The impact of negative affect on reality discrimination

Background and objectives

People who experience auditory hallucinations tend to show weak reality discrimination skills, so that they misattribute internal, self-generated events to an external, non-self source. We examined whether inducing negative affect in healthy young adults would increase their tendency to make external misattributions on a reality discrimination task.

Methods

Participants (N = 54) received one of three mood inductions (one positive, two negative) and then performed an auditory signal detection task to assess reality discrimination.

Results

Participants who received either of the two negative inductions made more false alarms, but not more hits, than participants who received the neutral induction, indicating that negative affect makes participants more likely to misattribute internal, self-generated events to an external, non-self source.

Limitations

These findings are drawn from an analogue sample, and research that examines whether negative affect also impairs reality discrimination in patients who experience auditory hallucinations is required.

Conclusions

These findings show that negative affect disrupts reality discrimination and suggest one way in which negative affect may lead to hallucinatory experiences.     

Age-related differences in spontaneous trait judgments from facial appearance

We tested whether there are age-related declines in detecting cues to trustworthiness, a skill that has been demonstrated to be rapid and automatic in younger adults. Young (M_age = 21.2 years) and older (M_age = 70.15 years) adults made criminal appearance judgments to unfamiliar faces, which were presented at a duration of 100, 500 or 1,000 ms. Participants’ response times and judgment confidence were recorded. Older were poorer than young adults at judging trustworthiness at 100 ms, and were slower overall in making their judgments. Further, the cues (i.e. perceptions of anger, trustworthiness and happiness) underlying criminality judgments were the same across age groups. Judgment confidence increased with increasing exposure duration for both age groups, while older adults were less confident in their judgments overall than their young counterparts. The implications are discussed.     

Development and implementation of prospective outcome monitoring in a regional burns service using cumulative sum (CUSUM) techniques

Introduction

Real-time monitoring of mortality in burns units has the potential to immediately mark when mortality rates are significantly higher or lower than predicted. Rapid feedback from targeted internal audit allows early intervention, to reinforce positive practices, and improve systems where outcomes are unsatisfactory.This is the first study to describe prospective use of cumulative sum (CUSUM) methodology in mortality monitoring outside of cardiac surgery.

Methods

An eight-year retrospective study of mortality was performed on all admissions to a regional burns intensive care unit in the UK. Risk-adjusted CUSUM charts, variable life adjusted displays (VLADs) and zeroed VLADs were produced to track mortality against that predicted by the Belgium burns score. The same techniques were implemented prospectively for one year (76 admissions) using the Osler modification of the Baux score for risk adjustment.

Results

Internal audit would have been triggered on nine occasions using zeroed VLAD monitoring in the retrospective study. The Belgium score overpredicts mortality in the elderly.Internal audit was triggered for better than predicted outcomes on two occasions in the prospective study.

Discussion

This study describes a successful design for an early-warning system to monitor outcomes in a burns intensive care setting.     

Progressive stage transition does mean getting better: a further test of the Transtheoretical Model in recovery from alcohol problems

Aims   To test two central assumptions of the Transtheoretical Model (TTM) regarding recovery from alcohol problems: (i) individuals making a forward transition from pre-action to action stages will show greater drinking improvements than those remaining in pre-action stages; and (ii) individuals remaining in pre-action stages will not demonstrate improvements in drinking outcomes.
Design and setting   Large, multi-centre, randomized controlled trial of treatment for alcohol problems [United Kingdom Alcohol Treatment Trial (UKATT)].
Measurements   Stage of change, drinks per drinking day and percentage days abstinent at baseline, 3- and 12-month follow-ups.
Findings   In support of TTM assumption 1, improvements in drinking outcomes were consistently greater among clients who showed a forward stage transition (Cohen's d  = 0.68) than among those who did not ( d  = 0.10). Two tests of assumption 2 showed a significant improvement in drinking outcomes in non-transition groups, inconsistent with the TTM; one test showed a significant deterioration and the other showed equivalent drinking outcomes across time. An explanation is offered as to why, under the relevant assumption of the TTM, clients in non-transition groups showed small changes in drinking outcomes.
Conclusions   In contrast to a previous study by Callaghan and colleagues, our findings largely support the TTM account of recovery from alcohol problems in treatment. The discrepancy can be explained by the use in our study of a more reliable and valid method for assigning stage of change.     

Frailty: an independent predictor of burns mortality following in-patient admission

Introduction

Burn injury in the elderly is associated with increased morbidity and mortality. It is not uncommon for biological age, or frailty, to differ from chronological age in this patient group and thus predicting individual clinical outcomes remains challenging. It has been previously shown that Rockwood’s Clinical Frailty Scale, a global clinical measure of fitness and frailty in older people, can be a useful adjunct for predicting outcomes for elderly patients with burns >10% TBSA. We refine our previous work to investigate the impact of frailty on mortality of elderly patients with thermal burns of any size admitted to a burns unit and explore its role as a meaningful adjunct to the modified Baux score.

Noninvasive Positive Pressure Ventilation in burns

Objective: Acute respiratory failure is a common complication of the severely burn-injured patient. Endotracheal intubation and mechanical ventilation is associated with a high rate of complications. Noninvasive Positive Pressure Ventilation (NIPPV) has been shown to be as effective as conventional ventilation in improving gas exchange and is associated with fewer complications with patients in acute hypercapnic and hypoxaemic respiratory failure. We report our experience with NIPPV in 30 burn patients.

Method: The records of all burn patients from 1998 to 2000, where NIPPV was used as part of their management at the St. Andrew’s Centre for Plastic Surgery and Burns, were reviewed.

Results: Mean age was 47.56 years (range 12–81). Nine patients were female. Mean burn size was 24.4% total body surface area (TBSA) (range 3–54). Inhalation injury was confirmed in eight cases. A positive diagnosis of pneumonia was made in 29 patients. The mean PaO₂/FiO₂ ratio prior to institution of NIPPV was 28.98 Kpa (range 8.75–52). Intermittent Positive Pressure Breathing (IPPB) was the most common ventilatory mode employed (25 patients) and the face mask was the most used interface (18 cases). Twenty-two patients (74%) avoided endotracheal intubation and their respiratory function continued to improve after NIPPV was discontinued. One patient (3%) died and seven patients (23%) were reintubated. Three out of the seven were electively reintubated for burns surgery.

Conclusion: In burn-injured patients with acute respiratory failure, NIPPV appears to be effective in supporting respiratory function such that endotracheal intubation can be avoided in most cases.     

Childhood abuse and neglect: specificity of effects on adolescent and young adult depression and suicidality

OBJECTIVE: To investigate the magnitude and independence of the effects of childhood neglect, physical abuse, and sexual abuse on adolescent and adult depression and suicidal behavior. METHOD: A cohort of 776 randomly selected children was studied from a mean age of 5 years to adulthood in 1975, 1983, 1986, and 1992 during a 17-year period. Assessments included a range of child, family, and environmental risks and psychiatric disorders. A history of abuse was determined by official abuse records and by retrospective self-report in early adulthood on 639 youths. Attrition rate since 1983 has been less than 5%. RESULTS: Adolescents and young adults with a history of childhood maltreatment were 3 times more likely to become depressed or suicidal compared with individuals without such a history (p < .01). Adverse contextual factors, including family environment, parent and child characteristics, accounted for much of the increased risk for depressive disorders and suicide attempts in adolescence but not in adulthood (p < .01). The effects of childhood sexual abuse were largest and most independent of associated factors. Risk of repeated suicide attempts was 8 times greater for youths with a sexual abuse history (odds ratio = 8.40, p < .01). CONCLUSIONS: Individuals with a history of sexual abuse are at greater risk of becoming depressed or suicidal during adolescence and young adulthood. Adolescence is the most vulnerable period for those youths who may attempt suicide repeatedly. Many of the apparent effects of neglect, in contrast, may be attributable to a range of contextual factors, suggesting broader focus for intervention in these cases.     

Cough strength,secretions and extubation outcome in burn patients who have passed a spontaneous breathing trial

The aim of this study was to develop a clinical prediction model to inform decisions about the timing of extubation in burn patients who have passed a spontaneous breathing trial (SBT). Rapid shallow breathing index, voluntary cough peak flow (CPF) and endotracheal secretions were measured after each patient had passed a SBT and just prior to extubation. We used multiple logistic regression analysis to identify variables that predict extubation outcome. Seventeen patients failed their first trials of extubation (14%). CPF and endotracheal secretions are strongly associated with extubation outcome (p < 0.0001). Patients with CPF ≤ 60 L/min are 9 times as likely to fail extubation as those with CPF > 60 L/min (risk ratio = 9.1). Patients with abundant endotracheal secretions are 8 times as likely to fail extubation compared to those with no, mild and moderate endotracheal secretions (risk ratio = 8). Our clinical prediction model combining CPF and endotracheal secretions has strong predictive capacity for extubation outcome (area under receiver operating characteristic curve = 0.96, 95% confidence interval 0.91–0.99) and therefore may be useful to predict which patients will succeed or fail extubation after passing a SBT.