The Center for Epidemiologic Studies Depression scale (CES-D) : is it suitable for use with older adults?

With the aim of verifying the suitability of the CES-D scale for use in long-term care institutions for older adults, the CES-D questionnaire was used to collect patient-reported assessments, and two well-known psychometric instruments – the Hospital Anxiety and Depression Scale (HADS) and the Barthel Index of Abilities of Daily Living – were used to collect nurse-reported assessments, based on observations of patients’ behaviours. With regard to possible frequent cases of cognitive impairment and/or insufficient motivation to give sensible responses to CES-D questions, the patient-reported responses were collected from patients during one-on-one sessions with a nurse. The reliability, concurrent validity, and the trustworthiness of the obtained data were supported with proper values of the Cronbach’s alpha coefficient, 0.70 < alpha < 0.85, with significant correlation between CES-D and HADS-Depression, R = 0.50, p < 0.001, and with significant correlation between scores of particular CES-D items vs. final CES-D evaluations of depression, proved by significance p < 0.001 for 18 of 20 CES-D items. These findings supported the effectiveness of the one-on-one session methodology in questionnaire surveys for older adults. The postulation that cases of self-reported depression included somewhat different information about the patient than nurse-reported depression concerning the same patient was supported with the evidence that, in spite of the significant correlation between the Barthel Index and HADS-Depression, R = −0.17, p = 0.016, and in spite of the significant correlation between CES-D and HADS-Depression, the correlation between the Barthel Index and CES-D, equal to R = −0.08 was insignificant at p = 0.244. The findings of this study, considered jointly, support the valuableness of the CES-D scale for use in one-on-one surveys for older adults

Uncovering supplementary information from questionnaire inquiry on physical ability with the aim to develop psycho-educational intervention : an example of a study using the SF-36 questionnaire among convalescents after acute pancreatitis

The aim of this paper was to complete a series of our own reports on health-related outcomes of rehabilitation following successful clinical therapy in Poland, based on data from a questionnaire survey using the SF-36 questionnaire, on a group of N = 142 participants hospitalized for acute pancreatitis at General Surgery in the Jagiellonian University of Krakow from 2000 to 2006. The data from the questionnaire survey were used to estimate two auxiliary individual attributes of the survey participants: the predictable ability to accept (PAA) any fixed ordering of scale items; and the inclination to avoid extreme scores (AES). The participants of the study differed significantly with respect to their individual PF AES, and PAA scores, N=48 persons didn't agree with the standard ordering of PF items of SF-36, N=30 persons agreed with any possible ordering. The findings of this study have some practical worth: first, in case of a need to reveal the patient's true ordering of the questionnaire items, it can be concluded that the persons with a great predictable ability to accept any ordering should be examined once more with some special technique. It seems to be sensible that patients with a quite different inclination to avoid extreme scores need a somewhat distinct style of motivation for healthy behavior

Factors influencing quality of life of patients after the acute pancreatitis

Acute pancreatitis (AP) is a significant challenge for the modern medicine for medical reasons, social and economic aspects. Patients with acute pancreatitis demonstrate physical, psychological and social problems. The aim of the study was to assess the quality of life of convalescents after moving pancreatitis, hospitalized from 2000 to 2006 in the Jagiellonian University in Cracov. The study involved 142 adults - 61 women and 81 men, aged from 22 to 69 years. Three investigational methods were used: a retrospective analysis of medical records, original questionnaire and standardised questionnaire SF-36. Demographic and social parameters, such as gender, education, occupational status, are the principal factors influencing individual components of quality of life evaluated with the SF-36 questionnaire. However, clinical variables related to acute pancreatitis, i.e. severity of disease, therapy, and complications have a limited impact on patients quality of life. Results of the study demonstrated that parameters related to quality of life obtained in the study population with the SF 36 questionnaire were markedly lower, but not significantly different, from normal results for the general US population or patients surviving acute pancreatitis in Finland. The results may be helpful in estimating the scope of the social needs of the traveling disease in the education of medical professionals, as well as directly in the planning of rehabilitation

The scope of acceptance by patients motherly and friendly style of nurse's supporting behaviour in palliative care

The patients' reactions to care-providers, as well as patients' demographic and clinical features, not always provide the sufficient basis for concluding about their preferences, because of patents' specific situation. At this study the subject was restricted to easy observable nurse’s touch. Evidence on patients’ acceptance of motherly and friendly style of behaviour in palliative care. The answers 35-item questionnaire were obtained at study group of 55 patients in the terminal stage of cancer. Each patient under study expected and experienced the nurse’s touch; 55 (95%) patients are satisfied with obtaining an instrumental touch, 51 (93%) - with caring touch, 50 (91%) - with communicating touch, 53 (96%) - with healing touch. Similar results were obtained for the kin's and doctors' touch. Considering the healing touch, 32 (58%) patients accept friendly style but don’t accept motherly touch, 19 (35%) accept both styles. The above patients' groups don't differ significantly in their demographic and clinical features. Among patients in terminal stage of cancer, there are significant differences in individual preferences concerning the style and form of supporting behaviour of care-providers. The patient's demographic and clinical features, his reaction to experiencing touch don't provide sufficient basis for conclusions about their preferences, therefore, the interviews carried out at another time by other persons are necessary. Thus, the obtained results confirm the necessity of continuation of the studies of the means of achieving compliance between the nurses’ behaviour and patients' preferences

Dwa argumenty za opcją odpowiedzi Nie-wiem oprócz opcji Tak/Nie w anonimowych testach zrozumienia zależności przyczynowo-skutkowych

Two Arguments for Options I-don’t-know Except Options Yes /No in Anonymous Questionnaire Survey on Understanding the Causal Relations In the experiment we examined the behaviour of the participants at the two seemingly equivalent decision situations. At the fi rst situation the participants, aimed to avoid a decisive answer, can only refuse at all, neither Yes nor No. But at the second situation they can choose an additional option I-don’t-know. It was proved that, even in the anonymous survey, the same participants tried to guess the proper Yes or No answers, signifi cantly more oft en at the fi rst situation than at the second one. Th erefore, the option I-don’t-know creates the better opportunity to obtain unbiased information. Th en, the observed relationship between the proportion of Yes versus No answers and the frequency of the I-don’t-know answers gives an additional insight into reliability of the obtained data

Ethical problems of palliative care in the period of its evolutionary transformation

Our long-time experience in palliative care allowed us to notice changes in ethics of palliative medicine. In the handbook of palliative medicine, its authors R.G.Twycross and D.Frampton in 1995 did formulate the following ethical postulate: respect for life, acceptance of death of a patient as an unavoidable event, respect for a patient as a person, beneficence, nonmaleficence, justice. In addition, they stressed prohibition of euthanasia as a rule. Nine years later, however, in the Oxford handbook of palliative care, its authors: M.S.Watson, C.T.Lukas, M.A.Hoy and J.N.Back described their ethical basis, which were slightly different but quite similar to those of T.L.Beauchamp and J.F.Childers: autonomy of a patient, beneficence, nonmaleficence, justice and the trust. Their set of principles may induce controversy because of unlimited patient's autonomy and absence of physician's autonomy. Further, it may permit euthanasia, which is excluded by palliative medicine