Diagnostic concordance of DSM-IV and DSM-% posttrauamtic stress disorder (PTSD) in a clinical simple / Concordancia diagnóstica entre DSM-IV y DSM-5 para el Trastorno de Estrés Postraumático (TEPT) en una muestra clínic

BACKGROUND: the present study aims to analyze diagnostic concordance between the DSM-IV and the DSM-5 for posttraumatic stress disorder (PTSD) diagnostic criteria and their different groups of symptoms. Furthermore, analyses are conducted to establish the features of participants with no concordant diagnoses. METHOD: The study assessed 166 people over 18 who had experienced at least one traumatic event. PTSD diagnosis was established using the Global Scale for Posttraumatic Stress (EGEP), a self-report measure to assess PTSD. RESULTS: The presence of cognitive avoidance was a determinant in the PTSD DSM-5 diagnosis (86% positive predictive value). The analysis of the non-concordant individuals revealed that individuals who were diagnosed according to the DSM-IV criteria but not the DSM-5 criteria were primarily indirect victims. Conversely, individuals who were diagnosed with the DSM-5 criteria and not with the DSM-IV criteria presented cognitive avoidance and alterations in cognition not included in the DSM-IV criteria. CONCLUSIONS: A within-subjects concordance analysis showed high agreement for PTSD diagnosis between the two classifications. Differences between the diagnoses are due to the new definition of C (avoidance) and D (negative alterations in cognitions and mood) in the DSM-5

ANTECEDENTES: el presente estudio tiene como objetivo analizar la concordancia diagnóstica entre la clasificación DSM-IV y DSM-5 para el Trastorno de Estrés Postraumático (TEPT), en relación al diagnóstico y a la presencia de los diferentes grupos de síntomas. Además, se analizan las características de los participantes que no obtienen concordancia diagnóstica entre las dos clasificaciones. MÉTODO: 166 participantes, mayores de 18 años, fueron evaluados utilizando la Escala Global de Estrés Postraumático (EGEP), instrumento autoaplicado para evaluar la presencia de sintomatología postraumática y diagnóstico de TEPT. RESULTADOS: el análisis de la no concordancia entre los diagnósticos reveló que los participantes diagnosticados de TEPT, según DSM-IV pero no diagnosticados según DSM-5, eran principalmente víctimas indirectas, mientras que los participantes diagnosticados de TEPT según DSM-5 pero no según DSM-IV presentaban síntomas de evitación cognitiva y alteraciones en cognición y ánimo, ambos síntomas no recogidos en la clasificación DSM-IV. CONCLUSIONES: existe una alta concordancia entre las clasificaciones para el diagnóstico de TEPT. Las diferencias en el diagnóstico son debidas fundamentalmente a la nueva conceptualización de criterio C (evitación) y del criterio D (alteraciones negativas cognitivas y del estado del ánimo) en el DSM-5

Psychological consequences of aggression in pre-hospital emergency care: cross sectional survey.

BACKGROUND: Pre-hospital emergency care is a particularly vulnerable setting for workplace violence. However, there is no literature available to date on the psychological consequences of violence in pre-hospital emergency care. OBJECTIVES: To evaluate the psychological consequences of exposure to workplace violence from patients and those accompanying them in pre-hospital emergency care. DESIGN: A retrospective cross-sectional study. SETTING: 70 pre-hospital emergency care services located in Madrid region. PARTICIPANTS: A randomized sample of 441 health care workers (135 physicians, 127 nurses and 179 emergency care assistants). METHODS: Data were collected from February to May 2012. The survey was divided into four sections: demographic/professional information, level of burnout determined by Maslach Burnout Inventory (MBI), mental health status using General Health Questionnaire (GHQ-28) and frequency and type of violent behaviour experienced by staff members. RESULTS: The health care professionals who had been exposed to physical and verbal violence presented a significantly higher percentage of anxiety, emotional exhaustion, depersonalization and burnout syndrome compared with those who had not been subjected to any aggression. Frequency of verbal violence (more than five times) was related to emotional exhaustion and depersonalization. CONCLUSION: Type of violence (i.e. physical aggression) is especially related to high anxiety levels and frequency of verbal aggression is associated with burnout (emotional exhaustion and depersonalization). Psychological counselling should be made available to professional staff who have been subjected to physical aggression or frequent verbal violence.

Violencia laboral en urgencias extrahospitalarias: una revisión sistemática y líneas de intervención psicológica / Workplace violence in prehospital emergency care: A systematic review and outlines of psychological intervention

La violencia laboral en el ámbito sanitario ha experimentado un crecimiento exponencial en los últimos años. El objetivo de este trabajo es hacer una revisión sistemática de la literatura y señalar algunas líneas de intervención psicológica. En general se observan elevadas tasas de violencia física y verbal; sin embargo se observan mayores diferencias en las variables asociadas a la agresión, como las características de los profesionales agredidos, causas y lugar de la agresión, probablemente unidas a la organización del sistema sanitario de cada país. Se recomienda: a) priorizar la formación especializada de los profesionales que trabajan en servicios de emergencia, b) programas de prevención dirigidos al entrenamiento en habilidades de comunicación con los pacientes y/o acompañantes, la identificación de situaciones de riesgo y la puesta en marcha de estrategias de afrontamiento adecuadas y medidas de seguridad, y c) la atención psicológica de los profesionales que ya han sufrido alguna agresión

Workplace violence has grown exponentially in recent years. The objective of this paper is to present a systematic review of the literature, as well as to point out some specific outlines of psychological intervention. Generally, high rates of physical and verbal violence are reported; however, major differences are observed in the variables associated with aggressions that are likely to be linked to the organization of the healthcare system in each country. It is recommended: a) specialized training to professionals working in emergency services; b) preventions programs aimed to the training in communication skills with patients and/or those accompanying them, identifying risk situations and implementing safety measures; and c) psychological care to professionals who have suffered aggressions

Dementia special care units: a comparison with standard units regarding residents' profile and care features.

BACKGROUND: Unlike other countries, no data about residents and care features in Special Care Units (SCUs) in Spanish nursing homes have been reported to date. The present paper is the first to analyze the characteristics of residents with dementia and the features of provided care in SCUs in comparison to residents with dementia in standard beds, thus not receiving specialized care in nursing homes in Spain. METHODS: Data on residents with dementia were collected in 11 nursing homes. Residents with diagnosis of dementia and Mini-Mental State Examination scores of less than 27 were randomly selected in each center. Altogether 197 residents were assessed: 102 (52%) placed in SCUs, and 95 (48%) in standard beds. Analyses of the characteristics of residents in SCUs versus standard beds regarding socio-demographic and clinical variables, features of the care provided, and residents' quality of life (QoL) were performed using univariate and multivariate tests (binary logistic regression analysis). RESULTS: Residents in SCUs did not differ from those in standard beds in socio-demographic variables. Placement of residents in SCUs seemed to be related with the presence of severe cognitive and functional impairment and aggressive behaviors. Being in an SCU conveyed a higher probability of having individual bedroom and bathroom; nevertheless, there were no differences in the care provided in SCUs, considering use of nappies, and feeding and restraint systems. Patients in SCUs showed lower QoL reported by the staff. CONCLUSIONS: Although residents in SCUs present higher levels of impairment, there are no real differences in the care provided besides a higher probability of having individual rooms. Regulations on required features for SCUs in Spain are necessary to guarantee that care provided to residents is truly special.

Assessing quality of life of nursing home residents with dementia: feasibility and limitations in patients with severe cognitive impairment.

BACKGROUND: The Quality of Life-Alzheimer's Disease Scale (QOL-AD) is a reliable and valid self-report measure for assessing quality of life (QoL) in people with dementia in long-term care settings, but little is known yet about the number of patients with severe cognitive impairment who are able to complete this measure, and the characteristics of those unable to do so. The aim of the study is to advance knowledge of these issues. METHODS: Data on residents with dementia were collected from 11 nursing homes. The QOL-AD residential version was directly applied to residents with dementia diagnosis and Mini-Mental State Examination scores under 27, randomly selected in each center. Residents' QoL was further assessed from the perspective of some close relative and some staff member. Altogether, 102 data sets from residents, 184 from relatives, and 197 from staff members were collected. An analysis of the characteristics of completers versus non-completers regarding levels of cognitive impairment was carried out. RESULTS: People with dementia in long-term care are able to report their QoL. The QOL-AD completion rate decreases as the cognitive impairment level increases; non-completion is associated with greater overall impairment. About 30% of residents with severe cognitive impairment could self-report on their QoL with acceptable reliability. CONCLUSIONS: QoL self-rating should be the first-line option when assessing residents with severe cognitive impairment. For those that are not able to complete self-report measures, proxies' report could be an alternative, although the development of other assessment procedures (e.g. observational) should be considered.

La calidad del cuidado asistencial en residencias de ancianos: una revisión de la literatura / No disponible

La calidad del cuidado asistencial en residencias de ancianos tiene un papel fundamental en su bienestar, pero es difícil de medir porque se trata de un concepto que abarca múltiples dimensiones. El objetivo de este artículo es efectuar un análisis sistemático de las investigaciones publicadas entre 1995 y 2011 en relación a la calidad del cuidado asistencial en residencias de ancianos. Todos los estudios informan de un buen cuidado básico tanto en las unidades geriátricas de larga estancia como en los centros residenciales. No obstante, se observan factores que influyen en una mejor calidad del cuidado asistencial relacionados con las características del centro, del personal a cargo de los residentes, de los propios residentes, y de la satisfacción de estos y sus familiares con los centros. Existen pocos estudios en España, y han sido realizados por instituciones no científicas y publicados en revistas no especializadas. Esto hace que se observen limitaciones, especialmente en el análisis y la exposición de los resultados (AU)

Quality of care for older people living in residential homes has a fundamental effect on their well-being but is difficult to measure because it is a concept that embraces multiple dimensions. The aim of this paper is to perform a systematic analysis of research published from 1995 to 2011 in relation to quality of care in residential homes for older people. All studies report a good basic care in nursing homes and residential homes. However some factors related to facility characteristics, staff, characteristics of residents, resident satisfaction and family satisfaction facilitate a better quality of care. Few studies have been conducted in Spain, and they have been conducted by non-scientific institutions and have been published by non-specialized journals. This fact has caused limitations specially in the analysis and presentation of data (AU)

Quality of life of nursing home residents with dementia: a comparison of perspectives of residents, family, and staff.

PURPOSE: Quality of Life (QoL) has become increasingly valued as a key outcome in dementia both in clinical practice and in research. This study compares the QoL of long-term residents with dementia as assessed by the individuals, their relatives, and their care staff. DESIGN AND METHODS: Data on residents with dementia were collected in 11 nursing homes. The Quality of Life-Alzheimer's Disease Scale (QOL-AD) residential version was directly applied to residents with dementia diagnosis and Mini-Mental State Examination scores under 27, randomly selected in each canter. Residents' QoL was further assessed from the perspective of some close relative and of some staff member. Altogether, 102 data sets from residents, 184 from relatives, and 197 from staff members were collected. RESULTS: The completion rate for the resident QOL-AD was 48.8%. Residents' QoL ratings were significantly higher than proxies' ratings. Proxy (i.e., family and staff) scores in the QOL-AD tended to correlate with each other and did not correlate with resident scores. IMPLICATIONS: Various sources of data provided different perspectives on resident's QoL. Each perspective is relatively independent and somewhat unique. In those patients with mild to moderate cognitive impairment, direct measures of QoL should be considered.