Perceptions of Malingering or Factitious Disorder by Army Behavioral health Providers

Thesis (Master's)--University of Washington, 2016-06Abstract Introduction: The topic of malingering or factitious disorder in the military population generates strong opposing viewpoints within the military medical community. As a result, the estimated frequency of malingering in this population ranges widely from “rare” to a “majority of claimants seeking disability compensation.” Even though we do not know the specific rate of malingering in the United States Military, there is evidence that malingering is significantly underdiagnosed in this population. The reason for this potential under-diagnosis is unknown. Objective: This study explored this topic by examining the perceptions of military behavior health providers on malingering within the military healthcare community. Greater understanding potential factors contributing to the thoughts and diagnosis of malingering can potentially prevent provider burnout, identify potential need for additional training, and provide improved medical care to service members diagnosed with malingering or factitious disorder. Methods: We surveyed all military health providers who see Active Duty Soldiers. From December 2015 to Jan 2016 emails were sent to the each installation behavioral health representative who forwarded a link of the survey to all individual behavioral health providers at their installation. These surveys collected demographics including the type of behavioral health professional, active duty status, training level, location, type of practice, and history of deployment. They also included the ProQOL burnout scale and measured the perceptions of malingering and factitious disorder. Results: 502 subjects responded with a response rate of 42%. On average each behavioral health provider estimates seeing 8.34 cases of malingering or factitious disorder each year but diagnoses only 0.68 cases. Additional analysis reveals that each provider provider does not diagnose 7.698 cases of conditions involving intentional patient deceptionin the last year (95% CI 6.32-9.08, p-value <0.001). Multivariate analysis shows that factors associated with increased diagnosis of malingering/factitious disorder include inpatient setting (β 4.411, 95% CI 0.019-8.802), p-value 0.049), and increased burnout scores on the ProQOL instrument (β 0.406, 0.203-0.610, p-value <0.001). No differences were seen between different types of behavioral health professional, active duty status, deployment history, training level, location, or type of practice (other than inpatient). Lack of evidence/difficulty proving, policy and pressure from above, being unsure of the diagnosis, and fears of a negative impact on the provider made up 2/3 of the qualitative open-ended responses that explain the diagnostic gap but only the perception of policy and pressure from above (β 8.659, 95% CI (4.77-12.55), p-value <0.001) and politics (β 8.975, 95% CI (2.54-15.41), p-value 0.006) were significantly associated with this outcome. Conclusions: Our findings support the current literature that the diagnosis of malingering and factitious disorder is minimized by Army behavioral health providers. This study estimates that up to 14,500 Soldiers are not accurately diagnosed with malingering or factitious disorder every year in the Army medical system.. Inpatient setting and increased burnout are all associated with greater rates of perception and diagnosis. Perceptions of politics and policy/pressure from above were factors that were significantly associated with a diagnostic gap. As this is the first study that has examined this finding in the United States Military, we strongly suggest additional studies to examine the effect that this diagnostic gap can have on the system, on other patients, the iatrogenic impact on the Soldiers themselves, and overall military readiness

Att leva med långvarig smärta : Patienters upplevelser och hantering av sin situation

Det är 40-65 procent av den svenska befolkningen som lever med långvarig smärta, vilket är ett folkhälsoproblem. Smärta är förknippat med både psykologiska och emotionella reaktioner. Målet med smärtlindring är att minska patientens lidande. Det är då viktigt att sjuksköterskan inte underskattar patientens upplevelser. Långvarig smärta ger en fysisk, psykisk och social påfrestning vilket gör att det kan vara svårt för patienten att förklara sin smärta. Syftet med denna litteraturstudie är att undersöka vad patienter med långvarig smärta har för upplevelser av mötet med vården och vad patienterna har för strategier för att hantera den långvariga smärtan. Studien är en litteraturstudie som behandlar ämnet långvarig smärta. Resultatet är indelat i två huvudteman: Vårdarnas absoluta betydelse och Egen anpassning. Under dessa teman tas det bland annat upp förståelse och kunskap, känslan av övergivenhet och misstro, acceptans, planering och prioritering, praktiska metoder och identifikation. Vårdarna har en stor betydelse för patienten och det är viktigt med ett gott bemötande i mötet med patienten för att inte orsaka ett vårdlidande eller förvärra situationen. Det är också viktigt att sjukvårdspersonalen inte är passiva utan visar ett engagemang i vårdandet av patienten, och tar hänsyn till dennes önskemål och livsförhållanden. Det finns en brist på kunskap hos sjukvårdspersonalen om att lindra patientens långvariga smärta utöver farmakologisk behandling.Program: Sjuksköterskeutbildnin

Att leva med långvarig smärta : Patienters upplevelser och hantering av sin situation

Det är 40-65 procent av den svenska befolkningen som lever med långvarig smärta, vilket är ett folkhälsoproblem. Smärta är förknippat med både psykologiska och emotionella reaktioner. Målet med smärtlindring är att minska patientens lidande. Det är då viktigt att sjuksköterskan inte underskattar patientens upplevelser. Långvarig smärta ger en fysisk, psykisk och social påfrestning vilket gör att det kan vara svårt för patienten att förklara sin smärta. Syftet med denna litteraturstudie är att undersöka vad patienter med långvarig smärta har för upplevelser av mötet med vården och vad patienterna har för strategier för att hantera den långvariga smärtan. Studien är en litteraturstudie som behandlar ämnet långvarig smärta. Resultatet är indelat i två huvudteman: Vårdarnas absoluta betydelse och Egen anpassning. Under dessa teman tas det bland annat upp förståelse och kunskap, känslan av övergivenhet och misstro, acceptans, planering och prioritering, praktiska metoder och identifikation. Vårdarna har en stor betydelse för patienten och det är viktigt med ett gott bemötande i mötet med patienten för att inte orsaka ett vårdlidande eller förvärra situationen. Det är också viktigt att sjukvårdspersonalen inte är passiva utan visar ett engagemang i vårdandet av patienten, och tar hänsyn till dennes önskemål och livsförhållanden. Det finns en brist på kunskap hos sjukvårdspersonalen om att lindra patientens långvariga smärta utöver farmakologisk behandling.Program: Sjuksköterskeutbildnin

Struktur und Dynamik von Lipidmembranen

Peer Reviewe

Utilization of Assistive Devices among Individuals with Low Vision

Purpose: The mixed method pilot study was conducted to identify visual aids most commonly used, their level of accessibility, the education received on device, and which devices are most and least effective by individuals with low vision. Method: Subjects were verbally administered an 80-item survey and the results were analyzed using descriptive statistics. Results: Low accessibility to obtain assistive devices was reported due to financial limitations and lack of awareness of devices at time of low vision diagnosis. Findings show among listed assistive devices, magnifiers were considered the most and least effective forms of assistive devices. Conclusion: The results of this study infer that the population of individuals diagnosed with low vision are not provided adequate education or resources to obtain beneficial assistive devices, effecting their quality of life and executions of occupations

Measuring the level of agreement between a veterinary and a human point-of-care glucometer and a laboratory blood analyzer in Hispaniolan Amazon parrots (Amazona ventralis)

Although abnormalities in blood glucose concentrations in avian species are not as common as they are in mammals, the inability to provide point-of-care glucose measurement likely results in underreporting and missed treatment opportunities. A veterinary glucometer that uses different optimization codes for specific groups of animals has been produced. To obtain data for a psittacine bird-specific optimization code, as well as to calculate agreement between the veterinary glucometer, a standard human glucometer, and a laboratory analyzer, blood samples were obtained from 25 Hispaniolan Amazon parrots (Amazona ventralis) in a 2-phase study. In the initial phase, blood samples were obtained from 20 parrots twice at a 2-week interval. For each sample, the packed cell volume was determined, and the blood glucose concentration was measured by the veterinary glucometer. The rest of each sample was placed into a lithium heparin microtainer tube and centrifuged, and plasma was removed and frozen at -30 degrees C. Within 5 days, tubes were thawed, and blood glucose concentrations were measured with a laboratory analyzer. The data from both procedures were used to develop a psittacine bird-specific code. For the second phase of the study, the same procedure was repeated twice at a 2-week interval in 25 birds to determine agreement between the veterinary glucometer, a standard human glucometer, and a laboratory analyzer. Neither glucometer was in good agreement with the laboratory analyzer (veterinary glucometer bias, 9.0; level of agreement, -38.1 to 56.2; standard glucometer bias, 69.4; level of agreement -17.8 to 156.7). Based on these results, the use of handheld glucometers in the diagnostic testing of Hispaniolan Amazon parrots and other psittacine birds cannot be recommended

Measuring the Level of Agreement Between a Veterinary and a Human Point-of-Care Glucometer and a Laboratory Blood Analyzer in Hispaniolan Amazon Parrots ( Amazona ventralis

Although abnormalities in blood glucose concentrations in avian species are not as common as they are in mammals, the inability to provide point-of-care glucose measurement likely results in underreporting and missed treatment opportunities. A veterinary glucometer that uses different optimization codes for specific groups of animals has been produced. To obtain data for a psittacine bird-specific optimization code, as well as to calculate agreement between the veterinary glucometer, a standard human glucometer, and a laboratory analyzer, blood samples were obtained from 25 Hispaniolan Amazon parrots (Amazona ventralis) in a 2-phase study. In the initial phase, blood samples were obtained from 20 parrots twice at a 2-week interval. For each sample, the packed cell volume was determined, and the blood glucose concentration was measured by the veterinary glucometer. The rest of each sample was placed into a lithium heparin microtainer tube and centrifuged, and plasma was removed and frozen at -30 degrees C. Within 5 days, tubes were thawed, and blood glucose concentrations were measured with a laboratory analyzer. The data from both procedures were used to develop a psittacine bird-specific code. For the second phase of the study, the same procedure was repeated twice at a 2-week interval in 25 birds to determine agreement between the veterinary glucometer, a standard human glucometer, and a laboratory analyzer. Neither glucometer was in good agreement with the laboratory analyzer (veterinary glucometer bias, 9.0; level of agreement, -38.1 to 56.2; standard glucometer bias, 69.4; level of agreement -17.8 to 156.7). Based on these results, the use of handheld glucometers in the diagnostic testing of Hispaniolan Amazon parrots and other psittacine birds cannot be recommended