Profiling the Psychological Training and Support Needs of Oncology Staff,and Evaluating the Effectiveness of a Level 2 Psychological Support Training Program Workshop

The importance of training non-psychology healthcare professionals to offer psychological support to people with cancer is becoming increasingly recognized. This small-scale pilot project sought to identify the training and support needs of oncology staff and to evaluate the effectiveness of a Level 2 Psychological Support Training Program workshop. Semi-structured interviews with five members of multidisciplinary oncology staff identified that training needs were primarily around communication skills, recognizing and dealing with emotions, offering support and empathy, and self-care. Pre and post-training questionnaires developed with these themes in mind revealed that the Level 2 Training Program workshops run in this network of hospitals are effective in increasing participants’ levels of perceived knowledge and confidence across each of these domains. Recommendations are made for further enhancing this effectiveness.     

Daring to be wise: We are black boxes,and artificial intelligence will be the solution

Emergency physicians seek wisdom through personal resilience, deliberate reasoning, clinical consensus and reflective practice. However, there is a limit to how useful psychological training, clinical guidelines and audit initiatives can be in the face of inherent human fallibility, increasing system complexity and escalating demand. Wisdom may be more easily attained through the careful design of new technology and this should be a priority for the emergency medicine community.     

长航对舰员心理健康状况的影响分析

目的 探讨长航对舰员心理健康状况的影响,为制定相应应对措施提供依据.方法 以整群抽样的方法选取某批次护航编队的全体舰员为测试对象,采用症状自评量表、应对方式问卷等调查表对参加长航的舰员进行集体测试,并分析心理健康与应对方式及个人因素的关系.结果 长航初期(航行15d)躯体化、强迫、焦虑、症状总分等指标与后面3个阶段(航行50、90、140d)存在显著差异(P＜0.05),而后3个阶段之间差异不明显.长航初期抑郁、敌对指标与长航后期及返航期存在显著差异(P＜0.05).舰员心理健康状况随着长航时间的推移有变差的趋势,心理健康状况与消极应对方式密切相关,长航后期的心理健康状况未恢复至正常水平.不同学历、婚姻状况、职务人员的心理健康因子无显著差异(F=2.241,p=0.123; F=1.152,P=0.284:F=1.172.P=0.311).自我效能感等指标是心理健康水平的重要预测指标.结论 长航对舰员心理健康状况有影响.长航时须关注消极应对方式多、自我效能感弱的人员.长航结束后须对长航人员进行必要的心理干预以帮助解决其心理健康问题.     

Guided imagery to improve functional outcomes post-anterior cruciate ligament repair: randomized-controlled pilot trial

Imagery can improve functional outcomes post‐anterior cruciate ligament repair (ACLR). Research is needed to investigate potential mechanisms for this effect. The aim of this study was to (a) evaluate the effectiveness of an imagery intervention to improve functional outcomes post‐ACLR, and (b) explore potential mechanisms. A randomized‐controlled pilot trial was conducted. Participants were randomized to guided imagery and standard rehabilitation or standard rehabilitation alone (control). The primary outcome was knee strength 6‐month post‐operatively. Secondary outcomes were knee laxity at 6‐months, and change in psychological (self‐efficacy) and neurohormonal (adrenaline, noradrenaline, dopamine) variables. Participants (n=21; 62% male) were 34.86 (SD 8.84) years. Following the intervention, no statistical differences between groups for knee strength extension at 180°/s (t=?0.43, P=0.67), or at 60°/s (t=?0.72, P=0.48) were found. A statistically significant effect was found for knee laxity, F=4.67, P<0.05, mean difference of ?3.02 (95% CI ?4.44 to ?1.60), favoring the intervention. No differences were found for self‐efficacy; however, an overall effect was found for noradrenaline, F(1, 19) 19.65, P<0.001, η²=0.52, and dopamine, F(1, 19) 6.23, P=0.02, η²=0.29, favoring the intervention. This imagery intervention improved knee laxity and healing‐related neurobiological factors.     

Consequences of Female Genital Mutilation on Women’s Sexual Health – Systematic Review and Meta-Analysis

BackgroundFemale genital mutilation (FGM) can leave a lasting mark on the lives and minds of those affected.AimTo assess the consequences of FGM on women’s sexual function in women who have undergone FGM compared to women who have not undergone FGM.MethodsA systematic review and meta-analysis were conducted from 3 databases; inclusion and exclusion criterions were determined. Studies included adult women having undergone FGM and presenting sexual disorders assessed by the Female Sexual Function Index (FSFI).ResultsOf 129 studies, 5 that met the criteria were selected. The sexual function of mutilated women, based on the FSFI total score and its different domains, was compared to the sexual function of non-mutilated women. There was a significant decrease in the total FSFI scores of mutilated women compared to non-mutilated women. However, the results obtained for the different domains were not the same for all authors. The meta-analysis highlighted a high heterogeneity with inconsistency and true variance in effect size between-studies.ConclusionAnalysis of studies showed that there is a significant decrease in the total FSFI score, indicating that FGM of any type may cause impaired sexual functioning. But a firm conclusion on this topic is not yet achievable because the results of this analysis do not allow to conclude a cause and effect relationship of FGM on sexual function.Nzinga A-M, De Andrade Castanheira S, Herklmann J, et al. Consequences of Female Genital Mutilation on Women’s Sexual Health – Systematic Review and Meta-Analysis. J Sex Med 2021;18:750–760.     

Benefits of Sexual Activity on Psychological,Relational, and Sexual Health During the COVID-19 Breakout

BackgroundThe COVID-19–related lockdown has profoundly changed human behaviors and habits, impairing general and psychological well-being. Along with psychosocial consequences, it is possible that sexual behavior was also affected.AimsWith the present study, we evaluated the impact of the community-wide containment and consequent social distancing on the intrapsychic, relational, and sexual health through standardized psychometric tools.MethodsA case-control study was performed through a web-based survey and comparing subjects of both genders with (group A, N = 2,608) and without (group B, N = 4,213) sexual activity during lockdown. The Welch and chi-square tests were used to assess differences between groups. Univariate analysis of covariance, logistic regression models, and structural equation modeling were performed to measure influence and mediation effects of sexual activity on psychological, relational, and sexual outcomes.OutcomesMain outcome measures were General Anxiety Disorder-7 for anxiety, Patient Health Questionnaire-9 for depression, Dyadic Adjustment Scale for quality of relationship and a set of well-validated sexological inventories (International Index of Erectile Function, Female Sexual Function Index, and male-female versions of the Orgasmometer).ResultsAnxiety and depression scores were significantly lower in subjects sexually active during lockdown. Analysis of covariance identified gender, sexual activity, and living without partner during lockdown as significantly affecting anxiety and depression scores (P < .0001). Logistic regression models showed that lack of sexual activity during lockdown was associated with a significantly higher risk of developing anxiety and depression (OR: 1.32 [95% CI: 1.12 - 1.57, P < .001] and 1.34 [95% CI: 1.15 - 1.57, P < .0001], respectively). Structural equation modeling evidenced the protective role of sexual activity toward psychological distress (β_males = -0.18 and β_females = -0.14), relational health (β_males = 0.26 and β_females = 0.29) and sexual health, both directly (β_males = 0.43 and β_females = 0.31), and indirectly (β_males = 0.13 and β_females = 0.13).Clinical translationThe demonstrated mutual influence of sexual health on psychological and relational health could direct the clinical community toward a reinterpretation of the relationship among these factors.Strengths and limitationsBased on a large number of subjects and well-validated psychometric tools, this study elucidated the protective role of sexual activity for psychological distress, as well for relational and sexual health. Main limitations were the web-based characteristics of the protocol and the retrospective nature of prelockdown data on psychorelational and sexual health of subjects recruited.ConclusionsCOVID-19 lockdown dramatically impacted on psychological, relational, and sexual health of the population. In this scenario, sexual activity played a protective effect, in both genders, on the quarantine-related plague of anxiety and mood disorders.Mollaioli D, Sansone A, Ciocca G, et al. Benefits of Sexual Activity on Psychological, Relational, and Sexual Health During the COVID-19 Breakout. J Sex Med 2021;18:35–49.     

Indication

Should the indications for therapies differ from one nation to the next? What are the reasons behind controversial therapeutic variations? What roles do cultural history and authoritarian conflict among clinicians play in the adoption of therapies? When I worked at a rural hospital in Kenya, a woman experiencing obstructed labor made me ponder many questions—but only after our emergency ended in the death of her newborn son. In recounting and learning from this episode, I listened to the disparate Kenyan voices of the patient, the hospital’s director, the consultant obstetrician, and to the even more controversial voices of evidence-based medicine. In reflecting on this process, I have learned at least 3 lessons—about the transmissibility of arrogance, the role of guests in other countries, and the nature of science.     

枞阳县重点人群性行为学特征和梅毒感染状况调查分析

目的了解枞阳县重点人群性行为学特征及梅毒感染状况,为制定性病艾滋病防控措施提供科学依据。方法对性病门诊就诊者、孕产妇及娱乐场所暗娼人群进行面对面问卷调查,并抽取5ml静脉血进行梅毒血清学检测。结果调查暗娼40名,280名性病门诊就诊者和402例孕产妇,暗娼及性病门诊就诊者的艾滋病知识知晓率分别为47.5%和43.2%,他们在最近一次性行为中安全套的使用率分别为37.5%和28.9%。孕产妇有1.7%的人曾经患过性病,有11.7%的人有过非婚性性行为。暗娼的梅毒感染率为12.5%,性病门诊就诊者的梅毒感染率为6.4%,0.5%的孕产妇梅毒血清学实验阳性。结论梅毒已经在高危人群中流行与扩散,加强性病艾滋病宣传和干预力度,规范性病门诊及强化孕产妇保健工作是控制梅毒流行与传播的关键措施。     

对肿瘤放疗患者的心理及皮肤护理体会

放疗作为治疗恶性肿瘤的主要手段已被广泛应用于临床。几乎所有患者对放疗都会有焦虑恐惧心理,同时由于放疗的毒副作用患者会出现不同程度的皮肤反应。加强护士对患者的健康教育和心理支持以及局部皮肤的观察护理,可减轻患者的痛苦,提高生活质量。本文总结了对肿瘤放疗患者的心理及皮肤护理方法与注意事项。