Dianne Groll

Measuring the Symptom Experience of Seriously Ill Cancer and Noncancer Hospitalized Patients Near the End of Life with the Memorial Symptom Assessment Scale

The objectives of this study were twofold: (1) to explore and compare the symptom experience of seriously ill hospitalized cancer and noncancer patients near the end of life using the Memorial Symptom Assessment Scale (MSAS) and (2) to determine if the MSAS is a valid and useful measure of symptom distress for patients with noncancer conditions. This was a prospective cohort study of hospitalized patients with end-stage congestive heart disease, chronic pulmonary disease, cirrhosis, or metastatic cancer. Eligible patients were interviewed to ascertain symptom prevalence, severity and distress using the MSAS and levels of fatigue using the Piper Fatigue Scale (PFS). Sixty-six patients with metastatic cancer and 69 patients with end-stage disease were enrolled in the study. There was a significant difference in the prevalence of selected physical symptoms, but not psychological symptoms, between cancer and noncancer patients. There were no significant differences in symptom distress scores, a computed score of frequency, severity and distress, if the symptom was present. In both groups the principal components factor analysis with varimax rotation yielded one factor comprising psychological symptoms and a second factor comprising three subgroups of physical symptoms. Internal consistency was high for the psychological subscale (Cronbach alpha coefficients of 0.85 for the cancer group and 0.77 for the noncancer group) and for the physical subscale groupings, with coefficients ranging between 0.78 to 0.87. The symptom scores were significantly correlated with perceptions of fatigue. These findings show that both seriously ill cancer and noncancer patients experience symptom distress, and that the MSAS seems to be a reliable measure of symptom distress in noncancer patients, as well as with cancer patients.

An observational study of associations among maternal fluids during parturition, neonatal output, and breastfed newborn weight loss

BackgroundNewborn weight measurements are used as a key indicator of breastfeeding adequacy. The purpose of this study was to explore non-feeding factors that might be related to newborn weight loss. The relationship between the intravenous fluids women receive during parturition (the act of giving birth, including time in labour or prior to a caesarean section) and their newborns weight loss during the first 72 hours postpartum was the primary interest.MethodsIn this observational cohort study, we collected data about maternal oral and IV fluids during labour or before a caesarean section. Participants (n = 109) weighed their newborns every 12 hours for the first three days then daily to Day 14, and they weighed neonatal output (voids and stools) for three days.ResultsAt 60 hours (nadir), mean newborn weight loss was 6.57% (SD 2.51; n = 96, range 1.83-13.06%). When groups, based on maternal fluids, were compared (≤1200 mls [n = 21] versus > 1200 [n = 53]), newborns lost 5.51% versus 6.93% (p = 0.03), respectively. For the first 24 hours, bivariate analyses show positive relationships between a) neonatal output and percentage of newborn weight lost (r(96) = 0.493, p < 0.001); and b) maternal IV fluids (final 2 hours) and neonatal output (r(42) = 0.383, p = 0.012). At 72 hours, there was a positive correlation between grams of weight lost and all maternal fluids (r(75) = 0.309, p = 0.007).ConclusionsTiming and amounts of maternal IV fluids appear correlated to neonatal output and newborn weight loss. Neonates appear to experience diuresis and correct their fluid status in the first 24 hours. We recommend a measurement at 24 hours, instead of birth weight, for baseline when assessing weight change. Because practices can differ between maternity settings, we further suggest that clinicians should collect and analyze data from dyads in their care to determine an optimal baseline measurement.

The IBS-36: A new Quality of Life measure for irritable bowel syndrome

OBJECTIVE:We aimed to develop and validate a quality of life instrument for patients with irritable bowel syndrome (IBS).METHODS:Using focus groups, existing questionnaires, and literature reviews, five IBS patients and nine gastroenterologists compiled and pilot tested for content validity a 70-item questionnaire. The questionnaire was then administered to 107 IBS patients, and using these data, the 70-item questionnaire was reduced to 36 questions through statistical and consensus methodology. The IBS-36 questionnaire was tested for construct validity, reliability, reproducibility, and responsiveness using a gold standard of structured interviews by three gastroenterologists, the Medical Outcomes Study Short Form Quality of Life Questionnaire, and the Coping Resource Inventory.RESULTS:The IBS-36 consists of 36 questions scored on a 7-point Likert scale. It has a very high internal consistency (Cronbachs α= 0.95) and a high test-retest reliability (Spearmans r= 0.92) and correlates as hypothesized with the Medical Outcomes Study Short Form Quality of Life Questionnaire (p < 0.001), McGill pain scores (p < 0.001), and IBS patient-reported sleep, symptom, and pain scores (ps = 0.030, <0.001, and <0.001, respectively).CONCLUSIONS:The IBS-36 addresses all areas of quality of life affected by IBS and is easy to administer and score. The IBS-36 is a well-validated, condition-specific quality of life measure for IBS patients that is sensitive to clinical intervention and highly correlated with established quality of life measures and patient-reported symptom scores.

Mental Disorder Symptoms among Public Safety Personnel in Canada

Background: Canadian public safety personnel (PSP; e.g., correctional workers, dispatchers, firefighters, paramedics, police officers) are exposed to potentially traumatic events as a function of their work. Such exposures contribute to the risk of developing clinically significant symptoms related to mental disorders. The current study was designed to provide estimates of mental disorder symptom frequencies and severities for Canadian PSP. Methods: An online survey was made available in English or French from September 2016 to January 2017. The survey assessed current symptoms, and participation was solicited from national PSP agencies and advocacy groups. Estimates were derived using well-validated screening measures. Results: There were 5813 participants (32.5% women) who were grouped into 6 categories (i.e., call center operators/dispatchers, correctional workers, firefighters, municipal/provincial police, paramedics, Royal Canadian Mounted Police). Substantial proportions of participants reported current symptoms consistent with 1 (i.e., 15.1%) or more (i.e., 26.7%) mental disorders based on the screening measures. There were significant differences across PSP categories with respect to proportions screening positive based on each measure. Interpretation: The estimated proportion of PSP reporting current symptom clusters consistent with 1 or more mental disorders appears higher than previously published estimates for the general population; however, direct comparisons are impossible because of methodological differences. The available data suggest that Canadian PSP experience substantial and heterogeneous difficulties with mental health and underscore the need for a rigorous epidemiologic study and category-specific solutions.

A Systematic Review of the Safety and Effect of Neurofeedback on Fatigue and Cognition

Background. Many cancer survivors continue to experience ongoing symptoms, such as fatigue and cognitive impairment, which are poorly managed and have few effective, evidence-based treatment options. Neurofeedback is a noninvasive, drug-free form of brain training that may alleviate long-term symptoms reported by cancer patients. Objective. The purpose of this systematic review of the literature was to describe the effectiveness and safety of neurofeedback for managing fatigue and cognitive impairment. Methods. A systematic review of the literature was conducted using Joanna Briggs Institute (JBI) methodology. A comprehensive search of 5 databases was conducted: Medline, CINAHL, AMED, PsycInfo, and Embase. Randomized and nonrandomized controlled trials, controlled before and after studies, cohort, case control studies, and descriptive studies were included in this review. Results. Twenty-seven relevant studies were included in the critical appraisals. The quality of most studies was poor to moderate based on the JBI critical appraisal checklists. Seventeen studies were deemed of sufficient quality to be included in the review: 10 experimental studies and 7 descriptive studies. Of these, only 2 were rated as high-quality studies and the remaining were rated as moderate quality. All 17 included studies reported positive results for at least one fatigue or cognitive outcome in a variety of populations, including 1 study with breast cancer survivors. Neurofeedback interventions were well tolerated with only 3 studies reporting any side effects. Conclusions. Despite issues with methodological quality, the overall positive findings and few reported side effects suggest neurofeedback could be helpful in alleviating fatigue and cognitive impairment. Currently, there is insufficient evidence that neurofeedback is an effective therapy for management of these symptoms in cancer survivors, however, these promising results support the need for further research with this patient population. More information about which neurofeedback technologies, approaches, and protocols could be successfully used with cancer survivors and with minimal side effects is needed. This research will have significance to nurses and physicians in oncology and primary care settings who provide follow-up care and counseling to cancer survivors experiencing debilitating symptoms in order to provide information and education related to evidence-based therapy options.

Measuring function in older adults with co-morbid illnesses who are undergoing coronary artery bypass graft (CABG) surgery

Measuring function in individuals post CABG surgery is difficult because of the diversity of functional abilities/disabilities. This study compared the human activity profile (HAP) to the medical outcome study short form (SF-36v2™), in individuals with functional co-morbidities undergoing CABG surgery. The sample consisted of 84 men and 17 women, with a mean age of 63 years. The majority (n=83, 82%) had three to six co-morbid illnesses. There were significant negative correlations between the functional co-morbidity index (FCI) scores and the HAP, maximum activity score (MAS) (r=-0.32, p=0.002), adjusted activity score (AAS) (r=-0.29, p=0.004), indicating that function was lower in individuals with higher co-morbidities. There was a non-significant negative correlation between FCI scores and physical component summary (PCS) scores of the SF-36v2™ (r=-0.19, p=0.07). Results of this study are consistent with those of others who reported a growing incidence of older individuals with co-morbid factors undergoing CABG surgery. Generic instruments that have traditionally been used to measure function may not be sensitive enough to differences in function in individuals with co-morbidities. Results of this study imply that the HAP is more sensitive than the PCS to these differences, but further research evaluating the HAP in populations with co-morbid burden is necessary.

Measuring policing stress meaningfully: establishing norms and cut-off values for the Operational and Organizational Police Stress Questionnaires

Abstract The Operational and Organizational Police Stress Questionnaires (PSQ-Op and PSQ-Org) are useful tools for understanding individual differences in the perception of policing-specific stress. However, two of the limitations of the PSQ-Op and PSQ-Org are their lack of normative values that provide organizations with a baseline with which to judge the effectiveness of stress-reduction interventions or new resilience-based training initiatives and cut-offs that can identify the percentage of employees who might be experiencing high, moderate, and low levels of policing-specific stress. Specifically, they do not allow individual departments or policing organizations to assess the relative degree of work-related stress their members are experiencing, or to determine whether that level of stress is excessive. To address this gap in knowledge, we developed gender-based norms and cut-off values for the two PSQ measures. These norms are provided for both overall scale scores and individual items, and implications for addressing officer stress are discussed.

Making Choices: Adoption Seekers’ Preferences and Available Children with Special Needs

Most children available from public adoption agencies are children with special needs, such as disabilities. This pilot study on the child profile preferences of 5830 adults registered with province-wide adoption agency found that those who were most open to considering children with special needs had been formally seeking to adopt for some time and had completed government-required SAFE assessments and training. Most preferred younger children, and half would consider sibling groups. Between 43% to 60% indicated willingness to consider adopting children with degrees of learning disabilities, emotional behavioral disorders, and physical disabilities, although the willing proportion decreased as the level of each disabilitys specified impact progressed from “mild” to “moderate” to “severe.” Most preferred, among 20 categories of available childrens possible exposures and health diagnoses, were past abuse exposures versus diagnosed disabilities or enduring conditions. Possible explanations for these findings and their implications are explored and ideas for further research proposed.

Improving suicide risk assessment in the emergency department through physician education and a suicide risk assessment prompt

OBJECTIVE To determine the efficacy of two interventions on suicide risk assessment within emergency departments (EDs) on improving the documentation of suicide risk factors by emergency medicine and psychiatric physicians during suicide risk assessment. METHOD An educational intervention on suicide was provided to all emergency medicine and psychiatry physicians and was followed by the placement of a suicide risk assessment prompt within local EDs. The medical charts of all ED patients presenting with suicidal ideation or behaviours were reviewed immediately and six months after the interventions and compared to pre-intervention. Differences in the documentation of 40 biopsychosocial suicide risk factors between specialties and after the interventions were determined. RESULTS The documentation of 34/40 (p ≤ 0.008) and 33/40 (p ≤ 0.009) suicide risk factors was significantly improved by emergency medicine and psychiatry physicians, respectively, after the interventions and maintained six months later. Immediately and six months after the interventions, the documentation of 8/40 (p ≤ 0.041) and 14/40 (p ≤ 0.048) suicide risk factors, respectively, significantly differed between specialties. CONCLUSION This suggests that providing a brief educational intervention on suicide to emergency medicine and psychiatry physicians followed by placing a prompt for important, yet commonly undocumented risk factors within the ED is a low-cost and effective intervention for improving documentation of suicide risk assessments within the ED.

Assessing Suicide Risk: What is Commonly Missed in the Emergency Room?

Objective: Although risk assessment for suicide has been extensively studied, it is still an inexact process. The current study determined how busy emergency clinicians actually assessed and documented suicide risk, while also examining the differences between psychiatric and emergency medicine opinions on the importance of various suicide predictors. Method: Phase 1 of the study involved the administration of a survey on the relative importance of various suicide predictors for the specialties of psychiatry and emergency medicine. In phase 2 of the study, a chart review of psychiatric emergency room patients was conducted to determine the actual documentation rates of the suicide predictors. Results: Several predictors that were deemed to be important, including suicidal plan, intent for suicide, having means available for suicide, and practicing suicide (taking different steps leading up to suicide but not actually attempting suicide), had low documentation rates. Conclusions: Medical specialties have different opinions on the importance of various suicide predictors. Also, some predictors deemed important had low documentation rates. Educational interventions and simple assessment tools may help to increase documentation rates of several suicide predictors in busy clinical settings.