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ABSTRACT: This repeated measures, prospective study was designed to explore and describe symptom dimensions, depressive symptoms, and uncertainty in newly diagnosed oropharyngeal and laryngeal cancer patients during and 1 month following treatment.
A non-probability sample of 21 oropharyngeal and laryngeal cancer patients receiving definitive radiation completed the Memorial Symptom Assessment Scale, Beck Depression Inventory, and Mishel's Uncertainty in Illness Scale at treatment initiation, and at 5, 9, and 12 weeks.
A common pattern of 11 symptoms, which changed as treatment progressed, was problematic for patients. Physical symptoms increased by 50% at week 5 and 9. Depression was experienced by 24% of patients. Uncertainty was found to be high at all time points and unexpectedly remained unchanged over time (p = 0.73). Positive correlations (p < 0.05) were found among number of symptoms, symptom distress, and depressive symptoms. Uncertainty was correlated (p < 0.05) statistically only to symptom distress.
This study is the first to identify uncertainty in illness among oropharyngeal and laryngeal cancer patients and found it to be higher than for other cancer populations. Findings provide insights into the uncertainty of living through treatment and provide information for patient care. The consistent pattern of high levels of uncertainty during and 1 month after treatment suggests that the uncertainty related to acute illness could extend into chronic uncertainty which may interfere with a cancer survivor's adaption to daily living after treatment. Further research is needed to investigate other variables that influence uncertainty during treatment as well as 1 to 6 months after treatment for head and neck cancer.
Supportive Care in Cancer 10/2011; 20(8):1885-93. · 2.09 Impact Factor
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ABSTRACT: Accurate assessment in hospice patients who cannot communicate their pain is almost impossible, increasing their risk for unrecognized and inadequately managed pain.
The purpose of this article is to describe a series of small-scale projects aimed at developing and refining an instrument to assess acute pain in noncommunicative hospice patients.
Project 1 was a clinical project in which focus groups with hospice nurses yielded an adaptation of an existing pain assessment measure that was named the Multidimensional Objective Pain Assessment Tool (MOPAT) and had behavioral and physiological subscales. Projects 2 and 3 tested the MOPAT in 30 cognitively impaired/nonresponsive hospice inpatients and 28 alert and oriented hospice inpatients, with study nurses and hospice nurses rating pain with the MOPAT before and after a pain-relieving intervention and rating its clinical usefulness. Projects 3 and 4 analyzed the reliability, validity, and clinical utility of the MOPAT.
Overall internal consistency reliability of the MOPAT was demonstrated with Cronbach's α coefficients of 0.79 before and 0.84 after the pain-relieving intervention. The behavioral and physiological subscale scores changed significantly (p < .035) after pain medication, demonstrating sensitivity to changes in pain. Principal components factor analysis revealed two factors matching the subscales and accounting for 66% of the variance. Nearly all the hospice nurses found the MOPAT helpful, easy to use and understand, and conducive to use in daily practice.
The MOPAT has preliminary evidence of reliability, validity, and clinical utility. Full-scale psychometric testing in hospice and acute care hospital patients is currently underway.
Journal of palliative medicine 01/2011; 14(3):287-92. · 1.84 Impact Factor
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ABSTRACT: The mental health consequences of living with intimate partner violence (IPV) are substantial. Despite the growing awareness of the incidence of depression and PTSD in women experiencing IPV, few studies have examined prospectively the experience of IPV during pregnancy and the impact of the abuse on women's mental health. As a component of a larger clinical trial of an intervention for pregnant abused women, 27 women participated in a qualitative study of their responses to the abuse in the context of pregnancy and parenting. Results indicate that women's changing perceptions of self was related to mental distress, mental health, or both mental distress and mental health.
Issues in Mental Health Nursing 02/2010; 31(2):103-11.
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ABSTRACT: To present a comprehensive summary of the existing research literature related to prevalence and correlates of depression in adult patients with head and neck cancer to establish a knowledge base for future research.
Quantitative studies in English measuring depression or mood in adults with head and neck cancer published from 1986-2008.
A substantial body of knowledge exists regarding prevalence, correlates, and predictors of depression in patients with head and neck cancer. Prevalence rates of depression are high at diagnosis, during treatment, and in the first six months following treatment, and mild to moderate depression may continue for three to six years after diagnosis. Certain patient demographic characteristics (e.g., marital status, education), symptoms, and specific time points in the illness trajectory (e.g., time of treatment) are correlated with depression. Specific patient variables at diagnosis, such as depression, can predict depression at later time points.
Additional research should assess symptoms using consistent depression instruments or clinical interviews based on specific criteria in patients with head and neck cancer. Specifically, multisite studies should be conducted to increase sample sizes. Research related to symptom clusters and the effect of clusters on patients is needed. Longitudinal studies that examine depression and patient characteristics, symptoms, type of treatments, and the correlates of depression across the trajectory of illness are important. Replication of existing research using multiple patient and clinical characteristics to explore predictors of depression may reveal profiles for patients most at risk.
This comprehensive summary of existing research literature related to the prevalence and correlates of depression among adult patients with head and neck cancer provides evidence-based information that can be used by oncology nurses in their practice.
Oncology Nursing Forum 06/2009; 36(3):E107-25. · 1.91 Impact Factor
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ABSTRACT: We examined social support as a protective factor in the relationship between lifetime exposure to traumatic events and Post-Traumatic Stress Disorder (PTSD) symptomatology among urban women. Seventy-six women who sought care in a trauma center for injuries from physical or sexual violence completed an interview. When tangible support, rather than total social support, and the interaction of tangible support and lifetime trauma were tested, tangible support moderated the relationship between lifetime trauma and PTSD. Given the complex etiology of lifetime trauma, risk for future trauma and the health needs of women who have experienced trauma, a broader range of intervention strategies that include attention to tangible support need to be developed and evaluated.
Research in Nursing & Health 11/2007; 30(5):558-68. · 1.71 Impact Factor
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ABSTRACT: The purpose of this study is to examine the effectiveness of the interventions for improving mental health of caregivers of people with stroke by synthesizing individual studies. A meta-analysis was performed to summarize findings of intervention studies of caregivers of elderly stroke patients. Additionally, a sensitivity analysis and a publication bias were tested. The overall mean weighted effect size (MWES) for the four studies is 0.277 (Z = 3.432, p = .001) with a 95% CI .118 to .435 (N = 718) indicating that the intervention was effective in improving the mental health of informal stroke caregivers. The MWES for the education program was 0.354 (Z= 2.613, p < .01) and for the support program was .234 (Z = 2.335, p= .02). The MWES for the Europe study was .219 (Z= 2.613, p < .01) and for the United States was .922 (Z = 3.287, p = .001). The results show that overall interventions improved mental health of informal stroke caregivers. The small number of studies included in the meta-analysis limits the generalizability of results while supporting the need for more research in this area.
Western Journal of Nursing Research 05/2007; 29(3):344-56; discussion 357-364. · 1.19 Impact Factor
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ABSTRACT: In 1996 the NewYork State Office of Mental Health issued a policy requiring all State-operated psychiatric facilities to develop and implement a proactive violence-prevention program based on guidelines issued by the US Occupational Safety and Health Administration. This presented an opportunity to evaluate the impact of the guidelines on worker health and safety. The authors report the findings of a mixed-method study to evaluate the feasibility and impact of a participatory intervention to prevent workplace violence. They describe the implementation of the intervention in 3 in-patient facilities, including an extensive worksite analysis, staff focus groups, and a baseline and post-intervention survey of changes in staff perception of the quality of the program's elements and physical assault following implementation of the program. The authors provide evidence for the feasibility and positive impact of a comprehensive violence-prevention program in the in-patient mental health workplace. Staff perception of the quality of management commitment and employee involvement in violence-prevention was significantly improved in all worksites post-implementation.
The Canadian journal of nursing research = Revue canadienne de recherche en sciences infirmières 01/2007; 38(4):96-117.
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ABSTRACT: In 1996 the New York State Office of Mental Health issued a policy requiring all State-operated psychiatric facilities to develop and implement a proactive violence-prevention program based on guidelines issued by the US Occupational Safety and Health Administration. This presented an opportunity to evaluate the impact of the guidelines on worker health and safety. The authors report the findings of a mixed-method study to evaluate the feasibility and impact of a participatory intervention to prevent workplace violence. They describe the implementation of the intervention in 3 in-patient facilities, including an extensive worksite analysis, staff focus groups, and a baseline and post-intervention survey of changes in staff perception of the quality of the program's elements and physical assault following implementation of the program. The authors provide evidence for the feasibility and positive impact of a comprehensive violence-prevention program in the in-patient mental health workplace. Staff perception of the quality of management commitment and employee involvement in violence-prevention was significantly improved in all worksites post-implementation.
French
En 1996, le New York State Office of Mental Health adoptait une politique obligeant tous les établissements psychiatriques administrés par l'État à se doter d'un programme proactif de prévention de la violence fondé sur les lignes directrices imposées par la U.S. Occupation Safety and Health Administration. Cette décision a fourni une occasion d'évaluer l'effet de ce type de lignes directrices sur la santé et la sécurité au travail. Les auteurs rapportent ici les résultats d'une étude à plusieurs volets dont le but était d'évaluer la faisabilité et les répercussions d'une intervention participative destinée à prévenir la violence au travail. Ils décrivent la mise en œuvre d'un programme de prévention dans trois établissements hospitaliers, en se fondant sur : une analyse approfondie du milieu de travail; des groupes de discussion réunissant des employés; des sondages menés avant et après l'instauration du programme dans le but d'évaluer les changements de perception à l'égard des agressions physiques et de la qualité des différents volets du projet. Les résultats attestent de la faisabilité de ce type de programme et de ses répercussions favorables au sein des établissements de santé mentale. On a constaté chez les employés de tous les milieux de travail concernés une amélioration notable des perceptions concernant l'engagement de la direction et la participation du personnel en matière de prévention de la violence.
The Canadian journal of nursing research = Revue canadienne de recherche en sciences infirmières 11/2006; 38(4):96-117.
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ABSTRACT: This study compared the prevalence of anticonvulsant treatment for youths with a diagnosis of a psychiatric disorder to youths with a diagnosis of a seizure disorder.
Administrative claims from outpatient visits and prescriptions were organized for a data set of 258,472 youths who were younger than 18 years of age in a mid-Atlantic state Medicaid program and were continuously enrolled in 2000. Youths dispensed an anticonvulsant were grouped into the following ICD-9 diagnostic categories: a diagnosis of a psychiatric disorder without a seizure disorder, a diagnosis of a seizure disorder without a psychiatric disorder, and a diagnosis of both a psychiatric and a seizure disorder. Anticonvulsant use was analyzed for specific diagnostic classes by age, gender, race or ethnicity, and Medicaid eligibility categories.
A total of 4,522 youths in the one-year data set received an anticonvulsant (1.75 percent): 3,061 had a psychiatric disorder only, 251 had a seizure disorder only, and 611 had both psychiatric and seizure disorders. Among anticonvulsant-treated youths with diagnosis information in their records (3,923 of 4,522 youths), 81 percent had a psychiatric diagnosis and 19 percent had a seizure disorder; 71 percent of those with a seizure disorder also had a psychiatric disorder. Anticonvulsant use for seizure control was proportionally greater for those younger than five years. By contrast, a vast majority of anticonvulsant users with a psychiatric diagnosis were between five and 17 years. Among anticonvulsant-treated youths with a psychiatric diagnosis, males were approximately twice as common as females. For youths with a seizure disorder, no difference was found for gender. Mood disorders and attention-deficit hyperactivity disorder were the major psychiatric diagnoses associated with anticonvulsant use. Valproic acid products were the most commonly dispensed type of anticonvulsant.
Recent state Medicaid data reveal that youths who use anticonvulsants are far more likely to have a psychiatric diagnosis than a seizure diagnosis. Widespread off-label use of anticonvulsants for psychiatric disorders among youths warrants attention to ensure benefits and minimize risks.
Psychiatric Services 06/2006; 57(5):681-5. · 2.38 Impact Factor
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ABSTRACT: This study sought to determine the degree to which Medicaid eligibility categories modify disparities between black and white youths in the prevalence of psychotropic medication.
Computerized claims for 189,486 youths aged two to 19 years who were continuously enrolled in a mid-Atlantic state Medicaid program for the year 2000 were analyzed to determine population-based annual prevalence of psychotropic medication by race or ethnicity and by whether the youths were eligible for Medicaid for reasons of family income, disability, or foster care placement. Logistic regression was used to assess the interaction of eligibility category and race.
The mean annual prevalence of psychotropic medication for the population was 9.9 percent. The prevalence was 2.17 times higher for white youths than for black youths (16.5 percent compared with 7.6 percent). However, within eligibility categories, the white-to-black disparity was 3.8 among youths who were eligible for Medicaid because their family income was below the federal poverty level and 3.2 for youths enrolled in the State Children's Health Insurance Program.
Medicaid eligibility categories had a profound impact on the racial disparity associated with the prevalence of psychotropic medications for youths. Eligibility category should be taken into account when ascertaining the role of access, undertreatment, and culture in disparities in mental health treatment.
Psychiatric Services 03/2005; 56(2):157-63. · 2.38 Impact Factor
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ABSTRACT: To examine changes in the full spectrum of psychotropic medication treatment for youths from 1987 to 1996.
A population-based analysis of community treatment data on nearly 900,000 youths enrolled in 2 US health care systems included (1) computerized Medicaid data from 2 states (a midwestern state and a mid-Atlantic state) composed of outpatient prescription claims and enrollment records and (2) computerized prescription dispensing records from a group-model health maintenance organization. Ten 1-year cross-sectional data sets from 1987 through 1996 were analyzed.
Total psychotropic medication prevalence for youths increased 2- to 3-fold and included most classes of medication. The rapid growth since 1991 of alpha-agonists, neuroleptics, and "mood stabilizer" anticonvulsants was particularly notable. The 1996 prevalence of any psychotropic medication among youths younger than 20 years was remarkably similar (5.9%-6.3%) across all 3 sites, with stimulants and antidepressants consistently ranked first and second. Medicaid rates almost always exceeded health maintenance organization rates by large margins, particularly for alpha-agonists, neuroleptics, "mood stabilizer" anticonvulsants, and lithium. Youths in health maintenance organizations had rates similar to Medicaid-insured youths for antidepressants and hypnotics. Over the decade, there was a proportional increase in females receiving stimulants and in males receiving antidepressants, particularly for the 10- to 14-year-old group. The prevalence ratios of whites to African Americans narrowed substantially in 1 Medicaid site.
Youth psychotropic treatment utilization during the 1990s nearly reached adult utilization rates. Youth findings can be used to accurately assess the duration of treatment and unforeseen practice pattern changes, and to identify safety concerns.
Archives of Pediatrics and Adolescent Medicine 02/2003; 157(1):17-25. · 4.14 Impact Factor
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ABSTRACT: To carry out a systematic review of the literature examining the efficacy of psychological interventions (e.g., relaxation, biofeedback, cognitive-behavioral therapy) in the treatment of rheumatoid arthritis (RA).
Studies that met the following criteria were included: random assignment, wait-list or usual care control condition; publication in peer-reviewed journals; treatment that included some psychological component beyond simply providing education information; and separate data provided for patients with RA if subjects with conditions other than RA were included. Two investigators independently extracted data on study design, sample size and characteristics, type of intervention, type of control, direction and nature of the outcome(s).
Twenty-five trials met the inclusion criteria. Methodologic quality was assessed, and effect sizes were calculated for 6 outcomes. Significant pooled effect sizes were found postintervention for pain (0.22), functional disability (0.27), psychological status (0.15), coping (0.46), and self efficacy (0.35). At followup (averaging 8.5 months), significant pooled effect sizes were observed for tender joints (0.33), psychological status (0.30), and coping (0.52). No clear or consistent patterns emerged when effect sizes for different types of treatment and control conditions were compared, or when higher quality trials were compared to lower quality ones. Findings do, however, suggest that these psychological interventions may be more effective for patients who have had the illness for shorter duration.
Despite some methodologic flaws in the literature, psychological interventions may be important adjunctive therapies in the medical management of RA.
Arthritis & Rheumatism 07/2002; 47(3):291-302. · 7.87 Impact Factor
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ABSTRACT: To examine changes in antidepressant (ATD) prevalence and the sociodemographic and clinical correlates of ATD use among youths who are treated in community practice settings.
A retrospective study was undertaken using large data sets from 3 US sites. Outpatient prescription and clinical service records of youths who were aged 2 to 19 and enrolled in Midwestern Medicaid (MWM) and mid-Atlantic Medicaid (MAM) state programs and a group-model health maintenance organization (HMO) were organized into seven 1-year cross-sectional data sets from 1988 through 1994 to evaluate ATD utilization patterns.
In 1994, ATD prevalence per 1000 youths was 19.10 (MWM), 17.78 (MAM), and 12.85 (HMO), which represented a consistent increase in prevalence from 1988-1994: 2.9-fold (MWM), 4.6-fold (MAM), and 3.6-fold (HMO). Despite the rapidly expanding use of selective serotonin reuptake inhibitors prescribed mainly for depression, more than half of ATD use in 1994 was still attributable to tricyclic antidepressants prescribed mainly for attention-deficit/hyperactivity disorder. ATD prevalence was generally predominant among 10- to 14-year-old boys and among 15- to 19-year-old girls. In the Medicaid populations, 42% (MAM) and 72% (MWM) of ATD-treated youths had primary care services, whereas the bulk of the remainder had psychiatric services. Attention-deficit/hyperactivity disorder followed by depression led the physician-reported primary care diagnoses associated with ATD use, whereas that diagnostic rank order was reversed for youths who received psychiatric services.
ATD treatments among youths substantially increased in the 1990s. This was generated primarily by primary care providers, and thus evaluations of the outcome of ATD treatment need to target primary care in addition to psychiatric providers. Longitudinal study designs are needed to evaluate the use of ATDs in youths in regard to the duration of treatment, combination medications, and the reasons for treatment.
PEDIATRICS 06/2002; 109(5):721-7. · 4.47 Impact Factor
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ABSTRACT: To examine the quality of reports of complementary and alternative medicine (CAM) systematic reviews in the pediatric population. We also examined whether there were differences in the quality of reports of a subset of CAM reviews compared to reviews using conventional interventions.
We assessed the quality of reports of 47 CAM systematic reviews and 19 reviews evaluating a conventional intervention. The quality of each report was assessed using a validated 10-point scale.
Authors were particularly good at reporting: eligibility criteria for including primary studies, combining the primary studies for quantitative analysis appropriately, and basing their conclusions on the data included in the review. Reviewers were weak in reporting: how they avoided bias in the selection of primary studies, and how they evaluated the validity of the primary studies. Overall the reports achieved 43% (median = 3) of their maximum possible total score. The overall quality of reporting was similar for CAM reviews and conventional therapy ones.
Evidence based health care continues to make important contributions to the well being of children. To ensure the pediatric community can maximize the potential use of these interventions, it is important to ensure that systematic reviews are conducted and reported at the highest possible quality. Such reviews will be of benefit to a broad spectrum of interested stakeholders.
BMC Pediatrics 02/2002; 2:3. · 1.88 Impact Factor
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ABSTRACT: Although fall prevention studies for the elderly have been reported, there is a paucity of work summarizing the effectiveness of these interventions.
The research question that guided this study was: 'What are the effects of fall prevention programs on the proportion of falls in the elderly?"
Meta-analysis was employed to summarize findings of intervention studies of fall prevention in the elderly involving a comparison group and a quantifiable outcome. Studies were reviewed by two of the authors with the eligibility criteria in mind. Studies were then coded and an inter-rater reliability check was performed.
The overall mean weighted effect size for the 12 studies included in the meta-analysis was .0779 (Z = 5.03, p < .001). For fall prevention intervention types, exercise alone had a mean weighted effect size of .0220 (Z = .5303, p > .5), exercise and risk modification had a mean weighted effect size of .0687 (Z = 3.41, p < .001), and comprehensive risk assessment intervention studies had an effect size of .1231 (Z = 3.97, p < .001). The mean weighted effect size size for community-based studies was .0972 (Z = 5.37, p < .001) and for institution-based studies was .0237 (Z = .7822, p = .22). Time to outcome measure analyses revealed that the mean weighted effect size for studies measuring proportion of falls at 12 months was .0905 (Z = 5.43, p < .001), and those measuring at four months or less was -.0972 (Z = -.005, p > .50).
The results of this meta-analysis indicate that there was a 4% decrease in the rate of falls for individuals who were in the treatment groups receiving various fall prevention interventions. Additional intervention studies need to be conducted in the elderly population with a goal of preventing falls.
Nursing Research 51(1):1-8. · 1.40 Impact Factor
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ABSTRACT: Examine physicians' attitudes toward the incorporation of psychosocial factors in diagnosis and treatment and identify barriers to the integration of evidence-based mind-body methods.
Random sample of primary care physicians and physicians from selected non-primary specialties was drawn. A total of 1058 physicians completed a 12-page survey.
The response rate was 27%. Although a majority of physicians seem to recognize the importance of addressing psychosocial issues, approximately one third believe that addressing such factors would lead to minimal or no improvements in outcomes. A minority reports their training regarding the role of psychosocial factors was effective, and relatively few indicate interest in receiving further training in these areas. Males were less likely to believe in the importance of addressing psychosocial factors. Additional factors included perceptions that training was poor in these areas; feelings of low self-efficacy to address psychosocial issues and the perception that such factors are difficult to control; lack of knowledge of the evidence-base supporting the role of psychosocial factors; and lack of time and inadequate reimbursement to address the psychosocial domain.
These results suggest the need for more comprehensive training in the role of psychosocial factors in health. In addition, the finding that physicians identify lack of time and inadequate reimbursement as significant barriers suggests that the current health care delivery system may, in many respects, be antithetical to the biopsychosocial model.
The Journal of the American Board of Family Medicine 19(6):557-65. · 2.05 Impact Factor
