Lived experience and the dual process model of coping with bereavement: A participatory research study.

The Dual Process Model of Coping with Bereavement (DPM) proposes that there is an adaptive oscillation between loss-oriented (LO) and restorative-oriented (RO) coping processes. Empirical data supports these processes, but the oscillation process is not well-understood. This study explored the correspondence between the DPM and lived experience of bereaved people, with an additional investigation of perceived changes in grief over time. Using a cooperative inquiry inspired participatory research design, nine bereaved adults and three researchers met nine times to discuss experiences of grief. Knowledge production took place through ongoing sharing, exploration, and reflection upon personal experiences and grief theory. Support was found for the LO and RO processes, but they were perceived to overlap. Support was also found for the oscillation process, which was found to hold learning properties. Time off from grief was not supported. Perspectives on how and why grief experiences change over time emerged, emphasizing the importance of acceptance, learning, time, and contextual factors.

Zero Self-Harm app: a mobile phone application to reduce non-suicidal self-injury-study protocol for a randomized controlled trial.

BACKGROUND: Non-suicidal self-injury (NSSI) is a growing healthcare problem. Individuals with NSSI have an increased risk of suicidality. Due to stigma, they may self-injure in secret, which means they might not seek help until events have escalated to include suicidal ideation or a mental disorder. Interventions delivered via mobile phone applications (apps) have been linked to reductions in self-injury. This protocol outlines a trial, which examines whether the Zero Self-Harm intervention, consisting of an app for people with NSSI, can reduce the number of NSSI episodes, suicide ideation, and depressive symptoms. METHODS: The trial will be conducted as a 6-month 2-arm, parallel-group, multicentre, pragmatic, randomized clinical superiority trial. The intervention group will receive the app and instructions on how to use it, while the control group will be allocated to a waitlist and allowed to download the app after 6 months. After inclusion, participants will be asked to complete questionnaires at baseline, 3 months, and 6 months. The primary outcome is the number of NSSI episodes during the preceding month, as measured at the 6 months follow-up with the Deliberate Self-Harm Inventory. A total of 280 participants, 140 in each arm, will be included. DISCUSSION: This trial will assess the effectiveness of the Zero Self-Harm intervention to reduce the number of NSSI episodes. If effective, the app will have the potential to support a large group of people with NSSI. Considering the stigma related to NSSI, the fact that the app may be used in private and anonymously might make it an appealing and acceptable option for support. The app was developed in collaboration with people with lived experiences related to current and/or previous NSSI. As a result of this, the app focuses on minimizing harm, rather than stopping NSSI. This might enhance its utilization. TRIAL REGISTRATION: ClinicalTrials.gov NCT04463654 . Registered on 7 June 2020.

Stigma experienced as worse than symptoms of schizophrenia: A qualitative study about The OpusPanel.

AIM: Former patients and relatives of people who have received treatment in OPUS, a Danish specialized early intervention for first episode psychosis, have since 2009 worked to reduce stigma and increase hope related to schizophrenia and psychosis. They established The OpusPanel to share their own stories of living with an invisible disorder with new patients, health care professionals, politicians, and members of the public. The impact of The OpusPanel on stigma has not previously been explored or evaluated. The article aims to evaluate and gain an in-depth understanding of The OpusPanel's anti-stigma impact. METHODS: In a qualitative design, 27 people with different affiliations to The OpusPanel were interviewed using semi-structured interview guides to capture their individual experiences of listening to, interacting with, or being part of The OpusPanel. Interview guides were constructed following a focus group interview with members of The OpusPanel. Analysis of the multi-perspectival dataset was facilitated through an interpretative phenomenological approach with investigator triangulation. Preliminary results were returned to the focus group members to ensure relevance and accuracy. RESULTS: The study found that almost all interviewees described a sense of hopefulness and decreased stigma after having experienced a member from The OpusPanel present their story or participating as panel members themselves. CONCLUSION: The findings suggest that attending presentations or participating in The OpusPanel reduces stigmatizing views about others or oneself. The study may inform The OpusPanel and similar initiatives for challenging stigma related to schizophrenia or psychosis.

A Group Therapy Program for Parentally Bereaved Young Adults With Grief Complications: Rationale, Method and Case Examples.

Considerable effort has gone into studying bereavement in children, adults and the elderly, but few studies have investigated the effects of bereavement or grief interventions in young adults. Even fewer studies have reported on the effect of interventions for young adults with grief complications. The present study seeks to help fill this gap by describing a Danish treatment program specially developed for young adults with complicated grief reactions. The dual process model of coping with bereavement, psychodynamic theory, and a narrative approach provide the foundation for the treatment. In addition, it utilizes an eclectic use of techniques and a group treatment modality that involves providing individual therapy within a group context. The core elements of the treatment are discussed and then exemplified in two case studies.

Effects of an Integrated Treatment Program on Grief and Distress Among Parentally Bereaved Young Adults.

This study examined the effectiveness of an 18-session manualized integrative group psychotherapy intervention for parentally bereaved young adults with grief complications. Participants, 63 young adults aged 20-27 years, completed questionnaires assessing symptoms of prolonged grief, PTSD, depression and anxiety prior to and following treatment. Treatment effectiveness was assessed by comparing outcomes for the intervention group to a waitlist comparison group. Results revealed a statistically significant reduction in symptoms of grief (large effects size), PTSD (medium effect sizes), and depression (medium effect size). The treatment did not result in a significant reduction in anxiety symptoms. The study provided preliminary support for this intervention for parentally bereaved young adults.

Letter Writing as a Clinical Tool in Grief Psychotherapy.

The benefits of expressive writing have been explored since at least the 1980s. The effect of expressive bereavement-related writing has been studied primarily in college students, yielding inconclusive results. Nonetheless, recent effective, integrated psychotherapy protocols, targeting complicated and prolonged grief, include writing assignments, typically in the form of letters. The present paper explores how and why letter writing might be effective and meaningful as a therapeutic tool in the context of grief psychotherapy. It describes how working with letters, addressed to the deceased, might help facilitate self-disclosure, promote exposure to what is avoided, confront unfinished business, encourage continuing bonds, and help achieve a coherent narrative around experiences with the loss. As a therapeutic tool, letter writing has the potential to be helpful to many bereaved people, as it is a simple, effective, and meaningful way to access and work with relevant clinical material in the context of psychotherapy.

The impact of exercise training complementary to early intervention in patients with first-episode psychosis: a qualitative sub-study from a randomized controlled feasibility trial.

BACKGROUND: Burgeoning evidence suggests that exercise improves physical and mental health in people with schizophrenia. However, little is known about the feasibility and acceptability of high-intensity training in patients with first-episode psychosis. This qualitative study explored motivation, social interaction and experiences of participants and instructors in relation to an eight-week moderate to high intensity exercise training programme in a clinical trial including patients with first-episode psychosis. METHODS: The study used a combination of method, source and investigator triangulation. Data were collected by means of semi-structured individual interviews with participants at baseline (n = 16) and at follow-up (n = 9), as well as by means of participant observations during the programme (8 sessions × 1.5 h, 12 h in total) and focus group discussions with participants (n = 3) and instructors (n = 4), respectively, after the programme. Data were analysed using thematic analysis as described by Braun and Clarke. RESULTS: Three main themes and ten subthemes emerged during the analysis: 1) motivation and expectations for enrolment (subthemes: routines and structure, social obligation, goal setting and self-worth); 2) new demands and opportunities (subthemes: practicalities of the training, an understanding exercise setting, and alone and together); and 3) looking ahead - reflections on impact (subthemes: restored sleep and circadian rhythm, energy and sense of achievement, changed everyday life, and hope of finding a new path). Findings suggest that the programme was appealing to, and appreciated by, the participants because of its potential to create an equally challenging and caring non-clinical environment. CONCLUSIONS: This study indicates that supervised, group-based, moderate to high intensity exercise training complementary to early intervention in psychosis is acceptable. Specifically, the intervention appeared to provide patients an opportunity to integrate the notion of being a young individual along with being a patient with a psychiatric diagnosis, thus supporting and promoting recovery. TRIAL REGISTRATION: ClinicalTrials.gov identifier: NCT03409393. Registered January 24, 2018.

Comparison of proposed diagnostic criteria for pathological grief using a sample of elderly bereaved spouses in Denmark: Perspectives on future bereavement research.

BACKGROUND: A distinct grief-specific disorder is included in the ICD-11. Lack of clarity remains regarding whether different proposed diagnostic criteria capture similar or different diagnostic entities. Our aim was to examine the specificity of four proposed diagnostic criteria-sets for pathological grief in a population-based sample. METHODS: Participants were 206 conjugally bereaved elderly Danes (59% female; mean age = 72.5 years, SD = 4.2; range 65-81) who completed self-report questionnaires six months post-loss. The main measure was the Danish version of Inventory of Complicated Grief-Revised. RESULTS: Results indicate substantial agreement between Prolonged Grief Disorder (PGD), Persistent Complex Bereavement Disorder (PCBD) and ICD-11-PGD (kappa's = 0.69-0.84), which found 6-9% of cases tested positive for pathological grief. Complicated Grief (CG) was partly in agreement with the three other symptom-diagnostic tests (kappa's = 0.13-0.20), and the prevalence-rate of pathological grief was 48%. LIMITATIONS: The low response-rate of 39%. The selective inclusion of data ≥6 months post-loss prevents a comparison of acute and prolonged grief reactions. Using self-reported data, not diagnostic interviews, challenges the validity of our findings. Using a sample of elderly people may limit the generalizability of our results to other age groups. CONCLUSION: We suggest that PGD, PCBD and ICD-11-PGD may be more discriminative in identifying a specific grief-related psychopathology, while CG may identify a broader set of grief reactions.

Fasoracetam in adolescents with ADHD and glutamatergic gene network variants disrupting mGluR neurotransmitter signaling.

The glutamatergic neurotransmitter system may play an important role in attention-deficit hyperactivity disorder (ADHD). This 5-week, open-label, single-blind, placebo-controlled study reports the safety, pharmacokinetics and responsiveness of the metabotropic glutamate receptor (mGluR) activator fasoracetam (NFC-1), in 30 adolescents, age 12-17 years with ADHD, harboring mutations in mGluR network genes. Mutation status was double-blinded. A single-dose pharmacokinetic profiling from 50-800 mg was followed by a single-blind placebo at week 1 and subsequent symptom-driven dose advancement up to 400 mg BID for 4 weeks. NFC-1 treatment resulted in significant improvement. Mean Clinical Global Impressions-Improvement (CGI-I) and Severity (CGI-S) scores were, respectively, 3.79 at baseline vs. 2.33 at week 5 (P < 0.001) and 4.83 at baseline vs. 3.86 at week 5 (P < 0.001). Parental Vanderbilt scores showed significant improvement for subjects with mGluR Tier 1 variants (P < 0.035). There were no differences in the incidence of adverse events between placebo week and weeks on active drug. The trial is registered at https://clinicaltrials.gov/ct2/show/study/NCT02286817 .

Implantation of permanent pleural catheter for palliation of malignant pleural effusion.

PURPOSE: Malignant pleural effusion (MPE) is a disabling condition caused in most instances by far-advanced cancer. The treatment is palliative and should ideally be minimally invasive. The aim of this retrospective study was to evaluate the effectiveness of implantation of a permanent PleurX catheter in the treatment of recurrent MPE in patients with terminal cancer disease. PATIENTS AND METHODS: Eighteen consecutive patients with terminal cancer and MPE, who had a permanent PleurX catheter implanted in the period from February 2014 to August 2015, were retrospectively evaluated. Medical records were reviewed for data on procedures and patients. RESULTS: Twenty-two PleurX catheters were implanted in the pleural cavity of 18 patients. The technical success rate was 100%. All patients had relief of symptoms. Catheter patency was 91%. Six patients experienced minor adverse events (AEs) and two patients experienced moderate-to-severe AEs. The median survival time for the 14 patients who died during follow-up was 45 days. CONCLUSION: Implantation of a permanent PleurX catheter is a safe procedure with a high success rate and only few AEs. The procedure has the potential to serve as an effective procedure for palliation of recurrent MPE in terminal cancer patients.

Adolescents' Lived Experiences While Hospitalized After Surgery for Ulcerative Colitis.

Adolescents are in a transitional phase of life characterized by major physical, emotional, and psychological challenges. Living with ulcerative colitis is experienced as a reduction of their life quality. Initial treatment of ulcerative colitis is medical, but surgery may be necessary when medical treatment ceases to have an effect. No research-based studies of adolescents' experience of the hospital period after surgery for ulcerative colitis exist. The objective of the study was to identify and describe adolescents' lived experiences while hospitalized after surgery for ulcerative colitis. This qualitative study was based on interviews with eight adolescents. Analysis and interpretation were based on a hermeneutic interpretation of meaning. Three themes were identified: Body: Out of order; Seen and understood; and Where are all the others? The adolescents experience a postoperative period characterized by physical and mental impairment. Being mentally unprepared for such challenges, they shun communication and interaction. The findings demonstrate the importance of individualized nursing care on the basis of the adolescent's age, maturity, and individual needs. Further study of adolescent patients' hospital stay, focusing on the implications of being young and ill at the same time, is needed.

A companionship between strangers - the hospital environment as a challenge in patient-patient interaction in oncology wards.

AIM: To present an identification and discussion of the impact of the hospital environment on interaction among people with cancer. BACKGROUND: In recent years, researchers have focused on identifying and describing features of the hospital environment that promote healing, recovery and well-being. It has been discovered that architectural features affect hospitalized patients both positively and negatively. But the research has failed to include fellow patients as part of the hospital environment. DESIGN: A qualitative approach influenced by ethnography. METHOD: Participant observation and individual qualitative interviews were used to collect data. From a total of 85 observed people with cancer 10 men and 10 women were interviewed. Data were collected over 6 months in 2010-2011 and analysed using inductive thematic analysis. FINDINGS: Patients had ambiguous views regarding their fellow patients and the hospital environment. The hospital environment imposed conditions that caused stress factors such as the loss of personal privacy and control, but it also offered the possibility of good company and support from fellow patients. Refuge from fellow patients was hard to achieve and the fact that personal conversations might be overheard by fellow patients caused patients to withhold important information from healthcare professionals. Nevertheless, patients accepted the hospital environment uncritically, with resignation or with silent rebellion. Despite the challenges, 18 of 20 patients preferred multiple-bed rooms with the company of fellow patients. CONCLUSION: The influence of the hospital environment on hospitalized people with cancer and their interpersonal interaction needs to be acknowledged by healthcare professionals. In addition, evidence-based hospital design must include research into patient preferences and arguments. Further investigation is needed.

Voluntary Rehabilitation? On Neurotechnological Behavioural Treatment, Valid Consent and (In)appropriate Offers.

Criminal offenders may be offered to participate in voluntary rehabilitation programs aiming at correcting undesirable behaviour, as a condition of early release. Behavioural treatment may include direct intervention into the central nervous system (CNS). This article discusses under which circumstances voluntary rehabilitation by CNS intervention is justified. It is argued that although the context of voluntary rehabilitation is a coercive circumstance, consent may still be effective, in the sense that it can meet formal criteria for informed consent. Further, for a consent to be normatively valid ("take the wronging out of the act") under a coercive circumstance, the subject to be treated must (1) have the sovereign authority to consent, and (2) the offer-giver must be in the right normative position to make the offer. While I argue that subjects do have the sovereign authority to consent to treatment, I also argue that inappropriate offers yield invalid consents. Considerations on inappropriate offers should therefore inform which kinds of CNS intervention-based rehabilitation schemes the state may propose as part of the criminal justice system. Yet as I conclude in this paper, while there are some intrinsic constraints on voluntary rehabilitation programs, the main constraints on voluntary rehabilitation are likely to be contingent overriders. However, CNS intervention is not ruled out as such in the context of voluntary rehabilitation.

An ambiguous relationship--a qualitative meta-synthesis of hospitalized somatic patients' experience of interaction with fellow patients.

AIM: The aim of this study was to provide a clear view of the existing knowledge regarding patients' significance to fellow patients during hospitalization. METHOD: Sandelowski and Barroso's approach to qualitative meta-synthesis was selected and systematically used for collecting and assessing findings from qualitative studies. Data consisted of seven qualitative studies published as one book, four scientific articles and two doctoral theses from Scotland, UK, Norway and Denmark. The analysis and synthesis were conducted with inspiration from both Sandelowski and Barroso and Ian Dey's approach to qualitative data analysis. RESULTS: The qualitative meta-synthesis resulted in the heading An Ambiguous Relationship under which three core categories illustrate the hospitalized patients' different interaction roles. The core categories were as follows: (i) the fellow patient experienced as an enforced companion, (ii) the fellow patient experienced as an expert on illness and hospital life and (iii) the fellow patient experienced as a care provider. Each core category was elaborated through several subcategories. Social interaction among hospitalized patients embedded elements of both enforced and volunteered participation. Typically, the social interaction was experienced as giving and was referred to in positive terms but recurrently, the opposite was experienced too. The ambiguity of the relationship clearly emerged in all of the synthesized themes presented in this article. IMPLICATIONS FOR PRACTICE: Hospitalized patients experienced interaction with fellow patients to be of great significance. We suggest that knowledge of patients' interaction is to be included in the nursing education and that nurses reflect on how this knowledge may be implemented as a part of caring in nursing.

Patient-patient interaction--caring and sharing.

AIM: The aim of this study is to provide an understanding of the significance of hospitalized patients' interpersonal interaction with fellow patients in an infectious disease ward in a large Danish hospital. METHOD: A qualitative approach was selected using participant observation and semi-structured qualitative interviews. Six female participants at the age of 32-81 years with different types of infectious diseases accepted to participate in interviews. The analysis was carried out using Kvales' three levels of qualitative data analysis. Data were catalogued into two main categories with several subcategories representing significance of patients' interaction with fellow patients. RESULTS: The qualitative analysis resulted in two main categories: (i) Caring for fellow patients and (ii) Sharing illness information with fellow patients. Each of the main categories was elucidated through several subcategories. Our findings clearly showed that interpersonal interaction with fellow patients was of utmost importance when it came to care and support and when they needed information about their illness. Typically, the interpersonal interaction was experienced as giving and referred to in positive terms, but occasionally, the opposite was experienced too. Less typically, the patients experienced interaction with fellow patients as a burden and referred to it in negative terms. CONCLUSIONS: Patients' interaction resembled care as well as self-care. Patient-patient interaction was an important part of the social support system during hospitalization.

Color Doppler myocardial imaging demonstrates reduced diastolic tissue velocity in growth retarded fetuses with flow redistribution.

OBJECTIVES: In fetuses suffering from intrauterine growth retardation with cerebroplacental redistribution (IUGR CPR), the diastolic heart function may be particularly susceptible to hypoxemia as described in postnatal pathological conditions. Using the newly introduced ultrasound technique, color Doppler myocardial imaging (CDMI), we investigated the correlation between diastolic tissue velocities and diastolic blood flow velocities and compared diastolic myocardial tissue velocities in fetuses with IUGR CPR and normal fetuses. STUDY DESIGN: Peak early and active atrial tissue velocities (E' and A') were acquired from both ventricular free walls in 18 fetuses with IUGR CPR and 42 normal fetuses. In 35 normal fetuses, blood flow across the atrio-ventricular valves was also recorded. Umbilical artery (UA), middle cerebral artery (MCA) and ductus venosus (DV) flows were obtained in all fetuses. Nonparametric tests were used for statistical analysis. RESULTS: There was a tendency towards increased E' and A' with fetal age in normal pregnancies. No correlation between tissue velocity and blood flow velocity was established. IUGR CPR fetuses had significantly lower E' and A', but when indexing to heart length, only A' remained significantly lower. E'/A' ratio was increased in the left ventricle but unchanged in the right. CONCLUSION: CDMI is easily applicable during standard fetal echocardiography and provides new information on the diastolic properties of the fetal myocardium. In fetuses with IUGR CPR, diastolic tissue velocities are abnormal and especially A' may be a marker of diastolic dysfunction.