Metabolic Syndrome in Dutch Patients With Bipolar Disorder: A Cross-Sectional Study.

OBJECTIVE: To characterize the prevalence of metabolic syndrome (MetS) among Dutch patients with bipolar disorder (BD), identify factors associated with MetS, and estimate the rate of pharmacologic treatment of MetS in this population. METHODS: A cross-sectional analysis of medical records of adult patients (≥ 18 years) with BD receiving psychotropic drug treatment was performed in a Dutch psychiatric outpatient setting. MetS was determined according to National Cholesterol Education Program Adult Treatment Panel III-Adapted (NCEP ATP III-A) criteria. Data collection via review of medical records from 2015 was conducted in 2016. RESULTS: The prevalence of MetS in the sample (N = 71) was 42.3%. Multivariate analysis showed sex and body mass index were independently associated with MetS. Males had an almost 8-fold higher risk of MetS than females (OR = 7.7, 95% CI, 1.5-39.6), and with every point of increase on BMI, the risk of MetS increased by 40% (OR = 1.4, 95% CI, 1.2-1.8). Of the patients with hyperglycemia, hypercholesterolemia, and hypertension, 81%, 72.4%, and 65.0%, respectively, did not receive drug treatment for these conditions. CONCLUSIONS: The study found a high prevalence rate of MetS and substantial undertreatment of the components of MetS in patients with BD in a Dutch outpatient clinic. Follow-up investigation in larger samples is warranted.

Development and testing of an analytic rubric for a master's course systematic review of the literature: A cross-sectional study.

Background: Conducting grading of systematic reviews in master's level programs of health sciences education is a complex process. Students conduct systematic reviews under the supervision of course faculty in seminar groups where both draft version and definite version of the literature review are graded/assessed. The aim of this study was to develop a systematic review of the literature rubric (SRL-rubric) for the evaluation of systematic reviews in the course of SRL in a master's Program of Health Care Sciences and to investigate students and faculty experiences with and the usability of the SRL-rubric. Methods: The SRL-rubric was developed using a seven-step approach. Usability was investigated with cross-sectional survey. Results: The SRL-rubric included nine categories and five proficiency levels. Fifty-two of 59 students and all six faculty members at Utrecht University Program of Health Care Sciences completed the survey. Students rated the ease of working with the rubric with an average 6.6 (10-point scale). Faculty ratings ranged from 7 to 9. Problems were identified with distinction among cells describing proficiency levels and final grading. Discussion: A structured process focused on the requisite actions to develop the SRL-rubric. It was useful in writing and grading systematic reviews. However, some students indicated that they missed specific feedback and suggestions describing how to improve their weaknesses. Further development and research is needed to enhance grading reliability of SLR-rubric and to establish content validity and maintain consistency with criteria for conducting and reporting reviews.

From judgment to understanding: mental health nurses' perceptions of changed professional behaviors following positively changed attitudes toward self-harm.

Nurses experience feelings of frustration, anger and fear when caring for patients who self-harm. Training programmes were developed that aimed to positively influence nurses' knowledge, attitudes and skills. The aim of this study was to investigate professional behavior of mental health nurses with positively changed attitudes after following a training program. Using grounded theory, semi-structured interviews were conducted with 11 mental health nurses. Participants reported using less restrictive interventions, being more patient oriented, and choosing a more empathic and exploratory approach after the training. A work environment conductive to making autonomous professional decisions with supportive colleagues enabled these changes.

Patients with anorexia nervosa who self-injure: a phenomenological study.

PURPOSE: This study investigates self-injury from the perspective of patients with anorexia nervosa. DESIGN AND METHODS: A phenomenological design was used. Twelve patients participated. Data were collected using a semi-structured interview guide. FINDINGS: Participants display self-injurious behavior predominantly in situations when they are forced to eat. They are terrified of gaining weight and use self-injurious behavior to cope with their anxiety. Self-injury is envisioned as a technique to regain control of their own eating pattern without bothering anyone. They feel shame for not controlling their emotions more constructively. PRACTICE IMPLICATIONS: Healthcare professionals should systematically observe signals and explore less harmful strategies that help to regulate overwhelming feelings.

Sexuality of patients with chronic heart failure and their spouses and the need for information regarding sexuality.

BACKGROUND: Psychological and physiological effects of chronic heart failure (CHF) can influence sexuality. Both CHF patients and their partners may experience changes and have questions about sexuality. Despite this, healthcare professionals give little information regarding sexuality. This may be due to the paucity of literature describing patients' concerns and questions about sexuality and CHF. AIMS: The aims of this study were to describe the sexuality of patients and their partners and to describe their needs for information regarding sexuality. METHODS: A prospective, descriptive cross-sectional design was used. A convenience sample was obtained in three hospitals (Belgian and the Netherlands). Patients and partners completed two questionnaires: Sexual Adjustment Scale (SAS) and the Needs of Sexual Counseling Scale for Chronic Heart Failure (NSCS-CHF). RESULTS: There were 52 patients and 32 partners who participated in the study. No or slight disturbance was seen in sexual discussions and intimacy. Marked or serious disturbance was reported in sexual activity. A mixed profile was seen in sexual performance, sexual interest and sexual pleasure. The majority of patients with CHF and their partners want information regarding sexuality. The NSCS-CHF clearly identified the information needs of patients and partners and most needs concerned the areas of symptoms, the relationship and relaxation. CONCLUSION: The questionnaires were easy to complete and changes in sexuality and information needs were identified. The NSCS-CHF needs further validation as a research instrument. Healthcare professionals can use both questionnaires to bring up the topic of sexuality and to identify topics that require further discussion or counselling with patients and partners.

Educational intervention for patients with head and neck cancer in the discharge phase.

PURPOSE: The consequences of head and neck cancer (HNC) treatment have great impact on patients' lives. Despite the importance of preparing patients for the period after discharge, patients frequently experience a lack of information. Aims of the study were to develop a nurse-led educational intervention to provide information during a discharge interview and to investigate the effects of the intervention on informational needs and satisfaction with information in HNC patients. METHODS: A total of 48 patients participated in this quasi-experimental study. The control group (n = 26) received standard care, which included a short interview using the patients' discharge letter dictated by the nurse. The intervention group (n = 22) received the educational intervention, namely a discharge interview where trained nurses used a checklist to inform patients about: general information, wound-care, physical-social problems, work and finances. Effects associated with discharge interview were measured with the Patient Information Need Questionnaire (PINQ) and the Satisfaction with Cancer Information Profile. RESULTS: The findings showed that patients need information concerning: illness, treatment, side-effects, physical fitness, impact on functioning, duration of recovery time and impact on quality of life. The educational intervention had no significant effect on the informational needs or the level of satisfaction with information. CONCLUSIONS: A nurse-led intervention to provide discharge information was developed however no effects on patient outcomes were found. Nurses need to use an instrument to assess the informational needs of patients prior to the discharge interview. The effects of the educational intervention need to be tested in a larger group of patients.

Regained control: a phenomenological study of the use of a relapse prevention plan by patients with a bipolar disorder.

PURPOSE: To explore the lived experiences with the development and use of a relapse prevention plan by patients with a bipolar disorder. DESIGN AND METHODS: In this phenomenological study, we conducted unstructured interviews. Colaizzi's data analysis method was used. FINDINGS: The relapse prevention plan was perceived to provide a guide for patients to regain control over their lives and develop self-management skills. Contact with relatives and the match with the professional were critical facilitating factors. PRACTICE IMPLICATIONS: Professionals can draw upon the patient's experiential knowledge as an important source that guides clinical practice and decision-making.

Integrating preconceptional care into an IVF programme.

AIM: This paper is a report of a mixed method study of the outcomes of integrating preconceptional care into an in-vitro fertilization programme on nurses' and patients' attitudes and patients' weight and smoking behaviour. BACKGROUND: Increasing evidence points to the significant effect of lifestyle factors on in-vitro fertilization outcomes. Optimizing the health of couples before they commence in-vitro fertilization may improve the chance of achieving success. METHOD: In 2007, 130 couples attending a university hospital in-vitro fertilization unit and seven nurses were invited to participate in the study. Questionnaires were developed to assess the attitudes of both patients and nurses. Furthermore, the impact of interventions on body mass index and smoking patterns were evaluated. RESULTS: All nurses (n = 7) and 101 patients (77·7%) returned completed questionnaires. Analysis revealed a considerable degree of scepticism among the nurses at the outset as to the value of the programme and their ability to perform their new role effectively. Patients valued positively the increased attention to adjusting lifestyle factors with the goal to improve fertility outcomes. Of those participants who smoked or had a body mass index >30, 30% (n = 7/23) of the patients quit smoking and 50% lost weight (n = 15/30), mean loss: 6·1 kg. CONCLUSION: Fertility nurses can play a key role in the provision of preconceptional care. Patients with a fertility problem can be motivated to address lifestyle issues before embarking on in-vitro fertilization treatment. The integration of preconceptional care and lifestyle interventions was shown to be feasible in our clinical setting.

Health and social needs of traumatized refugees and asylum seekers: an exploratory study.

PURPOSE: The purpose of this study was to describe the care needs of adult traumatized refugees and asylum seekers. DESIGN AND METHODS: A mixed-methods design was used. A survey was conducted using the Camberwell Assessment of Need (CAN) among 30 patients. Semistructured in-depth interviews were subsequently conducted with eight of these patients. FINDINGS: Key themes among refugees are loneliness and grief. Refugees are in severe psychological distress. They also encounter all kinds of practical problems that influence their quality of life. Furthermore, many of them suffer from serious psychiatric and trauma-related problems. PRACTICE IMPLICATIONS: The results of this explorative study can contribute to the quality of care for traumatized refugees.

The effects of music on physiological responses and sedation scores in sedated, mechanically ventilated patients.

AIMS AND OBJECTIVES: A pilot study designed as future randomised controlled trial was carried out to determine the effects of music on physiological responses and sedation scores in sedated, mechanically ventilated patients. BACKGROUND: Mechanically ventilated ICU patients, even when receiving intravenous sedatives, may experience stress and anxiety. One possible intervention to reduce stress and anxiety is listening to music. DESIGN: A randomised controlled trial design with repeated measures was used. METHODS: Data were collected over a six-month period in 2006. Twenty subjects were randomly assigned to either the experimental or control group. Subjects in the experimental group listened to music three times for 30 minutes over two days; subjects in the control group undertook three 30 minute rest periods. Physiological effects of music on systolic, diastolic and mean arterial blood pressure and heart and respiratory rate were assessed. Sedation scores were also measured. RESULTS: Physiological parameters did not show a significant difference between the groups. Patients in the experimental group showed significantly higher Ramsay (sedation) scores than patients in the control group after the first session. The higher scores indicate that patients were less responsive to external stimuli. CONCLUSION: Our results suggest that listening to music leads to higher sedation scores in sedated, mechanically ventilated ICU patients. No significant decreases in physiological parameters were observed. Listening to music showed no negative changes in the condition of these patients. Future research should focus on the use of other measures, such as stress hormones, to assess stress in sedated, mechanically ventilated ICU patients. RELEVANCE TO CLINICAL PRACTICE: For the sedated, mechanically ventilated ICU patient, the benefit of music may lie in the associated (deeper) level of sedation that is achieved, which in turn may make the patient less susceptible to stress and anxiety.

Filling up the hours: how do stroke patients on a rehabilitation nursing home spend the day?

OBJECTIVE: To describe the time use of stroke patients on rehabilitation units of a nursing home focusing on the time spent on therapeutic activities, non-therapeutic activities, interactions and the location wherein these took place. DESIGN: A descriptive study. SETTING: Rehabilitation units of a nursing home. SUBJECTS: Seventeen chronic stroke patients, including 9 men, 8 women, with a mean age of 77 years (SD +/- 7.6 years). MAIN MEASURES: Daily activities of patients were measured using Behavioural Mapping, including therapeutic activities, non-therapeutic activities, interactions and their location. Functional status was measured with the Barthel Index. RESULTS: Of the patients 15 (88%) were partly/fully paralysed, with a mean Barthel Index score of 9.4 (SD +/- 4.3). The patients spent 20% of the day on therapeutic activities, whereas 80% of the day was spent on non-therapeutic activities; 9% on therapeutic activities with the nurse. For 60% of the day patients were alone and not interacting with others. CONCLUSIONS: Stroke patients spend only short periods of time during the day on therapeutic activities. For the largest part of the day, the patient is alone and passive. A challenge for nurses is how to activate patients and engage them in purposeful task-oriented training in daily activities.

Withdrawal symptoms in critically ill children after long-term administration of sedatives and/or analgesics: a first evaluation.

OBJECTIVE: To establish frequencies of benzodiazepine and opioid withdrawal symptoms, and correlations with total doses and duration of administration. DESIGN: A prospective, repeated-measures design. SETTING: Two pediatric intensive care units in a university children's hospital. PATIENTS: Seventy-nine children, aged 0 days to 16 yrs, who received intravenous midazolam and/or opioids for >5 days. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: Pediatric intensive care unit nurses assessed withdrawal symptoms using the Sophia Benzodiazepine and Opioid Withdrawal Checklist, which includes all withdrawal symptoms (n = 24) described in the pediatric literature. Over 6 months, 2188 observations in 79 children were recorded. Forty-two percent of observations were performed within 24 hrs after tapering off or discontinuation of medication. Symptoms representing overstimulation of the central nervous system, such as anxiety, agitation, grimacing, sleep disturbance, increased muscle tension, and movement disorder, were observed in >10% of observations. Of symptoms reflecting gastrointestinal dysfunction, diarrhea and gastric retention were most frequently observed. Tachypnea, fever, sweating, and hypertension as manifestations of autonomic dysfunction were observed in >13% of observations. The Spearman's rank-correlation coefficient between total doses of midazolam and maximum sum score (of the Sophia Benzodiazepine and Opioid Withdrawal Checklist) was .51 (p < 0.001). The correlation between total doses of opioids and the maximum sum score was .39 (p < 0.01). A significant correlation (.52; p < 0.001) was also found between duration of use and maximum sum score. CONCLUSIONS: This is the first study to report frequencies of all 24 withdrawal symptoms observed in children after decrease or discontinuation of benzodiazepines and/or opioids. Agitation, anxiety, muscle tension, sleeping <1 hr, diarrhea, fever, sweating, and tachypnea were observed most frequently. Longer duration of use and high dosing are risk factors for development of withdrawal symptoms in children.

Withdrawal symptoms in children after long-term administration of sedatives and/or analgesics: a literature review. "Assessment remains troublesome".

BACKGROUND: Prolonged administration of benzodiazepines and/or opioids to children in a pediatric intensive care unit (PICU) may induce physiological dependence and withdrawal symptoms. OBJECTIVE: We reviewed the literature for relevant contributions on the nature of these withdrawal symptoms and on availability of valid scoring systems to assess the extent of symptoms. METHODS: The databases PubMed, CINAHL, and Psychinfo (1980-June 2006) were searched using relevant key terms. RESULTS: Symptoms of benzodiazepine and opioid withdrawal can be classified in two groups: central nervous system effects and autonomic dysfunction. However, symptoms of the two types show a large overlap for benzodiazepine and opioid withdrawal. Symptoms of gastrointestinal dysfunction in the PICU population have been described for opioid withdrawal only. Six assessment tools for withdrawal symptoms are used in children. Four of these have been validated for neonates only. Two instruments are available to specifically determine withdrawal symptoms in the PICU: the Sedation Withdrawal Score (SWS) and the Opioid Benzodiazepine Withdrawal Scale (OBWS). The OBWS is the only available assessment tool with prospective validation; however, the sensitivity is low. CONCLUSIONS: Withdrawal symptoms for benzodiazepines and opioids largely overlap. A sufficiently sensitive instrument for assessing withdrawal symptoms in PICU patients needs to be developed.

Use of a simple relaxation technique in burn care: literature review.

AIM: This paper presents a literature review examining the implications of previous research in order to make evidence-based decisions about the possible use of breathing exercises with adult patients with burns for pain management during wound care. BACKGROUND: Adult patients with burns experience pain during wound care despite pharmacological interventions. Additional interventions are needed to improve the effectiveness of pain management. Relaxation techniques can be considered, for example breathing exercises, music and distraction. A simple breathing relaxation technique is especially relevant because it involves no risk, is easy and quick to learn, equipment does not need to be purchased and it can be employed immediately by the often exhausted and ill patient. However, the effect of breathing exercises on procedural pain during burn wound care has not been investigated. METHOD: The CINAHL, PubMed and Cochrane databases were searched in 2004 in order to answer two questions: are breathing exercises effective in the management of procedural pain in adult burn patients, and what are the implications of previous investigations for future research concerning pain reduction in adult patients with burns during wound care? Eleven papers were included in the review. FINDINGS: The effect of breathing exercises for pain management in patients with burns has not been investigated. Prior to undertaking an effect study, additional basic research is needed. The number of sessions necessary to learn to use the technique should be clarified. A valid and reliable instrument to assess relaxation must be developed. The adequacy of the proposed data collection procedure needs to be assessed. CONCLUSION: It is not possible at this time to base decisions about the use of breathing exercises during wound care in adult patients with burns on research specific to the procedure and patient group. The most suitable relaxation technique for future investigation is concentration on breathing, in combination with jaw relaxation.

Anxiety and well-being in first-time coronary angioplasty patients and repeaters.

INTRODUCTION: Preparatory information before an invasive procedure has positive effects (e.g. on recovery, well-being and anxiety). However, preparation of patients for a repeat procedure is hardly investigated. The question is whether these patients benefit from the same preparatory information. AIMS: To determine whether there are differences in terms of anxiety and well-being between patients undergoing their first percutaneous transluminal coronary angioplasty (PTCA) and those undergoing a repeat PTCA. DESIGN: Descriptive correlational study with a quantitative and qualitative research component. METHOD: First-time PTCA patients (n=46) and re-PTCA patients (n=40) were asked to complete three psychological self-report questionnaires (HADS, HPPQ and VAS) before the procedure. Five re-PTCA patients were interviewed the day after the procedure. RESULTS: We were not able to show statistically significant differences between the two groups. On the anxiety scales re-PTCA patients scored 6.5 (HADS) and 4.0 (VAS) vs. 5.0 (P=0.25) and 2.6 (P=0.30) for first-time PTCA patients. On well-being (HPPQ) these differences were 18.0 vs. 19.0 (P=0.40). Once the interview data were coded, four themes were apparent, namely: recurrent symptoms, information, experience and future prospects. CONCLUSION: A trend is seen towards a worse condition in the re-PTCA group with respect to anxiety and well-being. However, the differences are not statistically significant, they seem to be clinically relevant. The interviews point out that the return of symptoms and future prospects, rather than the procedure itself, are an important part in preparing for a repeat intervention. This aspect is currently no part of the provided preparatory information. Future research will have to determine the most beneficial method of preparing these patients (e.g. tailored preparation, emotional support, coaching).