Addressing externalized behavioral concerns in primary care: Listening to the voices of parents.

This article presents the perceptions parents have of the causative and curative factors for their child's externalized behaviors and what treatment they prefer to receive from their primary care integrated behavioral health team. This is a qualitative study, using interpretative phenomenological analysis. Semi-structured interviews were conducted with a purposive sample of 12 parents representing 14 patients with a disruptive behavior disorder (DBD) who sought care from their primary care physician for treatment of the DBD. Participants spoke of uncertainty of the cause of the DBD and the desire to find parenting approaches that augment the effectiveness of pharmacological intervention provided by the primary care team. Parents' responses suggest that they are eager for more education about their child's DBD and how to engage at-home management of the symptoms. Discussion focused on the import of considering the voices of these parents when implementing brief parent management training programs in integrated behavioral health primary care programs.

Positive Psychological Assessment and Early-Stage Dementia.

OBJECTIVES: There are no known positive psychological (PP) measures adapted/validated for use with people in the early stages of dementia. Objectives were to: (1) develop/pilot an accessible protocol for administering PP measures in this population; (2) examine their psychometric properties; and (3) provide preliminary observations about how people with early-stage dementia perceive various aspects of PP as it pertains to living with dementia. METHODS: Five PP measures were adapted/administered to 36 people with early-stage dementia. Constructs of interests were gratitude, life satisfaction, meaning in life, optimism, and resilience. Psychometric data were calculated and response patterns analyzed. RESULTS: Participants easily completed the adapted measures using the accessible protocol. Preliminary evidence of reliability and validity were yielded. Response patterns suggested a range of PP perceptions and experiences among participants. CONCLUSIONS: This study represents a step towards validating the psychometric properties of several PP measures adapted for use with people in the early stages of dementia and provides insight into how PP works in this population. CLINICAL IMPLICATIONS: PP assessment may assist clinicians and researchers to better understand PP functioning in this population potentially contributing to effective strengths based psychosocial interventions. Recommendations for clinical practice and future research are provided.

Predictors of mortality in hospitalized patients with acute exacerbation of bronchiectasis.

BACKGROUND: In-hospital and long term outcomes of patients admitted to the hospital for acute exacerbation of bronchiectasis (AEB) has been evaluated in only a limited fashion. The resulting debilitation after an AEB can increase mortality. This study aims to evaluate the factors associated with mortality in patients admitted with an acute exacerbation of bronchiectasis (AEB). METHODS: All charts of the patients admitted between 2003 and 2006 with an AEB were reviewed through an electronic database. Demographics, sputum cultures, pulmonary functions tests and other factors associated with long-term mortality were examined. The social security death index was used to determine long term mortality (http://ssdi.genealogy.rootsweb.com). RESULTS: Forty-three patients (13 men and 30 women) with a mean age of 71.8+/-11.8 were studied. The hospital mortality was 9% and one-year mortality was 30% with a median survival of 46.6 months. Variables associated with mortality were male gender (female vs. male (HR), 0.36; (CI), 0.14-0.98; p=0.045), use of systemic steroids (with vs. without steroids HR, 3.12; CI 1.08-9.02; p=0.036), decreased FEV(1.0)% predicted (HR, 0.96; CI 0.92-0.999; p=0.042), elevated creatinine (HR, 2.36; CI 1.093-5.10; p=0.029), history of smoking (HR, 0.283; CI 0.097-0.825; p=0.021), and mechanical ventilation (HR, 66.011; CI 6.64-656.76; p=0.0004). CONCLUSIONS: Male gender, elevated creatinine, decreased FEV(1.0)% predicted, mechanical ventilation, history of smoking, and acute use of systemic steroids during the hospitalization were associated with an increased risk of mortality.