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Biomedical subjects

T Sensky

Publications and source records attributed to T Sensky.

At least 37 records · Page 2Linked to original sources
PubMed1997

Psychosocial predictors of long-term success of in-patient pulmonary rehabilitation of patients with COPD.

Studies of the long-term outcome of pulmonary rehabilitation have measured quality of life (QOL) mainly as disease-specific functional impairment, but long-term effects on overall satisfaction with health or life have not yet been adequately evaluated. Furthermore, the influence of personality traits on the long-term outcome of pulmonary rehabilitation have not so far been examined. The following questions were studied: 1) What are the short- and long-term effects of a rehabilitation programme on lung function (forced expiratory volume in one second as percentage of predicted (FEV1 % pred)), on satisfaction with life (defined as quality of life), and on health satisfaction (HS)? 2) Are there physical or psychosocial predictors for the success of pulmonary therapy? In this prospective clinical study, baseline data (FEV1 % pred, arterial oxygen tension (Pa,O2), QOL, HS, dyspnoea, coping scales) were studied at entry (t1); follow-up on discharge (t2); and 1 yr after hospitalization (t3) in 54 consecutive patients (mean age 64 yrs) with chronic obstructive pulmonary disease (COPD). Complete data were obtained at follow-up on 32 subjects. FEV1 % pred improved from 42% (t1) to 52% (t2) (p<0.001) but dropped to 46% at t3 (t1-t3: p<0.05). QOL improved significantly during hospitalization but dropped to initial levels 1 yr after discharge. A significant increase in health satisfaction during hospitalization was maintained at follow-up. Improvements in lung function were greater in patients with higher QOL scores on entry; subjects with the greatest tendency to use wishful thinking as a coping strategy had less improvement. In conclusion, the effects of pulmonary rehabilitation on lung function and health satisfaction are positive and enduring. Quality of life and coping have an effect on the long-term outcome of pulmonary rehabilitation, probably as expressions of patients' personality traits.

Adaptation, Psychological↗
PubMed1996

Causal attributions about common somatic sensations among frequent general practice attenders.

The causal attributions that people make about bodily symptoms or sensations are likely to influence their decisions whether or not to consult a doctor. Previous research has supported the model that people tend initially to look for external or environmental explanations for bodily sensations (normalizing attributions) and only if this process fails do they search for attributions internal to themselves (somatic or psychological attributions). This study tested two hypotheses about frequent general practice attenders: (1) compared with others, they are more likely to make somatic attributions and less likely to make normalizing ones; and (2) given a bodily symptom together with a somatic explanation, frequent attenders will have greater difficulty than others in finding reasons why the given (pathological) explanation is untrue. The frequent attenders' group had themselves initiated an average of 12 general practice visits in the 12 months before assessment, while a control group of infrequent attenders had not made appointments to see their general practitioner for an average of 24 months. The results provide partial support for the hypotheses. Frequent attenders generated significantly fewer normalizing explanations for a series of common bodily sensations than the comparison group, although the two groups did not differ in their somatic attributions. Given a common bodily sensation and an accompanying pathological explanation, the frequent attenders were less able than the control group to generate reasons why the given explanation might be untrue. Some associations were found between these measures and anxiety.

Adult↗
PubMed1996

Psychosocial and cognitive factors associated with adherence to dietary and fluid restriction regimens by people on chronic haemodialysis.

BACKGROUND: Failure by people on chronic haemodialysis to adhere adequately to dietary and fluid restrictions can have serious medical consequences. Numerous psychosocial factors possibly associated with adherence have been investigated in previous research. However, most previous studies have examined one or a few variables in isolation, and have tended to focus on sociodemographic variables not easily amenable to intervention. Much previous work has tended to ignore potential differences in adherence between male and female dialysands. METHODS: Sociodemographic and psychosocial factors associated with adherence to dietary and fluid restrictions were investigated in 45 people on haemodialysis attending one renal unit, excluding those with a residual urine volume > 500 ml/day. Multiple regression analyses were used to estimate the contribution to adherence of a range of variables, including gender, age, duration of dialysis, affective disturbance, past psychiatric history, health locus of control, social adjustment and social supports. RESULTS: Adherence to diet (measured by predialysis serum potassium) and to fluid restriction (interdialysis weight gain) were not linked, and had different psychosocial correlates. Regression models of four different aspects of adherence revealed very distinct psychosocial correlates, with contributions to adherence from complex interactions between psychosocial and cognitive variables, notably gender, age, social adjustment, health locus of control, and depression. CONCLUSIONS: The findings cast doubt on the results of many previous studies which have used simple models of adherence. Adherence is likely to be influenced in a complex manner by multiple factors including age, gender, locus of control, social adjustment, and past psychiatric history.

Adaptation, Psychological↗
PubMed1996

Eliciting lay beliefs across cultures: principles and methodology.

Lay beliefs about illness, its causes and its treatment, do not necessarily concur with medical knowledge, and can sometimes be highly idiosyncratic. These beliefs are likely to be influential in help-seeking, in patients' attitudes to professional help, and in the manner in which patients participate is the management of their illness. Clinicians thus need to understand such lay beliefs and attitudes in order to engage their patients in treatment and to provide optimal care. Lay beliefs are likely to be influenced by the individual's culture and hence also by ethnic group. In attempting to understand the patient's beliefs, the researcher or clinician runs the risk of ethnocentricity-viewing the patient's culture inappropriately from the clinician's own perspective. In some senses, this applies to every clinical encounter-patient and clinician always come from different cultures, in the broad sense. Sensitive clinicians develop expertise at bridging this cultural gap and seeing the patient's problems from the latter's viewpoint. However, more systematic investigation of beliefs and attitudes within a given culture can be pursued using the anthropological technique of ethnography. Ethnographic interviewing can yield qualitative data which can then be taken further in quantitative studies. To minimise the risks of ethnocentricity, it may be appropriate to analyse such data not using customary statistical methods but non-linear multivariate data analysis.

Attitude to Health↗
PubMed1995

Doctors' legal position in treating temporarily incompetent patients.

Doctors in accident and emergency departments are sometimes presented with patients with potentially life threatening conditions who refuse to consent to treatment. The doctors then face a dilemma: to withhold necessary treatment or to act against a patient's express wishes. Two such cases are presented, and we asked a lawyer, two medical ethicists, a psychiatrist, and an accident and emergency physician to comment on the implications.

Adult↗
PubMed1993

Psychosomatic aspects of end-stage renal failure.

End-stage renal failure (ESRD) is more than a typical chronic disease. Its treatment includes features which arguably make this condition unique. Selected psychosomatic aspects of ESRD are reviewed, including psychiatric morbidity, patients' adherence to their treatments, quality of life and the emotional impact on staff involved in treating patients with ESRD. Rather than presenting a comprehensive review of the results of published research, particular emphasis is laid on the critical appraisal of the methodology of published studies, to examine the extent to which these have provided answers to clinically important questions.

Adaptation, Psychological↗
PubMed1991

Diabetologists' assessments of their outpatients' emotional state and health beliefs: accuracy and possible sources of bias.

The accuracy of physicians' perceptions of their patients' emotional state and health attitudes was examined in a diabetes outpatient clinic by comparing patients' ratings of anxiety, depression and health locus of control with physicians' ratings. In 234 patients, doctors' and patients' ratings correlated significantly for depression and anxiety. The physicians rated patients with a strong belief in control of health by others as most dependent on doctors. Men but not women with external locus of control were also rated as very dependent on doctors. Anxious or depressed patients were rated by their doctors as less able to cope with diabetes. The results indicate that non-psychiatric physicians are able to assess their patients' emotions and health attitudes with greater accuracy than is usually assumed.

Adaptation, Psychological↗
PubMed1991

Glycaemic control in adolescents with type I diabetes and parental expressed emotion.

The parents of 34 adolescents with type I diabetes were interviewed using the Camberwell Family Interview, a well validated and reliable standardised interview which measures aspects of family interaction previously reported as important in the families of diabetics. Contrary to predictions from previous research, poor glycaemic control was not associated with parental apathy, criticism of the child with diabetes, or marital discord. Greater emotional involvement by parents was associated with good glycaemic control. Overall, there was close agreement between parents in their responses although mothers showed more accurate appraisal of their child's diabetes than did fathers.

Adolescent↗
PubMed1991

Compulsory psychiatric treatment in the community. I. A controlled study of compulsory community treatment with extended leave under the Mental Health Act: special characteristics of patients treated and impact of treatment.

Following in-patient psychiatric treatment under Section 3 of the Mental Health Act, some patients have in the past remained on Section after discharge, and subsequently the Section has been renewed while the patient remained 'on leave'. People treated thus with 'extended leave' probably resemble closely those who would be placed on a community treatment order if this were available. A group of these extended-leave patients was compared with a control group, matched for age, sex and diagnosis, selected by consultant psychiatrists as not requiring treatment using a community treatment order. The two groups showed very few differences, but the extended-leave patients more commonly had a history of recent dangerousness and non-compliance with psychiatric treatment. Use of extended leave improved treatment compliance, reduced time spent in hospital, and reduced levels of dangerousness.

Case-Control Studies↗
PubMed1991

Compulsory psychiatric treatment in the community. II. A controlled study of patients whom psychiatrists would recommend for compulsory treatment in the community.

Several English consultant psychiatrists were asked to identify which patients currently under their care they would recommend for treatment with a community treatment order, if such a provision existed. The psychiatrists were asked to match each such 'nominated' patient for age, sex and diagnosis with one or two control patients, not considered to require compulsory treatment in the community. From specific data collected, it was found that: the two groups did not differ in their 'lifetime' histories of psychiatric admissions, substance misuse, criminal charges or dangerousness; 65-72% of the total sample had a history of serious dangerousness; but in the 12 months before nomination, the 'nominated' patients were significantly less likely than the controls to have complied with psychiatric treatment, and more likely to have defaulted from follow-up. The results indicate that a psychiatrist's decision to recommend a patient for treatment with a community treatment order will depend predominantly on specific criteria related to the patient's recent past.

Activities of Daily Living↗
PubMed1989

The development and evaluation of a method of teaching liaison psychiatry to medical students.

A method is described of teaching medical students aspects of psychiatry related to their work with physically ill patients. The teaching requires few resources and focuses on a limited number of educational objectives centred on the acquisition of knowledge of psychiatry relevant to medical practice. The course comprised eight weekly one-hour seminars held during the first clinical year attachment to medical firms, prior to the students' psychiatry attachments. Clinically based, traditional 'bedside' teaching was used, involving patients known to the students. In a preliminary analysis of the effects of the teaching, students who had participated in the seminars scored significantly better on a test of liaison psychiatry knowledge than a matched group who had not experienced the course.

Clinical Clerkship↗
PubMed1989

Cognitive therapy with patients with chronic physical illness.

Selected cognitive concepts are reviewed which are relevant to the management of emotional disturbance in chronic physical illness. The concepts chosen do not comprise a comprehensive list, but are among those commonly encountered in clinical practice. These are illustrated by brief clinical case descriptions and also discussed in terms of relevant research findings. Particular assets of cognitive therapy are discussed in relation to chronic physical illness.

Adaptation, Psychological↗
PubMed1989

Psychiatric morbidity in renal transplantation.

51 patients on chronic dialysis, awaiting transplantation, were assessed using a standardised psychiatric interview, together with measures of anxiety, depression, locus of control and social adjustment. 33% of the patients warranted a psychiatric diagnosis. During the study period, 30 patients received a transplanted kidney and 18 could be followed up 12 months after transplantation, when only 3 had a psychiatric disorder (17%). Previous psychiatric history was the main predictor of psychiatric symptomatology and of psychiatric referral during follow-up. However, symptomatology at follow-up also correlated with affective symptoms and selected aspects of social adjustment at initial interview.

Adaptation, Psychological↗