Irene Palmares Carvalho

Preoperative anxiety in ambulatory surgery: The impact of an empathic patient-centered approach on psychological and clinical outcomes.

OBJECTIVE This study aims to evaluate the influence of an empathic patient-centered approach on preoperative anxiety and surgical outcomes in ambulatory surgery patients. METHODS A sample of 104 patients undergoing general ambulatory surgery was randomly assigned to the intervention (IG) and the control (CG) groups. Before surgery, the IG received personalized information through an empathic patient-centered interview. The CG received standardized information on surgical procedures. Anxiety was assessed before and after the preoperative interview and after the surgery. Wound healing, post-surgical recovery and satisfaction with the quality of preoperative information were assessed after the surgery. RESULTS The two groups were identical at baseline regarding anxiety, socio-demographic and clinical characteristics. After the patient-centered intervention, the IG showed lower levels of preoperative anxiety (p<0.001) and pain (p<0.001), better surgery recovery (p<0.01) and higher levels of daily activity (p<0.001) and of satisfaction with the information received (p<0.01) than the CG. The IG also showed better wound healing (tissue type, p<0.01; local pain, p<0.01). CONCLUSION An empathic patient-centered intervention can reduce preoperative anxiety and increase surgical recovery, wound healing and patient satisfaction. PRACTICE IMPLICATIONS This approach is applicable in pre-surgical interviews and can potentially be used in the routine care of various surgical contexts.

Teaching communication skills in clinical settings: comparing two applications of a comprehensive program with standardized and real patients

BackgroundCommunication is important for the quality of clinical practice, and programs have been implemented to improve healthcare providers’ communication skills. However, the consistency of programs teaching communication skills has received little attention, and debate exists about the application of acquired skills to real patients. This study inspects whether (1) results from a communication program are replicated with different samples, and (2) results with standardized patients apply to interviews with real patients.MethodsA structured, nine-month communication program was applied in two consecutive years to two different samples of healthcare professionals (25 in the first year, 20 in the second year). Results were assessed at four different points in time, each year, regarding participants’ confidence levels (self-rated), basic communication skills in interviews with standardized patients, and basic communication skills in interviews with real patients. Data were analyzed using GLM Repeated-Measures procedures.ResultsImprovements were statistically significant in both years in all measures except in simulated patients’ assessment of the 2008 group. Differences between the two samples were non-significant. Differences between interviews with standardized and with real patients were also non-significant.ConclusionsThe program’s positive outcomes were replicated in different samples, and acquired skills were successfully applied to real-patient interviews. This reinforces this type of program structure as a valuable training tool, with results translating into real situations. It also adds to the reliability of the assessment instruments employed, though these may need adaptation in the case of real patients.

Computer-Assisted Rehabilitation Program - Virtual Reality (CARP-VR): A program for cognitive rehabilitation of executive dysfunction

Every year millions of individuals sustain Acquired Brain Injury (ABI) often resulting in physical, cognitive and psychosocial deficits, leading to life-long changes in the quality of life of patients and their families. In the domain of rehabilitation, virtual-reality (VR) technology has assumed a crucial role in the creation of innovative assessment and training programs. The purpose of this study is to present the Computer-Assisted Rehabilitation Program (CARP-VR) after a brief review of the state of the art. CARP-VR was tailored to the rehabilitation of executive functioning and other related cognitive functions in patients with ABI. It consists of virtual environments that simulate real-life contexts in which patients perform various activities that are based on daily situations. The final version of CARP-VR is now ready to be employed, and tests have been designed to validate it as a tool for the rehabilitation of executive functioning and related cognitive functions.

An fMRI paradigm based on Williams inhibition test to study the neural substrates of attention and inhibitory control

The purpose of this study is to present an fMRI paradigm, based on the Williams inhibition test (WIT), to study attentional and inhibitory control and their neuroanatomical substrates. We present an index of the validity of the proposed paradigm and test whether the experimental task discriminates the behavioral performances of healthy participants from those of individuals with acquired brain injury. Stroop and Simon tests present similarities with WIT, but this latter is more demanding. We analyze the BOLD signal in 10 healthy participants performing the WIT. The dorsolateral prefrontal cortex, the inferior prefrontal cortex, the anterior cingulate cortex, and the posterior cingulate cortex were defined for specified region of interest analysis. We additionally compare behavioral data (hits, errors, reaction times) of the healthy participants with those of eight acquired brain injury patients. Data were analyzed with GLM-based random effects and Mann-Whitney tests. Results show the involvement of the defined regions and indicate that the WIT is sensitive to brain lesions. This WIT-based block design paradigm can be used as a research methodology for behavioral and neuroimaging studies of the attentional and inhibitory components of executive functions.

Study of behavioural and neural bases of visuo-spatial working memory with an fMRI paradigm based on an n-back task.

The goal of this study was to propose a new functional magnetic resonance imaging (fMRI) paradigm using a language-free adaptation of a 2-back working memory task to avoid cultural and educational bias. We additionally provide an index of the validity of the proposed paradigm and test whether the experimental task discriminates the behavioural performances of healthy participants from those of individuals with working memory deficits. Ten healthy participants and nine patients presenting working memory (WM) deficits due to acquired brain injury (ABI) performed the developed task. To inspect whether the paradigm activates brain areas typically involved in visual working memory (VWM), brain activation of the healthy participants was assessed with fMRIs. To examine the tasks capacity to discriminate behavioural data, performances of the healthy participants in the task were compared with those of ABI patients. Data were analysed with GLM-based random effects procedures and t-tests. We found an increase of the BOLD signal in the specialized areas of VWM. Concerning behavioural performances, healthy participants showed the predicted pattern of more hits, less omissions and a tendency for fewer false alarms, more self-corrected responses, and faster reaction times, when compared with subjects presenting WM impairments. The results suggest that this task activates brain areas involved in VWM and discriminates behavioural performances of clinical and non-clinical groups. It can thus be used as a research methodology for behavioural and neuroimaging studies of VWM in block-design paradigms.

P-784 - A new fMRI paradigm to study behavioral and neural bases of visual working memory

Introduction Working memory (WM) is a cognitive process that refers to storing information in a temporary system that allows monitoring and handling this information. Objectives To propose and validate a new fMRI paradigm to study WM and its neuroanatomical substrates, using a language-free adaptation of the 2-back working memory task in order to avoid cultural and educational bias. Aims To test the hypothesis that the proposed paradigm would produce an increase of the BOLD signal in specialized areas for spatial WM (Superior Frontal Sulcus) and areas for monitoring and handling this information (Dorsolateral Prefrontal Cortex) in healthy participants. We also expected a significantly higher behavioral performance in this group than in subjects with suspected WM impairment due to acquired brain injury. Methods 10 neurologically healthy participants and 11 ABI participants performed the task in a block design experiment with four runs. These observed a 9-square matrix with one of the squares painted black and pressed a button each time the black square was the same as the one two trials back. We analyzed behavioral performance and brain activation in repeated trials. Results Higher BOLD activation of brain regions was associated with the performance of the WM task in the healthy group, as well as better behavioral performance. We also present behavior results of both groups, so these data can be compared to other clinical groups with suspected WM deficits. Conclusions This task may be used as a research methodology for behavioral and neuroimaging studies of visual WM in block-design paradigms.

Two Siblings Concordant for Male-to-Female Transsexualism: A Case Report

ABSTRACT This report presents two male-to-female transsexuals from a family that comprises, in addition, seven nontranssexual and nonhomosexual older siblings. Information was gathered mainly through in-depth interviews and hospital records. Similarities and differences between the two cases are explored within the family context, and some emergent mechanisms for transsexualism are outlined. The reported cases fit the hypothesis that prenatal conditions, such as alteration of parental biology, give rise to transsexualism. But the sense of “belonging to the other sex” may develop only late in life with a pressing need for normalcy. Even though “feminine treatment” of boys may not directly lead to transsexualism, special care for (some) children may play a role if it is unusual/unexpected. Future studies would benefit from extending examinations performed on transsexuals to their families.