Self-perceived Improvement Research Articles

Effect of combined systematized behavioral modification education program with desmopressin in patients with nocturia: a prospective, multicenter, randomized, and parallel study.

PurposeThe aims of this study were to investigate the efficacy of combining the systematized behavioral modification program (SBMP) with desmopressin therapy and to compare this with desmopressin monotherapy in the treatment of nocturnal polyuria (NPU).MethodsPatients were randomized at 8 centers to receive desmopressin monotherapy (group A) or combination therapy, comprising desmopressin and the SBMP (group B). Nocturia was defined as an average of 2 or more nightly voids. The primary endpoint was a change in the mean number of nocturnal voids from baseline during the 3-month treatment period. The secondary endpoints were changes in the bladder diary parameters and questionnaires scores, and improvements in self-perception for nocturia.ResultsA total of 200 patients were screened and 76 were excluded from the study, because they failed the screening process. A total of 124 patients were randomized to receive treatment, with group A comprising 68 patients and group B comprising 56 patients. The patients' characteristics were similar between the groups. Nocturnal voids showed a greater decline in group B (-1.5) compared with group A (-1.2), a difference that was not statistically significant. Significant differences were observed between groups A and B with respect to the NPU index (0.37 vs. 0.29, P=0.028), the change in the maximal bladder capacity (-41.3 mL vs. 13.3 mL, P<0.001), and the rate of patients lost to follow up (10.3% [7/68] vs. 0% [0/56], P=0.016). Self-perception for nocturia significantly improved in both groups.ConclusionsCombination treatment did not have any additional benefits in relation to reducing nocturnal voids in patients with NPU; however, combination therapy is helpful because it increases the maximal bladder capacity and decreases the NPI. Furthermore, combination therapy increased the persistence of desmopressin in patients with NPU.

Improving physiological and psychological status in a hemodialysis patient: a nursing experience using an exercise training program

Exercise training during hemodialysis has been found to improve functional capacity, nutritional status, cardiovascular risk factors, depression, and well being in hemodialysis patients. This report describes a nursing experience that applied exercise training to improve activity intolerance, powerlessness, and ineffective health maintenance in a hemodialysis patient. The care period was from May 11 to July 27, 2012. The author collected information using observation, interview, physical examination, and medical record review and identified patient care problems including activity intolerance, powerlessness, and ineffective health maintenance. In addition to providing individual nursing interventions, the author designed a stationary bicycle installed at the end of the bed. The patient was asked use the bicycle to exercise 30 mins per time, three times per week for a period of 12 weeks during the patient's hemodialysis period. Before and after a 12-week of exercise training, collected the 6-minute walk test (6MWT), self-perceived improvement, and self-reported depression scales were performed prior to and after completion of the intervention. Hematological triglyceride, albumin, and hemoglobin data were collected each week. Heart rate, blood pressure, and oxygen saturation were examined prior to and after the intervention to ensure patient safety. After the 12-week intervention, the average heart rate achieved 40-60% of the maximum heart rate and the heart rate peaked between 85 and 121 bpm. Moreover, the 6MWT distance increased from 210 m to 255 m, triglyceride decreased from 622 mg/dL to 173 mg/dL, and self-perceived fatigue and depression markedly improved. This nursing experience is shared with nurses caring for patients with similar conditions.

Acupuncture applied as a sensory discrimination training tool decreases movement-related pain in patients with chronic low back pain more than acupuncture alone: a randomised cross-over experiment

BackgroundHigh-quality clinical evidence suggests that although acupuncture appears superior to usual care in the management of chronic low back pain, there is little meaningful difference between true and sham acupuncture....

Interprofessional, simulation-based training in end of life care communication: a pilot study

This paper reports on the process and outcomes of a study, designed to pilot the use of interprofessional, simulation-based training in end of life care communication. Participants comprised 50 final year medicine, nursing, physiotherapy and pharmacy students. Learning methods included observation of role play and facilitated, interactive group discussion. A Likert scale rating questionnaire was used to evaluate the impact of the learning experience. Evaluation data revealed that students were supportive of interprofessional learning and could recognise its benefits. The results indicated self-perceived improvements in knowledge, skills, confidence and competence when dealing with challenging end of life care communication situations. Comparison of pre- and post-intervention scores revealed a statistically significant positive change in the students' perceptions about their level of knowledge (Z = −5.887, p = 0.000). The reported benefits need to be balanced against design and delivery issues that proved labour and resource intensive. Economic evaluation is worthy of further consideration.

The introduction and the validation of a surgical encounter template to facilitate surgical coaching of gynaecologists at a metropolitan tertiary obstetrics and gynaecology hospital

At a metropolitan tertiary obstetrics and gynaecology hospital some gynaecologists identified a need for surgical coaching. Full-time specialists in a teaching hospital are expected to teach surgery whilst having limited access to improving their own surgical skills. Over time, this resulted in some degree of technical deskilling. This in turn led to a loss of confidence in their technical ability to perform complex procedures. The trainee was potentially taught surgery by gynaecologists who were not confident in some aspects of their own surgical skill. A pilot program was introduced to validate a structured surgical encounter template to facilitate surgical coaching in a dedicated regular operating list. There was a high degree of satisfaction amongst participants in the program. Learning objectives were predominantly related to acquisition of psychomotor skills, but cognitive and affective skills were also identified. Participants felt they gained confidence and improved their surgical skill as a result of the program. The descriptive feedback validated the structured encounter template in facilitating the learning and teaching environment in the operating room. Most participants expressed an intention to adopt a more structured approach in their surgical teaching. A structured surgical coaching template used in a surgical coaching program facilitated short-term self-perceived improvement in surgical skill and confidence. Participants also expressed an intention to introduce a more structured approach in their teaching. The structured programme using the encounter template may have a potential role in remediating a surgeon identified as an outlier by a credentialing body.

Conversion of Arthrodesis to Total Hip Arthroplasty: Clinical Outcome, Complications, and Prognostic Factors of 21 Consecutive Cases

Although the results of hip arthrodesis compare favorably with those of total hip arthroplasty (THA) in younger patients, long-term consequences such as osteoarthritis of the neighboring joints may necessitate conversion of the arthrodesis to THA. The purpose of the present study is to assess mid-term clinical outcome and self-perceived improvement in patients who underwent conversion at our department. Secondary aims were incidence of complications and association between patient characteristics and characteristics of the fusions with the outcome of the procedure. The study sample comprised 21 cases in 20 patients. Minimum follow-up was 3years (mean, 8 ± 6.5years) in 20 cases. Thirteen patients had surgical hip fusions and 7 (8 hips) had nonsurgical fusions. Mean age at the time of conversion was 58.5years. Nineteen out of 21 cases had functioning implants at the latest follow-up visit. According to the Merle d'Aubigné scale, outcome was considered excellent, very good, or good in 15 cases. Lower back pain was reduced in all patients. All but two patients were satisfied after the conversion. The main complications observed included incomplete removal of bone block, intra-operative fractures, dislocation and damage to the femoral artery. Time to conversion and type of fusion had no significant correlation with the clinical outcome. Conversion THA is a challenging but successful procedure according to the mid-term clinical outcome observed. Our study suggests that, prognostic factors should be used with caution when establishing indications and post-surgical expectations.

Cochlear implantation for unilateral deafness with and without tinnitus: A case series

To investigate cochlear implantation (CI) in patients with unilateral deafness with and without tinnitus. Prospective case series of patients undergoing cochlear implantation for unilateral deafness and tinnitus in a tertiary academic unit. Nine postlingually deafened subjects with unilateral hearing loss, with and without tinnitus ipsilaterally, and functional hearing in the contralateral ear were implanted with a standard electrode. Speech perception in noise was tested using the Bamford-Kowal-Bench presented at 65 dB SPL. The Speech, Spatial, and Qualities (SSQ) of Hearing Scale was used to evaluate the subjective perception of hearing outcomes, and the Tinnitus Reaction Questionnaire assessed the effect on tinnitus. All patients were implanted with the Med-El Flex soft electrode, Innsbruck, Austria. They are regularly wearing the speech processor and find it beneficial in improving their ability to hear, particularly in noise. Decrease of tinnitus perception and an improvement of sound localization sounds were also reported by these patients. In our case series, CI was successful for all nine patients, with improvement of speech recognition in noise, self-perceived improvement of hearing, and for tinnitus control. Several factors such as deafness duration, age of deafness onset, the presence of residual hearing, patient motivation, and the rehabilitation intensity need to be further investigated in order to understand their impact on performance after implantation. 4.

Relationship Between Camp Attendance and Self-Perceptions in Children With Chronic Health Conditions: A Meta-Analysis

A meta-analysis examined the association between camp attendance and changes in self-perceptions in children with chronic health conditions. Studies using quantitative methods to assess changes in self-perceptions while attending camps designed for children with chronic health conditions were included in analyses. A random-effects model was used, and Cohen's d was used to calculate effect sizes at both post-camp and follow-up. Some potential moderators of effects were examined (i.e., type of measure of self-perceptions, children's chronic health condition, camp components). 31 studies were included in the analyses. Children experienced small, but statistically significant, improvements in self-perceptions at both post-camp (d = .25, 95% CI [.16-.34]) and extended follow-up (d = .15, 95% CI [.05-.26]). This relationship was moderated by type of measure of self-perceptions and child health condition. Camp attendance is associated with small improvements in self-perceptions for children with some chronic health conditions.

Pedlar inexpensive ergometer-based exercise program improves activity intolerance in a heart failure case

This paper reports on the efficacy of a pedlar inexpensive ergometer-based structured exercise program in improving activity intolerance in a heart failure case. Data were collected between May 15, 2010 and May 20, 2010 using physical assessments, observations, and interviews. Several home visits were conducted after hospital discharge until August 8. Health problems identified included disease-related weakness, inability to complete daily activities, activity intolerance, malnutrition, and ineffective tissue perfusion. In addition to providing nutrition and dietary guidance, we designed an exercise rehabilitation program to improve activity intolerance both during hospitalization and after hospital discharge. Outcome measurements included the six-minute walk test, blood pressure, heart rate, oxygen saturation, and self-perceived improvement. Improvements achieved by the 12th week of the exercise training program included: (1) Able to complete the six-minute walk test (initially unable). (2) Walking distance increased by 54 meters. (3) Target heart rate achieved 40-60% of the maximum heart rate. (4) Resting systolic blood pressure and heart rates decreased tremendously, and (5) Fatigue and shortness of breath improved greatly. Results indicate the pedlar inexpensive ergometer exercise program may help improve the health of heart failure cases suffering from activity intolerance.

Assessing therapeutic effectiveness of scalp treatments for dandruff and seborrheic dermatitis, part 1: a reliable and relevant method based on the adherent scalp flaking score (ASFS)

Background: Dandruff and seborrheic dermatitis (D/SD) are common and troublesome scalp conditions with the primary signs and symptoms being presence of skin flakes, pruritus, a tight feeling, and sometimes erythema. Aim: To demonstrate the reliability and relevance of a clinical model for the assessment of therapeutic efficacy of a treatment using the Adherent Scalp Flaking Score (ASFS) method to quantitate the flaking severity. Methods: Six randomized, double-blind, parallel design studies were conducted in either North America or Asia with subjects suffering from dandruff using the ASFS grading method before and after a 3-week test product treatment period. Results: Treatment with a commercial potentiated 1% zinc pyrithione (ZPT) shampoo resulted in statistically significant (p < 0.0001) improvements in total ASFS compared with the placebo cosmetic shampoo. Results were consistent across all studies, geographies, and product usage protocols (controlled on-site versus home use conditions), and were associated with statistically significant improvements in self-perception of scalp condition. Conclusion: The ASFS-based clinical model was demonstrated to be a reliable and proven methodology to assess the effectiveness of widely used anti-dandruff treatments. The results are consistent with patient self-assessments, establishing this methodology as relevant to patient perception of product benefits.

Management of acute and chronic migraine

We highlight the recent clinical trials for the management of acute and chronic migraine. In women with menstrual migraine, triptans seem to be well tolerated irrespective of whether or not patients are taking oestrogen-containing contraceptives or have comorbidities that indicate increased cardiovascular risk. The new acute drug, telcagepant, a calcitonin gene-related peptide (CGRP) antagonist, is safe for long-term use (up to 18 months) in migraine patients with stable coronary artery disease in whom the use of triptans is not advisable. From the pooled analysis of the two Phase III Research Evaluating Migraine Prophylaxis Therapy studies of onabotulinumtoxinA (BOTOX) in chronic migraineurs, it clearly emerged that efficacy increases overtime (up to 56 weeks) and paralleled self-perceived improvement in quality of life. Effectiveness was also observed in patients with severely disabling headaches, who met criteria for triptan abuse and were refractory to several prophylactic treatments. Finally, combination of preventive pharmacological agents with different action mechanisms may be the next frontier in therapeutic advancements for treating migraine. Although triptans are safe and well tolerated, CGRP antagonists may be an option for nonresponsive patients or those in whom the use of triptans is not advisable. New drugs and combinations of old therapeutic options may help patients with severe forms of headache.

Characteristics of Alcoholics Attending ‘Clubs of Alcoholics in Treatment’ in Italy: A National Survey

To provide an overview of alcoholics attending a socio-ecological treatment programme [Clubs of Alcoholics in Treatment (CATs)] and to identify factors associated with abstinence and self-perceived improvement in lifestyle. A national sample of 7522 subjects (76% males and 24% females, mean age 53.2 ± 11.3 years ± SD) attending CATs was evaluated using a self-administered questionnaire completed at a weekly meeting in 2006. Of participants, >70% reported no alcohol use in the last year and around 90% indicated no use in the previous month, whereas 4% of them declared no alcohol use before club attendance. Abstinence and lifestyle improvement were related positively to the number of years of club attendance but negatively to the presence of other problems in addition to the alcohol-related one. Moreover, being older or female was associated with more likely achievement of abstinence as well as with the perception of a better lifestyle. Finally, attending the club with one or more family members was associated with achievement of better lifestyle. These data provide an overview of alcoholics attending the CAT programme and are a first step toward developing a surveillance system. In addition, on the basis of this preliminary picture further research (notably longitudinal studies) can be planned considering this method and its effectiveness.

Measured Neurological Improvements Correlate with Self-perceived Improvements After Stroke

Important advantages of neurologic impairment scales after stroke include measurements of within-subject changes over time starting at baseline. We compared percent improvement on the National Institutes of Health stroke scale (NIHSS) to stroke outcome that seems tangible to patients and caregivers: their perceived percent improvement. We prospectively measured improvement on the NIHSS between baseline and 3 to 6 months in consecutive patients with acute stroke presenting within 48 hours after onset. Unaware of the measured result, patients and caregivers were asked to estimate their perceived overall improvement since baseline assessment at the time of enrollment. We excluded patients with baseline NIHSS <3, clear improvement before screening, coma, brain herniation, or intraventricular hemorrhage. Of 40 enrolled patients, 9 died, 5 could not return for reevaluation, and the remaining 26 were reevaluated and analyzed. Median time from stroke onset to enrollment was 19.5 hours (range 2-45) and the median baseline NIHSS score was 8 (range 3-31). The measured improvements on the NIHSS ranged between 12.5% and 100% and correlated moderately (Spearman rank coefficient 0.54) and significantly (P = .005) with the patient- and caregiver-perceived percent improvement. Percent improvement on the NIHSS after stroke correlates moderately and significantly with patient and caregiver perceived overall improvement and appears to be a useful addition to the current functional outcome measures.

823 THE INFLUENCE OF BIOFEEDBACK ON SELF-ESTEEM IN CHILDREN WITH DYSFUNCTIONAL VOIDING: A PROSPECTIVE RANDOMIZED CONTROLLED TRIAL

INTRODUCTION AND OBJECTIVES: The objective of the present study was to evaluate the impact of biofeedback with validated, standardized questionnaires regarding perception of self-esteem as well as urinary symptoms in children referred with dysfunctional voiding. Children included in the study had a diagnosis of dysfunctional voiding, EMG activity during voiding phase of flow curve, and lower urinary tract symptoms. METHODS: Ninety seven patients were screened to enroll sixty patients which where then the distributed into two experimental groups via computer randomization: 1) the study group completed the questionnaires, history and flow rate prior to receiving biofeedback and received biofeedback the following week; 2) the control group completed the same questionnaires, history and flow rate at the initial visit and six weeks later prior to receiving biofeedback (delayed treatment group). All patients where then re-evaluated after six biofeedback sessions. Self perception domains were analyzed with the Self-Perception Profile for Children and Behavior Assessment Scale for Children questionnaires. RESULTS: No significant differences where seen in baseline characteristics (age, gender, history of UTI, reflux, constipation or anti-cholinergic therapy) or questionnaire scores. Patients undergoing biofeedback (study group) had significant and clinically relevant improvement (based on previous self-perception studies) and in total dysfunctional voiding scores (P 0.001), social acceptance (P 0.012), social stress (P 0.022), and self esteem (P 0.034). CONCLUSIONS: This is the first randomized controlled study to show that biofeedback significantly improves self-esteem and social acceptance, while significantly decreasing social stress in children with dysfunctional voiding. The current results suggest that continued use of biofeedback has a positive impact on urinary function, which translates into improvement in self-perception.

Awareness among Indian dentist regarding the role of physical activity in prevention of work related musculoskeletal disorders

The prevalence of work-related musculoskeletal complaints in dentists is high and the past two decades have witnessed a sharp rise in the incidence of various disorders. The prevalence of musculoskeletal pain ranges between 64% and 93%. The most effected regions have been back and neck. Various studies have been done to record stress levels and health-related behaviors of dentists in other countries but limited data is available among the Indian dentists. Therefore a questionnaire survey was carried out among 102 Indian dentists belonging to different fields having at least one musculoskeletal disorder in last 6 months. The total sample consists of 80 males and 22 females. Out of the 102 over 97 of dentists had sought medical advice for these disorders during the previous 06 months and 74 of them also consulted the physiotherapist for exercises and ergonomic advice. The number of sessions taken for regular physical exercises was minimum 6 till 44 the most. The percentage of improvement in symptoms varied between 20% and 80%. A significant direct correlation between the number of sessions taken for physical activity and the self-perceived improvement in the symptoms was found using the Pearson correlation test. The work-related musculoskeletal disorders among dentists not only decrease their efficiency but also is a major concern among them. Self-awareness and benefits of regular exercise is the need of the hour.

Long-term Follow-up of Patients with Spasmodic Dysphonia Repeatedly Treated with Botulinum Toxin Injections

ABSTRACT Adductor spasmodic dysphonia (SD) is a focal laryngeal dystonia mainly resulting in a strained voice quality with spastic voice breaks and frequency shifts, perturbing fluency and intelligibility. SD-patients report unusually high impairment of their quality of life. The standard treatment is botulinum toxin injection in the thyroarytenoid muscles, in order to interfere with the perturbed sensory feedback loop of kinetic muscle tension regulation. The globally favorable effects are temporary, but the botulinum injections can be repeated. There is a lack of information about long-term effects. This is the first study investigating effects over several years, and comparing self-evaluation of patients with objective multimodal acoustic analysis. Results show that 72% of the individual injections are successful. The effects of botulinum are not reduced after repeated injections. In contrary, the self-perceived improvement increases in average over time. When self-evaluations preinjection are considered, patients tend to evaluate their voice and their handicap as worsening over time. This contrasts with the results of multimodal acoustic analysis. Objective data reveal a relative stability over time for as well pre- as postinjection. This seems to indicate that there is no shift over time in the objective severity of deviance in voice quality.

Correlation of a Patient Satisfaction Questionnaire with Standard Outcome Instruments: An Analysis of 1,037 Patients

Routine collection of outcomes data after lumbar spine surgery at our institution has revealed, not uncommonly, discrepancies between outcomes instrument scores and patient's self-perceived improvement. For many years we have used the NASS five-item satisfaction questionnaire form, rating patients' satisfaction with results of their spine surgery. Concomittantly we have used well-validated and routine outcomes instruments scores including the Oswestry Disability Index (ODI) and Roland Morris Questionnaire (RM) for all patients undergoing low back spine surgery.

Learning to re-appraise the self during video feedback for social anxiety: Does depth of processing matter?

Video feedback (VF) with cognitive preparation (CP) has been widely integrated into cognitive-behavioral therapy (CBT) protocols for social anxiety disorder (SAD) due to its presumed efficacy in improving negative self-perception. However, previous experimental studies have demonstrated that improvements in negative self-perception via VF+CP do not typically facilitate anxiety reduction during subsequent social interactions – a troubling finding for proponents of cognitive models of social anxiety. We examined whether VF+CP could be optimized to enhance participants’ processing of corrective self-related information through the addition of a post-VF cognitive review (CR). Sixty-eight socially anxious individuals were randomly assigned to perform two public speeches in one of the following conditions: a) exposure alone (EXP); b) CP+VF; and c) CP+VF+CR. Those in the CP+VF+CR condition demonstrated marginally significant reductions in anxiety from speech 1 to speech 2 relative to those who received EXP – an improvement not shown for those in the CP+VF condition. Furthermore, only those who received CP+VF+CR demonstrated significant improvements in self-perception and performance expectations relative to EXP. Decreases in anxiety among participants who received CP+VF+CR relative to EXP were fully mediated by improvements in self-perception. Implications are discussed in the context of cognitive models of social anxiety and mechanisms of exposure-based learning.

Self-perceptions of social function 2 years after pediatric epilepsy surgery

The present qualitative study explored how participants perceive their quality of life within the social domain 2 years following epilepsy surgery. Semistructured, open-ended interviews were conducted with 27 participants (11–21 years old), 2 years following epilepsy surgery. Thirteen of the 27 participants were seizure free. Data were transcribed and coded inductively to allow for the identification of salient themes. Many of the seizure-free participants reported greater independence following surgery. However, most participants, irrespective of seizure status, continued to report some problems with peer relations and isolation. These findings suggest that self-perceived improvements in social function among seizure-free participants may require longer than 2 years to develop.

A Multifaceted Inter-Specialty Approach to Teaching Advanced Airway Management

Objective: Our aim was to establish a multifaceted interspeciality advanced airway training program for residents using multiple teaching methods, including lectures, animal models, and simulation scenarios. Methods: 41 residents in Otolaryngology, General Surgery, Anesthesia, and Emergency rotated through seven stations, each representing a teaching objective in airway management. Residents completed a pre and post questionnaire about their level of skill and knowledge of airway management. Results: The mean pre-post difference calculated showed a self-perceived improvement in skill and knowledge in all topics covered (p<.05), namely cricothyroidotomy, emergency tracheostomy, controlled open tracheostomy, fiberoptic bronchoscopic intubation, laryngoscopic video-assisted intubation and management of the pediatric airway. The majority rated the course highly in terms of usefulness and all would recommend the course to their colleagues. Conclusion: The multifaceted interspecialty course was well received by all residents. Self-perceived improvement was found for all topics covered. The interspecialty aspect allowed improvement in communication and professionalism.