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PubMed2002

A first survey. Measuring burnout in emergency medicine physician assistants.

Using the Maslach Burnout Inventory (a device used in prior studies on emergency physicians) and the EMPA Demographic, Work, and Lifestyle Characteristics Survey, we assessed the burnout levels of emergency medicine physician assistants (EMPAs) and the presence of characteristics associated with higher burnout levels. Fifty-nine percent had moderate or high burnout levels on the Emotional Exhaustion subscale; 66% on the Depersonalization subscale; and only 34% on the Personal Accomplishment subscale. Several associations were found between EMPA burnout and individual characteristics, including insomnia and low satisfaction with physician supervision. Similarities were noted with regard to burnout among EMPAs and emergency physicians.

Adult↗
PubMed1999

[Predictors of nurses' professional burnout: a study in a university hospital].

This study was designed to examine the level of burnout and to identify stressor among nurses in a teaching hospital. Based on a sample of 625 nurses, results show that burnout levels are moderate (M. = 24.3, SD = 9.3) and comparable to those observed in physicians (M. = 26.6, SD = 9.8) and in the administrative staff of the same hospital (M. = 25.1, SD = 11.9). Multiple regression analyses selected 11 predictors significantly associated with burnout. Some contributed positively to burnout (job strain, lack of social support, conflicts with other nurses, conflicts with physicians, presence of stressors related to private life, feeling that the job is threatened, full-time vs. part-time status), whereas others contributed negatively (perceived job control, hierarchical level, death and dying of patients, feeling protected against occupational hazards). It is worthy of noting that leadership dimensions were not significantly related to burnout, once stressors were included in the regression model. We also tested Karasek's (1979) model, according to which job demands interact with perceived job control in influencing burnout. For example, the worst situation is one in which job demands are high and perceived control is low. This is defined as a high-strain job. The results from this study confirm that perceived control reduces the effect of job strain on burnout. This suggests that if job strain is high, managers can reduce its effect by providing nurses with opportunities to control their work environment and relations with patients. Results also demonstrate that burnout is negatively correlated with job satisfaction and perceived unit effectiveness. Managers should invest in prevention programs, since burnout is as deleterious to individuals as to the organization. A limitation of this study is its focus on emotional exhaustion which is known to be the first step of the burnout process. Future research should examine whether the predictors identified here would also be relevant for explaining further stages of the burnout process, such as depersonalization and reduced personal accomplishment.

Adult↗
PubMed2002

Recovering from cardiac surgery: what patients want you to know.

BACKGROUND: Care of cardiac surgery patients has changed substantially in the past decade, with an emphasis on streamlined procedures and shortened hospital stays. The few qualitative reports of patients' perspectives of this experience focus primarily on physical complications and discomforts during the immediate postoperative period. OBJECTIVE: To examine patients' perceptions of the quality of the nursing and medical care they received during their hospital stay after cardiac surgery. METHODS: Data were collected from a consecutive sample of 89 cardiac surgical patients who consented to participate in 2 telephone interviews at 1 week and 6 weeks after hospitalization. Patients responded to a single open-ended question: "What do you want your nurses and doctors to know to help them do a better job?" Thematic extraction analysis of patients' responses was conducted by using commercially available statistical software. Extracted themes were applied to the structure-process-outcome framework of quality of care. RESULTS: Four major themes (and 12 subthemes) were identified: (1) being satisfied (having a positive experience, getting information), (2) not being cared for (feeling depersonalized, having expectations that did not match recovery experiences, not being listened to, experiencing unprofessional behavior by care providers, experiencing continued care needs after going home), (3) physical needs unmet (sleep, pain, complications, physical environment), and (4) informational needs unmet (needing more or different information). CONCLUSIONS: Patients want nurses and doctors to provide a smooth transition to home, recognize the patients as individuals, prepare them honestly for their experiences with specific information, and manage pain and sleep.

Aged↗
PubMed2002

[Abnormal magnetic resonance imaging in a child with Alice in Wonderland syndrome following Epstein-Barr virus infection].

Characteristic pathologic changes of cranial computed tomography (CT) and magnetic resonance imaging (MRI) have never been reported in "Alice in Wonderland" syndrome (AIWS) caused by Epstein-Barr (EB) virus infection. We present here a 10-year-old girl with AIWS with an abnormal MR finding. During the course of serologically confirmed EB virus encephalopathy, she had distortion of the body image, visual hallucinations and depersonalization characteristic of AIWS. MRI demonstrated transient T2 prolongation and swelling of the cerebral cortex, especially at the bilateral temporal lobes, bilateral cingulate gyrus, right upper frontal gyrus, bilateral caudate nucleus, and bilateral putamen, whereas CT showed no abnormalities. Transient MRI lesions were occasionally reported in patients with EB virus encephalopathy/encephalitis who presented visual illusions and psychotic reactions, although the diagnosis of AIWS was not described. We consider that any patient with symptoms of AIWS should have MRI because the abnormal MRI findings may disappear in a short period.

Brain↗
PubMed2002

[Obligatory and facultative symptoms of the Alice in wonderland syndrome].

The Alice in Wonderland syndrome (AIWS), as described by Todd in 1955, denotes a variety of self-experienced paroxysmal body schema disturbances (obligatory core symptoms of the AIWS) which may co-occur with depersonalization, derealization, visual illusions and disorders of the time perception (facultative symptoms of the AIWS). The name comes, of course, from Lewis Carroll's 1865 novel "Alice's Adventures in Wonderland", which is believed to have been inspired by Carroll's own migraine experiences documented as early as 1856. Recent studies of the AIWS occurring as somesthetic migraine aura indicated that the body schema disturbance of macrosomatognosia most frequently affects the head and upper extremities, paralleling the extension of their representation in the human brain. As a misapprehension commonly encountered in the medical literature, it has been suggested to define the AIWS by the presence of visual rather than somesthetic perceptual disturbances, e.g. metamorphopsia and/or visual hallucinations, but this change and broadening of Todd's definition of the AIWS turns it to a both scientifically and clinically useless concept.

Hallucinations↗
PubMed2002

Prevalence and determinants of burnout among physical and occupational therapists.

It is generally speculated that the ongoing changes in the health care system may increase the incidence of burnout among health care providers. The purposes of this cross-sectional study were to determine (1) the prevalence of burnout among physical therapists (PTs) and occupational therapists (OTs), (2) sociodemographic and work-related factors associated with emotional exhaustion (EE), depersonalization (DP), and personal achievement (PA) traits of PTs and OTs. In fall 1998, 169 PTs and 138 OTs employed in various clinical settings in New York City completed the survey. Part I of the research questionnaire solicited sociodemographic and work-related information such as age, marital status, number of children (NC), religious affiliation (RA), exercise habits, level of support from supervisor (LSS), and level of support from colleagues (LSC). Part II of the questionnaire contained the Maslach Burnout Inventory (MBI). From the MBI, each subject's EE, DP, and PA scores were obtained. The data were analyzed with oneway analysis of variance and linear, multiple, and stepwise regression models to determine the relative and combined contributions of the independent (sociodemographic and work-related) variables toward predicting EE, DP, and PA. Overall the MBI scores revealed high (28.9 +/- 6.8) EE, high (18.3 +/- 4.7) DP, and low (18.0 +/- 7.0) PA. The contribution of sociodemographic and work-related variables toward the prediction of EE (26.7%), DP (12.8%) and PA (19.8%) was minimal. Of the 20 independent variables examined in this study, only 3 (LSS, NC and RA) were viable predictors of EE. The only viable predictor of PA trait was LSC. None of the variables examined accurately predicted DP trait. The EE, DP, and PA scores of the PTs and OTs in this study were higher than the norms reported in previous studies for the general population and other human service professionals, including PTs and OTs. The findings suggest the need for reorganization of the work environment to address the stressors responsible for burnout in this cohort of therapists.

Allied Health Personnel↗
PubMed2002

[Evaluation of stress factors and burnout in the emergency department staff].

INTRODUCTION: Burnout has been defined as a syndrome of emotional exhaustion, depersonalization, and 1 reduced personal accomplishment. The syndrome have been linked to high levels of absenteeism from work among professionals group. METHODS: We studied on 22 emergency service and 22 other health staff working at our Hospital. We investigated on health workers with burnout symptoms by the protocol was self-reported (using a poll). Also we used, Maslach Burnout Inventory in order to obtain as valid data as possible to assess the level of burnout. RESULT: 45.3% showed high levels of burnout on emotional exhaustion subscale, 32.~% on depersonalizaion subscale and 28.1% on personal accomplishment. Seven (31.82%) have been determined to be under serious. stress based on the investigation in emergency services; where as 2 (9.09%) in other health services workers as well (t=1.903; p< 0.05 ). CONCLUSION: Burnout symptoms were more likely to occur in the emergency personnel than the other health service workers. Sharing experiences with family and friends and with other health staff who understand what health staffs do best, prevents burnout syndrome. KEYWORDS: Burnout, emergency services, stress.

Adult↗
PubMed2003

[Slow-progressive schizophrenia (actual problems of clinical appearance and systematics)].

Slow-progressive schizophrenia is a slow-progredient endogenous process characterized by a prevalence of either negative disorders which do not reach final stages as in a case of psychotic types, or positive symptom complexes showing affinity to psychopathological appearances of "borderline" level (obsessions, somatoform, dissociate, nonpsychotic affective disorders, over-value formations). The clinical systematics of slow-progressive schizophrenia is built on a model implying a prevalence of either negative or positive disorders. Respectively, in the terms of "negative" schizophrenia, there are disease variants featured by a predominance of basic manifestations of an endogenous process: slow-progredient simple, asthenic, and senestopathic schizophrenia. Positive schizophrenia following the pattern of pseudoneurosis is represented by the following variants: neurotic-like, hysteric, depersonalization, visceral neurotic, hypohondriac as well as reactive schizophrenia.

Diagnosis, Differential↗
PubMed2002

[Attitudes and beliefs of citizens of Montreal towards psychiatric patients living in a society].

In the past 50 years, new health policies all over the world have led to the introduction of rehabilitation and deinstitutionalization programs to overcome the depersonalizing effects of asylums. As a result, large numbers of former psychiatric patients are now living and working in society. The public's attitudes and beliefs about these former patients play a central role in their harmonious integration into the community. To find out more about these attitudes and beliefs, we interviewed a representative sample of the population of Montreal Island (n = 899). Our study indicates that a majority of respondents show a favourable attitude towards former psychiatric patients (in terms of recognizing their rights, accepting them in the workplace, creating warm relationships, etc.), but that people still entertain many negative beliefs (seeing mental illness as a deviation from the norm). The study interprets these ambivalent signs of tolerance and fear towards ex-psychiatric patients among Montrealers. An encouraging sign is that a trend towards greater acceptance seems to be emerging among young people in terms of both attitudes and beliefs.

Adult↗
PubMed1976

[Presence of the husband in the delivery room (author's transl)].

For the past 7 years a single delivery room was available for all patients in labour. Our unit delivers approximately 1200 babies yearly. It was therefore possible to encourage the husbands progressively to be present during the delivery of their wives. Almost one half of the husbands have since been present during the delivery of their wives. The majority of the couples responded positively to the offer of the husband's presence in the delivery room. 650 couples were extensively questioned following the experience and over 90% of these couples were happy with the experience. Doubtful husbands were advised to remain. Husbands with pronounced aversion against remaining in the delivery room were not persuaded to stay. The husbands had the possibility to leave the room for short breaks and to leave the room during examinations and procedures. Delivery room clothing was supplied. For the psychic benefit of the husband, the husband was kept busy with mild services. Presence of the husband during the actual delivery of the infant was always voluntary since there was no psychologic benefit to remain during the short anaesthesia used during delivery. In many cases husbands who had not even planned to remain stayed during the actual delivery and were very impressed. Late questioning after discharge from the hospital showed that almost all couples valued the experience as positive and planned to have the husband present for the next delivery. The presence of the husband during the delivery of his infant offers a chance for the additional humanization of obstetrics which appears to be very important because of the increasing danger of depersonalization of the labour and delivery process due to the new technology. Presence of the husband during the delivery in the hospital permits a partial return to the "idyllic" state of domicilary obstetrics.

Female↗
PubMedDate not supplied

[Schizophrenia and addiction: An evaluation of the self-medication hypothesis].

Despite the fact that most researchers acknowledge the high prevalence of comorbid substance abuse among schizophrenic patients, there is no common agreement regarding the etiology of this serious public health problem. At the center of this debate though, Khantzian's self-medication hypothesis has captured most of the attention. In the present literature review, the authors evaluate this hypothesis in the light of our current knowledge. Formulated in a clinical context, in reaction to the psychoanalytic interpretation of addiction as a pleasure seeking pathology, Khantzian's hypothesis holds that schizophrenic patients use psychoactive substances to relieve their symptoms. Properly understood, this conjecture presupposes that, with the relief of certain target symptoms, substance use would no more be a necessity. But in reality, the use of psychoactive substances usually leads to a general deterioration of the patients' condition. Pharmacodependent schizophrenic patients relapse more often, they are more frequently hospitalized, they show more violent behaviors, and they are more frequently homeless. In particular, the positive symptoms of these patients are generally exacerbated by the psychoactive drugs--with the possible exception of opiates. This observation is in lign with the fact that psychostimulants (cocaine, amphetamines), anesthesic dissociatives (PCP, ketamine) as well as hallucinogens (cannabis, LSD) are all known to exert psychotomimetic effects. As for negative symptoms, the reality is more complex. Preliminary results certainly suggest that stimulants (minor or major) relieve these symptoms, but in the case of the other psychoactive substances, empirical evidence remains fragmentary. Still, the properties of psychoactive substances invite to pay close attention, among the negative symptoms, to the cognitive deficits, the social inaptitudes and the hedonic deficits of these patients. Unsatisfied with the self-medication hypothesis, an increasing number of researchers hypothesize that schizophrenic patients abuse drugs in hope to relieve the negative affects (stress, depression) that commonly accompany their symptomatology. Interestingly, increasing data link these negative manifestations and substance abuse among schizophrenic patients. But these same data do not elucidate whether these manifestations are primary or secondary to drug abuse. For the moment, these findings must be replicated. Furthermore, it remains to be clarified what negative affect is involved here. Is it stress, anxiety or, as commonly thought, depression? Other paths aim in the direction of personality traits and dissociation. The first path is suggested by recent studies demonstrating that pharmacodependent schizophrenic patients differ from non-abusing schizophrenics in that their personality is characterized by traits such as sensation seeking and impulsivity. As for the second path, it is suggested by a recurrent observation in addictive medicine practice, that is: alcohol, cannabis, ketamine, LSD, opiates, PCP, all these substances can induce dissociative states (depersonalization, derealization, etc.). Surprisingly, most of the hypotheses advanced so far have been formulated without reference to neuroscience. However, from a biological perspective, substance abuse among schizophrenic patients appears paradoxical: while the positive symptoms of schizophrenia might involve an hyperactivity of the reward system, the drugs of abuse all seem to increase dopamine release in that same system. That very paradox further casts some doubt on the self-medication hypothesis. And it opens an alternative: schizophrenic patients might be biologically vulnerable to the rewarding effects of drugs abuse. On the therapeutic level finally, the authors argue that polypharmacy medications such as clozapine and quetiapine, known to act on the reward system preferentially to the extrapyramidal system and known to dissociate fastly from the dopamine-D2 receptor, could simplify clinical intervention.

Antipsychotic Agents↗
PubMedDate not supplied

Repairing damaged care.

These are times of great change and upheaval in health care. More and more people are uninsured, consumers and employers pay substantially higher health insurance premiums for care, there is a shortage of nurses, and doctors go on strike. And these facts don't take into account that hospitals are going bankrupt while searching for their roles in the 21st century, the population is aging, the growth of alternative and complementary health care, the biotechnology and genetics revolution, the depersonalization of health care, and the huge cutbacks in federal and state government funding of health care and other human services.

Delivery of Health Care↗
PubMed1992

[Transient psychogenic psychoses in servicemen].

To specify the clinical picture, criteria for differential diagnosis and for medicolegal estimation of transitory psychogenic psychoses, 26 servicemen admitted irresponsible in respect to the actions committed in a state of psychosis were examined. Responsible servicemen who committed crimes in a state of physiological affect (n-26) or at the moment of acute situational personality reactions (n-26) were examined as reference groups. It has been established that transitory psychogenic psychoses occurred in servicemen with a definite personality and mental disposition (inhibited pathocharacteristic features and phenomena of residual organic brain injury) in a chronic (from 3 to 12 months) psychotraumatizing situation of permanent ill treatment and humiliation, causing long sleep deprivation. 3 stages were distinguished in the development of psychosis: stage I (preneurotic) was partial mental disadaptation; stage II (neurotic) involved further development of the phenomena of partial disadaptation and was characterized by well-defined asthenoneurotic and depressive dysphoric syndromes and not infrequently by syndromes of autistic aggressive fantasies; stage III was complete mental disadaptation marked only by transitory psychoses. The latter stage was short-lived (commonly lasting several hours), characterized by psychotic depth and by unmarked phenomena of agitated depression and pathological interpretations. Psychogenic psychosis that occurred in the presence of the above symptoms manifested, as a rule, by a depressive raptus with severe psychomotor excitation, vital melancholy, fragmentary hyperquantivalent depressive delirium, and phenomena of deep depersonalization and derealization.

Adaptation, Psychological↗
PubMedDate not supplied

[Stress and nursing. Comparison of the levels of burnout between surgical departments and intensive care units].

Burnout is a state of workers of helping professions that results from a situation of work stress and is characterised by emotional exhaustion, depersonalization and low personal accomplishment. Burnout levels were measured in three nursing staffs: two of them working in intensive care units and one in a surgical department. The results show significant statistical differences between the two staffs of intensive care units. Such differences seem to be connected with the psychological climate evaluated in the units.

Burnout, Professional↗
PubMed1992

Burnout in hospital social workers who work with AIDS patients.

Fears of a future shortage of experienced social workers in the acquired immune deficiency syndrome (AIDS) field because of burnout prompted this study of 128 hospital social workers who work with AIDS patients. Results show that hospital AIDS social workers had slightly higher rates of emotional exhaustion and depersonalization on the Maslach Burnout Inventory but also felt a substantially higher level of personal accomplishment. Age, autonomy, and belonging to a support group explained 19 percent of the variance in burnout. Hospital administrators are urged to examine their administrative policies concerning these factors and to explore ways to preserve and enhance the most satisfying aspects of the work. Further research is encouraged to explore the relationship between young age and burnout and to better understand the factors that make AIDS work satisfying.

Acquired Immunodeficiency Syndrome↗
PubMed1992

[Neurotic symptoms of borderline patients: a case review study].

The author investigated neurotic symptoms of borderline patients by reviewing the clinical charts of twenty-six patients of longer than one year treatment period (8 men, 18 women; 23 patients with DSM III-R borderline personality disorder (BPD), 14 with schizotypal personality disorder (SPD), (11 BPD-SPD overlaps); age at the first contact: mean = 24.3 y. o., SD = 6.7 y. o.; treatment period: mean = 51 months, SD = 35 months). The diagnoses of the comorbid neurotic disorders were obsessive compulsive disorder: 5 cases (19% (BPD: 22%, SPD: 7%)), somatoform disorder: 5 (19% (BPD: 22%, SPD: 21%)), panic disorder: 4 (15% (BPD: 17%, SPD: 14%)), social phobia: 2 (8% (BPD: 9%, SPD: 7%)), dissociative disorder: 2 (8% (BPD: 9%, SPD: 0%)), and generalized anxiety disorder: 1 (4% (BPD: 4%, SPD: 7%)). The neurotic symptoms identified in the charts of the subjects were as follows; symptoms of social phobia: 11 cases (42% (BPD: 43%, SPD: 43%)) including 6 with anthropophobic symptoms (23% (BPD: 26%, SPD: 36%)), obsessive compulsive symptoms and diffuse and floating anxiety: 9 (35% (BPD: 39%, SPD: 38%)), panic attacks: 8 (31% (BPD: 35%, SPD: 36%)), conversion symptoms: 7 (27% (BPD: 30%, SPD: 21%)), dissociative episodes: 6 (23% (BPD: 26%, SPD: 7%)), depersonalization: 5 (19% (BPD: 22%, SPD: 14%)), multiple apprehensive expectations: 4 (15% (BPD: 17%, SPD: 14%)), derealization: 3 (12% (BPD: 13%, SPD: 14%)), hyperventilation attacks: 3 (12% (BPD: 13%, SPD: 7%)), and somatization: 1 (4% (BPD: 4%, SPD: 7%)). In short, 54% (BPD: 61%, SPD: 43%) of the subjects had comorbid neurotic disorders, and 92% (BPD: 91%, SPD: 93%) reported at least one, and 54% (BPD: 61%, SPD: 50%), more than two kinds of neurotic symptoms, though no specific symptom correlating with BPD or SPD diagnosis was found. These findings suggest that neurotic symptoms and neurotic disorders cannot be ignored as peripheral in the borderline symptomatology. By analyzing in detail the neurotic experiences, the author pointed out as their characteristics, ego syntonicity, deterioration of reality sense and symptomatic polymorphism, ambiguity and multiplicity (panneurosis). In the symptoms the author observed signs of defective personality functioning such as disavowal of reality, low anxiety tolerance, various forms of identity disturbances. The findings counted above, suggest that the borderline neurotic symptoms are more severe in nature than those of neurotics, and could be situated in between neurotic and psychotic levels of symptomatic severity. The results indicate that the neurotic experiences of borderline patients are, as a whole, deeply ingrained in the borderline psychopathology.

Adolescent↗
PubMedDate not supplied

[The stress index: proposed method for risk assessment of stress and burnout in health care settings].

To assess the risk from exposure to stress and burnout in health care workers, a pilot study was planned to compare and integrate the information based on the risk evaluation obtained through different parameters that can be quantified and elaborated to produce a numerical index, called the "Stress Index", and the subjective symptoms from the individual workers. For these purposes, three internationally validated questionnaires were administered: the Job Content Questionnaire, the State-Trait Anxiety Inventory and the Maslach Burnout Inventory. The study considered six different Units from three divisions of Internal Medicine of a large public hospital in Northern Italy, and a total group of 228 health care workers employed in the six units. The results showed an association between the Stress Index scores and the scores from the questionnaires. In particular, in the two units with the highest levels of the index, a significantly higher unbalance between job demand and decision latitude was observed, together with the highest levels of state and trait anxiety and of depersonalization, indicating higher burnout levels.

Burnout, Professional↗
PubMed1992

The grief response to mid-trimester fetal loss.

This descriptive study examines the grief response of mothers who experienced a fetal loss in the middle trimester of pregnancy. Twenty mothers who lost a baby through spontaneous abortion or perinatal death within 1 year participated in this study. Data were collected by mailed questionnaires. All characteristics typical of the grief response were identified, including despair, anger or hostility, guilt, loss of control, rumination, depersonalization, somatization, and death anxiety. Comparison of the study population to a group of parents who suffered the loss of a child and to a group of women who had suffered the death of a close relative demonstrated that the study group presented a grief response similar in nature and intensity to the two normative groups. This study supports previous studies that indicated the existence of grief after mid-trimester fetal loss. Replication of this study with a larger sample is recommended to further support these findings.

Abortion, Spontaneous↗