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The psycho-oncology and social work services recognised that a cancer diagnosis and treatment can result in considerable emotional consequences for patients, yet the referral rate to both services was extremely low. Only very visibly distressed patients were being referred to the service. The “Distress Thermometer” (DT), a distress screening tool, was introduced as a pilot project with day care and inpatient oncology patients of St Vincent ' s University Hospital, Dublin, in an effort to improve the identification, management and treatment of psychological distress in oncology patients. The purpose of this paper is to evaluate the effectiveness of this new intervention.

The Psycho-oncology service in conjunction with the Medical Social Work Department and Nursing Management at St Vincent ' s University Hospital, Dublin, initiated a Distress Education Management and Training Programme (DEMP). The initiative involved providing a training programme for oncology nursing staff and the introduction of a distress-screening tool for patients. In 1998, the DT was developed and validated for evaluation of distress (and depression) in cancer. It was adopted into recommendations made by the US National Comprehensive Cancer Network. The DT is a simple, self-report, pencil and paper measure consisting of a line with a 0-10 scale anchored at the zero point with “No distress” and at scale point ten with “Extreme distress”. Patients are given the instruction, “How distressed have you been during the past week on a scale of 0-10”? Patients indicated their level of distress with a mark on the scale. Patients scoring 4 or above were regarded as requiring intervention. The DT includes a problem checklist. The patient is asked to identify those problems from the checklist which are contributing to their score. The use of the DT was evaluated through interviews with patients and professionals.

Patients who scored four or above (38 per cent of patients), were seen by the Oncology Social Worker for psychosocial assessment and mental health triage. Patients who scored above a certain level (usually above 12/20) in the clinical range on the Hospital Anxiety and Depression scale (3 per cent) were referred to Psycho-oncology. That 38 per cent of oncology patients required intervention from a specialist service accurately reflects international findings on the rate of distress among cancer patients.

Assessment of cancer patients ' distress levels in a structured and planned manner with a Distress Thermometer, as recommended by best international practice, works very effectively and should be considered for all cancer out-patients This will have implications in terms of staff that will be required to manage such a service.

This was the first time that this internationally recognised tool was used to such an extent and to positive effect in an Irish context.

The purpose of this paper is to carry out a quali-quantitative study to analyze unease and perceived stress in a population of 485 male and female police officers in a large city in northern Italy, and investigate the consequences of these and the coping strategies adopted. The working context the paper chose to investigate was the Municipal Police, which is characterized by strong links with the local community. As suggested in the literature, the paper focalized the attention both on organizational and operational stressors.

Quali-quantitative study: a self-administered questionnaire.

Results show that both men and women are self-critical and their evaluation of the professional and contextual circumstances in which they operate is filtered by pessimism and self-blame, with higher levels of somatization in women: female patrol police officers are at the highest risk of psychological distress.

This is, to the best of the knowledge, the first quali-quantities study in Italy to consider the gender variable within a single police force.

The uniqueness of the pre-hospital setting and the need for quick decision-making confronts pre-hospital emergency personnel with various moral conflicts that can lead to moral distress (MD) in them. This study aimed to design a valid scale for the assessment of MD in emergency medical service (EMS) staff.

This exploratory mixed-method study was conducted among the EMS provider's community. In the qualitative section, data were gathered and analyzed with semi-structured interviews and conventional content analysis, respectively. The initial pool of items was formed and the primary scale was designed. In the quantitative section, a methodological study was carried out to determine the psychometric properties of the scale including qualitative-quantitative face validity, qualitative-quantitative content validity with content validity ratio and index (CVR/CVI), construct validity by exploratory factor analysis (EFA), and convergent validity, internal consistency (Cronbach's alpha/ Omega McDonald's/ floor and ceiling effect) and stability with intra-class correlation (ICC).

After interviews with 14 emergency technicians, the initial scale was designed with 60 items. Of the total items, 17 poor items were dropped during face and qualitative content validity. In the content validity phase, the items with CVR > 0.62, modified Kappa > 0.74 were retained, which eliminated 23 items. EFA was conducted with 20 items and lead to the 5 factors. The floor and ceiling effect for the whole scale was zero. Finally, the reliability of the scale was confirmed (a = 0.83, O = 0.86, ICC = 0.95).

The developed 20-item scale is a valid and reliable scale for the assessment of the MD in EMS providers.

Nurse leaders are challenged by ethical issues in today’s complex health-care settings. The purpose of this study was to describe and analyze key elements of moral distress identified by nurse leaders from health-care systems in the USA, Germany, Austria and Switzerland. The aim was to develop an understanding of distressing ethical issues nurse leaders face in the USA and three German-speaking European countries.

This descriptive cross-sectional study surveyed a convenience sample of nurse leaders in the USA, Germany, Austria and Switzerland. The voluntary, anonymous survey also included qualitative questions and was distributed using the Qualtrics® platform. A thematic analysis of the qualitative data in each country was carried out and a comparative analysis identified similarities and differences between the groups of nurse leaders comparing the US data to that from three German-speaking European countries.

The survey was completed by 316 nurse leaders: Germany, Austria, and Switzerland (n = 225) and the USA (n = 91). Similar themes identified as causing all nurse leaders moral distress included a lack of individual and organizational integrity, hierarchical and interprofessional issues, lack of nursing professionalism, patient care/patient safety concerns, finances negatively impacting care and issues around social justice. Within these six themes, there were also differences between the USA and the three German-speaking European countries.

Understanding the experiences associated with distressing ethical situations can allow nurse leaders and organizations to focus on solutions and develop resilience to reduce moral distress in the USA and three German-speaking European countries.

The purpose of this paper is to examine the self-experience of people with moderate to advanced dementia. While people with dementia are widely assumed to lose their sense of self, emotions are preserved long into dementia and some can still discuss their lives, enabling exploration of respondents’ own self-conceptualisation of experience.

Ten people, purposively sampled, living in long-term residential or nursing care. A mixed methods design with Interpretative Phenomenological Analysis approach used semi-structured empathetic interviews to explore their experience and continuing goals, using supplementary information from family and others to contextualise core data. Data analysis identified emerging themes and superordinate concepts.

Sustained well-being and resistant ill-being emerged as major themes. Findings demonstrated continuity in sense of self, moral awareness and diversity of emotional reactions to living with dementia, associated with their emotional capital.

The sample was small and limited to well- and moderately funded care homes. How to provide such support in less-well-funded homes needs further research as do reasons for resistant ill-being in advanced dementia.

Findings suggest care provision for people with advanced dementia which acknowledges individual feelings may support their sustained well-being. Psychological assessments should take closer account of multiple factors in individuals’ situations, including their emotional capital.

Findings suggest everyday care of people with advanced dementia, may sustain their sense of self, well-being and emotional capital.

By empathically facilitating in-depth expression of individuals’ feelings and views, this research illuminates the personal self-experience of advanced dementia, hitherto little explored.

Hematopoietic stem cell transplant (HSCT) patients can suffer from long-term transplant-related complications that affect their quality of life and daily activities. This study, a narrative review, aims to report the impact of HCT complications, the benefits of rehabilitation intervention, the need for long-term care and highlights the research gap in clinical trials involving rehabilitation.

A comprehensive search strategy was performed on several databases to look for relevant articles published from 1998 to 2018. Articles published in English with the following terms were used: hematopoietic stem cell transplant, chronic graft-versus-host disease, rehabilitation, exercise, physical therapy, occupational therapy. A patient/population, intervention, comparison, and outcomes (PICO) framework was employed to ensure that the search strategies were structured and precise. Study year, design, outcome, intervention, sample demographics, setting and study results were extracted.

Of the 1,411 records identified, 51 studies underwent title/abstract screening for appropriateness, 30 were reviewed in full, and 19 studies were included in the review. The review found that, for the majority of patients who underwent HSCT and developed treatment-related complications, rehabilitation exercises had a positive impact on their overall quality of life. However, exercise prescription in this patient group has not always reflected the scientific approach; there is a lack of high-quality clinical trials in general. The review also highlights the need to educate healthcare policymakers and insurance companies responsible for rationing services to recognise the importance of offering long-term follow-up care for this patient group, including rehabilitation services.

A large number of HSCT patients require long-term follow-up from a multidisciplinary team, including rehabilitation specialists. It is important for healthcare policymakers and insurance companies to recognise this need and take the necessary steps to ensure that HSCT patients receive adequate long-term care. This paper also highlights the urgent need for high-quality rehabilitation trials to demonstrate the feasibility and importance of rehabilitation teams.

Healthcare policymakers and insurance companies need to recognise that transplant patients need ongoing physiotherapy for early identification of any functional impairments and appropriate timely intervention.

The purpose of this paper is to investigate the applicability of developed country turnaround predication models as well as an “in country” developed turnaround prediction model for a sample of financially distressed Malaysian companies over the period of 2000‐2007.

Multiple Discriminant Analysis (MDA) technique was used to determine companies' financial health.

It was found that severity of financial distress, profitability, liquidity and size are significant predictor variables in determining turnaround potential of distressed companies in Malaysia. The findings show that developed country turnaround predication models have relatively better prediction accuracies compared to turnaround model based on Malaysian firm‐level data. These models' prediction accuracies were gauged by comparing their predicated successful/failed turnaround companies (Type I and II errors) with actual classification of successful/failed turnaround companies by the Bursa Malaysia, and it was found that developed country models were better than model developed using Malaysian data in identifying correctly some of the actual successful turnaround companies.

The paper's comparisons show that Bursa's methodology is appropriate in classifying and monitoring the distressed companies.

This is believed to be the first paper to examine turnaround of the companies in Malaysian context.

The purpose of this paper is to investigate the vehicle-based sensor effect and pavement temperature on road condition assessment, as well as to compute a threshold value for the classification of pavement conditions.

Four sensors were placed on the vehicle’s control arms and one inside the vehicle to collect vibration acceleration data for analysis. The Analysis of Variance (ANOVA) tests were performed to diagnose the effect of the vehicle-based sensors’ placement in the field. To classify road conditions and identify pavement distress (point of interest), the probability distribution was applied based on the magnitude values of vibration data.

Results from ANOVA indicate that pavement sensing patterns from the sensors placed on the front control arms were statistically significant, and there is no difference between the sensors placed on the same side of the vehicle (e.g., left or right side). A reference threshold (i.e., 1.7 g) was computed from the distribution fitting method to classify road conditions and identify the road distress based on the magnitude values that combine all acceleration along three axes. In addition, the pavement temperature was found to be highly correlated with the sensing patterns, which is noteworthy for future projects.

The paper investigates the effect of pavement sensors’ placement in assessing road conditions, emphasizing the implications for future road condition assessment projects. A threshold value for classifying road conditions was proposed and applied in class assignments (I-17 highway projects).