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John T Chibnall

Publications and source records attributed to John T Chibnall.

At least 19 recordsLinked to original sources
PubMed2007

An interdisciplinary expert consensus statement on assessment of pain in older persons.

This paper represents an expert-based consensus statement on pain assessment among older adults. It is intended to provide recommendations that will be useful for both researchers and clinicians. Contributors were identified based on literature prominence and with the aim of achieving a broad representation of disciplines. Recommendations are provided regarding the physical examination and the assessment of pain using self-report and observational methods (suitable for seniors with dementia). In addition, recommendations are provided regarding the assessment of the physical and emotional functioning of older adults experiencing pain. The literature underlying the consensus recommendations is reviewed. Multiple revisions led to final reviews of 2 complete drafts before consensus was reached.

Age Factors↗
PubMed2006

The relationship between measures of psychopathology, intelligence, and memory among adults seen for psychoeducational assessment.

This study assessed the relationship between symptoms of psychopathology and cognitive functioning in clients completing comprehensive psychoeducational assessments at a university-based outpatient mental health clinic. Seventy clients (36 women, 34 men, mean age=28.8) completed the Wechsler Memory Scale-Third Edition (WMS-III), Wechsler Adult Intelligence Scale-Third Edition (WAIS-III), and Minnesota Multiphasic Personality Inventory-Second Edition (MMPI-2). Partial correlations between the MMPI-2 clinical scales, WMS-III Index scores, WAIS-III Index scores, and WAIS-III IQ scores were not significant. Memory and Intelligence scores for clients with comorbid symptoms of depression and anxiety were comparable to scores for clients without comorbid symptomatology. Psychopathology factors accounted for 22% of the variance in the WAIS-III Full Scale IQ and 6.5% of the variance in the WMS-III General Memory Index. The results suggest that psychopathology as measured by the MMPI-2 may be minimally associated with intelligence and memory test performance in adults seen for psychoeducational assessment.

Adult↗
PubMed2006

Race differences in diagnosis and surgery for occupational low back injuries.

STUDY DESIGN: Population-based telephone survey in Missouri. OBJECTIVE: To examine the unique contribution of race to diagnosis and surgery rates in workers' compensation claimants. SUMMARY OF BACKGROUND DATA: Race differences in diagnostic specificity and rates of surgery may mediate documented differences in workers' compensation case management outcomes (treatment expenditures, disability ratings, and settlement awards) between African Americans and whites with low back injuries. PARTICIPANTS AND METHODS: African American (n = 580) and white (n = 892) workers' compensation claimants with single-incident low back injuries were interviewed regarding diagnoses and treatments received for their injury. Participants were, on average, 21 months after settlement. Analyses examined the association of race (controlling for clinical findings, legal representation, age, gender, and socioeconomic status) with diagnosis (herniated disc vs. regional backache) and surgery. Risk ratios for race were calculated. RESULTS: Whites were 40% more likely than African Americans to receive a herniated disc diagnosis. Of claimants with the latter diagnosis, whites were 110% more likely than African Americans to undergo surgery. CONCLUSIONS: Race differences in diagnosis and surgery may help to explain why African Americans, relative to whites, receive lower workers' compensation medical expenditures, disability ratings, and settlement awards.

Adolescent↗
PubMed2006

Cerebral blood flow changes during vagus nerve stimulation for depression.

Positron emission tomography (PET oxygen-15 labeled water or PET [15O]H2O) was used to identify changes in regional cerebral blood flow (rCBF) in response to acute vagus nerve stimulation (VNS) in four subjects with treatment-resistant major depression (TRMD). Four 90-s PET [15O]H2O scans were performed on each subject in an off-on sequence (2 VNS de-activated; 2 VNS activated). PET images were aligned, normalized for global uptake, and resampled to standard atlas space. Statistical t-images were used to evaluate change. VNS-induced increases in rCBF were found in the bilateral orbitofrontal cortex, bilateral anterior cingulate cortex, and right superior and medial frontal cortex. Decreases were found in the bilateral temporal cortex and right parietal area. Regions of change were consistent with brain structures associated with depression and the afferent pathways of the vagus nerve.

Adult↗
PubMed2006

Disability determination: validity with occupational low back pain.

UNLABELLED: Disability determination for occupational low back pain challenges indemnification systems because spinal pathoanatomy is weakly related to pain intensity and functional capacity, making judgments of disability vulnerable to such confounding factors as sociodemographic variables (eg, race, socioeconomic status). To assess the contribution of impairment, race, and socioeconomic status to disability ratings and post settlement functional status, the current study investigated 580 African American and 892 white workers' compensation claimants with occupational low back pain who were surveyed an average of 21 months after claim settlement. Results indicated that diagnosis, surgery, and medical costs (indicators of impairment) were associated with disability ratings at the time of case settlement. African American race was negatively associated with disability ratings and also with diagnosis/surgery and medical costs. Disability ratings, however, correlated only weakly with post settlement status at 21-month follow-up. The association between race and disability ratings suggests that inequities operate in disability determination. Furthermore, the relative lack of association between disability ratings and postsettlement status raises questions about the validity of disability determination for workers' compensation claimants with low back pain. PERSPECTIVE: Results demonstrated apparent racial/ethnic disparities in treatment and little association between disability ratings and post settlement status. Together, these results raise questions about social justice in the management of occupational back pain, as well as the validity of associated disability determination processes.

Adolescent↗
PubMed2006

Comparison of the Saint Louis University mental status examination and the mini-mental state examination for detecting dementia and mild neurocognitive disorder--a pilot study.

CONTEXT: The Mini-Mental State Examination (MMSE) is commonly used as a screening tool to detect dementia. However, it performs poorly in identifying persons with mild neurocognitive disorder. The Saint Louis University Mental Status (SLUMS) examination is a 30-point screening questionnaire that tests for orientation, memory, attention, and executive functions. OBJECTIVE: The objective of this study was to compare SLUMS and the MMSE for detecting dementia and mild neurocognitive disorder (MNCD) using Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV) criteria. METHODS: Patients at the Veterans' Affairs Geriatric Research, Education and Clinical Center, St. Louis, MO (N = 702) were clinically classified as having normal cognitive functioning, MNCD, or dementia based on DSM-IV criteria. The SLUMS and MMSE were administered for comparison. RESULTS: Mean age was 75.3 years (standard deviation: 5.5). Regarding education, 62.4% of the sample had at least completed high school and 30.6% had not. Sensitivity and specificity were calculated and receiver operator curves (ROCs) generated for SLUMS and MMSE as a function of diagnosis (MCND versus dementia) and education. Both the SLUMS and MMSE produced acceptable ROCs for the diagnosis of dementia, but the ROCs for SLUMS were better than the MMSE for the diagnosis of MNCD in both education groups. CONCLUSION: These results suggest that the SLUMS and MMSE have comparable sensitivities, specificities, and area under the curve in detecting dementia. Although the definition of MNCD is controversial, the authors believe that the SLUMS is possibly better at detecting mild neurocognitive disorder, which the MMSE failed to detect, but this needs to be further investigated.

Aged↗
PubMed2006

Clinical and social predictors of application for social security disability insurance by workers' compensation claimants with low back pain.

OBJECTIVE: The objective of this study was to identify clinical and social predictors of application for Social Security Disability Insurance (SSDI) in workers' compensation claimants with low back pain. METHODS: Archival and interview data were analyzed for 1372 Missouri claimants who were, on average, nearly 42 months postinjury. RESULTS: Two hundred sixty-five (19.3%) claimants were receiving SSDI (8.0%) or had applied for SSDI (11.3%). Logistic regression indicated that black race, older age, herniated disc diagnosis, surgery, and longer time since injury were associated with increased odds of SSDI. Higher preinjury wage, more education, and higher satisfaction with medical treatment and/or treatment by employer were associated with decreased odds of SSDI. CONCLUSIONS: Application for SSDI among claimants with occupational low back pain is associated with social factors like race, satisfaction, and socioeconomics as well as clinical factors like diagnosis and surgery.

Adolescent↗
PubMed2005

Effect of treatment success and empathy on surgeon attributions for back surgery outcomes.

This study examined the effect of conservative and surgical treatment success/failure on attributions by surgeons for low back surgical outcomes. It also examined empathy as a moderator of these attributions. Forty surgeons attributed surgical outcome in a hypothetical patient to physical and psychological factors. Results indicated that surgeons were less likely to attribute the cause of surgical failure to physical factors when the patient had already failed conservative treatment for low back pain. Surgeons also were more likely to attribute failed surgery, relative to successful surgery, to patient psychological factors. An interaction effect indicated that the latter difference was significant only when the patient had previously succeeded at conservative treatment. Empathy moderated this effect: empathic surgeons were less likely to see the failed surgery patient as psychologically culpable. This self-serving attributional style, as moderated by empathy, is discussed regarding its potential impact on patient care and physician judgment processes.

Adult↗
PubMed2005

Factor structure of the pain disability index in workers compensation claimants with low back injuries.

OBJECTIVE: To examine the factor structure of a telephone-administered Pain Disability Index (PDI) and the effects of race and sex on the PDI. DESIGN: Computer-assisted telephone interviews of a cohort with occupational low back injuries. SETTING: General community. PARTICIPANTS: Missouri workers compensation claimants (N=1329) with low back injuries. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: PDI, levels of pain severity, Social Security Disability Insurance status, and the Fear-Avoidance Behavior Questionnaire. RESULTS: Results for the total sample and by race/sex group indicated support for a 2-factor model of the PDI corresponding to voluntary activities (eg, social, occupational, recreational) and obligatory activities (eg, activities of daily living, eating, sleeping). Additional psychometric analyses of the voluntary and obligatory subscales indicated adequate reliability and construct validity overall and in each of the race/sex groups. African Americans reported more pain-related disability on both subscales than whites. Women reported more disability on the voluntary subscale than men. CONCLUSIONS: The results support use of the PDI as a bidimensional measure of pain-related disability, with strong psychometric properties. They also support its administration by telephone.

Adolescent↗
PubMed2005

Confirmatory factor analysis of the Pain Catastrophizing Scale in African American and Caucasian Workers' Compensation claimants with low back injuries.

Pain catastrophizing is an important cognitive construct that has been linked with many aspects of the pain experience, including pain intensity, emotional distress, pain-related disability, and pain behavior. The Pain Catastrophizing Scale (PCS), an instrument often used to assess this construct, reflects three aspects of catastrophizing: Rumination, Magnification, and Helplessness. Its factor structure, however, has never been examined in clinical samples of persons with occupational injury or as a function of race. In this study, exploratory and confirmatory factor analyses were used to examine the factor structure of the PCS in a large, racially diverse sample of Workers' Compensation claimants with low back injuries. Results indicated that a two-factor model of the PCS (Rumination and 'Powerlessness,' the latter a combination of the PCS Magnification and Helplessness scores) was the most parsimonious fit to the data, particularly in the African American sample. Future research in other clinical samples that include African Americans is needed to examine the stability of the results reported here.

Adaptation, Psychological↗
PubMed2005

Race and socioeconomic differences in post-settlement outcomes for African American and Caucasian Workers' Compensation claimants with low back injuries.

The purpose of this study was to predict post-settlement pain intensity, psychological distress, disability, and financial struggle among African American (n=580) and non-Hispanic Caucasian (n=892) Workers' Compensation claimants with single incident low back injury. The study was a population-based telephone survey conducted in three population centers in Missouri. Post-settlement outcomes were predicted from claimant demographics (race, age, gender); socioeconomic status (SES); diagnosis and legal representation; and Workers' Compensation resolution variables (treatment costs, temporary disability status, disability rating, settlement costs). Simultaneous-entry, hierarchical multiple linear regression analyses indicated that African American race and lower SES predicted higher levels of post-settlement pain intensity, psychological distress (general mental health, pain-related catastrophizing), disability (pain-related role interference), and financial struggle, independent of age, gender, diagnosis, legal representation, and Workers' Compensation resolution variables. The results suggest that African American race and lower SES-relative to Caucasian race and higher SES-are risk factors for poor outcomes after occupational low back injury. Mechanisms to explain these associations are discussed, including patient-level, provider-level, legal, and Workers' Compensation system-level factors.

Adolescent↗
PubMed2005

Psychological and religious coping strategies of mothers bereaved by the sudden death of a child.

The authors examined the associations of 3 types of psychological coping (task-based, emotion-based, avoidance), 2 types of religious coping (positive, negative), and their interactions with grief of 57 mothers bereaved by the sudden death of a child. Results indicated that mothers who use emotion-based coping report significantly higher levels of grief, whereas mothers who use avoidance coping report lower levels of grief. The interaction of task coping and positive religious coping was also associated with lower self-reported grief. The findings support the differential utility of various coping styles on mothers' grief reactions to the sudden death of a child.

Adaptation, Psychological↗
PubMed2005

Supportive-affective group experience for persons with life-threatening illness: reducing spiritual, psychological, and death-related distress in dying patients.

BACKGROUND: Attention to psycho-socio-spiritual needs is considered critical by patients with life-threatening illnesses and their caregivers. Palliative care interventions that address these needs--particularly spirituality--are lacking. OBJECTIVE: To evaluate the effects of an innovative program to address psycho-socio-spiritual needs in patients with life-threatening illnesses. DESIGN: A group intervention entitled Life-Threatening Illness Supportive-Affective Group Experience (LTI-SAGE) was developed for reducing patient spiritual, emotional, and death-related distress. SETTING/SUBJECTS: African American and Caucasian patients (n = 69) from two hospitals in St. Louis, Missouri, with life-threatening medical conditions (cancer; human immunodeficiency virus/acquired immune deficiency syndrome [HIV/AIDS]; geriatric frailty; liver, kidney, pulmonary, or cardiovascular disease) were randomly assigned to intervention or control groups. Intervention patients participated in a maximum of 12 LTI-SAGE groups over a 12-month period. Control patients received standard care. MEASUREMENTS: Outcome measures were depression symptoms, anxiety, spiritual well-being, and death-related emotional distress. RESULTS: After attrition, 51 (73.9%) patients completed the trial. At the end of the trial, after factoring in compliance, intervention patients had significantly fewer depression symptoms and death-related feelings of meaninglessness and significantly better spiritual well-being than did control patients. CONCLUSIONS: The use of the LTI-SAGE model for enhancing the end-of-life illness experience is promising.

Analysis of Variance↗
PubMed2005

Appetite assessment: simple appetite questionnaire predicts weight loss in community-dwelling adults and nursing home residents.

BACKGROUND: Anorexia-related weight loss can have devastating consequences on quality-of-life, morbidity, and mortality. Without a simple tool to evaluate appetite, health care providers often use inaccurate surrogates, such as measurement of energy consumption and nutritional risk, to reflect appetite. OBJECTIVE: We aimed to validate a simple tool for assessing appetite and predicting weight loss. DESIGN: This was a cross-sectional measurement study conducted on long-term care residents and community-dwelling adults. Construct validity of the 8-item Council on Nutrition appetite questionnaire (CNAQ) and its 4-item derivative, the simplified nutritional appetite questionnaire (SNAQ), were examined through correlation with a previously validated research tool: the appetite hunger and sensory perception questionnaire (AHSP). The length and complexity of the AHSP render it inefficient for clinical use. The sensitivity and specificity of the CNAQ and SNAQ to predict significant weight loss were calculated. RESULTS: Cronbach's alpha coefficients for the CNAQ were 0.47 (long-term care group) and 0.72 (community-dwelling group). In the long-term care group, the CNAQ correlated with the AHSP (r = 0.60, P < 0.001) and with the AHSP domains of taste (r = 0.47, P < 0.0001), hunger (r = 0.51, P < 0.0001), and smell (r = 0.53, P < 0.0001). The CNAQ showed sensitivities and specificities for 5% and 10% weight losses of 80.2 and 80.3 and 82.4 and 81.9, respectively. The SNAQ had sensitivities and specificities for 5% and 10% weight losses of 81.3 and 76.4 and 88.2 and 83.5, respectively. CONCLUSIONS: The SNAQ and CNAQ are short, simple appetite assessment tools that predict weight loss in community-dwelling adults and long-term care residents. The SNAQ is a 4-item derivative of the CNAQ and thus is clinically more efficient.

Adult↗
PubMed2005

Effect of acetaminophen on behavior, well-being, and psychotropic medication use in nursing home residents with moderate-to-severe dementia.

OBJECTIVES: To evaluate the effect of regularly scheduled administration of analgesic medication on behavior, emotional well-being, and use of as-needed psychotropic medications in nursing home residents with moderate-to-severe dementia. DESIGN: Randomized, double-blind, placebo-controlled, crossover trial. SETTING: Nursing-home based. PARTICIPANTS: Twenty-five nursing home residents with moderate-to-severe dementia. INTERVENTION: Participants received 4 weeks of acetaminophen (3,000 mg/d) and 4 weeks of placebo. MEASUREMENTS: Behavior and emotional well-being were assessed using Dementia Care Mapping, an observational method that quantifies time spent in behaviors across 26 domains (e.g., social interaction, unattended distress) and assesses emotional state while behaviors are being observed. Agitation was measured using the Cohen-Mansfield Agitation Inventory. As-needed psychotropic medication use was aggregated from medication logs. RESULTS: Participants spent more time in social interaction, engaged with media, talking to themselves, engaged in work-like activity, and experiencing unattended distress when they received acetaminophen than they did when they received placebo. Participants also spent less time in their rooms, less time removed from the nursing home unit, and less time performing personal care activities when they received acetaminophen. There were no effects on agitation, emotional well-being, or as-needed psychotropic medication use. CONCLUSION: Untreated pain inhibits activity in nursing home residents with moderate-to-severe dementia. Pain treatment in this group may facilitate engagement with the environment.

Acetaminophen↗