Use of hypnosis in controlling lumbar puncture distress in an adult needle-phobic dementia patient.

Lumbar punctures are often vital to the medical management of patients with suspected organic pathology, yet they are commonly met with such distress that medical risk is significantly increased, and patient rapport is significantly decreased, further compromising medical treatment. Although the use of hypnosis for lumbar punctures is well established in pediatric patients, no literature exists for adult patients. Similarly, there is no extant research regarding hypnosis for dementia patients, likely due to the limiting factors of impaired attention and concentration. With these factors in mind, a method for incorporating hypnosis into a lumbar puncture procedure is described for a needle-phobic adult patient suffering from dementia.

Medical hypnosis for temporomandibular disorders: treatment efficacy and medical utilization outcome.

AIM: The aim of this study was to examine the effectiveness of a particular behavioral medicine treatment modality, medical hypnosis, on reducing the pain symptoms of temporomandibular disorders (TMD). METHODS: Twenty-eight patients who were recalcitrant to conservative treatment for TMD participated in a medical hypnosis treatment program and completed measures of their pain symptoms on 4 separate occasions: during wait list, before treatment, after treatment, and at a 6-month follow-up. In addition, pretreatment and posttreatment medical use were examined. RESULTS: Statistical analysis of this open trial suggests that medical hypnosis is a potentially valuable treatment modality for TMD. Patients reported a significant decrease in pain frequency (F [3, 87] = 14.79, P<.001), pain duration (F [3, 87] = 9.56, P<.001), and pain intensity (F [3, 87] = 15.08, P<. 001), and an increase in daily functioning. Analysis suggests that their symptoms did not simply spontaneously improve, and that their treatment gains were maintained for 6 months after hypnosis treatment. Further, after hypnosis treatment, patients exhibited a significant reduction in medical use. CONCLUSION: Medical hypnosis appears to be an effective treatment modality for TMD, in terms of reducing both symptoms and medical use.

The COPE program: treatment efficacy and medical utilization outcome of a chronic pain management program at a major military hospital.

This study presents a treatment efficacy and medical utilization evaluation of a cognitive-behavioral, outpatient, chronic pain management program in a military hospital setting. A total of 61 nonmalignant chronic pain patients with heterogeneous pain syndromes who participated in sequential group programs were included in the study. Comprehensive and multi-dimensional outcome criteria were used, including pain ratings, relaxation skills, quality of life, satisfaction ratings, and medical utilization. The findings demonstrated improvements on all general indices. Military status had no effect on any of the outcome measures. Most significant was an 87% reduction in outpatient clinic visits in the first 3 months after treatment. This reduction amounts to a projected net annual saving of $78,960 in the first year after behavioral medicine intervention. In light of the increasing cost of health care for chronic pain patients, psychological approaches as an adjunct to traditional medical care seem to present a sound solution for cost savings. This study also supports the notion that a strategic biopsychosocial pain program, which targets the multiple dimensions of persistent pain, provides effective treatment and increases patient satisfaction.

The sodium pentothal hypnosis interview with follow-up treatment for complex regional pain syndrome.

A patient who was unresponsive to multiple conservative medical treatments for complex regional pain syndrome was assessed using a novel approach--the sodium pentothal hypnosis interview. The interview suggested that his pain was centrally generated. The patient's pain symptoms resolved with hypnotherapeutic treatment. Indications for this procedure and implications for assessment and treatment are discussed. This case raises more questions than it answers, and leaves the reader to struggle with current difficulties in diagnostic decision-making.

Hypnosis using a communication device to increase magnetic resonance imaging tolerance with a claustrophobic patient.

This is a case report of a patient who prematurely terminated two previous magnetic resonance imaging procedures because of his highly claustrophobic condition. The patient was induced into a hypnotic trance twice before his third magnetic resonance imaging examination and he was given posthypnotic suggestions for decreased anxiety and increased physiologic control. Using a communication device with headphones on the patient, he was induced into a trance as he entered the magnet. This patient was successfully able to cope with this procedure and reported great satisfaction with treatment.

Medical hypnosis for hyperemesis gravidarum.

Hyperemesis gravidarum in pregnancy is a serious condition that is often resistant to conservative treatments. Medical hypnosis is a well-documented alternative treatment. This article reviews the empirical studies of medical hypnosis for treating hyperemesis gravidarum, explains basic concepts, and details the treatment mechanisms. The importance of a thorough differential diagnosis and appropriate referrals is stressed. The article presents three case studies to illustrate the efficacy of this treatment approach. It is suggested that medical hypnosis should be considered as an adjunctive treatment option for those women with hyperemesis gravidarum. It is also stressed that medical hypnosis can be used to treat common morning sickness that is experienced by up to 80 percent of pregnant women. Its use could allow a more comfortable pregnancy and healthier fetal development, and could prevent cases that might otherwise proceed to full-blown hyperemesis gravidarum.

Clinical applications of hypnotherapy in a medical setting.

Since 1958, hypnosis has been recognized by the American Medical Association as a legitimate form of medical treatment when administered by an appropriately trained practitioner. With the prevalence of certification societies and international organizations, the specialty has increased its level of professionalism and clinical applications. However, in spite of increased exposure and utilization of this unique clinical application, its use within medical settings varies considerably. The purpose of this article is to provide an understanding of clinical hypnosis and offer clinical applications, with the goal of increasing its exposure and utilization within medical settings.

Delivery of home care services after discharge: what really happens.

Social workers in hospitals develop discharge plans for in-home patient care with little systematic feedback about postdischarge implementation. A telephone follow-up study of patients discharged from an urban teaching hospital in 1990 was undertaken to determine the extent to which discharge plans for home services were carried out and to identify factors associated with unsuccessful implementation. Overall, 72 percent of the patients received all, 19 percent some, and 9 percent none of the planned home care services. Great variability was found in service delivery: Registered nurse visits were the most successfully delivered type of service; 24-hour companions were the least successfully delivered service. Further, over one-third of patients experienced termination or reduction of services between discharge and the follow-up interview 21 to 28 days after discharge. Such unexpected and varied outcomes suggest the need for development of discharge follow-up programs that move beyond hospital walls to ensure that patients receive needed services.

Predictors of patient and proxy satisfaction with discharge plans.

If patients are not readily available, family members or others sometimes are used as substitute informants when evaluating consumer satisfaction. Little is known, however, about the extent to which responses of patients and proxies are interchangeable. In this study, patients (N = 225) or significant others (N = 115) provided an overall rating of discharge plans, as well as information on psychosocial, health, and post-hospital service related factors, at 3-4 weeks post-discharge. While no difference was found between mean plan ratings for the two groups, substantial differences were found in factors predicting satisfaction for patients and for proxies. Results indicate that care should be taken in using proxy ratings in the place of patient ratings, particularly when developing strategies for enhancing consumer satisfaction. Findings are discussed as they relate to continuity of care initiatives and programs for enhancement of desirable health utilization behaviors, in the context of managed care.

Survival bonding: a response to stress and work with AIDS.

There is ample literature describing the ongoing stressors and tremendous emotional impact on health care professionals caring for patients with AIDS. This paper is a report of a research study which explored collegial relationships and staff retention to determine factors that reduced staff burnout. The study explored an observed phenomenon of pairing among staff members of various disciplines, working with patients with AIDS, in a tertiary care hospital. The authors called this phenomenon "survival bonding." These informal but intense relationships offered staff a mutually supportive environment which reduced their anxiety, stress, and helped prevent burnout. Given the growing volume of HIV infected persons, and the increased work load of many health care professionals in the aids field, it is important to understand the complex emotional and social support needs of staff to prevent burnout and to improve staff recruitment and retention.

Research for the research phobic: developing research expertise in hospital social work.

The need for professional accountability and empirically based practice in hospital social work is growing. Yet, many clinicians are hampered by doubts about their knowledge and skill in research. A staff development program was designed by the author to increase staff awareness of empirical practice techniques and to reduce staff anxiety about their ability to consume and produce research. The program combines peer support and an incremental approach to learning research skills. Many of the participants were able to complete research-related activities after completing the program.

The legal clinic: helping social workers master the legal environment in health care.

The social environment for all is becoming increasingly legalized. This fact is evidenced in the extensive entitlement regulations and ethical decision-making processes surrounding health care consumers and professional providers. The authors of this paper describe a program designed to educate social workers in an acute care hospital to the legal issues and considerations that influence decision-making and interventions in social work practice. The purpose of the paper is two-fold: to highlight the program planning process in establishing and institutionalizing a Legal Clinic for social work, and secondly to stress the significance of legal content in the knowledge base of social workers in health care settings.

The interim homecare program: an innovative discharge planning alternative.

With the advent of prospective payment systems and diagnostic related groups, hospitals are under increasing pressure to discharge patients as soon as they are medically ready. Many patients require additional time to recover physically, socially, emotionally, and functionally. The Interim Homecare Program (IHP) provides time-limited intensive home health aide services for elderly patients who are at risk for protracted recovery times or rehospitalization due to incomplete or failed recuperation after hospital discharge. In this article the authors report on a study of data from case records of all IHP patients served during the first year of operation. The study compared the length of stay (LOS) for IHP patients to the estimated LOS that they would have had if IHP services had not been available. The success of IHP in shortening LOS for this high-risk population exceeded projected estimates and expectations.