Baring all: the impact of the hospital gown on patient wellbeing

Objectives The importance of personalized and dignified care is increasingly being recognized in health care policy and practice. Despite the known impact of clothing on social identity and self-expression, the impact of hospital clothing on patient well-being has been widely overlooked. Patients are often required to wear hospital clothing, commonly a backless gown, during medical procedures and surgeries. The impact of wearing patient clothing on well-being, during this time of vulnerability, was explored. Design A sequential multi-method approach consisting of two studies. Methods Two studies were carried out to consider the impact of the hospital gown on well-being among adults with and without chronic health conditions. The first study consisted of conducting in-depth, semi-structured interviews (n = 10) with adults living with a lifelong chronic health condition (congenital heart disease). The second study was a cross-sectional online survey exploring adults' views (n = 928) and experiences of wearing the hospital gown. Results Qualitative analysis identified the following master themes: (1) symbolic embodiment of the ‘sick’ role, (2) relinquishing control to medical professionals, and (3) emotional and physical vulnerability. Quantitative analysis of the online survey data indicated that adults often reported wearing the hospital gown despite a lack of medical necessity. Its design was considered to be not fit for purpose and lacking in dignity. Conclusions The implications of these findings for health policy and practice are discussed, emphasizing the importance of challenging cultural norms in health care since dehumanizing aspects of care, as symbolically represented by the hospital gown, may adversely impact on patient well-being. Statement of contribution What is already known Getting dressed is a form of self-expression, which contributes to the construction of social identity, yet few studies have explored the impact of wearing hospital clothing on patient well-being. The few studies on hospital clothing that exist suggest it is predominantly associated with feeling depersonalized, stigmatized, and devitalized, being in the ‘patient role’, low status, and a lack of control and privacy. However, previous studies include a variety of hospital clothing including pyjamas (Edvardsson, 2009) and dressing gowns (Topo & Iltanen-Tähkävuori, 2010), whereas in the United Kingdom, a 'one-size-fits-all' backless gown, held together with ties at the back, is most commonly used. What this study adds This study furthers understanding about the lived experience of wearing hospital clothing for people living with a chronic health condition (congenital heart disease) and without. Wearing hospital clothing (most commonly the hospital gown) was associated with symbolic embodiment of the ‘sick’ role, relinquishing control to medical professionals, and emotional and physical vulnerability for people living with a chronic health condition. Findings from a wider sample, drawn from the general population, suggest that the hospital gown is often being used despite a lack of medical necessity often leaving patients feeling exposed, self-conscious, vulnerable, uncomfortable, cold, embarrassed, and disempowered. These findings are exacerbated for people living with a long-term health condition and women. Together, these studies suggest that the current design of the hospital gown is not fit for purpose and impacts negatively on patient well-being

Sucrose and Warmth for Analgesia in Healthy Newborns: An RCT

Increasing data suggest that neonatal pain has long-term consequences. Nonpharmacologic techniques (sucrose taste, pacifier suckling, breastfeeding) are effective and now widely used to combat minor neonatal pain. This study examined the analgesic effect of sucrose combined with radiant warmth compared with the taste of sucrose alone during a painful procedure in healthy full-term newborns

Atypical autonomic regulation, auditory processing, and affect recognition in women with HIV

This study examined the effect of HIV on visceromotor (i.e., heart rate and heart rate variability) and somatomotor (i.e., auditory processing and affect recognition) components of a social engagement system defined by the Polyvagal Theory (Porges, 1995) that links vagal regulation of the heart with brainstem regulation of the striated muscles of the face and head. Relative to at risk HIV- seronegative women, HIV-seropositive women had less heart rate variability (i.e., respiratory sinus arrhythmia) and had poorer performance on auditory processing and affect recognition tasks. CD4 was negatively correlated with the accuracy to detect specific emotions. The observed indices of atypical autonomic and behavioral regulation may contribute to greater difficulties in social behavior and social communication between HIV- infected women and other individuals in their social network

Transcutaneous vagus nerve stimulation (t-VNS): A novel effective treatment for temper outbursts in adults with Prader-Willi Syndrome indicated by results from a non-blind study.

Temper outbursts are a severe problem for people with Prader-Willi Syndrome (PWS). Previous reports indicate that vagus nerve stimulation (VNS) may reduce maladaptive behaviour in neurodevelopmental disorders, including PWS. We systematically investigated the effectiveness of transcutaneous VNS (t-VNS) in PWS. Using a non-blind single case repeat measures modified ABA design, with participants as their own controls, t-VNS was evaluated in five individuals with PWS [three males; age 22-41 (M = 26.8)]. After a baseline phase, participants received four-hours of t-VNS daily for 12 months, followed by one month of daily t-VNS for two-hours. The primary outcome measure was the mean number of behavioural outbursts per day. Secondary outcomes included findings from behavioural questionnaires and both qualitative and goal attainment interviews. Four of the five participants who completed the study exhibited a statistically significant reduction in number and severity of temper outbursts after approximately nine months of daily four-hour t-VNS. Subsequent two-hour daily t-VNS was associated with increased outbursts for all participants, two reaching significance. Questionnaire and interview data supported these findings, the latter indicating potential mechanisms of action. No serious safety issues were reported. t-VNS is an effective, novel and safe intervention for chronic temper outbursts in PWS. We propose these changes are mediated through vagal projections and their effects both centrally and on the functioning of the parasympathetic nervous system. These findings challenge our present biopsychosocial understanding of such behaviours suggesting that there is a single major mechanism that is modifiable using t-VNS. This intervention is potentially generalizable across other clinical groups. Future research should address the lack of a sham condition in this study along with the prevalence of high drop out rates, and the potential effects of different stimulation intensities, frequencies and pulse widths

Brainstem enlargement in pre-school children with autism : results from an inter-method agreement study of segmentation algorithms

The inter-method agreement between automated algorithms for brainstem segmentation is investigated, focusing on the potential involvement of this structure in Autism Spectrum Disorders (ASD). Inconsistencies highlighted in previous studies on brainstem in the population with ASD may in part be a result of poor agreement in the extraction of structural features between different methods. A sample of 76 children with ASD and 76 age-, gender- and intelligence-matched controls was considered. Volumetric analyses were performed using common tools for brain structures segmentation, namely FSL-FIRST, FreeSurfer (FS), and Advanced Normalization Tools (ANTs). For shape analysis SPHARM-MAT was employed. Inter-method agreement was quantified in terms of Pearson correlations between pairs of volumes obtained by the different methods. The degree of overlap between segmented masks was quantified in terms of the Dice index. Both Pearson correlations and Dice indices, showed poor agreement between FSL-FIRST and the other methods (ANTs and FS), which by contrast, yielded Pearson correlations greater than 0.93 and average Dice indices greater than 0.76 when compared with each other. As with volume, shape analyses exhibited discrepancies between segmentation methods, with particular differences noted between FSL-FIRST and the others (ANT and FS), with under- and over-segmentation in specific brainstem regions. These data suggest that research on brain structure alterations should cross-validate findings across multiple methods. We reliably detected an enlargement of brainstem volume in the whole sample and in the male cohort across multiple segmentation methods, a feature particularly driven by the subgroup of children with idiopathic intellectual disability associated with ASD

When Too Much Is Not Enough: Obsessive-Compulsive Disorder as a Pathology of Stopping, Rather than Starting

Background: In obsessive-compulsive disorder (OCD), individuals feel compelled to repeatedly perform security-related behaviors, even though these behaviours seem excessive and unwarranted to them. The present research investigated two alternative ways of explaining such behavior: (1) a dysfunction of activation—a starting problem—in which the level of excitation in response to stimuli suggesting potential danger is abnormally strong; versus (2) a dysfunction of termination— a stopping problem—in which the satiety-like process for shutting down security-related thoughts and actions is abnormally weak. Method: In two experiments, 70 patients with OCD (57 with washing compulsions, 13 with checking compulsions) and 72 controls were exposed to contamination cues—immersing a hand in wet diapers —and later allowed to wash their hands, first limited to 30 s and then for as long as desired. The intensity of activation of security motivation was measured objectively by change in respiratory sinus arrythmia. Subjective ratings (e.g., contamination) and behavioral measures (e.g., duration of hand washing) were also collected. Results: Compared to controls, OCD patients with washing compulsions did not differ significantly in their levels of initial activation to the threat of contamination; however, they were significantly less able to reduce this activation by engaging in the corrective behavior of hand-washing. Further, the deactivating effect of hand-washing in OCD patients with checkin

HIV and HPV infections and ocular surface squamous neoplasia: systematic review and meta-analysis.

BACKGROUND: The frequency of ocular surface squamous neoplasias (OSSNs) has been increasing in populations with a high prevalence of infection with human immunodeficiency virus/acquired immunodeficiency syndrome (HIV/AIDS) and infection with human papillomavirus (HPV). We aimed to quantify the association between HIV/AIDS and HPV infection and OSSN, through systematic review and meta-analysis. METHODS: The articles providing data on the association between HIV/AIDS and/or HPV infection and OSSN were identified in MEDLINE, SCOPUS and EMBASE searched up to May 2013, and through backward citation tracking. The DerSimonian and Laird method was used to compute summary relative risk (RR) estimates and 95% confidence intervals (95% CI). Heterogeneity was quantified with the I(2) statistic. RESULTS: HIV/AIDS was strongly associated with an increased risk of OSSN (summary RR=8.06, 95% CI: 5.29-12.30, I(2)=56.0%, 12 studies). The summary RR estimate for the infection with mucosal HPV subtypes was 3.13 (95% CI: 1.72-5.71, I(2)=45.6%, 16 studies). Four studies addressed the association between both cutaneous and mucosal HPV subtypes and OSSN; the summary RR estimates were 3.52 (95% CI: 1.23-10.08, I(2)=21.8%) and 1.08 (95% CI: 0.57-2.05, I(2)=0.0%), respectively. CONCLUSION: Human immunodeficiency virus infection increases the risk of OSSN by nearly eight-fold. Regarding HPV infection, only the cutaneous subtypes seem to be a risk factor

Autoimmune inflammatory disorders, systemic corticosteroids and pneumocystis pneumonia: A strategy for prevention

BACKGROUND: Pneumocystis pneumonia (PCP) is an increasing problem amongst patients on immunosuppression with autoimmune inflammatory disorders (AID). The disease presents acutely and its diagnosis requires bronchoalveolar lavage in most cases. Despite treatment with intravenous antibiotics, PCP carries a worse prognosis in AID patients than HIV positive patients. The overall incidence of PCP in patients with AID remains low, although patients with Wegener's granulomatosis are at particular risk. DISCUSSION: In adults with AID, the risk of PCP is related to treatment with systemic steroid, ill-defined individual variation in steroid sensitivity and CD4+ lymphocyte count. Rather than opting for PCP prophylaxis on the basis of disease or treatment with cyclophosphamide, we argue the case for carrying out CD4+ lymphocyte counts on selected patients as a means of identifying individuals who are most likely to benefit from PCP prophylaxis. SUMMARY: Corticosteroids, lymphopenia and a low CD4+ count in particular, have been identified as risk factors for the development of PCP in adults with AID. Trimethoprim-sulfamethoxazole (co-trimoxazole) is an effective prophylactic agent, but indications for its use remain ill-defined. Further prospective trials are required to validate our proposed prevention strategy

Attachment Theory: Developments, Debates and Recent Applications in Social Work, Social Care and Education

This is an Accepted Manuscript of an article published by Taylor & Francis in Journal of Social Work Practice on 16/12/2019, available online: http://www.tandfonline.com/10.1080/02650533.2019.1700493.Attachment theory may be considered controversial given that some of its foundational principles are contested. Not only this, it is currently being developed by insights from neuroscience, another perspective that academics have subjected to critique. Nevertheless, at the beginning of the twenty-first century in England and the United Kingdom in general, there has been a renewed interest in its explanation of child development, as well as its application in schools, social care settings and the practice of professionals such as social workers and teachers. This paper outlines the core principles of attachment theory, acknowledges some of the criticisms, then traces the ways in which the theory has been developed over time. The theory is then illustrated with a description of the ways in which it is being applied in the training of foster carers, the provision of support to adoptive parents and in the school environment