Do constitutional types really exist? A further study using grade of membership analysis

'Constitutional types' are a feature of homeopathy. Constitutions are constellations of mental, physical and general features. We present results of a 152-item 'Constitutional Type Questionnaire' (CTQ), relating to 19 major constitutional remedies. Patients referred to the Royal London Homoeopathic Hospital (RLHH) were recruited from outpatient clinics. Each remedy was assigned eight associated features. Each item is rated as it applies to the subject most of the time on a five-point scale. Grade of Membership analysis (GOM) was used for evaluation of remedy profiles. Four hundred and forty-seven individuals provided usable data. Demographic data were collected. A nine pure type solution provided the best fit to the data. Few subjects had exclusive 'membership' of one pure type. There are some difficulties in interpretation; for instance some groups were characterised by the absence of 'constitutional' features. Some pure types are coherent, recognisable types.The results give some support to the homeopathic concept of constitution. CTQ results correlate quite well with the actual prescribing of homeopaths. Further validation with other cohorts is required and with refinement it might become a useful screening method. It cannot simulate complex information processing performed by homeopathic practitioners.     

肿瘤科护士对照顾终末期癌症患者的职责认同与负性感受研究

目的:了解肿瘤科护士对照顾终末期癌症患者的态度。方法:采用自行编制的"护士照顾终末期癌症患者的态度评估量表",对全国19家医院的463名肿瘤科护士进行调查,内容包括护士对照顾终末期癌症患者的职责认同程度以及工作中的负性感受两个维度,每个维度均包括症状控制、心理辅导以及家属支持3个方面的测量。结果:①护士对症状控制、心理辅导以及家属支持3方面的职责普遍认同,但在心理辅导方面,对帮助患者应对疾病状况和死亡的职责的认同分值不高,存在不确定性。②护士在3方面的实践中负性感受均较高,其中在帮助家属应对悲伤过程中的负性感受最强,对症状控制的无能为力感受次之。心理辅导方面,护士在帮助患者应对当前疾病状况和谈论死亡问题上感到困难。③护士在症状控制和心理辅导两方面的职责认同程度与工作中的负性感受呈负相关。结论:肿瘤姑息护理的继续教育仍需进一步加强,帮助更多的肿瘤科护士明确职责,更新理念,提高专科护理知识水平和能力,才能为终末期癌症患者提供更加专业、有效的护理,同时也有助于减轻工作中的负性感受和压力。     

A comparison of the affective state and quality of life of chemotherapy patients who do and do not develop chemotherapy-induced oral mucositis

The purpose of this longitudinal study was to compare the quality of life and affective state of patients receiving chemotherapy who developed oral mucositis to patients who did not. Outpatients had their mouths assessed at the beginning of their chemotherapy, completed the Multidimensional Quality of Life scale, Cancer version (MQOLS-CA) and the Profile of Mood States (POMS). Patients again completed the MQOLS-CA and POMS if they developed mucositis during their three cycles (monthly), or if they did not and were exiting the study. Seventy-seven outpatients completed the study; 28 patients developed mucositis and 49 did not. The MQOLS-CA total scores for the entire sample decreased significantly over time (F_1,75 = 25.44, P < 0.001), but there was no group by time interaction, i.e., the change in MQOLS-CA total scores did not depend on mucositis status. While the POMS Total Mood Disturbance scores for the entire sample increased significantly over time (F_1,75 = 19.55, P < 0.001), there was a significant group by time interaction (F_1,75= 4.85, P = 0.03). Patients who developed mucositis had a significant increase in mood disturbance compared to patients who did not. Further, the POMS subscales of depression and anger showed the same pattern of significant increases. In conclusion, the development of mucositis adversely affected the outpatients' affective states, but not their QOL.     

The effects of a mindfulness meditation-based stress reduction program on mood and symptoms of stress in cancer outpatients: 6-month follow-up

The goals of this work were to assess the effects of participation in a mindfulness meditation-based stress reduction program on mood disturbance and symptoms of stress in cancer outpatients immediately after and 6 months after program completion. A convenience sample of eligible cancer patients were enrolled after they had given informed consent. All patients completed the Profile of Mood States (POMS) and Symptoms of Stress Inventory (SOSI) both before and after the intervention and 6 months later. The intervention consisted of a mindfulness meditation group lasting 1.5 h each week for 7 weeks, plus daily home meditation practice. A total of 89 patients, average age 51, provided pre-intervention data. Eighty patients provided post-intervention data, and 54 completed the 6-month follow-up The participants were heterogeneous with respect to type and stage of cancer. Patients' scores decreased significantly from before to after the intervention on the POMS and SOSI total scores and most subscales, indicating less mood disturbance and fewer symptoms of stress, and these improvements were maintained at the 6-month follow-up. More advanced stages of cancer were associated with less initial mood disturbance, while more home practice and higher initial POMS scores predicted improvements on the POMS between the pre- and post-intervention scores. Female gender and more education were associated with higher initial SOSI scores, and improvements on the SOSI were predicted by more education and greater initial mood disturbance. This program was effective in decreasing mood disturbance and stress symptoms for up to 6 months in both male and female patients with a wide variety of cancer diagnoses, stages of illness, and educational background, and with disparate ages.     

Clinical utility of the MDASI-BT in patients with brain metastases

Symptom occurrence has been shown to predict treatment course and survival in cancer patients. The M. D. Anderson Symptom Inventory-Brain Tumor Module (MDASI-BT) was recently validated as a tool for primary brain tumor patient self-report of symptoms. This study evaluated the reliability and validity of the MDASI-BT in patients with brain metastases. Data collection included demographic and clinical factors, and the MDASI-BT (0-10 scale). Construct validity was assessed using confirmatory factor analysis, and known-group validity was evaluated by detecting group differences due to disease severity and treatment approach. For reliability, Cronbach's alpha values were computed for each subscale. A sample of 124 patients participated, of which 53.2% were women. Participants were primarily white (79.8%) and married (78.2%), and a variety of solid tumor malignancies were represented. Factor analysis revealed six underlying constructs, including affective symptoms, cognitive dysfunction, focal neurologic deficits, constitutional and gastrointestinal symptoms, and interference with life. The solution with these factors explained 68.4% of the variance. Mean symptom scores were 1.2 and 2.6, and mean interference scores were 1.8 and 4.3 for patients with good and poor Karnofsky scores, respectively (P<0.001). These subscales were also sensitive to opioid analgesic use, with group differences of 1.5 and 2.2 (P<0.001). Cronbach's alpha was 0.9 for each of the two subscales. Fatigue, sleep disturbance, drowsiness, distress, and dry mouth were the most severe symptoms. The MDASI-BT demonstrated validity and reliability in brain metastases patients and can be used to identify and monitor symptom occurrence in relation to treatment course and survival.     

Development and testing of a scale to measure caregiving load in caregivers of cancer patients in Taiwan, the care task scale-cancer

The purpose of this study was to develop and test an instrument to measure care tasks for Taiwanese spouse caregivers of cancer patients. A 37-item Care Task Scale-Cancer (CTS-C) was developed using both quantitative and qualitative approaches. The reliability and validity of the CTS-C was tested on a convenience sample of 150 spouse caregivers caring for patients with breast cancer, head neck cancer, or esophageal cancer. Factor analysis showed that the CTS-C had 4 underlying factors (subscales): (1) accompany patient and monitor care (12 items), (2) substitutive care for social and general affairs (12 items), (3) communication and emotional care (9 items), and (4) mobility maintenance care (4 items). These 4 factors explained 52.3% of the total variance. Cronbach alpha coefficients for these 4 subscales ranged from .83 to .88. Test-retest coefficients (r) ranged from 0.92 to 0.94. The construct validity of this scale was supported by demonstrating a negative correlation between CTS-C scores (demand, difficulty, and caregiving load) and functional performance status, and positive correlations with caregiver burden and symptom distress. These results showed satisfactory validity and reliability for the CTS-C.     

Determination of the Minimal Clinically Significant Difference on a Patient Visual Analog Satisfaction Scale

Abstract. Objective:To determine the minimal clinically significant difference (MCSD) on a visual analog patient satisfaction scale.
Methods:The authors prospectively collected patient satisfaction evaluations during a clinical trial assessing the effect of introducing personal television sets on overall patient satisfaction from their ED encounters. Patient satisfaction was assessed with 2 scales: a 100-mm visual analog scale (VAS) (0 = least satisfied, 100 = most satisfied) and a 7-point categorical scale ("terrible,""mostly dissatisfied,""mixed,""partially satisfied,""mostly satisfied,""pleased," and "delighted"). The differences between the mean VAS scores of "delighted" and "pleased" patients, and between "pleased" and "mostly satisfied" patients were used to determine the MCSD on the VAS. Reliability of each of the scales was determined.
Results:181 patients were evaluated. Mean age was 41 years; 59% were female. On a subset of 19 patients, the VAS yielded an interobserver correlation of 0.93. The kappa measurement of agreement on the categorical scale was 0.77. The mean difference between "delighted" and "pleased" patient VAS satisfaction scores was 6.8 mm (95% CI, 1.3–12.3 mm). The mean difference between "pleased" and "mostly satisfied" patient VAS satisfaction scores was 10.7 mm (95% CI, 5.5–15.8 mm).
Conclusion:The MCSD in patient satisfaction scores measured with a 100-mm VAS was approximately 7–11 mm. Future studies evaluating differences in patient satisfaction should be designed to detect this difference.     

The effectiveness of self-management training for individuals with HIV/AIDS.

This study tested the effects of a 7-week individual self-management and coping skills training program on various measures of health and well-being of persons with HIV/AIDS. Forty men and women were randomly assigned to the treatment or wait-list control group. Treated participants showed significant posttreatment changes on all four major measures of mood, coping, and health attitudes. Treatment significantly improved coping strategies as measured by the use and effective measures of the Jalowiec Coping Scale and several of its subscales, including decreases in use of emotive, fatalistic, and palliative coping styles. Psychological mood was improved, as measured by the Profile of Moods Total Mood Disturbance (POMS TMD) score and specific subscales of the POMS, which were targeted in the intervention (e.g., Anger). Treated participants also showed significant increases on the Internal subscale of the Health Attribution Test.     

Assessment of symptom severity and functional status in patients with carpal tunnel syndrome: reliability and functionality of the Turkish version of the Boston Questionnaire

OBJECTIVES: The aim of this study was to develop a Turkish version of the Boston Questionnaire and assess its reliability and validity. METHODS: Sixty-seven patients with idiopathic carpal tunnel syndrome were included in the study. The Turkish version of Boston Questionnaire was obtained after translation process, and was then administered to subjects twice within seven days. Reliability was assessed by internal consistency (Cronbach's alpha and item-total correlation), and reproducibility. Validity was examined by correlating the Boston Questionnaire scores to general health status (Short Form-36), pain severity (Visual Analogue Scale) and pinch and grip strength measures. RESULTS: Reliability of the Turkish version was very good, with high internal consistency (Cronbach's alpha 0.82 for symptom severity scale, and 0.88 for functional status scale), and reproducibility (Pearson correlation coefficient 0.60 for symptom severity scale, and 0.77 for functional status scale). The Boston Questionnaire scores were correlated with Visual Analogue Scale, physical functioning, physical role, bodily pain and emotional role subscales of Short Form-36, pinch and grip strength scores to obtain coefficients for external construct validity. CONCLUSION: Adaptation of the Boston Questionnaire for use in Turkey was successful. Our results seem to support previous finding of the English version, indicating that it is valid and reliable.     

Efficacy of the potentized homeopathic drug, Carcinosin 200, fed alone and in combination with another drug, Chelidonium 200, in amelioration of p-dimethylaminoazobenzene-induced hepatocarcinogenesis in mice

OBJECTIVES: This study was conducted to examine whether the potentized homeopathic remedy Carcinosin 200, fed alone and in combination with Chelidonium 200, has differential protective effects against p-dimethylaminoazobenzene (p-DAB)-induced hepatocarcinogenesis in mice. DESIGN: Liver tumors were induced in mice through chronic feeding of p-DAB (initiator) and phenobarbital (PB, promoter). The mice were divided into two subgroups: (1) one was fed potentized Alcohol 200 and served as controls; and (2) the other was fed Carcinosin 200 alone or in combination with Chelidonium 200 and divided into several sets. The relative efficacy of the two potentized remedies, alone or in combination, in combating hepatocarcinogenesis was assessed through several cytogenetical endpoints such as chromosome aberrations, induction of micronuclei, sperm head anomaly, and mitotic index at several intervals of fixation (days 7, 15, 30, 60, 90, and 120). Several toxicity biomarkers such as acid and alkaline phosphatases, glutamate oxaloacetate transaminase, glutamate pyruvate transaminase, and lipid peroxidation activity were also assayed in three organs of treated and control mice. In addition, recovery by the homeopathic drugs, if any, of tissue damage inflicted because of chronic feeding of p-DAB and PB was also assessed by optical, scanning, and transmission electron microscopies of liver done at days 60 and 120. RESULTS: Both Carcinosin 200 and Chelidonium 200 when administered alone show considerable ameliorative effect against p-DAB-induced hepatocarcinogenesis in mice; but the conjoint feeding of these two drugs appears to have had a slightly greater protective effect. CONCLUSIONS: These homeopathic remedies have the potential to be used as complementary and alternative medicine in liver cancer therapy, particularly as supporting palliative measures.     

A comparison of life satisfaction and mood in nursing home residents and community-dwelling elders

This study compared life satisfaction and mood in a sample of 138 cognitively intact and ambulatory elders, including 70 who lived in nursing homes and 68 who lived independently in the community. Community-dwelling elders reported greater life satisfaction, and scored higher on the Vigor-Activity subscale of the Profile of Mood States (POMS) than those who lived in a nursing home. Nursing home residents scored higher on the Depression-Dejection, Tension-Anxiety, and Confusion-Bewilderment subscales of the POMS. No between group differences were shown on the Anger-Hostility and Fatigue-Inertia subscales of the POMS. The diminished life satisfaction and high depression found in the nursing home residents hold immediate implications for professionals who work in this area.     

The memorial symptom assessment scale: modified for use in understanding family caregivers' perceptions of cancer patients' symptom experiences

The purpose of this study was to determine whether the Memorial Symptom Assessment Scale (MSAS) could serve as a feasible, reliable, and valid tool for use in assessing the reports of 98 family caregivers (FC) on the symptom experiences of advanced stage cancer patients. The MSAS consists of subscales that describe psychological symptom distress (PSYCH), physical symptom distress (PHYS), and global symptom distress (Global Distress Index [MSAS-GDI]). The majority of FCs was able to respond to 32 MSAS symptom items; however, the greatest difficulty in FC responding occurred on the 'sexual interest' item. The mean PSYCH score was 1.42 (SD=0.83), the mean PHYS score was 0.96 (SD=0.67), and the mean MSAS-GDI was 1.46 (SD=0.24). Internal consistency was high in the PHYS (alpha=0.84), PSYCH (alpha=0.82), and MSAS-GDI (alpha=0.84) subscales. The average item-scale correlation ranged between r=0.50 and 0.60, indicating that the items were moderately to strongly correlated with the respective total subscales. The average inter-item correlation ranged between r=0.30 and 0.45, indicating that the items were moderately correlated with each other on the respective subscales. Good to excellent intraclass correlations (ICC) with patients' ordinal ratings support the concurrent validity and utility of the PHYS and MSAS-GDI subscales in FC populations who care for cancer patients in the home setting. Depending on the symptom, a range of slight to substantial Kappa values on dichotomous PHYS and PSYCH items, and fair ICC values on the ordinal PSYCH subscale provide questionable validity in FC populations caring for cancer patients.     

Psychometric properties of the Swedish Diabetes Empowerment Scale

OBJECTIVE: This study was conducted to determine the psychometric properties of the Swedish version of the Diabetes Empowerment Scale (Swe-DES-23). RESEARCH DESIGN AND METHODS: A convenience sample of 195 patients with type 1 and type 2 diabetes completed the Swe-DES-23 questionnaire. To establish discriminant validity, Swe-DES subscales were compared with the Semantic Differential in Diabetes scale (SDD) and a general health scale (EVGFP). Construct validity was tested using factor analyses. To determine unidimensionality of the subscales, inter-item correlations were calculated. Internal consistency was tested by the use of the Crohnbach-alpha coefficient. RESULTS: The factor analysis resulted in four factors (empowerment subscales) with eigenvalues >1.0, explaining 60% of the variance. The four empowerment subscales: goal achievement, self-awareness, stress management and readiness to change showed Crohnbach-alpha values ranging from 0.68 to 0.91. Patients with good self-reported health and low burden of diabetes scored significantly higher on almost all empowerment subscales. Only weak correlations were found between metabolic control and the empowerment subscales. CONCLUSIONS: The SWE-DES-23 scale had acceptable validity and reliability and, thus, could be a suitable tool in evaluating empowerment-based education programmes. Further testing is needed to shorten the questionnaire.     

跨理论模型的照护行为干预对新诊断癫痫患儿家属照护行为及心理状况的影响

目的探讨跨理论模型(TTM)照护行为干预对新诊断癫痫患儿家属心理状况的影响。方法选择本市及周边地区2012年6月-2015年6月新诊断癫痫患儿的家属96例,采用随机数字表法分为观察组与对照组各48例。两组在干预前均采用变化阶段量表、焦虑自评量表(SAS)和抑郁自评量表(SDS)对其进行基线评估。对照组患儿接受系统治疗护理,患儿家属接受一般心理护理和健康教育,观察组在与对照组相同护理基础上,根据评估结果,针对患儿家属制定并实施个性化的TTM照护行为干预,为期6个月。干预后对两组患儿家属进行跟进评估,分析干预前后患儿家属在照护行为变化阶段的分布情况及SAS、SDS得分的变化。结果干预6个月后,两组患儿家属的SAS、SDS得分比较,观察组明显优于对照组,差异具有统计学意义(P0.01);观察组干预前后SAS、SDS得分比较,改善幅度明显大于对照组,差异有统计学意义(P0.01)。结论运用TTM为指导的照护行为干预,能有效改善新诊断癫痫患儿家属的照护行为,降低焦虑、抑郁水平,利于癫痫患儿的照护。     

Distress and growth outcomes in mothers of medically fragile infants.

BACKGROUND: With recent advances in medical and nursing care, many high-risk infants are surviving the neonatal period with severe, life-threatening chronic illnesses, resulting in extended hospitalizations and/or frequent rehospitalizations and long periods of dependence on technology for survival. OBJECTIVE: To describe the factors predicting maternal adjustment in mothers caring for medically fragile infants. METHOD: Subjects were mothers (n = 67) whose infants had a serious life-threatening illness requiring hospitalization and technology for survival. Data for this longitudinal study were collected at enrollment and hospital discharge, and at 6, 12, and 16 months after birth. Distress was measured as depressive symptoms using the Center for Epidemiologic Studies Depression Scale, and growth was assessed using a personal developmental impact rating scale. Data about personal characteristics, parental role attainment, infant-illness characteristics, and maternal illness distress were collected. RESULTS: Mothers of medically fragile infants experience distress and growth as a result of their child's illness. Mean scores on the depression scale at both time points were moderately high and a high percentage of mothers scored at risk for depressive symptoms. Maternal developmental impact ratings at 6 months were neutral to slightly negative and at 16 months were between neutral and positive. While the mean depressive symptom scores and maternal developmental ratings were lower at the later time points, these differences were not significant. Maternal depressive symptoms and developmental impact ratings were moderately but negatively correlated at 6 and 16 months, indicating that higher depressive symptoms were related to more negative developmental impact ratings. Distress was influenced by maternal characteristics, hospital environmental stress, and worry about the child's health. Growth was influenced by characteristics of the child's illness, hospital environmental stress, concern about the child's health, and level of maternal role attainment. CONCLUSIONS: Nurses should consider personal characteristics and level of parental role attainment as well as characteristics of the child and illness-related distress in their approaches to intervention with mothers of critically ill infants.