Anxiety,helplessness/hopelessness and ‘desire for hastened death’ in Korean cancer patients

SHIM E.‐J. & HAHM B.‐J. (2011) European Journal of Cancer Care 20 , 395–402
Anxiety, helplessness/hopelessness and ‘desire for hastened death’ in Korean cancer patients Despite a relatively high rate of suicide associated with cancer, this issue has not been explored in Korean patients. This study investigates the prevalence and factors related to ‘the desire for hastened death’ (DHD) in Korean cancer patients. A cross‐sectional survey using standardised measures, including the Schedule of Attitudes toward Hastened Death and the Hospital Anxiety and Depression Scale, was performed with 131 patients with different types of cancer. 13.7% of the participants experienced moderate DHD (Schedule of Attitudes toward Hastened Death scores 5–9) and 1.7% experienced high DHD (≥10). Socio‐demographic and disease‐associated factors of the DHD included age, overall health and shortness of breath. The majority of psychosocial variables such as sadness, distress, ‘helplessness/hopelessness’ and ‘anxious preoccupation’ had a moderate association with DHD. Patients with a clinically significant level of anxiety or depression reported higher levels of DHD. Other significant correlates included ‘meaning/peace’, a sense of burdening family, dignity impairment and suicidal thoughts after diagnosis. Helplessness/hopelessness and anxiety were the strongest predictors of DHD in multivariate analysis. In view of significant role of helplessness/hopelessness and anxiety in the DHD of cancer patients, careful monitoring and management of these factors should be an integral part of cancer care to reduce the occurrence of DHD.     

The growing role of football as a vehicle for interventions in mental health care

In recent years there has been a growing interest in the use of football as a vehicle for mental health interventions. This paper outlines some of the ways that mental health service providers have begun to develop strategies with football clubs, the Football Association and government departments that involve playing or watching football and placing mental health services in football clubs. The paper also looks at how some attempts are being made at regional and national levels to develop and bring together services that use football as a vehicle for mental health service delivery.     

Use of educational games in the health professions: A mixed-methods study of educators' perspectives in the UK

Educational games have been shown to be effective in supporting learning, especially to reinforce knowledge, and students are generally positive about the use of games. The aim of this mixed-methods study that was conducted in the UK was to explore educators' views towards the use of educational games in the health sciences. The data were collected via semistructured interviews with 13 health educators and an online survey that was completed by 97 health educators. Three factors influence the use of classroom games: reflective practice, the impact of games on students, and the impact of logistical factors. Educators assess their own performance and the impact of the games on students when planning their use; however, large classes and the need for preparation time have a negative impact on educators' willingness to use games. Similar constraints might restrict the use of active learning strategies, such as simulation, that are crucial for enabling health professionals to develop competence. These issues require consideration when planning educational methods.     

Safety of laser use under the dental microscope

The aim of this study was to investigate the safety of laser use under the dental microscope. Nd:YAG, Er:YAG and diode lasers were used. The end of the tips was positioned at a distance of 5 cm from the objective lens of a dental microscope. Each eye protector was made into a flat disc, which was fixed on the lens of the microscope. The filters were placed in front of the objective lens or behind the eye lens. Transmitted energy through the microscope with or without the filters was measured. No transmitted laser energy was detected when using matched eye protectors. Mismatched eye protectors were not effective for shutting out laser energy, especially for Nd:YAG and diode lasers. None or very little laser energy was detected through the microscope even without any laser filter. Matched filters shut out all laser energy irrespective of their positions.     

Clinical evaluation of suicide risk

Abstract Suicide risk assessment may well be the most complex clinical task that mental health professionals face. Tests have shown to be of little use. To confront this complexity, assessment and prediction are best seen as interwoven with understanding suicide, a multi-dimensional malaise. With the essential concepts of lethality and perturbation, a clinical theory of suicide is presented. Intrapsychic aspects (i.e., unbearable psychological pain, cognitive constriction, indirect expressions, inability to adjust, and ego) as well as interpersonal aspects (i.e., interpersonal relations, rejection-aggression, identification-egression), are outlined to aid in assessment. Transference and countertransference issues in assessment are noted. A case illustration to aid in clinical insight is provided. It is concluded that all assessment and prediction of suicide risk ultimately depends on the skill of the clinician.     

Identification of predictors of post-ictal delirium after electroconvulsive therapy

Aim:  Although electroconvulsive therapy (ECT) often causes post-ictal delirium (PID), to date, the specific risk factors of PID have not been described. The purpose of the present study was therefore to elucidate the predictors of PID via identification of the characteristics of patients with PID.
Methods:  ECT was conducted in 50 patients and all patients underwent more than four sessions. A sine wave or a brief-pulse square wave ECT instrument was used. After convulsions the patients' PID was monitored for 30 min. The patients were allocated into four groups based on PID severity (none, mild, moderate or severe PID). Variables, including age, gender, duration of illness, diagnosis, clinical features (psychotic or catatonic features) and stimulus waveform (sine or brief pulse square waveform), were analyzed.
Results:  Moderate to severe PID developed during the ECT sessions in 18 patients (36%). Most patients with severe delirium were successfully treated with i.v. bolus of propofol (1–2 mg/kg). Although the incidence of PID was 24% in patients without catatonic features, the incidence in patients with catatonic features was extremely high (88%; P  < 0.001). Multiple regression analyses showed that the severity of PID correlated significantly with the presence of catatonic features (β = 0.428, P  < 0.01).
Conclusion:  The presence of catatonic features before ECT is a predictor of PID. Propofol is useful for the treatment of PID.