Exploring beliefs and distress in patients with facial palsies.

Evidence suggests that people with facial palsy may experience higher levels of distress, but the reasons for this are yet to be explored. This study aimed to explore people's illness beliefs, emotions, and behaviours in relation to their facial palsy and understand how distress is experienced by this group. Semi-structured individual interviews were conducted in the UK with adults with facial palsy. Interview questions were theoretically informed by the Common-Sense Self-Regulatory Model (CS-SRM). Thematic Analysis was conducted following a combined inductive and deductive approach. Twenty people with facial palsy participated (70% female; aged 29-84). Patient distress was accounted for by illness beliefs (symptoms, cause, control and treatment, timeline and consequences), and four additional themes (coping behaviours, social support, identity and health service provision). Experiences of anxiety, depression, and anger were widespread, and some participants experienced suicidal ideation. The burden of managing a long-term condition, altered self-perception, and social anxiety and isolation were key drivers of distress. There is a need for more integrated psychological support for patients with facial palsy. Within clinical consultations, patient's beliefs about facial palsy should be identified and systematically addressed. Service development should include appropriate referral to specialist psychological support via an established care pathway.

Psychological distress and coping following eye removal surgery.

Purpose: Psychological distress is reasonably well documented in people with facial disfigurement; however, in patients following eye removal surgery this has not been studied adequately. We hypothesised that lower distress levels would be associated with age and more adaptive coping strategies and that women would be more likely to report higher levels of distress and, therefore, use maladaptive coping strategies.Methods: This exploratory, cross-sectional study measured distress and coping in a sample of 56 post enucleation or evisceration patients. The Hospital Anxiety and Depression Scale and the Brief COPE measured distress and coping strategies.Results: In all, 25.5% and 10.9% of the sample had high levels of anxiety and depression, respectively. Significant associations were found between levels of distress, coping strategies and demographic variables (p < .05). There were significant differences in coping strategies between those with higher and lower levels of distress (p < .05). Females reported higher levels of anxiety (U = 202.5, p < .01) and depression (U = 229, p < .05) than males. Those who experienced enucleation or evisceration aged between 20 and 39 years reported significantly higher levels of depression compared with other age groups (U = 68.5, p < .01).Conclusions: There was a relatively low level of distress across the whole sample, but we found high levels of distress in a considerable proportion (18.18%) of participants. Participants' coping strategies and levels of distress were correlated. Females and participants aged between 20 and 39 years at time of eye removal were particularly vulnerable to distress.

Factors influencing patient uptake of an exercise referral scheme: a qualitative study.

Exercise referral schemes aim to increase physical activity amongst inactive individuals with or at risk of long-term health conditions. Yet many patients referred to these schemes (by health professionals) fail to take up the exercise opportunities on offer. Understanding factors influencing uptake to exercise referral schemes may help improve future attendance. Using the Socio-Ecological Model as a framework, this qualitative study aimed to explore factors influencing uptake to an exercise referral scheme based in the North West of England. Semi-structured interviews were conducted with referred patients (n = 38) about their reasons for referral, interactions with referring health professionals, events following referral and ideas to improve future uptake. Data were analysed thematically and mapped onto the constructs of the Socio-Ecological Model. Factors reported to influence uptake included intrapersonal (past PA experiences, motivation, competing priorities), interpersonal (scheme explanations, support) and organizational influences (scheme promotion, communication between service, cost). Whilst several intrapersonal-level factors influenced patient decisions to uptake the exercise referral scheme, modifiable interpersonal and organizational factors were identified as potential targets for intervention. Recommendations are made for improving awareness of exercise referral schemes and for enhancing communication between referring practitioners, patients and referral scheme staff.

ESPGHAN position paper on management of percutaneous endoscopic gastrostomy in children and adolescents.

OBJECTIVES: This European Society for Pediatric Gastroenterology, Hepatology, and Nutrition (ESPGHAN) position statement provides a comprehensive guide for health care providers to manage percutaneous endoscopic gastrostomy tubes in a safe, effective, and appropriate way. METHODS: Relevant literature from searches of PubMed, CINAHL, and recent guidelines was reviewed. In the absence of evidence, recommendations reflect the expert opinion of the authors. Final consensus was obtained by multiple e-mail exchange and during 3 face-to-face meetings of the gastroenterology committee of the European Society for Pediatric Gastroenterology, Hepatology, and Nutrition. RESULTS: Endoscopically placed gastrostomy devices are essential in the management of children with feeding and nutritional problems. The article focuses on practical issues such as indications and contraindications. CONCLUSIONS: The decision to place an endoscopic gastrostomy has to be made by an appropriate multidisciplinary team, which then provides active follow-up and care for the child and the device.

Engaging depressed African American adolescents in treatment: lessons from the AAKOMA PROJECT.

The authors describe and illustrate means of engaging depressed African American adolescents in treatment. Twenty-eight youth participated in focus groups or individual interviews. Using grounded theory and transcript based analysis, they derived 5 themes describing African American adolescents' experience of depression and suggested mechanisms for improving African American youth treatment engagement. Practitioners can educate African American youth about depression as a medical disorder, build trust, and apply innovative approaches to recognizing differential manifestations of depression in African American youth.

Maternal parenting stress and its correlates in families with a young child with cerebral palsy.

OBJECTIVE: To investigate factors predicting parenting stress in mothers of pre-school children with cerebral palsy. METHOD: Eighty mothers and children participated. Mothers completed the Parenting Stress Index (PSI) and the following measures of family functioning: family support, family cohesion and adaptability, coping strategies, family needs and locus of control. Children were assessed using the Griffiths Scales and the Gross Motor Function measure. The child's home environment was assessed using Home Observation for Measuring the Environment. RESULTS: Mothers had higher mean total PSI scores than the means for the typical sample; 43% had total PSI scores above the threshold for clinical assessment. Cluster analysis demonstrated five distinct clusters of families, more than half of whom were coping well. High stress items were role restriction, isolation and poor spouse support, and having a child who was perceived as less adaptable and more demanding. Lower stress items indicated that this sample of mothers found their children emotionally reinforcing and had close emotional bonds. Regression analysis showed that the factors most strongly related to parenting stress levels were high family needs, low family adaptability and cognitive impairment in the child. CONCLUSIONS: The results confirmed the individuality of families, and that individual characteristics of coping and feeling in control, together with family support and cohesion, are associated with variation in amount of stress experienced in parenting a child with cerebral palsy.

Randomized blinded controlled trial of dipyrone as a treatment for pyrexia in horses.

OBJECTIVE To evaluate the effectiveness and safety of dipyrone to control pyrexia in horses with naturally occurring disease under field conditions. ANIMALS 138 horses with pyrexia and various infections evaluated at 14 veterinary sites in 12 states. PROCEDURES In the first (effectiveness) phase of this 2-phase study, horses were randomly assigned 3:1 to receive 1 dose of dipyrone (30 mg/kg [13.6 mg/lb], IV) or an equivalent amount of placebo. Effectiveness was defined as a decrease in rectal temperature ≥ 1.1°C (2°F), compared with the pretreatment value, or a rectal temperature of ≤ 38.3°C (101.0°F) 6 hours after treatment administration. Horses deemed to have an appropriate reduction in rectal temperature (regardless of treatment group) by 6 hours were immediately entered into the safety phase of the study, in which dipyrone was administered IV at 30 mg/kg between 0 and 8 times up to every 8 hours on an as-needed basis, as determined by the clinical investigators. Horses were monitored throughout for adverse events. RESULTS A significantly greater proportion of dipyrone-treated horses (76/99 [77%]) had an effective treatment response than did placebo-treated horses (6/31 [19%]). Posttreatment adverse events were mild and transient. No differences in types or prevalence of gastrointestinal adverse events were evident between treatment groups. CONCLUSIONS AND CLINICAL RELEVANCE Dipyrone was effective in controlling pyrexia by 6 hours after IV administration of a single 30-mg/kg dose in a large proportion of treated horses. Adverse effects were minimal.

Bernas ion source discharge simulation.

As the technology and applications continue to grow up, the development of plasma and ion sources with clearly specified characteristic is required. Therefore comprehensive numerical studies at the project stage are the key point for ion implantation source manufacturing (especially for low energy implantation). Recently the most commonly encountered numerical approach is the Monte Carlo particle-in-cell (MCPIC) method also known as particle-in-cell method with Monte Carlo collisions. In ITEP the 2D3V numerical code PICSIS-2D realizing MCPIC method was developed in the framework of the joint research program. We present first results of the simulation for several materials interested in semiconductors. These results are compared with experimental data obtained at the ITEP ion source test bench.

Status of ITEP decaborane ion source program.

The joint research and development program is continued to develop steady-state ion source of decaborane beam for ion implantation industry. Both Freeman and Bernas ion sources for decaborane ion beam generation were investigated. Decaborane negative ion beam as well as positive ion beam were generated and delivered to the output of mass separator. Experimental results obtained in ITEP are presented.

Ion sources for energy extremes of ion implantation.

For the past four years a joint research and development effort designed to develop steady state, intense ion sources has been in progress with the ultimate goal to develop ion sources and techniques that meet the two energy extreme range needs of meV and hundreads of eV ion implanters. This endeavor has already resulted in record steady state output currents of high charge state of antimony and phosphorus ions: P(2+) [8.6 pmA (particle milliampere)], P(3+) (1.9 pmA), and P(4+) (0.12 pmA) and 16.2, 7.6, 3.3, and 2.2 pmA of Sb(3+)Sb(4+), Sb(5+), and Sb(6+) respectively. For low energy ion implantation, our efforts involve molecular ions and a novel plasmaless/gasless deceleration method. To date, 1 emA (electrical milliampere) of positive decaborane ions was extracted at 10 keV and smaller currents of negative decaborane ions were also extracted. Additionally, boron current fraction of over 70% was extracted from a Bernas-Calutron ion source, which represents a factor of 3.5 improvement over currently employed ion sources.

Planning for the future: the implementation of an automated clinical system.

Preparing for automation is as important to the whole automation process as choosing the correct system. Planning should start some time before actual purchase. Once the strategic planning is complete, staff can begin researching what applications are available, what they do, what vendors are reputable, etc. Then the agency can begin the actual implementation.

Development of the ion source for cluster implantation.

Bernas ion source development to meet needs of 100s of electron-volt ion implanters for shallow junction production is in progress in Institute for Theoretical and Experimental Physics. The ion sources provides high intensity ion beam of boron clusters under self-cleaning operation mode. The last progress with ion source operation is presented. The mechanism of self-cleaning procedure is described.

Treatment of complex regional pain syndrome in adults: a systematic review of randomized controlled trials published from June 2000 to February 2012.

Complex regional pain syndrome (CRPS) is a disabling pain condition with sensory, motor and autonomic manifestations. Uncertainty remains about how CRPS can be effectively managed. We conducted a systematic review of randomized controlled trials (RCTs) for treatment and prophylactic interventions for CRPS published during the period 2000-2012, building on previous work by another group reviewing the period 1966-2000. Bibliographic database searches identified 173 papers which were filtered by three reviewers. This process generated 29 trials suitable for further analysis, each of which was reviewed and scored by two independent reviewers for methodological quality using a 15-item checklist. A number of novel and potentially effective treatments were investigated. Analysing the results from both review periods in combination, there was a steep rise in the number of published RCTs per review decade. There is evidence for the efficacy of 10 treatments (3× strong--bisphosphonates, repetitive transcranial magnetic stimulation and graded motor imagery, 1× moderate and 6× limited evidence), and against the efficacy of 15 treatments (1× strong, 1× moderate and ×13 limited). The heterogeneity of trialled interventions and the pilot nature of many trials militate against drawing clear conclusions about the clinical usefulness of most interventions. This and the observed phenomenon of excellent responses in CRPS subgroups would support the case for a network- and multi-centre approach in the conduct of future clinical trials. Most published trials in CRPS are small with a short follow-up period, although several novel interventions investigated from 2000 to 2012 appear promising.

The Significance of Strategic Community Engagement in Recruiting African American Youth & Families for Clinical Research.

We present baseline data and describe the utility of a community engaged, culturally relevant approach to recruiting African American youth and families for phase I of The AAKOMA Project. The AAKOMA Project is a two phase treatment development study to improve mental health service use among depressed African American youth. We completed capacity building activities using a community engaged framework and Community Based Participatory Research (CBPR) methods. Replicating the (Alvarez et al. in West J Nurs Res 28:541-560, 2006) model of systematic community out-reach enhanced our ability to effectively recruit partners and evaluate outreach efforts as demonstrated by our Recruitment Success Factor (RSF-i.e. 'an adjusted ratio of eligible participant yield to contacts made'). Using the chi-square goodness-of-fit statistic; we compared the RSFs of the various modes of participant study entry to determine which was most effective. Our target enrollment was 56 persons. We recruited 130 and enrolled 57. Our baseline data is drawn from a gender balanced and socioeconomically diverse sample who participated in youth focus groups and individual interviews and adult focus groups. We identified 3 study participant referral modes (self-referral, provider referral and participant-to-participant referral) with multiple sources per mode and an overall RSF of 0.41. Study findings support the effectiveness of assiduous and systematic community interaction, reflective review of recruitment efforts and the importance of disseminating information on strategic recruitment processes for engaging diverse populations in clinical research.

Chronic pain and coping: a proposed role for nurses and nursing models.

AIMS: Activity of living based nurse models such as that proposed by Roper, Logan and Tierney are utilized commonly to rationalize, structure and guide practice. This paper proposes that their use, in the context of chronic pain, should be extended to incorporate the assessment of coping and its effect on disability. BACKGROUND: As coping has been found to account for some of the variance in adaptation to chronic pain, generic models of coping and their utility in this context are considered. The need for reliable and valid means to assess coping are of paramount importance as this will facilitate and inform treatment and management of chronic pain. At the present time coping is most generally assessed using self report instruments which primarily focus on the number and type of strategies used to cope rather than their effectiveness in reducing disability and increasing function. FINDINGS: A classification system which categorizes chronic pain patients in terms of how they function in daily life as either adaptive copers, interpersonally distressed or dysfunctional is outlined. The similarities between this and a routine nursing assessment based on an activities of living model are highlighted. CONCLUSIONS: It is proposed that the innovative use of nursing activity of living models could provide the framework for a pain clinic based assessment of coping that has greater utility for professionals and patients alike.