A test of carver and scheier's self-control model of stress in exploring burnout among mental health nurses

A sample of Australian psychiatric nurses completed a questionnaire which included operational measures of elements of Carver and Scheier's self-control model of stress including the frequency dimension of the subscales of the Maslach Burnout Inventory — emotional exhaustion, depersonalization, and diminished accomplishment. Other scales completed by participants included independent subscales contained in the Positive and Negative Affectivity Scale and the private and public self-focus and social anxiety subscales of the Self-Consciousness Scale (Revised). Two interpretable canonical variates labelled emotional exhaustion–depersonalization and diminished accomplishment were derived from analysis of the date. Each element of the self-control model showed an expected contribution to an emotional exhaustion–depersonalization canonical variate, whereas reported levels of only positive affectivity and private self-focus made a notable contribution to explanation of variance on the diminished accomplishment canonical variate.     

Competences for self-care and self-control in diabetes mellitus type 2 in primary health care

The purpose of the guidelines of self-care and self-control of type 2 diabetes mellitus proposed by the Brazilian Ministry of Health is to strengthen and qualify users and health care professionals through the integrality and longitudinality of care with this disease. This article aims to present the self-care and self-control of people with type 2 diabetes mellitus in objective terms, taking into account the current recommen-dations based on scientific evidence and also from the subjective point of view, that is, emphasizing the aspects related to experience and subjectivity of these people. Next, we present the essential skills for self-care and self-control of users and professionals working in primary health care.     

Counterproductive work behaviours in response to emotional exhaustion: a moderated mediational approach

Drawing from the conservation of resources framework and self-control principles, we proposed a moderated mediational model through which emotional exhaustion may be linked to counterproductive work behaviours (CWBs). Analyses conducted with 175 Midwestern government workers revealed that both depersonalization (i.e. detachment from one's work, customers or co-workers) and organizational disidentification (i.e. cognitive opposition to an organization) were viable predictors of deviancy. Further, depersonalization and disidentification mediated the relationship between emotional exhaustion and CWBs, although disidentification drove these findings. Lastly, trait self-control moderated most variations of this relationship, in that this mediational model only applied to individuals with low and moderate self-control but not high self-control. Consistent with the conservation of resources framework, this study suggests that in a state of depleted emotional resources, heightened depersonalization and disidentification together provide the necessary levels of psychological/emotional withdrawal and justification for CWBs to emerge.     

医护一体院感防控模式在医院感染管理中的效果

目的 探讨医护一体院感防控模式在医院感染管理中的效果。方法 采用自身前后对照研究的方法 对传统院感防控模式和医护一体化院感防控模式进行效果比较,从手卫生、医疗废物、消毒隔离、多重耐 药菌、职业暴露和传染病6方面监测内容进行指标评价。结果 医护一体院感防控模式的实施在院感的医疗 废物处理正确率、消毒隔离知识掌握正确率、职业暴露知识掌握正确率、传染病监测正确率均高于传统院 感防控模式（P＜0.05）;在手卫生执行和多重耐药菌感染的正确率方面虽有波动,但医护一体院感防控模 式仍优于传统模式（P＜0.05）;医护一体化感控模式实施后,科室院感管控综合水平从全院第34名上升至 第3名。结论 医护一体院感防控模式的实施让医院感染的发生率得到了有效控制,极大程度上增加了医务 人员的手卫生依从率和医院感染诊断相关病原学送检率,是一种有效可行的院感防控模式。     

聚左旋乳酸与肉毒毒素在下颌线清晰紧致中的应用效果

目的 观察聚左旋乳酸改善下颌缘皮肤松弛的临床效果及安全性。方法 选取2022年12月-2023年 1月于我院就诊的26例下颌缘皮肤松弛患者为研究对象。研究采用自体对照方式，分别注射聚左旋乳酸 与A型肉毒毒素于下颌两侧。对照侧采用A型肉毒毒素治疗，观察侧采用聚左旋乳酸注射治疗，比较两侧 MAS评分改善值、不良反应发生率及患者满意度。结果 观察侧MAS评分改善值为（1.31±0.47）分，高于 对照侧的（0.92±0.27）分，差异有统计学意义（P＜0.05）；患者对于观察侧的GAIS满意度评分为 （2.12±0.59）分，高于对照侧的（1.58±0.50）分，差异有统计学意义（P＜0.05）；两侧均未出现超 过1周的不良反应或严重并发症。结论 聚左旋乳酸治疗下颌缘皮肤松弛的效果更好，且安全性良好，患者 满意度较高，值得临床应用。     

Investigation of elevated fear-avoidance beliefs for patients with low back pain: a secondary analysis involving patients enrolled in physical therapy clinical trials

STUDY DESIGN: Secondary analysis. OBJECTIVE: To investigate the Fear-Avoidance Beliefs Questionnaire (FABQ) for its ability to predict 6-month outcomes for patients with low back pain (LBP) participating in physical therapy clinical trials. BACKGROUND: Consistent evidence suggests that fear-avoidance beliefs are predictive of short-term outcomes for patients with LBP. However, proposed cut-off scores have not been widely investigated for longer-term outcomes in samples of patients receiving physical therapy. METHODS AND MEASURES: Subjects (n = 160) were participants in 2 separate randomized trials that used standard methodology and investigated the efficacy of physical therapy interventions for LBP. Subjects completed baseline measures of pain, disability, fear-avoidance beliefs, and physical impairment. They completed 4 weeks of randomly assigned physical therapy and were reassessed at 6 months with standard examination techniques. The accuracy of previously proposed cut-offs for elevated FABQ scores were determined by independent t tests and chi-square analysis on raw 6-month Oswestry Disability Questionnaire (ODQ) scores, 6-month ODQ change scores, and minimally clinical important difference (MCID) in ODQ scores (6 points). Next, a hierarchical regression model determined which FABQ scale better predicted 6-month ODQ scores after controlling for previously reported prognostic factors and relevant treatment parameters. Last, receiver operating characteristic curve analyses were planned to generate a range of FABQ cut-off scores that predicted 6-month MCID in the ODQ. RESULTS: The previously reported cut-off score for the FABQ physical activity scale (>14) resulted in 111 (69.4%) of 160 patients being classified as having elevated baseline scores, while the previously reported cut-off score for the FABQ work scale (>29) resulted in 19 (11.9%) of 160 patients being classified as having elevated baseline scores. Patients with elevated FABQ physical activity scale scores (>14) had no significant differences in 6-month ODQ outcomes. Patients with elevated FABQ work scale (>29) scores reported higher 6-month ODQ scores and were more likely to have reported no improvement in ODQ score. The final regression model explained 24.4% of the variance in 6-month ODQ scores, with only manipulation and exercise and the FABQ work scale as unique predictors. Fifteen of the subjects (12.7%) had a 6-month change in ODQ that indicated no improvement. The area under the receiver operating characteristic curve for the FABQ physical activity scale predicting this outcome was 0.562 (95% CI: 0.415-0.710) and for the FABQ work scale was 0.694 (95% CI: 0.542-0.846). Cut-off scores were explored for the FABQ work scale only, with positive likelihood ratios that ranged from 1.19 to 5.15 and negative likelihood ratios that ranged from 0.30 to 0.83. CONCLUSIONS: The FABQ work scale was the better predictor of self-report of disability in this sample of patients participating in physical therapy clinical trials. Future studies are necessary to further test and refine the FABQ work scale as a screening tool alone, and in combination with other examination findings.     

重症急性胰腺炎早期肠内营养的影响因素分析

目的 研究重症急性胰腺炎早期肠内营养(enteral nutrition,EN)应用的相关影响因素.方法 回顾上海交通大学医学院附属瑞金医院SICU收治的57例SAP(severe acute panereati tis)患者,以入科后EN开始时间分为A组(≤5 d)和B组(>5 d),比较组间相关影响因素差异.以不同营养途径分组比较EN开始时间及相关影响因素.结果 A组患者入科APACHEⅡ评分、Ranson评分和Bahhazar CT评分均显著低于B组(P<0.05),EN开始时A组患者APACHE Ⅱ评分低于B组,但无统计学意义.在并发症比较中,B组多脏器功能障碍综合征(multiple organ dysfunction of syndrome,MODS)、休克和腹腔间隔室综合征(abdominal compartment syndrome,ACS)的发病率明显高于A组(P<0.05),而其他并发症在两组间无统计学意义;鼻空肠管组患者入科时APACHE Ⅱ评分、Ranson评分和Balthazar CT评分均低于空肠造瘘管组,EN开始时间也显著提前(P<0.05).结论 SAP患者EN的应用受胰腺炎病情的严重度、严重并发症(休克、MODS与ACS)及喂养途径等多因素影响.早期EN的标准应当以病情评估为基础,以内环境稳定、胃肠功能开始恢复为起始标志,在≤5d内启用EN是可行的.APACHE Ⅱ评分对EN开始时机的把握可能具有指导意义.     

The influence of mental health on outcomes following total shoulder arthroplasty

BackgroundAnxiety and depression symptoms have been associated with higher pain and lower functional scores in patients with glenohumeral osteoarthritis (GHOA). The influence of mental health on outcomes following total shoulder arthroplasty (TSA) for GHOA has not been fully investigated .MethodsThis observational cohort study included 143 shoulders in 135 subjects undergoing TSA for GHOA. Preoperative imaging was assessed for glenoid wear pattern. Patients completed preoperative and postoperative American Shoulder and Elbow Surgeons (ASES) score, Visual Analog Pain Scale (VAS), and PROMIS Upper Extremity (UE), Physical Function (PF), and Pain Interference (PI) scores. The Western Ontario Osteoarthritis Score (WOOS) was collected postoperatively. Mean postoperative pain and functional scores, improvement from preoperative scores, and surgical regret were compared between varying severity of anxiety or depression and pattern of glenoid wear.ResultsCompared to subjects without anxiety, those with moderate-to-severe anxiety reported worse postoperative ASES (p=0.019), WOOS (p<0.01) and PROMIS UE (p=0.02) and higher PROMIS PI scores (p<0.01). Compared to those without depression, those with moderate-to-severe depression reported worse postoperative ASES and WOOS and higher VAS and PROMIS Pain scores (p<0.01). Linear regression showed that anxiety and concentric glenoid wear were associated with worse postoperative PROMIS scores. There were no significant differences in pre-to-postoperative improvement in any outcome measures among those with and without anxiety or depression. Patients with moderate-to-severe depression were less likely to want to undergo the same procedure again (p=0.035).DiscussionPatients with anxiety and depression report similar improvements in pain and function following TSA similar to those without depression or anxiety. Despite the similar improvement, those with moderate-to-severe depression and anxiety symptoms reported persistently lower functional and higher pain scores. Though most patients are satisfied following TSA, those with moderate-to-severe depression may be more likely to regret undergoing surgery. Future studies should identify mental health symptoms preoperatively and evaluate the effect of preoperative intervention on postoperative outcomes following TSA.     

Symptom exaggeration in a PTSD inpatient population: Response set or claim for compensation

This study examines the relationship between service-connection (financial compensation) and exaggeration of PTSD symptoms. Sixty inpatient Vietnam combat veterans in PTSD treatment comprised three groups: those financially compensated for PTSD, those financially compensated for physical or other mental problems, and those not financially compensated. Results indicate that those veterans who are not service-connected do not exaggerate symptoms on the MMPI F-scale more than those who are service-connected. Also, F scores reported for inpatient PTSD were higher than previously established cut-off criteria found chiefly in outpatient populations. Implications for therapists' biases concerning financial compensation and symptom claims are discussed in terms of their clinical relevance.     

A senior elective designed to prepare medical students for surgical residency

BACKGROUND: The transition from medical student to surgery internship can be stressful. The goal of this project was to design, implement, and evaluate a 1-month long elective course that would meet the majority of the American College of Surgeons Graduate Medical Education Committee prerequisites for graduate surgical education METHODS: The major elements of the curriculum included faculty- and resident-facilitated case-based sessions and cadaver dissections. In addition, the students participated in skills laboratory experiences, Intensive Care Unit rounds, and mock interviews and clinical pages. The students took a knowledge pretest and post-test that was compared with the performance of 8 surgical interns on the same examination. RESULTS: The highest rated elements of the course were those that provided hands-on experience or practical knowledge. The post-test knowledge examination scores were significantly higher than pretest scores and surgical intern scores. CONCLUSIONS: It was possible to develop a 1-month senior medical student elective course that provided students with the essential prerequisites believed to be essential for all surgical interns.     

布托啡诺超前镇痛用于隆乳术后镇痛的临床效果观察

目的:评价术前给予布托啡诺超前镇痛用于隆乳手术后患者静脉自控镇痛的临床效果。方法:于2013-8—2014-8间,选择ASA分级I~II级,静脉全麻下行硅胶假体隆乳需术后镇痛患者120例,随机分为术前给药组(A组)和对照组(B组)各60例;A组术前30min给予酒石酸布托啡诺20μg/kg静脉滴注,B组术前给于等量生理盐水静脉滴注。结果:A组患者手术后48h内各观察点的VAS评分均明显低于B组(P均0.05)。A组患者术后48h内PICA按压总次数、镇痛药用量、镇痛期间总不良反应发生率,均明显少于B组(P0.05)。结论:术前给予布托啡诺行超前镇痛增强自控镇痛的效果,减少镇痛药用量及不良反应发生率,提高镇痛的质量与安全性。     

An investigation of the impact of nocturnal enuresis on children's self-concept

OBJECTIVE: This study sought to evaluate the relationship between the self-esteem and the self-image of children with nocturnal enuresis and to examine these in relation to various aspects of clinical and demographic variables. Previous studies investigating the self-esteem of bedwetting children have had mixed findings. Some studies report that children with nocturnal enuresis have a lower self-esteem than their non-bedwetting peers, but other studies report that children with nocturnal enuresis perceive themselves similarly to non-bedwetting children. However, what have not been studied to date are the self-perceptions of bedwetting children treated in community clinics. MATERIAL AND METHODS: A total of 114 bedwetting children treated in community clinics provided the sample. School nurses conducted a routine first-visit assessment, collected baseline demographic and social information and invited children to complete the Butler Self-Image Profile and the Coopersmith Self-Esteem Inventory. RESULTS: Age and extent of wetting were not significantly related to self-concept measures. Girls had significantly (p = 0.008) higher scores on positive self-image compared with boys. Children with secondary enuresis also scored higher on positive self-image compared with those with primary nocturnal enuresis (p = 0.02). The Butler self-image scores indicated a number of significant links between positive self-image and enuresis variables, whereas the Coopersmith self-esteem scores generally failed to distinguish between the enuresis variables and closely reflected those of the negative self-image scores. CONCLUSIONS: These findings suggest that amongst children with nocturnal enuresis, the most vulnerable in terms of self-image are male, those with primary enuresis and those with a greater number of wet nights a week.     

乳癌手术病人心理干预模型的构建及临床应用

目的探讨手术病人心理干预模型(下称模型)的临床应用效果。方法将120例乳癌病人随机分为观察组和对照组各60例。对照组采用常规心理护理,观察组应用模型实施心理干预,即根据病人心理成熟度的不同进行心理干预。于病人出院前采用抑郁自评量表(SDS)、焦虑自评量表(SAS)测评,并对其应对方式进行评分。结果观察组SDS、SAS评分均高于对照组(均P<0.05);观察组积极应对评分高于对照组,消极应对评分低于对照组(均P<0.05)。结论模型的应用能减轻病人抑郁、焦虑程度,有效地缓解其心理障碍。     

Occupational stress in female and male graduate managers — A comparative study

Levels of occupational stress were examined using an adapted version of the occupational Stress Indicator (OSI) in 126 female graduate managers and 220 male graduate managers occupying a range of managerial jobs throughout the UK. In comparison with the most recently established normative group of white-collar workers, management graduates reported greater pressure with regard to career and achievement, higher Type A behaviour pattern scores, higher levels of job satisfaction and higher mental ill-health scores. When comparing the male and female graduates on OSI variables, female graduate managers scored significantly higher pressure scores on all seven ‘sources of pressure’ subscales, including the added gender factor related to discrimination and prejudice. While females were more likely than males to adopt positive coping strategies, they had lower overall job satisfaction scores and were more at risk of mental and physical ill-health (particularly those in junior and middle management positions). Multivariate analyses disclosed that predictors of physical ill-health, mental health and job dissatisfaction were often quite dissimilar for male and females. The research implications of the findings are discussed with special emphasis on organizational and policy change strategies required in the 1990s.     

Evaluation of male sexual function by the International Index of Erectile Function after deep dorsal vein arterialization of the penis.

PURPOSE: The objective of vascular surgery for erectile dysfunction is to provide long-term improvement of erectile function. We evaluated that claim after deep dorsal vein arterialization by a cross-sectional study of multifaceted male sexual function with the validated International Index of Erectile Function (IIEF). MATERIALS AND METHODS: We performed a mail survey of male sexual function after deep dorsal vein arterialization in 68 consecutive literate men who underwent surgery between 1984 and 1998 for severe erectile dysfunction. The IIEF questionnaire and a questionnaire on patient characteristics were answered in a self-administered and nominative manner. Scores of the responders pertaining to the 5 domains of male sexuality were compared with those of the control groups used for the psychometric validation of the IIEF. RESULTS: Of the patients 38 (55.9%) with a mean age plus or minus standard deviation of 46.5 +/- 11.9 years responded. Mean followup was 61.2 +/- 34.7 months. Compared to controls with erectile dysfunction controls men who underwent deep dorsal vein penile arterialization had significantly higher scores for erectile function, sexual desire, orgasmic function, intercourse satisfaction and overall satisfaction. Conversely compared with normal controls these patients reported significantly lower erectile function, orgasmic function, intercourse satisfaction and overall satisfaction scores, whereas sexual desire scores were similar in the 2 groups. No correlations were noted of the 5 IIEF domains with the duration of followup after arterialization. When erectile function scores were graded, 25.0% and 28.1% of patients reported no and or mild dysfunction, respectively, while 15.6% still complained of severe erectile dysfunction. CONCLUSIONS: Long-term improvement in the various aspects of male sexual function was observed after deep dorsal vein penile arterialization in a significant proportion of patients.     

Prediction of indolent prostate cancer: validation and updating of a prognostic nomogram

PURPOSE: Screening with serum prostate specific antigen testing leads to the detection of many prostate cancers early in their natural history. Statistical models have been proposed to predict indolent cancer. We validated and updated model predictions for a screening setting. MATERIALS AND METHODS: We selected 247 patients with clinical stage T1C or T2A from the European Randomized Study on Screening for Prostate Cancer who were treated with radical prostatectomy. We validated a nomogram that had previously been developed in a clinical setting. Predictive characteristics were serum prostate specific antigen, ultrasound prostate volume, clinical stage, prostate biopsy Gleason grade, and total length of cancer and noncancer tissue in biopsy cores. Indolent cancer was defined as pathologically organ confined cancer 0.5 cc or less in volume without poorly differentiated elements. Logistic regression was used to update the previous model and examine the contribution of other potential predictors. RESULTS: Overall 121 of 247 patients (49%) had indolent cancer, while the average predicted probability was around 20% (p <0.001). Effects of individual variables were similar to those found before and discriminative ability was adequate (AUC 0.76). An updated model was constructed, which merely recalibrated the nomogram and did not apply additional predictors. CONCLUSIONS: Prostate cancers identified in a screening setting have a substantially higher likelihood of being indolent than those predicted by a previously proposed nomogram. However, an updated model can support patients and clinicians when the various treatment options for prostate cancer are considered.     

Cortisol variability and self‐reports in the measurement of work‐related stress

We examined whether a high cortisol awakening response (CAR) and low cortisol decline over the day (CDD) are related to self‐reported work stress and well‐being, and whether there are gender differences in these relationships. Three hundred eighty‐three working men and women responded to a survey measuring job stress factors, mastery at work, symptoms and well‐being. Salivary cortisol was sampled at awakening, after 45 min and at 21:00, from which the variables CAR and CDD were defined. A high CAR was associated with lower perceived job control and work mastery, and poorer well‐being. Low CDD was associated only with higher job demands, but the self‐report scores showed a number of interactions between cortisol group and gender. Among women, those showing a low CDD, compared with those with a higher CDD, had more favourable scores on a number of job stress factors and symptom load. In contrast, among men, a similar comparison showed those with low CDD to have poorer scores on job stress factors and symptom load. We conclude that individuals displaying high CAR or low CDD differ from those not displaying these cortisol profiles in self‐report of work stress and well‐being, and that gender differences appear in these relationships. Copyright © 2010 John Wiley & Sons, Ltd.     

Impact of Liver Transplantation on Health-Related Quality of Life

This study is designed to measure the impact of orthotopic liver transplantation (OLT) on patients' health-related quality of life. Two types of health-related quality-of-life questionnaires were administered at baseline and after OLT: generic (Medical Outcomes Study Short Form 36) and liver specific (Chronic Liver Disease Questionnaire). We also recorded clinical, demographic, and laboratory data. Pre-OLT scores of liver transplant candidates were compared with those of the general population and patients with congestive heart failure (CHF) and chronic obstructive pulmonary disease (COPD). Thirty-seven liver transplant candidates were evaluated: 25 men and 12 women; age, 50.2 ± 12 years; Child's class A, 3 patients; class B, 30 patients; class C, 4 patients; and galactose elimination capacity, 277 ± 81. Health-related quality-of-life scores for patients awaiting liver transplants were significantly lower than those for patients with COPD and CHF and those in the general population. Sex and cause of liver disease did not affect the scores. There was a weak but significant inverse correlation between some aspects of health-related quality of life and both age (r = –0.31 to –0.34) and worsening of the Child-Pugh score (r = –0.32 to –0.43). All measured aspects of health-related quality of life significantly improved after OLT, and mental health scores were indistinguishable from the population norms. Similar improvements were evident in physical and disease-specific aspects of health-related quality of life, but some residual dysfunction persisted. (Liver Transpl 2000;6:779-783.)     

Patient reported outcomes associated with surgical intervention for breast cancer

BackgroundPatient reported outcomes (PROs) are an important addition to oncologic breast surgical care. The majority of BREAST-Q PRO literature has been focused on mastectomy with reconstruction (MR), with a paucity of information on more common surgical approaches in practice namely, breast conserving therapy (BCT) and mastectomy (M). This information will help inform patients around decision-making regarding surgical options.Methods837 women underwent surgery between 2010 and 2012, and were later invited to complete the postoperative BREAST-Q module specific to their most recent surgery. Multivariate analysis was performed to compare BREAST-Q subscale scores between each of the three surgical cohorts.Results257 women participated (161 BCT, 84 M, 12 MR). Patients undergoing BCT reported scores in the satisfaction with breasts domain 8 points higher than those undergoing mastectomy (p = 0.046). BCT also reported higher scores than mastectomy in the areas of psychosocial well being (12 points higher) as well as sexual well-being (17 points higher) (p = 0.0006).ConclusionsBCT appears superior to mastectomy in terms of satisfaction with breasts, sexual well-being and now psychosocial well-being. Overall, BCT is associated with excellent patient reported outcomes.     

Subjective experience after traumatic brain injury

The present investigation aims to show which specific difficulties are reported with greater frequency in traumatic brain injury (TBI) patients than in controls, and in hetero-assessment than in self-assessment. Ninety-seven patients with severe TBI were compared to 97 controls matched for age and gender. The 63-item European Brain Injury Questionnaire (EBIQ) was completed by patients, close relatives and controls. A principal component analysis showed three main factors: 'depressive mood', 'cognitive difficulties', and 'difficulties in social interactions'. Relatives scored higher than patients for items concerning the three domains. Patients scored higher than controls for 'depressive mood' and 'cognitive difficulties', but not for 'difficulties in social interactions', which included items related to both self-assertion and lack of self-control. After TBI, emotional problems and, especially, depressive mood associated to cognitive difficulties have an important impact in everyday life and family functioning. Difficulties in social interactions are not specific of TBI patients.