Spiritual experiences of continuity and discontinuity among parents who lose a child

This is a study of parents' spiritual experience of the loss of a child. Many parents experience continuing bonds with their deceased child as well as forms of posttraumatic growth. Twelve parents of children dying after severe illness were interviewed about their experiences. The interviews contain stories about premonitions, the intensity of the moment of the child's death and the child's presence after death. Thematically the stories reflect the dialectics of continuity and discontinuity in the relationship with the child. This is interpreted in terms of attributing meaning, significance and comprehensibility. © 2012 Koninklijke Brill NV, Leiden, The Netherlands

Journal positioning meta-issues as evolving contexts: Organizational marketing at the crossroads

As Industrial Marketing Management (IMM) has completed 45 years of publication, Industrial Marketing Management: An Interorganizational Interdisciplinary Journal comes of age yet again. A description of the proliferation of journals and associated titles within cognate subfields is provided noting the societal forces creating this necessity. Relief is brought to the complexity and diversity of journals therein. The unit of analysis is that of an individual circumspect scholar viewing the journal mix landscape and its associated impact on their scholarship and career. Contexts and criteria are offered for sorting out this meta-dilemma that has been evolving since time immemorial. Peter J. LaPlaca's (PJL's) presence in our field and IMM is explicated with awe and appreciation. Closing thoughts are offered regarding our collective future and some criteria for getting there – the next interlude. The reader is invited to ascertain their unique scholarly path. Both quantitative and qualitative analyses are used in the evaluation of the mere incidence of article outlets and the moderating effect on institutional and industry constraints as accelerated over the past 45 years. Industry sources that measure and monitor journal use and their activity are broadly and succinctly portrayed. Historical analyses of college business school education's evolution with the associated impact of these industrial forces for journal publishing are derived. A narrative describing the evolution in the quantity of journals and their proliferation is provided. The analysis is by definition contemporary yet retrospective, qualitative yet adductive. PJL's long-term contribution to the field is documented with awe and appreciation. Individual scholars are to know that their own acumen and that of those whom they may come to supervise are constrained yet enabled by the mere quantity of journal options and their inevitable domain enmeshment. The impact on education and the management thereof are noted in detail and associated sense making in the performance of our job. The analyses of the journals publishing provides a paradox of opportunity yet a twisted knot of options for any scholar requiring yet further criteria to untie. Over most of our career lifespans the data and analysis provided help contextualize the character of your scholarly journey. A glimpse into the evolution of research in the area of business-to-business marketing and its components over the last few decades helps magnify the positioning of the journals for prospective authors and would-be readers

Toward the Development of a Monitoring and Feedback System for Predicting Poor Adjustment to Grief

Losing a loved one is a fundamental and ubiquitous life experience that is often characterized by a certain period of grief and emotional distress. Although the majority of the bereaved can cope with grief resiliently, around 1 of 10 individuals could experience an unusually protracted and intense response referred to as prolonged grief disorder (PGD) following death of a loved one. PGD is associated with work and social impairment and heightened risk of severe medical and psychological conditions. Current means of diagnosis requires a minimum of 6 months to confirm and identify PGD and is discrepant with the fact that the bereaved may need psychotherapeutic intervention in a more timely manner. Contemporary studies have outlined prospective risk factors that could cause poor bereavement outcome, which can potentially contribute to early identification and prevention of problematic response to grief. Self-monitoring applications have been developed and broadly implemented in a vast spectrum of mental and health-related interventions and self-managing processes. This study presents the conceptualization and development of an Internet-based screening method designed by the researchers and psychotherapists that aims to provide meaningful and quantitative feedback in the early phase of the grief and to support decision making in the bereavement process through monitoring the susceptibility to problematic grief outcome

PRODIGY score predicts respiratory depression in the post-anesthesia care unit: A post-hoc analysis

Surgical patients who experience respiratory depressive episodes (RDEs) during their post-anesthesia care unit (PACU) admission are at a higher risk of developing subsequent respiratory complications in general care wards. A risk assessment tool for PACU RDEs has not been previously assessed. The PRediction of Opioid-induced respiratory Depression In patients monitored by capnoGraphY (PRODIGY) score is an assessment tool that uses baseline patient variables to categorize patients into low, intermediate, or high risk groups for RDEs in general care wards. This study assessed whether PRODIGY groups are associated with PACU RDEs. This analysis utilized data from a previous observational trial of PACU RDEs detected by capnography. PRODIGY scores were retrospectively calculated, and the number and duration of respiratory alerts were compared among PRODIGY groups. Twenty-six (29.9%) patients were classified as low risk, 29 (33.3%) as intermediate risk, and 32 (36.8%) as high risk. A total of 3,580 alerts were recorded in the PACU, 47% of which were apnea episodes lasting ≥ 10 seconds. The total number and duration of alerts were highest in high risk group patients (median 56 [IQR 12 – 87] alerts per patient vs 22 [9 – 37] in low risk and 26 [13 – 42] in intermediate risk patients, P = 0.035; 303 [123 – 885] seconds vs 177 [30 – 779] in low risk and 301 [168 – 703] in intermediate risk patients, P = 0.042). Poisson regression analysis indicated that the rate of RDEs in the high PRODIGY risk group was higher than in the intermediate (rate ratio estimate = 2.01 [95% CI 1.86 – 2.18], P < 0.001) and low (rate ratio estimate = 2.25 [95% confidence interval 2.07 – 2.45], P < 0.001) risk groups. This analysis suggests that the PRODIGY score may be useful in assessing the risk of PACU RDEs. Trial Registration: https://www.clinicaltrials.gov/ct2/show/NCT02707003

Development and preliminary evaluation of EMPOWER for surrogate decision-makers of critically ill patients

OBJECTIVE: The objectives of this study were to develop and refine EMPOWER (Enhancing and Mobilizing the POtential for Wellness and Resilience), a brief manualized cognitive-behavioral, acceptance-based intervention for surrogate decision-makers of critically ill patients and to evaluate its preliminary feasibility, acceptability, and promise in improving surrogates' mental health and patient outcomes. METHOD: Part 1 involved obtaining qualitative stakeholder feedback from 5 bereaved surrogates and 10 critical care and mental health clinicians. Stakeholders were provided with the manual and prompted for feedback on its content, format, and language. Feedback was organized and incorporated into the manual, which was then re-circulated until consensus. In Part 2, surrogates of critically ill patients admitted to an intensive care unit (ICU) reporting moderate anxiety or close attachment were enrolled in an open trial of EMPOWER. Surrogates completed six, 15-20 min modules, totaling 1.5-2 h. Surrogates were administered measures of peritraumatic distress, experiential avoidance, prolonged grief, distress tolerance, anxiety, and depression at pre-intervention, post-intervention, and at 1-month and 3-month follow-up assessments. RESULTS: Part 1 resulted in changes to the EMPOWER manual, including reducing jargon, improving navigability, making EMPOWER applicable for a range of illness scenarios, rearranging the modules, and adding further instructions and psychoeducation. Part 2 findings suggested that EMPOWER is feasible, with 100% of participants completing all modules. The acceptability of EMPOWER appeared strong, with high ratings of effectiveness and helpfulness (M = 8/10). Results showed immediate post-intervention improvements in anxiety (d = -0.41), peritraumatic distress (d = -0.24), and experiential avoidance (d = -0.23). At the 3-month follow-up assessments, surrogates exhibited improvements in prolonged grief symptoms (d = -0.94), depression (d = -0.23), anxiety (d = -0.29), and experiential avoidance (d = -0.30). SIGNIFICANCE OF RESULTS: Preliminary data suggest that EMPOWER is feasible, acceptable, and associated with notable improvements in psychological symptoms among surrogates. Future research should examine EMPOWER with a larger sample in a randomized controlled trial

Efficacy of metacognitive therapy for prolonged grief disorder: protocol for a randomised controlled trial

Introduction: Studies of effective psychotherapy for individuals suffering from the effects of prolonged grief disorder (PGD) are scarce. This paper describes the protocol for an evaluation of a metacognitive therapy programme designed specifically for PGD, to reduce the psychological distress and loss of functioning resulting from bereavement. Methods and analysis: The proposed trial comprises three phases. Phase 1 consists of a review of the literature and semistructured interviews with key members of the target population to inform the development of a metacognitive therapy programme for Prolonged Grief. Phase 2 involves a randomised controlled trial to implement and evaluate the programme. Male and female adults (N=34) will be randomly assigned to either a wait list or an intervention group. Measures of PGD, anxiety, depression, rumination, metacognitions and quality of life will be taken pretreatment and posttreatment and at the 3-month and 6-month follow-up. The generalised linear mixed model will be used to assess treatment efficacy. Phase 3 will test the social validity of the programme. Discussion: This study is the first empirical investigation of the efficacy of a targeted metacognitive treatment programme for PGD. A focus on identifying and changing the metacognitive mechanisms underpinning the development and maintenance of prolonged grief is likely to be beneficial to theory and practice