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1.
BMC Palliat Care ; 21(1): 189, 2022 Nov 02.
Artículo en Inglés | MEDLINE | ID: mdl-36324101

RESUMEN

BACKGROUND: Patients with advanced cancer are prone to experience burdensome physical, psychological, and financial consequences. Healthcare providers may not fully appreciate advanced cancer patients' medical care autonomy, such as at that emboded by Advance Care Planning (ACP), and by doing so may compromise their quality of end-of-life (EOL). Hence, it is essential for healthcare providers to effectively assess and communicate with patients' regarding their medical decisions before their patients are incapacitated by their disease progression. The purpose of this investigation was to describe the decisional balance, attitudes, and practice behaviors of ACP and its predictors of ACP-related experiences in Taiwanese patients with advanced cancer. METHODS: This cross-sectional, descriptive study employed a mixed-methodsquantitative and qualitative design with a sample of 166 patients that were purposely recruited from in-patient oncology units at a regional teaching hospital in southern Taiwan. Study data consisted of patient replies to a 34-item self-report tool, Decisional Balance, Attitudes, Practice Behaviors of ACP (DAP-ACP) and 4 semi-structured questions. RESULT: Findings indicated that, in general, study participants exhibited favorable ACP-decisional balance and positive ACP-attitudes & practice behaviors. The results also indicated that gender, educational level, and cancer diagnosis were associated with significant differences on the "ACP-decisional balance" and "ACP-attitudes" scales. In addition, our findings documented that the participants' gender and educational level were significant predictors of both ACP-decisional balance and ACP-attitudes. Furthermore the participants' ACP-practice behaviors were predicted by ACP-decisional balance, but not with their ACP-attitudes. The qualitative analysis of the semi-structured questions identified six themes in responses to current medical decision making (e.g., compliance with physician instructions, family engagement in treatment decision-making); and eight themes pertaining to future ACP-related concerns were identified (e.g., family conflict, effectiveness of time-limited trials). CONCLUSION: To promote patients' engagement in ACP, the healthcare professional need to assess and advocate patients' concerns or attitudes regarding ACP in a timely manner. In addition, factors or concerns that might influence patients' responses to ACP derived from both the quantitative and qualitative findings of this current study need to be considered especially in initiating the dialogue regarding ACP with patients with advanced cancer. TRIAL REGISTRATION: No. CYCH 2,019,072, Date of registration 5 Dec 2019.


Asunto(s)
Planificación Anticipada de Atención , Neoplasias , Médicos , Humanos , Estudios Transversales , Actitud , Neoplasias/terapia
2.
BMC Palliat Care ; 21(1): 180, 2022 Oct 14.
Artículo en Inglés | MEDLINE | ID: mdl-36242014

RESUMEN

BACKGROUND: End-stage renal disease (ESRD) is a major chronic illness worldwide, and Taiwan reports one of the highest incidence rates of ESRD with 529 cases per million population (pmp). A number of patients with ESRD patients might require lifelong hemodialysis (HD) or peritoneal dialyses (PD). Due to the progression of dialysis, patients are likely to experience other chronic comorbidities, anxiety and depression, frequent hospitalizations, and higher rates of mortality compared to patients with other types of chronic illnesses. As a result, dialysis patients are prone to experience advance care planning (ACP) needs, such as whether they withdraw from receiving dialysis while approaching their end-of-life (EOL). Yet, existing studies have shown that dialysis patients seldom receive timely consultation regarding ACP and there are limited studies examining ACP amongst Taiwan HD patients. PURPOSE: The purpose of this study was to examine ACP awareness, contemplation, self-efficacy and readiness; and factors influencing ACP readiness. DESIGN: This cross-sectional descriptive study with convenience sampling was conducted in the out-patient HD unit at a regional teaching hospital in southern Taiwan. A total of 143 ESRD patients undergoing HD treatments were recruited. A 55-item ACP engagement survey containing the subscales of awareness, contemplation, self-efficacy, and readiness was employed. The data were analyzed with t-tests, one-way ANOVAs, Pearson's correlations and multiple regressions. RESULTS: The results of our investigation revealed that approximately half of the participants (n = 67, 46.9%) were not informed of ACP. Although they reported considering their EOL, medical decisions and desired care, they demonstrated significantly low self-efficacy in discussing ACP (t= -5.272, p < 0.001). HD duration influenced all four ACP subscales; religious beliefs significantly influenced ACP-self-efficacy and readiness; and marital status, education, and primary decision-maker status significantly influenced ACP-readiness. The predictors of ACP-readiness were high self-efficacy and being the primary decision-maker (Adjusted R2 61%). CONCLUSION: Most of the HD patients in this study had low ACP-awareness, contemplation, self-efficacy, and readiness, and most had not completed any ACP-related advance directives (AD). Healthcare professionals should proactively provide HD patients with ACP-related information and answer patients' and medical decision-makers' questions in a timely manner, thereby improving the quality of EOL care.


Asunto(s)
Planificación Anticipada de Atención , Fallo Renal Crónico , Enfermedad Crónica , Estudios Transversales , Humanos , Fallo Renal Crónico/terapia , Diálisis Renal , Autoeficacia
3.
Eur J Cancer Care (Engl) ; 28(2): e12976, 2019 Mar.
Artículo en Inglés | MEDLINE | ID: mdl-30536809

RESUMEN

The purpose of this study was to evaluate the longitudinal incidence, severity, pattern of changes or predictors of oxaliplatin-induced peripheral neuropathy (OXAIPN) in Taiwanese patients with colorectal cancer. A longitudinal repeated measures study design was employed, and 77 participants were recruited from the colorectal and oncology departments of two teaching medical centres in Taiwan. Physical examinations were performed, and self-reports regarding adverse impacts of OXAIPN and quality of life were obtained at five time points throughout 12 cycles of chemotherapy (C/T). The incidence of OXAIPN increased with C/T cycles (31.1%-81.9%), and the upper limb numbness and cold sensitivity were most significant acute OXAIPN symptoms (29.9%-73.6%). Findings also documented significant increases in overall severity, symptom distress, interference and physical results associated with OXAIPN over the course of C/T. Predictors of OXAIPN severity varied by treatment cycle, including younger patient, higher cumulative dose of oxaliplatin, greater body surface area, receipt of chemotherapy in winter and the occurrence of OXAIPN during prior C/T cycles. The results from this study might help healthcare providers to recognise the symptom characteristics, degree of influences, trends and high-risk group of OXAIPN, facilitating early evaluation and potential interventions to mitigate or prevent negative effects of OXAIPN on patients.


Asunto(s)
Antineoplásicos/efectos adversos , Neoplasias Colorrectales/tratamiento farmacológico , Oxaliplatino/efectos adversos , Enfermedades del Sistema Nervioso Periférico/inducido químicamente , Actividades Cotidianas , Enfermedad Aguda , Anciano , Antineoplásicos/administración & dosificación , Ansiedad/inducido químicamente , Enfermedad Crónica , Neoplasias Colorrectales/etnología , Femenino , Humanos , Incidencia , Estudios Longitudinales , Masculino , Persona de Mediana Edad , Oxaliplatino/administración & dosificación , Enfermedades del Sistema Nervioso Periférico/etnología , Estudios Prospectivos , Calidad de Vida , Factores de Riesgo , Estaciones del Año , Taiwán/etnología
4.
BMC Palliat Care ; 18(1): 99, 2019 Nov 11.
Artículo en Inglés | MEDLINE | ID: mdl-31711482

RESUMEN

BACKGROUND: Despite the documented and well known patient benefits of ACP, the completion of ACP, only a minority of patients, during the advanced or EOL stage of their illnesses, receive such care. The misconceptions about ACP for healthcare providers, such as nurses, might become potential barriers to the effective implication of ACP. Also, from the transcultural perspective, it is evident essential to explore Taiwanese nurses' attitudes, knowledge, and actions of ACP. The purposes of this study were to explore the implication of ACP or hospice care for nurses caring for non-cancer chronic illness patients at a regional teaching hospital in Taiwan; and, to identify predictors of those nurses' knowledge, attitudes, and actions toward ACP. METHODS: This cross-sectional study with a purposive sample of 218 nurses was conducted at a teaching hospital in southern Taiwan. Structured questionnaires were employed and data were analyzed with descriptive statistics, t-test, one-way ANOVAs, Pearson's correlation and multiple regressions. RESULTS: 16.1% of Taiwanese physicians actively initiated ACP issues or conversations with patients or their family members. Nurses' attitudes toward ACP were fairly positive but their knowledge about ACP was insufficient and actions of ACP were not positively executed. The predictors of ACP-Knowledge (ACP-K) included position title, education hours and lacking of educational training. The predictors of ACP-Attitude (ACP-A) included ACP-K and "fear of patient or family member not accepting", whereas ACP-A, position title, "patients do not feel necessary" and "not sure physician's concern" were the predictors of ACP-Act. CONCLUSION: Continuous education and training for nurses regarding ACP needs to be improved by taking those predictors found in this current study into account, and more studies on the nurse's role in ACP also should be further examined. TRIAL REGISTRATION: KAFGH 106-012. Date of registration 1 May 2017.


Asunto(s)
Planificación Anticipada de Atención/organización & administración , Actitud del Personal de Salud , Conocimientos, Actitudes y Práctica en Salud , Cuidados Paliativos al Final de la Vida/organización & administración , Adulto , Planificación Anticipada de Atención/normas , Estudios Transversales , Cuidados Paliativos al Final de la Vida/normas , Hospitales de Enseñanza , Humanos , Persona de Mediana Edad , Médicos/organización & administración , Factores Socioeconómicos , Taiwán , Adulto Joven
5.
AAOHN J ; 59(9): 401-6; quiz 407, 2011 Sep.
Artículo en Inglés | MEDLINE | ID: mdl-21877672

RESUMEN

In 2009, occupational health nursing faculty and professionals at the University of Washington developed an innovative continuing nursing education offering, the OHN Institute. The OHN Institute was designed to meet the following objectives: (1) extend basic occupational health nursing training to non-occupational health nurses in Federal Region X, (2) target new occupational health nurses or those who possessed little or no advanced education in occupational health nursing, and (3) offer a hybrid continuing nursing education program consisting of on-site and distance learning modalities. Evaluation findings suggested that the various continuing nursing education modalities and formats (e.g., asynchronous vs. synchronous, online modules vs. live modules) were essentially comparable in terms of effectiveness. Perhaps most importantly, the OHN Institute evaluation demonstrated that quality continuing nursing education outcomes for occupational health nurses depended largely on knowledgeable and engaging faculty and a compelling vision of desired outcomes, including the application of learned content to professional practice.


Asunto(s)
Instrucción por Computador/métodos , Educación a Distancia/métodos , Educación Continua en Enfermería/métodos , Enfermería del Trabajo/educación , Curriculum , Humanos , Internet , Persona de Mediana Edad , Evaluación de Programas y Proyectos de Salud , Washingtón
6.
Nurs Educ Perspect ; 31(4): 237-41, 2010.
Artículo en Inglés | MEDLINE | ID: mdl-20882865

RESUMEN

A substantial number of children and families experience emotional difficulties in the aftermath of disasters and terrorist events. Only recently has training in disaster preparedness and response been systematically incorporated into the curricula of mental health disciplines. The goal of the Child & Family Disaster Research Training & Education Program is to enhance the nation's capacity and infrastructure needed to conduct rigorous disaster mental health research on children and families. This article describes the creation and training of 10 specialized research teams, curriculum development, implementation of the program, and progress to date as well as lessons learned and challenges to sustainability.


Asunto(s)
Planificación en Desastres , Capacitación en Servicio/organización & administración , Servicios de Salud Mental , Investigación/educación , Trastornos por Estrés Postraumático/prevención & control , Niño , Servicios de Salud del Niño , Curriculum , Humanos , Desarrollo de Programa , Investigación/organización & administración , Estados Unidos
7.
Eur J Oncol Nurs ; 49: 101834, 2020 Dec.
Artículo en Inglés | MEDLINE | ID: mdl-33120223

RESUMEN

PURPOSE: Many colorectal cancer (CRC) patients report having Oxaliplatin-induced peripheral neuropathy (OXAIPN), compromising their overall quality of life (QoL). Yet, the existing studies on examining the effects of elastic-band resistance exercise yielded inconsistent results and there was a scare study with CRC population employing a longitudinal research design. The purpose of this non-randomized preliminary study was to examine the effects of an educational program providing skills and knowledge about OXAIPN along with home-based lower extremity elastic-band exercise training in a sample (n = 42) of Taiwanese patients with CRC. METHOD: A quasi-experimental study with one-group, pretest-posttest repeated measures and longitudinal design was employed. The 4.5-month interventional protocol included 8 sessions of face-to-face education from the 3rd to the 7th cycles of chemotherapy. Physical exams, muscle strength and endurance, and self-reports regarding adverse impacts of OXAIPN and QoL were obtained at three time points throughout chemotherapy course. RESULTS: The most consistently significant increase was the participants' muscle strength and endurance measured with one-repetition maximum and 6-min walk distance, respectively (both P < .001). The participants' OXAIPN-related QoL showed significant improvements at some time points of the chemotherapy cycles, but not others. CONCLUSION: Study findings indicated that an educational program combined with knowledge about OXAIPN symptom management and skills with lower extremity resistance training had potential benefits over time on muscle strength and endurance and autonomic dimension of CIPN-related QoL. These preliminarily results may assist healthcare providers to incorporate self-management strategies such as lower extremity exercise for patients with OXAIPN to partially mitigate its negative effects.


Asunto(s)
Neoplasias del Colon/tratamiento farmacológico , Neoplasias Colorrectales/tratamiento farmacológico , Oxaliplatino/efectos adversos , Oxaliplatino/uso terapéutico , Enfermedades del Sistema Nervioso Periférico/inducido químicamente , Enfermedades del Sistema Nervioso Periférico/terapia , Entrenamiento de Fuerza/educación , Adulto , Anciano , Anciano de 80 o más Años , Pueblo Asiatico/psicología , Escolaridad , Femenino , Humanos , Masculino , Persona de Mediana Edad , Fuerza Muscular/fisiología , Estado Nutricional , Resistencia Física/fisiología , Rendimiento Físico Funcional , Calidad de Vida/psicología , Índice de Severidad de la Enfermedad , Taiwán
8.
J Public Health Manag Pract ; 15(6): E1-11, 2009.
Artículo en Inglés | MEDLINE | ID: mdl-19823144

RESUMEN

OBJECTIVES: Children and youth have been shown to be vulnerable to negative mental and behavioral health consequences following mass disasters and terrorist attacks. The purpose of this article was to identify the primary roles and responsibilities of public health agencies and systems that both promote resiliency and reduce the mental health risks to children and their families following disastrous events. METHODS: The authors conducted a review and synthesis of public and mental health research literatures, resources, and policies focused on mental and behavioral health outcomes in children and families in the aftermath of disasters. RESULTS: The available research evidence supported the contention that children experience heightened psychosocial vulnerabilities and lasting psychosocial burdens following disasters. The major roles that public health organizations and systems can play to both prevent and deter such harmful mental and behavioral health impacts of disasters during all phases of the disaster cycle were identified. CONCLUSIONS: The roles identified that public health organizations and systems can undertake included coordination and collaboration with various local and federal agencies, advocacy and promotion of community resilience, deterring harmful effects of disastrous events by assessment, screening, case finding and education, training of personnel, guiding interventions, formulating policy, and conducting research investigations.


Asunto(s)
Conducta del Adolescente , Conducta Infantil , Desastres , Salud Pública , Adolescente , Niño , Humanos , Trastornos Mentales/etiología , Trastornos Mentales/terapia
9.
AAOHN J ; 57(3): 112-9; quiz 120-1, 2009 Mar.
Artículo en Inglés | MEDLINE | ID: mdl-19338261

RESUMEN

The potential for biological, chemical, radiological, or nuclear terrorism has been widely acknowledged since the events of September 11, 2001. Terrorists' use of a radiological dispersal device (RDD), or dirty bomb, is considered to be a threat for which Americans must prepare. Occupational health nurses must have the knowledge and skill set to plan for, respond to, and recover from a radiologic event potentially affecting significant numbers of first responders as well as businesses and their workers. This article describes the hazards related to RDDs and provides resources supporting occupational health nurses' roles in such events occurring near or at their workplaces. Occupational health nurses are prepared to assess and treat RDD causalities using current information to identify signs and symptoms of exposed and contaminated RDD victims. Decontamination, treatment, and recovery methods for workers and businesses affected by an RDD event are described.


Asunto(s)
Planificación en Desastres , Enfermería del Trabajo , Liberación de Radiactividad Peligrosa , Terrorismo , Descontaminación/métodos , Humanos , Rol de la Enfermera
11.
Am J Health Syst Pharm ; 64(3): 285-93, 2007 Feb 01.
Artículo en Inglés | MEDLINE | ID: mdl-17244878

RESUMEN

PURPOSE: The effectiveness of a point of dispensing (POD) used in a mass dispensing exercise was evaluated. METHODS: Public Health-Seattle & King County (PHSKC), in conjunction with the University of Washington, conducted a functional exercise of mass dispensing plans to test the effectiveness of a POD. Specifically, the organization and maintenance of patient flow, staffing model, signage, and dissemination of public information were evaluated. A data collection application using cellular telephones was used to record time and patient flow data to evaluate patient flow. Questionnaires distributed to staff and volunteer patients at the end of the exercise obtained feedback regarding the setup, organization, and operations of the POD. RESULTS: The POD was operational for approximately 68 minutes. The majority of POD staff reported feeling comfortable with their specific job tasks and duties within 15 minutes of opening the doors to the POD to the public. Staff questionnaires also revealed a high level of self-reported confidence in their ability and in the ability of their colleagues to perform the job-specific responsibilities required of them or respond to this hypothetical event. The majority of volunteer patients found the signs helpful and easy to follow and the check-in form easy to complete. Despite efforts to provide patients with oral and written information about the medications being dispensed, only 80% indicated that they knew how to take the medication, and only 73% reported understanding the medication instructions for all the individuals for whom they picked up medication. CONCLUSION: The majority of volunteer patients and staff who participated in a functional exercise of mass dispensing plans found the POD to be effective. Time-flow analysis provided preliminary estimates of the total amount of time needed to complete the dispensing process for each head of household.


Asunto(s)
Eficiencia Organizacional , Sistemas de Medicación/organización & administración , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Niño , Preescolar , Planificación en Desastres , Femenino , Humanos , Lactante , Recién Nacido , Difusión de la Información , Masculino , Persona de Mediana Edad , Washingtón
12.
BMJ Open ; 6(10): e011897, 2016 10 03.
Artículo en Inglés | MEDLINE | ID: mdl-27697870

RESUMEN

OBJECTIVES: To explore the prevalence, discomfort, and self-relief behaviours of painful diabetic neuropathy (PDN) among rural community residents with type 2 diabetes. DESIGN: A community-based, cross-sectional study. SETTING: This study was part of a longitudinal cohort study of a nurse-led health promotion programme for preventing foot ulceration in Chiayi County, Taiwan. PARTICIPANTS: Six hundred and twenty-eight community adults with type 2 diabetes participated in this study. OUTCOME MEASURES: Parameters assessed included peripheral neuropathy, peripheral vasculopathy, glycaemic control and metabolic biomarkers. Statistical analyses included descriptive statistics and a multivariate logistic regression model. RESULTS: About 30.6% of participants (192/628) had PDN. Factors associated with PDN included an abnormal ankle brachial index (ABI; OR=3.4; 95% CI 1.9 to 6.2; p<0.001), Michigan neuropathy screening index (OR=1.69; 95% CI 1.0 to 2.6; p=0.021), triglyceride level (OR=1.61; 95% CI 1.0 to 2.4; p=0.036) and being female (OR=1.68; 95% CI 1.1 to 2.4; p=0.022). PDN was characterised by uncomfortable feelings of prickling, stinging or burning pain and inexplicable dullness around the base or dorsal areas of the feet, but received little attention or treatment from primary healthcare providers. CONCLUSIONS: A high prevalence of PDN was found in rural community residents with type 2 diabetes and the healthcare workers provided little attention to, or treatment of, discomfort. It is important to identify high-risk groups with PDN early in order to prevent foot ulceration and reduce the incidence of amputation of the extremities. It is also urgent to develop appropriate treatment and self-relief behaviours to halt or reverse the progression of PDN for this population living in rural areas.


Asunto(s)
Diabetes Mellitus Tipo 2/complicaciones , Pie Diabético , Pie/patología , Manejo del Dolor , Dolor/etiología , Autocuidado , Anciano , Índice Tobillo Braquial , Glucemia/metabolismo , Presión Sanguínea , Estudios de Cohortes , Estudios Transversales , Diabetes Mellitus Tipo 2/terapia , Pie Diabético/sangre , Pie Diabético/complicaciones , Pie Diabético/epidemiología , Pie Diabético/terapia , Neuropatías Diabéticas , Femenino , Humanos , Modelos Logísticos , Masculino , Persona de Mediana Edad , Oportunidad Relativa , Dolor/epidemiología , Prevalencia , Población Rural , Factores Sexuales , Taiwán/epidemiología , Triglicéridos/sangre
13.
Prehosp Disaster Med ; 17(3): 119-25, 2002.
Artículo en Inglés | MEDLINE | ID: mdl-12627914

RESUMEN

INTRODUCTION: In the wake of domestic terrorists attacks on 11 September 2001 and subsequent bioterrorist events employing anthrax, there no longer can be any debate about the potential for attacks employing Nuclear, Biological, or Chemical (NBC)/Weapons of Mass Destruction (WMD). As one way of acknowledging this long-standing threat and, in a concerted effort to mitigate the effects of possible future domestic NBC/WMD terrorist attacks, the US Department of Defense (DOD) and other US governmental agencies already had mounted an effort to provide Domestic Preparedness Training for First Responders in urban centers throughout the USA. METHODS: A paper and pencil questionnaire specifically designed to evaluate the effectiveness of Domestic Preparedness Training for Emergency First Responders has been developed. An earlier version of this instrument was piloted with a convenience sample of firefighters and paramedics (n = 78) in a northwest state. Based on replies to the pilot questionnaire, a pool of 27 items based on the objectives and content of the NBC/WMD Domestic Preparedness Awareness and Operations courses (plus additional background and appraised competency items) were selected for inclusion in a Domestic Preparedness Questionnaire (DPQ). RESULTS: This paper first describes the essential psychometric properties of the DPQ based on replies from baseline and follow-up samples (n = 206 and n = 246 respectively) of urban firefighters and paramedics employed by a metropolitan city in a northwest state. The DPQ was employed to evaluate the outcomes of Domestic Preparedness training provided to a sample of urban fire-service personnel. The DPQ documented significant improvements in a group of "DP trained"-urban firefighters (n = 80) both in their awareness and operations content knowledge as well as in their perceived competencies to respond to acts of biological, chemical, or nuclear terrorism "in their own community" at four months post-training. A comparison group of "Not DP-trained" firefighters (n = 78) showed no statistically significant changes on these DPQ indices, suggesting that the documented improvements in the "DP-trained" firefighters on the DPQ were not due to "test reactivity" or to "historical" factors. CONCLUSION: The findings suggest that the DPQ has adequate inter-item and test-retest reliability, possesses concurrent validity, and appears to be a sensitive measure of the Domestic Preparedness Training provided for urban firefighter and paramedic First Responders.


Asunto(s)
Planificación en Desastres , Servicios Médicos de Urgencia/organización & administración , Auxiliares de Urgencia/educación , Capacitación en Servicio/organización & administración , Terrorismo , Bioterrorismo , Humanos , Proyectos Piloto , Evaluación de Programas y Proyectos de Salud , Psicometría , Encuestas y Cuestionarios , Estados Unidos
14.
J Psychosoc Nurs Ment Health Serv ; 41(6): 22-31, 2003 Jun.
Artículo en Inglés | MEDLINE | ID: mdl-12812002

RESUMEN

1. Eye movement desensitization and reprocessing (EMDR) is an integrative therapy that "unlocks" disturbing memories or beliefs and reprocessess them, in some way, so they are no longer as disabling. 2. EMDR can be used for any experientially based psychological problems and has proven especially effective for traumatic imagery associated with posttraumatic stress disorder. 3. A primary benefit of EMDR is its time efficiency, requiring as few as 3 to 5 hours of treatment. 4. Many potential mechanisms (i.e., cognitive, hypnotic, self-disclosure, biological) may account for the effectiveness of EMDR.


Asunto(s)
Desensibilización Psicológica/métodos , Movimientos Oculares , Trastornos por Estrés Postraumático/terapia , Abreacción , Terapia Cognitivo-Conductual , Femenino , Humanos , Hipnosis , Servicios de Información , Acontecimientos que Cambian la Vida , Procesos Mentales , Ciudad de Nueva York , Escalas de Valoración Psiquiátrica , Trastornos por Estrés Postraumático/diagnóstico , Trastornos por Estrés Postraumático/etiología , Trastornos por Estrés Postraumático/psicología , Terrorismo/psicología , Factores de Tiempo , Resultado del Tratamiento
16.
Traumatology (Tallahass Fla) ; 18(4): 86-91, 2012 Nov 19.
Artículo en Inglés | MEDLINE | ID: mdl-23264756

RESUMEN

This case study describes the process and outcomes of the Northwest Center for Public Health Practice Child and Family Disaster Research Training (UWDRT) Program housed at the University of Washington, which used web-based distance learning technology. The purposes of this program were to provide training and to establish a regional cadre of researchers and clinicians; to increase disaster mental health research capacity and collaboration; and to improve the scientific rigor of research investigations of disaster mental health in children and families. Despite a number of obstacles encountered in development and implementation, outcomes of this program included increased team member awareness and knowledge of child and family disaster mental health issues; improved disaster and public health instruction and training independent of the UWDRT program; informed local and state disaster response preparedness and response; and contributions to the child and family disaster mental health research literature.

17.
Pain ; 152(10): 2432-2442, 2011 Oct.
Artículo en Inglés | MEDLINE | ID: mdl-21802850

RESUMEN

To date, patients with bony metastases were only a small fraction of the samples studied, or they were entirely excluded. Patients with metastatic cancers, such as bone metastases, are more likely to report pain, compared to patients without metastatic cancer (50-74% and 15%, respectively). Their cancer pain results in substantial morbidity and disrupted quality of life in 34-45% of cancer patients. Massage therapy (MT) appears to have positive effects in patients with cancer; however, the benefits of MT, specifically in patients with metastatic bone pain, remains unknown. The purpose of this randomized clinical trial was to compare the efficacy of MT to a social attention control condition on pain intensity, mood status, muscle relaxation, and sleep quality in a sample (n=72) of Taiwanese cancer patients with bone metastases. In this investigation, MT was shown to have beneficial within- or between-subjects effects on pain, mood, muscle relaxation, and sleep quality. Results from repeated-measures analysis of covariance demonstrated that massage resulted in a linear trend of improvements in mood and relaxation over time. More importantly, the reduction in pain with massage was both statistically and clinically significant, and the massage-related effects on relaxation were sustained for at least 16-18 hours postintervention. Furthermore, massage-related effects on sleep were associated with within-subjects effects. Future studies are suggested with increased sample sizes, a longer interventional period duration, and an objective and sensitive measure of sleep. Overall, results from this study support employing MT as an adjuvant to other therapies in improving bone pain management.


Asunto(s)
Afecto , Neoplasias Óseas/secundario , Masaje/métodos , Manejo del Dolor/métodos , Terapia por Relajación/métodos , Sueño , Adulto , Anciano , Anciano de 80 o más Años , Neoplasias Óseas/psicología , Neoplasias Óseas/terapia , Femenino , Humanos , Masculino , Masaje/psicología , Persona de Mediana Edad , Manejo del Dolor/psicología , Dimensión del Dolor/métodos , Calidad de Vida , Terapia por Relajación/psicología , Taiwán
18.
J Pain Symptom Manage ; 37(4): 754-63, 2009 Apr.
Artículo en Inglés | MEDLINE | ID: mdl-19070458

RESUMEN

Bone involvement, a hallmark of advanced cancer, results in intolerable pain, substantial morbidity, and impaired quality of life in 34%-45% of cancer patients. Despite the publication of 15 studies on massage therapy (MT) in cancer patients, little is known about the longitudinal effects of MT and safety in cancer patients with bone metastasis. The purpose of this study was to describe the feasibility of MT and to examine the effects of MT on present pain intensity (PPI), anxiety, and physiological relaxation over a 16- to 18-hour period in 30 Taiwanese cancer patients with bone metastases. A quasi-experimental, one-group, pretest-post-test design with repeated measures was used to examine the time effects of MT using single-item scales for pain (PPI-visual analog scale [VAS]) and anxiety (anxiety-VAS), the modified Short-Form McGill Pain Questionnaire (MSF-MPQ), heart rate (HR), and mean arterial pressure (MAP). MT was shown to have effective immediate [t(29)=16.5, P=0.000; t(29)=8.9, P=0.000], short-term (20-30 minutes) [t(29)=9.3, P=0.000; t(29)=10.1, P=0.000], intermediate (1-2.5 hours) [t(29)=7.9, P=0.000; t(29)=8.9, P=0.000], and long-term benefits (16-18 hours) [t(29)=4.0, P=0.000; t(29)=5.7, P=0.000] on PPI and anxiety. The most significant impact occurred 15 [F=11.5(1,29), P<0.002] or 20 [F=20.4(1,29), P<0.000] minutes after the intervention. There were no significant time effects in decreasing or increasing HR and MAP. No patient reported any adverse effects as a result of MT. Clinically, the time effects of MT can assist health care providers in implementing MT along with pharmacological treatment, thereby enhancing cancer pain management. Randomized clinical trials are needed to validate the effectiveness of MT in this cancer population.


Asunto(s)
Ansiedad/etiología , Ansiedad/terapia , Neoplasias Óseas/complicaciones , Masaje , Terapia por Relajación , Adulto , Anciano , Neoplasias Óseas/secundario , Femenino , Hemodinámica/fisiología , Humanos , Estudios Longitudinales , Masculino , Persona de Mediana Edad , Dolor/etiología , Dolor/psicología , Manejo del Dolor , Dimensión del Dolor , Cuidados Paliativos , Proyectos Piloto , Taiwán
19.
Cancer Nurs ; 31(6): E24-35, 2008.
Artículo en Inglés | MEDLINE | ID: mdl-18987505

RESUMEN

Findings from studies of massage, one of the most commonly used nonpharmacological nursing interventions for managing cancer pain, are inconsistent. The purpose of this article was to elucidate the methodological underpinnings of these inconsistencies with a systematic review of study design, methods, and massage efficacy in adult patients with cancer. A total of 15 studies published in English between 1986 and 2006 were identified by searching in 6 electronic databases. An author-developed tool and an adapted assessment tool were used to extract information from each study and examine the quality of reviewed studies. Methodological issues that potentially account for discrepancies across studies included less rigorous inclusion criteria, failure to consider potential confounding variables, less than rigorous research designs, inconsistent massage doses and protocols, measurement errors related to sensitivity of instruments and timing of measurements, and inadequate statistical power. Areas for future study include determination of appropriate cutoff values of selected outcome measures, delivery of equal doses along with standardized massage protocols, examination of length of massage effects over time, and use of single-blinding randomized clinical trials with large sample sizes.


Asunto(s)
Terapias Complementarias , Masaje , Neoplasias/complicaciones , Dolor/etiología , Adulto , Anciano , Ansiedad , Femenino , Humanos , Masculino , Persona de Mediana Edad , Neoplasias/psicología , Manejo del Dolor , Dimensión del Dolor , Proyectos Piloto , Calidad de Vida , Estudios Retrospectivos
20.
J Trauma Stress ; 16(1): 17-25, 2003 Feb.
Artículo en Inglés | MEDLINE | ID: mdl-12602648

RESUMEN

In this study, we examined the violent death bereavement trajectories of 173 parents by following them prospectively for 5 years after their children's deaths by accident, suicide, homicide, or undetermined causes. Using latent growth curve methodology, we examined how the initial level of PTSD and the rate of change over time were influenced by 9 predictors: the deceased children's causes of death, parents' gender, self-esteem, 3 coping strategies, perceived social support, concurrent levels of mental distress, and an intervention offered in early bereavement. Six of the nine factors predicted initial levels of PTSD; however, only parents' gender and perceived social support predicted change in PTSD over the 5-year time frame. Five years postdeath, 3 times as many study mothers (27.7%) met diagnostic criteria for PTSD and twice as many study fathers (12.5%) met diagnostic criteria for PTSD compared with the normative samples.


Asunto(s)
Aflicción , Muerte , Relaciones Padres-Hijo , Trastornos por Estrés Postraumático/epidemiología , Trastornos por Estrés Postraumático/etiología , Violencia , Adaptación Psicológica , Adolescente , Adulto , Anciano , Causas de Muerte , Niño , Femenino , Humanos , Masculino , Persona de Mediana Edad , Prevalencia , Factores de Riesgo , Autoimagen , Factores Sexuales , Apoyo Social , Trastornos por Estrés Postraumático/psicología
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