即可免費獲得體驗金 $168，無需儲值即可輕鬆試玩。此外，富遊娛樂城還提供首存禮金 100% 獎勵，最高可領取 $1000。

2. AT99娛樂城
AT99娛樂城以高品質的遊戲體驗和優秀的客戶服務聞名。該平台提供各種老虎機和真人遊戲，並定期推出新遊戲，讓玩家保持新鮮感。

3. BCR娛樂城
BCR娛樂城是一個新興的平台，專注於提供豐富的體育賽事投注選項。無論是足球、籃球還是其他體育賽事，BCR都能為玩家提供即時的投注體驗。

熱門遊戲推薦
WM真人視訊百家樂
WM真人視訊百家樂是許多玩家的首選，該遊戲提供了真實的賭場體驗，並且玩法簡單，容易上手。

戰神賽特老虎機
戰神賽特老虎機以其獨特的主題和豐富的獎勵機制，成為老虎機愛好者的最愛。該遊戲結合了古代戰神的故事背景，讓玩家在遊戲過程中感受到無窮的樂趣。

最新優惠活動
富遊娛樂城註冊送體驗金
富遊娛樂城新會員獨享 $168 體驗金，無需儲值即可享受全場遊戲，讓您無壓力地體驗不同遊戲的魅力。

VIP 日日返水無上限
富遊娛樂城為 VIP 會員提供無上限的返水優惠，最高可達 0.7%。此活動讓玩家在遊戲的同時，還能享受額外的回饋。

結論
選擇合適的娛樂城不僅能為您的遊戲體驗增色不少，還能通過各種優惠活動獲得更多的利益。無論是新會員還是資深玩家，都能在這些推薦的娛樂城中找到適合自己的遊戲和活動。立即註冊並體驗這些優質娛樂平台，享受無限的遊戲樂趣！

Пеларгонии сортовые
Пеларгонии сортовые: прекрасный решение для своего дома и участка

Если вы выбираете цветы, которые будут радовать вас их внешностью и ароматом, одновременно с тем не запрашивая трудного присмотра, разновидности пеларгонии — лучший вариант. Эти растения обладают исключительными характеристиками, что превращают их лидерами среди декоративных растений.

Почему разновидные пеларгонии?

Неприхотливость и легкость в уходе
Пеларгонии не требуют особых требований для роста и быстро адаптируются к различным условиям. Они замечательно чувствуют себя как в жилище, так и на улице. Не беспокойтесь о прихотливых растениях — герани хватает поливать по мере высыхания грунта и наслаждаться их процветанием.

Насыщенные и различные тона
Определенный разновидность пеларгоний содержит свои особенные тона и формы. Сорта, к примеру, Ю Полонез, впечатляют интенсивными цветами и впечатляющими бутонами. Это растения, что сразу привлекают интерес и создают яркие нотки в каждом месте.

Легкий благоухание, создающий уют
Пеларгонии не просто украшают помещение — они снабжают его приятным, ненавязчивым запахом. Этот натуральный благоухание обеспечивает сформировать ощущение спокойствия и спокойствия, а к тому же работает как естественный отпугиватель для насекомых.

Долгое цветение
Сортовые пеларгонии продолжают удивлять взоры своим красотой в течение долгих недель. Люди будут восхищаться их процветанием с начала лета и до поздней осени. Такое непрекращающееся процветание — исключительное свойство среди декоративных растений.

Лучший решение для любого места
Пеларгонии многофункциональны — их желательно содержать как в горшках на оконных рамах, так и в саду. Компактные кустики, включая ИВ Галина Уланова, прекрасно смотрятся в эстетичных контейнерах, а разновидности, как Survivor idols Rosalinda, будут украшением клумбы.

Для чего следует выбрать именно герани?
Данные цветы — не лишь часть декора. Они выгодно выделяются по сравнению с других растений благодаря своей неприхотливости, декоративности и длительному процветанию. Их живописные тона формируют уникальную атмосферу, будь то в доме или на участке. Герани — это лучший баланс красоты и удобства.

Выбирайте пеларгонии — сделайте вокруг красоту без дополнительных забот!

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