Behavioral Preparation of Patients for Gastrointestinal Endoscopy: Information,Relaxation, and Coping Style

Abstract

The effectiveness of two techniques for preparing patients to undergo a stressful medical examination was assessed using observer self-report, and physiological measures of distress during gastrointestinal endoscopy. Patients were either informed about expected sensations, trained in systematic muscle relaxation, or received normal hospital procedures. The influence of coping styles on the effectiveness of information and relaxation techniques was examined for measures of fear, avoidance, emotional control, arousability, and independence.

Information and relaxation interventions reduced heart rate increases and observer ratings of distress during tube insertion. Relaxation training also increased positive mood change following the procedure. Interactions between coping styles and recovery measures suggested patients benefited most from preparation that matched their preferred coping style, but were not harmed by preparation that did not match their preferred style. Discussion focuses on how coping styles may interact with preparation procedures and suggests that the use of coping styles as criteria for excluding patients from certain preparation techniques is inappropriate.     

Effects of mindful breath awareness and muscle relaxation and transcranial electrical stimulation techniques on improving blood pressure status in patients with type 2 diabetes

ObjectiveThe present study aimed to determine the effects of mindful breath awareness & muscle relaxation (MBMR) and transcranial electrical stimulation (tCES) techniques on improving the systolic and diastolic blood pressure status in patients with type 2 diabetes.MethodsThe research method was randomized controlled trial (RCT) using split-plot ANOVA (SPANOVA). Thirty patients were selected through purposive sampling from Bonab County Diabetes Association (Iran) and were randomly divided into three 10-member groups, namely MBMR, tCES, and MBMR+tCES groups. Participants received their group interventions in 10 individual sessions. All patients were evaluated for systolic and diastolic blood pressure at two stages, before and immediately after each session. SPANOVA and Bonferroni pairwise comparison tests were used for data analysis.ResultsThe results indicated that the MBMR and tCES techniques, alone and in combination, had significant and equal effects on reducing diastolic blood pressure, but the MBMR treatment was more effective in the systolic blood pressure than the tCES.ConclusionsThe MBMR and tCES techniques were effective and safe in treating hypertension in patients with type 2 diabetes.     

Comparison of Frontal EMG Biofeedback and Several Types of Relaxation Instructions in Reducing Multiple Indices of Arousal

During the training phase, 96 subjects were given one of four types of relaxation instructions (single instructions, repeated instructions, relaxation training, no instructions) and in addition either did or did not receive frontal EMG biofeedback training. Results indicated that each of the instructions and biofeedback procedures were equally effective in reducing frontal EMG, but that none of these procedures had any effect on subjective anxiety or autonomic indices of arousal (pulse rate, skin temperature, and finger pulse volume). During the generalization/stress phase, subjects were threatened with electric shock and were told to apply the relaxation techniques they learned during the training phase even though no additional instructions and/ or biofeedback training would be provided. To assess the effectiveness of the shock manipulation, a no-threat control group was included. Results indicated that: a) the shock manipulation was effective in increasing arousal, b) previous instructions and/or biofeedback were equally effective in reducing frontal EMG levels, but that c) only relaxation training was consistently effective in reducing subjective and autonomic indices of arousal. These findings: a) suggest that in stressful situations, relaxation training may be more effective than either EMG biofeedback or simple relaxation instructions in producing a general relaxation effect as opposed to a specific EMG effect; and b) indicate the importance of assessing the effectiveness of relaxation procedures during stressful situations during which subjects’ levels of arousal are elevated above resting baseline levels.     

The role of tablets in accessing information throughout undergraduate medical education in Botswana

BackgroundMobile learning (mLearning) uses wireless networks and mobile devices to expand physician trainees’ and healthcare providers’ access to and exchange of medical information. Opportunities to increase implementation and expand use of mobile devices to support health care information access and delivery in Africa are vast, but the rapid growth of mLearning has caused project implementation to outpace objective measurement of impact. This study makes a contribution to the existing body of literature regarding mLearning implementation in Africa through its focus on the use of smart devices (tablets) in undergraduate medical education and medical students’ perceptions of the effects on their learning environment.Materials and methodsThe population of this prospective mixed-methods study consisted of 82 undergraduate medical students (45 third year and 37 fourth year) at the University of Botswana Faculty of Medicine. They received tablets in the earliest phase of the mLearning project implementation (between November 2012 and January 2013), when they were in the third and fourth year of their medical training. Usage of the tablets was assessed both quantitatively and qualitatively, through both application usage tracking and focus groups.ResultsBased on application usage data and coding and analysis of focus group discussions, undergraduate medical students indicated that tablets were useful in their medical education, allowing them continual access to information and opportunities for communication. Participants noted that the primary barrier to use of tablets was the lack of mobile cellular Internet beyond the Wi-Fi zones at the training sites. Moreover, participants offered suggestions for improvements to the implementation process.ConclusionsEven in resource-limited settings where Internet access can be unreliable and intermittent, the adoption of tablets can have benefits to medical education by providing consistent access to extensive and current medical information resources. This study highlights the value of clinical resources with offline functionality, with or without consistent access to the Internet. There is also the potential for optimizing the use of tablets through improved training and technical support.     

The influence of a question prompt list on patient-oncologist information exchange in an African-American population

ObjectivesQuestion Prompt Lists (QPL) increase patient active participation in oncology interactions, but questions remain regarding how QPLs influence patient-oncologist information exchange. We examined how a QPL influenced information exchange during oncology interactions with African-American patients.MethodsData were self-reports and video recordings from a parent study testing the effects of a QPL in the outpatient clinics of two urban cancer hospitals. In this secondary analysis, we investigated which QPL questions patients identified as ones they wanted to ask their oncologists, how frequently patients/companions used patient active participation statements to seek information related to each QPL question, whether oncologists provided QPL-related information unprompted or prompted by patients/companions, and how frequently patients’ QPL-related information needs were addressed or unaddressed.ResultsThe QPL influenced information exchange by increasing patients’ and companions’ (if present) prompting for QPL-related information from their oncologists. Patients/companions most often prompted for QPL-related information about side effects and patient experience.ConclusionThis study builds on prior research on QPL interventions by expanding the object of study to information exchange and by analyzing patients’ information needs.Practice implicationsThis research demonstrates that a QPL supports patient/companion participation in oncology consultations by making information exchange more interactive.     

Information seeking behavior and perceived health literacy of family caregivers of persons living with a chronic condition. The case of spinal cord injury in Switzerland

ObjectiveTo examine the information seeking behavior and health literacy of caregivers of individuals living with spinal cord injury in Switzerland and their impact on the caregiving experience.MethodsNationwide survey of family caregivers of people with spinal cord injury (N = 717). Caregivers aged 18+ who assisted with activities of daily living were included. Self-reported information seeking behavior, including topics, preferred sources, and health literacy were assessed and analyzed.ResultsHealth professionals were the most trusted source of information. Among information-seekers, higher health literacy levels were shown to be associated with lower subjective caregiver burden and, in turn, with higher caregivers’ satisfaction with own health.ConclusionCaregivers use information on different topics and coming from different sources. In order for information to improve the caregiving experience, however, caregivers need health literacy skills to make sense of it.Practice implicationsBuilding health literacy is a promising approach to support caregivers in their activities, reduce their subjective burden, and even to improve their health. Interventions should consider involving health professionals, as the most trusted source of information, and address both health-related and more practical issues.     

Effects of patient education and therapeutic suggestions on cataract surgery patients: A randomized controlled clinical trial

Objective

This paper describes a randomized controlled single blind study testing the effects of a patient education intervention combined with positive therapeutic suggestions on anxiety for cataract surgery patients.

Methods

84 patients participated in the study. Physiological and behavioral indicators of anxiety were compared between a regularly treated control and an intervention group receiving an audio CD containing information, relaxation, and positive imagery.

Results

We found that the intervention group was calmer throughout the four measurement points of the study (p = .004; d = 0.71) and they were more cooperative (p = .01; d = 0.60) during the operation. The groups did not differ in sleep quality before the day of the operation, heart rate during the procedure, and subjective Well-being.

Conclusion

Findings indicate that preoperative information combined with positive suggestions and anxiety management techniques might reduce patient anxiety in the perioperative period of cataract surgery, but further research is needed to investigate the benefits of such interventions and to uncover the underlying mechanisms.

Practice implications

Patient education interventions providing additional anxiety management techniques are recommended for use prior to cataract surgery.     

A Visual Interactive Narrative Intervention (VINI) for aphasia education: Can digital applications administer augmented input to educate stroke survivors with aphasia?

ObjectivePersons with aphasia (PWA) face additional barriers to proper healthcare due to inadequate patient education by health professionals unequipped to use augmentative and alternative communication (AAC). The current study examines a digital application that evokes and sustains health information processing through AAC specifically aimed at increasing comprehension with augmented input (AI).MethodsA digital application designed to educate PWA about their health condition was compared to a video-recorded doctor providing oral-only education. Sixteen PWA received both education interventions in a crossover manner. Health information processing was assessed through heart rate (HR) and skin conductance levels (SCL), which were collected continually during each administration of education interventions.ResultsPWA demonstrated greater cognitive processing of health information via HR and SCL indices during the digital application compared to the typical oral-only education intervention. The oral-only intervention led PWA to disengage with health information.ConclusionBy combining visuographic materials and adapted language into a customizable narrative structure, digital applications can utilize AI to educate PWA about basic health information (i.e., diagnosis and prognosis).Practice ImplicationsThe current study’s AAC requires minimal training and can be used as an aided support in conjunction with other techniques that increase PWA’s access to health information.     

The Effect of Stress and Meditation on Salivary Protein and Bacteria: A Review and Pilot Study

Abstract

Dentally-induced stress and relaxation-induced anxiety reduction have been correlated with salivary changes in dental patients in two recent studies. In two subsequent studies, test anxiety-induced stress and relaxation-induced anxiety reduction were correlated with salivary changes in dental students. In another study using the resazurin dye indicator, increased salivary bacterial levels were correlated with an increased dental caries incidence. As a result of these findings, it was decided to reinvestigate the effects of stress and relaxation on salivary changes and in addition to examine the effects of those conditions on salivary bacteria. The hypotheses under consideration were: (1) Salivary changes from stress to relaxation will be from opaque to translucent and from high to low protein levels; and (2) salivary bacteria will increase under the condition of stress and decrease under the condition of relaxation. The subjects were twelve dental students. Stress and relaxation were evaluated before and after meditation by verbal reports and examination of saliva for opacity, translucency, protein and bacteria (resazurin dye method). There were significant anxiety-reduction changes by the end of the meditation sessions (p < 0.001) as measured by increased salivary translucency, decreased salivary protein and reduced subjective evaluation of stress. Using the resazurin dye method, bacterial levels showed a significant decrease by the end of the meditation sessions (p < 0.001). The results support hypothesis 1 and reaffirm previous findings in regard to the effectiveness of: (1) salivary changes as measures of stress and relaxation; and (2) meditation to induce deep relaxation. The finding of high bacteria levels under stress and lower bacterial levels under relaxation supports hypothesis 2 and indicates that stress may contribute to dental caries and relaxation may have an anti-caries effect.     

The effects of suggestibility on relaxation

Thirty-two college student subjects were selected on the basis of scores on the Creative Imagination Scale. Eight of the high suggestibility subjects were assigned randomly to each training mode, progressive relaxation (PR) and suggestions of relaxation (SR). The 16 low suggestibility subjects were similarly assigned, which resulted in a 2 × 2 factorial design with one repeated measure, a pre-post relaxation scale that yields a total score and three subscale scores. A significant pre-post relaxation effect emerged. Main effects were found both for suggestibility and mode of training. High suggestibility subjects performed significantly better regardless of the training mode. PR yielded significantly higher relaxation scores than did SR. An interaction between suggestibility and training mode occurred on the cognitive factor scale; subjects who scored low on suggestibility reported relaxing significantly better when the training mode was PR.     

Viscoelastic and failure properties of two configurations of triple-folded hamstring tendons used for anterior cruciate ligament (ACL) reconstruction

BackgroundHamstring autografts are commonly used for anterior cruciate ligament (ACL) reconstruction. Different folding techniques exist in tripling the semitendinosus. Few anatomical studies exist in evaluating their viscoelastic properties. The purpose of this study was to characterize and compare the viscoelastic and failure properties of two hamstring graft configurations, the “Z” construct and “2” construct.MethodsTen matched pairs of fresh-frozen cadaveric semitendinosus hamstring grafts were used to create the “2” configuration or “Z” configuration. The biomechanical testing consisted of four phases: preconditioning, where graft dimensions (mm) were measured; stress relaxation, where load, displacement and time data were collected and equilibrium relaxation (%) was calculated; dynamic creep, where the total construct elongation was calculated; and ramp-to-failure, where maximum failure load was recorded.ResultsThe “2” configuration demonstrated recorded forces (N) significantly greater at each time point when compared to the “Z” configuration during stress relaxation (p = 0.003). The “2” configuration exhibited significantly less construct elongation (mm) during dynamic creep at 10 cycles (p = 0.008) and 2000 cycles (p = 0.0001). The maximum measured load at failure was significantly greater in the “2” configuration constructs than “Z” configuration (p = 0.013). Moreover, the axial loads at 2, 3 and 4 mm of displacement were, on average, greater in the “2” configuration than “Z” configuration (p = 0.152; p = 0.080; p = 0.012), respectively.ConclusionThe results of this study provide support for folding techniques for tripled grafts to provide higher viscoelastic and failure properties for techniques with less suture interfaces. Future studies can potentially evaluate the clinical significance of these findings.     

Acute effects of different set configurations during a strength-oriented resistance training session on barbell velocity and the force–velocity relationship in resistance-trained males and females

Purpose

This study explored the acute effects of strength-oriented resistance training sessions performed using three different set configurations on barbell velocity and the force–velocity (F–v) relationship of upper-body muscles in men and women.

Method

Thirteen men (age: 23.8 ± 2.5 years; 6-repetition maximum [6RM] load: 73.4 ± 15.6 kg) and 13 women (age: 21.5 ± 1.4 years; 6RM load: 32.8 ± 5.2 kg) performed 24 repetitions with a 6RM load during the bench press exercise using traditional (TR: 6 sets of 4 repetitions with 3 min of rest between sets), cluster (CL: 6 sets of 4 repetitions with 15 s of intra-set rest every two repetitions and 2 min and 45 s of rest between sets) and inter-repetition rest (IRR: 1 set of 24 repetitions with 39 s of rest between repetitions) set configurations. The F–v relationship parameters [maximum force (F₀), maximum velocity (v₀) and maximum power (P_max)] were determined before and after each training session.

Results

The average training velocity did not differ between the three set configurations (p = 0.234), but the IRR set configuration generally provided higher velocities during the last repetition of each set. Significant decreases in F₀ (p = 0.001) and P_max (p = 0.024) but not in v₀ (p = 0.669) were observed after the training sessions. Comparable velocity loss was observed for men and women (− 12.1% vs. − 11.3%; p = 0.699).

Conclusions

The administration of very short intra-set rest periods does not allow for the attainment of higher velocities than traditional set configurations during strength-oriented resistance training sessions conducted with the bench press exercise when the work-to-rest ratio is equated.

     

Development and evaluation of an online infertility peer supporter training program

ObjectiveTo outline the development and evaluation of an online infertility peer supporter training program.MethodsMen and women with diverse infertility backgrounds were recruited and trained to provide online peer support to people undergoing fertility treatment. Training required volunteers to (1) read a peer support training manual, (2) watch a webinar, and (3) complete practice questions, each of which was evidence-based and reviewed by key stakeholders.ResultsSeventeen women and one man were trained and provided online peer support. Program satisfaction was high and training materials were rated as helpful. Peer supporters felt comfortable providing support and having their discussions monitored. They liked helping others and the convenience of a mobile application.ConclusionOnline recruitment and training of infertility peer supporters is feasible. The current program was acceptable and offers steps for improving future online peer support interventions.Practice implicationsCurrent evidence supports the acceptability and feasibility of this training and supervision program, and provides service providers with information guiding its development and implementation.     

Physician communication styles in initial consultations for hematological cancer

ObjectiveTo characterize practices in subspecialist physicians’ communication styles, and their potential effects on shared decision-making, in second-opinion consultations.MethodsTheme-oriented discourse analysis of 20 second-opinion consultations with subspecialist hematologist-oncologists.ResultsPhysicians frequently “broadcasted” information about the disease, treatment options, relevant research, and prognostic information in extended, often-uninterrupted monologs. Their communicative styles had one of two implications: conveying options without offering specific recommendations, or recommending one without incorporating patients’ goals and values into the decision. Some physicians, however, used techniques that encouraged patient participation.ConclusionsBroadcasting may be a suboptimal method of conveying complex treatment information in order to support shared decision-making. Interventions could teach techniques that encourage patient participation.Practice implicationsTechniques such as open-ended questions, affirmations of patients’ expressions, and pauses to check for patient understanding can mitigate the effects of broadcasting and could be used to promote shared decision-making in information-dense subspecialist consultations.     

Practice Patterns of Athletic Trainers Regarding the On-Site Management of Patients With Joint Dislocations

ContextAs part of clinical practice, athletic trainers (ATs) provide immediate management of patients with acute joint dislocations. Management techniques may include on-site closed joint reduction of the dislocated joint. Although joint reduction is part of the 2020 educational standards, currently practicing ATs may have various levels of exposure, knowledge, and skills.ObjectiveTo capture AT self-reported knowledge and practice patterns concerning closed joint reductions.DesignCohort study.SettingOnline survey (Qualtrics).Patients or Other ParticipantsThe survey link was emailed to 5000 certified ATs. A total of 772 responses were completed by certified ATs with clinical practice experience (15.4% response rate).Main Outcome Measure(s)Participants were asked to complete a survey about their practice patterns concerning patients with closed joint reductions, which included questions about the types of closed reductions ATs performed most commonly, the frequency of on-site reduction by ATs, and participants'' demographic information. Additionally, the survey addressed the ATs'' training and comfort level in performing closed reductions and knowledge of standing orders and the state practice act.ResultsNinety percent (n = 694) of ATs reported ever performing a closed reduction (either with or without a physician present), with 10% (n = 78) stating they had never performed a joint reduction. The interphalangeal joint of the finger (73.2% of ATs), shoulder (63.3%), and patella (48.2%) were cited as the 3 most common reductions performed without a physician present. Only 46.5% (n = 359) of ATs indicated receiving training in joint-reduction techniques as part of their precertification athletic training curriculum or program; a greater percentage (64%) said they learned directly from a physician. Fewer than 60% of ATs reported having standing orders related to joint reductions.ConclusionsConsidering the high percentage of ATs who reported performing closed joint reductions and the low percentage with formal training, further development of joint-reduction training and standing orders is warranted.     

Relaxation therapy in asthma: a critical review

This review discusses the relationship between the psychological and physiological factors responsible for airways in asthma and indicates the mechanisms by which psychological methods of treatment may influence airway caliber. The effects of mental and muscular relaxation therapy, systematic desensitization, and biofeedback-assisted relaxation are evaluated in children and adults with asthma. The methodology and results of studies are analyzed critically to present a balanced opinion of the subjective and objective effects of these methods of treatment. Muscular relaxation therapy alone appears to have no effect. Certain mental relaxation techniques, such as autogenic training and transcendental mediation, systematic desensitization, and biofeedback-assisted relaxation, can produce subjective improvement as well as clinically significant improvement in respiratory function and other objective parameters. As with any therapy the response is variable and is influenced by factors such as age and severity of asthma.     

National train-the-trainer certificate programme for improving healthcare communication in Austria

ObjectivesIn Austria a national train-the-trainer programme (TTT) has been developed, implemented and evaluated with the aim of training and certifying participants for developing, implementing and delivering communication skills training (CST) for health professionals.MethodsThe programme included 5 in-person courses, application homework with feedback, peer work, and regular trainer network meetings. Global satisfaction with training and changes in self-efficacy among TTT-participants and their learners in the CST delivered as practice projects were evaluated.Results18 participants have graduated from the TTT-pilot. 98 people took part in the 9 CST delivered by TTT-participants. Participants’ satisfaction has been rated very positively both for TTT and CST. At post-programme/post-training, statistically significant improvement was observed in self-efficacy for the TTT-participants and for the CST-participants. Additionally, valuable suggestions for programme/training improvement were identified.ConclusionsThis programme is an important step to sustainably improving CST in Austria. To guarantee high quality and consistency, a set of standards for certification have been developed for TTT and CST.Practice implicationsImplementation of best practices in training trainers and communication skills teaching can be guided by a structured approach. Those wanting to implement similar programmes can benefit from strengths and suggestions for improvement identified in this national project.     

Stress management training and relaxation imagery in the treatment of essential hypertension

The present study compared the effectiveness of three procedures in the treatment of 34 individuals with essential hypertension: (1) stress management training plus relaxation imagery, which consisted of an adaptation of existing stress management techniques in conjunction with extensive relaxation training using relaxation imagery; (2) relaxation imagery alone; and (3) weekly blood pressure checks. The relaxation imagery technique involved visualization of a relaxing image along with concentration on suggestions of relaxation, heaviness, and warmth. Treatment was individualized and lasted 8 weeks. Results indicated stress management plus relaxation imagery and relaxation imagery alone were significantly more effective than blood pressure checks in reducing systolic and diastolic blood pressures during treatment and in maintaining diastolic blood pressure reductions during follow-up. However, no significant differences were found between the two treatment procedures. Clinical implications of these findings are discussed.     

The effects of nonconcurrent and concurrent relaxation training on cardiovascular reactivity to a psychological stressor

Eight patients in a cardiac rehabilitation program, after exposure to two psychological stressors approximately equivalent with respect to cardiovascular reactivity, were given nonconcurrent progressive muscle relaxation training and retested for reactivity. They were then provided with relaxation training concurrently with one of the stressors and exposed again to the two stressors. No significant effects for nonconcurrent progressive muscle relaxation training were detected. Concurrent training, in contrast, produced reductions in both systolic and diastolic blood pressure. Reductions resulting from training on the target stressor showed little tendency to generalize to the nontarget stressor; the discrimination was particularly well defined for systolic blood pressure. We conclude that muscle relaxation techniques are maximally effective in reducing reactivity to psychological stressors when relaxation training is provided concurrently with the stressor. Our findings further suggest that to inculcate the relaxation response reliably across different situations, specific training to enhance generalization may be needed.