Measuring Negative and Positive Thoughts in Children: An Adaptation of the Children’s Automatic Thoughts Scale (CATS)

The aim of this study is to describe the factor structure and psychometric properties of an extended version of the Children’s Automatic Thoughts Scale (CATS), the CATS-Negative/Positive (CATS-N/P). The CATS was originally designed to assess negative self-statements in children and adolescents. However, positive thoughts also play a major role in childhood disorders such as anxiety and depression. Therefore, positive self-statements were added to the CATS. The CATS-N/P was administered to a community sample of 554 children aged 8–18 years. The results of a confirmatory factor analysis revealed that the positive self-statements formed a separate and psychometrically sound factor. Internal and short-term test–retest reliability was good. Boys reported more hostile and positive thoughts than girls; and younger children reported more negative thoughts concerning physical threat, social threat, and failure than older children. In conclusion, the results of the current study support the use of the CATS-N/P for the measurement of positive and negative thoughts in children. The application of the CATS-N/P can facilitate further research on cognitive factors in different childhood disorders.     

What Do Parents Value Regarding Pediatric Palliative and Hospice Care in the Home Setting?

ContextChildren with life-shortening serious illnesses and medically-complex care needs are often cared for by their families at home. Little, however, is known about what aspects of pediatric palliative and hospice care in the home setting (PPHC@Home) families value the most.ObjectivesTo explore how parents rate and prioritize domains of PPHC@Home as the first phase of a larger study that developed a parent-reported measure of experiences with PPHC@Home.MethodsTwenty domains of high-value PPHC@Home, derived from the National Consensus Project's Guidelines for Quality Palliative Care, the literature, and a stakeholder panel, were evaluated. Using a discrete choice experiment, parents provided their ratings of the most and least valued PPHC@Home domains. We also explored potential differences in how subgroups of parents rated the domains.ResultsForty-seven parents participated. Overall, highest-rated domains included Physical aspects of care: Symptom management, Psychological/emotional aspects of care for the child, and Care coordination. Lowest-rated domains included Spiritual and religious aspects of care and Cultural aspects of care. In exploratory analyses, parents who had other children rated the Psychological/emotional aspects of care for the sibling(s) domain significantly higher than parents who did not have other children (P = 0.02). Furthermore, bereaved parents rated the Caregiver support at the end of life domain significantly higher than parents who were currently caring for their child (P = 0.04). No other significant differences in domain ratings were observed.ConclusionKnowing what parents value most about PPHC@Home provides the foundation for further exploration and conversation about priority areas for resource allocation and care improvement efforts.     

Developing the Scale of Parental Participation in Care: Neonatal Intensive Care Unit and Examining the Scale’s Psychometric Properties

ObjectivesThe purpose of this study was to develop the Scale of Parental Participation in Care: Neonatal Intensive Care Unit and to examine the Scale’s psychometric properties.MethodsThe draft scale’ items were created through relevant literature reviews, focus group interviews with nurses, and content validity evaluations by experts. Study data were collected in the neonatal intensive care unit of a public hospital in Turkey from June 2019 to February 2020. The study participants were comprised of 205 parents with an infant in the neonatal intensive care unit. The Scale’s content validity and construct validity were evaluated to determine the validity of the scale. Cronbach’s alpha coefficient, item-total score correlations, and intraclass correlation were calculated to evaluate the Scale’s reliability.ResultsContent validity index values of the draft form of the scale ranged from 0.93 to 1.00. The final scale consisted of 18 items. From the exploratory factor analysis, it was found that the scale structure comprised a single factor that accounted for 51.92% of the total variance. Concerning the reliability of the Scale, it was calculated that Cronbach’s alpha level was 0.93; item total correlations ranged from 0.48 to 0.78; intraclass correlation level was 1.000.ConclusionIt was found that the Parental Participation in Care Scale: Neonatal Intensive Care Unit was valid and reliable in this sample.     

Is the Palliative Care Outcome Scale useful to staff in a day hospice unit?

AIM: this study was undertaken to elicit a day hospice team's experience of using the Palliative Care Outcome Scale (POS), with the intention of determining its usefulness to staff. An adapted version of POS was used for the purpose of the study. SAMPLE: a multiprofessional team of eight day hospice staff took part in the study. All had used POS on a weekly basis for a minimum period of 3 months. DESIGN: a focus group was conducted at the hospice. It was tape-recorded and transcribed verbatim. The data were analysed using an interpretive phenomenological approach. RESULTS: staff felt POS had limited value as an outcome measure for use in this day hospice. Other simultaneous organizational changes at the hospice may also have influenced staff negatively. Further research is needed to explore similar implementation issues in more depth, as practice developments may be abandoned for potentially the wrong reasons.     

Diagnosing the problem: Using a tool to identify pre-registration nursing students’ mathematical ability

Mathematical ability is a skill nurses need to safely administer medicines and fluids to patients (Elliott, M., Joyce, J., 2005. Mapping drug calculation skills in an undergraduate nursing curriculum. Nurse Education in Practice 5, 225–229). However some nurses and nursing students lack mathematical proficiency (Hilton, D.E., 1999. Considering academic qualification in mathematics as an entry requirement for a diploma in nursing programme. Nurse Education Today 19, 543–547). A tool was devised to assess the mathematical abilities of nursing students. This was administered to 304 nursing students in one Higher Education Institution (HEI) in Wales, United Kingdom (UK) on entry to a pre-registration undergraduate nursing course. The students completed a diagnostic mathematics test comprising of 25 non-clinical General Certificate of Secondary Education (GCSE) level multiple choice questions with a pass mark set at 72%. The key findings were that only 19% (n = 53) of students passed the test. Students appeared to have difficulties with questions involving decimals, SI units, formulae and fractions. The key demographic variable that influenced test scores was previous mathematical qualifications on entry to the course.The tool proved useful in two ways. First, in identifying those students who needed extra tutorial support in mathematics. Second, in identifying those areas of mathematics that presented difficulties for students.     

Validation of the Children’s Beliefs and Intentions to Play with Peers with Disabilities in Middle School Physical Education Scale

This study assessed structural validity and internal consistency of the Children’s Beliefs and Intentions to Play with Peers with Disabilities in Middle School Physical Education (CBIPPD-MPE); a scale measuring beliefs and intentions of middle school children without disabilities to play with a hypothetical peer with a physical disability in general physical education, and determined relationships among the CBIPPD-MPE subscales. A background questionnaire and the CBIPPD-MPE were administered to a convenience sample of 808 middle school students. As a part of cross-validation, the sample was stratified by gender and grade and randomly split into a calibration sample (n = 404) and a validation sample (n = 404). The results of two confirmatory factor analyses showed a good fit of the model to the data. Internal consistency of the four subscales ranged between .71 and .91. Belief scores were strongly associated with intentions and the belief subscales were inter-correlated (p < .01).     

Changes in employment and household income during the 24 months following a cancer diagnosis

Goals of work  The purpose of the study was to describe the changes in employment and household income following a cancer diagnosis. Materials and Methods  Participants were 68 recent cancer survivors (6–24 months since diagnosis) aged 18 years or older who were employed full- or part-time prior to receiving a cancer diagnosis. Data were both quantitative and qualitative. Participants completed a mailed questionnaire about various issues faced by cancer survivors, including 36 questions about work, finances, and income. In addition, space was provided for participants to write optional narrative details about work experiences. Main Results  Before cancer, all 68 participants were employed, 45 full-time and 23 part-time. After completion of primary cancer treatment, 49 (72%) were employed (29 full-time and 20 part-time). A decrease in household income after cancer diagnosis was reported by 37% of participants. Of those who were the main income earners in their households prior to cancer, 26% were no longer the main earners after cancer. The qualitative data about work difficulties fell broadly into two areas: physical difficulties and attitudes of employers. Conclusions  Though limited by a comparatively small sample size, this study is the first to focus on employment in the very early survivorship period, using both questionnaire and qualitative data. The findings show that many individuals continue to work during and after treatment, though reduction of work hours or quitting work is not uncommon. The complex factors associated with work decisions are not easily assessed with questionnaires, and in-depth qualitative studies of recent cancer survivors are warranted.     

CAESAR: a new tool to assess relatives’ experience of dying and death in the ICU

Purpose

To develop an instrument designed specifically to assess the experience of relatives of patients who die in the intensive care unit (ICU).

Methods

The instrument was developed using a mixed methodology and validated in a prospective multicentre study. Relatives of patients who died in 41 ICUs completed the questionnaire by telephone 21 days after the death, then completed the Hospital Anxiety and Depression Scale, Impact of Event Scale-Revised and Inventory of Complicated Grief after 3, 6, and 12 months.

Results

A total of 600 relatives were included, 475 in the main cohort and 125 in the reliability cohort. The 15-item questionnaire, named CAESAR, covered the patient’s preferences and values, interactions with/around the patient and family satisfaction. We defined three groups based on CAESAR score tertiles: lowest (≤59, n = 107, 25.9 %), middle (n = 185, 44.8 %) and highest (≥69, n = 121, 29.3 %). Factorial analysis showed a single dimension. Cronbach’s alpha in the main and reliability cohorts was 0.88 (0.85–0.90) and 0.85 (0.79–0.89), respectively. Compared to a high CAESAR score, a low CAESAR score was associated with greater risks of anxiety and depression at 3 months [1.29 (1.13–1.46), p = 0.001], post-traumatic stress-related symptoms at 3 [1.34 (1.17–1.53), p < 0.001], 6 [OR = 1.24 (1.06–1.44), p = 0.008] and 12 [OR = 1.26 (1.06–1.50), p = 0.01] months and complicated grief at 6 [OR = 1.40 (1.20–1.63), p < 0.001] and 12 months [OR = 1.27 (1.06–1.52), p = 0.01].

Conclusions

The CAESAR score 21 days after death in the ICU is strongly associated with post-ICU burden in the bereaved relatives. The CAESAR score should prove a useful primary endpoint in trials of interventions to improve relatives’ well-being.

     

Current practices and barriers impairing physicians’ and nurses’ adherence to analgo-sedation recommendations in the intensive care unit - a national survey

Introduction

Appropriate management of analgo-sedation in the intensive care unit (ICU) is associated with improved patient outcomes. Our objectives were: a) to describe utilization of analgo-sedation regimens and strategies (assessment using scales, protocolized analgo-sedation and daily sedation interruption (DSI)) and b) to describe and compare perceptions challenging utilization of these strategies, amongst physicians and nurses.

Methods

In the 101 adult ICUs in Belgium, we surveyed all physicians and a sample of seven nurses per ICU. A multidisciplinary team designed a survey tool based on a previous qualitative study and a literature review. The latter was available in paper (for nurses essentially) and web based (for physicians). Topics addressed included: practices, perceptions regarding recommended strategies and demographics. Pre-testing involved respondents’ debriefings and test re-test reliability. Four reminders were sent.

Results

Response rate was 60% (898/1,491 participants) representing 94% (95/101) of all hospitals. Protocols were available to 31% of respondents. Validated scales to monitor pain in patients unable to self-report and to monitor sedation were available to 11% and 75% of respondents, respectively. Frequency of use of sedation scales varied (never to hourly). More physicians than nurses agreed with statements reporting benefits of sedation scales, including: increased autonomy for nurses (82% versus 68%, P <0.001), enhancement of their role (84% versus 66%, P <0.001), aid in monitoring administration of sedatives (83% versus 68%, P <0.001), and cost control (54% versus 29%, P <0.001). DSI was used in less than 25% of patients for 75% of respondents. More nurses than physicians indicated DSI is contra-indicated in hemodynamic instability (66% versus 53%, P <0.001) and complicated weaning from mechanical ventilation (47% versus 29%, P <0.001). Conversely, more physicians than nurses indicated contra-indications including: seizures (56% versus 40%, P <0.001) and refractory intracranial hypertension (90% versus 83%, P <0.001). More nurses than physicians agreed with statements reporting DSI impairs patient comfort (60% versus 37%, P <0.001) and increases complications such as self-extubation (82% versus 69%, P <0.001).

Conclusions

Current analgo-sedation practices leave room for improvement. Physicians and nurses meet different challenges in using appropriate analgo-sedation strategies. Implementational interventions must be tailored according to profession.

Electronic supplementary material

The online version of this article (doi:10.1186/s13054-014-0655-1) contains supplementary material, which is available to authorized users.     

How and Why Did a Regional Palliative Care Program Lead to Changes in a Region? A Qualitative Analysis of the Japan OPTIM Study

ContextImproving palliative care is one of the major issues throughout the world.ObjectivesThe primary aim of this study was to explore how and why a regional palliative care program led to changes in a region.MethodsAs part of a nationwide mixed-methods study of a regional palliative care program, a qualitative study was performed with 101 health care professionals involved in the implementation of the program. In-depth interviews were done, focusing on perceived changes and the perceived reasons for the changes. We used thematic analyses.ResultsSeven themes were identified as follows: 1) improved communication and cooperation among regional health care professionals; 2) increased confidence in the system to care for cancer patients at home; 3) improved knowledge/skills, practice, and perception of palliative care; 4) contribution to self-growth; 5) wide variability in perceived changes in the knowledge and perception of patients, family members, and the general public; 6) wide variability in the perceived regionwide effects of the project; and 7) unresolved issues. Participants emphasized improved communication and cooperation among regional health care professionals and stated a variety of ways of how communication and cooperation influenced daily practice. The main reasons for changes included regionwide interdisciplinary conferences and informal interactions at a variety of meetings.ConclusionThis study advances understanding of how the regional palliative care program created a change in the region. The findings are useful for developing a conceptual framework and identifying key interventions to improve regional palliative care for clinicians, researchers, and policy makers.     

Fertilization: a sperm’s journey to and interaction with the oocyte

Mammalian fertilization comprises sperm migration through the female reproductive tract, biochemical and morphological changes to sperm, and sperm-egg interaction in the oviduct. Recent gene knockout approaches in mice have revealed that many factors previously considered important for fertilization are largely dispensable, or if they are essential, they have an unexpected function. These results indicate that what has been observed in in vitro fertilization (IVF) differs significantly from what occurs during “physiological” fertilization. This Review focuses on the advantages of studying fertilization using gene-manipulated animals and highlights an emerging molecular mechanism of mammalian fertilization.     

A Multi-Level Investigation of the Association between Sensory Features in Boys and Adolescents with ASD and Their Mothers’ Anxiety and Depression

The association between boys’ Sensory Features (SF) and their mothers’ anxiety and depression was investigated in two groups of boys with ASD (M age Gp 1 = 7.5 yr.; M age Gp 2 = 14.3 yr). Mothers completed the Sensory Profile (SP) on their sons, and the GAD7 and PHQ9 on themselves. Results indicated significant associations between mothers’ GAD7 scores and the boys’ SP quadrant scores (global level), between GAD7 scores and Auditory, Visual and Touch Processing Domains (subscale level), and between boys’ specific SF-related Visual and Touch behaviours and specific symptoms of mothers’ GAD7 and PHQ9 scores (item level). Implications for clinical interventions with parents of these children are described.     

Cerebral Monitoring in the Operating Room and the Intensive Care Unit – An Introductory for the Clinician and a Guide for the Novice Wanting to Open a Window to the Brain

An evoked potential differs from the EEG mainly in two ways: 1.The EEG is a random, continuous signal, which arises from the ongoing activity of the outer layers of the cortex. An evoked potential is the brain's response to a repetitive stimulus along a specific nerve pathway. 2.EEG signals range from 10-200 milliVolt (mV). Evoked potentials are smaller in amplitude (1-5-20 microVolt requiring precise electrode positioning and special techniques (signal averaging) to extract the specific response from the underlying EEG "noise". The technique of signal averaging, as originally described by Dawson in 1954 [69J, has been further developed in computer processing. The technique is now used by applying a stimulus repeatedly--preferably at randomized intervals--and to record the evoked response over the corresponding area of the brain, averaging out mathematically the change over the number of stimuli. Rationale for the use of EPs in the OR and the ICU. Evoked potentials (EPs) serve the following major purposes: 1. Monitoring of the functional integrity of neural structures that may be at risk during, for instance, ECC (extracorporeal circulation) or endarterectomy indicating cerebral hypoxia. 2. Monitoring of the effects of anesthetic agents and other centrally active drugs, which, besides the cortex, affect deeper neuronal structures. 3. Orthopedic cases where the spinal cord is at risk such as Harrington rod insertion and removal. 4. Clamping of the abdominal aortic artery during aneurysmectomy resulting in a potential damage of the lower parts of the spinal cord. 5. Clipping of an intracerebral aneurysm, which may be impeding blood flow to vital cerebral textures. 6. An indicator of cerebral hypoxia when the blood pressure is deliberately lowered. 7. Operation on peripheral nerves and nerve roots to identify early trauma. 8. Monitoring the cerebral function during controlled hypothermia when the EEG becomes flat. 9. Monitoring of the pathophysiological conditions after severe head trauma and the effects of therapy. 10. An intraoperative warning device of unsuspected awareness during light anesthesia when movement is abolished by muscle relaxants and cardiovascular responses are modified by vasoactive drugs. In case of the latter the stimulus is a small electrical potential applied to the skin of the hand. Thereafter, the stimulus travels along the specific nervous pathways inducing (= generating) potential activation at various sites. The generation of potential changes at various sites along the pathway is an index for the integrity of the nerve. Thus, the evoked potential can be considered a neurophysiological response (usually of the cortex) to impulses originating from some externally stimulated sensory nerve. They provide a physiological measure of the functional integrity of the sensory nerve pathway, which can be used as a clinical diagnostic tool as well as for intraoperative monitoring. The evoked potential usually is recorded from the specific cortical area corresponding to the stimulus input. The classification of evoked potentials. Stimulating a sensory nervous pathway induces evoked potentials. If the auditory nerve is stimulated by "clicks" from headphones, it is called the auditory evoked potential (AEP). The early part of the AEP waveform (less than 10 msec) is called the Brainstem Auditory Evoked Potential (BAEP) since it reflects the passing of the impulse through the brainstem.If a nerve on the arm or the leg is stimulated by a small electrical current applied to the overlying skin, it is called the Somatosensory Evoked Potential (SSEP). If, however, the retina is stimulated by means of flicker light or a sudden change in a checkerboard pattern, the evoked potential thus recorded over the corresponding cortical area is called the Visual Evoked Potential (VEP). Evoked potentials are used both as a diagnostic tool and as a monitoring technique. As diagnostic tests, evoked potentials are useful to evaluate neurologic disorders such as: a) multiple sclerosis, b) acoustic nerve tumors, and c) optic neuritis. As a monitoring modality, evoked potentials are used during all surgical procedures, which might compromise part of the brain or the spinal cord.     

Acute abdominal pain and urgency to defecate in the young and the old: a useful symptom-complex?

In the belief that "pattern recognition" is an important first step of the diagnostic process, we report our observation of an uncommon and heretofore poorly documented symptom-complex in 10 patients, and suggest that the constellation of abdominal pain and urgency to defecate in the acutely ill surgical patient should raise the diagnostic possibility of intra-abdominal bleeding. In our experience, this is statistically likely to be associated with a ruptured abdominal aortic aneurysm in the old and a ruptured ectopic pregnancy in the young.     

Using the lens of enablement to explore patients’ experiences of Nurse Practitioner care in the Primary Health Care setting

Background

Patient enablement is a patient-centred concept reflecting a patient’s ability to cope, understand and manage their own health. It can be used as a measure of the quality of care and has been linked with improved patient outcomes. While there have been studies into patient enablement following consultations with General Practitioners (GPs) and practice nurses, Nurse Practitioners’ (NPs) role in enabling patients remains unexplored.

Using mixed methods to assess how cancer patients’ needs in relation to their relatives are met in the Danish health care system: a report from the population-based study “The Cancer Patient’s World”

Aim

The aims of this paper were to validate four items assessing how patients’ needs regarding support to and from their relatives are met and to investigate patients’ evaluation of this support.

Method

Items were validated by patient–observer agreement and cognitive interviews. Adequacy of support was assessed in a cross-sectional study of 1,490 Danish cancer patients; 147 of these also answered an open-ended question.

Results

All items performed well in the validation. Only 4?% reported lack of support from their relatives, whereas 9 and 11?% had lacked support from the health care professionals regarding how to tell the relatives about the disease and regarding the relatives in general, respectively. Although the patients’ expectations are not unequivocal, a large proportion (35?%) reported that the health care professionals had shown little interest in how the relatives were doing. This was most pronounced for female patients and patients sampled in urban areas. Compared to older patients, younger patients lacked more support with respect to the relatives in general and regarding how to tell them about the disease. Divorced patients were less satisfied than married patients on all measures.

Conclusion

While most patients felt well-supported by their relatives, the oldest, the divorced, and those without children may be a vulnerable group. Many patients reported that the health care staff showed insufficient interest in the well-being of the relatives. Thus, it may be beneficial for both the patient and the relatives if health care professionals acknowledge and support the relatives in fulfilling their important role as caregiver and companion.     

The functional cognitive evaluation and model to assess older adults’ ability to function in their homes in the community

Abstract

Aims: The functional cognitive evaluation (FCE) was designed to evaluate the safety and functioning of community older adults with cognitive decline (CD). The FCE validity was examined and a clinical model was derived. Methods: Older adult with CD ages ≥ 65?years (N?=?110) were evaluated in their homes with the FCE, which examines basic/instrumental ADL, safety, executive functions, awareness and decision-making. A telephone follow-up (2?months) and a second home visit (4?months) were conducted. Persons scoring < 10 on the Mini Mental State Examination (MMSE) or those who were not mobile were excluded from the study. Results: The FCE results correlated significantly with a routine geriatric clinic evaluation. Regression analyses revealed that executive functioning and self-efficacy predict basic and instrumental activities of daily living. Significant mediators were found. Conclusions: The validity of the battery was demonstrated. The FCE model and evaluation enable practitioners to provide recommendations supporting older adults’ ability to function in their homes.