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Cohen LL, Lemanek K, Blount RL, Dahlquist LM, Lim CS, Palermo TM, McKenna KD, Weiss KE. Evidence-based assessment of pediatric pain. J Pediatr Psychol 2007; 33:939-55; discussion 956-7. [PMID: 18024983 DOI: 10.1093/jpepsy/jsm103] [Citation(s) in RCA: 209] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023] Open
Abstract
OBJECTIVE To conduct an evidence-based review of pediatric pain measures. METHODS Seventeen measures were examined, spanning pain intensity self-report, questionnaires and diaries, and behavioral observations. Measures were classified as "Well-established," "Approaching well-established," or "Promising" according to established criteria. Information was highlighted to help professionals evaluate the instruments for particular purposes (e.g., research, clinical work). RESULTS Eleven measures met criteria for "Well-established," six "Approaching well-established," and zero were classified as "Promising." CONCLUSIONS There are a number of strong measures for assessing children's pain, which allows professionals options to meet their particular needs. Future directions in pain assessment are identified, such as highlighting culture and the impact of pain on functioning. This review examines the research and characteristics of some of the commonly used pain tools in hopes that the reader will be able to use this evidence-based approach and the information in future selection of assessment devices for pediatric pain.
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Forys KL, Dahlquist LM. The influence of preferred coping style and cognitive strategy on laboratory-induced pain. Health Psychol 2007; 26:22-9. [PMID: 17209694 DOI: 10.1037/0278-6133.26.1.22] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
OBJECTIVE To evaluate the effects of matching an individual's coping style (low, mixed, or high monitoring) to an appropriate cognitive strategy (distraction or sensation monitoring) to improve pain management. DESIGN This study used a split-plot factorial design in a laboratory setting. MAIN OUTCOME MEASURES Main outcomes were pain threshold, pain tolerance, pain intensity, pain affect, and anxiety. RESULTS The results of the 2 x 3 x 3 (Experimental Condition x Coping Style x Trial) analysis of variance (ANOVA) interaction were significant for pain threshold scores, F(4, 178) = 2.95, p < .01. Low monitors in the matched distraction trial had higher pain threshold scores than during baseline, t(15) = -2.68, p = .017, and the mismatched sensation monitoring trial, t(15) = 2.80, p = .014. High monitors' pain threshold scores were higher than baseline only during the matched sensation monitoring trial, t(27) = -2.75, p = .010. The results of the 2 x 3 x 3 ANOVA interaction were not significant for pain tolerance scores; however, when the mixed monitors were excluded, the 3-way interaction was significant, F(2, 124) = 3.48, p < .05. The results were nonsignificant for pain intensity, pain affect, and anxiety. CONCLUSION Results demonstrate that matching coping style to the appropriate cognitive strategy is important for improving pain threshold and pain tolerance; however, matching did not reduce pain intensity, pain affect, or anxiety. Future studies should explore the explanation for differential responses of high and low monitors and should test these hypotheses in a clinical setting.
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Bollinger ME, Dahlquist LM, Mudd K, Sonntag C, Dillinger L, McKenna K. The impact of food allergy on the daily activities of children and their families. Ann Allergy Asthma Immunol 2006; 96:415-21. [PMID: 16597075 DOI: 10.1016/s1081-1206(10)60908-8] [Citation(s) in RCA: 239] [Impact Index Per Article: 13.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
BACKGROUND Food allergy affects a significant number of children, and its management requires considerable time and vigilance. OBJECTIVE To determine the impact of food allergy on the daily activities of food allergic children and their families. METHODS Caregivers of food allergic children from a university-based allergy practice completed a questionnaire that evaluated their perception of the impact of their child's food allergy on family activities. RESULTS Of the 87 families who completed the study, more than 60% of caregivers reported that food allergy significantly affected meal preparation and 49% or more indicated that food allergy affected family social activities. Forty-one percent of parents reported a significant impact on their stress levels and 34% reported that food allergy had an impact on school attendance, with 10% choosing to home school their children because of food allergy. The number of food allergies had a significant impact on activity scores, but the existence of comorbid conditions such as asthma and atopic dermatitis did not significantly affect the results. CONCLUSIONS Food allergy has a significant effect on activities of families of food allergic children. Further study is needed to determine more detailed effects of food allergy on parent-child interactions and development.
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Dahlquist LM, Pendley JS. When Distraction Fails: Parental Anxiety and Children’s Responses to Distraction during Cancer Procedures. J Pediatr Psychol 2005; 30:623-8. [PMID: 16166250 DOI: 10.1093/jpepsy/jsi048] [Citation(s) in RCA: 40] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
OBJECTIVE To examine parental anxiety in the context of successful and unsuccessful distraction treatment of preschool aged children undergoing chemotherapy procedures. METHODS Twenty-nine children (M age = 42 months) experiencing intramuscular or portacatheter injections participated in the study. Parents and children were shown how to use a portable electronic toy as a distractor during chemotherapy injections. Parental anxiety was assessed at baseline and child distress was coded during each procedure. RESULTS Parents' baseline state anxiety accounted for 17% of the variance in changes in children's distress following distraction intervention. Parents of children who did not benefit from distraction reported significantly higher state anxiety at baseline than parents of the other participants. CONCLUSIONS Results highlight the importance of examining individual outcomes in intervention studies and suggest that parents' emotional states may moderate distraction treatment outcome in young children. Future research formally testing parent anxiety as a moderator is recommended.
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Gelfand KM, Dahlquist LM. An Examination of the Relation Between Child Distress and Mother and Nurse Verbal Responses During Pediatric Oncology Procedures. CHILDRENS HEALTH CARE 2003. [DOI: 10.1207/s15326888chc3204_2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
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Pringle B, Dahlquist LM, Eskenazi A. Memory in pediatric patients undergoing conscious sedation for aversive medical procedures. Health Psychol 2003; 22:263-9. [PMID: 12790253 DOI: 10.1037/0278-6133.22.3.263] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
This study investigated preserved memory in 26 pediatric cancer patients (65% boys, 77% Caucasian, mean age = 12.5 years) undergoing midazolam-induced conscious sedation during painful medical procedures to treat hematological or oncological diseases. The sedative midazolam had a significant anterograde amnesic effect on participants' performance on a visual recognition (explicit) memory task but not on a visual perceptual facilitation (implicit) memory task. That implicit memory scores were relatively unaffected while explicit memory scores deteriorated significantly indicates that leaning occurred while participants were sedated, even when participants did not recollect the learning event. These findings, which replicate those of M. R. Polster, R. A. McCarthy, G. O'Sullivan, P. A. Gray, and G. R. Park (1993) in a study of adults, have implications for the development and treatment of conditioned anxiety reactions associated with aversive medical procedures.
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Power TG, Dahlquist LM, Thompson SM, Warren R. Interactions between children with juvenile rheumatoid arthritis and their mothers. J Pediatr Psychol 2003; 28:213-21. [PMID: 12654947 DOI: 10.1093/jpepsy/jsg009] [Citation(s) in RCA: 38] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVE To determine the degree to which mothers of children with juvenile rheumatoid arthritis (JRA) show an overprotective or highly controlling interaction style. METHOD We videotaped 84 mother-child pairs (42 JRA and 42 healthy, ages 6 to 13) while working on a collaborative problem-solving task. Based on physical therapy evaluations, children in the JRA group were assigned to "more severe" (n = 19) and "milder" (n = 22) arthritis subgroups. RESULTS Results showed numerous differences between mothers of children with more severe arthritis and the other mothers (no differences between the milder arthritis and healthy comparison groups were found). Compared to mothers in the other two groups, mothers of children with more severe arthritis were more directive of their children's behavior during the task, showing higher rates of structure and rule setting, general clues, and prompting the child for an answer. DISCUSSION Sequential analyses showed that mothers in the more severe group appeared to treat the task in a more evaluative manner, being more likely than other mothers to respond to correct answers with positive feedback and to incorrect answers with structure and rule setting. Mothers in the other groups were more likely to respond to both correct and incorrect answers with specific clues. CONCLUSIONS We discuss how these differences in interactional style might impact the social development of children with JRA.
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Dahlquist LM. Commentary: Are children with JRA and their families at risk or resilient? J Pediatr Psychol 2003; 28:45-6. [PMID: 12490630 DOI: 10.1093/jpepsy/28.1.45] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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Switkin MC, Gelfand KM, Amari A, Dahlquist LM, Slifer K, Eskenazi AE. The Impact of Types of Distractors on Child-Critical Statements by a Caregiver During Chemotherapy Injections: A Case Study. CHILDRENS HEALTH CARE 2002. [DOI: 10.1207/s15326888chc3104_4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
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Dahlquist LM, Pendley JS, Landthrip DS, Jones CL, Steuber CP. Distraction intervention for preschoolers undergoing intramuscular injections and subcutaneous port access. Health Psychol 2002; 21:94-9. [PMID: 11846350] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/23/2023]
Abstract
This study evaluated a distraction intervention designed to reduce the distress of preschool children undergoing repeated chemotherapy injections. Twenty-nine children aged 2-5 years were randomly assigned either to distraction by a developmentally appropriate electronic toy or to a wait-list control. Children who received the distraction intervention demonstrated lower overt behavioral distress and were rated by parents and nurses as less anxious than children in the control condition. The improvements were maintained over the 8-week intervention. The results suggest that a developmentally appropriate, multisensory, variable-distracting activity that requires active cognitive processing and active motor responses may be a viable cost-effective alternative to more time-intensive parent-training programs for preschool-age children.
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Dahlquist LM, Busby SM, Slifer KJ, Tucker CL, Eischen S, Hilley L, Sulc W. Distraction for children of different ages who undergo repeated needle sticks. J Pediatr Oncol Nurs 2002; 19:22-34. [PMID: 11813138 DOI: 10.1053/jpon.2002.30009] [Citation(s) in RCA: 55] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Abstract
A distraction intervention for pain management and behavioral distress was implemented for six children with chronic illnesses and their parents as the children underwent repeated needle sticks. The children ranged in age from two to eight years. Several different cognitive distractors were used for the children based on their respective developmental levels. The needle stick procedures during which treatment was implemented included intramuscular injections, implanted port accesses, and intravenous placements. Nine sessions of distraction were provided in which a therapist taught parents to coach their children to use distraction techniques. Dependent measures included the child's behavioral distress and heart rate, parent ratings of the child's fear before the procedure, parent self-ratings of feeling upset during the procedure, and nurse ratings of the child's cooperation. Reductions in child behavioral distress during the distraction treatment program were observed in five out of the six cases. Concomitant improvements in parental reports of child distress, nurse estimates of child cooperation, and parents' self-report of feeling upset during the medical procedures also were found. Follow-up data were available for one of the successfully treated children. His improvements were maintained for both intramuscular injections and portacatheter accesses over 16 weeks without therapist involvement.
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Dahlquist LM, Pendley JS, Landtrip DS, Jones CL, Steuber CP. Distraction intervention for preschoolers undergoing intramuscular injections and subcutaneous port access. Health Psychol 2002. [DOI: 10.1037/0278-6133.21.1.94] [Citation(s) in RCA: 59] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Tucker CL, Slifer KJ, Dahlquist LM. Reliability and validity of the brief behavioral distress scale: a measure of children's distress during invasive medical procedures. J Pediatr Psychol 2001; 26:513-23. [PMID: 11700336 DOI: 10.1093/jpepsy/26.8.513] [Citation(s) in RCA: 35] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
OBJECTIVE To evaluate the reliability and validity of a new observational measure of children's procedure-related distress behaviors, the Brief Behavioral Distress Scale (BBDS), to provide clinicians with an efficient, economical alternative measure that does not depend on continuous interval coding. METHODS Forty-eight randomly selected videotaped invasive medical procedures performed on children (ages 2 to 10 years) with chronic illness were coded with the BBDS and the Observation Scale of Behavioral Distress (OSBD). Reliability and validity analyses along with item analysis were conducted. RESULTS Total distress scores of the BBDS were highly correlated with six of seven concurrent validity measures from multiple sources (i.e., OSBD, parent ratings, two nurse ratings, child self-report, and a physiological arousal measure, heart rate) (range r =.57-.76, p <.001-.0001). A robust association was found between the BBDS distress scores and OSBD total distress scores (r =.72, p <.0001). For two concurrent validity measures, the BBDS demonstrated stronger associations than did the OSBD. Interrater reliability was high for each BBDS distress behavior category. CONCLUSIONS Based on the findings reported, the BBDS is a reliable and valid measure of children's procedure-related distress with functional utility in both research and clinical settings.
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Pringle B, Hilley L, Gelfand K, Dahlquist LM, Switkin M, Diver T, Sulc W, Eskenazi A. J Clin Psychol Med Settings 2001; 8:119-130. [DOI: 10.1023/a:1009560011513] [Citation(s) in RCA: 21] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
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Dahlquist LM. Commentary on "Treatments that work in pediatric psychology: Procedure-related pain". J Pediatr Psychol 1999; 24:153-4. [PMID: 10361395 DOI: 10.1093/jpepsy/24.2.153] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Pendley JS, Dahlquist LM, Dreyer Z. Body image and psychosocial adjustment in adolescent cancer survivors. J Pediatr Psychol 1997; 22:29-43. [PMID: 9019046 DOI: 10.1093/jpepsy/22.1.29] [Citation(s) in RCA: 138] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023] Open
Abstract
Examined body image and social adjustment in 21 adolescents who had completed cancer treatment and a healthy comparison group. Subjects completed questionnaires assessing body image and social adjustment and were videotaped during an interview. Raters blind to health status independently rated subjects' attractiveness. Cancer survivors reported less than half as many social activities as the healthy controls. No group differences were found on social anxiety, loneliness, or composite body image scores. However, within the cancer group, adolescents who had been off treatment longer reported lower self-worth, more social anxiety, and more negative body image perceptions, but were not rated as less attractive by observers. Findings suggest body image concerns and social anxiety may not develop until several years after treatment termination.
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Dahlquist LM, Czyzewski DI, Jones CL. Parents of children with cancer: a longitudinal study of emotional distress, coping style, and marital adjustment two and twenty months after diagnosis. J Pediatr Psychol 1996; 21:541-54. [PMID: 8863463 DOI: 10.1093/jpepsy/21.4.541] [Citation(s) in RCA: 107] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023] Open
Abstract
Evaluated emotional distress, coping style, and marital adjustment in 84 parents (42 couples) of children with cancer 2 months after diagnosis and again about 20 months after diagnosis. As expected, mothers' mean state anxiety and trait anxiety scores decreased to near normal levels over time. Fathers' scores were lower initially and did not change. Neither mothers' nor fathers' mean marital adjustment scores changed over time. Marital adjustment at treatment follow-up was predicted by depression and the spouse's marital satisfaction in mothers, and depression, child health status, and spouse's marital satisfaction in fathers. In contrast to findings obtained 2 months after diagnosis, coping style was not related to marital adjustment at follow-up. Results are discussed in terms of possible gender differences in the role of social support in marital adjustment and the stability versus situational specificity of coping styles.
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Dahlquist LM, Power TG, Carlson L. Physician and parent behavior during invasive pediatric cancer procedures: relationships to child behavioral distress. J Pediatr Psychol 1995; 20:477-90. [PMID: 7666289 DOI: 10.1093/jpepsy/20.4.477] [Citation(s) in RCA: 43] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023] Open
Abstract
Observed 51 children with cancer, their parents, and their physicians during routine bone marrow aspirations and lumbar punctures. Child distress was measured via the Observational Scale of Behavioral Distress (OSBD); adult behaviors were coded via the Child Adult Medical Procedure Interaction Scale (CAMPIS). In general, physicians were less verbally interactive than parents both before and during the procedure. As expected, several parent behaviors were positively related to child distress. However, physician behaviors were uniformly negatively related to child distress. Findings are discussed in terms of the physician-patient relationship and the possible role of physicians as change agents in reducing child distress during invasive procedures.
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Hockenberry-Eaton M, Iwamoto RR, Bauer SM, Meyers PA, Post-Whites J, Dahlquist LM. Managing treatment related side effects of nausea and vomiting. CANCER PRACTICE 1995; 3:203-6. [PMID: 7620484] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
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Thompson SM, Dahlquist LM, Koenning GM, Bartholomew LK. Brief report: adherence-facilitating behaviors of a multidisciplinary pediatric rheumatology staff. J Pediatr Psychol 1995; 20:291-7. [PMID: 7595817 DOI: 10.1093/jpepsy/20.3.291] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023] Open
Abstract
Investigated the behaviors of pediatric rheumatology health care providers that were expected to be related to patient or parent adherence. Medical charts of 108 patients ages 1 to 20 years diagnosed with Juvenile Rheumatoid Arthritis were examined. The 473 outpatient visits over 15 months yielded a total of 2,578 treatment recommendations, but only 1,390 adherence-facilitating behaviors by medical staff were documented. Providing information about how often to perform the recommendation was the most common staff behavior. In contrast, care providers rarely indicated that they addressed their patients' concerns and barriers to implementing the recommendations, or employed behavior modification strategies to increase adherence. Implications of these findings for development of programs designed to increase treatment adherence in children with chronic diseases requiring time-consuming, intrusive medical regimens are discussed.
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Dahlquist LM, Power TG, Cox CN, Fernbach DJ. Parenting and child distress during cancer procedures: a multidimensional assessment. CHILDRENS HEALTH CARE 1994; 23:149-66. [PMID: 10136934 DOI: 10.1207/s15326888chc2303_1] [Citation(s) in RCA: 70] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
Abstract
We examined the relationship between children's distress during invasive cancer procedures and parent anxiety, parent disciplinary attitudes, and parent behavior during the medical procedure. Sixty-six children with cancer and their parents were evaluated during a routine bone marrow aspiration. Significantly higher levels of distress were obtained for young (under age 8) versus older children. Patterns of relationships with parent variables also varied by age. Anxious parents of young children reported relying on less effective discipline strategies. They also were less reassuring prior to to medical procedure. Age differences in the correlations between child distress and parenting are discussed in terms of developmental differences in children's dependence on caregivers for emotional regulation and control. Implications for clinical distress reduction programs are also discussed.
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Kunik ME, Merritt SG, Dahlquist LM, Marks D. Correlates of psychiatry grand rounds attendance. ACADEMIC PSYCHIATRY : THE JOURNAL OF THE AMERICAN ASSOCIATION OF DIRECTORS OF PSYCHIATRIC RESIDENCY TRAINING AND THE ASSOCIATION FOR ACADEMIC PSYCHIATRY 1993; 17:77-83. [PMID: 24443239 DOI: 10.1007/bf03341858] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
Although grand rounds is an important educational conference in most medical schools and psychiatry departments, there have been few studies of which variables influence faculty and trainee attendance. The authors hypothesized that psychiatry grand rounds attendance would be affected by content area, the speaker's discipline and geographic origin, and the label of "research" in the presentation title. In 3 years of grand rounds presentations at the Baylor College of Medicine Department of Psychiatry and Behavioral Sciences, fewer residents attended grand rounds when "research" was in the label and attendance was greater when the rounds were cosponsored by another agency, presented in honor of someone, or given by an out-of-town speaker.
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Dahlquist LM, Czyzewski DI, Copeland KG, Jones CL, Taub E, Vaughan JK. Parents of children newly diagnosed with cancer: anxiety, coping, and marital distress. J Pediatr Psychol 1993; 18:365-76. [PMID: 8340845 DOI: 10.1093/jpepsy/18.3.365] [Citation(s) in RCA: 81] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023] Open
Abstract
Evaluated anxiety, approach-avoidance coping style, and marital distress in 134 parents of children with cancer shortly after diagnosis. Of the 67 marital pairs studied, approximately 25% of the mothers and 28% of the fathers reported significant marital distress. Regression analyses revealed that marital distress was predicted by a combination of general emotional distress, the discrepancy between the couple's state anxiety levels, and the couple's use of sensitizing coping strategies. Greater differences in anxiety levels between the parents and greater stimulus approach coping activity in the marriage were associated with greater reported marital distress.
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