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Biomedical subjects

G Humphris

Publications and source records attributed to G Humphris.

At least 19 recordsLinked to original sources
PubMed2003

Use of simulated clients in training veterinary undergraduates in communication skills.

A course in communication skills has been developed specifically for veterinary students, based on those delivered at many medical schools, and making extensive use of professional actors as simulated clients. Its aim is to raise awareness of the importance of communication among veterinary undergraduates at all stages of the curriculum, and it allows them to role-play in acted-out scenarios. Facilitated small groups provide an environment in which students can receive feedback on their own performance and also give feedback to their colleagues. An independent evaluation suggests that the opportunity to role-play increased the students' confidence in communicating with others. They were able to identify their personal strengths as communicators and gain insights into the aspects of communication they could improve. Feedback and subsequent discussions were highly valued, with the actors playing a crucial role in providing feedback from the client's perspective. Students were able to use the knowledge they acquired when consulting with real clients. Most of the students suggested that the course should continue in its current format, but with more time provided for it in the curriculum.

Communication↗
PubMed2001

A preliminary communication on whether general dental practitioners have a role in identifying dental patients with mental health problems.

OBJECTIVE: To examine whether general dental practitioners regard themselves as having a role in identifying dental patients with mental health problems. METHOD: Telephone interviews were conducted with, and postal questionnaires were sent to, a random sample (n = 94) of general dental practitioners on Health Authority lists within the Mersey Region. A total of 84 general dental practitioners responded, resulting in an 89% response rate. RESULTS: The majority of general dental practitioners had encountered patients with mental health problems (78% of interviewees, 56% of questionnaire responders). However, nearly half of the interviewees (46%) do not refer patients with mental health problems. When referrals to dental specialists were made, they tended to be regarding a physical manifestation rather than a psychological one. The majority of interviewees and questionnaire responders (55% and 82% respectively) expressed a 'positive' response to the development of a referral role. Nevertheless, there were some reservations concerning the practicalities of its development and implementation. CONCLUSION: The majority of general dental practitioners consider a role in identifying patients with possible mental health problems. This role might include, being able to identify patients with undiagnosed mental health problems, and being aware of dental conditions which may be caused by mental health problems. To achieve this, inter-professional co-operation between general dental practitioners and other health professionals requires development.

Attitude of Health Personnel↗
PubMed2001

Smoking cessation through comprehensive critical care.

There has been little research on smoking cessation after critical illness. Smokers make up a high percentage of patients admitted to intensive care (ICU) and stopping smoking is one message that should be clearly given to recovering patients. The recovery period provides an important opportunity for patients to quit smoking as the period of sedation and ventilation allows patients to start nicotine withdrawal. Smoking cessation advice was included in a 6-week self-help ICU rehabilitation package comprising information and an exercise programme. Recovering ICU patients were randomised to receive either the routine follow-up of ward visits and ICU clinic appointments or routine follow-up plus the ICU rehabilitation package. Twenty out of thirty-one intervention patients and 16/30 control patients were smokers pre-ICU admission. At the 6-month follow-up, previous smokers given the rehabilitation package had a relative risk reduction for smoking of 89% (CI 98%-36%). Smoking cessation after critical illness is aided by the provision of a rehabilitation programme.

Adolescent↗
PubMed2001

Memory, delusions, and the development of acute posttraumatic stress disorder-related symptoms after intensive care.

OBJECTIVE: To examine prospectively the relationship between memories of intensive care (ICU) and levels of anxiety after ICU discharge, the stability of these memories with time, and their relationship to the development of acute posttraumatic stress disorder (PTSD)-related symptoms. DESIGN: Case series cohort assessed by interview at 2 and 8 wks after ICU discharge. SETTING: District general hospital (serving a population of 350,000) general intensive care unit. PATIENTS: Memories of ICU and anxiety levels were studied in 45 patients after ICU discharge. Thirty patients were examined again at 8 wks to assess memory stability and development of acute PTSD-related symptoms. MEASUREMENTS AND MAIN RESULTS: Standardized interviews and questionnaires were used to assess memory for ICU, anxiety, and depression 2 wks after ICU discharge. In addition, PTSD-related symptoms and panic were assessed 8 wks after ICU discharge. A total of 33 of 45 patients had delusional memories from ICU at 2 wks; nine of the patients with delusional memories had no factual memories, and these patients had higher anxiety levels 2 wks after ICU discharge (p < .0001). Thirty patients had paired assessments at 2 and 8 wks. Those patients who had no factual recall of ICU but had delusional memories at 2 wks scored highly for PTSD-related symptoms and panic attacks at 8 wks (p = .023 and .014, respectively). The only predictors of possible acute PTSD-related symptoms at the 8-wk assessment were trait anxiety (p = .006) and having delusional memories without recall of factual events in the ICU at 2 wks (p < .0001). Only delusional memories were retained over time, whereas the recall of factual events in the ICU declined. CONCLUSIONS: We propose that the development of acute PTSD-related symptoms may be related more to recall of delusions alone. This study suggests that even relatively unpleasant memories for real events during critical illness may give some protection from anxiety and the later development of PTSD-related symptoms when memories of delusions are prominent.

Acute Disease↗
PubMed2001

Factors affecting dental attendance following treatment for dental anxiety in primary dental care.

AIM: To explore factors affecting patients' dental attendance behaviour following referral from a dental anxiety clinic to a general dental practitioner. DESIGN: A four-year follow up of patients who completed a course of treatment for dental anxiety by conducting semi-structured interviews, face-to-face or by telephone, with confirmation of dental attendance from the dental records. SUBJECTS: Forty-one patients who had completed a course of treatment for dental anxiety, in a specially designed community clinic. Mean time since last dental visit before treatment was 7.8 years (range 0.5-29). RESULTS: Twenty-three patients were successfully followed up and 11 (47%) were receiving regular asymptomatic dental care. The dental anxiety scores of those who subsequently became asymptomatic attenders were significantly lower at follow-up than the patients who became symptomatic attenders (P = 0.01). Effective dentist-patient communication was a common theme of the interviews. CONCLUSIONS: At four-year follow-up, dental anxiety was substantially lower in those who subsequently became asymptomatic attenders than those who became symptomatic attenders. A positive dentist-patient relationship had developed with the asymptomatic attenders.

Adult↗
PubMed2000

Sedation agents.

Explore the source record for details and available documents.

Anesthesia, Dental↗
PubMed2000

Distinct patient groups in oral cancer: a prospective study of perceived health status following primary surgery.

Health-related quality of life (HRQOL) is an important consideration in the management of patients with cancer. Pre-treatment data can give an indication of the anticipated response following cancer treatment. However, in order to use HRQOL data meaningfully it is essential to have an appreciation of how different patient groups respond. The aim of the study was to identify distinct patient groups at baseline using the University of Washington head and neck cancer questionnaire (UW-QOL). It was also the intention to see how these groups differed in their: (1) clinical and demographic attributes; (2) European Organisation for Research and Treatment of Cancer (EORTC) C30 and SF 36 scores; and (3) longitudinal trends over 6 and 12 months. One-hundred and thirty consecutive patients with previously untreated oral and oro-pharyngeal cancer were recruited. All were treated by primary surgery. Attrition was evident in the study but care was taken to allow for this. There were two distinct groups of patients identified by the cumulative UW-QOL score at presentation. These groups discriminated throughout the EORTC C30 and SF 36, at baseline and longitudinally, with the exception of mental health. This study demonstrates that HRQOL items are interrelated. There are difficulties in using baseline scores for treatment selection, and scores need to be interpreted in the light of clinical and demographic factors.

Adult↗
PubMed2000

Disturbed memory and amnesia related to intensive care.

Patients, when admitted to an intensive care unit (ICU), have one thing in common: their illness is life-threatening. Patients may remain on ICU in a critical condition, needing support with their breathing, circulation, and/or kidneys for varying lengths of time, from days to weeks. During that time the patients will receive sedative and analgesic drugs to ensure compliance with artificial ventilation. Patients recovering from critical illness frequently have little or no recall of their period in ICU, or remember nightmare, hallucinations, or paranoid delusions. The nature, extent and reason for these difficulties, have been under-reported and consequently our purpose was to conduct a review of memory problems experienced by ICU patients. A systematic literature review of computer databases (Medline, PsycLit, and CINAHL) identified 25 relevant papers. In addition, other relevant articles were obtained, citation lists and associated articles retrieved. Due to lack of research on processes underlying memory problems in ICU patients all articles that introduced an insight into possible mechanisms were included in the review. There seem to be two possible processes contributing to memory problems in ICU patients. First the illness and treatment may have a general dampening effect on memory. Delirium and sleep disturbance are both common in ICU patients. Delirium can result in a profound amnesia for the period of confusion. Sleep deprivation exacerbates the confusional state. Slow wave sleep is important for the consolidation of episodic memories. Treatment administered to patients in ICU can have effects on memory. Opiates, benzodiazepines, sedative drugs such as propofol, adrenaline, and corticosteroids can all influence memory. In addition, the withdrawal of drugs, such as benzodiazepines, can cause profound withdrawal reactions, which may contribute to delirium. Second, we hypothesise that there is a process that affects memory negatively for external events but enhances memory for internal events. The physical constraints and social isolation experienced by ICU patients and the life-threatening nature of the illness may increase the experience of hypnagogic hallucinations. Attentional shift during hypnagogic images from external stimuli to internally generated images would explain why ICU patients have such poor recall of external ICU events, but can clearly remember hallucinations and nightmares. Patients describe these memories as being very vivid and this is explored in terms of flashbulb memory formation. The absence of memories for real events on ICU can result in ICU patients remembering paranoid delusions of staff trying to kill them, with little information to reject these vivid memories as unreal. This has implications for patients' future psychological health.

Critical Care↗
PubMed1999

A case of Capgras delusion following critical illness.

Hallucinations and paranoid delusions are recognised complications of critical illness. However, the occurrence of Capgras syndrome, in response to critical illness, where patients are convinced that doubles have replaced close family has not been described in the literature. There have been isolated case histories in the literature in response to medical procedures or illness but mostly in patients suffering from schizophrenia. A 42 year old woman was admitted to the intensive care unit (ICU) with pneumonia, following extensive surgery for a squamous cell carcinoma, secondary to Crohns disease. She had no history of previous head injury, cerebro-vascular problems or psychiatric disorder. She reported having memories of all her family, with the exception of her mother, being replaced by aliens while she was on the ICU. The delusion was only diagnosed once it had resolved and the patient was able to talk, and this highlights the difficulty of diagnosing delusions while patients are still intubated and unable to verbalise their concerns. It has been suggested that a defect in the ability to recognise the emotional significance of the face lies at the root of Capgras syndrome.

Adult↗
PubMed1999

How big is a drop? A volumetric assay of essential oils.

There has been an increase in the use of aromatherapy in nursing, and many issues are now being raised which need addressing in order to maintain professional credibility and safe practice. These issues include: who can safely practise aromatherapy, what qualifications are required to practise, who provides indemnity, and other issues, including the safety and toxicity of essential oils. A small study was undertaken to examine the differences in drop size of bergamot essential oil. Drop size was determined by weighing different manufacturers' essential oil of bergamot and it was found that drop size did differ, resulting in unequal doses of essential oil. It is important to be aware of this, because there are implications for the size of the dose administered in an aromatherapy treatment. This paper raises the issue of standardizing the measurement of essential oils, to ensure that there are no problems regarding safety in their administration.

Analysis of Variance↗
PubMed1999

Assessing the ability of medical students to apply evidence in practice: the potential of the OSCE.

OBJECTIVES: Critical analysis and application of evidence-based practice are key skills for students to master. Assessment of these skills can be undertaken by written examination. Regardless of how knowledge of the appraisal process may be assessed, written examinations ignore assimilation of that evidence into everyday practice. DESIGN: A combined clinical and communication skills station was used in an objective structured clinical examination where the ability to appraise evidence critically was assessed along with the application of that evidence in managing a common clinical problem. SETTING: University of Liverpool. SUBJECTS: Undergraduate medical students. RESULTS: The results from 156 undergraduate medical students demonstrated that it is possible to assess the application of evidence in practice, both in terms of outcome and patient assessment of the encounter. CONCLUSIONS: Assessment is a powerful tool in promoting learning and adoption of such assessment strategies may help to address concerns surrounding apparent poor effect of critical appraisal training.

Adult↗
PubMed1999

A study to determine the acceptability in patients and dentists of toluidine blue in screening for oral cancer.

Opportunistic screening for oral cancer has been advocated as a possible beneficial procedure, especially with high-risk individuals. To assist in the identification of malignant lesions a dye has been developed which can be used routinely. Issues of acceptability for both patient and practitioner are raised. The adoption of this procedure for employees in a large retail chain in the UK has enabled an investigation into the use of the dye. The objective of the study was to determine the acceptability of toluidine blue in aiding the screening for oral cancer in regular attending dental patients who are at high-risk. A two-stage study design was conducted. The first stage consisted of a patient survey in which 10 patients from each of 14 stores of the retail chain were invited to complete a questionnaire. The level of embarrassment, taste and anxiety about the procedure was assessed. The second stage included a clinician questionnaire and telephone interview on the difficulties, if any, of conducting the screening procedure with the aid of the dye. The oral health screen (OHS) with OraScreen procedure was conducted in the retail store medical room. The participants consisted of 140 employees attending the routine dental examination at the store of their workplace. All employees in the survey reported that they smoked tobacco, drank alcohol and were over the age of 40 years. Fourteen dentists visited the stores to complete examinations, screening, questionnaires and telephone interview. The main outcome measures consisted of dentist and patient rating scales of acceptability developed for the study. Of the respondents 89% (n = 124) gave usable questionnaire data. The patients found the dye acceptable (for example 83% rated the oral health screen 'a comfortable experience') and 93% expected the examiner to give an opinion of the state of their mouths. A wish was expressed by 95% to take part in future oral health screens. The dentist-respondents were in favour of the use of the dye. In conclusion, the acceptability of toluidine blue dye to assist in the screening for oral cancer is good according to both patient and clinician. The use of this dye should now be encouraged more extensively by trained clinicians in the identification of oral cancerous and precancerous lesions.

Adult↗
PubMed1998

The impact of surgery for oral cancer on quality of life as measured by the Medical Outcomes Short Form 36.

Quality of life evaluation is an important measure of outcome following the treatment of head and neck cancer. The aim of this study was to evaluate the quality of life of patients undergoing primary surgery for oral and oropharyngeal squamous cell carcinoma. 50 consecutive patients with previously untreated oral cancer were assessed using two questionnaires, the Medical Outcomes Short Form 36 (SF-36) and University of Washington Head and Neck Questionnaire (UW-QOL) at four time intervals; pretreatment, and 3, 6, 12 months. At the time of presentation, patients with oral cancer scored lower than norms, particularly for physical role limitation, mental role limitation, and social functioning. At 3 months following surgery, there was a considerable deterioration in physical functioning, limitation of physical role, energy and general health perception. By 12 months postoperatively patients approached pretreatment scores. The SF-36 and UW-QOL provide outcome information suitable for international comparison.

Adult↗
PubMed1998

A review of burnout in dentists.

Burnout, a distinct psychological construct that has a number of features which separate it from occupational stress, is strongly associated with the emotional effects of providing patient- or client-centred services. Depression may be a consequence of prolonged experience of burnout. Recent findings suggest that burnout has features of maladaptive coping in the short term but is, paradoxically, protective in the longer term. Dentists are prone to burnout due to the nature of their work but may be able to prevent it if they can recognize the burnout process and take regular holiday breaks. Burnout is assumed to have an adverse influence on patient care, although no dental studies, as yet, have tackled the issue.

Burnout, Professional↗
PubMed1997

Burnout and stress-related factors among junior staff of three dental hospital specialties.

OBJECTIVE: To determine whether occupational stress, health status, job satisfaction and burnout differed between the three major hospital dental specialties, and to compare this data with previous studies. DESIGN: A cross-sectional survey. SETTING: The regional dental teaching hospital and outlying hospital units in Merseyside in 1993. SUBJECTS AND METHODS: All 52 junior hospital dentists in the Merseyside area were invited to complete a self-report questionnaire to be returned by post. Up to three reminders were sent. 42 staff replied (81% response rate). MAIN OUTCOME MEASURES: Occupational Stress Indicator, Maslach Burnout Inventory. RESULTS: The profile of stressors was comparable to a previously reported sample of hospital dentists. Job satisfaction varied significantly across specialties (P < 0.015) whereas personal achievement was reported to be strong regardless of the nature of work. Self-reported health (physical and mental) was similar across specialties. 10% of respondents were suffering burnout. Depersonalisation (a result of extended and demanding contacts with patients) was significantly (P < 0.05) greater in restorative and oral surgery specialties in comparison with orthodontists. CONCLUSIONS: Although short-term stressors among hospital dental staff were not different between occupational groups, some important longer term effects were identified.

Achievement↗
PubMed1997

Fear of cancer recurrence--a literature review and proposed cognitive formulation to explain exacerbation of recurrence fears.

Modern treatments for cancer are resulting in cancer patients living longer with the risk of the disease returning at a later stage. Many patients who experience a recurrence blame themselves (Mahon et al., 1990), while those in remission live with the constant fear that the cancer may return. Although fear of recurrence is recognised in the literature, few researchers have focused on this aspect as a precursor to psychological distress. This paper reviews the literature about fear of recurrence and its measurement. Leventhal's Self Regulation Model of Illness is presented to help understand patients' reactions to cancer and fears for the future. The authors propose a formulation for fear of recurrence and examples of interventions that are indicated.

Adaptation, Psychological↗