Background Approximately 30–80% of postoperative patients complain about moderate to severe post-surgical pain, indicating that postoperative pain treatment is still a problem. Methods We analysed ...prospectively collected data on patients in a university hospital receiving systemic and epidural patient-controlled analgesia and continuous peripheral nerve block (CPNB) documented by the acute pain service team in a computer-based system. Results Of 18 925 patients visited in the postoperative period between 1998 and 2006, 14 223 patients received patient-controlled epidural analgesia (PCEA), 1591 i.v. patient-controlled analgesia (IV-PCA), 1737 continuous brachial plexus block, and 1374 continuous femoral/sciatic nerve block. Mean dynamic and resting pain scores (VAS 0–100) were significantly lower for peripheral or neuroaxial regional analgesia compared with patient-controlled systemic opioid analgesia (P<0.05). The risk of a symptomatic spinal mass lesion including epidural haematoma (0.02%; 1:4741) or epidural abscess (0.014%; 1:7142) after PCEA was 1:2857 (0.04%). Neurological complications after CPNB occurred in two patients who received interscalene brachial plexus block. Conclusions We demonstrated that PCEA, IV-PCA, and CPNB are safe and efficient. Although all of these treatment strategies provide effective analgesia, PCEA and CPNB provided superior pain relief compared with IV-PCA. We demonstrated that serious complications of analgesic techniques are rare but possibly disastrous necessitating a close supervision by an acute pain service. We found a low rate of adverse effects including hypotension and motor impairment and a low incidence of epidural haematoma for thoracic PCEA compared with lumbar PCEA.
Objective: Recent work has identified intimacy as a potentially important determinant of psychological adjustment in couples coping with cancer. Little work has examined specific social support ...processes within the context of the everyday life of couples' cancer experience. Specifically, we examined the links between breast cancer patient reports of receiving support from one's spouse/partner (support receipt) and spouse reports of providing support to the patient (support provision) with daily intimacy outcomes. We hypothesized that both patient and spouse would benefit from support receipt and support provision. Method: Forty-five women with early stage breast cancer and their spouses independently completed an Internet-based electronic diary assessing support receipt, support provision, and relationship intimacy for seven consecutive evenings shortly after surgery. Study outcomes consisted of daily relationship intimacy reported by each partner. Results: As hypothesized, when controlling for patient report of support receipt, spouse report of support provision was uniquely associated with a significant additional increase in feelings of relationship intimacy for patients. Moreover, the independent effects of support receipt and support provision were also found to be beneficial for nonpatient spouses' daily feelings of intimacy. Conclusion: Findings highlight the use of dyadic diary methods and corresponding modeling to uncover the unique benefits of support provision that may sometimes occur outside the awareness of the recipient. Results are discussed in terms of conceptualizing the cancer experience in a shared interpersonal context, whereby patients and their spouses can both benefit from support as they adjust to cancer together.
Data to estimate the palliative care needs and its outpatient coverage are of public health interest.
The theoretical palliative care needs were determined on the basis of a population with advanced ...cancer in selected regions of Westphalia (Germany); information from evaluated death certificates issued in 2011 in the cities of Bochum (BO) and Muenster (MS) and the rural districts of Coesfeld (COE) and Borken (BOR) were used for the analysis. The number of patients thus assessed was linked to anonymized data from the regional palliative home care teams and an estimate was made on the extent of palliative care provision.
A total of 12,424 death certificates from 2011 were evaluated. In 22.1% (n=2,751), palliative care needs before death can be assumed. In the same year, 2,396 patients were cared for by the regional palliative home care teams, with 1,288 patients dying of cancer. The coverage of outpatient palliative care was calculated as follows: BO 54.2% (567/1,046), MS 60.6% (385/635), COE 54.4% (210/386), BOR 18.4% (126/684).
One in 5 individuals has a need for palliative care before death. In statistical terms, more than 50% of tumor patients were cared for by regional palliative home care teams in the cities of Bochum and Muenster and the rural district of Coesfeld. By contrast, the degree of palliative care was less than 20% in the rural district of Borken.
Using a daily diary methodology, we assessed meaning-making processes and perceived positive changes in response to daily stressors. Eighty-two undergraduates completed nightly surveys for seven ...consecutive days reporting on their worst event of the day. Participants' core belief disruption, rumination, and sense of resolution resulting from this worst event were assessed as predictors of daily reports of stress-related growth. The results of multilevel analyses indicated that daily growth was reported as a function of the significant Level-1 three-way interaction involving relatively high levels of daily core belief disruption, rumination, and resolution. Further exploratory analyses revealed a significant four-way interaction that also included dispositional optimism (Level-2), such that the Level-1 three-way interaction was significant only for participants high on optimism. These findings are consistent with the meaning-making and growth literatures but extend relevant processes to the context of daily stressors. PUBLICATION ABSTRACT
Little is known about the role of genetic variants in the early stages of age-related macular degeneration (AMD). We aimed to investigate how genetic variations within five well-defined genes relate ...to AMD severity.
We analysed SNPs in the genes for complement factor H (CFH), age-related maculopathy susceptibility (ARMS2), HtrA serine peptidase 1 (HtrA1), complement factor B (CFB), and complement component 2 (C2)in 183 controls and 730 patients with increasing severity of AMD from the Muenster aging and retina study (MARS). Severity scoring was based on the Rotterdam classification of fundus photographs.
Compared with controls, patients with very early AMD showed a significantly increased minor allele frequency (MAF) only for CFH-rs1061170. With increasing severity of AMD, SNPs in CFH-rs1061170,as well as ARMS2-rs10490924, became consistently more common (P<0.001). Likewise, HtrA1-rs11200638 was less clearly associated with AMD severity, whereas C2-rs9332739 and CFB-rs641153 showed no relation. Multifactorial models confirmed CFH and ARMS2 as major determinants of AMD severity, whereas addition of HtrA1, C2 and CFB did not improve model prediction. In the models, age did not contribute to very early but to all more severe AMD stages, whereas smoking history had a significant impact only for late AMD.
Our findings indicate that the CFH gene is involved in the onset of AMD, whereas both, the CFH and ARMS2 genes, and more weakly, the HtrA1 gene, appear to account for the advancement of AMD. The results for SNPs in the C2 and CFB genes were inconclusive. Genetic factors dominated in their impact over age and smoking history.
We used a daily diary design to evaluate a daily model of stress generation that included both daily sadness and hostility as precipitants, and interpersonal competence as a moderator variable. Our ...results indicated that daily stress generation was precipitated by daily hostile, but not sad, mood. Participants’ skill at initiating interactions influenced daily stress generation in an unexpected direction. Specifically, the positive daily relationship between hostility and dependent stress was stronger for those with higher initiation scores. The results suggest that stress generation at the daily level functions differently than stress generation involving major life events. We discuss the implications of these findings for future research on stress generation.
Involuntary pregnancy loss is a common and often traumatic event for couples. To examine the impact of pregnancy loss on relationship stability, this study examined how perceived incongruent grief ...(i.e., differences in grief responses as perceived by mothers) influenced relationship outcomes. Thirty-nine women who had experienced an involuntary pregnancy loss participated in an online survey that measured women’s self-reported grief, perceptions of their partner’s grief, and relationship satisfaction and commitment. It was predicted that perceived incongruent grief would be negatively related to satisfaction and commitment, and satisfaction would mediate the association between incongruent grief and commitment. T tests indicated that women perceived that they grieved more intensely than their partners. Regression analyses demonstrated that women’s grief negatively predicted satisfaction. Perceived incongruent grief was also negatively related to satisfaction but not commitment. Considering the impact of perceived incongruent grief on satisfaction, these findings have implications for mental health professionals working with couples following pregnancy loss.
Fifty-three breast cancer patients completed an Internet-based diary measuring daily negative affect and positive affect and daily negative and positive events for seven consecutive evenings shortly ...after surgery. The authors used Hierarchical Linear Modeling (Raudenbush and Bryk in Hierarchical linear models: applications and data analysis methods. Sage, Thousand Oaks, CA, 2002) to examine moderators of affective differentiation, or the daily relationship between the patients’ negative affect and positive affect. Strong affective differentiation is characterized by the relative independence of negative and positive affect. There were no significant Level 1 (within-subject) moderators of affective differentiation. However, at Level 2 (between-subject), as predicted, increased age was associated with stronger affective differentiation, as was greater use of planning to cope with breast cancer. Also as predicted, increased anxiety and greater use of behavioral disengagement and denial coping were associated with weaker affective differentiation. The results suggest the value of the affective differentiation construct, and a daily diary methodology, for research on the daily lives of breast cancer patients.
We conducted a 10-day diary study that assessed daily stressors and end-of-day affect and self-esteem. We predicted that sociotropy would be associated with stronger sadness and self-esteem ...reactivity to daily interpersonal, but not achievement events, and that autonomy would be associated with the same pattern for daily achievement, but not interpersonal events. For the sample as whole, both daily interpersonal and achievement stressors were related to increased sadness and decreased self-esteem. As expected, the relationships involving interpersonal stressors were stronger for those high on sociotropy. However, the negative relationship between achievement stressors and self-esteem was also stronger for those high on sociotropy. Autonomy was associated with weaker self-esteem reactivity to interpersonal stressors. Our results are consistent with previous research on major life events, suggesting that sociotropy functions as a nonspecific vulnerability factor, and that autonomy’s role is unclear. Our results also suggest the heuristic value of a daily diary design to study the mechanisms underlying vulnerability factors’ role in the development and maintenance of depression.
Coping in Caregivers of Youth with Spinal Cord Injury Dasch, Kimberly B.; Russell, Heather F.; Kelly, Erin H. ...
Journal of clinical psychology in medical settings,
12/2011, Letnik:
18, Številka:
4
Journal Article
Recenzirano
This study examined coping among caregivers of youth with spinal cord injuries (SCI). Using a cross-sectional survey study design, 164 caregivers completed a demographics questionnaire and the Brief ...COPE. Their children, youth with SCI ages 7–18, completed the Kidcope. T-tests were conducted to examine differences in caregiver coping by demographic and injury-related factors. Further, logistic regression models were evaluated to examine predictive relationships between caregiver coping and youth coping. Several demographic and injury-related factors were related to caregiver coping, including caregiver gender, race, and education, as well as youth gender, age at injury, and time since injury. In the logistic regressions, two caregiver coping strategies were related to youth coping: caregiver self-blame coping was related to youth self-criticism, and caregiver behavioral disengagement coping (giving up attempts to cope) was related to youth blaming others coping. The findings suggest that caregiver coping may play a role in the coping of their children, and should be considered when addressing coping among youth with SCI.
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