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PubMed2006

[Spanish adaptation of the disease-specific questionnaire MSQOL-54 in multiple sclerosis patients].

INTRODUCTION: The Multiple Sclerosis Quality of Life 54 (MSQOL-54) is a health-related quality of life specific questionnaire for multiple sclerosis (MS) patients. The objective of this study was to develop the Spanish version of the MSQOL-54 and to obtain a conceptually equivalent version to the original one for its use in patients with MS in the first phase of the project. METHODS: A transcultural adaptation procedure was designed according to the following phases: a) two independent translations made by bilingual native Spanish speaking translators (forward translation); b) a revision of the items by an expert panel; c) a back translation by a bilingual native English speaking person; d) comparison with the original version (expert panel and advise by the original authors), and e) cognitive debriefing (interviews with subjects with MS) to test the comprehension and feasibility of the instrument. RESULTS: Ten interviews were carried out with 5 men and 5 women with MS, aged 21 to 54 years, with different education levels and EDSS scores ranging from 1,0 to 8,0. Most of the patients found the questionnaire easy to fill out and the understanding favorable. Only one item (item 51) was modified after the cognitive debriefing to improve its comprehension. Finally, a final pretest version was obtained. CONCLUSIONS: The procedure carried out maximizes the conceptual equivalence between the original MSQOL-54 and the translated version and shows that the Spanish pre-test version is comprehensible and its administration feasible in patients with MS. The psychometric properties must be evaluated in the next phase of the project.

Activities of Daily Living↗
PubMed1991

Working hours and fatigue of Japanese flight attendants (FA).

There have been some reports concerning high complaint rates of fatigue or fatigue-related symptoms including lower back pain in flight attendants (FA). Thus, the relations of working conditions with work stress and fatigue symptoms were studied chiefly by focusing on working hours. From analysis of the time-table and fatigue symptoms of workers on international flights, it was suspected that there were some work-related factors jointly causing serious FA fatigue symptoms; night time and early morning work, long flight hours and a large time difference, thus disturbing their biological rhythms. On domestic flights, showing up early in the morning and debriefing late in the night were often observed together with a highly irregular FA time schedule. By statistical analyses, some factors including long working hours, frequent landing and late debriefing hours were considered to contribute significantly to the high fatigue complaint rates. Thus, it should be emphasized that many countermeasures are necessary to improve FA working conditions including working hours, rest on the airplane (ONO et al., 1990) and sleep during layover, in order to reduce their work stress and fatigue symptoms.

Aerospace Medicine↗
PubMed1988

Analysis of sleep on Shuttle missions.

Many aspects of Shuttle missions may have significant impact on the normal sleeping patterns of crewmembers. Using a standard debriefing form, 58 crewmembers from 9 Shuttle flights (6 single-shift flights, and 3 dual-shift flights) were debriefed within 3 d postflight. Specific questions on the form relating to sleep quality and quantity, fatigue, and sleep medication usage during all flight phases were analyzed. Of crewmembers on dual-shift missions 50% (11 of 22) used sleep medications at least once inflight compared to 19.4% (7 of 36) of single-shift. The biggest impact on normal sleep patterns occurred during the first and last days of a mission, with averages of 5.7 h and 5.6 h, respectively. These results suggest that sleep disruption is a common occurrence on Shuttle missions. Further studies are suggested to develop strategies for coping with this potential problem.

Circadian Rhythm↗
PubMed1987

Applying the acute ischemic heart disease predictive instrument.

A predictive instrument (or index) previously reported to be of value in reducing unnecessary coronary care unit admissions was tested in a randomized study. Acceptability to the physician was then measured by monitoring utilization in a subsequent nonrandomized phase and by debriefing. The predictive instrument retained predictive accuracy in the new setting with good correlation between predicted and actual risk of acute cardiac ischemia (r = 0.925). False-positive diagnosis rate decreased from 71 percent to 0.0 percent (P = .0096) in a subgroup admitted to the intermediate care unit, consistent with previously reported usefulness in low-risk patients. Acceptability was poor, however, with utilization rate of only 2.8 percent of eligible patients. Debriefing revealed low perceived usefulness. This problem will need to be addressed if widespread utilization is to occur. The criteria of predictive accuracy, usefulness, and acceptability are suggested as a standard panel for testing new predictive instruments.

Adult↗
PubMed1995

Cockpit-cabin crew interaction: satisfaction with communication and information exchange.

BACKGROUND: There were 1240 members of flight deck crews (F/D) and cabin crews (C/C) in SAS Norway who responded to a questionnaire that included issues related to communication between crews. The response rate was 84%. HYPOTHESIS: Possible differences between F/D and male and female C/C concerning evaluations of information exchange and communication between crews were examined. METHODS: A multi-faceted questionnaire containing 250 questions concerning organizational and psychosocial issues, safety questions, and subjective health was employed. Regression analyses were applied to examine predictors of satisfaction with information and communication. RESULTS: One half of aircrew members were dissatisfied with information exchange and cooperation between the cockpit and the cabin in general. About 70% were dissatisfied with interaction related to debriefing and stop. Differences between F/D and C/C were significant concerning debriefing. Cabin crews, and especially females, reported being inadequately informed about specific operational procedures and technical matters. Nine of ten female C/C wanted better information about technical aspects of the airplane or flying. Pilots reported inadequate information about how emergency procedures influence C/C and passengers. Between 72% and 94% were satisfied with interpersonal relationships, while 53% expressed satisfaction with supervision and social support. A majority (86%) confirmed that frequent changes between crews were stressful. Regression analyses yielded significant relationships between frequencies of meetings, supervision and support issues, and scheduling schemes and satisfaction with information exchange and cooperation. CONCLUSIONS: Results suggest a strong need to provide more open, continuous and effective communication between the cockpit and the cabin. Several practical suggestions for improvements are discussed.

Adult↗
PubMed1996

Group dynamics during the EXEMSI isolation study. Experimental Campaign for the European Manned Space Infrastructure.

The objectives of this study were to investigate the social behavior, interrelations, cohesion, efficiency and team formation of the crew during 60 days of isolation and confinement, to make a critical comparison of a variety of test methods used for this purpose and to formulate recommendations for their applications in selection, training and support for future studies of this kind. The study consisted of three phases: (1) the pre-isolation period, in which initial individual and group assessment were made to understand the motivation, characteristics, and styles of the crew members, the state of the crew, and to make a prognosis for the behavior of the group and its members, (2) the isolation period, with tests and observations to follow and analyze behavior and group dynamics of the crew, and to detect manifestations of stress, and (3) the post-isolation period with final assessment and debriefing. During these three periods individual and group tests were carried out. Direct methods, questionnaires and tests, as well as indirect methods, observations of behavior, were used. These had cognitive, affective-emotional and social components; they were quantitative, qualitative or a combination. Before isolation the crew members expressed strong confidence in the team and in their own personal capability. The leadership of the Commander seemed uncontested. Crew functioning during this period was conflict-free, but was structured in a rather rigid and defensive way (isolation of affects, denial of anxiety). Apparently, the members strongly needed to present a good image image of themselves. The relatively short period of the experiment, and the absence of real risk suggested that the crew would be able to maintain their cohesion, but in a real spaceflight situation this behavior could be inadequate and even dangerous. The pre-isolation prognosis for crew behavior during isolation was validated to a large extent. During isolation there were no clear manifestations of stress. Nevertheless, the confinement and isolation were experienced as the major stress factors. The crew members described themselves as a heterogeneous but harmonious group that was successful in their mission. In fact, the team maintained its cohesion by opposing external authority, using management as a scapegoat. Occasionally, in times of crisis, they also criticized ground crew. The Commander supported this attitude. Strongly differences in personality and behavior were noted. Analysis of the sociometric data showed that the asserted harmony was more apparent than real. It is questionable whether the group cohesion would have persisted in a life threatening crisis or even in a prolongation of the experiment. The most reliable instruments for this type of survey seem to be: group methods, non-obstructive tests, indirect instruments, and qualitative tools. The least reliable are: strictly quantitative methods, self-evaluations, standard debriefing techniques, since these reinforced in most cases subjects' defenses in an unconscious avoidance of criticism. Several recommendations were made for the organization, definition of objectives, experiment selection, crew selection, roles of external management and personnel. In particular, it is felt to be necessary to explain the aims of the mission to the subjects, to give clear and complete information, to establish confident and cooperative relations with the crew. It is essential to allow dialogue, to take opinions and suggestions of the crew seriously, and to establish clear rules of confidentiality.

Communication↗
PubMed1996

Preventing post-traumatic stress disorders in military medical personnel.

Medical personnel in military units are highly vulnerable to post-traumatic stress disorder. They are removed from their conventional identity, stature, and social support system, and are deprived of a sense of control and physical comforts. They then must witness and immerse themselves in the gruesome results of warfare. Ideal training of medical personnel includes training intact units and functional teams, training on the deployment platform, and desensitizing with real casualty management. Using stress inoculation techniques prior to casualty handling, and providing for post-event debriefing (Critical Incidence Stress Debriefing), will reduce the incidence of combat casualty-induced stress disorders.

Humans↗
PubMed1996

[Communication with intubated patients].

For critically ill patients on assisted respiration caring behavior is particularly important. In this paper we review the literature on patient satisfaction with medical care and with their communication with the nursing staff. Communication skills of staff of intensive respiratory care units were studied by direct observation, debriefing of hospitalized patients and by interview of discharged patients. Direct observation showed that nurses spent only a small proportion of their time talking to patients. The interactions dealt with technical rather than emotional matters and consisted mostly of negative and discouraging comments rather than positive and supporting messages. Debriefing of hospitalized intubated patients revealed a high degree of overall satisfaction with care on the one hand, and complaints of communication problems, anxiety and anger on the other. Lastly, interviews with discharged patients revealed that as many as a quarter of those who could remember their hospitalization reported feelings of anxiety, anger, distrust in the staff and difficulty in communication. These findings suggest that the nursing staff needs improved communication skills. There is evidence that the judicious use of communication techniques may improve patient satisfaction, reduce anxiety and reduce duration of treatment.

Anger↗
PubMed1978

Comments on "Studies of the interaction of psychological and pharmacological determinants of smoking" by Schachter et al.

The work by Schachter and his colleagues on the psychological and pharmacological determinants of smoking is reviewed. The experiemental procedures are critically examined, and some are judged to be in violation of ethical standards for the conduct of research with human participants. Questions are raised concerning matters of informed consent, the description of debriefing procedures, and use of the college classroom as a psychological laboratory.

Behavioral Research↗
PubMed1977

Behavioral science research: ethical and policy implications.

Problems centered about protection of human subjects in behavioral science research are discussed. Difficulties in obtaining truly informed consent are noted. It is concluded that the risks involved to subjects are minimal in this field of research. The use of deception in psychological research is discussed along with the necessity of appropriately debriefing the subject. The use of institutional committees to protect subjects' rights is contrasted with the bureaucratic review processes of the government. It is concluded that, in the absence of evidence to the contrary, the local institutional review process is likely to induce greater cooperation from investigators in protecting subjects' rights.

Behavioral Research↗
PubMed1994

Psychosocial interest, medical interviews, and the recognition of depression.

OBJECTIVES: To measure primary care physicians' attitudes toward psychosocial issues, determine their relationship to the style of the medical interview, and assess whether attitudes and interview behaviors lead to correct diagnosis in patients with depression. DESIGN: Physicians were videotaped while interviewing four patients standardized with criteria symptoms of major depression. Physicians were unaware of the mental health focus of the study. SETTING: Patient examining rooms. PARTICIPANTS: Physicians were eligible for recruitment if they were board certified or eligible in family practice or internal medicine, practiced primary care medicine, and were listed in regional directories. Standardized patients were recruited from the community. MAIN OUTCOME MEASURES: Attitudes toward psychosocial issues (measured by the Physician Belief Scale), interview content (measured by review of the videotaped encounters), interview behaviors (measured by the Interaction Analysis System for Interview Evaluation), and a listing of depression in the differential diagnosis (determined by physician debriefing interviews). RESULTS: Forty-seven community-based practitioners participated. Forty-eight percent of interviews resulted in a diagnosis of depression. Physician Belief Scale scores were not significantly correlated with patient-centered interviewing, psychosocial questions, inquiry about depression symptoms, or a depression diagnosis. Longer interviews were more likely to result in a depression diagnosis. CONCLUSIONS: High interest in psychosocial issues was not associated with patient-centered interviewing behaviors, questions about psychosocial or depression symptoms, or depression diagnoses. However, certain patient-centered interviewing behaviors, particularly those defined as "affective," did lead to the recognition of depression.

Adult↗
PubMed2000

Clues to patients' explanations and concerns about their illnesses. A call for active listening.

Most patients who experience illness symptoms develop an explanatory model. More frequently than physicians realize, these attributions involve serious and potentially life-threatening medical conditions. Only a minority of patients spontaneously disclose or "offer" their ideas, concerns, and expectations. Often patients suggest or imply their ideas through "clues." Active listening is a skill for recognizing and exploring patients' clues. Without this communication skill, patients' real concerns often go unrecognized by health care professionals. Qualitative techniques including videotape analysis, postinterviewing debriefing, and interpersonal process recall were used to identify types of clues. We propose a taxonomy of clues that includes (1) expression of feelings (especially concern or worry), (2) attempts to understand or explain symptoms, (3) speech clues that underscore particular concerns of the patient, (4) personal stories that link the patient with medical conditions or risks, and (5) behaviors suggestive of unresolved concerns or unmet expectations. This clue taxonomy will help physicians recognize patients' clues more readily and thereby improve their active listening skills. A deeper understanding of the true reasons for the visit should result in increased patient satisfaction and improved outcomes.

Humans↗
PubMed1998

Primary care providers' responsiveness to health-risk behaviors reported by adolescent patients.

OBJECTIVE: To assess clinicians' responsiveness to health-risk behaviors reported by adolescent patients during a comprehensive clinical preventive services visit. DESIGN: Nonprobability sample of adolescent patients scheduled for a routine physical examination. SETTING: Seven clinical sites in the Chicago, Ill, area. PARTICIPANTS: Fifteen primary care providers and 95 adolescent patients between 11 and 18 years of age. INTERVENTION: Providers delivered comprehensive clinical preventive services to adolescent patients using the Guidelines for Adolescent Preventive Services model. This model includes screening, guidance, a physical examination, and immunizations. Prior to the visit, adolescent patients completed a screening questionnaire that included a 52-item health-risk behavior profile. Responses on the screening questionnaire were discussed during the visit. MAIN OUTCOME MEASURES: Each provider's responsiveness to reported health-risk behaviors was determined by comparing the adolescent patient's responses on the screening questionnaire with those reported during a debriefing interview with the adolescent about whether specific subjects were discussed. Responsiveness to highly sensitive behaviors was determined by comparing the screening questionnaire and the medical record. RESULTS: On average, each adolescent patient reported 10 risk behaviors, of which 7 were discussed. The severity of the reported risk behavior, the number of reported biological health concerns, and the adolescent patient's sex were significant predictors of the provider's responsiveness. The number of reported health-risk behaviors, visit duration, provider's professional role and sex, whether the adolescent was a new patient, and the adolescent patient's age were unrelated to responsiveness. CONCLUSIONS: Providers addressed most health-risk behaviors reported during a single visit, but responsiveness declined when 3 or more biological health concerns or relatively severe problems were reported. Steps can be taken to increase providers' responsiveness.

Adolescent↗
PubMed1997

Biological terrorism. Preparing to meet the threat.

The threat of terrorists using biological warfare agents has received increased attention in recent years. Despite the hope that, with the right mix of policies, security measures, and intelligence gathering, a major biological warfare terrorist attack can be prevented, the history of conventional terrorism indicates otherwise. The greatest payoff in combating biological terrorism lies in focusing on how best to respond to a terrorist attack. The medical and emergency service communities will play the most important role in that process. Ensuring that they are trained to recognize the symptoms of diseases caused by biological warfare agents and have Critical Incident Stress Debriefing teams available to help them cope with the emotional aspects of treating exposed survivors should be part of contingency planning. By improving our readiness to respond to biological terrorism, many lives can be saved and terrorists denied their goal of creating panic and crisis throughout the country.

Biological Warfare↗
PubMed2026

BMT4me En Español: Multisite Feasibility and Usability Testing of a Spanish-Language mHealth Adherence Support App for Spanish-Speaking Caregivers of Children After Hematopoietic Stem Cell Transplantation and Cancer Treatment.

BACKGROUND: Medication nonadherence during the first 100 days after pediatric hematopoietic stem cell transplantation (HSCT) and during oncology treatment increases risk for complications. BMT4me is a caregiver-facing mobile health (mHealth) application providing medication reminders, symptom tracking, and note-taking features to support medication management. Spanish-speaking caregivers are frequently excluded from digital adherence interventions due to the lack of language-accessible tools. PROCEDURE: We conducted a multisite, mixed-methods usability testing of a Spanish-language version of BMT4me ("BMT4me en Español") with Spanish-speaking caregivers of children (ages 2-17 years) post-HSCT or with an oncology diagnosis on active treatment. Caregivers completed a facilitated, three-step usability session (unobtrusive observation, interactive observation, and debriefing), followed by a semi-structured interview, and then completed the system usability scale (SUS). Quantitative outcomes were summarized descriptively; qualitative data were analyzed using content analysis with constant comparison. RESULTS: Fifteen participants enrolled at each site for a total of 30 participants. Across both sites, the recruitment rate was 91%. All participants completed all parts of the study. The SUS score (M = 80.09; SD = 17.35) was above average (>68). Two key qualitative themes emerged: (1) the perceived positive impact of BMT4me on managing a serious illness and (2) the acceptance and sociocultural relevance of BMT4me for Spanish-speaking families. Caregivers also shared suggestions to add educational content and multiuser functionalities to BMT4me. CONCLUSIONS: The acceptance and perceived positive impact of the Spanish BMT4me app indicates that socioculturally relevant, Spanish mHealth interventions have strong potential to support Spanish-speaking caregivers in pediatric oncology and HSCT settings. CLINICAL TRIALS NCT: NCT06361173.

Adolescent↗
PubMed2006

The aftermath: aspects of recovery described by perpetrators of maternal filicide committed in the context of severe mental illness.

Mentally abnormal maternal filicide is a rare and horrifying event. Clinicians are unlikely to develop broad experience with this and there is little information available about recovery. This paper presents a range of descriptions of recovery experiences derived from a qualitative study of mentally abnormal maternal filicide perpetrators. Transcripts from a qualitative, semi-structured interview study of six women who committed filicide in the context of major mental illness were reviewed. Descriptions related to rehabilitation issues were grouped and themes extracted. The women described patchy but horrific memories they avoided thinking and talking about. They described intense self-judgement and self-hate. They valued ongoing relationships with surviving children and were distressed by perceptions that they might be a danger to other children. Managing illness was not described as a major challenge. Acknowledgement of illness was described as important in coming to terms with what they had done. Surviving children and relationships with family and other support networks were described as important in their rehabilitation. We conclude that optimizing treatment and rehabilitation for mental illness, supporting the woman to acknowledge the role of illness in the offence, maximizing support from personal networks, and enabling her to regain some aspect of the mother role may be more efficacious than debriefing with respect to the offence.

Adaptation, Psychological↗
PubMed2005

Reciprocal peer teaching: students teaching students in the gross anatomy laboratory.

Three common instructional strategies used to teach gross anatomy are lecture, discovery or inquiry-based learning, and cooperative learning. One form of cooperative learning, called reciprocal peer teaching (RPT), illustrates circumstances where students alternate roles as teacher and student. By assuming the responsibility of teaching their peers, students not only improve their understanding of course content, but also develop communication skills, teamwork, leadership, confidence and respect for peers that are vital to developing professionalism early in their medical careers. Traditionally in our Anatomy department, students dissect the entire body using a standard dissection manual. More non-traditionally, however, we have increased cooperative learning in the dissection laboratory by involving students in a series of supplementary RPT activities. During these exercises, 10% of the class practiced their demonstration with course instructors until the students felt prepared to demonstrate the exercise to their classmates. We designed one peer demonstration emphasizing three to six teaching objectives for most of the 40 dissection units. This resulted in a compendium of peer demonstrations for implementation throughout the course. The multitude of diverse exercises permitted each student many opportunities to teach their peers. A debriefing questionnaire was administered at the end of the course demonstrating that 100% of students agreed the RPT experience increased their understanding of the topics they taught and 97% agreed it increased their retention of information they taught to their peers. In addition, 92% agreed that RPT improved their communication skills, which can be applied beyond anatomy to their careers as future physicians.

Anatomy↗
PubMed2004

Knowledge translation: the role and place of practice reflection.

Reflection is the mechanism by which we contemplate and try to understand relatively complex and sometimes troubling ideas for which there is no obvious solution. Reflection allows us to transform current ideas and experiences into new knowledge and action. Personal experiences and organizational feedback can trigger reflection, whereas a lack of time, available colleagues, and social networks detract from the ability professionals have to reflect. Educational programs can encourage reflection through the judicious use of case-based discussion, formal and informal needs assessments, and commitment to change exercises. Learning journals and personal learning projects are self-directed methods that facilitate reflection. In the workplace, critical incident techniques and debriefing of cases provide opportunities for thoughtful inquiry. Additional study is needed to understand how and why reflection works to transform surface learning into deep learning and change in practice; how reflection enhances the integration of reading, collegial interchange, and classroom discussion into practice; and how technology can enhance reflection.

Education, Medical↗