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PubMed2003

Understanding implantable cardioverter defibrillator shocks and storms: medical and psychosocial considerations for research and clinical care.

The experience of shock is the distinguishing feature for patients with implantable cardioverter defibrillators (ICDs) and is associated with diminished psychological functioning and quality of life. Multiple shocks and ICD storm are a relatively common event among patients with ICDs (10-20%) and may present specific challenging medical and psychological management for the attending health care providers. This paper examines the medical and psychological aspects of ICD shocks and storms and describes a model of biopsychosocial management for patients following the experience of ICD storm. Successful management of patients post shock includes the use of antiarrhythmic medications and careful attention to the causality of the shocks via stored electrograms. The psychological management includes specific attention to debriefing post-shock feelings and attributions, preventing avoidance behavior, and facilitating positive "return to life" actions. Preliminary research examining formal psychosocial treatment supports a cognitive behavioral strategy to reduce psychological distress and facilitate quality of life. Collectively, these data suggest that interdisciplinary management of patients with multiple ICD shocks or the experience of ICD storm is advised, and routine psychological consultation may be indicated for the patient post ICD storm to reduce the possibility of symptoms of post-traumatic stress.

Adaptation, Psychological↗
PubMed1994

A retrospective study of promethazine and its failure to produce the expected incidence of sedation during space flight.

Since March 1989, intramuscular (IM) promethazine has been successfully used to treat the symptoms of space motion sickness. The incidence of sedation associated with promethazine administration on the ground is large and may result in operational impact. The authors undertook a retrospective study to quantify the incidence of sedation from promethazine use during Space Shuttle flights. Crew medical debriefings from 14 shuttle missions were reviewed for crew members who had been treated with IM promethazine and their corresponding symptoms were identified. Twenty-one crew members received IM promethazine (25-50 mg), and only one experienced any associated sedation with no operational impact. This sedation incidence of less that 5% is in stark contrast to the 60 to 73% incidence of sedation seen in ground-based studies. The incidence of sedation during space flight from IM promethazine is substantially less than that seen on the ground and does not present an operational problem during Space Shuttle flights. Future investigations of environmental stressors and pharmacodynamic changes associated with space flight may explain the huge disparity between the space-flight and ground-based data.

Humans↗
PubMed1994

Sleep and circadian rhythms in space.

This paper presents a detailed critical review of the knowledge accumulated in the last three decades concerning research on sleep, work-rest schedules, and circadian rhythms in space. The focus of the paper is preceded by a brief review of the basic principles of the human circadian system and the physiology of the sleep-wake cycle, relevant to understanding the problem of astronaut work-rest scheduling. Much of what is known is based on anecdotal reports, mission log books, and debriefing of astronauts after flights. The broad literature reviewed, which includes studies from American and Soviet space missions, as well as some studies conducted under simulated weightlessness, offers just a handful of objective studies on the physiology of sleep and circadian rhythms in space. Nevertheless, the data are remarkably consistent, and indicate that sleep can be of reasonably good quality in space. The risk of sleep loss and associated performance degradation appears to be a manageable one. However, one clear conclusion arises from this review: whatever the type of mission of flight plan, its success will depend on whether the principles of circadian and sleep-wake regulation have been taken into account during the planning phase of work-rest schedules. That is, satisfactory sleep and alertness is more likely to occur if crews maintain a reasonable (i.e., constant) relation with their normal terrestrial rhythm. This is not as easy a task as it may appear; indeed, unexpected, high-intensity operational demands have been the major cause of acute problems of sleep loss and performance degradation in space. Moreover, the growing complexity of space missions indicate that emergencies will never disappear. Therefore, one of the most important research challenges for future space missions is the development of strategies that could permit astronauts to function closest to maximal efficiency during intensive and prolonged work. Countermeasures for optimizing astronaut performance, as well as other factors affecting sleep and performance in space, are reviewed and discussed in detail in this paper.

Circadian Rhythm↗
PubMed2005

Understanding placebo, nocebo, and iatrogenic treatment effects.

Placebo and nonplacebo treatments have both positive and negative effects on patient outcomes. To better understand the patterning of treatment effects, three specific interventions will be discussed that are reported to produce more harm than benefit: critical incident stress debriefing, group therapy for adolescents with conduct disorders, and psychotherapy for dissociative identity disorder. In each case, there is an interaction between mechanisms thought to underlie both placebo and specific treatment effects. Mechanisms hypothesized to underlie placebo and nocebo effects include patient expectancy, self-focused attention to symptoms, motivation to change, and sociocultural role-enactment cues. In the three treatments discussed, specific mechanisms interact with nonspecific mechanisms to produce iatrogenic effects. To advance knowledge, it is important both to specify the theory of treatment and its expected outcomes and to put the theory to test. Only with attention to the empirical findings from programmatic research of specific and nonspecific effects and their interaction is it possible to improve the outcomes of treatment beyond the status quo.

Humans↗
PubMed2004

Alzheimer's disease caregiving information and skills, part III: group process issues and concerns.

In this descriptive study we examined content and processes in a group-based component of an ongoing clinical trial with family caregivers of persons with dementia. The purpose was to identify issues arising from the group processes that could be used to inform future skill-building caregiver groups. Summaries from two types of intervention groups, a caregiver skill-building (CSB) treatment intervention and an information and support only (ISO) control intervention were examined, along with data collected during a group leader debriefing session. Three major categories of process information were identified: (a) group member behaviors that support group processes necessary for skill development, (b) group leader behaviors that support group processes necessary for skill development, and (c) the phases of learning in caregiver (CG) skill development. Subcategories and specific content in each of these areas are identified in this article, and a list of member and leader behaviors that might support future skill development in groups is presented.

Alzheimer Disease↗
PubMed2002

Assessment of feasibility of workplace health promotion.

BACKGROUND: A simple empirically based method for assessment of the feasibility of workplace health promotion programs is described, focusing on cancer hazards (lifestyles, workplace hazards, deficient early detection). The basic components of feasibility are addressed: extent of hazards; needs of employees for hazard reduction and acceptability of WHP; and social context. METHODS: The procedure consists of six modules: guidelines on feasibility assessment; employee questionnaire; interview checklists for probing attitudes of management and partners (social context); data form; debriefing; and assessment of feasibility. Pretesting was completed in 16 workplace communities representing industry, construction, transport, telecommunications, health care, lodging and catering, teaching, and municipality jobs in five countries; a total of 1,085 subjects completed the employee questionnaire on health hazards, needs, and acceptability. RESULTS: The method demonstrated its utility in obtaining and summarizing the necessary data. Feasibility was assessed for the 16 test communities. CONCLUSION: The procedure can be customized; it has a high degree of face validity or understandability, and it is applicable in a wide variety of settings.

Attitude to Health↗
PubMed1997

A synthesis of the findings from the Quake Impact Study: a two-year investigation of the psychosocial sequelae of the 1989 Newcastle earthquake.

This paper summarises the major findings from the Quake Impact Study (QIS), a four-phase longitudinal project that was conducted in the aftermath of the 1989 Newcastle (Australia) earthquake. A total of 3,484 subjects participated in at least one component of the QIS, comprising a stratified sample of 3,007 drawn from community electoral rolls and 477 from specially targeted supplementary samples (the injured, the displaced, the owners of damaged businesses, and the helpers). Subjects' initial earthquake experiences were rated in terms of weighted indices of exposure to threat and disruption. Psychological morbidity was measured at each phase using the General Health Questionnaire (GHQ-12) and the Impact of Event Scale (IES). Selected findings and key conclusions are presented for each of six areas of investigation: service utilisation during the first 6 months post-disaster; patterns of earthquake experience and short-term (6-month) psychosocial outcome; earthquake exposure and medium term (2-year) psychosocial outcome; vulnerability factors and medium-term psychosocial outcome; specific community groups at increased risk (e.g., the elderly and immigrants from non-English-speaking backgrounds); the effects of stress debriefing for helpers. Threshold morbidity (i.e., likely caseness) rates are also presented for a broad range of subgroups. In addition to presenting an overview of the QIS, this paper synthesises the major findings and discusses their implications for future disaster management and research from a mental health perspective.

Adult↗
PubMed1992

Measurement of sexual aggression in college men: a methodological analysis.

Researchers have devoted increased attention in recent years to the measurement of sexual aggression in college populations. This review describes and critically examines current methods of measuring sexual aggression which rely on a self-reported history of such behavior. We suggest that the construct validity of these approaches can be enhanced through a systematic consideration of instrumentation and methodological issues. Twenty-six empirical studies were evaluated with regard to sample characteristics such as size, type, representativeness, and subject exclusion criteria, as well as study design, measurement method, statistics reported, use of debriefing, and control for socially desirable response bias. Specific instrumentation methodology to measure a self-reported history of sexual aggression was examined in detail.

Adult↗
PubMed1994

Psychological symptoms and psychiatric diagnoses in Operation Desert Storm troops serving Graves registration duty.

This clinical report describes symptoms of psychological and physical distress and psychiatric disorders in 24 Army Reservists who served war zone graves registration duty in support of Operation Desert Storm. Troops underwent comprehensive assessment for evidence of psychopathology that might be associated with war zone duty as one component of a debriefing protocol scheduled during regular drill exercises eight months after their return to the United States. Troops endorsed items suggestive of high war zone stress exposure, common symptoms of anxiety, anger, and depression, and multiple health and somatic concerns. Almost half of the sample met criteria for post-traumatic stress disorder, and diagnosis of this disorder was strongly associated with evidence of depressive and substance abuse disorders. The gruesome aspects of body recovery and identification in a war zone setting were cited as stressor elements of significant negative impact.

Adult↗
PubMed1995

The Kings Cross fire: psychological reactions.

The psychological reactions of 50 survivors of the King's Cross fire, which hit London's underground railway system on the 18th day of November 1987, are described. Results are presented for the Impact of Event scale, the General Health Questionnaire (28-item version), the Eysenck Personality Questionnaire and a King's Cross Event Schedule. These are investigated in relation to (a) validity measures, (b) relationships between exposure and personality, and (c) spontaneous de-briefing. Two thirds of the sample had significant levels of psychological distress (meeting the "caseness" criterion on the GHQ). Both personality (neuroticism and L-scale) and degree of trauma exposure were related to subsequent reaction. Spontaneous debriefing was associated with subjective benefit. Transportation disasters present particular problems in relation to research and service delivery.

Adaptation, Psychological↗
PubMed1994

A shooting incident in an elementary school: effects of worker stress on public safety, mental health, and medical personnel.

The effects of impact of event and five categories of worker stress were studied with 140 police, fire, medical, and mental health personnel who were involved in emergency service work following a shooting in an elementary school. A questionnaire distributed 6 months after the incident was utilized. Public safety personnel reported a recollection of significantly fewer intrusive thoughts than medical and mental health professionals immediately following the incident. Groups did not differ in intrusive or avoidance scores on the Impact of Event Scale 6 months after the event and all groups showed a significant decrease in both scores over time. Stepwise linear regression showed that a self-reported qualitatively heavy work load predicted intrusiveness and avoidance of thoughts both immediately after and at the 6-month anniversary of the incident. Additionally, time pressure and quantitatively heavy work load also predicted avoidance score at the time of the incident. Results are discussed in terms of control models of anxiety and as foci for debriefing with affected personnel.

Adjustment Disorders↗
PubMed1996

PTSD diagnosis and treatment for mental health clinicians.

This article focuses on four issues: PTSD assessment, treatment approaches, therapist issues, and current controversies. Important assessment issues include the trauma history, comorbid disorders, and chronicity of PTSD. Effective intervention for acute trauma usually requires a variant of critical incident stress debriefing. Available treatments for chronic PTSD include group, cognitive-behavioral, psychodynamic, and pharmacological therapy. Therapist self-care is essential when working with PTSD patients since this work may be functionally disruptive and psychologically destabilizing. Current controversies include advocacy vs. therapeutic neutrality, eye movement desensitization and reprocessing (EMDR), the so-called false memory syndrome, and the legitimacy of complex PTSD as a unique diagnostic entity.

Attitude of Health Personnel↗
PubMed1998

Oklahoma City: disaster challenges mental health and medical administrators.

Mental health and medical administrators responded to the Oklahoma City bombing with cooperative and overlapping efforts to meet community needs in the wake of terrorism. The major agencies assisted in the immediate rescue response, organized crisis hotlines, prepared mental health professionals to counsel bereaved families and victims, organized debriefing of rescuers, assessed mental health needs of local school children, planned for longer term treatment, and coordinated research efforts to learn from the disaster. Implications to mental health administrators responding to significant acts of terrorism are discussed.

Adult↗
PubMedDate not supplied

Psychometric validation of a patient-reported sensory perception and preference instrument: the Sensory Perceptions Questionnaire.

This study evaluated the psychometric properties of content validity, construct validity, and test-retest reliability of a 23-item Sensory Perceptions Questionnaire (SPQ) used to survey sensory perceptions of intranasal corticosteroid sprays. Two patient cohorts (men and women aged > or =18 years who had at least a 1-year history of allergic rhinitis and had been using a corticosteroid nasal spray) were enrolled. The content validity and construct validity of the SPQ questions were evaluated using a cognitive debriefing method after cohort 1 (n=15) completed the SPQ. Test-retest reliability (assessed with intraclass correlation coefficients [ICCs] of the SPQ questions) was evaluated in cohort 2 (n=50), after they answered a Web-based version of the SPQ on two occasions, each separated by 7 days. In cohort 1, 7 of 15 patients believed all relevant sensory perceptions were addressed in the questionnaire. Although 8 patients mentioned at least 1 sensory perception that was not addressed, only 4 sensory perceptions were mentioned by more than 1 patient, and none was mentioned reliably by more than 2 patients. Those 4 sensory perceptions not addressed in the SPQ were all intentionally excluded, because they were potential symptoms of rhinitis or adverse events associated with intranasal corticosteroid spray use. Patients regarded the questions as straightforward, nonburdensome, and nonthreatening, signs suggesting the questions were not likely to challenge the construct validity of the SPQ. The responses to 2 questions (one in which patients were asked to indicate whether they were pleased or displeased overall with a particular spray; the other to indicate their overall product preference) were somewhat influenced by the effectiveness of the sprays. Results of test-retest reliability (cohort 2) showed both high (>0.8) and low (<0.7) ICCs. A high degree of correspondence between the 2 administrations produced a low between-patient variance, which likely resulted in lower ICCs. The SPQ adequately represents the sensory attributes reported by patients regarding intranasal corticosteroid spray use and, overall, is a valid measure of patient preference based on sensory perception.

Administration, Intranasal↗
PubMed2002

[Innovative training for enhancing patient safety. Safety culture and integrated concepts].

INTRODUCTION: Patient safety is determined by the performance safety of the medical team. Errors in medicine are amongst the leading causes of death of hospitalized patients. These numbers call for action. Backgrounds, methods and new forms of training are introduced in this article. METHOD: Concepts from safety research are transformed to the field of emergency medical treatment. Strategies from realistic patient simulator training sessions and innovative training concepts are discussed. RESULTS: The reasons for the high numbers of errors in medicine are not due to a lack of medical knowledge, but due to human factors and organisational circumstances. A first step towards an improved patient safety is to accept this. We always need to be prepared that errors will occur. A next step would be to separate "error" from guilt (culture of blame) allowing for a real analysis of accidents and establishment of meaningful incident reporting systems. Concepts with a good success record from aviation like "crew resource management" (CRM) training have been adapted my medicine and are ready to use. These concepts require theoretical education as well as practical training. Innovative team training sessions using realistic patient simulator systems with video taping (for self reflexion) and interactive debriefing following the sessions are very promising. CONCLUSION: As the need to reduce error rates in medicine is very high and the reasons, methods and training concepts are known, we are urged to implement these new training concepts widely and consequently. To err is human - not to counteract it is not.

Clinical Competence↗
PubMed2006

Expectations to and evaluation of a palliative home-care team as seen by patients and carers.

OBJECTIVES: Although the number of palliative home-care teams is increasing, knowledge of what patients and principal informal carers expect from a home-care team is sparse. We aimed to elucidate this as well as evaluate a home-care team. PATIENTS AND METHODS: Individual semi-structured interviews with nine patients and six carers before receiving home care and 2-4 weeks after. In total, 26 interviews were conducted. Interviews were analysed with Template Analysis. Peer debriefing was performed. MAIN RESULTS: Patients and carers expected the team members to have specialised knowledge in palliative care and to improve their sense of security being at home. They also expected respite for carers and activities for patients. They evaluated the team positively but missed respite for carers and 24-h on-call service. CONCLUSIONS: Patients and carers found the home-care team essential to their sense of security being at home. Primary health care professionals must receive any necessary training outside patients' homes. Offering respite for carers and 24-h on-call service would be an improvement.

Adult↗
PubMed2005

Inter-rater reliability of explicit indicators of prescribing appropriateness.

OBJECTIVE: To assess the inter-rater reliability of 14 explicit indicators of appropriate long-term prescribing. METHOD: All available data required for the assessment of 59 long-term prescriptions started during a hospital admission for 25 patients were transcribed from the patients' medical records. These transcripts were presented in a standardised format and random order to four raters (two doctors and two pharmacists) who used the indicators to judge the appropriateness of each prescription. Debriefing interviews were held with each rater. An a priori level of acceptable agreement between the raters was set at a weighed kappa of 0.70. RESULTS: There was no apparent difference between pharmacists and doctors for all findings, so data were combined. Two indicators showed poor agreement, three showed moderate agreement, and nine showed substantial or near perfect agreement, exceeding a weighted kappa of 0.70. There was excellent positive agreement as to which prescriptions were judged appropriate by the indicators, but much worse negative agreement as to which prescriptions were judged to be inappropriate. In the interviews, the raters remarked on the difficulty of applying explicit indicators when they routinely made implicit judgements about data in the medical records. CONCLUSION: Nine of the indicators achieved the required level of reliability and the negative agreement levels showed that this was the area that required greater improvement in future developments of the indicators. Further work needs to be conducted to investigate ways of the improving instructions on how to make explicit judgements and reducing the need for implicit or subjective assessments.

Continuity of Patient Care↗
PubMed2005

Cross-cultural adaptation and validation of the Korean version of the EQ-5D in patients with rheumatic diseases.

OBJECTIVES: This study aimed to determine the cross-cultural adaptation and validation of the Korean version of the EQ-5D in rheumatic conditions. METHODS: Translation, back-translation and cognitive debriefing were performed according to the EuroQol group's guidelines. For validity, 508 patients were recruited and administered the EQ-5D, Short-Form 36 and condition-specific measures. Construct validity and sensitivity were evaluated by testing a-priori hypotheses. For reliability, another 57 patients repeated the EQ-5D at 1-week interval, and intra-class correlations (ICC) and kappa statistics were estimated. For responsiveness, another 60 patients repeated it at 12-week interval within the context of clinical trial, and standardized response mean(SRM) were calculated. RESULTS: The cross-cultural adaptation produced no major modifications in the scale. The associations of the EQ-5D with the generic- and condition-specific measures were observed as expected in hypotheses: the higher EQ-5Dindex and EQ-5D(VAS) scores, the better health status by generic- or condition-specific measures, and the better functional class. The ICCs were 0.751 and 0.767, respectively, and kappa ranged from 0.455 to 0.772. The SRM were 0.649 and 0.410, respectively. CONCLUSION: The Korean EQ-5D exhibits good validity and sensitivity in various rheumatic conditions. Although its reliability and responsiveness were not excellent, it seems acceptable if condition-specific measures are applied together.

Adult↗