A Comparison of Nonpharmacologic Interventions on the Emotional State of Children in the Emergency Department.

OBJECTIVES: The majority of children and adolescents presenting to the emergency department are in pain and require painful procedures. This randomized study was to investigate the efficacy of 3 different nonpharmacologic interventions (clowns, dogs, and musicians) to reduce pain and analyze the perception of positive and negative affects after the presence of these activities in a short-stay observation unit (SSOU). METHODS: Participants were composed of 105 children (54 boys and 51 girls; aged 3-16 years) assigned randomly to an experimental group (N = 57) that was composed of patients who were present in the SSOU. They received one of the following nonpharmacologic interventions: clowns (n = 18), dogs (n = 24), or musicians (n = 15) or they were assigned to a control group (CG) (N = 48) that consists of the patients who were present in the SSOU without the presence of nonpharmacologic interventions. RESULTS: Differences among the groups did not emerge; in fact, the 3 interventions have a similar influence in a different way on a child's well-being. No significant main effect about pain emerged for both groups across age and sex. CONCLUSIONS: The presence of different nonpharmacologic interventions (clowns, dogs, and musicians) seemed to empower positive affect in children but did not influence the self-reported pain.

Key factors in psychotherapy training: an analysis of trainers', trainees' and psychotherapists' points of view.

The literature on clinical training lacks identifications of the factors that are most relevant in training programs; accordingly, the main aim of this work is to fill this research gap by assessing which factors that trainers, trainees and psychotherapists consider most relevant in psychotherapy training programs. A secondary aim is to identify whether these factors differ among trainers, trainees and psychotherapists. An ad hoc questionnaire was created and administered at 24 psychotherapy schools from 14 institutions; the sample included 641 trainees, 172 trainers and 218 psychotherapists of various theoretical orientations. The questionnaire included 63 items and used a 5-point Likert scale. An exploratory factor analysis was completed to identify the latent structure. The reliability of the dimensions was then checked. Finally, an analysis of variance and a multivariate analysis of variance were completed to achieve the study's aims. Four factors emerged from the study's results: trainers' relational characteristics, supervision, transmission of clinical know-how, and theoretical background and technical support. All these factors displayed acceptable reliability and internal consistency. Moreover, their relative rankings varied based on the participants' roles and theoretical backgrounds. This study's results indicate that the new instrument's psychometric qualities are acceptable. It thus could be used to develop a new approach to psychotherapy training, as this study's results regarding trainees' needs underline the differences between trainees' perceptions of those needs, as compared to trainers' and psychotherapists' perceptions.

A pilot study of the Italian adaptation of the Session Evaluation Questionnaire fourth version.

The Session Evaluation Questionnaire (SEQ) measures the impact of counselling and psychotherapy sessions; it may be conceived as a bridge between psychotherapy process and outcome. Even if the original American SEQ has been translated into many languages, only a few translations have been validated. This is a pilot study that attempted to replicate the five-dimensional structure of the fourth version of the Anglo-American SEQ, for the Italian population. The SEQ is a self-report tool asking patients about their experience with the clinical session just ended; it consists of 27 adjectives in semantic differential scale, divided into three thematic parts: evaluation of the session itself, feelings after the session, and evaluation of the therapist. Data were collected on 111 outpatients attending the Dynamic Psychological Service for University Students, after their first two clinical interviews. Exploratory factor analyses were performed on each of the three parts of the SEQ. Results confirmed the original factorial structure, for Depth, Smoothness, Positivity and Arousal dimensions; Good Therapist dimension overlapped perfectly with the original one. The Italian SEQ showed adequate internal consistency. Convergent validity measured with an index of perceived satisfaction in the counselling process showed significant positive correlations. This pilot study showed that the Italian SEQ is a reliable instrument to measure the impact of clinical sessions. Validation studies are needed, especially to replicate the factor structure of the instrument and to better assess its validity.

Sexual function after modified radical hysterectomy (Piver II/Type B) vs. classic radical hysterectomy (Piver III/Type C2) for early stage cervical cancer. A prospective study.

INTRODUCTION: When cervical cancer is detected at an early stage (International Federation of Gynecology and Obstetrics [FIGO] IA2-IB1), it can be successfully treated by radical surgery alone. Considering that most patients are young and sexually active at the moment of diagnosis and the long life expectancy of survivors after the treatment, quality of life (QoL) and sexual function are important issues for cancer survivors and caregivers. However, only a few studies have examined the QoL and sexual function in disease-free cervical cancer survivors, and there are no studies in the literature comparing prospectively sexual function after different types of radical hysterectomy. AIM: To compare sexual function in two groups of early stage cervical cancer survivors treated by radical surgery alone, undergoing two different types of radical hysterectomy. METHODS: Patients treated by radical hysterectomy with systematic lymphadenectomy for early stage cervical cancer (FIGO IA2-IB1) have been enrolled and divided in two groups with regard to type of radical hysterectomy performed; S1: modified radical hysterectomy (Piver II/Type B), S2: classic radical hysterectomy (Piver III/ Type C2). MAIN OUTCOME MEASURE: Twenty-four months after surgery we assessed the sexual function using the European Organization for Research and Treatment of Cancer Cervix Cancer Module Questionnaire, which is a validated system for the assessment of disease- and treatment-specific issues that affect the QoL and sexual functioning of women who are treated for cervical cancer. RESULTS: Of the 31 patients enrolled in the S1 group and 46 in the S2 group, 23 and 33 patients have been included, respectively. We observed significant differences between the two groups in terms of symptom experience, sexual/vaginal functioning, sexual activity, and sexual enjoyment. There was not any significant difference regarding lymphedema, peripheral neuropathy, and sexual worry. CONCLUSION: Survivors of early stage cervical cancer treated by modified radical hysterectomy (Piver II/ Type B) have a better sexual function than those operated by classic radical hysterectomy (Piver III/ Type C2).

Update on urodynamic bladder dysfunctions after radical hysterectomy for cervical cancer.

INTRODUCTION: Bladder dysfunctions are a common sequela after radical hysterectomy (RH, former type III sec Piver) ranging from 8 to 80%. This discrepancy, probably, reflects the different bladder function evaluation methods utilized in literature. MATERIAL AND METHODS: We searched English-language medical reports published from 1952 to 2010, on MEDLINE. Inclusion criteria were: (1) studies of urological dysfunctions in patients with cervical cancer, treated with type III sec Piver (C2 sec Querleu) radical hysterectomy; (2) use of urodynamic measurement. RESULTS: The overall incidence of urodynamic bladder dysfunctions is 72%. Follow-up >12 months studies report a high incidence of overactive detrusor low compliance (34%). Eight out of 19 studies show a decrease of the maximal urethral closure pressure (MUCP). DISCUSSION AND CONCLUSIONS: Follow-up timing seems to be the major factor influencing the wide range of incidence of bladder dysfunction. Urodynamic data could help physicians to formulate appropriate evaluation and treatment for patients having urge incontinence (UI) after RH.

Quality of life and sexual function after type C2/type III radical hysterectomy for locally advanced cervical cancer: a prospective study.

INTRODUCTION: The introduction of screening programs have made cervical cancer detectable at earlier stages and in younger patients. Nevertheless, only a few studies have examined the QoL and sexual function in disease-free cervical cancer survivors. AIM: The objective of this study is to evaluate the sexual function in a cervical cancer patient's group treated with neoadjuvant chemotherapy (NACT) plus type C2/type III radical hysterectomy (RH). METHODS: We have enrolled in the oncologic group (OG) sexually active patients affected by cervical cancer (stage IB2 to IIIB) treated with NACT followed by RH. MAIN OUTCOME MEASURES: Included subjects were interviewed with the European Organization for Research and Treatment of Cancer (EORTC) QLQ-CX24 Questionnaire. Two consecutive assessments were recorded: at the first evaluation postoperatively (T1) and at the 12-month follow-up visit (T2). Results were compared with a benign gynecological disease group (BG) and with a healthy control group (HG). RESULTS: A total of 33 patients for OG, 37 for BG, and 35 women for HG were recruited. After surgery, sexual activity has been resumed by 76% of the OG patients and 83.7% of the BG patients (P = not significant). Cancer survivors had clinically worse problems with symptom experience, body image, and sexual/vaginal functioning than controls (P < 0.05). OG patients also reported more severe lymphedema, peripheral neuropathy, menopausal symptoms, and sexual worry. For sexual activity, the score difference between cancer survivors and women with benign gynecological disease is not statically significant. Concerning sexual enjoyment assessment, our study shows comparable results for OG and BG. CONCLUSION: Nevertheless, the worsening of symptom experience, body image, and sexual/vaginal functioning, OG patients have same sexual activity and sexual enjoyment data compared with those of BG patients. Thus, NACT followed by RH could be a valid therapeutic strategy to treat and improve well-being especially in young cervical cancer patients.