Benjamin A. Bensadon

Coping mediates the relationship between disease severity and illness intrusiveness among chronically ill patients

Reducing perceptions of illness intrusiveness may improve quality of life and mental health among patients with cardiopulmonary disease. To better understand relationships between coping style, locus of control, perceived illness intrusiveness, and disease severity, we analyzed data from 227 older Veterans with chronic obstructive pulmonary disease or congestive heart failure. Regressions revealed illness intrusiveness to be associated with younger age and greater disease severity, less internal locus of control, and avoidant/emotion-focused coping. Avoidant/emotion-focused coping but not active coping mediated the relationship between illness severity and illness intrusiveness. Findings suggest that supportive psychological interventions may reduce illness intrusiveness by targeting an avoidant/emotion-focused coping style and associated behaviors.

Current Management Decisions in Mild Cognitive Impairment

Efforts toward early detection of Alzheimer disease (AD) have focused on refinement and identification of diagnostic markers, with the goal of preventing or delaying disease progression. Mild cognitive impairment (MCI) has emerged as a potential precursor to dementia. Though not without controversy, MCI has been associated with an increased risk for conversion to AD. In this article, with emphasis on meta-analyses, randomized controlled trials, and extant literature reviews, considerations and recommendations for optimal clinical management of MCI are offered. Given the substantial heterogeneity of this patient population and inconsistent research methodologies, the need for informed, clinical judgment is critical.

Attitudes, Beliefs, and Behavior

This chapter reviews decades of empirical evidence and theory linking attitudes, beliefs and behavior, with special focus on medical and geriatric populations. The clinical relevance of patient self-efficacy and stereotyping is emphasized. The discussion covers patient, caregiver and physician attitudes, beliefs and behavior and how they can influence patient outcomes, including adherence and chronic disease self-management.

Maximizing treatment adherence: physician-patient partnerships vs procedures.

In the August issue of Hypertension , Burnier et al1 open their review article with an encouragingly clear patient focus. They explicitly state effective hypertension management requires 2 types of patient behavior change: lifestyle modification and lifelong adherence to pharmacotherapy. The latter can work, they emphasize, “only if the patient is motivated to take the prescribed medication.” Yet, they fail to address further the critical role the physician should and must play …

Understanding chronic disease: student exposure to support groups

What problem was addressed? The intensive care unit (ICU) is a daunting place in which to begin clinical training. Trainees often find the plethora of information, coupled with the severity and complexity of disease, overwhelming. They struggle to adapt because no formal textbook can fully prepare them for the nuances of caring for critically ill patients. The ICU is unique in that learners receive little formal training specifically for this environment. We believe this environment presents distinct educational challenges suited to online teaching methods tailored to the new generation of learner. What was tried? The new learner is technologically savvy regarding access to information and media via smartphones and tablets. We aimed to capitalise on this by developing visual media presentations on a YouTube channel (www.youtube.com/iucriticalcare) to allow learners to engage with humorous, pithy, visually stimulating videos that introduce key elements of caring for critically ill patients. We called this the ‘Critical Care Survival Guide’ and developed it for our local medical students and interns. The videos were created by a team of physicians (the authors), and were choreographed and edited utilising Chroma keying techniques, and then linked to PowerPoint slides via video-editing software. This enabled video and graphic interfaces that highlighted key teaching points, such as ventilator waveforms and ICU monitors. What lessons were learned? The response to our educational content surprised us. It has truly ‘gone viral’. In one year of online publication, our videos have been viewed over 77 000 times by learners from all over the world. YouTube allows us to track the duration of view (280 000 minutes in total), country of viewership (53% is USA-based), and receive feedback through comments posted. Interestingly, we now have 1550 current ‘subscribers’ to our channel on YouTube. Comments have included: ‘Great production and better than just still slides and voiceover’ and ‘Thank you so much for these videos, they are helping me as a nursing student!’ By tracking how long learners watch each video, we learn which videos are engaging and which videos need adjustment. Locally, our experience has been that students and interns who view the videos in advance of their ICU rotation feel more prepared than those who do not. Specifically, learners appreciate the videos that equip them in the psychomotor (central lines, intubation, running codes) and knowledge (X-ray interpretation, sepsis management, ventilator alarms) domains of learning. Our perspective on medical education has been changed by this project. The popularity of these videos attests to their demand and usefulness. The medical profession has not defined metrics to ‘measure’ the significance of scholarship in the YouTube realm; however, we believe that over 77 000 views is an impressive impact. Our success is likely to have resulted from the format, delivery and accessibility of the videos. They can be viewed anywhere, at any time and in any environment. Learners are using smartphones, tablets and personal computers to tune in. The content of the videos helps to equip learners from the medical, nursing and respiratory medicine fields. Finally, they showcase our teaching philosophy that learning can be fun! We encourage others to embrace YouTube as an educational tool and look forward to impacting more learners in the years to come.

Hypothesis: glutaminyl cyclase inhibitors decrease risks of Alzheimer’s disease and related dementias

Alzheimer’s disease and related dementias (ADRD) comprise several progressive and incurable neurodegenerative disorders that some have classified as amyloidosis. With increased aging of the world’s population, the prevalence of the sporadic form of ADRD, which comprises over 99% of cases, continues to rise at an alarming rate. The enormous societal burdens of ADRD already rival those of the many other major chronic diseases causing premature morbidity and mortality in the USA and worldwide such as cardiovascular disease and cancer. At present, there is an insufficient totality of evidence concerning the efficacy and safety of any pharmacologic agents to delay slow progression or reduce complications of ADRD. In this context, glutaminyl cyclase (QC) inhibitors have shown some early possible evidence of efficacy with a reassuring safety profile. To reliably test the glutaminyl cyclase (QC) and any other promising hypotheses will require cogent data from large-scale randomized trials of sufficient size and duration.

Chapter 11 – Simulation Education

The greatest advantage of simulation training is that it closely approximates actual clinical work, but in a controlled setting with minimal potential for harm. This type of training can use programmed mannequins or actors (professional or not) serving as “standardized patients” (SPs) to help teach and evaluate trainees’ clinical examination skills. Faculty and students can review the videos of simulated training sessions to ensure technical aspects of these behaviors are performed correctly, such as placing one’s hands or equipment (e.g., stethoscope) appropriately. Videos also reveal key verbal and non-verbal aspects of communication quality, such as interruption patterns and body language. Video technology transforms even the subtlest elements of therapeutic encounters into observable, behavioral data. Clinically relevant interpersonal competencies, therefore, can be assessed objectively. And for trainees, video review is an unparalleled learning tool. Given simulation’s precise fit with clinical psychologists’ training, better integration of psychology and medicine can uniquely sensitize learners and cultivate their self-awareness and insight, in a manner that no other modality can.