ABSTRACT
OBJECTIVE: To quantify visual estimation inaccuracies of infant emesis by parents and caregivers (P/Cs) and health care professionals (HCPs). METHODS: A single-blinded survey was performed in which P/Cs and HCPs visually estimated predetermined volumes of simulated emesis spilled on receiving blankets or pyjamas. RESULTS: HCPs' estimations of volumes 1 and 3 were 150.4% and 145.1%, respectively, of the actual volumes, and their estimations of volumes 2 and 4 were 81.9% and 85.8%, respectively, of the actual volumes. This was, on average, significantly more accurate than the P/Cs' estimations (P<0.001 to P=0.002), which ranged from 130.4% to 275.7% of the actual volumes. CONCLUSION: P/Cs and HCPs were, on average, highly inaccurate at visually estimating simulated emesis volume, an important consideration when making clinical judgments based on these estimations. In addition, HCPs now have an evidence-based tool to use in their practice when reassuring and counselling anxious parents.
OBJECTIF: Quantifier les inexactitudes d'évaluation d'émésie des nourrissons par les parents et les personnes qui s'occupent d'eux (PPO) ainsi que par des professionnels de la santé (PdS). MÉTHODOLOGIE: Les chercheurs ont procédé à un sondage à simple insu au cours duquel des PPO et des PdS ont estimé visuellement des volumes prédéterminés d'émésie simulée sur des couvertures ou des pyjamas. RÉSULTATS: Les PdS ont évalué les volumes 1 et 3 à 150,4 % et à 145,1 % des volumes réels, respectivement, et les volumes 2 et 4 à 81,9 % et à 85,8 % des volumes réels, respectivement. En moyenne, ces réponses étaient considérablement plus précises que celles des PPO (P<0,001 à 0,002), qui se situaient entre 130,4 % et 275,7 % des volumes réels. CONCLUSION: En moyenne, les PPO et les PdS sont très imprécis lorsqu'ils évaluent visuellement un volume d'émésie simulée, une considération importante lorsqu'on pose des jugements cliniques selon ces estimations. Par ailleurs, les PdS possèdent désormais un outil probant à utiliser dans leur pratique lorsqu'ils rassurent et conseillent des parents anxieux.
ABSTRACT
Eighty-six participants wishing to stop benzodiazepine and who met DSM-IV (Diagnostic and Statistical Manual of Mental Disorders, 4th ed. American Psychological Association, 1994) criteria for anxiety disorder or insomnia were assessed pre- and post-taper on clinical, pharmacological and psychosocial measures. An initial cohort of 41 participants received treatment as usual (taper only) plus physician counselling in the same clinic setting. A second cohort of 45 participants were randomly allocated to group cognitive-behavioural therapy (CBT) plus taper, or group support (GS) plus taper. At 3 months follow-up, the outcomes in both the CBT and the GS subgroups were equivalent. Intention to treat analysis revealed a slight advantage to the CBT over the GS group and the CBT group showed higher self-efficacy post-taper.Over all 86 participants, a high-baseline level of psychological distress, anxiety and dosage predicted a poor outcome, but increase in self-efficacy contributed to a successful outcome particularly in those with initially poor baseline predictors. Although there was a decrease in positive affect during preliminary stages of tapered discontinuation compared to baseline, there was no significant overall increase in negative affect.
Subject(s)
Anti-Anxiety Agents/therapeutic use , Anxiety Disorders/drug therapy , Cognitive Behavioral Therapy/methods , Diazepam/therapeutic use , Sleep Initiation and Maintenance Disorders/drug therapy , Adult , Anti-Anxiety Agents/adverse effects , Anti-Anxiety Agents/pharmacology , Anxiety Disorders/chemically induced , Cohort Studies , Diazepam/adverse effects , Diazepam/pharmacology , Dose-Response Relationship, Drug , Drug Administration Schedule , Female , Follow-Up Studies , Humans , Intelligence/drug effects , Longitudinal Studies , Male , Middle Aged , Predictive Value of Tests , Psychotherapy, Group/methods , Self Efficacy , Sleep Initiation and Maintenance Disorders/chemically induced , Stress, Psychological/chemically induced , Substance Withdrawal Syndrome , Treatment Outcome , Young AdultABSTRACT
The efficacy of a new cognitive-behavioral group program to help discontinuation of benzodiazepines (PASSE) was evaluated by comparison to a group receiving only social support. Both programs lasted 20 weeks commencing with a preparatory period of one month and then tapering continually during 16 subsequent weeks until discontinuation. Forty-eight participants (24 in each condition) with a diagnosis of anxiety disorder took part in the study. These two active conditions were compared with a separate group of 41 people receiving standard tapering with physician counselling only. The results post-treatment supported the hypothesis that those receiving either of the two active treatments succeeded better in discontinuing benzodiazepines than those receiving the standard treatment. Among those completing the two active programs there was no difference in outcome between the social support and the cognitive behavioral (PASSE) group. However, when the rate of dropout was considered, the cognitive-behavioral group proved significantly superior than the social support group. The results suggest that a cognitive-behavioral program can help people wishing to discontinue benzodiazepines to psychologically tolerate the immediate effects of discontinuation.
