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Kinds of Schedule Terms modified by Schedule Selected AbstractsThe European Service Mapping Schedule (ESMS): development of an instrumentfor the description and classificationof mental health servicesACTA PSYCHIATRICA SCANDINAVICA, Issue 2000S. Johnson Objective: This paper describes the development of an instrument for description and classification of mental health services and for measurement of service use. Purposes to be served by the instrument include: (i) identification of gaps in the spectrum of services in a catchment area; (ii) obtaining background information which may be important to understanding why apparently similar interventions lead to different outcomes in different areas; (iii) investigating how introduction of a particular type of service influences use of other local services; and (iv) understanding the relationship between sociodemographic factors and service use. Method: The instrument was developed through meetings of an international expert panel and pilot stages in several European countries. Results: Use of the European Mapping Service Mapping Schedule (ESMS) appears feasible in several countries and allowed description and classification of the full range of services identified within each of the study catchment areas. Conclusion: The ESMS promises to fill a gap in the technology available for mental health services research. Further practical experiences of its use for a variety of purposes in a variety of settings are now needed to indicate how far the ESMS does successfully generate data which are useful to researchers and planners. [source] Illicit tranquilliser use and dependence among female opiate usersDRUG AND ALCOHOL REVIEW, Issue 5 2006GAIL GILCHRIST Abstract This study determined the predictors of 12-month dependence on illicit tranquillisers among female opiate users attending three services in Glasgow, Scotland, UK. Twelve-month drug dependence was measured using the Diagnostic Interview Schedule. The Revised Clinical Interview Schedule (CIS-R) measured current neurotic symptoms. 60% (159/266) had used illicit tranquillisers in the past 30 days, and 50% (132/266) met criteria for 12-month dependence on illicit tranquillisers. Polydrug use, injecting drug use, childhood and adulthood abuse, adverse life experiences and current and previous mental health problems were associated with 12-month dependence on illicit tranquillisers. Using multiple logistic regression, polydrug use in last 30 days (OR 3.2, 95% CI 1.5,7.0), history of deliberate self-harm (OR 2.5, 95% CI 1.4-4.4), history of injecting drug use (OR 2.5, 1.2,5.2) and likely to need treatment for current neurotic symptoms (CIS-R , 18) (OR 2.4, 95% CI 1.3,4.4) predicted 12-month dependence on illicit tranquillisers. Drug users in general and female drug users in particular who are using illicit tranquillisers are also particularly likely to have psychiatric symptoms requiring treatment. Mental health problems should be assessed and monitored among this client group and counselling and psychosocial support should be provided when indicated. [source] Association of adolescent symptoms of depression and anxiety with daily smoking and nicotine dependence in young adulthood: findings from a 10-year longitudinal studyADDICTION, Issue 9 2010Maria McKenzie ABSTRACT Aims To examine the association of adolescent depression and anxiety symptoms with daily smoking and nicotine dependence in young adulthood. Design A prospective cohort study of adolescent and young adult health (n = 1943). Teen assessments occurred at 6-monthly intervals, with two follow-up assessments in young adulthood (wave 7, 1998; wave 8, 2001,03). Setting Victoria, Australia. Participants Students who participated at least once during the first six (adolescent) waves of the cohort study. Measurements Adolescent depression and anxiety symptoms were assessed using the Revised Clinical Interview Schedule (CIS-R). Young adult tobacco use was defined as: daily use (6 or 7 days per week) and dependent use (,4 on the Fagerstrom Test for Nicotine Dependence). Findings Among adolescent ,less than daily' smokers, those with high levels of depression and anxiety symptoms had an increased risk of reporting nicotine dependence in young adulthood [odds ratio (OR) 3.3, 95% confidence interval (CI) 1.2,9.1] compared to young adults who had low levels of adolescent depression and anxiety symptoms, after adjusting for potential confounding factors. Similarly, in the adjusted model (OR 1.9, 95% CI 1.0,3.4), among adolescent ,daily' smokers, those with high levels of depression and anxiety symptoms had an almost two-fold increase in the odds of reporting nicotine dependence in young adulthood compared to young adults with low levels of adolescent depression and anxiety symptoms. Conclusions Adolescent smokers with depression and anxiety symptoms are at increased risk for nicotine dependence into young adulthood. They warrant vigilance from primary care providers in relation to tobacco use well into adulthood. [source] The familial aggregation of cannabis use disordersADDICTION, Issue 4 2009Kathleen R. Merikangas ABSTRACT Aims The aim of this paper is to examine the familial aggregation of cannabis use disorders and other psychiatric conditions among first-degree relatives and spouses of probands with a cannabis use disorder. Design Controlled family study methods. Setting Out-patient psychiatric clinics and the local community (same geographic area). Participants Two hundred and sixty-two probands with a life-time history of cannabis use disorder, alcohol dependence, anxiety disorders or no history of any disorder, and their first-degree relatives and spouses. Measurements Cannabis use disorders and other DSM-III-R disorders in the relatives and spouses using the Schedule for Affective Disorders and Schizophrenia. Findings Results reveal an elevated risk of life-time history of cannabis use disorders among siblings [odds ratio (OR: 3.6), adult offspring (OR): 6.9], and spouses (OR: 4.4) of probands with cannabis use disorders. There is a latent familial factor underlying cannabis use disorders that was shared partially with alcohol abuse/dependence. Comorbid mood and anxiety disorders aggregated independently from cannabis use disorders in families. Equal elevation in the magnitude of the association among the first-degree adult relatives and spouses of probands with a cannabis use disorder suggests the probable contribution of both environmental and genetic factors. Conclusions These findings support a family-based approach to drug abuse intervention and the importance of future research concerning environmental mediators of familial transmission of drug abuse. [source] The Demands of 24/7 Coverage: Using Faculty Perceptions to Measure Fairness of the ScheduleACADEMIC EMERGENCY MEDICINE, Issue 1 2004Frank L. Zwemer Jr. MD Objectives: Ensuring fair, equitable scheduling of faculty who work 24-hour, 7-day-per-week (24/7) clinical coverage is a challenge for academic emergency medicine (EM). Because most emergency department care is at personally valuable times (evenings, weekends, nights), optimizing clinical work is essential for the academic mission. To evaluate schedule fairness, the authors developed objective criteria for stress of the schedule, modified the schedule to improve equality, and evaluated faculty perceptions. They hypothesized that improved equality would increase faculty satisfaction. Methods: Perceived stress was measured for types of clinical shifts. The seven daily shifts were classified as weekday, weekend, or holiday (plus one unique teaching-conference coverage shift). Faculty assigned perceived stress to shifts (ShiftStress) utilizing visual analog scales (VAS). Faculty schedules were measured (ShiftScores) for two years (1998,1999), and ShiftScore distribution of faculty was determined quarterly. Schedules were modified (1999) to reduce interindividual ShiftScore standard deviation (SD). The survey was performed pre- and postintervention. Results: Preintervention, 26 faculty (100% of eligible) assigned VAS to 22 shifts. Increased stress was perceived in progression (weekday data, 0,10 scale) from day to evening to night (2.07, 5.00, 6.67, respectively) and from weekday to weekend to holiday (day-shift data, 2.07, 4.93, 5.87). The intervention reduced interindividual ShiftScore SD by 21%. Postintervention survey revealed no change in perceived equality or satisfaction. Conclusions: Faculty perceived no improvement despite scheduling modifications that improved equality of the schedule and provided objective measures. Other predictors of stress, fairness, and satisfaction with the demanding clinical schedule must be identified to ensure the success of EM faculty. [source] Evaluating the validities of different DSM-IV-based conceptual constructs of tobacco dependence,ADDICTION, Issue 7 2008Peter S. Hendricks ABSTRACT Aim To compare the concurrent and predictive validities of two subsets of DSM-IV criteria for nicotine dependence (tolerance and withdrawal; withdrawal; difficulty controlling use; and use despite harm) to the concurrent and predictive validity of the full DSM-IV criteria. Design Analysis of baseline and outcome data from three randomized clinical trials of cigarette smoking treatment. Setting San Francisco, California. Participants Two samples of cigarette smokers (n = 810 and 322), differing with regard to baseline characteristics and treatment received, derived from three randomized clinical trials. Measurements DSM-IV nicotine dependence criteria were measured at baseline with a computerized version of the Diagnostic Interview Schedule for DSM-IV (DIS-IV). Additional baseline measures included the Fagerström Test of Nicotine Dependence (FTND), number of cigarettes smoked per day, breath carbon monoxide (CO) level, the Minnesota Nicotine Withdrawal Scale (MNWS), the Michigan Nicotine Reinforcement Questionnaire (M-NRQ) and the Profile of Mood States (POMS). Seven-day point-prevalence abstinence was assessed at week 12. Findings Full DSM-IV criteria displayed greater concurrent validity than either of the two subsets of criteria. However, DSM-IV symptoms accounted for only a nominal amount of the variance in baseline smoking-related characteristics and were unrelated to smoking abstinence at week 12. Cigarettes smoked per day was the only significant predictor of abstinence at week 12. Conclusions Although the findings do not provide a compelling alternative to the full set of DSM-IV nicotine dependence criteria, its poor psychometric properties and low predictive power limit its clinical and research utility. [source] Modafinil and nicotine interactions in abstinent smokersHUMAN PSYCHOPHARMACOLOGY: CLINICAL AND EXPERIMENTAL, Issue 1 2008Mehmet Sofuoglu Abstract In this study, we examined the effects of a wakefulness-promoting medication, modafinil, alone and with the nicotine lozenge, on subjective, physiological and cognitive measures as well as on nicotine withdrawal in overnight abstinent cigarette smokers. Nineteen smokers, 13 male and 6 female, participated in a double-blind, placebo-controlled, crossover study. In each of three experimental sessions, subjects were treated orally with a single 200,mg or 400,mg dose of modafinil or placebo. Two hours and 10 min following the medication treatment, subjects received a single 2,mg nicotine lozenge. Both doses of modafinil alone increased the rating of elated-depressed on the Profile of Mood States (POMS) subscale in the direction of depressed and increased ratings of negative affect on the Positive and Negative Affect Schedule (PANAS). In contrast, the 200,mg modafinil dose combined with a 2,mg nicotine lozenge, increased the rating of energetic-tired in the direction of energetic on the POMS subscale. Modafinil attenuated self-reported rating of ,drug strength' in response to the nicotine lozenge. Modafinil, alone or in combination with the nicotine lozenge, did not affect tobacco withdrawal symptoms. There was an increase in baseline heart rate and systolic blood pressure under modafinil treatment. In addition, modafinil speeded reaction times on a modified Stroop task. The clinical utility of modafinil for smoking cessation needs to be determined in future studies. Copyright © 2007 John Wiley & Sons, Ltd. [source] Do medical courses adequately prepare interns for safe and effective prescribing in New South Wales public hospitals?INTERNAL MEDICINE JOURNAL, Issue 7 2009S. N. Hilmer Abstract Aims: To assess ability of interns immediately before starting clinical practice in New South Wales (NSW) teaching hospitals to prescribe medications safely and appropriately and to describe their impressions of the adequacy of their clinical pharmacology training in medical school. Methods: A cross-sectional study was performed on all interns (n= 191) who attended intern orientation programmes at four NSW hospitals in January 2008. A clinical case scenario that tested prescribing ability and a survey investigating impressions of clinical pharmacology training in medical school were administered to the interns in exam format. Outcome measures were: (i) ability to prescribe medications safely and appropriately for the clinical case scenario and (ii) interns' impressions of their training in clinical pharmacology at medical school. Results: No intern completed all prescribing tasks correctly. No intern charted the patient's usual medications on admission completely correctly, only six wrote an accurate discharge medication list, and none wrote both an accurate discharge medication list and a legal Schedule 8 discharge script. None of the respondents strongly agreed that they felt adequately trained to prescribe medications in their intern year and 84% would have liked to have more training in pharmacology as medical students. Conclusions: Interns about to commence clinical practice in NSW teaching hospitals demonstrated significant deficits in prescribing of regular medications, initiation of new therapies, prescribing of discharge medications, and particularly prescribing of Schedule 8 medications. Most interns recognized these deficits and would have liked more clinical pharmacology training at medical school. [source] Does the presence of anxiety affect the validity of a screening test for depression in the elderly?INTERNATIONAL JOURNAL OF GERIATRIC PSYCHIATRY, Issue 4 2002Gary Sinoff Abstract Introduction Depression in the elderly is frequently detected by screening instruments and often accompanied by anxiety. We set out to study if anxiety will affect the ability to detect depression by a screening instrument. Objective To validate the short Zung depression rating scale in Israeli elderly and to study the affect of anxiety on its validity. Design The short Zung was validated against a psychiatric evaluation, in a geriatric inpatient and outpatient service. The overall validity was determined, as well as for subgroups of sufferers and non-sufferers of anxiety. Setting An urban geriatric service in Israel. Patients 150 medical inpatients and outpatients, aged 70 years and older. Measures Psychiatric evaluation of modified Anxiety Disorders Interview Schedule for DSM-IV as criterion standard for anxiety and depression and short Zung instrument for depression. Results By criterion validity, 60% suffered from depression. The overall validity of the short Zung was high (sensitivity 71.1%, specificity 88.3%, PPV 90.1%, NPV 67.1%). The validity for those not suffering from anxiety was good (sensitivity 71.1%, specificity 90.2%, PPV 84.4%, NPV 80.7%). In those with anxiety, sensitivity, specificty and PPV were high (71.2%, 77.8%, 94.9% respectively), although the specificity was less than in non-suffers. However major difference was in the NPV rate being much lower (31.8%). Conclusion The short Zung, an easily administered instrument for detecting depression, is also valid in the Israeli elderly. However, anxiety limits the usefulness of this instrument in correctly ruling out depression. The clinician must be aware, therefore, that those suffering from anxiety may score negatively for depression on a screening instrument, such as the short Zung. Copyright © 2002 John Wiley & Sons, Ltd. [source] Inter-rater reliability of the Brief Psychiatric Rating Scale and the Groningen Social Disabilities Schedule in a European multi-site randomized controlled trial on the effectiveness of acute psychiatric day hospitalsINTERNATIONAL JOURNAL OF METHODS IN PSYCHIATRIC RESEARCH, Issue 4 2003Dr Matthias Schützwohl Abstract The objectives of this study were to report the inter-rater reliability of the Brief Psychiatric Rating Scale (BPRS 4.0) and the Groningen Social Disabilities Schedule (GSDS-II) as assessed in a randomized controlled trial on the effectiveness of psychiatric day hospitals spanning five sites in countries of Central and Western Europe. Following brief training sessions, videotaped BPRS-interviews and written GSDS-vignettes were rated by clinically experienced researchers from all participating sites. Inter-rater reliability often proved to be poor for items assessing the severity of both psychopathology and social dysfunction, but findings suggest that both instruments allow for the assessment of the presence or absence of specific psychopathological symptoms or social disabilities. Inter-rater reliability at subscale level proved to be good for both instruments. Results indicate that, with a brief training session and proper use of the instruments, psychopathology and social disabilities can be reliably assessed within cross-national research studies. The results are of particular interest given that the need to conduct cross-national multi-site studies including countries with different cultural backgrounds increases. Copyright © 2003 Whurr Publishers Ltd. [source] A French, abridged version of the Hospitals and Hostels Practices Profile ScheduleINTERNATIONAL JOURNAL OF METHODS IN PSYCHIATRIC RESEARCH, Issue 4 2001Marc Corbière Abstract This study aims to validate the Hospitals and Hostels Practices Profile Schedule (HHPPS) in the French version according to the statistical requirements of factor analysis and internal consistency, and to arrive at as parsimonious a version of the questionnaire as possible. As no validation of the original English instrument exists to our knowledge, the most parsimonious factor structure suggested by hypothetical constructs was used. Analyses of variance of six categories of residential settings served to underscore their points of convergence and divergence in terms of degree of autonomy allowed to patients. The following seven scales emerged from the analyses: ,activities: house rules', ,activities: morning wake-up', ,health and hygiene', ,activities: curfew', ,personal effects', ,activities: night-time surveillance' and ,meals'. These accounted for 65% of the cumulative explained variance. Of the residential settings considered, supervised apartments allowed patients the most autonomy, compared with psychiatric hospital wards, hostels, nursing homes, foster families and group homes. Aside from its primary role of measuring the degree of autonomy that residential settings allow patients, this questionnaire seems suitable for gauging the adequacy of fit between a patient's needs and available residential facilities. This should help to direct persons with severe and persistent mental disorders towards facilities better tailored to their needs. Copyright © 2001 Whurr Publishers Ltd. [source] Measurement of racial life events in schizophrenia: development of a new schedule , a pilot studyINTERNATIONAL JOURNAL OF METHODS IN PSYCHIATRIC RESEARCH, Issue 3 2001Dinesh Bhugra Abstract The relationship between stressors and the onset of psychosis is well described in the literature. However, for minority ethnic groups in the UK the impact of racism and racial life events has not been studied to the same extent. In this paper we describe the development of a semi-structured interview , Racial Life Events Schedule (RALES) , in order to measure racial life events as well as continuing difficulties attributable to racial discrimination. The interview was piloted on 12 African-Caribbean and eight Asian patients presenting with first onset schizophrenia. The interview was useful in eliciting racial events but overall there were no differences between patients and community controls. We believe that this schedule is useful for understanding racial events in the individual's personal and cultural context. The development and the schedule are described in this paper. Copyright © 2001 Whurr Publishers Ltd. [source] The Galicia study of mental health of the Elderly I: general description of methodologyINTERNATIONAL JOURNAL OF METHODS IN PSYCHIATRIC RESEARCH, Issue 4 2000Professor R. Mateos Abstract Reports of epidemiological surveys do not always adequately provide a careful description of the methodology used and the sociocultural context involved. The objective of this paper is to describe the methodology used in a survey whose aim was to study the prevalence of the wide range of psychiatric disorders that were present in a population aged 60 and above who were living at home. The Galicia Community Study of Mental Health of the Elderly was designed in two phases. In the first, a random sample of 3,580 people over 60 years of age, representative of each of the nine public health authority areas, was interviewed at home. The 60-item version of Goldberg's General Health Questionnaire (GHQ) was the screening instrument. In the second phase, all the traced subjects with high GHQ scores (N = 532) and a representative sample (N = 149) of people below the cut-off point, were interviewed at home using the Diagnostic Interview Schedule (DIS-III). This paper analyses the sociodemographic context of Galicia (a natural region in south-western Europe with a population of 2.7 million inhabitants), the sampling method, the sociodemographic makeup of the sample, the fieldwork, and the method for obtaining the estimate of prevalence. Copyright © 2000 Whurr Publishers Ltd. [source] Studying the incidence of depression: an ,interval' effectINTERNATIONAL JOURNAL OF METHODS IN PSYCHIATRIC RESEARCH, Issue 4 2000Jane M. Murphy Abstract A review of studies about the incidence of depression suggested that the length of the ,interval' of follow up may influence the findings. Exploration of these issues is carried out using data from the Stirling County Study, an investigation of psychiatric epidemiology in a general population. The study's customary method of diagnosis, DePression and AnXiety (DPAX), and the Diagnostic Interview Schedule (DIS) were used in an incidence investigation whose ,interval' was less than three years. Average annual incidence rates of depression for both DPAX and DIS were about 15 per 1000. Where longer intervals were used in the Stirling Study, rates were close to four per 1000. Projected lifetime risk based on the lower rates was more congruent with reported lifetime prevalence than that based on the higher rates. Irrespective of method, 90% or more of the incident cases gave an onset that predated the initial interview, suggesting poor reliability. This was often due to the fact that information given in the first interview met some but not all of the criteria for diagnosis. Being in the ,borderline' category at the beginning of the study significantly increased incidence. Thus, evidence from the Stirling County Study replicated findings that suggest an ,interval effect' and pointed to the need in incidence studies for distinguishing between the onset of the prodrome and the onset of diagnosable depression. Copyright © 2000 Whurr Publishers Ltd. [source] Fatigued Elderly Patients With Chronic Heart FailureINTERNATIONAL JOURNAL OF NURSING TERMINOLOGIES AND CLASSIFICATION, Issue 2003Anna Ehrenberg PURPOSE To compare descriptions of fatigue based on the NANDA characteristics from interviews with elderly people with congestive heart failure (CHF) and data recorded by nurses at a Swedish outpatient heart failure clinic. METHODS Patients were screened for moderate to severe CHF. A total of 158 patients were interviewed using a revised form of the Fatigue Interview Schedule (FIS) based on the NANDA characteristics. Of these patients, half (n= 79) were offered visits at a nurse-monitored heart failure clinic. Nursing documentation of fatigue at the heart failure clinic was reviewed based on the NANDA characteristics and compared with the content in the patient interviews. FINDINGS Tiredness was documented in 43 (75%) records and indicated in 36 patients based on patient scores on the FIS (X,= 5.5; range 1,9). The most frequently recorded observation related to fatigue was the symptom emotionally labile or irritable, followed by notes on lack of energy and decreased performance. Patients' descriptions of their fatigue were expressed as a decreased ability to perform and a perceived need for additional energy. Results indicated poor concordance in patients' descriptions and record content concerning fatigue. Whereas patients emphasized the physical characteristics of fatigue, nurses emphasised the emotional features. Decreased libido was linked to fatigue according to the patients but not according to the nurses' records. Whereas cognitive characteristics of fatigue occurred rarely in the records, they were more frequent in the patient interviews. DISCUSSION Symptoms such as irritability and accident-proneness may be seen as manifestations of the patients' experiencing the need for more energy or a feeling of decreased performance. These consequences of being fatigued, rather than the different dimensions of fatigue, seemed to have been easy for the nurses to observe and document. Earlier studies indicate that poor observation, medication, and diet in patients with heart failure might partly be explained by cognitive impairment. CONCLUSIONS Findings of this study highlight the need for nurses to pay attention to the experience of fatigue in patients who suffer from CHF, and to validate their observations with the patients own expressions. Using the patients' words and expressions and the diagnostic characteristics of fatigue in recording can support the nurses in developing both understanding of patients living with CHF and strategies to help patients cope with their restricted ability in daily life. [source] The clinically related predictors of dental fear in Taiwanese childrenINTERNATIONAL JOURNAL OF PAEDIATRIC DENTISTRY, Issue 6 2008CHEN-YI LEE Background. Dental fear has been singled out as one of the most troublesome problems facing paediatric dentistry today. Children with dental fear may avoid visiting dentists; therefore, their oral health protection is often compromised. However, the aetiology of dental fear is still not entirely understood. Objective. This study investigated the dental visiting habit, the previous dental experiences, the conditioning pathway, and the clinically related predictors of dental fear in children. Design., The dental history of 247 children (2,10 years old) was obtained when they came to a dental clinic for treatment. The level of dental fear in these children was assessed using the Children's Fear Survey Schedule,Dental Subscale (CFSS-DS). Observers rated the clinically anxious responses and uncooperative behaviour towards dental treatment in these children. Three stepwise regression analyses were performed to determine significant predictors of CFSS-DS score, clinically anxious responses, and uncooperative behaviour of children, respectively. Results. We found that the CFSS-DS score and clinical anxiety have different predictors, but age , 3.99 years old and cooperativeness in the first dental visit were important predictors for both the CFSS-DS score and the clinical anxiety. Furthermore, the other predictors of the CFSS-DS score were maternal dental fear, unbearable pain during the first dental visit, and visiting dentists in a regular dental clinic; the other predictors of clinical anxiety were first-born, regular dentist, and CFSS-DS score. Finally, the only significant predictor for uncooperative behaviour was clinical anxiety. Conclusion. Children's dental fear and their anxious response during dental treatment were dynamic processes that consisted of many different factors. The direct conditioning of subjective experience of pain was more important than the objective pathway of child dental fear, and the indirect conditioning does not seem influential in this study sample. [source] A study to assess the validity of clinical judgement in determining paediatric dental anxiety and related outcomes of managementINTERNATIONAL JOURNAL OF PAEDIATRIC DENTISTRY, Issue 3 2005R. D. HOLMES Summary. Objective. The aim of the present study was to determine the validity of subjective anxiety assessment and the outcomes of management of children receiving operative dental treatment. Setting., The study was conducted at the Departments of Sedation and Child Dental Health, Newcastle Dental Hospital, Newcastle upon Tyne, UK. Subjects and methods., One hundred children and adolescents aged between 8 and 15 years participated in the study. Clinicians subjectively allocated 50 children for treatment with local analgesia alone (low anxiety), and identified 50 children who had the potential to benefit from nitrous oxide and oxygen sedation (high anxiety). Participants then completed the State-Trait Anxiety Inventory for Children (STAIC), the Venham Picture Test (VPT) and the Child Fear Survey Schedule , Dental Subscale (CFSS-DS). A global rating scale classified behaviour during dental treatment. Results., State anxiety and dental fear prior to treatment were significantly higher in children allocated to receive inhalation sedation (P = 0·004 and P = 0·005, respectively). There was no significant difference in trait anxiety or post-treatment state anxiety between the two groups (P = 0·69 and P = 0·06, respectively). Only 11% displayed ,negative' behaviour during treatment: 82% of this group represented those allocated to receive sedation. Conclusion., Children receiving inhalation sedation were significantly more anxious prior to treatment than children receiving treatment with local analgesia alone. The findings support the subjective assessment of anxiety in children; however, objective anxiety measures may assist clinicians in identifying specific fears, which may ultimately aid patient management. [source] Relationship between assertiveness and burnout among nurse managersJAPAN JOURNAL OF NURSING SCIENCE, Issue 2 2009Eiko SUZUKI Abstract Aim:, We aimed to clarify the relationship between assertiveness and burnout among nurse managers at university hospitals. Methods:, The directors at three university hospitals agreed to cooperate with our study. During a one-month period from May to June 2007, a self-administered questionnaire was distributed to 203 nurse managers (head and sub-head nurses). The Japanese version of the Rathus Assertiveness Schedule (J-RAS) and the Japanese version of the Maslach Burnout Inventory (MBI) were used as scales. Burnout was operationally defined as a total MBI score in the highest tertile. Results:, Valid responses were obtained from 172 nurse managers. The mean J-RAS score of the burnout group (,14.3) was significantly lower than that of the non-burnout group (,3.3). Responses about work experience and age showed no significant group difference. Total MBI score was inversely correlated with J-RAS score (R = ,0.30, P < 0.01). Multiple logistic regression analyses indicated a decrease in the risk of burnout by 26% (0.74 times) for every 10 point increase in the J-RAS score, and by 60% (0.40 times) for greater satisfaction with own care provision. Conclusions:, The results suggest that increasing assertiveness and satisfaction with own care provision contributes to preventing burnout among Japanese nurse managers. [source] American Tegumentary Leishmaniasis in Older Adults: 44 Cases Treated with an Intermittent Low-Dose Antimonial Schedule in Rio de Janeiro, BrazilJOURNAL OF AMERICAN GERIATRICS SOCIETY, Issue 3 2010Érica De Camargo Ferreira e Vasconcellos MSc No abstract is available for this article. [source] A Novel Tetracycline Labeling Schedule for Longitudinal Evaluation of the Short-Term Effects of Anabolic Therapy With a Single Iliac Crest Bone Biopsy: Early Actions of Teriparatide,JOURNAL OF BONE AND MINERAL RESEARCH, Issue 3 2006Robert Lindsay MD Abstract We describe a quadruple tetracycline labeling method that allows longitudinal assessment of short-term changes in bone formation in a single biopsy. We show that 1 month of hPTH(1-34) treatment extends the bone-forming surface, increases mineral apposition rate, and initiates modeling-based formation. Introduction: Iliac crest biopsy, with histomorphometric evaluation, provides important information about cellular activity in bone. However, to obtain longitudinal information, repeat biopsies must be performed. In this study, we show the capability to obtain short-term longitudinal information on bone formation in a single biopsy using a novel, quadruple labeling technique. Materials and Methods: Two tetracycline labels were administered using a standard 3 days on, 12 days off, 3 days on format. Four weeks later, the tetracycline labeling was repeated using the same schedule but with a different tetracycline that can be distinguished from the first by its color under fluorescent light. Iliac crest biopsies were performed 1 week later and prepared undecalcified for histomorphometry. Indices of bone formation 1 month apart were measured and calculated using the two sets of labels. We used this method to investigate the early effects of teriparatide [hPTH(1-34)] treatment on bone formation. The results were compared with those from a group of control subjects who were quadruple-labeled, but did not receive hPTH(1-34). Results: Treatment with hPTH(1-34) dramatically stimulated bone formation on cancellous and endocortical surfaces. This was achieved by both an increase in the linear rate of matrix apposition and extension of the bone-forming surface. New bone was deposited on previously quiescent surfaces (i.e., modeling-based formation), but a proportion of this could occur by encroachment from adjacent resorption cavities. Conclusions: A single transiliac crest bone biopsy, after sequential administration of two sets of tetracycline labels is a useful approach to study the short-term effects of anabolic agents on human bone. One month of hPTH(1-34) treatment extends the bone-forming surface, increases mineral apposition rate, and initiates modeling-based formation. [source] Radiofrequency Catheter Ablation of Atrial Fibrillation in Athletes Referred for Disabling Symptoms Preventing Usual Training Schedule and Sport CompetitionJOURNAL OF CARDIOVASCULAR ELECTROPHYSIOLOGY, Issue 5 2008FRANCESCO FURLANELLO M.D. Introduction: Atrial fibrillation (AF) may occasionally affect athletes by impairing their ability to compete, and leading to noneligibility at prequalification screening. The impact of catheter ablation (CA) in restoring full competitive activity of athletes affected by AF is not known. The aim of our study was to investigate the effectiveness of CA of idiopathic AF in athletes with palpitations impairing physical performance and compromising eligibility for competitive activities. Methods and Results: Twenty consecutive competitive athletes (all males; 44.4 ± 13.0 years) with disabling palpitations on the basis of idiopathic drug-refractory AF underwent 46 procedures (2.3 ± 0.4 per patient) according to a prospectively designed multiprocedural CA approach that consolidates pulmonary veins (PV) isolation through subsequent steps. Preablation, effort-induced AF could be documented in 13 patients (65%) during stress ECG and significantly reduced maximal effort capacity (176 ± 21 W), as compared with patients with no AF during effort (207 ± 43 W, P < 0.05). At the end of CA protocol, which also included ablation of atrial flutter (AFL) in 7 patients, 18 (90.0%) patients were free of AF and two (10.0%) reported short-lasting (minutes) episodes of palpitations during 36.1 ± 12.7 months follow-up. Compared with preablation, postablation maximal exercise capacity significantly improved (from 183 ± 32 to 218 ± 20 W, P < 0.02). All baseline quality of life (QoL) parameters pertinent to physical activity significantly improved (P < 0.05) at the end of CA protocol. All athletes obtained reeligibility and could effectively reinitiate sport activity. Conclusions: AF, alone or in combination with AFL, may significantly impair maximal effort capacity thereby limiting competitive performance. Multiple PV isolation proved very effective in these patients to restore full competitive activity and allow reeligibility. [source] A structured observation of the interaction between nurses and patients during the administration of medication in an acute mental health unitJOURNAL OF CLINICAL NURSING, Issue 17-18 2010Joy A Duxbury Aims., This aims of this study are to describe current practice in the administration of medication in an acute psychiatric unit and explore factors that influence nurses' decisions regarding the administration of medication during ,rounds'. Background., Medication ,rounds' form part of the ward routine in many inpatient mental health settings. Nurses make several clinical decisions about administrating medication; yet, concerns have been raised about the poor assessment of patients' needs and the quality of the information exchanged. Design., A structured non-participant observational design was used for this research. Method., This study involved the observation of 20 medication ,rounds' over three months. The Ward Administration of Medication Schedule was used to report on the interactions between nurses and patients and aspects of their communication during each round. Results., From the rounds observed nurses appeared adept at communicating a positive interpersonal style but less so in demonstrating skills portraying collaboration and information giving. For example whilst nurses communicated warmth in 97% of cases, using non-verbal behaviours such as good eye contact, the provision of information was only initiated in 46% of cases. Enquiries regarding the patient's general health and medication taking (35% and 17% respectively) were less commonly observed. Verbal consent was sought in only 25% of cases. Procedural matters were adhered to overall. Conclusions., Findings suggest limited collaboration between nurses and patients and the poor monitoring of health status and medication effects. Information exchange could be improved; however, this may be related to medication procedures that make it difficult to explore sensitive information with patients, rather than nursing skills and behaviour. Relevance to clinical practice., The Ward Administration of Medication Schedule can be used as a clinical or educational tool in the administration of medication. In both instances, it may be self-administered and used to reflect on personal skills or employed as an observational tool during peer review and audit. [source] Life satisfaction among older people (65+) with reduced self-care capacity: the relationship to social, health and financial aspectsJOURNAL OF CLINICAL NURSING, Issue 5 2006Christel Borg RN Aims and objectives., This study aimed at investigating life satisfaction and its relation to living conditions, overall health, self-care capacity, feeling lonely, physical activities and financial resources among people (65+) with reduced self-care capacity. Background., Knowledge about factors related to low life satisfaction among older people with reduced self-care capacity is sparse, although this is important in health care and nursing so that the care is adapted to their needs and perspective. Previous research has mainly focused on isolated aspects such as pain in relation to life satisfaction among older people in general and less among so those with reduced self-care capacity in general. Design and method., A subsample of 522 persons was selected from a randomly selected cross-sectional survey using a modified form of the Older Americans' Resources Schedule and Life Satisfaction Index Z. Results., The mean age in the total sample was 77·9; women (79·5) were significantly older than men (77·0). Low life satisfaction was found among women, as well as those living in special accommodations. Life Satisfaction Index Z was 15·3 (SD 5·6) in the total sample. Gender and living conditions did not explain life satisfaction whilst poor overall self-reported health and poor financial resources in relation to needs had the strongest explanatory value. Also of significant importance were loneliness, the degree of reduced self-care capacity and feeling worried. Conclusion., Life satisfaction in older people with reduced self-care capacity is determined by several factors, with social, physical, mental and financial aspects probably interacting with each other; especially feeling lonely, degree of self-care capacity, poor overall health, feeling worried and poor financial resources in relation to needs. These factors need to be considered in the care of these people to preserve or improve their life satisfaction. Relevance to clinical practice., Nursing interventions in terms of preventive home visits, rehabilitation, health education directed towards physical, psychological, social and economic aspects of importance may help to preserve or improve life satisfaction for those with reduced self-care capacity. [source] Handicaps and the development of skills between childhood and early adolescence in young people with severe intellectual disabilitiesJOURNAL OF INTELLECTUAL DISABILITY RESEARCH, Issue 12 2005O. Chadwick Abstract Background While a number of studies have examined the development of skills in children with intellectual disabilities (ID), most have been cross-sectional, most have been concerned with particular syndromes such as Down's syndrome or autism and few have attempted to identify factors associated with improvements in skills. Methods From a sample of 111 children with severe ID who had been identified from the registers of six special schools at 4,11 years of age, 82 were traced and reassessed 5 years later at the age of 11,17 years. On both occasions, information on the children's handicaps and skills was collected by interviewing their main carers using a shortened version of the Vineland Adaptive Behaviour Scales and the Disability Assessment Schedule. Results and conclusions There were small but statistically significant improvements in Vineland age-equivalent communication and daily living skills scores, but not in Vineland Socialization scores, over the 5-year period of follow-up. This pattern of improvement was observed in most aetiological subgroups. Improvement in skills was greatest in younger children, and was associated with reductions in behaviour problems and in levels of parental stress. In spite of the improvements in age-equivalent scores, Vineland standard scores showed significant declines over the same period of time, indicating that the improvements observed were smaller than would be expected in a general population sample of children of the same age. The dangers of using standard scores or quotients to quantify the level of functioning of children with severe ID are highlighted. [source] The reliability and validity of general psychotic rating scales with people with mild and moderate intellectual disabilities: an empirical investigationJOURNAL OF INTELLECTUAL DISABILITY RESEARCH, Issue 7 2005C. Hatton Abstract Background Whilst assessment tools have been developed to diagnose schizophrenia in people with mild intellectual disabilities (IDs), little attention has been paid to developing reliable and valid dimensional measures of psychotic experiences with this population. This study investigates the reliability and validity of two such measures developed for the general adult psychiatric population, the Positive and Negative Syndrome Scale (PANSS) and the Psychotic Symptom Rating Scales (PSYRATS), with a population of adults with mild IDs. Method Sixty-two adults with mild IDs were interviewed using the PANSS and PSYRATS, and independently interviewed using the Psychiatric Assessment Schedule , Adults with Developmental Disability (PAS-ADD) to obtain psychiatric diagnoses to the criteria of the International Classification of Diseases , Tenth Revision (ICD-10). On the basis of ICD-10 diagnosis, participants were divided into three groups: psychosis (n = 11); other mental health problem (n = 14); no mental health problem (n = 37). PANSS and PSYRATS subscale scores were compared across these three groups and were correlated with PAS-ADD symptom scores across a number of PAS-ADD symptom domains. Results All PANSS and PSYRATS subscales showed adequate internal reliability, largely good test-retest reliability, and logical inter-correlations between subscales. The PANSS positive symptoms and the PSYRATS auditory hallucinations subscales differentiated between the psychosis group and the other groups; the PANSS general symptoms subscale differentiated between the psychosis and no mental health problem groups; and the PANSS negative symptoms and the PSYRATS delusions subscales did not differentiate between the three groups. Conclusions The PANSS and PSYRATS are promising measures for use with people with mild IDs and psychotic experiences, although further investigation of items relating to negative symptoms and delusions is warranted. [source] Factors affecting the risk of behaviour problems in children with severe intellectual disabilityJOURNAL OF INTELLECTUAL DISABILITY RESEARCH, Issue 2 2000O. Chadwick In order to examine the importance of a range of potential risk factors for behaviour problems in children with severe intellectual disability, a sample was identified by the administration of a screening version of the Vineland Adaptive Behaviour Scales (VABS) to the parents of children aged 4,11years attending six special needs schools in three adjacent inner London boroughs. Parents whose children had a VABS standard score of 50 were interviewed using the Disability Assessment Schedule and both parents and teachers completed the Aberrant Behaviour Checklist. Most behaviour problems were more common in ambulant children, but problems less dependent on the ability to walk, such as sleeping difficulties, screaming and self-injury, were equally common in ambulant and non-ambulant children. Among ambulant children, there were few significant associations between the severity of the child's behaviour problems and the age or sex of the child, the presence or absence of epilepsy, and various indices of socio-economic disadvantage. Sleeping difficulties, overactivity, self-injury, destructive behaviour and autistic features, such as social withdrawal and stereotypies, were strongly associated with skills deficits, but aggression, temper tantrums and general disruptive behaviour were not. Limitations in daily living skills were better predictors of behaviour problems than were poor communication skills. [source] Schedule of Passive Ethanol Exposure Affects Subsequent Intragastric Ethanol Self-InfusionALCOHOLISM, Issue 11 2009Tara L. Fidler Background:, Many studies have shown that chronic ethanol exposure can enhance later self-administration of ethanol, but only a few studies have identified critical parameters for such exposure. The present studies examined temporal and other parameters of chronic ethanol exposure on subsequent intragastric (IG) self-infusion of ethanol. Methods:, Sprague,Dawley rats implanted with IG catheters were passively infused with ethanol for 5 to 6 days and then allowed to self-infuse ethanol or water using a procedure in which infusions were contingent upon licking fruit-flavored solutions. Experiment 1 examined the time interval between consecutive periods of passive infusion (Massed Group: 12 hours vs. Spaced Group: 36 hours). Experiment 2 studied the interval between the final passive infusion and onset of self-infusion (12 vs. 36 hours). Finally, Experiment 3 tested the effect of inserting self-infusion days within the passive infusion phase. Results:, Passive ethanol exposure on consecutive days induced relatively large amounts of ethanol self-infusion (4.1 to 7.9 g/kg/d). Increasing the duration of the ethanol-free interval between periods of passive exposure to 36 hours significantly reduced ethanol self-infusion (2.2 g/kg/d; Exp. 1). The time delay between the last passive ethanol exposure and onset of self-infusion had no effect on self-infusion (Exp. 2). Moreover, inserting no-choice self-infusion days between the last few passive exposure days did not increase self-infusion (Exp. 3). Conclusions:, Measurement of withdrawal signs indicated that Massed passive exposure produced stronger dependence than Spaced passive exposure, suggesting that enhanced ethanol self-infusion in Massed Groups might be explained by the opportunity for greater negative reinforcement by ethanol. Although enhanced negative reinforcement might also explain why the Massed Group showed a weaker aversion for the ethanol-paired flavor than the Spaced Group, this observation could also be explained by the development of greater tolerance to ethanol's aversive pharmacological effects in the Massed Group. [source] Individual quality of life of people with severe mental disordersJOURNAL OF PSYCHIATRIC & MENTAL HEALTH NURSING, Issue 1 2009A. PITKÄNEN mnsc People with mental disorders have been found to suffer from impaired quality of life (QoL). Therefore, the assessment of QoL has become important in psychiatric research. This explorative study was carried out in acute psychiatric wards. Thirty-five patients diagnosed with schizophrenia and related psychosis were interviewed. QoL was rated by the Schedule for Evaluation of Individual Quality of Life which is a respondent-generated QoL measure using semi-structured interview technique. Patients named five areas of life important to them and then rated their current status and placed relative weight on each QoL area. The data were analysed with qualitative content analysis and descriptive statistics. The most frequently named areas for QoL were health, family, leisure activities, work/study and social relationships, which represented 72% of all QoL areas named. Patients' average satisfaction with these QoL areas ranged 49.0,69.1 (scale 0,100). The mean global QoL score was 61.5 (standard deviation 17.4; range 24.6,89.6; scale 0,100). Awareness of patients' perceptions of their QoL areas can enhance our understanding of an individual patient's QoL and reveal unsatisfactory areas where QoL could be improved with individually tailored needs-based interventions. [source] Atraumatic Restorative Treatment and Dental Anxiety in Outpatients Attending Public Oral Health Clinics in South AfricaJOURNAL OF PUBLIC HEALTH DENTISTRY, Issue 3 2007Steffen Mickenautsch BDS Abstract Objectives: This study was undertaken to test the hypotheses that using the atraumatic restorative treatment (ART) approach results in lower patient anxiety and that lower anxiety leads to higher restoration/extraction ratios. Methods: The test group of dental operators (n=9) was trained in ART. The control group (n=11) was not, and did not apply ART. The Short Form of the Dental Subscale of the Children's Fear Survey Schedule (CFSS-SF) and Corah's Dental Anxiety Scale (DAS) were used to assess patient anxiety after ART (test group) and after traditional restorations (control group). The restoration/extraction ratio calculated for primary (children) and permanent dentitions (adults) per operator was based on 12-month treatment statistics. Dental anxiety assessments were analysed using ANOVA. Differences were compared using the t -test and corrected for confounding factors (ANCOVA). The Pearson correlation coefficient was used to measure the correlation between dental anxiety levels and restoration/extraction ratios. Results: The mean CFSS-SF score for test-group children was statistically significantly lower than for the control-group children. The mean DAS score for test-group adults was statistically significant lower than the control. No significant correlation was observed between dental anxiety level and restoration/extraction ratio per operator for both dentitions in both groups. Conclusion: The first hypothesis was accepted; the second, rejected. Although dental anxiety scores were lower both in child and in adult patients treated by ART than in those who received traditional restorative treatments, this positive effect had not resulted in higher restoration/extraction ratios. [source] Psychiatric Comorbidity in Long-Term Abstinent Alcoholic IndividualsALCOHOLISM, Issue 5 2007Victoria Di Sclafani Background: A high prevalence of comorbid psychiatric disorders has been demonstrated in individuals with an alcohol use disorder in both community and treatment samples, with higher comorbidity in treatment samples. In this study, we examined lifetime and current psychiatric diagnoses in long-term abstinent alcoholic individuals (LTAA; mean abstinence=6.3 years; n=52) compared with age and gender-comparable non-alcoholic controls (NC; n=48). We asked the following questions: (1) to achieve long-term abstinence, must an individual be relatively psychiatrically healthy (i.e., comparable with NC) and (2) can ongoing abstinence be maintained in the face of a current psychiatric disorder? Methods: Lifetime and current (prior 12 months) psychiatric diagnoses were assessed in the mood, anxiety, and externalizing disorder domains using the computerized Diagnostic Interview Schedule (c-DIS). Results: Over 85% of LTAA had a lifetime psychiatric diagnosis, compared with 50% of NC. Long-term abstinent alcoholic individuals had a higher prevalence than NC of lifetime mood, anxiety, and externalizing disorder diagnoses. Long-term abstinent alcoholic individuals also had a greater prevalence than NC of current mood and anxiety diagnoses. Although LTAA had a greater lifetime prevalence of an antisocial personality disorder (ASPD) than NC, no LTAA or NC had a current ASPD diagnosis. Finally, there was no association of duration of abstinence with lifetime or current psychiatric diagnoses, consistent with psychiatric diagnoses having little effect on relapse. Conclusions: Our results suggest that: (1) the presence of a lifetime psychiatric diagnosis does not militate against achieving long-term abstinence, (2) abstinence can be maintained in the presence of a current mood or anxiety disorder, and (3) a current diagnosis of ASPD may not be compatible with long-term abstinence. The relatively low levels of antisocial behavior compared with preabstinence (as indicated by no LTAA meeting current criteria for ASPD) raises the question of whether the neurobiology underlying antisocial behavior is changed in abstinence, or brought under increased executive control, or both. [source] | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||