Prism Adaptation Treatment Predicts Improved Rehabilitation Responses in Stroke Patients with Spatial Neglect

Spatial neglect (SN) impedes functional recovery after stroke, leading to reduced rehabilitation gains and slowed recovery. The objective of the present study was to investigate whether integrating prism adaptation treatment (PAT) into a highly intensive rehabilitation program eliminates the negative impact of spatial neglect on functional and motor recovery. We examined clinical data of the 355 consecutive first-time stroke patients admitted to a sub-acute inpatient neurorehabilitation program that integrated PAT. The 7-item Motor Functional Independence Measure, Berg Balance Scale, and Motor Activity Log were used as main outcome measures. We found that 84 patients (23.7%) had SN, as defined by a positive score on the Catherine Bergego Scale via the Kessler Foundation Neglect Assessment Process (KF-NAP^®). Although 71 patients (85%) received PAT, the presence of SN at baseline, regardless of PAT completion, was associated with lower functional independence, higher risk of falls, and a lower functional level of the affected upper limb both at admission and at discharge. The severity of SN was associated with inferior rehabilitation outcomes. Nonetheless, patients with SN who received PAT had similar rehabilitation gains compared to patients without SN. Thus, the present study suggests that integrating PAT in an intensive rehabilitation program will result in improved responses to regular therapies in patients with SN.

Tower of London test - short version

Tower of London (ToL) is a neuropsychological method for assessing planning ability. In this study, we attempted to introduce a shorter version of ToL. Two studies were carried out. In Study 1, patients with mild cognitive impairment due to Parkinson's Disease (n = 36) and a control group (n = 225) were included in order to select a suitable short version of ToL for Study 2. In Study 2, patients with schizophrenia (n = 30) and a control group (n = 31) were included in order to assess psychometric properties of the shortened version of ToL. Based on psychometric evaluations in Study 1, we offered three possible shortened versions. In Study 2, all three shortened versions proved to have good discriminative validity in our schizophrenia sample, but interestingly not in the healthy sample. We concluded that the use of shortened ToL is possible in specific psychiatric/neurological patient groups, although we do not recommend doing so in healthy individuals.

Prism adaptation treatment to address spatial neglect in an intensive rehabilitation program: A randomized pilot and feasibility trial

Spatial neglect (SN) is a common cognitive disorder after brain injury. Prism adaptation treatment (PAT) is one of the promising interventions for SN albeit inconsistent results from previous studies. We carried out a comparison intervention (PAT vs. Sham) and aimed to evaluate the efficacy of PAT on visuospatial symptoms of SN in an inpatient rehabilitation setting that offered a highly intensive comprehensive brain injury rehabilitation program. A total of 34 patients with moderate-to-severe SN secondary to stroke or traumatic brain injury were randomized to the PAT group and the Sham group (an active control group). Both groups received 10 sessions of treatment, over two weeks, in addition to the rehabilitation therapies provided by their rehabilitation care teams. Outcomes were measured using an ecological instrument (the Catherine Bergego Scale) and paper-and-pencil tests (the Bells Test, the Line Bisection Test and the Scene Copying Test). Patients were assessed at baseline, immediately after treatment, two weeks after treatment, and four weeks after treatment. 23 (67.6%) patients completed treatment and all the assessment sessions and were included in the final analyses using mixed linear modeling. While SN symptoms reduced in both groups, we found no difference between the two groups in the degree of improvement. In addition, the average SN recovery rates were 39.1% and 28.6% in the PAT and Sham groups, respectively, but this discrepancy did not reach statistical significance. Thus, the present study suggests that PAT may contribute little to SN care in the context of a highly intensive inpatient rehabilitation program. Further large-scale investigation is required to uncover the mechanisms underlying PAT and Sham in order to refine the treatment or create new interventions.

Burnout Syndrome and Lifestyle Among Primary School Teachers: A Czech Representative Study

BACKGROUND Burnout is a state of vital exhaustion that is manifested on physical, cognitive, and emotional levels. Teachers work in a field where they are exposed daily to high job-related stressors, which can result in job change, a higher rate of unhappiness, and even earlier retirement. This study explored the relationship between job stressors, lifestyle, and burnout. MATERIAL AND METHODS Descriptive statistics were used to explore the burnout levels, together with t tests to compare between men and women, and regression analysis was performed to explore the relationship between the rates of burnout and lifestyle. RESULTS The overall sample size was 2394 teachers from primary schools. While males had higher emotional burnout, females reported higher physical burnout rates. We found that higher income was associated with less burnout, and a healthier lifestyle is associated with lower burnout rates. Teachers who take time for family and personal interests have significantly lower rates of burnout than those that do not. CONCLUSIONS Based on our results, we propose that teachers should be informed about the risk of burnout. We found that some teachers reported they do not know what burnout syndrome is. The primary aim should be to increase awareness. In fact, burnout is a major threat to those who are perfectionists and who tend to work overtime.

Patient awareness, perception and attitude to contrast-enhanced CT examination: Implications for communication and compliance with patients' preferences

BACKGROUND

Despite the high volume of contrast-enhanced computed tomography (CECT) examinations, there is limited awareness about its risks among patients and little is known about the influence of patient information sheets.

OBJECTIVES

The objective of this study was to assess patients' awareness and perception of risks related to CECT examination and how they are influenced by an information sheet.

MATERIAL AND METHODS

A total of 263 adult patients scheduled for a CECT examination completed a questionnaire. The first page evaluated patients' characteristics, their fear and awareness about examination-related risks, and source of information. Page 2 contained the Zung self-rating anxiety scale. After reading the information sheet, patients completed page 3 that surveyed how their awareness and fear had changed.

RESULTS

Nearly half of the patients underestimated the risk of secondary malignancy (n = 121, 46%), or the risk of renal impairment (n = 110, 42%). The vast majority (n = 227, 86%) stated that they were not instructed to maintain fluid intake up to 1 h before the procedure. After reading the information sheet, patients generally corrected their knowledge, but 195 (74%) reported experiencing greater fear (p < 0.0001). Fear was more pronounced in younger female patients who had not undergone CT previously. Patients feared the result more than examination-related risks. Most patients (n = 204, 78%) would feel uncomfortable before receiving the examination result.

CONCLUSIONS

Most patients do not assess risks related to CECT examination correctly. Although the information sheet improves patients' understanding of CECT-related risks, it lacks empathically delivered reassurance and increases their fear. Fast communication of examination results would make patients feel more comfortable.

Unidimensionality of the personality inventory for DSM-5 facets: Evidence from two Czech-speaking samples

To date, numerous studies have confirmed empirical relevance of the personality trait model defined in the Alternative DSM-5 Model for Personality Disorders. The supposed single-factor structure of its facets and general domains across various samples, however, has not been researched thoroughly. This study focused on evaluating the hypothesized unidimensional factor structure of the lower-order personality trait facets, as well as the validity of the higher-order domains. The Czech version of the Personality Inventory for DSM-5 (PID-5) was used in a sample of 351 community volunteers and 143 psychiatric patients. The fit of the model for 25 facets could not be replicated with the original PID-5, while a shortened version confirmed the single-factor structure of all facets and their relevance to the five proposed domains. The findings support unidimensional structure of the modified DSM-5 personality trait model and imply discussion of the utility of the proposed PID-5 version. Copyright © 2018 John Wiley & Sons, Ltd.

A Comparative Study of Tower of London Scoring Systems and Normative Data

Objective

Tower of London (ToL) is a planning ability task that includes multiple versions. The original ToL was developed by Shallice together with two scoring systems (ToL-SS). Another two ToL-SS were proposed by Anderson et al. and Krikorian et al. The purpose of this study is to provide normative data for four ToL-SS and explore the effects of demographic variables on ToL performance. Furthermore, we aimed to determine the discriminative validity of these ToL-SS in clinical samples.

Method

Four groups were included in the study: a normative sample of healthy adults (HC; n = 298); patients with Parkinson's disease with mild cognitive impairment (PD-MCI; n = 52) and without cognitive impairment (PD-ND; n = 57); and patients with schizophrenia (SCH; n = 28). The effects of demographic variables on ToL-SS were examined in the HC group. Between-groups comparisons of ToL-SS were conducted using regression analysis with dummy codes.

Results

All four ToL-SS were not significantly affected by age, whereas the effect of gender and education is not consistent. ToL-SS significantly (p < .05) differentiate HC from PD-MCI and SCH. Cohen's effect size coefficients d range from 0.68 to 1.29. Internal consistency coefficients (Cronbach's α) of ToL-SS range from 0.33 to 0.60.

Conclusions

Despite poor to questionable internal consistency of ToL-SS, the discriminative validity and clinical utility for assessing planning deficits in PD-MCI and SCH are high. This study provides normative standards for all four ToL-SS on an adult population for use in clinical practice.

Growing number of emergency cranial CTs in patients with head injury not justified by their clinical need

BACKGROUND

Computed tomography (CT) is widely available in most hospitals, usually 24 h a day, which results in an expansion of its indications, sometimes beyond medically justifiable extent.

AIM

To evaluate trends in emergency cranial CTs in a general university hospital during the last 15 years.

METHODS

We conducted a database search for emergency cranial CTs between January 2000 and December 2015 that were performed in patients after head injury on weekends and bank holidays and between 8 P.M. and 6 A.M. on workdays. The numbers were compared with demographic data, the number of hospital beds, and total number of CT examinations.

RESULTS

The annual number of emergency cranial CTs increased 5.5 times from 124 to 679 with a sharp increase since 2013. This trend showed a negative correlation with the number of hospital beds (r = -0.88, p = 0.0001), the proportion of important findings on cranial CT (r = -0.74, p = 0.0010), or the proportion of patients indicated for cranial CT by NICE 2014 criteria (r = -0.90, p < 0.0001) and positive correlation with the proportion of inebriated patients (r = 0.94, p < 0.0001), and their average GCS score (r = 0.92, p < 0.0001). Compared to the number of emergency cranial CTs, the slope of regression lines for all trends was significantly different (p < 0.001) apart from the number of inebriated patients (p = 0.062).

CONCLUSIONS

The increase in the emergency cranial CTs cannot be entirely justified by their clinical need. We assume that this is the result of an absent support of adherence to the guidelines in the legislation together with a medicolegally unpredictable environment.

Psychosocial Factors in Patients Indicated for Lumbar Spinal Stenosis Surgery

In the context of the interdisciplinary care of patients with chronic back pain, surgery is an option for those who do not benefit from conservative treatment. Psychological assessment prior to back surgery aims to identify suitable candidates for surgery and predict possible complications or poor treatment effects. The literature suggests that psychosocial factors are important outcome predictors of lumbar spinal surgery; however, there is not enough empirical evidence to show that early identification and treatment of these factors help improve surgical outcome. This review discusses the possible psychosocial risk factors in patients with lumbar spinal stenosis who are undergoing decompression or stabilization surgery, shows the association between presurgical psychological parameters and surgical treatment outcome, and describes the characteristics of our pilot study to implement presurgical psychological assessment in routine clinical practice.

Effects of different types of instruction on the Scores of PID-5 profile

Introduction

Section III of 5th edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) includes a hybrid model of personality pathology, in which dimensional personality traits (PTs) are used to derive one of six categorical Personality Disorder (PD) diagnoses. The Personality Inventory for DSM-5 (PID-5) has been developed to assess PTs within this new system.

Objectives

PT is a tendency to feel, perceive, behave, and think in relatively consistent ways across time and situations. PD diagnosis is generally stated if a pattern of maladaptive PTs persists at least 5 years. Nevertheless, the PID-5 instruction does not cover duration of symptoms.

Aims

We have explored the effect of two different types of instructions, in which duration of symptoms is or is not explicitly mentioned, on the PID-5 scores. Moreover, we have asked whether the scores differ in psychiatric patients and healthy individuals.

Methods

Differences between original and modified instructions of the Czech PID-5 version have been evaluated in a group of 62 psychiatric patients and 38 healthy controls; each respondent has been administered both instruction types in random sequence. ANOVA mixed design has been used to test the relation between groups and different sequence of administration.

Results

We have found no consistent differences in PID-5 scores using the different types of instruction described above.

Conclusions

In our sample, PID-5 seems to reflect strong beliefs of a subject regardless of symptoms’ duration and could be reliably used with both types of instruction. The PID-5 represents an appropriate instrument for the assessment of maladaptive PTs.

Disclosure of interest

The authors have not supplied their declaration of competing interest.

Burnout syndrome in medical professionals: a manifestation of chronic stress with counterintuitive passive characteristics

By operational criteria, burnout appears to be a multifaceted behavioral syndrome consisting of maladaptive individual responses subsequent to prolonged stressful situations. Given the intense physical and cognitive demands of providing high quality healthcare to a wide spectrum of patients, healthcare professionals are particularly susceptible to developing burnout syndrome, a notable phenomenon that has gleaned significant societal attention in recent years. Clearly, widespread manifestation of burnout by health care professionals represents a serious potential threat to the overall quality of patient care and to the realization of positive outcomes to multiple treatment strategies. It will most certainly engender a serious negative impact on the economic viability of the entire healthcare system. Presently, our brief review focuses on current research efforts to 1) provide precise behavioral and psychiatric diagnostic criteria for burnout syndrome in healthcare professionals, 2) identify potential etiological factors and ongoing stressors, and 3) outline an integrative approach for treatment and prevention.

P300 wave: a comparative study of impulsive aggressive criminals

Event-Related potentials are a simple non-invasive neurophysiological method enabling to comprehend certain aspects of the cognitive processing of information in humans. The best-known component of Event-Related Potentials is the so-called P3 wave. Alterations in the parameters of P300 wave have been discovered in certain personality disorders and in persons with impulsively aggressive behaviour. The purpose of this study is to investigate the changes of these parameters, especially an amplitude and latency in the place of Pz electrode. We examined 15 persons with the impulsive aggressive behaviour and compared them to a population comparable of normal age, gender and approximate degree of education. We used P300 auditory and a neuropsychological Eysenck IVE battery. The results showed that significantly lower amplitudes had been found in the aggressive impulsive subjects as compared to the control group. No statistically significant differences have been discovered in the latency. These results seem to confirm previous studies.