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The purpose of this study was to conduct a randomized clinical trial to assess whether a self-management group intervention can improve mood, self-efficacy, and activity in people with central vision loss due to age-related macular degeneration (AMD). Ninety-two elderly patients with AMD (average age=79) from a university ophthalmology clinic were randomly assigned to the self-management intervention (n=44) or to a wait-list (n=48). All patients were legally blind in at least one eye. The intervention consisted of 6 weekly 2-hour group sessions providing education about the disease, group discussion, and behavioral and cognitive skills training to address barriers to independence. All participants eventually completed the intervention allowing pre-post comparisons for all patients. The battery of measures included the Profile of Mood States (POMS); Quality of Well-Being Scale; and assessments of self-efficacy, participation in activities, and use of vision aids. Participants' initial psychological distress was high (mean total POMS=59.72) and similar to distress experienced by other serious chronic illness populations (e.g. cancer, bone marrow transplant). Analysis of covariance testing the primary hypothesis revealed that intervention participants experienced significantly (p=.04) reduced psychological distress (pre $$\bar x = 61.45$$ ; post $$\bar x = 51.14$$ ) in comparison with wait-list controls (pre $$\bar x = 57.72$$ ; post $$\bar x = 62.32$$ ). Intervention participants also experienced improved (p=.02) self-efficacy (pre $$\bar x = 70.16$$ ; post $$\bar x = 77.27$$ ) in comparison with controls (pre $$\bar x = 67.71$$ ; post $$\bar x = 69.07$$ ). Further, intervention participants increased their use of vision aids (p

BACKGROUND: For patients with carcinomatous meningitis, treatment needs to be expedited, especially for patients with hematologic malignancies. Using neuroendoscopy as an adjunct at the time of ventricular reservoir placement allows immediate confirmation of catheter placement rather than waiting for a post-operative CT scan and waiting for contact from the surgeon. This confirmation allows delivery of intrathecal chemotherapy at the time of surgery saving the patient delays in chemotherapy delivery and potential side effects of the first chemotherapy delivery, as they are still under general anesthesia. Delay in confirmation of appropriate catheter placement or poor catheter placement delays treatment; this technique also allows the surgeon and oncologist to know definitively that the reservoir is properly positioned and functional at the time of surgery. METHODS: Five patients with carcinomatous meningitis who were candidates for intrathecal chemotherapy were prospectively followed. All of them had a ventricular reservoir placed with neuroendoscopy and immediate delivery of intrathecal chemotherapy. RESULTS: All five of the patients had a reservoir placed without incident. Four of the patients had chemotherapy delivered during surgery without incident. For one patient, there was a pharmacy delay, but the chemotherapy was delivered while the patient was still recovering from anesthesia. There were no complications related to the treatment. CONCLUSIONS: Neuroendoscopy has the power to immediately confirm proper ventricular placement of an Ommaya reservoir and to safely allow the delivery of intrathecal chemotherapy in the operating room. This technique eliminates delays in chemotherapy delivery and is safe.