Modelling elderly patients’ perception of the community pharmacist image when providing professional services*

Professional pharmaceutical services may impact on patient’s health behaviour as well as influence on patients’ perceptions of the pharmacist image. The Health Belief Model predicts health-related behaviours using patients’ beliefs. However, health beliefs (HBs) could transcend beyond predicting health behaviour and may have an impact on the patients’ perceptions of the pharmacist image. This study objective was to develop and test a model that relates patients’ HBs to patient’s perception of the image of the pharmacist, and to assess if the provision of pharmacy services (Intervention group-IG) influences this perception compared to usual care (Control group). A qualitative study was undertaken and a questionnaire was created for the development of the model. The content, dimensions, validity and reliability of the questionnaire were pre-tested qualitatively and in a pilot mail survey. The reliability and validity of the proposed model were tested using Confirmatory Factor Analysis (CFA). Structural Equation Modelling (SEM) was used to explain relationships between dimensions of the final model and to analyse differences between groups. As a result, a final model was developed. CFA concluded that the model was valid and reliable (Goodness of Fit indices: x²(80) = 125.726, p = .001, RMSEA = .04, SRMR = .04, GFI = .997, NFI = .93, CFI = .974). SEM indicated that ‘Perceived benefits’ were significantly associated with ‘Perceived Pharmacist Image’ in the whole sample. Differences were found in the IG with also ‘Self-efficacy’ significantly influencing ‘Perceived pharmacist image’. A model of patients’ HBs related to their image of the pharmacist was developed and tested. When pharmacists deliver professional services, these services modify some patients’ HBs that in turn influence public perception of the pharmacist.     

Men’s experience of a guided self-help intervention for hot flushes associated with prostate cancer treatment

Up to 80% of men who receive androgen deprivation therapy report hot flushes and for many these are associated with reduced quality of life. However it is recognised that there are a number of barriers to men’s engagement with support to manage symptoms and improve quality of life. This qualitative study was embedded within a larger randomised controlled trial (MANCAN) of a guided self-help cognitive behavioural intervention to manage hot flushes resulting among men receiving androgen deprivation therapy. The study aimed to explore the engagement and experiences with the guided self-help intervention. Twenty men recruited from the treatment arm of the MANCAN trial participated in a semi-structured interview exploring acceptability of the intervention, factors affecting engagement and perceived usefulness of the intervention. Interviews were audio-recorded, transcribed verbatim and analysed using a Framework approach. Over two thirds of respondents (69%) reported reading the intervention booklet in full and over 90% reporting practising the relaxation CD at least once a week. Analysis of the interviews identified three super-ordinate themes and these related to changes in hot flush symptomatology (learned to cope with hot flushes in new ways), the skills that participants had derived from the intervention (promoting relaxation and reducing stressors), and to a broader usefulness of the intervention (broader impact of the intervention and skills). The present study identified positive engagement with a guided self-help intervention and that men applied the skills developed through the intervention to help them undertake general lifestyle changes. Psycho-educational interventions (e.g. cognitive behaviour therapy, relaxation, and positive lifestyle elements) offer the potential to be both effective and well received by male cancer survivors.     

Psychological health in long-term cancer survivorship: an Italian survey on depression and anxiety

Since long-term survivorship is now a reality for an increasingly number of people with a history of cancer, understanding their psychological health can inform health care policy as well as help supporting individual patients. This study was aimed to describe depression and anxiety (i.e. two of the most common psychological symptoms reported in oncology) in a sample of Italian long-term cancer survivors (LTCSs) defined as people who have been free from cancer and cancer treatments for at least five years. Four hundred and four Italian adult LTCSs completed a battery of questionnaires including the Zung Self-rating Depression Scale and the State Anxiety sub-scale of the State-Trait Anxiety Inventory respectively for depression and anxiety assessment. 16.5% of the sample displayed mild depression, 11.1% moderate depression, and 7.1% severe depression. depression was negatively associated with education (p = .017), perceived social support as provided by the family (p = .028), and perceived social support provided by friends (p = .008), and it was positively associated with occupational status (p = .023), presence of health issues (p = .010), and anxiety (p < .001). 8.7 and 15.8% of the sample were respectively possible and probable cases of anxiety. Anxiety was negatively associated with occupational status (p = .038) and it was positively associated with depression (p < .001). These data support ongoing assessment and monitoring of depression and anxiety in LTCSs, and stimulate the development and testing of psychological interventions for such individuals. In addition, they encourage further study on the psychological health of this specific population.     

Relationship between religious beliefs and post-traumatic growth in patients with cancer in southeast of Iran

Information about religious beliefs and post-traumatic growth is limited in Iranian cancer patients. This study was conducted to determine the relationship between religious beliefs and post-traumatic growth among cancer patients in Iran. This correlational study included a convenience sample of 200 eligible cancer patients who were hospitalized in the oncology wards and outpatient clinics. Using Post-traumatic Growth Inventory (PTGI) and Religious Beliefs Scale, data were collected. Findings showed that, the total mean score of PTG was 93.81 (SD?=?15.25). Among the categories, the lowest score belonged to “appreciation of life” component (7.67±1.99), and the highest score belonged to “spiritual change” component (67.49 ± 17.78). The mean score of Religious Beliefs Scale was 67.20 (12.35). Post-traumatic growth positively correlated with religious beliefs (r?=?.345; p?=?.001). The results suggest that, information about religious beliefs and post-traumatic growth should be included in the continuous and in-service education of cancer patients and nurses who work with them.     

TRANSFERENCE BEFORE TRANSFERENCE

This paper is predominantly a clinical presentation that describes the transmigration of one patient's transference to another, with the analyst functioning as a sort of transponder. It involves an apparently accidental episode in which there was an unconscious intersection between two patients. The author's aim is to show how transference from one case may affect transference in another, a phenomenon the author calls transference before transference. The author believes that this idea may serve as a tool for understanding the unconscious work that takes place in the clinical situation. In a clinical example, the analyst finds himself caught up in an enactment involving two patients in which he becomes the medium of what happens in session.     

‘It was all intertwined’: Illness representations and self-management in patients with cancer and anxiety/depression

Objective: Cancer and anxiety/depression frequently co-occur, leading to poorer outcomes for these illnesses. However, the majority of existing research investigates how participants view single illnesses alone. This study aimed to explore the content of individuals’ multimorbid representations and how these relate to their coping behaviours and self-management strategies for cancer and anxiety/depression.

Design: A semi-structured qualitative research design with theoretical thematic analysis.

Main Outcome Measures: Multimorbid illness representations, coping behaviours, and self-management strategies.

Results: In interviews with 21 participants multimorbid representations varied, three participants viewed cancer and anxiety/depression as unrelated, five participants were uncertain about the relationship between cancer and anxiety/depression, and the majority of participants perceived cancer and anxiety/depression as related. This third group of participants often described relationships as causal, with representations having both positive and negative influences on coping behaviours and self-management strategies. Representations were shown to change over the course of the cancer experience, with fear of cancer recurrence and the influence of participants’ most challenging illness also discussed.

Conclusions: People hold multimorbid illness representations that can influence self-management. An awareness of these representations by researchers, health professionals, and patients is important for the creation of future interventions that aim to improve and maintain patient wellbeing.     

The role of stressful life events on the cortisol reactivity patterns of breast cancer survivors

Objective: Atypical patterns of cortisol secretion following an acute stressor have been commonly reported in breast cancer survivors. Stressful life events have been associated with blunted acute cortisol levels in other populations. The purpose of this study was to explore the role of stressful life events on cortisol secretion patterns of breast cancer survivors following an acute stressor.

Design: The Trier Social Stress (TSST) was used to elicit a moderate stress response in breast cancer survivors (n = 19) and a control group (n = 17). Saliva samples were collected before, during and after the TSST to provide cortisol concentrations. During recovery, we recorded the frequency and subjective impact of stressful life events in the past year using the Life Experience Survey.

Results: Simple regressions analyses were performed; results suggest no group differences between the total number of stressful life events and their subjective impact. However, the total number of stressful life events as well as their subjective impact correlated negatively with the peak cortisol concentration in breast cancer survivors.

Conclusions: The cumulative effect of stressful life events, positive and negative, may impact the endocrine stress system of breast cancer survivors more so than that of women with no history of cancer.     

Exploring definitions of bullying among personality disordered patients in a maximum‐secure hospital

The current study explored the perceptions of staff and patients concerning how patient‐to‐patient bullying should be defined and what behaviours it should include. Participants were randomly selected from the Personality Disorder Unit of a maximum secure hospital. A total of sixty interviews were conducted (30 staff and 30 patients). Problems in attempting to utilise definitions of bullying developed for use in other contexts, i.e., schools, were identified. Patients and staff presented with similar views about how it should be defined: both felt that aggression did not have to be repeated or severe in order to be classed as bullying, that bullying could be accidental, that the power imbalance between perpetrator and victim was not always explicit and, finally, that victims could provoke bullies unintentionally. Indirect (i.e. covert) forms of aggression were less likely to be considered bullying than direct (i.e. overt) forms. A number of differences were found between staff and patients regarding how bullying was conceptualised. Staff were more likely than patients to hold the belief that some patients liked being bullied, and appeared to acknowledge a broader definition of bullying than patients, accounting for a wider range of aggressive behaviours. A number of similarities between the current study and previous prison‐based research were found. The implications of these findings for current research and the value in attending to prison‐based research are highlighted. Aggr. Behav. 00:000–000, 2005. © 2005 Wiley‐Liss, Inc.     

医患冲突与诚信的缺失

在新的历史条件下,医患冲突表现出更为复杂的特点,从深层次研究医患冲突的原因,诚信的缺失往往被人们所忽视.多数医疗纠纷源于医患双方缺乏诚信,以自我为中心,过分强调经济利益,缺少人文关怀.必须加强诚信道德教育,建立健全信用法律制度,使诚实守信成为人人自我约束、自觉遵守的行为规范.     

目前形势下临床教学问题的探讨与改革

当前医疗大环境的改变,社会评价的影响及病人的维权、自我保护意识等使临床教学工作发生了很大变化.需要我们采取相应的变革,注重病历的书写,基本功的培训,语言能力的指导和改变查房的方式,以完成培养新一代合格医生的任务.