Supporting parents of very young children with type 1 diabetes: Results from a pilot study

Objective

To assess initial efficacy and feasibility of a telephone-based supportive intervention for parents of young children with type 1 diabetes (T1D) designed to improve parental quality of life (QOL) through decreased parental stress, increased social support, and improved daily management of their child's diabetes.

Methods

The research team developed a brief program based on social cognitive theory for parents of young children with T1D. Twenty-four parents (88% mothers) of young children with T1D (ages 2-5 years) participated in a pilot study of the program and completed psychosocial questionnaires and a program satisfaction survey.

Results

Paired t-tests of pre- and post-intervention scores suggested a favorable within-group impact for the intervention group, as evidenced by decreased pediatric parenting stress and a trend for increased perceived social support. The program was well-received, with the majority of participants rating it as helpful and interesting.

Conclusion

Assisting parents with the unique challenges of diabetes management in young children through implementation of a structured intervention is promising.

Practice implications

A telephone-based intervention focused on child development, coping, and problem-solving skills has the potential to positively impact parents’ QOL and may have implications for children's health.     

Tele-health: lessons and strategies from specialists in poison information

Objective

The use of the telephone for providing healthcare is growing. The aim of this exploratory study was to describe tele-health lessons and strategies as discussed by specialists who provide information and recommendations on poison control hotlines.

Methods

Three focus groups of 25 participants who work as specialists in poison information in poison control centers were conducted. Group discussions were analyzed using qualitative content analysis.

Results

Themes that emerged from the data on strategies for telephone communication include: taking control of the call, developing a therapeutic relationship, tailoring communication to fit each caller, preventing information overload, confirming caller understanding, and hands-on training for the development of telephone communication skills.

Conclusion

Specialists in poison information identified challenges specific to communicating with patients over the telephone and reported several types of strategies they used to manage them.

Practice implications

Telephone communication training may be needed to assist health care providers in improving their communication skills.     

Health information seeking: a review of measures and methods

Objective

Outlines the methods and measures commonly used to study active health information seeking and prescribes important considerations in advancing the study of patient information seeking.

Methods

A systematic review of the literature from 1978 to 2010. A single bibliometric database, PsychInfo, identified 648 articles of health information seeking. The 129 articles included in the review were coded by type of sample, measures (n = 12) utilized to study health information seeking, and types of study methods (n = 5).

Results

A majority of studies used non-clinical samples and measured general health information seeking (i.e., whether the participant engaged in a search for health information) through cross-sectional study designs.

Conclusions

There are varying samples, measures, and designs used to identify those who do or do not seek health information. Future research should look into how health information seeking influences health management and should uncover the social and relational functions of health information seeking using more advanced (and less routinely applied) measures and methods of studying health information seeking.

Practice implications

More people are actively searching for health information and health providers should address this in their discussions with patients.     

Informing abortion counseling: an examination of evidence-based practices used in emotional care for other stigmatized and sensitive health issues

Objective

Emotional care is an important component of abortion services. Evidence-based counseling for other stigmatized and sensitive health issues may be informative for the improvement of abortion counseling.

Methods

We searched the literature for practices used in emotional care for stigmatized and sensitive health issues. We made analytic choices for the selection of articles using the “constant comparative method,” a grounded theory technique. We selected practices that were effective in supporting coping and improving psychosocial adjustment. Findings were synthesized and analyzed to draw evidence-based implications for abortion counseling.

Results

We uncovered nine practices used in emotional care for stigmatized and sensitive health issues that have been shown to support coping or improve psychological adjustment. The techniques and interventions identified were: self-awareness assessments, peer counseling, decision aids, encouraging active client participation, supporting decision satisfaction, support groups, Internet-based support, ongoing telephone counseling, and public artistic expression.

Conclusion

A variety of patient-centered, evidence-based interventions used for other health issues are applicable in emotional care for abortion. Evaluation of these practices in the abortion counseling setting can determine their appropriateness and effectiveness.

Practice implications

Abortion care providers may be able to integrate additional patient-centered practices to support coping or improve psychological adjustment after abortion.     

Cholesterol and serotonin transporter polymorphism interactions in late-life depression

Background

It has been suggested that the functional polymorphism in the serotonin transporter gene linked promoter region (5-HTTLPR) modifies associations between vascular diseases (coronary artery syndrome or stroke) and depression. This study investigated whether the 5-HTTLPR polymorphism has modifying effects on previously identified associations between cholesterol levels and prevalence/incidence of late-life depression.

Methods

In 732 community residents aged 65+, depression was ascertained (Geriatric Mental State Schedule) at baseline and after 2 years. 5-HTTLPR genotype and lipid levels (total, HDL and LDL cholesterol and triglycerides) were assayed. Covariates were age, sex, education, disability, and cognitive function.

Results

Significant associations between lower baseline HDL cholesterol levels with prevalent and incident depression were also modified by 5-HTTLPR polymorphism, and were only significant in the presence of one or more copies of the s allele.

Conclusion

A more atherogenic lipid profile, as indicated by lower HDL cholesterol is a risk factor for late-life depression and this risk is modified by a gene implicated in serotonin transport.     

M-ficolin in children with cancer

Objectives

M-ficolin (ficolin-1) is a complement-activating pattern-recognition molecule structurally related to mannan-binding lectin. It is produced by monocytes and neutrophils, and is found in serum. Its biological role is largely unknown. We assessed M-ficolin concentration in serum from pediatric cancer patients. The aim of this study was to explore association of M-ficolin with clinical and hematological parameters, and to investigate whether the risk of chemotherapy-related infections was related to M-ficolin concentrations in serum.

Methods

M-ficolin was measured by time-resolved immunofluorometric assay in serum taken at cancer diagnosis and was correlated with peripheral blood counts and bone marrow examinations performed at the same time.

Results

Median M-ficolin concentration in 94 children with cancer was 1.6 μg/mL (interquartile range, 0.57-2.7; range, 0.055-25.8), and was not different from age-matched controls (median, 1.7 μg/mL; p = 0.92). M-ficolin was strongly associated with absolute counts of neutrophils (Spearman's rho, 0.45; 95%-CI, 0.26-0.65; p < 0.001), monocytes (0.34; 0.12-0.55; p < 0.001), and thus phagocytes (0.42; 0.20-0.63; p < 0.001) in peripheral blood. Similarly, M-ficolin correlated strongly with neutrophils (0.36; 0.14-0.59; p = 0.002) and phagocytes (0.31; 0.08-0.54; p = 0.009) in bone marrow. Low serum M-ficolin (≤0.5 μg/mL) was not associated with an increased incidence of fever in neutropenia during chemotherapy (multivariate Poisson rate ratio, 1.04; 95%-CI, 0.68-1.60; p = 0.85).

Conclusions

The concentration of M-ficolin in serum from children with cancer was strongly associated with neutrophil and monocyte counts in blood and bone marrow. These results suggest that M-ficolin concentrations in serum reflect the pool of phagocytes.     

Serum levels of carbonylated and nitrosylated proteins in mobbing victims with workplace adjustment disorders

Aim

Today the most important problem in the work place is psychological abuse, which may affect the health because of high levels of stress and anxiety.There is evidence that most psychiatric disorders are associated with increased oxidative stress but nothing is reported about the presence of oxidative stress in mobbing victims.

Methods

This study has been carried out in a group of 19 patients affected by workplace mobbing-due adjustment disorders, in comparison with 38 healthy subjects, to evaluate whether oxidative stress may be induced by mobbing.

Results

Serum levels of protein carbonyl groups and of nitrosylated proteins, biological markers of oxidative stress conditions, were higher than those measured in healthy subjects.

Conclusions

These findings may contribute to a better understanding of the redox homeostasis dysregulation occurring in victims of workplace mobbing.     

How to use contextual knowledge in medical case-based reasoning systems: a survey on very recent trends

Objectives

This paper aims at systematizing the ways in which the contextual knowledge embedded in the case library can support decision making, within case-based reasoning (CBR) systems. In particular, CBR applications to the medical domain are considered.

Methods and material

After a quick survey on the definition and on the role of context in artificial intelligence research, we have focused on CBR, with a particular emphasis on medical applications. In this field, we have identified a number of very recent contributions, which strongly recognize context per se as a major knowledge source. These contributions propose to maintain and to rely on contextual information, in order to support human reasoning in different fashions.

Results

We have distinguished three main directions in which contextual knowledge can be resorted to, in order to optimize physicians’ decision making. Such directions can be summarized as follows: (1) to reduce the search space in the case retrieval step; (2) to maintain the overall knowledge content always valid and up to date, and (3) to adapt knowledge application and reasoning to local/personal constraints. We have also properly categorized the surveyed works within these three clusters, and identified the most significant ones, able to exploit contextual knowledge along more than one direction.

Conclusions

Innovative applications of the contextual knowledge recorded in the case library, described and systematized in this paper, can trace promising research directions for the future.     

Effects of two different levels of computerized decision support on blood glucose regulation in critically ill patients

Introduction

Although the use of computerized decision support systems (CDSS) in glucose control in the ICU has been reported, little is known about the effect of the systems’ operating modes on the quality of glucose control. The objective of this study was to evaluate the effect of providing patient-specific and patient non-specific computerized advice on timing of blood glucose level (BGL) measurements. Our hypothesis was that both levels of support would be effective for improving the quality of glucose regulation and safety, with patient specific advice being the most effective strategy.

Patients and methods

A prospective study was performed in a 30-bed mixed medical-surgical intensive care unit (ICU) of a university hospital. In phase 1 the CDSS provided non-specific advice and thereafter, in phase 2, the system provided specific advice on timing of BGL measurements. The primary outcome measure was delay in BGL measurements before and after the two levels of support. Secondary endpoints were sampling frequency, mean BGL, BGL within pre-defined targets, time to capture target, incidences of severe hypoglycemia and hyperglycemia. These indicators were analyzed over the course of time using Statistical Control Charts. The analysis was restricted to patients with at least two blood glucose measurements.

Results

Data of 3934 patient admissions were evaluated, which corresponded to 119,116 BGL measurements. The BGL sampling interval, delays in BG sampling, and percentage of hypoglycemia all decreased after introducing either of the two levels of decision support. The effect was however larger for the patient specific CDSS. Mean BGL, time to capture target, hyperglycemia index, percentage of hyperglycemia events and “in range” measurements remained unchanged and stable after introducing both patient non-specific and patient specific decision support.

Conclusion

Adherence to protocol sampling rules increased by using decision support with a larger effect at the patient specific level. This led to a decrease in the percentage of hypoglycemia events and improved safety. The use of the CDSS at both levels, however, did not improve the quality of glucose control as measured by our indicators. More research is needed to investigate whether other socio-technical factors are in play.     

Using freelisting to understand shared decision making in ADHD: Parents’ and pediatricians’ perspectives

Objective

To compare and contrast notions of ADHD among pediatricians and parents of affected children to understand the perspectives they bring to shared decision making (SDM).

Methods

In this freelisting study, 60 parents of children with ADHD and 30 primary care pediatricians listed words reflecting their understanding of (1) Attention Deficit Hyperactivity Disorder (ADHD), (2) getting/offering help for ADHD, (3) talking to doctors/families about ADHD, and (4) “mental health.” Smith's salience score established terms that were salient and cultural consensus analysis identified variation within subgroups of participants.

Results

Parents’ terms reflected ADHD's effects on the child and family, while clinicians often mentioned school. Lists suggested differing needs and goals for clinicians and subgroups of parents in SDM: “time” for clinicians, “learning” and “understanding” for non-college educated parents, and “comfort” and “relief” for college educated parents. Neither parents nor clinicians framed ADHD in the same way as “mental health.”

Conclusion

Parents and clinicians, who conceptualize ADHD differently, should negotiate a shared understanding of ADHD as a basis for SDM. Treatment discussions should be tailored to encompass families’ varied emotional and educational needs.

Practice implications

Fostering SDM in primary care is consonant with notions of ADHD as distinct from mental health.     

Integrative qualitative communication analysis of consultation and patient and practitioner perspectives: towards a theory of authentic caring in clinical relationships

Objective

We developed a method whereby relationships can be studied simultaneously from the perspectives of each party and researchers’ observations of their dialogue. Then we used this method to study how to recognise authentic, caring clinical relationships.

Methods

Participants were 20 patients who had recently received surgery for breast cancer and nine surgeons with whom they had a post-operative consultation. We audiorecorded consultations, before interviewing patients and surgeons about their perceptions of the consultation and each other. Cross-case qualitative analyses (analysing consultations and surgeon and patient interviews, respectively) were supplemented by integrative, within-case analysis.

Results

Surgeons and patients described their relationship as personal and emotional, but emotional talk was absent from consultations. For patients and surgeons, their relationship depended, instead, on surgeons’ expertise and character.

Conclusion

Our integrative approach suggested that authentic caring in these relationships lay in practitioners’ conscientious execution of their role and, contrary to currently influential views, not in an explicit emotional engagement.

Practice implications

Relationships between patients and practitioners cannot be described adequately using analyses of interactions between them. Researchers will need to triangulate between these observations and the patient and practitioner perspectives in order to understand what makes for authentically caring relationships.     

The trials and tribulations of enrolling couples in a randomized, controlled trial: A self-management program for hyperlipidemia as a model

Objective

Capitalizing on spousal support may enhance the effectiveness of interventions for chronic disease management. However, couples-based interventions present logistical challenges. We describe our experience and lessons learned while recruiting couples into the Couples Partnering for Lipid-Enhancing Strategies (CouPLES) trial.

Methods

This trial seeks to reduce serum low-density lipoprotein cholesterol levels using a couples-based intervention designed to help patients engage in self-management behaviors. We proposed enrolling 250 couples over 13 months.

Results

Due to practical challenges that we encountered, recruitment and enrollment lasted 21 months. Those challenges included: travel to study site; effectively marketing the study; participant burden; and establishing eligibility criteria. By modifying our protocol to address these challenges, the recruitment rate increased from 12 to 33%.

Conclusion

In the absence of trials identifying the most effective recruitment strategies, investigators may need to experiment, amending their protocol intermittently until target enrollment numbers are reached. The lessons we present may help researchers conducting couples-based interventions develop more effective protocols.

Practice implications

To achieve target enrollment numbers, researchers conducting couples-based interventions should consider minimizing travel to the study site; carefully crafting recruitment materials; budgeting more for participant incentives and staff effort; and limiting exclusion criteria. These practices may also enhance retention.     

A course for nurses to handle difficult communication situations. A randomized controlled trial of impact on self-efficacy and performance

Objective

To evaluate the impact of a communication skills course for nurses on how to handle difficult communication situations in their daily work.

Methods

A 7-h course was developed using a construct of “Awareness, Feelings, Listen, Solve” (AFLS). A pedagogy of experiential, learner-centered learning was adopted. The course evaluation used a randomized controlled design with pre- and post-measures of self-efficacy and performance.

Results

Forty-one nurses volunteered and thirty-three nurses completed all assigned parts of the study. On self-assessment, there was significant improvement for self-efficacy (F = 24.43, p < 0.001), but not for emotional awareness. On performance, there was no significant improvement between intervention and control groups (F = 3.46, p = 0.073).

Conclusion

A short course for nurses on handling difficult communication situations achieved significant improvements in self-efficacy but not in performance.

Practice implications

Teaching communication skills in community-based settings is important for the safety and effectiveness of patient care. Sponsoring organizations should weigh trade-offs between feasibility and achievement of measurable improvements in performance. One possible approach is to focus on specific communication skills rather than a full suite of skills.     

Automatic detection of epileptic seizures on the intra-cranial electroencephalogram of rats using reservoir computing

Introduction

In this paper we propose a technique based on reservoir computing (RC) to mark epileptic seizures on the intra-cranial electroencephalogram (EEG) of rats. RC is a recurrent neural networks training technique which has been shown to possess good generalization properties with limited training.

Materials

The system is evaluated on data containing two different seizure types: absence seizures from genetic absence epilepsy rats from Strasbourg (GAERS) and tonic-clonic seizures from kainate-induced temporal-lobe epilepsy rats. The dataset consists of 452 hours from 23 GAERS and 982 hours from 15 kainate-induced temporal-lobe epilepsy rats.

Methods

During the preprocessing stage, several features are extracted from the EEG. A feature selection algorithm selects the best features, which are then presented as input to the RC-based classification algorithm. To classify the output of this algorithm a two-threshold technique is used. This technique is compared with other state-of-the-art techniques.

Results

A balanced error rate (BER) of 3.7% and 3.5% was achieved on the data from GAERS and kainate rats, respectively. This resulted in a sensitivity of 96% and 94% and a specificity of 96% and 99% respectively. The state-of-the-art technique for GAERS achieved a BER of 4%, whereas the best technique to detect tonic-clonic seizures achieved a BER of 16%.

Conclusion

Our method outperforms up-to-date techniques and only a few parameters need to be optimized on a limited training set. It is therefore suited as an automatic aid for epilepsy researchers and is able to eliminate the tedious manual review and annotation of EEG.     

What can people approaching death teach us about how to care?

Objective

This study sought to hear what patients approaching death had to say about doctor-patient interactions and care in order that doctors can learn how to demonstrate care more effectively so that each patient feels cared for as an individual.

Methods

In semi-structured interviews, 13 people dying of cancer shared their experiences and perspectives on care within the patient-doctor relationship.

Results

Participants’ recollections of experiences with doctors showed that genuine demonstration of care begins with doctors seeking common ground with the patient as a fellow human being and individual. The psychological and physical suffering that results from allowing stereotypical assumptions and behaviours to shape doctor-patient interaction was clear.

Conclusion

The consequences of allowing the stereotypes and power of the primary context in which patients and doctors interact challenge the process of building a caring doctor-patient relationship. Caring doctors overcame this by exploring and carefully attending to the individual characteristics and needs of patients as people first and foremost.

Practice implications

To demonstrate genuine care doctors must learn to recognise and question the social expectations and inherent assumptions of medical contexts and roles of patient and doctor and allow unique characteristics of patient and context to guide their interactions.     

Understanding information and education gaps among people with type 1 diabetes: A qualitative investigation

Objective

Many patients with type 1 diabetes struggle to self-manage this chronic disease, often because they have a poor knowledge and understanding of the condition. However, little attention has been paid to examining the reasons for this poor knowledge/understanding. To inform future educational interventions, we explored patients’ accounts of the education and information they had received since diagnosis, and the reasons behind gaps in their diabetes knowledge.

Methods

Semi-structured interviews were conducted with 30 type 1 diabetes patients enrolled on a structured education programme in the UK. Data were analysed using an inductive, thematic approach.

Results

Patients’ accounts illustrated a number of knowledge deficits which were influenced by various lifecourse events. Reasons for deficits included: diagnosis at a young age and assumption of decision-making responsibility by parents; lack of engagement with information when feeling well; transitions in care; inconsistency in information provision; and, lack of awareness that knowledge was poor or incomplete.

Conclusion

Patients’ knowledge deficits can arise for different reasons, at different points in the lifecourse, and may change over time.

Practice implications

The delivery of individualised education should take account of the origins of patients’ knowledge gaps and be provided on a regular and on-going basis.     

“I need to lead my own life in any case”—A study of patients in dialysis with or without a partner

Objective

To elicit psychological and psychosocial problems existing in patients in dialysis and their partners, its being felt that the diversity involved has important implications for how service in dialysis units is delivered to patients and their partners.

Methods

The results of a series of interviews of 39 patients in dialysis and 21 partners of theirs, each interview individual, concerning their ways of thinking and their feelings and the behaviour, were analyzed in qualitative and content-oriented terms.

Results

Five basic themes could be identified: importance of treatment being individualized, dependency on an apparatus, consequences of the disease and its treatment, hopes for the future, and thoughts concerning life and death. Diversities relating to age, civil status, cultural and gender matters were disclosed.

Conclusion

The interview approach illustrated the importance of extended professional and individualized support in handling psychological and psychosocial disparities and needs in order to make treatment regimes more acceptable to the persons involved.

Practice implications

Suggestions are made concerning efforts to improve the care of patients receiving dialysis, and the importance of working with the patients and those closest to them in multidisciplinary teams.     

A systematic review and meta-analysis of cognitive bias to food stimuli in people with disordered eating behaviour

Aim

Maladaptive cognitions about food, weight and shape bias attention, memory and judgment and may be linked to disordered eating behaviour. This paper reviews information processing of food stimuli (words, pictures) in people with eating disorders (ED).

Method

PubMed, Ovid, ScienceDirect, PsychInfo, Web of Science, Cochrane Library and Google Scholar were searched to December 2009. 63 studies measured attention, memory and judgment bias towards food stimuli in women with ED.

Results

Stroop tasks had sufficient sample size for a meta-analyses and effects ranged from small to medium. Other studies of attention bias had variable effects (e.g. the Dot-Probe task, distracter tasks and Startle Eyeblink Modulation). A meta-analysis of memory bias studies in ED and RE yielded insignificant effect. Effect sizes for judgment bias ranged from negligible to large.

Conclusions

People with ED have greater attentional bias to food stimuli than healthy controls (HC). Evidence for a memory and judgment bias in ED is limited.     

Junior physician's use of Web 2.0 for information seeking and medical education: A qualitative study

Background

Web 2.0 internet tools and methods have attracted considerable attention as a means to improve health care delivery. Despite evidence demonstrating their use by medical professionals, there is no detailed research describing how Web 2.0 influences physicians’ daily clinical practice. Hence this study examines Web 2.0 use by 35 junior physicians in clinical settings to further understand their impact on medical practice.

Method

Diaries and interviews encompassing 177 days of internet use or 444 search incidents, analyzed via thematic analysis.

Results

Results indicate that 53% of internet visits employed user-generated or Web 2.0 content, with Google and Wikipedia used by 80% and 70% of physicians, respectively. Despite awareness of information credibility risks with Web 2.0 content, it has a role in information seeking for both clinical decisions and medical education. This is enabled by the ability to cross check information and the diverse needs for background and non-verified information.

Conclusion

Web 2.0 use represents a profound departure from previous learning and decision processes which were normally controlled by senior medical staff or medical schools. There is widespread concern with the risk of poor quality information with Web 2.0 use, and the manner in which physicians are using it suggest effective use derives from the mitigating actions by the individual physician. Three alternative policy options are identified to manage this risk and improve efficiency in Web 2.0's use.