Young at heart: understanding the unique psychosocial adjustment of young implantable cardioverter defibrillator recipients.

This article reviews the data related to psychosocial adjustment of young ICD recipients, postulates theories to explain potential adjustment difficulties to ICD therapy experienced by younger recipients, and suggests clinical management techniques for addressing the unique psychosocial concerns of young ICD recipients. Studies of young ICD recipients suggest that a wide range of psychosocial adjustment issues are prominent in the post-ICD implantation period and that the issues may be different from older ICD recipients. The disability-stress-coping model and the transactional-stress-coping model are postulated as explanations for the unique adjustment concerns of children and adolescents with ICDs. Social comparison theory is also applied to the concerns of young adults with ICDs such that they often lack same age peers to compare experiences with cardiac difficulties. Brief, clinic-based interventions by health care providers, like a screening and referral heuristic and an "ICD Buddy" system, are suggested to increase effective coping and decrease social isolation for young ICD recipients.

Assessing the psychosocial impact of the ICD: a national survey of implantable cardioverter defibrillator health care providers.

The implantable cardioverter defibrillator (ICD) provides a survival advantage over antiarrhythmic medications for patients with life-threatening ventricular arrhythmias. However, the effect of ICD therapy on quality-of-life and psychosocial functioning are not as well understood. Health care providers (e.g., physicians, nurses) can serve as a valuable source of information related to these ICD outcomes. The purpose of this study was to investigate health care provider perceptions regarding: (1) the quality-of-life and psychosocial functioning of their ICD recipients, (2) the concerns or problems reported by ICD recipients, and (3) the degree of provider comfort in managing these concerns. The final sample of health care providers (n = 261) rated ICD recipients' global quality-of-life and psychosocial functioning, and specific concerns about health care, lifestyle, special population adjustment, marital and family adjustment, and emotional well-being. With regard to quality-of-life, health care providers reported that the majority of ICD recipients were functioning better (38%) or about the same (47%) than before implantation. However, health care providers reported that 15% of recipients experienced worse quality-of-life postimplantation. Similarly, health care providers indicated that 10%-20% of ICD recipients experienced worse emotional functioning and strained family relationships. Moreover, issues related to driving, dealing with ICD shocks, and depression were the most common ICD recipient concerns. Significant differences were noted between physicians and nurses/other health care professionals on a wide range of psychosocial issues. Health care providers generally reported the most comfort dealing with traditional medical issues (i.e., patient adherence), and the least comfort in managing emotional well-being issues (e.g., depression and anxiety). These results suggest that routine attention to ICD quality-of-life and psychosocial outcomes is indicated for health care providers who care for ICD recipients.

Supportive communication with implantable cardioverter defibrillator patients: seven principles to facilitate psychosocial adjustment.

METHODS: This article incorporates known findings from the psychological literature regarding health behaviors and adjustment to cardiac illness with identified psychosocial needs of implantable cardioverter defibrillator (ICD) patients. An emphasis is placed on healthcare providers' unique ability to facilitate adjustment during routine patient contacts. RESULTS: Seven principles of supportive communication are presented to enhance healthcare providers' awareness of the psychosocial needs of ICD patients. A table of "quotes" representing each principle is provided to show how each form of supportive communication may be delivered to optimize health outcomes for ICD patients. CONCLUSIONS: Brief, routine communication between healthcare providers and ICD patients about psychosocial issues can facilitate patient adjustment. Although not sufficient to meet the needs of all ICD patients, supportive communication bolsters problem-solving and coping strategies of most ICD patients. For patients with more severe psychological adjustment difficulties, supportive communication may lead to better identification of patients who would benefit from referrals to mental health professionals.

A home-based maintenance exercise program after center-based cardiac rehabilitation: effects on blood lipids, body composition, and functional capacity.

BACKGROUND: Previous research indicates that patients exiting a 12-week cardiac rehabilitation program (CRP) have difficulty maintaining an adequate exercise program. Thus, the authors' purpose was to determine if a home-based exercise program would enable patients to maintain/improve their blood lipids, body composition, and functional capacity after exiting the CRP. METHODS: Thirty-one patients exiting an initial 12-week CRP were assigned randomly to the home-based (HB) intervention or the standard care (SC) condition. After one home visit, the HB participants (n = 16) were contacted by telephone every other week by CRP staff and completed and returned weekly exercise logs. The SC participants (n = 15) had no contact with the CRP other than to schedule follow-up tests. A third group (n = 17), randomly selected from patients that elected to remain in the center-based CRP (CB) for the same duration, also were examined. All groups underwent exercise testing, fasting blood lipid analysis, and body composition assessment before starting CRP (0M), after 3 months (3M) in a standard CRP, and after 9 months (12M) in either HB, SC, or CB condition (12 months after starting CRP). RESULTS: Analysis of variance indicated that there were significant increases in metabolic equivalents and high-density lipoprotein, in all three groups, over time. However, analysis of covariance revealed no significant differences between the HB, SC, and CB groups at 12M for any variable. CONCLUSIONS: These data indicate that the HB program was as effective as the CB program at improving/maintaining functional capacity, blood lipids, and body weight/composition. The similar success of the SC group is likely due to their prior experience in CRP and knowledge of follow-up testing. Home-based maintenance program could be offered as a low-cost alternative to CB programs.

How to shape positive relationships in medical practices and hospitals.

Managing workplace conflict is one of the most important, stressful, and time-consuming tasks faced by today's medical leaders. Poorly managed workplace conflict can alienate patients, demoralize staff, increase turnover, damage relationships with valued referral sources and third party carriers concerned about patient satisfaction, and lead medical practices to costly "corporate divorces." Physician executives cannot solve the problems caused by disruptive doctors simply by bolstering their own conflict management skills or by policing offenders. The larger contexts within which inappropriate workplace behavior occurs must also be assessed and addressed. The true leadership challenge is to intervene in ways that help to foster a "culture" of appropriate interpersonal dynamics throughout your organization. This requires learning to think and to intervene systematically.

Part 2, Conflict management. How to shape positive relationships in medical practices and hospitals.

Managing workplace conflict is one of the most important, stressful, and time-consuming tasks faced by today's physician leaders. In Part 1 of this article series, the authors describe how to assess an organization's interpersonal dynamics. True change comes from interventions that help an organization to become a positive interpersonal culture, one that fosters cooperation and collaboration. Part 2 offers seven steps to solving the disruptive physician problem: (1) provide protection to complainants; (2) listen, empathize, and avoid communication triangles; (3) confront offenders with data, authority, and compassion; (4) if needed, get outside help; (5) offer workplace training and experiences that foster positive relationships; (6) follow-up; and (7) practice what you preach. The self-assessment and intervention guidelines discussed in this series of articles can help physician executive move beyond struggling with episodes of conflict to shaping stress-resilient medical organizations.

Examining the psychosocial impact of implantable cardioverter defibrillators: a literature review.

BACKGROUND: The implantable cardioverter defibrillator (ICD) has proven to be superior to medications in treating potentially life-threatening ventricular arrhythmias, resulting in reduced mortality rates. Despite the number of patients receiving this therapy, its psychosocial impact is not well understood. HYPOTHESIS: The purposes of this paper are (1) to review the available literature documenting the psychosocial impact of the ICD on patients, (2) to hypothesize possible mechanisms for this psychosocial impact, and (3) to suggest clinical risk profiles and indications for psychological consultation. METHODS: Electronic and library searches (e.g., MEDLINE, PsychLit) were used to gather studies examining the psychosocial impact of the ICD. Only studies investigating psychosocial outcomes (e.g., psychological distress, quality of life, social and role functioning), either prospectively or cross-sectionally, were admitted into the review. No literature reviews or secondary sources were included. RESULTS AND CONCLUSIONS: Current research suggests that ICD-specific fears and symptoms of anxiety (e.g., excessive worry, physiological arousal) are the most common psychological symptoms experienced by ICD recipients, with approximately 13-38% of recipients experiencing diagnosable levels of anxiety. Depressive symptoms are reported at rates that are generally consistent with other cardiac populations. Although the incidence of psychological disorders appears to be similar to that found in general cardiac populations, specific ICD-related concerns such as fear of shock, fear of device malfunction, fear of death, and fear of embarrassment have been identified. Selected psychological theories such as classical conditioning, learned helplessness, and a cognitive appraisal model help to explain the occurrence of psychological symptoms post implantation. Psychosocial adjustment risk profiles indicate that young ICD recipients and those with high discharge rates may experience the most adjustment difficulties.

Helping older patients to cope with cardiac and pulmonary disease.

Family challenges, depression, and age-related developmental and psychological issues must be considered when structuring interventions for elder cardiopulmonary patients. Elderly patients tend to have difficulty coping when they face novel, unpredictable circumstances and are left to flounder in suspenseful anticipation. Furthermore, if support is not forthcoming during such times--or if they are treated in ways that strip them of control rather than in ways that bolster their sense of control--elderly patients are at great risk of quickly developing a passive, learned helplessness that can significantly complicate their rehabilitation. The overall well-being of elderly cardiopulmonary patients is affected by more than the actions of health-care providers. Poverty, pension and health-care plans, institutionalization, concomitant diseases, family issues, and other factors have a profound and, frequently, an overriding effect on the functional status of the elderly population. However, it is also true that the provision of spirit-enhancing care can make a tremendous difference in quality of life for elderly patients, independent of factors such as residential circumstance or health status. The most valued and valuable sources of social support for elderly patients come from family, church, and health-care providers. Our interventions either enhance or diminish an elderly patient's sense of autonomy and control. Our task-driven health-care system, replete with its growing emphasis on brevity of treatments and cost-effectiveness, can create a style and pace of delivering care that demoralizes an elderly patient. The results can be devastating: "When the spirit is broken, one has no will to marshall coping skills". But health-care providers who are attuned to the psychosocial issues relevant to the later life stages can make a profound difference in enhancing both rehabilitation and quality of life for elderly cardiopulmonary patients and their loved ones.

The angry physician--Part 2. Managing yourself while managing others.

One of the most difficult aspects of physician leadership is addressing angry colleagues. The first article in this series called attention to the problems that come with the Type A coping styles of many physicians and outlined strategies for managing oneself. Part 2 provides specific strategies that can be helpful in managing others' anger-generating behaviors and anger reactions. There are eight practical communication guidelines recommended by experts in the field for managing anger in others. They include: Strike while the "iron is warm." Match, then lead. Stay in your own zone. De-escalate the other's angry reactions. Do something different. Be assertive, not aggressive. Use effective negotiation tactics. Operationalize the problem.

The angry physician-Part 1. The temper-tantruming physician.

Angry physicians create problems--for the people they treat and work with, for their administrators, and for their loved ones. Addressing negative emotions is one of the most prevalent organizational and personal challenges facing physician leaders. Solving this problem starts with taking an honest look at the factors and processes that shape physicians' coping patterns. Learning effective emotional management skills is underscored by a simple fact: Emotions are contagious. The Type A behavior pattern (TYABP) refers to an aggressive coping mode. Cross-cultural research suggests that, compared to the general population, physicians show elevated scores on TYABP measures, and that women physicians are at particular risk of developing TYABP. In Part 2 of this series, interpersonal anger management strategies will be presented.

The penile prosthesis: a review.

This paper reviews the literature concerning the penile prosthesis. Included are discussions of the historical development of the penile prosthesis, characteristics of patients treated with prosthetic implantation, assessment techniques utilized in patient selection, and the relative outcome and complication rates for the two major types of prostheses. Recommendations regarding future research and practice are presented throughout.

Effects of group systematic desensitization on female orgasmic dysfunction.

This study investigated the impact of group systematic desensitization (SD) on varied aspects of sexual functioning in primary and secondary nonorgasmic women. After serving as their own controls, 22 women (eight primary, 14 secondary) received 15 sessions of group SD using four common hierarchies of sexual scenes. The measures were administered to each subject and her regular sex partner at each of the testing periods. Significant positive treatment effects were found on measures of general and specific sexual adjustment and in extracoital orgasmic frequency. Treatment also enhanced sexual communication among subjects and their partners, increased the females' acceptance of their mates as being satisfactory sexual partners, and increased the females' self-acceptance as sexual beings. All but one of the treatment effects (degree of pleasure experienced during extracoital stimulation) were maintained at the 6-week follow-up. Secondary subjects reported significantly greater pleasure from coital and extracoital stimulation and significantly increased frequency of orgasm in response to extracoital stimulation than primary subjects. Primary and secondary subjects did not differ in their evaluation of the experiment. The need for controlled comparative treatment investigations is stressed.

The differential impact of self-monitoring on smoking behavior: an exploratory study.

This study investigated the impact of self-monitoring on smoking patterns of internal and external smokers. Eighty-nine Ss charted their smoking behavior (number of cigarettes per day) on a daily basis for 4 consecutive weeks, after which personality measures were administered. Self-monitoring produced wide changes in reported cigarette consumption, although this procedure did not change significantly smoking behavior for the entire sample. Ss were divided arbitrarily into three categories: Ss who increased 20 cigarettes or more, Ss who decreased 20 cigarettes or more, and Ss who increased or decreased up to 19 cigarettes. Negative affect traits, locus of control, and self-concept variables did not differentiate increasers, decreasers, or maintainers. Ss who increased consumption reported greater reinforcement value from solitary related as opposed to socially oriented functions than the decreasers and the maintainers. Future studies should explore the meaningfulness of an intervention designed to improve the smoker's social interactions.

A sexual-enhancement workshop: beyond group systematic desensitization for women's sexual anxiety.

This study investigated whether six women who previously had received 15 sessions of group systematic desensitization (SD) for their sexual anxiety would report additional treatment gains from participation in a sexual-enhancement workshop with their partners. After group SD six couples participated in six, 1 1/2 hour weekly group sessions. The women reported a significant increase in marital adjustment and a significant decrease in sexual anxiety. A significant decrease was found in the women's sexual nonresponsiveness as perceived by their partners. Future studies should (1) contrast the effects of group SD with women alone versus couple group treatment, (2) determine which treatment components are most influential for defined subject types, and (3) obtain data on men's sexual functioning.