Healthcare professionals’ perception of their working environment and how to handle mental strain

Healthcare professionals (HCP) are an important resource, but the shortage of staff and an increased volume of patients with comorbidities might put a pressure on them. We speculated if mental strain was a challenge for HCP working in a department of Anaesthesiology. The purpose of the study was to explore HCP's perception of their psychosocial work environment and how they handle the mental strain in a department of Anaesthesiology in a university hospital. In addition, to identify types of strategies to handle the mental strain. This was an exploratory study based on semi-structured, individual interview with anaesthesiologists, nurses and nurse assistants employed in the Department of Anaesthesiology. The interviews were conducted online and were recorded in Teams, transcribed, and analysed using systematic text condensation. A total of 21 interviews were conducted with HCP from the different sections of the department. The interviewees described that they had experienced mental strain at work, with the unforeseen situation as the most challenging. High workflow is mentioned as an important contributing factor to mental strain. Most of the interviewees found that their traumatising experiences were met with support. Overall, everyone had someone to talk to either at work or privately, but they still found it difficult to talk about collegial conflicts or own vulnerabilities. Teamwork is described as strong in some sections. All HCP had experienced mental strain. Differences were found in how they perceived the experience of mental strain, their reactions and needs of support as well as their coping strategies.     

Assessment and treatment of Asian-American survivors of mass violence

This paper presents Asian-Americans' experiences of mass violence with the hope of stimulating much-needed research and clinical activities in this area. After a discussion of the literature on the types of traumatic events leading to Post-traumatic Stress Disorder (PTSD) and other psychological sequelae, the occurrence of similar events in Asia during the past 40 years which may predispose Asian people to PTSD will be reviewed. Asian cultural coping styles which mitigate against or conceal PTSD will be discussed. Assessment and treatment methods tailored for Asian patients will be outlined. Finally, recommendations for clinical service, training, and research in this area with Asian patients will be presented.     

烧伤患者共病情绪障碍调查

目的：调查急性烧伤后的情绪障碍的相关影响因素。方法：对知情同意后的受试者进行自编一般情况量表、Hamilton焦虑量表（HAMA）和Hamilton抑郁量表（HAMD）的评定。结果：26例受试者参加评定,53.8%的受试者表现为重症抑郁症状,11.5%表现为重度焦虑症状。HAMA总分与躯干部位烧伤、烧伤面积、HAMD总分等正相关（P〈0.05）,阻滞因子分与烧伤面积正相关（P〈0.05）,绝望感与头颈部烧伤正相关（P〈0.05）。结论：急性烧伤后常患共病抑郁焦虑情绪。     

������������������������

术后谵妄是一种并不少见且复杂的术后并发症,主要发生在老年男性病人,随着我国人口结构老龄化,手术及其相关学科的发展,更多老年病人将可能接受外科治疗。因而,对于本病的认知显得非常重要,特别是在腹部外科中,本病易与术后离子紊乱、肝性脑病、胰性脑病等表现出的精神症状相重叠,易造成误诊和漏诊。     

精神心理学干预在慢性疼痛治疗中的应用研究进展

越来越多的研究关注精神心理学参与慢性疼痛的治疗,在临床中不断有报道提出慢性疼痛复合心理干预有效,并能综合的改善患者的生活质量.常见慢性疼痛的心理学干预包括心理药理学干预与心理行为学干预,均对慢性疼痛的改善有效.     

心理弹性对社区老年人心理压力与心理健康的中介效应

目的探讨心理弹性对社区老年人心理压力与心理健康的中介作用,尝试从新的角度为其缓解心理压力、促进心理健康提供干预的依据。方法采用心理弹性量表(RS-14)、中文版知觉压力量表(CPSS)和一般健康量表(CHQ-12),调查辽宁省锦州市凌河区、古塔区和太和区三个社区410名老年人,并运用SPSS17.0软件和AMOS17.0软件进行数据统计分析。结果心理弹性、心理压力和心理健康三者间存在线性相关关系,且心理弹性与心理健康、心理压力呈负相关。心理压力和心理弹性对心理健康都有预测作用,心理弹性亦可作为心理压力和心理健康之间的中介变量。结论心理弹性作为心理压力与心理健康的中介变量,使其不良影响有所下降。关注心理弹性的作用,并对其影响因素进行干预,是提升老年人心理健康的积极探索。     

心理干预在减轻腰穿恐惧及术后头痛和腰痛中的作用

为探讨心理干预在减轻腰穿恐惧及术后头痛和腰痛中的作用,将１３１例腰穿病人随机分成两组,对照组（５４例）常规腰穿,干预组（７７例）加用认知、情绪、行为的心理干预。结果：干预组恐惧及术后头痛发生率较对照组明显降低,程度明显减轻（Ｐ〈０．０１）;术后腰痛发生降低,程度减轻（均Ｐ〈０．０５）。提示心理干预作用显著,临床上应予高度重视。     

Total Knee Arthroplasty Has A Positive Effect on Patients With Low Mental Health Scores

BackgroundThe purpose of this study is to determine the impact of total knee arthroplasty (TKA) on mental health.MethodsA total of 205 patients who underwent primary TKA with baseline and 1-year postoperative Short Form-12 Mental Component Score (MCS) were included in this retrospective analysis. Eighty-five (41%) patients had a preoperative MCS less than 50 points, while 120 (59%) patients had a preoperative MCS over 50 points. Two groups were assigned to the patients based on their preoperative MCS: low MCS <50 and high MCS >50.ResultsA preoperative MCS less than 50 points was predictive of greater improvement in MCS at 1 year after TKA (P < .001). Patients with low MCS improved by a mean of 10.6 points from 39.1 ± 8.6 points preoperatively to mean of 49.7 ± 10.7 points 1 year after TKA (P < .001). Patients with a high MCS decreased by a mean of 3.5 points from 60.01 ± 6.0 points preoperatively to mean of 56.6 ± 6.8 points 1 year after TKA (P < .001). This remained higher than the postoperative MCS of the patients with a low MCS, 49.7 ± 10.7 (P < .001). The patients with a high MCS had greater improvement in the Short Form-12-Physical domain (14.8 points) than the patients with a low MCS (9.2 points, P < .001).ConclusionPatients with lower baseline mental health had greater improvement in postoperative mental health following TKA than patients with higher baseline mental health. Low preoperative MCS was associated with less improvement in patient-reported outcome measures. Patients with lower baseline mental health scores before TKA benefit mentally and physically from the procedure.     

骨科老年患者术后精神障碍的预防护理

目的探讨围术期精神状态评估在骨科老年患者术后精神障碍预防护理中的应用效果。方法按入院时间将骨科住院老年手术患者分为两组,2012年1月至2013年1月收治的老年手术患者110例为对照组,2013年2~12月收治的106例老年手术患者为观察组。对照组按围术期常规实施护理干预,观察组在常规护理基础上加强围术期精神状态评估并采用临床护理路径表实施护理干预。结果观察组术后精神障碍发生率及症状持续发作时间显著低于及短于对照组,患者满意度显著高于对照组,意外拔管发生率显著低于对照组(P0.05,P0.01)。结论对骨科老年手术患者加强围手术期精神状态评估及护理干预,可有效降低老年患者术后精神障碍发生率,并缩短症状持续发作时间,提高患者对护理工作的满意度。     

Teachers' stress in Japanese primary schools: Comparison with workers in private companies

The levels and characteristics of stress in Japanese primary school teachers and white-collar workers of private companies were compared. Two hundred and twenty-four teachers and two hundred and fifty workers answered the stress test, which included subscales on subjective mood, social events, and physical conditions. The results indicated that the claim of lower stress in Japanese primary school teachers than in white-collar workers was not true. The findings suggested an interaction between group and stress subscales: that is, teachers were experiencing severe mental stress while white-collar workers were suffering from physical disease.     

The Long-Term Mental Health Consequences of Child Sexual Abuse: An Exploratory Study of the Impact of Multiple Traumas in a Sample of Women

The current study examined exposure to multiple traumas as mediators of the relationship between childhood sexual abuse and negative adult mental health outcomes. Participants were 174 women interviewed in the third wave of a longitudinal study of the consequences of child sexual abuse. Child sexual abuse victims reported a lifetime history of more exposure to various traumas and higher levels of mental health symptoms. Exposure to traumas in both childhood and adulthood other than child sexual abuse mediated the relationship between child sexual abuse and psychological distress in adulthood. There were also some significant direct effects for child sexual abuse on some outcome measures. Results point to the importance of understanding the interconnected nature of trauma exposure for some survivors.     

Impact of serious mental illness on surgical patient outcomes

Background

People with comorbid mental illness have poorer health status and disparate access to healthcare. Several studies internationally have reported mixed findings regarding the association between mental illness and surgical patient outcomes. This study examines the surgical outcomes in people with decompensated serious mental illness (SMI) within the setting of the Australian universal healthcare system.

Methods

Retrospective cohort study involving elective overnight surgical patients aged 18 years and above who attended a large public tertiary referral hospital in Sydney, Australia, between 2010 and 2014. Patients were identified using ICD‐10‐AM diagnosis codes. Outcomes measure including in‐hospital mortality, post‐operative complications, morbidity, admission and time in intensive care, length and cost of hospitalization, discharge destination and 28‐day re‐admission rates were examined.

Results

Of 23 343 surgical patient admissions, 451 (2%) patients had decompensated comorbid SMI with a subset of 47 (0.2%) having a specific psychotic illness. Patients with SMI comorbidity had significantly higher in‐hospital mortality (2% versus 0%), post‐operative complications (22% versus 8%), total comorbidity (7.6 versus 3.4 secondary codes), admissions (29% versus 9%) and time in intensive care (34.6 h versus 5.0 h), stay in hospital (12.2 days versus 4.6 days), admission costs ($24 162 versus $12 336), re‐admission within 28 days (14% versus 10%) and discharges to another facility (11% versus 3%).

Conclusion

Patients with comorbid SMI had significantly worse surgical outcomes and incur much higher costs compared with the general surgical population. These results strongly highlight that specific perioperative interventions are needed to proactively improve the identification, management and outcomes for these disadvantaged patients.     

Mental disorder in pregnancy and the early postpartum

Perinatal mental illness is common, affecting up to 20% of women, but remains under-recognised and under-diagnosed. It may have adverse effects on pregnancy and neonatal outcomes, and mental disorder remains one of the leading causes of maternal death in the UK. Women with mental ill health face difficult decisions in balancing risks and benefits of treatment. Stigma related to mental disorder may lead to non-engagement with maternity care. Some disorders bring specific challenges for anaesthetists working in maternity settings and it is vital that anaesthetists have knowledge of these disorders so they may offer care which is sensitive and appropriate.     

Organ donation after euthanasia,morally acceptable under strict procedural safeguards

In this paper, we will present a case of organ donation after active euthanasia (ODE) in the Netherlands from a patient who had his life ended at his explicit and voluntary request. The form of ODE we describe here concerns patients who are not unconscious and on life support, but who are conscious and want to have their life ended because of their hopeless and unbearable suffering, for instance due to a terminal illness such as Amyotrophic Lateral Sclerosis (ALS) or Multiple Sclerosis (MS). This form of ODE is of course only possible in jurisdictions where euthanasia is allowed. In these jurisdictions, organ donation after euthanasia is an option that may be considered. We believe ODE is worthwhile to pursue, as it can strengthen patient autonomy, can give meaning to the inevitable death of the patient, and be an extra source of much needed donor organs. To ensure voluntariness of both euthanasia and organ donation and avoid conflict of interest by physicians, ODE does need strict procedural safeguards however. The most important safeguard is a strict separation between the 2 procedures. The paper discusses several ethical issues such as who should broach the subject of organ donation and who should perform the euthanasia, and how a conflict of interest can be avoided.     

老年痴呆患者主要照顾者感知益处与经验性回避的相关性

目的分析老年痴呆患者主要照顾者感知益处与经验性回避之间的相关性,为其心理护理干预提供依据。方法对老年痴呆患者的主要照顾者142人,采用益处发现评定量表及接纳与行动问卷进行调查。结果老年痴呆患者主要照顾者感知益处总均分为(2.03±0.31)分,经验性回避总均分为(4.98±0.57)分,两者存在负相关(r=-0.702,P0.01)。结论老年痴呆患者主要照顾者感知益处于较低水平,经验性回避处于中等水平。采取措施提升老年痴呆患者主要照顾者感知益处水平,有助于改善经验性回避状况,改善其心理状况。     

老年患者术后精神障碍

术后精神障碍是老年患者常见的术后并发症，有多种因素可能与其发生有关，包括年龄、术前合并症、术前脑功能状态、围术期用药、术中管理、术后并发症以及遗传和环境因素等。针对相关因素的综合预防措施是老年患者术后精神障碍重要的治疗策略。     

Stress‐related mental health and growth among first‐time grandparents: The moderating role of family support

Grandparents play a significant role in modern society, often while struggling to juggle the expectations, demands, and commitments of career and family. The current study examined the unique and combined contribution of stress‐related variables associated with multiple roles, such as work stress over commitment, economic stress, and grandchild care burden, to mental health and personal growth of first‐time grandparents. The study also examined the role of family support as a moderator of these associations. One hundred ninety‐seven first‐time Israeli grandparents were asked to complete a series of self‐report questionnaires. Higher levels of work‐related stress were associated with lower mental health, whereas grandchild care burden was associated with higher personal growth. Self‐mastery and family support contributed to the prediction of mental health. When family support was high, work commitment was positively related to mental health, and economic stress was positively related to personal growth. The findings point to the crucial role of family support in balancing and preserving resources that are important to the mental health of first‐time grandparents, while enabling grandparents to be challenged and thrive through their stressors. Therapists who meet with first‐time grandparents in the community should take these factors into account when assisting them in adjusting to their new role.