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PubMed2002

Working in clients' homes: the impact on the mental health and well-being of visiting home care workers.

The purpose of this paper is to examine the effects of working in clients' homes on the mental health and well-being of visiting home care workers. This paper reports the results of a survey of 674 visiting staff from three non-profit home care agencies in a medium-sized city in Ontario, Canada. Survey results are also complimented by data from 9 focus groups with 50 employees. For purposes of this study, home care workers include visiting therapists, nurses, and home support workers. Mental health and well-being is measured by three dependent variables: stress; job stress; and intrinsic job satisfaction. Multiple least squared regression analyses show several structural, emotional, physical, and organizational working conditions associated with the health and well-being of visiting home care workers. Overall, results show that workload, difficult clients, clients who take advantage of workers, sexual harassment, safety hazards, a repetitious job, and work-related injuries are associated with poorer health. Being fairly paid, having good benefits, emotional labour, organizational support, control over work, and peer support are associated with better health. Results suggest that policy change is needed to encourage healthier work environments for employees who work in clients' homes.

Adult↗
PubMed1993

Microbial composition and pattern of antibiotic resistance in subgingival microbial samples from patients with refractory periodontitis.

A series of 993 subgingival microbial samples sent to a diagnostic microbiology laboratory included 196 samples that could be identified as compatible with a clinical diagnosis of refractory or recurrent periodontitis. In descending order of prevalence the associated microbiota included Bacteroides forsythus (84%), spirochetes (83%), motile rods (76%), Fusobacterium species (68%), Porphyromonas gingivalis (63%), Campylobacter rectus (47%), Capnocytophaga species (38%), Prevotella intermedia (23%), Peptostreptococcus micros (18%), Actinobacillus actinomycetemcomitans (16%), Candida (14%), enteric rods (9%), Staphylococcus species, not including aureus (5.6%). Eikenella corrodens (3%), Staphylococcus aureus (1.5%), and Enterococcus species (< 1%). Antibiotic resistance to tetracycline, penicillin G, or metronidazole was particularly noticeable for enteric rods, Fusobacterium species, Capnocytophaga species, Staphylococcus, and Actinobacillus actinomycetemcomitans. It was largely absent for Campylobacter rectus. No antibiotic sensitivity data were obtained for Porphyromonas gingivalis or Bacteroides forsythus, as these species were detected by immunofluorescence. The results indicate that a substantial number of microorganisms associated with refractory periodontitis are variably resistant to commonly-used antibiotics. Diagnostic microbiology must be considered an essential adjunct to the therapist faced with periodontal lesions refractory to conventional treatment.

Adult↗
PubMed1993

Issues in assessment of psychosocial components of function.

For occupational therapy to provide a holistic view of meaningful activity, we must understand the relationship between physical, psychological, and social variables, especially as they affect our psychosocial evaluations and treatment. Existing definitions of psychosocial variables are unclear and, for occupational therapy practice, must be linked to activity and occupational performance. Occupational therapists need to become more educated about the uses and limitations of psychosocial instruments and to develop new instruments that address the central tenets of occupational therapy by focusing on whether or not a person is able to do what is necessary and fulfilling. Further, understanding what is meant by meaningful activity and what people need to accomplish it will advance our effectiveness in occupational therapy assessment and practice.

Activities of Daily Living↗
PubMed1980

Allergic contact dermatitis from oxygen cannulas.

A patient experienced allergic contact dermatitis on two occasions two months apart as a result of wearing the same brand of polyvinyl chloride oxygen cannula. In one instance the cannula was removed and not replaced, as continuing oxygen was unnecessary; on the other occasion the original cannula was replaced by a cannula of another brand. In both cases the dermatitis disappeared after removal of the original cannula. The reaction was probably to a resin remaining in the polyvinyl chloride after the curing process in the manufacture of the plastic from which the cannula was made. Allergic reactions to plastics have been documented in other medical products but have not previously been reported in respiratory therapy plastic appliances. Because of variability in residual resins in different brands and batches of plastics, and because of varying individual sensitivity, therapists and others should be alert to the possibility of allergic contact dermatitis from respiratory therapy devices.

Delaware↗
PubMed2003

Self-disclosure in psychoanalytic-existential therapy.

This article is an effort to integrate contemporary psychoanalytic and existential perspectives on intentional therapist self-disclosure. It offers a two-stage decision-making model that considers self-disclosure from the vantage points of style and internalization. Clinical and research findings are presented to support the notion that the meanings a patient attributes to a particular self-disclosure, and its power to move him or her towards greater health, is the product of a fluctuating matrix of interpersonal and intrapsychic variables. Special consideration is given to the challenges that arise during the early and termination stages of treatment and to the psychotherapy of therapists.

Decision Making↗
PubMed2002

The active movement scale: an evaluative tool for infants with obstetrical brachial plexus palsy.

Newborns with peripheral nerve lesions involving the upper extremity are difficult to evaluate. The reliability of the Active Movement Scale (AMS), a tool for assessing motor function in infants with obstetrical brachial plexus palsy (OBPP), was examined in 2 complementary studies. Part A was an interrater reliability study in which 63 infants younger than 1 year with OBPP were independently evaluated by 2 physical therapists using the AMS. The scores were compared for reliability and controlled for chance agreement by using kappa statistics. Overall kappa analysis of the 15 tested movements showed a moderate strength of score agreement (kappa = 0.51). Quadratic-weighted kappa (kappa(quad)) statistics showed that 8 of the 15 movements tested were in the highest strength of agreement category (kappa(quad) = 0.81-1.00). Five movements showed substantial agreement (kappa(quad) = 0.61-0.80), and 2 movements had moderate agreement (kappa(quad) = 0.41- 0.60). The overall kappa(quad) was 0.89. Part B was a variability study designed to examine the dispersion of scores when infants with OBPP were evaluated with the AMS by multiple raters. Ten pediatric physical therapists with varying degrees of experience using the scale attended a 1(1/2)-hour instructional workshop on administration of the tool for infants with OBPP. A chain-block study design was used to obtain 30 assessments of 10 infants by 10 raters. A 2-way analysis of variance indicated that the variability of scores due to rater factors was low compared with the variability due to patient factors and that variation in scores due to rater experience was minimal. The results of part A indicate that the AMS is a reliable tool for the assessment of infants with OBPP when raters familiar with the scale are compared. The results of part B suggest that, with minimal training, raters with a range of experience using the AMS are able to reliably evaluate infants with upper-extremity paralysis.

Brachial Plexus↗
PubMed2004

Empowering respiratory therapists to take a more active role in delivering quality care for infants with bronchiolitis.

BACKGROUND: Cincinnati Children's Hospital Medical Center developed a bronchiolitis-treatment guideline and implemented a program, led by respiratory therapists, to encourage the use of respiratory function assessment to determine the need for and effect of bronchodilator treatment of infant bronchiolitis patients. METHODS: The program was implemented on January 14, 2002, and included (1). a revised respiratory scoring form, (2). a change in the respiratory score threshold for a recommendation of bronchodilator treatment, (3). establishment of multidisciplinary rounds, (4). providing current data to the respiratory therapists, and (5). increasing effective data-based communication between the respiratory therapists and physicians. Guideline-eligible patients admitted before the implementation of the program (between 12/1/01 and 1/13/02) were compared to patients admitted during the program (between 1/14/02 and 3/31/02). We compared the mean numbers of bronchodilator treatments per patient in fiscal years 2001 and 2002. We defined "perfect respiratory care" as administration of bronchodilator only if preceded by suction treatment that resulted in a post-suction respiratory score >or= 3. RESULTS: Documentation of respiratory scoring significantly increased following implementation of the program, as did "perfect respiratory care." Between the 2001 and 2002 bronchiolitis seasons, there was a decrease in both the mean number and the variability in the number of bronchodilator doses administered. CONCLUSIONS: Expanding guideline recommendations to the level of specific protocols and empowering respiratory therapists to take a more active role improve the quality of care for infant bronchiolitis patients.

Algorithms↗
PubMed1980

Predicting the outcome of psychotherapy. findings of the Penn Psychotherapy Project.

Our study of predictability of outcomes of psychotherapy used predictions of two kinds: (1) direct predictions by patients, therapists, and clinical observers; and (2) predictive measures derived from the same sources. Seventy-three nonpsychotic patients were treated in psychoanalytically oriented psychotherapy (mean, 44 sessions). Two thirds of the therapists were residents in psychiatry; one third were more experienced. The two main composite outcome measures, measured at termination, were Raw Gain (residualized) and Rated Benefits, which intercorrelated at .76. Most patients improved and showed a considerable range of benefits. The clinical observers' direct predictions of Rated Benefits were highest (.27, P less than 905). The success of the predictive measures were generally insignificant, and the best of them were in the .2 to .3 range meaning that only 5% to 10% of the outcome variance was predicted. The Prognostic Index Interview variables did the best (eg, emotional freedom composite, .30; a crossvalidation for 30 patients was .39 (P less than .05). Neither the therapist measures nor the early psychotherapy session measures predicted significantly. Reanalysis of the similar Chicago Counseling Center study, in our terms, showed a similar low level of prediction success, eg, adequacy of functioning, marital status match, and length of treatment predicted significantly in both studies.

Adolescent↗
PubMed2001

Centralization phenomenon as a prognostic factor for chronic low back pain and disability.

STUDY DESIGN: Two hundred twenty-three consecutive adults with acute low back pain with or without referred spinal symptoms were treated conservatively and followed prospectively for 1 year. OBJECTIVES: To investigate the predictive value of centralization phenomenon (CP) with psychosocial variables previously identified as important risk factors for patients with acute onset of nonserious or nonspecific low back pain who subsequently develop chronic pain or disability. SUMMARY OF BACKGROUND DATA: Psychosocial factors have been shown to be predictors of chronic disability, but measures from physical examination rarely predict chronic behavior. The authors of the present study investigated whether dynamic assessment of changes in clinical measures during treatment could be used to classify patients and predict occurrence of chronic pain or disability. METHODS: Patients with acute symptoms and no history of surgery were treated by five physical therapists trained in McKenzie evaluation/treatment methods. Seventy-three percent were receiving workers' compensation benefits. At initial evaluation and discharge, 23 independent variables were assessed representing psychosocial, clinical, and demographic factors. Pain location changes to repeated trunk movements were assessed at every visit. Patients were placed in two groups: 1) those with pain that did not centralize and 2) those who completely centralized or demonstrated partial reduction of pain location with time. Treatment was individualized and based on McKenzie methods. Patients were contacted at 12 months after discharge, and dependent variables of pain intensity, return to work status, sick leave at work, activity interference at home, and continued use of health care were assessed. RESULTS: Nine independent variables influenced pain symptoms or disability. Pain pattern classification (noncentralization) and leg pain at intake were the strongest predictive variables of chronicity. CONCLUSION: Dynamic assessment of change in anatomic pain location during treatment and leg pain at intake were predictors of developing chronic pain and disability.

Adult↗
PubMed1982

Predicting psychotherapy duration from therapists' sex, professional affiliation, democratic values, and community mental health ideology.

Analyzed therapists' scores on the Community Mental Health Ideology (CMHI) and Democratic values scales and their sex and professional affiliation to predict the number of psychotherapy visits of 166 outpatients. A step-wise multiple regression indicated that all variables taken together accounted for 3% of the variance in treatment duration. A four-way analysis of variance revealed only a significant main effect for the CMHI scale. Thus, low-scoring CMHI therapists had significantly more therapy sessions with their clients than high-scoring CMHI therapists. The latter may emphasize briefer treatment approaches that stress outside resources and primary prevention.

Attitude of Health Personnel↗
PubMed1975

Self-disclosure in group therapy with schizophrenics.

Self-disclosure was investigated as a process variable in group psychotherapy with chronic schizophrenic patients. Consistent with previous data obtained from nonpsychotic populations, greater perceived therapist interpersonal facillitativeness was associated with higher levels of patient self-disclosure. In contrast to earlier findings, however, patients who were more self-revealing made less therapeutic progress than their counterparts who divulged less personal material. This failure to replicate was tentatively attributed to the limited ability of psychotic persons to integrate social feedback. The results underscore the delicacy of the psychotherapeutic undertaking with schizophrenics.

Adult↗
PubMed1982

Providing sexual information to ostomy patients.

Forty patients with a permanent colostomy, ileostomy, or ileal conduit were interviewed. Besides changes in sexual performance postoperatively, the authors specifically attempted to determine answers to other sexual variables such as attractiveness, appliance problems, and partner reactions. The extent of information provided to patients on sexuality prior to the permanent ostomy was also examined. There was a significant but predictable incidence of male impotence and female dyspareunia after surgery. Despite innumerable sexual variables, other than performance, which these patients faced postoperatively, 42 per cent received no information regarding sexuality at the time of ostomy surgery. most patients (97.5 per cent) stated that sexuality, including variables other than performance, should be discussed primarily by the surgeon prior to permanent ostomy surgery. The enterostomal therapist has an important role in the total patient adjustment in the long-term postoperative period.

Adaptation, Psychological↗
PubMed2001

Concluding causation from correlation: comment on Burns and Spangler (2000).

This commentary critiques the study conducted by D. D. Burns and D. Spangler (2000) in which the relationship between homework compliance and therapy outcome was estimated using structural equation modeling (SEM). Although the authors of the commentary advocate the use of SEM, they suggest greater caution in the indiscriminate endorsement of a causal relationship based on (a) correlational data and (b) retrospective accounts of the main predictor variable within a cross-sectional design. This discussion also highlights a need to address the issue of therapist competence in homework administration. The results of Burns and Spangler's report are consistent with existing empirical evidence suggesting that compliance with homework facilitates therapeutic outcome. However, the gold standard for determining causal inferences rests on prospective, experimental research rather than on retrospective, correlational models.

Humans↗
PubMed2002

Comparison of two methods for teaching therapists to score the test of infant motor performance.

PURPOSE: This study compared the effectiveness of a CD-ROM self-study program with a workshop and scoring videotapes as methods for learning to score the Test of Infant Motor Performance. METHODS: Twenty-three therapists participated. Subjects in the videotape group (N = 11) were trained by attending a four-hour workshop and scoring 14 training videotapes, whereas subjects in the CD-ROM group (N = 12) used a CD-ROM self-study program. All subjects scored four videotapes for rater reliability analysis after completing the training procedures. Student t tests were used to compare the means of the two groups on three reliability variables (percentage of aberrant ratings, rater consistency, and rater severity) obtained from Rasch analysis and to compare average time spent on learning. RESULTS: Seven therapists (58.3%) in the CD-ROM group and six (54.5%) in the videotape group met the preestablished criteria for achieving satisfactory rater reliability. No statistically significant difference between learning methods was found in percentage of aberrant ratings or rater consistency, but raters in the videotape group were more lenient in scoring than those in the CD-ROM group. The CD-ROM group spent significantly less time learning than the videotape group. CONCLUSIONS: Therapists can learn how to score the Test of Infant Motor Performance by using the CD-ROM self-study program in about half the time and with similar reliability when compared with a workshop and videotape practice training procedure. About 40% of therapists will need more training to attain acceptable rater reliability.

Journal Article↗
PubMedDate not supplied

Working with adult homicide survivors, part II: helping family members cope with murder.

TOPIC: The process of coping with the murder of a loved one and ways in which therapists may assist homicide survivors in the aftermath. PURPOSES: To identify coping strategies used by homicide survivors, describe variables that may affect the grieving process, discuss treatment strategies related to posttraumatic stress and complicated mourning within the framework of outcome-oriented nursing process, and explore the concept of posttraumatic growth. SOURCES: Review of the literature and the author's own clinical work. CONCLUSIONS: Coping with the aftermath of murder is a difficult and long-lasting process. While no one method or strategy for assisting homicide survivors works for everyone, a combination of therapeutic approaches-including crisis intervention, individual, family, and group therapy, peer support groups, pharmacological-that may assist the survivor in working through the trauma and grief of such a violent loss.

Adaptation, Psychological↗
PubMed1996

Onset conditions for psychological and psychosomatic symptoms during psychotherapy: a new theory based on a unique data set.

OBJECTIVE: The author's goal was to evaluate theories of the conditions that exist before onset of psychological and somatic symptoms by assessing these preconditions clinically and quantitatively. METHOD: He assembled a set of texts from the cases of seven patients who had recurrent psychological or somatic symptoms and examined the segments of texts that came before the symptoms occurred; he then compared these segments with segments of text that occurred before control points in the same case. The recurrent psychological symptoms were momentary forgetting, shifts in level of depression, and phobic behavior; the recurrent somatic symptoms were stomach ulcer pains, migraine headaches, absence epilepsy (petit mal) episodes, and premature ventricular contractions of the heart. RESULTS: 1)Independent ratings of presymptom segments compared with precontrol segments revealed some significant differences in all seven cases. 2) Some variables that distinguished the presymptom from the precontrol segments occurred in all of the cases. In rank order of their effect size across cases, these variables were hopelessness, lack of control, anxiety, feeling blocked, helplessness, concern about "supplies," depression, and hostility toward the therapist. For example, hopelessness was significant in seven of the seven cases. CONCLUSIONS: For the first time, segments of texts of psychotherapy sessions that occurred before recurrent symptoms have been assembled and analyzed. These brief segments before recurrent symptoms showed more of certain qualities than did segments before control points where no symptoms appeared. On the basis of these results the author constructed a new symptom-context theory of symptom formation and compared this new theory with five classical theories of symptom formation, drawing implications for research and for treatment techniques.

Depressive Disorder↗
PubMed2006

Effects of therapeutic touch on blood hemoglobin and hematocrit level.

BACKGROUND: Therapeutic Touch (TT) is a widely used complementary therapy. This study investigated the effects of TT on hemoglobin and hematocrit level in students who were basically healthy. METHOD: The volunteers with a hemoglobin level less than 12 grams per deciliter (g/dl) were randomly assigned to three groups of TT, mimic therapeutic touch (MT), and control. Blood samples were collected before the first treatment and again a week after the last one and measurements were taken. RESULTS: TT increased the level of hemoglobin (.99 .13 g/dl) and hematocrit (2.82 .43%) significantly. MT also increased the level of hemoglobin (.55 .11 g/dl) and hematocrit (2.75 .44%) significantly. No significant changes were found in the control group. TT increased hemoglobin more effectively than MT (p< .05). CONCLUSIONS: Significant changes of both variables in TT and MTgroups suggest that more careful precision might be needed while selecting individuals as sham therapists in further experiments.

Adult↗
PubMed1976

Field work experience ratings and certification examination scores as predictors of job performance and satisfaction in occupational therapy.

The American Occupational Therapy Association's certification instruments, the Certification Examination for Occupational Therapists Registered and the Field Work Performance Report, were examined in terms of their ability to predict future job performance and satisfaction of occupational therapists. A job satisfaction questionnaire was administered to 208 occupational therapists, and their supervisors rated them on a job performance instrument. The resulting correlations between these work adjustment variables and the previously administered certification instruments failed to reveal any predictive ability. Some plausible reasons for these negative results and possible directions for further research into this professional screening process were explored.

Certification↗