[Assessment of Maltreatment in Childhood and Adolescence]. / Erfassung von Misshandlung im Kindes- und Jugendalter.

Assessment of Maltreatment in Childhood and Adolescence In view of mounting evidence for substantial prognostic relevance of child maltreatment for the future developmental course, assessment of maltreatment in children and adolescents is increasingly gaining attention. At the same time, maltreatment assessment is replete with difficulties, ranging from the definition of maltreatment and establishment of threshold values determining when events meet prognostically relevant criteria, to poor agreement between sources. The aim of this paper is to provide an overview of instruments for assessing maltreatment in children and adolescents. This overview serves as a point of departure to emphasize the importance of various sources for the purpose of assessing maltreatment and to consider the unique role of the child's or young person's perspective. We conclude with preliminary proposals regarding the role of maltreatment assessment in clinical practice.

Better opioid prescribing in an inpatient oncology unit: quality improvement project.

OBJECTIVES: Unsafe opioid prescribing can lead to significant patient harm and improving standards is a national priority. This report summarises a three-stage process relating to opioid prescribing, which has led to a sustained improvement. METHODS: Opioid prescriptions were reviewed retrospectively over a 4-year period in a tertiary cancer centre. The first audit cycle took place in 2017. When repeated in February 2020 following an opioid education programme implementation, prescribing remained poor. In September 2020, a quality improvement project (QIP) was developed with several interventions including opioid prescribing guidelines. RESULTS: The first audit demonstrated that 76% met safe prescribing and 68% best practice. The second audit showed a deterioration in prescribing, 61% met safe prescribing and 39% best practice despite the implementation of an education programme. The QIP has led to an improvement in prescribing, at 4 months, 87% met safe prescribing and 56% best practice. CONCLUSIONS: Despite implementation of a medical education initiative, a marked deterioration in safe opioid prescribing occurred. A shift towards QI methodology led to a successful pilot of focused interventions and resulted in improved standards of safe prescribing.

Criterion Validity of the Implicit Positive and Negative Affect Test: Prediction of Facial Affect Perception.

This study focused on the criterion-related validity of the Implicit Positive and Negative Affect Test (IPANAT). The IPANAT is thought to be a measure of automatic activation of cognitive representations of affects. In this study, it was investigated whether implicit affect scores differentially predict ratings of facial emotions over and above explicit affectivity. Ninety-six young female participants completed the IPANAT, the Positive and Negative Affect Schedule (PANAS) as an explicit measure of state and trait affectivity, and a task for the perception of facial emotions. Implicit negative affect predicted the perception of negative but not positive facial emotions, whereas implicit positive affect predicted the perception of positive but not negative facial emotions. The observed double-dissociation in the correlational pattern strongly supports the validity of the IPANAT as a measure of implicit affectivity and is indicative of the orthogonality and thus functional distinctness of the two affect dimensions of the IPANAT. Moreover, such affect-congruent correlations were absent for explicit affect scales, which additionally supports the incremental validity of the IPANAT.

Electronic palliative care coordination systems (EPaCCS): a systematic review.

OBJECTIVES: To systematically search, evaluate and report the state of the science of electronic palliative care coordination systems (EPaCCS). METHODS: We searched CINAHL, MEDLINE, Embase, the Cochrane Library and grey literature for articles evaluating or discussing electronic systems to facilitate sharing of information about advance care plans. Two independent review authors screened full-text articles for inclusion, assessed quality and extracted data. RESULTS: In total, 30 articles and reports were included. Of the 26 articles, 14 were 'expert opinion' articles (editorials, discussion papers or commentaries), 9 were observational studies (cross-sectional, retrospective cohort studies or service evaluations), 2 were qualitative studies and 1 a mixed-methods study. No study had an experimental design. Quantitative studies described the proportion of people with EPaCCS dying in their preferred place, and associations between EPaCCS use and hospital utilisation. Qualitative, mixed-methods studies and reports described the burden of inputting data and difficulties with IT systems as main challenges of implementing EPaCCS. CONCLUSIONS: Much of the current scientific literature on EPaCCS comprises expert opinion, and there is an absence of experimental studies evaluating the impact of EPaCCS on end-of-life outcomes. Given the current drive for national roll-out of EPaCCS by 2020, it is essential that rigorous evaluation of EPaCCS is prioritised.

Individual differences in anxiety and automatic amygdala response to fearful faces: A replication and extension of Etkin et al. (2004).

Trait anxiety refers to the stable tendency to attend to threats and experience fears and worries across many situations. According to the widely noticed, pioneering investigation by Etkin et al. (2004) trait anxiety is strongly associated with reactivity in the right basolateral amygdala to non-conscious threat. Although this observation was based on a sample of only 17 individuals, no replication effort has been reported yet. We reexamined automatic amygdala responsiveness as a function of anxiety in a large sample of 107 participants. Besides self-report instruments, we administered an indirect test to assess implicit anxiety. To assess early, automatic stages of emotion processing, we used a color-decision paradigm presenting brief (33 ms) and backward-masked fearful facial expressions. N = 56 participants were unaware of the presence of masked faces. In this subset of unaware participants, the relationship between trait anxiety and basolateral amygdala activation by fearful faces was successfully replicated in region of interest analyses. Additionally, a relation of implicit anxiety with masked fear processing in the amygdala and temporal gyrus was observed. We provide evidence that implicit measures of affect can be valuable predictors of automatic brain responsiveness and may represent useful additions to explicit measures. Our findings support a central role of amygdala reactivity to non-consciously perceived threat in understanding and predicting dispositional anxiety, i.e. the frequency of spontaneously occurring anxiety in everyday life.

Implicit Affect and Autonomous Nervous System Reactions: A Review of Research Using the Implicit Positive and Negative Affect Test.

In everyday life, affective processes occur spontaneously and typically go along with an automatic activation of action tendencies and physiological responses. Because self-reports of affect are also known to be biased by various factors, including deficits in introspection or impression management strategies, an indirect measure, the Implicit Positive and Negative Affect Test (IPANAT), was developed to assess implicit affect and to circumvent these difficulties. In this review, findings from neurobiological and clinical studies administering the IPANAT are revised, we focus on the link between implicit affect and psychophysiological reactions to affective stimuli and stressors. Specifically, implicit affect as measured by the IPANAT was found to predict cardiovascular, endocrine, and functional neuroimaging correlates of stress or fear beyond explicit affect. The present evidence strongly suggests the usage of implicit affect measures in future research on stress and psychopathology.

The Second Conversation project: -Improving training in end of life care communication among junior doctors.

Junior doctors describe a need for greater support and training in end of life care (EoLC) communication skills. The Second Conversation project was designed by a multi-professional steering group as a workplace based training intervention for junior doctors to improve their skills and confidence in undertaking EoLC conversations. Qualitative interviews were carried out with 11 junior doctors and five senior doctors across two sites who took part in, or facilitated, a 'second conversation'. This is a three-step training intervention that involves 1) observation - the junior doctor observes an EoLC conversation between a senior doctor and patient/caregiver; 2) direct experience - the junior doctor undertakes a follow-up second conversation with the patient/caregiver; and 3) reflection - the junior doctor discusses and reflects on the experience with a senior colleague. Interviews were analysed using framework analysis and findings informed iterative changes to the intervention and its implementation using 'Plan, Do, Study, Act' cycles. Benefits that were identified included the flexibility of the intervention and its positive impact on the confidence and skills of junior doctors. The Second Conversation was felt to be of most value to newly qualified doctors and worked well on wards where length of stay was longer and EoLC conversations frequently happen. Further evaluation and exploration of patient and caregiver experiences is required.

A new approach to multi-professional end of life care training using a sequential simulation (SqS Simulation™) design: A mixed methods study.

BACKGROUND: A need for improved education and training for hospital staff caring for patients in the last year of life was identified at an urban UK hospital. Sequential Simulation (SqS Simulation™) is a type of simulation that recreates a patient's journey, considering the longitudinal element of care and how this might impact on the patient's experiences, wishes and needs. OBJECTIVES: The aim of this study was to investigate a new end of life care training intervention for multi-professional hospital staff, and its effect on their confidence in managing patients at the end of their life. SETTING/PARTICIPANTS: Based on the results of a formal Training Needs Analysis, four SqS Simulation™ specialty-based courses were designed for general medical and surgical multidisciplinary teams in an acute UK hospital. METHODS: Over three months, seven SqS Simulation™ sessions were attended by fifty-seven multidisciplinary healthcare professionals. A quasi-experimental mixed-methods study was conducted using open and closed-ended questionnaires, pre and post-intervention. Changes in course attendees' confidence levels were analysed and qualitative data from free-text answers informed potential reasons for any differences identified. RESULTS: Confidence improved for all professional cohorts (p < 0.001). The differences were found to be highly significant for 'doctors' (p < 0.001), significant for 'therapists' (p = 0.02) and not significant for the 'nurses' cohort (p = 0.238). This was explored further using a qualitative explanatory framework. Categories included: Communicating with Families; Teamwork; Goal Planning; Do Not Attempt Cardiopulmonary Resuscitation; Course Usefulness; Prior Training; and Clinical Experience. CONCLUSION: This study has shown an overall improvement in confidence across disciplines after attending a SqS Simulation™ course. The differences in quantitative results between disciplines were explored through the qualitative data and revealed a difference in what the professionals gained from it. Further studies are required to assess its effectiveness in maintaining confidence of end of life care in practice, as well as its benefit to patient outcomes.