Summa St. Thomas Hospital

Given the devastation caused by disasters and mass violence, it is critical that intervention policy be based on the most updated research findings. However, to date, no evidence-based consensus has been reached supporting a clear set of recommendations for intervention during the immediate and the mid-term post mass trauma phases. Because it is unlikely that there will be evidence in the near or mid-term future from clinical trials that cover the diversity of disaster and mass violence circumstances, we assembled a worldwide panel of experts on the study and treatment of those exposed to disaster and mass violence to extrapolate from related fields of research, and to gain consensus on intervention principles. We identified five empirically supported intervention principles that should be used to guide and inform intervention and prevention efforts at the early to mid-term stages. These are promoting: 1) a sense of safety, 2) calming, 3) a sense of self- and community efficacy, 4) connectedness, and 5) hope.

Using a nationally representative sample of American married or cohabiting women, this prospective study examined women who reported or denied intimate partner violence (IPV) at wave 1 and compared them on a range of psychosocial outcomes at a 5-year follow-up. This study also examined the rate of divorce or separation during the 5-year interval among women who reported IPV at wave 1 and explored whether certain predictors were related to ending an abusive relationship with an intimate partner during the period. Women with IPV at wave 1, compared to women without IPV, were significantly more likely to experience a greater degree of depressive symptoms and functional impairment and less self-esteem and life satisfaction at the 5-year follow-up. Also, nearly half of the women in an abusive relationship left the relationship within the period. Leaving the abusive relationship was associated with lower individual income and more social support at wave 1.

Although posttraumatic stress disorder (PTSD) factor analytic research has yielded little support for the DSM-IV 3-factor model of reexperiencing, avoidance, and hyperarousal symptoms, no clear consensus regarding alternative models has emerged. One possible explanation is differential instrumentation across studies. In the present study, the authors used confirmatory factor analysis to compare a self-report measure, the PTSD Checklist (PCL), and a structured clinical interview, the Clinician-Administered PTSD Scale (CAPS), in 2,960 utility workers exposed to the World Trade Center Ground Zero site. Although two 4-factor models fit adequately for each measure, the latent structure of the PCL was slightly better represented by correlated reexperiencing, avoidance, dysphoria, and hyperarousal factors, whereas that of the CAPS was slightly better represented by correlated reexperiencing, avoidance, emotional numbing, and hyperarousal factors. After accounting for method variance, the model specifying dysphoria as a distinct factor achieved slightly better fit. Patterns of correlations with external variables provided additional support for the dysphoria model. Implications regarding the underlying structure of PTSD are discussed.

Cases of Legionnaires' disease have been categorized as definitive and presumptive. The sensitivity and specificity of antibody titers of > or = 256 and of urinary antigen ratios of > or = 3 were evaluated in 68 patients with "definitive" Legionnaires' disease and in 636 patients with pneumonia who had negative cultures and did not have fourfold rises in titers of antibody to Legionella pneumophila. An acute-phase antibody titer of > or = 256 did not discriminate between cases and noncases (10% vs. 6%; P = .29). The urinary antigen assay gave a positive result in fewer than 1% of noncases but was positive in 55.9% of all cases. This assay was most sensitive (80%) in cases in which L. pneumophila serogroup 1 was isolated. We propose that the case definition for definitive Legionnaires' disease be expanded to include positive urinary antigen assays and that the category of presumptive Legionnaires' disease--based on acute-phase or standing antibody titers of > or = 256 in the nonoutbreak setting--be discarded. The urinary antigen assay will be a valuable tool in the prompt diagnosis of Legionnaires' disease.

In the United States and around the world, effective, efficient, and reliable strategies to provide emergency care to aging adults is challenging crowded emergency departments (EDs) and strained healthcare systems. In response, geriatric emergency medicine clinicians, educators, and researchers collaborated with the American College of Emergency Physicians, American Geriatrics Society, Emergency Nurses Association, and Society for Academic Emergency Medicine to develop guidelines intended to improve ED geriatric care by enhancing expertise, educational, and quality improvement expectations, equipment, policies, and protocols. These Geriatric Emergency Department Guidelines represent the first formal society-led attempt to characterize the essential attributes of the geriatric ED and received formal approval from the boards of directors of each of the four societies in 2013 and 2014. This article is intended to introduce emergency medicine and geriatric healthcare providers to the guidelines while providing recommendations for continued refinement of these proposals through educational dissemination, formal effectiveness evaluations, cost-effectiveness studies, and eventually institutional credentialing.

Posttraumatic stress disorder (PTSD) factor analytic research to date has not provided a clear consensus on the structure of posttraumatic stress symptoms. Seven hypothesized factor structures were evaluated using confirmatory factor analysis of the Posttraumatic Stress Disorder Checklist, a paper-and-pencil measure of posttraumatic stress symptom severity, in a sample of 1,218 women who experienced a broad range of workplace sexual harassment. The model specifying correlated re-experiencing, effortful avoidance, emotional numbing, and hyperarousal factors provided the best fit to the data. Virtually no support was obtained for the Diagnostic and Statistical Manual of Mental Disorders, fourth edition (DSM-IV; American Psychiatric Association, 1994) three-factor model of re-experiencing, avoidance, and hyperarousal factors. Different patterns of correlations with external variables were found for the avoidance and emotional numbing factors, providing further validation of the supported model.

Intimate partner violence continues to be a social crisis that results in a complex array of physical and mental health problems. Although resources to counteract the effects of the violence are sometimes available, the posttrauma sequelae may prevent access by those in need. Using the Chicago Women's Health Risk Study, a naturalistic longitudinal study of 320 abused women, the current study examined the impact of posttraumatic stress disorder (PTSD) and depression on battered women's safety at follow-up. Participants completed both a baseline and follow-up interview, including data on abuse experiences. Results suggest symptoms of PTSD predict severity of violence at follow-up over the impact of help-seeking behaviors, perceived helpfulness of these behaviors, and social support. Implications of results are discussed.

Empowerment is a primary outcome of many health interventions with women. Typical outcome measures, however focus exclusively on specific symptoms, neglecting the clinically important attitudes and behaviors associated with increased empowerment and well-being. Empowerment is conceptualized as enabling women to access skills and resources to cope more effectively with current as well as future stress and trauma. This study investigated a new measure of personal empowerment in women, the Personal Progress Scale-Revised (PPS-R). Results suggest that the PPS-R is a promising measure of empowerment in women, demonstrating excellent reliability and validity in diverse sample of women. Additionally, the PPS-R demonstrated preliminary utility with a subgroup of abused women, a vulnerable group of women for whom empowerment is a variable of high importance.

In the United States and around the world, effective, efficient, and reliable strategies to provide emergency care to aging adults is challenging crowded emergency departments (EDs) and a strained health care system. In response, geriatric emergency medicine (EM) clinicians, educators, and researchers collaborated with the American College of Emergency Physicians (ACEP), American Geriatrics Society (AGS), Emergency Nurses Association (ENA), and the Society for Academic Emergency Medicine (SAEM) to develop guidelines intended to improve ED geriatric care by enhancing expertise, educational, and quality improvement expectations; equipment; policies; and protocols. These "Geriatric Emergency Department Guidelines" represent the first formal society-led attempt to characterize the essential attribute of the geriatric ED and received formal approval from the boards of directors for each of the four societies in 2013 and 2014. This article is intended to introduce EM and geriatric health care providers to the guidelines, while providing proposals for educational dissemination, refinement via formal effectiveness evaluations and cost-effectiveness studies, and institutional credentialing.

Do you feel overwhelmed when attempting to treat battered women with ongoing safety concerns? Could battered women in shelters benefit from psychotherapy in addition to the case management they traditionally receive? What type of treatment would be most beneficial for battered women in shelters? Posttraumatic Stress Disorder (PTSD) is the most prevalent disorder associated with intimate partner violence (IPV). PTSD is associated with severe impairment and loss of resources which can severely impact a sheltered battered woman's ability to establish long-term safety for herself and her children. Conequently, we have developed a new treatment for sheltered battered women with Posttraumatic Stress Disorder (PTSD), Helping to Overcome PTSD through Empowerment (HOPE). HOPE is a short-term cognitive-behavioral treatment in a preliminary stage of development for battered women with PTSD in domestic violence shelters. It focuses on stabilization, safety, and empowerment and teaches women skills to manage their PTSD symptoms which may interfere with their ability to access important community resources and establish safety for themselves and their children. A case example utilizing HOPE is offered. Future directions and clinical applications are discussed.

Despite the high rates of posttraumatic stress disorder (PTSD) among battered women in shelters, virtually no treatments for these women have been developed or tested. This study evaluated the initial feasibility and efficacy of an individual, cognitive-behavioral treatment for battered women with PTSD or subthreshold PTSD in shelters. Eighteen women participated in an open-trial where they received a new treatment, Helping to Overcome PTSD with Empowerment (HOPE). Intent-to-treat analyses indicate that participants experienced significant decreases in PTSD symptoms, depressive symptoms, in their loss of resources and degree of social impairment; and significant increases in their effective use of community resources. These gains were maintained over time. Results should be interpreted with caution due to the small sample size and lack of a control group.

Posttraumatic growth (PTG)-deriving benefits following potentially traumatic events-has become a topic of increasing interest. We examined factors that were related to self-reported PTG, and the relationship between PTG and symptoms of post-traumatic stress (PTS) following the 2006 Israel-Hezbollah. Drawing from a national random sample of Israel, data from 806 terrorism-exposed Israeli adults were analyzed. PTG was associated with being female, lower education, greater recent terrorism exposure, greater loss of psychosocial resources, greater social support, and greater self-efficacy. PTG was a consistent predictor of PTS across hierarchical linear regression models that tested whether demographic, stress, or personal resources moderated the relationship between PTG and PTS. PTG did not relate to PTS differently for people who differed by age, sex, ethnicity, education, religiosity, degree of terrorism exposure, self-efficacy, nonterrorism stressful life events, and loss of psychosocial and economic resources. PTG was not related to well-being for any of these subgroups.

Child physical abuse (CPA) and child sexual abuse (CSA) were hypothesized to be associated with revictimization and interpersonal resource loss in adulthood. These adulthood experiences were, in turn, hypothesized to increase risk for current posttraumatic stress disorder (PTSD). High-risk women were recruited from an innercity drug and alcohol treatment center (N = 105). Interpersonal resource losses, partner-produced physical assault, adulthood rape, CPA, and CSA had direct effects on PTSD. CPA and CSA also had indirect effects on PTSD through rape, which, in turn, predicted PTSD. Results suggest that the traumatic origins of current PTSD among substance-using women are multifaceted and support the importance of considering interpersonal coping resources in evaluating and treating female substance users.

Intimate Partner Violence (IPV) is a significant societal problem associated with Posttraumatic Stress Disorder (PTSD) and depression, which in turn can cause impairment in a variety of areas. Previous research suggests that African American women experience more frequent and severe IPV than White women, yet report fewer PTSD symptoms related to their abuse. One proposed explanation for this relationship is that African American women are more resilient due to internal coping methods such as empowerment; however, this relationship has yet to be empirically tested. The current study investigates the role of empowerment in mediating IPV-related psychological distress in a sample of African American and White battered women (N = 204). As hypothesized, personal empowerment mediated the relationships between race and PTSD and race and depression, suggesting that empowered African American women may demonstrate greater resiliency when faced with IPV. Results are discussed in terms of their implication for developing culturally-sensitive empowerment-based interventions for battered women.

Abstract Foster parents have special needs which must be addressed to retain them in the child welfare system. Several of these needs may be addressed within their foster parent training experience; however, little research is available to determine the effectiveness of these training programs. What little research is available is frought with methodological limitations, calling into question the reliability, validity, or generalizability of study results. This article provides a comprehensive review of 17 studies, published between 1980 and 2007, investigating foster parent training programs. The studies reviewed include 1 investigation relying solely on case records, 1 case study, and 15 group studies (5 using no control group and 10 utilizing a control group). This article points out research deficiencies and outlines several suggestions for future research. KEYWORDS: child welfarefoster parentsparent training

Abstract The purpose of this study was to examine the prevalence and predictors of transgender identity disclosure in a gender minority sample. Participants (n = 156) were recruited from a New England transgender conference, and most (81%) reported male gender assignment at birth. Significant predictors of disclosure included age, transgender group, amount of time dressing as the identified gender, and involvement in the transgender community. The majority of participants indicated that they had disclosed to spouses and friends, followed by siblings and mothers. Individuals who disclosed to a greater number of people reported more social support than those who had disclosed to fewer people. Implications and limitations of this study are discussed.

Fungal infection is a rare but devastating complication of total joint arthroplasty. Many patients require removal of the components and resection arthroplasty for cure; however, revision arthroplasty with medicated polymethylmethacrylate bone cement may be used to salvage the joint. Some studies have documented the efficacy of mixing antibiotics with polymethylmethacrylate, but the efficacy of antifungal drugs when mixed with polymethylmethacrylate is unknown. An in vitro agar diffusion method was used in the current study to investigate this potential, and several clinically important conclusions resulted: (1) after incorporation into bone cement, fluconazole and amphotericin B remained active whereas 5-flucytosine did not, (2) inhibitory activity improved with greater drug concentrations, and (3) more drug eluted from Palacos R than Simplex P cement.

Medical librarianship literature has focused primarily on the needs of physicians, medical students, and faculty, while the library needs of nurses have been covered infrequently. The paucity of such literature and the perceived limited use of the library by nurses stimulated one hospital librarian to examine nurses as a user group. This article presents a case study about the use of a marketing audit and strategies targeted to nurses in one hospital setting

The present study aimed to investigate the prevalence of self-reported impairment (Criterion F) as part of a probable DSM-IV diagnosis of posttraumatic stress disorder (PTSD) within a sample of 1001 Israeli Jews subjected to direct and indirect exposure to rocket attacks. Further, the present study aimed to investigate predictors of endorsing posttraumatic stress (PTS)-related impairment, with specific attention to the influence of resources and resource loss. Data were collected via phone surveys. Twenty-nine percent of the sample reported impairment; however, only 19% of those reporting impairment met criteria for probable PTSD. Logistic regression results indicated that psychosocial resource losses, experiencing personal injury or injury to a family member or close friend, experiencing other major life stressors in the past year, having poorer health, having significant sleep difficulty, and having traditional (moderate) religious practices, significantly predicted PTS-related impairment. Results suggest that addressing impairment only within the context of full PTSD misses many individuals experiencing significant PTS-related impairment.

Prior research has identified both rumination and negative affect (NA) as dimensional constructs related to the development and maintenance of posttraumatic stress disorder (PTSD). While both dimensions demonstrate significant positive relationships with symptoms of PTSD, the relationship between the two within the context of the disorder has yet to be explored. Consistent with prior research in the social anxiety literature, the present study seeks to examine a model of mediation by which rumination accounts for the significant relationship between NA and PTSD symptoms. Participants included 65 female interpersonal trauma survivors diagnosed with PTSD using structured, clinician-administered interviews. Both NA and rumination were observed as significant predictors of PTSD symptoms, and the variables were significantly associated with each other. However, NA was no longer a significant predictor of PTSD symptoms when rumination was entered into the mediation model, suggesting full mediation of the relationship by rumination. Results from the current study suggest a complex relationship between NA and rumination in interpersonal trauma survivors with PTSD, such that a ruminative cognitive coping style may either mitigate or exacerbate PTSD symptoms in the presence of sustained negative emotion. The current findings provide support for a cognitive model of PTSD, within which PTSD symptoms are influenced via negative, ruminative cognitions. Primary implications of these results include (a) the consideration of assessment of rumination in interpersonal trauma survivors with PTSD in clinical settings; (b) the selection of treatment that may address a ruminative cognitive style in this population, given the mediation between subjective distress and PTSD symptoms by rumination; and (c) the necessity for the validation of this mediation model within other traumatized populations.