This report is the first empirical study to compare pathological gambling (PG), posttraumatic stress disorder (PTSD), and their co-occurrence. The sample was 106 adults recruited from the community (35 with current PG; 36 with current PTSD, and 35 with BOTH). Using a cross-sectional design, the three groups were rigorously diagnosed and compared on various measures including sociodemographics, psychopathology (e.g., dissociation, suicidality, comorbid Axis I and II disorders), functioning, cognition, life history, and severity of gambling and PTSD. Overall, the PG group reported better psychological health and higher functioning than PTSD or BOTH; and there were virtually no differences between PTSD and BOTH. This suggests that it is the impact of PTSD, rather than comorbidity per se, that appears to drive a substantial increase in symptoms. We also found high rates of additional co-occurring disorders and suicidality in PTSD and BOTH, which warrants further clinical attention. Across the total sample, many reported a family history of substance use disorder (59%) and gambling problems (34%), highlighting the intergenerational impact of these. We also found notable subthreshold PTSD and gambling symptoms even among those not diagnosed with the disorders, suggesting a need for preventive care. Dissociation measures had mixed results. Discussion includes methodology considerations and future research areas.
The benefits of involving patients as partners in research across diverse medical and psychiatric settings are well established in the literature. However, researchers continue to struggle to access, engage and retain participants from hard-to-reach populations. The main objective of this study was to co-create pet therapy activities with patients admitted for serious and complex mental illness to a large urban mental health and addiction hospital. Informed by the principles of participatory action research methodology, we conducted focus group discussions with 38 inpatients in seven different clinical units. An experienced volunteer handler and a certified therapy dog helped facilitate our discussions. Participating researchers, recreational therapists, volunteer handlers and our participants all reported that the presence of a certified therapy dog at each of our discussions was integral to their success. Certified therapy dogs increased the motivation to participate in our study, helped to build rapport with participants and created connections in our discussions that enriched our data. To our knowledge our study is the first to demonstrate the value of using a therapy dog as a participatory research tool in a healthcare setting. The authors believe that therapy dogs are a low-tech intervention that could be used effectively to engage hard-to-reach populations in research about their treatment and care in a diverse range of medical settings. These findings support the creation of a pilot study to test the value of including therapy dogs in patient-centered research with vulnerable and hard-to-reach populations.
Introduction Despite advances in anaesthesia many children are distressed at induction of anaesthesia (1). The use of paediatric premedication has declined considerably over the last ten years (2). The aim of our audit was to look at preoperative behaviour and premedication practice at our institute. Method One hundred and seventy seven patients undergoing elective procedures in the main theatre suite at the hospital were audited. This therefore excluded cardiac and neuroanaesthesia. Behaviour scores in the anaesthetic room prior to and at induction were assessed by the operating department assistants. We looked at frequency, type, dose and timing of premedication. The induction method, age and previous anaesthesia were noted. Parents routinely accompany children at induction of anaesthesia. Results Overall 75% of children had satisfactory behaviour scores in the anaesthetic room dropping to 47% at induction. The graph shows the age distribution and associated behaviour scores. Of the patients with satisfactory behaviour scores all received their premedication between 20 and 60 min prior to induction. Three patients in the unsatisfactory behaviour group received their premedication outside this optimal time. Children who had had previous anaesthetics (76%) had worse behaviour scores than those with none both in the anaesthetic room and at induction with satisfactory scores of 71% vs. 84% and 44% vs. 51 % respectively. Those having gas inductions (63%) had worse behaviour scores at induction compared with children having intravenous induction with satisfactory scores of 42% vs. 52% respectively. 12% of all children audited received a sedative premedication. 16 received Midazolam 0.5 mg/kg, 3 Temazepam 10 or 20 mg and 1 Triclofos 50 mg·kg−1 all given orally. The premedication rate for children with previous anaesthetic experience was 14% vs. 5% in those with none. Only 5% of children received an atropine premedication 20–40 mcg·kg−1 orally. Only 1 of the 14 children age 6 months and 2 of the 14 children age 6 months−1 year were premedicated with atropine. Discussion As a paediatric tertiary referral centre, many of the patients have previous experience of anaesthetics and have ongoing medical problems Our audit found that many of these children, especially age 1–3, are distressed at induction of anaesthesia despite methods shown to reduce peri‐operative anxiety, including play specialists. It also confirms the perceived trend for decreasing use of sedative and anticholinergic premedication. However several papers report decrease in distress at induction (1) especially in high‐risk groups (2) without undue delays in awakening and discharge using midazolain premedication. Conclusion It was decided that a more child friendly anaesthetic room with pictures, toys and other distractions would be helpful. There may also be a need to increase the use of sedative premedication in high‐risk groups especially preschool children.
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