Catastrophic thinking and heightened perception of pain in others.

Past research has shown that pain catastrophizing contributes to heightened pain experience. The hypothesis advanced in this study was that individuals who score high on measures of pain catastrophizing would also perceive more intense pain in others. The study also examined the role of pain behaviour as a determinant of the relation between catastrophizing and estimates of others' pain. To test the hypothesis, 60 undergraduates were asked to view videotapes of individuals taking part in a cold pressor procedure. Each individual in the videotapes was shown three times over the course of a 1min immersion such that the same individual was observed experiencing different levels of pain. Correlational analyses revealed a significant positive correlation between levels of pain catastrophizing and inferred pain intensity, r=.31, p<.01. Follow-up analyses indicated that catastrophizing was associated with a heightened propensity to rely on pain behaviour as a basis for drawing inferences about others' pain experience. Catastrophizing was associated with more accurate pain inferences on only one of three indices of inferential accuracy. The pattern of findings suggests that increasing reliance on pain behaviour as a means of inferring others' pain will not necessarily yield more accurate estimates. Discussion addresses the processes that might underlie the propensity to attend more to others' pain behaviour, and the clinical and interpersonal consequences of perceiving more pain in others.

The relation between catastrophizing and the communication of pain experience.

The Communal Coping Model of pain catastrophizing proposes that pain catastrophizers enact pain behaviors in order to solicit support or empathy from their social environment. By this account, pain catastrophizers might be expected to engage in behavior aimed at maximizing the probability that their pain will be perceived by others in their social environment. To test this prediction, 40 undergraduates were videotaped during a cold pressor procedure. A separate sample of 20 (10 men, 10 women) undergraduates were asked to view the video sequences and infer the pain ratings of the cold pressor participants. Correlational analyses revealed that higher levels of pain catastrophizing of the cold pressor participants were associated with observer inferences of more intense pain, r=.39, p<.01. The relation between cold pressor participants' level of pain catastrophizing and observer inferences of pain intensity was mediated by the cold pressor participants' pain behavior. Although pain catastrophizing was associated with observers' inferences of more intense pain, cold pressor participants' level of pain catastrophizing was not associated with observers' accuracy in inferring self-reported pain. Implications of the findings for theory and clinical practice are addressed.

[Evaluation of the physician-patient relationship competence. Development and validation of an assessment instrument]. / Evaluation des compétences relationnelles du médecin avec le patient. Elaboration et validation d'une grille.

OBJECTIVE: To develop and validate the design of a grid that assesses doctor-patient relationship skills. DESIGN: Evaluation study of an assessment instrument. SETTING: Private practices and family practice units. PARTICIPANTS: From a sample of volunteers, 100 family physicians either in private practice or in a family practice unit completed the proposed grid independently. MAIN OUTCOME MEASURES: The Cronbach alpha coefficient was used to analyze internal consistency. Factorial analysis was used to determine whether the grid's anticipated dimensions were in fact present. RESULTS: The Cronbach alpha coefficient had a very high value (0.92), indicating that the items in the grid were highly homogeneous. Two key factors emerged from the factorial analysis; the first factor alone (understanding patients' experience) accounted for almost 42% of the variance. CONCLUSION: The proposed grid presents some interesting metrologic qualities. It is short and relatively simple to use to assess relationship skills of future and practising family physicians. The grid must now be further validated using a variety of cases.

Verification of segmented beam delivery using a commercial electronic portal imaging device.

In modern radiotherapy, three-dimensional conformal dose distributions are achieved through the delivery of beam ports having precalculated planar distributions of photon beam intensity. Although sophisticated means to calculate and deliver these spatially modulated beams have been developed, means to verify their actual delivery are relatively cumbersome, making equipment and treatment quality assurance difficult to enforce. An electronic portal imaging device of the scanning liquid ionization chamber type yields images which, once calibrated from a previously determined calibration curve, provide highly precise planar maps of the incident dose rate. For verification of an intensity-modulated beam delivered in the segmented approach with a multileaf collimator, a portal image is acquired for each subfield of the leaf sequence. Subsequent to their calibration, the images are multiplied by their respective associated monitor unit settings, and summed to produce a planar dose distribution at the measurement depth in phantom. The excellent agreement of our portal imager measurements with calculations of our treatment planning system and measurements with a one-dimensional beam profiler attests to the usefulness of this method for the planar verification of intensity-modulated fields produced in the segmented approach on a computerized linear accelerator equipped with a multileaf collimator.

An electronic portal imaging device as a physics tool.

An electronic portal imaging device (EPID) can be used not only to acquire megavoltage patient images but also to measure certain radiation beam parameters of the linear accelerator. EPID images can be used to verify field junctions, center of collimator rotation, or radiation vs. light field coincidence. If the EPID images are calibrated in terms of dose rate, an EPID can be applied to beam penumbra measurement, collimator transmission determination, or compensator verification. Beam parameters measured with EPIDs are in close agreement with those measured with film or ionization chamber, making EPIDs reliable physics tools for quality control of various beam parameters in radiotherapy.

Safety and feasibility of a self-monitored, home-based phase II exercise program for high risk patients after cardiac surgery.

OBJECTIVE: To determine the safety and effectiveness of a self-monitored, home-based phase II exercise program for high risk patients after cardiac surgery. METHODS: High risk patients were defined as those presenting with severe left ventricular dysfunction with an ejection fraction less than 35%, severe ventricular arrhythmias, incomplete revascularization, abnormal response to a standard walking test or significant (grade 3/4) valvular regurgitation persisting postoperatively. Eighty patients (mean age 58.5 +/- 8.9 years) were randomly assigned to two groups. The experimental group (n = 37) received a home program of aerobic training with an intensity gradually increasing from 1.5 to 4.0 multiples of resting oxygen consumption (METs). This program was started at discharge from the hospital and lasted eight weeks. The control group (n = 43) received general guidelines for progressive increase of their activity level. Functional capacity was measured at discharge by the 6 min walking test and between the sixth and eighth week following discharge by a symptom-limited exercise test, according to the Naughton protocol. RESULTS: No cardiovascular complications occurred during the training program. At the final evaluation, there was no significant difference between the experimental and control groups regarding aerobic capacity (5.1 +/- 1.8 versus 4.9 +/- 1.6 METs respectively, P = 0.61), nor peak rate-pressure product (22.8 +/- 4.9 versus 23.6 +/- 5.2 beats/min x mmHg x 10(3) respectively, P = 0.54).