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PubMedDate not supplied

Perceived learning needs of patients with heart failure.

OBJECTIVE: To determine the perceived learning needs of patients with heart failure (HF) compared with identified needs by registered nurses (RNs). DESIGN: Descriptive, comparative. SETTING: Two midwestern hospitals: 1 community hospital and 1 that is part of a large, university-affiliated, integrated health care system. SAMPLE: A convenience sample of 84 adult patients with HF from left ventricular systolic dysfunction and 84 registered nurses. OUTCOME MEASURE: The Heart Failure Learning Needs Inventory, developed for this study, was used to rate 98 individual items divided into 8 subscales suggested in the Agency for Health Care Policy and Research (AHCPR) practice guidelines. The subscales include general HF information, psychologic adaptation to illness, risk factors, medications, diet, activity, prognosis, and signs and symptoms. RESULTS: Multivariate analysis of variance was completed. The patients perceived the subscales of general HF information, risk factors, medications, prognosis, and signs and symptoms as more important to learn than the RNs did (P <.05). Patients perceived diet information as less important to learn than the RNs did (P <. 05). There were no differences in the patients' and nurses' perceptions in the activity and psychologic subscales. The patients perceived all 8 subscales as more realistic to learn than the RNs did (P <.05). Although not in identical order, both groups ranked education related to medication and signs and symptoms as the 2 priority areas. Diet information was ranked eighth by the patients and third by the RNs. CONCLUSION: The findings are consistent with previous research supporting the overall trend that patients with HF perceived patient education to be more important and realistic to learn during hospitalization than the nurses did. Patients and nurses identified education related to signs and symptoms and medication as the 2 most important content areas. In comparison with the AHCPR clinical practice guidelines, the group of RNs studied would ascribe the additional category of signs and symptoms as essential content to be taught during hospitalization.

Adult↗

PubMedDate not supplied

Factors related to the quality of life in adolescents with chronic pain.

OBJECTIVE: This study examined the relationships between pain characteristics, psychosocial factors, and quality of life among adolescents with chronic pain that existed for at least 3 months, either recurrently (ie, pain with pain-free intervals) or continuously. METHODS: The authors conducted a cross-sectional study in 194 adolescents aged 12 to 18 years who completed questionnaires on pain, psychosocial factors (ie, vulnerability, reinforcement, modeling, and coping), and quality of life, and also kept a diary about their pain complaints for 3 weeks. RESULTS: Multiple hierarchical regression analysis revealed that psychosocial variables accounted for a significant variance in the adolescents' quality of life, even when controlling for pain characteristics. Analysis of the independent variables showed that pain intensity and vulnerability contributed significantly and uniquely to the variance of most quality-of-life domains. In addition, the authors found that emotion-focused avoidance coping strategies (ie, catastrophizing) strengthened the negative relation between pain intensity and psychological functioning. CONCLUSIONS: In addition to pain, psychosocial factors (vulnerability, reinforcement, modeling, and coping) are strongly associated with quality of life in adolescents with chronic pain. These results may contribute to psychological interventions focused on psychological adaptation in young pain patients to improve their quality of life.

Adolescent↗

PubMed1980

Achievement levels and mental health in medical students: a Monash University study.

An extensive battery of multi-choice psychology tests was administered to Monash Unversity medical students in 1975. Respondents were classified by sex, year and achievement level. Significant differences in parameters of psychological adaptation were detected when students in the three different achievement groups were compared. In general, the low achievers were more depressed and anxious, and less extroverted and empathic than their colleagues. In addition, their own assessment of their mental health was lower than that of their colleagues. They also tended to study less actively, were more prone to avoid the study of core material and derived less gratification overall from the medical course. It is suggested that underachievement in medical students is a danger signal connoting psychological difficulties and that under-achievers constitute a potentially under-counselled group. Counselling facilities should be sufficiently comprehensive to deal with the problems outlined as it is unlikely that this particular set of observations is unique to the group studied who happened to be medical students. The lesson is there for all faculties.

Achievement↗

PubMed1987

An animal model to examine the response to environmental stress as a factor in sudden cardiac death.

Sudden cardiac death is the leading mode of death in adults in the United States. While it appears intimately associated with coronary artery disease, the factors that render some subjects vulnerable to sudden cardiac death, while others with the same coronary disease do not die suddenly, are unknown. An approach is described which considers that sudden cardiac death represents a separate syndrome of coronary artery disease within certain vulnerable subjects. It is suggested that the response to psychosocial stress in vulnerable subjects results in deleterious cerebral cortical influences on the autonomic control of the heart which render it more vulnerable to ischemia-induced ventricular fibrillation. Studies in the pig, an animal known to be susceptible to sudden death resulting from an environmental stress, demonstrate that cerebral cortical influences on autonomic centers play a central role in vulnerability to ventricular fibrillation after coronary artery occlusion. In this model, the incidence of ventricular fibrillation can be reduced by psychologic adaptation of the animal to his environment, cryoblockade of frontal cortical brain stem pathways and by central administration of propranolol. The relative role of adrenergic and cholinergic innervation of the heart is an important consideration.

Animals↗

PubMed2003

Description of stable pain in rheumatoid arthritis: a 6 year study.

OBJECTIVE: To study pain quality and variability in patients with rheumatoid arthritis (RA). METHODS: Pain, disease activity, and functional status were assessed 3 times over 6 years in an initial cohort of 120 clinic patients with chronic pain from RA. A pain visual analog scale and the McGill Pain Questionnaire (MPQ) were used to record pain intensity and quality. RA disease activity and function were measured. RESULTS: There was no statistically significant difference in any measure over the 3 assessments. RA pain intensity was moderate. The MPQ showed that sensory components of the pain were described in terms of pressure and constriction. Pain related affect was described with adjectives suggesting positive psychological adaptation to pain. CONCLUSION: The results indicate a general profile of no change in pain sensation, affect, and emotional quality in clinic monitored patients with ongoing RA and ongoing, moderate levels of disease activity and function. The MPQ provides qualitative detail to patient's report of pain severity that could be a useful addition to longterm documentation of RA outcome. Regular MPQ documentation of current pain in outpatients could indicate whether any significant change in pain levels is reflected in altered word selection that reflects physiological or psychological change, and could assist clinicians to select the most appropriate form of therapy for RA pain.

Activities of Daily Living↗

PubMed1988

The hidden victims of AIDS: healthcare workers and families.

With the realization that acquired immune deficiency syndrome (AIDS) is an epidemic, the focus on prevention and treatment of the AIDS patients has intensified. However, there has been a lack of recognition of other potential victims. Specifically, little attention has been paid to the psychological impact of AIDS on healthcare workers who care for AIDS patients and on families of AIDS victims. In addition to confronting the premature dying of a young patient, both healthcare workers and families must confront their own conflicts regarding the stigmatizing nature of AIDS as it relates to the patient's sexuality or drug abuse. Failure to resolve these issues often serves as a major obstacle to the provision of effective medical care and prevents families from providing the essential emotional support that can help patients cope with their illness. Furthermore, failure to resolve family conflicts about the patient's life-style may significantly impair the grieving process and may lead to family disengagement and dissolution. The purpose of this paper is to review the literature on the impact of AIDS on healthcare workers and families, and to propose intervention strategies which will alleviate stress and facilitate appropriate psychological adaptation. "....this dreadful disease is not only killing young people in the prime of life and destroying their familial and social relationships. It is also damaging the bond between the care giver and the patient with AIDS as well."

Acquired Immunodeficiency Syndrome↗

PubMed1994

Alcohol withdrawal: an adaptation to heavy drinking of no practical significance?

Markedly differing views can be found among both clinicians and researchers regarding whether alcohol withdrawal is a phenomenon of any practical or theoretical importance. Evidence has mounted that alcohol withdrawal, even in a severe form, is rarely life-threatening and the great majority of cases can be managed in non-medical settings, including the home. There is also a widely held view among clinicians that withdrawal symptoms have little motivational significance and may be best regarded as but epiphenomena of prolonged heavy drinking. There are also experimental data from both human and animal laboratory studies to the effect that withdrawal symptoms do not readily trigger further alcohol consumption. Against this most unpromising background a case is presented for alcohol withdrawal being but one manifestation of important biological and psychological adaptive processes which occur almost whenever alcohol is consumed with any regularity. It is proposed that understanding this more general phenomenon is critical to a better understanding of the factors which maintain heavy and problematic drinking. Recent evidence also suggests that minor alcohol withdrawal symptoms are far more common in the general population than had previously been realized, and that this has important implications for prevention policy.

Alcohol Drinking↗

PubMed2003

[Etiology and pathogenesis of peptic ulcer].

PU is a disease having many etiologies. The psychological constitutional type, low psychological adaptability and vegetative imbalance are the main causes in the pathogenesis of the disease. Chronic and acute stresses lead to vegetative tone disturbance, immunological imbalance, reduced resistance to HP, hypercoagulation and local blood flow impairment, causing hemorrhage and necrosis in the mucous coat of the gastroduodenal area.

Animals↗

PubMed2004

["Phthisia-School": a complex action system for a patient with tuberculosis].

To make the outcomes of treatment in patients with tuberculosis better, a complex action system has been developed, by using the data obtained from studies of the clinical, psychological, and social characteristics. Four hundred and sixty four patients (211 new cases of tuberculosis and 253 with fibrocavernous tuberculosis) were examined. The examination was comprehensive and involved a package of psychological tests and a special questionnaire survey. Analysis of the results of the study made it possible to develop a complex action system for a patient with tuberculosis, which was called the "Phthisia-School". It includes the provision of positive information, regulated drug therapy, and a corrective package aimed at altering the patient's attitude towards to his/her disease, intent-to-treat development, enhancing systemic and psychological adaptation. There was a statistically significant increase in the efficiency of treatment, a tendency towards harmonization of the type of the patient's attitude towards his/her disease, a change in this attitude, treatment, personal hygiene rules, untraditional treatments, an increase in the discipline of treatment and confidence in good prognosis.

Adult↗

PubMed1995

The role of exercise in the patient with post-polio syndrome.

Recent studies have shown that judicious exercise can improve muscle strength, cardiorespiratory fitness, and the efficiency of ambulation in post-polio patients. It may also add to the patient's sense of well-being. These benefits appear to occur when the patients stay within reasonable bounds while exercising in order to avoid overuse problems. In particular, the patients should be instructed to avoid activities that cause increasing muscle or joint pain or excessive fatigue, either during or after their exercise program. The literature indicates that exercise within these constraints leads to a number of beneficial physiologic and psychologic adaptations in patients with post-polio syndrome. Judicious exercise should be viewed as important adjuvant in the overall therapeutic program of the patient. Patients seen in post-polio clinics frequently complain of new fatigue, weakness, muscle pain, and/or joint pain. The most frequent complaints involving activities of daily living include new difficulties with walking and stair climbing. The therapeutic benefit of exercise in these patients to minimize or reverse decline in function is an important question frequently asked by patients with post-polio syndrome. In the general population, physical activity is known to be an important adjunct to good health, bestowing both physiologic and psychologic benefits leading to a reduction in the risk to develop a number of serious ailments as well as leading to better psychological adjustment. On the other hand, limitation in physical activity results in a number of deleterious effects. Patients with post-polio syndrome have unique problems, however, which need to be considered when prescribing an exercise program for an individual patient. A number of functional etiologies for declining function have been hypothesized including disuse weakness, overuse weakness, weight gain, and chronic weakness. Because of the variability in which the motor neurons to different muscle groups may have been affected in a particular patient, both asymmetric and scattered weakness may be present. The challenge in prescribing exercise for the patient with post-polio syndrome comes in recognizing these unique factors in each patient and modifying the prescription accordingly. One must protect muscles and joints experiencing the adverse effects of overuse or body areas with very significant chronic weakness (in general, in areas where the muscles have less than antigravity strength on manual muscle testing) while exercising those body areas experiencing the deleterious effects of disuse. Weight gain is to be avoided if at all possible in this population, because increased weight only leads to further difficulty in the performance of daily activities.(ABSTRACT TRUNCATED AT 400 WORDS)

Activities of Daily Living↗

PubMed1996

Medical compliance and its predictors in the first year after heart transplantation.

BACKGROUND: Although poor medical compliance is a major risk factor for morbidity and mortality after heart transplantation, no prospective data are available on rates of noncompliance with each component of the posttransplantation regimen. Little is known about the impact of health history, sociodemographic, or perioperative psychosocial variables on long-term compliance. METHODS: Compliance in eight domains was examined in a cohort of 101 heart recipients followed through the first year after transplantation. Patients received detailed interviews at 2, 7, and 12 months after transplantation. Additional corroborative information was obtained from family member interviews and nurse evaluations. Potential predictors of noncompliance were obtained from medical record reviews and from initial patient interviews. Predictors pertained to cardiac-related history, psychiatric history, sociodemographic variables, and perioperative psychosocial status (psychologic adaptation, social supports, coping strategies). RESULTS: Although degree of noncompliance varied across timepoints, rates of persistent noncompliance during the year were as follows: 37% (exercise); 34% (monitoring blood pressure); 20% (medications); 19% (smoking); 18% (diet); 15% (having blood work completed); 9% (clinic attendance); and 6% (heavy drinking). Compliance in most areas worsened significantly (p < 0.05) over time. Background health-related and sociodemographic characteristics showed no significant influence on any area of posttransplantation compliance. Perioperative psychosocial characteristics were strong and significant predictors of noncompliance. CONCLUSIONS: Pretransplantation screening for background and demographic variables may have limited utility for compliance outcomes. Strategies to improve compliance should focus on psychosocial risk factors pertaining to early psychologic reactions to transplantation, the quality of family relationships, and patients' styles of coping. These risk factors are each potentially modifiable through appropriate educational and supportive interventions.

Adolescent↗

PubMed2005

Growth hormone treatment of short stature: status of the quality of life rationale.

The unlimited availability of biosynthetic human growth hormone (rhGH) has contributed to the disassociation of the treatment of short stature from its causes. The rationale for treatment has traditionally rested upon the assumption that short stature, in the extreme, may constitute a physical disability, and otherwise represents a significant psychosocial burden for the individual. This review summarizes what is known about the psychosocial aspects of short stature and the quality of life benefits of rhGH treatment. Stereotypes and assumptions about short stature are evaluated in light of empirical findings. Problems of psychosocial adjustment are relatively common in the general population. Because of the salience of short stature, and its potential to serve as a lightning rod to divert attention from other factors interfering with a healthy psychological adaptation, the clinician must be watchful of misattributions for ongoing problems, or unrealistic predictions of the benefits of taller stature. For these reasons, the clinician should consider incorporating a psychosocial component in the diagnostic evaluation to broaden potential treatment recommendations. Finally, studies of factors influencing family decisions regarding factors for and against rhGH therapy provide important clues to how clinicians might enhance the informed consent process.

Adolescent↗

PubMed1997

Measuring the quality of later life.

This paper examines quality of life as a scientific construct with a wide range of applications. The assessment of patients' quality of life is assuming increasing importance in medicine and health care. Illnesses, diseases and their treatments can have significant impacts on such areas of functioning as mobility, mood, life satisfaction, sexuality, cognition and ability to fulfil occupational, social and family roles. The emerging quality of life construct may be viewed as a paradigm shift in outcome measurement since it shifts the focus of attention from symptoms to functioning. This holistic approach more clearly establishes the patient as the centre of attention and subsumes many of the traditional measures of outcome. Quality of life assessment is particularly relevant to ageing populations both for healthy elderly and for those who develop chronic diseases where maintenance of quality of life rather than cure may be the primary goal of treatment. This paper introduces the concept of quality of life and describes the significant difficulties in definition, measurement and interpretation that must be addressed before such measures can be used as reliable and valid indicators of disease impact and treatment outcomes. It is argued that approaches to quality of life assessment in the elderly should incorporate advances in knowledge about the psychological adaptation to ageing. Consequently, the unique perspective of the individual on his or her own quality of life must be incorporated into outcome assessments aimed at improving the quality of health care. Incorporating measures of subjective outcome such as quality of life into policy decisions on resource allocation in health care will prove one of the major challenges for health services over the next decade.

Affect↗

PubMed1996

Prediction of psychological functioning one year after the predictive test for Huntington's disease and impact of the test result on reproductive decision making.

For people at risk for Huntington's disease, the anxiety and uncertainty about the future may be very burdensome and may be an obstacle to personal decision making about important life issues, for example, procreation. For some at risk persons, this situation is the reason for requesting predictive DNA testing. The aim of this paper is two-fold. First, we want to evaluate whether knowing one's carrier status reduces anxiety and uncertainty and whether it facilitates decision making about procreation. Second, we endeavour to identify pretest predictors of psychological adaptation one year after the predictive test (psychometric evaluation of general anxiety, depression level, and ego strength). The impact of the predictive test result was assessed in 53 subjects tested, using pre- and post-test psychometric measurement and self-report data of follow up interviews. Mean anxiety and depression levels were significantly decreased one year after a good test result; there was no significant change in the case of a bad test result. The mean personality profile, including ego strength, remained unchanged one year after the test. The study further shows that the test result had a definite impact on reproductive decision making. Stepwise multiple regression analyses were used to select the best predictors of the subject's post-test reactions. The results indicate that a careful evaluation of pretest ego strength, depression level, and coping strategies may be helpful in predicting post-test reactions, independently of the carrier status. Test result (carrier/ non-carrier), gender, and age did not significantly contribute to the prediction. About one third of the variance of post-test anxiety and depression level and more than half of the variance of ego strength was explained, implying that other psychological or social aspects should also be taken into account when predicting individual post-test reactions.

Adult↗

PubMedDate not supplied

Sibling self-report, parental proxies, and quality of life: the importance of multiple informants for siblings of a critically ill child.

Assessment of quality of life (QoL) has thus far been a neglected approach in describing psychological adaptation in siblings of seriously ill children. The present results concern differences and correspondences between parent- and child-reported QoL in siblings of pediatric cancer patients, at 1 month and 2 years after the diagnosis in the ill child. A total of 83 Siblings aged 7-18 participated in the study at 1 month after the diagnosis; 57 of these siblings (69%) participated in follow-up assessment 24 months later. The parent and child form of the TNO-AZL Children's Quality of Life questionnaire (TACQoL) and the Child Behaviour Check List (CBCL) and Youth Self-Report (YSR) were used to assess QoL and behavioral problems in siblings. The General Health Questionnaire (GHQ) was used to assess parent mental health. Mean differences, correspondences between informants, and partial correlations with parent mental health were assessed at both measurement occasions. Correspondence between parent and child was low to moderate for most domains at both assessments. Low agreement was observed on several domains in our study group compared to reference data. Young siblings (ages 7-11) reported significantly more physical and motor problems at 1 and 24 months and less positive emotions at 24 months than their parents. Adolescent siblings reported more physical complaints at 1 month and more emotional and behavior problems (YSR) at both assessments, but also reported higher social QoL than their parents at 24 months. Parent psychological distress was negatively correlated with parent-reported physical QoL in the sibling. The findings suggest that siblings of children with cancer experience a more serious burden from the illness than is perceived by the parents. Physical complaints and emotional problems remain mostly unnoticed, although distressed parents are more focused on the child's physical health. These results imply that assessment of self-reported well-being is especially relevant in siblings of a critically ill child, to obtain a realistic image of siblings' QoL. Further studies on sibling QoL are needed.

Adolescent↗

PubMed2001

Personality factors, stoicism and motivation in subjects under hypoxic stress in extreme environments.

Previous studies on the physiological and psychological adaptation of subjects to survival conditions involving high-altitude hypoxia (>6,500 m) have shown that personality factors are important in this adaptation. We, therefore, proposed personality traits assessments in two groups of subjects engaged in sporting activities under extreme hypoxic environmental conditions: a group of mountaineers at high altitudes (>5,500 m) and a group of free-lung divers at great depths (<30-60 m). These subjects were compared with two control groups: a group of subjects practicing no sport and another one practicing various competitive athletic activities involving speed constraints. The personality traits assessed concerned mainly the subjects' attitudes and their propensities to act out their feelings and fantasies; they were assessed using projective procedures, the Hand Test and Clark's Situational Pain Questionnaire based on the Sensory Decision Theory. Subjects trained in mountaineering and free-lung diving under extreme environmental conditions displayed a high degree of stoicism. These individuals shared some personality traits with other sportsmen, particularly aggressive tendencies and introversion although not to an extent which interfered with normal interpersonal relationships. However, at least when practicing these extreme sports, the subjects did retreat from society. One of our questions concerns the grounds for this social withdrawal, that is, whether it derives from a inner compulsion founded on personality factors or if it is merely an artifact of our perceptions of the subjects, created by the confluence of the individualistic nature of these sports and the extreme environments in which they are performed.

Acclimatization↗

PubMed2005

Prognosis and decision making in severe stroke.

CONTEXT: An increasing number of deaths following severe stroke are due to terminal extubations. Variation in withdrawal-of-care practices suggests the possibility of unnecessary prolongation of suffering or of unwanted deaths. OBJECTIVES: To review the available evidence on prognosis in mechanically ventilated stroke patients and to provide an overall framework to optimize decision making for clinicians, patients, and families. DATA SOURCES: Search of MEDLINE from 1980 through March 2005 for English-language articles addressing prognosis in mechanically ventilated stroke patients. From 689 articles identified, we selected 17 for further review. We also identified factors that influence, and decision-making biases that may result, in overuse or underuse of life-sustaining therapies, with a particular emphasis on mechanical ventilation. EVIDENCE SYNTHESIS: Overall mortality among mechanically ventilated stroke patients is high, with a 30-day death rate approximating 58% (range in literature, 46%-75%). Although data are limited, among survivors as many as one third may have no or only slight disability, yet many others have severe disability. One can further refine prognosis according to knowledge of stroke syndromes, early patient characteristics, use of clinical prediction rules, and the need for continuing interventions. Factors influencing preferences for life-sustaining treatments include the severity and pattern of future clinical deficits, the probability of these deficits, and the burdens of treatments. Decision-making biases that may affect withdrawal-of-treatment decisions include erroneous prognostic estimates, inappropriate methods of communicating evidence, misunderstanding patient values and expectations, and failing to appreciate the extent to which patients can physically and psychologically adapt. CONCLUSIONS: Although prognosis among mechanically ventilated stroke patients is generally poor, a minority do survive without severe disability. Prognosis can be assessed according to clinical presentation and patient characteristics. There is an urgent need to better understand the marked variation in the care of these patients and to reliably measure and improve the patient-centeredness of such decisions.

Communication↗

PubMed1999

A prospective study on quality of life of laryngeal cancer patients treated with radiotherapy.

BACKGROUND: The aim of this study was to describe prospectively quality of life and mood before and after radiotherapy for laryngeal cancer. METHODS: Sixty-five patients with Tis-T3 laryngeal cancer treated with radiotherapy completed the European Organization for Research and Treatment of Cancer (EORTC) Core Questionnaire, the EORTC Head and Neck Cancer module, and the Center for Epidemiologic Studies Depression Scale before treatment and 6 and 12 months later. RESULTS: There was a significant but temporary deterioration of physical functioning, fatigue and most head and neck symptoms. Speech was the only symptom which improved. Patients with T2 tumors had significantly worse physical symptoms compared with patients with T1 tumors. There was a high level of depressive symptomatology at baseline, followed by an improvement after treatment. CONCLUSIONS: After radiotherapy for laryngeal cancer, a temporary deterioration of physical functioning and symptoms occurs, mostly caused by side effects of treatment. Despite physical deterioration, there is an improvement of emotional functioning and mood after treatment, probably as a result of psychological adaptation and coping processes.

Adult↗