Sample records for handicapped patients set

  1. Orthodontics for mentally handicapped patients [Orthodontie bij pati�nten met een verstandelijke handicap

    NARCIS (Netherlands)

    Remmelink, H.J.


    The mentally handicapped exhibit a 3 times higher incidence of malocclusions and related functional problems than the general population. In contrast there is little available literature relating to the orthodontic treatment of handicapped patients. Based on published articles on orthodontic

  2. Mortality of mentally handicapped patients after mass inter-hospital ...

    African Journals Online (AJOL)


    Aug 18, 1990 ... handicapped group the death rate was as high as 58,5/1 000 because it was an older population. In our patients we observed that in spite of the preparation before transfer, and the improved facilities and nursing care afterwards, there was an increase in the death rate of mentally handicapped patients after ...

  3. Voice Handicap Index (VHI in Persian Speaking Parkinson\\'s Disease Patients

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    Fatemeh Madjdinasab


    Full Text Available Objectives: “Voice” is affected more and sooner than other speech subsystems in Parkinson's Disease (PD. Voice Handicap Index (VHI is the most applicable subjective self-rating questionnaire in VD patients. The aim of this study was the investigation of Voice handicap in Iranian PD patients. Methods & Materials: This cross-sectional, analytical and non-interventional study was done on 50 (35 males, 15 females patients who reported a VD related to their PD. They were selected from thepatients referring to movement disorders’ clinic in Rasool Akram Hospital affiliated withTehran University of medical sciences, through easy sampling. VHI total score (VHIT and its domains (functional-VHIF, Emotional VHIE, Physical VHIP was assessed in all of participants and by gender segregation. Results: 83% of patients reported voice handicap. There wasn't any difference between VHIT and its mentioned 3 domains in both sexes. There is positive correlation between VHIT, VHIE and VHIF with age. VHIT and VHIF had a positive relationship with disease duration (DD. The males VHIT and the mentioned domains had positive correlations with DD. Conclusion: Most of Iranian PD patients feel handicap due to voice disorder caused by PD and their quality of life was affected by voice impairment. Increase in age and disease duration caused more voice disorder and reduced quality of life especially patients feel more handicaps in functional domain (VHIF. In addition, the males feel more handicap than females when DD develops.

  4. The natural environment and human development: implications for handicapped children in urban settings (United States)

    Dennis A. Vinton; Donald E. Hawkins


    This review of literature is intended to promote awareness of the needs of the 15 percent of the nation's children and youth who are afflicted with some form of handicap. It is imperative that those who design children's programs that utilize natural environments understand the special problems of handicapped children.

  5. Nursing-care dependency : Development of an assessment scale for demented and mentally handicapped patients

    NARCIS (Netherlands)

    Dijkstra, Ate; Buist, Girbe; Dassen, T


    This article describing the first phase in the development of an assessment scale of nursing-care dependency (NCD) for Dutch demented and mentally handicapped patients focuses on the background to the study and the content validation of the nursing-care dependency scale. The scale aims to

  6. Dental treatment for handicapped patients: sedation vs general anesthesia and update of dental treatment in patients with different diseases


    Corcuera Flores, José Ramón; Delgado Muñoz, José María; Ruiz Villandiego, José Cruz; Maura Solivellas, Isabel; Machuca Portillo, Guillermo


    Dental treatment on Handicapped Patients is often difficult because many people with a wide range of ages (from children to the elderly) with different pathologies that can affect the oral cavity and differ widely are included in this group. This situation creates some controversy, because according to pathology, each patient will be treated differently depending on collaboration, general health status, age or medication used to treat this pathologies. According to this situation we can opt f...

  7. A cohort study of accidents occurring in mentally handicapped patients living in institutions

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    Muriel Alfonso


    Full Text Available Abstract Background Mentally handicapped patients who require extensive and generalised care and are resident in mental health institutions have certain characteristics that could mean that they suffer certain types of accidents. The aim of this study was to determine the number and type of accident-related injuries in this population in order to design appropriate preventative strategies. Methods Accident-related injuries in patients resident in six institutions in the north of Spain were recorded prospectively over a period of 21 months. The characteristics of these injuries were recorded in a database linked to another in which patient data were recorded. A logistic regression model employing the generalized estimating equation (GEE methodology was employed due to the repetition of patient accidents. Results There was one death due to foreign body aspiration into the airways. A total of 1,671 injuries were recorded, 0.5% of which were classified as serious, 10% moderate and 89.5% minor. The serious injuries involved fractures (6 and cuts (2, the moderate injuries mainly cuts (57%, bruising (18% and sprains (13%, and the minor injuries bruising (40%, cuts (35% and scratches (20%. Falls were the main cause of these injuries (25.2%. The variables associated with serious accidents were self-harm (OR = 1.18, non-collaborative behaviour (OR = 1.21 and inpatient (OR = 1.37. Conclusions Accidents in mentally handicapped patients occur in different ways compared to those in the general population. The majority of injuries found were minor (an average of 0.8 to 3.4 accidents per year, with falls being the most common cause. Patients with behavioural disorders undergoing treatment with neuroleptic agents were found to be a risk group, therefore this finding should be taken into consideration when establishing care groups.

  8. Dental treatment for handicapped patients; sedation vs general anesthesia and update of dental treatment in patients with different diseases (United States)

    Corcuera-Flores, José R.; Delgado-Muñoz, José M.; Ruiz-Villandiego, José C.; Maura-Solivellas, Isabel


    Dental treatment on Handicapped Patients is often difficult because many people with a wide range of ages (from children to the elderly) with different pathologies that can affect the oral cavity and differ widely are included in this group. This situation creates some controversy, because according to pathology, each patient will be treated differently depending on collaboration, general health status, age or medication used to treat this pathologies. According to this situation we can opt for an outpatient treatment without any kind of previous medication, a treatment under conscious or deep sedation or a under general anesthesia treatment. With this systematic review is intended to help clarify in which cases patients should be treated under general anesthesia, sedation (conscious or deep) or outpatient clinic without any medication, as well as clarify what kind of treatments can be carried in private dental clinics and which should be carried out in a hospital. It will also discuss the most common diseases among this group of patients and the special care to be taken for their dental treatment. Key words:Hospital dentistry, handicapped patient. PMID:24121922

  9. The subscales and short forms of the dizziness handicap inventory: are they useful for comparison of the patient groups? (United States)

    Ardıç, Fazıl Necdet; Tümkaya, Funda; Akdağ, Beyza; Şenol, Hande


    Dizziness Handicap Inventory (DHI) is one of the most frequently used surveys for vertigo. The aim of the study was re-analyze the consistency of subscales and correlation between original and different short forms. The data of 2111 patients were analyzed. Original three subscales, screening form of DHI and short form of DHI were evaluated. The suitability of the data set for factor analysis and factor structure was analyzed with Kaiser-Meyer-Olkin (KMO) coefficient, Bartlett's Sphericity Test, and Varimax method. Pearson correlation analysis was performed. Factor analysis showed that two factor solutions are more prominent in our data. The factors proposed in different studies are not in harmony with each other. There is high correlation between the original and screening and short forms of DHI. This study indicated that the factor structure of the scale was not consistent. It is not advised to use subscale scores for comparison especially in international level. Therefore, total score should be used rather than the scores of the subscales. Using DHI screening form instead of original 25 questions is more convenient, because it is highly correlated with the original one and has fewer questions. Implications for rehabilitation Factor structure of the DHI is not consistent enough for comparison of the international studies. Total score of DHI is reliable. Using the screening version of DHI is better, because it is highly correlated with the original form and has fewer questions (10 questions).

  10. Effect of intralaryngeal muscle synkinesis on perception of voice handicap in patients with unilateral vocal fold paralysis. (United States)

    Lin, R Jun; Munin, Michael C; Rosen, Clark A; Smith, Libby J


    Intralaryngeal muscle synkinesis associated with unilateral vocal fold paralysis (UVFP) is thought to preserve thyroarytenoid-lateral cricoarytenoid muscle complex tone, resulting in a better voice despite the presence of vocal fold paralysis (VFP). This study compares voice handicap in patients with unilateral VFP (UVFP) with and without evidence of adductory synkinesis on laryngeal electromyography (LEMG). Retrospective review of LEMG data and Voice Handicap Index-10 (VHI-10) scores of patients diagnosed with permanent UVFP. LEMG was performed within 1 to 6 months post onset of UVFP. Patients were stratified into two groups: 1) recurrent laryngeal nerve (RLN) neuropathy with synkinesis and 2) RLN neuropathy without synkinesis. Synkinesis was diagnosed when the sniff to phonation maximum amplitude ratio was ≥0.65. VHI-10 scores at 6-month follow-up were recorded. Four hundred forty-nine patients with UVFP and who had an LEMG were reviewed. Eighty-three patients met the inclusion criteria, with 16 in group 1 and 67 in group 2. There was no significant difference between the groups with regard to age, timing of LEMG from onset of VFP, number of patients undergoing temporary vocal fold injection or use of off-label nimodipine. Average VHI-10 scores at 6 months post onset of VFP were 14.4 ± 10.6 for patients with LEMG-identified synkinesis (group 1) and 21.0 ± 10.1 for patients with no LEMG evidence of synkinesis (group 2). This was statistically significant (P = .02). Patients with unilateral vocal fold paralysis and LEMG evidence of laryngeal synkinesis are more likely to have less perceived voice handicap than those without synkinesis. 4. Laryngoscope, 127:1628-1632, 2017. © 2016 The American Laryngological, Rhinological and Otological Society, Inc.

  11. Dementia and severity of parkinsonism determines the handicap of patients in late-stage Parkinson's disease: the Barcelona-Lisbon cohort. (United States)

    Coelho, M; Marti, M J; Sampaio, C; Ferreira, J J; Valldeoriola, F; Rosa, M M; Tolosa, E


    Handicap has not been explored as a patient-centred outcome measure in Parkinson's disease (PD). The clinical features and medication use in late stages of PD (LS-PD) were reported previously. Handicap, medical conditions, use of healthcare resources and the impact of LS-PD upon caregivers were characterized in a cross-sectional study of LS-PD stages 4 or 5 of Hoehn and Yahr (H&Y). Handicap was measured using the London Handicap Scale (LHS: 0, maximal handicap; 1, no handicap). The mean LHS score in 50 patients was 0.33 (SD ±0.15). The presence of dementia, the Unified Parkinson's Disease Rating Scale part I score and the H&Y stage in 'off' independently predicted the LHS score (adjusted R(2) = 0.62; P = 0.000). Comorbidities and past medical conditions were frequent. Thirty-five patients lived at their house. Forty-five received unpaid care. Mean visits to the family doctor in the preceding 6 months were 2.2 (SD ±3.0) and to a neurologist 1.7 (SD ±1.0). Use of other health resources was low. Unpaid caregivers spent much time with patients and reported a high burden. Handicap could be measured in LS-PD and the LHS was easily completed by patients and caregivers. The high handicap in our cohort was mostly driven by the presence of dementia, behavioural complaints and the severity of non-dopaminergic motor features. Patients visited doctors infrequently and made low use of health resources, whilst unpaid caregivers reported a high burden. © 2014 EAN.

  12. A Comparison of the Long-term Health Related Quality of Life and Handicap of Stroke Patients in Mainland China and Hong Kong

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    T Kwok


    Full Text Available Purpose To compare health related quality of life (HRQOL and handicap of stroke survivors in Hong Kong (HK and Chengdu (CD in Mainland China. Method Fifty-four pairs of first ever stroke patients in CD and in HK matched by age, sex and Modified Barthel Index (MBI were interviewed using a structured questionnaire at 16–36 months after stroke. HRQOL and handicap outcomes were evaluated by the Chinese version of the Short-Form Health Survey (SF-36 and London Handicap Scale (LHS respectively. Results Compared to stroke patients in CD, HK subjects reported significantly greater handicap, especially in the occupation domain. HK subjects also had significantly lower HRQOL Z scores in domains of role limitations due to emotional or physical problems, and bodily pain. CD subjects had more social support, but had more difficulties in meeting medical costs, and were less likely to have regular medical follow-up and dysphagia symptom. After adjusting for social and health related factors, the site differences in handicap and the role limitation (physical domain of SF36 became insignificant. Conclusions CD stroke survivors had better scores in HRQOL and fewer handicaps than their counterparts in HK, because of social and health related factors.

  13. [Handicapped patients and leisure sports--a chance for social integration]. (United States)

    Wilhelm, U


    Organizing leisure time in an active way with lots of experiences is getting more and more important in western society. Accordingly, sports activities and travelling as well as their combination, holiday sports activities, are in great demand. A general idea of the literature in that field with regard to the possibilities and difficulties of handicapped persons is that holiday sports activities are considered apt to offer outstanding prerequisites for handicapped and nonhandicapped people getting closer to each other. Starting out on this basis, this survey is mainly dedicated to the following questions: What is the situation for handicapped persons in holiday sports activities? Is holiday sporting in a position to meet the expectations of social integration, and to what extent? A questionnaire about these items was answered by wheelchair users, making it clear, on the one hand, that there are hardly any offers for disabled people to take part in holiday sporting activities. On the other hand, the survey confirms that holiday sports activities are well suited to answer major demands of the integration issue, i.e., communication and interaction as well as other factors conducive to social integration. Subsequently, the author formulates the request that access to and participation in holiday sporting activities be made easier for disabled people so that greater use can be made of these special opportunities for social integration.

  14. The effectiveness of three sets of school-based instructional materials and community training on the acquisition and generalization of community laundry skills by students with severe handicaps. (United States)

    Morrow, S A; Bates, P E


    This study examined the effectiveness of three sets of school-based instructional materials and community training on acquisition and generalization of a community laundry skill by nine students with severe handicaps. School-based instruction involved artificial materials (pictures), simulated materials (cardboard replica of a community washing machine), and natural materials (modified home model washing machine). Generalization assessments were conducted at two different community laundromats, on two machines represented fully by the school-based instructional materials and two machines not represented fully by these materials. After three phases of school-based instruction, the students were provided ten community training trials in one laundromat setting and a final assessment was conducted in both the trained and untrained community settings. A multiple probe design across students was used to evaluate the effectiveness of the three types of school instruction and community training. After systematic training, most of the students increased their laundry performance with all three sets of school-based materials; however, generalization of these acquired skills was limited in the two community settings. Direct training in one of the community settings resulted in more efficient acquisition of the laundry skills and enhanced generalization to the untrained laundromat setting for most of the students. Results of this study are discussed in regard to the issue of school versus community-based instruction and recommendations are made for future research in this area.

  15. Quality of life, functional outcome, and voice handicap index in partial laryngectomy patients for early glottic cancer

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    Kandogan Tolga


    part 1. (p = 0. A statistically significant difference was also established between cordectomy and fronto-lateral laryngectomy groups, as well as between cordectomy and cricohyoidopexi groups in answers to the University of Washington- Quality of Life- Revised survey part 2. (p = 0,036 and p = 0.009, respectively. Cricohyoidopexi group has given the lowest scores and the cordectomy group has given the highest scores in three survey questions representing the quality of life, performances and new voices. These ranges are also consistent with the laryngeal tissue excised during surgery (cricohyoidopexi > fronto-lateral laryngectomy > cordectomy. There was no statistically significant difference between groups in Performance Status Scale for Head and Neck cancer patients instrument. The difference between the Voice Handicap Index and Voice Handicap Index (functional; Voice Handicap Index (physical and Voice Handicap Index (emotional scores in three patient groups was not significant either. All of the patients evaluated that their new voices have similar functional, physical and emotional impact on their life. Decanulation and oral feeding times of cricohyoidopexi and fronto-lateral laryngectomy patients are found to be significantly longer than cordectomy patients. Lastly, the removal of arytenoid does not have any significant adverse effects on the quality of life, the functional outcomes, or the quality of voice. Conclusion In the present study, all patients with early glottic cancer, treated with different surgical technics reported fairly good quality of life outcomes, functional results and voice qualities. This study also finds that the removal of arytenoid does not have any adverse effects on the quality of life and voice from the patients' point of view.

  16. Achados oftalmológicos em pacientes com múltiplas deficiências Ophthalmologic findings in multiple handicapped patients

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    Maria Cecília Remígio


    Full Text Available OBJETIVO: Relatar os achados oftalmológicos em portadores de múltiplas deficiências. MÉTODOS: Foram estudados 274 usuários do Sistema Único de Saúde atendidos no Departamento de Oftalmologia Pediátrica e Estrabismo da Fundação Altino Ventura (FAV, no período de junho a setembro de 2004. RESULTADOS: A freqüência dos pacientes quanto ao gênero foi de 58,5% para o masculino e 41,5% para o feminino. A variação das idades foi de 0,1 a 20 anos com mediana de 5. A maioria (61,3% dos pacientes apresentava boa acuidade visual, contudo 38,7% apresentava baixa de visão (PURPOSE: To report the visual findings in patients with multiple handicaps. METHODS: Two hundred and seventy-four patients cared for at the Pediatric and Strabismus Ophthalmology Department of the "Fundação Altino Ventura" - Brazilian National Health System, were examined from June to September 2004. Age varied from 0.1 to 20 years with a median of 5. RESULTS: The majority of the patients (61.3% presented good visual acuity; however low visual acuity (< 20/80 was observed in 38.7% of the patients. Heterotropias were observed in 66 patients (24.0%; astigmatism (53.2% and hyperopia (29.0% were more frequent. CONCLUSION: Children with multiple handicaps need an early ophthalmologic diagnosis and treatment for better global development. The integration of a multidisciplinary team with pediatricians, pediatric ophthalmologists and specialists in low vision, may assure a better visual rehabilitation.

  17. [Effects of an intensive therapy program for behaviorally disordered mentally handicapped patients on staff personnel in residential care]. (United States)

    Elbing, U; Rohmann, U H


    This study evaluates the effects of an intensive therapy program designed for mentally handicapped persons with severely disturbed or autistic behavior on their staff personal which had an active role in the program. The staff members rated their professional competence, quality of interaction with the client, team culture and work satisfaction before and after being engaged in the program, with additional ratings of their personal aims at the beginning of the program. Three sets of data were obtained with the program being conducted three times in a row. The testings of the related as well as the independent samples show differentiated program effects. The main effect is an increase of the professional competence and quality of interaction, especially by the qualified staff members. Trainees put emphasis on the development of their personal relationship with the client. The results are discussed in terms of the impact of learning processes specific to the roles of the staff members and motivational factors on learning and therapy outcome, along with institutional conditions influencing successful learning. Thus the program facilitates the professional and interpersonal learning process of staff members in a specific way with success as well as with limitations.




  19. Voice restoration following total laryngectomy by tracheoesophageal prosthesis: Effect on patients' quality of life and voice handicap in Jordan

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    Wreikat Mahmoud M


    Full Text Available Abstract Background Little has been reported about the impact of tracheoesophageal (TE speech on individuals in the Middle East where the procedure has been gaining in popularity. After total laryngectomy, individuals in Europe and North America have rated their quality of life as being lower than non-laryngectomized individuals. The purpose of this study was to evaluate changes in quality of life and degree of voice handicap reported by laryngectomized speakers from Jordan before and after establishment of TE speech. Methods Twelve male Jordanian laryngectomees completed the University of Michigan Head & Neck Quality of Life instrument and the Voice Handicap Index pre- and post-TE puncture. Results All subjects showed significant improvements in their quality of life following successful prosthetic voice restoration. In addition, voice handicap scores were significantly reduced from pre- to post-TE puncture. Conclusion Tracheoesophageal speech significantly improved the quality of life and limited the voice handicap imposed by total laryngectomy. This method of voice restoration has been used for a number of years in other countries and now appears to be a viable alternative within Jordan.

  20. Correlation between morphological characteristics in spectral-domain-optical coherence tomography, different functional tests and a patient's subjective handicap in acute central serous chorioretinopathy. (United States)

    Gerendas, Bianca S; Kroisamer, Julia-Sophie; Buehl, Wolf; Rezar-Dreindl, Sandra M; Eibenberger, Katharina M; Pablik, Eleonore; Schmidt-Erfurth, Ursula; Sacu, Stefan


    The purpose of this study was to identify quantitatively measurable morphologic optical coherence tomography (OCT) characteristics in patients with an acute episode of central serous chorioretinopathy (CSC) and evaluate their correlation to functional and psychological variables for their use in daily clinical practice. Retinal thickness (RT), the height, area and volume of subretinal fluid (SRF)/pigment epithelium detachments were evaluated using the standardized procedures of the Vienna Reading Center. These morphologic characteristics were compared with functional variables [best-corrected visual acuity (BCVA), contrast sensitivity (CS), retinal sensitivity/microperimetry, fixation stability], and patients' subjective handicap from CSC using the National Eye Institute 25-item Visual Function Questionnaire (NEI VFQ-25). Data from 39 CSC patients were included in this analysis. Three different SRF height measures showed a high negative correlation (r = -0.7) to retinal sensitivity within the central 9°, which was also negatively correlated with SRF area and volume (r = -0.6). The CS score and fixation stability (fixation points within 2°) showed a moderate negative correlation (r = -0.4) with SRF height variables. Comparison of the subjective handicap with morphological characteristics in spectral-domain (SD)-OCT showed SRF height had the highest correlation (r = -0.4) with the subjective problems reported and overall NEI VFQ-25 score. In conclusion, SRF height measured in SD-OCT showed the best correlation with functional variables and patients' subjective handicap caused by the disease and therefore seems to be the best variable to look at in daily clinical routine. Even though area and volume also show a correlation, these cannot be so easily measured as height and are therefore not suggested for daily clinical routine. © 2018 Acta Ophthalmologica Scandinavica Foundation. Published by John Wiley & Sons Ltd.

  1. Citizens and Handicaps. (United States)

    Thomas, Stanley B., Jr.

    In a speech delivered at the National Easter Seal Society's Annual Convention (1974), the author discusses progress toward full citizenship for the handicapped focusing on the roles of the Department of Health, Education, and Welfare (DHEW) and the Office for the Handicapped, Constitutional guarantees of equal rights for all citizens, and national…

  2. Teaching the Handicapped Imagination. (United States)

    Sloane, Sarah


    The article describes exercises in drama and creative writing to broaden the imaginations of visually handicapped children through stories and poems with a nonvisual imagery. Examples of stories and poems written specifically for the visually handicapped are included. (Author/CL)

  3. Academic Self-Handicapping and Achievement: A Meta-Analysis (United States)

    Schwinger, Malte; Wirthwein, Linda; Lemmer, Gunnar; Steinmayr, Ricarda


    Self-handicapping represents a frequently used strategy for regulating the threat to self-esteem elicited by the fear of failing in academic achievement settings. Several studies have documented negative associations between self-handicapping and different educational outcomes, inter alia academic achievement. However, studies on the relation…

  4. Self-Handicapping by Task Choice: An Attribute Ambiguity Analysis. (United States)

    Handelsman, Mitchell M.; And Others

    Self-handicapping strategies are behaviors or choices of performance settings which allow people to maintain self-esteem by avoiding negative self-relevant attributions. People will behave in such a way that accurate, nonambiguous attributions about their performance cannot be made. Research on self-handicapping has focused on clinically relevant…

  5. Non-Discriminatory Psychological Assessment of the Handicapped. (United States)

    Phelps, William R.

    In 1979 the National Research Council established a panel to study testing of handicapped people for selection and placement purposes in educational and employment settings. The study involved the review of relevant literature, solicitation of pertinent information from organizations representing handicapped persons and from professionals involved…

  6. The Dance Within: A Pilot Project in Dance for the Handicapped and Teaching Dance for the Handicapped: A Curriculum Guide. (United States)

    Michigan Dance Association, Lansing.

    The Michigan Dance Association's Dance Project for the Handicapped is the subject of the two pamphlets that make up this document. The first pamphlet, "The Dance Within," describes the history, nature and goals of the Jackson Pilot Project, the first handicapped dance program in Michigan; it also offers suggestions on how to set up similar…

  7. Facilitating creativity in handicapped and non-handicapped children ...

    African Journals Online (AJOL)

    The prime objective of this paper is to create awareness on the presence of the handicapped in Nigeria and the need to facilitate creative potentials in handicapped and non-handicapped children. Various factors that could facilitate creativity and other factors that could inhibit creativity were discussed. The implications for ...

  8. An Assessment of the Self-Protective Function of Self-Handicapping. (United States)

    Steinhauer, Annie; And Others

    Self-handicapping is the phenomenon of setting oneself up to fail a feared evaluation task to protect a sense of self-worth. A study examined whether individuals self-handicap to protect a general or global perception of themselves or to protect perceptions of competence in the specific domain being evaluated. Handicapping behaviors related to…

  9. Handicap, Architecture & Design

    DEFF Research Database (Denmark)


    Cd-rommen er et visuelt projekteringsværktøj for byggeriets parter. Den viser nogle af de problemer mennesker med handicap har ved at færdes i de fysiske omgivelser, men peger også mulige løsninger for at gøre omgivelserne tilgængelige for alle....

  10. The Multiply Handicapped Child. (United States)

    Wolf, James M., Ed.; Anderson, Robert M., Ed.

    Articles presented in the area of the medical and educational challenge of the multiply handicapped child are an overview of the problem, the increasing challenge, congenital malformations, children whose mothers had rubella, prematurity and deafness, the epidemiology of reproductive casualty, and new education for old problems. Discussions of…

  11. Factors related to tinnitus and hyperacusis handicap in older people. (United States)

    Aazh, Hashir; Lammaing, Karen; Moore, Brian C J


    The aim was to assess factors related to tinnitus and hyperacusis handicap in older people. Retrospective cross-sectional. Data were gathered for 184 patients with an average age of 69 years. Tinnitus handicap as measured via the Tinnitus Handicap Inventory (THI) was significantly predicted by tinnitus annoyance as measured via the visual analogue scale (VAS) (regression coefficient, b = 2.9, p tinnitus on the patient's life as measured via the VAS (b = 3.9, p tinnitus annoyance significantly predicts tinnitus handicap, it is important to explore factors associated with annoyance that may be useful in designing appropriate rehabilitative interventions aimed at reducing tinnitus handicap in older people. Future studies should explore whether hyperacusis and insomnia in older people with tinnitus need to be managed in conjunction with treatment for depression.

  12. Correlation of the Voice Handicap Index-10 (VHI-10) and Voice-Related Quality of Life (V-RQOL) in patients with dysphonia. (United States)

    Romak, Jonathan J; Orbelo, Diana M; Maragos, Nicolas E; Ekbom, Dale C


    This study examines the correlation between two voice-specific patient-reported outcome measures: the Voice Handicap Index-10 (VHI-10) and Voice-Related Quality of Life (V-RQOL). Retrospective chart review. Eight hundred four patients presenting to our voice clinic between May 2009 and August 2011. All patients completed the VHI-10 and V-RQOL in a single sitting. Correlation between the two scales was examined using Spearman rank analysis. Calculated VHI-10 score was derived from V-RQOL score by direct conversion equation and compared with measured VHI-10 score. Receiver Operating Characteristic (ROC) curves were derived for diagnostic groups. Spearman correlation coefficient between the VHI-10 and V-RQOL was -0.91 (P dysphonia (V-RQOL AUC = 0.536 [SE ± 0.026]; VHI-10 AUC = 0.508 [SE ± 0.26]; P = 0.018) groups, with the V-RQOL showing relatively greater sensitivity. The VHI-10 and V-RQOL are highly correlated. However, VHI-10 score cannot be calculated from V-RQOL score using the tested equation. The V-RQOL may be more sensitive than the VHI-10 in detecting the impact of presbyphonia and muscle tension dysphonia. Copyright © 2014 The Voice Foundation. Published by Mosby, Inc. All rights reserved.

  13. Benefits for handicapped children

    CERN Multimedia


    The introduction of long-term care benefits within the CERN Health Insurance Scheme requires the coordination of the benefits foreseen for handicapped children. Measures were adopted by the Management following the recommendation made by the Standing Concertation Committee on 26 March 2003. A document clarifying these measures is available on the Web at the following address: Social Affairs Service 74201

  14. Antroduodenal motility in neurologically handicapped children with feeding intolerance

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    Werlin Steven L


    Full Text Available Abstract Background Dysphagia and feeding intolerance are common in neurologically handicapped children. The aim is to determine the etiologies of feeding intolerance in neurologically handicapped children who are intolerant of tube feedings. Methods Eighteen neurologically handicapped children, followed in the Tube Feeding Clinic at the Children's Hospital of Wisconsin who were intolerant of gastrostomy feedings. The charts of these 18 patients were reviewed. Past medical history, diagnoses, history of fundoplication and results of various tests of gastrointestinal function including barium contrast radiography, endoscopy and antroduodenal manometry were documented. Results Five of 11 children had abnormal barium upper gastrointestinal series. Seven of 14 had abnormal liquid phase gastric emptying tests. Two of 16 had esophagitis on endoscopy. All 18 children had abnormal antroduodenal motility. Conclusions In neurologically handicapped children foregut dysmotility may be more common than is generally recognized and can explain many of the upper gastrointestinal symptoms in neurologically handicapped children.

  15. Self-handicapping and burnout. (United States)

    Akin, Ahmet


    Self-handicapping is a process containing strategies of externalization in which an individual can excuse failure and internalize success. This study investigated the relationship of self-handicapping with measures of burnout. The Self-handicapping Scale and the Maslach Burnout Inventory were administered to 309 university students. Self-handicapping was positively correlated to emotional exhaustion, lowered personal accomplishment, and depersonalization. A structural equation model fit the data well and accounted for 20% of the variance in emotional exhaustion, 14% in lowered personal accomplishment, and 10% in depersonalization.

  16. Costs of self-handicapping. (United States)

    Zuckerman, Miron; Tsai, Fen-Fang


    Four studies examined the relation of trait self-handicapping with health-related measures. Study 1 showed that, over time, self-handicapping and maladjustment reinforce each other. Study 2 showed that self-handicappers reported a loss in competence satisfaction which, in turn, mediated the relation of self-handicapping with negative mood. Study 3 found that, over time, self-handicappers report an increase in substance use. Study 4 showed that self-handicappers reported a loss in intrinsic motivation for their jobs. It was suggested that people with unstable (or contingent) self-esteem use self-handicapping to bolster a fragile self-concept.

  17. [Respiratory handicap. Recognition, evaluation and social benefits]. (United States)

    Marsac, J; Pujet, J C


    The medico-social aspects of respiratory handicap pose some perplexing problems, notably in their recognition, rigorous evaluation and in the granting of social security benefits. The clinical and respiratory function data should be standardised and classified according to type and significance of respiratory disease and also according to the degree of co-operation and understanding of the patient. The respiratory handicap should be evaluated after considering the functional disability engendered by the disorder and their socio-professional repercussions. The abnormality in the lungs should be measured by resting tests; the degree of disability by exercise studies; the socio-professional handicap by ergonometric tests to assess the scale of the demands and requirements of family and social and professional life, indeed the cultural and economic style of the individual concerned. Such combined studies would enable recognition of severe chronic respiratory handicap leading to decisions for exemption certificates, such as cases of severe respiratory failure in patients requiring supplementary treatment for oxygen therapy or assisted ventilation. The benefits and grants offered to those with respiratory handicaps would involve a number of rights relating to: care, work, costs of replacement of workers in the event of prolonged sick leave or the benefits of an invalidity pension. There will be other allowances such as invalidity cards, lodging special studies and other rights particularly relating to lodging and special equipment. The present scale is difficult to use both because of its lack of specificity and its ill-chosen terminology. For better balance between the handicap and the benefits offered, a common and more flexible system, with a printed table should be at hand for the doctor to use for certain decisions: long term illness, period of invalidity or early retirement because of medical incapacity. Within each table a sub-section should exist to allow for

  18. Quality of life in oncological patients with oropharyngeal dysphagia: validity and reliability of the Dutch version of the MD Anderson Dysphagia Inventory and the Deglutition Handicap Index. (United States)

    Speyer, Renée; Heijnen, Bas J; Baijens, Laura W; Vrijenhoef, Femke H; Otters, Elsemieke F; Roodenburg, Nel; Bogaardt, Hans C


    Quality of life is an important outcome measurement in objectifying the current health status or therapy effects in patients with oropharyngeal dysphagia. In this study, the validity and reliability of the Dutch version of the Deglutition Handicap Index (DHI) and the MD Anderson Dysphagia Inventory (MDADI) have been determined for oncological patients with oropharyngeal dysphagia. At Maastricht University Medical Center, 76 consecutive patients were selected and asked to fill in three questionnaires on quality of life related to oropharyngeal dysphagia (the SWAL-QOL, the MDADI, and the DHI) as well as a simple one-item visual analog Dysphagia Severity Scale. None of the quality-of-life questionnaires showed any floor or ceiling effect. The test-retest reliability of the MDADI and the Dysphagia Severity Scale proved to be good. The test-retest reliability of the DHI could not be determined because of insufficient data, but the intraclass correlation coefficients were rather high. The internal consistency proved to be good. However, confirmatory factor analysis could not distinguish the underlying constructs as defined by the subscales per questionnaire. When assessing criterion validity, both the MDADI and the DHI showed satisfactory associations with the SWAL-QOL (reference or gold standard) after having removed the less relevant subscales of the SWAL-QOL. In conclusion, when assessing the validity and reliability of the Dutch version of the DHI or the MDADI, not all psychometric properties have been adequately met. In general, because of difficulties in the interpretation of study results when using questionnaires lacking sufficient psychometric quality, it is recommended that researchers strive to use questionnaires with the most optimal psychometric properties.

  19. Telecommunication for the Physically Handicapped. (United States)

    Cunningham, Pat; Gose, Joan

    The paper examines the uses of telecommunication for physically handicapped students. Basic equipment, including a modem and keyboard interface, are described. The types and uses of computer bulletin boards are also described. Among benefits of telecommunications for physically handicapped students noted in the paper are social prestige,…

  20. Working with Handicapped Art Students. (United States)

    Silver, Rawley A.

    Presented at the 1979 National Art Education Association Convention on the arts in special education, the paper focuses on studies of the aesthetic and therapeutic use of special art procedures with handicapped students. The art education needs of handicapped students are briefly discussed, along with the impact and implications of new…

  1. Sexual Adjustment in the Handicapped (United States)

    Glass, Dorothea D.; Padrone, Frank J.


    Major topics discussed include introduction and background of the growing recognition of sexual feelings and concerns of the handicapped, attitudes and assumptions resulting from lack of information for both the handicapped and the various disciplines that serve them, medical and psychological aspects of sexual response, and services for the…

  2. The Self-Handicapping Phenomenon. (United States)

    Ferguson, Janet M.; Dorman, Jeffrey


    Asserts that self-handicapping students protect their self-images by deliberately not trying to achieve for fear of trying hard, failing anyway, and appearing "dumb." Surveys of high school students examined three areas of students' perceptions (self-handicapping, academic self-efficacy, and classroom environment). The correlation…

  3. Initial ventilator settings for critically ill patients


    Kilickaya, Oguz; Gajic, Ognjen


    The lung-protective mechanical ventilation strategy has been standard practice for management of acute respiratory distress syndrome (ARDS) for more than a decade. Observational data, small randomized studies and two recent systematic reviews suggest that lung protective ventilation is both safe and potentially beneficial in patients who do not have ARDS at the onset of mechanical ventilation. Principles of lung-protective ventilation include: a) prevention of volutrauma (tidal volume 4 to 8 ...

  4. Exploring nurses' and patients' perspectives of limit setting in a forensic mental health setting. (United States)

    Maguire, Tessa; Daffern, Michael; Martin, Trish


    Limit setting is an intervention that is frequently used by mental health nurses. However, limit setting is poorly conceptualized, its purpose is unclear, and there are few evidence-based guidelines to assist nurses to set limits in a safe and effective manner. What is known is that the manner in which nurses set limits influences patients' perceptions of the interactions and their emotional and behavioural responses. In this qualitative study, 12 nurses and 12 patients participated in personal, semistructured interviews that aimed to explore limit setting and to propose principles to guide practice. The findings suggested that: (i) limit setting is important to safety in mental health hospitals; (ii) engaging patients in an empathic manner is necessary when setting limits (when nurses engage in an empathic manner, the therapeutic relationship is more likely to be preserved and the risk of aggressive responses is reduced); and (iii) an authoritative (fair, respectful, consistent, and knowledgeable), rather than authoritarian (controlling and indifferent), limit-setting style enhances positive outcomes with regards to adherence, reduced likelihood of aggression, and preservation of the therapeutic relationship. In conclusion, a limit-setting style characterized by empathic responding and an authoritative, rather than authoritarian interpersonal, style is recommended. Elucidating the components of this style is critical for effective training and best practice of mental health nurses, and to reduce aggressive responses from limit setting. © 2013 Australian College of Mental Health Nurses Inc.

  5. The psychometric properties of the Tinnitus Handicap Questionnaire in a Dutch-speaking population. (United States)

    Vanneste, S; To, W T; De Ridder, D


    The aim of the study is to translate and validate the tinnitus handicap questionnaire (THQ) for a Dutch-speaking population. The factor structure of the questionnaire, the reliability and the validity is determined. Furthermore, a statistical comparison with the original English version of the tinnitus handicap questionnaire is performed. We assessed 101 patients at the Tinnitus Research Initiative clinic of Antwerp University Hospital. Twenty-seven Dutch items from the tinnitus handicap questionnaire by Kuk et al. [(1990), Ear Hear11:434-45.] were obtained by the process of translation and back translation. The factor structure, internal consistency, was evaluated using Cronbach's alpha coefficient and item correlations were used to confirm reliability. The construct validity was confirmed with a visual analogue scale for loudness and distress, awareness, annoyance, the Tinnitus Questionnaire (TQ), the mini-Tinnitus Questionnaire, the Hospital Anxiety and Depression Scale (HADS), the Beck Depression Inventory (BDI) and the Profile of Mood State (POMS), ensuring that this new instrument measures the tinnitus handicap. This study demonstrates that the Dutch version of the tinnitus handicap questionnaire is a reliable (Cronbach's alpha coefficient α = 0.93) and valid measure of self-perceived tinnitus-related distress [with visual analogue scale for loudness (r = 0.39) and distress (r =0.45), awareness (r = 0.39), annoyance (r = 0.57), the Tinnitus Questionnaire (r = 0.82), the mini-Tinnitus Questionnaire (r = 0.79), the Hospital Anxiety and Depression Scale (r = 0.62) and the Beck Depression Inventory (r = 0.32)]. The psychometric properties are in line with previous findings on the English version with regard to reliability and validity. However, the items in the subscales differ from the English version. While the English version has three subscales, our version has only two subscales. Yet, the English version reports that for the three factors, there is a low

  6. Academic Goals and Self-Handicapping Strategies in University Students. (United States)

    Ferradás, María del Mar; Freire, Carlos; Valle, Antonio; Núñez, José Carlos


    In highly competitive settings like university, the fear of failure leads some students to protect their self-worth using self-handicapping strategies. The present investigation examines to what extent academic goals are related to those tactics in university students. Specifically, MANCOVA was applied to estimate statistical differences linked to behavioral and claimed self-handicapping strategies according to the level (high/medium/low) of four types of academic goal (achievement approach, achievement avoidance, mastery approach, and work avoidance). Degree, year in school, and gender were entered as covariates. 940 students (86.5% women) from University of A Coruña (M = 20.44; SD = 1.73) participated. Results show that: (a) both behavioral and claimed self-handicapping are promoted by ego-oriented goals (achievement avoidance, F(2, 937) = 23.56, p self-handicapping (F(2, 937) = 9.09, p self-handicapping; and (c) mastery approach goals are significantly, negatively related to both types of self-handicapping (F(2, 937) = 20.09, p < .001, η p 2 = .041). Psychological and educational implications of the findings are discussed.

  7. [Evaluation of an intensive therapy program for treatment of severe behavioral disorders in mentally handicapped patients with autistic or psychotic behavior]. (United States)

    Elbing, U; Rohmann, U H


    The development of severely disturbed and socially accepted behavior in mentally handicapped persons with autistic or psychotic symptoms is documented before, during and after an intensive therapy program conducted in a residential institution for mentally handicapped persons. Seven single case studies were made as long term observation with a duration between 18 and 33 weeks, mostly with a multiple baseline design. One or two follow ups with at least four weeks length were conducted in six out of seven cases up to four years after the end of the intensive therapy. The main results show (1) the decrease of disturbed behavior and the increase of socially accepted behavior during the therapy program, and (2) the significant reduction of the disturbed behavior patterns taking place during the baseline phase before the beginning of the therapy in all cases but one. The results are discussed under the aspects of a possible explanation for the findings and their impact on the discussion about psychotherapy research.

  8. Priority Settings in patients with Chronic Diseases and Cancer

    DEFF Research Database (Denmark)

    Arreskov, Anne Beiter; Graungaard, Anette Hauskov; Søndergaard, Jens

    Priority setting in patients with cancer and comorbidities Background and aim As both the cancer incidence and the number of patients diagnosed with chronic diseases are increasing, a growing population of cancer survivors will also deal with comorbid chronic diseases. The period after completed...... to comorbidities. Some studies show that participation in regular follow-up consultations concerning comorbid chronic diseases and lifestyle are lower among cancer survivors than non-cancer patients. This could be explained by changes in the patient’s priority setting or in the doctor’s priority and attempt...... to spare the patient for further treatment burden, perhaps resulting in comorbidities falling down the agenda. The overall purpose is to explore patients’ and doctors’ priority settings of comorbidities in patients who have been diagnosed with non-metastatic cancer. Method: The study will consist of three...

  9. 38 CFR 18.434 - Education setting. (United States)


    ... not handicapped to the maximum extent appropriate to the needs of the handicapped person. A recipient shall place a handicapped person in the regular educational environment operated by the recipient unless... Adult Education § 18.434 Education setting. (a) Academic setting. A recipient shall educate, or shall...

  10. Patient engagement in the inpatient setting: a systematic review. (United States)

    Prey, Jennifer E; Woollen, Janet; Wilcox, Lauren; Sackeim, Alexander D; Hripcsak, George; Bakken, Suzanne; Restaino, Susan; Feiner, Steven; Vawdrey, David K


    To systematically review existing literature regarding patient engagement technologies used in the inpatient setting. PubMed, Association for Computing Machinery (ACM) Digital Library, Institute of Electrical and Electronics Engineers (IEEE) Xplore, and Cochrane databases were searched for studies that discussed patient engagement ('self-efficacy', 'patient empowerment', 'patient activation', or 'patient engagement'), (2) involved health information technology ('technology', 'games', 'electronic health record', 'electronic medical record', or 'personal health record'), and (3) took place in the inpatient setting ('inpatient' or 'hospital'). Only English language studies were reviewed. 17 articles were identified describing the topic of inpatient patient engagement. A few articles identified design requirements for inpatient engagement technology. The remainder described interventions, which we grouped into five categories: entertainment, generic health information delivery, patient-specific information delivery, advanced communication tools, and personalized decision support. Examination of the current literature shows there are considerable gaps in knowledge regarding patient engagement in the hospital setting and inconsistent use of terminology regarding patient engagement overall. Research on inpatient engagement technologies has been limited, especially concerning the impact on health outcomes and cost-effectiveness. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to

  11. Cultural diversity and patients with reduced capacity: the use of ethics consultation to advocate for mentally handicapped persons in living organ donation. (United States)

    Spike, J


    Living organ donation will soon become the source of the majority of organs donations for transplant. Should mentally handicapped people be allowed to donate, or should they be considered a vulnerable group in need of protection? I discuss three cases of possible living organ donors who are developmentally disabled, from three different cultures, the United States, Germany, and India. I offer a brief discussion of three issues raised by the cases: (1) cultural diversity and cultural relativism; (2) autonomy, rationality, and self-interest; and (3) the proper use and role for clinical ethics consults.

  12. Healthcare professional versus patient goal setting in intermittent allergic rhinitis. (United States)

    O'Connor, J; Seeto, C; Saini, B; Bosnic-Anticevich, S; Krass, I; Armour, C; Smith, L


    To examine the impact of healthcare professional versus patient goal setting for the self-management of intermittent allergic rhinitis (AR) on symptom severity and quality of life. This was a 6 week, parallel group study. Group A participants, with pharmacist facilitation, nominated personally relevant goals and strategies relating to their AR. Group B participants had their goals and strategies set by the pharmacist. The main outcome measures used included perceived symptom severity and quality of life. In addition, goals and strategies data from participants of both groups were collected and analysed. Both groups demonstrated significant improvements in symptom severity and quality of life scores however Group B symptom severity scores improved more. Group B set a greater number of goals and strategies which were better structured and more task specific. This is the first study to investigate the impact of goal setting on patient behaviour in a chronic yet episodic illness. Our results suggest that self-management goals set by the healthcare professional which are clinically indicated but tailored to the patient's nominated symptoms yields better outcomes than goals nominated by the patient. A brief, structured intervention, tailored to patient symptoms, can enhance self-management of intermittent allergic rhinitis.

  13. Errors in imaging patients in the emergency setting. (United States)

    Pinto, Antonio; Reginelli, Alfonso; Pinto, Fabio; Lo Re, Giuseppe; Midiri, Federico; Muzj, Carlo; Romano, Luigia; Brunese, Luca


    Emergency and trauma care produces a "perfect storm" for radiological errors: uncooperative patients, inadequate histories, time-critical decisions, concurrent tasks and often junior personnel working after hours in busy emergency departments. The main cause of diagnostic errors in the emergency department is the failure to correctly interpret radiographs, and the majority of diagnoses missed on radiographs are fractures. Missed diagnoses potentially have important consequences for patients, clinicians and radiologists. Radiologists play a pivotal role in the diagnostic assessment of polytrauma patients and of patients with non-traumatic craniothoracoabdominal emergencies, and key elements to reduce errors in the emergency setting are knowledge, experience and the correct application of imaging protocols. This article aims to highlight the definition and classification of errors in radiology, the causes of errors in emergency radiology and the spectrum of diagnostic errors in radiography, ultrasonography and CT in the emergency setting.

  14. Handicap questionnaires: what do they assess?

    NARCIS (Netherlands)

    Cardol, M.; Brandsma, J. W.; de Groot, I. J.; van den Bos, G. A.; de Haan, R. J.; de Jong, B. A.


    There is an increasing need to get insight into the social and societal impact of chronic conditions on a person's life, i.e. person-perceived handicap. The purpose of this study is to report how current handicap questionnaires assess handicap. A literature search using both Medline and the database

  15. Emotionally Handicapped Pupils: Developing Appropriate Educational Programs. (United States)

    North Carolina State Dept. of Public Instruction, Raleigh. Div. for Exceptional Children.

    The document is designed to assist local school systems as they plan, develop, and improve programs for emotionally handicapped students. Sections cover the following areas: definition of emotionally handicapped students; pre-planninq for emotionally handicapped programs; identification, referral, screening, assessment, and placement; service…

  16. Assessment of Self-Recognition in Young Children with Handicaps. (United States)

    Kelley, Michael F.; And Others


    Thirty young children with handicaps were assessed on five self-recognition mirror tasks. The set of tasks formed a reproducible scale, indicating that these tasks are an appropriate measure of self-recognition in this population. Data analysis suggested that stage of self-recognition is positively and significantly related to cognitive…

  17. Social Interpersonal Skills of Handicapped and Nonhandicapped Adults at Work


    Lignugaris/Kraft, Benjamin; Rule, S.; Salzberg, Charles L.; Stowitschek, J. J.


    The pattern and content of social interactions of successful handicapped and nonhandicapped employees were observed in two employment settings. Data suggest that both groups were active social interactants who frequently worked cooperatively, yet interacted relatively infrequently with their supervisors. Implications for future research are discussed.

  18. Psychology and the Handicapped Child. (United States)

    Sherrick, Carl E., Ed.; And Others

    Reviewed in seven author contributed chapters are findings of experimental psychology relevant to the education of handicapped children in the areas of sensory processes, visual perception, memory, cognition and language development, sustained attention and impulse control, and personality and social development. Noted in an introductory chapter…

  19. Equine Therapy for Handicapped Students. (United States)

    Minner, Sam; And Others


    Four aspects in planning a therapeutic horsemanship program for handicapped individuals are considered: training instructors, obtaining the needed horses and equipment, identifying the participants, and implementing the program and developing a curriculum. An example of a horsemanship program begun in Kentucky is offered. (CL)

  20. Handicaps No Hindrance with Horses (United States)

    Seeley, Colleen


    A horseback riding program, sponsored by 4-H members for handicapped children in Michigan's Genesse County, has proven physically and emotionally veneficial for the children. All therapeutic exercises were performed with the approval of the child's physician and therapist. Plans for expanding the program are being considered. (AG)

  1. Patients' perception of traditional bone setting in Calabar | Ikpeme ...

    African Journals Online (AJOL)

    This study was undertaken to find out and document the reasons and factors responsible for this patronage, who made the choice, the role of healthworkers, patients' perception of the practice and if their experience will encourage or discourage them from patronizing traditional bone setting in future. We also compared the ...

  2. How clerkship students learn from real patients in practice settings

    NARCIS (Netherlands)

    Steven, Kathryn; Wenger, Etienne; Boshuizen, Els; Scherpbier, Albert; Dornan, Tim


    Purpose To explore how undergraduate medical students learn from real patients in practice settings, the factors that affect their learning, and how clerkship learning might be enhanced. Method In 2009, 22 medical students in the three clerkship years of an undergraduate medical program in the

  3. Patients' views on priority setting in neurosurgery: A qualitative study. (United States)

    Gunaratnam, Caroline; Bernstein, Mark


    Accountability for Reasonableness is an ethical framework which has been implemented in various health care systems to improve and evaluate the fairness of priority setting. This framework is grounded on four mandatory conditions: relevance, publicity, appeals, and enforcement. There have been few studies which have evaluated the patient stakeholders' acceptance of this framework; certainly no studies have been done on patients' views on the prioritization system for allocating patients for operating time in a system with pressure on the resource of inpatient beds. The aim of this study is to examine neurosurgical patients' views on the prioritization of patients for operating theater (OT) time on a daily basis at a tertiary and quaternary referral neurosurgery center. Semi-structured face-to-face interviews were conducted with thirty-seven patients, recruited from the neurosurgery clinic at Toronto Western Hospital. Family members and friends who accompanied the patient to their clinic visit were encouraged to contribute to the discussion. Interviews were audio recorded, transcribed verbatim, and subjected to thematic analysis using open and axial coding. Overall, patients are supportive of the concept of a priority-setting system based on fairness, but felt that a few changes would help to improve the fairness of the current system. These changes include lowering the level of priority given to volume-funded cases and providing scheduled surgeries that were previously canceled a higher level of prioritization. Good communication, early notification, and rescheduling canceled surgeries as soon as possible were important factors that directly reflected the patients' confidence level in their doctor, the hospital, and the health care system. This study is the first clinical qualitative study of patients' perspective on a prioritization system used for allocating neurosurgical patients for OT time on a daily basis in a socialized not-for-profit health care system with

  4. [22q11.2 deletion: handicap-related problems and coping strategies of primary caregivers]. (United States)

    Briegel, Wolfgang; Schneider, Marco; Schwab, K Otfried


    To investigate handicap-related problems of children and adolescents with 22q11.2 deletion syndrome and their primary caregivers' coping strategies. Primary caregivers of 153 subjects aged 2-16 years were anonymously asked to fill out questionnaires, e.g., the Handicap Related Problems for Parents Inventory. Primary caregivers of 96 subjects (53 males, 43 females; mean age: 7;0 [2;1-16;11] years) sent back questionnaires. Patient's behaviour and discipline were the most important handicap-related problems. Significant correlations could be found between the patient's age and his/her relationship with the primary caregiver (rho=0.228; p=.029) and other family members (rho=0.293; p=.004). Compared to other parents of physically handicapped children or those with multiple handicaps, these parents did not experience increased stress. The more the coping strategies "self-fulfillment" and "intensification of partnership" were used, the lower parental stress was (p=.012, p=.025, respectively). "Focusing on the handicapped child" was positively correlated with high parental stress (p=.000). With regard to parental stress and coping strategies, primary caregivers of children and adolescents with 22q11.2 deletion do not significantly differ from other parents of physically handicapped children. As handicap-related family problems increase with the patient's age, a growing need for counseling, especially for aspects of parenting and discipline, and for treatment can be presumed.

  5. Treatment of Orally Handicapped Edentulous Older Adults Using Dental Implants. (United States)

    Zahedi, Charles


    The oral handicap of complete edentulism is the terminal outcome of a multifactorial process involving biological factors and patient-related factors. Fully edentulous orally handicapped older adults have been neglected because removable acrylic dentures have been the classic therapy for complete edentulism but are only rehabilitative, not therapeutic. Not replacing missing teeth with stable dentures could prevent adequate food intake. Osseointegrated endosseous implants used as a therapeutic adjunct can reduce the problem of long-term bone resorption to less than 0.1 mm per year. Implant-borne prostheses substantially increase the overall health and quality of life of orally handicapped fully edentulous older adults. Copyright © 2016 Elsevier Inc. All rights reserved.

  6. [Greeting modalities preferred by patients in pediatric ambulatory setting]. (United States)

    Eymann, Alfredo; Ortolani, Marina; Moro, Graciela; Otero, Paula; Catsicaris, Cristina; Wahren, Carlos


    The greeting is the first form of verbal and nonverbal communication and is a valuable tool to support the physician-patient relationship. Assess parents and children preferences on how they want pediatricians greet and address them. Cross-sectional study. The population was persons accompanying patients (parents or guardians) between 1 month and 19 years old and patients older than 5 years old. A survey questionnaire was completed after the medical visit. A total of 419 surveys from patients' companions and 249 from pediatric patients were analyzed; 68% of the companions preferred the doctor addressed them by the first name, 67% liked to be greeted with a kiss on the cheek and 90% liked to be treated informally. Preferring to be greeted with a kiss on the cheek was associated in multivariate analysis with the companion was the mother, age younger than 39 years and longer time in knowing the pediatrician; 60% of the patients preferred to be addressed by their first name. In the outpatient setting patients companions and patients themselves prefer to be addressed by their name informally and be greeted with a kiss on the cheek.

  7. Self-esteem, self-conscious emotions, resilience, trait anxiety and their relation to self-handicapping tendencies


    Török, Lilla; Szabó, Zsolt Péter; Boda-Ujlaky, Judit


    Jones and Berglas (1978) define self-handicapping as any action or choice of performance setting that enhances the opportunity to externalize (or excuse) failure and to internalize (reasonably accept credit for) success (p. 406). The present study examined the role of potential precursors in the self-handicapping process. A total of 626 undergraduates from various Hungarian universities completed measures of dispositional self-handicapping, self-esteem, self-conscious emotions, trait anxiety,...

  8. Patients' experiences of NPWT in an outpatient setting in Denmark

    DEFF Research Database (Denmark)

    Ottosen, B; Pedersen, B D


    qualitative interviews regarding their NPWT treatment. The French philosopher, Ricoeur's,theory of interpretation guided the data analysis, which included three levels: naive reading, structural analysis and critical interpretation and discussion. RESULTS: The patients experienced a high level of dependency......OBJECTIVE: To study patients' experiences of negative pressure wound therapy (NPWT) used for wounds of various aetiologies in the outpatient setting and the influences on daily life. METHOD: In this qualitative study, a phenomenological-hermeneutic approach was used. Ten patients underwent......, and they experienced embarrassment about odour,anxiety and uneasiness in relation to complications, a need for relatives' support and other social relation issues. It was important to include relatives as a resource and make use of the opportunity they presented to assist patients during information sessions about...

  9. Common Vocational Training Project for the Handicapped (CVTPH). (United States)

    Amritmahal, Ananda; Mehta, J. M.


    A project of the Poona (India) District Leprosy Committee offers training in the industrial sector to leprosy patients, orthopedically handicapped individuals, and socioeconomically disadvantaged individuals, under a common roof. The project aims to combat the leprosy stigma and to aid rehabilitation by making the trainees economically…

  10. Environmental qualities and patient wellbeing in hospital settings

    DEFF Research Database (Denmark)

    Frandsen, Anne Kathrine


    undertaken by Architecture and Design and the Danish Building Research Institute (Aalborg University) set out in 2008 to review research on the impact of the environmental qualities of health-care facilities on patients and staff. The objective of the review team was to develop a tool that would allow......Within the last decades the impacts of the physical environments of hospitals on healing and health-care outcomes have been subject to ample research. The amount of documentation linking the design of physical environments to patient and staff outcomes is increasing. A Danish research project...

  11. [Essential data set's archetypes for nursing care of endometriosis patients]. (United States)

    Spigolon, Dandara Novakowski; Moro, Claudia Maria Cabral


    This study aimed to develop an Essential Data Set for Nursing Care of Patients with Endometriosis (CDEEPE), represented by archetypes. An exploratory applied research with specialists' participation that was carried out at Heath Informatics Laboratory of PUCPR, between February and November of 2010. It was divided in two stages: CDEEPE construction and evaluation including Nursing Process phases and Basic Human Needs, and archetypes development based on this data set. CDEEPE was evaluated by doctors and nurses with 95.9% of consensus and containing 51 data items. The archetype "Perception of Organs and Senses" was created to represents this data set. This study allowed identifying important information for nursing practices contributing to computerization and application of nursing process during care. The CDEEPE was the basis for archetype creation, that will make possible structured, organized, efficient, interoperable, and semantics records.

  12. Setting research priorities for patients on or nearing dialysis. (United States)

    Manns, Braden; Hemmelgarn, Brenda; Lillie, Erin; Dip, Sally Crowe P G; Cyr, Annette; Gladish, Michael; Large, Claire; Silverman, Howard; Toth, Brenda; Wolfs, Wim; Laupacis, Andreas


    With increasing emphasis among health care providers and funders on patient-centered care, it follows that patients and their caregivers should be included when priorities for research are being established. This study sought to identify the most important unanswered questions about the management of kidney failure from the perspective of adult patients on or nearing dialysis, their caregivers, and the health care professionals who care for these patients. Research uncertainties were identified through a national Canadian survey of adult patients on or nearing dialysis, their caregivers, and health care professionals. Uncertainties were refined by a steering committee that included patients, caregivers, researchers, and clinicians to assemble a short-list of the top 30 uncertainties. Thirty-four people (11 patients; five caregivers; eight physicians; six nurses; and one social worker, pharmacist, physiotherapist, and dietitian each) from across Canada subsequently participated in a workshop to determine the top 10 research questions. In total, 1570 usable research uncertainties were received from 317 respondents to the survey. Among these, 259 unique uncertainties were identified; after ranking, these were reduced to a short-list of 30 uncertainties. During the in-person workshop, the top 10 research uncertainties were identified, which included questions about enhanced communication among patients and providers, dialysis modality options, itching, access to kidney transplantation, heart health, dietary restrictions, depression, and vascular access. These can be used alongside the results of other research priority-setting exercises to guide researchers in designing future studies and inform health care funders. Copyright © 2014 by the American Society of Nephrology.

  13. Setting priorities for reducing risk and advancing patient safety. (United States)

    Gaffey, Ann D


    We set priorities every day in both our personal and professional lives. Some decisions are easy, while others require much more thought, participation, and resources. The difficult or less appealing priorities may not be popular, may receive push-back, and may be resource intensive. Whether personal or professional, the urgency that accompanies true priorities becomes a driving force. It is that urgency to ensure our patients' safety that brings many of us to work each day. This is not easy work. It requires us to be knowledgeable about the enterprise we are working in and to have the professional skills and competence to facilitate setting the priorities that allow our organizations to minimize risk and maximize value. © 2016 American Society for Healthcare Risk Management of the American Hospital Association.

  14. The performance-perceptual test and its relationship to unaided reported handicap. (United States)

    Saunders, Gabrielle H; Forsline, Anna; Fausti, Stephen A


    Measurement of hearing aid outcomes is necessary for demonstration of treatment efficacy, third-party payment, and cost-benefit analysis. Outcomes are usually measured with hearing-related questionnaires and/or tests of speech recognition. However, results from these two types of test often conflict. In this paper, we provide data from a new test measure, known as the Performance-Perceptual Test (PPT), in which subjective and performance aspects of hearing in noise are measured using the same test materials and procedures. A Performance Speech Reception Threshold (SRTN) and a Perceptual SRTN are measured using the Hearing In Noise Test materials and adaptive procedure. A third variable, the discrepancy between these two SRTNs, is also computed. It measures the accuracy with which subjects assess their own hearing ability and is referred to as the Performance-Perceptual Discrepancy (PPDIS). One hundred seven subjects between 24 and 83 yr of age took part. Thirty-three subjects had normal hearing, while the remaining seventy-four had symmetrical sensorineural hearing loss. Of the subjects with impaired hearing, 24 wore hearing aids and 50 did not. All subjects underwent routine audiological examination and completed the PPT and the Hearing Handicap Inventory for the Elderly/Adults on two occasions, between 1 and 2 wk apart. The PPT was conducted for unaided listening with the masker level set to 50, 65, and 80 dB SPL. PPT data show that the subjects with normal hearing have significantly better Performance and Perceptual SRTNs at each test level than the subjects with impaired hearing but that PPDIS values do not differ between the groups. Test-retest reliability for the PPT is excellent (r-values > 0.93 for all conditions). Stepwise multiple regression analysis showed that the Performance SRTN, the PPDIS, and age explain 40% of the variance in reported handicap (Hearing Handicap Inventory for the Elderly/Adults scores). More specifically, poorer performance

  15. Educational assistance to students with physical handicaps

    Directory of Open Access Journals (Sweden)

    Anselmo Vázquez Vázquez


    Full Text Available The present study was developed with the aim of determining the state of educational attention to students with handicaps. The Methods used are: General dialectical, Historic and logical and Systemic, Observation, Interview and Survey. As sample were taken 20 teachers and 100% of the students with handicaps from the faculty. Results: The educational assistance to students with ha ndi caps is being given empirically , regulations and guidelines from the Higher Ministry of Education related to handicaps are not known; There is scarce knowledge about the characteristics of handicaps and needs of guidance for effective learning. It recog nizes the importance of providing necessary resources for inclusion in the Higher Education.

  16. When a High Distinction Isn't Good Enough: A Review of Perfectionism and Self-Handicapping (United States)

    Kearns, Hugh; Forbes, Angus; Gardiner, Maria; Marshall, Kelly


    This paper addresses two problems which are common amongst university students, namely perfectionism and self-handicapping. Perfectionism deals with setting unreasonably high standards for one's own performance, while self-handicapping behaviours provide a possible excuse for poor performance, for example putting tasks off until the last minute.…

  17. Customer care. Patient satisfaction in the prehospital setting. (United States)

    Doering, G T


    The focus of the study was to prioritize six emergency medical service treatment factors in terms of their impact upon patient satisfaction in the prehospital setting. The six treatment areas analyzed were: EMS response time; medical care provided on scene; explanation of care by the provider; the provider's ability to reduce patient anxiety; the provider's ability to meet the patient's non-medical needs; and the level of courtesy/politeness shown by the EMS provider toward the patient. Telephone interviews were conducted with both patients and bystanders to obtain their perception of how well the system met their needs. The study analyzed how the six issues were rated and then evaluated the impact an individual's low score in a category had on that person's overall rating of the service provided. The overall satisfaction rating is not a calculated score, but an overall score specified by the respondent. The effect each issue had on the respondent's overall rating was determined by averaging the overall ratings for a category's low scorers, averaging the overall ratings for high scorers and then measuring the difference. Results of the study indicate that the factor with the greatest negative impact on patient satisfaction came from a perceived lack of crew courtesy and politeness. Respondents who indicated a fair to poor score in this category decreased their overall score by 60.2%. Ratings in other categories yielded the following results: When respondents rated the response time as fair to poor, their average overall rating showed an 18.4% decrease. When respondents rated the quality of medical care as fair to poor, their average overall rating showed a decrease of 22.6%. When the crew's ability to explain what was happening to the patient was rated as fair to poor, the average overall score dropped 33.6%. When the EMT's and medic's ability to reduce the patient's anxiety was rated fair to poor, average overall score declined by 32.6%. Finally, when the crew


    Directory of Open Access Journals (Sweden)

    Peter SKUBER


    Full Text Available In my discussion about the early treatment, I am going to point out three important matters:1. Open public health serviceThe deliveries are made at hospitals and the health service is the first to detect and treat children who are disturbed in their development. It also supervisor pregnancies. Upon the delivery, the screening test is used to analyze the risk delivery. At the beginning, the treatment is individual.2. Group (5-8 children in regular kindergartenThe transition of the child from the clinical treatment to the kindergarten is the result of an agreement between the team of experts both from the health institutes and pedagogical field of activity working in this way also when the child is in the nursery.The group of 5-8 handicapped children is now under the supervision of a nursery teacher having been to obtain special pedagogical education.3. Seminars of parentsThe state unity of associations providing for handicapped, in cooperation with local associations, organizes seminars lasting several days for parents and children.The purpose of the seminars is first of all helping parents in solving their emotional problems and also informing them on numerous issues appearing in connection with their child and themselves.

  19. Can patients report patient safety incidents in a hospital setting? A systematic review. (United States)

    Ward, Jane K; Armitage, Gerry


    Patients are increasingly being thought of as central to patient safety. A small but growing body of work suggests that patients may have a role in reporting patient safety problems within a hospital setting. This review considers this disparate body of work, aiming to establish a collective view on hospital-based patient reporting. This review asks: (a) What can patients report? (b) In what settings can they report? (c) At what times have patients been asked to report? (d) How have patients been asked to report? 5 databases (MEDLINE, EMBASE, CINAHL, (Kings Fund) HMIC and PsycINFO) were searched for published literature on patient reporting of patient safety 'problems' (a number of search terms were utilised) within a hospital setting. In addition, reference lists of all included papers were checked for relevant literature. 13 papers were included within this review. All included papers were quality assessed using a framework for comparing both qualitative and quantitative designs, and reviewed in line with the study objectives. Patients are clearly in a position to report on patient safety, but included papers varied considerably in focus, design and analysis, with all papers lacking a theoretical underpinning. In all papers, reports were actively solicited from patients, with no evidence currently supporting spontaneous reporting. The impact of timing upon accuracy of information has yet to be established, and many vulnerable patients are not currently being included in patient reporting studies, potentially introducing bias and underestimating the scale of patient reporting. The future of patient reporting may well be as part of an 'error detection jigsaw' used alongside other methods as part of a quality improvement toolkit.

  20. Impact of the frequency of online verifications on the patient set-up accuracy and set-up margins

    Directory of Open Access Journals (Sweden)

    Mohamed Adel


    Full Text Available Abstract Purpose The purpose of the study was to evaluate the patient set-up error of different anatomical sites, to estimate the effect of different frequencies of online verifications on the patient set-up accuracy, and to calculate margins to accommodate for the patient set-up error (ICRU set-up margin, SM. Methods and materials Alignment data of 148 patients treated with inversed planned intensity modulated radiotherapy (IMRT or three-dimensional conformal radiotherapy (3D-CRT of the head and neck (n = 31, chest (n = 72, abdomen (n = 15, and pelvis (n = 30 were evaluated. The patient set-up accuracy was assessed using orthogonal megavoltage electronic portal images of 2328 fractions of 173 planning target volumes (PTV. In 25 patients, two PTVs were analyzed where the PTVs were located in different anatomical sites and treated in two different radiotherapy courses. The patient set-up error and the corresponding SM were retrospectively determined assuming no online verification, online verification once a week and online verification every other day. Results The SM could be effectively reduced with increasing frequency of online verifications. However, a significant frequency of relevant set-up errors remained even after online verification every other day. For example, residual set-up errors larger than 5 mm were observed on average in 18% to 27% of all fractions of patients treated in the chest, abdomen and pelvis, and in 10% of fractions of patients treated in the head and neck after online verification every other day. Conclusion In patients where high set-up accuracy is desired, daily online verification is highly recommended.

  1. Impact of the frequency of online verifications on the patient set-up accuracy and set-up margins

    International Nuclear Information System (INIS)

    Rudat, Volker; Hammoud, Mohamed; Pillay, Yogin; Alaradi, Abdul Aziz; Mohamed, Adel; Altuwaijri, Saleh


    The purpose of the study was to evaluate the patient set-up error of different anatomical sites, to estimate the effect of different frequencies of online verifications on the patient set-up accuracy, and to calculate margins to accommodate for the patient set-up error (ICRU set-up margin, SM). Alignment data of 148 patients treated with inversed planned intensity modulated radiotherapy (IMRT) or three-dimensional conformal radiotherapy (3D-CRT) of the head and neck (n = 31), chest (n = 72), abdomen (n = 15), and pelvis (n = 30) were evaluated. The patient set-up accuracy was assessed using orthogonal megavoltage electronic portal images of 2328 fractions of 173 planning target volumes (PTV). In 25 patients, two PTVs were analyzed where the PTVs were located in different anatomical sites and treated in two different radiotherapy courses. The patient set-up error and the corresponding SM were retrospectively determined assuming no online verification, online verification once a week and online verification every other day. The SM could be effectively reduced with increasing frequency of online verifications. However, a significant frequency of relevant set-up errors remained even after online verification every other day. For example, residual set-up errors larger than 5 mm were observed on average in 18% to 27% of all fractions of patients treated in the chest, abdomen and pelvis, and in 10% of fractions of patients treated in the head and neck after online verification every other day. In patients where high set-up accuracy is desired, daily online verification is highly recommended

  2. Euthanasia of Severely Handicapped Infants: Ethical Issues. (United States)

    Cohen, Libby

    Ethical decisions are involved in life and death decisions for severely handicapped infants. Although it has become common practice for physicians not to treat severely handicapped infants, the ethical considerations involved in euthanasia are complex. A review of the literature reveals that concerns center around the quality of life of the…

  3. Arts for the Handicapped Child. Why? (United States)

    National Committee, Arts for the Handicapped, Washington, DC.

    Presented is a collection of case studies by therapists, educators, artists, parents, and recreation leaders, dealing with the arts as learning experiences for handicapped children. Each of the ten articles records the positive effects of arts experiences (dance, art, music, drama) on the growth and development of a particular handicapped child or…

  4. 28 CFR 41.31 - Handicapped person. (United States)


    ... Persons § 41.31 Handicapped person. (a) Handicapped person means any person who has a physical or mental...: (1) Physical or mental impairment means: (i) Any physiological disorder or condition, cosmetic... disorder, such as mental retardation, organic brain syndrome, emotional or mental illness, and specific...

  5. Handicapped Litigation: A Review of Significant Decisions. (United States)

    Bowen, John W.

    Since 1979 many courts have handed down rulings in favor of handicapped children under the Education of the Handicapped Act. This twentieth chapter in a book on school law summarizes these cases. In "Kruelle v. Biggs," the court ruled that a school district must provide residential placement free of charge if such placement is necessary…

  6. Psychological distress longitudinally mediates the effect of vertigo symptoms on vertigo-related handicap. (United States)

    Probst, Thomas; Dinkel, Andreas; Schmid-Mühlbauer, Gabriele; Radziej, Katharina; Limburg, Karina; Pieh, Christoph; Lahmann, Claas


    Vertigo symptoms can lead to more or less vertigo-related handicap. This longitudinal study investigated whether depression, anxiety, and/or somatization mediate the relationship between vertigo symptoms and vertigo-related handicap. N=111 patients with vertigo/dizziness provided complete data on the following measures: Vertigo symptoms at baseline, depression at 6-month follow-up, anxiety at 6-month follow-up, somatization at 6-month follow-up, and vertigo handicap at 12-month follow-up. Mediation analyses with bootstrapping were performed to investigate the mediating role of anxiety, depression, and somatization in the relationship between vertigo symptoms and vertigo-related handicap. When the mediating role of anxiety, depression, and somatization was evaluated separately from each other in single mediation models, the effect vertigo symptoms at baseline exerted on vertigo-related handicap at 12-month follow-up was significantly mediated by depression at 6-month follow-up (pvertigo symptoms at baseline on vertigo-related handicap at 12-month follow-up (pvertigo symptoms lead to vertigo-related handicap. Copyright © 2016 Elsevier Inc. All rights reserved.

  7. Self-handicapping and intrinsic motivation: buffering intrinsic motivation from the threat of failure. (United States)

    Deppe, R K; Harackiewicz, J M


    High and low self-handicappers (as measured by E. E. Jones & F. Rhodewalt's [1982] Self-Handicapping Scale) were asked to play a game of pinball (in a competitive or noncompetitive setting) after they had practices as much as they wanted on a related task (thus, not practicing could have served as a self-handicap). High self-handicappers who did not practice much became more involved in the game and subsequently reported enjoying the game more than high self-handicappers who practiced a lot. Furthermore, the effects on enjoyment were mediated by task involvement, suggesting that the protection afforded by self-handicapping affects intrinsic motivation by allowing the individual to become absorbed in the activity instead of focusing on performance concerns. Individuals who self-handicap may be providing themselves with the "breathing room" they need to become absorbed in an activity and to experience the activity as enjoyable.

  8. Seroprevalence of hepatitis B and C virus in two institutions caring for mentally handicapped adults.


    Cramp, M E; Grundy, H C; Perinpanayagam, R M; Barnado, D E


    Hepatitis B virus infection is common in institutions caring for the mentally handicapped. Hepatitis B virus and hepatitis C virus share routes of transmission but the prevalence of hepatitis C virus infection in this population is unknown. We have tested 101 patients from two institutions in South-East England caring for adults with mental handicap for the presence of hepatitis C antibody, hepatitis B core antibody, and if necessary hepatitis B surface antigen. None tested positive for hepat...

  9. Patient satisfaction among Spanish-speaking patients in a public health setting. (United States)

    Welty, Elisabeth; Yeager, Valerie A; Ouimet, Claude; Menachemi, Nir


    Despite the growing literature on health care quality, few patient satisfaction studies have focused upon the public health setting; where many Hispanic patients receive care. The purpose of this study was to examine the differences in satisfaction between English and Spanish-speaking patients in a local health department clinical setting. We conducted a paper-based satisfaction survey of patients that visited any of the seven Jefferson County Department of Health primary care centers from March 19 to April 19, 2008. Using Chi-squared analyses we found 25% of the Spanish-speaking patients reported regularly having problems getting an appointment compared to 16.8% among English-speakers (p speaking patients controlling for center location, purpose of visit, and time spent waiting. Specifically, Spanish speaking patients were more likely to report problems getting an appointment and less likely to report having their medical problems resolved when leaving their visit as compared to those who spoke English. Findings presented herein may provide insight regarding the quality of care received, specifically regarding patient satisfaction in the public health setting. © 2011 National Association for Healthcare Quality.

  10. Ready for goal setting? Process evaluation of a patient-specific goal-setting method in physiotherapy. (United States)

    Stevens, Anita; Köke, Albère; van der Weijden, Trudy; Beurskens, Anna


    Patient participation and goal setting appear to be difficult in daily physiotherapy practice, and practical methods are lacking. An existing patient-specific instrument, Patient-Specific Complaints (PSC), was therefore optimized into a new Patient Specific Goal-setting method (PSG). The aims of this study were to examine the feasibility of the PSG in daily physiotherapy practice, and to explore the potential impact of the new method. We conducted a process evaluation within a non-controlled intervention study. Community-based physiotherapists were instructed on how to work with the PSG in three group training sessions. The PSG is a six-step method embedded across the physiotherapy process, in which patients are stimulated to participate in the goal-setting process by: identifying problematic activities, prioritizing them, scoring their abilities, setting goals, planning and evaluating. Quantitative and qualitative data were collected among patients and physiotherapists by recording consultations and assessing patient files, questionnaires and written reflection reports. Data were collected from 51 physiotherapists and 218 patients, and 38 recordings and 219 patient files were analysed. The PSG steps were performed as intended, but the 'setting goals' and 'planning treatment' steps were not performed in detail. The patients and physiotherapists were positive about the method, and the physiotherapists perceived increased patient participation. They became aware of the importance of engaging patients in a dialogue, instead of focusing on gathering information. The lack of integration in the electronic patient system was a major barrier for optimal use in practice. Although the self-reported actual use of the PSG, i.e. informing and involving patients, and client-centred competences had improved, this was not completely confirmed by the objectively observed behaviour. The PSG is a feasible method and tends to have impact on increasing patient participation in the goal-setting

  11. Anatomical correlates of self-handicapping tendency. (United States)

    Takeuchi, Hikaru; Taki, Yasuyuki; Nouchi, Rui; Hashizume, Hiroshi; Sekiguchi, Atsushi; Kotozaki, Yuka; Nakagawa, Seishu; Miyauchi, Carlos M; Sassa, Yuko; Kawashima, Ryuta


    Self-handicaps are obstacles created (or claimed) by individuals in anticipation of failure. Despite the vast amount of psychological research on self-handicapping tendency, the neural mechanisms underlying individual differences in self-handicapping tendency in young and healthy subjects are unknown. We used voxel-based morphometry (VBM) and a questionnaire to measure individual self-handicapping tendency, and we investigated the association between regional gray matter volume (rGMV) and self-handicapping tendency across the brain in healthy young adult (mean age, 21.3 years; standard deviation - SD = 1.9) men (n = 94) and women (n = 91). We discovered that higher individual self-handicapping tendency was associated with larger rGMV in the subgenual cingulate gyrus (sgCG). A wide range of previous studies showed (a) the opposite pattern is seen in the association between rGMV in the sgCG and depression and (b) this area is active when negative emotions are suppressed. The present results suggest that the sgCG is also involved in self-handicapping, which is a behavior thought to be engaged in the protection of self-esteem. Copyright © 2013 Elsevier Ltd. All rights reserved.

  12. Discussion of the dizziness handicap inventory. (United States)

    Mutlu, Basak; Serbetcioglu, Bulent


    A review of the Dizziness Handicap Inventory (DHI). NUMBER OF STUDIES: Seventy-four studies. Articles published between January 1990 and May 2012 were identified by searches in PubMed electronic database. Of the 227 articles meeting the inclusion criteria 74 were reviewed. These articles are discussed under nine topics; Reliability, validity and internal consistency of the original version of DHI, relationship between vestibular/balance tests and DHI, association between DHI and the other scales related to balance impairments, exploratory factor analysis of the DHI, screening version of DHI, translations of DHI into other languages, the role of DHI to assess the success of the treatment of balance disorder, DHI results in various vestibular disorders, general characteristics of DHI in patients with balance impairment. Self reported measures represent unique pieces of the information important for the management of dizzy patients. DHI is the most widely used self reported measurement of patients with dizziness. It has been translated into fourteen languages, so it is widely accepted.

  13. Development of bladder control in mentally handicapped children

    Directory of Open Access Journals (Sweden)

    Bruschini Homero


    Full Text Available PURPOSE:To analyze the role of mental handicap as a possible source of lack of development of bladder control and to find out the chance of continence to advise future patients. MATERIALS AND METHODS: The parents and relatives of 100 consecutive mentally handicapped patients were inquired by a personal interview. Questions included the age when they stopped using diapers, enuretic events, frequency, urgency and leakage episodes, urinary infections. Etiology of their mental problem was unknown in 34, perinatal anoxia in 17, Down syndrome in 15, phenylketonuria in 18 and others minors causes. The grade of mental deficiency were profound in 1, severe in 10, moderate in 39, mild in 33 and normal inferior value in 17. The age varied from 7 to 37 years old, with an average of 14 by the time of the interview, comprising 60 males and 40 females. RESULTS: All profound and severe patients presented leakage episodes regardless of the age. The mild and normal inferior value acquired progressive urinary control with aging, and 33% still remain with urinary symptoms above 16 years old. Urinary infection was similar in males and females, around 29%. The most committed group presented less urinary infections. The etiology of the mental handicap was not correlated to the incidence of urinary leakage. CONCLUSIONS: The lack of bladder control was correlated to the grade of mental handicap. In severe and profound groups, the expectancy of control is disappointing. In the less compromised groups, there is a delay in bladder training, with achievement of control in 2/3 after 16 years of age. Those in the normal inferior value have a chance of postponed urinary control, easily misdiagnosed by normal urological interviews.

  14. Consumer Education for the Mentally Handicapped (United States)

    Alperstein, Neil M.


    Discusses community placement of mentally handicapped people and remedial procedures for encouraging independent decision making and behavior. Intertwines this behavior change with an alternative method of consumer education. (Author/RK)

  15. Is Being Gifted a Social Handicap? (United States)

    Coleman, Laurence J.; Cross, Tracy L.


    Interviews with 15 gifted/talented adolescents indicated that many of them experienced giftedness as a social handicap. Some students coped with this by managing information about themselves to minimize their visibility as gifted students to others. (Author/JDD)

  16. Enhancing the prediction of self-handicapping. (United States)

    Harris, R N; Snyder, C R; Higgins, R L; Schrag, J L


    Levels of test anxiety, Type A and Type B coronary-prone behavior, fear of failure, and covert self-esteem were studied as predictors of self-handicapping performance attributions for college women who were placed in either a high- (N = 49) or low- (N = 49) evaluative test or task situation. We hypothesized that test anxiety. Type A or Type B level, and their interaction would account for reliable variance in the prediction of self-handicapping. However, we also theorized that underlying high fear of failure and low covert self-esteem would explain the self-handicapping claims of test-anxious and Type A subjects. The results indicated that only high levels of test anxiety and high levels of covert self-esteem were related to women's self-handicapping attributions.

  17. Handicap principle implies emergence of dimorphic ornaments. (United States)

    Clifton, Sara M; Braun, Rosemary I; Abrams, Daniel M


    Species spanning the animal kingdom have evolved extravagant and costly ornaments to attract mating partners. Zahavi's handicap principle offers an elegant explanation for this: ornaments signal individual quality, and must be costly to ensure honest signalling, making mate selection more efficient. Here, we incorporate the assumptions of the handicap principle into a mathematical model and show that they are sufficient to explain the heretofore puzzling observation of bimodally distributed ornament sizes in a variety of species. © 2016 The Author(s).

  18. 45 CFR 605.34 - Educational setting. (United States)


    ... needs of the handicapped person. A recipient shall place a handicapped person in the regular educational environment operated by the recipient unless it is demonstrated by the recipient that the education of the..., Elementary, and Secondary Education § 605.34 Educational setting. (a) Academic setting. A recipient to which...

  19. Psychometric properties of the Persian version of the Tinnitus Handicap Inventory (THI-P

    Directory of Open Access Journals (Sweden)

    Mir Mohammad Jalali


    Full Text Available Introduction: Tinnitus can have a significant effect on an individual’s quality of life, and is very difficult quantify. One of the most popular questionnaires used in this area is the Tinnitus Handicap Inventory (THI. The aim of this study was to determine the reliability and validity of a Persian translation of the Tinnitus Handicap Inventory (THI-P.   Materials and Methods: This prospective clinical study was performed in the Otolaryngology Department of Guilan University of Medical Sciences, Iran. A total of 102 patients aged 23–80 years with tinnitus completed the (THI-P. The patients were instructed to complete the Beck Depression Inventory (BDI and the State-Trait Anxiety Inventory (STAI. Audiometry was performed. Eight-five patients were asked to complete the THI-P for a second time 7–10 days after the initial interview. We assessed test–retest reliability and internal reliability of the THI-P. Validity was assessed by analyzing the THI-P of patients according to their age, tinnitus duration and psychological distress (BDI and STAI. A factor analysis was computed to verify if three subscales (functional, emotional, and catastrophic represented three distinct variables.   Results: Test–retest correlation coefficient scores were highly significant. The THI-P and its subscales showed good internal consistency reliability (α = 0.80 to 0.96. High-to-moderate correlations were observed between THI-P and psychological distress and tinnitus symptom ratings. A confirmatory factor analysis failed to validate the three subscales of THI, and high inter-correlations found between the subscales question whether they represent three distinct factors. Conclusion:  The results suggest that the THI-P is a reliable and valid tool which can be used in a clinical setting to quantify the impact of tinnitus on the quality of life of Iranian patients.

  20. Skill set or mind set? Associations between health literacy, patient activation and health.

    Directory of Open Access Journals (Sweden)

    Samuel G Smith

    Full Text Available There is ongoing debate on whether health literacy represents a skill-based construct for health self-management, or if it also more broadly captures personal 'activation' or motivation to manage health. This research examines 1 the association between patient activation and health literacy as they are most commonly measured and 2 the independent and combined associations of patient activation and health literacy skills with physical and mental health.A secondary analysis of baseline cross-sectional data from the LitCog cohort of older adults was used. Participants (n = 697 were recruited from multiple US-based health centers. During structured face-to-face interviews, participants completed the Test of Functional Health Literacy in Adults (TOFHLA, the Patient Activation Measure (PAM, the SF-36 physical health summary subscale, and Patient Reported Outcomes Measurement Information Service (PROMIS short form subscales for depression and anxiety.The relationship between health literacy and patient activation was weak, but significant (r = 0.11, p<0.01. In models adjusted for participant characteristics, lower health literacy was associated with worse physical health (β = 0.13, p<0.001 and depression (β = -0.16, p<0.001. Lower patient activation was associated with worse physical health (β = 0.19, p<0.001, depression (β = -0.27, p<0.001 and anxiety (β-0.24, p<0.001.The most common measures of health literacy and patient activation are weakly correlated with each other, but also independently correlated with health outcomes. This suggests health literacy represents a distinct skill-based construct, supporting the Institute of Medicine's definition. Deficits in either construct could be useful targets for behavioral intervention.

  1. Placing wireless tablets in clinical settings for patient education. (United States)

    Stribling, Judy C; Richardson, Joshua E


    The authors explored the feasibility and possible benefit of tablet-based educational materials for patients in clinic waiting areas. We distributed eight tablets preloaded with diagnosis-relevant information in two clinic waiting areas. Patients were surveyed about satisfaction, usability, and effects on learning. Technical issues were resolved. Thirty-seven of forty patients completed the survey. On average, the patients were satisfied in all categories. Placing tablet-based educational materials in clinic waiting areas is relatively easy to implement. Patients using tablets reported satisfaction across three domains: usability, education, and satisfaction.

  2. Placing wireless tablets in clinical settings for patient education

    Directory of Open Access Journals (Sweden)

    Judy C. Stribling, MA, MLS


    Full Text Available Objective: The authors explored the feasibility and possible benefit of tablet-based educational materials for patients in clinic waiting areas. Methods: We distributed eight tablets preloaded with diagnosis-relevant information in two clinic waiting areas. Patients were surveyed about satisfaction, usability, and effects on learning. Technical issues were resolved. Results: Thirty-seven of forty patients completed the survey. On average, the patients were satisfied in all categories. Conclusions: Placing tablet-based educational materials in clinic waiting areas is relatively easy to implement. Patients using tablets reported satisfaction across three domains: usability, education, and satisfaction.

  3. Patient identification errors are common in a simulated setting. (United States)

    Henneman, Philip L; Fisher, Donald L; Henneman, Elizabeth A; Pham, Tuan A; Campbell, Megan M; Nathanson, Brian H


    We evaluate the frequency and accuracy of health care workers verifying patient identity before performing common tasks. The study included prospective, simulated patient scenarios with an eye-tracking device that showed where the health care workers looked. Simulations involved nurses administering an intravenous medication, technicians labeling a blood specimen, and clerks applying an identity band. Participants were asked to perform their assigned task on 3 simulated patients, and the third patient had a different date of birth and medical record number than the identity information on the artifact label specific to the health care workers' task. Health care workers were unaware that the focus of the study was patient identity. Sixty-one emergency health care workers participated--28 nurses, 16 technicians, and 17 emergency service associates--in 183 patient scenarios. Sixty-one percent of health care workers (37/61) caught the identity error (61% nurses, 94% technicians, 29% emergency service associates). Thirty-nine percent of health care workers (24/61) performed their assigned task on the wrong patient (39% nurses, 6% technicians, 71% emergency service associates). Eye-tracking data were available for 73% of the patient scenarios (133/183). Seventy-four percent of health care workers (74/100) failed to match the patient to the identity band (87% nurses, 49% technicians). Twenty-seven percent of health care workers (36/133) failed to match the artifact to the patient or the identity band before performing their task (33% nurses, 9% technicians, 33% emergency service associates). Fifteen percent (5/33) of health care workers who completed the steps to verify patient identity on the patient with the identification error still failed to recognize the error. Wide variation exists among health care workers verifying patient identity before performing everyday tasks. Education, process changes, and technology are needed to improve the frequency and accuracy of

  4. Patient portal readiness among postpartum patients in a safety net setting. (United States)

    Wieland, Daryl; Gibeau, Anne; Dewey, Caitlin; Roshto, Melanie; Frankel, Hilary


    Maternity patients interact with the healthcare system over an approximately ten-month interval, requiring multiple visits, acquiring pregnancy-specific education, and sharing health information among providers. Many features of a web-based patient portal could help pregnant women manage their interactions with the healthcare system; however, it is unclear whether pregnant women in safety-net settings have the resources, skills or interest required for portal adoption. In this study of postpartum patients in a safety net hospital, we aimed to: (1) determine if patients have the technical resources and skills to access a portal, (2) gain insight into their interest in health information, and (3) identify the perceived utility of portal features and potential barriers to adoption. We developed a structured questionnaire to collect demographics from postpartum patients and measure use of technology and the internet, self-reported literacy, interest in health information, awareness of portal functions, and perceived barriers to use. The questionnaire was administered in person to women in an inpatient setting. Of the 100 participants surveyed, 95% reported routine internet use and 56% used it to search for health information. Most participants had never heard of a patient portal, yet 92% believed that the portal functions were important. The two most appealing functions were to check results and manage appointments. Most participants in this study have the required resources such as a device and familiarity with the internet to access a patient portal including an interest in interacting with a healthcare institution via electronic means. Pregnancy is a critical episode of care where active engagement with the healthcare system can influence outcomes. Healthcare systems and portal developers should consider ways to tailor a portal to address the specific health needs of a maternity population including those in a safety net setting.

  5. Effect of a 0.5% chlorhexidine gel on dental plaque superinfecting microorganisms in mentally handicapped patients Efeito do gel de clorexidina a 0,5% em microrganismos superinfectantes da placa bacteriana de portadores de necessidades especiais

    Directory of Open Access Journals (Sweden)

    Cláudio Mendes Pannuti


    Full Text Available A randomized clinical trial was conducted to investigate the effect of a 0.5% chlorhexidine (CHX gel on dental plaque superinfecting microorganisms in mentally handicapped patients. Thirty inmates from the institution "Casas André Luiz" were assigned to either test group (CHX gel, n = 15 or control group (placebo gel, n = 15. The gel was administered over a period of 8 weeks. Supragingival plaque samples were collected at baseline, after gel use (8 weeks and 16 weeks after baseline. The presence of Gram-negative Enterobacteriaceae, Staphylococcus and yeasts was evaluated. No significant growth of any superinfecting microorganism was observed in the CHX group, when compared to the placebo group. The results indicated that the 0.5% chlorhexidine gel did not produce an undesirable shift in these bacterial populations.Foi conduzido um ensaio clínico aleatório com objetivo de investigar o efeito do gel de clorexidina (CHX a 0,5% sobre microorganismos superinfectantes da placa bacteriana de pacientes especiais. Trinta internos da instituição "Casas André Luiz" foram aleatoriamente divididos em grupo teste (gel de CHX, n = 15 e controle (gel placebo, n = 15. O gel foi utilizado por oito semanas. Amostras de placa supragengival foram coletadas no início do estudo, após o uso do gel (oito semanas e 16 semanas após o início do estudo. Foi avaliada a presença de bacilos entéricos Gram-negativos, Staphylococcus e leveduras. Não houve diferença entre os grupos quanto à presença desses microorganismos em qualquer momento do estudo. Os resultados indicam que o gel de CHX não provocou mudanças significativas na composição desses microorganismos.

  6. Learning Handicapped and Nonlearning Handicapped Female Juvenile Offenders: Educational and Criminal Profiles. (United States)

    Fejes-Mendoza, Kathy E.; Rutherford, Robert B., Jr.


    Interviews with 30 female juvenile offenders were conducted to (1) describe their educational and criminal backgrounds and (2) describe a subgroup of learning handicapped juvenile female offenders. Nearly one third had received special education services prior to their incarceration with additional offenders diagnosed as handicapped upon entry…

  7. Horticultural therapy in a psychiatric in-patient setting


    de Seixas, Miguel; Williamson, David; Barker, Gemma; Vickerstaff, Ruth


    In-patient mental health services have a duty to constantly seek to improve patient experience and to assist in the development of new skills that can aid recovery. Horticultural therapy can be implemented in an economic, social and environmentally sustainable way to achieve those goals.

  8. Horticultural therapy in a psychiatric in-patient setting. (United States)

    de Seixas, Miguel; Williamson, David; Barker, Gemma; Vickerstaff, Ruth


    In-patient mental health services have a duty to constantly seek to improve patient experience and to assist in the development of new skills that can aid recovery. Horticultural therapy can be implemented in an economic, social and environmentally sustainable way to achieve those goals.

  9. "I know you self-handicapped last exam": gender differences in reactions to self-handicapping. (United States)

    Hirt, Edward R; McCrea, Sean M; Boris, Hillary I


    Past research has shown that self-handicapping involves the trade-off of ability-related attributional benefits for interpersonal costs. Study 1 examined whether perceiver or target sex moderates impressions of self-handicapping targets. Although target sex was not an important factor, female perceivers were consistently more critical of behavioral self-handicappers. Two additional studies replicated this gender difference with variations of the handicap. Study 3 examined the motives inferred by perceivers and found that women not only view self-handicappers as more unmotivated but also report greater suspicion of self-handicapping motives; furthermore, these differences in perceived motives mediated sex differences in reactions to self-handicappers. Implications for the effectiveness of self-handicapping as an impression management strategy are discussed.

  10. Behavioral Analytic Approach to Placement of Patients in Community Settings. (United States)

    Glickman, Henry S.; And Others

    Twenty adult psychiatric outpatients were assessed by their primary therapists on the Current Behavior Inventory prior to placing them in community settings. The diagnoses included schizophrenia, major affective disorder, dysthymic disorder, and atypical paranoid disorder. The inventory assessed behaviors in four areas: independent community…

  11. Development of the patient setting system for BNCT at JRR-4

    International Nuclear Information System (INIS)

    Kumada, H.; Yamamoto, K.; Torii, Y.


    A new treatment planning software: Computational Dosimetry System (JCDS) is in progress its development for BNCT with epithermal neutron beam in JAERI. Irradiation conditions such as beam angle to a patient are calculated by JCDS. In order to implement these conditions, it is necessary to precisely set the patient to actual irradiation position simulated by JCDS beforehand. Therefore, the Patient Setting System, which accurately and quickly sets the patient to the irradiation position, is being developed with JCDS concurrently. In this report, the current status of the development of JCDS and the Patient Setting System in JAERI will be described. (author)

  12. Goal-setting in multidisciplinary team care for patients with rheumatoid arthritis

    DEFF Research Database (Denmark)

    Meesters, Jorit; Hagel, Sofia; Klokkerud, Mari


    %) to "Environmental Factors" (e-codes). Thirty-five of the 151 unique ICF codes (23%) were not in the comprehensive ICF Core Set for RA, whereas 23 of the ICF codes in this Core Set (24%) were not in the rehabilitation goals. Conclusion: The goals set in a team rehabilitation setting for patients with rheumatoid...

  13. Handicapped Infants and Euthanasia: A Challenge to Our Advocacy. (United States)

    Smith, J. David


    The issue of pediatric euthanasia for handicapped newborns is examined and contrasting viewpoints emphasizing the quality and the sanctity of life are considered. The author asserts that advocacy for handicapped children involves decisions regarding the euthanasia question. (CL)

  14. Handicapping: the effects of its source and frequency. (United States)

    McElroy, James C; Crant, J Michael


    Using a sample of 246 working adults, the authors created a 2 x 2 x 2 experimental design to isolate the influence of performance outcome, source of handicapping, and frequency of handicapping on reactions to handicapping in organizations. Dependent measures were observers' allocations of credit/blame, interpersonal affect, and the perceived credibility of the explanation. Results showed direct effects on observer impressions for all 3 independent variables, along with a significant Source x Frequency interaction. Handicapping information presented by others yielded more favorable observer impressions than did self-handicapping, and frequent handicapping decreased observer impressions. The least credible handicapping strategy was multiple self-handicaps. A significant 3-way interaction showed that source and frequency affected perceived credibility differently, depending upon whether actual performance was a success or a failure.

  15. Low trait self-control predicts self-handicapping. (United States)

    Uysal, Ahmet; Knee, C Raymond


    Past research has shown that self-handicapping stems from uncertainty about one's ability and self-presentational concerns. The present studies suggest that low dispositional self-control is also associated with self-handicapping. In 3 studies (N = 289), the association between self-control and self-handicapping was tested. Self-control was operationalized as trait self-control, whereas self-handicapping was operationalized as trait self-handicapping in Study 1 (N = 160), self-reported self-handicapping in Study 2 (N = 74), and behavioral self-handicapping in Study 3 (N = 55). In all 3 studies, hierarchical regression analyses revealed that low self-control predicts self-handicapping, independent of self-esteem, self-doubt, social desirability, and gender. © 2012 The Authors. Journal of Personality © 2012, Wiley Periodicals, Inc.

  16. Nurses' assessment of patients' cognitive orientation in a rehabilitation setting. (United States)

    Alverzo, J P; Galski, T


    Orientation is a critical determinant of a patient's neurological status and an indicator of change in condition during hospitalization. The ways rehabilitation nurses assess orientation and the manner in which findings are interpreted and reported can have significant implications for the care of neurologically compromised patients. This study used a questionnaire to examine how 52 nurses appraised and reported the results of orientation evaluations. Analyses produced descriptive statistics and correlational measures for determining nurses' tendencies and consistency in evaluating orientation. Most respondents, regardless of their education and experience, used a clinical interview, rather than psychometric tests, as a basis for forming opinions about orientation. Although most evaluations included assessments in terms of person, time, place, and circumstance, no consistent pattern emerged regarding questioning or in the ways results were reported. Findings revealed a significant lack of consensus in terms of assessing and reporting orientation results, which could reflect insufficient awareness about the importance of maintaining consistency in evaluations, the relevance of using standardized evaluations and comparing measures over time, and the necessity of agreeing on how to report cognitive disturbances.

  17. Review of the Studies on Self-Handicapping


    伊藤, 忠弘


    Since Jones & Berglas (1978) presented the conception of self-handicapping, a lot of empirical research on self-handicapping was reported. Some reseachers drew a distinction between ""acquired"" (or ""behavioral"") self-handicapping such as drug ingestion, alcohol consumption, effort reduction, and choosing a difficult task, and ""claimed"" (or ""self-reported"") self-handicapping such as verbal claim to be ill, socially anxious, test anxious, or in a bad mood. This paper reviewed these studi...

  18. The impact of self-handicapping strategies use on the impression formation


    Hip-Fabek, Irena


    Self-handicapping is usually defined as any claim, action or choice of performance setting that enhances the opportunity to externalize (or excuse) failure and to internalize (accept credit for) success. The purpose of this study was to examine the impact of using different self-handicapping strategies on formation of the impression about the person. We collected data from 365 participants, whose task was to read a story about the person who failed on the task delegated to him/her, and to app...

  19. The Special Needs of Prison Inmates with Handicaps: An Assessment. (United States)

    Veneziano, Louis; And Others


    Surveyed 45 workers in correctional agencies to examine number of handicapped inmates and types of programs provided to them. Found that most prison systems had identified some handicapped inmates. Variety of programs were offered to inmates, many systems did not have specialized treatment for handicapped. Found need for evaluation and treatment…

  20. Handicap og beskæftigelse i 2006

    DEFF Research Database (Denmark)

    Høgelund, Jan; Larsen, Brian; Kløft Schademan, Helle

    Denne rapport giver ny viden om beskæftigelsessituationen for personer med handicap. Den viser, at personer med handicap er lige så tilfredse med deres arbejde, som personer uden handicap, og at de oplever at de har de samme jobkrav og de samme muligheder for indflydelse og udvikling, og de har s...

  1. Excuses, Excuses: Self-Handicapping in an Australian Adolescent Sample. (United States)

    Warner, Suzanne; Moore, Susan


    The purpose of the present study was to examine gender differences in the self-handicapping tendencies of a sample of 337 Australian school attending adolescents, who were aged between 15 and 19 years. Self-handicapping, as measured by the shortened Self-Handicapping Scale, was examined in relation to self-esteem, performance attributions, coping…

  2. Self-Handicapping Behavior: A Critical Review of Empirical Research. (United States)

    Carsrud, Robert Steven

    Since the identification of self-handicapping strategies in 1978, considerable attention has been paid to this phenomenon. Self-handicapping is a strategy for discounting ability attributions for probable failure while augmenting ability attributions for possible success. Behavioral self-handicaps are conceptually distinct from self-reported…

  3. Issues in the Enumeration of Handicapping Conditions in the United States. (United States)

    Martini, Linda; MacTurk, Robert H.


    The article identifies sources of prevalence and incidence rates for handicaps and disabilities, points out problems regarding obtaining this information, and examines reasons for the problems. Two measures are suggested: first, to set up a national directory of those health statistics already being collected; and second, to develop a nationwide…

  4. Integrating Severely Handicapped Learners: Potential Teacher Liability in Community Based Programs. (United States)

    Brady, Michael P.; Dennis, H. Floyd


    The paper examines elements of negligence and other legal concerns in view of the evolving trend to educate severely handicapped persons in integrated, community based settings. Duty, care, risk, and appropriate placement and instruction are discussed. Finally, recommendations for avoiding teacher liability are presented. (Author/CL)

  5. 'Finding a balance' in involving patients in goal setting early after stroke: a physiotherapy perspective. (United States)

    Lloyd, A; Roberts, A R; Freeman, J A


    Collaborative goal setting (between patient and professional) confers benefits within stroke and neurological rehabilitation, and is recommended in clinical guidelines. However, evidence suggests that patient participation in rehabilitation goal setting is not maximized, particularly within the hospital setting. The purpose of this study was to investigate physiotherapists' perceptions about their experiences of collaborative goal setting with patients in the sub-acute stages after stroke, in the hospital setting. This qualitative study employed constructivist grounded theory methodology. Nine physiotherapists, of varying experience, were selected using purposive then theoretical sampling from three National Health Service hospital stroke units in England. Semi-structured interviews were conducted, audio-recorded and transcribed. Transcripts were coded and analysed using the constant comparative method of grounded theory to find common themes. Three themes emerged from the data: 1) 'coming to terms with stroke' - the individual patient journey; 2) the evolution of goal setting skill - the individual physiotherapist journey; and 3) 'finding a balance' - managing expectations and negotiating interactions. A provisional grounded theory was constructed, which highlighted that, from the physiotherapists' perspective, collaboration with patients within goal setting early after stroke involved finding a balance between numerous different drivers, which have the potential to compete. Patient-directed and therapist-directed goal setting approaches could be viewed as opposite ends of a continuum, along which patient-centred goal setting is possible. Physiotherapists perceived that collaborating with patients in goal setting was important but challenging. Goal setting interactions with other professionals, patients and families were perceived as complex, difficult and requiring significant effort. The importance of individuality and temporality were recognized suggesting that

  6. Telecommunications: A New Horizon for the Handicapped. (United States)

    Cunningham, Pat; Gose, Joan

    The paper describes a computer bulletin board program operated by physically handicapped high school students. Through the bulletin board system, resource people have been contacted, students' written communication and interpersonal relationships have been strengthened, and professional contact has been strengthened. Administrative implications…

  7. Therapeutic Intervention for the Physically Handicapped (United States)

    Spillios, James; Janzen, Henry L.


    The need for training counselors specifically for intervention with the physically handicapped is the major focus of this article. Definitions of disabilities, rehabilitation and emotional factors are stressed as important variables in physical and psychotherapeutic treatment. The authors review some of the psychological aspects in counseling the…

  8. Rehabilitation and Care of the Handicapped. (United States)

    Engberg, Eugenie; And Others

    An overview of services to help the handicapped is given in light of the characteristics of social conditions and social development in Denmark, and the history of rehabilitative care is examined. Information is given on the following areas: legislative, organization and financing; the national health service; the general education of handicapped…

  9. Disability and handicap among elderly Singaporeans. (United States)

    Yadav, S S


    Singapore's elderly population has been growing rapidly and is expected to constitute more than 25 percent of the total population by the year 2030. The ageing process brings with it a host of health problems. Here the question arises--Are the increasing years of life going to create a high proportion of sick and disabled elderly people, or a rich human resource of healthy senior citizens? Since more women are living longer than men, who would face a higher risk of disability and handicap? These questions are yet to be answered in Singapore. This paper seeks answers to these questions. The study is based on a sample survey of 1209 elderly Singaporeans living in Kampong Glam, Kreta Ayer and Bukit Merah parliamentary constituencies which have some of the highest proportions of the aged population. The results revealed that more than half of the aged had a disability and the rate of disability was significantly higher among the women as compared to the men. More than one-third of the elderly had a handicap and the rate of handicap among the women was twice as much as that among the men. Severity of handicap was directly correlated with age.

  10. Handicapped Students in the Danish Educational System. (United States)

    Ministry of Education, Copenhagen (Denmark).

    The educational policy of Denmark and the educational system which has evolved from this policy are described. The policy states that everyone has a right to the same access to education and training, regardless of sex, social origins, geographic origins, and physical or mental handicap; and all public education is free of charge from the age of 5…

  11. Employment of Handicapped People in Leisure Occupations. (United States)

    Compton, David M.; Vinton, Dennis A.

    In response to the need for up-to-date information on employment opportunities for handicapped people in the leisure occupations, a national survey was conducted to determine both existing levels of employment and employer practices. The survey was sent to 500 agencies and businesses representing four leisure occupational subclusters: travel,…

  12. Reducing Truancy in Students with Mild Handicaps. (United States)

    Hess, Albert M.; And Others


    Contingency contracting and group counseling were provided to 26 mildly to moderately handicapped middle school students with high rates of truancy. Subjects exhibited attendance gains after treatment; gains were not maintained at followup but attendance rates were still higher than the rates of control students. Measures of academic performance…

  13. Development of Self-Handicapping Tendencies. (United States)

    Kimble, Charles; Kimble, Emily A.; Croy, Nan A.


    Determines when U.S. children begin to self-handicap, that is, to reduce preparation effort before evaluations. Finds that the high-self-esteem third graders acted adaptively by practicing more for the evaluation task, while the high-self-esteem sixth graders prepared more only if they had been reminded of their personal resources beforehand. (CMK)

  14. Predictors of Choral Directors' Voice Handicap (United States)

    Schwartz, Sandra


    Vocal demands of teaching are considerable and these challenges are greater for choral directors who depend on the voice as a musical and instructive instrument. The purpose of this study was to (1) examine choral directors' vocal condition using a modified Voice Handicap Index (VHI), and (2) determine the extent to which the major variables…

  15. Patient data and patient rights: Swiss healthcare stakeholders' ethical awareness regarding large patient data sets - a qualitative study. (United States)

    Mouton Dorey, Corine; Baumann, Holger; Biller-Andorno, Nikola


    There is a growing interest in aggregating more biomedical and patient data into large health data sets for research and public benefits. However, collecting and processing patient data raises new ethical issues regarding patient's rights, social justice and trust in public institutions. The aim of this empirical study is to gain an in-depth understanding of the awareness of possible ethical risks and corresponding obligations among those who are involved in projects using patient data, i.e. healthcare professionals, regulators and policy makers. We used a qualitative design to examine Swiss healthcare stakeholders' experiences and perceptions of ethical challenges with regard to patient data in real-life settings where clinical registries are sponsored, created and/or used. A semi-structured interview was carried out with 22 participants (11 physicians, 7 policy-makers, 4 ethical committee members) between July 2014 and January 2015. The interviews were audio-recorded, transcribed, coded and analysed using a thematic method derived from Grounded Theory. All interviewees were concerned as a matter of priority with the needs of legal and operating norms for the collection and use of data, whereas less interest was shown in issues regarding patient agency, the need for reciprocity, and shared governance in the management and use of clinical registries' patient data. This observed asymmetry highlights a possible tension between public and research interests on the one hand, and the recognition of patients' rights and citizens' involvement on the other. The advocation of further health-related data sharing on the grounds of research and public interest, without due regard for the perspective of patients and donors, could run the risk of fostering distrust towards healthcare data collections. Ultimately, this could diminish the expected social benefits. However, rather than setting patient rights against public interest, new ethical approaches could strengthen both


    Directory of Open Access Journals (Sweden)

    Yougan Saman


    Full Text Available ABSTRACTEvidence is emerging of a significant clinical and neuro-anatomical relationship between balance and anxiety. Research has suggested a potentially priming effect with anxiety symptoms predicting a worsening of balance function in patients with underlying balance dysfunction. We propose to show that a vestibular stimulus is responsible for an increase in state anxiety and there is a relationship between increased state anxiety and worsening balance function. Aims1.To quantify state anxiety following a vestibular stimulus in patients with a chronic vestibular deficit.2.To determine if state anxiety during a vestibular stimulus would correlate with the severity of chronic balance symptoms and handicap. MethodsTwo separate cohorts Vestibular Schwannoma (VS patients underwent vestibular tests (electronystagmography, cervical and ocular vestibular evoked myogenic potentials and caloric responses and questionnaire assessment (Vertigo handicap Questionnaire, Vertigo Symptom Scale, State Trait Anxiety InventoryFifteen post resection Vestibular schwannoma patients, with complete unilateral vestibular deafferentation, were assessed at a minimum of 6 months after surgery in Experiment 1 (Aim 1. Forty-five patients with VS in-situ and with preserved vestibular function formed the cohort for Experiment 2 (Aim 2. Experiment 1: VS subjects (N=15 with a complete post-resection unilateral vestibular deafferentation completed a State anxiety questionnaire before caloric assessment and again afterwards with the point of maximal vertigo as the reference (Aim 1. Experiment 2: State anxiety measured at the point of maximal vertigo following a caloric assessment was compared between two groups of presenting with balance symptoms (Group 1 N=26 and without balance symptoms (Group 2 N=11 (Aim 2. The presence of balance symptoms was defined as having a positive score on the VSS-VER.ResultsIn experiment 1, a significant difference (p<0.01 was found when comparing

  17. Designing Patient-facing Health Information Technologies for the Outpatient Settings: A Literature Review


    Yushi Yang; Onur Asan


    Introduction: The implementation of health information technologies (HITs) has changed the dynamics of doctor–patient communication in outpatient settings. Designing patient-facing HITs provides patients with easy access to healthcare information during the visit and has the potential to enhance the patient-centred care.   Objectives: The objectives of this study are to systematically review how the designs of patient-facing HITs have been suggested and evaluated, and how they may pot...

  18. Patient Satisfaction in Chamber Setting in Bangladesh measured by Patient-Doctor Relationship Questionnaire (PDRQ-9 Bangla)


    Arafat, S.; Andalib, A.; Shams, S.; Kabir, R.; Shah, M.; Fariduzzaman, A.; Liton, M.; Ansary, E.


    Abstract Background: Assessment of patient satisfaction is crucial but there is significant lagging in this sector. Patient satisfaction is an important indicator of health care quality as well as a predictor of treatment adherence. The Good patient-doctor relationship is considered as an integral part of the patient satisfaction. In Bangladesh, this domain is yet to be explored in a large scale. Aim: It was aimed to look into the patient satisfaction level in chamber setting in Bangl...

  19. Patient-Centered Goal Setting in a Hospital-Based Outpatient Stroke Rehabilitation Center. (United States)

    Rice, Danielle B; McIntyre, Amanda; Mirkowski, Magdalena; Janzen, Shannon; Viana, Ricardo; Britt, Eileen; Teasell, Robert


    Goal-setting can have a positive impact on stroke recovery during rehabilitation. Patient participation in goal formulation can ensure that personally relevant goals are set, and can result in greater satisfaction with the rehabilitation experience, along with improved recovery of stroke deficits. This, however, not yet been studied in a stroke outpatient rehabilitation setting. To assess patient satisfaction of meeting self-selected goals during outpatient rehabilitation following a stroke. Retrospective chart review. Stroke patients enrolled in a multidisciplinary outpatient rehabilitation program, who set at least 1 goal during rehabilitation. Patients recovering from a stroke received therapy through the outpatient rehabilitation program between January 2010 and December 2013. Upon admission and discharge from rehabilitation, patients rated their satisfaction with their ability to perform goals that they wanted to achieve. Researchers independently sorted and labeled recurrent themes of goals. Goals were further sorted into International Classification of Functioning, Disability and Health (ICF) categories. To compare the perception of patients' goal satisfaction, repeated-measures analysis of variance was conducted across the 3 ICF goal categorizations. Goal satisfaction scores. A total of 286 patients were included in the analysis. Patient goals concentrated on themes of improving hand function, mobility, and cognition. Goals were also sorted into ICF categories in which impairment-based and activity limitation-based goals were predominant. Compared to activity-based and participation-based goals, patients with impairment-based goals perceived greater satisfaction with meeting their goals at admission and discharge (P rehabilitation program (P stroke rehabilitation setting, patients set heterogeneous goals that were predominantly impairment based. Satisfaction in achieving goals significantly improved after receiving therapy. The type of goals that patients

  20. Grief elaboration in families with handicapped member. (United States)

    Calandra, C; Finocchiaro, G; Raciti, L; Alberti, A


    Families with handicapped member seem to follow the same five stages (rejection and isolation, anger, dealing with the problem, depression, acceptance) of Kubler-Ross grief elaboration theory while dealing with the narcissistic wound of a handicapped child. Some of these families show a block in one of the stages. The effort of psychotherapy is to remove the block and let them reach the last stage. In this paper families under systemic psychotherapeutic treatment are analyzed, who had in common the birth of a child with low or modest invalidating signs and psychotic or autistic features. The families structure did not show the characteristics of a psychotic family. Nevertheless either one or both parents ignored the evidence of their child disease and they built a "disease-incongrous" wait around the child, trying to push away the painful reality. The authors explain the importance of this approach for the improvement of the autistic traits.

  1. Evaluating quality of patient care communication in integrated care settings: a mixed methods apporach

    NARCIS (Netherlands)

    Gulmans, J.; Gulmans, J.; Vollenbroek-Hutten, Miriam Marie Rosé; van Gemert-Pijnen, Julia E.W.C.; van Harten, Willem H.


    Background. Owing to the involvement of multiple professionals from various institutions, integrated care settings are prone to suboptimal patient care communication. To assure continuity, communication gaps should be identified for targeted improvement initiatives. However, available assessment

  2. Psychosomatic symptoms in medical outpatients: an investigation of self-handicapping theory. (United States)

    Organista, P B; Miranda, J


    Investigated self-handicapping theory as it relates to somatization in medical patients. We predicted that medical outpatients (N = 113) would report psychosomatic symptoms in response to events that threaten their self-esteem. As predicted, results of hierarchical multiple regression indicated that high-perfectionism patients reported somatic symptoms positively related to the number of events that jeopardize their sense of accomplishment, whereas low-perfectionism patients' somatic symptoms were not related to these events (p = .005). Contrary to prediction, high-dependency patients did not differ significantly from low-dependency patients in the relationship of somatic symptoms and events that threatened their interpersonal relationships (p = .115). Implications of these findings and the utility of self-handicapping theory for predicting somatization in medical patients are discussed.

  3. Feasibility of geometrical verification of patient set-up using body contours and computed tomography data

    International Nuclear Information System (INIS)

    Ploeger, Lennert S.; Betgen, Anja; Gilhuijs, Kenneth G.A.; Herk, Marcel van


    Background and purpose: Body contours can potentially be used for patient set-up verification in external-beam radiotherapy and might enable more accurate set-up of patients prior to irradiation. The aim of this study is to test the feasibility of patient set-up verification using a body contour scanner. Material and methods: Body contour scans of 33 lung cancer and 21 head-and-neck cancer patients were acquired on a simulator. We assume that this dataset is representative for the patient set-up on an accelerator. Shortly before acquisition of the body contour scan, a pair of orthogonal simulator images was taken as a reference. Both the body contour scan and the simulator images were matched in 3D to the planning computed tomography scan. Movement of skin with respect to bone was quantified based on an analysis of variance method. Results: Set-up errors determined with body-contours agreed reasonably well with those determined with simulator images. For the lung cancer patients, the average set-up errors (mm)±1 standard deviation (SD) for the left-right, cranio-caudal and anterior-posterior directions were 1.2±2.9, -0.8±5.0 and -2.3±3.1 using body contours, compared to -0.8±3.2, -1.0±4.1 and -1.2±2.4 using simulator images. For the head-and-neck cancer patients, the set-up errors were 0.5±1.8, 0.5±2.7 and -2.2±1.8 using body contours compared to -0.4±1.2, 0.1±2.1, -0.1±1.8 using simulator images. The SD of the set-up errors obtained from analysis of the body contours were not significantly different from those obtained from analysis of the simulator images. Movement of the skin with respect to bone (1 SD) was estimated at 2.3 mm for lung cancer patients and 1.7 mm for head-and-neck cancer patients. Conclusion: Measurement of patient set-up using a body-contouring device is possible. The accuracy, however, is limited by the movement of the skin with respect to the bone. In situations where the error in the patient set-up is relatively large, it is

  4. Simulating Category Learning and Set Shifting Deficits in Patients Weight-Restored from Anorexia Nervosa (United States)


    Neuropsychology, in press     Simulating Category Learning and Set Shifting Deficits in Patients Weight-Restored from Anorexia Nervosa J...University   Objective: To examine set shifting in a group of women previously diagnosed with anorexia nervosa (AN) who are now weight-restored (AN-WR...participant fails to switch to the new rule but rather persists with the previously correct rule. Adult patients with Anorexia Nervosa (AN) are often impaired

  5. Atribuição de gravidade à deficiência física em função da extensão do acometimento e do contexto escolar Attribution of seriousness degree to physical handicap due to injury extension and school setting

    Directory of Open Access Journals (Sweden)

    Rita de Cássia Tibério Araújo


    in the attribution of mild or severe injury to physical handicap depending upon four information sets. Ninety-seven Pedagogy students took part in the study. Data collecting instrument, consisting of a descriptive text concerning the need of computer keyboard adaptation for reading and written activity accomplishment by a hypothetical student, took account of two body conditions of motor deficit and two teaching settings. The indication of upper limb movement limitation characterized the partial injury. The global injury was represented by the indication of both upper limbs and lower ones movement limitation, besides difficulty in balance maintenance in seated position. The teaching settings were informed pointing out the use of adapted resource in regular class or in special class. Combining these indications, four conditions, whose effects on seriousness level attribution to the motor injury, were constituted. The four conditions received growing attribution of severe motor injury in following order: using adapted resource in regular class and partial injury, using adapted resource in regular class and global injury, using adapted resource in special class and partial injury and using adapted resource in special class and global injury. The results showed that the segregated teaching setting and global injury information tended toward maximization of the idea of injury severity.

  6. Application of video imaging for improvement of patient set-up

    International Nuclear Information System (INIS)

    Ploeger, Lennert S.; Frenay, Michel; Betgen, Anja; Bois, Josien A. de; Gilhuijs, Kenneth G.A.; Herk, Marcel van


    Background and purpose: For radiotherapy of prostate cancer, the patient is usually positioned in the left-right (LR) direction by aligning a single marker on the skin with the projection of a room laser. The aim of this study is to investigate the feasibility of a room-mounted video camera in combination with previously acquired CT data to improve patient set-up along the LR axis. Material and methods: The camera was mounted in the treatment room at the caudal side of the patient. For 22 patients with prostate cancer 127 video and portal images were acquired. The set-up error determined by video imaging was found by matching video images with rendered CT images using various techniques. This set-up error was retrospectively compared with the set-up error derived from portal images. It was investigated whether the number of corrections based on portal imaging would decrease if the information obtained from the video images had been used prior to irradiation. Movement of the skin with respect to bone was quantified using an analysis of variance method. Results: The measurement of the set-up error was most accurate for a technique where outlines and groins on the left and right side of the patient were delineated and aligned individually to the corresponding features extracted from the rendered CT image. The standard deviations (SD) of the systematic and random components of the set-up errors derived from the portal images in the LR direction were 1.5 and 2.1 mm, respectively. When the set-up of the patients was retrospectively adjusted based on the video images, the SD of the systematic and random errors decreased to 1.1 and 1.3 mm, respectively. From retrospective analysis, a reduction of the number of set-up corrections (from nine to six corrections) is expected when the set-up would have been adjusted using the video images. The SD of the magnitude of motion of the skin of the patient with respect to the bony anatomy was estimated to be 1.1 mm. Conclusion: Video

  7. An Integrative Literature Review of Patient Turnover in Inpatient Hospital Settings. (United States)

    Park, Shin Hye; Weaver, Lindsay; Mejia-Johnson, Lydia; Vukas, Rachel; Zimmerman, Julie


    High patient turnover can result in fragmentation of nursing care. It can also increase nursing workload and thus impede the ability of nurses to provide safe and high-quality care. We reviewed 20 studies that examined patient turnover in relation to nursing workload, staffing, and patient outcomes as well as interventions in inpatient hospital settings. The studies consistently addressed the importance of accounting for patient turnover when estimating nurse staffing needs. They also showed that patient turnover varied by time, day, and unit type. Researchers found that higher patient turnover was associated with adverse events; however, further research on this topic is needed because evidence on the effect of patient turnover on patient outcomes is not yet strong and conclusive. We suggest that researchers and administrators need to pay more attention to patterns and levels of patient turnover and implement managerial strategies to reduce nursing workload and improve patient outcomes. © The Author(s) 2015.

  8. Aerodynamic findings and Voice Handicap Index in Parkinson's disease. (United States)

    Motta, Sergio; Cesari, Ugo; Paternoster, Mariano; Motta, Giovanni; Orefice, Giuseppe


    To verify possible relations between vocal disability and aerodynamic measures in selected Parkinson's disease (PD) patients with low/moderate-grade dysphonia. Fifteen idiopathic dysphonic PD male patients were examined and compared with 15 euphonic subjects. Testing included the following measures: Voice Handicap Index (VHI), maximum phonation time (MPT), mean estimated subglottal pressure (MESGP), mean sound pressure level (MSPL), mean phonatory power (MPP), mean phonatory efficiency (MPE) and mean phonatory resistance (MPR). Statistical analysis showed: a significant reduction in MPR and MSPL in PD subjects compared to the healthy ones; a significant positive correlation between VHI score and MSPL, MPR, MPP, MESGP and a significant negative correlation between VHI and MTP within PD subjects. Test for multiple linear regression showed a significant correlation between VHI score, MPT, MPR and MSPL. A relationship between VHI and aerodynamic measures was shown in the present study. Compensatory mechanisms may aggravate vocal disability in PD subjects.

  9. Use of patient-reported outcomes in outpatient settings as a means of patient involvement and self-management support

    DEFF Research Database (Denmark)

    Mejdahl, Caroline; Nielsen, Berit Kjærside; Hjøllund, Niels Henrik Ingvar


    Rationale, aims and objectives: Patient-reported outcomes (PROs) are being implemented in clinical practice across different healthcare settings with varying purposes. Involving patients in reporting outcomes may increase their attention to symptoms and thereby support their self-management. The ...... to strengthen patient involvement and securing benefit from PROs.......Rationale, aims and objectives: Patient-reported outcomes (PROs) are being implemented in clinical practice across different healthcare settings with varying purposes. Involving patients in reporting outcomes may increase their attention to symptoms and thereby support their self......-management. The aim of the present study was to describe patients’ experiences with a web-based PRO system where patients complete a PRO questionnaire at home or in the outpatient clinic prior to a consultation. Moreover, the study aimed to explore how PROs influenced the interaction between patients and clinicians...

  10. Involving patients in setting priorities for healthcare improvement: a cluster randomized trial. (United States)

    Boivin, Antoine; Lehoux, Pascale; Lacombe, Réal; Burgers, Jako; Grol, Richard


    Patients are increasingly seen as active partners in healthcare. While patient involvement in individual clinical decisions has been extensively studied, no trial has assessed how patients can effectively be involved in collective healthcare decisions affecting the population. The goal of this study was to test the impact of involving patients in setting healthcare improvement priorities for chronic care at the community level. Cluster randomized controlled trial. Local communities were randomized in intervention (priority setting with patient involvement) and control sites (no patient involvement). Communities in a canadian region were required to set priorities for improving chronic disease management in primary care, from a list of 37 validated quality indicators. Patients were consulted in writing, before participating in face-to-face deliberation with professionals. Professionals established priorities among themselves, without patient involvement. A total of 172 individuals from six communities participated in the study, including 83 chronic disease patients, and 89 health professionals. The primary outcome was the level of agreement between patients' and professionals' priorities. Secondary outcomes included professionals' intention to use the selected quality indicators, and the costs of patient involvement. Priorities established with patients were more aligned with core generic components of the Medical Home and Chronic Care Model, including: access to primary care, self-care support, patient participation in clinical decisions, and partnership with community organizations (p Priorities established by professionals alone placed more emphasis on the technical quality of single disease management. The involvement intervention fostered mutual influence between patients and professionals, which resulted in a 41% increase in agreement on common priorities (95%CI: +12% to +58%, p priorities. Patient involvement can change priorities driving healthcare

  11. Tuberculosis treatment delivery in high burden settings: does patient choice of supervision matter? (United States)

    Kironde, S; Meintjies, M


    The Northern Cape Province, Republic of South Africa. To determine the effect of patient choice of treatment delivery option on the treatment outcomes of tuberculosis (TB) patients in a high burden setting under actual programme conditions. Cohort study involving 769 new and retreatment TB patients recruited from 45 randomly selected clinics. Patients were interviewed and subsequent follow-up was done through regular visits to the clinics to check progress through formal health records. There was a statistically significant difference (P < 0.001) between the treatment outcome of new patients (70% successful) and re-treatment patients (54% successful). Direct observation of treatment (DOT) was found to have no effect on the treatment outcome of new patients (P = 0.875), but re-treatment patients were found to fare better with than without DOT (OR 14.2, 95% CI 4.18-53.14, P < 0.001). The results obtained for new patients are similar to those of two recent randomised controlled trials on DOT. This study revealed that for new patients, undue emphasis on universal DOT might be unnecessary. It would perhaps be more beneficial to target supervision at those patients who are most likely to benefit from it (i.e., re-treatment patients). This is of particular relevance in high burden, resource-limited settings where universal DOT for all TB patients is generally unfeasible.

  12. Examining the relationship between authenticity and self-handicapping. (United States)

    Akin, Ahmet; Akin, Umran


    Self-handicapping includes strategies of externalization in which people excuse failure and internalize success, but which also prevents them from behaving in an authentic way. The goal was to investigate the relation of authenticity with self-handicapping. The study was conducted with 366 university students (176 men, 190 women; M age = 20.2 yr.). Participants completed the Turkish version of the Authenticity Scale and the Self-handicapping Scale. Self-handicapping was correlated positively with two factors of authenticity, accepting external influence and self-alienation, and negatively with the authentic living factor. A multiple regression analysis indicated that self-handicapping was predicted positively by self-alienation and accepting external influence and negatively by authentic living, accounting for 21% of the variance collectively. These results demonstrated the negative association of authenticity with self-handicapping.

  13. Designing Patient-facing Health Information Technologies for the Outpatient Settings: A Literature Review

    Directory of Open Access Journals (Sweden)

    Yushi Yang


    Full Text Available Introduction: The implementation of health information technologies (HITs has changed the dynamics of doctor–patient communication in outpatient settings. Designing patient-facing HITs provides patients with easy access to healthcare information during the visit and has the potential to enhance the patient-centred care.   Objectives: The objectives of this study are to systematically review how the designs of patient-facing HITs have been suggested and evaluated, and how they may potentially affect the doctor–patient communication and patient-centred care.   Method: We conducted an online database search to identify articles published before December 2014 relevant to the objectives of this study. A total of nine papers have been identified and reviewed in this study.   Results: Designing patient-facing HITs is at an early stage. The current literature has been exploring the impact of HITs on doctor–patient communication dynamics. Based on the findings of these studies, there is an emergent need to design more patient-centred HITs. There are also some papers that focus on the usability evaluation of some preliminary prototypes of the patient-facing HITs. The design styles of patient-facing HITs included sharing the health information with the patients on: (1 a separate patient display, (2 a projector, (3 a portable tablet, (4 a touch-based screen and (5 a shared computer display that can be viewed by both doctors and patients. Each of them had the strengths and limitations to facilitate the patient-centred care, and it is worthwhile to make a comparison of them in order to identify future research directions.   Conclusion: The designs of patient-facing HITs in outpatient settings are promising in facilitating the doctor-patient communication and patient engagement. However, their effectiveness and usefulness need to be further evaluated and improved from a systems perspective.

  14. Designing Patient-facing Health Information Technologies for the Outpatient Settings: A Literature Review. (United States)

    Yang, Yushi; Asan, Onur


      The implementation of health information technologies (HITs) has changed the dynamics of doctor-patient communication in outpatient settings. Designing patient-facing HITs provides patients with easy access to healthcare information during the visit and has the potential to enhance the patient-centred care.  The objectives of this study are to systematically review how the designs of patient-facing HITs have been suggested and evaluated, and how they may potentially affect the doctor-patient communication and patient-centred care.  We conducted an online database search to identify articles published before December 2014 relevant to the objectives of this study. A total of nine papers have been identified and reviewed in this study.  Designing patient-facing HITs is at an early stage. The current literature has been exploring the impact of HITs on doctor-patient communication dynamics. Based on the findings of these studies, there is an emergent need to design more patient-centred HITs. There are also some papers that focus on the usability evaluation of some preliminary prototypes of the patient-facing HITs. The design styles of patient-facing HITs included sharing the health information with the patients on: (1) a separate patient display, (2) a projector, (3) a portable tablet, (4) a touch-based screen and (5) a shared computer display that can be viewed by both doctors and patients. Each of them had the strengths and limitations to facilitate the patient-centred care, and it is worthwhile to make a comparison of them in order to identify future research directions.  The designs of patient-facing HITs in outpatient settings are promising in facilitating the doctor-patient communication and patient engagement. However, their effectiveness and usefulness need to be further evaluated and improved from a systems perspective.

  15. Evaluation of rotational set-up errors in patients with thoracic neoplasms

    International Nuclear Information System (INIS)

    Wang Yanyang; Fu Xiaolong; Xia Bing; Fan Min; Yang Huanjun; Ren Jun; Xu Zhiyong; Jiang Guoliang


    Objective: To assess the rotational set-up errors in patients with thoracic neoplasms. Methods: 224 kilovoltage cone-beam computed tomography (KVCBCT) scans from 20 thoracic tumor patients were evaluated retrospectively. All these patients were involved in the research of 'Evaluation of the residual set-up error for online kilovoltage cone-beam CT guided thoracic tumor radiation'. Rotational set-up errors, including pitch, roll and yaw, were calculated by 'aligning the KVCBCT with the planning CT, using the semi-automatic alignment method. Results: The average rotational set-up errors were -0.28 degree ±1.52 degree, 0.21 degree ± 0.91 degree and 0.27 degree ± 0.78 degree in the left-fight, superior-inferior and anterior-posterior axis, respectively. The maximal rotational errors of pitch, roll and yaw were 3.5 degree, 2.7 degree and 2.2 degree, respectively. After correction for translational set-up errors, no statistically significant changes in rotational error were observed. Conclusions: The rotational set-up errors in patients with thoracic neoplasms were all small in magnitude. Rotational errors may not change after the correction for translational set-up errors alone, which should be evaluated in a larger sample future. (authors)

  16. An International Standard Set of Patient-Centered Outcome Measures After Stroke

    NARCIS (Netherlands)

    Salinas, J. (Joel); Sprinkhuizen, S.M. (Sara M.); Ackerson, T. (Teri); Bernhardt, J. (Julie); Davie, C. (Charlie); George, M.G. (Mary G.); Gething, S. (Stephanie); Kelly, A.G. (Adam G.); Lindsay, P. (Patrice); Liu, L. (Liping); Martins, S.C.O. (Sheila C.O.); Morgan, L. (Louise); B. Norrving (Bo); Ribbers, G.M. (Gerard M.); Silver, F.L. (Frank L.); Smith, E.E. (Eric E.); Williams, L.S. (Linda S.); Schwamm, L.H. (Lee H.)


    markdownabstract__BACKGROUND AND PURPOSE:__ Value-based health care aims to bring together patients and health systems to maximize the ratio of quality over cost. To enable assessment of healthcare value in stroke management, an international standard set of patient-centered stroke outcome measures

  17. Norovirus epidemiology in community and health care settings and association with patient age, denmark

    DEFF Research Database (Denmark)

    Franck, Kristina T; Fonager, Jannik; Ersbøll, Annette K


    Norovirus (NoV) is a major cause of gastroenteritis. NoV genotype II.4 (GII.4) is the predominant genotype in health care settings but the reason for this finding is unknown. Stool samples containing isolates with a known NoV genotype from 2,109 patients in Denmark (patients consulting a general...

  18. Patient involvement in a scientific advisory process: setting the research agenda for medical products.

    NARCIS (Netherlands)

    Elberse, J.E.; Pittens, C.A.C.M.; de Cock Buning, J.T.; Broerse, J.E.W.


    Patient involvement in scientific advisory processes could lead to more societally relevant advice. This article describes a case study wherein the Health Council of the Netherlands involved patient groups in an advisory process with a predefined focus: setting a research agenda for medical products

  19. Prospective Validation of the Decalogue, a Set of Doctor-Patient Communication Recommendations to Improve Patient Illness Experience and Mood States within a Hospital Cardiologic Ambulatory Setting

    Directory of Open Access Journals (Sweden)

    Piercarlo Ballo


    Full Text Available Strategies to improve doctor-patient communication may have a beneficial impact on patient’s illness experience and mood, with potential favorable clinical effects. We prospectively tested the psychometric and clinical validity of the Decalogue, a tool utilizing 10 communication recommendations for patients and physicians. The Decalogue was administered to 100 consecutive patients referred for a cardiologic consultation, whereas 49 patients served as controls. The POMS-2 questionnaire was used to measure the total mood disturbance at the end of the consultation. Structural equation modeling showed high internal consistency (Cronbach alpha 0.93, good test-retest reproducibility, and high validity of the psychometric construct (all > 0.80, suggesting a positive effect on patients’ illness experience. The total mood disturbance was lower in the patients exposed to the Decalogue as compared to the controls (1.4±12.1 versus 14.8±27.6, p=0.0010. In an additional questionnaire, patients in the Decalogue group showed a trend towards a better understanding of their state of health (p=0.07. In a cardiologic ambulatory setting, the Decalogue shows good validity and reliability as a tool to improve patients’ illness experience and could have a favorable impact on mood states. These effects might potentially improve patient engagement in care and adherence to therapy, as well as clinical outcome.

  20. Patients' perceptions of their roles in goal setting in a spinal cord injury regional rehabilitation program. (United States)

    Draaistra, Harriett; Singh, Mina D; Ireland, Sandra; Harper, Theresa


    Goal setting is a common practice in rehabilitation, yet there is a paucity of literature exploring patients' perceptions of their roles in this process. This study was conducted using a qualitative descriptive methodology to explore patients' perceptions of their roles in setting goals in a spinal cord injury regional rehabilitation program. Imogene King's theory of goal attainment was used to frame the study. Data were collected through interviews and analyzed using a content analysis. The results revealed four themes: Visioning, Redefining, Brainstorming, and Rebuilding Participants (n = 13) envisioned their roles as setting an overarching priority goal, defining detailed rehabilitation goals, sharing knowledge with the team, and rebuilding skills to attain goals. Implications for nursing practice include the need to understand patients' experiences and perceptions, share knowledge, and support effective communication to promote collaborative goal setting. A need to enhance health professionals' education to fully understand factors influencing patients' abilities to set rehabilitation goals, and future research in methods to promote patients' engagement in goal setting was also clearly indicated.

  1. Recognizing potential barriers to setting and achieving effective rehabilitation goals for patients with persistent pain. (United States)

    Schmidt, Stephen G


    Although the process of goal setting in rehabilitation of individuals with persistent pain is considered a fundamental and requisite skill, it is frequently reported as a challenging element of clinical practice. Factors which may contribute to the complexity of goal setting include the potential for unrecognized shifts in cognitive function, psychological comorbidities, and the social context of both providers and patients. This review aims to describe factors which may confound the process of setting and achieving collaborative rehabilitation goals using a biopsychosocial framework and to provide recommendations to enhance goal setting effectiveness.

  2. Predicting nonrecovery among whiplash patients in the emergency room and in an insurance company setting. (United States)

    Rydman, Eric; Ponzer, Sari; Ottosson, Carin; Järnbert-Pettersson, Hans


    To construct and validate a prediction instrument for early identification of patients with a high risk of delayed recovery after whiplash injuries (PPS-WAD) in an insurance company setting. Prospective cohort study. On the basis of a historic cohort (n = 130) of patients with a whiplash injury identified in an emergency room (ER, model-building set), we used logistic regression to construct an instrument consisting of two demographic variables (i.e. questions of educational level and work status) and the patient-rated physical and mental status during the acute phase to predict self-reported nonrecovery after 6 months. We evaluated the instrument's ability to predict nonrecovery in a new cohort (n = 204) of patients originating from an insurance company setting (IC, validation set). The prediction instrument had low reproducibility when the setting was changed from the ER cohort to the IC cohort. The overall percentage of correct predictions of nonrecovery in the ER cohort was 78 % compared with 62 % in the IC cohort. The sensitivity and specificity in relation to nonrecovery were both 78 % in the ER cohort. The sensitivity and specificity in the insurance company setting was lower, 67 and 50 %. Clinical decision rules need validation before they are used in a new setting. An instrument consisting of four questions with an excellent possibility of identifying patients with a high risk of nonrecovery after a whiplash injury in the emergency room was not as useful in an insurance company setting. The importance and type of the risk factors for not recovering probably differ between the settings, as well as the individuals.

  3. The Relationship Between Academic Identity and Self-Handicapping


    Carlisle, Brandon Lamare


    The purpose of the present dissertation was to examine whether, and how, behavioral academic self-handicapping and claimed academic self-handicapping differentially relate to the academic identity statuses (i.e., achieved, diffused, moratorium, and foreclosed). Self-handicapping has been defined as creating or claiming obstacles to performance in order to enhance the ability to externalize failure and internalize success. Academic identity status involves a student’s decision to attend colleg...

  4. Honig v. Doe: the suspension and expulsion of handicapped students. (United States)

    Yell, M L


    Public Law 94-142 provides for a free appropriate public education for all handicapped children, but does not address the issue of disciplining handicapped students. The result has been confusion and uncertainty, particularly concerning expulsion and suspension. The courts have been forced into this vacuum, acting as arbiters. The Supreme Court's ruling in Honig v. Doe will help to delineate the proper role of educators in the suspension and expulsion of handicapped students. This article examines that role and offers recommendations for school policies regarding the discipline of handicapped students.

  5. A motivational analysis of defensive pessimism and self-handicapping. (United States)

    Elliot, Andrew J; Church, Marcy A


    Two studies examined motivational influences on and correlates of defensive pessimism and self-handicapping and investigated the relationship between these two cognitive strategies and performance attainment. The findings indicated that defensive pessimism and self-handicapping have similar motivational profiles, with the primary difference being that self-handicapping represents the absence of approach motivation in the achievement domain, as well as the presence of avoidance motivation. Self-handicapping, but not defensive pessimism, was shown to undermine performance-attainment, and performance-avoidance goals were validated as mediators of this negative relationship. Issues regarding the functional nature of the two cognitive strategies are discussed.

  6. Academic self-handicapping and their correlates in adolescence

    Directory of Open Access Journals (Sweden)

    Cocoradă, E.


    Full Text Available The self-handicapping has been examined as a self-protectivestrategy, used by adults and young, males and females, in different situations assessed as threatening for the positive self-esteem. The purpose of this study is to explore the relations between self-handicapping and some variables relevant in the academic field as learning motivation, academic results, selfesteem. Age and gender are the criteria of our analysis. The results suggestthe males and later adolescents (males and females self-handicap more that the females and the young adolescents. Self-esteem and some components of learning motivation are the variables that influence self-handicapping at significant levels.

  7. Survival, momentum, and things that make me "me": patients' perceptions of goal setting after stroke. (United States)

    Brown, Melanie; Levack, William; McPherson, Kathryn M; Dean, Sarah G; Reed, Kirk; Weatherall, Mark; Taylor, William J


    Goal setting and patient-centredness are considered fundamental concepts in rehabilitation. However, the best way to involve patients in setting goals remains unclear. The purpose of this study was to explore patient experiences of goal setting in post-acute stroke rehabilitation to further understanding of its application to practice. Thematic analysis was used to analyse interview transcripts from 10 stroke survivors, recruited from 4 rehabilitation units as part of a pilot study investigating the effects of a structured means of eliciting patient-centred goals in post-acute stroke rehabilitation. Three key themes emerged: (1) "A Day by Day Momentum", comprising subordinate themes of "Unpredictability" and "Natural Progression" in which daily progress forwards was seen as an integral part of rehabilitation; (2) "Battle versus Alliance" in which issues of struggle versus support influenced participants' advancement; and (3) "The Special Things", consisting of subordinate themes of "What Makes Me 'Me'" and "Symbolic Achievements" concerning issues defining individuals and their rehabilitation experiences. Patients' discourse around goal setting can differ from the discourse conventionally used by clinicians when describing "best practice" in rehabilitation goal setting. Understanding patients' non-conventional views of goals may assist in supporting and motivating them, thus providing drive for their rehabilitation. Stroke patients think about goals very differently from health professionals. Individual patients have diverse ideas about goals within the context of the uncertainty of stroke, their life as a whole and recovery after formal rehabilitation is completed. To meet these diverse needs, health professionals need to communicate fully with patients to gain an understanding of their experiences of stroke and wider views on goals.

  8. Factors affecting experiences of intensive care patients in Turkey: patient outcomes in critical care setting. (United States)

    Demir, Yurdanur; Korhan, Esra Akin; Eser, Ismet; Khorshid, Leyla


    To determine the factors affecting a patient's intensive care experience. The descriptive study was conducted at an intensive care unit in the Aegean Region of Turkey, and comprised 158 patients who spent at least 48 hours at the unit between June and November 2009. A questionnaire form and the Intensive Care Experience Scale were used as data collection tools. SPSS 11.5 was used for statistical analysis of the data. Of the total, 86 (54.4%) patients related to the surgical unit, while 72 (45.5%) spent time at the intensive care unit. Most of the subjects (n=113; 71.5%) reported that they constantly experienced pain during hospitalisation. Patients receiving mechanical ventilation support and patients reporting no pain had significantly higher scores on the intensive care experience scale. Patients who reported pain remembered their experiences less than those having no pain. Interventions are needed to make the experiences of patients in intensive care more positive.

  9. Supporting the Sexual Intimacy Needs of Patients in a Longer Stay Inpatient Forensic Setting. (United States)

    Quinn, Chris; Happell, Brenda


    To explore perceptions of nurses and patients regarding sexual intimacy in a long-term mental health unit. Qualitative exploratory design including in-depth semi-structured individual interviews with 12 registered nurses and 10 long-term patients of a forensic mental health hospital. The theme of supporting sexual intimacy was identified and described in this paper and included the following subthemes for nurses: It depends on the setting, need for guidelines and consent, and for patients-it depends on the setting; and need for support. The findings suggest that current guidelines regarding sexual intimacy in acute inpatient settings may not be appropriate in long-term facilities, with a need for guidelines to specifically address this setting. Furthermore, support for sexual intimacy needs of patients was identified as a strong need for patients and they believed not currently met. Nurses have an important role to play as part of their holistic approach to care and barriers to providing this aspect of care must be overcome to ensure patients' rights are respected. © 2015 Wiley Periodicals, Inc.

  10. Assessing Patient Activation among High-Need, High-Cost Patients in Urban Safety Net Care Settings. (United States)

    Napoles, Tessa M; Burke, Nancy J; Shim, Janet K; Davis, Elizabeth; Moskowitz, David; Yen, Irene H


    We sought to examine the literature using the Patient Activation Measure (PAM) or the Patient Enablement Instrument (PEI) with high-need, high-cost (HNHC) patients receiving care in urban safety net settings. Urban safety net care management programs serve low-income, racially/ethnically diverse patients living with multiple chronic conditions. Although many care management programs track patient progress with the PAM or the PEI, it is not clear whether the PAM or the PEI is an effective and appropriate tool for HNHC patients receiving care in urban safety net settings in the United States. We searched PubMed, EMBASE, Web of Science, and PsycINFO for articles published between 2004 and 2015 that used the PAM and between 1998 and 2015 that used the PEI. The search was limited to English-language articles conducted in the United States and published in peer-reviewed journals. To assess the utility of the PAM and the PEI in urban safety net care settings, we defined a HNHC patient sample as racially/ethnically diverse, low socioeconomic status (SES), and multimorbid. One hundred fourteen articles used the PAM. All articles using the PEI were conducted outside the U.S. and therefore were excluded. Nine PAM studies (8%) included participants similar to those receiving care in urban safety net settings, three of which were longitudinal. Two of the three longitudinal studies reported positive changes following interventions. Our results indicate that research on patient activation is not commonly conducted on racially and ethnically diverse, low SES, and multimorbid patients; therefore, there are few opportunities to assess the appropriateness of the PAM in such populations. Investigators expressed concerns with the potential unreliability and inappropriate nature of the PAM on multimorbid, older, and low-literacy patients. Thus, the PAM may not be able to accurately assess patient progress among HNHC patients receiving care in urban safety net settings. Assessing

  11. Learning Patient Safety in Academic Settings: A Comparative Study of Finnish and British Nursing Students' Perceptions. (United States)

    Tella, Susanna; Smith, Nancy-Jane; Partanen, Pirjo; Turunen, Hannele


    Globalization of health care demands nursing education programs that equip students with evidence-based patient safety competences in the global context. Nursing students' entrance into clinical placements requires professional readiness. Thus, evidence-based learning activities about patient safety must be provided in academic settings prior to students' clinical placements. To explore and compare Finnish and British nursing students' perceptions of learning about patient safety in academic settings to inform nursing educators about designing future education curriculum. A purpose-designed instrument, Patient Safety in Nursing Education Questionnaire (PaSNEQ) was used to examine the perceptions of Finnish (n = 195) and British (n = 158) nursing students prior to their final year of registration. Data were collected in two Finnish and two English nursing schools in 2012. Logistic regressions were used to analyze the differences. British students reported more inclusion (p motivation" related to patient safety in their programs. Both student groups considered patient safety education to be more valuable for their own learning than what their programs had provided. Training patient safety skills in the academic settings were the strongest predictors for differences (odds ratio [OR] = 34.69, 95% confidence interval [CI] 7.39-162.83), along with work experience in the healthcare sector (OR = 3.02, 95% CI 1.39-6.58). To prepare nursing students for practical work, training related to clear communication, reporting errors, systems-based approaches, interprofessional teamwork, and use of simulation in academic settings requires comprehensive attention, especially in Finland. Overall, designing patient safety-affirming nursing curricula in collaboration with students may enhance their positive experiences on teaching and learning about patient safety. An international collaboration between educators could help to develop and harmonize patient safety education and to better

  12. Discipline in the Public Schools: A Dual Standard for Handicapped and Nonhandicapped Students? (United States)

    Simon, Sue G.


    Federal regulation protects handicapped students' education against unwarranted interruption without specifying procedures for disciplining handicapped students. This article reviews court decisions in disciplinary cases and provides procedural guidelines to follow in disciplining handicapped students. (MD)

  13. Safety considerations for patients with communication disorders in rehabilitation medicine settings. (United States)

    Cristian, Adrian; Giammarino, Claudia; Olds, Michael; Adams, Elizabeth; Moriarty, Christina; Ratner, Sabina; Mural, Shruti; Stobart, Eric C


    Communication barriers can pose a significant safety risk for patients. Individuals in a communication-vulnerable state are commonly seen in rehabilitation settings. These patients cannot adequately communicate their symptoms, wants, and needs to providers. Causes of communication barriers include neurologic impairments, such as stroke, cerebral palsy, and Parkinson disease, and language barriers. The ability of clinicians to adequately diagnose, treat, and monitor these patients is also hindered. This article identifies key communication barriers and strategies that clinicians can use to effectively communicate with these patients. Copyright © 2012 Elsevier Inc. All rights reserved.

  14. Patient and public engagement in priority setting: A systematic rapid review of the literature (United States)

    Vandall-Walker, Virginia; Mason-Lai, Ping


    Background Current research suggests that while patients are becoming more engaged across the health delivery spectrum, this involvement occurs most often at the pre-preparation stage to identify ‘high-level’ priorities in health ecosystem priority setting, and at the preparation phase for health research. Objective The purpose of this systematic rapid review of the literature is to describe the evidence that does exist in relation to patient and public engagement priority setting in both health ecosystem and health research. Data sources HealthStar (via OVID); CINAHL; Proquest Databases; and Scholar’s Portal. Study eligibility criteria i) published in English; ii) published within the timeframe of 2007—Current (10 years) unless the report/article was formative in synthesizing key considerations of patient engagement in health ecosystem and health research priority setting; iii) conducted in Canada, the US, Europe, UK, Australia/New Zealand, or Scandinavian countries. Study appraisal and synthesis i) Is the research valid, sound, and applicable?; ii) what outcomes can we potentially expect if we implement the findings from this research?; iii) will the target population (i.e., health researchers and practitioners) be able to use this research?. A summary of findings from each of the respective processes was synthesized to highlight key information that would support decision-making for researchers when determining the best priority setting process to apply for their specific patient-oriented research. Results Seventy articles from the UK, US, Canada, Netherlands and Australia were selected for review. Results were organized into two tiers of public and patient engagement in prioritization: Tier 1—Deliberative and Tier 2—Consultative. Highly structured patient and public engagement planning activities include the James Lind Alliance Priority Setting Partnerships (UK), Dialogue Method (Netherlands), Global Evidence Mapping (Australia), and the Deep

  15. Patient and public engagement in priority setting: A systematic rapid review of the literature.

    Directory of Open Access Journals (Sweden)

    Elizabeth Manafò

    Full Text Available Current research suggests that while patients are becoming more engaged across the health delivery spectrum, this involvement occurs most often at the pre-preparation stage to identify 'high-level' priorities in health ecosystem priority setting, and at the preparation phase for health research.The purpose of this systematic rapid review of the literature is to describe the evidence that does exist in relation to patient and public engagement priority setting in both health ecosystem and health research.HealthStar (via OVID; CINAHL; Proquest Databases; and Scholar's Portal.i published in English; ii published within the timeframe of 2007-Current (10 years unless the report/article was formative in synthesizing key considerations of patient engagement in health ecosystem and health research priority setting; iii conducted in Canada, the US, Europe, UK, Australia/New Zealand, or Scandinavian countries.i Is the research valid, sound, and applicable?; ii what outcomes can we potentially expect if we implement the findings from this research?; iii will the target population (i.e., health researchers and practitioners be able to use this research?. A summary of findings from each of the respective processes was synthesized to highlight key information that would support decision-making for researchers when determining the best priority setting process to apply for their specific patient-oriented research.Seventy articles from the UK, US, Canada, Netherlands and Australia were selected for review. Results were organized into two tiers of public and patient engagement in prioritization: Tier 1-Deliberative and Tier 2-Consultative. Highly structured patient and public engagement planning activities include the James Lind Alliance Priority Setting Partnerships (UK, Dialogue Method (Netherlands, Global Evidence Mapping (Australia, and the Deep Inclusion Method/CHoosing All Together (US.The critical study limitations include challenges in comprehensively

  16. Pain management of opioid-treated cancer patients in hospital settings in Denmark

    DEFF Research Database (Denmark)

    Lundorff, L.; Peuckmann, V.; Sjøgren, Per


    AIM: To evaluate the performance and quality of cancer pain management in hospital settings. METHODS: Anaesthesiologists specialised in pain and palliative medicine studied pain management in departments of oncology and surgery. Study days were randomly chosen and patients treated with oral opioids......-treated patients in hospital settings: however, focussing on average pain intensity, the outcome seems favourable compared with other countries. Pain mechanisms were seldom examined and adjuvant drugs were not specifically used for neuropathic pain. Opioid dosing intervals and supplemental opioid doses were most...

  17. Patient perceptions of surgeon-industry relations in a military setting. (United States)

    Ortiz, Dionisio; Jenne, Joel


    Investigations into the financial relationships between orthopedic surgeons and device manufacturers have recently been investigated. Despite these investigations, the public appears to maintain trust and confidence that their surgeons are acting in patients' best interest. However, patient perceptions of these relationships have not been investigated in a military treatment setting. We surveyed patients' perception of the surgeon-industry relationship in a single military treatment facility. From March 2012 to March 2013, we surveyed 282 preoperative and postoperative spine and arthroplasty patients in a single military treatment facility. Patients were eligible if they were adult TRICARE beneficiaries being followed in one of those clinics and within the age requirements. Most patients were aware of private industry involvement in the manufacture of orthopedic implants (77%). Most patients thought that it was beneficial for surgeons to serve in an advisory role to device companies (81%) and most (65%) felt that the relationship was appropriate and beneficial for patient care. A minority (29%) felt their surgeon should receive payment for this role. Most patients in the military setting had a positive view of the relationship that their surgeons had with industry, which is reflective of data obtained in the civilian literature. Reprint & Copyright © 2014 Association of Military Surgeons of the U.S.

  18. A method for patient set-up guidance in radiotherapy using augmented reality

    International Nuclear Information System (INIS)

    Talbot, J.; Meyer, J.; Watts, R.; Grasset, R.


    Full text: A system for patient set-up in external beam radiotherapy was developed using Augmented Reality (AR). Live images of the linac treatment couch and patient were obtained with video cameras and displayed on a nearby monitor. A 3D model of the patient's external contour was obtained from planning CT data, and AR tracking software was used to superimpose the model onto the video images in the correct position for treatment. Throughout set-up and treatment, the user can view the monitor and visually confirm that the patient is positioned correctly. To ensure that the virtual contour was displayed in the correct position, a process was devised to register the coordinates of the linac with the camera images. A cube with AR tracking markers attached to its faces was constructed for alignment with the isocentre using room lasers or cone-beam CT. The performance of the system was investigated in a clinical environment by using it to position an anthropomorphic phantom without the aid of additional set-up methods. The positioning errors were determined by means of CBCT and image registration. The translational set-up errors were found to be less than 2.4 mm and the rotational errors less than 0.3 0 . This proof-of-principle study has demonstrated the feasibility of using AR for patient position and pose guidance.

  19. Vocational Reintegration of Handicapped Workers with Assistive Devices (United States)

    Cooper, N. E.


    Two approaches to vocational reintegration of handicapped workers are described: (1) adapting the disabled to the working environment through treatment, therapy, counseling, selective placement, and prostheses, and (2) adapting the working environment to particular handicaps, with the assistive device fitted to the machine or tool rather than to…

  20. The Impact of Handicapping Conditions on Consumer Attitudes in Families. (United States)

    Collins, Eleanor M.; And Others

    The report summarizes results of a study of attitudes of 222 undergraduate university students (University of Minnesota, Duluth) toward financial decisions involving a family member with a handicap. The Situational Attitude Scale--Handicapped Family Consumer (which assesses attitudes toward parental expenditure of money for siblings or…

  1. "Euthanasia" of Persons with Severe Handicaps: Refuting the Rationalizations. (United States)

    Lusthaus, Evelyn


    The article examines two common rationalizations for euthanasia of persons with severe handicaps and presents arguments to refute them. The article calls for parents, professionals, and friends of persons with severe handicaps to be vocal in refuting euthanasia and its rationales. (Author/CL)

  2. Frequency of Divorce Among Parents of Handicapped Children. (United States)

    Shufeit, Lawrence J.; Wurster, Stanley R.

    Seventy-six parents of handicapped children were surveyed to compare the frequency of divorce in the sample population to that of the U.S. population. A research review revealed that the first-born child causes extensive to severe crises in the parents' marital relationship; that the presence of a child with a handicapping condition causes a…

  3. Underachievers' Cognitive and Behavioral Strategies--Self-Handicapping at School. (United States)

    Nurmi, Jari-Erik; And Others


    Two studies with a total of 153 junior and senior high-school students and vocational students in Finland investigated whether underachievers applied a self-handicapping or learned-helplessness strategy in achievement contexts. Underachievers seemed to apply a self-handicapping strategy rather than a learned-helplessness approach. (SLD)

  4. Academic Self-Handicapping and Achievement Goals: A Further Examination. (United States)

    Midgley, Carol; Urdan, Tim


    This study extends previous research on the relations among students' personal achievement goals, perceptions of the classroom goal structure, and reports of the use of self-handicapping strategies. Surveys, specific to the math domain, were given to 484 7th-grade students in nine middle schools. Personal performance-avoid goals positively predicted handicapping, whereas personal performance-approach goals did not. Personal task goals negatively predicted handicapping. Perceptions of a performance goal structure positively predicted handicapping, and perceptions of a task goal structure negatively predicted handicapping, independent of personal goals. Median splits used to examine multiple goal profiles revealed that students high in performance-avoid goals used handicapping more than did those low in performance-avoid goals regardless of the level of task goals. Students low in performance-avoid goals and high in task goals handicapped less than those low in both goals. Level of performance-approach goals had little effect on the relation between task goals and handicapping. Copyright 2001 Academic Press.

  5. Siblings of the Handicapped: A Literature Review for School Psychologists. (United States)

    Hannah, Mary Elizabeth; Midlarsky, Elizabeth


    Siblings of handicapped children may have adjustment problems associated with increased family responsibilities, increased parental expectations, and perceived parental neglect in favor of the disabled sibling. Problems may be related to socioeconomic status; family size; age, sex, and birth order of the sibling; and severity of the handicap. (GDC)

  6. Personal Integration Resources of Mentally Handicapped Teenagers into Society (United States)

    Konovalova, Natalia


    The paper deals with the issues concerning the study of mentally handicapped teenagers' integrative potential within modernisation of contemporary Russian education. The research is concentrated on the study of personal and social determinants influencing the readiness of mentally handicapped students to be integrated into the environment.…

  7. Risk factors for geriatric patient falls in rehabilitation hospital settings: a systematic review. (United States)

    Vieira, Edgar Ramos; Freund-Heritage, Rosalie; da Costa, Bruno R


    To review the literature to identify and synthesize the evidence on risk factors for patient falls in geriatric rehabilitation hospital settings. Eligible studies were systematically searched on 16 databases from inception to December 2010. The search strategies used a combination of terms for rehabilitation hospital patients, falls, risk factors and older adults. Cross-sectional, cohort, case-control studies and randomized clinical trials (RCTs) published in English that investigated risks for falls among patients ≥65 years of age in rehabilitation hospital settings were included. Studies that investigated fall risk assessment tools, but did not investigate risk factors themselves or did not report a measure of risk (e.g. odds ratio, relative risk) were excluded. A total of 2,824 references were identified; only eight articles concerning six studies met the inclusion criteria. In these, 1,924 geriatric rehabilitation patients were followed. The average age of the patients ranged from 77 to 83 years, the percentage of women ranged from 56% to 81%, and the percentage of fallers ranged from 15% to 54%. Two were case-control studies, two were RCTs and four were prospective cohort studies. Several intrinsic and extrinsic risk factors for falls were identified. Carpet flooring, vertigo, being an amputee, confusion, cognitive impairment, stroke, sleep disturbance, anticonvulsants, tranquilizers and antihypertensive medications, age between 71 and 80, previous falls, and need for transfer assistance are risk factors for geriatric patient falls in rehabilitation hospital settings.

  8. Patient Expectations and Perceptions of Goal-setting Strategies for Disease Management in Rheumatoid Arthritis. (United States)

    Strand, Vibeke; Wright, Grace C; Bergman, Martin J; Tambiah, Jeyanesh; Taylor, Peter C


    To identify how patients perceive the broad effect of active rheumatoid arthritis (RA) on their daily lives and indicate how RA disease management could benefit from the inclusion of individual goal-setting strategies. Two multinational surveys were completed by patients with RA. The "Good Days Fast" survey was conducted to explore the effect of disease on the daily lives and relationships of women with RA. The "Getting to Your Destination Faster" survey examined RA patients' treatment expectations and goal-setting practices. Respondents from all countries agreed that RA had a substantial negative effect on many aspects of their lives (work productivity, daily routines, participation in social and leisure activities) and emotional well-being (loss of self-confidence, feelings of detachment, isolation). Daily pain was a paramount issue, and being pain- and fatigue-free was considered the main indicator of a "good day." Setting personal, social, and treatment goals, as well as monitoring disease progress to achieve these, was considered very beneficial by patients with RA, but discussion of treatment goals seldom appeared to be a part of medical appointments. Many patients with RA feel unable to communicate their disease burden and treatment goals, which are critically important to them, to their healthcare provider (HCP). Insights gained from these 2 surveys should help to guide patients and HCP to better focus upon mutually defined goals for continued improvement of management and achievement of optimal care in RA.

  9. Tailored patient information using a database system: Increasing patient compliance in a day surgery setting

    DEFF Research Database (Denmark)

    Grode, Jesper Nicolai Riis; Grode, Louise; Steinsøe, Ulla

    rehabilitation. The hospital is responsible of providing the patients with accurate information enabling the patient to prepare for surgery. Often patients are overloaded with uncoordinated information, letters and leaflets. The contribution of this project is a database system enabling health professionals...... to empower patients through tailored individualized information. Performing 6500 operations per year at our Day Surgery Centre, health professionals need a computer based system to create individualized information material. Health professionals must be able to adapt the information material quickly...... was established to support these requirements. A relational database system holds all information pieces in a granular, structured form. Each individual piece of information can be joined with other pieces thus supporting the tailoring of information. A web service layer caters for integration with output systems...

  10. Nutritional screening for improving professional practice for patient outcomes in hospital and primary care settings. (United States)

    Omidvari, Amir-Houshang; Vali, Yasaman; Murray, Susan M; Wonderling, David; Rashidian, Arash


    Given the prevalence of under-nutrition and reports of inadequate nutritional management of patients in hospitals and the community, nutritional screening may play a role in reducing the risks of malnutrition. Screening programmes can invoke costs to health systems and patients. It is therefore important to assess the effectiveness of nutritional screening programmes. To examine the effectiveness of nutritional screening in improving quality of care (professional practice) and patient outcomes compared with usual care. We searched the following databases: CENTRAL (The Cochrane Library), MEDLINE, EMBASE and CINAHL up to June 2012 to find relevant studies. Randomised controlled studies, controlled clinical trials, controlled before-after studies and interrupted time series studies assessing the effectiveness of nutritional screening were eligible for inclusion in the review. We considered process outcomes (for example patient identification, referral to dietitian) and patient outcomes (for example mortality, change in body mass index (BMI)). Participants were adult patients aged 16 years or over. We included studies conducted in different settings, including hospitals, out-patient clinics, primary care or long term care settings. We independently assessed the risk of bias and extracted data from the included studies. Meta-analysis was considered but was not conducted due to the discrepancies between the studies. The studies were heterogeneous in their design, setting, intervention and outcomes. We analysed the data using a narrative synthesis approach. After conducting initial searches and screening the titles and abstracts of the identified literature, 77 full text papers were retrieved and read. Ultimately three studies were included. Two controlled before-after studies were conducted in hospital settings (one in the UK and one in the Netherlands) and one cluster randomised controlled trial was conducted in a primary care setting (in the USA).The study conducted in

  11. Asian patients with Hinchey Ia acute diverticulitis: a condition for the ambulatory setting? (United States)

    Chan, Dedrick Kok Hong; Tan, Ker-Kan


    Diverticulitis in Asians is a different disease entity from Western counterparts. Few Asian studies have evaluated the management of acute Hinchey Ia diverticulitis with consideration for outpatient management. The purpose of this study was to evaluate the outcomes of Asian patients with Hinchey Ia acute diverticulitis. A retrospective review of all patients who were treated for Hinchey Ia acute colonic diverticulitis between 2012 and 2014 was performed. All patients were diagnosed on computed tomography (CT). There were 129 patients with Hinchey Ia acute diverticulitis. Fifty-five (42.6%) patients were male, and the median age was 54 years (range, 30-86). Eighty-seven (67.4%) patients had right-sided diverticulitis. Most patients were treated empirically with intravenous ceftriaxone and metronidazole (89.1%). They were then discharged with oral antibiotics. Only 6.1% of patients had a positive blood culture. The median length of stay in the hospital was 4 (range, 3-4) days. Only three (2.3%) patients were readmitted for acute diverticulitis within 30 days. They were managed with antibiotics and discharged well. The repeated CT scans reconfirmed Hinchey Ia diverticulitis. No patients required emergency surgery, and there were no 30-day mortalities. Asian patients with Hinchey Ia diverticulitis recovered well with conservative management and could be amenable to outpatient therapy. Future prospective studies should be performed amongst Asians to evaluate managing this condition in an ambulatory setting.

  12. Assessment of patient safety culture in primary care setting, Al-Mukala, Yemen. (United States)

    Webair, Hana H; Al-Assani, Salwa S; Al-Haddad, Reema H; Al-Shaeeb, Wafa H; Bin Selm, Manal A; Alyamani, Abdulla S


    Patient safety culture in primary care is the first step to achieve high quality health care. This study aims to provide a baseline assessment of patient safety culture in primary care settings in Al-Mukala, Yemen as a first published study from a least developed country. A survey was conducted in primary healthcare centres and units in Al-Mukala District, Yemen. A comprehensive sample from the available 16 centres was included. An Arabic version of the Medical Office Survey on Patient Safety Culture was distributed to all health workers (110). Participants were physicians, nurses and administrative staff. The response rate from the participating centres was 71 %. (N = 78). The percent positive responses of the items is equal to the percentage of participants who answered positively. Composite scores were calculated by averaging the percent positive response on the items within a dimension. Positive safety culture was defined as 60 % or more positive responses on items or dimensions. Patient safety culture was perceived to be generally positive with the exception of the dimensions of 'Communication openness', 'Work pressure and pace' and 'Patient care tracking/follow-up', as the percent positive response of these dimensions were 58, 57, and 52 % respectively. Overall, positive rating on quality and patient safety were low (49 and 46 % respectively). Although patient safety culture in Al-Mukala primary care setting is generally positive, patient safety and quality rating were fairly low. Implementation of a safety and quality management system in Al-Mukala primary care setting are paramount. Further research is needed to confirm the applicability of the Medical Office Survey on Patient Safety Culture (MOSPSC) for Al-Mukala primary care.

  13. International patient and physician consensus on a psoriatic arthritis core outcome set for clinical trials

    DEFF Research Database (Denmark)

    Orbai, Ana-Maria; de Wit, Maarten; Mease, Philip


    OBJECTIVE: To identify a core set of domains (outcomes) to be measured in psoriatic arthritis (PsA) clinical trials that represent both patients' and physicians' priorities. METHODS: We conducted (1) a systematic literature review (SLR) of domains assessed in PsA; (2) international focus groups t...

  14. The Experiences of Registered Nurses Transitioning from Patient Care Settings to Academia (United States)

    Gwin, Teresa


    Registered nurses (RNs) who make the move from a patient-care service setting to an academic teaching environment often go through a transition phase in their first semesters of teaching that is difficult and traumatic. RNs that go on to higher academic degrees often do so in order to teach in schools of nursing. However, graduate work in nursing…

  15. Adler's psychology (of use) today: personal history of traumatic life events as a self-handicapping strategy. (United States)

    DeGree, C E; Snyder, C R


    We investigated the hypothesis that the reporting of a history of traumatic life events may serve as a strategy to control attributions about performance in an evaluative setting (i.e., self-handicapping). Following from Alfred Adler's early theorization in the psychology of use, as well as more recent theory and research on self-handicapping, we predicted that individuals would emphasize the adversity of events and experiences in their background when an uncertain evaluation was expected and when a traumatic background would serve as a suitable excuse for potential failure. Results generally supported the hypothesized self-protective reporting of traumatic life events.

  16. Translation, validity, and reliability of a persian version of the iowa tinnitus handicap questionnaire. (United States)

    Arian Nahad, Homa; Rouzbahani, Masomeh; Jarollahi, Farnoush; Jalaie, Shohreh; Pourbakht, Akram; Mokrian, Helnaz; Mahdi, Parvane; Amali, Amin; Nodin Zadeh, Abdolmajid


    Tinnitus is a common otologic symptom that can seriously affect a patient's quality of life. The purpose of the present study was to translate and validate the Iowa Tinnitus Handicap Questionnaire (THQ) into the Persian language, and to make it applicable as a tool for determining the effects of tinnitus on a patient's life. The main version of the THQ was translated into the Persian language. The agreed Persian version was administered to 150 tinnitus patients. The validity of the Persian THQ was evaluated and internal reliability was confirmed using Cronbach's α-coefficient. Finally, the effect of independent variables such as age, mean patient threshold, gender, and duration of tinnitus were considered in order to determine the psychometric properties of tinnitus. After an exact translation process, the Persian THQ was found to exhibit face validity. In terms of content validity, content validity index in total questionnaire was 0.93. Further, in structural validity measurements, intermediate correlation with annoyance from tinnitus (r=0.49), low correlation with duration of tinnitus (r=0.34) and high correlation with the Tinnitus Handicap Inventory (THI) questionnaire (r=0.84) were demonstrated. Additionally, a negligible effect of gender and age was noted on degree of tinnitus handicap (P= 0.754, P= 0.573, respectively). In the internal reliability assessment for Factors 1, 2, 3, and the whole questionnaire, Cronbach`s α-coefficient was 0.95, 0.92, 0.25 and 0.88, respectively. The Persian version of the Iowa THQ demonstrates high validity and reliability and can be used for the determination of tinnitus handicap and for following-up in the intervention process in Persian tinnitus patients.

  17. Social Comparison, Multiple Reference Groups, and the Self-Concepts of Academically Handicapped Children Before and After Mainstreaming. (United States)

    Strang, Louise; And Others


    Predictions from social comparison theory and group reference theory were tested in two experiments assessing the impact of half-day mainstreaming upon the self-concepts of academically handicapped children. The results supported the theoretical viability of social comparison theory and group reference theory in educational settings. (Author/BH)

  18. Patient-Physician Communication About Complementary and Alternative Medicine in a Radiation Oncology Setting

    International Nuclear Information System (INIS)

    Ge Jin; Fishman, Jessica; Vapiwala, Neha; Li, Susan Q.; Desai, Krupali; Xie, Sharon X.; Mao, Jun J.


    Purpose: Despite the extensive use of complementary and alternative medicine (CAM) among cancer patients, patient-physician communication regarding CAM therapies remains limited. This study quantified the extent of patient-physician communication about CAM and identified factors associated with its discussion in radiation therapy (RT) settings. Methods and Materials: We conducted a cross-sectional survey of 305 RT patients at an urban academic cancer center. Patients with different cancer types were recruited in their last week of RT. Participants self-reported their demographic characteristics, health status, CAM use, patient-physician communication regarding CAM, and rationale for/against discussing CAM therapies with physicians. Multivariate logistic regression was used to identify relationships between demographic/clinical variables and patients’ discussion of CAM with radiation oncologists. Results: Among the 305 participants, 133 (43.6%) reported using CAM, and only 37 (12.1%) reported discussing CAM therapies with their radiation oncologists. In multivariate analyses, female patients (adjusted odds ratio [AOR] 0.45, 95% confidence interval [CI] 0.21-0.98) and patients with full-time employment (AOR 0.32, 95% CI 0.12-0.81) were less likely to discuss CAM with their radiation oncologists. CAM users (AOR 4.28, 95% CI 1.93-9.53) were more likely to discuss CAM with their radiation oncologists than were non-CAM users. Conclusions: Despite the common use of CAM among oncology patients, discussions regarding these treatments occur rarely in the RT setting, particularly among female and full-time employed patients. Clinicians and patients should incorporate discussions of CAM to guide its appropriate use and to maximize possible benefit while minimizing potential harm.

  19. Changing Default Fluoroscopy Equipment Settings Decreases Entrance Skin Dose in Patients. (United States)

    Canales, Benjamin K; Sinclair, Lindsay; Kang, Diana; Mench, Anna M; Arreola, Manuel; Bird, Vincent G


    Proper fluoroscopic education and protocols may reduce the patient radiation dose but few prospective studies in urology have been performed. Using optically stimulated luminescent dosimeters we tested whether fluoroscopy time and/or entrance skin dose would decrease after educational and radiation reduction protocols. At default manufacturer settings fluoroscopy time and entrance skin dose were prospectively measured using optically stimulated luminescent dosimeters in patients undergoing ureteroscopy, retrograde pyelogram/stent or percutaneous nephrolithotomy with access for stone disease. A validated radiation safety competency test was administered to urology faculty and residents before and after web based, hands-on fluoroscopy training. Default fluoroscopy settings were changed from continuous to intermittent pulse rate and from standard to half-dose output. Fluoroscopy time and entrance skin dose were then measured again. The cohorts of 44 pre-protocol and 50 post-protocol patients with stones were similarly matched. The change in mean fluoroscopy time and entrance skin dose from pre-protocol to post-protocol was -0.6 minutes and -11.6 mGy (33%) for percutaneous nephrolithotomy (p = 0.62 and default settings to intermittent pulse rate (12 frames per second) and half-dose lowered the entrance skin dose by 30% across all endourology patients but most significantly during percutaneous nephrolithotomy. To limit patient radiation exposure fluoroscopy default settings should be decreased before all endourology procedures and image equipment manufacturers should consider lowering standard default renal settings. Copyright © 2016 American Urological Association Education and Research, Inc. Published by Elsevier Inc. All rights reserved.

  20. Self-reflection and set-shifting mediate awareness in cognitively preserved schizophrenia patients. (United States)

    Gilleen, James; David, Anthony; Greenwood, Kathryn


    Poor insight in schizophrenia has been linked to poor cognitive functioning, psychological processes such as denial, or more recently with impaired metacognitive capacity. Few studies, however, have investigated the potential co-dependency of multiple factors in determining level of insight, but such a model is necessary in order to account for patients with good cognitive functioning who have very poor awareness. As evidence suggests that set-shifting and cognitive insight (self-reflection (SR) and self-certainty) are strong predictors of awareness we proposed that these factors are key mediators in the relationship between cognition and awareness. We hypothesised that deficits specifically in SR and set-shifting determine level of awareness in the context of good cognition. Thirty schizophrenia patients were stratified by high and low awareness of illness and executive functioning scores. Cognitive insight, cognition, mood and symptom measures were compared between sub-groups. A low insight/high executive functioning (LI-HE) group, a high insight/high executive functioning (HI-HE) group and a low insight/low executive functioning (LI-LE) group were revealed. As anticipated, the LI-HE patients showed significantly lower capacity for SR and set-shifting than the HI-HE patients. This study indicates that good cognitive functioning is necessary but not sufficient for good awareness; good awareness specifically demands preserved capacity to self-reflect and shift-set. Results support Nelson and Narens' [1990. Metamemory: A theoretical framework and new findings. The Psychology of Learning and Motivation, 26, 125-173] model of metacognition by which awareness is founded on control (set-shifting) and monitoring (SR) processes. These specific factors could be targeted to improve insight in patients with otherwise unimpaired cognitive function.

  1. Global patient safety and antiretroviral drug-drug interactions in the resource-limited setting. (United States)

    Seden, Kay; Khoo, Saye H; Back, David; Byakika-Kibwika, Pauline; Lamorde, Mohammed; Ryan, Mairin; Merry, Concepta


    Scale-up of HIV treatment services may have contributed to an increase in functional health facilities available in resource-limited settings and an increase in patient use of facilities and retention in care. As more patients are reached with medicines, monitoring patient safety is increasingly important. Limited data from resource-limited settings suggest that medication error and antiretroviral drug-drug interactions may pose a significant risk to patient safety. Commonly cited causes of medication error in the developed world include the speed and complexity of the medication use cycle combined with inadequate systems and processes. In resource-limited settings, specific factors may contribute, such as inadequate human resources and high disease burden. Management of drug-drug interactions may be complicated by limited access to alternative medicines or laboratory monitoring. Improving patient safety by addressing the issue of antiretroviral drug-drug interactions has the potential not just to improve healthcare for individuals, but also to strengthen health systems and improve vital communication among healthcare providers and with regulatory agencies.

  2. Improving patient and carer communication, multidisciplinary team working and goal-setting in stroke rehabilitation. (United States)

    Monaghan, J; Channell, K; McDowell, D; Sharma, A K


    To determine the extent to which three forms of multidisciplinary team (MDT) care in stroke rehabilitation meet the standards set by the United Kingdom National Service Framework (NSF). Consecutive assessment of the three forms of care was completed. The study included three groups of 25 stroke inpatients on the stroke rehabilitation ward. (1) A standard weekly MDT meeting using a standard form for documentation; (2) a standard MDT meeting using a newly devised form; and (3) a novel MDT ward round using the new form, and attended by doctors. MDT ward rounds result in significantly better consideration of patients' needs (median 7 per patient compared with 0 and 5 in phases one and two), enhanced SMART (specific, measurable, achievable, realistic and time framed) goal-setting (median 3 per patient compared to 1 in phases one and two); greater patient involvement (12 patients compared to 0 and 4 in phases one and two); and improved team working (measured using the team climate inventory) than do MDT meetings. In the present study, standard weekly MDT meetings did not meet the standards set for MDT care by the NSF. The use of a MDT ward round allows these standards to be achieved.

  3. Evaluation of ceiling lifts in health care settings: patient outcome and perceptions. (United States)

    Alamgir, Hasanat; Li, Olivia Wei; Gorman, Erin; Fast, Catherine; Yu, Shicheng; Kidd, Catherine


    Ceiling lifts have been introduced into health care settings to reduce manual patient lifting and thus occupational injuries. Although growing evidence supports the effectiveness of ceiling lifts, a paucity of research links indicators, such as quality of patient care or patient perceptions, to the use of these transfer devices. This study explored the relationship between ceiling lift coverage rates and measures of patient care quality (e.g., incidence of facility-acquired pressure ulcers, falls, urinary infections, urinary incontinence, and assaults [patient to staff] in acute and long-term care facilities), as well as patient perceptions of satisfaction with care received while using ceiling lifts in a complex care facility. Qualitative semi-structured interviews were used to generate data. A significant inverse relationship was found between pressure ulcer rates and ceiling lift coverage; however, this effect was attenuated by year. No significant relationships existed between ceiling lift coverage and patient outcome indicators after adding the "year" variable to the model. Patients generally approved of the use of ceiling lifts and recognized many of the benefits. Ceiling lifts are not detrimental to the quality of care received by patients, and patients prefer being transferred by ceiling lifts. The relationship between ceiling lift coverage and pressure ulcer rates warrants further investigation. Copyright (c) 2009, SLACK Incorporated.

  4. Patient autonomy preferences among hypertensive outpatients in a primary care setting in Japan. (United States)

    Nomura, Kyoko; Ohno, Maiko; Fujinuma, Yasuki; Ishikawa, Hirono


    To investigate autonomy preferences and the factors to promote active patient participation in a primary care setting in Japan. Ninety-two hypertensive outpatients who consecutively visited a Japanese hospital between January and May of 2005 in Tokyo, Japan. This cross-sectional study was conducted by using a self-administered questionnaire. The main outcome measures were patient preferences for autonomy (i.e., decision-making and information-seeking preferences), measured by the Autonomy Preference Index (API). The variables studied were patient sociodemographic characteristics, physician characteristics based on patient preference (i.e., ability to communicate, extent of clinical experience, qualifications, educational background, gender, and age), and the Multidimensional Health Locus of Control. On the API scale from 0 to 100, the patients had an intermediate desire for decision-making (median: 51) and a greater desire for information (median: 95). A multivariate regression model indicated that decision-making preference increased when patients were woman and decreased as physician age increased, and information-seeking preference was positively associated with good communication skills, more extensive clinical experience, physicians of middle age, and patient beliefs that they were responsible for their own health, and was negatively associated with a preference for man physicians. Physicians may need to understand that patient autonomy preferences pertain to physician age and gender, physician communication ability and extent of clinical experience, and patient beliefs about self-responsibility toward health, and could use the information to promote reliable patient-physician relationships.

  5. Glycated albumin is set lower in relation to plasma glucose levels in patients with Cushing's syndrome. (United States)

    Kitamura, Tetsuhiro; Otsuki, Michio; Tamada, Daisuke; Tabuchi, Yukiko; Mukai, Kosuke; Morita, Shinya; Kasayama, Soji; Shimomura, Iichiro; Koga, Masafumi


    Glycated albumin (GA) is an indicator of glycemic control, which has some specific characters in comparison with HbA1c. Since glucocorticoids (GC) promote protein catabolism including serum albumin, GC excess state would influence GA levels. We therefore investigated GA levels in patients with Cushing's syndrome. We studied 16 patients with Cushing's syndrome (8 patients had diabetes mellitus and the remaining 8 patients were non-diabetic). Thirty-two patients with type 2 diabetes mellitus and 32 non-diabetic subjects matched for age, sex and BMI were used as controls. In the patients with Cushing's syndrome, GA was significantly correlated with HbA1c, but the regression line shifted downwards as compared with the controls. The GA/HbA1c ratio in the patients with Cushing's syndrome was also significantly lower than the controls. HbA1c in the non-diabetic patients with Cushing's syndrome was not different from the non-diabetic controls, whereas GA was significantly lower. In 7 patients with Cushing's syndrome who performed self-monitoring of blood glucose, the measured HbA1c was matched with HbA1c estimated from mean blood glucose, whereas the measured GA was significantly lower than the estimated GA. We clarified that GA is set lower in relation to plasma glucose levels in patients with Cushing's syndrome. Copyright © 2013 Elsevier B.V. All rights reserved.

  6. Patients' self-interested preferences: empirical evidence from a priority setting experiment. (United States)

    Alvarez, Begoña; Rodríguez-Míguez, Eva


    This paper explores whether patients act according to self-interest in priority setting experiments. The analysis is based on a ranking experiment, conducted in Galicia (Spain), to elicit preferences regarding the prioritization of patients on a waiting list for an elective surgical intervention (prostatectomy for benign prostatic hyperplasia). Participants were patients awaiting a similar intervention and members of the general populations. All of them were asked to rank hypothetical patients on a waiting list. A rank-ordered logit was then applied to their responses in order to obtain a prioritization scoring system. Using these estimations, we first test for differences in preferences between patients and general population. Second, we implement a procedure based on the similarity between respondents (true patients) and the hypothetical scenarios they evaluate (hypothetical patients) to analyze whether patients provide self-interested rankings. Our results show that patient preferences differ significantly from general population preferences. The findings also indicate that, when patients rank the hypothetical scenarios on the waiting list, they consider not only the explicit attributes but also the similarity of each scenario to their own. In particular, they assign a higher priority to scenarios that more closely match their own states. We also find that such a preference structure increases their likelihood of reporting "irrational" answers. Copyright © 2011 Elsevier Ltd. All rights reserved.

  7. The Patient-Healthcare Professional Relationship and Communication in the Oncology Outpatient Setting

    DEFF Research Database (Denmark)

    Prip, Anne; Møller, Kirsten Alling; Nielsen, Dorte Lisbet


    and communication with healthcare professionals during chemotherapy in the oncology outpatient setting. METHODS: The systematic literature review was carried out according to PRISMA guidelines and the PICO framework, and a systematic search was conducted in MEDLINE, CINAHL, The Cochrane Library, and Joanna Briggs...... on satisfaction of care, that hope and positivity are both a need and a strategy for patients with cancer and were facilitated by healthcare professionals, and that outpatient clinic visits framed and influenced communication and relationships. CONCLUSIONS: The relationship and communication between patients...... and healthcare professionals in the outpatient setting were important for the patients' ability to cope with cancer. IMPLICATIONS FOR PRACTICE: Healthcare professionals need to pay special attention to the relational aspects of communication in an outpatient clinic because encounters are often brief. More...

  8. Computer-facilitated rapid HIV testing in emergency care settings: provider and patient usability and acceptability. (United States)

    Spielberg, Freya; Kurth, Ann E; Severynen, Anneleen; Hsieh, Yu-Hsiang; Moring-Parris, Daniel; Mackenzie, Sara; Rothman, Richard


    Providers in emergency care settings (ECSs) often face barriers to expanded HIV testing. We undertook formative research to understand the potential utility of a computer tool, "CARE," to facilitate rapid HIV testing in ECSs. Computer tool usability and acceptability were assessed among 35 adult patients, and provider focus groups were held, in two ECSs in Washington State and Maryland. The computer tool was usable by patients of varying computer literacy. Patients appreciated the tool's privacy and lack of judgment and their ability to reflect on HIV risks and create risk reduction plans. Staff voiced concerns regarding ECS-based HIV testing generally, including resources for follow-up of newly diagnosed people. Computer-delivered HIV testing support was acceptable and usable among low-literacy populations in two ECSs. Such tools may help circumvent some practical barriers associated with routine HIV testing in busy settings though linkages to care will still be needed.

  9. The Patient-Healthcare Professional Relationship and Communication in the Oncology Outpatient Setting: A Systematic Review. (United States)

    Prip, Anne; Møller, Kirsten Alling; Nielsen, Dorte Lisbet; Jarden, Mary; Olsen, Marie-Helene; Danielsen, Anne Kjaergaard


    Today, cancer care and treatment primarily take place in an outpatient setting where encounters between patients and healthcare professionals are often brief. The aim of this study was to summarize the literature of adult patients' experiences of and need for relationships and communication with healthcare professionals during chemotherapy in the oncology outpatient setting. The systematic literature review was carried out according to PRISMA guidelines and the PICO framework, and a systematic search was conducted in MEDLINE, CINAHL, The Cochrane Library, and Joanna Briggs Institute Evidence Based Practice Database. Nine studies were included, qualitative (n = 5) and quantitative (n = 4). The studies identified that the relationship between patients and healthcare professionals was important for the patients' ability to cope with cancer and has an impact on satisfaction of care, that hope and positivity are both a need and a strategy for patients with cancer and were facilitated by healthcare professionals, and that outpatient clinic visits framed and influenced communication and relationships. The relationship and communication between patients and healthcare professionals in the outpatient setting were important for the patients' ability to cope with cancer. Healthcare professionals need to pay special attention to the relational aspects of communication in an outpatient clinic because encounters are often brief. More research is needed to investigate the type of interaction and intervention that would be the most effective in supporting adult patients' coping during chemotherapy in an outpatient clinic.This is an open-access article distributed under the terms of the Creative Commons Attribution-Non Commercial-No Derivatives License 4.0 (CCBY-NC-ND), where it is permissible to download and share the work provided it is properly cited. The work cannot be changed in any way or used commercially without permission from the journal.

  10. Patient Safety Culture Survey in Pediatric Complex Care Settings: A Factor Analysis. (United States)

    Hessels, Amanda J; Murray, Meghan; Cohen, Bevin; Larson, Elaine L


    Children with complex medical needs are increasing in number and demanding the services of pediatric long-term care facilities (pLTC), which require a focus on patient safety culture (PSC). However, no tool to measure PSC has been tested in this unique hybrid acute care-residential setting. The objective of this study was to evaluate the psychometric properties of the Nursing Home Survey on Patient Safety Culture tool slightly modified for use in the pLTC setting. Factor analyses were performed on data collected from 239 staff at 3 pLTC in 2012. Items were screened by principal axis factoring, and the original structure was tested using confirmatory factor analysis. Exploratory factor analysis was conducted to identify the best model fit for the pLTC data, and factor reliability was assessed by Cronbach alpha. The extracted, rotated factor solution suggested items in 4 (staffing, nonpunitive response to mistakes, communication openness, and organizational learning) of the original 12 dimensions may not be a good fit for this population. Nevertheless, in the pLTC setting, both the original and the modified factor solutions demonstrated similar reliabilities to the published consistencies of the survey when tested in adult nursing homes and the items factored nearly identically as theorized. This study demonstrates that the Nursing Home Survey on Patient Safety Culture with minimal modification may be an appropriate instrument to measure PSC in pLTC settings. Additional psychometric testing is recommended to further validate the use of this instrument in this setting, including examining the relationship to safety outcomes. Increased use will yield data for benchmarking purposes across these specialized settings to inform frontline workers and organizational leaders of areas of strength and opportunity for improvement.

  11. Clinical analysis of aqueductal stenosis in patients with hydrocephalus in a Kenyan setting. (United States)

    Kaur, Loyal Poonamjeet; Munyiri, Nderitu Joseph; Dismus, Wekesa Vincent


    Aqueductal stenosis is the commonest cause of congenital hydrocephalus. The scope of this paper is to highlight the disease burden of hydrocephalus attributed to aqueductal stenosis which still remains unknown in our setting. In a descriptive cross-sectional study, 258 records of patients diagnosed with hydrocephalus were analyzed after ethical approval from Kenyatta National Hospital- University of Nairobi (KNH-UON) ethics and research committee from January 2010 to May 2016. Patients with a diagnosis of hydrocephalus due to aqueductal stenosis were included in this study. Patients age, sex, mode of delivery, associated comorbidities, presenting complaints, neurosurgical intervention performed, Kafarnosky score were recorded. Data were divided into 2 sets based on the patient's age i.e. whether 12 years. Data were recorded on google data collection form and analyzed using Google spreadsheets. Out of 258 cases of hydrocephalus, 52 had aqueductal stenosis. Male to female sex ratio for this condition was 3:2. There were 25 cases 12 years old who were diagnosed with hydrocephalus due to aqueductal stenosis. Associated conditions were bilateral congenital talipes equinovarus, spina bifida, Arnold Chairi malformations, meningitis and HIV. The presenting complaints differed according to the age groups. Neurosurgical interventions included Endoscopic Third Ventriculostomy (ETV) in 21 cases, insertion of Ventriculoperitoneal (VP) shunt and ETV were done in 3 cases while the rest had only insertion of VP shunt. The Kafanosky score improve from hydrocephalus. Clinical presentation differs according to patients age. Accurate diagnosis and treatment remain a cardinal to improving patient outcome.

  12. Development of a new model to engage patients and clinicians in setting research priorities. (United States)

    Pollock, Alex; St George, Bridget; Fenton, Mark; Crowe, Sally; Firkins, Lester


    Equitable involvement of patients and clinicians in setting research and funding priorities is ethically desirable and can improve the quality, relevance and implementation of research. Survey methods used in previous priority setting projects to gather treatment uncertainties may not be sufficient to facilitate responses from patients and their lay carers for some health care topics. We aimed to develop a new model to engage patients and clinicians in setting research priorities relating to life after stroke, and to explore the use of this model within a James Lind Alliance (JLA) priority setting project. We developed a model to facilitate involvement through targeted engagement and assisted involvement (FREE TEA model). We implemented both standard surveys and the FREE TEA model to gather research priorities (treatment uncertainties) from people affected by stroke living in Scotland. We explored and configured the number of treatment uncertainties elicited from different groups by the two approaches. We gathered 516 treatment uncertainties from stroke survivors, carers and health professionals. We achieved approximately equal numbers of contributions; 281 (54%) from stroke survivors/carers; 235 (46%) from health professionals. For stroke survivors and carers, 98 (35%) treatment uncertainties were elicited from the standard survey and 183 (65%) at FREE TEA face-to-face visits. This contrasted with the health professionals for whom 198 (84%) were elicited from the standard survey and only 37 (16%) from FREE TEA visits. The FREE TEA model has implications for future priority setting projects and user-involvement relating to populations of people with complex health needs. Our results imply that reliance on standard surveys may result in poor and unrepresentative involvement of patients, thereby favouring the views of health professionals.

  13. Characteristics of Patients With Satisfactory Functional Gain Following Total Joint Arthroplasty in a Postacute Rehabilitation Setting. (United States)

    Hershkovitz, Avital; Vesilkov, Marina; Beloosesky, Yichayaou; Brill, Shai


    Total joint arthroplasty (TJA) is an effective and successful treatment of osteoarthritis of the hip and knee as quantified by several measures, such as pain relief, improved walking, improved self-care, functions, and increased quality of life. Data are lacking as to the definition of a satisfactory functional gain in a postacute setting and identifying the characteristics of older patients with TJA who may achieve that gain. Our aim was to characterize patients who may achieve a satisfactory functional gain in a postacute rehabilitation setting following TJA. This was a retrospective study of 180 patients with TJA admitted during 2010-2013. The main outcome measures were the Functional Independence Measure (FIM), the Montebello Rehabilitation Factor Score (MRFS) on the motor FIM, and the Timed Get Up and Go Test. Satisfactory functional gain was defined as an mFIM MRFS score above median score. Comparisons of clinical and demographic characteristics between patients who achieved a satisfactory functional gain versus those who did not were performed by the Mann-Whitney U test and the χ test. The proportion of patients who achieved a satisfactory functional gain was similar in the total knee arthroplasty and total hip arthroplasty (THA) groups. The most significant characteristic of patients who achieved a satisfactory functional gain was their admission functional ability. Age negatively impacted the ability to achieve a satisfactory functional gain in patients with THA. Functional level on admission is the best predictive factor for a better rehabilitation outcome for patients with TJA. Age negatively affects functional gain in patients with THA.

  14. Sleep Disturbances in Patients With Advanced Cancer in Different Palliative Care Settings. (United States)

    Mercadante, Sebastiano; Aielli, Federica; Adile, Claudio; Ferrera, Patrizia; Valle, Alessandro; Cartoni, Claudio; Pizzuto, Massimo; Caruselli, Amanda; Parsi, Renato; Cortegiani, Andrea; Masedu, Francesco; Valenti, Marco; Ficorella, Corrado; Porzio, Giampiero


    Information regarding sleep disturbances in the population with advanced cancer is meager. To assess the prevalence of sleep disturbances and possible correlations with associated factors in a large number of patients with advanced cancer admitted to different palliative care settings. This was an observational study performed in different settings of palliative care. A consecutive sample of patients with advanced cancer was prospectively assessed for a period of six months. Epidemiological and clinical data, treatments received in the last month, Karnofsky status, Edmonton Symptom Assessment System scores, and concomitant medical treatment were recorded. Patients were administered the Athens Insomnia Scale and the Hospital Anxiety and Depression Scale (HADS). A total of 820 patients were surveyed. Mean age was 69.7 years (SD 12.7), and 429 patients were males. Consistent sleep disturbances (moderate to maximum) were found in 60.8% of patients. Aged patients were less likely to have sleep disturbances, whereas a poor Karnofsky level was significantly associated with sleep problems. Breast, gastrointestinal, head and neck, lung, and prostate cancers were associated with sleep problems. Patients who had a secondary school or undergraduate education had less sleep disturbances. Hormone therapy and use of opioids and corticosteroids were positively associated with sleep disturbances, and there was a positive correlation of HADS-Anxiety and HADS-Depression scores with sleep disturbances. More than 60% of palliative care patients have relevant sleep disturbances. Several factors associated with sleep disorders have been identified and should prompt physicians to make a careful examination and subsequent treatment of these disturbances. Copyright © 2015 American Academy of Hospice and Palliative Medicine. Published by Elsevier Inc. All rights reserved.

  15. Identification of Australian Aboriginal and Torres Strait Islander Cancer Patients in the Primary Health Care Setting

    Directory of Open Access Journals (Sweden)

    Audra de Witt


    Full Text Available BackgroundAboriginal and Torres Strait Islander Australians have poorer cancer outcomes and experience 30% higher mortality rates compared to non-Indigenous Australians. Primary health care (PHC services are increasingly being recognized as pivotal in improving Indigenous cancer patient outcomes. It is currently unknown whether patient information systems and practices in PHC settings accurately record Indigenous and cancer status. Being able to identify Indigenous cancer patients accessing services in PHC settings is the first step in improving outcomes.MethodsAboriginal Medical Centres, mainstream (non-Indigenous specific, and government-operated centers in Queensland were contacted and data were collected by telephone during the period from 2014 to 2016. Participants were asked to (i identify the number of patients diagnosed with cancer attending the service in the previous year; (ii identify the Indigenous status of these patients and if this information was available; and (iii advise how this information was obtained.ResultsTen primary health care centers (PHCCs across Queensland participated in this study. Four centers were located in regional areas, three in remote areas and three in major cities. All participating centers reported ability to identify Indigenous cancer patients attending their service and utilizing electronic Patient Care Information Systems (PCIS to manage their records; however, not all centers were able to identify Indigenous cancer patients in this way. Indigenous cancer patients were identified by PHCCs using PCIS (n = 8, searching paper records (n = 1, and combination of PCIS and staff recall (n = 1. Six different types of PCIS were being utilized by participating centers. There was no standardized way to identify Indigenous cancer patients across centers. Health service information systems, search functions and capacities of systems, and staff skill in extracting data using PCIS varied between centers

  16. Demonstration of a software design and statistical analysis methodology with application to patient outcomes data sets. (United States)

    Mayo, Charles; Conners, Steve; Warren, Christopher; Miller, Robert; Court, Laurence; Popple, Richard


    With emergence of clinical outcomes databases as tools utilized routinely within institutions, comes need for software tools to support automated statistical analysis of these large data sets and intrainstitutional exchange from independent federated databases to support data pooling. In this paper, the authors present a design approach and analysis methodology that addresses both issues. A software application was constructed to automate analysis of patient outcomes data using a wide range of statistical metrics, by combining use of C#.Net and R code. The accuracy and speed of the code was evaluated using benchmark data sets. The approach provides data needed to evaluate combinations of statistical measurements for ability to identify patterns of interest in the data. Through application of the tools to a benchmark data set for dose-response threshold and to SBRT lung data sets, an algorithm was developed that uses receiver operator characteristic curves to identify a threshold value and combines use of contingency tables, Fisher exact tests, Welch t-tests, and Kolmogorov-Smirnov tests to filter the large data set to identify values demonstrating dose-response. Kullback-Leibler divergences were used to provide additional confirmation. The work demonstrates the viability of the design approach and the software tool for analysis of large data sets.

  17. Breaking Bad News in Ethnic Settings: Perspectives of Patients and Families in Northern Sri Lanka

    Directory of Open Access Journals (Sweden)

    Chrishanthi Rajasooriyar


    Full Text Available Purpose: The discussion of a cancer diagnosis and prognosis often is difficult. This study explored the expectations of Tamil-speaking patients with cancer and their families with respect to receiving their cancer diagnosis in northern Sri Lanka. Methods: This exploratory, descriptive, qualitative study used semistructured interviews. Results: Thematic analysis identified two major themes: communication and information seeking. The findings illustrate a discrepancy between patient preference for direct disclosure of the diagnosis and that of families. Ninety-five percent of patients wanted medical staff to disclose their cancer diagnosis, whereas only 45% of family members believed that the diagnosis should be disclosed to the patient rather than to the family. Conclusion: Although patients and their family members’ views and expectations of the disclosure of diagnosis and prognosis differ, a majority of patients want to be told directly about their diagnosis rather than to learn of it from a relative. The findings are similar to the literature on other ethnic groups from Sri Lanka and studies from English-speaking developed countries. Therefore, the main questions are how to educate families and physicians about the benefits of open disclosure to patients and how to change culture. Results of this study along with a previous study call for the development of strategies and guidelines to improve societal views, educate patients and families, and train health professionals in the area of breaking bad news and discussing prognosis in the Sri Lankan setting.

  18. Effects of neurofeedback on adult patients with psychiatric disorders in a naturalistic setting. (United States)

    Cheon, Eun-Jin; Koo, Bon-Hoon; Seo, Wan-Seok; Lee, Jun-Yeob; Choi, Joong-Hyeon; Song, Shin-Ho


    Few well-controlled studies have considered neurofeedback treatment in adult psychiatric patients. In this regard, the present study investigates the characteristics and effects of neurofeedback on adult psychiatric patients in a naturalistic setting. A total of 77 adult patients with psychiatric disorders participated in this study. Demographic data and neurofeedback states were retrospectively analyzed, and the effects of neurofeedback were evaluated using clinical global impression (CGI) and subjective self-rating scales. Depressive disorders were the most common psychiatric disorders (19; 24.7 %), followed by anxiety disorders (18; 23.4 %). A total of 69 patients (89.6 %) took medicine, and the average frequency of neurofeedback was 17.39 ± 16.64. Neurofeedback was applied to a total of 39 patients (50.6 %) more than 10 times, and 48 patients (62.3 %) received both β/SMR and α/θ training. The discontinuation rate was 33.8 % (26 patients). There was significant difference between pretreatment and posttreatment CGI scores (neurofeedback as an effective complimentary treatment for adult patients with psychiatric disorders.

  19. Rough Set Theory based prognostication of life expectancy for terminally ill patients. (United States)

    Gil-Herrera, Eleazar; Yalcin, Ali; Tsalatsanis, Athanasios; Barnes, Laura E; Djulbegovic, Benjamin


    We present a novel knowledge discovery methodology that relies on Rough Set Theory to predict the life expectancy of terminally ill patients in an effort to improve the hospice referral process. Life expectancy prognostication is particularly valuable for terminally ill patients since it enables them and their families to initiate end-of-life discussions and choose the most desired management strategy for the remainder of their lives. We utilize retrospective data from 9105 patients to demonstrate the design and implementation details of a series of classifiers developed to identify potential hospice candidates. Preliminary results confirm the efficacy of the proposed methodology. We envision our work as a part of a comprehensive decision support system designed to assist terminally ill patients in making end-of-life care decisions.

  20. Lifestyle and dietary habits of patients with gout followed in rheumatology settings. (United States)

    Manara, M; Carrara, G; Scirè, C A; Cimmino, M A; Govoni, M; Montecucco, C; Matucci-Cerinic, M; Minisola, G; Study Group, The King


    Diet and lifestyles modification are core aspects of the non-pharmacological management of gout, but a poor consistency with suggested guidelines is reported. This study aimed to investigate dietary and lifestyle habits of patients with gout followed in rheumatology settings. Data were retrieved from the baseline dataset of the KING study, a multicentre cohort study of patients with gout followed in rheumatology settings. Dietary habits were assessed with the Italian National Institute of Statistics (ISTAT) food-frequency questionnaire and compared with reported data about general population. The relative increase of exposure was estimated by standardized prevalence ratios adjusted for gender, age and geographical distribution. The study population included 446 patients, with a mean age of 63.9 years and a M/F ratio of 9:1. Compared to the Italian population, gouty patients showed a higher prevalence of obesity [1.82 (1.52-2.18)] and a higher consumption of wine [1.85 (1.48-2.32)] and beer [2.21 (1.68-2.90)], but a lower prevalence of smoking and a lower intake of liquor. They showed a lower intake of red meat [0.80 (0.71-0.91)], but a similar intake of other tested dietary factors. Gouty patients' lifestyle is still partially different from the recommended.

  1. Feasibility of 4 patient-reported outcome measures in a registry setting

    DEFF Research Database (Denmark)

    Paulsen, Aksel; Pedersen, Alma Becic; Overgaard, Søren


    Background and purpose Feasibility is an important parameter when choosing which patient-reported outcomes (PRO) to use in a study. We assessed the feasibility of PROs in a hip registry setting. Methods Primary total hip arthroplasty (THA) patients (n = 5,747) who had been operated on 1-2, 5.......1% to 46%, respectively. Missing items ranged from 1.2% to 3.4%, and 0.8-4.3% required manual validation (p analysis, depending on descriptive factor and choice of PRO. Interpretation All 4 PROs fulfilled...

  2. The patient experience of patient-centered communication with nurses in the hospital setting: a qualitative systematic review protocol. (United States)

    Newell, Stephanie; Jordan, Zoe


    The objective of this systematic review is to synthesize the eligible evidence of patients' experience of engaging and interacting with nurses, in the medical-surgical ward setting.This review will consider the following questions: Communication is a way in which humans make sense of the world around them. Communication takes place as an interactive two-way process or interaction, involving two or more people and can occur by nonverbal, verbal, face-to-face or non-face-to-face methods. Effective communication is described to occur when the sender of a message sends their message in a way that conveys the intent of their message and then is understood by the receiver of the message. As a result of the communication from both the sender and the receiver of the message a shared meaning is created between both parties.Communication can therefore be viewed as a reciprocal process. In the health care literature the terms communication and interaction are used interchangeably.Communication failures between clinicians are the most common primary cause of errors and adverse events in health care. Communication is a significant factor in patient satisfaction and complaints about care. Communication plays an integral role in service quality in all service professions including health care professions.Within healthcare, quality care has been defined by the Institute of Medicine as 'care that is safe, effective, timely, efficient, equitable and patient-centred'. Patient-centered care is defined as 'care that is respectful of and responsive to individual patient preferences, needs and values, and ensuring that patient's values guide all clinical decisions. Patient centered-care encompasses the 'individual experiences of a patient, the clinical service, the organizational and the regulatory levels of health care'. At the individual patient level, patient-centered care is care that is 'provided in a respectful manner, assures open and ongoing sharing of useful information in an

  3. Patient Health Questionnaire 15 as a generic measure of severity in fibromyalgia syndrome: surveys with patients of three different settings. (United States)

    Häuser, Winfried; Brähler, Elmar; Wolfe, Frederick; Henningsen, Peter


    Graduated treatment of patients with functional somatic syndromes (FSS) and fibromyalgia syndrome (FMS) depending on their severity has been recommended by recent guidelines. The Patient Health Questionnaire 15 (PHQ 15) is a validated measure of somatic symptom severity in FSS. We tested the discriminant and transcultural validity of the PHQ 15 as a generic measure of severity in persons with FMS. Persons meeting recognized FMS-criteria of the general German population (N=98), of the US National Data Bank of Rheumatic Diseases (N=440), and of a single German pain medicine center (N=167) completed validated self-report questionnaires on somatic and psychological distress (Polysymptomatic Distress Scale, Patient Health Questionnaire 4), health-related quality of life (HRQOL) (Short Form Health Survey 12 or 36) and disability (Pain Disability Index). In addition, self-reports of working status were assessed in the clinical setting. Overall severity of FMS was defined by PHQ 15 scores: mild (0-9), moderate (10-14) and severe (15-30). Persons with mild, moderate and severe FMS did not differ in age and gender. Irrespective of the setting, persons with severe FMS reported more pain sites, fatigue, depressed mood, impaired HRQOL and disability than persons with moderate or mild FMS. Patients with severe FMS in the NDB and in the German clinical center reported more work-related disability than patients with mild FMS. The PHQ 15 is a valid generic measure of overall severity in FMS. Copyright © 2014 Elsevier Inc. All rights reserved.

  4. Extracranial stereotactic radiation therapy: set-up accuracy of patients treated for liver metastases

    International Nuclear Information System (INIS)

    Herfarth, K.K.; Debus, J.; Lohr, F.; Bahner, M.L.; Fritz, P.; Hoess, A.; Schlegel, W. Ph.D.; Wannenmacher, M.F.


    Purpose: Patients with liver metastases might benefit from high-dose conformal radiation therapy. A high accuracy of repositioning and a reduction of target movement are necessary for such an approach. The set-up accuracy of patients with liver metastases treated with stereotactic single dose radiation was evaluated. Methods and Materials: Twenty-four patients with liver metastases were treated with single dose radiation therapy on 26 occasions using a self-developed stereotactic frame. Liver movement was reduced by abdominal pressure. The effectiveness was evaluated under fluoroscopy. CT scans were performed on the planning day and directly before treatment. Representative reference marks were chosen and the coordinates were calculated. In addition, the target displacement was quantitatively evaluated after treatment. Results: Diaphragmal movement was reduced to median 7 mm (range: 3-13 mm). The final set-up accuracy of the body was limited to all of median 1.8 mm in latero-lateral direction (range: 0.3-5.0 mm) and 2.0 mm in anterior-posterior direction (0.8-3.8 mm). Deviations of the body in cranio-caudal direction were always less than the thickness of one CT slice (<5 mm). However, a repositioning was necessary in 16 occasions. The final target shift was median 1.6 mm (0.2-7.0 mm) in latero-lateral and 2.3 mm in anterior-posterior direction (0.0-6.3 mm). The median shift in cranio-caudal direction was 4.4 mm (0.0-10.0 mm). Conclusions: In patients with liver metastases, a high set-up accuracy of the body and the target can be achieved. This allows a high-dose focal radiotherapy of these lesions. However, a control CT scan should be performed directly before therapy to confirm set-up accuracy and possibly prompt necessary corrections

  5. The Role of Classroom Goal Structure in Students' Use of Self-Handicapping Strategies. (United States)

    Urdan, Tim; Midgley, Carol; Anderman, Eric M.


    Surveyed 656 fifth graders on their use of self-handicapping strategies and examined predictors of self-handicapping. Boys used handicapping more than girls did, and grade point average and perceived academic competence were negatively related to handicapping. Ability goal structure and teaching practices highlighting relative ability were…

  6. Self-handicapping status, claimed self-handicaps and reduced practice effort following success and failure feedback. (United States)

    Thompson, T; Richardson, A


    Self-handicapping involves the strategic establishment of an impediment or obstacle to success prior to a performance situation which thereby provides a convenient excuse for poor performance. The study sought to establish that relative to low trait self-handicappers, high trait self-handicappers exposed to failure in an intellectually evaluative situation will (a) pre-emptively claim more handicaps, and (b) behaviourally self-handicap through reduced practice effort, and (c) report greater anxiety and negative affect relative to low trait self-handicappers. Participants were 72 undergraduate students, divided equally between high and low self-handicapping groups. This study utilised a 2 (self-handicapping status: high, low) x 3 (performance feedback: fail, low task importance; fail, high task importance; success) between-subjects factorial design to investigate claimed and behavioural self-handicapping through reduced practice effort. This was done by manipulating performance outcome and perceived task importance. Relative to low trait self-handicappers, high trait high self-handicappers claimed more handicaps and engaged in greater behavioural self-handicapping following failure when working on tasks that were described as potentially diagnostic of low ability. While low self-handicappers internalised their success more than their failure in the high task importance condition, high self-handicappers were undifferentiated in their attributions across performance conditions. Greater anxiety and greater negative affect were also characteristic of high self-handicappers. The study highlights the self-protective benefit of self-handicapping in sparing the individual from conclusions of low ability, and the failure of high self-handicappers to fully internalise their success. These elements and the role of uncertain estimates of ability are discussed in considering implications for intervention.

  7. Doctor-patient communication without family is most frequently practiced in patients with malignant tumors in home medical care settings. (United States)

    Kimura, Takuma; Imanaga, Teruhiko; Matsuzaki, Makoto


    Promotion of home medical care is absolutely necessary in Japan where is a rapidly aging society. In home medical care settings, triadic communications among the doctor, patient and the family are common. And "communications just between the doctor and the patient without the family" (doctor-patient communication without family, "DPC without family") is considered important for the patient to frankly communicate with the doctor without consideration for the family. However, the circumstances associated with DPC without family are unclear. Therefore, to identify the factors of the occurrence of DPC without family, we conducted a cross-sectional mail-in survey targeting 271 families of Japanese patients who had previously received home medical care. Among 227 respondents (83.8%), we eventually analyzed data from 143, excluding families of patients with severe hearing or cognitive impairment and severe verbal communication dysfunction. DPC without family occurred in 26.6% (n = 38) of the families analyzed. A multivariable logistic regression analysis was performed using a model including Primary disease, Daily activity, Duration of home medical care, Interval between doctor visits, Duration of doctor's stay, Existence of another room, and Spouse as primary caregiver. As a result, DPC without family was significantly associated with malignant tumor as primary disease (OR, 3.165; 95% CI, 1.180-8.486; P = 0.022). In conclusion, the visiting doctors should bear in mind that the background factor of the occurrence of DPC without family is patient's malignant tumors.

  8. Self-reported versus behavioral self-handicapping: empirical evidence for a theoretical distinction. (United States)

    Hirt, E R; Deppe, R K; Gordon, L J


    The present study was an investigation of how Ss would respond when given 2 self-handicapping options, 1 behavioral (withdrawal of practice effort) and 1 self-reported (reporting high levels of stress). Ss anticipating a diagnostic test of intellectual ability were given different instructions regarding the effects of stress and practice on test performance. Ss were told that (a) stress only, (b) practice only, (c) both stress and practice, or (d) neither stress nor practice affected test scores. Ss were then given the opportunity to self-report a handicap on a stress inventory and to behaviorally self-handicap by failing to practice before the test. High self-handicapping men and women showed evidence of self-reported handicapping, but only high self-handicapping men behaviorally self-handicapped. However, when both self-handicaps were viable, both high self-handicapping men and women preferred the self-reported over the behavioral self-handicap.

  9. Assessment of satisfaction with pharmaceutical services in patients receiving antiretroviral therapy in outpatient HIV treatment setting. (United States)

    Agu, Kenneth Anene; Oqua, Dorothy; Agada, Peter; Ohiaeri, Samuel I; Adesina, Afusat; Abdulkareem, Mohammed Habeeb; King, Rosalyn C; Wutoh, Anthony K


    The patient's perception and satisfaction are increasingly considered as a useful factor in the assessment of competency of health care providers and quality of care. However, these patient focused assessments are largely ignored when assessing health care outcomes. The study assessed the perception and satisfaction of patients receiving antiretroviral therapy (ART) with pharmaceutical services received in outpatient HIV treatment settings. Seventeen HIV treatment centres in Nigeria. This cross-sectional survey included 2,700 patients randomly selected from 26,319 HIV patients on ART, who received pharmaceutical services in the study setting. A study-specific Likert-type instrument was administered to the participants at point of exit from the pharmacy. Midpoint of the 5-point scale was computed and scores above it were regarded as positive while below as negative. Chi-square was used for inferential statistics. All reported p values were 2-sided at 95 % confidence interval (CI). Patient satisfaction with pharmaceutical services. Of 2,700 patients sampled, data from 1,617 (59.9 %) were valid for analysis; 62.3 % were aged 26-40 years and 65.4 % were females. The participants had received pharmaceutical services for a mean duration of 25.2 (95 % CI 24.3-26.1) months. Perception of participants regarding the appearance of pharmacy was positive while that regarding the pharmacists' efforts to solve patients' medication related problems was negative. The participants' rating of satisfaction with the waiting time to access pharmaceutical services was negative; the satisfaction decreases with increasing waiting time. However, the satisfaction with the overall quality of pharmaceutical services received was rated as positive; 90.0 % reported that they got the kind of pharmaceutical services they wanted; 98.2 % would come back to the pharmacy if they were to seek help again and would recommend services to others. The level of satisfaction was found to be associated with

  10. Potential Drug-Drug Interactions among Patients prescriptions collected from Medicine Out-patient Setting. (United States)

    Farooqui, Riffat; Hoor, Talea; Karim, Nasim; Muneer, Mehtab


    To identify and evaluate the frequency, severity, mechanism and common pairs of drug-drug interactions (DDIs) in prescriptions by consultants in medicine outpatient department. This cross sectional descriptive study was done by Pharmacology department of Bahria University Medical & Dental College (BUMDC) in medicine outpatient department (OPD) of a private hospital in Karachi from December 2015 to January 2016. A total of 220 prescriptions written by consultants were collected. Medications given with patient's diagnosis were recorded. Drugs were analyzed for interactions by utilizing Medscape drug interaction checker, checker and stockley`s drug interactions index. Two hundred eleven prescriptions were selected while remaining were excluded from the study because of unavailability of the prescribed drugs in the drug interaction checkers. In 211 prescriptions, two common diagnoses were diabetes mellitus (28.43%) and hypertension (27.96%). A total of 978 medications were given. Mean number of medications per prescription was 4.6. A total of 369 drug-drug interactions were identified in 211 prescriptions (175%). They were serious 4.33%, significant 66.12% and minor 29.53%. Pharmacokinetic and pharmacodynamic interactions were 37.94% and 51.21% respectively while 10.84% had unknown mechanism. Number wise common pairs of DDIs were Omeprazole-Losartan (S), Gabapentine- Acetaminophen (M), Losartan-Diclofenac (S). The frequency of DDIs is found to be too high in prescriptions of consultants from medicine OPD of a private hospital in Karachi. Significant drug-drug interactions were more and mostly caused by Pharmacodynamic mechanism. Number wise evaluation showed three common pairs of drugs involved in interactions.

  11. Single port laparoscopic colorectal surgery in debilitated patients and in the urgent setting.

    LENUS (Irish Health Repository)

    Moftah, M


    Single port laparoscopy is a relatively new niche in the expanding spectrum of minimal access surgery for colorectal disease. To date the published experience has predominantly focused on planned operations for neoplasia in the elective setting. It seems probable however that the benefits of minimal abdominal wounding will be greatest among those patients with the highest risk of impaired wound healing. Combining this with the impression of improved cosmesis suggests that (the mostly young) patients with inflammatory bowel disease needing urgent operation are the most likely to appreciate and benefit from the extraoperative effort. The extension of single port surgery to the acute setting and for debilitated individuals is therefore a likely next step advance in broadening the category of patients for whom it represents a real benefit and ultimately aid in focusing by selection the subgroups for whom this technique is best suited and most appropriate. We describe here our approach (including routine use of a surgical glove port) to patients presenting for urgent colorectal operation for benign disease. As provision of specialized approaches regardless of timing or mode of presentation is a defining component of any specialty service, this concept will soon be more fully elucidated and established.

  12. Assessment of patient satisfaction with pain management in small community inpatient and outpatient settings. (United States)

    Corizzo, C C; Baker, M C; Henkelmann, G C


    To describe patient outcomes (e.g., pain intensity and relief, satisfaction, expectations) and analgesic practices of healthcare providers for inpatients and outpatients in community hospital settings. Descriptive, correlational, and random sampling. Three community-based institutions in southeast Louisiana. 114 inpatients and outpatients with cancer-related or acute postoperative pain. Inpatients (n = 68) mostly were women and younger than 60 years of age. Outpatients (n = 46) mostly were men and older than 60 years of age. Both groups were predominantly well-educated and Caucasian. Subjects completed a modified version of the American Pain Society's Patient Satisfaction Survey. Researchers completed a chart audit tool reviewing analgesic prescriptive and administrative practices. Weak to moderately strong correlations existed for the relationships between the satisfaction variables and the pain intensity, pain relief, and expectation variables for all subjects. Satisfaction with current pain intensity was correlated most strongly with pain intensity and relief scores. Higher pain intensity and relief were related to lower satisfaction with current pain intensity. Regardless of setting or pain type, subjects experienced significant amounts of pain during a 24-hour period. Patient expectations for experiencing high levels of pain were realized, but expectations for significant pain relief were not. Institutional pain management programs that approach pain from a multidimensional perspective need to be developed. Continued education for healthcare professionals and patients is a vital part of this process.

  13. Interfaces and ventilator settings for long-term noninvasive ventilation in COPD patients

    Directory of Open Access Journals (Sweden)

    Callegari J


    Full Text Available Jens Callegari,1 Friederike Sophie Magnet,1 Steven Taubner,1 Melanie Berger,2 Sarah Bettina Schwarz,1 Wolfram Windisch,1 Jan Hendrik Storre3,4 1Department of Pneumology, Cologne-Merheim Hospital, Kliniken der Stadt Koeln, Witten/Herdecke University Hospital, 2Department of Pneumology, Malteser Hospital St Hildegardis, Cologne, 3Department of Pneumology, University Medical Hospital, Freiburg, 4Department of Intensive Care, Sleep Medicine and Mechanical Ventilation, Asklepios Fachkliniken Munich-Gauting, Gauting, Germany Introduction: The establishment of high-intensity (HI noninvasive ventilation (NIV that targets elevated PaCO2 has led to an increase in the use of long-term NIV to treat patients with chronic hypercapnic COPD. However, the role of the ventilation interface, especially in more aggressive ventilation strategies, has not been systematically assessed.Methods: Ventilator settings and NIV compliance were assessed in this prospective cross-sectional monocentric cohort study of COPD patients with pre-existing NIV. Daytime ­arterialized blood gas analyses and lung function testing were also performed. The primary end point was the distribution among study patients of interfaces (full-face masks [FFMs] vs nasal masks [NMs] in a real-life setting.Results: The majority of the 123 patients studied used an FFM (77%, while 23% used an NM. Ventilation settings were as follows: mean ± standard deviation (SD inspiratory positive airway pressure (IPAP was 23.2±4.6 mbar and mean ± SD breathing rate was 16.7±2.4/minute. Pressure support ventilation (PSV mode was used in 52.8% of patients, while assisted pressure-controlled ventilation (aPCV was used in 47.2% of patients. Higher IPAP levels were associated with an increased use of FFMs (IPAP <21 mbar: 73% vs IPAP >25 mbar: 84%. Mean compliance was 6.5 hours/day, with no differences between FFM (6.4 hours/day and NM (6.7 hours/day users. PaCO2 assessment of ventilation quality revealed

  14. Horticulture for Secondary Level Handicapped Adolescents: The Cherokee County Model. (United States)

    Frith, Greg H.; And Others


    The Cherokee County (Alabama) horticulture training program provides 40 mildly mentally retarded adolescents with vocational training in a marketable skills. The broad spectrum of vocational skills makes horticulture ideal for the handicapped. (DB)

  15. Handicaps for the large scale commercial application of micropropagation.

    NARCIS (Netherlands)

    Pierik, R.L.M.


    In the last 10 years micropropagation has shown a spectacular development. However, at present the widespread use of micropropagation is handicapped by the following facts: Frequently mutations occur, particularly when applying the adventitious bud technique and callus systems. Basic knowledge

  16. Sexuality and the Developmentally Handicapped: Health Education Strategies. (United States)

    Martin, Mary-Lou; Forchuk, Cheryl


    The article describes a sex education program for small groups of developmentally handicapped adolescents and young adults which includes information on and discussion of body parts, acceptable social behavior, assertiveness, birth control, and sexually transmitted diseases. (Author/JW)

  17. Personal, interpersonal, and situational influences on behavioral self-handicapping. (United States)

    Brown, Christina M; Kimble, Charles E


    This study explored the combined effects of personal factors (participant sex), interpersonal factors (experimenter sex), and situational factors (performance feedback) on two forms of behavioral self-handicapping. Participants received non-contingent success or failure feedback concerning their performance on a novel ability and were given the opportunity to self-handicap before performing again. Behavioral self-handicapping took the form of (a) exerting less practice effort (practice) or (b) choosing a performance-debilitating tape (choice). Men practiced least after failure feedback and chose a debilitating tape if they were interacting with a female experimenter. Generally, across all participants in both choice and practice conditions, high performance concern and the presence of a male experimenter led to the most self-handicapping. Results are interpreted in terms of self-presentational concerns that emphasize a desire to impress or an awareness of the female or male experimenter's acceptance of self-handicappers.

  18. Progressively engaging: constructing nurse, patient, and family relationships in acute care settings. (United States)

    Segaric, Cheryl Ann; Hall, Wendy A


    In this grounded theory study, informed by symbolic interactionism, we explain how nurses, patients, and family members construct relationships in acute care settings, including managing effects of work environments. We recruited participants from 10 acute care units across four community hospitals in a Western Canadian city. From 33 hr of participant observation and 40 interviews with 13 nurses, 17 patients, and 10 family members, we constructed the basic social-psychological process of progressively engaging. Nurses, patients, and family members approached constructing relationships through levels of engagement, ranging from perspectives about "just doing the job" to "doing the job with heart." Progressively engaging involved three stages: focusing on tasks, getting acquainted, and building rapport. Workplace conditions and personal factors contributed or detracted from participants' movement through the stages of the process; with higher levels of engagement, participants experienced greater satisfaction and cooperation. Progressively engaging provides direction for how all participants in care can invest in relationships. © The Author(s) 2014.

  19. Patient Communication in Health Care Settings: new Opportunities for Augmentative and Alternative Communication. (United States)

    Blackstone, Sarah W; Pressman, Harvey


    Delivering quality health care requires effective communication between health care providers and their patients. In this article, we call on augmentative and alternative communication (AAC) practitioners to offer their knowledge and skills in support of a broader range of patients who confront communication challenges in health care settings. We also provide ideas and examples about ways to prepare people with complex communication needs for the inevitable medical encounters that they will face. We argue that AAC practitioners, educators, and researchers have a unique role to play, important expertise to share, and an extraordinary opportunity to advance the profession, while positively affecting patient outcomes across the health care continuum for a large number of people.

  20. Diagnostic criteria for CRPS I: differences between patient profiles using three different diagnostic sets. (United States)

    Perez, Roberto S G M; Collins, Susan; Marinus, Johan; Zuurmond, Wouter W A; de Lange, Jaap J


    Complex Regional Pain Syndrome type I (CRPS I) is an illness which usually occurs due to major or minor tissue injury to the extremities. Because a unique pathophysiological mechanism for CRPS I has not yet been established, the diagnosis is based on observation and measurement of clinical symptoms and signs. In this study, a comparison was made between three sets of diagnostic criteria (the IASP, Bruehl et al. and Veldman et al.) based on patient reports and physicians' assessments of signs and symptoms associated with CRPS I, in 372 outpatients suspected of having CRPS I. Agreement between CRPS I diagnosis among the three sets was poor (kappa-range: 0.29-0.42), leading to positive CRPS I diagnoses according to Veldman et al.'s criteria in 218 cases (59%), according to the IASP in 268 cases (72%), and according to Bruehl et al. in 129 cases (35%). Significant differences in patient profiles were found between the diagnostic sets for the number of patients reporting continuing disproportionate pain, larger area affected than the initial trauma (both pCRPS I were found for reported hyperesthesia (SE+SP:165%), allodynia (160%), observed color asymmetry (162%), hyperesthesia (157%), temperature asymmetry (154%) and edema (152%). The lack of agreement between the different diagnostic sets for CRPS I and the different clinical profiles that result from it may lead to different therapeutic and study populations, hampering adequate treatment and scientific development for this illness. We propose explicit reference to diagnostic criteria used in studies, and registration in trials of a broad variety of CRPS I features, as used in this study, to make subgroup phenotyping and post hoc analyses based on different diagnostic criteria possible.

  1. Screening of patients with diabetes mellitus for tuberculosis in community health settings in China. (United States)

    Lin, Yan; Innes, Anh; Xu, Lin; Li, Ling; Chen, Jinou; Hou, Jinglong; Mi, Fengling; Kang, Wanli; Harries, Anthony D


    To assess the feasibility and results of screening of patients with DM for TB in routine community health services in China. Agreement on how to screen patients with DM for TB and monitor and record the results was obtained at a stakeholders meeting. Subsequent training was carried out for staff at 10 community health centres, with activities implemented from June 2013 to April 2014. Patients with DM were screened for TB at each clinical visit using a symptom-based enquiry, and those positive to any symptom were referred to the TB clinic for TB investigation. A total of 2942 patients with DM visited these ten clinics. All patients received at least one screening for TB. Two patients were identified as already known to have TB. In total, 278 (9.5% of those screened) who had positive TB symptoms were referred for TB investigations and 209 arrived at the TB centre or underwent a chest radiograph for TB investigation. One patient (0.5% of those investigated) was newly diagnosed with active TB and was started on anti-TB treatment. The TB case notification rate of those screened was 102/100,000. This pilot project shows it is feasible to carry out TB screening among patients with DM in community settings, but further work is needed to better characterise patients with DM at higher risk of TB. This may require a more targeted approach focused on high-risk groups such as those with untreated DM or poorly controlled hyperglycaemia. © 2015 John Wiley & Sons Ltd.

  2. Evaluation of pharmacists' educational and counselling impact on patients' clinical outcomes in a diabetic setting

    Directory of Open Access Journals (Sweden)

    Winifred Aitalegbe Ojieabu


    Full Text Available Background: Nigeria had the highest number of people living with diabetes mellitus in the African region in year 2013. Previous researchers have found that patients with knowledge of their diseases including their treatment methods have a high likelihood to succeed in managing the disease conditions. Many pharmaceutical care programmes which have been successfully applied in various countries to enhance clinical outcomes and health-related quality of life are not very common in Nigeria. Objective: This study was to evaluate pharmacist's educational and counselling impact on diabetic patients' outcomes in a diabetic setting. Materials and Methods: The 4-month randomised controlled study involved 150 elderly Type 2 diabetic patients. Sociodemographic and clinical parameters were measured. We educated and counselled the 75 patients in our intervention group at least four times during the study period, but the control group was deprived of the pharmacist's intervention. Results: Female to male participants was in the ratio of 9:6 and 9:5 in both control and intervention groups, respectively. Majority (>40% of the patients in both groups had primary education. Baseline and 4-month mean fasting blood sugar in the control group was 162.2 ± 69.1 and 159.9 ± 57.2, respectively (P = 0.825, whereas the intervention group had 156.7 ± 30.5 and 131.8 ± 40.4, respectively (P < 0.001. Mean systolic blood pressure in both groups was 146.4 ± 13.9 and 133.8 ± 18.5 (P < 0.001, respectively. Adherence levels to medication taking in both groups were 42.7%:94.7%, respectively (P = 0.001. Conclusion: This study encourages the inclusion of clinical pharmacists into multidisciplinary healthcare groups in hospital and clinic settings as well as incorporation of this type of intervention into diabetic management programmes for optimal patients' outcomes.

  3. Achievement goals, self-handicapping, and performance: a 2 x 2 achievement goal perspective. (United States)

    Ntoumanis, Nikos; Thøgersen-Ntoumani, Cecilie; Smith, Alison L


    Elliot and colleagues (2006) examined the effects of experimentally induced achievement goals, proposed by the trichotomous model, on self-handicapping and performance in physical education. Our study replicated and extended the work of Elliot et al. by experimentally promoting all four goals proposed by the 2 x 2 model (Elliot & McGregor, 2001), measuring the participants' own situational achievement goals, using a relatively novel task, and testing the participants in a group setting. We used a randomized experimental design with four conditions that aimed to induce one of the four goals advanced by the 2 x 2 model. The participants (n = 138) were undergraduates who engaged in a dart-throwing task. The results pertaining to self-handicapping partly replicated Elliot and colleagues' findings by showing that experimentally promoted performance-avoidance goals resulted in less practice. In contrast, the promotion of mastery-avoidance goals did not result in less practice compared with either of the approach goals. Dart-throwing performance did not differ among the four goal conditions. Personal achievement goals did not moderate the effects of experimentally induced goals on self-handicapping and performance. The extent to which mastery-avoidance goals are maladaptive is discussed, as well as the interplay between personal and experimentally induced goals.

  4. Effect of maternal education on the rate of childhood handicap. (United States)

    Shawky, S; Milaat, W M; Abalkhail, B A; Soliman, N K


    The objectives of this study were to determine the relation between maternal education and various maternal risk factors, identify the impact of maternal education on the risk of childhood handicap and estimate the proportion of childhood handicap that can be prevented by maternal education. Data was collected from all married women attending the two major maternity and child hospitals in Jeddah during April 1999. Women with at least one living child were interviewed for sociodemographic factors and having at least one handicapped child. The risk of having a handicapped child and the population attributable risk percent were calculated. Some potential risk factors are dominant in our society as approximately 30% of women did not attend school and 84% did not work. Consanguineous marriages accounted for about 43%. Pre-marriage counseling was limited as only 10% of women counseled before marriage. The proportion of unemployment and consanguineous marriages decreased significantly by increase in maternal education level. Conversely, the proportion of women reporting pre-marriage counseling increased significantly by increase in maternal education level. Approximately, 7% of women reported having at least one handicapped child. The risk of having a handicapped child showed a significant sharp decline with increase in maternal education level. At least 25% of childhood handicap can be prevented by achieving female primary education and up to half of cases can be prevented if mothers finish their intermediate education. Female education plays a major role in child health. The results of this study suggest investment in female education, which would have substantial positive effects in reducing incidence of childhood handicap in Jeddah.

  5. Self-Handicapping and Its Impact on Mental Health

    Directory of Open Access Journals (Sweden)

    Yeter Sinem Uzar Ozcetin


    Full Text Available Self handicapping is characterized by experiencing anxiety at succeeding a mission although the person has the capacity to fulfill the assignment or duty. It describes one's showing tendency to link own failures to problems in own performance instead of own abilities to protect oneself from the possibility of failure. When individuals care about performance much but doubt about success, they display self-handicapping strategies to protect their self. Self-handicappers try to protect their self by internalizing successes and externalizing failures. This strategies help them feel well in both successes and failures. Self-handicapping becomes a trait of personality in time and the individual begins to use it continuously as a negative coping mechanism to protect his/her self and to avoid failures. These actions eliminates the capability of rational thinking and prevents solution of the problems as a result of irrational interpretations. Self-handicapping causes the decrease of life satisfaction and motivation, and causes the increase of maladaptation, negative mood, somatic symptoms and alcohol-drug abuse. As a conclusion, self-handicapping hinders performance and this negative performance influences adaptation and psychological well-being. The most essential approach to prevent occurrence of self-handicapping behaviours is empowerment of the self. [Psikiyatride Guncel Yaklasimlar - Current Approaches in Psychiatry 2016; 8(2: 145-154

  6. [Physical handicapped, economic practices and matrimonial strategies in Senegal]. (United States)

    Fassin, D


    Social relations around the handicapped are generally presented in terms of economic dependence and social inadaptation. This point of view leads to give greater importance, especially in Africa, to studying the way in which group and society help the physically or mentally ill. Actually, this approach does not give a complete account about the real situation of the handicapped in social relations of production and reproduction. From a series of in-depth interviews conducted in handicapped families of the suburbs of Dakar, two aspects are analyzed: the economic role of the handicapped, through the circulation of the product of his begging in his household or through the exploitation of his work as apprentice in a workshop; and his value on the marriage market, where invalid persons are given without dowry if they are women, and must pay a much more important amount if they are men. The social situation of the handicapped thus is not only a matter of assistance or charity, but as well of strategies that the handicapped and above all his circle implement in order to take advantage of the stigma or on the contrary try to erase it.

  7. A managed clinical network for cardiac services: set-up, operation and impact on patient care

    Directory of Open Access Journals (Sweden)

    Karen E. Hamilton


    Full Text Available Purpose: To investigate the set up and operation of a Managed Clinical Network for cardiac services and assess its impact on patient care. Methods: This single case study used process evaluation with observational before and after comparison of indicators of quality of care and costs. The study was conducted in Dumfries and Galloway, Scotland and used a three-level framework. Process evaluation of the network set-up and operation through a documentary review of minutes; guidelines and protocols; transcripts of fourteen semi-structured interviews with health service personnel including senior managers, general practitioners, nurses, cardiologists and members of the public. Outcome evaluation of the impact of the network through interrupted time series analysis of clinical data of 202 patients aged less than 76 years admitted to hospital with a confirmed myocardial infarction one-year pre and one-year post, the establishment of the network. The main outcome measures were differences between indicators of quality of care targeted by network protocols. Economic evaluation of the transaction costs of the set-up and operation of the network and the resource costs of the clinical care of the 202 myocardial infarction patients from the time of hospital admission to 6 months post discharge through interrupted time series analysis. The outcome measure was different in National Health Service resource use. Results: Despite early difficulties, the network was successful in bringing together clinicians, patients and managers to redesign services, exhibiting most features of good network management. The role of the energetic lead clinician was crucial, but the network took time to develop and ‘bed down’. Its primary “modus operand” was the development of a myocardial infarction pathway and associated protocols. Of sixteen clinical care indicators, two improved significantly following the launch of the network and nine showed improvements, which were

  8. A managed clinical network for cardiac services: set-up, operation and impact on patient care. (United States)

    Stc Hamilton, Karen E; Sullivan, Frank M; Donnan, Peter T; Taylor, Rex; Ikenwilo, Divine; Scott, Anthony; Baker, Chris; Wyke, Sally


    To investigate the set up and operation of a Managed Clinical Network for cardiac services and assess its impact on patient care. This single case study used process evaluation with observational before and after comparison of indicators of quality of care and costs. The study was conducted in Dumfries and Galloway, Scotland and used a three-level framework. Process evaluation of the network set-up and operation through a documentary review of minutes; guidelines and protocols; transcripts of fourteen semi-structured interviews with health service personnel including senior managers, general practitioners, nurses, cardiologists and members of the public. Outcome evaluation of the impact of the network through interrupted time series analysis of clinical data of 202 patients aged less than 76 years admitted to hospital with a confirmed myocardial infarction one-year pre and one-year post, the establishment of the network. The main outcome measures were differences between indicators of quality of care targeted by network protocols. Economic evaluation of the transaction costs of the set-up and operation of the network and the resource costs of the clinical care of the 202 myocardial infarction patients from the time of hospital admission to 6 months post discharge through interrupted time series analysis. The outcome measure was different in National Health Service resource use. Despite early difficulties, the network was successful in bringing together clinicians, patients and managers to redesign services, exhibiting most features of good network management. The role of the energetic lead clinician was crucial, but the network took time to develop and 'bed down'. Its primary "modus operand" was the development of a myocardial infarction pathway and associated protocols. Of sixteen clinical care indicators, two improved significantly following the launch of the network and nine showed improvements, which were not statistically significant. There was no difference

  9. Patient safety culture in China: a case study in an outpatient setting in Beijing. (United States)

    Liu, Chaojie; Liu, Weiwei; Wang, Yuanyuan; Zhang, Zhihong; Wang, Peng


    To investigate the patient safety culture in an outpatient setting in Beijing and explore the meaning and implications of the safety culture from the perspective of health workers and patients. A mixed methods approach involving a questionnaire survey and in-depth interviews was adopted. Among the 410 invited staff members, 318 completed the Hospital Survey of Patient Safety Culture (HSOPC). Patient safety culture was described using 12 subscale scores. Inter-subscale correlation analysis, ANOVA and stepwise multivariate regression analyses were performed to identify the determinants of the patient safety culture scores. Interviewees included 22 patients selected through opportunity sampling and 27 staff members selected through purposive sampling. The interview data were analysed thematically. The survey respondents perceived high levels of unsafe care but had personally reported few events. Lack of 'communication openness' was identified as a major safety culture problem, and a perception of 'penalty' was the greatest barrier to the encouragement of error reporting. Cohesive 'teamwork within units', while found to be an area of strength, conversely served as a protective and defensive mechanism for medical practice. Low levels of trust between providers and consumers and lack of management support constituted an obstacle to building a positive patient safety culture. This study in China demonstrates that a punitive approach to error is still widespread despite increasing awareness of unsafe care, and managers have been slow in acknowledging the importance of building a positive patient safety culture. Strong 'teamwork within units', a common area of strength, could fuel the concealment of errors. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to

  10. Outcome of small cell lung cancer (SCLC) patients with brain metastases in a routine clinical setting

    International Nuclear Information System (INIS)

    Lekic, Mirko; Kovac, Viljem; Triller, Nadja; Knez, Lea; Sadikov, Aleksander; Cufer, Tanja


    chemotherapy. Median overall survival (OS) of 34 patients with brain metastases was 9 months (95% CI 6–12) while OS of 153 patients with metastases in other locations was 11 months (95% CI 10–12); the difference did not reach the level of significance (p = 0.62). As expected, the OS of patients without metastases at the time of primary diagnosis turned out to be significantly better compared to the survival of patients with either brain or other location metastases at the primary diagnosis (15 months vs 9 and 11 months, respectively, p < 0.001). In our investigated population, the prognosis of patients with extensive SCLS with brain metastases at the primary diagnosis treated with chemotherapy and WBRT was not significantly worse compared to the prognosis of patients with extensive SCLC and metastases outside the brain. In extensive SCLC brain metastases were not a negative prognostic factor per se if the patients were able to be treated appropriately. However, the survival rates of extensive SCLC with or without brain metastases remained poor and novel treatment approaches are needed. The major strength of this study is that it has been done on a population of patients treated in a routine clinical setting

  11. Data acquisition for a patient-directed intervention protocol in the dynamic intensive care unit setting. (United States)

    Chlan, Linda; Patterson, Robert P; Heiderscheit, Annie


    Methods to easily, accurately, and efficiently obtain data in an ICU-based clinical trial can be challenging in this high-tech setting. Patient medical status and the dynamic nature of this clinical setting further complicate data collection. The purpose of this paper is to describe the modifications of commercially available headphones and the application of a data logging device to capture frequency and length of protocol use (music listening or headphones only for noise cancellation) without burdening participants or busy ICU nurses. With the automatic capture of protocol use by research participants, there have been no instances of lost data for this clinical trial. Copyright © 2011 Elsevier Inc. All rights reserved.

  12. Use of endoscopy in diagnosis and management of patients with dysphagia in an African setting. (United States)

    Mudawi, H M Y; Mahmoud, A O A; El Tahir, M A; Suliman, S H; Ibrahim, S Z


    The objectives of this study were to define the utility of esophagogastroduodenoscopy in the diagnosis and management of patients presenting with dysphagia and to determine the relative incidence of the various causes of dysphagia in Sudan. This is a prospective, cross-sectional, descriptive, hospital-based study carried out at the endoscopy unit of Soba University Hospital, Khartoum, Sudan. All patients complaining of dysphagia underwent upper gastrointestinal endoscopy with therapeutic intervention when necessary. A total of 114 patients were enrolled in the study, with a mean age of 47 years SD +/- 19 and a male to female ratio of 1 : 1.04. A benign condition was diagnosed in 56% of the cases; this included esophageal strictures in 21% of the cases and achalasia in 14%. Malignant causes were mainly due to esophageal cancer (40.4%) and cancer of the stomach cardia (3.5%). Therapeutic intervention was attempted in 83% of the cases. Risk factors predictive of a malignant etiology were age over 40 years (P dysphagia lasting between 1 month and 1 year (P endoscopy in our African setting is an accurate and useful investigation in the diagnosis and management of patients presenting with dysphagia. Patients over the age of 40 years presenting with dysphagia and weight loss are more likely to have a neoplastic disease and should be referred for urgent endoscopy.

  13. Assessment of Patient Safety Culture in Primary Health Care Settings in Kuwait

    Directory of Open Access Journals (Sweden)

    Maha Mohamed Ghobashi


    Full Text Available Background Patient safety is critical component of health care quality. We aimed to assess the awareness of primary healthcare staff members about patient safety culture and explore the areas of deficiency and opportunities for improvement concerning this issue.Methods: This descriptive cross sectional study surveyed 369 staff members in four primary healthcare centers in Kuwait using self-administered “Hospital Survey on Patient Safety Culture” adopted questionnaire. The total number of respondents was 276 participants (response rate = 74.79%.Results: Five safety dimensions with lowest positivity (less than 50% were identified and these are; the non – punitive response to errors, frequency of event reporting, staffing, communication openness, center handoffs and transitions with the following percentages of positivity 24%, 32%, 41%, 45% and 47% respectively. The dimensions of highest positivity were teamwork within the center’s units (82% and organizational learning (75%.Conclusion: Patient safety culture in primary healthcare settings in Kuwait is not as strong as improvements for the provision of safe health care. Well-designed patient safety initiatives are needed to be integrated with organizational policies, particularly the pressing need to address the bioethical component of medical errors and their disclosure, communication openness and emotional issues related to them and investing the bright areas of skillful organizational learning and strong team working attitudes.    

  14. Implementing oral care to reduce aspiration pneumonia amongst patients with dysphagia in a South African setting

    Directory of Open Access Journals (Sweden)

    Jaishika Seedat


    Full Text Available Oral care is a crucial routine for patients with dysphagia that, when completed routinely, can prevent the development of aspiration pneumonia. There is no standardised protocol for oral care within government hospitals in South Africa. This study aimed to investigate the outcome of an oral care protocol. Participants were patients with oropharyngeal dysphagia, with either stroke or traumatic brain injury as the underlying medical pathology, and nurses. All participants were recruited from one tertiary level government hospital in Gauteng, South Africa. 139 nurses participated in the study and received training on the oral care protocol. There were two groups of participants with oropharyngeal dysphagia. Group one (study group, n = 23 was recruited by consecutive sampling, received regular oral care and were not restricted from drinking water; however, all other liquids were restricted. Group two (comparison group, n = 23 was recruited via a retrospective record review, received inconsistent oral care and were placed on thickened liquids or liquid restricted diets. Results showed that a regimen of regular oral care and free water provision when combined with dysphagia intervention did prevent aspiration pneumonia in patients with oropharyngeal dysphagia. The article highlights two key findings: that regular and routine oral care is manageable within an acute government hospital context and a strict routine of oral care can reduce aspiration pneumonia in patients with oropharyngeal dysphagia. An implication from these findings is confirmation that teamwork in acute care settings in developing contexts must be prioritised to improve dysphagia management and patient prognosis.

  15. Evaluating the use of the Cleo 90 infusion set for patients on a palliative care unit. (United States)

    Schneider, Michael; Hoffmann, Martin; Lorenzl, Stefan


    Although the use of subcutaneous infusion is common in palliative care, problems can occur. Normally, butterfly needles are used; however, there are occasional issues with patients being able to walk around or with restless patients who suffer from delirium. In these cases, needles often dislocate; therefore, a small observational study was undertaken to evaluate the use of the Cleo 90 infusion set. The use of this needle system has been well established in diabetic patients who require continuous subcutaneous infusion of insulin, but has never been tested in a wider range of patients with other medications. In this 6-month study, 45 patients were identified for subcutaneous infusion and a total of 112 needles were used for this study, since we initially changed each site after 2 days to control the local site for adverse reactions. We have not observed any complications with drug combinations delivered via the attached tube and the needle, and have used up to five different drugs mixed together in a single syringe. Needles could be used for a mean time of 5 +/- 2 days (range 2-12 days). Local site reactions have been observed only with sodium chloride infusions, which were not delivered via a pump system. Reddening and induration of the skin occurred, but they were reversible after removing the needle. As this was a small study in only one unit, without standardization the results can only be observational. However, it has shown, for the first time, that the Cleo 90 needle can be safe and comfortable.

  16. The development of a patient-specific method for physiotherapy goal setting: a user-centered design. (United States)

    Stevens, Anita; Köke, Albère; van der Weijden, Trudy; Beurskens, Anna


    To deliver client-centered care, physiotherapists need to identify the patients' individual treatment goals. However, practical tools for involving patients in goal setting are lacking. The purpose of this study was to improve the frequently used Patient-Specific Complaints instrument in Dutch physiotherapy, and to develop it into a feasible method to improve physiotherapy goal setting. An iterative user-centered design was conducted in co-creation with the physiotherapists and patients, in three phases. Their needs and preferences were identified by means of group meetings and questionnaires. The new method was tested in several field tests in physiotherapy practices. Four main objectives for improvement were formulated: clear instructions for the administration procedure, targeted use across the physiotherapy process, client-activating communication skills, and a client-centered attitude of the physiotherapist. A theoretical goal-setting framework and elements of shared decision making were integrated into the new-called, Patient-Specific Goal-setting method, together with a practical training course. The user-centered approach resulted in a goal-setting method that is fully integrated in the physiotherapy process. The new goal-setting method contributes to a more structured approach to goal setting and enables patient participation and goal-oriented physiotherapy. Before large-scale implementation, its feasibility in physiotherapy practice needs to be investigated. Implications for rehabilitation Involving patients and physiotherapists in the development and testing of a goal-setting method, increases the likelihood of its feasibility in practice. The integration of a goal-setting method into the physiotherapy process offers the opportunity to focus more fully on the patient's goals. Patients should be informed about the aim of every step of the goal-setting process in order to increase their awareness and involvement. Training physiotherapists to use a patient

  17. Job Resources, Physician Work Engagement, and Patient Care Experience in an Academic Medical Setting. (United States)

    Scheepers, Renée A; Lases, Lenny S S; Arah, Onyebuchi A; Heineman, Maas Jan; Lombarts, Kiki M J M H


    Physician work engagement is associated with better work performance and fewer medical errors; however, whether work-engaged physicians perform better from the patient perspective is unknown. Although availability of job resources (autonomy, colleague support, participation in decision making, opportunities for learning) bolster work engagement, this relationship is understudied among physicians. This study investigated associations of physician work engagement with patient care experience and job resources in an academic setting. The authors collected patient care experience evaluations, using nine validated items from the Dutch Consumer Quality index in two academic hospitals (April 2014 to April 2015). Physicians reported job resources and work engagement using, respectively, the validated Questionnaire on Experience and Evaluation of Work and the Utrecht Work Engagement Scale. The authors conducted multivariate adjusted mixed linear model and linear regression analyses. Of the 9,802 eligible patients and 238 eligible physicians, respectively, 4,573 (47%) and 185 (78%) participated. Physician work engagement was not associated with patient care experience (B = 0.01; 95% confidence interval [CI] = -0.02 to 0.03; P = .669). However, learning opportunities (B = 0.28; 95% CI = 0.05 to 0.52; P = .019) and autonomy (B = 0.31; 95% CI = 0.10 to 0.51; P = .004) were positively associated with work engagement. Higher physician work engagement did not translate into better patient care experience. Patient experience may benefit from physicians who deliver stable quality under varying levels of work engagement. From the physicians' perspective, autonomy and learning opportunities could safeguard their work engagement.

  18. Humor as a Communication Strategy in Provider-Patient Communication in a Chronic Care Setting. (United States)

    Schöpf, Andrea C; Martin, Gillian S; Keating, Mary A


    Humor is a potential communication strategy to accomplish various and potentially conflicting consultation goals. We investigated humor use and its reception in diabetes consultations by analyzing how and why humor emerges and its impact on the interaction. We did this by using an interactional sociolinguistics approach. We recorded 50 consultations in an Irish diabetes setting. Analysis of the humor events drew on framework analysis and on concepts from Conversation Analysis and pragmatics. The study also comprised interviews using tape-assisted recall. We identified 10 humor functions and two umbrella functions. A key finding is that most humor is relationship-protecting humor initiated by patients, that is, they voice serious messages and deal with emotional issues through humor. Our findings imply that patients' and providers' awareness of indirect communication strategies needs to be increased. We also recommend that researchers employ varied methods to adequately capture the interactive nature of humor.

  19. Capnography as a tool to detect metabolic changes in patients cared for in the emergency setting

    Directory of Open Access Journals (Sweden)

    Francisco José Cereceda-Sánchez

    Full Text Available ABSTRACT Objective: to evaluate the usefulness of capnography for the detection of metabolic changes in spontaneous breathing patients, in the emergency and intensive care settings. Methods: in-depth and structured bibliographical search in the databases EBSCOhost, Virtual Health Library, PubMed, Cochrane Library, among others, identifying studies that assessed the relationship between capnography values and the variables involved in blood acid-base balance. Results: 19 studies were found, two were reviews and 17 were observational studies. In nine studies, capnography values were correlated with carbon dioxide (CO2, eight with bicarbonate (HCO3, three with lactate, and four with blood pH. Conclusions: most studies have found a good correlation between capnography values and blood biomarkers, suggesting the usefulness of this parameter to detect patients at risk of severe metabolic change, in a fast, economical and accurate way.

  20. Clinical assessment of prognostic factors for long-term pain and handicap after whiplash injury: a 1-year prospective study

    DEFF Research Database (Denmark)

    Kasch, H; Qerama, E; Kongsted, Alice


    BACKGROUND AND PURPOSE: Physical mechanisms are the possible factors involved in the development and maintenance of long-term handicaps after acute whiplash injury. This study prospectively examined the role of active neck mobility, cervical and extra-cervical pains, as well as non-painful...... of non-painful complaints and active neck mobility [active cervical range of motion (CROM)]. All 458 high-risk patients and 230 low-risk patients received mailed questionnaires after 3, 6 and 12 months. Two examiners examined all high-risk patients (n = 458) and 41 consecutive low-risk patients at median...... complaints after a whiplash injury as predictors for subsequent handicap. METHODS: Consecutive acute whiplash patients (n = 688) were interviewed and examined by a study nurse after the median of 5 days after injury, and divided into a high- or a low-risk group by an algorithm based on pain intensity, number...

  1. Detection of mental disorders with the Patient Health Questionnaire in primary care settings in Nigeria

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    Michael O. Olatawura


    Full Text Available Mental disorders lead to difficulties in social, occupational and marital relations. Failure to detect mental disorder denies patients potentially effective treatment. This study aimed to assess the prevalence and nature of mental disorders at the primary care settings and the recognition of these disorders by the attending physicians. Over a period of eight weeks, consecutive and consenting patients who attended three randomly selected primary health care facilities in Sagamu Local Government Area of Ogun state were recruited and administered a questionnaire that included a socio-demographic section and Patient Health Questionnaire (PHQ. A total of 412 subjects took part in the study. Subject age ranged from 18-90 years with a mean age of 52.50±21.08 years. One hundred and seventy- six (42.7% of the subjects were males. A total of 120 (29.1% of the subjects had depressive disorder, 100 (24.3% had anxiety disorder, 196 (47.6% somatoform disorder and 104 (25.2% met the criteria for an alcohol related problem. The PHC physicians were only able to diagnose disorders relating to mental health in 52 (12.6% of the subjects. Health and work situations accounted for more than three-quarters of the causes of stress experienced by the subjects. We conclude that there is a high prevalence of mental disorders among patients seen in primary care settings and that a significant proportion of them are not recognized by the primary care physicians. Stress relating to health, work and financial problems is common among primary health care attendees. Physicians in primary health care should be alert to the possibility and the impact of undetected psychiatric morbidity.

  2. Social cognition and interaction training for patients with stable schizophrenia in Chinese community settings. (United States)

    Wang, Yongguang; Roberts, David L; Xu, Baihua; Cao, Rifang; Yan, Min; Jiang, Qiongping


    Accumulated evidence suggests that Social Cognition and Interaction Training (SCIT) is associated with improved performance in social cognition and social skills in patients diagnosed with psychotic disorders. The current study examined the clinical utility of SCIT in patients with schizophrenia in Chinese community settings. Adults with stable schizophrenia were recruited from local community health institutions, and were randomly assigned to SCIT group (n = 22) or a waiting-list control group (n = 17). The SCIT group received the SCIT intervention plus treatment-as-usual, whereas the waiting-list group received only treatment-as-usual during the period of the study. All patients were administered the Chinese versions of the Personal and Social Performance Scale (PSP), Face Emotion Identification Task (FEIT), Eyes task, and Attributional Style Questionnaire (ASQ) at baseline of the SCIT treatment period and at follow-up, 6 months after completion of the 20-week treatment period. Patients in SCIT group showed a significant improvement in the domains of emotion perception, theory of mind, attributional style, and social functioning compared to those in waiting-list group. Findings indicate that SCIT is a feasible and promising method for improving social cognition and social functioning among Chinese outpatients with stable schizophrenia. © 2013 Elsevier Ireland Ltd. All rights reserved.

  3. Patient perspectives of maintaining dignity in Indonesian clinical care settings: A qualitative descriptive study. (United States)

    Asmaningrum, Nurfika; Tsai, Yun-Fang


    To gain an understanding towards the perspectives of hospitalized inpatients in Indonesia regarding maintaining dignity during clinical care. Dignity is a basic human right that is crucial for an individual's well-being. Respect for a person as a valuable human is a concept that is comparable to treating a person with dignity. Maintaining patient's dignity is an ethical goal of nursing care. Nevertheless, the concept is highly dependent on cultural context. This issue has not been well studied in Indonesia. This study used a qualitative descriptive design. Thirty-five participants were recruited by purposive sampling from medical to surgical wards of six public hospitals in Eastern Java, Indonesia. Data were collected in 2016 through individual face-to-face semi-structured interviews. Inductive content analysis was applied to the data. Four major categories which described qualities of nursing care essential for maintaining a patient's dignity in clinical care settings were revealed: (1) responsiveness; (2) respectful nurse-patient relationships; (3) caring characteristics and (4) personalized service. Our findings provide a cultural viewpoint of dignity for care recipients in Indonesia. The findings provide empirical support for linking dignified care and person-centred care principles with regards to cultural sensitivity. Nurses must not only be clinically competent but also culturally competent. The ability to provide culturally competent care is important for nurses as a strategy to maintain patient dignity during hospitalized care. © 2017 John Wiley & Sons Ltd.

  4. Psychometric assessment of the patient activation measure short form (PAM-13) in rural settings. (United States)

    Hung, Man; Carter, Marjorie; Hayden, Candace; Dzierzon, Rhonda; Morales, Jose; Snow, Laverne; Butler, Jorie; Bateman, Kim; Samore, Matthew


    The patient activation measure short form (PAM-13) assesses patients' self-reported health management skills, knowledge, confidence, and motivation. We used item response theory to evaluate the psychometric properties of the PAM-13 utilized in rural settings. A Rasch partial credit model analysis was conducted on the PAM-13 instrument using a sample of 812 rural patients recruited by providers and our research staff. Specially, we examined dimensionality, item fit, and quality of measures, category response curves, and item differential functioning. Convergent and divergent validities were also examined. The PAM-13 instrument has excellent convergent and divergent validities. It is fairly unidimensional, and all items fit the Rasch model well. It has relatively high person and item reliability indices. Majority of the items were free of item differential functioning. There were, however, some issues with ceiling effects. Additionally, there was a lack of responses for category one across all items. Patient activation measure short form (PAM-13) performs well in some areas, but not all. In general, more items need to be added to cover the upper end of the trait. The four response categories of PAM-13 should be collapsed into three.

  5. Risk factors of mortality among dengue patients admitted to a tertiary care setting in Kerala, India

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    Aswath Karunakaran


    Full Text Available Dengue is one of the most serious and rapidly emerging tropical mosquito-borne diseases. The state of Kerala in India is hyperendemic for the disease and is one of the leading states in the reporting of deaths due to dengue. As primary prevention of dengue has had limited success, the prevention of mortality through the identification of risk factors and efficient patient management is of utmost importance. Hence, a record-based case control study was conducted in the Medical College Hospital in Thiruvananthapuram to identify the risk factors of mortality in patients admitted with dengue. Dengue patients over 40 years of age were 9.3 times (95% CI; 1.9–44.4 more likely to die compared with younger patients. The clinical features associated with mortality from dengue were altered sensorium (odds ratio (OR – 156, 95% CI; 12.575–1935.197, abnormal reflexes (OR – 8.5, 95% CI; 1.833–39.421 and edema (OR – 13.22, 95% CI; 2.651–65.951. Mortality was also higher in those patients with co-morbidities such as diabetes mellitus (OR – 26, 95% CI; 2.47–273.674 and hypertension (OR – 44, 95% CI; 6.23–315.499. The independent predictors of mortality were altered sensorium and hypertension. Dengue fever patients with these clinical features and those who are elderly should be more rigorously monitored and promptly referred from lower settings when required to reduce mortality. Keywords: Dengue, Mortality, Risk factors, Kerala, Thiruvananthapuram


    Directory of Open Access Journals (Sweden)

    Hasan KARAL


    Full Text Available Nowadays knowledge and communication technologies are developing rapidly and changing people’s lives. With the help of the developing technologies, people can access knowledge independent of time and place and distance education technologies offer handicapped students a range of opportunities in order that they may access a better level of education. By defining perceptions related to the distance education of a physically handicapped student engaged in a program of synchrony distance education at Karadeniz Technical University to throw a fresh light on this topic. Due to the nature research problem, phenomenology, one of qualitative research patterns, was used in this study which has a qualitative character. In this study, because it was intended to present a handicapped person’s thoughts related to distance education, semi-structured interview, one of qualitative data collection techniques was thought to be the most appropriate data collection instrument. The sampling of the research included the handicapped student receiving courses by synchrony distance education in Karadeniz Technical University, two friends of the student following the same course and the assistant in the course environment. The interviews were recorded with a video camera, a transcript of each of the interviews was prepared and the data was analyzed scientifically. In the light of the research findings, it was decided that the synchrony distance education environment helped handicapped person feel more secure and relaxed and for his handicap not to be noticed by others. In addition, without the lecturers’ feeling of compassion, it presented handicapped student with an opportunity to prove himself. Also, because the courses classes? were recorded in this environment, students could review the content of the class in their own time and this process could be repeated, thus the students could learn at their own speed.

  7. Power and color Doppler ultrasound settings for inflammatory flow: impact on scoring of disease activity in patients with rheumatoid arthritis. (United States)

    Torp-Pedersen, Søren; Christensen, Robin; Szkudlarek, Marcin; Ellegaard, Karen; D'Agostino, Maria Antonietta; Iagnocco, Annamaria; Naredo, Esperanza; Balint, Peter; Wakefield, Richard J; Torp-Pedersen, Arendse; Terslev, Lene


    To determine how settings for power and color Doppler ultrasound sensitivity vary on different high- and intermediate-range ultrasound machines and to evaluate the impact of these changes on Doppler scoring of inflamed joints. Six different types of ultrasound machines were used. On each machine, the factory setting for superficial musculoskeletal scanning was used unchanged for both color and power Doppler modalities. The settings were then adjusted for increased Doppler sensitivity, and these settings were designated study settings. Eleven patients with rheumatoid arthritis (RA) with wrist involvement were scanned on the 6 machines, each with 4 settings, generating 264 Doppler images for scoring and color quantification. Doppler sensitivity was measured with a quantitative assessment of Doppler activity: color fraction. Higher color fraction indicated higher sensitivity. Power Doppler was more sensitive on half of the machines, whereas color Doppler was more sensitive on the other half, using both factory settings and study settings. There was an average increase in Doppler sensitivity, despite modality, of 78% when study settings were applied. Over the 6 machines, 2 Doppler modalities, and 2 settings, the grades for each of 7 of the patients varied between 0 and 3, while the grades for each of the other 4 patients varied between 0 and 2. The effect of using different machines, Doppler modalities, and settings has a considerable influence on the quantification of inflammation by ultrasound in RA patients, and this must be taken into account in multicenter studies. Copyright © 2015 by the American College of Rheumatology.

  8. Novel screen printed electrode set for routine EEG recordings in patients with altered mental status. (United States)

    Myllymaa, Sami; Lepola, Pasi; Hukkanen, Taina; Oun, Andre; Mervaala, Esa; Toyras, Juha; Lappalainen, Reijo; Myllymaa, Katja


    There is a growing need for an easy to use screening tool for the assessment of brain's electrical function in patients with altered mental status (AMS). The purpose of this study is to give a brief overview of the state-of-the-art in electrode technology, and to present a novel sub-hairline electrode set developed in our research group. Screen-printing technology was utilized to construct the electrode set consisting of ten electroencephalography (EEG) electrodes, two electrooculography (EOG) electrodes, two ground electrodes and two reference electrodes. Electrical characteristics of hydrogel-coated silver ink electrodes were found adequate for clinical EEG recordings as assessed by electrical impedance spectroscopy (EIS). The skin-electrode impedances remain stable and low enough at least two days enabling high-quality long-term recordings. Due to the proper material selection, thin ink layers and detachable zero insertion force (ZIF) - connector, electrode was observed to be CT- and MRI-compatible allowing imaging without removing the electrodes. Pilot EEG recordings gave very promising results and an on-going clinical trial with larger number of patients will show the true feasibility of this approach.

  9. A casemix study of patients seen by a dermatology trainee in rural and urban outpatient settings. (United States)

    Tilakaratne, Dev; Warren, Lachlan; Menz, Jennifer


    For 8 years South Australian dermatologists have provided an outreach service to the Northern Territory (NT), including rural and remote areas. In 2012 and 2013, a trainee accompanied a dermatologist on these outreach visits. This is the first prospective study that documents the spectrum of dermatological diseases requiring outpatient specialist input in various settings in the NT, and also the first study to compare the clinical experience of one Australian dermatology trainee in urban and rural settings. Characteristics of patients managed primarily by the outreach dermatology registrar were recorded prospectively from February 2013 to July 2013. The data from the trainee's urban encounters were compared to that of the rural centres. The spectrum of conditions seen in these two settings was placed in the disease categories specified in the Australasian College of Dermatologists (ACD) curriculum. The Royal Adelaide Hospital outpatient experience provided greater exposure to skin neoplasms, lymphoproliferative and myeloproliferative disorders and non-infectious neutrophilic/eosinophilic disorders. The outreach sites provided greater exposure to infections, adnexal diseases and genodermatoses. Both urban and rural experiences provided a broad exposure to the disease categories outlined in the ACD curriculum. The spectrum of disease requiring specialist dermatology input varies between urban South Australia and rural NT. The inclusion of dermatology trainees in outreach visits broadens their clinical exposure. It is recommended that other dermatology service providers in Australia consider documenting clinical casemix comparisons to assess dermatology demand, outcomes and trainee exposure. © 2014 The Australasian College of Dermatologists.

  10. [Applicability of Voice Handicap Index to the evaluation of voice therapy effectiveness in teachers]. (United States)

    Niebudek-Bogusz, Ewa; Kuzańska, Anna; Błoch, Piotr; Domańska, Maja; Woźnicka, Ewelina; Politański, Piotr; Sliwińska-Kowalska, Mariola


    The aim of this study was to assess the applicability of Voice Handicap Index (VHI) to the evaluation of effectiveness of functional voice disorders treatment in teachers. The subjects were 45 female teachers with functional dysphonia who evaluated their voice problems according to the subjective VHI scale before and after phoniatric management. Group I (29 patients) were subjected to vocal training, whereas group II (16 patients) received only voice hygiene instructions. The results demonstrated that differences in the mean VHI score before and after phoniatric treatment were significantly higher in group 1 than in group II (p teacher's dysphonia.

  11. Treatment profiles and costs of patients with chronic pain in the population setting

    Directory of Open Access Journals (Sweden)

    Sicras Mainar A


    Full Text Available Antoni Sicras Mainar1, Ruth Navarro Artieda2, Jesús Villoria Morillo3, Ana Esquivias Escobar41Dirección de Planificación, Badalona Serveis Assistencials SA, 2Documentación Médica, Hospital Germans Trias i Pujol, Badalona, Barcelona; 3Diseño y Redacción Científica, Medicxact, Alpedrete, 4Departamento Médico, Grünenthal Pharma SA, Madrid, SpainBackground: The purpose of this study was to gather information about analgesic drug therapy in patients with chronic pain and perform cost estimates to guide future cost-effectiveness research in the area.Methods: Data from patients aged 44 years and over suffering from any chronic condition and receiving regular analgesic drug therapy (for ≥6 months who attended health care facilities within the area of Badalona during 2008 were collected in a retrospective study. Morbidity profiles were defined according to treatment setting (pain unit, hospital, World Health Organization analgesic step (1–2 versus 3, and a raw cost model based on resource use and work absenteeism was applied. Patients attending the pain unit or the hospital were considered undertreated if they were on step 1–2 analgesics. Multiple regression was used to compare costs between undertreated and non-undertreated patients among those attending the pain unit or the hospital.Results: Only 410 of 18,157 patients ascertained (2.3% were on step 3 analgesics. Their direct costs were greater than those of patients on step 1–2 analgesics, although the opposite was true regarding indirect costs. Of patients seen in the pain unit and in the hospital, 2.3% and 20.1%, respectively, were considered undertreated. Regression analyses revealed even greater costs in the subgroup of undertreated patients.Conclusion: Step 3 analgesics are barely used. Up to one-fifth of patients may be undertreated, generating greater costs than those considered to be properly treated. Regression analyses did not clarify the proportion of their cost excess

  12. Getting to know the person behind the illness - the significance of interacting with patients hospitalised in forensic psychiatric settings


    Salzmann-Erikson, Martin; Rydlo, Cecilia; Wiklund Gustin, Lena


    Source: AIMS AND OBJECTIVES: To describe what nurses want to accomplish in relationships with patients who are hospitalised in forensic psychiatric settings. BACKGROUND: Relationships between staff and patients in forensic psychiatric settings should be grounded in trust and confidence, and the patients need opportunities for emotional reconciliation. However, relationships can be challenging for nurses, who sometimes dist...

  13. On the self-serving function of social anxiety: shyness as a self-handicapping strategy. (United States)

    Snyder, C R; Smith, T W; Augelli, R W; Ingram, R E


    We tested the hypothesis that socially anxious or shy individuals use their anxiety symptoms as a strategy to control attributions made about their performances in social-evaluative settings (i.e., self-handicapping strategies). Specifically, we predicted that trait-socially anxious or shy persons would report more symptoms of social anxiety in an evaluative setting in which anxiety or shyness could serve as an excuse for poor performance than would individuals in (a) an evaluative setting in which shyness was precluded as an excuse or (b) a nonevaluative setting. Furthermore, we predicted that this self-protective pattern of symptom reporting would not occur for individuals who were not trait-socially anxious because these persons would not commonly use such symptoms as a self-handicapping strategy. Results supported these predictions for male subjects, but not for female subjects. Sex differences in the strategic use of shyness are discussed in relation to other research on sex differences in the etiology and correlates of social anxiety.

  14. The experiences of chronically ill patients and registered nurses when they negotiate patient care in hospital settings: a feminist poststructural approach: A qualitative study that explores negotiation of patient care between patients and chronically ill patients in hospital settings. (United States)

    Griscti, Odette; Aston, Megan; Martin-Misener, Ruth; Mcleod, Deborah; Warner, Grace


    The aim of this study was to understand the experiences of chronically ill patients and registered nurse in negotiating patient care in hospital. Specifically, we explored how social and institutional discourses shaped power relations and negotiation of patient care. Current literature indicates that although nurses embrace this notion, such partnerships are not easily implemented. Most existing studies focus on the role of the nurse as the leader of the partnership with little attention paid to how social and institutional values, beliefs and practices shape nurse/patient power relations; or how these relationships are negotiated between nurses and patients. The theoretical and methodological approaches used in this study are based on the precepts of Foucault and feminist poststructural theorists. In depth interviews were conducted with eight chronically ill patients and 10 registered nurses. Both nurses and patients commented about the relationships that develop between nurses and chronically ill patients and how these relationships facilitate negotiation of patient care. Both parties described challenging moments and how institutional discourses may hinder positive negotiations of care. In this paper we highlight three themes that emerged: getting to know each other, they are not the sickest patients and finding time to listen. This study offers an innovative way of unpacking negotiation of care between chronically ill patients and registered nurses. It exposes how social and institutional discourses play a pivotal role in shaping negotiations between nurses and chronically ill patients. Negotiating care with chronically ill patients is not as asymmetric as portrayed in some of the literature and tends to be based on mutual agreements between nurses and patients. Nurses make it a point to listen to patients' needs and resist institutional discourses that preclude them from spending time with patients. © 2016 John Wiley & Sons Ltd.

  15. Defining a core outcome set for adolescent and young adult patients with a spinal deformity. (United States)

    de Kleuver, Marinus; Faraj, Sayf S A; Holewijn, Roderick M; Germscheid, Niccole M; Adobor, Raphael D; Andersen, Mikkel; Tropp, Hans; Dahl, Benny; Keskinen, Heli; Olai, Anders; Polly, David W; van Hooff, Miranda L; Haanstra, Tsjitske M


    Background and purpose - Routine outcome measurement has been shown to improve performance in several fields of healthcare. National spine surgery registries have been initiated in 5 Nordic countries. However, there is no agreement on which outcomes are essential to measure for adolescent and young adult patients with a spinal deformity. The aim of this study was to develop a core outcome set (COS) that will facilitate benchmarking within and between the 5 countries of the Nordic Spinal Deformity Society (NSDS) and other registries worldwide. Material and methods - From August 2015 to September 2016, 7 representatives (panelists) of the national spinal surgery registries from each of the NSDS countries participated in a modified Delphi study. With a systematic literature review as a basis and the International Classification of Functioning, Disability and Health framework as guidance, 4 consensus rounds were held. Consensus was defined as agreement between at least 5 of the 7 representatives. Data were analyzed qualitatively and quantitatively. Results - Consensus was reached on the inclusion of 13 core outcome domains: "satisfaction with overall outcome of surgery", "satisfaction with cosmetic result of surgery", "pain interference", physical functioning", "health-related quality of life", "recreation and leisure", "pulmonary fatigue", "change in deformity", "self-image", "pain intensity", "physical function", "complications", and "re-operation". Panelists agreed that the SRS-22r, EQ-5D, and a pulmonary fatigue questionnaire (yet to be developed) are the most appropriate set of patient-reported measurement instruments that cover these outcome domains. Interpretation - We have identified a COS for a large subgroup of spinal deformity patients for implementation and validation in the NSDS countries. This is the first study to further develop a COS in a global perspective.

  16. Magnetic resonance imaging in the preoperative setting for breast cancer patients with undetected additional disease

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    Barco, Israel [Breast Unit, Department of Gynecology, University Hospital of Mútua Terrassa, Research Foundation Mútua Terrassa, University of Barcelona (Spain); Chabrera, Carolina [Department of Nursing, School of Health Science TecnoCampus Mataró-Maresme (Spain); and others


    Highlights: • Preoperative MRI displays additional disease in 10.4% of cases in patients with infiltrating ductal carcinoma. • In cases with a complex intraductal-associated component, MRI is helpful in managing the surgical approach, and can potentially reduce reoperation rates. • Preoperative MRI showed a 91.9% agreement with the final histology, but core-needle biopsy cannot be rejected, so as to limit unnecessary surgery. • When MRI shows additional disease, there is often a change in the initial surgical plan. • Evolving surgery techniques, such as oncoplastic procedures, can be safely performed as an alternative to mastectomy in some patients. - Abstract: Objective: The last few years have witnessed a significant increase in the preoperative use of Magnetic Resonance Imaging (MRI) for staging purposes in breast cancer (BC) patients. Many studies have confirmed the improvement that MRI can provide in terms of diagnostic assessment, especially with regard to additional disease foci. In the present study, we address the advantages and disadvantages of MRI in the preoperative setting for BC patients. Patients and methods: There were 1513 consecutive breast MRI studies performed in patients with either primary or recurrent BC, who were scheduled for surgery. Results: Beyond the primary lesion, 10.4% of our cases had additional disease at the final histological assessment. MRI overall sensitivity, when considering tumour size and additional foci together, was 74.3%, and 80.3% when considering additional foci exclusively. MRI specificity for additional disease was 95.3%, positive predictive value was 77.4%, and negative predictive value was 94.6%. Nevertheless, 5% of cases had additional tumours that were missed by MRI or, conversely, had additional foci on MRI that were not confirmed by histology. Age (p = 0.020) and lobular carcinomas (p = 0.030) showed significance in the multivariate analysis by logistic regression, using the presence of additional

  17. Magnetic resonance imaging in the preoperative setting for breast cancer patients with undetected additional disease. (United States)

    Barco, Israel; Chabrera, Carolina; García-Fernández, Antonio; Fraile, Manel; Vidal, MCarmen; González, Sonia; Lain, Jose María; Reñé, Assumpta; Canales, Lidia; Vallejo, Elena; Deu, Jordi; Pessarrodona, Antoni; Giménez, Nuria; García-Font, Marc


    The last few years have witnessed a significant increase in the preoperative use of Magnetic Resonance Imaging (MRI) for staging purposes in breast cancer (BC) patients. Many studies have confirmed the improvement that MRI can provide in terms of diagnostic assessment, especially with regard to additional disease foci. In the present study, we address the advantages and disadvantages of MRI in the preoperative setting for BC patients. There were 1513 consecutive breast MRI studies performed in patients with either primary or recurrent BC, who were scheduled for surgery. Beyond the primary lesion, 10.4% of our cases had additional disease at the final histological assessment. MRI overall sensitivity, when considering tumour size and additional foci together, was 74.3%, and 80.3% when considering additional foci exclusively. MRI specificity for additional disease was 95.3%, positive predictive value was 77.4%, and negative predictive value was 94.6%. Nevertheless, 5% of cases had additional tumours that were missed by MRI or, conversely, had additional foci on MRI that were not confirmed by histology. Age (p=0.020) and lobular carcinomas (p=0.030) showed significance in the multivariate analysis by logistic regression, using the presence of additional foci diagnosed by MRI as a dependent variable. Preoperative MRI seems to have a role in preoperative tumour staging for breast cancer patients, as it discloses additional disease foci in some patients, including contralateral involvement. However, given the lack of absolute accuracy, core-needle biopsy cannot be neglected in the diagnosis of such additional malignant foci, which could result in a change in surgical treatment. Copyright © 2016 Elsevier Ireland Ltd. All rights reserved.

  18. Prevalence and Risk of Polypharmacy Among Elderly Cancer Patients Receiving Chemotherapy in Ambulatory Oncology Setting. (United States)

    Goh, Ivy; Lai, Olive; Chew, Lita


    This was a single center, retrospective cross-sectional study looking into the incidence and types of drug-related problems (DRPs) detected among elderly cancer patients receiving at least three long-term medications concurrent with IV chemotherapy, and the types of intervention taken to address these DRPs. This paper serves to elucidate the prevalence and risk of polypharmacy in our geriatric oncology population in an ambulatory care setting, to raise awareness on this growing issue and to encourage more resource allocation to address this healthcare phenomenon. DRP was detected in 77.6% of elderly cancer patients receiving at least three long-term medications concurrent with IV chemotherapy, with an average incidence of three DRPs per patient. Approximately half of DRPs were related to long-term medications. Forty percent of DRPs required interventions at the prescriber level. The use of five or more medications was shown to almost double the risk of DRP occurrence (OR 1.862, P = 0.039). Out of the eight predefined categories of DRPs, underprescribing was the most common (26.7%), followed by adverse drug reaction (25.0%) and drug non-adherence (16.2%). Polypharmacy leading to DRPs is a common occurrence in elderly cancer patients receiving outpatient IV chemotherapy. There should be systematic measures in place to identify patients who are at greater risk of inappropriate polypharmacy and DRPs, and hence more frequent drug therapy optimization and monitoring. The identification of DRPs is an important step to circumvent serious drug-related harm. Future healthcare interventions directed at reducing DRPs should aim to assess the clinical and economic impact of such interventions.

  19. [Attitudes towards patient safety culture in a hospital setting and related variables]. (United States)

    Mir-Abellán, Ramon; Falcó-Pegueroles, Anna; de la Puente-Martorell, María Luisa

    To describe attitudes towards patient safety culture among workers in a hospital setting and determine the influence of socio-demographic and professional variables. The Hospital Survey on Patient Safety Culture was distributed among a sample of professionals and nursing assistants. A dimension was considered a strength if positive responses exceeded 75% and an opportunity for improvement if more than 50% of responses were negative. 59% (n=123) of respondents rated safety between 7 and 8. 53% (n=103) stated that they had not used the notification system to report any incidents in the previous twelve months. The strength identified was "teamwork in the unit/service" and the opportunity for improvement was "staffing". A more positive attitude was observed in outpatient services and among nursing professionals and part-time staff. This study has allowed us to determine the rating of the hospital in patient safety culture. This is vital for developing improvement strategies. Copyright © 2016 SESPAS. Publicado por Elsevier España, S.L.U. All rights reserved.

  20. Characterization of mammographic masses based on level set segmentation with new image features and patient information

    International Nuclear Information System (INIS)

    Shi Jiazheng; Sahiner, Berkman; Chan Heangping; Ge Jun; Hadjiiski, Lubomir; Helvie, Mark A.; Nees, Alexis; Wu Yita; Wei Jun; Zhou Chuan; Zhang Yiheng; Cui Jing


    Computer-aided diagnosis (CAD) for characterization of mammographic masses as malignant or benign has the potential to assist radiologists in reducing the biopsy rate without increasing false negatives. The purpose of this study was to develop an automated method for mammographic mass segmentation and explore new image based features in combination with patient information in order to improve the performance of mass characterization. The authors' previous CAD system, which used the active contour segmentation, and morphological, textural, and spiculation features, has achieved promising results in mass characterization. The new CAD system is based on the level set method and includes two new types of image features related to the presence of microcalcifications with the mass and abruptness of the mass margin, and patient age. A linear discriminant analysis (LDA) classifier with stepwise feature selection was used to merge the extracted features into a classification score. The classification accuracy was evaluated using the area under the receiver operating characteristic curve. The authors' primary data set consisted of 427 biopsy-proven masses (200 malignant and 227 benign) in 909 regions of interest (ROIs) (451 malignant and 458 benign) from multiple mammographic views. Leave-one-case-out resampling was used for training and testing. The new CAD system based on the level set segmentation and the new mammographic feature space achieved a view-based A z value of 0.83±0.01. The improvement compared to the previous CAD system was statistically significant (p=0.02). When patient age was included in the new CAD system, view-based and case-based A z values were 0.85±0.01 and 0.87±0.02, respectively. The study also demonstrated the consistency of the newly developed CAD system by evaluating the statistics of the weights of the LDA classifiers in leave-one-case-out classification. Finally, an independent test on the publicly available digital database for screening

  1. Improving patient safety in the radiation oncology setting through crew resource management. (United States)

    Sundararaman, Srinath; Babbo, Angela E; Brown, John A; Doss, Richard


    they considered something potentially unsafe. We have increased our efficiency (and profitability); in 2012, our units of service were up 11.3% over 2009 levels with the same staffing level. The rigor and standardization introduced into our practice, combined with the increase in communication and teamwork have improved both safety and efficiency while improving both staff and patient satisfaction. CRM principles are highly adaptable and applicable to the radiation oncology setting. © 2014. Published by Elsevier Inc. All rights reserved.

  2. Spiritual well-being of Italian advanced cancer patients in the home palliative care setting. (United States)

    Martoni, A A; Varani, S; Peghetti, B; Roganti, D; Volpicella, E; Pannuti, R; Pannuti, F


    This study evaluates the spiritual well-being (SpWB) in very advanced cancer patients assisted by the home palliative care program of ANT Foundation, a no-profit Italian organisation. SpWB was assessed by the Functional Assessment of Chronic Illness Therapy-Spiritual Well-Being Scale (FACIT-Sp12), including Meaning, Peace, and Faith subscales. The quality-of-life (QoL) was evaluated by using the Functional Assessment of Cancer Therapy-General scale. Questionnaires were distributed to 1,055 patients and 683 were compiled and evaluable for analysis. The mean scores of FACIT-Sp12 as well as of QoL were notably lower than reference values for cancer survivors. The FACIT-Sp12 score was higher in patients with less impaired Karnofsky Performance Status, fully participating in religious rituals and living in central Italy. A high Pearson's correlation was found between QoL and FACIT-Sp12 (r = .60), Peace (r = .71) and Meaning (r = .52), while it was marginal for Faith (r = .27). The hierarchical regression analysis showed that FACIT-Sp12 is a significant predictor of QoL. The study suggests that Italian patients with advanced cancer assisted by expert multi-professional teams in the home palliative care setting have a low level of SpWB thereby highlighting the need for the integration of spiritual support as part of comprehensive cancer care. © 2017 John Wiley & Sons Ltd.

  3. Brand-to-generic levetiracetam switch in patients with epilepsy in a routine clinical setting. (United States)

    Markoula, Sofia; Chatzistefanidis, Dimitrios; Gatzonis, Stylianos; Siatouni, Anna; Siarava, Eleftheria; Verentzioti, Anastasia; Kyritsis, Athanassios P; Patsalos, Philip N


    The therapeutic equivalence of generic and brand antiepileptic drugs, based on studies performed on healthy volunteers, has been questioned. We compare, in a routine clinical setting, brand versus generic levetiracetam (LEV) bioequivalence in patients with epilepsy and also the clinical efficacy and tolerability of the substitution. A prospective, open-label, non-randomized, steady-state, multiple-dose, bioequivalence study was conducted in 12 patients with epilepsy (5 females), with a mean age of 38.4±16.2 years. Patients treated with the brand LEV (Keppra; UCB Pharma) were closely followed for a four-week period and subsequently switched to a generic LEV (Pharmaten) and followed for another four-week period. Blood samples were collected at the end of each 4-week period, during a dose interval for each formulation, for LEV concentration measurements by liquid chromatography mass spectrometry. Steady-state area under the curve (AUC) and peak plasma concentration (Cmax) data were subjected to conventional average bioequivalence analysis. Secondary clinical outcomes, including seizure frequency and adverse events, were recorded. Patients had epilepsy for a mean period of 14.1±10.6years and the mean daily LEV dose was 2583.3±763.7mg. The mean AUC±SD and Cmax±SD was 288.4±86.3(mg/L)h and 37.8±10.4mg/L respectively for brand LEV and 319.2±104.7(mg/L)h and 41.6±12.3mg/L respectively for the generic LEV. Statistic analysis showed no statistical significant difference in bioequivalence. Also, no change in seizures frequency and/or adverse events was recorded. In our clinical setting, generic LEV was determined to be bioequivalent to brand LEV. Furthermore, seizures frequency or/and adverse events were not affected upon switching from brand to generic LEV. Copyright © 2017 British Epilepsy Association. Published by Elsevier Ltd. All rights reserved.

  4. The self-serving function of hypochondriacal complaints: physical symptoms as self-handicapping strategies. (United States)

    Smith, T W; Snyder, C R; Perkins, S C


    The present experiment tested the hypothesis that hypochondriacal individuals commonly use reports of physical illness and symptoms as a strategy to control attributions made about their performances in evaluative settings (i.e., self-handicapping strategies). Specifically, it was predicted that hypochondriacal individuals would report more recent physical illness and complaints and more current physical symptoms in an evaluative setting in which poor health could serve as an alternative explanation for poor performance than would either individuals in an evaluative setting in which poor health was precluded as an excuse or individuals in a nonevaluative setting. As predicted, results supported this self-protective pattern of complaints in a hypochondriacal sample but not in a nonhypochondriacal group. The self-protective role of hypochondriacal behavior is discussed in relation to other theory and research on the nature and treatment of hypochondriasis.

  5. "Keep All Thee 'Til the End": Reclaiming the Lifeworld for Patients in the Hospice Setting. (United States)

    West, Emily; Onwuteaka-Philipsen, Bregje; Philipsen, Hans; Higginson, Irene J; Pasman, H R W


    St Christopher's Hospice, London, was founded to provide specialist care to the incurably ill. We studied the dimensions of difference that set St Christopher's Hospice apart from hospital care of the dying, focusing on physical space and social organization. Material from 1953 to 1980 from the Cicely Saunders Archive was analyzed qualitatively. Through thematic analysis, quotes were found and analyzed using open coding. Five themes were developed. Themes identified were home/homelike, community, consideration of others, link with outside world, and privacy. The hospice philosophy functioned as the catalyst for the development of the physical environment of St Christopher's Hospice. Taking Habermas' concept of lifeworld, it seems that, in contrast to acute care, the need for hospice to formulate their own lifeworld to support and fully engage patients was central. As lifeworlds are culture sensitive, this underlines the need for variation in design and organization of hospices around the world.

  6. Defining a core outcome set for adolescent and young adult patients with a spinal deformity

    DEFF Research Database (Denmark)

    de Kleuver, Marinus; Faraj, Sayf S A; Holewijn, Roderick M


    Background and purpose - Routine outcome measurement has been shown to improve performance in several fields of healthcare. National spine surgery registries have been initiated in 5 Nordic countries. However, there is no agreement on which outcomes are essential to measure for adolescent and young...... adult patients with a spinal deformity. The aim of this study was to develop a core outcome set (COS) that will facilitate benchmarking within and between the 5 countries of the Nordic Spinal Deformity Society (NSDS) and other registries worldwide. Material and methods - From August 2015 to September...... consensus rounds were held. Consensus was defined as agreement between at least 5 of the 7 representatives. Data were analyzed qualitatively and quantitatively. Results - Consensus was reached on the inclusion of 13 core outcome domains: "satisfaction with overall outcome of surgery", "satisfaction...

  7. Fast Setting Silk Fibroin Bioink for Bioprinting of Patient-Specific Memory-Shape Implants. (United States)

    Costa, João B; Silva-Correia, Joana; Oliveira, Joaquim M; Reis, Rui L


    The pursuit for the "perfect" biomimetic and personalized implant for musculoskeletal tissue regeneration remains a big challenge. 3D printing technology that makes use of a novel and promising biomaterials can be part of the solution. In this study, a fast setting enzymatic-crosslinked silk fibroin (SF) bioink for 3D bioprinting is developed. Their properties are fine-tuned and different structures with good resolution, reproducibility, and reliability can be fabricated. Many potential applications exist for the SF bioinks including 3D bioprinted scaffolds and patient-specific implants exhibiting unique characteristics such as good mechanical properties, memory-shape feature, suitable degradation, and tunable pore architecture and morphology. © 2017 WILEY-VCH Verlag GmbH & Co. KGaA, Weinheim.

  8. Personality traits, age and sex as predictors for self-handicapping tendency

    Directory of Open Access Journals (Sweden)

    Čolović Petar


    Full Text Available Self-handicapping is one of the strategies people use when facing potential failure. Paper presents new scale for assessing self-handicapping tendency as relatively stable trait, as well as its relations with personality traits, sex and age. Self-handicapping questionnaire and shortened form of Zuckerman-Kuhlman Personality Questionnaire were administered to 230 participants of both sexes, age 18 to 59. Confirmatory factor analysis shows that model with four latent dimensions, encompassed by a higher-order latent dimension, fits the data well. Those lower order dimensions correspond to originally created scales: External handicaps in interpersonal area, Internal handicaps in interpersonal area, Internal handicaps in achievement area and External handicaps in achievement area. Results of MANCOVA shows that Neuroticism is predictor of all dimensions of self- handicapping. Impulsive sensation seeking predicts choice of external handicaps in interpersonal area, as well as internal handicaps in achievement area. Latter is predicted also by low Activity. Younger subjects show significantly higher tendency to use internal handicaps, and men in general show more self-handicapping tendency than women, except in choosing internal handicaps in achievement area, where sex shows no significant effect.

  9. Psychiatric morbidity among adult patients in a semi-urban primary care setting in Malaysia

    Directory of Open Access Journals (Sweden)

    Omar Khairani


    Full Text Available Abstract Background Screening for psychiatric disorders in primary care can improve the detection rate and helps in preventing grave consequences of unrecognised and untreated psychiatric morbidity. This is relevant to the Malaysian setting where mental health care is now also being provided at primary care level. The aim of this paper is to report the prevalence of psychiatric illness in a semi-urban primary care setting in Malaysia using the screening tool Patient Health Questionnaire (PHQ. Methods This is a cross-sectional study carried out in a semi-urban primary healthcare centre located south of Kuala Lumpur. Systematic random sampling was carried out and a total of 267 subjects completed the PHQ during the study period. Results The proportion of respondents who had at least one PHQ positive diagnosis was 24.7% and some respondents had more than one diagnosis. Diagnoses included depressive illness (n = 38, 14.4%, somatoform disorder (n = 32, 12.2%, panic and anxiety disorders (n = 17, 6.5%, binge eating disorder (n = 9, 3.4% and alcohol abuse (n = 6, 2.3%. Younger age (18 to 29 years and having a history of stressors in the previous four weeks were found to be significantly associated (p = 0.036 and p = 0.044 respectively with PHQ positive scores. Conclusion These findings are broadly similar to the findings of studies done in other countries and are a useful guide to the probable prevalence of psychiatric morbidity in primary care in other similar settings in Malaysia.


    Directory of Open Access Journals (Sweden)

    K. Turgut GÜRSEL


    Full Text Available Although the technological developments, the handicappeds do not take part sufficiently in the social and economic life, because buildings, road construction features and means of the transport are not suitable for them. In this study, a lift for handicappeds was designed, that is supposed to be installed to the middle door of city buses. The lift, whose installation should require a few changes at the bus, is driven by a hydraulic system from the street to the level of the bus floor and vice-versa. In the work, at first a construction was developed in accordance with the dimensions of the middle door of a city bus. After determining of dimensions of all elements, a hydraulic mechanism was constructed, that raises the handicapped, its wheelchair and the platform. Furthermore the construction of the elements of the system were determined, and its proofs of strength analysis were indicated

  11. Quality and Variability of Patient Directions in Electronic Prescriptions in the Ambulatory Care Setting. (United States)

    Yang, Yuze; Ward-Charlerie, Stacy; Dhavle, Ajit A; Rupp, Michael T; Green, James


    that could pose patient safety risks or workflow disruptions that could necessitate pharmacist callbacks to prescribers for clarification or other manual interventions. The quality of free-text patient directions in e-prescriptions can vary dramatically. However, more than half of all patient directions sent in the ambulatory setting can be categorized into only 25 Sig concepts. This suggests an immediate, practical opportunity to improve patient safety and workflow efficiency for both prescribers and pharmacies. Recommendations include implementing enhancements to Sig creation tools in e-prescribing and EHR software applications, adoption of the Structured and Codified Sig format supported by the current national e-prescribing standard, and improved usability testing and end-user training for generating complete and unambiguous patient directions. Such quality improvements are essential for optimizing the safety and effectiveness of patient care as well as for minimizing workflow disruptions to both prescribers and pharmacies. This research received no specific grant from any funding agency in the public, commercial, or not-for-profit sectors. Yang, Ward-Charlerie, Dhavle, and Green are employed by Surescripts. Rupp reported receiving consulting fees from Surescripts during the conduct of this study. No other disclosures were reported. The content in this article is solely the responsibility of the authors and does not necessarily represent the official views of Surescripts and Midwestern University or any of the affiliated institutions of the authors. Study concept and design were contributed by all the authors. Yang and Ward-Charlerie collected the data, and data interpretion was performed by Yang, Ward-Charlerie and Dhavle. The manuscript was primarily written by Yang, along with Dhavle and Green, and revised by Yang, Dhavle, Rupp, and Green.

  12. Correlations between self-handicapping and self-defeating personality. (United States)

    Schill, T; Morales, J; Beyler, J; Tatter, T; Swigert, L


    In this study scores on Strube's self-handicapping scale were correlated with scores on Schill's self-defeating personality scale. Berglas believes there are subtypes of self-defeating personality and that his concept of self-handicapping should be correlated with the three criteria which represent a self-protective component of self-defeating personality. Some support for Berglas' proposition was found, particularly for men. However, correlations with other components of self-defeating personality suggest the criteria thought to be self-protective may need to be reconsidered.

  13. Minimizing Teacher Stress. Structuring Positive Interactions for Handicapped and Nonhandicapped Children in Physical Education. (United States)

    Colvin, Nola R.; And Others


    Components of an integrated physical education program, which consists of handicapped and nonhandicapped students, include: (1) activities that promote interaction among all students; (2) strategies that place handicapped and nonhandicapped students together; and (3) reinforcement of cooperative behavior. (CJ)

  14. Growth motivation as a moderator of behavioral self-handicapping in women. (United States)

    Brown, Christina M; Park, Sun W; Folger, Susan F


    Behavioral self-handicapping is a strategy used to protect attributions about ability. People behaviorally self-handicap by creating an obstacle to their success so failure is attributed to the obstacle instead of to their ability. Although past research has observed behavioral self-handicapping exclusively in men, the current research revealed a moderator of behavioral self-handicapping in women: growth motivation, which reflects the desire to develop one's abilities and learn from failure. Participants (N = 100) completed a test purportedly predictive of successful careers and relationships, and some were given failure feedback about their performance. Participants could behaviorally self-handicap by choosing to complete another test in a performance-impairing environment. Although men self-handicapped more overall, women self-handicapped more after failure when they were low in growth motivation. These results highlight a novel moderator of behavioral self-handicapping in women.

  15. The current trend of administering a patient-generated index in the oncological setting: a systematic review. (United States)

    Tang, Jessica A; Oh, Taemin; Scheer, Justin K; Parsa, Andrew T


    The patient-generated index (PGI) is a more novel approach to evaluating health-related quality of life (HRQOL) that allows patients to formulate their own responses in an open-ended format in order to measure HRQOL based on each patient's own stated goals and expectations. To date the use of PGI in the setting of patients diagnosed with cancer remains relatively less common compared to other health conditions. This systematic review primarily aims to identify current literature in which PGI has been used as a tool to assess quality of life in cancer patients. A systematic review using the MEDLINE database from January 1990 to July 2013 was performed with the following search terms to identify the implementation of PGI in oncology settings: (PGI OR patient generated index OR patient-generated OR patient-reported OR patient generated OR patient reported) AND (cancer OR oncology OR tumor OR neoplasm OR malignancy). Of the 2167 papers initially identified, 10 papers evaluated quality of life in oncology patients by collecting free-form responses from the patient, 4 of which actually used PGI. An overarching theme observed in these studies highlighted the concerns mentioned by patients that were not targeted or detected by standardized quality of life measures. While implementing the PGI may require slightly more investment of resources in the beginning, the potential implications of allowing patients to characterize their quality of life on their own terms are tremendous.

  16. Patients' preference for exercise setting and its influence on the health benefits gained from exercise-based cardiac rehabilitation. (United States)

    Tang, Lars H; Kikkenborg Berg, Selina; Christensen, Jan; Lawaetz, Jannik; Doherty, Patrick; Taylor, Rod S; Langberg, Henning; Zwisler, Ann-Dorthe


    To assess patient preference for exercise setting and examine if choice of setting influences the long-term health benefit of exercise-based cardiac rehabilitation. Patients participating in a randomised controlled trial following either heart valve surgery, or radiofrequency ablation for atrial fibrillation were given the choice to perform a 12-week exercise programme in either a supervised centre-based, or a self-management home-based setting. Exercise capacity and physical and mental health outcomes were assessed for up to 24months after hospital discharge. Outcomes between settings were compared using a time×setting interaction using a mixed effects regression model. Across the 158 included patients, an equivalent proportion preferred to undertake exercise rehabilitation in a centre-based setting (55%, 95% CI: 45% to 63%) compared to a home-based setting (45%, 95% CI: 37% to 53%, p=0.233). At baseline, those who preferred a home-based setting reported better physical health (mean difference in physical component score: 5.0, 95% CI 2.3 to 7.4; p=0.001) and higher exercise capacity (mean between group difference 15.9watts, 95% CI 3.7 to 28.1; p=0.011). With the exception of the depression score in the Hospital Anxiety and Depression Score (F(3.65), p=0.004), there was no evidence of a significant difference in outcomes between settings. The preference of patients to participate in home-based and centre-based exercise programmes appears to be equivalent and provides similar health benefits. Whilst these findings support that patients should be given the choice between exercise-settings when initiating cardiac rehabilitation, further confirmatory evidence is needed. Copyright © 2017. Published by Elsevier B.V.

  17. 13 CFR 113.3-3 - Structural accommodations for handicapped clients. (United States)


    ... handicapped clients. 113.3-3 Section 113.3-3 Business Credit and Assistance SMALL BUSINESS ADMINISTRATION... ADMINISTRATOR General Provisions § 113.3-3 Structural accommodations for handicapped clients. (a) Existing... by handicapped clients. Where structural changes are necessary to make the recipient's goods or...

  18. Re-Examining the Effects of Noncontingent Success on Self-Handicapping Behaviour (United States)

    Thompson, T.


    Background: Self-handicapping refers to the practice on the part of certain individuals to handicap their performance when poor performance is likely to reveal low ability. Noncontingent success (feedback that is inflated relative to performance) is more likely to promote self-handicapping behaviour than noncontingent failure (failure feedback…

  19. Some Costs of Caring at Home for an Intellectually Handicapped Child. (United States)

    Chetwynd, Jane


    Household expenditure patterns of families in the general population were compared with those of 91 families caring for an intellectually handicapped child. Results indicated that handicapped child families spent on average $NZ17 per week more on household items and $NZ7 a week on items related to care of the handicapped child. (Author/CL)

  20. Penile prosthesis surgery in out-patient setting: Effectiveness and costs in the “spending review” era

    Directory of Open Access Journals (Sweden)

    Nicola Mondaini


    Full Text Available Introduction: Penile implant patients are required to remain in the hospital after the operation for monitoring, antibiotic and analgesia administration. Cost containment, however, has resulted in the increased use of ambulatory surgery settings for many surgical procedures. Few studies have studied the feasibility of performing penile prosthesis insertion in an outpatient setting. The results are controversial and nowadays, in the most of centers that deal with prosthetic surgery, patients are still hospitalized. Aim: The aim of our investigation was to compare the feasibility of the performance as well as the complication profiles of penile implant surgery performed in an in-patient and an outpatient setting at a single center by a single surgeon. Methods: From January 2009 to June 2014, 50 patients of the same uro-andrological unit underwent penile prosthesis implantation performed by a single surgeon (N.M.. Twenty implantations were performed in an ambulatory day surgery setting. Main outcome measures: Effectiveness and costs of outpatient setting versus the in-patient setting of the penile prosthesis surgery. Results: There were some differences between the two groups in the intra-operative parameters, such as, operating time. Time lost from work was similar in both groups approximating 14 days. The mean number of analgesic pills ingested by the patients post-operatively was similar in both groups, averaging just under 25 pills per patient. There weren’t post-operative complications in the outpatient group. Cost were 17% less in outpatient clinic. Conclusions: The outpatient setting for this surgery is safe and effective even in patients with comorbidities or in case of secondary procedures. Costs are reduced by 17%.

  1. The current trend of administering a patient-generated index in the oncological setting: a systematic review

    Directory of Open Access Journals (Sweden)

    Jessica A. Tang


    Full Text Available The patient-generated index (PGI is a more novel approach to evaluating health-related quality of life (HRQOL that allows patients to formulate their own responses in an open-ended format in order to measure HRQOL based on each patient’s own stated goals and expectations. To date the use of PGI in the setting of patients diagnosed with cancer remains relatively less common compared to other health conditions. This systematic review primarily aims to identify current literature in which PGI has been used as a tool to assess quality of life in cancer patients. A systematic review using the MEDLINE database from January 1990 to July 2013 was performed with the following search terms to identify the implementation of PGI in oncology settings: (PGI OR patient generated index OR patient-generated OR patient-reported OR patient generated OR patient reported AND (cancer OR oncology OR tumor OR neoplasm OR malignancy. Of the 2167 papers initially identified, 10 papers evaluated quality of life in oncology patients by collecting free-form responses from the patient, 4 of which actually used PGI. An overarching theme observed in these studies highlighted the concerns mentioned by patients that were not targeted or detected by standardized quality of life measures. While implementing the PGI may require slightly more investment of resources in the beginning, the potential implications of allowing patients to characterize their quality of life on their own terms are tremendous.

  2. Patients' satisfaction ratings and their desire for care improvement across oncology settings from France, Italy, Poland and Sweden. (United States)

    Brédart, A; Robertson, C; Razavi, D; Batel-Copel, L; Larsson, G; Lichosik, D; Meyza, J; Schraub, S; von Essen, L; de Haes, J C J M


    There has been an increasing interest in patient satisfaction assessment across nations recently. This paper reports on a cross-cultural comparison of the comprehensive assessment of satisfaction with care (CASC) response scales. We investigated what proportion of patients wanted care improvement for the same level of satisfaction across samples from oncology settings in France, Italy, Poland and Sweden, and whether age, gender, education level and type of items affected the relationships found. The CASC addresses patient's satisfaction with the care received in oncology hospitals. Patients are invited to rate aspects of care and to mention for each of these aspects, whether they would want improvement.One hundred and forty, 395, 186 and 133 consecutive patients were approached in oncology settings from France, Italy, Poland and Sweden, respectively. Across country settings, an increasing percentage of patients wanted care improvement for decreasing levels of satisfaction. However, in France a higher percentage of patients wanted care improvement for high-satisfaction ratings whereas in Poland a lower percentage of patients wanted care improvement for low-satisfaction ratings. Age and education level had a similar effect across countries. Confronting levels of satisfaction with desire for care improvement appeared useful in comprehending the meaning of response choice labels for the CASC across oncology settings from different linguistic and cultural background. Linguistic or socio-cultural differences were suggested for explaining discrepancies between countries. Copyright 2002 John Wiley & Sons, Ltd.

  3. Patient involvement in research programming and implementation: a responsive evaluation of the Dialogue Model for research agenda setting

    NARCIS (Netherlands)

    Abma, T.A.; Pittens, C.A.C.M.; Visse, M.; Elberse, J.E.; Broerse, J.E.W.


    Background: The Dialogue Model for research agenda-setting, involving multiple stakeholders including patients, was developed and validated in the Netherlands. However, there is little insight into whether and how patient involvement is sustained during the programming and implementation of research

  4. Stigma of addiction and mental illness in healthcare: The case of patients' experiences in dental settings.

    Directory of Open Access Journals (Sweden)

    Mario A Brondani

    Full Text Available To explore the ways in which stigma is experienced in healthcare and dental settings by patients with a history of addiction and mental illness.Audio-recorded, semi-structured interviews with a purposefully selected convenience sample of residents from two community treatment centres in Vancouver, Canada were conducted. The interview guide contained questions about experiences while seeking health and dental care and was based on an existing framework of labeling, stereotyping, exclusion, discrimination, and power imbalance. Interviews were transcribed verbatim for coding and thematic analysis.Twenty-five participants between 23 and 67 years of age were interviewed; 17 were males. Most had a self-reported history of depression combined with use of alcohol and crack-cocaine; most of them only sought dental care for emergency purposes. Textual analysis of more than 300 pages of transcribed interviews revealed that participants perceived stigma when they were negatively stereotyped as 'unworthy', labeled as 'different', excluded from the decision-making process, discriminated against, 'treated unfairly', and felt powerless when interacting in the heath and dental care systems. Conversely, positive experiences were characterized by empathy, reassurance and good communication, which were empowering for patients.When associated with stigma, mental illness and addictions have negative implications for accessing health and dental care. From our participants' perspectives, it seems that the lack of understanding about their life conditions by the healthcare professionals was the origin of stigma. We suggest that an increased social awareness of these health issues be enhanced among current and future health and dental care professionals to help improve care experiences for this marginalized population.

  5. Positive Predictive Value of True Bacteremia according to the Number of Positive Culture Sets in Adult Patients. (United States)

    Kitaura, Tsuyoshi; Chikumi, Hiroki; Fujiwara, Hiromitsu; Okada, Kensaku; Hayabuchi, Tatsuya; Nakamoto, Masaki; Takata, Miyako; Yamasaki, Akira; Igishi, Tadashi; Burioka, Naoto; Shimizu, Eiji


    Performing multiple blood culture sets simultaneously is a standard blood culture methodology, although it is often difficult to distinguish true bacteremia from contamination when only one of several blood culture sets is positive. This study clarified the relationship between the number of positive blood culture sets and clinical significance in patients with positive blood culture. Patients aged 18 years and over with at least 1 positive blood culture were enrolled. Positive blood culture episodes were categorized from clinical records as true bacteremia, contamination, or unknown clinical significance. The associations among episodes of true bacteremia, isolated bacteria, the number of positive blood culture sets from among the performed sets, and the clinical background of patients were analyzed. Among a total of 407 episodes, 262, 67 and 78 were true bacteremia, contamination and unknown clinical significance, respectively. The positive predictive values (PPVs) of 1 out of 1, 1 out of 2 and 2 out of 2 positive sets in cases of Staphylococcus aureus, were 81.3%, 50% and 100% respectively; those in cases of coagulase-negative Staphylococci were 20.5%, 10.8% and 63.5%, respectively. Almost all cases of Escherichia coli, Pseudomonas aeruginosa, Klebsiella species and Candida species were true bacteremia. The probability of true bacteremia was strongly associated with recent surgery in multivariate analysis (P sets from among the performed sets varies by microorganism. Therefore, PPVs calculated using this method may help physicians distinguish true bacteremia from contamination.

  6. Curricular Guidelines for Dental Hygiene Care for the Handicapped. (United States)

    Journal of Dental Education, 1984


    The American Association of Dental Schools' guidelines for dental hygiene curriculum cover the scope and definitions of care for the handicapped, interrelationships between disciplines and courses, a curriculum overview, primary educational goals, prerequisites, a core content outline, specific behavioral objectives, sequencing, faculty, and…

  7. Workshops for the Handicapped; An Annotated Bibliography - No. 6. (United States)

    Perkins, Dorothy C., Comp.; And Others

    An annotated bibliography of workshops for the handicapped covers the literature on work programs for the period July, 1968 through June, 1969. One hundred and fifty four publications were reviewed; the number of articles on administration, management, and planning of facilities and programs has increased since the last edition. (Author/RJ)

  8. Aerobic energy expenditure of handicapped children after training

    NARCIS (Netherlands)

    Dresen, M. H.; de Groot, G.; Mesa Menor, J. R.; Bouman, L. N.


    The effect is reported of a 10-week physical training program, consisting of three sessions with a total duration of two hours weekly, on the physical work capacity and efficiency of physically handicapped children aged 8 to 14 years. The program for the experimental group (n = 6) was an

  9. Demographic and audiological factors as predictors of hearing handicap

    Directory of Open Access Journals (Sweden)

    Leposavić Ljubica


    Full Text Available INTRODUCTION Currently available evidence reveals comparatively few studies of psychological effects of hearing impairments, in spite of the fact that clinicians have for a long time been aware of a connection between the acquired hearing impairment and mental disorders. They are focused on the investigation of dysfunction in general. Thus, three domains of the auditory imbalance may be distinguished: disorder, disability and handicap. 'Handicap', according to the definition of the World Health Organization, is a hindrance in an individual that results from an impairment or disability and represents psychological response of the individual to the impairment. OBJECTIVE Validation of acquired hearing impairment as a risk factor of psychical disorders as well as an analysis of relation of some demographic factors (sex, age, education and audiological factors (degree and duration of the impairment with the frequency of hearing handicap. METHOD MMPI-201 has been applied in 60 subjects affected with otosclerosis, potential candidates for stapedectomy, before and after the surgery. RESULTS Individuals with acquired hearing impairment manifest more frequent disorders of psychical functioning in comparison with general population, while demographic and audiometric parameters did not correlate with acquired hearing handicap. CONCLUSION It may be assumed that the very recognition of demographic and audio-logical factors can not help much in the understanding of the psychological stress associated with hearing impairment.

  10. Effects of Handicap and Job Characteristics on Selection Evaluations. (United States)

    Rose, Gerald L.; Brief, Arthur P.


    Business administration students evaluated a hypothetical job applicant who was either an amputee, an epileptic, or "normal." The hypothetical job openings varied as to levels of supervisory responsibility and public contact. With some noted exceptions, the handicapped applicants were evaluated no differently than the normal applicants.…

  11. Signal modulation as a mechanism for handicap disposal (United States)

    Gavassa, Sat; Silva, Ana C.; Gonzalez, Emmanuel; Stoddard, Philip K.


    Signal honesty may be compromised when heightened competition provides incentive for signal exaggeration. Some degree of honesty might be maintained by intrinsic handicap costs on signalling or through imposition of extrinsic costs, such as social punishment of low quality cheaters. Thus, theory predicts a delicate balance between signal enhancement and signal reliability that varies with degree of social competition, handicap cost, and social cost. We investigated whether male sexual signals of the electric fish Brachyhypopomus gauderio would become less reliable predictors of body length when competition provides incentives for males to boost electric signal amplitude. As expected, social competition under natural field conditions and in controlled lab experiments drove males to enhance their signals. However, signal enhancement improved the reliability of the information conveyed by the signal, as revealed in the tightening of the relationship between signal amplitude and body length. Signal augmentation in male B. gauderio was independent of body length, and thus appeared not to be curtailed through punishment of low quality (small) individuals. Rather, all individuals boosted their signals under high competition, but those whose signals were farthest from the predicted value under low competition boosted signal amplitude the most. By elimination, intrinsic handicap cost of signal production, rather than extrinsic social cost, appears to be the basis for the unexpected reinforcement of electric signal honesty under social competition. Signal modulation may provide its greatest advantage to the signaller as a mechanism for handicap disposal under low competition rather than as a mechanism for exaggeration of quality under high competition. PMID:22665940

  12. Game Plans for Victors: New Skills for Severely Handicapped Children. (United States)

    Schoen, Sharon; And Others

    The paper describes an approach in which games were planned to provide instruction for three severely handicapped children (5-6 years old) with few leisure, social, or academic skills and many aberrant behaviors. The first of two games involved a language program to teach verbal interactions, picture identification, and picture matching. The…

  13. Comprehensive Social Service Programs for Handicapped Citizens through Title XX. (United States)

    Roten, Shelby Jean

    Reviewed are present and potential services and social programs for handicapped children in Mississippi through purchase of service contracts under Title XX of the Social Security Act. Sections cover the following topics: background and purpose of Title XX which gives states greater control over social service programs, planning state supported…

  14. Assessing Transition Service for Handicapped Youth: A Cooperative Interagency Approach. (United States)

    Stodden, Robert A.; Boone, Rosalie


    The article presents a cooperative interagency approach for assessing effectiveness of programs and services to facilitate the transition of handicapped students from school to adult community living. Features of the model include cooperative planning at the policy level, implementation level, and direct service level; and collaboration by state…

  15. Occupational Opportunities for the Physically Handicapped. Part B. Manual. (United States)

    Uthe, Elaine F.

    This manual presents the master lists of 206 job titles of 167 different Dictionary of Occupational Titles (DOT) code numbers which were held by physically handicapped graduates/completers of vocational programs as determined by a business and industry survey and graduate followup. (The project itself is reported in CE 026 163; survey and followup…

  16. Early Intervention and the Integration of Handicapped and Nonhandicapped Children. (United States)

    Guralnick, Michael J.

    This collection of 11 articles focuses on integrating handicapped and nonhandicapped children in preschool programs. Article 1 presents arguments for preschool integration. Article 2 discusses research on peer interaction and mixed-age socialization. Article 3 advocates a behavior analysis and operant conditioning approach to studying and…

  17. 2001: Employment Odyssey or Opportunity for Persons with Handicapping Conditions? (United States)

    Linari, Ronald F.; Belmont, Robert M.


    Implications of trends in population, families, communications, automation, the environment, and employment changes are noted for the training and employment of handicapped persons. The need for emphasis in vocational education on generalizability, job readiness and vocational adjustment skills, and job analysis is stressed. (CL)

  18. Some Personality Characteristics of Self-Handicapping Behavior. (United States)

    Levey, Cathy A.

    Based on a modification of Berglas and Jones' (1978) design, conditions of contingent and noncontingent success and failure were manipulated to determine when and why individuals choose to adopt self-handicapping strategies. Male undergraduates (N=76) were informed that they were participating in a study investigating the effects of music on…

  19. Predictors of Middle School Students' Use of Self- Handicapping Strategies. (United States)

    Midgley, Carol; Urdan, Tim


    By procrastinating, allowing others to keep them from studying, deliberately not trying, and using other "self-handicapping" strategies, students can convey that those circumstances, rather than lack of ability, are the reasons for subsequent poor performance. Survey data from 256 eighth-grade students indicated that boys use those strategies more…

  20. Attitudes of Preschool Teachers toward the Integration of Handicapped Children. (United States)

    Dyson, Lily L.; Kubo, H. Richard

    Forty-six supervisors and teachers were surveyed regarding their attitudes toward integration of handicapped children in a regular preschool program, the helpfulness of supportive services, and the necessary conditions for the integration of their programs. Findings showed that the majority of teachers were in favor of integration and supportive…

  1. Developmental Trampoline Activities for Individuals with Multiple Handicapping Conditions. (United States)

    Thomas, Bill


    The use of trampoline activities with multiple handicapped students is discussed. Management considerations in safety are noted, and developmental trampoline skills are listed beginning with bouncing for stimulation. Progression to limited independence and finally independent jumping is described. The position statement of the American Alliance…

  2. 49 CFR Appendix A to Part 609 - Elderly and Handicapped (United States)


    ... capabilities, are unable without special facilities or special planning or design to utilize mass... planning, facilities, or design. However, deafness is recognized as a handicap in the Department of Transportation's ADA regulation, and applicants for Section 5 assistance are encouraged to include the deaf as...

  3. Employers' Attitudes toward Employing People with Mental Handicap. (United States)

    Tse, John W. L.


    A survey of 66 Hong Kong companies and factories identified factors affecting employers' decisions to hire workers with mental handicaps. The five most important factors were emotional problems and personalities of workers, workers' ability to perform the job, availability of low-level jobs, productivity of workers, and possible special…

  4. Aquatics for the Handicapped--A Review of Literature. (United States)

    Christie, Irene


    The author reviews the literature on aquatic activity for the disabled, discussing the physical, physiological, psychological, and sociological benefits of swimming and water safety activities. Unique properties of water and legal requirements regarding physical education of the handicapped, specifically citing the development of skills in…

  5. Patient set-up verification by infrared optical localization and body surface sensing in breast radiation therapy

    International Nuclear Information System (INIS)

    Spadea, Maria Francesca; Baroni, Guido; Riboldi, Marco; Orecchia, Roberto; Pedotti, Antonio; Tagaste, Barbara; Garibaldi, Cristina


    Background and purpose: The aim of the study was to investigate the clinical application of a technique for patient set-up verification in breast cancer radiotherapy, based on the 3D localization of a hybrid configuration of surface control points. Materials and methods: An infrared optical tracker provided the 3D position of two passive markers and 10 laser spots placed around and within the irradiation field on nine patients. A fast iterative constrained minimization procedure was applied to detect and compensate patient set-up errors, through the control points registration with reference data coming from treatment plan (markers reference position, CT-based surface model). Results: The application of the corrective spatial transformation estimated by the registration procedure led to significant improvement of patient set-up. Median value of 3D errors affecting three additional verification markers within the irradiation field decreased from 5.7 to 3.5 mm. Errors variability (25-75%) decreased from 3.2 to 2.1 mm. Laser spots registration on the reference surface model was documented to contribute substantially to set-up errors compensation. Conclusions: Patient set-up verification through a hybrid set of control points and constrained surface minimization algorithm was confirmed to be feasible in clinical practice and to provide valuable information for the improvement of the quality of patient set-up, with minimal requirement of operator-dependant procedures. The technique combines conveniently the advantages of passive markers based methods and surface registration techniques, by featuring immediate and robust estimation of the set-up accuracy from a redundant dataset

  6. “It Depends”: Viewpoints of Patients, Physicians, and Nurses on Patient-Practitioner Prayer in the Setting of Advanced Cancer (United States)

    Balboni, Michael J.; Babar, Amenah; Dillinger, Jennifer; Phelps, Andrea C.; George, Emily; Block, Susan D.; Kachnic, Lisa; Hunt, Jessica; Peteet, John; Prigerson, Holly G.; VanderWeele, Tyler J.; Balboni, Tracy A.


    Context Although prayer potentially serves as an important practice in offering religious/spiritual support, its role in the clinical setting remains disputed. Few data exist to guide the role of patient-practitioner prayer in the setting of advanced illness. Objectives To inform the role of prayer in the setting of life-threatening illness, this study used mixed quantitative-qualitative methods to describe the viewpoints expressed by patients with advanced cancer, oncology nurses, and oncology physicians concerning the appropriateness of clinician prayer. Methods This is a cross-sectional, multisite, mixed-methods study of advanced cancer patients (n = 70), oncology physicians (n = 206), and oncology nurses (n = 115). Semistructured interviews were used to assess respondents’ attitudes toward the appropriate role of prayer in the context of advanced cancer. Theme extraction was performed based on interdisciplinary input using grounded theory. Results Most advanced cancer patients (71%), nurses (83%), and physicians (65%) reported that patient-initiated patient-practitioner prayer was at least occasionally appropriate. Furthermore, clinician prayer was viewed as at least occasionally appropriate by the majority of patients (64%), nurses (76%), and physicians (59%). Of those patients who could envision themselves asking their physician or nurse for prayer (61%), 86% would find this form of prayer spiritually supportive. Most patients (80%) viewed practitioner-initiated prayer as spiritually supportive. Open-ended responses regarding the appropriateness of patient-practitioner prayer in the advanced cancer setting revealed six themes shaping respondents’ viewpoints: necessary conditions for prayer, potential benefits of prayer, critical attitudes toward prayer, positive attitudes toward prayer, potential negative consequences of prayer, and prayer alternatives. Conclusion Most patients and practitioners view patient-practitioner prayer as at least occasionally

  7. Patient-as-observer approach: an alternative method for hand hygiene auditing in an ambulatory care setting. (United States)

    Le-Abuyen, Sheila; Ng, Jessica; Kim, Susie; De La Franier, Anne; Khan, Bibi; Mosley, Jane; Gardam, Michael


    A survey pilot asked patients to observe the hand hygiene compliance of their health care providers. Patients returned 75.1% of the survey cards distributed, and the overall hand hygiene compliance was 96.8%. Survey results and patient commentary were used to motivate hand hygiene compliance. The patient-as-observer approach appeared to be a viable alternative for hand hygiene auditing in an ambulatory care setting because it educated, engaged, and empowered patients to play a more active role in their own health care. Copyright © 2014 Association for Professionals in Infection Control and Epidemiology, Inc. Published by Mosby, Inc. All rights reserved.

  8. The London handicap scale: a re-evaluation of its validity using standard scoring and simple summation


    Jenkinson, C.; Mant, J.; Carter, J.; Wade, D.; Winner, S.


    OBJECTIVE—To assess the validity of the London handicap scale (LHS) using a simple unweighted scoring system compared with traditional weighted scoring
METHODS—323 patients admitted to hospital with acute stroke were followed up by interview 6 months after their stroke as part of a trial looking at the impact of a family support organiser. Outcome measures included the six item LHS, the Dartmouth COOP charts, the Frenchay activities index, the Barthel index, and the hospital...

  9. Causal uncertainty, claimed and behavioural self-handicapping. (United States)

    Thompson, Ted; Hepburn, Jonathan


    Causal uncertainty beliefs involve doubts about the causes of events, and arise as a consequence of non-contingent evaluative feedback: feedback that leaves the individual uncertain about the causes of his or her achievement outcomes. Individuals high in causal uncertainty are frequently unable to confidently attribute their achievement outcomes, experience anxiety in achievement situations and as a consequence are likely to engage in self-handicapping behaviour. Accordingly, we sought to establish links between trait causal uncertainty, claimed and behavioural self-handicapping. Participants were N=72 undergraduate students divided equally between high and low causally uncertain groups. We used a 2 (causal uncertainty status: high, low) x 3 (performance feedback condition: success, non-contingent success, non-contingent failure) between-subjects factorial design to examine the effects of causal uncertainty on achievement behaviour. Following performance feedback, participants completed 20 single-solution anagrams and 12 remote associate tasks serving as performance measures, and 16 unicursal tasks to assess practice effort. Participants also completed measures of claimed handicaps, state anxiety and attributions. Relative to low causally uncertain participants, high causally uncertain participants claimed more handicaps prior to performance on the anagrams and remote associates, reported higher anxiety, attributed their failure to internal, stable factors, and reduced practice effort on the unicursal tasks, evident in fewer unicursal tasks solved. These findings confirm links between trait causal uncertainty and claimed and behavioural self-handicapping, highlighting the need for educators to facilitate means by which students can achieve surety in the manner in which they attribute the causes of their achievement outcomes.

  10. Involving patients in setting priorities for healthcare improvement: a cluster randomized trial

    NARCIS (Netherlands)

    Boivin, A.; Lehoux, P.; Lacombe, R.; Burgers, J.; Grol, R.P.


    BACKGROUND: Patients are increasingly seen as active partners in healthcare. While patient involvement in individual clinical decisions has been extensively studied, no trial has assessed how patients can effectively be involved in collective healthcare decisions affecting the population. The goal

  11. Correlation between vocal tract symptoms and modern singing handicap index in church gospel singers. (United States)

    Pinheiro, Joel; Silverio, Kelly Cristina Alves; Siqueira, Larissa Thaís Donalonso; Ramos, Janine Santos; Brasolotto, Alcione Ghedini; Zambon, Fabiana; Behlau, Mara


    To verify the correlation between vocal tract discomfort symptoms and perceived voice handicaps in gospel singers, analyzing possible differences according to gender. 100 gospel singers volunteered, 50 male and 50 female. All participants answered two questionnaires: Vocal Tract Discomfort (VTD) scale and the Modern Singing Handicap Index (MSHI) that investigates the vocal handicap perceived by singers, linking the results of both instruments (psinging. Female gospel singers present higher frequency and intensity of vocal tract discomfort symptoms, as well as higher voice handicap for singing than male gospel singers. The higher the frequency and intensity of the laryngeal symptoms, the higher the vocal handicap will be.

  12. Getting to know the person behind the illness - the significance of interacting with patients hospitalised in forensic psychiatric settings. (United States)

    Salzmann-Erikson, Martin; Rydlo, Cecilia; Wiklund Gustin, Lena


    To describe what nurses want to accomplish in relationships with patients who are hospitalised in forensic psychiatric settings. Relationships between staff and patients in forensic psychiatric settings should be grounded in trust and confidence, and the patients need opportunities for emotional reconciliation. However, relationships can be challenging for nurses, who sometimes distance themselves from patients' expressions of suffering. The role of forensic mental health nurses is nebulous, as are the prescriptives and the implementation of nursing practices. Qualitative descriptive design. In-depth interviews with five nurses who all work in forensic psychiatric settings. We present a descriptive analysis of what nurses want to accomplish in relationships with patients who are hospitalised in forensic psychiatric settings. The results are presented in two main categories: (1) getting to know the person behind the illness and (2) making a difference. Care in forensic psychiatry needs to shift towards a more long-term view of the role of nursing, focusing less on the traditional and stereotypical identity of the productive nurse and more on the care given when nurses slow down and take the time to see the patients as individuals. Establishing trusting relationships with patients in forensic psychiatric settings is viewed as a less oppressive way to control patients and guide them in directions that are preferable for the nurses and for the society. Nurses may use simple strategies in their daily practice such as sitting on the sofa with patients to establish trust. We stress that nurses should abandon policing roles and custodial activities in favour of guiding principles that promote individual recovery, treatment and health-promoting care. © 2016 John Wiley & Sons Ltd.

  13. Prevalence of Depression and Anxiety amongst Cancer Patients in a Hospital Setting: A Cross-Sectional Study

    Directory of Open Access Journals (Sweden)

    Anish Khalil


    Full Text Available Background. The biomedical care for cancer has not been complemented by psychosocial progressions in cancer care. Objectives. To find the prevalence of anxiety and depression amongst cancer patients in a hospital setting. Design and Setting. This cross-sectional study was conducted at the tertiary care hospitals Shifa International Hospital Islamabad and Nuclear Medicine, Oncology, and Radiotherapy Institute [NORI]. Patients and Methods. 300 patients were interviewed from both the outpatient and inpatient department using The Aga Khan University Anxiety and Depression Scale (AKUADS. Main Outcome Measures. Using a score of 20 and above on the AKUADS, 146 (48.7% patients were suffering from anxiety and depression. Results. When cross tabulation was done between different factors and the cancer patients with anxiety and depression, the following factors were found out to be significant with associated p value < 0.05: education of the patient, presence of cancer in the family, the severity of pain, and the patient’s awareness of his anxiety and depression. Out of 143 (47.7% uneducated patients, 85 (59.4% were depressed, hence making it the highest educational category suffering from depression and anxiety. Conclusion. The prevalence of anxiety and depression amongst cancer patients was high showing that importance should be given to screening and counseling cancer patients for anxiety and depression, to help them cope with cancer as a disease and its impact on their mental wellbeing. Limitations. The frequency of female patients in our research was higher than those of male patients.

  14. CT of the infants and children with mental and/or physical handicaps

    International Nuclear Information System (INIS)

    Okada, Junichiro; Takeuchi, Kazuo


    Computed tomography (CT) was performed on 47 children and adolescents with mental and/or physical handicaps. Of these series, 22 cases of morphological change were noted. Another 25 cases showed no overt CT abnormality. These 47 cases were divided into three groups in the following manner. Group 1, with no CT abnormality; Group 2, with ventricular dilatation and/or cerebral atrophy, and Group 3, with a major morphological anomaly of the brain. Group 1 (25 cases) showed a marked dissociation between the CT findings and the IQ. EEG showed normal findings in two cases, diffuse abnormality in 5 cases, and focal abnormality in 9 cases. This group alone included 8 cases of athetosis. Group 2 (14 cases). Seven cases of EEG showed diffuse abnormality in 3 cases and focal abnormality in 4 cases. So-called cerebral palsy was noted in 11 cases. Group 3 (8 cases). This group included cases of hemihydranencephaly, porencephaly, agenesis of the corpus callosum, and arachnoid cyst. The mean and standard deviations of the IQ's in the groups are 57.1 +- 21.6, 65.2 +- 20.5, and 72.0 +- 8.0. That is, an inverted correlation between the CT abnormality and the IQ was noted. CT is a noninvasive study and a reasonable method of investigation for mentally handicapped children. DeMyer gave three categories of cerebral malformation: cytogenetic malformations, organogenetic disorders, and histogenetic disorders. On the other hand, EEG aimed at evaluating cerebral function and CT undertaken for morphological evaluation reveal no intimate correlation with one another. Rather, these two procedures each have their one value for the evaluation of the function and the structure of the brain. Mentally and/or physically handicapped patients without any overt cerebral anomaly have been found to be as follows: Murobushi, 12.29%; Malamud, 34%; Gross, 15.8%; Benda, 15%, and Hamada, 45.4%. (author)

  15. Improving patient health engagement with mobile texting: A pilot study in the head and neck postoperative setting. (United States)

    Sosa, Alan; Heineman, Nathan; Thomas, Kimberly; Tang, Kai; Feinstein, Marie; Martin, Michelle Y; Sumer, Baran; Schwartz, David L


    Cell phone ownership is nearly universal. Messaging is one of its most widely used features. Texting-based interventions may improve patient engagement in the postoperative setting, but remain understudied. Patients were recruited before discharge from the hospital and received automated daily texts for 1 week providing information about expected recovery. Patients were encouraged to text questions to providers, which were triaged for intervention. Web-based surveys solicited patient feedback about the platform. Thirty-two patients were approached, and 23 patients (72%) were enrolled in the study. All study patients texted their providers, although frequency (median, 7 texts; range, 2-44 texts) varied. Unmarried patients and those facing surgical complications used the platform more frequently. Mean patient satisfaction with the platform was high (mean, 3.8 on a 4-point Likert scale). Text messaging seems feasible in the acute postoperative setting and potentially improves engagement of patients with head and neck cancer. Further study is warranted to confirm scalability and impact. © 2017 Wiley Periodicals, Inc. Head Neck 39: 988-995, 2017. © 2017 Wiley Periodicals, Inc.

  16. Mortality Associated With Emergency Department Boarding Exposure: Are There Differences Between Patients Admitted to ICU and Non-ICU Settings? (United States)

    Reznek, Martin A; Upatising, Benjavan; Kennedy, Samantha J; Durham, Natassia T; Forster, Richard M; Michael, Sean S


    Emergency Department (ED) boarding threatens patient safety. It is unclear whether boarding differentially affects patients admitted to intensive care units (ICUs) versus non-ICU settings. We performed a 2-hospital, 18-month, cross-sectional, observational, descriptive study of adult patients admitted from the ED. We used Kaplan-Meier estimation and Cox Proportional Hazards regression to describe differences in boarding time among patients who died during hospitalization versus those who survived, controlling for covariates that could affect mortality risk or boarding exposure, and separately evaluating patients admitted to ICUs versus non-ICU settings. We extracted age, race, sex, time variables, admission unit, hospital disposition, and Elixhauser comorbidity measures and calculated boarding time for each admitted patient. Among 39,781 admissions from the EDs (21.3% to ICUs), non-ICU patients who died in-hospital had a 1.2-fold risk (95% confidence interval, 1.03-1.36; P=0.016) of having experienced longer boarding times than survivors, accounting for covariates. We did not observe a difference among patients admitted to ICUs. Among non-ICU patients, those who died during hospitalization were more likely to have had incrementally longer boarding exposure than those who survived. This difference was not observed for ICU patients. Boarding risk mitigation strategies focused on ICU patients may have accounted for this difference, but we caution against interpreting that boarding can be safe. Segmentation by patients admitted to ICU versus non-ICU settings in boarding research may be valuable in ensuring that the safety of both groups is considered in hospital flow and boarding care improvements.

  17. Being in togetherness: meanings of encounters within primary healtcare setting for patients living with long-term illness. (United States)

    Nygren Zotterman, Anna; Skär, Lisa; Olsson, Malin; Söderberg, Siv


    The aim of this study was to elucidate meanings of encounters for patients with long-term illness within the primary healthcare setting. Good encounters can be crucial for patients in terms of how they view their quality of care. Therefore, it is important to understand meanings of interactions between patients and healthcare personnel. A phenomenological hermeneutic method was used to analyse the interviews. Narrative interviews with ten patients with long-term illness were performed, with a focus on their encounters with healthcare personnel within the primary healthcare setting. A phenomenological hermeneutical approach was used to interpret the interview texts. The results demonstrated that patients felt well when they were seen as an important person and felt welcomed by healthcare personnel. Information and follow-ups regarding the need for care were essential. Continuity with the healthcare personnel was one way to establish a relationship, which contributed to patients' feelings of being seen and understood. Good encounters were important for patients' feelings of health and well-being. Being met with mistrust, ignorance and nonchalance had negative effects on patients' perceived health and well-being and led to feelings of lower confidence regarding the care received. Patients described a great need to be confirmed and met with respect by healthcare personnel, which contributed to their sense of togetherness. Having a sense of togetherness strengthened patient well-being. By listening and responding to patients' needs and engaging in meetings with patients in a respectful manner, healthcare personnel can empower patients' feelings of health and well-being. Healthcare personnel need to be aware of the significance of these actions because they can make patients experience feelings of togetherness, even if patients meet with different care personnel at each visit. © 2016 John Wiley & Sons Ltd.

  18. Expression of SET Protein in the Ovaries of Patients with Polycystic Ovary Syndrome


    Xu Boqun; Dai Xiaonan; Cui YuGui; Gao Lingling; Dai Xue; Chao Gao; Diao Feiyang; Liu Jiayin; Li Gao; Mei Li; Yuan Zhang; Xiang Ma


    Background. We previously found that expression of SET gene was up-regulated in polycystic ovaries by using microarray. It suggested that SET may be an attractive candidate regulator involved in the pathophysiology of polycystic ovary syndrome (PCOS). In this study, expression and cellular localization of SET protein were investigated in human polycystic and normal ovaries. Method. Ovarian tissues, six normal ovaries and six polycystic ovaries, were collected during transsexual operation and ...

  19. Finger prosthesis: a boon to handicapped. (United States)

    Gupta, Ridhima; Kumar, Lakshya; Rao, Jitendra; Singh, Kamleshwar


    This is a clinical case report of a 52-year-old male patient with four partially missing fingers of the left hand. The article describes the clinical and laboratory procedure of making prosthesis with modern silicone material. A wax pattern was fabricated using the right hand of the patient. A special type of wax was formulated to make the pattern so that it can be easily moulded and carved. Intrinsic and extrinsic staining was also performed to match the adjacent skin colour. The patient was given the finger prosthesis and was asked to use a half glove (sports) to mask the junction between the prosthesis and the normal tissue. It also provides additional retention to the artificial fingers. The patient felt his social acceptance improved after wearing the finger prosthesis.

  20. Self-Assessed Hearing Handicap in Older Adults with Poorer-than-Predicted Speech Recognition in Noise (United States)

    Eckert, Mark A.; Matthews, Lois J.; Dubno, Judy R.


    Purpose: Even older adults with relatively mild hearing loss report hearing handicap, suggesting that hearing handicap is not completely explained by reduced speech audibility. Method: We examined the extent to which self-assessed ratings of hearing handicap using the Hearing Handicap Inventory for the Elderly (HHIE; Ventry & Weinstein, 1982)…

  1. The ethical leadership challenge: creating a culture of patient- and family-centered care in the hospital setting. (United States)

    Piper, Llewellyn E


    The growing number of medical errors and resulting preventable deaths in hospitals presents an ethical dilemma that must be addressed by health care leaders and managers. These medical errors and deaths raise questions about safety and quality issues resulting in rising public mistrust and patient dissatisfaction. Many of these medical errors and deaths could have been avoided by including the patient and family in the care. The ethical challenge for leadership is creating a culture of patient- and family-centered care as a means to improve quality, safety, patient satisfaction, and public trust. This article addresses ways to improve safety, quality, patient satisfaction, and cost and thereby reduce medical errors and deaths by implementing a patient- and family-centered care culture. The first critical step for improvement is for hospital leaders and managers to answer the ethical call to create a culture centered on patient- and family-centered care in the hospital setting.

  2. Validity and Reliability of the Persian Version of the Dysphagia Handicap Index (DHI). (United States)

    Asadollahpour, Faezeh; Baghban, Kowsar; Asadi, Mozhgan


    The Dysphagia Handicap Index (DHI) is one of the instruments used for measuring a dysphagic patient's self-assessment. In some ways, it reflects the patient's quality of life. Although it has been recognized and widely applied in English speaking populations, it has not been used in its present forms in Persian speaking countries. The purpose of this study was to adapt a Persian version of the DHI and to evaluate its validity, consistency, and reliability in the Persian population with oropharyngeal dysphagia. Some stages for cross-cultural adaptation were performed, which consisted in translation, synthesis, back translation, review by an expert committee, and final proof reading. The generated Persian DHI was administered to 85 patients with oropharyngeal dysphagia and 89 control subjects at Zahedan city between May 2013 and August 2013. The patients and control subjects answered the same questionnaire 2 weeks later to verify the test-retest reliability. Internal consistency and test-retest reliability were evaluated. The results of the patients and the control group were compared. The Persian DHI showed good internal consistency (Cronbach's alpha coefficients range from 0.82 to 0.94). Also, good test-retest reliability was found for the total scores of the Persian DHI (r=0.89). There was a significant difference between the DHI scores of the control group and those of the oropharyngeal dysphagia group (P‹0.001). The Persian version of the DHI achieved Face and translation validity. This study demonstrated that the Persian DHI is a valid tool for self-assessment of the handicapping effects of dysphagia on the physical, functional, and emotional aspects of patient life and can be a useful tool for screening and treatment planning for the Persian-speaking dysphagic patients, regardless of the cause or the severity of the dysphagia.

  3. Emergency department care for trauma patients in settings of active conflict versus urban violence: all of the same calibre? (United States)

    Valles, Pola; Van den Bergh, Rafael; van den Boogaard, Wilma; Tayler-Smith, Katherine; Gayraud, Olivia; Mammozai, Bashir Ahmad; Nasim, Masood; Cheréstal, Sophia; Majuste, Alberta; Charles, James Philippe; Trelles, Miguel


    Trauma is a leading cause of death and represents a major problem in developing countries where access to good quality emergency care is limited. Médecins Sans Frontières delivered a standard package of care in two trauma emergency departments (EDs) in different violence settings: Kunduz, Afghanistan, and Tabarre, Haiti. This study aims to assess whether this standard package resulted in similar performance in these very different contexts. A cross-sectional study using routine programme data, comparing patient characteristics and outcomes in two EDs over the course of 2014. 31 158 patients presented to the EDs: 22 076 in Kunduz and 9082 in Tabarre. Patient characteristics, such as delay in presentation (29.6% over 24 h in Kunduz, compared to 8.4% in Tabarre), triage score, and morbidity pattern differed significantly between settings. Nevertheless, both EDs showed an excellent performance, demonstrating low proportions of mortality (0.1% for both settings) and left without being seen (1.3% for both settings), and acceptable triage performance. Physicians' maximum working capacity was exceeded in both centres, and mainly during rush hours. This study supports for the first time the plausibility of using the same ED package in different settings. Mapping of patient attendance is essential for planning of human resources needs. © The Author 2016. Published by Oxford University Press on behalf of Royal Society of Tropical Medicine and Hygiene.

  4. Valuing psychiatric patients' stories: belief in and use of the supernatural in the Jamaican psychiatric setting. (United States)

    James, Caryl C A B; Carpenter, Karen A; Peltzer, Karl; Weaver, Steve


    The aim of this study was to examine illness presentation and understand how psychiatric patients make meaning of the causes of their mental illnesses. Six Jamaican psychiatric patients were interviewed using the McGill Illness Narrative Interview Schedule. Of the 6, 3 representative case studies were chosen. The hermeneutic phenomenological approach and the common sense model were used in the formulation of patients' explanatory models. Results indicate that psychiatric patients actively conceptualized the causes and resultant treatment of their mental illnesses. Patients' satisfaction and compliance with treatment were dependent on the extent to which practitioners' conceptualization matched their own, as well as practitioners' acknowledgement of patients' concerns about causation, prognosis, and treatment.

  5. Expression of SET Protein in the Ovaries of Patients with Polycystic Ovary Syndrome. (United States)

    Boqun, Xu; Xiaonan, Dai; Yugui, Cui; Lingling, Gao; Xue, Dai; Gao, Chao; Feiyang, Diao; Jiayin, Liu; Gao, Li; Li, Mei; Zhang, Yuan; Ma, Xiang


    Background. We previously found that expression of SET gene was up-regulated in polycystic ovaries by using microarray. It suggested that SET may be an attractive candidate regulator involved in the pathophysiology of polycystic ovary syndrome (PCOS). In this study, expression and cellular localization of SET protein were investigated in human polycystic and normal ovaries. Method. Ovarian tissues, six normal ovaries and six polycystic ovaries, were collected during transsexual operation and surgical treatment with the signed consent form. The cellular localization of SET protein was observed by immunohistochemistry. The expression levels of SET protein were analyzed by Western Blot. Result. SET protein was expressed predominantly in the theca cells and oocytes of human ovarian follicles in both PCOS ovarian tissues and normal ovarian tissues. The level of SET protein expression in polycystic ovaries was triple higher than that in normal ovaries (P polycystic ovaries more than that in normal ovaries. Combined with its localization in theca cells, SET may participate in regulating ovarian androgen biosynthesis and the pathophysiology of hyperandrogenism in PCOS.

  6. An evaluation of patient safety culture in a secondary care setting in Kuwait

    Directory of Open Access Journals (Sweden)

    Hamad Alqattan, MPH


    لمرضى. الاستنتاجات: أظهرت هذه الدراسة أن سلامة المرضى ينظر إليها بشكل مختلف بين الطاقم الطبي من مختلف بلدان المنشأ، والمجموعات المهنية، والفئات العمرية. يجب الإقرار بهذه المتغيرات ومعالجتها عند تخطيط وتقييم مبادرات سلامة المرضى. Abstract: Objectives: To improve patient safety outcomes, it is considered essential to create a positive culture of patient safety. This study carried out an initial evaluation of the patient safety culture in a secondary care setting in Kuwait. Methods: This cross-sectional questionnaire study was conducted in a general hospital medical department in Kuwait, using the Hospital Survey on Patient Safety Culture (HSPSC. Multiple linear regression analyses were used to identify patient safety culture predictors. Both an ANOVA and a Kruskal Wallis test were carried out to assess the differences between participants' total scores and the scores they achieved in each dimension, categorized by nationality. Results: A total of 1008 completed questionnaires were received, yielding a response rate of 75.2%. Three dimensions of patient safety culture were found to be priority areas for improvement: non-punitive responses to errors, staffing, and communication openness. Teamwork within units and organizational learning with continuous improvement were identified as areas of strength. Respondents from Kuwait and the Gulf State countries had a less positive perception of the hospital's patient safety culture than did Asian respondents. A regression analysis showed that the respondents' countries of origin, professions, age, and patient safety course/lecture attendance were significantly correlated with their perceptions of the hospital's patient safety culture. Conclusion: This study demonstrates that patient safety is perceived differently by medical staff members from

  7. Pediatrics Education in an AHEC Setting: Preparing Students to Provide Patient Centered Medicine (United States)

    Evans, Steven Owens


    Patient centered medicine is a paradigm of health care that seeks to treat the whole person, rather than only the illness. The physician must understand the patient as a whole by considering the patient's individual needs, social structure, socioeconomic status, and educational background. Medical education includes ways to train students in this…

  8. Doctor-Patient Communication in a Southeast Asian Setting: The Conflict between Ideal and Reality (United States)

    Claramita, Mora; Utarini, Adi; Soebono, Hardyanto; Van Dalen, Jan; Van der Vleuten, Cees


    Doctor-patient communication has been extensively studied in non-Western contexts and in relation to patients' cultural and education backgrounds. This study explores the perceived ideal communication style for doctor-patient consultations and the reality of actual practice in a Southeast Asian context. We conducted the study in a teaching…

  9. Interactive "Video doctor" counseling reduces drug and sexual risk behaviors among HIV-positive patients in diverse outpatient settings


    Gilbert, P; Ciccarone, D; Gansky, SA; Bangsberg, DR; Clanon, K; McPhee, SJ; Calderón, SH; Bogetz, A; Gerbert, B


    Background Reducing substance use and unprotected sex by HIV-positive persons improves individual health status while decreasing the risk of HIV transmission. Despite recommendations that health care providers screen and counsel their HIV-positive patients for ongoing behavioral risks, it is unknown how to best provide “prevention with positives” in clinical settings. Positive Choice, an interactive, patient-tailored computer program, was developed in the United States to improve clinic-based...

  10. Capnography as a tool to detect metabolic changes in patients cared for in the emergency setting. (United States)

    Cereceda-Sánchez, Francisco José; Molina-Mula, Jesús


    to evaluate the usefulness of capnography for the detection of metabolic changes in spontaneous breathing patients, in the emergency and intensive care settings. in-depth and structured bibliographical search in the databases EBSCOhost, Virtual Health Library, PubMed, Cochrane Library, among others, identifying studies that assessed the relationship between capnography values and the variables involved in blood acid-base balance. 19 studies were found, two were reviews and 17 were observational studies. In nine studies, capnography values were correlated with carbon dioxide (CO2), eight with bicarbonate (HCO3), three with lactate, and four with blood pH. most studies have found a good correlation between capnography values and blood biomarkers, suggesting the usefulness of this parameter to detect patients at risk of severe metabolic change, in a fast, economical and accurate way. avaliar a utilidade da capnografia para a detecção de alterações metabólicas em pacientes com respiração espontânea, no contexto das emergências e dos cuidados intensivos. pesquisa bibliográfica estruturada aprofundada, nas bases de dados EBSCOhost, Biblioteca Virtual em Saúde, PubMed, Cochrane Library, entre outras, identificando estudos que avaliavam a relação entre os valores da capnografia e as variáveis envolvidas no equilíbrio ácido-base sanguíneo. foram levantados 19 estudos, dois eram revisões e 17 eram estudos observacionais. Em nove estudos, os valores capnográficos foram correlacionados com o dióxido de carbono (CO2), em oito com o bicarbonato (HCO3), em três com o lactato, e em quatro com o pH sanguíneo. na maioria dos estudos foi observada uma correlação adequada entre os valores capnográficos e os biomarcadores sanguíneos, sugerindo a utilidade deste parâmetro para a identificação de pacientes com risco de sofrer uma alteração metabólica grave, de uma forma rápida, econômica e precisa. explorar la utilidad de la capnografía para la detecci

  11. Continuous subcutaneous delivery of medications for home care palliative patients-using an infusion set or a pump? (United States)

    Menahem, Sasson; Shvartzman, Pesach


    The purpose of this study was to evaluate safety, feasibility, and efficacy of continuous drug delivery by the subcutaneous route through a solution bag connected to an infusion set compared with an infusion pump in a home palliative care setting. Patients in need of continuous subcutaneous medication delivery for pain control, nausea, and/or vomiting were recruited. The study was designed as a double-blind, crossover study. The patient was connected to two parallel subcutaneous lines running simultaneously, connected together to a line entering the subcutaneous tissue. One line is connected to an infusion set and the other to a pump. The infusion set included a 500-cc solution bag connected to a 1.5-m plastic tube containing a drip chamber controlled by a roller clamp that is gravity driven without hyaluronidase. Active medications were randomly assigned to start in either administration method and switched after 24 h. An independent research assistant evaluated symptom control and side effects at baseline and every 24 h for 2 days using a structured questionnaire. Another independent research assistant connected the lines after adding medications and evaluated technical and clinical failures. Twenty-seven patients were recruited, and of them, 18 completed the study. Incidents in fluid administration were more common through the infusion set (18 times) compared to the pump (only twice). On the other hand, no clinical significant change was noted in the average symptom levels and side effects when medications were given through the infusion set versus the pump. No local edema or irritation was observed in either way of administration. In a home palliative care setting with a medical staff on call for 24 h, using medications for symptom control can be considered to be infused to a fluid solution bag through an infusion set instead of using a syringe driver or a pump when there is a responsible caregiver to follow up on the fluid. Subcutaneous constant drug delivery

  12. [The status of travel by severely handicapped patients by railroads]. (United States)

    Mittler, H


    An essential prerequisite for integrating disabled persons is their mobility. The special transport approach, both in terms of handling capacity and cost involved, is increasingly turning out to be unable to achieve future-oriented solutions in this context. Disabled people wish to use the transport services available to the general public. They therefore demand public transportation policies to provide for their access to the mainstream system, ideally independent of outside assistance. Deutsche Bundesbahn, the German federal railways, in the field of tension between the need to orient its business policies on economic and financial considerations and disabled persons' demands that vehicles and premises be designed in a barrier-free manner, seeks to achieve solutions that are responsive to users' needs and at the same time economically justifiable. On account of the 19th century infrastructure legacy and a wide range of rolling stock in long- and short-distance rail travel, this can however be realized only step by step. The facilities offered to disabled people so far range from free use of short-distance trains to the accessibility-oriented design of coaches for the Intercity Express, the future of the railways in the European rapid transit network. The various services and facilities provided are hoped to foster disabled persons' decision in favour of the environmentally compatible rail mode of travelling.

  13. Evaluation of attitudes of university students for handicapped individuals

    Directory of Open Access Journals (Sweden)

    Özkan Zekiye


    Full Text Available Education has an important role in humans’ behaviours. Undergraduate education has headed among factors that influence maturation period before vocational lifes of individuals. The purpose of this study is to determine whether attitudes of university students for handicapped individuals differ according to some variables. This study which was carried out in screening model was done with 1167 people including 646 females 521 males who maintain their education at faculties taking initial teacher training in 2016 spring term at Yuzuncu Yil University. As data collection tool, Attitude Scale for Being Educated of Handicapped Individuals and Personal Information Form, which was developed by Kosterilioglu [12], was used. As statistical method, Duncan’s multiple range test was used in determining different groups following one-wat analysis of variance. Among these variables, pearson coefficients of correlation were calculated separately in groups in determining relation. In determining relationship between groups and categorical variables , chi square test was used. In calculations, value of p was taken as 0,05 and SPSS statistic program was used for calculations. While point average of attitudes of male students , who maintain their educations at Yuzuncu Yil University, for handicapped people was ascertained as 54.27±23.54, point average of attitudes of female students was determined as 55.86±26.34. A significant difference between male and female students according to gender variable was not seen in attitudes for being educated of handicapped individuals (P>0,05. It was observed that attitudes for being educated of handicapped individuals in starting and end of undergraduate term were higher than intermediate classes (P<0,01. Although a significant difference in kind of high schools from which students graduated was not seen, attitudes of graduates from science and sport high schools were found higher than graduates from other high schools

  14. Voice-controlled Internet Browsing for Motor-handicapped Users

    DEFF Research Database (Denmark)

    Brøndsted, Tom; Aaskoven, Erik


    The public-funded project "Indtal" ("Speak-it") has succeeded in developing a Danish voice-controlled utility for internet browsing targeting motor-handicapped users having difficulties using a standard keyboard and/or a standard mouse. The system has been designed and implemented in collaboration...... with an advisory board of motor-handicapped (potential) end-users and underlies a number of a priori defined design criteria: learnability and memorability rather than naturalness, minimal need for maintenance after release, support for "all" web standards (not just HTML conforming to certain "recommendations......"), independency of the language on the websites being browsed, etc. These criteria have lead to a primarily message-driven system interacting with an existing browser on the end users' systems...

  15. The effect of spiritual intelligence instruction on the increasing spiritual intelligence and two components in Maybod adult physical handicaps

    Directory of Open Access Journals (Sweden)

    L Movahedi


    Full Text Available Abstract The purpose of this research was the effect of spiritual intelligence instruction on increasing spiritual intelligence’s Maybod adult handicaps in 2014. 28 female and male (7 men and 21 women adult handicaps participated in this research which was as done pretest quasi – experimental – intervention studing with control group. These people were chosen as purposeful sampling and set in two experimental and control group in equal numbers. After fulfilling pretest, two group were compared by T test and after ensuring of absence of significant difference between two group, In ten session (90 minutes, the experimental group were been taught spiritual intelligence and the control group didn’t have any teaching. Befor and after session, these two groups were been complete Abdollahzade spiritual intelligence test. The analysis of data did on one way covariance statistical analysis. The results showed the experimental group got significantly high scores in regard to control group of general spiritual intelligence, the underestsnding of the relation to universe sourceand spiritual life in emphasis of internal core. Regarding to findings, it results the spiritual intelligence instruction can on increase spiritual intelligence of handicaps.

  16. Palliative Care in Critical Care Settings: A Systematic Review of Communication-Based Competencies Essential for Patient and Family Satisfaction. (United States)

    Schram, Andrew W; Hougham, Gavin W; Meltzer, David O; Ruhnke, Gregory W


    There is an emerging literature on the physician competencies most meaningful to patients and their families. However, there has been no systematic review on physician competency domains outside direct clinical care most important for patient- and family-centered outcomes in critical care settings at the end of life (EOL). Physician competencies are an essential component of palliative care (PC) provided at the EOL, but the literature on those competencies relevant for patient and family satisfaction is limited. A systematic review of this important topic can inform future research and assist in curricular development. Review of qualitative and quantitative empirical studies of the impact of physician competencies on patient- and family-reported outcomes conducted in accordance with the Preferred Reporting Items for Systematic reviews and Meta-Analyses guidelines for systematic reviews. The data sources used were PubMed, MEDLINE, Web of Science, and Google Scholar. Fifteen studies (5 qualitative and 10 quantitative) meeting inclusion and exclusion criteria were identified. The competencies identified as critical for the delivery of high-quality PC in critical care settings are prognostication, conflict mediation, empathic communication, and family-centered aspects of care, the latter being the competency most frequently acknowledged in the literature identified. Prognostication, conflict mediation, empathic communication, and family-centered aspects of care are the most important identified competencies for patient- and family-centered PC in critical care settings. Incorporation of education on these competencies is likely to improve patient and family satisfaction with EOL care.

  17. Bed care for patients in palliative settings: considering risks to caregivers and bed surfaces. (United States)

    Fragala, Guy


    Ensuring patients are comfortable in bed is key to effective palliative care, but when moving and positioning patients in bed, health professionals face an occupational risk of injury. The turning and positioning (TAP) system is a new method of moving patients in bed, that evidence has shown to reduce the risk of injury to caregivers. Providing the correct bed surface is another aspect of bed care essential to the comfort of the palliative patient, and to aid wound prevention and treatment. It is important to take a patient-centred approach when considering the most appropriate bed surface patients. This article provides an overview and discussion of these two aspects of bed care for palliative patients.

  18. Military Families with Handicapped Children: The Reassignment Problem (United States)


    of them ( education service center, Lub- bock Medical facilities , Lubbock State School, psychiatric facilities , etc.) 18. Additional comments: Rapidly...Attached DD ) AN 73 1473 EDITION OF I NOV6GS IS OBSOLETE UNCL 23 Oct 81 8 1 10 2oc 0 6 2 !CURITY CLASSIFICATION OF THIS PAGE (I7,n Data Entered) AIR WAR...COLLEGE AIR UNIVERSITY Report No. MS107-81 MILITARY FAMILIES WITH HANDICAPPED CHILDREN: THE REASSIGNMENT PROBLEM (A (WiDE TO SPECIAL EDUCATION AVAILABLE

  19. Medical History of Elderly Patients in the Emergency Setting: Not an Easy Point-of-Care Diagnostic Marker

    Directory of Open Access Journals (Sweden)

    Tobias Lindner


    Full Text Available Background. Medical histories are a crucially important diagnostic tool. Elderly patients represent a large and increasing group of emergency patients. Due to cognitive deficits, taking a reliable medical history in this patient group can be difficult. We sought to evaluate the medical history-taking in emergency patients above 75 years of age with respect to duration and completeness. Methods. Anonymous data of consecutive patients were recorded. Times for the defined basic medical history-taking were documented, as were the availability of other sources and times to assess these. Results. Data of 104 patients were included in the analysis. In a quarter of patients (25%, n=26 no complete basic medical history could be obtained. In the group of patients where complete data could be gathered, only 16 patients were able to provide all necessary information on their own. Including other sources like relatives or GPs prolonged the time until complete medical history from 7.3 minutes (patient only to 26.4 (+relatives and 56.3 (+GP minutes. Conclusions. Medical histories are important diagnostic tools in the emergency setting and are prolonged in the elderly, especially if additional documentation and third parties need to be involved. New technologies like emergency medical cards might help to improve the availability of important patient data but implementation of these technologies is costly and faces data protection issues.

  20. Tooth-brushing intervention programme among children with mental handicap. (United States)

    Stefanovska, E; Nakova, M; Radojkova-Nikolovska, V; Ristoska, S


    For realizing our study the supervised tooth-brushing program was carried out among 100 schoolchildren at the age of 9-12 and 13-16 years with low and moderate mental handicap in Skopje. To evaluate the results of six months intervention program, concentrated on encouragement of independent manual skills, OHI levels were detected by Green-Vermillion and CPITN index levels to characterize the gingival and periodontal health. For comparative analyzes of date-base OHI levels and after six months of intervention program, we detected that the mean date-base OHI index level for mentally handicaped children are 2.46, and at the end of the program (after six months) it was 0.73. CPITN index levels at the beginning and after six months of intervention programmed for mentally handicaped children in both age groups, also confirmed r statistical significance for this examined parameter, with evident reduction of CPITN mean levels from 2.11 to 0.95. Correlation among date-base OHI levels and levels at the end of our intervention program means high positive correlation between these index levels at the beginningand final examinations. This program gave promising results and was effective in reducing the plaque and gingivitis scores, so the key to long-term success of the program is to maintain the subjects' motivation to make oral hygiene a part of their daily routine and thus sustain this improvement (Tab. 1, Fig. 4, Ref. 12). Full Text (Free, PDF)

  1. Evaluating patient care communication in integrated care settings: application of a mixed method approach in cerebral palsy programs

    NARCIS (Netherlands)

    Gulmans, J.; Gulmans, J.; Vollenbroek-Hutten, Miriam Marie Rosé; van Gemert-Pijnen, Julia E.W.C.; van Harten, Willem H.


    Objective. In this study, we evaluated patient care communication in the integrated care setting of children with cerebral palsy in three Dutch regions in order to identify relevant communication gaps experienced by both parents and involved professionals. - Design. A three-step mixed method

  2. Patients' preference for exercise setting and its influence on the health benefits gained from exercise-based cardiac rehabilitation

    DEFF Research Database (Denmark)

    Tang, Lars H.; Kikkenborg Berg, Selina; Christensen, Jan


    .011). With the exception of the depression score in the Hospital Anxiety and Depression Score (F(3.65), p=0.004), there was no evidence of a significant difference in outcomes between settings. CONCLUSION: The preference of patients to participate in home-based and centre-based exercise programmes appears to be equivalent...

  3. Exploring the Relationships between the Electronic Health Record System Components and Patient Outcomes in an Acute Hospital Setting (United States)

    Wiggley, Shirley L.


    Purpose: The purpose of this study was to examine the relationship between the electronic health record system components and patient outcomes in an acute hospital setting, given that the current presidential administration has earmarked nearly $50 billion to the implementation of the electronic health record. The relationship between the…

  4. 77 FR 38634 - Request for Information: Collection and Use of Patient Work Information in the Clinical Setting... (United States)


    ... (specialty) health care: At your clinical facility, how is the patient's work information collected... the Clinical Setting: Electronic Health Records AGENCY: The National Institute for Occupational Safety... Occupational Safety and Health (NIOSH) of the Centers for Disease Control and Prevention (CDC), Department of...

  5. Calculation errors of Set-up in patients with tumor location of prostate. Exploratory study; Calculo de errores de Set-up en pacientes con localizacion tumoral de prostata. Estudio exploratorio

    Energy Technology Data Exchange (ETDEWEB)

    Donis Gil, S.; Robayna Duque, B. E.; Jimenez Sosa, A.; Hernandez Armas, O.; Gonzalez Martin, A. E.; Hernandez Armas, J.


    The calculation of SM is done from errors in positioning (set-up). These errors are calculated from movements in 3D of the patient. This paper is an exploratory study of 20 patients with tumor location of prostate in which errors of set-up for two protocols of work are evaluated. (Author)

  6. Cone beam CT evaluation of patient set-up accuracy as a QA tool

    DEFF Research Database (Denmark)

    Nielsen, Morten; Bertelsen, Anders; Westberg, Jonas


    Purpose. To quantify by means of cone beam CT the random and systematic uncertainty involved in radiotherapy, and to determine if this information can be used for e.g. technical quality assurance, evaluation of patient immobilization and determination of margins for the treatment planning. Patients...... and lateral directions). In the CC direction, the margin has to be 5 mm for the Thorax patients. The total uncertainty on the patient position grows during the treatment course, especially in the CC direction for patients receiving thoracical irradiation. This may stem from problems in the immobilization...... and methods. Eighty four cancer patients have been cone beam CT scanned at treatment sessions 1, 2, 3, 10 and 20. Translational and rotational errors are analyzed. Results and conclusions. For the first three treatment sessions the mean translational error in the AP direction is 1 mm; this indicates a small...

  7. Validity and Reliability of the Persian Version of the Dysphagia Handicap Index (DHI

    Directory of Open Access Journals (Sweden)

    faezeh asadollahpour


    Full Text Available Introduction: The Dysphagia Handicap Index (DHI is one of the instruments used for measuring a dysphagic patient’s self-assessment. In some ways, it reflects the patient’s quality of life. Although it has been recognized and widely applied in English speaking populations, it has not been used in its present forms in Persian speaking countries. The purpose of this study was to adapt a Persian version of the DHI and to evaluate its validity, consistency, and reliability in the Persian population with oropharyngeal dysphagia.   Materials and Methods: Some stages for cross-cultural adaptation were performed, which consisted in translation, synthesis, back translation, review by an expert committee, and final proof reading. The generated Persian DHI was administered to 85 patients with oropharyngeal dysphagia and 89 control subjects at Zahedan city between May 2013 and August 2013. The patients and control subjects answered the same questionnaire 2 weeks later to verify the test-retest reliability. Internal consistency and test-retest reliability were evaluated. The results of the patients and the control group were compared.   Results: The Persian DHI showed good internal consistency (Cronbach’s alpha coefficients range from 0.82 to 0.94. Also, good test-retest reliability was found for the total scores of the Persian DHI (r=0.89. There was a significant difference between the DHI scores of the control group and those of the oropharyngeal dysphagia group (P‹0.001.   Conclusion:  The Persian version of the DHI achieved Face and translation validity. This study demonstrated that the Persian DHI is a valid tool for self-assessment of the handicapping effects of dysphagia on the physical, functional, and emotional aspects of patient life and can be a useful tool for screening and treatment planning for the Persian-speaking dysphagic patients, regardless of the cause or the severity of the dysphagia.

  8. Setting Goals and Objectives for LD Children-Process and Problems (United States)

    Gallistel, Elizabeth R.


    Discussed are problems and procedures in setting goals and objectives for learning disabled children in the implementation of Individualized Education Programs required by the Education for All Handicapped Children Act. (Author/ DLS)

  9. A Systematic Review on Communication and Relations between Health Care Professionals and Patients with Cancer in Outpatient Settings Matter

    DEFF Research Database (Denmark)

    Prip, Anne


    Background: The development in cancer care has shifted towards shorter hospital stays and more outpatient treatment. Today, cancer care and treatment predominantly takes place in outpatient settings where encounters between patients and health care professionals are often brief. This development...... will probably continue internationally as the global cancer burden seems to be growing significantly. Furthermore, the number of patients who require ambulatory treatments such as chemotherapy is increasing. Research has shown there is a possible risk of overlooking cancer patients´ needs when the time allotted...

  10. Addressing Barriers to Shared Decision Making Among Latino LGBTQ Patients and Healthcare Providers in Clinical Settings. (United States)

    Baig, Arshiya A; Lopez, Fanny Y; DeMeester, Rachel H; Jia, Justin L; Peek, Monica E; Vela, Monica B


    Effective shared decision making (SDM) between patients and healthcare providers has been positively associated with health outcomes. However, little is known about the SDM process between Latino patients who identify as lesbian, gay, bisexual, transgender, or queer (LGBTQ), and their healthcare providers. Our review of the literature identified unique aspects of Latino LGBTQ persons' culture, health beliefs, and experiences that may affect their ability to engage in SDM with their healthcare providers. Further research needs to examine Latino LGBTQ patient-provider experiences with SDM and develop tools that can better facilitate SDM in this patient population.

  11. Management of hypertension in an Australian community pharmacy setting - patients' beliefs and perspectives. (United States)

    Bajorek, Beata V; LeMay, Kate S; Magin, Parker J; Roberts, Christopher; Krass, Ines; Armour, Carol L


    To explore patients' perspectives and experiences following a trial of a pharmacist-led service in hypertension management. A qualitative study comprising individual interviews was conducted. Patients of a community pharmacy, where a pharmacist-led hypertension management service had been trialled in selected metropolitan regions in Sydney (Australia), were recruited to the study. Emergent themes describing patients' experiences and perspectives on the service were elicited via thematic analysis (using manual inductive coding). Patients' (N = 18) experiences of the service were extremely positive, especially around pharmacists' monitoring of blood pressure and provision of advice about medication adherence. Patients' participation in the service was based on their trust in, and relationship with, their pharmacist. The perception of working in a 'team' was conveyed through the pharmacist's caring style of communication and the relaxed atmosphere of the community pharmacy. Patients felt that the community pharmacy was an obvious place for such a service because of their regular contact with the pharmacist, but was limited because the pharmacists were not able to prescribe medication. Patients were extremely positive about the role of, and their experience of, the pharmacy-based hypertension management service. Factors contributing to the patients' positive experiences provide important insights for community pharmacy practice. Good rapport with the pharmacist and a long-term relationship underpin patient engagement in such services. Restrictions on the pharmacists' scope of practice prevent their expertise, and the benefits of their accessibility as a primary point of contact, from being fully realised. © 2016 Royal Pharmaceutical Society.

  12. Improving doctor-patient communication in the outpatient setting using a facilitation tool: a preliminary study. (United States)

    Neeman, Naama; Isaac, Thomas; Leveille, Suzanne; Dimonda, Clementina; Shin, Jacob Y; Aronson, Mark D; Freedman, Steven D


    Patients often do not fully understand medical information discussed during office visits. This can result in lack of adherence to recommended treatment plans and poorer health outcomes. We developed and implemented a program utilizing an encounter form, which provides structure to the medical interaction and facilitates bidirectional communication and informed decision-making. We conducted a prospective quality improvement intervention at a large tertiary-care academic medical center utilizing the encounter form and studied the effect on patient satisfaction, understanding and confidence in communicating with physicians. The intervention included 108 patients seen by seven physicians in five sub-specialties. Ninety-eight percent of patients were extremely satisfied (77%) or somewhat satisfied (21%) with the program. Ninety-six percent of patients reported being involved in decisions about their care and treatments as well as high levels of understanding of medical information that was discussed during visit. Sixty-nine percent of patients reported that they shared the encounter form with their families and friends. Patients' self-confidence in communicating with their doctors increased from a score of 8.1 to 8.7 post-intervention (P-value = 0.0018). When comparing pre- and post-intervention experiences, only 38% of patients felt that their problems and questions were adequately addressed by other physicians' pre-intervention, compared with 94% post-intervention. We introduced a program to enhance physician-patient communication and found that patients were highly satisfied, more informed and more actively involved in their care. This approach may be an easily generalizable approach to improving physician-patient communication at outpatient visits.

  13. Parkinson's patients' executive profile and goals they set for improvement: Why is cognitive rehabilitation not common practice? (United States)

    Vlagsma, T T; Koerts, J; Fasotti, L; Tucha, O; van Laar, T; Dijkstra, H; Spikman, J M


    Impairments in executive functions (EF) are the core cognitive impairment in patients with Parkinson's disease (PD). Surprisingly, cognitive rehabilitation is not routinely offered to patients with PD. However, in patients with acquired brain injury (ABI), cognitive rehabilitation, in particular strategic executive training, is common practice and has been shown to be effective. In this study, we determined whether PD patients have different needs and aims with regard to strategic executive training than ABI patients, and whether possible differences might be a reason for not offering this kind of cognitive rehabilitation programme to patients with PD. Patients' needs and aims were operationalised by individually set goals, which were classified into domains of EF and daily life. In addition, patients with PD and ABI were compared on their cognitive, in particular EF, profile. Overall, PD patients' goals and cognitive profile were similar to those of patients with ABI. Therefore, based on the findings of this study, there is no reason to assume that strategic executive training cannot be part of standard therapy in PD. However, when strategic executive training is applied in clinical practice, disease-specific characteristics need to be taken into account.

  14. Outpatient costs in pharmaceutically treated diabetes patients with and without a diagnosis of depression in a Dutch primary care setting

    Directory of Open Access Journals (Sweden)

    Bosmans Judith E


    Full Text Available Abstract Background To assess differences in outpatient costs among pharmaceutically treated diabetes patients with and without a diagnosis of depression in a Dutch primary care setting. Methods A retrospective case control study over 3 years (2002-2004. Data on 7128 depressed patients and 23772 non-depressed matched controls were available from the electronic medical record system of 20 general practices organized in one large primary care organization in the Netherlands. A total of 393 depressed patients with diabetes and 494 non-depressed patients with diabetes were identified in these records. The data that were extracted from the medical record system concerned only outpatient costs, which included GP care, referrals, and medication. Results Mean total outpatient costs per year in depressed diabetes patients were €1039 (SD 743 in the period 2002-2004, which was more than two times as high as in non-depressed diabetes patients (€492, SD 434. After correction for age, sex, type of insurance, diabetes treatment, and comorbidity, the difference in total annual costs between depressed and non-depressed diabetes patients changed from €408 (uncorrected to €463 (corrected in multilevel analyses. Correction for comorbidity had the largest impact on the difference in costs between both groups. Conclusions Outpatient costs in depressed patients with diabetes are substantially higher than in non-depressed patients with diabetes even after adjusting for confounders. Future research should investigate whether effective treatment of depression among diabetes patients can reduce health care costs in the long term.

  15. Impact of Interprofessional Relationships from Nurses’ Perspective on the Decision-Making Capacity of Patients in a Clinical Setting

    Directory of Open Access Journals (Sweden)

    Jesús Molina-Mula


    Full Text Available Interprofessional relationships may impact the decision making of patients in a clinical setting. The objective of this study was to analyse the decision-making capabilities of patients from nurses’ perspectives of interprofessional relationships using Foucauldian ethics. This qualitative study was based on poststructuralist Foucault references with in-depth interviews of nurses working in internal medicine and specialties in a general hospital. The patients constantly appeared in the definition of teamwork, but also as a passive element used by every professional to communicate with others. Nurses continue modelling a type of patient passivity, or what Foucault called passive subjectivity in relation to oneself, because the patient is guided and directed to take charge of a truth provided by professionals. Nurses must break the rigid design of sections or professional skills, and adopt a model of teamwork that meets the needs of the patient and increases their decision-making power. The quality of care will increase to the extent that professionals establish a relationship of equality with the patient, allowing the patient to make real decisions about their care. An egalitarian model of teamwork is beneficial to the patient, abandoning the idea of a team where the patient and family are constantly excluded from decisions about their care.

  16. Impact of Interprofessional Relationships from Nurses' Perspective on the Decision-Making Capacity of Patients in a Clinical Setting. (United States)

    Molina-Mula, Jesús; Gallo-Estrada, Julia; Perelló-Campaner, Catalina


    Interprofessional relationships may impact the decision making of patients in a clinical setting. The objective of this study was to analyse the decision-making capabilities of patients from nurses' perspectives of interprofessional relationships using Foucauldian ethics. This qualitative study was based on poststructuralist Foucault references with in-depth interviews of nurses working in internal medicine and specialties in a general hospital. The patients constantly appeared in the definition of teamwork, but also as a passive element used by every professional to communicate with others. Nurses continue modelling a type of patient passivity, or what Foucault called passive subjectivity in relation to oneself, because the patient is guided and directed to take charge of a truth provided by professionals. Nurses must break the rigid design of sections or professional skills, and adopt a model of teamwork that meets the needs of the patient and increases their decision-making power. The quality of care will increase to the extent that professionals establish a relationship of equality with the patient, allowing the patient to make real decisions about their care. An egalitarian model of teamwork is beneficial to the patient, abandoning the idea of a team where the patient and family are constantly excluded from decisions about their care.

  17. Misdiagnosis trends in patients with hereditary angioedema from the real-world clinical setting

    DEFF Research Database (Denmark)

    Zanichelli, Andrea; Longhurst, Hilary J; Maurer, Marcus


    . OBJECTIVE: To evaluate the history of misdiagnosis in patients participating in the Icatibant Outcome Survey (IOS). METHODS: The IOS is an observational study in which safety and effectiveness of icatibant have been evaluated since 2009. As part of the IOS, patients record any misdiagnoses received before...

  18. Follow-up of patients with rheumatic heart diseases in the outpatient setting

    Directory of Open Access Journals (Sweden)

    B S Belov


    Full Text Available The major tasks of a follow-up of patients with rheumatic cardiac defects (RCD are formulated on the basis of the recommendations of international and national scientific associations. At the same time, a clinicianXs experience and judgments play an important role in supervising patients with chronic rheumatic heart disease and RCD.

  19. Medication and care in Alzheimer’s patients in the acute care setting

    DEFF Research Database (Denmark)

    Jensen, Anders Møller; Pedersen, Birthe D.; Bang Olsen, Rolf


    day-to-day care might be overlooked, and might partly explain why the poor outcome for this group of patients is not fully understood. This study used participant observation to follow patients with Alzheimer’s disease admitted to orthopaedic wards after fall incidents. To gather longitudinal data...

  20. Brucellosis in household members of Brucella patients residing in a large urban setting in Peru

    NARCIS (Netherlands)

    Mendoza-Núñez, Marjorie; Mulder, Maximilian; Franco, María Pía; Maas, Kathlène S. J. S. M.; Castañeda, Maria L.; Bonifacio, Nilo; Chacaltana, Jesús; Yagui, Elena; Gilman, Robert H.; Espinosa, Benjamin; Blazes, David; Hall, Eric; Abdoel, Theresia H.; Smits, Henk L.; Castañeda-Castañeda, Laura; Manrique, Jenny; Cordova, Nancy; Tuesta, Pilar; Osorio, Pilar; Yausen, Zósimo; Méndez, Melissa; Zavaleta, Milagros


    During home visits and using a point-of-care test for brucellosis, we screened the household members of adult patients found to have brucellosis by investigation at the Hospital Nacional Daniel Alcides Carrión in Callao, Peru. A total of 206 household members of 43 patients were screened, and 15

  1. Patient experience and use of probiotics in community-based health care settings. (United States)

    Chin-Lee, Blake; Curry, William J; Fetterman, John; Graybill, Marie A; Karpa, Kelly


    To investigate patient experience with probiotics and factors that influence probiotic use among adult patients. Patients were invited to complete a questionnaire that assessed their experiences and opinions regarding probiotics. Questionnaires were distributed to patients seeking primary health care services at a family and community medicine practice site and a community pharmacy. Patients were invited to complete the questionnaire while awaiting the physician or waiting for prescriptions to be filled. Overall, 162 surveys were completed and returned (66% response rate) from patients aged 18 to 89 years of age (mean 49.5 years). Most patients (n=107; 65%) were familiar with the term "probiotic", and 49 patients (29.9%) had personally used the supplements in the past. Of those who had used probiotics, the majority (57%) had used the supplements to maintain "good gastrointestinal health" and most (59%) felt that the supplements had been beneficial. However, most (59%) had not informed their health care provider about their use of the supplements. Use of probiotic supplements is common among consumers, but may not be reported to health care providers.

  2. Patient experience and use of probiotics in community-based health care settings

    Directory of Open Access Journals (Sweden)

    Chin-Lee B


    Full Text Available Blake Chin-Lee,1 William J Curry,1 John Fetterman,2 Marie A Graybill,1 Kelly Karpa2 1Department of Family and Community Medicine, 2Department of Pharmacology, Pennsylvania State University, College of Medicine Hershey, PA, USA Objective: To investigate patient experience with probiotics and factors that influence probiotic use among adult patients.Method: Patients were invited to complete a questionnaire that assessed their experiences and opinions regarding probiotics. Questionnaires were distributed to patients seeking primary health care services at a family and community medicine practice site and a community pharmacy. Patients were invited to complete the questionnaire while awaiting the physician or waiting for prescriptions to be filled. Results: Overall, 162 surveys were completed and returned (66% response rate from patients aged 18 to 89 years of age (mean 49.5 years. Most patients (n=107; 65% were familiar with the term “probiotic”, and 49 patients (29.9% had personally used the supplements in the past. Of those who had used probiotics, the majority (57% had used the supplements to maintain “good gastrointestinal health” and most (59% felt that the supplements had been beneficial. However, most (59% had not informed their health care provider about their use of the supplements.Conclusion: Use of probiotic supplements is common among consumers, but may not be reported to health care providers. Keywords: primary care, community pharmacy, probiotic

  3. The prevalence and correlates of alcohol use disorder amongst bipolar patients in a hospital setting, Malaysia. (United States)

    Yee, Hway Ann; Loh, Huai Seng; Ng, Chong Guan


    To determine the prevalence of alcohol-use disorder and associated correlates amongst bipolar patients in a university hospital in Malaysia. In this cross-sectional study, a total of 121 bipolar disorder patients were included. Their alcohol use disorders were assessed with the Mini International Neuropsychiatric Interview (plus version) and the Addiction Severity Index-Lite-Clinical Factors version. The number of lifetime hospitalizations and the survival days (the number of days between the last discharge and the most current readmission) were calculated. The prevalence of alcohol-use disorder amongst bipolar patients was 18.2%. Indian ethnicity was the only demographic factor that was statistically associated with alcohol-use disorder (p rate of suicidal attempt (p Malaysia. Since alcohol-use disorder, as well as the potential interactions with the course of the disorder, is highly prevalent amongst bipolar patients, alcohol use should be addressed in these patients.

  4. Thank you for asking: Exploring patient perceptions of barcode medication administration identification practices in inpatient mental health settings. (United States)

    Strudwick, Gillian; Clark, Carrie; McBride, Brittany; Sakal, Moshe; Kalia, Kamini


    Barcode medication administration systems have been implemented in a number of healthcare settings in an effort to decrease medication errors. To use the technology, nurses are required to login to an electronic health record, scan a medication and a form of patient identification to ensure that these correspond correctly with the ordered medications prior to medication administration. In acute care settings, patient wristbands have been traditionally used as a form of identification; however, past research has suggested that this method of identification may not be preferred in inpatient mental health settings. If barcode medication administration technology is to be effectively used in this context, healthcare organizations need to understand patient preferences with regards to identification methods. The purpose of this study was to elicit patient perceptions of barcode medication administration identification practices in inpatient mental health settings. Insights gathered can be used to determine patient-centered preferences of identifying patients using barcode medication administration technology. Using a qualitative descriptive approach, fifty-two (n=52) inpatient interviews were completed by a Peer Support Worker using a semi-structured interview guide over a period of two months. Interviews were conducted in a number of inpatient mental health areas including forensic, youth, geriatric, acute, and rehabilitation services. An interprofessional team, inclusive of a Peer Support Worker, completed a thematic analysis of the interview data. Six themes emerged as a result of the inductive data analysis. These included: management of information, privacy and security, stigma, relationships, safety and comfort, and negative associations with the technology. Patients also indicated that they would like a choice in the type of identification method used during barcode medication administration. As well, suggestions were made for how barcode medication

  5. Focus Groups in Elderly Ophthalmologic Patients: Setting the Stage for Quantitative Preference Elicitation. (United States)

    Danner, Marion; Vennedey, Vera; Hiligsmann, Mickaël; Fauser, Sascha; Stock, Stephanie


    Patients suffering from age-related macular degeneration (AMD) are rarely actively involved in decision-making, despite facing preference-sensitive treatment decisions. This paper presents a qualitative study to prepare quantitative preference elicitation in AMD patients. The aims of this study were (1) to gain familiarity with and learn about the special requirements of the AMD patient population for quantitative data collection; and (2) to select/refine patient-relevant treatment attributes and levels, and gain insights into preference structures. Semi-structured focus group interviews were performed. An interview guide including preselected categories in the form of seven potentially patient-relevant treatment attributes was followed. To identify the most patient-relevant treatment attributes, a ranking exercise was performed. Deductive content analyses were done by two independent reviewers for each attribute to derive subcategories (potential levels of attributes) and depict preference trends. The focus group interviews included 21 patients. The interviews revealed that quantitative preference surveys in this population will have to be interviewer assisted to make the survey feasible for patients. The five most patient-relevant attributes were the effect on visual function [ranking score (RS): 139], injection frequency (RS: 101), approval status (RS: 83), side effects (RS: 79), and monitoring frequency (RS: 76). Attribute and level refinement was based on patients' statements. Preference trends and dependencies between attributes informed the quantitative instrument design. This study suggests that qualitative research is a very helpful step to prepare the design and administration of quantitative preference elicitation instruments. It especially facilitated familiarization with the target population and its preferences, and it supported attribute/level refinement.

  6. Analysis of Internet Usage Among Cancer Patients in a County Hospital Setting: A Quality Improvement Initiative (United States)

    Lilley, Lisa; Lodrigues, William; Dreadin-Pulliam, Julie; Xie, Xian-Jin; Mathur, Sakshi; Rao, Madhu; Harvey, Valorie; Leitch, Ann Marilyn; Rao, Roshni


    Background Cancer is one of the most common diseases that patients research on the Internet. The Commission on Cancer (CoC) recommended that Parkland Memorial Hospital (PMH) improve the oncology services website. PMH is Dallas County’s public health care facility, serving a largely uninsured, minority population. Most research regarding patient Internet use has been conducted in insured, Caucasian populations, raising concerns that the needs of PMH patients may not be extrapolated from available data. The PMH Cancer Committee, therefore, adopted a quality improvement initiative to understand patients’ Internet usage. Objective The objective of the study was to obtain and analyze data regarding patients’ Internet usage in order to make targeted improvements to the oncology services section of the institutional website. Methods A task force developed an 11-question survey to ascertain what proportion of our patients have Internet access and use the Internet to obtain medical information as well as determine the specific information sought. Between April 2011 and August 2011, 300 surveys were administered to newly diagnosed cancer patients. Multivariate analyses were performed. Results Of 300 surveys, 291 were included. Minorities, primarily African-American and Hispanic, represented 78.0% (227/291) of patients. Only 37.1% (108/291) of patients had Internet access, most (256/291, 87.9%) having access at home. Younger patients more commonly had Internet access, with a mean age of 47 versus 58 years for those without (PInternet research was to develop questions for discussion with one’s physician. Patients most frequently sought information regarding cancer treatment options, outcomes, and side effects. Conclusions Less than one-half of PMH oncology patients have Internet access. This is influenced by age, educational level, and ethnicity. Those with access use it to obtain information related to their cancer diagnosis. The most effective way of addressing our

  7. Implementation and adoption of mechanical patient lift equipment in the hospital setting: The importance of organizational and cultural factors. (United States)

    Schoenfisch, Ashley L; Myers, Douglas J; Pompeii, Lisa A; Lipscomb, Hester J


    Work focused on understanding implementation and adoption of interventions designed to prevent patient-handling injuries in the hospital setting is lacking in the injury literature and may be more insightful than more traditional evaluation measures. Data from focus groups with health care workers were used to describe barriers and promoters of the adoption of patient lift equipment and a shift to a "minimal-manual lift environment" at two affiliated hospitals. Several factors influencing the adoption of the lift equipment and patient-handling policy were noted: time, knowledge/ability, staffing, patient characteristics, and organizational and cultural aspects of work. The adoption process was complex, and considerable variability by hospital and across units was observed. The use of qualitative data can enhance the understanding of factors that influence implementation and adoption of interventions designed to prevent patient-handling injuries among health care workers. Copyright © 2011 Wiley Periodicals, Inc.

  8. Experience-based design for integrating the patient care experience into healthcare improvement: Identifying a set of reliable emotion words. (United States)

    Russ, Lauren R; Phillips, Jennifer; Brzozowicz, Keely; Chafetz, Lynne A; Plsek, Paul E; Blackmore, C Craig; Kaplan, Gary S


    Experience-based design is an emerging method used to capture the emotional content of patient and family member healthcare experiences, and can serve as the foundation for patient-centered healthcare improvement. However, a core tool-the experience-based design questionnaire-requires words with consistent emotional meaning. Our objective was to identify and evaluate an emotion word set reliably categorized across the demographic spectrum as expressing positive, negative, or neutral emotions for experience-based design improvement work. We surveyed 407 patients, family members, and healthcare workers in 2011. Participants designated each of 67 potential emotion words as positive, neutral, or negative based on their emotional perception of the word. Overall agreement was assessed using the kappa statistic. Words were selected for retention in the final emotion word set based on 80% simple agreement on classification of meaning across subgroups. The participants were 47.9% (195/407) patients, 19.4% (33/407) family members and 32.7% (133/407) healthcare staff. Overall agreement adjusted for chance was moderate (k=0.55). However, agreement for positive (k=0.69) and negative emotions (k=0.68) was substantially higher, while agreement in the neutral category was low (k=0.11). There were 20 positive, 1 neutral, and 14 negative words retained for the final experience-based design emotion word set. We identified a reliable set of emotion words for experience questionnaires to serve as the foundation for patient-centered, experience-based redesign of healthcare. Incorporation of patient and family member perspectives in healthcare requires reliable tools to capture the emotional content of care touch points. Copyright © 2013 Elsevier Inc. All rights reserved.

  9. Patients' Perceptions of Dehumanization of Patients in Dental School Settings: Implications for Clinic Management and Curriculum Planning. (United States)

    Raja, Sheela; Shah, Raveena; Hamad, Judy; Van Kanegan, Mona; Kupershmidt, Alexandra; Kruthoff, Mariela


    Although the importance of empathy, rapport, and anxiety/pain awareness in dentist-patient relations has been well documented, these factors continue to be an issue with patients in many dental school clinics. The aim of this study was to develop an in-depth understanding of how patients at an urban, university-affiliated medical center and its dental school's clinic experienced oral health care and to generate ideas for improving the dental school's clinical curriculum and management of the clinic. Although patient satisfaction surveys are common, in-depth patient narratives are an underutilized resource for improving dental education. In-depth qualitative interviews were conducted with 20 uninsured or underinsured dental patients at these sites, and the results were analyzed using content analysis. Major phenomena that participants discussed were the importance of empathy and good rapport with their oral health providers and provider awareness of dental pain and anxiety. Many patients also discussed feeling dehumanized during dental visits. Based on their positive and negative experiences, the participants made suggestions for how oral health professionals can successfully engage patients in treatment.

  10. Has beta-blocker use increased in patients with heart failure in internal medicine settings? Prognostic implications: RICA registry. (United States)

    González-García, Andrés; Montero Pérez-Barquero, Manuel; Formiga, Francesc; González-Juanatey, José R; Quesada, M Angustias; Epelde, Francisco; Oropesa, Roberto; Díez-Manglano, Jesús; Cerqueiro, José M; Manzano, Luis


    Underuse of beta-blockers has been reported in elderly patients with heart failure. The aim of this study was to evaluate the current prescription of beta-blockers in the internal medicine setting, and its association with morbidity and mortality in heart failure patients. The information analyzed was obtained from a prospective cohort of patients hospitalized for heart failure (RICA registry] database, patients included from March 2008 to September 2011) with at least one year of follow-up. We investigated the percentage of patients prescribed beta-blockers at hospital discharge, and at 3 and 12 months, and the relationship of beta-blocker use with mortality and readmissions for heart failure. Patients with significant valve disease were excluded. A total of 515 patients were analyzed (53.5% women), with a mean age of 77.1 (8.7) years. Beta-blockers were prescribed in 62.1% of patients at discharge. A similar percentage was found at 3 months (65.6%) and 12 months (67.9%) after discharge. All-cause mortality and the composite of all-cause mortality and readmission for heart failure were significantly lower in patients treated with beta-blockers (hazard ratio=0.59, 95% confidence interval, 0.41-0.84 vs hazard ratio=0.64, 95% confidence interval, 0.49-0.83). This decrease in mortality was maintained after adjusting by age, sex, ejection fraction, functional class, comorbidities, and concomitant treatment. The findings of this study indicate that beta-blocker use is increasing in heart failure patients (mainly elderly) treated in the internal medicine setting, and suggest that the use of these drugs is associated with a reduction in clinical events. Copyright © 2013 Sociedad Española de Cardiología. Published by Elsevier Espana. All rights reserved.

  11. Comparison of attitudes of guilt and forgiveness in cancer patients without evidence of disease and advanced cancer patients in a palliative care setting. (United States)

    van Laarhoven, Hanneke W M; Schilderman, Johannes; Verhagen, Constans A H H V M; Prins, Judith B


    : Attitudes toward guilt and forgiveness may be important factors determining distress in cancer patients. Direct comparative studies in patients with different life expectancies exploring attitudes toward guilt and forgiveness are lacking. Also, sociodemographic and religious characteristics determining the attitudes toward guilt and forgiveness are unknown. : The objective of this study was to compare attitudes toward guilt and forgiveness in cancer patients without evidence of disease and advanced cancer patients. : A descriptive research design was used. Ninety-seven patients without evidence of disease and 55 advanced cancer patients filled out the Dutch Guilt Measurement Instrument and the Forgiveness of Others Scale. : Both groups had an attitude of nonreligious guilt and forgiveness, but not of religious guilt. No significant differences in attitudes toward guilt and forgiveness were observed between the 2 groups. In contrast to sociodemographic characteristics, religious characteristics were relevant predictors for guilt and forgiveness. Significant differences in relations between images of God and attitudes toward guilt were observed between the 2 patient groups. : An attitude of nonreligious guilt and forgiveness was found in cancer patients, irrespective of the stage of disease. Religious characteristics were significantly associated with attitudes of guilt and forgiveness. This correlation differed in the early and the advanced setting of disease. : The observed relations between religious characteristics and attitudes of guilt and forgiveness suggest that a careful examination of the role of religious beliefs and values is relevant in the clinical care of patients with cancer, both in the setting of early and advanced disease.

  12. A Proposed Set of Metrics to Reduce Patient Safety Risk From Within the Anatomic Pathology Laboratory. (United States)

    Banks, Peter; Brown, Richard; Laslowski, Alex; Daniels, Yvonne; Branton, Phil; Carpenter, John; Zarbo, Richard; Forsyth, Ramses; Liu, Yan-Hui; Kohl, Shane; Diebold, Joachim; Masuda, Shinobu; Plummer, Tim; Dennis, Eslie


    Anatomic pathology laboratory workflow consists of 3 major specimen handling processes. Among the workflow are preanalytic, analytic, and postanalytic phases that contain multistep subprocesses with great impact on patient care. A worldwide representation of experts came together to create a system of metrics, as a basis for laboratories worldwide, to help them evaluate and improve specimen handling to reduce patient safety risk. Members of the Initiative for Anatomic Pathology Laboratory Patient Safety (IAPLPS) pooled their extensive expertise to generate a list of metrics highlighting processes with high and low risk for adverse patient outcomes. : Our group developed a universal, comprehensive list of 47 metrics for patient specimen handling in the anatomic pathology laboratory. Steps within the specimen workflow sequence are categorized as high or low risk. In general, steps associated with the potential for specimen misidentification correspond to the high-risk grouping and merit greater focus within quality management systems. Primarily workflow measures related to operational efficiency can be considered low risk. Our group intends to advance the widespread use of these metrics in anatomic pathology laboratories to reduce patient safety risk and improve patient care with development of best practices and interlaboratory error reporting programs. © American Society for Clinical Pathology 2017.

  13. Cognitive work analysis to evaluate the problem of patient falls in an inpatient setting (United States)

    Lopez, Karen Dunn; Cary, Michael P; Kanak, Mary F


    Objective To identify factors in the nursing work domain that contribute to the problem of inpatient falls, aside from patient risk, using cognitive work analysis. Design A mix of qualitative and quantitative methods were used to identify work constraints imposed on nurses, which may underlie patient falls. Measurements Data collection was done on a neurology unit staffed by 27 registered nurses and utilized field observations, focus groups, time–motion studies and written surveys (AHRQ Hospital Survey on Patient Culture, NASA-TLX, and custom Nursing Knowledge of Fall Prevention Subscale). Results Four major constraints were identified that inhibit nurses' ability to prevent patient falls. All constraints relate to work processes and the physical work environment, opposed to safety culture or nursing knowledge, as currently emphasized. The constraints were: cognitive ‘head data’, temporal workload, inconsistencies in written and verbal transfer of patient data, and limitations in the physical environment. To deal with these constraints, the nurses tend to employ four workarounds: written and mental chunking schemas, bed alarms, informal querying of the previous care nurse, and informal video and audio surveillance. These workarounds reflect systemic design flaws and may only be minimally effective in decreasing risk to patients. Conclusion Cognitive engineering techniques helped identify seemingly hidden constraints in the work domain that impact the problem of patient falls. System redesign strategies aimed at improving work processes and environmental limitations hold promise for decreasing the incidence of falls in inpatient nursing units. PMID:20442150

  14. Patient and organisational variables associated with pressure ulcer prevalence in hospital settings: a multilevel analysis. (United States)

    Bredesen, Ida Marie; Bjøro, Karen; Gunningberg, Lena; Hofoss, Dag


    To investigate the association of ward-level differences in the odds of hospital-acquired pressure ulcers (HAPUs) with selected ward organisational variables and patient risk factors. Multilevel approach to data from 2 cross-sectional studies. 4 hospitals in Norway were studied. 1056 patients at 84 somatic wards. HAPU. Significant variance in the odds of HAPUs was found across wards. A regression model using only organisational variables left a significant variance in the odds of HAPUs across wards but patient variables eliminated the across-ward variance. In the model including organisational and patient variables, significant ward-level HAPU variables were ward type (rehabilitation vs surgery/internal medicine: OR 0.17 (95% CI 0.04 to 0.66)), use of preventive measures (yes vs no: OR 2.02 (95% CI 1.12 to 3.64)) and ward patient safety culture (OR 0.97 (95% CI 0.96 to 0.99)). Significant patient-level predictors were age >70 vs organisation of care improvements, that is, by improving the patient safety culture and implementation of preventive measures. Some wards may prevent pressure ulcers better than other wards. The fact that ward-level variation was eliminated when patient-level HAPU variables were included in the model indicates that even wards with the best HAPU prevention will be challenged by an influx of high-risk patients. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to

  15. Review of two years of experiences with SPECT among psychiatric patients in a rural hospital setting. (United States)

    Sheehan, William; Thurber, Steven


    We summarize single proton emission computed tomography (SPECT) findings from 63 psychiatric patients in a small rural hospital in western Minnesota. SPECT scans were ordered only for patients in whom documentation of hypoperfusion and functional deficits might be helpful in clarifying diagnoses and treatment planning. The patients referred for SPECT scans had histories of traumatic brain injuries, atypical psychiatric symptom presentations, or conditions that were refractory to standard treatments. In the context of strict referral guidelines and close psychiatrist-radiologist collaboration, a much higher yield of significant findings was obtained compared with those noted in other reports in the literature.

  16. Older Patients in the Acute Setting - Is There a Better Solution?

    DEFF Research Database (Denmark)

    Pressel, Eckart; Reichstein Wejse, Miriam; Demény, Ann Kathrin

    Background A substantial amount of older (>65 years) patients admitted to the Acute Medical Unit (AMU) at Bispebjerg Hospital are often characterized by complex health related and medication problems, functional loss and atypical presentation of symptoms. We established a Geriatric Acute Team (GATE...... and 58 % had more than 3 simultaneous present diseases. Implementing GATE resulted in shorter hospitalization times at AMU (p=0.03), fewer doctors attending the single patient (p=0.02), fewer 30-day readmission (p=0.05) and more patients being transferred to the geriatric ward (p=0.002). Conclusion...

  17. Pattern of postoperative pain management among adult surgical patients in a low-resource setting

    Directory of Open Access Journals (Sweden)

    Ogboli-Nwasor E


    Full Text Available Elizabeth Ogboli-Nwasor,1 Sa’adatu T Sule,2 Lazarus MD Yusufu31Department of Anaesthesia, Ahmadu Bello University Teaching Hospital, Zaria, Nigeria; 2Department of Obstetrics and Gynaecology, Ahmadu Bello University Teaching Hospital, Zaria, Nigeria; 3Department of Surgery, Ahmadu Bello University Teaching Hospital, Zaria, NigeriaObjective: Postoperative pain is one of the most common complications of surgery. The pattern of management varies between centers. The current study aimed to study the prescription pattern and the common drugs used in the management of postoperative pain in adult surgical patients at Ahmadu Bello University Teaching Hospital (ABUTH; Zaria, Nigeria.Methods: Following ethical approval, a prospective observational study of consecutive adult patients who had surgery at the ABUTH Zaria was performed from January to December 2005. The data were entered into a proforma and analyzed using the Minitab statistical package.Results: One hundred and thirty-eight patients were included in the study. The age range was 17 to 80 years, with a mean age of 41 years. One hundred and thirty-two (95.7% of the prescriptions were written solely by the surgeon or surgical resident; passive suggestions were given by the anesthetists for only six patients (4.3%. Intermittent intramuscular injections of opioids/opiates were prescribed for 126 patients (91.3%, while nine patients (6.5% received intermittent intramuscular injections with non-steroidal anti-inflammatory drugs. Oral paracetamol was prescribed for six patients (4.3%, while three patients (2.1% received no postoperative analgesic. Moderate pain was recorded in 48 patients (34.8%, and 90 patients (65.2% had mild pain 8 hours after their operation before subsequent doses of analgesics were given. More females (81 patients [58.7%], than males (42 patients [29.7%] suffered moderate to severe pain. The reported side effects were nausea (reported by 32.6% of patients, dry mouth (21

  18. Setting priorities for improving the preoperative assessment clinic: the patients' and the professionals' perspective.

    NARCIS (Netherlands)

    Edward, G.M.; de Haes, J.C.J.M.; Oort, F.J.; Lemaire, L.C.; Hollmann, M.W.; Preckel, B.


    Background: The quality of the preoperative assessment clinic (PAC) is determined by many factors. Patients’ experiences are important indicators, but often overlooked. We prepare to set priorities to improve the PAC by obtaining detailed patients’ feedback on the quality of the PAC, and

  19. Recommended patient-reported core set of symptoms to measure in adult cancer treatment trials

    NARCIS (Netherlands)

    Reeve, B.B.; Mitchell, S.A.; Dueck, A.C.; Basch, E.; Cella, D.; Miller Reilly, C.; Minasian, L.M.; Denicoff, A.M.; O'Mara, A.M.; Fisch, M.J.; Chauhan, C.; Aaronson, N.K.; Coens, C.; Watkins Bruner, D.


    Background: The National Cancer Institute’s Symptom Management and Health-Related Quality of Life Steering Committee held a clinical trials planning meeting (September 2011) to identify a core symptom set to be assessed across oncology trials for the purposes of better understanding treatment

  20. Ventilation area measured with eit in order to optimize peep settings in mechanically ventilated patients

    NARCIS (Netherlands)

    Blankman, P; Groot Jebbink, E; Preis, C; Bikker, I.; Gommers, D.


    INTRODUCTION. Electrical Impedance Tomography (EIT) is a non-invasive imaging technique, which can be used to visualize ventilation. Ventilation will be measured by impedance changes due to ventilation. OBJECTIVES. The aim of this study was to optimize PEEP settings based on the ventilation area of

  1. Results from a Community-Wide Pilot Program to Standardize COPD Education for Patients Across Healthcare Settings in Rhode Island. (United States)

    Pelland, Kimberly; Youssef, Rouba; Calandra, Kathleen; Cellar, Jennifer; Thiesen, Jennifer; Gardner, Rebekah


    Chronic obstructive pulmonary disease (COPD) is associated with significant morbidity, decreased quality of life, and burdensome hospital admissions. Therefore, patients with COPD interact with clinicians in a number of healthcare settings. A coalition of healthcare practitioners in Rhode Island, in partnership with the local Quality Improvement Organization, designed and implemented a standardized, COPD education program for use across multiple healthcare settings. More than 60 organizations participated, producing 140 Master Trainers, who trained 634 staff members at their facilities from October 2015 through June 2016. Master Trainers were satisfied with the training, and we observed significant increases in knowledge scores post-training among all participants, which remained significant when stratified by setting. These results demonstrate that implementation of a community-based program to disseminate patient-centered, standardized COPD education in multiple healthcare settings is feasible. We hope this program will ultimately improve patient outcomes and serve as the foundation for expanding standardized education for other chronic conditions. [Full article available at].

  2. Patient Aggression and the Wellbeing of Nurses: A Cross-Sectional Survey Study in Psychiatric and Non-Psychiatric Settings. (United States)

    Pekurinen, Virve; Willman, Laura; Virtanen, Marianna; Kivimäki, Mika; Vahtera, Jussi; Välimäki, Maritta


    Wellbeing of nurses is associated with patient aggression. Little is known about the differences in these associations between nurses working in different specialties. We aimed to estimate and compare the prevalence of patient aggression and the associations between patient aggression and the wellbeing of nurses in psychiatric and non-psychiatric specialties (medical and surgical, and emergency medicine). A sample of 5288 nurses (923 psychiatric nurses, 4070 medical and surgical nurses, 295 emergency nurses) participated in the study. Subjective measures were used to assess both the occurrence of patient aggression and the wellbeing of nurses (self-rated health, sleep disturbances, psychological distress and perceived work ability). Binary logistic regression with interaction terms was used to compare the associations between patient aggression and the wellbeing of nurses. Psychiatric nurses reported all types of patient aggression more frequently than medical and surgical nurses, whereas nurses working in emergency settings reported physical violence and verbal aggression more frequently than psychiatric nurses. Psychiatric nurses reported poor self-rated health and reduced work ability more frequently than both of the non-psychiatric nursing groups, whereas medical and surgical nurses reported psychological distress and sleep disturbances more often. Psychiatric nurses who had experienced at least one type of patient aggression or mental abuse in the previous year, were less likely to suffer from psychological distress and sleep disturbances compared to medical and surgical nurses. Psychiatric nurses who had experienced physical assaults and armed threats were less likely to suffer from sleep disturbances compared to nurses working in emergency settings. Compared to medical and surgical nurses, psychiatric nurses face patient aggression more often, but certain types of aggression are more common in emergency settings. Psychiatric nurses have worse subjective

  3. Features of the reproductive setting of men and women which are patients of the programs of assisted reproductive technologies (ARTs

    Directory of Open Access Journals (Sweden)

    A. V. Kaminsky


    Full Text Available Infertility refers to those states that significantly affect the psycho-emotional status of a person, causing the state of chronic stress. In turn, chronic stress can lead to the development of stress-induced infertility. The aim of the study was to identify features of the reproductive setting of men and women who are patients of assisted reproductive technology (ART programs in connection with reproductive behavior. Material and methods. Under supervision, there were 233 women and men who needed infertility treatment using ART methods, and 142 fertile women and men who had already had births, and applied for pre-gestational preparation before planning another pregnancy. Methods of psychological testing are used. Results. It has been established that the reproductive setting of infertile men and women is uncertain (contradictory; in it there is a discrepancy and ambivalence in the content of affective, cognitive and conative components. Reproductive testing of individuals having children is definite (harmonious; there is consistency in the content of affective, cognitive and conative components. There are gender differences in the components of the reproductive setting, both infertile and those with children. There is a connection between the type of reproductive setting and the personality characteristics, the relation to the spouse, the motives for the birth of the child. Conclusions. The reproductive settings of infertile men and women who are patients of the ART are different from those of mothers and fathers with newborn babies and require psychological correction.

  4. Job Resources, Physician Work Engagement, and Patient Care Experience in an Academic Medical Setting

    NARCIS (Netherlands)

    Scheepers, Renée A.; Lases, Lenny S. S.; Arah, Onyebuchi A.; Heineman, Maas Jan; Lombarts, Kiki M. J. M. H.


    Purpose Physician work engagement is associated with better work performance and fewer medical errors; however, whether workengaged physicians perform better from the patient perspective is unknown. Although availability of job resources (autonomy, colleague support, participation in decision

  5. An Exploration of the Use of a Sensory Room in a Forensic Mental Health Setting: Staff and Patient Perspectives. (United States)

    Wiglesworth, Sophie; Farnworth, Louise


    Despite the increased use of sensory rooms, there is little published evidence related to their benefits. The purpose of this study was to explore staff and patient perspectives of the use of a sensory room in an Australian forensic mental health setting. Staff and patients on a forensic hospital unit were recruited for this study. Focus group data was obtained from the perspective of the healthcare staff. A sensory assessment identified patients' sensory preferences. The details of the patients sensory room use and stress experienced before and after using the sensory room were recorded. The results showed a mean decrease in stress that was attributed to the use of the sensory room. Stress reducing benefits of sensory room use may improve a patient's experience within a forensic mental health facility while applying a recovery approach. As a limitation of the study, patient stress was rated on an un-validated scale. Further research is needed for greater insight and evidence in evaluating the use of sensory rooms in forensic mental health settings in reducing stress. Copyright © 2016 John Wiley & Sons, Ltd. Copyright © 2016 John Wiley & Sons, Ltd.

  6. [Patients' intervention in a therapeutic education program dedicated to systemic lupus: definitions, setting and benefits]. (United States)

    Hervier, B; Magar, Y; Allab, F; Richard, K; Neves, Y; Danjou, S; Amoura, Z; Ayçaguer, S


    Though recommended, participation of patients with specific expertise in therapeutic education programs (TEP) is rare. This work reports the experience of a national reference centre for rare systemic diseases. Involvement of "expert patients" (EP) has been planned from the development of a TEP dedicated to systemic lupus: patients' roles and required expertise have been defined and linked to the pedagogical tools. Such patients have been recruited during individual interviews and called to participate to specific pedagogical training. EP intervention have been evaluated by questionnaire to EP and health care providers. Three EP's functions have been identified: sharing experiences, giving "tips and tricks" and promoting dialogue. EP's interventions has been organised into a hierarchy (from sharing to co-animation). Among 298 patients enrolled in the TEP, 25 (8.4%) have been identified as possible EP. Eight of them (32%) benefited from a specific training of 12 hours. Among these patients, two (25%) regularly participate to the education sessions. For EP as well as for health care providers, EP's intervention seems beneficial (visual scale scores of 7.5 and 9.5, respectively). Though difficult to organise, EP's intervention in TEP dedicated to rare systemic diseases seems useful and would earn to be increase. Copyright © 2015 Société nationale française de médecine interne (SNFMI). Published by Elsevier SAS. All rights reserved.

  7. Does HIPE data capture the complexity of stroke patients in an acute hospital setting?

    LENUS (Irish Health Repository)

    Clarke, B


    The Hospital Inpatient Enquiry (HIPE) system is currently used as a principle source of national data on discharges from acute hospitals. The Casemix Programme is used to calculate funding for patient care (HIPE activity and Specialty Costs Returns). Th coding is usually undertaken by clerical personnel. We were concerned that the medical complexity of our stroke patients was not captured by the process. The aims of this study were to compare activity coded by HIPE coding staff and medical staff in consecutive stroke patients discharged from the hospital. One hundred consecutive discharged patients with stroke as primary diagnosis were coded by clerical staff [usual practice] and by medical staff. We compared the coding and any differences. We calculated the financial comparison of subsequent differences in Diagnostic Related Groups (DRGs) and Relative Values (RVs). Clinician coded DRGs resulted in a higher assigned RV in 45 cases. The total RV value for HIPE using clerical coding was 595,268.94 euros and using medical coding was 725,252.16 euros. We conclude that medical input is useful in detailing the complications arising in stroke patients. We suggest that physicians should assist in the HIPE coding process in order to capture clinical complexity, so that funding can be appropriately assigned to manage these complex patients.

  8. Implementing standardized, inter-unit communication in an international setting: handoff of patients from emergency medicine to internal medicine. (United States)

    Balhara, Kamna S; Peterson, Susan M; Elabd, Mohamed Moheb; Regan, Linda; Anton, Xavier; Al-Natour, Basil Ali; Hsieh, Yu-Hsiang; Scheulen, James; Stewart de Ramirez, Sarah A


    Standardized handoffs may reduce communication errors, but research on handoff in community and international settings is lacking. Our study at a community hospital in the United Arab Emirates characterizes existing handoff practices for admitted patients from emergency medicine (EM) to internal medicine (IM), develops a standardized handoff tool, and assesses its impact on communication and physician perceptions. EM physicians completed a survey regarding handoff practices and expectations. Trained observers utilized a checklist based on the Systems Engineering Initiative for Patient Safety model to observe 40 handoffs. EM and IM physicians collaboratively developed a written tool encouraging bedside handoff of admitted patients. After the intervention, surveys of EM physicians and 40 observations were subsequently repeated. 77.5% of initial observed handoffs occurred face-to-face, with 42.5% at bedside, and in four different languages. Most survey respondents considered face-to-face handoff ideal. Respondents noted 9-13 patients suffering harm due to handoff in the prior month. After handoff tool implementation, 97.5% of observed handoffs occurred face-to-face (versus 77.5%, p = 0.014), with 82.5% at bedside (versus 42.5%, p face-to-face and bedside handoff, positively impacted workflow, and increased perceptions of safety by EM physicians in an international, non-academic setting. Our three-step approach can be applied towards developing standardized, context-specific inter-specialty handoff in a variety of settings.

  9. The Performance-Perceptual Test (PPT) and its relationship to aided reported handicap and hearing aid satisfaction. (United States)

    Saunders, Gabrielle H; Forsline, Anna


    significant predictors of scores on the HHIE/A such that greater reported handicap is associated with underestimating hearing ability, poorer aided ability to understand speech in noise, and being younger. Scores on the Satisfaction with Amplification in Daily Life were not well explained by the PPT, age, or audiometric thresholds. When individuals were grouped by their HHIE/A scores, it was seen that individuals who report more handicap than expected based on their audiometric thresholds, have a more negative PPDIS, i.e., underestimate their hearing ability, relative to individuals who report expected handicap, who in turn have a more negative PPDIS than individuals who report less handicap than expected. No such patterns were apparent for the Performance SRTN. The study showed the PPT to be a reliable outcome measure that can provide more information than a performance measure and/or a questionnaire measure alone, in that the PPDIS can provide the clinician with an explanation for discrepant objective and subjective reports of hearing difficulties. The finding that self-reported handicap is affected independently by both actual ability to hear and the (mis)perception of ability to hear underscores the difficulty clinicians encounter when trying to interpret outcomes questionnaires. We suggest that this variable should be measured and taken into account when interpreting questionnaires and counseling patients.

  10. Is systematic screening and treatment for latent tuberculosis infection in HIV patients useful in a low endemic setting? (United States)

    Maniewski, Ula; Payen, Marie-Christine; Delforge, Marc; De Wit, Stephane


    A decreasing incidence of tuberculosis (TB) among HIV patients has been documented in high-income settings and screening for tuberculosis is not systematically performed in many clinics (such as ours). Our objectives are to evaluate whether a same decline of incidence was seen in our Belgian tertiary center and to evaluate whether systematic screening and prophylaxis of tuberculosis should remain part of routine practice. Between 2005 and 2012, the annual incidence of tuberculosis among adult HIV patients was measured. The impact of demographic characteristics and CD 4 nadir on the incidence of active TB was evaluated. Among the 1167 patients who entered the cohort, 42 developed active TB with a significant decrease of annual incidence from 28/1000 patient-years in 2005 to 3/1000 patient-years in 2012. Among the 42 cases, 83% were of sub-Saharan origin. Median CD4 cell count upon HIV diagnosis was significantly lower in TB cases and 60% had a nadir CD4 below 200/μl. Thirty-six percent of incident TB occurred within 14 days after HIV diagnosis. A significant decline of TB incidence in HIV patients was observed. Incident TB occurred mainly in African patients, with low CD4 upon HIV diagnosis. A significant proportion of TB cases were discovered early in follow-up which probably reflects TB already present upon HIV diagnosis. In a low endemic setting, exclusion of active TB upon HIV diagnosis remains a priority and screening for LTBI should focus on HIV patients from high risk groups such as migrants from endemic regions, especially in patients with low CD4 nadir.

  11. Fear of failure and self-handicapping in college physical education. (United States)

    Chen, Lung Hung; Chen, Mei-Yen; Lin, Meng-Shyan; Kee, Ying Hwa; Shui, Shang-Hsueh


    The purpose of this study was to examine the relationship between fear of failure and self-handicapping within the context of physical education. Participants were 103 college freshmen enrolled in aerobic dance physical education classes in Taiwan. They completed the Performance Failure Appraisal Inventory and Self-Handicapping Scale for Sport 3 mo. after entering the class. Hierarchical regression indicated that scores on fear of failure predicted self-handicapping scores.

  12. Recovery outcomes of schizophrenia patients treated with paliperidone palmitate in a community setting: patient and provider perspectives on recovery. (United States)

    Williams, Wesley; McKinney, Christopher; Martinez, Larry; Benson, Carmela


    This study evaluated the effect of paliperidone palmitate long-acting injectable (LAI) antipsychotic on recovery-oriented mental health outcomes from the perspective of healthcare providers and patients during the treatment of patients with schizophrenia or schizoaffective disorders. Archival data for patients with a primary diagnosis of schizophrenia or schizoaffective disorder receiving ≥6 months of paliperidone palmitate LAI were retrieved from the electronic medical records system at the Mental Health Center of Denver. Mental health recovery was assessed from both a provider's (Recovery Markers Inventory [RMI]) and patient's (Consumer Recovery Measure [CRM]) perspective. A three-level hierarchical linear model (HLM) was utilized to determine changes in CRM and RMI scores by including independent variables in the models: intercept, months from treatment (slope), treatment time period (pretreatment and treatment), age, gender, primary diagnosis, substance abuse diagnosis, concurrent medications, and adherence to paliperidone palmitate LAI. A total of 219 patients were identified and included in the study. Results of the final three-level HLMs indicated an overall increase in CRM scores (p a retrospective, non-comparative design, and did not adjust for multiplicity Conclusions: The current study demonstrates that changes in recovery-oriented mental health outcomes can be detected following the administration of a specific antipsychotic treatment in persons with schizophrenia or schizoaffective disorders. Furthermore, patients receiving paliperidone palmitate LAI can effectively improve recovery-oriented outcomes, thereby supporting the drug's use as schizophrenia treatment from a recovery-oriented perspective.

  13. Outcomes of surgery in patients aged ≥90 years in the general surgical setting. (United States)

    Sudlow, A; Tuffaha, H; Stearns, A T; Shaikh, I A


    Introduction An increasing proportion of the population is living into their nineties and beyond. These high risk patients are now presenting more frequently to both elective and emergency surgical services. There is limited research looking at outcomes of general surgical procedures in nonagenarians and centenarians to guide surgeons assessing these cases. Methods A retrospective analysis was conducted of all patients aged ≥90 years undergoing elective and emergency general surgical procedures at a tertiary care facility between 2009 and 2015. Vascular, breast and endocrine procedures were excluded. Patient demographics and characteristics were collated. Primary outcomes were 30-day and 90-day mortality rates. The impact of ASA (American Society of Anesthesiologists) grade, operation severity and emergency presentation was assessed using multivariate analysis. Results Overall, 161 patients (58 elective, 103 emergency) were identified for inclusion in the study. The mean patient age was 92.8 years (range: 90-106 years). The 90-day mortality rates were 5.2% and 19.4% for elective and emergency procedures respectively (p=0.013). The median survival was 29 and 19 months respectively (p=0.001). Emergency and major gastrointestinal operations were associated with a significant increase in mortality. Patients undergoing emergency major colonic or upper gastrointestinal surgery had a 90-day mortality rate of 53.8%. Conclusions The risk for patients aged over 90 years having an elective procedure differs significantly in the short term from those having emergency surgery. In selected cases, elective surgery carries an acceptable mortality risk. Emergency surgery is associated with a significantly increased risk of death, particularly after major gastrointestinal resections.

  14. Exploring the Dimensions of Doctor-Patient Relationship in Clinical Practice in Hospital Settings

    Directory of Open Access Journals (Sweden)

    Saurabh RamBiharilal Shrivastava


    Full Text Available The Doctor-Patient Relationship (DPR is a complex concept in the medical sociology in which patients voluntarily approach a doctor and thus become a part of a contract in which they tends to abide with the doctor’s guidance. Globally, the DPR has changed drastically over the years owing to the commercialization and privatization of the health sector. Furthermore, the dynamics of the DPR has shown a significant change because of the formulation of consumer protection acts; clauses for professional misconduct and criminal negligence; establishment of patient forums and organizations; massive expansion of the mass media sector leading to increase in health awareness among people; and changes in the status of the doctors. Realizing the importance of DPR in the final outcome and quality of life of the patient, multiple measures have been suggested to make a correct diagnosis and enhance healing. To conclude, good DPR is the crucial determinant for a better clinical outcome and satisfaction with the patients, irrespective of the socio-cultural determinants.

  15. Psychometric evaluation and design of patient-centered communication measures for cancer care settings. (United States)

    Reeve, Bryce B; Thissen, David M; Bann, Carla M; Mack, Nicole; Treiman, Katherine; Sanoff, Hanna K; Roach, Nancy; Magnus, Brooke E; He, Jason; Wagner, Laura K; Moultrie, Rebecca; Jackson, Kathryn D; Mann, Courtney; McCormack, Lauren A


    To evaluate the psychometric properties of questions that assess patient perceptions of patient-provider communication and design measures of patient-centered communication (PCC). Participants (adults with colon or rectal cancer living in North Carolina) completed a survey at 2 to 3 months post-diagnosis. The survey included 87 questions in six PCC Functions: Exchanging Information, Fostering Health Relationships, Making Decisions, Responding to Emotions, Enabling Patient Self-Management, and Managing Uncertainty. For each Function we conducted factor analyses, item response theory modeling, and tests for differential item functioning, and assessed reliability and construct validity. Participants included 501 respondents; 46% had a high school education or less. Reliability within each Function ranged from 0.90 to 0.96. The PCC-Ca-36 (36-question survey; reliability=0.94) and PCC-Ca-6 (6-question survey; reliability=0.92) measures differentiated between individuals with poor and good health (i.e., known-groups validity) and were highly correlated with the HINTS communication scale (i.e., convergent validity). This study provides theory-grounded PCC measures found to be reliable and valid in colorectal cancer patients in North Carolina. Future work should evaluate measure validity over time and in other cancer populations. The PCC-Ca-36 and PCC-Ca-6 measures may be used for surveillance, intervention research, and quality improvement initiatives. Copyright © 2017 The Authors. Published by Elsevier B.V. All rights reserved.

  16. Effects of 3,4-Methylenedioxymethamphetamine on Patient Utterances in a Psychotherapeutic Setting. (United States)

    Corey, Vicka Rael; Pisano, Vincent D; Halpern, John H


    3,4-Methylenedioxymethamphetamine (MDMA) administered as an adjunct to talk therapy influences patient speech content and increases improvement in treatment-resistant posttraumatic stress disorder (PTSD). Data came from the recordings of Mithoefer et al. (2011). In the third therapeutic session studied, patients were assigned, double blind, to an MDMA or a placebo group. Condition-blind scorers listened to therapy recordings and scored utterances where patients initiated topics that were empathic (regarding others' emotions), entactic (requesting or appreciating physical touch), or ensuic (describing a change in their sense of themselves). Patients who received MDMA produced high levels of ensuic, empathic, and entactic utterances compared with those who received the placebo. Interrater discourse scoring was reliable. The relationship between the number of scored utterances and the Clinician Administered PTSD Scale scores measuring PTSD severity after the treatment was significant, and reanalysis grouped bimodally into "many" or "few" such utterances remained significant. MDMA assisted these patients in having meaningful and disorder-resolving thoughts and discourse in talk therapy.

  17. Health-related quality of life of irritable bowel syndrome patients in different cultural settings. (United States)

    Faresjö, Ashild; Anastasiou, Foteini; Lionis, Christos; Johansson, Saga; Wallander, Mari-Ann; Faresjö, Tomas


    Persons with Irritable bowel syndrome (IBS) are seriously affected in their everyday life. The effect across different cultural settings of IBS on their quality of life has been little studied. The aim was to compare health-related quality of life (HRQOL) of individuals suffering from IBS in two different cultural settings; Crete, Greece and Linköping, Sweden. This study is a sex and age-matched case-control study, with n = 30 Cretan IBS cases and n = 90 Swedish IBS cases and a Swedish control group (n = 300) randomly selected from the general population. Health-related quality of life, measured by SF-36 and demographics, life style indicators and co-morbidity, was measured. Cretan IBS cases reported lower HRQOL on most dimensions of SF-36 in comparison to the Swedish IBS cases. Significant differences were found for the dimensions mental health (p cultural environments could perceive their disease differently and that the disease might affect their everyday life and quality of life in a different way. The Cretan population, and especially women, are more seriously affected mentally by their disease than Swedish IBS cases. Coping with IBS in everyday life might be more problematic in the Cretan environment than in the Swedish setting.

  18. Health-related quality of life of irritable bowel syndrome patients in different cultural settings (United States)

    Faresjö, Åshild; Anastasiou, Foteini; Lionis, Christos; Johansson, Saga; Wallander, Mari-Ann; Faresjö, Tomas


    Background Persons with Irritable bowel syndrome (IBS) are seriously affected in their everyday life. The effect across different cultural settings of IBS on their quality of life has been little studied. The aim was to compare health-related quality of life (HRQOL) of individuals suffering from IBS in two different cultural settings; Crete, Greece and Linköping, Sweden. Methods This study is a sex and age-matched case-control study, with n = 30 Cretan IBS cases and n = 90 Swedish IBS cases and a Swedish control group (n = 300) randomly selected from the general population. Health-related quality of life, measured by SF-36 and demographics, life style indicators and co-morbidity, was measured. Results Cretan IBS cases reported lower HRQOL on most dimensions of SF-36 in comparison to the Swedish IBS cases. Significant differences were found for the dimensions mental health (p cultural environments could perceive their disease differently and that the disease might affect their everyday life and quality of life in a different way. The Cretan population, and especially women, are more seriously affected mentally by their disease than Swedish IBS cases. Coping with IBS in everyday life might be more problematic in the Cretan environment than in the Swedish setting. PMID:16566821

  19. Health-related quality of life of irritable bowel syndrome patients in different cultural settings

    Directory of Open Access Journals (Sweden)

    Johansson Saga


    Full Text Available Abstract Background Persons with Irritable bowel syndrome (IBS are seriously affected in their everyday life. The effect across different cultural settings of IBS on their quality of life has been little studied. The aim was to compare health-related quality of life (HRQOL of individuals suffering from IBS in two different cultural settings; Crete, Greece and Linköping, Sweden. Methods This study is a sex and age-matched case-control study, with n = 30 Cretan IBS cases and n = 90 Swedish IBS cases and a Swedish control group (n = 300 randomly selected from the general population. Health-related quality of life, measured by SF-36 and demographics, life style indicators and co-morbidity, was measured. Results Cretan IBS cases reported lower HRQOL on most dimensions of SF-36 in comparison to the Swedish IBS cases. Significant differences were found for the dimensions mental health (p Conclusion The results from this study tentatively support that the claim that similar individuals having the same disease, e.g. IBS, but living in different cultural environments could perceive their disease differently and that the disease might affect their everyday life and quality of life in a different way. The Cretan population, and especially women, are more seriously affected mentally by their disease than Swedish IBS cases. Coping with IBS in everyday life might be more problematic in the Cretan environment than in the Swedish setting.

  20. Differences between patients' and clinicians' research priorities from the Anaesthesia and Peri-operative Care Priority Setting Partnership. (United States)

    Boney, O; Nathanson, M H; Grocott, M P W; Metcalf, L


    The James Lind Alliance Anaesthesia and Peri-operative Care Priority Setting Partnership was a recent collaborative venture bringing approximately 2000 patients, carers and clinicians together to agree priorities for future research into anaesthesia and critical care. This secondary analysis compares the research priorities of 303 service users, 1068 clinicians and 325 clinicians with experience as service users. All three groups prioritised research to improve patient safety. Service users prioritised research about improving patient experience, whereas clinicians prioritised research about clinical effectiveness. Clinicians who had experience as service users consistently prioritised research more like clinicians than like service users. Individual research questions about patient experience were more popular with patients and carers than with clinicians in all but one case. We conclude that patients, carers and clinicians prioritise research questions differently. All groups prioritise research into patient safety, but service users also favour research into patient experience, whereas clinicians favour research into clinical effectiveness. © 2017 The Association of Anaesthetists of Great Britain and Ireland.

  1. The patient's use of metaphor within a palliative care setting: theory, function and efficacy. A narrative literature review. (United States)

    Southall, David


    The modes of communication which patients use are seen as important within the sphere of palliative care and have been the focus of much research. This literature review aims to identify and analyse one particular mode of patient expression, namely that of the figure of speech (trope) 'metaphor', and ask questions regarding metaphor's therapeutic usefulness when engaging with the life-limited patient. The investigation revolves around a literature review of academic papers which focus on the metaphorical ways in which patients speak of their condition. This paper provides the theoretical foundations for the patient's metaphoric utterances. It also delineates the variety and diversity of metaphors used by patients and categorises them into broad groupings which encompass metaphors of war, journeying, personhood, the natural world and existential concepts. The papers reviewed suggest that metaphoric communication allows sensitive subjects to be dealt with and provides benefits for patients. The results suggest that engaging with patients at the metaphoric level enables them to create new ways of viewing their situation and opens up the possibilities of new coping strategies. Finally, some developmental trajectories emanating from the reviewed papers are suggested, which will allow the efficacy of metaphor to be explored further within a palliative care setting.

  2. Supplementing electronic health records through sample collection and patient diaries: A study set within a primary care research database. (United States)

    Joseph, Rebecca M; Soames, Jamie; Wright, Mark; Sultana, Kirin; van Staa, Tjeerd P; Dixon, William G


    To describe a novel observational study that supplemented primary care electronic health record (EHR) data with sample collection and patient diaries. The study was set in primary care in England. A list of 3974 potentially eligible patients was compiled using data from the Clinical Practice Research Datalink. Interested general practices opted into the study then confirmed patient suitability and sent out postal invitations. Participants completed a drug-use diary and provided saliva samples to the research team to combine with EHR data. Of 252 practices contacted to participate, 66 (26%) mailed invitations to patients. Of the 3974 potentially eligible patients, 859 (22%) were at participating practices, and 526 (13%) were sent invitations. Of those invited, 117 (22%) consented to participate of whom 86 (74%) completed the study. We have confirmed the feasibility of supplementing EHR with data collected directly from patients. Although the present study successfully collected essential data from patients, it also underlined the requirement for improved engagement with both patients and general practitioners to support similar studies. © 2017 The Authors. Pharmacoepidemiology & Drug Safety published by John Wiley & Sons Ltd.


    Directory of Open Access Journals (Sweden)

    V. V. Streltsov


    Full Text Available The psychological trauma of pulmonary tuberculosis and long-term treatment may cause the development and progression of different borderline neuropsychic disorders in patients, lower therapeutic effectiveness, and prematurely discontinue therapy. The main practical tasks of psychological rehabilitation during intensive treatment are to render care for a patient during his adaptation to the hospital setting, to correct inadequate attitude towards disease, and to motivate active cooperation with specialists. Competent psychological support of drug therapy promotes a reduction in the intensity of psychic and somatic experiences in the patient and an increase in his psychological resources. A respective microclimate in the tuberculosis control facility and a patient-centered doctorpatient model should be considered as the most important rehabilitation factors.

  4. Percutaneous Tibial Nerve Stimulation in the Office Setting: Real-world Experience of Over 100 Patients. (United States)

    Sirls, Evan R; Killinger, Kim A; Boura, Judith A; Peters, Kenneth M


    To examine the outcomes and compliance with percutaneous tibial nerve stimulation (PTNS) for overactive bladder (OAB) symptoms. Adults who had PTNS from June 30, 2011, to October 8, 2015, were retrospectively reviewed for demographics, copay, travel distance, employment status, history, symptoms, and treatments used before, during, and after PTNS. Pearson chi-square test, Fisher exact test, Wilcoxon rank and paired t test were performed. Of 113 patients (mean age 75 ± 12 years), most were women (65.5%), married (78.1%), and retired or unemployed (80.2%). The median distance to the clinic was 8.1 mi, and the median copay was $0. The most common indication for PTNS was nocturia (92.9%) followed by OAB with urgency urinary incontinence (75.2%) and urinary urgency and/or frequency (24.8%). Prior treatments included anticholinergics (75.2%), mirabegron (36.6%), behavioral modification (29.2%), pelvic floor physical therapy (18.6%), and others (19.5%). Patients completed a mean of 10.5 ± 3 of 12 planned weekly PTNS treatments. Of 105 patients, 40 (38.1%) used concomitant treatments (most commonly anticholinergics). Of 87 patients, 62 (71.3%) had decreased symptoms at 6 weeks, and of 85 patients, 60 (70.6%) had decreased symptoms at 12 weeks. The majority (82; 75.6%) completed all 12 weekly treatments and 45 (54.9%) completed 3 (median) monthly maintenance treatments. The most common reason for noncompliance was lack of efficacy. Visit copay, employment status, and distance to the clinic were not associated with failure to complete weekly treatments or progression to monthly maintenance. Although most patients' symptoms decreased after weekly PTNS, nonadherence to maintenance and lack of efficacy may limit long-term feasibility. Copay and distance traveled were not associated with noncompliance. Copyright © 2017 Elsevier Inc. All rights reserved.

  5. Choosing the right rehabilitation setting after herniated disc surgery: Motives, motivations and expectations from the patients' perspective. (United States)

    Löbner, Margrit; Stein, Janine; Luppa, Melanie; Konnopka, Alexander; Meisel, Hans Jörg; Günther, Lutz; Meixensberger, Jürgen; Stengler, Katarina; Angermeyer, Matthias C; König, Hans-Helmut; Riedel-Heller, Steffi G


    This study aims to investigate (1) motives, motivations and expectations regarding the choice for a specific rehabilitation setting after herniated disc surgery and (2) how rehabilitation-related motivations and expectations are associated with rehabilitation outcome (ability to work, health-related quality of life and satisfaction with rehabilitation) three months after disc surgery. The longitudinal cohort study refers to 452 disc surgery patients participating in a subsequent rehabilitation. Baseline interviews took part during acute hospital stay (pre-rehabilitation), follow-up interviews three months later (post-rehabilitation). Binary logistic regression and multiple linear regression analyses were applied. (1) Motives, motivations and expectations: Inpatient rehabilitation (IPR) patients stated "less effort/stress" (40.9%), more "relaxation and recreation" (39.1%) and greater "intensity of care and treatment" (37.0%) regarding their setting preference, whereas outpatient rehabilitation (OPR) patients indicated "family reasons" (45.3%), the wish for "staying in familiar environment" (35.9%) as well as "job-related reasons" (11.7%) as most relevant. IPR patients showed significantly higher motivation/expectation scores regarding regeneration (p job (p example, patients with less motivations/expectations to achieve improvements regarding "physical burden" showed a better health-related quality of life (p satisfaction with rehabilitation (OR = .806; p < .05). Rehabilitation-related motivations and expectations differed substantially between IPR and OPR patients before rehabilitation and were significantly associated with rehabilitation outcome. Taking motivational and expectation-related aspects into account may help to improve allocation procedures for different rehabilitation settings and may improve rehabilitation success.

  6. The diagnostic value of endoscopy and Helicobacter pylori tests for peptic ulcer patients in late post-treatment setting

    Directory of Open Access Journals (Sweden)

    Kull Ingrid


    Full Text Available Abstract Background Guidelines for management of peptic ulcer patients after the treatment are largely directed to detection of H. pylori infection using only non-invasive tests. We compared the diagnostic value of non-invasive and endoscopy based H. pylori tests in a late post-treatment setting. Methods Altogether 34 patients with dyspeptic complaints were referred for gastroscopy 5 years after the treatment of peptic ulcer using a one-week triple therapy scheme. The endoscopic and histologic findings were evaluated according to the Sydney classification. Bacteriological, PCR and cytological investigations and 13C-UBT tests were performed. Results Seventeen patients were defined H. pylori positive by 13C-UBT test, PCR and histological examination. On endoscopy, peptic ulcer persisted in 4 H. pylori positive cases. Among the 6 cases with erosions of the gastric mucosa, only two patients were H. pylori positive. Mucosal atrophy and intestinal metaplasia were revealed both in the H. pylori positive and H. pylori negative cases. Bacteriological examination revealed three clarithromycin resistant H. pylori strains. Cytology failed to prove validity for diagnosing H. pylori in a post-treatment setting. Conclusions In a late post-treatment setting, patients with dyspepsia should not be monitored only by non-invasive investigation methods; it is also justified to use the classical histological evaluation of H. pylori colonisation, PCR and bacteriology as they have shown good concordance with 13C-UBT. Moreover, endoscopy and histological investigation of a gastric biopsy have proved to be the methods with an additional diagnostic value, providing the physician with information about inflammatory, atrophic and metaplastic lesions of the stomach in dyspeptic H. pylori positive and negative patients. Bacteriological methods are suggested for detecting the putative antimicrobial resistance of H. pylori, aimed at successful eradication of infection in

  7. [Gastric cancer risk estimate in patients with chronic gastritis associated with Helicobacter pylori infection in a clinical setting]. (United States)

    Arismendi-Morillo, G; Hernández, I; Mengual, E; Abreu, N; Molero, N; Fuenmayor, A; Romero, G; Lizarzábal, M


    Severity of chronic gastritis associated with Helicobacter pylori infection (CGAHpI) could play a role in evaluating the potential risk to develop gastric cancer. Our aim was to estimate the risk for gastric cancer in a clinical setting, according to histopathologic criteria, by applying the gastric cancer risk index (GCRI) METHODS: Histopathologic study of the gastric biopsies (corpus-antrum) from consecutive adult patients that underwent gastroesophageal duodenoscopy was carried out, and the GCRI was applied in patients presenting with CGAHpI. One hundred eleven patients (77% female) with a mean age of 38.6±13.1 years were included. Active Helicobacter pylori infection (aHpi) was diagnosed in 77 cases (69.40%). In 45% of the cases with aHpi, pangastritis (23%) or corpus-predominant gastritis (22%) was diagnosed. Nine cases were diagnosed with intestinal metaplasia (8%), 7 of which (77.70%) were in the aHpi group. Twenty one percent of the patients with aHpi had a GCRI of 2 (18.10%) or 3 (2.50%) points (high risk index), while 79.10% accumulated a GCRI of 0 or 1 points (low risk index). Of the patients with no aHpi, none of them had 3 points (p=0.001). Of the 18 patients that accumulated 2 or 3 points, 6 (33.30%) presented with intestinal metaplasia (all with pangastritis and corpus-predominant gastritis), of which 4 cases (66.60%) had aHpi. The estimated gastric cancer risk in patients with CGAHpI in the clinical setting studied was relatively low and 5% of the patients had a histopathologic phenotype associated with an elevated risk for developing gastric cancer. Copyright © 2012 Asociación Mexicana de Gastroenterología. Published by Masson Doyma México S.A. All rights reserved.

  8. Blood-borne virus transmission in healthcare settings in Ireland: review of patient notification exercises 1997-2011.

    LENUS (Irish Health Repository)

    Donohue, S


    A review of patient notification exercises (PNEs) carried out in Ireland between 1997 and 2011 to investigate potential exposure to blood-borne viruses (BBVs) in healthcare settings was undertaken to inform future policy and practice. A questionnaire was sent to key informants in the health services to identify all relevant PNEs. Structured interviews were conducted with key investigators, and available documentation was examined. Ten BBV-related PNEs were identified. Despite testing over 2000 patients, only one case of transmission was found. However, in-depth local investigations before undertaking the PNEs identified six cases of healthcare-associated transmission.

  9. Use of intubating laryngeal mask airway in a morbidly obese patient with chest trauma in an emergency setting

    Directory of Open Access Journals (Sweden)

    Tripat Bindra


    Full Text Available A morbidly obese male who sustained blunt trauma chest with bilateral pneumothorax was referred to the intensive care unit for management of his condition. Problems encountered in managing the patient were gradually increasing hypoxemia (chest trauma with multiple rib fractures with lung contusions and difficult mask ventilation and intubation (morbid obesity, heavy jaw, short and thick neck. We performed awake endotracheal intubation using an intubating laryngeal mask airway (ILMA size 4 and provided mechanical ventilation to the patient. This report suggests that ILMA can be very useful in the management of difficult airway outside the operating room and can help in preventing adverse events in an emergency setting.

  10. Optimizing the Nutritional Support of Adult Patients in the Setting of Cirrhosis. (United States)

    Perumpail, Brandon J; Li, Andrew A; Cholankeril, George; Kumari, Radhika; Ahmed, Aijaz


    The aim of this work is to develop a pragmatic approach in the assessment and management strategies of patients with cirrhosis in order to optimize the outcomes in this patient population. A systematic review of literature was conducted through 8 July 2017 on the PubMed Database looking for key terms, such as malnutrition, nutrition, assessment, treatment, and cirrhosis. Articles and studies looking at associations between nutrition and cirrhosis were reviewed. An assessment of malnutrition should be conducted in two stages: the first, to identify patients at risk for malnutrition based on the severity of liver disease, and the second, to perform a complete multidisciplinary nutritional evaluation of these patients. Optimal management of malnutrition should focus on meeting recommended daily goals for caloric intake and inclusion of various nutrients in the diet. The nutritional goals should be pursued by encouraging and increasing oral intake or using other measures, such as oral supplementation, enteral nutrition, or parenteral nutrition. Although these strategies to improve nutritional support have been well established, current literature on the topic is limited in scope. Further research should be implemented to test if this enhanced approach is effective.

  11. Lyme disease in the Dutch policy context: patient consultation in government research agenda setting

    NARCIS (Netherlands)

    den Oudendammer, W.M.; Broerse, J.E.W.


    Prevalence of Lyme disease (LD) is increasing in the Netherlands. The Dutch Association for Lyme Disease Patients (NVLP) presented a petition to the Dutch Parliament for more LD research and political attention. The Parliament requested advice from the Health Council of the Netherlands, which among

  12. Risk of Lymphoma and Solid Cancer among Patients with Rheumatoid Arthritis in a Primary Care Setting

    DEFF Research Database (Denmark)

    Andersen, Christen Bertel L; Lindegaard, Hanne Merete; Vestergaard, Hanne


    lymphoproliferative malignancies or solid cancers. These risk estimates did not change when eosinophilia, CRP, and comorbidities were included in the models. CONCLUSIONS: In this large cohort of patients with RA of short or long duration recruited from a primary care resource, RA was not associated with an increased...

  13. Optimizing the Nutritional Support of Adult Patients in the Setting of Cirrhosis

    Directory of Open Access Journals (Sweden)

    Brandon J. Perumpail


    Full Text Available Aim: The aim of this work is to develop a pragmatic approach in the assessment and management strategies of patients with cirrhosis in order to optimize the outcomes in this patient population. Method: A systematic review of literature was conducted through 8 July 2017 on the PubMed Database looking for key terms, such as malnutrition, nutrition, assessment, treatment, and cirrhosis. Articles and studies looking at associations between nutrition and cirrhosis were reviewed. Results: An assessment of malnutrition should be conducted in two stages: the first, to identify patients at risk for malnutrition based on the severity of liver disease, and the second, to perform a complete multidisciplinary nutritional evaluation of these patients. Optimal management of malnutrition should focus on meeting recommended daily goals for caloric intake and inclusion of various nutrients in the diet. The nutritional goals should be pursued by encouraging and increasing oral intake or using other measures, such as oral supplementation, enteral nutrition, or parenteral nutrition. Conclusions: Although these strategies to improve nutritional support have been well established, current literature on the topic is limited in scope. Further research should be implemented to test if this enhanced approach is effective.

  14. [Cost-effectiveness analysis of schizophrenic patient care settings: impact of an atypical antipsychotic under long-acting injection formulation]. (United States)

    Llorca, P M; Miadi-Fargier, H; Lançon, C; Jasso Mosqueda, G; Casadebaig, F; Philippe, A; Guillon, P; Mehnert, A; Omnès, L F; Chicoye, A; Durand-Zaleski, I


    Schizophrenia is a disease affecting the young adults and amounts to approximately 300,000 people in France. The French public psychiatric sector takes care of approximately 150,000 adults schizophrenics: 50% benefit from ambulatory care, 50% are in partial or full-time hospitalization care. Schizophrenia represents the first diagnosis that psychiatric sectors take in charge. The costs associated with schizophrenia, mainly hospital costs, are important and were estimated at 2% of the total medical costs in France. In the French social welfare system, the social costs (pensions, allowances, managements of custody or guardianship by social workers) are also to be taken into account: it amounts to a third of the global direct cost. Schizophrenia also generates indirect costs (losses of productivity and premature deaths) which would be at least equal, or even more important, than direct medical costs. The non-compliance to the antipsychotic treatment is a major problem with people suffering from schizophrenia. Indeed the lack of compliance to the treatment, estimated at 20 to 40%, is a major handicap for schizophrenic patient stabilization. The poor level of compliance is due to many various causes: adverse effects that are considered unbearable, medicine viewed as persecutory, negation of the disease, nostalgia for the productive phases of the disease, lack of social support, complexity of the prescription, relapse itself. Compliance is thus influenced by the patient's clinical features, local provision of health care and the specific nature of the drug (adverse effects, pharmaceutical formulation). The atypical antipsychotics present fewer extrapyramidal side effects and reduce the cognitive deficits associated with the disease, which results in improved compliance. Long-acting injectable antipsychotics allow a better therapeutic compliance and thus better efficacy of the treatment. Several studies have shown a significant improvement in compliance related to the

  15. Reliability of Patient-Led Screening with the Malnutrition Screening Tool: Agreement between Patient and Health Care Professional Scores in the Cancer Care Ambulatory Setting. (United States)

    Di Bella, Alexandra; Blake, Claire; Young, Adrienne; Pelecanos, Anita; Brown, Teresa


    feedback, almost all reported that the MST was clear (92%), questions were easy to understand (95%), and completion time was ≤5 minutes (99%). Patient-led screening with the MST is reliable and well accepted by patients. Patient-led screening in the cancer care ambulatory setting has the potential to improve patient autonomy and screening completion rates. Copyright © 2018 Academy of Nutrition and Dietetics. Published by Elsevier Inc. All rights reserved.

  16. Assessment of patient satisfaction with acute pain management service: Monitoring quality of care in clinical setting

    Directory of Open Access Journals (Sweden)

    Fizzah Farooq


    Full Text Available Background and Aims: Assessment of patient satisfaction is an important tool for monitoring the quality of care in hospitals. The aim of this survey was to develop a reliable tool to assess patient satisfaction with acute pain management service (APMS and identify variables affecting this so that care can be improved. Methods: A questionnaire was developed and administered to  patients after being discharged from APMS care by an unbiased person. Data collected from record included patient demographics, surgical procedure, analgesic modality, co-analgesics and dynamic and static pain scores. Questions included pain expected and pain experienced, APMS response time, quality of pain relief with treatment, professionalism of APMS team, overall experience of pain relief and choosing/suggesting same modality for themselves/family/friends again. Five-point Likert scale was used for most of the options. Statistical analysis was done using SPSS 19. Results: Frequency and percentages were computed for qualitative observation and presented on pie chart and histogram. Seventy-one per cent patients expected severe pain while 43% actually experienced it. About 79.4% would choose same analgesia modality in future for self/family/friends. Ninety-nine per cent found APMS staff courteous and professional. About 89% rated their experience of pain management as excellent to very good. Conclusion: The survey of patients′ satisfaction to monitor the quality of care provided by APMS provided positive inputs on its role. This also helps to identify areas requiring improvement in care and as a tool to gauge the quality of care.

  17. Risk factors of treatment default and death among tuberculosis patients in a resource-limited setting. (United States)

    Alobu, Isaac; Oshi, Sarah N; Oshi, Daniel C; Ukwaja, Kingsley N


    To evaluate the rates, timing and determinants of default and death among adult tuberculosis patients in Nigeria. Routine surveillance data were used. A retrospective cohort study of adult tuberculosis patients treated during 2011 and 2012 in two large health facilities in Ebonyi State, Nigeria was conducted. Multivariable logistic regression analyses were used to identify independent predictors for treatment default and death. Of 1 668 treated patients, the default rate was 157 (9.4%), whilst 165 (9.9%) died. Also, 35.7% (56) of the treatment defaults and 151 (91.5%) of deaths occurred during the intensive phase of treatment. Risk of default increased with increasing age (adjusted odds ratio (aOR) 1.2; 95% confidence interval (CI) 1.1-1.9), smear-negative TB case (aOR 2.3; CI 1.5-3.6), extrapulmonary TB case (aOR 2.7; CI 1.3-5.2), and patients who received the longer treatment regimen (aOR 1.6; 1.1-2.2). Risk of death was highest in extrapulmonary TB (aOR 3.0; CI 1.4-6.1) and smear-negative TB cases (aOR 2.4; CI 1.7-3.5), rural residents (aOR 1.7; CI 1.2-2.6), HIV co-infected (aOR 2.5; CI 1.7-3.6), not receiving antiretroviral therapy (aOR 1.6; CI 1.1-2.9), and not receiving cotrimoxazole prophylaxis (aOR 1.7; CI 1.2-2.6). Targeted interventions to improve treatment adherence for patients with the highest risk of default or death are urgently needed. This needs to be urgently addressed by the National Tuberculosis Programme. Copyright © 2014 Hainan Medical College. Published by Elsevier B.V. All rights reserved.

  18. Diabetes Health Literacy Among Somali Patients with Diabetes Mellitus in a US Primary Care Setting. (United States)

    Njeru, Jane W; Hagi-Salaad, Misbil F; Haji, Habibo; Cha, Stephen S; Wieland, Mark L


    The purpose of this study was to describe diabetes literacy among Somali immigrants with diabetes and its association with diabetes outcomes. Among Somali immigrants in North America, the prevalence of diabetes exceeds that of the general population, and their measures of diabetes control are suboptimal when compared with non-Somali patients. Diabetes literacy is an important mediator of diabetes outcomes in general populations that has not been previously described among Somali immigrants and refugees. Diabetes literacy was measured using a translated version of the spoken knowledge in low literacy in diabetes (SKILLD) scale among Somali immigrants and refugees with type 2 diabetes. Diabetes outcome measures, including hemoglobin A1C, low-density lipoprotein (LDL) cholesterol, and blood pressure, were obtained for each patient. Multivariate logistic regression was used to assess associations between diabetes literacy and diabetes outcomes. Among 50 Somali patients with diabetes who completed the survey, the mean SKILLD score was low (42.2 %). The diabetes outcome measures showed a mean hemoglobin A1C of 8 %, LDL cholesterol of 99.17 mg/dL (2.57 mmol/L), systolic blood pressure of 130.9 mmHg, and diastolic blood pressure of 70.2 mmHg. There was no association between diabetes literacy scores and diabetes outcome measures. Somali patients with diabetes mellitus had low diabetes literacy and suboptimal measures of diabetes disease control. However, we found no association between diabetes literacy and diabetes outcomes. Future work aimed at reduction of diabetes-related health disparities among Somali immigrants and refugees to high-income countries should go beyond traditional means of patient education for low-literacy populations.

  19. Health-seeking behaviour among patients with faecal incontinence in a Malaysian academic setting. (United States)

    Roslani, A C; Ramakrishnan, R; Azmi, S


    Faecal incontinence (FI) is not a common presenting complaint in Malaysia, and little has been published on this topic. Since it is a treatable condition, a greater understanding of factors contributing to healthseeking behaviour is needed in order to plan effective provision of services. A survey of 1000 patients and accompanying relatives, visiting general surgical and obstetrics and gynaecology clinics for matters unrelated to FI, was conducted at University Malaya Medical Centre between January 2009 and February 2010. A follow-up regression analysis of the 83 patients who had FI, to identify factors associated with health-seeking behaviour, was performed. Variables identified through univariate analysis were subjected to multivariate analysis to determine independence. Reasons for not seeking treatment were also analysed. Only eight patients (9.6%) had sought medical treatment. On univariate analysis, the likelihood of seeking treatment was significantly higher among patients who had more severe symptoms (OR 30.0, p=0.002), had incontinence to liquid stool (OR 3.83, p=0.002) or when there was an alteration to lifestyle (OR: 17.34; p<0.001). Nevertheless, the only independently-associated variable was alteration in lifestyle. Common reasons given for not seeking treatment was that the condition did not affect patients' daily activities (88.0%), "social taboo" (5.3%) and "other" reasons (6.7%). Lifestyle alteration is the main driver of healthseeking behaviour in FI. However, the majority do not seek treatment. Greater public and physician-awareness on FI and available treatment options is needed.

  20. [Therapeutic effects of venlafaxine extended release for patients with depressive and anxiety disorders in the German outpatient setting - results of 2 observational studies including 8500 patients]. (United States)

    Anghelescu, I-G; Dierkes, W; Volz, H-P; Loeschmann, P-A; Schmitt, A B


    The therapeutic effects of venlafaxine extended release have been investigated by two prospective observational studies including 8506 patients in the outpatient setting of office based general practitioners and specialists. The efficacy has been documented by the Clinical Global Impression (CGI) scale and by the Hamilton depression (HAMD-21) scale. The tolerability has been assessed by the documentation of adverse events. About (2/3) of the patients were treated because of depression and about (1/3) mainly because of anxiety disorder. The patients of specialists did receive higher dosages and were more severely affected. The response rate on the CGI scale was 87.4 for the patients of general practitioners and 74.2 % for the patients of specialists. The results of the HAMD-21 scale, which has been used by specialists, showed a response rate of 71.8 and a remission rate of 56.3 %. These positive effects could be demonstrated even for the more severely and chronically affected patients. The incidence of adverse events was low in both studies and comparable to the tolerability profile of randomized studies. Importantly, the good tolerability profile was similar even for patients with concomitant cardiovascular disease. In conclusion, these results confirm the efficacy and good tolerability of venlafaxine extended release in the outpatient setting in Germany. Georg Thieme Verlag KG Stuttgart, New York.

  1. Goal Setting and Treatment Adherence Among Patients With Chronic Illness and Depressive Symptoms: Applying a Patient-Centered Approach. (United States)

    Houston, Eric; Tatum, Alexander K; Guy, Arryn; Mikrut, Cassandra; Yoder, Wren


    Poor treatment adherence is a major problem among individuals with chronic illness. Research indicates that adherence is worsened when accompanied by depressive symptoms. In this preliminary study, we aimed to describe how a patient-centered approach could be employed to aid patients with depressive symptoms in following their treatment regimens. The sample consisted of 14 patients undergoing antiretroviral therapy (ART) for HIV who reported clinically-significant depressive symptoms. Participant ratings of 23 treatment-related statements were examined using two assessment and analytic techniques. Interviews were conducted with participants to determine their views of information based on the technique. Results indicate that while participants with optimal adherence focused on views of treatment associated with side effects to a greater extent than participants with poor adherence, they tended to relate these side effects to sources of intrinsic motivation. The study provides examples of how practitioners could employ the assessment techniques outlined to better understand how patients think about treatment and aid them in effectively framing their health-related goals.

  2. Patient's perception, compliance to treatment and health education of antiretroviral therapy among HIV patients at a tertiary healthcare setting

    International Nuclear Information System (INIS)

    Hussain, A.R.; Abbas, S.M.; Reza, T.E


    Objective: To illustrate perceptions, compliance to treatment and satisfaction levels regarding health education services pertaining to the anti-retrovival therapy among HIV and AIDS patients. Methods: The cross-sectional survey was carried out at the HIV Treatment Centre, Pakistan Institute of Medical Sciences (PIMS), Islamabad, from September 2009 to February 2010 in which patients were interviewed separately regarding their perceptions, compliance to treatment and satisfaction levels regarding health education services pertaining to the anti-retrovival therapy. All data collected was entered into SPSS version 15.0. The data was re-validated and analysed. Results: One hundred and forty patients were interviewed; there were 99 (70.7%) males.. Of the total, 28 (20%) had no knowledge about the beneficial effects of the therapy, and 45 (32 %) ranked health education services extremely beneficial in understanding the anti-retrovival therapy. Conclusion: While a significant proportion of patients considered ART either somewhat beneficial or beneficial in treating their ailment, they were unclear about the impact of health education provided at the treatment centre and different forms of print media. (author)

  3. Patient's perception, compliance to treatment and health education of antiretroviral therapy among HIV patients at a tertiary healthcare setting. (United States)

    Hussain, Aleem Raza; Abbas, Syed Muslim; Uzma, Qudsia; Reza, Tahira Ezra


    To illustrate perceptions, compliance to treatment and satisfaction levels regarding health education services pertaining to the anti-retrovival therapy among HIV and AIDS patients. The cross-sectional survey was carried out at the HIV Treatment Centre, Pakistan Institute of Medical Sciences (PIMS), Islamabad, from September 2009 to February 2010 in which patients were interviewed separately regarding their perceptions, compliance to treatment and satisfaction levels regarding health education services pertaining to the anti-retrovival therapy. All data collected was entered into SPSS version 15.0. The data was revalidated and analysed. One hundred and forty patients were interviewed; there were 99 (70.7%) males.. Of the total, 28 (20%) had no knowledge about the beneficial effects of the therapy, and 45 (32 %) ranked health education services extremely beneficial in understanding the anti-retrovival therapy. While a significant proportion of patients considered ART either somewhat beneficial or beneficial in treating their ailment, they were unclear about the impact of health education provided at the treatment centre and different forms of print media.

  4. Vocal handicap index in popular and erudite professional singers. (United States)

    Loiola-Barreiro, Camila Miranda; Silva, Marta Assumpção de Andrada E

    To compare the voice handicap index of popular and erudite professional singers according to gender, age, professional experience time, and presence or absence of self-reported vocal complaints. One hundred thirty-two professional singers, 74 popular and 58 erudite, who responded to a questionnaire with regards to identification, age, gender, professional experience time in singing, musical genres (for popular singers), vocal classification (for erudite singers), presence of self-reported vocal complaints, and the specific protocols for popular (Modern Singing Handicap Index - MSHI) and erudite (Classical Singing Handicap Index - CSHI) singing. Higher proportion of women and higher incidence of vocal complaints were observed in the popular singers compared with the erudite singers. Most of the popular singers belonged to the genre of Brazilian Popular Music. Regarding the classification of erudite singers, there was greater participation of sopranos and tenors. No statistical differences were observed with respect to age and professional experience time between the groups. Comparison of the MSHI and CSHI scores showed no statistically significant difference between these scores and genre or age in both groups of singers. Professional experience time was related to the total score and the subscales disability and impairment in the MSHI, only for popular singers with vocal complaints. There was no correlation between these variables and the CSHI for erudite singers. The impact of vocal difficulty/problem interferes differently in these two musical genres when related to vocal complaint and professional experience time. The MSHI and CSHI protocols proved to be important tools not only for the identification of problems, but also for the understanding of how these individuals relate their voices with this occupational activity.

  5. Selective nontreatment of handicapped newborns: a critical essay. (United States)

    Kohrman, A F


    The neonatal intensive care unit is the site of some of the most dramatic technology, complex decision-making and costly activity in the current range of medical institutions. Thus, the decisions made there are particularly visible, and of concern to a society which has increasingly scrutinized and challenged medical practices. Questions of marginal utility and cost-benefit relationships are becoming increasingly prominent. These concerns are heightened by the social and political tensions over issues of the time of initiation of life, quality of life, and assurances of equity for those less well off or handicapped from birth. Robert Weir's book, Selective Nontreatment of Handicapped Newborns, successfully summarizes the current dilemmas and identifies areas of uncertainty and lack of knowledge which cloud the decision-making processes. The book reviews the positions of the major protagonists of the last several years; inevitably, their positions will undergo continuous evolution in response to new data and vigorous political and public policy activity. Weir appropriately identifies the difficulty in arriving at an accurate prognosis as an important and prominent problem in decision-making about defective newborns. The population of surviving, compromised newborns is relatively unfamiliar and their problems remain largely unstudied. Weir's discussion of the desirability of the establishment of Infant Care Review Committees in those institutions which care for defective and handicapped newborns thoughtfully concludes that such committees are, on the balance, desirable. As experience accumulates with Infant Care Review Committees, they should serve the positive purpose of generating open discussion of legitimate disagreements. These committees will provide a forum in which decision-makers can disclose uncertainty, consider alternatives, and receive counsel.(ABSTRACT TRUNCATED AT 250 WORDS)

  6. Electronic health records and patient safety: co-occurrence of early EHR implementation with patient safety practices in primary care settings. (United States)

    Tanner, C; Gans, D; White, J; Nath, R; Pohl, J


    The role of electronic health records (EHR) in enhancing patient safety, while substantiated in many studies, is still debated. This paper examines early EHR adopters in primary care to understand the extent to which EHR implementation is associated with the workflows, policies and practices that promote patient safety, as compared to practices with paper records. Early adoption is defined as those who were using EHR prior to implementation of the Meaningful Use program. We utilized the Physician Practice Patient Safety Assessment (PPPSA) to compare primary care practices with fully implemented EHR to those utilizing paper records. The PPPSA measures the extent of adoption of patient safety practices in the domains: medication management, handoffs and transition, personnel qualifications and competencies, practice management and culture, and patient communication. Data from 209 primary care practices responding between 2006-2010 were included in the analysis: 117 practices used paper medical records and 92 used an EHR. Results showed that, within all domains, EHR settings showed significantly higher rates of having workflows, policies and practices that promote patient safety than paper record settings. While these results were expected in the area of medication management, EHR use was also associated with adoption of patient safety practices in areas in which the researchers had no a priori expectations of association. Sociotechnical models of EHR use point to complex interactions between technology and other aspects of the environment related to human resources, workflow, policy, culture, among others. This study identifies that among primary care practices in the national PPPSA database, having an EHR was strongly empirically associated with the workflow, policy, communication and cultural practices recommended for safe patient care in ambulatory settings.

  7. Patients with uninjured lungs may also benefit from lung-protective ventilator settings [version 1; referees: 2 approved

    Directory of Open Access Journals (Sweden)

    Roger Alencar


    Full Text Available Although mechanical ventilation is a life-saving strategy in critically ill patients and an indispensable tool in patients under general anesthesia for surgery, it also acts as a double-edged sword. Indeed, ventilation is increasingly recognized as a potentially dangerous intrusion that has the potential to harm lungs, in a condition known as ‘ventilator-induced lung injury’ (VILI. So-called ‘lung-protective’ ventilator settings aiming at prevention of VILI have been shown to improve outcomes in patients with acute respiratory distress syndrome (ARDS, and, over the last few years, there has been increasing interest in possible benefit of lung-protective ventilation in patients under ventilation for reasons other than ARDS. Patients without ARDS could benefit from tidal volume reduction during mechanical ventilation. However, it is uncertain whether higher levels of positive end-expiratory pressure could benefit these patients as well. Finally, recent evidence suggests that patients without ARDS should receive low driving pressures during ventilation.

  8. Early initiation of night-time NIV in an outpatient setting: a randomized non-inferiority study in ALS patients. (United States)

    Bertella, Enrica; Banfi, Paolo; Paneroni, Mara; Grilli, Silvia; Bianchi, Luca; Volpato, Eleonora; Vitacca, Michele


    In patients with amyotrophic lateral sclerosis (ALS), non-invasive ventilation (NIV) is usually initiated in an in-hospital regime. We investigated if NIV initiated in an outpatient setting can be as effective in terms of patients' acceptance/adherence. We also evaluated factors predicting NIV acceptance and adherence and disease progression. Prospective randomized study. Outpatient versus inpatient rehabilitation. ALS patients. ALS patients were randomized to two groups for NIV initiation: outpatients versus inpatients. At baseline (T0), end of NIV trial program (T1) and after 3 months from T1 (T2), respiratory function tests, blood gas analysis, and sleep study were performed. At T1, we assessed: NIV acceptance (>4 h/night), and dyspnea symptoms (day/night) by Visual analogue scale (VAS), staff and patients' experience (how difficult NIV was to accept, how difficult ventilator was to manage, satisfaction); at T2: NIV adherence (>120 h/month) and patients' experience. Fifty patients participated. There were no differences in acceptance failure (P=0.733) or adherence failure (P=0.529). At T1, outpatients had longer hours of nocturnal ventilation (PNIV acceptance/adherence failure. There were no between-group differences in progression of respiratory impairment, symptoms and sleep quality. Early outpatient initiation of NIV in ALS is as effective as inpatient initiation.

  9. Mechanisms that contribute to the tendency to continue chemotherapy in patients with advanced cancer. Qualitative observations in the clinical setting. (United States)

    Brom, Linda; Onwuteaka-Philipsen, Bregje D; Widdershoven, Guy A M; Pasman, H Roeline W


    The study aims to describe mechanisms that contribute to the tendency towards continuing chemotherapy in patients with advanced cancer. The study conducted qualitative observations of outpatient clinic visits of 28 patients with advanced cancer (glioblastoma and metastatic colorectal cancer). We uncovered four mechanisms in daily oncology practice that can contribute to the tendency towards continuing chemotherapy in patients with advanced cancer: (1) "presenting the full therapy sets the standard"--patients seemed to base their justification for continuing chemotherapy on the "standard" therapy with the maximum number of cycles as presented by the physician at the start of the treatment; (2) "focus on standard evaluation moments hampers evaluation of care goals"--whether or not to continue the treatment was mostly only considered at standard evaluation moments; (3) "opening question guides towards focus on symptoms"--most patients gave an update of their physical symptoms in answer to the opening question of "How are you doing?" Physicians consequently discussed how to deal with this at length, which often took up most of the visit; (4) "treatment is perceived as the only option"--patients mostly wanted to continue with chemotherapy because they felt that they had to try every available option the physician offered. Physicians also often seemed to focus on treatment as the only option. Discussing care goals more regularly with the patient, facilitated for instance by implementing early palliative care, might help counter the mechanisms and enable a more well-considered decision. This could be either stopping or continuing chemotherapy.

  10. Creating opportunities for interdisciplinary collaboration and patient-centred care: how nurses, doctors, pharmacists and patients use communication strategies when managing medications in an acute hospital setting. (United States)

    Liu, Wei; Gerdtz, Marie; Manias, Elizabeth


    management in an acute hospital setting. Language discourses shaped and were shaped by complex power relations between patients and clinicians and among clinicians themselves. Clinicians need to be encouraged to have regular conversations to talk about and challenge each other's practices. More emphasis should be placed on ensuring that patients are given opportunities to voice their concerns about how their medications are managed. © 2016 John Wiley & Sons Ltd.

  11. A randomised controlled trial of extended brief intervention for alcohol dependent patients in an acute hospital setting (ADPAC

    Directory of Open Access Journals (Sweden)

    Williamson Paula


    Full Text Available Abstract Background Alcohol dependence affects approximately 3% of the English population, and accounts for significant medical and psychiatric morbidity. Only 5.6% of alcohol-dependent individuals ever access specialist treatment and only a small percentage ever seek treatment. As people who are alcohol dependent are more likely to have experienced health problems leading to frequent attendance at acute hospitals it would seem both sensible and practical to ensure that this setting is utilised as a major access point for treatment, and to test the effectiveness of these treatments. Methods/Design This is a randomised controlled trial with a primary hypothesis that extended brief interventions (EBI delivered to alcohol-dependent patients in a hospital setting by an Alcohol Specialist Nurse (ASN will be effective when compared to usual care in reducing overall alcohol consumption and improving on the standard measures of alcohol dependence. Consecutive patients will be screened for alcohol misuse in the Emergency Department (ED of a district general hospital. On identification of an alcohol-related problem, following informed written consent, we aim to randomize 130 patients per group. The ASN will discharge to usual clinical care all control group patients, and plan a programme of EBI for treatment group patients. Follow-up interview will be undertaken by a researcher blinded to the intervention at 12 and 24 weeks. The primary outcome measure is level of alcohol dependence as determined by the Severity of Alcohol Dependence Questionnaire (SADQ score. Secondary outcome measures include; Alcohol Use Disorders Identification Test (AUDIT score, quantity and frequency of alcohol consumption, health-related quality of life measures, service utilisation, and patient experience. The trial will also allow an assessment of the cost-effectiveness of EBI in an acute hospital setting. In addition, patient experience will be assessed using qualitative methods

  12. Effectiveness of sound therapy in patients with tinnitus resistant to previous treatments: importance of adjustments

    Directory of Open Access Journals (Sweden)

    Flavia Alencar de Barros Suzuki

    Full Text Available ABSTRACT INTRODUCTION: The difficulty in choosing the appropriate therapy for chronic tinnitus relates to the variable impact on the quality of life of affected patients and, thus, requires individualization of treatment. OBJECTIVE: To evaluate the effectiveness of using sound generators with individual adjustments to relieve tinnitus in patients unresponsive to previous treatments. METHODS: A prospective study of 10 patients with chronic tinnitus who were unresponsive to previous drug treatments, five males and five females, with ages ranging from 41 to 78 years. Bilateral sound generators (Reach 62 or Mind 9 models were used daily for at least 6 h during 18 months. The patients were evaluated at the beginning, after 1 month and at each 3 months until 18 months through acuphenometry, minimum masking level, the Tinnitus Handicap Inventory, visual analog scale, and the Hospital Anxiety and Depression Scale. The sound generators were adjusted at each visit. RESULTS: There was a reduction of Tinnitus Handicap Inventory in nine patients using a protocol with a customized approach, independent of psychoacoustic characteristics of tinnitus. The best response to treatment occurred in those with whistle-type tinnitus. A correlation among the adjustments and tinnitus loudness and minimum masking level was found. Only one patient, who had indication of depression by Hospital Anxiety and Depression Scale, did not respond to sound therapy. CONCLUSION: There was improvement in quality of life (Tinnitus Handicap Inventory, with good response to sound therapy using customized settings in patients who did not respond to previous treatments for tinnitus.

  13. The music therapy of an anorectic mentally handicapped adult. (United States)

    Heal, M; O'Hara, J


    Where words fail, music may be a medium through which to explore one's inner world and experiences. Psychodynamic approaches have helped us to understand what it means to be handicapped (e.g. Sinason, 1992). The subtleties of diagnosing anorexia nervosa have recently been recognized in this group (e.g. Cottrell & Crisp, 1984). Music therapy has been used with clients of normal intelligence who have eating disorders (Nolan, 1989; Sloboda, 1993; Smeijsters & van den Hurk 1993). This article illustrates the music therapy of a woman with Down's syndrome (IQ = 50) and anorexia nervosa. It describes her management and progress in music therapy in relation to her external world and anorectic behaviours.

  14. Infanticide for handicapped infants: sometimes it's a metaphysical dispute. (United States)

    Long, T A


    Since 1973 the practice of infanticide for some severely handicapped newborns has been receiving more open discussion and defence in the literature on medical ethics. A recent and important argument for the permissibility of infanticide relies crucially on a particular concept of personhood that excludes the theological. This paper attempts to show that the dispute between the proponents of infanticide and their religious opponents cannot be resolved because one side's perspective on the infant is shaped by a metaphysics that is emphatically rejected by the other. In such a situation philosophical argument is powerless to bring about a resolution because there can be no refutation of one side by the other. PMID:2969052

  15. Dose and Duration of Opioid Use in Patients with Cancer and Noncancer Pain at an Outpatient Hospital Setting in Malaysia. (United States)

    Zin, Che S; Rahman, Norny A; Ismail, Che R; Choy, Leong W


    There are currently limited data available on the patterns of opioid prescribing in Malaysia. This study investigated the patterns of opioid prescribing and characterized the dosing and duration of opioid use in patients with noncancer and cancer pain. This retrospective, cross-sectional study was conducted at an outpatient hospital setting in Malaysia. All prescriptions for opioids (dihydrocodeine, fentanyl, morphine, and oxycodone) issued between January 2013 and December 2014 were examined. The number of prescriptions and patients, the distribution of mean daily dose, annual total days covered with opioids, and annual total opioid dose at the individual level were calculated and stratified by noncancer and cancer groups. A total of 1015 opioid prescriptions were prescribed for 347 patients from 2013 to 2014. Approximately 41.5% of patients (N = 144/347) and 58.5% (N = 203/347) were associated with noncancer and cancer diagnosis, respectively. Oxycodone (38.0%) was the highest prescribed primarily for the noncancer group. The majority of patients in both noncancer (74.3%) and cancer (60.4%) groups were receiving mean daily doses of 90 days per year) was associated with 21.8% of patients in the noncancer group and 17.5% in the cancer group. The finding from this study showed that 41.5% of opioid users at an outpatient hospital setting in Malaysia received opioids for noncancer pain and 21.8% of these users were using opioids for longer than 90 days. The average daily dose in the majority of patients in both groups of noncancer and cancer was modest. © 2016 World Institute of Pain.

  16. Determinants of successful chronic hepatitis C case finding among patients receiving opioid maintenance treatment in a primary care setting. (United States)

    Senn, Oliver; Seidenberg, André; Rosemann, Thomas


    Injection drug users are at high risk for chronic hepatitis C virus infection (CHC). Opioid maintenance treatment (OMT) offers a unique opportunity to screen for CHC. This study proposed the hypothesis that a general practitioner (GP) with special interest in addiction medicine can achieve CHC screening rates comparable to specialized centres and aimed to investigate determinants for a successful CHC case finding in a primary care setting. Retrospective medical record analysis of 387 patients who received opioid maintenance therapy between 1 January 2002 and 31 May 2008 in a general practice in Zurich, Switzerland. Successful CHC assessment was defined as performance of hepatitis C virus (HCV) serology with consecutive polymerase chain reaction-based RNA and genotype recordings. The association between screening success and patient characteristics was assessed using multiple logistic regression. findings: Median (interquartile range) age and duration of OMT of the 387 (268 males) patients was 38.5 (33.6-44.5) years and 34 (11.3-68.0) months, respectively. Fourteen patients (3.6%) denied HCV testing and informed consent about screening was missing in 13 patients (3.4%). In 327 of 360 patients (90.8%) with informed consent a successful CHC assessment has been performed. Screening for HCV antibodies was positive in 136 cases (41.6%) and in 86 of them (63.2%) a CHC was present. The duration of OMT was an independent determinant of a successful CHC assessment. In addicted patients a high CHC assessment rate in a primary care setting in Switzerland is feasible and opioid substitution provides an optimal framework.

  17. Lack of effect of unrefrigerated young whole blood transfusion on patient outcomes after massive transfusion in a civilian setting. (United States)

    Ho, Kwok M; Leonard, Anton D


    Warm fresh whole blood has been advocated for critical bleeding in the military setting. This study assessed whether unrefrigerated young whole blood transfusion, from donation to transfusion less than 24 hours, could reduce mortality of patients with critical bleeding in a civilian setting. A linked data cohort study was conducted on a total of 353 consecutive patients requiring massive transfusion, defined as 10 units or more of red blood cells or whole blood transfusion within 24 hours, in a quaternary health care center in Australia. Of the 353 patients with massive blood transfusion in the study, 77 received unrefrigerated young whole blood transfusion (mean, 4.0 units; interquartile range, 2-6). The diagnosis, severity of acute illness, age, sex, and ABO blood group were not significantly different between the patients who received unrefrigerated young whole blood and those who did not. Unrefrigerated young whole blood transfusions were associated with a slightly improved coagulation profile (lowest fibrinogen concentrations 1.7g/L vs. 1.4g/L, p=0.006; worst international normalization ratio, 2.4 vs. 2.8, p=0.05) but did not reduce the total utilization of allogeneic blood products and subsequent use of recombinant Factor VIIa (27% vs. 22%, p=0.358). Thirty-day mortality and 8-year survival after hospital discharge (hazard ratio, 1.05; 95% confidence interval, 0.41-2.65; p=0.93) were also not different after the use of unrefrigerated young whole blood transfusion. Unrefrigerated young whole blood transfusion was not associated with a reduced mortality of patients requiring massive transfusion in a civilian setting when other blood products were readily available. © 2010 American Association of Blood Banks.

  18. Preoperative fasting among burns patients in an acute care setting: a best practice implementation project. (United States)

    Giuliani, Sara; McArthur, Alexa; Greenwood, John


    Major burn injury patients commonly fast preoperatively before multiple surgical procedures. The Societies of Anesthesiology in Europe and the United States recommend fasting from clear fluids for two hours and solids for six to eight hours preoperatively. However, at the Royal Adelaide Hospital, patients often fast from midnight proceeding the day of surgery. This project aims to promote evidence-based practice to minimize extended preoperative fasting in major burn patients. A baseline audit was conducted measuring the percentage compliance with audit criteria, specifically on preoperative fasting documentation and appropriate instructions in line with evidence-based guidelines. Strategies were then implemented to address areas of non-compliance, which included staff education, development of documentation tools and completion of a perioperative feeding protocol for major burn patients. Following this, a post implementation audit assessed the extent of change compared with the baseline audit results. Education on evidence-based fasting guidelines was delivered to 54% of staff. This resulted in a 19% improvement in compliance with fasting documentation and a 52% increase in adherence to appropriate evidence-based instructions. There was a notable shift from the most common fasting instruction being "fast from midnight" to "fast from 03:00 hours", with an overall four-hour reduction in fasting per theater admission. These results demonstrate that education improves compliance with documentation and preoperative fasting that is more reflective of evidence-based practice. Collaboration with key stakeholders and a hospital wide fasting protocol is warranted to sustain change and further advance compliance with evidence-based practice at an organizational level.

  19. Successful aging theory and the patient with chronic renal disease: application in the clinical setting. (United States)

    Blevins, Candy; Toutman, Meredith Flood


    As life expectancies increase, nurses will care for more individuals with chronic conditions, one of which is chronic renal disease. Increasing diversity and complexity of older adult healthcare needs signals a need to reconceptualize perceptions of successful aging. By emphasizing health promotion and adaptation, successful aging is possible for those with chronic renal disease. This article provides an overview of theory-based strategies for fostering successful aging in the patient with chronic renal disease.

  20. Anxiety and Depression among Breast Cancer Patients in an Urban Setting in Malaysia. (United States)

    Hassan, Mohd Rohaizat; Shah, Shamsul Azhar; Ghazi, Hasanain Faisal; Mohd Mujar, Noor Mastura; Samsuri, Mohd Fadhli; Baharom, Nizam


    Breast cancer is one of the most feared diseases among women and it could induce the development of psychological disorders like anxiety and depression. An assessment was here performed of the status and to determine contributory factors. A cross-sectional study was conducted among breast cancer patients at University Kebangsaan Malaysia Medical Center (UKMMC), Kuala Lumpur. A total of 205 patients who were diagnosed between 2007 until 2010 were interviewed using the questionnaires of Hospital Anxiety and Depression (HADS). The associated factors investigated concerned socio-demographics, socio economic background and the cancer status. Descriptive analysis, chi-squared tests and logistic regression were used for the statistical test analysis. The prevalence of anxiety was 31.7% (n=65 ) and of depression was 22.0% (n=45) among the breast cancer patients. Age group (p= 0.032), monthly income (p=0.015) and number of visits per month (p=0.007) were significantly associated with anxiety. For depression, marital status (p=0.012), accompanying person (p=0.041), financial support (p-0.007) and felt burden (p=0.038) were significantly associated. In binary logistic regression, those in the younger age group were low monthly income were 2 times more likely to be associated with anxiety. Having less financial support and being single were 3 and 4 times more likely to be associated with depression. In management of breast cancer patients, more care or support should be given to the young and low socio economic status as they are at high risk of anxiety and depression.

  1. Methods for intraoperative, sterile pose-setting of patient-specific microstereotactic frames (United States)

    Vollmann, Benjamin; Müller, Samuel; Kundrat, Dennis; Ortmaier, Tobias; Kahrs, Lüder A.


    This work proposes new methods for a microstereotactic frame based on bone cement fixation. Microstereotactic frames are under investigation for minimal invasive temporal bone surgery, e.g. cochlear implantation, or for deep brain stimulation, where products are already on the market. The correct pose of the microstereotactic frame is either adjusted outside or inside the operating room and the frame is used for e.g. drill or electrode guidance. We present a patientspecific, disposable frame that allows intraoperative, sterile pose-setting. Key idea of our approach is bone cement between two plates that cures while the plates are positioned with a mechatronics system in the desired pose. This paper includes new designs of microstereotactic frames, a system for alignment and first measurements to analyze accuracy and applicable load.

  2. Adaptation of the Patient Feedback Survey at a Community Treatment Setting (United States)

    Kolodziej, Monika E.; Muchowski, Patrice M.; Hamdi, Nayla R.; Morrissette, Paula; Psy.D.; McGowan, Alicen J.; Weiss, Roger D.


    The Patient Feedback Survey is a performance improvement measure designed to assess the quality of outpatient substance abuse treatment. We modified and administered this measure to 500 individuals at a multi-site treatment provider. Although the feedback scores were high in general, analyses of variance showed score variability in relation to type and length of treatment. Moreover, respondents who reported any use of marijuana, cravings for substances, or mutual-support group attendance (i.e. Alcoholics Anonymous or Narcotics Anonymous) had lower feedback scores than respondents without these experiences. We highlight the importance of investigating treatment evaluations in the context of other recovery experiences. PMID:22211348

  3. Determinants of smoking cessation in COPD patients treated in the outpatient setting

    DEFF Research Database (Denmark)

    Tøttenborg, Sandra S; Thomsen, Reimar W; Johnsen, Søren P


    .79; 95% CI, 0.67-0.94), lived alone (HR, 0.75; 95% CI, 0.64-0.88), were unemployed (HR, 0.70; 95% CI, 0.54-0.90), had milder COPD with an HR of 0.67 (95% CI, 0.53-0.84) for Global Initiative for Chronic Obstructive Lung Disease (GOLD) A and 0.61 (95% CI, 0.47-0.80) for GOLD B compared with GOLD D, had...... Medical Research Council (MRC) dyspnea scale score disadvantaged patients have more difficulties achieving...

  4. Hypertension management research priorities from patients, caregivers, and healthcare providers: A report from the Hypertension Canada Priority Setting Partnership Group. (United States)

    Khan, Nadia; Bacon, Simon L; Khan, Samia; Perlmutter, Sara; Gerlinsky, Carline; Dermer, Mark; Johnson, Lonni; Alves, Finderson; McLean, Donna; Laupacis, Andreas; Pui, Mandy; Berg, Angelique; Flowitt, Felicia


    Patient- and stakeholder-oriented research is vital to improving the relevance of research. The authors aimed to identify the 10 most important research priorities of patients, caregivers, and healthcare providers (family physicians, nurses, nurse practitioners, pharmacists, and dietitians) for hypertension management. Using the James Lind Alliance approach, a national web-based survey asked patients, caregivers, and care providers to submit their unanswered questions on hypertension management. Questions already answered from randomized controlled trial evidence were removed. A priority setting process of patient, caregiver, and healthcare providers then ranked the final top 10 research priorities in an in-person meeting. There were 386 respondents who submitted 598 questions after exclusions. Of the respondents, 78% were patients or caregivers, 29% lived in rural areas, 78% were aged 50 to 80 years, and 75% were women. The 598 questions were distilled to 42 unique questions and from this list, the top 10 research questions prioritized included determining the combinations of healthy lifestyle modifications to reduce the need for antihypertensive medications, stress management interventions, evaluating treatment strategies based on out-of-office blood pressure compared with conventional (office) blood pressure, education tools and technologies to improve patient motivation and health behavior change, management strategies for ethnic groups, evaluating natural and alternative treatments, and the optimal role of different healthcare providers and caregivers in supporting patients with hypertension. These priorities can be used to guide clinicians, researchers, and funding bodies on areas that are a high priority for hypertension management research for patients, caregivers, and healthcare providers. This also highlights priority areas for improved knowledge translation and delivering patient-centered care. ©2017 Wiley Periodicals, Inc.

  5. Preadmission tracheostomy is associated with better outcomes in patients with prolonged mechanical ventilation in the postintensive care respiratory care setting. (United States)

    Huang, Chun-Ta; Lin, Jou-Wei; Ruan, Sheng-Yuan; Chen, Chung-Yu; Yu, Chong-Jen


    Prolonged mechanical ventilation (PMV) is the most common situation where tracheostomy is indicated for intensive care unit (ICU) patients. However, it is unknown if this procedure confers survival benefits on PMV patients in a post-ICU setting. Patients who were admitted to the specialized weaning unit from 2005 to 2008 and received PMV were included in this study. On admission, data pertaining to patient characteristics, physiologic status, and type of artificial airway (tracheostomy vs. no tracheostomy) were obtained. Outcomes of tracheostomized and nontracheostomized patients were evaluated using multivariate Cox proportional hazards and propensity score-matching models. The primary outcome of interest was 1-year survival. A total of 401 patients (mean age 74.4 years, 204 male) were identified. In multivariate analyses, higher Acute Physiology and Chronic Health Evaluation II score [hazard ratio (HR) = 1.061, 95% confidence interval (CI) = 1.016-1.107] and presence of comorbidities, including congestive heart failure (HR = 1.562, 95% CI = 1.119-2.181), malignancy (HR = 1.942, 95% CI = 1.306-2.885), and liver cirrhosis (HR = 2.373, 95% CI = 1.015-5.544), were independently associated with 1-year mortality. An association between having tracheostomy and a better 1-year outcome was observed (HR = 0.625, 95% CI = 0.453-0.863). The matched cohort study also demonstrated a favorable 1-year survival for tracheostomized patients, and these patients had significantly lower in-hospital mortality (24% vs. 36%, p = 0.049) and risk of ventilator-associated pneumonia (10% vs. 20%, p = 0.030) than nontracheostomized ones. Preadmission tracheostomy may be associated with better outcomes of PMV patients in a post-ICU respiratory care setting. The findings suggest that this procedure should be recommended before PMV patients are transferred to specialized weaning units. Copyright © 2016. Published by Elsevier B.V.

  6. Management of dexamethasone-induced hyperglycemia in patients undergoing chemotherapy in an outpatient setting: a best practice implementation project. (United States)

    Sinaga, Gery; de Koeijer, Elizabeth


    The objective of this project was to implement best practice in an outpatient clinical setting in order to increase both nursing staff and patients' knowledge and awareness on the importance of blood sugar management during chemotherapy and to show that through compliance with best practice, the incidence of dexamethasone-induced hyperglycemia during chemotherapy can be minimized. Steroid-induced hyperglycemia is a commonly neglected symptom in cancer treatment, contributing to poor patient prognosis and extended hospital stay. Evidence shows that controlled blood sugar during chemotherapy is associated with improved patient outcomes and better tolerance to cancer treatment. For the purpose of this paper steroid-induced hyperglycemia will be referred to as dexamethasone-induced hyperglycemia. This project utilized the Joanna Briggs Institute Practical Application of Clinical Evidence System (JBI-PACES) and Getting Research into Practice (GRiP) audit tools to promote compliance in the clinical setting. Thirty patients participated in the audit, which was executed by nursing staff in the Medical Oncology Outpatient Unit at the Cancer Ambulatory and Community Health Support Department at the Canberra Hospital. The baseline audit revealed large gaps between best practice and current practice. This underlined the need for more education for both nursing staff and patients. Other barriers such as the absence of assessment and documentation by the clinicians and the minimum number of potential referrals to the diabetes educator were addressed by encouraging patients to speak about their diabetes, and also in the development of a simplified referral process in order to have patients reviewed by the Diabetes Educator in a timely manner. There were significant improvements after more information sessions were held and more resources made available to both nursing staff and patients, but there were also minimal to zero compliance drop on parts of the follow-up audit. In an

  7. Neighborhood socioeconomic disadvantage is not associated with wound healing in diabetic foot ulcer patients treated in a multidisciplinary setting. (United States)

    Hicks, Caitlin W; Canner, Joseph K; Mathioudakis, Nestoras; Sherman, Ronald L; Hines, Kathryn; Lippincott, Christopher; Black, James H; Abularrage, Christopher J


    Socioeconomic deprivation is associated with poor glycemic control and higher hospital admission rates in patients with diabetes. We sought to quantify the effects of neighborhood socioeconomic deprivation on wound healing among a cohort of patients with diabetic foot ulceration (DFU) treated in a multidisciplinary setting. Socioeconomic disadvantage was calculated for all patients using the area deprivation index (ADI) stratified by quartile (from ADI-0: least through ADI-3: most). Predictors of wound healing were assessed using Cox proportional hazards models accounting for patient demographics, wound characteristics, and ADI category. Six hundred twenty-one wounds were evaluated, including 59% ADI-0, 7% ADI-1, 12% ADI-2, and 22% ADI-3. After accounting for patient demographics and wound characteristics, the likelihood of wound healing was similar between groups (ADI-3 versus ADI-0: hazards ratio [HR] 1.03 [95% confidence interval 0.76-1.41]). Independent predictors of poor wound healing included peripheral arterial disease (HR 0.75), worse wound stage (stage 4: HR 0.48), larger wound area (HR 0.99), and partially dependent functional status (HR 0.45) (all, P healing was largely dependent on wound characteristics and vascular status rather than patient demographics or neighborhood socioeconomic disadvantage. Use of a multidisciplinary approach to the management of DFU may overcome the negative effects of socioeconomic disadvantage frequently described in the diabetic population. Copyright © 2017 Elsevier Inc. All rights reserved.

  8. Core information sets for informed consent to surgical interventions: baseline information of importance to patients and clinicians. (United States)

    Main, Barry G; McNair, Angus G K; Huxtable, Richard; Donovan, Jenny L; Thomas, Steven J; Kinnersley, Paul; Blazeby, Jane M


    Consent remains a crucial, yet challenging, cornerstone of clinical practice. The ethical, legal and professional understandings of this construct have evolved away from a doctor-centred act to a patient-centred process that encompasses the patient's values, beliefs and goals. This alignment of consent with the philosophy of shared decision-making was affirmed in a recent high-profile Supreme Court ruling in England. The communication of information is central to this model of health care delivery but it can be difficult for doctors to gauge the information needs of the individual patient. The aim of this paper is to describe 'core information sets' which are defined as a minimum set of consensus-derived information about a given procedure to be discussed with all patients. Importantly, they are intended to catalyse discussion of subjective importance to individuals. The model described in this paper applies health services research and Delphi consensus-building methods to an idea orginally proposed 30 years ago. The hypothesis is that, first, large amounts of potentially-important information are distilled down to discrete information domains. These are then, secondly, rated by key stakeholders in multiple iterations, so that core information of agreed importance can be defined. We argue that this scientific approach is key to identifying information important to all stakeholders, which may otherwise be communicated poorly or omitted from discussions entirely. Our methods apply systematic review, qualitative, survey and consensus-building techniques to define this 'core information'. We propose that such information addresses the 'reasonable patient' standard for information disclosure but, more importantly, can serve as a spring board for high-value discussion of importance to the individual patient. The application of established research methods can define information of core importance to informed consent. Further work will establish how best to incorporate

  9. Validation of a pediatric early warning system for hospitalized pediatric oncology patients in a resource-limited setting. (United States)

    Agulnik, Asya; Méndez Aceituno, Alejandra; Mora Robles, Lupe Nataly; Forbes, Peter W; Soberanis Vasquez, Dora Judith; Mack, Ricardo; Antillon-Klussmann, Federico; Kleinman, Monica; Rodriguez-Galindo, Carlos


    Pediatric oncology patients are at high risk of clinical deterioration, particularly in hospitals with resource limitations. The performance of pediatric early warning systems (PEWS) to identify deterioration has not been assessed in these settings. This study evaluates the validity of PEWS to predict the need for unplanned transfer to the pediatric intensive care unit (PICU) among pediatric oncology patients in a resource-limited hospital. A retrospective case-control study comparing the highest documented and corrected PEWS score before unplanned PICU transfer in pediatric oncology patients (129 cases) with matched controls (those not requiring PICU care) was performed. Documented and corrected PEWS scores were found to be highly correlated with the need for PICU transfer (area under the receiver operating characteristic, 0.940 and 0.930, respectively). PEWS scores increased 24 hours prior to unplanned transfer (P = .0006). In cases, organ dysfunction at the time of PICU admission correlated with maximum PEWS score (correlation coefficient, 0.26; P = .003), patients with PEWS results ≥4 had a higher Pediatric Index of Mortality 2 (PIM2) (P = .028), and PEWS results were higher in patients with septic shock (P = .01). The PICU mortality rate was 17.1%; nonsurvivors had higher mean PEWS scores before PICU transfer (P = .0009). A single-point increase in the PEWS score increased the odds of mechanical ventilation or vasopressors within the first 24 hours and during PICU admission (odds ratio 1.3-1.4). PEWS accurately predicted the need for unplanned PICU transfer in pediatric oncology patients in this resource-limited setting, with abnormal results beginning 24 hours before PICU admission and higher scores predicting the severity of illness at the time of PICU admission, need for PICU interventions, and mortality. These results demonstrate that PEWS aid in the identification of clinical deterioration in this high-risk population, regardless of a hospital

  10. Perception of need for nutritional support in advanced cancer patients with cachexia: a survey in palliative care settings. (United States)

    Amano, Koji; Morita, Tatsuya; Miyamoto, Jiro; Uno, Teruaki; Katayama, Hirofumi; Tatara, Ryohei


    Few studies have investigated the need for nutritional support in advanced cancer patients in palliative care settings. Therefore, we conducted a questionnaire to examine the relationship between the perception of need for nutritional support and cancer cachexia and the prevalence of specific needs, perceptions, and beliefs in nutritional support. We conducted a questionnaire in palliative care settings. Patients were classified into two groups: (1) non-cachexia/pre-cachexia and (2) cachexia/refractory cachexia. A total of 117 out of 121 patients responded (96.7%). A significant difference was observed in the need for nutritional support between the groups: non-cachexia/pre-cachexia (32.7%) and cachexia/refractory cachexia (53.6%) (p = 0.031). The specific needs of patients requiring nutritional support were nutritional counseling (93.8%), ideas to improve food intake (87.5%), oral nutritional supplements (83.0%), parenteral nutrition and hydration (77.1%), and tube feeding (22.9%). The top perceptions regarding the best time to receive nutritional support and the best medical staff to provide nutritional support were "when anorexia, weight loss, and muscle weakness become apparent" (48.6%) and "nutritional support team" (67.3%), respectively. The top three beliefs of nutritional treatments were "I do not wish to receive tube feeding" (78.6%), "parenteral nutrition and hydration are essential" (60.7%), and "parenteral hydration is essential" (59.6%). Patients with cancer cachexia expressed a greater need for nutritional support. They wished to receive nutritional support from medical staff when they become unable to take sufficient nourishment orally and the negative impact of cachexia becomes apparent. Most patients wished to receive parenteral nutrition and hydration.

  11. Tracking Restoration of Park and Urban Street Settings in Coronary Artery Disease Patients

    Directory of Open Access Journals (Sweden)

    Regina Grazuleviciene


    Full Text Available The physiological effects of natural and urban environments on the cardiovascular system of coronary artery disease (CAD patients are not fully understood. This controlled field study examines the effects of restorative walking in a park vs. in an urban street environment on CAD patients’ stress parameters and cardiac function. Methods: Twenty stable CAD patients were randomly allocated to 7 days controlled walking in a city park or in an urban street environment group. The relationship between different environmental exposures and health effects was analyzed using Wilcoxon signed-rank test and exact Mann-Whitney U test. Results: The mean reduction in cortisol levels and negative effects after the walk on the first day was greater in the city park than in the urban street exposed group, while a reduction in negative effects in the urban group were greater after seven days. The reduction in diastolic blood pressure (DBP in the park group was evident on the seventh day before the walk (−4 mm Hg, p = 0.031 and 60 min after the walk (−6.00 mm Hg, p = 0.002. The cortisol slope was negatively associated with the DBP changes (r = −0.514, p < 0.05. Conclusions: Physical activity in a green environment with noise and air pollution levels lower than in an urban environment has a greater positive effect on CAD patients’ stress level and hemodynamic parameters. Mitigating green environmental influences may allow urban residents to maintain health and reduce disability.

  12. Respiratory failure in tetanic patient: maintenance of airway problem in intensive care unit setting (United States)

    Utami, I. N.; Arifin; Susilo, R. S. B.; Redhono, D.; Sumandjar, T.


    Tetanus is a toxin-mediated disease caused by Clostridium tetani resulting in muscular stiffness and painful spasm. The case fatality rates are high (10-80%), and the most frequent cause of mortality is airway problem that results in respiratory failure. A 52-year-old malecame to the hospital with lockjaw, rhesussardonicus, opisthotonus, and seizure for the last 12 hours, diagnosed with tetanus grade II. We placed the patient in an isolation room, gave 3000U tetanus immunoglobulin, 20mg diazepam in 500ml dextrose 5%/8 hours, and 500mg/6hrs metronidazole. On the seventh day, seizure became frequent, respiratory rate increased with crackles found on the auscultation, and the blood gas analysis showed respiratory failure type II (PCO2 53mmHg). The patientwas immediately sent to the ICU, intubated and given ventilator support. The patientwas sedated with continuous injection of midazolam 3 mg/h, morphine 10mcg/kgBW/h and also levofloxacin 750mg/24hours. Bronchoalveolar lavage culture was positive for Acinetobacter baumanii, so we changed the antibiotic to amikacin injection 500 mg/8hrs. After four days, we extubated the ventilator and transferred from HCU three days later. The patient was fully recovered and discharged after eighteen days of hospitalization.

  13. The reliability of lung crackle characteristics in cystic fibrosis and bronchiectasis patients in a clinical setting

    International Nuclear Information System (INIS)

    Marques, Alda; Bruton, Anne; Barney, Anna


    Lung sounds provide useful information for assessing and monitoring respiratory patients, but standard auscultation is subjective. Computer aided lung sound analysis (CALSA) enables the quantification and characterisation of added lung sounds (e.g. crackles). At present, little is known about the reliability of these sound characteristics. Therefore, the aim of this study was to explore the reliability of crackle initial deflection width (IDW) and two-cycle deflection (2CD) in a clinical population. Fifty-four subjects (37 bronchiectasis, 17 cystic fibrosis) were recruited from out-patient clinics. Three repeated lung sound recordings were taken at seven anatomical sites with a digital stethoscope connected to a laptop computer. The intra-subject reliability of crackle IDW and 2CD was found to be 'good' to 'excellent', estimated by the analysis of variance, intraclass correlation coefficient (IDW 0.76;0.85, 2CD 0.83;0.94), Bland and Altman 95% limits of agreement (IDW −0.50;0.47 ms, 2CD −2.12;1.87 ms) and smallest real difference (IDW 0.30;0.66 ms, 2CD 1.57;2.42 ms). Crackle 2CD was found to be more reliable than IDW. It is concluded that crackle IDW and 2CD characterized by CALSA have good test–retest reliability. This technique requires further evaluation since CALSA has potential to diagnose or monitor respiratory conditions, and provide an objective physiological measure for respiratory interventions

  14. Are patients deemed 'dangerous and severely personality disordered' different from other personality disordered patients detained in forensic settings? (United States)

    Howard, Rick; Khalifa, Najat; Duggan, Conor; Lumsden, John


    In 1999, the UK government initiated a programme for the assessment and treatment of individuals deemed to have 'dangerous and severe personality disorder' (DSPD). After over 10 years of specialist service development, it is not clear whether DSPD patients represent a distinct group. The aim of this study was to establish whether people admitted to DSPD hospital units could be distinguished in presentation or personality traits from people with personality disorder admitted to standard secure hospital services. Thirty-eight men detained in high-security hospital DSPD units were compared with 62 men detained in conventional medium or high security hospital units, using the Psychopathy Checklist-Revised (PCL-R) and other standard personality disorder, clinical and offending measures. Compared with their counterparts in standard services, the DSPD group had higher scores on PCL-R psychopathy, significantly more convictions before age 18 years, greater severity of institutional violence and more prior crimes of sexual violence. Regression analysis confirmed that only PCL-R Factor 1, reflecting core interpersonal and affective features of psychopathy, predicted group membership. The DSPD group emerged as having higher psychopathy scores, but as there is currently no evidence that the core personality features of psychopathy are amenable to treatment, there is little justification for treating high-psychopathy forensic patients differently from those with other disorders of personality. Copyright © 2011 John Wiley & Sons, Ltd.

  15. Physician Decision-Making in the Setting of Advanced Illness: An Examination of Patient Disposition and Physician Religiousness. (United States)

    Frush, Benjamin W; Brauer, Simon G; Yoon, John D; Curlin, Farr A


    Little is known about patient and physician factors that affect decisions to pursue more or less aggressive treatment courses for patients with advanced illness. This study sought to determine how patient age, patient disposition, and physician religiousness affect physician recommendations in the context of advanced illness. A survey was mailed to a stratified random sample of U.S. physicians, which included three vignettes depicting advanced illness scenarios: 1) cancer, 2) heart failure, and 3) dementia with acute infection. One vignette included experimental variables to test how patient age and patient disposition affected physician recommendations. After each vignette, physicians indicated their likelihood to recommend disease-directed medical care vs. hospice care. Among eligible physicians (n = 1878), 62% (n = 1156) responded. Patient age and stated patient disposition toward treatment did not significantly affect physician recommendations. Compared with religious physicians, physicians who reported that religious importance was "not applicable" were less likely to recommend chemotherapy (adjusted odds ratio [OR] 0.39, 95% CI 0.23-0.66) and more likely to recommend hospice (OR 1.90, 95% CI 1.15-3.16) for a patient with cancer. Compared with physicians who ever attended religious services, physicians who never attended were less likely to recommend left ventricular assist device placement for a patient with congestive heart failure (OR 0.57, 95% CI 0.35-0.92). In addition, Asian ethnicity was independently associated with recommending chemotherapy (OR 1.72, 95% CI 1.13-2.61) and being less likely to recommend hospice (OR 0.59, 95% CI 0.40-0.91) for the patient with cancer; and it was associated with recommending antibiotics for the patient with dementia and pneumonia (OR 1.64, 95% CI 1.08-2.50). This study provides preliminary evidence that patient disposition toward more and less aggressive treatment in advanced illness does not substantially factor

  16. Object permanence development in infants with motor handicaps. (United States)

    Fetters, L


    This study was an investigation of the effects of a motor handicap on the development of object permanence in the young child. Motor abilities were evaluated for 12 infants aged 13 to 29 months. Based on this evaluation, the children were described as manipulators or nonmanipulators in reference to their upper extremity skills. Their stage of object permanence was assessed using traditional and nontraditional assessments. Heart rate and visual tracking were recorded during the nontraditional assessment. Heart rate did not significantly relate to visual fixation or search response. There was, however, a significant difference (p less than .02) between stage achievement with traditional testing and age-appropriate levels. There was no significant difference between the nontraditional assessment and the age-appropriate levels. In addition, there was no significant difference in the development of object permanence between infants described as manipulators and those described as nonmanipulators. The last two findings suggest that infants with motor handicaps may develop object permanence at the expected ages, according to a nontraditional assessment.

  17. Ethics of professional relations to functionally handicapped users

    Directory of Open Access Journals (Sweden)

    Mateja Griljc


    Full Text Available The basic purpose of 1ibrarianship code is to form and build librarian personality who can make possible the same opportunity to acquiring knowledge for all users, irrespective of their different demands or special needs.When we discuss the importance of building librarian personality the demanding work with users we confront the problem of ethical treatment very often. Ethics advises only general rules which are rarely simple and they are frequently opposite to each other.The process of reacting between the librarian and the user - as with general information needs as with special functional needs - is also dependent on librarian's professional relation which is formed on important elements such as professional qualification,experiences, creativeness and ethics.We are also interested in question where is the border between ethical and non - ethical action in key situations when the 1ibrarian meets functionally handicapped user. Opportunities for non - ethical reaction of professional workers are much more possible if the library's premises and the furniture don't offer suitable conditions for adaptable communication with the handicapped.But on the other side the 1ibrarian has just because of the bad arhitectural conditions better occasion to introduce himself as one of the best ethically formed personalies compared with other professions. With adaptable communication, creative work and with professional relation in offering help to disabled people, the librarian can contribute to more quality service and even more - he/she becomes an example to other professions - also in ethical sense.

  18. Supporting for Visually Handicapped to Walk Around with RFID Technologies

    Directory of Open Access Journals (Sweden)

    Masayoshhi Asano


    Full Text Available Visually handicapped use their white cane to find obstacles. They follow tactile walking surface indicators to find routes and intersections. They use all sensory organs they can use to acquire the surrounding information. They match the surrounding information with routing information they have, to find their current location and target direction. However, even if tactile walking surface indicators are installed, it is difficult for them to visit unknown places because they have no correct routing information. When they go outside depending on tactile walking surface indicators, they have to follow them. They cannot plan their walking routes for themselves in unknown places. It is impossible for them to walk around various places such as shopping malls and station concourses as sighted persons, which is indispensable to enjoy their daily life. In this work, we propose a method which supports visually handicapped people to visit and walk around in their unknown places. We use RFID technologies to achieve voice navigation with the direction to their destination from their current location and their moving direction. To verify effectiveness of our system, we navigate blindfolded people experimentally. In the experiment, we have confirmed the success rate is 81 %.

  19. Choosing the right rehabilitation setting after herniated disc surgery: Motives, motivations and expectations from the patients' perspective.

    Directory of Open Access Journals (Sweden)

    Margrit Löbner

    Full Text Available This study aims to investigate (1 motives, motivations and expectations regarding the choice for a specific rehabilitation setting after herniated disc surgery and (2 how rehabilitation-related motivations and expectations are associated with rehabilitation outcome (ability to work, health-related quality of life and satisfaction with rehabilitation three months after disc surgery.The longitudinal cohort study refers to 452 disc surgery patients participating in a subsequent rehabilitation. Baseline interviews took part during acute hospital stay (pre-rehabilitation, follow-up interviews three months later (post-rehabilitation. Binary logistic regression and multiple linear regression analyses were applied.(1 Motives, motivations and expectations: Inpatient rehabilitation (IPR patients stated "less effort/stress" (40.9%, more "relaxation and recreation" (39.1% and greater "intensity of care and treatment" (37.0% regarding their setting preference, whereas outpatient rehabilitation (OPR patients indicated "family reasons" (45.3%, the wish for "staying in familiar environment" (35.9% as well as "job-related reasons" (11.7% as most relevant. IPR patients showed significantly higher motivation/expectation scores regarding regeneration (p < .001, health (p < .05, coping (p < .001, retirement/job (p < .01, psychological burden (p < .05 and physical burden (p < .001 compared to OPR patients. (2 Associations with rehabilitation outcome: Besides other factors (e.g. age, gender and educational level rehabilitation-related motivations/expectations were significantly associated with rehabilitation outcome measures. For example, patients with less motivations/expectations to achieve improvements regarding "physical burden" showed a better health-related quality of life (p < .01 three months after disc surgery. Less motivations/expectations to achieve improvements regarding "psychological burden" was linked to a better mental health status (p < .001 and a

  20. Health Information Technology, Patient Safety, and Professional Nursing Care Documentation in Acute Care Settings. (United States)

    Lavin, Mary Ann; Harper, Ellen; Barr, Nancy


    The electronic health record (EHR) is a documentation tool that yields data useful in enhancing patient safety, evaluating care quality, maximizing efficiency, and measuring staffing needs. Although nurses applaud the EHR, they also indicate dissatisfaction with its design and cumbersome electronic processes. This article describes the views of nurses shared by members of the Nursing Practice Committee of the Missouri Nurses Association; it encourages nurses to share their EHR concerns with Information Technology (IT) staff and vendors and to take their place at the table when nursing-related IT decisions are made. In this article, we describe the experiential-reflective reasoning and action model used to understand staff nurses' perspectives, share committee reflections and recommendations for improving both documentation and documentation technology, and conclude by encouraging nurses to develop their documentation and informatics skills. Nursing issues include medication safety, documentation and standards of practice, and EHR efficiency. IT concerns include interoperability, vendors, innovation, nursing voice, education, and collaboration.

  1. Follow-up of ischemic cardiopathy, an essential moment in the communication between in-patient and out-patient setting: problems and opportunities

    Directory of Open Access Journals (Sweden)

    Italo Paolini


    Full Text Available It is known that the transition from the inpatient to the outpatient setting is a critical time. Evidence suggests that contact between patients and providers (i.e., physicians, nurse practitioners, and physician assistants during this interval may be crucial for appropriate treatment modifications and recognition of errors in treatment. Ambulatory follow-up provides opportunities for clinical assessment, patient education, and medication review, which may in turn improve outcomes. However, little is known about the appropriate timing and type of follow-up that is necessary following hospitalization for AMI. In Italian System of Heath contact between general pratictioner and specialists, after dicharge, is critical moment for management of chronic pharmacological and non pharmacological therapy. If professional approaches are not integrated can reduce patients compliance and effectiveness of therapies themselves. Good management of chronic cardiovascular disease requires attention to stenghtening the continuity of information and management of patients.

  2. KI-Aikido for Handicapped Students at Leeward Community College: Theory and Practice. (United States)

    MacGugan, Kirk

    In an effort to provide physical education instruction for handicapped students, Leeward Community College implemented, on a pilot basis, a non-credit course in KI-Aikido, an oriental martial art which combines theory and exercise toward the goal of controlling the body through the power of the mind. The course, offered to both handicapped and…

  3. Self-Esteem, Achievement Goals, and Self-Handicapping in College Physical Education. (United States)

    Chen, Zuosong; Sun, Kaihong; Wang, Kun


    This study aims to investigate the relationships among self-esteem, achievement goals, and self-handicapping and the potential mediating role of achievement goals in the relationship between self-esteem and self-handicapping in college physical education. The participants were 320 Chinese college students. Three validated scales were employed to assess participants' self-esteem, achievement goals, and self-handicapping in college physical education. Results showed that self-esteem had a negative effect on self-handicapping. Self-esteem had a positive effect on mastery goals, but had a negative effect on performance-avoidance goals. Mastery goals had a negative effect and performance-avoidance goals had a positive effect on self-handicapping. Moreover, mastery goals and performance-avoidance goals partially mediated the relationship between self-esteem and self-handicapping, and self-esteem had both direct and indirect effects on self-handicapping in college physical education. The findings indicate that improving individual's self-esteem and promoting mastery goals while reducing performance-avoidance goals may be relevant strategies to reduce self-handicapping in college physical education.

  4. Trait self-esteem and claimed self-handicapping motives in sports situations. (United States)

    Finez, Lucie; Berjot, Sophie; Rosnet, Elisabeth; Cleveland, Christena; Tice, Dianne M


    We examined the relationship between physical self-esteem and claimed self-handicapping among athletes by taking motives into consideration. In Study 1, 99 athletes were asked to report their tendency to engage in claimed self-handicapping for self-protective and self-enhancement motives (trait measures). Low self-esteem athletes reported a higher tendency to engage in claimed self-handicapping for these two motives compared with high self-esteem athletes. Neither low nor high self-esteem athletes reported a preference for one motive over the other. In Study 2, 107 athletes participated in a test that was ostensibly designed to assess high physical abilities - and thus to encourage self-handicapping for self-enhancement motives (success-meaningful condition) - or to assess low physical abilities, and thus to encourage self-handicapping for self-protective motives (failure-meaningful condition). Before starting the test, athletes were given the opportunity to claim handicaps that could impair their performance. Low self-esteem athletes claimed more handicaps than high self-esteem athletes in both conditions. Findings suggest that low physical self-esteem athletes engage more in claimed handicapping regardless of motives, relative to high physical self-esteem athletes.

  5. The Barthel index as predictor of handicap in stroke survivors: a ...

    African Journals Online (AJOL)

    Results: After adjusting for other variables, the multivariable analysis showed that handicap in stroke is significantly associated with the Barthel index (p<0.05) and atrial fibrillation (p<0.05). Conclusion: Barthel index is an important predictor of handicap following stroke. Atrial fibrillation should also be considered in the ...


    Directory of Open Access Journals (Sweden)

    Ljupco AJDINSKI


    Full Text Available This work gives an detailed review of the basic issues of development of protection and rehabilitation of handicapped people in Macedonia with data especially for the period pf the last five decades.A plentitude of documentary materials proved to be important starting assumption for further historical studies on protection and rehabilitation of handicapped people in the Republic of Macedonia.

  7. Self-Handicapping, Defensive Pessimism, and Goal Orientation: A Qualitative Study of University Students. (United States)

    Martin, Andrew J.; Marsh, Herbert W.; Williamson, Alan; Debus, Raymond L.


    Interviews with university students selected as high or low in either self-handicapping or defensive pessimism identified personal perspectives on the nature of self-handicapping and defensive pessimism, the perceived reasons why they engage in these strategies and the perceived advantages that follow from them, and the extent to which ego goals…

  8. Academic Self-Handicapping: The Role of Self-Concept Clarity and Students' Learning Strategies (United States)

    Thomas, Cathy R.; Gadbois, Shannon A.


    Background: Self-handicapping is linked to students' personal motivations, classroom goal structure, academic outcomes, global self-esteem and certainty of self-esteem. Academic self-handicapping has yet to be studied with respect to students' consistency in self-description and their description of themselves as learners. Aims: This study…

  9. Self-Handicapping in School Physical Education: The Influence of the Motivational Climate (United States)

    Standage, Martyn; Treasure, Darren C.; Hooper, Katherine; Kuczka, Kendy


    Background: Self-handicapping is an attribution-related process whereby individuals create performance impediments/excuses to protect self-worth in socially evaluative environments. Thus, the prevailing motivational climate would appear to be an important factor when attempting to understand the situational self-handicapping process within school…

  10. The effects of self-handicapping on attributions and perceived judo competence. (United States)

    Greenlees, Iain; Jones, Simon; Holder, Tim; Thelwell, Richard


    The aim of this study was to examine hypotheses derived from Jones and Berglas's (1978) self-handicapping model. It was hypothesized that individuals using many self-handicaps would use more internal attributions and report greater gains in perceived judo ability following success than individuals using few self-handicaps. In addition, it was hypothesized that individuals using many self-handicaps would use more external attributions and report less reduction in perceived judo ability following failure. Fifty-three judo players completed measures of trait self-handicapping, situational self-handicapping and a measure of perceived judo ability before competition. Following competition, the participants completed the Causal Dimension Scale II and the measure of perceived judo ability for a second time. Analyses of variance revealed that high self-handicappers attributed failure to more external factors than low self-handicappers. It was also found that high self-handicappers reported less of a reduction in perceived judo ability following failure than low self-handicappers. The findings therefore provide support for the potential short-term benefits of self-handicapping in sport, although further research is required to examine the long-term implications of using self-handicaps.

  11. Implications of Self-Handicapping Strategies for Academic Achievement: A Reconceptualization. (United States)

    Murray, Carolyn B.; Warden, M. Robert


    Presents questionnaire results concerning self-handicapping, course-related expectancies, and study habits. Reports that self-handicappers were more likely than others to make external and unstable attributions. Concludes that the underlying cognitive mechanism of self-handicapping strategies is a defensive attributional pattern that protects an…

  12. The Relationship between High School Mathematics Classroom Environment and Student Self-Handicapping. (United States)

    Dorman, Jeffrey P.; Adams, Joan E.; Ferguson, Janet M.

    Classroom environment research investigating the relationship between classroom environment and self-handicapping was conducted in Australian, Canadian, and British high schools. A sample of 3,602 students from 29 schools responded to a questionnaire that assessed student perceptions of classroom environment, self-handicapping, and academic…

  13. Causes of blindness in blind unit of the school for the handicapped ...

    African Journals Online (AJOL)

    To describe the causes of blindness in pupils and staff in the blind unit of the School for the Handicapped in Kwara State. 2. To identify problems in the blind school and initiate intervention. All the blind or visually challenged people in the blind unit of the school for the handicapped were interviewed and examined using a ...

  14. Complementary alternative medicine use among patients with dengue fever in the hospital setting: a cross-sectional study in Malaysia. (United States)

    Ching, SiewMooi; Ramachandran, Vasudevan; Gew, Lai Teck; Lim, Sazlyna Mohd Sazlly; Sulaiman, Wan Aliaa Wan; Foo, Yoke Loong; Zakaria, Zainul Amiruddin; Samsudin, Nurul Huda; Lau, Paul Chih Ming Chih; Veettil, Sajesh K; Hoo, Fankee


    In Malaysia, the number of reported cases of dengue fever demonstrates an increasing trend. Since dengue fever has no vaccine or antiviral treatment available, it has become a burden. Complementary and alternative medicine (CAM) has become one of the good alternatives to treat the patients with dengue fever. There is limited study on the use of CAM among patients with dengue fever, particularly in hospital settings. This study aims to determine the prevalence, types, reasons, expenditure, and resource of information on CAM use among patients with dengue fever. This is a descriptive, cross-sectional study of 306 patients with dengue fever, which was carried out at the dengue clinic of three hospitals. Data were analysed using IBM SPSS Statistics version 21.0 and logistic regression analysis was used to determine the factors associated with CAM use. The prevalence of CAM use was 85.3% among patients with dengue fever. The most popular CAMs were isotonic drinks (85.8%), crab soup (46.7%) and papaya leaf extract (22.2%). The most common reason for CAM use was a good impression of CAM from other CAM users (33.3%). The main resource of information on CAM use among patients with dengue fever was family (54.8%). In multiple logistic regression analysis, dengue fever patients with a tertiary level are more likely to use CAM 5.8 (95% confidence interval (CI 1.62-20.45) and 3.8 (95% CI 1.12-12.93) times than secondary level and primary and below respectively. CAM was commonly used by patients with dengue fever. The predictor of CAM use was a higher level of education.

  15. The effect of facility characteristics on patient safety, patient experience, and service availability for procedures in non-hospital-affiliated outpatient settings: A systematic review. (United States)

    Berglas, Nancy F; Battistelli, Molly F; Nicholson, Wanda K; Sobota, Mindy; Urman, Richard D; Roberts, Sarah C M


    Over recent decades, numerous medical procedures have migrated out of hospitals and into freestanding ambulatory surgery centers (ASCs) and physician offices, with possible implications for patient outcomes. In response, states have passed regulations for office-based surgeries, private organizations have established standards for facility accreditation, and professional associations have developed clinical guidelines. While abortions have been performed in office setting for decades, states have also enacted laws requiring that facilities that perform abortions meet specific requirements. The extent to which facility requirements have an impact on patient outcomes-for any procedure-is unclear. We conducted a systematic review to examine the effect of outpatient facility type (ASC vs. office) and specific facility characteristics (e.g., facility accreditation, emergency response protocols, clinician qualifications, physical plant characteristics, other policies) on patient safety, patient experience and service availability in non-hospital-affiliated outpatient settings. To identify relevant research, we searched databases of the published academic literature (PubMed, EMBASE, Web of Science) and websites of governmental and non-governmental organizations. Two investigators reviewed 3049 abstracts and full-text articles against inclusion/exclusion criteria and assessed the quality of 22 identified articles. Most studies were hampered by methodological challenges, with 12 of 22 not meeting minimum quality criteria. Of 10 studies included in the review, most (6) examined the effect of facility type on patient safety. Existing research appears to indicate no difference in patient safety for outpatient procedures performed in ASCs vs. physician offices. Research about specific facility characteristics is insufficient to draw conclusions. More and higher quality research is needed to determine if there is a public health problem to be addressed through facility

  16. A clinical algorithm for triaging patients with significant lymphadenopathy in primary health care settings in Sudan

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    Eltahir A.G. Khalil


    Full Text Available Background: Tuberculosis is a major health problem in developing countries. The distinction between tuberculous lymphadenitis, non-specific lymphadenitis and malignant lymph node enlargement has to be made at primary health care levels using easy, simple and cheap methods. Objective: To develop a reliable clinical algorithm for primary care settings to triage cases ofnon-specific, tuberculous and malignant lymphadenopathies. Methods: Calculation of the odd ratios (OR of the chosen predictor variables was carried out using logistic regression. The numerical score values of the predictor variables were weighed against their respective OR. The performance of the score was evaluated by the ROC (ReceiverOperator Characteristic curve. Results: Four predictor variables; Mantoux reading, erythrocytes sedimentation rate (ESR,nocturnal fever and discharging sinuses correlated significantly with TB diagnosis and were included in the reduced model to establish score A. For score B, the reduced model included Mantoux reading, ESR, lymph-node size and lymph-node number as predictor variables for malignant lymph nodes. Score A ranged 0 to 12 and a cut-off point of 6 gave a best sensitivity and specificity of 91% and 90% respectively, whilst score B ranged -3 to 8 and a cut-off point of3 gave a best sensitivity and specificity of 83% and 76% respectively. The calculated area underthe ROC curve was 0.964 (95% CI, 0.949 – 0.980 and -0.856 (95% CI, 0.787 ‑ 0.925 for scores Aand B respectively, indicating good performance. Conclusion: The developed algorithm can efficiently triage cases with tuberculous andmalignant lymphadenopathies for treatment or referral to specialised centres for furtherwork-up.

  17. Fast evaluation of patient set-up during radiotherapy by aligning features in portal and simulator images

    International Nuclear Information System (INIS)

    Bijhold, J.; Herk, M. van; Vijlbrief, R.; Lebesque, J.V.


    A new fast method is presented for the quantification of patient set-up errors during radiotherapy with external photon beams. The set-up errors are described as deviations in relative position and orientation of specified anatomical structures relative to specified field shaping devices. These deviations are determined from parameters of the image transformations that make their features in a portal image align with the corresponding features in a simulator image. Knowledge of some set-up parameters during treatment simulation is required. The method does not require accurate knowledge about the position of the portal imaging device as long as the positions of some of the field shaping devices are verified independently during treatment. By applying this method, deviations in a pelvic phantom set-up can be measured with a precision of 2 mm within 1 minute. Theoretical considerations and experiments have shown that the method is not applicable when there are out-of-plane rotations larger than 2 degrees or translations larger than 1 cm. Inter-observer variability proved to be a source of large systematic errors, which could be reduced by offering a precise protocol for the feature alignment. (author)

  18. Social meanings and understandings in patient-nurse interaction in the community practice setting: a grounded theory study

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    Stoddart Kathleen M


    Full Text Available Abstract Background The patient-nurse relationship is a traditional concern of healthcare research. However, patient-nurse interaction is under examined from a social perspective. Current research focuses mostly on specific contexts of care delivery and experience related to medical condition or illness, or to nurses’ speciality. Consequentially, this paper is about the social meanings and understandings at play within situated patient-nurse interaction in the community practice setting in a transforming healthcare service. Methods Grounded theory methodology was used and the research process was characterised by principles of theoretical sensitivity and constant comparative analysis. The field of study was four health centres in the community. The participants were patients and nurses representative of those attending or working in the health centres and meeting there by scheduled appointment. Data collection methods were observations, informal interviews and semi-structured interviews. Results Key properties of ‘Being a good patient, being a good nurse’, ‘Institutional experiences’ and ‘Expectations about healthcare’ were associated with the construction of a category entitled ‘Experience’. Those key properties captured that in an evolving healthcare environment individuals continually re-constructed their reality of being a patient or nurse as they endeavoured to perform appropriately; articulation of past and present healthcare experiences was important in that process. Modus operandi in role as patient was influenced by past experiences in healthcare and by those in non-healthcare institutions in terms of engagement and involvement (or not in interaction. Patients’ expectations about interaction in healthcare included some uncertainly as they strived to make sense of the changing roles and expertise of nurses and, differentiating between the roles and expertise of nurses and doctors. Conclusions The importance of social

  19. Factors affecting effective communication between registered nurses and adult cancer patients in an inpatient setting: a systematic review. (United States)

    Tay, Li Hui; Hegney, Desley; Ang, Emily


    , whereas conflict among the staff led to increased use of blocking behaviours. Cultural norms within the Chinese society were also found to inhibit nurse-patient communication. Within the constraints of the study and the few quality papers available, it appeared that personal characteristics of patients and nurses are the key factors that influence effective nurse-patient communication within the oncology setting. Very little evidence exists to explain the role of environment in effective nurse-patient communication, particularly within an Asian setting. Training can be implemented to inform nurses about the communication challenges, to equip them with effective communication skills and improve their receptivity to patient cues. Information-sharing can be used as a non-threatening approach to initiate rapport-building and open communication. Nurses should consider patients' psychological readiness to communicate and respect their preference as to whom they wish to share their thoughts/emotions with. Hospitals/institutions also need to ensure a supportive ward culture and appropriate workload that will enable nurses to provide holistic care to patients. Further research on the effect of the Asian culture on effective communication within the oncology setting is required to expand the knowledge in this area. Studies to ascertain the effect of the patient's age and place within the oncology treatment cycle are also warranted. The lack of evidence on the effectiveness of post-basic communication education also requires further investigation. © 2011 The Authors. International Journal of Evidence-Based Healthcare © 2011 The Joanna Briggs Institute.

  20. Glycaemic control of diabetic patients in an urban primary health care setting in Sarawak: the Tanah Puteh Health Centre experience. (United States)

    Wong, J S; Rahimah, N


    Achieving glycaemic goals in diabetics has always been a problem, especially in a developing country with inadequate facilities such as in Sarawak in Malaysia. There are no reported studies on the control of diabetes mellitus in a diabetic clinic in the primary health care setting in Sarawak. This paper describes the profile of 1031 patients treated in Klinik Kesihatan Tanah Puteh Health Centre. The mean age was 59 years, the mean BMI 27 kg/m2. There was a female preponderance and mainly type-2 diabetes. Mean HbA1c was 7.4%. Glycaemic control was optimal in 28% (HbA1c 7.5%). Reasonable glycaemic control can be achieved in the primary health care setting in Sarawak.