Patients' perspectives on point-of-care diagnostics and treatment by emergency medical technicians in acute COPD exacerbations: A qualitative study.

BACKGROUND: In Denmark emergency medical technicians transport patients with acute COPD exacerbations to the nearest emergency department. From a clinical and economic perspective, this transport and assessment at the hospital may be inconvenient if the patient is immediately discharged from the emergency department. We established an emergency technical technicians point-of-care diagnostics and treatment program of patients with COPD with use of ultrasound and blood analysis. Patients' perspectives on treatment at home and sense of security are important to qualify clinical practice at home with patients with acute exacerbation. AIM AND OBJECTIVES: To explore patient's and relatives' experience of treatment at home during emergency calls due to COPD in exacerbation and to investigate their attitude to avoid hospitalization as well as experience of stress during point-of-care diagnostics in their own home. METHOD: A qualitative study comprising semi-structured interviews with 16 patients carried out from April 1st, 2019 to March 31st, 2020 in Denmark. Data was analysed inspired by Malteruds' text condensation and informed by Critical Psychology with first person perspective focusing on the patient's views on point-of-care diagnostics and treatment of their COPD in acute exacerbation. RESULTS: The interviews revealed that in order to ensure an experience of quality in the assessment and treatment of patients in their own homes, it was important that the ambulance staff showed great safety and experience in the use of the technical equipment and treatment of dyspnea. It was also of importance that the patients felt confident that their general practitioner followed up on the home treatment initiated. CONCLUSION: Patients' perspectives showed that point-of-care diagnostics and treatment of acute COPD in exacerbation was considered a qualitative offer by the patients and their relatives. At the same time, it was crucial that the emergency medical technicians showed experience and safety in handling shortness of breath as well as the technical equipment. TRIAL REGISTRATION: Approved by the Danish Data Protection Agency Project-ID: 20/24845.

Tension-type headache and stressful events: the role of selective memory in the reporting of stressors.

This study examined evidence for the role of selective memory for stressful events in women with headache. Previous studies have reported that on retrospective measures of stress, those with tension-type headache report more stressful events and rate the events as more stressful than did headache-free controls. However, when ratings are made concurrently, participants with headache and controls did not differ in their ratings of equivalent stressors presented in the laboratory. One theory for why differences are found in stress ratings made retrospectively, but not concurrently, is that selective memory biases recollection of past events in patients with headache. This study compared self-report ratings of stressful events and their perceived impact made either concurrently or retrospectively to determine if selective memory might explain the discrepancies found in earlier studies. Participants included 20 patients with tension-type headache and 22 headache-free controls. Participants were compared on hourly, daily, and weekly measures of stressors and their perceived impact via hourly and nightly visual analog scale ratings, the Daily Stress Inventory, and the Weekly Stress Inventory. If support was to be offered to the hypothesis that selective memory biases the retrospective memory of patients with headache, then an interaction between group assignment (ie, headache versus control group) and time of rating would be expected. No such interaction occurred. Results from the study suggest that all participants have a tendency to overestimate stress on retrospective measures, but that patients with headache do not do so at a significantly different rate than do headache-free controls. The alternative hypothesis that patients with headache tend to appraise everyday events as more stressful is supported.

Differences in daily stress, mood, coping, and eating behavior in binge eating and nonbinge eating college women.

This study investigated differences between binge eaters and controls on measures of daily stress, mood, coping, and eating behavior. The same measures were also used to compare binge days to nonbinge days for the binge group. Participants included 20 college women who reported binge eating at least two times per week and 20 women who reported no disturbance in their eating behavior. They were asked to self-monitor their daily stress, coping, mood, and eating behavior for three weeks. Results indicated that the binge group reported more stress and negative mood over the three weeks than the control group. The binge group reported experiencing a similar number of stressful events on binge days as compared to nonbinge days, however, the impact of those events was much greater on binge days. The binge eaters also reported less positive mood and more episodes of eating on binge days. The groups did not differ in the number of coping strategies used. Stress and negative mood appear to be common antecedents for binge eating. The role of coping responses and daily eating behavior (i.e., restraint) on binge eating is somewhat less clear.

Appraisal of subjective stress in individuals with tension-type headache: the influence of baseline measures.

These studies investigated appraisal and coping strategies of tension-type headache sufferers and headache-free controls. In study 1, 60 women engaged in an interpersonal stressor. They completed measures that assessed subjective stress and coping strategies. Headache sufferers reported greater levels of stress at baseline than did controls but were not more reactive to a stressful interpersonal situation. All participants reported greater use of disengagement coping during the interpersonal interaction, while the amount of engagement coping strategies did not differ. Participants (30 women) in Study 2 engaged in progressive muscle relaxation. Headache participants again reported higher levels of subjective stress at baseline, this difference was nearly gone following relaxation. Together, the results suggest that individuals with tension-type headache report higher levels of subjective stress than headache-free controls when they make baseline ratings of stress and that this elevation cannot be attributed to the anticipation of a future stressful event.

The comparison of individuals with recurrent tension-type headache and headache-free controls in physiological response, appraisal, and coping with stressors: a review of the literature.

It is widely accepted that stress plays an important role in the experience of tension-type headache. This article reviews the literature in which individuals with recurrent tension-type headache are compared to headache-free controls in the experience and appraisal of stress, psychophysiological response to stress, and coping with stress. A modified and extended version of the transactional model of stress as it might apply to tension-type headache is used to organize the relevant literature. In summary, there is evidence to suggest that individuals with recurrent tension-type headache experience more stressful events and are more sensitive and have a lower threshold to pain. There are some suggestions that headache sufferers may use different coping strategies for stress and pain. There is little evidence of differences in physiological responses to stressful events. The shortcomings of this body of literature are addressed and directions for future research are identified.

The comparison of individuals with tension-type headache and headache-free controls on frontal EMG levels: a meta-analysis.

For many years, the dominant theory of tension-type headache has been that individuals who suffer from these headaches have elevations in electromyographic (EMG) activity at rest or during stressful life experiences. This theory has come under increasing attack in recent years. Although the research that is relevant to the controversy has been reviewed previously using box score and voting methods, no one has analyzed the relevant data using a statistical approach. This study used meta-analysis to summarize the studies that have directly compared individuals with tension-type headache to headache-free control subjects on measures of frontal EMG at baseline and during rest. Twenty-three studies were included in the analysis. The overall effect size was .395; however, there was heterogeneity of effect size. Several potential moderator variables were investigated. Perhaps the most interesting moderator variable was whether the studies clearly stated that subjects were headache-free during assessment. This group of studies produced a nonsignificant effect size that had homogeneity of effects. Several interpretations of the results are presented.

Appraisal and coping strategies in stressful situations: a comparison of individuals who binge eat and controls.

OBJECTIVE: The objective of this study was to investigate whether individuals who engage in binge eating appraise and cope with stressful situations in a different manner than people who do not regularly binge eat. METHOD: Female undergraduates participated in a two-part study. The laboratory portion of the study involved participation in two tasks: an interpersonal stressor and an academic stressor. In the second portion of the study, participants completed a daily stress inventory for 1 week. RESULTS: Individuals in the binge group appraised both the laboratory and natural environment stressors as more stressful than did the controls. Differences were evident in the amount and type of coping strategies used between eating groups. The binge group reported using more positive coping strategies and more catastrophizing in both settings. DISCUSSION: Together, the results suggest that appraisal and coping or stress management components may be useful in treatment packages for individuals who binge eat.

Localization and expression of ciliary neurotrophic factor (CNTF) in postmortem sciatic nerve from patients with motor neuron disease and diabetic neuropathy.

Ciliary neurotrophic factor (CNTF) is thought to play an important role in the maintenance of the mature motor system. The factor is found most abundantly in myelinating Schwann cells in the adult sciatic nerve. Lack of neuronal growth factors has been proposed as one possible etiology of amyotrophic lateral sclerosis (ALS) and spinal muscular atrophy (SMA). Growth factor replacement therapies are currently being evaluated as a treatment for motor neuron disease. In this report we determined whether the expression of CNTF in sciatic nerve differed in patients with motor neuron disease compared to controls or patients with another form of axonopathy. We identified 8 patients (7 with ALS and 1 with SMA) with motor neuron disease and 6 patients with diabetic motor neuropathy who had autopsy material available. Immunoperoxidase staining showed reduced CNTF expression in nerves of patients with motor neuron disease but not in patients with diabetic motor neuropathy. Decreased CNTF appears be associated with primary motor neuron disease rather than a generalized process of axon loss. This result supports suggestions that CNTF deficiency may be an important factor in the development of motor neuron disease.

Headache-free controls? Evidence of headaches in individuals who deny having headaches during diagnostic screening.

In the course of two studies investigating whether individuals with recurrent tension headache differ from headache-free controls in the frequency and appraisal of stressful life events, subjects were asked to complete a headache diary for 1 week. Subjects in the headache-free control group were screened twice and reported having infrequent headaches (two or less per month). However, 13 of 38 control subjects reported multiple headache days on their headache diaries. These subjects also reported a greater frequency of stressful events and a greater stress impact score. These results suggest that a careful screening of control subjects may be necessary in studies that examine differences between subjects with recurrent headache and headache-free controls. There is also some evidence that the inclusion of these subjects in a control group may bias the sample, making it less likely to find between-group differences.

Psychometric properties of the Weekly Stress Inventory (WSI): extension to a patient sample with coronary heart disease.

The psychometric characteristics of the Weekly Stress Inventory (WSI) were examined in a sample of medical patients (N = 84) diagnosed with coronary heart disease. In addition to the WSI, patients completed measures assessing recent depressive symptoms, physical symptoms, Type A behavior, and trait anxiety. Patients also monitored stress for 3 weeks (n = 46), completing the Daily Stress Inventory (a measure of minor stress) daily and the WSI at concurrent 1-week intervals. Results indicated that the WSI is an internally consistent and moderately stable measure. Validity of the WSI was supported by (a) strong correlations with a concurrently administered measure of minor stress (concurrent validity); (b) significant positive correlations with measures assessing recent depressive symptoms, physical symptoms, and Type A behavior; and (c) a lack of relationship with a measure of trait anxiety (discriminant validity).

Erectile dysfunction in men with chronic medical illness.

This study examined interrelationships of psychosocial variables found in a psychological evaluation for erectile disorder in 75 male veterans with chronic medical illness. Patients whose partners participated in the evaluation were compared with those whose partners were not involved, and agreement on measures between patients and partners was examined. Finally, a principal components analysis was performed to assess the primary dimensions underlying the variance in mental health and sexual functioning variables. Five factors were identified, accounting for 65.5% of the variance. Results of these analyses are discussed in order to obtain an understanding of the interrelationship between behavioral, psychological, and interpersonal variables in the onset and course of sexual dysfunction.

Pain perception and coping in female tension headache sufferers and headache-free controls.

The purpose of this study was to investigate how headache sufferers and headache-free controls differ in their responses to acute pain. Thirty-three women completed the study (15 headache sufferers and 18 controls). The cold pressor was used to induce pain, and a partially inflated blood pressure cuff was used as a nonpainful comparison task. Headache sufferers reported more discomfort during both tasks; however, the 2 groups did not differ in the number of facial expressions of pain displayed during the tasks. Headache sufferers reported a tendency to catastrophize during both tasks; positive coping did not differ between the 2 groups. These results offer evidence that recurrent tension headache sufferers are more sensitive to both painful and nonpainful stimuli and that they cope differently from controls with these physical stressors.

Subjective stress and coping in recurrent tension-type headache.

Subjects with tension-type headache and headache-free control subjects completed two mental stressor tasks, solving anagrams and mental arithmetic. During the experimental session, measures of heart rate, muscle tension, and subjective stress ratings were recorded. In addition, all subjects completed a week-long series of questionnaires which monitored headache activity in addition to frequency and intensity of stressful life events. Recurrent tension headache sufferers were found to have higher levels of depression and trait anxiety. Headache and control subjects were not found to respond differently to stressors presented in the laboratory based on measures of EMG, heart rate, or subjective stress ratings, nor were there differences in reports of coping. However, diary questionnaires revealed that headache subjects experienced stressful events more frequently than headache-free controls. Headache subjects also rated these events as causing more stress.

Lipoic acid improves nerve blood flow, reduces oxidative stress, and improves distal nerve conduction in experimental diabetic neuropathy.

OBJECTIVE: To determine whether lipoic acid (LA) will reduce oxidative stress in diabetic peripheral nerves and improve neuropathy. RESEARCH DESIGN AND METHODS: We used the model of streptozotocin-induced diabetic neuropathy (SDN) and evaluated the efficacy of LA supplementation in improving nerve blood flow (NBF), electrophysiology, and indexes of oxidative stress in peripheral nerves affected by SDN, at 1 month after onset of diabetes and in age-matched control rats. LA, in doses of 20, 50, and 100 mg/kg, was administered intraperitoneally five times per week after onset of diabetes. RESULTS: NBF in SDN was reduced by 50%; LA did not affect the NBF of normal nerves but improved that of SDN in a dose-dependent manner. After 1 month of treatment, LA-supplemented rats (100 mg/kg) exhibited normal NBF. The most sensitive and reliable indicator of oxidative stress was reduction in reduced glutathione, which was significantly reduced in streptozotocin-induced diabetic and alpha-tocopherol-deficient nerves; it was improved in a dose-dependent manner in LA-supplemented rats. The conduction velocity of the digital nerve was reduced in SDN and was significantly improved by LA. CONCLUSIONS: These studies suggest that LA improves SDN, in significant part by reducing the effects of oxidative stress. The drug may have potential in the treatment of human diabetic neuropathy.

The relationship of expectancies to outcome in stress management treatment of essential hypertension: results from the Joint USSR-USA Behavioral Hypertension Project.

Outcome expectancy and efficacy expectancy measures were made during the course of a cross-cultural comparison of thermal biofeedback and autogenic training as treatments for mild essential hypertension. There were no differences between groups at either pre- or posttreatment, and expectancy measures were not related to initial success or failure at the completion of treatment. However, both outcome and efficacy expectations were related to relapse over the three months immediately following the completion of treatment. Treatment failures had lower ratings for both outcome and efficacy expectations at the posttreatment assessment in comparison to treatment successes. Implications of these results are discussed.

Predictors of depression among male cancer patients.

The diagnosis of cancer is often associated with a host of negative emotional responses, including depressed mood. Social support and quality of life were used to predict depression in a sample of older male cancer patients. Depression was found to be a common, but not universal, reaction to the diagnosis and treatment of cancer. Almost 40% of subjects reported symptoms of moderate depression and nearly one fifth produced scores indicative of clinical depression. A stepwise multiple regression analysis revealed that our social support and quality of life measures accounted for 31.5% of the variance in total Beck Depression Inventory scores. Quality of life accounted for more of the variance in depression than did social support.

An experimental analysis of facilitated communication.

We evaluated the authorship of messages produced through facilitated communication by 7 adults with moderate or severe mental retardation and their facilitators. The clients had been reported to be communicating fluently through facilitated communication. We controlled the facilitators' access to information to be communicated in two evaluation formats, naming pictures and describing activities. In both formats we conducted three conditions: (a) the facilitator and client had access to the same information, (b) the facilitator did not have access to the picture or activity, and (c) the facilitator was given false information about the picture or activity. The results showed that the clients typed the correct answer only when the facilitator had access to the same information, never typed the correct answer when the facilitator had no information or false information, and typed the picture or activity presented to the facilitator when it was different from the one experienced by the client. These results provide unequivocal evidence for facilitator control of typing during facilitated communication.

Thermal biofeedback as an effective substitute for sympatholytic medication in moderate hypertension: a failure to replicate.

Thirty-three moderate hypertensives were converted to a 2-drug regimen of metoprolol and diuretic and BPs stabilized at a well-controlled level. They then completed one of three conditions over an 8-week interval: (I) 16 sessions of TBF (hand and foot warming); (II) 16 sessions of frontal EMG-BF; (III) regular home monitoring of BP. Attempts were then made to withdraw the patients from the sympatholytic medication. Those successfully withdrawn were followed up for one year. There were no significant advantages for TBF over the other two conditions in the short term or with long-term follow-up. Only 27% of treated patients (including Condition III failures who were remedicated and treated with TBF) were successfully off of the sympatholytic at a one-year follow-up. The generally poor results on clinical outcome were confirmed by clinic BPs, home BPs by patients, and 24-hour ambulatory BPs.

Histochemistry and ultrastructure of the metacercarial cyst of Bolbogonotylus corkumi (Trematoda: Cryptogonimidae).

Histochemical and ultrastructural studies were conducted on the metacercarial cyst of the cryptogonimid trematode Bolbogonotylus corkumi from the muscle tissue of fantail darters Etheostoma flabellare. The metacercarial cyst consisted of an outer host capsule and an inner parasite cyst. The host capsule was composed of an outer region of fibroblasts, collagen, macrophages, and unidentified cells, and an inner region containing degenerating cells. The parasite cyst was thin, homogenous, and noncellular in nature. The host capsule stained strongly for connective tissue and proteins and moderately for lipids, nucleic acids, nonspecific esterase activity, and acid and alkaline phosphatase activities. The parasite cyst stained intensely for acid mucopolysaccharides and moderately for acid phosphatase activity. A thick glycocalyx occurred between the parasite cyst and metacercarial tegument.