Sean Hammond

A qualitative study to explore the concept of fatigue/tiredness in cancer patients and in healthy individuals.

Interest in fatigue research has grown since the finding that fatigue/tiredness is the most frequently reported symptom of cancer and its treatment. But even though several authors have tried to conceptualise fatigue, its mechanisms are still poorly understood. The aim of this study was twofold: (a) to explore fatigue in cancer patients inductively, and (b) to compare experiences of fatigue/tiredness of healthy individuals with those of cancer patients to identify cancer-specific fatigue/tiredness and related concepts. A qualitative research strategy was adopted using a grounded-theory approach. The prospective study took place in the oncology department of the Kantonsspital, St. Gallen, Switzerland, with samples of 20 cancer patients and 20 healthy individuals. Unstructured, tape-recorded interviews were conducted to collect data. The transcripts of the interviews were analysed using content analysis and constant comparison. Different themes emerged between the two groups although both fitted a classification system that categorised fatigue into physical, affective and cognitive expressions of fatigue/tiredness. Physical signs were more frequent than affective and cognitive signs in both groups. In the cancer patients, fatigue involved decreased physical performance, extreme, unusual tiredness, weakness and an unusual need for rest, which was distinctly different for healthy persons. Affective and cognitive distress was also more prominent in cancer patients. Interestingly, the concept of malaise was not identified by either sample and not understood as an expression of fatigue by this German-speaking population. Linguistic differences in the description of fatigue/tiredness between healthy and ill individuals revealed different perceptions of the phenomenon. A step-like theory, explaining the production of fatigue/tiredness was tentatively put forward involving nociception, perception and expression of tiredness. The emerging concepts break tiredness/fatigue into an expression of physical, affective and cognitive tiredness/fatigue. The experience is different between healthy individuals and cancer patients. Care must be taken when drawing generalised conclusions but the results of the study identify and clarify ideas that might form an important basis for further, controlled studies.

A Qualitative Study to Explore the Concept of Fatigue/Tiredness in Cancer Patients and in Healthy Individuals

Interest in fatigue research has grown since the finding that fatigue/tiredness is the most frequently reported symptom of cancer and its treatment. But even though several authors have tried to conceptualise fatigue, its mechanisms are still poorly understood. The aim of this study was twofold: (a) to explore fatigue in cancer patients inductively, and (b) to compare experiences of fatigue/tiredness of healthy individuals with those of cancer patients to identify cancer-specific fatigue/tiredness and related concepts. A qualitative research strategy was adopted using a grounded-theory approach. The prospective study took place in the oncology department of the Kantonsspital, St. Gallen, Switzerland, with samples of 20 cancer patients and 20 healthy individuals. Unstructured, tape-recorded interviews were conducted to collect data. The transcripts of the interviews were analysed using content analysis and constant comparison. Different themes emerged between the two groups although both fitted a classification system that categorised fatigue into physical, affective and cognitive expressions of fatigue/tiredness. Physical signs were more frequent than affective and cognitive signs in both groups. In the cancer patients, fatigue involved decreased physical performance, extreme, unusual tiredness, weakness and an unusual need for rest, which was distinctly different for healthy persons. Affective and cognitive distress was also more prominent in cancer patients. Interestingly, the concept of malaise was not identified by either sample and not understood as an expression of fatigue by this German-speaking population. Linguistic differences in the description of fatigue/tiredness between healthy and ill individuals revealed different perceptions of the phenomenon. A step-like theory, explaining the production of fatigue/tiredness was tentatively put forward involving nociception, perception and expression of tiredness. The emerging concepts break tiredness/fatigue into an expression of physical, affective and cognitive tiredness/fatigue. The experience is different between healthy individuals and cancer patients. Care must be taken when drawing generalised conclusions but the results of the study identify and clarify ideas that might form an important basis for further, controlled studies.

A psychometric appraisal of the DREEM

BackgroundThe quality of the Educational environment is a key determinant of a student centred curriculum. Evaluation of the educational environment is an important component of programme appraisal. In order to conduct such evaluation use of a comprehensive, valid and reliable instrument is essential. One of most widely used contemporary tools for evaluation of the learning environment is the Dundee Ready Education Environment Measure (DREEM). Apart from the initial psychometric evaluation of the DREEM, few published studies report its psychometric properties in detail. The aim of this study was to examine the psychometric quality of the DREEM measure in the context of medical education in Ireland and to explore the construct validity of the device.Methods239 final year medical students were asked to complete the DREEM inventory. Anonymised responses were entered into a database. Data analysis was performed using PASW 18 and confirmatory factor analysis performed.ResultsWhilst the total DREEM score had an acceptable level of internal consistency (alpha 0.89), subscale analysis shows that two subscales had sub-optimal internal consistency. Multiple group confirmatory factor analysis (using Flemings indices) shows an overall fit of 0.76, representing a weak but acceptable level of fit. 17 of the 50 items manifest fit indices less than 0.70. We sought the best fitting oblique solution to the 5-subscale structure, which showed large correlations, suggesting that the independence of the separate scales is open to question.ConclusionsThere has perhaps been an inadequate focus on establishing and maintaining the psychometric credentials of the DREEM. The present study highlights two concerns. Firstly, the internal consistency of the 5 scales is quite variable and, in our sample, appears rather low. Secondly, the construct validity is not well supported. We suggest that users of the DREEM will provide basic psychometric appraisal of the device in future published reports.

Representing disability in charity promotions

Social psychological research in relation to charity advertising in the area of disability has attempted to distinguish between ‘positive’ and ‘negative’ images and the way in which these are related to their fundraising potential. In the light of the critique of charity advertising offered by a number of disability theorists, it is suggested that this perspective would be enhanced by consideration of the attitudes of disabled people to charity advertisements. A study is reported that compares the attitudes of disabled and non-disabled people to two charity advertisements. Differences between these two groups are reported and in the light of the nature of these it is suggested that what are considered to constitute ‘positive images’ is unlikely to be consensual. Copyright

Cytologic diagnosis and grading of ductal carcinoma in situ

Fine‐needle aspiration cytology plays an important role in the preoperative diagnosis of palpable masses as well as impalpable lesions that can only be sampled by stereotactic or ultrasound techniques. A further refinement of cytologic diagnosis would be the ability to distinguish among the different types of ductal carcinoma in situ (DCIS) also between in situ and invasive malignant disease.

Some pitfalls in the use of factor scores: The case of the Kirton adaption-innovation inventory

Abstract The use of factor analysis to generate scores on composite scales has some psychometric appeal as it allows for the partition of item variance. However, two major issues make such procedures problematic. The first concerns generalizing factor score weights from one sample to another and is essentially the problem of factor invariance. The second issue concerns the psychometric problem of factor indeterminacy. Mulligan and Martin have advocated the use of factor scores with the increasingly widely used Kirton Adaption-Innovation Inventory (KAI). This paper discusses the pitfalls of using factor scores in general and then investigates empirically whether Mulligan and Martins proposal is justified with the KAI using an Irish sample. It is concluded that the summated rating method of scoring the KAI is superior to the factor-analytic procedure.

An IRT Investigation of the Validity of Non-Patient Analogue Research Using the Beck Depression Inventory

This paper presents an IRT analysis of the Beck Depression Inventory which was carried out to assess the assumption of an underlying latent trait common to non-clinical and patient samples. A one parameter rating scale model was fitted to data drawn from a patient and non-patient sample. Findings suggest that while the BDI fits the model reasonably well for the two samples separately there is sufficient differential item functioning to raise serious duobts of the viability of using it analogously with patient and non-patient groups.

The Medical Student Stress Profile: a tool for stress audit in medical training

Medical Education 2010: 44: 1027–1037

Expressed Emotion in relationships between staff and patients in forensic services: Changes in relationship status at 12 month follow‐up

Background. Research on Expressed Emotion (EE) has demonstrated substantial consistency across cultures and over time, endorsing the social environment as important in determining the course and outcome of problems in mental health. The aim of this study was to measure EE in staff-patient relationships in three forensic services for in-patients with a history of mental disorder and offending, using a prospective, naturalistic design, with a 12-month follow-up of staff and patient outcomes. Methods. Keyworker or team nurse and patient pairs (N=75) consented to participate in an interview which included an audiotaped task. Twelve months after this interview, information on outcome for staff and patients was collected by researchers blind to the EE status of participants. Results. Comparatively high levels of criticism were rated during staff speech samples: N=55 high-EE relationships as determined by conventional criteria. Principal component analysis of the EE rating scales comprising the Five-MinuteSpeech-Sample (FMSS) established a composite of ‘low-EE’ vs. ‘high-EE’ variables. The staff ‘continuum’ measure of high criticism, low positive remarks and ‘negative’ relationship quality was significantly associated with change in the relationship 12 months later. There was no association between patient EE ratings and rehabilitative outcome, nor EE and staff outcome. Conclusions. The study replicates recent findings that staff attitudes and behaviour in professional relationships influence clinical outcomes.

When statistical models fail: problems in the prediction of escape and absconding behaviour from high-security hospitals

The issue of the prediction of problematic behaviour in psychiatric settings has generated a large body of literature over the last decade. There appears to be a clear consensus that statistical methods of prediction are more accurate and defensible than those based solely upon clinical judgement. The present study explores the prediction of absconding behaviour from maximum-security hospitals. A number of difficulties with standard statistical methods are identified and it is concluded that there is a strong case for idiographic assessment of absconding risk.