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BACKGROUND: Recently, the authors commenced a randomised controlled trial to study the effectiveness of cognitive behavioural coping skills (CBCS) to reduce cocaine usage in methadone-maintained patients' in a clinical setting by assessing attendance at treatment sessions and outcomes in terms of cocaine use. However, recruitment into the study stopped when it became apparent that attendance at counselling sessions was poor. AIMS: The aim of the current study was to determine the reasons for both non-attendance and attendance from a patient's perspective at counselling sessions. METHODS: A cross-sectional design was employed whereby participants who were recruited for the original study were interviewed utilising a semi-structured interview format. RESULTS: Motivational inconsistencies were most frequently cited as the reason for dropping out of counselling, whereas a good relationship with staff was cited by attenders as the most important factors which aided their attendance at counselling sessions. CONCLUSIONS: Selecting opiate-dependent methadone-maintained cocaine abusers on the basis of their urine toxicology and offering them counselling as a way of reducing their harmful drug use did not prove efficacious. Attempting to address cocaine misuse within this cohort may need a more stepped approach including brief interventions, such as motivational interviewing, or other enhancers of motivation before we can test the effectiveness of CBCS in this population.

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BACKGROUND: Patients attending for endoscopy are generally anxious and worried. AIMS: To examine whether music reduced anxiety levels in patients attending for endoscopic procedures. METHODS: Prospective randomized controlled trial of 180 patients (M:F 81:99). The effect of age (< or = or >51 years) and procedure (gastroscopy or flexible sigmoidoscopy/colonoscopy) on anxiety levels (state-trait anxiety inventory) on arrival in the unit and immediately before the endoscopy procedure, after listening to music or no music (control group) for the same period. RESULTS: At baseline, anxiety levels were not influenced by age (< or =51 years, n = 56:42.21 +/- 9.18; >51 years, n = 124:39.99 +/- 10.13 (P = 0.15) or procedure: gastroscopy, n = 87:39.43 +/- 9.9, flexible sigmoidoscopy/colonoscopy: n = 93:41.86 +/- 9.75 (P = 0.98). No difference was found in anxiety scores in the control group (n = 88) at baseline and immediately pre-endoscopy (P = 0.243), but music led to a significant reduction in anxiety scores (n = 92), which was maintained for all age groups irrespective of procedure (all P < 0.0001). CONCLUSIONS: Anxiety levels in patients attending for endoscopy were not influenced by age or procedure, but were significantly reduced by listening to music compared to controls. The availability of music within the endoscopy unit is a simple strategy that will improve the well-being of patients.

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AIMS: The aim of this study was to determine the possible usefulness of the assay of the aminoterminal propeptide of type III procollagen and fibronectin in detecting connective tissue changes associated with gynecologic malignancies. STUDY DESIGN: Serum aminoterminal propeptide of type III procollagen and plasma fibronectin were measured in 36 women with gynecologic malignancies, 20 women with benign gynecologic tumors and 10 healthy women serving as controls. RESULTS: A significant serum propeptide was significantly high in the group with gynecologic malignancies and normal in the benign tumor group. The serum propeptide levels were related to of disease stage and presence of ascites in patients with ovarian carcinoma but not in those with cervical or endometrial carcinoma. In the follow-up study, a favorable clinical response was associated with normalizing propeptide levels whereas in rapidly progressive disease the levels fell initially but rose again. In partial response with ultimate progression, the propeptide concentration decreased but remained clearly above the normal range. No difference in plasma fibronectin was found among the malignant tumor, benign tumor and control groups. CONCLUSIONS: The present study indicates that the aminoterminal propeptide of type III procollagen could serve as an additional, non specific marker to follow the clinical behavior of gynecologic malignancies and consequently of connective tissue metabolism reflecting tumor matrix interaction.

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