Rasch analysis of the firefighters’ critical incident inventory questionnaire

BACKGROUND: The Critical Incident Inventory (CII) was developed to assess stressful exposures in firefighters and emergency service workers. The CII includes six subscales: trauma to self, victims known to fire-emergency worker, multiple casualties, incidents involving children, unusual or problematic tactical operations, and exposure to severe medical trauma. OBJECTIVES: To examine the construct validity of all subscales of the Critical Incident Inventory (CII) by assessing the unidimensionality of the scales, and the interval properties of CII subscales by examining fit to the Rasch model and ordering of item thresholds. METHODS: This was a secondary data analysis based on survey data collected from a sample of 390 firefighters. RESULTS: Item 4 and Item 20 were removed with the confirmation of unacceptable fit residual. This revised version of the CII showed satisfactory fit to the Rasch model by non-significant Chi-square test and acceptable level of item fit. We rescored the CII original version and considered all items as only dichotomous response options where 0 represented the original no experience, and 1 presents the combination of experiencing 1, 2, 3 cases. CONCLUSION: The re-appraisal of the revised version CII indicated a satisfactory level of Rasch model fit.

Current Utility of Sequential Organ Failure Assessment Score: A Literature Review and Future Directions

The Sequential Organ Failure Assessment (SOFA) score is commonly used in the Intensive Care Unit (ICU) to evaluate, prognosticate and assess patients. Since its validation, the SOFA score has served in various settings, including medical, trauma, surgical, cardiac, and neurological ICUs. It has been a strong mortality predictor and literature over the years has documented the ability of the SOFA score to accurately distinguish survivors from non-survivors on admission. Over the years, multiple variations have been proposed to the SOFA score, which have led to the evolution of alternate validated scoring models replacing one or more components of the SOFA scoring system. Various SOFA based models have been used to evaluate specific clinical populations, such as patients with cardiac dysfunction, hepatic failure, renal failure, different races and public health illnesses, etc. This study is aimed to conduct a review of modifications in SOFA score in the past several years. We review the literature evaluating various modifications to the SOFA score such as modified SOFA, Modified SOFA, modified Cardiovascular SOFA, Extra-renal SOFA, Chronic Liver Failure SOFA, Mexican SOFA, quick SOFA, Lactic acid quick SOFA (LqSOFA), SOFA in hematological malignancies, SOFA with Richmond Agitation-Sedation scale and Pediatric SOFA. Various organ systems, their relevant scoring and the proposed modifications in each of these systems are presented in detail. There is a need to incorporate the most recent literature into the SOFA scoring system to make it more relevant and accurate in this rapidly evolving critical care environment. For future directions, we plan to put together most if not all updates in SOFA score and probably validate it in a large database a single institution and validate it in multisite data base.

Posttraumatic Stress Disorder and the Nature of Trauma in Patients with Cardiovascular Diseases: A Case-Control study

IntroductionA large body of evidence indicates a significant and morbid association between posttraumatic stress disorder (PTSD) and cardiovascular disease (CVD). Few studies, however, have addressed the range of trauma in this medical population, from massive heart attack, to defibrillator shock to previous interpersonal aggression.ObjectiveThe main objective of this study was to examine the nature of trauma associated with the development of PTSD in CVD patients. More precisely, we were interested in knowing if trauma was medical in nature and whether cumulative trauma resulted in PTSD.MethodsWe performed a 1:3 case-control study. The authors compared CVD patients diagnosed with PTSD (n=37) to those with adjustment disorder (n=111) in terms of trauma/stressor types and medical and demographic characteristics.ResultsHalf (51%) of CVD patients suffering from PTSD had endured a medical trauma, 35% an external (non-medical) trauma, and 14% both. There were no significant differences with CVD patients diagnosed with adjustment disorder, 40% of them having experienced a medical stressor, 40% an external (non-medical) stressor and 20% both. Cumulative trauma was seen in only 19% of CVD patients suffering from PTSD. Traditional risk factors (female sex, younger age) were not prominent in CVD patients with PTSD as compared to those with adjustment disorder. Cases were, however, significantly more likely to have psychiatric antecedents and recent surgical interventions.ConclusionsBy uncovering characteristics of PTSD patients/trauma in CVD patients, this work will serve future research and clinical initiatives to better screen at-risk patients or at-risk medical situations.

Posttraumatic Stress Disorder Associated with Cancer Diagnosis and Treatment

Posttraumatic stress disorder (PTSD) is a set of maladaptive responses to intensely fearful or life-threatening events. Unlike other traumas, the trauma of cancer is not generally a single catastrophic event, but is instead an ongoing series of fearful and painful experiences associated with the threat of death. Unlike the DSM-IV, the DSM-5 defines medical trauma in objective terms as an identifiable catastrophic event, and this complicates the applicability of the model to cancer. Nonetheless, maladaptive stress responses can clearly result in increased distress in cancer patients, and in a subset of highly symptomatic people they may interfere with adherence to necessary or even life-saving medical treatments. The heterogeneity of studies and methodologies does not yet allow clear estimation of the prevalence of such responses. However, rates of posttraumatic stress symptoms among patients diagnosed with cancer are consistently higher than those in the general population. Risk factors are not clearly defined in the general population and are less well described in the cancer population, but it is likely that patients with pre-existing psychiatric diagnoses and especially patients with prior trauma are at elevated risk. Diagnosis and treatment of PTSD in the cancer setting are currently analogous to that in the noncancer setting, although research on nonpharmacological interventions is developing, and research on medications is almost nonexistent. For psycho-oncologists, the task is to devise more effective and methodical ways of identifying at-risk or symptomatic populations, and to develop treatments that may improve the quality of life and improve adherence in these vulnerable patients.

Sentience and transcendence: personal reflections on physical and mental adaptation from a near-death event and life-limiting surgery

Summary In this article I reflect on my experience of adapting physically, mentally and spiritually to a medical trauma that had life-changing consequences. I consider how, over 7 years to the time of writing, mental difficulties were inseparable from the physical; and how, for me, both are aspects of a form of understanding knowable only as mystery. Writing from a position of religious faith, I try to convey my experiences in a way that will be of interest to others regardless of their views. At the end, I reflect on aspects of my care that might be particularly relevant for a holistic, person-centred therapeutic approach.