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Biomedical subjects

P Blakeney

Publications and source records attributed to P Blakeney.

At least 19 recordsLinked to original sources
PubMed2000

Anxiety: current practices in assessment and treatment of anxiety of burn patients.

Anxiety is an affective response commonly experienced by persons after emotional and physical trauma, as well as associated with aversive medical treatments. The scientific information related to the conceptualization, assessment, and treatment of anxiety is limited. In order to develop a pilot protocol for anxiety management, nursing directors at 64 burn centers were surveyed. At 89% of the centers, anxiety measures were not used. Most of the teams assess informally through observation of patient (n=21), dialogue with patient (n=12), or both observation and dialogue with patient (n=15). Assessors of anxiety range in breadth from nurse only to the entire burn team, including pastoral care representatives and family. The class of medication most frequently endorsed in treating anxiety is the benzodiazipine, most often lorazepam (Ativan). A number of non-pharmacologic techniques are used to manage anxiety, e.g., muscle relaxation, breathing, imagery. Consideration should be given to assessing anxiety systematically, so knowledge can be gleaned and applied to conceptualization of symptom presentation and application of treatment resources.

Adult↗
PubMed1999

Disfiguring burn scars and adolescent self-esteem.

Although children with burn scars are reported to have positive self-concepts, social and sexual maturation can be expected to stimulate anxiety, depression and diminished self-esteem in adolescents with disfiguring scars. This study examines complex self-regard of adolescents with burn scars. The following were hypothesized: (1) adolescents with disfiguring burn scars would view themselves as less competent than unburned normative samples; (2) subjects' perceived competence would be incongruent with the importance ascribed to the domains of physical appearance and athletic competence and (3) depression/anxiety would correlate negatively with perceived competence. Subjects were 14 adolescents: 6 male and 8 female, 13-20 years old, at least 2 years post-burn injury (TBSA = 39% +/- 23%). All had scars in at least 2 of the following areas: head/face, neck, chest, hands, genitals. Each subject was administered the Harter Self Perception Profile, a standardized measure of self-competence and value in 8 domains plus a general competence measure. The subjects were also assessed for anxiety/depression by the Child Behavioral Checklist. Overall, adolescents in this sample exhibited a similar or higher degree of self-worth as compared to their peers. However, the athletic competence and physical appearance sub-domains of self-worth for the burn survivors were significantly lower as compared to the normative group. Half of the participants rated the importance of physical appearance to be higher than their level of personal competence in this area, making for distressing emotions. Mood was similar to the normative group and mood correlated significantly with self-worth.

Adolescent↗
PubMed1998

Long-term psychosocial adaptation of children who survive burns involving 80% or greater total body surface area.

OBJECTIVE: To examine the psychosocial adjustment of survivors of massive pediatric burn injuries, the change in adjustment across time, and the impact on parents. BACKGROUND: Patients/parents were assessed at regular intervals postburn using standardized tests of adjustment. Patients who could not be included in standardized longitudinal assessments were administered questionnaires by mail/telephone. METHODS: The Child Behavior Checklist, the Teacher Report Form, the Youth Self Report Form, and the Parenting Stress Index were utilized to assess adjustment. RESULTS: On all objective measures, the group of survivors and their parents were within normal limits. Adjustment neither improved nor deteriorated over time. CONCLUSION: Children who survive massive burn injuries can achieve positive psychosocial adaptation.

Activities of Daily Living↗
PubMed1997

Applying what burn survivors have to say to future therapeutic interventions.

Statements by caregivers can be beneficial to paediatric burn patients, facilitating their psychological adaptation. However, the concerns of the burned child are not always obvious, and caregivers may flounder, not knowing how to elicit the concerns of the patient. The purpose of this paper is to examine whether universal concerns of the postburn survivor can be detected through one type of psychological assessment tool, a sentence completion task. Sixty paediatric burn survivors, ages 6-19, were administered a 30-item Incomplete Sentences measure. Five major aspects of postburn life were identified and proscribed the following descriptive labels: (1) preoccupation with health; (2) the struggle for internal acceptance; (3) reconstruction of one's life map; (4) changing relationships; and (5) redefining the world. These five dimensions of postburn life are discussed, as well as applications for each.

Adaptation, Psychological↗
PubMed1982

Personality characteristics of women entering medical school over a 10-year period.

Personality characteristics of entering women medical students, as determined by their responses to the Omnibus Personality Inventory and the Minnesota Multiphasic Personality Inventory, are similar over the past decade. These women, as in the past, are independent, socially outgoing, sensitive, concerned about others, optimistic, well adjusted, and active and possess a positive self-image. Changing societal attitudes toward women's roles and the increased numbers of women admitted to medical school have not resulted in more diversity of personality types among women students. Rather they have opened the door to larger numbers of women with personalities similar to those of women entering a decade ago. Reasons for the difficulties that women students express today in finding role models among their faculty are suggested.

Female↗
PubMed1977

Treatment of sexual dysfunction: a review of outcome studies.

Studies that have reported the outcome of treatment of various sexual dysfunctions are reviewed. While the number of published studies is limited, the results are remarkably consistent. By use of a variety of techniques, the prognosis for successful treatment of primary orgasmic dysfunction in women and premature ejaculation in men is quite good. The treatment of secondary or situational orgasmic dysfunction is more difficult and results in much lower success rates. Variables that affect treatment outcome and implications for future research and treatment are discussed.

Female↗
PubMed1976

A short-term, intensive workshop approach for the treatment of human sexual inadequacy.

A rapid treatment approach to common sexual dysfunctions has been used in treating 59 couples, including 74 symptomatic individuals. Using a multidisciplinary team approach in an intensive 2 1/2 day workshop format, symptom improvement has been obtained in 86.5% of the dysfunctional individuals, with complete symptom reversal in 63.5%. The intensive workshop format has resulted in a saving of both patient and professional time and is seen as a viable and successful alternative to more time-consuming approaches of treating various sexual dysfunctions.

Adult↗
PubMedDate not supplied

Long-term psychosocial adjustment following burn injury.

Young adult survivors of severe childhood burn injuries were assessed for indicators of psychopathology and for factors that might enhance psychosocial adjustment. The results describe this group of burn victims as young people of average intelligence, still in school or otherwise employed and within normal limits on the measures of psychological adjustment. Some individuals, however, did evidence significant indicators of psychological disturbance. The only factors identified as significantly differentiating the most obviously disturbed subjects from the better-adjusted or well-adjusted victims were the perceptions held by those subjects that their families are less cohesive and less independent. These results emphasize the need to promote the familial support system and to encourage the values of autonomy and self-sufficiency. The results also affirm that severely injured burn victims can be expected to develop acceptably happy lives.

Adaptation, Psychological↗
PubMedDate not supplied

Familial values as factors influencing long-term psychological adjustment of children after severe burn injury.

This study replicates earlier findings that children who survive severe burn injury do make positive psychological adjustment. Family support and a family value of autonomy were predicted to be critical variables in promotion of psychological adjustment. In addition, the study presents the hypothesis that length of time after burn injury and level of intelligence are contributing factors in psychological adjustment. Forty-four adolescents with a mean of 60% total body surface area (TBSA) full-thickness burns were studied. Half of the subjects scored within the normal range on a measure of psychological adjustment. Familial value patterns were critical in the prediction of psychological adjustment. Positive psychological adjustment was predicted by greater family cohesion, independence, and more open expressiveness within the family. Level of intelligence did not contribute to adjustment. Length of time after injury, if it is important to psychological healing, appears to be a factor only during the initial 2 years after burn injury.

Adaptation, Psychological↗
PubMedDate not supplied

Social competence and behavioral problems of pediatric survivors of burns.

Sixty children (35 boys, 25 girls) with burns were surveyed at least 1 year after burn injury to assess the behavior problems and difficulties with competency that they were having. The Child Behavior Checklist, the Youth Self Report, and the Teacher Report Form developed by Achenbach were administered to obtain standardized measures of behavior and competence. The mean values for these scales were in the normal range for each age and sex. However, the Child Behavior Checklist revealed a statistically significant (p < 0.05) increase in problems and decrease in competency for most age groups and both sexes when compared with the reference population. In contrast, the Teacher Report Form and the Youth Self Report revealed very few differences from the reference population. The burn size (15% to 20% total body surface area, 35% to 50% total body surface area, and > 70% total body surface area) did not account for any of the group differences. Further studies involving detailed clinical interviews and other standardized measures are needed to understand the discrepancies between the Child Behavior Checklist and the other scales.

Adolescent↗
PubMedDate not supplied

Parental stress as a cause and effect of pediatric burn injury.

The current study reports assessments of stress for parents of children with acute burns at the time of hospital admission and during the first 5 years after injury. At each assessment, parents of children with burns report neither more nor less stress than a normal population. At the time of admission, parents of children with acute burns do not differ from the normal sample on any of the measures of parenting stress. Parents of recovering children with burns do report significant changes. They report significantly higher depressive symptoms at year 2 after the child's burn injury and lower than normal levels of depression in years 4 and 5 after the child's injury. During the recovery period, these parents also attribute their stress more often to the child with burns, whereas other parents more evenly divide blame among their children and their personal characteristics.

Acute Disease↗
PubMedDate not supplied

Psychologic adjustment after childhood burn injuries as predicted by personality traits.

The purpose of this study was to examine the nature of psychologic adjustment in persons who have survived childhood burn injuries. It was hypothesized that survivors who were well-adjusted psychologically would possess specific personality traits that would differentiate them from their poorly adjusted peers. Thirty-two subjects were given a standardized assessment of psychologic adjustment and a standardized personality inventory. The subjects were assigned to either a "poorly adjusted" group or a "well-adjusted" group, on the basis of each subject's score on a standardized measure of adjustment. There were no significant differences between the two groups in variables of gender, age, time since burn, or age at time of burn injury. The results indicate three personality traits that seem to be related to psychologic adjustment after a severe burn injury in pediatric patients.

Adaptation, Psychological↗
PubMedDate not supplied

Psychosocial sequelae of pediatric burns involving 80% or greater total body surface area.

Important questions for pediatric burn care specialists relate to the quality of life for those children who survive the most severe burn injuries. This study examines the psychological adjustment of 25 children who survived injuries > or = 80% total body surface area and the impact of such injury on the families. Data were analyzed from the most recent assessment, with the Child Behavior Checklist, Teacher Report Form, Piers-Harris Children's Self-Concept Scale, Parenting Stress Index, and a parental questionnaire designed by the authors. As a group, the children's behavioral problems as reported by both parents and teachers were within normal limits. Measures of parental stress, however, clearly differentiated the burn population. These parents attributed more stress to characteristics of their children. Children with > or = 80% TBSA burns develop positive feelings about themselves and appear no more troubled than a comparable group of nonburned children. The impact on the families is significant, however, and must be considered of consequence in the rehabilitation of the burned child.

Adaptation, Psychological↗
PubMedDate not supplied

Parental well-being and behavioral adjustment of pediatric survivors of burns.

Parents of pediatric patients with burns often perceive their children as troubled and having an increased number of problem behaviors. This study examines the relationship between these problem behaviors and the parent's own emotional well-being. Mothers of 38 burned children completed three standardized questionnaires: Child Behavior Checklist, Parental Stress Index, and the Eight State Questionnaire. The population was further divided into troubled and untroubled by a Child Behavior Checklist total problem T score of 60. Parents were not significantly different from reference populations on most of the scales. However, the Parental Stress Index results revealed that parents who report their children as troubled are themselves stressed, not only by their children's behaviors but in areas unrelated to their children. In addition, these mothers report often feeling depressed and guilty on the Eight State Questionnaire. This study emphasizes the need for psychological assessment of both parents and children.

Adaptation, Psychological↗
PubMedDate not supplied

Visible scars and self-esteem in pediatric patients with burns.

The supposition of often made that visible scarring is more psychologically damaging than are "hidden" burn scars, but little evidence exists to support that idea. We compared the self-evaluations of 28 male and 21 female pediatric patients with burns to the amount and visibility of scars. Males were 6 to 18 years old at the time of burn and sustained 15% to 99% total body surface area burns. They were evaluated 1 to 6 years after their burn injury. Females constituted a similar group. They were 5 to 18 years old at the time of burn, sustained 15% to 94% total body surface area burns, and were evaluated 1 to 7 years after their burn injury. All of the children underwent evaluation with the Piers-Harris Children's Concept Scale, evaluating themselves on intellectual and school status, physical appearance, anxiety, happiness and satisfaction, and behavior and popularity. Scores from these parameters were compared against each child's "visible" scars as seen on the face, head, neck, and hands. Also, comparisons were made with the numbers of reconstructive needs in these areas. Significant inverse correlations were found in the males. As the number of scars increased in these areas, the patient's scores for "physical appearance" and "happiness and satisfaction" decreased (p < 0.001). Other psychologic parameters were not affected. There was no effect by age of patient, and no significant correlations were found for the female group. The results emphasize the importance of the burn team's awareness that pediatric survivors of burns may appear superficially to be adjusting well, while harboring grave self-deprecating feelings. Those with "visible" scars will need special support to enhance self-esteem.

Adaptation, Psychological↗
PubMedDate not supplied

School reintegration.

School reintegration programs have been developed to enhance a positive sense of self-worth in a child who has been burned. The premise of these programs is that cognitive and affective education about children with burns will diminish the anxiety of the patient with burns, the patient's family, faculty and staff of the school, and the students. Five principles guide school reentry programs: (1) preparation begins as soon as possible; (2) planning includes the patient and family; (3) each program is individualized; (4) each patient is encouraged to return to school quickly after hospital discharge; and (5) burn team professionals remain available for consultation to the school. Reintegration programs can vary in format depending on patient and/or family need and capability of the burn team, thus allowing flexibility in assisting every child with burns make the transition from hospital patient to normal living.

Burns↗
PubMedDate not supplied

Efficacy of school reentry programs.

Evaluation of school reentry programs are rarely reported, and statements of the value of reentry programs are usually based on anecdotal information. No known reports of empiric data support claims of positive benefit for burned children. This article reports a multifaceted effort to evaluate the effectiveness of one reentry program involving three approaches: (1) questionnaire answered by the school contact person after reentry program, (2) interviews with a random sample of patients (n = 58) and parents (n = 44) 1 to 5 years after burn, and (3) assessment of patients' behavior problems by teachers on a standardized behavior checklist comparing 10 patients who had a school reentry program involving videos to introduce them to their classmates with 10 patients who were matched for age, sex, and total body surface area burned and had no reentry program beyond phone contact. Results indicate that school reentry programs are popular with teachers and parents. This pilot effort involving empiric data failed to demonstrate a positive effect on the adjustment of the child.

Adaptation, Psychological↗