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Biomedical subjects

N Rumsey

Publications and source records attributed to N Rumsey.

15 recordsLinked to original sources
PubMed2006

The psychosocial benefits of corrective surgery for adults with strabismus.

BACKGROUND: Few papers have addressed the psychological impact of strabismus in adults, with none comparing preoperative and postoperative data using standardised questionnaires relating surgical results and psychosocial outcomes. METHODS: 46 participants were seen at their 6 week preoperative and 3 month postoperative appointments. Standardised measures of anxiety and depression (Hospital Anxiety and Depression Scale), social anxiety (Derriford Appearance Scale), and quality of life (WHOQoLBref) were completed. RESULTS: Preoperatively, levels of depression were comparable to relevant population norms; however, levels of general anxiety were slightly raised and levels of social anxiety and social avoidance were significantly poorer than population norms. Surgery resulted in significant improvements in psychosocial adjustment with improvements on all study variables for the participant group as a whole. The non-diplopic group made more significant gains than the diplopic group. Approximately one third of study measures were significantly correlated with the objective measure of eye misalignment preoperatively dropping to only one variable postoperatively. Calculations involving the subjective measure of eye misalignment and study variables showed the opposite pattern with five variables achieving significance postoperatively. There were no clear sex or age effects apparent in the data. CONCLUSION: Strabismus surgery offers significant improvements to psychological and physical functioning.

Adolescent↗
PubMed2003

Psychosocial distress associated with disfiguring eye conditions.

PURPOSE OF STUDY: Visible disfigurement is associated with a range of psychosocial difficulties; however, the problems encountered by patients with eye conditions are under-researched. This study aimed to establish the extent and type of psychosocial distress in this patient population, and to explore the extent to which patients' needs are currently met. METHOD: Standardised measures (anxiety, depression, appearance-related distress, and quality of life) and a semistructured interview (exploring individual experiences and satisfaction with care) were administered to 153 consecutive attenders at outpatient eye clinics in three different hospitals. Responses were analysed using descriptive statistics, multiple regression, and cluster analyses. RESULTS: Between 10 and 49% of the patient sample scored unfavourably on standardised measures in comparison with normative values. Cluster analyses revealed that more distressed patients typically exhibited higher levels of anxiety, depression, social anxiety, self-consciousness, and social avoidance. Quality of life scores were also less favourable. Distressed patients felt less well informed, less involved in their treatment, and less well supported in the clinic setting. Variability within the sample was high; however, the effects of the cause and duration of the condition were not significantly related to distress. Clinic staff identified a variety of constraints to meeting patients' need, including patient numbers, the lack of appropriate training, and the lack of referral possibilities. CONCLUSIONS: A considerable proportion of patients with disfiguring eye conditions experience high levels of psychosocial distress. Several options exist for ways in which patients' needs might more effectively be met within the constraints currently facing care providers.

Adaptation, Psychological↗
PubMed2003

Exploring the psychosocial concerns of outpatients with disfiguring conditions.

OBJECTIVE: This study was undertaken to establish the extent and type of psychosocial need in outpatients attending for treatment for a variety of disfiguring conditions. METHOD: A total of 220 outpatients receiving treatment for burns, skin conditions or head and neck cancer, together with those seeking plastic surgery for other appearance concerns, completed standardised measures of anxiety, depression, social anxiety and quality of life. Participants also completed a semi-structured interview exploring individual concerns and satisfaction with care. RESULTS: A considerable proportion of the outpatients with disfiguring conditions experienced psychosocial difficulties, displaying raised levels of anxiety, depression, social anxiety and social avoidance and reduced quality of life. Levels of psychosocial distress were not well predicted by the severity of disfigurement. CONCLUSION: The psychosocial needs of these patients are not well met in the outpatient setting. Recommendations are made on how patients' concerns might be more effectively addressed.

Adult↗
PubMed2001

Psychological aspects of breast reconstruction: a review of the literature.

AIM: This paper critically examines the research literature relating to the psychological aspects of breast reconstruction. Particular attention is given to the role of specialist breast care nurses in supporting women faced with the decision of whether or not to opt for reconstructive surgery. BACKGROUND: Breast reconstruction is intended to offer psychological benefits (e.g. improvements to quality of life, body image, anxiety and depression) to women treated by mastectomy following diagnosis of breast cancer. METHODS: A literature search was carried out on the PSYCHINFO, MEDLINE and CINAHL databases using the terms "breast reconstruction", "mastectomy", "reconstructive surgery", "breast surgery", "breast implants", "transverse rectus adominis myocutaneous (TRAM) flap" and "Lat-dorsi". Further relevant articles were identified from the reference lists of papers detected by this literature search. Finally, proceedings of recent psychological and surgical meetings were scrutinized to identify any conference papers on this topic. FINDINGS: A thorough search of the existing literature revealed a lack of theoretically based studies examining breast reconstruction in terms of relevant psychological constructs, especially in relation to coping and decision-making. This review highlights the methodological flaws with much of the existing research in this area, in particular the reliance upon retrospective designs and the inappropriate use of randomised controlled trials. Suggestions are given for further research in this topical area. CONCLUSIONS: Existing research into the psychological aspects of breast reconstruction is limited and not sufficiently conclusive to inform changes to policy and the provision of care. More methodologically rigorous research is needed.

Adaptation, Psychological↗
PubMed1999

Specialist nurse counsellor interventions at the time of diagnosis of breast cancer: comparing 'advocacy' with a conventional approach.

Over recent years, specialist breast care nurses have become increasingly recognized as core members of any breast care team within the UK. Part of the role is to support patients at the highly stressful stage of receiving a diagnosis. This paper describes an 'advocacy' style of nurse counsellor intervention which aims to improve patients' preparation for, and involvement in, the diagnostic consultation and provides a framework for future counselling support. One hundred and three women undergoing surgery following diagnosis of breast cancer or a benign breast lump were supported using either this advocacy intervention or a more conventional model of care. The aim was to identify the most effective and appropriate method of intervening at this important stage. Assessment took place before surgery, with 2-week and 6-month follow-ups, and included the Hospital Anxiety and Depression Scale, Rotterdam Symptom Check List and semi-structured interviews addressing perceived quality of care, involvement in decision-making and psycho-social functioning. Whilst the results of many measures were similar for women in the two intervention groups, qualitative data support the implementation of the advocacy method by the breast care nurse.

Adaptation, Psychological↗
PubMed1998

Psychological aspects of cleft lip and palate.

In addition to the influences of family dynamics, educational and vocational factors on the social development and rehabilitation of CLP patients, psychological problems, such as lowered self-esteem and difficulties during social interaction, are also experienced by CLP individuals. As only 20 per cent of cleft teams world-wide carry out a psychological assessment for their patients, it is likely that the prevalence of psychological problems is higher than the literature suggests. To maximize the chances of a positive outcome in the care of cleft affected individuals, CLP patients who are concerned about their appearance or who experience psychosocial problems need to be identified by cleft teams. Interventions, such as counselling or social interaction skills training, should be offered in order that the patient's self-esteem and social self-confidence can be increased. Current research surrounding patient and parent satisfaction with cleft care suffers from several areas of methodological weakness.

Adaptation, Psychological↗
PubMed1997

Psychological outcomes amongst cleft patients and their families.

Our aims were to determine the psychological status of a sample of cleft lip and palate patients and their parents using standardised interviews and to assess subjects' satisfaction with cleft treatment. In all, 242 interviews of 112 patients and 130 parents were carried out in nine base hospitals used for cleft treatment. 73% (n = 38) of 15- and 20-year-old subjects felt their self-confidence had been very much affected as a result of their cleft. 60% of all 112 interviewed patients were teased about speech or cleft related features. A significant minority of 15-year-old subjects (23%, n = 7) felt excluded from treatment planning decisions. Despite high levels of overall satisfaction with cleft care, 60% (n = 78) of parents and 37% (n = 41) of interviewed patients made suggestions for improvements. No agreement between parent/child pairs for their satisfaction with clinical outcome of cleft related features was found using the weighted kappa statistic to determine the level of agreement. Differences between parents' and their child's satisfaction ratings for cleft related features were not statistically significant except for the ratings for 'lip' (P < 0.005) and 'teeth' (P < 0.05) for 15-year-old subjects (Wilcoxon signed rank sum test). Patients' views on planned treatment should therefore be independently sought from their parents' views, as no agreement was found within the groups for perceived satisfaction with clinical outcome. This study demonstrates the importance of identifying 'psychological outcome' as well as 'clinical outcome' in order to improve rehabilitation for cleft lip and palate patients. Seven families were referred for counselling for cleft-associated emotional problems as a result of this survey.

Adolescent↗
PubMed1997

Satisfaction with facial appearance among subjects affected by a cleft.

OBJECTIVE: This study examined the satisfaction of patients with clefting and their parents with facial appearance and how this alters with age. The relationship between satisfaction with appearance and psychosocial functioning was also examined. DESIGN: Prospective SETTING: Subjects were recruited for the study from nine hospital-based clinics. PARENTS, PARTICIPANTS: All subjects has some type of cleft and were 10, 15 or 20 years of age. In all, 111 subjects with clefting and 62 parents were included. MAIN OUTCOME MEASURES: Facial appearance was rated on a subjective ordinal scale of 1 to 7; psychosocial adjustment was measured with the Childhood Experience Questionnaire. RESULTS: Self-satisfaction with appearance among the 10- and 15-year-old subjects correlated with their psychosocial adjustment (p = .027). The 20-year-old subjects were, on average, significantly more satisfied with their appearance than the 10- and 15-year-olds (p = .009 and p = .012, respectively). However, some 20-year-old subjects remained greatly dissatisfied with aspects of their facial appearance. Subjects with visible anomalies were significantly more dissatisfied with their appearance than subjects with invisible anomalies (p = .035). The 15-year-old subjects were identified as being significantly more dissatisfied with appearance than their parents (p = .005). CONCLUSIONS: Subjects affected by a cleft with visible impairments are more dissatisfied with their facial appearance than are subjects with invisible impairments. Satisfaction with facial appearance among 10- and 15-year-old subjects with a cleft may be associated with their self-reported levels of psychosocial functioning. Measuring self-satisfaction with appearance may help to identify subjects at risk from adjustment problems.

Adaptation, Psychological↗
PubMed1996

An evaluation of the impact of social interaction skills training for facially disfigured people.

Facially disfigured people can experience significant psychological problems, commonly relating to difficulties in social interaction. The effect of social interaction skills workshops on the psychological well-being of 64 facially disfigured participants is described. Participants completed the Hospital Anxiety and Depression Scale (HAD), the Social Avoidance and Distress Scale (SAD) and an open-ended questionnaire, before a workshop and at 6 weeks and 6 months follow-up. The high levels of anxiety evident prior to the workshop fell significantly 6 weeks post-workshop (HSD = 1.297, P < 0.01) and remained significantly lower at 6 month follow-up (HSD = 1.563, P < 0.01). Similarly, SAD scores fell significantly at 6 weeks (HSD = 1.89, P < 0.05) and again at 6 month follow-up (HSD = 2.26, P < 0.01). 6 weeks post-workshop, participants reported feeling more confident in the company of strangers (HSD = -1.266, P < 0.01) and about meeting new people (HSD = -1.159, P < 0.01). This increase in confidence was maintained at 6 months (HSD = -1.068 and -1.042 respectively, P < 0.01 for both). 61% of those who experienced problems before the workshop reported a positive change in these situations. The potential of these workshops as an addition to surgical intervention is discussed.

Adaptation, Psychological↗
PubMed1986

A developmental study of children's stereotyping of facially deformed adults.

A frequent complaint of facially deformed people is that they are rejected by others. This study was designed to examine whether negative reactions to facially deformed people would be demonstrated by girls and boys aged 5-11 years. The children were asked to attribute positive or negative characteristics to photographs in which adults were shown before and after minor oral surgery. Despite the relatively small differences in appearance between each adult's before- and after-operation photographs, it was found that, whereas overall the younger children selected faces at around chance level (i.e. 50 per cent), the 11-year-olds on 75 per cent of occasions selected in response to questions concerning friendliness and helping (deemed 'positive') the after-operation photographs, and in response to questions concerning fear and anger (deemed 'negative') the before-operation photographs. When the children's own judgements of facial attractiveness were related to the faces they had chosen in response to positive and negative questions, while again for the five-year-olds only chance responding (50 per cent) was observed, by age seven 75 per cent, and by age 11 90 per cent, of choices suggested facial stereotyping.

Beauty↗
PubMedDate not supplied

Factors implicated in the decision whether or not to join the tamoxifen trial in women at high familial risk of breast cancer.

Why, given similar medical circumstances-high familial risk of breast cancer-will some women elect to join a trial of drugs designed to reduce that risk but others choose not to take part? The aim of this study was to identify measurable differences between women who elect to join a placebo-controlled, double-blind randomised trial of the drug tamoxifen and women who elect not to join. One hundred and six women attending a breast care clinic completed questionnaires covering demographic details, health locus of control, perception of risk and adequacy of medical communication. All were eligible for inclusion in the tamoxifen trial. Only half (n=53) of the sample elected to join, the other half (n=53) declined. Those who declined the trial were significantly more aware of lifestyle factors thought to influence the development of cancers-diet, exercise and oestrogen-prolonging activities (p<0.001), and they also appeared to find the information given by the hospital about tamoxifen harder to understand than did the group who had joined the trial (p=0.01). They could think of significantly fewer positive reasons for joining (p<0.001) and were significantly younger (p=0.001). Participants in both groups significantly overestimated the relative risks of breast cancer. The average estimation of risk for women aged 30 with a family history of breast cancer was 22 times higher than that given by their consultant. This gives rise to considerable concerns about the information underpinning informed consent.

Adult↗