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PubMed2000

Perfectionism and chronic insomnia.

The relationship between chronic insomnia and perfectionism was investigated using a sample of 32 adults with chronic insomnia and 26 healthy controls. Different aspects of perfectionism were measured using two Multi-Dimensional Perfectionism Scales [Frost RO, Marten P, Lahart C, Rosenblate R. The dimensions of perfectionism. Cognit Ther Res 1990;14(5):449-468; Hewitt PL, Flett GL. The Multidimensional Perfectionism Scale: development and validation. Can Psychol 1989;30:339; Hewitt PL, Flett GL. Perfectionism in the self and social contexts: conceptualization, assessment, and association with psychopathology. J Pers Soc Psychol 1991;60:456-470.]. Using a univariate approach, results indicated that those with chronic insomnia were more likely to endorse features of "maladaptive" perfectionism relative to healthy controls. Further, those with chronic insomnia were more likely to report doubts about action, frequent parental criticism, and concern over mistakes. Although those with chronic insomnia were found to be more perfectionistic in these areas, only perception of heightened parental criticism was associated with the reporting of delayed sleep-onset latency. No other aspect of perfectionism was associated with sleep-onset latency, total sleep time, or sleep quality. Implications for theories of the development of insomnia are discussed.

Adaptation, Psychological↗

PubMed2001

Tolerability of bacille Calmette-Guérin maintenance therapy for superficial bladder cancer.

OBJECTIVES: To study the influence of adverse reactions on adherence to an immunotherapy maintenance schedule and the recurrence rate of bladder cancer. Bacille Calmette-Guérin immunotherapy has documented efficacy in the management of high-risk superficial bladder cancer. However, the optimal duration of intravesical bacille Calmette-Guérin therapy and the risk/benefit ratio of maintenance therapy are controversial. METHODS: From April 1996 to April 2000, 72 patients with superficial bladder cancer were treated with Immucyst (six consecutive weekly instillations of 81 mg) and then received maintenance therapy consisting of three consecutive weekly instillations 3, 6, 12, 18, 24, 30, and 36 months later. Adverse reactions, studied during 518 instillations, were classified in four categories using a scale based on the World Health Organization recommendations, and their impact on the adherence to therapy was analyzed. RESULTS: After an average follow-up of 24 months, a durable disease-free response was observed in 84.9% of the patients; 12.5% of patients had a relapse and 2.6% had disease progression. The response rate was similar in patients with and without adverse reactions. Only 14 patients (19%) received all the scheduled maintenance instillations. The dose was reduced in 41 patients (57%), and treatment was stopped in 28 patients (39%). In multivariate analysis, an adverse event score of 1.5 or greater during induction therapy was significantly associated with cessation or modification of maintenance therapy (P = 0.01). CONCLUSIONS: The scale developed in this study to monitor the adverse reactions to bacille Calmette-Guérin and their impact on the adherence to maintenance therapy may be helpful for tailoring maintenance regimens or implementing protective measures (dose reduction or treatment postponement).

Adjuvants, Immunologic↗

PubMedDate not supplied

Legibility and completeness of physicians' handwritten medication orders.

OBJECTIVE: To assess handwritten medication orders for legibility and completeness, legibility of physician signatures, and presence of date and time the orders were written. DESIGN: Descriptive. SETTING: Three patient care units in one hospital in Texas. SAMPLE: One hundred seventy-six medication orders and 55 signatures by 36 different physicians for 39 patients. METHODS: Six experienced nurses evaluated medication orders and signatures for legibility using a rating scale developed for the study. Completeness of medication orders and presence of date and time were determined. RESULTS: Twenty percent [corrected] of the medication orders and 78% of the signatures were illegible or legible with effort. Twenty-four percent of the medication orders were incomplete. Date was omitted on 18% of the medication orders, and time was missing on 58%. CONCLUSION: Difficult-to-read and incomplete medication orders continue to be an important system problem that can increase risk for medication errors and patient harm. Good penmanship and complete orders are unrealistic goals without system support.

Drug Prescriptions↗

PubMed2004

[Atopic dermatitis: which are the diagnostic criteria used in medical literature?].

INTRODUCTION: Diagnosis of atopic dermatitis currently relies on diagnostic criteria scales developed by Hanifin and Rafka in 1980 and by the "United Kingdom Working party" in 1994. Some authors have proposed: "AEDS" [sM1] and "Atopiform Dermatitis", which has led to the distinction between different sub-populations and the exclusion of certain diseases from the diagnosis of atopic dermatitis. The aim of our study was to collect the criteria retained in the scientific medical literature during the year 2002 for the definition of atopic dermatitis and to try to understand not only the interest but also the questions that the various definitions lead to. METHOD: A PubMed research was launched with the key word "atopic dermatitis" from January to September of 2002. All the scientific articles either in French or in English were studied. RESULTS: Hanifin and Rafka's criteria were selected in 44 p. 100 of the scientific articles, and the "United Kingdom Working Party" criteria in 12 p. 100. Personal definitions were used in 21 p. 100 of the articles; these were based on the level of total and specific IgE or on personal clinical criteria. For twenty-three p. 100 of the authors, the definition of atopic dermatitis was not specified. DISCUSSION: There was not just one definition of atopic dermatitis. This may affect the interpretation of diagnostic or therapeutic papers concerning the disease, because there has been no proof that these definitions cover the same population of patients.

Dermatitis, Atopic↗

PubMed2004

Minor physical anomalies in non-familial unipolar recurrent major depression.

BACKGROUND: The prevalence of minor physical anomalies (MPAs) was evaluated in patients with unipolar recurrent major depression to get indirect data on the possible role of aberrant neurodevelopment in the aetiology of major depression. One published study [Lohr et al., Am. J. Geriatr. Psychiatry 5 (1997) 318] on the MPA prevalence in unipolar depression, evaluated by the recently widely criticized Waldrop-scale, reports on a significantly higher MPA rate among patients. METHODS: A scale developed by Méhes [Prog. Clin. Biol. Res. 163 (1985) 45] was used to detect the presence or absence of 57 MPAs in 30 patients with major depression and in 30 matched controls. RESULTS: The depressive sample did not differ significantly from the control group (P=0.200). By comparing each MPA individually we could not find any significant differences between the depressive and the control sample. LIMITATIONS: Patients and control subjects had a negative family history in connection with affective disorders; a high-risk population should give significant positive results. CONCLUSIONS: The results do not support the role of an 'early neurodevelopmental origin' in unipolar depression.

Adult↗

PubMed2000

AVS/express for the PC implementation of a 3D visualization module for radiotherapy.

Treatment planning systems (TPS) are nowadays of great help in cancer radiotherapy. Basically, they allow the pair physician/physicist to simulate the beams' irradiation effects on tumors as well as healthy tissues in terms of delivered radiation doses and finally to assess the validity of a beam setup. The state of the art in TPS leads to the following evidence concerning the future of such softwares: an access to a 3D visualization at each step of the design and verification of a plan has become necessary. Moreover, the fast increasing performances of personal computers (PC) will make possible in a near future the implementation at a lower cost of a complete 3D TPS. One of the keys of such an ambition is the compatibility between the implementation tools and the needs for power and flexibility. A first implementation on Open VMS of a simple 3D visualization for Institut Curie's TPS ISIS using Advanced Visual Systems' AVS 5 has been achieved. Their next generation tool, AVS/Express, seemed to meet the needs of a wide scale development. The use of AVS/Express working together with Microsoft Visual C++ in the implementation on Windows NT of a 3D visualization module is exposed.

Humans↗

PubMedDate not supplied

Manual muscle strength testing: intraobserver and interobserver reliabilities for the intrinsic muscles of the hand.

The reliability of manual muscle strength testing of the intrinsic muscles of the hand is reported. The muscle strengths of 28 patients who had neuropathies of the ulnar nerve or the ulnar and median nerves were graded by two physiotherapists to determine intraobserver and interobserver reliabilities. Muscle strength was graded using the numeric scale developed by the Medical Research Council (grades 0 to 5). Reliabilities were established for nine muscles or muscle groups. Intraobserver reliabilities ranged from 0.71 to 0.96 and interobserver reliabilities from 0.72 to 0.93. It is difficult to isolate, and hence grade, most of the intrinsic muscles of the hand. Therefore, it is suggested that specific movements be tested and graded when assessing and evaluating muscle or nerve function.

Adult↗

PubMed1998

Evaluation of the readiness to change questionnaire with problem drinkers in treatment.

Prochaska and DiClemente's (1982, 1983) readiness to change model proposes that people resolve health-related concerns by working through a qualitative progression of distinct motivational stages. The present study examined the responses of 66 (44 males, 22 females) mildly dependent outpatient alcohol abusers to the Readiness to Change Questionnaire, a scale developed to classify individuals according to their motivational stage. It has been suggested that the RTCQ may have applicability to problem drinkers in treatment. Reliability analyses conducted on the questionnaire's three subscales resulted in alpha coefficients of .30 for the Precontemplation subscale, .52 for the Contemplation subscale, and .76 for the Action subscale. The low internal reliability for the first two subscales does not support the use of this questionnaire in a treatment context at this time. Further studies are needed to refine the subscales. A psychometrically sound measure, once developed, would provide guidance in treatment matching.

Adult↗

PubMed1997

[APN: evaluation behavioral scale of acute pain in newborn infants].

AIM: This study was designed to validate a behavioral acute pain rating scale for term and preterm neonates (APN). METHODS: From January through June 1996, neonates requiring a heel lance or a venous puncture for blood sampling at the intensive care unit and the nursery of Poissy Hospital were recruited into the study. After a pilot study, a pain rating scale was developed. The scale score pain ranged from 0 to 10 and it evaluated three items: facial expression, limb movements, and vocal expression with ratings per item ranging from 0 to 4, 0 to 3 and 0 to 3, respectively. Two observers evaluated independently each infant during a painful procedure (puncture for a blood sample) and during a dummy procedure (rubbing the thigh softly). RESULTS: Forty-two neonates born between 25 and 41 weeks gestational age were included in the study. Medians (quartiles) of gestational age, birth weight, and corrected postmenstrual age at time of investigation were 34 (29-39) weeks, 1,850 (1,055-3,093) g, and 35.5 (31-39) weeks, respectively. Ten infants were intubated. The scale showed to be sensitive because all possible scores were obtained; during painful procedures scores ranged from 1 to 10, with 95% of scores > or = 3 while during dummy procedures they ranged from 0 to 5, with 88% of scores < or = 2. The medians (95% confidence interval) of scores were for painful procedures 5 (5 to 7) and for dummy procedures 1 (0 to 1). This indicates a good specificity of the scale. High intercorrelation of items (internal consistency) was confirmed by a Cronbach's coefficient alpha of 0.88. Inter-rater agreement was high since the Krippendorff R test was 91.2. CONCLUSION: This behavioral acute pain rating scale for newborns demonstrated a good specificity and sensitivity, internal consistency and inter-rater reliability. This scale could be used to test the analgesic effects of different therapies during painful procedures.

Acute Disease↗

PubMed2000

Sensitivity and specificity of the Braden Scale in the cardiac surgical population.

PURPOSE: A descriptive study was conducted to investigate the sensitivity and specificity of the Braden Scale for Predicting Pressure Ulcer Risk in a cardiac surgical population. PATIENTS AND SETTING: A convenience sample of 337 pressure ulcer-free patients undergoing cardiothoracic surgery at a large midwestern national referral center were enrolled in the study. METHODS: Systematic skin and Braden Scale assessments were completed independently on the day of surgery and on postoperative days 1, 3, and 5. The presence of a pressure ulcer was determined and classified using the 4-stage scale developed by the WOCN Society. RESULTS: Sixteen patients (4.7%) developed a total of 22 pressure ulcers. Sensitivity and specificity of Braden scores were calculated for the day of surgery and for postoperative days 1, 3, and 5. The established Braden "cutoff" score of < or = 16 to identify those "at risk" had poor specificity and sensitivity in this patient population. The appropriate cutoff score varied by hospital day. A preoperative Braden score of 22 correctly classified 50% of the pressure ulcer-positive patients. The appropriate cutoff scores on postoperative day 1, 3, and 5 were 13, 14, and 20, respectively. Those scores correctly classified 67% of the pressure ulcer-positive patients on postoperative day 1, 57% on postoperative day 3, and 50% on postoperative day 5. CONCLUSION: These results illustrate that optimum prediction of pressure ulcer risk can only be accomplished with reassessments and determination of the Braden cutoff score or scores that are reflective of the patient's changing clinical condition throughout the hospitalization.

Adult↗

PubMed2003

Muscularity and the gay ideal: body dissatisfaction and disordered eating in homosexual men.

The present study investigated body concerns in a community sample of 52 homosexual men, as well as two comparison groups comprising 51 heterosexual men and 55 heterosexual women. Gay men were found to score significantly more highly than heterosexual men on all measures of disordered eating, and did not differ significantly from women on Drive for Thinness or Bulimia. They also scored significantly more highly than heterosexual men and women on Drive for Muscularity (a scale developed for this study), suggesting that the gay 'ideal' involves not only being thin, but also being muscular. Interestingly, however, gay men did not differ significantly from heterosexual men on body esteem, with both groups scoring higher than the women. While body esteem was found to be related to self-esteem for all of the groups, for gay men only self-esteem was negatively related to the importance to others of appearance, weight, and muscularity, perhaps reflecting increased pressure within the gay community to attain the ideal body shape.

Journal Article↗

PubMed1997

Measuring core bereavement phenomena.

As part of a longitudinal study of bereavement phenomena in three groups, bereaved spouses, bereaved adult children and bereaved parents, scale development was carried out using a pool of bereavement phenomenology questions administered prospectively. The items were derived from the literature, in particular studies dealing with the measurement of grief/bereavement, as well as from clinical experience. Factor analysis of theoretically grouped items produced seven subscales, three of which tapped frequently experienced phenomena in the bereaved. These three subscales formed the basis of a single measure, labelled the Core Bereavement Items (CBI), which demonstrated high reliability and sound face and discriminant validity. Preliminary analysis suggested that the CBI will prove to be a reliable and valid instrument with respect to the measure of core bereavement phenomena in commonly bereaved groups in Western society.

Adult↗

PubMed1997

Clinical dementia rating: a reliable and valid diagnostic and staging measure for dementia of the Alzheimer type.

Global staging measures for dementia of the Alzheimer type (DAT) assess the influence of cognitive loss on the ability to conduct everyday activities and represent the "ultimate test" of efficacy for antidementia drug trials. They provide information about clinically meaningful function and behavior and are less affected by the "floor" and "ceiling" effects commonly associated with psychometric tests. The Washington University Clinical Dementia Rating (CDR) is a global scale developed to clinically denote the presence of DAT and stage its severity. The clinical protocol incorporates semistructured interviews with the patient and informant to obtain information necessary to rate the subject's cognitive performance in six domains: memory, orientation, judgment and problem solving, community affairs, home and hobbies, and personal care. The CDR has been standardized for multicenter use, including the Consortium to Establish a Registry for Alzheimer's Disease (CERAD) and the Alzheimer's Disease Cooperative Study, and interrater reliability has been established. Criterion validity for both the global CDR and scores on individual domains has been demonstrated, and the CDR also has been validated neuropathologically, particularly for the presence or absence of dementia. Standardized training protocols are available. Although not well suited as a brief screening tool for population surveys of dementia because the protocol depends on sufficient time to conduct interviews, the CDR has become widely accepted in the clinical setting as a reliable and valid global assessment measure for DAT.

Aged↗

PubMed2003

An open label pilot study of citalopram for depression and boredom in ambulatory cancer patients.

OBJECTIVE: Significant levels of depressive symptoms are an impediment to adjustment and affect greater than one-third of people with cancer. The clinical diagnosis of major depression is estimated to occur in 25%. Depression is dramatically underrecognized by oncologists and oncology nurses, and as a result, often undertreated. Clinical experience suggests that antidepressants of virtually all types are well tolerated and potentially efficacious. There is, however, a lack of an evidence base for the use of antidepressants in cancer patients. METHODS: We undertook an open-label pilot study using citalopram in 30 cancer patients who reported a high level of depressive symptoms on the Zung Self-Rating Depression Scale (ZSDS). In addition to the ZSDS, eligible patients completed a series of visual analog scales for pain, depression, and sleep disturbance; the Functional Assessment of Cancer Therapy-General Module; and the Purposelessness, Understimulation, and Boredom Scale developed by the research team. Patients began a 2-month course of therapy with citalopram 20 mg, increasing to 40 mg at the end of the fourth week if the patient was in the same range of depressive symptoms as measured by the ZSDS. RESULTS: Twenty-one of 30 patients completed the protocol. The average age of the sample was 57.32 years (SD = 12.6) and was comprised of 11 women (52.4%) and 10 men (47.6%). Depressive symptoms decreased and quality of life improved during the 8-week treatment period. Of special interest was the rate of improvement in boredom, and using the total boredom score of the PUB, significant improvement compared to baseline was seen in weeks 6 (F = 5.266, p < .05) and 8 (F = 9.248, p < .01). SIGNIFICANCE OF RESULTS: Overall, the positive findings suggest the need for a randomized, double-blind, placebo-controlled trial of citalopram in cancer patients. Regarding the interplay of boredom and depression, the relationship between improvements in depressive symptoms and boredom is complex. This is illustrated by the way in which the different elements respond to antidepressant treatment. Depression began to improve almost immediately upon initiation of treatment whereas improvement in boredom does not become evident until week 6.

Adult↗

PubMed2000

The South Oaks Gambling Screen Revised for Adolescents (SOGS-RA): further psychometric findings from a community sample.

The broad expansion of gambling across North America during the last two decades has generated concern about the extent of gambling and problem gambling in youth, and the need to more accurately monitor it. The South Oaks Gambling Screen-Revised for Adolescents (SOGS-RA) is a promising instrument for screening problem gambling (Winters, Stinchfield, & Fulkerson, 1993) that requires more evaluation. Accordingly, further psychometric analysis of the instrument was conducted as part of a community survey of gambling in a sample of 1,000 male and female youth, aged 12 to 17 years. The analyses extended previous focus by including females, young adolescents, and an evaluation of youth classified as "at-risk." Consistent with preliminary findings obtained during scale development, the distribution of item endorsement revealed trends of over-endorsement for some items (e.g., gambled more than intended, felt bad about the amount bet), and under-endorsement for others (e.g., criticized or told you had a gambling problem). These results suggest consideration of some form of weighting procedure, item deletion or re-wording. A factor analysis of the SOGS-RA items suggested a two-factor solution, with one factor interpreted as Control over Gambling and the other Gambling Consequences. It is proposed that the two factors may represent early versus more severe levels of gambling problems, respectively. The results highlight the need for further psychometric evaluation and refinement of instruments used to identify gambling problems in young people.

Journal Article↗

PubMed1997

Questionnaire methods of cognitive self-statement assessment.

Questionnaire methods can be used to assess thoughts, which are cognitive products often referred to as self-statements, automatic thoughts, or internal dialogue. This review examines the nature of endorsement measures of self-statements and considers their advantages and disadvantages as well as scoring issues. A psychometric evaluation of self-statement questionnaires discusses the issues of reliability, content validity and scale development, criterion validity, construct validity, and clinical utility. Descriptions of and psychometric findings for over 2 dozen measures are summarized, including measures for depression, anxiety, eating disorders, pain, and applications with children and adolescents, and conclusions and future directions are suggested.

Awareness↗

PubMed1990

Quality of social support and associated social and psychological functioning in women with rheumatoid arthritis.

Using a cross-sectional interview study of 194 women with rheumatoid arthritis, investigated the relationship between health status, social integration, qualitative aspects of social support, and social and psychological functioning in the presence of a chronic, disabling disease. Even after controlling for the influences of current physical limitations and social integration, qualitative dimensions of social support as measured by the Quality of Social Support Scale, a scale developed for this study, explained a significant proportion of the variance in home and family functioning and in depression.

Adaptation, Psychological↗

PubMed2000

An examination of the nature and correlates of ethnic harassment experiences in multiple contexts.

The authors examined the nature and correlates of ethnic harassment experiences in 4 predominantly Hispanic samples of working men and women (N = 575) using a newly developed scale. Confirmatory factor analyses supported a 2-factor structure for the Ethnic Harassment Experiences scale (i.e., verbal ethnic harassment and exclusion due to ethnicity). Most experiences of ethnic harassment in the workplace during the previous 24 months included verbal ethnic harassment (i.e., ethnic slurs, derogatory ethnic comments, or ethnic jokes). It was also found that participants who experienced verbal ethnic harassment and exclusion reported negative correlates that could not be attributed to affective disposition. For some correlates, those who experienced low levels of verbal harassment and high levels of exclusion were more negatively affected than others, perhaps as a result of the attributional ambiguity of the situation.

Adult↗