Parkinson's Disease Medication Administration During a Care Transition: The Impact of Interprofessional Team Simulation on Student Competency, Comfort, and Knowledge.

AIM: This study investigated the impact of an interprofessional mock code on students' comfort and competency related to Parkinson's disease (PD) medication administration during care transitions. BACKGROUD: Patients with PD are at increased risk for medication errors during hospitalization. Individualization of PD medication creates vulnerability during care transitions. METHOD: Four interprofessional groups took part in this study: baccalaureate degree senior nursing students (n = 113), master's level nurse anesthesia students (n = 35), doctor of osteopathic medicine fourth-year students (n = 32), and doctor of clinical psychology fourth-year students (n = 22). Groups participated in an unfolding case study simulation involving a mock code with a focus on the omission of time-sensitive PD medication. Pre- and postsimulation test results were compared. RESULTS: Findings indicated an increased understanding among three of the four groups relating to medication timing during care transitions. CONCLUSION: All groups improved with respect to perceived comfort and competency.

A mental health professional survey of cognitive-behavioral therapy for the treatment of opioid use disorder.

OBJECTIVE: The objective of this survey was to obtain mental health professional perspectives on cognitive-behavioral therapy (CBT) for opioid use disorder (OUD) treatment. METHODS: Respondents (N = 84) rated components of CBT for their efficacy in OUD treatment. Ratings were reported for the overall sample, by degree completed, and by clinicians versus nonclinicians. Respondents also ranked additional therapeutic strategies that might enhance the efficacy of CBT for OUD. RESULTS: Respondents rated treatment alliance/rapport, coping skills, and motivational interviewing as the most effective CBT components for OUD. Forms and worksheets were rated as the least effective component. The most beneficial additions to CBT for OUD would be mindfulness, peer support, and medication adherence strategies. Finally, the survey responses suggested that addressing co-morbid mental health disorders and life stressors may be important within CBT treatment for OUD.

Cross-cultural adaptation and validation for the Brazilian population of the instrument Amyotrophic Lateral Sclerosis-Specific Quality of Life-Short Form (ALSSQOL-SF).

OBJECTIVE: This study aims to produce and validate the version of the instrument Amyotrophic Lateral Sclerosis-Specific Quality of Life-Short Form (ALSSQOL-SF) into Portuguese, adapted to the Brazilian cultural context. METHODOLOGY: It is a cross-cultural adaptation and validation study, carried out in two Brazilian Public Universities, in the period from March, 2017, to November, 2018, according to the six steps guidelines of cultural and linguistic adaptation proposed by Beaton et al. (Spine 25(24):3186-3191, 2000). The World Health Organization Quality of Life (WHOQOL-BREF) and the Amyotrophic Lateral Sclerosis Functional Rating Scale Revised (ALSFRS-R) were used for perform the validation. In order to analyze the correlations between the ALSSQOL-SF, WHOQOL-BREF, and ALSFRS-R scores, Spearman's correlation coefficients were calculated. The project was approved by the Research Ethics Committee of the two participating institutions. RESULT: All steps of the transcultural adaptation process were performed without intercurrence. The pilot test had the participation of 30 individuals, and the "Questionário Breve Específico de Qualidade de Vida para Pacientes com ELA (QVELA-20/Br)" tool was developed. During the validation phase, 100 patients were included, most of them were male (58%) with a median age of 59 years. The created version of the questionnaire are positively and strongly correlated with the WHOQOL-BREF and positively and weakly correlated with ALSFRS-R, as expected. CONCLUSION: The study produced and validated a version of the instrument ALSSQOL-SF into Portuguese that is adapted to the Brazilian cultural context.

Interprofessional Education: Collaboration and Learning in Action.

Interprofessional education (IPE) is necessary to ensure that future health care professionals are prepared to provide holistic, patient-centered prevention programs, assessments, diagnoses, treatment plans, and chronic illness management in a collaborative manner. Accrediting bodies such as the Commission on Osteopathic College Accreditation and the American Psychological Association newly require programs to implement instruction and evaluate IPE core competency development in each year of their programs. The IPE core team at the Philadelphia College of Osteopathic Medicine has designed, implemented, and tested an IPE core course over the past 2 years that includes students in osteopathic medicine, clinical psychology, mental health counseling, and physician assistant programs. Throughout this process, the IPE core team has identified strengths, weaknesses, opportunities, and challenges. Cultural considerations, institutional resources, pedagogy for large interdisciplinary groups at different stages of training, and technology and assessment tools for student and course evaluation are all critical considerations.

Amyotrophic lateral sclerosis-specific quality of life-short form (ALSSQOL-SF): A brief, reliable, and valid version of the ALSSQOL-R.

INTRODUCTION: The Amyotrophic Lateral Sclerosis (ALS)-Specific Quality of Life instrument and its revised version (ALSSQOL and ALSSQOL-R) have strong psychometric properties, and have demonstrated research and clinical utility. In this study we aimed to develop a short form (ALSSQOL-SF) suitable for limited clinic time and patient stamina. METHODS: The ALSSQOL-SF was created using Item Response Theory and confirmatory factor analysis on 389 patients. A cross-validation sample of 162 patients assessed convergent, divergent, and construct validity of the ALSSQOL-SF compared with psychosocial and physical functioning measures. RESULTS: The ALSSQOL-SF consisted of 20 items. Compared with the ALSSQOL-R, optimal precision was retained, and completion time was reduced from 15-25 minutes to 2-4 minutes. Psychometric properties for the ALSSQOL-SF and its subscales were strong. DISCUSSION: The ALSSQOL-SF is a disease-specific global QOL instrument that has a short administration time suitable for clinical use, and can provide clinically useful, valid information about persons with ALS. Muscle Nerve 58: 646-654, 2018.

Verbal communication impacts quality of life in patients with amyotrophic lateral sclerosis.

Global quality of life (QoL) in patients with ALS has been found to be independent of overall physical function. However, the relationship between verbal communication ability and QoL has not been explored. This was a retrospective study using data from a study validating the ALS-Specific QoL Questionnaire (ALSSQoL). Speech function was assessed using the first question on the ALS Functional Rating Scale (ALSFRS), ranging from 4 (normal speech) to 0 (loss of useful speech). There were 338 participants for whom data were available for speech function and for all ALSSQoL subscales. Analysis of variance revealed that QoL varied among individuals with different functional abilities for speech (F (4,333) = 5.13, p = 0.001). Specifically, poorer QoL was related to initial impairments in verbal communication ability (p = 0.005). QoL also was poorer in those with no speech ability compared to those with normal speech (p = 0.008). In conclusion, the ability to communicate verbally, unlike overall physical function, is directly related to overall QoL in patients with ALS. The initial period of speech impairment appears to have a particularly strong impact on QoL, and may be an important time for intervention.

A Qualitative Study of Multidisciplinary ALS Clinic Use in the United States.

OBJECTIVES: The multidisciplinary clinic (MDC) has become the standard of care for individuals with amyotrophic lateral sclerosis (ALS) in the United States, yet many patients choose not to receive care at MDCs. We undertook a qualitative study of individuals with ALS to explore patients' perceptions of this form of service delivery. METHODS: Participants completed an online survey that posed open-ended questions about their attitudes and behaviors surrounding MCDs. Qualitative analysis was performed whereby response data was evaluated and grouped into themes. RESULTS: The unique aspect of MDCs most commonly cited by patients was integrated care. Other reasons for attending MDC included those common to specialist centers, such as expertise, access to clinical trials, and participation in research. Perceived disadvantages unique to the MDC model were long and tiring visits. In common with many specialist centers, long travel times were cited as a disadvantage of MDCs. CONCLUSIONS: This information provides a foundation for improving ALS care. For those able to travel, the MDC model has much to offer, but patients' time should be respected. For those patients who cannot travel, alternative models of care should be devised to provide integrated care, clinical expertise, and access to research.

Compliance with recommendations made in a multidisciplinary ALS clinic.

Multidisciplinary ALS clinics provide recommendations at each visit, but these do little good unless recalled and followed. This study was conducted to determine recall of, and compliance with, these recommendations, and to study factors affecting compliance. Patients were contacted by telephone six weeks after their ALS clinic visit and asked about recommendations made by the multidisciplinary team. Themes for recall and compliance were generated by three coders using qualitative analysis, and validated using triangulation and consensual validation. Pearson correlation coefficients were calculated for the relationship of function and quality of life to recommendation categories. Results demonstrated that most recommendations centered around physical needs, whereas few were provided for Caregiver Support and Mental Health. Fewer than 40% of all recommendations were recalled, with the highest category being Physical Function. Compliance was highest for this category as well (mean 4.27/5). Monitoring of patients between clinic visits appeared to enhance compliance. In conclusion, for ALS clinic teams seeking to maximize the impact of recommendations, discussions to facilitate understanding, instruction in problem-solving skills, and closer follow-up between clinic visits should facilitate better recall and compliance, and thus improve care. The potential benefits of greater emphasis on mental health and caregiver well-being should be explored.

Non-invasive ventilation and gastrostomy may not impact overall quality of life in patients with ALS.

Non-invasive positive pressure ventilation (NIPPV) may improve health-related quality of life (HRQoL) in patients with ALS. The effect of percutaneous endoscopic gastrostomy (PEG) on HRQoL is not known. Instruments measuring QoL more broadly have not been used to assess effects of these interventions. This study was undertaken to do so via the ALS-Specific Quality of Life Instrument-revised (ALSSQOL-R). A retrospective review was carried out of ALS patients who had undergone one QoL assessment prior to NIPPV or PEG initiation and two assessments following one of these interventions. Random coefficients models were developed. Twenty-two patients met criteria for inclusion: six NIPPV, 11 PEG, and five NIPPV + PEG. The ALSSQoL-R did not change significantly following NIPPV or PEG or both. Function declined in all three groups over the same time-period. In conclusion, overall QoL in ALS does not appear to change after NIPPV or PEG. This may reflect the impact of non-health-related factors or may be due to a response shift. QoL instruments that include domains outside of health status may not be sensitive to changes from single interventions. Larger, prospective studies are needed.

Psychological health in patients with ALS is maintained as physical function declines.

Although quality of life (QoL) in patients with ALS has been shown to be independent of physical function and to be maintained over time, the status of psychological health over the disease course has not been studied using an ALS-specific instrument. It is also uncertain how three common interventions - antidepressants, percutaneous endoscopic gastrostomy (PEG), and non-invasive ventilatory support (NIPPV) - influence psychological health. We performed a retrospective review of the Negative Emotion subscale (NES) score, a measure of psychological health within the ALS-Specific QoL Instrument. Analysis of 72 patients over three months, and of a subset of 48 over six months, showed stability of psychological health despite a decline in the ALS Functional Rating Scale-Revised to 88.4% of baseline at three months and 82.6% at six months. NES did not change after antidepressants, PEG, or NIPPV, although there was a suggestion of improvement with antidepressants in a subgroup. In conclusion, as with overall QoL, psychological health of ALS patients as measured with an ALS-specific instrument does not decline as physical function is lost. Supports found in a multidisciplinary ALS clinic may influence expectations, facilitate response shift, and stabilize psychological health while masking the independent effects of specific interventions.

Psychological morbidity in ALS: the importance of psychological assessment beyond depression alone.

The assessment of psychological morbidity in patients with ALS has centered around depression, hopelessness, and anxiety. The Brief Symptom Inventory (BSI) offers an opportunity to explore psychological morbidity more broadly. We administered this instrument to 111 patients with ALS as part of a larger study of quality of life. Scores of ALS patients on the Global Severity Index and Positive Symptom Distress Index were comparable to the majority of distressed psychiatric outpatients and significantly higher than those of non-patient adults. Among BSI subscales, scores on the Anxiety, Depression, Phobic Anxiety, and Somatization subscales also were not significantly different from distressed adult psychiatric outpatients, and were greater than normal mean scores for a non-patient population sample. Based on these data, ALS patients appear to be significantly more distressed than non-patients in the identified areas, and as distressed as approximately 68% of a distressed psychiatric outpatient sample. In conclusion, a substantial number of individuals with ALS experience psychological distress of various types. Because psychological health impacts lifespan and quality of life in these individuals, broadly-based mental health assessment and treatment should remain an important part of care for patients with ALS. The effects of physical symptoms on responses to questions used to assess psychological distress must be considered.

The SEIQoL-DW for assessing quality of life in ALS: strengths and limitations.

The Schedule for the Evaluation of the Individual Quality of Life-Direct Weighting (SEIQoL-DW) has been used to measure quality of life (QoL) in small cohorts of individuals with ALS, but its suitability for assessing aggregate QoL for between-group comparisons is uncertain. We undertook a prospective study in which 120 patients with ALS completed two measures of QoL, the SEIQoL-DW and the McGill Quality of Life Single-Item Scale (MQoL-SIS). There was a weak correlation between the SEIQoL-DW index score and the MQoL-SIS. Only three of five cues accounted for a significant amount of variance in the MQoL-SIS, and even those accounted for only 12.8%-13.9% of the variance. Cues relating to family or significant other were chosen by over 90% of patients, and were the most heavily weighted. This study demonstrates that the SEIQoL-DW is of great value in identifying those factors which contribute to the psychosocial well-being of an individual with ALS. However, SEIQoL index scores may not reflect aggregate QoL of groups of patients with ALS, and may be measuring a construct other than QoL. Caution should be exercised in using the SEIQoL index score to measure QoL of groups, such as would be needed in interventional trials.

Problem solving skills predict quality of life and psychological morbidity in ALS caregivers.

Amyotrophic lateral sclerosis (ALS) often is associated with a particularly intensive caregiving experience, and the well-being of caregivers impacts that of patients. Thus, identification of factors leading to distress in caregivers may provide avenues for intervention that will help both the caregiver and the patient. We prospectively examined caregivers' social problem solving skills, the quality of the patient-caregiver relationship, caregivers' spirituality and religiousness, and the ways in which these impact caregivers' quality of life (QoL) and psychological morbidity in 75 caregivers of ALS patients. Data were analyzed through correlational and hierarchical multiple regression analyses. Social problem solving and spirituality were the best predictors of caregivers' QoL, accounting for 15.6% and 7.8% of the variance in QoL, respectively (F (2, 69) = 11.83, p<.001). Social problem solving also predicted and accounted for 25.4% of the variance in psychological morbidity (F (1, 71) = 25.571, p<.001). Level of care provided did not predict either QoL or psychological morbidity in caregivers. In conclusion, the problem-solving skills of ALS caregivers are an important determinant of caregiver well-being. Developing interventions to teach ALS caregivers effective methods of problem solving would probably be beneficial to this population.

Factors supporting quality of life over time for individuals with amyotrophic lateral sclerosis: the role of positive self-perception and religiosity.

BACKGROUND: Amyotrophic lateral sclerosis (ALS) is a progressive neuromuscular disease with no known cure. Maintaining quality of life (QOL) as the disease progresses is an important treatment goal. PURPOSE: the purpose of this study is to identify factors that support QOL as ALS progresses. METHODS: Changes in QOL were monitored in 162 individuals with ALS at 3- to 4-month intervals. Forty-nine of the participants survived in the study for over 1 year and were included in a longitudinal comparison. The 49 long-term participants were younger and stronger at Time 1 than were the participants who died before reaching the 1-year point. The McGill Quality of Life Scale demonstrated a high and stable QOL despite physical deterioration. RESULTS: Patients maintained a positive self-perception of their health despite the physical deterioration. Over time, self-perception of health and religiosity were shown to be significantly correlated with QOL. CONCLUSIONS: Results support the need for better instrumentation to enable future studies to more precisely measure multiple dimensions of ALS-related QOL, to identify reference points for self-ratings of both health and QOL, and to capture the religious and spiritual mechanisms related to QOL as individuals face the end of life.

Project Genesis: assessing the efficacy of problem-solving therapy for distressed adult cancer patients.

The efficacy of problem-solving therapy (PST) to reduce psychological distress was assessed among a sample of 132 adult cancer patients. A second condition provided PST for both the patient and a significant other. At posttreatment, all participants receiving PST fared significantly better than waiting list control patients. Further, improvements in problem solving were found to correlate significantly with improvements in psychological distress and overall quality of life. No differences in symptom reduction were identified between the 2 treatment protocols. At a 6-month follow-up, however, patients who received PST along with their significant other reported lower levels of psychological distress as compared with members of the PST-alone condition on approximately half of the outcome measures. These effects were further maintained 1-year posttreatment.

Religiousness is related to quality of life in patients with ALS.

The authors studied quality of life (QOL) and religiousness in 49 patients with ALS over five consecutive visits spanning approximately 1 year. QOL was not significantly correlated with religiousness at entry. Over time, a significant relationship developed between QOL and total, public, and private religiousness.