Voorlichting aan hartchirurgische patiënten : een gerandomizeerd gecontroleerd interventie-onderzoek

This dissertation describes an experimental study into information provision for patients undergoing cardiac surgery. In the general introduction the reason for undertaking the study is described. From 1980 until the end of 1987 a preoperative educational programme had been offered to patients awaiting coronary artery bypass surgery at the University Hospital in Rotterdam. The underlying assumption was that information provision would reduce anxiety and facilitate postoperative recovery, the more so since it was assumedDe opbouw van het proefschrift is als volgt. Gezien de vooronderstelling die aan het aanbieden van het voorlichtingsprogramma ten grondslag lag, leek het zinvol om in de literatuur na te gaan wat onder de begrippen patientenvoorlichting, angst en (postoperatief) herstel verstaan wordt. Hiervan wordt respectievelijk in hoofdstuk 1, 2 en 3, verslag gedaan. Hoofdstuk 4 geeft een overzicht van de literatuur (tot media 1986) met betrekking tot eerder verrichte onderzoeken naar de effectiviteit van psychologische voorbereidingsinterventies op ingrijpende medische procedures. De oorspronkelijke versie van dit hoofdstuk is reeds eerder in artikelvorm gepubliceerd. Het voordee1 van dit hoofdstuk is dat het als een afgerond geheel gelezen kan worden; het heeft echter als nadeel dat enkele herhalingen voorkomen. In de volgende hoofdstukken wordt het eigen onderzoek beschreven. De methode van onderzoek wordt in hoofdstuk 5 beschreven. In hoofdstuk 6 worden kenmerken van de steekproefpatienten gepresenteerd. De resultaten van de effectmetingen ten aanzien van het voorlichtingsprogramma komen in hoofdstuk 7 aan de orde. In de discussie, hoofdstuk 8, wordt ingegaan op de betekenis van de resultaten van het onderzoek. Tevens komen complicerende factoren aan bod die de resultaten beinvloed kunnen hebben. Verder worden enkele aanbevelingen voor toekomstig onderzoek gedaan

Termination of pregnancy for fetal anomalies: Parents' preferences for psychosocial care

Objective: To investigate, from the perspective of women and partners, at what stage of a termination of pregnancy (TOP) for fetal anomalies psychosocial care (PSC) is most meaningful, what topics should be discussed, and who should provide PSC. Method: A cross‐sectional retrospective cohort study was conducted with a consecutive series of 76 women and 36 partners, who completed a semi‐structured online questionnaire. Results: Overall, women expressed a greater need for PSC than their partners. Parents expressed a preference for receiving support from a maternal‐fetal medicine specialist to help them understand the severity and consequences of the anomalies found and to counsel them in their decision regarding termination. Parents showed a preference for support from mental healthcare providers to help with their emotional responses. Forty‐one percent of the women visited a psychosocial professional outside of the hospital after the TOP, indicating a clear need for a well‐organised aftercare. Conclusion: Different disciplines should work together in a complementary way during the diagnosis, decision making, TOP, and aftercare stages. Parents' need for PSC should be discussed at the beginning of the process. During aftercare, attention should be paid to grief counselling, acknowledgement of the lost baby's existence, and possible future pregnancies

Cardiac status and health-related quality of life in the long term after surgical repair of tetralogy of Fallot in infancy and childhood

The long-term results of surgical repair of tetralogy of Fallot were assessed by means of extensive cardiologic examination of 77 nonselected patients 14.7 +/- 2.9 years after surgical repair of tetralogy of Fallot in infancy and childhood. Because of the frequent use of a transannular patch (56%) for the relief of right ventricular outflow tract obstruction, the prevalence of elevated right ventricular systolic pressure was low (8%), but the prevalence of substantial right ventricular dilation with severe pulmonary regurgitation was high (58%). The exercise capacity of patients with a substantially dilated right ventricle proved to be significantly decreased (83% +/- 19% of predicted) when compared with that of patients with a near normal sized right ventricle (96% +/- 13%). Eight out of 10 patients who had needed treatment for symptomatic arrhythmia had supraventricular arrhythmia, which makes supraventricular arrhythmia--in numbers--a more important sequela in the long-term survivors than ventricular arrhythmia. Older age at the time of the operation and longer duration of follow-up were not associated with an increase in prevalence or clinical significance of sequela

Cardiac arrest in infants, children, and adolescents: long-term emotional and behavioral functioning

Very little is known about the psychological consequences of a cardiac arrest (CA) during childhood. Our aim was to assess long-term emotional and behavioral functioning, and its predictors, in survivors of CA in childhood. This long-term follow-up study involved all consecutive infants, children, and adolescents surviving CA in a tertiary-care university children’s hospital between January 2002 and December 2011. Emotional and behavioral functioning was assessed with the Child Behavior Checklist (CBCL), Teacher’s Report Form (TRF), and Youth Self-Report (YSR). Of the eligible 107 CA survivors, 52 patients, parents, and/or teachers filled out online questionnaires. Compared with normative data, parents and teachers reported significantly more attention and somatic problems (age range 6–18 years). Parents also reported more attention problems for age range 1.5–5 years. Twenty-eight percent of the children (n = 14) scored in the psychopathological range (i.e., for age range 1.5–18 years; p < 0.001) according to parent reports. Male gender, older age, and basic life support were significantly related to worse scores on the scales internalizing problems, externalizing problems, and total problems and subscale attention problems. Conclusion: Long-term deficits in attention and somatic complaints were reported. Attention problems after childhood CA can interfere with school performance. Long-term follow-up with neuropsychological assessment should be organized.(Table presented.

Long-term neuropsychological outcomes in children and adolescents after cardiac arrest

Purpose: Research into neuropsychological functioning of survivors of cardiac arrest (CA) in childhood is scarce. We sought to a

Threat-Related Selective Attention Predicts Treatment Success in Childhood Anxiety Disorders

Abstract OBJECTIVE: The present study examined whether threat-related selective attention was predictive of treatment success in children with anxiety disorders and whether age moderated this association. Specific components of selective attention were examined in treatment responders and nonresponders. METHOD: Participants consisted of 131 children with anxiety disorders (aged 8-16 years), who received standardized cognitive-behavioral therapy. At pretreatment, a pictorial dot-probe task was administered to assess selective attention. Both at pretreatment and posttreatment, diagnostic status of the children was evaluated with a semistructured clinical interview (the Anxiety Disorders Interview Schedule for Children). RESULTS: Selective attention for severely threatening pictures at pretreatment assessment was predictive of treatment success. Examination of the specific components of selective attention revealed that nonresponders showed difficulties to disengage their attention away from severe threat. Treatment responders showed a tendency not to engage their attention toward severe threat. Age was not associated with selective attention and treatment success. CONCLUSIONS: Threat-related selective attention is a significant predictor of treatment success in children with anxiety disorders. Clinically anxious children with difficulties disengaging their attention away from severe threat profit less from cognitive-behavioral therapy. For these children, additional training focused on learning to disengage attention away from anxiety-arousing stimuli may be beneficial

Cognitive Behavioural Therapy for Anxiety Disorders in Young Children: A Dutch Open Trial of the Fun FRIENDS Program

Anxiety disorders in young children are highly prevalent and increase the risk of social, school, and familial problems, and also of psychiatric disorders in adolescence and adulthood. Nevertheless, effective interventions for this age group are lacking. One of the few available interventions is the Fun FRIENDS program. We examined whether young children with anxiety disorders showed less anxiety after participating in Fun FRIENDS. Twenty-eight clinically anxious children (4–8 years old) participated in the cognitive behavioural Fun FRIENDS program. The program consists of 12 weekly 1.5-hour sessions and was provided in groups of 3 to 5 children. At preintervention and direct postintervention, parents completed the Anxiety Disorders Interview Schedule for Children and Child Behavior Checklist. Clinically and statistically significant decreases were found in number of anxiety disorders, symptom interference, emotional and behavioural problems, internalising problems, and anxiety problems. The decrease in anxious/ depressed problems and externalising problems was not significant. Furthermore, higher preintervention anxiety levels predicted more treatment progress, whereas sex and age did not. The Dutc

Netherton syndrome; neuropsychological and psychosocial functioning of child and adult patients and their parents

Background: Netherton syndrome is a rare severe skin disease. Clinical experience showed considerable psychosocial burdens among Netherton syndrome patients/families. Their (neuro)psychological functioning has never been investigated. Objective: To investigate neuropsychological/psychosocial functioning of Netherton syndrome patients and parents. Methods: A total of 12 Netherton syndrome patients and/or parents completed neuropsychological tests, semi-structured-interviews, and psychological-questionnaires. Results: Intelligence results showed disharmonic profiles, with below-average scores on processing speed. Neuropsychological problems and unfavorable outcomes on health-related quality of life, illness-appearance-related problems, and negative social consequences among patients/parents were found. Psychopathological (emotional) problems were reported; stigmatization, bullying was common among Netherton syndrome patients. Conclusion: Compared with normative data, Netherton syndrome patients showed neuropsychological and psychosocial problems. Standard follow-up is necessary to identify problems at early stage