Thesis (Ph.D.)--Kent State University, 2008. / Title from PDF t.p. (viewed Sept. 28, 2009). Advisor: Stan Wearden. Keywords: journalism; trauma; broadcasting; reporting; television; posttraumatic stress; compassion fatigue. Includes bibliographical references (p. 164-184).

Thesis (Ph. D.)--University of Texas at Austin, 2000. / Vita. Includes bibliographical references (leaves 140-151). Available also in a digital version from Dissertation Abstracts.

The human wrist is a vital joint in daily life, and it is subject to injuries and disease. Currently, severe wrist disease is normally treated with wrist arthrodesis, which is normally reliable but results in a fixed wrist incapable of allowing wrist motion. Another method of treating a nonfunctional or severely painful wrist is wrist arthroplasty where the wrist joint is replaced with an implant that allows wrist movement. As of yet, a suitable wrist implant has not been developed, especially for the case of the post-traumatic, young male wrist, and most current wrist implants fail from failure of the bone-implant interface. Through simulation and literature review, it is concluded that implants that restrict axial rotation are bound to fail overtime. With this conclusion, a new wrist implant prototype is designed that incorporates state of the art materials, fluid film lubrication, proper kinematics, a suitable range of motion, and more. This implant contributes several improvements to the field of wrist arthroplasty. / text

The experience of psychosis (e.g. threatening symptoms such as persecutory delusion and terrifying hallucinations) and its treatment (e.g. coercive measures such as involuntary admission and seclusion) are distressing. In view of the potential severity of the distress associated with psychosis, previous research has applied the trauma model to understand the experience of psychosis and its treatment and found that 11-67% of psychotic patients presented with clinically significant PTSD reactions in response to their psychosis and treatment experience. This phenomenon is termed as post-psychotic PTSD (PP-PTSD). However, previous research generally failed to find consistent relationship between PP-PTSD reactions and objective psychotic and treatment experiences (except for positive psychotic symptoms). Cognitive conceptualization of PTSD opines that it is the cognitive appraisal of the traumatic event, rather than the trauma per se, that is related to the development of PTSD. The present study aims to contribute to a better understand of PP-PTSD through a cognitive perspective. The present study applies Ehlers and Clark’s cognitive model of PTSD in understanding PP-PTSD. It explores the roles of fear of relapse and perceived risk of relapse, attribution of the causes of psychosis, perceived stigma and rejection and perceived consequence of the psychotic illness in PP-PTSD. The present study was a cross-sectional study and recruited 38 patients with schizophrenia-spectrum disorders. Semi-structured interview was used to determine whether the patients met the PP-PTSD diagnosis. The patient’s positive psychotic symptoms and social and occupational functioning were assessed by semi-structured interview while their PP-PTSD symptoms, trauma history and cognitive appraisals were measured using self-report questionnaires. Results showed that 15.8% of patients meet the full criteria of PP-PTSD and more than 50% of patients demonstrated some PP-PTSD reactions, which provides support for the application of the PP-PTSD construct in the local context. Treatment experiences were found to induce more severe PP-PTSD reactions than psychotic experience. Cognitive appraisals were found to be associated with PP-PTSD and there was some support for the application of Ehlers and Clark’s model in PP-PTSD. Specially, the present study found that fear of relapse, higher perceived risk of relapse, perceived helplessness and self-blame of causing the onset of psychosis, stable attribution of the cause of psychosis onset, perceived stigma, perceived large and chronic consequence of psychosis were all associated with more severe PP-PTSD reactions. Fear of relapse was also found to predict PP-PTSD severity. Clinical implications on the prevention, assessment and treatment with reference to the present results are discussed. / published_or_final_version / Clinical Psychology / Master / Master of Social Sciences

Not available / text

The long-term psychological effects of surviving a major disaster are poorly understood. A survey of survivors of the Piper Alpha oil platform disaster (1988) was undertaken to examine the role of factors relating to: the trauma; the survivors, and the survivors’ circumstances in relation to long-term outcome. Methods: Ten years after the disaster 78% (46/59) of the survivors were located, and, of these, 72% (33/46) agreed to be participate in a study conducted by questionnaire, diagnostic interview and semi-structured interview. In total, 61% of all survivors participated in this study. A further three individuals (7%) completed postal self-report measures. Results: High levels of physical disorder, general psychopathology and post-traumatic symptoms were reported. Twenty one percent (7/33) of the survivors who participated in the study still met the most stringent diagnostic criteria for PTSD over 10 years after the disaster; 73% met the same rule within three months of the disaster. Features such as physical injury, personal exposure to certain stressors during the trauma, survivor guilt, anger and employment difficulties were significantly correlated with long-term general and specific post-traumatic psychopathology and with social and occupational function. Features of the legal proceedings were also associated with long-term outcome. Whilst the media was experienced as intrusive, no statistically significant associations with long-term outcome were found. Treatment was generally accessible to participating survivors (97%) with non-professional help (82%) and outreach (69%; 25/36) widely used. Although many difficulties were experienced 61% of participants could identify some positive outcomes from the experience. Discussion: This study emphasises the need to consider a broad range of factors affecting outcome including the individual’s experience during a traumatic event, pre-existing stressors and factors relating to the response to the disaster and their environment. High rates of help-seeking were found to co-exist with high symptoms levels and this may relate to treatment effectiveness or failure to apply appropriate treatment in disaster populations. Attention to issues such as employment difficulties and compensation processes may improve survivor well-being in the long-term after disasters. Conclusions: This long-term follow-up of survivors of a major disaster has confirmed that the impact of a disaster is durable and extensive with psychological services required over prolonged periods.

This report examines the state of research regarding the psychological impact of war on American soldiers deployed in military operations in Afghanistan (Operation Enduring Freedom) and Iraq (Operation Iraqi Freedom). Particular focus is given to examination of marital and relationship satisfaction within the Hispanic soldier and veteran population. A wide range of research examines the traumatic aftereffects of wartime service with predominant themes of posttraumatic stress, depression, anxiety, and substance abuse appearing across the literature. Examination of the Hispanic population is disputed with researchers producing conflicting findings: some researchers have indicated an increased risk of psychological disturbances in Hispanic wartime veterans while other have found no such difference between the Hispanic and majority groups. Attempts to explain these discrepant results have ranged from differences in acculturation, to potentially increased traumatic exposure, or to underlying feelings of persecution and alienation. However, consistent results were found in regards to the negative relationship between traumatic exposure and romantic relationship satisfaction. Younger males of lower socioeconomic status with increased trauma exposure and comorbid mental health diagnoses consistently reported less relationship satisfaction than their peers. Given the nature of family and the importance of close relationships within the Hispanic culture, it is increasingly necessary for clinicians working with Hispanic veterans to be aware of these findings. This author purposes that future researchers explore this concept of relationship satisfaction within the Hispanic veteran population with attention given to potentially mediating variables such as level of acculturation and traumatic experience exposure. / text

Traumatic brain injury (TBI), also referred to as an acquired brain injury, is caused by damage to the brain as a result of trauma to the head. The following report serves as a resource for patients and families wanting to gain information regarding community integration outcomes after participation in post-acute rehabilitation programs. The goal of the post-acute level of medical care is to increase functionality and serve as a transition for the patient from the rehabilitation facility to life within the community. A thorough examination of community integration after participation in a post-acute rehabilitative program with the use of the Community Integration Questionnaire (CIQ) is provided. After investigation of the available literature, four articles were found to meet inclusion criteria and were included within the review. All studies included met the following criteria. Participants were ages 17 to 65 years old, had a diagnosis of moderate to severe TBI, were enrolled in post-acute rehabilitation, and were assessed with the Community Integration Questionnaire (CIQ). Overall, the available literature suggests that completion of a program within a post-acute facility does create positive outcomes for the individual with TBI; however, the outcomes are dependent on various factors regarding TBI severity, the administration of intervention, the type of intervention, time post-onset and age of participants at the time of onset. Future research is necessary to provide a more comprehensive view of post-acute rehabilitation and the outcomes that these patients may expect as they begin their road to recovery. / text

This report provides an overview of the adverse effects of the antiepileptic drug topiramate. Specifically, it evaluates the negative cognitive-communication effects of topiramate on individuals with epilepsy and postulates that treating these deficits is within the scope of practice of speech-language pathologists. It begins with a discussion on epilepsy, description of seizures, and the mechanism of action for antiepileptic drugs. It then provides an overview of cognitive communication deficits caused by antiepileptic drugs, including: memory problems, impairments in attention, and executive dysfunction. The final section provides an outline of potentially beneficial treatments a speech-language pathologist may provide to patients experiencing adverse effects from topiramate and how continued research can expand this area of practice. / text

Background: Traumatic brain injury (TBI) patients are often sedated, yet sedation assessment scales have not been thoroughly studied in this population. This project inquiry describes the use of the Richmond Agitation Sedation Scale (RASS) in assessing sedation in TBI patients. Methods: A retrospective, descriptive analysis of 38 ventilated, sedated TBI patients was performed to describe 1) the characteristics of the study TBI population, 2) the use of the RASS to guide titration of sedation medication, and 3) the nursing perspective of a sedation titration protocol that includes the use of the RASS. Results: Prescribed RASS score for the study population was -2; the actual RASS score was -2.04 +/-1.05. The days spent on mechanical ventilation were 3.46 +/- 1.95. The Injury Severity Score (ISS) correlated with sedation titration (r = -0.373; p<.05). The ICD-9 code also correlated with the RASS (r = -0.400; p<0.05). There was no correlation between RASS and sedation titration (r = -0.061; p = 0.717). The majority of nurses perceived that when using the RASS, sedation level did not affect their feeling of accuracy of neurological assessment (56%), and the patient's agitation level did not affect their feeling of accurate neurological assessment (58%). Conclusion: While the degree of injury was associated with the ability of the TBI patient to maintain the prescribed RASS level, there was no association between the RASS score and sedation titration, indicating that in this small study, the RASS did not guide sedation titration in the TBI population. However, the time spent at the prescribed RASS level and days of mechanical ventilation, which was similar to reported norms, suggest that the RASS is an adequate tool for assessing sedation in the TBI population. From the nursing perspective, the use of the RASS was not a barrier in assessing sedation titration. To our knowledge, this is the first study to describe the use of RASS for assessment of sedation in TBI patients. Additional prospective studies are necessary to fully understand the ability of the RASS to guide sedation titration.