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BMC musculoskeletal disorders 11
Clinical and radiological outcomes after management of traumatic knee dislocation by open single stage complete reconstructionrepair.
BACKGROUND: The purpose of our study was to analyze the clinical and radiological long-term outcomes of surgically treated traumatic knee dislocations and determine prognostic factors for outcome. METHODS: Retrospective consecutive series of patients... expand abstract treated surgically for traumatic knee dislocation with reconstruction/refixation of the anterior (ACL) and posterior cruciate ligaments (PCL) and primary complete repair of collaterals and posteromedial and posteromedial corner structures. 68 patients were evaluated clinically (IKDC score, SF36 health survey, Lysholm score, Knee Society score, Tegner score, visual analogue scale - VAS pain and satisfaction, Cooper test) and radiologically (weight bearing and stress radiographs) with a mean follow up of 12 +/- 8 years. Instrumented anterior-posterior translation was measured (Rolimeter, KT-1000). Pearson correlation and stepwise regression analysis was used. RESULTS: 82% of patients (n = 56) returned to their previous work. At final follow-up 6 patients (9%) suffered from pain VAS > 3. The mean side-to-side difference of anterior/posterior translation (KT-1000, 134N) was 1.6 +/- 1.6 mm and 2.6 +/- 1.4 mm. Valgus and varus stress testing in 30 degrees flexion was <3 mm (normal) in 57 patients (86%). The IKDC score was normal/nearly normal in 38 (58%) patients and the mean Lysholm score 83 +/- 17 (intact 98 +/- 7). The median Tegner score decreased from 7 preinjury (range 3-10) to 5 at follow-up (range 0-10). The mean Knee Society score was 187 +/- 15 (out of maximum 200). In 7 patients (10%) a secondary ligament reconstruction was performed. Three patients (4%) underwent a high tibial osteotomy and four (6%) received a primary unconstrained total knee replacement. According to the Kellgren Lawrence osteoarthritis score only mild degenerative changes were present. The stress radiographs showed stable results for anteroposterior translation. Injury of the lateral collateral ligament, refixation of the ACL/PCL and delayed surgery >40 days were significantly associated with worse outcome (p < 0.05). CONCLUSIONS: Early complete reconstruction can achieve good functional results and patient satisfaction with overall restoration of sports and working capacity. Negative predictive factors for outcome were injury pattern, type of surgical procedure and timing of surgery. collapse abstract
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European journal of vascular and endovascular surgery : the official journal of the European Society for Vascular Surgery 2010 Jun; 40(1)
Ease of application of medical compression-stocking systems for the treatment of venous ulcers.
OBJECTIVE: To evaluate the ease of application of two-piece, graduated, compression systems for the treatment of venous ulcers. METHODS: Four kits used to provide limb compression in the management of venous ulcers were evaluated. These have been pro... expand abstractven to be non-inferior to various types of bandages in clinical trials. The interface pressure exerted above the ankle by the under-stocking and the complete compression system and the force required to pull the over-stocking off were assessed in vitro. Ease of application of the four kits was evaluated in four sessions by five nurses who put stockings on their own legs in a blinded manner. They expressed their assessment of the stockings using a series of visual analogue scales (VASs). RESULTS: The Sigvaris Ulcer X((R)) kit provided a mean interface pressure of 46 mmHg and required a force in the range of 60-90 N to remove it. The Mediven ulcer kit exerted the same pressure but required force in the range of 150-190 N to remove it. Two kits (SurePress Comfort and VenoTrain Ulcertec) exerted a mean pressure of only 25 mmHg and needed a force in the range of 100-160 N to remove them. Nurses judged the Ulcer X and SurePress kits easiest to apply. Application of the VenoTrain kit was found slightly more difficult. The Mediven kit was judged to be difficult to use. CONCLUSIONS: Comparison of ease of application of compression-stocking kits in normal legs revealed marked differences between them. Only one system exerted a high pressure and was easy to apply. Direct comparison of these compression kits in leg-ulcer patients is required to assess whether our laboratory findings correlate with patient compliance and ulcer healing. collapse abstract
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The British journal of surgery 2009 Dec; 97(1)
Impact of a multifunctional image-guided therapy suite on emergency multiple trauma care.
BACKGROUND:: The multifunctional image-guided therapy suite (MIGTS), a combined diagnostic and operating theatre, is currently the subject of considerable interest. This study investigated the effect of instituting a MIGTS on the emergency treatment ... expand abstractof multiply injured patients. METHODS:: This prospective controlled intervention study (MIGTS versus conventional treatment) included consecutive multiply injured trauma patients (Injury Severity Score of 16 or more) admitted between February 2003 and April 2005 to a university hospital. Main outcome measures were time to computed tomography (CT) and number of in-hospital transfers. RESULTS:: A total of 168 patients were enrolled, 87 in the MIGTS and 81 in the control group. On average, CT was started at least 13 min sooner in the MIGTS group (P < 0.001), and these patients underwent fewer within-hospital transfers before arrival in the intensive care unit (median 2 versus 4 for controls; odds ratio -2.92, P < 0.001). Team members indicated increased satisfaction with the quality of the MIGTS procedure over the course of the study (P = 0.009). Thirty-day mortality rate (17 per cent for MIGTS versus 22 per cent for controls; P = 0.420) and long-term outcome did not differ between the two groups. CONCLUSION:: Implementation of a MIGTS in the emergency treatment of multiple trauma significantly accelerated the procedure and reduced the number of in-hospital transports. Registration number: NCT0072213 (http://www.clinicaltrials.gov). Copyright (c) 2009 British Journal of Surgery Society Ltd. Published by John Wiley & Sons, Ltd. collapse abstract
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World journal of surgery 2009 Oct; 33(11)
In search of benchmarking for mortality following multiple trauma: a Swiss trauma center experience.
BACKGROUND: The manifestations associated with non-survival after multiple trauma may vary importantly between countries and institutions. The aim of the present study was to assess the quality of performance by comparing actual mortality rates to th... expand abstracte literature. METHODS: The study involved evaluation of a prospective consecutive multiple trauma cohort (injury severity score, ISS > 16) primarily admitted to a university hospital. Univariate and multivariate testing of routine parameters and scores, such as the Trauma and Injury Severity Score (TRISS), was used to determine their predictive powers for mortality. RESULTS: The 30-day mortality of 22.8% (n = 54) exactly matched predicted TRISS versions of Champion or the Major Trauma Outcome Study for our 237 multiple trauma patients (42.8 +/- 20.9 years; ISS 29.5 +/- 11.5). Univariate analysis revealed significant differences between survivors and non-survivors when compared for age, ISS, Glasgow coma scale (GCS), pulse oximeter saturation (SapO2), hemoglobin, prothrombin time, and lactate. In multivariate analysis, age, ISS, and GCS (P < 0.001 each) functioned as major independent prognostic parameters of both 24 h and 30-day mortality. Various TRISS versions hardly differed in their precision (area under the curve [AUC] 0.83-0.84), but they did differ considerably in their level of requirement, with the TRISS using newer National Trauma Data Bank coefficients (NTDB-TRISS) offering the highest target benchmark (predicted mortality 13%, Z value -5.7) in the prediction of 30-day mortality. CONCLUSIONS: Because of the current lack of a single, internationally accepted scoring system for the prediction of mortality after multiple trauma, the comparison of outcomes between medical centers remains unreliable. To achieve effective quality control, a practical benchmarking model, such as the TRISS-NTDB, should be used worldwide. collapse abstract
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Clinical orthopaedics and related research 2010 May; 468(6)
Reliability of shoulder abduction strength measure for the Constant-Murley score.
Reports using the Constant-Murley score often lack details regarding how strength measurement was performed, which may have an important impact on the results obtained. A description of the measurement is especially important when patients are unable... expand abstract to adopt the prescribed position of 90 degrees shoulder abduction, leading to invalid or highly discrepant scores. We investigated the influence of shoulder abduction and torso position on strength measurement with special emphasis on intraobserver reliability. Thirty-three healthy volunteers were examined using a handheld dynamometer (Isobex) in 30 degrees , 60 degrees , and 90 degrees abduction with or without stabilization of the torso. A linear correlation between strength measurements in different degrees of abduction was observed, with values at 90 degrees abduction on average 15% lower than at 60 degrees and 45% lower than at 30 degrees . In multivariate analysis, gender and weight had a substantial impact on the strength of individual measurement positions. Intraobserver reliability was related to arm and torso position (intraclass correlation coefficients, 0.71-0.93) and was highest for 90 degrees abduction without torso stabilization. These findings emphasize the importance of standardized torso and arm positions ensuring high reliability when performing the strength measurement of the Constant-Murley score. collapse abstract
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Journal of vascular surgery : official publication, the Society for Vascular Surgery [and] International Society for Cardiovascular Surgery, North American Chapter 2009 Aug; 50(3)
In search of optimal compression therapy for venous leg ulcers: a meta-analysis of studies comparing diverse corrected bandages with specifically designed stockings.
OBJECTIVE: In search of an optimal compression therapy for venous leg ulcers, a systematic review and meta-analysis was performed of randomized controlled trials (RCT) comparing compression systems based on stockings (MCS) with divers bandages. METHO... expand abstractDS: RCT were retrieved from six sources and reviewed independently. The primary endpoint, completion of healing within a defined time frame, and the secondary endpoints, time to healing, and pain were entered into a meta-analysis using the tools of the Cochrane Collaboration. Additional subjective endpoints were summarized. RESULTS: Eight RCT (published 1985-2008) fulfilled the predefined criteria. Data presentation was adequate and showed moderate heterogeneity. The studies included 692 patients (21-178/study, mean age 61 years, 56% women). Analyzed were 688 ulcerated legs, present for 1 week to 9 years, sizing 1 to 210 cm(2). The observation period ranged from 12 to 78 weeks. Patient and ulcer characteristics were evenly distributed in three studies, favored the stocking groups in four, and the bandage group in one. Data on the pressure exerted by stockings and bandages were reported in seven and two studies, amounting to 31-56 and 27-49 mm Hg, respectively. The proportion of ulcers healed was greater with stockings than with bandages (62.7% vs 46.6%; P < .00001). The average time to healing (seven studies, 535 patients) was 3 weeks shorter with stockings (P = .0002). In no study performed bandages better than MCS. Pain was assessed in three studies (219 patients) revealing an important advantage of stockings (P < .0001). Other subjective parameters and issues of nursing revealed an advantage of MCS as well. CONCLUSIONS: Leg compression with stockings is clearly better than compression with bandages, has a positive impact on pain, and is easier to use. collapse abstract
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Phlebology / Venous Forum of the Royal Society of Medicine 23(5)
Leg symptoms of healthy people and their treatment with compression hosiery.
OBJECTIVES: Occasional leg symptoms, like feelings of heaviness and tension, and occupational or evening oedema are considered typical features of a venous disorder but show low specificity in epidemiological and observational studies. We evaluated t... expand abstracthe prevalence and nature of such symptoms in subjects with no history or signs of venous disease and investigated the optimal strength that medical compression stockings (MCS) should exert in order to alleviate the symptoms and to prevent leg swelling. METHODS: Specifically designed questionnaires were used to assess the symptoms of 40 healthy employees of a factory producing MCS. Lower leg volumes were quantified in the morning and evening. Calf size hosiery providing documented ankle pressures of 4-9 (mean 7.3), 12-18 (mean 14.9) and 18-22 (mean 19.5) mmHg, respectively, were tested in a prospective, open-label, randomized trial lasting three weeks. Endpoints were the relief of symptoms, prevention of vesperal oedema and comfort in wearing the stockings. RESULTS: Sixty-five percent of the participants reported at least occasional leg symptoms and oedema. Somatic-type symptoms (i.e. pain, heaviness, swelling, unattractive legs) were present in two, psychic-type symptoms (i.e. leg- and personality-related unrest and stress) in 17 and both components in seven of the 40 subjects. MCS exerting 15 and 20 mmHg prevented the symptoms and oedema. Stockings providing <10 mmHg were ineffective and those providing >19 mmHg were not well-tolerated. The effect on the somatic-type symptoms was strongly correlated with the amount of lower leg volume which could be reduced by wearing stockings (P = 0.005). No correlation was found between the efficacy of compression and the emotional component of the symptoms. CONCLUSION: The cause of occasional pain in the legs of apparently healthy people is unknown. Some features of the syndrome reflect an emotional disorder while others mirror venous insufficiency. MCS of 15 mmHg effectively relieve the symptoms resembling venous insufficiency, prevent oedema and are well-tolerated. collapse abstract
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Acta anaesthesiologica Scandinavica 2008 Dec; 53(1)
Technical and non-technical skills can be reliably assessed during paramedic simulation training.
BACKGROUND: Medical teams depend on technical skills (TS) as well as non-technical skills (NTS) for successful management of critical events. Simulated scenarios are an opportunity for presentation of similar crisis situations. The aim of this study ... expand abstractwas to test whether TS and NTS are assessable with satisfactory interrater reliability (IRR) during a regular paramedic training. METHODS: Thirty paramedics were rated by two independent observers using video-recording and previously validated checklists while managing two simulated emergency scenarios as a team of two. The observed items of the team's TS included type, order, and time of adequate medical care. The NTS were restricted to six team-oriented dimensions. The IRR was quantified by calculating the intraclass correlation coefficient (ICC). The z-transformed values of the TS and NTS were correlated by Pearson's correlation. Internal consistency was controlled using Cronbach's alpha. RESULTS: The average measures ICC for the IRR was between 0.97 [95% confidence interval (CI) 0.91-0.99] and 0.98 (95% CI 0.94-0.99) for the TS sum-score, and was 0.94 (95% CI 0.87-0.97) for the NTS sum-score; the Cronbach's alpha of this NTS sum-score was 0.86. There is a positive correlation between the normalised TS and NTS sum-scores (r=0.53; P<0.05). CONCLUSION: Assessment of TS and NTS is feasible and reliable during paramedic training in emergency scenarios. TS can be reliably assessed by one trained observer; for NTS, two trained raters provide a suitable condition for excellent observations. There is a significant positive correlation between TS and NTS. collapse abstract
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European journal of vascular and endovascular surgery : the official journal of the European Society for Vascular Surgery 2008 Feb; 35(3)
Compression therapy for occupational leg symptoms and chronic venous disorders - a meta-analysis of randomised controlled trials.
OBJECTIVE: Leg discomfort and oedema are commonly attributed to a venous disorder (CVD) or chronic venous insufficiency (CVI) and treated with compression hosiery. The pressure needed to achieve clinical benefit is a matter of debate. DESIGN: We perf... expand abstractormed a meta-analysis of randomised controlled trials (RCT) that compared stockings exerting an ankle pressure of 10-20mmHg with placebo or no treatment and with stockings exerting a pressure of more than 20mmHg. METHODS: RCT were retrieved and analysed with the tools of the Cochrane Collaboration. Each study was reviewed independently. Subjective dichotomous and continuous factors and objective findings were pooled for statistical treatment. RESULTS: Eleven RCT fulfilled the predefined criteria. They included 1453 randomised subjects, 794 healthy people exposed to various forms of stress, 552 patients with a chronic venous disorder or chronic venous insufficiency and 141 patients after varicose vein surgery. Over all, compression with 10-20mmHg had a clear effect on oedema and symptoms as compared with <10mmHg pressure, placebo stockings, or no treatment (p<.0001). No study showed a difference between 10-20 and >20mmHg stockings. CONCLUSIONS: Despite important methodological heterogeneity and sometimes sub-standard reporting the meta-analysis suggests that leg compression with 10-15mmHg is an effective treatment for CVD. Less pressure is ineffective and higher pressure may be of no additional benefit. collapse abstract
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Psychopathology 40(6)
Disease variables and depression affecting the process of coping in families with a somatically ill parent.
AIM AND METHODS: Based on the investigation of 134 families with a seriously ill parent and 214 offspring, we compared--by means of semistructured psychiatric interviews--the capacity of the ill and the healthy parent and their children to cope with ... expand abstractvarious diseases. We evaluated how disease characteristics such as duration and severity of the disease (assessed by the Karnofsky Index) and associated depression [measured by the Beck Depression Inventory for parents and the Depression Inventory for Children and Adolescents (Depressions-Inventar für Kinder und Jugendliche) for children] influence the coping capacity of all family members. RESULTS: The coping capacity of patients with organic disease (cancer, multiple sclerosis, other somatic diseases) is significantly higher than that of patients with somatization disorder, whereas the depression score of patients with organic disease is significantly lower than that of patients with somatization disorders. The depression of the patient negatively influences his/her coping capacity. Children's coping capacity does not differ with respect to the parental illness and is not influenced by their own depression. There are significant correlations between the coping capacity of children and their healthy and ill parents affected by organic disease (multiple sclerosis, other somatic diseases, cancer), but not between children and healthy and ill parents with somatization disorders. Multivariate regression analysis shows the mutual influence of coping capacities between the parental couple as well as between the parents and their children. The better the patient (partner) is able to cope with a severe disease, the higher are the values of the coping capacity of the partner (patient). Children older than 6 years with a severely ill, nondepressed and well-coping parent cope well. These results do not apply to parents with somatization disorders. CONCLUSIONS: Patients with organic disease cope better and are less depressed, whereas patients with somatization disorders have a lower coping capacity and a higher depression score. Children older than six years cope better. Comprehensive care of a patient with a severe illness has to include his/her family in order to evaluate coping capacities of all family members, particularly of small children, and to assess and treat associated parental depression. collapse abstract
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European journal of obstetrics, gynecology, and reproductive biology 2007 Oct; 135(1)
Acute stress reactions in the first 3 weeks postpartum: a study of 219 parturients.
OBJECTIVES: There is increasing research on posttraumatic stress (PS) 4-6 weeks and 3 months postpartum, but, there are no data on acute stress reactions (ASR) in the first 3 weeks postpartum, i.e. the potential precursors of PS. However, ASR may hav... expand abstracte long-term effects, e.g., on a subsequent pregnancy without having manifested as PS in the meantime. We propose: (i) to describe the patterns of ASR after childbirth, (ii) to explore differences between women with normal and traumatogenic ASR, and (iii) to provide data on the early detection of traumatogenic ASR 2 and 3 weeks postpartum. STUDY DESIGN: Intra-event variables (relationship with caregivers, overall birth experience, and dissociative experiences, as well as obstetric variables) were assessed 48-96 h. postpartum, as were ASR (by means of the Impact-of-Event Scale IES) in weeks 1, 2, and 3 postpartum. According to research on PS the upper 33%-range of ASR in weeks 2 and 3 was defined as 'traumatogenic'. RESULTS: Normal ASR in week 1 are at a level which in non-obstetric trauma-situations is considered as the upper range of low stress or lower range of medium distress. ASR decline constantly from week 1 to week 3. However, high ASR in week 1 do not drop faster than do low ones, thus indicating a prolonged stress reaction in women with high ASR in week 1. Low ASR (IES-scores <10) and high ASR (IES-scores >20) in week 1 are highly predictive for normal ASR, and traumatogenic ASR in weeks 2 and 3, respectively. Medium ASR (IES-scores 10-20) in week 1 are of uncertain predictive value for stress reactions in weeks 2 and 3 and have to be re-assessed at that time. CONCLUSIONS: Clinical screening for ASR appears to be helpful in detecting women with a compromised ability to process childbirth-related stress. The association between ASR and long-term development should be further explored. collapse abstract
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Journal of psychosomatic obstetrics and gynaecology 2006 Nov; 27(4)
Memory of childbirth in the second year: the long-term effect of a negative birth experience and its modulation by the perceived intranatal relationship with caregivers.
OBJECTIVE: To assess the memory of various subdimensions of the birth experience in the second year postpartum, and to identify women in the first weeks postpartum at risk of developing a long-term negative memory. DESIGN, METHOD, OUTCOME MEASURES: N... expand abstractew mothers' birth experience (BE) was assessed 48-96 hours postpartum (T1) by means of the SIL-Ger and the BBCI (perception of intranatal relationships); early postnatal adjustment (week 3 pp: T1(bis)) was also assessed. Then, four subgroups of women were defined by means of a cluster-analysis, integrating the T1/T1(bis) variables. To evaluate the memory of the BE, the SIL-Ger was again applied in the second year after childbirth (T2). First, the ratings of the SIL-Ger dimensions of T1 were compared to those at T2 in the whole sample. Then, the four subgroups were compared with respect to their ratings of the birth experience at T2 (correlations, ANOVAs and t-tests). RESULTS: In general, fulfillment, emotional adaptation, physical discomfort, and anxiety improve spontaneously over the first year postpartum, whereas in negative emotional experience, control, and time-going-slowly no shift over time is observed. However, women with a negative overall birth experience and a low level of perceived intranatal relationship at T1 run a high risk of retaining a negative memory in all of the seven subdimensions of the birth experience. CONCLUSIONS: Women at risk of developing a negative long-term memory of the BE can be identified at the time of early postpartum, when the overall birth experience and the perceived intranatal relationship are taken into account. collapse abstract
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European child & adolescent psychiatry 2007 Mar; 16(3)
Mental health problems in children of somatically ill parents, e.g. multiple sclerosis.
OBJECTIVES: Based on the investigation of 144 families (144 patients affected by Multiple Sclerosis (MS), 109 partners, and 192 children) examined in three different European child and adolescent psychiatric University centres by means of questionnai... expand abstractres, we evaluated the prevalence of psychological symptoms in the offspring and associated risk factors such as duration and severity of the disease as well as depression of the ill and the healthy parent. RESULTS: Indicate that the severe disease of MS is associated with depression of the ill and healthy parent. Ill parents, especially ill mothers, as well as depressed ill, or depressed healthy parents evaluate their children's mental health problems with a higher prevalence within the internalizing spectrum. Healthy parents report normal psychological adjustment of their children. If two parents present a depressive state, the prevalence of relevant psychological internalizing symptoms is twice or three times as high as the age norms. CONCLUSION: Children in families with a parent affected by MS and associated depression of the parental couple are at high risk of mental health problems, especially internalizing disorders. In focusing on the mental health of children one must also be aware of the potential opportunities to address the parents' own psychological needs. collapse abstract
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Acta psychiatrica Scandinavica 2006 Sep; 114(4)
Pretreatment social functioning predicts 1-year outcome in early onset psychosis.
OBJECTIVE: The aim was to investigate the association of pretreatment social functioning (12 months before initial presentation) with symptom dimensions and social functioning at 1-year follow-up. METHOD: Fifty-six adolescents, age 14-18, first admit... expand abstractted for early onset psychosis, were evaluated at baseline and 1-year follow-up assessing psychopathology (PANSS), social functioning (Strauss and Carpenter Prognostic Scale), and duration of untreated psychosis (DUP). RESULTS: Adolescents with low pretreatment social functioning were at risk of more severe negative symptoms and lower social functioning at follow-up. Negative symptoms at baseline were less predictive and DUP was not predictive in this sample. CONCLUSION: Results of this study suggest a strong longitudinal inter-relatedness between social functioning and negative symptoms in this age group. An integrative treatment approach including family interventions, social skills training, long-term specialized work/school rehabilitation, and adequate antipsychotic treatment is warranted to improve both, social functioning and negative symptoms. collapse abstract
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Der Chirurg; Zeitschrift für alle Gebiete der operativen Medizen 2005 Sep; 76(10)
Interdisciplinary emergency room management of trauma patients from the standpoint of coworkers
INTRODUCTION: The purpose of this study was to examine whether staff questionnaire evaluation is useful for quality control in the emergency room (ER) setting. METHODS: Consecutive anonymous questionnaires (Likert scale 1-5) were filled out by the in... expand abstractvolved medical staff in all ER trauma cases in a university hospital from July 2002 to December 2003 (analysis of variance, P<0.05). RESULTS: In 171 ER cases, 844 staff members responded. Main criticisms concerned time management or satisfaction with personal ER training (Likert <4). Consultants rated the quality of their training significantly higher than younger doctors, two thirds of consultants vs one third of residents having passed an Advanced Trauma and Life Support course (P<0.001). Depending on responders' professional specialties and whether the situation concerned multiple trauma (Injury Severity Score >15), a significant systematic difference resulted. CONCLUSION: Our standardized staff questionnaire evaluation was revealed to be a discriminative instrument for quality management of trauma cases in the ER. To confirm these findings, correlation with clinical outcome data and further validation of the method are needed. collapse abstract
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European journal of anaesthesiology 2005 Sep; 22(10)
Multiple-trauma management: standardized evaluation of the subjective experience of involved team members.
BACKGROUND AND OBJECTIVE: Staff attitude plays a pivotal role in quality management. The objective of the present study was to further define how interdisciplinary emergency hospital staff experience their daily work and the extent to which the profe... expand abstractssional speciality and training of an individual influences his/her assessment of multiple-trauma team performance. METHODS: The clinical staff involved in multiple-trauma emergency management of a university hospital was asked to answer a confidential questionnaire. Factorial analysis was used to identify 8 major dimensions from a total of 53 items. RESULTs: The questionnaire was returned by 128 team members. All professional groups were most dissatisfied with the dimensions 'education and training', 'work sequence between specialities' and 'communication between specialities'. Assessment of the quality of in-hospital emergency-trauma management differed significantly between professional specialities (ANOVA, F=5.2; P=0.028); surgeons gave the highest ratings for all but one dimension. Having taken an Advanced Trauma Life Support (ATLS) course influenced significantly the total rating of multiple-trauma treatments of anaesthetists and surgeons (F=5.5; P=0.024). CONCLUSIONS: The perceptions of interdisciplinary trauma team members without the completion of an ATLS training course were that they did not communicate enough with each other and that there were differences between their expectations and reality. The differences and the communication deficits were overcome in team members who had passed an ATLS course. collapse abstract
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Psychopathology 38(1)
Indication for psychotherapy in offspring of a parent affected by a chronic somatic disease (e.g. multiple sclerosis).
Based on the transcripts of video-recorded, semi-structured interviews with 41 offspring (aged 6-18 years) of parents with multiple sclerosis, we evaluated the indication for psychotherapy. These results were then compared with the previously determi... expand abstractned coping ability of each child/adolescent. Psychotherapy was indicated for 22 out of the 41 children/adolescents. There was a significant relation between the indication for psychotherapy and the children's inability to cope with the parental disease. The present findings confirm the risk of mental health problems in children of somatically ill parents. In our sample, half of the children and adolescents were estimated to benefit from individual psychotherapy, which might enhance their ability to cope with the parental illness. collapse abstract
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European journal of obstetrics, gynecology, and reproductive biology 2004 Jul; 115(1)
How do obstetric variables influence the dimensions of the birth experience as assessed by Salmon's item list (SIL-Ger)?
OBJECTIVE: To analyse the effect of obstetric variables on four dimensions of the birth experience. DESIGN/PARTICIPANTS: The birth experience of 251 German-speaking women was assessed at 48-96 h postpartum by means of Salmon's item list--German-langu... expand abstractage version (SIL-Ger). METHOD/MAIN OUTCOME MEASURES: Statistical correlations and variances between four dimensions of the birth experience (fulfillment, emotional adaptation, negative emotional experience, physical discomfort) and common obstetric variables were calculated. The explained variance is assessed by a stepwise regression analysis. RESULTS: In general the variance explained by the investigated obstetric variables per se is low. The mode of delivery affects the dimension of negative emotional experience with a constant qualitative worsening in the order of spontaneous deliveries, instrumental deliveries, elective and unplanned caesarean sections. Epidurals are associated neither with positive nor with negative evaluative feelings. To assess the impact of duration, the subjective latent phase of labour has to be taken into consideration in addition to the duration of labour itself. Not only very long durations of labour, but also very short ones may induce negative evaluative feelings in the immediate postpartum. CONCLUSIONS: Further research on this question must include the aspect of the parturients' subjective perception of both obstetric procedures and the attending staff. Clinicians should be aware that epidurals and elective caesarean sections do not necessarily enhance positive evaluative feelings in the immediate postpartum. collapse abstract
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Anaesthesia 2004 Jan; 59(2)
Improving anaesthetists' communication skills.
The attitude, behaviour and communication skills of specialised doctors are increasingly recognised as important and they have been identified as training requirements. We designed a programme to teach communication skills to doctors in a University ... expand abstractDepartment of Anaesthesia and evaluated its effect on patient outcomes such as satisfaction and anxiety. The 20 h programme was based on videotaped reviews of actual pre-operative visits and role-playing. Effects on patient satisfaction and pre-operative anxiety were assessed using a patient questionnaire. In addition, all participating anaesthetists assessed the training. We provide evidence that the training increased patient satisfaction with the pre-operative anaesthetic visit. Training also decreased anxiety associated with specific aspects of anaesthesia and surgery, but the effect was rather small given the intense programme. The anaesthetists agreed that their interpersonal skills increased and they felt better prepared to understand patients' anxieties. Communication skills training can increase patient satisfaction and decrease specific anxieties. The authors conclude that in order to better demonstrate the efficacy of such a training programme, the particular communication skills of anaesthetists rather than indirect patient outcome parameters should be measured. collapse abstract
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Supportive care in cancer : official journal of the Multinational Association of Supportive Care in Cancer 2003 Sep; 11(10)
The years after: a concept of the psychological integration of childhood cancer.
GOALS OF WORK: To define and measure the psychological integration of childhood cancer experiences into a personal biography and to explore the association between integration with illness-related factors and psychosocial conditions. PATIENTS AND MET... expand abstractHODS: Analysis of cancer survivors' narratives on the course of their illness was used to measure integration. Psychosocial condition, body concepts, health locus of control, and illness-related distress were evaluated by questionnaires. Illness factors were assessed by reviewing hospital case notes and sociodemographic factors by a structured interview. Of 72 eligible subjects contacted, 60 agreed to participate. MAIN RESULTS: High inter-rater correlations established the reliability of the concept of testing integration by narrative analysis. Subjects with good psychological integration of the experience of cancer saw chance as having less to do with illness and health, and perceived illness and therapy retrospectively as more distressing than survivors with poor integration. In contrast, integration did not correlate with distress evoked by present feelings toward illness and therapy or by thoughts of a relapse. CONCLUSIONS: Successful integration of the experience of cancer may be associated with the ability to accept painful feelings and to allow them to emerge, and with a readiness to accept responsibility in relation to health and medical care. Assisting young cancer patients and their families to create and maintain their personal narratives of the experience of illness is an important clinical task for all professionals working in paediatric oncology. collapse abstract
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Praxis der Kinderpsychologie und Kinderpsychiatrie 2003 Feb; 52(3)
Siblings of children with cancer: integration of illness experiences into personal life history
Based on the hypothesis that personal narratives help to cope people with stressful life events, 33 adult siblings of former childhood cancer patients were asked how they had experienced illness and treatment of their brother or sister. Analysis of t... expand abstracthe narratives was used to measure the integration of these experiences into personal biography. Good integration correlated positively with good body concepts. Siblings with good integration also scored lower for fatalistic health locus of control and perceived the illness retrospectively as more distressing than those with poor integration. In contrast, integration did not correlate with distress evoked by present feelings towards illness and therapy or by thoughts of a relapse or a personal cancer illness. The findings of this exploratory investigation may suggest that successful integration of the experiences associated with a brother's or sister's cancer is associated with a trustful relation to the own body and with the ability to accept painful feelings and to allow them to emerge. Assisting siblings of young cancer patients to create and maintain their personal narratives of their experiences can make an important contribution to coping. collapse abstract
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Psychopathology 34(5)
Gender-specific differences in the process of coping in families with a parent affected by a chronic somatic disease (e.g. multiple sclerosis).
Based on the investigation of 52 families and their 87 offspring by means of semistructured interviews, we evaluated the coping abilities of the parent affected by multiple sclerosis (MS), the healthy parent and their children. The results show that ... expand abstractthe gender of the child significantly influences his or her coping behaviour. Daughters cope better than sons, independently of the gender of the MS-affected parent. Only the daughter's coping is positively affected by age and disease variables. The correlation between the coping behaviour of parents and children is significant between children and their healthy parents and even stronger between children and healthy parents of the same gender. Healthy mothers and daughters cope better with the increasing disability of the father. This is not the case for healthy fathers and sons. Gender seems to be an important moderating factor in chronic parental disease and it has complex effects on the coping capacity of children. collapse abstract
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Praxis der Kinderpsychologie und Kinderpsychiatrie 2002 Jan; 51(2)
Discontinuation of treatment in child and adolescent ambulatory psychiatric care in Basel: an evaluation within the scope of quality assurance
Attrition in child and adolescent psychiatry occurs frequently and has often been investigated. Attempts to establish general criteria that are associated with dropping-out have produced contradictory results. In the present study, factors that influ... expand abstractenced attrition at a child psychiatry outpatient clinic in Basel were assessed during two separate periods. Between the two assessments, the results of the first period were presented to the staff and were discussed. At first assessment, attrition was increased in patients who were referred as emergencies or by somatic hospitals. In contrast, attrition was low in patients who were referred involuntarily. At second assessment, there was a significant decrease in dropping-out for the total sample and for emergencies. This result may be explained by a more careful clarification of the setting before first consultation and, as a consequence, by higher congruence between patients' expectations and the clinic's offers. Further studies on the subject of attrition in child and adolescent psychiatry should focus on clearly defined clinical situations and samples and include measures of patients' expectations as well as of the therapeutic relationship. collapse abstract
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Journal of psychosomatic obstetrics and gynaecology 2001 Nov; 22(4)
Birth as a multidimensional experience: comparison of the English- and German-language versions of Salmon's Item List.
Results concerning satisfaction with the birth experience in different trials are difficult to compare, owing to a lack of internationally used research scales. Salmon's Item List (SIL) is easy-to-handle and would therefore be very helpful for resear... expand abstractch as well as for obstetric clinic quality control. Two hundred and fifty-one patients were investigated using a German-language version of SIL (SIL-ger); the statistical evaluation was carried out by means of a principal components analysis. Principal components analysis revealed two major findings: (1) as stated by other authors the birth experience is multidimensional, each aspect influencing the others in a non-linear way; (2) in addition to Salmon's dimensions (i.e. postnatal 'fulfillment', intranatal 'physical discomfort' and intranatal 'emotional distress') another postnatal dimension labeled 'negative emotional experience' was detected. Not only are intranatal experiences multidimensional, but so too are evaluative feelings afterwards. In addition to fulfillment, as developed by Salmon, a dimension of negative emotional experience needs to be taken into account. This dimension does not correlate in a linear way with fulfillment. It is appropriate to use SIL in research. Before using it for purposes of clinical quality control, however, larger samples need to be evaluated in order to prove the stability of the factor structure. collapse abstract
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Resuscitation 2001 Mar; 49(1)
Team performance in the emergency room: assessment of inter-disciplinary attitudes.
In-hospital emergency medicine in central Europe relies on inter-disciplinary co-operation. To improve team performance in the emergency room (ER), a questionnaire for assessment of attitudes and judgements in resuscitation procedures was developed. ... expand abstractA total of 43 items were evaluated according to a five-point Likert scale. With a response rate of 81%, 143 questionnaires were evaluated. Assessment of data was performed with regard to professional speciality and level in the medical hierarchy. Factorial analysis identified four main factors: Assessment of 'quality of performance' (F1), 'importance of structure' (F2), 'quality of team culture' (F3), and 'importance of hierarchy' (F4). Influences from the categories 'speciality' and 'hierarchy' and from the covariate 'gender' on these main factors were evaluated by two-factorial analysis of variance. For all four factors, 'speciality' produced significant differences. Surgeons accorded high values to F1 and low values to F2, whereas anaesthesiologists accorded low values to F1 and high values to F2. F3 showed a low ranking from within the ER nursing staff and the residents in internal medicine, whereas F4 received high scores by medical residents and staff members. For F1 and F3, there was a tendency towards hierarchy dependency, whereas no factor was influenced by gender. In conclusion, team performance in the ER is mainly influenced by different perceptions and attitudes of the different disciplines involved in the resuscitation process. collapse abstract
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