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Bowdish DME, Chandran V, Hitchon CA, Kaplan GG, Avina-Zubieta JA, Fortin PR, Larché MJ, Boire G, Gingras AC, Dayam RM, Colmegna I, Lukusa L, Lee JLF, Richards DP, Pereira D, Watts TH, Silverberg MS, Bernstein CN, Lacaille D, Benoit J, Kim J, Lalonde N, Gunderson J, Allard-Chamard H, Roux S, Quan J, Hracs L, Turnbull E, Valerio V, Bernatsky S. When Should I Get My Next COVID Vaccine? Data from the SUrveillance of responses to COVID-19 vaCcines in systEmic immunE mediated inflammatory Diseases (SUCCEED)study. J Rheumatol 2024:jrheum.2023-1214. [PMID: 38621797 DOI: 10.3899/jrheum.2023-1214] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/17/2024]
Abstract
OBJECTIVE To determine how serologic responses to COVID vaccination/infection in immunemediated inflammatory disease (IMID) are affected by time since last vaccination and other factors. METHODS Post-COVID-19 vaccination, data and dried blood spots/sera were collected from adults with rheumatoid arthritis, inflammatory bowel disease, systemic lupus, ankylosing spondylitis/spondylarthritis and psoriasis/psoriatic arthritis. First sample was at enrolment and then 2-4 weeks and 3, 6, and 12 months after latest vaccine dose. Multivariate generalized estimating equation regressions (including medications, demographics, and vaccination history) evaluated serologic response, based on log-transformed anti-RBD IgG titres; we also measured anti-nucleocapsid IgG. RESULTS Positive associations for log-transformed anti-RBD titres were seen with female sex, number of doses, and self-reported COVID infections in 2021-2023. Negative associations were seen with prednisone, anti-TNF agents, and rituximab.Over 2021-2023, most (94%) of anti-nucleocapsid positivity was associated with a self-reported infection in the 3 months prior. From March 2021 to Feb 2022, anti-nucleocapsid positivity was present in 5-15% of samples and was highest in the post-Omicron era, with anti-nucleocapsid positivity trending to 30-35% or higher as of March 2023. Anti-nucleocapsid positivity in IMID remained lower than Canada's general population seroprevalence (>50% in 2022 and >75% in 2023).Time since last vaccination was negatively associated with log-transformed anti-RBD titres, particularly after 210 days. CONCLUSION Ours is the first pan-Canadian IMID assessment of how vaccine history and other factors affect serologic COVID-19 vaccine responses. These findings may help individuals personalize vaccination decisions, including consideration of additional vaccination when >6 months has elapsed since last COVID vaccination/infection.
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Affiliation(s)
- Dawn M E Bowdish
- Dawn ME Bowdish PhD, Department of Medicine, McMaster University, 1280 Main St W, Hamilton, Ontario, Canada
| | - Vinod Chandran
- Vinod Chandran MD PhD, Schroeder Arthritis Institute, Krembil Research Institute, University Health Network, Toronto, Ontario, Canada; Division of Rheumatology, Department of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Carol A Hitchon
- Carol A Hitchon MD MSc, Department of Internal Medicine, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Canada
| | - Gilaad G Kaplan
- Gilaad G. Kaplan MD MPH, Division of Gastroenterology and Hepatology, Departments of Medicine and Community Health Sciences, University of Calgary, Calgary, Alberta, Canada
| | - J Antonio Avina-Zubieta
- J. Antonio Avina-Zubieta MD PhD, Arthritis Research Canada and Division of Rheumatology, University of British Columbia, Vancouver, British Columbia, Canada
| | - Paul R Fortin
- Paul R Fortin MD MPH, Centre de Recherche Arthrite, Division of Rheumatology, Department of Medicine, CHU de Québec - Université Laval, Québec City, Québec, Canada
| | - Maggie J Larché
- Maggie J. Larché MD PhD, Division of Rheumatology, Department of Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Gilles Boire
- Gilles Boire MD MSc, Division of Rheumatology, Department of Medicine, Université de Sherbrooke, Sherbrooke, Québec, Canada
| | - Anne-Claude Gingras
- Anne-Claude Gingras PhD, Lunenfeld-Tanenbaum Research Institute at Mount Sinai Hospital, Sinai Health, Toronto, Ontario, Canada
| | - Roya M Dayam
- Roya M Dayam PhD, Lunenfeld-Tanenbaum Research Institute at Mount Sinai Hospital, Sinai Health, Toronto, Ontario, Canada
| | - Ines Colmegna
- Ines Colmegna MD, The Research Institute of the McGill University Health Centre, McGill University, Montreal, Quebec, Canada; Department of Medicine, Division of Rheumatology, McGill University, Montreal, Quebec, Canada
| | - Luck Lukusa
- Luck Lukusa MSc, The Research Institute of the McGill University Health Centre, McGill University, Montreal, Quebec, Canada
| | - Jennifer L F Lee
- Jennifer LF Lee BSc, The Research Institute of the McGill University Health Centre, McGill University, Montreal, Quebec, Canada
| | - Dawn P Richards
- Dawn P Richards PhD, Canadian Arthritis Patient Alliance, Toronto, Ontario, Canada
| | - Daniel Pereira
- Daniel Pereira BSc, Schroeder Arthritis Institute, Krembil Research Institute, University Health Network, Toronto, Ontario, Canada
| | - Tania H Watts
- Tania H Watts PhD, Department of Immunology, University of Toronto, Toronto, Ontario, Canada
| | - Mark S Silverberg
- Mark S Silverberg MD PhD, Lunenfeld-Tanenbaum Research Institute at Mount Sinai Hospital, Sinai Health, Toronto, Ontario, Canada; Zane Cohen Centre for Digestive Diseases, Division of Gastroenterology, Mount Sinai Hospital, Sinai Health, Ontario, Canada
| | - Charles N Bernstein
- Charles N Bernstein MD, Department of Internal Medicine, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Canada
| | - Diane Lacaille
- Diane Lacaille MD MHSc, Arthritis Research Canada and Division of Rheumatology, University of British Columbia, Vancouver, British Columbia, Canada
| | - Jenna Benoit
- Jenna Benoit, Department of Medicine, McMaster University, 1280 Main St W, Hamilton, Ontario, Canada
| | - John Kim
- John Kim PhD, National Microbiology Laboratory, Public Health Agency of Canada, Winnipeg, Manitoba, Canada
| | - Nadine Lalonde
- Nadine Lalonde BSc, Canadian Arthritis Patient Alliance, Toronto, Ontario, Canada
| | - Janet Gunderson
- Janet Gunderson BEd, Canadian Arthritis Patient Alliance, Toronto, Ontario, Canada
| | - Hugues Allard-Chamard
- Hugues Allard-Chamard MD PhD, Division of Rheumatology , Department of Medicine, Université de Sherbrooke, Sherbrooke, Québec, Canada
| | - Sophie Roux
- Sophie Roux MD PhD, Division of Rheumatology , Department of Medicine, Université de Sherbrooke, Sherbrooke, Québec, Canada
| | - Joshua Quan
- Joshua Quan MSc, Division of Gastroenterology and Hepatology, Departments of Medicine and Community Health Sciences, University of Calgary, Calgary, Alberta, Canada
| | - Lindsay Hracs
- Lindsay Hracs PhD, Division of Gastroenterology and Hepatology, Departments of Medicine and Community Health Sciences, University of Calgary, Calgary, Alberta, Canada
| | - Elizabeth Turnbull
- Elizabeth Turnbull RN, The Research Institute of the McGill University Health Centre, McGill University, Montreal, Quebec, Canada
| | - Valeria Valerio
- Valeria Valerio MD, The Research Institute of the McGill University Health Centre, McGill University, Montreal, Quebec, Canada
| | - Sasha Bernatsky
- Sasha Bernatsky MD PhD, The Research Institute of the McGill University Health Centre, McGill University, Montreal, Quebec, Canada; Department of Medicine, Division of Rheumatology, McGill University, Montreal, Quebec, Canada
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2
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Stacey D, Lewis KB, Smith M, Carley M, Volk R, Douglas EE, Pacheco-Brousseau L, Finderup J, Gunderson J, Barry MJ, Bennett CL, Bravo P, Steffensen K, Gogovor A, Graham ID, Kelly SE, Légaré F, Sondergaard H, Thomson R, Trenaman L, Trevena L. Decision aids for people facing health treatment or screening decisions. Cochrane Database Syst Rev 2024; 1:CD001431. [PMID: 38284415 PMCID: PMC10823577 DOI: 10.1002/14651858.cd001431.pub6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/30/2024]
Abstract
BACKGROUND Patient decision aids are interventions designed to support people making health decisions. At a minimum, patient decision aids make the decision explicit, provide evidence-based information about the options and associated benefits/harms, and help clarify personal values for features of options. This is an update of a Cochrane review that was first published in 2003 and last updated in 2017. OBJECTIVES To assess the effects of patient decision aids in adults considering treatment or screening decisions using an integrated knowledge translation approach. SEARCH METHODS We conducted the updated search for the period of 2015 (last search date) to March 2022 in CENTRAL, MEDLINE, Embase, PsycINFO, EBSCO, and grey literature. The cumulative search covers database origins to March 2022. SELECTION CRITERIA We included published randomized controlled trials comparing patient decision aids to usual care. Usual care was defined as general information, risk assessment, clinical practice guideline summaries for health consumers, placebo intervention (e.g. information on another topic), or no intervention. DATA COLLECTION AND ANALYSIS Two authors independently screened citations for inclusion, extracted intervention and outcome data, and assessed risk of bias using the Cochrane risk of bias tool. Primary outcomes, based on the International Patient Decision Aid Standards (IPDAS), were attributes related to the choice made (informed values-based choice congruence) and the decision-making process, such as knowledge, accurate risk perceptions, feeling informed, clear values, participation in decision-making, and adverse events. Secondary outcomes were choice, confidence in decision-making, adherence to the chosen option, preference-linked health outcomes, and impact on the healthcare system (e.g. consultation length). We pooled results using mean differences (MDs) and risk ratios (RRs) with 95% confidence intervals (CIs), applying a random-effects model. We conducted a subgroup analysis of 105 studies that were included in the previous review version compared to those published since that update (n = 104 studies). We used Grading of Recommendations Assessment, Development, and Evaluation (GRADE) to assess the certainty of the evidence. MAIN RESULTS This update added 104 new studies for a total of 209 studies involving 107,698 participants. The patient decision aids focused on 71 different decisions. The most common decisions were about cardiovascular treatments (n = 22 studies), cancer screening (n = 17 studies colorectal, 15 prostate, 12 breast), cancer treatments (e.g. 15 breast, 11 prostate), mental health treatments (n = 10 studies), and joint replacement surgery (n = 9 studies). When assessing risk of bias in the included studies, we rated two items as mostly unclear (selective reporting: 100 studies; blinding of participants/personnel: 161 studies), due to inadequate reporting. Of the 209 included studies, 34 had at least one item rated as high risk of bias. There was moderate-certainty evidence that patient decision aids probably increase the congruence between informed values and care choices compared to usual care (RR 1.75, 95% CI 1.44 to 2.13; 21 studies, 9377 participants). Regarding attributes related to the decision-making process and compared to usual care, there was high-certainty evidence that patient decision aids result in improved participants' knowledge (MD 11.90/100, 95% CI 10.60 to 13.19; 107 studies, 25,492 participants), accuracy of risk perceptions (RR 1.94, 95% CI 1.61 to 2.34; 25 studies, 7796 participants), and decreased decisional conflict related to feeling uninformed (MD -10.02, 95% CI -12.31 to -7.74; 58 studies, 12,104 participants), indecision about personal values (MD -7.86, 95% CI -9.69 to -6.02; 55 studies, 11,880 participants), and proportion of people who were passive in decision-making (clinician-controlled) (RR 0.72, 95% CI 0.59 to 0.88; 21 studies, 4348 participants). For adverse outcomes, there was high-certainty evidence that there was no difference in decision regret between the patient decision aid and usual care groups (MD -1.23, 95% CI -3.05 to 0.59; 22 studies, 3707 participants). Of note, there was no difference in the length of consultation when patient decision aids were used in preparation for the consultation (MD -2.97 minutes, 95% CI -7.84 to 1.90; 5 studies, 420 participants). When patient decision aids were used during the consultation with the clinician, the length of consultation was 1.5 minutes longer (MD 1.50 minutes, 95% CI 0.79 to 2.20; 8 studies, 2702 participants). We found the same direction of effect when we compared results for patient decision aid studies reported in the previous update compared to studies conducted since 2015. AUTHORS' CONCLUSIONS Compared to usual care, across a wide variety of decisions, patient decision aids probably helped more adults reach informed values-congruent choices. They led to large increases in knowledge, accurate risk perceptions, and an active role in decision-making. Our updated review also found that patient decision aids increased patients' feeling informed and clear about their personal values. There was no difference in decision regret between people using decision aids versus those receiving usual care. Further studies are needed to assess the impact of patient decision aids on adherence and downstream effects on cost and resource use.
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Affiliation(s)
- Dawn Stacey
- School of Nursing, University of Ottawa, Ottawa, Canada
- Centre for Implementation Research, Ottawa Hospital Research Institute, Ottawa, Canada
| | | | | | - Meg Carley
- Centre for Implementation Research, Ottawa Hospital Research Institute, Ottawa, Canada
| | - Robert Volk
- The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Elisa E Douglas
- Health Services Research, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | | | - Jeanette Finderup
- Department of Renal Medicine, Aarhus University Hospital, Aarhus, Denmark
| | | | - Michael J Barry
- Informed Medical Decisions Program, Massachusetts General Hospital, Boston, MA, USA
| | - Carol L Bennett
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Canada
| | - Paulina Bravo
- Education and Cancer Prevention, Fundación Arturo López Pérez, Santiago, Chile
| | - Karina Steffensen
- Center for Shared Decision Making, IRS - Lillebælt Hospital, Vejle, Denmark
| | - Amédé Gogovor
- VITAM - Centre de recherche en santé durable, Université Laval, Quebec, Canada
| | - Ian D Graham
- Centre for Implementation Research, Ottawa Hospital Research Institute, Ottawa, Canada
- School of Epidemiology, Public Health and Preventative Medicine, University of Ottawa, Ottawa, Canada
| | - Shannon E Kelly
- Cardiovascular Research Methods Centre, University of Ottawa Heart Institute, Ottawa, Canada
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, Canada
| | - France Légaré
- Centre de recherche sur les soins et les services de première ligne de l'Université Laval (CERSSPL-UL), Université Laval, Quebec, Canada
| | | | - Richard Thomson
- Institute of Health and Society, Newcastle University, Newcastle upon Tyne, UK
| | - Logan Trenaman
- Department of Health Systems and Population Health, School of Public Health, University of Washington, Seattle, WA, USA
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Berger-Höger B, Lewis KB, Cherry K, Finderup J, Gunderson J, Kaden J, Kienlin S, Rahn AC, Sikora L, Stacey D, Steckelberg A, Zhao J. Determinants of practice for providing decision coaching to facilitate informed values-based decision-making: protocol for a mixed-methods systematic review. BMJ Open 2023; 13:e071478. [PMID: 37968011 PMCID: PMC10660977 DOI: 10.1136/bmjopen-2022-071478] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/29/2022] [Accepted: 10/18/2023] [Indexed: 11/17/2023] Open
Abstract
INTRODUCTION Decision coaching is a non-directive approach to support patients to prepare for making health decisions. It is used to facilitate patients' involvement in informed values-based decision-making and use of evidence-based health information. A recent systematic review revealed low certainty evidence for its effectiveness with and without evidence-based information. However, there may be opportunities to improve the study and use of decision coaching in clinical practice by systematically investigating its determinants of practice. We aim to conduct a systematic review to identify and synthesise the determinants of practice for providing decision coaching to facilitate patient involvement in decision-making from multiple perspectives that influence its use. METHODS AND ANALYSIS We will conduct a mixed-methods systematic review guided by the Cochrane' Handbook of Systematic Reviews. We will include studies reporting determinants of practice influencing decision coaching with or without evidence-based patient information with adults making a health decision for themselves or a family member. Systematic literature searches will be conducted in Medline, EMBASE, Cochrane CENTRAL and PsycINFO via Ovid and CINAHL via EBSCO including quantitative, qualitative and mixed-methods study designs. Additionally, experts in the field will be contacted.Two reviewers will independently screen and extract data. We will synthesise determinants using deductive and inductive qualitative content analysis and a coding frame developed specifically for this review based on a taxonomy of barriers and enablers of shared decision-making mapped onto the major domains of the Consolidated Framework for Implementation Research. We will assess the quality of included studies using the Mixed Methods Appraisal Tool. ETHICS AND DISSEMINATION Ethical approval is not required as this systematic review involves only previously published literature. The results will be published in a peer-reviewed journal, presented at scientific conferences and disseminated to relevant consumer groups. PROSPERO REGISTRATION NUMBER CRD42022338299.
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Affiliation(s)
- Birte Berger-Höger
- Institute of Public Health and Nursing Research, Faculty 11 Human and Health Sciences, University of Bremen, Bremen, Germany
| | - Krystina B Lewis
- School of Nursing, Faculty of Health Sciences, University of Ottawa, Ottawa, Ontario, Canada
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
| | - Katherine Cherry
- Department of Nephrology, Austin Health, Heidelberg, Melbourne, Australia
| | - Jeanette Finderup
- Department of Renal Medicine and Department of Clinical Medicine, Aarhus University Hospital, Aarhus, Denmark
- Research Centre for Patient Involvement, Aarhus University & Central Region, Aarhus, Denmark
| | - Janet Gunderson
- Patient partner with the Saskatchewan Centre for Patient-Oriented Research and the Strategy for Patient-Oriented Research's (SPOR) Chronic Pain Network, Cochrane, and the Evidence Alliance. Committee member for the Canadian Arthritis Patient Alliance, Saskatchewan, Western Canada, Canada
| | - Jana Kaden
- Institute of Public Health and Nursing Research, Faculty 11 Human and Health Sciences, University of Bremen, Bremen, Germany
| | - Simone Kienlin
- Department of Health and Caring Sciences, Faculty of Health Sciences, UiT The Arctic University of Norway, Langnes, Norway
- Department of Medicine and Healthcare, South-Eastern Norway Regional Health Authority, Hamar, Norway
| | - Anne C Rahn
- Nursing Research Unit, Institute for Social Medicine and Epidemiology, University of Lübeck, Lübeck, Germany
| | - Lindsey Sikora
- Health Sciences Library, University of Ottawa, Ottawa, Ontario, Canada
| | - Dawn Stacey
- School of Nursing, Faculty of Health Sciences, University of Ottawa, Ottawa, Ontario, Canada
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
| | - Anke Steckelberg
- Institute of Health and Nursing Science, Faculty of Medicine, Martin-Luther-University of Halle-Wittenberg, Halle (Saale), Germany
| | - Junqiang Zhao
- School of Nursing, Faculty of Health Sciences, University of Ottawa, Ottawa, Ontario, Canada
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4
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Vader K, Tutelman PR, Linkiewich D, Paré C, Wagenaar-Tison A, Birnie KA, Chambers CT, Eubanks K, Ghasemlou N, Gunderson J, Hudspith M, Lane T, Miller J, Richards DP. The state of patient engagement among pain research trainees in Canada: Results of a national web-based survey. Can J Pain 2022; 6:185-194. [DOI: 10.1080/24740527.2022.2115879] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/15/2022] Open
Affiliation(s)
- Kyle Vader
- School of Rehabilitation Therapy, Queen’s University, Kingston, Ontario, Canada
| | - Perri R. Tutelman
- Department of Psychology & Neuroscience, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Delane Linkiewich
- Chronic Pain Network, McMaster University, Hamilton, Ontario, Canada
- Department of Psychology, University of Guelph, Guelph, Ontario, Canada
| | - Catherine Paré
- Department of Psychology, McGill University, Montréal, Québec, Canada
| | - Alice Wagenaar-Tison
- Department of Anatomy, Université du Québec à Trois-Rivières, Trois-Rivières, Québec, Canada
| | - Kathryn A. Birnie
- Department of Psychology & Neuroscience, Dalhousie University, Halifax, Nova Scotia, Canada
- Chronic Pain Network, McMaster University, Hamilton, Ontario, Canada
- Department of Anesthesiology, Perioperative and Pain Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Christine T. Chambers
- Department of Psychology & Neuroscience, Dalhousie University, Halifax, Nova Scotia, Canada
- Department of Pediatrics, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Kathleen Eubanks
- Chronic Pain Network, McMaster University, Hamilton, Ontario, Canada
| | - Nader Ghasemlou
- Chronic Pain Network, McMaster University, Hamilton, Ontario, Canada
- Departments of Anesthesiology & Perioperative Medicine and Biomedical & Molecular Sciences, Queen’s University, Kingston, Ontario, Canada
| | - Janet Gunderson
- Chronic Pain Network, McMaster University, Hamilton, Ontario, Canada
| | - Maria Hudspith
- Chronic Pain Network, McMaster University, Hamilton, Ontario, Canada
- Pain BC, Vancouver, British Columbia, Canada
| | - Therese Lane
- Chronic Pain Network, McMaster University, Hamilton, Ontario, Canada
| | - Jordan Miller
- School of Rehabilitation Therapy, Queen’s University, Kingston, Ontario, Canada
| | - Dawn P. Richards
- Chronic Pain Network, McMaster University, Hamilton, Ontario, Canada
- Five02 Labs Inc, Toronto, Ontario, Canada
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5
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Carey B, Dell CA, Stempien J, Tupper S, Rohr B, Carr E, Cruz M, Acoose S, Butt P, Broberg L, Collard L, Fele-Slaferek L, Fornssler C, Goodridge D, Gunderson J, McKenzie H, Rubin J, Shand J, Smith J, Trask J, Ukrainetz K, Meier S. Outcomes of a controlled trial with visiting therapy dog teams on pain in adults in an emergency department. PLoS One 2022; 17:e0262599. [PMID: 35263346 PMCID: PMC9064456 DOI: 10.1371/journal.pone.0262599] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2021] [Accepted: 11/13/2021] [Indexed: 01/15/2023] Open
Abstract
CONTEXT Pain is a primary reason individuals attend an Emergency Department (ED), and its management is a concern. OBJECTIVES Change in symptoms and physiologic variables at 3 time points pre-post a ten-minute St. John Ambulance therapy dog team visit compared to no visit in ED patients who experienced pain. DESIGN, SETTING AND PARTICIPANTS Using a controlled clinical trial design, pain, anxiety, depression and well-being were measured with the Edmonton Symptom Assessment System (revised version) (ESAS-r) 11-point rating scales before, immediately after, and 20 minutes post- therapy dog team visit with Royal University Hospital ED patients participating in the study (n = 97). Blood pressure and heart rate were recorded at the time points. Control data was gathered twice (30 minutes apart) for comparison (n = 101). There were no group differences in age, gender or ethnicity among the control and intervention groups (respectively mean age 59.5/57.2, ethnicity 77.2% Caucasian/87.6%, female 43.6% /39.2%, male 56.4%/60.8%,). INTERVENTION 10 minute therapy dog team visit in addition to usual care. MAIN OUTCOME MEASURES Change in reported pain from pre and post therapy dog team visit and comparison with a control group. RESULTS A two-way ANOVA was conducted to compare group effects. Significant pre- post-intervention differences were noted in pain for the intervention (mean changeint. = -0.9, SD = 2.05, p = .004, 95% confidence interval [CI] = [0.42, 1.32], ηp2 = 04) but not the control group. Anxiety (mean changeint. = -1.13, SD = 2.80, p = .005, 95% CI = [0.56, 1.64], ηp2 = .04), depression (mean changeint. = -0.72, SD = 1.71, p = .002, 95% CI = [0.39, 1.11], ηp2 = .047), and well-being ratings (mean changeint. = -0.87, SD = 1.84, p < .001, 95% CI = [0.49, 1.25], ηp2 = .07) similarly improved for the intervention group only. There were no pre-post intervention differences in blood pressure or heart rate for either group. Strong responders to the intervention (i.e. >50% reduction) were observed for pain (43%), anxiety (48%), depression (46%), and well-being (41%). CONCLUSIONS Clinically significant changes in pain as well as significant changes in anxiety, depression and well-being were observed in the therapy dog intervention compared to control. The findings of this novel study contribute important knowledge towards the potential value of ED therapy dogs to affect patients' experience of pain, and related measures of anxiety, depression and well-being. TRIAL REGISTRATION This controlled clinical trial is registered with ClinicalTrials.gov, registration number NCT04727749.
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Affiliation(s)
- Ben Carey
- Department of Sociology, University of Saskatchewan, Saskatoon,
Canada
| | - Colleen Anne Dell
- Department of Sociology, University of Saskatchewan, Saskatoon,
Canada
- * E-mail:
| | - James Stempien
- College of Medicine, University of Saskatchewan, Saskatoon,
Canada
| | - Susan Tupper
- Quality, Safety & Standards, Saskatchewan Health Authority,
Saskatoon, Saskatchewan, Canada
| | - Betty Rohr
- Department of Sociology, University of Saskatchewan, Saskatoon,
Canada
| | - Eloise Carr
- Faculty of Nursing University of Calgary, Calgary, Alberta,
Canada
| | - Maria Cruz
- Department of Sociology, University of Saskatchewan, Saskatoon,
Canada
| | - Sharon Acoose
- School of Indigenous Social Work, First Nations University of Canada,
Saskatoon, Saskatchewan, Canada
| | - Peter Butt
- College of Medicine, University of Saskatchewan, Saskatoon,
Canada
| | - Lindsey Broberg
- College of Medicine, University of Saskatchewan, Saskatoon,
Canada
| | - Lisa Collard
- Emergency Services, Saskatchewan Health Authority, Saskatoon,
Saskatchewan, Canada
| | | | - Cathie Fornssler
- Saskatchewan Centre for Patient Oriented Research, University of
Saskatchewan, Saskatoon, Saskatchewan, Canada
| | - Donna Goodridge
- College of Nursing & Respirology, Critical Care and Sleep Medicine,
University of Saskatchewan, Saskatoon, Saskatchewan, Canada
| | - Janet Gunderson
- Saskatchewan Centre for Patient Oriented Research, University of
Saskatchewan, Saskatoon, Saskatchewan, Canada
| | - Holly McKenzie
- Department of Sociology, University of Saskatchewan, Saskatoon,
Canada
| | - Joe Rubin
- Veterinary Microbiology, University of Saskatchewan, Saskatoon,
Saskatchewan, Canada
| | - Jason Shand
- Clinical Analyst, Saskatchewan Health Authority, Saskatoon, Saskatchewan,
Canada
| | - Jane Smith
- St. John Ambulance, Saskatoon, Saskatchewan, Canada
| | - Jason Trask
- Emergency Services, Saskatchewan Health Authority, Saskatoon,
Saskatchewan, Canada
| | - Kerry Ukrainetz
- Saskatchewan Centre for Patient Oriented Research, University of
Saskatchewan, Saskatoon, Saskatchewan, Canada
| | - Simona Meier
- Clinical Research Professional Clinical Trial Support Unit, University of
Saskatchewan, Saskatoon, Canada
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Proulx L, Stones S, Coe J, Richards D, Wilhelm L, Robertson N, Gunderson J, Sirois A, Mckinnon A. OP0196-PARE #ARTHRITISATWORK: USING TWITTER TO ENGAGE THE INTERNATIONAL ARTHRITIS COMMUNITY. Ann Rheum Dis 2020. [DOI: 10.1136/annrheumdis-2020-eular.4793] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Background:In 2019, EULAR launched the #Time2Work campaign [1] to raise awareness of the impact of rheumatic and musculoskeletal diseases on individuals, society, and the economy. Building on this theme, the Canadian Arthritis Patient Alliance (CAPA) developed a social media campaign and Twitter chat in collaboration with international patient advocates and organizations. The Twitter chat built upon CAPA’s successful development of workplace resources for people living with arthritis [2].Objectives:To deliver an international #ArthritisAtWork social media campaign on Twitter, in support of the #Time2Work campaign.Methods:A one-hour Twitter Chat was held on World Arthritis Day (October 12, 2019) on arthritis in the workplace (#ArthritisAtWork) from 18:00 to 19:00 UTC. The chat was hosted by CAPA and co-hosted by Simon Stones, a patient advocate from the United Kingdom (UK) and CreakyJoints, patient-driven arthritis organization in the United States (US). The Twitter Chat questions were co-developed in advance by the hosts, and blog posts were shared from CAPA’s website. Each host also promoted the Twitter Chat through their websites, newsletters and online communities. A social media analytical tool, Symplur, was used to measure audience engagement using the hashtag #ArthritisAtWork. In addition, pertinent Tweets before, during, and after the chat were obtained. The analysis of themes was undertaken to identify common issues and questions.Results:One hundred and ten users participated in the Twitter chat between 17:20 and 19:20 UTC. Participants included people living with arthritis, researchers, patient organizations, health information outlets and academic institutions. During this period, 565 tweets were shared between participants in Australia, Canada, Ireland, Spain, UK and US. There were 3.352 million Twitter impressions. This represents the number of times a tweet appears to users in either their timeline or search results. Emergent themes of the analysis include:common workplace challenges such as employer attitudes and stigma;effective workplace supports such as prioritizing tasks and requesting workplace accommodations; andareas of improvement such as instituting workplace policies, flexible workplace approaches and education for employees and managers.Conclusion:The social media campaign was successful in reaching a diverse audience and supporting the #Time2Work campaign. Social media tools can provide an important social support for people living with arthritis as they navigate workplace challenges. It also offers a more contemporary platform to engage the international community on issues of common interest. Working together, internationally helps expand reach and reduce barriers in communication. Research can be conducted to measure potential behavior change that leverages digital social support for people living with arthritis.References:[1]EULAR (2019). Press release “EULAR launches Time2Work campaign to highlight the importance of keeping people with rheumatic and musculoskeletal diseases in work. Available from:https://www.eular.org/sysModules/obxContent/files/www.eular.2015/1_42291DEB-50E5-49AE-5726D0FAAA83A7D4/time2work_campaign_press_release_final.pdf2. CAPA (2019). Arthritis in the Workplace: Resources for Patients by Patients. Available from:http://arthritispatient.ca/arthritis-in-the-workplace-resources-for-patients-by-patients/Disclosure of Interests:Laurie Proulx Grant/research support from: Sources of grants and support received by the Canadian Arthritis Patient Alliance (including in-kind support) in the last two years include: AbbVie Canada, Alliance for Safe Biologic Medicines, Amgen Canada, Arthritis Alliance of Canada, The Arthritis Society, Best Medicines Coalition, CADTH, Canadian Rheumatology Association, Eli Lilly Canada, European League Against Rheumatism, Janssen Canada, Manulife, Novartis Canada, Ontario Rheumatology Association, Pfizer Canada (including Pfizer Hospira), Purdue Pharma Canada, Sanofi, and UCB Pharma., Speakers bureau: I have provided speaking services to Sanofi and Eli Lilly. These engagements do not relate to this abstract., Simon Stones Consultant of: I have been a paid consultant for Envision Pharma Group and Parexel. This does not relate to this abstract., Speakers bureau: I have been a paid speaker for Actelion and Janssen. These do not relate to this abstract., Joseph Coe: None declared, Dawn Richards Grant/research support from: Sources of grants and support received by the Canadian Arthritis Patient Alliance (including in-kind support) in the last two years include: AbbVie Canada, Alliance for Safe Biologic Medicines, Amgen Canada, Arthritis Alliance of Canada, The Arthritis Society, Best Medicines Coalition, CADTH, Canadian Rheumatology Association, Eli Lilly Canada, European League Against Rheumatism, Janssen Canada, Manulife, Novartis Canada, Ontario Rheumatology Association, Pfizer Canada (including Pfizer Hospira), Purdue Pharma Canada, Sanofi, and UCB Pharma., Consultant of: Dawn has done small consulting projects on patient engagement for companies., Speakers bureau: Dawn has been a paid speaker for several companies., Linda Wilhelm Grant/research support from: Sources of grants and support received by the Canadian Arthritis Patient Alliance (including in-kind support) in the last two years include: AbbVie Canada, Alliance for Safe Biologic Medicines, Amgen Canada, Arthritis Alliance of Canada, The Arthritis Society, Best Medicines Coalition, CADTH, Canadian Rheumatology Association, Eli Lilly Canada, European League Against Rheumatism, Janssen Canada, Manulife, Novartis Canada, Ontario Rheumatology Association, Pfizer Canada (including Pfizer Hospira), Purdue Pharma Canada, Sanofi, and UCB Pharma., Nathalie Robertson Grant/research support from: Sources of grants and support received by the Canadian Arthritis Patient Alliance (including in-kind support) in the last two years include: AbbVie Canada, Alliance for Safe Biologic Medicines, Amgen Canada, Arthritis Alliance of Canada, The Arthritis Society, Best Medicines Coalition, CADTH, Canadian Rheumatology Association, Eli Lilly Canada, European League Against Rheumatism, Janssen Canada, Manulife, Novartis Canada, Ontario Rheumatology Association, Pfizer Canada (including Pfizer Hospira), Purdue Pharma Canada, Sanofi, and UCB Pharma., Janet Gunderson Grant/research support from: Sources of grants and support received by the Canadian Arthritis Patient Alliance (including in-kind support) in the last two years include: AbbVie Canada, Alliance for Safe Biologic Medicines, Amgen Canada, Arthritis Alliance of Canada, The Arthritis Society, Best Medicines Coalition, CADTH, Canadian Rheumatology Association, Eli Lilly Canada, European League Against Rheumatism, Janssen Canada, Manulife, Novartis Canada, Ontario Rheumatology Association, Pfizer Canada (including Pfizer Hospira), Purdue Pharma Canada, Sanofi, and UCB Pharma., Alexandra Sirois Grant/research support from: Sources of grants and support received by the Canadian Arthritis Patient Alliance (including in-kind support) in the last two years include: AbbVie Canada, Alliance for Safe Biologic Medicines, Amgen Canada, Arthritis Alliance of Canada, The Arthritis Society, Best Medicines Coalition, CADTH, Canadian Rheumatology Association, Eli Lilly Canada, European League Against Rheumatism, Janssen Canada, Manulife, Novartis Canada, Ontario Rheumatology Association, Pfizer Canada (including Pfizer Hospira), Purdue Pharma Canada, Sanofi, and UCB Pharma., Annette McKinnon Grant/research support from: Sources of grants and support received by the Canadian Arthritis Patient Alliance (including in-kind support) in the last two years include: AbbVie Canada, Alliance for Safe Biologic Medicines, Amgen Canada, Arthritis Alliance of Canada, The Arthritis Society, Best Medicines Coalition, CADTH, Canadian Rheumatology Association, Eli Lilly Canada, European League Against Rheumatism, Janssen Canada, Manulife, Novartis Canada, Ontario Rheumatology Association, Pfizer Canada (including Pfizer Hospira), Purdue Pharma Canada, Sanofi, and UCB Pharma.
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Keller M, Plishka C, King M, Gunderson J, Stobart CA, Dunn K, Haver CRA. The Creation of a Tool to Measure Engagement in Patient-Oriented Research. Healthc Q 2020; 23:34-38. [PMID: 32249737 DOI: 10.12927/hcq.2020.26141] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
In 2017, the Saskatchewan Centre for Patient-Oriented Research (SCPOR) engaged patient and family advisors (PFAs) to review patient-oriented research grant proposals. The PFAs observed that the reviews would be less subjective if they were assessing the projects based on more rigorous criteria. Together the PFAs and SCPOR staff members developed a tool based on the Canadian Institutes of Health Research's Strategy for Patient-Oriented Research definition for patient-oriented research and the International Association for Public Participation's Spectrum of Public Participation. This article discusses the process of initiating a patient-identified project and co-creating the tool to indicate the level of patient-orientedness.
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Affiliation(s)
- Malori Keller
- The Patient Engagement & Empowerment Platform lead at the Saskatchewan Centre for Patient-Oriented Research. Her work focuses on supporting the advancement of patient engagement and patient- and family-centred care in health research and health system improvement. She can be reached by e-mail at
| | - Christopher Plishka
- A methods platform facilitator at the Saskatchewan Centre for Patient-Oriented Research. His work focuses on identifying and addressing the needs of researchers engaging in patient-oriented and community-engaged research
| | - Malcolm King
- The scientific director at the Saskatchewan Centre for Patient-Oriented Research. Dr. King is also a former scientific director of the CIHR Institute of Aboriginal Peoples' Health, where he spearheaded the development of a national health research agenda aimed at improving wellness and achieving health equity for people from First Nations Métis and Inuit in Canada
| | - Janet Gunderson
- has been a patient and family advisor with the Saskatchewan Centre for Patient-Oriented Research and the Chronic Pain Network for two years
| | - Christine Andrews Stobart
- A Knowledge Translation and Capacity Development Platform lead at the Saskatchewan Centre for Patient-Oriented Research. Dr. Stobart is an educator with a background in instructional leadership and mentorship. Currently, she develops and facilitates training opportunities for researchers and trainees pursuing patient-oriented research
| | - Kate Dunn
- A knowledge translation specialist at the Saskatchewan Centre for Patient-Oriented Research. Kate received the Knowledge Translation Professional Certificate from the University of Toronto and provides knowledge translation support to research teams
| | - Charlene R A Haver
- A Methods Platform lead at the Saskatchewan Centre for Patient-Oriented Research. Dr. Haver is also an exercise physiologist, serves on the Research Ethics Board for the local health authority and has experience in many research methodologies, including pragmatic trials, surveys, realist methodology and program evaluation
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Abstract
As part of the Saskatchewan Centre for Patient-Oriented Research (SCPOR)'s commitment to improving the experience of patient and family advisors (PFAs) who engage with local patient-oriented research teams, one of the supports offered is an evaluation that assesses the experiences and effectiveness of PFAs as research team members. In a recent evaluation project, SCPOR used an academically validated questionnaire and a survey co-designed by local PFAs. The results showed that PFAs wanted more frequent updates throughout the research project and greater role clarity. They also reported that the best part of their engagement was feeling like a valued team member.
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Affiliation(s)
- Michelle Flowers
- A patient engagement specialist with SCPOR working out of the Saskatchewan Health Quality Council. Her work focuses on supporting patients and research teams in patient-oriented research projects. She can be contacted at
| | - Janet Gunderson
- A patient family advisor with the SCPOR Patient Family Advisory Council and the Strategy for Patient-Oriented Research's (SPOR) Chronic Pain Network. She also volunteers with the Canadian Arthritis Patient Alliance and the Cochrane Collaboration
| | - Dale Hall
- A patient family advisor who sits on the SCPOR Patient Family Advisory Council. He has experienced the healthcare system as both a patient and a caregiver. Dale was a member of a SCPOR team that organized a speed networking event where patients and researchers connected to discuss their ideas for research questions
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Naeem S, Ingram JC, Varga A, Agardy T, Barten P, Bennett G, Bloomgarden E, Bremer LL, Burkill P, Cattau M, Ching C, Colby M, Cook DC, Costanza R, DeClerck F, Freund C, Gartner T, Goldman-Benner R, Gunderson J, Jarrett D, Kinzig AP, Kiss A, Koontz A, Kumar P, Lasky JR, Masozera M, Meyers D, Milano F, Naughton-Treves L, Nichols E, Olander L, Olmsted P, Perge E, Perrings C, Polasky S, Potent J, Prager C, Quetier F, Redford K, Saterson K, Thoumi G, Vargas MT, Vickerman S, Weisser W, Wilkie D, Wunder S. Get the science right when paying for nature's services. Science 2015; 347:1206-7. [DOI: 10.1126/science.aaa1403] [Citation(s) in RCA: 181] [Impact Index Per Article: 20.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022]
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10
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Jackson T, Iezzi T, Nagasaka T, Fritch A, Gunderson J. Does the mere presence of over-the-counter pain medication affect pain perception? Some preliminary findings. PSYCHOL HEALTH MED 2010. [DOI: 10.1080/13548500120116102] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/16/2022]
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12
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Filardo G, Nicewander D, Herrin J, Edwards J, Galimbertti P, Tietze M, Mcbride S, Gunderson J, Collinsworth A, Haydar Z, Williams J, Ballard DJ. A hospital-randomized controlled trial of a formal quality improvement educational program in rural and small community Texas hospitals: one year results. Int J Qual Health Care 2009; 21:225-32. [DOI: 10.1093/intqhc/mzp019] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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13
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Abstract
The five-factor model of personality, which has been widely studied in personality psychology, has been hypothesized to have specific relevance for DSM-defined personality disorders. To evaluate hypothesized relationships of the five-factor model of personality to personality disorders, 144 patients with personality disorders (diagnosed via a structured interview) completed an inventory to assess the five-factor model. Results indicated that the majority of the personality disorders can be differentiated in theoretically predictable ways using the five-factor model of personality. However, while the personality disorders as a whole appear to be differentiable from normal personality functioning on the five factors, the patterns are quite similar across the disorders, a finding that may provide some insight into the general nature of personality pathology but may also suggest problems with discriminant validity. Third, it does not appear that considering disorders as special combinations of features (as might be expected in some categorical models) is more informative than considering them as the sum of certain features (as might be expected in a dimensional model).
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Affiliation(s)
- L C Morey
- Department of Psychology, Texas A&M University, College Station 77843, USA
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14
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Abstract
The occurrence of pathological narcissism in bipolar patients, and the diagnostic relation between narcissistic personality disorder (NPD) and bipolar disorder (BD), were investigated. The Diagnostic Interview for Narcissism (DIN) was administered to bipolar patients when manic and when euthymic. The scores were compared to those of an NPD sample and a control group of general psychiatric patients. Euthymic bipolars do not exhibit a higher level of pathological narcissism or a higher prevalence of NPD than psychiatric patients in general. However, when manic, bipolar patients do appear similar to the narcissistic group, sharing 12 out of 14 of the identifying criteria for NPD. The results support the inclusion of mania in the differential diagnosis of NPD.
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Affiliation(s)
- D Stormberg
- Department of Psychiatry, Harvard Medical School, Boston, MA, USA
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15
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Abstract
The mechanisms responsible for the co-occurrence of personality disorders with Axis I disorders are not well understood. We propose a number of models that include various relationships at the etiological, pathophysiological, and observable clinical levels between personality disorders and Axis I disorders. It is recommended that such models be subjected to empirical tests to assess their validity.
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Affiliation(s)
- M J Lyons
- Psychology Dept., Boston University, MA 02215, USA
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16
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Abstract
Comorbidity between major psychiatric disorders (Axis I) and personality disorders (Axis II) is widespread, often extremely strong, and invariably confusing. The strongest associations are found between substance use and the cluster B (flamboyant) personality disorders, anxiety disorders and the anxious/fearful personality group (cluster C), and between somatisation and both cluster B and C disorders. The significance of these associations is far from clear, and almost certainly include more than one type of relationship. Empirical studies of patients with and without Axis I and II comorbidity show that the presence of a personality disorder can affect the outcome of treatment, both positively and negatively, in a way that currently appears unpredictable. One useful way of interpreting this comorbidity is by postulating personality dispositions that make some people prone to certain mental state disorders.
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Affiliation(s)
- P Tyrer
- St. Charles Hospital, London, UK
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Gunderson J, Hinkle G, Leipe D, Morrison HG, Stickel SK, Odelson DA, Breznak JA, Nerad TA, Müller M, Sogin ML. Phylogeny of trichomonads inferred from small-subunit rRNA sequences. J Eukaryot Microbiol 1995; 42:411-5. [PMID: 7620466 DOI: 10.1111/j.1550-7408.1995.tb01604.x] [Citation(s) in RCA: 74] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
Small subunit (16S-like) ribosomal RNA sequences were obtained from representatives of all four families constituting the order Trichomonadida. Comparative sequence analysis revealed that the Trichomonadida are a monophyletic lineage and a deep branch of the eukaryotic tree. Relative to the early divergent eukaryotic assemblages the branching pattern within the Trichomonadida is very shallow. This pattern suggests the Trichomonadida radiated recently, perhaps in conjunction with their animal hosts. From a morphological perspective the Devescovinidae and Calonymphidae are considered more derived than the Monocercomonadidae and Trichomonadidae. Molecular trees inferred by distance, parsimony and likelihood techniques consistently show the Devescovinidae and Calonymphidae are the earliest diverging lineages within the Trichomonadida, however bootstrap values do not strongly support a particular branching order. In an analysis of all known 16S-like ribosomal RNA sequences, the Trichomonadida share most recent common ancestry with unidentified protists from the hindgut of the termite Reticulitermes flavipes. The position of two putative free-living trichomonads in the tree is indicative of derivation from symbionts rather than direct descent from some free-living ancestral trichomonad.
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Affiliation(s)
- J Gunderson
- Center for Molecular Evolution, Marine Biological Laboratory, Woods Hole, Massachusetts 02543, USA
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18
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Abstract
OBJECTIVE This study investigated types of change that occur over time in the psychopathology of narcissistic patients. METHOD Baseline scores on the Diagnostic Interview for Narcissism of 20 patients, clinically diagnosed as having narcissistic personality disorder, were contrasted with their scores 3 years later by means of t tests and chi-square statistics. The authors then compared these changes in narcissism with the patients' accounts of their life events during the interval between the two assessments. RESULTS A significant decrease in the overall level of pathological narcissism was found, particularly in the areas of interpersonal relations and reactiveness. At follow-up, 60% of the subjects had reached the cutoff score on the diagnostic interview that indicated significant improvement, and 40% remained unchanged, with a high level of pathological narcissism. A high baseline level of narcissism in interpersonal relations was associated with absence of change at follow-up. Examination of life events in the interval between assessments suggests that changes in pathological narcissism are related to three kinds of experiences: achievements, new durable relationships, and disillusionments. CONCLUSIONS The instability of narcissistic psychopathology found in this study raises questions about the construct validity of narcissistic personality disorder as a diagnostic category and about the core construct of pathological narcissism.
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Affiliation(s)
- E Ronningstam
- Psychosocial Research Program, McLean Hospital, Belmont, MA 02178-9106
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19
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Abstract
The results of the Boston Psychotherapy of Schizophrenia Study were reported with a mixture of hopes and fears (Gunderson et al. 1984; Stanton et al. 1984). The hope was that those therapists, hospitals, and training programs that promoted and promulgated the idea that an exploratory, insight-oriented (EIO) psychotherapy was an important, usual, and practical way of treating schizophrenia would step back from this claim and see this approach in a more restricted and selective perspective. The fear was that the results would be reduced to a broader indictment of this modality such that its proper role with schizophrenic patients would be buried. Behind both this wish and this fear were the types of vivid personal experience in working with schizophrenic patients that the papers by Sandin and by Levander and Cullberg illustrate.
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20
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Gunderson J, Waldinger R, Sabo AN, Najavits LM. Stages of change in dynamic psychotherapy with borderline patients : clinical and research implications. J Psychother Pract Res 1993; 2:64-72. [PMID: 22700127 PMCID: PMC3330320] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Subscribe] [Scholar Register] [Received: 10/16/1991] [Revised: 05/14/1992] [Accepted: 05/29/1992] [Indexed: 06/01/2023]
Abstract
The authors offer guidelines for research on the first stages of long-term dynamic psychotherapy for borderline personality disorder. On the basis of five successfully treated cases, the authors outline methods for measuring the effectiveness, at different points in therapy, of psychotherapeutic treatment for borderline personality disorder.
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Affiliation(s)
- J Gunderson
- Personality and Psychosocial Research Program, McLean Hospital, Belmont, Massachusetts 02178
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21
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Gajadhar AA, Marquardt WC, Hall R, Gunderson J, Ariztia-Carmona EV, Sogin ML. Ribosomal RNA sequences of Sarcocystis muris, Theileria annulata and Crypthecodinium cohnii reveal evolutionary relationships among apicomplexans, dinoflagellates, and ciliates. Mol Biochem Parasitol 1991; 45:147-54. [PMID: 1904987 DOI: 10.1016/0166-6851(91)90036-6] [Citation(s) in RCA: 176] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
Sarcocystis muris is a coccidium with a two-host life cycle involving the domestic cat and the mouse, Mus musculus. S. muris and Theileria annulata belong to the phylum Apicomplexa, but the latter organism is a tick-borne protozoon in the subclass Piroplasmea and causes tropical theileriosis in cattle. The small-subunit ribosomal RNA (16S-like rRNA) coding regions of these organisms as well as that of the free living dinoflagellate Crypthecodinium cohnii were amplified using polymerase chain reaction techniques and compared to 16S-like rRNA sequences from other eukaryotes. The 16S-like rRNA genes of S. muris and T. annulata are more similar to each other than either is to Plasmodium falciparum, the cause of malignant tertian malaria of humans or Plasmodium berghei, the agent of the commonly studied malaria of rodents. Evolutionary trees inferred from the rRNA sequence similarities support a close phylogenetic relationship between the Apicomplexa and Dinoflagellata as represented by Prorocentrum micans and C. cohnii. Apparently members of these related phyla arose from an ancestral stock that gave rise to the ciliated protozoa.
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Affiliation(s)
- A A Gajadhar
- Department of Biology, Colorado State University, Ft. Collins
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22
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Abstract
The authors report an exploratory effort to identify useful criteria for narcissistic personality disorder. They used the semistructured Diagnostic Interview for Narcissism to assess 24 narcissistic patients and 58 others on 33 characteristics imputed to pathological narcissism. The following characteristics were significantly more common among the patients with narcissistic personality disorder: a sense of superiority, a sense of uniqueness, exaggeration of talents, boastful and pretentious behavior, grandiose fantasies, self-centered and self-referential behavior, need for attention and admiration, arrogant and haughty behavior, and high achievement. The results provide an empirical basis for developing an improved set of criteria for narcissistic personality disorder.
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Affiliation(s)
- E Ronningstam
- Psychosocial Research Program, McLean Hospital, Belmont, MA 02178
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23
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Ronningstam E, Gunderson J. Descriptive studies on narcissistic personality disorder. Psychiatr Clin North Am 1989; 12:585-601. [PMID: 2798198] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
This article describes a series of empirical studies on narcissistic disturbances and the narcissistic personality disorder in psychiatric patients. The work began with a survey of the literature and a comparison of three diagnostic systems for narcissistic personality disorder that helped clarify the degree of concordance among the existing systematic descriptions. This work gave rise to the development of a semistructured interview: the Diagnostic Interview for Narcissism. This tool was then used for investigating the following two main questions about pathologic narcissism: (1) Which characteristics identify and best distinguish patients with pathologic narcissism from psychiatric patients with various other diagnoses? (2) Can the Diagnostic Interview for Narcissism identify and distinguish patients with narcissistic personality disorder from patients with other psychiatric disturbances or related personality disorders?
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Abstract
This paper reports a first step towards identifying the descriptive characteristics of what is called pathological narcissism by clinicians. Twenty-three patients with various forms of narcissistic disturbances were evaluated with a semistructured interview for the presence of 27 putative signs of pathological narcissism. They were compared with patients with other psychiatric disorders (n = 28) to determine what features characterize and discriminate them. Fifteen statements proved to be useful in identifying patients with narcissistic disturbances. An additional two discriminate certain narcissistic patients. Implications for differential diagnosis and future research are noted.
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Affiliation(s)
- E Ronningstam
- Psychosocial Research Program, McLean Hospital, Belmont MA 02178
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