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Journal of Trauma & Dissociation : the... 2024Functional neurological disorder (FND) represents a broad group of motor and sensory clinical symptoms which cannot be explained by other neurological diagnoses....
Functional neurological disorder (FND) represents a broad group of motor and sensory clinical symptoms which cannot be explained by other neurological diagnoses. Dissociation is considered a key mechanism in their development and maintenance. Despite psychological therapy being the recommended choice of treatment for FND, evidence for its effectiveness is in its infancy. This study explored the dissociative profile of forty-seven patients with FND and evaluated whether individual psychological therapy improved dissociative symptoms, psychological distress and general functioning among twenty-five adults with FND. Patients completed the Multiscale Dissociation Inventory, the EuroQol five-dimensional descriptive system, the General Anxiety Disorder-7 scale and the Patient Health Questionnaire-9. Our sample showed high levels of disengagement, depersonalization and memory disturbance at baseline. Treatment was associated with significant improvements in general functioning, and symptoms of dissociation and anxiety. Improvements in dissociative experiences were found to be possibly due to reduction in anxiety. Improvements in depression were the strongest predictor of improvements in general functioning. Limitations and areas for further research are discussed.
Topics: Humans; Female; Dissociative Disorders; Male; Adult; Psychological Distress; Middle Aged; Psychotherapy; Psychiatric Status Rating Scales; Treatment Outcome; Surveys and Questionnaires; Nervous System Diseases
PubMed: 38780533
DOI: 10.1080/15299732.2024.2356591 -
Frontiers in Psychology 2024Reliability is a property of tests scores that varies from sample to sample. One way of generalizing reliability of a test is to perform a meta-analysis on some...
INTRODUCTION
Reliability is a property of tests scores that varies from sample to sample. One way of generalizing reliability of a test is to perform a meta-analysis on some reliability estimator. In 2011, a reliability generalization meta-analysis on the Maslach Burnout Inventory (MBI) was conducted, concluding that average alpha values for the MBI dimensions ranged from 0.71 to 0.88. In the present study, we aimed to update the average reliability values of the MBI by conducting a literature search from 2010 until now and comparing to statistical procedures of meta-analysis: the Univariate approach, that were used in the previous study, and a novel meta-analytic approach based on structural equation modeling.
METHOD
An estimation of average reliability was done based on 69 independent primary reliability coefficients for the Univariate approach. The average reliability was based on 9 independent studies in the case of the Meta-analytic Structural Equation Modeling (MASEM) approach. Given that MASEM has the additional capability of testing the internal structure of a test, we also fitted several models.
RESULTS
The data was well-suited to the bifactor model, revealing the dominance of the general factor over the domain-specific ones. Acceptable overall alpha and omega coefficients were achieved for the two of the MBI dimensions, having depersonalization reliability estimates below recommendations.
DISCUSSION
In general, the MBI can be viewed as a highly interconnected three-factor scale, being its appropriate for research purposes.
PubMed: 38778881
DOI: 10.3389/fpsyg.2024.1383619 -
Psychopathology May 2024Abnormal self-experiences are a common feature of major depression despite their absence from current diagnostic manuals. Current diagnostic criteria leave us with an...
INTRODUCTION
Abnormal self-experiences are a common feature of major depression despite their absence from current diagnostic manuals. Current diagnostic criteria leave us with an impoverished conception of depressive disorders, and they fail to exploit the diverse experiential alterations that might be useful for understanding and diagnosing patients, and last but not least for explaining the aetiology of these disorders. Although some phenomenological descriptions of abnormal self-experiences in major depression are available, further research is needed to validate these through detailed clinical interviews.
METHODS
To characterize these phenomena in more detail and to verify and consolidate previous accounts, we conducted a qualitative study using the Consensual Qualitative Research method.
RESULTS
Our findings identified three categories of abnormal self-experiences: (1) impossibility to project oneself forward, (2) not recognizing one's self, and (3) losing control on one's self.
CONCLUSION
Before delving into these results, we briefly described how the self is conceptualized in phenomenological psychopathology and explored in the literature on the self-experience in major depression. After discussing our results in the light of recent and contemporary phenomenological literature, we suggest that the inability to recognize otherness as part of oneself - which is the core of depressive experiences - ends in specific symptoms of depersonalization that differ from schizophrenic ones. We conclude that the self-experience, and in particular narrative identity, is central to the development and maintenance of depression.
PubMed: 38776880
DOI: 10.1159/000538942 -
BMC Medical Education May 2024Primary care in the US faces challenges with clinician recruitment, retention, and burnout, with further workforce shortages predicted in the next decade. Team-based...
BACKGROUND
Primary care in the US faces challenges with clinician recruitment, retention, and burnout, with further workforce shortages predicted in the next decade. Team-based care can be protective against clinician burnout, and opportunities for interprofessional education (IPE) on professional development and leadership could encourage primary care transformation. Despite an increasingly important role in the primary care workforce, IPE initiatives training physician assistants (PAs) alongside physicians are rare. We describe the design, curriculum, and outcomes from an interprofessional primary care transformation fellowship for community-based primary care physicians and PAs.
METHODS
The Community Primary Care Champions (CPCC) Fellowship was a one-year, part-time fellowship which trained nine PAs, fourteen physicians, and a behavioralist with at least two years of post-graduate clinical experience in six content pillars: quality improvement (QI), wellness and burnout, mental health, social determinants of health, medical education, and substance use disorders. The fellowship included a recurring schedule of monthly activities in self-study, lectures, mentoring, and community expert evening discussions. Evaluation of the fellowship included pre, post, and one-year follow-up self-assessments of knowledge, attitudes, and confidence in the six content areas, pre- and post- wellness surveys, lecture and discussion evaluations, and midpoint and exit focus groups.
RESULTS
Fellows showed significant improvement in 24 of 28 self-assessment items across all content areas post-fellowship, and in 16 of 18 items one-year post-fellowship. They demonstrated reductions in emotional exhaustion and depersonalization post-fellowship and increased confidence in working in interprofessional teams post-fellowship which persisted on one-year follow-up assessments. All fellows completed QI projects and four presented their work at national conferences. Focus group data showed that fellows experienced collaborative, meaningful professional development that was relevant to their clinical work. They appreciated the flexible format and inclusion of interprofessional community experts in evening discussions.
CONCLUSIONS
The CPCC fellowship fostered an interprofessional community of practice that provided an effective IPE experience for physicians and PAs. The learning activities, and particularly the community expert discussions, allowed for a flexible, relevant experience, resulting in personal and professional growth along with increased confidence working within interprofessional teams.
Topics: Humans; Physician Assistants; Fellowships and Scholarships; Primary Health Care; Curriculum; Burnout, Professional; Female; Program Evaluation; Male; Interprofessional Relations; Physicians, Primary Care; Interprofessional Education
PubMed: 38773571
DOI: 10.1186/s12909-024-05559-z -
Global estimate of burnout among the public health workforce: a systematic review and meta-analysis.Human Resources For Health May 2024Burnout is an occupational phenomenon resulting from chronic workplace stress. We conducted this review to estimate the pooled global prevalence of burnout among the... (Meta-Analysis)
Meta-Analysis
INTRODUCTION
Burnout is an occupational phenomenon resulting from chronic workplace stress. We conducted this review to estimate the pooled global prevalence of burnout among the public health workforce.
METHODS
We conducted this review as per the PRISMA 2020 guidelines. We included only cross-sectional studies reporting outcome estimates among the study population. We included articles published before December 2023. We used a search strategy to systematically select the articles from PubMed, Embase, and Google Scholar. We assessed the quality of the studies using an adapted version of NIH's study tool assessment for cross-sectional and observational cohort studies. We estimated the pooled proportion using the random-effects model.
RESULTS
We included eight studies in our review, covering a sample size of 215,787. The pooled proportion of burnout was 39% (95% CI: 25-53%; p-value: < 0.001). We also identified high heterogeneity among the included studies in our review (I: 99.67%; p-value: < 0.001). Seven out of the eight studies were of good quality. The pooled proportion of the studies conducted during the COVID-19 pandemic was 42% (95% CI: 17-66%), whereas for the studies conducted during the non-pandemic period, it was 35% (95% CI: 10-60%).
CONCLUSION
In our review, more than one-third of public health workers suffer from burnout, which adversely affects individuals' mental and physical health. Burnout among the public health workforce requires attention to improve the well-being of this group. Multisite studies using standardized definitions are needed for appropriate comparisons and a better understanding of variations in burnout in various subgroups based on sociodemographic characteristics and type of work responsibilities. We must design and implement workplace interventions to cope with burnout and increase well-being.
LIMITATIONS
Due to the limited research on burnout among public health workers, we could not perform a subgroup analysis on various factors that could have contributed to burnout.
Topics: Humans; Burnout, Professional; COVID-19; Cross-Sectional Studies; Health Personnel; Health Workforce; Prevalence; Public Health; SARS-CoV-2; Workplace
PubMed: 38773482
DOI: 10.1186/s12960-024-00917-w -
Practical Neurology May 2024Virtual learning resources such as podcasts and social media are increasingly used in medical education. Podcasts are one example of virtual learning, where prerecorded...
Virtual learning resources such as podcasts and social media are increasingly used in medical education. Podcasts are one example of virtual learning, where prerecorded audio files are available to stream or download from the internet, usually without a fee and at any time. This gives listeners flexibility in when and where they engage with the educational material, enabling learning to be better tailored to individual needs. Podcasts are often enjoyed for their relaxed and conversational style. However, listeners must be aware of the lack of external peer review and incomplete coverage of information. There are also risks inherent to distant learning, including depersonalisation of medical education. We describe the roles that podcasts now play in neurological education, exploring some of the ways that they can be used to enhance neurological training both as a learner and educator and giving our top tips, based on our own experiences, for anyone keen to add to the expanding field of available podcasts.
PubMed: 38769014
DOI: 10.1136/pn-2024-004109 -
The Journal of Perinatal & Neonatal...To assess the relationship between job burnout and resilience among nurses working in neonatal intensive care units (NICUs) in Oman.
PURPOSE
To assess the relationship between job burnout and resilience among nurses working in neonatal intensive care units (NICUs) in Oman.
BACKGROUND
NICUs induce a significant amount of stress that predisposes nurses to a substantial degree of burnout. Resilience can play a role in reducing the effects of job burnout. A limited number of studies have examined job burnout and resilience among NICU nurses.
METHODS
A cross-sectional survey design was utilized. The Maslach Burnout Inventory was used to assess burnout, and the Brief Resilience Scale was used to assess perceptions of resilience. Pearson correlation was used to assess the relationship between job burnout and resilience.
RESULTS
A total of 173 staff nurses participated. Participants reported low levels of emotional exhaustion and depersonalization but moderate levels on the personal accomplishment subscale. Nurses reported moderate levels of resilience. Emotional exhaustion and depersonalization were negatively correlated with resilience, while personal accomplishment was positively correlated with resilience.
CONCLUSION
This study demonstrated that enhancing resilience can reduce the effect of burnout among NICU nurses.
IMPLICATIONS FOR PRACTICE AND RESEARCH
Enhancing levels of resilience among NICU nurses, in addition to providing adequate managerial support and good collegial relations, is essential to reduce their perceived job burnout.
Topics: Humans; Burnout, Professional; Intensive Care Units, Neonatal; Cross-Sectional Studies; Female; Resilience, Psychological; Adult; Male; Oman; Job Satisfaction; Nursing Staff, Hospital; Neonatal Nursing; Surveys and Questionnaires; Nurses, Neonatal; Infant, Newborn
PubMed: 38758275
DOI: 10.1097/JPN.0000000000000817 -
Women and Birth : Journal of the... May 2024A variety of technologies are used to monitor fetal wellbeing in labour. Different types of fetal monitoring devices impact women's experiences of labour and birth. (Review)
Review
How does the use of continuous electronic fetal monitoring influence women's experiences of labour? A systematic integrative review of the literature from high income countries.
BACKGROUND
A variety of technologies are used to monitor fetal wellbeing in labour. Different types of fetal monitoring devices impact women's experiences of labour and birth.
AIM
This review aims to understand how continuous electronic fetal monitoring (CEFM) influences women's experiences, with a focus on sense of control, active decision-making and mobility.
METHODS
A systematic search of the literature was conducted. Findings from qualitative, quantitative and mixed methods studies were analysed to provide a review of current evidence.
FINDINGS
Eighteen publications were included. The findings were synthesised into three themes: 'Feeling reassured versus anxious about the welfare of their baby', 'Feeling comfortable and free to be mobile versus feeling uncomfortable and restricted', and 'Feeling respected and empowered to make decisions versus feeling depersonalised with minimal control '. Women experienced discomfort and a lack of mobility as a result of some CEFM technologies. They often felt anxious and had mixed feelings about their baby's welfare whilst these were in use. Some women valued the data produced by CEFM technologies about the welfare of their baby. Many women experienced a sense of depersonalisation and lack of control whilst CEFM technologies were used.
DISCUSSION
Fetal monitoring technologies influence women's experiences of labour both positively and negatively. Wireless devices were associated with the most positive response as they enabled greater freedom of movement.
CONCLUSION
The design of emerging fetal monitoring technologies should incorporate elements which foster freedom of movement, are comfortable and provide women with a sense of choice and control. The implementation of fetal monitoring that enables these elements should be prioritised by health professionals.
PubMed: 38754249
DOI: 10.1016/j.wombi.2024.101619 -
International Journal of Medical... Aug 2024Improved survival of patients after acute coronary syndromes, population growth, and overall life expectancy rise have led to a significant increase in the proportion of...
BACKGROUND
Improved survival of patients after acute coronary syndromes, population growth, and overall life expectancy rise have led to a significant increase in the proportion of patients with stable coronary artery disease (CAD), creating a significant load on the entire healthcare system. The disease often progresses with the development of many complications while significantly increasing the likelihood of hospitalization. Developing and applying a machine learning model for predicting hospitalizations of patients with CAD to an inpatient medical facility will allow for close monitoring of high-risk patients, early preventive interventions, and optimized medical care.
AIMS
Development and external validation of personalized models for predicting the preventable hospitalizations of patients with stable CAD and its complications using ML algorithms and data of real-world clinical practice.
METHODS
135,873 depersonalized electronic health records of 49,103 patients with stable CAD were included in the study. Anthropometric measurements, physical examination results, laboratory, instrumental, anamnestic, and socio-demographic data, widely used in routine medical practice, were considered as potential predictors, a total of 73 features. Logistic regression, decision tree-based methods including gradient boosting (AdaBoost, LightGBM, XGBoost, CatBoost) and bagging (RandomForest and ExtraTrees), discriminant analysis (LinearDiscriminant, QuadraticDiscriminant), and naive Bayes classifier were compared. External validation was performed on the data of a separate region.
RESULTS
The best results and stability to external validation data were shown by the CatBoost model with an AUC of 0.875 (95% CI 0.865-0.885) for the internal testing and 0.872 (95% CI 0.856-0.886) for the external validation. The best model showed good performance evaluated through AUROC, Brier score and standardized net benefit (for the target NPV threshold) for the validation dataset that was only slightly similar to the train data.
CONCLUSION
The metrics of the best model were superior to previously published studies. The results of external validation demonstrated the relative stability of the model to new data from another region that confirms the possibility of the model's application in real clinical practice.
Topics: Humans; Coronary Artery Disease; Machine Learning; Female; Male; Hospitalization; Aged; Middle Aged; Electronic Health Records; Algorithms
PubMed: 38743996
DOI: 10.1016/j.ijmedinf.2024.105476 -
European Journal of Psychotraumatology 2024While several studies documented a positive correlation between childhood maltreatment severity and dissociation severity, it is currently unknown whether specific...
While several studies documented a positive correlation between childhood maltreatment severity and dissociation severity, it is currently unknown whether specific dissociative symptoms cluster together among individuals with childhood trauma histories ranging from none to severe. We aimed to explore symptom constellations across the whole spectrum of dissociative processing from patients with severe dissociative disorders to healthy controls and relate these to maltreatment severity and sociodemographic characteristics. We employed latent profile analysis to explore symptom profiles based on five subscales, measuring absorption, depersonalization, derealization, somatoform and identity alteration, based on the 20 items of the German short version of the Dissociative Experiences Scale-II (20) in a large aggregate sample ( = 3,128) overrepresenting patients with trauma-related disorders. We then related these profiles to maltreatment severity as measured by the five subscales of the Childhood Trauma Questionnaire as well as sociodemographic characteristics. Based on the five FDS subscales, six clusters differentiated by symptom severity, but not symptom constellations, were identified. Somatoform dissociation varied in accordance with the remaining symptom clusters. The cluster with the highest overall symptom severity entailed nearly all subjects diagnosed with Dissociative Identity Disorder and was characterized by extreme levels of childhood maltreatment. Both abuse and neglect were predictive of cluster membership throughout. The higher the severity of dissociative processing in a cluster, the more subjects reported high severity and multiplicity of childhood maltreatment. However, some subjects remain resilient to the development of dissociative processing although they experience extreme childhood maltreatment.
Topics: Humans; Dissociative Disorders; Female; Male; Adult; Surveys and Questionnaires; Adult Survivors of Child Abuse; Middle Aged; Adverse Childhood Experiences; Child Abuse; Germany; Psychiatric Status Rating Scales; Child
PubMed: 38739008
DOI: 10.1080/20008066.2024.2348345