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1.
Cancer Med ; 2020 Mar 04.
Artigo em Inglês | MEDLINE | ID: mdl-32129946

RESUMO

This Longitudinal patient navigation Matrix Model was developed to overcome barriers across the cancer care continuum by offering prepatients, patients, and their families with support services. The extraordinary heterogeneity of patient needs during cancer screening, risk assessment, treatment, and survivorship as well as the vast heterogeneity of oncology care settings make it nearly impossible to follow a static navigation model. Our model of patient cancer navigation is unique as it enhances the traditional model by being highly adaptable based on both patient and family needs and scalable based on institutional needs and resources (eg, clinical volumes, financial resources, and community-based resources). This relatively new operational model for system-wide and systematic navigation incorporates a carefully cultivated supportive care program that evolved over the last decade from a bottom up approach that identified patient and family needs and developed appropriate resources. A core component of this model includes shifting away from department-centric operations. This model does not require a patient to opt in or independently be able to report their needs or ask for services-it is an opt out model. The multidisciplinary "cross-training" model can also facilitate reimbursement and sustainability by clarifying the differentiating actions that define navigation services: identification of barriers to quality care and specific actions taken to overcome those barriers, across the full continue of cancer care from community engagement to survivorship or end-of-life care.

2.
Psychooncology ; 28(6): 1293-1300, 2019 06.
Artigo em Inglês | MEDLINE | ID: mdl-30946499

RESUMO

OBJECTIVES: Research has demonstrated that serving in the caregiver role is often associated with increased symptoms of depression, stress, and anxiety, but some people fare better than others in managing the burden of caregiving. The goal of the present study was to examine the potential moderating role of goal adjustment (the ability to disengage from unattainable goals and reengage in alterative ones) on the relation between caregiver burden and distress in family caregivers of cancer patients. METHODS: Caregivers of adult family members diagnosed with cancer in the past 3 years participated (N = 102). Participants were consented and completed online questionnaires on psychological distress, caregiver burden, and goal adjustment. RESULTS: The ability to disengage from unattainable goals was associated with lower anxiety and stress in the face of increasing caregiver burden. By contrast, the ability to reengage in alternative goals was associated with lower depression as burden increased. CONCLUSIONS: The present study suggests that goal adjustment may play an important moderating role in the relationship between caregiver burden and distress. Caregivers who are better able to disengage from unattainable goals may experience less stress and anxiety, and caregivers who are better able to reengage in alternative goals experience less depressed mood. This study provides preliminary evidence that learning different ways to approach and adjust goals may reduce depression, anxiety, and stress in family caregivers.

3.
Cognit Ther Res ; 41(2): 266-277, 2017 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-28579660

RESUMO

Experience sampling methodology (ESM) was used in a randomized controlled trial of short-term therapy to examine changes in daily affect and reactivity to daily event appraisals among depressed patients. Fifty-five depressed adults (mean age 37 years, 80% female) were randomly assigned to one of two therapy conditions. Using an interactive voice response system, participants rated activities and emotional functioning eight times per day for seven days. Thirty-one participants completed treatment and repeated ESM post-treatment. Broad improvements in mood, cognition, and physical functioning were similar across treatment conditions, with the largest improvements for markers of positive affect. Participants demonstrated increased resilience, i.e., diminished reactivity to stressors at post-treatment. Changes in reactivity to positive daily situations were minimal. Findings underscore the utility of ESM in psychotherapy research and the importance of including measures of both positive and negative affect and experiences.

4.
Contemp Clin Trials ; 57: 51-57, 2017 06.
Artigo em Inglês | MEDLINE | ID: mdl-28408335

RESUMO

BACKGROUND/AIMS: Pain is common in cancer patients and results in lower quality of life, depression, poor physical functioning, financial difficulty, and decreased survival time. Behavioral pain interventions are effective and nonpharmacologic. Traditional randomized controlled trials (RCT) test interventions of fixed time and dose, which poorly represent successive treatment decisions in clinical practice. We utilize a novel approach to conduct a RCT, the sequential multiple assignment randomized trial (SMART) design, to provide comparative evidence of: 1) response to differing initial doses of a pain coping skills training (PCST) intervention and 2) intervention dose sequences adjusted based on patient response. We also examine: 3) participant characteristics moderating intervention responses and 4) cost-effectiveness and practicality. METHODS/DESIGN: Breast cancer patients (N=327) having pain (ratings≥5) are recruited and randomly assigned to: 1) PCST-Full or 2) PCST-Brief. PCST-Full consists of 5 PCST sessions. PCST-Brief consists of one 60-min PCST session. Five weeks post-randomization, participants re-rate their pain and are re-randomized, based on intervention response, to receive additional PCST sessions, maintenance calls, or no further intervention. Participants complete measures of pain intensity, interference and catastrophizing. CONCLUSIONS: Novel RCT designs may provide information that can be used to optimize behavioral pain interventions to be adaptive, better meet patients' needs, reduce barriers, and match with clinical practice. This is one of the first trials to use a novel design to evaluate symptom management in cancer patients and in chronic illness; if successful, it could serve as a model for future work with a wide range of chronic illnesses.


Assuntos
Neoplasias da Mama/terapia , Terapia Cognitivo-Comportamental/métodos , Manejo da Dor/métodos , Adaptação Psicológica , Adulto , Neoplasias da Mama/complicações , Terapia Cognitivo-Comportamental/economia , Análise Custo-Benefício , Feminino , Humanos , Manejo da Dor/economia , Medição da Dor
5.
J Soc Clin Psychol ; 35(8): 629-642, 2016 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-29887670

RESUMO

More optimistic expectations for change in patients entering treatment often predict more favorable outcomes. However, our understanding of the nature and function of those expectancies is limited. The current study tested the proposal that optimistic expectancies among patients seeking outpatient psychotherapy for major depressive disorder may be explained in part by having a more adaptive self-regulatory style. A sample of 56 adults (78.6% female; mean age 36.5) completed measures of expectancies, depressive symptoms, and aspects of self-regulation. Participants also completed a week of experience sampling using a cell phone system that signaled them 8 random times per day for 7 days. Results were largely consistent with hypotheses. Depressed participants with more optimistic expectancies had a stronger promotion goal orientation, higher goal re-engagement, and reported greater progress on their most important personal goals; daily positive affect and positive situational appraisals were also higher. Findings may suggest a possible self-regulatory mechanism underlying optimistic expectancies for change.

6.
J Am Acad Child Adolesc Psychiatry ; 53(5): 579-88.e9, 2014 May.
Artigo em Inglês | MEDLINE | ID: mdl-24745957

RESUMO

OBJECTIVE: Youth with disruptive behavior disorders (DBD), including conduct disorder (CD) and oppositional defiant disorder (ODD), have difficulties in reinforcement-based decision making, the neural basis of which is poorly understood. Studies examining decision making in youth with DBD have revealed reduced reward responses within the ventromedial prefrontal cortex/orbitofrontal cortex (vmPFC/OFC), increased responses to unexpected punishment within the vmPFC and striatum, and reduced use of expected value information in the anterior insula cortex and dorsal anterior cingulate cortex during the avoidance of suboptimal choices. Previous work has used only monetary reinforcement. The current study examined whether dysfunction in youth with DBD during decision making extended to environmental reinforcers. METHOD: A total of 30 youth (15 healthy youth and 15 youth with DBD) completed a novel reinforcement-learning paradigm using environmental reinforcers (physical threat images, e.g., striking snake image; contamination threat images, e.g., rotting food; appetitive images, e.g., puppies) while undergoing functional magnetic resonance imaging (fMRI). RESULTS: Behaviorally, healthy youth were significantly more likely to avoid physical threat, but not contamination threat, stimuli than youth with DBD. Imaging results revealed that youth with DBD showed significantly reduced use of expected value information in the bilateral caudate, thalamus, and posterior cingulate cortex during the avoidance of suboptimal responses. CONCLUSIONS: The current data suggest that youth with DBD show deficits to environmental reinforcers similar to the deficits seen to monetary reinforcers. Importantly, this deficit was unrelated to callous-unemotional (CU) traits, suggesting that caudate impairment may be a common deficit across youth with DBD.


Assuntos
Transtornos de Deficit da Atenção e do Comportamento Disruptivo/fisiopatologia , Transtornos de Deficit da Atenção e do Comportamento Disruptivo/psicologia , Transtorno da Conduta/fisiopatologia , Transtorno da Conduta/psicologia , Imagem por Ressonância Magnética , Meio Social , Adolescente , Nível de Alerta/fisiologia , Transtornos de Deficit da Atenção e do Comportamento Disruptivo/diagnóstico , Encéfalo/fisiopatologia , Núcleo Caudado/fisiopatologia , Criança , Transtorno da Conduta/diagnóstico , Tomada de Decisões/fisiologia , Dominância Cerebral/fisiologia , Feminino , Humanos , Masculino , Rede Nervosa/fisiopatologia
7.
Psychiatry Res ; 202(3): 239-44, 2012 Jun 30.
Artigo em Inglês | MEDLINE | ID: mdl-22819939

RESUMO

Youths with conduct disorder or oppositional defiant disorder and psychopathic traits (CD/ODD+PT) are at high risk of adult antisocial behavior and psychopathy. Neuroimaging studies demonstrate functional abnormalities in orbitofrontal cortex and the amygdala in both youths and adults with psychopathic traits. Diffusion tensor imaging in psychopathic adults demonstrates disrupted structural connectivity between these regions (uncinate fasiculus). The current study examined whether functional neural abnormalities present in youths with CD/ODD+PT are associated with similar white matter abnormalities. Youths with CD/ODD+PT and comparison participants completed 3.0 T diffusion tensor scans and functional magnetic resonance imaging scans. Diffusion tensor imaging did not reveal disruption in structural connections within the uncinate fasiculus or other white matter tracts in youths with CD/ODD+PT, despite the demonstration of disrupted amygdala-prefrontal functional connectivity in these youths. These results suggest that disrupted amygdala-frontal white matter connectivity as measured by fractional anisotropy is less sensitive than imaging measurements of functional perturbations in youths with psychopathic traits. If white matter tracts are intact in youths with this disorder, childhood may provide a critical window for intervention and treatment, before significant structural brain abnormalities solidify.


Assuntos
Transtornos de Deficit da Atenção e do Comportamento Disruptivo/patologia , Mapeamento Encefálico , Transtorno da Conduta/patologia , Sistema Límbico/patologia , Fibras Nervosas Mielinizadas/patologia , Adolescente , Análise de Variância , Anisotropia , Transtorno da Personalidade Antissocial/complicações , Transtorno da Personalidade Antissocial/patologia , Transtornos de Deficit da Atenção e do Comportamento Disruptivo/complicações , Estudos de Casos e Controles , Criança , Transtorno da Conduta/complicações , Imagem de Tensor de Difusão , Feminino , Humanos , Processamento de Imagem Assistida por Computador , Masculino , Escalas de Graduação Psiquiátrica
8.
Pers Individ Dif ; 53(3): 335-340, 2012 Aug 01.
Artigo em Inglês | MEDLINE | ID: mdl-22736878

RESUMO

This study examined the moderating effects of motivational orientation on daily affect and goal pursuit. Based on recent revisions to Reinforcement Sensitivity Theory, measures of BIS (BIS-r and Fight-Flight-Freeze System or FFFS), BAS, and regulatory focus (Promotion and Prevention) were administered to 84 college students who participated in a 14-day diary study. Diary items assessed goal-directed activities and positive and negative affect (PA and NA). Results showed that higher FFFS and Promotion were consistently associated with higher NA and PA, respectively, and FFFS was also associated with avoidance of responsibilities. Higher Promotion predicted greater daily goal progress and tendencies to rate goals as more promotion- and prevention-focused. Relationships between daily goal-directed activities and both sadness and satisfaction were moderated by BIS-r. Inconsistent with our hypothesis, low BAS Reward Responsiveness predicted increased enthusiasm with greater goal progress. A trend in the data showed evidence of regulatory fit in daily activities predicted by both Promotion and Prevention. Implications for the theoretical and practical distinctions between measures of motivational orientation are discussed.

9.
Psychiatry Res ; 193(1): 38-45, 2011 Jul 30.
Artigo em Inglês | MEDLINE | ID: mdl-21601433

RESUMO

Generalized social phobia (GSP) involves the fear of being negatively evaluated. Previous work suggests that self-referentiality, mediated by the medial prefrontal cortex (MFPC), plays an important role in the disorder. However, it is not clear whether this anomalous MPFC response to self-related information in patients with GSP concerns an increased representation of their own or others' opinions. In this article, we examine whether GSP is associated with increased response to own (1st person) or other individuals' (2nd person) opinions relative to healthy individuals. Unmedicated individuals with GSP (n=15) and age-, IQ-, and gender-matched comparison individuals (n=15) read 1st (e.g., I'm ugly), and 2nd (e.g., You're ugly) person viewpoint comments during functional magnetic resonance imaging. We observed significant group-by-viewpoint interactions within the ventral MPFC. Whereas the healthy comparison individuals showed significantly increased (or less decreased) BOLD responses to 1st relative to 2nd person viewpoints, the patients showed significantly increased responses to 2nd relative to 1st person viewpoints. The reduced BOLD responses to 1st person viewpoint comments shown by the patients correlated significantly with severity of social anxiety symptom severity. These results underscore the importance of dysfunctional self-referential processing and MPFC in GSP. We believe that these data reflect a reorganization of self-referential reasoning in the disorder with a self-concept perhaps atypically related to the view of others.


Assuntos
Lateralidade Funcional/fisiologia , Transtornos Fóbicos/patologia , Transtornos Fóbicos/psicologia , Córtex Pré-Frontal/fisiopatologia , Autoimagem , Adulto , Mapeamento Encefálico , Estudos de Casos e Controles , Feminino , Seguimentos , Humanos , Processamento de Imagem Assistida por Computador/métodos , Imagem por Ressonância Magnética/métodos , Masculino , Oxigênio/sangue , Córtex Pré-Frontal/irrigação sanguínea , Escalas de Graduação Psiquiátrica , Estatística como Assunto , Adulto Jovem
10.
Am J Psychiatry ; 167(12): 1526-32, 2010 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-20889651

RESUMO

OBJECTIVE: Little is known about the neural underpinnings of generalized social phobia, which is defined by a persistent heightened fear of social disapproval. Using event-related functional MRI (fMRI), the authors examined whether the intent of an event, which mediates the neural response to social disapproval in healthy individuals, differentially affects response in generalized social phobia. METHOD: Sixteen patients with generalized social phobia and 16 healthy comparison subjects group-matched on age, gender, and IQ underwent fMRI scans while reading stories that involved neutral social events, unintentional social transgressions (e.g., choking on food at a party and coughing it up), or intentional social transgressions (e.g., disliking food at a party and spitting it out). RESULTS: Significant group-by-transgression interactions were observed in ventral regions of the medial prefrontal cortex. Healthy individuals tended to show increased blood-oxygen-level-dependent responses to intentional relative to unintentional transgressions. Patients with generalized social phobia, however, showed significantly increased responses to the unintentional transgressions. They also rated the unintentional transgressions as significantly more embarrassing than did the comparison subjects. Results also revealed significant group main effects in the amygdala and insula bilaterally, reflecting elevated generalized social phobia responses in these regions to all event types. CONCLUSIONS: These results further implicate the medial prefrontal cortex in the pathophysiology of generalized social phobia, specifically through its involvement in distorted self-referential processing. These results also further underscore the extended role of the amygdala and insula in the processing of social stimuli more generally in generalized social phobia.


Assuntos
Emoções/fisiologia , Lobo Frontal/fisiopatologia , Transtornos Fóbicos/fisiopatologia , Adulto , Tonsila do Cerebelo/fisiopatologia , Feminino , Humanos , Imagem por Ressonância Magnética/métodos , Masculino , Autoimagem
11.
J Neurosci ; 30(17): 5825-9, 2010 Apr 28.
Artigo em Inglês | MEDLINE | ID: mdl-20427643

RESUMO

There has been a long controversy concerning whether the amygdala's response to emotional stimuli is automatic or dependent on attentional load. Using magnoencephalography and an advanced beamformer source localization technique, we found that amygdala automaticity was a function of time: while early amygdala responding to emotional stimuli (40-140 ms) was unaffected by attentional load, later amygdala response (280-410 ms), subsequent to frontoparietal cortex activity, was modulated by attentional load.


Assuntos
Tonsila do Cerebelo/fisiologia , Atenção/fisiologia , Encéfalo/fisiologia , Emoções/fisiologia , Adulto , Feminino , Humanos , Magnetoencefalografia , Masculino , Vias Neurais/fisiologia , Testes Neuropsicológicos , Tempo de Reação , Processamento de Sinais Assistido por Computador , Fatores de Tempo , Percepção Visual/fisiologia , Adulto Jovem
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