Case Vignettes (case + vignette)

Distribution by Scientific Domains


Selected Abstracts


The Network Perspective: An Integration of Attachment and Family Systems Theories,

FAMILY PROCESS, Issue 3 2002
FRANZCP, Kasia Kozlowska MBBS
In this article we discuss the network paradigm as a useful base from which to integrate attachment and family systems theories. The network perspective refers to the application of general systems theory to living systems, and provides a framework that conceptualizes the dyadic and family systems as simultaneously distinct and interconnected. Network thinking requires that the clinician holds multiple perspectives in mind, considers each system level as both a part and a whole, and shifts the focus of attention between levels as required. Key epistemological issues that have hindered the integration of the theories are discussed. These include inconsistencies within attachment theory itself and confusion surrounding the theoretical conceptualizations of the relationship between attachment and family systems theories. Detailed information about attachment categories is provided using the Dynamic Maturational model. Case vignettes illustrating work with young children and their families explore the clinical implications of integrating attachment data into family therapy practice. [source]


Mind the gap: the need for a generic bridge between psychoanalytic and systemic approaches

JOURNAL OF FAMILY THERAPY, Issue 2 2003
Mary Donovan
The context for this paper is the ongoing systemic/psychoanalytic debate. It offers an alternative perspective to the recent contribution by Brodie and Wright (2002), in which they are concerned to underscore difference between the two therapeutic approaches. Here it is argued that the relationship is a great deal more complex than Brodie and Wright's analysis might suggest. Attention is focused on significant areas of commonality, in particular the impact of social constructionist thinking across the two therapies as well as current developments in technique. A case is made for the consolidation of generic space where there is opportunity for cross-fertilization and for integrative and combined systemic/psychoanalytic approaches to be nurtured and developed where appropriate. Case vignettes are used to highlight different aspects of the generic component in child and family therapy and to underline the need for bridge-building between these key therapeutic approaches in the field. [source]


When Immigration Is Trauma: Guidelines for the Individual and Family Clinician

AMERICAN JOURNAL OF ORTHOPSYCHIATRY, Issue 2 2001
RoseMarie Perez Foster Ph.D.
This paper considers two pertinent strands in the contemporary immigrant mental health literature: 1) the distinction made between stressors that are endemic to most immigrant experiences vs. those migration stressors that precipitate trauma per se; and 2) clinical guidelines that continue to refine the assessment of immigrants' presenting mental health problems, given the provision of services in institutions that are foreign to both the language and idioms of distress of the populations being served. Case vignettes highlight the research findings and practice recommendations. [source]


Dementia and the Over-75 Check: the role of the primary care nurse

HEALTH & SOCIAL CARE IN THE COMMUNITY, Issue 1 2000
Heather Trickey BSc MSc (Med)
Abstract Primary care nurses are very likely to provide a substantial part of the routine care for patients with dementia. In order to examine the knowledge and attitudes of the primary care nurses who undertake the Over-75 Check, towards assessing and managing patients with symptoms of dementia, and to assess their level of support for a clinical practice guideline, a postal questionnaire survey was undertaken of primary care nurses responsible for the Over-75 Check in 209 general practices in Gloucester, Avon and Somerset. The questionnaire ascertained some demographic information about the nurses, their training and the practice routine for the Over-75 Check. It also included a case vignette describing a typical presentation of dementia at an Over-75 Check. A 65% response rate was achieved. Only one-fifth of respondents ever used formal validated cognitive tests as part of the Over-75 Check. In response to the vignette, nearly 10% took no action at all and a further 25% simply referred the patient on. Amongst the remainder there was considerable variation regarding the tasks considered to be within their remit. The respondents strongly supported the introduction of guidelines. Given the variation in professional responsibilities between practices, it is proposed that a clinical practice guideline covering diagnosis, assessment and management of dementia should address the practice as a whole rather than be targeted to specific professionals. The guideline should prompt professionals carrying out an Over-75 Check to recognize symptoms of dementia and raise awareness of the range of tasks which need to be undertaken in confirming diagnosis, assessing needs and managing patients. Results from this study suggest that improved training and increased autonomy for primary care nurses would improve access to services for these patients and their carers. [source]


A judicial,mental health partnership to heal young children in juvenile court

INFANT MENTAL HEALTH JOURNAL, Issue 1 2008
Judge Cindy Lederman
In this article, we describe the background and issues to be addressed related to dependent children in juvenile court. In an important effort to systematically examine developmental functioning and treatment needs in maltreated and violence-exposed young children, the Prevention and Evaluation of Early Neglect and Trauma (PREVENT) initiative of the Dependency Court Intervention Program for Family Violence, a national demonstration project in the Miami-Dade Juvenile Court, developed a program to evaluate all infants, toddlers, and preschoolers who are adjudicated dependent by the court. The goal of the intervention is to raise awareness of the needs of infants and toddlers in juvenile court and to work toward healing the child. The PREVENT program involved the evolution of a judicial,mental health partnership designed to assist the court in making more informed decisions about the best interest of the child by adding scientific knowledge about development, prevention, intervention, evaluation, and treatment. The outcome of the partnership and multidisciplinary approach is illustrated through presenting a case vignette of a mother and baby showing the challenges and strengths of intervention. Finally, we consider overall outcomes of the intervention and directions for the future. [source]


Expanding the usefulness of Interpersonal Psychotherapy (IPT) for depressed elders with co-morbid cognitive impairment

INTERNATIONAL JOURNAL OF GERIATRIC PSYCHIATRY, Issue 2 2007
Mark D. Miller
Abstract Background The utility of Interpersonal Psychotherapy (IPT) has been documented as a maintenance treatment for late life depression as mono-therapy or in combination with antidepressant medication. Late life depression, however, is frequently co-morbid with declining memory or other cognitive abilities such that the usefulness of one-to-one psychotherapies is called into question for this subgroup. Additionally, concerned caregivers often accompany these patients to request help and their role in the presenting symptoms and in their potential resolution must also be addressed by any successful psychotherapy in this population. Objectives To explore ways in which IPT could be modified to better serve the particular presentation and needs of depressed elders with cognitive decline along with their caregivers. Methods Various modifications of traditional IPT techniques were experimented with and refined in our collaborative late life research center using regular group supervision and feedback from patients and their caregivers. Results A key component of these modifications involves the integration of the caregiver into the treatment process in flexible ways that recognize their own role transition that is taking place simultaneously with that of the patient's role transition from a greater to a lesser functional state. Other techniques for resolving role conflicts, particularly those directly involving care issues for the patient, are also delineated. These modifications are collectively referred to as IPT-CI for cognitive impairment. A brief case vignette is presented. Conclusion The modifications outlined in this communication reflect an evolving work-in-progress and serve as a framework for the future development of a manual of guidelines to assist healthcare personnel to optimally treat this population and their caregivers. Copyright © 2006 John Wiley & Sons, Ltd. [source]


Applying the developmental perspective in the psychiatric assessment and diagnosis of persons with intellectual disability: part I , assessment

JOURNAL OF INTELLECTUAL DISABILITY RESEARCH, Issue 1 2005
A. Dosen
Abstract Background In generic psychiatry there has been increasing interest among scientists for the developmental perspective. However, professionals active in the mental health care of people with intellectual disability (ID) have not shown the same degree of interest. The author of this article, who has had a liberal amount of rewarding experiences with the developmental approach in the field of ID, considers the developmental perspective to be innovative and very useful in psychiatric assessment, diagnosis and treatment of this population. The aim of the article is to stimulate a wider application of the developmental perspective as well as to challenge a professional discussion on this issue. Methods Basic assumptions of the developmental perspective are discussed and assessment tools and methods are described. Results In a case vignette, the advantages of developmentally based assessment are emphasized. Emotional development and personality development are viewed as the developmental components that play an important role in adaptive and maladaptive behaviour as well as in the onset and presentation of psychopathology. It is clear that interpretative insight into the totality of the psychosocial aspects of these individuals cannot only be obtained by measuring the level of cognitive development. A wider frame of mind is needed for unambiguous psychiatric diagnostics. Therefore, a replacement of the three dimensional paradigm (bio,psycho,social) by a four dimensional one (bio,psycho,socio,developmental) for the assessment and diagnosis of persons with ID is proposed. [source]


Pathways from Traumatic Child Victimization to Delinquency: Implications for Juvenile and Permanency Court Proceedings and Decisions

JUVENILE AND FAMILY COURT JOURNAL, Issue 1 2006
JULIAN D. FORD
ABSTRACT Research studies and observations by mental health and judicial professionals suggest that childhood traumatic victimization may contribute to the development of juvenile delinquency. Based on this evidence, we describe a chronological pathway that runs from: (a) early childhood victimization, to (b) escalating dysregulation of emotion and social information processing ("survival coping," which takes the form of depression, anxiety, social isolation, peer rejection, and conflicted relationships), to (c) severe and persistent problems with oppositional-defiance and overt or covert aggression compounded by post-traumatic reactivity and hypervigilance ("victim coping"). A case vignette is provided, and implications for judicial review and decisions are discussed. [source]


Comparative gender biases in models of personality disorder

PERSONALITY AND MENTAL HEALTH, Issue 1 2009
Douglas B. Samuel
The potential of gender bias within the DSM personality disorders has long been a concern of scholars and clinicians. Over the past three decades, research findings utilizing the case vignette methodology have repeatedly indicated a gender bias within the histrionic diagnosis. The current study replicates these findings using a novel case vignette, but extends them to investigate the potential for gender biases within an alternative dimensional model of personality,the Five-Factor Model (FFM). One hundred and forty-one practicing clinicians rated either a male or a female version of a case vignette in terms of either the FFM or the personality disorders from the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV-TR). The results supported the concern of gender bias, with the female case less likely to be diagnosed as antisocial and the male case less likely to be diagnosed as histrionic. However, when the FFM conceptualizations of these two disorders were compared, no significant differences were noted. The results indicate that the FFM may be less prone to gender bias than the current DSM nomenclature. Copyright © 2009 John Wiley & Sons, Ltd. [source]


Personal stigma and coping strategies in families of patients with schizophrenia: Comparison between Japan and Korea

ASIA-PACIFIC PSYCHIATRY, Issue 2 2010
Setsuko Hanzawa PhD
Abstract Introduction: It has been extensively documented that caregivers of persons who have serious and persistent mental disorders must successfully cope with many challenging problems in order to provide good care. However, little is known about the relationship between family stigma and strategies for coping with patients with schizophrenia. Therefore, the present study compared the personal stigma and coping strategies of families of patients with schizophrenia by examining the socio-cultural factors that affect the care experience of families in Northeast Asian countries. Methods: Two self-rating scales were used to compare personal stigma and coping strategies regarding family members of patients with schizophrenia in 47 Japanese and 92 Korean families. Respondents reported their personal attitudes (personal stigma) with respect to a case vignette that described a person with chronic schizophrenia. Results: Analysis revealed the following: 1) although no differences in coping strategies were observed between the countries, the personal stigma of families was significantly higher in Korea than in Japan; 2) coping strategies, such as positive communication, coercion, and avoidance, were significantly associated with personal stigma in Korean families; however, in Japanese families, resignation was significantly associated with personal stigma. Discussion: The present findings suggest that personal family stigma was higher in Korea than Japan, and the features associated with coping strategies differ between countries. It is important to determine the features of personal stigma that are associated with schizophrenia. Furthermore, education and support programs for families with schizophrenia based on trans-cultural considerations must be emphasized in both countries. [source]


Family stigma and care burden of schizophrenia patients: Comparison between Japan and Korea

ASIA-PACIFIC PSYCHIATRY, Issue 3 2009
Setsuko Hanzawa PhD
Abstract Introduction: In the present study, we compared the care burden and stigma experienced by families of patients with schizophrenia in Japan (Niigata) and Korea (Seoul and Daegu) to elucidate similarities and differences in the sociocultural factors that affect the care experience of families in East Asia. Methods: Factors such as care burden (evaluated using the eight-item short version of the Zarit Caregiver Burden Interview [ZBI-8]), stigma, and social distance were evaluated in members of support groups for families of mentally ill individuals in Japan (n=47) and Korea (n=92) using an interview questionnaire. Interviewees reported their personal attitudes (personal stigma and social distance) and perceptions of the attitudes of others in the community (perceived stigma) with respect to a case vignette. These vignettes described a person with chronic schizophrenia. Results: The data analysis revealed the following: (i) feelings of care burden (according to ZBI-8), perceived stigma, and social distance were significantly stronger in Japan compared to Korea, and (ii) feelings of personal stigma were significantly stronger in Korea than in Japan. Discussion: The care burden and stigma experienced by families of patients with schizophrenia differed between Japan and Korea. The present findings suggest that to provide effective support for reducing family stigma and care burden, the necessity of such support must be emphasized in both countries. [source]


Recognition and referral of girls with Attention Deficit Hyperactivity Disorder: case vignette study

CHILD: CARE, HEALTH AND DEVELOPMENT, Issue 6 2009
C. Groenewald
Abstract Background Compared with boys, girls with Attention Deficit Hyperactivity Disorder (ADHD) are under-recognized. Parents commonly discuss concerns with teachers, who play an important role in the recognition and referral of children with ADHD. We investigated whether the predominating subtype of symptomatology influences teacher recognition of affected girls. Methods A total of 212 teachers from 40 randomly selected primary schools in England participated in a postal questionnaire study. The questionnaire consisted of a case vignette (based on DSM-IV criteria) describing a girl with either combined or predominantly inattentive subtype ADHD. Each school received an equal number of each type of vignette for distribution. Further questions elicited teachers' conceptualization of the girl's difficulties and need for specialist referral, their views on treatment modalities and demographic data. Results Most (98%) teachers recognized the presence of a problem but mainly conceptualized the girl's behaviour as reflecting attentional (89%) or emotional (62%) difficulties. Teachers were less likely to correctly identify a girl with inattentive than combined subtype ADHD (14% vs. 43%) or recommend clinical referral (50% vs. 59%) for her. Few (15%) teachers thought that medication might be helpful for a girl meeting diagnostic criteria for ADHD. Conclusions Teachers are able to recognize ADHD-related behaviours and impairments but conceptualize these as reflecting attentional or emotional difficulties rather than as relating to a disorder (ADHD). Teachers' conceptualization of ADHD and views about medication are important factors that could affect accurate recognition and referral. Improving teachers' knowledge about ADHD, especially the inattentive subtype, could assist in tackling gender-related barriers to care. [source]


How psychiatrists inform themselves and their patients about risks and benefits of antipsychotic treatment

ACTA PSYCHIATRICA SCANDINAVICA, Issue 2 2009
R. Mendel
Objective:, In order to choose the best treatment option, physicians have to inform themselves and their patients about both the benefits and risks of available treatment options equally. Our study aims to investigate whether psychiatrists actually do conduct such a balanced information search and presentation. Method:, Psychiatrists' information search and information presentation to a patient with schizophrenia were studied using two separate experiments. In both, participants were presented with hypothetical case vignettes and descriptions of fictitious antipsychotics. Results:, When searching for information, psychiatrists looked more for risks than benefits of antipsychotic treatment options (t = ,3.4, df = 74, P = 0.001). However, when informing a patient, they named more benefits than risks (t = 17.1, df = 224, P < 0.001). Conclusion:, The risk-biased information search presumably follows the principle of ,primum non nocere'. The benefit-biased information presentation might be motivated by the wish to persuade patients to accept the proposed therapy. [source]


Do we agree about when patients are psychotic?

ACTA PSYCHIATRICA SCANDINAVICA, Issue 4 2008
J. Nielsen
Objective:, To investigate into the use of the term ,psychotic' as defined by ICD-10 or by the concept of impaired reality testing, among psychiatric staff members. Method:, Questionnaire investigation using 11 short case vignettes. Results:, Responses were received from 266 psychiatric staff members: psychiatrists, nursing staff and psychologists. When using ICD-10, patients were identified as psychotic with a sensitivity ranging from 90% to 55%. Specificity ranged from 60% to 75%. According to the concept of impaired reality testing, all three groups showed a sensitivity of about 60%, whereas specificity ranged from 65% to 50%. The combined use of the terms correlated significantly with responses regarding indication for legal detention for psychiatrists and nursing staff. Conclusion:, In identifying a patient as ,psychotic' a broad concept of impaired reality testing was widely used particularly in cases with legal issues. Psychotic symptoms, however, were identified with high sensitivity and specificity. [source]


Validity and reliability of the guidelines of the Surveillance of Cerebral Palsy in Europe for the classification of cerebral palsy

DEVELOPMENTAL MEDICINE & CHILD NEUROLOGY, Issue 11 2008
Mary Gainsborough MRCPCH
The validity and reliability of the guidelines of the Surveillance of Cerebral Palsy in Europe (SCPE) for the classification of cerebral palsy (CP) were tested by administering 10 written case vignettes via an interactive web-based link to 30 SCPE partners. There was a moderately good level of agreement (,=0.59) about inclusion as a CP case on the SCPE database. Classification by CP subtype differed in two main areas: assigning spastic versus dyskinetic and judgement of distribution of spastic involvement. Agreement on Gross Motor Function Classification System (GMFCS) level was less good than reported in previous studies. Twenty respondents repeated the test 5 months later and there was good repeatability for case inclusion (,= 0.72) but considerable variation in assignment of CP subtype and GMFCS level. There is a need for further collaborative work and training to improve harmonization of the classification of CP, including examination, application of SCPE guidelines, and register coding. [source]


Medical Error Identification, Disclosure, and Reporting: Do Emergency Medicine Provider Groups Differ?

ACADEMIC EMERGENCY MEDICINE, Issue 4 2006
Cherri Hobgood MD
Abstract Objectives: To determine if the three types of emergency medicine providers,physicians, nurses, and out-of-hospital providers (emergency medical technicians [EMTs]),differ in their identification, disclosure, and reporting of medical error. Methods: A convenience sample of providers in an academic emergency department evaluated ten case vignettes that represented two error types (medication and cognitive) and three severity levels. For each vignette, providers were asked the following: 1) Is this an error? 2) Would you tell the patient? 3) Would you report this to a hospital committee? To assess differences in identification, disclosure, and reporting by provider type, error type, and error severity, the authors constructed three-way tables with the nonparametric Somers' D clustered on participant. To assess the contribution of disclosure instruction and environmental variables, fixed-effects regression stratified by provider type was used. Results: Of the 116 providers who were eligible, 103 (40 physicians, 26 nurses, and 35 EMTs) had complete data. Physicians were more likely to classify an event as an error (78%) than nurses (71%; p = 0.04) or EMTs (68%; p < 0.01). Nurses were less likely to disclose an error to the patient (59%) than physicians (71%; p = 0.04). Physicians were the least likely to report the error (54%) compared with nurses (68%; p = 0.02) or EMTs (78%; p < 0.01). For all provider and error types, identification, disclosure, and reporting increased with increasing severity. Conclusions: Improving patient safety hinges on the ability of health care providers to accurately identify, disclose, and report medical errors. Interventions must account for differences in error identification, disclosure, and reporting by provider type. [source]


Punitive Reactions to Completed Crimes Versus Accidentally Uncompleted Crimes,

JOURNAL OF APPLIED SOCIAL PSYCHOLOGY, Issue 4 2005
Margit E. Oswald
Previous studies have shown that the harm caused by crime affects punitive reactions even if differences in the degree of harm are merely accidental. However, it remains unclear whether the effect is direct or whether it is mediated by attributed responsibility or blame. Participants were 303 university students who listened to 4 case vignettes (between-subjects design). Half received information about a completed crime and half about an accidentally uncompleted crime. Crime type was either fraud or rape. The results suggest that individuals consider the actual harm to a significantly greater extent than attribution theory would predict. Moreover, the link between harm and punishment was virtually not mediated by attributed blame and not moderated by individual differences in morality. Future studies should investigate whether the harm-punishment link is a result of an automatic act of retaliation or a desire to compensate for the harm done to the victim (restorative justice). [source]


Gender acts as a context for interpreting diagnostic criteria

JOURNAL OF CLINICAL PSYCHOLOGY, Issue 12 2005
Elizabeth H. Flanagan
This study used a unique methodology to determine the aspects of case vignettes that elicited an effect of case gender on diagnosis. A total of 99 psychiatrists and psychologists were shown cases representing a man or a woman that contained varying numbers of histrionic and antisocial criteria. The cases were presented by computer a few sentences at a time. Clinicians were asked to offer a diagnosis for the case after each group of sentences was presented. Results indicated that case gender tended to affect clinicians' diagnostic decisions when criteria related to that diagnosis were shown, suggesting that case gender was acting as a context in which diagnostic criteria were interpreted. © 2005 Wiley Periodicals, Inc. J Clin Psychol 61: 1485,1498, 2005. [source]


Counteracting the effects of invisibility in work with lesbian patients

JOURNAL OF CLINICAL PSYCHOLOGY, Issue 5 2001
Carolyn SaariArticle first published online: 9 APR 200
Lesbian women frequently experience "invisibility," the failure of others to recognize the significance of their sexuality and partnership relations. Such invisibility can have deleterious effects, such as a reduced ability to relate life stories to others and thereby to extend and integrate aspects of identity and its healthy complexity. Although this invisibility often is intertwined with coming-out phenomena, it continues to exist in many social contexts throughout life. Therefore, it is important for psychotherapists to recognize and understand the concept of invisibility so that they do not perpetuate it within the therapy. Several case vignettes are used as examples of how invisibility can affect a woman's life and functioning and can be counteracted in therapy. © 2001 John Wiley & Sons, Inc. J Clin Psychol/In Session 57: 645,654, 2001. [source]


Description of a return-to-work occupational therapy programme for stroke rehabilitation in Singapore

OCCUPATIONAL THERAPY INTERNATIONAL, Issue 2 2008
Mei Leng Chan
Abstract Stroke is the fourth leading cause of death and the major cause of disability in Singapore. The number of stroke survivors is expected to rise with the increase in the ageing population. This paper describes how occupational therapists are involved in stroke and work rehabilitation in Singapore. A retrospective study of stroke clients referred to a vocational assessment unit in 2004 showed that 55% of the clients were able to return to work. The majority of the clients changed their job positions from blue-collar workers to clerical workers. On the other hand, the main reasons for poor outcome were: unfit to work in general, needed further rehabilitation, further medical care was indicated, failed to meet appointments and withdrawal from the job trial. Three case vignettes are discussed to illustrate the multifactorial aspects influencing positive work outcomes. Further research is needed in exploring the factors that affect stroke rehabilitation and return-to-work outcomes. Copyright © 2008 John Wiley & Sons, Ltd. [source]


Where is help sought for depression or suicidal ideation in an elderly population living in a rural area of Japan?

PSYCHIATRY AND CLINICAL NEUROSCIENCES, Issue 5 2004
SHINJI SAKAMOTO phd
Abstract, Although suicide is increasingly becoming a social problem in Japan, especially among the elderly, little early intervention or suicide prevention is done. A project was begun which, since 1999, has aimed to detect depression at an early stage as a suicide prevention measure in a model area of Town A, which had a high suicide rate. In order to promote early intervention and prevention in a community, it is important to know where residents seek help if they become depressed or have suicidal ideation. Therefore, in the present study, help-seeking behavior using case vignettes was investigated. Data from 230 residents (82 men, 148 women) in the model area of Town A, aged 65 or over, were analyzed in the present study. If participants were unable to answer by themselves due to physical condition, public health nurses read out each item and wrote in their answers. The relationship between help-seeking behavior and demographic variables, psychosocial variables, depressive symptoms and so forth, were examined. The results show that participation in mental health workshops facilitated consultation with specialists (e.g. primary care doctors and nurses). The expected effects of psychoeducation on the general public and specialists were considered. [source]


Men's Sexual Health: Evaluating the Effectiveness of Print- and PDA-based CME

THE JOURNAL OF SEXUAL MEDICINE, Issue 9 2009
Gregory A. Broderick MD
ABSTRACT Introduction., Personal digital assistant (PDA)-based continuing medical education (CME) activities have become widely available. Aims., To evaluate the effectiveness of print- and PDA-based CME materials in erectile dysfunction (ED). Methods., CME materials describing links between ED and comorbid medical conditions, effects of certain lifestyle modifications on ED, and treatment of ED with phosphodiesterase 5 (PDE5) inhibitors were distributed as a print supplement and as electronic modules, viewed with PDAs. We evaluated how effectively these materials improved evidence-based clinical choices, using survey questions about case vignettes and comparing responses of CME participants (N = 85) and matched nonparticipants (N = 94). Main Outcome Measures., Effect size, measuring the difference in evidence-based clinical scores between participants and nonparticipants. Results., CME certificates were awarded to 3,557 participants (459 print, 3,098 PDA). Among survey respondents, significantly more CME participants recognized that ED was associated with greater risk for myocardial infarction (61% participants; 34% nonparticipants; P , 0.001) and was a strong marker for diabetes mellitus (37% participants; 9% nonparticipants; P , 0.001). In contrast, participants and nonparticipants both displayed a good understanding of the relationships of smoking, obesity, and sedentary lifestyle with ED and of using PDE5 inhibitors to treat ED in patients with prostate cancer or benign prostatic hyperplasia; this likely reflects a good baseline understanding of these topics. Participants and nonparticipants each displayed a poor understanding of the recommendations regarding nonarteritic anterior ischemic optic neuropathy and PDE5 inhibitor use. Patient reluctance to discuss sexual concerns was perceived as the most significant barrier to optimal ED management. Conclusions., Given patient reluctance to discuss sexual concerns, future CME activities should focus on educating health-care providers and patients that ED is a risk factor for cardiovascular disease and diabetes. Both print- and PDA-based CME on ED were effective; the large number of lesson completers suggests a trend toward on-demand, self-selected CME is positive. Broderick GA, and Abdolrasulnia M. Men's sexual health: Evaluating the effectiveness of print- and PDA-based CME. J Sex Med 2009;6:2417,2424. [source]


Treatment of extremely preterm infants: parents'attitudes

ACTA PAEDIATRICA, Issue 6 2003
B Mølholm Hansen
Aim: To conduct a survey of the attitude towards treatment of extremely preterm infants by comparing the attitude towards life-saving treatment between a group of parents of extremely preterm children and parents in the general population. The importance the two groups of respondents assigned to parental preferences was also investigated. Methods: A Danish national cohort of children born from 1994 to 1995 with a birthweight below 1000 g or a gestational age below 28 wk were assessed in a 5-y follow-up study including a reference group of children born at term. The parents of the children were given a sequence of case vignettes presenting different clinical situations, which formed part of a questionnaire. Results: More than 80% of 222 possible index respondents and 76 possible reference respondents fulfilled the vignettes. Both groups of respondents were positive towards life-saving treatment of extremely preterm infants. The recommendations given by both groups were significantly influenced by the hypothetical child's risk of having a serious handicap and the parents'preferences. The results suggest that parents of extremely preterm children do not have a more conservative attitude towards life-saving treatment of extremely preterm infants than parents in the general population, and also support the view that parents'preferences should influence treatment decisions; although many believe that these should not be decisive. Conclusion: Compared to the general population, parents of children born extremely preterm did not express a more conservative attitude towards life-saving treatment of extremely preterm infants. [source]