Caregiver Training Courses

Caregiver Training Ebooks

The caregiver training e-book gives a training course on how to provideassistance to another person who is ill, disabled or needs help with daily activities. It can also serve as a useful guide to the individuals in the need of help. The product deals in physical, mental, social, and psychological needs and well-being of both the caregivers and the elderly person requiring care. Everyone needs a little help from time to time and while many seniors lean on the friends and family members for support, there may be some instances in which it's necessary to seek additional assistance or long-term care which was why this product was created by the author. This caregiver product is a practical guide created by the author who is an expert in the field. This product embeds in it several training sections in which each section gives detailed information on how to provide assistance to people who are ill, disabled, or aged. This product is a trusted and 100% guarantee to provide the necessary details needed in caring for the physically challenged, aged and ill individuals. The product is also an essential overview of issues from Alzheimer's to diabetes to strokes.

Caregiver Training Ebooks Summary

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Contents: Ebooks
Author: Kenneth Watts
Price: $47.00

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Highly Recommended

I started using this book straight away after buying it. This is a guide like no other; it is friendly, direct and full of proven practical tips to develop your skills.

When compared to other e-books and paper publications I have read, I consider this to be the bible for this topic. Get this and you will never regret the decision.

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Psychosocial Therapy for Dementia Caregivers

Depression and anxiety, higher use of psychotropic medications, poorer physical health, and increased mortality have all been documented for family caregivers. Recognition of caregiver burden has led to numerous psychosocial interventions aimed at alleviating stress and adverse health consequences. Early forms of interventions such as peer support groups and education were found to have only very small benefits when subjected to careful study. A second generation of caregiver interventions has included individual and family counseling, case management, skills training, and combinations of these approaches. In general, multicomponent approaches that offer options to fit individual caregivers' needs and relatively intensive as opposed to brief interventions have been found to be most beneficial (Schulz et al. 2002). In the most ambitious study of caregiver interventions to date in the United States, the multisite Resources for Enhancing Alzheimer's Caregiver Health (REACH) investigation...

Ie Parent Provider or caregiver

In adult HRQL research, proxies who have been used to provide HRQL ratings of an ill person include significant others caregivers and healthcare providers 57, 65 von Essen 66 conducted a recent review of all proxy ratings of adult patient HRQL, and supported the use of proxy reports together with self reports whenever possible. This review emphasizes that self report is the preferred rating to consider when the patient is cognitively intact and a reasonable reporter. Differences in patient-proxy ratings for adults tend to be most pronounced for ratings of emotional functioning, similar to pediatric studies that demonstrate weaker concordance between parent and child ratings for internalizing behaviors 65 .

Feeding Disorder of Poor Caregiver Infant Reciprocity

Children with this condition show a lack of develop-mentally appropriate signs of social reciprocity with the primary caregiver during feeding, leading to significant growth deficiency. However, because of the difficulty of assessing attachment in infants under 1 year of age, feeding disorder of poor caregiver-infant reciprocity was chosen as diagnostic label to capture the lack of engagement between mother and infant in this feeding disorder.

Psychiatric Disorders 601411 Schizophrenia

While defined as an anxiety disorder, obsessive compulsive disorder (OCD) has several distinct features that set it apart. It is characterized by an overwhelming sense that negative consequences will arise from the failure to perform a specific ritual. The rituals are repetitive, taking a variety of forms including hand washing, checking to see if the stove is turned off, or the recitation of particular words or phrases. DSM-IV-TR criteria require that the symptoms include obsessions or compulsions that cause marked distress and occupy at least 1 h per day. OCD interferes with normal routine and produces a social impairment equivalent to schizophrenia. In addition to the disabling effect OCD has on the patient, it also produces a significant strain on family relations as relatives become caregivers and are drawn into a routine of providing reassurance and ritual maintenance. OCD becomes apparent at between 22 and 36 years, affecting males and females equally. OCD is highly prevalent,...

Neurodegenerative Diseases

AD or dementia of the Alzheimer type (DAT) is a progressive and debilitating disorder characterized by dementia and a loss of cognitive function. Approximately 15 million individuals in developed countries are estimated to currently suffer from AD. Initial symptoms include confusion, loss of initiative, progressive decline in executive function, mood changes, and memory loss. However a decline in cognitive abilities ultimately results in a complete loss of mental function with disease progression. While approximately 10 of cases are early onset, AD predominately afflicts those over the age of 65. It is estimated that 5 of those over the age of 65 and 24 of those over the age of 85 suffer from AD. Diagnosis is made on an exclusionary basis using general medical and psychological evaluation, interview of caregivers, and assessment of family history of the disease. While recent advances in neuroimaging hold promise for future early detection, there is currently not a consensus that this...

The Pediatric Pain Experience

The magnitude of the problem of inadequate pain treatment in children was brought to light in the late 1980s when studies in various institutions independently confirmed that children were undertreated despite the caregivers' recognition of the presence of pain (13,14). The incidence of pediatric pain is unknown because most studies addressed either one specific type of pain or pain treatment and not the general presence and intensity of pain. Anxiety during blood sampling via venipuncture has been cited as a major cause of distress for children. Up to

Video and Audio Recordings

Seriously ill, or children or other vulnerable people. When disability prevents patients from giving informed consent, the GMC advises the doctor to obtain agreement from a close relative or caregiver where children lack the understanding to consent, the permission of the parent or guardian is recommended.

Extended Families Friends and Group Involvement

Being socially involved and depended on by others is important for successful aging. Fulfilling multiple social roles (e.g., worker, spouse, caregiver, and grandparent) has been linked to higher life satisfaction and feelings of self-efficacy for both white and black older Americans. Having a sense of social worth is also important for health and survival. Two recent studies, one in Japan and one in the United States, found reduced rates of death among Increasing numbers of grandparents are now providing custodial care for grandchildren or extensive noncustodial caregiving, especially in black and Hispanic families. About one-half of older Americans attend church regularly, and about one in six are active in volunteering. Religious beliefs may play an especially important role in adaptation for older Americans of African descent, whereas elderly white persons may rely more often on nonreligious social connectedness (Consedine et al. 2004).

Medical and Sexual History

When children are examined, the parent or caregiver should provide comprehensive details of the past medical history. When adults are examined, only relevant medical and sexual history should be sought because confidentiality cannot be guaranteed. What constitutes relevant medical history must be determined on a case-by-case basis by considering the differential causes for any medical findings and the persistence data for the different sexual acts.

Mood Disorders Diagnosis

Depression is the most common mood disorder in later life. It can have serious consequences, including disability, functional decline, diminished quality of life, mortality from comorbid medical conditions or suicide, demands on caregivers, and increased service utilization (Charney et al. 2003, p. 664). Because of the seriousness of these consequences, geriatric depression has been identified as a major public health problem, yet it is undiagnosed in about 50 of cases (Mulsant and Ganguli 1999). Even when it is recognized, depression in the elderly tends to be undertreated Steffens and colleagues (2000) found that only 35.7 of elderly patients with major depression were taking an antidepressant of these, it is likely that a substantial minority were less than optimally compliant with treatment (Katon et al. 1999). Several factors contribute to this suboptimal response by the medical profession, including 1) the normative fallacy that is, the belief that symptoms of depression are...

Normal Grief Bereavement

Although the studies cited earlier did not address the specific circumstances surrounding the onset and course of bereavement, they do suggest that the time course of normal grief in the individual patient is fairly variable and that most patients should be at, or clearly moving toward, baseline status by the end of the first year. But specific circumstances also appear to be important. A study of 217 caregivers of family members with dementia (Schulz et al. 2003) found that 72 of the caregivers reported feeling relief after the death of their loved one. Their scores on the Center for Epidemiologic Stud ies Depression Scale increased about 50 over prebereavement scores immediately after the death but returned to prebereavement levels within 15 weeks within 1 year, scores were below the levels reported when these persons had been active caregivers.

Incidence And Sources Of Cytomegalovirus Infection

A dramatic rise in age-related prevalence of CMV infection in children attending child care centers compared with those kept at home has been demonstrated. Furthermore, the transmission of CMV strains among children in this setting has been documented by molecular epidemiology (24). Studies of parents of children attending day care centers and child care workers demonstrated a high rate of seroconversion and a strong association between care of younger CMV-shedding children and seroconversion (25-27). Molecular analysis of the isolates provided further evidence for transmission of CMV strains from child to caregiver (26-28). from the medical significance of congenital CMV infection, infants who acquire CMV in utero, during delivery, or from mother's milk shed virus for years and serve as a source of the virus for other children and caregivers with whom they have close contact.

Pain Measurement by Methods Other Than Self Report

Many children are unable to have their pain measured by self-report because they are nonverbal or otherwise unable to self-report by indicating nonverbally, such as by pointing. This can be because of young age, cognitive impairment, or regression with illness. The use of formal behavioral measurement scales and having a trusted caregiver report on behavioral changes observed in the infant or child are components of assessing pain in the nonverbal child. Noting changes in such physiological parameters as the elevation of pulse or blood pressure can be helpful when present. However, changes in such measures are not necessarily consistent or reliable correlates for pain, particularly in the very ill child and if pain is chronic.

Pain Measurement in Children With Neurocognitive Impairment

Some of the work done in this area has provided a broader view of acute and postoperative pain. In one study, 24 children aged 3-19 years with cognitive impairment were rated by their caregivers and researchers regarding perceived intensity of the child's pain pre- and postsurgery (23). One outcome of this study was that familiarity with the individual child was not necessary for observers to have congruent pain measurements (23). Another study generated a checklist of typical pain behaviors from interviews with 33 caregivers and compared that list with another from a different cohort of 63 children with similar cognitive impairment. Seven observational items were predictive of numerical pain ratings with 85 sensitivity and 89 specificity. It is clear that caregivers' retrospective reports may have clinical utility (24). Pain cues reported by 29 caregivers of noncommunicative children 2-12 years old with life-limiting conditions were compared against a checklist of 203 items. This...

Clinical Trial Issues

Various clinical instruments have been used in the diagnosis of AD and can be used to monitor drug efficacy. These include the AD Assessment Scale (ADAS), noncognitive versus cognitive (cog), the Blessed Dementia Scale (BDS), the Blessed Information Memory Concentration (BIMC), the Behavior Rating Scale for Dementia (BRSD), the Clinical Dementia Rating (six categories CDR), the Clinician's Interview-based Impression of Change (CIBIC), the Sum of Boxes (Global CDR, CDR-SB), the Dementia Rating Scale (DRS), the Extended Scale for Dementia (ESD), Global Deterioration Scale (GDS), the Mini-Mental State Examination (MMSE), the Progressive Deterioration Scale (PDS), and the Severe Impairment Battery (SIB).27 Each scale measures both cognitive ability and activity of daily living but they are difficult to compare as their absolute ranges are very different, making comparison of results across clinical trials using different scales difficult. Thus, the only basis to compare data is on the...

Psychotherapy for Geriatric Depression

Assets or roles, and demands of caregiving, and these problems often form the content of psychotherapy. For persons with high levels of disability or recurrent mental and physical problems, appropriate clinical goals may be to manage, rather than eliminate, symptoms and to sustain as high a level of independence as possible. Higher-functioning older adults often do well with the usual forms of individual, group, or family therapies that are provided in outpatient settings. Depressed elders with cognitive impairment may benefit more from systematic adjustments in the social or physical environment to maximize functional skills, behavior modification (e.g., to increase participation in pleasurable activities), or specialized cognitive training techniques (see Chapter 6, Other Dementias and Delirium). For individuals with chronic health problems or significant physical disabilities, techniques for addressing specific medical comorbidities (e.g., pain or insomnia) can be especially...

Diagnostic Assays For Evaluation Of Infant And Mother

Most experts do not recommend termination when a woman has varicella during pregnancy unless obvious birth defects are present on ultrasound, as noted in this section (7). The risk to the fetus of being born with a serious birth defect due to varicella is on the order of about 2 , which is not much greater than the overall risk of 4 without varicella. Obviously, however, the caregiver needs to provide a great deal of counseling in this situation because of its uncertainties.

Overall Goals of Psychiatric Treatment of Persons with Mental Retardation

The most common mistake made by mental health clinicians treating persons with mental retardation is to consider suppression (usually with medications) of single problems (as a rule disruptive behaviors) as the only goal of treatment. This approach used to be the rule in the past when people with mental retardation were not expected to achieve any measure of independence and keeping them docile was the goal. Lately, such approaches are reemerging, partly related to the pressure from insurers to achieve a fast and inexpensive symptomatic improvement, even if short lived. Fortunately, in the past three decades, the quality of life (QOL) has been assuming a central role as the goal of treatment in the mental retardation field. More recently, the importance of the subjective aspects of QOL have been stressed the individual's subjective feeling of contentment, well-being, and satisfaction with his or her own life as opposed to the caregiver's satisfaction. In other words, personal...

Suicide History Taking

Thoughts and feelings is highly cathartic. Thoughts of suicide while providing some measure of consolation and control may also be frightening, distressing, and painful. Sharing suicidal feelings with an empathic listener is not only relieving but may also provide the patient with a new perspective. To resolve a suicidal crisis, it is important to reestablish bonds, provide the patient with a supportive network of family, loved ones, friends, and caregivers, and identify and treat psychiatric disorders. Crisis intervention, networking, and ongoing psychiatric care may help prevent suicide.

Psychosocial Interventions

Goal of these interventions is to provide a proper living and programmatic environment. For instance, certain persons easily become overstimulated, anxious, and disruptive in noisy and confused large workshops arranging for a smaller and quieter workroom is preferable to a prescription for a neuroleptic. The vocational and educational program should be individualized and should focus on developing the person's strengths and providing an opportunity for success. In turn, this will lead to results such as an improvement in self-image. Many persons with severe mental retardation are placed in prevocational training indefinitely, for example, screwing or unscrewing nuts and bolts, although no one expects them to ever be employed on an assembly line. They often engage in a struggle with caregivers because of their noncompliance and may resort to aggression, which leads to removal for a time out and thus avoidance of a boring task. Creating a more suitable task even such as making rounds of...

Trauma And Interpersonal Effects

Although the majority of people exposed to trauma appears to be resilient to the experience (Bonanno, 2004), that is not the case for survivors of childhood abuse because such abuse typically involves repeated trauma at the hands of a trusted caregiver. In fact, for women with symptoms of posttraumatic stress disorder (PTSD), the most common etiology is childhood sexual or physical abuse (Kessler, Sonnega, Bromet, Hughes, & Nelson, 1995). When trauma involves childhood sexual abuse, the long-term effects may

Respite and Recuperation

The fourth reason for removing people from their environment is simply to provide an opportunity for rest, respite, or recovery. The general idea is that, if the management of disease, disability, or suffering is a constant task for the patient, caregivers, or both, then the temporary reprovision of that care in a formal environment will provide opportunities for resources of time to be spent differently in the home. The typical example is respite care for families who have children with complex congenital disability caused by conditions, such as cerebral palsy.

Psychosocial Therapy for Bipolar Disorder

Ated from friends, family, treating physicians, and other caregivers. Generally, insight-oriented therapies are avoided during the acute phase of illness but may be quite effective when the most severe symptoms are under control. Both individual and family therapy approaches can be used, whereas group settings may not provide enough structure to allow the elderly bipolar patient to benefit. Psychosocial treatment of bipolar depression is similar to the treatment of unipolar depression but calls for more psychoeducation of the patient and family regarding the early signs of a switch into mania, which can occur spontaneously or be provoked by antidepressant therapy.

Identifying the Dementia Syndrome History

An accurate history of the current illness is particularly important in the diagnostic evaluation of dementia, in order to 1) establish the temporal relationship between possible etiological factors and the onset of cognitive decline, which can help to identify the underlying pathophysiological process causing dementia and 2) permit the potentially important distinction between early- and late-onset Alzheimer's disease. Accordingly, multiple sources of information, including the patient's medical records, should be used to supplement information provided by the patient and the patient's primary caregiver, and an attempt should be made to establish detailed timelines. It is particularly important to focus on trauma signs or symptoms of neurological or psychiatric illness substance use, including alcohol and medications past and present exposure to potential toxins past surgeries and past and present psychosocial stressors. The family history should include inquiry about Down syndrome,...

Rating Functional Skills

Examinations or neuropsychological tests, and thus it is important to assess these skills in addition to testing mental status when dementia or other cognitive impairments are suspected. Also, because persons with little or no education often perform poorly on mental status examinations, a very brief mental status examination, combined with functional assessment, may be preferable to more extensive cognitive assessment for screening or diagnosing dementia (Wilder et al. 1995). Several brief rating scales have been developed for use with family members or other caregivers to identify problems in everyday functioning. A widely used functional scale is the Instrumental Activities of Daily Living measure developed by Lawton and Brody (1969) (see Appendix), which consists of eight items assessing areas of function considered crucial for maintaining independent living in the community (e.g., using the telephone, shopping, being responsible for medications). The Direct Assessment of...

Other Rating Measures

Other observer-rated scales have been developed to aid in screening for dementia or to identify specific psychiatric symptoms that can accompany dementia. Examples of such scales include the Informant Questionnaire on Cognitive Decline in the Elderly (IQCODE Jorm et al. 1991) and the Neuropsychiatry Inventory (NPI Cummings 1997). The IQCODE relies on observations of caregivers or others familiar with everyday behaviors and abilities of the patient. The scale measures a single general factor of cognition, has high reliability, and performs as well as brief cognitive screening tests in detection of dementia (Jorm 2004). Unlike scores on many cognitive screening tests, scores on the IQCODE are relatively unaffected by education, premorbid ability levels, or language proficiency. The NPI (Cummings et al. 1994) is rated by physicians or trained professionals on the basis of observation of the patient and input from caregivers. The NPI provides frequency and severity ratings for 12...

Fabricated or Induced Illness

The fabrication or induction of illness in children by a caregiver is referred to by several different terms, most commonly Munchausen syndrome by proxy, factitious illness by proxy or illness induction syndrome. In the United States, the term pediatric condition falsification is being adopted by the American Fabricated or induced illness is a persistent fabrication of a child's illness either simulated or produced by the child's parent or caretaker. There are three main ways of the caregiver fabricating or inducing illness in a child

Functional Assessment and Impact

2002a), in which a computer chip embedded in the top of the pill bottle automatically records the date, time, and duration of pill bottle opening. While these medication management assessment techniques are not part ofa traditional neuropsychological battery, patients with neuropsychological deficits and their significant others or caregivers should be asked about their (or the patient's) medication adherence. The Instrumental Activities of Daily Living Scale (Lawton and Brody, 1969) can be used to assess complaints about the inability to accomplish instrumental activities of daily living. This scale assesses the ability to perform tasks such as preparing meals, managing finances, and taking medications properly. For patients with functional impairments, visiting nurse service, a home health aide, or an occupational therapy referral may be appropriate. For patients with cognitive impairments who drive, a driving evaluation is recommended.

Clinical Presentation

Delusions are usually persecutory in nature and are typically fragmented and inconsistent, unlike those seen in the common functional disorders (e.g., schizophrenia, delusional disorder, or mood disorder with psychosis). Common delusional content includes the belief that one is being threatened, deprived, or abused by caregivers or that possessions are being stolen hypochondriacal delusions and Capgras' syndrome are also common (Migliorelli et al. 1995). Delusions in Alzheimer's disease typically do not have the elaborate connectedness seen in functional delusions (i.e., the myriad ways in

Psychological Treatments

(2) knowing what constitutes an appropriate reaction to these behaviors on the part of the caregiver. To determine the antecedent is often extraordinarily difficult, since it is often not apparent as to what exactly happened in the environment that stimulated the behavior. This is particularly true if the behavior is chronic and has developed some autonomous function (i.e., no longer a stimulus-response event). To make things more complicated, it could be internal perception or the meaning of what happened in a child with autism (poor language and socially nonresponsive) that may have initiated the behavior.

Practical Implementation of Nutritional Support

Depending on the underlying cause of energy imbalance (decreased dietary intake or increased nutritional requirements), initial nutritional therapy may range from adaptations of the dietary behaviour and food pattern to implementation of nutritional supplements. Nutritional support should be given as energy-dense supplements well-divided during the day to avoid loss of appetite and adverse metabolic and ventilatory effects resulting from a high caloric load. When feasible, patients should be encouraged to follow an exercise program. For severely disabled cachectic patients unable to perform exercise training, even simple strength manoeuvres combined with ADL training and energy conservation techniques may be effective. Exercise not only improves the effectiveness of nutritional therapy, but also stimulates appetite. After 4-8 weeks, the response to therapy can be determined. If weight gain and functional improvement are noted, the caregiver and the patient have to decide whether...

Screening Instruments and Rating Scales

Items for this scale were based on behaviors described in diagnostic consensus reports (e.g., Neary et al. 1998) for fronto-temporal dementia. The Frontal Behavioral Inventory has good reliability and appears effective in discriminating clearly diagnosed frontotemporal dementia from Alzheimer's disease or vascular dementia. However, norms for clinical use are lacking. The Neuropsychiatric Inventory (NPI see Chapter 5, Dementia and Alzheimer's Disease, and Appendix) is another behavior rating scale completed by professionals on the basis of a caregiver interview. It taps several behaviors that are often affected in frontotemporal dementia and has been used in clinical trials. A caregiver-completed form of the NPI has been developed (Kaufer et al. 2000), but data are limited on the clinical usefulness of this version. The symptoms of frontotemporal dementia, especially the frontal variant, are often very distressing to family members, and education is...

Harold W Goforth Mary Ann Cohen and James Murrough

Mood disorders have complex synergistic and catalytic interactions with HIV infection. They are significant factors in nonadherence to risk reduction and to medical care. Mood disorders associated with HIV include illness- and treatment-related depression and mania, responses to diagnoses of HIV, and comorbid primary mood disorders such as major depressive disorder and bipolar disorder. While persons with HIV and AIDS may have potentially no or multiple psychiatric disorders, alterations in mood are frequent concomitants of HIV infection. They have a profound impact on quality of life, level of distress and suffering, as well as direct and indirect effects on morbidity, treatment adherence, and mortality. In this chapter we will describe the significance of each of the mood disorders and their impact on the lives ofpersons with HIV and AIDS and on their families and caregivers. More detailed discussions of the epidemiology and prevalence of mood disorders are found in Chapter 4....

And Significant Others

Within palliative care, hope should also be considered for those who are close to the patients either personally or professionally. Caring for someone close can be very stressful and has been associated with causing psychological and social distress in carers, and therefore with caregiver burden (Kissane et al. 1997 Pitceathly and Ma-guire 2003 Siegel et al. 1991). Pitceathly and Maguire (2003) found, in their review of the psychological impacts of cancer on patients' partners and other key relatives, that most people can cope with the role of caregiver, but that there are an important few that become highly distressed or develop an affective disorder. Farran et al. (1991) suggested that hope was one of the important factors in supporting the ability of carers to cope with the care-giving role under difficult circumstances. The importance of hope to families and care-givers alike has been supported in other research (Herth 1993 Hickey 1990), and it is believed that the presence of...

Fear of Pain Episodes at School

A primary goal in working with these children is to assist them in learning that they can cope with their pain (4). Walker recommended that children's initial return to school be brief, perhaps only 1-2 hours day. Most children will be able to attend school and even manage their pain for brief periods. The brief school attendance will assist children in building confidence so they may later be able to survive a pain episode at school. The child's health care provider and caregivers should have a plan in place in case the child experiences pain while at school. It is typically best if the child is allowed to lie down and rest until well enough to return to class or until it is time to leave school for the day. A child may also work with a school counselor to learn relaxation or distraction techniques (4,14). Walker cautioned it is often counterproductive for children to call home or be allowed to leave school early when a pain episode occurs as this reinforces complaining and passive...

Family Reinforcement of Sick Behavior

No specific differences have been found between families of well children and those of children with chronic pain on family measures like marital satisfaction and cohesion (4). However, some clinical evidence suggests that these families may differ in areas not gaged by standardized instruments. Overprotectiveness and enmeshment are two of these areas. Walker suggested that social modeling of pain may contribute to recurrent pain episodes among children, particularly if the child vicariously observes a parent receiving attention from other family members if there are complaints of pain. Levy and coworkers noted that a child may learn pain behavior when caregivers seek extensive medical consultation for pain (16). Walker noted that caregivers of children with abdominal pain may view their children as vulnerable, and these caregivers may attempt to protect their children from potential health-related threats (4). This pattern may result in caregivers letting a child stay home from...

Increasing School Attendance 31 Assessment

A careful analysis is critical in the identification of factors that may contribute to the child's or the family's reluctance about the child's return to school. These data should be elicited from both the child and the caregiver in a forthright interview, with specific questions about coping with return to school, managing peer questions, and concerns about a new school environment.

Conclusions and Future Directions

This chapter underscores the potential efficacy of behavioral approaches in supporting children's return to school. Numerous reasons for lack of school attendance are reviewed, including separation anxiety, fear of returning to school because of missed work, specific health- and pain-related issues that are made worse in the school setting, and inappropriate school placement. Despite the undisputed efficacy of behavioral approaches at school, potential barriers exist. These can include a lack of information among both caregivers and school professionals on the value of behavioral approaches. Other barriers that might impede implementation of these behavioral techniques include severe psychopathology of caregivers, lack of motivation on the part of caregivers and school personnel, and reinforcement systems that are not sufficiently motivating to the child or are not followed carefully. staff services, adjunctive care for families, and transportation for caregivers) will also be...

Developmental profile

In the DIR model of development, there are three dynamically related influences on development. Biological, including genetic, influences affect what the child brings into his or her interactive patterns. They do not act directly on behavior, but on part of the child-caregiver interactive process. Cultural, environmental, and family factors influence what the caregiver or interactive partner brings into the interactions. The resultant child-caregiver interactions then determine the relative mastery of six core developmental processes (e.g., regulation, relating, preverbal affective reciprocity). Symptoms or adaptive behaviors are the result of these stage-specific affective interactions.

Case Example Of The Dir Developmental Profile

In cases like this, with a little child who can elaborate themes, I found that many therapists would focus predominantly on the content of the child's themes (in this case, her preoccupation with sexual and aggressive themes) and obviously want to explore the family dynamics that were contributing, including questions of sexual abuse, sexual play with other children or babysitters, or overstimulation due to exposure to sexual materials or witnessing sexual scenes. But our profile, in addition to alerting us to these factors, also alerts us to the fact that there is a lack of mastery of critical early phases of development, including an ability for consistent attention, engagement, and the earliest types of affective reciprocity. When, for example, children cannot match the content of their interests to their affects, it often suggests that early in life, a caregiver was unable to enter into reciprocal gesturing around certain affective inclinations. For example, the way children learn...

Treatment Approaches to Meet the Developmental challenges of adolescents and Young adults

There is limited evidence that individual counseling may be appropriate in some cases. Cain et al. 44 studied adult female cancer patients who attended psy-choeducational counseling sessions over a 6-month period. After the 6-month period, the patients were significantly less depressed and anxious, had more knowledge about their illness, developed better relationships with their caregivers, experienced fewer sexual difficulties, and participated in more leisure activities.

Historical Context

Margaret Edson was born on July 4, 1961, in Washington, D.C. Her medical social worker mother and her newspaper columnist father encouraged her high school drama interests. After she received a bachelor's degree in Renaissance history, magna cum laude, from Smith College in 1983, she traveled for two years working at odd jobs. Then in 1985 she became an oncology and AIDS patient clerk and volunteer social worker at the National Cancer Institute in Bethesda, Maryland, where she witnessed protocols being developed to treat patients for ovarian cancer and HIV. She wrote a training manual titled Living with AIDS Perspectives for Caregivers. In 1991, from observing the medical teams and patients on the ward and from listening, she wrote Wit (also known as W t), initially a regional theater and off-off Broadway production. Edson received a master's degree in English from Georgetown University in 1992, then she taught English as a second language and first grade in a Washington, D.C., public...

The Meaning of Eating in Terminally Ill Patients Importance of Carers

Meares et al. conducted semi-structured interviews with women primary caregivers of adult inhome hospice patients with terminal cancer 15 . This systematic qualitative study summarises as follows 'Shift in thinking eating is best to not eating is best.' It reports seven elements related to gradual cessation of oral intake (1) the meaning of food (cultural aspects, love, socialised role of food, social situations, dinner hour) (2) the caregiver as sustainer (knowledge of care-giving, difference of emotion and intellect, vigilance, balance of respect and concern in choice of action) (3) concurrent losses (lived experience enmeshed, carer's personal pain) (4) personal responses (patient eats to please family) (5) ceasing to be-starved to death (6) being bereaved - the meaning now (meaning of cooking changed, patient remembered by using the old, shared cooking ware) (7) paradox (wavering pattern). This work did not specifically assess caregiver eating-distress, but provided insights...

Questions Related to the Clinical Assessment of the Older Person

Relevant questions also concern reversible barriers to treatment, including inadequate transportation, limited economic resources, and absence of a home caregiver able to react in the presence of emergencies, and additional risk factors, such as malnutrition, polypharmacy, memory disorders, depression, and poorly controlled comorbidity.

Obstetric And Developmental Effects

IQ scores (though still in the normal range) on the Stanford-Binet for children prenatally exposed to cocaine in combination with other drugs this study also identified mediating variables such as home environment, head circumference, and child behavior. In addition, a large study found that cocaine-exposed children were twice as likely to be significantly delayed developmentally throughout the first 2 years of life and were twice as likely to require intervention as the noncocaine polydrug-exposed comparison group. These cognitive delays were not due to exposure to other drugs or to covariates. Furthermore, poorer cognitive outcomes were related to higher levels of prenatal cocaine exposure (Singer et al., 2002). In addition to cognitive delays, 2-year-olds who had been prenatally exposed to both PCP and cocaine were found to utilize less mature play strategies and to evidence less sustained attention, more deviant behaviors, and poorer quality interactions with caregivers (Beckwith...

Heidi E Hutton and Glenn J Treisman

The risk behaviors that transmit HIV and complicate HIV treatment are often influenced by psychiatric disorders. Major depression, substance abuse, and chronic mental illness are problems that commonly complicate HIV treatment, but none can generate more distress and dissention among medical providers than personality problems. Caregiver burnout, failure to establish stable medical care relationships, and excessive resource utilization have been associated with certain personality traits and disorders. There has been relatively little research on the role of personality traits in HIV despite their stable, durable, and heritable influence on thoughts, feelings, and behavior. Certain traits, however, appear to increase the likelihood of engaging in HIV risk behaviors, having poorer quality of life and management of HIV, and adhering to treatment regimens. Effective HIV prevention and treatment programs should consider specific personality traits that render some individuals more...

Ernest R Katz Tasha Burwinkle James W Varni Ronald D Barr

(i.e., Parent, Provider, or caregiver) 390 treatment creates unique and difficult additional challenges for young people, including frequent hospitalizations, separation from family and friends, coping with changes in appearance and physical abilities, disruption of schooling, traumatic medical procedures, and the uncertainty of survival 37, 41, 42 . Cancer in adolescents and young adults often requires a return to dependence on parents and caregivers, leading to real and perceived disruptions in the forward momentum of life and a decrease in quality of life 32, 33, 36, 37 .

The Diet for Seizure Management

All antiepileptic drugs (AEDs) share a common feature they supply specially designed chemicals to the brain that are able to change the neurophysiology of the brain, thereby controlling the bioelectrical discharges that cause seizures. The need to control seizures is self-evident. In addition to the clinical and observable behavior changes that define an epileptic seizure, animal studies have shown that a seizure can impair important functions of the hippocampus (a brain structure that is involved with memory, execution of logical tasks, and emotion, among other functions) causing, for example, disturbances in learning to avoid and escape from an unpleasant environment (1-4). At the cellular and biochemical level, functional changes in the hippocampus following a seizure include a decrease in both the short and the persisting electrical activity of the cells' activity (1,5-7), as well as structural changes, such as loss of neurons in critical areas of the hippocampus (3). AEDs are...

Electronic Health Record

EHRs are, at their simplest, replications of paper medical records. They can, however, be much more and could transform many aspects of health care and health care decision making. The promise of the EHR is consistent and universally available health information on individual patients. The EHR would ensure that test results are properly filed and accessible to caregivers, thereby eliminating duplication and reducing time delays and the chance of adverse interactions. There are, however, many problems with the implementation of EHRs. At the caregiver end, many health professionals do not have the time currently needed to enter the data. The myriad current medical records systems do not communicate easily, and repeated transformations of poorly designed EHRs can be more cumbersome and error prone than the traditional paper record. New breeds of EHRs based on standards and meta-tagging are under investigation to remove these barriers. Once the EHR is established in the health care...

Monoclonal Antibodies

Radioimmunoconjugates provide monoclonal antibody-targeted delivery of radioactive particles to tumor cells (Table 2). 131Iodine (131I) is a commonly used radioisotope since it is readily available, relatively inexpensive, and easily conjugated to a monoclonal antibody. The y-particles emitted by 131I can be used for both imaging and therapy, but they have the drawbacks of releasing free 131I and 131I-tyrosine into the blood and present a potential health hazard to care givers. The P-emitter, 90Yttrium (90Y), has emerged as an attractive alternative to 131I, based on its higher energy and longer path length, which may be more effective in tumors with larger diameters. It also has a short half-life and remains conjugated, even after endocytosis, providing a safer profile for outpatient use. However, disadvantages include its inability to image, and it is less available and more expensive. Clinically, radioimmunoconjugates have been developed with murine monoclonal antibodies against...

Dsmivtr Diagnostic Criteria

(1) persistent failure to initiate or respond in a developmentally appropriate fashion to most social interactions, as manifested by excessive inhibited, hypervigilant, or highly ambivalent and contradictory responses (e.g., the child may respond to caregivers with a mixture of approach, avoidance, and resistance to comforting, or may exhibit frozen watchfulness). (3) repeated changes of primary caregiver that prevent formation of stable attachments (e.g., frequent changes in foster care). The disturbed social behavior that characterizes RAD should be evident by report or observation across most social contexts and relationships. Obviously, self-report in young children is less likely to be obtained or elicit relevant clinical information therefore, caregiver report is essential. Observation of the child in the clinic interacting with relative strangers as well as in naturalistic settings is quite valuable. Specialized structured clinical interviews and semistructured observational...

Communication for Efficient Teamwork

The patient and his family should be the centre of the interdisciplinary team, and the information about how they live through illness and its multiple consequences is essential to plan appropriate care. In this sense, the patient and his family should take part in all decisions, since they are the only ones who can express what is most meaningful at each moment of their illness. Patients are our teachers, but only if we, as team members, are able to listen attentively to them with our minds and our hearts. Handling information concerning a patient within the team needs perceptiveness, tact and sensitivity. Everything that has been said to one caregiver in an authentic and trustful climate does not necessarily need to be shared with the whole team. The profound meanings behind words are to be received as real gifts in a spirit of human fraternity, from human being to human being. On the other hand, there are some situations when the patient asks the caregiver to keep a secret for...

Differential Diagnosis

Pervasive Developmental Disorders (PDD). Although deficits in reciprocal social interaction are at the core of autism and Pervasive Developmental Disorders (PDD) and are observed early in life, children with these disorders do form selective attachments, although they may be deviant. Also complicating this picture is that these children also have cognitive delay and stere-otypies, conditions that are frequently associated with institutionalization or profound neglect (see below). If the psychosocial and caregiving environment is deemed adequate and there is no history of pathologic caregiving, the social disturbance is likely a social deficit in the child rather than reactive to the caregiving environment. In this case, PDD will be the most likely diagnosis. Changes in the caregiving environment will not result in improved social or attachment behaviors and may worsen the child's condition because of loss of an attachment figure. Posttraumatic Stress Disorder (PTSD). Children who have...

Modulation of Visceral Pain by Stress

Stress influences the manifestations or the development of visceral pain in IBS patients (Table 1) (5,8,9). For instance, IBS patients exposed to an acute psychological or physical stressor exhibit increased visceral sensitivity to rectal electrostimulation (10). Convergent clinical reports established that stressful life events before or after an acute enteric infection are strong predictors of acquiring postinfectious IBS (26). Childhood trauma by biopsychosocial stressful factors (neglect, abuse, loss of caregiver, or life threatening situation) impact the susceptibility to subsequently develop visceral pain and comorbidity with anxiety, depression, and emotional distress (34-36).

Building a Common Vision and Sharing Leadership

In order to work as efficiently as possible within the interdisciplinary team, there is a need for building a common vision based on individual visions of the different team members. A common vision can be a fantastic motor for the team, as long as the team members as a group take time to think through the following questions Which values do we share What are our common objectives, meaning the objectives that we all can stick to together As persons and as a group, which are our strong and weak points How do we use our strong points complementarily for the patient's and his caregiver's benefit How do we manage to remedy to our weak points According to Senge 9 , a common vision is the answer to this question What do we want to create together and how are we going to do so It seems relatively evident that the preoccupations of the team are, or should be, centred on the patient's and caregiver's family's quality of life. But it is less evident that the team also has to look at its own...

Case Example Of Depression

Caregivers as well as the presence of specific concrete objects serve security and communicative purposes. Around 18 to 24 months, however, under optimal circumstances, they develop the ability to create internal images, as Mahler and others (1975) described so well. These internal images become invested with certain wishes and feelings. Once children can create images, these can obviously be used for self-soothing as well as for fantasizing about anger. Once individuals have the flexibility to create representational images, they can create a temporary sense of security and experiment with anger while embraced in the safety of real relationships. Many individuals, for a variety of reasons, cannot create aspects of mental representations, often because of early conflicts in their prerepresen-tational stage and or certain regulatory patterns. I believe this scenario holds true for the woman discussed here, where the seeking of dependency and support was involved in behavioral-level...

Alternative Coercive Psychosocial Treatments

Several alternative treatments of attachment, such as coercive holding therapies, rebirthing therapies, and similar rage reduction therapies, have resulted in the well-publicized deaths of several children. Parents of these children were following the advice of holding therapists, or allowing the therapists to coerce their children into rageful outbursts, followed by tragically misguided or frankly sadistic parental responses. It is more than likely that these cases represent early onset conduct disorders with a history of early pathologic caregiving rather than RAD. These nonconventional and not recommended treatments may be called attachment therapies, but are not drawn from either attachment theory or research and appear to run the risk of retraumatizing already traumatized children

Aids Palliative Care And Death And Dying

They can also provide an impetus for overall life review, which can prove quite distressing to a patient who is unprepared for this process. These decisions are increasingly complicated and distressing, as recent political actions have been taken to limit the ability of same-sex couples to enter contracts approximating marriage with survival benefits. Dying patients must struggle with the impact of their dying on loved ones and caregivers, and caregiver distress can frequently lead to burnout and suboptimal care for the patient.

Professional and Family roles

No individual can meet all the complex needs of any person with a chronic illness. The importance of a team approach is hard to overemphasize, as both professional roles and the personal characteristics of the professionals themselves are important to cover the many areas involved. Key roles can be filled by physicians, nurses, social workers, psychologists, spiritual caregivers, and family members and friends. The most important functions are ongoing throughout an illness, and reflect both changing circumstances (relapse, toxicities) and the developmental stages of individuals and families. Key functions include Accurate diagnosis identification of the patient's and family members' concerns and therapeutic options communication of choices to patient and family establishment of realistic goals attention to management of symptoms maintenance of hope preparation for events, which respects the need to prepare for transitions, including the need to say goodbye.

Background and Principles

Finally, several barriers that impede successful transition have been identified through focus group survey methodology. Barriers on the part of providers may include time restrictions, lack of knowledge or training, financial reimbursement and letting go of the established relationship with the child 10, 14, 23-26 . Obstacles to transition for the patient may include dependent behavior, immaturity, lack of support systems, lack of trust in the caregiver, and noncompli-ance. For the family, the need for control, emotional dependency, overprotectiveness, and lack of trust in the prospective adult care providers may also present barriers to transition 25 .

The Affected Individual

There are two important positive effects of disclosure on the affected individual. First, for the newborn, the disclosure can be life-saving, and certainly life-exceeding. In the case of sickle cell anemia, for example, if the family and attending medical caregivers do not know that the newborn has the disease, months and even years can pass during which symptomatic conditions are not appropriately treated. A physician may misdiagnose the painful crises occasioned by the sickling of the blood in joints and organs.

Who Needs Decision Support

Decision making is central to the organization and delivery of health care. Hence, decision makers are to be found at all levels of health care operation. At the strategic level, policy makers are making investment decisions relating to new health care facilities and provision, including those relating to public health. Operationally, health care professionals, both clinicians and allied health professionals, are making diagnostic and therapeutic decisions so as best to manage the individual patient. In the arena of chronic disease, in particular, increasingly patients both wish to, and are encouraged to, be involved in the management of their condition, as are their family members and care givers. Decision making is thus an activity that involves health managers and policy makers, health care professionals of all grades, patients, and their care givers among others. Hence all may benefit from support in relation to the decisions needing to be made. Clearly this need for support will...

Common Treatment Obstacles And Possible Solutions

Supportive caregiver involvement is the ideal for the model described above however, this involvement may not always be possible. Although the model can be applied to children individually, it is best to find some outside source of adult support. If a caregiver is not available, other adults in the child's life, such as a caseworker, relative, or family friend, may be able to participate in some aspects of treatment. In cases where a caregiver is present but does not believe the child's allegations of abuse and is clearly standing by the perpetrator, it may be best to recommend individual therapy for the caregiver. A long-term goal could be to reunite the child and caregiver for joint sessions, once the caregiver is able to provide more appropriate levels of support to the child. On the other hand, nonoffending parents who are trying to be supportive but are struggling with initial feelings of shock, disbelief, and or ongoing feelings for the perpetrator may respond well to this...

Expert Consultation and Testimony on Competency

Here it may be prudent to elicit testimony on direct examination that clinical assessment and diagnosis of psychiatric illness in the elderly are commonly reliant on information from sources (such as spouses, relatives, caregivers, and medical records) other than direct examination of the patient, especially if the patient is severely cognitively impaired, uncooperative, mute, or catatonic. This explanation may be important testimony if the court is inclined to believe, as some clearly are, that retrospective evaluation is not part of reasonable clinical practice, is therefore not protected by Rule 703, and is of highly questionable probative value. Anticipating and correcting this mispercep-tion can be of great value in preserving the proper weight of expert testimony.

Conclusions And Recommendations

Other individual serving in a guardian role. Helping a caregiver to function as a supportive resource for a child has value that may exceed what a therapist can offer in weekly sessions and may produce therapeutic benefits that last long after therapy has terminated. Thus, when possible, it behooves therapists to engage both nonoffending maternal and paternal figures in the therapy process. Second, it appears that the structure and directive nature of the CBT model enables parents and children to focus effectively on skills and or information relevant to overcoming the traumatic experience(s). The results from several studies in which nondirective and or client-centered approaches were utilized indicate that children are not likely to focus on the abuse without the structured and directive guidance of a skilled therapist. Wolfelt, A. D. (1996). Healing the bereaved child Grief gardening, growth through grief and other touchstones for caregivers. Fort Collins, Co Companion Press.

James Murrough and Mary Ann Cohen

Advanced HIV infection are vulnerable to multiple causes of dementia, the most common of which is HAD. HIV-associated dementia is a metabolic enceph-alopathy caused by viral replication in brain macrophages and microglia and associated inflammatory and neurotoxic host responses (Gendelman et al., 1998 Zink et al., 1999 Anderson et al., 2002 Kaul et al., 2005). HAD is characteristic of a subcortical dementia in which cognitive decline, motor slowing, and behavior changes are predominant (Clifford, 2002). For a more detailed and thorough description of HAD we refer the reader to Chapters 3 and 19 of this volume. In this chapter we describe some of the behavioral consequences of HAD and their impact on persons with HAD, on their families, and on their care-givers. Caregivers of persons with HAD face multiple challenges that require special education and training. Some of the unique manifestations of HAD include accidental firesetting, violent behavior, and the repetitive taking of other...

Objectives for a Clinical Trial

The primary objective of the study is to evaluate the effects of treatment on a critical hallmark of cachexia, the patients' loss of lean body mass. Lean body mass is a biologically rational endpoint and logical target measure for the efficacy assessment of anti-TNF-a therapy. Loss of meta-bolically active lean tissue, including skeletal respiratory muscle, is associated with worsened performance status, a higher incidence of infections and toxicities due to chemotherapy, progressive impairment of function, dependence on care-givers, and markedly decreased survival time. Clinical evidence of preservation of lean body mass in these cancer patients would provide proof of the concept that blocking the actions of TNF-a systemically with infliximab can inhibit the prote-olytic pathways of cachexia.

Accidental Firesetting

It is important that caregivers be aware of this potentially dangerous behavior among persons with HIV. We strongly recommend programs of smoking cessation. Ideally, all health care environments should be smoke free for fire prevention and for the health of both patients and staff. Smoking should be prohibited except with direct staff supervision and preferably out of doors with supervision. Staff education and frequent fire drills are important. Warning signs of unsafe smoking include severe dementia, delirium, visual impairment, and neuropathy. Specific measures that can be taken to decrease the risk of firesetting include limiting unsupervised cigarette smoking, providing flame-retardant clothing, and encouraging smoking cessation.

Severely and Persistently Mentally III Populations

Several investigators have examined integrated treatments for SPMI adults. Effectiveness trials by Drake and colleagues have obtained more success in decreasing substance use (Drake et al., 1998 McHugo, Drake, Teague, & Xie, 1999) and hospitalization (McHugo et al., 1999) than in diminishing psychiatric symptoms (Drake, Yovetich, Bebout, Harris, & McHugo, 1998 Drake et al., 1998) or improving functional status or quality of life (Drake et al., 1997). However, these interventions did not compare patients randomized to different treatments. Rather, treatment clinics were assigned to administer one intervention versus another. A recent review of the prospective, controlled trials of integrated treatment programs for SPMI dually diagnosed individuals (Jeffery, Ley, McLaren, & Siegfried, 2003) concluded that methodological flaws precluded determining whether one particular integrated treatment model is more effective than another, or whether integrated treatment in general is...

Transfusion In Palliative Care

When, quality may not be significantly altered.92-94 Transfusions can be administered in the patient's home as well as in conventional care settings however, home transfusion therapy requires greater commitment and communication between care givers in order to provide safe and efficient transfusion therapy.95-98 Home transfusion therapy, and transfusion in the hospice setting, has been well-received by those patients unable or unwilling to travel to the hospital or infusion unit.99-101 If palliative care initiatives for adult and pediatric patients are to be performed in the home, then transfusion therapy should be given consideration in this setting. Adverse reactions to transfusions should be handled with the same due diligence as in any other conventional care setting in order to guard against and prevent any increased morbidity and mortality.97-101

Theoretical Constructs

And replace autism with the term presymbiosis here. The second stage is normal symbiosis, in which the infant functions as if the caregiver and infant form a dual unity, occurring from about 2 to 4 months of age. The third stage, separation-individuation, has been divided by Mahler into subphases differentiation (about 4 to 11 months), in which the infant shifts from an inward-directed focus to outward-directed tension and alertness practicing (about 11 to 17 months), in which the newly mobile infant moves away from the symbiotic orbit to explore the world, returning to the mother periodically for refueling rapprochement (about 18 to 24 months), in which the toddler becomes increasingly aware of his or her vulnerability and thus seeks closeness with the mother, yet simultaneously has a strong need for separateness and autonomy and on the way to object constancy (about 24 to 36 months), in which the toddler increasingly separates from the mother while integrating the good and bad parts...

Companion Animals and Human Health

Studies of Alzheimer's disease patients showed that animal-assisted therapy (especially with dogs) is associated with less aggression, agitation, and wandering, and more social interaction (7-10). Companion animals also have benefits for caregivers (11). Although people with Alzheimer's disease may have seizures as a consequence of the condition, studies of the effect of this therapy present little comment on seizure frequency. Work with people who have spinal cord injury suggests that animal-assisted therapy may provide sensory stimulation, reduce stress, increase self-esteem, and help the patient express feelings (12). At least one report documents the benefits of pet ownership for people living with HIV infection pet ownership is said to promote self-esteem although the evidence for this and for the use in spinal cord injury rehabilitation is mainly anecdotal (13).

Pcp0304rptSurvivorshippdf

Mony received at 5 meetings conducted between May 2003 and January 2004, as well as additional data gathering. The nearly 200 meeting participants included survivors, caregivers, healthcare providers, advocates, and others who candidly described their experiences of life after cancer and the issues of providing care and support. Testimony was provided both in formal hearings and at evening Town Hall meetings.

Complications And Obstacles For Fap Therapists In Treating Complex Ptsd

Efforts to understand therapists' and caregivers' reactions to traumatic material and to provide help for them are underway (Cadell, Regehr, & Hemsworth, 2003 Figley, 2002 Follette et al., 1994 Jenkins & Baird, 2002 Holmqvist & Anderson, 2003 Pearlman & Mac Ian, 1995). This new effort is not surprising, given that over 50 or professionals who work with trauma report feeling distressed and 27 report experiencing extreme distress (Meldrum, King, & Spooner, 2002). Working with traumatized clients can be emotionally draining for the therapist. Given that about 30 of therapists also report having experienced trauma during childhood, the questions of if and how these histories contribute to therapeutic process and outcome are frequently explored (Follette et al., 1994 Jenkins & Baird, 2002).

The Developmental Basis of Psychotherapeutic Processes

Earlier affective interactions between a baby and his or her caregiver (e.g., a smile begetting a smile). At each stage of early cognitive development, emotional interactions lead the way. The meaning of words, early quantity concepts (a lot to a 21 2-year-old is more than he expects a little is less than he wants), logical and abstract thinking, and even important components of grammar depend on specific types of emotional interactions (Greenspan, 1997b Greenspan & Wieder, 1999). Similarly, early ego development can now be traced to specific types of early emotional interactions. For example, complex reciprocal affective interactions in the second year of life enable children to begin integrating affective polarities and form a more integrated sense of self.

Health Utilities Index

Self- Interviewer Telephone Caregiver- and Proxy-administered Self-administered versions 6 to 10 minutes (mean 8 minutes) Interviewer-administered versions 3 to 6 minutes (mean 4 minutes) Yes no -descriptive phrases of levels from HUI health status classification systems Global score Scores by dimension Higher scores show better QoL Yes

How to Use This Book

The book is written for a lay audience patients, their families, and caregivers. Part I presents a primer on kidneys, explaining what happens when kidneys fail and some of the reasons that might have led to their failure. Once that is established, we then move on to what can be done to make life better for a kidney failure patient.

Methodology

A MEDLINE search between 1966 and April 1999 (Table 2.1) was conducted to better define the frequency with which dual-blind studies are misleadingly reported as doubleblind in the CAM literature. MEDLINE is a well-known biomedical bibliographic database of articles about health care that is published by the United States National Library of Medicine. (Double-blind method was used as a key string and cross-referenced with different CAM modalities in which clinical trials using double-blind methodology were unlikely.) The scope note for double-blind method as a medical subject heading (MeSH) term in MEDLINE (A method of studying a drug or procedure in which both the subjects and investigators are kept unaware of who is actually getting which specific treatment) uses the term investigators but implies the actual caregivers. Regrettably, in several studies (4-6), the description of the methodology was poor, and we could not discern the methods. These studies were excluded from our sample....

Results

Patients also served as the evaluators in some of the studies we reviewed. This methodology is commonly used when the outcome or the independent variable is subjective (e.g., postoperative pain or nausea). We consider this methodology to be a modified version of dual-blind because patients are still open to suggestions by caregivers. Further, a patients' perception of the treatment or the interaction with their caregiver can interfere with their role as evaluators. Thus, it is even more difficult to control for all sorts of confounds using this method. These weaknesses make this modified version of the dual-blind method very problematic.

Discussion

The term double-blind is used in two different ways that impair its usefulness as a methodologic recommendation and as a descriptor. In its legitimate usage, double-blind implies that neither the patient nor the caregiver is aware of the intervention performed. In its aberrant use, however, this term is used to describe an experimental arrangement in which two parties are blind, but a critical third party is not. Most often, the patient and an external evaluator investigator are blind but the person actually providing the care is unblinded. Confusion exists around this concept. iment can help differentiate between treatment and the control conditions, but it does not guarantee full blindness or the ability to detect the subtle influences on the unblind-ed party. Unless the caregiver is blind to the research condition, as can be done easily in most drug studies, this research methodology cannot control for the caregiver biases. The expectations of physicians, as well as subtle messages...

Case

None of these strategies is superior to the other. It is with the degree of liberty to move through the four quadrants of the diagram that one can be more comfortable with uncomfortable feelings. The first task of the caregiver is to respect the preferred coping styles of the patient. Only then he can invite the patient to broaden his repertoire and to try other coping strategies.

Commentary

Caspi and his colleagues provide a valuable look at the vexing problem of proof. How do we determine if a standard or alternative complementary therapy actually works and is safe Western medicine has faced a challenging road to reach its current burden of proof. Complementary and alternative medicine (CAM) remains enormously popular among diverse segments of Western and non-Western societies. Proving the efficacy and safety of these techniques poses significant challenges. In part, the medical-scientific culture that defines mainstream medicine is different than the CAM culture that runs parallel and divergent from it however, when it comes to proof, we are left with few alternatives that eliminate the bias inherent in patients, caregivers, and scientific researchers.

Perioperative Pain

Death distress is usually more profound in young patients and appears to be inversely correlated to spiritual groundedness (101). Differing spiritual beliefs between the caregiver and the adolescent patient can be a cause of worsening distress. Health professionals are encouraged to be familiar and nonjudgmental of spiritual or religious beliefs of their patients (102).

Beneficence

The principle of beneficence places a high value on acting for the benefit of others. The primary focus is benefit to patient, but healthcare decisions may also provide benefits to family members, employers, a variety of others, or even society as a whole, provided that they are also in the best interest of the patient. The most obvious and direct benefit of pain management is the alleviation of suffering, and other benefits may include improved physical, psychological, and social function, reduced demands on caregivers, or more productive work life. The ethical obligation to manage pain and relieve the patient's suffering is at the core of the health professional' s commitment and a fundamental responsibility 2, 9 . Yet chronic pain tends to be undertreated as a result of focus on diagnosis and cure of disease 5, 10 and fear of opioid addiction 6, 11 and regulatory action 12 .

Clinical Care

Sadly, significant barriers persist to excellence in pediatric pain management both at the end of a child's life and through the course of the child's illness. Misperceptions and concerns relating to pain in childhood and pain relief must be proactively addressed as the child is reliant on the adult caregivers for access to measures that ensure their comfort (17). Although a cross-Canada survey of pain practices in pediatric oncology centers was conducted since entering the millennium, this age of presumed increased awareness, addiction was mentioned as a barrier to optimal pain management. This mirrors the concerns clinicians encounter (49).

Treatment Structure

An adult accompanies each young person. The adult has two tasks. The first task is to act as the guardian for the adolescent. This also means that the service provider, the hospital, does not have to be staffed with pediatric nurses to act as a guardian for the children, giving the environment more in common with home and school than a hospital ward and substantially reducing costs. The second is to enable the primary caregiver of the adolescent to be exposed to treatment. This has become more explicit as an aim over the history of the treatment. The accompanying adult, usually the mother (although we have had good results with grandparents and older siblings), is present during most of the therapy sessions and is expected to participate in group discussion, exercise, and activity sessions.

Alzheimers Disease

All subjects were submitted to nutritional, neuropsychological, and functional evaluation. The results showed that only the interview and the checklist that explored caregiver burden predicted weight loss in AD patients, suggesting the possibility that caregivers who consider themselves overburdened by the disease process are not willing to invest adequate resources to allow AD patients to properly nourish themselves. Clinical observation, among AD patients, of periods of weight gain, periods of acute weight loss, and greater fluctuations in weight suggest that the natural history of weight change in AD may be characterised by dysfunction in body weight regulation. However, it remains a fundamental concept that a nutritional education program for caregivers of AD patients is the best way to prevent weight loss and improve the nutritional status of these patients.

Conclusions

The adverse physiological, psychological, and economic effects of inadequate pain management have become increasingly recognized in recent years. This has been accompanied by a growing awareness on the part of patients and caregivers that pain need not be tolerated, and an increased emphasis amongst physicians on the proactive treatment of pain. The unmet need for new analgesics remains substantial. Recent advances in the neurobiology of pain, together with the development of new preclinical and clinical pain paradigms, have revealed new opportunities for the development of analgesics, and raised the exciting possibility of entirely novel classes of analgesics in the future.

MakeUp Work

Many children seem to be overwhelmed by the amount of make-up work when they return to school after a prolonged illness (4). Some children fear that they may not be able to complete all of the work, or that they may not understand the assignments. These feelings of self-doubt and negative cognitions may even exacerbate pain symptoms. In these cases, Walker suggested a structured plan in which a missed assignment is broken into manageable parts, with a schedule that underscores specific progress toward accomplishing missed assignments rather than completing final products. Caregivers and teachers can establish specific periods of time for making up missed assignments (e.g., performing make-up work for approx 30 minutes day). Frequently, caregivers must contact the school to determine what make-up work will be required and to negotiate a reasonable timeline for completing the assignments. A reduction in work assignments will sometimes be necessary if the child cannot manage the...

Infantile Anorexia

In this condition, the infant refuses to eat adequate amounts of food for at least 1 month, leading to significant growth deficiency. The onset of the food refusal under 3 years of age is most commonly during the transition to spoon- and self-feeding. Furthermore, the infant does not communicate hunger signals, lacks interest in food, but shows strong interest in exploration and or interaction with the caregiver. Infants with this infantile anorexia are usually referred for a psychiatric evaluation due to food refusal and growth failure. The infants' food refusal usually becomes of concern between 6 months and 3 years, most commonly between 9 and 18 months of age, during the transition to spoon- and self-feeding.

Learning Problems

A history of academic difficulties in one or more subject areas, problems with attention and concentration, failure to complete assignments, or an inappropriate class placement may signify a learning problem or a stressful experience. Some children may use pain to cope with such difficulties. To increase coping skills, caregivers may need to contact school personnel to develop a plan that might include special education services, tutoring, or assistance with organizational skills (4). Efforts should be made to minimize the chance of the plan failing, and procedures should be implemented that allow the child to make a smooth transition back to school.

Separation Anxiety

Separation anxiety refers to developmentally inappropriate and excessive anxiety concerning separation from home or from those to whom the child is attached (15). One symptom criterion for the diagnosis of separation anxiety disorder includes repeated complaints of physical symptoms (such as headaches or stomachaches, nausea or vomiting) when separation from major attachment figures occurs or is anticipated (p. 113). Typically, such symptoms occur on the morning of schooldays and are less pervasive on weekends when the child will not be separated from caregivers (4). Symptoms may reoccur on Sunday evening in anticipation of separation from caregivers to attend school on Monday. Often, caregivers of children with separation anxiety disorder have an enmeshed relationship with their children. Children may sleep with their parents and may sit very close to the parents during the interview (4). Both the caregiver and the child tend to perceive pain as so severe that it makes school...

Interventions

Walker recommended that a graduated plan be implemented that incorporates as its ultimate optimal goal returning to school full time (4). This is suggested because some children, particularly those who have separation anxiety, will become distressed at any mention of returning to school. Walker acknowledged that, if children with recurrent pain are required to attend school the day following their medical evaluation, it is likely that they may manifest a severe pain episode that will serve to prevent or impede school attendance. As noted, an important first step in assisting children in their return to school is the identification of obstacles and addressing these specific issues and concerns (4,18). Walker also suggested that the health care provider consult with both the child and the caregiver to identify a manageable goal for initial attendance at school. The provider generally begins with the goal of a half-day return to school. If the child or caregiver notes concern, the time...

Summary

When rewards are given, parents should also provide verbal praise. Rewards should be given for each period of school attendance but should diminish over time as the behavior is more concretely in place. It is important that all care-givers be involved in the program, and that the program be reviewed on a regular basis for revision and to reflect accomplishments, new goals, and new rewards. Long-term goals should include sustained school attendance.

Construction

The presence of everyday functional impairment is necessary to diagnose HIV-associated neurocogni-tive disorders. In patients with HIV, cognitive dysfunction has been associated with impairments in both basic and instrumental activities of daily living (Schif-fitto et al., 2001), poor adherence to HAART (Hinkin et al., 2002), and reduced ability to work (Rabkin et al., 2004a). There is no uniformly accepted or validated measure of functional impairment in HIV infection. Assessment should focus on instrumental activities of daily living (IADL), functions that allow individuals to live independently. These include shopping, cooking, cleaning and laundry, using the telephone, managing money, and adherence to medication (Lawton and Brody, 1969 Albert et al., 2003). As with cognitive complaints, self-reported functional impairment correlates poorly with neuropsychological test performance. Therefore, observations of family members, caregivers, and clinical assessment over time are key...

Affect Regulation

Sexual abuse can interfere with affect regulation development in two ways. First, the abuse itself directly contributes to affect regulation problems because it promotes chronic arousal. Second, the family environments of children who experience abuse provide little learning opportunity to develop affect regulation skills. Caregivers in such families often have affect regulation and impulse control problems themselves, such as mood disorders, domestic violence, and substance abuse problems (Shearer, Peters, Quaytman, & Ogden, 1990 Kellogg & Hoffman, 1997).

Double Protection

To their children than parents of children with asthma and parents of healthy children. The findings obtained were equivalent for the mothers and the fathers. We believe that, in order to be able to count their child among the lucky ones who will survive the disease, parents create an image of vitality and zest for life. This positive attribution by parents of children with cancer may be a beneficial coping strategy as long as the emotional feelings of children are not underestimated. Caregivers should be aware of this coping strategy, especially if this coping strategy is out of balance or pathological. It can also be possible that children give their parents the impression they are doing fine to protect their parents from the more negative emotions resulting from the stressful situation.

Hemispherectomy

Complete removal, or disconnection of one cerebral hemisphere, is indicated in patients with unilateral ictal onsets that are either multifocal or nonlocalizable to a single lobe associated with severe hemispheric dysfunction involving movement. Ideal candidates have already lost any usable function of the hand, particularly fine finger movements, and many are almost hemiplegic. The absence of a visual field deficit is not a contraindication to hemispherectomy as long as the patient and or primary caregivers are well-informed of the inevitable deficit and language function will relocate to the opposite hemisphere if the surgery is performed before the age of 10 and ideally before the age of 6. Outcomes can be excellent, with seizurefree rates of 60-70 in well selected candidates (77,78). Surgical procedures range from complete removal of the entire hemisphere to decortication or functional hemispherectomy. None of these procedures have been performed within an iMRI however, the latter...

Telephone Systems

Computer telephony systems are useful in the completion of simple, straightforward tasks, such as collecting daily diary data and sending reminders to attend appointments, practice skills, or submit data. These tasks have predictable outcomes, and limited variance in vocabulary is expected. The advantage of this use of telephony to the patient or caregiver is that they can enter data at times convenient to them rather than adapting to the timetable of the coach or clinic. Computer telephony systems, such as NUANCE (11), can now be used to respond to more general queries using voice recognition and disambiguation software to identify the question and generate a response from either a database or from a list of set answers to frequently asked questions. Although the use of filters and passwords provides some protection for children accessing health information on the Web, private networks guarantee the level of security, privacy, and vetting of content in a way that gives caregivers...

Risk Prediction

Risk prediction is of increasing importance for care-givers of adolescent and young adult cancer survivors who need to be provided with ongoing health surveillance to monitor the possible late effects of illness and treatment 34 . In addition, health insurance purchasers, payers, and policy makers also need this information to allocate resources appropriately 105 . Predicting resource utilization is key to managing defined populations in a prospective payment system and for proactively case-managing those at greatest risk of poor health. When practitioners know in advance which survivors are most likely to experience debilitating late effects of illness and treatment, they are able to target those individuals in order to minimize or prevent morbidity and associated costs.