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Enhancing patient experience through personalization of health services.
Snowdon, Anne W; Alessi, Charles; Bassi, Harpreet; DeForge, Ryan T; Schnarr, Karin
Patient engagement is a challenge many leaders are facing, as consumer expectations of health services demand a more personalized approach to care. This article examines consumer trends that are influencing patient engagement and empowerment relative to the use of digital technologies. Informed by consumer and population health trends that can personalize health services, three strategies leaders can engage to strengthen patient experience include placing greater focus on personal health and wellness, shifting towards personalized rather than standardized healthcare, and facilitating the democratization of healthcare information. PMID:26135292
Childhood experiences of parental rearing patterns reported by Chinese patients with borderline personality disorder.
Huang, Jianjun; Napolitano, Lisa A; Wu, Jiang; Yang, Yunping; Xi, Yingjun; Li, Yawen; Li, Kai
The primary purposes of this study were to (1) compare the characteristics of childhood experiences of parental rearing patterns in China reported by patients with borderline personality disorder (BPD), patients with other personality disorders and patients without personality disorders; (2) identify the reported parental rearing patterns associated with BPD in China; and (3) determine whether these patterns differ for males and females. One hundred and fifty-two patients with BPD, 79 patients with other personality disorders and 55 patients without Axis II diagnoses were administered the Chinese version of the McLean Screening Instrument for BPD and completed the Egna Minnen av Barndoms Uppfostran (EMBU), a self-report measure of childhood parental rearing patterns. Parental rearing patterns reported by the BPD group were characterized by less emotional warmth, and greater punishment, rejection and control than patterns reported by the other two groups. Within the BPD group, males were more likely than females to report parental punishment, rejection and control. Paternal punishment, low maternal emotional warmth and female gender predicted BPD diagnosis. Negative parental rearing patterns appear to contribute to the development of BPD in China and vary with the gender of the child. Maternal emotional warmth may be a protective factor against BPD. PMID:24811721
Experiences of patients with borderline personality disorder with the brief admission intervention: a phenomenological study.
Helleman, Marjolein; Goossens, Peter J J; Kaasenbrood, Ad; van Achterberg, Theo
Brief admission is a crisis intervention for patients with borderline personality disorder (BPD), and refers to a clinical admission at a psychiatric hospital for a period of 1-5 nights. Patients formulate a treatment plan together with their community mental health nurse about the maximum frequency allowed for these brief admissions. The purpose of the study was to describe the lived experiences of patients with BPD with use of the brief admission intervention. The study used a phenomenological approach. Inclusion criteria were a diagnosis of BPD, according to the Diagnostic and Statistical Manual of Mental Disorders-IV criteria; experience with brief admission, and sufficient understanding of the Dutch language. A total of 16 female patients and one male patient participated in the study. Thematic analysis of the transcripts of the interviews revealed four major meaning units: (i) organization of the brief admission; (ii) contact with a nurse; (iii) time out from daily life; and (iv) experienced value for the patient. Patients highlighted the quality of the contact with a nurse as the most important aspect of the brief admission. Nurses should be aware of the importance of connecting with patients who have BPD during a brief admission, particularly in light of the interpersonal hypersensitivity that characterizes these patients. PMID:24890615
Birth order and memories of traumatic and family experiences in Greek patients with borderline personality disorder versus patients with other personality disorders.
Karamanolaki, Hara; Spyropoulou, Areti C; Iliadou, Aggeliki; Vousoura, Eleni; Vondikaki, Stamatia; Pantazis, Nikos; Vaslamatzis, Grigoris
The purpose of this study was to assess the possible effect of recalled traumatic experiences, perceived parental rearing styles, and family parameters on the occurrence of borderline personality disorder (BPD) versus other personality disorders (other-PDs). A total of 88 adult outpatients with personality disorders completed the Traumatic Antecedents Questionnaire and the Egna Minnen av Barndoms Uppfostran, which measures perceptions regarding parental rearing. Results indicated that incidence of traumatic childhood experiences was higher among those in the BPD group compared to those in the other-PD group. Firstborns were less likely to carry a diagnosis of BPD over other-PDs. Also, significantly more BPD compared to other-PD patients reported being the father's favorite child over siblings. Results suggest that traumatic experiences, birth order, and family interactions in the presence of siblings seem to differentially affect the formation of borderline diagnosis compared to other-PDs. Limitations and clinical implications of the study are discussed in detail. PMID:27583811
Personal Epistemology and Personal Experience.
ERIC Educational Resources Information Center
Unger, Rhoda K.; And Others
The world view of students was investigated, measuring covert causal assumptions about the relationship between the person and physical and social reality. The results indicate that people place themselves in particular intellectual arenas because of their preexisting ideology. Suggestions for further study are made. (PS)
ERIC Educational Resources Information Center
Hessler, Peter; Bradeen, Ryan; Wang, Richard; Masalski, Kathleen Woods
This article presents four stories of personal experiences of China. In "A Journey Between China's Past and Present," Peter Hessler, a former Peace Corps volunteer and author, highlights misconceptions between Chinese and Americans and the desire both peoples share for knowledge about one another. In "Life on Liberation Avenue," Ryan Bradeen…
Persons with Disability: Their Experiences as Standardized Patients in an Undergraduate Nursing Program.
Smeltzer, Suzanne C; Mariani, Bette; Gunberg Ross, Jennifer; de Mange, Elizabeth Petit; Meakim, Colleen H; Bruderle, Elizabeth; Nthenge, Serah
This descriptive qualitative study examined experiences of standardized patients with disabilities (SPWDs) in an undergraduate nursing program through focus group and telephone interviews. Content analysis identified five themes: 1) desire to improve care for others, 2) opportunity to be productive again, 3) joy in seeing students learn, 4) desire for more feedback on performance, and 5) importance of having SPWDs assess accessibility of the facility. SPWDs participated to improve sensitivity of students to disability and appreciated having a voice in educating future nurses. They requested more feedback on their performance and identified accessibility issues in the state-of-the-art nursing school building. PMID:26753302
The effect of postoperative symptom experience, and personality and psychosocial factors on depression among postgastrectomy patients in Japan.
Maeda, Takako; Onuoha, Francis N; Munakata, Tsunetsugu
Depression, the most common affective disorder in cancer, has a major impact on quality of life. Various risk factors may interact and affect a cancer patient's depressive state. The purpose of this study was to examine the relationships between depression and postoperative symptom experience, personality, and psychosocial factors in Japanese gastrectomy patients. Causal relationships of these variables were also estimated. Eighty-two Japanese gastrectomy patients (M age = 63.63 years, SD = 10.21; men = 50, women = 32), who had been discharged within the last 3 years with no indication of cancer recurrence, participated in the study. Results showed significant correlations between depression and age, time-since-discharge, postoperative symptom experience, frequency of symptoms, self-esteem, and emotional support. Path analysis showed sufficient goodness of fit index (GFI = 0.993, AGFI = 0.963). Interpersonal dependency, emotional support, and marital status showed a direct effect on self-esteem, which, along with postoperative symptom experience, had a direct effect on depression. Findings provide a useful reference point for further understanding the mental health condition of postgastrectomy patients. PMID:17273010
ERIC Educational Resources Information Center
Knotts, Lester William
Literacy is inextricably linked to the social context in which literacy is taught, and in which the language is used. Cultural expectations require the use of specific literacies. Who a person is, in terms of a literacy user and a literacy worker are dictated by the culture in which a person chooses to operate. Literacy is not neutral, but an…
Visual laser ablation of prostate (VLAP) for patients with retention of urine: personal experience
NASA Astrophysics Data System (ADS)
Bhatta, Krishna M.
A total of 21 consecutive patients with retention of urine underwent visual laser ablation of prostate. Twelve of these had spinal anesthesia, eight had local anesthesia and one had general anesthesia. Seventeen had acute retention; 13 from BPH, 1 due to carcinoma of prostate and three were due to Bladder Neck Stenosis (BNS). Four had chronic retention; three due to BPH and one due to BNS. A Nd:YAG/KTP laser was used and the laser was delivered via Angle Delivery Device. All 13 patients in acute retention due to BPH became catheter free after a mean catheter time of 8 days (range 1 - 22 days), the three patients with acute retention due to BNS were catheter free the next day after the laser incision of the BNS and the patient with acute retention from carcinoma of prostate required a TURP after 45 days of initial laser irradiation. Of the four patients with chronic retention, three with BPH required a TURP procedure after waiting over a month. The patient with chronic retention with BNS was catheter free after 7 days of his laser procedure. We conclude that laser prostatectomy using a side firing laser probe is effective in patients with acute retention but did not work well in our hands for chronic retention patients.
Culture, personal experience and agency.
McCarthy, John; Sullivan, Paul; Wright, Peter
In this article, we explore what we perceive to be a gap between agency as articulated in practice theories and agency as personally experienced. The gap is not created by a turn to practice in theorizing, but by the tendency to produce theoretical representations that silence the particularity of experience and the diversity of voices in experience. In exploring the gap, we identify aspects of practice theories that explicitly commit to theoretical representation over personal experience and describe Bakhtin's commitment to action and personal experience as an alternative. In order to exemplify Bakhtin's approach in practice, we then present an analysis of one artist-teacher's experience of her own agency in making art and in teaching. Finally, we comment on what a commitment to representational theorizing does to accounts of an artist's activities and personal experience. PMID:16762108
Delivering Hattie... a personal experience.
Jennings, Sarah
Following a textbook pregnancy and subsequent spontaneous labour at home, I arrived at hospital awaiting a review of my cervical progress; but this became the least of my thoughts as, following routine auscultation of the fetal heart, no sound was audible. The following article outlines my own personal experiences of a term stillbirth as both a midwife and a mother. PMID:22720450
Personal Experiences and Professional Strategies
ERIC Educational Resources Information Center
Georgii-Hemming, Eva
This article is based on empirical research carried out in Sweden during the years 2000 and 2004. The study concerns five music teachers who teach at upper secondary school and the main aim was to acquire an understanding of the teachers' views of the core subject Music. A further aim was to describe the five teachers' personal experiences of…
Patients' experiences following breast cancer treatment: an exploratory survey of personal and work experiences of breast cancer patients from three European countries.
Braybrooke, J P; Mimoun, S; Zarca, D; Elia, D; Pinder, B; Lloyd, A J; Breheny, K; Lomazzi, M; Borisch, B
Improved treatments for early breast cancer have led to a significant increase in overall survival. While evidence regarding potential long-term sequelae of adjuvant treatments exists, relatively little research reports patients' own perceptions of change before and after adjuvant chemotherapy (AC). This study aimed to identify key ongoing issues associated with AC in daily life. An online survey developed for this study was completed by 198 women (mean age 49.7 years) in the UK, France and Germany who had AC 1-5 years previously for oestrogen receptor positive, HER2 negative early breast cancer. Women without AC and endocrine therapy, those treated with Trastuzumab or who had recurrent disease were excluded. A third of women who responded were currently unable to perform their former family role. The majority had needed support, particularly with child care, during treatment. While 54% were in full-time employment before diagnosis this had reduced to 32% following AC. Of those women still working, over half reported difficulties with tiredness or concentration. Most (85.8%) were satisfied with healthcare professionals' treatment information, but only 29.7% received information about returning to work. This exploratory survey highlights areas of women's lives affected 1-5 years following AC for early breast cancer. The impact on returning to work and issues surrounding childcare particularly, require further study. PMID:25053521
[Personality characteristics of hypertensive patients].
Kubej, P; Korán, M
Essential hypertension, as well-known specialists believe, is due both to genetic and external environment factors. Apart from the steadily growing complexity of social life and various important life events, high-risk factors may also be seen in a certain way of behaviour and man's psychophysiological reactivity. Recent literature on this topic informs about some common characteristics found in the behaviour of hypertensive persons, for example: anxiety in social contacts, suppressed hostility, manifestations of perfectionism, suppression of emotions, exaggerated behavioral adaptability and defensive attitudes to stress stimuli. In accordance with literary data, the control group of hypertensive patients (N = 89) gave evidence of some identical characteristics. Their knowledge permits to carry out more specific attempts at influencing hypertension in a non-pharmacological way. PMID:2720750
Violence and Personality in Forensic Patients: Is There a Forensic Patient-Specific Personality Profile?
ERIC Educational Resources Information Center
Stupperich, Alexandra; Ihm, Helga; Strack, Micha
Concerning the discussion about the connection of personality traits, personality disorders, and mental illness, this study focused on the personality profiles of male forensic patients, prison inmates, and young men without criminal reports. The main topic centered on group-specific personality profiles and identifying personality facets…
Augmented Becoming: Personal Reflections on Collaborative Experience
ERIC Educational Resources Information Center
Barak, Judith
This self-study is an exploratory, autoethnographic journey, aiming towards understanding my becomings through the 14 years of my collaborative experience. It provides a reflective look at the effects of this unique experience on my personal-professional self, questioning my understandings and trying to identify my becomings along these years.…
Integrating protocol schedules with patients' personal calendars.
Civan, Andrea; Gennari, John H; Pratt, Wanda
We propose a new approach for integrating protocol care schedules into patients' personal calendars. This approach could provide patients with greater control over their current and future scheduling demands as they seek and receive protocol-based care. PMID:17238511
Partial Knee with Personalized Patient Care
MedlinePlus Videos and Cool Tools
Eating again: a physician's personal experience after laryngectomy.
Brook, Itzhak
This article presents the author's personal experiences in eating again after becoming a laryngectomee. He was diagnosed with hypopharyngeal carcinoma and underwent total laryngectomy with a free flap reconstruction. The personal story is told in the hope that nutritionists and other health care providers will realize the difficult challenges in obtaining adequate nutrition that a patient diagnosed with cancer who undergoes laryngectomy must face. These include the effects of radiation treatment and surgery, which create functional and anatomical changes that make swallowing difficult. PMID:22563988
Preservation of Person-Specific Semantic Knowledge in Semantic Dementia: Does Direct Personal Experience Have a Specific Role?
Péron, Julie A.; Piolino, Pascale; Moal-Boursiquot, Sandrine Le; Biseul, Isabelle; Leray, Emmanuelle; Bon, Laetitia; Desgranges, Béatrice; Eustache, Francis; Belliard, Serge
Semantic dementia patients seem to have better knowledge of information linked to the self. More specifically, despite having severe semantic impairment, these patients show that they have more general information about the people they know personally by direct experience than they do about other individuals they know indirectly. However, the role of direct personal experience remains debated because of confounding factors such as frequency, recency of exposure, and affective relevance. We performed an exploratory study comparing the performance of five semantic dementia patients with that of 10 matched healthy controls on the recognition (familiarity judgment) and identification (biographic information recall) of personally familiar names vs. famous names. As expected, intergroup comparisons indicated a semantic breakdown in semantic dementia patients as compared with healthy controls. Moreover, unlike healthy controls, the semantic dementia patients recognized and identified personally familiar names better than they did famous names. This pattern of results suggests that direct personal experience indeed plays a specific role in the relative preservation of person-specific semantic meaning in semantic dementia. We discuss the role of direct personal experience on the preservation of semantic knowledge and the potential neurophysiological mechanisms underlying these processes. PMID:26635578
[The personality of wives of alcoholic patients].
Avila Escribano, J J; Ledesma Jimeno, A
This work is a study of the personality of the wives of alcoholic patients composed by means of a structures interview, the MMPI personality questionnaire and the Instrument I used to evaluate aggressivity. Among the discoveries made, we must emphasize that 20% of the wives knew of their partner's excessive alcohol consumption before marriage, while married, 75% were victims of some kind of violent incident, 43% had personal psychopathological backgrounds, 15% were "repeaters wives" "those who had alcoholic parents). In the MMPI test, these women represent a significantly high profile, in which the scales Hs, D and Hy are the highest, amongst which their most outstanding personality traits include passivity, dependency and insecurity. Furthermore, those wives whose husbands have had relapses, represent a higher Pd scale than the other group. The Instrument I used to evaluate aggressivity also emphasizes this passive-aggressive tendency in the wives. PMID:2094171
Personality traits in patients with oral malodor.
Sugiyama, Toshiko; Yamakura, Daiki; Tomita, Sachiyo; Kameyama, Atsushi; Morinaga, Kazuki; Tsunoda, Masatake
Many patients presenting at oral malodor clinics have psychological halitosis, which is characterized as being obsessive about having oral malodor or being distressed from a keen awareness of oral odor. We used the Tokyo University Egogram (TEG) to evaluate personality traits in patients presenting at the oral malodor clinic of this institute. The incidence of each TEG personality type was compared between a total of 600 patients presenting at the clinic and a cohort of healthy individuals. Differences were found between the malodor patient and healthy groups. Nurturing Parent (NP)-dominant, Adult (A)-dominant, inverse N (NP low, Free Child high), showed a significant decrease of 6.7, 11.3, and 3.6%, respectively; whereas N (A low) and N (NP high, Free Child low) showed a significant increase of 3.3 and 6.4%, respectively (p < 0.01). PMID:25477041
Positive Childhood Experiences: Resilience and Recovery From Personality Disorder in Early Adulthood
Skodol, Andrew E.; Bender, Donna S.; Pagano, Maria E.; Shea, M. Tracie; Yen, Shirley; Sanislow, Charles A.; Grilo, Carlos M.; Daversa, Maria T.; Stout, Robert L.; Zanarini, Mary C.; McGlashan, Thomas H.; Gunderson, John G.
Objective Recent follow-along studies of personality disorders have shown significant improvement in psychopathology over time. The purpose of this study was to prospectively investigate the association between positive childhood experiences related to resiliency and remission from personality disorder. Method Five hundred twenty patients with DSM-IV–based semistructured interview diagnoses of schizotypal, borderline, avoidant, or obsessive-compulsive personality disorders were evaluated 6 times over 4 years between September 1996 and June 2002. Positive childhood experiences, including achievements, positive interpersonal relationships with others, and caretaker competencies, were measured using the Childhood Experiences Questionnaire-Revised. The effects of positive childhood experiences on clinically significant remission from personality disorder were determined using survival and proportional hazard regression analyses. Results Positive achievement experiences and positive interpersonal relationships during childhood or adolescence were significantly associated with remission from avoidant and schizotypal personality disorders. The greater the number of positive experiences and the broader the developmental period they spanned, the better the prognosis of these personality disorders. Conclusions The prognosis of certain personality disorders is better in patients whose developmental histories include positive experiences. Early treatment designed to foster personal strengths and competencies and to develop inter-personal skills might benefit young patients diagnosed with personality disorders. PMID:17685749
Translating personality psychology to help personalize preventive medicine for young adult patients.
Israel, Salomon; Moffitt, Terrie E; Belsky, Daniel W; Hancox, Robert J; Poulton, Richie; Roberts, Brent; Thomson, W Murray; Caspi, Avshalom
The rising number of newly insured young adults brought on by health care reform will soon increase demands on primary care physicians. Physicians will face more young adult patients, which presents an opportunity for more prevention-oriented care. In the present study, we evaluated whether brief observer reports of young adults' personality traits could predict which individuals would be at greater risk for poor health as they entered midlife. Following the cohort of 1,000 individuals from the Dunedin Multidisciplinary Health and Development Study (Moffitt, Caspi, Rutter, & Silva, 2001), we show that very brief measures of young adults' personalities predicted their midlife physical health across multiple domains (metabolic abnormalities, cardiorespiratory fitness, pulmonary function, periodontal disease, and systemic inflammation). Individuals scoring low on the traits of Conscientiousness and Openness to Experience went on to develop poorer health even after accounting for preexisting differences in education, socioeconomic status, smoking, obesity, self-reported health, medical conditions, and family medical history. Moreover, personality ratings from peer informants who knew participants well, and from a nurse and receptionist who had just met participants for the first time, predicted health decline from young adulthood to midlife despite striking differences in level of acquaintance. Personality effect sizes were on par with other well-established health risk factors such as socioeconomic status, smoking, and self-reported health. We discuss the potential utility of personality measurement to function as an inexpensive and accessible tool for health care professionals to personalize preventive medicine. Adding personality information to existing health care electronic infrastructures could also advance personality theory by generating opportunities to examine how personality processes influence doctor-patient communication, health service use, and patient
Translating Personality Psychology to Help Personalize Preventive Medicine for Young-Adult Patients
Israel, Salomon; Moffitt, Terrie E.; Belsky, Daniel W.; Hancox, Robert J.; Poulton, Richie; Roberts, Brent; Thomson, W. Murray; Caspi, Avshalom
The rising number of newly insured young adults brought on by healthcare reform will soon increase demands on primary-care physicians. Physicians will face more young-adult patients which presents an opportunity for more prevention-oriented care. In the current study, we evaluated whether brief observer reports of young adults' personality traits could predict which individuals would be at greater risk for poor health as they entered midlife. Following the Dunedin Study cohort of 1,000 individuals, we show that very brief measures of young adults' personalities predicted their midlife physical health across multiple domains (metabolic abnormalities, cardiorespiratory fitness, pulmonary function, periodontal disease, and systemic inflammation). Individuals scoring low on the traits of Conscientiousness and Openness-to-Experience went on to develop poorer health even after accounting for preexisting differences in education, socioeconomic status, smoking, obesity, self-reported health, medical conditions, and family medical history. Moreover, personality ratings from peer informants who knew participants well, and from a nurse and receptionist who had just met participants for the first time, predicted health decline from young adulthood to midlife despite striking differences in level of acquaintance. Personality effect sizes were on par with other well-established health-risk factors such as socioeconomic status, smoking, and self-reported health. We discuss the potential utility of personality measurement to function as an inexpensive and accessible tool for healthcare professionals to personalize preventive medicine. Adding personality information to existing healthcare electronic infrastructures could also advance personality theory by generating opportunities to examine how personality processes influence doctor-patient communication, health service use, and patient outcomes. PMID:24588093
The 'Patient experience' revolution.
Hooten, Doug; Zavadsky, Matt
We're arguably at the most pivotal time in our young profession. The ACA has provided EMS an unprecedented opportunity to become a part of the healthcare system, a move that many of us have dreamed about for decades. We need to pay attention to the changing dynamics of the environment in which we operate. The factors that currently impact hospitals, doctors and other healthcare providers will also impact us sooner than we think. Take the time to help shape our future and how we participate in this new healthcare system. It's time to focus on the patient and the patient's experience with our service. Wayne Gretzky said two important things during an interview when he was asked what makes him such a great hockey player. One was, "You miss 100% of the shots you don't take." The other was, "A good hockey player plays where the puck is. A great hockey player plays where the puck is going to be. I skate to where the puck is going to be, not where it has been." Our advice to you is to go ahead, take the shot, get ahead of the other team and focus on improved customer satisfaction sooner rather than later. PMID:24660359
[The old person--a trouble patient?].
Kojer, Marina
Persons well advanced in years suffer from constantly increasing polypathia, loss of performance and loss of functions. At the same time the demands of an ever more quickly changing society grow. Society hardly cares for the elderly, the handicapped and disabled. Often, these people are regarded as a burden, a fact that they are very well aware of. When the usual patterns of communication fail, physicians may become impatient and are, as a consequence, perceived as intimidating and indifferent by the patient. In this way the physician initiates a vicious circle, which often leads to a complete failure in communication. This is by no means surprising, as the art of communication and its fundamental significance for the physicians and their work have still not found entry into medical curricula. As long as physicians define their very old patients exclusively in terms of their increasing physical weaknesses, their task can only be restricted to improving patients' weakened condition to a very limited extent. The patient well advanced in years is thus not recognized as an individual person with feelings, worries and desire desire to find a meaning in life. PMID:15490763
Towards personalized care for persons with spinal cord injury: a study on patients' perceptions
Garrino, Lorenza; Curto, Natascia; Decorte, Rita; Felisi, Nadia; Matta, Ebe; Gregorino, Silvano; Actis, M. Vittoria; Marchisio, Cecilia; Carone, Roberto
Objective/background A newly designed Spinal Cord Unit (SCU) was set up at the Orthopedic Traumatology Center (OTC), Turin, Italy, in July 2007. With the relocation of the SCU came the need to reorganize and improve the delivery of its services. The study reported here is a preliminary part of a project entitled 'Experimentation and evaluation of personalized healthcare for patients with spinal cord injury', which is a component of an overarching program of targeted research into healthcare funded by the Piedmont Region in 2006. The aim of this study was to assess the perception of care by patients with spinal cord injury (SCI) by collecting important data in order to determine whether an integrated and personalized care pathway could be effective both in hospital and in a rehabilitation setting. Design Qualitative research study. The interview format was based on a narrative approach. Methods Qualitative in-depth semi-structured interviews were conducted with 21 patients with SCI. Qualitative content analysis was used to identify categories and themes arising from the data. Results Six main categories emerged from the perspectives of patients: expectations of rehabilitation care, impact and welcome, relationship with nurses and their involvement in treatment, relationship with physical therapists and participation in rehabilitation programs, relationship with physicians and their availability and attendance, and imparting of information on injury and rehabilitation outcomes. Care was the aspect new patients admitted to the SCU found most important. When closer relationships with staff formed, the healthcare professionals became an essential support. Patients with SCI commonly stated that receiving explicit information was necessary for accepting their condition. Conclusions Analysis of the patients' perceptions revealed a wealth of details on their experience in the SCU and the need for flexible planning of care time in particular. Incorporating the patients
Suffering Depression in the Christian Church--One Person's Experience.
Welby-Roberts, Katharine
The author has suffered for several years from Anxiety and depression. Here she describes her experiences, both of depression and of her experience as a person suffering from depression within the Christian Church. PMID:26417772
Patient reactions to personalized medicine vignettes: An experimental design
Butrick, Morgan; Roter, Debra; Kaphingst, Kimberly; Erby, Lori H.; Haywood, Carlton; Beach, Mary Catherine; Levy, Howard P.
Purpose Translational investigation on personalized medicine is in its infancy. Exploratory studies reveal attitudinal barriers to "race-based medicine" and cautious optimism regarding genetically personalized medicine. This study describes patient responses to hypothetical conventional, race-based, or genetically personalized medicine prescriptions. Methods Three hundred eighty-seven participants (mean age = 47 years; 46% white) recruited from a Baltimore outpatient center were randomized to this vignette-based experimental study. They were asked to imagine a doctor diagnosing a condition and prescribing them one of three medications. The outcomes are emotional response to vignette, belief in vignette medication efficacy, experience of respect, trust in the vignette physician, and adherence intention. Results Race-based medicine vignettes were appraised more negatively than conventional vignettes across the board (Cohen's d = −0.51−0.57−0.64, P < 0.001). Participants rated genetically personalized comparably with conventional medicine (− 0.14−0.15−0.17, P = 0.47), with the exception of reduced adherence intention to genetically personalized medicine (Cohen's d = −0.38−0.41−0.44, P = 0.009). This relative reluctance to take genetically personalized medicine was pronounced for racial minorities (Cohen's d =−0.38−0.31−0.25, P = 0.02) and was related to trust in the vignette physician (change in R2 = 0.23, P < 0.001). Conclusions This study demonstrates a relative reluctance to embrace personalized medicine technology, especially among racial minorities, and highlights enhancement of adherence through improved doctor-patient relationships. PMID:21270639
Applying Transactional Analysis and Personality Assessment to Improve Patient Counseling and Communication Skills
Lawrence, Lesa
Objective To teach pharmacy students how to apply transactional analysis and personality assessment to patient counseling to improve communication. Design A lecture series for a required pharmacy communications class was developed to teach pharmacy students how to apply transactional analysis and personality assessment to patient counseling. Students were asked to apply these techniques and to report their experiences. A personality self-assessment was also conducted. Assessment After attending the lecture series, students were able to apply the techniques and demonstrated an understanding of the psychological factors that may affect patient communication, an appreciation for the diversity created by different personality types, the ability to engage patients based on adult-to-adult interaction cues, and the ability to adapt the interactive patient counseling model to different personality traits. Conclusion Students gained a greater awareness of transactional analysis and personality assessment by applying these concepts. This understanding will help students communicate more effectively with patients. PMID:17786269
Promoting Patient- and Family-Centered Care Through Personal Stories.
Johnson, Beverley H
Patient- and family-centered care is an approach to the planning, delivery, and evaluation of health care that is grounded in mutually beneficial partnerships among patients, their families, and health care professionals. It redefines the relationships in health care by placing an emphasis on collaborating with patients of all ages, and their families, at all levels of care, in all health care settings, and in organizational change and improvement. This collaboration ensures that health care is responsive to an individual's priorities, preferences, and values. In patient- and family-centered care, patients define their "family" and determine how they and their family will participate in care and decision making. While patient- and family-centered care can improve the experience of care, safety, and quality, it also can improve the learning environment for students and trainees. The author shares personal stories to illustrate the core concepts of patient- and family-centered care, when they are present in health care interactions, and when they are not. Drawing from these stories and the author's experience in working with academic medical centers and other health care organizations over many decades, recommendations for changes in medical education are suggested that can contribute to the development of a health care workforce with the skills and commitment to partner respectfully, effectively, and authentically with patients and families. The implementation of the Affordable Care Act gives new impetus for building a health care delivery system and related educational programs to support patient- and family-centered practice. PMID:26796094
Transforming the patient experience in radiation therapy.
Jarvis, J Andrew
Healthcare providers are paying more attention to behavioral neuroscience research that confirms what patients intuitively know: physical environments deeply influence one's sense of well being. Recognizing the importance of comforting environments, healthcare providers have been working with architects to design new facilities around the patient's experience. This doesn't mean that functional and technical considerations are unimportant; it's just that the patient's experience comes first. The patient is the most important user of a healthcare facility, and yet is the only user not sitting at the table during design meetings. For this reason, some healthcare providers work with their architects to develop the conceptual design from the patient's standpoint before seeking detailed staff input. Many indignities experienced by patients may be unwittingly imposed by caring and dedicated professional staff. Medical clutter, waste containers, water coolers, coffee makers, personal displays and decorations add up to create a distressing level of visual chaos. Departments are required to eliminate clutter and maintain a calm, pleasing environment. Employees appreciate a well-designed physical environment, too. Facilities that reduce stress for patients have the same impact on staff, alleviating tension as they care for patients. Putting the patient's experience first need not add capital construction cost to a project. Rearranging spaces for the sake of the patient adds no more to floor area. Added windows, skylights and interior finishes can add cost, but the incremental cost of these amenities is small in proportion to the total project cost. Facilities project powerful visual dues about an institution's values. Providers who carefully plan for a positive patient experience traditionally enjoy strong reputations and exceptional customer loyalty. These providers know that good design is not simply wrapping a pretty facade around a building or decorating the lobby. Good
Supporting Aphasics for Capturing, Organizing and Sharing Personal Experiences
NASA Astrophysics Data System (ADS)
Al Mahmud, Abdullah
When a person, due to brain injury or another disease, suffers in his or her ability to speak, it becomes inherently cumbersome to share needs, emotions, and experiences through personal stories and social interaction. This paper describes the aim and progress of the author's dissertation, which focuses on designing a support system to share daily experiences for people suffering from expressive aphasia.
Dental Students' Clinical Expectations and Experiences Treating Persons with Disabilities.
Perusini, Darsi J; Llacuachaqui, Marcia; Sigal, Michael J; Dempster, Laura J
Persons with disabilities (PWDs) have a disproportionate level of dental disease relative to the general population. Access to care is a cause along with dentists' willingness to treat PWDs. The aim of this study was to investigate the expectations and experiences of dental students in providing treatment to these patients in a hospital-based dental clinic for PWDs. Senior dental students at the Faculty of Dentistry, University of Toronto (n=92) were surveyed prior to (Phase I) and at the end of (Phase II) mandatory clinical rotations at the Mount Sinai Hospital's Dentistry Clinic for Persons with Special Needs. Response rates were 88% for Phase I and 58% for Phase II. Before the rotations, 70% of the respondents reported little or no experience with PWDs, and 46% said they did not feel comfortable providing basic dental treatment to PWDs. However, in Phase II, significantly more students reported being comfortable than in Phase I (p=0.001). Overall, the majority of respondents (Phase I 95%; Phase II 98%) indicated they would at least attempt to provide basic dental care to PWDs after graduation. The majority also identified the opportunity to provide care and interact with PWDs as the most enjoyable aspect of their experience at the clinic. They reported that the experience helped reduce their concerns about treating PWDs including being more realistic about the time required and ideal quality of the treatment they could provide. These results suggest that their experience in the clinic significantly increased students' comfort in treating PWDs. The respondents expressed a willingness to treat PWDs once graduated and generally identified their experience as being more positive than their expectations. PMID:26933105
Personality functioning in patients with avoidant personality disorder and social phobia.
Eikenaes, Ingeborg; Hummelen, Benjamin; Abrahamsen, Gun; Andrea, Helene; Wilberg, Theresa
Avoidant personality disorder (APD) and social phobia (SP) are closely related, such that they are suggested to represent different severity levels of one social anxiety disorder. This cross-sectional study aimed to compare patients with APD to patients with SP, with particular focus on personality dysfunction. Ninety-one adult patients were examined by diagnostic interviews and self-report measures, including the Index of Self-Esteem and the Severity Indices of Personality Problems. Patients were categorized in three groups; SP without APD (n = 20), APD without SP (n = 15), and APD with SP (n = 56). Compared to patients with SP without APD, patients with APD reported more symptom disorders, psychosocial problems, criteria of personality disorders, and personality dysfunction regarding self-esteem, identity and relational problems. These results indicate that APD involves more severe and broader areas of personality dysfunction than SP, supporting the conceptualization of APD as a personality disorder as proposed for DSM-5. PMID:23786266
Personalized Learning and the Ultraversity Experience
ERIC Educational Resources Information Center
Powell, Stephen; Tindal, Ian; Millwood, Richard
This paper describes a model of personalized work-integrated learning that is collaborative in nature, uses emerging Internet technologies and is accessed fully online. The Ultraversity project was set up by Ultralab at Anglia Ruskin University to develop a fully online, 3-year duration, undergraduate degree program with an emphasis on action…
Comorbid personality disorders among patients with depression
Wongpakaran, Nahathai; Wongpakaran, Tinakon; Boonyanaruthee, Vudhichai; Pinyopornpanish, Manee; Intaprasert, Suthi
Purpose To investigate the personality disorders (PDs) diagnosed in patients with depressive disorders. Material and methods This study included a cross-sectional analysis, and was an extension of the Thai Study of Affective Disorder (THAISAD) project. Eighty-five outpatients with depressive disorders were interviewed using the Mini International Neuropsychiatric Inventory to assess for depression, in accordance with the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Text Revision and using the Thai version of the Structured Clinical Interview for PDs to assess for PD. Results Seventy-seven percent of the patients had at least one PD, 40% had one PD and 60% had two or more PDs (mixed cluster). The most common PDs found were borderline PD (20%) and obsessive–compulsive PD (10.6%), while the occurrence of avoidant PD was low when compared to the findings of previous, related studies. Among the mixed cluster, cluster A combined with cluster C was the common mix. Both dysthymic disorder and double depression were found to have a higher proportion of PDs than major depressive disorder (85.7% versus 76.1%). Dependent PD was found to be less common in this study than in previous studies, including those carried out in Asia. Conclusion The prevalence of PDs among those with depressive disorder varied, and only borderline PD seems to be consistently high within and across cultures. Mixed cluster plays a prominent role in depression, so more attention should be paid to patients in this category. PMID:25945052
Experiences of person-centred care - patients' perceptions: qualitative study
Background Patient care models have been implemented and documented worldwide. Many studies have focused on features that hinder and facilitate the shift to such models, including the implementation process, staff involvement, resistance to new models and cultural dimensions. However, few studies have identified the potential effects of such new care models from a patient perspective. The aim of the present study was to investigate whether patients did in fact perceive the intentions of partnership in the new care model 1 year after its implementation. Methods Sixteen participants were interviewed, selected from two wards in a medical department where a new care model had been implemented 1 year earlier. A directed deductive content analysis was selected. The aim of the directed approach to content analysis was to investigate to what extent the new care model had been implemented, using patients' perspectives to describe the level of implementation. A coding framework was developed based on a theoretical paper that described the key features of the new care model. Results The implementation of person-centred care had clearly occurred to a large degree, even if some patients appeared not to have been exposed to the model at all. Aspects of the newly implemented care model were obvious; however, it was also clear that implementation was not complete. The analysis showed that patients felt listened to and that their own perception of the situation had been noted. Patients spontaneously expressed that they felt that the staff saw them as persons and did not solely focus on their disease. It was also stated that not every ailment or aspect of a patient's illness needed to be addressed or resolved for open listening to be perceived as a positive experience. Conclusions The findings indicate that even though some patients were not interested in participating and playing an active role in their own care, this might relate to a lack of understanding on how to invite
Reported Experiences of Persons with Alopecia Areata
ERIC Educational Resources Information Center
Hunt, Nigel; McHale, Sue
Alopecia is a chronic disease of hair loss. The study focuses on psychological issues relating to the experience of alopecia. Previous research has considered psychological problems as secondary to the medical disorder. The first part consisted of spontaneous written accounts (N=162) of the experience of alopecia. The second part was an…
Reported Experiences of Persons with Alopecia Areata
ERIC Educational Resources Information Center
Hunt, Nigel; McHale, Sue
Alopecia is a chronic disease of hair loss. The study focuses on psychological issues relating to the experience of alopecia. Previous research has considered psychological problems as secondary to the medical disorder. The first part consisted of spontaneous written accounts (N = 62) of the experience of alopecia. The second part was an…
Personality Traits and Impairment Experiences of Abusive Drinkers.
ERIC Educational Resources Information Center
Giga, Susan; Redfering, David L.
Examined the relationship between personality traits and impairment experiences of 80 males who completed the California Psychological Inventory and an impairment scale. Results showed significant differences between the personality scores of impaired and unimpaired problem drinkers, suggesting that impairment aspects differ both in nature and…
Calibrating the physician. Personal awareness and effective patient care. Working Group on Promoting Physician Personal Awareness, American Academy on Physician and Patient.
Novack, D H; Suchman, A L; Clark, W; Epstein, R M; Najberg, E; Kaplan, C
Physicians' personal characteristics, their past experiences, values, attitudes, and biases can have important effects on communication with patients; being aware of these characteristics can enhance communication. Because medical training and continuing education programs rarely undertake an organized approach to promoting personal awareness, we propose a "curriculum" of 4 core topics for reflection and discussion. The topics are physicians' beliefs and attitudes, physicians' feelings and emotional responses in patient care, challenging clinical situations, and physician self-care. We present examples of organized activities that can promote physician personal awareness such as support groups, Balint groups, and discussions of meaningful experiences in medicine. Experience with these activities suggests that through enhancing personal awareness physicians can improve their clinical care and increase satisfaction with work, relationships, and themselves. PMID:9256226
Personal experience with 411 hepatic resections.
Iwatsuki, S; Starzl, T E
Over a 24-year period, 411 partial hepatic resections were performed: 142 right or left trisegmentectomies, 158 lobectomies, 25 segmentectomies, and 86 local excisions. The operations were performed for benign lesions in 182 patients, for primary hepatic malignancies in 106, and for hepatic metastases in 123, including 90 from colorectal cancers. The 30-day (operative) mortality rate was 3.2%, and there were an additional six late deaths (1.5%) due to hepatic failure caused by the resection. The highest operative mortality rate (6.3%) resulted from the trisegmentectomies, but this merely reflected the extent of the disease being treated. A mortality rate of 8.5% for patients with primary hepatic malignancy was associated not only with the extensiveness of lesions, but also with cirrhosis in the remaining liver fragment. There was no mortality for 123 patients with metastatic disease, 100 patients with cavernous hemangioma, 22 with liver cell adenoma, 17 with focal nodular hyperplasia, 16 with congenital cystic disease, and five with hydatid cysts. Trauma, pre-existing iatrogenic injury, and cirrhosis were the only conditions that had lethal portent in patients with benign disease. Furthermore, patients with benign disease who survived operation had minimal liability from recurrence of their original disease and none from the resection per se. By contrast, tumor recurrence dominated the actuarial survival rates for cancer patients, which at 1 and 5 years were 68.5% and 31.9%, respectively, after resection for primary hepatic malignancy, and 84.2% and 29.5%, respectively, for hepatic metastases. In this report, the expanding role of partial hepatectomy in the treatment of liver disease was emphasized, as well as the need for considering, in some cases, the alternative of total hepatectomy and liver replacement. Images Fig. 1. Fig. 2. Fig. 3. Fig. 4. Fig. 5. Fig. 9. PMID:3178330
State Effect of Traumatic Experience on Personality Structure
Lee, Hong-seock; Lee, Sang-Kyu; Lee, Heung-Pyo
Objective Personality is defined as the trait-like qualities of a person. However, it has been recently suggested that the state effect of a situation leads to changes in scores on personality assessments. We predicted that traumatic experiences would induce changes not only in personality scores but also in the factor structures of personality assessments. Methods MethodsaaWe conducted a cross-sectional, case-controlled study using two data sets: a traumatized adolescent sample (n=71) and a non-traumatized adolescent sample (n=296). Personality factor structures were compared between the two samples using exploratory factor analyses for 25 lower-ordered subscales of the Temperament and Character Inventory (TCI). In the non-traumatized sample, evaluation of the scree plot suggested a five-factor solution supporting TCI's original seven-factor model. Results The traumatized sample showed a three-factor structure representing a biological factor, a social factor and an existential factor. This decrease in number of personality factors was caused by strengthened correlations among personality subscales related to coping with traumatic situations. Cloninger's psychobiological model of personality (i.e., temperament-character) was adequate in capturing personality traits of non-traumatized adolescents, but the tripartite view of existential psychology (i.e., body-mind-spirit) clearly corresponded to the factor structure of the traumatized adolescents. Conclusion The three-factor solution of the present traumatized group is consistent with the tripartite model of personality (i.e., body-mind-spirit), while the five-factor solution of the non-traumatized group corresponds to Cloninger's seven-factor model. This is the first study to describe the state effects of traumatic experiences on personality structure. PMID:23251200
Personal History of Nucleon Polarization Experiments
DOE R&D Accomplishments Database
Chamberlain, O.
The history of nucleon scattering experiments is reviewed, starting with the observation of large proton polarizations in scattering from light elements such as carbon, and ending with the acceleration of polarized proton beams in high-energy synchrotrons. Special mention is made about significant contributions made by C.L. Oxley, L. Wolfenstein, R.D. Tripp, T. Ypsilantis, A. Abragam, M. Borghini, T. Niinikoski, Froissart, Stora, A.D. Krisch, and L.G. Ratner.
Art and astronomy: my personal experience
NASA Astrophysics Data System (ADS)
Astronomy and Art, two worlds seemingly opposite. One scientific and rigorous, the other perceived as light and whimsical. But if these two worlds were united? If art gave itself to the service of science? If fantasy became a playful pretext to transmit knowledge to young children? I recount here my experience, that of a meeting, and of an adventure. How and why an astronomy book for the very young emerged from the collaboration between a painter and an astronomer of the Observatory of Paris.
Lifetime experiences, the brain and personalized medicine: an integrative perspective.
McEwen, Bruce S; Getz, Linn
The aim of personalized medicine is to base medical prevention and therapy on the unique health and disease susceptibility profile of each individual. Starting from this idea, we briefly discuss the meaning of the word 'personalized' before analyzing the practical content of personalized healthcare. From a medical perspective, knowledge of a person encompasses both biological and biographical perspectives. The latter includes significant events and experiences throughout the person's lifespan, from conception to the present, in which epigenetic influences play an important role. In practice, we believe personalized medicine should emphasize the development and maintenance of a healthy nervous system. The neurobiological processes involved here depend heavily on the psychosocial environment, in particular the presence of responsible, caring adults and integration in a reasonably fair society. A healthy brain subsequently promotes good health throughout life, both through direct, favorable influences on the body's intrinsic biological pathways, and indirectly by enabling the person to engage in supportive relationships, make wise decisions and take good care of him/herself. From a public health perspective, we conclude that hi-tech personalized medicine based on detailed bio-molecular mapping, monitoring and tailored drug interventions holds promise only as part of a wider, socio-culturally informed approach to the person. PMID:23009787
Pharmacogenomics in Pediatric Patients: Towards Personalized Medicine.
Maagdenberg, Hedy; Vijverberg, Susanne J H; Bierings, Marc B; Carleton, Bruce C; Arets, Hubertus G M; de Boer, Anthonius; Maitland-van der Zee, Anke H
It is well known that drug responses differ among patients with regard to dose requirements, efficacy, and adverse drug reactions (ADRs). The differences in drug responses are partially explained by genetic variation. This paper highlights some examples of areas in which the different responses (dose, efficacy, and ADRs) are studied in children, including cancer (cisplatin), thrombosis (vitamin K antagonists), and asthma (long-acting β2 agonists). For childhood cancer, the replication of data is challenging due to a high heterogeneity in study populations, which is mostly due to all the different treatment protocols. For example, the replication cohorts of the association of variants in TPMT and COMT with cisplatin-induced ototoxicity gave conflicting results, possibly as a result of this heterogeneity. For the vitamin K antagonists, the evidence of the association between variants in VKORC1 and CYP2C9 and the dose is clear. Genetic dosing models have been developed, but the implementation is held back by the impossibility of conducting a randomized controlled trial with such a small and diverse population. For the long-acting β2 agonists, there is enough evidence for the association between variant ADRB2 Arg16 and treatment response to start clinical trials to assess clinical value and cost effectiveness of genotyping. However, further research is still needed to define the different asthma phenotypes to study associations in comparable cohorts. These examples show the challenges which are encountered in pediatric pharmacogenomic studies. They also display the importance of collaborations to obtain good quality evidence for the implementation of genetic testing in clinical practice to optimize and personalize treatment. PMID:27142473
Openness to Experience as a Basic Dimension of Personality.
ERIC Educational Resources Information Center
McCrae, Robert R.
This paper opens by describing research since 1975 (McCrae and Costa) on a set of related traits that identified as aspects of Openness to Experience. The historic roots of the concept of Openness to Experience are traced. Data are provided on the convergent and discriminant validity of the six Revised NEO-Personality Inventory facets of Fantasy,…
How Are Transpersonal Experience and Personal Maturity Related?
ERIC Educational Resources Information Center
Koltko, Mark Edward
This study examined one of the fundamental questions in humanistic and transpersonal psychology: what kind of relationship exists between transcendent experience and personal psychological well-being? College undergraduates (N=92) at three colleges were asked to recall their "most wonderful" experience, and then to complete an adaptation of Hood's…
Exploring Sensory Experiences and Personalization in an Inpatient Residential Hospice Setting.
Niedzielski, Oksana K; Rodin, Gary; Emmerson, Debbie; Rutgers, Job; Sellen, Katherine M
Residential hospices are often purpose-built to enhance the experience of patients and families. However, there has been relatively little research on ambient and sensory experiences of patients and families. This study explored the ambient and sensory experience of residents and families in a residential hospice. Hospice users participated in personalizing environments and experiences, adapting and developing rituals, and enjoying the experience (including smells and sounds) of communal spaces and private rooms. Opportunity for developing new rituals, in particular, suggests an environment supportive of sense of control, social support, and positive distractors. The design of an inpatient hospice can offer a platform through which to support the delivery of flexible care practices, providing opportunities for personal expression, shared experiences, and the maintenance or development of rituals. PMID:26809827
Facial rejuvenation and light: our personal experience.
Trelles, Mario A; Mordon, Serge; Calderhead, R Glen
The treatment of ageing skin remains a very hot topic, and many systems have been reported as having varying degrees of success. Nonablative lasers were developed to avoid the problematic and uncomfortable sequelae following laser ablative resurfacing, and while there was no downtime, there was also poor patient satisfaction. The same was true of the intense pulsed light systems. The use of different modalities in various combinations was found to offer much better results, however, such as a 595-nm pulsed dye laser followed by a 1,450-nm diode laser, and so on, all used at subablative thresholds. The recent entry of blue and infrared tunable plasma light and light-emitting diodes into the skin rejuvenation arena has attracted a great deal of attention. The authors suggest that no single modality can accomplish all the complex events required for effective skin rejuvenation, suggest that combination phototherapy is the best approach combined with an adjunctive epidermal care regimen, and demonstrate their development of this methodology. PMID:17122954
Striving to maintain a dignified life for the patient in transition: Next of kin's experiences during the transition process of an older person in transition from hospital to home
Hvalvik, Sigrun; Reierson, Inger Å.
Next of kin represent significant resources in the care for older patients. The aim of this study was to describe and illuminate the meaning of the next of kin's experiences during the transition of an older person with continuing care needs from hospital to home. The study has a phenomenological hermeneutic design. Individual, narrative interviews were conducted, and the data analysis was conducted in accordance with Lindseth and Norberg's phenomenological hermeneutic method. Two themes and four subthemes were identified and formulated. The first theme: "Balancing vulnerability and strength," encompassed the subthemes "enduring emotional stress" and "striving to maintain security and continuity." The second theme: "Coping with an altered everyday life," encompassed "dealing with changes" and "being in readiness." Our findings suggest that the next of kin in striving to maintain continuity and safety in the older person's transition process are both vulnerable individuals and significant agents. Thus, it is urgent that health care providers accommodate both their vulnerability and their abilities to act, and thereby make them feel valued as respected agents and human beings in the transition process. PMID:25746043
Spinal cord injury rehabilitation. 4. Individual experience, personal adaptation, and social perspectives.
Stiens, S A; Bergman, S B; Formal, C S
This learner-directed module highlights contemporary perspectives on personal success in the adjustment and adaptation of patients with spinal cord injury (SCI). It is the fourth in a series of five modules within the chapter on spinal cord injury rehabilitation in the Self-Directed Physiatric Education Program for practitioners and trainees in physical medicine and rehabilitation. This module explores models of the multisystem effects on a person after SCI, disablement, theories of adjustment, patient autonomy, quality of life, community experience, adaptations enhancing sexuality, and minimization of pain after SCI. Perspectives of the patient's experience in disablement, interdisciplinary person-centered rehabilitation, and success of the individual in chosen life roles are emphasized. The module is designed to update SCI issues reviewed in past syllabi. PMID:9084370
Sibling Experiences: Living with Young Persons with Autism Spectrum Disorders.
Ward, Beth; Tanner, Brianna Smith; Mandleco, Barbara; Dyches, Tina T; Freeborn, Donna
Like other young people, those with autism spectrum disorder (ASD) have an impact on siblings in both positive and negative ways. Research indicates positive attributes include maturity and responsibility; positive self-concept; less quarrelling and competition; admiration for the person with ASD; and satisfactory sibling relationships. Negative attributes include fear of frightening or violent behavior, decreased sibling intimacy, and social and emotional difficulties. However, most research relies on information from parents/teachers, rather than from siblings. Therefore, this qualitative descriptive study explored experiences of 11 brothers and 11 sisters living with a young person with ASD through audiorecorded semi-structured interviews. Analysis revealed the overall theme was contradiction. Participants recognized difficulties (decreased parental attention, extra responsibility, bothersome behaviors, communication difficulties) and positive aspects (became empathetic, loved and appreciated the child, realized the experience was life-changing) of living with a young person with ASD. Younger siblings frequently reflected on childhood experiences, wished they could play together, and mentioned what the young person could do. Adolescent siblings learned life lessons from the experience, talked about life changes when ASD was diagnosed, and seemed introspective and protective toward the young person with ASD. Male siblings often wished they played more often while growing up with the young person, and frequently mentioned the child/adolescent's aggressive behaviors; female siblings focused on relationship and communication difficulties of the young person ASD. Interventions to help siblings provide positive behavioral support, engage in developmentally appropriate play, and communicate reciprocally are warranted. Nurses can help parents understand siblings' perceptions and can encourage parents to support siblings. PMID:27254975
Early Family Environments and Traumatic Experiences Associated with Borderline Personality Disorder.
ERIC Educational Resources Information Center
Weaver, Terri L.; Clum, George A.
Assessed childhood trauma experiences (sexual abuse, physical abuse, witnessed violence, early separation) and family environment characteristics of 17 depressed female patients with borderline personality disorder (BPD) and 19 without BPD. Significantly, more BPD subjects reported histories of sexual abuse, physical abuse, and witnessed violence.…
[Personal experience in the surgery of nasal sinus polyps].
García Juncal, J; Soto Sánchez, C; Farina Conde, J; Rodríguez Alvarez, E; Estrada Gromaz, J
Personal opinions on surgery of polyps of the nasal cavity and paranasal sinuses, including from simple polypectomy to ethmoid microsurgery and nasal endoscopic surgery. The diagnostic importance of tomodensitometry and the essential postsurgical care are emphasized. The results of 29 patients with polyps of the nasal cavity and paranasal sinuses treated with intranasal microsurgery and endoscopic surgery are reported. PMID:8068361
Experiences of female partners of masculine identifying trans persons
Theron, Liesl; Collier, Kate L.
This study explores the intimate relationship experiences of cisgender (i.e., not transgender) female partners of masculine identifying transgender persons, with a particular focus on these partners' self-understanding of their sexual orientation. Limited research about this topic has been conducted to date. Semi-structured interviews were conducted with eight South African women who are or have been cisgender female partners of masculine identifying trans persons. Although the interviews showed that the relationship experiences of female partners of masculine identifying trans persons are diverse, several common themes emerged in the narratives. The way that participants labelled their sexual orientation did not change from before to after their relationship with a transgender partner. The participants reported varied family and community responses to their relationships. Specific emotional and informational support needs for women with transgender partners were identified. PMID:23668602
Crucial dimensions constituting dignity experience in persons living with dementia.
Tranvåg, Oscar; Petersen, Karin Anna; Nåden, Dagfinn
Dignity is seen as an essential need, fundamental right, and inherent quality of each human being. There is however, a need for increased knowledge on crucial dimensions constituting dignity experience in persons living with dementia. This study explored personal dimensions of life which persons with dementia perceived crucial for experiencing dignity in their daily lives. Based on the findings of eight empirical sub-dimensions, three main dimensions crucial for constituting dignity experience, were identified through hermeneutical interpretation: A historical dignity-dimension, acknowledging one's own life-projects and life-history; an intrapersonal dignity-dimension, recognizing one's own human worth, and living according to internal values; and an interpersonal dignity-dimension, experiencing being part of a caring and confirming communion. Knowledge of dignity preservation should be a crucial foundation for future dementia care. PMID:24742877
Personality traits and developmental experiences as antecedents of childbearing motivation.
Miller, W B
Childbearing motivation may be conceptualized as based upon psychological traits and shaped by experiences during childhood, adolescence, and early adult life. This paper explores what those traits and developmental experiences are. Two measures of childbearing motivation, one positive and the other negative, are described. Using a sample of 362 married men and 354 married women, the paper systematically examines the factors associated with these measures. In addition to a set of basic personality traits, these factors include parental characteristics, teenage experiences, and a number of variables from young adult behavior domains such as marriage, education, work, religion, and parental relationships. Stepwise multiple regression analyses lead to two final constrained, simultaneous-equation regression models. These models indicate the importance of both personality traits and diverse life-cycle experiences in the development of childbearing motivation, the differential gender distribution of predictors, and the different experiential antecedents of positive and negative motivation. PMID:1607052
ERIC Educational Resources Information Center
Shore, Rebecca Martin
Describes how a typical high school in Huntington Beach, California, curbed disruptive student behavior by personalizing the school experience for "problem" students. Through mostly volunteer efforts, an adopt-a-kid program was initiated that matched kids' learning styles to adults' personality styles and resulted in fewer suspensions and numerous…
Tech for Patient Engagement: Make it Personal!
Felkey, Bill G.; Fox, Brent I.
The quest for a reformed health care system in which patients are engaged and are active participants is clearly a marathon, not a sprint. In this article, we go beyond channel management, which we addressed previously, and focus on the content of communication exchanges that you will have with patients. PMID:24421486
Visualizing desirable patient healthcare experiences.
Liu, Sandra S; Kim, Hyung T; Chen, Jie; An, Lingling
High healthcare cost has drawn much attention and healthcare service providers (HSPs) are expected to deliver high-quality and consistent care. Therefore, an intimate understanding of the most desirable experience from a patient's and/or family's perspective as well as effective mapping and communication of such findings should facilitate HSPs' efforts in attaining sustainable competitive advantage in an increasingly discerning environment. This study describes (a) the critical quality attributes (CQAs) of the experience desired by patients and (b) the application of two visualization tools that are relatively new to the healthcare sector, namely the "spider-web diagram" and "promotion and detraction matrix." The visualization tools are tested with primary data collected from telephone surveys of 1,800 patients who had received care during calendar year 2005 at 6 of 61 hospitals within St. Louis, Missouri-based, Ascension Health. Five CQAs were found by factor analysis. The spider-web diagram illustrates that communication and empowerment and compassionate and respectful care are the most important CQAs, and accordingly, the promotion and detraction matrix shows those attributes that have the greatest effect for creating promoters, preventing detractors, and improving consumer's likelihood to recommend the healthcare provider. PMID:20155554
Imagining Other People's Experiences in a Person with Impaired Episodic Memory: The Role of Personal Familiarity
Rabin, Jennifer S.; Carson, Nicole; Gilboa, Asaf; Stuss, Donald T.; Rosenbaum, R. Shayna
Difficulties remembering one's own experiences via episodic memory may affect the ability to imagine other people's experiences during theory of mind (ToM). Previous work shows that the same set of brain regions recruited during tests of episodic memory and future imagining are also engaged during standard laboratory tests of ToM. However, hippocampal amnesic patients who show deficits in past and future thinking, show intact performance on ToM tests, which involve unknown people or fictional characters. Here we present data from a developmental amnesic person (H.C.) and a group of demographically matched controls, who were tested on a naturalistic test of ToM that involved describing other people's experiences in response to photos of personally familiar others ("pToM" condition) and unfamiliar others ("ToM" condition). We also included a condition that involved recollecting past experiences in response to personal photos ("EM" condition). Narratives were scored using an adapted Autobiographical Interview scoring procedure. Due to the visually rich stimuli, internal details were further classified as either descriptive (i.e., details that describe the visual content of the photo) or elaborative (i.e., details that go beyond what is visually depicted in the photo). Relative to controls, H.C. generated significantly fewer elaborative details in response to the pToM and EM photos and an equivalent number of elaborative details in response to the ToM photos. These data converge with previous neuroimaging results showing that the brain regions underlying pToM and episodic memory overlap to a greater extent than those supporting ToM. Taken together, these results suggest that detailed episodic representations supported by the hippocampus may be pivotal for imagining the experiences of personally familiar, but not unfamiliar, others. PMID:23355827
Real-life experience with personally familiar faces enhances discrimination based on global information
Van Belle, Goedele
Despite the agreement that experience with faces leads to more efficient processing, the underlying mechanisms remain largely unknown. Building on empirical evidence from unfamiliar face processing in healthy populations and neuropsychological patients, the present experiment tested the hypothesis that personal familiarity is associated with superior discrimination when identity information is derived based on global, as opposed to local facial information. Diagnosticity and availability of local and global information was manipulated through varied physical similarity and spatial resolution of morph faces created from personally familiar or unfamiliar faces. We found that discrimination of subtle changes between highly similar morph faces was unaffected by familiarity. Contrariwise, relatively more pronounced physical (i.e., identity) differences were more efficiently discriminated for personally familiar faces, indicating more efficient processing of global, as opposed to local facial information through real-life experience. PMID:26855852
Predictors of comorbid personality disorders in patients with panic disorder with agoraphobia.
Latas, M; Starcevic, V; Trajkovic, G; Bogojevic, G
The aim of this study was to ascertain predictors of comorbid personality disorders in patients with panic disorder with agoraphobia (PDAG). Sixty consecutive outpatients with PDAG were administered the Structured Clinical Interview for DSM-IV Axis II Personality Disorders (SCID-II) for the purpose of diagnosing personality disorders. Logistic regressions were used to identify predictors of any comorbid personality disorder, any DSM-IV cluster A, cluster B, and cluster C personality disorder. Independent variables in these regressions were gender, age, duration of panic disorder (PD), severity of PDAG, and scores on self-report instruments that assess the patient's perception of their parents, childhood separation anxiety, and traumatic experiences. High levels of parental protection on the Parental Bonding Instrument (PBI), indicating a perception of the parents as overprotective and controlling, emerged as the only statistically significant predictor of any comorbid personality disorder. This finding was attributed to the association between parental overprotection and cluster B personality disorders, particularly borderline personality disorder. The duration of PD was a significant predictor of any cluster B and any cluster C personality disorder, suggesting that some of the cluster B and cluster C personality disorders may be a consequence of the long-lasting PDAG. Any cluster B personality disorder was also associated with younger age. In conclusion, despite a generally nonspecific nature of the relationship between parental overprotection in childhood and adult psychopathology, the findings of this study suggest some specificity for the association between parental overprotection in childhood and personality disturbance in PDAG patients, particularly cluster B personality disorders. PMID:10646616
Personal Traits Underlying Environmental Preferences: A Discrete Choice Experiment
Soliño, Mario; Farizo, Begoña A.
Personality plays a role in human behavior, and thus can influence consumer decisions on environmental goods and services. This paper analyses the influence of the big five personality dimensions (extraversion, agreeableness, conscientiousness, neuroticism and openness) in a discrete choice experiment dealing with preferences for the development of an environmental program for forest management in Spain. For this purpose, a reduced version of the Big Five Inventory survey (the BFI-10) is implemented. Results show a positive effect of openness and extraversion and a negative effect of agreeableness and neuroticism in consumers' preferences for this environmental program. Moreover, results from a latent class model show that personal traits help to explain preference heterogeneity. PMID:24586905
Personal traits underlying environmental preferences: a discrete choice experiment.
Soliño, Mario; Farizo, Begoña A
Personality plays a role in human behavior, and thus can influence consumer decisions on environmental goods and services. This paper analyses the influence of the big five personality dimensions (extraversion, agreeableness, conscientiousness, neuroticism and openness) in a discrete choice experiment dealing with preferences for the development of an environmental program for forest management in Spain. For this purpose, a reduced version of the Big Five Inventory survey (the BFI-10) is implemented. Results show a positive effect of openness and extraversion and a negative effect of agreeableness and neuroticism in consumers' preferences for this environmental program. Moreover, results from a latent class model show that personal traits help to explain preference heterogeneity. PMID:24586905
[The satisfaction of personal needs in patients with pulmonary tuberculosis].
Sukhova, E V
The founder of humanistic psychology A. Maslow divided the needs of a personality into several levels--from the lowest to the highest ones. Higher-leveled needs rise when the lower-leveled needs are satisfied. A great deal of factors affect the origination and satisfaction of needs, but they are always interrelated with social values. The extent to which personality needs are satisfied in patients with pulmonary tuberculosis has not been studied. A special questionnaire has been drawn up to study the extent to which personality needs are met. Its suitability has been determined, by using a group of patients with bronchial asthma. The extent to which personality needs are satisfied in patients with pulmonary tuberculosis was studied in 178 patients with infiltrative pulmonary tuberculosis and 253 patients with fibrocavernous pulmonary tuberculosis. The results have shown that the extent to which personality needs are satisfied in patients with tuberculosis is lower than that in apparently healthy individuals of the same social status. In females with infiltrative pulmonary tuberculosis, the needs for safety are satisfied to a lesser extent. In those with fibrocavernous pulmonary tuberculosis, the extent to which the physiological, safety, and self-realization needs is decreased. In males with infiltrative pulmonary tuberculosis, the physiological, noetic, and self-realization needs are satisfied to a lesser extent. In those with fibrocavernous pulmonary tuberculosis, the extent to which the physiological, safety, group decision-making, noetic and self-realization needs is decreased. PMID:15801639
Infection control: maintaining the personal hygiene of patients and staff.
Parker, Lynn
This article concentrates on the importance of personal hygiene for staff and patients in reducing the risk of healthcare-associated infections for patients. It provides an historical context to the associated risks of "basic nursing care" and how these can be counteracted. With the introduction of modern matrons and directors of infection control, emphasis is again focused on these practices. PMID:15150465
An exploration of links between early parenting experiences and personality disorder type and disordered personality functioning.
Parker, G; Roy, K; Wilhelm, K; Mitchell, P; Austin, M P; Hadzi-Pavlovic, D
Reports of early parenting were assessed using two measures, the Parental Bonding Index (PBI) and the Measure of Parenting Style (MOPS), in a sample of 265 patients with DSM-defined major depressive disorder. Psychiatrists then rated the extent to which sample members evidenced the personality "styles" underpinning 15 separate personality disorders, returning personality vignette scores. The extent of disordered functioning was also assessed across "parameters" and "domains" by psychiatrists, referrers, and family members, using a range of measures. Those with higher scores on vignettes measuring borderline, anxious, depressive, and self-defeating personality style rated parents as uncaring, overcontrolling, and abusive. When vignettes were consolidated into scores akin to the DSM clusters, the most consistent links between perceived dysfunctional parenting were with the Cluster C (anxious), and Cluster B (dramatic) styles and were nonsignificant for Cluster A (eccentric) style. Meeting criteria for an increasing number of personality disorder clusters was associated with increasing levels of adverse parenting. Multiple regression analyses indicated that disordered functioning (as assessed by the three independent rater groups) was most distinctly associated with paternal indifference and maternal overcontrol. PMID:10633316
Decision support system based semantic web for personalized patient care.
Douali, Nassim; De Roo, Jos; Jaulent, Marie-Christine
Personalized medicine may be considered an extension of traditional approaches to understanding and treating diseases, but with greater precision. A profile of a patient's genetic variation can guide the selection of drugs or treatment protocols that minimize harmful side effects or ensure a more successful outcome. In this paper we describe a decision support system designed to assist physicians for personalized care, and methodology for integration in the clinical workflow. A reasoning method for interacting heterogeneous knowledge and data is a necessity in the context of personalized medicine. Development of clinical decision support based semantic web for personalized patient care is to achieve its potential and improve the quality, safety and efficiency of healthcare. PMID:22874401
Borderline personality features in depressed or anxious patients.
Distel, Marijn A; Smit, Johannes H; Spinhoven, Philip; Penninx, Brenda W J H
Anxiety and depression frequently co-occur with borderline personality disorder. Relatively little research examined the presence of borderline personality features and its main domains (affective instability, identity problems, negative relationships and self-harm) in individuals with remitted and current anxiety and depression. Participants with current (n=597) or remitted (n=1115) anxiety and/or depression and healthy controls (n=431) were selected from the Netherlands Study of Depression and Anxiety. Assessments included the Personality Assessment Inventory - Borderline Features Scale and several clinical characteristics of anxiety and depression. Borderline personality features were more common in depression than in anxiety. Current comorbid anxiety and depression was associated with most borderline personality features. Anxiety and depression status explained 29.7% of the variance in borderline personality features and 3.8% (self-harm) to 31% (identity problems) of the variance in the four domains. A large part of the variance was shared between anxiety and depression but both disorders also explained a significant amount of unique variance. The severity of anxiety and depression and the level of daily dysfunctioning was positively associated with borderline personality features. Individuals with a longer duration of anxiety and depression showed more affective instability and identity problems. These findings suggest that patients with anxiety and depression may benefit from an assessment of personality pathology as it may have implications for psychological and pharmacological treatment. PMID:27183108
Pending appendicectomy: a personal experience and review of a doctor's own illness.
Hariri, Ahmad; Hay, Alexandra Naomi
Doctors will inevitably 1 day become patients. Whether as an acute emergency or as part of routine screening, doctors often find it difficult to recognise and act on their own healthcare needs. This article aims to provide a personal account and reflections from the point of view of a doctor in denial about his acute appendicitis, and a friend and fellow colleague's attempts to convince him to seek help. We review the challenges, learning points and literature about why doctors ignore their health needs, both physical and psychological, and suggest potential changes to tackle this issue based on the current literature, support networks and personal experiences. PMID:27174455
Carlson, Erika N.; Oltmanns, Thomas F.
Do people with personality problems have insight into how others experience them? In a large community sample of adults (N = 641), the authors examined whether people with personality disorder (PD) symptoms were aware of how a close acquaintance (i.e., a romantic partner, family member, or friend) perceived them by measuring participants' metaperceptions and self-perceptions as well as their acquaintance's impression of them on Five-Factor Model traits. Compared to people with fewer PD symptoms, people with more PD symptoms tended to be less accurate and tended to overestimate the negativity of the impressions they made on their acquaintance, especially for the traits of extraversion, agreeableness, and conscientiousness. Interestingly, these individuals did not necessarily assume that their acquaintance perceived them as they perceived themselves; instead, poor insight was likely due to their inability to detect or utilize information other than their self-perceptions. Implications for the conceptualization, measurement, and treatment of PDs are discussed. PMID:26200846
The Role of Metaperception in Personality Disorders: Do People with Personality Problems Know How Others Experience Their Personality?
Carlson, Erika N; Oltmanns, Thomas F
Do people with personality problems have insight into how others experience them? In a large community sample of adults (N = 641), the authors examined whether people with personality disorder (PD) symptoms were aware of how a close acquaintance (i.e., a romantic partner, family member, or friend) perceived them by measuring participants' metaperceptions and self-perceptions as well as their acquaintance's impression of them on Five-Factor Model traits. Compared to people with fewer PD symptoms, people with more PD symptoms tended to be less accurate and tended to overestimate the negativity of the impressions they made on their acquaintance, especially for the traits of extraversion, agreeableness, and conscientiousness. Interestingly, these individuals did not necessarily assume that their acquaintance perceived them as they perceived themselves; instead, poor insight was likely due to their inability to detect or utilize information other than their self-perceptions. Implications for the conceptualization, measurement, and treatment of PDs are discussed. PMID:26200846
Experiences of identification and differentiation as functions of leprosy, personality and age.
Chauhan, N S; Dhar, U; Singh, Y
It is a study of sociogenic need satisfactions that determines the homeostasis of 'being' by remaining contingent conditions of perpetuation or debasement of the social 'self'. The paper has a focus on identification satisfaction and differentiation experience of patients of the highly stigmatized leprosy. The study proceeds with an 'Experimental Group--Control-Group' randomized design. Experimental Groups are two, viz., those of Lepromatous and Non-lepromatous patients. 'Control Group' consists of 'disease-free' normal people. The three independent variables are disease types, age, personality factors. The dependent variables are two, viz., score of identification satisfaction and differentiation experience, measured by standardized tools. Each dependent variable has four '3 X 3 X 2' factorial experiments to test 56 'Null Hypotheses'. The sample consists of 360 elements for each one of the eight experiments. Leprosy elements are drawn from the Central JALMA Institute for Leprosy and the 'Kushta Seva Sadan' (Agra). The 'F' test is run for statistical verification of 'Null hypotheses'. Results show presence of 'role-reversion' and 'role negation' of age and personality factors. The disease possesses 'anti-roles'. It does not allow age and personality factors to promote identification satisfaction and to demote differentiation and experience. The disease actively promotes differentiation and demotes identification through its own 'alien system'. The senescents are the greatest sufferers. 'Social Stigma' works a 'social thanatos' and exposes senescents to substantial 'self-erosion'. PMID:6548499
Shared Negative Experiences Lead to Identity Fusion via Personal Reflection.
Jong, Jonathan; Whitehouse, Harvey; Kavanagh, Christopher; Lane, Justin
Across three studies, we examined the role of shared negative experiences in the formation of strong social bonds--identity fusion--previously associated with individuals' willingness to self-sacrifice for the sake of their groups. Studies 1 and 2 were correlational studies conducted on two different populations. In Study 1, we found that the extent to which Northern Irish Republicans and Unionists experienced shared negative experiences was associated with levels of identity fusion, and that this relationship was mediated by their reflection on these experiences. In Study 2, we replicated this finding among Bostonians, looking at their experiences of the 2013 Boston Marathon Bombings. These correlational studies provide initial evidence for the plausibility of our causal model; however, an experiment was required for a more direct test. Thus, in Study 3, we experimentally manipulated the salience of the Boston Marathon Bombings, and found that this increased state levels of identity fusion among those who experienced it negatively. Taken together, these three studies provide evidence that shared negative experience leads to identity fusion, and that this process involves personal reflection. PMID:26699364
Shared Negative Experiences Lead to Identity Fusion via Personal Reflection
Jong, Jonathan; Whitehouse, Harvey; Kavanagh, Christopher; Lane, Justin
Across three studies, we examined the role of shared negative experiences in the formation of strong social bonds—identity fusion—previously associated with individuals' willingness to self-sacrifice for the sake of their groups. Studies 1 and 2 were correlational studies conducted on two different populations. In Study 1, we found that the extent to which Northern Irish Republicans and Unionists experienced shared negative experiences was associated with levels of identity fusion, and that this relationship was mediated by their reflection on these experiences. In Study 2, we replicated this finding among Bostonians, looking at their experiences of the 2013 Boston Marathon Bombings. These correlational studies provide initial evidence for the plausibility of our causal model; however, an experiment was required for a more direct test. Thus, in Study 3, we experimentally manipulated the salience of the Boston Marathon Bombings, and found that this increased state levels of identity fusion among those who experienced it negatively. Taken together, these three studies provide evidence that shared negative experience leads to identity fusion, and that this process involves personal reflection. PMID:26699364
The lived experience of physicians dealing with patient death
Whitehead, Paul Richard
Background A growing body of research indicates that physicians suffer high levels of stress, depression and burnout. Related literature has found that physician stress can negatively impact patient care. This study builds upon previous research that found some dying patients experienced 'iatrogenic suffering' caused by the way physicians communicated with them regarding terminal diagnoses and palliative treatment. The goal of this research was to explore physicians' experiences of dealing with patient death in order to understand how such experiences affect them and their communication with patients. Methods This study used qualitative methods to conduct and analyse 10 individual, semistructured interviews with senior physicians from several specialty areas at a large, tertiary care hospital. The resulting themes were validated using member checks and expert review. Results This article presents five essential themes that provide a concise description of the lived experience of patient death for these physicians. Interpretation: These themes indicate that physicians can experience very strong and lasting emotional reactions to some patient deaths, and also that patient death can elicit intense experiences related to professional responsibility and competence. A key finding is the description of a complex process of managing the balance between personal and professional reactions in the face of patient death. The implication is that difficulties negotiating this balance may lead to unintended lapses in compassion and suboptimal outcomes in patient care. PMID:24644159
African American Women's Breastfeeding Experiences: Cultural, Personal, and Political Voices.
Spencer, Becky; Wambach, Karen; Domain, Elaine Williams
The low rate of breastfeeding among African American women in the United States is a poorly understood, persistent disparity. Our purpose in this study was to gain an understanding of how African American women experience breastfeeding in the context of their day-to-day lives. The Sequential-Consensual Qualitative Design (SCQD), a 3-stage qualitative methodology aimed at exploring the cultural, personal, and political context of phenomena, was used to explore the experiences of African American women who felt successful with breastfeeding. An integration of qualitative content analysis and Black feminist theory was used to analyze the data. Themes that emerged from Stage-2 data analysis included self-determination, spirituality and breastfeeding, and empowerment. In Stage 3 of the study, participant recommendations regarding breastfeeding promotion and support initiatives for African American breastfeeding were categorized into three themes, including engaging spheres of influence, sparking breastfeeding activism, and addressing images of the sexual breast vs. the nurturing breast. PMID:25288408
Pharmacologic approaches to treatment resistant depression: Evidences and personal experience
Tundo, Antonio; de Filippis, Rocco; Proietti, Luca
AIM: To review evidence supporting pharmacological treatments for treatment-resistant depression (TRD) and to discuss them according to personal clinical experience. METHODS: Original studies, clinical trials, systematic reviews, and meta-analyses addressing pharmacological treatment for TRD in adult patients published from 1990 to 2013 were identified by data base queries (PubMed, Google Scholar e Quertle Searches) using terms: "treatment resistant depression", "treatment refractory depression", "partial response depression", "non responder depression", "optimization strategy", "switching strategy", "combination strategy", "augmentation strategy", selective serotonin reuptake inhibitors antidepressants (SSRI), tricyclic antidepressants (TCA), serotonin norepinephrine reuptake inhibitors antidepressants, mirtazapine, mianserine, bupropione, monoamine oxidase inhibitor antidepressant (MAOI), lithium, thyroid hormones, second generation antipsychotics (SGA), dopamine agonists, lamotrigine, psychostimulants, dextromethorphan, dextrorphan, ketamine, omega-3 fatty acids, S-adenosil-L-metionine, methylfolat, pindolol, sex steroids, glucocorticoid agents. Other citations of interest were further identified from references reported in the accessed articles. Selected publications were grouped by treatment strategy: (1) switching from an ineffective antidepressant (AD) to a new AD from a similar or different class; (2) combining the current AD regimen with a second AD from a different class; and (3) augmenting the current AD regimen with a second agent not thought to be an antidepressant itself. RESULTS: Switching from a TCA to another TCA provides only a modest advantage (response rate 9%-27%), while switching from a SSRI to another SSRI is more advantageous (response rate up to 75%). Evidence supports the usefulness of switching from SSRI to venlafaxine (5 positive trials out 6), TCA (2 positive trials out 3), and MAOI (2 positive trials out
An epidemiological perspective of personalized medicine: the Estonian experience
Milani, L; Leitsalu, L; Metspalu, A
Milani L, Leitsalu L, Metspalu A (University of Tartu). An epidemiological perspective of personalized medicine: the Estonian experience (Review). J Intern Med 2015; 277: 188–200. The Estonian Biobank and several other biobanks established over a decade ago are now starting to yield valuable longitudinal follow-up data for large numbers of individuals. These samples have been used in hundreds of different genome-wide association studies, resulting in the identification of reliable disease-associated variants. The focus of genomic research has started to shift from identifying genetic and nongenetic risk factors associated with common complex diseases to understanding the underlying mechanisms of the diseases and suggesting novel targets for therapy. However, translation of findings from genomic research into medical practice is still lagging, mainly due to insufficient evidence of clinical validity and utility. In this review, we examine the different elements required for the implementation of personalized medicine based on genomic information. First, biobanks and genome centres are required and have been established for the high-throughput genomic screening of large numbers of samples. Secondly, the combination of susceptibility alleles into polygenic risk scores has improved risk prediction of cardiovascular disease, breast cancer and several other diseases. Finally, national health information systems are being developed internationally, to combine data from electronic medical records from different sources, and also to gradually incorporate genomic information. We focus on the experience in Estonia, one of several countries with national goals towards more personalized health care based on genomic information, where the unique combination of elements required to accomplish this goal are already in place. PMID:25339628
Energy-efficient MAC Protocol for Patient Personal Area Networks.
Lamprinos, I; Prentza, A; Sakka, E; Koutsouris, D
The formulation of a Personal Area Network (PAN), consisting of a wireless infrastructure of medical sensors, attached to patient's body, and a supervising device carried by them, lays the path for continuous and real-time monitoring of vital signs without discomforting the person in question. This infrastructure enhances the context of remote healthcare services by supporting flexible acquisition of crucial vital signs, while at the same time it provides more convenience to the patient. Aiming at the exploitation of the inherent features and requirements of wireless medical sensor networks, in this paper we focus on the main design guidelines of a low power Medium Access Control (MAC) protocol, designated to support a patient PAN. The proposed protocol intends to improve energy efficiency in such applications and thus is oriented towards the prevention of main energy wastage sources, such as collision, idle listening and power outspending. PMID:17281057
[Personalized medicine from the viewpoint of patients and their relatives].
Pogány, Gábor
Our goal was to overview the situation of personalized medicine, especially to characterize the role of patient organizations. We embedded this process into the on-going procedures of the transformation of health care system, outlining the Hungarian and international tendencies. We introduce the exceptional role of rare diseases, among others the rare cancers, thanks to their special status. Some results of the recent Hungarian and international surveys are also demonstrated. The presented global tendencies give the frame for the necessary alteration of the Hungarian health care system. Beside the solution of the country-specific problems of our health care system, the main principles of the new paradigm of 21st century medicine are also influencing: personalized, participatory, preventive, predictive and proactive. The new medicine is continuously associated with the patients, instead of separated interventions. The changing of attitude is necessary for spreading these principles and also gives the basis of future medical service of society. The role of patient organizations is vital during this progress. The development is possible to the direction of patient-centred health care model by changing the structure of residential expenditure, even during the time of global financial crisis. However, a stronger community involvement is required. Good examples of this patient organization involvement are presented in the case of rare diseases, which can be, together with orphan drugs, the precursors to personalized medicine, paving the path to this direction. A closer participation of patients and their organizations is essential to transform the present health care system to the route of personalized medicine and to alter the public outlook. PMID:23573516
Anesthesia in a patient with Stiff Person Syndrome.
Yagan, Ozgur; Özyilmaz, Kadir; Özmaden, Ahmet; Sayin, Özgür; Hanci, Volkan
Stiff Person Syndrome (SPS), typified by rigidity in muscles of the torso and extremities and painful episodic spasms, is a rare autoimmune-based neurological disease. Here we present the successful endotracheal intubation and application of TIVA without muscle relaxants on an SPS patient. A 46 years old male patient was operated with ASA-II physical status because of lumber vertebral compression fracture. After induction of anesthesia using lidocaine, propofol and remifentanil tracheal intubation was completed easily without neuromuscular blockage. Anesthesia was maintained with propofol, remifentanil and O2/air mixture. After a problem-free intraoperative period the patient was extubated and seven days later was discharged walking with aid. Though the mechanism is not clear neuromuscular blockers and volatile anesthetics may cause prolonged hypotonia in patients with SPS. We think the TIVA technique, a general anesthetic practice which does not require neuromuscular blockage, is suitable for these patients. PMID:27591471
Nutrition counseling for patients with osteoporosis: a personal approach.
Kitchin, Beth
Patients are often bombarded with information from the internet, family, friends, and television about what is good and bad for their bones-particularly in the area of diet and nutrition. Although some information is valid and evidence based, much is not. Patients often believe that adequate nutrition alone is enough to improve bone density and decrease fragility fracture risk. Although calcium and vitamin D remain the mainstays of medical nutrition therapy, many patients are not receiving adequate counseling on how to get the right amounts of these 2 nutrients and may not understand that calcium and vitamin D are but 2 of many factors in this multifactorial disease. Clinicians must listen carefully to their patients' concerns, beliefs, and questions and help them develop a personalized plan to achieve their daily calcium and vitamin D intakes. Clinicians must stay apprised of the recent research in nutrition and bone health and evaluate the evidence to adequately educate their patients. PMID:24075239
MMPI for personality characteristics of patients with different diseases.
Pop-Jordanova, N
In the field of psychosomatic medicine the relationship between personality characteristics and diseases is supposed to be an important issue. The aim of this article is to present group's MMPI profiles obtained for patients with different chronic diseases and to discuss about possible specific features of these different groups. We summarized results obtained by psychological testing of following groups of patients: adult patients treated with chronic maintenance dialysis, patients with diabetic retinopathy, general anxiety group, attack panic syndrome, parents of children with rheumatoid arthritis, as well as adolescents with mental anorexia, cystic fibrosis, diabetes mellitus and leukemia. Two control groups comprised adults and adolescents, both without any health problems, selected randomly. As a psychometric test MMPI-201 was used. Statistic 10 package is used for statistical analysis. In our presentation it can be seen some typical personality characteristics for patients with chronic conditions. These findings could be helpful for clinicians concerning treatment planning and follow-up. In general, the MMPI helps us to obtain a global, factual picture from the self-assessment of the patient, explained in a psycho-technical language. Group's profile could be used in clinical practice for planning treatment and to suppose the prognosis of the illness. PMID:26076785
Patient Experience in Health Center Medical Homes.
Cook, Nicole; Hollar, Lucas; Isaac, Emmanuel; Paul, Ludmilla; Amofah, Anthony; Shi, Leiyu
The Human Resource and Services Administration, Bureau of Primary Health Care Health Center program was developed to provide comprehensive, community-based quality primary care services, with an emphasis on meeting the needs of medically underserved populations. Health Centers have been leaders in adopting innovative approaches to improve quality care delivery, including the patient centered medical home (PCMH) model. Engaging patients through patient experience assessment is an important component of PCMH evaluation and a vital activity that can help drive patient-centered quality improvement initiatives. A total of 488 patients from five Health Center PCMHs in south Florida were surveyed in order to improve understanding of patient experience in Health Center PCMHs and to identify quality improvement opportunities. Overall patients reported very positive experience with patient-centeredness including being treated with courtesy and respect (85 % responded "always") and communication with their provider in a way that was easy to understand (87.7 % responded "always"). Opportunities for improvement included patient goal setting, referrals for patients with health conditions to workshops or educational programs, contact with the Health Center via phone and appointment availability. After adjusting for patient characteristics, results suggest that some patient experience components may be modified by educational attainment, years of care and race/ethnicity of patients. Findings are useful for informing quality improvement initiatives that, in conjunction with other patient engagement strategies, support Health Centers' ongoing transformation as PCMHs. PMID:26026275
Adolescents with personality disorders suffer from severe psychiatric stigma: evidence from a sample of 131 patients
Catthoor, Kirsten; Feenstra, Dine J; Hutsebaut, Joost; Schrijvers, Didier; Sabbe, Bernard
Background The aim of the study is to assess the severity of psychiatric stigma in a sample of personality disordered adolescents in order to evaluate whether differences in stigma can be found in adolescents with different types and severity of personality disorders (PDs). Not only adults but children and adolescents with mental health problems suffer from psychiatric stigma. In contrast to the abundance of research in adult psychiatric samples, stigma in children and adolescents has hardly been investigated. Personality disordered adolescents with fragile identities and self-esteem might be especially prone to feeling stigmatized, an experience which might further shape their identity throughout this critical developmental phase. Materials and methods One hundred thirty-one adolescent patients underwent a standard assessment with Axis I and Axis II diagnostic interviews and two stigma instruments, Stigma Consciousness Questionnaire (SCQ) and Perceived Devaluation–Discrimination Questionnaire (PDDQ). Independent sample t-tests were used to investigate differences in the mean SCQ and PDDQ total scores for patients with and without a PD. Multiple regression main effect analyses were conducted to explore the impact of the different PDs on level of stigma, as well as comorbid Axis I disorders. Age and sex were also entered in the regression models. Results and conclusions Adolescents with severe mental health problems experience a burden of stigma. Personality disordered patients experience more stigma than adolescents with other severe psychiatric Axis I disorders. Borderline PD is the strongest predictor of experiences of stigma. More severely personality disordered adolescents tend to experience the highest level of stigma. PMID:25999774
Therapeutic interaction with an older personality disordered patient.
Josephs, Lawrence; Sanders, Avihay; Gorman, Bernard S
This study reflects an assessment of the relationship between change in defensive functioning and change in the therapeutic interaction during an eight-year treatment episode of an older personality disordered woman. The patient, Ms. Q, possessed schizoid, avoidant, and depressive personality disorders as well as major depression as assessed by the Millon Clinical Multiaxial Inventory-III (MCMI-III). At the end of the treatment episode, Ms. Q still possessed an avoidant personality disorder and significant depressive personality traits but no longer possessed clinically significant schizoid traits or major depression. Ms. Q made significant positive change in her adaptive defensive functioning as assessed by the Defense Mechanism Rating Scale (DMRS). Through time-series analysis it was discovered that positive change in adaptive defenses was predicted by increases in a specific type of therapeutic interaction as assessed by the Psychotherapy Q Sort (PQS). In this therapeutic interaction the therapist in a didactic and advice-giving manner highlighted the patient's role in a problem in a clear and coherent way that could be perceived as tactless. Time-series analysis revealed a reciprocal relationship in which positive changes in adaptive defenses predicted further increases in that particular quality of therapeutic interaction. PMID:24828587
The Earth System Science Education Experience: Personal Vignettes
NASA Astrophysics Data System (ADS)
Ruzek, M.; Aron, J.; Maranto, G.; Reider, D.; Wake, C.
Colleges and universities across the country and around the world have embraced the Earth system approach to gain deeper understanding of the interrelationships of processes that define the home planet. The Design Guide for Undergraduate Earth System Science Education, a product of the NASA/USRA Earth System Science Education for the 21st Century Program (ESSE 21), represents a synthesis of community understanding of the content and process of teaching and learning about Earth as a system. The web-based Design Guide serves faculty from multiple disciplines who wish to adopt an ESS approach in their own courses or programs. Illustrating the nine topical sections of the Design Guide are a series of short vignettes telling the story of how ESS is being used in the classroom, how ESS has contributed to institutional change and personal professional development, how ESS is being implemented at minority serving institutions, and the impact of ESS education on student research. Most vignettes are written from a personal perspective and reflect a direct experience with Earth System Science Education. Over forty vignettes have been assembled aiming to put a face on the results of the systemic reform efforts of the past fifteen years of the ESSE programs, documenting the sometimes intangible process of education reform to be shared with those seeking examples of ESS education. The vignettes are a vital complement to the Design Guide sections, and are also available as a separate collection on the Design Guide and ESSE 21 web sites.
["...cause in such a big hospital ... visually impaired persons like me, alone, can't get anywhere"--the experience of visually impaired people of the in-patient care--an empirical, explorative study].
Golde, Christian
The aim of this study is to explore the experiences of people with visual impairment within in-patient care. Actually, in nursing literature, no similar research is known in the German speaking area. Therefore, an qualitative research framework was used. By using a convenience sampling eight participants have been chosen. Mainly, the thematic content analysis of Burnard has been applied to the analysis of the empirical data. Mental spatial concepts for orientation, primarily acoustically made communicative resonance fields, and Action techniques constitute three major topics, which have been categorised in this study. These concepts are discussed in the cause of the research with respect to their implications on nursing care. PMID:17294372
The soothing patients' anxiety 'SPA' experience.
Harris, P
This paper examines a blended approach to minimising patient anxiety levels prior to general anaesthesia for adult and paediatric patients with a learning disability by introducing reasonable adjustments and reasonable distractions. A therapeutic environment is created that promotes wellbeing; restrictive interventions are used only when there is potential for harm to the patient or others. The result can be excellent holistic individual patient care, the patient receiving 'added value' and a positive experience. PMID:26302589
Promoting Good Psychiatric Management for Patients With Borderline Personality Disorder.
Links, Paul S; Ross, James; Gunderson, John G
General psychiatric management for patients with borderline personality disorder was devised to be an outpatient intervention that could be readily learned and easily delivered by independent community mental health professionals. To disseminate the approach, Drs. Gunderson and Links developed the Handbook of Good Psychiatric Management for Borderline Personality Disorder (Gunderson & Links, ) that presented the basics of the approach, videos to illustrate the appropriate clinical skills, and case examples to practice adherence to the approach. Unfortunately, the inclusion of "psychiatric" in the treatment's name may discourage psychologists and other mental health professionals from using this therapy. In this article, we review the basic principles and approaches related to general psychiatric management. With a case example, we illustrate how psychologists can use all the general psychiatric management principles for their patients with BPD, except medications and, as a result, provide and deliver this approach effectively. PMID:26197971
Psychopathology and personality of young women who experience food cravings.
Gendall, K A; Sullivan, P F; Joyce, P R; Fear, J L; Bulik, C M
The objective of the present study was to investigate the psychopathology and personality characteristics of women who experience food cravings. A total of 101 young women selected at random from the community completed the Diagnostic Interview for Genetic Studies with a trained interviewer. The interview included a section about food-craving experiences and associated factors. Subjects also completed a self-report questionnaire booklet containing the Temperament and Character Inventory (TCI) and the Eating Disorder Inventory (EDI). Compared to noncravers, women who reported food cravings were significantly more likely to report a history of alcohol abuse/dependence (p = .003), significant weight changes (p = .003), and to have undertaken dieting (p = .02), bingeing (p = .05), vomiting (p = .02), exercise (p = .04), diet pill (p = .03), and laxative use (p = .01) to control weight. There was a trend for the cravers to have higher novelty-seeking scores on the TCI (p = .06). Our findings suggest that women who experience food cravings are more likely to have met criteria for alcohol abuse/dependence and tend to have temperament characterized by higher levels of novelty seeking. In addition the high rates of eating-disorder symptomatology implies overconcern with body weight and shape in the women who experienced food cravings. PMID:9290863
Lived Observations: Linking the Researcher's Personal Experiences to Knowledge Development.
Thoresen, Lisbeth; Öhlén, Joakim
As researchers in palliative care, we recognize how involvement with seriously ill and dying persons has an impact on us. Using one's own senses, emotional and bodily responses in observations might open intersubjective dimensions of the research topic. The aim of the article is to highlight how phenomenological theories on intersubjectivity can be useful to develop rich and transparent data generation and analysis. We present three field note examples from observation in a hospice ward, which illuminate how researcher awareness of aspects of intersubjectivity can add valuable insights to data and analysis. Out of the examples, we elaborate on three arguments: (a) how the researcher's lived experience of time and space during fieldwork triggers new research questions, (b) how observations as an embodied activity can bring new insights and open new layers of meaning, and (c) the value of observations in gaining insight into relational aspects in a hospice. PMID:25711845
Personality of patients with Sudeck's atrophy following tibial fracture.
De Vilder, J
Patients with reflex sympathetic dystrophy are often considered by physicians and allied health personnel as having a peculiar personality. In medical literature they are frequently described as anxious and depressive, emotional, nervous and irritable patients with neurovegetative instability. A review of the literature on psychological research in this field is not always illuminating. Hypochondria and hysteria, whether or not accompanied by depression, are frequently reported to be typical traits, whereas other findings point more in the direction of psychosis. Increased anxiety, emotional lability and lowered self-esteem are psychological entities that are regularly encountered. The present study includes 42 cases of severe reflex sympathetic dystrophy. Except for the 7 cases of Sudeck atrophy of the hand and wrist, the localization was always in the foot or ankle. The majority of patients had a history of fractures or orthopedic procedures on the lower limbs as a causative factor. In addition to an interview, two questionnaires and a projective test (Rorschach) were used in the personality assessment. While the Rorschach test did not reveal any findings that could be considered as typical of our study population, we did observe different frequency distributions for the personality traits "self-satisfaction", "rigidity" and "somatization". PMID:1280898
[Personality changes of neurotic patients as outcome of the treatment].
Jodzio, K
The present article attempted to assess the importance of outcomes which appeared during the treatment of 30 neurotic patients. This study specially concentrates on measures of emotional empathy, self-confidence and introspection. There were two surveys in the clinical group: before and after the treatment was completed. Data were compared with a control group, also consisting of 30 persons (15 male and 15 female) matched for age and education. All patients attending group psychotherapy were also treated by pharmacotherapy. As it appeared from the analysis before treatment high empathy in patients was found, but this declined after therapy, however it was still significantly higher than in the control group. The first survey revealed also that patients demonstrated lower levels of self-confidence and introspection. After treatment there were no important differences between the groups. Relationships between the studied qualities were not statistically significant. PMID:8134493
Experiences of air travel in patients with chronic heart failure
Ingle, Lee; Hobkirk, James; Damy, Thibaud; Nabb, Samantha; Clark, Andrew L.; Cleland, John G.F.
Aim To conduct a survey in a representative cohort of ambulatory patients with stable, well managed chronic heart failure (CHF) to discover their experiences of air travel. Methods An expert panel including a cardiologist, an exercise scientist, and a psychologist developed a series of survey questions designed to elicit CHF patients' experiences of air travel (Appendix 1). The survey questions, information sheets and consent forms were posted out in a self-addressed envelope to 1293 CHF patients. Results 464 patients (response rate 39%) completed the survey questionnaires. 54% of patients had travelled by air since their heart failure diagnosis. 20% of all patients reported difficulties acquiring travel insurance. 65% of patients who travelled by air experienced no health-related problems. 35% of patients who travelled by air experienced health problems, mainly at the final destination, going through security and on the aircraft. 27% of all patients would not travel by air in the future. 38% of patients would consider flying again if there were more leg room on the aeroplane, if their personal health improved (18%), if they could find cheaper travel insurance (19%), if there were less waiting at the airport (11%), or if there were less walking/fewer stairs to negotiate at the airport (7%). Conclusion For most patients in this sample of stable, well managed CHF, air travel was safe. PMID:21256607
Psychological Patient Reactions after Septorhinoplasty - Our Personal View
Kopacheva-Barsova, Gabriela; Nikolovski, Nikola; Arsova, Slavica; Kopachev, Dragoslav
AIM: The aim of our study is to observe adequate and inadequate psychological reactions in patients who are candidates for septorhinoplasty, before and after surgery and to create an adequate psychological model of a person suitable for septorhinoplasty in this group of patients. MATERIAL AND METHODS: In this study, 140 patients with nasal septal deviation (deviatio septi nasi), alone or together with other nasal deformities, were observed in the period of 4 years (2011-2015 year). Our patients were psychologically observed using two standard psychological tests: Patients selection for septorhinoplasty and their psychological abilities ("Self-body image" questionnaire) and Brief Symptom Inventory (BSI) test. RESULTS: Most of the patients 43 (39.8%), thought that after rhinoseptoplasty their self-confidence arise, 32 (29.63%) expected changing's in their life's, few of them 9 (8, 3%) thought that the environment will act different with them. The Brief Symptom Inventory (BSI) in women group was shown that most of the women patients presented symptoms of somatisation; 23 (23.33%) and 15 (25%) one year after surgery. CONCLUSIONS: The patients made a sound decision for intervention, which was useful for the surgeon too, because it helped them choose an adequate operative technique and especially helped them in the postoperative period. PMID:27275300
The DSM-5 Levels of Personality Functioning and Severity of Iranian Patients With Antisocial and Borderline Personality Disorders
Amini, Mehdi; Pourshahbaz, Abbas; Mohammadkhani, Parvaneh; Khodaie Ardakani, Mohammad Reza; Lotfi, Mozhgan
Background: Fundamental problems with Personality Disorders (PD) diagnostic system in the previous version of DSM, led to the revision of DSM. Therefore, a multidimensional system has been proposed for diagnosis of personality disorder features in DSM-5. In the dimensional approach of DSM-5, personality disorders diagnosis is based on levels of personality functioning (Criteria A) and personality trait domains (Criteria B). Objectives: The purpose of this study was firstly, to examine the DSM-5 levels of personality functioning in antisocial and borderline personality disorders, and second, to explore which levels of personality functioning in patients with antisocial and borderline personality disorders can better predicted severity than others. Patients and Methods: This study had a cross sectional design. The participants consisted of 252 individuals with antisocial (n = 122) and borderline personality disorders (n = 130). They were recruited from Tehran prisoners, and clinical psychology and psychiatry centers of Razi and Taleghani Hospitals, Tehran, Iran. The sample was selected based on judgmental sampling. The SCID-II-PQ, SCID-II and DSM-5 levels of personality functioning were used to diagnose and assess personality disorders. The data were analyzed by correlation and multiple regression analysis. All statistical analyses were performed using the SPSS 16 software. Results: Firstly, it was found that DSM-5 levels of personality functioning have a strong correlation with antisocial and borderline personality symptoms, specially intimacy and self-directedness (P < 0.001). Secondly, the findings showed that identity, intimacy and self-directedness significantly predicted antisocial personality disorder severity (P < 0.0001). The results showed that intimacy and empathy were good predictors of borderline personality disorder severity, as well (P < 0.0001). Conclusions: Overall, our findings showed that levels of personality functioning are a significant
Psychopathology of Lived Time: Abnormal Time Experience in Persons With Schizophrenia.
Stanghellini, Giovanni; Ballerini, Massimo; Presenza, Simona; Mancini, Milena; Raballo, Andrea; Blasi, Stefano; Cutting, John
Abnormal time experience (ATE) in schizophrenia is a long-standing theme of phenomenological psychopathology. This is because temporality constitutes the bedrock of any experience and its integrity is fundamental for the sense of coherence and continuity of selfhood and personal identity. To characterize ATE in schizophrenia patients as compared to major depressives we interviewed, in a clinical setting over a period of 15 years, 550 consecutive patients affected by schizophrenic and affective disorders. Clinical files were analyzed by means of Consensual Qualitative Research (CQR), an inductive method suited to research that requires rich descriptions of inner experiences. Of the whole sample, 109 persons affected by schizophrenic (n = 95 acute, n = 14 chronic) and 37 by major depression reported at least 1 ATE. ATE are more represented in acute (N = 109 out of 198; 55%) than in chronic schizophrenic patients (N = 14 out of 103; 13%). The main feature of ATE in people with schizophrenia is the fragmentation of time experience (71 out of 109 patients), an impairment of the automatic and prereflexive synthesis of primal impression-retention-protention. This includes 4 subcategories: disruption of time flowing, déjà vu/vecu, premonitions about oneself and the external world. We contrasted ATE in schizophrenia and in major depression, finding relevant differences: in major depressives there is no disarticulation of time experience, rather timelessness because time lacks duration, not articulation. These core features of the schizophrenic pheno-phenotype may be related to self-disorders and to the manifold of characteristic schizophrenic symptoms, including so called bizarre delusions and verbal-acoustic hallucinations. PMID:25943123
Swedish ambulance nurses' experiences of nursing patients suffering cardiac arrest.
Larsson, Ricard; Engström, Åsa
Effective pre-hospital treatment of a person suffering cardiac arrest is a challenging task for the ambulance nurses. The aim of this study was to describe ambulance nurses' experiences of nursing patients suffering cardiac arrest. Qualitative personal interviews were conducted during 2011 in Sweden with seven ambulance nurses with experience of nursing patients suffering cardiac arrests. The interview texts were analyzed using qualitative thematic content analysis, which resulted in the formulation of one theme with six categories. Mutual preparation, regular training and education were important factors in the nursing of patients suffering cardiac arrest. Ambulance nurses are placed in ethically demanding situations regarding if and for how long they should continue cardio-pulmonary resuscitation (CPR) to accord with pre-hospital cardiac guidelines and patients' wishes. When a cardiac arrest patient is nursed their relatives also need the attention of ambulance nurses. Reflection is one way for ambulance nurses to learn from, and talk about, their experiences. This study provides knowledge of ambulance nurses' experiences in the care of people with cardiac arrest. Better feedback about the care given by the ambulance nurses, and about the diagnosis and nursing care the patients received after they were admitted to the hospital are suggested as improvements that would allow ambulance nurses to learn more from their experience. Further development and research concerning the technical equipment might improve the situation for both the ambulance nurses and the patients. Ambulance nurses need regularly training and education to be prepared for saving people's lives and also to be able to make the right decisions. PMID:23577977
Personality Compensates for Impaired Quality of Life and Social Functioning in Patients With Psychotic Disorders Who Experienced Traumatic Events
Boyette, Lindy-Lou; van Dam, Daniëlla; Meijer, Carin; Velthorst, Eva; Cahn, Wiepke; de Haan, Lieuwe; Kahn, René; de Haan, Lieuwe; van Os, Jim; Wiersma, Durk; Bruggeman, Richard; Cahn, Wiepke; Meijer, Carin; Myin-Germeys, Inez
Background: Patients with psychotic disorders who experienced childhood trauma show more social dysfunction than patients without traumatic experiences. However, this may not hold for all patients with traumatic experiences. Little is known about the potential compensating role of Five-Factor Model personality traits within this group, despite their strong predictive value for social functioning and well-being in the general population. Methods: Our sample consisted of 195 patients with psychotic disorders (74% diagnosed with schizophrenia) and 132 controls. Cluster analyses were conducted to identify and validate distinct personality profiles. General linear model analyses were conducted to examine whether patients with different profiles differed in social functioning and quality of life (QoL), while controlling for possible confounders. Mediation models were tested to assess potential causal links. Results: In general, patients with higher levels of self-reported traumatic experiences (PT+) showed lower QoL and more social withdrawal compared with patients with lower traumatic experiences (PT−). Two clusters reflecting personality profiles were identified. PT+ with the first profile (lower neuroticism and higher extraversion, openness, agreeableness, and conscientiousness) presented higher levels of QoL and better social functioning in several areas, including less withdrawal, compared with both PT+ and PT− with the second profile. PT+ and PT− with the first personality profile did not differ in QoL and social functioning. Mediation analyses suggested that personality traits mediate the relation between traumatic experiences and QoL and social withdrawal. Conclusions: Our findings indicate that personality may "buffer" the impact of childhood traumatic experiences on functional outcome in patients with psychotic disorders. PMID:24771304
Experiences of critical care nurses caring for unresponsive patients.
Villanueva, N E
Grounded theory methodology was utilized to explore the experiences of critical care nurses caring for patients who were unable to respond due to a traumatic brain injury or receiving neuromuscular blocking agents. The registered nurses participating in the study worked in a neuroscience intensive care unit. Saturation of the categories was achieved with 16 interviews. The core category that emerged from the study is Giving the Patient a Chance. The subcategories of Learning about My Patient, Maintaining and Monitoring, Talking to My Patient, Working with Families, Struggling with Dilemmas and Personalizing the Experience all centered upon the focus of doing everything to help the patient attain the best possible outcome. Factors influencing each of the subcategories were identified such as the acuity of the patient, experience level of the nurse and the presence or absence of family members or significant others. These factors accounted for the variations in the nurses' experience. Several reasons accounting for the variations were determined. The study identified areas that need to be addressed in both general nursing education and nursing practice, such as instruction on talking to comatose patients, working with families and orientation information for nurses new to caring for these populations. Recommendations for improvement in these areas, as well as for future studies are discussed. PMID:10553569
Personalizing retrieval of journal articles for patient care.
Teufel, S.; Hatzivassiloglou, V.; Teufel, S.; McKeown, K. R.; Jordan, D. A.; Dunn, K. M.; Sigelman, S.; Kushniruk, A.
We present a system for patient-specific searches on a database of medical journal articles which uses natural language techniques to match search results against patient records. We performed an information retrieval experiment comparing the performance of this system to two strategies, one of which uses extensive medical knowledge, while the other uses the same patient information our system has. The results show that our system is useful in improving recall over the strategy simulating a human specialist, and clearly outperforms the strategy of using the patient record content without intelligent processing. PMID:11825275
Personalized Immunomonitoring Uncovers Molecular Networks that Stratify Lupus Patients.
Banchereau, Romain; Hong, Seunghee; Cantarel, Brandi; Baldwin, Nicole; Baisch, Jeanine; Edens, Michelle; Cepika, Alma-Martina; Acs, Peter; Turner, Jacob; Anguiano, Esperanza; Vinod, Parvathi; Kahn, Shaheen; Obermoser, Gerlinde; Blankenship, Derek; Wakeland, Edward; Nassi, Lorien; Gotte, Alisa; Punaro, Marilynn; Liu, Yong-Jun; Banchereau, Jacques; Rossello-Urgell, Jose; Wright, Tracey; Pascual, Virginia
Systemic lupus erythematosus (SLE) is an autoimmune disease characterized by loss of tolerance to nucleic acids and highly diverse clinical manifestations. To assess its molecular heterogeneity, we longitudinally profiled the blood transcriptome of 158 pediatric patients. Using mixed models accounting for repeated measurements, demographics, treatment, disease activity (DA), and nephritis class, we confirmed a prevalent IFN signature and identified a plasmablast signature as the most robust biomarker of DA. We detected gradual enrichment of neutrophil transcripts during progression to active nephritis and distinct signatures in response to treatment in different nephritis subclasses. Importantly, personalized immunomonitoring uncovered individual correlates of disease activity that enabled patient stratification into seven groups, supported by patient genotypes. Our study uncovers the molecular heterogeneity of SLE and provides an explanation for the failure of clinical trials. This approach may improve trial design and implementation of tailored therapies in genetically and clinically complex autoimmune diseases. PAPERCLIP. PMID:27040498
Patient-reported outcomes in borderline personality disorder
Hasler, Gregor; Hopwood, Christopher J.; Jacob, Gitta A.; Brändle, Laura S.; Schulte-Vels, Thomas
Patient-reported outcome (PRO) refers to measures that emphasize the subjective view of patients about their health-related conditions and behaviors. Typically, PROs include self-report questionnaires and clinical interviews. Defining PROs for borderline personality disorder (BPD) is particularly challenging given the disorder's high symptomatic heterogeneity, high comorbidity with other psychiatric conditions, highly fluctuating symptoms, weak correlations between symptoms and functional outcomes, and lack of valid and reliable experimental measures to complement self-report data. Here, we provide an overview of currently used BPD outcome measures and discuss them from clinical, psychometric, experimental, and patient perspectives. In addition, we review the most promising leads to improve BPD PROs, including the DSM-5 Section III, the Recovery Approach, Ecological Momentary Assessments, and novel experimental measures of social functioning that are associated with functional and social outcomes. PMID:25152662
Patient Experience of Australian General Practices.
Narayanan, Ajit; Greco, Michael
The number of data-based research articles focusing on patient sociodemographic profiling and experience with healthcare practices is still relatively small. One of the reasons for this relative lack of research is that categorizing patients into different demographic groups can lead to significant reductions in sample numbers for homogeneous subgroups. The aim of this article is to identify problems and issues when dealing with big data that contains information at two levels: patient experience of their general practice, and scores received by practices. The Practice Accreditation and Improvement Survey (PAIS) consisting of 27 five-point Likert items and 11 sociodemographic questions is a Royal Australian College of General Practitioners (RACGP)-endorsed instrument for seeking patient views as part of the accreditation of Australian general practices. The data were collected during the 3-year period May 2011-July 2014, during which time PAIS was completed for 3734 individual general practices throughout Australia involving 312,334 anonymous patients. This represents over 60% of practices in Australia, and ∼75% of practices that undergo voluntary accreditation. The sampling method for each general practice was convenience sampling. The results of our analysis show how sociodemographic profiles of Australian patients can affect their ratings of practices and also how the location of the practice (State/Territory, remote access area) can affect patient experience. These preliminary findings can act as an initial set of results against which future studies in patient experience trends can be developed and measured in Australia. Also, the methods used in this article provide a methodological framework for future patient experience researchers to use when dealing with data that contain information at two levels, such as the patient and practice. Finally, the outcomes demonstrate that different subgroups can experience healthcare provision differently, especially
Patient experiences during awake mechanical ventilation
Prime, Danille; Arkless, Paul; Fine, Jonathan; Winter, Stephen; Wakefield, Dorothy B.; Scatena, Robyn
Background Sedation practices in an ICU have shifted significantly in the past 20 years toward the use of minimizing sedation in mechanically ventilated patients. While minimizing sedation is clearly in the best interest of patients, data are lacking about how this approach affects patients' experiences. Methods We interviewed mechanically ventilated patients receiving minimal sedation, over a 6-month period in an ICU, in order to explore their emotional, comfort, and communication experiences. Their responses were compared with the responses of their available family members regarding their attitudes and perceptions of the patients' experiences. Results Seventy-five percent of the patients agreed or strongly agreed that they experienced pain, and 50% agreed or strongly agreed that they were comfortable. Half of the patients agreed or strongly agreed that they preferred to be kept awake. Five patients (31%) indicated that they were frustrated while 17 relatives (89%) agreed or strongly agreed that the patients were frustrated. When controlling for age and gender of respondents, family members perceived higher levels of patient pain (least square [LS] mean [95% CI]: 4.2 [3.7, 4.7] vs. 3.1 [2.5, 3.8]; p=0.022), frustration (LS mean [95% CI]: 4.2 [3.7, 4.6] vs. 3.2 [2.6, 3.9]; p=0.031), and adequate communication with nurses and doctors (LS mean [95% CI]: 3.9 [3.5, 4.4] vs. 3.1 [2.4, 3.7]; p=0.046) than the patients themselves. Conclusion Patients tolerated minimal sedation without significant frustration while mechanically ventilated despite experiencing discomfort. Patient and family member perceptions of the patient experience may differ, especially in regards to pain and frustration. The use of a communication tool can facilitate understanding of patient experiences and preferences. PMID:26908386
Inconsistency and social decision making in patients with Borderline Personality Disorder.
Preuss, Nora; Brändle, Laura S; Hager, Oliver M; Haynes, Melanie; Fischbacher, Urs; Hasler, Gregor
Inconsistent social behavior is a core psychopathological feature of borderline personality disorder. The goal of the present study was to examine inconsistency in social decision-making using simple economic social experiments. We investigated the decisions of 17 female patients with BPD, 24 patients with major depressive disorder (MDD), and 36 healthy controls in three single shot economic experiments measuring trust, cooperation, and punishment. BPD severity was assessed using the Zanarini Rating Scale for BPD. Investments across identical one-shot trust and punishment games were significantly more inconsistent in BPD patients than in controls. Such inconsistencies were only found in the social risk conditions of the trust and punishment conditions but not in the non-social control conditions. MDD patients did not show such inconsistencies. Furthermore, social support was negatively correlated with inconsistent decision-making in the trust and punishment game, which underscores the clinical relevance of this finding. PMID:27380424
ICU professionals' experiences of caring for conscious patients receiving MVT.
Karlsson, Veronika; Bergbom, Ingegerd
Over the last decade, caring for patients who are conscious while receiving mechanical ventilator treatment has become common in Scandinavian intensive care units. Therefore, this study aimed to describe anesthetists', nurses', and nursing assistants' experiences of caring for such patients. Nine persons were interviewed. A hermeneutic method inspired by Gadamer's philosophy was used to interpret and analyze the interview text. Staff members found it distressing to witness and be unable to alleviate suffering, leading to ethical conflicts, feelings of powerlessness, and betrayal of the promises made to the patient. They were frustrated about their inability to understand what the patients were trying to say and often turned to colleagues for help. When caring for conscious patients, it takes time to get to know them and establish communication and a trusting relationship. PMID:24558056
Auricular reconstruction of congenital microtia: personal experience in 225 cases.
Anghinoni, M; Bailleul, C; Magri, A S
Microtia is a congenital disease with various degrees of severity, ranging from the presence of rudimentary and malformed vestigial structures to the total absence of the ear (anotia). The complex anatomy of the external ear and the necessity to provide good projection and symmetry make this reconstruction particularly difficult. The aim of this work is to report our surgical technique of microtic ear correction and to analyse the short and long term results. From 2000 to 2013, 210 patients affected by microtia were treated at the Maxillo-Facial Surgery Division, Head and Neck Department, University Hospital of Parma. The patient population consisted of 95 women and 115 men, aged from 7 to 49 years. A total of 225 reconstructions have been performed in two surgical stages basing of Firmin's technique with some modifications and refinements. The first stage consists in fabrication and grafting of a three-dimensional costal cartilage framework. The second stage is performed 5-6 months later: the reconstructed ear is raised up and an additional cartilaginous graft is used to increase its projection. A mastoid fascial flap together with a skin graft are then used to protect the cartilage graft. All reconstructions were performed without any major complication. The results have been considered satisfactory by all patients starting from the first surgical step. Low morbidity, the good results obtained and a high rate of patient satisfaction make our protocol an optimal choice for treatment of microtia. The surgeon's experience and postoperative patient care must be considered as essential aspects of treatment. PMID:26246664
Managing the Personal Side of Health: How Patient Expertise Differs from the Expertise of Clinicians
Pratt, Wanda
Background When patients need health information to manage their personal health, they turn to both health professionals and other patients. Yet, we know little about how the information exchanged among patients (ie, patient expertise) contrasts with the information offered by health professionals (ie, clinician expertise). Understanding how patients' experiential expertise contrasts with the medical expertise of health professionals is necessary to inform the design of peer-support tools that meet patients' needs, particularly with the growing prevalence of largely unguided advice sharing through Internet-based social software. Objective The objective of our study was to enhance our understanding of patient expertise and to inform the design of peer-support tools. We compared the characteristics of patient expertise with that of clinician expertise for breast cancer. Methods Through a comparative content analysis of topics discussed and recommendations offered in Internet message boards and books, we contrasted the topic, form, and style of expertise shared in sources of patient expertise with sources of clinician expertise. Results Patient expertise focused on strategies for coping with day-to-day personal health issues gained through trial and error of the lived experience; thus, it was predominately personal in topic. It offered a wealth of actionable advice that was frequently expressed through the narrative style of personal stories about managing responsibilities and activities associated with family, friends, work, and the home during illness. In contrast, clinician expertise was carried through a prescriptive style and focused on explicit facts and opinions that tied closely to the health care delivery system, biomedical research, and health professionals' work. These differences were significant between sources of patient expertise and sources of clinician expertise in topic (P < .001), form (P < .001), and style (P < .001). Conclusion Patients
Patients Know Best: Qualitative Study on How Families Use Patient-Controlled Personal Health Records
Schneider, Hanna; Hill, Susan
Background Self-management technologies, such as patient-controlled electronic health records (PCEHRs), have the potential to help people manage and cope with disease. Objective This study set out to investigate patient families' lived experiences of working with a PCEHR. Methods We conducted a semistructured qualitative field study with patient families and clinicians at a children's hospital in the UK that uses a PCEHR (Patients Know Best). All families were managing the health of a child with a serious chronic condition, who was typically under the care of multiple clinicians. As data gathering and analysis progressed, it became clear that while much of the literature assumes that patients are willing and waiting to take more responsibility for and control over their health management (eg, with PCEHRs), only a minority of participants in our study responded in this way. Their experiences with the PCEHR were diverse and strongly shaped by their coping styles. Theory on coping identifies a continuum of coping styles, from approach to avoidance oriented, and proposes that patients' information needs depend on their style. Results We identified 3 groups of patient families and an outlier, distinguished by their coping style and their PCEHR use. We refer to the outlier as controlling (approach oriented, highly motivated to use PCEHR), and the 3 groups as collaborating (approach oriented, motivated to use PCEHR), cooperating (avoidance oriented, less motivated to use PCEHR), and avoiding (very avoidance oriented, not motivated to use PCEHR). Conclusions The PCEHR met the needs of controller and collaborators better than the needs of cooperators and avoiders. We draw on the Self-Determination Theory to propose ways in which a PCEHR design might better meet the needs of avoidance-oriented users. Further, we highlight the need for families to also relinquish control at times, and propose ways in which PCEHR design might support a better distribution of control
Awareness about the persons with disability act among leprosy patients and other disabled persons.
Robins, R; Martin, D; Raj, K Durai; Raju, M S
To assess the level of awareness about the different provisions of the Persons with Disability Act (PWD Act) among leprosy patients and other disabled, 233 disabled persons from the self-help groups formed by Vadathorasalur Leprosy Control Unit have been interviewed using a structured interview checklist. The results show that 74.7% of the respondents were aware that identity cards are available for the disabled, 56.2% were aware of the free education benefit to the disabled, as low as 35.6% were aware of the scholarships, 33% knew about the employment reservations, 24.9% heard about the housing scheme of the government for the disabled, but 24.5% only knew about law against discrimination, 31.8% came in contact with institutions for the severely disabled and only 16% were aware of the unemployment allowance to the disabled. The level of awareness is low among women with regard to all components of the Act. It was found that students studying up to secondary level were not aware of the availability of scholarships and free education, which needs to be seriously looked into, especially by educational institutions. The level of formal education played a significant role in increasing awareness about the Act among literates. The knowledge is low among persons of all occupations. The study showed that there is a great need for an educational intervention programme to publicize the provisions of the Act among the disabled and their families. PMID:17120505
Adult burn survivors' personal experiences of rehabilitation: an integrative review.
Kornhaber, R; Wilson, A; Abu-Qamar, M Z; McLean, L
Burn rehabilitation is a lengthy process associated with physical and psychosocial problems. As a critical area in burn care, the aim was to systematically synthesise the literature focussing on personal perceptions and experiences of adult burn survivors' rehabilitation and to identify factors that influence their rehabilitation. Studies were identified through an electronic search using the databases: PubMed, CINAHL, EMBASE, Scopus, PsycINFO and Trove of peer reviewed research published between 2002 and 2012 limited to English-language research with search terms developed to reflect burn rehabilitation. From the 378 papers identified, 14 research papers met the inclusion criteria. Across all studies, there were 184 participants conducted in eight different countries. The reported mean age was 41 years with a mean total body surface area (TBSA) burn of 34% and the length of stay ranging from one day to 68 months. Significant factors identified as influential in burn rehabilitation were the impact of support, coping and acceptance, the importance of work, physical changes and limitations. This review suggests there is a necessity for appropriate knowledge and education based programmes for burn survivors with consideration given to the timing and delivery of education to facilitate the rehabilitation journey. PMID:24050979
The frequency of personality disorders in patients with gender identity disorder
Meybodi, Azadeh Mazaheri; Hajebi, Ahmad; Jolfaei, Atefeh Ghanbari
Background: Co-morbid psychiatric disorders affect prognosis, psychosocial adjustment and post-surgery satisfaction in patients with gender identity disorder. In this paper, we assessed the frequency of personality disorders in Iranian GID patients. Methods: Seventy- three patients requesting sex reassignment surgery (SRS) were recruited for this crosssectional study. Of the participants, 57.5% were biologically male and 42.5% were biologically female. They were assessed through the Millon Clinical Multiaxial Inventory II (MCMI- II). Results: The frequency of personality disorders was 81.4%. The most frequent personality disorder was narcissistic personality disorder (57.1%) and the least was borderline personality disorder. The average number of diagnoses was 3.00 per patient. Conclusion: The findings of this study revealed that the prevalence of personality disorders was higher among the participants, and the most frequent personality disorder was narcissistic personality disorder (57.1%), and borderline personality disorder was less common among the studied patients. PMID:25664291
Staff's experiences of a person-centered health education group intervention for people with a persistent mental illness.
Jormfeldt, Henrika; Brunt, David Arthur; Rask, Mikael; Bengtsson, Agneta; Svedberg, Petra
Patient education in mental health care is a conventional intervention to increase patients' knowledge about their illness and treatment. A provider-centered focus in patient education may put patients in a passive role, which can counteract their processes of recovery. There is an increasing emphasis on recovery-oriented practice, an approach that is aligned with the service user perspective, but little is known about health care staff's perspectives on person-centered mental health care. A qualitative approach was used to describe staff's experiences of being group leaders in a person-centered health education intervention in municipal services for persons with a persistent mental illness. The analysis of staff experiences revealed three core categories: (1) implications of the division of responsibility among local authorities, (2) awareness of facilitating factors of growth, and (3) the meaning of dialogue. These formed the theme Preconditions for Person-Centered Care. Further research is required to explore larger economic, political, and social structures as backdrops to person-centered mental health care, from the perspective of service users, families, health professionals, and the community at large. PMID:23875550
Psychotic patients' impressions of a person from written descriptions.
Luchins, A S; Luchins, E H
The present study examined the impressions of personality formed from written descriptions of behavior by over 200 hospitalized male schizophrenics, tested individually when they seemed in contact with reality. One description was of extrovert (E) behavior by a youth named Jim; another was of his introvert (I) behavior in similar settings. Combined communications gave one description immediately after the other. After 150 patients read one of the communications, they were generally willing and able to respond to a 36-item questionnaire about Jim. This also occurred when 96 patients were asked to answer it before any communication, on the basis of their expectations about Jim; 56 subsequently received a communication, followed by readministration of the questionnaire. Patients' responses, before or after the communications, revealed few pathological signs and, like those of normal Ss, could usually be classified as E or I. Patients had less differential effects, and far fewer I responses than normal Ss. Patients and normals showed preconceptions of Jim as extrovertive. Results were discussed in light of the projective hypothesis and other theories. PMID:6706109
Borderline Personality Features in Students: the Predicting Role of Schema, Emotion Regulation, Dissociative Experience and Suicidal Ideation
Sajadi, Seyede Fateme; Arshadi, Nasrin; Zargar, Yadolla; Mehrabizade Honarmand, Mahnaz; Hajjari, Zahra
Background: Numerous studies have demonstrated that early maladaptive schemas, emotional dysregulation are supposed to be the defining core of borderline personality disorder. Many studies have also found a strong association between the diagnosis of borderline personality and the occurrence of suicide ideation and dissociative symptoms. Objectives: The present study was designed to investigate the relationship between borderline personality features and schema, emotion regulation, dissociative experiences and suicidal ideation among high school students in Shiraz City, Iran. Patients and Methods: In this descriptive correlational study, 300 students (150 boys and 150 girls) were selected from the high schools in Shiraz, Iran, using the multi-stage random sampling. Data were collected using some instruments including borderline personality feature scale for children, young schema questionnaire-short form, difficulties in emotion-regulation scale (DERS), dissociative experience scale and beck suicide ideation scale. Data were analyzed using the Pearson correlation coefficient and multivariate regression analysis. Results: The results showed a significant positive correlation between schema, emotion regulation, dissociative experiences and suicide ideation with borderline personality features. Moreover, the results of multivariate regression analysis suggested that among the studied variables, schema was the most effective predicting variable of borderline features (P < 0.001). Conclusions: The findings of this study are in accordance with findings from previous studies, and generally show a meaningful association between schema, emotion regulation, dissociative experiences, and suicide ideation with borderline personality features. PMID:26401490
The Effect of Turkish Geography Teacher's Personality on His Teaching Experiences
ERIC Educational Resources Information Center
Ozel, Ali
It is aimed in this study to determine to what extent the geography teachers at high schools reflect their personality on their teaching experiences. It has been observed by researchers that teachers with different personalities affect their students in different ways. The personal characteristics of a teacher play a significant role in…
Personal Health Records for Patients with Chronic Disease
Rozenblum, R.; Park, A.; Dunn, M.; Bates, D.W.
Summary Background Personal health records (PHRs) connected to a physician's electronic health record system hold substantial promise for supporting and engaging patients with chronic disease. Objectives: To explore how U.S. health care organizations are currently utilizing PHRs for chronic disease populations. Methods A mixed methods study including semi-structured interviews and a questionnaire was conducted. A purposive sample was developed of health care organizations which were recognized as exemplars for PHRs and were high performers in national patient satisfaction surveys (H-CAHPS or CAHPS). Within each organization, participants were health IT leaders or those managing high-risk or chronic disease populations. Results Interviews were conducted with 30 informants and completed questionnaires were received from 16 organizations (84% response rate). Most PHRs allowed patients to access health records and educational material, message their provider, renew prescriptions and request appointments. Patient generated data was increasingly being sought and combined with messaging, resulted in greater understanding of patient health and functioning outside of the clinic visit. However for chronic disease populations, there was little targeted involvement in PHR design and few tools to help interpret and manage their conditions beyond those offered for all. The PHR was largely uncoupled from high risk population management interventions and no clear framework for future PHR development emerged. Conclusion This technology is currently underutilized and represents a major opportunity given the potential benefits of patient engagement and shared decision making. A coherent patient-centric PHR design and evaluation strategy is required to realize its potential and maximize this natural hub for multidisciplinary care co-ordination. PMID:25024758
What do patients value in the hospital meal experience?
Hartwell, Heather J; Shepherd, Paula A; Edwards, John S A; Johns, Nick
A number of previous studies have reported on the aspects of hospital food service that patients value, but usually as a secondary finding, and not generally based upon patient-centred approaches. This study employed a questionnaire produced ab initio from interviews with patients and hospital staff, the data from which were subjected to factor and cluster analysis, in order to identify and prioritise the factors that contribute to the meal experience empirically. The most important factors, food and service were as identified by other authors. In decreasing order of importance were social, personal and situational factors. The results confirm that improving the quality of the food and the efficiency with which it reaches the patients remain the most important objectives of hospital food service. PMID:26408943
Some experiences with treating thyroid cancer patients.
Achey, B; Miller, K L; Erdman, M; King, S
U.S. NRC Regulatory Guide 8.39 provides for the release of patients treated with 131I provided that predetermined calculations indicate that no member of the public will receive a total dose equivalent in excess of 5 mSv (500 mrem). When this condition cannot be met or there are other reasons for keeping the patient hospitalized after treatment, control of contamination and exposure from the patient must be taken into consideration. If the patients are hospitalized following treatment, decontaminating the patient's room after discharge and controlling the exposure potential from the patient are considerations for the hospital radiation safety staff. This paper reviews the experiences from fifty patients treated as inpatients over the past two years. PMID:11316085
Ultrasound-guided removal of foreign bodies: personal experience.
Callegari, Leonardo; Leonardi, Anna; Bini, Amedeo; Sabato, Chiara; Nicotera, Paolo; Spano', Emanuela; Mariani, Davide; Genovese, Eugenio A; Fugazzola, Carlo
Foreign bodies (FBs) retained in the soft tissues are a common reason for medical consultation, and usually consist of wooden or metal splinters or glass shards. Failure to remove foreign bodies is likely to give rise to acute or late complications, such as allergies, inflammation or infection, that may be severe. The surgical removal of an FB is invasive, costly and technically challenging. The procedure may fail in some cases and carries the risk of complications. Our study describes a technique for the ultrasound-guided removal of an FB, devised from our experience, and demonstrates its advantages over the standard surgical procedure. Sixty-two patients (43 males and 19 females aged from 9 to 65 years, median age 31 years) presented at our institution between October 2005 and June 2008 with suspected foreign bodies retained in the soft tissues of various body districts. Radiographic and/or ultrasound diagnosis was established by a radiologist expert in musculoskeletal sonography. The same radiologist helped by a nurse subsequently undertook the ultrasound-guided removal in the outpatient's clinic according to the technique described in the paper. ATL 5000 and PHILIPS iu22 ultrasound systems were used with high-frequency linear-array probes, sterile material, local anaesthetic (lidocaine 2%), scapels and surgical forceps. Antibiotic prophylaxis with amoxicillin and clavulanic acid were prescribed to all patients for 7 days after the procedure. Ninety-five FBs (39 glass, 35 metal, 17 vegetable, 2 plastic, 2 stone) were successfully removed under ultrasound guidance in all patients and the procedure took between 15 and 30 min. No complications arose either during or after the procedure. Seventy-five skin incisions were made and the wounds closed with Steri-Strips in 73/75 cases, whereas skin sutures were used in 2/75 cases. No complications arose either during or after the procedure. Ultrasound-guided removal of an FB retained in the soft tissues is a good
Directionality of Person-Situation Transactions: Are There Spillovers Among and Between Situation Experiences And Personality States?
Rauthmann, John F; Jones, Ashley Bell; Sherman, Ryne A
To elucidate temporal sequences among and between person and situation variables, this work examines cross-measurement spillovers between situation experiences S (on the Situational Eight DIAMONDS characteristics [Duty, Intellect, Adversity, Mating, pOsitivity, Negativity, Deception, Sociality]) and personality states P (on the Big Six HEXACO dimensions [Honesty/Humility, Emotionality, eXtraversion, Agreeableness, Conscientiousness, Openness to Experience]) in experience sampling data. Multi-level modeling of lagged data at tn -1 and non-lagged data at tn grants the opportunity to examine (a) the stability (P → P, S → S), (b) cross-sectional associations (S ↔ P), and (c) cross-lagged associations among and between situation experiences and personality states (S → P, P → S). Findings indicated that there were (a) moderate stability paths, (b) small to moderate cross-sectional paths, and (c) only very small cross-lagged paths (though the different situation characteristics and personality states showed differential tendencies toward no directionality, S → P or P → S unidirectionality, or bidirectionality). Findings are discussed in light of refining studies on dynamic person-situation transactions. PMID:27229678
Personalizing the High School Experience for Each Student
ERIC Educational Resources Information Center
Dimartino, Joseph; Clarke, John H.
Discover the six most pervasive problem areas in high school education today, and learn what schools are doing to connect with students, personalize learning, differentiate instruction, and make high school curriculum more relevant.
How Person-Centred Counselling Trainers Understand and Experience Their Role in the Current British Context
ERIC Educational Resources Information Center
Ballinger, Liz
This article reports the findings of a qualitative study into the experience of person-centred training from the viewpoint of the trainer. Interpretative phenomenological analysis was the adopted approach. The researcher conducted a series of in-depth semi-structured interviews with five person-centred trainers with experience across a range of…
The Effects of Personal Divorce Experience on Teacher Perceptions of Children of Divorce.
ERIC Educational Resources Information Center
Green, Virginia P.; Schaefer, Lyn
Determined whether teachers with personal divorce experience differed from other teachers in their opinions on divorce, knowledge about divorce, and feelings about schools' role and responsibility to children of divorce. Those with personal divorce experience were more likely to encourage teacher and school involvement with children of divorce.…
Person-centered osteopathic practice: patients' personality (body, mind, and soul) and health (ill-being and well-being).
Fahlgren, Elin; Nima, Ali A; Archer, Trevor; Garcia, Danilo
Background. Osteopathic philosophy and practice are congruent with the biopsychosocial model, a patient-centered approach when treating disease, and the view of the person as a unity (i.e., body, mind, and soul). Nevertheless, a unity of being should involve a systematic person-centered understanding of the patient's personality as a biopsychosociospiritual construct that influences health (i.e., well-being and ill-being). We suggest Cloninger's personality model, comprising temperament (i.e., body) and character (i.e., mind and soul), as a genuine paradigm for implementation in osteopathic practice. As a first step, we investigated (1) the relationships between personality and health among osteopathic patients, (2) differences in personality between patients and a control group, and (3) differences in health within patients depending on the presenting problem and gender. Method. 524 osteopathic patients in Sweden (age mean = 46.17, SD = 12.54, 388 females and 136 males) responded to an online survey comprising the Temperament and Character Inventory and measures of health (well-being: life satisfaction, positive affect, harmony in life, energy, and resilience; ill-being: negative affect, anxiety, depression, stress, and dysfunction and suffering associated to the presenting problem). We conducted two structural equation models to investigate the association personality-health; graphically compared the patients' personality T-scores to those of the control group and compared the mean raw scores using t-tests; and conducted two multivariate analyses of variance, using age as covariate, to compare patients' health in relation to their presenting problem and gender. Results. The patients' personality explained the variance of all of the well-being (R (2) between .19 and .54) and four of the ill-being (R (2) between .05 and .43) measures. Importantly, self-transcendence, the spiritual aspect of personality, was associated to high levels of positive emotions and
Informing cancer patient in relation to his type of personality: the emotional-hyperthymic (dramatizing) patient.
Kallergis, G
Informing a cancer patient has been an issue of particular interest to the scientific community over the last 50 years. Since 1989 we have been studying the characters or personality types based on the Kahana and Bibring's approach as part of Consultation-Liaison (C-L) Psychiatry. The question posed was how these characters or personality types could be useful in the process of informing the cancer patient. The aim of this paper was to describe the emotional-hyperthymic character or type of personality thoroughly, so that any physician can make a diagnosis and tailor the information strategy to the patient's needs. The qualitative method of research through groups with doctors and nurses was used, while the research within groups lasted for 5 years. The degree of patients' denial varied between "large" and "very large" and sometimes was "medium". Initially, the degree of information was "minimal", then "small" until it reached "medium". A discordance was evident between what the patient showed and what the family reported about him. The patient presented himself as courageous and extrovert, but the relatives considered him as faint-hearted. PMID:22331735
First Person Experience of Body Transfer in Virtual Reality
Slater, Mel; Spanlang, Bernhard; Sanchez-Vives, Maria V.; Blanke, Olaf
Background Altering the normal association between touch and its visual correlate can result in the illusory perception of a fake limb as part of our own body. Thus, when touch is seen to be applied to a rubber hand while felt synchronously on the corresponding hidden real hand, an illusion of ownership of the rubber hand usually occurs. The illusion has also been demonstrated using visuomotor correlation between the movements of the hidden real hand and the seen fake hand. This type of paradigm has been used with respect to the whole body generating out-of-the-body and body substitution illusions. However, such studies have only ever manipulated a single factor and although they used a form of virtual reality have not exploited the power of immersive virtual reality (IVR) to produce radical transformations in body ownership. Principal Findings Here we show that a first person perspective of a life-sized virtual human female body that appears to substitute the male subjects' own bodies was sufficient to generate a body transfer illusion. This was demonstrated subjectively by questionnaire and physiologically through heart-rate deceleration in response to a threat to the virtual body. This finding is in contrast to earlier experimental studies that assume visuotactile synchrony to be the critical contributory factor in ownership illusions. Our finding was possible because IVR allowed us to use a novel experimental design for this type of problem with three independent binary factors: (i) perspective position (first or third), (ii) synchronous or asynchronous mirror reflections and (iii) synchrony or asynchrony between felt and seen touch. Conclusions The results support the notion that bottom-up perceptual mechanisms can temporarily override top down knowledge resulting in a radical illusion of transfer of body ownership. The research also illustrates immersive virtual reality as a powerful tool in the study of body representation and experience, since it supports
Personalization and Patient Involvement in Decision Support Systems: Current Trends
Sacchi, L.; Lanzola, G.; Viani, N.
Summary Objectives This survey aims at highlighting the latest trends (2012-2014) on the development, use, and evaluation of Information and Communication Technologies (ICT) based decision support systems (DSSs) in medicine, with a particular focus on patient-centered and personalized care. Methods We considered papers published on scientific journals, by querying PubMed and Web of Science™. Included studies focused on the implementation or evaluation of ICT-based tools used in clinical practice. A separate search was performed on computerized physician order entry systems (CPOEs), since they are increasingly embedding patient-tailored decision support. Results We found 73 papers on DSSs (53 on specific ICT tools) and 72 papers on CPOEs. Although decision support through the delivery of recommendations is frequent (28/53 papers), our review highlighted also DSSs only based on efficient information presentation (25/53). Patient participation in making decisions is still limited (9/53), and mostly focused on risk communication. The most represented medical area is cancer (12%). Policy makers are beginning to be included among stakeholders (6/73), but integration with hospital information systems is still low. Concerning knowledge representation/management issues, we identified a trend towards building inference engines on top of standard data models. Most of the tools (57%) underwent a formal assessment study, even if half of them aimed at evaluating usability and not effectiveness. Conclusions Overall, we have noticed interesting evolutions of medical DSSs to improve communication with the patient, consider the economic and organizational impact, and use standard models for knowledge representation. However, systems focusing on patient-centered care still do not seem to be available at large. PMID:26293857
Minority ethnicity patient satisfaction and experience: results of the National Cancer Patient Experience Survey in England
Pinder, Richard J; Ferguson, Jamie; Møller, Henrik
Objectives This study sought to explore the differential patient satisfaction reported by patients with cancer who are from ethnic minority backgrounds, examining patient-reported experience of interacting with medical and nursing staff. Setting As a secondary analysis, we collated data collected over two consecutive annual rounds of the National Cancer Patient Experience Survey (NCPES) from September 2012 to November 2013. Participants There were 138 878 responses from 155 hospital trusts across the National Health Service in England, representing a response rate of 63.9% based on the total identified cohort of patients receiving cancer care over those 2 years. Outcomes We used the results of the annual survey, which sought to assess overall patient satisfaction along with patient experience of interacting with clinical nurse specialists, hospital doctors and ward nurses. Results Ethnic minority patients reported lower satisfaction and less positive experiences of care overall. While some of this difference appeared related to demographic and socioeconomic variation, ethnic minority patients remained less positive than those in the White British group, after statistical adjustment. Ethnic minority patients also reported lower confidence in, and less understanding of, healthcare professionals, including clinical nurse specialists, doctors and ward nurses. Conclusions Given the diversity of the British population, as well as the clustering of ethnic minority patients in certain urban areas, a better understanding of the expectations and additional needs of ethnic minority patients is required to improve their experience of and satisfaction with cancer care. PMID:27354083
Patient experience key in hospice refurb.
Beach, Matt
A major design and build scheme which has seen the inpatient unit at St. Luke's Hospice in Sheffield extended and refurbished to provide a more comfortable and homely environment, and bring the facilities up to the best 21st century standards, has benefited significantly from both high quality architecture and stakeholder commitment. The result, reports Matt Beach, associate at scheme architects, Race Cottam Associates, is an even better and 'more personal'environment for delivery of end-of-life-care at a facility that, as one patient puts it,'has something very rare and special about it'. PMID:26268027
The experience of caring for former long-stay psychiatric patients.
McGilloway, S; Donnelly, M; Mays, N
This study investigated the experiences and the mental health status of the informal carers (usually relatives) of 38 former long-stay psychiatric patients. According to the GHQ-12, 45 per cent of carers were classified as minor psychiatric 'cases'. Women were significantly more likely than men to experience poor mental health. Most carers reported personal and social restrictions, but cases were significantly more likely than non-cases to report personal, physical and financial burden. PMID:9051286
[Borderline personality disorder: the patients and their relatives].
Apfelbaum, Sergio; Gagliesi, Pablo
This present paper reviews the current theories about the borderline personality disorder and their relations with their families and significant others. The biosocial theory states that the relationship between emotional vulnerability and the interactions with family relations seems to explain the problems with DLP clients. This disorder is defined then as an interaction disease. Relatives and significant others usually have symptoms, beliefs, and emotions produced by this interaction. A list of general strategies for the assistance of these clients and their families is introduced: The transformation of the complaint into a problem, the psycho education, the reduction of expressed emotions, the acceptance and the training in different abilities. At the end, the experience with psycho education approach workshops is commented, as well as the use of a psycho educational manual. PMID:15597126
Personal Growth and the Outdoor Experience: Some Empirical Evidence.
ERIC Educational Resources Information Center
Yaffey, Dave
The Personal Orientation Inventory (POI), a measure of self-actualizing tendencies, was administered to 10 instructors at Plas y Brenin, to 23 tutors at Outward Bound Wales, and to 35 students before and after a course at Outward Bound Aberdovey. Instructors scored higher on the POI than students. Student scores significantly increased after the…
International Students and Their Experiences of Personal Development Planning
ERIC Educational Resources Information Center
Baker, Kate L.; Perkins, Joy; Comber, Darren P. M.
Taught postgraduate students are a unique group, undergoing a short, intensive period of study. Many taught postgraduate students are international, engaging for the first time with new learning approaches, including Personal Development Planning (PDP). This article provides analysis of the views of international taught postgraduates about the…
An Activity Group Experience for Disengaged Elderly Persons.
ERIC Educational Resources Information Center
Harris, John Ewing; Bodden, Jack L.
Tested the activity theory (which proposes that elderly persons remain in active contact with their environment) and disengagement theory (which suggests adjustment comes through reduction of activity and social contact). Disengaged elderly were identified. Subjects demonstrated significant improvement over the untreated control subjects. Results…
It's a Funny Thing about Suicide: A Personal Experience.
ERIC Educational Resources Information Center
Walen, Susan
This paper focuses vividly on personal, subjective aspects of suicide. The complex role of suicidal rumination in the course of an intermittent but chronic depression is discussed, as are the importance of cognitive schema, interpersonal exacerbation, and failed diagnosis. A key feature of the paper is the central heuristic of a therapist…
Establishing a Personal Health Record System in an Academic Hospital: One Year's Experience
Ro, Hyun Jung; Jung, Se Young; Hwang, Hee; Yoo, Sooyoung; Baek, Hyunyoung; Lee, Kiheon; Bae, Woo Kyung; Han, Jong-Soo; Kim, Sarah; Park, Hwayeon
Background Personal health records (PHRs) are web based tools that help people to access and manage their personalized medical information. Although needs for PHR are increasing, current serviced PHRs are unsatisfactory and researches on them remain limited. The purpose of this study is to show the process of developing Seoul National University Bundang Hospital (SNUBH)'s own PHR system and to analyze consumer's use pattern after providing PHR service. Methods Task force team was organized to decide service range and set the program. They made the system available on both mobile application and internet web page. The study enrolled PHR consumers who assessed PHR system between June 2013 and June 2014. We analyzed the total number of users on a monthly basis and the using pattern according to each component. Results The PHR service named Health4U has been provided from June 2013. Every patient who visited SNUBH could register Health4U service and view their medical data. The PHR user has been increasing, especially they tend to approach via one way of either web page or mobile application. The most frequently used service is to check laboratory test result. Conclusion For paradigm shift toward patient-centered care, there is a growing interest in PHR. This study about experience of establishing and servicing the Health4U would contribute to development of interconnected PHR. PMID:26019761
Doctors' experiences of adverse events in secondary care: the professional and personal impact.
Harrison, Reema; Lawton, Rebecca; Stewart, Kevin
We carried out a cross-sectional online survey of fellows and members of the Royal College of Physicians to establish physicians' experiences of adverse patient safety events and near misses, and the professional and personal impact of these. 1,755 physicians answered at least one question; 1,334 answered every relevant question. Of 1,463 doctors whose patients had an adverse event or near miss, 1,119 (76%) believed this had affected them personally or professionally. 1,077 (74%) reported stress, 995 (68%) anxiety, 840 (60%) sleep disturbance and 886 (63%) lower professional confidence. 1,192 (81%) became anxious about the potential for future errors. Of 1,141 who had used NHS incident reporting systems, only 315 (28%) were satisfied with this process. 201 (14%) received useful feedback, 201 (19%) saw local improvements and 277 (19%) saw system changes. 364 (25%) did not report an incident that they should have. Adverse safety events affect physicians, but few formal sources of support are available. Most doctors use incident-reporting systems, but many describe a lack of useful feedback, systems change or local improvement. PMID:25468840
From idealistic helper to enterprising learner: critical reflections on personal development through experiences from Afghanistan.
Wickford, Jenny; Rosberg, Susanne
There is little written about the cultural, social, and ethical challenges encountered by physiotherapists engaging in development work. This article takes a critical perspective on what it means to engage in development work as an expatriate physiotherapist, through a self-critical reflection on experiences from Afghanistan. The field notes from an ethnographic study of a development project conducted in Afghanistan were analysed to explore the transformative process of personal and professional development of the development worker. The critical reflective process entailed a change in meaning perspective, described as a shift from the position of an Idealistic Helper to an Enterprising Learner. Of importance in this process were "disorienting dilemmas" that challenged personal perceptions. Critical reflection over such dilemmas led to deeper understanding facilitating the process of change. The essential lesson learned is that the baseline for understanding others is an understanding of one's own meaning perspectives and manner of participation in relation to others and their context. The insights gained have implications for physiotherapists working in development contexts, for other development workers, and for physiotherapists working with patients in clinical practice in a nondevelopment context. Exploring how to collaborate in development contexts could be done using reflective groups with expatriate and local physiotherapists and/or patients. This could lead to greater understanding of oneself, each other, and the local context. PMID:22047471
Personality assessment inventory profile and predictors of elevations among dissociative disorder patients.
Stadnik, Ryan D; Brand, Bethany; Savoca, Angela
Assessing patients with dissociative disorders (DD) using personality tests is difficult. On the Minnesota Multiphasic Personality Inventory-2 ( J. N. Butcher, W. G. Dahlstrom, J. R. Graham, A. Tellegen, & B. Kaemmer, 1989 ), DD patients often obtain elevations on multiple clinical scales as well as on validity scales that were thought to indicate exaggeration yet have been shown to be elevated among traumatized individuals, including those with DD. No research has been conducted to determine how DD patients score on the Personality Assessment Inventory (PAI; L. C. Morey, 1991 ), which includes the symptom exaggeration scale Negative Impression (NIM) and the malingering scales Malingering Index (MAL) and Rogers Discriminant Function (RDF). The goals of this study were to document the PAI profile of dissociative identity disorder (DID) and dissociative disorder not otherwise specified (DDNOS) patients and to determine how the validity and Schizophrenia scales are related to other PAI scales as well as dissociation. A total of 42 inpatients with DID or DDNOS were assessed on the PAI as well as the Dissociative Experiences Scale-II. The DID/DDNOS patients were elevated on many PAI scales, including NIM and, to a lesser extent, MAL, but not RDF. Dissociation scores significantly and uniquely predicted NIM scores above and beyond Depression and Borderline Features. In addition, after we controlled for MAL and RDF, dissociation was positively associated with NIM. In contrast, after we controlled for the other 2 scales, dissociation was not related to MAL and was negatively related to RDF, indicating that RDF and, to a lesser extent, MAL are better correlates of feigning in DD patients than NIM. PMID:24060036
The Self-Report of Personal Punitive Childhood Experiences and Those of Siblings.
ERIC Educational Resources Information Center
Rausch, Kelly; Knutson, John F.
This study found that 1,414 college students' descriptions of their personal punitive childhood experiences and experiences of siblings were similar, but subjects more often labeled their siblings' experience as abuse than their own experience. The evaluation of severely punitive events as abusive was a function of whether the punishment was…
My recent experiences as a patient.
Pandya, Sunil K
As a neurosurgeon, it was a new experience for me to face the consequences of an accidental fall just before I underwent simple spinal surgery for relief from backache. This essay describes how I was affected by the unexpected operations that followed. The physical pain, the anxieties, small inconveniences and the relatively free use of drugs such as antibiotics, that I might have taken for granted in my patients undergoing surgery, now took on a new meaning for me. My perspective on my illness as patient, rather than as physician, and the special care given to me by medical, nursing, and paramedical colleagues were transforming experiences. Based on these occurrences, I offer suggestions on how we can improve our approach to patients. PMID:22864069
Personal Narrative of an Asian American's Experience with Racism.
ERIC Educational Resources Information Center
Talbot, Donna M.
We often speak the same language and assume that we mean the same thing. Experiences in Ghana refocused this author's earlier experiences of racism. As a counselor educator, she encourages students to appreciate the richness of experience available in a society that embraces diversity. (EMK)
Impaired ability to give a meaning to personally significant events in patients with schizophrenia.
Berna, Fabrice; Bennouna-Greene, Mehdi; Potheegadoo, Jevita; Verry, Paulina; Conway, Martin A; Danion, Jean-Marie
Schizophrenia is a severe mental illness affecting sense of identity. Autobiographical memory deficits observed in schizophrenia could contribute to this altered sense of identity. The ability to give a meaning to personally significant events (meaning making) is also critical for identity construction and self-coherence. Twenty-four patients with schizophrenia and 24 control participants were asked to recall five self-defining memories. We assessed meaning making in participants' narratives (spontaneous meaning making) and afterwards asked them explicitly to give a meaning to their memories (cued meaning making). We found that both spontaneous and cued meaning making were impaired in patients with schizophrenia. This impairment was correlated with executive dysfunctions and level of negative symptoms. Our results suggest that patients' difficulties in drawing lessons about past experiences could contribute to explain the lack of coherence observed in their life trajectories and their impaired social adjustment abilities. Implications for psychotherapy are also discussed. PMID:21459619
Rheumatoid arthritis patients' experience of climate care.
Vaks, Katrin; Sjöström, Rita
The purpose of this qualitative study was to understand and examine how patients with rheumatoid arthritis (RA) experience climate care and its effects. A qualitative approach was chosen for the study. Two men and six women were interviewed according to a semistructured interview guide. The text was analyzed using a manifest content analysis. The analysis resulted in four categories and 10 subcategories. The interviewees experienced climate care positively. The training was perceived increasing gradually. The patients felt that they performed to a maximum capacity during training and were impressed by the staff's enthusiasm and encouragement. The patients felt that they were involved in the goal setting and the choice of treatment, and the staff noticed individual needs. There was a feeling among the patients of being acknowledged by the staff. Information about the disease was perceived as individualized. The climate and beautiful surroundings were viewed as encouraging physical activity and a feeling of well-being. Patients made new friends, had fun together and also shared experiences about their disease. Furthermore, the patients described a sense of belonging to a group as well as a feeling of not being the only one that was sick among the healthy. Not having to do everyday tasks and having time to themselves were perceived positively. Several factors contributed to the positive experiences of climate care; climate, environment, physical activity, social context, staff involvement, and information about the disease were described as interacting together and resulting in a sense of well-being. A proposal for future research would be to examine if/how the various factors might interact and affect the RA patients' illness and quality of life. PMID:26730385
Beyond Intuition: Patient Fever Symptom Experience
Ames, Nancy J.; Peng, Claudia; Powers, John H.; Leidy, Nancy Kline; Miller-Davis, Claiborne; Rosenberg, Alice; VanRaden, Mark; Wallen, Gwenyth R.
Context Fever is an important sign of inflammation recognized by health care practitioners and family caregivers. However, few empirical data obtained directly from patients exist to support many of the long-standing assumptions about the symptoms of fever. Many of the literature-cited symptoms, including chills, diaphoresis, and malaise, have limited scientific bases, yet they often represent a major justification for antipyretic administration. Objectives To describe the patient experience of fever symptoms for the preliminary development of a fever assessment questionnaire. Methods Qualitative interviews were conducted with 28 inpatients, the majority (86%) with cancer diagnoses, who had a recorded temperature of ≥38°C within approximately 12 hours before the interview. A semi-structured interview guide was used to elicit patient fever experiences. Thematic analyses were conducted by three independent research team members, and the data were verified through two rounds of consensus building. Results Eleven themes emerged. The participants reported experiences of feeling cold, weakness, warmth, sweating, nonspecific bodily sensations, gastrointestinal symptoms, headaches, emotional changes, achiness, respiratory symptoms, and vivid dreams/hallucinations. Conclusion Our data not only confirm long-standing symptoms of fever but also suggest new symptoms and a level of variability and complexity not captured by the existing fever literature. Greater knowledge of patients' fever experiences will guide more accurate assessment of symptoms associated with fever and the impact of antipyretic treatments on patient symptoms in this common condition. Results from this study are contributing to the content validity of a future instrument that will evaluate patient outcomes related to fever interventions. PMID:23742739
Preliminary study of relationships between hypnotic susceptibility and personality disorder functioning styles in healthy volunteers and personality disorder patients
Background Hypnotic susceptibility is one of the stable characteristics of individuals, but not closely related to the personality traits such as those measured by the five-factor model in the general population. Whether it is related to the personality disorder functioning styles remains unanswered. Methods In 77 patients with personality disorders and 154 healthy volunteers, we administered the Stanford Hypnotic Susceptibility Scale: Form C (SHSSC) and the Parker Personality Measure (PERM) tests. Results Patients with personality disorders showed higher passing rates on SHSSC Dream and Posthypnotic Amnesia items. No significant correlation was found in healthy volunteers. In the patients however, SHSSC Taste hallucination (β = 0.26) and Anosmia to Ammonia (β = -0.23) were significantly correlated with the PERM Borderline style; SHSSC Posthypnotic Amnesia was correlated with the PERM Schizoid style (β = 0.25) but negatively the PERM Narcissistic style (β = -0.23). Conclusions Our results provide limited evidence that could help to understand the abnormal cognitions in personality disorders, such as their hallucination and memory distortions. PMID:21801440
How should nurses deal with patients' personal racism? Learning from practice.
Deacon, M
This paper aims to promote practice development in the difficult area of managing patients' expressions of personal racism within the clinical environment. Racism is a global phenomenon and it is well documented that nurses experience racism within their routine practice. Nurses face unpleasant dilemmas in managing racist patients who are also vulnerable because of their health status. The paper is based on the ethnography of acute mental health nursing, conducted within a UK hospital. The study found that nurses conceptualized patients' expressions of racism as a consequence of their mental ill-health and that they managed this difficult issue through nursing methods of direct engagement, trouble avoidance and the minimization of strangeness. It is concluded that patients' racism cannot be managed by following simple, procedural rules but neither should it be managed 'behind closed doors'. A culture should be facilitated in which nurses can feel secure that colleagues and managers will take their concerns about personal racism extremely seriously and engage with, and value their contribution in working out just what to do in specific cases. The nursing methods discussed can be used as a basis for practice development in this unpleasant and uncomfortable area. PMID:21749555
Do personal stories make patient decision aids more effective? A critical review of theory and evidence
Background Patient decision aids support people to make informed decisions between healthcare options. Personal stories provide illustrative examples of others' experiences and are seen as a useful way to communicate information about health and illness. Evidence indicates that providing information within personal stories affects the judgments and values people have, and the choices they make, differentially from facts presented in non-narrative prose. It is unclear if including narrative communications within patient decision aids enhances their effectiveness to support people to make informed decisions. Methods A survey of primary empirical research employing a systematic review method investigated the effect of patient decision aids with or without a personal story on people's healthcare judgements and decisions. Searches were carried out between 2005-2012 of electronic databases (Medline, PsycINFO), and reference lists of identified articles, review articles, and key authors. A narrative analysis described and synthesised findings. Results Of 734 citations identified, 11 were included describing 13 studies. All studies found participants' judgments and/or decisions differed depending on whether or not their decision aid included a patient story. Knowledge was equally facilitated when the decision aids with and without stories had similar information content. Story-enhanced aids may help people recall information over time and/or their motivation to engage with health information. Personal stories affected both "system 1" (e.g., less counterfactual reasoning, more emotional reactions and perceptions) and "system 2" (e.g., more perceived deliberative decision making, more stable evaluations over time) decision-making strategies. Findings exploring associations with narrative communications, decision quality measures, and different levels of literacy and numeracy were mixed. The pattern of findings was similar for both experimental and real
Taurine for the Treatment of Canine Dilated Cardiomyopathy: A Veterinarian's Personal Experience.
Vail, Jane
In dogs, dilated cardiomyopathy is a common cardiac disease that is associated with treatment failure, a progressively compromised quality of life, and eventual death from heart failure. Cardiomyopathy in companion animals is treated with a variety of drugs manufactured for the management of cardiac dyfunction in humans, but often those agents do not produce a significantly beneficial response in veterinary patients. In this article, Lara Ivan, DVM, presents her personal experience with the use of a compounded form of the amino acid taurine in the treatment of her Doberman pinscher, whose dilated cardiomyopathy was characteristically sudden in onset. Robert Borger, RPh, a specialist in veterinary compounding, comments on the preparation of taurine for use in dogs with dilated cardiomyopathy. PMID:23974413
Insomnia patients' help-seeking experiences.
Cheung, Janet M Y; Bartlett, Delwyn J; Armour, Carol L; Glozier, Nicholas; Saini, Bandana
Timely access to appropriate treatment is important for optimizing insomnia management. To date, little is known about insomnia patients' treatment experiences or how they access and engage with the available health care resources. This study sought to capture the help-seeking experiences and behavioral patterns of patients with insomnia who are seeking or receiving specialist care. A purposive sample of 26 insomnia patients from specialist sleep and mental health clinics located in metropolitan New South Wales, Australia was recruited. Participants completed a brief questionnaire, followed by an in-depth, semi-structured interview. Interviews were digitally recorded, transcribed verbatim, and analyzed using framework analysis. Three key themes emerged from the data: patients' sleep beliefs, treatment beliefs, and accessing specialized care. The findings show that daytime symptoms arising from insomnia serve as important illness cues for patients to seek medical help. In addition, participants' treatment pathways highlight factors that prevent the widespread use of cognitive behavioral therapy for insomnia (CBT-I), including limited awareness about CBT-I, tentative referral mechanisms, limited service providers, and the high cost of CBT-I. PMID:23514322
Coed Trecastell: A Personal Experience of the John Muir Award.
ERIC Educational Resources Information Center
Collister, Rob
A John Muir Award participant describes his satisfying experience cleaning up a wooded gorge near his home in Wales. Sidebar explains how the British award achieves its purpose of empowering people to conserve wild places through four challenges: discover a wild place, explore it, conserve it, and share the experience with others. The award has…
Paperless medical records: reinventing the patient experience.
Tobey, Mary Ellen
At North Shore Magnetic Imaging Center, the patient paper medical record system was becoming very cumbersome, and it served as a source of frustration for everyone involved: patients, technologists, radiologists, and staff members. The center's mapping of a typical patient experience indicated that, from the initial phone call scheduling an exam to a completed visit (claim processed and payment received), a record could be handled by as many as 20 sets of hands! In June 2002, the center's growth and a concern that patients were losing a one-on-one experience with the medical staff led to an evaluation of workflow processes existing at that time. The evaluation began with a survey of staff members, center management, radiologists, and referring physicians. Their responses indicated 3 common themes: stress, overload, and frustration over systems in place. Comments from the survey were grouped into 3 areas: Continue to Do, Stop Doing, and Start Doing. The Start Doing responses provided solid objectives. The center set out to establish a breakthrough project that included all stakeholders--patients, staff, management, and radiologists. The Reinvention Project had 2 primary goals: move to a paperless environment and increase the level of patient care. The project was divided into internal and external teams. The internal team, called the Reinvention Team, was responsible for the actual hands-on aspects of the process. There were numerous external teams; each had defined roles and specific outcomes for achievement. The external teams' responsibilities included implementing an Internet protocol telephone system; researching voice recognition; restructuring job descriptions, training manuals, and performance evaluations; and conducting a patient-centered focus group. PMID:15259685
Individual Characteristics, Familial Experience, and Psychopathology in Children of Mothers with Borderline Personality Disorder
ERIC Educational Resources Information Center
Barnow, Sven; Spitzer, Carsten; Grabe, Hans J.; Kessler, Christoph; Freyberger, Harald J.
Objective: The aim of this study was to examine individual characteristics, familial experience, and psychopathology of children of mothers with borderline personality disorder (BPD). Method: Children of mothers with BPD were compared to children of mothers (1) with depressive disorders, (2) with cluster C personality disorders, and (3) without…
The Earth Is Flat when Personally Significant Experiences with the Sphericity of the Earth Are Absent
ERIC Educational Resources Information Center
Carbon, Claus-Christian
Participants with personal and without personal experiences with the Earth as a sphere estimated large-scale distances between six cities located on different continents. Cognitive distances were submitted to a specific multidimensional scaling algorithm in the 3D Euclidean space with the constraint that all cities had to lie on the same sphere. A…
Researching Mathematical Experience from the Perspective of an Empathic Second-Person Observer
ERIC Educational Resources Information Center
Metz, Martina L.; Simmt, Elaine S.
In this paper, we explore the implications of adopting (and developing the capacities necessary to adopt) an empathic second-person research perspective. Such a perspective aims to mediate participants' access to their own experience, thereby providing a rich source of first-person data as well as a powerful pedagogical tool. Working within the…
The phenomenology of fit: linking the person and environment to the subjective experience of person-environment fit.
Edwards, Jeffrey R; Cable, Daniel M; Williamson, Ian O; Lambert, Lisa Schurer; Shipp, Abbie J
The authors distinguished 3 approaches to the study of perceived person-environment fit (P-E fit): (a) atomistic, which examines perceptions of the person and environment as separate entities; (b) molecular, which concerns the perceived comparison between the person and environment; and (c) molar, which focuses on the perceived similarity, match, or fit between the person and environment. Distinctions among these approaches have fundamental implications for theory, measurement, and the subjective experience of P-E fit, yet research has treated these approaches as interchangeable. This study investigated the meaning and relationships among the atomistic, molecular, and molar approaches to fit and examined factors that influence the strength of these relationships. Results showed that the relationships among the approaches deviate markedly from the theoretical logic that links them together. Supplemental analyses indicated that molar fit overlaps with affect and molecular fit gives different weight to atomistic person and environment information depending on how the comparison is framed. These findings challenge fundamental assumptions underlying P-E fit theories and have important implications for future research. PMID:16834507
[Anesthetic Management for a Patient with Stiff-person Syndrome].
Nakamura, Kumiko; Murao, Kohei; Kimoto-Shirakawa, Michiyo; Takahira, Kazuyo; Toorabally, Farah; Shingu, Koh
The stiff-person syndrome (SPS) is a rare autoimmune neurologic disorder that affects the gamma-aminobutyric acid (GABA) mediated inhibitory network in the central nervous system with anti-glutamic acid decarboxylase (GAD) antibodies. SPS is characterized by muscle rigidity and painful episodic spasms in axial and lower limb muscles. This case report describes successful peri-operative management of a 61-year-old female (height, 158 cm; weight, 60 kg, ASA-PS 2) with her right upper arm fracture who was scheduled for open reduction and internal fixation. This patient had bulbar paralysis, dysphagia and muscle rigidity associated with a high titer of anti-GAD auto antibodies (2,800 U x ml(-1)). She was diagnosed as SPS and has been treated with predonisolone (30 mg x day(-1)) and diazepam (20 mg x day(-1)) for 1 year. Predonisolone (15 mg) and diazepam (30 mg) was given orally before induction of general anesthesia with propofol, remifentanil and rocuronium bromide. Posture change from supine to beach-chair position led to sudden drop in blood pressure to 38/25 mmHg, which recovered promptly by injecting intravenous ephedrine hydrochloride (28 mg) and hydrocortisone (100 mg). Postanesthetic course was uneventful without postoperative neurologic abnormalities. PMID:27017773
Social Cognition in a Clinical Sample of Personality Disorder Patients.
Ruiz-Tagle, Amparo; Costanzo, Elsa; De Achával, Delfina; Guinjoan, Salvador
Social cognition was assessed in a clinical sample of personality disorder (PD) stable patients receiving ambulatory treatment (N = 17) and healthy matched controls (N = 17) using tests of recognition of emotions in faces and eyes, in a test of social faux pas and in theory of mind (ToM) stories. Results indicated that when compared with healthy controls, individuals with PD showed a clear tendency to obtain lower scoring in tasks assessing recognition of emotion in faces (T = -2.602, p = 0.014), eyes (T = -3.593, p = 0.001), ToM stories (T = -4.706, p = 0.000), and Faux pas (T = -2.227, p = 0.035). In the present pilot study, PD individuals with a normal cognitive efficiency showed an impaired performance at social cognition assessment including emotion recognition and ToM. PMID:26074824
Social Cognition in a Clinical Sample of Personality Disorder Patients
Ruiz-Tagle, Amparo; Costanzo, Elsa; De Achával, Delfina; Guinjoan, Salvador
Social cognition was assessed in a clinical sample of personality disorder (PD) stable patients receiving ambulatory treatment (N = 17) and healthy matched controls (N = 17) using tests of recognition of emotions in faces and eyes, in a test of social faux pas and in theory of mind (ToM) stories. Results indicated that when compared with healthy controls, individuals with PD showed a clear tendency to obtain lower scoring in tasks assessing recognition of emotion in faces (T = −2.602, p = 0.014), eyes (T = −3.593, p = 0.001), ToM stories (T = −4.706, p = 0.000), and Faux pas (T = −2.227, p = 0.035). In the present pilot study, PD individuals with a normal cognitive efficiency showed an impaired performance at social cognition assessment including emotion recognition and ToM. PMID:26074824
Enhancing the Imaging Experience for Pediatric Patients.
Baron, Molly; Joslin, Shannon; Kim, Jane S; Shet, Narendra S; Pocta, Brigitte; Olivi, Penny
The University of Maryland Medical Center's goal was to improve the safety and comfort of pediatric imaging by enhancing the experience for children. Two pediatric radiologists and two child life specialists worked together to create a training program to help guide radiology technologists on how to approach and interact with children undergoing medical imaging. The results of surveys administered to technologists and parents or caregivers helped refine the strategy for both creating training sessions for technologists and reading materials for children and their parents to optimally prepare for the procedures. Training sessions included information on language choices, developmental considerations, comfort techniques, patient- and family-centered care practices, procedural support techniques, and coping styles. Through the implementation of learning sessions and distraction resources for technologists, and the development of preparation books, the imaging experience for pediatric patients at UMMC has improved. PMID:27514108
Postoperative pain: nurses' knowledge and patients' experiences.
Francis, Lavonia; Fitzpatrick, Joyce J
The aim of this study was to determine nurses' knowledge and attitudes regarding postoperative pain and identify postoperative patients' pain intensity experiences. The assessment and management of acute postoperative pain is important in the care of postoperative surgical patients. Inadequate relief of postoperative pain can contribute to postoperative complications such as atelectasis, deep vein thrombosis, and delayed wound healing. A pilot study with an exploratory design was conducted at a large teaching hospital in the eastern United States. The convenience samples included 31 nurses from the gastrointestinal and urologic surgical units and 14 first- and second-day adult postoperative open and laparoscopic gastrointestinal and urologic patients who received patient-controlled analgesia (PCA). The Knowledge and Attitudes Survey Regarding Pain was used to measure nurses' knowledge about pain management. The Short-Form McGill Pain Questionnaire (SF-MPQ) was used to measure patients' pain intensity. The nurses' mean score on the Knowledge and Attitudes Survey Regarding Pain was 69.3%. Patients experienced moderate pain, as indicated by the score on the SF-MPQ. There is a need to increase nurses' knowledge of pain management. PMID:24315258
Diagnostic and therapeutic iter in paediatric OSAS: personal experience.
Piumetto, E; Sammartano, A M; Meinardi, G; Dagna, F; Gervasio, F C; Albera, R
Obstructive sleep apnoea syndrome in a child is characterized by prolonged episodes of obstructive hypopnoea and/or apnoea of upper airway leading to morbidity. The most common risk factor is adeno-tonsillar hypertrophy. Obstructive sleep apnoea syndrome diagnosis is based on clinical ENT evaluation and an instrumental approach, such as pulse oximetry or the gold standard overnight polysomnography. The aim is to establish, in a population of children with suspected obstructive sleep apnoea syndrome, the frequency of this disorder, the effect of adenotonsillectomy and the risk of post-operative complications. A total of 481 patients (297 male, 184 female) with suspected obstructive sleep apnoea syndrome (aged 2-14 years) were evaluated between March 2007 and April 2010 and divided into 3 morphological phenotypes: classic, adult and congenital. All patients underwent ENT assessment and a pulse oximetry with 4 channels cardiopulmonary monitoring. The examination following the Brouillette criteria was defined as negative, positive or inconclusive; when positive, adenotonsillectomy was the first therapeutic approach. At 6 months after surgery, all patients underwent check-up pulse oximetry. Of the overall sample, 96% of the patients had a classical phenotype, 3% an adult type and 1% a congenital type. The monitoring resulted pathological in 19% (17% of them were at increased post-operative risk), negative in 61% and inconclusive in 20%. All 5 patients with congenital phenotype were positive. Of the positive patients, 86% underwent adenotonsillectomy and a control pulse oximetry 6 months thereafter, 96% resulted negative. Pulse oximetry was efficient in order to avoid incorrect surgery indications, improving appropriateness and safety of adenotonsillectomy in children with obstructive sleep apnoea syndrome. Adenotonsillectomy showed a success rate of 96% and there were no episodes of post-surgery complications in particular in those patients at increased risk. PMID
Emotional benefit of cosmetic camouflage in the treatment of facial skin conditions: personal experience and review
Levy, Lauren L; Emer, Jason J
Background Recent studies highlighting the psychological benefits of medical treatment for dermatological skin conditions have demonstrated a clear role for medical therapy in psychological health. Skin conditions, particularly those that are overtly visible, such as those located on the face, neck, and hands, often have a profound effect on the daily functioning of those affected. The literature documents significant emotional benefits using medical therapy in conditions such as acne, psoriasis, vitiligo, and rosacea, but there is little evidence documenting similar results with the use of cosmetic camouflage. Here we present a review highlighting the practical use of cosmetic camouflage makeup in patients with facial skin conditions and review its implications for psychological health. Methods A search of the Medline and Scopus databases was performed to identify articles documenting the emotional benefit of cosmetic camouflage. Results Cosmetic camouflage provides a significant emotional benefit for patients with facial skin conditions, and this is substantiated by a literature review and personal experience. More clinical studies are needed to assess and validate the findings reported here. Conclusion Patients with visible skin conditions have increased rates of depression, anxiety, and decreased self-esteem. It is prudent for us to consider therapies that can offer rapid and dramatic results, such as cosmetic camouflage. PMID:23152694
Necrotizing Craniocervical Soft Tissue Infections: Clinical Experience and Personal Considerations
Lenzi, Riccardo; Castelnuovo, Paolo; Dallan, Iacopo
Necrotizing cervical soft tissue infections (NCSTIs) are devastating uncommon clinical entities that are often life threatening. We report two patients suffering from NCSTI and treated at our institution. Diagnosis of NCSTI has been confirmed histologically and surgically. Both patients were managed with very aggressive treatment (medical and surgical) and survived with minimal morbidity. Early diagnosis and aggressive, multimodality treatment can reduce mortality and morbidity rates. Thoracic and mediastinal involvement requires appropriate management. A strong clinical suspicion remains one of the most important aspects of the management of such shattering conditions. PMID:23304596
Directed abstraction: Encouraging broad, personal generalizations following a success experience.
Zunick, Peter V; Fazio, Russell H; Vasey, Michael W
People with negative self-views may fail to generalize appropriately from success experiences (e.g., Wood, Heimpel, Newby-Clark, & Ross, 2005). We drew on theories regarding self-views (Swann, Griffin, Predmore, & Gaines, 1987) and abstraction (Semin & Fiedler, 1991), as well as past linguistic framing work (e.g., Marigold, Holmes, & Ross, 2007, 2010; Salancik, 1974), to create a new technique to encourage people with negative self-views to generalize broadly from a success experience to the self-concept. We call this technique directed abstraction. In Experiment 1, participants with negative self-views who completed a directed abstraction writing task following success feedback regarding a novel laboratory task generalized more from that success, reporting higher ability levels and greater expectations of future success in the relevant domain. In Experiment 2, directed abstraction produced similar results (including more positive self-related affect, e.g., pride) after participants recalled a past public speaking success. In Experiment 3, participants high in fear of public speaking gave two speeches in a context designed to be challenging yet also to elicit successful performances. Directed abstraction helped these participants generalize from their success to beliefs about their abilities, expectations about the future, and confidence as a speaker. In Experiment 4, directed abstraction following success on a verbal task increased persistence in the face of failure on a subsequent verbal task. We discuss implications for understanding how and when people generalize from a success, compare directed abstraction to existing interventions, and suggest practical applications for this influence technique. PMID:25984786
Enjoying work or burdened by it? How personal assistants experience and handle stress at work.
Ahlström, Gerd; Wadensten, Barbro
A personal assistant has to promote equality in living conditions for persons with severe disabilities. The aim of this study was to explore how personal assistants experience their work and what strategies they employ to alleviate work-related stress. Thirty personal assistants were interviewed and latent content analysis was performed. The findings regarding the experiences of work-related stress could be brought together under the theme of "difficulties of being in a subordinate position," and those regarding management strategies could be brought together under the theme of "coming to terms with the work situation." There is a need to empower personal assistants through training programs including tailored education, working communities, and coaching. PMID:22630600
[Personal experience in the organization of mass admission of traumatized refugees].
Pavlović, D; Bijedić, S
Here is showed experience and importance of Emergency Medical Service during mass reception of traumatised displaced persons from Srebrenica in July 1995. During organisation of reception a good willingness and experience of this service with repard a to fast action, examination and selection of more than 15,000 displaced persons. In short time, whole coming persons were examined; medicine treated and in other way cared. There were arranged, 234 doctor teams, 22 stomatologist teams, 42 laboratory teams, 42 hygiene-epidemiologist teams and 18 teams for vaccination of children. In the various pathology of coming displaced persons there were dominated: respiratory disease case and uncared skin infections in children, chronical cardiovascular disease and malnutrition in adults. For successful realisation of this complex tasks, like the organising of reception and medical care of huge number of traumatised displaced persons, it is needed to have well organised, qualified and technical equipped Emergency medical Service. PMID:9601774
Elastoplasty: First Experience in 12 Patients
Urlings, Thijs A. J. Linden, Edwin van der
Percutaneous vertebroplasty with polymethylmethacrylate (PMMA) is used increasingly for pain relief in symptomatic neoplastic or osteoporotic compression fractures. However, restoration of the stiffness of the treated vertebrae might propagate secondary fracture of adjacent vertebrae. Elastoplasty might prevent these secondary fractures. We assessed retrospectively our experience with elastoplasty in 12 patients, focusing on silicone migration. During the period from July 2011 to January 2012, all patients with an indication for vertebroplasty were treated with elastoplasty. The exclusion criterion was the presence of posterior wall defects. Chest computed tomography (CT) scans were performed to evaluate the presence of perivertebral leakage and pulmonary embolism. The prevalence of leakage was compared with the results obtained for vertebroplasty with PMMA reported in the literature. Other complications during the postprocedural period were recorded. Twenty-one vertebral bodies in 12 patients were treated with elastoplasty. Silicone pulmonary emboli were detected on the postprocedural chest CT in 60 % (6/10) of the patients. Leakage to the perivertebral venous plexus was seen in 67 % (14/21) of the treated vertebrae. One major complication occurred: severe, medication-resistant dyspnea developed in one patient with multiple peripheral silicone emboli. This preliminary evidence suggests that VK100 silicone cement should not be used in elastoplasty because of the increased risk of silicone pulmonary embolism, when compared with the use of PMMA, which occurs worldwide. The major technical disadvantage is that the time taken for the VK100 silicone material to achieve its final strength is too long for practical application.
Interaction between Personality and Mood in Unipolar and Bipolar Patients.
ERIC Educational Resources Information Center
Alexander, Gene E.; And Others
Much of the literature on affective disorders has been devoted to categorizing, assessing, and treating the mood and behavioral symptoms typically associated with depressive illness, and much research has studied how personality traits interact with these state symptoms. The personality scales of the Millon Clinical Multiaxial Inventory (MCMI) are…
Personal health records, symptoms, uncertainty, and mood in brain tumor patients
Cahill, Jennifer E.; Lin, Lin; LoBiondo-Wood, Geri; Armstrong, Terri S.; Acquaye, Alvina A.; Vera-Bolanos, Elizabeth; Gilbert, Mark R.; Padhye, Nikhil S.
Background The advantages of patient access to the electronic medical record (EMR) through integrated personal health records (PHR) may be substantial, and foremost is the enhanced information flow between patient and practitioner. Because this is an emerging technology, the actualized benefits to complex patient groups remain largely unknown. MD Anderson Cancer Center provides web-based PHR portal access to the EMR including clinic notes, MRI results, and pathology reports. This study sought to evaluate PHR use by glioma patients. Methods Cross-sectional survey and PHR-derived user data from 186 patients were analyzed using descriptive and inferential statistics. Logistic regression assessed disparities between users and nonusers. Dependence of PHR access on treatment stage was tested through linear regression. Path analysis evaluated PHR access, disease-related uncertainty, symptom experience, and mood. Results Patients averaged 44.2 years (range 19y–80y), 77% had a high-grade tumor, and 60% had accessed PHR at least one time (range 0–126). Strongest predictors of access included education level (college level or higher), low performance status, middle income, and in-state residency. Patients undergoing treatment were more active users. PHR access was associated with lower disease-related uncertainty and lower symptom severity. Mood was not directly related to PHR use but mediated an association between symptom severity and uncertainty. Conclusions While many reports presume better disease and symptom understanding for patients with EMR access, this study is the first to correlate PHR use to lower patient uncertainty levels. Early examination of PHR provides an important basis for critical evaluation and optimization to better structure this benefit for brain tumor patients. PMID:26034618
The relation between type D personality and the clinical condition of patients suffering from psoriasis
Woźniewicz, Agnieszka
Introduction Type D personality is the last distinguished specific type of personality that is characterised by two dimensions: a tendency for feeling negative emotions – depression, anxiety, anger or hostility, and a tendency for withdrawal from the society. The latest research shows the significant role played by type D personality in the aetiology and course of a variety of diseases. Aim The article discusses the problem of the occurrence of type D personality in the group of patients suffering from psoriasis. Diversities in the clinical condition of psoriasis patients due to increasing type D personality traits are specified. Material and methods Ninety psoriasis patients and 86 healthy subjects participated in the research. In the research questionnaires, the scale for assessing increasing psoriasis complaints and the DS-14 scale to assess type D personality were applied. Results Research results made it possible to corroborate more frequent occurrence of type D personality among psoriasis patients. Moreover, it was found that with increasing negative affectivity – one of type D personality components – complaints increase as far as the clinical condition of psoriasis patients is concerned. Conclusions Monitoring of psychological well-being of psoriasis patients, especially within type D personality, seems to be a vital element, irrespective of purely medical treatment. PMID:24494001
Using Linked Data for polarity classification of patients' experiences.
Noferesti, Samira; Shamsfard, Mehrnoush
Polarity classification is the main subtask of sentiment analysis and opinion mining, well-known problems in natural language processing that have attracted increasing attention in recent years. Existing approaches mainly rely on the subjective part of text in which sentiment is expressed explicitly through specific words, called sentiment words. These approaches, however, are still far from being good in the polarity classification of patients' experiences since they are often expressed without any explicit expression of sentiment, but an undesirable or desirable effect of the experience implicitly indicates a positive or negative sentiment. This paper presents a method for polarity classification of patients' experiences of drugs using domain knowledge. We first build a knowledge base of polar facts about drugs, called FactNet, using extracted patterns from Linked Data sources and relation extraction techniques. Then, we extract generalized semantic patterns of polar facts and organize them into a hierarchy in order to overcome the missing knowledge issue. Finally, we apply the extracted knowledge, i.e., polar fact instances and generalized patterns, for the polarity classification task. Different from previous approaches for personal experience classification, the proposed method explores the potential benefits of polar facts in domain knowledge aiming to improve the polarity classification performance, especially in the case of indirect implicit experiences, i.e., experiences which express the effect of one entity on other ones without any sentiment words. Using our approach, we have extracted 9703 triplets of polar facts at a precision of 92.26 percent. In addition, experiments on drug reviews demonstrate that our approach can achieve 79.78 percent precision in polarity classification task, and outperforms the state-of-the-art sentiment analysis and opinion mining methods. PMID:26210363
Engaging Primary Care Patients to Use a Patient-Centered Personal Health Record
Krist, Alex H.; Woolf, Steven H.; Bello, Ghalib A.; Sabo, Roy T.; Longo, Daniel R.; Kashiri, Paulette; Etz, Rebecca S.; Loomis, John; Rothemich, Stephen F.; Peele, J. Eric; Cohn, Jeffrey
PURPOSE Health care leaders encourage clinicians to offer portals that enable patients to access personal health records, but implementation has been a challenge. Although large integrated health systems have promoted use through costly advertising campaigns, other implementation methods are needed for small to medium-sized practices where most patients receive their care. METHODS We conducted a mixed methods assessment of a proactive implementation strategy for a patient portal (an interactive preventive health record [IPHR]) offered by 8 primary care practices. The practices implemented a series of learning collaboratives with practice champions and redesigned workflow to integrate portal use into care. Practice implementation strategies, portal use, and factors influencing use were assessed prospectively. RESULTS A proactive and customized implementation strategy designed by practices resulted in 25.6% of patients using the IPHR, with the rate increasing 1.0% per month over 31 months. Fully 23.5% of IPHR users signed up within 1 day of their office visit. Older patients and patients with comorbidities were more likely to use the IPHR, but blacks and Hispanics were less likely. Older age diminished as a factor after adjusting for comorbidities. Implementation by practice varied considerably (from 22.1% to 27.9%, P <.001) based on clinician characteristics and workflow innovations adopted by practices to enhance uptake. CONCLUSIONS By directly engaging patients to use a portal and supporting practices to integrate use into care, primary care practices can match or potentially surpass the usage rates achieved by large health systems. PMID:25354405
Self-Compassion Promotes Personal Improvement From Regret Experiences via Acceptance.
Zhang, Jia Wei; Chen, Serena
Why do some people report more personal improvement from their regret experiences than others? Three studies examined whether self-compassion promotes personal improvement derived from recalled regret experiences. In Study 1, we coded anonymous regret descriptions posted on a blog website. People who spontaneously described their regret with greater self-compassion were also judged as having expressed more personal improvement. In Study 2, higher trait self-compassion predicted greater self-reported and observer-rated personal improvement derived from recalled regret experiences. In Study 3, people induced to take a self-compassionate perspective toward a recalled regret experience reported greater acceptance, forgiveness, and personal improvement. A multiple mediation analysis comparing acceptance and forgiveness showed self-compassion led to greater personal improvement, in part, through heightened acceptance. Furthermore, self-compassion's effects on personal improvement were distinct from self-esteem and were not explained by adaptive emotional responses. Overall, the results suggest that self-compassion spurs positive adjustment in the face of regrets. PMID:26791595
Minimizing the Pervasiveness of Women's Personal Experiences of Gender Discrimination
ERIC Educational Resources Information Center
Foster, Mindi D.; Jackson, Lydia C.; Hartmann, Ryan; Woulfe, Shannon
Given the Rejection-Identification Model (Branscombe, Schmitt, & Harvey, 1999), which shows that perceiving discrimination to be pervasive is a negative experience, it was suggested that there would be conditions under which women would instead minimize the pervasiveness of discrimination. Study 1 (N= 91) showed that when women envisioned…
Shifting from Instruction to Construction: A Personal Meaningful Experience.
ERIC Educational Resources Information Center
Blocher, J. Michael; Echols, Jennifer; de Montes, Laura Sujo; Willis, Elizabeth; Tucker, Gary
Presents a case study of one student's passage through an online M.ED. in Educational Technology degree program and her subsequent experience integrating her newly acquired knowledge, skills, and methods in the real world of her own teaching practice, focusing on her dilemma in assessing her students' learning as she shifted her educational…
Teaching Marketing in a Transition Economy: Some Personal Experiences
ERIC Educational Resources Information Center
McKenzie, Brent
In addition to the challenges faced when delivering a marketing course to international students in general, the challenges are compounded when the students have little interest in the subject and the students are located in a country in transition. This study examines the experiences of the author in teaching marketing theory to first-year…
Corporal Punishment in Schools: Theoretical Discussion and Personal Experience
ERIC Educational Resources Information Center
Alsaif, Omar Abdulaziz
This paper ponders the lasting effects of corporal punishment on students. The paper first considers the benefits and faults of corporal punishment by comparing the experiences of two generations of students and teachers. Starting with the definition of corporal punishment as applied locally and globally, the paper analyzes the reasons for its…
Positive patient experiences in an Australian integrative oncology centre
Background The purpose of this study was to explore the experiences of cancer patients' utilising complementary and integrative therapies (CIT) within integrative oncology centres across Western Australia. Methods Across four locations 135 patients accessed CIT services whilst undergoing outpatient medical treatment for cancer. Of the 135 patients, 66 (61 ± 12 y; female n = 45; male n = 21) agreed to complete a personal accounts questionnaire consisting of open-ended questions designed to explore patients' perceptions of CIT. All results were transcribed into nVivo (v9) and using thematic analysis, key themes were identified. Results Of the 66 participants, 100% indicated they would "recommend complementary therapies to other patients" and 92% stated "CIT would play a significant role in their future lifestyle". A mean score of 8 ± 1 indicated an improvement in participants' perception of wellbeing following a CIT session. Three central themes were identified: empowerment, support and relaxation. Fourteen sub-themes were identified, with all themes clustered into a framework of multifaceted views held by cancer patients in relation to wellbeing, role of significant others and control. Conclusions Exploration of patients' experiences reveals uniformly positive results. One of the key merits of the environment created within the centres is patients are able to work through their cancer journey with an increased sense of empowerment, without placing them in opposition to conventional medical treatment. In order to effectively target integrative support services it is crucial to explore the experiences of patients in their own words and use those forms of expression to drive service delivery. PMID:24886476
[Skills Training for Patients with Borderline Personality Disorder].
Armbrust, Michael; Ehrig, Christian
The emotionally instable personality disorder, mostly called borderline disorder, shows central abnormalities in impulse control as well as instability of mood and identity. It is composed of behaviour problems in creating relationships and in self-management, first of all by high psychophysiological tension. The prevalence of this disorder is 10 % in outpatients and 20 % in inpatients and has therefore high relevance for the medical-psychotherapeutic care system. The treatment is deemed to be complex and interminable. Regarding all evaluated techniques of treatment the best examined is the Dialectical Behavioral Therapy (DBT). This specific therapy, developed in the eighties by Marsha M. Linehan, can be used for inpatient and outpatient treatment and combines single and group sessions. It is essential in mental health care of this disorder, but not available everywhere. Essential part of DBT is the skill training, a specific technique for the acquirement and for exercising skills for mindfulness, modulation of tension, regulation of emotions, structuring of social competence and developing self value. The central goal of DBT is to ensure the survival of the patients, to reduce self- and external aggressive behaviour and to provide inpatient crisis interventions. For sustained crisis management skills for reality acceptance are best fitting. But before, fast available sensory and active body-related skills should be used. Radical acceptance is the most important, since most effective, skill. The skills training, although in use for only twenty years, is permanently expanding in practice and is meanwhile also used for other disorders such as, for example, PTSD or ADHD. Since 2010, there also exists an elaborated DBT-version for adolescents. For medical care politics and health-economic reasons a supply with skills training for in- and outpatients all over the country is desirable. PMID:27388871
Trigger factors of migraine and tension-type headache: experience and knowledge of the patients.
Wöber, Christian; Holzhammer, Julia; Zeitlhofer, Josef; Wessely, Peter; Wöber-Bingöl, Ciçek
The objective was to examine potential trigger factors of migraine and tension-type headache (TTH) in clinic patients and in subjects from the population and to compare the patients' personal experience with their theoretical knowledge. A cross-sectional study was carried out in a headache centre. There were 120 subjects comprising 66 patients with migraine and 22 with TTH from a headache outpatient clinic and 32 persons with headache (migraine or TTH) from the population. A semistructured interview covering biographic data, lifestyle, medical history, headache characteristics and 25 potential trigger factors differentiating between the patients' personal experience and their theoretical knowledge was used. The most common trigger factors experienced by the patients were weather (82.5%), stress (66.7%), menstruation (51.4%) and relaxation after stress (50%). The vast majority of triggers occurred occasionally and not consistently. The patients experienced 8.9+/-4.3 trigger factors (range 0-20) and they knew 13.2+/-6.0 (range 1-27). The number of experienced triggers was smallest in the population group (p=0.002), whereas the number of triggers known did not differ in the three study groups. Comparing theoretical knowledge with personal experience showed the largest differences for oral contraceptives (65.0 vs. 14.7%, p<0.001), chocolate (61.7 vs. 14.3%, p>0.001) and cheese (52.5 vs. 8.4%, p<0.001). In conclusion, almost all trigger factors are experienced occasionally and not consistently by the majority of patients. Subjects from the population experience trigger factors less often than clinic patients. The difference between theoretical knowledge and personal experience is largest for oral contraceptives, chocolate and cheese. PMID:16897622
Hospital Preparations for Viral Hemorrhagic Fever Patients and Experience Gained from Admission of an Ebola Patient
Minderhoud, A.L.C. (Ben); Wind, Jelte D.D.; Leenen, Luke P.H.; Hoepelman, Andy I.M.; Ellerbroek, Pauline M.
The Major Incident Hospital of the University Medical Centre of Utrecht has a longstanding history of preparing for the management of highly pathogenic and infectious organisms. An assessment of the hospital's preparations for an outbreak of viral hemorrhagic fever and its experience during admission of a patient with Ebola virus disease showed that the use of the buddy system, frequent training, and information sessions for staff and their relatives greatly increased the sense of safety and motivation among staff. Differing procedures among ambulance services limited the number of services used for transporting patients. Waste management was the greatest concern, and destruction of waste had to be outsourced. The admission of an Ebola patient proceeded without incident but led to considerable demands on staff. The maximum time allowed for wearing personal protective equipment was 45 minutes to ensure safety, and an additional 20 minutes was needed for recovery. PMID:26812146
Personal Characteristics and Experience of Primary Care Predicting Frequent Use of Emergency Department: A Prospective Cohort Study
Hudon, Catherine; Sanche, Steven; Haggerty, Jeannie L.
Objective A small number of patients frequently using the emergency department (ED) account for a disproportionate amount of the total ED workload and are considered using this service inappropriately. The aim of this study was to identify prospectively personal characteristics and experience of organizational and relational dimensions of primary care that predict frequent use of ED. Methods This study was conducted among parallel cohorts of the general population and primary care patients (N = 1,769). The measures were at baseline (T1), 12 (T2) and 24 months (T3): self-administered questionnaire on current health, health behaviours and primary care experience in the previous year. Use of medical services was confirmed using administrative databases. Mixed effect logistic regression modeling identified characteristics predicting frequent ED utilization. Results A higher likelihood of frequent ED utilization was predicted by lower socioeconomic status, higher disease burden, lower perceived organizational accessibility, higher number of reported healthcare coordination problems and not having a complete annual check-up, above and beyond adjustment for all independent variables. Conclusions Personal characteristics such as low socioeconomic status and high disease burden as well as experience of organizational dimensions of primary care such as low accessibility, high healthcare coordination problems and low comprehensiveness of care are prospectively associated with frequent ED utilization. Interventions developed to prevent inappropriate ED visits, such as case management for example, should tailor low socioeconomic status and patients with high disease burden and should aim to improve experience of primary care regarding accessibility, coordination and comprehensiveness. PMID:27299525
The Undergraduate Research Experience from a Personal Point of View
NASA Astrophysics Data System (ADS)
Kartaltepe, J. S.
As an undergraduate at Colgate University, I have had many opportunities to get involved with research. I spent the summer after my first year on a project at Colgate that extended into a junior research course and I have also worked at two very different national programs (National Radio Astronomy Observatory at Green Bank and the Space Telescope Science Institute). As a result, I have gained research and observing experience at different observatories, including the Foggy Bottom Observatory at Colgate, Lowell Observatory, and the NRAO at Green Bank. From these diverse experiences I have learned a great deal about research in astronomy in general as well as what some aspects of the field are like specifically. For instance, I have learned about quasars, weak gravitational lensing, and HI absorption. I have come to appreciate things about astronomy that one never learns inside of a classroom. By having the chance to try out different types of research, I have gotten a better idea of what areas of research I might like to pursue in the future. These experiences have given me some highly beneficial skills for my future career in research.
[Our experience with hormonal therapy in transsexual patients].
Weiss, Vladimír; Weiss, Petr; Fifková, Hana
Hormonal therapy in transsexual patients (TS) includes sexagens administration: androgens in female-to-male transsexual patients (FtM) and oestrogens and antiandrogens in male-to-female transsexual patients (MtF). Duration of hormonal therapy should continue at least 1 year before gender reassignment surgery. Hormonal therapy supresses former gender and induces partially new gender changes. Hormonal therapy continues subsequently after surgery during life. Hormonal therapy in MtF TS includes oestrogens and antiandrogens application. In very young persons in both groups blocking gonadoliberin analogues can be used. In FtM TS testosterone oneself is given (orally and/or parenterally). Authors describe their own experiences with hormonal treatment in 282 TS (163 FtM and 119 MtF). During hormonal therapy statistically significant weight increasing was found in both groups. Total cholesterol increased in FtM. In MtF during hormonal therapy average prolactin level increased from 350.1 to 570.5 mU/l without clinical significance. Total average hormonal therapy duration was 6.73 years in FtM and 4.64 years in MtF and so overall therapy safety assessment is not possible. Any endocrinopathy occurence in the beginning of surveillance was found in 35 persons (12.4 %): simple goiter, autoimmune thyreoiditis, hypothyroidism, hyperthyroidism, gynecomastia, DM type 1, congenital adrenal hyperplasia (CAH), Klinefelter syndrome and nonfunctional pituitary adenoma. It is appropriate as well as in other rare medicine conditions to manage diagnosing and therapy in centers with experience with these issues. PMID:25873114
The Effect of Attending Good Psychiatric Management (GPM) Workshops on Attitudes Toward Patients With Borderline Personality Disorder.
Keuroghlian, Alex S; Palmer, Brian A; Choi-Kain, Lois W; Borba, Christina P C; Links, Paul S; Gunderson, John G
The effect that attending a 1-day workshop on Good Psychiatric Management (GPM) had on attitudes about borderline personality disorder (BPD) was assessed among 297 clinicians. Change was recorded by comparing before and after scores on a 9-item survey previously developed to assess the effects of workshops on Systems Training for Emotional Predictability and Problem Solving (STEPPS). Participants reported decreased inclination to avoid borderline patients, dislike of borderline patients, and belief that BPD's prognosis is hopeless, as well as increased feeling of competence, belief that borderline patients have low self-esteem, feeling of being able to make a positive difference, and belief that effective psychotherapies exist. Less clinical experience was related to an increased feeling of competence and belief that borderline patients have low self-esteem. These findings were compared to those from the STEPPS workshop. This assessment demonstrates GPM's potential for training clinicians to meet population-wide needs related to borderline personality disorder. PMID:26111249
Personalized Strategies to Activate and Empower Patients in Health Care and Reduce Health Disparities
ERIC Educational Resources Information Center
Chen, Jie; Mullins, C. Daniel; Novak, Priscilla; Thomas, Stephen B.
Designing culturally sensitive personalized interventions is essential to sustain patients' involvement in their treatment and encourage patients to take an active role in their own health and health care. We consider patient activation and empowerment as a cyclical process defined through patient accumulation of knowledge, confidence, and…
Plasma skin resurfacing: personal experience and long-term results.
Bentkover, Stuart H
This article presents a comprehensive clinical approach to plasma resurfacing for skin regeneration. Plasma technology, preoperative protocols, resurfacing technique, postoperative care, clinical outcomes, evidence-based results, and appropriate candidates for this procedure are discussed. Specific penetration depth and specific laser energy measurements are provided. Nitrogen plasma skin regeneration is a skin-resurfacing technique that offers excellent improvement of mild to moderate skin wrinkles and overall skin rejuvenation. It also provides excellent improvement in uniformity of skin color and texture in patients with hyperpigmentation with Fitzpatrick skin types 1 through 4. PMID:22537783
Managing E-mail Interactions with Patients: A Discussion with Clinicians in Evaluating the Personal Health Link Project
Serrato, Carl A; Retecki, Sally
One software feature in the Personal Health Link (PHL) Project allows members of Kaiser Permanente to send secure e-mail messages to clinicians and staff. As an early step in the PHL evaluation process, a group of primary care physicians met to discuss their opinions and experiences with e-mail interactions with patients and to suggest strategies for effectively managing these e-mail interactions. Most clinicians spoke from their experience with e-mail interactions with patients in a conventional e-mail environment; only one clinician in the group was using PHL. PMID:26705166
Lessons from history: asylum patients' Christmas experience.
Carpenter, Diane
This article outlines the asylum building programme of the mid-to-late nineteenth century and focuses on case studies of the two Hampshire asylums built during this period, the subject of the author's doctoral thesis. It demonstrates the plight of 'pauper lunatic' before asylum reform and contrasts this with the improved quality of life provided by the Hampshire County Lunatic Asylum and the Borough of Portsmouth Lunatic Asylum respectively. Asylum care during this period followed the moral treatment regime which became the Victorian blueprint for mental health, components of which are illustrated. Criticism of this regime is addressed briefly and arguments are made against anachronistic analysis. Comparison with contemporary in-patient care and treatment is made concluding with a call to reconsider some of the better aspects of earlier care delivery. The particular experience of patients in Hampshire asylums at Christmas is used to exemplify the points raised. PMID:22241488
Mobility Experience of Persons with Visual Impairments in Indian Railway Station Environments.
Raheja, Gaurav; Tyagi, Megha
Mobility for persons with visual impairments in Indian railway stations poses multidimensional challenges for access to an inclusive travel experience. India is a home to about twenty million persons with diverse disabilities out of which about five million are persons with visual impairments. Diversity of passenger movements on a railway station including persons with visual impairments requires a Universal Design approach to respond to the accessibility issues in these contexts. This research study is based on a series of live on-site experiences conducted along with persons with visual impairments at New Delhi Railway Station. It also includes the generic studies carried out with other diversities of railway passengers including aging, gender and diverse physical abilities. It employs research methods like ethnography, focus group interactions and trace study to develop a deeper understanding of human and spatial parameters of mobility in railway station environments. A Universal Design perspective with a holistic understanding remains critical to the foundation of this research study. While it deals in specific requirements of persons with visual impairments, it also brings an illustration of handling diversity on a railway station from a unique Indian perspective. It concludes by highlighting and reinterpreting the Universal Design India Principles integrating the needs of persons with visual impairments in railway station environments. Brief recommendation for an inclusive mobility experience on railway station forms a vital part of this grounded research study. PMID:27534355
Can Personality Disorder Experts Recognize DSM-IV Personality Disorders from Five-Factor Model Descriptions of Patient Cases?
Rottman, Benjamin M.; Kim, Nancy S.; Ahn, Woo-kyoung; Sanislow, Charles A.
Background Dimensional models of personality are under consideration for integration into the next Diagnostic and Statistical Manual of Mental Disorders (DSM-V), but the clinical utility of such models is unclear. Objective To test the ability of clinical researchers who specialize in personality disorders to diagnose personality disorders using dimensional assessments, and to compare these researchers' ratings of clinical utility for a dimensional system versus for the DSM-IV. Method A sample of 73 researchers who had each published at least three (Median=15) articles on personality disorders participated between December 2008 and January 2009. The Five-Factor Model (FFM), one of the most-studied dimensional models to date, was compared to the DSM-IV. Participants provided diagnoses for case profiles in DSM-IV and FFM formats, and then rated the DSM-IV and FFM on six aspects of clinical utility. Results Overall, participants had difficulty identifying correct diagnoses from FFM profiles, and the same held true for a subset reporting equal familiarity with the DSM-IV and FFM. Participants rated the FFM as less clinically useful than the DSM for making prognoses, devising treatment plans, and communicating with professionals, but more useful for communicating with patients. Conclusions The results suggest that personality disorder expertise and familiarity with the FFM are insufficient to correctly diagnose personality disorders using FFM profiles. Because of ambiguity inherent in FFM profile descriptors, it may be that this insufficiency is unlikely to be attenuated with increased clinical familiarity with the FFM. PMID:21208595
[Personal experiences with conservative treatment of central retinal degeneration].
Pojda, S M; Bandych-Biniszkiewiczowa, D
21 patients (40 eyes) aged 27-84 years (15 women and 6 men) were treated orally with cavinton 3 x 5 mg, sadamine++ 3 X 75 mg, cinnarizine++ 3 X 40 mg, vit. A+E 3 X 1 caps. daily. Intramuscularly++ were given vit. B1 25 mg, vit. B12 1000 micrograms, geriocaine++ 100 mg, and not in all sadamine++ 300 mg daily. Improvement of visual acuity for distance was observed in 31 eyes (77.5%) and for near vision in 17 eyes (42.5%). Within 34 eyes with visual field abnormalities in 9 the central or pericentral scotomas were observed. After medical treatment the central scotomas were diminished in 6 eyes (66.6%) and the enlargement of peripheral visual border from 10 to 30 degree in 10 eyes (40%) were observed. PMID:1635363
Pre-Service Teachers' Personal Practical Theories and Autonomy: Development during Professional Internship Experiences
ERIC Educational Resources Information Center
Shin, Doohyun L.
Professional internship experiences play a critical role in the development of pre-service teachers. This research investigates pre-service teachers' personal practical theories (PPTs) and autonomy and how they are developed during professional internship experiences. This study also explores relationships that exist for PPTs and autonomy and…
Reappraising Personal Experience in the Reform of Curriculum in Educational Administration.
ERIC Educational Resources Information Center
Bredeson, Paul V.
The use of personal administrative experiences as bases for thinking about and effecting curricular reform in educational administration is discussed. The purposeful application of individual past experiences is valuable to the reform effort in that it taps a vital resource of individual knowledge and suggests a way of bridging the chasm between…
The Role of Personal Experience and Social Interaction in Knowledge Creation and Utilisation.
ERIC Educational Resources Information Center
Handzic, Meliha; Tolhurst, Denise
This paper reports the results of an empirical examination of the effects of personal experience and social interaction on individual knowledge and performance in a specific decision making task context. The study revealed a differential effect of increased experience on the quality of participants decisions. In particular, increased experience…
Experience of Career-Related Discrimination for Female-to-Male Transgender Persons: A Qualitative Study
ERIC Educational Resources Information Center
Dispenza, Franco; Watson, Laurel B.; Chung, Y. Barry; Brack, Greg
In this qualitative study, the authors examined the experience of discrimination and its relationship to the career development trajectory of 9 female-to-male transgender persons. Participants were between 21 and 48 years old and had a variety of vocational experiences. Individual semistructured interviews were conducted via telephone and analyzed…
Near-Death Experiences and the "Fantasy-Prone" Personality: Preliminary Findings.
ERIC Educational Resources Information Center
Council, James R.; Greyson, Bruce
Near-death experiences (NDEs) are subjective experiences at the threshold of death which can include strong positive affect, dissociation from the physical body, and paranormal/transcendental phenomena. Empirical investigation of NDEs has typically relied upon retrospective reports and personality studies of individuals who have come close to…
Social Sharing of Bereavement Experience by Chinese Bereaved Persons in Hong Kong
ERIC Educational Resources Information Center
Chow, Amy Y. M.; Chan, Cecilia L. W.; Ho, Samuel M. Y.
Contrary to the belief that the Chinese do not share emotionally intense experiences, findings from a cross-sectional study of 292 respondents who lost either a spouse or a parent in the previous 2 years in Hong Kong indicated that only 10% did not share their bereavement experiences with another person. The physical health and emotional state of…
Professionals' Experiences of the Relations between Personal History and Professional Role
Binder, Per-Einar
The purpose of this paper is to explore whether and how workers in a crisis resolution home treatment (CRHT) team experience the relationship between their personal history and professional role. This paper is based on 13 in-depth interviews with health professionals working in CRHT. The interviews were analysed using a hermeneutic-phenomenological approach. Participants expressed that there is a relationship between their personal history and professional role, and three themes are highlighted as particularly important in, namely experiences related to the participants as individuals, work-related experiences and family-related experiences. The participants write meaning into the relationship between their personal history and professional role. By relating and exploring their own life stories in the interviews, they work on forming meaning and identity. PMID:23589772
Infantile spasms: review of the literature and personal experience
This epileptic disorder has become a classic topic for neuropediatricians and the interest is documented by the large number of publications on this subject. The relative frequency among the epileptic syndromes is an another reason why not only neuropediatricians but also general pediatricians must be fully informed about diagnostic, clinical, imaging and genetic aspects. Early diagnosis is of paramount importance in order to obtain even complete results in patients with so called idiopathic situations. A number of problems are still to be solved. There is no agreement on the type and the schedule of treatment. A common denominator about this problem is not jet available even if some advances in this regard have been accomplished. Of paramount importance is an accurate clinical and laboratory examination as a prerequisite regarding prognosis and results of therapy in every single case. However, even if more than 170 years have elapsed since the first communication of dr. West on the peculiar syndrome that his child was suffering of, the interest of scientists on this subject has now been enriched and rewarded. PMID:20181122
Protective measures, personal experience, and the affective psychology of time.
Peters, E; Kunreuther, H; Sagara, N; Slovic, P; Schley, D R
We examined the role of time and affect in intentions to purchase a risk-protective measure (Studies 1 and 2) and explored participant abilities to factor time into the likelihood judgments that presumably underlie such intentions (Study 3). Participants worried more about losing their possessions and were more likely to purchase a protective measure given a longer term lease than a short-term lease, but only if their belongings were described in affect-poor terms. If described instead as being particularly special and affect-rich, participants neglected time and were about equally likely to purchase a risk-protective measure for shorter and longer term leases. However, and consistent with prior literature, the cognitive mechanism underlying this time-neglect-with-affect-richness effect seemed to be the greater use of the affect heuristic in the shorter term than the longer term. Study 2 results demonstrated that prior experience with having been burglarized amplified the interactive effect of time and affect. Greater deliberation did not attenuate this effect as hypothesized whether deliberation was measured through numeracy or manipulated through instructions. The results of Study 3 indicated that few participants are able to calculate correctly the risk numbers necessary to take time into account. Two possible solutions to encourage more purchases of protective measures in the long term are discussed. PMID:22548249
[Personal experience with strain-induced diseases--neurologic aspects].
Kovarík, J; Salandová, J; Kuzelová, M; Ehler, E
The author summarizes his experience with diseases of the locomotor system of the extremities caused by long-term, excessive unilateral overload (item 29 of the Czechoslovak "List of occupational diseases") assembled during the period 1976 to 1987. In the department for occupational diseases of the District Institute of National Health Pardubice 349 subjects were examined where the disease was suspected, in 93 workers the occupational affection was notified. From a total of 2,294 notified occupational during the above period disease due to overload accounted for 4.1%. The cause of the affection was most frequently bursitis (32x), epicondylitis (25x) and carpal tunnel syndromes (24x), other affections being less frequent. The author analyzed the results with regard to sex, age, period of exposure, occupation. Special attention was devoted to glass workers who accounted for 51.6% of all affected subjects. The author discusses possible neurological affections, i. e. damage of the peripheral nerves. In the assessment of disease caused by overload the authors emphasized the importance of close cooperation of specialists for occupational diseases, neurologists, orthopaedists, physiologists and specialists in hygiene of work. PMID:2598283
Patient-Reported Use of Personalized Video Recordings to Improve Neurosurgical Patient-Provider Communication
Porter, Randall
Background: Providing patients with a video recording of their visit with a medical professional is a common-sense method for improving patient-provider communication. Objective: To describe the patient and provider experiences to video recording clinical medical encounters and providing the patient with a copy of the video for informational purposes. Methods: Since 2009, over 2,800 patients of eight different neurosurgeons chose to be video recorded during their encounter with the doctor and were provided access to the recording to watch over again as a way to recall what the doctor had said. The video system was set up as a handheld video camera, and video files were downloaded and made accessible to patients via a secure Internet patient portal. Between 2012 and 2014, patients who participated were surveyed regarding their use of the video and what was recorded on the video. The experience of the providers from a clinical and medico-legal standpoint was also reviewed. Results: Three hundred and thirty-three responses to the survey were received (39.2% response rate). More than half of patients (N=333; 56.2%) watched their video more than once, and over two-thirds (N=333; 68.6%) shared their video with a family member, friend, or another physician. Patients self-reported improved memory after watching their videos (N=299; 73.6% could remember more) and 50.2% responded that having the video made them feel more "at ease" with their medical problem (N=299). Overall, 88.0% of respondents indicated that their video had been helpful to them, and 98.5% would recommend having future visits video recorded. No patient made a comment that the video was intrusive or had prevented them from being open with their doctor. Finally, in the high-risk specialty of neurosurgery, none of the 2,807 patients who have been recorded since 2009 have used a video in a medico-legal action. Conclusions: Patient responses to the recording system and having a copy of their video
[AESOP 3000--computer-assisted surgery, personal experience].
Kasalický, M A; Sváb, J; Fried, M; Melechovský, D
At present the most widely used system of CAS is a vocally controlled manipulator of the laparoscope AESOP 3000 (Automated Endoscopic System for Optimal Positioning) which makes it possible to implement some operations without the assistance of another surgeon ("Solo-surgery"). Because of financial costs the so far little used equipment ZEUS or DA VINCI are already "master-slave" systems with several robot arms where the surgeon operates by means of manipulators in the controlling unit without direct contact with the patient. At the First Surgical Clinic, General Faculty Hospital and First Medical Faculty Charles Universitx the authors use the robot system AESOP 3000 since March 2000, in particular in laparoscopic gastric banding on account of obesity, in laparoscopic cholecystectomies, laparoscopic gastroenteroanastomoses and operations in the area if the hiatus. This system made it possible to reduce the number of assisting physicians. E.g. in gastric banding one assistant is sufficient, in laparoscopic cholecystectomy it is possible to operate only with a suture nurse. The application of AESOP is particularly useful in laparoscopic appendectomies and inguinal hernioplasties where it makes possible so-called "solo-surgery" or "one man surgery". No doubt, it is however necessary to have the possibility to call immediately another doctor to the operation theatre in case of necessary conversion of laparoscopy of laparotomy. The authors did not record any case of unwanted movement of the robot arm or another serious technical problem. As compared with a manually guided laparoscope during the use of AESOP the number of unwanted or inadequate shifts of the optical equipment or its angular rotation decreased considerably. PMID:12197168
Family members' experiences of personal assistance given to a relative with disabilities.
Ahlström, Gerd; Wadensten, Barbro
Personal assistance is a type of home care common to many countries even though entitlement and legislative framework may vary from country to country. At present, there exists no knowledge about the family members' experiences of such assistance; therefore, the aim of this study was to investigate family members' experiences of personal assistance given to a relative of working age with a functional disability. Twenty-five family members who had a relative with a severe neurological disease in Sweden were interviewed about the significance of personal assistance, and the qualitative interviews were subjected to qualitative latent content analysis. The overall findings verify the close connection between the family members' experiences and their perception of the quality of the caring relationship between the personal assistant and the person with disability. The main finding was an appreciation of the personal assistance on the part of the family members. However, in situations where the encounter between the assistant and the relative with disability was perceived negatively, the family members experienced great anxiety. The shortcomings were the inability to maintain a private life with assistance and the limitation of choice because of the shortage of personal assistants. Beyond these general findings, this study found that personal assistance was experienced by the family members in terms of dignity and empowering care. This theme was generated from seven subthemes: Insight into private life, Security through the close relation, Social life through freedom of movement, Influence over the organisation of assistance, Self-determination and understanding, Friendship and mutual respect and Adaption to the dependency on assistance. The findings indicate that responsible officials, work leaders and assistants need constantly to improve the implementation of the law. In such efforts, the experiences of family members described in this study are a source of knowledge
Renewing everyday hope: the hope experience of family caregivers of persons with dementia.
Duggleby, Wendy; Williams, Allison; Wright, Karen; Bollinger, Sue
The purpose of this grounded theory study was to explore the experience of hope for family members caring for a person with dementia. Seventeen family members caring for persons with dementia were interviewed. The participants described their hope as the possibility of a positive future within their daily lives and in the social context of grief and loss, stress, fatigue, and constantly dealing with challenging behaviours of the person with dementia. The main concern of the study participants was "fading hope," which they dealt with by "renewing every day hope" through (a) coming to terms, (b) finding positives, and (c) seeing possibilities. PMID:19591026
Patient-oriented Personality Traits of First-year Pharmacy Students
Lauri, Mary-Anne; Lauri, Josef
Objective To determine, using the Gordon Personal Profile-Inventory (GPP-I), if the personality traits of first-year pharmacy students match the traits required for patient-centered practice. Methods The GPP-I, which measures the personality traits of ascendency, responsibility, emotional stability, sociability, cautiousness, original thinking, personal relations, and vigor, was administered to incoming pharmacy students at the beginning of their first semester. Results The pharmacy school had attracted students with strong traits of original thinking, followed by personal relations, and vigor. The students, however, were limited in emotional stability and ascendency. Conclusion The pharmacy profession needs to be more proactive in projecting the desired image and communicate its increasingly challenging and patient-oriented practice to attract individuals whose personalities are conducive to current practice models. PMID:20798801
[Management of children and adolescents with diabetes mellitus: personal experience].
Dorchy, H
The increasing prevalence of type 2 diabetes in the USA has closely paralleled the increase in childhood obesity noted there, but now across the Western world and therefore in Belgium. (Pre)type 2 diabetes is preceded by insulin resistance which must be diagnosed and treated. In Belgium, type 1 diabetes is the predominant (97%) form of diabetes in young people (< 2,000 cases under the age of 18 years). Type 1 diabetes is an auto-immune disease which is more aggressive in younger children. At onset, the key-symptoms are : polyuria, polydipsia, weight loss, asthenia. Diagnosis is confirmed with 2 strips measuring glycaemia and glycosuria. Treatment and diabetes education for self-management should be initiated immediately in paediatric clinics of diabetology with a specialised multidisciplinary team. Thanks to the Belgian Social medicine, medical consultations and material necessary for treatment are nearly without cost. The principal aims of therapeutic management of the child, adolescent and adult with type 1 diabetes are to allow good quality of life and to avoid long-term complications by maintaining blood glucose concentrations close to the normal range and an HbA1c level under 7%. The number of daily insulin injections, 2 or > or = 4, by itself does not necessarily give better results, but the 4-injection regimen allows greater freedom, taking into account that the proper insulin adjustment is difficult before adolescence. Successful glycaemic control in young patients depends mainly on the quality and intensity of diabetes education. Any dogmatism must be avoided. Dietary recommendations issued over the last few years are the same for diabetic and non-diabetic individuals in order to avoid degenerative diseases. In the twice-daily injection regimen, the allocation of carbohydrates throughout the day is essential. Due to their pharmakokinetic characteristics, rapid-acting and long-acting insulin analogues have specific indications in both the twice
Objective and personalized longitudinal assessment of a pregnant patient with post severe brain trauma
Torres, Elizabeth B.; Lande, Brian
Background: Following severe trauma to the brain (whether internally generated by seizures, tumors or externally caused by collision with or penetration of objects) individuals may experience initial coma state followed by slow recovery and rehabilitation treatment. At present there is no objective biometric to track the daily progression of the person for extended periods of time. Objective: We introduce new analytical techniques to process data from physically wearable sensors and help track the longitudinal progression of motions and physiological states upon the brain trauma. Setting and Participant: The data used to illustrate the methods were collected at the hospital settings from a pregnant patient in coma state. The patient had brain trauma from a large debilitating seizure due to a large tumor in the right pre-frontal lobe. Main Measures: We registered the wrist motions and the surface-skin-temperature across several daily sessions in four consecutive months. A new statistical technique is introduced for personalized analyses of the rates of change of the stochastic signatures of these patterns. Results: We detected asymmetries in the wrists' data that identified in the dominant limb critical points of change in physiological and motor control states. These patterns could blindly identify the time preceding the baby's delivery by C-section when the patient systematically brought her hand to her abdominal area. Changes in temperature were sharp and accompanied by systematic changes in the statistics of the motions that rendered her dominant wrist's micro-movements more systematically reliable and predictable than those of the non-dominant writst. Conclusions: The new analytics paired with wearable sensing technology may help track the day-by-day individual progression of a patient with post brain trauma in clinical settings and in the home environment. PMID:25852516
Mystical Experiences Occasioned by the Hallucinogen Psilocybin Lead to Increases in the Personality Domain of Openness
MacLean, Katherine A.; Johnson, Matthew W.; Griffiths, Roland R.
A large body of evidence, including longitudinal analyses of personality change, suggests that core personality traits are predominantly stable after age 30. To our knowledge, no study has demonstrated changes in personality in healthy adults after an experimentally manipulated discrete event. Intriguingly, double-blind controlled studies have shown that the classic hallucinogen psilocybin occasions personally and spiritually significant mystical experiences that predict long-term changes in behaviors, attitudes and values. In the present report we assessed the effect of psilocybin on changes in the five broad domains of personality - Neuroticism, Extroversion, Openness, Agreeableness, and Conscientiousness. Consistent with participant claims of hallucinogen-occasioned increases in aesthetic appreciation, imagination, and creativity, we found significant increases in Openness following a high-dose psilocybin session. In participants who had mystical experiences during their psilocybin session, Openness remained significantly higher than baseline more than one year after the session. The findings suggest a specific role for psilocybin and mystical-type experiences in adult personality change. PMID:21956378
Infective endocarditis in chronic hemodialysis patients: experience from Morocco.
Montasser, Dina; Bahadi, Abdelali; Zajjari, Yassir; Asserraji, Mohamed; Alayoude, Ahmed; Moujoud, Omar; Aattif, Toufik; Kadiri, Moncef; Zemraoui, Nadir; El Kabbaj, Driss; Hassani, Mohamed; Benyahia, Mohamed; El Allam, Mustapha; Oualim, Zouhir; Akhmouch, Ismail
Since the 1960s, regular hemodialysis (HD) was recognized as a risk factor for the development of infective endocarditis (IE), particularly at vascular access sites. The present report describes our experience at the Etat Major General Agadir, Morocco, of taking care of IE in patients on regular dialysis. A retrospective analysis was made of five cases of IE in patients receiving regular HD having arteriovenous fistula as vascular access. They were sent from four private centers and admitted in our formation between January 2004 and March 2009. Infective endocarditis was detected after 34.5 months following initiation of dialysis. The causative organisms included Staphylococcus and Enterococcus in two cases each and negative blood culture in one case. A recent history of infection (<3 months) of the vascular access was found in three cases. Peripheric embolic phenomena were noted in two cases. A pre-existing heart disease was common and contributed to heart failure. Mortality was frequent due to valvular perforations and congestive heart failure, making the medical treatment alone unsatisfactory. Two patients survived and three of our patients received a prosthetic valve replacement, with a median survival after surgery of 10.3 months/person. The clinical diagnosis of infective endocarditis in regularly dialyzed patients remains difficult, with the presence of vascular calcification as a common risk factor. The vascular catheter infections are the cardinal gateway of pathogenic organisms, which are mainly Staphylococcus. The prognosis is bad and the mortality is significant, whereas medical and surgical treatments are often established in these patients who have many factors of comorbidity. PMID:21196639
The role of personal goals in autonoetic experience when imagining future events.
Lehner, Edith; D'Argembeau, Arnaud
Although autonoetic experience-a sense of mental time travel-has been considered as the hallmark of episodic future thinking, what determines this subjective feeling is not yet fully understood. Here, we investigated the role of autobiographical knowledge by manipulating the relevance of imagined events for personal goals. Participants were asked to imagine three types of events (goal-related future events, experimenter-provided future events, and atemporal events) and to assess various characteristics of their mental representations. The results showed that the three types of events were represented with similar levels of detail and vividness. Importantly, however, goal-related future events were associated with a stronger autonoetic experience. Furthermore, autonoetic experience was significantly predicted by the importance of imagined events for personal goals. These findings suggest that the subjective feeling of pre-experiencing one's personal future in part depends on the extent to which imagined events can be placed in an autobiographical context. PMID:27089529
A Phenomenological Investigation of Women's Experiences With Personal Training
Personal training is a rapidly growing industry in a country that is in dire need of physical fitness and health improvements. The purpose of this phenomenological study was to better understand women's experiences with personal training. To address the research question, eight female participants ages 24 to 54 years were interviewed using the following phenomenological question: "When you think about your current experience with personal training what stands out for you?" The interviews were conducted, transcribed, and qualitatively analyzed to identify themes in participants' responses. The ground that emerged was positive experience within which existed four figural themes: Relationships, trainer qualities, outcomes, and motivation. Results reveal new insight for professionals in the fitness industry and provide future directions for research in kinesiology and exercise psychology. PMID:27182342
78 FR 63139 - Designee for Patient Personal Property
Federal Register 2010, 2011, 2012, 2013, 2014
... personal effects in the event that such veteran was to die while in a VA field facility. The proposed rule... CONTACT: Kristin J. Cunningham, Director, Business Policy, Chief Business Office, Department of Veterans....) SUPPLEMENTARY INFORMATION: If a competent veteran who is receiving VA medical care dies in a VA field...
Borderline Personality Traits and Disorder: Predicting Prospective Patient Functioning
ERIC Educational Resources Information Center
Hopwood, Christopher J.; Zanarini, Mary C.
Objective: Decisions about the composition of personality assessment in the "Diagnostic and Statistical Manual of Mental Disorders" (5th ed.; DSM-V) will be heavily influenced by the clinical utility of candidate constructs. In this study, we addressed 1 aspect of clinical utility by testing the incremental validity of 5-factor model (FFM)…
A phenomenological study: the lived experience of persons having a different sense of hearing.
Aquino-Russell, Catherine E
Living with a different sense of hearing, including loss of hearing, is a worldwide phenomenon, known to be a silencing condition that can change persons' patterns of relating and divest effective ways of giving and receiving messages of sound. This research describes the meaning of this experience for 7 participants. The researcher followed Giorgi's descriptive phenomenological method for analysis-synthesis to arrive at a general structural description of the experience. Parse's theory of human becoming framed the researcher's theoretical perspective. Findings build on Parse's theory and may enhance nurses' understanding, in turn altering the way nurses approach persons having a different sense of hearing. PMID:16982722
ePatient Conference Explores Future of Personalized Medicine | NIH MedlinePlus the Magazine
... page please turn Javascript on. ePatient Conference Explores Future of Personalized Medicine Past Issues / Spring - Summer 2010 ... FNLM Chairman How are computer networks and digital technologies changing the future of health care? Will you ...
Typus melancholicus and the Temperament and Character Inventory personality dimensions in patients with major depression.
Kimura, S; Sato, T; Takahashi, T; Narita, T; Hirano, S; Goto, M
Although many clinical studies have been conducted to determine the etiological role and clinical implications of typus melancholicus for unipolar depression, maladaptive personality features in depressive patients have not been well described. This study explores typus melancholicus, as measured by the rigidity subscale of the Munich Personality Test, and maladaptive personality features, as measured by the Temperament and Character Inventory (TCI), in 131 remitted patients with DSM-IV major depression and 154 normal controls. The patients reported significantly higher scores on rigidity and harm avoidance and significantly lower scores on self-directedness and cooperativeness. Only 23.6% of the variance of the rigidity scale was explained by the variance of the seven TCI scales, in which only persistence was significantly correlated positively to rigidity. Cluster analysis identified four subgroups, two of which were characterized by a high rigidity score. One of these two subgroups showed no maladaptive personality features, as measured by the TCI, while the other showed high harm avoidance and low self-directedness. These results indicate that the personality of depressive patients is characterized not only by typus melancholicus but also by maladaptive personality features, that typus melancholicus is not well represented by any TCI scale, and that typus melancholicus and maladaptive personality features can coexist in some depressive patients. PMID:10803813
Type D personality negatively associated with self-care in Chinese heart failure patients
Cao, Xi; Wang, Xiu-Hua; Wong, Eliza ML; Chow, Choi Kai; Chair, Sek Ying
Background Little is known about the association between type D personality and self-care behaviors in heart failure (HF) patients. We examined the effect of type D personality on self-care behaviors and self-efficacy among Chinese HF patients. Methods A cross-sectional study with a convenience sample was conducted. All participants completed the questionnaires of the self-care of HF index (V6) and type D personality scale. Demographic and clinical variables were obtained from medical records and patient interviews. The methods used for data analysis included descriptive analysis, independent-sample t-test, χ2 test, and multiple linear regression. Results A total of 127 HF patients were included and 61.4% of them were male. The average age for this study sample was 64.9 ± 12.34 years. The majority of the participants were in a New York Heart Association class III or IV (87%), and the average length of living with HF was 38.24 ± 41.1 months. A total of 33.1% of the participants were identified as having type D personality. No significant differences were determined in the demographic and clinical variables between type D and non-type D patients, except for the mean age and the length of living with HF. Type D patients were younger and had a shorter time of living with HF than their non-type D counterparts. Multiple regression demonstrated significant associations between type D personality and self-care maintenance and self-efficacy after adjusting the demographic and clinical factors. However, type D personality was not significantly associated with self-care management behaviors. Conclusions Type D personality was negatively related to self-care maintenance and self-efficacy in Chinese HF patients. Future study is warranted to develop a tailored intervention to improve engagement in self-care behaviors in HF patients with type D personality. PMID:27594867
The contribution of genetics and early rearing experiences to hierarchical personality dimensions in chimpanzees (Pan troglodytes).
Latzman, Robert D; Freeman, Hani D; Schapiro, Steven J; Hopkins, William D
A reliable literature finds that traits are related to each other in an organized hierarchy encompassing various conceptualizations of personality (e.g., Big Three, five-factor model). Recent work suggests the potential of a similar organization among our closest nonhuman relative, chimpanzees (Pan troglodytes), with significant links to neurobiology suggesting an evolutionarily and neurobiologically based hierarchical structure of personality. The current study investigated this hierarchical structure, the heritability of the various personality dimensions across levels of the hierarchy, and associations with early social rearing experience in a large sample (N = 238) of socially housed, captive chimpanzees residing in 2 independent colonies of apes. Results provide support for a hierarchical structure of personality in chimpanzees with significant associations with early rearing experiences. Further, heritabilities of the various dimensions varied by early rearing, with affective dimensions found to be significantly heritable among mother-reared apes, whereas personality dimensions were largely independent of relatedness among the nursery-reared apes. Taken together, these findings provide evidence for the influence of both genetic and environmental factors on personality profiles across levels of the hierarchy, supporting the importance of considering environmental variation in models of quantitative trait evolution. PMID:25915132
The contribution of genetics and early rearing experiences to hierarchical personality dimensions in chimpanzees (Pan troglodytes)
Latzman, Robert D.; Freeman, Hani D.; Schapiro, Steven J.; Hopkins, William D.
A reliable literature finds that traits are related to each other in an organized hierarchy encompassing various conceptualizations of personality (e.g., Big Three, Five Factor Model). Recent work suggests the potential of a similar organization among our closest nonhuman relative, chimpanzees (Pan troglodytes), with significant links to neurobiology suggesting an evolutionarily- and neurobiologically-based hierarchical structure of personality. The current study investigated this hierarchical structure, the heritability of the various personality dimensions across levels of the hierarchy, and associations with early social rearing experience in a large sample (N = 238) of socially-housed, captive chimpanzees residing in two independent colonies of apes. Results provide support for a hierarchical structure of personality in chimpanzees with significant associations with early rearing experiences. Further, heritabilities of the various dimensions varied by early rearing, with affective dimensions found to be significantly heritable among mother-reared apes, while personality dimensions were largely independent of relatedness among the nursery-reared apes. Taken together, these findings provide evidence for the influence of both genetic and environmental factors on personality profiles across levels of the hierarchy, supporting the importance of considering environmental variation in models of quantitative trait evolution. PMID:25915132
Specialised teams or personal continuity across inpatient and outpatient mental healthcare? Study protocol for a natural experiment
Giacco, Domenico; Bird, Victoria Jane; McCrone, Paul; Lorant, Vincent; Nicaise, Pablo; Pfennig, Andrea; Bauer, Michael; Ruggeri, Mirella; Lasalvia, Antonio; Moskalewicz, Jacek; Welbel, Marta; Priebe, Stefan
Introduction Mental healthcare organisation can either pursue specialisation, that is, distinct clinicians and teams for inpatient and outpatient care or personal continuity of care, that is, the same primary clinician for a patient across the two settings. Little systematic research has compared these approaches. Existing studies subject have serious methodological shortcomings. Yet, costly reorganisations of services have been carried out in different European countries, inconsistently aiming to achieve specialisation or personal continuity of care. More reliable evidence is required on whether specialisation or continuity of care is more effective and cost-effective, and whether this varies for different patient groups and contexts. Design and methods In a natural experiment, we aim to recruit at least 6000 patients consecutively admitted to inpatient psychiatric care in Belgium, Germany, Italy, Poland, and the UK. In each country, care approaches supporting specialisation and personal continuity coexist. Patients will be followed up at 1 year to compare outcomes, costs and experiences. Inclusion criteria are: 18 years of age or older; clinical diagnosis of psychosis, affective disorder or anxiety/somatisation disorder; sufficient command of the language of the host country; absence of cognitive deterioration and/or organic brain disorders; and capacity to provide informed consent. Ethics and dissemination Ethical approval was obtained in all countries: (1) England: NRES Committee North East—Newcastle & North Tyneside (ref: 14/NE/1017); (2) Belgium: Comité d'Ethique hospitalo-facultaire des Cliniques St-Luc; (3) Germany: Ethical Board, Technische Universität Dresden; (4) Italy: Comitati Etici per la sperimentazione clinica (CESC) delle provincie di Verona, Rovigo, Vicenza, Treviso, Padova; (5) Poland: Komisja Bioetyczna przy Instytucie Psychiatrii i Neurologii w Warszawie. We will disseminate the findings through scientific publications and a study
Culture and Drug Profiling of Patient Derived Malignant Pleural Effusions for Personalized Cancer Medicine
Pietilae, Elina; Vlajnic, Tatjana; Baschiera, Betty; Arabi, Leila; Lorber, Thomas; Oeggerli, Martin; Savic, Spasenija; Obermann, Ellen; Singer, Thomas; Rothschild, Sacha I.; Zippelius, Alfred; Roth, Adrian B.; Bubendorf, Lukas
Introduction The use of patients' own cancer cells for in vitro selection of the most promising treatment is an attractive concept in personalized medicine. Human carcinoma cells from malignant pleural effusions (MPEs) are suited for this purpose since they have already adapted to the liquid environment in the patient and do not depend on a stromal cell compartment. Aim of this study was to develop a systematic approach for the in-vitro culture of MPEs to analyze the effect of chemotherapeutic as well as targeted drugs. Methods MPEs from patients with solid tumors were selected for this study. After morphological and molecular characterization, they were cultured in medium supplemented with patient-derived sterile-filtered effusion supernatant. Growth characteristics were monitored in real-time using the xCELLigence system. MPEs were treated with a targeted therapeutic (erlotinib) according to the mutational status or chemotherapeutics based on the recommendation of the oncologists. Results We have established a robust system for the ex-vivo culture of MPEs and the application of drug tests in-vitro. The use of an antibody based magnetic cell separation system for epithelial cells before culture allowed treatment of effusions with only moderate tumor cell proportion. Experiments using drugs and drug-combinations revealed dose-dependent and specific growth inhibitory effects of targeted drugs. Conclusions We developed a new approach for the ex-vivo culture of MPEs and the application of drug tests in-vitro using real-time measuring of cell growth, which precisely reproduced the effect of clinically established treatments by standard chemotherapy and targeted drugs. This sets the stage for future studies testing agents against specific targets from genomic profiling of metastatic tumor cells and multiple drug-combinations in a personalized manner. PMID:27548442
Sexual dysfunction, mood, anxiety, and personality disorders in female patients with fibromyalgia
Kayhan, Fatih; Küçük, Adem; Satan, Yılmaz; İlgün, Erdem; Arslan, Şevket; İlik, Faik
Background We aimed to investigate the current prevalence of sexual dysfunction (SD), mood, anxiety, and personality disorders in female patients with fibromyalgia (FM). Methods This case–control study involved 96 patients with FM and 94 healthy women. The SD diagnosis was based on a psychiatric interview in accordance with the Diagnostic and Statistical Manual of Mental Disorders, fourth edition criteria. Mood and anxiety disorders were diagnosed using the Structured Clinical Interview. Personality disorders were diagnosed according to the Structured Clinical Interview for DSM, Revised Third Edition Personality Disorders. Results Fifty of the 96 patients (52.1%) suffered from SD. The most common SD was lack of sexual desire (n=36, 37.5%) and arousal disorder (n=10, 10.4%). Of the 96 patients, 45 (46.9%) had a mood or anxiety disorder and 13 (13.5%) had a personality disorder. The most common mood, anxiety, and personality disorders were major depression (26%), generalized anxiety disorder (8.3%), and histrionic personality disorder (10.4%). Conclusion SD, mood, and anxiety disorders are frequently observed in female patients with FM. Pain plays a greater role in the development of SD in female patients with FM. PMID:26937190
Early experience, structural dissociation, and emotional dysregulation in borderline personality disorder: the role of insecure and disorganized attachment.
Mosquera, Dolores; Gonzalez, Anabel; Leeds, Andrew M
Persistent problems in emotional regulation and interpersonal relationships in borderline patients can be understood as developing from difficulties in early dyadic regulation with primary caregivers. Early attachment patterns are a relevant causal factor in the development of Borderline Personality Disorder (BPD). Links between attachment issues, early history of neglect, and traumatic experiences, and symptoms observed in patients with BPD as per the DSM-5 classification (American Psychiatric Association: Diagnostic and statistical manual of mental disorders: DSM-5 (Fifth ed.). Washington, D.C; (2013)) are described in this article, while delineating possible pathways from attachment disruptions to the specific symptomatology of these patients. The theory of structural dissociation of the personality (TSDP) provides an essential framework for understanding the processes that may lead from insecure early attachment to the development and maintenance of BPD symptoms. Dyadic parent-child interactions and subsequent modulation of emotion in the child and future adult are considered closely related, but other factors in the development of BPD, such as genetic predisposition and traumatic experiences, should also be considered in conceptualizing and organizing clinical approaches based on a view of BPD as a heterogeneous disorder. PMID:26401299
Sensory processing dysfunction in the personal experience and neuronal machinery of schizophrenia.
Javitt, Daniel C; Freedman, Robert
Sensory processing deficits, first investigated by Kraepelin and Bleuler as possible pathophysiological mechanisms in schizophrenia, are now being recharacterized in the context of our current understanding of the molecular and neurobiological brain mechanisms involved. The National Institute of Mental Health Research Domain Criteria position these deficits as intermediaries between molecular and cellular mechanisms and clinical symptoms of schizophrenia, such as hallucinations. The prepulse inhibition of startle responses by a weaker preceding tone, the inhibitory gating of response to paired sensory stimuli characterized using the auditory P50 evoked response, and the detection of slight deviations in patterns of sensory stimulation eliciting the cortical mismatch negativity potential demonstrate deficits in early sensory processing mechanisms, whose molecular and neurobiological bases are increasingly well understood. Deficits in sensory processing underlie more complex cognitive dysfunction and are in turn affected by higher-level cognitive difficulties. These deficits are now being used to identify genes involved in familial transmission of schizophrenia and to monitor potentially therapeutic drug effects for both treatment and prevention. This research also provides a clinical reminder that patients' sensory perception of the surrounding world, even during treatment sessions, may differ considerably from others' perceptions. A person's ability to understand and interact effectively with the surrounding world ultimately depends on an underlying sensory experience of it. PMID:25553496
College students with tattoos and piercings: motives, family experiences, personality factors, and perception by others.
Forbes, G B
The motives, family experiences, and personality characteristics of 341 college students with and without tattoos or piercings were studied. Participants completed Lippa's 1991 measures of the Big Five personality factors, a shortened version of the Body Cathexis Scale, a series of questions about their childhood experiences, and questions about risk-taking behaviors. In addition, reasons to have or not have body modifications and the perceptions of people with body modifications were investigated. Of the 116 men and 186 women, 25% and 33%, respectively, had at least one tattoo or body piercing. There were very few differences in the childhood experiences or personality characteristics of people with or without body modifications. Although people with body modifications did not differ from people without modifications on the Big Five personality measures, people without modifications perceived people with modifications as much different from themselves on these measures. These results indicate that tattoos and piercings in college students are associated with significantly more risk-taking behavior, greater use of alcohol and marijuana, and less social conformity. However, the traditional stereotype that body modifications are indicators of social or personal pathology does not describe contemporary college students. PMID:11824749
Are Persons Reporting "Near-Death Experiences" Really Near Death? A Study of Medical Records.
ERIC Educational Resources Information Center
Stevenson, Ian; And Others
Examination of medical records from 40 patients who reported unusual experiences during an illness or injury revealed that only 18 patients were judged to have had serious, life-threatening conditions, while 33 believed they had been dead or near death. Findings suggest that an important precipitator of so-called near-death experience is belief…
ePatients on YouTube: Analysis of Four Experiences From the Patients' Perspective
Gómez-Zúñiga, Beni; Pousada, Modesta; Hernández-Encuentra, Eulàlia; Armayones, Manuel
Background Many patients share their personal experiences and opinions using online video platforms. These videos are watched by millions of health consumers and health care professionals. Although it has become a popular phenomenon, little is known about patients who share videos online and why they do so. Objective We aimed to explore the motivations and challenges faced by patients who share videos about their health and experiences on YouTube. As part of a conference discussion, we asked several patients actively engaged on YouTube to make a video explaining their motivations. This paper discusses these videos. Methods In this qualitative study, we performed an analysis of the videos created by 4 patients about their self-reported motivations and challenges they face as YouTube users. First, two judges compared the transcriptions and decided the exact wording when confusing content was found. Second, two judges categorized the content of the videos to identify the major themes. Results Four main categories emerged: (1) the origin or cause for making the first video, (2) the objectives that they achieve by continuing to make videos, (3) the perception of community, and (4) the negative consequences of the experience. Conclusions The main reason for making videos was to bridge the gap between traditional health information about their diseases and everyday life. The first consequence of sharing their life on YouTube was a loss of privacy. However, they also experienced the positive effects of expressing their feelings, being part of a large community of peers, and helping others to deal with a chronic condition. PMID:25075229
Erythropoietin treatment for non-uremic patients: a personal view.
Biesma, D H
The correction of anemia in patients with chronic renal failure (CRF) has become the most important application of recombinant human erythropoietin (rHuEpo). The merits of rHuEpo therapy in patients with CRF are overt. Firstly, patients with CRF have an absolute deficiency in endogenous erythropoietin production and a relatively low maintenance dose of rHuEpo (often less than 100 IU/kg body weight per week) is effective in avoiding regular transfusions in the majority of the patients with CRF. Secondly, rHuEpo is able to avoid long-term complications of frequent transfusions (hemochromatosis, transfusion-transmissible diseases). Thirdly, patients with uremia notice a considerable improvement in quality of life (QOL) after initiation of rHuEpo. These advantages justify administration of this costly drug in CRF patients. The use of rHuEpo outside the setting of uremia do, however, not cover the complete spectrum of beneficial effects as compared to its use in (pre)dialysis patients. The aim of this overview is to provide some annotations on recently approved (cisplatin-induced anemia, preoperative anemia, zidovudine-related anemia) and possibly future (several types of malignancy and inflammation) indications for rHuEpo in non-uremic patients, leaving out the correction of anemia due to relatively uncommon disorders in the Dutch population (such as sickle cell anemia and thalassemia). PMID:10048290
Medical Home Characteristics and the Pediatric Patient Experience
Burnet, Deborah; Gunter, Kathryn E.; Nocon, Robert S.; Gao, Yue; Jin, Janel; Fairchild, Paige; Chin, Marshall H.
Background The patient-centered medical home (PCMH) has roots in pediatrics, yet we know little about the experience of pediatric patients in PCMH settings. Objective To examine the association between clinic PCMH characteristics and pediatric patient experience as reported by parents. Research Design We assessed the cross-sectional correlation between clinic PCMH characteristics and pediatric patient experience in 24 clinics randomly selected from the Safety Net Medical Home Initiative, a 5-state PCMH demonstration project. PCMH characteristics were measured with surveys of randomly selected providers and staff; surveys generated 0 (worst) to 100 (best) scores for five subscales, and a total score. Patient experience was measured through surveying parents of pediatric patients. Questions from the Consumer Assessment of Healthcare Providers and Systems Clinician & Group (CAHPS-CG) instrument produced 4 patient experience measures: timeliness, physician communication, staff helpfulness, and overall rating. To investigate the relationship between PCMH characteristics and patient experience, we used generalized estimating equations with an exchangeable correlation structure. Results We included 440 parents and 214 providers and staff in the analysis. Total PCMH score was not associated with parents' assessment of patient experience; however, PCMH subscales were associated with patient experience in different directions. In particular, quality improvement activities undertaken by clinics were strongly associated with positive ratings of patient experience, while patient care management activities were associated with more negative reports of patient experience. Conclusions Future work should bolster features of the PCMH that work well for patients while investigating which PCMH features negatively impact patient experience, to yield a better patient experience overall. PMID:25310639
Successful treatment with personalized dosage of imatinib in elderly patients with gastrointestinal stromal tumors.
Saponara, Maristella; Gatto, Lidia; Di Nunno, Vincenzo; Tabacchi, Elena; Fanti, Stefano; Di Scioscio, Valerio; Nannini, Margherita; Gruppioni, Elisa; Altimari, Annalisa; Fiorentino, Michelangelo; Santini, Donatella; Ceccarelli, Claudio; Zompatori, Maurizio; Biasco, Guido; Pantaleo, Maria Abbondanza
Imatinib is the standard first-line therapy for metastatic gastrointestinal stromal tumors. It has markedly improved the prognosis and outcome of patients affected by gastrointestinal stromal tumors, especially in the case of exon 11 KIT mutations. Imatinib-associated adverse events are generally mild to moderate; however, in clinical practice, intolerance caused by chronic toxicities frequently leads to breaks in treatment. This is particularly true in elderly patients in whom age, decline in drug metabolism, and polypharmacy, with a possible drug-drug interaction, may influence the tolerability of imatinib. In the present article, we report our extensive experience with the management of imatinib therapy in a 'real' population, in particular in very elderly patients, discussing whether the use of personalized imatinib dosage could be a safe and advantageous option, enabling continuous administration, thus ensuring effective treatment. Only a few case reports in the literature provide data on outcome with low tailored dosage of imatinib and none of them has been carried out on a Western population. Here, we report four cases treated with low imatinib dosage as a safe and useful option enabling continued treatment with imatinib, improving tolerance, and maintaining good and lasting disease control. PMID:26720290
Effect of citalopram treatment on relationship between platelet serotonin functions and the Karolinska scales of personality in panic patients.
Neuger, Jolanta; Wistedt, Börje; Aberg-Wistedt, Anna; Stain-Malmgren, Rigmor
Using the Karolinska Scales of Personality (KSP), we investigated the effect of the selective serotonin reuptake inhibitor citalopram on personality traits and the relationship between personality traits and peripheral indexes for central serotonergic function in patients with panic disorder at baseline and after 6 months of treatment. The degree of anxiety and depression was assessed using the Beck Anxiety Inventory, the Beck Depression Inventory, the Clinical Anxiety Scale, and the Montgomery Asberg Depression Rating Scale. A reduction in anxiety and depression scores of 75% was observed after treatment in two thirds of the patients. Mean changes of 12% in the direction of normalization were observed in all KSP anxiety-related items (Somatic Anxiety, Muscular Tension, Psychic Anxiety, and Psychasthenia), the aggression and hostility related items (Inhibition of Aggression, Irritability, and Guilt) and the item of Socialisation. A positive correlation was found between Vmax for the platelet [14C]-serotonin uptake and Inhibition of Aggression before treatment, and a negative correlation was found between the affinity of serotonin uptake and Inhibition of Aggression after treatment. Negative childhood experiences influenced enhanced scores on some KSP items but not the serotonergic function. In panic patients treated with citalopram, effects were seen on personality traits, confirming an association between serotonergic activity and aggression. PMID:12172340
Relationship between personality traits and perceived internalized stigma in bipolar patients and their treatment partners.
Bassirnia, Anahita; Briggs, Jessica; Kopeykina, Irina; Mednick, Amy; Yaseen, Zimri; Galynker, Igor
Internalized stigma of mental disorders has significant negative outcomes for patients with bipolar disorder and their families. The aim of this study is to evaluate the association between personality traits and internalized stigma of mental disorders in bipolar patients and their treatment partners. Five different questionnaires were utilized in this study: (1) Demographic data questionnaire, (2) Millon Clinical Multiaxial Inventory-III (MCMI-III) for personality traits, (3) Internalized Stigma of Mental Illness (ISMI) for stigma, (4) Self Report Manic Inventory (SRMI) for mania and (5) Center for Epidemiological Studies-Depression Scale (CES-D) for depression. The scores of personality traits were combined to create externalizing and internalizing personality trait scores. Results showed that patients with bipolar disorder and their treatment partners both experienced internalized stigma of mental health disorders. There was a significant positive correlation between internalized stigma and internalizing personality traits, but not externalizing traits. In a multi-variate regression analysis, internalizing personality trait score was found to be a significant predictor of internalized stigma. In conclusion, patients with bipolar disorder and their treatment partners perceive higher level of internalized stigma of mental disorders if they have internalizing personality traits. PMID:26421901
Borderline personality disorder and self-conscious emotions in response to adult unwanted sexual experiences.
Schoenleber, Michelle; Gratz, Kim L; Messman-Moore, Terri; DiLillo, David
Borderline personality disorder (BPD) is associated with a proneness to unpleasant self-conscious emotions (SCE). Given that BPD is also associated with heightened rates of SCE-eliciting events (including unwanted sexual experiences), research examining the factors influencing SCE in response to these events is needed. This study examined associations between BPD pathology and SCE in response to adult unwanted sexual experiences among 303 community women. Extent of sharing about and perceived personal responsibility for the event were examined as moderators of the association between BPD and current event-related SCE. Both self-reported BPD symptom severity in the full sample and interview-based measures of BPD symptom count and diagnosis in a subsample (n = 75) were associated with greater SCE at the event and currently. Moreover, in the subsample, both BPD symptom count and diagnosis were associated with heightened current SCE only when (a) extent of sharing was low or (b) perceived personal responsibility was high. PMID:24689761
Life experiences in active addiction and in recovery among treated and untreated persons: a national study.
Laudet, Alexandre; Hill, Thomas
Addiction treatment can be effective but fewer than 50% of addiction affected persons are ever treated. Little is known about the addiction and recovery experience of this large subgroup. A national sample of persons in recovery (N = 3,176, 29.5% untreated) was used to begin addressing these questions to inform strategies to encourage help-seeking and to contribute to the small knowledge base on untreated individuals. Study domains were finances, family, social and civic functioning, health, criminal justice involvement, and employment. Treated persons reported significantly greater levels of negative-and fewer positive-experiences in all areas during active addiction than did the untreated group. This gap was significantly narrowed in recovery. PMID:25775078
Borderline Personality Disorder and Self-conscious Emotions in Response to Adult Unwanted Sexual Experiences
Schoenleber, Michelle; Gratz, Kim L.; Messman-Moore, Terri; DiLillo, David
Borderline personality disorder (BPD) is associated with a proneness to unpleasant self-conscious emotions (SCE). Given that BPD is also associated with heightened rates of SCE-eliciting events (including unwanted sexual experiences), research examining the factors influencing SCE in response to these events is needed. This study examined associations between BPD pathology and SCE in response to adult unwanted sexual experiences among 303 community women. Extent of sharing about and perceived personal responsibility for the event were examined as moderators of the association between BPD and current event-related SCE. Both self-reported BPD symptom severity in the full sample and interview-based measures of BPD symptom count and diagnosis in a subsample (n=75) were associated with greater SCE at the event and currently. Moreover, in the subsample, both BPD symptom count and diagnosis were associated with heightened current SCE only when (1) extent of sharing was low, or (2) perceived personal responsibility was high. PMID:24689761
Weight bias as a function of person variables and contact experiences.
Jackson, Jay W; James, Audrey; Poulsen, Joan Rose; Dumford, Jennifer
We tested a mediation model of weight bias that considers person attributes and contact experiences with overweight individuals. In Study 1, we administered a survey to assess Openness, Agreeableness, Attributional Complexity, contact experiences with overweight individuals, and weight bias. Mediation analyses found that Agreeableness predicted less weight bias through contact experiences. In Study 2, we asked participants to interact with a peer whose weight and attributions regarding the weight were experimentally manipulated. We then measured acceptance of the peer. Agreeableness was found to indirectly predict more acceptance of an overweight peer through Empathy and contact experiences. These results show that contact theory is applicable to the domain of weight bias, and support person-situation approaches to prejudice. PMID:26392205
Personality Change Pre- to Post- Loss in Spousal Caregivers of Patients with Terminal Lung Cancer
Hoerger, Michael; Chapman, Benjamin P.; Prigerson, Holly G.; Fagerlin, Angela; Mohile, Supriya G.; Epstein, Ronald M.; Lyness, Jeffrey M.; Duberstein, Paul R.
Personality is relatively stable in adulthood but could change in response to life transitions, such as caring for a spouse with a terminal illness. Using a case-control design, spousal caregivers (n=31) of patients with terminal lung cancer completed the NEO-FFI twice, 1.5 years apart, before and after the patient's death. A demographically-matched sample of community controls (n=93) completed the NEO-FFI on a similar timeframe. Based on research and theory, we hypothesized that bereaved caregivers would experience greater changes than controls in interpersonal facets of extraversion (sociability), agreeableness (prosocial, nonantagonistic), and conscientiousness (dependability). Consistent with hypotheses, bereaved caregivers experienced an increase in interpersonal orientation, becoming more sociable, prosocial, and dependable (Cohen's d = .48−.67), though there were no changes in nonantagonism. Changes were not observed in controls (ds ≤ .11). These initial findings underscore the need for more research on the effect of life transitions on personality. PMID:25614779
Chapter 4: A Comparison of Personal Attributes and Experiences among Physically Active and Inactive Children
ERIC Educational Resources Information Center
Castelli, Darla M.; Erwin, Heather E.
In this study, the researchers aim to compare the personal attributes and experiences of children who met or exceeded physical activity guidelines with those who did not. By creating profiles, the researchers could compare motor performance, physical fitness, self-efficacy, time spent outdoors during physical activity, social support from friends…
My Experience with Alcohol, a 17th-Century Mathematician, and a Personal Decision
ERIC Educational Resources Information Center
Eaton, Dennis R.; Rector, Sheila M.
This writing shares the first author's personal experience with alcohol, the negative consequences of his choices, and the ultimate answering of the question, "Am I an alcoholic and should I drink again?" The decision-making process and the eventual answer come from Blaise Pascal, a 17th-century mathematician. This process is explained and…
Personal, Professional, and Sociocultural Experiences of African American Female School Leaders
ERIC Educational Resources Information Center
Robinson, Armentress D.
The purpose of this phenomenological study was to explore and gain an in-depth understanding of the personal, professional, and sociocultural experiences of ten African American female school leaders serving as assistant principals, principals, and central office administrators in four suburban school districts in the southeast region of the…
Exploring How Teachers' Personal Experiences with Childhood Bullying Influence Their Response to Student Bullying
ERIC Educational Resources Information Center
Lay, Debra J.
The results of the study provided a unique perspective of 20 teachers and how their personal childhood bullying experiences influenced their response to student bullying. Teachers who participated in this study acknowledged that they had a heightened awareness of student bullying, felt their positive attitude was due to their Olweus training as…
"It's Better Life Here than There": Elasticity and Ambivalence in Narratives of Personal Experience
ERIC Educational Resources Information Center
Warriner, Doris S.
This article investigates when and how narratives of personal experience and displacement reference and characterize dimensions of time and space, with a focus on how temporal elasticity might serve as an interactional resource. Examining the dynamic, situated, and intertwined nature of such narratives, the analysis looks at how…
Teacher Candidates' Implementation of the Personal and Social Responsibility Model in Field Experiences
ERIC Educational Resources Information Center
Lee, Okseon
With the teacher concerns theory (Fuller, 1969) as a theoretical framework, this study has set out to examine how physical education teacher candidates perceive their implementation of the Personal and Social Responsibility Model (Hellison, 2003) and how they actually implement it during field experience. Five teacher candidates (three female, two…
Visual Data Collection Methods for Research on the Affective Dimensions of Children's Personal Experiences of PE
ERIC Educational Resources Information Center
Georgakis, Steve; Light, Richard
The rapid growth of research on Teaching Games for Understanding (TGfU) over the past decade has paid little attention to research methodology. This paper redresses this lack of attention to research methods and reports on a study conducted on children's personal experiences of Game Sense. The study focuses on the use of year six students'…
Personal Experience of Aging in the Children of a Parent with Dementia
ERIC Educational Resources Information Center
Gerritsen, Debby; Kuin, Volande; Steverink, Nardi
We investigated whether adults with a parent with dementia experience their personal aging differently than adults whose parents do not have dementia. Semi-structured interviews were conducted with 25 adults who had a parent with dementia and 25 controls. We found that, although in a general sense the two groups were quite similar in their…
School Experiences Influence Personal Health and Interpersonal Relationships of Adolescents: The Canadian Case
ERIC Educational Resources Information Center
Ma, Xin
Canadian data from the 1998 Cross-National Survey on Health Behaviors in School-Aged Children were analyzed to examine the effects of school experiences on personal health (physical health, mental health, self-esteem, helplessness, and body image) and interpersonal relationships (number of close friends and making friends) among adolescents.…
Predicting Adolescent Drug Abuse Treatment Outcome with the Personal Experience Inventory (PEI)
ERIC Educational Resources Information Center
Stinchfield, Randy; Winters, Ken C.
The purposes of this study were to examine the clinical utility of the Personal Experience Inventory (PEI) Psychosocial scales to predict adolescent drug abuse treatment outcome. The role of psychosocial risk factors in predicting treatment outcome also has theoretical interest given that such factors have been associated with the development of…
The Role of Personality and Learning Experiences in Social Cognitive Career Theory
ERIC Educational Resources Information Center
Schaub, Michael; Tokar, David M.
We sought to extend the empirical literature on Social Cognitive Career Theory (SCCT) by testing (a) the posited indirect effect of personality on interests through learning experiences and sociocognitive mechanisms, and (b) hypotheses that self-efficacy percepts and outcome expectations derive from corresponding career-relevant learning…
Assessing the Academic, Personal and Social Experiences of Pre-College Students
ERIC Educational Resources Information Center
Hicks, Terence
This study examined the before-and-after effects of transitional summer programs at the University of Maryland?Eastern Shore, on pre-college students? perceptions, expectations, emotions, and knowledge about college. The study focused on academic, personal and social experiences, and how these changed throughout the course of the summer program.…
Teachers Speak about Their Learning: Personal Experience Research through Non-Fictional Narrative Story
ERIC Educational Resources Information Center
Linn, Genie Bingham
Based on the theoretical framework of reflective practice and teacher education, this article shares portions of a personal experience research project designed to gain understanding of teacher learning through nonfictional narrative story. Excerpts comprise the stories of learning-based journeys shared by five East Texas teachers that focus on a…
Practitioners' Experiences of Personal Ownership and Autonomy in Their Support for Young Children's Thinking
ERIC Educational Resources Information Center
Robson, Sue; Fumoto, Hiroko
This article reports the third phase of the Froebel Research Fellowship Project: "The Voice of the Child: ownership and autonomy in early learning". Building on the first and second phases of this study, this phase examined early years practitioners' experiences of supporting young children's thinking in relation to the personal ownership and…
Psychosocial Dimensions of Exceptional Longevity: A Qualitative Exploration of Centenarians' Experiences, Personality, and Life Strategies
ERIC Educational Resources Information Center
Darviri, Christina; Demakakos, Panayotes; Tigani, Xanthi; Charizani, Fotini; Tsiou, Chrysoula; Tsagkari, Christina; Chliaoutakis, Joannes; Monos, Dimitrios
This qualitative study provides a comprehensive account of the social and life experiences and strategies and personality attributes that characterize exceptional longevity (living to 100 or over). It is based on nine semi-structured interviews of relatively healthy and functional Greek centenarians of both sexes. The analytic approach was…
Stepped care: an alternative to routine extended treatment for patients with borderline personality disorder.
Paris, Joel
This review examined evidence supporting stepped care for borderline personality disorder as an alternative to routine extended treatment. Empirical studies have shown that patients with borderline personality disorder have a heterogeneous course, but symptomatic improvement can sometimes be relatively rapid. Currently, there is no evidence that any long-term treatment is superior to briefer interventions for borderline personality disorder. Long-term therapy may not be necessary for all patients, and its routine use leads to access problems. A stepped-care model, similar to models applied to other severe mental disorders, might provide a better use of resources. Stepped care can be used to limit the use of expensive programs and reduce waiting lists. Not all patients with borderline personality disorder can be treated briefly, but a stepped-care model allows those with less severe symptoms to be managed with fewer resources, freeing up more time and personnel for the treatment of those who need treatment the most. PMID:23945913
Pathological Gambling in Parkinson's disease patients: Dopaminergic medication or personality traits fault?
Brusa, L; Pavino, V; Massimetti, M C; Ceravolo, R; Stefani, S; Stanzione, P
Impulse control disorders (ICDs) are clinically relevant in Parkinson disease (PD) patients, with an established association with PD medication. Aim of our study was to study whether the increased frequency of pathological gambling (PG), reported in subgroups of PD patients, is related to specific personality tracts additional to dopaminergic medications. Thirty-seven PD patients with a personal history of PG where enrolled. Twenty one PD patients, matched for disease and dopaminergic therapy, never experiencing PG, were enrolled as controls. All subjects were tested with the Minnesota Multiphasic Inventory Personality scales (MMPI-2). Our data showed that PD group with PG exhibited significantly higher mean values of the three validity scales in comparison to the non-PG-PD group, demonstrating an higher tendency to lie. Content scales showed a significant increase of cynicism and bizarre ideation scales score in the PG-PD group, not exhibiting pathological values at the validity scales, (p: 0.02) in comparison to non-PG PD patients. According to our results, PG seems to be associated with precise personality tracts. Personality profiles of cluster A personality disturbances - Axys 2 according with DSM-5 TR (paranoid type) at MMPI-2 might be a warning index helpful in selecting dopaminergic treatment, to avoid subsequent ICDs appearance. PMID:27288799
Variables associated with patient activation in persons with multiple sclerosis.
Goodworth, Marie-Christine R; Stepleman, Lara; Hibbard, Judith; Johns, Lisa; Wright, Dustin; Hughes, Mary D; Williams, Mitzi J
Identifying variables associated with patient activation in the multiple sclerosis population could serve to facilitate better multiple sclerosis self-management behaviors. Using a cross-sectional survey design, 199 participants were recruited from a multiple sclerosis center in the Southeastern United States. Depression, multiple sclerosis quality of life, and multiple Sclerosis self-efficacy were all significantly correlated with patient activation. Results of a hierarchical regression indicated that patient activation was significantly related to educational attainment, depression, and self-efficacy but not to quality of life. The results suggest several possible targets for intervention to increase patient activation, including health literacy, depression symptoms, and self-efficacy for multiple sclerosis disease management. PMID:24591120
Clearing the Air: A Qualitative Investigation of Genetic Counselors' Experiences of Counselor-Focused Patient Anger.
Schema, Lynn; McLaughlin, Michaela; Veach, Patricia McCarthy; LeRoy, Bonnie S
Patient anger is challenging for healthcare professionals to manage, particularly when it is directed at them. This study comprises the first in-depth investigation of genetic counselors' experiences with patient anger. Using a brief survey and interview methods, this study explored prevalence and context of patient anger directed at the genetic counselor, how genetic counselors manage patient anger directed at them, and possible thematic differences due to genetic counseling experience. Individuals enrolled in the National Society of Genetic Counselors (NSGC) listserv were invited to participate in a study of their experiences with patient anger directed at them. A majority of survey respondents (95.7 %, 243/254) reported experiencing patient anger directed at them, and 19.4 % reported having feared for their safety because of patient anger. Twenty-two survey respondents were purposively selected to participate in individual interviews. Inductive and cross case analysis yielded prevalent themes concerning patient triggers for anger, including bad news, logistical mishaps, and perceived counselor characteristics. Interview results further suggest unaddressed patient anger negatively affected patient and counselor emotional well-being and hindered genetic counseling goals. Prevalent challenges included genetic counselor attempts to accurately recognize, understand, and effectively manage patient anger without taking it personally. Commonly recommended strategies for addressing anger were empathy (i.e., understanding origins of patient anger), anticipating and acknowledging anger, maintaining personal, professional and legal protection, and debriefing with colleagues. Themes were quite similar across counselor experience levels. The findings underscore the importance of training and continuing education regarding patient anger. Additional findings, practice implications, and research recommendations are presented. PMID:25651823
Relationship between sleep disturbance and recovery in patients with borderline personality disorder
Plante, David T.; Frankenburg, Frances R.; Fitzmaurice, Garrett M.; Zanarini, Mary C.
Objective Patients with borderline personality disorder (BPD) frequently experience sleep disturbance, however, the role of sleep quality in the course of BPD is unknown. The purpose of this study was to evaluate the cross-sectional association between sleep quality and recovery status (symptomatic remission plus good concurrent psychosocial functioning) in a well-characterized cohort of patients with BPD to examine the role of sleep disturbance in the course of the disorder. Methods 223 patients with BPD participating in the McLean Study of Adult Development (MSAD) were administered the Pittsburgh Sleep Quality Index (PSQI) as part of the 16-year follow-up wave. Sleep quality was compared between recovered (n=105) and non-recovered (n=118) BPD participants, including adjustment for age, sex, depression, anxiety, and primary sleep disorders. Results Non-recovered BPD patients had significantly worse sleep quality than recovered BPD participants as measured by the global PSQI score (adjusted means 12.01 vs. 10.73, p=0.03). In addition, non-recovered BPD participants had longer sleep onset latency (adjusted means 39.20 vs. 28.11 minutes, p=0.04), as well as increased odds of using sleeping medication (adjusted OR 1.49, p=0.009) and experiencing daytime dysfunction as a result of their sleep disturbance (adjusted OR 1.48, p=0.008). Conclusion These results demonstrate an association between subjective sleep disturbance and recovery status among BPD patients. Further research is indicated to evaluate the mechanisms underlying sleep disturbance in BPD, and whether treatment of sleep complaints improves the symptomatic and psychosocial course of the disorder. PMID:23497827
How to Conduct Clinical Qualitative Research on the Patient's Experience
ERIC Educational Resources Information Center
Chenail, Ronald J.
From a perspective of patient-centered healthcare, exploring patients' (a) preconceptions, (b) treatment experiences, (c) quality of life, (d) satisfaction, (e) illness understandings, and (f) design are all critical components in improving primary health care and research. Utilizing qualitative approaches to discover patients' experiences can…
Should health care providers be accountable for patients' care experiences?
Anhang Price, Rebecca; Elliott, Marc N; Cleary, Paul D; Zaslavsky, Alan M; Hays, Ron D
Measures of patients' care experiences are increasingly used as quality measures in accountability initiatives. As the prominence and financial impact of patient experience measures have increased, so too have concerns about the relevance and fairness of including them as indicators of health care quality. Using evidence from the Consumer Assessment of Healthcare Providers and Systems (CAHPS®) surveys, the most widely used patient experience measures in the United States, we address seven common critiques of patient experience measures: (1) consumers do not have the expertise needed to evaluate care quality; (2) patient "satisfaction" is subjective and thus not valid or actionable; (3) increasing emphasis on improving patient experiences encourages health care providers and plans to fulfill patient desires, leading to care that is inappropriate, ineffective, and/or inefficient; (4) there is a trade-off between providing good patient experiences and providing high-quality clinical care; (5) patient scores cannot be fairly compared across health care providers or plans due to factors beyond providers' control; (6) response rates to patient experience surveys are low, or responses reflect only patients with extreme experiences; and (7) there are faster, cheaper, and more customized ways to survey patients than the standardized approaches mandated by federal accountability initiatives. PMID:25416601
Correlations between Pre-morbid Personality and Depression Scales in Stroke Patients
Hwang, Sung Il; Park, Oak Tae; Park, Si-Woon; Choi, Eun Seok; Yi, Sook-Hee
Objective To investigate the correlation between pre-morbid personality and depression scales in patients with stroke. Method The subjects of this study included 45 patients with stroke and their caregivers. We conducted an interview of patients with Beck Depression Inventory (BDI) and also evaluated general characteristic (age, sex, location of lesion, cause of stroke, duration of illness, educational background, history of medication for depression) and functional level. Caregivers were evaluated with Hamilton Rating Scale for Depression (HRSD) for depressive mood, with NEO-PI (Neuroticism, Extraversion and Openness Personality Inventory) for pre-morbid personality. The results of each questionnaire were analyzed in order to investigate their correlation. The results were statistically analyzed with independent t-test, ANOVA, and Pearson correlation test. Results The HRSD score of the caregivers had a significant correlation with the BDI score (p=0.001) of the patients. The BDI score correlated with Neuroticism (p=0.021) and the HRSD score also correlated with Neuroticism (p=0.015). There were no statistical correlation of depression with sex, age, case of stroke, location of lesion, duration of illness and functional level. Conclusion Among pre-morbid personalities, neuroticism of NEO-PI is the only factor which is significantly correlated with depression scales in stroke patients. Evaluating pre-morbid personality can be helpful in predicting the depressive mood in stroke patients, so we may have early intervention for it. PMID:22506141
Personality traits in women with multiple sclerosis: Discrepancy in patient/partner report and disease course
Benedict, Ralph H.B.; Wahlig, Elizabeth L.; Topciu, Raluca A.; Englert, Jessica; Schwartz, Eben; Chapman, Ben; Weinstock-Guttman, Bianca; Duberstein, Paul R.
Objective Patients diagnosed with multiple sclerosis (MS) are believed to undergo personality changes, which could have implications for how they perceive themselves and are perceived by others. We endeavored to examine the extent to which patients' self-perceptions are congruent with how they are perceived by significant others across five trait domains as demarcated by the well known Five-Factor Model (FFM). Methods The NEO Five-Factor Inventory (NEOFFI) (Costa and McCrae, 1992) was administered to women with MS (n=70) and their spouses or partners. Pearson correlations and general linear models (GLMs) were employed to test for differences between patient self-reports and partner reports of FFM traits. Results Correlation analyses revealed good correspondence between patient and partner NEOFFI data in relapsing-remitting MS patients, but not secondary progressive patients. There was no significant correlation among progressive course patients for all NEOFFI domains, except Agreeableness. GLMs revealed significant differences where patients rated themselves higher than their partners rated them in Extraversion and Openness. Conclusion These discrepancies in the way patients and partners view patient personality are probably multidimensional and may have neurological and/or psychological causes. The direction of the discrepancies are consistent with some prior research suggesting MS, which is a disease affecting both the cerebral white and gray matter, may give rise to lowering in self awareness. Conversely, patients may be finding emotional or personal benefits in their response to the disease unbeknownst to partners. PMID:19154857
Persons Versus Situations in the Real-Life Functioning of Chronically Institutionalized Mental Patients
ERIC Educational Resources Information Center
Mariotto, Marco J.; Paul, Gordon L.
The present study examined the "person versus situation" controversy regarding the contribution to variance of behavior in real-life environments of 34 severely disabled psychiatric patients, using reliable and valid observational assessment of both patient behavior and dimensions of situations. (Editor/RK)
Incorporating Personal Health Records into the Disease Management of Rural Heart Failure Patients
ERIC Educational Resources Information Center
Baron, Karen Parsley
Personal Health Records (PHRs) allow patients to access and in some cases manage their own health records. Their potential benefits include access to health information, enhanced asynchronous communication between patients and clinicians, and convenience of online appointment scheduling and prescription refills. Potential barriers to PHR use…
Assessing and Interpreting Personality Change and Continuity in Patients Treated for Major Depression
ERIC Educational Resources Information Center
De Fruyt, Filip; Van Leeuwen, Karla; Bagby, R. Michael; Rolland, Jean-Pierre; Rouillon, Frederic
Structural, mean- and individual-level, differential, and positive personality continuity were examined in 599 patients treated for major depression assigned to 1 of 6 forms of a 6-month pharmacy-psychotherapy program. Covariation among traits from the Five Factor model remained invariant across treatment, and patients described themselves as…
Personalizing oral anticoagulant treatment in patients with atrial fibrillation.
Capranzano, Piera; Miccichè, Eligio; D'Urso, Lucia; Privitera, Fiorella; Tamburino, Corrado
For decades, warfarin has remained the standard oral anticoagulation for stroke prevention in atrial fibrillation (AF). Three novel oral anticoagulants (NOACs) have been recently approved for stroke prevention in non-valvular AF: dabigatran, rivaroxaban and apixaban. Better pharmacological and clinical profiles make these newcomers a preferable alternative over warfarin. Current AF guidelines do not endorse NOACs over warfarin, or one NOAC over another. Indeed, choice of the anticoagulation regimen should be personalized based on the relative efficacy and safety of different agents across subgroups stratified by thrombotic and bleeding risk, as well as on other clinical factors, including anticoagulation control on warfarin, drug interactions, compliance and need for coagulation monitoring. This review appraises i) the randomized evidence on approved NOACs versus warfarin in AF across subgroups stratified by risk factors of stroke and bleeding and by the anticoagulation level reached on warfarin; and ii) clinical factors impacting on the anticoagulation regimen selection. PMID:23957907
The Relation Between Supervisors' Big Five Personality Traits and Employees' Experiences of Abusive Supervision.
Camps, Jeroen; Stouten, Jeroen; Euwema, Martin
The present study investigates the relation between supervisors' personality traits and employees' experiences of supervisory abuse, an area that - to date - remained largely unexplored in previous research. Field data collected from 103 supervisor-subordinate dyads showed that contrary to our expectations supervisors' agreeableness and neuroticism were not significantly related to abusive supervision, nor were supervisors' extraversion or openness to experience. Interestingly, however, our findings revealed a positive relation between supervisors' conscientiousness and abusive supervision. That is, supervisors high in conscientiousness were more likely to be perceived as an abusive supervisor by their employees. Overall, our findings do suggest that supervisors' Big Five personality traits explain only a limited amount of the variability in employees' experiences of abusive supervision. PMID:26903919
Nonfamily Experience and Receipt of Personal Care in a Rapidly Changing Context
Yarger, Jennifer; Brauner-Otto, Sarah R.
Scholars and policy makers have expressed concern that social and economic changes occurring throughout Asia are threatening the well-being of older adults by undercutting their systems of family support. Using a sample of 1,654 men and women aged 45 and older from the Chitwan Valley Family Study in Nepal, we evaluated the relationship between individuals' nonfamily experiences, such as education, travel, and nonfamily living, and their likelihood of receiving personal care in older adulthood. Overall, we found that among individuals in poor health, those who had received more education, traveled to the capital city, or lived away from their families were less likely to have received personal care in the previous two weeks than adults who had not had these experiences. Our findings provide evidence that although familial connections remain strong in Nepal, experiences in new nonfamily social contexts are tied to lower levels of care receipt. PMID:24999289
The Relation Between Supervisors' Big Five Personality Traits and Employees' Experiences of Abusive Supervision
Camps, Jeroen; Stouten, Jeroen; Euwema, Martin
The present study investigates the relation between supervisors' personality traits and employees' experiences of supervisory abuse, an area that – to date – remained largely unexplored in previous research. Field data collected from 103 supervisor-subordinate dyads showed that contrary to our expectations supervisors' agreeableness and neuroticism were not significantly related to abusive supervision, nor were supervisors' extraversion or openness to experience. Interestingly, however, our findings revealed a positive relation between supervisors' conscientiousness and abusive supervision. That is, supervisors high in conscientiousness were more likely to be perceived as an abusive supervisor by their employees. Overall, our findings do suggest that supervisors' Big Five personality traits explain only a limited amount of the variability in employees' experiences of abusive supervision. PMID:26903919
The lived experience of grieving for persons living with HIV who have used injection drugs.
Cody, W K
Parse's research method was used to investigate the lived experience of grieving for 10 persons self-identified as HIV-positive injection drug users. These individuals compose an understudied and poorly understood population, and their grief experiences have rarely been documented. The losses grieved by persons living with HIV infection include the loss of life, friends, family members, employment, energy, and sex. The lived experience of grieving was found to be "overwhelming anguish that shapes hopes and intentions as a wretched aloneness is punctuated with cherished uplifting engagements, while gratitude inspires courage in the midst of ambiguity." This new conceptualization of the grieving process is discussed in light of Parse's human becoming theory of nursing. PMID:10826306
Relationship of personal health experiences with interest in health careers among youth from an underserved area
Todaro, Alyssa; Washington, Shakira; Boekeloo, Bradley O.; Gilchrist, Brian; Wang, Min Qi
Only 10% of health professionals are from racial/ethnic minority groups, and much research has been focused on encouraging minorities to enter a health career. The lack of health workforce diversity has many implications for the effective delivery of care to an increasingly diverse US population. The goal of this analysis is to examine the influence of personal health experiences on interest in a health career. "Personal Health Experiences" is a newly created scaled variable that assesses the influence of direct and indirect health experiences of respondents. In a sample of 134 predominantly minority 10th graders from underprivileged neighborhoods, the scale had adequate psychometric properties (range = 1 to 7; mean = 4.44, s.d. = 1.46, median=4.60, Cronbach's alpha = 0.72), and multivariate regression modeling revealed that "Personal Health Experiences" predicted increased "Interest in Health Careers" (B=0.47, s.e.=0.10). Future research is needed to determine the role that personal health experiences play in career choices and one's success in health career decisions. Such information could, for example, help to refine health profession recruitment strategies. PMID:24013242
Arrhythmia risk stratification of patients after myocardial infarction using personalized heart models.
Arevalo, Hermenegild J; Vadakkumpadan, Fijoy; Guallar, Eliseo; Jebb, Alexander; Malamas, Peter; Wu, Katherine C; Trayanova, Natalia A
Sudden cardiac death (SCD) from arrhythmias is a leading cause of mortality. For patients at high SCD risk, prophylactic insertion of implantable cardioverter defibrillators (ICDs) reduces mortality. Current approaches to identify patients at risk for arrhythmia are, however, of low sensitivity and specificity, which results in a low rate of appropriate ICD therapy. Here, we develop a personalized approach to assess SCD risk in post-infarction patients based on cardiac imaging and computational modelling. We construct personalized three-dimensional computer models of post-infarction hearts from patients' clinical magnetic resonance imaging data and assess the propensity of each model to develop arrhythmia. In a proof-of-concept retrospective study, the virtual heart test significantly outperformed several existing clinical metrics in predicting future arrhythmic events. The robust and non-invasive personalized virtual heart risk assessment may have the potential to prevent SCD and avoid unnecessary ICD implantations. PMID:27164184
Arrhythmia risk stratification of patients after myocardial infarction using personalized heart models
Arevalo, Hermenegild J.; Vadakkumpadan, Fijoy; Guallar, Eliseo; Jebb, Alexander; Malamas, Peter; Wu, Katherine C.; Trayanova, Natalia A.
Sudden cardiac death (SCD) from arrhythmias is a leading cause of mortality. For patients at high SCD risk, prophylactic insertion of implantable cardioverter defibrillators (ICDs) reduces mortality. Current approaches to identify patients at risk for arrhythmia are, however, of low sensitivity and specificity, which results in a low rate of appropriate ICD therapy. Here, we develop a personalized approach to assess SCD risk in post-infarction patients based on cardiac imaging and computational modelling. We construct personalized three-dimensional computer models of post-infarction hearts from patients' clinical magnetic resonance imaging data and assess the propensity of each model to develop arrhythmia. In a proof-of-concept retrospective study, the virtual heart test significantly outperformed several existing clinical metrics in predicting future arrhythmic events. The robust and non-invasive personalized virtual heart risk assessment may have the potential to prevent SCD and avoid unnecessary ICD implantations. PMID:27164184
A Qualitative Study of How Patients with Type 2 Diabetes Use an Electronic Stand-Alone Personal Health Record
Abbott, Amy A.; Galt, Kimberly A.
Abstract Background: Patient use of personal health records (PHRs) to manage their health information has been proposed to enhance patient knowledge and empower patients to make changes in their self-care behaviors. However, there remains a gap in understanding about patients' actual PHR use behaviors. The purpose of this qualitative study was to explore how patients with type 2 diabetes used a PHR to manage their diabetes-related health information for self-care. Materials and Methods: Fifty-nine patients with type 2 diabetes were interviewed 3–6 months after receiving initial training on a free-of-charge, Web-based PHR. Interviews were audio-recorded, transcribed, and analyzed using an iterative process of in vivo coding, categorization, and theme development. Results: Nine themes emerged, three of which expressed positive experiences: complete and accessible record; increased awareness; and behavioral changes. The remaining six themes expressed negative experiences: out of sight, out of mind; I would have used it if I were sicker; economic, infrastructure, and computer literacy barriers; lack of patient–provider engagement; double tracking; and privacy and security concerns. Conclusions: Despite some potential positive benefits resulting from PHR use, several barriers inhibited sustained and effective use over time. Provider and patient education about the benefits of PHR use and about the potential for filling in information gaps in the provider-based record is key to engage patients and stimulate PHR adoption and use. PMID:25614996
Women's experiences of victimizing sexualization, Part II: Community and longer term personal impacts.
Smith, S K
This is the second of a two-part article describing the results of a qualitative study on women's experiences of victimizing sexualization. Ten adult women described their experiences of harmful learning about themselves as female and sexual. A four-part thematic description of women's experiences of victimizing sexualization was derived. This article reports on two of the major categories: community and cultural characteristics and longer term personal impacts. Findings of the study support the feminist position that the enactment of gender itself at social and cultural levels sometimes places women at risk for victimization. PMID:9362721
Negative and positive childhood experiences across developmental periods in psychiatric patients with different diagnoses – an explorative study
Saleptsi, Evangelia; Bichescu, Dana; Rockstroh, Brigitte; Neuner, Frank; Schauer, Margarete; Studer, Karl; Hoffmann, Klaus; Elbert, Thomas
Background A high frequency of childhood abuse has often been reported in adult psychiatric patients. The present survey explores the relationship between psychiatric diagnoses and positive and negative life events during childhood and adulthood in psychiatric samples. Methods A total of 192 patients with diagnoses of alcohol-related disorders (n = 45), schizophrenic disorders (n = 52), affective disorders (n = 54), and personality disorders (n = 41) completed a 42-item self-rating scale (Traumatic Antecedents Questionnaire, TAQ). The TAQ assesses personal positive experiences (competence and safety) and negative experiences (neglect, separation, secrets, emotional, physical and sexual abuse, trauma witnessing, other traumas, and alcohol and drugs abuse) during four developmental periods, beginning from early childhood to adulthood. Patients were recruited from four Psychiatric hospitals in Germany, Switzerland, and Romania; 63 subjects without any history of mental illness served as controls. Results The amount of positive experiences did not differ significantly among groups, except for safety scores that were lower in patients with personality disorders as compared to the other groups. On the other side, negative experiences appeared more frequently in patients than in controls. Emotional neglect and abuse were reported in patients more frequently than physical and sexual abuse, with negative experiences encountered more often in late childhood and adolescence than in early childhood. The patients with alcohol-related and personality disorders reported more negative events than the ones with schizophrenic and affective disorders. Conclusions The present findings add evidence to the relationship between retrospectively reported childhood experiences and psychiatric diagnoses, and emphasize the fact that a) emotional neglect and abuse are the most prominent negative experiences, b) adolescence is a more 'sensitive' period for negative experiences as compared to
Affective instability and suicidal ideation and behavior in patients with borderline personality disorder.
Links, Paul S; Eynan, Rahel; Heisel, Marnin J; Barr, Aiala; Korzekwa, Marilyn; McMain, Shelley; Ball, Jeffrey S
This study employed an Experience Sampling Methodology (ESM) to test whether various elements of affective instability can predict future suicide ideation in patients with borderline personality disorder (BPD) and a history of recurrent suicidal behavior. Eighty-two individuals with BPD and a history of recurrent suicidal behavior were followed prospectively for one month during which time they recorded their current mood states, 6 times daily over three weeks. Accounting for a set of robust suicide risk factors in multiple regression analyses, only negative mood intensity was significantly related to intensity of self-reported suicide ideation and to number of suicidal behaviors over the past year. Other elements of affective instability examined (e.g., mood amplitude, dyscontrol, and reactivity) were not associated with future suicide ideation or with recent suicidal behavior. Affective instability in patients with BPD is highly variable from one individual to another and is characterized by high levels of intense negative mood. These negative mood states, versus other aspects of mood variability, seem to be more closely tied to the occurrence of suicidal ideation and behavior. PMID:17373891
Cerebral processing of social rejection in patients with borderline personality disorder
Koppe, Georgia; Niedtfeld, Inga; Vollstädt-Klein, Sabine; Schmahl, Christian; Bohus, Martin; Lis, Stefanie
An intense fear of abandonment or rejection is a central feature of social relationships for individuals with borderline personality disorder (BPD). A total of 20 unmedicated BPD patients and 20 healthy participants (HC, matched for age and education) played a virtual ball-tossing game including the three conditions: exclusion, inclusion and a control condition with predefined game rules, whereas cerebral activity was assessed using functional magnetic resonance imaging. Subjective experiences of exclusion were assessed after each blocked condition. Both groups felt similarly excluded during the exclusion condition; however, BPD subjects felt more excluded than HC during the inclusion and control conditions. In all three conditions, BPD patients showed a stronger engagement of the dorsal anterior cingulate and medial prefrontal cortex. For HC, activation in several cerebral regions such as the insula and the precuneus differed depending on the interaction situation, whereas for BPD subjects activation in these regions was not modulated by experimental conditions. Subjects with BPD differed from HC in both their subjective reactions to and their neural processing of social interaction situations. Our data suggest that individuals with BPD have difficulty in discriminating between social situations, and tend to hypermentalize during social encounters that are not determined by the intentions of others. PMID:24273076
On the safety of persons accompanying nuclear medicine patients.
Díaz Barreto, Marlenin; López Bejerano, Gladys M; Varela Corona, Consuelo; Fleitas Estévez, Ileana
The presence of caretakers/comforters during nuclear medicine examinations is relatively common. These caretakers receive higher doses than the general public, who receive only environmental/background exposure. The aim of this research was to know about the doses received by two significant groups of caretakers: comforters of cancer patients (Group I) and mothers of small children (Group II). The patients were scheduled to undergo two different diagnostic studies: Inmuno-Scintigraphy using a monoclonal antibody bound to (99m)Tc (for adults) and Renal Scintigraphy using (99m)Tc-dimercaptosuccinic acid (for children). The average effective doses were 0.27 and 0.29 mSv for Groups I and II, respectively. Additionally, environmental monitoring was performed in the waiting room for injected patients (Room I) and inside the procedure room (Room II). Equivalent environmental doses of 0.28 and 0.24 mSv for Rooms 1 and II, respectively, were found, which are similar to values reported by other authors. PMID:22517979
Utility of personality measurement of clinic patients with insomnia.
Sexton-Radek, Kathy; Urban, Amanda; Pichler-Maury, Rene
An assessment study examining the relationship between sleep quality and personality style in individuals presenting to a sleep clinic with symptoms of insomnia was conducted. The protocol entailed standard clinical interviews conducted by a board certified sleep physician and licensed clinical psychologist. Participants were then assessed using a standard interview and the Millon Clinical Multi-axial Inventory III (MCMI-III) A follow-up appointment was conducted to provide interpretation and treatment recommendations from the interview and testing data. The results from a review of 210 cases are presented in terms of their sleep quality and dominant MCMI-III patterns. Preliminary multivariate analyses indicated two common profiles that correspond to the presentation of insomnia symptomology. These clusters were termed "avoidant" and "anxious" profiles, accordingly. Item content analyses were conducted via the Noteworthy Item classification in the MCMI-III manual to determine the viability of a category determined by the authors called Sleep Behavior Preoccupation. Of this sample 17% fit into the category. PMID:17566457
Personalized therapeutic strategies for patients with retinitis pigmentosa
Zheng, Andrew; Li, Yao
Introduction Retinitis pigmentosa (RP) encompasses many different hereditary retinal degenerations that are caused by a vast array of different gene mutations and have highly variable disease presentations and severities. This heterogeneity poses a significant therapeutic challenge, although an answer may eventually be found through two recent innovations: induced pluripotent stem cells (iPSCs) and clustered regularly interspaced short palindromic repeats (CRISPR)/Cas genome editing. Areas covered This review discusses the wide-ranging applications of iPSCs and CRISPR–including disease modelling, diagnostics and therapeutics – with an ultimate view towards understanding how these two technologies can come together to address disease heterogeneity and orphan genes in a novel personalized medicine platform. An extensive literature search was conducted in PubMed and Google Scholar, with a particular focus on high-impact research published within the last 1 – 2 years and centered broadly on the subjects of retinal gene therapy, iPSC-derived outer retina cells, stem cell transplantation and CRISPR/Cas gene editing. Expert opinion For the retinal pigment epithelium, autologous transplantation of gene-corrected grafts derived from iPSCs may well be technically feasible in the near future. Photoreceptor transplantation faces more significant unresolved technical challenges but remains an achievable, if more distant, goal given the rapid pace of advancements in the field. PMID:25613576
Personalized Mortality Prediction Driven by Electronic Medical Data and a Patient Similarity Metric
Lee, Joon; Maslove, David M.; Dubin, Joel A.
Background Clinical outcome prediction normally employs static, one-size-fits-all models that perform well for the average patient but are sub-optimal for individual patients with unique characteristics. In the era of digital healthcare, it is feasible to dynamically personalize decision support by identifying and analyzing similar past patients, in a way that is analogous to personalized product recommendation in e-commerce. Our objectives were: 1) to prove that analyzing only similar patients leads to better outcome prediction performance than analyzing all available patients, and 2) to characterize the trade-off between training data size and the degree of similarity between the training data and the index patient for whom prediction is to be made. Methods and Findings We deployed a cosine-similarity-based patient similarity metric (PSM) to an intensive care unit (ICU) database to identify patients that are most similar to each patient and subsequently to custom-build 30-day mortality prediction models. Rich clinical and administrative data from the first day in the ICU from 17,152 adult ICU admissions were analyzed. The results confirmed that using data from only a small subset of most similar patients for training improves predictive performance in comparison with using data from all available patients. The results also showed that when too few similar patients are used for training, predictive performance degrades due to the effects of small sample sizes. Our PSM-based approach outperformed well-known ICU severity of illness scores. Although the improved prediction performance is achieved at the cost of increased computational burden, Big Data technologies can help realize personalized data-driven decision support at the point of care. Conclusions The present study provides crucial empirical evidence for the promising potential of personalized data-driven decision support systems. With the increasing adoption of electronic medical record (EMR) systems, our
Psychiatrists׳ fear of death is associated with negative emotions toward borderline personality disorder patients.
Bodner, Ehud; Shrira, Amit; Hermesh, Hagai; Ben-Ezra, Menachem; Iancu, Iulian
This study examines the relationship between psychiatrists׳ fear of death and negative emotions toward patients with borderline personality disorder (BPD). A survey (N=120) demonstrated that fear of death is associated with stronger negative attitudes toward BPD patients, after controlling for attitudes toward suicide. Our findings emphasize the importance of psychiatrists׳ awareness to their fear of death as a relevant factor for their emotions toward BPD patients. PMID:26184990
Personalized Strategies to Activate and Empower Patients in Health Care and Reduce Health Disparities.
Chen, Jie; Mullins, C Daniel; Novak, Priscilla; Thomas, Stephen B
Designing culturally sensitive personalized interventions is essential to sustain patients' involvement in their treatment and encourage patients to take an active role in their own health and health care. We consider patient activation and empowerment as a cyclical process defined through patient accumulation of knowledge, confidence, and self-determination for their own health and health care. We propose a patient-centered, multilevel activation and empowerment framework (individual-, health care professional-, community-, and health care delivery system-level) to inform the development of culturally informed personalized patient activation and empowerment (P-PAE) interventions to improve population health and reduce racial and ethnic disparities. We discuss relevant Affordable Care Act payment and delivery policy reforms and how they affect patient activation and empowerment. Such policies include Accountable Care Organizations and value-based purchasing, patient-centered medical homes, and the community health benefit. Challenges and possible solutions to implementing the P-PAE are discussed. Comprehensive and longitudinal data sets with consistent P-PAE measures are needed to conduct comparative effectiveness analyses to evaluate the optimal P-PAE model. We believe the P-PAE model is timely and sustainable and will be critical to engaging patients in their treatment, developing patients' abilities to manage their health, helping patients express concerns and preferences regarding treatment, empowering patients to ask questions about treatment options, and building up strategic patient-provider partnerships through shared decision making. PMID:25845376
The relationship between personal experience and belief in the reality of global warming
NASA Astrophysics Data System (ADS)
Myers, Teresa A.; Maibach, Edward W.; Roser-Renouf, Connie; Akerlof, Karen; Leiserowitz, Anthony A.
In this paper, we address the chicken-or-egg question posed by two alternative explanations for the relationship between perceived personal experience of global warming and belief certainty that global warming is happening: Do observable climate impacts create opportunities for people to become more certain of the reality of global warming, or does prior belief certainty shape people's perceptions of impacts through a process of motivated reasoning? We use data from a nationally representative sample of Americans surveyed first in 2008 and again in 2011; these longitudinal data allow us to evaluate the causal relationships between belief certainty and perceived experience, assessing the impact of each on the other over time. Among the full survey sample, we found that both processes occurred: `experiential learning', where perceived personal experience of global warming led to increased belief certainty, and `motivated reasoning', where high belief certainty influenced perceptions of personal experience. We then tested and confirmed the hypothesis that motivated reasoning occurs primarily among people who are already highly engaged in the issue whereas experiential learning occurs primarily among people who are less engaged in the issue, which is particularly important given that approximately 75% of American adults currently have low levels of engagement.
The pain experience of patients with sickle cell anemia.
Jacob, E
Sickle cell anemia is a genetic disorder that affects 1 in 600 black infants in the United States. The painful crisis is one of its most characteristic manifestations and consists of pain in the extremities, back, abdomen, or chest. It may occur in 4 phases and may be precipitated by a variety of factors. The frequency, location, duration, severity, and character of pain differ both within and among patients. The pain may be localized, involve several areas, be diffuse, or be migratory. The intensity of pain varies from mild to excruciating and is perceived to be more intense by those who have experienced other forms of pain such as postoperative pain. Patients with sickle cell anemia who experience frequent painful crises exhibit problems with self-concept and low self-esteem, anxiety, depression, dissatisfaction with body image, poor school performance, social isolation, decreased participation in normal activities of daily living, and poor peer and family relationships. The periodic and unpredictable episodes can be incapacitating and may affect the way children see and feel about themselves, the way they relate to other people, the goals they set for themselves, and the way they approach a range of activities and situations. Research is very limited, and most of the available literature is based on personal observations, opinions, and anecdotal reports. The purpose of this report is to describe the phases of a painful episode as well as to examine the predisposing factors to, defining characteristics of, and patient outcomes associated with a painful crisis from sickle cell anemia. PMID:11710089
[Power of personal goal sharing--treatment plan using personal goal maps for patients with mental disorders].
Zhao, Yueren
A female patient in her sixties with schizophrenia had secretly disposed of all her medication and was not cooperating with hospital staff for about four months. During one of our consultations she mentioned that she wanted to be out of hospital by a certain date. That date happened to be her grandchild's birthday. It was at this point that she shared her goals with us, and voluntarily started having treatment. She was able to return home three months later, just in time to celebrate her grandchild's birthday with her family. A male patient in his sixties was able to leave the seclusion room after 10 years. The first doctor in charge and other hospital staff had firmly believed that releasing him from the seclusion room wasn't a possibility. However the patient decided he wanted to be discharged and was interested in finding out how to go about it. The moment he realized it was possible, his outlook changed immensely. He gradually started to open up and communicate better with his new doctor in charge, and was able to work towards his newly found goals. Staff members were also surprised when he was able to leave the seclusion room. They realized this patient was another person like them who had dreams and goals, and stopped stereotyping patients who seemed to be 'difficult to handle'. I have always experienced the power of goal sharing at clinical scenes, and have noticed its importance for patients making a start on the road to recovery. In order to discuss goals and the way to go about achieving them, I use a simple drawing of a mountain. I call this mountain 'A Personal Goal Map'. I like to think of myself (the doctor) as the mountain guide, and my patient as the mountain climber. The three key philosophies are acknowledging individuality, diversity and freedom. These are important when we think about where we are now, where we are going, and where we want to be. Firstly at the start point, we need to define the patient's problem and discuss ideas and goals
Psychiatric Stigma in Treatment-Seeking Adults with Personality Problems: Evidence from a Sample of 214 Patients
Catthoor, Kirsten; Schrijvers, Didier; Hutsebaut, Joost; Feenstra, Dineke; Sabbe, Bernard
Stigmatization is a major burden in adult psychiatric patients with Axis-I diagnoses, as shown consistently in most studies. Significantly fewer studies on the emergence of psychiatric stigma in adult patients with personality disorders (PDs) exist, although the resulting evidence is conclusive. Some authors consider patients with PDs at risk for severe stigmatization because of intense difficulties during interpersonal contact, even in a psychotherapeutic relationship. The aim of this study was primarily the assessment of pre-existing stigma in patients referred for intensive treatment for PDs. The study enrolled 214 patients admitted to the adult department of a highly specialized mental health care institute offering psychotherapy for patients with severe and complex personality pathology. All patients underwent a standard assessment with self-report questionnaires and a semi-structured interview to measure Axis II PDs. The stigma consciousness questionnaire and the perceived devaluation-discrimination questionnaire, both validated instruments, were used to measure perceived and actual experiences of stigma. Independent sample t-tests were used to investigate differences in the mean total stigma scores for patients both with and without a PD. One-way ANOVAs were performed to assess the differences between having a borderline PD, another PD, or no PD diagnosis. Multiple regression main effect analyses were conducted in order to explore the impact of the different PD diagnosis on the level of stigma. The mean scores across all patient groups were consistent with rather low stigma. No differences were found for patients with or without a PD diagnosis. Level of stigma in general was not associated with an accumulating number of PDs. Given the remarkable results, we would strongly recommend further investigations in the field to better understand the phenomenon of stigma in all its aspects. PMID:26217243
Five-Factor Model Personality Traits and the Objective and Subjective Experience of Body Weight.
Sutin, Angelina R; Terracciano, Antonio
Research on personality and adiposity has focused primarily on middle-aged and older adults. The present research sought to (a) replicate these associations in a young adult sample, (b) examine whether sex, race, or ethnicity moderate these associations, and (c) test whether personality is associated with the subjective experience of body weight and discrepancies between perceived and actual weight. Participants (N = 15,669; M(age) = 29; 53% female; ∼40% ethnic/racial minority) from Wave 4 of the National Longitudinal Study of Adolescent Health completed a Five-Factor Model personality measure and reported their weight, height, and perception of weight category (e.g., overweight); trained staff measured participants' height, weight, and waist circumference. Conscientiousness was associated with healthier weight, with a nearly 5 kg difference between the top and bottom quartiles. Neuroticism among women and Extraversion among men were associated with higher adiposity. Neuroticism was also associated with misperceived heavier weight, whereas Extraversion was associated with misperceived taller and leaner. The associations were similar across race/ethnic groups. Personality is associated with objective and subjective adiposity in young adulthood. Although modest, the effects are consistent with life span theories of personality, and the misperceptions are consistent with the conceptual worldviews associated with the traits. PMID:25329238
[Control locus, stress resistance and personal growth of the participants in experiment Mars-500].
Solcova, I; Vinokhodova, A G
The article deals with positive personal transformations in a simulated space mission. The investigation was focused on the aspects of control locus, stamina, proactive behavior to overcome challenges, and stress-related personal growth. Besides, ingenious psychophysiological techniques designed to select Russian cosmonauts were used for assessing stress-resistance and ability to control own emotions voluntarily. Experiment Mars-500 simulated the basic features of a mission to Mars. The crew consisted of 6 males 27 to 38 years of age who volunteered to spend 520 days in isolation and confinement in the IBMP experimental facility (Moscow). To detect personality changes, the volunteers were tested before the experiment and after its completion. According to the test results, the participants commonly demonstrated the ability to see the bright side of the Mars-500 adversities, which most often was caused by their social growth. Positive changes were particularly pronounced in the crewmembers who possessed a better ability to control own emotions. The simulated challenges were also beneficial for personal growth of the volunteers. PMID:24032161
Older persons' experiences of depressive ill-health and family support.
Lyberg, Anne; Holm, Anne Lise; Lassenius, Erna; Berggren, Ingela; Severinsson, Elisabeth
The aim of this study was to explore experiences of the meaning of family support among older persons with depressive ill-health. Data were collected from twenty-nine participants through semistructured interviews and analysed using interpretative hermeneutic and reflective methodology. The findings revealed a main theme, hovering between feelings of belongingness and aloneness in relationships with family members, based on two themes: a sense of being worthy and a sense of being unworthy. Experiences of support and lack of support from family members were not opposites but connected in internal relationships and can be pictured as a movement on a continuum of ambiguity. Family support promotes the emotional needs of older persons with depressive ill-health to be confirmed. The family plays a vital role, not always by direct assistance, but indirectly by supporting the older person's own "guiding principles" for managing her/his situation. The feelings of aloneness as well as shame and guilt at poor or absent family responsiveness should be adequately addressed. Innovative nursing care can lead to improvement by focusing on acquiescence to the older person's life situation. PMID:24078871
Older Persons' Experiences of Depressive Ill-Health and Family Support
Lyberg, Anne; Holm, Anne Lise; Lassenius, Erna; Berggren, Ingela; Severinsson, Elisabeth
The aim of this study was to explore experiences of the meaning of family support among older persons with depressive ill-health. Data were collected from twenty-nine participants through semistructured interviews and analysed using interpretative hermeneutic and reflective methodology. The findings revealed a main theme, hovering between feelings of belongingness and aloneness in relationships with family members, based on two themes: a sense of being worthy and a sense of being unworthy. Experiences of support and lack of support from family members were not opposites but connected in internal relationships and can be pictured as a movement on a continuum of ambiguity. Family support promotes the emotional needs of older persons with depressive ill-health to be confirmed. The family plays a vital role, not always by direct assistance, but indirectly by supporting the older person's own "guiding principles" for managing her/his situation. The feelings of aloneness as well as shame and guilt at poor or absent family responsiveness should be adequately addressed. Innovative nursing care can lead to improvement by focusing on acquiescence to the older person's life situation. PMID:24078871
What Are You? A CRT Perspective on the Experiences of Mixed Race Persons in "Post-Racial" America
ERIC Educational Resources Information Center
Anderson, Celia Rousseau
In this article, the author employs Critical Race Theory (CRT) to examine the experiences of mixed race individuals in the United States. Drawing on historical and contemporary conditions involving persons of mixed race, the author considers how key ideas from CRT can be useful to frame an analysis of the experiences of multiracial persons in the…
'Personal Care' and General Practice Medicine in the UK: A qualitative interview study with patients and General Practitioners
Adam, Rachel
Background Recent policy and organisational changes within UK primary care have emphasised graduated access to care, speed of access to the first available general practitioner (GP) and care being provided by a range of healthcare professionals. These trends have been strengthened by the current GP contract and Quality and Outcomes Framework (QOF). Concern has been expressed that the potential for personal care is being diminished as a result and that this will reduce quality standards. This paper presents data from a study that explored with patients and GPs what personal care means and whether it has continuing importance to them. Methods A semi-structured questionnaire was used to interview participants and Framework Analysis supported analysis of emerging themes. Twenty-nine patients, mainly women with young children, and twenty-three GPs were interviewed from seven practices in Lothian, Scotland, ranged by practice size and relative deprivation score. Results and Discussion Personal care was defined mainly, though not exclusively, as care given within the context of a continuing relationship in which there is an interpersonal connection and the doctor adopts a particular consultation style. Defined in this way, it was reported to have benefits for both health outcomes and patients' experience of care. In particular, such care was thought to be beneficial in attending to the emotions that can be elicited when seeking and receiving health care and in enabling patients to be known by doctors as legitimate seekers of care from the health service. Its importance was described as being dependent upon the nature of the health problem and patients' wider familial and social circumstances. In particular, it was found to provide support to patients in their parenting and other familial caring roles. Conclusion Personal care has continuing salience to patients and GPs in modern primary care in the UK. Patients equate the experience of care, not just outcomes, with high
Personal Factors Determining Patient Satisfaction with All-Ceramic Crown Treatment for Single Anterior Teeth.
Zou, Yun; Zhan, DeSong
The Eysenck Personality Questionnaire's (EPQ) N value (neuroticism) was used to evaluate information from 158 patients before ceramic crown treatment. Patient satisfaction was also evaluated using a satisfaction questionnaire 2 weeks post treatment. Patient expectations were not correlated with sex, age, or N value, and sex was not correlated with patient satisfaction other than in relation to crown shape. Total esthetic satisfaction and feature improvement were positively correlated with age, while satisfaction for five specific criteria was negatively correlated with N value and overall expectation. These observations underscore the importance of considering the physical and psychologic aspects of patient care when planning dental treatment. PMID:27611752
Theory and practice of chaplain's spiritual care process: A psychiatrist's experiences of chaplaincy and conceptualizing trans-personal model of mindfulness
Parameshwaran, Ramakrishnan
Background: Of various spiritual care methods, mindfulness meditation has found consistent application in clinical intervention and research. "Listening presence," a chaplain's model of mindfulness and its trans-personal application in spiritual care is least understood and studied. Aim: The aim was to develop a conceptualized understanding of chaplain's spiritual care process based on neuro-physiological principles of mindfulness and interpersonal empathy. Materials and Methods: Current understandings on neuro-physiological mechanisms of mindfulness-based interventions (MBI) and interpersonal empathy such as theory of mind and mirror neuron system are used to build a theoretical framework for chaplain's spiritual care process. Practical application of this theoretical model is illustrated using a carefully recorded clinical interaction, in verbatim, between chaplain and his patient. Qualitative findings from this verbatim are systematically analyzed using neuro-physiological principles. Results and Discussion: Chaplain's deep listening skills to experience patient's pain and suffering, awareness of his emotions/memories triggered by patient's story and ability to set aside personal emotions, and judgmental thoughts formed intra-personal mindfulness. Chaplain's insights on and ability to remain mindfully aware of possible emotions/thoughts in the patient, and facilitating patient to return and re-return to become aware of internal emotions/thoughts helps the patient develop own intra-personal mindfulness leading to self-healing. This form of care involving chaplain's mindfulness of emotions/thoughts of another individual, that is, patient, may be conceptualized as trans-personal model of MBI. Conclusion: Chaplain's approach may be a legitimate form of psychological therapy that includes inter and intra-personal mindfulness. Neuro-physiological mechanisms of empathy that underlie Chaplain's spiritual care process may establish it as an evidence-based clinical
Experiences of family carers of people diagnosed with borderline personality disorder.
Lawn, S; McMahon, J
There is limited understanding of the experience of family carers of people diagnosed with borderline personality disorder (BPD). This study aimed to explore their experiences of being carers, their attempts to seek help for the person diagnosed with BPD and their own carer needs. An invitation to participate in an online survey was distributed to carers across multiple consumer and carer organizations and mental health services, by the Private Mental Health Consumer Carer Network (Australia) in 2011. Responses from 121 carers showed that they experience significant challenges and discrimination when attempting to engage with and seek support from health services. Comparison with consumers' experiences (reported elsewhere) showed that these carers have a clear understanding of the discrimination faced by people with this diagnosis, largely because they also experience exclusion and discrimination. Community carer support services were perceived as inadequate. General practitioners were an important source of support; however, they and other service providers need more education and training to support attitudinal change to address discrimination, recognize carers' needs and provide more effective support. This study provides the first detailed account of BPD carers' experiences across a broad range of support needs and interactions with community support and health services. PMID:25857849
A biofeedback intervention to control impulsiveness in a severely personality disordered forensic patient.
Howard, Rick; Schellhorn, Klaus; Lumsden, John
Impulsiveness in personality disordered forensic patients is associated with poor treatment completion and high risk of re-offending. A biofeedback training protocol, previously found to reduce impulsiveness and improve attention in children with Attention Deficit Hyperactivity Disorder, was used in an initial attempt to reduce impulsiveness in a severely personality disordered man with borderline, antisocial and histrionic features. Electrocortical, behavioural and self-report measures of impulsiveness were taken before and immediately following 6 weeks of biofeedback training and at 3 months follow-up. The patient successfully engaged with the intervention. His self-reports of reduced impulsiveness and improved attention were corroborated by behavioural and electrocortical measures that indicated reduced impulsiveness and better focused attention. Results suggest this intervention might prove useful in improving behavioural and emotional self-regulation in severely personality disordered patients. PMID:24343943
Comparison of serum from gastric cancer patients and from healthy persons using FTIR spectroscopy
NASA Astrophysics Data System (ADS)
Sheng, Daping; Wu, Yican; Wang, Xin; Huang, Dake; Chen, Xianliang; Liu, Xingcun
Since serum can reflect human beings' physiological and pathological conditions, FTIR spectroscopy was used to compare gastric cancer patients' serum with healthy persons' serum in this study. The H2959/H2931, H1646/H1550, H1314/H1243, H1453/H1400 and H1080/H1550 ratios were calculated, among these ratios, the H2959/H2931 ratio might be a standard for distinguishing gastric cancer patients from healthy persons. Then curve fitting was processed using Gaussian curves in the 1140-1000 cm-1 region, and the result showed that the RNA/DNA ratios of gastric cancer patients' serum were obviously lower than those of healthy persons' serum. The results suggest that FTIR spectroscopy may be a potentially useful tool for diagnosis of gastric cancer.
FTIR spectroscopic comparison of serum from lung cancer patients and healthy persons
NASA Astrophysics Data System (ADS)
Wang, Xin; Shen, Xiang; Sheng, Daping; Chen, Xianliang; Liu, Xingcun
The incidence and mortality of lung cancer remains so high that it is very urgent to develop an effective method for early detection of lung cancer. Serum can reflect physiological and pathological changes of human body, so FTIR spectroscopy was used to compare lung cancer patients' and healthy persons' serum in this study. The A1080/A1170 ratio might be potentially useful for distinguishing lung cancer patients' serum from healthy persons' serum. Moreover, the result of curve fitting indicated that the ratios of α-helix/antiparallel β-sheet were lower for lung cancer patients' serum than those for healthy persons' serum. These results indicated that IR spectra of serum might be potentially useful for detecting lung cancer.
A review of systems for the personal aspects of patient care.
Matthews, D A; Feinstein, A R
Because patients are appropriate judges of the personal aspects of the care received from physicians, the authors conducted lengthy interviews with 50 randomly chosen medical inpatients. They were asked to describe, in an open-ended but semistructured fashion, their favorable and unfavorable impressions and reactions to the personal aspects of care rendered by their physicians. From the specific comments made by the patients in these interviews, we constructed a detailed taxonomy of desired physician attitudes and behaviors. The taxonomy can be used in a manner analogous to a Review of Systems for teaching students and practitioners the elements of personal care and also can be applied for research in patient-physician communication. PMID:3354589
Promoting the use of personally relevant stimuli for investigating patients with disorders of consciousness.
Perrin, Fabien; Castro, Maïté; Tillmann, Barbara; Luauté, Jacques
Sensory stimuli are used to evaluate and to restore cognitive functions and consciousness in patients with a disorder of consciousness (DOC) following a severe brain injury. Although sophisticated protocols can help assessing higher order cognitive functions and awareness, one major drawback is their lack of sensitivity. The aim of the present review is to show that stimulus selection is crucial for an accurate evaluation of the state of patients with disorders of consciousness as it determines the levels of processing that the patient can have with stimulation from his/her environment. The probability to observe a behavioral response or a cerebral response is increased when her/his personal history and/or her/his personal preferences are taken into account. We show that personally relevant stimuli (i.e., with emotional, autobiographical, or self-related characteristics) are associated with clearer signs of perception than are irrelevant stimuli in patients with DOC. Among personally relevant stimuli, music appears to be a promising clinical tool as it boosts perception and cognition in patients with DOC and could also serve as a prognostic tool. We suggest that the effect of music on cerebral processes in patients might reflect the music's capacity to act both on the external and internal neural networks supporting consciousness. PMID:26284020
Promoting the use of personally relevant stimuli for investigating patients with disorders of consciousness
Perrin, Fabien; Castro, Maïté; Tillmann, Barbara; Luauté, Jacques
Sensory stimuli are used to evaluate and to restore cognitive functions and consciousness in patients with a disorder of consciousness (DOC) following a severe brain injury. Although sophisticated protocols can help assessing higher order cognitive functions and awareness, one major drawback is their lack of sensitivity. The aim of the present review is to show that stimulus selection is crucial for an accurate evaluation of the state of patients with disorders of consciousness as it determines the levels of processing that the patient can have with stimulation from his/her environment. The probability to observe a behavioral response or a cerebral response is increased when her/his personal history and/or her/his personal preferences are taken into account. We show that personally relevant stimuli (i.e., with emotional, autobiographical, or self-related characteristics) are associated with clearer signs of perception than are irrelevant stimuli in patients with DOC. Among personally relevant stimuli, music appears to be a promising clinical tool as it boosts perception and cognition in patients with DOC and could also serve as a prognostic tool. We suggest that the effect of music on cerebral processes in patients might reflect the music's capacity to act both on the external and internal neural networks supporting consciousness. PMID:26284020
Enhancing the revenue cycle experience for patients.
Consolver, Patti; Phillips, Scott
In 2013, Texas Health Resources began to record discussions with patients at each revenue cycle touch point, from scheduling through registration. The recordings give leaders insight on the accuracy and consistency of information communicated at each touch point and provide a tool for improving customer service. The initiative has improved patient satisfaction and increased point-of-service collections. PMID:25647892
Partnering With a Patient and Family Advisory Council to Improve Patient Care Experiences With Pain Management.
Bookout, Michelle L; Staffileno, Beth A; Budzinsky, Christine M
Patient-centered care is a key driver for the nation's health system, yet patient experience surveys indicate that hospitals are far from achieving favorable outcomes. Partnering with patients and families through a patient and family advisory council (PFAC) advances the practice of patient-centered care to improve outcomes and experiences. This article describes the process of implementing a PFAC and presents outcomes related to patients' perception of pain management in the acute care hospital setting. PMID:26963442
Experiences of mentoring influences on the personal and professional growth of Hispanic registered nurses.
Egues, Aida L
The purpose of this qualitative descriptive study was to explore the meaning of the experiences of mentoring influences on the personal and professional growth of Hispanic registered nurses (RNs). Focus group methodology was employed in the New York City metropolitan area with monolingual English or bilingual English/Spanish RNs (N = 20) who perceived themselves to be at all levels of practice. The findings offer a summary of the experiences of mentoring for the 20 Hispanic RNs that includes little advancement support; hesitancy to being mentored; dependency on the self for personal and professional growth; and educational, practice, and socioeconomic barriers. This study suggests that mentoring of Hispanic nurses needs to be reexamined to improve and sustain a culture of mentoring that may enhance the education, recruitment, and retention of Hispanic RNs. PMID:24831071
Mental Health Nurses' Experiences of Caring for Patients Suffering from Self-Harm
Talseth, Anne-Grethe
The aim of this study was to explore mental health nurses' experiences of caring for inpatients who self-harm during an acute phase. The setting was four psychiatric clinics in Norway. Fifteen mental health nurses (MHNs) were recruited. Semistructured interviews comprised the method for data collection, with content analysis used for data analysis. Two main categories emerged: challenging and collaborative nurse-patient relationship and promoting well-being through nursing interventions. The underlying meaning of the main categories was interpreted and formulated as a latent theme: promoting person-centered care to patients suffering from self-harm. How MHNs promote care for self-harm patients can be described as a person-centered nursing process. MHNs, through the creation of a collaborative nurse-patient relationship, reflect upon nursing interventions and seek to understand each unique patient. The implication for clinical practice is that MHNs are in a position where they can promote patients' recovery processes, by offering patients alternative activities and by working in partnership with patients to promote their individual strengths and life knowledge. MHNs strive to help patients find new ways of living with their problems. The actual study highlighted that MHNs use different methods and strategies when promoting the well-being of self-harm patients. PMID:25512876
An intelligent rollator for mobility impaired persons, especially stroke patients.
Hellström, Thomas; Lindahl, Olof; Bäcklund, Tomas; Karlsson, Marcus; Hohnloser, Peter; Bråndal, Anna; Hu, Xiaolei; Wester, Per
An intelligent rollator (IRO) was developed that aims at obstacle detection and guidance to avoid collisions and accidental falls. The IRO is a retrofit four-wheeled rollator with an embedded computer, two solenoid brakes, rotation sensors on the wheels and IR-distance sensors. The value reported by each distance sensor was compared in the computer to a nominal distance. Deviations indicated a present obstacle and caused activation of one of the brakes in order to influence the direction of motion to avoid the obstacle. The IRO was tested by seven healthy subjects with simulated restricted and blurred sight and five stroke subjects on a standardised indoor track with obstacles. All tested subjects walked faster with intelligence deactivated. Three out of five stroke patients experienced more detected obstacles with intelligence activated. This suggests enhanced safety during walking with IRO. Further studies are required to explore the full value of the IRO. PMID:27078084
The experience of specialist inpatient treatment for anorexia nervosa: A qualitative study from adult patients' perspectives.
Smith, Vivien; Chouliara, Zoe; Morris, Paul G; Collin, Paula; Power, Kevin; Yellowlees, Alex; Grierson, David; Papageorgiou, Elena; Cook, Moira
This qualitative study aimed to explore experiences of women currently undergoing specialist inpatient treatment for anorexia nervosa. Interviews were carried out with 21 women with a diagnosis of anorexia nervosa from a specialist adult inpatient eating disorder unit. Five master themes emerged using thematic analysis: (1) shifts in control, (2) experience of transition, (3) importance of supportive staff relationships, (4) sharing with peers and (5) process of recovery and self-discovery. Findings suggest that patients experience a process of change and adjustment in relation to levels of perceived personal control, attachment to the treatment environment and a sense of self-identity. PMID:24505059
Coping mediates the influence of personality on life satisfaction in patients with rheumatic diseases.
Vollmann, Manja; Pukrop, Jörg; Salewski, Christel
A rheumatic disease can severely impair a person's quality of life. The degree of impairment, however, is not closely related to objective indicators of disease severity. This study investigated the influence and the interplay of core psychological factors, i.e., personality and coping, on life satisfaction in patients with rheumatic diseases. Particularly, it was tested whether coping mediates the effects of personality on life satisfaction. In a cross-sectional design, 158 patients diagnosed with a rheumatic disease completed questionnaires assessing the Big 5 personality traits (BFI-10), several disease-related coping strategies (EFK) and life satisfaction (HSWBS). Data were analyzed using a complex multiple mediation analysis with the Big 5 personality traits as predictors, coping strategies as mediators and life satisfaction as outcome. All personality traits and seven of the nine coping strategies were associated with life satisfaction (rs > |0.16|, ps ≤ 0.05). The mediation analysis revealed that personality traits had no direct, but rather indirect effects on life satisfaction through coping. Neuroticism had a negative indirect effect on life satisfaction through less active problem solving and more depressive coping (indirect effects > -0.03, ps < 0.05). Extraversion, agreeableness, and conscientiousness had positive indirect effects on life satisfaction through more active problem solving, less depressive coping and/or a more active search for social support (indirect effects > 0.06, ps < 0.05). Personality and coping play a role in adjustment to rheumatic diseases. The interplay of these variables should be considered in psychological interventions for patients with rheumatic diseases. PMID:26898985
Making a difference to the patient experience.
Baillie, Jonathan
A "bed pod" featuring "modesty screens", enhanced acoustics, multi-level light, and extra storage; quickly erectable washroom "pods" for improving patient convenience and ward layout with minimal disruption; a "one-size-fits-all" hospital gown claimed to provide a more comfortable fit than existing designs; and a reclining day chair designed to enhance patient comfort and safety, were among a raft of new hospital items developed in lightning-fast time by multidisciplinary teams, and shown in prototype in London recently, as part of a Department of Health/Design Council project to improve patient privacy and dignity. Jonathan Baillie reports. PMID:20527593
Older persons' experiences and perspectives of receiving social care: a systematic review of the qualitative literature.
de São José, José; Barros, Rosanna; Samitca, Sanda; Teixeira, Ana
The topic of social care for older people has gained increasing attention from the part of academics, professionals, policy makers and media. However, we know little about this topic from the perspectives of older persons, which hinders future developments in terms of theory, empirical research, professional practice and social policy. This article presents and discusses a systematic review of relevant qualitative research-based evidence on the older persons' experiences and perspectives of receiving social care published between 1990 and September 2014. This review aimed to obtain answers to the following questions: How is the reception of social care experienced by the older persons? What are the negative and positive aspects of these experiences? What are the factors which influence the experiences? The synthesis of the findings of reviewed papers identified six analytical themes: asking for care as a major challenge; ambivalences; (dis)engagement in decisions concerning care; multiple losses as outcomes of receiving social care; multiple strategies to deal with losses originated by the ageing process; and properties of 'good care'. These themes are discussed from the point of view of their implications for theory, care practice and social policy, and future research. PMID:25660372
Personalized Strategies to Activate and Empower Patients in Health Care and Reduce Health Disparities
Chen, Jie; Mullins, C. Daniel; Novak, Priscilla; Thomas, Stephen B.
Designing culturally-sensitive personalized interventions is essential to sustain patients' involvement in their treatment, and encourage patients to take an active role in their own health and health care. We consider patient activation and empowerment as a cyclical process defined through patient accumulation of knowledge, confidence, and self-determination for their own health and health care. We propose a patient-centered, multi-level activation and empowerment framework (individual-, health care professional-, community-, and health care delivery system-level) to inform the development of culturally informed personalized patient activation and empowerment (P-PAE) interventions to improve population health, and reduce racial and ethnic disparities. We discuss relevant Affordable Care Act payment and delivery policy reforms, and how they impact patient activation and empowerment. Such policies include Accountable Care Organizations and Value Based Purchasing, Patient Centered Medical Homes, and the Community Health Benefit. Challenges and possible solutions to implementing the P-PAE are discussed. Comprehensive and longitudinal data sets with consistent P-PAE measures are needed to conduct comparative effectiveness analyses to evaluate the optimal P-PAE model. We believe the P-PAE model is timely and sustainable, and will be critical to engaging patients in their treatment, developing patients' abilities to manage their health, helping patients to express concerns and preferences regarding treatment, empowering patients to ask questions about treatment options, and building up strategic patient-provider partnerships through shared decision making. PMID:25845376
What Determines the Surgical Patient Experience? Exploring the Patient, Clinical Staff, and Administration Perspectives.
Mazurenko, Olena; Zemke, Dina; Lefforge, Noelle; Shoemaker, Stowe; Menachemi, Nir
Hospitals are increasingly concerned with enhancing surgical patient experience given that Medicare reimbursements are now tied in part to patient satisfaction. Surgical patients' experience may be influenced by several factors (e.g., integration of care, technical aspects of care), which are ranked differently in importance by clinicians and patients. Strategies designed to improve patient experience can be informed by our research, which examines the determinants of the surgical patient experience from the perspective of multiple healthcare team members. We conducted 12 focus groups with surgical patients, family members, physicians, nurses, and hospital administrators at one acute care, for-profit hospital in a western state and analyzed the content for determinants of the overall surgical patient experience. Specifically, we analyzed the content of the conversations to determine how frequently participants discussed the determinants of the surgical patient experience and how positive, negative, or neutral the comments were. The study's findings suggest that surgical patients and members of the healthcare team have similar views regarding the most important factors in the patient experience-namely, interdisciplinary relationships, technical infrastructure, and staffing. The study results will be used to improve care in this facility and can inform the development of initiatives aimed at improving the surgical patient experience elsewhere. Our study could serve as a model for how other facilities can analyze the surgical patient experience from the perspectives of different stakeholders and improve their performance on the basis of data directly relevant to their organization. PMID:26554144
"Doing ethics" in the context of sharing patients' personal health information.
Somerville, Margaret A
There are at present two inconsistencies with respect to the sharing of personal health information (PHI) among health care professionals caring for a patient whom the information concerns. First, there is an inconsistency between what is in theory the ethics and law governing the confidentiality and privacy of this information--it may only be disclosed with informed consent--and what is the actual practice of health care professionals--they share it without such consent. Second, there is an inconsistency between what ethics and law demand in theory and what all parties want: They all approve of the current practice. Ethics and law can be brought into line with what is needed to act in the patient's best interests and with what people want, without opening up any serious potential for abuse of privacy and confidentiality, by establishing a safeguarded, provision-of-care exception that allows co-caring health care professionals to share patients' PHI. The requirements for a system establishing such safeguards are proposed. The basic governing presumption is respect for the person and for rights to autonomy, self-determination, privacy, and confidentiality. Therefore, disclosure may only be made with the informed consent of the competent person to whom the information pertains, unless a defence of necessity applies. Where there is doubt about someone's competence, there should likewise be doubt about disclosure without that person's informed consent. Where the person is incompetent, such a disclosure can be made to the patient's substitute decision makers, most often the family, if that is necessary for the care of the patient and in the patient's best interests. To the extent possible, consistent with the best interests of the patient, the wishes of incompetent people should be respected. PMID:15660294
Personal experience with narrated events modulates functional connectivity within visual and motor systems during story comprehension.
Chow, Ho Ming; Mar, Raymond A; Xu, Yisheng; Liu, Siyuan; Wagage, Suraji; Braun, Allen R
Past experience of everyday life activities, which forms the basis of our knowledge about the world, greatly affects how we understand stories. Yet, little is known about how this influence is instantiated in the human brain. Here, we used functional magnetic resonance imaging to investigate how past experience facilitates functional connectivity during the comprehension of stories rich in perceptual and motor details. We found that comprehenders' past experience with the scenes and actions described in the narratives selectively modulated functional connectivity between lower- and higher-level areas within the neural systems for visual and motor processing, respectively. These intramodal interactions may play an important role in integrating personal knowledge about a narrated situation with an evolving discourse representation. This study provides empirical evidence consistent with the idea that regions related to visual and motor processing are involved in the reenactment of experience as proposed by theories of embodied cognition. PMID:25545633
Exploring the Patient and Staff Experience With the Process of Primary Care
Brown, Elizabeth J.; Kangovi, Shreya; Sha, Christopher; Johnson, Sarah; Chanton, Casey; Carter, Tamala; Grande, David T.
PURPOSE Previous studies suggest that the highest-risk patients value accessible, coordinated primary care that they perceive to be of high technical quality. We have limited understanding, however, of how low-income, chronically ill patients and the staff who care for them experience each individual step in the primary care process. METHODS We conducted qualitative interviews with uninsured or Medicaid patients with chronic illnesses, as well as with primary care staff. We interviewed 21 patients and 30 staff members with a variety of job titles from 3 primary care practices (1 federally qualified health center and 2 academically affiliated clinics).] RESULTS The interviews revealed 3 major issues that were present at all stages of a primary care episode: (1) information flow throughout an episode of care is a frequent challenge, despite systems that are intended to improve communication; (2) misaligned goals and expectations among patients, clinicians, and staff members are often an impediment to providing and obtaining care; and (3) personal relationships are highly valued by both patients and staff. CONCLUSIONS Vulnerable populations and the primary care staff who work with them perceive some of the same challenges throughout the primary care process. Improving information flow, aligning goals and expectations, and developing personal relationships may improve the experience of both patients and staff. PMID:26195680
The Family's Experience of Sharing the Care of a Person with Dementia with the Services in Specialized Day-Care Units
Gústafsdóttir, Margrét
Background Services in specialized day-care units for individuals with dementia are set up to enable these persons to live in their own home. The purpose of this paper is to discern the experiences of families with these services while caring for a close relative with dementia. Method Longitudinal interviews with 8 family members were conducted. In total, 25 interviews were carried out over a period of 5 years. Results The experience of these families of looking after a close person with dementia appeared to be influenced by (a) the multifaceted meaning of ties, (b) the perception of purposeful relief of the day-care services and (c) the progress of the disease. Conclusion All families found the services of specialized day-care units both useful and pleasant. This kind of resource was shown to make everyday life much more manageable for all persons involved, most importantly for the patient with dementia. PMID:25337077
Residents learning from a narrative experience with dying patients: a qualitative study.
Tait, Glendon R; Hodges, Brian D
For patients at the end of life, it is crucial to address the psychological, existential, and spiritual distress of patients. Medical education research suggests trainees feel unprepared to provide the whole person, humanistic care held as the ideal. This study used an empirically based narrative intervention, the dignity interview, as an educational intervention with first year residents. The interview helps patients tell and make meaning of their life story. The intervention was aimed at addressing trainee perceived gaps in the non-physical aspects of end-of-life care. It was also intended to stimulate broader reflection on lessons learned in medical education about the value of narrative as part of humanistic care. Twelve first year residents administered a 1 h interview to dying patients. The resident returned to read the transcribed story back to the patient. Semi-structured interviews of the residents were transcribed and analyzed using the constant comparative method to identify emergent themes. This experience was seen as distinct from the 'traditional" medical interview. Residents reflected on lessons learned from patients and on their own professional and personal lives. Residents felt conversations with dying patients, and more broadly the art of soliciting a patient's story are poorly taught and modeled. More concerning, the hidden curriculum seems to be sending messages that learning a patient's story is not the domain of a physician and that it is not valued like the curing and technical imperatives. These findings have implications for medical education's ongoing attempts to better produce humanistic physicians. PMID:23053870
Patient Experiences of Loneliness: An Evolutionary Concept Analysis.
Karhe, Liisa; Kaunonen, Marja
Loneliness is a painful experience for patients. To clarity the concept of patient loneliness, this study undertook an evolutionary concept analysis based on a literature search in the main relevant databases. We identified 7 dimensions in adult patients' experiences of loneliness. These dimensions of loneliness have different causes and theoretical foundations, which have different implications for patient care. Patients may be lonely in their different relationships, including those with nurses and doctors. Loneliness in relation to health care professionals is a new application of the concept of loneliness that provides a useful starting point for future research. PMID:26517346
Patient experience with mupirocin or povidone-iodine nasal decolonization.
Maslow, Jed; Hutzler, Lorraine; Cuff, Germaine; Rosenberg, Andrew; Phillips, Michael; Bosco, Joseph
Led by the federal government, the payers of health care are enacting policies designed to base provider reimbursement on the quality of care they render. This study evaluated and compared patient experiences and satisfaction with nasal decolonization with either nasal povidone-iodine (PI) or nasal mupirocin ointment (MO). A total of 1903 patients were randomized to undergo preoperative nasal decolonization with either nasal MO or PI solution. All randomized patients were also given 2% chlorhexidine gluconate topical wipes. Patients were interviewed prior to discharge to assess adverse events and patient experience with their assigned preoperative antiseptic protocol. Of the 1903 randomized patients, 1679 (88.1%) were interviewed prior to discharge. Of patients receiving PI, 3.4% reported an unpleasant or very unpleasant experience, compared with 38.8% of those using nasal MO (P<.0001). Sixty-seven percent of patients using nasal MO believed it to be somewhat or very helpful in reducing surgical site infections, compared with 71% of patients receiving PI (P>.05). Being recruited as an active participant in surgical site infection prevention was a positive experience for 87.2% of MO patients and 86.3% of PI patients (P=.652). Those assigned to receive PI solution preoperatively reported significantly fewer adverse events than the nasal MO group (P<.01). Preoperative nasal decolonization with either nasal PI or MO was considered somewhat or very helpful by more than two-thirds of patients. PMID:24972440
A Personalized Approach to Assessing and Managing Pain in Patients With Cancer
Hui, David; Bruera, Eduardo
Pain is one of the most common and distressing symptoms in patients with cancer. In this review, we discuss an evidence-based approach to personalized pain assessment and management. Recent insights into the pain expression pathway have led to a paradigm shift in pain management, allowing clinicians to deliver personalized treatments tailored to the individual's needs. Personalized pain management begins with systematic screening, followed by comprehensive pain assessment. Impeccable characterization of pain informs its etiology and the mechanism to guide treatment choices. Identification of modulators of pain expression such as psychological distress, alcoholism, substance use, and delirium allow clinicians to further tailor treatment recommendations. Documentation of a personalized pain goal provides an individualized response criterion. A multidimensional treatment plan is then formulated targeting the pain mechanism, etiologic factors, and modulators. Finally, longitudinal monitoring customized to the individual's needs allows clinicians to improve adherence and, ultimately, to optimize pain control over time. PMID:24799495
A Better Patient Experience Through Better Communication
Lang, Elvira V.
The transformation of healthcare from a seller's market to a consumer's market has pushed the element of patient satisfaction into the forefront of various medical facility evaluation tools, including those used by Medicare when weighing reimbursement to hospitals for patient care. Research has identified good communication skills to be a key factor in ensuring better patient outcomes, and nurturing patient satisfaction. Because of the growing amount of money at stake for patients' satisfaction with a facility, the communication skills of individual healthcare providers are bound to impact their employees' reimbursement, bonuses, and promotion options. Although the dangers of "poor communication," are evident: "poor communication" is a primary reason for filing a law suit in >80% of cases (Avery, 1985). Identifying the characteristics of "good communication" has been difficult. One factor that adds to the confusion is that research has found some long accepted codes of professional communication protocol to actually be counterproductive. Another factor that adds to the uncertainty is that accurate interpretations of some communication events are counterintuitive. Fortunately it has been possible to extract observable, proven, and teachable "good communication" behaviors from large-scale trials in the radiology department. The resultant Comfort Talk™ approach to communication includes rapid rapport techniques, patient-centered talking styles, and use of hypnotic language. This article overviews some of the Comfort Talk™ approaches to patients interaction and provides operational summaries of a sampling of specific Comfort Talk™ communication techniques, which nurses, technologists, and other healthcare workers can implement in their own practices. PMID:23471099
Psychodynamics and psychopharmacotherapy in the treatment of difficult patients with personality and eating disorders.
Marčinko, Darko
The complex inter-relationship between external and internal reality, a source of interest and controversy in psychiatry, has come to the foreground more prominently in the context of more integrative understanding of psychopharmacotherapy. This paper discusses the meaning and clinical applications of the psychodynamic related to psychopharmacotherapy for difficult personality and eating disorders patients. The one of the psychodynamic explanations for patients' being difficult is related to their perceived lack of mentalizing (reflective) capacities. Lack of mentalizing capacity implies disturbed view of psychopharmacotherapy. Therapeutic relationship and optimal alliance offers the frame for acceptance of psychiatric drugs as positive and useful for personality and eating disorder patients. Mentalization and intersubjectivity theories have direct implications for clinical practice, and that the notion of the third is particularly useful in understanding what happens in the patient-doctor relationship. PMID:26400147
Type-D Personality Can Predict Suicidality in Patients with Major Depressive Disorder
Ko, Young-Hoon; Lee, Moon-Soo; Lee, Heon-Jeong; Kim, Leen
Objective This study investigated the putative association between type-D personality and suicidality, including the history of suicide attempt and suicidal ideation in patients with major depressive disorder (MDD). Methods Eighty-six outpatients aged between 18 and 65 years with MDD were recruited for this study from Ilsan Paik Hospital. The cohort was stratified into two subgroups according to the presence of type-D personality and history of suicide attempt (yes vs. no). Depression severity was evaluated using the Hamilton Depression Rating Scale. The type-D Personality Scale-14 (DS-14), the Beck Hopelessness Scale (BHS), the Barratt Impulsiveness Scale (BIS), the Hamilton Anxiety Scale, and the Beck Scale for Suicidal Ideation (BSS) were also applied. Results The total BSS, BHS, and BIS scores were higher for the group with type-D personality than for the group without this personality (p=0.004, 0.01, and 0.003, respectively). In addition, the total scores for the BSS, BHS, and social inhibition (SI; subscale of DS-14) were higher for the group with a history of suicide attempt than for the group without this history (p=0.0000004, 0.003, and 0.033, respectively). There were positive correlations between the total DS-14 score and the total BSS, BHS, and BIS scores (r=0.413 and p=0.000077, r=0.404 and p=0.00012, and r=0.245 and p=0.024, respectively). Conclusion Depressed patients with type-D personality are more vulnerable to suicidality than those without type-D personality, even when the MDD severity is identical. In addition, the SI score was higher in patients with a history of suicide attempt than in those without this history. PMID:25110494
Patient Experience Shows Little Relationship with Hospital Quality Management Strategies
Groene, Oliver; Arah, Onyebuchi A.; Klazinga, Niek S.; Wagner, Cordula; Bartels, Paul D.; Kristensen, Solvejg; Saillour, Florence; Thompson, Andrew; Thompson, Caroline A.; Pfaff, Holger; DerSarkissian, Maral; Sunol, Rosa
Objectives Patient-reported experience measures are increasingly being used to routinely monitor the quality of care. With the increasing attention on such measures, hospital managers seek ways to systematically improve patient experience across hospital departments, in particular where outcomes are used for public reporting or reimbursement. However, it is currently unclear whether hospitals with more mature quality management systems or stronger focus on patient involvement and patient-centered care strategies perform better on patient-reported experience. We assessed the effect of such strategies on a range of patient-reported experience measures. Materials and Methods We employed a cross-sectional, multi-level study design randomly recruiting hospitals from the Czech Republic, France, Germany, Poland, Portugal, Spain, and Turkey between May 2011 and January 2012. Each hospital contributed patient level data for four conditions/pathways: acute myocardial infarction, stroke, hip fracture and deliveries. The outcome variables in this study were a set of patient-reported experience measures including a generic 6-item measure of patient experience (NORPEQ), a 3-item measure of patient-perceived discharge preparation (Health Care Transition Measure) and two single item measures of perceived involvement in care and hospital recommendation. Predictor variables included three hospital management strategies: maturity of the hospital quality management system, patient involvement in quality management functions and patient-centered care strategies. We used directed acyclic graphs to detail and guide the modeling of the complex relationships between predictor variables and outcome variables, and fitted multivariable linear mixed models with random intercept by hospital, and adjusted for fixed effects at the country level, hospital level and patient level. Results Overall, 74 hospitals and 276 hospital departments contributed data on 6,536 patients to this study (acute
Using Negative Emotions to Trace the Experience of Borderline Personality Pathology: Interconnected Relationships Revealed in an Experience Sampling Study.
Law, Mary Kate; Fleeson, William; Arnold, Elizabeth Mayfield; Furr, R Michael
While emotional difficulties are highly implicated in borderline personality disorder (BPD), the dynamic relationships between emotions and BPD symptoms that occur in everyday life are unknown. The current paper examined the function of negative emotions as they relate to BPD symptoms in real time. Experience sampling methodology with 281 participants measured negative emotions and borderline symptoms, expressed as a spectrum of experiences, five times daily for two weeks. Overall, having a BDP diagnosis was associated with experiencing more negative emotions. Multilevel modeling supported positive concurrent relationships between negative emotions and BPD symptoms. Lagged models showed that even after 3 hours negative emotions and several symptoms continued to influence each other. Therefore, results indicated that negative emotions and BPD symptoms are intricately related; some evidenced long-lasting relationships. This research supports emotion-symptom contingencies within BPD and provides insight regarding the reactivity and functionality of negative emotions in borderline pathology. PMID:25710731
Using negative emotions to trace the experience of borderline personality pathology: Interconnected relationships revealed in an experience sampling study
Law, Mary Kate; Fleeson, William; Arnold, Elizabeth Mayfield; Furr, R. Michael
While emotional difficulties are highly implicated in borderline personality disorder (BPD), the dynamic relationships between emotions and BPD symptoms that occur in everyday life are unknown. The current paper examined the function of negative emotions as they relate to BPD symptoms in real time. Experience sampling methodology with 281 participants measured negative emotions and borderline symptoms, expressed as a spectrum of experiences, five times daily for two weeks. Overall, having a BDP diagnosis was associated with experiencing more negative emotions. Multilevel modeling supported positive concurrent relationships between negative emotions and BPD symptoms. Lagged models showed that even after three hours negative emotions and several symptoms continued to influence each other. Therefore, results indicated that negative emotions and BPD symptoms are intricately related; some evidenced long-lasting relationships. This research supports emotion-symptom contingencies within BPD and provides insight regarding the reactivity and functionality of negative emotions in borderline pathology. PMID:25710731
Personality traits and autobiographical memory: Openness is positively related to the experience and usage of recollections.
Rasmussen, Anne S; Berntsen, Dorthe
We examined the relationship between the Five-Factor Model of personality and the experience and overall usage of autobiographical memory in two studies. In both studies we found that Openness was related to the directive and self functions of overall usage. In addition, Openness was related to the vividness, reliving, coherence, and centrality of event to the person's identity and life story of concrete memories in Study 2, whereas this was not found in Study 1. For the remaining "Big Five" personality traits the results were less consistent across studies. Neuroticism was related to the self function in Study 1, but also to the directive function as well as to negative affect of concrete memories in Study 1. Extraversion was positively related to the social function as well as to conversational rehearsal of memories in Study 1, but this was also not replicated in Study 2. Finally, in both studies there were no significant relationships with regard to Agreeableness and Conscientiousness. Overall, the findings replicate and extend previous work showing a positive relationship between Openness and the experience and overall usage of autobiographical memory, whereas the roles for the remaining "Big Five" are less clear. PMID:20924950
Personality and complex brain networks: The role of openness to experience in default network efficiency.
Beaty, Roger E; Kaufman, Scott Barry; Benedek, Mathias; Jung, Rex E; Kenett, Yoed N; Jauk, Emanuel; Neubauer, Aljoscha C; Silvia, Paul J
The brain's default network (DN) has been a topic of considerable empirical interest. In fMRI research, DN activity is associated with spontaneous and self-generated cognition, such as mind-wandering, episodic memory retrieval, future thinking, mental simulation, theory of mind reasoning, and creative cognition. Despite large literatures on developmental and disease-related influences on the DN, surprisingly little is known about the factors that impact normal variation in DN functioning. Using structural equation modeling and graph theoretical analysis of resting-state fMRI data, we provide evidence that Openness to Experience-a normally distributed personality trait reflecting a tendency to engage in imaginative, creative, and abstract cognitive processes-underlies efficiency of information processing within the DN. Across two studies, Openness predicted the global efficiency of a functional network comprised of DN nodes and corresponding edges. In Study 2, Openness remained a robust predictor-even after controlling for intelligence, age, gender, and other personality variables-explaining 18% of the variance in DN functioning. These findings point to a biological basis of Openness to Experience, and suggest that normally distributed personality traits affect the intrinsic architecture of large-scale brain systems. Hum Brain Mapp 37:773-779, 2016. © 2015 Wiley Periodicals, Inc. PMID:26610181
Electrophysiological evidence of personal experiences in the great Sichuan earthquake impacting on selective attention.
Qiu, Jiang; Li, Hong; Zhang, QingLin; Huang, LiHui; Guo, YaQiao; Tu, Shen; Wang, Ting; Wei, DongTao
Event-related brain potentials (ERPs) were measured when 24 Chinese subjects performed the earthquake color-matching Stroop task. All of them have experienced the great Sichuan earthquake (5.12), with 12 subjects in each of Chengdu city and Chongqing city (different earthquake experiences) groups. The behavioral data showed that the earthquake Stroop task yielded robust the earthquake interference effect as indexed by longer RT for earthquake-related (Related) words than earthquake-unrelated (Unrelated) words only in the Chengdu group. Scalp ERP analysis also revealed the neurophysiological substrate of the interference effect: a greater positivity (P350-450) in Related words as compared to Unrelated words was found between 350 and 450 ms post-stimulus over fronto-central scalp regions in the Chengdu group, while the interference effect was not found in the Chongqing group. The P350-450 might reflect an earthquake experience interference, but also attention enhancing, effect of earthquake-related words. Dipole source analysis of the difference wave (Related-Unrelated) showed that a generator was localized in the parahippocampal gyrus, which was possibly associated with flashbulb memory (personal earthquake experience). The results indicated that different personal earthquake experiences might be critical in engaging the neural mechanisms that underlie the modulation of selective attention. PMID:19641874
Survival of breast cancer patients. Our experience.
Marrazzoa, Antonio; Taormina, Pietra; David, Massimo; Riili, Ignazio; Casà, Luigi; Catalano, Filippo; Lo Gerfo, Domenico; Noto, Antonio
Life expectancy for patients with breast carcinoma has changed in Europe over the last two decades. In Italy, the overall survival rate is about 77% at 5 years. When considering the situation in Sicily, the EUROCARE 2 study examined survival data from the Ragusa Cancer Registry, showing that the curves are worse than in other regions of Italy. Starting from these considerations we decide to evaluate whether these data from the Ragusa Cancer Registry corresponded to Palermo data. So we analysed data from 575 consecutive patients with breast cancer, treated in our Breast Unit from 1990 to 2003 according to the St. Gallen Recommendations and followed for a median period of 5 years. The prognostic role of age, tumour size, nodal status, TNM, stage, grading and hormonal receptors (OR, PR) were analysed and survival curves at 5 and 10 years were produced using the actuarial survival methods. All causes of death were considered. The median follow-up was 33 months. The Log rank test and univariate cox proportional model were used to demonstrate the association between prognostic factors and outcome. When considering T and N status, the curves showed an inverse correlation between survival and increases in these parameters. Overall survival was 92.9% at 5 years and 81.4% at 10 years for T1, 78.4% at 5 years and 61.4% at 10 years for T2 and 40.8% for T3-T4 at 5 and 10 years. Overall survival for NO was 92.1% and 78.2%, respectively, at 5 and 10 years, but decreased to 72.0% and 59.9% at 5 and 10 years for N1. In N2 patients we found that only about 50% of patients were still alive at 5 and 10 years, while for N3 patients the figures were 57.2% and 40%, respectively. PMID:17663369
Personal factors influencing patients' adherence to ART in Addis Ababa, Ethiopia.
Negash, Tefera; Ehlers, Valerie
Our study attempted to identify personal (patient-related) factors influencing antiretroviral therapy (ART) adherence in Addis Ababa, Ethiopia. A quantitative, descriptive design was used. Structured interviews were conducted with 355 HIV-infected patients on ART. The findings revealed that stigma, discrimination, depression, and alcohol use negatively affected patients' ART adherence levels. However, patients' knowledge levels had no influence on their ART adherence levels, contrary to other researchers' reports. Addressing stigma and discrimination at community levels might enhance patients' abilities to take their medications in the presence of others. Health care professionals should be educated to diagnose and treat depression in patients during the early stages of ART administration. Patients who are nonadherent to ART should be counseled about potential alcohol abuse. Stigma-related challenges also need to be addressed. PMID:23465401
The Effect of Attending Good Psychiatric Management (GPM) Workshops on Attitudes Toward Patients with Borderline Personality Disorder
Keuroghlian, Alex S.; Palmer, Brian A.; Choi-Kain, Lois W.; Borba, Christina P. C.; Links, Paul S.; Gunderson, John G.
The effect that attending a 1-day workshop on good psychiatric management (GPM) had on attitudes about borderline personality disorder (BPD) was assessed among 297 clinicians. Change was recorded by comparing before and after scores on a 9-item survey previously developed to assess the effects of workshops on Systems Training for Emotional Predictability and Problem Solving (STEPPS). Participants reported decreased inclination to avoid borderline patients, dislike of borderline patients, and belief that BPD's prognosis is hopeless, as well as increased feeling of competence, belief that borderline patients have low self-esteem, feeling of being able to make a positive difference, and belief that effective psychotherapies exist. Less clinical experience was related to an increased feeling of competence and belief that borderline patients have low self-esteem. These findings were compared to those from the STEPPS workshop. This assessment demonstrates GPM's potential for training clinicians to meet population-wide needs related to borderline personality disorder. PMID:26111249
A Quantitative Exploration of the Relationship between Patient Health and Electronic Personal Health Records
ERIC Educational Resources Information Center
Hines, Denise Williams
The use of electronic personal health records is becoming increasingly more popular as healthcare providers, healthcare and government leaders, and patients are seeking ways to improve healthcare quality and to decrease costs (Abrahamsen, 2007). This quantitative, descriptive correlational study examined the relationship between the degree of…
"Doing Ethics" in the Context of Sharing Patients' Personal Health Information
ERIC Educational Resources Information Center
Somerville, Margaret A.
There are at present two inconsistencies with respect to the sharing of personal health information (PHI) among health care professionals caring for a patient whom the information concerns. First, there is an inconsistency between what is in theory the ethics and law governing the confidentiality and privacy of this information--it may only be…
Relationship Between Patient SWAP-200 Personality Characteristics and Therapist-Rated Therapeutic Alliance Early in Treatment.
Smith, Scott W; Levy, Saryn R; Hilsenroth, Mark J; Fiori, Katherine; Bornstein, Robert F
In the present study, we assess the extent to which patient personality features and prototypes are associated with early treatment therapist-rated alliance. The study sample consisted of 94 patients receiving psychodynamic psychotherapy at an outpatient clinic. Clinicians completed the Working Alliance Inventory (J Couns Psychol 36:223-233; Psychother Res 9:405-423) to assess their views of early alliance and the Shedler-Westen Assessment Procedure 200 (SWAP-200; Assessment 5:333-353, Am J Psychiatry 161:1350-1365, 1743-1754; Am J Psychiatry 156:258-272, 273-285) to assess patient personality. The SWAP-200 Narcissistic Clinical Prototype, Dysphoric Q-Factor, and Dysphoric/High-Functioning Neurotic Q-Subfactor significantly correlated with early therapist-rated alliance. Correlations that trended toward significance were also found. Also identified were specific SWAP-200 items that were found to relate to high early therapist-rated alliance scores. These results demonstrate some relationship, albeit small, between patient personality characteristics and therapists' views of the alliance that may serve to further a conceptual understanding of the alliance, specific personality syndromes, and the associated impact on the therapeutic interaction. PMID:27176789
Affective temperaments and psychopathological dimensions of personality in bipolar and cyclothymic patients.
Harnic, Désirée; Pompili, Maurizio; Mazza, Marianna; Innamorati, Marco; Di Nicola, Marco; Catalano, Valeria; Bruschi, Angelo; Del Bono, Diletta; Forte, Alberto; Lester, David; Girardi, Paolo; Bria, Pietro; Janiri, Luigi
The aims of the study were: (1) to study possible associations between temperament, personality dimensions, and psychopathological variables in a clinical sample of euthymic patients with bipolar disorder (BD) and cyclothymia; and (2) to assess how Cloninger's temperament and personality dimensions were associated with affective temperaments. Participants, consisting of 60 patients with BD (type I or II) and cyclothymia in the euthymic phase, completed Akiskal's Temperament Evaluation of Memphis, Pisa, Paris, and San Diego-Autoquestionnaire (TEMPS-A), and Cloninger's Temperament and Character Inventory-revised version (TCI-R). The diagnostic groups differed in past hospitalization, for age at onset of the disorder, and on two affective temperaments: the TEMPS-A Hyperthymia, and the TEMPS-A Irritability. There were six significant associations between affective temperaments and Cloninger's personality dimensions, ranging from 0.26 to 0.54. The measures of Akiskal and of Cloninger tap common behavioral features in patients with bipolar disorder and cyclothymia, yet the differences indicate that the two measures are not redundant. BD and cyclothymic patients differed significantly in temperament and personality, differences that may have important implications for treatment. PMID:23398272
Living with Stigma: Depressed Elderly Persons' Experiences of Physical Health Problems
Holm, Anne Lise; Lyberg, Anne
The aim of this paper is to deepen the understanding of depressed elderly persons' lived experiences of physical health problems. Individual in-depth interviews were conducted with 15 depressed elderly persons who suffer from physical health problems. A hermeneutic analysis was performed, yielding one main theme, living with stigma, and three themes: longing to be taken seriously, being uncertain about whether the pain is physical or mental, and a sense of living in a war zone. The second theme comprised two subthemes, feeling like a stranger and feeling dizzy, while the third had one subtheme: afraid of being helpless and dependent on others. Stigma deprives individuals of their dignity and reinforces destructive patterns of isolation and hopelessness. Nurses should provide information in a sensitive way and try to avoid diagnostic overshadowing. Effective training programmes and procedures need to be developed with more focus on how to handle depressive ill health and physical problems in older people. PMID:25013728
Anticipated emotions and personal experience for predicting behavioral intentions and behavioral expectations.
Carrera, Pilar; Caballero, Amparo; Muñoz, Dolores; Oceja, Luis
We tested how anticipated emotions interact with personal experience in risk behavior to improve predictions from TPB on behavioral intention (BI) and behavioral expectation (BE) for sex without condom (Study 1) and excessive drinking (Study 2). In the moderate-high experience group, anticipated emotional profiles (AEPs) improve TPB prediction from 28% to 45% in the case of BI and from 19% to 40% in that of BE in relation to sexual risk behavior (Study 1), and from 23% to 36% in the case of BI and from 17% to 31% in that of BE in relation to binge drinking (Study 2). However, in the low-experience group (Study 2) AEPs improve TPB predictions for BI (12% to 34%) but not for BE, showing that in less experienced people BI and BE are not equivalent: anticipated emotions have different relevance in their prediction. These results were replicated using a general negative anticipated emotion index (averaging emotional categories). PMID:22059300
Personality traits in established schizophrenia: aspects of usability and differences between patients and controls using the Swedish universities Scales of Personality
Fagerberg, Tomas; Söderman, Erik; Gustavsson, J. Petter; Agartz, Ingrid; Jönsson, Erik G.
Abstract Background: Personality is considered as an important aspect that can affect symptoms and social function in persons with schizophrenia. The personality questionnaire Swedish universities Scales of Personality (SSP) has not previously been used in psychotic disorder. Aims: To investigate if SSP has a similar internal consistency and factor structure in a psychosis population as among healthy controls and if patients with psychotic disorders differ from non-psychotic individuals in their responses to the SSP. Methods: Patients with psychotic disorders (n = 107) and healthy controls (n = 119) completed SSP. SSP scores were analyzed for internal consistency and case-control differences by Cronbach's alfa and multiple analysis of covariance, respectively. Results: Internal consistencies among patients were overall similar to that of controls. The patients scored significantly higher in seven (Somatic trait anxiety, Psychic trait anxiety, Stress susceptibility, Lack of assertiveness, Detachment, Embitterment, Mistrust) and lower in three (Physical trait aggression, Verbal trait aggression, Adventure seeking) of the 13 scales of the inventory. In three scales (Impulsiveness, Social desirability and Trait irritability) there was no significant difference between the scoring of patients and healthy controls. Conclusion: The reliability estimates suggest that SSP can be used by patients with psychotic disorders in stable remission. Patients score higher on neuroticism-related scales and lower on aggression-related scales than controls, which is in accordance with earlier studies where other personality inventories were used. PMID:27103375
Non surgical laser and light in the treatment of chronic diseases: a review based on personal experiences
NASA Astrophysics Data System (ADS)
Longo, L.
Since many years some effects of non surgical laser and light on biological tissue have been demonstrated, in vitro and in vivo. This review is based on the results obtained by me and my colleagues/follower in Italy. Aim of our study is to verify the anti-inflammatory and regenerative effects of non surgical laser and light therapy on patients with chronic diseases not good treatable with traditional therapies, as diabetes, and central nervous system injuries. In addition, many clinical data have emerged from double-blind trials on laser treatment of rheumatic diseases and in sports medicine. So, we would like to do a review on the state of the art of non surgical laser treatment in medicine, included aesthetic laser and light therapy field. We discuss the indications and limitations of aesthetic laser medicine, as concluded from the data analysis of the published literature and from over thirty years of personal experiences.
Out-of-Hospital Endotracheal Intubation Experience and Patient Outcomes
Wang, Henry E.; Balasubramani, G. K.; Cook, Lawrence J.; Lave, Judith R.; Yealy, Donald M.
Study objective Previous studies suggest improved patient outcomes for providers who perform high volumes of complex medical procedures. Out-of-hospital tracheal intubation is a difficult procedure. We seek to determine the association between rescuer procedural experience and patient survival after out-of-hospital tracheal intubation. Methods We analyzed probabilistically linked Pennsylvania statewide emergency medicine services, hospital discharge, and death data of patients receiving out-of-hospital tracheal intubation. We defined tracheal intubation experience as cumulative tracheal intubation during 2000 to 2005; low=1 to 10 tracheal intubations, medium=11 to 25 tracheal intubations, high=26 to 50 tracheal intubations, and very high=greater than 50 tracheal intubations. We identified survival on hospital discharge of patients intubated during 2003 to 2005. Using generalized estimating equations, we evaluated the association between patient survival and out-of-hospital rescuer cumulative tracheal intubation experience, adjusted for clinical covariates. Results During 2003 to 2005, 4,846 rescuers performed tracheal intubation. These individuals performed tracheal intubation on 33,117 patients during 2003 to 2005 and 62,586 patients during 2000 to 2005. Among 21,753 cardiac arrests, adjusted odds of survival was higher for patients intubated by rescuers with very high tracheal intubation experience; adjusted odds ratio (OR) versus low tracheal intubation experience: very high 1.48 (95% confidence interval [CI] 1.15 to 1.89), high 1.13 (95% CI 0.98 to 1.31), and medium 1.02 (95% CI 0.91 to 1.15). Among 8,162 medical nonarrests, adjusted odds of survival were higher for patients intubated by rescuers with high and very high tracheal intubation experience; adjusted OR versus low tracheal intubation experience: very high 1.55 (95% CI 1.08 to 2.22), high 1.29 (95% CI 1.04 to 1.59), and medium 1.16 (95% CI 0.97 to 1.38). Among 3,202 trauma nonarrests, survival was not
Experiences of care by Australians with a diagnosis of borderline personality disorder
McMahon, J.
Accessible summary Borderline personality disorder (BPD) is a complex and challenging mental health condition for the person and service providers who support them.This paper reports on the results of a survey of 153 people with a diagnosis of BPD about their experiences of attempting to receive support in managing this mental health condition. It provides their perceptions of a range of experiences not reported in the existing literature, including general practitioner roles, urban and rural differences, public and private hospital differences, and comparison of usefulness of support across multiple support types.People with a diagnosis of BPD continue to experience significant discrimination when attempting to get their needs met within both public and private health services. Further education for nurses and other health professionals is indicated to address pervasive negative attitudes towards people with a diagnosis of BPD. Abstract There is limited understanding of the experience of seeking and receiving treatment and care by people with a diagnosis of borderline personality disorder (BPD), their perceptions of barriers to care and the quality of services they receive. This study aimed to explore these experiences from the perspective of Australians with this diagnosis. An invitation to participate in an online survey was distributed across multiple consumer and carer organizations and mental health services, by the Private Mental Health Consumer Carer Network (Australia) in 2011. Responses from 153 people with a diagnosis of BPD showed that they experience significant challenges and discrimination when attempting to get their needs met within both public and private health services, including general practice. Seeking help from hospital emergency departments during crises was particularly challenging. Metropolitan and rural differences, and gender differences, were also apparent. Community supports were perceived as inadequate to meet their needs. This study
Patient Activation and Mental Health Care Experiences Among Women Veterans.
Kimerling, Rachel; Pavao, Joanne; Wong, Ava
We utilized a nationally representative survey of women veteran primary care users to examine associations between patient activation and mental health care experiences. A dose-response relationship was observed, with odds of high quality ratings significantly greater at each successive level of patient activation. Higher activation levels were also significantly associated with preference concordant care for gender-related preferences (use of female providers, women-only settings, and women-only groups as often as desired). Results add to the growing literature documenting better health care experiences among more activated patients, and suggest that patient activation may play an important role in promoting engagement with mental health care. PMID:25917224
Patient Activation and Mental Health Care Experiences Among Women Veterans
Pavao, Joanne; Wong, Ava
We utilized a nationally representative survey of women veteran primary care users to examine associations between patient activation and mental health care experiences. A dose–response relationship was observed, with odds of high quality ratings significantly greater at each successive level of patient activation. Higher activation levels were also significantly associated with preference concordant care for gender-related preferences (use of female providers, women-only settings, and women-only groups as often as desired). Results add to the growing literature documenting better health care experiences among more activated patients, and suggest that patient activation may play an important role in promoting engagement with mental health care. PMID:25917224
Adverse Childhood Experiences and Suicide Attempts: The Mediating Influence of Personality Development and Problem Behaviors.
Perez, Nicholas M; Jennings, Wesley G; Piquero, Alex R; Baglivio, Michael T
Adverse childhood experiences, comprised of forms of maltreatment and certain dysfunctional household environments, can affect the development of a child in a variety of different ways. This multitude of developmental changes may subsequently produce compounding harmful effects on the child's life and increase acutely maladaptive outcomes, including adolescent suicidal behavior. This study uses data collected from 2007 to 2012 for 64,329 Florida Department of Juvenile Justice youth (21.67 % female, 42.88 % African American, and 15.37 % Hispanic) to examine the direct and indirect effects of adverse childhood experiences on suicide attempts. Using a generalized structural equation model, the effects of adverse childhood experience scores are estimated on suicidal behavior through pathways of certain aspects of a child's personality development (aggression and impulsivity), as well as adolescent problem behaviors (school difficulties and substance abuse). The results show that a large proportion of the relationship between childhood adversity and suicide is mediated by the aforementioned individual characteristics, specifically through the youth's maladaptive personality development. These results suggest that, if identified early enough, the developmental issues for these youth could potentially be addressed in order to thwart potential suicidal behavior. PMID:27289554
How to Get Better Care with Lower Costs? See the Person, Not the Patient.
Westphal, Erin C; Alkema, Gretchen; Seidel, Rene; Chernof, Bruce
The U.S. health system perceives people as "patients" almost exclusively as they enter and exit the healthcare system, but with this emphasis on context, have we lost sight of the people who should be in the foreground of care? Does such a view impede care effectiveness and efficiency? How can we shift our frame of reference moving forward? To foster this needed conceptual shift, a group of national thought-leaders convened by the American Geriatrics Society (AGS) defined "person-centered care" to reorient the perspective toward individuals remaining in the center of pursuing high-quality care. This article explores how a person-centered care approach can improve healthcare effectiveness and efficiency, particularly for older adults with heightened health and daily living needs, and healthcare costs. The process for supporting a person-centered program is outlined, three critical indicators that define person-centered quality are highlighted, and several models that embrace the person-centered paradigm are briefly noted. Although there is no one-size-fits-all schematic, how and why overall success entails fidelity to essential elements of person-centered programs as the AGS expert panel identified is explained. PMID:26639104
Personality change as defensive responses of patients evaluated for liver transplant.
Bonaguidi, F; Giovanna Trivella, M; Michelassi, C; Filipponi, F; Mosca, F; L'Abbate, A
Patients affected by endstage liver disease and awaiting liver transplant suffer very stressful conditions. The aim of this study was to evaluate the person ality and behavioral responses of a group of liver transplant candidates, 95 men (M age 50 yr.) and of a group of 18 normal men (M age 49 yr.). The 16 Personality Factor Questionnaire of Cattell, and the PSY Inventory for Behavioral Assessment were administered to assess personality and behavior. On the 16PF Questionnaire, patients had significantly different mean scores from normal subjects on Scale B- (low mental capacity), G (conformity), N (shrewdness), and Q1- (conservatism). They also showed a somewhat lower but not a statistically significant mean on Scale E (submissiveness). In addition, on the four second-order factors of the 16PF (Anxiety, Control, Pathemia, and Extraversion) patients had a significantly higher mean on Control. With respect to PSY Inventors factors, patients showed impairment in energy, sleep, sexual disturbances, and obsessive behaviors. It appears these patients with endstage liver disease, who were evaluated for liver transplant, showed psychological regressive functioning, i.e., high control and dependency on medical staff, submissiveness, which are interpretable as defensive responses to upcoming transplant. PMID:11597078
Personalized disclosure by information-on-demand: attending to patients' needs in the informed consent process.
Siegal, Gil; Bonnie, Richard J; Appelbaum, Paul S
Obtaining informed consent has typically become a stylized ritual of presenting and signing a form, in which physicians are acting defensively and patients lack control over the content and flow of information. This leaves patients at risk both for being under-informed relative to their decisional needs and of receiving more information than they need or desire. By personalizing the process of seeking and receiving information and allowing patients to specify their desire for information in a prospective manner, we aim to shift genuine control over the informational process to patients. A new paradigm of Information on Demand, such as we suggest, would also enhance legal certainty, achieve greater congruence between the information patients want and the information they receive, and promote more meaningful patient-physician interactions, a desirable outcome that has been difficult to achieve by other means. PMID:22789051
Stability of personality traits in patients who received intensive treatment for a severe eating disorder.
Bloks, Hans; Hoek, Hans Wijbrand; Callewaert, Ineke; van Furth, Eric
A longitudinal prospective design with four assessments was used to examine the stability of personality traits and their relation to recovery in patients with restrictive anorexia nervosa (N=35), bingeing/purging anorexia nervosa (N=37), bulimia nervosa (N=47), and eating disorder not otherwise specified (N=27). Recovery is associated with changes in personality traits in the direction of healthy control women. Recovered patients still show higher harm avoidance and higher persistence than healthy control women. These temperament factors seem to be a vulnerability factor for developing an eating disorder. Novelty seeking seems to define the type of eating disorder one is prone to develop. The character dimensions contribute the most to recovery. High self-directedness contributes to a favorable prognosis of bulimic symptomatology, whereas high cooperativeness contributes to an unfavorable prognosis in patients with anorexia nervosa. PMID:14770057
Personality and the physician-patient relationship as predictors of quality of life of cardiac patients after rehabilitation
Background Numerous studies document the influence of psychosocial variables on the course of coronary heart disease. This study examines the influence of personality traits (trait anger, cynicism) and aspects of the physician-patient relationship (promoting patient participation by the physician, active communication behavior of the patient, trust in the physician) on the health related quality of life (HRQOL) of cardiac patients after rehabilitation. Methods N = 331 patients with chronic ischemic heart disease were surveyed using questionnaires at two time points (beginning and end of 3-weeks inpatient rehabilitation). In addition, characteristics of the disease and cardiac risk factors were provided by the physician. HRQOL was measured using a total of six scales and three instruments: SF-12, MacNew questionnaire, and SAQ. Hierarchical regression analyses were carried out to predict HRQOL after rehabilitation, in which the baseline values of HRQOL, sociodemographic variables, characteristics of the disease and risk factors, personality traits, and finally the aspects of the physician-patient relationship were included stepwise. As a number of variables were used for the regression models, multiple imputation was conducted. Results The baseline values explain most of the variance (42%-60%). After controlling the baseline values, the sociodemographic variables explain up to 5% incremental variance of HRQOL, with income being the most important predictor. The characteristics of the disease and cardiac risk factors explain between 0.4% and 3.8% incremental variance, however, variance increase is often not significant. The personality traits added in the fourth step explain up to 2% additional variance; trait anger is a significant predictor of HRQOL in three of the six scales. The features of the physician-patient relationship included in the last step lead to a significant increase in explained variance (between 1.3% and 3.9%) for all six scales. In particular, the
A model of time-effective group psychotherapy for patients with personality disorders: the clinical model.
Budman, S H; Cooley, S; Demby, A; Koppenaal, G; Koslof, J; Powers, T
This article describes a model of time-limited psychotherapy for patients with personality disorders that emphasizes the group as a social microcosm. The patient population described is relatively high functioning, although the majority of the group members meet DSM-III-R (American Psychiatric Association, 1987) criteria for an Axis II diagnosis. The clinical model's key theoretical concepts, for example, interpersonal focus; active therapist stance; emphasis on group interaction and processes; use of time limits; primary care/intermittent treatment philosophy; and emphasis on patients' strengths, goals, and resources are described. The relationships between the phases of group therapy and the key theoretical concepts are delineated. PMID:8753151
Personality Impact on Experiences of Strain among Staff Exposed to Violence in Care of People with Intellectual Disabilities
ERIC Educational Resources Information Center
Lundstrom, Mats; Graneheim, Ulla H.; Eisemann, Martin; Richter, Jorg; Astrom, Sture
Explored are the relationships among personality and emotional reactions, work-related strain, and experiences of burnout among staff exposed vs. not exposed to violence when caring for people with intellectual disabilities (ID). Questionnaires measuring personality, emotional reactions, strain and burnout, and exposure to violence were…
The Role of Positive Personality Traits in Emotion Regulation of Patients with Irritable Bowel Syndrome (IBS)
MAZAHERI, Mina; NIKNESHAN, Shekoufeh; DAGHAGHZADEH, Hamed; AFSHAR, Hamid
Background: Personality traits and emotion regulation processes play an important role in human health. The purpose of this study was to investigate the role of positive personality traits (psychological hardiness and interpersonal forgiveness) in emotion regulation of patients with Irritable Bowel Syndrome. Methods: The research was a cross-sectional study. Statistical population included all of IBS patients referred to the Subspecialty Center of Psychiatry in Isfahan in 2013. Overall, 123 subjects (100 women, 83.3%, and 30 men, 16.7%) were selected by census method, according to criteria of research and during a particular period. To collect data, the Difficulties in Emotion Regulation Scale (DERS), Lang and Goulet Hardiness Scale (LGHS) and Interpersonal forgiveness Inventory (IFI) were used. Data was analyzed using Pearson's correlation coefficient and Multivariate and Binary Logistic regression analyses. Results: Mean age of patients was 33.82±10.45 years and 83.3% (100) of them were female. Regression analyses showed that both personality traits of hardiness and forgiveness were as protective factors for emotional dysregulation with OR, 95% CI: 0.93 and 0.96 sequentially, with adjusting demographic variables (age, gender, and education level and disease duration). Conclusion: Patients who are more hardy and forgiving toward others, are likely more successful at adaptive emotion regulation. It emphasizes the positive and beneficial role of the personality traits in regulating of emotional problems of IBS patients. Hence, these variables should be considered as effective factors in the treatment process of the patients. PMID:26056675
Biomedical practices from a patient perspective. Experiences of Polish female migrants in Barcelona, Berlin and London.
Main, Izabella
This paper focuses on the diversity in patients' experience of bio-medicine and contrasts it with the normative view characteristic of health professionals. Ethnographic fieldwork among Polish migrant women in London, Barcelona and Berlin included interviews about their experiences with local healthcare and health professionals. Themes drawn from the narratives are differences between the cities in terms of communication between patients and health professionals, respect for patients' choices and dignity, attitudes to pregnancy and birth (different levels of medicalization), and paediatric care. It is argued that patients continuously negotiate among their own views and expectations based on previous experiences and knowledge from personal communication; internet forums and publications; and the offer of medical services in the countries of their settlement. Patients experience pluralism of therapeutic traditions within and outside bio-medicine. In turn, representatives of bio-medicine are rarely aware of other medical practices and beliefs and this leads to various misunderstandings. By highlighting the pluralism of medical practices in European countries and the increasing mobility of patients, this case study has useful implications for medical anthropologists and health professionals in a broader Western context, such as raising sensitivity to different communication strategies and a diversity of curing traditions and expectations. PMID:27258327
The Experience of Being at Home throughout the Life Span. Investigation of Persons Aged from 2 to 102.
ERIC Educational Resources Information Center
Zingmark, Karin; And Others
Examined experience of 150 persons related to the phenomenon "being at home." Common aspects identified entailed cognitive, emotional, and conative dimensions. The sense of being related was a common experience, that is, related to significant others, things, places, and activities. A progression in the experience throughout the life span was…
Personality and complex brain networks: The role of openness to experience in default network efficiency
Kaufman, Scott Barry; Benedek, Mathias; Jung, Rex E.; Kenett, Yoed N.; Jauk, Emanuel; Neubauer, Aljoscha C.; Silvia, Paul J.
Abstract The brain's default network (DN) has been a topic of considerable empirical interest. In fMRI research, DN activity is associated with spontaneous and self‐generated cognition, such as mind‐wandering, episodic memory retrieval, future thinking, mental simulation, theory of mind reasoning, and creative cognition. Despite large literatures on developmental and disease‐related influences on the DN, surprisingly little is known about the factors that impact normal variation in DN functioning. Using structural equation modeling and graph theoretical analysis of resting‐state fMRI data, we provide evidence that Openness to Experience—a normally distributed personality trait reflecting a tendency to engage in imaginative, creative, and abstract cognitive processes—underlies efficiency of information processing within the DN. Across two studies, Openness predicted the global efficiency of a functional network comprised of DN nodes and corresponding edges. In Study 2, Openness remained a robust predictor—even after controlling for intelligence, age, gender, and other personality variables—explaining 18% of the variance in DN functioning. These findings point to a biological basis of Openness to Experience, and suggest that normally distributed personality traits affect the intrinsic architecture of large‐scale brain systems. Hum Brain Mapp 37:773–779, 2016. © 2015 Wiley Periodicals, Inc. PMID:26610181
Heart rate variability in patients with post-traumatic stress disorder or borderline personality disorder: relationship to early life maltreatment.
Meyer, Peter-Wolfgang; Müller, Laura E; Zastrow, Arne; Schmidinger, Ilinca; Bohus, Martin; Herpertz, Sabine C; Bertsch, Katja
Traumatic experiences have severe impact on the autonomous nervous system. Heart rate variability (HRV) is a reliable psychophysiological marker for the autonomous nervous system functioning. Reduced vagally mediated HRV has been found in patients with post-traumatic stress disorder (PTSD) and, in some studies, in patients with borderline personality disorder (BPD). In this study, we compared HRV parameters of patients with PTSD, current BPD, and BPD in remission with healthy volunteers in a 5 min resting-state electrocardiogram recording. 91 unmedicated female participants took part in the study (18 with PTSD, 27 with the current BPD, 23 with BPD in remission, and 23 healthy volunteers). We found significant group differences in both time-domain and frequency-domain (total power, low-frequency and high-frequency power) HRV parameters. Root mean square of the successive differences (RMSSD) was lowest in patients with PTSD (M = 48.6 ms, SD = 23.5 ms) followed by patients with BPD in remission (M = 57.7 ms, SD = 31.5 ms) and patients with the current BPD (M = 71.1 ms, SD = 44.5 ms), while the highest RMSSD was found in healthy volunteers (M = 84.1 ms, SD = 41.7 ms). Variance of HRV was higher in patients with BPD than in patients with PTSD. In addition, RMSSD was significantly negatively correlated with self-reported early life maltreatment assessed with the Childhood Trauma Questionnaire. Our findings point out a complex interaction between traumatic experiences, the functioning of the autonomic nervous system, and psychopathology. Alterations in HRV might be related to early life maltreatment or associated psychological factors rather than diagnostic entities. PMID:27311838
Relationship between Personality Profiles and Suicide Attempt via Medicine Poisoning among Hospitalized Patients: A Case-Control Study
Shafiee-Kandjani, Ali Reza; Amiri, Shahrokh; Arfaie, Asghar; Ahmadi, Azadeh; Farvareshi, Mahmoud
Objectives. Inflexible personality traits play an important role in the development of maladaptive behaviors among patients who attempt suicide. This study was conducted to investigate the relationship between personality profiles and suicide attempt via medicine poisoning among the patients hospitalized in a public hospital. Materials and Methods. Fifty-nine patients who attempted suicide for the first time and hospitalized in the poisoning ward were selected as the experimental group. Sixty-three patients hospitalized in the other wards for a variety of reasons were selected as the adjusted control group. Millon Clinical Multiaxial Personality Inventory, 3rd version (MCMI-III) was used to assess the personality profiles. Results. The majority of the suicide attempters were low-level graduates (67.8% versus 47.1%, OR = 2.36). 79.7% of the suicide attempters were suffering from at least one maladaptive personality profile. The most common maladaptive personality profiles among the suicide attempters were depressive personality disorder (40.7%) and histrionic personality disorder (32.2%). Among the syndromes the most common ones were anxiety clinical syndrome (23.7%) and major depression (23.7%). Conclusion. Major depression clinical syndrome, histrionic personality disorder, anxiety clinical syndrome, and depressive personality disorder are among the predicators of first suicide attempts for the patients hospitalized in the public hospital due to the medicine poisoning. PMID:27433491
The personality and quality of life in HNSCC patients following treatment.
Aarstad, H J; Aarstad, A K H; Birkhaug, E J; Bru, E; Olofsson, J
The aim of the present study was to investigate the association between self-reported quality of life (QoL) and personality in successfully treated primary head and neck squamous cell carcinoma (HNSCC) patients. We determined QoL using the European Organisation for Research and Treatment of Cancer Quality of life Questionnaire (EORTC-QLQ) C30/H and N35, and personality by the Eysenck Personality Inventory (EPI). All patients younger than 80 years who had been diagnosed with HNSCC in Western Norway in the period from 1992 to 1997, and who had survived until 1999, were sampled. 96 patients (a 90% response rate) were included. Questionnaires were also mailed to all Norwegian laryngectomised patients; 104 patients returned the questionnaires (a 50% response rate). The neuroticism scores were test re-test reliable as determined by the neuroticism scores measured at the primary HNSCC diagnosis for a sub-sample (N=22) of the included patients. High neuroticism was associated with a low QoL in both patient samples. The neuroticism score was associated with the QLQ-C30 scales (common variance: 17-25%) and all QoL scores in the laryngectomised group (common variance: 11-25%), and the H and N35 symptom scores in the laryngectomised sample. The associations could still be shown when adjustments were made for gender, age, marital status, educational level, number of children and level of treatment. Extraversion was associated with general QoL, physical and emotional scores in the HNSCC patient sample. Radiation therapy in the HNSCC sample was associated with the H and N35 symptom scores, but different ones to those associated with neuroticism. In conclusion, high neuroticism, but not extraversion, is associated with a lowered QoL. PMID:12932662
Effect of disease duration on personality type in multiple sclerosis patients and healthy individual
Vesal, Sahar; Dehghani, Leila; Etemadifar, Masoud; Poorazizi, Elahe; Akhavan, Sima; Mazrouei, Samaneh; Mehdizadeh, Nasim; Saraf, Zahra
Background: Multiple sclerosis may have profound emotional consequences. The relation between psychological and physical factors could lead patients toward unforeseen disease. This study focuses on multiple sclerosis (MS) disease duration on personality type A and B in relation to individuals' behaviors. Materials and Methods: This descriptive-analytical study was conducted in Isfahan Alzahra hospital in 2013. Three hundred MS patients and 100 healthy individuals were determined. The distributed questionnaires related to MS patients and considering the descriptive statistics such as demographic variables. Data were analyzed by SPSS software (version 18) based on Chi-square test and independent T-test. Results: Disease duration varied between 1 to 38 years: 30% (1-4 years), 38% (5-10 years), 20% (10-20 years), and 12% (more than 20 years). Significant relationship was observed between disease duration and tendency to type A (higher stress). This relation was positive and significant in Relapsing Remitting MS patients; but negative correlation was seen in Secondary Progressive MS patients. These patients tended to type B (lower stress) when disease duration increased. Conclusions: Individuals with disease duration of one year and less than one year tend to type A personality, while patients with increment of disease duration have tendency to type B. PMID:27099848
Great patient experiences can earn big payer bonuses.
Luallin, Meryl D
Although many healthcare providers have been railing against the stringent new requirements of the Affordable Care Act and the burdensome mandates from the Centers for Medicare & Medicaid Services, making simple improvements in patient satisfaction can require little to no expense and can result in increased dollars, as well as more satisfied patients. By following six simple steps, successful organizations have been able to transform their patients' experiences and raise satisfaction scores through a series of practical activities designed to assess the current environment, improve patient and employee/provider experience, and maintain the improvement gains. It doesn't always take money to make money. It's a matter of telling employees what the organization expects of them and holding them accountable. When the patient has a positive experience, everyone profits! PMID:25807613
The Experience of Peer Mentors in an Intervention to Promote Smoking Cessation in Persons with Psychiatric Illness.
Dickerson, Faith; Savage, Christina L G; Schweinfurth, Lucy A B; Goldberg, Richard W; Bennett, Melanie; Dixon, Lisa; Daumit, Gail; Chinman, Matthew; Lucksted, Alicia
Peer support is an important component of services for persons with psychiatric illness but the experience of peer mentors is not well understood. This study explored the experiences of peer mentors, all former smokers and persons with psychiatric illness, who provided smoking cessation counseling as part of a 6 month professionally-led intervention. Data was obtained from 383 contact log entries and in-depth interviews with eight peer mentors. Qualitative analysis indicated that mentor roles were unexpectedly varied beyond the focus on smoking cessation. Of the two aspects of "peer-ness," shared smoking history was more prominent, while the shared experience of psychiatric illness was sometimes overlooked. Peer mentors experienced multiple challenges trying to help participants to change their smoking behaviors. Nonetheless, they described their experience as personally rewarding. Future interventions may be improved by anticipating peer mentor role complexity and the inherent tension between providing person-centered support and promoting behavior change. PMID:26602772
Memorable Experiences in Therapeutic Assessment: Inviting the Patient's Perspective Following a Pretreatment Randomized Controlled Trial.
De Saeger, Hilde; Bartak, Anna; Eder, Eva-Emily; Kamphuis, Jan H
Accumulating evidence documents the efficacy of Therapeutic Assessment (TA) in terms of symptom reduction and other outcomes, but only minimal data speak to the patient's perspective of what is memorable, or potentially important, about this intervention. In line with the humanistic and phenomenological philosophy of TA, we solicited patient input by asking personality disorder (PD) patients who participated in a recent randomized controlled trial (De Saeger et al., 2014 ) about their experiences. We report on 10 PD patients who were administered semistructured interviews designed to assess an in-depth perspective of undergoing TA. Our methodological approach can be described as phenomenological and integrative, approximating guidelines provided by the Consensual Qualitative Research paradigm (Hill, 2012 ). Four core content domains emerged from the transcribed and coded interview protocols: (a) relationship aspects, (b) new insight into personal dynamics, (c) sense of empowerment, and (d) validation of self. Novel experiences were mostly of a relational nature, and pertained to feeling of being treated like an equal and essential partner in a highly individualized venture. Research and clinical implications of these patient reports of TA participation are discussed. PMID:26829376
[Effect of recognition of head and neck malignancies on patients' psychosomatic condition and personality].
Yamagiwa, M; Sakakura, Y; Ukai, K; Majima, Y; Hamaguchi, Y; Harada, T; Kubo, M
In order to elucidate the effect of recognition of head and neck malignancies on patients' psychosomatic condition and personality, we applied the Cornell Medical Index Health Questionnaire (CMI) and the Maudsley Personality Inventory (MPI) and collected medical and psychological data from 35 male (42-78 years of age; average 62.5) and 15 female (20-76 years of age; average 54.7) patients with malignant head and neck tumors (10 nose and paranasal, 8 oral, 8 pharyngeal, 14 laryngeal, 6 thyroid gland and 4 others). The two tests were done twice for each patients; at first immediately before hospitalization for treatment of the tumors at Mie University Hospital and secondly just before discharge from the hospital. The period of hospitalization ranged 1 to 13 months, average 3.3 months. At the end of hospitalization doctors and nurses who had mainly taken care of the patients estimated the patients' recognition of their malignancy by analyzing behavior and information mainly from their family and classified patients into three groups; Group R (Patients who recognized that they were patients with head and neck malignancies) comprised 22 patients, Group N (who did not recognize the condition) comprised 15 and Group U (who could not be classified into Groups R or N) comprised 13. Comparison among the three groups revealed the followings. 1) Patients in Group R were relatively young (average 56.3 years) and extrovert (estimated by MPI) and their somatic and psychological complaints registered on the CMI were less than those in other 2 groups. Psychosomatic condition after recognition that they had been patients with malignant tumors was better than before.(ABSTRACT TRUNCATED AT 250 WORDS) PMID:1744792
Experiences and perspectives on the GIST patient journey
Macdonald, Nancy; Shapiro, Ari; Bender, Christina; Paolantonio, Marc; Coombs, John
Purpose The tyrosine kinase inhibitor (TKI) imatinib has improved outcomes for patients with unresectable or metastatic gastrointestinal stromal tumors (GIST), and for patients receiving adjuvant therapy following GIST resection. This qualitative study explored the experiences and emotions of patients through GIST diagnosis, treatment initiation, disease control, and in some patients, loss of response and therapy switch. Patients and methods Ethnographic investigations were conducted, including semi- structured qualitative interviews of patients with resected or metastatic/unresectable GIST and their caregivers, from Canada (n = 15); the United States (n = 10); and Brazil, France, Germany, Russia, and Spain (n = 5 each). Some interviewees also kept 7-day photo journals. Responses were qualitatively analyzed to identify gaps and unmet needs where communication about disease, treatments, and adherence could be effective. Results Patients shared common experiences during each stage of disease management (crisis, hope, adaptation, new normal, and uncertainty). Patients felt a sense of crisis during diagnosis, followed by hope upon TKI therapy initiation. Over time, they came to adapt to their new lives (new normal) with cancer. With each follow-up, patients confronted the uncertainty of becoming TKI resistant and the possible need to switch therapy. During uncertainty many patients sought new information regarding GIST. Cases of disease progression and drug switching caused patients to revert to crisis and restart their emotional journey. Patients with primary or unresectable/metastatic GIST shared similar journeys, especially regarding uncertainty, although differences in the scope and timing of phases were observed. Strategies patients used to remain adherent included obtaining family support, setting reminder mechanisms, taking medicine at routine times, and storing medicine in prominent places. Conclusions Physicians and support staff can manage patient
Anticipating posttraumatic growth from cancer: patients' and collaterals' experiences.
Tallman, Benjamin A; Lohnberg, Jessica; Yamada, Torricia H; Halfdanarson, Thorvardur R; Altmaier, Elizabeth M
Posttraumatic growth has been demonstrated to occur following the diagnosis and treatment of cancer. Still unknown is whether patients expect such growth, how growth is perceived at early points in time that follow the cancer experience, and whether patient reports of growth are corroborated by others. Participants were 87 patients and 55 collaterals who reported their anticipation of growth pretreatment and their perceived growth at a 9-month follow-up. Patients' expectations for their own growth were significantly higher than collaterals' expectations for theirs. When anticipated growth was compared to later reported growth, patients overanticipated growth across all domains and collaterals underanticipated growth. PMID:24611890
Safety vs. privacy: elderly persons' experiences of a mobile safety alarm.
Melander-Wikman, Anita; Fältholm, Ylva; Gard, Gunvor
The demographic development indicates an increased elderly population in Sweden in the future. One of the greatest challenges for a society with an ageing population is to provide high-quality health and social care. New information and communication technology and services can be used to further improve health care. To enable elderly persons to stay at home as long as possible, various kinds of technology, such as safety alarms, are used at home. The aim of this study was to describe the experiences of elderly persons through testing a mobile safety alarm and their reasoning about safety, privacy and mobility. The mobile safety alarm tested was a prototype in development. Five elderly persons with functional limitations and four healthy elderly persons from a pensioner's organisation tested the alarm. The mobile alarm with a drop sensor and a positioning device was tested for 6 weeks. This intervention was evaluated with qualitative interviews, and analysed with latent content analysis. The result showed four main categories: feeling safe, being positioned and supervised, being mobile, and reflecting on new technology. From these categories, the overarching category 'Safety and mobility are more important than privacy' emerged. The mobile safety alarm was perceived to offer an increased opportunity for mobility in terms of being more active and as an aid for self-determination. The fact that the informants were located by means of the positioning device was not experienced as violating privacy as long as they could decide how to use the alarm. It was concluded that this mobile safety alarm was experienced as a tool to be active and mobile. As a way to keep self-determination and empowerment, the individual has to make a 'cost-benefit' analysis where privacy is sacrificed to the benefit of mobility and safety. The participants were actively contributing to the development process. PMID:18613909
Personality changes and the role of counseling in the rehabilitation of patients with laryngeal cancer.
Sharma, Deepika; Nagarkar, Anu N; Jindal, Pankaj; Kaur, Rajinder; Gupta, Ashok K
We conducted a study of 65 adults who had undergone laryngectomy for the treatment of laryngeal cancer. Our goal was to identify any abnormal personality traits in these patients and to assess the effect that psychological counseling might have on correcting these abnormalities and thereby improving postoperative voice rehabilitation. A Personality Trait Inventory (PTI) administered to all patients preoperatively identified 47 patients who had abnormal scores for at least three personality traits. These 47 patients were sent for preoperative psychological counseling, and 3 months following surgery, they underwent a follow-up PTI. At the follow-up assessment, 40 of these patients-32 men and 8 women-still registered abnormal scores for at least three traits. Half of the men and half of the women were randomized to receive 12 sessions of individualized psychological counseling over 6 months in addition to standard speech therapy (group I); the other patients received speech therapy only (group II). A follow-up PTI was administered at the completion of psychological counseling and/or speech therapy (postoperative month 9). Statistical analysis of the data was performed with the paired-samples test. Intragroup analysis of the follow-up PTI results revealed that both groups experienced a significant improvement in activity scores (p < 0.001) compared with their previous PTI results and that group I had significantly better scores for two other PTI traits-cyclothymia (mood swings) and depressive tendency (p < 0.05); neither group showed a significant improvement in dominance scores. Intergroup comparisons revealed that group I's activity and depressive tendency scores were significantly better than those of group II; there was no significant difference between the two groups in cyclothymia and dominance scores. Finally, comparison of results by sex, regardless of group, revealed that men had a significantly higher score for dominance and women had significantly higher
Freedom and Confinement: Patients' Experiences of Life with Home Haemodialysis
Vestman, C.; Hasselroth, M.; Berglund, M.
Patients with chronic end stage renal disease need dialysis to survive; however, they also need a treatment that suits their life situation. It is important that healthcare providers provide reliable, up-to-date information about different dialysis treatment options. Since home haemodialysis is a relatively new treatment, it is necessary to gather more knowledge about what the treatment entails from the patient's perspective. The aim of this study was to describe patients' experiences of having home haemodialysis. To gain access to the patients' experiences, they were asked to write narratives, which describe both their good and bad experiences of life with the treatment. The narratives were analysed with a qualitative method. The results of this analysis are subdivided into five themes: freedom to be at home and control their own treatment, feeling of being alone with the responsibility, changes in the home environment, need for support, and security and well-being with home haemodialysis. The conclusion is that home haemodialysis provides a certain level of freedom, but the freedom is limited as the treatment itself is restrictive. In order to improve patients' experiences with home haemodialysis, more research based on patients' experiences is needed and it is necessary to involve the patients in the development of the care. PMID:25587441
Personality, emotions and coping styles: predictive value for the evolution of cancer patients.
Cardenal, Violeta; Cerezo, M Victoria; Martínez, Joaquina; Ortiz-Tallo, Margarita; José Blanca, M
This study had a twofold goal: to define differences in psychological aspects between cancer patients and a control group and to explore the predictive value of such aspects for the evolution of the disease two years later. Firstly, personality, anxiety, anger and depression were assessed in both groups. Results of t-analyses revealed significant group differences. In personality, cancer patients had higher levels of neuroticism and lower levels of extraversion, agreeableness and conscientiousness than the control group. In emotional variables, cancer patients had higher levels of anxiety and some aspects of anger, but there were no group differences in depression levels. Secondly, applying a quasi-prospective design, the predictive value of personality, emotions and coping styles for the evolution of cancer (favourable or unfavourable) was explored using generalized linear models and logistic regression. A four-predictor logistic model was fitted: Anger Expression-In, Resignation, Self-blame and Conscientiousness, indicating that the higher Anger Expression-in, Resignation, and Self-blame scores together with a lower Conscientiousness score, the more likely it is for patients' cancer to evolve unfavourably. These results indicate the crucial role of psychological aspects for the evolution of the disease and the need to include such aspects in the design of clinical interventions. PMID:22774449
The relationship between the fear-avoidance model of pain and personality traits in fibromyalgia patients.
Martínez, María Pilar; Sánchez, Ana Isabel; Miró, Elena; Medina, Ana; Lami, María José
This study examined the relationship between several cognitive-affective factors of the fear-avoidance model of pain, the big five model of personality, and functional impairment in fibromyalgia (FM). Seventy-four FM patients completed the NEO Five-Factor Inventory, the Pain Catastrophizing Scale, the Pain Anxiety Symptoms Scale-20, the Pain Vigilance and Awareness Questionnaire, and the Impairment and Functioning Inventory. Results indicated that the cognitive-affective factors of pain are differentially associated with personality traits. Neuroticism and conscientiousness were significant predictors of pain catastrophizing, and neuroticism, openness, and agreeableness were significant predictors of pain anxiety. Personality traits did not contribute significantly to vigilance to pain. The effect of neuroticism upon pain anxiety was mediated by pain catastrophizing, and neuroticism showed a trend to moderate the relationship between impairment and pain anxiety. Results support the fear-avoidance model of pain. Implications of the findings for the understanding and management of FM are discussed. PMID:21964824
The Nebraska experience in biocontainment patient care.
Beam, Elizabeth L; Boulter, Kathleen C; Freihaut, Frank; Schwedhelm, Shelly; Smith, Philip W
Public health nurses in local health departments may receive the first call regarding a potential case of avian influenza, monkeypox, or viral hemorrhagic fever. One public health approach to containing these dangerous infectious disease outbreaks is the use of specialized isolation units. Early access to a biocontainment patient care unit (BPCU) for isolation during a bioterrorism or public health emergency event along with appropriate use of epidemiological and therapeutic interventions in the community may dramatically impact the size and severity of a disease outbreak (Smith et al., 2006). As emerging infectious agents, pandemics, resistant organisms, and terrorism continue to threaten human life; health care and emergency care providers must be empowered to work with nurses and other professionals in public health to plan for the consequences. This article describes the evolution of Nebraska's BPCU strategy for public health preparedness in the face of a biological threat. Design priorities, unit management, challenges, and lessons learned will be shared to guide others in establishing similar infrastructure. PMID:20433668
Personal experience and perception of abuse in people with intellectual disabilities.
Leutar, Zdravka; Vitlov, Josipa; Leutar, Ivan
This article presents a qualitative study designed to gain insight into personal experience and perception of abuse in people with intellectual disabilities. Ten members of the organization for people with intellectual disabilities in Zadar, Croatia, who have a diagnosis of light or moderate intellectual disability, were included in the research. Analysis of responses showed that most participants had experienced psychological, physical and financial abuse. The most frequent perpetrators of abuse were identified by participants as friends, acquaintances and volunteer carers. Typical sites for the experience of abuse were school, social clubs/support institutions, the street and the urban environment. Most participants seek assistance and support in cases of abuse through discussion with their loved ones, mostly their parents and friends. In addition to such informal relationships, some participants mentioned the importance of formal forms of support. PMID:24958168
Schizotypy and personality profiles of Cluster A in a group of schizophrenic patients and their siblings
Background Schizotypy, or the set of personality traits related to schizophrenia, is considered an endophenotypic manifestation that is more represented in first-degree relatives of patients with schizophrenia than in the general population. The assessment of schizotypy is primarily based on self-reports, and for this reason it presents several limitations. In order to assess schizotypy, this study proposes a diagnostic instrument based on clinical reports. Methods A sample of 66 subjects, composed of 25 outpatients with schizophrenia, 18 siblings of these patients and 23 healthy controls, was subjected to the personality assessment test SWAP-200 by trained clinical interviewers. To test the hypothesis of the difference between the profiles of the Personality Disorders within the schizophrenia spectrum, a Multivariate Analysis of Variance and subsequent planned comparisons were conducted. Results Patients with schizophrenia scored higher than both their siblings and the controls on all SWAP-200 scales; their siblings, compared to the healthy controls, showed significant statistical differences, with higher mean scores for paranoid (F(1,63) = 7.02; p = 0.01), schizoid (F(1,63) = 6.56; p = 0.013) and schizotypal (F(1,63) = 6.47; p = 0.013) traits (PD T scores of Cluster A and Q-factor scores for the schizoid scale [F(1,63) = 6.47; p = 0.013]). Conclusions Consistent with previous data, first-degree relatives of patients with schizophrenia scored higher on schizophrenia-related personality traits than a general population comparison sample. SWAP-200, as an alternative diagnostic instrument to self-report measures, is able to reveal the higher prevalence of schizotypal traits in siblings of patients with schizophrenia, suggesting its possible use as a complementary instrument for the assessment of schizophrenia. PMID:24094118
Use of Personal Electronic Devices by Nurse Anesthetists and the Effects on Patient Safety.
Snoots, Lauren R; Wands, Brenda A
Certified Registered Nurse Anesthetists (CRNAs) provide high-quality patient care to ensure patient safety. Strict vigilance and prompt response is required of the CRNA to make critical decisions. Distractions during anesthesia delivery may threaten patient safety. Personal electronic devices (PEDs) have become an integral tool used by 90% of adults. Adaptation of PEDs has permitted their integration into current anesthesia practice. Although technologic advancements have improved accessibility to resources and communication, they also serve as a source of distraction. Inappropriate PED use while administering anesthesia remains grossly underreported and understudied related to its impact on patient safety. The purpose of this article is to illustrate the critical need for further research in order to analyze safety risk, appropriately guide CRNA education, and properly develop and enforce media policies within organizations. Currently, PED use by the CRNA exists in ethically blurred boundaries, with potentially major patient safety and legal consequences. PMID:27311152
On the relationship between personal experience, affect and risk perception: The case of climate change
van der Linden, Sander
Examining the conceptual relationship between personal experience, affect, and risk perception is crucial in improving our understanding of how emotional and cognitive process mechanisms shape public perceptions of climate change. This study is the first to investigate the interrelated nature of these variables by contrasting three prominent social-psychological theories. In the first model, affect is viewed as a fast and associative information processing heuristic that guides perceptions of risk. In the second model, affect is seen as flowing from cognitive appraisals (i.e., affect is thought of as a post-cognitive process). Lastly, a third, dual-process model is advanced that integrates aspects from both theoretical perspectives. Four structural equation models were tested on a national sample (N = 808) of British respondents. Results initially provide support for the "cognitive" model, where personal experience with extreme weather is best conceptualized as a predictor of climate change risk perception and, in turn, risk perception a predictor of affect. Yet, closer examination strongly indicates that at the same time, risk perception and affect reciprocally influence each other in a stable feedback system. It is therefore concluded that both theoretical claims are valid and that a dual-process perspective provides a superior fit to the data. Implications for theory and risk communication are discussed. © 2014 The Authors. European Journal of Social Psychology published by John Wiley & Sons, Ltd. PMID:25678723
Underlying personality differences between alcohol/substance-use disorder patients with and without an affective disorder.
Janowsky, D S; Hong, L; Morter, S; Howe, L
The Myers-Briggs Type Indicator (MBTI), a popular personality test, was used to profile the personalities of in-patient alcoholics/substance-use disorder patients who had, and those who did not have, a concurrent affective disorder diagnosis. The MBTI divides individuals into eight categories: Extroverts and Introverts, Sensors and Intuitives, Thinkers and Feelers, and Judgers and Perceivers. Alcohol/substance-use disorder patients with no affective disorder differed from a normative population only in being significantly more often Sensing and significantly less often Intuitive single-factor types. The Extroverted/Sensing/ Feeling/Judging four-factor type was also significantly over-represented in this group, compared to a normative population. In contrast, mood-disordered alcohol/substance-use disorder patients were significantly more often Introverted, Sensing, Feeling, and Perceiving and significantly less often Extroverted, Intuitive, Thinking, and Judging single-factor types. They were also significantly more often Introverted/Sensing/ Feeling/Perceiving and Introverted/Intuitive/Feeling/Perceiving four-factor types. 'Pure' alcohol/ substance-use disorder patients differed from alcohol/substance-use disorder patients with a mood disorder in that they were significantly more often Extroverted and Thinking and significantly less often Introverted and Feeling single-factor types; and significantly less often were an Introverted/Sensing/ Feeling/Perceiving four-factor type. The above results may have psychogenetic, diagnostic, and psychotherapeutic implications. PMID:10414613
Ontology-Driven Monitoring of Patient's Vital Signs Enabling Personalized Medical Detection and Alert
Hristoskova, Anna; Sakkalis, Vangelis; Zacharioudakis, Giorgos; Tsiknakis, Manolis; De Turck, Filip
A major challenge related to caring for patients with chronic conditions is the early detection of exacerbations of the disease. Medical personnel should be contacted immediately in order to intervene in time before an acute state is reached, ensuring patient safety. This paper proposes an approach to an ambient intelligence (AmI) framework supporting real-time remote monitoring of patients diagnosed with congestive heart failure (CHF). Its novelty is the integration of: (i) personalized monitoring of the patients health status and risk stage; (ii) intelligent alerting of the dedicated physician through the construction of medical workflows on-the-fly; and (iii) dynamic adaptation of the vital signs' monitoring environment on any available device or smart phone located in close proximity to the physician depending on new medical measurements, additional disease specifications or the failure of the infrastructure. The intelligence lies in the adoption of semantics providing for a personalized and automated emergency alerting that smoothly interacts with the physician, regardless of his location, ensuring timely intervention during an emergency. It is evaluated on a medical emergency scenario, where in the case of exceeded patient thresholds, medical personnel are localized and contacted, presenting ad hoc information on the patient's condition on the most suited device within the physician's reach. PMID:24445411
Barriers Prevent Patient Access to Personalized Therapies Identified by Molecular Tumor Profiling of Gynecologic Malignancies
Hillman, R. Tyler; Ward, Kristy; Saenz, Cheryl; McHale, Michael; Plaxe, Steven
Objective. This study was designed to evaluate the ability of commercial molecular tumor profiling to discover actionable mutations and to identify barriers that might prevent patient access to personalized therapies. Methods. We conducted an IRB-approved retrospective review of 26 patients with gynecologic malignancies who underwent commercial tumor profiling at our institution during the first 18 months of test availability. Tumor profiles reported targeted therapies and clinical trials matched to patient-specific mutations. Data analysis consisted of descriptive statistics. Results. Most patients who underwent tumor profiling had serous epithelial ovarian, primary peritoneal, or fallopian tube carcinoma (46%). Patients underwent profiling after undergoing a median of two systemic therapies (range 0 to 13). A median of one targeted therapy was suggested per patient profile. Tumor profiling identified no clinically actionable mutations for seven patients (27%). Six patients sought insurance approval for a targeted therapy and two were declined (33%). One patient (4%) received a targeted therapy and this was discontinued due to tumor progression. Conclusions. There are formidable barriers to targeted therapy for patients with gynecologic malignancies. These barriers include a dearth of FDA-approved targeted agents for gynecologic malignancies, lack of third party insurance coverage and limited geographic availability of clinical trials. PMID:26011384
A psychometric study of the prevalence of DSM-IV personality disorders among office-based methadone maintenance patients.
Teplin, David; O'Connell, Tara; Daiter, Jeff; Varenbut, Michael
Using the DSM-IV criteria for personality disorders, prevalence rates for these disorders were evaluated among methadone maintenance patients, with a psychometric test--the Millon Clinical Multiaxial Inventory (MCMI-III). We found that 77% of patients met the study criteria for at least one personality disorder. Of those who had a personality disorder, 20% had two personality disorders, 14% had three personality disorders, and 6% had four personality disorders. Rates of specific personality disorders are reported. Consistencies and divergence from existing research literature are noted. It is suggested that future research compare psychometrically based self-report questionnaires to a structured clinical interview format, within the same clinical population. PMID:15540490
Reducing Adverse Polypharmacy in Patients With Borderline Personality Disorder: An Empirical Case Study
Oldham, John M.; Gonzalez, Sylvia; Fowler, J. Christopher
Objective: Polypharmacy is common and especially challenging in the context of borderline personality disorder in light of impulsivity and self-harm associated with the disorder, risk of adverse drug-drug interactions, and financial burden. Reduction in polypharmacy could be conceptualized as a high priority in the treatment of borderline personality disorder. This case aims to demonstrate that potential. Method: This case report presents outcomes data for an individual with borderline personality disorder during the course of an extended psychiatric hospitalization. Symptomatic change is based on the Patient Health Questionnaire Somatic, Anxiety, and Depression Symptoms scales and World Health Organization 5-Item Well-Being Index. Change in polypharmacy is presented both in terms of absolute number and complexity of the medication regimen. Clinical outcomes data are provided at 2, 12, and 24 weeks postdischarge. Results: During a 56-day hospitalization, the patient demonstrated clinical improvement across clinical domains—all occurred within the context of reduced number (43%) and complexity (40%) of her medication regimen. Symptomatic improvement was sustained up to 6 months postdischarge. Conclusions: Despite good intentions, polypharmacy can be associated with iatrogenic harm and contribute to functional impairment, especially in the context of borderline personality disorder, in which symptomatic fluctuations are part of the illness itself. A reduction in the patient's high-risk polypharmacy during treatment represents a noteworthy treatment outcome in and of itself. Additional measures of medication risk and liability have the potential to become markers of clinical effectiveness. PMID:26693036
Executive attention and personality variables in patients with frontal lobe damage.
Rodríguez-Bailón, María; Triviño, Mónica; Lupiáñez, Juan
Executive Control is required to deal with novel situations or when an action plan is needed. This study aimed to highlight the executive attention deficits of patients with frontal lobe damage. To do so, the ANT-I task (Attention Network Test-Interactions) was administered for the first time to a group of 9 patients with frontal damage caused by traumatic brain injury (TBI) and a matched control group. This task made it possible to measure the three attentional networks proposed by Posner and Dehaene (1994) and their interactions. Results on the alerting and orienting networks did not show any significant differences between the groups. However, a significant effect of group on the executive control network was observed. In addition, participants' personality was assessed with a clinical inventory (the Millon Personality Inventory) that showed a significant positive correlation between borderline personality disorder and the conflict index. These results suggest that frontal lobe damage causes an exclusive impairment in the conflict resolution network that is related to personality traits characterized by a lack of behavioral control. More research will be necessary to study this causal relationship. PMID:23156906
The effect of physician personality on laboratory test ordering for hypertensive patients.
Ornstein, S M; Markert, G P; Johnson, A H; Rust, P F; Afrin, L B
Laboratory tests are responsible for a large percentage of health care expenses in the United States. In a retrospective study of the outpatient test ordering by residents for hypertensive patients between the years 1980 and 1986 at the Department of Family Medicine at the Medical University of South Carolina, we found great variability in laboratory test ordering as well as an association between personality as measured by the Myers-Briggs Type Indicator (MBTI) and test ordering. Introverts ordered more than extroverts, and intuitives ordered more than sensors. This association was confirmed by a multiple regression analysis controlling for potential confounders of test ordering, such as severity of disease, the presence of coexisting diabetes mellitus, the demographic characteristics of the patient population, and the number of initial evaluations for hypertension. Elucidation of a relationship between resident personality and laboratory test ordering has important implications for planning intervention strategies to reduce excessive laboratory test ordering in ambulatory care. PMID:3379985
A Personalized Approach to Parkinson's Disease Patients Based on Founder Mutation Analysis.
Giladi, Nir; Mirelman, Anat; Thaler, Avner; Orr-Urtreger, Avi
While the phenotype of Parkinson disease (PD) is heterogeneous, treatment approaches are mostly uniform. Personalized medicine aims to treat diseases with targeted therapies based on cumulative variables, including genotype. We believe that sufficient evidence has accumulated to warrant the initiation of personalized medicine in PD based on subjects genotype and provide examples for our reasoning from observations of GBA and LRRK2 mutations carriers. While PD patients who carry the G2019S mutation in the LRRK2 gene seem to develop relatively mild disease with more frequent postural instability gait disturbance phenotype, carriers of mutations in the GBA gene tend to have an early onset, rapidly deteriorating disease, with more pronounced cognitive and autonomic impairments. These characteristics have significant implications for treatment and outcome and should be addressed from an early stage in the attempt to improve the patient's quality of life. PMID:27242656
Distinct symptom experiences in subgroups of patients with COPD
Christensen, Vivi L; Rustøen, Tone; Cooper, Bruce A; Miaskowski, Christine; Henriksen, Anne H; Bentsen, Signe B; Holm, Are M
Background In addition to their respiratory symptoms, patients with COPD experience multiple, co-occurring symptoms. Objectives The aims of this study were to identify subgroups of COPD patients based on their distinct experiences with 14 symptoms and to determine how these subgroups differed in demographic and clinical characteristics and disease-specific quality of life. Patients and methods Patients with moderate, severe, and very severe COPD (n=267) completed a number of self-report questionnaires. Latent class analysis was used to identify subgroups of patients with distinct symptom experiences based on the occurrence of self-reported symptoms using the Memorial Symptom Assessment Scale. Results Based on the probability of occurrence of a number of physical and psychological symptoms, three subgroups of patients (ie, latent classes) were identified and named "high", "intermediate", and "low". Across the three latent classes, the pairwise comparisons for the classification of airflow limitation in COPD were not significantly different, which suggests that measurements of respiratory function are not associated with COPD patients' symptom burden and their specific needs for symptom management. While patients in both the "high" and "intermediate" classes had high occurrence rates for respiratory symptoms, patients in the "high" class had the highest occurrence rates for psychological symptoms. Compared with the "intermediate" class, patients in the "high" class were younger, more likely to be women, had significantly more acute exacerbations in the past year, and reported significantly worse disease-specific quality of life scores. Conclusion These findings suggest that subgroups of COPD patients with distinct symptom experiences can be identified. Patients with a higher symptom burden warrant more detailed assessments and may have therapeutic needs that would not be identified using current classifications based only on
New Horizon in Life: Experiences of Patients Receiving Chemotherapy
Nasrabadi, Alireza Nikbakht; Mohammadpour, Ali; Fathi, Mohammad
Introduction: The treatment quality of diseases can affect the patient's experience. Due to its different complications among cancer patients, the experience of chemotherapy is unique. The present study was conducted to explore the lived experience among cancer patients who had received chemotherapy. Methods: The study was conducted by a qualitative approach and a phenomenological method. In so doing, 12 cancer patients who had received chemotherapy were purposefully selected were interviewed using an in-depth method. After the required data were collected, they were analyzed by Tanner, Allen, Diekelmann method. Results: Analysis of the collected data indicated that the experience of chemotherapy appeared as "a new horizon in life" for the patients. Secondary themes of the new horizon in life included rebirth, understanding of life values, dependence, and need. Conclusion: According to the results of the study, it was concluded that in addition to taking into providing mental-spiritual support and reducing the complications of the treatment, nurses in chemotherapy wards should pay attention to the experiences of the patients receiving chemotherapy and enhance hope and positive attitude among them. PMID:26573050
Third-person Diagnostic Interview on the Cognitive Insight Level of Psychotic Patients with an Insight at the Denial Level
Mehdizadeh, Mahsa; Rezaei, Omid
Objectives: According to the previous findings, the third-person technique improved the clinical insight of psychotic patients, therefore the present study aims to examine the effect of a third-person interview compared to a first-person interview on the level of cognitive insight of psychotic patients with an insight at the denial level. Materials and Methods: In this study, using interviews and questionnaires, a total number of 44 patients of Razi Psychiatric Educational and Treatment Center with an insight at the denial level being assessed using diagnostic interviews were divided randomly into two groups. Then, the two groups of patients' cognitive insights were evaluated using Beck Cognitive Insight Scale. Results: The findings indicated that in psychotic patients with an insight at the denial level, the third-person technique of interview compared to the first-person had little effect on the improvement of overall cognitive insight and its components, including self-reflection and self-assurance; however, this effect was not strong enough to make a significant difference between the two groups of patients. Conclusion: According to the study findings, we can conclude that the third-person interview compared to the first-person interview has no effect on the improvement of the cognitive insight of psychotic patients with an insight at the denial level. This finding is consistent with the previous studies indicating that although the theory of mind has some correlations with the clinical insight of patients, it has no effect on their cognitive insight. PMID:27335517
Experiences of expert nurses in caring for patients with postoperative pain.
Richards, Jennifer; Hubbert, Ann O
Despite enormous technologic advances and substantial research in the area of pain management in recent years, numerous studies indicate that postoperative pain is not relieved in most patients. Nurses are the health care professionals who spend the most time with patients in pain. Despite this, there is a lack of research that has sought to understand the experiences of nurses, the professionals most closely tied to this issue. The purpose of this pilot qualitative study was to learn how expert nurses assess, manage, and care for patients with postoperative pain. A phenomenologic mode of inquiry was used to interview three expert nurse participants. Four themes emerged during the data analysis phase: considering the whole person, the independent art of nursing, accepting what the patient says, and commitment to surgical nursing. PMID:17336866
Exploring Women's Personal Experiences of Giving Birth in Gonabad City: A Qualitative Study
Askari, Fariba; Atarodi, Alireza; Torabi, Shirin; Moshki, Mahdi
Background: Women's health is an important task in society. The aim of this qualitative study that used a phenomenological approach was to explain women's personal experiences of giving birth in Gonabad city that had positive experiences of giving birth in order to establish quality cares and the related factors of midwifery cares for this physiological phenomenon. Methods: The participants were 21 primiparae women who gave a normal and or uncomplicated giving birth in the hospital of Gonabad University of medical sciences. Based on a purposeful approach in-depth interviews were continued to reach data saturation. The data were collected through open and semi-structured interactional in-depth interviews with all the participants. All the interviews were taped, transcribed and then analyzed through a qualitative content analysis method to identify the concepts and themes. Findings: Some categories were emerged. A quiet and safe environment was the most urgent need of the most women giving birth. Unnecessary routine interventions that are performed on all women regardless of their needs and should be avoided were considered such as: "absolute rest, establishing vein, frequent vaginal examinations, fasting and early Amniotomy". All the women wanted to take part actively in their giving birth, because they believed it could affect their giving birth. Conclusion: We hope that the women's experiences of giving birth will be a pleasant and enjoyable experience for all the mothers giving birth. PMID:25168980
Transhistorical variations in personality and their association with experiences of parental rearing.
Lundberg, M; Perris, C; Schlette, P; Adolfsson, R
A population sample comprised of 765 subjects (367 males and 398 females), in the age range of 15-81 years, completed the EMBU, a reliable questionnaire aimed at assessing experiences of parental rearing, and the TCI, a self-report questionnaire aimed at assessing dimensions of temperament and character. The study had three main aims: 1) to verify, on a larger scale, previous findings suggesting the occurrence of significant associations between experiences of parental rearing and aspects of temperament and character, 2) to assess possible variations in temperament and character in cohorts of subjects who have grown up in different historical epochs, and 3) to investigate to what extent transgenerational differences in parental rearing are detectable in different associations with various dimensions of personality. Several, albeit small, significant and meaningful associations between experiences of parental rearing and both temperament and character dimensions have been found, adding support to the robustness of previously reported results obtained in an independent smaller series. Also, several significant differences among subjects in different age groups have been found, both concerning temperament variables and character dimensions. Finally, the results show that associations between experiences of parental rearing and dimensions of temperament and character are most pronounced in subjects belonging to the youngest cohort and almost nil in the cohort comprising the oldest subjects. PMID:10572362
Neural Response during the Activation of the Attachment System in Patients with Borderline Personality Disorder: An fMRI Study.
Buchheim, Anna; Erk, Susanne; George, Carol; Kächele, Horst; Martius, Philipp; Pokorny, Dan; Spitzer, Manfred; Walter, Henrik
Individuals with borderline personality disorder (BPD) are characterized by emotional instability, impaired emotion regulation and unresolved attachment patterns associated with abusive childhood experiences. We investigated the neural response during the activation of the attachment system in BPD patients compared to healthy controls using functional magnetic resonance imaging (fMRI). Eleven female patients with BPD without posttraumatic stress disorder (PTSD) and 17 healthy female controls matched for age and education were telling stories in the scanner in response to the Adult Attachment Projective Picture System (AAP), an eight-picture set assessment of adult attachment. The picture set includes theoretically-derived attachment scenes, such as separation, death, threat and potential abuse. The picture presentation order is designed to gradually increase the activation of the attachment system. Each picture stimulus was presented for 2 min. Analyses examine group differences in attachment classifications and neural activation patterns over the course of the task. Unresolved attachment was associated with increasing amygdala activation over the course of the attachment task in patients as well as controls. Unresolved controls, but not patients, showed activation in the right dorsolateral prefrontal cortex (DLPFC) and the rostral cingulate zone (RCZ). We interpret this as a neural signature of BPD patients' inability to exert top-down control under conditions of attachment distress. These findings point to possible neural mechanisms for underlying affective dysregulation in BPD in the context of attachment trauma and fear. PMID:27531977
Changes in schemas of patients with severe borderline personality disorder: the Oulu BPD study.
Leppänen, Virpi; Kärki, Anna; Saariaho, Tom; Lindeman, Sari; Hakko, Helinä
Borderline personality disorder (BPD) is a relatively common and severe psychiatric disorder that can impair quality of life in many ways. The aim of this study was to determine whether a combined treatment model for BPD patients, utilising major principles from schema-focused therapy (SFT) and dialectical behavioral therapy (DBT), could be more effective in relieving early maladaptive schemas of BPD patients, compared to treatment as usual (TAU). This study is a part of the Oulu BPD study conducted at mental health care services run by Oulu city social and health care services. The study is a multisite, randomized controlled trial conducted over a one year period, involving two groups of patients with severe BPD: (1) Community Treatment By Experts (CTBE) patients (n = 18) receiving the combined treatment model, and 2) TAU patients (n = 27). The patients' schemas were assessed using the Young Schema Questionnaire (YSQ-L3a) before and after one year of treatment. The results reveal that CTBE patients who attended the combined treatment model showed a statistically significant reduction in eight out of 18 early maladaptive schemas, while patients receiving treatment as usual did not demonstrate any significant changes in schemas. The cognitive therapeutic treatment model can be applied for clinical use in public mental health settings using existing professionals, and appears to produce positive changes in patients with BPD. PMID:25358652
Emotional responses in patients with borderline as compared with avoidant personality disorder.
Herpertz, S C; Schwenger, U B; Kunert, H J; Lukas, G; Gretzer, U; Nutzmann, J; Schuerkens, A; Sass, H
The aim of this study was to assess psychophysiological affect correlates, in addition to the usual self-report in borderline personality disorder (BPD) compared with avoidant personality disorder (APD) and normal controls (NCs), when responding to standardized experimental stimuli. In 24 BPD female patients, 23 APD female patients, and 27 female NCs, skin conductance response (SCR), heart rate (HR) change, and startle response were recorded while the subjects viewed slides with emotional content. Neither the self-report nor the psychophysiological data supported the hypothesis that affective responses of BPD individuals are generally stronger than those with APD. BPD patients showed no potentiation of the affective modulation of the startle reflex and their electrodermal reactivity was lower than in either the APD subjects or the NCs. The hypothesis of a general affective hyperresponsivity could not be confirmed. Low somatic arousal in BPD can interfere with the anticipation of signal stimuli and may explain the exaggerated openness borderline personalities show to stimuli, particularly in interpersonal situations. PMID:11204341
Person-centred psychopharmacotherapy: what is it? Each patient is a unique, responsive and responsible subject.
Jakovljevic, Miro
Modern psychopharmacotherapy is currently in contention both outside and within the field of psychiatry. Conventional psychopharmacology paradigms focusing just on a disease perspective, biological narrative and a "one fits all" treatment are often regarded as inadequate and disjunctive. A significant proportion of psychiatric patients achieve no improvement or only partial improvement in their symptoms, while many of them suffer adverse and even toxic effects of medications. Psychopharmacotherapy as a sole form of treatment may carry the wrong message that patients don't have to change their life style and don't have to learn any new skills, they just have to receive their medication on time because the only problem is in brain chemistry. Evidence-based psychopharmacotherapy and person-centered narrative psychopharmacotherapy are not competitors but a complementuary duality, as intimately connected as brain and soul. Narrative preserves individuality, distinctivenesss and therapeutic context, whereas quantitative methods and evidence-based guidelines offer a solid foundation for what is reliably and generally correct. The purpose of person-centered psychopharmacotherapy is to empower the patients to control their disease, to re-author their problematic life story, to obtain full personal recovery and to regain control over their life. PMID:26417733
Evidence-Based Care of the Patient with Borderline Personality Disorder.
Antai-Otong, Deborah
Borderline personality disorder (BPD) is a complex, serious, and high-cost psychiatric disorder. The high prevalence of patients with BPD and co-occurring depression, eating disorders, and substance-use disorders in primary care and mental health settings contribute to their high use of resources in these practice settings. Regardless of treatment challenges associated with BPD, researchers suggest a more positive outlook in the treatment of this complex psychiatric condition. This article focuses on areas in which nurses can strengthen their understanding of underpinnings and multimodal approaches, assess the patient's immediate needs, and manage distressful emotional states and impulsivity. PMID:27229283
Patient experience of computerised therapy for depression in primary care
Knowles, Sarah E; Lovell, Karina; Bower, Peter; Gilbody, Simon; Littlewood, Elizabeth; Lester, Helen
Objective To explore patient experience of computerised cognitive behaviour therapy (cCBT) for depression in a pragmatic randomised controlled trial (Randomised Evaluation of the Effectiveness and Acceptability of Computerised Therapy, REEACT). Design Qualitative semistructured interviews with 36 participants. Participants Depressed patients with a Patient Health Questionnaire 9 of 10 or above recruited into the REEACT randomised controlled trial. Setting Primary care settings in England. Results Participant experience was on a continuum, with some patients unable or unwilling to accept psychological therapy without interpersonal contact while others appreciated the enhanced anonymity and flexibility of cCBT. The majority of patients were ambivalent, recognising the potential benefits offered by cCBT but struggling with challenges posed by the severity of their illness, lack of support and limited personalisation of programme content. Low completion rates were commonly reported, although more positive patients reported greater engagement. Both positive and ambivalent patients perceived a need for monitoring or follow-up to support completion, while negative patients reported deliberate non-adherence due to dissatisfaction with the programme. Patients also reported that severity of depression impacted on engagement, and viewed cCBT as unsuitable for patients undergoing more severe depressive episodes. Conclusions The study demonstrates both the unique demands and benefits of computerised therapy. cCBT was preferred by some patients and rejected by others, but the majority of patients were ambivalent about the therapy. cCBT could be offered within a menu of options in stepped care if matched appropriately to individual patients or could be offered with enhanced support to appeal to a greater number of patients. Trial registration number ISRCTN91947481. PMID:26621513
Virtual Nursing Intervention Adjunctive to Conventional Care: The Experience of Persons Living With HIV
Rouleau, Geneviève; Ramirez-Garcia, Pilar; Bourbonnais, Anne
Background Persons living with HIV (PLHIV) must adhere optimally to antiretroviral therapy (ART) on a daily basis and for their lifetime to maintain an undetectable viral load, allowing them to preserve their health. Taking advantage of the opportunity that information and communication technologies provide to broaden intervention modalities and intensify clinical follow-up, a virtual nursing intervention consisting of four interactive computer sessions was developed to empower PLHIV to manage their ART and symptoms optimally. Compared with other types of information and communication technologies-assisted interventions such as text messages, HIV Treatment, Virtual Nursing Assistance and Education (VIH-TAVIE) requires a certain degree of active engagement on the part of the user to develop and strengthen the self-management skills to optimize adherence. After the intervention's impact on ART adherence was measured quantitatively, a qualitative study was undertaken to describe how users experience the intervention. Understanding how PLHIV perceive being assisted asynchronously by a virtual nurse was of particular interest. Objective The objective of the study was to explore and describe how PLHIV experience VIH-TAVIE, that is, receiving customized asynchronous accompaniment via a virtual nurse. Methods A qualitative study was conducted with 26 PLHIV (20 men, 6 women) who received all four VIH-TAVIE sessions. Participants had been diagnosed with HIV 14 years earlier on average and had been on ART for a mean period of 10 years. The sessions lasted 20-30 minutes each and were received two weeks apart. They are hosted by a virtual nurse who engages the user in a self-management skills-learning process for the purpose of treatment adherence. Semistructured interviews were conducted lasting 30-40 minutes to get participants to share their experience of the intervention through personal stories and what they thought and felt during their participation. Data were analyzed
A behavioral treatment for opioid-dependent patients with antisocial personality.
Neufeld, Karin J; Kidorf, Michael S; Kolodner, Kenneth; King, Van L; Clark, Michael; Brooner, Robert K
Antisocial personality disorder (APD) is associated with increased problem severity in treatment-seeking opioid-dependent patients. Treatment studies have reported mixed results but generally show that patients with APD make progress that is often comparable to drug-dependent patients without the personality disorder. Much of this work is based on secondary analyses of studies evaluating responses to a variety of drug abuse treatment interventions. This study reports on a randomized prospective trial evaluating a behavioral approach for managing opioid-dependent patients with APD. Subjects (N = 100) met Diagnostic and Statistical Manual of Mental Disorders criteria for opioid dependence and APD using a structured clinical interview and were randomly assigned to either an experimental condition (n = 51), which used a highly structured contingency management intervention, or a control condition (n = 49), which reflected standard methadone treatment. Subjects in the experimental group had significantly better counseling attendance and some indication of lower psychosocial impairment compared to the control group. The experimental intervention increased attendance in subjects with low and high levels of psychopathy and with and without other psychiatric comorbidity. These findings support the development of interventions more tailored to drug-dependent patients with APD. PMID:17574801
Personality disorder, emotional intelligence, and locus of control of patients with alcohol dependence
Prakash, Om; Sharma, Neelu; Singh, Amool R.; Sengar, K. S.; Chaudhury, Suprakash; Ranjan, Jay Kumar
Aim: To assess personality disorder (PD), emotional intelligence (EI), and locus of control of alcohol dependent (AD) patients and its comparison with normal controls. Materials and Methods: Based on purposive sampling technique, 33 AD patients were selected from the De-Addiction Ward of Ranchi Institute of Neuro-Psychiatry and Allied Sciences (RINPAS) and 33 matched normal subjects were selected from Ranchi and nearby places. Both the groups were matched on various sociodemographic parameters, that is, age, gender, and socioeconomic level. All participants were assessed with Millon Clinical Multiaxial Inventory-III, Mangal EI Inventory, and Locus of Control scale. Obtained responses were scored by using standard scoring procedures and subsequently statistically analyzed by using Chi-square test. Results: AD patients have more comorbid pathological personality traits and disorders in comparison to their normal counterparts. Depressive, narcissistic, and paranoid PDs were prominent among AD group; followed by schizotypal, antisocial, negativistic, dependent, schizoid, sadistic, masochistic, and borderline PD. In comparison to normal participants, AD patients were significantly deficient in almost all the areas of EI and their locus of control was externally oriented. Conclusion: Patients with AD have significantly higher PDs, low EI, and an external orientation on the locus of control. Identification and management of these comorbid conditions are likely to improve the management and outcome of AD. PMID:26257482
Increased hair testosterone but unaltered hair cortisol in female patients with borderline personality disorder.
Dettenborn, Lucia; Kirschbaum, Clemens; Gao, Wei; Spitzer, Carsten; Roepke, Stefan; Otte, Christian; Wingenfeld, Katja
A number of studies have reported on dysfunctions in steroid secretion, including altered cortisol and testosterone levels in borderline personality disorder (BDP) patients compared to healthy controls. The present study extends findings from blood and saliva studies to the cumulative measure of hair steroids. We investigated women with BPD (n=18) and age- and education-matched healthy women (n=17). We did not find differences between BPD patients and healthy women (p=0.40) concerning hair cortisol levels but increased hair testosterone levels among BPD patients compared to controls (p=0.03). These results remained when restricting the analyses to unmedicated patients. Our data indicate altered long-term testosterone but not cortisol levels in females with BPD. Future studies should address the possible impact of altered testosterone on medical illness processes including metabolic syndrome in this population. PMID:27290653
Volumes of the hippocampus and amygdala in patients with borderline personality disorder: a meta-analysis.
Nunes, Paulo Menezes; Wenzel, Amy; Borges, Karinne Tavares; Porto, Cristianne Ribeiro; Caminha, Renato Maiato; de Oliveira, Irismar Reis
Individuals with borderline personality disorder (BPD) often exhibit impulsive and aggressive behavior. The hippocampus and amygdala form part of the limbic system, which plays a central role in controlling such expressions of emotional reactivity. There are mixed results in the literature regarding whether patients with BPD have smaller hippocampal and amygdalar volume relative to healthy controls. To clarify the precise nature of these mixed results, we performed a meta-analysis to aggregate data on the size of the hippocampus and amygdala in patients with BPD. Seven publications involving six studies and a total of 104 patients with BPD and 122 healthy controls were included. A significantly smaller volume was found in both the right and left hippocampi and amygdala of patients with BPD compared to healthy controls. These findings raise the possibility that reduced hippocampal and amygdalar volumes are biological substrates of some symptoms of BPD. PMID:19663654
The Influence of Posttraumatic Stress Disorder on Treatment Outcomes of Patients With Borderline Personality Disorder.
Boritz, Tali; Barnhart, Ryan; McMain, Shelley F
The aim of this study was to determine the influence of posttraumatic stress disorder (PTSD) on treatment outcomes in patients with borderline personality disorder (BPD). Participants were 180 individuals diagnosed with BPD enrolled in a randomized controlled trial that compared the clinical and cost effectiveness of dialectical behavior therapy (DBT) and general psychiatric management (GPM). Multilevel linear models and generalized linear models were used to compare clinical outcomes of BPD patients with and without PTSD. BPD patients with comorbid PTSD reported significantly higher levels of global psychological distress at baseline and end of treatment compared to their non-PTSD counterparts. Both groups evidenced comparable rates of change on suicide attempts and non-suicidal self-injury (NSSI), global psychological distress, and BPD symptoms over the course of treatment and post-treatment follow-up. DBT and GPM were effective for BPD patients with and without PTSD across a broad range of outcomes. PMID:26305394
Personality and Fibromyalgia Syndrome
Malin, Katrina; Littlejohn, Geoffrey O
Objectives: We aimed to review how personality characteristics contribute to the onset, maintenance or modulation of fibromyalgia. Method: The databases Medline and PsychINFO were examined from 1967 to 2012 to identify studies that investigated associations between fibromyalgia and personality. Search terms included fibromyalgia and personality, trait psychology, characteristics and individual differences. Results: Numerous studies indicate that patients with fibromyalgia experience psychological distress. Various instruments have been used to evaluate distress and related psychological domains, such as anxiety or depression, in fibromyalgia. In many cases, these same instruments have been used to study personality characteristics in fibromyalgia with a subsequent blurring of cause and effect between personality and psychological distress. In addition, the symptoms of fibromyalgia may change pre-illness personality characteristics themselves. These issues make it difficult to identify specific personality characteristics that might influence the fibromyalgia process. Despite this inherent problem with the methodologies used in the studies that make up this literature review, or perhaps because of it, we found no defined personality profile specific to fibromyalgia. However, many patients with fibromyalgia do show personality characteristics that facilitate psychological responses to stressful situations, such as catastrophising or poor coping techniques, and these in turn associate with mechanisms contributing to fibromyalgia. Conclusion: No specific fibromyalgia personality is defined but it is proposed that personality is an important filter that modulates a person's response to psychological stressors. Certain personalities may facilitate translation of these stressors to physiological responses driving the fibromyalgia mechanism. PMID:23002409
My personal experiences at the BEST Medical Center: A day in the clinic-the afternoon.
Cohen, Philip R; Kurzrock, Razelle
Dr. Ida Lystic is a gastroenterologist who recently began her new faculty position at the BEST (Byron Edwards and Samuel Thompson) Medical Center. After completing her MD degree at the prestigious Harvey Medical School (recently renamed the Harvey Provider School), she did her internal medicine residency and fellowship training at the OTHER (Owen T. Henry and Eugene Rutherford) Medical Center. Her morning in gastroenterology clinic was highlighted by: (1) being reprimanded by the clinic nurse manager for a patient who not only arrived early, before clinic had opened, but also neglected to schedule the anesthesiologist for his colonoscopy; (2) the continued challenges of LEGEND (also known as Lengthy and Excessively Graded Evaluation and Nomenclature for Diagnosis by her colleagues), the new electronic medical record system after the BEST discarded the SIMPLE (Succinct Input Making Patient's Lives Electronic) system; (3) a nurse's interruption of an office visit-once the egg timer on the examination room door ran out-because she had exceeded the allocated time for the appointment; and (4) her chairman's unanticipated arrival in the clinic to visit with the clinic nurse manager. In addition to seeing her patients, Dr. Lystic's afternoon is occupied by attending a LOST (Laboratory OverSight and Testing) Committee meeting and a visit from a wayfinding and signage specialist to depersonalize the doorpost plaques of the examination rooms. Her day ends with a demeaning email from her chairman regarding the poor results of the most recent patient satisfaction survey and being personally held accountable to develop solutions to improve not only her performance but also that of the clinic. Although Dr. Ida Lystic and the gastroenterology clinic at "the BEST Medical Center" are creations of the authors' imagination, the majority of the anecdotes mentioned in this essay are based on individual patients and their physicians, clinics in medical centers and their administration
Is personal continuity of care compatible with free choice of doctor? Patients' views on seeing the same doctor.
Freeman, G K; Richards, S C
While much has been written about the benefits of personal continuity of care there has been little research about the views of patients. In this cross sectional study 111 patients from three group practices (one of which ran a personal list system) were interviewed at home within a week of consulting a general practitioner. Patients were selected randomly from a systematic series of consulting sessions and a semi-structured interview was administered. Patients receiving more personal continuity of care were likely to be older, to have booked their most recent appointment further in advance, to desire personal continuity of care, to have an external health locus of control and to have a lower extroversion score. In the practice with a personal list, patients had a high level of continuity of care, were satisfied and showed little interest in having a choice of doctor. In the combined list practices patients valued their choice of doctor but often could not exercise it enough and they were more critical. They made more suggestions for change than those in the practice with a personal list system, mostly about receptionists and appointments. It is concluded that most patients like to see the same doctor, but they may not be willing to wait two days for this if there is a quicker option. It may be difficult to deliver both personal continuity of care and choice in group practice. PMID:8312019
Experience of Subjective Symptoms in Euthymic Patients with Bipolar Disorder
Joe, Soohyun; Joo, Yeonho
Bipolar patients often experience subjective symptoms even if they do not have active psychotic symptoms in their euthymic state. Most studies about subjective symptoms are conducted in schizophrenia, and there are few studies involving bipolar patients. We examined the nature of the subjective symptoms of bipolar patients in their euthymic state, and we also compared it to that of schizophrenia and normal control. Thirty bipolar patients, 25 patients with schizophrenia, and 21 normal control subjects were included. Subjective symptoms were assessed using the Korean version of the Frankfurter Beschwerde Fragebogen (K-FBF) and the Symptom Check List 90-R (SCL90-R). Euthymic state was confirmed by assessing objective psychopathology with the Positive and Negative Syndrome scale of Schizophrenia (PANSS), the Young Mania Rating Scale (YMRS), and the Montgomery Asberg Depression Rating Scale (MADRS). K-FBF score was significantly higher in bipolar patients than in normal controls, but similar to that in schizophrenia patients (F=5.86, p=0.004, R2=2033.6). In contrast, SCL90-R scores did not differ significantly among the three groups. Euthymic bipolar patients experience subjective symptoms that are more confined to cognitive domain. This finding supports the hypothesis that subtle cognitive impairments persists in euthymic bipolar patients. PMID:18303193
Experience of subjective symptoms in euthymic patients with bipolar disorder.
Joe, Soohyun; Joo, Yeonho; Kim, Seongyoon
Bipolar patients often experience subjective symptoms even if they do not have active psychotic symptoms in their euthymic state. Most studies about subjective symptoms are conducted in schizophrenia, and there are few studies involving bipolar patients. We examined the nature of the subjective symptoms of bipolar patients in their euthymic state, and we also compared it to that of schizophrenia and normal control. Thirty bipolar patients, 25 patients with schizophrenia, and 21 normal control subjects were included. Subjective symptoms were assessed using the Korean version of the Frankfurter Beschwerde Fragebogen (K-FBF) and the Symptom Check List 90-R (SCL90-R). Euthymic state was confirmed by assessing objective psychopathology with the Positive and Negative Syndrome scale of Schizophrenia (PANSS), the Young Mania Rating Scale (YMRS), and the Montgomery Asberg Depression Rating Scale (MADRS). K-FBF score was significantly higher in bipolar patients than in normal controls, but similar to that in schizophrenia patients (F=5.86, p=0.004, R2=2033.6). In contrast, SCL90-R scores did not differ significantly among the three groups. Euthymic bipolar patients experience subjective symptoms that are more confined to cognitive domain. This finding supports the hypothesis that subtle cognitive impairments persists in euthymic bipolar patients. PMID:18303193
The Relationship Between Personality Traits, Flow-Experience, and Different Aspects of Practice Behavior of Amateur Vocal Students.
Heller, Katharina; Bullerjahn, Claudia; von Georgi, Richard
Most of the existing studies on musical practice are concerned with instrumentalists only. Since singers are seldom considered in research, the present study is based on an online-sample of amateur vocal students (N = 120; 92 female, 28 male). The study investigated the correlations between personality traits, flow-experience and several aspects of practice characteristics. Personality was represented by the three personality dimensions extraversion, neuroticism and psychoticism, assessed by Eysenck's Personality Profiler as well as the trait form of the Positive and Negative Affect Schedule. 'Flow-experience,' 'self-congruence' and 'fear of losing control over concentration,' assessed by the Practice Flow Inventory, served as variables for flow-experience. The practice motivation was measured by the Practice Motivation Questionnaire in four categories ('self,' 'group,' 'audience,' 'teacher'). In addition, the Practice Behavior Questionnaire was used to provide an insight into the practice situation and behavior of singing students. The results show significant correlations: participants with high extraversion-scores experience significantly more flow than less extraverted persons, whereas lesser flow-experience seems to be related to high neuroticism-scores. Nevertheless, there is no influence in flow-experience concerning singing style ('classical' or 'popular'). The longer the practicing time, the more likely students are to achieve flow-experience. However, older singers tend to have less flow-experience. Consequently, singers seem to differ in their personality and practice behavior compared to other musicians. Most of the findings show that having control over one's instrument is decisive for achieving a performance of high quality, especially for singers. On the other hand, certainty in handling an instrument is essential to arouse a flow-feeling. However, flow-experience seems to be common mainly with amateur singers. In conclusion, this offers a starting
The relationship between personality traits and AIDS in patients with human immunodeficiency virus.
Salehi, Bahman; Zarinfar, Nader; Noori, Hasan
This study carried out to survey the relationship between personality traits and Acquired Immunodeficiency Syndrome (AIDS) in patients with human immunodeficiency virus. This case-control study was conducted on 79 AIDS patients of Triangle Clinic in Arak (case group) and 80 healthy people of Valiasr Hospital in Arak (control group). Demographic information checklist and Cloninger' Temperament and Character inventory (TCI) were two instruments applied in the study. SPSS software V.19 and tests independent t-tests, Chi squared and Spearman correlation coefficient were used for data analysis with significant level of <0.05. The average of innovativeness variables (M:74.12), harm avoidance (M: 65.17), reward dependence (M:50.030), and self-directedness (M:35.02) in case group in comparison with control group was significantly higher, and there was a significant difference between two groups variables (P-0.000). The novelty seeking had the highest average in the AIDS patients with a history of addiction (M:74.00), and there was statistically significant difference between perseverance variable (P-0.021) and cooperativeness variable (P-0.041) in the two groups of AIDS patients. There was a significant relationship between novelty seeking and age at the onset of AIDS (P-0.038), harm avoidance and age at the onset of addiction (P-0.046), persistence and age at the onset of AIDS (P-0.035) and the time infected with HIV (P-0.033). It is found that two groups are different due to the personalities, so it is essential to consider the personality traits in order to prevent AIDS and also successfully treat patients suffering from AIDS. PMID:27208456
Compliance on neuropsychological performance validity testing in patients with borderline personality disorder.
Ruocco, Anthony C
Complaints of cognitive dysfunction are common in patients with borderline personality disorder (BPD), and they are often accompanied by deficits on neuropsychological testing. Prior studies of BPD, however, did not evaluate compliance on neuropsychological performance validity testing, which could partially account for cognitive deficits observed in patients. The aims of the current study were to evaluate the frequency at which patients with BPD show less than adequate compliance on performance validity testing, and whether patients showing less compliance perform lower on standardized neuropsychological measures. Fifty outpatients with BPD completed the Victoria Symptom Validity Test, a 2-alternative, forced-choice recognition test as part of a larger neuropsychological test battery for research on cognitive functioning in BPD. As a group, patients with BPD made more errors and had longer response latencies on seemingly difficult items as compared to healthy individuals. Based on established guidelines for interpretation of performances on the Victoria Symptom Validity Test, 2% of the sample was classified as probably not compliant, 10% questionably compliant, and 88% compliant. Patients with questionably or probably not compliant performances had lower estimated premorbid intellectual functioning and displayed poorer response control on neuropsychological testing than compliant patients. These findings highlight the value of incorporating performance validity testing in neuropsychological studies of patients with BPD and suggest that prior research on the disorder should be interpreted with caution because the results may not be based on valid performances. (PsycINFO Database Record PMID:26121384
Understanding Statin Non-Adherence: Knowing Which Perceptions and Experiences Matter to Different Patients
Wouters, Hans; Van Dijk, Liset; Geers, Harm C. J.; Winters, Nina A.; Van Geffen, Erica C. G.; Stiggelbout, Anne M.; Bouvy, Marcel L.
Background Non-adherence to statins is substantial and is associated with numerous perceptions and experiences. However, time limits in clinical practice constrain in depth explorations of these perceptions and experiences. Objectives To propose and examine a strategy aimed at an efficient assessment of a wide array of perceptions and experiences regarding the efficacy, side effects, and practical problems of statins. Furthermore, to assess associations between this wide array of experiences and perceptions and non-adherence and to examine whether patients' 'perceived self-efficacy' moderated these associations. Methods Patients were recruited through community pharmacies. A wide array of specific patient perceptions and experiences was efficiently assessed using the electronic Tailored Medicine Inventory that allows people to skip irrelevant questions. Adherence was measured through self-report and pharmacy refill data. Results Of the two-hundred twenty-nine patients who participated (mean age 63.9, standard deviation 10.2), 40%-70% doubted the necessity of or lacked knowledge about the efficacy of statins, 20%-35% of the patients were worried about joint and muscle side effects or had experienced these, and 23% had encountered practical problems regarding information about statins, intake of tablets, the package, or the blister. Experiencing more practical problems was associated with increased unintentional non-adherence (Odds ratio 1.54, 95%CI:1.13–2.10, P < 0.01), whereas worrying about side effects was associated with increased intentional non-adherence (Odds ratio 1.90, 95%CI:1.17–3.08, P < 0.01). Higher 'perceived self-efficacy' did not moderate these associations. Conclusions Insight into patients' specific barriers with regard to appropriate statin use may reveal personal reasons for being non-adherent. The Tailored Medicine Inventory is a promising tool to devise individualized intervention strategies aimed at improving adherence by the clinician-patient
Experiences of stigma and discrimination among caregivers of persons with schizophrenia in China: a field survey.
Yin, Yi; Zhang, Weijun; Hu, Zhenyu; Jia, Fujun; Li, Yafang; Xu, Huiwen; Zhao, Shuliang; Guo, Jing; Tian, Donghua; Qu, Zhiyong
In China, caregivers for family members with schizophrenia play an important role in treatment and recovery but may experience stigma and discrimination simply because of their family relationship. The object of this study was to measure the degrees and correlates of stigma and discrimination experiences among this group. Four hundred twenty-seven caregivers participated in this hospital-based and cross-sectional study in Ningbo and Guangzhou, China. Data were collected by trained interviewers using fixed questionnaires. Stigma and discrimination experiences were measured by the Modified Consumer Experiences of Stigma Questionnaire (MCESQ). Caregivers' social support was measured by the Social Support Rating Scale. Parametric analysis, nonparametric analysis and multivariate linear regression were used. The mean (SD) score of MCESQ was 2.44(0.45), 2.91(0.71) for stigma experiences and 1.97(0.37) for discrimination experiences on a five-point score ("1 = never" and "5 = very often"). Approximately 65% of caregivers reported that they tried to conceal their family members' illness, and 71% lacked the support of friends. The experience of stigma was significantly negatively associated with the perceived social support of caregivers (standard β = -0.2,p<0.001). Caregivers who were children of the patients experienced fewer stigmas than other (standard β = -0.18, p<0.001). Urban residence (standard β = -0.12, p<0.01) and patients did not complete primary school education (standard β = -0.13, p<0.01) were negatively related with stigmas. In addition, stigma and discrimination was more experienced in Zhejiang than in Guangdong (p<0.05). In conclusion, this study performed that caregivers of people with schizophrenia in China experienced general stigmas and rare discrimination and found the relations with social support, kinship, patient's educational level and regional differences. More interventions and supports should been given to caregivers
Grief and Personal Growth Experience of Spouses and Adult-Child Caregivers of Individuals with Alzheimer's Disease and Related Dementias
ERIC Educational Resources Information Center
Ott, Carol H.; Sanders, Sara; Kelber, Sheryl T.
Purpose: The purpose of this study was to describe the grief and personal growth experience of spouses and adult children of individuals with Alzheimer's disease and related dementias and the factors contributing to these experiences. Design and Methods: We used a modification of the Marwit-Meuser-Sanders Caregiver Grief model to examine the…
A Personal Counseling Experience for Master's Level Counseling Students: Practices and Perceptions of Counselor Education Program Directors
ERIC Educational Resources Information Center
UnKauf, Kristen Guidry
There exists a strong endorsement in the literature of the effectiveness of an individual counseling experience as an influence in the personal and professional development of counseling students, yet few counselor education programs seem to require that students complete such an experience. Thus, the question arises as to why the required…
How Do You Know You're Old? Gender Differences in Cues Triggering the Experience of Personal Aging
ERIC Educational Resources Information Center
Panek, Paul E.; Hayslip, Bert, Jr.; Pruett, Jessica H.
In order to evaluate the gender differences on the experience of aging, 142 individuals 50 years of age and older completed an interview regarding experiences with another individual conveying the message that they were "old." Interviewees were asked about the type of situation, the age and gender of the response person, and the…
Chest wall reconstruction. Experience with 100 consecutive patients.
Arnold, P G; Pairolero, P C
Experience with 100 consecutive chest wall reconstructions during the past 7 years was reviewed. There were 52 female and 48 male patients with ages ranging from 13 to 78 years (average 53). Of the 100 patients, 42 had tumors of the chest wall, 19 had radiation necrosis, 24 had infected median sternotomies , and 15 had combinations of the three. Seventy-six patients underwent skeletal resection of the chest wall. An average of 5.7 ribs were resected in 63 patients. Total or partial sternectomies were performed in 29. Ninety-two patients underwent 142 muscle flaps: 77 pectoralis major, 29 latissimus dorsi, and 36 other muscles, including serratus anterior, rectus abdominis, and external oblique muscles. The omentum was transposed in ten patients. Chest wall skeletal defects were closed with Prolene mesh in 29 patients and with autogenous ribs in 11. Eighty-nine patients underwent primary closure of the skin. The 100 patients underwent an average of 2.1 operations. Hospitalization averaged 17.5 days. There was one perioperative death (29 days). Two patients required tracheostomy. Follow-up averaged 21.6 months. There were 24 late deaths. All 99 patients who were alive 30 days after operation had excellent results at the time of death or last follow-up. Images Figs. 2A-D. Figs. 3A-F. Figs. 4A-D. Figs. 4A-D. Fig. 5. Fig. 5. PMID:6732314
Creating the Exceptional Patient Experience in One Academic Health System.
Lee, Vivian S; Miller, Thomas; Daniels, Chrissy; Paine, Marilynn; Gresh, Brian; Betz, A Lorris
Whether patient satisfaction scores can act as a catalyst for improving health care is highly debated. Some argue that pursuing patient satisfaction is overemphasized and potentially at odds with providing good care because it leads providers to overtest and overtreat patients and to bend to unreasonable patient demands, all to improve their ratings. Others cite studies showing that high patient satisfaction scores correlate with improved health outcomes. Ideally, assessing patient satisfaction metrics will encourage empathy, communication, trust, and shared decision making in the health care delivery process. From the patient's perspective, sharing such metrics motivates physicians to provide patient-centered care and meets their need for easily accessible information about their providers. In this article, the authors describe a seven-year initiative, which began in 2008, to change the culture of the University of Utah Health Care system to deliver a consistently exceptional patient experience. Five factors affected the health system's ability to provide such care: (1) a lack of good decision-making processes, (2) a lack of accountability, (3) the wrong attitude, (4) a lack of patient focus, and (5) mission conflict. Working groups designed initiatives at all levels of the health system to address these issues. What began as a patient satisfaction initiative evolved into a model for physician engagement, values-based employment practices, enhanced professionalism and communication, reduced variability in performance, and improved alignment of the mission and vision across hospital and faculty group practice teams. PMID:26606723
Experience of pleasure and emotional expression in individuals with schizotypal personality features.
Shi, Yan-fang; Wang, Yi; Cao, Xiao-yan; Wang, Ya; Wang, Yu-na; Zong, Ji-gang; Xu, Ting; Tse, Vincent W S; Hsi, Xiao-lu; Stone, William S; Lui, Simon S Y; Cheung, Eric F C; Chan, Raymond C K
Difficulties in feeling pleasure and expressing emotions are one of the key features of schizophrenia spectrum conditions, and are significant contributors to constricted interpersonal interactions. The current study examined the experience of pleasure and emotional expression in college students who demonstrated high and low levels of schizotypal personality disorder (SPD) traits on self-report questionnaires. One hundred and seventeen subjects with SPD traits and 116 comparison controls were recruited to participate. Cluster analyses conducted in the SPD group identified negative SPD and positive SPD subgroups. The negative SPD group exhibited deficient emotional expression and anticipatory pleasure, but showed intact consummatory pleasure. The positive SPD group reported significantly greater levels of anticipatory, consummatory and total pleasure compared to the control group. Both SPD groups reported significantly more problems in everyday memory and greater levels of depressive and anxiety-related symptoms. PMID:22615731
Experiences of persons with multiple chemical sensitivity with mental health providers
Gibson, Pamela Reed; Lockaby, Sharon D; Bryant, Jenna Michele
In this paper, we summarize the results of an online survey of persons in the United States with chemical intolerance/multiple chemical sensitivity who sought help from mental health providers, including counselors, psychologists, psychiatrists, and others. Respondents reported on their most recent contact with a provider, describing reasons for the contact, accommodations requested and received, and suggestions for how the experience could be more helpful. Overall, though clients were accommodated in small ways, some received no accommodation, and many felt that the providers needed to be more knowledgeable regarding chemical intolerance. Results are discussed in terms of the importance of providers becoming more aware of multiple chemical sensitivity and more willing to make their services accessible to these clients. PMID:27103817
Community health nursing practices in contexts of poverty, uncertainty and unpredictability: a systematization of personal experiences.
Laperrière, Hélène
Several years of professional nursing practices, while living in the poorest neighbourhoods in the outlying areas of Brazil's Amazon region, have led the author to develop a better understanding of marginalized populations. Providing care to people with leprosy and sex workers in riverside communities has taken place in conditions of uncertainty, insecurity, unpredictability and institutional violence. The question raised is how we can develop community health nursing practices in this context. A systematization of personal experiences based on popular education is used and analyzed as a way of learning by obtaining scientific knowledge through critical analysis of field practices. Ties of solidarity and belonging developed in informal, mutual-help action groups are promising avenues for research and the development of knowledge in health promotion, prevention and community care and a necessary contribution to national public health programmers. PMID:17934576
Experiences in the creation of an electromyography database to help hand amputated persons.
Atzori, Manfredo; Gijsberts, Arjan; Heynen, Simone; Hager, Anne-Gabrielle Mittaz; Castellimi, Claudio; Caputo, Barbara; Müller, Henning
Currently, trans-radial amputees can only perform a few simple movements with prosthetic hands. This is mainly due to low control capabilities and the long training time that is required to learn controlling them with surface electromyography (sEMG). This is in contrast with recent advances in mechatronics, thanks to which mechanical hands have multiple degrees of freedom and in some cases force control. To help improve the situation, we are building the NinaPro (Non-Invasive Adaptive Prosthetics) database, a database of about 50 hand and wrist movements recorded from several healthy and currently very few amputated persons that will help the community to test and improve sEMG-based natural control systems for prosthetic hands. In this paper we describe the experimental experiences and practical aspects related to the data acquisition. PMID:22874308
Effects of virtual human animation on emotion contagion in simulated inter-personal experiences.
Wu, Yanxiang; Babu, Sabarish V; Armstrong, Rowan; Bertrand, Jeffrey W; Luo, Jun; Roy, Tania; Daily, Shaundra B; Dukes, Lauren Cairco; Hodges, Larry F; Fasolino, Tracy
We empirically examined the impact of virtual human animation on the emotional responses of participants in a medical virtual reality system for education in the signs and symptoms of patient deterioration. Participants were presented with one of two virtual human conditions in a between-subjects experiment, static (non-animated) and dynamic (animated). Our objective measures included the use of psycho-physical Electro Dermal Activity (EDA) sensors, and subjective measures inspired by social psychology research included the Differential Emotions Survey (DES IV) and Positive and Negative Affect Survey (PANAS). We analyzed the quantitative and qualitative measures associated with participants emotional state at four distinct time-steps in the simulated interpersonal experience as the virtual patients medical condition deteriorated. Results suggest that participants in the dynamic condition with animations exhibited a higher sense of co-presence and greater emotional response as compared to participants in the static condition, corresponding to the deterioration in the medical condition of the virtual patient. Negative affect of participants in the dynamic condition increased at a higher rate than for participants in the static condition. The virtual human animations elicited a stronger response in negative emotions such as anguish, fear, and anger as the virtual patients medical condition worsened. PMID:24650990
Intrinsic Brain Activity of Cognitively Normal Older Persons Resembles More That of Patients Both with and at Risk for Alzheimer's Disease Than That of Healthy Younger Persons
Pasquini, Lorenzo; Tonch, Annika; Plant, Claudia; Zherdin, Andrew; Ortner, Marion; Kurz, Alexander; Förstl, Hans; Zimmer, Claus; Grimmer, Timo; Wohlschäger, Afra; Riedl, Valentin
Abstract In Alzheimer's disease (AD), recent findings suggest that amyloid-β (Aβ)-pathology might start 20–30 years before first cognitive symptoms arise. To account for age as most relevant risk factor for sporadic AD, it has been hypothesized that lifespan intrinsic (i.e., ongoing) activity of hetero-modal brain areas with highest levels of functional connectivity triggers Aβ-pathology. This model induces the simple question whether in older persons without any cognitive symptoms intrinsic activity of hetero-modal areas is more similar to that of symptomatic patients with AD or to that of younger healthy persons. We hypothesize that due to advanced age and therefore potential impact of pre-clinical AD, intrinsic activity of older persons resembles more that of patients than that of younger controls. We tested this hypothesis in younger (ca. 25 years) and older healthy persons (ca. 70 years) and patients with mild cognitive impairment and AD-dementia (ca. 70 years) by the use of resting-state functional magnetic resonance imaging, distinct measures of intrinsic brain activity, and different hierarchical clustering approaches. Independently of applied methods and involved areas, healthy older persons' intrinsic brain activity was consistently more alike that of patients than that of younger controls. Our result provides evidence for larger similarity in intrinsic brain activity between healthy older persons and patients with or at-risk for AD than between older and younger ones, suggesting a significant proportion of pre-clinical AD cases in the group of cognitively normal older people. The observed link of aging and AD with intrinsic brain activity supports the view that lifespan intrinsic activity may contribute critically to the pathogenesis of AD. PMID:24689864
Personality disorders in heart failure patients requiring psychiatric management: comorbidity detections from a routine depression and anxiety screening protocol.
Tully, Phillip J; Selkow, Terina
Several international guidelines recommend routine depression screening in cardiac disease populations. No previous study has determined the prevalence and comorbidities of personality disorders in patients presenting for psychiatric treatment after these screening initiatives. In the first stage 404 heart failure (HF) patients were routinely screened and 73 underwent structured interview when either of the following criteria were met: (a) Patient Health Questionnaire ≥10; (b) Generalized Anxiety Disorder Questionnaire ≥7); (c) Response to one item panic-screener. Or (d) Suicidality. Patients with personality disorders were compared to the positive-screen patients on psychiatric comorbidities. The most common personality disorders were avoidant (8.2%), borderline (6.8%) and obsessive compulsive (4.1%), other personality disorders were prevalent in less than <3% of patients. Personality disorder patients had significantly greater risk of major depression (risk ratio (RR) 1.2; 95% confidence interval (CI) 1.2-13.3), generalized anxiety disorder (RR 3.2; 95% CI 1.0-10.0), social phobia (RR 3.8; 95% CI 1.3-11.5) and alcohol abuse/dependence (RR 3.2; 95% 1.0-9.5). The findings that HF patients with personality disorders presented with complex psychiatric comorbidity suggest that pathways facilitating the integration of psychiatric services into cardiology settings are warranted when routine depression screening is in place. PMID:25238983
Improving patients' and staff's experiences of acute care.
Chaplin, Rob; Crawshaw, Jacob; Hood, Chloe
The aim of this audit was to assess the effect of the Quality Mark programme on the quality of acute care received by older patients by comparing the experiences of staff and older adults before and after the programme. Data from 31 wards in 12 acute hospitals were collected over two stages. Patients and staff completed questionnaires on the perceived quality of care on the ward. Patients rated improved experiences of nutrition, staff availability and dignity. Staff received an increase in training and reported better access to support, increased time and skill to deliver care and improved morale, leadership and teamwork. Problems remained with ward comfort and mealtimes. Overall, results indicated an improvement in ratings of care quality in most domains during Quality Mark data collection. Further audits need to explore ways of improving ward comfort and mealtime experience. PMID:25727634
A Composite Measure of Personal Financial Burden Among Patients With Stage III Colorectal Cancer
Veenstra, Christine M.; Regenbogen, Scott E.; Hawley, Sarah T.; Griggs, Jennifer J.; Banerjee, Mousumi; Kato, Ikuko; Ward, Kevin C.; Morris, Arden M.
Background Despite improved survival with chemotherapy for stage III colorectal cancer (CRC), patients may suffer substantial economic hardship during treatment. Methods for quantifying financial burden in CRC patients are lacking. Objective To derive and validate a novel patient-reported measure of personal financial burden during CRC treatment. Data Collection Within a population-based survey of patients in the Detroit and Georgia Surveillance, Epidemiology and End Results regions diagnosed with stage III CRC between 2011 and 2013, we asked 7 binary questions assessing effects of disease and treatment on personal finances. Data Analysis We used factor analysis to compute a composite measure of financial burden. We used χ2 tests to evaluate relationships between individual components of financial burden and chemotherapy use with χ2 analyses. We used Mantel-Haenszel χ2 trend tests to examine relationships between the composite financial burden metric and chemotherapy use. Results Among 956 patient surveys (66% response rate), factor analysis of 7 burden items yielded a single-factor solution. Factor loadings of 6 items were >0.4; these were included in the composite score. Internal consistency was high (Cronbach α = 0.79). The mean financial burden score among all respondents was 1.72 (range, 0–6). The 812 (85%) who reported chemotherapy use had significantly higher financial burden scores than those who did not (mean burden score 1.88 vs. 0.88, P < 0.001). Conclusions Financial burden is high among CRC patients, particularly those who use adjuvant chemotherapy. We encourage use of our instrument to validate our measure in the identification of patients in need of additional financial support during treatment. PMID:25304021
Efficacy and tolerability of aripiprazole augmentation in sertraline-resistant patients with borderline personality disorder.
Bellino, Silvio; Paradiso, Erika; Bogetto, Filippo
Information is available on aripiprazole as a treatment for borderline personality disorder (BPD), but no data have yet been presented concerning the use of this drug as an adjunctive treatment for drug-resistant BPD patients. This study investigates aripiprazole augmentation of ongoing sertraline therapy in drug-resistant BPD patients. Twenty-one outpatients with a DSM-IV-TR diagnosis of BPD who did not respond to sertraline, 100-200 mg/day for 12 weeks, were treated for 12 weeks with the addition of aripiprazole, 10-15 mg/day. Patients were assessed at baseline, week 4, and week 12 with the Clinical Global Impression Scale - Severity item (CGI-S), the Brief Psychiatric Rating Scale (BPRS), the Hamilton scales for depression and anxiety (HAM-D, HAM-A), the Social Occupational Functioning Assessment Scale (SOFAS) for social functioning, the Borderline Personality Disorder Severity Index (BPDSI), and the Barratt Impulsiveness Scale (BIS-11). Adverse effects were evaluated using the Dosage Record and Treatment Emergent Symptom Scale (DOTES). Sixteen patients completed the study. Five patients (23.8%) dropped out due to anxiety/insomnia or non-compliance. Nine patients (56.3%) were responders. Analysis of variance revealed significant changes in the following measures: CGI-S, BPRS, BPDSI total score, BPDSI "impulsivity" and "dissociation/paranoid ideation" items, and BIS-11. Adverse effects were mild headache, insomnia, and anxiety. Aripiprazole is an efficacious and well-tolerated add-on treatment for sertraline-resistant BPD patients. It acts on impulsive and psychotic-like symptoms. PMID:18848360
Personality profiles and coping styles in migraine patients with fibromyalgia comorbidity.
de Tommaso, Marina; Federici, Antonio; Loiacono, Anna; Delussi, Marianna; Todarello, Orlando
Fibromyalgia syndrome (FM) is frequently associated with migraine. In this study we aimed to compare personality profiles and coping styles across 23 migraine without aura patients sharing FM comorbidity (MWA-FM), 28 migraine without aura patients without FM symptoms (MWA) and 51 age- and sex-matched controls, by means of Big Five Questionnaire (BFQ) and Coping Orientation to Problem Experienced (COPE), and to correlate main results with clinical features. The "Energy" personality factor was significantly reduced in patients presenting with FM symptoms, compared to both migraine without aura patients and controls. A low score in "Dynamism" sub-item with a high score in denial coping style was able to distinguish MWA from MW-FM groups with an accuracy of 82.35% (Wilks lambda=0.98; chi-square=8.99, DF=1, p=0.005). In particular, lower "Dynamism" scores corresponded to a major expression of allodynia, fatigue, anxiety, depression, headache frequency and poor quality of sleep and life. Avoidance from active coping with stressful events may facilitate worsening of migraine and fibromyalgia comorbidity. PMID:24138956
Pain in Hospice Patients With Dementia: The Informal Caregiver Experience
Tarter, Robin; Demiris, George; Pike, Kenneth; Washington, Karla; Oliver, Debra Parker
Introduction At the end of life, patients with dementia often experience high levels of pain due to complex interplay of disease processes and numerous barriers to symptom management. In the hospice setting, informal caregivers play an essential role in pain management. This study describes their experience managing pain in hospice patients with dementia. Methods We conducted a qualitative analysis of audio-recorded interviews with informal caregivers of hospice patients with dementia who had chosen pain as the challenge they wanted to work on within a problem-solving therapy intervention. Results The thematic analysis of sessions with 51 caregivers identified 4 themes: difficulty in communicating with patients, lack of consistent guidance from health-care professionals, perceived uncertainty about the etiology of pain, and secondary suffering. Discussion Our findings indicate the possible need for increased support for caregivers, including educational interventions targeting pain etiology and assessment, and improved communication with health-care professionals. PMID:27303062
[Nursing experience with an lymphangioleiomyomatosis patient with chylothorax].
Sung, Rung-Ping; Jong, Shwu-Yuan; Lu, Pi-Chen
This article discusses experience providing nursing care to a patient suffering from Lymphangioleiomyomatosis who was re-hospitalized for recurrence of chylothorax complications, which caused dyspnea, sterility and mental instability. Based on parameters provided by Roy's adaptation model, the patient was identified as suffering from respiratory impairment, acute pain, sleep pattern disturbance and low self-esteem. Data was collected through interviews, observation and physical assessments. During the course of providing nursing care, the author established a good relationship with the patient through devoted attention to the patient's needs and by actively caring, listening and accompanying. Increased family member visits and interaction, resulting from the author's urgings, gave the patient added support and consolation. Eventually, the author gained the trust of the patient, who, in turn, regained self-control as well as physical and sociopsychological adaptabilities. Clinical nursing must attend to the physical care needs of patients as well as patient mental wellness, the latter of which extends beyond the disease itself, in order to achieve a truly comprehensive quality of nursing care. We are glad to share this successful experience with others in the nursing profession. PMID:16874609
Experiences of Patients on Outpatient Hemodialysis Therapy Who Are Anticipating a Transplant.
Moran, Aoife
The person with kidney failure may experience many lifestyle disruptions that initiate distressing responses. This article reports on the results of a phenomenological study that explored the experiences of patients with kidney failure who were receiving outpatient hemodialysis therapy and who were either on the transplant list or in the process of being assessed to get on the transplant list. The participants described the existential distress they endured as a result of living with this disease and treatment; however, the participants' descriptions of distress were different than the psychological perspective of emotional distress depicted in the existing research. The information provided in this article can enhance nurses' ability to recognize and respond more appropriately to the distressing moods experienced by patients with kidney failure on outpatient hemodialysis. PMID:27501631
Neural Response during the Activation of the Attachment System in Patients with Borderline Personality Disorder: An fMRI Study
Buchheim, Anna; Erk, Susanne; George, Carol; Kächele, Horst; Martius, Philipp; Pokorny, Dan; Spitzer, Manfred; Walter, Henrik
Individuals with borderline personality disorder (BPD) are characterized by emotional instability, impaired emotion regulation and unresolved attachment patterns associated with abusive childhood experiences. We investigated the neural response during the activation of the attachment system in BPD patients compared to healthy controls using functional magnetic resonance imaging (fMRI). Eleven female patients with BPD without posttraumatic stress disorder (PTSD) and 17 healthy female controls matched for age and education were telling stories in the scanner in response to the Adult Attachment Projective Picture System (AAP), an eight-picture set assessment of adult attachment. The picture set includes theoretically-derived attachment scenes, such as separation, death, threat and potential abuse. The picture presentation order is designed to gradually increase the activation of the attachment system. Each picture stimulus was presented for 2 min. Analyses examine group differences in attachment classifications and neural activation patterns over the course of the task. Unresolved attachment was associated with increasing amygdala activation over the course of the attachment task in patients as well as controls. Unresolved controls, but not patients, showed activation in the right dorsolateral prefrontal cortex (DLPFC) and the rostral cingulate zone (RCZ). We interpret this as a neural signature of BPD patients' inability to exert top-down control under conditions of attachment distress. These findings point to possible neural mechanisms for underlying affective dysregulation in BPD in the context of attachment trauma and fear. PMID:27531977
Does the Integration of Personalized Ultrasound Change Patient Management in Critical Care Medicine? Observational Trials
Breitkreutz, Raoul; Campo delľ Orto, Marco; Hamm, Christian; Cuca, Colleen; Zechner, Peter M.; Stenger, Tanja; Walcher, Felix; Seeger, Florian H.
Objective. To test the influence of personalized ultrasound (PersUS) on patient management in critical care. Design of the Study. Prospective, observational, and critical care setting. Four substudies compared PersUS and mobile ultrasound, work distribution, and diagnostic and procedural quality. Patients and Interventions. 640 patient ultrasound exams including 548 focused diagnostic exams and 92 interventional procedures. Main Outcome Measures. Number of studies, physician's judgement of feasibility, time of usage per patient, and referrals to echo lab. Results. Randomized availability of PersUS increased its application in ICU work shifts more than twofold from 33 to 68 exams mainly for detection and therapy of effusions. Diagnostic and procedural quality was rated as excellent/very good in PersUS-guided puncture in 95% of cases. Integrating PersUS within an initial physical examination of 48 randomized cases in an emergency department, PersUS extended the examination time by 100 seconds. Interestingly, PersUS integration into 53 randomized regular ward rounds of 1007 patients significantly reduced average contact time per patient by 103 seconds from 8.9 to 7.2 minutes. Moreover, it lowered the patient referral rate to an echo lab from 20% to 2% within the study population. Conclusions. We propose the development of novel ultrasound-based clinical pathways by integration of PersUS. PMID:24455272
Does the integration of personalized ultrasound change patient management in critical care medicine? Observational trials.
Breitkreutz, Raoul; Campo Delľ Orto, Marco; Hamm, Christian; Cuca, Colleen; Zechner, Peter M; Stenger, Tanja; Walcher, Felix; Seeger, Florian H
Objective. To test the influence of personalized ultrasound (PersUS) on patient management in critical care. Design of the Study. Prospective, observational, and critical care setting. Four substudies compared PersUS and mobile ultrasound, work distribution, and diagnostic and procedural quality. Patients and Interventions. 640 patient ultrasound exams including 548 focused diagnostic exams and 92 interventional procedures. Main Outcome Measures. Number of studies, physician's judgement of feasibility, time of usage per patient, and referrals to echo lab. Results. Randomized availability of PersUS increased its application in ICU work shifts more than twofold from 33 to 68 exams mainly for detection and therapy of effusions. Diagnostic and procedural quality was rated as excellent/very good in PersUS-guided puncture in 95% of cases. Integrating PersUS within an initial physical examination of 48 randomized cases in an emergency department, PersUS extended the examination time by 100 seconds. Interestingly, PersUS integration into 53 randomized regular ward rounds of 1007 patients significantly reduced average contact time per patient by 103 seconds from 8.9 to 7.2 minutes. Moreover, it lowered the patient referral rate to an echo lab from 20% to 2% within the study population. Conclusions. We propose the development of novel ultrasound-based clinical pathways by integration of PersUS. PMID:24455272
Personality traits associated with suicidal behaviors in patients with depression: the CRESCEND study.
Seo, Ho-Jun; Jung, Young-Eun; Jeong, Seunghee; Kim, Jung-Bum; Lee, Min-Soo; Kim, Jae-Min; Yim, Hyeon Woo; Jun, Tae-Youn
The aim of the current study was to identify personality traits associated with suicidal behavior in patients with depression. Of the 1183 patients screened for an observational cohort study of depression, 334 (28.2%) who completed the Temperament and Character Inventory (TCI) were included in these analyses. To minimize the effect of current mood state, the TCI was performed 12 weeks after initiation of treatment, and we adjusted for the severity of depression. Of the 344 participants, 59 had a lifetime history of at least one suicide attempt, 37 had a lifetime history of multiple suicide attempts, and 5 attempted suicide during the 12-week study period. At baseline, patients with a lifetime history of at least one suicide attempt, a lifetime history of multiple suicide attempts, and a suicide attempt during the study period expressed more serious current suicidal ideation than did those without such a history, despite the absence of differences among the groups in the severity of depressive and anxiety symptoms. Of the seven personality scales of the TCI, lower scores on the self-directedness scale of the character dimension were associated with a history of at least one suicide attempt (OR [95% CI], 0.91 [0.87-0.96]; p<0.001), a history of multiple suicide attempts (0.91 [0.86-0.97]; p=0.003), and suicide attempts during study period (0.80 [0.69-0.94]; p=0.006). These findings suggest that depressed patients with a history of suicidal behavior differ from non-attempters with regard to personality traits, especially the character dimension of self-directedness. It is noteworthy that this result emerged after controlling for the effect of current mood state. PMID:24794639
Creating the Exceptional Patient Experience in One Academic Health System
Miller, Thomas; Daniels, Chrissy; Paine, Marilynn; Gresh, Brian; Betz, A. Lorris
Whether patient satisfaction scores can act as a catalyst for improving health care is highly debated. Some argue that pursuing patient satisfaction is overemphasized and potentially at odds with providing good care because it leads providers to overtest and overtreat patients and to bend to unreasonable patient demands, all to improve their ratings. Others cite studies showing that high patient satisfaction scores correlate with improved health outcomes. Ideally, assessing patient satisfaction metrics will encourage empathy, communication, trust, and shared decision making in the health care delivery process. From the patient's perspective, sharing such metrics motivates physicians to provide patient-centered care and meets their need for easily accessible information about their providers. In this article, the authors describe a seven-year initiative, which began in 2008, to change the culture of the University of Utah Health Care system to deliver a consistently exceptional patient experience. Five factors affected the health system's ability to provide such care: (1) a lack of good decision-making processes, (2) a lack of accountability, (3) the wrong attitude, (4) a lack of patient focus, and (5) mission conflict. Working groups designed initiatives at all levels of the health system to address these issues. What began as a patient satisfaction initiative evolved into a model for physician engagement, values-based employment practices, enhanced professionalism and communication, reduced variability in performance, and improved alignment of the mission and vision across hospital and faculty group practice teams. PMID:26606723
Patients' experiences of absconding from a psychiatric setting in Indonesia.
Nurjannah, Intansari; FitzGerald, Mary; Foster, Kim
Absconding from psychiatric institutions is a relatively common phenomenon. Yet patients' experience of absconding is a perspective that has received little attention in the West and none in Indonesia. A case study using mixed methods was undertaken in order to provide a profile of absconding events over a 1-year period in a psychiatric setting in Indonesia. In the qualitative phase of the study, in a semistructured interview, 16 patients who absconded described their experiences of absconding. Three themes of experience were identified: the call to home, hopes and realities, and us and them. The call to home theme described patients' eagerness to connect with family and others and to feel safe. Hopes and realities identified patients' hopes for happiness, which were dashed by the realities of life at home and in the hospital. The final theme, us and them, described the competing interests and different opinions of patients in relation to others including hospital staff and family. There is a need for changes to mental health policy and service provision in order to reduce the incidence of absconding in Indonesia and enable patients and their families to receive adequate support while living in the community. PMID:19740142
The caregiving experience among Hispanic caregivers of dementia patients.
Mier, Nelda
This research reviewed studies that investigated factors influencing the caregiving experience among informal Hispanic caregivers of dementia patients. This review identified 24 journal articles published between 1985 and 2003. Variables studied were depression and social support. In addition, methodological issues were detected such as sampling bias and multiple measurements. This review concluded that there is a need for an extensive, in depth research of the caregiving experience among Hispanics and further research needs are discussed. PMID:19172968
Patients with borderline personality disorder who are chronically suicidal: therapeutic alliance and therapeutic limits.
Jimenez, Xavier F
Therapeutic work with patients who are chronically suicidal and have borderline personality disorder (BPD) is challenging, and clinicians often resort to setting firm limits or excessively cautious interventions in efforts to prevent manipulation, regression, or over-dependence. Litigation and malpractice fears reinforce these stances, and reduced compensation for additional time and energy devoted to patients adds further disincentives to sole providers. However, elements of the working alliance and therapeutic limits are within the therapist's control. A case vignette illustrates an individual therapist's modification of usual therapeutic limits while working with a chronically suicidal patient with BPD within a dialectical behavior therapy (DBT) framework over a 16-week period. Discussions regarding the case, interventions used, DBT, and legality concerns follow. PMID:23909059
Bidirectional Relationships Between Fatigue and Everyday Experiences in Persons Living With HIV.
Cook, Paul F; Hartson, Kimberly R; Schmiege, Sarah J; Jankowski, Catherine; Starr, Whitney; Meek, Paula
Fatigue symptoms are very common among persons living with HIV (PLWH). Fatigue is related to functional and psychological problems and to treatment nonadherence. Using secondary data from ecological momentary assessment, we examined fatigue as a predictor of PLWH everyday experiences. In bidirectional analyses based on the shape shifters model, we also examined these experiences as predictors of fatigue. Data were examined from 67 PLWH who completed daily surveys on a handheld computer. Brief validated scales were used to assess participants' control beliefs, mood, stress, coping, social support, experience of stigma, and motivation. At the beginning and end of the study, fatigue was measured with two CES-D items that have been used in past HIV symptom research. Multilevel models and logistic regression were used to test reciprocal predictive relationships between variables. Moderate to severe fatigue affected 45% of PLWH in the study. Initial fatigue predicted PLWH subsequent overall level of control beliefs, mood, stress, coping, and social support, all p < .05. These state variables remained relatively constant over time, regardless of participants' initial fatigue. In tests for reciprocal relationships with 33 PLWH, average daily stress, OR = 4.74, and stigma, OR = 4.86, also predicted later fatigue. Fatigue predicted several daily survey variables including stress and social support. Stress and support in turn predicted fatigue at a later time, suggesting a self-perpetuating cycle but also a possible avenue for intervention. Future studies should examine daily variation in fatigue among PLWH and its relation to other everyday experiences and behaviors. © 2016 Wiley Periodicals, Inc. PMID:27059443
Evaluating Aesthetic Experience through Personal-Appearance Styles: A Behavioral and Electrophysiological Study
Cheung, Mei-chun; Law, Derry; Yip, Joanne
Consumers' aesthetic experience has often been linked with the concept of beauty, which is regarded as subjective and may vary between individuals, cultures and places, and across time. With the advent of brain-imaging techniques, there is more and more evidence to suggest that aesthetic experience lies not only in the eye of the beholder, but also in the brain of the beholder. However, there are gaps in the previous research in this area, as several significant issues have not yet been addressed. Specifically, it is unclear whether the human brain really pays more attention and generates more positive emotional responses to beautiful things. To explore the brain activity relating to consumers' aesthetic experiences, 15 participants were recruited voluntarily to view a series of personal-appearance styles. They were invited to make aesthetic judgments while their brain activity was recorded by electroencephalography. Two electroencephalographic (EEG) indicators, theta coherence and frontal alpha symmetry, were utilized. Theta coherence is a measure of linear synchronization between signals at two electrode sites. It reflects the degree of functional cooperation between the underlying neuronal substrates and was used to explore the attentional processing involved in aesthetic judgments. Frontal alpha asymmetry is derived by subtracting the log-transformed absolute alpha power of the left hemisphere from the analogous log-transformed alpha power of the right hemisphere. It was used as an indicator of emotional response. During aesthetic judgments, long-range theta coherence increased in both hemispheres and more positive frontal alpha asymmetry was found when the styles were judged to be beautiful. Therefore, participants demonstrated brain activity suggestive of central executive processing and more positive emotional responses when they considered styles to be beautiful. The study provides some insight into the brain activity associated with consumers' aesthetic
[The first episode of psychosis in juvenile patients: personality features and cognitive functioning].
Meleshko, T K; Kritskaia, V P; Sergeeva, O E; Kaleda, V G
A systemic study of personality features and cognitive processes based on the conception of pathopsychological syndrome has been conducted in patients with the first episode of juvenile endogenous psychosis. The association between characteristics of a pathopsychological syndrome and clinically determined premorbid features has been identified. The highest expression of schizotypal features (reduced selectivity, social perception) and cognitive impairment (motivation, mental activity regulation, adequate self-esteem, emotional reaction to success/failure) were characteristic of a group named "deficit variant of pseudopsychopathy" which contained a large number of passive schizoids. It has been shown that premorbid personality features are most distinct in initial stages of disease ("pathos" factors). "Nosos" factors are implicit and can be only presumably regarded as predictors of disease course. PMID:24429942
A Personal Health Network for Chemotherapy Care Coordination: Evaluation of Usability Among Patients.
Kim, Katherine K; Bell, Janice F; Bold, Richard; Davis, Andra; Ngo, Victoria; Reed, Sarah C; Joseph, Jill G
Cancer is a top concern globally. Cancer care suffers from lack of coordination, silos of information, and high cost. Interest is emerging in person-centered technology to assist with coordination to address these challenges. This study evaluates the usability of the "personal health network" (PHN), a novel solution leveraging social networking and mobile technologies, among individuals undergoing chemotherapy and receiving care coordination. Early results from interviews of 12 participants in a randomized pragmatic trial suggest that they feel more connected to the healthcare team using the PHN, find value in access to the patient education library, and are better equipped to organize the many activities that occur during chemotherapy. Improvements are needed in navigation, connectivity, and integration with electronic health records. Findings contribute to improvements in the PHN and informs a roadmap for potentially greater impact in technology-enabled cancer care coordination. PMID:27332197
A Personalized Approach to Parkinson's Disease Patients Based on Founder Mutation Analysis
Giladi, Nir; Mirelman, Anat; Thaler, Avner; Orr-Urtreger, Avi
While the phenotype of Parkinson disease (PD) is heterogeneous, treatment approaches are mostly uniform. Personalized medicine aims to treat diseases with targeted therapies based on cumulative variables, including genotype. We believe that sufficient evidence has accumulated to warrant the initiation of personalized medicine in PD based on subjects genotype and provide examples for our reasoning from observations of GBA and LRRK2 mutations carriers. While PD patients who carry the G2019S mutation in the LRRK2 gene seem to develop relatively mild disease with more frequent postural instability gait disturbance phenotype, carriers of mutations in the GBA gene tend to have an early onset, rapidly deteriorating disease, with more pronounced cognitive and autonomic impairments. These characteristics have significant implications for treatment and outcome and should be addressed from an early stage in the attempt to improve the patient's quality of life. PMID:27242656
Priorities in the primary care of persons experiencing homelessness: convergence and divergence in the views of patients and provider/experts
Steward, Jocelyn; Holt, Cheryl L; Pollio, David E; Austin, Erika L; Johnson, Nancy; Gordon, Adam J; Kertesz, Stefan G
Purpose Homeless individuals face unique challenges in health care. Several US initiatives seeking to advance patient-centered primary care for homeless persons are more likely to succeed if they incorporate the priorities of the patients they are to serve. However, there has been no prior research to elicit their priorities in primary care. This study sought to identify aspects of primary care important to persons familiar with homelessness based on personal experience or professional commitment, and to highlight where the priorities of patients and professionals dedicated to their care converge or diverge. Methods This qualitative exercise asked 26 homeless patients and ten provider/experts to rank 16 aspects of primary care using a card sort. Patient-level respondents (n=26) were recruited from homeless service organizations across all regions of the USA and from an established board of homeless service users. Provider/expert-level respondents (n=10) were recruited from veteran and non-veteran-focused homeless health care programs with similar geographic diversity. Results Both groups gave high priority to accessibility, evidence-based care, coordination, and cooperation. Provider/experts endorsed patient control more strongly than patients. Patients ranked information about their care more highly than provider/experts. Conclusion Accessibility and the perception of care based on medical evidence represent priority concerns for homeless patients and provider/experts. Patient control, a concept endorsed by experts, is not strongly endorsed by homeless patients. Understanding how to assure fluid communication, coordination, and team member cooperation could represent more worthy targets for research and quality improvement in this domain. PMID:26929607
What effect can manual therapy have on a patient's pain experience?
Bishop, Mark D; Torres-Cueco, Rafael; Gay, Charles W; Lluch-Girbés, Enrique; Beneciuk, Jason M; Bialosky, Joel E
Manual therapy (MT) is a passive, skilled movement applied by clinicians that directly or indirectly targets a variety of anatomical structures or systems, which is utilized with the intent to create beneficial changes in some aspect of the patient pain experience. Collectively, the process of MT is grounded on clinical reasoning to enhance patient management for musculoskeletal pain by influencing factors from a multidimensional perspective that have potential to positively impact clinical outcomes. The influence of biomechanical, neurophysiological, psychological and nonspecific patient factors as treatment mediators and/or moderators provides additional information related to the process and potential mechanisms by which MT may be effective. As healthcare delivery advances toward personalized approaches there is a crucial need to advance our understanding of the underlying mechanisms associated with MT effectiveness. PMID:26401979
SU-E-I-95: Personalized Radiography Technical Parameters for Each Patient and Exam
Soares, F; Camozzato, T; Kahl, G; Soares, A; Zottis, A
Purpose: To determine exact electrical parameters (kV, mAs) a radiological technologist shall use taking account the exam and patient's structure, with guarantee of minimum dose and adequate quality image. Methods: A patient's absorbed dose equation was developed by means of Entrance Skin Dose (ESD), irradiated area and patient width for specific anatomy. ESD is calculated from a developed equation, where entrance surface air-KERMA and backscatter factor are included, with air-to-skin coefficient conversion. We developed specific Lambert-Beer attenuation equations derived from mass energy-absorption coefficients data for skin, fat, and muscle and bone as one tissue. Anatomy tissue thickness distribution at central X-ray location in anteroposterior incidence for hand and chest, was estimate by discounting constant skin and bone thickness from patient measured width, assuming the result as muscle and fat. A clinical research at a big hospital were executed when real parameters (kV, mAs, filtration, ripple) used by technologists were combined with the image quality and patient's data: anatomy width, height and weight. A correlation among the best images acquired and electrical parameters used were confronted with patient's data and dose estimation. The best combinations were used as gold standards. Results: For each anatomy, two equations were developed to calculate voltage (kV) and exposure (mAs) to reproduce and interpolate the gold standards. Patient is measured and data are input into equations, giving radiological technologists the right set of electrical parameters for that specific exam. Conclusion: This work indicates that radiological technologist can personalize the exact electrical parameters for each patient exam, instead of using standard values. It also guarantee that patients under or over-sized measures will receive the right dose for the best image. It will stop wrong empiric adjusts technologists do when examining a non-standard patient and reduce
Nanomedicine-Based Neuroprotective Strategies in Patient Specific-iPSC and Personalized Medicine
Jang, Shih-Fan; Liu, Wei-Hsiu; Song, Wen-Shin; Chiang, Kuan-Lin; Ma, Hsin-I; Kao, Chung-Lan; Chen, Ming-Teh
In recent decades, nanotechnology has attracted major interests in view of drug delivery systems and therapies against diseases, such as cancer, neurodegenerative diseases, and many others. Nanotechnology provides the opportunity for nanoscale particles or molecules (so called "Nanomedicine") to be delivered to the targeted sites, thereby, reducing toxicity (or side effects) and improving drug bioavailability. Nowadays, a great deal of nano-structured particles/vehicles has been discovered, including polymeric nanoparticles, lipid-based nanoparticles, and mesoporous silica nanoparticles. Nanomedical utilizations have already been well developed in many different aspects, including disease treatment, diagnostic, medical devices designing, and visualization (i.e., cell trafficking). However, while quite a few successful progressions on chemotherapy using nanotechnology have been developed, the implementations of nanoparticles on stem cell research are still sparsely populated. Stem cell applications and therapies are being considered to offer an outstanding potential in the treatment for numbers of maladies. Human induced pluripotent stem cells (iPSCs) are adult cells that have been genetically reprogrammed to an embryonic stem cell-like state. Although the exact mechanisms underlying are still unclear, iPSCs are already being considered as useful tools for drug development/screening and modeling of diseases. Recently, personalized medicines have drawn great attentions in biological and pharmaceutical studies. Generally speaking, personalized medicine is a therapeutic model that offers a customized healthcare/cure being tailored to a specific patient based on his own genetic information. Consequently, the combination of nanomedicine and iPSCs could actually be the potent arms for remedies in transplantation medicine and personalized medicine. This review will focus on current use of nanoparticles on therapeutical applications, nanomedicine-based neuroprotective
A behavioral view on chimpanzee personality: exploration tendency, persistence, boldness, and tool-orientation measured with group experiments.
Massen, Jorg J M; Antonides, Alexandra; Arnold, Anne-Marie K; Bionda, Thomas; Koski, Sonja E
Human and nonhuman animals show personality: temporal and contextual consistency in behavior patterns that vary among individuals. In contrast to most other species, personality of chimpanzees, Pan troglodytes, has mainly been studied with non-behavioral methods. We examined boldness, exploration tendency, persistence and tool-orientation in 29 captive chimpanzees using repeated experiments conducted in an ecologically valid social setting. High temporal repeatability and contextual consistency in all these traits indicated they reflected personality. In addition, Principal Component Analysis revealed two independent syndromes, labeled exploration-persistence and boldness. We found no sex or rank differences in the trait scores, but the scores declined with age. Nonetheless, there was considerable inter-individual variation within age-classes, suggesting that behavior was not merely determined by age but also by dispositional effects. In conclusion, our study complements earlier rating studies and adds new traits to the chimpanzee personality, thereby supporting the existence of multiple personality traits among chimpanzees. We stress the importance of ecologically valid behavioral research to assess multiple personality traits and their association, as it allows inclusion of ape studies in the comparison of personality structures across species studied behaviorally, and furthers our attempts to unravel the causes and consequences of animal personality. PMID:23649750
Dealing with Stigma: Experiences of Persons Affected by Disabilities and Leprosy
Zweekhorst, Marjolein B. M.; Miranda-Galarza, Beatriz; Peters, Ruth M. H.; Cummings, Sarah; Seda, Francisia S. S. E.; Bunders, Joske F. G.; Irwanto
Persons affected by leprosy or by disabilities face forms of stigma that have an impact on their lives. This study seeks to establish whether their experiences of stigma are similar, with a view to enabling the two groups of people to learn from each other. Accounts of experiences of the impact of stigma were obtained using in-depth interviews and focus group discussion with people affected by leprosy and by disabilities not related to leprosy. The analysis shows that there are a lot of similarities in impact of stigma in terms of emotions, thoughts, behaviour, and relationships between the two groups. The main difference is that those affected by leprosy tended to frame their situation in medical terms, while those living with disabilities described their situation from a more social perspective. In conclusion, the similarities offer opportunities for interventions and the positive attitudes and behaviours can be modelled in the sense that both groups can learn and benefit. Research that tackles different aspects of stigmatization faced by both groups could lead to inclusive initiatives that help individuals to come to terms with the stigma and to advocate against exclusion and discrimination. PMID:25961008
Gender, Narratives and Intersectionality: can Personal Experience Approaches to Research Contribute to "Undoing Gender"?
NASA Astrophysics Data System (ADS)
Cole, Barbara Ann
This paper examines narrative methodologies as one approach to exploring issues of gender, education and social justice and, particularly, insights into "undoing gender". It furthermore examines the possibilities of exploring gender and its multiple intersections in a range of global and policy contexts through the use of personal experience approaches. The "storying" of lived experience is examined as a means of challenging dominant discourses which can construct and other individuals and groups in relation to many aspects of gender and education. Drawing on intersectionality, as a complex and developing feminist theory, the paper considers ways in which narrative can illuminate often hidden complexities while seeking to avoid generalisations and essentialisms. The difficulties of using narrative in relation to these aims are explored in the light of the warnings of feminist writers such as Michele Fine and bell hooks. The paper briefly considers narrative as both methodology and phenomenon, and finally, drawing on critical discourse analysis, discusses the potential of intersectionality and narrative in relation to undoing gender.
Opening toward life: Experiences of basic body awareness therapy in persons with major depression
Danielsson, Louise; Rosberg, Susanne
Although there is a vast amount of research on different strategies to alleviate depression, knowledge of movement-based treatments focusing on body awareness is sparse. This study explores the experiences of basic body awareness therapy (BBAT) in 15 persons diagnosed with major depression who participated in the treatment in a randomized clinical trial. Hermeneutic phenomenological methodology inspired the approach to interviews and data analysis. The participants' experiences were essentially grasped as a process of enhanced existential openness, opening toward life, exceeding the tangible corporeal dimension to also involve emotional, temporal, and relational aspects of life. Five constituents of this meaning were described: vitality springing forth, grounding oneself, recognizing patterns in one's body, being acknowledged and allowed to be oneself, and grasping the vagueness. The process of enhanced perceptual openness challenges the numbness experienced in depression, which can provide hope for change, but it is connected to hard work and can be emotionally difficult to bear. Inspired by a phenomenological framework, the results of this study illuminate novel clinical and theoretical insight into the meaning of BBAT as an adjunctive approach in the treatment of depression. PMID:25956354
Liver volumetry: Is imaging reliable? Personal experience and review of the literature.
D'Onofrio, Mirko; De Robertis, Riccardo; Demozzi, Emanuele; Crosara, Stefano; Canestrini, Stefano; Pozzi Mucelli, Roberto
The amount of the future liver remnant volume is fundamental for hepato-biliary surgery, representing an important potential risk-factor for the development of post-hepatectomy liver failure. Despite this, there is no uniform consensus about the amount of hepatic parenchyma that can be safely resected, nor about the modality that should be chosen for this evaluation. The pre-operative evaluation of hepatic volume, along with a precise identification of vascular and biliar anatomy and variants, are therefore necessary to reduce surgical complications, especially for extensive resections. Some studies have tried to validate imaging methods [ultrasound, computed tomography (CT), magnetic resonance imaging] for the assessment of liver volume, but there is no clear evidence about the most accurate method for this evaluation. Furthermore, this volumetric evaluation seems to have a certain degree of error, tending to overestimate the actual hepatic volume, therefore some conversion factors, which should give a more reliable evaluation of liver volume, have been proposed. It is widespread among non-radiologists the use of independent software for an off-site volumetric analysis, performed on digital imaging and communications in medicine images with their own personal computer, but very few studies have provided a validation of these methods. Moreover, while the pre-transplantation volumetric assessment is fundamental, it remains unclear whether it should be routinely performed in all patients undergoing liver resection. In this editorial the role of imaging in the estimation of liver volume is discussed, providing a review of the most recent literature and a brief personal series of correlations between liver volumes and resection specimens' weight, in order to assess the precision of the volumetric CT evaluation. PMID:24778768
Liver volumetry: Is imaging reliable? Personal experience and review of the literature
D'Onofrio, Mirko; De Robertis, Riccardo; Demozzi, Emanuele; Crosara, Stefano; Canestrini, Stefano; Pozzi Mucelli, Roberto
The amount of the future liver remnant volume is fundamental for hepato-biliary surgery, representing an important potential risk-factor for the development of post-hepatectomy liver failure. Despite this, there is no uniform consensus about the amount of hepatic parenchyma that can be safely resected, nor about the modality that should be chosen for this evaluation. The pre-operative evaluation of hepatic volume, along with a precise identification of vascular and biliar anatomy and variants, are therefore necessary to reduce surgical complications, especially for extensive resections. Some studies have tried to validate imaging methods [ultrasound, computed tomography (CT), magnetic resonance imaging] for the assessment of liver volume, but there is no clear evidence about the most accurate method for this evaluation. Furthermore, this volumetric evaluation seems to have a certain degree of error, tending to overestimate the actual hepatic volume, therefore some conversion factors, which should give a more reliable evaluation of liver volume, have been proposed. It is widespread among non-radiologists the use of independent software for an off-site volumetric analysis, performed on digital imaging and communications in medicine images with their own personal computer, but very few studies have provided a validation of these methods. Moreover, while the pre-transplantation volumetric assessment is fundamental, it remains unclear whether it should be routinely performed in all patients undergoing liver resection. In this editorial the role of imaging in the estimation of liver volume is discussed, providing a review of the most recent literature and a brief personal series of correlations between liver volumes and resection specimens' weight, in order to assess the precision of the volumetric CT evaluation. PMID:24778768
Neuroticism personality trait is associated with Quality of Life in patients with Chronic Heart Failure
Samartzis, Lampros; Dimopoulos, Stavros; Manetos, Christos; Agapitou, Varvara; Tasoulis, Athanasios; Tseliou, Eleni; Pozios, Iraklis; Kaldara, Elisavet; Terrovitis, John; Nanas, Serafim
AIM: To evaluate Quality of life (QoL) in chronic heart failure (CHF) in relation to Neuroticism personality trait and CHF severity. METHODS: Thirty six consecutive, outpatients with Chronic Heart Failure (6 females and 30 males, mean age: 54 ± 12 years), with a left ventricular ejection fraction ≤ 45% at optimal medical treatment at the time of inclusion, were asked to answer the Kansas City Cardiomyopathy Questionnaire (KCCQ) for Quality of Life assessment and the NEO Five-Factor Personality Inventory for personality assessment. All patients underwent a symptom limited cardiopulmonary exercise testing on a cycle-ergometer, in order to access CHF severity. A multivariate linear regression analysis using simultaneous entry of predictors was performed to examine which of the CHF variables and of the personality variables were correlated independently to QoL scores in the two summary scales of the KCCQ, namely the Overall Summary Scale and the Clinical Summary Scale. RESULTS: The Neuroticism personality trait score had a significant inverse correlation with the Clinical Summary Score and Overall Summary Score of the KCCQ (r = -0.621, P < 0.05 and r = -0.543, P < 0.001, respectively). KCCQ summary scales did not show significant correlations with the personality traits of Extraversion, Openness, Conscientiousness and Agreeableness. Multivariate linear regression analysis using simultaneous entry of predictors was also conducted to determine the best linear combination of statistically significant univariate predictors such as Neuroticism, VE/VCO2 slope and VO2 peak, for predicting KCCQ Clinical Summary Score. The results show Neuroticism (β = -0.37, P < 0.05), VE/VCO2 slope (β = -0.31, P < 0.05) and VO2 peak (β = 0.37, P < 0.05) to be independent predictors of QoL. In multivariate regression analysis Neuroticism (b = -0.37, P < 0.05), the slope of ventilatory equivalent for carbon dioxide output during exercise, (VE/VCO2 slope) (b = -0.31, P < 0.05) and peak
Personal Health Records: Beneficial or Burdensome for Patients and Healthcare Providers?
Lester, Melissa; Boateng, Samuel; Studeny, Jana; Coustasse, Alberto
Personal health records (PHRs) have been mandated to be made available to patients to provide increased access to medical care information, encourage participation in healthcare decision making, and enable correction of errors within medical records. The purpose of this study was to analyze the usefulness of PHRs from the perspectives of patients and providers. The methodology of this qualitative study was a literature review using 34 articles. PHRs are powerful tools for patients and healthcare providers. Better healthcare results and correction of medical records have been shown to be positive outcomes of the use of PHRs. PHRs have also been shown to be difficult for patients to use and understand, and providers had concerns about correct information transferring to the portals and patients eliminating information from the record. Concerns regarding patient understanding of medical records, legal liability, and the response time required of providers were also identified. For the PHR to succeed in the US healthcare system, assurance that the information will be protected, useful, and easily accessed is necessary. PMID:27134613
Acoustic Emotional Processing in Patients With Borderline Personality Disorder: Hyper- or Hyporeactivity?
Pfaltz, Monique C; Schumacher, Sonja; Wilhelm, Frank H; Dammann, Gerhard; Seifritz, Erich; Martin-Soelch, Chantal
Earlier studies have demonstrated emotional overreactions to affective visual stimuli in patients with borderline personality disorder (BPD). However, contradictory findings regarding hyper- versus hyporeactivity have been reported for peripheral physiological measures. In order to extend previous results, the authors investigated emotional reactivity and long-term habituation in the acoustic modality. Twenty-two female BPD patients and 19 female nonclinical controls listened to emotionally negative, neutral, and positive sounds in two identical sessions. Heart rate, skin conductance, zygomaticus/corrugator muscle, and self-reported valence/arousal responses were measured. BPD patients showed weaker skin conductance responses to negative sounds than controls. The elevated zygomaticus activity in response to positive sounds observed in controls was absent in BPD patients, and BPD patients assigned lower valence ratings to positive sounds than controls. In Session 2, patients recognized fewer positive sounds than controls. Across both groups, physiological measures habituated between sessions. These findings add to growing evidence toward partial affective hyporeactivity in BPD. PMID:25710735
Using Eye Tracking to Assess Reading Performance in Patients with Glaucoma: A Within-Person Study
Smith, Nicholas D.; Glen, Fiona C.; Mönter, Vera M.; Crabb, David P.
Reading is often cited as a demanding task for patients with glaucomatous visual field (VF) loss, yet reading speed varies widely between patients and does not appear to be predicted by standard visual function measures. This within-person study aimed to investigate reading duration and eye movements when reading short passages of text in a patient's worse eye (most VF damage) when compared to their better eye (least VF damage). Reading duration and saccade rate were significantly different on average in the worse eye when compared to the better eye (P < 0.001) in 14 patients with glaucoma that had median (interquartile range) between-eye difference in mean deviation (MD; a standard clinical measure for VF loss) of 9.8 (8.3 to 14.8) dB; differences were not related to the size of the difference in MD between eyes. Patients with a more pronounced effect of longer reading duration on their worse eye made a larger proportion of "regressions" (backward saccades) and "unknown" EMs (not adhering to expected reading patterns) when reading with the worse eye when compared to the better eye. A between-eye study in patients with asymmetric disease, coupled with eye tracking, provides a useful experimental design for exploring reading performance in glaucoma. PMID:24883203
The Impact of Pre-Adult Appearance-Related Experiences on Young Adults' Personality.
ERIC Educational Resources Information Center
Longo, Laura C.
Reviewers of the physical attractiveness literature have concluded that there is a strong general link between attractiveness and personality with most "good-looking" people having positive personalities and their less well-endowed compatriots possessing relative negative qualities. The attractiveness-personality covariation is often explained,…
Use of Patient Portals for Personal Health Information Management: The Older Adult Perspective.
Turner, Anne M; Osterhage, Katie; Hartzler, Andrea; Joe, Jonathan; Lin, Lorelei; Kanagat, Natasha; Demiris, George
The personal health information management (PHIM) practices and needs of older adults are poorly understood. We describe initial results from the UW SOARING project (Studying Older Adults & Researching Information Needs and Goals), a participatory design investigation of PHIM in older adults (60 years and older). We conducted in-depth interviews with older adults (n=74) living in a variety of residential settings about their management of personal health information. A surprising 20% of participants report using patient portals and another 16% reported prior use or anticipated use of portals in the future. Participants cite ease of access to health information and direct communication with providers as valuable portal features. Barriers to the use of patient portals include a general lack of computer proficiency, high internet costs and security concerns. Design features based on consideration of needs and practices of older adults will facilitate appeal and maximize usability; both are elements critical to adoption of tools such as patient portals that can support older adults and PHIM. PMID:26958263
Use of Patient Portals for Personal Health Information Management: The Older Adult Perspective
Turner, Anne M.; Osterhage, Katie; Hartzler, Andrea; Joe, Jonathan; Lin, Lorelei; Kanagat, Natasha; Demiris, George
The personal health information management (PHIM) practices and needs of older adults are poorly understood. We describe initial results from the UW SOARING project (Studying Older Adults & Researching Information Needs and Goals), a participatory design investigation of PHIM in older adults (60 years and older). We conducted in-depth interviews with older adults (n=74) living in a variety of residential settings about their management of personal health information. A surprising 20% of participants report using patient portals and another 16% reported prior use or anticipated use of portals in the future. Participants cite ease of access to health information and direct communication with providers as valuable portal features. Barriers to the use of patient portals include a general lack of computer proficiency, high internet costs and security concerns. Design features based on consideration of needs and practices of older adults will facilitate appeal and maximize usability; both are elements critical to adoption of tools such as patient portals that can support older adults and PHIM. PMID:26958263
Identity-related autobiographical memories and cultural life scripts in patients with Borderline Personality Disorder.
Jørgensen, Carsten René; Berntsen, Dorthe; Bech, Morten; Kjølbye, Morten; Bennedsen, Birgit E; Ramsgaard, Stine B
Disturbed identity is one of the defining characteristics of Borderline Personality Disorder manifested in a broad spectrum of dysfunctions related to the self, including disturbances in meaning-generating self-narratives. Autobiographical memories are memories of personal events that provide crucial building-blocks in our construction of a life-story, self-concept, and a meaning-generating narrative identity. The cultural life script represents culturally shared expectations as to the order and timing of life events in a prototypical life course within a given culture. It is used to organize one's autobiographical memories. Here, 17 BPD-patients, 14 OCD-patients, and 23 non-clinical controls generated three important autobiographical memories and their conceptions of the cultural life script. BPD-patients reported substantially more negative memories, fewer of their memories were of prototypical life script events, their memory narratives were less coherent and more disoriented, and the overall typicality of their life scripts was lower as compared with the other two groups. PMID:22356875
The Role of Childhood Traumatic Experience in Personality Disorders in China
Zhang, TianHong; Chow, Annabelle; Wang, LanLan; Dai, YunFei; Xiao, ZePing
Background There has been no large-scale examination of the association between types of childhood abuse and personality disorders (PDs) in China using standardised assessment tools and the DSM-IV diagnostic criteria. Hence, this study aimed to explore the relationship between retrospective reports of various types of childhood maltreatments and current DSM-IV PDs in a clinical population in China, Shanghai. Method 1402 subjects were randomly sampled from the Shanghai Psychological Counselling Centre. PDs were assessed using the Personality Diagnostic Questionnaire (PDQ4+). Participants were also interviewed using the Structured Clinical Interview (SCID-II). The Child Trauma Questionnaire (CTQ) was used to assess childhood maltreatment in five domains (emotional abuse, physical abuse, sexual abuse, emotional neglect, and physical neglect). Results According to Pearson's correlations, childhood maltreatment had a strong association with most PDs. Subsequently using partial correlations, significant relationships were also demonstrated between Cluster-B PDs and all the traumatic factors except physical neglect. A strongest positive correlation was found between Cluster-B PD and CTQ total scores (r=.312, p <.01). Using the Kruskal-Wallis rank sum test, significant differences in 4 groups of subjects (Cluster-A PD, Cluster-B PD, Cluster-C PD and Non-PD) in terms of emotional abuse (χ2 = 34.864, p <.01), physical abuse (χ2 = 14.996, p <.05), sex abuse (χ2 = 9.211, p <.05), and emotional neglect (χ2 = 17.987, p <.01) were found. Stepwise regression analysis indicated that emotional abuse and emotional neglect were predictive for Cluster-A PD and Cluster-B PD, and sexual abuse was highly predictive for Cluster-B PD, only emotional neglect was predictive for Cluster-C PD. Conclusion Early traumatic experiences are strongly related to the development of PDs. The effects of childhood maltreatment in the three clusters of PDs are different. Childhood trauma has the most
Factors in Sensory Processing of Prosody in Schizotypal Personality Disorder: An fMRI Experiment
Dickey, Chandlee C.; Morocz, Istvan A.; Minney, Daniel; Niznikiewicz, Margaret A.; Voglmaier, Martina M.; Panych, Lawrence P.; Khan, Usman; Zacks, Rayna; Terry, Douglas P.; Shenton, Martha E.; McCarley, Robert W.
Introduction Persons diagnosed with schizophrenia demonstrate deficits in prosody recognition. To examine prosody along the schizophrenia spectrum, antipsychotic-naïve schizotypal personality disorder (SPD) subjects and healthy control subjects were compared. It was hypothesized that SPD subjects would perform more poorly; with cognitive and demographic factors contributing to the poor performance. The superior temporal gyrus (STG) was selected as the region-of-interest (ROI) given its known abnormalities in SPD and its important role in the processing of prosody. Methods SPD and healthy comparison (HC) subjects were matched on age, IQ, and parental social-economic status (PSES). Cognitive measures included the Speech Sound Perception Test (SSPT) to examine phonological processing (SPD= 68, HC = 74) and the Verbal Fluency task to examine executive functioning (SPD = 129, HC = 138). The main experiment was a novel fMRI task of prosody identification using semantically neutral sentences spoken with emotional prosody (SPD = 16, HC = 13). Finally, volumetric measurement of the superior temporal sulcus (STS), a key region for processing prosody, and partially overlapping with the STG, was performed (SPD = 30, HC = 30). Results Phonological processing and executive functioning were both impaired in SPD subjects compared with HC subjects. Contrary to the prediction, SPD subjects, as a group, were similar to HC subjects in terms of correctly indentifying the emotion conveyed and reaction time. Within the SPD group, prosody identification accuracy was influenced by executive functioning, IQ and perhaps PSES, relationships not found with HC subjects. Phonological perception aided prosody identification in both diagnostic groups. As expected, both groups activated the STG while performing the prosody identification task. However, SPD subjects may have been less "efficient" in their recruitment of STG neurons. Finally, SPD subjects demonstrated a trend toward smaller STS
Breast Cancer Patients' Experiences within and outside the Safety Net
Fayanju, Oluwadamilola M.; Jeffe, Donna B.; Elmore, Leisha; Ksiazek, Deborah N.; Margenthaler, Julie A.
Background Following reforms to the breast-cancer referral process for our city's health Safety Net (SN), we compared the experiences from first abnormality to definitive diagnosis of breast-cancer patients referred to Siteman Cancer Center from SN and non-Safety-Net (NSN) providers. Materials and Methods SN-referred patients with any-stage (0–IV) and NSN-referred patients with late-stage (IIB–IV) breast cancer were prospectively identified post-diagnosis during cancer-center consultations conducted between September 2008 and June 2010. Interviews were taped and transcribed verbatim; transcripts were independently coded by two raters using inductive methods to identify themes. Results Of 82 eligible patients, 57 completed interviews (33/47 SN [70%], 24/35 NSN [69%]). Eighteen (52%) SN-referred patients had late-stage disease at diagnosis, as did all NSN patients (by design). A higher proportion of late-stage SN patients (67%) than either early-stage SN (47%) or NSN (33%) patients reported feelings of fear and avoidance that deterred them from pursuing care for concerning breast findings. A higher proportion of SN late-stage patients than NSN patients reported behaviors concerning for poor health knowledge/behavior (33% vs. 8%), but reported receipt of timely, consistent communication from healthcare providers once they received care (50% vs. 17%). Half of late-stage SN patients reported improper clinical or administrative conduct by healthcare workers that delayed referral and/or diagnosis. Conclusions While SN patients reported receipt of compassionate care once connected with health services, they presented with higher-than-expected rates of late-stage disease. Psychological barriers, life stressors, and provider/clinic delays affected access to and navigation of the healthcare system and represent opportunities for intervention. PMID:24768022
Personality Factor as a Predictor of Depression Score Among Depressed and CHD Patients
Kikhavani, Sattar
Introduction Many risk factors can affect depression and coronary disease, these including physiological and psychological risk factors (such as personality traits) Objectives Our objectives were to examine whether personality factors (The Five-Factor Model) can predict depression score in the depressed and coronary heart disease (CHD) individuals compared to that of healthy subjects. Materials and Methods To achieve the above objectives, 100 depressed (Mean=35.90 years, SD=10.59 years), and 100 CHD (Mean=46.42 years, SD=12.52 years), patients and 100 healthy subjects (Mean = 37.97 years, SD =12.49 years) were selected by convenience sampling method. To compare the three groups of participants, ANOVA test was used. Stepwise Multiple Regression Analysis was used to identify the variables that most closely predict the perceived stress and depression scores. Pearson's Correlation Co-efficient was used to examine the correlation between variables. Results In Neuroticism, the CHD patients had significant highest scores, followed by depressed patients. The healthy group had the least scores. In case of Extraversion, Openness and Agreeableness, healthy participants had significant higher scores followed by the depressed and CHD patients. Only in conscientiousness factor, Depressive and CHD groups had statistically less scores compared to the healthy group. Also, high Neuroticism and Age, and low Extraversion were significant protective factors for depression Scores of CHD patients, while high Neuroticism and low Extraversion function as predictors in the depressed and healthy groups. Conclusion The effects of Neuroticism and Extraversion on depression have been reported as inconsistent across previous studies. This study indicates that, older CHD individuals with high Neuroticism and low Extraversion scores are more vulnerable for depression. PMID:26557596
Experiences of Stigma and Discrimination among Caregivers of Persons with Schizophrenia in China: A Field Survey
Yin, Yi; Zhang, Weijun; Hu, Zhenyu; Jia, Fujun; Li, Yafang; Xu, Huiwen; Zhao, Shuliang; Guo, Jing; Tian, Donghua; Qu, Zhiyong
In China, caregivers for family members with schizophrenia play an important role in treatment and recovery but may experience stigma and discrimination simply because of their family relationship. The object of this study was to measure the degrees and correlates of stigma and discrimination experiences among this group. Four hundred twenty-seven caregivers participated in this hospital-based and cross-sectional study in Ningbo and Guangzhou, China. Data were collected by trained interviewers using fixed questionnaires. Stigma and discrimination experiences were measured by the Modified Consumer Experiences of Stigma Questionnaire (MCESQ). Caregivers' social support was measured by the Social Support Rating Scale. Parametric analysis, nonparametric analysis and multivariate linear regression were used. The mean (SD) score of MCESQ was 2.44(0.45), 2.91(0.71) for stigma experiences and 1.97(0.37) for discrimination experiences on a five-point score ("1 = never" and "5 = very often"). Approximately 65% of caregivers reported that they tried to conceal their family members' illness, and 71% lacked the support of friends. The experience of stigma was significantly negatively associated with the perceived social support of caregivers (standard β = −0.2,p<0.001). Caregivers who were children of the patients experienced fewer stigmas than other (standard β = −0.18, p<0.001). Urban residence (standard β = −0.12, p<0.01) and patients did not complete primary school education (standard β = −0.13, p<0.01) were negatively related with stigmas. In addition, stigma and discrimination was more experienced in Zhejiang than in Guangdong (p<0.05). In conclusion, this study performed that caregivers of people with schizophrenia in China experienced general stigmas and rare discrimination and found the relations with social support, kinship, patient's educational level and regional differences. More interventions and supports should
My personal experiences at the BEST Medical Center: A day in the clinic-the morning.
Cohen, Philip R; Kurzrock, Razelle
Dr. Ida Lystic is a gastroenterologist who trained at the OTHER (Owen T. Henry and Eugene Rutherford) Medical Center, after having completed her MD degree at the prestigious Harvey Medical School (recently renamed the Harvey Provider School). She accepted a faculty position at the BEST (Byron Edwards and Samuel Thompson) Medical Center. Dr. Lystic shares her experiences on a typical morning in gastroenterology clinic. Although her clinic start date was delayed by 2 months after becoming sick following a mandatory flu shot and having to complete more than 70 hours of compliance training modules, she is now familiar with the BEST system. Clinic scheduling priorities include ensuring that the staff can eat lunch together and depart at 5:00 pm. It is a continual challenge to find time to complete the electronic medical record after BEST changed from the SIMPLE (Succinct Input Making Patients Lives Electronic) system to LEGEND (referred to as Lengthy and Excessively Graded Evaluation and Nomenclature for Diagnosis by her colleagues). To maintain clinic punctuality, a compliance spreadsheet is e-mailed monthly to the Wait Time Committee. Their most recent corrective action plan for tardy physicians included placing egg timers on the doors and having nurses interrupt visits that exceed the allotted time. Administrative decisions have resulted in downsizing personnel. Patients are required to schedule their own tests and procedures and follow-up appointments-causing low patient satisfaction scores; however, the money saved lead to a large year-end bonus for the vice president of BEST Efficiency, who holds "providers" accountable for the poor patient experience. Although Dr. Ida Lystic and the gastroenterology clinic at "the BEST Medical Center" are creations of the authors' imagination, the majority of the anecdotes are based on actual events. PMID:27265082
Continuous ambulatory peritoneal dialysis: nurses' experiences of teaching patients.
Shubayra, Amnah
Nine nurses were interviewed to determine nurses' experiences of teaching patients to use continuous ambulatory peritoneal dialysis (CAPD). The material was analyzed using content analysis. Data were sorted into four themes and ten subthemes. The themes were presented as follows: Importance of language, individualized teaching, teaching needs and structure of care in teaching. The findings highlighted important insights into how nurses experience teaching patients to perform CAPD. The study revealed some barriers for the nurses during teaching. The major barrier was shortage of Arabic speaking nursing staff. Incidental findings involved two factors that played an important role in teaching, retraining and a special team to perform pre-assessments, including home visits. In conclusion, the findings of this study showed several factors that are considered as barriers for the nurses during teaching the CAPD patients and the need to improve the communication and teaching in the peritoneal dialysis units, including the importance of individualized teaching. PMID:25758880
The Meaning of Patient Experiences of Medically Unexplained Physical Symptoms.
Kornelsen, Jude; Atkins, Chloe; Brownell, Keith; Woollard, Robert
Current diagnostic models in medical practice do not adequately account for patient symptoms that cannot be classified. At the moment, when all known diagnostic possibilities have been excluded, physicians-and patients-confront uncertainty in diagnosis, which gives rise to the label of Medically Unexplained Physical Symptoms (MUPS). This phenomenological study, conducted by two research teams in two geographic locations, sought to explore patients' experiences of prolonged uncertainty in diagnosis. Participants in this study described their experiences with and consequences of MUPS primarily in relation to levels of acuity and acceptance of uncertainty, the latter loosely correlated to length of time since onset of symptoms (the longer the time, the more forbearance participants expressed). We identified three experiential periods including the active search for a diagnosis, living with MUPS, and, finally, acceptance/resignation of their condition. Findings point to the heightened importance of the therapeutic relationship when dealing with uncertainty. PMID:25583957
The impact of user- and system-initiated personalization on the user experience at large sports events.
Sun, Xu; May, Andrew; Wang, Qingfeng
This article describes an experimental study investigating the impact on user experience of two approaches of personalization of content provided on a mobile device, for spectators at large sports events. A lab-based experiment showed that a system-driven approach to personalization was generally preferable, but that there were advantages to retaining some user control over the process. Usability implications for a hybrid approach, and design implications are discussed, with general support for countermeasures designed to overcome recognised limitations of adaptive systems. PMID:26851458
War and peace? The oncologic and the palliative care perspective on personalized cancer treatment in a patient with advanced cancer.
Masel, Eva K; Schur, Sophie; Posch, Doris; Weixler, Dietmar; Meran, Johannes G; Schmidinger, Manuela; Watzke, Herbert H
Personalized cancer treatment utilizing targeted therapies in a tailored approach is based on tumor and/or patient-specific molecular profiles. Recent clinical trials continue to look for new potential targets in heavily pretreated patients or rare disease entities. Careful selection of patients who may derive benefit from such therapies constitutes a challenge. This case report presents an experimental personalized cancer treatment in an advanced cancer patient and provides a list of issues for discussion: How can we combine treatment goals and simultaneously meet the individual needs in advanced cancer reconciling both perspectives: oncology and palliative care? PMID:25986998
Psychiatric Patients Experiences with Mechanical Restraints: An Interview Study
Lanthén, Klas; Rask, Mikael; Sunnqvist, Charlotta
Objective. To examine psychiatric patients' experience of mechanical restraints and to describe the care the patients received. Background. All around the world, threats and violence perpetrated by patients in psychiatric emergency inpatient units are quite common and are a prevalent factor concerning the application of mechanical restraints, although psychiatric patients' experiences of mechanical restraints are still moderately unknown. Method. A qualitative design with an inductive approach were used, based on interviews with patients who once been in restraints. Results. This study resulted in an overbridging theme: Physical Presence, Instruction and Composed Behaviour Can Reduce Discontent and Trauma, including five categories. These findings implicated the following: information must be given in a calm and sensitive way, staff must be physically present during the whole procedure, and debriefing after the incident must be conducted. Conclusions. When mechanical restraints were unavoidable, the presence of committed staff during mechanical restraint was important, demonstrating the significance of training acute psychiatric nurses correctly so that their presence is meaningful. Nurses in acute psychiatric settings should be required to be genuinely committed, aware of their actions, and fully present in coercive situations where patients are vulnerable. PMID:26199931
Patient experiences with electronic medical records: Lessons learned
Rose, Dale; Richter, Louiseann T; Kapustin, Jane
Purpose To describe the lived experience of patients communicating with their nurse practitioners and physicians while using paper health records (PHRs) and electronic health records (EHRs) in the examination rooms. The significance of the study lies in the salience of communication between the patient and provider in promoting optimal clinical outcomes and the highest level of patient satisfaction. Data sources The study used a qualitative, phenomenological design. Audio-taped focus group interviews were conducted with 21 patients from a diabetes clinic in Baltimore, Maryland. Patients had visits with the provider before and after implementation of EHRs in the clinic. Conclusions The four themes that emerged from the three focus groups included communication issues, patient preferences for electronic records, safety and security concerns, and transition problems with implementation of EHRs. Implications for practice Potential benefits for nurse practitioners implementing the recommendations in this study include enhanced communication between patients and providers while using EHRs, increased patient satisfaction, higher levels of nurse practitioner and physician satisfaction, and avoidance of communication issues during implementation of EHR systems. PMID:25234112
Patients' experiences in hospital following a liver transplantation.
Nåden, Dagfinn; Bjørk, Ida Torunn
Research is scarce regarding patients' experiences, feelings and thoughts the first 4 weeks after liver transplantation. Most research involving patients with a liver transplant are conducted several months, or even years, after the transplantation. The aim of this study is to present results from research interviews that took place post-transplant while patients still were in hospital. The design is explorative and hermeneutic. Fifteen patients were interviewed 3-5 weeks after transplantation. The results are presented in the following themes: (i) general contentment with the hospital stay, (ii) physical discomfort, (iii) dreams, nightmares and hallucinations, (iv) Comedowns experienced during rejection of the transplant and (v) Other psychological/mental reactions. A major result from our study is patients' own descriptions of comedowns experienced during rejection of the transplant, and the seemingly little consolation and support the patients received. Another major result is patients' own descriptions of dreams, nightmares and hallucinations, which are not fully described from the patients' own perspective while still in hospital. PMID:21812799
Following the Francis report: investigating patient experience of mental health in-patient care
Csipke, E.; Williams, P.; Rose, D.; Koeser, L.; McCrone, P.; Wykes, T.; Craig, T.
Background The Francis report highlights perceptions of care that are affected by different factors including ward structures. Aims To assess patient and staff perceptions of psychiatric in-patient wards over time. Method Patient and staff perceptions of in-patient psychiatric wards were assessed over 18 months. We also investigated whether the type of ward or service structure affected these perceptions. We included triage and routine care. The goal was to include at least 50% of eligible patients and staff. Results The most dramatic change was a significant deterioration in all experiences over the courseof the study. Systems of care or specific wards did not affect patient experience but staff were more dissatisfied in the triage system. Conclusions This is the first report of deterioration in perceptions of the therapeutic in-patient environment that has been captured in a rigorous way. It may reflect contemporaneous experiences across the National Health Service of budget reductions and increased throughput. The ward systems we investigated did not improve patient experience and triage may have been detrimental to staff. PMID:26989098
Experiences of patients identifying with chronic Lyme disease in the healthcare system: a qualitative study
Background Chronic Lyme disease is a term that describes a constellation of persistent symptoms in patients with or without evidence of previous Borrelia burgdorferi infection. Patients labeled as having chronic Lyme disease have a substantial clinical burden. Little is known about chronic Lyme disease patient experiences in the healthcare system and their relationships with healthcare providers. The purpose of this study was to gather insights about the experiences of patients who carry a diagnosis of chronic Lyme disease in the United States healthcare system. Methods Qualitative, phenomenological study in 12 adult participants who identified themselves as having chronic Lyme disease. Semi-structured face-to-face in-depth interviews were conducted, 60–90 minutes in length, focusing on perceptions of disease burden and of their healthcare providers, using the dimensions of the Health Belief Model. Transcribed interviews were analyzed for emergent topics and themes in the categories of beliefs/understanding, personal history/narrative, consequences/limitations, management, and influences on care. Results Enrollment continued until theoretical saturation was obtained. Four major themes emerged from participants' descriptions of their experiences and perceptions: 1) changes in health status and the social impact of chronic Lyme disease, 2) doubts about recovery and the future, 3) contrasting doctor-patient relationships, 4) and the use of unconventional therapies to treat chronic Lyme disease. Conclusions Participants reported a significant decline in health status associated with chronic Lyme disease and were often unsatisfied with care in conventional settings. Negative experiences were associated with reports of dismissive, patronizing, and condescending attitudes. Positive experiences were associated with providers who were reported to be attentive, optimistic, and supportive. Consultations with CAM practitioners and use of CAM therapies were common. Actively
Person-Centered, Physical Activity for Patients with Low Back Pain: Piloting Service Delivery.
Bloxham, Saul; Barter, Phil; Scragg, Slafka; Peers, Charles; Jane, Ben; Layden, Joe
Low back pain (LBP) is one of the most common and costly conditions in industrialized countries. Exercise therapy has been used to treat LBP, although typically using only one mode of exercise. This paper describes the method and initial findings of a person-centered, group physical activity programme which featured as part of a multidisciplinary approach to treating LBP. Six participants (aged 50.7 ± 17 years) completed a six-week physical activity programme lasting two hours per week. A multicomponent approach to physical activity was adopted which included aerobic fitness, core activation, muscular strength and endurance, Nordic Walking, flexibility and exercise gaming. In addition, participants were required to use diary sheets to record physical activity completed at home. Results revealed significant (p < 0.05) improvements in back strength (23%), aerobic fitness (23%), negative wellbeing (32%) and disability (16%). Person's Correlation Coefficient analysis revealed significant (p < 0.05) relationships between improvement in perceived pain and aerobic fitness (r = 0.93). It was concluded that a person-centered, multicomponent approach to physical activity may be optimal for supporting patients who self-manage LBP. PMID:27417616
Digital patient: Personalized and translational data management through the MyHealthAvatar EU project.
Kondylakis, Haridimos; Spanakis, Emmanouil G; Sfakianakis, Stelios; Sakkalis, Vangelis; Tsiknakis, Manolis; Marias, Kostas; Xia Zhao; Hong Qing Yu; Feng Dong
The advancements in healthcare practice have brought to the fore the need for flexible access to health-related information and created an ever-growing demand for the design and the development of data management infrastructures for translational and personalized medicine. In this paper, we present the data management solution implemented for the MyHealthAvatar EU research project, a project that attempts to create a digital representation of a patient's health status. The platform is capable of aggregating several knowledge sources relevant for the provision of individualized personal services. To this end, state of the art technologies are exploited, such as ontologies to model all available information, semantic integration to enable data and query translation and a variety of linking services to allow connecting to external sources. All original information is stored in a NoSQL database for reasons of efficiency and fault tolerance. Then it is semantically uplifted through a semantic warehouse which enables efficient access to it. All different technologies are combined to create a novel web-based platform allowing seamless user interaction through APIs that support personalized, granular and secure access to the relevant information. PMID:26736530
Gender differences in the clinical characteristics and psychiatric comorbidity in patients with antisocial personality disorder.
Sher, Leo; Siever, Larry J; Goodman, Marianne; McNamara, Margaret; Hazlett, Erin A; Koenigsberg, Harold W; New, Antonia S
Gender is an important variable in the study of mental health because of the actual and perceived differences between men and women. Relatively little is known how males and females differ in their manifestations of antisocial personality disorder (ASPD). Demographic and clinical features of 323 participants with ASPD were assessed and recorded. Women had fewer episodes of antisocial behavior involving or not involving police, higher scores on the Childhood Trauma Questionnaire (CTQ) and on Emotional Abuse and Sexual Abuse subscales of the CTQ compared to men. CTQ scores positively correlated with the number of episodes of antisocial behavior involving police in men but not in women. The percentage of patients with comorbid borderline and histrionic personality disorders was higher and the percentage of participants with cocaine use disorder was lower among women compared to men. Comorbid alcohol use disorder was frequent in both groups, while a higher percentage of women had comorbid mood disorders compared to men. Logistic regression analysis demonstrates that CTQ scores, histrionic personality disorder, and antisocial behavior involving the police drive the difference between the groups. Our findings indicate that treatment of individuals with ASPD should focus on the management of comorbid psychiatric disorders. PMID:26296756
Antisocial personality disorder is associated with receipt of physical disability benefits in substance abuse treatment patients
Byrne, Shannon A.; Cherniack, Martin G.; Petry, Nancy M.
Background Opioid dependence is growing at an alarming rate in the United States, and opioid dependent patients have substantial medical, as well as psychiatric, conditions that impact their ability to work. This study evaluated the association between antisocial personality disorder (ASPD) and receipt of physical disability payments in methadone maintenance patients. Methods Using data from 115 drug and alcohol abusing methadone maintained patients participating in two clinical trials, baseline characteristics of individuals receiving (n = 22) and those not receiving (n = 93) physical disability benefits were compared, and a logistic regression evaluated unique predictors of disability status. Results Both an ASPD diagnosis and severity of medical problems were significant predictors of disability receipt, ps < .05. After controlling for other variables that differed between groups, patients with ASPD were more than five times likelier to receive physical disability benefits than patients without ASPD (odds ratio = 5.66; 95% confidence interval = 1.58 – 20.28). Conclusions These results demonstrate a role of ASPD in the receipt of disability benefits in substance abusers and suggest the need for greater understanding of the reasons for high rates of physical disability benefits in this population. PMID:23394688
Relationship between maladaptive cognitions about sleep and recovery in patients with borderline personality disorder
Plante, David T.; Frankenburg, Frances R.; Fitzmaurice, Garrett M.; Zanarini, Mary C.
Borderline personality disorder (BPD) has been associated with maladaptive cognitive processes including dysfunctional attitudes and a negative attribution style. Comorbid insomnia affects the course of multiple psychiatric disorders, and has been associated with absence of recovery from BPD. Because dysfunctional beliefs and attitudes are common among patients with insomnia, the purpose of this study was to evaluate the association between maladaptive sleep-related cognitions and recovery status (symptomatic remission plus good concurrent psychosocial functioning) in patients with BPD. 223 BPD patients participating in the McLean Study of Adult Development (MSAD) were administered the Dysfunctional Beliefs and Attitudes about Sleep questionnaire (DBAS-16) as part of the 16-year follow-up wave. Maladaptive sleep cognitions were compared between recovered (n=105) and non-recovered (n=118) BPD participants, in analyses that adjusted for age, sex, depression, anxiety, and primary sleep disorders. Results demonstrated non-recovered BPD patients had significantly more severe maladaptive sleep-related cognitions as measured by the overall DBAS-16 score. These results demonstrate an association between dysfunctional beliefs and attitudes about sleep and recovery status among BPD patients. Further research is warranted to evaluate treatments targeted towards maladaptive sleep-related cognitions, and their subsequent effects on the course of BPD. PMID:23972789
Executive functions and social cognition in highly lethal self-injuring patients with borderline personality disorder.
Williams, Gregory E; Daros, Alexander R; Graves, Bryanna; McMain, Shelley F; Links, Paul S; Ruocco, Anthony C
Risk for potentially lethal self-injurious behavior in borderline personality disorder (BPD) may be associated with deficits in neuropsychological functions and social cognition. In particular, individuals with BPD engaging in more medically damaging self-injurious behaviors may have more severe executive function deficits and altered emotion perception as compared to patients engaging in less lethal acts. In the current study, 58 patients with BPD reporting a lifetime history of self-injurious behavior were administered neuropsychological measures of response inhibition, planning and problem-solving,and tests of facial emotion recognition and discrimination. Patients who engaged in more medically lethal self-injurious behaviors reported engaging in impulsive behaviors more frequently and displayed neuropsychological deficits in problem-solving and response inhibition. They were also less accurate in recognizing happy facial expressions and in discerning subtle differences in emotional intensity in sad facial expressions. These findings suggest that patients with BPD that engage in more physically damaging self-injurious behaviors may have greater difficulties with behavioral control and employ less efficient problem-solving strategies. Problems in facial emotion recognition and discrimination may contribute to interpersonal difficulties in patients with BPD who self-injure. PMID:25602784
Personality Disorder and Changes in Affect Consciousness: A 3-Year Follow-Up Study of Patients with Avoidant and Borderline Personality Disorder
Johansen, Merete Selsbakk; Normann-Eide, Tone; Egeland, Jens
Personality disorders (PDs) are highly prevalent in patients receiving psychiatric services, and are associated with significant personal and social costs. Over the past two decades, an increasing number of treatment studies have documented the effectiveness of treatment for patients with PDs, especially when it comes to reduction of symptom distress, risk taking behavior, self-harm, or suicide attempts. However, less is known about the more complex aims of improving the personality structure itself, such as identity- and interpersonal disturbances. Emotional dysfunction is closely associated with PD pathology. The present study investigated changes in affect consciousness (AC) in patients with avoidant or borderline PD, and how these changes were associated with clinical status after 3 years of follow-up. The study included 52 individuals; 79 percent were females, and mean age was 30 years. The evaluations included the Affect Consciousness Interview, Symptom Checklist-90-R, Circumplex of Interpersonal Problems, the Index of Self-Esteem, and three domains (Identity Integration, Relational Capacities, and Self-Control) of the Severity Indices of Personality Problems (SIPP-118). There was a significant increase in the Global AC and AC scores for most of the specific affects from baseline to follow-up. As the present study did not include a control group, it cannot be concluded that changes in AC are effects of psychotherapy, and the possibility of age-related maturation processes cannot be excluded. The change in Global AC contributed significantly to explained variance in the follow-up levels of Circumplex of Interpersonal Problems, and the two SIPP-118 domains Relational Capacities and Identity Integration. Improved AC was not associated with change in the Self-Control domain or the Global Severity Index of Symptom Checklist-90-R. The results suggest that AC may be altered for patients with borderline and avoidant PDs, and this is the first study to report that
Personality Disorder and Changes in Affect Consciousness: A 3-Year Follow-Up Study of Patients with Avoidant and Borderline Personality Disorder.
Normann-Eide, Eivind; Johansen, Merete Selsbakk; Normann-Eide, Tone; Egeland, Jens; Wilberg, Theresa
Personality disorders (PDs) are highly prevalent in